A Prescription For Murder

Wow! What a title! Sounds like an Agatha Christie novel or a cheap horror movie. It’s actually the title of a BBC Panorama documentary which hypothesises a link between SSRI antidepressant medication and an increased propensity to commit violent acts. 

Is there a link? Statistically yes maybe. A very tiny percentage of people taking SSRIs experience psychosis as a side effect, but statistically more people are killed as a result of trying to put on a pair of trousers. So why is there not a documentary about trouser deaths called Leg Ends Of The Fall? I believe it is because of the manner of the respective causes of death. 

Accidental deaths caused by embarrassing wardrobe malfunctions would be uncomfortable, voyeuristic subject matter. You don’t kick a man when he’s down through no fault of his own. So what’s the difference between that and someone who’s mentally ill through no fault of their own?

It’s because violent mentally ill people are juicy subject matter. A ratings winner. The subject retains a ghoulish car crash fascination. The notion that mental illness equates to violent, dangerous derangement is deeply embedded in the public’s psyche. Why else were lunatics locked in mental asylums, strapped in straitjackets, if not to prevent them from being a danger to others?

There are many variations of the escaped mental patient urban myth, with invariably innocents being slaughtered by the rampaging, almost supernatural human monster. The thing cannot be reasoned with; it is beyond reason. It is animalistic, bloodthirsty, evil. Something to be hunted and killed on sight. 

The factual reality is that mentally ill people are more likely to be a victim of violence than the general population. Only 3% of mentally ill people ever commit a criminal act of aggression. That means that 97% never commit an act of aggression. The person a mentally ill person is most likely to harm or kill is themselves. Suicide is the biggest cause of death in men aged 20-49 in the U.K. and the biggest cause of death of teenage girls worldwide. 

What then is the basis for a 21st century documentary about mentally ill killers, that lingers over gory details? According to Shelley Jofre, the BBC reporter who made the documentary, it is a public interest story. I see that it’s a story the public will be interested in, but is it in the public interest?

The Panorama programme claims that the incredibly rare side effect of SSRI medication causing psychosis, potentially leading to aggression and violence, needs to be more widely known to both the general public and to people taking SSRIs. The problem with this argument is that family doctors and prescribing psychiatrists already weigh up potential side effect risks and discuss them with patients before prescribing. And there are many possible side effects from taking SSRI medications, the most common of which include weight gain, sedation, fatigue and loss of sex drive. The average person taking an SSRI has been informed by their doctor of likely side effects, thoroughly read the leaflet that comes with the medication, probably read up some more about the risks on Wikipedia and discussed the risks with other people taking the same medication. The vast majority of mentally ill people are already very well aware of the potential and actual side effects of taking SSRI medications. 

What about the wider population? Don’t they deserve to know the danger too? If the 40,000,000 prescriptions for SSRI medications in the U.K. every year are going to trigger a nationwide bloodbath, don’t the public have a right to be warned? Therein lies the central weakness in the programme’s premise. 40,000,000 SSRI prescriptions per year already in the U.K., no mental patient slasher movie apocalypse as a result. 

I don’t deny that there are records of isolated cases where an SSRI may have contributed to a tragic incident. But is the potential danger both proven and statistically significant enough to warrant making an hour long documentary about it? What about the much more prevalent side effect of an increased risk of death by suicide among teenagers when they first start taking some, but not all, SSRI medications? That kills more people. Surely that’s more newsworthy?

The unpalatable reality is that few care about mentally ill teenagers killing themselves. It’s dull TV, compared to bloodsoaked rampaging mental patients. Real Hannibal Lecters lurking in our midst. 

This perpetuates the myth that mentally ill people are inherently violent and a well behaved one is just one waiting to explode in a killing frenzy at any moment. Drugs are supposed to suppress this huge danger, not enhance it. A dribbling, sedated, locked up mental patient is the only safe one. 

This is of course total nonsense. One in four of us will suffer a mental illness in our lifetime. The vast majority of people will be treated with a combination of medication and therapy. Out in society. Not locked up. Normal, but unwell people, not dangerous in any way. 

What are the likely outcomes of the documentary being aired?

There is a small possibility that a handful of people who are taking SSRIs and experiencing psychosis as a side effect will realise what has been wrong and seek help and advice from their doctor. This is a good thing. 

Something which is much more likely is that some mentally ill people currently benefitting from taking SSRI medications will stop taking them, to avoid the remote possibility of becoming violent. The benefits of that medication will then stop. Clinically depressed people will slide back into the abyss. People with anxiety disorders will retreat back into tormented Hell. Some of these people may well take their own lives as a result. The documentary could possibly cause more deaths, not fewer. 

Then there is the stigma issue. Some think that the term “mental health stigma” is overused. In the face of the ongoing tide of derision, fear, mistrust and demonisation of mentally ill people, I can assure you that the term could be used much more indeed. Just like black people and gay people have had to stand up and say enough is enough, mentally ill people are now standing up to be counted. 

My name is Patrick. I suffer from clinical depression, severe OCD and PTSD. I am a mentally ill person, a loving husband, a good father. I take a high dose of Prozac, an SSRI medication. It helps me to function normally. I’m not an unquestioning fanboy of Prozac. I have side effects from taking it, but I’m zero danger to anyone. Enough is enough. The unwarranted stigma against all the ordinary people just like me has to stop. This documentary will perpetuate stigma and prejudice. That is harmful and dangerous. Much more dangerous than a rare medication side effect. 

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Hell and faith. 

I have a faith. I believe in God. I don’t believe in Big Angry Beardy Man In The Sky. I believe that God is good. More specifically, God is the capacity for good within people, enacted in their lives. I believe that evil is the absence of the capacity for good. I believe that Hell is the absence of God. 

I have been to Hell. I have called out to God in the greatest extremes of my mental despair and he hasn’t replied. He wasn’t there when depression was doing its damnedest to kill me and three times nearly succeeded. I was on my own. Hell is the absence of God. 

I’ve thought about this a lot since. How can I still have a faith when God has never been there with me during the darkest moments? Never. Not once. And they were very dark moments indeed. I’ve heard the old “God moves in mysterious ways” bollocks:

“Maybe He was there all along, guiding you and you just didn’t realise.” 

“Maybe God’s answer was that you were strong enough to get through it yourself.”

“Maybe there was someone more deserving of His attention all those times. Think of all the starving babies in Africa. Aren’t you being a bit selfish?”

All bollocks. God wasn’t there with me. I was on my own. I prayed, but it was a monologue into the void, with no reply. I had to go on alone. I had to believe in myself and trust myself. I had to help me. Yes, those were my footprints in the sand; Jesus wasn’t carrying me. 

This sounds like shouty, bitter, former-Christian-now-Atheist ranting, but it’s not. I still believe. I still have a faith. I still thank God when I experience good things. I still pray informally and often. But why? If I had asked a close friend or family member for help under those circumstances and there had been zero reply, I would have cut them out of my life from that point onwards.  Why haven’t I booted God into the middle distance?

I have always had a questioning faith. I believe that blind, unquestioning faith is no faith. Yet this question is a biggie about the continued existence of my faith at all. It’s a fair question. Do I have an answer to it?

God is good. Literally, not descriptively. Substantially. I see good in my kids. I see so much good in my wife. I see good in my dachshund. I see good in nature. I see good in people’s actions towards each other every day. Doesn’t this mean I’m a “glass is half full” kind of person? A kindly, optimistic, naive soul who always sees the good in things? Not at all. My World view can often be bleak and cynical. I have experienced the very worst of man’s inhumanity to man at first hand. I know how cruel and indeed evil human beings can be and I literally have the physical and mental scars to prove it. 

Am I just stupid and stubborn then? Refusing to relinquish yet another dysfunctional lifelong core belief? Am I so feeble minded that I need a “made up sky fairy” to guide my moral compass, for fear I would run amok without its steadying guidance?

On this point I can firmly say no. I have OCD. A common type of OCD obsession is Religious OCD, where the sufferer experiences obsessions and extreme incessant anxiety for having unholy thoughts or not being religious, faithful and pious enough. I have never ever experienced this. My moral compass is true. I don’t need to be a Holy Joe, going to church twice a day, to know that I am a decent person, living my faith through my actions. 

Seeing the capacity for good being enacted in the world is my evidence of God. There is a lot of the lack of the capacity for good – Evil – in this world too. That doesn’t surprise me at all. It saddens me. 

I have my own capacity for good. To have a living faith is to use that capacity for good to the common benefit. I’m no saint by any means. I don’t know the words to all the hymns (and I mime the words anyway). I don’t go to church services enough. I rarely feel worthy to receive communion. (Facts, not OCD religious thinking). But I live it. Quietly. I am there, even when God isn’t. The capacity for good within me is there. Godliness, not God. I make God present by using that capacity for good. I don’t believe in an omnipotent, omnipresent being. By definition, there’d be no evil if there was one. Sometimes we are on our own, like it or lump it. 

Depression dulls the senses. It stops you from experiencing. It stops you from being. It stops you from doing. If you do nothing, your capacity for good sits idle. God is not there. He cannot be. Depression isn’t evil, but it is Hell in its true sense. Hell is the absence of God. 

I have been lucky a few times in my life to be able to make God present for others in their darkest hour. Not in a preachy, self aggrandising, bible waving way. Quietly. Just by being there, listening, holding a hand, offering a few words of support, letting them know they aren’t alone in Hell. God is the capacity for good, put into use. God is good. 

Words. Worth?

I wandered lonely in a crowd,

With anxious high unquelled by pills, 

Moving though as under cloud,

A ghost, beholden to my ills; 

The smile is false, beneath I freeze,

Stuttered words betray unease. 

Continuous are these scars of mine 

Though hidden from the light of day,

The product of the family line

Around the margins, I must stay:

To others, normal, at a glance,

 I curse my head’s internal chants. 

The groups around me danced; but I

Just hid from sparkling waves of glee:

My calm demeanour was a lie,

Amid such jocund company: 

I gazed—and gazed—and then I thought 

Their ease was what I dearly sought: 
For oft, when on my couch I lie 

In vacant or in pensive mood, 

What flashes on that inward eye 

Amid my cursed solitude; 

A hollowed mind with envy fills, 

Of dancers free, whilst I stay still. 

The voice of mental illness

This isn’t a blog post about “hearing voices”, in the sense of auditory hallucinations. It is about the tone of voice and phraseology of the thoughts that accompany mental illnesses. For me, each of my mental health conditions has a consistent and recognisable voice. When I have a thought, I can now recognise which condition is doing the talking, or if the thought is of my own creation. Being able to do this is a fundamental part of the toolkit of recovery. 

So how do the conditions sound to me?

OCD: The voice of OCD is insidious, like a snake’s hiss. That should be a massive warning klaxon to the mind, but the mind doesn’t hear the hiss, just the words. 

The OCD whispers that it’s our friend and protector. It puts a reassuring arm round our shoulder, steering us where it wants us to go. And we go. Like someone vulnerable, groomed and coherced by a creepy family friend. 

The voice of OCD is persuasive. Plausible. Believable. No matter how ridiculous the idea is that it whispers to the mind. We know that it’s whispering nonsense. We’re sure that it’s whispering nonsense. But… there’s a sliver of doubt. I’d best do what OCD wants me to do, just in case…

Aaaaaand it’s got us. Hook, line and sinker. Again. No matter how many times we’ve been caught before. 

Then there’s the OCD trigger voice. Like an opera soprano with her hand caught in a car door. Strident. Loud above all else. Screaming the panic into you to take action now. Immediately! If you don’t, the very worst is definitely going to happen. ACT NOW! Carry out the compulsion to avoid certain disaster! Do it before it’s too late! She keeps wailing, drowning everything else out. 

So eventually you do the compulsion. The trapped-handed soprano stops screaming. The panic drops. A tiny moment of calm, maybe even relief. But then the whispering voice starts again. What if you didn’t do the compulsion correctly? What if disaster hasn’t been averted, merely delayed? What if? What if? What if? And before you know it, the careless soprano has her hand trapped in the car door again. 

Doubt is OCD’s weapon. It doesn’t even have to be reasonable doubt, in the legal sense. A single, tiny, poisonous sliver of doubt is enough to pierce the mind and embed the toxin once again. 

OCD is a one trick pony. Sure, it has infinite variations on a theme, but it always plays the same tune. Recognising the lyrics and disbelieving them is the start of putting the hissing serpent back into its basket, with the lid shut tight.

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OCPD: If Obsessive Compulsive Personality Disorder was a person, it would be a US marines drill sergeant. An uncompromising bully for which nothing is ever good enough. Ever. A harrying voice which pushes ever forward. 

The voice goads you to do better, always better. The last success was a fleeting thing, to be improved upon. Never worthy of congratulation, only introspection and analysis of how it could have been done better, how the next thing must be done better. 

Each task is a competition with your previous self. The OCPD says that Old Self was weak. Imperfect. Flawed. Unacceptable. Not good enough. New Self must be better. No excuses. No mercy. Everything is a task. Perfection is the goal. Anything less than perfection is failure, no matter how close it came. Do the task, meet the deadline, be perfect, don’t show weakness, don’t hesitate, don’t slow down, don’t draw breath. Keep the juggernaut rolling forwards, ever forwards. Failure is not an option. 

The voice of OCPD is an absolute bastard. Absolute in its true sense. All or nothing, black or white, win or lose. No room for grey. No room for error. No room for weakness. OCPD is an utter asshole. A shouty, demanding asshole. And sadly, that’s what the sufferer can become in turn. A task driven, order obsessed, singleminded, inflexible, perfectionist asshole. The inner bully begets the outer asshole. 

It’s stressful being that protégé asshole. Exhausting. Lonely. It gets results. Success. But what is all the success in the world worth, if it requires being whipped through life by an asshole in your mind?

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Depression: Of all the mental health conditions I have experienced, depression is by far the most deliberately harmful and destructive. It is just as much a parasite as the other conditions, but seems Hell bent on destroying both its host and itself in turn. 

The voice of depression is mean, evil, remorseless. There is no pretence. It wants to do you down. Its vocabulary is scathing: “Pathetic. Failure. Carcass. Dead man walking. Waste of breath. Waste of a soul. Sad little fat failure. You’re better off dead. You are a liability to this world”. The tone is harsh and sadistic , like a Dickensian villain. 

The voice of depression is internalised death-by-a-thousand-cuts. It eats away at you, like a wasp larva, hollowing its way out of its living host victim. 

I get angry at the voice of depression now. When it spits its bile through its gritted teeth, I shout “FUCK OFF!” back at it, sometimes out loud, if nobody can hear me. Depression is an evil thing, intent on killing. It is my enemy. I will show my enemy no mercy. My family motto is “Cut and burn to victory”. I like to summon a little of that family bloodlust when fighting the voice of depression, cutting it down mid sentence. 
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PTSD: For me, PTSD is voiceless. That is to say, it has no voice of its own, only echoes of my voice in memories and flashbacks. 

I can hear the voice of my thoughts as I relive or recall events. “You’re trapped. Cornered. There is no escape. You must hide, fight or die. Don’t show weakness. Don’t fall. If you fall, you’re dead. Stay on your feet. No, stop drop and roll! Roll to cover. Head down. Cover vital organs with limbs. Make yourself small. Invisible. Take the pain. Stay quiet. Take it. The pain will stop eventually. Please let me die a clean death God. A bullet to the head. Instantaneous. Don’t let me be blown up. Half dead. Dying. Gargling. Moaning. Screaming. Run! RUNUNRUNRUNRUNRUNRUN! Keep running. Don’t look back. Don’t slow down. Don’t stop. Knife out. Ready to be caught. Ready to defend. Be ready. Be ready. Get home.  Get home. Quietly. Calm your breathing. In shadow. Survive.  Hide. Hide. Hide. In darkness. Silent. Curled. Hide”. 

That is all so fresh in my mind. I can hear myself think it all, because those phrases never went away. The phrases from so many different situations. Some I escaped from, some I couldn’t. 

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The worst thing about these voices is that, as for many people who suffer mental illness, there isn’t just the one voice. There is a cacophony of voices from all sides, all the time. Like being trapped in a crammed full lift (elevator), surrounded by people shouting. Some of them constant, never even drawing breath. Others watching for signs of fatigue, weakness, the guard dropping, before joining in the discordant haranguing chorus. All of them heard. Every single word. 

A few moments on the beach or in the woods, with the mind briefly quiet, are blessed respite. 

Alternative therapies

I had an interesting discussion on Twitter recently with a “Cognitive hypnotherapist” who was very keen to treat people who have OCD. If they had also been a BABCP accredited Cognitive Behavioural Therapist with good experience of treating people with OCD, I would have said, “fair enough. Please work on unhindered by me”. 

But they weren’t. There wasn’t a single mention on their entire website about OCD treatment and only one mention of treating anxiety, not anxiety disorders. Mostly it was the usual hypnotherapy stuff about weightloss, stopping smoking, business success and confidence boosting. But disturbingly, there was also mention of curing the infertility caused by polycystic ovary syndrome with hypnotism and also past life regression using hypnosis. And this person wants to get into the minds of people with OCD?! She may sincerely believe that she can help, but OH-MY-GOD! There was also reference to NLP (neuro linguistic programming) and life coaching. Whenever I see the unholy trio of hypnotherapy, NLP and life coaching, it sets off the QUACK ALERT alarm bells. Every single one of these life coaching people I have met at small business networking events, I would guess 17 or 18 of them, have been lovely, earnest, keen, deeply damaged individuals who should NEVER be allowed to tinker with another person’s fragile mind. 

I was wary about letting anyone into my head, even a properly trained, accredited, experienced medical professional. It only eventually happened as a last resort, when it was a choice of either that or death by suicide. I’m glad that I chose the former, not the latter. But even then, it was difficult to trust someone else. Now imagine if I had been looking over the edge of the abyss and a friend who had lost some weight by going to a hypnotherapist had recommended them to me because they “did OCD too”. It makes me shudder in fear and disgust. That person would have “had a go” at treating somebody, using hypnosis, who needed immediate crisis care from specialist mental health professionals. 

It’s this kind of example which makes me instinctively wary of all alternative remedies and therapies. There are just so many jolly, well meaning, utter fruitcakes out there, willing to “have a go”. If the laws were less strict, would they “have a go” at being amateur dentists too?

I have seen the following “therapies” and remedies touted online as suitable for curing OCD:

  • Number therapy
  • Hypnotherapy
  • The Linden Method
  • The Lightning Process
  • NLP
  • Life coaching
  • Crystal healing
  • Herb therapy
  • Nutrition therapy
  • Vitamin therapy
  • Dietary supplement therapy
  • Vegan diet therapy
  • EFT – Emotional Freedom Technique
  • Exorcism
  • Faith healing
  • Prayer therapy 
  • Experimental electric current therapy

The U.K. National Health treatment regulator NICE (national institute for health and clinical excellence) recommends none of these for treatment of OCD. The only one to have shown evidence of even a short term benefit is hypnotherapy and there is still no objective scientific evidence of any kind of efficacy. The approved therapy is CBT (cognitive behavioural therapy), sometimes used in conjunction with medication. CBT works for many, but not universally. I’m not an unquestioning cheerleader for CBT, but it has worked and does work for me. 

I am not totally closed to the idea of using other things to help improve mental health and resilience, just very difficult to persuade. 

I reluctantly tried mindfulness. With its links to Buddhism, prayer bells and incense sticks, it seemed a bit hippy-drippy and ethereal to me. It also smacked of being the latest fashionable lifestyle fad bandwagon to jump aboard.

But a couple of trusted friends had achieved some success in using mindfulness, so I chose to give it a go. In my usual thorough way, I investigated the possible ways of trying it out. Local practitioners? Surprisingly few. And heavy on the prayer bells and zen. Online then? I looked for mindfulness apps and discovered Headspace. 

After persisting for several weeks, with my OCD conditioned mind wrestling with the completely alien concept of letting thoughts go, it started to work. I’ve found it to be a useful, real life tool and technique to use, alongside CBT techniques, to expedite my own recovery. 

So, you see, my mind isn’t closed to a broader approach to achieving recovery. I just recognise a snakeoil salesman or dangerously wellmeaning amateur when I see one. I believe there should be tighter regulation on what supposed “therapies” can be offered commercially as being effective for overcoming serious mental illness. I can’t set up a business as a mender of broken legs using a hot bread poultice, but I could set up a business tomorrow offering hot bread poultice cures for depression, #OCD, #PTSD and other anxiety disorders. This would be laughable, if it wasn’t so incredibly dangerous and happening RIGHT NOW. 

In the meantime, whenever I encounter an enthusiastic, well meaning idiot, I try to persuade them to leave treating actual mental illnesses to trained, accredited medical professionals and for them to stick to business performance coaching. And I also report the few genuinely cynical charlatons I come across, preying on vulnerable, fragile people who may be at the lowest ebb. 

If you’re going to let anyone inside your mind, it’s reasonable to be cautious, even with trained, experienced professionals. It is a great thing to be helped towards recovery, but the mind is as delicate as the human heart and more intricate than the human cardiovascular system. You wouldn’t place your heart into the hands of anyone but a highly skilled, experienced professional. Why risk the mind with anyone less capable or trustworthy?