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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A temporary vegetarian 

My wife is a dietitian. Starting yesterday, she and the team of dietitians she leads are trying out some of the clinical and controlled diets that their patients experience. So, for a week, my wife has chosen to be a temporary vegetarian. 

Two of my daughters are already vegetarian; the other is a devout carnivore. But, for this week, the whole family is having a go at the vegetarian thing, in solidarity with my wife. 

We’re into our second day and it’s going OK so far. We bought a lot of vegetables and vegetarian food at the supermarket yesterday. We didn’t buy any fish or shellfish – we’re not doing the ‘pescetarian’ cop out, but we’re also not trying the full vegan thing either. I will struggle enough with just a vegetarian diet. 

One thing I insisted upon was trying some of the facsimile products, like Quorn ‘chicken’ nuggets. We will make some meals from scratch, but I wanted to try some of the foods which are considered as ‘cheating’ by some proper, permanent vegetarians. If one likes meat, but for whatever reason chooses to be vegetarian, then why not have some things which are meatlike in taste and texture?

We have been trying to have one or two meatfree evening meals a week, so we’ve already tried some products. I find the Quorn Mince an unconvincing texture, so we just use it to bulk out a smaller amount than normal of proper beef mince. This week, we’ll have only Quorn mince, so I’ve decided that chilli sin carne would be the best way to disguise it, with kidney beans, peppers & onions adding some bite and texture. 

As well as trying the food, I will also be attempting to cook some of the meals. Normally, I struggle with contamination OCD intrusive thoughts so much that it renders me incapable of handling raw meat products. The decontamination rituals make preparing a meal distressing, prolonged and impractical. So I’m seeing how I deal with veggie cookery. I will still have to face handling things like eggs, so there are some pretty big triggers remaining. It’s still going to be a challenge. I will do my best. 

I’m keen to try a couple of Indian and North African recipes. I’d like the experiment to be a balance between cooking from scratch and lazy convenience foods. 

My wife will be taking professional nutritional, qualitative, cost and environmental impact notes throughout the week, in order to present her findings & experiences to her team. I think that the added data of the whole family participating will make the experiment much more useful. Since it’s only day two, I haven’t yet started to crave bacon sandwiches, but I expect to. From past experience, vegetarian ‘bacon’ is both weird and disappointing. I do intend to try doing a veggie fry-up though, with veggie sausages, which are OK. 

Do I expect to go permanently vegetarian by the end of the experiment? Not a chance. I will always be carnivorous, but it would be good to broaden the repertoire of vegetarian food which could be interspersed among the usual non-stop meat frenzy. 

The experiment ends

It was an interesting week. We set out with a few objectives and achieved some, but not all of them. We had some of our preconceptions challenged and confirmed other things we expected to be true. 

  • We all stuck with the experiment without lapse for the full week
  • We ate more processed products than we intended to, cooking fewer things than planned completely from scratch
  • My vegetarian daughter who still lives at home ate a more varied diet with fewer processed products than usual during the experiment 
  • The range, quality & texture of processed products has improved greatly since I last paid attention to them
  • The texture issue is still variable. Fake chicken nuggets and chicken burgers were convincingly like cheap chicken products, but without the gristle. We’d get them again. Fake meat pies were sub-football-ground quality. We wouldn’t get these again
  • The quality of food based upon price wasn’t consistently equivalent to the meat based version. Processed vegetarian foods aren’t always great value for money
  • Both me and my youngest daughter regularly felt hungry and unfulfilled throughout the week. I tried increasing carbohydrate intake to compensate, but this didn’t help
  • The nicest meal of the week was a chunky veg chilli prepared from scratch
  • The other really enjoyable meal was a barbecue, the highlight being satay kebabs made of peppers, onion, courgette and haloumi. These will be a part of all future barbecues
  • The issue of farting wasn’t as bad as anticipated. I expected a remake of the Blazing Saddles campfire scene
  • I did however find that the instant I woke up in the morning, I had to dash to the bathroom for a “long sit”. The sudden increase in vegetable and fibre intake had a noticeable effect in this respect
  • The flavour of the processed products was often quite strong. It felt over the top at times. Was this to disguise a bland base product? Maybe. 

So, will we repeat the experiment? No, I don’t reckon we will. Will we eat fewer meat based dishes, more vegetarian dishes and more vegetables? Definitely. We will also be trying a more varied diet, with more seafood and less red meat, which is a positive outcome. I’m glad that we joined in with my wife’s experiment. It was educational. 

    The Zika virus

    The Zika virus is the number one killer of men aged 20-49 in the UK. Between 5,600 to 6,000 people die of the Zika virus each year in the UK, killing 4 times as many men as women. 

    It killed over 840,000 people Worldwide in 2013. It is no respecter of age, geography or social circumstances. 

    It is an epidemic running out of control and not nearly enough is being done to control this needless loss of life. Preventative measures, health screening and appropriate medical care could cut this epidemic scourge down in its tracks. But it’s not happening. It’s almost completely unrecognised as the massive threat to humanity that it poses. 

    What’s that? It’s been all over the TV news channels for days?

    Oh, my mistake. Did I say Zika virus? I meant to say suicide. 

    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?

      Here Be Dragons

      Some medical secretaries and doctors’ receptionists are utter bastards. Most are clearly not at all, but a memorable minority are. Why? What is it about working in this particular role in a care based service sector that attracts a few obnoxious dragons?

      It is a cliché that all doctors’ admin staff are surly, hateful, ignorant hate-the-worlds. In my experience, it is mostly an undeserved reputation. But people don’t remember being treated with dignity and civility by someone who is smiling and cheerful. People remember when they were treated with disdain and condescension.

      There is an uncomfortable atmosphere in some doctor’s waiting rooms. Yes, part of that for me is being surrounded by ill people, worrying that I will catch what they all have and die within a week. Thanks for that, OCD. There is also the extended period of waiting in a confined area and reluctant anticipation of the consultation itself. My GP normally runs at least 40 minutes late. I am always early for my appointments. An appointment is scheduled to be no more than 12 minutes.

      But for me, these aren’t the primary cause of the unwelcoming atmosphere. What makes it so is the profusion of low level passive aggression expressed through the medium of the carefully produced A4 poster. There is always an up to date sheet with the latest number of DNAs (Did Not Attend appointment), the number of hours this wasted and the cost to the surgery. WHAT ARE YOU TELLING US FOR?! We’re here for our fucking appointment! Send a fucking snidey letter to the DNAs, don’t gripe to us about it. There is of course, the year running total version of this too.

      There are also all of the other little signs: No mobile phones, no prams in the surgery, zero tolerance of disrespect to reception staff (but it’s OK for them to dish it out freely), no Ebola patients (yes, really), no asking about prescriptions before 11am, no asking for prescriptions earlier than 3 days after you submit a prescription request. No booking appointments, except at 8am. No phoning at 8am unless it’s absolutely necessary. No wasting my very valuable important time by forcing me to interact with you. I may have made that last one up. 

      Modern technology brings the added joy of monitors, mounted high on two walls, showing a PowerPoint version of all the passive-aggressive posters, with jaunty animation emphasising the thinly veiled contempt for the great inconvenience known as The Patients.

      I may be generalising, but these all look like the work of a single person.

      You know the one. The brassy, big hairdo, too much makeup, immaculately taloned one, who exudes an air of being too good for this place. You can see that she had aspirations of being a consultant surgeon’s PA. Maybe more than his PA, if she played her cards right. But no. Never made it out of the common office scum. Left the hospital after a first verbal warning for a bad attitude, not being a good team player. Her! Expected to be a team player, when she was much better than the lot of them. So she took the receptionist job at the GP’s surgery. That showed them. Just temporary like. Maybe she’d stick with it if they recognised her proper worth and made her practice manager.

      But no. The old practice manager had stayed another fifteen years, only to be replaced by a fast-track graduate trainee. A bloody kid! So she stayed anyway, just temporary like, always looking out for something better, never getting the interviews for the hospital consultant PA jobs she applied for every eight months or so. Never wondering why. Never giving up completely on the dream.

      The just temporary weeks became months, just temporary months became years. The endless flow of the great unwashed kept pouring through the doors, day after day, always looking the same, dressing the same, smelling the same.

      She despises each and every one of them. Not that she can tell them apart. All the same sob stories. All wanting to talk rubbish when she has more important things to do. The bottom jaw is tight with frustration as she says, “Yes dear, no dear”, thinks “Go away dear, stop bothering me dear, stop offending my sense of smell dear”. The condescension seeps through the gritted teeth. The forced smile sometimes slips momentarily to reveal the grimace underneath.

      This is of course mere conjecture surely? That sounds like a twisted characature from a rejected Alan Bennett monologue play. I am describing not one, but two actual people. One from a local doctor’s surgery and another, someone I used to know as a neighbour. If you met either one and had a conversation with them, you would recognise them both from the description. Embittered, chip-on-their-shoulder, failed social climbers, with more ambition than talent. People with little or no empathy, who don’t belong in a caring environment, but who have become trapped there. Hell is other people, especially if you despise them. A sad sort of karma.

      Thankfully, they do seem to be a dying breed. Where their toxicity used to leech into other members of the team, it no longer seems to. The great majority of medical admin staff are there because they want to be. Because they like people and care about people. The dragon is an endangered species. Let’s hope it becomes extinct.