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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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. 

The “Just Pray” Advert

Yesterday, a Twitter account I follow tweeted a link to the new Church Of England cinema advert. I watched it. I liked it. I liked that it was encouraging people to pray informally, whenever and wherever they chose to, as they went about their day. The advert was well made, had a good mix of people from different backgrounds, doing all sorts of activities, while saying The Lord’s Prayer. The intercut dialogue-montage technique has been done before, but it worked well here, suggesting a commonality of activity and belief, that Anglicans are linked by an invisible bond of faith. 

I saw it as primarily an advert for informal prayer and only secondarily an advert for The Church Of England. I would even say that it could be taken as an advert for prayer and reflection in general, regardless of faith or belief. I often pray informally. Rarely do I say a formally worded prayer though, preferring to use my own words. I believe strongly in having a living faith, so praying while doing other things seems quite normal to me. I go to church too, but the vast majority of time, we’re not in church, so it makes sense to remind people that living a faith is an everyday doing thing, not just a Sunday morning bums on pews thing. 

It surprised me then to learn that the advert had apparently been banned from being shown in cinemas. I wondered why such an innocuous piece of communication would be banned. It wasn’t hard selling Anglicanism. It wasn’t claiming that Anglicanism was The One True Faith and that all non Anglicans were heretics, destined to burn in Hell for eternity. Its content wasn’t prejudicial against any group of people, whether religious, political, sexual, racial or cultural. It was actually a very “safe” advert in that respect. You’d have to try pretty damned hard to take offence at it, even if you were a regular objector to the promotion of “sky fairies”. It was a nice little film. Not particularly distinctive or memorable, but not the kind of thing that would usually incur a ban either. 

Odd. Very odd indeed. 

The next few references to the advert on Twitter all referred to its being “banned”. Some supported the ban, some were apparently incensed by the ban. I remained bemused by the ban. Was there something I had missed? A copy of the Quran being desecrated in the background? A gay rights flag being burned? I watched it again forensically, looking for the potentially controversial thing I must have missed. It wasn’t there. The advert was safe, nice, innocuous, inoffensive, unremarkable. 

It was then that I learned it hadn’t been singled out and banned at all, instead merely being subject to a consistent policy by DCM of not accepting and not showing ANY advert which had either political or religious content. Assuming that this is the truth, that it was a pre-existing policy, it seems fair enough to me that the company remained consistent in its manner of doing business. 

I wondered about the Archbishop Of Canterbury’s reaction. He was apparently livid at the advert being “banned”. The Church Of England Director of communications, the reverend Arun Arora was surprised at the company’s refusal to screen the advert. As someone who creates advertising for clients, it made me wonder if the advertising agency media planner was doing their job properly. Did Arun Arora, representing  the client, not think to double check that the advert would be acceptable to be broadcast in cinemas?

With my cynical professional head on, I think that there are two possible scenarios. The total balls-up or the cunning masterplan. 

The Total Balls-Up

The Church Of England commissioned an advertising agency to produce a campaign to promote prayer as part of everyday life. The budget was tight – certainly not enough to buy TV airtime, but the client wanted “a filmed advert”. The agency’s solution? An advert that would be shown in cinemas, along with the trailers, before the film. A reasonable enough solution for a project with a tight media budget. Given the subject matter though, a professional agency would have confirmed, before even pitching the idea to the client, that DCM would be prepared to show the advert in cinemas. Apparently, the agency didn’t do this. They pitched the idea, made the advert, got it passed by the BBFC for broadcast and then blithely sent the files for showing, not checking at any stage. Oops! That’s a very expensive way to find out a company’s policy of not accepting religious content in adverts. Much egg on face all round. A total balls-up of biblical proportions. 

The Cunning Masterplan

I really hope this is the real sequence of events.

The Church Of England commissioned an advertising agency to produce a campaign to promote prayer as part of everyday life. The budget was tight – certainly not enough to buy TV airtime, but the client wanted “a filmed advert”. The agency’s solution? An advert that would be announced as intended to be screened in cinemas, along with the trailers, before the film. But the agency knew full well that the advert would be rejected because of DCM’s policy on content. There was no intention to actually show the advert in cinemas, incurring the media cost. The intention was always to deliberately create a controversy about the advert being “banned”. 

This would generate huge, viral awareness of the advert. It would make the advert seem more edgy, cool, relevant, newsworthy. It would deliver massive, great value media exposure for the advert. Most importantly, the campaign would be totally bang on brief, making the concept of an everyday living faith a popular talking point in the run up to Christmas. If it was indeed planned like this, it’s a masterclass in achieving maximum value for minimum budget and imaginatively meeting a challenging brief in today’s increasingly secular society. Getting lots of people to talk about praying while getting on with your day? Job done. 

But which is it? Epic balls-up or advertising masterclass? It could easily be either. Which do you reckon?

Claiming to have OCD…

…because you’re merely organised, motivated or like to clean, is like…

Claiming to have skin cancer because you have a wart,

Claiming to have an amputated foot, because you cut your toenails too short,

Claiming to have tuberculosis when you have a slight cold,

Claiming you’re having a heart attack, when you have indigestion,

Claiming you have septicaemia because your fingernail has gone septic,

Claiming that shivering with the cold is mild epilepsy,

Claiming that mild sunburn is 80% third degree burns,

Claiming that a grazed knee is a compound fracture of the leg,

Claiming that an eyelash in your eye is profound blindness,

Claiming that a slight headache is a brain tumour,

Claiming that dandruff is leprosy, 

Claiming that a bad hangover is decapitation. 

Nobody does these things. Only an idiot would. Why claim to have OCD if you don’t? It’s just as daft a thing to do. 

Obsessive Compulsive Cleaners – an OCD sufferer’s opinion

I deliberately wasn’t going to write a blog post about Obsessive Compulsive Cleaners – a television series on Channel 4 in the UK, because I don’t believe in feeding the troll – giving the oxygen of publicity to something or someone causing harm. 

After discussing the show with fellow OCD sufferers and some of the viewers of the show, I have reluctantly changed my mind. I wish it wasn’t necessary to write this blog post.  

The basic premise of the show is getting people who are obsessed with cleaning or very motivated to clean, to do cleaning challenges. Mostly the challenge is to tidy, then clean the revoltingly dirty house of someone with severe hoarding problems. They do other, smaller, highly orchestrated challenges too. 

The implication of the name of the show is that the cleaners all suffer from contamination focussed Obsessive Compulsive Disorder. Some of the cleaning participants have indeed been clinically diagnosed with OCD.

  

Some of the participants are just highly motivated people who love to clean. Some are people who run cleaning or cleaning-product businesses. I’ve derived this information by both enduring watching the show sometimes (with great difficulty and anxiety) and also seeing participants interacting on Twitter. They are generally nice, genuine people, but most are on the show for some form of material self advancement. I have no objection to people earning a living, but not if it’s stigmatising and harming others in the process. 

    
   

  

The implied mental health diagnoses of the hoarding problem participants isn’t so clear, but unlike possibly some of the cleaning participants, some of the hoarders may be suffering from OCD – hoarding can be an OCD driven compulsion. I myself hoard, but not to the same extreme extent as the programme’s participants. But whatever the cause, nobody with a healthy mind hoards and builds up filth in the way that the show’s participants do. 

    
   

 

The show’s creators and supporters rightly argue that everyone who takes part in the show has done so voluntarily. Yes, some of the participants are clearly severely mentally ill, but even we, mentally ill people are capable of rational thought and making decisions about what we do or don’t do. I accept that.

So that’s OK then? No different to X-Factor or Britain’s Got Talent? 

No. X-Factor audition-shows do sometimes cruelly feature excruciating footage of people who are not 100% mentally healthy, are devoid of talent, yet are still giving it their all. But neither of those two talent shows sets out to recruit mentally ill participants specifically because of their particular mental illness. That is the crucial distinction. 

People aren’t recruited to appear on Obsessive Compulsive Cleaners on the basis that they have an amazing talent for competitive cleaning. The show would have been called The Great British Cleanoff if it was a cleaning talent competition. 

Because of the show’s name, the implication is that participants are compelled to clean up other people’s filth because OCD makes them do it. This is a complete fallacy. None of those people are there because OCD is making them rid the world of contamination, one filthy house at a time, like some anxiety riddled superhero. They are there for the 15 minutes of fame that Andy Warhol promised them. 

  

Or they are there to promote their cleaning business. Or in the case of the hoarders, they are there to get some other fool to shovel dogshit off their living room carpet. 

   

 

I sincerely pray to God, yes really, that none of the participants are on the show believing that taking part will benefit their mental health more than seeking specialist professional medical treatment. The mere possibility of that appalls and horrifies me. I have heard anecdotally that one participant claims that the show has benefitted them, but I have no evidence either way about this claim, so cannot comment upon it. 

I am someone who has suffered from severe OCD all my life. In adulthood this has been primarily, but not exclusively, contamination focussed OCD. I can say hand on heart that the immediate reaction by anyone who has contamination focussed OCD to setting foot in a filthy shit-laden house would be to run screaming from it, burn their clothes and shoes and then bleach and scrub their entire body. I have done exactly this on numerous occasions when accidentally exposed to a serious contamination source. 

So the people on the show are bravely facing their fears?

Up to a point, perhaps yes, but then they throw bucketloads of bleach at the problem to make the threat of contamination go away, thus negating the initial exposure experience. This is known as carrying out a compulsion. The “C” bit of OCD.

Disordered obsessive-compulsive thinking about contamination happens like this:

“Arghhh! That object or place has become contaminated. I can see dirt, I can smell a bad smell or I can feel something on the surface which doesn’t feel right. IT IS CONTAMINATED! ITISCONTAMINATED… ITISCONTAMINATED… ITISCONTAMINATED… I’m certain it now contains bacteria or diseases which will kill me, my family or other people if I don’t destroy the contamination. It will be my fault and my responsibility if someone dies. I must destroy this contamination now!”

This may sound far fetched or exaggerated, but this is absolutely textbook, typical OCD contamination thinking. I thought like this for decades. These thoughts won’t go away. If the person sits and does nothing for three days, at the end of three days their mind is still overwhelmingly screaming at them that they must destroy the contamination to avoid catastrophe. 

OCD tells them that the only way to quell the thoughts and the resultant huge surge of anxiety is to destroy the contamination. No contamination, no thoughts. So they carry out the compulsion. They clean, scrub, bleach, burn. Whatever it takes to destroy the contamination. 

Phew! What a relief! Hey presto! Problem solved. Let’s stand back proudly, admire the pristine cleanliness, then enjoy a well earned cuppa. 

  

Emmmmm, no. The relief gained by carrying out the compulsion is all too brief. The OCD is already whispering toxicly into the person’s mind that maybe they missed a bit, maybe the bleach didn’t spread everywhere, maybe the contaminated cleaning cloth touched something else, which is now contaminated too, maybe the person is kidding themselves that they did the job properly, maybe they cut corners lazily, maybe, maybe, maybe… What if… what if… WHAT IF???!!!!!

So the person cleans, scrubs, bleaches, burns again. Job done this time. Isn’t it great? Let’s have a cuppa. 

Nope. The OCD is whispering again. 

And so the exhausting, destructive, maddening cycle of obsession-anxiety-compulsion-relief-doubt-obsession-anxiety-compulsion-relief-doubt… goes round and round forever. Imagine this, every waking second of every single day. That is the constant reality of an OCD sufferer. 

So cleaning something is a compulsion? A bad thing? How can cleaning up some utter shithole be a bad thing?

Firstly, it is reinforcing dysfunctional core beliefs that 100% deadly contamination exists everywhere, that it must be destroyed and it is the person’s responsibility if somebody dies because they haven’t done it properly. 

  

Secondly it is the compulsion stage in the toxic cycle. What inevitably follows the compulsion is doubt. There is never surety of a job well done, no matter how well it was done. There is no satisfaction. No self praise. Only doubt, anxiety, guilt and fear. Carrying out the compulsion makes the OCD stronger, worse, more powerful, more credible. OCD is the bully who pretends to be your friend and protector.  

Thirdly, cleaning up a hoarder’s house doesn’t miraculously cure them of the mental health problems which are causing them to hoard. Without appropriate professional medical treatment, within weeks their house will be stacked high once more with detritus, filth and dogshit. 

  

For a person with contamination focussed OCD to benefit from being in the filthy house, they would need to sit on the infested sofa, shoes resting amongst the dogshit on the carpet, for a prolonged period of time, whilst not cleaning. Yes. Not cleaning. They would need to observe their anxiety level spike off the scale, then watch the anxiety curve very slowly subside. They’d next need to get up calmly and leave, then not wash or bleach their hands, not shower, not wash or burn their clothes and shoes. They’d then need to wait, maybe up to a week, to see if the OCD was telling the truth, that the contamination would definitely kill them and all those around them. They’d finally have to consciously acknowledge that the OCD had lied to them because they were still alive and well, despite having carried out no compulsions. 

This is a well established therapeutic technique called Exposure and Response Prevention (ERP), which forms part of Cognitive Behavioural Therapy (CBT), the standard, largely successful therapy technique for overcoming OCD. The show doesn’t do this, it instead encourages harmful compulsions. But hey, we can’t have a cleaning show without cleaning. 

So cleaning makes contamination focussed OCD worse and doesn’t help the hoarders either? What’s the point of the TV show then?

Entertainment. Pure and simple. Like a modern Molière play. It is the latest in the Minorities As Entertainment genre which Channel 4 and Channel 5 have sadly made their own in recent years. My Big Fat Gypsy Wedding, Benefits Street, Immigration Street, Obsessive Compulsive Cleaners. “Let’s deride Pikeys, Dolescum, Foreigns and Handwashing Nutters.” Cynical, shot-to-a-script, ignorant prejudice reinforcing, exploitation television.

   

  

 

There is no empathy in the scripting, visual treatment, filming, editing, storytelling, background music or narration. Just sneery, formulaic, predictable, everyone’s in on the joke but the participants, cynicism. 

     

  

 

Channel 4 is consistently shameless in its flippant, mocking approach to promoting the programme. 

   

 

It’s ghoulish voyeurism, nothing more. Like stopping at a car crash to watch people bleed. If P.T. Barnum was alive today, he wouldn’t be running a circus freakshow, he’d have a TV production company making cheap, generic, voyeuristic exploitation documentaries for Channels 4 and 5. 

  

But no real harm done though, eh? Apart from maybe to some of the participants? Just a bit of a giggle at the participants’ expense. 

Again, no. 

The show both trivialises and misrepresents the reality of suffering from OCD. It’s not something which can be made happy ever after at the end of a one hour TV show. It’s also mostly not about cleaning. 

  

Not about cleaning?! But OCD’s that handwashing cleanfreak thing. Everybody knows that!

No, it’s mostly not. OCD obsessions can have many focusses: fear of harming others, fear of being harmed by others, religious obsessions, moral obsessions, fear of causing offence to others, fear of accidental fire, flooding, electrocution, fear of causing road accidents, fear of public humiliation, fear of failure, fear of chemical contamination, fears of sexually unacceptable thoughts & behaviour, rumination, hoarding. All equally life-destroying, all equally OCD. So mostly not “that handwashing cleanfreak thing”.

Imagine having obsessive fears that you are going to stab your entire family and thinking that OCD was just about people who love to clean. What sort of monster would you imagine yourself to be? A latent psychopath? When really it is an irrational fear, created by OCD because you love your family and would never actually hurt them in any way. OCD takes the best of us and turns it against us, making us doubt our very identity. 

But surely I’m just some random online nutter with a bee in my bonnet, ranting about a TV programme I simply don’t like?

Nutter. A bee in my bonnet. Very funny. OCD is a whole bloody beehive. Hell, I’m thinking of going into business selling honey. It is an important issue to me, yes – suffering from a life destroying anxiety disorder which people think is entertaining, quirky or funny isn’t a barrel of laughs, putting it very mildly. 

I am passionate, though surprisingly not obsessed, about reducing the stigma suffered by all of us with OCD. I want to help more people seek appropriate medical help sooner, not suffer in isolated shame for decades as I and many others have done. 

And I’m not a lone, random oddball in my objections to the programme. 

OCD-UK and OCD Action, the two national charities for OCD sufferers, have raised written objections to the programme and refuse to co-operate with its production. Professor Paul Salkovskis, a world renowned expert in OCD and its treatment, has raised his own objections to the stigmatising, trivialising and misrepresentative nature of the programme.  

 

Increasingly, more and more diagnosed OCD sufferers are making their objections online to the show. A look at the #occleaners hashtag on Twitter shows this clearly. Even viewers of the programme are beginning to question the cruel basic premise of the programme. The days of Obsessive Compulsive Cleaners as a series are numbered. It has overstayed its welcome. It’s an obscenity which should never have been commissioned in the first place.

  

  

  
  

  

  

  

 

  

  

So what can the TV production company Betty, who make OCC, create for Channel 4 as a replacement?

Morbidly obese people being fed doughnuts until they cry in despair?

Injecting type one diabetics with massive amounts of insulin and watching them become dangerously hypoglycaemic?

Tipping people out of their wheelchairs to watch them struggle to get back in the chair?

Katie Hopkins on a jetski toppling refugee boats into the Mediterranean?

The crass, tasteless possibilities are endless. And OFCOM don’t seem too worried about cruelty or stigma as entertainment. Thank goodness there are none of those tiresome ethics that Channel 4 used to have to get in the way of a good laugh. If you can’t mock the afflicted, who can you mock?

EDIT: 13/09/15. I have sent a link to this blog post to OCC’s production company and Channel 4. I honestly expect no response from them. 

If in the unlikely event that they do respond, I’m fully expecting the usual flannel about it being a brave, boundary pushing, carefully supervised, social experiment to raise awareness of mental health issues, with expert mental health consultants on location at all times, assuring the wellbeing of all participants. 

Nobody’s buying that spurious waffle. The finished product unambiguously shows the cynical intent of the show. It’s car crash TV, poking fun at serious mental illnesses. Nothing more. END EDIT.  

If you are in the UK and believe you are suffering from OCD, the best thing you can do is see your GP or refer yourself directly to specialist NHS mental health services, if available. Below is a link to advice on what to say to your doctor:

Click here

Good luck. You are not alone. We are not freaks. We are ordinary people. There is hope.