The third letter



















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. 

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. 

Reclaiming Christmas

A couple of days ago @me_bpd posed an interesting question on Twitter. “Have you suffered childhood trauma at Christmas & do you still celebrate Christmas?

My answers were “yes” and “yes”. 

It got me thinking. I have a few friends on twitter who, for one reason or another no longer celebrate Christmas, as it is a time associated with bad experiences or events. This makes perfect sense to me. Why go through the motions of celebration, if you’re not in a celebratory frame of mind?

So why was my second answer “yes”, not “no”?

Christmas was always a time of drunkenness, conflict and violence from my parents. So basically like any other day of the year, but with tinsel. One of my earliest memories is of Christmas 1973. My mother (heavily pregnant with my sister, who would be born a week later) and father, both very drunk, beating Hell out of each other, and also me every time I tried to get between them to break up their brawling. My dad also knocked me out of the way as he threw the Christmas tree off the balcony of our 7th floor flat in Johannesburg. I remember watching the tree fall from where I lay. I went onto the balcony and looked at the white artificial tree lying in the street below. It was already being scavenged by people heading towards the train station to travel back to Soweto. 

The physical trauma I suffered that day has melded into the great mass of trauma I experienced over the years, but the mental trauma of my parents “killing Christmas” marked me permanently and profoundly. From that point onwards, I became The Guardian Of The Tree. I was already suffering from what I now know to be severe OCD, but this wasn’t and isn’t an OCD “thing”. I don’t obsess that my family will definitely all die a horrible death if a few baubles are misplaced. Take note, all you assholes who are “sooooo OCD” about decorating your Christmas tree. You really are not OCD sufferers. Count yourselves lucky that you aren’t. 

Imagine what it takes to make a three year old think, “I am going to take back Christmas, be its protector and ensure its safe continuation”. I was an old head on very young shoulders. So protecting Christmas became my responsibility and when my sister was old enough to understand, I schooled her in its importance and she began to share this sacred duty. We scrubbed the hearth for Father Christmas, we decorated the tree, we took ourselves to church. 

This was an early act of defiance against our degenerate parents. Christmas was a tiny spark of magic which we would not let them extinguish. Kids need a little magic. Neglected, abused kids even more so. To be factually accurate, our parents did buy a few cheap presents and dad made Christmas dinner, but we were The Protectors Of Christmas. We resurrected it and we kept it alive. 

This wasn’t Miracle On 34th Street or The Polar Express. It wasn’t symbolic or mythological. It really was about keeping hope, faith and magic alive. The alternative was despair and capitulation to the grimness of the only reality we had ever known. 

I had to stop briefly to recompose myself after writing that last paragraph. 

So this is how we continued. Through tribulation, carrying the embers of hope from one year to the next, reigniting the flame of Christmas from last year’s dying spark. 

Then on December 26th 1985, the season was punctuated by more trauma. My mother and father had by then divorced. My sister and I were living with my dad. My dad invited my mum for Boxing Day lunch. Being alcoholics, they were both completely drunk well before lunch was even ready. Inevitably the arguing started. My mother was schizophrenic, but refused to take any medication for her condition. When she drank, she became disinhibited. She then often became violent. Sometimes extremely violent. Out of control violent. This was one of those times. 

My sister had already telephoned my dad’s brother because things were getting dangerous. By the time he arrived, I was putting myself between my parents, as I had done so many times since the time I could first stand. I was taking punches and kicks from them both as they tried to injure each other. My uncle restrained my dad by the arms and pulled him back. I tried to push my mother away too, into the bathroom. She smashed the bathroom medicine cabinet mirror with her fists and used two daggerlike shards to start slashing through me to get at my dad. She managed to stab into my head several times and slash my forehead and left cheek. My head and face were bleeding badly. Blood was running into my left eye. My mum’s hands and arms were covered in her own blood from where she was gripping the shards of mirror. I managed to get hold of her wrists, so that she couldn’t slash any more. She was a small woman, but when this berserk frenzy was upon her, she was frighteningly strong, beyond reason and almost unstoppable.

My sister had opened the front door and my uncle had subdued my dad in the living room. I managed to drag my mum down the stairs by the wrists and push her out of the front door. My sister slammed the door shut. My mum, still deranged, hacked at the wood of the front door until the two shards of mirror were embedded in it and she couldn’t remove them again. 

From this point I don’t recall much, apart from cleaning my wounds and putting plasters on them. I didn’t go to hospital. I never went to hospital with such injuries. There was a lot of blood spatter on the walls. My sister and I cleaned that up. My uncle calmed my dad down and helped him drink himself into a stupor. 

And yet I still celebrate Christmas?! Why?! Why would anybody want to still celebrate Christmas after that?!

Because it was mine. Mine and my sister’s. It was a thing which we protected. This, though slightly more extreme than usual, was just more shit, different day. It was unfortunate that it happened during Christmas, but it could have happened any day of the year. 

The physical scars eventually healed. I am always amazed at my physical healing ability. All of the injuries my mother inflicted upon me over the years are almost invisible to the eye now. I know where they are and when I point them out, other people can see the scar tissue or indentations. I am grateful that I don’t carry the physical scars more visibly. 

The psychological scars are etched more deeply. But that is something to discuss on a different day. This is about Christmas. My Christmas. My sister’s Christmas. 

Into adulthood and then parenthood, I have retained my role as The Protector Of Christmas. The role has become more elaborate as the number and quality of Christmas decorations increased and improved. It now also includes gift buying, entertaining guests and food & drink preparation. It has never been a responsibility the way my OCD compulsions are a responsibility. I don’t fear catastrophe if I don’t complete the tasks perfectly. Things do however have to be done properly, in a certain way, to a very high standard. Doing Christmas properly is IMPORTANT. It can be stressful, as I am a perfectionist, who places too much importance in the symbolism of certain things. I am OK sharing out the workload among the whole family, but I have indoctrinated them all to do things “properly”.

I enjoy the prelude to Christmas and the holiday season itself. I still struggle very much with having larger gatherings of extended family as guests. I’m not good with large groups of people or having anyone other than my core family unit in my house. My ideal Christmas day is an early church service, followed by a day at home with my wife, daughters and dog. And maybe a walk on the beach after Christmas lunch. I’m not keen on the gross commercialism of modern Western Christmas, but I do love choosing a few presents with love, thought and care. Sometimes quite a few presents. 

In an odd way, I am grateful that I have had such attention placed upon Christmas. My Christmas has meaning, worth and significance. It is not made of plastic, assembled in China. What was born out of defiance, has softened at the edges. The kids do most of the tree decorating now. They do it well, with a little gentle guidance from me. I enjoy the traditions. The traditional traditions and the traditions I have invented myself. 

That is why I said “yes” and not “no” to the second question. I have reclaimed Christmas from when it was stolen from me and kept the magic alive. 

The “coming out” thing

Fear can hold you prisoner; hope can set you free. – Stephen King, The Shawshank Redemption. 

Since being diagnosed with OCD, I have learned a lot about the condition. I have suffered from OCD my whole life, but I was only officially diagnosed nine years ago, aged 37. 

I was pretty sure for a long time before that I was an OCD sufferer, but self stigma and shame had prevented me from seeking help. Even before knowing it was called OCD, I had known from a very young age (two years old) that I was somehow “different”. Damaged goods, impregnated with an evil that I had to keep secret. I had badness in me that was trying to leech out. If anyone found out, I would be locked up. My mother reinforced these cast iron beliefs almost every day, when she beat me and I bled or bruised. “That’s the badness coming out of you. When they find out, they’re going to lock you up in The Home”. 

So it took 37 years for me to summon the courage to seek help. By then, it was simply a case of either die by suicide or risk being sectioned and locked up to protect the World from me. I had feigned an outwardly normal life until then. In many respects I was “normal” and successful. But the whole time, I carried this burden of latent evil around with me. I knew I was essentially a good person, but my mind told me I was capable of doing bad things and of not doing good things properly, which would result in evil, catastrophic consequences, which would be my fault. 

I first began to suspect that my “differentness” was partially something called OCD in my mid teens, when I watched two documentaries about people with OCD, one about people living with it day to day, the other about inpatient treatment of severe, treatment resistant OCD. That was a frightening realisation. I was an undiscovered mental patient, like the mental patients on TV. Mental patients were dangerous and needed to be locked up. Everybody knew that. I needed to work harder on seeming normal, in case I was discovered and locked up too. 

With the benefit of hindsight, I remember that the documentaries both concentrated on the compulsions of the sufferers they featured. I recognised similarities to my own compulsions. Up to that point, my primary compulsions were checking compulsions. I don’t recall much mention in the documentaries of the mechanisms of OCD or the intrusive thoughts which fuelled the OCD cycle. So for me at that time, OCD equated to Obsessively Checking things Disorder. 

I didn’t realise then that the physical tics I had, the hair pulling, the skin picking, the ripping off of my fingernails and toenails, which had all happened throughout childhood, were also all indicative of OCD and the anxiety it created. 

So I quietly knew for about 22 years that at least part of my “differentness” was OCD, yet didn’t seek help. Stupid, eh? So many wasted years. Utterly daft. Yet that whole time it seemed perfectly rational. The OCD parasite is cunning. It convinces its host that it is both friend and protector. That the host will be vulnerable, weaker without its presence. So it seemed logical to allow the OCD to remain in control of me. I needed it there to keep me safe, to keep others safe. I couldn’t live with myself if harm came to anyone if I abdicated my burden of responsibility. And so the OCD parasite continued to feed off my anxiety, propagating it with horrific mental images, fear, guilt and paranoia.  

So eventually, in terminal desperation, I went to my family doctor aged 37 to get help for OCD. In order to realise that we need help and then to seek help, many OCD sufferers necessarily self diagnose. Some people go to their doctor knowing just that something is mentally wrong. Some have an inkling that it might be OCD. I was more organised and thorough. In my typical manner, to confirm my self diagnosis, I had looked up OCD on Wikipedia, as well as looking at the OCD-UK, OCD Action and IOCDF websites. My education had begun in earnest. I listed my “OCD things”, three printed pages of a bullet-point list and showed them to the doctor. He agreed with the self diagnosis. He put me onto medication to help control my anxiety. 

Looking back at that list, there were also a few things like “straightening picture frames” that I now know are misconceptions about OCD. Crooked picture frames annoyed me; I never thought anyone would come to serious harm if I didn’t straighten the picture frames. But I can forgive myself now for the commonly held misconceptions. It was early in my education about OCD. That’s what many think OCD is – being mildly annoyed at crooked picture frames. So very far from the horrible truth. 

Perhaps I should be more forgiving of other people’s misconceptions of OCD. They mostly only have media misrepresentations, online memes and jokes to go on. The fact that we OCD sufferers conceal our suffering so well has also helped to perpetuate misconceptions and misunderstanding of the actual condition. I have beaten myself up mentally for concealing my OCD and perpetuating the myths. I’m learning to cut myself and others some slack about that now. We were and are hostages to the parasite in our minds. You don’t shout for help when there’s a gun muzzle pressed to your forehead. 

So I was diagnosed. What changed? Initially, not a lot. The huge burden of self responsibility lifted slightly from my shoulders. The medication reduced my anxiety slightly, but also made me gain weight and feel drowsy. I didn’t magically get well. I bounced along the bottom of the abyss for several more years. 

But then I began to read more about OCD. I began to interact on an online OCD-UK forum. I read a lot about other people’s experiences of OCD. So much of it was like reading someone else’s description of me, but interestingly, a fair chunk of what I read surprised me. I have a bad habit of assuming that my experience of a thing is absolutely typical and indicative of that thing. I’m not good at golf. Therefore I don’t enjoy playing golf. How can anybody enjoy this stupid pastime that I loathe? Only an idiot could enjoy golf. You see? Just like that. 

I had assumed that everybody’s OCD would be exactly like mine: Always present, at maximum volume, every waking second of every single day. Primarily focussed (in adulthood) on contamination, with consistent minor themes such as checking. I was wrong. I discovered that whilst there is a core mechanism to OCD, there can be big personal variations. 

I discovered that some people’s OCD can be less severe. I envied them. I discovered that a few people’s OCD was more severe. I pitied their suffering. I learned that some people’s OCD could fluctuate in severity, depending on the time of day, week or year. This was a revelation!

I also started to learn about the different main themes of obsessional focus: contamination, checking, fear of harming others – accidentally or deliberately, fear of sexually harming others, sexual identity fears, magical thinking, fear of harm from others, religious obsessions, moral obsessions, relationship obsessions, rumination or hoarding. I recognised that I had experienced more of the themes than I had realised and was surprised that I hadn’t encountered others. Given that I was sexually abused for the first 11 years of my life, I’m still amazed that OCD has never latched onto suggesting the possibility of the phenomenon of abused becoming abuser. I simply know unequivocally that I would never repeat the actions of my mother on anyone and the OCD has never tried to suggest otherwise. A good example of the random, unpredictable nature of what OCD does or doesn’t torment its host with. 

Sometimes, when I read or hear of someone else’s experiences of OCD, I consider myself lucky not to have experienced their variation of the torment. Oddly, several of those people have said the same thing in reverse when I have described some of my experiences. We are typically empathetic people. Other people’s suffering seems worse than our own. We are also stoical and determined. We quietly endure years of suffering alone – typically 12 years from onset to diagnosis. It’s hideous mental torture, yet we consider ourselves lucky in comparison when we hear of the horrors in other people’s minds. We are all victims of the same torturer – OCD, which uses the same torture techniques on us. It merely varies the subject matter of what it tortures us with. 

It is good to have now heard and read the experiences of so many other OCD sufferers. It makes me realise that we have a common enemy, which behaves in consistent, predictable ways. That enemy is weak. We are strong. That is why it parasitises us, because it can feed off and drain our strength, but as soon as we learn to control the anxiety triggered by the intrusive thoughts it latches onto, we begin to deprive it of its source of nourishment. 

The thing which had the biggest positive impact for me was attending an OCD sufferers’ support group. I had spent the years since formal diagnosis continuing to endure the OCD parasite, but in a medicated state. I had previously improved my knowledge of OCD, but I hadn’t done anything else, other than attend a one-to-one talking therapy course, which was only briefly beneficial. The support group increased my knowledge of OCD exponentially. It made me challenge my self stigma and see that my shame as a sufferer was unwarranted. It made me start to feel better about myself as a person. 

The most practical things to come from starting to attend the support group were learning about the benefits of CBT (Cognitive Behavioural Therapy) in overcoming OCD and gathering the courage and motivation to ask my family doctor to refer me for CBT treatment. 

Other OCD sufferers gave me support at one of the lowest ebbs of my life and indirectly helped to save me from death by suicide. OCD sufferers are more empathetic and supportive than the general population. It’s in our nature. It’s one reason why we fall prey to OCD. It makes us doubt the innate good in ourselves and feeds off the resultant anxiety. I have been very glad of the support of other sufferers and it is a privilege to return that support in kind. 

Coming out as an OCD sufferer is difficult, frightening, daunting. It is a big thing to do. But it is liberating. For me it was like being reborn and learning to be a proper human being for the first time. I’m still learning: about OCD, about what “normal” is, about self care, about how to be free and untortured. But it’s good. It’s a new adventure. It’s good to feel the rain on my face. 

If you believe that you might be suffering from OCD, these blog posts can help you to seek support and treatment:

• How to first get help if you have OCD – click here 

• Going to an OCD support group – click here

You are not alone. You are not a freak. You are not a bad person. You can recover. You too can break free.