Tuesday, September 27, 2005



Horribly sorry about the delay in posting. Lots of stuff to talk about and too tired to talk about any of it.

Coming on up to midnight over here, after three days of on and off rain. The chickens are sleeping, the horse stands in the barn and the cats are in tangles and clumps around the house.

And now is the winter of my discontent made glorious summer by Sarah, who was asleep in bed when I came home, having returned from across the desert. All new coloured hair (apparently) and pale skin and dark lashes and a little smile upon her lips. Sigh.

Well, enough of that. What's been going on? About thirty different things.

I did an internet test to tell whether I am a nerd (someone who is passionate about learning/being smart/academia), a geek (someone who is passionate about some particular area or subject, often an obscure or difficult one) or a dork (someone who has difficulty with common social expectations/interactions)... or none of the above. Chillingly, not only did I get better than ninety percent on the nerd scale, I also scored highly on the dork one. I'm pretty much an antigeek, because I have a terror of new technology and any day now will have mastered the electric phonograph.

I am trying to write another story, since apparently "they" liked the last one, and I am gradually working my way around to starting a novel.

Work goes well. In the ED we have had a run of Bad People. These are those people who for some reason are out of the prison system and are generally not welcome in big parts of the outside world (i.e.: hard to get accomodation because they have armed robbery on their CV, can't move in with friends because they either have none or their friends are headcases, etc...) and end up in the ED.

The following contains adult themes.

Unfortunately, while they have real and often terrible problems, they are not problems that we are particularly good at fixing, so their stay in the ED tends to be rather tension filled for all concerned.

Take yesterday's example. Since I have done a fair amount of psych and some forensic stuff (and have actually been in prison*) people ask me advice about this kind of stuff. Often they arrive with a fax from the mental health or prison people, detailing this person's significant history, and their name on the computer is accompanied by various alerts.

"Thank you for seeing Wolfgang Throatrend" reads the letter. "He is a twenty two year old man currently awaiting sentencing for multiple/aggravated/armed/third degree ..." and then a list of crimes that are too depressing to relate. And the computer informs you that he must be searched before entering the ED, must be accompanied by a security guard at all times and is given to spitting, swearing and armed assault without warning or provocation.

It is difficult to be objective about this. it is tempting to attribute all of this man's physical problems to his character -

"And I woke up with this really bad pain in my chest... what do you reckon caused that, doc?"

"Maybe you being a piece of shit?"

Seriously, I tend to see these people because no other bugger wants to but it is vital we get them seen as soon as possible, treated as quickly as possible, and out of the ED (if possible) prefereably sooner.

But it does get a little bit depressing. Mr Throatrend, last night's least wanted, whose alerts mentioned the breaking of his sister's jaw and a truly ghastly sexual assault on a child, was in there complaining about being depressed and wanting to kill himself, an admission which generated much more hope than dismay. I went in to see him, and did the mental health stuff, and then the psych registrar came in and did the same, and so did the social worker...

and all the while, sitting next to him, holding his hand, is his new girlfriend. A young woman, slim boned, dark hair that hangs around her unlined, open, earnest face. A ring on one slim finger. Five, maybe six months pregnant.

Well, what do you do? From your patient's point of view, this may possibly be seen as a good thing. May stabilise him a bit, someone to listen to him, someone to help him through the bad times, a positive influence. people can change, I am assured.

And I believe people can change, but I also believe most don't. And this man has not got one of the classic mental illnesses - although people with personality disorders are more prone to the classic mental illnesses - he had predominantly the features of a personality disorder. He is another psychopath. Someone who is mentally ill and responds to treatment can understand that things are not as they once believed them to be, we give them chemicals that stop other chemicals being released where they should not be. Someone with a personality disorder cannot be given that chemical insight. He is truly unlikely to change.

Anyway,I feel this is new relationship is not a good thing. It is probably not a good thing for him, because I think he will continue to be the same kind of person he was before. it is not a good thing for the child. It is assuredly not a good thing for her.

Anyway, as we escorted them out, he turned to the psych registrar (a remarkably beautiful young woman who listened, and so someone he wanted to keep talking to) and nodded to his girlfriend and said "Tell her she can do a lot better than me."

I stared up at the ceiling, and the psych reg smiled and said something non-committal, but all I could think of was him using that whole guilt/sympathy/"I'll tell you to leave so you won't/I'll say I'm crap so you cuddle me" stuff that children use.

I don't know. When I was a kid, I loved astronomy. I didn't have the patience to get out there and learn all the stars, but I knew where many of the planets were, and I could recite surface gravities and numbers of satellites at will. And I loved the terminology - Arabic and Greek and Latin, words like incantations: azimuth, perhelion, occultation, lunation. Like many children who had difficulty with common social expectations/interactions, I felt reassured by the empty sky and the orderly movements of the worlds. Much more simple than human beings.

Nowadays, I think may be things weren't like that. "Seek simplicity, then mistrust it". Planets wobble, are perturbed, dark worlds move in unknown paths. And human beings, I think, are less free than I thought they were. There are currents in this girl's genome, things that drag her along like fish-hooks, blind and dumb subconscious evolutionary imperatives that make her hitch herself to a man like this, caress a man who broke his sister's jaw, carry the child of a child molester.

One of the words we use in astronomy is perhelion. The time when a body, a major or minor planet, is closest to the sun. Once perhelion has passed the planet or planetoid begins the long fall away, into the dark. Depending on a very few things - gravity, perturbations of other bodies - it may return only after many years, or it may not return at all.

That was the feeling I got, seeing her walk out of the room. Knowing we might or might not see her again (we see a lot of domestic violence here) but knowing that this probably was as good as it would get. Once the baby's born, or once he starts to get over her, or starts drinking seriously again, or gets off parole and back on the speed, once he gets suspicious, or "loses his temper", the first time he hits her ... it's never going to be any better than this.

This time was her time in the sun. From here it's all into the dark.

Anyway, thanks for listening. Will reply to comments in a day or so.


* Four hours, animal rights demonstration, early eighties.


Blogger Prom said...

So what do you think are the basis of personality disorders if not chemical imbalances?

My bf's ex seems to be narcissitic borderline PD with periodic rage behavior. So was her mother. One of her kids seems to be on the same path but the other (although affected by her mom's moods and lack of empathy and sensitivity) has more of her Dad's pragmatic personality. Which is it, genes and chemistry or learned behavior?

12:40 AM  
Blogger Foilwoman said...

I think some of it is just chemistry, but then there is what we do with the chemistry. I know I have depression and ADD/ADHD, but really, that is not who I am. I do have to take it into account, and make appropriate adjustments. That's how I started making lists of the good things. Cognitive therapy, sort of. But the problem with a personality disorder, like psychopathy or narcissism is that these people don't want to change. Psychotics and schizophrenics are problematic because the actual facts of reality (not just the interpretation) are at issue. Ugh.

Perhelion is a beautiful word. I don't think we want it to happen too early.

4:38 AM  
Blogger Bronze John said...

Looking back I don't think I explained myself at all well. As far as I understand it, there's an interplay between chemicals and neuroanatomy on the one hand and thoughts on the other. Chemicals and neuroanatomy determine the thoughts you can think (i.e.: chemical treatment of depression, neuroanatomical predispositions to schizophrenia, etc) but thoughts also determine chemicals and possibly, in the long term, neuroanatomy (at the very small scale). CBT, which works on depression, must therefore also work on serotonin/noradrenaline/etc levels in the various tracts, and may in the long term affect even neuroanatomy.

This all gets into philosophical questions on free will that I have given up trying to answer.

As to the personality disorder/mental illness thing, I agree that psychosis is inaccessible to CBT... there's something more fundamental going on. CBT and its variants does have some success in some of the PDs, and so do some drugs, but it's a hard row to hoe. Maybe it comes back to "real" diseases being those that doctors and pharmaceutical companies have a treatment for.

I personally sometimes think these things are on a continuum - classic mental illnesses grade into personality disorders, schizophrenia grades into schizoid PD which grades into "that weirdo down the road". There are people whose personality is so resilient that it seems nothing can depress them. Others are more easily brought down, and are brought down for longer.

And then there are those people who technically have a personality disorder except for the fact that it makes their life better - narcissistic political figures, etc.

Anyway, all very interesting.


3:09 PM  
Blogger Benedict 16th said...

I think I met him yesterday. Recently out of hospital with 3rd degree burns attained when he fell asleep next to the bonfire and woke with his shoulder on fire* He presented with a story of the pain "oh the pain", "I can't sleep when I role over in bed"**... I wrote a script for amitryptaline and spent about 10 minutes explaining how it helps with neuropathic pain. He wanted the Panadeine Forte/Diazepam combo***. He asked and received a letter from me about needing urgent housing trust accommodation as he was staying at his cousin's place and was in an unstable environment etc etc... . Anyway after shaking my hand and thanking me on the way out, the two receptionists were both stuck on phones, he hung around for maybe 10 seconds then walked out to his car (where his cousin was sitting) sat in the car, showed the cousin the script and letter, looked up at the practice (they can't see in but I could see them clearly) sat there for maybe 5 minutes as I watched. I think he decided no one was going to come out and get him to sign the medicare form# so he drove off.

He still owes $14 from 2 years ago. I suggested to the practice manager we ban him from the practice but she suggested we just get his signature before booking him in to see anyone...

That might not sound too bad but 2 months ago I had his ex detained to Southern Mordor where she spent 25 days## as she went psychotic and she had come in because her ex- had given her some speed for her birthday and she didn't take her antidepressants### when taking the speed. Tried to find her antidepressants (she said he took them from her) so he supplied her speed for a few more days, she entertained him and his cousin, there 7 year old started shitting himself just like the last time his father came back and the 2 year old became very clingy and she started having screaming nightmares, then his ex- ended up in Mordor South.

I can no longer be objective in this case and I can no longer see him as a patient.

I do regret I cannot be so eloquent as BJ in these things

- Benny XVI

* he denies any chemicals other than alcohol.
**I had discharge summaries from the Royal and even looked at the burns
*** Panadeine Forte = Paracetamol 500mg/Codeine 30mg x 20, and diazepam is 5mg x 50 - its amazing when you offer 50x2mg they know there is a stronger one, but unsure of the dose but needed it last time....
# he wasn't even being charged any cash, he was being bulk-billed under medicare where the government pays and couldn't even bother to wait to sign the form so the practice got the money (and I get my cut)
## 24 hours detention, a 3 day extension and a 21 day extension
### As had been agreed with me previously, if she took speed she wouldn't have her antidepressants that day. She is a pretty, late 20's and IQ lower than George Bush - not a good combination.

9:29 PM  
Blogger Prom said...

I really wonder why mental illness seems so prevalent. It seems that the genetic basis for it and even the response of it to environmental cues must have had some selective advantage during our evolution to have become so prevalent.

I also wonder why so many psychotic thoughts are unpleasant. Why hallucinate terrors when the brain could as easily conjure up pleasant and entertaining thoughts? Where is the rose colored glasses psychosis?

10:52 PM  
Blogger Foilwoman said...

Yes, why can't someone be psychotic in a way that they see friend instead of enemies, decide they don't need expensive consumer goods, and do listen to their spouses with attentiveness? Maybe they do, but we don't call it illness then.

11:06 PM  
Blogger Chade said...

Isn't that Mania?
I swear there's a disorder for everything. Did anyone see that film 'Tarnation'? Very intense look at living with mental illness and the effects it has across generations.

8:52 AM  
Blogger Bronze John said...

Hail all,
Didn't see Tarnation, but have heard good stuff about it.

I reckon that while there aren't any good illnesses, there are certain mood states and maybe some fixed false beliefs that are pretty similar to what we call the mental illnesses - except, as FW says, none dare call them madness. Some people have a strong tendency to a stable, but depressed mood, regardless of outside events - I'm sure everyone's met people who are consistently mildy happy (the euthymic temperament). Some of it is cognitive but I reckon some could be genetic.

I also reckon most of us run around with some fixed, false beliefs in our head that "are genetic" and have been strongly selected for: beliefs about our own importance, ideas about everyone elses opinions of us, propensities to certain religious ideas, that kind of thing.

Having said that, from an evolutionary POV, a sense of increased watchfulness is not that disabling, so there you have the paranoid states.

When I was working as a psych reg, I once came up with the idea of "orthonoia", sortof like paranoia - it's a strong suspicion that you are following or spying on someone, and that strangers are not talking about you and are conspiring to do you a favour.


9:34 PM  
Blogger Benedict 16th said...

So what's metanoia?

Orthonoia and Metanoia discussed
According to Wiki metanoia means repentance well according to a Christian Death Metal band anyway...

And the Wictionary metanoia same as above, maybe it could be that case where someone is attracted to someone else for their mind?

9:46 PM  
Blogger cupcakegrrl said...

As for why mental illness is so prevalent-- I think it's because there's less manual labor to do. I think of my grandmother, running her husband's pig-farm and mother of 7 children. I doubt she ever had time to question the validity of her path, if she was even aware of having "chosen" it. I doubt she had time to indulge the luxury of neurotic self-absorbtion. Perhaps the devil freed by our modern times finds work not for idle hands but rather for idle minds.

Simplistic hypothesis, I know. And I'm sure personality disorders exist behind many a laborer's exhaustion. But if you're too tired to act on your pathology, you'd present as sane. No?

2:36 PM  

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