RE: Am i crazy?.....

I agree with macjoyce. There's so much information there and it's so clinical. For me it's very difficult to comment. The human mind is a strange thing. I don't think any of us are totally sane and rationale. We all have our own ways of coping. If you can't sort it out alone you should definitely get help.

"Describe your view of life to a doctor and, with extremely high probability, you'll find you've got one of your very own. That's not a facetious comment or a put-down, it isn't cynicism, nor is it directed particularly at you. True and accurate of most people." I don't think this is true and accurate of most people. You're right to suggest that a phenomenally high percentage of people could go to a GP, describe the systems of depression and get given some tablets, if they felt the need to do so. But the fact that people reach the point where they choose to do so suggests that there mental health difficulties have started to affect their lives to the extent that they need to seek professional help. Being in that position isn't easy or pleasant. Beyond bog-standard depression and anxiety (which is unpleasant but, as you suggest, not unusual) there are mental health conditions such as: bipolar disorder, schizophrenia or personality disorder (and others). It's very unlikely that most people would get diagnosed with one of these conditions by describing their world view to a doctor. If you experience the symptoms of these conditions on an ongoing basis and simply attempt to get on with life without seeking help, you generally end up in an extremely bad way.

Our prison system is full of people with serious mental illness, it has been since they started shutting down the psychiatric hospitals and turned to care in the community. It's actually estimated that 80% of the penal system have some sort of personality disorder, the 60 is probably serious mental illness. Prison is not full of career criminals with mansions in Essex, it's full of screwed up drop outs, this is acknowledged by everyone involved in the penal system, the only reason nothing is done is because of the expense. Many of these severe personality disorders are triggered from severe neglect or other traumatic incidents in childhood. What's really sad is that the majority of these recidivist offenders first come into contact with the system at a very young age. A lot of drug addicts and alcoholics are self medicating for some sort of mental illness. By the time they are seeking help they've led such a messed up life it's near impossible to get a diagnosis unless it's something like schitzophrenia. Craig

"In that case, do you believe that McJoyce's claim that 60% of the prison population have a personality disorder is a meaningful statement?" I think it's entirely possible because there are reasons - some of which have already been alluded to - why people with a personality disorder often find themselves in prison, and there are reasons why the experience of being in prison would exacerbate the experience of having a personality disorder. "By applying different standards you could come up with a figure anywhere between zero and 100%. Pick whichever suits your case." Surely that's true with any physical or mental condition. Mental health conditions are particular collection of psychological symptoms that present a series of barriers and problems to people who experience them. The point of putting symptoms together and calling them conditions is to enable people get treatment that might help them.

Glad your open for correction FTSEE, no in a short term prison you're not likely to be assessed by a psychiatrist, but then going into care as a child the minimum attenetion is shown through psychiatrists. Now maybe through your answer you've spent a couple of weeks in a short term jail, you're not the sort of people analysed, why because you're not the problem. The stats, they've been hard come by, if you knew any of the people involved you'd know that, they don't bring these things up for nothing and dish out daft quotes. The people who discover these things go onto jobs at a pretty high level, and if you think their paid the salaries they end up getting for talking crap then you're pretty dumb. Having been one of these people, (and spending over two years in an intensive theraputic unit in a penal system that catered for, at the time around 60,000, and only had about 600 places I may know what I'm on about), it's not babble or made up figures. As I said earlier, which you obviously chose not to answer, why the hell do most people involved in the penal system agree that most poeple locked up aint all there. Jesus Christ, even the POA, (Prison Officer Association) complain about it, about the only thing they agree with the penal reformers about. Screws are not trained to deal with the mentally ill. Listen Ftsee, you obviously haven't got a clue what you are on about. I understand your position, but you're well wrong, maybe you can prove me wrong but I discuss my thoughts with on the ground level to the highest level, inc government, regarding prisoners, and they all agree. But maybe you know something the rst of us don't. If so write it here, cos it's the 1,000,000 question. Craig

FTSE100, I don't disagree with your broad based wariness towards stats. Up to and including the national census, all stats of large groups of people are based on incomplete information and the indicative results that are generated often mean different things to different people. It's a big leap from the information about mental illness being imperfect to this: "Here's the problem. There are no objective criteria by which the existence or severity of mental illness can be determined. In everyday life, the vast majority of mentally ill people self-select. They choose to ask for help. In prison, your mental state is likely to be decided by a third party. The two are in no way comparable." which is utterly ridiculous. The vast majority of people who experience severe mental illness are no more self-selecting that the vast majority of people who experience severe back pain. It's true that someone who experiences a mental health difficulty - for example, auditory hallucinations - does choose whether or not they seek treatment but, as with the back pain, that decision is completely irrelevant to the question of the reality of that experience. I don't think the criteria for diagnosing mental illness are less objective than the criteria for diagnosis of physical illness. Prejudices, assumptions and lack of knowledge are potential factors in the diagnosis of physical illness, too, the difference with mental illness is the absence of physical evidence but that's missing information not a lack of objectivity. I don't know if the methods involved in diagnosis with mental health conditions are fundamentally different in prison to in the outside world but you haven't demonstrate that you know either.

Ftse, I'm sorry if I insulted you, really I am. It's a subject close to my heart and I'm passionate about, my intention wasn't to insult you and I mean that. I just get carried away on the subject, (maybe more than I should). Again sorry. Craig

Not playing devil's advocate. Maybe I don't understand what your case is. If you're saying that you can't diagnose a mental illness in the way that you can diagnose cancer or a virus through x-rays, blood test and other physical evidence then your statement's clearly correct. Mental health conditions are labels on sets of symptoms and people who have a set of symptoms are described as experiencing a condition. But you seem to imply that experience only takes place - or only becomes mental illness - if someone goes to a doctor and tells them about it. And then, you apparently believe, the doctor decides if they have a condition or not on a purely subjective basis. I don't see any other obvious meaning of 'no objective criteria'. "In everyday life, the vast majority of mentally ill people self-select. They choose to ask for help." This bit, in terms of severe mental illness, is just literally untrue. I won't bother finding stats as you don't believe in them but in terms of people with severe conditions, a significant percentage are diagnosed after ending up in either hospital or custody or being referred by another agency.

This is a fascinating thread, if only to see the different opinions. My wife and I have an adopted son who we knew, almost from the day he arrived, was 'different'. After almost seven years we finally managed to find a child clinical psychologist who actually understood and could explain his problems. So we got a diagnosis. Which you have to have if you expect to get any help from the education system which insists on a 'label'. Our son needs it, he has a very low IQ, no idea about social interaction and a dangerous propensity to over-confidence - none of which are likely to improve as he gets older. I would suggest that it is a reflection of the rest of society. Probably a very large number of people have a personality disorder but unless that seriously impacts on fellow citizens, no-one is really concerned. Hence only the serious issues attract a label and consequently the help of medical professionals. Surely most people who commit murder have some sort of personality disorder? Whether it be a total lack of moral restraint or just an inability to control their temper. But society classes some as mentally ill and some as evil, without ever explaining where the dividing line lies. So in trying to quantify mental illness are we really just trying to quantify the people who are a threat to either themselves or the general population - whatever the reason?

No worries Ftse, just cross wiring I guess! It affect me mostly for the generations to come, personally I didn't know any different in my life so it was the norm so I feel no resentment, my life is great and it wouldn't be that way if it wasn't for my life experiences. It did however annoy me that the system knew where I was destined from a young age and for decades had done nothing to stop it happening to generation after generation. The cost of a lack of early intervention to tax payers, enormous, both cash wise and emotional, the emotional being the straight person being my victim. Until intensive therapy I really saw nothing wrong with this, and I mean really, to me it was normal. As sad as it sounds I didn't understand the regular concepts of life compassion, sentimentality things like that, I really didn't. Again part of my passion. I make no excuses for what I was, it does bother me though that the system knows the kids like me, and has done for years, and does nothing to stop it, all the while it gets worse. I'd go further than Buk, yes many are diagnosed as a result of coming into contact with the system, many remain undiagnosed, (I have an associate who had severe paranoid schitozophrenia who was locked up on a regular basis when acting out, in turn the prisons didn't know what to do and he ended up in segregation, a 10-12 ft by 6ft room alone 24 hours a day probably not the best for his condition, he wasn't diagnosed for years.). Yeah poeple cope with life's events, the ones who can't and need a doctors help are the mentally unwell, hence they need to seek help. The brain, in individuals, works in varying ways, an example I use is often Post Traumatic Stress Syndrome, although extreme, what some people see on the frontline they can digest, or at least accept, for others it messes their heads. Craig

Sorry – somewhat off topic, but something Craig said about early intervention reminded me. Did anyone see Dispatches ‘Britain’s Challenging Children’ on C4? http://www.channel4.com/video/brandless-catchup.jsp?vodBrand=dispatches-...(link is external) It followed a group of disruptive and often violent primary school children. Apart from severely hampering the rest of the class, the teachers feared that once these kids reached secondary school, they’d be all but lost – truancy, expulsion etc. So a few schools have set up ‘Nurture Rooms’… sounds a tad tree-huggy but the results were fantastic. The rooms are a cross between a class and a home setting – that is, a peaceful, secure, nurturing home setting. The children spend varying amounts of the day in the Nurture Room with amazing staff who patiently unravel what is lying behind their anger issues. Crucially, they also involve the parents, giving support and parenting advice etc. The children are eventually integrated successfully back into mainstream class. Not only is their behaviour transformed but one kid who previously appeared un-teachable, increased his academic ability by two years in three terms, another found himself to be exceptionally artistic etc. These rooms only exist in about 4% of schools and some are at risk of closure due to lack of funds. The teachers argue that this is nuts and that the long-term savings of such early intervention are incalculable to the kids and society. I doubt anyone could watch the programme and not end up believing that every Primary in the country should have a Nurture Room. Worth a watch. ~ www.fabulousmother.co.uk(link is external)

"Do you think that everyone with a mental illness should have to undergo therapy, until they have recovered from their illness, as a legal requirement? Because I feel they should. I believe everyone with a mental illness should have to take treatment, from the moment they are diagnosed." No. The moral implications of forced treatment aside, treatment for mental illness is highly unlikely to be effective if people are forced to engage with it against their will.

"I think the reason why most people with mental illness don't take therapy isn't because they're totally against the idea. It's just because they haven't thought about it in any great depth, or because they're just lazy." Well, there are regional variations in the NHS but I'd be surprised if there were many areas in the UK where there are large numbers of people rejecting talking therapies on principle. In most areas demand currently vastly exceeds supply, even before you try and cajole people who don't want therapy into engaging with it. There are laws in place to force other treatment or detention on people who are in danger of doing themselves or others serious physical damage. When it comes to making loved ones lives a misery and generally making a mess of their own lives, I don't think people with mental health conditions should have any less right to get on with doing that than anyone else. I'm all in favour of offering people as much help and support as possible once they've chosen to do their best to improve their situation (as most do) but I think a compulsory treatment system would be pretty futile.

"Only a minority of people with mental illness actually take talking treatments. Borderline Personality Disorder, for example, is "the disorder that exists in order to deny the disorder". Most people with BPD don't even tell others that they have BPD, let alone get it treated." Well, BPD is particularly difficult because - while there's a proportion of mental health activists with other conditions who may disagree with labeling (and even psychiatry itself) on a political level but accept that they're experiencing mental distress - with BPD many people who might be diagnosed with the condition actively think that it's the world that has a problem rather than them. I'd be surprised (and I'm not sure how anyone could possibly measure) if there's lots of people in the UK sitting at home thinking "I've got BPD but I'm not telling anyone." What there is, is lots of people (definitely thousands, possibly hundreds of thousands, possibly more) experiencing a series of difficulties in their lives who - if they went to their GP and were then referred to mental health services - would be diagnosed with BPD and would be likely to benefit from talking therapies if they chose to engage with them. There might be a list of people who've been diagnosed with BPD and then chosen not to do anything about it but it's nowhere near the 2% of the population (1.2 million people) that is estimated to experience the condition. I completely agree that the number of people who end up engaging with talking therapies and are able to improved their situation as a result needs to increase. But - once again temporarily ignoring the moral questions - I can't imagine on a practical level how you could force someone to participate in talking therapy. It's fundamentally a two-way process.

I don’t really want to get involved in this argument since the main protagonists don’t seem to have a clue of what the reality of the situation is. I’m simply going to state my position and hope it will hint at the depth of the problem. Remember you are talking about helping sick people not dealing with terrorists! Psychotherapy rarely works, or at least it rarely works in the NHS since they haven’t the time, the money, or the resources to make it available to more than a handful of the people who might benefit from it. So far as I know Freud only claimed to cure one patient and she later committed suicide – I could be wrong but not very :O) Most of the severely mentally ill who are a danger to society or themselves are probably beyond the reach of psychotherapy anyway and are usually treated with heavy duty chemical coshes for the violent and ECT for the suicidal (after various chemical concoctions have failed). The practice of confining large numbers of emotionally disturbed people together results in almost everybody getting worse... and generally ends up with patients getting medication that is stronger than they would normally require... the cabbage patch solution. It would probably be better to segregate patients according to their symptoms but it would be too expensive and time consuming and, again, there isn’t the staff or the facilities. There are also a significant amount of people in which their actual brain is quite obviously mal-functioning and, like a computer with faulty hardware, no amount of software modification could hope to fix them. There are people with attitude problems, there are people who are dealing with emotional problems like the death of a loved one or a stressful end to a relationship, there are people with mild depression – all these can be confused with mentally illness much like a cold can be confused with Influenza – but these people can usually be helped by a psychologist and don’t require a psychiatrist. In my opinion treating the mentally ill is an art not a science and like most arts it is more reliant on the skill of the artists involved than on the techniques that they employ. In the end treatment relies to a great extent on the co-operation of the patient and you cannot force co-operation! It is a popular misconception that the mad are stupid, although they often seem so due to their medication. If you were to try to force those who do not want conventional treatment to have such treatment you would certainly find that in many cases you would simply exacerbate the illness while at the same time increasing their paranoia and anti-social tendencies. Many would be clever enough to mask this development and end up, when released, being far more dangerous than they were before!

Just musing, there is nothing wrong with idea of help being available at the point of need, though as has been noted in previous posts to this thread, difficult to obtain and uneven in geographical distribution. How help is meted out depends entirely on individual Health Authority economics, time and current trends in cognitive psychology/psychiatry, the pet theory of any one department head and a strong prevailing wind. I recall reading a piece in the BMJ on the desire to train a vast body of behavioural therapists to develop a comprehensive CBT service rather than dish out huge quantities of SSRIs, but how far down the line this has progressed is anyones guess. Recruitment and retaining staff on a decreasing budget is a problem. Mental Health Services are more often than not, marginalised and to some extent still a taboo subject. I've read the original Link begining this thread and the term Sociometric Psychobabble springs to mind. I sincerely hope that if the author requires help, they seek it via their GP who can refer them on, self-diagnosis or our conjecture is not beneficial. Macjoyce, you mentioned you had read part of this piece before, do you recall where?

"It's the complete absence of encouragement that really gets to me. It's as though society wants the mentally ill to remain ill." The government is putting some cash into talking therapies: http://www.communitycare.co.uk/Articles/2007/10/11/106069/mental-health-...(link is external) There's a big new lottery-funded national anti-stigma campaign: http://www.time-to-change.org.uk/(link is external) And the BBC is doing this: http://www.bbc.co.uk/headroom/(link is external) In a general sense, we're going to see a phenomenal amount of public information about mental health and wellbeing being pumped out in the next few years. It'll be interesting to see how BPD is handled within this because, for some of the reasons discussed above, people with BPD are less likely to be fighting their corner within the mental health system (as in actively demanding more and better services) than people with, for example, bipolar disorder.

The Mind w/site seems to offer a clear, uncluttered overview of BPD and highlights some of the problems in obtaining appropriate therapy, partially due to the apparent conflict of professional opinion of its validity as a diagnosis. Long url, sorry http://www.mind.org.uk/Information/Booklets/Understanding/Understanding+...(link is external)

I haven't been on the site for a few weeks, so to answer a few questions. I was sent to a unit for people with severe personality disorders, I was never told what that disorder might be, but the very fact I went there, in a system at the time catering for 60 odd thousand and only having a few hundred places would suggest there was a problem. I should also add I was much younger than all other residents. It NEVER cured me, it did however make me more aware of myself and how I acted and how I saw the world very differently to most people, this took a couple of years. I now spend my time passing on the knowledge I have gained to others. What Lou was saying is interesting, I wrote an article for Guardian Society last year which called for earlier psychiatric/therapeutic intervention when people came into contact with the authorities, (May 6th), most people caught up in the system are identified around 12 years old or younger. What is sad, is that it could have been done with me at a much younger age, probably without me being aware the therapy was even happening. Instead, at a much greater cost, emotionaly and financialy, I rampaged through society, doing the most terrible things to people and seeing nothing wrong with it. I don't say that as some sort of brag, in fact the opposite, it's shameful. Alcoholics and Drug addicts will understand in the CURED stakes, it's always there. Craig

Francis, isn't there another GP Practice in your area you could switch to? Sadly, help can be very difficult to access until Crisis and meltdown, the Mental Health Team are reached by self-referral to A&E in those circumstances, a disgrace that it has to reach that point. Hope you find your way to yourself and all the best L

BBF, change your GP, there is a lot they can do to help through therapy. The fact that you are aware is a big start though, I don't think it can be cured but the awareness is where it matters. Craig

Hello! Long time no see! Borderline Personality Disorder, and other personality disorders aren't 'things' in themselves. What they are is best understood as maladaptive coping strategies. We all develop ways of getting by in the world, which we learn and refine as we grow up. We learn how to understand other people and to understand ourselves to best get on and do what we need to do. The range of things that get described as personality disorders are ways of understanding or getting on that either don't work to well, or only work up to a point. They are kind of like a way of dealing with a particular situation that then gets applied to all situations. At a basic level, for example, people who are diagnosed with Borderline Personality Disorder find it very difficult to trust that they have a place in the world and that they are allowed to be themselves. This makes it difficult to trust others, and leads you to make assumptions about the motives of other based on what you feel they must feel towards you. In short, you feel that others must dislike you because you can't understand how they could like you. This can lead you to behaving in a way that you feel pre-empts others behaviour towards you, for example ending a relationship because you are sure that the other person is hiding their true feelings of dislike towards you. In general, most of the things described as personality disorders are ways of behaving that might have worked at some point, but which tend to cause difficulties to people and those around them when they are applied to other situations. They may help you cope, but they also tend to bring further problems which are difficult to cope with, which are worsened by applying the same coping strategy. A good definition of mental health difficulty is 'a disturbance of mood, feeling, thought or perception that persists for a period of time and prevents someone from doing the things that they need or wish to do'. It's not really about dividing the the sane from the insane. It's about working out what's best to help someone do the things that they need or want to do. That's why compulsory treatment of the things referred to as personality disorders is difficult, because rather than helping, it often just confirms to the individual that their coping strategy is correct. The same is true of most compulsory treatment using talking cures. You have to want them to work before they will, because you have to enter into a relationship with a therapist which involves trust and mutual respect. Macjoyce, Community Mental Health teams do pretty much the thing that you're suggesting and have done for a while. I like them. Cheers, Mark

Well, I don't accept your suggestion that social conventions 'arbitrarily change' (they do change but usually not arbitrarily) but that debate is only fairly tangentially linked to contemporary discussion of mental health difficulty. Taking Mark's definition: 'a disturbance of mood, feeling, thought or perception that persists for a period of time and prevents someone from doing the things that they need or wish to do', I think percentage of people who are 'perfectly content' to have that experience is very small. Psychiatry is an imperfect medical process based on our current knowledge of how people's minds work, as physical health treatments are also imperfect and subject to modification as we learn more how people's bodies work. Physical treatments are also influenced by cultural factors. It's not a lot more than 200 years ago (it maybe less) that the most common cures for many ailments were vomiting, laxatives, bleeding, leeches and the power of prayer. I agree, though, that the 'cure' question is more complicated. I think you're right that for most people with mental health difficulty being able to control their condition is what matters most and that making a mental health difficulty literally go away (in the way that a virus can go away) is often not possible in the case of mental health conditions.