Archive | August, 2013

Cashpoint

26 Aug

Talking potatoes Family Superfoods

You know the first thing friends from the psychiatric ward ask when we bump into each other? “Have you been back in since?” We just want to stay out. Our ward wouldn’t pass the “friends & family test”: going back to that place is seen as the worst thing that could happen. “Hi! How you doing? Been back in? “No. You?” “No, thank goodness. What’ve you been up to?” “Doing what I need to do to stay out.” “Me too.”

Last night at a cashpoint, a tall young woman approached me. “Got any spare change? My benefits were stopped. I’ve got no food or electricity.” She looked into my eyes, from eye to eye, imploring. “I’ve got no money. My benefits were stopped.” Hang on … We looked again and recognised each other from the ward. Back then, she was so vulnerable, so easily led, so naive. Just a teenager. She’d been in for 18 months.

“Are you still with the community mental health team?” I asked? Last time I’d seen her, she’d been there with her mum, waiting in the waiting room for an appointment. “Yes,” she said. “Let’s make an appointment with the benefits adviser. She’s really good. She’ll help with your benefits. They’re stopping them for the least little thing at the moment. Maybe she can get you help with a loan or a grant or something.” She looked around. “How’s your mum? Is she okay?” “I don’t know. We had an argument. We don’t speak any more. Do you have any spare change?”

“What would you like me to buy you?” I asked her. The cashpoint was outside a supermarket. “I was just going into the shop. Come with me and choose something nice to eat.” She shifted from foot to foot, looked down, looked up into my eyes again. “I just need cash. I’ve got no electricity or food at home. Can you give me some cash?”

“Come back to my house then.” I lived just round the corner. “I’ll cook you dinner. What would you like?” “No thanks. I just want money. Have you got any spare change?” Her skin was bad. She’d cut her hair short. Her glow was gone. She kept looking around behind my head, shifting from foot to foot.

In hospital, she’d been beautiful, naive and full of enthusiasm. She wanted to be a doctor. Or a model. Or both. She had no street smarts or guile. Just an enormous smile.

As a girl, she’d had an argument with her bullying brother one night and had run away from home. She’d been placed in a hostel, a safe place for vulnerable young people to stay. In the hostel, she’d been sexually assaulted by another resident. The mutual friend she’d confided in hadn’t believed her. Had blamed her. She hadn’t told anyone else about the assault. She was young and naive and hadn’t known how to deal with it. She’d kept living at the hostel. With her attacker. Who’d come back for more.

She’d stopped eating when her food started talking to her; when she could see little mouths in the baked beans speaking to her. When she’d become so skinny people noticed, she’d told them about the little mouths in the baked beans. She hadn’t told them about the assaults. It takes time and trust to build up to telling someone something like that. And she hadn’t had that.

She’d been taken from the hostel to the psychiatric hospital. They’d given her drugs for the little mouths in the baked beans; for the food that was speaking to her. They’d kept giving her more drugs and more drugs till she’d told them the food wasn’t talking to her any more and had put on weight.

When I met her on ward, she’d been there for 18 months. She hadn’t had any talking therapy. Just drugs. She hadn’t had any help to prepare for life outside the ward. Just weekly group sessions with the occupational therapists where we painted our toenails or tasted smoothies. But at least she wasn’t skinny any more.

When I met her on ward, she was so sweet and helpless that everyone was protective and did stuff for her. I encouraged her to learn to do things for herself: she’d need that when she got out; or at least the confidence to believe she could learn to do things for herself.

One day, she asked me to put on false eyelashes for her. Instead, I taught her how to do it herself. It took the whole evening. But she did it. Next day, she came back & showed me she’d done it herself. They weren’t on quite straight, but she was so pleased and proud. I was too. False eyelashes rock. She looked fabulous on the outside, with her dramatic eye make-up; and she felt fabulous on the inside, with her sense of achievement.

Next day, she told me about the assaults. She told me about her life and how she’d ended up on ward. She told me she was due for discharge soon. She said she’d started to see the little mouths in the baked beans again.

I didn’t know what to do. My mind was blown by that place, by what they’d done to me there. It was too big for me to process. Hearing her disclosure scorched my brain as I listened. All I could think of to do was to tell her to tell the nurses.

She told the nurses about the little mouths in the baked beans. But not about the assaults. She still hadn’t talked about those. They increased the drugs dose to make the little mouths in the baked beans go away again. She was discharged shortly afterwards and placed in a shared flat with a stranger. After 18 months on ward. And still a teenager. She didn’t know how to wash her clothes, cook, or budget. She couldn’t even keep her room on ward tidy.

Looking at her last night, I wondered whether, all these years later, she’s had any help to process the sexual assaults. Any help with the voices. Any help with managing her life. I wondered if it mattered. Or if drugs were enough. I couldn’t tell how she was. I only knew that she was different. I only knew that I held both her hands and squeezed them as I looked into her eyes, and hugged her and hugged her, then saw her slowly walk away.

And, of course, we both knew – because it’s the first thing we ask when we meet a ward friend – that we hadn’t been back in since.

So tomorrow I’ll drop a note to CMHT asking them to check up on her. She’s too vulnerable to be begging at cashpoints. I don’t know what else to do for the best.

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Links to related websites:

  • My Storify story of tweets – Cashpoint
  • A rather creepy video of talking food (1 min) used to promote TV show Family Supercooks, an initiative of the Food Standards Agency and the Good Food Channel
  • Eleanor Longden: The voices in my head (14 mins) – her recent fascinating and inspiring TED talk

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Madsplaining … as it was mansplained to me. On offering advice to people with mental health problems

18 Aug
The Yolkr - teach your granny a new way to suck egg yolks from egg whites

The Yolkr – teach your granny a new way to suck eggs (or at least to suck yolks from whites)

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Madsplaining: Offering unsolicited advice to someone on how they should manage their mental health (especially by peers and mental health professionals)

On twitter (and no doubt on other social media platforms), we mental health folks share a lot of detail about our lives. We talk about our good and bad experiences of mental health treatment, medications, symptoms, cheese sandwiches, our lives in general. Sometimes, when someone’s sharing a problem they’re experiencing with managing their mental health, other tweeps – those with lived experience or mental health professionals (or both) – will chip in with helpful tips.  We can be a sharing, caring bunch.

“Oh, I tried X and it works wonders for me. Why not give it a go?” “I saw a documentary about this new thing the other day that I thought would help you with that thing you mentioned.” Sometimes this moves towards more generic helpful tips, along the lines of, “Have you tried a nice cup of tea / hot bath / going for a walk / phoning a friend?” Advice and tips on all sorts of things. It happens offline too.  It can be good advice. Generally it’s well-meant. But …  is it welcome? Well, maybe yes. And maybe no.

The thing is, if someone is managing a mental health (or physical) condition, especially if they’ve been doing so for a while, they’ve probably had a good old go at trying the various drugs, treatments, therapies, supplements and diets on offer. They may be working their way through them with their healthcare team. They may be researching in the library or online. They may have joined a self-help group or forum. They may even have tried any number of hocus pocus remedies that make it into the Daily Mail or documentaries. So, when someone tweets about their condition and you’re tempted to mention something off the top of your head, think: are they asking for advice?

If it’s an offline friend or family member you know well, do they see a doctor and take medication regularly for their condition? Do they have a self-management plan? If someone is managing a long-term condition, the likelihood is they’re keeping some sort of track of how they’re doing. “Are you sure you’re not doing too much and, you know, starting to go hypo?” “Isn’t it time to go to bed now?” “Did you forget to take your medication today? You seem a bit … you know.”

Such comments can be helpful: sometimes we can ignore our own self-management early warning signs and only pay attention when we hear it from someone we trust. If you know someone well enough, or if they’ve asked you to be part of their self-management team – an early warning ally, as it were – it may be appropriate to chip in. But otherwise?

Unsolicited advice to someone managing a long term health condition can be seen as patronising. It may feel like criticism. It can be viewed as a sign that the advice-giver does not respect the person’s ability to manage their own healthcare needs properly. It can be seen as a suggestion that the person does not know their own mind … which, in the context of managing a  mental health problem, puts the advice-giver in really dodgy territory. Really dodgy.

Why am I writing this post now? Because only today I was reminded of how quick I can be to offer unsolicited advice. To leap in with handy hints and tips about how they could make their life better … if only they’d do as I suggest.  Partly that comes from my work background; partly because, being fairly long in the tooth, I (think I) know a lot of stuff; and party because I have a caring nature & like to help. Once, in response to a tweet from veteran mental health writer and thought leader Mark Brown (twitter: @MarkOneinFour), I tweeted “helpful advice” about light boxes. Of course, he’d tried that back at the dawn of time. Luckily he let me off the hook graciously.  Earlier today, I spotted a tweet about a medication issue I had faced myself. I replied with several helpful practical tips … Or so I thought. Because then I remembered … no advice had been sought. And that’s when I coined the term “madsplaining“. Let me explain.

I first came across the term “mansplaining” (with an “n”) when tweeter Phil Dore (twitter @thus_spake_z) used it.  When I did an online search, this (from Urban Dictionary) was on the first page that came up:

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“Mansplaining: To explain in a patronizing manner, assuming total ignorance on the part of those listening. The mansplainer is often shocked and hurt when their mansplanation is not taken as absolute fact, criticized or even rejected altogether. Named for a behavior commonly exhibited by male newbies on internet forums frequented primarily by women. Often leads to a flounce. Either sex can be guilty of mansplaining.

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A lot of the terribly clever online debate passes right over my head, and that’s as far as my knowledge of “mansplaining” goes (though I understand it’s been used online in feminist discourse for several years).  As it happened, it fitted perfectly with an encounter I’d recently had with a trainee psychiatrist: he was very new to twitter, had dived into an ongoing conversation with a patronising explanation, and was then flumoxed when I pointed that out. The “flounce” went on for quite some time.

And so what do you think happened when I first tweeted the word madsplaining …? Yes, you guessed it: I got mansplained!

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So after “mansplaining”, do we have madsplaining? ie offering unsolicited advice to someone on how they should manage their mental health (My tweet)

I think that would be psychsplaining. mad folks being splained to. but i notice your rhetoric is from feminist & poc activism… Erick Fabris (twitter: @exic)

Oh hi Erick, are you mansplaining to me what I mean when I say madsplaining …? (My tweet)

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Priceless. Well, thanks for asking, Erick, but I do mean just that: madsplaining. As other tweeps chipped in:

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This is perfect! madsplaining gets right on my tits! “Have you just tried….?” “Everyone worries…” Hahahahaha my new word!Molly Teaser (twitter @mollteaser36)
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Always fascinated about how much they know about their advice and how little they know of me. It’s the assumption that just because their advice works on their own neurosis, it works for everyone else. MH Extremist (twitter @wildwalkerwoman)
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“You mean: “Snap out of it” “cheer up!” It’s all in your mind” “What have you got to be depressed about?” YES. Can you imagine this: “Cancer? You don’t look like you have cancer. Pull yourself together, get over it.” Ect” MScarlet Wilde (twitter @wilde)
 

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I draw a distinction between madsplaining and what I call “patienting“, which is when someone uses your status as a “mental patient” to try to shut you up. An example would be (as has happened to me several times on twitter) a mental health professional will say to me something along the lines of, “Think you’d better take your meds now, love”.  Perhaps that’s a topic for another blog.

And, finally, here’s a little interchange to bring a smile to your face:

Or will this all turn meta and become splainsplaining?Phil 

I blame you entirely, Phil, for introducing me to the word “mansplaining” … which you can take any way you like ;-D (My tweet)

The concept of splainsplaining is kinda blowing my mind Dr Sarah Knowles (twitter: @dr_know)

Don’t worry, I’ll splainsplainsplain it to youPhil

*head explodes*Sarah

 
Sometimes I love twitter. And sometimes I need to take my own advice.
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  • My twitter conversation on Storify:
  • What have you got to be so depressed about?Men Will Pause blog by Scarlet Wilde (twitter: @wilde), written in response to the madsplaining twitter conversation
  • Eric Fabris‘s website – Mr Fabris is a Canadian researcher, artist and writer. Amongst other things, he lectures at the Ryerson University School of Disability Studies.

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But we’re not all like that …

16 Aug

Blue Toyota toy car

“But we’re not all like that!” We’ve all said it, haven’t we? Read or heard something that seems to criticise a group we belong to or feel part of and said, “But we’re not all like that!” I know I have. It’s instinctive. Especially so for those working in social care or the NHS, perhaps even more so for those working in mental health which seems to get criticism from every angle. There are many committed, hard-working, professional, compassionate staff who do the best they can in difficult circumstances, make a  positive difference to people’s lives and do a really good job.

So when a dedicated  GP or mental health occupational therapist hears a story on the news about terrible care in a service elsewhere, he might say, “But not all of us are like that!” A compassionate doctor or psychiatric nurse will read a story about a patient abused in another hospital and say, “We don’t all do that!” A social worker will see a story on a soap about a child being taken from its mother and say, “Not all social workers!” A psychiatrist or mental health healthcare assistant will read a patient describing their experience of poor care and tweet back, “But we’re not all like that!” It’s true: we’re not. But … And there is a but.

What happens when someone – such as a patient who’s had a brutal experience of mental health care or been badly let down by the NHS when she needed help – describes their experience and gets the response, “But we’re not all like that!”? What happens? The conversation stops being about the person who’s describing their own difficult experience and becomes … all about the person who’s interrupted. It becomes all about the interrupter talking about me,  me, me.

Now that’s understandable … to an extent. We all have our own experiences and perspectives. We all have our own hot buttons or soft spots. Many working in the mental health field have, I’ve come to learn through twitter, their own personal experience of mental health problems – whether directly or through family members. It really isn’t them and us.

It’s always easiest to see our own perspective. But … there is a time and a place for raising it. When someone is describing their own experience of pain, abuse or neglect it may, I’d suggest, not be the time to butt in defensively and talk about yourself. Sometimes, a sense of perspective is needed. This is well illustrated, it seems to me, with this simple anecdote:

Me: Someone driving a blue Toyota just hit and killed my four year old child.

You: I drive a blue Toyota. Not everyone who drives a blue Toyota hits four year old children.

What does this do? I was talking about having been recently bereaved: you turn the conversation around to … you being a good driver. No doubt that’s true or, if not, you sincerely believe it to be the case, are a conscientious driver and are genuinely offended at any suggestion you might not be. Perhaps there have even recently been stories in the press about bad drivers. But … was I criticising drivers of blue Toyotas? No. Was I criticising drivers? No. Was I criticising you? No. I was talking about the painful personal experience of bereavement.

Or, as mental health researcher Dr Sarah Knowles tweeted:

“I broke my leg :(” “Okay, but not all legs are broken. Why do you generalise? For example my leg is intact.” “I … what?!”

Put like that, it should, I hope, be obvious why the response, “But we’re not like that!” is inappropriate. And how responding or butting in with, “But we’re not all like that!” derails the conversation and belittles the experience of the person describing it.

It’s not about you.

Why do I raise this now? Because the “But we’re not all like that!” argument was raised earlier this evening in a twitter conversation. The conversation did – as these sorts of things so often do on twitter – broaden out to include many other tweeps and move on to other debating gambits, such as victim blaming, “if you can’t stand the heat, stay out of the kitchen” and the “them and us” culture. Read on for some fascinating insights and well-made points.

As Charlotte Walker (twitter @BipolarBlogger) tweeted:

“If someone has a terrible experience, I am going to honour that experience. There is no point in saying to someone who’s waited 18 months for CBT, ‘Oh don’t be harsh, in other Trusts it’s better.’ No use at all.”

And as NHS doctor Elin Roddy (twitter: @elinlowri) tweeted:

“I always remember you saying – just because you don’t work in a bad service doesn’t mean they don’t exist … It stuck with me and stops me getting too defensive (I hope) when people criticise health care.”

Next time you’re tempted to butt in and say, “But we’re not all like that!”, take a breath, pause and think … Maybe it’s not the right time to interrupt and hijack the conversation. Maybe  it’s time, instead, to listen.  Maybe it’s not about you. And, next time someone tries to stop you in your tracks with a “But we’re not all like that!”, maybe send them a link to this blog!

Not all drivers

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Pill shaming, Giles Fraser and happy pills

10 Aug
Photo courtesy of medicalhumour.wordpress.com

Photo courtesy of medicalhumour.wordpress.com

What’s hot and what’s not in media land? Fashions ebb and flow. Mental health stories come in and out of the spotlight. Recently, the  supposed psychiatrist vs psychologist war has been stoked. This past week, we’ve had various pundits rehashing the old, old story that mental illness doesn’t really exist. Today, it was the turn of Giles Fraser to spin this line, having made the same case on BBC Radio 4’s debate show the Moral Maze.

Fr Giles has had what I hope will turn out to be an education by twitter’s expert’s by experience and experts by profession. I’ve been commenting on twitter today. Various writers have put it far better than I could, so I’ll let their words speak for me by picking what I consider to be three of the best rebuttals:

Many others have written excellent pieces and all the relevant links I’ve come across are also linked below. Enjoy.

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Mainstream media (pill shaming):

  • Psychiatrists: the drug pushers

    Guardian newspaperWill Self  – “Is the current epidemic of depression and hyperactivity the result of disease-mongering by the psychiatric profession and big pharma? Does psychiatry have any credibility left at all?” (3rd August)

  • The Moral Maze – The Pursuit of Happiness

    BBC Radio 4 – “As a nation we have a reputation for being phlegmatic, stiff upper-lipped types. The reality, it seems, could hardly be further from that caricature. When it comes to anxiety and depression, we’re a nation of pill poppers.” Debate chaired by Michael Buerk with Claire Fox, Anne McElvoy, Kenan Malik and Giles Fraser, and witnesses David Pearce (World Transhumanist Association / Humanity Plus), Alison Murdoch (Foundation for Developing Compassion and Wisdom) Oliver James (clinical psychologist and author) and Mark Williamson (Action for Happiness) (7th August)

  • Taking pills for unhappiness reinforces the idea that being sad is not human

    Guardian newspaper – Giles Fraser “If you have a terrible job or home life, being unhappy is hardly inappropriate. Pathologising it can only make everything worse.” (9th August) (twitter: @giles_fraser)

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Rebuttals – mainstream media:

  1. Letters – Psychiatry, drugs and the future of mental healthcare

    Guardian newspaper (rebuttals to the Will Self piece) (7th August)

  2. Depression is not the same as “being sad”, Giles Fraser

    New StatesmanGlosswitch (twitter: @glosswitch) – “Casual “let’s not pathologise sadness” musings don’t contribute much to the debate about medication for depression. I’m writing this post to dispel a few myths about depression and the use of medication. I should mention, however, that I’m none of the following: psychiatrist, psychologist, pharmacist, biologist, philosopher, renowned expert in happiness and the inner workings of every human soul. That said, neither is Giles Fraser, the Guardian’s Loose Canon, but he hasn’t let that stop him.” (10th August)

  3. Depression is more than simple unhappiness

    Guardian newspaper – Margaret McCartney (twitter: @mgtmccartney) – “Antidepressants may be overprescribed, but as a GP I know the solution is not to minimise the experience of this condition.” (12th August)

  4. We don’t know if antidepressants work, so stop bashing them 

    Guardian newspaper, SciencePete Etchells (twitter: @petetchells) – “It’s a difficult debate, because it is so often emotionally charged on both sides. The best thing that we can do is to look at the data for answers.” (15th August) – An examination of scientific studies into anti-depressant use, including the 2 main ones that say they do and do not work.

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Rebuttals – blogosphere:

  1. My tweets (Storify)
  2. Doctor, Doctor… Pt 2

    Tania Browne blog (twitter: @CherryMakes) –“I read an article today that shows the stigma of mental health that hinders people seeking help isn’t going to go away any time soon. Speaking in The Guardian’s Comment section, Giles Fraser suggested that we may be too happy just to pop to the doc and get some jolly old pills to cheer us up when sadness is a very normal side of the human condition.” (10th August)

  3. For Giles Fraser, ignorance truly is bliss

    The Dirty Ho blog (twitter: @the_dirty_ho) – “In his recent article Giles Fraser allows a valid underlying point to be undermined by his profound lack of understanding of depression.”) (10th August)

  4. In the interests of clarity, Giles Fraser should exercise the right to reply

    The Dirty Ho blog (twitter: @the_dirty_ho) (11th August)

  5. Response to Giles Fraser’s Latest Article on Depression

    Elliot Hollingsworth blog (twitter: @ElliotHollings) – “I have a lot of time for Giles Fraser. However his latest article in the Guardian’s Comment is Free seems fairly lax on the facts and also on the difference between normal sadness and the mental illness, depression.” (10th August)

  6. Giles Fraser and mental health: When the Church fails at being a church, when the spiritual let down spirituality

    by Heathen Hub blog (twitter: @gurdur) (10th August)

  7. Common Misconceptions About Depression

    A Hot Bath Won’t Cure It blog (twitter: @chloemiriam) -– BINGO! – “In rebuttal to Giles Fraser’s poorly argued piece on anti depressants and ADHD medication, which may have hit ‘common misconceptions about depression BINGO!”  I am inspired to reply in a somewhat tired and mixed up manner.” (10th August)

  8. Dear Giles Fraser, Depression and Unhappiness are NOT the Same

    Gibbs Gubbins blog (twitter: @msjenmac) (10th August)

  9. Depression, Anti-Psychiatry and Christianity

    Los the Skald blog (twitter: @lostheskald) – “In his Guardian column today, Fr. Giles Fraser presents an argument which, has, in various guises, been with us since at least the 1960s: that mental illness, and specifically depression, is the ‘pathologisation of sadness’, and that biochemical treatments for depression are an example of ‘the scientists [being] called in to reinforce generally conservative norms of appropriate behaviour’. This post responds to his article by assessing the ‘anti-psychiatry’ tradition within which it falls, discussing some differences between sadness and depression, examining this difference in the Old Testament, and suggesting a Christian response to mental illness based on the stories of healings and exorcisms performed by Jesus in the Gospels.” (10th August)

  10. The Continuum Concept – why your sadness is not my depression

    Mental Health Cop (twitter: @MentalHealthCop) – “I recently read the piece you are about to read – a service user’s reaction to a recent media piece – and was totally blown away …” Reblogged piece, plus introduction (11th August)

  11. My “peculiar reaction” to Giles Fraser’s thoughts on anti-depressants

    Nurture My Baby blog (twitter: @nurturemybaby) (10th August)

  12. The continuum concept: why your sadness is not my depression

    Purple Pursuasion blog (twitter: @bipolar blogger) – “Modern medicine is widely held to be A Good Thing. It is allowing us to live longer, healthier lives than at any other point in human history. The media loves the story of a scientific breakthrough and the promise of yet more astounding treatments in years to come, whether through improved surgical techniques, gene therapy or new, more effective drug treatments.Unless, that is, we’re talking about the modern medicine of psychiatry. Suddenly, the ground shifts and medication is viewed with suspicion, even disgust. Antidepressants become “happy pills”; using drugs as directed by a doctor is described as being “hooked” or “addicted.” (10th August)

  13. Depression is not Being a Bit Sad

    A Reflex Anglican blog by Eileen Fitzroy Russell (9th August)

  14. Sadness and Depression – NOT the same thing

    Ruby Wax‘s website (12th August)

  15. Plaster of paris on a broken leg reinforces the idea that having a broken limb is not human

    Ruth Stirton blog (twitter: @RuthStirton) – “Giles Fraser misses the point. His entire comment is premised on the idea that being sad, and having clinical depression are on the same spectrum. Of course clinical depression can be solved with diet and exercise, because we all know that those things make us feel better if we’re having a sad day. No. Wrong. Clinical depression is a different thing entirely.” (10th August)

  16. Forgive him father, for he knows not what he does

    The Dirty Ho blog (twitter: @thedirtyho) (14th August)

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Older pieces – mainstream media:

  • Britain – the Prozac Nation? Not So Fast

    Discover Magazine – by Neuroskeptic (twitter: @neuro_skeptic) – “The media coverage has been predictable with lots of scary, context-free statistics, and boilerplate quotes from the usual suspects. No doubt tomorrow we’ll see a selection of moralistic op-eds about this. But not one of the many nigh-identical articles provided a link to the original data, or even a useful description of where one might find it. After contacting one of the NHS organizations named as the source, I managed to track the numbers down.” (December 2011)

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Older pieces – blogosphere:

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Additional:

  • Depression

    Royal College of Psychiatrists

  • Resources for churches

    Time to Change – “We aim to encourage organisations from all sectors and communities to challenge stigma and discrimination. One example of this is work that the Church of England have done to get church congregations talking about mental health. The Revd Eva McIntyre has produced a web resource providing ideas and resources for churches to plan worship on the theme of mental health.”

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