Still Life with Ex-Colleague Outside Supermarket

If I were a credulous sort, I’d class the dream I had last night about absent colleagues as prophetic (rather than pathetic, as I do now). Going down to the supermarket today, I ran into one of my colleagues. Not literally, of course. She was standing outside the supermarket with her boyfriend, who was unlocking his bike. I wasn’t sure it was her at first (or I’d have probably turned around and ran away, like the coward I am); by the time I’d acheived an accurate identification, it was too late. So I mentally prepared for the ordeal of saying hello, asking how people at work were, fielding questions about my own health “I went mad. Still am. Still they say a change is as good as a rest…”

So I was more than a little annoyed when she turned away from me as I got close enough for the whole exchange of pleasantaries. She saw me, recognised me, then decided to completely ignore me.

Ouch.

It’s been eight months and talking to a potentially mental ex-colleague probably isn’t her idea of fun, but still… we worked together for a year and knew each other reasonably well. I mean, if she still works there, she could have got some great gossip to share, but actually having to talk to me isn’t worth it, apparently.

incapacity / dreams / income support

I spent most of yesterday ignoring the world by geeking out heavily on psychopharmaceuticals and constructing a number of pointless lists. Then I found Neutotransmitter.net: Drug Reference for FDA Approved Psychiatric Drugs which does it so much better. I was trying to avoid thinking about my finances, because all such thoughts were sprialling towards a panicky suicidal nightmare.

I’d received a letter from the benefits people telling me that, no, I’m not entitled to incapacity benefit. Because I haven’t paid enough national insurance contributions. Well, hang on there a moment, benefits people. I’ve been employed for most of the time since I finished university. There’s been a few gaps (the longest of which would have been 6 months or so), but I’ve paid you lots of those contributions. Plus I was, you know, working full-time for two years before I went to university. What gives?

Apparently my contributions in 2004 weren’t high enough. Bastards. I finished university in 2004 and didn’t get a proper job until the end of the year. Now, if only I could claim back the national insurance I paid in 2005 and 2006…

This is why I was metphorically sitting with my hands over my ears going LA LA LA LA LA!

Sometime around 3AM, there was a very loud sound of something falling and smashing just outside my window. I panicked, closed the windows and sat shaking for a while with a knife held in my hand. This is not rational behaviour, I know. I managed to get to sleep a bit later and had a dream about work.

In the dream, my colleagues were mostly people I knew when I was in school in [CHILDHOOD CITY] and the city we were in was [CITY I USED TO LIVE IN]. I’d arranged to meet a couple of them, the only two who weren’t people from my past masquerading as extras in my dreams. I turned up and nobody was around and I couldn’t remember where to find them. And I was naked.

I can’t remember ever having an “Oh god! I’m naked in a public place!” dream before. And I wasn’t so much embarrassed as bemused. Why had I come to the city naked? I lingered outside a tattoo shop, thinking about getting a tattoo (of a skull on my wrist for some reason), then went to a clothes shop and bought some clothes.

I met the people I was meeting in a pub. One of them was a girl who I don’t recognise outside the dream. The guy didn’t turn up. Things devolved into weird sexual tension, strange arguments and accusations. Then I woke up.

I have a cheque from the benefits people, because I’m now getting income support. This is welcome and lets me hate the benefits people slightly less. I need to send them my more recent sick note so they’ll continue to pay me. In fact, I need to send copies to a couple of places: My workplace and the insurance people who deal with my loan. In a move of astounding foresight, I’d already made these copies. Unfortunately, I have only two stamps, meaning I’ll have to go somewhere to purchase some more. Hence, I’m going to go shopping even though I’d rather curl up in a moderately useless fashion for the day.

Still, it’ll do me good to get out, where I can let my paranoia about random people on the street rise to gut-churning levels and find my vision messed up by the cursed light of the sun.

Wikipedia, AstraZeneca and Seroquel

[The second part of this story is at: Astrazeneca and Wikipedia: More Edits Uncovered]

I’ve been playing with an interesting new tool called Wikiscanner, intended to “list anonymous wikipedia edits from interesting organisations”. I’ve been looking at what kind of information various pharmaceutical companies put into Wikipedia anonymously. After all, Wikipedia has become a lot of people’s source of choice, at least as a starting point for further research.

My first reaction to being prescribed a drug is to look it up on Wikipedia. For an encyclopedia that can be edited by anyone, it’s often very accurate. The basic idea is that with enough eyes, each article converges on the truth (or at least the verifiable). So it’s a little disconcerting when you find out that large sections of an article about a certain drug were written by someone who works for the company that makes it.

In a series of edits on the 11th July, a user with the IP address 156.70.222.27 made a number of changes to the wikipedia article on Seroquel. An IP address is a unique number given to a computer on the internet. When your computer connects to the internet, either through dial-up or broadband, your ISP assigns one that it owns for your computer to use. Big companies usually have their own pool of IP addresses for their own networks.

So who is 156.70.222.27? Type this into a whois search like the one at GeekTools and you’ll find out:

OrgName: AstraZeneca Pharmaceuticals LP
NetRange: 156.70.0.0 – 156.70.255.255

You can see the changes that the AstraZeneca employee made below. They involve a shift in emphasis from the drug being “approved” to “indicated” and the deletion of a quote from a National Institute of Health recommendation that teenagers taking the drug may be at risk of self-harm and suicide.

Before the AstraZeneca Edit

Quetiapine has the United States Food and Drug Administration (FDA) and international approvals for the treatment of schizophrenia, treatment as an adjunct to either Lithium or Divalproex, and acute mania in bipolar disorder. Quetiapine was first approved by the FDA in 1997. In October 2006, Seroquel was also approved by the FDA for the treatment of depressive episodes associated with Bipolar I (or Bipolar-II) Disorder and is the only agent approved for this indication as a single agent monotherapy. Despite a general National Institutes of Health recommendation against its use in children or those under 18, as well as a known risk that teenagers taking the drug “may be more likely to think about harming or killing themselves or to plan or try to do so”, Seroquel is controversially marketed to parents of moody and irritable teenagers in magazines such as Parade and TV Guide…

The AstraZeneca Version

SEROQUEL is indicated for the treatment of schizophrenia as well as for the treatment of acute manic episodes associated with bipolar I disorder, as either monotherapy or adjunct therapy to lithium or divalproex. SEROQUEL received its initial indication from the FDA for treatment of Schizophrenia in 1997. In 2004, it received its second indication for the treatment of Mania associated Bipolar Disorder. Seroquel is controversially marketed to parents of moody and irritable teenagers in magazines such as Parade and TV Guide…

I’m not arguing about the accuracy of the information. What concerns me is the fact that a representative of a company who has a financial interest in the drug in question has anonymously shifted the emphasis of the article, which seems completely inappropriate to me. Editing Wikipedia should make it a better encyclopedia, not push corporate interests.

Distant Suns II

My heartbeat is fast. My vision’s fucked up. I can’t think because I want to run away and hide, but there’s nothing to run from and nowhere to go. It’s like being lost in a crowd as a child, too many legs and bodies passing by, spun round, disoriented, full of fear and confusion.

That’s what thinking about Rebecca does. Not all the time, most memories don’t hurt. It’s knowing that she’s not frozen in time, that things have changed and she’s moved on. Having to think of her as a real person, and not just a fiction I used to know hurts. Only I don’t know how to be hurt, so I just feel panicked and afraid.

What started this off was a comment on another post that could have been made by her. It probably – indeed, almost certainly – wasn’t. But the thought of her finding and reading this blog, knowing all about how my life is at the moment, that’s scary. I don’t want anyone I know, or have ever known reading this, her least of all. There’s a reason I’m anonymous and change the name of everyone from real-life that I mention.

She has a blog. For obvious reasons, I’m not going to give out the url. I don’t obsess over it, or even check it on a regular basis. I think I’ve looked at it maybe three times in the last year. In a recent post she mentions her new boyfriend. And I almost want to post a comment on there, from the last email she sent me after we’d broken up, which said (paraphrased): “I can’t be with anyone. I don’t want to be with anyone. If I did, then it would be you.”

Rationally, I know that it’s a variation on the “It’s not you, it’s me,” theme. Even if she was lying at the time, the intention was obviously to spare my feelings. And it might have even been true when she said it, but things change. And you can’t hold things like this against someone. It’s not as if I expected her to sit around pining for the rest of her life. And breaking up (the decision was kind of mutual) was the right thing; the relationship wasn’t working for either of us.

But still, there’s a bit of me that wants to scream “Fuck you! I loved you! I still do! And you go off and find yourself some other guy when you told me you didn’t want to be with anyone? That if you did want to be with anyone, you’d want to be with me? Fuck you, and everything you ever were to me.”

Which isn’t exactly rational, or fair. And really, it’s been a year and I should be over this. But then rationality and fairness is my way of not having to deal with any emotions that arise from negative events. In a way I don’t have any strategies at all for dealing with negative emotions, only for not dealing with them. That’s what I’m doing now, of course: Rather than face the anger and pain of the perceived emotional betrayal, I’m dissecting it, analysing it. But knowing what something is doesn’t change it. It just means I endlessly circle around the pain without it ever really going away. Just because you have your hands over your ears doesn’t mean the falling tree in the forest is silent.

And I don’t have any solutions. To feel is to die. To remain in control is to avoid living. I’m sick of the Catch-22 situation that my life’s become. Things don’t get easier. They don’t go away. Nothing changes.

A Sense of Humour: Classifying Mental Illnesses

Depression was, up until the 19th Century, seen as an excess of the melancholic humour. Mania, too much of the sanguine humour. Psychosis Choleric. Catatonia: Phlegmatic. And let’s be clear, these humours of the body weren’t metaphorical, we’re talking about black bile, blood, yellow bile and phlegm.

It’s one system of categorisation. Not a particularly useful one, but a system nevertheless. You know the rest of the story in its vague outlines: Madness, asylums, medicalisation, etc. etc. Leading to the development of the modern categories of madness, as outlined in the DSM and other similar manuals.

Categories are not real. They’re ways of organising information by specific properties. I’m going to take a quick detour via skin disease, we’ll get back to madness in a minute. Let’s take an example: Melanomas are a type of skin cancer. Melanomas are real things; in simple terms they’re a collection of skin cells (melanocytes, to be exact) that grow and divide uncontrollably. The category they’re put into is a way of understanding them. The international classification of diseases (ICD) categorises them as:

Neoplasms – Malignant Neoplasms – Malignant neoplasms, stated or presumed to be primary, of specified sites, except of lymphoid, haematopoietic and related tissue – Melanoma and other malignant neoplasms of skin.

Each subcategory adds information as it becomes more specific. The most important feature is that they’re neoplasms, the next that they’re malignant, and so on. This is useful, because it tells us that malignant melanomas can be treated in similar ways to other malignant neoplasms. Other skin diseases – warts for example – are in another category entirely (viral infections characterised by skin and mucous membrane lesions) despite looking superficially similar. What the ICD cares about isn’t looks, but aetiology – the causes behind the disease.

By comparison, a textbook from 1887 (Treatise on Diseases of the Skin, with Special Reference to their Diagnosis and Treatment by Thomas McCall Anderson) would have classified melanomas like so:

Diseases of the Skin – Organic Affections – New Formations – Epithelioma

For Anderson, the important thing is that it’s a disease of the skin, organic rather than function and involves a new formation rather than an inflammation or haemmorrhage. Warts are in the same category, because they present in the same way.

Both categorisations are designed for a particular use. Anderson’s classification works for a 19th century doctor, trying to diagnose skin diseases; the ICD works for modern medicine. And they are both based on assumptions about what knowledge is pertinent for a given use. All categorical systems do this: That’s what they’re for. The quality of a categorical system depends on the quality of the knowledge that informs it and the appropriateness of the use it’s put to.

I’m done with skin diseases: Back to madness. The ICD classification for bipolar disorder goes:

Mental and behavioural disorders – Mood [affective] disorders – Bipolar affective disorder

Which of the two classifications does this most look like? It’s nothing like the etiological classification for melanoma. The knowledge that informs it is, like Thomas McCall Anderson’s classification, based on what it looks like, not how it’s caused. Which is fair enough, because mental illnesses are famed for having unknown causes. We don’t know how they work, so it would be unreasonable to expect them to be classified that way.

Consider how the categorisation of melanoma allows us to generalise about them: All kinds of abnormal growths (neoplasms) have similar causes: Specific kinds of cells proliferating in an abnormal way. Malignant neoplasms have similar causes: Genes going wrong, which causes the abnormal proliferation of cells. All melanomas have similar causes: Genes going wrong in melanocytes, causing an abnormal proliferation of cells.

The categorisation of mental illnesses does not allow us to do the same thing: Do bipolar disorder and unipolar depression have similar causes? Who knows? For that matter is every case of bipolar disorder caused by the same thing? No clue.

Problems occur when people try to use a 19th century classification as if it were 21st century. Classifications are only as useful as the use they’re put to. Strict diagnostic criteria for malignant melanomas are a good thing. They can look like warts, but a quick application of salicylic acid isn’t going to help. Nor would you want chemotherapy for a verucca. Strict diagnostic criteria for mental disorders are nonsensical: They aren’t informed by the kind of knowledge that can distinguish between conditions that look the same, but present differently. Putting elaborate structures in place to hide this fact isn’t helpful: It informs neither diagnosis nor treatment.

To put it simply: All depressed people are probably not depressed in the same way. We cannot generalise about how depressed people should be treated because when we say “depression” we’re probably referring to a class of diseases that look the same, but have different causes. The same applies to every other mental illness. Most treatments for depression are only slightly effective when measured across a random sample of depressed people; one type of treatment may work for one depressed person, but not another. That’s hardly suprising if they’re different diseases that look the same. No drug is going to be very effective if it’s only targetted at a subset of the people that you think it’s targetted at.

This is why psychiatric treatment is so hit and miss. There’s plenty of psychiatrists who are fully aware of the limitations of their particular branch of medicine, but there’s plenty who aren’t. Diagnosis is fairly subjective, and focusing on sorting people into their correct categories so that you can follow a treatment protocol is useless. The process should be exploratory, like putting a jigsaw together in the dark. You can only feel the edges of the disease based on how it presents: You have to try to fit the edge pieces together to build up a picture of what you’re dealing with and intuit how to treat it.

The categories in the DSM and ICD are better than the four humours, but they’re far more limited and blurry than anyone usually wants to admit. They’re useful, but only when used appropriately and too often they’re not.

Last Night

Last night I was writing about how mental illness is categorised when I heard a noise. My flat is filled with noise at night. The flat upstairs has a leaky overflow pipe. Drops of water fall down and, depending on the breeze, hit my boiler’s overflow pipe. This results in the entire pipe, most of it inside my flat, making a loud clicking noise. There’s plenty of people in the building who get in late at night. Suffice to say that a single noise does not mean that anything’s invade my flat.

So my response of frantically tidying so I could more easily see if there was a creature of some sort here was perhaps not the most rational one. I’d been feeling vaguely agitated all day. My mum had called earler and I ended up ranting about my doctor (while avoiding any mention of my codeine mis-use). And with the sudden burst of activity, my anxiety exploded.

The visual symptoms are the worst bit of it. They got bad enough, possibly for the first time, that it was difficult to read from my monitor. I ended up sitting, curled up, on my sofa as everything devolved into chaos. Every surface was a mess of static. Shimmering lines moved across my field of vision, around a central circle of darkness. My peripheral vision was filled with moving patterns of light. There was a certain amount of dizziness to this. Making sense of anything became harder and harder – too much information to process, too much random craziness to filter out.

After a while, though I’m not sure exactly how long, I managed to get up and turn the light out. This made it worse for a while, the patterns continuing in the darkness, eyes awash with moving lights (mostly red, for some reason). Until my night vision started working, I was horribly disoriented – the sensation of movement in strange directions without any actual movement taking place. Eyes open/eyes shut, it didn’t make much difference. Music running through my head: “Justified candy / brandy for the nerves / eloquence belongs / to the conquerer”.

Lying down, still looking for the invading creature with my shimmering, grainy night-scope eyes. Dawn approaching behind my shut curtains. Disorganised thoughts giving way to sleep for a few hours. Eight AM. Wake up. Fall back to sleep. Nine AM. Wake up. A fly or wasp buzzes around the room. Sudden fear (I’ve been intensely phobic of wasps since I was a child). Just a fly. Hold open window, fly gets confused, smashes into mirror once or twice (the hazards of a visual system based on polarised light), then manages to find the exit. Too jangled to sleep again. Sit up. Drink Pepsi. Smoke cigarette. Vision still mildly screwed up more than normal. An edge of fear. Too many thoughts.

Distant Suns

Rebecca and I broke up about a year ago, give or take a week. A month and a half later, I was having unfulfilling casual sex with a dental assistant. A month after that started, I began to cut myself again and, not wanting said dental assistant to see the fresh scars, I stopped seeing her. Then another month on, I went crazy.

This is a sequential list of events. It doesn’t imply that later events were caused by previous ones. My memory of this time is somewhat hazy, so I’ve reconstructed it from emails and such.

I was already on my way down when Rebecca and I split up. I was so tired all the time that it was impossible to feel sad or angry about it. It was impossible to feel anything at all. The subsequent year hasn’t been filled with much of any value. The dental assistant certainly wasn’t. It was just sex, and deeply uninteresting sex at that.

Last night Rob turned up at 11pm because he was bored. We drove around the city for a while. Our conversations almost take the form of improvised comedy. When we got back here, we talked for a while about what’s happening with me.

“What are you going to do?” he asked. “You can’t live like this forever.”

“I know,” I said.

“You’ve been depressed as long as I’ve known you. What are you depressed about?”

“Well, there’s a lot of things,” I said, “But depression isn’t really about things being shit. I mean, lots of things in my life are quite shit, but when you’re not depressed you can deal with that. It’s about not being able to function properly. Up until this week I’d spent the last couple of weeks so down that I couldn’t concentrate on anything at all. I couldn’t even read a book. I’d get to the next page and wouldn’t be able to remember what the last page said.”

“I don’t really understand depression, because I’ve never really been through it,” he said. “When I feel down I look out the door and there’s all this life around to live.”

“Being depressed means you can’t even get to the door to look out of it.”

“So what are you going to do?”

“I don’t know. Maybe medication will help. Who knows?”

Last time my sister called, she was trying to think of a hobby for me. Something to get me out of my flat, meeting people. Because I don’t meet people these days. Sometimes that’s because I don’t have any desire to meet anyone, sometimes it’s because my sleep/wake schedule is so fucked. A lot of it is probably because life slips through your fingers when you’re down and it’s difficult to get hold of anything again.

I don’t know if I want a relationship. It’s definitely not a path to salvation or redemption. But the unfulfilling, deeply uninteresting, casual sex seems attractive at some points when I’m feeling OK. And even the unfulfilling, deeply uninteresting, casual sex is probably out of reach at the moment. My scars don’t bother me, until I think about how other people will see them. They’re an advertisement of my screwed-up-ness. And though there are undoubtedly women out there who won’t mind them, or take them as evidence that I’m potentially dangerous (ah, you’re mental, therefore you’re probably an axe murderer), it definitely limits the field. Casual sex pretty much excludes in-depth discussions of your mental health, and my scars speak of my craziness whether I want them to or not.

I’m used to being alone. I’m not really bothered by my mostly solitary existence. It’s the physical loneliness that gets to me sometimes; the knowledge that nobody’s touched me in a long time. Not for nearly a year now. Even the most casual of casual sex, free from emotion and meaning takes away the desperate feeling of separation. I’m not afraid of being alone or lonely, I’m afraid of the disconnection between me and the world of people, this sensation of floating far away in deep space, with the warmth of the sun a distant memory.

Splitting the Hyper from the Mania

So, I was thinking about some things and it occurred to me that describing my moods as depressed/hypomanic doesn’t really capture how I’m feeling at any particular time. There’s more to it that just “feeling awful” and “feeling great”. I could be wrong, but I think that applies to a lot of people.

I was also thinking about how “mixed state” is a really stupid term. If depression and mania are two distinct states at the opposite end of a spectrum, then mixing the two shouldn’t be possible, but lots of people seem to experience them. And this also implies that the classic single axis description of depression/mania isn’t capturing the whole story.

Frankly I’d be amazed if nobody’s suggested this before, but I can’t remember seeing it.

The classic axis goes:

depressed ---- normal ---- hypomanic ---- manic

But I can feel awful and be rather hyper at the same time. I can feel good and not want to do much. So maybe by splitting out depression/happiness from calmness/hyperness, things would make more sense:

psychotic|
         |
         |
agitated |
         |
         |
calm     |
         |
         |
apathetic|
         |_________________________________________
          dysphoric -- unhappy -- happy -- euphoric

In which case, we can fill in some labels:

psychotic|
         |  mixed state                       mania
         |
agitated |       anxiety/akathesia  hypomania
         |
         |
calm     |           dysthymia   euthymia
         |
         |  depression
apathetic|
         |_________________________________________
          dysphoric -- unhappy -- happy -- euphoric

I’m still without a working computer mouse, which is why these graphs have been presented in mangled text graphics rather than the customary classy graphics. Please imagine each label as a hazily defined area, rather than a point.

Obviously this is completely free of any actual evidence, but this kind of graph makes more sense to me than picking a point on a line. I’d write ‘blissed out’ in the right hand corner, but that would make it look so much less scientific and I’m all about the pseudoscience.

If I’ve missed the stunningly obvious scientific work that I’ve been doomed to recreate badly, please let me know; other thoughts and comments are welcome.

Feeling better

I’ve been feeling surprisingly happy these last couple of days. I’m back to being able to concentrate on things for more than a few seconds at a time. Suddenly everything that was seeming hopeless isn’t quite so futile any more. I don’t know why this is. I didn’t do anything to prompt this, nor has anything changed over the last couple of days.

Still, it’s nice not feeling like shit for now.

I’ve been having weird dreams recently. Sometimes I dream in layers. Last night (and it was night for once) I was dreaming a standard dream at the same time as I was dreaming a semiotic critique of the dream. No, I’m not sure what that means either, but it’s the closest to a description that I can get.

I went shopping for food yesterday. I even bought some oranges, which means my vitamin consumption has increased massively.

Umwelt

All that’s good is gone.
It’s gone
I have tried too long.
    — Rasputina, A Quitter

I make traps for myself. And the world moves on, leaving me behind. Train yourself to see through lies and fantasy and you end up unable to believe in anything at all. All those little lies that make up a normal life, the idea that this is sufficient, the idea that one small compromise after another doesn’t equal moral bankruptcy. All the choices that people make; I can’t see them as anything but retreat.

I want to be stupid. Thinking’s never got me anywhere except here. I don’t want my decisions loaded down with meaning and consequences. This isn’t intelligence, but it’s something similar.

All social interaction is manipulation.
Every adaptation is a compromise.

I want to be able to define a space in which happiness is possible and not be aware that my world is artificial. I want to be able to pretend things are true without having to keep telling myself to keep pretending. Live in a world where I’m not aware my own beliefs are constructs, where argument is more than just a diversion because there is no true and no false, just constant repetitions of maybe.

I want to be unaware of the scale of the world. I want to confuse the parochial with the universal. I want to be unaware that my assumptions and prejudices are assumptions and prejudices.

I want to erase myself. Erase the things I learned, the constant doubt about the meaning of everything. I want an incisive mind that doesn’t examine itself. I want to be able to look at the world and get angry and stop questioning right there. Stay angry because it makes me feel good and self-righteous and gives me purpose. I don’t want to make the link between the world and myself, because connecting the two destroys me.

And I can’t stop.