Hazel McHaffie

bipolar disorder

What the papers say

This post should carry a government health warning: If you are quickly bored with facts or allergic to conundrums do not continue with this week’s blog.

I’ve always maintained that the subjects I write about are issues which challenge us as a society; they repeatedly hit the headlines. And this remains the case. To illustrate the point, I decided to monitor the medical ethical challenges that were reported in one newspaper (The Telegraph) for just one week (4-10 August 2014) and share with you what I found. Wow! Even I was bowled over with the sheer volume of material in this category in just seven days.

Please bear in mind as you read, that papers have their own agendas and the facts might not all be correct. However, on this occasion I’m not going to research every issue or attach links or hedge the topics around with qualifiers and alternatives; all these ‘extras’ would detract from my focal point. I’ll simply itemise the issue, and leave you to ask yourself: How would I feel in this situation? What would I do in these circumstances? What should society do? What is fair and just? What are the implications for educating the public, or our limited resources, or competing demands? … Or you can just accept the point if you prefer an easier life!

So … are you sitting comfortably? …

Perusing the newspapers

ASSISTED CONCEPTION

There’s been an outcry against the first national sperm bank (in Birmingham) which openly caters for lesbians and single women who want to start a family without having a relationship with a man.

The ongoing story of Gammy, the baby with Downs Syndrome (discussed in my last post) who was allegedly rejected by his commissioning parents following a surrogate twin  pregnancy, rolled on with almost daily updates unravelling more and more bizarre aspects, bringing the whole question of surrogacy under the spotlight.

A Japanese businessman is said to have fathered nine babies during the past two years using Thai surrogate mothers. Seven nannies have been hired to care for them. Reports vary as to his motives: from ‘he wanted a big family for himself’, to ‘he’s part of a child trafficking ring’.

ASSISTED DYING

Former teacher, Dawn Faizey Webster, has been in a locked-in state following a stroke at the age of 30, two weeks after giving birth to her son. She was featured this week completing a university degree 12 years later, by blinking using a laptop that translates her eye movements into text. And yet other people in a similar state are pleading for assisted dying because life is intolerable.

MATERNAL v FETAL RIGHTS

Women who drink alcohol during pregnancy slow the development of their children’s brains, reported researchers in Los Angeles. They compared the brains of children with fetal alcohol spectrum disorders and unaffected children over a period of two years.

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DEMENTIA

Saga conducted a survey of the over 50s and found that far more are afraid of developing dementia than cancer.

A study of 1658 Americans aged 65 and over has found that a severe lack of vitamin D appears to more than double the risk of dementia. But hey, the winter sun in the UK is too weak to generate adequate vitamin levels and older skin is less efficient at doing so. Cue salmon, tuna, mackerel and fortified foods etc etc etc.

A report from the Centre for Economics and Business Research has estimated that the number of people who are forced to retire early because they have (or a loved one has) dementia will double within 15 years.

PERSONAL LIBERTY v PUBLIC SAFETY

Several Britons have been quarantined over fears of the Ebola virus entering this country. It’s alleged that certain ‘special’ patients have been given specific experimental untested drugs to good effect which are not available to others.

MENTAL HEALTH

A nationwide survey of people with bipolar disorder, their carers and the professionals who treat them, is about to begin in this country. The researchers say it’s too often the case that other people remote from the sharp end are the ones who influence research expenditure; they want to remedy this. Critics question the morality of including people with mental illnesses.

A teenage girl in Merseyside took her own life after visiting pro-anorexia websites and self-harming.

ORGAN DONATION

A 24 year old, Stephanie Reynolds, has launched an appeal for a kidney for her mother via Facebook. Thousands of strangers from around the world have offered to be tested to see if they are compatible as potential donors. Her mother, Elaine, has an autoimmune element which means she cannot have an organ from a blood relation. The odds of finding a match are less than one in 10,000. Hence Stephanie’s Facebook appeal. Apparently such appeals have been successful in the USA.

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PUBLIC HEALTH and LIFE STYLE CHOICES

Grizzly bears gorge themselves and become obese prior to hibernation but they don’t get diabetes. Scientists are asking: Could this offer a clue for treating humans?

A report in Annals of Oncology has stated that if everyone between 50 and 64 took a low dose aspirin daily for 10 years it would prevent 6518 cancer deaths each year and 474 fatal heart attacks. But the price would include an extra 896 deaths per annum from strokes and stomach bleeds. (Hmmmm. This one affects me personally. Some years ago, taking that small prophylactic dose for only six months triggered lymphocytic colitis which has plagued me ever since. So I wouldn’t myself describe it as poetically as Christopher Howse: ‘Aspirins are the vanilla cynosure of the rattling world of pills; unsparkling but attractive, like pearls’. Not in my book, matey! Sorry, I digress.)

It seems that prostate cancer screening could save more lives than programmes to detect breast cancer – so says a European study of 162,000 men from 8 countries. That would mean saving around 2300 lives per annum in the UK. And yet … the research has concluded that such screening should not be introduced. Why?  Because a high level of over-diagnosis (resulting from the unreliable PSA test) would mean thousands of men going through needless treatment and ending up with incontinence or impotence.

RESOURCE ISSUES

A staffing agency, Prestige Nursing + Care, has issued new figures which indicate that pensioners’ incomes have fallen further behind the cost of care homes. This is adding to the pressure on NHS hospitals and putting vulnerable elderly people in danger. Also the number of people receiving home adaptations has fallen by 12% since 2010, heightening the risk and incidence of falls and injuries.

A report, The Future of Loneliness, has predicted that hundreds of thousands of pensioners will be all but cut off from services, shops and their local communities within 15 years because of the rise in the use of the internet. The result will be a hugely inflated risk of loneliness, already a worrying aspect of old age.

A ‘wonder drug’, metformin, normally used to treat diabetes, has been found to increase the life expectancy of patients with other conditions such as cancer and cardiovascular disease. This could mean an extra two and a half – three years for today’s 65 year olds. What’s more it only costs 10p a day. But hey, we’re already struggling with the problems of an aging society …

The National Institute for Health and Care Excellence has decided that a revolutionary drug, Kadcyla, that is said to give women with advanced breast cancer an extra six months of life, will not be available on the NHS because it is too expensive, even after the manufacturers have offered a discount. Countries elsewhere in Europe fund it. Ahhh, the old chestnut: if you look at the individual cases, doesn’t every family want to hang on to their loved ones for as long as possible? – well, most families anyway. But add up all those astronomical bills and balance them against only a few more weeks of life and set that against all the other treatments competing for the limited pot of money, and the perspective looks different.

Researchers at Imperial College have found that injecting a patient’s CD34+ stem cells into their brain following a stroke encourages tissue repair and may save them from death or severe disability. However, an expert has said these improvements could just be due to chance or the special care this small safety trial has provided for a tiny number of patients.

FAILURES IN CARE

The Care Quality Commission has admitted that at least 750 homes providing care for the elderly and disabled have been failing to attain at least one basic standard for more than a year. Why? Because the CGC feared legal threats from the owners of the homes. As a result vulnerable people have been knowingly put at risk. The CQC say that a new regime is being introduced to make protection much more robust.

Official statistics on NHS waiting times have revealed that the number of patients forced to queue in ambulances outside A&E departments has almost doubled in three years. In addition, over 3 million people are now on waiting lists for operations – a rise of 700,000 compared with 2010 figures.

Phew! As you can see, I shall never run out of triggers for new novels! I’m constantly thinking, What if ……?

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Literary Eugenides

Jeffrey Eugenides book, Middlesex, is one of my top twenty favourites, so I naturally pounced on his third novel, The Marriage Plot, when I saw it in a bargain book shop for £1. But … oh dear … it was only my Mastermind rule, (‘I’ve started so I’ll finish‘), that kept me reading. It’s very long (406 pages of tiny type), very dense, and for me not very satisfying. I try to be positive in recognition of the colossal amount of work that goes into writing a book, but this time I’m afraid I have to share more disappointment than praise.

Eugenides bookEssentially the story is of a love triangle set in Brown University in the 1980s with three idealistic young people in love with books and ideas. Leonard Bankhead is a clever scientist and charismatic loner. Madeleine Hanna is intensely attracted to him. But her old friend, theology student Mitchell Grammaticus is convinced Madeleine is destined to be with him. So far so standard. But this is no classic Victorian romance, and the book is literary rather than commercial fiction; I knew that, so why was I less than thrilled?

Eugenides is without doubt an accomplished author – he’s won prestigious prizes too – and he set the bar extremely high with his first novel, Middlesex. In The Marriage Plot his inclusion of wide-ranging and erudite detail – of place, literature, mental health, science, psychology, politics, history – is impressive. There was even an aspect of the story that was of particular interest to me: the unravelling of an illness, bipolar disorder, or as it was back then, manic depression, which he handles with enviable authenticity and sensitivity. I’ve seen the devastation this illness can cause, and Eugenides has captured its modus operandi without allowing it to override the central narrative thrust … goodness, I’ve adopted ponderous language myself now! Sorry.

There’s plenty of humour in the book too. At one point an eccentric elderly female scientist is interviewed following the announcement that she’s just won the Nobel prize:

‘Dr MacGregor, where were you when you heard the news?’

‘I was asleep. Just like I am right now.’

‘Could you tell us what your scientific work is all about?’

‘I could. But then you’d be asleep.’

‘What do you plan to do with the money?’

‘Spend it.’

And plenty of clever throw-away lines:

‘ … he didn’t so much run the class as observe it from behind the one-way mirror of his opaque personality.’

‘… moving in her hovercraft way owing to the long hem of her robe …’

‘Chaouen was painted light blue to blend in with the sky. Even the flies couldn’t find it.’

But as I ploughed laboriously through it I could identify increasingly with the heroine’s sentiments. Early on she attends a Semiotics class and gets bogged down in the abstruse use of language. She goes to the library to grab an ordinary comprehensible nineteenth century novel ‘to restore herself to sanity’. Ah, here was a story she could understand without effort, with people in it, something happening to them in a place resembling the world as she knew it. ‘How wonderful it was when one sentence followed logically from the sentence before! What exquisite guilt she felt, wickedly enjoying narrative!’

At times with Eugenides’ book I felt myself drowning in the complexity of the allusions and profound thoughts. It just felt like too much hard work with too little reward. And I found it hard to care about the three central characters. Yes, I too wanted to escape into wickedly enjoyable narrative. How very low brow of me! But hey, come on, I did persevere to the bitter end. And the knitting for good causes grew apace.

As a reward to myself I bought a stack of more promising reading from another charity sale (it’s been a very busy week with special events for three charities I’m involved with). Goddard, Grisham and Coben are tried and tested favourite authors. Baldacci I’ve yet to sample. Joys in store … mmm.

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Art and mental illness

Friday evening and here I am in the transformed square of the beautiful old Medical School where I so often patrolled in days of yore. The Medical School transformedI’m here to watch The Fantasist by Theatre Témoin. I met the producer, director and principal actor at the symposium on Thursday – another young company who combine art and storytelling around themes questioning contemporary social issues; other artists beating a similar drum to my own. So I simply had to fit this one in. And they very generously gave me a complimentary ticket. What an honour.

Theatre Témoin brought this production to the Fringe last year to excellent reviews, so it’s saying something that they’re back again this year with the same show. Playing to full houses again too. As with Killing Roger, The Fantasist includes puppetry to excellent effect. (It’s been a revelation to me understanding the special role puppets can play in these dramas, and a pleasure to see them employed with such skill.)

I’m on the front row so don’t miss a thing.The stage The basic story? Louise has bipolar disorder. We first meet her tossing and turning in bed, unable to sleep. Her mental anguish is captured by inanimate objects doing crazy things and, though many in the audience reacted with laughter, the build up of atmosphere touched a more raw nerve for me. It’s scary entering the world of the mentally ill, and I’ve long been aware of the fine dividing line between sanity and insanity. I’ve hovered perilously close myself at times!

For Louise, the boundaries between the real and the fanciful grow increasingly blurred, and she becomes entangled in a relationship with a seductive stranger who opens up a world of exhilaration and magic to her. When he’s around she feels alive and ‘good‘. But to the onlooker, the destructive elements of her fantasies are all too evident.

Throughout, the metaphor of speed is used most effectively. The changing rhythm of the thrumming heartbeat. The calm slow empathy of the community psychiatric nurse, Josie, (‘my jovial jailkeeper‘) is a perfect foil to Louise’s manic behaviour and speech. Julia Yevnine – who plays Louise – is herself French and her ability to gabble deliriously in both languages is impressive: a furious game of ping-pong played on an express train. When depression strikes, the pain is palpable, Louise is immobile; Josie, and Louise’s friend, Sophie, speed up.

The endless seesawing of moods, the exhausting demands, the threat to relationships, the constant dread of falling into a dark chasm, the stranglehold the illness exerts, all are captured most effectively. At once mesmerising and impressive. And authentic, because Julia is utterly convincing – helped perhaps by her own firsthand experience of the illness (her mother has it).

I have several friends who have bipolar disorder, and I know the devastation it can wreak on families, so I’m delighted to see this illness portrayed so sympathetically, and to know from review comments that audiences are moved by the messages. This is exactly what we need.

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