Before I thought rationally about my mental health, I bought into the idea that antidepressant medication was bad for you – that it would somehow permanently change my brain and personality, that it was an unwanted intrusion into my person. I eventually went to see my GP when things got too bad for me to bear anymore, and I realised that the medication I was given did alter my mind – to allow me to be the person I was before I got ill. There is a ton of dodgy advice out there pushing the “natural” option, 99% of which is from people with no medical qualifications. There’s a conspirational-level anti-psychiatry movement, whose followers seem fixated on the idea of “mind control”. With so much nonsense being spewed under the guise of advice, it’s no wonder that there are misconceptions about mental health and treatments. And this gem appeared on my Facebook feed earlier this week (I suppose this is the downside of having unlimited information at one’s fingertips); which is just bloody dangerous and irresponsible:


Fortunately, someone fixed it for them:

 For Real.

And there are plenty of variations on this theme out there. And you know what Google is for, so go discover them yourself! But although this debunking seems like light-hearted fun, the attitudes behind the original post can have very damaging consequences. Pseudoscience kills. We could also do better with science reporting, too. This BBC News article has a valid point to make, but saves the good stuff until after the sensationalistic claims (the “extreme” side-effects described are well-documented and are listed in information leaflets accompanying the medicine.  They are manageable, and should be monitored by a doctor, who may prescribe something that suits the patient better.  I’ve used medications that really didn’t suit me, and so I worked with my doctor to find ones that did.  There’s no one-size-fits-all, and zero-nuance articles just make life more difficult for doctors and patients). Science communication is important, and we have a responsibility to do it properly – else there is little for the unwary to distinguish between actual science and fantasy-holistic-woo-woo.




In a previous post, I wrote about what it means to (not) eat an elephant, or boil the ocean.  And now I have a practical solution to my problems – which I’d love to share with you!

It’s not just the app in question I’m talking about, it’s the way that I use it.  I recently found this blog post at Better Humans, on an alternative way to make to-do lists.

Their idea is to keep a to-do list with only a few small tasks on it, and to tick things off and add new things as the day progresses. It’s all about Living In The Now. Their article says you can complete more than 100 tasks in a day, and I do think that’s pretty optimistic, but I have only been using the method for one day.

And here’s what I do differently: I am adding future tasks to my to-do lists, and recurring tasks (such as every three days write a new post, etc), but I’m breaking them down into short, discrete activities. I also only concentrate on getting things done and then moving on to another small task. If a task requires more attention, I break it down further. And then I have the satisfaction of crossing more things off the list!

I’m using a web-based program called Remember The Milk, which also has an app for iOS and Android, so I can take my lists wherever I go.  Oh yeah, did I say list(s)? Remember The Milk is far more sophisticated than merely a tick-list: you can have many lists with different titles, and it’s possible to add notes to individual tasks.  It has a ton of other productivity tools, mostly with the premium version, for those who crave more than the mere satisfaction of checking items off the list.

And that’s one of my deviations from the rules.  I have so much to do that it’s easier to break it down into categories, with one list for each. As long as I fight the small battles, I’m on to a winner!




Because I’ve been going back over old posts, to check that they’re formatted correctly (oh yes, there is some spring cleaning going on!), I’ve also re-read a lot of things that I posted over the first two years. It’s interesting looking back, but it was part of a mammoth task that won’t go away (changing my WordPress theme caused me a world of pain – there’d have to be something really special to make me do that again). I noticed that the further back the posts went, the more simplistic they were, and they were more likely to be reblogs of other content.

A part of this is that my writing style has just developed anyway since then (if I’d gone backwards, I’d worry), but when I was mentally healthier I used to be able to trot out opinion pieces like magazines were going out of fashion (turns out they were, hurrah for the Internet!). With the fog brought down by depression, I could actually feel the cognitive decline. It was scary – a part of my OCD is hypochondria, and I believed I had a neurodegenerative illness. But the inability to concentrate, and poor memory, are symptoms of depression, which is a far more likely cause in someone of my age.

And while earlier pieces might not have been that original, or very well constructed; they’re a part of my recovery, and so I will leave them as they are. Maybe I’ll look back on this post two years from now and think this is a load of crap. And here’s hoping – if I can be an even better thinker in future then I’ll be a happier & better person.




I’ve recently been updating this and other sites of mine.  As well as re-learning a bit of HTML, I re-familiarised myself with the fonts that are suitable for use in most browsers.  There’s a lot of commonality between the sets, and although I only use Windows, I’ve included examples for all operating systems below (how generous of me).

I find it pretty annoying that there’s a limited number of fonts that are likely to work on my sites, but if a font is specified that’s incompatible with the browser or OS, it will default to a web-suitable one – it won’t just not display the content. I’ve seen it revert to Times New Roman mostly, and I only really use Windows OS.

There are some fonts that are generally recognised to be compatible with everything, but there’s always the possibility that you’ll find an exception. No matter how ubiquitous a typeface, if your operating system (or the particular version of the OS that you’re using) doesn’t support it, it won’t show up!

Things are sure improving – with each new software release, more features are added, and we approach something like harmonisation. Sometimes, you’ll also find a cool font that just so happens to work – but you need to consider what it will look like if it reverts to the standard for some browsers & devices.

I love looking at lists of text – it’s amazing how much beauty there is in rows and rows of typed words.  Below is a sample of fonts that are a relatively safe bet, along with a little supplementary information.

Font Name What does it look like? Windows? Mac? Linux?
Andale Mono  andale mono Hell Yeah! Hell Yeah! Hell Yeah!
Arial  arial Hell Yeah! Hell Yeah! Hell Yeah!
Arial Black  arial black Hell Yeah! Hell Yeah! Hell Yeah!
Avant Garde  avant garde Usually* Usually* Usually*
Book Antiqua  book antiqua Usually* Perhaps** Perhaps**
Bookman Old Style  bookman old style Usually* Perhaps** Perhaps**
Calibri  calibri Usually* Perhaps** Perhaps**
Calisto MT  calisto mt Usually* Perhaps** Perhaps**
Cambria  cambria Usually* Perhaps** Perhaps**
Candara  candara Usually* Perhaps** Perhaps**
Century Gothic  century gothic Usually* Perhaps** Perhaps**
Charcoal  charcoal Nope. Hell Yeah! Nope.
Chicago  chicago Nope. Hell Yeah! Nope.
Comic Sans MS
WARNING: NEVER USE THIS FONT, not even ironically or on a children’s party invitation ***
 comic sans ms Hell Yeah! Hell Yeah! Hell Yeah!
Consolas  consolas Usually* Perhaps** Perhaps**
Constantia  constantia Usually* Perhaps** Perhaps**
Corbel  corbel Usually* Perhaps** Perhaps**
Courier New  courier new Hell Yeah! Hell Yeah! Hell Yeah!
Garamond  garamond Usually* Perhaps** Perhaps**
Geneva  geneva Nope. Hell Yeah! Nope.
Georgia  georgia Hell Yeah! Hell Yeah! Hell Yeah!
Impact  impact Usually* Perhaps** Perhaps**
Lucida Console  lucida-console Usually* Perhaps** Perhaps**
Luxi Mono  luxi-mono Nope. Nope. Hell Yeah!
Luxi Serif  luxi-serif Nope. Nope. Hell Yeah!
Microsoft Sans Serif  microsoft-sans-serif Usually* Perhaps** Perhaps**
Monaco  monaco Nope. Hell Yeah! Nope.
Monotype Corsiva  monotype-corsiva Usually* Perhaps** Perhaps**
New Century Schoolbook  new-century-schoolbook Nope. Nope. Hell Yeah!
New York  new-york Nope. Hell Yeah! Nope.
News Gothic MT  news-gothic-mt Usually* Perhaps** Perhaps**
Palatino Linetype  palatino-linetype Usually* Perhaps** Perhaps**
Tahoma  tahoma Usually* Perhaps** Perhaps**
Times New Roman  times-new-roman Hell Yeah! Hell Yeah! Hell Yeah!
Trebuchet MS  trebuchet-ms Hell Yeah! Hell Yeah! Hell Yeah!
Utopia  utopia Nope. Nope. Hell Yeah!
Verdana  verdana Hell Yeah! Hell Yeah! Hell Yeah!

* Most of the time, you should be ok. But you just know you’ll find the one time that it isn’t.
** Give it a go, but there are no guarantees!
*** Seriously, use of Comic Sans seems immature to even the average pre-schooler. Respect your audience’s intelligence and avoid this font At All Costs!




How exciting, I’ve embarked on a new project!  Taking my inspiration in part from Bojack Horseman, and in part from my desire for it to be Hallowe’en every single day.  And so behold! My new CafePress store, Hallowe’en in January:





There’ll be tons of creepy designs to choose from, and not just for Hallowe’en!  Expect spooky everyday gifts, and seasonal items with a macabre touch.




“I went to church and I liked it;
hope my boyfriend don’t mind it”

Is what I’ve had going round in my head for the last 24 hours (thanks, OCD!).  But at least it helped me to remember to write this post.  I’m pretty sure that Mr. Science Gentleman will be concerned about my Skeptical Muscle after I confided in him by text that I actually felt really positive about attending a church service.

The occasion was a family funeral, and I felt strongly that the local church was the right place to hold it. My relative had been a regular attendee, and part of the “family” in the church community. Their funeral was well-attended by people from many parts of the community – turns out that my relative was something of a social butterfly (amongst the pious, at least). The service was conducted by the old vicar who was brought out of retirement for this funeral. They knew each other well, and the vicar’s family was almost like a distant branch of ours (I may be the first instance of an atheist being on first-name terms with the local clergy). And I felt it was totally appropriate for him to conduct a traditional Church of England ceremony in a church that I’d not set foot in for almost 20 years.

The experience really reinforced the attraction to religion for both those who are strong believers, and those who are not.  The church back home has over 1000 years of history (I grew up in a place that was pivotal to British history in almost every era – it’s kinda cool, here‘s a good starting point if you’d like to find out more), and that history is a part of what made me who I am.  Even though my relative’s funeral was a religious one, it was highly personalised and because the minister knew them well, he relayed some anecdotes about them in the sermon – some of the stories were things that I didn’t even know about them.  Even though I have a lot of anxieties about churches and religious figures (again, thanks for that, OCD) being inside The Abbey felt comforting and safe.  It was a known quantity, and a place of familiarity after so many years away.

So what now?  Am I going to convert back to Christianity?  Not likely.  I still feel strongly that a church is not a place for me, and not only do I not want any of my milestones celebrated in a church ceremony, I also feel that I would be a hypocrite if I did.  The experience has alerted me to the role that humanism can play in meeting the needs that religion often caters for.  A need to celebrate and affirm life events, a sense of togetherness, something to identify with.  I don’t buy into the idea of a humanist congregation, or feel that my humanism is part of a faith group, but I like the fact that humanism is flexible enough to accept everyone without forcing a set of rules on those it serves.  For me, losing religion was about leaving behind the shackles that chained me to a limited life.  As a result, I don’t like the ideas of the “humanist community”, or “sceptical community”, even though I participate in both.  I am a humanist, and a skeptic, but that’s not all I am.  Defining me only as that would do an injustice to the exciting, varied, and unrestricted life I have chosen.  You don’t gain freedom by choosing a new captor.

I would strongly recommend a humanist ceremony to anyone who wants the experience of a formal ceremony, but without the “God” bit. I’ve not attended any humanist funerals yet, but I have been to a few humanist weddings. These were a far better reflection of the couples’ aspirations and beliefs about marriage than a rigid, religion-based ceremony could ever be. My relative’s funeral was a perfect send-off because it shared with humanism so many of the aspects that made the ceremony appropriate and memorable; not because it was in a church.



Last time, I posted responses to questions I was asked during the Q&A on the night of my talk “Are We Mental?”.  Today, I’m posting responses to a couple of questions I was sent by email, from someone who was in the audience.  Their initial question was related to Slide 13, the one with the ableist slurs, but our conversation went on to other topics as well:

“Hi, I was at skeptics last night and actually had a question for you but didn’t ask because social anxiety (diagnosed by a medical professional!) and being in a group of mostly strangers don’t mix well. My question is what words/phrases should be used to replace ones such as “mental” or “insane” or any of the others on that slide?”

I try to say things like “wild”, “extraordinary”, “weird”, “odd”, “crappy”, “awful”, “ridiculous”; but sometimes for expediency and/or dramatic effect I do use some of the “forbidden words” 😉 it’s also very difficult to wean yourself off it when you’ve been using those words without any thought for years! You need to be ready to seriously question yourself. I actually had a conversation about this on the way home, re. whether there are certain types of humour that were always inappropriate. One person didn’t see a problem with jokes that demean, another did feel that certain jokes were so beyond the pale that people *should not* find them funny. I side slightly more with the latter (hear me out) because I can see how condoning crappy speech about minorities leads to a culture of “othering”, but I also know that we often find funny the things that are taboo, and we can’t censor people’s thoughts (and it might be harmful to try). A part of me screams “this is such a cop-out”, but I think a lot of the acceptability of words, opinions, jokes, depends on your audience, and how it is said. And what the potential for harm is. It’s so context-dependent that I feel every instance has to be considered on its own merits. This comes back to my final point in the talk: people really need to use their brains, and flex their empathy muscle.

“Hey, thanks. I guess there’s also a point to be made for how a word that has been adopted to describe a mental state or behaviour is associated with that state or behaviour. For example words like retard feel more off limits than words like mad and crazy in my view (of course maybe that’s just my shortcoming) because I think these days people get an image of a person with learning difficulties before an image of “slowness” when they hear retard but mad and crazy perhaps don’t inspire that sort of negative image in the same way (maybe they should and/or maybe it’s worse that they don’t?). And having “mad skillz” at something you’re “crazy good” at is generally intended to be positive – does that help redeem those words or is it harmful in a way similar to cultural appropriation?”

Yeah, I’d agree that some words have evolved in meaning so much that their original meaning doesn’t seem relevant. But context is really important, as you identify above – no-one ever uses the term “retard” as a compliment, right? But having “mad skillz” is a good thing, and to be a little crazy can mean exciting, wild. If you said someone was crazy while describing an unpleasant behaviour that they were doing, the word has different connotations. So perhaps I’d like people to be more aware of what it is they are actually saying.

Regarding cultural appropriation, I feel there’s a fine line to be trodden between appropriation and appreciation, which is almost completely dependent on context. I saw a really interesting local news item from Shropshire about Morris Dancers wearing blackface, which I will blog about next: Let Morris dancers wear black-face make up, say Shropshire Star readers.

Not really the same thing, but it does raise interesting questions about intent and interpretation.  There’s also the matter of people reclaiming a once-oppressive word for themselves: queer, nigger, crip, etc. But even that’s controversial, because of the powerful taboos surrounding that type of language.


And then we talked about a whole other bunch of stuff with no relevance to my talk – which I’m not going to share here.  But please carry on the conversation in the comments below; I said we need to talk about mental health, so let’s do it!



Remember way back when I posted about how there’s no such thing as a “male brain” or a “female brain”?  Well, today I was sent an article that:

a) Illustrates one of the ways in which brain scans can mislead if not viewed in context, and with full information of the stated assumptions;

b) Is flippin’ hilarious.

It’s this one: What a dead fish can teach you about neuroscience and statistics, sent to me via my friend Claire Witch File.

That’s right, they put a dead salmon in an MRI scanner! But all in the name of science. This has got to be the most creative way of proving a point about statistics that I have ever seen (and this is coming from the person who did their ‘A’ Level stats project on Smarties in order to prove that you can both demonstrate intellectual rigour, and fill your face with chocolate at the same time. I got an A on that coursework, and the world’s biggest sugar crash. Joke’s on you, Mr. P!).

As silly as it sounds, it demonstrated the care that must be taken in such experiments to set the appropriate significance level, and to be sure you’re interpreting the results correctly.

Three things I learnt as a result of reading this:

      1. I knew that these scans show blood flow to regions of the brain, but I didn’t know that what you’re seeing on the scan is the blood flow resulting from what happened up to 6 seconds ago.
      2. The images from an fMRI scan show a statistic – which must be viewed in context and measured against specific criteria with robust controls.  Basically, it shows which brain regions are likely to have activity – but it tells us nothing about that activity – yet.  There’s a lot about the brain and the mind that we don’t know, but we’re amassing new knowledge quickly.  We may one day be able to discern that sort of information with brain scans; we already know quite broad information on what’s going on in there – we need to refine it.
      3. Studies that sound really outrageous will get you a lot of media exposure.  They even won an Ig Nobel for their work!




As I mentioned in my previous post, the Q&A at our Skeptical Soapbox was as good as each of the talks.  An opportunity for the speaker to think on their feet and demonstrate that they know their stuff.  Here I will share some of the questions I was asked, and my responses:

“You said that we shouldn’t assume that the woman in Tesco’s was still suffering from a mental health problem, and that the cashier was wrong to refuse to serve her.  But how would you know that someone in that position wasn’t mentally ill and/or vulnerable?”

The simple answer is that I wouldn’t. You can’t tell if someone is mentally or physically ill by seeing them in a supermarket queue. But I would consider whether or not I thought it appropriate to say something. The cashier’s heart may have been in the right place; not wishing to take responsibility for the customer coming to harm. However, a person’s agency must be respected. Of course, anyone may end up self-harming or indulging in unhealthy behaviour, but it would probably happen with or without our “permission”. And that’s the key point: the cashier was refusing the customer permission to carry out a normal, adult task. Even if someone is mentally ill, it doesn’t mean they’re mentally incapable. I would suggest that the cashier’s response could have done more harm by dehumanising and infantilising the customer. It’s all about assumptions. Sure, I can’t assume that a person doesn’t have a mental illness, but I’m damn sure that I’m not qualified to diagnose other people’s ailments.

“What if I’m worried about a friend’s mental state; should I say something?”

This is a difficult question to answer; it depends on so many variables, many of which will be unique to your friend and the relationship you have with them. But broadly speaking, you need to judge the situation carefully to decide if you should say something, and how to say it. It’s pretty safe to advise that you should be discreet about it, however you choose to phrase it. It might be a good idea to arrange a day out, or a coffee, or something, with your friend – don’t make your questioning the focus of the day, but also make sure that you will have the time and space available to sit down and chat. Perhaps mention that you’re worried about something in their behaviour, and ask if they’ve spoken about it with anyone else.

Your friend’s reaction could be anything from relief, to fear, to defensiveness, so you’re really just going to have to do the best you can based on your own judgement.  Hopefully if you’ve handles it ok thus far, you’ll be able to work through it.  Your friend might need advice and support, and the best thing you can do is stand by them while they’re dealing with whatever issues they have.  Talk with them, stay in touch, invite them round for a cuppa, let them know that you understand what they’re going through.  And if you don’t understand, educate yourself.  The Mind website is an excellent source of information for people with mental health problems, those who are close to them, and anyone who wants to learn about mental health.

Things to NOT do:

Don’t try to diagnose them.  Talking about symptoms and what they might indicate is ok, but there is a line between suggesting that they may wish to consult a doctor, and deciding that you are the doctor.  Even if you are a qualified psychiatrist, (you will know that) there are serious ethical implications for offering your opinion on the mental health of friends and strangers.

Don’t gossip about it behind your friend’s back.  Even talking about it with close mutual friends with a view to looking at ways to help can backfire.  Your friend is the one with the (potential) problem.  They need to be at the heart of this conversation.  Interventions are a great way to alienate people and ruin friendships – no-one wants to be “surprised” by everyone sticking their oar into their private life.

Don’t avoid them.  They might be really difficult to deal with as a result of their illness; they really cannot help this.  From the outside, your friend might seem lazy, rude, aloof, anti-social, but if you were to experience their life you would come to realise that sometimes “being a bit flaky” is the best they can muster right now.  They are going to need the support of a good group of friends – their behaviour is likely to isolate them (through no fault of their own), and if you can help keep some semblance of normality and stability in their life, you are doing them a huge service.

Don’t smother them, but don’t just “leave them to it” either.  If you’re repeatedly checking if they’re “OK”, or doing things on their behalf because you’re worried they’re “incapable”, you are going to come across as condescending with no respect for their autonomy.  Again, mentally ill ≠ mentally incapable.  There are going to be times when your friend just needs a break, though.  Offering to perform specific tasks like cooking dinner one evening, or helping them tidy their house, not only helps them to keep on top of managing their life, but shows that there are people they can rely on, even when things get really bad.  And who doesn’t relish the opportunity to put their feet up and forget their troubles?

“The racist woman on the tram: obviously her behaviour was objectionable, but she just seemed out of control – like it would be reasonable to assume that she is mentally ill.  What do you think about that?”

The problem is the perception of associating mental illness with being out of control. There are many reasons why someone might behave like that, and yet our go-to explanation is “mental illness”. It might look like she has a mental illness; maybe she does. But she doesn’t need a bunch of strangers providing a running commentary on her behaviour and thought processes. Sometimes we are right in our armchair diagnoses. But sometimes it’s just better to keep one’s mouth shut. It’s worth returning to Slide 4, the one that states “There is no mental illness in DSM V or ICD 10 Ch 5 that lists racist abuse as a behavioural characteristic. Period. It does not happen.” – the author of this post goes on to say:

“My point is this: yes, a mental problem can lower inhibitions so that a person’s attitudes will inevitably be expressed at least verbally but also in their more general behaviour.  For that to happen, though, those attitudes must already be there to be expressed.

The other stuff is actually immaterial: what is relevant here is her attitudes and what allows them to be expressed so candidly.  With or without any mental illness, those attitudes are already there.”

And so, she might be out of control, she might well have a mental illness.  But that’s not what’s important here; we don’t need to invoke mental illness to condemn this woman’s actions.  What if she was irritable due to having a sprained ankle, and she launched the same tirade?  We wouldn’t link her behaviour to the physical injury, would we?

“Do you think the culture of scrutinising ‘benefit scroungers’ is contributing to the trend in people ‘diagnosing’ other people’s mental disorders?”

It’s definitely a contributing factor, but also related to this culture of Diagnosis By Internet is the fact that we are more aware these days of mental health conditions among the general population. It’s great that the average person has a better understanding than they did even ten or twenty years ago, but there’s a long way to go, and it neatly illustrates the point that a little knowledge can be a dangerous thing.

Back to the original question: is it the strivers vs. skivers mentality that’s fuelling this particular fire? Well, yes. The focus on whether a recipient of disability benefits ‘deserves’ it or not has been perpetuated by the media and the government, so that we end up with stories like this, this, and this. People expect to see evidence of hardship or disability. If you have an invisible illness, the options seem to be:

a) assume the person is lying;

b) find some physical evidence of their disability to make it easier to process.

I often find myself caught in a loop of over-explaining and apologising for taking up people’s time, because I’ve learned to make my struggles identifiable if I want any allowances made for me.  That’s another assumption about mental health that needs to be thrown out – that one must be struggling 24/7, with visible indication of said struggles, in order for people to consider one’s needs.

“What do you think is the solution to better educating the public about this topic?”

This may seem a surprising answer, but the tabloid press and soap operas are the best place to start conversations. These media have a far greater reach than science communicators, or possibly any other broadcaster. But specifically, they are accessible to an audience that skeptics are very rarely able to capture. The mass media is great for raising awareness of controversial topics like HIV/AIDS, teenage pregnancy, domestic abuse, etc. Seeing something on the TV or in the newspapers generates conversations, which is the first step to achieving wider understanding. As intellectuals, we may scoff at soaps and The Sun, but those are the outlets we need to target to communicate with those who will derive the most benefit. We might spend hours on YouTube watching science documentaries, but the average citizen does not.


There were more questions, too many for one blog post, and I also can’t remember all of them.  But I was asked some further questions by email, which I will respond to in my next post.




CN: Derogatory terms for mental health conditions and those affected by them.

On Thursday just gone, I took part in the annual Skeptical Soapbox held by the Greater Manchester Skeptics Society (GMSS).  The idea is that members of the society give a short talk on a subject with a skeptical connection. This was really cool in itself, but I also presented on a subject that’s very personal to me, and I did really well!

Part of the impetus behind this post is that not everyone who wanted to make it could, and so I’m sharing as much of it here as I can (you won’t get the warmth of my company or experience my unique style of humour, but just try and imagine, OK?).  I’m including every slide, with a bit of blurb.  I’m especially proud of the fact that I didn’t just read off of the slides á la Death By PowerPoint, because:

  1. I didn’t want to bore the audience to tears, and it seemed to work out OK;
  2. I don’t have nearly as much presentation experience as I’d like or need, and this was a big challenge that I totally managed to ace.

And now I present to you, the abridged version of “Are We Mental?”:

Before we begin

My presentation had an interactive element!  Prior to our guests arriving, I placed a questionnaire on each of the seats.  More on this later….

Slide 1


Two things about this slide, the title and the image:

The Title: I called this presentation “Are We Mental?”; partly because I couldn’t think of a snappy one and so the GMSS Social Sec provided one for me in the event listing (well, I couldn’t change it then, could I?), and also because we can’t objectively say if we are “mental” or not because that term means different things depending on who says it, to whom, and in what context.

The Image: Is from the Wellcome Image Library, and I found it while browsing one of the many blogs by science peeps that I follow (the blog hasn’t been updated for over a year, but there’s some interesting stuff there – go check it out!).  I selected it because I wanted a image that symbolised the stereotypical “lunatic asylum”, without using any images of patients.  I find those sort of photos interesting and a useful and personal record of history, but I thought it would be inappropriate for this presentation because, well, I was looking for a stereotypical image, but I also wanted to smash stereotypes.

Slide 2


My presentation began with a question: “Does anyone in the room have a medical degree?”, to which the response was silence.  “Good,” I responded, “because everyone is this room is equally qualified to make mental health diagnoses”.  But we were in luck!  There’s a simple way to gain your medical credentials, from the University of Google.  There are an awful lot of Keyboard Doctors out there, but only an actual doctor can diagnose health problems.  As skeptics, we often hold up the example of the patient who believes their 20 minutes on Google trumps their Doctor’s 20 years of training and experience.  PLEASE, PLEASE, PLEASE can we not engage in the very same behaviour we condemn?  Every time I see someone “diagnosing” someone by Internet (or even in person, more on this in a later slide), or describing antisocial behaviour as “mental health issues”, it annoys the crap out of me, not just because I have a mental illness, but because it’s factually incorrect and dangerous.

Slide 3


And so, I have a couple of examples.  Recently, there was a video posted on Twitter & Facebook of a woman on the Metrolink racially abusing other passengers.  Whether or not you think it was right to post the video online is another question entirely, but what really pissed me off was the inevitable wheeling out of the Mental Health Issues Bandwagon.  I think we managed to get two comments in before the obligatory denigration of those with mental health concerns, and then it was a bit of a free-for-all.  These people do not have any medical training, and yet they are throwing around diagnoses like a drinking game at a party for medical students.  Look at the type of language they are using:

“learning difficulties”, “disturbed”, “needs help”, “not of sound mind”, “a bit mental”, “alcohol and drug abuse”, “obviously a very damaged woman”

So what’s the problem?  It’s just a metaphor, right?  Well, now that mental health care has improved, we are recognising conditions that might well have been dismissed previously as odd behaviour or a character trait, and those that have those conditions nowadays don’t really like to be classed in the same category as people who are just arseholes, frankly.  One of the comments above reads: “as a person with learning difficulties and mental heath issues, these are not excuses, she a nasty bigot”.  Right on two counts: when people with whichever condition is Lazy Metaphor Of The Month read stuff like this, it can add to the shame and stigma already attached to mental health (it’s the 21st Century, people!).  But there’s another point in their comment:

Using “mental health” as a catch-all for unacceptable behaviour, or strange beliefs, serves to let horrible people off the hook.  You don’t have to be mentally ill to be mean, oppressive, irrational or crude – you might just be a dickhead.  Mentally unwell people will not be delusional all the time, and delusional beliefs are not always the product of mental illness.

A wonderful example of this is when we criticise political and religious stances.  Painting one’s opponent as mentally unstable seems to be the debating tactic of choice in the US Presidential campaign.  While no reasonable person likes Donald Trump, we don’t have to stoop to his level in criticising him.  And just to demonstrate this is a non-partisan presentation, I noted that the other side are having a psychiatric dig at Hillary too.

Slide 4


There was a Lone Rational Voice in the comments on that Facebook post: a human with an actual medical background!  Making unqualified medical diagnoses of strangers isn’t just hugely unethical, but it also perpetuates stereotypes, reinforces stigma, and spreads misinformation.  As our learned friend points out above, “Being Racist On A Tram” is not a diagnostic criteria for any mental illness.  And nor is “Being Donald Trump”.

Slide 5


The Goldwater Rule is a damn good rule with an unfortunate origin.  It came about because a US Senator, Barry Goldwater, sued the editor of a magazine that sent out a survey (as the basis for an article) to over 12,000 psychiatrists asking them to provide a long-distance diagnosis of his mental state.  Snr. Goldwater was obviously peeved as this seemed to be used as a stain on his character (thereby buying into the stigma), but seriously, it was a crappy and unethical thing to do.  The survey generated over 2,400 responses (admittedly 571 of those said they didn’t have enough info to make a diagnosis), which is problematic enough; but those responses were also subject to the publication’s Artistic License, which painted a less-than-favourable picture.

And so, because some of its members evidently needed to revisit their training in patient confidentiality and ethics (and the statement the APA had itself put out prior to the publication of the article), the American Psychiatric Association decided, in 1970, to make The Goldwater Rule policy.

So if a psychiatrist is forbidden from diagnosing strangers from behind a keyboard, what makes the rest of us think we have any right or reason to do so?

Want to see how harmful one’s “well-meaning” questioning can be?  How about this:

Slide 6


When I showed this slide, there was an audible intake of breath from the audience.  I, and they, were shocked that somebody could think it their place to say such a thing to someone they do not know.  It may have been well-intentioned, but the underlying message is that the person behind the till felt superior to the customer, and belittled and discriminated against them because of a perceived mental health condition.  If that customer had been suffering mental ill-health at that time, how do we think they would react to being body-shamed and told that they lack the capacity to make adult decisions?

I’ve had it happen to me.  I wonder if a part of the problem is that well-meaning strangers are looking for a physical sign of an invisible illness.  First example: I have alopecia areata, an autoimmune condition that causes my hair to fall out in patches, typically up to the size of an old 10p piece, but sometimes (much) larger.  There is a specific pattern to the baldness, and I have been diagnosed by someone with 7 years of medical training, and at least 15 years’ postgraduate practice.  Knowing that I was dealing with one mental illness, the graduates of Google Medical School think that once you’ve got one, you’ve got all of them (it’s definitely possible to have more than one mental health condition at a time, and some are more likely to occur with others, but it’s not universal.  It’s not like Pokémon – you ain’t gotta catch ’em all!).  And so a “helpful” friend suggested that I might suffer from trichotillomania, but I just didn’t realise it.  Presumably my sick brain was deluding me into believing I’d actually attended a GP’s surgery and received a diagnosis.  I guess that line in my medical record is a figment of my imagination, too.

The second one wasn’t just insulting, it was potentially dangerous.  I mentioned to a friend that I was on a diet, and I was proud of how much weight I’d lost (I used to be obese, and by this point I was at the higher end of “normal” – whatever that is).  They saw it as an opportunity to reveal their (lack of) medical expertise by suggesting that I might have anorexia.  They knew nothing of my eating or exercise habits, my body image, or any of the other factors that contribute to a healthy self.  But if I did have an eating disorder, is body-shaming the thing that would have helped me?  Or could it have made things worse?  Pro Tip: Telling someone with (perceived) anorexia to, just, like, not have anorexia; is not a recognised treatment option.

Slide 7


And now we get on to the meaty stuff.  I suffer from OCD, one of the most misunderstood mental health conditions one can have.  Lucky me!  It’s also one of the most debilitating, with the World Health Organisation listing it in the top ten most handicapping illnesses in terms of lost productivity & quality of life (Veale, Willson, 2005).

Trouble is, the common perception is that it’s a bit of a joke, right?  It’s all about being a nitpicker and excessively tidy and precise, with no psychological reasoning behind it other than the person affected is just “fussy”.  Wow, it doesn’t even sound like a disorder – it must be great to be so tidy and organised!  WRONG – excessive cleanliness, and its associated obsessions of contamination, are symptoms of OCD, but not all OCD sufferers have them; in fact, obsessions about cleanliness only affect about a quarter of those with the condition.

And the popular view of OCD being just a preference for tidiness and order is completely wrong.  And that’s where the brain scans come in.  It’s not possible to diagnose someone’s OCD from a brain scan.  But we can use brain scans to see the resulting activity in the brain and use this to better understand the disease.  What we see in the above scans is increased activity in the frontal lobes, the parts of the brain responsible for reasoning and emotion, battling against the limbic system; which takes care of instinctive functions like hunger, fear, and the sense of danger.  A simplified way of looking at it is that the limbic system is the trigger for an obsession – and the frontal lobes frantically search for a compulsion to placate the limbic system’s overenthusiasm.  There is nothing wrong with the structure of the brains of those with OCD, the activity is a consequence of the disease, and not the other way round.  When people are successfully treated for OCD, their brain scans appear like that of a typical brain.

So to return to the neurobiological explanation for OCD: it doesn’t tell us about the content of the obsessions and compulsions, but it does help us to explain what OCD is.  The obsessions experienced are typically worst-case scenarios, of situations the patient could realistically encounter.  The obsessions play on the patient’s core beliefs and values.  The disease makes the obsessions seem plausible, like terrible harm could occur, and the brain needs a solution.  That “solution” comes in the form of a compulsion, a behaviour performed to reduce the anxiety generated by the obsession.  Unfortunately, the relief is only temporary, and performing compulsions actually fuels the obsession.  OCD is a particularly cruel disease for a skeptic, because it is essentially an extreme form of magical thinking and superstition.  But even knowing that the thoughts and actions are irrational; it’s not enough.  OCD is a pattern of thinking and behaviour that is ingrained and responds to emotional reactions.  It’s very difficult to treat, and I needed to attend a 12-week group CBT programme, and I see a psychiatrist regularly.  I take medication alongside the techniques I learnt in therapy: this combination is the most effective course of treatment for severe OCD.  But it is still tough – OCD latches on to the parts of the personality and experience that matter the most to the patient.

Does that sound like something to do with cleaning?  It’s mental torture – believing you have the power to change future events one moment, and the next suffering crippling doubt and fear that you’re not doing enough.  And on top of this, knowing that you are “mad” and being powerless to do anything about it.  Obsessions and compulsions can take up several hours of the day; precious time that could be used for so many worthwhile and enriching activities.  But it’s not all serious.  We can still poke fun at the condition, as long as we understand what we’re laughing about:

Slide 8


I find these jokes rather more amusing than those about “nitpicking”, or being “anal-retentive”.  Because they actually describe what OCD is like!  It’s funny because it’s true.  They were compiled by an actual OCD sufferer – a beautiful demonstration of how talking about mental health with those affected can yield better understanding and smash taboos.

Slide 9


“Ahh, Mr. Tourette, we need a brand new livery for our executive city flyer jet service; we’re looking for a solution that will work for the international market”

Slide 10


I love Modern Toss, and in spite of my preachiness a mere two slides previously, I actually find Mr. Tourette extremely funny.  But his profane creativity is not a symptom of Tourette’s.

Slide 11


And yet that’s what the commonly-held view of Tourette’s is!  Not quite that one is just naturally bawdy and lacking in self-awareness, but that the most common (or only) tic that people with Tourette’s have is random expletives.  And I can see why this idea has gained such popularity: because swearing is a bit naughty and hence inherently funny, yeah?

Slide 12


There is a wonderful resource at that describes what it is actually like to live with Tourette’s. It’s in an accessible blog format, and was created by possibly the most famous Tourette’s sufferer around today, Jessica Thom.  You may know her from her tic of saying “biscuits!” mid-sentence, but she is more than that one characteristic, she is a complex, talented and flawed human, just like any of us.

The above image is from the gallery on the site, which features artwork submitted by people with Tourette’s.  The images represent one of the artist’s tics (and the variety of things that can be tics is huge; take a look in the gallery to see!).  The above image represents a tic that was repetition of the phrase “green screen cheese” – which seems a lot more funny when viewed in a literal context.

Slide 13


The power of words, eh?  I included this slide to demonstrate how once innocent language and intentions can become twisted over time, and eventually end up as ableist slurs.  Most of them were taken from this list at Autistic Hoya.  Many of the words above were once medical terms (I think it is still common in American medical literature to speak of “mental retardation”, and I was once diagnosed with a “spastic neck“), but when they came into common parlance, and what with human nature being what it is, things went rapidly downhill.

So do I want to ban words? Hell, no!  I struggled a lot with the idea that I should consider more carefully how I express myself once I was diagnosed with OCD (I didn’t realise that was what I had, because the reality of the disease is concealed by the amount of misinformation freely available to all.  And equipped with this new knowledge, I started seeing jokes and inaccuracies about OCD everywhere).  I still use ethically questionable language often; I’m only human.  But I consider my audience carefully.  I’d only deliberately misuse language with people that know me well enough to “get” me, and who will understand what I really mean.  Around people I know less well, or speaking to a general audience, well, it would be completely inappropriate, and I’d feel so cringey if something slipped out. It might sound hypocritical, but I’m not asking people to be two-faced in their attitudes and beliefs.  It would be great if all of us could just drop outdated prejudices about mental health – I’m not saying it’s ok to have these prejudices.  What I am saying is that one might want to use a “forbidden” word to describe something, with full knowledge of its history and other associated meanings.  So I’d like people to educate themselves – and talk constructively about mental health.

I know full well that these words are used as metaphors, or illuminating descriptions of a concept.  But I’d really like it if we used those words with complete knowledge of what they actually mean, and if we stopped using them as insults – it’s not individual words that are the problem, it’s that we think certain medical conditions are an inherent flaw in another person.

Slide 14


I pre-empted this one (look at me, playing Devil’s Advocate!), because it’s a hot topic in the skeptical world at the moment.  The imagined schism between those standing up for social justice, and those who want to be able to say the worst thing possible at all times, and have it beamed into everyone’s brains (to do otherwise would be “no-platforming“, amirite?), removes all nuance from discussions and reduces everything to a dichotomy.  So I will just reiterate: I Do Not Want To Ban Words.  People will inevitably want to describe a tangible or conceptual idea with metaphors.  Sometimes the meaning becomes clearer if we don’t say exactly what we mean – that is the beauty of the English language, and why we have such a rich back-catalogue of literary masterpieces.

People will also make mistakes, and we need to allow this to happen.  There’s no point ostracising those who accidentally say the wrong thing, but we also have to accept that we were wrong if we do make a mistake, and listen and learn from it.  I want people to use the English language in its full breadth and glory; to have a better understanding of mental health terms, and of the history of our language.  I may not like what you have to say, but make a rational and eloquent argument with reliable sources, and I will defend to the death your right to say it.

Slide 15

Almost at the end now, and we finish by returning to the beginning.  I reproduced the “Mental Health Quiz” from Dean Burnett’s article on the proliferation of Facebook Quizzes that claim to offer some insight into the workings of your brain, or what some arbitrary preference really says about you.  By this time, everyone had had a chance to read through the quiz, which you can read in its original form here (Clicky!).  The answers are below:


Slide 16


This turned out to be the longest part of my presentation; people do have a lot of questions and it’s about time we answered them.  Ignorance leads to prejudice and fear, and there’s quite enough of that in the world.  I found it encouraging that all questions were respectful, and didn’t follow a predictable pattern.  Many of them were questions I’d not even thought of asking – so I really was talking about my subject on the fly.  I think I managed to wing it.

The conversations I had with attendees after the talk were illuminating: there were those with unbridled curiosity (it’s difficult to offend me, ask me whatever you like), but a surprising number of people thanking me for having brought these issues out into the open, and offering solidarity with a fellow sufferer (I had no idea that so many people had hidden conditions – the consequence of not feeling able to talk about them!).

So not only did I successfully impart my wisdom with relatively few mishaps, I also got the warm fuzzies at the end of it.  I made a difference, and we all can.  It’s time to talk.