Book TSR ii - Mental illness/health: History, process and progress

As posted yesterday through a book review, I developed an awareness for the role of process much earlier than previously thought. It wasn't Enid Mumford's work on the benefits of a socio-technical approach to successful deployment of information systems. I only discovered this well after the advent of home computing with the ZX81 and BBC micro 1981-1995.

It was 1978-79 to be more exact; on an admission ward during my three year student Registered Mental Nursing course at Winwick Hospital. On first recollection, I thought it was a clinic, with patients coming in for Clomipramine (Anafranil) infusion on to the ward. As students on placement we were allocated to support the clinic, completing regular observations, including pulse and blood pressure. Clearly, it was a long time ago. There is a paper (paywall), quite a significant one for me:

O’Flanagan PM. A Clomipramine (Anafranil) Infusion Unit. Journal of International Medical Research. 1973;1(5):375-381. doi:10.1177/030006057300100519 

I remember this Consultant's name being mentioned, but this was before my time(?). From the paper's first - accessible - page I can see the patients involved were actually in-patients. Which given the procedures, safety, observation makes better sense. There is reference to a film, in a hospital newsletter 'The Standard':

'Anafranil Film

In response to the interest shown in the film on Anafranil Infusion, Dr. P. O'Flanagan was present in the In-Service Training Room on Monday, October 29th for a second showing of the film, and to answer any questions from the audience.'

https://winwickremembered.org.uk/mags/mag316.htm

I wonder if the film is archived somewhere?

It isn't a surprise to see my former Community MH manager and friend David McKendrick listed on the Publications Committee. I do miss David - a great mentor!

In the previous post about 'The Sleep Room' I contrasted the mind-body dichotomy. In terms of evidence on 'both sides' of this divide, many people have made the observation of how you can see a broken arm, or leg, and other physical ailments, but mental health issues are often not obvious:

Powell J, Clarke A. Information in mental health: qualitative study of mental health service users. Health Expect. 2006 Dec;9(4):359-65. doi: 10.1111/j.1369-7625.2006.00403.x. PMID: 17083562; PMCID: PMC5060370.

The evidence-base of general medicine - physical health and psychiatry must be dynamic. The volume of publications bears testimony to the relentless change across all the sciences, research, technologies, knowledge, theory, practice, management and policy. On Twitter there is constant 'debate' between psychiatry and anti-psychiatry. 

Studies of intravenous clomipramine continue, the intervention much changed from the 1960-70s:

Fallon BA, Liebowitz MR, Campeas R, et al. Intravenous Clomipramine for Obsessive-Compulsive Disorder Refractory to Oral Clomipramine: A Placebo-Controlled Study. Arch Gen Psychiatry. 1998;55(10):918–924. doi:10.1001/archpsyc.55.10.918

Persson M-L. Adler Mats y Hetta J. Pulse Intravenous Clomipramine as an alternative antidepressant treatment to ECT: A pilot study. Eur. J. Psychiat. [online]. 2007, vol.21, n.4 [citado 2025-04-07], pp.263-267. Disponible en: <http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000400003&lng=es&nrm=iso>. ISSN 0213-6163.

Karameh WK, Khani M. Intravenous Clomipramine for Treatment-Resistant Obsessive-Compulsive Disorder. Int J Neuropsychopharmacol. 2015 Jul 28;19(2):pyv084. doi: 10.1093/ijnp/pyv084. Erratum in: Int J Neuropsychopharmacol. 2016 Apr 27;19(10):pyw031. doi: 10.1093/ijnp/pyw031. PMID: 26221004; PMCID: PMC4772819.

Perhaps, someone can please enlighten me? Given the time between William Sargant's practice, and today how much more do we know? We know the gap can't be fully closed (phenomenologically?), but has the evidence-gap been reduced? What are the evidential mile[Km]stones in psychiatry - mental health nursing? What are 'the standard' measures? If we look at a model that is bio-psycho-socio-political, what difference might this make, to the 'debate', theory, practice, research, management and politics (policy)? 

'Woke' is a tainted word these days, but in mental health care and nursing we all need to wake up and in a safe space.

Book: 'The Sleep Room' by Jon Stock i

Somewhat indirectly - I must emphasize, a book review reminded me of my Registered Mental Nursing student nursing days; and the mind - body divide. Without realising it then I heard the sound of two keys out of the five in Hodges' model. There were positive role models in the staff nurses involved; plus, learning in the routes and modalities of physical and psychological responses to treatments; in the form of medication and therapy. 

'The Sleep Room' highlights the dangers of unbounded belief in recourse to physical treatments. Such books are designed of course to 'sell', to be emotive, sensational. But mental illness - the asylum systems, presents a history of humanistic intent and mechanistic horrors. If mental illness, severe emotional responses can render us as a rag-doll, pursuit of physicalist solutions to the nth degree, is tantamount to shaking the doll: violently.

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

mental	physical  treatment
SOCIO-	resistance? -POLITICS of health

More to follow - ii ...

Sansom, I. Abused by a 'hero' of British medicine, Review. The Daily Telegraph, 29 March 2025. p.15. 

'What Kingdom' by Fine Gråbøl

client - person - individual - self - patient

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

What Kingdom

'Gråbøl was lucky. Eventually she started seeing a new psychiatrist, who looked at that record "and was like, "Wow, you receive So much more medicine than all the other people who live there. Why is that?'" She didn't know. Gradually, though, she was able to come off the drugs; and two doctors decided that she didn't, in fact, have borderline personality and bipolar disorders, removing the diagnoses that had shaped her sense of her self. In time, she left the unit and rebuilt her life. She's no longer on medication today, but the ghosts of her past diagnoses haunt her. She wonders whether the conditions are merely in hibernation and she'll wake up one day and enter another depressive episode. She doesn't wish she'd never been diagnosed, but does feel that her doctors underestimated the effect those labels would have on her development. At 17, she points out - the age she was diagnosed as bipolar - most teenagers don't yet know who they are. "You want to find a box or language to define yourself, so that you can close yourself in. And one way of getting that sense is getting into the psychiatric system." Since returning to "normal" life, she has also struggled with survivor's guilt: the feeling that while she made it out of the system, others did not.

'Above all, she wishes that the emphasis would shift away from the suffering individual and onto their broader context. We need to become better, as a society, at making room for people who aren't fully functional citizens. Gråbøl's narrator phrases it as a question: "Could we not imagine treatments that are instead externally directed involving the outside world gearing itself towards a wider and more comprehensive emotional spectrum?" Gråbøl's answer, though, is the same as my own: "I don't know."'

the system citizens?

My source:
Leaf Arbuthnot, Interview. We need to make room for the mentally ill. Review, The Daily Telegraph, 21 September 2024, pp.8-9.

Image:
https://images3.penguinrandomhouse.com/cover/9781953861849