The Reason For Now

Depression:


The most important thing anyone reading this needs to know is that everyone with depression will get better. The sooner you treat it the quicker and better the results.


LIfe time prevalence 4%, in fact in the USA up to 10% struggle with depression.

280 million people world-wide suffer from depression.


20% risk of suicide in untreated depression.


Used to be the 5th commonest cause of illness and death, now it is the commonest.

It is not because we have all become genetically susceptible to clinical depression, rather we have become more and more unhappy and stressed with modern life. What has risen is social media with the pressure to be perfect compare and online bullying and economic uncertainty as well as recent lockdown and health hysteria and vaccine mandates and most recently Ukraine War and spiralling energy prices. Mental health referrals are at all time highs.

Neuroscience New and Research July 2022 Ruairi J Mackenzie: Serotonin theory has been seen for years as an oversimplification. SSRI medications do often work in depression but depression is multifactorial and likely more than one illness.  The Biopsychosocial model of depression is preferred.

Even Epicurus 2,500 years ago and before him Buddha both said that seeking of pleasure would cause unhappiness as pleasure is transient and leads to more seeking of it hence is not only meaningless but destructive. Yet as a society that is exactly what we have become: cyclical reflex dopamine seekers especially with social media.

Furthermore the teaching of socialisation has been reversed with smart phone hunched pleasure seekers. We are all becoming depressed children with no effective parental supervision apart from the social media CEOs temping us ever further down the rabbit hole of instant gratification..

One of the definitions of the most dysfunctional members of our society namely personality disorders is self obsession as this is not tribe compatible yet the rest of us are rapidly heading that way pulling apart the integrity of our society and even civilisation itself if it continues. Close on the heals of self obsession is loss of boundaries and rules aka political correctness which is a Marxist view of demanding the same outcome for everyone despite the fact that everyone is different.

Without boundaries we are lost  because we have evolved to function in tribes with structure hierarchy and leadership. Now we are led by self serving politicians who will say anything that gets them elected which is what they think the voters want but voters are influenced by mass and social media. Add into that that 98% of what we do and think is emotional and not logical which means that currently we are being led by media driven hysteria which the politicians respond to. Even more dangerous is that media controls the masses on a global scale now almost instantly.

Diagnosis of clinical depression:

Diagnostic and Statistical Manual 5th Edition Americal Psychiatric Association  and International Classification of Diseases 11th Edition 296. And F32 codes respectively:

Require are certain number of symptoms for a certain period of time typically 5 symptoms for at least 2 weeks although this can be altered according to severity.

Symptoms making up depression include:

Low mood typically worse in the morning improving as the day goes on (diurnal mood variation)-  said to be due to raised levels of cortisol in depression with the coritsol peak being in the morning and lowest in the middle of the night-  I have seen severely depressed people walking around the ward at 2am feeling fine. This is one the reasons metyrapone is used with is a cortisol synthesis inhibitor in a resistant depressionL Ted Dinan et al.

Disturbed sleep typically waking early in the morning unable to get back to sleep

Reduced appetite and weight loss (although people can comfort eat) reduced energy concentration enjoyment motivation confidence libido and suicidal thoughts.


Treatment of depression:

Firstly there needs to be a risk assessment of suicide . in 2005 1.5% of all deaths were suicide and the commonst cause was depression and it is going up.

Investigation:

Biological:

Thyroid , metabolic, autoimmune, dietary, epileptic , raised indices of inflammation. Females my have hormonal issues including sensitivity to progesterone in oral contraceptives.

Psychological:

Aristotle argued that virtue is functioning according to you values and beliefs . A blunt knife is not a vrituous knife as knives are designed to cut. A virtuous human being is a human able to function according to their values and beliefs which is socialisation and reproduction. However in todays goal oriented society the pressure is one of endless goal seeking and perfectionism. That alone severely raises stress and cortisol levels but also makes you more unhappy as you not functioning according to your values and beliefs. It also means that if you achieve something at the cost of your values and beliefs you value it less in any case. Hence it is impossible to ever be happy with he result that more and more of us are depressed.

Note that chronic sleep deprivation causes clinical depression.


Treatment of depression:

Classically it is a combination of medication and psychological treatment eg cognitive behaviour therapy.

However one third of patients have raised indices of inflammation and those are likely to be resistant to antidepressants and can respond to aspirin.

Furthermore for moderate depression regular exercise is as effective as antidepressant.

Antidepressants: Currently they all work on a combination of serotonin noradrenaline and dopamine and a couple work additionally on melatonin receptors. None are better than the other although the newer ones have less side effects.

The new generation coming through are going to be based on psychedelics and glutamate receptor antagonists . In fact the latter has a drug licensed in the UK for 3rd line treatment of depression s ketamine nasal spray.


Treatment resistant depression:

Requires a review of diagnosis and physical investigations then switching to a different antidepressant and raising the dose according to plasma levels , combining antidepressants and adding in thyroid hormone, lithium or antipsychotic such as risperidone.

-Electro Convulsive Therapy

-rTMS daily for 4 weeks.


-Neurofeedback can be an alternative to antidepressants.

Sleep Deprivation and Depression: National Library of Medicine Jan 2021


Why is ECT becoming a preferred treatment for depression March 2022 Maclean Hospital Harvard Medical School Affiliate


Using neurofeedback as a means of reducing self blame in depression: Dr Zahn  Kings College News Centre  Sept 2021


Review of social participation interventions for those with mental health problems Social Psychiatry Psychiatric Epidemiology March 2017 Martin Webber


Exercise is an all natural treatment to fight depression: Harvard Health Publishing Dr Miller February 2021


The relationship between excessive internet use and Depression:

Morrison Gore Psychopathology 2010 43: 121-126


Treatment Resistant Depression: Web Med:  Dr Bruce  May 2022


Esketamine For Treatment Resistant Depression: BMJ Sept 2019 Jauhar


An evidence based approach for augmentation and combination strategies for treatment resistant depression Psychiatry July 2006 Barowski


Key differences between Venlafaxine XR and Desvenlafaxine: An analysis of pharmacokinetic and clinical data 

Michelle D. Colvard, PharmD

Mental Health Clinician (2014) 4 (1): 35–39.




 




A Popular Theory About Depression Wasn’t "Debunked" by a New Review

Published: July 22, 2022

 

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Ruairi J Mackenzie

A Popular Theory About Depression Wasn’t "Debunked" by a New Review

Published: July 22, 2022

 

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Ruairi J Mackenzie

A Popular Theory About Depression Wasn’t "Debunked" by a New Review

Published: July 22, 2022

 

| 

Ruairi J Mackenzie

Coaching: Anxiety Disorder:
We all have anxiety, not only is it normal it is essential for survival, in fact as a caveman the
more anxiety you had the more likely you were to escape predators and achieve survival
needs. The irony is that in todays society it these people that suffer the most as just like the
rest of us they are hard wired to continue escaping illusionary predators and acquire
illusionary survival needs that marketing and social media imprison us with.
We discussed stress last week which is mostly a normal response for an individual to a
situation where they do not feel in control
However if severity of anxiety or duration exceeds what is reasonable then it may become a
clinical disorder.
Anxiety Disorder:
33% life time prevalence of anxiety disorder often co morbid with depression or other
anxiety disorders, and 4% life time prevalence of GAD higher and more impairing in high
income countries. Females twice as likely as males.
Generalised Anxiety Disorder: DSM V 300.02
Generalised Anxiety Disorder: 8 studies of biological interventions:
Current Psychiatry July 2022 Saeed Majarwitz
Generalised Anxiety Disorder usually starts in early adulthood and persists throughout life.
Anxiety about a variety of events is excessive and unreasonable and causes distress and
impairs functioning.
There is a big variability in the effectiveness of physical intervention for Generalised Anxiety
Disorder.
SSRI, SNRI, agomelatine (melatonin 1 and 2 R agonist and 5HT 2c R antagonist –
antagonism increases noradrenaline and dopamine)- as effective as SSRI maybe with fewer
side effects eg nausea and sexual side effects.
Less used: Buspirone - 5HT 1a R agonist.
Acute anxiety: Benzodiazepine.
rTMS (FDA approval for Clinical depression 2008) right parietal cortex or right dorsolateral
prefrontal cortex with reduced relapse after completion of treatment.
CBT alone and improves response to medication.
Plus:
Diet exercise reduce alcohol and cigarettes, structure , self awareness , sleep with positive
studies for magnesium, chamomile extract and antioxidants.
Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder
Across the Globe
Ayelet Meron Ruscio, PhD1
; Lauren S. Hallion, PhD2
; Carmen C. W. Lim, MSc3
; et al
Dialogues Clin Neurosci. 2015 Sep; 17(3): 327–335.
Epidemiology of anxiety disorders in the 21st century
Borwin Bandelow, MD, PhD*
Ann Behav Med. Author manuscript; available in PMC 2016 Aug 1.
Generalised Anxiety Disorder: 8 studies of biological interventions:
Current Psychiatry July 2022 Saeed Majarwitz
Published in final edited form as:
Ann Behav Med. 2015 Aug; 49(4): 542–556
Exercise as Treatment for Anxiety: Systematic Review and Analysis

Coaching: Stress:

The key to stress is : control. If you have control you are not stressed, if you don’t have control you are stressed.

Mental Health Foundation 2018 study:

In the past year 75% had at some point felt overwhelmed with stress. Elderly less stressed than younger.

Of those who were stressed 50% felt depressed and 60% felt anxious, 50% overate or ate unhealthily,30% increased alcohol and 15% started or increased smoking.

Of those who felt stressed at some point in their life 30% had suicidal thoughts and 15% had self harmed.

30% felt lonely.

40% of stress was due to worries about health of self or others and 20% was due to debt.

18-24 year old had more stress with social media eg

Pressure to respond immediately to messages

Comparing yourself to your peers -50% and pressure to succeed: 60% Females more stressed about body image than men: 40% versus 20% The American Institute of Stress:

●      About 33 percent of people report feeling extreme stress

●      77 percent of people experience stress that affects their physical health

●      73 percent of people have stress that impacts their mental health

●      48 percent of people have trouble sleeping because of stress

80% of work place accidents are due to stress

Yearly cost to business of stress in the USA: $300 billion

Psychological and physical Symptoms:

Depression anxiety anger fatigue tension diabetes cardiovascular disease high blood pressure cancer substance abuse

Stress is increasing. American Psychiatric Association: APA 2011 : 5% increase to 49% of Americans had felt stressed. 33% of children.

APA 2021: Covid has caused significant stress in 80% worse in young adults associated with a sense of uncertainty about the future of their country and their own future.

Up until the pandemic stress had been rising more in the middle aged who were less able to cope with technological advance , work pressure and  job losses.

APA 2022: 90% of Americans feel stressed and 70% think Ukraine is the beginning of WW 3

Hormones of stress response:

Adrenaline then the Hypothalamus Pituitary Adenal Axis producing CRF ACTH and Cortisol Cortisol is catabolic breaking everything down increasing energy supply.  It is anti inflammatory and suppresses the immune system. However chronically raised cortisol causes cortisol hypofunction leading to chronic systemic inflammation.

Raising stress levels in the last 30 years is almost certainly the reason for the drop in vitamin D3 levels in the West which was already very low.  This is because the stress hormone cortisol blocks the receptors which absorb Vitamin D3. This in turn drops our immunity and makes us susceptible to infection and cancer.

We are naturally tribal and designed to function in relatively small groups of about 150 (Dunbar’s number).

We require structure , hierarchy and leadership with common identity and goals.

This is why religion works well. It is a transcontinental tribe with clear identity and rules. Destruction of this with globalism , political correctness, mass media with constant hysteria generation and social media designed to take control away from you as well as making you feel compelled to answer messages immediately and to negatively compare yourself to others are a modern catastrophe to our mental and physical health. Attempts to medicalise it are misguided and happen more out of a sense of duty and despair by the medical professionals. It is a leadership and political issue and a sign of a catastrophically badly run society. Freedom of speech? Freedom of Movement with hoards of people happy to work on minimum wage? Debates on whether to cancel Christmas and whether women can have penises?

These remove certainty and any sense of structure and clarity of direction.

What we can do:

Firstly:   Is self awareness. Ie stop worrying about our anxiety but accept it. This drops activity in the fight flight centre of the brain and gives you a chance of logical reflection. Secondly: Don’t worry or even think about larger issues beyond our control. Hence the key here is ‘thinking’ it is usually a matter of perception. Eg I can’t stop it raining but perhaps rain is good thing for many reasons. Instead I will use an umbrella or stay in or simply go out and enjoy the rain. Or there is lock down so I can t go to the gym. Let me review what other types of activity I can do, I may find something even more beneficial such as exercising outside. In short there is always a solution of some kind. It may not be what you originally wanted but as soon as you have a level of control your stress will drop by definition.

Thirdly:  Focus on family, close community, keep active, eat healthily and sleep well. If this is not working seek professional help as there is always a solution.

PTSD first defined in soldiers returning from the Vietnam War and officially recognised since 1980.


The distilled essence which you won't find anywhere else is as follows:

Similar to phobias there is a processing block causing an emotion logic gap: I know I should not feel like this but I can't help it. This is because we are hard wired to avoid or reduce anxiety so the brain actively supresses anything causing anxiety so you can't think about it long enough to bring the emotion down to the logic. No amount of sense or education helps here which is in contrast to a real danger where you need tools and education without which just thinking about it will not help at all.

There can be minor and major processing blocks. There can also be a processing block from a misperception of an event so here the processing needs to overcome the discomfort of having got it wrong and the consequences of that. It's easy to see how we all have various degrees of emotion logic gap. For instance have you found that no matter how well you explain something to someone they won't change their minds? Even if you know they have understood the logic? It is because it is too painful to do so and they have no reason to go through that pain. Or how many times have you done something knowing it is wrong just because you want to for various reasons? Here again there is a type of processing I teach bit it needs self awareness and motivation.

Yet the harm from chronically raised cortisol from even mild processing gaps can be measured by improvement in all aspects of mental and physical health when it is dealt with.

It is why I say you only have clarity of mind at two points in your life: 1 when you are borne, 2 after you have had good therapy by a true expert which you pay for. (The payment indicates your motivation versus just turning up).


Life time prevalence of PTSD 8% of the population, about 90% are exposed to trauma including unexpected death of a loved one, equating to a lifetime occurrence of 5 separate traumas in men and 4 in females.

Women are less likely to be exposed to traumas than men but the traumas they are exposed to are more likely to cause PTSD such as rape and sexual molestation where as males are more likely to be exposed to combat and witnessing trauma to others.

About 30% of women view their child birth as traumatic with 30% of those developing PTSD hence about 10% of all mothers have PTSD.

About 25% of acute medical problems including ITU have PTSD.


Psycholgical sequalae of PTSD: Clinical depression , alchol and drug abuse.

Predisoping factor: Clinical depression.


Self report questionnaire: PCL-5 Post traumatic stress disorder Check List for DSM 5 20 questions scored 0-4 relating to the previous month.


DSM 5:  SIACAD

Stressor

Intrusion

Avoidance

Cognition

Arousal

Distress

More than 1 month


Can specify whether dissociation or delayed onset.

Routine debriefing re living trauma may make it worse


CBT 4-5 sessions, EMDR, Reprocessing


Live Exposure


SSRI SNRI


Psychedelics FDA approval pending


Transcranial Magnetic Stimulation


Atypical Antipsychotic , ECT




Important nuances:

Chronic loss of control eg bullying or lock-down = Prolonged Duress Stress Disorder

Minor trauma still causes processing blocks or impaired processing which needs to be properly processed either with self journaling or with reprocessing therapy. In fact Professor Pennebaker showed that in Yale University students self journaling difficult events reduced cortisol and improved mental and physical health and exam results.



Naomi Breslau

The Epidemiology of Postraumatic Stress Disorder

Jounral of clinical psychology 2001

FIrstly about 1 in 10 children have ADHD and about half will grow out of it leaving 1 in 20 adults with ADHD. The long term studies in adults have not been done but the oldest patient I have diagnosed and treated with ADHD was 68.

There is a strong genetic component and it is almost certain that other members of the family will have symptoms of ADHD. There is also a greater than average association of ADHD with bipolar disorder and dyslexia.

People with ADHD often present with an inexplicable failure to succeed in life. In other words they are intelligent and affable and try to apply themselves but they fail.

ADHD can make is so difficult to function that there is a high incidence of depression and anxiety alcohol and substance use.

It is also not an uncommon cause of relationship problems amongst couples as the ADHD person will be impatient and irritable and impulsive and difficult to communicate with.often appearing not to listen.

Notably of patients diagnosed with clinical depression then 25% will have ADHD and unless it is treated the depression will not resolve.

As a child ADHD can have severe direct and indirect consequences on self esteem, socialisation and general ability to function and be consistent which are all hugely involved in success in life.

One can imagine a child with ADHD being relentlessly hyperactive impulsive and inattentive will be hard to manage for the parents who typically chastise verbally and physically. This negativity erodes the green shoots of self esteem . The child gets used to criticism, and also gets used to failure and comes to expect both.  One patient was so out of control that his father used to take him out into the garden and hose him down with cold water. They will have difficulty with socialisation and will tend misbehave as a consequence of the ADHD at school and be punished.

There are two issues as far as schools are concerned. 

ADHD -unless it is very mild- is a disability and is covered under the Disablity discrimination act 2010. Additionally even if the child is treated with medication the disability criterion applies as if the child is not on medication. Therefore if the school is sanctioning a child for behaviour as a result of disability or if they are insisting on behavioural targets such as a behavioural contract then they are setting up the child to fail.

Not making reasonable adjustments is part of disability discrimination and is illegal.

The second is abuse by neglect. If either parent or school knowingly do not take steps to help their child once they know they have ADHD then that is abuse by neglect.

Parents should be wary of the paradoxical reinforcement of shouting or physical punishment. Either may arouse the child so much that their dopamine goes up producing a compliant calm child. The parent in desperation learns this is an effective way of curbing unruly ADHD behaviour and the child gets used to being scolded criticised and punished and absorbs that into their self esteem and personality. One of my patients as a child was so hyperactive the only way his father could get him to calm down was to take him out and turn the high pressure water hose on him. That raised his dopamine.

This is also the rational when an occupational therapist recommends ‘Play breaks’ at school if an ADHD is getting unrully or for quiter play ‘hard putty’. All these provide physical stimulation hence raising dopamine.

Far preferable of course to take a simple tablet rather than treating the child differently to the others.


Medication for ADHD:

Stimulants: Methylphenidate and different types of preparation of this. They come is standard release or sustained release (modified release)

In the USA there is also Dexedrine (adderall) which is a mixture of standard and slow release salts.

All these are Class B drugs and have to be prescribed with a CD Pad (controlled drug pad)

National Institute of Clinical Excellence Guidlines state that one a consultant psychiatrist has made the diagnosis and continues supervision of the patient then the GP can prescribe it. Many GPs however do not. Either because they dont understand it, or they are anxious about a class B drug or they don’t believe in ADHD.

Unlicensed stimulant : Modafanil (Provigil) is a histaminergic agent which at high dose has been shown to treat ADHD. note that antihistamines sedtate so histaminergic agents will stimulate.

Non stimulant medications:

Atomoxetine (Strattera) : this raises dopamine and noradrenaline but it is a cumulative effect similar to an antidepressant and needs to be taken constantly . Stimulant medication can be taken according to the requirements and then not taken if not required.

Guanfacine: a central alpha 2 receptor agonist which raises dopamine in the Pre Fronatl Cortex.


Psychological:

This is required often due to the direct negative effects of ADHD and the indirect  effects eg therapy will teach good habits such as reflection, communication, impulse control. We also have to fix fractured self esteem. All this is almost completely useless -although it depends on the precise degree of ADHD-  if the patient is not on medication as they cannot concentrate enough to cooperate.

Family Therapy is important as the parents need to be educated on how to best help their child and also be reassured they are not bad parents.

I help them try and be mindful using a visualisation based on the film the Mask with Jim Carrey who played a gentle hopeless romantic with no confidence. Putting on the Mask exponentially magnified these qualities restoring his confidence and turning him into a mischievous charming hyper energetic caricature of himself. I say they are are getting angry with the Mask of ADHD not their child but their child absorbs all negative input and chastisement into their personalities.

Parents also benefit from education about the law as it applies to their child’s eduction:

All publicly funded nurseries, per-schools, state schools and local authorities must try and identity and assess children with Special Education Needs(SEND).

There must usually then be an Educatinoal Health Care Plan (EHCP) which must be reviewed annually and from Year 9 there must be a full review preparing the child for adulthood.

From the age of 5 onwards it is the law that every child has a right to full time education.

Schools will need to take appropriate steps such as expert assessment by educational psychologists, occupational therapists, speech therapists and referral to local child and adolescent mental health services. If necessary the EHCP will be submitted to the local health authority for extra funding if one to one is required although most schools do have some extra budget themselves for this but of course they dont like using it and usually need ‘encouragement’ by an ‘informed’ parent. The trouble is not all parents are informed. I remember seeing a Polish mother picking up her 7 year old son at lunchtime as the school had enforced half day attendance. This is illegal and refers back to one my basic rules of human behaviour: people do what you let them.

Private schools are bound by OFSTEAD and usually align themselves on their website to rights of equal access to full time education for all. I recently had to write a report for a 15 year old with ADHD -and the school knew he had ADHD- who had been put by the school on a behavioural contract which he broke as he could not stick to it and was sanctioned for it. This is not only failure to make reasonable adjustments but direct harm to the child. It is disability discrimation and therefore illegal. 



As far as physical treatment goes the American Text Book of Psychiatry states that after assessing for diagnostic criteria in DSM V then a definitive diagnosis is obtained by a positive trial of treatment with a stimulant, the point being that only someone with ADHD would become calm and focused on a stimulant and everyone else without ADHD would experience the stimulant effect.

Indeed many people with ADHD will self medicate with some kind of stimulant ie sippling coffee or coca cola throughout the day. Many will resort to Cannabis that does not so much focus the mind as give a blanket of relaxation that some equate with better functioning but it is not a direct cognitive effect and in some results in an amotivational syndrome.

Highly suggestive of ADHD is someone who has no difficulty getting to sleep after an espresso. Some people with ADHD also report paradoxical responses to cocaine so that while everyone was partying the night away after a line of coke they sat quietly on the sofa. (this will depend on the dose of cocaine as I will explain later).

Indeed Donald Trump drinks 6 diet cola day and will well known to not be able to sit through meetings and tends to be impulsive and disinhibited. Look at Boris Johsnon, impulsive and disinhibited and who apparently is not interested in the roll of prime minister, just the position of power. Since the work of the prime minister is not interesting to him he actually genuinely cannot do it. However he is a classic scholar and self professed lover of ancient Greece the writings of which have been the basis of study of oratory and because he likes the classics he has no difficulty writing a book on Ancient Greek.

The neurotransmitter deficit is dopamine. People with ADHD do not have enough dopamine and treatment seeks to bring dopamine levels back into the normal range. Taking too much stimulant may push dopamine above normal levels whereupon overstimulation would occur.

Precisely because the idea is to bring dopamine back to normal levels there should be few if any side effects.

Since dopamine is the pleasure neurotransmitter then this is why people with ADHD can focus if they like something  their dopamine goes up into the normal range so performance at school can be starkly binary being either great or awful at something. Indeed if they like something they can hyperfocus.

The reason why Depp and Heard are the tip of the ice-berg Personality DIsorder Part 2


Personality disorders ie those whoes behavior is by nature consistently anti-tribal are this way due to a combination of nature  (genetics) and nuture. They can be born this way or they can be affected by trauma of different types. For borderlines and psychopaths sexual trauma is especially important. Anything that fractures or does not affirm self esteem either acutely or chronically risks going onto also affect socialisation and both together will then create an individual who's behavior purely due to who they are is tribe incompatible aka personality disorder. The specific way in which anti tribal behavior reduces internal anxiety defines the type of personality disorder.

Interestingly the American Psychiatric Association talks about oversly sensitive overly reactive children  being a risk factor for developing personality disorder and I think this may refer in some cases to genetically overanxious children but more importantly , becausethis is somethign easily addressed it is referring to is ADHD. Parents often cannot cope and often dread dealing with their own children when they have ADHD and this not helped by an increasingly avoidant educational system who need to be strong armed by assertive parents who have read all the rules and guildelines into providing any useful support. The problem is that kids with ADHD are constantly chastised and scolded and have difficulty learning normal socialisation (without making serious compromises such as taking on the role of the charming misichieve maker who people are entertained by) and also get used to failure as schools often reject them or do not give them adequate learning support. Its important for parents to undersatnd they are getting angry with the ADHD not their kid . However it is the child's self esteem and self pereception that is being damaged . This is the most persuasive argument for discussing medication with parents who understandably do not want their children on tablets but equally do not want to harm the fundamental rewquirments for success in life ie self esteem and socialisation ie tribal living and how well you can do within the tribe.

Recently I had to write a report for a 15 year old who had been put by one of the UK's great public schools in the North on a behavioral contract. But he had ADHD. He could not stick to it and was expelled. The school have now lost aginst the parents during formal proceedings and rightly so. The damage to self esteem was incalculable. This directly through discrimination and inderectly through neglect of duty abuse of the child. This is the case if parents and professionals do not properly manage ADHD.

The commonest personaltiy disorder is Obsessive Compulsive characterised by individuals being socially awkward and often withdrawn, liable to routine and ritual and perfectionism and hard work. This is likely to be a misclassifaction or at least a duplicate classifcation for more functional Aspergers Spectrum disorder. Even more simply we are all on the emotion/autistic spectrum with females generally shifted left of centre to the more emotional end and males generally shifted right of centre towards the autistic end. The main mediator is the level of exposure to intrauterine testosterone. It means that a female with Aspergers tendencies is even more of an outlier than a male with Aspergers tendencies as the general female poplulation lies more the left than males. Indeed a right shifted narcissit female is especially toxic to the tribe often exactly because they can fly under the radar but they have most access to and responsiblity for raising chiildren and someone who is self serving and likely to be critical and controlling and unable to teach proper attachement and socilaistion to the kids is going to be very damaging to those kids. Furthermore females tend to be the social centres of tribes so a right shifting narcissist will be especially toxic to the tribe.

The reason personality disorder exists at all without being selected out by natural selection is that it confers a survival advantage. In times of strife famine or war etc the tribe needs an assertive leader able to make cold calculated decisions. Such as Churchill versus Hitler or Trump versus Putin. (Biden is of course a joke and a plant by the higher powers to be manipulated in an attempted Great Reset). Current society and emphasis on careers values hard work and persistence which is a key trait in obsessive compulsive/right shirters. Also right shifters are more resistant to trauma as they lack the normal emotioanl responses. They are able to pragmatically accept what has happened but their main distress is with the consequences and change in routine caused by the trauma . Hence my suggestion is that you will find a high proprotion of right shifters among refugees as the right shifters were able to remain functional enough to leave their coutnry whereas those closer to the population mean were overcome by stress and so less functional and less albe to leave and seek safety.

Society is changing infront of our eyes. Unregulated capitalism  and materialism and the destruction of religion morals and ethics and national identities combined with globalisation leading to different cultures being forced into close juxtaposition to one another is leading to increases stress and unhappiness especially in the West which is leading the way in this. Unfortunatley the digital age which selects for binary thinking right shifters who are especially suited to softtware programming  has resulted in narcisistic binary thinkers becoming the richest men in the World. The consequence of having intelligent binary thinking narcissists in charge is that they will in the blink of an eye (ie reflexly -hence the personality disorder nature) justify subjugation of the unhappy strife riven population with biometric passports and ultimately computer chipping in a bastardised biblical simile of God creating Man in his image. You will own nothing and be happy is the mantra of the Great Reset.

Since peronalit disorder causes suffering to the indvidual and those around them through being antirbal then the defining criteria are relative to the tribe. If we are all turned into subjugated robotic compliers then those seeking collaborative warm human contact would be considered the anti tribal personality disorders as they would be damaging to the binary thinking tribe. You think this is unlikely? Think again. How about those speaking the truth about COVID and vaccines being cancelled and revilled and subjgated by the media as well as the law? Now we know it was mostly lies and vested interest of large pharma and govenerments defining policy by public opinion which was manipualted by mass media and those controoling them. For instance BIll Gates controls the WHO and has interests in Pfizer and the same entity controlling Pfizer also controlls Thomson Reuters the golbal fact checker which was used by Twitter. The end of society as we know it is happening infront of our eyes.


How are personality disorders treated? Since they are not ill there is no treatment. However some may have the insgiht that if they want to benefit from what society has to offer then they have try and act agaisnt their nature and integrate more functionally. There exist therapeutic communities who mainly follow the method of putting these people on behavioral contracts exactly because they are responblle for themselves. So if they break the rules such as being voilent or self harming or generally being antitribal they are punished by being excluded from the community for a time or discharged alltogether. Some have come to me stressed by the pressure of society for them to be nicer ie less psychopathic or less narcissistic. Basically they are stressed as no one likes them so they are lonely and running out of victims or work is suffering and they want things to go better. My answer is dont try and act against your nature. It causes stress. Be yourself. Be a psychopath openly .It means that people can engage with you on fair terms. They then know what they are dealing with and are less likely to be damaged. Look at Boris Johsnons multiple relationships and multiple children. Look at his superficial charm yet talk to his ex wife and she is excoriating of him. Close prolonged contact with personality disorder can be devasting as they are entirely self serving and therefore destructive .

Indeed the Oxford English dictionary defines ''Evil'' as something wicked and amoral. If you look at amoral it means not moral. If you look up moral it means knowing the difference between good and bad and doing good. If you look up wicked it says something unpleasnat eg an unpleasant wind or something harmful. Therefore by definition in the two golbal classificaiton systems which state personaltiy disroder causes suffering to the individual and those around them lifelong then by their nature they are evil.

How does one respond to a personality disorder? Three ways. The first two require knowledge of the spefic antitribal mechanism they are using ie are they a psychopath, are they a narcisist , or a binary thinking micro controller? Are they an insecure attachment seeking borderline ? Ie you have to know the currency of their internal peace. 

Then you apply fear of losing that currency or reward with that currency.  The problem is that in order to that consistently and not be stressed in so doing it has to be in your nature it is not for most of us and generally not in the nature of victims seeking advice on how to deal with a personality disroder then fhe first two options are not practical which leaves the 3rd option of geographical separation.

Returning to Depp and Heard. How many witnesses did Depp have give evidence for him? Many. How man did Heard have ? None apart from her sister who clearly was a genetic close match to Heard .

This is the best overview of personality disorder currently available as understanding the distilled rules of human behaviour allows us to analyse the patterns in the world around us with a clarity some may find challenging but most find liberating. We look at the current diagnostic systems and what they try and do and their shortfalls.

Simply put most living organisms with self awareness are tribal because nature worked out millions of years ago that living in a tribe conferred a survival advantage to wondering the planes as a nomad.

The most fundamental behaviour we all exhibit is that we are hard wired to reduce our internal anxiety -our baseline arousal. This is our primitive survival mechanism. If we see a tiger we instantly run. There is no conscious thought . The quickest way of survival is to bypass the cortex -the amygdala hijack- so we are hard wired for reflex anxiety reduction.

Since we are tribal and the coexistence of any number of reflex anxiety reducers will instantly lead to chaos then were have a secondary hard wiring to reduce our anxiety by relating to and taking on the opinion of the majority around us -the mass narrative- to respond to authority, structure hierarchy, leadership.

This tribal consistent reflex anxiety reduction exists on a spectra with the majority of us lying around the mean so we are pretty good at it. However everything in nature exhibits variability and this is no exception. There are individuals who lie further from the mean of tribal consistent reflex anxiety reduction until you get to the extreme outliers where their tribal consistent reflex anxiety reduction has in fact inverted 180 degrees to be entirely self serving. The mechanism by which they reflexly reduce their anxiety by self serving defines the type of personality disorder.

It is globally accepted that personality disorder has to be present from birth or at least start in childhood following which it persists life long. As it is anti-tribe it leads to erratic destructive behaviour for the individual concerned and or more frequently for those around them which is why they are usually sooner or later rejected by the tribe.

Forensic psychiatry has been caricatured as using one of two diagnoses: Mad or bad but unfortunately this is not nuanced enough and can lead to miscategorising of individuals in either group.

The first things to say is that these people are therefore hazardous by their nature and not due to mental illness.

Unfortunately political correctness that gives centre stage to the outliers of society by insisting on equal outcome for everyone without considering whether this is appropriate or even healthy gives these individuals the power of the full force of the law -indeed positively discriminated for by political correctness. A basic understanding of their psychology shows how disastrous this can be.

A common mistake made by the police is how can this lady make these claims if they are not true?

The answer is that there is no logic involved. In order to reflexively achieve even a small degree of internal peace the personality disorder won’t think what they do to achieve this or the consequences there of. If the law allows them to utter a few simple words which lifts them out of the drudgery of normal existence into one of cossetted abrogation of responsibility then this will be their reflex action.

Similarly for mass murderers or serial killers. SInce everything for personality disorders is self referential rather than for the good of society then when they are inevitably rejected they will view themselves as hard done by victims and depending on other parts of their nature they will respond vindictively of which the outliers are the extreme actions, but plenty of personality disordered spurned spouses show remarkable and consistent degrees if vindictiveness.

Indeed the basic tenet of forensic psychology is that the main predictor of crime is opportunity. In other words if you let something happen it will. Almost anyone is capable of almost any atrocity given the wrong environment. We are products of our environment and our behaviour is bounded by structure hierarchy and leadership and within this ethics , morals, cultural norms, religion , law.  GIven the presence of this then break through velocity comes with different degrees of personality disorder which is why 50% of the prison population has personality disorder . Unfortunately our modern materialist society has also resulted in psychopaths being 20x more common amongst CEOs than in the general population. In other words modern society is being led off a cliff by self-serving outliers of the population who are predators and yet are worshipped as role models.

We look at some ways to deal with personality disorders in the likely event that one will cross your path.

We take a historical and macroeconomic look at patterns over the centuries that keep on repeating with the different players of various societies. Typically the life span of a society is marked by a slow start a rapid acceleration phase a plateau and a rapid drop off the edge. It's the same for bacteria in a Petri dish in fact. It's a matter of the build up of scale and then the sheer power of mass making competition useless with the big kid on the block until the resources have been used up at which point it is no longer viable or weak enough to be challenged and overthrown.
Typically the more extreme the distance between polar views of the society the higher the likelihood of collapse. This is also the point of maximally inequitable distribution of resources amongst the population. Western society is at such a point. It is almost always about the inability to service government debt usually due to exponential expansion or simply debt to gain or remain in power. Once the currency starts being devalued by printing money or as the Romans did putting less gold in the coins then confidence in the government drops. It is always the case. Roosevelt did it and Nixon did it. Currently 70-80% of government debt repayment goes to interest. Germany infact orchestrated the euro so it could have tarrif free trade as it is the major manufacturing nation in Europe. When countries ran out of money then Germany just leant more money to it's customers so they could continue buying their goods. Even though Greece was broke it lent so much money to the Athenians they had the largest number of Porsche SUVs in Europe. The European Central Bank is now broke . It cannot service bonds issued since 2014. Interest rates are stuck at zero or negative but instead of spending money citizens have simply taken money out of the banks and horded it. Pension funds which require an 8% annual return to break even are now also going bust. Western governments cannot and never intend to pay off their debt. Claus Schwabe of the World Economic Forum has been training and nudging heads of state for years with the idea of a Great Reset. 'build back better " is the phrase coming out of all heads of state lips from the global marketing firm Edleman. The idea is cancellation of government debt. Governments will default on debt. Bonds will not be honoured and pension funds will collapse. In order to stop riots all public debt will be cancelled so no mortgages or credit card debt. We will then all be put on a universal wage in this ultra Marxist regimen. However central control always fails as no one has the skills experience or vested interest in each enterprise and it's why Stalin after the crops failed in Russia stole the Ukrainian grain causing millions of deaths. Therefore covid which is easily proven to be a scam and the war in Ukraine which is clearly staged as the Americans via Kamala Harris purposefully broke the Bucharest agreement hence "triggering Putin" have been attempts to cause increasing global instability and hardship putting ever more people into debt so that people will be too weak and tired to resist a regimen change and only too ready to accept a solution. The Reason For Now.

Depression used to be the 5 th commonest cause of illness and death 25 years ago go and now it is the commonest we have not suddenly become genetically susceptible to clinical depression people are stressed and unhappy and are not designed for modern life The key element of stress is whether or not you have control if you have control you are not stressed if you're not in control you're stressed
Stress via the hormone cortisol is the grim reaper and destroys mind and body. Although all of us experience stress it can become a longer term problem as in post-traumatic stress or prolonged duress stress disorder. However throughout life there are often many psychological blocks which are signs that you haven't been able to process your experiences fully and safely and can be associated with mild raises in cortisol. Notably two major studies one in 2020 and one in 2022 showed a very strong association between vitamin D3 deficiency and severity of covid illness. It's also notable that the levels of vitamin D3 in the west have fallen stratospherically over the last 20-30 years just as as depression has been rising and of course it's not depression it's stress and cortisol prevents absorption of vitamin D3. You can imagine the the extreme stress caused by lock down and mask wearing and all the unnecessary restrictive measures associated with coronavirus. Never in the history of the world has global lockdown ever been recommended and the office of National Statistics freedom information shows that there were only 6,120 deaths exclusively with covid on the death certificate. Therefore there is no pandemic and all emergency measures are illegal. Not only has stress over the last 25 years worsened vitamin D3 deficiency but the increased stress over the last 2 years will have been catastrophic for D3 levels as well as causing excessive inflammation and pathology within the body which will have made people even more vulnerable to viruses as well as increasing death from other causes. We discuss specific therapy and we also discuss what can be done to maintain a sense of control.

It is a great privilege to discuss with my mentee Alexi the lessons he has learnt over the last 20 years with me. Firstly we all need therapy because it gives us self awareness. The purest our minds will ever be is the moment we are borne and after therapy. We are sensitive recording instruments of everything we experience from the first breath we take and how we express that going forwards is largely determined by the chassis we layer these experiences onto -- our personality. Self awareness usually lies deep within the strata of psychological blocks and damage that we pick up from the moment we are born. The journey to self awareness depends on many things including internal motivation , external events and personality. No man is an island and such is the emotional unpredictable nature of humans that we need to be constantly guided with structure and rules and values. Alexi surmises what he has learnt and what is really important in life. Suffice to say it as family and close community and not chasing your career.