Bipolar Disorder, Misunderstanding and the Armchair Diagnostician

Head in Hands

Possibly the world’s greatest face palm?

I have been inspired to write this post after reading a recent article on the Guardian website. As is often the case it is not the article that interests me, although I agree with much of what it says, rather it is the ignorance and buffoonery one sees in the comments section. I rarely pay attention to comments but in this case I have made an exception as I have a personal interest in the content. It is not necessary to post the precise text of the comment to which I am referring because it is not that specific content to which this post is a response. Additionally, I do not wish to give the author the oxygen of attention. It is easy to find if one looks. I am concerned about the ongoing misunderstandings it represents.

On Misunderstanding

The most difficult challenge one has when dealing with those who misunderstand mental illness is that they do not understand that they misunderstand. In fact it is far worse than that, since rather than being passively unsure of themselves owing to the fact that they are neither well read nor well informed on the matter, they will often aggressively assert themselves as though they could not possibly be wrong. This often manifests as the tyranny of common sense and the notion that all problems share the common characteristic of being simple to solve. The dreaded certainty of the Alexandrian Solution. Well, I am afraid that snipping through this particular Gordian Knot is neither productive, nor is it going to help at all. In reality this is no more than the Dunning Kruger Effect, something more commonly expressed as the following aphorism:

A little knowledge is a dangerous thing

The illusory superiority which ignorance confers upon its misguided subjects is a powerful weapon in the hands of those wishing to attack something they do not understand. I enjoy the words of H.L. Mencken on this subject:

‘For every complex problem there is an answer that is clear, simple, and wrong.’

You can often observe the Dunning Kruger Effect in full flow when listening to people talk. I am sure that everyone reading this has come across folk who genuinely believe that ‘Britain would be great again if we got rid of all the immigrants/politicians/Jews/black people/insert minority here’. I have no wish to argue about politics but I do hope that you can see how nonsensical this is. It is nonetheless true that an ignorant population is so very easily controlled and very often a simple buzzword or catchphrase is all that is needed to mobilise them. Racists regularly proclaim that ‘there ain’t no black in the Union Jack’, a statement rendered doubly stupid since the Union Flag is only a jack when flown at sea. That aside, the National Front has sustained a violent, racist organisation on that statement and little else. Elsewhere many of you will no doubt remember this powerful political message:

Labour isn't working

The famous ‘Labour Isn’t Working’ election poster.

This meme all but annihilated the Labour government against which it was a very well thought out and deadly attack. It meant that the Labour Party was not functioning, that the labour of the person reading it was getting them nowhere and also suggested that the word ‘Labour’ is the antonym of the word ‘working’. It remains a powerful image to this day and a testament to the fact that in order to win over hearts and minds it is more important to be pithy, catchy and appealing than it is to be armed with honesty and facts. In the current day and age media, marketing and public relations amounts to warfare, and as many of us know all too well, the first casualty of war is the truth. When it comes to mental illness the truth may well be the first casualty of war, however behind it is a long line of desperately sick people and those who have committed suicide out of desperation, amongst others. All because of those who believe that their simple answer is better than complex truth.

The Armchair Diagnostician

We have all met them, armchair diagnosticians. They are the people peddling their simple-minded solutions and thought processes as genius. They are the people who cannot grasp the concept of the law of unintended consequences, something that also has a pop culture version of itself that goes like this:

The road to hell is paved with good intentions

Armchair diagnosticians do not apply their genius to mental health issues alone. They are the same people who can tell you why climate change is a myth and that almost every climate scientist is wrong, despite being the most educated people on earth in their fields. They are the ones who know who really killed JFK or that NASA did not really send men to the moon. You might even hear their gusty proclamations concerning the notion that the world is unfair because it is run by Jews, for Jews. Of course, sometimes they turn out to be correct due to serendipitous good fortune and nothing else. For example, the historic practice of allowing nobility to hunt animals has led to the preservation of the UK’s beautiful countryside. This is not an argument in favour of hunting of course, simply a positive unintended consequence of morally objectionable behaviour,  and an outcome such as that can often embolden them to be even more militant about their preposterous views. The flip side of this rule is informally referred to in some quarters as the Streisand Effect, named due to Barbara Streisand’s efforts to censor photographs of her home that had been posted online. Her efforts only served to publicise the photographs which in turn resulted in them being downloaded 420000 times, as opposed to just 6 times prior to her lawsuit. This all serves to demonstrate that ignorance is dangerous not only for what it intends, but also for what it does not necessarily intend and cannot foresee.

So how does all of this relate back to mental illness? Ironically the connection is simple and easy to see. The comment in the above article suggests that it can by often be difficult to distinguish between genuine, bona fide mental illness and ‘SLS’ (sh*t life syndrome). That may seem reasonable to some, that many of those claiming to be mentally ill are in fact simply unhappy. After all, how would one make a firm distinction between the two? The answer to this is that there is no need to distinguish between the two because SLS is something invented by those who wish to sweep mental illness under the carpet. You will have never read any scholarly materials about SLS because nobody has ever observed it or documented it’s existence. It is a complete fabrication that bears no resemblance to reality.

SLS simply does not exist.

Our society and culture is currently in the throes of a massive denial epidemic concerning mental illness. Very few people wish to have any dealings with it and we have not moved on from the old way of doing things. Granted, we rarely use asylums any more, save for secure hospitals for people who present a danger to society, however what is noticeable is that where there used to be asylums there is now… Well, nothing really. If you presented with mental health symptoms tomorrow then where would you go? What would your family do with you? Call the police perhaps? As I will demonstrate in a future post, the current police response to mental health challenges is woefully inadequate, to the point where it borders on the criminal. Returning to the question, what does a mentally ill person do? Now that we are no longer shut out from society, are we a part of society? Or are we apart from society? Would you laugh at us and our symptoms? Or would you diagnose us as ‘faking it’ or ‘putting it on’, or my personal favourite ‘trying to get out of work’? Which one has, in the past, been your go to diagnosis for those about whom you would rather not go to the trouble of thinking?

Or did you just throw your shoulders back, puff out your chest and deny ever having done anything like that? You certainly would not be the first to have done so, but all of these truisms highlight the crushing, desperate, critical need for a new conversation to open up in our discourse and the first thing we must do is re-frame the question. No longer must we ask ‘what do we do with the mentally ill?’, rather society ought to say to itself ‘how can we love the mentally ill more?’. Two point four children is the average family size, or something of that order, and current research puts the prevalence of mental illness as affecting one in four people, almost always indiscriminately. That not only means that you almost certainly know someone with mental illness, but you also cannot comfort yourself with the notion that you will never be ‘one of them’. Madness and mental illness is no respecter of persons. It can strike anyone at any time, anywhere. Do not salve your conscience with the false consolation that it has not happened to you. Each of us is a heartbeat away from losing our minds, possibly for good. If and when it happens to you or your kin, those folks that you mocked, ignored or pretended were invisible, what will you do with them then?

Difficult questions lie ahead for the UK in terms of dealing with the mentally ill. Aside from the current government strategy of pretending that grossly inadequate NHS funding and provision will somehow right itself onto a straight course, the notion that the mentally ill are to be pitied, given a pittance in handouts and quietly shuffled into the corner is a recipe for disaster.

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Therapeutic Approaches to Living With Bipolar Disorder

One of the considerations that goes hand in hand with a diagnosis of bipolar disorder is the knowledge that it will be something one lives with for life. That can be a frightening prospect for a person with this illness and their friends and family. Diagnosis can often be traumatic and the pronouncement itself can be devastating, akin to being told to put one’s house in order and prepare to die. There is very often a social death that accompanies mental illness, with friends and family simply not wanting any part of it for whatever reason. Often the inadequacies of our approach to mental health in the UK means that simply obtaining the correct diagnosis itself can be a struggle of gargantuan proportions. It is not uncommon for bipolar disorder to be misdiagnosed as attention deficit hyperactivity disorder (ADHD) or as depression. This combined with the fact that once a correct diagnosis is received, there are several strains of the illness in question means that the prospect of a life lived as a mentally ill person can make for an extremely intimidating prospect. Beyond that, and let us be frank here, the label ‘mentally ill’ is likely to induce derision, laughter and hostility in many circles. How does one start to live a life that is fulfilled yet mindful of the illness and structured in such a way as to accommodate it? It is important to remember that, as is so often the case with a great many different conditions, there is no silver bullet. What works for one person will not work for another and the process of discovering what sort of lifestyle will help a person live with their illness is time consuming, emotionally painful and very often simply a matter of trial and error. As the saying goes, if you wish to learn to swim then you must jump in to the water.

I have developed my own way of living that has allowed me to live a productive and fulfilled life and I consider myself very fortunate to have not only the opportunity to do so, but also to have the understanding of my partner. I believe it is important to have a holistic approach to life with bipolar disorder. I do not mean the use of holistic medicine, rather that the changes in certain areas of life must be made with the goal of achieving happiness and fulfilment as a whole. Without a plan sufferers will often muddle through one episode to the next whereas planning and thought will go a long way to minimising the disruptive effect of bipolar disorder. I stress that it is important only to use medicine that has been prescribed by a trained mental health professional. Reliance on so-called holistic therapies, new age medicine, homeopathy and suchlike is a recipe for disaster. In this post I have decided to give you my recommendations for managing a fulfilled and happy life as someone with a diagnosis of bipolar disorder. I refer to this as therapeutic living. This is not a medical treatment and I am not a physician of any kind. If you are someone with bipolar disorder or you know someone who is and they are suffering in any way symptoms that are either undiagnosed or which represent an imminent danger to their person, lives or loved ones then you must seek out medical attention immediately, particularity if there is any suggestion of suicidal thinking or planning (also known as suicidal ideation). What I have decided to discuss here today is how a person with bipolar disorder might go about the everyday task of living a happy, fulfilled and productive life.

Planning

If you have family or friends in whom you have confided concerning your illness then it is very often a good idea to let them know that you are planning lifestyle adjustments in order to better deal with life. I am not suggesting that you ought to ask permission to do this, rather that they be made aware so that they can conduct themselves accordingly if necessary. For example, if you have decided to stop drinking then they will want to know so that they do not put you in the difficult position of being offered alcohol.

It is also important to decide ahead of time the things you would like to achieve, for example better awareness of moods or better strategies for when moods change. Once you decide what you like to achieve from a lifestyle point of view you can begin to measure the progress and effectiveness of the actions you have taken. Measuring outcomes is very important as it is the only way to determine the effectiveness of what you are doing. In addition to this it is also of critical importance to have an action plan in case there should ever be a point where emergency treatment and hospitalisation in necessary. The fewer things that are left to chance, the better the outcomes are likely to be.

Self-Medication

Self-medication is something that many mentally ill people do regularly. It is generally the habit of using alcohol or drugs to deal with symptoms. You might say it is the act of dulling the pain of life. This can be a very dangerous thing to do. Not only are these substances bad for human health, this in itself a reason not to do it, but also the outcomes of self-medication can often be extremely unpredictable. If a physician prescribes medication then he or she does so anticipating positive outcomes and will closely measure and monitor those outcomes in order to ensure that the correct medication is being administered at the correct dosage and that adverse side effects can be minimised. This is not so with self-medication. Very often a person self-medicating will do so until in a stupor. It is not hard to see why this is extraordinarily dangerous with overdose or alcohol poisoning being a real possibility. It is also the case that a drug dealer, alcohol retailer or pub landlord is not giving you the medication with your best interests in mind. They care about profit and your health is of no concern to them. After spending a few years medicating myself without understanding that that is what I was doing I have opted for the discipline of teetotalism. I recommend that to all, not just the mentally ill, but remember this is about a regime that is right for you, not me. I personally do not see any good arising as a result of alcohol or drug use. There is also the worry that drugs and alcohol could make symptoms worse, sending a manic person into greater, more challenging symptoms, or, even worse, tipping a depressed person into a suicidal mood.

I could not, nor would I ever endorse the use of illegal substances, however if you are able to drink alcohol safely without the risk of engaging in self-medication then good for you. I am of the opinion that a person with bipolar disorder ought to examine his or her relationship with alcohol very carefully. It may be difficult to stay teetotal, however in my experience the boundary between responsible drinking use and alcohol based self-harm is very much closer than we think.

Exercise

Exercise is recommended by many health professionals for the mentally ill, and with good reason. It is intrinsically good for a person to keep fit, no matter what their personal circumstances. It keeps blood pressure low, lengthens lifespan and strenuous exercise releases endorphins, the human ‘feel good’ chemicals in the brain. I am a keen cyclist, walker and swimmer. I run too, albeit less often. I generally tend to hammer my exercise routine as hard as I can. I work very hard in the swimming pool, I walk the school run whenever possible and when I need to commute I use my bicycle unless the weather is poor or the distance is prohibitive.

Aside from the health benefits I have outlined above, simply being outdoors and experiencing different scenery has its benefits. In my profession I am self employed and I work from home. The effect on my mood of sitting down all day at a computer screen without much stimulation can be very poor and exercise mitigates the effect it has upon me.

Emotion Management

Managing one’s emotions is a real challenge for someone with a mood disorder and often severe cases require professional intervention. I stress again that whatever I am saying is not medical advice, nor should it ever replace whatever prescribed medication or treatment you receive and rely upon for wellness.

Managing moods is something that, in my experience, has several components. These include prevention through the identification and avoidance of triggers, recognising an abnormal mood and acting upon it, and dealing with the fallout from mood changes.

Triggers

The word trigger is what I use to describe things that can have an adverse effect on an otherwise normal mood. It therefore follows that a trigger can only happen to somebody who is in the state of normal mood range. This state is known as euthymia. Obviously one is subject to normal mood swings whilst euthymic but not the extremes of mental illness. One of my worst periods of mental illness came when my mother passed away, very suddenly. The process of admittance to hospital with flu-like symptoms to death lasted less than twelve hours. You can imagine the emotional shock and trauma involved. For anyone, healthy or not, these times are the worst and most emotionally bruising experiences we will ever have. It is not unusual, even years later, to experience a song, smell or any number of stimuli that can be a reminder of darker times. Of course, anyone who has been bereaved will know that this is inevitable and over time black gives way to blue. The danger for those who suffer mental issues is that for us such stimuli can often be much more than a reminder. It can be the emotional trigger for a breakdown. The key to dealing with this is a threefold plan. Watch, record and look for patterns. Diligence and watchfulness can often result in a better understanding of what causes a particular state of mind and when triggers are identified they can be either prepared for or avoided.

Recognition

How does a person recognise an abnormal mood state when they are immersed in it? Mania in particular is difficult to identify due to the fact that it is so easy and extremely desirable to be swept along with the waves of euphoria. It matters too because early intervention can prevent damage being done to persons or relationships. Here is where friends and family can help. They can, as an outsider, use their contrasting perspectives to identify mania. Depression can be a lot harder to spot. So many people smile their way through life whilst dying on the inside. That is why relationships are very important to maintain. Intimate knowledge of a person can allow close friends to spot subtle signs that all is not well.

Fallout

It can be very difficult to emotionally detach oneself from the consequences of mental illness, especially as a friend or family member to a sufferer. They can often behave in ways that make others want to give up on them, or simply to avoid the drama. Obviously if steps one and two are adhered to then this step becomes less of a worry. It is very rare for a mentally ill person to look back at actions they took whilst in the grip of an episode and not feel bitter regret, yet at the same time we can feel very angry because we could not help it. All I can do here is appeal to those who live alongside a sufferer to be thick skinned and patient.

Monitoring and Self Expression

There is a lot to be said for keeping a mood diary or expressing oneself through some form of art, writing, music or similar pastime. The emergence of outsider art, a form that is often the work of those who simply cannot live without assistance and constant medical attention is well worth taking the time to investigate. Many people with mental illness use creative outlets to handle the highs and lows they experience and once a body of work is built up it can often be very revealing to look back and explore the moods expressed through whatever medium one might choose. This can often be a path to better understanding oneself and one’s illness.

Figuring Things Out

Ultimately the approach a person takes to their illness will be theirs and theirs alone. There will be a lot of trial and error and, inevitably, laughter and tears along the way. What is most important is that you work out the best thing for you. It is your head and you must live in it. Figure things out for yourself. That is the only real freedom any of us has anyway, and many of us neglect that. It is often easy to feel manipulated and controlled by those around you and I learned for myself that self-determination is very important and extremely liberating. Take ownership of your life and do not let anybody push you around. Being mentally ill makes you no less of a person than anyone else and you have as much right to live a life free from the malevolent influence of controlling or abusive people, and bullies. In my experience, though it can be emotionally difficult, getting rid of people who do you no good is very important. Life surrounded by positive people whose attitudes are healthy and who are not heavy-handed in their dealings with you is rewarding and the resulting quality of life is well worth the effort.

Bipolar Disorder and Creativity

Starry Night by Vincent van Gogh

Van Gogh’s Starry Night. Van Gogh is suspected to have been bipolar.

During the Second World War Adolf Hitler and the NAZIs instituted a programme of mass extermination using eugenics as a starting point, although I think most people would agree that the end game became antisemitism and the genocide of the entire Jewish race and culture. Whilst the Jews undoubtedly suffered the greatest loss as a result of Shoah (the Jewish word for the Holocaust), many people are unaware of the fact that the work of creating a master race through the use of eugenics began by targeting people who were found to be physically and/or medically inferior, often described as ‘feeble minded’, or other similar epithets, and those exhibiting mental illness were in the NAZI’s crosshairs from day one, along with certain other minorities such as homosexuals. Eugenics is a process of forced evolution where those deemed to possess undesirable traits are removed from the gene pool by either forced sterilisation or, more commonly, execution. With the advance of science and so-called ‘designer babies’ and genetic engineering the eugenics movement may once again rear its ugly head under the guise of wishing to produce ‘healthy’ offspring. Incidentally, if anyone reading this wonders why the mentally ill are so scared of revealing themselves and why we often lie about our conditions then do please read up on the history of how we have been treated by politicians and governments. If you begin to comfort yourself with the notion that it was just the NAZIs and it couldn’t happen here then you might also want to read about how the USA, not Germany pioneered the forced, illegal sterilisation and extermination of people with mental illness and also Winston Churchill’s views on eugenics and the segregation and forced sterilisation of the ‘feeble minded’. Mental illness used to be called demon possession and sufferers were often subjected to clerical torture under the euphemistic title of ‘exorcism’. If you care to read the links above then I would ask that you consider for yourself whether or not you think that governments and countries have behaved any better or differently to the religious in regard to the mentally ill. I think not and I also think that for as long as people have exhibited symptoms of mental illness, society has declared open season on us. We have endured state-mandated violence, isolation, public derision and humiliation, torture, medical experimentation and death. It should not surprise anyone to see that the mentally ill are often too terrified to reveal what they are.

Concerning eugenics, I speak to many people today who will, often unaware that they are talking to a person with a mental illness, advocate that the mentally ill be shut away from society, quietly disposed of or be bred out of the gene pool through selective reproduction techniques. Often with the best of intentions they claim that the world will be a better place without mental illness. I am sure they mean well and I don’t necessarily get too upset about the suggestion that I, along with others like me ought to be exterminated. It highlights the truth of the Confucian aphorism: ‘He who speaks does not know, he who knows does not speak’. Often a far too simplistic maxim but in this case it holds true that ignorance shouts the loudest. What is most upsetting about this attitude is not the threat it poses to I and others like me, rather that it is the implicit wish to remove some of the finest accomplishments yet to be achieved by humanity from our collective future. What I am referring to is creativity, and in particular the clear link, at least anecdotally, between mental illness, particularly bipolar disorder, and creativity. Anyone who doubts this in the first instance would do well to remember that some of the greatest literature, art and music that humanity has ever produced was conceived when its originators were three sheets to the wind, usually with the aid of alcohol or drugs. Many of our greatest thinkers often had to use such artificial methods to achieve the altered brain states and higher levels of consciousness that we nutters get for free.

The recent fuss kicked up at the suggestion that Robert Burns, arguably Scotland’s favourite son, was afflicted with bipolar disorder is very telling in this respect, with disquiet at the suggestion in some quarters revealing that many people feel that the inference is an insult and thus certain organisations have been accused of covering up Burns’ illness to protect his reputation. Why? Because in the UK as well as much of the rest of the world it is still acceptable to lose one’s soul but not one’s mind. I personally would be surprised if he and many of his contemporaries were not ‘Touched With Fire‘, for Aristotle observed that ‘no great genius has ever existed without a strain of madness’. This brings to mind the late Spike Milligan, a man who walked a tightrope between genius and complete mental breakdown. I cannot also pass this concept by without the suggestion that the biting footballer, Luis Suarez, is showing symptoms of this illness too.

On Creativity

Creativity is one of the most beautiful, inspirational and yet frustrating, draining and infuriating gifts to have. Believe me, I know. When the creative juices are flowing the feeling is simply electrifying, with ideas flowing out of a person like a freshwater fountain. When the ideas dry up then the crash comes and life can be vey difficult indeed. However, can you imagine a world without Burns and his work? What about history missing the art of Edvard Munch, painter of The Scream? Or, for those in the UK, where would we be without Stephen Fry?

I recently completed the final draft of my first book. I didn’t write the whole book, only a section. Aside from minor corrections it was done in one day and needed no editing. I cannot tell you how proud I was to have finally been published and also how joyful it was to write like that. Contrast that with my efforts to complete a second book, which has taken several years because of the mood difficulties I have. It was agony, yet I still had to do it. I do not write because I have to or want to. I write because I cannot do anything else. I am a decent photographer and I can make music too, but what I am in my essence is a writer. I always have been, even when I did not do it. That goes a long way towards explaining why I have proved to be so utterly useless at any other profession, and I assure you that I have tried many. The curse of creativity is that it cannot be turned on or off, it simply comes and goes as it pleases, and this frustrates both me and those who rely on me. I can promise you that many people have tried and failed to mould me into a normal human being who goes to work from nine to five and who has a regular, normal, everyday life. I worked as hard as I could at it but in the end they got angry, frustrated and often abusive and/or violent. Eventually I gave up, but not before having been written off as disruptive, awkward, stupid or worse. Nine to five is not for me and I have long since stopped forcing myself to endure the misery of trying. I can already hear some of the readers of this post proclaiming that I am using my illness as an excuse to be bone idle, or that I am not ill at all in fact, rather I am just lazy. Let me assure that for a long time I did little else other than wish I could be an everyday businessperson. I would be very well paid, reasonably well thought of and respected and life would be relatively easy. I certainly have the necessary intelligence and qualifications. All that said, however, I am afraid that I simply cannot do that sort of thing and any charge of laziness or excuse making is easily deflected with the fact that I have chosen a far more difficult career instead. Should any of my readers doubt me in this respect then I would challenge you to go away, write a book and try to get it published. It took me nigh on ten years to accomplish that and I am still a considerable way away from being able to live off book royalties. If you think I gave up on middle class comfort for that then I would have a rethink of your attitude towards me if I were you.

In the Media

Portrayals of characters with mental illness are becoming popular in film and television, no doubt because Hollywood is where those with bipolar disorder can to go succeed, provided it is not severe and they can manage it and work in a stressful environment which is not easy at all. Claire Danes portrays a bipolar US law enforcement and anti-terrorism officer in the drama Homeland and the superb and yet criminally underrated Perception stars Eric McCormack (of Will & Grace fame) as an academic with schizophrenia. McCormack’s performance I admire in particular because he has now played a gay man despite being straight and a schizophrenic man despite, as far as I know, not being mentally ill. Danes’ performance came to a magnificent zenith in a scene where her character, as a result of not taking medication experienced a manic episode. It was as though she had read my mail, although I will say that I do not think it went crazy enough. True mania can be bewildering and terrifying to watch. Danes was on the right track with how she acted but in my experience mania becomes far more intense than the degree to which she displayed it. Whether or not this is because a ‘normal’ person cannot understand it from the inside out or that she and the producers were concerned that they may be accused of overdoing it I do not know. I can easily imagine a scenario where a real manic episode can look completely absurd to the point where one might suspect it was being staged. It can be that bad.

The point here is that mental illness is slowly trickling into our discourse. I dream of a day when it is no longer a subject that is spoken about in hushed tones and something feared rather than treated, and the reason I do is that we have contributed to some of the great achievements of humanity. The suggestion that we ought to be bred out of the gene pool is outrageous not just for the bloody minded perfectionism it implies, but more because in doing so we will rob ourselves of our brightest and best as well as impoverishing our way of life and culture. We will take away from our descendants the opportunity to experience great art.

One fascinating study showed that children either with or at a high risk of having bipolar disorder shows that they tend to dislike shapes that are simple and/or highly symmetrical. That in a nutshell sums up why people like me are so important. We are frustrating, annoying and often subject people to experiences ranging from the sublime to the ridiculous, but to advocate getting rid of us is the wish for order, simplicity and symmetry. Not an equal society, rather a hegemonic one. A society where discrimination is impossible because there is no difference. Who really wants that? Coffee without the cream, drinks served with no cocktails or spirits. In a grey world it is the splash of colour that is often the most noticeable, most offensive and most challenging to deal with, however if you think that world with the mentally ill is hard to live in, try for a moment to conceive of a world without us. I think that would be a terrible place.