“Labour’s Health Team is working on a review of policy which would mean whole person health care and bring our health service, social care and mental health services much closer together. ”

You won’t have to look far. In Wales, funding for mental health services are fingfenced and protected by legislation that also imposes a statutory duty on local authorities to provide services. Early days yet, but we are ahead of the curve.

And while your at it, you need to abolish the work capabaility test and terminate the ATOS contract. Apologising for this is the litmus test for labour for me. Until you do this, I can’t vote for you.

According to the latest report, 75% of adults with mental health problems don’t get treatment. This is a shocking statistic.

Sure. It is shocking that people will lie like that. Mainly by dumbing down the definition of mental illness to the point of meaningless. However given our almost complete inability to do any good for anyone with most forms of mental illness, doing nothing is probably the best thing we can do. So they are the lucky ones.

When it comes to the kind of intensive, face to face treatment that can be so effective, things get even bleaker.

The problem with this is that it is not true. There is only one type of face-to-face treatment that can be shown to work – CBT – and even that does not have to be face-to-face. A computer can work as well as a therapist. The rest appear to be an expensive waste of time and so we should not be funding them at all.

In Hillingdon, West London, 0.01% of patients suffering from depression or anxiety related illnesses receive treatment. That’s 17 out of 29,000.

The entire population of Hillingdon is 266,000 or so. So we are being asked to believe that over 10% of the local population has depression of anxiety-related illnesses? I think not. This is just massive over-diagnosis by doctors out to make a lot of money from the gullible tax payer. 17 out of 266,000 is probably about the right number of people who should be getting any treatment at all.

The state of children’s mental health provision is equally bad. 78% of children are rarely able to get access to the services that they need.

Rarely able? Again one of those lovely little misleading phrases. How rarely is rarely?

The report also reveals that NHS practitioners seem ill-informed as to the prevalence of mental health problems. GPs are the first point of contact for any illness, and with mental illness, they are the prime providers of medication. Yet many GPs don’t do any training in mental health and as a result, fail to recognise physical symptoms as having mental causes.

In other words doctors, who meet patients, don’t think they are mentally ill. But the usual suspects and lobby groups, out to inflate their budgets, want to bully them into over-diagnosing. Perhaps the GPs who actually see the patients and have a lot of education know more about their patients health than people who have never seen said patients and know little about anything?

But their existence is threatened by the uncertainty and fragmentation caused by this government’s NHS re-organisation.

So it is not that their budget has been cut but that their budget might be cut? Perhaps the best start would be to stop suggesting it might be?

GPs as the frontline in mental health provision need to diagnose better and be more aware of mental health issues, while the NHS as a whole needs to target more of its resources towards the issue.

Dianne Abbott has a history degree. Yet she sees fit to lecture doctors on how best to treat their patients. Interesting. The NHS is short of cash. The whole country is short of cash. It is time we stopped indulging the sad and the self interested. We ought to cut funding for all mental health except asylums.

A concentrated effort on mental health would be cost-effective as well. The cost of more psychological treatments is low and the recovery rates are high. Whilst the benefit of having more people settled and working are obvious.

Recovery rates are not high. Unless you count people who are merely unhappy. Nigeria has better outcomes for schizophrenics than Britain does. We do worse than doing nothing. Giving people a mental illness diagnosis is the jack pot in life because it means not working any more. We need less of it, not more.

‘GPs as the frontline in mental health provision need to diagnose better and be more aware of mental health issues, while the NHS as a whole needs to target more of its resources towards the issue. This is especially so for vulnerable and socially excluded groups who can fall through the gaps with tragic consequences.’

A brilliant article and agree with everything but I think, personally, that a lot of the reason why people don’t seek help is the lack of privacy when it comes to health records. What happens when a new employer finds out you’ve had a history of mental ill health? What then?

This did put me off for a while (and the problems worsened) when I needed help the most yet when I did seek help a treasure trove of unspoken-about help was unearthed.

However I now feel I can be discriminated against in the same way as someone with a criminal record.

Thirty years ago nobody in China suffered from depression. They couldn’t, because there wasn’t even a word for it, but the condition was imported and “statistics now show” that depression rates are running at 5% of the population.

Michael R. Phillips, executive director of Beijing Suicide Research and Prevention Centre comments.

“Actually we do not really have evidence to prove that mental illness is becoming more and more common in China. What has happened is a gradual increase in the awareness of the problem.”

Indeed.

I’m with SFMS on this one.

“Yet many GPs don’t do any training in mental health and as a result, fail to recognise physical symptoms as having mental causes.”

In my experience it has been the exact opposite. My relatively rare (but by no means unheard of) physical conditions were only diagnosed after I had endured doctor after doctor telling me I was just depressed and/or anxious. One GP even ranted at me telling me there was nothing physically wrong with me, and insisted that if I didn’t try antidepressants then she couldn’t help me any further. Every person I know with my condition(s) could tell a similar story. For some, it can delay the correct diagnosis by many years.

If GPs are going to be educated about mental health then they need to be taught that you must rule out organic/physical causes of symptoms first, and not be too quick to decide someone is mentally ill. It can be an absolute nightmare to try and persuade a doctor that your symptoms need investigating, when the more frustrated you become the more they will take this as ‘evidence’ that you are just depressed.

This situation is made even worse if the patient happens to have a history of mental illness, as I did. Good luck, then, getting any doctor to take physical symptoms seriously. Thankfully I saw one sensible GP who reasoned that mental and physical illness are not mutually exclusive. Seems like common sense, but you’d be surprised how many doctors act as though it’s not the case.

I am surprised that a supposedly clued up senior politician is ‘surprised’ about the parlous state of our mental health services.
Why do you think psychiatry has a reputation as a perennial cinderella service? Obviously the ‘lack-of-care in the community’ policy has yet to permeate the higher echelons.

GP knocking is also incredibly unhelpful – this group manage the vast majority of patients with mental health problems (and all of the social issues that go hand in hand with alcoholism, severe mental illness, etc).

If Labour MPs are genuinely concerned about patients with mental health problems then the first thing they need to reconsider is their party’s obsession with a health market.
Look at Alan Milburn and Patricia Hewitt’s contribution to the NHS – PFIs, ISTCs and the abolishment of continuous 24hr GP care – the sort of money-making developments Andrew Lansley can only dream about (and I’m sure like his Nu-Labour predecessors it will not be too long before Andy joins Patricia and Alan on the board of a private health company).

The DoH is like a gargantuan factory pumping out an endless stream of diktats – it is clear to those of us on the ground that there is a massive disconnect between ivory tower policy makers and those tasked with the actual care of patients.

For example, it is known that acute psychiatric beds are often over subscribed yet in our locality a third of such beds have just been closed – of course (following a sham consultation process) these closures are wrapped up in the usual rhetorical bullshit about how patients prefer their own home to a hospital bed – yet as a result of these closures very disturbed patients now spend longer in A&E while the poor old psychiatrist desperately tries to identify a bed within a 20 mile radius.

@ Pagar,

Yes, it’s another so-called problem invented by irrational people who are making it all up!

default response of a bloggertarian.

Thirty years ago nobody in China suffered from depression. They couldn’t, because there wasn’t even a word for it,

That comment is surely meant to be in jest?

“Actually we do not really have evidence to prove that mental illness is becoming more and more common in China. What has happened is a gradual increase in the awareness of the problem.”

How the hell do you get from ‘an increased awareness of the problem’ to SMFS’ 19th Century idea that the only true mental illnesses are those requiring incarceration in asylums?

Thirty years ago nobody in China suffered from depression. They couldn’t, because there wasn’t even a word for it,

Go back far enough and there were no mental illnesses at all – just imbalances of the humours, or demonic possession.

That’s the thing about science: paradigms shift when theories are constructed to account for empirical evidence.

I’d like to hear more discussion of neurodiversity.

I’m bipolar, which is a mental illness by any definition, but I also have Aspergers, which, since I am high functioning, need not be a problem. My employer has followed the lead of successive governments in imposing a target culture and a strict regimentation of work processes – in a word, neo-Taylorism – based on neurotypical norms and which completely ignore differences in mental processing. This increasing regimentation of work patterns means that those of us who fall outside these norms are increasingly marginalised.

If I had mobility issues or back problems I’d have a ramp built or a special chair. The fact that my processes are different means I am treated like a problem, not someone who’s processes actually make me better at at some things (data processing or pattern recognition, for instance) than others (interpersonal skills).

Mental Illness, like all illness, operates on a sliding scale. There’s no ‘on/off’ switch for it.

Like a lot of illnesses, it can sometimes be countered with a few basic changes, such as the changing of thought processes, changing behaviour, and in some instances it needs some professional intervention.

What we need is not to argue about the extent in which these illnesses affect people but a cultural shift in how we understand them. Generalising the huge array of mental illnesses that exist is as helpful as generalising any illness; “You’re ill, have some fruit and veg and rest” does not work for everything, and the same is true for mental illness and wellbeing. My understanding of the current problems with mental illness is that treatment is very unresponsive to the needs of the person suffering. As far as I’m concerned, preventative treatment should be encourage as early as possible to prevent them developing into something worse. At the moment it seems like it’s only counted as serious if you’re bouncing off the walls or hanging over a precipice.

We have become more advanced as a species at recognising problems. Automatically discounting the discoveries made in understanding human wellbeing as simple fodder for funding groups is not only insulting to people who suffer with these problems, it’s also blithely accepting that somehow, everyone is actually more simple than you think and that we’re all similar. If you can accept that people *are* in fact different, then you can accept that people’s succeptibility to mental illness is also different.

I’d argue that there needs to be more responsiveness to the needs of people who are suffering, as well as a general mental wellbeing guidline, in the style of encouraging healthy eating or stopping smoking. And I’d bet some important anatomical features that mental illness feeds into a large array of social ills. Humanity, as far as I’m concerned, starts with the mind. If we don’t prioritise that, then worse things will follow. Fair play to the OP for this article, hopefully you can badger people into making actual policy commitments.

It was not a GP that diagnosed my grandsons autism, it was the teachers at his school who suspected he was autistic. Sure enough he was eventually diagnosed with High functioning autism.

My youngest daughter who has OCD was told by her GP to “embrace her anxiety”, at the same time he refused to give her beta-blockers which help with panic attacks. She does not want to take antidepressants because she is an artist and they take the edge off her work.

People with mental health problems should not be fobbed off by GPs who don’t always fully understand what they are dealing with.

9. Shatterface

How the hell do you get from ‘an increased awareness of the problem’ to SMFS’ 19th Century idea that the only true mental illnesses are those requiring incarceration in asylums?

I know better than think I won’t be misrepresented, but that is not my position. My position is that we cannot help people with mental illnesses. We can, at best, keep them quiet, which does nothing except prolong their illness. So we should stop pretending we can.

Shatterface

That’s the thing about science: paradigms shift when theories are constructed to account for empirical evidence.

What empirical evidence? We know nothing about how the brain works. We know less than nothing about mental illness. I would say we are at the leeches and bleeding stage if I was in an optimistic mood. We have not increased our knowledge of the brain by much since the 19th century and of mental illness hardly at all. So what new evidence do you think has come in? The fact is doctors give new names to old diseases, but this does not mean they have learnt something new. It means they want to escape prejudice and look like they are making progress. They aren’t.

Shatterface

I’m bipolar, which is a mental illness by any definition, but I also have Aspergers, which, since I am high functioning, need not be a problem. My employer has followed the lead of successive governments in imposing a target culture and a strict regimentation of work processes – in a word, neo-Taylorism – based on neurotypical norms and which completely ignore differences in mental processing. This increasing regimentation of work patterns means that those of us who fall outside these norms are increasingly marginalised. …. someone who’s processes actually make me better at at some things (data processing or pattern recognition, for instance) than others (interpersonal skills).

I know this is going to be misinterpreted too, I know, but I have to ask – surely a high level autistic is better off in a world where the main relationship with their manager involves numbers and patterns (ie that neo-Taylorism you are describing) rather than a more personal approach using interpersonal skills? Isn’t that an example of the sort of changes they ought to make to make someone with Aspergers more comfortable?

12:42 pm, June 20, 201212. Albert Spangler

Mental Illness, like all illness, operates on a sliding scale. There’s no ‘on/off’ switch for it.

You test for HIV you get back a yes or a no. You don’t get a test that says perhaps. Most illnesses do not remotely operate on a sliding scale. Yes, something like liver damage can be a spectrum, but malaria isn’t.

“You’re ill, have some fruit and veg and rest” does not work for everything, and the same is true for mental illness and wellbeing.

It is better for people with mental illnesses than what we are doing now. People have gone back and looked at the records from the previous century. They did next to nothing for their patients and they were more successful than we are today.

My understanding of the current problems with mental illness is that treatment is very unresponsive to the needs of the person suffering.

Sorry but what? Mental illnesses are entirely about the needs of the person. How can they be otherwise?

We have become more advanced as a species at recognising problems. Automatically discounting the discoveries made in understanding human wellbeing as simple fodder for funding groups is not only insulting to people who suffer with these problems

Sorry but what discoveries have we made with understanding human well being lately? Let’s look at SSRIs. It turns out they do not work the way we think they work and in fact they may not work at all.

I’d argue that there needs to be more responsiveness to the needs of people who are suffering, as well as a general mental wellbeing guidline, in the style of encouraging healthy eating or stopping smoking.

But what are their needs? In World War Two the Germans had a simple policy – no soldiers was allowed to escape the Army simply because they were mentally ill. Soldiers were kept as close to the Front as possible. In uniform. Mixed with other soldiers. The Allies sent pretty much everyone home. The number of German soldiers who were not eventually cured was low, while hundreds of thousands of Allied soldiers remained in hospitals decades after the war ended. Now everyone copies the German approach. It looks cruel. It often is cruel. But it serves the long-term interests of the patient. Needless to say we copy the Allied approach. We give no one an incentive to get better and by paying them – and giving them pity – we give them every incentive to remain sick. It is no surprise that we are so bad at curing people. True compassion must start with the long term health of the patient in mind.

Lynne

It was not a GP that diagnosed my grandsons autism, it was the teachers at his school who suspected he was autistic. Sure enough he was eventually diagnosed with High functioning autism.

Yes. But actually that can be read two ways can’t it?

14

Most illnesses DO operate on a sliding scale, you are confusing diagnosis with the impact on the person. Most cancers affect the sufferer on a sliding scale, dementia, MS, back-pain even broken limbs, your problem is that you can only perceive the world as polar opposites.

Looking at the essence of the rest of your post, you appear to be offering the notion of normalization for mental health sufferers, which is something the Mental Health Services have been attempting to implement, The Community Care Act (1991) started the ball in motion. Unfortunately, our culture still perceives those with a mental illness as some kind of mad axemen and are discriminated against by employers, many have to suffer intimidation from their neighbours and experience a solitary lifestyle.

Your history of mental illness seems to be flawed, since the 19th century most sufferers were held in asylums, which were often open to visitors to stare at the ‘lunatics’, very little therapeutic work was undertaken but that didn’t matter, they were out of sight.

In all areas of medicine, research is advancing our understanding and possible treatment of illnesses, but there are millions spent on cancer research and still we are no further forward in treating certain cancers in the same way that certain mental illness is proving hard to treat.

“Most illnesses do not remotely operate on a sliding scale”

In terms of the effect on the patient, virtually all illnesses operate on a sliding scale, with at one end patients only having minor effects from it, and on the other end the illness causing severe disabling effects. When you add the interaction of the various treatment options and how patients manage a condition you are talking about varying the scale even further to encompass almost every medical condition you can think of.

3 examples;

1. Multiple Sclerosis
2. Asthma
3. Tinnitus.

Even when you are talking about more serious life threatening conditions, the difference in outcomes is vast depending on treatment. A stroke can kill you, , cause severe disability, or if you get good treatment promptly you can walk away from hospital virtually unscathed within days (lifelong medication mind…).

14

It was another kind of doctor who diagnosed my grandsons autism. GPs know little about autism. My grandson also has epilepsy which can be treated and kept under control.

Not recognising or treating mental health problems is not being compassionate. Its more likely to push someone into commiting suicide.

I’m not surprised the germans sent there mentally ill people to the front during WW11. Good heavens their leader was a psychopath.

15. steveb

Most illnesses DO operate on a sliding scale, you are confusing diagnosis with the impact on the person.

You have moved from talking about the illness to talking about the effect on people. Yes, malaria can affect people in different ways. But whether they have it or not is a lot simpler. That does not apply for mental illness. We have no objective test for virtually all mental illnesses. The Americans try with their rather cute little check lists, but it still comes down to the opinion of the doctor. Who have been shown not to be objective.

Unfortunately, our culture still perceives those with a mental illness as some kind of mad axemen and are discriminated against by employers, many have to suffer intimidation from their neighbours and experience a solitary lifestyle.

Actually the downside to the dishonest 1-in-4 claim is that if you claim everyone is mentally ill, then the majority are treated no differently from everyone else.

Your history of mental illness seems to be flawed, since the 19th century most sufferers were held in asylums, which were often open to visitors to stare at the ‘lunatics’, very little therapeutic work was undertaken but that didn’t matter, they were out of sight.

Sorry but could you please name for me one single 19th century asylum that still allowed people to come to stare at the lunatics. At least one after, say, 1850. Yes, very little therapeutic work was done. Virtually none in fact. And they got better results than we get today. For most of Western history not going to a doctor was better for your health than going. The same is true of mental illnesses today.

In all areas of medicine, research is advancing our understanding and possible treatment of illnesses, but there are millions spent on cancer research and still we are no further forward in treating certain cancers in the same way that certain mental illness is proving hard to treat.

Certain cancers. But in fact we have learnt a great deal about cancer, how they are caused, how they grow, how they can be detected, how they can be treated. Some forms of cancer are now highly treatable. Some forms of cancer – especially in children – are virtually always curable. None of that applies to the mentally ill. For them we have no idea if schizophrenia is one disease or many. We have no idea about causes. We have no new treatments. In fact for the mentally ill we have CBT for minor problems. We have electro-shock therapy for serious depression. And what else? That is about it. Lithium perhaps although that is debatable. EST is not new by any means. Psychiatry is the branch of medicine the 20th century passed by. Not because doctors didn’t think their leeches worked, but because their leeches did not, in fact, actually work.

[18] ‘And they got better results than we get today’ – you’ve said this more than once (@14) but what do you mean?

On the one hand you seem to be saying that psychiatric illness does not exist as a definitive clinical entity, for example you say ‘The Americans try with their rather cute little check lists, but it still comes down to the opinion of the doctor. Who have been shown not to be objective’ but then assert that results were better in ye olden days (pre-functional MRI, etc)

You can’t have it both ways – either psychiatric illness as a bio-neurological entity does or does not exist, and if it does then there needs to be objective criteria as what does or does not constitute ‘better results’.

Your thinking is clearly muddled on this matter yet it does not prevent you from taking a judgemental approach about doctors and patients alike – rather like the t’fail’s philosophy you seem to have no reason to let ‘facts’ to get in the way of your own preferred agenda.

18

Unfortunately, as you only see the world as polar opposites, with no sliding scales, you are lumping all people with mental illness into one category. Those who suffer from schizophrenia are less likely to hide the affects of that illness, those who suffer from anxiety and depression tend to isolate themselves so they are not observed. People with schizophrenia are more likely to be hospitalized as a result of an initial diagnosis than those who suffer from anxiety and depression. Depending on the illness and/or whether the person is being treated effectively, will determine the extent of the impact on the person. The term ‘mental illness’ is a general term which is only as helpful as calling someone ‘overweight,’ it guides that person to the appropriate services.

So you think that 1850 wasn’t part of the 19th century, oh dear, you have got problems haven’t you?

I know better than think I won’t be misrepresented, but that is not my position. My position is that we cannot help people with mental illnesses. We can, at best, keep them quiet, which does nothing except prolong their illness. So we should stop pretending we can.

Horseshit. My bipolar condition is largely stabilised due to medication – I don’t have the extreme I did as a teenager – and my OCD is almost entirely under control: I don’t spend half the night checking doors are locked and lights are off, for instance. So your claim that we can’t help people with mental health conditions is demonstrably untrue.

What empirical evidence? We know nothing about how the brain works. We know less than nothing about mental illness. I would say we are at the leeches and bleeding stage if I was in an optimistic mood. We have not increased our knowledge of the brain by much since the 19th century and of mental illness hardly at all. So what new evidence do you think has come in? The fact is doctors give new names to old diseases, but this does not mean they have learnt something new. It means they want to escape prejudice and look like they are making progress. They aren’t.

Again, simply untrue. We know far more about the brain than we did even a decade ago let alone the 19th Century, and we know a great deal about the mechanisms of depression, etc. You seem to be projecting your ignorance onto those who actually study psychology for a living.

I know this is going to be misinterpreted too, I know, but I have to ask – surely a high level autistic is better off in a world where the main relationship with their manager involves numbers and patterns (ie that neo-Taylorism you are describing) rather than a more personal approach using interpersonal skills? Isn’t that an example of the sort of changes they ought to make to make someone with Aspergers more comfortable?

Not remotely. You seem to have a bizarre faith in the logic and efficiency of bureaucracies. Top-down processes are designed and imposed by people not actually doing that particular job and take no account of the knowledge and experience of those doing it, or the personal idiosyncrasies of the individual.

Bureacratic procedures aren’t designed for efficiency: they are designed so that the performance of one staff member can be measured against the performance of another. To do this each staff member is required to operate in exactly the same manner: otherwise the data collected in each staff member can’t be compared.

It’s fuck all to do with logic or efficiency.

SMFS,

Why do you think SSRIs do not work?

[22] no better than placebo according to the JAMA http://www.science20.com/natural_medicine_101_jeffrey_dach_md/ssri_antidepressants_no_better_placebo_says_jama

There seems to be a current land grap by psyciatrists to include as many people as possible within their realm. See the debate over DSM V
http://online.wsj.com/article/SB10001424052748703525704575061851569968656.html

Here there are attempts to redefine grief as depression. To try to predict who may suffer from mental illness and ‘treat’ them.

As well as continuing attempts to remain in control of medically unexplained diseases.

Having looked at how psyciatrists have tried to use CBT to cure ME I see a very poor standard of science where questionaires show slight improvements but objective tests don’t or get dropped. This then gets translated into ‘normal function’ thresholds which are far from normal and then translated into recovered. All peer reviewed of course. This line of research has for many years killed off biomedical research into ME although a couple of norwegen oncologists seem to have a potential breakthrough. http://debortgjemte.com/2012/06/07/the-drug/

Over the years psyciatrists have claimed many other diseases (e.g. parkinsons and MS) and failed with their methods. The question becomes how many of those diseases classified as mental health disorders have neurological causes which could be effectively treated this way rather than through ineffective talking theropies.

Of course the psycs have realised this hence the land grab in the DSM V guidelines and attempts by others to say neurology and psyciatry should be merged.

19. the a&e charge nurse

you’ve said this more than once (@14) but what do you mean?

I mean if you look at people five years out from an admission, they were much less likely to have been back and have on-going problems in 1910 than they are now.

On the one hand you seem to be saying that psychiatric illness does not exist as a definitive clinical entity, for example you say ‘The Americans try with their rather cute little check lists, but it still comes down to the opinion of the doctor. Who have been shown not to be objective’ but then assert that results were better in ye olden days (pre-functional MRI, etc)

You can’t have it both ways – either psychiatric illness as a bio-neurological entity does or does not exist, and if it does then there needs to be objective criteria as what does or does not constitute ‘better results’.

I don’t think we are sure that mental illnesses exist as a definite clinical entity. We may be lumping many diseases in under one label. We may be confusing one disease that manifests in several ways. We don’t know. I might agree that something like schizophrenia seems consistent across time and culture and so it probably does exist as a real disease, but it is hard to be sure. We have no tests. But I can have it both ways. After all, we used to have virtually no clue about the causes or nature of physical diseases. Doctors treated them anyway. We can be pretty sure bleeding and leeches did not help. Burning poor King George III with hot irons almost certainly did not help. Even though they did not know what he had and we can’t be sure. I agree there needs to be objective criteria. What is wrong with whether or not the patient relapsed?

steveb

Unfortunately, as you only see the world as polar opposites, with no sliding scales

Unfortunately this is an all too common response by those who have nothing to say about the actual argument.

Those who suffer from schizophrenia are less likely to hide the affects of that illness, those who suffer from anxiety and depression tend to isolate themselves so they are not observed. People with schizophrenia are more likely to be hospitalized as a result of an initial diagnosis than those who suffer from anxiety and depression.

I doubt this is true but the more important issue is relevance. I see none.

So you think that 1850 wasn’t part of the 19th century, oh dear, you have got problems haven’t you?

That is not what I said. Read what I say. So. Any asylum that was charging people to look at the mentally ill in 1850? How about 1830?

Shatterface

Horseshit. My bipolar condition is largely stabilised due to medication – I don’t have the extreme I did as a teenager – and my OCD is almost entirely under control

Yes but some conditions improve over time anyway. That is why talking cures appear to work. But the key word is stabilised. They do not cure patients. They have keep them calm. We have a treatment for OCD – CBT.

Again, simply untrue. We know far more about the brain than we did even a decade ago let alone the 19th Century, and we know a great deal about the mechanisms of depression, etc. You seem to be projecting your ignorance onto those who actually study psychology for a living.

The whole SSRI debacle proves that we do not know about the mechanisms of depression at all. We know more, but not far more.

Not remotely. You seem to have a bizarre faith in the logic and efficiency of bureaucracies. Top-down processes are designed and imposed by people not actually doing that particular job and take no account of the knowledge and experience of those doing it, or the personal idiosyncrasies of the individual.

Not all top-down procedures are. Depends on the company. But that is not the point. The issue is whether a high level autistic would have more problems with an irrational person with no experience doing that actual job or with an objective set of numbers and performance criteria. I am surprised to hear you say they are better off with the personal interaction.