## Is life a disease? The Diagnostic and Statistical Manual of the American Psychiatric Association - fifth edition (DSM-5)

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Edited by Jonathan Vernon, Friday, 16 May 2014, 06:25

A new edition of the ‘dictionary’ of mental illnesses was published this year – the catchily named, DSM 5 (Diagnostic and Statistical Manual of the American Psychiatric Association, fifth edition). Compared to its predecessors, it classifies many more types of behaviour as ‘mental disorders’.

For example, binge eating is now a disease, and you may also be categorised as mentally ill if you spend too long in front of your computer, if you are shy, or if you feel just feel sad.

Each edition of the DSM introduces us to new illnesses.
• The first edition, published in 1952, was 132 pages long.
• The 1987 edition was 569 pages a
• The 2013 edition as it has 1000.John McGowan and Anne Cooke
Its publication has provoked fierce arguments. Advocates say how important it is that illnesses are identified and treated. Critics claim that that it will lead to millions of us being unnecessarily labelled as sick and put on drugs. Some even believe that many of the conditions are simply inventions dreamed up for the benefit of pharmaceutical giants. W

Anne and John will introduce the main issues, and ask the question, ‘Is life a disease?’

Anne and John both blog regularly at Discursive of Tunbridge Wells. You can also follow them on Twitter (@CCCUAppPsy).

My view is that we should think of disease as the status quo, that  we all have something wrong with us, that this variety is part of what makes us human - we are not a troop of baboons, rather we are 7 billion lonely people, each unique, with very different brains, but also different responses to and vulnerabilities to disease. Modern science and computing in particular allows these conditions to be identified; many more such patterns will become clear as data is streamed into computers for analysis from people wearing or ingesting smart medical devices.

If this isn't a hypothesis that has been tested maybe I should take a look?

The 'error' surely is to think we can provide everyone with 'perfect health' - what will it do to us if all our 'problems' are ironed out? Will it make us less inventive? Do we have to live to 120? We need to struggle in order to progress - everything about the development of homo sapiens sapiens has been in response to problems, dangers, disease and events. I guess we'll just keep coming up with or creating new problems, in any case, even if we all had perfect health our brains - how wired during foetal development, and then what we are exposed to as we grow up, despite aspects of tribalism, makes for further difference.

Yes, life is a disease.

And the day we think we have eradicated all disease we or nature will come up with something new. In fact, I think if you had a population of 1000 people with no perceived health problems at all that within a few months one or more of them would develop some kind of psychosis - become a hypochondriac or self-harm or develop a Messiah complex just to ensure that the community had difference, a catalyst as it were, within it.
The DSM probably says the the joker/clown or comedian is a disease - a narcissistic craving for attention and adulation?

Anne Cooke is a clinical psychologist who has spent many years working in the NHS with people who are diagnosed as mentally ill. She works at Canterbury Christ Church University, training clinical psychologists for the NHS. She is currently editing a second edition of the British Psychological Society’s report ‘Understanding Psychosis’ and is interested in the way that we as a society think about and respond to emotional distress.

John McGowan is also a Clinical Psychologist. Like Anne has followed many years in the NHS by moving to academia and training clinical psychologists. As well as conducting research into self-harm and suicide he is currently editing a new British Psychological Society Report on Depression. He has written for The Guardian, the Health Service Journal and (most significantly) is an occasional columnist for Viva Lewes.

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## Reflecting on illness

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Edited by Jonathan Vernon, Friday, 9 Sep 2011, 19:12
I appreciate that some reading this will have gone through months of being unwell or their condition is long term. I am simply using ideas taught to me during H808 a year ago to reflect on what I have been through: 15 days of a ghastliness that has included a day in hospital and three clinic visits. In hospital I counted the seconds and did so for nearly five hours. At home I crave fresh air but repeatedly ended up back in bed. As the last week or so shows I would read, comment and write - though until today my head has felt decidedly befuddled. So I did some digital housekeeping, all my mind could manage, mostly shuffling pictures, screen grabs and such around in Picasa Web, even referencing them properly. And I slept a great deal. I read Martin Weller's new book but know, and will see this from notes, that a second reading will have me picking out different things and adding different notes. We humans are unstable at the best of times, gender, age and background doesn't start to define who we are and how our state of mind, openness to learning, levels of self-esteem, can influence how we will 'perform' one week to the next. Consistency, for me at least, is a futile, even a stultifying quest.
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## Piper Alpha - Disaster on an oil and gas platform in the North Sea, July 1988

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Piper Alpha - Disaster on an oil and gas platform in the North Sea, July 1988

Background / What Happened

A series of explosions and an oil fed fire on the Piper Alpha oil and gas platform in the North Sea on 6th July 1988, 120 miles Northeast of Aberdeen, killed 167 men. (Wikipedia, 2010)

Also see the moving BBC Documentary of 1989 'Spiral into Disaster.

An avoidable gas leak, followed by an explosion, that compromised other safety measures led to further cataclysmic and fatal explosions, which were compounded by a sequence of failures in safety procedures that weren't suitably 'joined-up' or authorised at a junior level. The explosions and following fire led to the death of 167 men, the loss of one rig and the closure of two others.

Lessons learnt should have resulted in a permanent shift in health & safety procedures in the oil & gas industries; events in the Gulf of Mexico would suggest otherwise

Oil production stared in 1976 on Piper Alpha with about 250,000 barrels of oil per day produced, increasing to 300,000 barrels. In 1980 the rig was converted to gas recovery ... wherein lies one of the causes of the disaster. Poor repurposing where safety was compromised.

The Piper Alpha platform comprised four modules which were initially separated by firewalls with the most dangerous operations distant from the personnel areas. The firewalls were 'firewalls' only - they were not designed to withstand gas explosions. When the rig was converted to gas some dangerous operations ended up being placed close to one of the command 'module.'

Because the platform was completely destroyed in the explosion and fire of July 6, 1988 and so many died, the chain of events leading to the disaster can only be suggested. (Wikipedia, 2010).

It reads like the run up to the sinking of the Titanic, a series of minor errors of communication and procedures comprising more series failings meaning that a single event quickly results in a cascade of other, often cataclysmic failures.

The were two pumps, A & B. The pressure safety valve on Pump A was removed for routine maintenance and replaced with disc of metal (a blind flange) with instructions that this pump must not be switched on under any circumstances. The work on maintaining the pressure safety valve was not completed when the next shift came on at 6.00pm and poor communication (failure of communication of something so important as 'DO NOT operate Pump A' failed to get through to the duty custodian. This would have not been a problem, and perhaps this situation had arisen before, but because chance would have it that Pump B lost pressure the need to operate Pump A arose. Not finding any communication to say otherwise, indeed, confusingly finding a docket that said the Pump was due for shut down for some other maintenance reason shortly, it was assumed to be OK. Fatal. When pump B stopped suddenly the Manager had only a few minutes to bring Pump A back online, otherwise the power supply for the offshore construction work that these pumps supplied would be compromised. Not being aware that there was no safety valve on Pump A and that it had been replaced temporarily with a disc of round metal across the pipe, when it came online, overpressure caused this loosely fitted disc to give way. Although six gas alarms were triggered the gas ignited before anyone could act. Further compromises in the safety system facilitated further explosions resulting in the gas line melting which released 15-30 tonnes of gas every second into the fire ... which was soon being fed by oil from two separate rigs that shared a communal oil pipe. The accommodation module where most of the men who were killed were sheltering, collapsed into the North Sea

Main Causes

106 safety recommendations were made coming out of Cullen enquiry which suggests there were almost as many causes for the disaster.

Occidental had a superficial attitude to safety the enquiry states.

‘I wouldn’t put it above or below other disasters. There’s an awful sameness about these incidents. They are nearly always characterised by lack of forethought and lack of analysis and down to poor management. It’s not just due to one particular person not following a procedure or doing something wrong. You always come back to the fact that things are sloppy, and ill-organised and unsystematic right from the top of the company downwards.’
Dr Tony Barrell, Former Chief Exectuvie North Sea Safety

I see it as a domino cascade in which each domino is twice the size of the one before ... the first domino is nothing more than a piece of paper not getting into the hands of the person who mattered, with the last domino being the collapse of the accommodation module into the sea. The BBC docu-drama on the subject was titled ‘Spiral into Disaster.’ There was an interesting interview with the former Chief Executive of North Sea Safety.

There are many contributing factors.

There was or can be ... and there was in this case, ‘a conflict between production and safety.’ Dr Tony Barrell, Former Chief Exectuvie North Sea Safety

Occidental new from a report published the previous year that there was potential for a high pressure gas explosion of such magnitude that it would be unstoppable.

* Pressure valve Pump A removed, this procedure poorly communicate to those who mattered.
* A second docket had been approved to take Pump A out for two weeks for routine maintenance. Failure to link these two permits proved disastrous.
* Replaced with ill fitting/unsuitable metal disc.
* Change of shift further compromising the failure in communication.
* Failure to ensure the new shift manager understood the state of Pump A 'because he was busy.'
* Simply put, the ‘procedures collapsed.’
* Loss of pressure in Pump B. It repeatedly failed to start risking the drill in operation getting stuck and all kinds of financial compromises and problems this leading to the necessity of calling in Pump A – which would not have happened had the docket saying it MUST NOT be started been seen.
* The pressure of gas once pump A came on was so great that it leaked  passed the temporary metal plate.
* The safety valve that had been removed was sighted 15ft up and out of sight – otherwise someone may have noticed that this vital piece of equipment was missing.
* The first explosion
* Compromised by
* a) 1 of 2 parts of the automated fire fighting ‘deluge’ system on manual as for 12 hours of the day divers were in the water. (If activated the system would have possibly sucked them into the water drenching system). It was switched over regardless of where divers were working – on other rigs it would be isolated only where the divers were working, and only when they were in the water – not for longer, indiscriminate periods.
* b) proximity of a dangerous appliance to the command module (a failure in rig design when it was repurposed from oil to gas in 1980)
* c) modules not built to resist gas explosion, but only fire.
*  Two men attempted to reach the deluge system to activate it. They left the accommodation block risking their lives ... and were never seen again.
* oil was being fed from two nearby rigs into a communal pipe. Due to loss of pressure on Piper Alpha this oil was drawn INTO the fire, feeding the flames which instigated such a powerful explosion that is engulfed the accommodation block and killed two rescue workers in a craft at the rig's base.
* riggers on these other two platforms felt they had no authority to shut off the oil that was evidently feeding the flames that were nearly 100m high. This delay because they felt inhabited from acting without the OK from senior managers who were hard to contact (on land) ... sounds like junior officers being unable to take the initiative from their generals in the First World War!
* Flames and smoke were being blown across the heli-deck preventing any rescue from here.
* Whilst fortuitous that the Occidental fire fighting vessel Tharos was at Piper Alphas it had to compromise on the powerful water cannons a) which were started to fast, jammed and had to be restarted over a ten minute period and b) they could put into operation as being hit by this powerful shot of water would kill a person c) the bridging crane would take an hour to extend to the platform ... when the next huge explosion occurred release 3 tonnes of gas per second, the Tharos had to retreat.
Those from the accommodation block who survived had ignored what little safety training they had been given, made their way under the rig and eventually jumped the ten storeys into the North Sea – some survived this, not all.

Main Effects Short Term

* 167 men killed.
* 167 grieving families and funerals.
* A memorial statue in an Aberdeen Park.
* An enquiry.
* Responsibility for safety on the rigs taken from the Department of Energy and put into to the Department of Health & Safety.

The Cullen enquiry concluded that the initial condensate gas leak was the result of maintenance work being carried out simultaneously on a pump and related safety valve. The second phase of enquiry made 106 recommendations for changes to North Sea Safety procedures, all of which were accepted by the industry (though you wonder what BP have been doing the last decade)

Occidental sank the remains of the Piper Alpha rig a year after the disaster and sold its interests in North Sea oil & gas exploitation.

Main Effects Long Term

Health & Safety measures and standards improved ... across the industry?

Billions spent on redesigning and improving the North Sea platforms. And all offshore platforms?
Putting in seabed shut off valves.
Lifeboats brought under the accommodation blocks

‘So much has been learnt from it, at least future events will have been prevented.’ Dr Tony Barrell, Former Chief Exectuvie North Sea Safety (Until 2010)

There are typically 10 gas escapes of the type they initiated the disaster on Piper Alpha a year ... it’s taken 22 years for another disaster on the scale of Piper Alpha to occur again.

Creation a the Piper Alpha Package .. . yours for $595. Obviously a price BPs' training and/or heath & safety department haven't been willing to play. Health & Safety 'Important to think the unthinkable.' Dr Tony Barrell, Former Chief Exectuvie North Sea Safety Not inclined to spend a lot of money on things that are considered extremely unlikely ever to occur. Local Impacts Any oil on the North East coast? Not aware of any (Though as a child enjoying these beaches in the 60s there were patches of oil washed ashore from time to time that killed birds and threatened the bird sanctuaries and grey seal of the Farnes Islands). Minimal. The North Sea Oil & Gas continued to thrive as long as there was/is oil and gas to retrieve and a market for it. A number of men from Aberdeen and Oban involved in the rescue attempts receiving the George Medal for bravery. A play 'Lest we forget' recalling the events of the disaster being performed on the 20th anniversary. Global Impacts The oil industry has had to pump more into health and safety .... more than it and its shareholders would have liked? BP has set$20bn aside to alleviated the impact on the Gulf Coast. How will other oil companies behave? How will the insurance industry respond?

Substantial sums will now be set aside to alleviate future potential environmental impacts.
Offshore oil exploration has had a set back.

Will this see more emphasis going into nuclear ?

Things that have changed as a result of that event

Not enough, evidently.

As above, in theory 106 changes in practice.

• Better Health & Safety.
• Fewer tragedies of this magnitude.
• Shareholders don't get a dividend.
• The BP CEO might find he's dipping into his £10.8m pension pot earlier than planned.

Permalink 3 comments (latest comment by Lucy Hollingworth, Saturday, 26 Jun 2010, 13:13)
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