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An excuse to live

Last Chance Saloon is the story of Neil ‘Twink’ Tinning, a troubled, magnificent man living with bipolar disorder, and his unique attempt to understand the science behind his, and many other, mental health conditions – all while getting ready to play the biggest gig of his life.

In part 8, The Tinstones’ rehearsals continue apace but Twink enters one of his severe depressions. He travels to London’s Royal College of Psychiatrists to find out if he and others with mental illness can be optimistic about the future. He quizzes two highly influential people in the world of neuroscience and mental health, Professor Nicholas Craddock of the Royal College and Dr John Williams of the Wellcome Trust. Contains strong language.

Previous episode: Part 7 - Post-traumatic stress disorder

Next episode: Part 9 - Harleys and Alzheimer's


[Previously on Last Chance Saloon…]

Twink: What is the brain?

Scientist: What is the brain?

Twink: Yeah. As if you’re talking to a child, because that’s the way my brain works, you’ve got to talk to me as if I’m a child.

We don’t know enough, we don’t know enough about the brain, we don’t know enough in research terms about bipolar.

A good day can be as simple as getting through the day and a bad day might be thinking, well, should I go on the internet to find out how to tie a hangman’s noose?


Twink: I’ve had three bad days on the trot and last night I got very, very ill. And when I say ill I mean suicidally ill. And the wife was fantastic, and I took my meds and went to bed, and I’ve woke up this morning feeling not suicidal but full of anxiety and dread. So this is what it’s like to have bipolar and you being ill for three or four days on the trot. Last night was a bit hairy because it was like, fuck it I’ve had enough. And that’s always the cue for the idea of suicide ideation to kick in.


Twink: Okay do that again.


Twink: Hello Vanessa, how are you? How lovely to see you. Hello Nick, good to see you again. Hi.

I’m talking to the Treasurer of the Royal College of Psychiatry and the Head of Neuroscience, is that correct?

John Williams: Yes that’s correct.

Twink: Of the Wellcome Trust. So I’m going to ask you a question. Correct me if I’m wrong, but it appears to me that mental ill health is the poor relation of physical health. Nick, I’ll go to you – why?

Nick Craddock: Because the brain is very complicated and the higher functions like thinking and emotion are the most complicated part of the human body, less has been understood about mental illness than say heart disease or lung disease. So I think as we improve understanding and we show that mental illness can be understood in the same ways as physical illnesses like cancer and heart disease, I think that will actually largely change things and I think it’ll actually turn it on its head and make psychiatry the most interesting and sought-after part of medicine because really there’s more opportunity there to do good for people than in any other single branch.

Twink: The thing about suicidal thinking and suicide ideation, which is what the professionals call it, it becomes a very, very logical process. And you get these, you know, uneducated people who say ‘oh it’s just a cry for help’. Well we were talking to Nick O’Donovan and he was telling me that 30,000 people in Japan actually commit suicide on a yearly basis. I think it’s something like 3,000 people this week will attempt suicide, and I’m not saying that everybody who attempts suicide has a major mental illness, but by the act of suicide and wanting to do it, suggests that there are issues. But when you’re in that way of thinking it’s – you get into this thinking of, ‘well I’m better off dead because I’m such a pain in the arse to everybody around me’. And you start to convince your mind that that’s the most logical thing you can do.

Very Beatle-esque I think, Barry. You remember them looking down from the EMI building?

Bipolar is such a hard thing to deal with. I just wish I could cry, try and get some of the bile out. It’s as if that emotional avenue that tears come through is somehow blocked. I feel fucking shit. By Twink.

Where do you think we’ll be in ten years from now?

Nick: Can I go first but with 20 years?

Twink: Go on.

Nick: We’re lucky we’ve got treatments that can be helpful but at the moment it’s trial and error. In the future I can imagine things being much more tailored so it’s not trial and error and we actually know in advance how to advise a person on what to do and how to help themselves.

John: And to my mind I think we now have to look closely indeed at how we train the next generation of psychiatrists and clinical psychologists. How do we equip them with the fundamental knowledge and actually inspire them with the excitement that contemporary neuroscience, contemporary psychology, can offer them so that they bring in this background information, are able to start to formulate and ask the research questions that are going to move us closer towards the next goal.

Man: Thank you Twink. [Laughter]

Nick: Because of the length of time that changes will occur over and the need to have people trained to be able to deliver new treatments and understand new ways of making diagnoses, we’ve actually got now really to be training the psychiatrists at the moment, that later on in their career they can deal with that. So it really does require action now to get the right people in, to give the right training, to arm them really to be able to do all these good and powerful things later on.

Twink: So, Freud, what do you think?

But it’s amazing, you get into a cab and somebody talks to you or the driver talks to you and he says, “Oh what are you doing?” “Oh I’m doing this series of mental health films.” “Oh well I’ve had depression.” “Oh really?” Or “The wife’s had depression,” or somebody they know’s had an issue. So as far as I’m concerned the more the merrier, the more people talk about mental health, as far as I’m concerned, is the way forward, because it’s the only way we’re going to get the funding to research these issues and hopefully we can research for a better future.

It’s encouraging to see that there are professionals such as yourself and John who are trying to make things better, but the length of time to make things better is a big ambition. We’re talking 10, 20 years –

Nick: Yes, to tell people, “Oh it’ll all be different in five years,” that’s incorrect. But if people are not led to understand it’s going to be different in 20 years you’re doing a disservice, because the tools are there and if we can get funding in the right direction, if we can get the right people doing the research, if we can get people who have experience of illness to engage with the research, then there’s no reason why we won’t be able to make the difference that’s happened in, say, cancer over the last 20 or 30 years.

Twink: So I have my new toy [blows whistle] so that’s hopefully going to get your attention. [Laughter]

One, two, three, come on!

Crowd: Cheese!

John: There really is cause for optimism but actually it’s going to take a lot of really smart people a lot of effort and energy to get those hard yards, to continue to move our knowledge base forward and then if you like to take the real leap, which is to say well how now do we apply this knowledge in a way that’s going to be clinically relevant and useful?

Twink: I’ve been very stressed, I’m feeling very, very – I hate the word, but I’m going to have to say it, disappointed in myself. I always strive to be perhaps better than I am, better than I’m capable of, and that feeds into the self-doubt and the – once you get the self-doubt and you don’t believe in the confidence of ignorance, then I tend to spiral to depths. I can’t do any more.

Nick: It’s not an easy task but we’ll get there.

Twink: Psychiatry saves lives, as much as heart surgeons save lives. I think we need to tell people that there’s hope, because when you’re on the thick end of a real bad episode, that’s what you’re looking for – you’re looking for an excuse to live.


[Coming up in part 9…]

Twink: One of my flatmates bought a Harley-Davidson and I always could remember him coming home, because you could hear it, so that’s the reason why I’ve got a Harley-Davidson, because of the sound. I just, I love the sound of a Harley roaring.


How big a problem will Alzheimer’s become in the next few decades?

Scientist: So you’re looking at 400, 450,000 with Alzheimer’s disease at the moment.

Twink: So you could fill this stadium six times and there still wouldn’t be enough room.

Scientist: Yes.

Twink: The gig, is, it’s the most exposed I’ve ever been. Unless I had some form of stability I couldn’t even contemplate it.


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