i-29e06d06af4d7cc9b0348e43251879c4-freebrain.jpg It's a new year, bringing new changes. I've decided to quit Omni Brain and move on to less important things, like creating baffling and somewhat offensive art and writing more books that I won't want anyone to read. It's been fun to be here, though. I'm grateful to Steve for being a terrific co-blogger, thankful to ScienceBlogs for hosting, and am glad we've all shared lots of laughs.

There's been plenty of silliness and also some seriousness. On pondering what to write in a farewell post, it seems appropriate to share a piece of writing I never really knew what to do with. It exposes the fragmented angles comprising the mental health field. So un-funny that it's absurdly funny; none of the factions involved would publish it and concede to some of the other points of view. Grey in a B&W world is near invisible.

Thanks for the lolz! Bye!


The thing about diabetes is that while some people manage fine with insulin injections, others go into diabetic comas.

When they do, they can die. But they don't always, and there are millions of people lying on sidewalks in comas, alive but unaware and incapable of communicating with any logic or coherency.

People step over them and say, "Get off the sidewalk! Get a job!" but the people in comas can't move.

Often critics say it's their own fault they're in a coma, they didn't eat the right foods and didn't take enough drugs to prevent it. Slothful, sinful, stigmatized.

Others call it freedom and self-determination. They say that people experiencing comas have the right to lay on the sidewalk for as long as they want. Doesn't matter if they waste away because they can't feed and shelter themselves, if they are robbed because they can't defend themselves from criminals, if they don't bathe and passersby turn up their noses. They may totally lose the ability to communicate through extended lack of speaking. But those who want to speak for them, who claim kinship, say it's all a choice and an issue of personal cognitive liberty.

For some people it is. They like to induce comas in themselves, and say that dreaming while in a coma is spiritual and sacred and will change humanity in 2012, a religious experience to be in a coma surrounded by the right music and people. They point to ancient forest tribes who built ceremonies around inducing comas. Those comas, though, have little to do with the guy sleeping in an alleyway soaking in his own urine. No magic potion.

The potions, the substances used to induce comas also cause euphoria and amnesia, so many if not most of those who use it are not seeking the divine, they're seeking temporary escape from miserable lives, or sometimes just a laugh. They don't chant and hold hands around bonfires. They crush pills and snort them in trendy club washrooms.

Trouble is, while people in comas may dream about love, it's unpredictable. The coma may bring peace but it may bring violence, and those that kill in their dreams kill for real. The violence is no altered perception or distortion of vision, death is death.

The victims of coma victims are often cops patrolling the sidewalks they're found on. So naturally, the law, the politicians and the people are mostly opposed to the substance that causes brief comas, and dislike dealing those who are in real comas. When somebody is found in a coma, it's assumed the substance is the cause, and they're thrown in jail from distrust. When the people in permanent comas don't follow orders or respond like those who've recovered from their induced comas it's considered bad behaviour and guards put them into solitary confinement. At times they're executed while still in the coma, assumed to be faking it.

A handful of advocates assert that diabetic coma victims shouldn't be on sidewalks where tragedy can happen, and that diabetes and resulting comas have nothing to do with taking a substance for kicks or escape from boredom or cultish New Age worshipping. The people who've been in the real comas have had limbs cut off and nearly died from other complications. They don't like comas. They know they aren't desirable. They want to be healthy.

Those who understand that, the advocates, pick up the diabetics from the sidewalks and put them in hospital beds. They're given medicine. There are anti-coma drugs, and atypical anti-coma drugs. The great thing is, most people who take these drugs are able to see and hear and understand again. They gain back their strength and clarity and purpose. They take joy in learning how to feed themselves and live in houses, not sidewalks. Though like may not be quite the same as before the coma, they get their lives back. Some go on to help other diabetics through peer support.

The problem is that half the people who take anti-coma drugs end up with an irreversible movement disorder that makes them uncontrollably contort their faces, frightening ordinary people who see them. It's so bad that some diabetics prefer the comas. Supposedly fewer people will develop this condition if they take the atypical anti-coma meds, but some still do, and the atypicals also make people so obese that there's a dramatically increased mortality rate in people who take them. There is one atypical anti-coma drug that doesn't do either, clozapine, but instead it can cause a serious blood disorder, and sometimes kills with one dose. Those are the choices, then: disfigurement, weight gain, or death from a blood disorder.

Those dire possibilities are why some diabetics don't want to be forced to take the drugs when they're in a coma, and don't want to keep taking them in between coma relapses. Why they'd rather be drug-free. That, or they don't believe they're ill and so the drugs are like poison to someone who isn't sick.

Other types of drugs can make people in comas calmer, and some treat different diabetic deficits, but otherwise, there are very few other effective anti-coma drugs. Just the one category of chemicals with the major drawbacks, and they don't always work. Not all people in comas wake up. Some never do. They remain in their kind of dream state, unable to feed or wash themselves, indefinitely.

Despite that, hospitals were closed en masse and beds are still being rapidly downsized with the idea diabetics can take anti-coma pills at home and that's good enough treatment. Cheaper that way. It's synergistic that there are people defending the "rights" of diabetics to be in comas on sidewalks. Because that's where many will end up.

Often they do want to help. They talk about wellness and recovery and having a positive attitude. They work to prevent diabetes. And many diabetics learn to self-manage their illness, a little dazed but getting by with diet and exercise and support groups.

Just not the ones in severe, persistent and recurrent comas.

Talking to someone in a coma doesn't wake them up, and neither does chaining them to the ground and beating them, which still continues to happen in parts of the world like Zambia, Malaysia and India.

Some people think all you can really do is put them in a soft bed in a comfortable environment where they won't get hurt and can't hurt anyone while they're dreaming. It's the nicer version of chaining them to the ground.

Others like to make jokes about diabetes and sneer and use coma terms as a putdown, treating diabetics as subhuman, discriminating against them in housing, jobs, social situations. There are sitcoms, movies, songs, books, comics, and many web sites openly spreading hate. LOLZ. Why should they deserve any treatment? They're dangerous and weird.

The other extreme is the coma pride movement, diabetics who say they are not only not defective, they are superior. They don't want treatment and they point to great works of art made in or about comas, as well as abilities enhanced with milder symptoms of diabetes. Eradicating diabetes might interfere with the work of a potential genius, a brilliant artist or savant. There are lists of afflicted celebrities (mustn't call it an affliction, it's not PC), most of whom died from diabetes and comas, whether or not their work benefited from illness.

More rational people are researching solutions to the problem of diabetes and diabetic comas. Better chemicals, they promise, and machines that cure. They've come up with nifty new ways to take anti-coma medicine, delivered in teeth and patches and time-release formulas. But the medicine hasn't really changed at all.

Scientists examine the body and explain in detail what happens during a coma. Many study other functions of the pancreas, how it works when it's healthy, how to treat other diseases affecting the pancreas. There are nearly as many pancreas specializations as there are cells, and they don't always communicate with each other.

In looking at how the pancreas works certain cells and processes have been identified as "promising new therapeutic targets." There are dozens of experimental chemicals and neurotechnologies in development to follow up on those promises. Eventually there will be a new anti-coma treatment that's effective and has no severe side effects. That's the hope.

But there are people who fight against them, claiming that drugs for diabetes are marketed to people who don't need them by drug companies only in it for the money. They say that studies of the pancreas are "pseudoscience" and they like to self-publish misleading statistical reviews on PLoS.

What they don't often tell you is that they actually think there's no such thing as diabetes, diabetics are whiners who can simply change their ways and if they hurt people while they're dreaming in comas they oughtta be shot. Also that doctors diagnose people as diabetic just so they can control society. A religious sect thinks of diabetics as political prisoners. Some also think these things because of their religion. They go on national TV and say there's no diabetes.

Other people's religions teach them that diabetes does exist, yes, but the cure for it is prayer. They tend to not like people who study molecules in the pancreas. They prefer to think the pancreas works in metaphysical ways. If you believe in a deity it will make your pancreas work. If you develop diabetes, it's because you sinned and the deity is punishing you.

If you don't repent you will end up in a coma on a sidewalk being beaten and humiliated and tortured, suffering miseries with no relief in sight.

Many would call that hell.

Instead, it's the mental health system.


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Ah. All of my well-meant and serious comments on your ESP blog post are gone. Pity. Well, no use commenting any more but to wish you the best and bye.

It does sound so starkly absurd when substituting one illness for another. I particularly liked the "pseudoscience" of the pancreas in PLoS.

BTW, BF, did you notice that this post and the ESP post were written by two different people?

Ah, yes, now I have realized, as she responded to me. Not very nicely. But her comment isn't there now, I note... Despite this, I wish them the very best... just like I did before...

Best of luck with all your future projects Sandra. I hope you drop by ScienceBlogs regularly to say hi. :)

Good luck Sandra!

Thanks, everyone!

By Sandra Kiume (not verified) on 07 Jan 2008 #permalink

Sad to see SB losing another voice, especially a female one.

However, as a sufferer from chronic depression and a constant lack of motivation, I thank you greatly for that piece. Tells me that a) there's still hope and b) there are still people that understand.