‘Flight of Ideas’

One of the current clinical definitions of “flight of ideas” is: “a rapid flow of thought, manifested by accelerated speech with abrupt changes from topic to topic: a symptom of some mental illnesses, especially manic disorder.”

I have never experienced mania and reckon that I never will. I am naturally of a quiet temperament and may be inclined to think a little more negatively than positively.  However I have found that “flight of ideas”, as a psychiatric concept, can be misapplied and misused. I have two personal examples.

First example:

In the early days of my writing on mental health I wrote a reply to a paper on the renaming of “schizophrenia”. I shared my reply with a psychiatrist colleague who sent me his perspective on it:

“There are two types of comments I want to make, one relating to the theme, and one to the way you put your thoughts across. I’ll start with the latter.

This is a very personal paper, even before you mention your sister. You are quoting people you admire, and you have a lot of ideas. This is good, but my feeling is that something written for publication in the yellow journal should have a different slant; i.e. just because you quote psychiatrists you like doesn’t necessarily mean their opinion should count, or be put together in form of an argument. The other worry I have is that when you quote there is too much of you and your opinion in it – you need to let the readers judge at the end of your argument whether we think that those guys are good guys. We don’t want to be told. Let Murray’s thoughts speak, not your own.

Secondly the paper is not focused enough, there are too many ideas which have too little connection with each other. (mind brain dichotomy, problem of consciousness, prevention versus treatment, and at the end omission of the patient’s voice). You don’t expand enough on your main hypothesis, although intuitively many of us would agree, (so why actually is salience dysregulation the better framework for care?). The paper is too crowded with ideas not sufficiently connected and too heavily reliant on your opinion.

I don’t mince my words because life is too short; but I hope you interpret these comments as what they are meant to be: as the encouraging comments from a friend.”

I  did not feel these comments to be encouraging, rather I felt pathologised. I therefore withdrew my letter for publication. I am glad to say, that since this time, I have had more letters published in the BMJ than any other Scottish doctor, alongside occasional ‘observation’ and ‘perspective’ pieces. I also had this paper published in another journal on Iatrogenic stigma.

Second Example:

In the summer of 2014, after careful discussion with my wife, I resigned from NHS Forth Valley after 13 years as a Consultant. The reasons behind this I have previously shared. On the day of my resignation, the Associate Medical Director phoned me at least three times. This Medical Director spoke rapidly in expressing concerns that seemed to focus on my mental health (this manager was aware of my only severe depression following withdrawal from Seroxat).  The Associate Medical Director, in a state of breathless concern said that she was “worried about me” as “I did not sound right” and then asserted: “you sound pressured”. I replied calmly, as I was calm: “actually it seems to me that it is you that has rapid speech”.

So that is the backdrop to this post, now many years past.

I now want to share a few words from writers, poets, philosophers and artists, including: Evelyn Waugh, Julian Barnes, Mukul Kesavan, Albert Camus, Edwin Morgan, Edmund DE Waal, J D Salinger, Oscar Wilde, Richard Holmes and Adam Nicolson:















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