874 ANZJP Correspondence Australian & New Zealand Journal of Psychiatry, 48(9) and almost certainly does not have the financial firepower to hire the best pro- fessional lobbyists. Without greater inde- pendent financial clout, it is likely always to be standing in a queue behind the min- ers, banks and large corporations. The third means of persuasion, pathos, is undoubtedly the strongest, but also the most complex and unpre- dictable, and hence inherently risky. It refers to an immediate, palpable call to emotions and sympathies, including prej- udices, and is particularly powerful when appealing to the identity and self-interest of the listener. The risks are illustrated, for example, in arguments to influence current Australian asylum-seeker policy that put forward a powerfully compas- sionate, humanitarian point of view; these have been easily countered by more powerful appeals to xenophobia. The result has been a hardening of politi- cal support for a morally untenable and logically contradictory policy of punish- ing victims of crime in order to deter the perpetrators of crime. Allison et al. (2014) take up this element of persuasion when they refer to ‘personal relationships’ and politicians being open to persuasion when they have ‘direct experience with a condition and understand(s) the impact’. As above, this can be a double-edged rhetorical sword, since some personal experi- ences may turn an individual towards a negative, stereotyped view of mental illness, leaving the person impervious to an alternative view. So, whoever seeks to advocate for continuing men- tal health reform needs to recognize both the strength and the risks of the third element of persuasion, and care- fully weigh up the potential costs and benefits of using it. A final consideration in mental health advocacy is to be aware of the political-economic context into which this country, along with most others, is moving. This is the age of big capital. The striking inequities in the 2014 Australian Federal Budget signal that the ‘age of entitlement’ may indeed be over for the sick, disabled, poor and disadvantaged, but not for big banks, mining companies, large corporations and rentiers. As the distributions of income and wealth become more ineq- uitable with time, we can look forward to a growing underclass of poor among which the burden of mental illness will inevitably grow. We will all pay a heavy price for this in the long term. Mental health advocacy may need to take a broader political and economic view than it has up to the present, and high- light the adverse mental health conse- quences of certain political and economic policies. For example, if we see a growing marketization of public health care, education, research and human services provision, with parallel curtailments of government spending in these areas, then the most vulnerable, the mentally ill, will likely suffer the most. Mental health advocacy will fail its constituency if it does not successfully adapt to or counter trends of this kind. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Declaration of interest The author reports no conflicts of inter- est. The author alone is responsible for the content and writing of the paper. See Viewpoint by Allison et al., 2014, 48(9): 802–804. References Allison S, Nance M, Bastiampillai T et al. (2014) Health advocacy and the funding of mental health ser- vices reform. Australian and New Zealand Journal of Psychiatry 48: 802–804. Carr VJ and Waghorn G (2013) To love and to work: The next major mental health reform goals. Australian and New Zealand Journal of Psychiatry 47: 696–698. Castle DJ (2013) Where to for Australian mental health services? Australian and New Zealand Journal of Psychiatry 47: 699–702. Jorm AF and Malhi GS (2013) Evidence-based men- tal health services reform in Australia: Where to next? Australian and New Zealand Journal of Psychiatry 47: 693–695. Whiteford H, Harris M and Diminic S (2013) Mental health service system improvement: Translating evidence into policy. Australian and New Zealand Journal of Psychiatry 47: 703–706. Lithium the magic ion: Restoring and preventing? Marc Masson 1 , Thomas Mauras 2 and Gin S Malhi 3 1 Clinique du Château, Garches, France 2 GH Pitié-Salpêtrière, ICM-A-IHU, Service de psychiatrie d’adultes, Assistance Publique – Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie Paris-VI, Paris, France 3 CADE Clinic, Department of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia Corresponding author: Marc Masson, Clinique du Château, 11 bis rue de la Porte Jaune, 92380 Garches, France. Email: marc.masson@clinique-garches.com DOI: 10.1177/0004867414547780 Lithium is one of the oldest treat- ments in psychiatry. Over the past six decades, it has totally transformed the prognosis of bipolar disorder, but even so its prescription has dramati- cally decreased in contrast to the use of atypical antipsychotics. This change in practice is partly linked to concerns about the long-term side effects of lithium. A recent meta-analysis (McKnight et al., 2012) revised down- ward the side-effects risks of lithium intake, though according to naturalis- tic studies and clinical experience monitoring the renal effects, which can lead to renal failure, remain important. In addition to reducing uri- nary concentrating ability, lithium can also cause hypothyroidism, hyperpar- athyroidism and weight gain (Malhi et al., 2012), as well as compromised cognition. This possibility of cognitive deficits has been the subject of extensive debate with mixed views from both patients and doctors. Most formular- ies inform clinicians that lithium can produce cognitive ‘slowing’: a com- plaint often echoed by patients treated with lithium. On the other hand, lith- ium can induce a persistent flattening of emotions, termed ‘the psychological syndrome’ in the French literature (Rosier et al., 1973). This is often con- strued by patients to be a side effect of lithium whereas psychiatrists are