Tag Archives: depression

Should we be worried about the rise of antidepressants? #PillShaming

6 Jan

Another post where I’ve set out my thoughts in tweets and hope to write it up into a blog post but, in the meantime, here are the tweets:

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How’s your day been? A Day in the Life

15 Nov

How are you cartoon

How’s your day been? That’s a question you’ve probably asked many times, and been asked a fair few too. It’s part of the normal everyday engagement between people that oils the social wheels. Often it’s not a genuine enquiry in the sense that a detailed response is not expected: instead, it’s a baton being passed, with you expected to pass it back and say, “Fine thanks. How about you?” That “fine” can mask a lot of days that aren’t fine, whether better or worse, but we’re all expected to join in the general cheerleading, pretending to be “fine” too.

For people struggling with mental health problems or managing a long-term mental health condition, how our day has been is probably a bit of a mystery to the general public. This can be a source of assumptions, stereotypes and prejudice, whether that’s the “lazy faker” of depression who just needs to take themselves in hand and go for a brisk walk; or the “dangerous maniac” of schizophrenia who should be monitored and contained for public safety. These prejudices and stereotypes can feed into self-stigma that brings about a sense of isolation.

Our daily lives are also likely to be a bit of a mystery to the professionals who provide our care, whether that’s a therapist an hour a week, 20 minutes with a psychiatrist every 3 months or 10 minutes with a GP every few weeks. What it’s actually like to live with a mental health problem can be pretty uncharted territory unless you’re doing it yourself or living with someone who is. There’s so much more to good mental health, and to good mental health services and support, than the NHS, drugs and talking treatments. People just like me are out there, living our lives, quietly getting on with things day to day, and there’s a new project that aims to capture that reality. It’s called A Day in the Life.Beatles A Day in the Life yellow

A Day in the Life (the mental health project, not the Beatles song) asks people with mental health problems to share what their day has been like – and what has helped or made the day worse – on four set days over a year.

The project aims to shine a light on the everyday lives of people with mental health problems to raise awareness and to help the general public better gain a better understanding: to challenge myths and bust some stigma. It also aims to get people who may never have blogged before writing about how their day went – and perhaps then finding an online voice they never knew they had. There’s guidance on how beginner bloggers can start writing.

But another objective – and the reason the project is funded by Public Health England – is to help policy-makers understand what makes a difference – good or bad – to the lives of people with mental health problems. Although not a scientific study, the project will provide an insight to help influence policy decisions on services provided in future. The online snapshot diaries will also help to highlight emerging themes and suggest future areas for investigation.

I’ve signed up to take part in the project and have already posted my entry for the first day, Friday 7th November. The remaining three days will be in winter, spring and summer 2015.

Follow the project on twitter using hashtag #DayInTheLifeMH and scroll down to find out more about the project and how you can take part.

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Below is my entry for 7th November, which will appear on the Day in the Life website when everyone’s contributions so far – totalling around 370 – go live on Monday 17th.

Please note: I chose to speak very candidly about what I experienced that day, so please read with care if you’ve been affected by suicide, suicidal thoughts or depression – or simply scroll down to the bottom where you’ll find useful links.

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I’m on Twitter – a lot! So, as usual, after turning off my alarm, the first thing I did this morning was to check what tweeps I follow had posted, to catch up on news in the mental health world. Then, returning to bed with breakfast and my pet, as it was the last day to sign up to #ADayintheLifeMH, I sent out a series of tweets to encourage as many people as possible to sign up. The more sign-ups, the more varied a picture of living with mental health problems it will provide.

Next, I checked what had been happening on the #SamaritansRadar hashtag. Samaritans Radar was launched by the Samaritans in October and, ironically, had had a disastrous impact on the Twitter mental health community. Numerous tweeps had contacted the Samaritans by Twitter, email, phone and letter to beg them to take the secret automated surveillance and alert app offline. Experts in various different professions had written about legal and ethical concerns. Mental health experts by experience had blogged about their pain and distress. There was an online petition, an investigation by the Information Commission and even a group proposing legal action against the Samaritans. I was involved in the campaign to have the app taken offline till it could be made safe.

On checking Twitter, it was clear that the outcry was continuing. And the Samaritans had tweeted their followers about A Day in The Life Mental Health!

Next, I tried to work on a blog post about the app. The powerful psychiatric medications I take have an impact on motivation, focus and concentration and, since I’d started taking them, I couldn’t quite connect the dots. It was cripplingly frustrating and is one reason I spend so much time on Twitter: 140 characters just about matches my attention span! Being sedated so your higher functions no longer work properly makes it hard to manage a home and get everyday tasks done, let alone get anywhere near organising your own healthcare in a system that relies on people being pushy. Being a sedated blob doesn’t get you very far and is one reason I haven’t been able to get proper treatment for myself over 3 years since I was discharged from hospital. Here I am, still parked on welfare benefits.

I struggled for a while to try to gather together my thoughts on Radar down on paper, but was unable to do so. I tried to make an overdue phone call, but couldn’t. So I had lunch, then caught the bus to a medical appointment.

Later, as I walked back through a tree-lined park on a beautiful autumn afternoon listening to the radio, I heard a trailer for this evening’s BBC Radio 4 Any Questions saying that one of the topics the panel would discuss was the Assisted Dying Bill. This caused my own “suicide radar” to go off.

Ever since getting notice of eviction from my home so my landlord could sell it (2 months’ notice, out of the blue, after over a decade), I’d been tipped into a deep, debilitating depression. At times, I was utterly tortured by suicidal thoughts. My home had been my security and stability and now I was losing that. And the awful Radar app had thrown a spotlight on suicide, meaning my Twitter feed was full of intellectual suicide talk.

Suicide was being discussed as a fascinating concept, rather than what it was to me and many other mental health folks using twitter: a very real mental pain we were struggling with at that very moment. At times, it seems as if there’s a part of my mind monitoring everything just in case it might be useful in some way in despatching myself – my own “suicide radar”. That’s why the Assisted Suicide Bill caught my attention. Being able to die with dignity alongside friends and family – rather than experience years of unalleviated suffering or go for a secret and uncertain DIY method –  was an option I’d like to have available too.

I’ve had thoughts about suicide in all sorts of places, with all sorts of people and whilst doing all sorts of things. Sometimes I’ll be plagued by all-consuming thoughts of suicide; other times they’d be a background hum, like a reflex response to every turn of events, a mental tic; and sometimes, as today, there’d be calm planning. These thoughts were going through my mind as I walked through the warm autumn afternoon, kicking up piles of fallen leaves. No-one looking at me would have known.

Back home, I checked Twitter again. At 6pm, the Samaritans tweeted to say that, after 10 days of uproar, the Radar app had been suspended! It was a begrudging statement which did not acknowledge the distress the app had caused, and the so-called apology was an example of how not to apologise. But, nevertheless, the announcement meant that mental health folks could sleep easier in their beds over the weekend. I continue to feel uneasy as to what “suspension” means in practice. Whilst no-one doubts the app was developed with good intensions, the way it was imposed on everyone had damaged trust in the Samaritans.

I spent the evening debating with people on Twitter about Samaritans Radar, listening to Any Questions, then retiring to bed to read Everyday Medical Ethics and Law. It didn’t use to be my sort of book at all, but that was before I was unlawfully arrested, sectioned, held in seclusion and treated by force. Nowadays, chapters on patient autonomy and choice and how they are glibly brushed aside for mental health patients concern me deeply.Close quotes

Sadly, lack of concentration scuppered my attempts to read the book – so it was back to Twitter.

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It’s okay to ask for help. Yes, but what if there isn’t any?

12 Aug

It is okay to ask for help Mind Charity

It’s okay to ask for help, as today’s Mind charity tweet says. However, it is NOT okay to have to ask again and again and still not get appropriate and timely help – or any help at all.

Thoughts exploring the theme of lack of actual help available for mental health problems, whether or not you’re able to ask.

(To be expanded into a written blog post when I have time.)

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“He’s a psycho” – Professor Adrian Furnham on the importance of cleansing the workplace of undesirables

19 Jun
Harry Enfield as Kevin the Teenager (PA)

Harry Enfield as Kevin the Teenager (PA)

 

Have you seen this? Rachel Hobbs of mental health charity Rethink Mental Illness asked me this afternoon. She was referring to the charity’s response to a piece in the Sunday Times headed “I’m sorry, he’s not a differently gifted worker – he’s a psycho”. I’d just arrived home so hadn’t but, sadly, I had already seen the piece that prompted the rebuttal – and been shocked to the core.

The Sunday Times piece to which Rethink had issued a response advises employers of the necessity of screening job applicants and employees to weed out undesirable ones. The author writes:

“There are three important questions. The first is how you spot these people at selection so you can reject them … The second is, given that they have already been appointed, how to manage them … Sometimes it is a matter of damage limitation …  The third is how to rid your workplace of these maladaptive personalities, and that is the toughest question of all.”

Putting aside for one moment the reference to “maladaptive personalities” and the telltale use of “these people” (a clue that we’re about to experience a group of people being made “other”), this all seems fair enough. After all, what employer wants to end up lumbered with rogues or duffers, or people who are simply not suited to the post being filled?

In any recruitment process, whether to fill a new role or replace a departing employee, some sort of selection process is inevitable. Indeed it is welcome, since it will give both prospective employer and employee the opportunity to see whether post and candidate are a good fit. I’ve read plenty of books and done courses including interview techniques, networking, career development and workplace psychology. I’ve undertaken interviews and assessments. It’s an interesting field and one that can bear fruit for employers and employees.

So what’s the problem? The problem is that the premise of the piece is – regardless of the role to be filled – people fall into two categories: they are either desirable or undesirable in the workplace, and the “unemployables” are to be hunted down and excluded. “These people” are to be avoided at all costs. “These people” have “maladaptive personalities”.

“These people”, according to the piece, fall into 5 categories, namely people who exhibit what is classified as antagonism,  disinhibition (Harry Enfield’s Kevin the Teenager – pictured above – is the illustration the author provides for this category), detachment, negative affect or psychoticism (bear with me – this isn’t made up). Each, as described in the piece, has a clear link to mental health problems.

Reading the piece, I had several strong immediate reactions – to the extent I sat down and wrote out my thoughts (then, unhelpfully, lost the piece of paper; perhaps there should be a sixth category of “unemployables”, the abstent-minded).

First, I took away the message that (based on the characteristics of the people described in the 5 categories, some of which I share) I was most definitely not wanted in the workplace. I was not wanted in the workplace and there were armies of workplace psychologists devising tests designed to make jolly sure I wouldn’t be able to sneak in undetected.

It felt as if, when I finally feel able to re-enter the competitive employment market and, were I ever to make it through to a job selection process, there would be a head to head battle. On one side would be the selectors, trying to expose my “maladaptive personality”; and, on the other, me, desperately trying to keep my deficiencies and undesirable characteristics under wraps. Then, in the unlikely event I was able to pull the wool over their eyes and win on that occasion, I would always be at risk of exposure and therefore dismissal. And, even if I started a job mentally healthy but then (for whatever reason – even if it was because too much work was loaded onto me at work, causing unnecessary stress) I became unwell, my employer wouldn’t seek to support me, a valuable employee, through that illness – but instead try to get me out.

I was reminded of the recent disappointment of prospective cabin crew Megan Cox. Notoriously, her offer of a dream job with Emirates Air was withdrawn when she disclosed a past history of depressive illness. In Megan’s case, it was clear that the prospective employer had based their decision on generalisations about depressive illness rather than the individual under consideration. Perhaps they were administering a standardised workplace psychological assessment which sought to weed out the undesirables. Megan Cox was deemed undesirable by Emirates Air. Lucky escape for them that they were able to spot her during the recruitment process. The piece made clear that, similarly, I would be weeded out.

Second, the contents made me want to send the piece to all those people involved in making decisions about the social security support of people who, like me, are managing disabilities, to show them the high barriers we have in getting into employment. Only today, it was reported that Employment and Support Allowance and the Work Programme were costing more than the predecessor welfare benefit Income Support and were getting fewer disabled people back into work. Is it any wonder that a system based around the notion that disabled people are out of work because of a lack of motivation (and incentives – or, rather, penalties) to seek work will fail when the actual barrier is the attitudes of employers – fed by pieces such as these – towards people with disabilities?

Third, having assumed at first glance that the piece was written by a generalist journalist to meet a deadline, I was gobsmacked to find it was written by a professor of psychology. A renowned academic – Professor Adrian Furnham – of a renowned institution – University College London – was the author. It simply did not compute.

So then  I did a little reading around the subject on the internet. I discovered that Furnham hadn’t made up terms like “dark traits” or “psychoticism”. No: they were legitimate. These terms came from last year’s new version of the US psychiatric manual (DSM5) and from workplace psychology (for the past couple of years).  The meat of the piece seemed to be almost a cut and paste from ideas that would be familiar to people who’d studied the field: nothing new, surprising or out of the ordinary. This wasn’t some rogue piece by a lazy journalist in a hurry: it reflected current thinking in (US) workplace psychology. That was hard to swallow.

However, on reading the piece again, there were some flaws (whether of the author or in the editing) which meant it was skewed to paint a worse picture than US workplace psychology actually seems to do. Thank goodness. For instance, the professor conflates the DSM5’s “maladaptive personality traits” (undesirable characteristics) with “maladaptive personalities” (undesirable people). To confuse a trait with a person is a big leap – and a damaging one for the people on the receiving end of the “undesirables” label. Furnham also conflates mental illness (with references to “disorders” and “pathology”) with personality disorders (he lists the 3 DSM5 clusters) and personality traits. Thankfully, therefore, the piece isn’t an accurate representation of the current state of play. In fact, it’s a bit of a mess.

In addition – as is common with fear-mongering pieces – the particular damage “these people” could do in the workplace is left vague; but the fact that they will cause damage is made plain.

The trouble is, however, that anyone not familiar with the nuances in the field (and that might be your average Sunday Times reader) would easily be expected to come away with the very clear message that people with mental health problems – yes, people like me – should be excluded from the workplace at all costs. And that is a damaging message.

Which leads me to my fourth thought on the topic: I wonder (and I don’t know) whether the piece might breach disability discrimination laws.

Furnham argues for keeping “these people” – people with “maladaptive personalities”, people whose symptoms which, as described, fall within mental health diagnoses such as anxiety, depression and schizophrenia – out of the workplace. My understanding is that, where a condition impacts on someone’s health for 12 months or longer, that counts as a disability and is protected by law. In other words, discriminating against someone in these circumstances counts as disability discrimination.

I’m trying hard to see how advising employers on how to avoid employing or get rid of people with disabilities is any different to advising employers to not employ black people or gay people or women. Whether or not it amounts to disability discrimination, it’s clear it is not good to advocate discrimination in the workplace.

Rethink Mental Illness has been in contact with the author and are hoping to have a piece – written with other mental health charities – published in this weekend’s Sunday Times. Rethink reports that Furnham and colleagues were surprised at the reaction to the piece and believe it has been misinterpreted. It seems to me there is a clear opportunity for a dialogue, and for largely commercially-focused workplace psychologists to gain a greater understanding of the crossover between their work and mental illness and the role they can play in the negative stereotypes.

Until employers are willing to consider job candidates or existing employees as individuals rather than categories based on assumption, the prejudices and assumptions of employers will impact on people managing mental health problems like a form of modern straight jacket.

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Update smallThe Sunday Times published a letter from Rethink Mental Illness and others on Sunday 22nd; and the following day Furnham wrote to explain, apologise and request that the article be withdrawn. Constructive engagement and a willingness to engage produced a positive result.

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The Sunday Times story and rebuttal:

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Employment and Support Allowance

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Emirates Air and depression

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Here’s the full text of the piece written by Adrian Furnham and published in the Sunday Times on 17th June under the heading “I’m sorry, he’s not a differently gifted worker – he’s a psycho”:

Open quotesTWO things account for the success of a popular personality test: extensive marketing and the reassuring message you get with your results. Whatever profile you have, or type you are, “it’s OK”. We have different gifts. We can’t all be the same. Everyone is fine. Celebrate your quirkiness.

The message makes it easy for consultants and trainers. Researchers, however, know that one of the best predictors of success at work is (raw) intelligence, along with emotional stability and adjustment. But too many in the selection business are afraid of using well-proven tests to assess these factors for fear of having to deliver feedback such as: “Sorry you were unsuccessful in your application: the reason is that you are too dim and too neurotic.”

However, the message of “we are all OK” is not true. There are people with a distinctly unhealthy personality. There are many words for this. Some talk of “dark-side” traits, others of “abnormal” traits. And for more than 20 years, clinicians have talked about the maladaptive personality.

Researchers have recently tried to spell out traits that are most clearly manifest in the maladaptive personality. There are five of them.

Antagonism
This is defined as manifesting behaviours that put people at odds with others. It has components such as manipulativeness, deceitfulness, self-centredness, entitlement, superiority, attention-seeking and callousness.

Antagonistic people put everyone’s back up. They are selfish, self-centred and bad team players. The clever and attractive ones are the worst, because they use their skills and advantages to get what they want, come hell or high water.

Disinhibition
Defined as manifesting behaviours that lead to immediate gratification with no thought of the past or future. It has components such as irresponsibility (no honouring of obligations or commitments), impulsivity, sloppiness, distractability and risk-taking.

Think Kevin the Teenager. It can mean enjoying shocking others with unacceptable language, outlandish clothing or poor manners. This may be amusing in the playground but hardly acceptable in any form in the workplace.

Detachment
This is defined as showing behaviours associated with social avoidance and lack of emotion. It has various components, such as a preference for being alone, an inability to experience pleasure, depressivity and mild paranoia.

These are the cold fish of the commercial world. They seem uninterested in nearly everything and certainly the people around them. Some seem frightened by others, most just not interested in being part of a team.

Negative affect
This is defined as experiencing anxiety, depression, guilt, shame, anger and worry. It has components such as intense and unstable emotions, anxiety, constricted emotional expression, persistent anger and irritability, and submissiveness.

These are the neurotics of the world. They can be very tiring to engage with and highly unpredictable because of their mood swings. The glass is always empty, and they seem always on edge.

Psychoticism
This is about displaying odd, unusual and bizarre behaviours. It includes having many peculiar beliefs and experiences (telekinesis, hallucination-like events), eccentricity and odd thought processes. Some may see such people as creative, others as in need of therapy.

Psychiatrists have grouped those with personality disorders into three similar clusters: dramatic, emotional and erratic types; odd and eccentric types; and anxious and fearful types.

There are three important questions. The first is how you spot these people at selection so you can reject them. This is easier with some disorders than others. It is virtually impossible to spot the psychopath or the obsessive-compulsive person at an interview. Clearly, you need to question those who have worked with them in the past to get some sense of their pathology, which many are skilled at hiding.

The second is, given that they have already been appointed, how to manage them. There is, alas, no simple method that converts the antagonist into a warm, open, honest individual or the disinhibited worker into a careful, serious and dutiful employee. Sometimes it is a matter of damage limitation.

The third is how to rid your workplace of these maladaptive personalities, and that is the toughest question of all.

Adrian Furnham is professor of psychology at University College London and co-author of High Potential: How to Spot, Manage and Develop Talented People at Work (Bloomsbury) Close quotes

 

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Help yourself! What are your favourite free online mental health resources?

9 Oct
My photo of Souzou: Outsider Art from Japan at Wellcome Collection

My photo of Souzou: Outsider Art from Japan at Wellcome Collection

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More links have been added below (scroll down) – please keep them coming!

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In the resources section of my website, I have a little page tucked away entitled self help. It’s where I’ve posted links to useful online resources to help you manage your mental health. It’s a random collection of what I happen to have stumbled across, mostly on twitter. I have to admit that I haven’t tried any of them personally – but they come highly recommended.

I’d like the page to be as helpful as possible – and I also know there will be things out there that I’d find useful myself, if only I knew about them! – so I’m inviting suggestions of free online resources that you have used and found helpful – or, alternatively, ones that you’d recommend people steer clear of! I’d like to mine the hive mind and see what we can come up with to help ourselves – so we can side-step those pesky waiting lists for treatment or do our best whilst waiting for treatment.

So far, my self help page includes links to three areas:

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Free online cognitive behaviour therapy (CBT)

What is CBT? As Living Life to the Full describes it, “CBT is a structured form of psychotherapy that aims to alter the unhelpful thinking (cognitions) & behaviour that commonly occur during times of distress.” The 4 resources I’ve come across so far are:

  • e-couch – An online programme for preventing and coping with depression, generalised anxiety disorder and social anxiety
  • Living Life to the Full (twitter @llttfnews) – This was recommended to me during a ward round. It’s a free life skills resource teaching practical skills using CBT. The strapline is, “Be happier, sleep better, do more, feel more confident” – which sounds pretty good to me!
  • MoodGYM – An Australian National University training programme that teaches CBT skills for preventing and coping with depression.
  • Moodjuice – A site developed by Choose Life Falkirk and the Adult Clinical Psychology Service, NHS Forth Valley. The site is designed to offer information, advice to those experiencing troublesome thoughts, feelings and actions.

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Free online mindfulness

What is mindfulness? It’s a method of mental training, a simple form of meditation that can be quite quick to do – and can be done any time, any place, anywhere. The resources below include guided mindfulness exercises you can listen to online or download for later.

  • Frantic WorldFree meditations from mindfulness, taken from the book ‘Mindfulness: Finding Peace in a Frantic World’. The book contains the complete 8 week mindfulness course developed at Oxford University.
  • Free Mindfulness – A collection of free-to-download mindfulness meditation exercises.“
  • MindfulFree online audio and video mindfulness instruction, online courses in mindfulness and other resources
  • UCLA Mindful Awareness Research CentreFree guided meditations

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Free online bipolar disorder resources:

  • Beating Bipolar“Beating Bipolar is an interactive internet based programme that aims to improve understanding of the condition. It includes video of professionals and people with lived experience of bipolar disorder and discuses various approaches that many have found to be beneficial.”

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Have you used a free online resource that’s helped (or hindered!) you to manage your mental health? If so, I’d really appreciate it if you could share that with me – so I can share that with the lovely twitter people and readers of this blog. I know you’ll have some great ones, so I’m really looking forward to being able to add them to this blog … and thank you in advance!

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UPDATE: Here are some of the fab links I’ve been sent already (they’ll be added to the self help page shortly):

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Cashpoint

26 Aug

Talking potatoes Family Superfoods

You know the first thing friends from the psychiatric ward ask when we bump into each other? “Have you been back in since?” We just want to stay out. Our ward wouldn’t pass the “friends & family test”: going back to that place is seen as the worst thing that could happen. “Hi! How you doing? Been back in? “No. You?” “No, thank goodness. What’ve you been up to?” “Doing what I need to do to stay out.” “Me too.”

Last night at a cashpoint, a tall young woman approached me. “Got any spare change? My benefits were stopped. I’ve got no food or electricity.” She looked into my eyes, from eye to eye, imploring. “I’ve got no money. My benefits were stopped.” Hang on … We looked again and recognised each other from the ward. Back then, she was so vulnerable, so easily led, so naive. Just a teenager. She’d been in for 18 months.

“Are you still with the community mental health team?” I asked? Last time I’d seen her, she’d been there with her mum, waiting in the waiting room for an appointment. “Yes,” she said. “Let’s make an appointment with the benefits adviser. She’s really good. She’ll help with your benefits. They’re stopping them for the least little thing at the moment. Maybe she can get you help with a loan or a grant or something.” She looked around. “How’s your mum? Is she okay?” “I don’t know. We had an argument. We don’t speak any more. Do you have any spare change?”

“What would you like me to buy you?” I asked her. The cashpoint was outside a supermarket. “I was just going into the shop. Come with me and choose something nice to eat.” She shifted from foot to foot, looked down, looked up into my eyes again. “I just need cash. I’ve got no electricity or food at home. Can you give me some cash?”

“Come back to my house then.” I lived just round the corner. “I’ll cook you dinner. What would you like?” “No thanks. I just want money. Have you got any spare change?” Her skin was bad. She’d cut her hair short. Her glow was gone. She kept looking around behind my head, shifting from foot to foot.

In hospital, she’d been beautiful, naive and full of enthusiasm. She wanted to be a doctor. Or a model. Or both. She had no street smarts or guile. Just an enormous smile.

As a girl, she’d had an argument with her bullying brother one night and had run away from home. She’d been placed in a hostel, a safe place for vulnerable young people to stay. In the hostel, she’d been sexually assaulted by another resident. The mutual friend she’d confided in hadn’t believed her. Had blamed her. She hadn’t told anyone else about the assault. She was young and naive and hadn’t known how to deal with it. She’d kept living at the hostel. With her attacker. Who’d come back for more.

She’d stopped eating when her food started talking to her; when she could see little mouths in the baked beans speaking to her. When she’d become so skinny people noticed, she’d told them about the little mouths in the baked beans. She hadn’t told them about the assaults. It takes time and trust to build up to telling someone something like that. And she hadn’t had that.

She’d been taken from the hostel to the psychiatric hospital. They’d given her drugs for the little mouths in the baked beans; for the food that was speaking to her. They’d kept giving her more drugs and more drugs till she’d told them the food wasn’t talking to her any more and had put on weight.

When I met her on ward, she’d been there for 18 months. She hadn’t had any talking therapy. Just drugs. She hadn’t had any help to prepare for life outside the ward. Just weekly group sessions with the occupational therapists where we painted our toenails or tasted smoothies. But at least she wasn’t skinny any more.

When I met her on ward, she was so sweet and helpless that everyone was protective and did stuff for her. I encouraged her to learn to do things for herself: she’d need that when she got out; or at least the confidence to believe she could learn to do things for herself.

One day, she asked me to put on false eyelashes for her. Instead, I taught her how to do it herself. It took the whole evening. But she did it. Next day, she came back & showed me she’d done it herself. They weren’t on quite straight, but she was so pleased and proud. I was too. False eyelashes rock. She looked fabulous on the outside, with her dramatic eye make-up; and she felt fabulous on the inside, with her sense of achievement.

Next day, she told me about the assaults. She told me about her life and how she’d ended up on ward. She told me she was due for discharge soon. She said she’d started to see the little mouths in the baked beans again.

I didn’t know what to do. My mind was blown by that place, by what they’d done to me there. It was too big for me to process. Hearing her disclosure scorched my brain as I listened. All I could think of to do was to tell her to tell the nurses.

She told the nurses about the little mouths in the baked beans. But not about the assaults. She still hadn’t talked about those. They increased the drugs dose to make the little mouths in the baked beans go away again. She was discharged shortly afterwards and placed in a shared flat with a stranger. After 18 months on ward. And still a teenager. She didn’t know how to wash her clothes, cook, or budget. She couldn’t even keep her room on ward tidy.

Looking at her last night, I wondered whether, all these years later, she’s had any help to process the sexual assaults. Any help with the voices. Any help with managing her life. I wondered if it mattered. Or if drugs were enough. I couldn’t tell how she was. I only knew that she was different. I only knew that I held both her hands and squeezed them as I looked into her eyes, and hugged her and hugged her, then saw her slowly walk away.

And, of course, we both knew – because it’s the first thing we ask when we meet a ward friend – that we hadn’t been back in since.

So tomorrow I’ll drop a note to CMHT asking them to check up on her. She’s too vulnerable to be begging at cashpoints. I don’t know what else to do for the best.

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Links to related websites:

  • My Storify story of tweets – Cashpoint
  • A rather creepy video of talking food (1 min) used to promote TV show Family Supercooks, an initiative of the Food Standards Agency and the Good Food Channel
  • Eleanor Longden: The voices in my head (14 mins) – her recent fascinating and inspiring TED talk

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Pill shaming, Giles Fraser and happy pills

10 Aug
Photo courtesy of medicalhumour.wordpress.com

Photo courtesy of medicalhumour.wordpress.com

What’s hot and what’s not in media land? Fashions ebb and flow. Mental health stories come in and out of the spotlight. Recently, the  supposed psychiatrist vs psychologist war has been stoked. This past week, we’ve had various pundits rehashing the old, old story that mental illness doesn’t really exist. Today, it was the turn of Giles Fraser to spin this line, having made the same case on BBC Radio 4’s debate show the Moral Maze.

Fr Giles has had what I hope will turn out to be an education by twitter’s expert’s by experience and experts by profession. I’ve been commenting on twitter today. Various writers have put it far better than I could, so I’ll let their words speak for me by picking what I consider to be three of the best rebuttals:

Many others have written excellent pieces and all the relevant links I’ve come across are also linked below. Enjoy.

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Mainstream media (pill shaming):

  • Psychiatrists: the drug pushers

    Guardian newspaperWill Self  – “Is the current epidemic of depression and hyperactivity the result of disease-mongering by the psychiatric profession and big pharma? Does psychiatry have any credibility left at all?” (3rd August)

  • The Moral Maze – The Pursuit of Happiness

    BBC Radio 4 – “As a nation we have a reputation for being phlegmatic, stiff upper-lipped types. The reality, it seems, could hardly be further from that caricature. When it comes to anxiety and depression, we’re a nation of pill poppers.” Debate chaired by Michael Buerk with Claire Fox, Anne McElvoy, Kenan Malik and Giles Fraser, and witnesses David Pearce (World Transhumanist Association / Humanity Plus), Alison Murdoch (Foundation for Developing Compassion and Wisdom) Oliver James (clinical psychologist and author) and Mark Williamson (Action for Happiness) (7th August)

  • Taking pills for unhappiness reinforces the idea that being sad is not human

    Guardian newspaper – Giles Fraser “If you have a terrible job or home life, being unhappy is hardly inappropriate. Pathologising it can only make everything worse.” (9th August) (twitter: @giles_fraser)

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Rebuttals – mainstream media:

  1. Letters – Psychiatry, drugs and the future of mental healthcare

    Guardian newspaper (rebuttals to the Will Self piece) (7th August)

  2. Depression is not the same as “being sad”, Giles Fraser

    New StatesmanGlosswitch (twitter: @glosswitch) – “Casual “let’s not pathologise sadness” musings don’t contribute much to the debate about medication for depression. I’m writing this post to dispel a few myths about depression and the use of medication. I should mention, however, that I’m none of the following: psychiatrist, psychologist, pharmacist, biologist, philosopher, renowned expert in happiness and the inner workings of every human soul. That said, neither is Giles Fraser, the Guardian’s Loose Canon, but he hasn’t let that stop him.” (10th August)

  3. Depression is more than simple unhappiness

    Guardian newspaper – Margaret McCartney (twitter: @mgtmccartney) – “Antidepressants may be overprescribed, but as a GP I know the solution is not to minimise the experience of this condition.” (12th August)

  4. We don’t know if antidepressants work, so stop bashing them 

    Guardian newspaper, SciencePete Etchells (twitter: @petetchells) – “It’s a difficult debate, because it is so often emotionally charged on both sides. The best thing that we can do is to look at the data for answers.” (15th August) – An examination of scientific studies into anti-depressant use, including the 2 main ones that say they do and do not work.

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Rebuttals – blogosphere:

  1. My tweets (Storify)
  2. Doctor, Doctor… Pt 2

    Tania Browne blog (twitter: @CherryMakes) –“I read an article today that shows the stigma of mental health that hinders people seeking help isn’t going to go away any time soon. Speaking in The Guardian’s Comment section, Giles Fraser suggested that we may be too happy just to pop to the doc and get some jolly old pills to cheer us up when sadness is a very normal side of the human condition.” (10th August)

  3. For Giles Fraser, ignorance truly is bliss

    The Dirty Ho blog (twitter: @the_dirty_ho) – “In his recent article Giles Fraser allows a valid underlying point to be undermined by his profound lack of understanding of depression.”) (10th August)

  4. In the interests of clarity, Giles Fraser should exercise the right to reply

    The Dirty Ho blog (twitter: @the_dirty_ho) (11th August)

  5. Response to Giles Fraser’s Latest Article on Depression

    Elliot Hollingsworth blog (twitter: @ElliotHollings) – “I have a lot of time for Giles Fraser. However his latest article in the Guardian’s Comment is Free seems fairly lax on the facts and also on the difference between normal sadness and the mental illness, depression.” (10th August)

  6. Giles Fraser and mental health: When the Church fails at being a church, when the spiritual let down spirituality

    by Heathen Hub blog (twitter: @gurdur) (10th August)

  7. Common Misconceptions About Depression

    A Hot Bath Won’t Cure It blog (twitter: @chloemiriam) -– BINGO! – “In rebuttal to Giles Fraser’s poorly argued piece on anti depressants and ADHD medication, which may have hit ‘common misconceptions about depression BINGO!”  I am inspired to reply in a somewhat tired and mixed up manner.” (10th August)

  8. Dear Giles Fraser, Depression and Unhappiness are NOT the Same

    Gibbs Gubbins blog (twitter: @msjenmac) (10th August)

  9. Depression, Anti-Psychiatry and Christianity

    Los the Skald blog (twitter: @lostheskald) – “In his Guardian column today, Fr. Giles Fraser presents an argument which, has, in various guises, been with us since at least the 1960s: that mental illness, and specifically depression, is the ‘pathologisation of sadness’, and that biochemical treatments for depression are an example of ‘the scientists [being] called in to reinforce generally conservative norms of appropriate behaviour’. This post responds to his article by assessing the ‘anti-psychiatry’ tradition within which it falls, discussing some differences between sadness and depression, examining this difference in the Old Testament, and suggesting a Christian response to mental illness based on the stories of healings and exorcisms performed by Jesus in the Gospels.” (10th August)

  10. The Continuum Concept – why your sadness is not my depression

    Mental Health Cop (twitter: @MentalHealthCop) – “I recently read the piece you are about to read – a service user’s reaction to a recent media piece – and was totally blown away …” Reblogged piece, plus introduction (11th August)

  11. My “peculiar reaction” to Giles Fraser’s thoughts on anti-depressants

    Nurture My Baby blog (twitter: @nurturemybaby) (10th August)

  12. The continuum concept: why your sadness is not my depression

    Purple Pursuasion blog (twitter: @bipolar blogger) – “Modern medicine is widely held to be A Good Thing. It is allowing us to live longer, healthier lives than at any other point in human history. The media loves the story of a scientific breakthrough and the promise of yet more astounding treatments in years to come, whether through improved surgical techniques, gene therapy or new, more effective drug treatments.Unless, that is, we’re talking about the modern medicine of psychiatry. Suddenly, the ground shifts and medication is viewed with suspicion, even disgust. Antidepressants become “happy pills”; using drugs as directed by a doctor is described as being “hooked” or “addicted.” (10th August)

  13. Depression is not Being a Bit Sad

    A Reflex Anglican blog by Eileen Fitzroy Russell (9th August)

  14. Sadness and Depression – NOT the same thing

    Ruby Wax‘s website (12th August)

  15. Plaster of paris on a broken leg reinforces the idea that having a broken limb is not human

    Ruth Stirton blog (twitter: @RuthStirton) – “Giles Fraser misses the point. His entire comment is premised on the idea that being sad, and having clinical depression are on the same spectrum. Of course clinical depression can be solved with diet and exercise, because we all know that those things make us feel better if we’re having a sad day. No. Wrong. Clinical depression is a different thing entirely.” (10th August)

  16. Forgive him father, for he knows not what he does

    The Dirty Ho blog (twitter: @thedirtyho) (14th August)

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Older pieces – mainstream media:

  • Britain – the Prozac Nation? Not So Fast

    Discover Magazine – by Neuroskeptic (twitter: @neuro_skeptic) – “The media coverage has been predictable with lots of scary, context-free statistics, and boilerplate quotes from the usual suspects. No doubt tomorrow we’ll see a selection of moralistic op-eds about this. But not one of the many nigh-identical articles provided a link to the original data, or even a useful description of where one might find it. After contacting one of the NHS organizations named as the source, I managed to track the numbers down.” (December 2011)

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Older pieces – blogosphere:

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Additional:

  • Depression

    Royal College of Psychiatrists

  • Resources for churches

    Time to Change – “We aim to encourage organisations from all sectors and communities to challenge stigma and discrimination. One example of this is work that the Church of England have done to get church congregations talking about mental health. The Revd Eva McIntyre has produced a web resource providing ideas and resources for churches to plan worship on the theme of mental health.”

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Let’s talk about poo! It’s tweet chat time …

28 Jul

Keep calm and poo with pride

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Update

 

Here’s the transcript & fab wordcloud from the tweet chat on 1st August – patients & nurses all talking about poo!

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This Thursday 1st August at 8pm, We Nurses will be hosting a tweet chat about constipation problems, at my suggestion. Here’s my earlier blog on constipation induced by psychiatric medication, including 25 tips you can try for yourself. It is my most read blog piece ever. I guess that makes me some sort of Poo Queen. Hmm …

However, if it gets people talking about an important but often overlooked or covered up topic, that’s all to the good. Let’s break the taboo about poo and make a date in our diaries for this Thursday’s poo chat!

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Background reading:

The Bristol stool tart cake!

The Bristol stool tart cake!

 

Additional information on constipation:

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What’s it really like to live with mental illness? Stephen Fry, bipolar and suicide

6 Jun
Banner from Stephen Fry's website

Banner from Stephen Fry’s website

Yesterday, Stephen Fry – actor, comedian and writer, national treasure and president of mental health charity Mind who has a diagnosis of bipolar disorder – spoke about his 2012 suicide attempt. Today, the press reported the suicide attempt of Michael Jackson’s daughter Paris and speculation about a diagnosis of bipolar disorder. The day’s press has been full of reports of these stories, together with supposedly contextual information on bipolar and suicide. Sadly, coverage I’ve seen so far has been unhelpful to those managing mental health problems and those wishing to know more about them.

As I tweeted earlier:

“I think if you’d just been diagnosed with bipolar & read that piece, you could think your life was over. There’s nothing to give you hope.”

This is the piece on Stephen Fry & bipolar disorder that got me started. Written by BBC health and science reporter James Gallagher and tweeted by the Royal College of Psychiatrists, at first glance it appears informative and well written: it quotes a scientific study, includes quotes from Fry himself as well as a mental health professional and a mental health charity, and includes links to sources of further information. So far so good.

However, look closer and the piece is a load of clichés linked together into a web of misleading hogwash. What are the problems with the article? Here’s a quick whizz through:

  • Speculation: “There are suggestions that at least a quarter and maybe even half of patients make at least one attempt.” Suggestions? You’d want to be really sure before delivering such a miserable prognosis to the legions of people in the UK who experience bipolar disorder.
  • The black and white characterisation of bipolar disorder as consisting of mania and depression, when it is far more nuanced.
  • The description of mania as being “extreme happiness and creativity”. Which really sounds like something we’d all enjoy!
  • References to “hypermania”, which has become the grey squirrel to hypomania’s red squirrel across today’s media coverage, the former existing only in journalists’ spellcheckers. I call it Hypermania Cluster Disorder; or “I’m too lazy to check the spelling for this pop science piece I’ve been told to write”.
  • Bald statements such as “There is no cure for bipolar disorder” deliver a bleak prognosis without recognising that, for instance, many people experience differing diagnoses throughout their lives. If someone’s diagnosis changes, are they cured, did they never have the disorder in the first place or does it reflect differences in clinical judgment?
  • Linking bipolar disorder to drink and illicit drugs, which some people objected to on Twitter today since they’d never taken either.
  • Only passing reference to the fact that, for many people, bipolar isn’t a second by second living hell but an episodic experience – a relapsing and remitting condition, in the jargon.

On the one hand, it’s good to see pieces in the media about serious issues like bipolar disorder and suicide: for too long, mental illness has been a secret shame kept hidden in the shadows. Yet, on the other, it’s not good to have misleading cliches & miserable hope-destroying myths doing the rounds.

A diagnosis of serious mental illness shouldn’t be a death sentence. Yet pop pieces like this make it sound like it is. Millions of people are getting on with their lives, passing by in the streets, buying their lunch, sitting on buses, managing conditions. The reality of living with a mental health condition isn’t reflected in articles like these.

As Mental Health North East (support for the north east mental health voluntary sector) tweeted:

“Was half expecting the article to contain a photo of Stephen Fry clutching his head on current BBC form #headclutcher

This story again raises for me a question I often ask: who speaks for mental illness? Who speaks for those of us managing mental health problems? Who speaks out with information in the face of a breaking story where the media’s emphasis is on speed rather than accuracy, on getting your story out there rather than educating and informing? Today’s stories, whilst on the surface being about the dramatic event of a suicide attempt are, underneath it all, really about what sometimes happens in the day to day realities of living with and managing a mental health problem. Where have we heard that story reported today?

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Below I’ve linked to people’s first hand experiences of managing bipolar disorder as well as sources of information, together with commentary and news reporting of today’s stories (if you don’t know where to start, try the commentaries and first hand experiences).

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Commentary following the reporting of Stephen Fry’s 2012 suicide attempt:

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First hand experiences of bipolar disorder:

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Sources of information on bipolar disorder:

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Some information on suicide:

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News coverage of Stephen Fry’s 2012 suicide attempt:

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Mental health nurse & patient tweet chat: what do newbies need to know?

11 Feb

Psychiatric Nurse - Garrison - Book cover

Update small..

The tweet chat took place on Thursday 20th February 2014 with We Nurses – catch up with the discussion by taking a look at the full transcript!

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I’m planning my first one hour tweet chat in a couple of weeks (date to be announced). (Check out my quick guide to tweet chats for more on what they are – this and other helpful links are below). Here’s what I have in mind, for an inpatient mental health nursing tweet chat:

  • Patients: Are you a patient who’s experienced inpatient mental health nursing? What would you like the newbies to know – the student nurses about to start a placement or the newly qualified mental health nurse. What things that nurses did – good or bad – made a difference to your experience on ward?
  • Students: Are you about to qualify as a mental health nurse? Are you a student nurse about to start your mental health placement?  What is the balance between fear and excitement? What would you like to know? What practical concerns do you have? What do you want help with to make your first days on ward a success?
  • Nurses: Are you a qualified mental health nurse? Are you a student nurse who has completed your mental health placement? What tips would you like to pass on to newbies about to qualify or about to undertake a placement? What are those little insider tips that really helped? What would you have liked to know when you were a newbie?

I’d like to be able to share some really useful tips to help new mental health nurses and nursing students make their best start on ward, because that benefits both staff and patients. Here are some example questions I’ve thought up that students might want to know the answer to:

“How can I prepare for my placement so I get the most from it?”

How can I put the knowledge I’ve learned at university into practice on the ward?”

“How can I settle in as quickly as possible so I fit in with my nursing team and ward life?”

“How can I switch off after a shift?”

“What should I do if I see another nurse doing treating a patient unkindly?”

Here are some examples of useful tips to pass on:

The Bic 4-colour pens are really useful for filling in your paperwork.”

“Remember to always respect the patient as an individual and see past the diagnosis.”

“Don’t make assumptions or have preconceived ideas based on what you’ve been told before. Remain open-minded and make your own judgments based on your own personal experiences.”

As I’m not a nurse and haven’t run a tweet chat before, I’ve invited @MHnursechat – associated with the awesome We Nurses website and tweet chats – to run a joint tweet chat with me. We’re going to be discussing how this will work and, hopefully, setting a date. Very exciting!

In preparation for the tweet chat, I’m asking you to please share your tips and questions. That will help set the agenda to be followed and the areas we’ll focus on in the tweet chat – so it covers the most burning questions and drills down to the most useful tips. It may be that there will be more than one tweet chat on this topic – perhaps one covering what nurses need to know in their first few days, and another for when they’ve been there a few weeks. We’ll see. A tweet chat needs to have enough of a focus to engage people without overwhelming them, but at the same time enough breadth so it doesn’t peter out prematurely! If there are other topics you think would be good for tweet chats then please let me know!

You can comment below or tweet me (please don’t try to pack more than one query or tip into each tweet ) @Sectioned_ (please remember the underscore). It’s helpful if you could say whether you’re offering your comment from your experience as a patient, nurse or student. Look forward to hearing from you!

Why a tweet chat? I’m often interested in discovering what other tweeps think about topics and then sharing those insights. So, quite a few times, I’ve tweeted questions then collated the responses into a Storify story which I’ve sometimes turned into a blog. (I was rather excited to learn that this is called “crowd sourcing” and “curating the chat”.) This time I thought I’d try making it a bit more organised & involve more people: I’m beginning to learn just how valuable Twitter is as a way to bring together groups of people to share views openly in a way they might not otherwise do. (I’m told this is called “disruption” – disrupting the natural order of things and mixing it up, like mental health peeps and staff learning together.) (Thanks to Victoria Betton for all the cool jargon!)

Why this topic? After all, I’m not a nurse. As a child, however, I remember being taken to one of the big long-stay psychiatric hospitals of the sort portrayed in the film One Flew Over the Cuckoo’s Nest. I remember the high ceilings, big windows and long corridors. Happily I wasn’t being booked in myself. I was visiting family friends who worked there as psychiatric nurses. Members of my family also worked on psychiatric wards and in nursing.  When I was sectioned a couple of years ago, my inpatient experience fell far short of the care I would hope all psychiatric nurses aim to deliver. You could say that everything that could go wrong did go wrong. But, as I’ve been around nurses my whole life, I know that the image and practice of mental health nursing has come a very long way since the fearsomely controlling figure portrayed by Nurse Ratched. For me, nurses are (or should be) an essential part of the team that helps get me well. So I’m all for sharing tips and best practice to help nurses be their best. I’m hoping this tweet chat will be one small way to do that.

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  • Guide to tweet chats – all you need to know to join in your first tweet chat or get more from them
  • Mental health jargon buster and acronym buster – please send yours in! We’ll try to avoid jargon during the tweet chat itself, but if the jargon’s in the jargon buster, I can just tweet a copy of that by way of explanation

For the nurses and student nurses amongst you, here’s some nurse-focussed content:

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