Tag Archives: psychiatrists

Secrets from the modern day asylum

20 Aug
Actor Ray Winstone in episode 1 of ITV's new series Secrets from the Asylum

Actor Ray Winstone in episode 1 of ITV’s new series Secrets from the Asylum

 

This evening, episode 1 of ITV’s new family history series Secrets from the Asylum aired. It delves into the murky world of dreaded Victorian lunatic asylums through the eyes of celebrities who make emotional discoveries about relatives incarcerated in the distant past. With a doom-laden commentory and spooky music, viewers were invited to be shocked that people with senile dementia were condemned as lunatics, to gasp at disturbing treatments like chaining or hosing with cold water (“treatments which now seem crazy themselves”) and to shake their heads at “sickening attitudes towards the mentally ill”.

I’ve often said that one of life’s cruel ironies is that, whilst nowadays we condemn with obvious horror what was done in the name of mental health care in the past, we don’t recognise the horror of some of what is being done now, today, in modern psychiatric hospitals. What is going on now – behind locked doors, out of sight, to the country’s most vulnerable people, sometimes by the most brutal of “carers” – goes unremarked. I’ve said before that, in the future, we will look back at some of today’s practice of mental health care with horror, just as we now look back  in horror on the lunatic asylum. How long will it be before we do that? And why can’t the general public see it now?

Because it is happening now. This minute, as I write this piece, as you read it, horrors of commission and omission, of things done and not done, are taking place in the name of mental health care. And yet the damage they cause – the lack of job satisfaction of good staff, the lives half-lived through inadequate treatment and support and even the lives cut short – go largely unremarked. It’s a secret from the modern day asylum, because no one is looking.

Only this morning, government minister Norman Lamb announced he was establishing a new mental health task force to look at the state of children and young people’s mental health care. Some of the papers ran the story. There was an excellent feature on the morning news. But, by lunchtime, it seems it had all been forgotten. What – if not hundreds of sick children detained in police cells for want of treatment of hospital beds, of sick children bussed from hospital to hospital, hundreds of miles from their parents – what could make the wider public see the utter inhumanity of the way in which people with mental health problems are treated today? If even sick children won’t make the public – and hence politicians – sit up and reach into their back pockes for some serious money and some serious thought how those in need of help can best be supported, then what hope is there, really for things to improve in mental health services in this country?

So today, the day that Norman Lamb announced that children’s mental health services were “in the dark ages”, ITV launches a new two-part series, Secrets from the Asylum. We gawp at the outdated practices of the old lunatic asylums. We gasp at the people locked away without proper treatment. We shake our heads in judgment at the barbaric treatments in days gone by.

And yet, it wasn’t until very recently that there were any effective treatments for mental distress and mental illness. Those running the old Victorian asylums had, in a way, an excuse. They did the best they could. In the words of the title to episode 1 , those trying to help people with mental health problems in the past had the “best intentions”. Nowadays, we don’t have that excuse.

Nowadays, there are treatments, help and support that can make a real difference to people’s lives. And yet … they are not employed. And, worst still, sometimes – in fact, far too often – practices that we know – through logic, humanity and research studies – are actively harmful to people are employed instead.

Why is that? It’s hard to explain. In large part it will be down to the resources allocated to NHS mental health care: with few staff on wards and paperwork to complete, there isn’t enough time to spend building therapeutic alliances with patients. There isn’t enough time to show the care and compassion, kindness and support so vital to helping people in mental health crisis. With wards that are badly designed and ill-equipped (as was the one on which I was detained), staff will be struggling from the outset.

But, also, it seems that there is something to do with the training of mental health professionals that creates a barrier, preventing staff from recognising human suffering. On ward, it seemed to me that the priority of even well-meaning staff was ward management. “Order and control took precedence over care,” said the commetator in episode 1: it seems that nothing has changed.

I speak as someone who was so traumatised by my experience of inpatient psychiatric care that I came out with the gift of PTSD (post-traumatic stress injury). Tonight’s episode refers to people in the past – before the advent of Victorian asylums – being chained, caged and beaten: I have been “chained” by means of the chemical cosh, a cocktail of drugs intended to quell me; I have been “caged” by being held in seclusion; I have been “beaten” by staff who assaulted me (in the criminal sense) and many more who physically restrained me, six at a time, for forced treatment and by patients from whom the staff did not protect me. Based on my experience of modern day inpatient psychiatric care, it doesn’t seem to me that there’s any obvious reason for us to pick over the bones of history and gloat about how far we’ve come.

And how is it such practices are allowed to continue, without a public outcry? Several powerful reasons. One is that there is still an enormous stigma to mental health problems. There is a shame to having been treated in a psychiatric hospital. It’s not something people speak out about readily. Another reason is that psychiatric patients lack almost any credibility. In an NHS system which we know is hard for even staff to raise concerns about and which has, it seems, a culture of closing ranks and covering up, what hope for patients’ complaints to be dealt with? And of course these things go on behind closed doors, out of sight. No one sees apart from those incarcerated in the strange world of the psychiatric ward, whether they are staff or patients.

It isn’t just me who thinks that some of what goes on on inpatient psychiatric wards is wrong. Here are a couple of examples from this week:

  • Here is a conversation that took place a couple of days ago when a psychiatrist, a psychiatric nurse and I discussed our experiences of physical restraint and bullying on mental health wards. The strong impression is that what I experienced is the norm, rather than the exception, which is heartbreaking.
  • Here is a post by Skye, the Secret Schizophrenic, about an upsetting incident that happened to her on ward recently. It illustrates how what happens on wards now can confound humanity and logic.
  • Here are some tweets on the hashtag #secretsfromtheasylum comparing modern day practices with those in Victorian asylums and questioning whether it really all is in the past.

I do know people who have had excellent experiences of psychiatric inpatient care that has transformed their lives for the better. It gives me hope. It should be the norm. Especially now that we there are effective treatments available to help people recover from  or manage mental health problems.

What is the hook? What is it that makes people want to watch programmes like Secrets from the Asylum but not care about the way mental health patients of today are neglected and mistreated? And how can some aspect of that be harnessed to our benefit, so that the lessons of the past are learned? Those are questions I wish I had the answer to but don’t.

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Forced medication: resistance is futile

19 Mar
Pacific Northwest Ballet principal dancer Carrie Imler, with corps de ballet dancers William Lin-Yee and Andrew Bartee in Jiri Kylian’s Sechs Tänze (Six Dances). Photo © Angela Sterling.

Pacific Northwest Ballet principal dancer Carrie Imler, with corps de ballet dancers William Lin-Yee and Andrew Bartee in Jiri Kylian’s Sechs Tänze (Six Dances). Photo © Angela Sterling.

Someone found my blog today by searching “how to get out of the restraint that psychiatric wards use”. That lead to these tweets on my experience of forced medication on a psychiatric ward (set out below, slightly edited).

I discovered that nothing I did or said made any difference to the use of restraint on me: they were going to carry on and do it, no matter what. It made no difference to them what I said or did. All I could do was try to make a difference to me.

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Someone found my blog today by searching “how to get out of the restraint that psychiatric wards use”. Yeah, no chance there: it’s six to one. I discovered that nothing I did or said made any difference to the use of restraint on me: they were going to carry on and do it, no matter what.

In my experience of restraint, once there’s a tick on the chart saying “forced medication”, it’s going to be done to you, no matter what. Once there’s a tick in the box saying “forced medication”, it doesn’t matter where you are or what you’re doing, you’re getting it.

It made no difference that I’d never been asked whether I’d like pills or an injection. The forced med squad just turned up and did it to me. It made no difference that I’d never been asked which drug I’d prefer to take. They just climbed on top, pinned me down and stuck it in me. It made no difference that I’d never had a discussion about symptoms or potential diagnoses or treatments. They just carried out orders.

It made no difference that I was sitting on my bed, reading quietly, minding my own business. They’d turn up mob-handed & do their business. It made no difference that I’d stepped out of a meeting with the IMHA to get a letter from my bedroom she’d asked to see. They came in as I sat on the floor, document wallet in hand, surrounded by papers. They did it to me there, then walked off chatting, leaving me to wander back to the IMHA, disheveled and dazed.

It made no difference when I pleaded with them to explain what they were doing, what was in the syringe (or syringes – it varied), what effect it would have on me. None. It made no difference when I talked calmly to them, speaking to each by name, asking them to explain why they were injecting me. None. It made no difference when I repeatedly called out a friend’s name, calling to mind someone who cared for me, who heard my words. None.

It made no difference whether it was night or day. They could turn up any time, stick it in me, roll off, leave me lying in dirty sheets. It made no difference when (realising nurses wouldn’t speak to me) I wrote notes and handed them to the nurses. The notes asked the nurses to explain what drugs they were injecting, what the effects were, what they were for and what the plan was going forwards. No response. They just handed each note back to me later, unopened.

It even made no difference when I was first in the drugs queue so I could take the pills instead: they still came for me again. I had a double dose that day.

The staff weren’t monsters. Far from it. They’d chat away to each other, coordinating between themselves who was going to take which limb; who was doing what when; and then when to let go as one.

They’d chat away to each other as if the person beneath them was not a person who spoke their language but a wild and senseless beast. They’d leave behind a bed pushed out from the wall, sheets trampled under their boots, empty swab wrappers on the floor, lumps and bruises on my arms and legs. They’d leave behind a person who didn’t know what had just been done to them, or why, or when it would happen again, or how to make it stop.

I learned that, when they come for you, there is no escape. You are locked in and cornered. It is going to happen. It makes no difference what you say or do.

I learned that, when they come for you, there is no escape. You are locked in and cornered. It is going to happen. It makes no difference what you say or do. You can’t reason with people who won’t listen to you. You can’t persuade people who don’t hear you. You can’t resist them when it’s six to one, even if (unlike me) you knew how. You can’t reason with people who are just carrying out orders. You can’t persuade people who don’t think you’re worth asking.

It’s like being in a science fiction novel. Resistance is futile. Your life as it has been is over. Comply, cooperate and engage. Resistance just prolongs the process. The quickest way to get out is to comply, cooperate & engage.

I found that there was nothing I could say or do to stop them using restraint on me. But things I said and did helped me cling on to me. Little things I did and said as they did their business on me helped me to cling to my sense of being a person, a human being not an animal.

It made no difference to them what I said or did. All I could do was try to make a difference to me.

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Hopefulness

11 Mar

Daffodils at the allotment

I’m a little bit in shock. I’m still not sure how to put it. It seems too good to be true. It’s taken nearly 3 years to be able to say this:

I’m being seen by a psychiatrist who seems to relate to me as a human being, wants to get to know me as a person and work with me in partnership.

What’s puzzled me so far is why all the psychiatrists I’ve seen haven’t been like this. I know they’re intelligent, caring professionals. So it’s been a genuine puzzle to me why the mental health care I’ve received so far has been so bad or inadequate, and in so many different ways. It’s one thing having one bad experience of care: it happens. But for it to happen repeatedly, with different professionals? It’s a puzzle.

I had no idea that, two years after joining twitter, I’d still be banging on about bad experiences of care. (It’s not because I like them!). I never thought I’d still be going on about what was done to me in hospital. (I’d much rather have had treatment for the resulting PTSD.) I never imagined I’d still be moaning about my bad experiences of community mental health care. (I thought I’d learn how to work the system to get what I needed.)

In fact, just so you know, I don’t do nearly as much moaning on about my supposed “care” as I could. (It would sound way too negative!) I’d summarise my experience of mental health care as having been brutalised, traumatised then parked on welfare benefits and sedating meds. Mental health nurses & doctors who’ve treated me so far have been akin to veterinary staff: they’ve observed, diagnosed and neutralised me.

Non-medically trained staff have related to me with humanity. But, ultimately, they’ve all had to defer to the doctors and nurses. It’s almost as if mental health training gets in the way, prevents staff from seeing the human being experiencing human distress right in front of them.

Does training prevent health care professionals from seeing that what’s in front of them isn’t a diagnosis but is a human being experiencing distressing symptoms? Is the human experience so broad and varied that mental health staff steel themselves to stick rigidly to assigned roles and designated boxes?

Let’s be clear. When I’m in mental distress, it’s not about mental health staff being “nice” to me. It’s not about them being my mate. I don’t need a new friend.

I need a competent professional who’ll work with me in partnership: I’m the expert in me; they’re the expert in mental health care.

No matter how unwell someone is, they’re still a person with thoughts, feelings, quirks, preferences, friends, family and a life to return to. They’re not a puzzle to be solved, a problem to be fixed. They’re a human being, not an animal.

I want to be able to write about good psychiatric care, I really do. I have a vested interest, after all! It’s just not been my experience. I’d much rather have been able to write about fantastic treatment by great nurses and doctors; and about how much better I was in myself. I’d even have settled for half decent care and a bit of respect, mediocre care with a modicum of interest. What I got instead was damaging.

I have seen excellent psychiatric care elsewhere: caring, effective, transforming treatment and support. (Though still with no talking therapy.) I’ve just not received it myself. The comparison is bitter sweet.

Is now my time? Am I on the threshold of receiving effective help? Can I get excited about it yet? Am I on my way to living a full life? I’m not silly. I’m not going to pin all my hopes on one busy professional “fixing” me. I know it doesn’t work that way. But … I feel a sense of anticipation.

I’m hopeful the new psychiatrist and I can come up with a plan that will achieve good results going forwards. I’m hopeful the plan we come up with will include meaningful support and help going forwards, so I’ll be able to get back on my feet. And, this time, it feels as if my hopefulness could be a realistic. I’ve been getting by on wishful thinking for too long.

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  • Collated tweets (Storify) – My tweets (and some initial responses from the lovely twitter people)
  • Twitter conversations – Responses and conversations with the lovely twitter people (these are really interesting – take a look!)

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Trust, respect and coercion in mental health services

12 Feb

Trust dancers

Trust, respect and coercion: Can people who use mental health services ever really trust staff when coercion is always an option?

Some thoughts of mine on the subject.

Some responses of the lovely twitter people.

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South London and Maudsley on film: humanity and humour

28 Oct

Bedlam (4) OCT 2013Bedlam (1) OCT 2013

Looking at a newspaper story about the murder of drummer Lee Rigby earlier in the year, Lloyd, who has a diagnosis of paranoid schizophrenia, said that hearing about schizophrenics in the news made him feel worse. He worried that he didn’t know his own mind and wondered if he himself could turn into a murderer too, since that’s what he read in the papers. Dealing with the symptoms of psychosis can be difficult enough in itself. Having to deal with society’s perceptions that people with your diagnosis are violent and unpredictable adds another level of difficulty.

Earlier today, I attended an advance screening of Channel 4’s new series on the realities of modern mental health care at the South London and Maudsley (SLaM) mental health trust.  In the screening room in the basement of Channel 4′s headquarters in Horseferry Road, a select audience sat in red plush seats watching one of four programmes in the series on modern mental health care. The series is entitled Bedlam and the name choice has caused controversy. To an extent it can be argued that, when a respected NHS trust calls a television series after a medieval asylum, it dilutes the strength of the case against Thorpe Park’s “mental patient scary fun” horror maze Asylum. But what of the series itself?

The episode previewed profiled the work of Speedwell community mental health team (CMHT) in Deptford, south London, over the course of a year. The four-part series, which starts at 9pm this Thursday, also covers the Anxiety Disorders Residential Unit, Lambeth Triage (the front line for emergency cases) and the older adults unit (over 65s).

Without giving too much away, we followed patients Tamara, Lloyd and Rosemary, all of whom experience psychosis. We saw them trying to cope with periods of illness, voices, delusional beliefs about bed bugs and with children being taken into foster care.  We saw them using prescription drugs as well as speed and alcohol to help manage their troubling symptoms. We saw them at times chaotic and disturbed, and at other times funny and happy.

We saw social worker Jim Thurkle doing his best to hunt down and help patients, a third of whom refuse to engage with him. We saw Dr Tom Werner doing his best to confirm the stereotype of the psychiatrist in the bow tie. We saw the fine line between enabling someone to live the life they choose and intervening in the interests of their own health and safety.

Not once did we see someone who could be considered a danger to anyone else. Not once did any of the patients present as anywhere remotely near the stereotype of the paranoid schizophrenic mad axe murderer. What we saw was patients struggling to manage their lives in difficult circumstances, and the professionals who tried to help them.

It was particularly interesting to see the work of a CMHT  which, along with GPs, carry out the bulk of psychiatric care in this country. As the booklet handed out at the advance screening says:

“The lion’s share of SLaM’s work takes place in a community setting, looking after more than 35,000 people with mental health issues. SLaM treats 8,000 psychosis patients a year; 6,000 of whom are based and treated in the community. We touch on different treatments available and see intense and moving interaction with social workers and mental health teams.”

As Pete Beard, the producer of the episode, who answered questions after the screening, said:

“We wanted to reflect the realities of this challenging work, following the actual narratives of people walking a tightrope with their mental health as it happened and the teams who act as a safety net. I feel that these realities are rarely reflected accurately in the media and as a result it is important to demystify the work performed as community teams, especially taboo subjects such as being sectioned”.

It was profoundly moving to see someone taken away from their own home, against their will, and detained with no legal authority other than the personal opinions of a social worker and doctors. No police arrest, no court process, no judge, no jury. Just a simple form signed, and you have no choice about even the simplest things like what you eat, where you sleep or what shampoo you use to wash your hair. And, on a more intrusive level, you have no right to refuse medication.

This extended scene cannot help but make you reflect on the balance of power between the state and the individual, and on what society deems to be acceptable norms of behaviour. This is especially so when you’re dealing with someone you don’t really know, as can be the case when a mental health team is called out to consider sectioning someone. Britain has a proud tradition of eccentricity, but that is not tolerated if you are deemed to be mentally ill. Simply being a nuisance to others but in no way dangerous to yourself or others can, ultimately, mean three people decide on your behalf that your quality of life will be improved by a compulsory stay in a locked psychiatric ward.

The sectioning sequence made me think about the boundaries or free will and autonomy and to what extent people’s peculiarities are tolerated. I have been on the receiving end of such a process, and it changed my life irrevocably. As Dr Baggaley said, when he’s taken part in sectionings he does wonder whether this was what he trained for. Although he sees it as difficult, he does see it as necessary.

Dr Baggaley described the person in question as a “revolving door patient” who would face repeated hospitalisations, some under section (compulsion), for the rest of their life. And yet this is someone who will – under the current welfare benefits system – also face repeated Work Capability Assessments. It is hard to see the point of such assessments in this case particularly since, as Dr Sarah Wollaston MP wrote today, WCA’s are not geared towards helping people with mental health problems find and retain employment.

One of the things which struck me in this episode was the amount of humour. Despite their difficult circumstances and troubling symptoms, the patients followed could come across as affable, amenable and warm-hearted. Ripples of laughter would regularly rumble across the audience, and not just because viewers were looking for a little light relief in what was, after all, a serious topic. As with any other fly-on-the-wall documentary, the colourful charaters in this episode were full of humour. The seriousness of the subject matter made the flashes of levity even more welcome.

Overall, this preview episode was intimate, insightful and profound. It showed human beings in all our difficulties, complexities and ambiguities. It showed the realities of trying to combat the stigma around mental illness with humanity and humour. It showed that danger and fear are the least of the concerns of the CMHT.

On a final note, I will end with a criticism that was raised by audience members with personal experience of mental health services: namely that the episode was somewhat naive and unrealistic. Audience members had received far worse experiences of mental health care, or had been able to deliver a far worse service due to cutbacks. It was acknowledged by the film makers that Speedwell CMHT had a ring-fenced budget, so had not been under the same constraints and workload other CMHT’s they’d liaised with had.

It was also highlighted that a lot of the difficulties patients needed help with were practical, and that these needs were not being met. The patients were unable to deal with these matters themselves and therefore they were stuck in difficult circumstances. Examples were the bedbugs which did actually exist in Tamara’s flat. It was not a delusional belief (though its extent may have been) and dealing with that practical problem may have lessened her delusional symptoms. This and her use of amphetamines may also have been the way she managed the immense sorrow of losing her children. Lloyd appeared to be using alcohol to numb his pain.

With a series planned over two years and filmed over twelve months, much footage will have ended up on the cutting room floor. It’s a shame, however, that the close relationship between medical help and social support, and the parts played by talking therapies and thereapeutic activities, were overlooked completely in this preview episode.

Nor was the 9% reduction in inpatient beds in the past 2 years mentioned.  Nor were the terrible cuts to community mental health services mentioned.

On the other hand, as Madeliene Long, SLaM chair said:

“Despite it affecting so many people, mental illness is still poorly understood. The stigma and discrimination that people face can make their mental health even worse and can prevent them from seeking help. So it’s really important that we do everything we can to raise awareness, challenge stereotypes and promote the facts about mental health. I’m really pleased that we have been able to work with Channel 4 and The Garden Productions on such an ambitious project which sets out to do exactly that.”

As executive producer Amy Flanagan said,

“Many of these patients had lived long lives with no history of mental illness. It could happen to our parents, to us.”

And, if it does happen to us or someone we know, programmes such as these will mean it feels a little less alien and a little more a part of everyday life.

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Media coverage:

  • Channel 4 press release about Bedlam
    • Anxiety (Episode 1/4) – 9pm Thursday 31st October – “It’s a condition every one of us experiences from time to time, but imagine if one day you woke up and found your anxiety had spiralled completely out of control.”
    • Crisis (Episode 2/4) – 9pm Thursday 7th November – “At Lambeth Hospital in south London, the Trust has pioneered the use of short-stay emergency wards for patients in crisis. It’s effectively run like A&E but for those with mental illness.”
    • Psychosis (Episode 3/4) – 9pm Thursday 14th November – “In this episode we explore the world of the mentally ill who live in the community.”
    • Breakdown (Episode 4/4) – 9pm Thursday 21st November – “In the final episode of Bedlam, cameras gain access to a psychiatric ward for over 65s at the South London and Maudsley (SLaM).”

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South London & Maudsley NHS Trust:

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People involved:

  • Dan Charlton – Head off communications & media at SLaM (twitter @Dan_Charlton1)
  • Dr Tom Werner (twitter @TellDrTom) – psychiatrist & CBT therapist – website

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But we’re not all like that …

16 Aug

Blue Toyota toy car

“But we’re not all like that!” We’ve all said it, haven’t we? Read or heard something that seems to criticise a group we belong to or feel part of and said, “But we’re not all like that!” I know I have. It’s instinctive. Especially so for those working in social care or the NHS, perhaps even more so for those working in mental health which seems to get criticism from every angle. There are many committed, hard-working, professional, compassionate staff who do the best they can in difficult circumstances, make a  positive difference to people’s lives and do a really good job.

So when a dedicated  GP or mental health occupational therapist hears a story on the news about terrible care in a service elsewhere, he might say, “But not all of us are like that!” A compassionate doctor or psychiatric nurse will read a story about a patient abused in another hospital and say, “We don’t all do that!” A social worker will see a story on a soap about a child being taken from its mother and say, “Not all social workers!” A psychiatrist or mental health healthcare assistant will read a patient describing their experience of poor care and tweet back, “But we’re not all like that!” It’s true: we’re not. But … And there is a but.

What happens when someone – such as a patient who’s had a brutal experience of mental health care or been badly let down by the NHS when she needed help – describes their experience and gets the response, “But we’re not all like that!”? What happens? The conversation stops being about the person who’s describing their own difficult experience and becomes … all about the person who’s interrupted. It becomes all about the interrupter talking about me,  me, me.

Now that’s understandable … to an extent. We all have our own experiences and perspectives. We all have our own hot buttons or soft spots. Many working in the mental health field have, I’ve come to learn through twitter, their own personal experience of mental health problems – whether directly or through family members. It really isn’t them and us.

It’s always easiest to see our own perspective. But … there is a time and a place for raising it. When someone is describing their own experience of pain, abuse or neglect it may, I’d suggest, not be the time to butt in defensively and talk about yourself. Sometimes, a sense of perspective is needed. This is well illustrated, it seems to me, with this simple anecdote:

Me: Someone driving a blue Toyota just hit and killed my four year old child.

You: I drive a blue Toyota. Not everyone who drives a blue Toyota hits four year old children.

What does this do? I was talking about having been recently bereaved: you turn the conversation around to … you being a good driver. No doubt that’s true or, if not, you sincerely believe it to be the case, are a conscientious driver and are genuinely offended at any suggestion you might not be. Perhaps there have even recently been stories in the press about bad drivers. But … was I criticising drivers of blue Toyotas? No. Was I criticising drivers? No. Was I criticising you? No. I was talking about the painful personal experience of bereavement.

Or, as mental health researcher Dr Sarah Knowles tweeted:

“I broke my leg :(” “Okay, but not all legs are broken. Why do you generalise? For example my leg is intact.” “I … what?!”

Put like that, it should, I hope, be obvious why the response, “But we’re not like that!” is inappropriate. And how responding or butting in with, “But we’re not all like that!” derails the conversation and belittles the experience of the person describing it.

It’s not about you.

Why do I raise this now? Because the “But we’re not all like that!” argument was raised earlier this evening in a twitter conversation. The conversation did – as these sorts of things so often do on twitter – broaden out to include many other tweeps and move on to other debating gambits, such as victim blaming, “if you can’t stand the heat, stay out of the kitchen” and the “them and us” culture. Read on for some fascinating insights and well-made points.

As Charlotte Walker (twitter @BipolarBlogger) tweeted:

“If someone has a terrible experience, I am going to honour that experience. There is no point in saying to someone who’s waited 18 months for CBT, ‘Oh don’t be harsh, in other Trusts it’s better.’ No use at all.”

And as NHS doctor Elin Roddy (twitter: @elinlowri) tweeted:

“I always remember you saying – just because you don’t work in a bad service doesn’t mean they don’t exist … It stuck with me and stops me getting too defensive (I hope) when people criticise health care.”

Next time you’re tempted to butt in and say, “But we’re not all like that!”, take a breath, pause and think … Maybe it’s not the right time to interrupt and hijack the conversation. Maybe  it’s time, instead, to listen.  Maybe it’s not about you. And, next time someone tries to stop you in your tracks with a “But we’re not all like that!”, maybe send them a link to this blog!

Not all drivers

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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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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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web links 5

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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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Some meandering thoughts on scientific studies

3 Jun
Elizabeth Garrett Anderson, Britain's first female doctor, by John Singer Sargent

Elizabeth Garrett Anderson, Britain’s first female doctor, by John Singer Sargent

Some thoughts on the nature of scientific studies – what gets studied, how studies are designed, how interventions are implemented – in response to the  publication of a blog looking at a study that showed Joint Crisis Plans were ineffective.

(I’ll work the twitter conversation up into a proper blog post when I have time, and then publicise it. In the meantime, it’s here as a repository for some thoughts of mine and thought-provoking responses of others.)

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web links 5

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Mental capacity, mental illness and pregnancy – Miss B and the “bipolar abortion” case

29 May

Mental Capacity Act 2005

Some thoughts (here, here & here) on the recent case of Miss B, a woman in  her 30s with a diagnosis of bipolar disorder who was sectioned to prevent her from exercising her reproductive health choices. She had to go to court and reveal the most personal details of her psychiatric and gynaecological health, as well as her sexual history, in order to be able to do so. In the end, just a few days before the legal time limit for abortion, the judge in the case came down very clearly on the side of mental capacity.

It’s all set out in the tweets (including conversations with a psychiatrist and a Mental Capacity Act trainer, as well as a woman of reproductive age with a bipolar diagnosis). I may put it into written form but here it is for now. It’s something that I and a lot of women of reproductive age feel strongly about.

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My Storify stories:

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Legal links:

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Commentary:

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Media:

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