Holby City Xmas Episode

Is it me, or was it slightly remiss of Sascha, not only to leave mid-shift for a brandy before returning to duty, but not to refer his suicide attempt patient for a psych evaluation before discharging him with a prescription Santa outfit?

Hospitals: A Safe Haven?

Given recent events, I have come to question the mental health training, if any, that NHS hospital staff receive.  Regardless the physical problem, the mental health label/history seems to penetrate the rest of the patient files, and the professionals' thought processes, ending up in a 'discussion' of 'is this all in your head?' or 'did you do this to yourself?' by every professional who passes the threshold of one's curtain, despite this being the 3rd time today. 

The fact that the hospital's mental health team has spoken at length and agreed a strategy and plan involving patient and family, and has this written up in the file for all to see seems to elude them all.  This has some how donned and invisibility cloak whilst the original history/diagnosis scrawled itself in indellable ink over every sheet in the file.  Meanwhile, doctors, nurses, surgeons, consultants run amock making faux pas left, right and centre, going against the patient's wishes, destroying their feelings of security and the pre-arranged, specialist-approved safety net. 

These were of course set up in order to take their thoughts, feelings and views into account, use existing effective measures of support, preserve their dignity and promote recovery.  For some reason the system seems to remain rather Victorian in this regard, and content to do as they will, ignorant to the detriment of their actions.

Why?

Failure to Communicate

Giving points of view, giving pre-made appointments, giving it 'all that,' they are good at.  But the key aspect of communication; all communication, but especially within mental health, is listening.  Without that, how they expect to draw accurate conclusions, let alone build trusting relationships is quite beyond me.  Asking a question about someone's life and then answering it themselves without so much as a glance for clarification is a sure fire way to foster anger, resentment and bring the relationship, what there is of it, crashing down.  Let alone build a false picture of what is going on, masking potential risks and provoking either the need to be rude in order to correct things, or to give up and let them get on with it if they're so determined to construct it all themselves anyway, and resign oneself to never receiving the right help and support.

Sticky Labels?

I recently revealed the diagnosis that I had, to some who knew I'd had issues in the past.  Following this talk, it came to my attention that it had been assumed that I was my label in the sense that I still had the label and diagnosis and therefore still came into the box of others with said diagnosis.  The idea that I was no longer my label, no longer had the diagnosis, and could have been 'cured' of it seemed inconceivable for some reason.  Sure, I used to struggle with many things, but I thought it was fairly clear and obvious now that these things were no longer an issue.  In which case, why would I still have the label?  Quite simply, because labels are sticky.  Stickers would be more apt a term.

The Dirty Diagnosis

It really does feel like the dirty diagnosis.  The label some are scared to give, and many are scared to own.  The one that immediately flags up words such as 'manipulative,' 'awkward,' and 'incurable.'  If the people that bandied around these connotations sat and thought for a minute, about the origins of the illness (the biosocial model) and tried to... wait for it.. empathise, they might see that some of these 'awkward' traits have roots in the past messages and feedback given at an early age, and that the person really is doing the best they can, with what they know, and what they have learnt from life thus far. 

Manipulation, for example, may well be borne of a person's feelings of worthlessness in so much that they do not feel they have the right to ask for something, or that they deserve the outcome they need and so go about plotting to get it instead. 

Equally, self destructive tendancies, whilst frustrating for those working with them, are usually a result of 'learned truths' for example, that 'things always go wrong' or 'I am useless at everything' or 'nothing I do is good enough' and so anything that doesn't fit into this accepted pattern is considered as an anomaly.  It takes a good deal of courage to risk standing the other side of the line - the hope side.  It means leaving everything the person knows, to stand with the single, or few things that have gone well.  If something threatens this new 'hope' idea, it is much easier to screw it up and go back to the 'everything is shit' mindset as it is familiar and comfortable.  A love hate relationship with failure - Failing leads to feeling like shit, but if everything is already shit, nothing bad can happen.  It's safe.  In a way.

Behaviours, whilst maladaptive, are coping mechanisms, and may very well be the only reason the person is still alive and fighting.  Whilst it may not be apparant, it is likely that the person is fighting it for the majority of moments every day, therefore, to go days at a time without enagaging in such behaviours is a major achievement.

Of course, most of these behaviours are there to endure emotions, or avoid them altogether.  Often feelings are intolerable in their own right, or which stem from other initial feelings that were learnt to be dismissed as 'wrong.'  The mere idea of 'being sad' or 'feeling guilty' are inconceivable; a harmful behaviour is much eaiser to bear, and has the added bonus of being a 'real' and tangible pain.  One that it is acceptable to hurt over.

The phrase 'born without an emotional skin' is used to describe the biological aspect.  The social aspect, however, is all linked to growing up in an invalidating environment.  Learning that one's feelings/views are wrong, and that they should be a certain way instead.  Learning that there is always a right way to feel and to look to others for verification of what that might be.  ...it destroys interpersonal relationships, leads to interpersonal dependancy and therefore opens up an increased liklihood of abusive relationships.   It also washes away self esteem and a sense of identity as there is a perceived ideal of what the person should be and how they should act, which over time takes them further and further away from who they are and what they want from life.  This ideal is often unattainable and leads to feelings of weakness, failure, and permanent ineptitude at not being able to achieve it.  It's being set up to fail at the very beginning of life.

Prescription Self-Help Books

I've just come from reading an article in the Staffordshire news about GPs prescribing self-help books from local libraries for people presenting with mental health difficulties.  I have a few issues with this idea.


When I was ill I wouldn't have dared go into a library and take out such books for fear of being seen as I was anxious and paranoid at the time.  Also, in being depressed, I lacked the motivation and concentration span to read and do things when left to my own devices.  Staring at the book on the floor from under my covers would have just amounted to another failure of mine to add to the list of reasons I was crap, ill through my own doing, and would never get better.

This may well work coupled with a therapy, where the tasks are homework and are to be discussed and evaluated with room for problem solving and praise, but alone they are asking for trouble.  But sure, if it saves money, fob us off.  That will definitely help us to feel that there is a point in keeping going...

What do you think?  Full story here:


http://www.thisisstaffordshire.co.uk/GPs-prescribe-self-help-books-patients-common/story-13953119-detail/story.html

Labels - useful or problematic?

There is debate as to whether labels are/can be useful or problematic.  Personally, I've found labels to be useful in many ways; from explaining to others what's going on for me, to receving the right treatment (some of which is only available if you have a specific diagnosis).  One label in particular was useful in helping me understand what was happening to me and why I felt a certain way. 

At the same time, I've not worn these labels with pride at any point.  They were useful on a personal level to inform me and guide me, but never to express who I was.  I never revealed them outside the therapeutic setting unless I had to.  On occassion, it helped me connect with others of the same diagnosis, but in general I lived in fear of being exposed/'outed'.  Mainly due to the unsavoury aspects of character alluded to in an array of related Google search results; stigma.  This was not something I wanted to put my name to.  Not something I wanted friends and family finding and assuming was true for me just because it was an opinion that someone, somewhere had of someone, somewhere they knew with the same diagnosis. 

Mental illnesses are not quite the same as their physical counter parts.  They cannot be seen directly and be scanned (for the most part) to detect something such as a 'break,' or a rash found and identified by referring to a photo.  Emotional pain is extremely difficult to verbalise and even harder to locate.  A label is not required for something such as a broken leg, as it is obvious.  People notice it, people sympathise, people try to help; they hold doors open and offer to carry things.  Mental illness is invisible.  People do not see it, people do not sympathise, and often do not try to understand.  Often people do not know what to do, and run away from it when we need their help the most.  We need to educate people, and tackle the taboo.  Are labels the way to go about this?  Are they ever useful?  What do you think?

Challenge #1

I am just in the process of finalising my email to Zane Lowe of Radio 1, about his excited exclamation of the 'schizophrenic start' to the show on Thursday 3rd November.  Fingers crossed for a response...

It starts.

Finally, I am getting the blog up and running.  I hope to make an impact, start initiatives and add some volume to the voice of mental health campaigning.  Care to join me?  :)