Ahoy, and a rant...

Found myself writing a marathon rant on a forum today, stopped myself, and am posting it here instead.

The issue at hand was the difficulty of obtaining psychodynamic therapy from the NHS, in particular for those with a diagnosis of BPD. The NHS tend to stick at offering stage one DBT (Dialectical Behaviour Therapy) only. Stage one DBT focusses on reducung self-injury and other maladaptive coping techniques. The idea is to make sure people have a basic stability and safety before they go through further therapy (DBT or otherwise). However, they do actually need further therapy to happen, otherwise the underlying problems remain, and you have someone who has basically been taught not to show their distress. It's all part and parcel of the generally dismissive attitude towards those diagnosed BPD from mental health professionals...

And so began my rant:

...

"It maks me feel so angry, actually - people turn to them in great need and are treated like they shouldn't make a fuss. It has parallels with the sexist treatment of women over the years - calm down dear, be quiet, please others, have no needs yourself, no opinion and no feelings.

In my opinion, this is closely liked to the BPD diagnosis - I mean, you have a diagnosis that more often than not involves abuse or other traumatic experiences, and yet people diagnosed BPD are treated like they are making a fuss about nothing! "Attention-seeking" is a phrase bandied around. No-one would say to someone yelling for help after being severely physically injured, "You're just attention seeking".

I wonder if it's a collective refusal to face the damage humans to do each other on a personal level? People don't like to think that there is abuse out there, or that the way they themselves act may seriously hurt others, or that the way society is structured may cause problems. Much easier for everyone to blame the victims, and decide they are "overreacting".

In that way I think psychiatry is an abuser. It gaslights people, twists things around to blame them, labels them as deviant from the norm, because their struggles show."

...

Madness and Mentalism

I've no idea, as I start writing, where this post is is going.  I'm seething inside at something a friend (I'll call him 'Q') said last night.  It echoed an attitude I have encountered in mental health professionals.  Q is thinking about becoming a mental health nurse, which means I should really try and make him understand... although I did try to point out the gaping flaws in his argument/attitude at the time. 

We were talking about a mutual friend ('P') in the context of this friend needing mental health help. 

The comment I objected to was about P not really being 'mad' as (apparently) his symptoms don't present in quite the same way as someone who really has them.  Not that he has different symptoms, but that his symptoms are someone not genuine.  At first I was intrigued by this, and questioned how 'real' symptoms would differ; assuming Q had experience of this in his care role.  However, it turned out he had no experience, and was simply judging based on a preconceived and uninformed idea of 'madness'.  The implication was that P was entirely responsible for his actions, and should be left to get on with it and “sort himself out” without needing any support. 

This takes us to the 'mad vs bad' debate that lies where mental health and the criminal justice system collide.  (For more on this, see the excellent blog by Mental Health Cop.)  Is someone 'mad' and deserving of sympathy and help, or 'bad' and to be punished for their actions? 

In mental health care, the mad/bad construct is also very relevant, although less to do with punishment (hmm...!) and more about whether someone is 'mad' enough to receive help/a certain level of help, or whether they are capable on their own.  Phrases like 'attention-seeking' are bandied around at this point.  There's also issues around retaining a level of independence, although this seems to be used largely by professionals to refuse all support, rather than in the context of appropriate support and treatment.  A bit like refusing to throw a lifebelt to someone who's drowning because they should be able to swim, rather than throwing them the lifebelt they are screaming for and then teaching them to swim for next time.  Anyway, I digress...  The mad/bad idea can be more helpfully reframed as 'mad, bad or sad', and in this context, if P isn't 'mad', he is most certainly 'sad', so he is surely deserving of support anyway! 

What really annoyed me about dismissing P's symptoms and difficulties in this way was that it relied upon a completely stereotyped and stigmatizing view of what a 'mad' person is like.  Q actually pointed out that P isn't constantly displaying symptoms and can interact with others in a perfectly ordinary way (ignoring the fact that P doesn't socialise when unable to, and his problems manifest in odd episodes of a few seconds to a few days).  A 'mad' person, according to Q's viewpoint, should be obviously identifiable all the time.  As if there is a massive difference between 'normal' and 'mad' people, rather than just people, who sometimes hurt a lot or get messed up by life.  Sadly, the opposite of being dismissed as not needing help is often being placed in the box marked “severe and enduring”, medicated, and removed from any meaningful use of the word 'recovery'. 

Another issue was summed up by something else Q said: that P is, apparently, “just a mad person”.  Yes, that does directly contradict the above, which is why mental health professionals and would-be professionals should think through this stuff before passing judgement!  Anyway, the comment was made with the implication being “he's just a mad person, why are you bothering with him?”  As if he somehow didn't deserve to be helped as I'd help anyone else, as if the issues he faces don't matter as much, or that problems are to be expected and ignored as natural consequences of being “a mad person”. 

This attitude is unfortunately apparent within the mental health system.  It's evident in the lack of support or sympathy given to (at least some) service users when catastrophic events have pushed their mental health over the edge.  Events like becoming homeless, finding out your partner is cheating on you, or losing a friend to suicide, barely nodded at before the anguish and pain is dismissed as merely a symptom of poor mental health.  It's all linked to 'mentalism', which is connected to 'ableism'.  Without going into too much detail, this sums up what I'm getting at: 

 

… mentalism at one extreme can lead to a categorical dividing of people into an empowered group assumed to be normal, healthy, reliable, and capable, and a powerless group assumed to be sick, disabled, crazy, unpredictable, and violent.  This divide can justify inconsiderate treatment of the latter group and expectations of poorer standards of living for them, for which they may be expected to express gratitude.

… The discrimination can be so fundamental and unquestioned that it can stop people truly empathizing (although they may think they are) or genuinely seeing the other point of view with respect.  (Source: Wikipedia)

Sometimes these mental health gurus (snigger) go one step further and actually use distressing life situations as diagnostic indicators.  Things like having a 'chaotic' lifestyle or relationship difficulties can be viewed as resulting from personality disorder, and the resulting distress can also be passed off as a 'symptom'.  (This is dodgy territory, littered with self-fulfilling prophecies.)  The individual had no support in coping with their – quite legitimate – distress, or with improving their situation, and is in fact blamed for their own misfortune.  Even if the difficulties they face do go hand-in-hand with their mental health issues, it doesn't make them any less difficult or traumatic (retraumatization is also an issue).  Instead, it merely highlights the urgent need for treatment and ongoing support. 
 
So, going back to the “just a mental person” comment, does that mean we shouldn't help P as these problems are 'only' a result of mental illness?  Should we leave him to suffer in a downward spiral and then assuage any twinges of guilt by suddenly changing tack and declaring him 'sane' and thus responsible for the situation?  

I don't think so! 

When you consider the prevalence of trauma in the development of mental disorders, and that the stigma surrounding them can be more debilitating than the original symptoms, it's obvious that society (that's us!) needs to take responsibility.  Not only is it grossly unfair to ignore the plight of individuals who are already suffering, it's also blindingly counter-productive.  If someone is treated as a 'loser', a 'weirdo', or an 'attention-seeker', is isolated, denied opportunities and forced to live in stressful and/or traumatic circumstances, their mental health is more likely to get worse than better.  Refusing to help those who are suffering, dehumanizing and even blaming them, not only perpetuates the cycle of trauma and disadvantage, it also shows a twisted lack of humanity. 
 

And that is the scariest psychological symptom out there.  

**Since I started writing this post I've had a chat with Q and he's 'seen the light'!  Or something.  Which means I should probably be slower to judge (or quicker to write...!)**

Just a Thought

In the aftermath of the Aurora shootings the media are picking apart the tragedy, exploring various aspects such as gun ownership and violence in films.  This is all accompanied by appropriately reverent quotes and mourning for the deceased, and less reverent photos of the carnage and grieving relatives (thank you Daily Mail). 

Without doubt, this is a tragedy.  Friends and relatives of those who died have suffered hugely traumatic losses, and the whole community has been shaken. 

However, my first thought as the news stories began to break was feeling sorry for the gunman.  This was worrying – am I a messed up individual who relates to psychopathic killers more than their victims?   After much pondering, I think the answer is no (sigh of relief all round).  However, I do think it's something to do with relating to the underdog.  More specifically, the misunderstood underdog.  Now I am not suggesting that this particular bloke is a traumatised, misunderstood little lamb, and certainly not at the expense of the horror that has happened.  However, I'd like to step away from that story specifically and look at the whole thing more generally. 

There is something I find incredibly irritating about the reaction to this kind of atrocity.  Mainly, it's the public outpouring of grief.  Not the genuine, heartfelt distress from media-harassed family and friends, but a sort of jumping-on-the-bandwagon from everyone else.  I think the UK may be worse than the US in this respect – the death of Princess Diana being a notable example.  However, in the bloke-with-a-gun type massacres, this response seems... oh I don't know... hypocritical.  On the one hand, you have an individualistic, consumerist society that indicates you are worth as much as your bank balance; a society that alienates and excludes people, especially those that don't fit into the narrow definition of 'normal'.  In the US you also have an awful lot of people that frankly, are probably not to be trusted with guns yet can legally own them.  On the other hand, when it all goes horribly wrong, people seem not only shocked but surprised.  People can be cold, cruel and heartless with impunity, yet certain acts are seen as horrific and terrible without any consideration of cause, effect, and a sort of sliding scale of evil.  I think it's best summed up in the lyrics of Jack Johnson's 'Cookie Jar': 
 

It was you, it was me, it was every man
We've all got the blood on our hands
We only receive what we demand
And if we want hell then hell's what we'll have

Next, there is the way the perpetrator is unmasked as being an oddball, an outcast, someone who's always been different; obscure people from their past are dredged up to confirm this.  They are the bad guy, the freak who blighted the lives of good people.  Now, how many 'oddballs' have you met?  How many people who could be described as being different, strange, a loner, or whatever else?  And how many of those people have gone on to commit murder?  This labelling just seems to be a way to see the perpetrator as different, 'out there' and as far removed from 'normal' people as possible.  This was highlighted for me in the wake of the Cumbria shootings two years ago, when one newspaper painted a picture of the killer as a pathetic loner who still lived with his mother, comparing him to his successful brother (one of the victims), who was well-off with a house to match.  But what if the brothers' roles were reversed?  They'd probably have described the killer as a greedy rich man and his brother as sacrificing his career to care devotedly for their elderly mother. 

Anything can be distorted to fit the desired narrative, and the desired narrative is utterly black-and-white.  The bad person vs the good people.  The freak who spoils it for the rest of us.  It's as if they are to be feared and ridiculed for being different as much as for the crimes they've committed - which leads to perfectly harmless 'oddballs' being inadvertently scapegoated too. 

It seems to be a sort of collective defence-mechanism, to pin all the blame on the individual rather than face the monumental task of unpicking the wider faults in systems and society.  Whilst I would like to think that most people, when pushed, would not opt for mass-murder (though they might if requested to, as Milgram's notorious 1961 experiment revealed), the question remains as to whether individuals who commit atrocities might not have done so in different circumstances.  I believe that anyone who commits such an act is mentally disturbed – perhaps not under current definitions, but something has clearly gone very wrong somewhere along the line.  It all gets quite complex and philosophical at this point – how much our choices are affected by past experiences, the old nature vs nurture debate, and so on.  But still, these questions should be asked.  There are lesser crimes and other undesirable behavoiurs that aren't criminal, yet still cause a huge amount of pain and grief for people.  I've no doubt that people who commit atrocities have suffered in these ways, and while it's not an excuse it does go some way to explain the reasons.  But no, we keep on setting it in black-and-white terms and all the other stuff is swept under the carpet while we point the finger and it's all about freak bad people.

On a personal note, I think this stuff really gets to me because I have often felt like 'the underdog' myself.  I know what it's like to be misunderstood, judged and labelled with life-changing consequences.  It seems there are certain things that are practically universally 'entitled' to compassion (losing a loved one, for example), whilst other situations that may cause untold distress are disregarded.  It also depends on how an indivudual expressess their distress – many may not recognise how to to do this in a constructive way, or do not have access to therapists or counsellors.  Again, it comes back to the good people who are allowed (rightly) to be outraged and upset when they are hurt, whilst the hurt they may have inflicted on the bad people is ignored.  It's just not fair.

It's time to look beyond the labels and recognise human distress in all it's forms - only then can we start to do something about it.

*** I started this post over a week ago, and in the meantime more information has come to light, including the fact that James Holmes (Aurora killer) was seeing a psychiatrist***

Must Try Harder

I can't remember when I first learned of depression; it was certainly before I ever considered I might be suffering from it, and before I had internet access to find answers easily.   I imagine the early filtering through of information came from posters and leaflets read out of boredom whilst waiting for doctor's appointments.  From this, I knew it was unhelpful to tell the person to “pull yourself together”, and that someone suffering from depression already felt useless and guilty so you needed to be nice to them. 

These two things seem pretty obvious to me.  If someone is depressed, they clearly can't “snap out of it”, or they presumably would have done so already.  Depression is, by it's very nature, no fun whatsoever.  And anyone suffering in any way is surely deserving of sympathy and support.

Apparently it's not so obvious to most people (including mental health professionals).  The same tired and unhelpful old assumptions just go on and on; people don't even realise they're doing it.  For example, people are always suggesting to me that I do things to help me feel better.  This irritates me beyond belief, because:

1. I already do that and their suggestion subtly sweeps aside my efforts as worthless.  I know when just getting out of bed is a huge achievement; they don't. 
2. They always suggest activities that are basically living everyday life – things like getting a job, socialising more, or taking up running/swimming/anything else that feels like climbing Everest when you're low. 

If I could do these things, I'd be fine!  The reason I don't do them is not because I am unimaginative, lazy or stupid.  It's because I feel exhausted, physically lifeless, struggle to concentrate, find things more effort than fun, and can't keep a fake smile plastered to my face at all the required times.  I'm not sat around twiddling my thumbs, bored and depressed, for want of a hobby.  Actually, I'm not bored at all, and certainly don't lack hobbies.  I'm just putting in a lot of effort for what seems like little return, trying to feel moderately ok whilst taking hours to keep on top of things like laundry, eating healthily, and not ending up being dragged to A&E by police.  I think I'm actually doing quite well, in my own small way, and suggestions for further action, however well-intended, just leave me feeling like I've got a to-do list the length of the Amazon, which is totally overwhelming and means I actually end up doing even less. 

I am constantly frustrated that otherwise kind and understanding people fail to grasp this.  It's the whole point (for want of a better word) of depression.  What gets to me especially - and I have been pondering this lately – is that other people seem to do the most silly things, whilst bumbling along quite happily and dealing with the eventual fallout with ease.  For me, the stakes are too high. I have to carefully consider every decision I make – and have learnt over time what is a good idea and what is not.  (A friend actually commented the other day that I am “quite sensible”, whilst incredulous at various unfortunate, unlucky situations I've been in.)  So, in terms of what people do with their life and the decisions they make that affect their happiness, I'm actually doing pretty well, and am in relative terms, it seems, quite wise (and oh-so-modest!)   Yet these same people who make silly mistakes in their own lives view me as someone who's just not trying very hard, or possibly is not clever enough to figure out what to do.  Even some mental health workers I've had the bad luck to encounter seem to be displaying signs of personality disorders that should render them ineligible to work with vulnerable people, let alone make judgements of them. 

I sometimes wonder if everyone actually has the same amount of 'depression potential' or whatever it'd be called, and it just manifests differently.  Some of these things are recognised as being linked to mental health – substance abuse and obesity, for example.  But what about things like having a messy house, eating erratically (though sensible weight), being racist/sexist, or generally a bit of a tosser?  These things aren't considered 'essential' by society in the same way as, say, holding down a job or managing to go to the shops without having a panic attack.  So theoretically, if I gave up bothering about certain things or caring about other people, would I have more resilience in dealing with other things?  Do I use up all my self-discipline and energy on things considered less important by society?

I've heard people being described as so depressed they “can't hold down a job”.  Yet for me, a job is the first thing that goes.  Having to be somewhere at a certain time, able to concentrate, not allowed to break down in tears, etc etc, is hard!  Yet I can keep my flat and myself relatively clean, and try to eat healthily, and don't turn to alcohol...

Do I have my priorities wrong?   Does society?

What really bugs me is that I'm the one asking for help from mental health services, I'm the 'broken' one, whilst others might be making all sorts of mistakes or living in a selfish way, yet perfectly 'fine'!  I want to yell at psych-types: “Give me some credit!” and point out all the sensible decisions I've made, not to mention the bad luck I've had too.  I suppose it's to do with the stigma of mental ill-health, and the blaming attitude towards certain diagnoses from mental health professionals.  If they decide you are not 'mad' (floridly psychotic), they automatically see you as 'bad' (attention-seeker, not trying hard enough etc).

I'm not really sure what conclusions to draw from all this, except that the mental health services are as messed up as those they treat, and their job is basically to make these individuals function in a messed up world.

On the plus side, I suddenly feel a lot saner!

Myrtle

First Post...

Have been dithering over my first blog post for some time.  This is partly because technical hitches setting up the blog and fiddling round with fonts etc has provided hours of procrastination and taken the edge of the 'new project' enthusiasm.  Of course, this isn't a 'project' but an outlet for thoughts, frustrations and reflections, but I have to constantly suppress the creative perfectionist tendencies that can take over.   Note to self: repeat ten times - “Blog is an outlet, not a masterpiece...”

The second and main reason for the delay in posting anything is that my rant-o-meter is swinging wildly all over the place, as the mental health services differ in their attitude towards me.  I set up this blog when it seemed all hope of treatment/therapy was lost, but as soon as I began expelling my wrath and disappointment in the form of a post, they suddenly became very helpful.  Rallying the forces after this unforeseen development, I started writing about my general thoughts and issues with psychiatry and mental health service provision, only to find myself becoming increasingly annoyed at and disillusioned with them and their previous attitude towards me.   I say 'previous', but this attitude seems to be indelibly, eternally etched into my notes; misunderstanding (wilful?) laid upon misunderstanding.  It causes mental health types to ask me some odd questions as they try to reconcile the person on file with the person in front of them, as well as a marked change in tone of voice over the phone whenever they get my notes up in front of them.   I sometimes worry that in future I might suffer from a rare disease, and instead of investigating it, I'll just get fobbed off as a mental attention-seeker. 

(Incidentally, whenever I imagine my psychiatric notes, I picture a huge bundle of yellowing, torn pages held together with chains, insulting words carved into them with a scalpel, sat forlornly on a trolley between dusty shelves of rustling paper.  They probably have dart-holes in too.)

Anyway, I digress; the point is that I am now wondering whether I'm actually better off out of the system. I've been reading “Users and Abusers of Psychiatry” by Lucy Johnstone which is very enlightening, although guaranteed to get the blood pressure up.  As well as being very skeptical of the mental health system, I'm also very aware that they may drop me due to a life situation (more in a moment) that would probably be labelled as non-compliance.  So I'm in a sort of non-committal, inbetween world whereby I don't want to hope for therapy I will never get, but also don't want to burn my bridges in case they may actually be helpful or I need them in future.

It really seems like it has to be one or the other though – I can't slink off, let down and hopeless; I need to be able to stick two fingers up at them, finding my own way on, knowing I tried the other way and it wasn't the answer.  I suppose what I mean is that it need to feel like a positive choice.  Obviously if they do help me, there is plenty of room for healthy skepticism, but I would need to embrace therapy to get the most use from it.

I guess I'm secretly hoping I'll just somehow get better during the next year without needing therapy, that somehow my reflections and insights will eventually all join up and complete the parts that make me struggle to function.  However, I'm not sure how likely this is, and I'm also going to be putting myself in a situation somewhat removed from everyday life so will likely appear to be fine when that may not be the case.  This is because I am going travelling (yey!) at some point over the winter.  It seems like a very good idea for my mental health to be off with the backpack again - all that soul-searching under the stars and whatnot.  Only now, of course, the mental health services are finally responding to my pleas for help (approx. 20 months after the initial GP appointment) and it will look like I am:

a) Completely irresponsible, immature, and unwilling to commit to a treatment plan, or anything for that matter (they would probably use the phrase 'not engaging with services')  

b) Trying to 'run away' from my problems (as if you can run away from problems in your mind!)

or

c) Obviously not really struggling, an attention-seeking waste of time as they previously thought.

With regards to the last one, I can see it seems odd that I can trot off to foreign lands when basic things here day-to-day seem so hard, and I have spent many hours musing on why this might be.  As it is, even planning the trip is making me happier although only marginally improving what I manage to do each day - probably because of the crippling tiredness I feel.   Still, when I am away I can still sleep when I want, socialise when I want, etc, etc – but with the added bonus of sunshine, exciting/entertaining experiences, and new and interesting people.  I don't know really, but if I could crack the puzzle and apply it to my everyday life, I'd be sorted.  I think it'll require further thought and a follow-up post...

Anyway, I am hoping the mental health services will understand my reasons for going away for a bit, and I will be able to get therapy when I return.  Even better, that I magically get better (or at least slowly get better via insights as mentioned) while I am away and hereafter lead a worthwhile, productive and fulfilling life.

Or something like that...

Myrtle