Holding on to this Wonderful Life

CW/TW Suicidal ideation

I don’t get to spend Christmas at home every year, we alternate, as do many people, between parents and in-laws and home. So far I think we’ve spent only two here together, and we’re trying to develop some traditions.

Every year Hebden Bridge Picture House plays “It’s A Wonderful Life” on Christmas Eve. Last time we went I admit I wasn’t totally taken with it. We were upstairs, it was full, and hot – I felt rushed and too conscious of my discomfort squishing into the old seats. But this time it was lovely. We went for the matinee showing. I settled down with a cup of coffee and a cake (which I didn’t eat but it’s worth mentioning a cinema where you can have a nice mug of coffee and home made cakes – or, as many others were partaking, beer or wine. I can’t imagine most matinee performances sell as much beer but it was Christmas after all.)

It’s a funny choice for a Christmas film really, where the pivotal scene is a man’s suicidal crisis. But it got me thinking all the way through about what it says about mental health, suicide prevention, self care, society, capitalism, selfishness and selflessness. It may be one catastrophic circumstance that pushes George Bailey to a bridge over a churning river, contemplating his death to solve other people’s problems with his life insurance – but before that he is not really a happy man. It may be that night of desperation, and the prayers of the townsfolk send up in his name which attract the attention of God, the Universe, and Joseph, and lead them to send Clarence Oddbody, (Angel, 2nd Class) down to save him – but as with many people – George’s suicidal thoughts come as the culmination of a long period of distress, made up of a variety of different problems.

Clarence is helpfully given a crash course in the key things we need to know about George’s life. Of course there is plenty more to a person’s life, but we can all look back and see these crucial moments which have significant impact, or switch the points on the railroad tracks of our lives to send us down a different path than that which we expected.

First up for George is saving his brother’s life. Playing on a frozen pond, his younger brother crashes through the ice and George doesn’t hesitate to dive in and rescue him. This leaves him with a nasty cold and ear infection which eventually takes his hearing in one ear. This illness will have had some impact on his development – the disability certainly impacts him later in life when it prevents him from fighting in the war like his hero brother and friends. That early teenage time – when we are forming out adult identity – is important, and problems in this are often involved in later issues of self esteem or dissatisfaction. We see George post illness working in the drug store, oblivious to the youthful admiration of his future wife Mary and good time girl Violet. His thoughts are not on anything so mundane as a girlfriend – George dreams of travelling the world, exploring the wonders shown to him in his National Geographic magazine. That is his idea of his identity. Who he wants to be, what he wants for his life. However our mind is trickier than that, it doesn’t necessarily give us what we want. Something subtler is happening in our subconscious, the result of our genetics, our early education and experiences. George’s rescue of his brother is merely the first example we are given of him saving someone else’s bacon. He is a good guy, desperate to do the right thing, prepared to disregard the negative consequences for himself if it will prevent the the other coming to harm or losing out. Next up he realises that his boss, Mr Gower the pharmacist, blind drunk and out of his mind with grief at losing his son, has made a grave error in filling a prescription, inexplicably filling a packet with poison pills instead of whatever cures diptheria. Unable to get the advice of his father (and sparking a life long enmity with Henry Potter by defending him in an argument) young George goes back and braves the wrath of Mr Gower, gets a beating on his bad ear, but is able to make him realise his mistake, averting disaster.

George is a talented man. He wants to be an architect, after his travels. He is intelligent and innovative, with an eye for opportunity. But instead of greedily keeping those ideas to himself, he shares them liberally. He comes up with the idea to put a swimming pool under a moving floor in the school gymnasium, he recommends his friend invests in plastics, and build his factory near Bedford Falls where there is both cheap real estate and a large pool of available labour. So why is it that George is on the bridge wringing his hands and praying for help, rather than luxuriating in a skyscraper he built after years of globe trotting?

Sometimes life gets in the way, doesn’t it. Things happen. In George’s case, his father dies suddenly on the eve of his graduation. He forgoes his year travelling – presumably to help comfort his mother, and also to help at the Building and Loan which his father had set up to allow working men a chance to own a decent home and get out of the grips of slum landlords like Potter. He is about to head off to College, but at the crucial moment the board insists he stay to run things as his father would have wanted, or else they will bow to Potter’s demand to liquidate the whole operation. So. He stays. Even though his Uncle and others urge him to go – say it’s not the end of the world. He sends his brother off instead, figuring he will come back and take his turn at the Building and Loan and release George from his obligations in four years time.

But no. Of course it isn’t to be. Harry returns with a wife, and a fancy job offer. For all his pledge that he’ll reject it if George wants him to – he clearly hasn’t told his wife that. He knows George, Good Guy ™ that he is, wouldn’t want him to lose out on such a chance. George will let go all his dreams and stay in Bedford Falls, consoling himself in the waiting arms of Mary, marrying and building a family, helping others to achieve their dreams building homes in the affordable haven of Bailey Park. He doesn’t even get to go on Honeymoon, ending up using his savings to stave off a run on the bank in the Great Depression.

You could say he seems happy at certain points in the retrospective. He clearly loves his wife and children. His essential goodness is innate, not forced. He doesn’t hold it over people, expect gratitude or reward as some people might. But he is tired. And there is a bitterness, a resentment, that runs deep within. He doesn’t want it. Most of him doesn’t really feel that way – but he has never let go of his dreams. His table is full of models and plans for buildings he will likely never build. He sees the glass half empty – not the beautiful home they have created out of a broken down ruin, but the creaks and draughts that remain, the loose knob on the banister, not the warm hearth and music in the air.

That resentment has eaten away at his joy. He doesn’t blame his father, his mother, his brother, his wife – Sam “Hee-Haw” Wainwright (though God knows I do, the annoying creature). He has chosen at every step. But even though we might accept that we wouldn’t choose differently even if we could go back – it doesn’t stop us mourning for what might have been. Always yearning for the greener grass of alternative futures. (Notice how we never think that those different choices would go wrong).

So when it seems that yet again he is going to feel the need to take the fall for someone else’s actions – when his hapless Uncle Billy “loses” the $8000 he was meant to deposit in the bank on the day the bank examiner comes to check their affairs, George erupts. He sees himself lose it all, his business, home, family, liberty. In the first moments he shouts “it won’t be me that goes to jail for it” – but quickly he reverts to type and starts to try and dig his way out. Debases himself to his enemy in vain, begs funds from a wealthy friend but can’t get in touch. And when this fails he thinks of the insurance, and makes his way to the bridge in despair.

It’s undeniable that George has problems. A long history of trials, disappointment, debt, depression, which colours our view of life, building to a final trigger which pushes him to consider final, drastic action.

Of course at this point Clarence falls from above into the waves, triggering George’s instinct to save him, and giving him a chance to see the value of his life. George admits he doesn’t want to die – again he’s thinking of others, the impact on his family – but instead he wishes he had never been. And in this Christmas classic it is not the Scrooge like Potter who gets the vision, not Christmas Past, Present or Yet to Come – but what might have been, had George never been born.

Clarence helps George to see what he has. How the world is a better place for him being in it. He helps him through that terrible, lonely moment. Gives him the insight he needs to have hope. Coming back to his home George still has all the problems he had before, but he now sees all that he missed before. Blessings large and small. The recognition of friends, the familiarity of his home, his wife, his children, the annoying loose knob on the banister.

I found myself pondering the messages of the film. What might have prevented George from reaching that moment of doubt and pain? What could he have done differently? What could others have done to help him?

Of course there is the Disney do-over, where nothing bad happens, and everyone behaves as they should. Harry doesn’t smash through the ice so doesn’t need saving, the pharmacist’s son doesn’t die, so there is no mistake with the pills, their father doesn’t die of a stroke so George goes travelling, goes to College, builds his skyscrapers. But would he have been happy?

Lets gloss over the Disney-ness of the actual ending, and come back to it in a bit.

You can’t say it’s wrong for George to make the sacrifices he does. Everyone has the right to put others first. It is a message to all of us to think about, and be grateful for the sacrifices others make to give us the opportunities and privileges we enjoy. To consider the needs of those we love. Much as Mary loves him and makes him a happy home – when they as teenagers throw stones though the windows of the old ruined house that would later be their married home, making wishes for the future, she doesn’t hesitate to wish away his dreams in favour of her own.

Then there are those whose actions hurt us. The models of how we should not be. It is clear from the outset that Potter has no care for anyone’s wellbeing except his own, but for the most part he is just a typical Free Market Capitalist, making hay on the misfortunes of others, blaming them for not being able to get out of the trap he has devised. But mostly he stops short of actual criminality, still causing enough woe along the way. Sam Wainright shows us (as far as we can see) a model of someone who does well without being so deliberately selfish and malign.

We are reminded that sometimes people can still do harm to others even though they think they are just “looking out for themselves” – like the man in the Building and Loan during the scene where George keeps the place open through the run by doling out his own money – who insists on having every penny of his savings, not just what he needs – thus meaning it is harder for George to help others and risking it all falling apart. But Potter oversteps finally. He keeps the mislaid money, and goes further to call in the police. Some men do evil by doing nothing, others on purpose.

Of course George has his part to play. Being honest – saying no – making sure his needs are met. Imagine if instead of allowing that resentment to build he had been able to acknowledge his frustrations earlier in his life and find a way to find fulfilment, but also take strength and happiness from the help he gives to others. To see the riches in his life without needing a celestial intervention.

On the other hand sometimes we do our loved ones no favours when we act the martyr and seek to solve all their problems, or never correcting their bad behaviour. Should Uncle Billy be allowed to take the consequences of his actions? The most recent example of his forgetfulness, his ineptitude. His family has made excuses for him and carried him along – given him a responsible job he probably isn’t equal to. Assuming he were able to take the blame – legally speaking – why wouldn’t George let him? Without George, it all falls apart. A family struggles. Without Billy it all might run better. Of course he should have been given a chance to stand on his own two feet and find a better path earlier on. Maybe opening a sanctuary for his animals. Much as we love people sometimes for their sake and our own, we must let them see the consequences of their actions, learn from their own mistakes.

So George might have reached his pivotal night with a stronger sense of self, better coping strategies, a more positive view of his life. But still – the crisis might have happened. Whether we see the accident of Billy misplacing the money in Potter’s paper, or the deliberate malevolence of Potter keeping the money despite knowing how it could ruin an avalanche of lives. Bad stuff happens. How do we respond to it?

George casts around in his despair, he asks some people for help – but not everyone. Crucially, he doesn’t tell his wife, doesn’t explain to her his problem, allow her to comfort him or try to find a solution. He doesn’t tell the people who might be in a position to help investigate the situation (the police) or give leeway (the bank examiner). He panics, as we do when we are desperate. But while he rails and reels his wife finds out and pulls together all the people of the town who have been helped by George through the years, and comes up with a sum to exceed the missing money.

Luckily Clarence has pulled off his side of the bargain and George is still there to see the miraculous and heartwarming show of goodwill. Sometimes we need someone to be there for us, to listen, to help us through the darkest moments, be our Clarence Oddbody.

Enjoying this Wonderful Life is a many faceted thing, sometimes we have to overcome more hurdles than others, deal with more challenges. We have to remember to look after ourselves as well as carry out our duties and responsibilities, know when to say no – not ask too much of others, consider their needs. Remember to look at our lives every day and see the good, not just the difficult bits. Be grateful and take joy from the littlest thing. But no matter how swimmingly things may go, sometimes life will throw things at us it is near impossible to deal with alone. So when we are struggling, we must, we absolutely must – talk to people, ask for help, allow people to help us look at things from every different angle and find a way through. Most of us are here to help, whether we end up with wings or not. For every Potter there are a million George Baileys. We need to find them and let them lift us up.

If you are struggling and need someone to listen – ring, or email the Samaritans, text “SHOUT” to 85258 – talk to your GP, or check your local NHS / Council / Mental Health Charity pages for crisis services in your area and please, please talk to your partner, family & friends.

Samaritans 116 123
jo@samaritans.org

Diagnosis

In my previous job, as a librarian, I knew well the importance of metadata. Of correct labelling. Sometimes, the labels and descriptors that we assign to an item help us to put it in its place, in context amongst other things. Help us to understand more about the item, than what we can see on the surface. I once did an exercise, thinking about how I would be described, what keywords would be attached to me, were I to be catalogued and put on a shelf in a great library of lives.

image of library catalogue card

What would we include? Title (Name) Originator (Parents) Physical description (Height, weight, sex, hair/eye colour) – beyond that though, the subject keywords – become a bit qualitative. But important – if you want to get the measure of me. My physical and mental health experiences would definitely have to be touched on. They have impacted my life and who I have become, and to varying extents still do.

So what do I put? How do I label this mess that has been in my head? Some would say – well, what’s your diagnosis? And there’s the rub. Do these things not exist before a doctor gives a name to them? I have, in my time had diagnoses of severe anxiety and depression. I still walk an ongoing tightrope with the symptoms that led to that diagnosis. But – I’ve also had conversations with doctors which suggested that there was more going on, that there was a possibility of Bipolar II, or Cyclothymia. Many times I was dismissed by doctors who didn’t want to engage. One doctor, when I persisted, said they would refer me to a psychiatrist for assessment – but never did. And I was in such a bad way at the time I didn’t follow it up. Latterly I have had much better doctors but concluded that as I seem to be managing my mental state better these days, and didn’t feel any need for medication – (which I would probably react badly to) – that I would leave the appointments to those who needed them more.

As I’ve learnt more about certain mental health conditions and understand my attachment issues, and the impact that events in my life may have had to contribute to some of “the way I am” – I can throw in other possible diagnoses that I might have been given. Or not. Recent years have given cause to think I may be on the autistic spectrum. But again – it’s not easy, quick or cheap to access diagnosis if it is not instantly offered to you on the NHS – so it is only something I would pursue if my issues, symptoms or behaviours started to significantly affect me in a negative way again. For now, I just use that tentative information in my head – to help me understand myself better. I might react like this, feel this way, find this difficult – for this reason. Sometimes that helps me find new coping mechanisms.

Diagnosis, after all, is just a label. A name agreed on by a bunch of doctors to describe a set of symptoms which seem to occur together in some people – and be helped by particular medications or therapeutic approaches. They change their minds over time. Fine tune their understanding.

The problem comes, if you need a diagnosis to access help. For instance – if my anxiety and depression were not “simply” that (not that it is ever that simple) – but were instead part of a Post Traumatic Stress response. Without someone recognising that, and referring me for appropriate treatment, perhaps EMDR – I may find myself revisiting medications and therapies that never quite help me to get the breakthrough I need to have a chance at recovery.

If my anxiety or depression affects me to such an extent that it impacts my work – maybe I am late a lot, take sick leave, or find certain tasks impossible. Perhaps my boss knows this, can see it, and wants to make adjustments to help me. But the HR department insists upon medical reports and Occupational Health visits to “prove” I am really ill – not faking it. But I am too nervous or stigmatised to go to the doctor, or cooperate with Occupational Health. The boss feels he is not “allowed” to help. Even in simple ways which are easily manageable across the team.

Problems don’t become real when you go to the doctor and get it labelled. I had lived with depression for 10 years at least before I even spoke to a doctor. Those other issues, for which I have no approved diagnosis – have had no less impact on my life and work for the fact they are not mentioned in great detail on my medical records if at all. I am fairly certain that the Equality Act does not require diagnosis for an employer to be expected to consider what adjustments can be made to help someone overcome a disability. Sometimes those around us recognise there is something amiss before we do. Sometimes we are in denial.

One of the things I like about Mental Health First Aid is that it doesn’t seek to make you a counsellor, a psychiatrist, a doctor. While it teaches you about some diagnoses that people may get – it doesn’t expect you to figure out what exactly is going on with someone. It helps you to understand possibilities – but emphasises that actually – diagnosis isn’t your job. Maybe sometimes it is going to be a necessary part of someone’s recovery – but figuring it out isn’t our role. Our role is recognising that someone is in distress, offering support, a listening ear, practical help – and signposting to services which may help – and may involve diagnosis. Or not. 

There are many roads to recovery. Diagnosis may give access to some wonderful new build bypass that gets you there quicker. But it also might prove to be a dodgy sat-nav that takes you off a cliff, or down a dead end road. Finding things that help with the feelings and symptoms we are experiencing, and learning to understand why we are experiencing them – could be more helpful for some than knowing the precise name a psychiatrist might put on that catalogue card. Especially knowing they might change their mind a few years down the line.

That being said – assessment and diagnosis need to be more accessible for those with severe and enduring mental health issues. It is more luck than judgement that I am still here to write about this. My teens and twenties were dangerously volatile at times – and I really should have been assessed. Who knows what life would have been like if I had. (Though I am under no illusions that it would necessarily have been better had I been further entrenched in “The System”. I’ve seen enough nightmare stories not to be that naïve) Sometimes, we can catch things early, we can make changes, we can learn techniques. But sometimes it is too late. Sometimes it is too much for us to bear alone. Sometimes the issues are much more complex.

In theory, if everyone experiencing mild or moderate mental health issues is helped to self-manage better, helped to access medication or short-term support, then their issues will not deteriorate and become “severe”, and things might free up down the line. Though those being trained to deal with those quick fix interventions are not going to be qualified to help in more complex cases, and it is no good telling those with severe mental health needs now that things will get better in 10 years time. 

It is not a simple picture. More money, more people, and a wholly different system approach are needed to even scratch the surface. I do still think the more we can do to support each other at all points along the way, in work and in the community, is worth doing – if only to provide comfort through dark days, and help us to remember we are not alone.

The power of negative/positive thinking

17126-illustration-of-a-battery-pv If it were possible, I’d have titled this piece “The power of positive negative thinking” – with the strikethrough. Or vice versa.

If I called it “The power of positive thinking” –  a good number would switch off. There’s a lot of that stuff about these days, positive psychology, Law of Attraction, etc. A lot of people swear by it. And even more swear at it. About it. It can’t be that easy – I hear – to turn our minds and lives around and find success and happiness just by thinking about it. Of course it can’t. Thinking on its own can’t do much. Can it? Though didn’t someone say “I think, therefore I am”?

More to the point I think (there I go again) – “I am, therefore I think, therefore I do.” And somewhere in there is “I feel” too. And how “I feel” will have a huge impact on what I do. And vice versa.

People are quick to diminish the possibility of positive thinking having a demonstrable impact upon our lives. But the power of negative thinking is acknowledged. When we become depressed, we become more prone to negative though patterns, which eat away at us. We ruminate, we blame ourselves, we jump to conclusions. Which comes first, the negative thoughts or the depression? Why do some of us suffer poor self esteem, lack of confidence, self loathing, mistrust, anger etc? The events and experiences of our lives sometimes don’t give us what we need for positive self worth in adulthood. Sometimes trauma, abuse or neglect might actively undermine those things. We can fall into patterns which reinforce this and every time those thoughts go through our head they get underlined  and emboldened  and emphasised  until we find it impossible to see past them.

Whether those thoughts are true or not – they have power. We believe them, and let them shape our world. Our beliefs about events and interactions and what other people think and feel about us influence our emotions and actions. We can believe quite negative and unhelpful things with no evidence at all. If I think someone hasn’t called me because they hate me, that will make me feel quite differently than if I think they haven’t called me because they are really busy. Cognitive Behavioural Therapy works on helping us to recognise when we are jumping to these negative conclusions or responses and gets us to question the evidence, think if there is another way of looking at something which does not have negative emotional consequences for us. If we have no evidence of the negative, we can choose to reach a neutral, or even positive conclusion if we want. Not easy, but we can learn.

So if we recognise that repeated negative thoughts can have a serious impact on our mental health, our behaviours, and therefore our lives – why are we so quick to reject the possibility that positive thinking might also have a power to it?

How we explain that power to ourselves is irrelevant. I know that decades of subconsciously repeating negative things to myself had the impact of making me believe those things. Whether they were true or not. So if instead I repeat positive things, to counteract that negativity – again, whether I really believe those things to begin with is irrelevant. Perhaps it will take hold.

I bought a calendar of affirmations a few years ago. I will admit it was a bit “American” for my cynical British self. But it made me smile each morning as I read the cheesy positivity. “Look in the mirror and say “Hi there beautiful, it’s going to be a great day”. Sometimes it made me laugh. When I’m feeling nervous about something, I try some affirmations in my head – “I am confident, capable, competent. I can do this. ” I don’t know why they all have to begin with c. And I repeat. Because at the very least while I am doing that I am not allowing the negative thoughts space in my head to undermine what little confidence I have at the beginning.

Sometimes when I am feeling low, and like hiding away from everything, but I have an engagement I don’t feel able to cancel – I drag myself out and I pretend. Sometimes it doesn’t work, but sometimes it does. Sometimes half way through pretending to enjoy myself, I actually do.

Some say if you ask the universe she will provide. I say if you ask the universe, it means you know what you want, and that’s a big first step. Knowing what our goals are, is setting intent, picking a destination. When we have that goal we are more likely to think about it, think about what we need to do to get there, what’s stopping us. And when we think about these things, and think about that goal with a positive mindset and belief in the possibility of reaching it, then we are more likely to start planning how to get there, to start trying to find solutions to our problems, people who can help us – and therefore inevitably more likely to reach that goal.

Maybe that’s how the Universe (or God, or Santa) provides. We are the universe. We need to believe in ourselves.

Anyway. Positive thinking is certainly less unpleasant than negative thinking. So I will persist, evidence or no. Every time the trolls in my brain throw a negative thought about what I can’t do my way, I’m going to keep trying to bat it away with a positive counteracting thought. The lower I am, the harder it is. So it’s even more important when I’m well to remember. To take note of the good, the things I’m grateful for. The things I achieve. The positive feedback. The small glimmers of hope. Gather them up and keep them in my bag to bring out when the clouds are darkest.

Happy Birthday Sarah Long Mental Health & Wellbeing

A paper napkin with writing on it saying "Do what you love!"

So about a year ago this week I ran my first freelance Mental Health First Aid course in Halifax and started my self-employed journey with the wobbly legs of a baby giraffe.

I’d been training for a few years back at my old employer so the training side of things was nothing new – I knew I could do it, well, and I knew I enjoyed it and found it incredibly rewarding. The question is can you do something you enjoy and also pay the rent? Could I make it work, get enough bookings? Would doing this as my “main” gig gradually sap the joy out of it?

Well – so far so reasonably good. It has been a slow builder, some months better than others, lots of learning experiences. Some successes, some less than successes. I’m still on the fence about the long term but failing disaster I’m hoping I can carry on for a while yet.

I’ve worked with a variety of partners, Unite the Union, MHFA England, St John Ambulance – I’ve also tried running independent courses but so far, a combination of running costs and difficulty getting people to book on – means that isn’t very viable. I’d love to have some courses scheduled through the year for people to book on to, but it feels like I am messing venues about when I end up cancelling all the time. Though I will try again!

I have run 12 non branded and 28 MHFA courses. Trained probably nearly 500 people. May-July was about right. If I can get back to that I can survive.

Do I still enjoy training? 90% absolutely. I still get to have amazing conversations, help people overcome stigma and recognise how they can help themselves and others in their lives. Don’t get me wrong, it’s not all roses – I am not the queen of early mornings, travel is tiring, and some days my own mental health might not be totally overjoyed about standing up and “performing” in front of people. But so far I have been able to do it pretty well, and I shake off the cobwebs soon enough. The admin I actually enjoy – ditto marketing though I need to find a way of getting enough done on my days of focus to make up for head fog the rest of the month. There is stress. Worry over whether I have enough work, especially when things get cancelled. Technological nightmares (yesterday all my videos seemed to be possessed by chipmunks). Travel chaos (Beast from the East… I’m looking at you). Knowing that a whole room of people are depending on you to get there, get it working and do it right and well – or you’re wasting their time and someone’s money. That’s stressful. But not the same kind of stress that used to make me ill in my old job. I have a good work/life balance going – I am forcing myself to do productive things when not training, setting goals, and working towards them. Constantly learning and updating my knowledge in one way or another. So I really hope I can make this year better than last and keep going.

A new partner to work with would be great – to bring new opportunities in different areas or sectors, and I also hope to add some different course options to my offer as well. So anyway – Bring on Year 2. Lets see what you’ve got

I offer a range of Mental Health Awareness and Mental Health First Aid courses – I can come and train on-site at your organisation or arrange off-site accommodation. If you are wanting to roll out Mental Health training to your staff, your line managers, your HR team – if you are wanting to improve the way Mental Health is handled in your workplace – get in touch and I’d love to help.

 

Self Harm – the crashing of the waves on an ocean

14942542900_712241b68a_z.jpg

Last week saw a flood of stories on the prevalence of self harm amongst our young people and especially girls and LGBTQ+ youth, stemming from the publication of the Children’s Society’s “The Good Childhood Report”. 

The report makes interesting and saddening reading, highlighting the deterioration in the emotional wellbeing and life satisfaction of children – those who if our parents’ are to be believed are supposed to be living out the best years of their lives.

What I found even more interesting, and alarming, in some of the commentary and discussion I read was the angles taken on it by some.

  • Disbelief – this can’t possibly be true. The definition is too vague. I didn’t know anyone who did this so it can’t really be a thing, it’s exaggerated.
  • Blame the media/internet/awareness – I never knew about this stuff when I was young so it’s because people see tv stories about it, or look it up online, or (even better) mental health awareness campaigns tell them that self harm is a thing, so people then go and try it.
  • Focus solely on the self harm – what can we do to stop people harming themselves?

So few seemed to be interested in discussing why 15% of young people are feeling the need to hurt themselves. 22% girls. 45% of those who may be LGBTQ+. (And ignoring the fact that the question asked wouldn’t necessarily pick up those, probably mainly boys – who turn the same urges outwards and get into fights or engage in risky behaviour)

Ignoring the rest of the report which explores the decline in happiness experienced by the young – as Matthew Reed, Chief Executive puts it in his foreword:

Children’s happiness with their lives had risen steadily in the 15 years from 1995 to 2010. But this progress has now been reversed and children’s well-being is now as low as it was two decades ago.

Hurting yourself is not ideal. Sometimes indeed it can be very dangerous. But to focus too intently on the act of self harm is to not see the wood for the trees. To not understand the nature of the act.

Self harm is not the problem. It is a symptom. Even if, for the sake of argument, we say that some people decide to hurt themselves because they heard about it on tv, the internet, or a mental health campaign. You will not continue to do it, unless it does something for you. Unless it serves a purpose. If it just hurts, and you have no need – it won’t become a habit. But for some, self harm serves a very real purpose in that it helps to relieve, express, or respond to deep emotional pain.

If someone hurts themselves and finds that it somehow distracts from, or drowns out the pain – how do we think it feels when someone tells them they shouldn’t do it?

Self harm is not ideal. We need to help people to develop healthier, less risky coping mechanisms. But it is not the main problem. It is the white horses on the wave as it crashes to shore, the sound of the surf on the pebbles. The problem is the ocean. That deep, dark, powerful and destructive mass which is the sadness, distress, anger, fear, hurt, frustration, anxiety that people are experiencing, which makes them seek ways to block out the noise, or show their emotions, or punish themselves for not coping, or feeling like a bad person. That is what we need to understand.

Why are our children in such pain?

We need to listen. Not assume. Not say it’s all social media, or exams. Because it’s so much more.

I was one of those LGBTQ+ children. I cut myself to relieve the pain caused by loneliness, emotional turmoil, feeling like I couldn’t talk to anyone, like my family would reject me. I was also worried about my exams, the future, my physical appearance, etc. etc. etc. The world these days is different but the same. Ensuring our children are loved, protected and accepted for who they are, supported through all their difficulties, shown that no matter what they can talk to someone without fear. Listen to them. And when they tell you they fear for their futures, look around at the world and ask yourself if you are surprised.

Ask them how they are feeling. What’s going on in their lives. Explore ways to keep them safe through harm minimisation. Get them some help and make sure they know they are loved.

https://youngminds.org.uk/find-help/for-parents/parents-guide-to-support-a-z/parents-guide-to-support-self-harm/

Cause of Death – not just suicide we need to worry about.

I was just checking to see if there were any updated statistics yet on the number of suicides in the UK – not yet. I wanted to see if last year’s slight reduction was the beginning of a trend or just a blip. Anyway – I found myself perusing the figures, and also those for all causes of death.

We, rightly, are making more noise about the fact that suicide is the no. 1 cause of death for men aged under 49. But other things also stand out to me. I need to spend more time looking into this stuff if I can.

Suicide is the leading cause of death for both males, and females aged 5 – 34. It continues to be the leading cause of death for men until 49. But lets look at some of those other causes.

3.6 Table 2. Leading causes of death by age group for males in England, 2015

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3.7 Table 3: leading causes of death by age group for females in England, 2015

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(Tables from: https://www.gov.uk/government/publications/health-profile-for-england/chapter-2-major-causes-of-death-and-how-they-have-changed – Open Government License)

 

Accidental poisoning, Cirrhosis and other liver disease, Homicide. Think about these first. Accidental poisoning is frequently a drug overdose. Cirrhosis and liver disease are heavily related with alcohol. Nearly 60% of violent crime is known to be alcohol related and this is an underestimation as not everyone is tested on arrest or note made of their level of intoxication.

Each suicide is a tragedy, 80-90% of which are related to mental ill health – whether diagnosed or not. But suicide is not the only way in which mental ill health is killing us. Many people, of whatever gender, respond to their mental distress by self-medicating with alcohol and drugs. We might not think it, but that glass of wine, those few pints after work on a Friday after a difficult week – if we are doing it to help us cope with stress, to distract ourselves from our difficulties, to help us sleep (a counterproductive measure) – that is self medication. It is a coping mechanism. Just not a healthy or very helpful one.

If it is a now and again thing, and we are sensible with it – then maybe that is not so bad. But if it goes from being now and again, to every week, every night – from one pint to five, to eight. One glass of wine to a bottle, two bottles. And/or if we have no other way to deal with our stress, respond to our difficulties. If we become dependent on it for feeling ok, getting by. Then, Houston, we have a problem.

That’s just the short term. Of course there is also the fact that our coping mechanism may soon start to add to our difficulties. Financial problems, health issues, and also ability to cope and concentrate and perform well, keep up with our responsibilities, relationships. Dependence may further develop into addiction.

Yesterday I was listening to an LBC phone in around the topic of alcohol dependence sparked by the Adrian Chiles story – his realisation of the grip alcohol has on his, and many other lives. https://metro.co.uk/2018/08/21/adrian-chiles-drank-up-to-24-pints-a-week-as-he-admits-he-is-undoubtedly-dependent-on-alcohol-7864742/

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Many of us think alcoholic means someone hiding bottles of vodka around their house, or homeless and begging for money with a bottle of cooking sherry or special brew in their hand. Undeniably that is how some people end up. But an unhealthy reliance on alcohol is far more commonplace, and often comes hand in hand with mental health issues. People who don’t necessarily think of it like that. They know things are hard, that they are stressed, or down. But they don’t think – I’m not well, I need to go talk to a doctor, or my partner. They think, I’ll have a few beers and shake it off.  And then it builds.

For some – they use other drugs to get by. For relaxation, or confidence, or total distraction. While those drugs may be illegal and alcohol is not – alcohol is no safer. There is no such thing as “risk free” drinking. Keeping within the recommended limit of 14 units a week may lessen risk of negative consequences – but it does not remove it. And when 14 units can be 4 pints of strong lager, it is easy to see why some of us really have a much bigger problem than we think we do.

In many social circles it is less socially acceptable not to drink than it is to take drugs. We have an odd culture. But many are not just drinking to have fun. Many are drinking to cope with mental ill health. Sometimes mental ill health makes us more likely to drink or take drugs because we become impulsive and forget about risks – for instance in the case of Bipolar disorder. Sometimes people take drugs to drown out the voices or other hallucinations experienced in psychosis. There is a complex interaction with mental ill health at all levels of severity – and alcohol increases the risk of developing more serious mental health issues, and the risk of acting on suicidal thoughts.

But looking at these figures – seeing how many of those deaths are potentially mental health related – through direct action in suicide, accidental overdose, alcohol related conditions – even Breast Cancer, Heart Disease and Stroke – the risk of which is increased with alcohol consumption. We need to keep educating to bring down not only suicide, but all mental health related deaths. Not just campaigns to get us to cut our drinking – but also to realise why we are doing it, and what we can do instead.

I count myself among those who really need to change. I have got to a point where I don’t think I would act on my suicidal thoughts (as I have done in the past) – they come, they go. But I still drink way, way too much. Rely on it when I am stressed, anxious, down. Allow myself to go way too far when my inhibitions drop. And drinking leads to risk taking, and poor dietary decisions, and spending money….

So next time I am feeling the strain, or I want to celebrate the end of a difficult week. I am going to try and find a new coping mechanism or reward. Because it feels a waste to have done such good work on my recovery, to end up with a life cut short by beer.

[A Post Script btw – How horrific that the second most prevalent cause of death for infant girls is murder. Another fact worth investigating further.]

 

Why is challenging stigma the most important part of what I do?

Stigma stops people thinking about Mental Health
Stigma stops people learning about Mental Health
Stigma stops people recognising when their mental health is deteriorating
Stigma stops people recognising when their friends / family are suffering
Stigma stops people accepting they have a Mental Health issue
Stigma stops people telling their friends they are struggling
Stigma stops people telling their partners they are in pain
Stigma stops people telling their employer there is a problem
Stigma stops people asking for help
Stigma stops people going to their doctor
Stigma stops people attending appointments
Stigma stops people taking anti depressants
Stigma stops people going for counselling
Stigma stops people believing little things can help
Stigma stops people asking their employers for workplace adjustments
Stigma stops employers recruiting staff with mental health issues
Stigma stops employers treating staff with mental health issues fairly
Stigma stops employers supporting staff with mental health issues
Stigma stops employers retaining staff with disabilities
Stigma stops people being able to stay in work
Stigma stops people being able to get support if they are unemployed due to mental health issues
Stigma stops people offering support when they see someone with mental health issues in distress
Stigma stops people getting better
Stigma stops people getting help
Stigma stops people living the lives they deserve
Stigma kills

 

The many faces of O.C.D.

I’ve long known that obsessive compulsive disorder was not about being neat and tidy. That the stereotype of an excessively orderly person, or someone obsessed with cleanliness and avoiding germs – is a simplification of one part of this complex set of experiences. But I recently set myself to learning a bit more as a bit of Continuing Professional Development reading – and have been surprised to find myself recognising aspects of myself in the past – and also understanding experiences that other people have shared with me over time.

The concept of my having anything to do with O.C.D. would have my parents rolling in the aisles. Because they probably share that stereotyped understanding that many of us have from media representations. And I am many things, but I am not tidy, orderly, clean, or any of those other words. My messiness has been a source of distress for them for four decades. They worry about it far more than I do.

So what do I mean? What in fact is O.C.D.?

At the core for most, is some kind of intrusive thought. Indeed for some people – intrusive and unpleasant thoughts of one variety or another, are the whole of it. With Rumination O.C.D, sometimes known as “Pure O” – all of the action is in the head, those intrusive thoughts and a person’s mental response to them, which can go round and round and become all consuming.

But many others will develop a response to the thoughts which takes the form of an action. Something they find which temporarily relieves the anxiety caused by the thoughts – and which over time they feel compelled to do, again and again, more and more. This might be washing their hands to avoid contamination by germs, or avoiding touching things, or cleaning, or all of the about. It may be repetitive, ritualised behaviours that have come to “mean” something to the person – i.e., someone worries about their spouse dying, and somehow come to believe that if they never step on a crack in the pavement, and cross every threshold seven times then they will prevent that from happening.  Sometimes people become obsessively worried and doubtful and need to check things over and over again, or seek reassurance over again, never trusting their memory.

Simply keeping your kitchen clean and tidy because it’s a good thing to do isn’t O.C.D. Even if you have to have everything just so. But – if you are doing it because it alleviates some other distressing thought – for instance that you might poison your family by accident – and if you clean over and over again, even when it is not necessary, then there might be an issue.

So what have I recognised in myself? Two things. Not really from now – though there is a ghost of it still which could re-emerge to haunt me any time.

Firstly – lets talk about the other end of the scale from that clean and tidy kitchen. Hoarding has been recognised as a kind of O.C.D. – an anxiety related disorder where compulsive behaviours come as a result of underlying trauma of some kind. Part of the reason my parents bewail my scruffiness is that I have so much stuff in my house.  Not quite packed to the rafters yet – but in some parts not far off. Some of that is simply because I used to live in a bigger house, and I could do with few more rooms. But when I think back, I can recognise a period of time when my behaviour became problematic.

I have a lot of books. I mean a lot. I have about 8 bookcases, all double stacked, plus cupboards and drawers full of books, piled hither and thither. I love books. But I have come to hate the books in my house. I am a librarian. They are in not a great deal of order beyond fiction / non fiction. I don’t know where anything is. I don’t know what I have anymore. They certainly aren’t decoratively displayed. They even get stood on. I hate it.  I’ve had a lot of books for a long time but I used to try to keep on top of them. Get a new bookcase when I needed one. Keep them in order. Set my prized collections apart in some way. But then at some point I went a bit mad with it. Literally.

The more I think about it the more I see it. A long while ago, I had a hypomanic period when I spent a load of money. And part of that was going into bookshops and coming out with bags of lovely books.  When I got better, I banned myself from buying new books, except for very occasionally.  I have actually stuck to that most of the time. However. A couple of things happened. In my then workplace – we had to move the library. Again. We moved a lot. And each time we had to pare the stock down and get rid of books, which was not pleasant. This time we had to a) get rid of a huge amount of stock, space wise – and b) weren’t given a lot of time to make the decisions about what to get rid of, and what to keep.  I was deeply distressed by the amount of really useful and interesting material I saw being marked up for discard. So I took it upon myself to rescue a load of them.

It was probably not in any way insignificant that this coincided with a difficult break up with a long term partner. As well as adding hundreds of books to my shelves from the library – I also started buying from charity shops. Because charity = good, and second hand is not “new books” which were banned. And it didn’t cost as much money…  But suddenly it was getting out of hand.  So I limited myself again, said, I can only buy books from authors I want to collect. But that started with one or two, then I added another, and another, and another….

Anyway. Time passed, and I gradually stopped. I went through an interesting transition. I love books. I loved books. Books gave me comfort, made me feel safe. I could lose myself in books and forget the mess that was my world. But I had all these books and I wasn’t reading. I didn’t have time, or the ability to concentrate. Books had been my treasures, along with the relics of past relationships and experiences that I had carried from house to house like religious totems, polishing, displaying – each ornament or photo having sacred significance. And yet despite all of that – my relationship had still fallen apart. And while I had a new one, I still grieved for that loss. The person I loved, the life we had thought we might have together. And so all of those material things lost their meaning.

The books on my shelves don’t comfort me any more. They nag at me. They get in the way. They remind me of my inadequacy. I will – sometime soon, try and do something about it.  I wish that could be to have a library built, give them the space they need and put them in order, but it can’t be – so I need to cull, and bring them into proportion. Unless we make the decision to pay for proper storage.  Meanwhile, I am trying to work my way through the other things I have hoarded, or collected. Another aspect is the perfectionist standards I set for myself in moving house. New home, new town – I was going to be a new person. I was going to be super ethical environmentalist, crafty, gardeny goddess lady.  So I started collecting things I thought might be useful. Plastic pots, egg boxes, corks, lids, bits of string, bits of cloth, cardboard, jars.  Again. Great if I had the space, and if I ever actually did anything with them. But I don’t. But sometimes it is physically painful to throw things away. Even to put in the recycling, because I am not living up to those stupid perfectionist standards. Did I think that if I met those standards it would stop my relationship breaking down this time? That I have to prove something to be loved?  I see this same pattern sometimes in the paralysis I get when shopping, or deciding what to eat. Shopping – what are my priorities? How much does it cost? Is it organic? Free range? Fair trade? Rainforest friendly, Cruelty free, do I know about the ethics of the producer, yes but how many air miles and what about palm oil and but then what about the fat/sugar/additives content, but does it taste nice and does my husband like it and oh I am now having a panic attack and abandon the whole shop.  Sometimes we just need to buy something to eat.

The other time is last year and my troubles with health anxiety. Obsessive worrying about my health – be it my heart, my digestion, my hernia, my operation, sepsis, my fall, my leg, tetanus, any of the above and more. Responding to said worries with checking – looking up on the internet, reading everything I can – ostensibly to understand the risk better, but actually fuelling it. Checking the physical area, poking, prodding, testing. Changing my diet, my habits. Asking people, doctors. It took about 6 months, at least, to bring it under control again. Though I still think my leg is broken.

I know people who are troubled with intrusive thoughts that make them think they are bad people, people who struggle with crowded places or public transport for fear of something bad happening. Some of them develop avoidance or safety routines that distract from their anxiety. I know people who compulsively shop online and then find themselves surrounded by boxes of stuff they don’t really want and certainly don’t need – not to mention the credit card bills.

At the root of it all is that anxiety – that fear of some perceived danger – insecurity, loss, trauma.  Something we need to work through, and something which we may need help to overcome.  Avoidance and distraction and these safety rituals only ever help momentarily, and they can become a bigger problem in themselves if they begin to take over.  If this is you – talk to someone. A friend, your GP, contact an organisation who may be able to help you free yourself from its grip.

OCD UK http://www.ocduk.org/

Anxiety UK https://www.anxietyuk.org.uk/

https://www.nhs.uk/conditions/obsessive-compulsive-disorder-ocd/

Lets talk about resilience

A weightlifter holds a heavy bar laden with weights above his head.
Image by flickr user Yasunobu HIRUOKA CC License

To some people resilience seems to be a dirty word. I get it, and I don’t get it.

What is resilience? To me – it’s like an immune system for the mind.

We all have an immune system that helps us fight off illness, disease, infection. When we get ill it is our immune system – sometimes in conjunction with medication, surgery, physiotherapy, other medical intervention – that will help us to recover. Some of us have superhuman immune systems and never seem to get sick. Some of are less fortunate for whatever reason and are prone to pick up colds, or stomach bugs. Some of us have weakened immune systems due to other conditions we live with, or have experienced in the past.

There are things we can do to strengthen, or help our immune system, and things that we sometimes might do that are not so helpful.

If we get a cold or flu, friends will often suggest remedies, or preventive measures.

“I like whisky and lemon with a paracetamol”
“You should gargle with aspirin and eat a slice of dry toast”
“I take [ecinacea / vitamin c / zinc / oil of oregano / etc…] and I hardly ever get colds”
“I find that first defence / Neti pot stops it in its tracks”

They aren’t trying to rub their relative healthiness in your face like a snotty tissue, they are trying to be helpful.  They’ve had colds, and they know they are rubbish, and that if we could, we would all like to avoid them. They’re offering both something which they think will make you feel better in the short term, reduce the length of your suffering, and their ideas for what might help avoid the situation in the future.

On the other hand, we know that no amount of vitamin C is likely to help if we come down with Pneumonia or Tuberculosis.

For me – the concept of resilience is really helpful. It tells me that I can have some power back. That I am not completely at the mercy of medications and waiting lists and availability of services all of the time. That sometimes, I might be successful in fending off a deterioration in my mental state by looking at what’s going on in my life, making changes if I can, or drawing on other resources.

I have had periods of my life which have been utterly blighted by mental ill health. Suicidal depressions. Life monopolising anxieties. Irrational and irresponsible highs that led to debt, ill health and destroyed relationships. I do not want to go back there if I can help it. I will take any help I can get – be it medication, therapy, or advice on what I can do myself to lessen the likelihood of that occurring. And because I have difficulty with medication (side effects), and because therapy is not always easy to come by – I think the latter is even more important.

It doesn’t always work. That word “Sometimes” is important to remember. Sometimes we spiral too quickly – there is no gradual decline that allows for spotting the warning signs and taking steps to try and prevent things getting worse. Sometimes we are running on empty and just haven’t got it in us.

When I am particularly unwell – with no energy, no motivation, no hope – everything feels so much more difficult. Weights are heavier, shadows darker, my skin is more sensitive, moving is exhausting. Even dragging myself out of bed to stare at the television is too much effort sometimes. So in those moments – thinking to myself that going for a walk, getting a shower and some make up on, eating some fruit, even meditating for 5 minutes, feels as pointless and intimidating as thinking I might climb mount Everest, run a marathon or win Strictly Come Dancing.

So I guess I understand why some people bristle – if resilience and self help is waved in their face at the wrong moment – too soon – in their recovery. It feels impossible and insensitive.

But on the other hand it is hope. It is saying – once you feel a little bit better, if we start doing a little bit of this, then hopefully it will help you to feel a little bit better still, and then even better, etc etc.

And if I can catch on to that hope, then I might think – “Ok. I can’t go for a walk, but I can look out of the window. I can stand on the doorstep for a moment and get some fresh air. I can’t face getting properly dressed, but I will wash my face. Or brush my hair. I will have a glass of water or juice. I will close my eyes and focus on my breathing for a minute.” Any one of these things. And maybe tomorrow I will do two of them.

And the better I am – the more I will try to build this into my life, in the hope – that when life throws some difficult stuff at me again – it doesn’t knock me completely over. Or if it does, that I am able to get back up more quickly, and get back to living my life the way I want to live it rather than being in the grip of my illness.

I get that some people think that a focus on resilience is like blaming us for our illness. If there are people out there who think like that – (and I don’t doubt it, the Human capability for cruelty and heartlessness is matched only by our capacity for good and compassion.) then they are stupid and in need of some education. Just as with physical illness – the reasons that some of us develop mental health difficulties are manifold. The factors that influence our likelihood to become unwell complex and intertwining.

  • What is going on in our lives at the present moment?
  • What is going on in the world around us – environment – society?
  • What has happened to us in the past?
  • What has happened to our parents?
  • What have we been taught to believe about these things?
  • Biology / Psychology / Personality

Even this is a simplification of the varying factors which may increase our risk, or protect us from developing issues.  There may be things we can learn to help offset, or deal with some of these things – but there is nothing that is guaranteed to work in every circumstance, and it is always a work in progress which can be sabotaged by events, physical illness, or other people’s thoughtlessness.

Similarly sometimes people say that emphasis on resilience takes the onus off health services, or employers, to fulfil their part of the bargain. If resilience training is all that is offered, then that is shoddy. That is not to say that it is not worth doing in those cases. After all, if your employer is taking such a minimal approach to wellbeing then you may need all the help you can get. However – resilience based approaches, mindfulness, stress management etc. should be offered as part of a wider, organisation based approach. Mental Health Promotion, Mental Health Awareness, Mental Health First Aid training, Mental Health Champions. Stress Audits and Risk Assessments with proper strategies on reducing stress across the organisation. Business planning which considers and does not place undue stress on employees either through workload, lack of resources, business practices or workplace culture.

Ditto – we need decent and comprehensive mental health services across the country. Sufficient beds and therapists and specialist services. They need to be adequately resourced, more people trained and recruited. They also need to be more flexible and person centred, and to listen to and engage the user base to ensure that they properly understand people and the barriers we face to recovery. We need those services to be there even more so when we think about resilience, because sometimes what we need to do to prevent our situation from worsening is to seek professional help. Recognising our boundaries, recognising when things have got too bad for us to continue trying to manage on our own – or with our friends’ and family support, no matter how well meaning. We need to know that actually – this is beyond our ability at this moment, and we need someone else to help us for a while.

The more we raise awareness and help people understand the signs and symptoms of mental ill health for what they are, the more there will be a draw on those services. So I think it is vital to also raise awareness that there are things that we can do which sometimes help us to stay well, or recover more quickly. Both to reduce that draw on services, but also to prevent people suffering any longer than they have to.

I’ve had a really painful arm for over a year. I pulled it carrying heavy bags or something. Finally I went to the GP who diagnosed tendonitis and referred me to physio. The physiotherapist explained the need to massage and stretch and exercise the damaged tissue. Things I had been avoiding because they hurt. I have had to go away and do those exercises myself. And it is getting better. If I had known what might help a year ago, I could have started recovering earlier – rather than avoiding activities which I thought would aggravate it, which instead compounded the problem. I am as much a part of my recovery as the physio, as the GP. I don’t mind that. If it were worse, I’d need a surgeon. And I’d need support until I was strong enough to start my physio. I wouldn’t want them to push me too hard too quickly – but I would also take heart from their belief that I have it in me to progress my recovery. It might mean they can see glimmers of something in me that I can’t yet see myself.