Sunday, 30 June 2013

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, which was obviously upsetting, even though this time it wasn't aimed at me.  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 (who I'm much closer to) in the context of me being very stressed out trying to help this friend (I'll call him 'P'.) 

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, and who Q had met that displayed these symptoms in order to make the comparison.  I assumed he must meet some people with mental health problems in his job as a carer.  However, it turned out he had no-one to make the comparison with, 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.  Incidentally, some of the most striking things that might be used to identify someone as 'mad' – such as confused or slow speech – are actually side-effects of psychiatric medication.  Sadly, the opposite of being dismissed as not needing help is often being placed in the box marked “severe and enduring”, given drugs, and removed from any meaningful use of the word 'recovery'. 

Another very relevant 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 any other friend, 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.  After a particularly disturbing series of events last year, I was dragged to A&E in a terrible state to be assessed by the Crisis Team.  Not only did they ignore the huge impact of what had happened (and I have the assurance of several friends that it was something that would knock anyone sideways), but they also offered appalling advice that contained a complete disregard for my welfare and mental state in both the short and long term.  They actually encouraged me to put myself in a situation where I'd be repeating previous traumas and failing to learn from past mistakes.  Dickheads.
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)

With reference to the above incident, I seriously doubt those members of the Crisis Team were advising me in the same way they would if I was their daughter or a friend.  But to them, I was just an overreacting, attention-seeking mental person.  To them, I didn't deserve to be treated with respect or be helped to find a way forward that wouldn't put me in a vulnerable position.  Instead I was to be ushered away as quickly as possible with vague and unhelpful platitudes.  

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. 

Anyway, back to P.  I am trying to help P access treatment (a process worthy of a whole new blog, and also a surprise for me that psychosis and severe trauma symptoms are not taken seriously either – I thought it was just us neurotics who were messed around!)  I am also trying to help P with a situation that's arisen due to his mental health issues.  So, going back to the “just a mental person” comment, does that mean I shouldn't help him as these problems are 'only' a result of mental illness?  Should I leave him to suffers 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...!)**

Sunday, 9 June 2013

Update...

I've not posted for a long time; not because I haven't felt the need to rant but because it's been harder to get my thoughts together to do so.  This is partly because I was abroad for a few months, which required much organisation, and partly because whenever I start to ponder mental health issues I find myself hopping mad over the way services let me down and can't think straight. 
This seems to be worse over recent months – although that's probably because I seem to be remembering more and more, each little incident or spiteful comment a little niggling wound that won't get better.  I imagine this blog will end up being a hugely ranty but therapeutic outlet – hopefully at least as satisfying as putting the crisis team in stocks, though not as swift. 

In other news:
  • The extreme fatigue and inability to do practically anything I was suffering turned out to be due to low iron and a severe vitamin D deficiency.  Apparently in northern Europe the sun isn't actually strong enough for half the year (on the rare occasions we see it!) for our bodies to make vitamin D, so deficiencies are widespread.  The grey summer and hiding indoors too much didn't help either.  (Sun exposure needed per day is half an hour on your face and forearms). 
  • I discovered the concept of 'emotional flashbacks' which has been the singular most useful piece of psychological information I have ever learned.  I have no idea why no-one I've seen in a mental health setting has ever mentioned the concept to me.  Perhaps because then they'd have to stop writing me off as a waste of time...
Now I'm just trying to keep the Jobcentre happy as I'm still living at the mercy of the government, and trying to figure out a way to make money from the creative stuff I do.  Not an easy task, but easier than miraculously suddenly being able to cope with a normal job...  Gah!  Being completely at odds with society would be easier if you didn't have to make a living...