What’s a Spoonie?

The spoon theory is a way of explaining that people With chronic illness or disability have fewer units of energy to do daily tasks and use more energy doing them, than other people.

There are 4 reason why I struggle with energy levels:

1. I’m an introvert in an world built for extroverts, my energy is sapped by other people – this is no one’s fault, just the way it is!

2. I’m a high sensitive person which means I take in the world around me and have to process it in a lot more detail than most people. A mild smell, quiet sound or moderate level of lighting to someone else is overwhelming to me and can lead to a migraine.

3. I have chronic pain in multiple parts of my body. Anyone who’s been in pain, just for a day can testify, it’s draining. Strong painkillers only take the edge of my pain, I am never pain free.

4. I don’t get restorative sleep. Most people go down through different levels of sleep, each of which have their benefits, but I do not reach stage 4 sleep which is where repairing and restoration happen.

I wake up in the morning and I’m exhausted. Unless they find a cure, this will be how it is for the rest of my life so I’ve got to find strategies that work!

Because my body doesn’t function optimally I use a lot of energy just keeping it going.

The spoon theory works like this:

Someone without a chronic illness would wake up with 25-30 or so spoons worth of energy, they use a spoon for their morning routine, a spoon to get to work, a few spoons for their morning at work, they’re replenished by eating lunch, they use a few more spoons in the afternoon and have some spoons spare to enjoy the evening. Even on a tired day, perhaps at the end of the week when they may wake up with less energy, you can see that they have enough to get through the day and don’t really need to think about how they spend their energy.

I, and other people with chronic illnesses and/or difficulties mentioned above, wake up with, maybe, 15 spoons. I use a spoon to get out of bed and dressed, if I need a shower, that’s another spoon used. I may use 4 spoons at work but if it’s been particular busy or the alarms are triggered more often, I might use 6 or 7 spoons and another to get home. If I have to run an errand, that might take 2 or 3 depending on what it is – doing the maths, I could be down to 3 by the evening. Spoonies have to save a spoon for getting to bed so I have 2 precious spoons to use in the evening. It may take me a whole spoon to make dinner, if I have a migraine or pain is particularly bad spoons just disappear from my reserve.

Some, but not all Spoonies are able to borrow spoons from the next day, if, for example, they know they can have a lie in or can take time to rest. This is an incredibly risky strategy as it’s not always straight forward. If I push myself today, using just 1 extra spoon, it can cost me 2-3 from tomorrow.

Spoonies often have to use energy managing their illness, for example, regular physio, taking medication or attending appointments.

Different people use different amounts of energy for the same thing, for example, I find 5 minutes of being with noisy children wipes me out, other people can last longer!

I hope this makes sense, it’s really difficult to explain to people who don’t experience it but I’m trying!

I’m not lazy, I’m not flakey, I’m a Spoonie.

Spoonies have to think more strategically about what they do when in order simply to make it through the day!

I do not feel sorry for myself – that would use more energy! I’d just really like it if people could understand!

For Spoonies out there, feeling at a loss, I have a few tips that help me:

  1. I use a lot of alarms on my phone – this means a) I do not have to use precious spoons trying to remember things and b) it means I remember to do things that help, like take my meds!
  2. I have routines (especially morning and evening) and I stick to them, this uses fewer spoons because there’s no decision making and I have to think less about what I’m doing.
  3. Strategically placed coffee – I’m fortunately that caffeine helps, it doesn’t help everyone but without it, I simple could not drive to work safely (believe my, I’ve tried, not good!) Some people find particular foods make managing energy levels better or worse – I’ve not found this to be the case for me.
  4. It’s ok to say “no” – if people judge you for saying “no” to something that’s going to cost you spoons you don’t have, that’s their problem.
  5. Work out what replenishes your spoons and do it! Although I don’t get refreshing sleep, I need to be in bed, resting for at least 8 hours. A couple of hours lost doesn’t just mean I’m tired the next day, it means I struggle to function, will have to borrow spoons and so the problem continues for many, many days! I also need rest time, down time, time out, me time, call it what you will – I need regular evenings of it!
  6. I write lists so I can plan my energy usage.
  7. If I want to do something I know will use a lot of spoons, I try to prepare by getting more sleep and making sure I know the plan so I can try and pace myself. It doesn’t always work but I do my best!
  8. Make sure you surround yourself with people who try to understand. They can support you to use your limited spoons wisely.

Spoonies do not own the monopoly on tiredness, it’s just a way of explaining the extra considerations we have to give to managing energy levels.

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Taking responsibility is empowering

It’s very easy to blame other people for our feelings. We may say “he made me so angry” or “you’re so irritating”, we all do it in the heat of the moment. But by using this language we are shirking responsibility for our own emotions.

It’s also quite attacking if someone says something like this. I once asked some honest questions of a friend, meant in the kindest way, I asked if she felt she was making progress in her recovery or whether the treatment she was receiving was keeping her stuck. I always want the best for my friends and living in hospital isn’t the life I want for anyone, let alone someone I care about. I later heard that following my visit she self harmed and was blaming me for this. Of course, I felt awful but I was also confused – I did not give her the harmful implement, I did not stand over her and make her do it – how could I be responsible for her harming herself? In this moment I vowed never to blame anyone else for my behaviour. If I self harmed (something I haven’t done for many years) I knew it was me that chose to do it – yes, at times, it did not feel like a choice but no one else made me do it, therefore responsibility lay with me.

Taking responsibility for our own feelings and actions can be difficult, even scary but I think it’s a vital part of mental health recovery. It can also be a helpful thing for anyone indulging in harmful behaviour. How easy is it to say, “I’ve had such a stressful day, I need a drink” for example.

If we stop and think about the thoughts we’re having and the feelings that have developed, we can choose how we behave. How empowering is that?!

If I’ve had a stressful day, it’s natural for me to lose my appetite, for other people, they may be inclined to eat more, or drink alcohol, or behave in a snappy way towards other people. But ultimately, no matter what feels natural, we can choose to go along with this or we can choose to act in an opposing way.

Anorexia is a illness where the sufferer converts distressing thoughts and feelings into avoiding food. For me, the thoughts and feelings were unbearable but avoiding food was something tangible I could do. In recovery, the neural pathways that connected painful feelings with avoiding food were well trodden. I was told, to recover, I needed to eat but no one could make me eat. It was me who had to make the effort. If I managed to get through a challenging meal, that was down to me. Yes, I’d appreciate any support given, but I was responsible for my actions.

I’m definitely not saying that mental illness is a choice – no one would deliberately choose for their brain to malfunction! If we are at a point where we’re able to engage in therapy and/or if medication is helping with the chemical imbalances, we can start to take back our lives, bit by bit, we can choose how we react to our changing condition. Of course, mental illness recovery is a lot more complicated than a few simple choices but if we do not take responsibility, we’re never going to get anywhere!

Anyone can fall into habitual behaviour. For example always having a drink with a meal or staying in bed when feeling low or anxious. These neural pathways are familiar and feel ok, familiar, safe, “normal” even!

It can be incredibly diffciult to break familiar patterns of behaviour or to build new patterns, especially if there are elements of behavioural or chemical addiction involved. When breaking or making habits, we often talk about will power and we feel like we don’t have enough of this elusive product! However, we can choose to be disciplined by making this decision:

What do we want now? vs what do we want most?

Do I want to have a drink, to binge, to sit on the sofa, to say ‘yes’ to something that will tire me out, to say ‘no’ to something because I’m scared…

Or

Do I want to take responsibility for being a healthy, happpier me?

I know it’s not easy! But it is possible for us to take responsibility for our decision and take control of our lives!

Why are numbers unhelpful when talking about eating disorders?

I was recently interviewed on BBC Radio Berkshire, I was incredibly grateful for the opportunity to raise awareness of eating disorders and the importance of early diagnosis and treatment. However, as part of telling my story, I was asked how much weight I had lost. In no way do I want to attack the presenter, I’m actually grateful that he’s raised an important issue that’s not really spoken about except within the recovery community.

Talking about numbers is a key factor that’s different between pro-Ana/Mia websites and the recovery community. If you come across a forum claiming to support people with their eating disorders, and people have l.w., h.w. or g.w. etc in their signature, alarm bells should ring. (Lowest weight, highest weight and goal weight)

Just imagine, you have an illness that tells you “you’re too fat/heavy”; you need medical treatment but you don’t think you deserve it, you don’t think you’re ill enough. You look online for some support and you see people who are aiming for lower weights and not seeking treatment. What are you going to think? Your illness tells you, you need to lose more weight!

My weight, when ill, was low enough to fit the diagnostic criteria for diagnosis, therefore, what would me sharing the specifics of my weight/weight loss add to my story? If it was a shocking amount, would my story have more gravity? Would people be more likely to listen? If it wasn’t a shocking amount, would people question my story? Would people think I hadn’t really been ill? Weight loss was just one symptom of my illness. People with other (just as dangerous) eating disorders may be a healthy weight.

In my interview I wanted to share that important early diagnosis and treatment are vital, delaying treatment means delaying recovery, however, I also wanted to offer hope, if you’ve been ill for a long time, recovery is possible. My message would have lost its profundity if people were distracted by the numbers.

Being embroiled in an eating disorder, for some people, is all about numbers:

  • Weight
  • Weight loss/gain
  • Calories consumed
  • Calories expended
  • Weight of food
  • Nutritional breakdown
  • Number of steps
  • Waist/thigh/arm etc measurements

The list is endless!

When I was ill, if it was possible to count it, my brain seems to do it whether I wanted it to or not! When I was recovering, one of the last things I stopped doing was having to cut my food into a specific number of pieces. Even now, I sometimes fall into the habit of counting, just because those neural pathways are well worn and it takes more effort not to follow familiar patterns.

I knew people with eating disorders would be listening to the radio, I did not want to trigger people into thinking about numbers, nor did I want to feed into people’s beliefs that to have an eating disorder you should be a certain weight or have lost a certain amount.

If you’re supporting someone recovering from an eating disorder, it’s helpful to avoid number talk, it’s triggering and unnecessary. Of course, some number talk will be necessary between dietitian/psychiatrist etc and patient, and a diet plan may involve some numbers but keeping it to a minimum is important.

Supportive forums will have a ban on numbers being mentioned. They’re not important, discussing how you feel or what you think is far more beneficial. A vital part of recovery is turning your back on the numbers, it is possible to be free from the grip of numbers.

World Mental Health Day: Young people in a changing world

Young people today face very different pressures to the ones I experienced. I cannot say whether it is better or worse to be a teen these days without experiencing them both first hand. I think the biggest difference is technology and it’s having a great impact on everyone, not just our young people.

It’s social media in particular that has revolutionised the way we interact with each other and the world at large. I can barely keep up with the number of platforms from Facebook and Twitter to LinkedIn and Aloqa to various online dating sites! My grandmother, bless her, even tried to “Facemail” me the other day, I’m assuming that was a mistake, not another networking platform!

YouTube wasn’t even a thing as I grew up, now we have someone whose identity is as a ‘YouTuber’ appearing as a ‘celebrity’ on Strictly Come Dancing (I think he’s amazing and might actually win!)

Anyone in the public eye and how the media portray them, influence young people as they grapple with issues such as identity, morals, ethics and personal boundaries. If you want to be successful and ‘liked’ there is a certain body shape we should have, a certain way to dress and a specific way to talk and behave – most of this for the average Jo is unobtainable. While these ‘ideals’ have always been there, perhaps with a different emphasis, they are now more accessible and almost invade our lives in a way never experienced before.

The speed of technological change is such that instead of us designing technology to meet a particular need, technological advances are now telling us what we need! As a young person, growing up, never did I think “I wish I had a device in my pocket that alerted me the minute a [insert reality TV star] goes up or down a dress size”!

Questioning the amount of screen time a young person should or shouldn’t have is just the tip of the iceberg. How their real relationships are impacted by their virtual relationships is complicated.

Technology has advanced before we’ve decided what we want and, as with any change, it’s open to abuse. Social media is great at enabling us to make positive connections, it’s also there if people want to make negative connection such as cyber-bullying and trolling.

Cyber-bullying has been named as a key factor in young people dying by suicide. Being bullied at school is bad enough, but when it flows beyond the school gates and into the private space of the individual, being told “you’re different and that’s a problem” would take its toll on anyone, there is no escape. People are trying to develop tech to tackle this problem, to support young people when they’re targeted but as one solution is found, a different problem will occur, we’re running to keep up!

Rates of self harm, depression, anxiety and eating disorders in young people are all on the rise – this is very worrying and mental health services are not able to keep up with demand. The government target is for any young person presenting with mental health symptoms to be seen within 4 weeks, this target just isn’t being met. Listen to BBC Radio Berkshire on Monday at 7am for more on this!

I did, however, have a very positive experience with social media while on the road to recovery. Berkshire Eating Disorders Service piloted a Support, Hope and Recovery Online Network (SHaRON) – an internet based forum for people suffering with eating disorders and their affected family members. Anonymous online support could never replace the important face-to-face therapy necessary to re-build a life destroyed by illness. However, the forum was very well designed and I would not have managed the multiple challenges I faced during recovery, if I hadn’t had the incredible support I received from fellow sufferers and professionals day and night at the touch of a button.

Young people these days do not have an easy job navigating changes as they happen. We all have a responsibility to support each other.

Myth#6 If you survive a suicide attempt you didn’t really want to die

Trigger warningthis blog talks frankly about suicide, if you may find this content triggering, please do not read any further.

Even if you’re not triggered by this blog, please be aware you may find it distressing.

Please use your usual support network or contact a national agency such as The Samaritans on 116123 for support.

Unfortunately, I have made a number of attempts on my life. Each and every one, I fully intended to die. Anyone who attempts suicide will have different reasons, for me, I was seriously mentally unwell. Depression stripped me of feeling human and created the perfect environment for intrusive thoughts and beliefs about the world being better off without me, I believed I was going to feel hopeless and helpless and it was so unbearable, death by suicide was the only option. Anorexia caused my brain to be devoid of the nutrients that it needed to attempt to differentiate fact from fiction.

With the active debate about assisted suicide, there are people who do not meet the criteria for a mental illness but believe their life or situation is not worth living, they may live with a chronic illness or permanent disability, they believe death by suicide is a rational decision to make but are unable to carry it out themselves and ask seek assistance – I’m not here to debate the rights and wrong of this, suffice to say, people with a desire to end their life may or may not fulfill the criteria to be diagnosed with a mental illness.

It’s important to remember that suicidal intent isn’t black and white. Multiple factors combine to measure someone’s intent, include: timing, expectation of fatality, preparations, purpose of action, medical rescuability and premeditation. Beck’s Suicide Intent Scale has been found to be useful in predicting death by suicide.

Whether suicide is completed on not, no-one but the person themselves really knows what’s gone on, unless they have been able to accurately articulate their thoughts and feelings prior to the event.

Some methods are more likely to result in a completed suicide than others but when ill it is not always possible to this logically about what method would be “best” and it usually depends on availability of resources.

(I did tell you this was going to be a frank blog!)

Some stats show that those in the medical profession, (including doctors, nurses, dentists and vets) and those in agriculture are at high risk of completed suicide due to their knowledge relating to suicide methods as well as access to means (drugs and/or firearms). People without precise knowledge and/or access to means will have no less intent but their “choice” or method may be less likely to result in completed suicide.

There are also a number of reasons why males are more likely to die by suicide than females but this does not mean than a female who survives a suicide attempt did not intend to die.

I can only talk about my experience of surviving suicide attempts but having spoken to other people who have survived, I know our story share similarities.

Waking up, coming round or coming to the realisation that an attempt has been “unsuccessful” brings up a number of emotions: (please note, the language I’m using is intended to emphasise the feelings surrounding suicide, I do not intend to offend or belittle the feelings)

  • Disappointment – “I have not “achieved” what I wanted”. Feeling even more of a failure than I did before – this is a very dark place.
  • Fear – “What are people going to think?” And “I’m going to have to live with what I’ve done” whether it’s ongoing physical effects of the attempt (e.g. broken bones, liver damage) or now living with the mental scarring/pain of the attempt.
  • Guilt – about having not completed suicide (continuing to believe it’s the correct action to take)
  • Shame – for the “fuss” or worry caused to those around. My attempts were often linked to guilt about taking up NHS resources – when my attempt was “unsuccessful”, I was taking even more resources.
  • Relief – after one attempt in particular, it felt like I’d woken up. This was a particularly violent attempt, no one could understand how I’d survived – but I did and I saw this as quite a powerful sign that I should be alive and I had a renewed desire to get through my illness.

It can be difficult to admit feeling relieved, it may not be that the person didn’t want to complete suicide, it’s likely that a new perspective has been found after the event.
People who show warning signs and/or attempt suicide need to be taken seriously.

It is not ok for professionals to say “we can’t save them all” (they used to teach this at medical school to relieve the guilt if a patient completed suicide). I’m not saying professionals should feel guilty, I’m saying nonchalance is inappropriate when it comes to preventable death from any illness, mental illness included.

Nor is it ok for professionals to say “this is their normal behaviour” and ignore warning signs of suicide. (Seriously, I’ve had a psychiatrist deny me support because they thought I was “just attention seeking” – sadly, the lack of support led to causing irreversible damage to my body in an attempt to take my life.)

I was plagued by suicidal ideation (thoughts and plans about suicide) for years. Even when in active recovery from depression and anorexia, I continued to keep suicide on the back burner – it was always an options if things got too bad. This may sound strange to some people, it will not sound strange to anyone who has gone through the pain and torture of mental illness.
However, I could only break free from mental illness once I made a commitment and said to myself “suicide is not an option”. To those still on the brink, keeping suicide as an option, may feel “safe” but you will never experience how freeing it is to finally say “I’m choosing to live, there IS a way through and I AM going to find it!”

Breaking free and turning your back on suicide as an option does not diminish the severity of your pain – it is about choosing life over an otherwise grey existence.

It is also important to recognise that people whose behavior is risky but they do not intent to die are experiencing severe mental pain. Suicidal or para-suicidal behaviour should not lead to feelings of shame, mental illness leads to people behaving out of character.

With this blog, I have wanted to speak openly about death by suicide, just as we should speak openly about death by other means. People who have attempted suicide and survived should not be discriminated against by medical professionals – I hope by speaking out, I’m chipping away at the taboo and stigma surrounding the issue.

Everything else you need to know about Madagascar

This blog follows my “10 essential things to know about Madagascar“.

Before coming to Madagascar there was a lot I didn’t know. So, I’ve put together few things I think it’s helpful/interesting to know! I went with my husband for a 12 night safari visiting 4 national parks and staying in 2*-3* accommodation (so I have no experience of bringing children or higher rated accommodation, for example). I hope you’ll find the following helpful! Please do comment below if you have any questions or what to add anything about your experience!

Money

  1. The currency is the Malagasy Ariary which is only available in Madagascar – it is best to buy it at the Airport. It’s best to have Euros or Dollars to change once you’re through visa/security etc. You can get by with a traveller card but you have to be visiting cities with ATMs and be prepared to get cash out multiple times as the daily limit isn’t very high.
  2. It is a tipping culture – everyone who helps you out will be relying on tips to boost their pay. For example, porters expect 1000-5000 Ariary (20p-£1). It’s important to have a supply of small notes. It is polite to tip 5000-15,000 Ariary/day (£1-£3) to a driver and 10,000-20,000/day (£2-£5) to a guide. They rely on the tips for basics like feeding their family.
  3. Restaurants etc don’t always give change, they consider any extra given as a tip – we found this strange at first (as we prefer to choose how much we tip but it was dependent on what notes we had) but we had a accept that this was their culture (and to us, we were only paying a few extra pennies each time, anyway).

Food and Drink

  1. Rice and zebu (Malagasy mammal similar to a cow with a hump) are staple foods. They eat this for breakfast, lunch and dinner. Hotels expecting tourists will offer, what they call, an “American breakfast” that usually includes French pastries or bread, eggs (fried, scrambled, omelette or hard (medium boiled)), coffee or tea, fruit and fruit juice – it is up to you which you choose.
  2. They know what a vegetarian/vegan is but be prepared for lots of spaghetti and Chinese food. For some reason they think that’s all we eat. I don’t know why since their staple food is rice and they cook with beans and (limited) veg so I don’t know why they can’t just adapt the meat dishes but on repeated occasions when asking for the vegetarian options and it was spaghetti – eventually I said I didn’t want spaghetti and one place gave me the meat dish without the meat (they didn’t think to put any other protein on it but I was just grateful it wasn’t spaghetti!), another place just gave me the sides…that was a plate a veg, not ideal but not awful! 
  3. Be aware, there are no diet drinks available, you can get water everywhere but soft drinks such as Coco-cola, Fanta and Sprite soft drinks are the full sugar versions. They also have a drink only available in Madagascar called called Bonbon Anglais which tastes like a sweat shop on steroids!
  4. If you’re eating dinner in the accommodation where you’re staying, they may ask you to book/order your dinner food before the time you want to eat – we never really understood why this was but thought it best just to do what we were asked!
  5. You will need to buy a lot of water – it is relatively inexpensive but you’ll need to ensure you can buy from a safe source (for example petrol station shops), unless your tour company provide it. You need water for drinking and washing teeth; it’s ok to shower in the water but it’s not advisable to swallow any.

Other practical bits’n’pieces

  1. Police may stop you at the entrance and exit of towns/city – this is nothing to worry about, they want to see the documents for the vehicle.
  2. Public toilets are pretty vile – where as men may pee at the side of the road, it’s not as easy for ladies so it’s good to take advantage of toilets within hotels restaurants etc whenever possible, where they have toilet paper, an actual toilet and a door that locks…enough said!
  3. Some accommodation has a limit on what you can plug into their electricity – do not expect to be able to use a hair dryer or kettle but you can charge a phone. If you plug something too large into the mains, it will cut the power but don’t worry they’re used to travellers doing this!
  4. There can be long drives from one region/city to the next but if you have a good guide, they will offer stops at workshops in the small villages where they are keen to show you their craft – they’re very proud of anything that originates in Madagascar from cotton and silk to sapphires and recycled aluminium pots. You do not need to pay or tip for the tour of the workshop but they appreciate you buying something from them, even something small, this helps the individuals working in the workshop and the economy in general.
  5. Some roads are straight and well maintained, others are not! If you get motion sickness, and are doing a tour/safari of any kind, you’ll probably need to take precautions most days. 
  6. Our experience of 2*-3* accommodation was that it was fairly basic but clean (which was the most important thing for me). The bed and pillow are not always the most comfortable but they’re adequate. They do not offer any extras such as kettle or water unless you’ve got an ‘apartment’ where you’ll have cooking facilities. They do all have mosquito nets of varying designs.
  7. If you’re taking an internal flights, be prepared for Air Madagascar to change flight times at the last minute. Our flight was changed twice, the second time whilst we were on our way to the airport! We spent a few extra hours in a hotel so it wasn’t a problem since we’d allowed extra time before our international flight home.
  8. It’s a good idea to take extra luggage space as they really appreciate you contributing their their economy and when visiting workshops they are grateful to you if you buy some of the crafts etc.

Culture – You don’t necessarily need to know any of this before you go but I think these are some interesting points:

  1. Malagasy people are generally very friendly – the language barrier can be difficult if you don’t speak French but we found people very eager to help.
  2. Malagasy people are grafters. If they’re serving you in some way, for example guiding or in a restaurant, they want to give you the best possible experience – you can ask anything you they will do their best to answer/provide for you.
  3. Some people do not like having their photo taken as it, it is considered taboo. Conversely, some people are very happy to have their photo taken, the couple in a house we visited actively wanted their photo taken so they could see what they looked like as they didn’t know – the best policy is to just ask and be sensitive.
  4. In the south they practice polygamy – men actively advertise that they are looking for their first wife, then second and third by placing a comb with er than front or back of their hair.
  5. In the poorer villages, the average age to get married is 15, by 12 girls will already be starting to look for a husband.
  6. Zebu stealing is a big problem – it is against the law but it’s a widespread tradition for a boy to be expected steal a zebu to show he is ready for marriage.
  7. All baby boys are circumcised – they do it in winter and use the cold as the anaesthetic, the oldest male of the family then eats the foreskin with rum and banana. A boy who has not been circumcised is considered a girl.

We were told on multiple occasions “Madagascar has everything” – this is actually quite true, they produce all sorts of foods etc and manage very well with a fairly basic lifestyle. What they do produce is generally very good quality, for example, the rice they produce is high quality and therefore expensive so they export the rice they produce and import a low quality affordable one for their population to buy and eat – I found this quite sad but I can see why they do it.

Would I recommend Madagascar? Definitely. Are there any down sides? Not really – if you can cope with the poverty and are happy to do your bit to help the economy, it’s all good! I’d recommend going now with an established tour company before the hoards discover it!

10 essential things to know about Madagascar

I recently travelled to Madagascar on holiday, however, before I went, I knew very little about the country (other than I could see lemurs in the wild!). There’s not very much on the internet because tourism in Madagascar is in its infancy. My husband and I went on a 12 night safari visiting 4 national parks (in the East and South) with Jenman Safaris, so the following is based on this experience. I’ve put together a list of things I think it’s essential to know before you go:

1. There are many species of animals and plants unique to Madagascar, this is a big selling point for visiting the country. I was very excited to see lemurs in the wild! It’s also reassuring to know there are no deadly animals in Madagascar – our guide helpfully told us this one, although there are plenty of animals, mostly insects, that can sting or produce dangerous venom, these only cause pain or itch. Malaria tablets are advisable even though malaria carrying mosquitoes are only found in certain areas – it’s better to be safe than sorry.

2. The landscape and animals vary from region to region so it’s worth thinking about why you want to go to Madagascar and what you want to see. It varies from lush rainforest in the east to hot desert in the west. Vanilla plantations are found in the north. The wildlife in each area is related to the habitat provided. It’s not really possible to see all regions in one trip unless you stay for a month or more.

3. They speak Malagasy but you can get by in French – if you do not speak Malagasy or French it’s best to hire an English speaking guide who will stay with you. I’d also advise you to brush up on any French you know. The basics like “bonjour”, “merci”, “boisson” and a few foods are really helpful.

4. You can only buy a visa at the airport with cash Euros or Dollars, important to have enough cash, there’s no other option! Also, Malagasy Ariary (currency used in Madagascar) is not available outside Madagascar. You’ll need to change money at the airport or plan to use ATMs; you can change money in some hotels but we were advised against the unfavourable exchange rate.

5. Tourism is in its infancy so don’t expect everything to run smoothly or as you would expect in another country. They had 230,000 tourists last year (compared with 39.2 million to the UK (a country less than half the size). We’ve not had bad experiences but when comparing this holiday with one in Kenya, Madagascar has a way to go – for example their visa system consisted of a pile of pieces of paper, no computerisation!

6. It is the 4th poorest country in the world – this affects tourists in a couple of ways. We were told to be aware of pick pockets (we didn’t experience anything but we were careful with our belongings). We were told to be especially careful when leaving an ATM as you could be followed. There’s a small amount of begging that goes on so it’s best to know where you stand on this, some people give money or food, others choose not to. Everything is incredibly cheap, we haven’t spent anywhere near as much as we thought we would – for example, a beautiful hand carved nativity set was bartered down to <£15, similar in the UK I think would be £80+. Lunch of a main course and drink will be £2-£4/person.

7. Healthcare isn’t good – we learnt this as unfortunately we needed trip to hospital – we were very well treated but cleanliness wasn’t a priority! Life expectancy is 60-65 years for Malagasy people, this is because there is no help with healthcare, they can either afford it or they can’t. So make sure you bring first aid supplies and all medications you may need. If you need medical attention while out in Madagascar you’ll have the choice of a village/town ‘doctor’ (usually a nurse) that serves the local rural population or a city hospital, which may be further away (up to 3-4 hours by road) but you’ll be able to see a qualified doctor.

8. Phone signal and WiFi varies – most places we stayed had WiFi in reception and/or restaurant but it was very slow. There is phone signal in most places but some carriers don’t allow you to send or receive texts. If people back home usually like to hear updates from you, you’d better warn them to assume “no news is good news” as we did before mobile phones!

9. Most National Parks are explored on foot – your travel agents will ask about your capabilities but even though we said “we like walking but can’t do too much” (because I have arthritis and use a brace on 1 ankle) our itinerary contained a lot of walking! Even “easy” or “short” routes around the national parks are often 5km+ over moderate-difficult terrain. Although local people/guides are willing to help we saw people with mobility issues really struggling to get around the national parks. We loved it and didn’t find it too difficult but it’s good to know what to expect.

10. Essential packing list:

  • Be prepared for rain, requiring wet weather gear, a rain jacket at least (especially in the rainforests in the east but we had unexpected torrential rain in the south too)
  • Be prepared for sun, requiring sun cream, sunglasses and a hat (especially in the west/south) – the only weather they don’t get is snow.
  • A good set of walking boots is also recommended if you’re planning on going into any of the national parks – they’re varied, some require scrambling through rainforest undergrowth, others are rocky.
  • Mosquito repellent – they were not a big problem when we visited but it’s just sensible! All the hotels we stayed in had mosquito nets.
  • If you’re visiting national parks you’ll most likely be offered a night walk, for which a torch is essential. If you don’t have one you can sometimes borrow from your guide.
  • The sockets require a 2 pin plug adaptor. Be aware that some hotels have a imit on what their sockets can be used for and some have specific periods without power.
  • Whether you’re exploring national parks or not, a camera is a must – the culture and landscapes are incredibly photogenic!
  • As with any holiday, any regular medication for the full duration of the trip.

For more exciting information, please watch out for my next blog “Everything else you need to know about Madagascar”.

Stop labelling food!

I hear a lot of conversations from colleagues about whether they’ve been “good”, “bad” or “a little bit naughty”. Despite trying to be good, it seems being “bad” is inevitable! I’m baffled about how to get involved in these conversations, I’m not entirely sure what “good”, “bad” or “naughty” means. Through my eating disorder recovery, I’ve learnt that food is essential for life so how can it be bad to eat?!

I hear things like “well you’ve got to haven’t you?!” referring to “being a bit naughty”. It seems that if you want to have a good time, enjoy the social experience etc, “bad” food is usually consumed.

As regular readers of my blog will be aware, the angle I’m coming at this is having had an eating disorder. In my anorexic world, fewer and fewer foods made the “acceptable” list as more foods were transferred to the “dangerous” “scary” or “never eat” list. I could sometimes move a food from one to the other depending on how I ate it, whether I’d starved myself for long enough or if I knew I was going to be able to get enough exercise in. When things got really bad, there were certain food that made a list I’m ashamed of, that is “easy to purge”.

I’ve written previously about disordered eating and how dangerous that is; I think labelling foods is unhelpful and is down the road to disordered eating, unfortunately, it’s incredibly common.

Even considering some foods as “more healthy” than others is unhelpful. There are diets that are more or less healthy but no individual food is inherently unhealthy. Yes, we all know we’re meant to eat more fruit and veg in your diet than cakes, chocolate and biscuits but it is perfectly healthy to have some chocolate, once in a while (or everyday if that works for you).

One study may show that brown or “whole” foods are “more healthy” than their white counterpart, indigestible fibre helps keep he gut healthy; however, there are numerous bowel conditions that are exacerbated by high residue foods which means “white” foods are more healthy for these people.

One study shows particular foods as able to prevent cancer or some other illness, the next week, the same food will be shown to cause the aforementioned illness. The only conclusion to take from these is there is a no special diet that will cause or prevent any illness.

What’s also unhelpful is people believing their diet is “better” than someone else’s. Who’s to say why someone eats the way they do? Some people need to eat calorie dense foods quickly because that’s what suits their lifestyle. Other people need to eat food that will metabolise more slowly. We all have different body makeups and it’s wrong for anyone to impose their idea of “health” on anyone else. Being vegetarian or vegan is a personal choice that should not be imposed on anyone else (if you want to campaign against the meat/dairy industry that’s fine but don’t attack or reproach individuals).

In our diet culture, when people try to lose weight (to get their BMI to within the healthy range), they (usually) have a list of acceptable foods and unacceptable foods; however, it has been proven that deny yourself foods makes you crave them more (restricting in generally makes you more likely to binge) and feeling guilty about eating just adds to the negative effects! Foods high in saturated fat, high in sugar sugar or foods subjected to a lot of processing may have a negative impact on our health but if you like it, don’t feel guilty about eating it!

Food has also become a way of people feeling morally superior, if you choose “organic”, “free range”, “ethically sourced” or “sustainable”, some people consider themselves a better person than someone who doesn’t or can’t choose those options, for whatever reason. I’m vegetarian for a variety of reasons, I do not consider myself as morally superior, it’s my choice, I do not push my values on anyone else, please don’t push your values onto me.

Don’t get me started on “clean” eating! It’s such a bizarre label, if you want to choose certain foods because they make you feel good, go for it, but as far as I’m concerned if I’ve washed it, it’s clean! Don’t label everyone else’s diets as dirty just because you want to restrict your diet and feel ok about it! This label can be the start of a dangerous spiral into orthorexia.

Having previously categorised foods a “ok”, “scary”, “bad” or “unbearable”, I’m glad those days are behind me. I now see food and decide if I want it based on whether I want it or not – if I’m hungry, I’ll eat foods that will satisfy my hunger. If I’m not hungry but food is available/offered, I make the decision based on whether I like the taste, whether I’ll enjoy eating it and if it’s going to appropriate within the context of other things I’ve eaten. If you’re not hungry it’s not “right” or “wrong” to eat food it just requires thought.

If we label the foods as “good”, “bad”, “naughty”, “healthy”, “unhealthy”, “better” or “worse”, by extension, we label ourselves, this can have a profound impact on our self esteem. Feeling guilty or shameful about eating is not ok, making other people feel guilty about eating because of the choices you want to make is not ok. Let’s just eat the food we want to eat and stop labelling ourselves as “good”, “bad” or “naughty”.

Myth#5 People with personality disorder aren’t really ill

Welcome to my mini series of myth busting blogs, this one is all about personality disorders. Find links to the others at the bottom, please read and share, we need to break down these inaccurate beliefs in order for people with mental illness to stop being discriminated against.

Let’s set this one straight immediately – Personality Disorders are listed as mental illnesses in the DSM 5 and the ICD 10 – the 2 most widely used diagnostic manuals.

Personality disorders (PD) are unique and highly misunderstood, this leads to people receiving poor treatment and falling through the gaps in services.

Even mental health institutions are getting this one wrong when they say things like “treat patients with enduring mental illness and personality disorder”, this says personality disorders are separate from mental illnesses. This is taken directly from the details of a hospital site:

I understand it’s important to mention it specifically as there are lots of places who would support people with mental illness and complex care needs but would not admit people with personality disorder, however, this would be simple to fix, they could put “…complex care need INCLUDING personality disorder”.

There are 10 classifications of personality disorder which fit into 3 clusters, they each have criteria that must be met in order for the diagnosis to be given. Diagnosis is a complex process of gathering information about the patient’s history and the difficulties they face. Read more about the specifics on this post from Psychology Today.

All too often I’ve seen individuals with this diagnosis fall through the gaps in services; personality disorders are complicated and misunderstood, general community mental health services are not specialised enough and the specialised services are a rarity and (where they do exist) under funded.

A fundamental symptom of personality disorders is a difficulty in maintaining healthy relationships, this includes professional relationships and as such, specialist services with adequately qualified professionals, are vital. (Expecting the community mental health team to support and manage people with personality disorder is like expecting GPS to do brain surgery.)

It is possible for sufferers to manage their condition, it takes a lot of hard work and a lot of support, because the symptoms are so varied and complex but it is possible for individuals to develop a life worth living.

I have seen inexperienced and under qualified professionals see the label ‘personality disorder’ and see this as permission to ignore, give up on or treat the individual badly.

I have also seen people who do not meet the criteria for a diagnosis of personality disorder, be given it because their symptoms and behaviour are proving challenging and labelling them as ‘PD’ is an excuse to discharge them from care (and give up on them).

Giving up on psychiatric patients is so far beyond unacceptable, there are no words to express my anger and frustration when I see this.

If the professionals don’t even understand these unique disorders and are seen to give up on their patients, we will never be able to break down the stigma and discrimination that exists with the general public.

We’re making good progress with understanding and accepting illnesses such as depression and anxiety but we’ve got a long way to go for public to understand personality disorders, by sharing blogs like this, we will make more progress.

Myth#1 – Mental illness is a sign of weakness

Myth#2 – Men need to get in touch with their feminine side to show their emotion

Myth#3 – Bipolar is more serious than depression and it’s preferable to have anorexia over bulimia

Myth#4 – If someone harms themselves they’re just attention seeking

Myth#4 If someone harms themselves they’re just attention seeking

Trigger warning – this blog focuses on self harm, if you think you may be adversely affected by the content, please turn away before reading any further.

This the forth in a series of myth busting blogs. You’ll find links to the others at the bottom, please read and share – we need to break down this misunderstanding and stigma!

If someone harms themselves it’s because of some inner turmoil, people turn to self harm when other forms of coping have failed. Self harm is on a wide spectrum from drinking every night (to dull stressful feelings) through to parasuicidal behaviour such as taking an overdose.

The self harm may be a way of relieving the mental pain, sometimes it’s a form of punishment, sometimes it’s a way of converting the mental pain into physical pain that’s more manageable. Some people do it because words are beyond reach, some because words just don’t feel enough.

People who self harm are not deliberately seeking attention, most do not want attention at all and will do anything to hide the results of their self harm. However, although they do not want attention, the likelihood is, they need it – we are all human beings who need love and attention in order to survive – someone with mental illness is no different.

This phrase ‘just attention seeking’ has become dismissive and prevents the sufferer getting the support and treatment they need. It may be a difficult and scary behaviour to encounter but we need to see self harm as a symptom, just like low mood, insomnia or decreased appetite in order to ensure anyone who self harms gets the treatment they need.

It is common for people with borderline personality disorder to harm themselves but people who self harm can have any diagnosis (or none). It is a common misconception, even amongst mental health professionals that people who self harm automatically have a diagnosis of BPD, misdiagnosis is unhelpful and even dangerous.

I’ve struggled with various forms of self harm, at times it’s attracted unwanted attention, I’ve been judged and have been badly treated by people in authority. At the time I thought I deserved it, but now I realise it was very wrong.

Just like suicide is a death caused by mental illnesses (not a crime that has been committed) self harm is a symptom of mental illness, we need to change our language to break down the stigma and discrimination that all too often seen in Emergency Departments, within mental health services and in the general population.

Myth#1 – Mental illness is a sign of weakness

Myth#2 – Men need to get in touch with their feminine side to show their emotions

Myth#3 – Bipolar is more serious than depression and it’s preferable to have anorexia over bulimia