Back on medication – have I failed?

Some of you will know, this time last year I was gradually coming off my psychiatric medication. I’d been on medication most of my adult life, I was still in therapy but I felt it was the right time to give it a go. If you’ve been on medication a long time it can be hard to tell if you still need it. The only way to be sure is to try coming off them in a controlled way and see if symptoms return. I did this, I came off everything very gradually, keeping a careful track of how I was feeling and what thoughts I was having. Soon after, my therapy came to an end and all seemed to be going well.

Unfortunately, my physical health in 2016 has taken a bad turn. I’ve had to see specialist after specialist as one organ system after another started going wrong. I was having numerous tests, appointments and procedures. For a time I was managing to keep positive and take it in my stride but there was only so much I could take and I started noticing symptoms of mental illness creeping back in. In an appointment with my GP I was updating her on all the hospital appointments I’d had and talking about test results etc, I was trying to hold it together but eventually the tears started falling. I then explained the other symptoms I was struggling with.

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We had both been keeping an eye on my mental health as it’s common for physical health problems to take their toll on ones mental health and so at this point we discussed going back on medication. I felt disappointed about the prospect but I made the tough decision to give it a go and see if it could help. Starting on a low dose, of course, and stepping it up gradually until I felt a benefit.

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Initially this felt like a failure, I’d worked so hard to remain stable but I’ve managed to re-frame how I see it and I now don’t see it as a failure. In fact, noticing my symptoms and flagging up the problems earlier rather than later is an achievement for me. If the chemicals in my brain are out of balance again, surely it’s sensible to try and put this right? My old habit was to ignore it for as long as possible and hope it would sort itself out but this landed me in hospital too many times! If someone breaks their leg, you don’t expect them to walk around on it, ignoring the pain, we’d all advise them to have it x-rayed and put in plaster. It’s the same with mental illness, it’s important to find the right treatment.

Fortunately, this time, it seems we’ve spotted the signs early enough and the medication is helping.

Like all medications it’s important you’re not on them if it’s not necessary. We’ve all heard about the antibiotic crisis, over treating can have a devastating effect. It is important that anti-depressants and the like are not taken lightly without thinking about therapy and lifestyle changes as well. Also, we need to give careful consideration to any unwanted side effects. It’s also been much trickier for me this time as we’ve had to consider the interactions with all the physical health medication I’m now taking.

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I do not want to be on psychiatric medication longer than necessary so when things settled down I will consider coming off them again. Unfortunately, this doesn’t look like it’s going to happen any time soon. But, I’m not going to beat myself up or apologise for putting my hand up and saying “I need some additional support just now”.

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Fake it ’til you make it – does it work?

As a mental health recovery worker, my heart sank when I heard my colleague (who I respect a great deal) use the phrase “fake it ’til you make it” with one of her service users.

This was the worst thing someone once said to me during my recovery journey. I had spent my whole life faking it, and this was what was making me sick. Constantly trying to “fit in”, to be “normal”, meant I’d lost sight of who I really was and it made me more and more unhappy.


I’m an introvert and in a world built for extroverts I feel I constantly have to fake social confidence. When I say I’m an introvert, I mean I’m at the extreme end of the spectrum.

By no means do I want anyone to feel sorry for me. Now I know I’m an introvert and I’m ok with it, I love it! How lucky am I that I don’t NEED other people to recharge my batteries? How great is it that I can amuse myself with a ball of yarn on the sofa for hours without getting bored or needing attention from anyone?

Faking being an extrovert is exhausting. In a room full of people, where background noice makes my ear drums painfully contract and  the ridiculously high watt light bulbs just want to shut my eyes, I smile and nod along to the conversation. I try desperately to drop in some interesting or helpful remark now and again just so someone doesn’t ask me if I’m ok.

No, I’m not ok…faking having a great time when your heart is screaming “get me out of here” takes a lot of self discipline!

If introverts don’t fake it, they’re considered a “party pooper” or “billy-no-mates” or a “hermit”, these are not considered indearing qualities, they’re unfair derogatory insults. The truth is, I just like being on my own, I find peace and quiet restful and other people (except a select few) sap my limited energy. Why is this considered strange?


I felt angry that my colleague had no idea the pain my faking had caused me and I considered her comment insensitive. Add insult to injury she has to be the most extrovert person I know! In my anger I was wondering how she could possibly make such a rookie mistake. But, as I say, I respect her so I knew she meant well and I had to stop and think about what she was trying to say.

The context of her comment was with someone who had mild depression and anxiety. They had previously been an extrovert and were disappointed and frustrated that they’d lost that part of them. My colleague was suggesting that they do the things they knew they’d previously enjoyed. The idea being if you immerse yourself in things, you know, deep down, are part of your character and enjoyable, then, fake a smile now and again, eventually the old you will emerge. My colleague was helping her service user believe in himself again. This genuinely works provided you also address the issues that led to the mental illness occurring in the first place.


Saying this to me, or any introvert, however, would just compound the issues that led to the illness developing. When this comment was said to me, it confirmed that was the failure I felt and unfortunately led me to feel that if I had to fake it for the rest of my life (since I’d been faking it all up until now and I’d never “made it” I wasn’t going to suddenly be able to make it now) there really was no point in going on.

If you tell an introvert to “fake it” to “make it” in the world, instead of building them up, you will be smashing their self esteem to smithereens. We’re already great fakers, what we really need is to be told, “it’s ok to be you”.

For an introvert, finding recovery can be a lot more subtle than for an extrovert. When depressed, the usual reaction is to hide away from the world. Extroverts needs to get out there, find people, build their energy from them. An introvert needs to be truthful about what makes them happy, it might be about treating yourself to some luxuary bath salts or lighting a candle while doing some breathing exercises. I’m not advocating introverts continuing to hide away, we all need someone in our lives, I’m just saying an introvert needs to find balance.


When searching for freedom from a mental illness, it’s about finding out who you really are. If faking being an extrovert will remind you of how fun it is, go for it. If faking being an extrovert will just remind you that you hate faking being an extrovert, please stop!

How to stay motivated…

It’s that time of year again, are you someone who makes New Year resolutions? Halfway through January, have you already broken yours?

One year, I made a resolution that this year would be better than the last. This did not work out as many things happened beyond my control, the year went from bad to worse and I then felt even more of a failure as I couldn’t keep (what I considered) a simple resolution.

Of course, looking back, this was a foolish resolution as there are so many things in life we cannot control and it was not possible to measure whether I’d had a “better” year so how would I know if I’d “achieved” it?!

So, what makes a good resolution and how do we keep it?


  1. Make sure it’s SMART: (sorry if this sounds like school but it’s basic stuff that works)
    1. Specific – make sure you know exactly what you’re doing!
    2. Measurable – how will you know you’ve achieved it?
    3. Achievable – is this something you know you can achieve or is it going to stretch you a bit? Even stretching you a lot is ok, as long as it’s within reach.
    4. Realistic – is it really some thing you want to do? Does it sound reasonable?
    5. Time limited – when are you going to achieve it? Some things you can start straight away, others, you may do with a stepped approach and therefore you need to know when you’re going to do what.
  2. Know what motivates you – if you can pat yourself on the back internally, well done. Most people need something external, either someone else to congratulate them or some external reward. This could be money, a new meal out, a holiday – work out what it is and make sure it’s in place. When the going gets tough, focus on the reward.  If you need recognition from family and friends, tell them and be accountable.
  3. Get the support you need – studies show people are four times more likely to successfully quit smoking with support vs doing it on their own. There must be similar success rates with other goals, make sure you get the right support at the right time.
  4. If you slip up, call it that – you have not failed, you are not back at square one, you’ve got experience behind you now, use that experience to have another go. Beating yourself up is unlikely to help you achieve your goal!
  5. Count your achievements – if you kept your resolution for 1 day and slipped up over the next 2, you still know you can do it for a day, focus on what you achieved that day, forget the others.
  6. Don’t be afraid to change your goal – if it’s not working, don’t give up, just re-evaluate, think about what’s happened, is it a lack of time, a change of circumstances or lack of support? Set something more realistic.
  7. There’s no time like the present – if you’ve not started yet, don’t wait for next year to make another resolution, 1st February is just as good as 1st January.
  8. Just do it! Ultimately, be honest with yourself, are you making silly excuses? Your the only one who knows, do you need to “cut the c***” and just get on with it?!

If, for example, you want to “get fit” – that’s not measurable so make sure you know what you’re aiming for, do you want to run a 5k, 10k or marathon, set a date and enter a race. Or, set yourself a goal of exercising x number of times a week.

If you want to lose weight, but ultimately know that money is more of a motivator, put £x in a jar for every pound lost then make sure you know what you’re going to buy.

“Sorting out my finances” isn’t tangible, instead, set yourself a specific budget plan.

“Get a new job” may be measureable but ultimately a lot of things out of your control, instead, set the goal of applying for x number of jobs per week or make sure you get feedback from all job interviews attended.

Being honest and being positive are qualities that will help you makes goals and stick to them. So even if things haven’t gone too well so far this year, pick yourself up, try again! Good luck!

Goodbye my friend, choosing to forgive

TW – Trigger Warning – contains suicide theme

A dear friend of mine died as a result of her own actions. We do not know if she intended to end her life, she was deeply unwell and the only way she knew how to cope with the despair was to repeatedly take extreme risks with her life and it was one of these actions that finally took her from this world.

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She was beautiful, inside and out. A bright light in the world. She was an inspiration to me. I first got to know her when she was facilitating an eating disorder recovery course I was attending. She been through the pain that is anorexia and she showed me it was possible to come out the other side. We grew to be good friends, but her vulnerability to mental illness continued and it took its grip once again.

At her funeral, I was very fortunate to be reminded about the power of forgiveness and how essential it is at times of grief. I needed to be reminded that holding onto sadness, anger and guilt won’t help anyone, the only way to move forward in life is to manage these emotions in a healthy way.

  • Days before she died, Mary (not her real name) had applied for a job and she was rejected by email because she’d previously been suspended relating to her mental health problems. Of course, I do not blame this person for her death, the world is full of triggering events, but this was a contributing factor to how she felt. I need to forgive this person for not giving her the chance she needed.
  • Mary’s husband had some difficulties which Mary really struggled to deal with. A lot of her friends tried to persuade her to leave him but I listened to her while she wrestled with her thoughts and feelings saying I would support her with whatever she decided. She decided to forgive him, I need to follow her amazing example and forgive him for putting her through such pain.
  • Before going to hospital Mary had received inadequate support from the community mental health team. This could have been for number of reasons. It’s sad that people with Borderline Personality Disorder often receive poor or disjointed care due to lack of understanding, stigma and discrimination. I blog, aiming to improve understanding of all mental health conditions, it’s one small way I hope I can help. All mental health services are stretched due to lack of funding. We can all join campaigns to improve the state of mental health services. Instead of feeling angry and let down, I need to forgive and use my emotions to act and improve things.
  • According to newspaper reports of the inquest into Mary’s death she’d been assessed on her admission to hospital and the doctor did not pick up that she was a suicide risk or at risk of harming herself and did not therefore recommend she be on a high level of observations. In my mind, something went wrong in this assessment. questionsWas Mary given the opportunity to tell someone how distressed she was? Did Mary feel she couldn’t tell anyone? Was she so distressed, she didn’t want anyone to stop her acting? Did Mary tell someone but they didn’t act or even record it? Was Mary so impulsive, she had no idea she was going to do what she did? These questions could go around in my head forever but I will never find the answers, no one can ever ask Mary what happened from her perspective so I need to forgive and let them go.
  • I need to forgive the ward manager who smirked during the hearing and had to be removed from court to be told how to behave. He has no idea how hurtful his behaviour was.
  • It is really hard to admit I feel angry at Mary for doing something so dangerous and putting her life at risk so many times. But I know she was ill. Mental illness is powerful and the voices accompanying the darkness can persuade the sufferer to act in uncharacteristic ways. Admitting I’m angry with Mary is the first step towards forgiving her.
  • I believe in God, as did Mary. The existence of mental illness doesn’t make sense but the brain is an organ like any other that can go wrong and get sick. God bears the brunt of much anger from anyone and everyone, whether they believe in him or not. Some people seem to think, when  all else fails, at least there’s God to blame. But holding onto anger doesn’t do anyone any good. Accepting that we live in a fallen world may be the only way to get past this one.
  • I wish I could ask Mary for forgiveness, I’m sorry for:
    • Not being there for her
    • Not making people step up and give her the care she needed
    • Anything I did that added to her distress
    • Anything I should have done but didn’t that could have prevented this tragedy
  • Ultimately, I need to forgive myself…

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None of these people will know the process I’m choosing to go through but if I don’t forgive them, I will be choosing to hold onto my anger, sadness, guilt and despair. Keeping myself trapped in these emotions will gnaw away at me, it will not bring Mary back and it would devastate her if she knew I was doing that to myself. Forgiveness is not a feeling, it’s a choice. I must follow Mary’s example of how healing forgiveness could be. I will never forget but the only way to ease the extreme pain is to forgive.

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Should I be glad my illness is invisible?

I have read a lot of blogs and articles with people outraged that people have no understanding about invisible illnesses. As a mental health blogger it’s easy for me to climb on the bandwagon but as usual I like to ponder things from a different angle. Mental illness by no means has the monopoly, most cancers, diabetes and most illnesses involving internal organs are on the list of invisible illness.

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Someone came to me the other day and told me about being jeered at in the street. He was confused about why but it made him angry and upset. The gentleman in question has a learning disability and the likelihood is that the way he was standing/walking/looking may have looked out of place/unusual, he is unaware that he looks different. Why would someone jeer at someone with an obvious disability? It’s plain cruel. It made me stop and think about how I feel about my illnesses being completely hidden.

I smile as I recall the number of times, while seriously unwell, even sectioned, in hospital, I was mistaken for a nurse on the ward. Most of the time, from my general behaviour and demeanour, no-one would have been able to tell the torture going on inside my head. No matter how unwell I’ve been I’ve always washed and dressed and tried to face the day.

chronic-illness

Sometimes mental illness is more apparent, for example if someone is unkempt, looking withdrawn or responding to stimuli other people cannot perceive. But most of the time mental illness is relatively hidden if not invisible.

Is this a good thing or a bad thing?

When I despair about having a hidden illness, am I seriously suggesting it’s better or easier when the illness or disability is on show? I have wept when I’ve watched documentaries about people with facial disfigurements, the stigma, the shame they feel and the impact this has on them day to day as they fear people staring, pointing and making judgements is totally undeserving. Katie Piper is a stunning example of someone who talks openly about what it’s like. I cannot begin to imagine how people manage a condition people can see.

Perhaps this is a blog about judgements people make.

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Why, whether obvious or hidden do people make assumptions and judgements about other people’s abilities and disabilities?

Why should I be afraid to park in the disabled bay? If I have a blue badge it’s because I need to park closer to the building, should it matter to other people why? The wheelchair is the universal sign for disability, it does not mean I have to be  in a wheelchair to use the space. People with conditions from autism to fibromyalgia, from COPD to paraplegia need to use disabled parking. Why is it anyone else’s business? If I have claimed a blue badge fraudulently, this is a matter between me and the authorities, not Joe Blogs Public.

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On the flip side, just because someone has a visible illness, disability or condition, it seems that people make judgements about what they can and can’t do. For example, the gentleman I wrote about earlier (with the learning disability), we are working very hard with him to become more independent, which he is managing very well and it’s building his self esteem. But the people in our local shop assume he cannot do this and therefore insist on him giving them his shopping list so they pick items for him, it is well meaning but completely unnecessary and making him think he can’t do it!

The benefit of an invisible illness is that you can choose to keep it hidden, no-one else has to know unless you wish to tell them. The down side is, if people assume I’m ok, I do not get the help and support I need.

The stigma and discrimination experienced by someone with an invisible illness is due to lack of understanding and awareness that the illness exists, the assumption is, if you look normal, surely you should just get on with life?

The stigma and discrimination experienced by someone with an obvious illness is due to people making inaccurate judgements about something they think they understand but the reality is they do not understand at all.

Why do we place so much importance on appearance? We need to stop judging a book by its cover. Just because I look “normal” don’t assume I can just get on with life; if I look different, don’t assume I’m not capable.

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Is it a diagnosis, a label or an identity?

I’ve had a number of conversations over the years about the language used around mental illness – it’s complicated matter, made more complicated by people not knowing the power behind their words.

“I am not my illness”

I’ve had a gentleman with schizophrenia say they detest being called “schizophrenic”, explaining this by saying “you would not say someone is a cancer”. However, we are not saying he “is schizophrenia”, we would be saying he “is schizophrenic” just like we say someone “is diabetic”. However, I think what he was trying to express was that he is not his illness, he did not identify with his illness, he did not want to be labelled in this way and this is to be respected.


Even professionals use words derogatorily

If I said someone “is diabetic” I would not have any opinion or judgement on their personality or any other characteristics. However, I recently heard a paramedic say this patient “is schizophrenic” with so much power, bitterness and judgement, I could tell he was casting aspersions on this person’s character. I had presented my service users as a “56 year old gentleman with [a number of medical complaints] and schizophrenia” as information that may lead to conclusions about the current presenting complaint. While one person may be able to say someone “is schizophrenic” without any preconceived judgements, this paramedic was not one of them. Stigma in society is so strong, but it’s people who are being stigmatised that suffer, those doing the stigmatising don’t realised a subtle language change could have a powerful impact. With this small change, a person is not labelled as their illness but someone who has an illness.

“I am more than my illness”

Mental illness can have a negative impact on one’s identity. When I was diagnosed with anorexia I could have let this be my identity… i could have felt, I am not Frances anymore, “I am anorexic”. I have seen people so consumed by their illness, they may as well say “I am anorexia” – I am not a person anymore, I am an illness. But I did not want to label myself in this way, although it was true I was “anorexic” I preferred to see myself as “a person with anorexia”, then my character and personality traits could exist alongside my illness. It has been proven that assumptions about what it means to be mentally ill such as incompetence and inadequacy (commonly held) will lead to a vicious cycle of impoverished sense of self and low self esteem, ceasing to try and work or fit into society and poorer psychosocial outcomes and sustained symptom severity. (Read the full article here.) It follows that, if you identify as your illness, you identify as incompetent and inadequate, whereas if you consider yourself to have an illness, you are not your illness, you can distance yourself from these negative characteristics.

Of course, this is down to the individual and if saying “I’m bi-polar” or “I’m schizophrenic” does not impact on their ability to see themselves as separate from the illness that’s their prerogative. Or, if they want to be identified as their illness, that’s also, up to them. Perhaps I’m saying, from within a mental illness it can be very difficult to see the path to recovery, how you see yourself in relationships with your illness can be the turning point. In my opinion, recovery and turning away from being consumed by mental illness is possible for everyone (recovery may not mean cure – but that’s a subject for a different blog).

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When is a diagnostic label unhelpful?

I’ve had other conversations with people who think we should do away with mental illness diagnoses all together as the words can have such a negative impact on the experience. It can be very confusing when some words can be used by the general population, for example feeling depressed or anxious are valid and appropriate emotions, however, clinical depression and anxiety disorder are very different experiences, in some ways a million miles away from the basic emotion. For other diagnoses there are other problems e.g. the use of derogatory terms, such as “schizo” which has been used to mean “unpredictable criminal”. Personality disorder is a confusing term, we think (as society) we understand what is meant by personality so if someone’s personality is disordered, surely, their core being is fundamentally altered/damaged? Well, no, personality disorders are extreme complex and there is much discussion about changing the label to fit the experience better. But an individual experience of different personality disorders is unique such that everyone has a different perspective on which words would be more useful.


Of course, diagnoses are an essential part of communicating. It’s helpful if a collection of symptoms has a name so that treatment can be targeted appropriately. I have also had the experience of an inaccurate diagnosis being used which then had a negative impact on the treatment I received.

Language changes, this is normal

The word spastic used to mean “muscle spasms, a common symptom of cerebral palsy” – it is now an offensive term, because of how it was used, and has fallen out of use. The media may hide behind “the dictionary definition”, but if we follow this through, we can still use the word spastic, but we don’t. The ~”dictionary definition” of “schizophrenic” is “a person with schizophrenia” or “contradictory”, e.g. “the rehearsal was schizophrenic” could mean “frantic and disjointed” but this is as it’s at odds with the definition of diagnosis. Many people still think someone with schizophrenia has a split personality or they will definitely be violent…continuing to use the word in different contexts perpetuates this misunderstanding of the illness.

Just hoping people think about what they say…

It’s not hard to change, “schizophrenic person” to “person with schizophrenia”.

Breaking down stigma is vitally important in a cruel and judgemental world. Not realising the power behind our words can have a negative impact on those affected by the illness by perpetuate societies misunderstanding, judgements and stigma. Even if you do not mean offence by the words you use it can have more of an impact than you realise.

Is it ok to be a little bit OCD?

No, it’s not ok, there’s no such thing!

I was horrified recently when I saw a young girl, hold a creased piece of paper aloft and call out “you’ve triggered my OCD”.

Would anyone call out “you’ve set off my bulimia” or “you’ve sparked off my schizoid personality disorder”? No!

So why is it ok to make fun of OCD?

It seems there’s something cute or glamorous about wanting things neat, tidy and organised. But this is not what obsessive compulsive disorder (OCD) is about…it’s a thought disorder with devastating consequences where people have uncontrollable urges to carry out meticulous actions in order to avoid perseived disaster occurring to them or their loved ones. People can need hospitalization as short term management. Long term the condition needs therapy to understand the meaning behind the symptoms and to break the compulsive behaviors.

I’m sure this young girly meant no harm by her comment but unfortunately, language like “I’m a little bit OCD” perpetuates stigma that people with serious mental health disorders could do without. If OCD (or any other disorder) is banded about in a frivolous way, full understanding of the nature and impact of the illness is missing, people think they understand but they miss the point. Misunderstanding has many consequences including discrimination and isolation.


If person A has advertised their OCD as not wanting a crease in their leaflet, how will anyone understand that person B will always be late for meeting friends because they have to perform a repetitive ritual lasting many hours before they can leave the house or they fear for the life of their children? Everyone experiences OCD differently, it’s a highly complicated and varied illness.

I’ve had anorexia and depression, at various times I’ve been more or less ill but at all points in my illness it impacted my ability to function. Yes, it can appear that some illness are on a continuum with neurotypical individuals but there is a line where you fit the criteria for diagnosis and it’s at that point, life is severely impacted. Anorexia is not losing a bit of weight, depression is not feeling a bit sad. Mental illness is complicated, sometimes not even fully understood by the individual who’s suffering.

We must stop this unhelpful language around mental illness. Talk about it, yes, if you suffer, talk about the triggers and how it impacts you but if you do not have a diagnosis, more sensitivity is needed, it is not ok to poke fun at or making light of something you don’t understand.

Prevention is better than cure

The incidents of mental health illness is rising. Currently the statistic quoted is 1 in 4 people will suffer during their lifetime and this is thought to be rising. Community Mental Health Teams are so under resourced they are constantly having to raise the threshold people have to reach to gain access to the service. All too often I hear people in crisis are not getting the support they need.


With mental health crisis services in crisis what can we do? 

In the past medication was the cure-all. But people often need therapy to fully understand the underlying problems and to develop management techniques. The government initiative of Improving Access to Psychological Therapies (IAPT) is great. Although it sounds great that I recently heard one service is doubling the number of Psychological Well-being Practitioners (PWP) it’s training, it concerns me that (although these therapies are obviously needed) we’re throwing money at the wrong end of the line.

Surely, prevention would be better than cure? But what’s being done in this respect?


Mental illness develops due to a variety of factors. These include biological, psychological, social and societal factors.

There is controversy about whether we genetically eradicate illness. Finding the genes responsible for mental illness predisposition is a long way off so we do not need to consider this just yet. So, what can we do about the other risk factors?

The World Health Organisation (WHO) published a document in 2004 detailing how prevention of mental health disorders is a public health concern. They found a number of protective factors to avoid developing a mental illness, these included:

  • Empowerment
  • Ethnic minorities integration
  • Positive interpersonal interactions
  • Social participation
  • Social responsibility and tolerance
  • Social services
  • Social support and community networks

The BBC published an article recently citing a longitudinal study of 10,000 people showing that if children had been involved in scouts or guides they were “15% less likely than other adults to suffer from anxiety or mood disorders.”


The Scout organisation states that they:

  • Offer challenging and unique opportunities
  • Enable people to help others and make a positive impact in communities
  • Help young people reach their full potential by developing skills including:
    • Teamwork
    • Time management
    • Initiative
    • Communication
    • Self-motivation
    • Cultural awareness
    • Commitment
    • Creativity
    • First aid
  • Help young people to get jobs
  • Create an environment to make friends and have fun
  • Ensure young people get outdoors

It strikes me that the being involved in scouts or guides covers all the the protective factors quoted in the WHO publication!


There is something unique about the variety of activities and opportunities offered and the environment created by scouts and guides as researchers “didn’t see the same protective effect from, for example, volunteering or from church groups”.

We assume that the “15% less likely to suffer…” is due to the protective factors produced by being involved in scouts of guides, however, it could be that people who are less susceptible, choose to be involved. There may be no way of knowing which way round the relationship is but I’d say there’s no harm in joining, it sounds like a lot of fun and the opportunity to gain skills and experience will definitely be of benefit to any young person.

Find out more:

The truth about ECT

Is this barbaric treatment still carried out?!

Electroconvulsive therapy (ECT) is a controversial treatment but the stigma relates to early treatments where high dose electricity was given to patients without anaesthetic.

What is it?

A general anaesthetic and muscle relaxant is used to ensure the patient remains as still as possible. Electrodes are used to pass a small electrical current through the brain causing a brief (20-50 second) seizure. It can be given uni-laterally (to one side of the brain) or bi-laterally (to both sides). Very small movements of the limbs will be seen to signify a seizure has taken place. It re-aligns the brain chemistry altered by certain mental illnesses.

Why is is given?

Mental illnesses are treated with medication and psychotherapy but when certain illnesses are severe, life threatening and resistant to these treatments ECT can be used.

Severe symptoms may include:

  • Suicidality
  • Refusal to eat and/or drink
  • Risky/life threatening behaviours associated with mania
  • Psychosis involving severe loss of touch with reality
  • Catatonia

ECT is also given if it has been successful in the past and the patient presents with similar symptoms. The decision is usually collaborative, between patients and prescribing psychiatrist, however, the patient may lack insight or have lost touch with reality, then consent is encouraged but not necessary.

Are there side effects?

An electrocardiogram (ECG) and blood tests will be taken to ensure the patient is physically fit enough to undergo the general anaesthetic and receive the treatment. However, side effects may occur.

Short term (minutes-hours):

  • Headache
  • Confusion/feeling out of sorts
  • Muscle aches
  • Memory loss
  • Sickness
  • Affects of general anaesthetic

Long term (days-years) reported in a minority of cases:

  • Memory problems
  • Personality changes
  • Loss of skills

Death or serious injury can occur in 1 in 80,000 treatments, about the same as with having a general anaesthetic for dental work.

Side effects can be reduced by given unilateral placement of the electrode on the non-dominant hemisphere rather than bilateral stimulation.

Does it work?

ECT is usually given in blocks of 6 treatments twice per week. Improvement in symptoms is usually reported after 2-3 treatments. If small improvements are seen after 6 sessions, up to 12 treatments are given. Treatment is stopped as soon as adequate improvement is seen.

A study of 1895 courses of treatment showed:

  • 1712 reported improvement (‘minimally’, ‘much’ or ‘very much’)
  • 113 reported no change
  • 28 reported feeling worse.

Bilateral and high electrical current is shown to be more effective at treating symptoms but will increase side effects.

There is little evidence for continued or “maintenance” ECT.

A personal story

Mental illness can strike anyone at any time. I have had long standing mental health issues but a few years ago, I became extremely unwell, lost insight and required sectioning under the mental health act to keep me safe. I was unable to control my suicidal behaviours and although medication was tried, it was not effective in the time scale needed. I could not engage with psychotherapy due to severely distorted thinking.

I had lost hope. ECT was offered as a last resort. Due to my distorted thinking I did not know why people were bothering to keep me alive but consented feeling as though I may as well give it a go. (Although, my consent was not necessary as I was section under the MHA.)

It was quite bizarre to be offered it, I had horrendous images of old movies where you’d see the patient’s brain electrocuted and they’d have a violent fit but I was reassured I would have an anaesthetic and muscle relaxant to reduce jerking. It was still hard to understand I was agreeing to my brain being zapped.

After each treatment I would feel muzzy and a bit dazed for the rest of the day but compared to the severity of the symptoms of my illness, this was manageable. I was initially given bilateral ECT we saw a slight improvement in my mood but I was getting severe headaches so we continued with unilateral ECT for 12 more sessions until my mood improved enough for me to engage in psychotherapy.

Long term, I have lost a few chucks of memory but this happens with severe mental illnesses anyway so who’s so say it’s due to the ECT? Without it, I’m in no doubt my suicidal behaviour would have continued and probably ended my life so it truly was a life saving treatment.

Conclusion

ECT should not be given lightly. It is a serious treatment for a serious illness. There are side effects, just like there are for any treatment but since it is reserved for the most seriously ill who’s lives are at risk already the benefits by far outweigh the risks.

If you or someone you care for is offered ECT you will have gone through numerous other treatments unsuccessfully which can lead to feelings of helplessness and hopelessness. ECT is an unusual treatment that can offer hope.

Useful links:

NICE guidelines

Royal College of Psychiatrists

Mayo Clinic

Restrained or calmed by chemicals or clothing?

TW – trigger warning, images and themes of this blog may cause distress to some people.

Imagine the chemicals in your brain are telling you to behave in certain ways that are either unsafe to you or unsafe to other people…

Imagine you become so unwell, you lose awareness that your thoughts, actions and behaviours are out of character, you lack insight. How would you want to be treated?

The Mental Health Act can be used to detain someone for assessment or treatment of a mental disorder if they or others are at risk.

Mental illness does not discriminate, just because you come from a certain background or have a high flying job or “perfect life”, mental illness can strike anyone at any time.

Image result for mental illness uncontrollable

When I became so unwell I was convinced killing myself was the only solution to my problems, I was behaving in ways that put my life at risk and was detained (under the mental health act) first by police in a cell and then by mental health professionals in hospital.

I was then forced to take medication, have electro-convulsive therapy (ECT) and engage with psychotherapy. All these combined with time and a safe place to stay enabled me to find my way out of the black hole and recover enough insight to decide what was best for me to continue my road to full recovery.

Listening to an old podcast of All In The Mind, a BBC radio 4 programme, recently, I was struck by a discussion about strong clothing. Clothing used in the asylums (C.19th) to hold patients and comfort them. The garments were often quilted, very heavy and warm. A similar idea to the straight jacket, the clothing would restrict movement and prevent them from harming themselves, others or their environment.

Image result for strong clothing mental health images 

The guest on the programme went on to talk about a survey they’d carried out with a group of mental health service users, artists, historians and clinicians. They asked whether they would rather be restrained by drugs or by clothing. Apparently everyone said they’d rather be restrained by a garment except one service users who would prefer a padded room and one psychiatrist who said he’d prefer drugs (although it was not clear whether he would prefer to use drugs on his patients or whether he would prefer to be restrained by drugs if he was the patient).

This has had me thinking about how the mental health system has swayed so strongly towards drugs and what I would prefer.

Image result for mental health drugs

There’s no doubt, preventing someone from harming themselves is important, but if there are a number of options, surely we should think carefully about whether different options would suit different people.

Strong clothing came into being as doctors tried to avoid  the “revolting instruments of mechanical coercion” rejected by the “non-restraint” movement of the 1840s and ‘50s. They claimed they were something else entirely. It seems that in the 21st century physical restraint is seen as inhumane, truing instead to chemical restraint.

strait-jacket

Feeling safe is a fundamental human need. When I think about feeling safe, I’m in a familiar environment being held (embraced) by a familiar person. When unwell (physically or mentally) feeling safe becomes even more important. When very unwell, to be with people who can assess and treat you appropriately, it is most often necessary to be in an unfamiliar environment away from people we know and therefore feeling safe in others ways becomes more important.

comforted

Strong clothing, it appears, was used to calm patients and to help them feel held in safety. With the addition of restricting the unwanted harmful behaviour.

But for me, not being able to move is connected to feeling trapped and this is a bad feeling, not a safe feeling. I had nightmares as a child about being in  strait jacket! I have never been trapped anywhere but it’s a deep fear, no idea where it comes from!

I don’t think I would have found this strong clothing comforting.

Safety, while I was in hospital had to come from trusting the professionals around me and from some familiar routines (such as always getting up on time and getting dressed etc). Having visitors was also vital as some familiarity.

Some people see mental health wards as somewhere all the patients are “drugged up on meds”. This is not the case – there are some patients, perhaps suffering highly disturbing mania and delusions making them behave in dangerous ways who are given sedating medication (and it might take a while to get the dose balanced) but not everyone.


I’m not sure what I would have thought about a padded room. It certainly screams “asylum” and conjures up images of someone throwing themselves around in a “frenzy”. Dare I say, I think I would have found that helpful – I like the idea of getting rid of my pent up frustrations and energy. At times (when hearing voices in my head) I would bang my head against the wall, it would help, but I would end up with terrible bruises – surely (although, finding another way to manage my emotions in the long run) banging my head against a padded wall would have been helpful?!

As I gained some insight I knew my thoughts and behaviour were unhelpful but I was still finding it hard to control my actions. I remembering feeling the relief of taking medication that slowed down my racing thought and calmed my tense body. I rarely used it, only as a last resort but I remember the feeling vividly.

Drugs act on the brain, to alter chemicals to change how we feel. Strong clothing acts on the body to prevent harmful behaviour. Psychotherapy works on all 3 areas but it takes a long time!

Image result for thought feelings behaviour cycle

If you were unwell and lacking insight and immediate action was needed to prevent harm, what would you prefer?