I
write this having been inspired by attending the History of Mental Health
conference at Leeds Trinity University earlier this week. This was a joint venture between the British
Psychological Society’s History/Philosophy of Psychology Section and the
Critical Psychiatry Network. If you know
me or have followed my views in this blog, you’ll be aware that this is right
up my street! The observant among you
will notice it’s been a wee while since I’ve posted here - aside from being busy with uni work, I’ve also been
writing a few bits for OMQ Fitness & Wellness magazine - so this was the perfect
prompt for me to add some fresh material.
I hope you find it a good read.
A
key theme over the two day conference was that of the epistemology of mental
health: What constitutes knowledge?
Where and whom does it come from?
How is it developed? Who decides
which knowledge is good or best or right?
Given the theme of the event, a large proportion of the delegates would
argue that too much credence is given to the knowledge of ‘experts by training’
(psychiatrists and so forth) and not enough to ‘experts by experience’ (those
who have experienced mental health difficulties and their relatives &
friends). A very balanced view was given
by keynote speaker Gail Hornstein, who suggested no type of knowledge or expertise
is superior, but that the two need to become more integrated and be used
together, not separately, to best support people’s mental wellbeing.
This
notion of separation and fragmentation was another theme that cropped up a lot
in my mind over the course of the two days.
Fragmentation between those ‘with’ and ‘without’ mental health problems;
between ‘experts’ and ‘patients’; between the ethos of recovery and the
obsession with quantitative evidence that underpins funding for services and
research; between people’s actual experience of distress and psychiatry’s
explanation for it. I strongly believe
that if we can build a more unified, inclusive approach, we can in turn build a
stronger mental health system and ultimately a heathier, happier, more
productive society.
To
illustrate my thoughts, I first cast my mind back a fair few years, to when I
read The Psychopath Test by Jon
Ronson. In hindsight, this was probably
my very first taste of critical psychiatry.
I was struck by Ronson’s statement that he had been able to diagnose
himself with about 6 ‘mental disorders’ by reading the DSM. As far as I can remember, I didn’t do a great
deal of thinking about this fact at the time, but some years on I’ve become a
lot more familiar with this field, and my professional interests have become
somewhat consumed with addressing the over-pathologisation (yep, I think I made
a new word up) of human experience and mental distress.
One
of my favourite things about the conference was a section that encompassed
accounts of mental distress from a range of sources. A key message was that psychiatry’s
depictions of and explanations for mental ‘illnesses’ are often very different
from those that the individual can make sense of themselves. Related to this, another key point was that
making sense of distress is a process that can take many years, and sticking alabel on it therefore simply doesn’t work (at least not for the labelled
individual, or indeed their loved ones). A third key theme was the need to consider
mental distress on a case by case basis, because each occurrence of it is as
unique as each person who experiences it.
Putting someone in a category based on your perceptions of their
experience isn’t conducive to helping them recover, whereas supporting them to understand
their unique experience is.
To
further illustrate my thoughts, I turn to the words of Caitlin Jenkins, who at
the event presented her research on service users’ experiences of psychiatric
diagnosis, along with snippets of her own experience (she herself has received
more than her share of psychiatric diagnoses and treatments over the years). She noted there is a danger of seeing a person
as a series of notes, rather than as a person.
One of her participants spoke of how a diagnosis gives rise to a
particular treatment; if that treatment doesn’t work, another diagnosis is
given, and so on. This resonates with my
own concerns that psychiatry arbitrarily tries to fit people into boxes in a
way that doesn’t facilitate true insight into their experience or therefore how
to help them. This got me thinking about
something that’s crossed my mind on occasions before: what would a psychiatrist
have to say about me if they had the chance to observe my life or conduct an
assessment on me? I have a few ideas as
to how this might go, and present them here with alternative explanations from
my own viewpoint.
Lauren’s
mood has been variable over the last two weeks; she moves between being bright
in mood and full of energy to being low and withdrawn, sometimes within a
single day. These mood swings do not
appear to be related to any particular events but happen spontaneously. At time of writing, Lauren is experiencing a
depressive episode; she is staying at home more regularly than usual and
neglecting to partake in all of her usual activities. Previous to this she was showing signs of
mild mania; her lifestyle was somewhat chaotic and she presented as being
obsessed with completing as many different activities as possible within each
day.
I
often experience ups and downs in mood, sometimes to a greater extent than
others, but see that as a normal part of human experience and manage it
accordingly. Sometimes I do feel like my
changes in mood are happening for no particular reason, but I can usually
identify the causes in hindsight if not at the time. I’m quite self-aware as I
practice mindfulness, so can usually recognise my mood changes quite quickly
and look after myself well to keep on top of this. Over the last couple of years I’ve had ups
and downs with my physical health, which I seem to be getting better at
managing. I thrive on being really busy
and active and have realised that I tend to feel healthier physically as well
as mentally when I keep this up, so when I feel good I make the most of it by
doing as much as possible. I’m really
ambitious so not one to waste time!
However, it’s really important to recognise when I need to take things
down a notch. I recently had a spell of
feeling poorly for a few days and responded to my body telling me to take it
east by having a rest week. This meant I
did gentle exercise rather than my usual intense, structured training, and spent
the rest of my free time relaxing at home.
After a few days of this I felt much better and more myself.
Lauren
has been persistently non-concordant with her medication. She expresses paranoia and delusions that it
will be harmful to her and do no good, and that the whole mental health system
is one big conspiracy. Lauren becomes
highly argumentative when staff attempt to explain the benefits of her
treatment and why she needs it.
I
have no desire to take brain-altering drugs that will cause a multitude of
unpleasant and potentially harmful effects.
Ultimately, we don’t really understand exactly how these drugs work and
what their effects are on the body long-term.
There is no real difference between these drugs and illicit ones, except
that psychiatric meds have been packaged and marketed in a way that implies
they will fix some sort of problem or deficit, rather than as psychoactive substances
(which they are). Because I feel so
strongly about this, any discussion about psychiatric meds is likely to end up
quite heated; not least if someone is trying to get me to take them!
Lauren
has been very low in mood and withdrawn today.
She has refused to spend time with others and spent a lot of time
isolating herself in her room, doing nothing.
I
meditated a lot today, which made me feel very peaceful and at one with myself
and the world.
From
my experience working in a psychiatric hospital, I genuinely believe that my
fictional patient notes above are quite a realistic representation of what
might be written about me if I were unfortunate enough to be subjected to
this. The problem is that once you’re in
a mental health service, the system seems to be hell-bent on giving you a
diagnosis, and this is really difficult to shake. In Caitlin’s research I mentioned above, one
participant noted how a diagnosis is given, which gives rise to a particular type
of medical treatment, and when it doesn’t work, another diagnosis is applied,
along with a change in medication, and so on.
This resonates with me from my experience working in mental health,
where new diagnoses and medication combinations appear to be flung around in a
sometimes arbitrary, trial-and-error type of manner. In my fictional situation above, I can see how
my diagnosis might have changed to try and fit my presentation at each time,
perhaps from bipolar disorder to paranoid schizophrenia to major depression,
and no doubt over a number of years of ‘failed’ attempts at treatment and
defiance of the system probably ultimately some sort of ‘personality disorder’.
I’ve
talked before about how I feel that my determination to take good care of
myself has really helped me to stay mentally well. When I feel things are not going so well, I
take the time to understand why this is and work out a way of remedying
this. I am very fortunate that I have
always been able to do this with just myself and my friends & family for
support, but I am all too aware of the many people who need extra support from
mental health services to get well.
Unfortunately, the approach to mental health that has developed over the
years jumps straight to medical solutions, with room to explore and work
through distress being reserved for the lucky few that are able to access such
services, or a kind of bolt-on to medical treatment. At the conference that prompted me to write
this post, I was inspired by the story of a mum who had seen her son go through
acute psychosis, which she and he were helped through by support from SoteriaBradford. He had been prescribed a
variety of antipsychotics, none of which had relieved his distress, and the
thing that really started to help him was a therapeutic approach called Open
Dialogue, which he and his mum engaged with as a family. This is a long process that requires concerted
effort from therapist, patient and their families, but by engaging with this
process they were able to identify factors that had contributed to his
declining mental health, which ultimately supported him to come through the
psychosis. As a family they recognise
that this may return at some stage but are confident that by accepting it and
working with it rather than trying to force it to be silenced pharmaceutically,
they can cope when this occurs. Interestingly,
there was no major trauma leading to his illness, but a culmination of elements
of life and how he perceived them that took their toll.
The
point I’m really trying to make here, and the reason for the title of this
post, is that, simply, we are all human, and could do well to remember that
more often. In her talk at the History
of Mental Health conference, Gail Hornstein talked of how we’re always placing
ourselves and others into categories – patient or professional, expert by
experience or expert by training, those needing support or those offering it. In reality we all have various roles and
identities we fulfil and usually sit on a spectrum or fit within multiple
categories simultaneously – if we can embrace this, perhaps we can achieve more
than we would’ve done otherwise – for instance, Peer Support has become quite
buzzword in the mental health arena, yet it is a term reserved for a
relationship between patients and other patients. Why not apply peer support to the staff too? Surely they need support as much as those
they seek to help, both in terms of professional development and looking after
their own wellbeing? And, indeed, to
return to my original point about epistemology (where does knowledge come from?),
professionals could do well to accept that patients may be able to help them
too, and offer knowledge about their condition that no diagnostic label could
ever hope to shed light on.
Patient-centredness
is supposed to be at the heart of mental healthcare these days, yet still so
many people within services don’t feel listened to or supported effectively. As an example, those wanting to prioritise losing
weight or giving up smoking are often told “let’s get your mental health sorted
first”, rather than trusting that this person intuitively knows what they need
and may see improvements in their mental health as a result of working on their
own personal goals. Using this innate
personal knowledge in conjunction with, rather than in opposition to, the
knowledge of healthcare professionals, could be a powerful tool in helping people
to recover and master their own wellness in a holistic way. An anecdote from my own work comes to mind
here: I work as a Wellness Coach, supporting people to make lifestyle changes
around weight management, physical activity, smoking and alcohol. We recently had a client who the staff member
that initially spoke to believed needed intensive mental health support, as he
reported having used such services extensively in the past. On speaking with this person myself and
exploring in more depth what their priorities were, it turned out they felt
getting more active was exactly what they needed in order to improve both their
physical health and mental state. This sits
perfectly within my remit as a coach, whereas others might have pointed him in
the direction of a mental health service, not fully understanding what it was
that he wanted to achieve. After a few
weeks of working with him on some basic goal setting and action planning, he
was feeling much more positive, in control and ready to move on with this
healthier new lifestyle without ongoing support.
I
could talk about this forever, but I’m aware that I’ve already gone on a bit
and may be pushing my luck in terms of keeping or losing your attention! If you’ve read this far then thanks for
persevering. I just want to end by emphasising
my message that being human is a powerful thing, and I believe that by
nurturing this fact – by always bearing in mind that ourselves and others are,
simply, human, and relating to ourselves and each other as such (rather than as
categories, diagnoses and so on), then we can cultivate recovery, wellness,
happiness and achievement of our potential.
This can be far more powerful than what can be achieved by constantly
striving for the perfect labels to separate ourselves off into various
boxes. We are human, we can grow and
develop by understanding ourselves and being understood by others, we do have
the capacity to recover and heal from trauma, and we will build a happier and
healthier society by nurturing these qualities of humanity.
