“Madness is a full and legitimate human experience”

This is a quote from Mary O’Hagan, user of mental health services in New Zealand, and Mental Health Commissioner.She was the keynote speaker at last year’s Scottish Recovery Network conference.

Her speech was one of the best summaries of ‘recovery’ as it applies to mental ill health, mental wellbeing and service developments that I have heard for some time. Recovery has been a theme on this blog for a while- here and here for example. You can listen to it all below.

All the more important at a time when nearly all media portrayals of mental illness are negative and dangerous to others, according to this report.

And if you think that this stuff does not apply to you- then consider this- mental ill health comes to all of us directly or indirectly. And even if the shape of your life keeps periods of crisis at bay, then I would contend that we learn far more for the human condition through coming to an understanding of mental distress than we do from a lauding only of success.

For those of us of faith, the hope of recovery is saturated with that most precious thing-

grace…

The insatiable moon film trailer…

We were discussing a book by Mike Riddell that I loaned to our friend Pauline the other day- called ‘Sacred Journey’. It is a good book for those of us long on the road, and still trying to make sense of the spiritual nature of this life of ours.

And I remembered that one of Riddell’s other books, a novel, had recently been made into a film.

I went searching, and discovered the trailer…

I am trying to decide whether to read the book or wait for the film- anyone seen/read either?

It seems to be about the two issues closest to my heart- mental illness and God- and looks great.

Perhaps need to wait for it to be released on DVD, I can’t imagine it coming to our local flea pit…

Recovery stories, and how we understand mental ill health…

I have been reading a few of the personal stories on the SRN website, and it set me thinking again about this thing called mental illness.

For those who are unaware of the powerful and life giving concept of ‘recovery’- in this use, is applies to a way of understanding mental illness that is radical and yet very simple. For too long, the dominant way of understanding mental illness has been through a medical paradigm-

Dysfuntion——————–Diagnosis———————Treatment

But for years, there have been voices saying that this way of seeing mental illness just does not work on any level.

Dysfunction?

What is ‘dysfunction’ when we apply it to mental health? We all have problems. We all have fluctuating mental health. One in four of us seek medical help because of this at some point of our lives. For the most part- we just get on with it, life goes on.

It is such a subjective experience. What you experience and cope with, I might experience and not cope with.

It might relate to a dreadful life event, like bereavement, or it might be because of vulnerabilities that we have carried since childhood. It also might have a biological/genetic element- although no-one has ever been able to agree how much of our vulnerability is nature, and how much is nurture. Because of this, the same ‘dysfunction’ may in fact relate to very different issues.

But there is no doubt that many of us do hit the rocks emotionally, psychologically and spiritually. Some of us will need help, so we go to the experts.

Diagnosis

Then we come to all the labels that psychiatry has come up with in an attempt to categorise dysfunction. Each one with its own set of sub categories- some examples below:

Schizophrenia (simple, paranoid, hebefrenic, etc)

Depression (reactive, chronic, manic, agitated etc)

Anxiety disorder (panic disorder, phobia, obsessive compulsive disorder etc)

Now all of these categories have a set of symptoms that we look for, and even (in today’s parlance) a ‘care pathway’ that people will then be expected to follow- with recognised assessment processes and evidence based interventions lined up and ready.

But make no mistake- researchers have looked in vain for a virus, or a brain-wiring fault, or any kind of identifiable physical, testable, observable location for these disorders. They are not like a broken leg, or a cancer, or other kinds of medical issue that are diagnosed according to observable scientific observation. Rather they are always nuanced, individualistic, mixed in with all sorts of personality/life experience/drug use stuff, and all that messy, unquantifiable humanity.

So what we have is a changing picture (we currently use international standard diagnostic classification version 10) of fairly loose observationally based, subjective categories, albeit applied as consistently as possible by highly trained and experienced doctors. The edges of the diagnostic categories are blurred, and their usefulness still much disputed.

Check out this decent summary of labelling theory.

Treatment

When we have our diagnosis, then we have associated treatments- usually drug based, intially from our GP. Sure there are lots of other ways of getting help- often called rather condescendingly ‘talking treatments’- counselling, psychological therapy etc, but these are not universally available, and the middle classes get far more than their fair share. Also because of the dominance of the medical model (which assumes some kind of biological basis for serious mental illnesses like schizophrenia) then most of this talking stuff is aimed at people who are regarded as ‘neurotic‘- as if these people are some how totally different in their needs to be listened to, understood and helped towards a greater self knowledge and self worth.

Most of the drug treatments are very ‘dirty’- in the sense that they are loaded with extremely debilitating side effects. The activity of the drug companies, and the power and position the system allows them to take within hospitals has to be seen to be believed. There is always a new wonder drug just round the corner- a new ‘lilly the pink’.

And yet, research would suggest that ‘getting better’ is not the goal of all this treatment for many of us. Rather it is aimed at alleviating some of our symptoms, and ‘maintaining’ us in some kind of stasis.

For some, this is OK- they are grateful and satisfied. For many more, the effect of the psycho-medical machine is to give a half life, or even a no-life. People lose just about everything- job, relationships, income, role, self worth, self determination, hope. Is there any wonder then that suicide rates are so high?

At the same time as experiencing all these losses people gain a few other things- a label, a new ‘sick’ role, benefits that have diminished in value in real terms. It is a poor exchange. Because in gaining this kind of identity- or rather being expected to live within the boundaries of this kind of identity- we are condemned to a dependent life. And transcending this can be extremely difficult.

Perhaps it might be far more difficult than the mental distress that started us down this road in the first place…

So, returning to the recovery stories.

These are records of people who have decided that it is possible to experience good mental wellbeing despite the presence (or the absence) of mental ill health.

They describe the landmarks on the journey towards a different kind of recovery- one that is less concerned with diagnosis or treatment, and much more motivated towards real life issues like

Hope

Self worth.

Real choice.

Friendship.

Meaningful activities.

Fun.

Please read some of them- because I suspect that there is more of the Kingdom of God in one of these stories than in a thousand sermons.

Reflecting on the losing of humanity…

Thank the good Lord for Friday. It has been another long hard week.

Regular readers and friends will know that I earn a living by working as a mental health social worker- for around 20 years now. Or to be honest, these days I do not do a lot of social work (although I still practice as a Mental Health Officer)- I do this other thing called ‘management’.  Some days I am not sure how much longer I can do it.

What has allowed me to survive so long working within a large bureaucratic institution has been two things- firstly the need to provide for my family, and secondly the hope that I might be able to genuinely make a difference to the lives of the people I work with. In management, it is possible to fulfil the first, but the second- well the evidence is not as strong.

Being in contact with people in the extremes of distress and crisis on a daily basis does something to you. It is impossible to stay as emotionally engaged as we do when we first begin these encounters. The best of my colleagues hold on to their compassion however- we nurture it by making it shape our language, our small talk and the way we treat everyone we come across. We have learnt that kindness in the small things, despite terrible external circumstances, can indeed make a difference.

And sometimes that is the only thing we have to offer.

Images by Fred Kleinberg

In the course of my work, I come across people who have done terrible things. People who others would say have lost all sense of humanity.

People who have harmed children, or killed and dismembered people.

Others who have locked themselves away (or been locked away) and have lost or forgotten almost all basic skills of human interaction.

Perhaps most striking is watching people slowly destroyed by addiction. To see them in the later stages of this- near to death- and wonder what incredible life force keeps a person alive when skin is bright jaundice-yellow and all organs are playing discords.

Sometimes it seems that almost all that makes us human is gone.

Almost- but not all.

Because in all of these people, despite their brokenness, what is left- what is most visible, is… their humanity.

Unhidden, undefended, right on the surface like an open flesh wound.

And should we lose sight of this, the danger is that it is not their humanity that will be at risk- but rather our own.

I wrote this in response to a recent event…

Deep in the soup and the stew of him

In the ooze and glisten of his grey matter

Some synapses spark and flicker

Sending out electro-chemical dots and dashes

.

And he- wired almost to breaking point

Is all strung out

Senses dulled

But deadly receptive

.

So bone becomes knuckle

Muscles turn to gristle

And poisoned sinew moves like a snake

Ready to strike

.

Later some said he was evil

That some dark thing was in him

Others called him mad

A flesh machine gone wrong

.

Still others bayed for his blood

-as if enough had not been spilt already

They want eyes put out for the eyes he closed

And every broken tooth smashed in return

.

Me, I stand over a stain in an old carpet

Through which something human has fallen

And feel a little of myself

Drain away

Hope for recovery…

I spent an afternoon meeting with some people who came together to discuss the establishment of a Recovery Network for people who have experienced mental ill health in Argyll.

The Recovery movement is one of the most exciting things to happen within the mental health world for years. It is a grass roots movement, turning the power relationships in psychiatry upside down. It’s persuasive idea is that we need to stop doing what we are doing, because it is not working- rather we need to equip, empower and inspire people towards control of their own choices and decisions towards building real and meaningful lives.

I was reminded again yesterday of the word HOPE.

Because recovery does not depend on the presence or absence of illness- for most people mental health ebbs and flows. For some of us, this ebbing and flowing can be more severe.

But recovery very much depends on the presence or absence of HOPE.

And where hope is being raised, it makes visible to me a kind of humanity that make clear that we are beautiful creatures, made a little lower than the angels.

But let us make no mistake- hope is a dangerous and scary word. It contains all possibilities, but also the danger of disaster and failure. It is something that we need to hold on to firmly but tenderly, like a bottle of nitro-glycerine.

And we need to acknowledge that for many, there is a recovery journey that begins first in daring to use the word again…

Here is a little more Foy Vance-

If theres one thing that I know
It is the 2 shades of hope
One the enlightening soul
And the other is more like a hangman’s rope
Well it’s true you may reap what you sow
But not that despair is the all time low
Baby, hope deals the hardest blows

There was once someone I loved
Whose heart overflowed his cup
And his shoes got covered in blood
Oh but he never knew cos he only looked up
Well he was in trouble and so
Had known pain more than most I know
Yet it was hope that dealt the hardest blows

And the girl that holds the hand
Of her somewhat distant man
Though she did everything she can
Still his heart set sail for distant lands
And she wonders sometimes if he knows
How she feels like a trampled rose
Baby, hope deals the hardest blows

Well some people think their sin
Caused the cancer thats eating into them
And the only way that they can win
Is by the healing of somebody’s hands on their skin and praying
But when the cancer does not go
Baby, hope dealt the hardest blows

And now all these truths are so
With foundations below them
They were dug out in a winter’s cold
When the world stole our young and preyed on the old, well
Hope deals in the hardest blows
Yet I cannot help myself but hope

I guess that’s why love hurts
And heartache stings
And despair is never worse
Than the despair that death brings
But hope deals the hardest blows, dear
The hardest
Hope deals the hardest blows

Making recovery real…

To Oban today to a Scottish Recovery Network conference on the promotion of ‘recovery’ as a concept and driver for mental health services, and more importantly, for those of us who experience mental ill health.

It snowed, and so we were a bit worried about the drive, but in the end Audrey, Victoria and I got there and back with no trouble.

The challenge and critique brought to services by the change of thinking and shifts in power required to move towards a recovery based system (rather than an illness based system) has been the stuff of my working life for a while now. I have found that it has had the capacity to reignite my passion for the work that I do.

I have spoken about recovery before- here and here, but for those who have not come across the concept before, here is the definition from the SRN website-

“Recovery is being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms. It is about having control over and input into your own life. Each individual’s recovery, like his or her experience of the mental health problems or illness, is a unique and deeply personal process.”

It is about trying to stop expecting people to fit into hierarchical burearocratic structures, but rather shifting power from the institution to the individual. It is about creating opportunities for people to rediscover hope, and to re imagine what a fuller life might look like.

You could say that it is about the redemption business- the Jesus business. And where he is, I want to be near.

But lest you think that I am doing that familiar paid helper thing, and dividing the world into us (the professionals) and you (the recipients of our expertise) then let me confess that I too am in a process of recovery.

Or should I say sometimes I am.

Because we were asked today to consider what might contribute to our own ‘wellness’, and people gave the usual answers- love, relationships, long walks in the country, meaningful activity, meditation and rich ruby wine… But I was led once again to reflect on my own mercurial sense of wellbeing, and how fragile it was at times.

Because sometimes it seems as though I am merely a victim to unfolding circumstance. Things happen, and I have little control over them, nor my emotional reaction to them. Of course, this is not true. There are lots of things I do, or avoid doing that make me who I am.

It is perhaps more like one of those slow unfolding accidents, that give you chance to react and minimise the inevitable impact- which is nonetheless still painful and shocking.

Of course there is such blessing in this journey of mine too- and I am so grateful that I do not walk alone.

So by way of celebrating these continuing outbreaks of redemption, almost in spite of my own ability to miss them- I offer you this lovely poem by Gerard Manley Hopkins-

As kingfishers catch fire, dragonflies draw flame;
As tumbled over rim in roundy wells
Stones ring; like each tucked string tells, each hung bell’s
Bow swung finds tongue to fling out broad its name;
Each mortal thing does one thing and the same:
Deals out that being indoors each one dwells;
Selves—goes itself; myself it speaks and spells,
Crying What I do is me: for that I came.
I say more: the just man justices;
Keeps grace: that keeps all his goings graces;
Acts in God’s eye what in God’s eye he is—
Christ—for Christ plays in ten thousand places,
Lovely in limbs, and lovely in eyes not his
To the Father through the features of men’s faces.

Asylums, churches, and the retreat of the institution…

I was in Lochgilphead today, with a series of meetings- including one at Argyll and Bute hospital. The building dates from 1862, and is one of the very few Victorian ‘lunatic asylums’ still in use today.

Lovely old building it might be, but it is a total anachronism. Built to house hundreds of patients from all over this area, only a handful of the original wards are still open, whilst the cost of maintaining the structure eats away at resources desperately needed by community services more fitted to present day understanding of treatment and support of people experiencing mental ill health. It is hoped that a new purpose built facility will (hopefully) replace it soon…

It stopped raining today, and I decided to take the camera into the woods at lunchtime.

I walked into a forest that until recently was managed by a woodland project run by patients from the hospital. The project has lost it’s funding now, as patient numbers have dwindled, and as segregated projects like this are now regarded as a potential obstacle to recovery, as they are not supportive of integration back into the community.

It was lovely though…

The subject I was chewing on as I walked, was the huge change that this areas has seen. The hospital was built as a means of providing what was regarded as much needed humane treatment of ‘lunatics’ and ‘idiots’. These very terms are now insulting and offensive, but at the time the hospital was progressive, impressive and planned to ‘scientific’ principles.

Even the trees I walked in were planted as a means of sheltering (or perhaps hiding) the hospital.

Evidence of the attempts to use the forest as a resource were everywhere- the notices describing different trees, the carvings, the rough wooden tables- and this…

I think it was built to make the best of a view, but in effect, it stands as a temporary monument to a rather meaningless industry.

A bridge into nowhere.

The people that made it are no longer in the hospital. I hope and pray their lives are rich and meaningful, and that the time spent working in these woods is a happy memory. But the fact is, such forms of occupational therapy are no longer part of common psychiatric practice.

And I thought of that other late Victorian institution that I am so familiar with- the modern protestant church. The buildings that were the places of the Protestant institutions still adorn all of our towns and cities- many are lovely too. Most of them are just as empty as this old hospital.

The parallels are pretty obvious. What both offered was good- perhaps even the best of what was possible in their day. They were raised with such energy and optimism. They changed the landscape of their times.

But as time passed, the rituals and routines that they followed became less and less in tune with the wider world. In some case, it was even toxic- what started off as an enclave of hope, became a backwater, where lives stagnated. Escaping such situations can be so very hard…

And what industry there is continued to look towards the institution. It was contained within the stone walls and the boundary fences.

And bridges were built to nowhere.

There will be a new hospital soon, which will not be perfect- there will be more compromises, more challenges- but we hope that the focus will shift to outside these old stone walls and into our homes and houses- where real lives are situated.

I kind of hope the same for church…