Tag Archives: mental illness

Holy Discommunion…

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After Lament

During my recent silent retreat, I found myself writing some odd things.

I was thinking about the nature of the Communion/Eucharist/Mass. This was triggered in part by an encounter with the centrality of the Mass within the Catholic church. Rightly so of course- it is one of the few specific things that Jesus told us to do- when you meet, do this in rememberence of me.

For many of my brothers and sisters the Mass is a place of mystical exchange. It has power that must be mediated through the ministry of Priests- and the exclusion of those outside the boundaries of the church. Having said that, many Catholics bemoan some of the power stuff that has attached itself to the church, and there is a long tradition of openness, generosity that warms my heart.

However, at one of the celebrations of mass that I attended recently, a Priest said something like this- “Each time we take this bread and this wine, it is doing its work of salvation within us.” I found myself in a place of divergence.

And I started to think about that final meal in the upper room- Jesus looking around at his closest friends, holding them in his heart, longing for them to get it. Get that it does not get any better than this- friends who laugh and love and share life together. Friends who take the stuff of their humanity- their bodies, their life blood, and lay it out for one another. And how Jesus knew that he would soon be gone. That a place at the table would be empty. How his heart must have ached.

Then I started to think about all those people who do not get to share a table like this- ever. All those people who life has broken and split off to live a kind of discommunion. Unmass. Nocharist.

And I suddenly felt a grief that our communal remembering of who Jesus was could ever become exclusive.

And I wrote this;

Holy Communion

.

Make me a mass from the broken bread

Of the schizoid on ward C

And for wine there’s a pool of Rogers blood

After suicide number three

.

And mix me some bread from the words he said

To Carrie when she was nine

The secret stains that drip from her

Will do for communion wine

.

Tear me a piece of the angry bread

Of Leroy on ICU

It took three nurses to inject his wine

They’ll need more before he’s through

.

Bake me bread in the boozers head

His clothes they sure do stink

Instead of wine have the turpentine

That was all he could find to drink

.

These are the holy broken ones

Gone soon and not much missed

From the first and the last of the least of these

We make our Eucharist

15 minutes of grace…

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I listened to this today, and it made me cry.

There was a story told by a woman who returned to the mental hospital secure ward where she had been incarcerated years before. The building was being demolished and she was there to take photographs. But walking into the building she could hear the noises of people shouting and screaming, and she could remember feeling so dreadful whilst she was there that she broke both arms by smashing them into the wall in the hope that they would have to take her somewhere else. She cried as she remembered the dead butterflies she saw on the floor of the empty ward, and could only bring herself to take photographs with all the heavy locked doors wide open.

But there were also lots of other stories of people who found their own healing- their own recovery.

It is 15 minutes long, but full of beauty. Go on, have a listen.

Miliband takes on mental illness…

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So, Ed Miliband is to tackle the Stigma of mental illness in his next speech, according to the Guardian. Good for him, although he seems to be choosing some rather soft celebrity hate figures to take a swipe at in order to give his speech some punch- Jeremy Clarkson and Janet Street Porter;

With the cost of mental illness to the NHS believed to be around £10bn, Miliband will announce he has set up a taskforce – led by Stephen O’Brien, the chairman of Barts Health NHS Trust and vice-president of Business in the Community – to draw up a strategic plan for mental health in society, in the hope that the next Labour government can begin work immediately on implementing reform.

He will also say that attitudes in society need to change, criticising “lazy caricatures” of people with mental health problems and highlighting recent comments by Clarkson and Street-Porter.

He will say: “There are still people who abuse the privilege of their celebrity to insult, demean and belittle others, such as when Janet Street-Porter says that depression is ‘the latest must-have accessory’ promoted by the ‘misery movement’.

“Jeremy Clarkson at least acknowledges the tragedy of people who end their own life but then goes on to dismisses them as ‘Johnny Suicides’ whose bodies should be left on train tracks rather than delay journeys.

“Just as we joined the fight against racism, against sexism and against homophobia, so we should join the fight against this form of intolerance. It is not acceptable, it costs Britain dear, and it has to change.”

Whilst I welcome the initiative- I feel slightly skeptical about the outcome, even before it begins. I hope I am wrong, but the problem faced by any such review (particularly one led by someone embedded in the NHS) is that its conclusions are inevitably shaped by the set of lens through which we look at the ‘problem’.

It reminds me a little of theology- we inherit a set of beliefs about who or what God is based on our culture, denomination and hermeneutic. These things are useful, valuable, even essential for a while- they are vehicles through which the Spirit travels. But there can come a point when they obscure, restrict, oppress and close down our understandings. For example, if our theology is based on a flat earth created in 6 days a few thousand years ago, then something has to give when we are confronted with the expanding universe.

The mental illness machine is not working.

I say this not in disrespect of the many wonderful people working within the system, but there comes a time when we have to see the machine for what it is- something that more often than not sucks people in, strips them of who they used to be, and replaces this with a new set of roles- patient, schizophrenic, lunatic, depressive, manipulative, unemployable, benefit scrounger.

Then there is the role played by the pharmaceutical companies, competing to push the next wonder drug, and employing a thousand drug reps to flood doctors, nurses and even social workers with half truths about their new product using everything from free toys (pens, flasks, binoculars) to free meals and holidays. The wonder drugs each turn out to be versions of what has gone before- no Lilly the Pink, just more chemical suspended animation to hold people in half lives.

A few months ago I wrote a piece reflecting on the monster that is the new  American Psychiatric Association  Dignostic and Statistical Manual of Psychiatric Disorders, otherwise known as DSM 5. In this, I wrote of my own hopes for change in the system along these lines;

Away from ‘illness’ towards an understanding that all forms of mental illness are caused by mental ‘distress’

Away from ‘symptoms’ towards understanding that we develop different  means of coping with this distress.

Away from restrictive labels towards listening to individual experience.

Away from medicalised interventions, towards encouragement and support of individual recovery.

Away from simplistic distinctions between ‘psychosis’ and ‘neurosis’ towards a greater interest and understanding of the effect of trauma.

Away from segregation and ‘otherness’ towards seeing mental distress as an essential part of the human experience and as such, part of all of our experiences.

Away from ‘maintenance’ (which is a form of medicalised slavery) towards hope.

If Ed can gather some real radicalism from his up coming review, I really hope it will contain some of these ideas.

Is it time to change our whole approach towards mental distress?

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In May, the American Psychiatric Association will publish the fifth edition of the Dignostic and Statistical Manual of Psychiatric Disorders, otherwise known as DSM 5. Although originating in the USA, this publication is immensely influential, and is likely to form the basis for Psychiatric diagnosis the world over, as with the out going DSM 4.

Does it matter?

Well, the answer to this is YES. It matters on an individual level because all of us will be affected by mental disorder. One in four of us will be diagnosed according to one of the classifications above, so even if this is not you it will be someone you love or someone you work with. Lots of us feel a strange relief when distress is given a name – it suggests understanding, companionship, a removal of uncertainty and the possibility of treatment. However, for many these can easily become self perpetuating and destructive as they may have the effect removing responsibility, ownership and even hope, which some never find again.

It matters too on a sociological level. Our societies are increasingly regulated by psychiatry. We medicalise, medicate and plan ‘evidence based interventions’ into all sorts of human variation. This may simply amount to the application of science and knowledge to the alleviation of mental illness, but the question is whether this is ‘healthy’? Are we seeking to make a world in which the mess and gristle of life is edited out, tidied away, chemically suppressed? And is it working?

Psychiatric classification almost always demands treatment, so step forward the drug companies, with another product to push by fair means or foul. All those countless drug rep funded lunches, gadgets, even holidays, in the name of publicity for the next wonder drug. Even if the drugs do half of what they promise there is no doubt that our population is increasingly medicated. This from here;

Prescription Pricing Authority data shows that more than 30 million prescriptions for SSRIs (selective serotonin reuptake inhibitors) such as Prozac and Seroxat, are now issued per year, twice as many as the early 1990s. Researchers at the University of Southampton found 90 per cent of people diagnosed with depression are now taking SSRIs either continuously or as repeated courses over several years.

Professor Kendrick adds: “Our previous research found that although these drugs are said not to be addictive, many patients found it difficult to come off them, due to withdrawal symptoms including anxiety. Many wanted more help from their GP to come off the drugs. We don’t know how many really need them and whether long-term use is harmful. This has similarities to the situation with Valium in the past.”

Unsurprisingly, there is evidence that the current economic recession is also having an effect. This from the Telegraph;

The number of prescriptions for drugs such as Prozac has risen from 16 million to 23 million since 2006 with many GPs saying patients are increasingly expressing concern about the recession.

Figures obtained by the BBC under the Freedom of Information Act found the number of prescriptions for the most common group of antidepressants rose by 43 per cent during the period covering the banking crisis and housing crash.

If we can agree that in terms of practice, prescription and intervention psychiatry is increasingly involved in our lives, then the emergence of a new set of diagnostic criteria must be a considerable significance to all of us. We should also know then that this classification process, already controversial, is in the middle of a storm of criticism following the release of advance details of the new DSM 5.

Firstly, what could be regarded as the ‘tabloid headlines’. This from here;

Bereavement, which has always been excluded from the mood disorders, will become a mental disorder. Mild forgetfulness will become a mental disorder (“mild neurocognitive disorder”). Your child’s temper tantrums will become a mental disorder (“disruptive mood dysregulation disorder”). Even preferring one of your parents to the other will become a mental disorder! (Yes, really: “parental alienation disorder”).

You will need to display fewer and fewer symptoms to get labeled with certain disorders, for exampleAttention Deficit Disorder and Generalized Anxiety Disorder. Children will have more and more mental disorder labels available to pin on them.  These are clearly boons to the mental health industry but are they legitimate additions to the manual that mental health professionals use to diagnose their clients?

You can listen to a short Radio 4 Today Programme debate on some of these issues between David Kupfer who chairs the DSM 5 committee for the American Psychiatric Association, and Peter Kinderman, professor and honorary Consultant Clinical Psychologist with Mersey Care NHS Trust about this between on this link.

Then there is the murky world of classification of ‘personality disorders’. Many people regard these as the ultimate examples of how abstract description of patterns of behaviour can become viewed as some kind of unassailable concrete ‘illness’, which then take on a reality in the same way as we might understand influenza or cancer.

DSM 5 complicates this further by adding more categories, for example “Apathy Syndrome,” “Internet Addiction Disorder,” and “Parental Alienation Syndrome”. This has raised so much concern that the American Psychological Association has begun an on line petition to allow people to express their concerns. This from here;

It is particularly concerning that a member of the Personality Disorders Workgroup has publicly described the proposals as “a disappointing and confusing mixture of innovation and preservation of the status quo that is inconsistent, lacks coherence, is impractical, and, in places, is incompatible with empirical facts” (Livesley, 2010), and that, similarly, Chair of DSM-III Task Force Robert Spitzer has stated that, of all of the problematic proposals, “Probably the most problematic is the revision of personality disorders, where they’ve made major changes; and the changes are not all supported by any empirical basis.”

How about this side of the Atlantic? This from the British Psychological Society (not renowned as a radical organisation) response to the consultation;

The Society is concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation. (p.1)

We believe that classifying these problems as ‘illnesses’ misses the relational context of problems and the undeniable social causation of many such problems. For psychologists, our well-being and mental health stem from our frameworks of understanding of the world, frameworks which are themselves the product of the experiences and learning through our lives. (p.4)

These comments go to the very heart of how we approach mental distress.

The Hearing Voices Network have been making a case for change for many years. Psychiatrist Marius Romme for example claimed that many people who hallucinate “are like homosexuals in the 1950s — in need of liberation, not cure.”

There is a change underway, akin to that of other great liberation movements and I believe that when we see chains on people it should be the intention and hope of the followers of Jesus to seek to break them. What is unfortunate is that the classification found in DSM5 do little to break chains. If anything DSM5 might yet forge new ones and as such, we should resist…

How might they be broken then? Here is my reading of (and my hope for) some of the changes;

Away from ‘illness’ towards ‘distress’

Away from ‘symptoms’ towards understanding that we develop different  means of coping with this distress.

Away from restrictive labels towards listening to individual experience.

Away from medicalised interventions, towards encouragement and support of individual recovery.

Away from simplistic distinctions between ‘psychosis’ and ‘neurosis’ towards a greater interest and understanding of the effect of trauma.

Away from segregation and ‘otherness’ towards seeing mental distress as an essential part of the human experience and as such, part of all of our experiences.

Away from ‘maintenance’ towards, hope.

Square world…

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I went for a meeting today in a posh new hospital. Everything squeaked as if in disapproval of my polluting presence.

I was there to chair a meeting about one of the patients, who had been transferred there recently to receive more specialist care. She had previously spent most of the last 40 years of her life as a resident of the local psychiatric hospital. Things went wrong after the death of her husband, and she somehow lost herself in the grief of it all. The whole range of psychiatric science was rolled out for her benefit – drugs that greyed her vision, Electric Shock Therapy that blew holes in her memory then finally psycho surgery in an attempt to cut grief out of her brain with a scalpel.

And here she remains – toothless, but given to scratching. Occasionally abusive but still with sense of humour intact.

She used to be a worker, a wife, a mother. She used to go on picnics and loved to dance. She enjoyed holidays and gossiped with her friends about the comings and goings of the village.

But that was 40 years ago.

Today we met to discuss her future care – a likely move to a specialist nursing home, and the legal issues around that given her lack of capacity to understand or to give consent.

But in the middle of this, she looked at the ceiling and said;

I hate those squares. Everything is square in here. Put me outside next to the beech hedge. Just put me outside.

And I looked out at the brown beech hedge, with dry leaves still rattling on the close cropped branches.

Through the square window.

And I wanted to wheel her out there, and sit her under the winter sky, wind waving her long grey hair in a curve of protest against all those bloody awful squares.

The end of an old asylum…

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Argyll and Bute hospital is at the end of its useful life. Soon it will be ‘reprovisioned’.

Hanging in the old reception area is a painting of the hospital from what I imagine is about 100 years ago. It shows a rear view of the hospital, at a time when it was a permanent home for hundreds of patients. If they could only tell their stories. I assume the painting was done by a patient at the hospital- it has a naive feel about it that is very affecting.

I took my camera today and took some shots between meetings. I wanted to record something of a visual monument to one of the last of a breed of failed social/medical experiments known as the ‘asylum’. By any measure, it was a desperately failed experiment. In the name of humanitarian treatment of the mentally ill, we removed people from society, and warehoused them in institutions. Even when these were well run (and the stories of abuse that was handed out by some staff are appalling) then the end result was that people were lost. They stopped being brothers, sisters, children, bakers, lovers- and became- patients.

Here are some of the shots (click to enlarge.)

“Madness is a full and legitimate human experience”

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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…
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The insatiable moon film trailer…

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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…

Vodpod videos no longer available.

Recovery stories, and how we understand mental ill health…

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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.