Tickets to The Show

Are you a pointer? A giggler?
Earnest whisperer?
Do you put on your faux plastic frown?
Head shaker? Face maker?
Picture taker?
Is your smartphone recording the “clown”?

YouTube the “nutter”?
A “funny” video?
Let the world enjoy, the High Street attraction.
Do you know of them?
Or care about them?
For you to place ridicule, above your compassion.

They could easily be you,
You, easily them.
A broken world spinning around in your head,
Needing of care
Without ridicule
More, the compassion of society instead.

Care for the person inside,
Traversing their mind,
Turning corners and resorting to the dance.
Take your soft hands to theirs,
To impart your care,
To understand, and then ignore their circumstance.

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Mental Health: Obsessive-Compulsive Disorder

I think most people will have their own number. Mine is three: most miles away from home that is, before I’ve had to turn the car around to check whether I had locked the front door and turned off the cooker. I have done it many times, though it is still thankfully rare, and usually only when leaving home for several days, and to be honest, usually at the behest of my wife, which I laughingly, dutifully do, while secretly beginning to doubt myself. That intrusive ‘have I or haven’t I’ thought and the infuriating compulsion to drive back home to check is essentially the topic I want to discuss. Obsessive-Compulsive Disorder (OCD) isn’t a simple matter of that uncomfortable insecurity we all get from time to time over the ‘did I, or didn’t I’ that we probably all occasionally feel, but it is at least a similar mechanism. However similarity ends there because OCD can be a crippling treadmill of terrible obsession and irresistible, unreasonable, repeated compulsions used as a means of controlling obsession. Those unbidden thoughts, urges or mental pictures can range from a terrible fear of germs, to insistent urges to do themselves or others harm and/or terrible images that pop into the unguarded mind. Again and again an obsession impales the sufferer leading to their compulsive responses, often as a repetitive action, such as repeated hand washing, in an effort to drive away a germ obsession. Yet, the compulsions can ruin a life just as surely as the unwanted obsessions, with increasingly intricate routines dominating the day.

Hollywood loves OCD for its superficially comedic rituals such as in “As good as it gets” where Jack Nicholson’s Melvin Udall in spite of his condition finds love in the shape of Helen Hunt, whilst undergoing a miraculous transformation during the course of the movie. Entertaining though the movie is with fine performances all round (7.7 on IMDB!), Melvin is miles away from the experience of real sufferers. Treatment and recovery is usually a long and bumpy road. Whilst medication can be prescribed, particularly for the depression that can be concomitant with OCD, in the majority of cases the most common and the most effective treatment is Cognitive Behavioural Therapy (CBT).

Though the symptoms will commonly come on slowly usually a pre-teens child or as a young adult, a psychosocial accelerant such as the stress brought on by traumatic life episodes may result in an almost sudden appearance of the condition. Whether the condition appears slowly or suddenly, the first step for all sufferers is to have OCD diagnosed, which in itself can be tough as the condition can be very difficult to pin down, with similarities between OCD and other mental health conditions, such as obsessive-compulsive personality disorder, anxiety disorders, etc. Added to that, many may at first be reluctant to discuss the full panoply of their symptoms, feeling shame and embarrassment at their rituals, and finally the usual societal stigmas attached to any mental illness, particularly here with what can be a very visual, very obvious condition. So access to a simple diagnosis can be a problem.

However, once diagnosis has been secured, a treatment plan will be put into place. It’s important to say, right away, that a complete cure of the condition may not be possible for everyone, and in fact is rare. Some seventy percent of sufferers will have to spend the rest of their lives sporadically in some form of treatment: though with greatly diminished symptoms and only episodic returns to their worst case scenarios. Before a sufferer can reach that relative peace they will typically have a course of CBT, or more precisely, a course of CBT with Exposure and Response Prevention therapy (ERP). In CBT the sufferer is essentially taught to recognise their anxiety, producing obsessions, and to change them at source, so to speak. The intrusive thoughts cannot be blocked, or stopped as we all have them. It is the perception of those thoughts that go awry in OCD and it is this perception that CBT seeks to change. The special process of ERP is where the usual response to the rising anxiety of an OCD trigger is deliberately not engaged. What this means in practise is that the compulsive behaviour is explicitly removed. This isn’t a step that is taken right at the start of ERP, but rather after much work is done to identify how the sufferer sees their compulsions as helping their obsessions. Once the therapy has helped them to achieve an understanding of compulsive response, they will begin to experiment with dropping those compulsions. Over time the sufferer learns to self regulate perhaps with the help of medication.

A bright untrammelled future it may not be but for many it is at least a future that they once might not have been able to contemplate, and all because they had drawn from somewhere the courage to share their condition with someone. And that is the key: sharing. Imagine yourself behind a closed door and it is hard to share what goes on in that room, but imagine yourself behind a window with a sympathetic, understanding person on the other side of the glass. They don’t and won’t see you as you fear they will see you. They will want to help you. Go talk to them, and tell them you need their help.

Mental Health: Postnatal Depression

First let’s deal with the (newborn) elephant in the room. In some circles postnatal depression, or PND, just doesn’t exist. It’s another example of people suffering from a partly disbelieved ailment. Now, I’m not going to pretend to tell learned men and maybe, who knows, even an occasional woman what constitutes a real mental health condition. However, in my enlightened country PND is recognised as a real issue of mental health so, we’ll just go with that.

The birth of a baby is a wonderful thing. The event enriches the lives of everyone touched by the new baby’s arrival. The creation of new life, a new citizen of the world, etc, etc. Everything about welcoming new life into the world drives us down the same narrative. However, what if the journey towards a happy childbirth somehow turns down a different avenue. When the birth of a baby simply isn’t the happy ending it was meant to be, PND is where most people end up. Let us be clear about one thing: the ‘Baby Blues’ is not what we’re talking about here. Feeling anxious and having the occasional tearful outburst, and even feeling a little down is reassuringly common in the first couple of weeks after the little bundle of joy arrives. After that initial period of an anxious, weeping, emotional jamboree most new parents will settle into the feeling that something special has happened to them. They will relish the task and cherish the love they lavish on their new child. Although they will eventually be just as much a loving parent, for some that place will be a longer journey to travel, sometimes much longer, before they too are full of the joys of parenthood.

The onset of PND can be a frightening experience. Sometimes it is a sudden clanking switch bringing down an almost instantaneous depression, whilst in others they experience a slow dawning of darkness. Reading stories of real people suffering real experiences reveals how misunderstood and misdiagnosed the condition can be. Of course, there are other stories where help was quickly available and the sufferer begins a tough journey back but here there is a familiar refrain, that sufferers of mental illness often receive poor treatment and even mistreatment, until they are in the hands of the expertise within the mental health service. PND is certainly no different. Whilst, a “good night’s sleep” is definitely a great idea for new mothers [sic] it certainly isn’t either terribly likely, nor the start of a cogent treatment strategy to deal with the sometimes nightmarish thought-palaces of postnatal depression.

The reasons a mother falls into depression are numerous and the depths of that depression figuratively ranges from snorkelling close to the shore, to the darkness of deep sea diving. Whether skimming along the surface, or clumping along the sea floor beneath the whole weight of it all, depression is depression. New motherhood can feel daunting. All of that pregnant expectation is finally over, perhaps the greatest life-changing event a woman ever experiences has produced the sudden, complete dependence of another life. The demands of a new baby seem endless especially as time off seems to amount to zero. As well as all this, normal life is also expected to plod along as normal. Yes, that does sound daunting to me too. In fact seen set against a blank canvass, instead of a rich support network, it may seem impossible, even though it isn’t. Self-help and community support, the therapy of talking to trained professionals and the additional help that may be offered by medication are the spokes of a recovery wheel. Time and attention, help and support, and the understanding of those around you are all signposts along the road to recovery, along with a sympathetic mental health service.

You could be forgiven for thinking, well that’s PND: it’s something which affects a proportion of new mothers, and of course it is, but you may be surprised that it is something that affects new fathers too. Although there are clearly some pressures of new parenthood that can only truly be felt by a mother, many of the very same pressures have a similar effect on fathers and can result in the same episodes of depression, postpartum. The usual likely triggers for depression, such as hugely emotional events and stressful life moments are very prevalent in childbirth. If you then consider the deprivation of sleep, the constant and overbearing workload, which can lead to changes in home relationships and maybe a financially unstable lifestyle, it becomes easy to see how consequential postnatal depression can readily appear.

Neither with PND, nor depression of any kind, is there a recipe you follow that reliably results in clinical depression. Rather, it is something you fall into, like not watching your step along a tricky pathway, being the poor soul who just happens to put your foot in that wrong place. We fall, and those who love us peer into the abyss trying to reach us. There is no recipe, but there is a preventative checklist that you can use to help yourself to maybe avoid those missed steps along the way, or at the very least lessen the severity of the fall.

Firstly, depression can appear during pregnancy so in the lead up try to take plenty of rest. Talk through your anxieties with those around you, particularly if this is your first birth. Try to maintain a good diet and definitely avoid as far as possible very stressful situations. As the day of arrival approaches it is a good idea to know where your support network lies. Speak to people close to you about the heavy workload and agree how much help you will be comfortable with. After baby arrives Try to maintain dialogue with your partner and set your relationship expectations: it is okay for ‘normal’ to be redefined for a while. After the arrival try as far as possible to avoid falling into gender roles by sharing the shareable. Remember that superwoman and superman only exist in comic books. You can’t do everything and be everything to everyone, so don’t try. If you have identified your support network, use them because they will probably be ready and willing to help. Finally, talk. Talk about anything and everything. Talk to everyone and anyone who will happily listen.

However, even with all of your careful planning PND might still affect you because mental health is a bit like Cupid’s arrow, it just strikes wherever it strikes. However, don’t let PND happen with a whisper, but rather make it as loud as a klaxon because the world is listening for your call, as long as you can make sure it hears you.

Mental Health: Eating Disorders

I have a poor relationship with food. I just can’t seem to stop at full and will sometimes eat until I feel physically ill. Why do I do it? Well I know I’m doing something that can ultimately have a detrimental effect on my health and yet I still do it. Surely everyone has heard of the idiom, ‘Naughty, but nice.’ What does that mean? To me it means that you know ‘this’ on some level is something you really shouldn’t do but hey, you’ll get some kind of reward from it. In my case of course, we’re talking about perhaps a cream cake, or a sausage roll, and the reward for me is that cream cake, or sausage roll. Someone suffering from Anorexia Nervosa or Bulimia Nervosa has the same reward mechanism at play, but enacted at the extreme edges of diet. Their reward is that in some way they see themselves advancing towards their goal, through their actions. Of course, they will never arrive at that goal, whatever the goal may be, because the disorder itself is immutable without intervention, so the goal becomes a constantly moving destination seen through the distorting lens of their illness.

Make no mistake about it, eating disorders are complex mental health issues and telling someone to ‘just eat’ is like telling an alopecia sufferer to ‘just grow hair’. Misconceptions about eating disorders typically start with family and friends who just can’t fathom how their loved one became so ‘self-absorbed’ as to care so much about their body image that they are prepared to starve themselves even to death. Society at large have the same broadly skewed view of a condition that appears to them to shine like a theatrical spotlight. Of course this couldn’t be further from the truth. It’s about body image and the hopeless pursuit of a distorted idea of a perfect body. Like two north facing magnets, the ‘perfect body’ moves away as the actual body approaches. Or it’s about low self esteem, where taking extreme control of their bodies, such as binging and purging, will make them feel better, about themselves. Ultimately a sufferer will hopefully receive treatment while others may meet a tragic end.

Whichever route sufferers take to arrive at the disorder, they will usually arrive with certain baggage that will to a greater or lesser extent be similar to their fellow sufferers. They may be working in a high pressure ‘thin’ environment such as working as a dancer, or have perhaps been criticised for eating habits throughout childhood. They may have had a torrid time with weight issues, with friends, family or just a common or garden playground bully focusing on their weight or shape, or both. Still others may already have an anxiety disorder or have suffered an abusive relationship. Others may have triggered at times of high stress, such as a family death, loss of employment or struggling with the pressures of school. For some, their baggage is a family history of addiction, depression or eating disorders that has inexorably delivered them to their inherited destination.

Once under the influence of an eating disorder sufferers can often be drawn into the miasmic world of pro-ana (pro-anorexic) websites, where tips for and encouragement to achieve the anorexic look serve to draw sufferers deeper into their illness. The spread of such sites have proved to be a magnet to real anorexics and those drawn to its quasi rebellious pretext. Moves to close these sites down have proved difficult. Whilst some have been banned others have persisted, whilst others spring up in place of those successfully removed. Reasonable sounding arguments in support of pro-ana sites can’t hide the harm they inflict on vulnerable sufferers while purporting to offer support. This fall into co-dependence helps to feed the feeling that their extreme world is where they belong while the rest of society sits a world apart.

There have been high profile sufferers in the past who have lost their battle, most famously Karen Carpenter, one half of the iconic American pop duo, The Carpenters. In Britain the Scottish child star Lena Zavaroni achieved international fame at the age of ten, but was struggling with anorexia by thirteen. Karen Carpenter died in 1983 aged just 32, less than one month before her 33rd birthday, and Lena Zavaroni was lost at just 35 years and 11 months of age. Both died of complications caused by their eating disorders. For some time afterwards the media light shone on this lonely and insidious struggle but, once the public’s appetite for the story waned, it returned to its secretive roots. Eating disorders have one of the highest mental health mortality rates inevitably as a result of associated behaviours, such as substance abuse. Though the terrible loss of life as a result of mental illness, and within this context – eating disorders in particular cannot be overlooked, the great majority of sufferers will survive. But what does the life of a survivor look like?

Generally the life of a survivor is a mix of standing a careful watch over their emotions and of knowing how to repel the demons of starvation, binging and purging, abusing laxatives, abusing appetite suppressants, anti-diuretics, and of recognising their endless comparison of body shapes and sizes as a trigger. They can also be dragged back into their disorder, which they may have struggled for years to control, by their tremendous sense of competitiveness when they are around innocent dieting, where another person’s simple striving for a different body shape might trigger in the sufferer another destructive episode of driving their body down the same old hard traveled road. They also suffer from the oldest mental health story, as stigma and bigotry rain down upon them from a society ignorant of their needs and troubles.

I have talked over the subject of eating disorders with people. Some seem to think it a wholly modern phenomena enacted by over-socialised, terminally-anxious people too bound up in self. Wrong. There is evidence scattered throughout history and all over the world of the great and the good binging and purging, and stories of starvation used in religious contexts as a means of showing devotion: the most famous of which being Catherine of Sienna (1347 – 1380) who died of a stroke after years of flirting with abstinence and eventually succumbing to extreme starvation. In 1873 the medical malaise of self starvation was given the name Anorexia Nervosa by royal physician Sir William Gull, in his paper “Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica)”. At about the same time the French psychiatrist Charles Lasegue rooted eating disorders firmly within the spheres of mental health, identifying it to family pressures, rebellion and the control of self, essentially defining the disorder 144 years ago. So, the condition and its links to mental health is a long known, well documented disorder and whilst it could be argued that eating disorders, fuelled by famous cases, has become a mass media picture show, clearly the actual disorder, the thing often dismissed as a modern, attention-seeking lifestyle choice, is really as old as history. So much for modernity. So much for stigma.

Mental Health: Schizophrenia

Schizophrenia. According to my rough and far from scientific straw poll of family and friends, as much as eighty percent of you when reading the word schizophrenia at some point have thought, or still think, split-personality. That’s what it is isn’t it? So ingrained is the notion of schizophrenia as split-personality, some of you may actually demand proof, that it isn’t. Because, it isn’t. Let’s wait for those people to go away and seek out some scholarly article describing the real symptoms.
Dum de dum, de dum de dum. Lah de dah de dum de dah. Patience has never been a trait of mine: to hell with it, they can catch up.

Whereas Dissociative Identity Disorder is the medical condition that encompasses split-personality, schizophrenia is generally an illness of psychosis: or disconnection with reality. Contrary to all the other conditions covered so far in this series, schizophrenia is a mental health disorder that is universally recognised across the world. Yet, in spite of this acceptance, public misconceptions of the condition, largely brought about by TV and Hollywood, permeates all casual discussion of the condition. That isn’t to say all movie depictions of Schizophrenia are bad. A Beautiful Mind starring Russell Crowe as John Nash, the brilliant American mathematician who suffered with paranoid schizophrenia, was beautifully told and showed the personal horrors that can afflict the sufferer.

Schizophrenics will typically hear their own thoughts coming echoing back at them as voices in their head or may hallucinate scenes that only exist in their mind. A sufferer will hear the voices as if from another person and perceive hallucinations as reality. They may hold conversations with their inner voices and may often seem agitated as the conversation progresses. These hallucinations and voices are as real to them as any conversation you may have had this morning, and anything you may have seen. Delusions are another potentiality terrifying symptom where a sufferer might feel there is a conspiracy against them and people and things are co-conspirators. The conspiracy tends to grow and become more incongruous anyone capable of rational thought. Any of the above would qualify as a psychotic episode. It is this which makes up the disorder of Schizophrenia.

Most people’s skewed appreciation of this misunderstood condition centres on the fear of violence. Whilst many Hollywood schizophrenia sufferers have violent tendencies, in real life the great majority of sufferers are much more likely to be a danger to themselves. People with schizophrenia are up to fifty times more likely to commit suicide with as many as forty percent having attempted suicide, according to some studies. It is of course true that a population subset of schizophrenics commit violence towards people and even commit murder but, it is also true that most often such incidents make news whilst other subsets such as young men in gangs, jealous spouses, etc. may not.

Schizophrenia is very treatable and most people who suffer the onset of this condition will usually recover to lead a normal life, with their disorder controlled and managed through careful living and antipsychotic medications, which are often eventually reduced to a very small dose. Relapses may happen from time to time but the same treatment regime that has worked well before will usually work just as well again.

We all give in to irrational fear sometimes, like when we step on an aeroplane with trepidation whilst happily driving to the shops, even though the drive to the shops is significantly more likely to prove fatal, statistically, than would flying in modern aircraft in modern skies. The reason our fears are so out of whack with what is really likely to hurt us is because virtually every airplane crash appears on the main news, sometimes staying in the headlines for days. Imagine if every single fatal road traffic accident in the entire nation, appeared on the national news, every day. Our news bulletins would be so full of car crashes that President Trump’s latest twitter ejeculate would barely raise a tweet in return, and Boris Johnson’s inane word stew would never amount to more than an amusing story at the annual lexicographers ball.

So it is with attacks by a schizophrenia sufferer. The attack fits so well with the Hollywood narrative of a violent schizophrenic that they are plastered all over news and media, sometimes for days, which then sits in the mind of the viewer like a virus, to be sprung whenever they come across some poor soul in the midst of a psychotic episode and in need of the kindness of strangers. I understand the statistics of plane travel so I love flying and I know that a schizophrenic is likely to need my help should a situation arise. Can I trust you to think the same? I’m certain I can.

Mental Health: Funding Crisis

Like most people I have during my life suffered moments of great stress. These life experiences that have taken me to the precipice; the crushing loss of my first child, the painful loss of my father to a stroke and quite recently the terrible loss of my dear brother, have all taken every ounce of the emotional strength and resolve I possessed. Fortunately for me, my personal reservoir has always just about been sufficient to precariously maintain my mental health. In particular, losing our child as a six and a half month old baby took my wife and I perilously close to falling down a very black hole, yet we came back out of the other side still with a bare smile in our pockets. However, when the great balance book of life eventually contains more debits than credits, in that time where a crisis overwhelms whatever reserves we have, we are left scrabbling for whatever help and support society can provide.

Too often in the Britain of today, the vital resource of mental healthcare falls woefully short of need. Beyond question, mental healthcare provision around the world differs enormously and someone in one of the poorer nations of the world might regard the complaints of the British churlish. In parts of Africa mental health issues are given a much lower priority than physical ailment and the fight for funding, as a slice of the whole, starts at close to zero. Everything is relative but as one of the wealthiest nations on earth, British public expectations of its healthcare systems are certainly high.

At this point it is worth noting that, the human component of mental healthcare in Britain more than rivals the best the world can offer, with a dedicated and highly skilled workforce working long, arduous hours spreading themselves as thinly as they dare, to meet and combat an overarching crisis of funding.

Funding is at crisis point in many areas of British healthcare and much recent focus has fallen on the piteous plight of people suffering the indignities of Britain’s A &E departments, and on the increased waiting lists for elective surgeries. Though there has been some public heat around the state of mental healthcare funding, it is usually short lived. So why is there no sustained pressure around the funding of such a vital service?

An unhealthy stigma still surrounds the subject of mental health in Britain. If your mother or grandfather has had their hip operation cancelled for the umpteenth time, you are most likely to be all over social media screaming at the injustice, and may even court press and media coverage of their plight. However, change that cancelled hip operation to the unavailability of timely psychiatric treatment and the great many of those afflicted and affected inevitably fall silent. Those working within the cash starved service will of course always stand up and shout to the world that more is needed, but with clever manipulation of the media narrative, this politically charged activity too often gets painted as simple militancy. Widespread public pressure remains sadly absent.

Over the years celebrities such as Stephen Fry have added valuable publicity to the scant pool of public discourse by openly talking about their own personal struggles with mental health. It might seem that while we sit and watch and listen to those luminaries trying to kick down the barriers to open discussion that we may be on the cusp of ridding ourselves of this outdated stigma. Indeed, when Stephen Fry openly discussed wrestling with suicide, for some time the nation talked and the subject opened up like a flower, promising societal shift. Unfortunately, as before it was just noise that fell back into the background hiss. More recently the Duke and Duchess of Cambridge’s Heads Together charity have sought to move the public towards a more empathetic tone, yet little still seems to change.

What can we do? Stigma is a two sided coin. That day where someone realises they are suffering from a psychiatric issue, they can become their own bête noire, feeling that they are in some way weak and that they should just “pull themselves together”, often reflecting what well-meaning friends and family, and even society has given them to think. Overcoming this self-doubt is about finding common community with others suffering similar issues through support groups, and is also about seeking and receiving treatment. However, it is also beholden upon society to view issues of mental health sympathetically.

I once saw a young lady in a city centre clearly in the depths of a serious episode. Around her, there were people offering a wide birth, others standing back with concern or disapproval, it was difficult to tell, while others laughed and smiled. Still others used mobile phones to film the scene, presumably before placing it on YouTube. (Tickets to The Show)  Eventually an elderly lady led her into a shop, hopefully helping to get her the help she needed. The prevelant attitude of this “audience” serves as a distasteful sketch of stigma actually being born, where the weight of society sees mental health almost as a show. The drive to open up the subject for national discussion will always stall as long as sufferers fear a reaction they have likely seen many times before. Political pressure for change unfortunately always starts with the people rising up against the status quo, railing at an inequality or just deciding that enough is enough. We appear more likely to slavishly add to YouTube clicks as we sneer from the comfort of the sidelines. As long as the under-funding of mental healthcare in Britain remains a niche subject for those few prepared to put themselves in the spotlight, proper funding for the service will continue to be a nearly subject, and politicians will continue to talk flowers, and offer weeds.

Chasing Rainbows

Sometimes I’m on it
Thoughts aligned
Chiming burnished dreams of gold
Sometimes the demons
Bring me down
’till the heat of the day turns cold
A mile below daylight
A day behind now
A fall to toneless end of the day
The overrun thought
The empty skin
The fight to hold darkness at bay
But I’ll rise up again
And I’ll smile again
The sun will come rolling over that hill
And it’s mine again
Over the line again
Life again bends to the weight of my will