Category Archives: mental health

Privileged glimpses 3: People do the best they can with what they’ve got

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

sweet shopImagine a small child in a very large sweetshop. The lights are off and it’s completely dark except for a single spotlight illuminating a tiny piece of shelving. On the shelf, visible in the little pool of light are three bars of chocolate. One bar is milk chocolate, another dark while the third is white chocolate. That is all the child can see.

The child has one simple instruction…

Take your pick…

Obviously the child will choose one of the three chocolate bars he can see. It doesn’t matter what other treats might be in the shop because he can’t see them – he doesn’t know that they are available options.

This little post isn’t really about chocolate bars and children in sweetshops though. It’s about social care service users and the options they have available.

The sweets in the shop represent coping strategies. They’re behaviours. Choices about what to do in different situations. And just like the child in the sweetshop service users (along with everybody else) only choose the options, the behaviours that they know about.

So if someone you work with makes poor choices that’s not necessarily because they don’t want to do better. It’s more likely because they either don’t know what else to do or because they don’t think that other options will work for them. Many people understand intellectually about good coping skills, socially acceptable behaviours but don’t believe that they will be given the opportunity to make different choices work for them. If they’re used to being treated with mistrust they won’t believe that the truth will work for them. If they’re used to being ignored they won’t believe that not drawing attention to themselves will meet their need for human contact. And they may well be right.

So, just like the child in the sweetshop they take the best option available to them.

They do the best they can with what they’ve got.

Privileged glimpses 2: People are just people

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

Be uniqueFollowing on from the ‘no such thing as ‘us and them’ post I’d like to make a more general point about people. Nobody is special. There – I’ve said it. You are not indispensible at work and your boss, your colleagues, your friends and your favourite service user are all replaceable. Nobody is special because people are just people.

If you work in mental health or social care services you will be used to certain professionals behaving as though they are more important or somehow more worthy of respect than others. You may even be tempted to behave that way yourself. Many in my own profession of nursing seem as though they have been pre-programmed to emphasise their own importance way beyond all recognition.

Different professional groups have different responsibilities and different levels of education are important but they don’t make us special. I’m a nurse – a pretty well educated and experienced nurse at that but that doesn’t put me in a position to tell a newly qualified social worker with a basic professional education how to do their job. I’m not special and I don’t know everything.

Similairly whilst I’ll happily defer to a GP when dealing with complex physical problems I’m not about to take their word when planning a cognitive therapy strategy for someone with psychosis. I will listen to them though.

By the same token I may be responsible for planning and organising a shift and delegating care tasks to support workers but I’d better not forget that they are more likely to know the best way to hoist, bathe or feed a particular resident than I do because they know their own jobs.

Nobody is special.

Nobody is indispensable.

Nobody is irreplaceable.

People are just people.

 

Privileged Glimpses 1: There is no ‘us and them’

I am a manThis series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

In spite of having had my own issues in the past I began my nurse training with a very superficial mindset. I believed, without even thinking about it, that there were essentially two types of people in the world. There were ‘the mentally healthy’ and then there were ‘the mentally unhealthy’.

As a student nurse I believed myself (very arrogantly, I might add) to be one of ‘the mentally healthy’. I thought that people were born to mental health or to mental ill health and that the work of mental health services was to protect ‘the mentally unhealthy’ from themselves either by medication or by more social methods.

I’m embarrassed to acknowledge that my training did little to challenge that idea. There were a couple of outstanding exceptions but in the main the discriminatory attitude went relatively unopposed. Fortunately things have moved on and continue to do so but the student nurse training of 20 years ago was very definitely saturated by an ‘us and them’ ideology.

Of course, nobody ever came out and said it quite so bluntly, so starkly as I just did but there were plenty of references to ‘chronic illness’ and ‘irrecoverable’ conditions to illustrate the point just as clearly. Nowhere was this more obvious than during placements on the wards where people were described as ‘revolving door’ or ‘long stay material’ as though their very essence was illness and nothing more. I’m ashamed to say that for my first few years after qualifying I bought into this mindset completely along with all its negative (and essentially false) assumptions about incurable psychotic illnesses and irredeemable personality disorders.

I was glad to be one of ‘us’.

Then an interesting thing happened. I moved away from my first job on an acute psychiatric ward serving a large, deprived inner city area to my home town and began to meet up with old friends – many of whom I hadn’t seen for years. Around half a dozen of us met up for a meal in a local pub one night – it was a way to reintroduce myself to my old mates. And we had a good time swapping stories of our schooldays and catching up on the events of the intervening years. That was when it first began to become clear to me that there really is no ‘us and them’.

Of the six of us sat around that pub table five were taking anti-depressants. Every single one of my old friends had been prescribed pills to make them feel better. But they were my old mates. They were my best friends. They definitely weren’t to be considered as ‘them’.

That was the beginning of a mental journey that led me to rethink my old assumptions about mental health and illness. I needed to work out what was different between my old school friends and me. It surely wasn’t simple biology as I’d been taught. They couldn’t all have ‘the depression gene’ (whatever that is).

Finally it dawned on me – Sally had had a point. The difference isn’t just biology, although that can have a part to play. Biology is not the complete answer. It’s not the complete answer by a very long way. Attitude, social situation, environment and general coping style are just as important – arguably very much more so. This matters.

Once we acknowledge the impact of social skills, environment, opportunity, coping methods and psychological style we begin to see that given the right life chances people can be far more than they might appear. Our own assumptions about ‘them’ keep people from overcoming their problems by limiting those opportunities. It’s truly amazing what people can do when we treat them like ‘us’.

There really is no such thing as ‘us and them’.

Privileged Glimpses (of the bleedin’ obvious)

About this series

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

Many of the ‘glimpses’ only become obvious once they are explained. Until then they appear ‘counter-intuitive’. To put that more simply they seem to make no sense at all to people not used to thinking in this way.

The real aim then is to help people to examine and in many cases change their basic approach to people who need their support.

As always I’d be grateful for feedback on the ‘privileged glimpses’, either by Email or though comments on the blog.

Contents

There is no ‘us and them’

People are just people

People do the best they can with what they’ve got

Coping skills develop slowly

Don’t expect your service user to perform perfectly. You don’t so why should they?

Don’t blame people with disorders for behaving like people with disorders

What people say may not be what they mean

Do as I do – model behaviours we want to encourage in others

Lapse and relapse – two different things

Sympathy is not usually helpful

Risk-free is impossible. Manageable risk is the way to go

Don’t flap

The saviour fantasy

You’re probably not an emergency service – don’t try to behave like one

Hanged if you do & hanged if you don’t – a duty of care myth

The word ‘support’ is meaningless in and of itself

Challenging behaviour means….

Learned behaviour

Unhelpful thinking

“It’s just behavioural” – a workers’ excuse for lazy thinking about service users’ needs.

Who put us in charge?

5 easy tricks to keep you happy

errorWe all know about sleep, diet and exercise. That’s not what this post is about. They’re just the basics – the essentials of life as a biological organism. Everyone knows that stuff. This is about the less obvious but really important strategies that most people don’t know – and never will. This is about attitude and behaviour.

Develop a philosophical approach

Too many people take things personally. If someone disagrees with them they think it’s an insult and they come out fighting. Another driver cuts them up at a junction and they act like an angry bear all day long. They leave their mood, their happiness and their quality of life to be decided by other people. Their emotions are driven by chance in a world so full of mishap and rudeness that it’s inevitable they’ll get angry or upset as a result.

Understand that the world is full of ingratitude, unpleasantness and downright hostility. That’s just how it is. If you go around acting as though you can only be happy if everything works just to your liking you’re not going to be happy very much.

Instead use life’s mishaps as opportunities to show the world just how much better you can be. You control your mood – not the inattentive shop assistant or the impatient driver who thinks their time is more important than yours. Make up your mind to stop pretending that anyone else is in charge of your emotions. They may be angry or offensive but you don’t have to join in.

Lose the positive mental attitude (or at least temper it)

There’s nothing positive about positive thinking. At least not when it becomes so blinkered that you can’t see past it. The glass is neither half full nor half empty. It’s just a glass with some water in it.

Make it a habit to think about every situation as it really is without needing to put a spin on it. Pessimism leads to cynicism and hopelessness. Optimism leads to blind faith in a world that can never be as helpful as we want it to be.

Realism means seeing the world for what it really is, honestly assessing our own strengths and weaknesses and coming up with realistic plans to face whatever life throws at us. That’s far more useful than blindly running over the cliff with the insanely positive opinion that we can fly.

Cut out the small talk with the small people

Do you work with others? Do you meet other people regularly? Are you a part of a club or organisation? The chances are that you answered yes to at least two of these (probably all three).

Look around you and listen to the conversations your friends and colleagues have most often. How many of them are inspiring, uplifting conversations about potential and about challenges to be overcome or rewards to be earned? How many are long, drawn out moans and gripes about how badly the boss treats us all or why there’s never enough time to do the work expected of us? I think that last one is particularly ironic, given the amount of time people spend moaning about their lack of time.

Make it a habit not to join in with these unhelpful conversations. It’s OK to take part for a minute or two to get a sense of what’s going on but then go and get on with whatever you have to do. Your colleagues may well continue the conversation for another hour or more but they won’t be saying anything new and they certainly won’t feel any better at the end of it.

Get involved in something meaningful

We all like to feel as though we’re of value. Nobody likes to feel useless and yet so many people ignore the potential they have to really contribute.

Develop an interest that lets you contribute to something of importance. Ideally get involved in something that you define as important. As Albert Ellis put it..

Humans are happiest when they are involved in some project or activity that they define as more important than themselves.

Do something that you can be proud of.

Give yourself permission to be wrong

Nobody’s perfect. Everybody makes mistakes. That’s part of being human and try as we might we can never change that. So don’t act as though you’re somehow different from the rest of the species.

When we get things wrong we have two basic choices…

  • We can learn from our mistakes and grow
  • We can get angry at our failures and shrink

Give yourself permission to get stuff wrong – that’s an important route to learning and personal growth. Be prepared to admit it and seek advice from others when you mess up and make a habit of encouraging others to do the same.

Interestingly enough if you start admitting your own mistakes to others they very quickly notice and start being honest about their own mistakes with you in return. You start having honest conversations. You get to solve problems and put stuff right. Everybody wins.

What have you got to lose?

Try these five ways in your life and do, please let me know how you get on.

Go on – you know you want to.

More stigmatising Halloween ‘fun’?

After campaigning so successfully in the past I really thought the mental health community had seen the last of this awful sort of abusive marketing in UK. Asda & Tesco both seem to have learned their lesson, judging by the range of costumes on offer on their respective shelves, but others have not.

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The impact of social stigma on people with mental health problems is bad enough without this crap making it worse.
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I just Emailed this to customer.services@joke.co.uk
I’d be really grateful if others would do the same.

“Dear Sir,

I sincerely hope I’m not the only person writing to you to express my disappointment at your choice of Halloween costumes for sale this year. The impact of social stigma on people with mental health problems is immensely detrimental. Your stereotypical and grossly misleading Halloween costumes can only exacerbate an already serious problem of social discrimination.

In recent years similairly stigmatizing and abusive Halloween costumes were presented for sale by other UK retail outlets including Asda & Tesco. Public outrage (& a subsequent drop in their retail sales) caused them to see the error of their ways. They do not appear to be making the same mistake again this year.

I would be very keen to discuss this issue further with you, should you be interested in learning more about the serious harm this sort of stigmatization creates.

Yours sincerely,

Stuart Sorensen
(Mental health nurse, trainer, writer & speaker)”

If you agree that this sort of stigmatisation is unacceptable why not Email: customer.services@joke.co.uk
to tell them so?

Or write to:
Jokers’ Masquerade
Abscissa.Com Limited
Union House
Kennet Side
Newbury
Berkshire
RG14 5PX
UNITED KINGDOM

You can telephone them on: 0845 1300 818.

They’re on Twitter too: @Joke_co_uk

This abusive company’s ridiculing, stigmatising approach to people with mental health problems is neither appropriate nor acceptable in a civilised society. Please join me in letting them know.

That’s all folks!

Do you remember ‘Mork and Mindy’?
I do. It was brilliantly funny back in the day. An unassuming little comedy series that launched (so far as I know) one of the most versatile and talented comic actors of a generation.

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And now that actor is dead – by his own hand.

I’ve no idea why Robin Williams killed himself. In truth, I don’t think any of us ever will have – not really. Without thinking the thoughts he thought and feeling the emotions he felt the best anyone could ever manage would be a superficial approximation of the truth.

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But that doesn’t stop the media from going wild (with the frenzied instincts of a pack of wolves who smell blood) at the thought of the money their printed speculations will bring. And it stinks.

Leave the poor guy alone.
Leave his memory alone.

Just stop it!

That’s all folks!

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Timing is everything (apparently)

Would you believe it?

I’ve just got home after a week working in Glasgow, Birmingham and Liverpool. Waiting for me was this.

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Out of the blue, publisher Palgrave Macmillan sent me a free review copy of Joanna Moncreiff’s latest book, ‘The bitterest pills’. That was a nice surprise 🙂

The only problem is timing. I’ve a mountain of work to get through and only two weeks to do it in. So the review will have to wait, alas.

But if you’re interested in understanding the arguments against antipsychotics watch this space. I’ll review the book here in a few weeks.

International society removes ‘schizophrenia’ from its title

Woohoo! First it was a joke that was taken seriously only in the post-psychiatry movement. Now it’s a mainstream opinion. Soon the only discussion will be how anyone could ever have believed in the syndrome of schizophrenia.

I wonder if this is true

Faith healing GP Accusations have come forward that a Staffordshire Dr. told his patient God would heal her & to stop taking her psychiatric medication. The GP denies any wrongdoing and claims that the allegations represent an attack on his Christian faith.

Whether or not this particular GP is guilty of such serious misconduct is a question yet to be answered. However it wouldn’t be the first time such medieval recommendations have been made in UK. The last few years have seen UK psychiatrists like Rob Waller refer psychotic patients for exorcism, several deaths resulting from exorcism worldwide and an Archbishop calling for exorcism of ‘the mentally ill’ in the House of Lords.

It’ll be interesting to see how this plays out.