Tag Archives: psychology

Privileged glimpses 9: Lapse is different from relapse

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.

A good friend of mine began attending a well known self-help group for problem drinking a few years ago. I’m happy to say that he didn’t attend for very long, partly because he found himself far from convinced about the group’s ‘message’.

He’d been having a difficult time at work and briefly retreated into alcohol as a way of coping. It wasn’t the best tactic he could have chosen by any means and it did start to cause more problems than it solved. It was a response to stress and like many such coping strategies it made him feel better in the short term but only served to exacerbate his troubles in the long term. But it was still a coping mechanism, however self-defeating it may have been over time.

The self-help group he attended took a very simplistic, almost religiose stance. All alcohol was bad, or so they told him and even a single drink would automatically put him right back to square one. They wanted him to believe that he had a permanent, unresolvable problem that could be managed with total abstinence but never ‘cured’.

According to my friend, we’ll call him Tom, the other members of the group accepted this idea uncritically. Presumably that was because those who didn’t accept it left the organisation, as did Tom after a few months. But he did stay around long enough to notice something very interesting.

As the pressures at work lessened he found himself able to drink in moderation once again. He reverted back to previous levels of alcohol use – social and quite infrequent. He stopped getting drunk and found himself quite able to ‘take it or leave it’ as the occasion required. However the other members of the group, those who believed the ‘one drink and you’re back where you began’ mantra didn’t seem able to do that.

During Tom’s time in the group he witnessed a small number of others ‘fall off the wagon’. They too had intended to have only a couple of drinks but they seemingly were unable to do so.

Lapse isnt relapse

Tom realised that their belief prevented them from controlling their alcohol use. They thought that they must keep drinking after their first little tipple and so didn’t attempt to do otherwise. They defined a single drink as impossible to achieve and nobody tries very hard to do what they think is impossible.

It was a self-fulfilling prophecy

Had those people been able to acknowledge the possibility of ‘lapse’, a single event, they might have stopped at a single drink but since they believed only in relapse or abstinence they couldn’t.

So it’s important that those of us who work in mental health and/or addiction services understand that success in any endeavour (not just in overcoming substance related problems) depends upon both achievements and lapses into previous ways of coping. The lapses are a vital part of the process because, as we saw in a previous entry, it’s how we learn. It is neither necessary nor desirable to convince people that they’ve failed when all they’ve really done is stumble a little along their path to success.

Lapse is different from relapse


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.

Models of mental health and disorder

The world of mental health care can be confusing – especially for those new to the topic. Often the different theories and professional approaches seem to contradict each other. It’s almost as though different workers speak different languages,

That’s not quite true but they do often come from different theoretical perspectives. That’s why, for example, a social worker and a psychiatrist will give you two completely different explanations for the same person’s problems. They’ve been taught radically different ‘models’ that they use to understand mental health and disorder, its causes and its treatments.

This little table isn’t intended to cover all the different models in depth. Instead think of it as a very basic list of models that can guide you in understanding why people focus upon different things. There’s more to it, of course but it’s a start for newcomers trying to get to grips with the contradictions they come across in practice.

The Care Guy Models of mental health and disorder

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.