depression

Is it Rob or Helen who needs a psychiatrist?

Last night, some of us were tweeting about The Archers. Specifically, about the scumbag Rob Titchenor whose latest act of psychological warfare against his wife Helen was to hit her and then make her feel so bad that, by the end of the 13 minute programme, she had apologised for making him do it. He then delivered his coup de grace, that she was in need of psychiatric help.

As you can imagine, this generated much debate. Quite a few people said that it wasn’t Helen that needed a psychiatrist, it was Rob. They said he was sick. I believe they are wrong. And I want to explain why I think this.

Is Helen mentally ill? And if she is, could Rob have caused it?

Only someone who is clinically qualified can really answer this question.  But as Helen is a fictional character and therefore unavailable for an assessment and formulation, we are entitled to make assumptions.

Helen has a tendency to depression, anxiety and problems such as anorexia in part because of her personality. She is someone who sets herself high standards and drives herself very hard. She has an overdeveloped sense of responsibility. She judges herself harshly and punishes herself for her own perceived failings. And she reacts badly to criticism from others.

She has some additional risk factors. She is, or rather was, a single mother. She has experienced several major losses: her older brother died in a farming accident when she was a teenager. Her last partner died by suicide. Also, her father was recently very ill. Her younger brother went missing for a year and her best friend felt betrayed by her.

All of this makes her vulnerable. So Rob hasn’t exactly caused it. But he has exacerbated it. And now he is using it against her.

Isn’t Rob also sick in the head?

Rob is also fictional. We only know what the writers have shown us. But again, we can make assumptions.

He certainly shows narcissistic tendencies. He cares a great deal about his own feelings, but little for those of others. He views the world as there to serve him. He constantly reminds Helen that she is Mrs Titchenor now, and that she must dress and act to please him. Henry must be “obedient”. The coming baby is “my son”. The house revolves around Rob . He is jealous and actively excludes those Helen is close to.

He also has a nasty temper, is untrustworthy and lacks morals. He hit the hunt saboteur and later lied about it. He cheated on his first wife with Helen, and lied to them both. There are suggestions he may have lied when he worked with Charlie. And there has been at least one occasion where he either raped Helen or was rough enough during sex to cause her bruising round the neck. She seems uneasy near him.

But these are not signs of mental illness. They are the tendencies of all bullies, cheats and those who get through life by using others. Rob has chosen Helen because she is vulnerable, and has resources that he wants  – she has her own house, and will inherit half of the family farm business. And she can give him a child.

What about his mother?  Is she mentally ill?

Aah, Ursula. She is a manipulator. She probably learned to behave like this as a small child herself because her own family was dysfunctional. Her relationship with Rob is deeply dysfunctional too. She wants to please him, and will go to any lengths to do so. She perceives Henry’s unhappiness as bad behaviour. She thinks sending him away to boarding school will help him. Her interest in Helen’s pregnancy, labour and other intimate matters such as Henry wetting his bed is prurient. I wonder whether she is a sex abuser. She gives me the creeps.

Why can’t Pat and Tony see through Rob and Ursula and why can’t they see their own daughter is so unhappy?

Because they are nice people. And they are deeply invested in Helen having made the right choice. They feel bad about not warming to Rob at the beginning. The truth for them is too awful to contemplate…at the moment.

What will happen to Helen?

Who knows? Only the writers. Perhaps her love for Henry will override her feelings for Rob, and she will confide in someone like Tom or Kirsty and they will help her to escape. Or perhaps she will be assessed by a mental health professional who will ask all the usual questions about things that are troubling her, and leave her enough space to express the doubts about Rob that we can already see lie just below the surface. Or perhaps she will continue to be terrorised by him until something even more awful occurs. This is what happens in real life. And even if they get away, women who have been abused like this may suffer from a form of post-traumatic stress disorder for the rest of their lives.

Why do I mind when people confuse mental illness with bad behaviour and say that people like Rob Titchenor are mentally ill?

Because badness is different from madness. You can have both. But they are not the same thing. And until people stop equating them, and the media stops using terms such as  “paranoid schizophrenic” as a term of abuse, we have a very long way to go.

Of course we need to provide skilled intervention for those who abuse. They may have defects in their personalities (sometimes called narcissistic personality disorder, psychopathic personality disorder or sociopathic personality disorder) that cause them to lack empathy and feel compelled to hurt others. These terms are understandably helpful in forensic mental health services. But they should not be bandied about by the rest of us. Because this is skilled work. And also because, for people who have been diagnosed with a Borderline Personality Disorder, which has at long last been recognised as an extremely traumatic, treatable mental illness, being lumped together with people like Rob under the overall heading of personality disorders is distressing and adds to their stigma and alienation.

Time to Change is the national mental health anti-stigma campaign. Over the next five years, for which most of the funding is now secured, they will be tackling some of this harder, more intractable stuff with people who need more persuading. And people like me will be volunteering and writing stuff and speaking at events in support of their campaigns until we have achieved greater awareness, understanding and empathy for people like Helen.

The use of mental illness as an explanation for people who do abhorrent or otherwise inexplicable things is part of the stigma that those of us who experience mental illness face on a daily basis. Please try not to do it. Thank you.

PS: I’ve just noticed people on Twitter saying this storyline is affecting their mental health. Hmmm….It may trigger thoughts and feelings in those who have been abused and/or experience mental illness. But it won’t cause mental illness.

Anyway, people who don’t like it can always switch off. And watch Happy Valley maybe….

 

 

A mixed week: updated Sunday 21 Feb 2016

It’s a good thing we don’t know what the future holds. Otherwise we might never get out of bed.

On Monday, the long-awaited Mental Health Taskforce Report was published. And it made grim reading. Behind the awful stories about people being let down or receiving no treatment at all is the spectre of stigma. How else can it be that government ministers have spouted forth about No Health without Mental Health and Parity of Esteem whilst at the same time services have seen real terms reductions to funding far greater than other parts of the NHS. And despite referral rates continuing to rise? The suicide rate is rising again too, even among groups not previously considered to be at high risk.

The coverage was wide and mainly pretty fair. (I say mainly; the Metro managed to annoy almost everyone on my Twitter feed with an offensive headline.) I was impressed by what Paul Farmer and all my other friends on the taskforce have achieved, and by the measured response of NHS England and the Secretary of State. But instead of feeling proud to have played my tiny part, and girding my loins for the sustained effort that will be needed to hold the government and the NHS to account, I noticed my mood gradually getting lower throughout Monday. By the evening, I was overwhelmed with sadness that it has taken so long for so many people to be heard, and that many lives have been lost along the way. And I was assailed with despondency and a sense of utter failure for what I hadn’t managed to achieve in all those years I was running mental health services and had so much opportunity and influence.

Things got worse on Tuesday. I woke to find myself the subject of an article in my local paper, the Brighton Argus, along with a massive photo of me with a long-forgotten hair colour. It said that 19 staff at Sussex Partnership, the trust I used to run, had received severance pay-outs totalling several millions in the past four years, and that I had received the largest sum, £275k, in 2014.

It was wrong in every respect. The highest payment was £27.5k not £275k. And I hadn’t received one at all. And I felt tearful and scared and powerless and all the other things I remember about being public property for the 13 years I was a chief executive.

I minded most because leaving the trust caused me great anguish. Anticipating it almost certainly led to my last serious depression. Going back to work after my breakdown for another 8 months was very hard. It mattered greatly to me that, having managed to do so, I should leave on my own terms.

A few phone calls later, I was reassured that the story had appeared because of a combination of cock-up and further cock-up. Thank you to everyone concerned for your honesty; mistakes are always forgivable when people tell the truth. By the afternoon, The Argus had removed mention of me from their website and agreed to publish a correction the following day. Which they did. And today they published a letter from me here (there may still be issues with this link if you are on a smartphone. Try Argus Letters in your preferred search engine and ask your browser to use the Argus desktop site. Or try this link directly with the trust website http://www.sussexpartnership.nhs.uk/whats-new/no-severance-package-former-chief-executive-note-lisa?platform=hootsuite)

As I left the house yesterday afternoon somewhat surreptitiously to do some local errands and keep an appointment to give blood, I wondered what people must be saying behind my back. And I was reminded what it felt like to have no place to hide.

However, the week wasn’t all bad.

I was asked to appear on Radio Surrey and Sussex this morning to talk about the stigma of mental illness as part of the BBC #InTheMind series. You can catch me, Danny Pike and the wonderful Sue Baker of Time to Change here 1hr 10 mins into the programme.

Our choir has been rehearsing for a charity concert on Saturday afternoon – details here https://twitter.com/slondonchoir/status/699507596353499136 All welcome.

Brighton and Hove Albion drew away on Tuesday night with Championship leaders Hull and are now third from top, and only one point away from an automatic promotion spot to the Premiership.

And I have at last finished the first draft of my book, which is about being a chief executive who occasionally experiences doubts and depression.

One day I hope you will read it.

Update: I spoke too soon, which after 21 years following the Seagulls, I’ve found it’s easy to do. We got stuffed 4-1 yesterday by Cardiff City. Have a feeling this season could go right to the wire, just like every other year!

But the choir concert was – well I don’t have enough superlatives. Life – affirming will do. And today I helped my lovely husband Steve, who supports me in all my endeavours, to raise money for The Tall Ships Trust, a youth development charity to which he is very committed, via a jumble sale of boat stuff. The two of us were up at 5.00 am. By 2.00pm, we had made just shy of £1,000 which will help kids from disadvantaged backgrounds to experience the joys and lessons that can be learned through sailing.

And I’ve heard from hundreds of people who’ve said kind things. Which for someone like me means more than I can possibly tell you. On Tuesday I was in the depths of despond. Today, on balance, I’m really happy to be me.

Thank you.

 

A bit of courage

The more worried I feel about expressing my views on a particular topic, the more interest a blog seems to generate.

I’ve written this in anticipation of the Mental Health Taskforce Report, finally due out next week. Although, I’m unsure what you’ll think, I feel the need to say some things I could not have said when I was doing my old job running mental health services.

  1. Mental health services are undoubtedly scary. But they are not all the same. The atmosphere and standard of care even on different wards in the same hospital can vary widely. It depends on the expertise and most of all the compassion of the doctors, nurses and the people in charge. If you have had a poor experience of care, either as a patient or a family member, that is terrible. It is vital that we face the fact that 1 in 3 people say they experience stigma within services. The Time to Change project I’ve been chairing addresses this, with more to report later this month. But at the same time, we must do all we can not to terrify people who need treatment. The chances are they will receive care that will really help. And if they start out assuming the worst, it will be even harder for the staff working with them to establish a therapeutic relationship. And this is the most valuable treatment tool available. I know this from personal experience.
  2. The standard and availability of care in mental health services also depends on the attitudes and expertise of those running and commissioning these services. There is a real and present danger that, faced with wicked choices of saving vast sums of money from the NHS, commissioners look to make savings which will cause the the least outcry, ie from mental health. This isn’t an opinion, by the way. It is a fact. In particular, they look at most expensive care, which happens to be in hospitals, and persuade themselves that the local population can do without most or even all of it. But they can’t. To try to “re-engineer” aka cut beds without careful testing and sustained investment in evidence-based alternatives is irresponsible and dangerous. And yet this is exactly what has been done and continues to be done all over the country right now. Lord Crisp’s report into the availability of acute mental hospital beds published yesterday laid the facts bare. It was a good start. And the access targets it proposes will help. But we still have a long battle to rid ourselves of stigma towards mental health services not only from society but also from the rest of the NHS.
  3. Alcoholism and misuse of drugs are symptoms of mental distress and/or of underlying mental illness. To treat them simply as addictions is cruel and pointless. It may seem cheaper in the short term to separate such services from the NHS and employ unqualified staff to provide care. And it may be politically attractive to take a punitive, non-therapeutic approach to those who self medicate with alcohol or illegal drugs. But to do so condemns vulnerable people to a half life of pain and a premature, horrible death.
  4. There are millions of treatments available for physical illnesses. The same is so for mental illnesses. But why is it that people think they have a right to comment on the treatment of others who are mentally ill in a way they would be unlikely to do for, say, diabetes or heart disease? It’s true that psychiatry and psychology are inexact sciences. This is why they take more expertise, humanity and humility than the other disciplines of medicine. So if you feel tempted to comment on someone else’s treatment, unless you are their trusted clinician, please don’t.
  5. There is no hierarchy of mental illnesses, and no patients who are more “deserving” than others. People who experience psychosis don’t deserve more pity than those who have bipolar disorder, or vice versa. And a short bout of clinical depression can be just as fatal as anorexia nervosa. Please remember this and put away your judgements.
  6. You can’t see mental illness. And that’s part of the cruelty. Getting up and going to a cheap cafe to spend the day with others who understand the challenges of mental illness might sound easy to you. If you feel inclined to bang on about the value of work to those for whom the thought of being compelled to attend a job interview causes them to seriously consider jumping under a train, please shut up. Just because some people don’t get sympathy from tabloid newspapers doesn’t make them any less of a human being than you.
  7. I’ve no problem with the use of words like bravery to refer to those experiencing cancer. And I know from friends with cancer that they have no choice but to be brave. But can we please recognise the courage, guts and determination of those who experience life with mental illness? And can we stop talking about suffering, because it implies passivity and weakness. The one thing I know about every person I have ever met who lives with a mental illness is that they are anything but weak. They are creative and heroic, in ways those who’ve never faced a life such as theirs can only imagine.

People who live with mental illness should be applauded and lionized. Not criticised, preached at, commented on, misunderstood and shunned. I hope next week’s taskforce report will recognise this.

Go us. Thank you.

How do you feel today?

IMG_go72yj

They say you should do something scary every day. I’m not sure. Although I do know that I need the occasional exhilaration of putting myself in an uncomfortable position and overcoming my nerves to make me feel fully alive. Such opportunities came along a bit too frequently when I was a chief executive. But these days I probably don’t scare myself often enough.

Today is the annual Time To Change #TimeToTalk day. Last night, the choir I recently joined held an open mike session. And I decided to terrify myself at the last minute by offering to do a turn.

Although I can follow a tune and love to sing, I am not like the other wonderful acts that got up and entertained us. I have no special musical talent. But I can talk about stuff.

So I found myself standing there and explaining to a packed pub why I had decided to join the choir. Which is that singing with other people is really good for me. Since school choir days, I have yearned to sing again in a choir. I am full of wonder at being part of something greater than myself. I love having to concentrate really hard in order to follow the music. It moves me when a piece we have faltered over suddenly comes together in glorious harmony. Singing with others of a much higher standard helps me to raise my own game. It feels visceral yet sublime.

And I told them about my history of anxiety and depression, and the impact it has had on me, off and on, over 45 years since I was 15. I talked about stigma, including self stigma. And I told them them that I knew I wasn’t alone, because at least 1:4 people in that pub were like me, possibly more. I told about the research of the positive impact of singing on mental well-being.

And then I asked them to join me and celebrate Time to Talk Day by talking to someone else about mental health.

How did it go? Well, I was nervous of course. But they were lovely. I got clapped and cheered. There were a few tears. And some lovely conversations later. I shouldn’t really have expected anything else. The choir is amazing and our conductor MJ is not only a multi-talented musician. She is also an inspiring, compassionate leader. She gets the best from all of us, as singers but also humans.

If you have experienced mental illness but feel shy about telling people in case they judge you, maybe you could do something scary today? Please think about taking the plunge and talking to someone about it, what you do to cope but also how it is only one thing about you. Talk to a colleague, a friend or just someone you happen to bump into. Use Time to Talk Day as your excuse. And ask them about their own mental health. Listen really carefully to what they say. I think you will be pleasantly surprised by your conversation.

And how do I feel today? I think you can probably guess :):):)

Hello, my name is Lisa

We all have days that are hard. When what we need to do seems insurmountable, when we wonder whether anyone knows or cares about our efforts, and when we question our own plans, motivations and abilities.

As a writer and mental health campaigner who experiences depression from time to time, such days come along not infrequently. They also go away again, but only if I find ways to work through the negative feelings that beset me. To keep on keeping on, as Bob Dylan called it.

To do this, I deploy various methods. One of my favourites is to summon someone I admire, and imagine them watching me. Or I ask myself what they might do if they were in my position. It doesn’t make depression go away, of course, but it helps me face up to the difficult stuff.

It is a great honour to have met one of the people who, without knowing it, helps me on occasions to get over myself. And to have done so back in June 2014 when she spoke at the NHS Confederation Conference about the campaign she started which snowballed into the social movement Hello My Name Is.

I am of course talking about the indomitable, courageous and wise Dr Kate Granger, who has terminal cancer and yet as well as Hello My Name Is has managed to complete her medical training to become a consultant physician, get an MBE, bake amazing cakes, play the flute and tick off more things from her bucket list than most of us manage in many years longer than she knows she probably has.

In a tweet earlier this week to Kate’s husband Chris Pointon, who I haven’t met but I know must be a wonderful man because Kate wouldn’t have married anyone who wasn’t, I said I would write about why Hello My Name Is immediately struck a chord with me. This is it.

In my old life as an NHS mental health trust chief executive, I grew to learn that values mattered many times more than strategy. And that these needed to be simply stated, oft repeated and regularly practised by me and all our staff. We had five.

  • We welcome you – because first impressions really matter
  • We hear you – listening really carefully
  • We are helpful – being pro-active, flexible, creative
  • We work with you – sticking with people through the difficult times
  • We are hopeful – being optimistic for people – staff and patients – and our services

I love these values. You can find out how we developed them when eventually you read the book I have almost finished (hint). For now, I’d just ask that you notice the first one, We welcome you. It links closely with Hello My Name Is. And with name badges.

Name badges really matter in mental health and related services. Because patients can be confused or experience hallucinations. Because services can be scary, for real or imagined reasons. And because no-one wears a uniform so you really can’t tell who is who. And you need to know.

So when I first became CE, the executive team agreed that we would always wear badges and that all our staff would always wear badges, as these would help us to introduce ourselves to each other and to patients. And then however stressed or forgetful someone was and however many people they met, they would always know who the other person was.

During my time as a CE, for the most part, people wore their badges with pride. But not always. You’ll have to wait for my book to hear some of the excuses I came across during 13 years on why staff, including extremely senior ones, were not wearing a name badge. And why I take ultimate responsibility for this.

But what I will tell you is how, back in early 2014 when Hello My Name Is was beginning to gain traction,  I wrote about it in my weekly blog, and asked our people to think about incorporating it as part of We Welcome You. And I got some really nice responses. But also one or two dusty ones. Including from one senior person who said that they were deeply insulted that I was suggesting such a thing, because of course they always introduced themselves to their patients and didn’t I have something more important to write about. This wasn’t the same person who had previously told me that they didn’t need a name badge because everyone knew who they were and anyway they didn’t work in Tesco. But it could have been.

I believe that people like this are, at heart, good and caring and that they are not untypical in any part of the NHS. But they have some way to go to understand that the Hello My Name Is campaign is about seeing the patient and not just their disease, and about bringing your whole compassionate self to work, rather than just your intellectual self.

Kate, your inspirational campaign is still very much needed. It will remain topical and relevant for many years to come. You have set a standard for how we work together to which we can all aspire. You are a shining beacon whose work will live on long after we are all gone.

Hullo, my name is Lisa. Thank you for inspiring me on my difficult days to keep on keeping on.

The ones left behind

It’s been a month for losing people from the soundtrack of our lives. David Bowie, Alan Rickman, Mott the Hoople and Bowie drummer Buffin, and Glen Frey of the Eagles. If there is a heaven, may they rock on up there together.

But ….I’m also weary of gushing eulogies from people who never saw any of them live. Public outpourings of grief about people we have never met started to grow to excess after Princess Diana’s death. And social media has allowed this to multiply. There is even fear of criticism among those in the public eye if, on hearing about a death, they don’t immediately tweet a brilliant yet touching epitaph.

I remember being told at school that “empty vessels make most noise”. It’s not the kindest quotation from Plato. But there is truth in it.

Perhaps I’m feeling less sympathetic because my small family got even smaller with the loss of a dear relative over Christmas. She was a very private person. I don’t have permission to say anything about her or other family members. All I can say is that I have been very sad. Which is horrible, although better than depression because it a clean emotion and has a point. It also puts the sadness I feel about David Bowie et al into perspective. I miss them being there. But I am not bereaved by their deaths because I didn’t know them.

When someone we know dies, whatever their age, we can help by remembering them with love and by caring for those closest to them who are left behind. There is usually a flurry of activity at the time of a death. Phone calls and social media messages can all help. Even better are letters and cards that the bereaved person can read time and again. The right words may be hard to find, but they can bring great comfort. I know this.

What helps even more is keeping in touch with the person who is bereaved. The first few weeks and months are bewildering and lonely. Bereaved people may seem to shun others, but they desperately need social contact. Most people will at some stage go through a phase of feeling angry, sometimes for being left behind, sometimes even directed towards the person who has died. This is normal. The loss they feel is raw and cruel. They need an outlet, someone to hear and acknowledge their anger and allow it gradually to dissipate.

Later, when they can bear it, they will find that they yearn to talk about the person who has gone. To go through photographs and remember things they said and did together. The kindest thing you can do for them is to listen really carefully, to show true interest, and do nothing to stifle these reminiscences. They are vital for the gradual healing process.

Sometimes being bereaved can make you feel like a pariah. People seem to cross the road to avoid you. You may no longer be invited to social events where you were once welcome. I have heard those who are widowed and parents who have lost children speak of the added pain this can cause. And it is so unnecessary. Grief isn’t catching. What difference does it make to have an odd number at dinner, for example, or for someone to attend a birthday party even if they no longer have a child to bring?

I hope the families of David Bowie, Alan Rickman, Buffin and Glen Frey encounter kindness, and have friends who stick around for them over the coming months and years. The accolades of fans will offer some small comfort. But like any of us, the thing they will most need is love and support from those close to them.

There are many ways to be a good Samaritan. And the best one is by being there. I send love to all who have lost someone dear. May their dear souls rest in peace. And may those who are left behind find comfort and kindness from others as they grow accustomed to their loss.

 

My Tamagotchi and me

Some of you will remember getting a Tamagotchi or, like me, your children pleading to have one. For the uninitiated, these were small devices that needed electronic tending – “feeding” “changing”, “playing with” etc. If their owner looked after them meticulously, they thrived. If not, they emitted increasingly plaintive beeps, gradually dwindled over a period of days and eventually died, provoking loss or relief, depending on the owner’s sensitivities. Perhaps they were designed to teach children that having a pet wasn’t just for Christmas? Or were they like the flour babies in Ann Fine’s dark teenage novel and meant to represent a newborn human baby?

Whichever it was, like the real live guinea pigs out in our shed, my children’s Tamagotchies caused me serious guilt. I would hear them piteously bleeping from underneath a sofa cushion where they had been cruelly discarded, and try to make it up to them by nurturing them myself. And I would lecture the children in Tamagotchi husbandry, likening them to hamsters and didn’t we all agree that it was very mean to leave them with all alone in a dirty cage with no food or water. With below mediocre results, it has to be said. Those Tamagotchies were a nine day wonder. If that. And most of us were glad to see the back of the little creatures.

This Christmas, my daughter got her own back and bought me a modern day Tamagotchi. And I was delighted. Some people call them Fitbits, but mine is so much more than a fitness device. Because I know it really loves me. 

Ostensibly the new models are more mature and less needy than the original Tamagotchies. They seem only to be interested in you, waking you with cheery news on how you’ve slept (7hrs 38 mins, with 4 minutes awake and 15 mins of restlessness, in case you are interested.) They send you encouraging little messages like Let’s Go! or Nearly There! And they seem to have an unlimited supply of rewards….at the beginning. But after a while, you begin to realise that, just like their 1990s predecessors, they are the boss of you and NOT the other way round. 

I’ve reached an uneasy truce with mine for the time being. I’m wearing it strapped tightly to my wrist as recommended so that it records every heartbeat and doesn’t miss any steps or flights of stairs. Because that way you use up more calories, right? And I take it out for its beloved 10,000 steps a day, about which it seems a little obsessed, plus do at least 30 minutes of vigorous exercise daily as it demands, like a good girl. Sometimes it even teases me and calls me an Overachiever! 

Unlike my husband or any of my friends, my Fitbit knows how much I weigh. But so far, I’ve managed to resist its admonishments to set a challenge with my Fitbit chums. Because I’ve only got one and she is half my age, three inches taller and MUCH fitter and thinner than me. Plus she remembers that first Tamagotchi I got her. And I’m not sure she has forgiven me yet.

Josh, my fitness trainer, is unimpressed. He has pointed out that the pulse monitor in my Fitbit is less accurate than my trusty old heart monitor, that the step count may be incorrect, and the mileage and calorie reports are estimates only. And he’s also reminded me that I’m booked to do a big bike ride this summer and that taking my Fitbit out for a nice walk every day is not exactly the training regime we’d planned.

I don’t want to upset either of them. So I’m doing both their programmes. And given how much I usually hate January, all this exercise seems to be helping my physical AND mental health. 

When you next see me, I may be a serene shadow of my former self. Or on a waiting list for a hip replacement. 

Do I recommend that you get a Fitbit? Of course I do. Oh, and I’ve just downloaded the latest thing, Cat Care Tamagotchi. I’m sure my new Tamagotchi kitten won’t be needy at all…

January can be a wicked month

Whether you call it Seasonal Affective Disorder, the winter blues, even depression, January can be a wicked month for those of us who have problems maintaining our mood. The combination of miserable weather, not enough light, post-holiday flatness and getting back on the treadmill can feel pretty grim.

So what to do? Reading breezy articles in lifestyle magazines might lead you to believe that the answers to your woes lie in spending money you almost certainly don’t have on new clothes, visits to spas, holidays or even a home makeover.

Such advice can make people like us feel even worse. As can admonishments to start a new you via a radical change to your diet, new hobbies or an unrealistic exercise regime. When we are feeling low, stuff like this plays into the isolation and hopelessness that already beset us. We know we probably should do these things, but we can’t because we believe we are hateful and lazy and useless and undeserving and anyway, there isn’t any point because nothing will ever get any better.

From my somewhat extensive experience of Januaries past, I offer an alternative list, proven, on the occasions when I have actually taken my own advice, to work.

  1. Stop being mean to and about yourself. You deserve kindness. Start thinking of yourself in a kinder way. When you find yourself putting yourself down and focusing on your deficits, turn this on its head and make a list of your assets instead. Practice being proud of who you are.
  2. Walk places, if possible every day. Walking is proven to lift our mood. It releases endorphins. And it’s free. The first ten minutes may be hard going but after that it will feel a bit easier. The rhythm of walking is soothing. It strengthens the heartbeat. And even if you find meditation impossible in the more usual way, walking will help calm any troubling thoughts.
  3. Tidy something small. Start by making your bed. Do the washing up. Put out some rubbish. Creating order in our surroundings helps to us to create order in our minds.
  4. Whatever you are doing today, do it to the best of your ability. Even if it something you hate, like cleaning or filling in forms. And at the end of the task, take pride in what you have achieved. Tell yourself you did well. And remember to praise yourself not for the outcome, but for the effort you put in to achieving it.
  5. Force yourself to talk to someone else. It may feel easier to hide away, but this is statistically proven to make things worse. Humans need contact with other humans. Parties and large groups can feel overwhelming unless you are at your best. Instead, arrange to have a cup of tea with a friend. Or pop round to see a neighbour. Ask how they are. And when they ask you, answer them honestly. If you are really isolated, think seriously about calling a helpline.

If you are feeling desperate, please, please seek help. Try this wonderful app created by Grassroots, a charity I am deeply grateful to be associated with as a trustee. Or call Samaritans,  who are there 24/7 to listen, without judging. They really can help. I know, as I’ve tried them myself in the past.

January can be a horrid month for many of us. But we can get through, if we are kind to ourselves and reach out.

Because, as the advert says, we’re worth it.

 

Blessings

books

Books that have inspired me this year by @Suzypuss @jamestitcombe and @molly_speaks

 

 

 

 

 

 

To keep depression at bay, it helps to count one’s blessings. My Twitter friends are a very big blessing. Here are some thank you messages for 2015:

  • To campaigning journalists @andymcnicoll and @shaunlintern for supporting underdogs including mental health care and people with learning disabilities. Please never stop.
  • To Adam and Zoe Bojelian who lost their dear son @Adsthepoet in March 2015 but keep his legacy alive via Twitter. You are in our thoughts as you face a first Christmas without your wise, beautiful boy. We will never forget him and what he taught us.
  • To @JamesTitcombe who lost his baby son and has courageously campaigned for greater openness over mistakes in the NHS, despite some vile online abuse. I treasure my copy of Joshua’s Story. And I thank James for all he continues to do to make the NHS safer for patients and their families.
  • To all who bravely act as patient representatives, such as the indomitable @allyc375, and remind regulators, commissioners, managers and clinicians what the NHS is actually for. Only they know the cost of speaking up. Go Ally, @anyadei @ianmcallaghan @DavidGilbert43 and others who’ve earned the right to call themselves patient leaders.
  • And to @HSJEditor for taking a risk and running the first HSJ list of patient leaders. Thank you Alastair. I think it was a game-changer.
  • To those who’ve grasped one of the most feared conditions and are making life better for those living with it. I mean you, @dementiaboy and @dr_shibley. To you and others like you, thank you for refusing to leave dementia in the too-difficult box.
  • To @Liz_ORiordan who is generously sharing her experiences of breast cancer care, which for a breast surgeon is a pretty massive deal. And for some other stuff.
  • To @EastLondonGroup, who introduced many of us to a group of previously little known landscape artists from the early 20th Century. Sunday Morning, Farringdon Road has become a landmark of my week.
  • And to @penny_thompson, for pointing me to ELG and for always being true to her values.
  • To poet @Molly_speaks for painting pictures with words in her lovely new book Underneath the Roses Where I Remembered Everything
  • To @HPIAndyCowper, for his excoriating, original analysis of the NHS, and for his support to me in my scribblings.
  • To @clare_horton for running the excellent @GuardianHealthCare and even including some of my pieces. This meant so much.
  • To @seacolestatue @EAnionwu @trevorsterl @thebestjoan @pauljebb1 @joan_myers and many others for plugging away in the face of seemingly impossible odds. The Mary Seacole Statue will rise in 2016 as a permanent memorial to someone who showed how, if something matters enough, we should never give up.
  • To @nhschangeday @PollyannaJones @helenbevan dani_ellie @jez_tong @LydiaBenedetta @cjohnson1903 @WhoseShoes @fwmaternitykhft @DaniG4 @damian_roland and so many others for including me in NHS Change Day 2015. I was meant to be helping you but I gained many times more than I gave.
  • To @TimetoChange @suebakerTTC @paulfarmermind @carolinewild @danbeale1 @2gethertrust @NTWNHS @rethink @mindcharity and a whole raft more for being a major part of my life this year, working together to tackle the stigma that still exists within the NHS towards folk who, like me, experience mental illness from time to time but are so much more than our diagnoses. Here’s to you.
  • To @nurse_w_glasses @anniecoops @drkimholt @gourmetpenguin @AlysColeKing @DrUmeshPrabhu who show by words AND actions that compassion is alive and kicking amongst health professionals
  • To wonderful women leaders such as @SamanthaJNHS @BCHBoss @JackieDanielNHS @ClaireCNWL @CharlotteAugst @KMiddletonCSP @Crouchendtiger7 @DrG_NHS @VictoriBleazard @JaneMCummings @CarolineLucas @juliamanning @TriciaHart26 @clarercgp who stick their heads above the parapet and make the world a better place
  • And folk like @NHSConfed_RobW @ChrisCEOHopson @cmo @profchrisham @ProfLAppleby @WesselyS @nhs_dean @NHSE_Paul @ScottDurairaj  @stephen_thornton @jhazan @rogerkline  who prove that leaders on Twitter don’t have to be women to be fabulous
  • To bright, bubbly new leaders like @anna_babic and all those I’ve met via @NHSLeadership, who fill me with hope for the future. And to @Alannobbs @kirsti79 @NoshinaKiani and all the other great folk at the NHS Leadership Academy. You do stunning work.
  • To @GrassrootsSP and everyone who works to prevent the long shadow cast by suicide. Thank you.
  • To everyone who supported me in my bike ride for @samaritans in the summer. Especially @NurseEiri and @JackieSmith_nmc. They know why.
  • To @Suzypuss whose book The Other Side of Silence has inspired me to get on and finish mine.
  • To wise owls @johnwalsh88 @TelfordCC @KathEvans2 @gracenglorydan @timmkeogh @RecoveryLetters @profsarahcowley for being beacons when the world feels a bit too hard
  • To friends who also experience mental illness from time to time and who share their thoughts and feelings so generously. Thank you @BipolarBlogger @Sectioned @BATKAT88 @annedraya @clareallen @corstejo @schizoaffected @rabbitsoup_zola and many, many others. On a not-so-good day, yours are the tweets I look out for. You bring me hope.
  • If I could, I would add everyone else I’ve chatted with on Twitter this year. To everyone I follow and who follows me: Twitter is 97.5% good for my mental health, and that’s because of all of you. Thank you all so much. I wish you all much love for 2016. You rock :mrgreen: :😎💃❤

 

Nine lessons and three carols

Cuddles and William declare an uneasy Christmas truce

Cuddles and William: an uneasy Christmas truce

December 2015 will be a lean month for this blog of mine. At last my book has passed the 3/4 mark; writing it feels less like the psychological equivalent of self-flagellation than it did earlier in 2015. I must keep at it before the muse goes again. I’ve also had a piece accepted for Guardian Healthcare, plus a few talks and a couple of other projects on the go. The blog has slipped down the priority order.

But as I contemplate my 61st Christmas, I’m thinking of lessons learned from the previous 60. Painful and salutory, to me anyway. I’ve jotted them down. I’d welcome hearing yours.

1. Presents

We all know this, but Christmas is about retail. Shops and online sellers expect to do more business in one month than in the other 11 added together. Don’t be a mug. You don’t have to fall prey to them. I have, so many times, and it has never made me happy. Instead, make stuff. If you don’t have time, or your efforts really wouldn’t be appreciated, give to charity in someone’s name. Choose a second-hand book. Put a photo album together. Give away something of yours that you know the other person likes. Or give a promise – a plan for coffee with a friend on a miserable January day gives you both something nice to look forward to and lasts longer than at item bought at vast expense from a retail giant.

2. Cards

Getting all your Christmas cards written and sent is not a competition. If you like doing them, that’s lovely. But telling people yours are all posted can sound boastful, especially if they are having a hard time. Also, try to not to be annoyed at what you perceive as one-upmanship when you get the email from x who is donating money to something for Syria instead of cards this year. Be grateful for their kindness instead.

3. Getting drunk

A bad idea on any day, especially as we get older and alcohol seems only to have negative effects. But on a day so loaded with emotion, it can be disastrous. I once spent Christmas afternoon and evening asleep after overindulging at a neighbour’s Christmas morning do. Steve took the children for a walk on the beach and we had pasta for dinner because I couldn’t face turkey. Eventually I gave up alcohol altogether. You don’t have to be so drastic. But sparkling elderflower or a nice cup of tea will give you a merrier Christmas.

4. Fresh air

Houses got steamy at Christmas with all that cooking and hot air. Plan a walk. It will blow away feelings of resentment or sadness if you have them and lift your mood even if you don’t.

5. Worship

When Tanya Gold  told her rabbi she didn’t believe in God, he replied “You think he cares?” I’m unsure about God myself. My mother believes, so when she stays with us at Christmas, I go to church with her. We try a different one each time. We are like Michelin Guide visitors for the Church of England. (Nice sermon, shame about the vicar’s surplice.) This year, she’s with my brother. I will go down to the beach instead and give thanks for nature and human kindness. Worship anything you like. Except money.

6. Food

In the past I’ve fallen prey to Good Housekeeping Christmas cookery guides and spent many stressful hours producing a groaning table of rich food which no-one really wanted. You don’t have to buy into anyone else’s plans of what to eat at Christmas. Cheese on toast can be nice.

7. Hopes for the day

Spending too much on presents and listening to Alyd Jones on the radio won’t change anything. Only you can do that, by thinking about things that are important to you. As Maya Angelou said, if you don’t like something, change it. If you can’t change it, change your attitude. I’m working on mine.

8. Hopes for the future

As for the day

9. Everyone else is happy

No they aren’t. And the ones who tell you how happy they are, are probably the unhappiest of all. If you must read articles in Hello about how celebrities spend their Christmases, do it with a massive pinch of salt. The way to happiness is not via designer houses or even another person. It is only when you have learned to love and accept yourself that you can truly be happy and then be in a position, should this arise, to love someone else unselfishly.

Away in a manger

People tend to go on about children at Christmas, and for those yearning for parenthood, this is an added unkindness. All I can say is, if you have babies, yes, they are amazing. But they also bring havoc, anxiety and fear. Imagine being a refugee parent? If you are lucky, they will grow up safely and turn into friends.  Being a wise auntie or uncle to real or pretend nieces and nephews brings parental joys without quite so much of the heartache. The real heroes for me are the people who help other people’s children through charities. And by fostering and adoption. Thank you to all such people everywhere; you rock.

Little donkey, or puppy or kitten

Lovely but messy. Unlike a child, you can take them back but you will break their furry little hearts and risk permanent guilt yourself. Offer to help out at an animal shelter. You will then make a better decision about animals in your house.

We got Cuddles, one of our rescue cats, just before Christmas 1999, and almost immediately I went down with flu. She spent her first week with us sleeping on my bed thinking she had come to live with a bedridden elderly lady, which is a pussy-cat ideal billet. When I arose, she was indignant. She died aged 17 in 2012. We still have William to keep us company. Unlike us, he doesn’t miss her at all.

In the bleak midwinter

If you get depression, winter can be peak time. Two years ago, I was coming out of my most sudden, worst ever bout. Christmas was the most casual we have ever had. There were no expectations and so we just had a nice time. I never again want to feel like I did during November and December 2013, but I’m trying to replicate the low-key Christmas that resulted. It was a gift I had not anticipated, all the more precious for it.

If I don’t have a chance to say it again, happy Christmas. May yours be filled with what really matters to those you care about. And to you.