forgiveness

You’ve got a friend

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Dear Friend

I saw the above from Stephen Fry a few days ago and loved it. It made me think how much I have to thank you for.

  1. Thank you for standing by me when I did things that later I came bitterly to regret. You never said  “I told you so” but you were there to help me pick up the pieces.
  2. Thank you for recognising that we are different, and for not sitting in judgement of me or the paths I choose to take.
  3. Thank you for keeping in touch during times when I “go quiet” and for not seeing my lack of effort as a personal slight or a sign that I am a rubbish friend. Even though I am.
  4. Thank you for listening to me, for only giving advice when I ask for it, and for not minding when I inevitably fail to take it.
  5. Thank you for being worried about me when I have done things to hurt myself, and for reminding me, despite how I sometimes feel, that I am worth caring about.
  6. Thank you for being there to celebrate my successes and for knowing the personal cost of these achievements.
  7. Thank you for the times when I couldn’t speak and you held my hand and told me you would always be there.
  8. Thank you for once sending me a postcard I will always keep which says “Blessed are the cracked, for they let in the light.”
  9. Thank you for understanding my need to be liked and needed, even though you are much more sanguine and self-contained. And thank you for letting me help you sometimes; I am so glad that I can.
  10. Thank you for never asking me why I get depression. Sometimes you know better than I do about why. And sometimes it just happens.

My life is a bit of a roller coaster. It has taken me nearly 60 years to learn that, no matter how much I try, I can’t completely change that, although I am at last learning to recognise my triggers and be kinder to myself and thus to others. You help to make the ups less scary and the downs a tiny bit less grim.

With my love and thanks to you for choosing to become and to stay my funny, kind, wise and very dear friend.

From me xxx

Are you feeling sad about the election?

The exit polls turned out to be right. And whilst Conservative and Scottish Nationalist supporters are ebullient, I’ve lost count of the number of people who have remarked on social media that they feel really depressed.

For the majority saying this, the feeling they are experiencing isn’t depression in any clinical sense. It is disappointment, sadness and loss. It is a normal grief reaction to something shocking and unexpected, which dashes hopes for the future. And it re-introduces and even expands fears that people who were hoping for a better result for Labour, the Lib Dems, the Greens and even UKIP had overcome, albeit just for a short while.

The five stages of grief model described by Dr Elizabeth Kubler-Ross was not intended to be prescriptive. It was an extremely well-received description of how people who are terminally ill get used to the idea of their own impending death. The stages of grief described are Shock, Denial, Bargaining, Anger, and Depression, better described perhaps as deep sadness. This, in time, leads to Accommodation/Acceptance. Depending on the nature of one’s loss, grief has to run its course. It is possible to get stuck at any stage, and for stages to have to be repeated. Trying to avoid the anger or sadness phases by keeping busy and pretending to be OK can be psychologically damaging; I have form on this myself.

There will be people today who will undoubtedly be at the start of a significant grief cycle, including the 3 party leaders who have resigned, those who have lost their livelihoods, and those closest to them. For the majority of the population, though, the cycle will pass quite quickly.

Some people are already into the angry phase; this is can be when blame gets sprayed about and bad decisions made. It is a time when we are advised not to make big decisions.

It is also important not to get stuck at the anger phase. Those who have learned to attribute responsibility for bad things that happen to them to others can waste huge amounts of energy re-traumatising themselves and failing to realise their own power to effect positive change.

Some people who experience mental illness get annoyed about the misuse of the term depression to describe feelings they see as relatively trivial compared to the self-hatred and hopelessness of clinical depression. I used to be one of them, but these days I am less fussed. As long as people understand that one word can have many meanings, I am more than happy to share it.  But I do want everyone to understand that there are no such things as happy-pills. If you aren’t clinically depressed, anti-depressants won’t make things better. Only you can do that, by getting to know yourself, and being kind and compassionate to yourself and to others.

It is tough advice, but as Maya Angelou said:

If you don’t like something, change it. If you can’t change it, change your attitude. 

The brilliant thing about our democratic system, apart of course from actually having one, is that MPs may only be elected by some of their constituents. But they are there to represent all of them. Occasionally they just need reminding.

I’m consoling myself about the the loss of the rainbow coalition I fondly imagined by thinking how to keep mental health on the agenda of the Conservative government, as they promised us during their election campaign. We have to make the business argument that investment in mental health treatment and support saves money in the long run. As well as the compassionate one about saving lives and making those lives worth living.

It is wonderful that there are millions of us who care enough to do the same.

 

 

 

Please take care, Twitter can be cruel

I love Twitter. But it can be a cruel place. Personal attacks and even threats of death are not uncommon. Sue Perkins and Jack Monroe are the latest high profile quitters following unrelated horridness – in Sue’s case, she was attacked for being (wrongly) tipped as Jeremy Clarkson’s replacement on Top Gear. Jack’s was about supporting the Greens on the election. Death threats for this? There are no words.

I’m nowhere near their league, but I’ve had my share of online nastiness, and it continues. It can be overwhelming when you are under an onslaught from many directions. And unless you reply and risk even worse, other more measured folk won’t know what’s happening, because the vile stuff won’t appear in their time line.

I am of the “Whatever we wear and wherever we go, Yes means Yes and No means No” generation. I don’t see why bullies should frighten us away from places that belong to us all. But I’m also concerned for my own wellbeing and that of others.

It is good that Twitter are cracking down on abuse – better late than never. Meanwhile, here are my tips for staying emotionally safe and still getting the best from Twitter.

  1. Be yourself but think really carefully about how much you share. Social media is still a relatively new medium. Some are already regretting earlier openness. I’m thinking particularly of people like me who experience mental illness from time to time. Talking with others who have similar experiences really helps, because with diseases of the mind, unchecked irrational thoughts about ourselves can snowball and be really bad for us. But sharing also makes us vulnerable. Only a handful of people have accused me of psychological weakness, attention seeking or of using my depression as an excuse for past failings. Even fewer have defaced my image, called me vile names, and traduced my appearance, intelligence, morals, motivations and career. I have forgiven but I cannot forget their words. On a bad day, I imagine that others may feel the same way about me. On a really bad day, I may even agree with some of this shit. So please, take care.
  2. Be wary of individual tweeters who follow few people themselves. They may say interesting stuff, but they are unlikely to be interested in an online conversation with you. Maybe you don’t mind just reading their views? It’s a good way to start, especially if you are shy. But most of us are on social media because we want to exchange thoughts, share experiences and ideas.
  3. Don’t just follow those you know you will agree with. It might feel cosy to be in a cocoon of like – minded folk, but it won’t stimulate or enlighten. If it weren’t for Twitter, we wouldn’t know the odious extent of the views of, say, Katie Hopkins on people seeking asylum. What better spur to get the previously disaffected to vote than the thought of people like Hopkins (who always vote, by the way – they know their rights) getting more of a say than us non neo-Nazis? We need to know these things.
  4. Take the plunge and join in conversations when you haven’t got a view or are still making up your mind. Some people think that being open – minded, even undecided, is feeble or wishy-washy. I disagree. Just be sure that when you in one of these discussions,  everyone is treated with politeness, including you. Be prepared to walk away if that doesn’t happen.
  5. Join in with conversations that are happening at the time you are actually on Twitter. Prepare yourself so you don’t feel too hurt if people whose views you admire don’t respond. Just move on and chat to someone else. Don’t assume people are being rude; they might be but that really isn’t your problem. Easier said than done when you desperately want a reply, I know!
  6. Try not to get involved in those angry ding-dongs where an increasing number of @names get added, until in the end there is no space to say anything. If you get copied in, these are best ignored, in my experience.
  7. Don’t be heavy – handed with the Block button. Some people collect blocks like trophies, and will proudly list you as a person who lacks empathy along with others you may prefer not to be associated with. And you won’t know about this if you have blocked them. Save blocking for porn sites, annoying bots and people who are genuinely harassing you. And for the latter, do also report them. Twitter are rightly upping their game in dealing with online harassment. If you are being repeatedly harassed by someone, you may also need to check if they have other profiles. In my experience, these are relatively easy to spot. And do also report them to the police. They definitely do take action when serious threats are made.
  8. My thoughts here are aimed at people like me who are able to tweet as individuals. The freedom we enjoy compared to those in public positions cannot be underestimated. I’ve been in one of those jobs, and written about use of Twitter from that perspective here. It is great if such people can share something personal of themselves, but it is a big ask, given what can happen and the impacts. Which leads me to my final point.
  9. Don’t rush to judgement of others. No-one knows what it’s like to sit where they are sitting, other than they themselves. Be kind, always. Never, ever make remarks like James May did recently about those who made death threats towards Sue Perkins. He only made a bad situation worse. If you can’t be kind, walk politely but firmly away.

I’ve blogged in the past about forgiveness. If you haven’t seen it and are interested, here it is.

I’m still practising by the way.

 

#NHSChangeDay is not a distraction from #Kirkup. It is how we will fix things

This week, a number of people have been challenging those of us involved in NHS Change Day to demonstrate its value. Particularly in the light of the Kirkup report about what went wrong with maternity services at Morecambe Bay Hospitals over an extended period.

For example @GeorgeJulian wrote this interesting blog.

There are others questioning whether NHS Change Day is a cult, a cheer-leading exercise led by those with not enough to do, a distraction from the grindingly hard work of running the NHS without sufficient resources, even an opportunity for organisations to put a gloss on how tough things are for patients and staff.

I can see why they might think that. I have another take on it.

The Kirkup report was shocking, for me even more so than the Mid Staffordshire Hospitals report. It got to the heart of what can go wrong when staff go rogue and collude, when key professionals who should be working together in harmony for the benefit of patients declare war on one another, when clinicians are simply not competent to practice, and when managers, commissioners, regulators and even the ombudsman indulge in a form of magical thinking, ignoring the evidence of high rates of death and other serious incidents and accepting assurances that should never have been given. The courage of families, including the man who worked at the hospital and lost his wife and new baby, and James Titcombe and his wife whose baby son Joshua died, has been extraordinary. We owe them a debt of gratitude for never giving up and continuing to insist that the evidence must be looked at properly.

So how can NHS Change Day help? I write now as a nurse and a manager. There have been many times in my 41 years when I have been aware of something not being right. The first time I blew the whistle, I was just 18 and hadn’t even started my nurse training. You’ll have to wait for my book to read the details; suffice to say, I was ill-prepared, it didn’t go well and I was sent away with a flea in my ear. Sometimes it was me that made mistakes, sometimes it was someone else; these things can happen, and we were rightly taught always to own up if we had erred. But what about the surgeon with the shaky hands that everyone was expected to ignore, or the night sister who slept in the laundry room when she should have been supervising us? Who wants to be hated for being a sneak and reporting people who are liked, or may be experiencing personal problems?

My blood ran cold reading about those midwives at Morecambe Bay. They reminded me of maverick teams I have known. Teams who are brusque and unwelcoming however hard you try to engage them, who repel enquiries, describe managers who visit their services and ask questions as interfering, or even talk about bullying if an aspect of their working practice is questioned. And what about more senior clinicians, such as doctors, who are described by colleagues as brilliant but eccentric, and can be extremely unpleasant and difficult to deal with. The ones who write you long letters describing, with great charm, the stupidity of your ways for trying to introduce a change to improve the experience of patients. These people are the exception, but they have a massive impact. I can remember as an executive being told by a senior clinician that to expect to see the results of their clinical audit reports was tantamount to a slur on their professional standing. Eventually a brave junior member of staff blew the whistle on this person. They were dismissed for gross misconduct, upheld on appeal. But despite a ton of evidence, their regulatory body decided to allow them to continue in clinical practice.

The point I am making is that it isn’t easy to be a whistleblower, nor is it straightforward to tackle poor practice. The law is loaded on the side of employee rather than the employer, rightly so, but in healthcare this can and does affect patients.

Initiatives like NHS Change Day are the antidote. They put patients and caring, committed, non-defensive staff where they belong, in the driving seat. Leaders, including patient leaders, set the direction and tone, patients and staff come up with the ideas, and managers support them to deliver these together. Those who object to the change being proposed have the opportunity to discuss it and put the alternative case forward. Ultimately, the majority will decide. Encouraging an open, enquiring culture that is always seeking to improve practice is the best possible way for the NHS to become safer and more compassionate for patients and the vast majority of staff.

It isn’t easy always to be open to change, but we should all be learning and improving continuously.

I’m leading the Time to Change initiative for NHS Change Day. This video explains why – the key bit is from 3 mins 20 seconds. I hope it explains why I feel so strongly about change and in particular, reducing the stigma of mental illness within the NHS.

Thank you.

 

 

 

What I have learned through recovery

An episode of clinical depression isn’t sadness. For me, it starts with brittleness and a growing sense of doom. I stop sleeping and become increasingly irrational and irritable. Beyond a certain point, I am unable to ignore or control it. Eventually, something snaps. I am smothered by a suffocating blanket of nothingness. The only feelings to permeate are deep guilt and self-loathing. All perspective is gone; I ruminate endlessly over things I have messed up and those I have hurt. I am frozen, unable to speak, or crying. The tears do not soothe. I detest myself.

Luckily I don’t feel like this all the time. Having been on my latest road to recovery for the best part of a year, I have learned a few things about looking after myself that I want to share.

  1. Choose to be all of me: having learned that it is so much better to be open about my experiences of mental illness, I now have to work hard at not allowing depression to become my defining characteristic. It is just one thing about me.

  2. Expect less: if someone likes something I have done, that’s lovely. But I need not feel disappointed if they don’t.

  3. Mindfulness: live in the world and be in the moment. Enjoy the little things – rinsing a cup, the warmth of the cat’s fur. Stop rushing.

  4. Going out: notice how exercise in the fresh air, even in wind and rain, makes me feel strong and alive. Embrace it and do more.

  5. Stop ruminating: I’ve wasted a lot of time going over and over things. It is important to learn lessons when something goes wrong – CBT has taught me to face the difficult stuff with less fear. But knowing when it is time to move on is a skill that needs frequent practice.

  6. Choose to forgive: This goes with number 5, and I like to think I am better at it than I was. Again, I have to practise every day.

  7. Create order from chaos: people think I’m tidy, but the more distracted I am, the messier I get. I have learned that, on a day when I am feeling low or anxious, I need to create order. Write a list, tidy a shelf, weed a flowerbed – completing a small task that brings order is soothing.

  8. Buy less stuff: I thought I loved shopping, but it made me feel guilty to spend money I couldn’t afford or could have given to someone more in need. Now I try to buy less. Except fresh vegetables.

  9. Make do: this goes with 8. I gain increasing satisfaction from mending things, making something from something else, or giving something of mine to someone who can make good use of it.

  10. Treating myself: on bad days, addictive substances such as alcohol, caffeine and chocolate can seem like treats. It takes some of us a lifetime to learn that they aren’t. A soak in the bath, a walk by the sea or some quiet contemplation in a sacred space can feed the soul rather than flooding the brain with dopamine.

  11. Competition: for me, best avoided, except with myself when trying to improve personal performance.

  12. Listen hard: I used to miss so much or misunderstand because I was too busy interpreting what people were saying and working out what response I should give. I am learning the value of listening really carefully. It is amazing what you hear when you listen properly.

  13. Don’t shy away from things that feel difficult or scary: it takes huge courage even to leave the house when you are in the early stages of recovery from depression. Standing up in front of 200 people in my first week back at work, I wanted to die. But I am so proud that I did it. I have found that, as I get better, I thrive from the boost to my endorphins that comes from feeling fearful yet excited about a new challenge, preparing carefully and managing my nerves so that I do a good job. I feel very lucky that in my new world, there are plenty of opportunities.

  14. Stop pretending: when someone asked me how I was, I used truly to believe it was a dereliction of duty to say I was anything other than great. I have learned to tell the truth about how I am – some days I am good, and some just OK. And when I am not OK, I am better at saying this too.

  15. Choose kindness: people have often said of me that I am kind and generous. This came at a cost. I have learned that to be truly and effortlessly kind, one must start with oneself. The love I feel for other people and the kindness that flows from me towards them has multiplied as I have let go of negative feelings towards myself. I am far from perfect and still have many faults, but I am worthy of love. This helps me to help others more than I ever could before.

These are just my thoughts; if they help someone else, that’s great. But please, don’t shout at me if you disagree. We are all different. And that’s what makes us so amazing xxx