Acquiring the DVD of Stephen Fry's two part documentary The Secret Life of a Manic Depressive has caused me to reflect on how differently I now feel about mental health services, Stephen, and myself - 5 years on from when the programmes were made.
Stephen and I go back a long way. I've often relied upon him for a bit of 'vicarious living', although of course we have never met. We seem similar in many ways (apart from the sexuality that is - I consider myself 95% straight).
Everyone enjoys some vicarious living, and since the rise of Hollywood in the 1930's, probably more so in our time than in previous eras. But the more socially isolated one is - the more one lives in fantasy with little 'reality checking', and the more one depends upon it for the sense of intimacy and belonging one would normally get face to face. Stated another way, those with a diagnosis or label of mental illness depend on fantasy more than others.
So having imaged for many years that Stephen and I had a temperamental connection, the revelations in the two documentaries came as no surprise. But my attitude on first viewing was very different to the one I have now. Then I was happy to describe myself as Bipolar, the label had explanatory value for me. Indeed the only reason to accept a diagnosis should be if it has some practical use value to you; if it explains something about you to yourself, making it easier to live with yourself; if it gives you access to useful help, or helpers; if it helps you to act differently, or to let you get things you want but don’t already have.
Also at that time I believed mental health services still had some useful expertise I could acquire (even though by that stage I'd been a service user - off and on - for 18 years) Equally, alongside 'Bipolar' explaining something to me about myself, when I found some supposed characteristic of the Bipolar person I'd not previously known about, I still gave serious thought to the possibility that I must have missed something more about myself. I was well on the way to becoming the next Kay Redfield Jameson.
Why do we hang-on to beliefs, routines, habits which appear illogical and sometimes positively self-destructive? Because they appear safer than the alternative. All change (good or bad) is at first experienced as stressful (occasionally terrifying). Others will be reassuring and tell you of the benefits of change, but this of course counts for nothing! Any change requires acting before we really feel competent to do so.
Having learnt something of the above much has changed in my life over the last five years. I have no 'symptoms' so cannot legitimately use the label, my identity is based upon my actual activities and the social contacts I make, my explanations of myself come from evolutionary biology and neuroscience (natural variation in the limbic system and as a consequence a lot of dodgy learning) and not from psychiatry or clinical psychology. But as I get better and happier, the more angry I become about the pathetic record of mental health services, past and present. However, I still take one prescription drug - having been on one mood stabilizer or another for 17 years, it gives me a certain minimal status and some entitlements in the face of unemploy-ability!
And Stephen? Well, I still follow his antics and enjoy his writing - he persists in making me laugh. I can see that his giving-up smoking and taking more physical exercise are hugely beneficial. But it now seems crazy for him to use an intense work schedule as therapy - a way of staying one step ahead of depression rather than stopping and confronting it. It is not until we give ourselves permission to relax that you can feel and let go of pain. He remains a man uncomfortable in his own body - especially in those moments of verbal linguistic magic. And that takes us to the core fear of the supposed Bipolar person - that recovery, change, or just stopping to relax and let go, means an end to creativity. IT'S A MYTH. Indeed, the ability to let go brings greater spontaneous creation. Stephen declares he must shut himself away in order to write, even to the extent of keeping the curtains drawn to shut out the rising sun. Tish and pish I say my fluffy friend, raise your eyes to the horizon, the answers come from being at home in the outside world.
For more on labelling ourselves, see my February post Goffman and Becker; stigma and labelling.
Stephen's website is at; http://www.stephenfry.com/
The DVD is available at Amazon; http://www.amazon.co.uk/Stephen-Frys-Secret-Manic-Depressive/dp/B002XT38GO/ref=sr_1_2?ie=UTF8&s=dvd&qid=1277016760&sr=1-2
As a child you watched how parents or siblings walked and then you began to copy them. So it was with everything else you learnt, as peers and other adults entered your environment. Experience and learning are inseparable. The more you practice existing skills, the more you try to reproduce today, the world as it was yesterday. All learning consists of first imitating (copying or modelling) how others behave, then repeated practice (trial and error) - both mentally and physically - until you gain a skill. All behaviours are habits. And the only way to overcome an unwanted habit is to copy a better one from someone else. We are social animals with a social brain.
At some point you learnt to walk down the street and avoid eye contact with someone (the invitation to normal social interaction), if that became a habit, not just towards those you disliked for a reason, but a practice applied to the whole social world of others you acquired a mental 'illness'. The classic way of avoiding eye contact is to look down and away (a gesture normally reserved for the occasional experience of shame), but if you stare at the pavement for a lifetime - rather than naturally allowing the eyes to return to the horizon giving an automatic upright posture - then you become a physical cripple because of your social isolation.
Another form of isolation is when we look through people, being physically present but mentally somewhere else. But that leaves the person terribly exposed, you can't do two things at once - fantasise and be in the present moment. Very quickly others notice that your speech simply doesn't fit the situation. The so-called 'psychotic' person follows an erratic path and easily becomes disorientated because they are disorganised. Eventually, they too will look down and away.
Sometimes people come to believe that hanging-on to familiar, habitual, well understood, fears will keep them safe, not just from occasional real physical danger, but from other anxieties in everyday living. The desire to be in control too much - causes more isolation from others. But when you make eye contact with others, when you operate your body in the same way as someone else, you begin to have the same kinds of thoughts (though the content may be different). The desire to belong, which is in all of us, is rewarded.
(See previous posts on meditation, and physical therapy for the 'up' side of the story. The acquisition of new social skills and better habits will be discussed in future posts).
Once in a while I find myself thinking that the experience of being transported at night by ambulance or police van, strapped or caged at a right angle to the direction of travel, becoming progressively disorientated as the streaking neon lights wipe short term memory, is not dissimilar to always being escorted whilst moving along the remorselessly straight corridors of the old Victorian asylums - and not necessarily because you were a threat to self or others - but because without help you would rapidly become lost.
For almost a decade now people have been saying that almost all confined young offenders have some form of mental disorder and/ or substance misuse problem. Amongst adults who are confined the official rate of ‘serious’ mental disorder is barely higher than amongst the general population - but that’s just a joke, nobody believes it. Much better to accept that a majority of the entire prison population now has a drug and/ or mental health problem - that prisons combined with special hospitals, regional secure units and other secure psychiatric wards - add-up to a new asylum system to replace the old. Given modern transportation and communications the corridors are now dual carriageways and motorways. Mental health law is as strong (and flexible) as it ever was. The impersonal bureaucratic rules and regulations remain. The NHS now runs prison medical services, so we can look forward to more and cleverer drugs!
During my career as a mental patient I spent time in two Victorian-style asylums, albeit towards the end their existence, I also had occasion to visit three others. Recently I was directed to a site with some photos of the first hospital in which I was a patient - Severalls in Colchester - I was amazed it hadn’t been redeveloped. The site is about 300-acres and held up to 2000 patients. Opened in 1913, it was based on the ‘echelon plan’, individual buildings but linked by interconnecting corridors to avoid the weather! Over the years the buildings have suffered vandalism and fire attacks but as the pictures here show you can still get a flavour of the environment. When I was there the staff were very proud of the murals, part of which are still visible. I was also told that one of the corridors was the longest of any asylum in the country - is that true?
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| Forensic unit 2017 |
Twelve months is a long time in online history. Last year I distributed the following April Fool to academic acquaintances, linking it to the one that appeared in The Guardian - a year on it all seems to have come true!
ACADEMICS MASS HYSTERIA SHOCK
Dear All
How sad that social scientists across the country have reacted in such a panic stricken way today to the news of the end of The Guardian (see below). Whilst it is true that for decades they have relied upon it as their sole source of ideas, surely they have registered some of the changes in knowledge acquisition over the last two decades.
The realisation that the majority of journal articles are never read.
The fact that students don't take books out of libraries, but just photocopy the introduction and conclusion.
That software could write a fake article on post-modernism and that it would be published.
That the reason the entry for your subject in Wikipedia is being edited every other day is that not just your rivals, but your research students and even your research subjects contest your authority.
The fact that the more enterprising of your colleagues have gone over the heads of the academic audience to the public at large on video at TED, Web2Expo, Meaning of Life TV, Blogging Heads, Edge.org...
Now with the advent of twittering there is no need to find research participants or record them. They've done it for you - you can see the world as it is today. With the development last year of a search engine to go with it, you can do global research on any issue tomorrow!
Flexibility in the face of change I am told is the key to mental wellbeing.
Best wishes
Nick
Twitter switch for Guardian, after 188 years of ink
Newspaper to be available only on messaging service
Experts say any story can be told in 140 characters
Rio Palof
The Guardian 1.4.09
Consolidating its position at the cutting edge of new media technology, the Guardian today announces that it will become the first newspaper in the world to be published exclusively via Twitter, the sensationally popular social networking service that has transformed online communication.
The move, described as "epochal" by media commentators, will see all Guardian content tailored to fit the format of Twitter's brief text messages, known as "tweets", which are limited to 140 characters each. Boosted by the involvement of celebrity "twitterers", such as Madonna, Britney Spears and Stephen Fry, Twitter's profile has surged in recent months, attracting more than 5m users who send, read and reply to tweets via the web or their mobile phones.
As a Twitter-only publication, the Guardian will be able to harness the unprecedented newsgathering power of the service, demonstrated recently when a passenger on a plane that crashed outside Denver was able to send real-time updates on the story as it developed, as did those witnessing an emergency landing on New York's Hudson River. It has also radically democratised news publishing, enabling anyone with an internet connection to tell the world when they are feeling sad, or thinking about having a cup of tea.
"[Celebrated Guardian editor] CP Scott would have warmly endorsed this - his well-known observation 'Comment is free but facts are sacred' is only 36 characters long," a spokesman said in a tweet that was itself only 135 characters long.
A mammoth project is also under way to rewrite the whole of the newspaper's archive, stretching back to 1821, in the form of tweets. Major stories already completed include "1832 Reform Act gives voting rights to one in five adult males yay!!!"; "OMG Hitler invades Poland, allies declare war see tinyurl.com/b5x6e for more"; and "JFK assassin8d @ Dallas, def. heard second gunshot from grassy knoll WTF?"
Sceptics have expressed concerns that 140 characters may be insufficient to capture the full breadth of meaningful human activity, but social media experts say the spread of Twitter encourages brevity, and that it ought to be possible to convey the gist of any message in a tweet.
For example, Martin Luther King's legendary 1963 speech on the steps of the Lincoln memorial appears in the Guardian's Twitterised archive as "I have a dream that my four little children will one day live in a nation where they will not be judged by the colour of their skin but by", eliminating the waffle and bluster of the original.
At a time of unprecedented challenge for all print media, many publications have rushed to embrace social networking technologies. Most now offer Twitter feeds of major breaking news headlines, while the Daily Mail recently pioneered an iPhone application providing users with a one-click facility for reporting suspicious behaviour by migrants or gays. "In the new media environment, readers want short and punchy coverage, while the interactive possibilities of Twitter promise to transform th," the online media guru Jeff Jarvis said in a tweet yesterday, before reaching his 140-character limit, which includes spaces. According to subsequent reports, he is thinking about going to the theatre tonight, but it is raining :(.
A unique collaboration between The Guardian and Twitter will also see the launch of Gutter, an experimental service designed to filter noteworthy liberal opinion from the cacophony of Twitter updates. Gutter members will be able to use the service to comment on liberal blogs around the web via a new tool, specially developed with the blogging platform WordPress, entitled GutterPress.
Currently, 17.8% of all Twitter traffic in the United Kingdom consists of status updates from Stephen Fry, whose reliably jolly tone, whether trapped in a lift or eating a scrumptious tart, has won him thousands of fans. A further 11% is made up of his 363,000 followers replying "@stephenfry LOL!", "@stephenfry EXACTLY the same thing happened to me", and "@stephenfry Meanwhile, I am making myself an omelette! Delicious!"
According to unconfirmed rumours, Jim Buckmaster, the chief executive of Craigslist, will next month announce plans for a new system of telepathy-based social networking that is expected to render Twitter obsolete within weeks.
It’s a skill because it doesn’t come naturally.
I once asked a friend of mine who is a senior mental health worker, and almost universally liked by everyone: ‘Isn’t the idea of “unconditional positive regard” totally unrealistic - it implies you can like anyone who walks through the door?’ He then claimed that he did like almost every client. I think he was fooling himself, and what he meant with the benefit of hindsight, was that he came to like almost every client - that the more he understood someone the more he liked them.
Carl Rogers started it when he asserted the possibility of unconditional positive regard towards others, built on the idea of accepting oneself:
‘I find I am more effective when I can listen acceptantly to myself, and can be myself.’ (Roger 1967:17)
‘…the curious paradox is that when I accept myself as I am, then I change.’
‘If I can accept the fact that I am annoyed at or bored with this client or this student, then I am also much more likely to be able to accept his feelings in response.’ (p.18)
‘I have found it highly rewarding when I can accept another person.’ (p.20)
The post-war humanist perspective in psychology lost touch with the biology of the human animal - as indeed did the cognitive revolution that followed it. Anxiety should rise when meeting strangers or outsiders, they are a potential threat, you should be cautiously testing each other. We do have very strong first impressions; it is called intuition, and relies on fast emotional responses - it is what keeps us alive. The only question on first meeting someone is: ‘Do I feel safe with this person?’ So the effective helper knows that they must appear safe and non-threatening, but what if you don‘t feel that? We can all be aggressive and violent, if we need to be. It’s not a matter of accepting people as they are, it’s about creating useful encounters where mutual learning can take place and that depends on establishing a relationship of trust. Sometimes it can happen very fast if there is a mutual liking, if there isn’t then it will never happen.
When asked, people self-report that what makes the best first impression is a sense of ‘warmth’ and ‘competence’ in the other person ( www.scientificamerican.com/article.cfm?id=mixed-impressions ), but I think what they really mean is someone who is non-threatening and can deliver something they need. Because first impressions are emotional responses they have very little to do with what is actually said, more with how it is said and the rest of our non-verbal behaviour. We trust those emotions displayed through facial expression much more than the accepting words.
The client is present because they know there is something wrong with them, whether they state it or not, something that stops them functioning in the social world as they would wish. That is why they are seeking help, they’re not looking for acceptance but action, on the assumption that they are meeting with someone with skills and expertise.
But what of Rogers’ underlying point that accepting oneself and others as we are now, is in some sense a precondition of change? Wrong. The preconditions are self-awareness and a willingness to learn new things! And the speed at which it can be done depends on the rapport between the people involved.
One barrier to rapport (effective communication) is the myth that the helper can be accepting as part of their professional role, setting aside their personal feelings. This is obviously ridiculous because feelings always leak-out through facial expression and tone of voice. This first becomes apparent when a prospective helper is still a student and at some point becomes aware of a conflict between their developing intellectual understanding and their emotional response in a given situation. The trick is integrating the two. If I believe in the knowledge I have acquired then I must live that way, the mistake is thinking that one is work and the other a private concern. The answer comes in two parts, firstly in terms of organisation there has to be proper team working - teams purposefully constructed of different kinds of people with different skills, hence giving the client choice!
Secondly, any kind of therapy is the learning of new social and psychological skills and the helper is the model. Acceptance is the skill of tolerating what we cannot change. Now if either or both, client and worker have it in their heads that the client is suffering an illness for which there is no cure… Even the Recovery approach leaves the medical model in place, telling the client to expect occasional relapse. So often both client and worker set each other up to fail. But if your model is one of adaptation in a particular social environment you have two choices, neither of which require acceptance of anything. Either you change yourself (learn new skills) to fit the environment you find yourself in, or you move on and live in a new environment.
It is a belief in people‘s lack of capacity to change which makes acceptance, so unnatural as it is, such a hard skill to learn - requiring decades of practice by the helper!
(See also my post, The ‘therapeutic relationship’ explained - Jan 2010)
Rogers, C (1967) On Becoming a Person: A Therapist’s View of Psychotherapy (Constable: London)
