The incident has stuck in my mind as amusing, though in
an ironic way. For one, the researchers were not very good, their subsequent
report would have barely passed as part of an undergraduate dissertation; two,
the trainer knew that the skills the model worker had acquired had very little
to do with his input, but had been largely self-taught from the bottom up. The boss
thought the Recovery approach had to be taught, and that someone could not have
worked it out independently for themselves. I, as a client of mental health
services, and having known this person for almost twenty years now, know that
what he does owes very little to training, in Recovery or anything else.
Now he is leaving his post and I won’t be seeing him
again as a client. Everyone feels very emotional about this - he’s almost
universally liked by both clients and workers. A familiar character known to
all, respected for being good at what he does and popular also with outsiders
such as workers from other agencies and students on placement.
We’ve always got on too, but we really only have one
thing in common - we both failed our ‘eleven plus’ examination at school and
therefore drew the short straw in what was then a much more selective school
system. He came from a working class background and left school at sixteen with
minimal qualifications, whilst I had a middle class upbringing and eventually
got a university education. These days we would both have undoubtedly been
diagnosed as dyslexic. It was his eldest child who became the first in his
family to go to university. But that bit of shared background has given me the legitimacy
to challenge him from time to time on his reading and writing skills and the
psychological barriers that schools often erect. (There was nothing
Recovery-like about the way I manipulated him into learning to write emails!) But
then I’ve always known ‘he’s everything I’m not, and I’m everything he’s not’,
in those situations, so long as you keep talking, you can make it a win-win
situation, where ‘the whole is greater than the sum of the parts’.
As a young man he joined the Merchant Marine and during
the Falklands War found himself stuck in mid-Atlantic aboard a tanker deployed
to refuel the naval task force. There he acquired the ability to maintain his
physical and mental balance on deck in the face of the heaviest swells that
could be tolerated whilst transferring fuel via a pipeline suspended on a line to
another ship. That’s a skill I’m convinced is not unrelated to being able to
‘hold the centre’ when in a confined space full of constantly moving people in
varying degrees of mental agitation and distress. When he started supervising
group activities with mental health clients in day-centre settings he had no
mental health training and no experience.
He married a local girl who’d been to the same school as he,
has continued to live, work and raise a family in the town in which he was born
and brought up. As a mental health worker he walks the same streets as his
clients, and it doesn’t bother him if he runs into them on any day of the week.
Such a situation is actually very rare, most mental health workers don’t live
in the same place as they work and don’t know their client’s territory.
We first met back in 1994 when my new CPN dutifully took
me on a tour of local social activities for those with mental health problems, my
friend was running a group in a rundown school building twice a week, he was offering
conversation over the newspapers, a cooked lunch and a video to watch in the
afternoons. The first thing I noticed about him, apart from his distinct
accent, was how upbeat he was. We didn’t meet regularly for some years, but it
soon became apparent from occasional encounters that he was relentlessly
positive. At the time I was prone to a lot of depression and found the habit
extremely annoying, to my mind it was mindless optimism. In the years to come, on
almost every occasion we met, he would suggest activities I might wish to
become involved in, nine times out of ten I turned him down. He’s never lost that
positive attitude, but these days his expectations are more sensitive to his
audience.
Another annoying habit was calling everyone mate or matey!
However it soon became apparent that this was because he had difficulty
remembering people’s names - I must confess that in recent years I’ve found
myself adopting those very words! More endearing is his addiction to anything
free, he had a run of luck a few years ago when he seemed to be winning a radio
phone-in competition almost every week. He’s been quite clever at supplementing
a modest income with various extras for the family. Thankfully he’s quite
strict with himself when it comes to gambling, but more than once, when I’ve
been early for an appointment, I’ve been able to find him in the betting shop.
A hallmark of those early years was the ‘Misery Tour’,
formally organised days-out using a hired coach which would pick up clients
from day centres, half-way houses and residential care homes. You might end up
anywhere from Lyme Regis to Plymouth, possibly via Dartmoor. For clients
however the scenery was never the priority, nor was the opportunity to meet new
people. On alighting from the coach there were only ever three concerns - food,
alcohol and or tobacco. For the supervising workers, watching the ‘crocodile’
wind off along the pavement, it was the terror of losing people that was
uppermost in their minds. Nonetheless, although social activities have changed
a lot since then, the instinct was right, for the value lay in their social
nature, a protection against the emotional isolation at the heart of mental
distress.
We met one-to-one, once a week, for about five years. We
would talk in a café or pub, or while out walking, in any one of four or five
local towns. From meeting at the agreed rendezvous to saying goodbye, would be
about an hour and a half. But like more formal counselling or psychotherapy the
encounter had a pattern to it from the initial tentative exchanges, leading to more
focused and intense concentration on an issue, followed by winding down to a
‘closure’ with which both parties were comfortable. The real work might happen
over a period of only twenty minutes, but the challenge was getting there.
Very quickly our encounters stopped being dominated by me
talking about myself and became a conversation. His style was to be anecdotal,
the points he wanted to make came in the form of what I think of as ‘pub
stories’ with a moral delivered with a laugh and a smile. In contrast, I like
to form explanations of human behaviour and ask questions that challenge. The
common ground between was that we both based what we said on observation and our
own examples. His positive outlook however comes with a kind of fatalism,
though he would ‘spin it’ as acceptance! Things are just the way they are, people
are just like that, but there is good in everyone! He is ‘non-directive’ by
instinct. Equally, he would never use a phrase like ‘unconditional positive
regard’, but he claims to have it. I tackled him once, saying it was totally
unrealistic, implying as it does that you can like anyone who walks through the
door! He countered that he did like almost every client, that there was
virtually no one he couldn’t work with. I think he is fooling himself, and what
he means, with the benefit of hindsight, is that he can come to like almost
every client, that the more he can understand someone, the more he can like
them.
We have argued a lot, though in a good natured way. We often
talked about other clients and other workers - on the understanding that the
conversation remained just between ourselves. That’s how we came to learn so
much from each other. Strictly speaking, he broke the rules in numerous other
ways too. It is tempting to think that we developed some kind of ‘special
relationship’. Was he ‘inappropriate’ with other clients, or just me? But then there
really are limits to worker/ client relationships, and those who seek to
eliminate the ‘them and us’ attitudes in mental health would do well to
remember them. (At one point he was concerned about my mental state and by contacting
my then CPN, set in train a series of events which led to me being picked up by
the police on a 136, and later detained in hospital - one day I’ll try and find
it in my heart to forgive him! A detailed account of that period of my life is
the subject of several future blog posts.) But I know many of his other clients
too. If I asked him about our relationship in contrast to others, I know what
he would say: ‘Everyone is unique mate.’ And of course I’d be saying to myself:
‘Is that it? Is that the sum total of your accumulated wisdom?’
What I do know is that I give value for money in a way
other clients don’t. I have a lot of knowledge and expertise that others have
not had the opportunity to acquire. Challenging others however, requires hard brain
work and intellectual confidence. Which is not to say of course, that at other times
I can be as non-responsive as the next client.
It was during this period that the organisation for which
he worked adopted a Recovery approach, and also began to address the forms of
dependency that many clients seemed to have carried with them from the old
institutions into their lives in the community. Day-centre type work took on a
different character as workers sensitised themselves to the ways in which they
may have reinforcing a client’s fixed and unhelpful routines. They learnt to
let go a little, and not conspire in closing down any opportunities clients had
for breaking-out of habitual thinking, behaviour, and emotional responses. It
is one of my friend’s great virtues that if someone can point out something
he’s missed he’ll be eager to learn rather than be defensive. Having undertaken
some basic Recovery training himself, eighteen months later he was urging me to
do the same. It wasn’t long before we were attending the same seminars. He also
started using me quite shamelessly as a cooperative client willing to talk at
length to mental health and social work students. Equally, for three years I
sat as the user representative on a committee which, on behalf of the NHS
commissioners, monitored the work he and his colleagues did.
One survival from the old days was the attempt by my friend,
once or twice a year, weather permitting, to get as many clients and workers as
possible to undertake a big country walk, with the promise of a pub lunch
before the return leg. It was on such occasions that, out of their normal
environment, you see most clearly the contrast between those in mental distress
and others in the community. The way mental ill-health disables physical health,
and vice versa. You also notice the contrast between workers and clients more
clearly. The natural answer is to imitate the healthy, that’s if you can bring
yourself to discriminate between the two, something almost all have had trained
out of them. Try telling anyone that the easiest way up a hill is to follow the
arse of the fittest female! A few years
ago it was decided to impose a gender divide in community social activities,
women’s and men’s networks. The recognition that many clients problems were intimately
tied to past traumatic experiences with the opposite sex, led to a cop-out. One
‘well fit’ female worker, for whom I have the greatest respect, refers to men’s
network activities as, ‘The Jolly Boy’s Outing’. Now, I can think of various
names for female only activities, but then I’m ‘pushin’ it’ already!
He was never much of a one for keeping notes. (When I
stopped being a regular client, I was able to acquire the file the organisation
had kept on me for ten years or so.) However, when it mattered;
‘20.1.04 NICK TALKED ABOUT MEDITATION TODAY AND DIFFERENT
LEVELLS of CONSESNESS, STATES of MIND AND THE CONCEPT of BRIEF THERAPY THE
IMPORTANCE of THE HEAR & NOW. A VERY POSITIVE CONVERSATION ENSUED, NICK
EXPRESSED HE WAS FEELING GOOD.’
‘3.2.04 TODAY WE TALKED ABOUT SUBJECT’S FROM LITERATURE
TO DEATH AND MORTALITY AGREED TO MEET SLIGHTLY EARLIER NEXT WEEK’
‘8.6.04 NICK SAID HE WAS FEELING LOW TODAY AS PAINTING
HIS FLAT AND THE HOT WEATHER WAS GETTING HIM DOWN. TALKED ABOUT STRATAGIE’S TO
AliviATE THIS. Nick SAID HE WOULD Like THE TRAIN JOURNEY TO TOT NES. AND IS
GOING TO FinLAKE ON THE 24th’
Perhaps the best way to sum-up the difference between me,
the client of services and my friend the worker, is to recall an incident that
occurred not so long ago. We were out for a walk with another client who is
famous for being quite uninhibited in saying out loud every thought that comes
into his head. Sometimes he seems aware of what he does, and able to choose
whether to control it, sometimes not. Unless you have been in and out of psychosis
many times, much of what he says is incomprehensible. But all of it is spoken
using the most explicit language! ‘Hey, keep it down mate! You know I’ve known
you ____ all these years and I still don’t understand a lot of what you say’. I
couldn’t help interrupting their conversation by asserting: ‘That’s the difference
between us, I do understand what he is saying, but don’t want to; whilst you
don’t understand, but want to!’
Despite having received care from workers using the
Recovery approach and undertaken some training in it myself; I am not a fan, as
readers of other posts on this blog will be aware. I would not wish to work in
the same way as my friend does, even if I had the skills. Nonetheless, I am in
a ‘unique’ position to confirm, what others could only hope was true, that he
has indeed been an effective helper of hundreds of people in mental distress.
Finally, here are some photos I took a while ago, they are of
course in no way related to the above post…
