It's not all in the mind

"People with severe mental illness die on average 20 years younger than the rest of the population, largely owing to physical health. People with severe mental illness are more likely to develop preventable conditions like diabetes, heart disease and some cancers." (Rethink mental illness) This statistic shocked me when I first saw it as part of the Rethink campaign "20 years too soon". However, recently I am beginning to associate this trend with my own treatment by doctors. Rethink assign four main reasons as to why this might be the case: medication side effects, life style factors, lack of physical health checks and most interesting to me, diagnostic overshadowing. Many of the medications prescribed for serious mental illness include some very serious side effects. One of the drugs I take is lithium. It is the most effective mood stabiliser used for people with Bipolar disorder, a salt originally designed for epilepsy and whose workings are not fully understood. There are potentially many weighty side effects to lithium, including kidney failure, thyroid malfunction and lithium toxicity. These are tested regularly through blood tests, and in my experience taken very seriously. In a similar manner once a year I have a full check up, in theory. In reality I have my blood pressure checked, height and weight measured and a nurse asks me bizarre questions about my family support, crisis help knowledge and work situation. Not exactly a full MOT, but it ticks the boxes. I have written before on the issue of being defined by your mental illness and this includes by health care professionals. Diagnostic overshadowing is when any physical symptoms you report are associated or dismissed as being a symptom or manifestation of your mental illness. On many occasions I have explained a physical symptom (headache, stomach pain, muscle pain) to be immediately asked "and how are YOU?" The emphasis on the 'you' designated the social shorthand for- you know, mentally? Another favourite is "are you stressed at the moment?" (I'm a teacher and have two small children, stress is relative!) It is entirely possible and likely that some or all of these symptoms may be a response to stress or mental health issues, but even when I am entirely well and can discount any extra stress I can sense that I am not believed. And on most occasions no further physical tests or investigations can take place. Today I experienced this dismissal in its fullest, leaving me feeling angry, ignored and still suffering symptoms. It was also a great example of the strange bureaucracy that slows down treatment. My most recent blood tests show that my lithium level is below the therapeutic level, meaning I am effectively unmedicated at present. Not good, and understandably triggering an appointment with my GP. Sadly, my GP can't actually alter my dosage, I have to contact my Psychiatrist for that. I'm waiting for the call back, and the letter to GP which will allow them to alter dose. However, the main issue for me (I'm so used to the bureaucracy) was the way my other physical issues were dismissed. Along with lithium, my kidney function, thyroid function and haemoglobin levels were checked because I have been unnaturally tired recently and I need to urinate very frequently (every 15 mins and 4-5 times a night!) When the tests were reported as normal I asked the GP about these symptoms. I was simply told these were probably 'just' a side effect or perhaps next time I could get my blood sugar tested. Next time, so in about 2 weeks minimum. It is very possible that these are side effects, perhaps from medication or low lithium levels. It could be something simple like an infection. But for me these are real physical symptoms causing me daily problems and potentially something completely unrelated to my mental illness. I and other sufferers deserve to have these physical issues taken seriously even if they are side effects, but especially investigated in case they are not.

The 'M' word

Mental health has been at the forefront of the media this last week, following the tragic Germanwings plane that was likely deliberately crashed by the co-pilot. The media is most interested in mental health when it involves celebrity or violence. I watched last week as the story unfolded from the initial reports of a tragic crash, to the slow realisation that this was not a technical error or human failure but a deliberate action of one man. And that is where the reports start to change, you can almost sense the excitement of the journalists uncovering pieces of an individuals life and medical reports, theorising and inferring where there was no solid information. The headlines included "Why was he allowed to fly?" and "Madman in the cockpit". A not very measured response from the media, attaching immediately to the possible diagnosis of depression, which in the first days referred to a period of time six years previously. Mental health violence, the "madman", the secret psychopath makes a good story, which is still being added to each day. And yet despite the revelation that the co-pilot may also have had eyesight problems, it is his depression and mental illness that continues to hold the attention of the media. I am certainly not going to deny that violence is sometimes a consequence of mental illness, but the data shows that a very small percentage (7.5%) of crime committed by people with mental illness is a direct result of the mental illness In fact people with mental illness are far more likely to be a victim of violence than a perpetrator. However due to media coverage of the mentally ill as crazed killers and out of control psychopaths, people typically associate random, unexplained violence with mental illness. Heather Stuart showed that people most fear violence that is "random, senseless and unpredictable" and they would prefer to know that a crime was committed as part of a robbery, which they can make sense of, than as a result of someone with a psychotic illness. Add to this a study that shows that the each widely publicised attack involving someone will mental health increases the public's real social distancing from mental illness, in other words and increase in stigma (Angermeyer and Matschinger in Stuart Apart from my love of studies and evidence this reassures me then that this stigma, this increase in discrimination is real, and only increases with the kind of media coverage experienced this week. I am certainly not suggesting that mental illness did not play a part in the actions of the co-pilot and understand the need to find answers and explanations for such tragic events. But it must be measured against the quick to blame mental illness attitude- he must have been mentally ill- must have? Must all inexplicable actions be written off as mental illness? The truth is most people with mental health problems are only of danger to themselves. The mentally ill are you teachers, police officers, nurses, train drivers, shop assistants, cleaners and care workers. As Alistair Campbell eloquently said this week

We may never fully understand why Lubitz crashed flight 4U9525. Despite that, the assumption that his mental health was the sole reason 149 others died will do nothing to diminish the stigma attached to mental health problems...if he had cancer we wouldn't be blaming that and banning people with cancer from working

What we need to do is demystify mental illness, not as a caricature of the psychopath or crazed killer, but as a very common, sometimes scary illness that can be very effectively treated. Because if the media demonise it as something that leads only to inexplicable tragedy, then less people will step forward and potentially receive treatment. I have Bipolar disorder, a sometimes psychotic illness, I'm a little bit strange but I'm not a danger to anyone.

The Ghost of the perfect Christmas

Christmas is recognised as not only a season of festivities and family, but a peak in mental health crisis calls and admissions. Many people find this time of year difficult for all manner of reasons. Existing emotional problems can be exaggerated by the pressure to feel festive; loneliness further highlighted in a season of socialising and family. The Samaritan's note an increase in calls at this time of year, and crisis teams often experience greater work load from existing service users, which seems at odd with with the season that should be jolly.

For me this time of year has always been a time of heightened emotions, often swinging from excitement and anticipation, to moods of glow and rumination. There is a huge amount of pressure around Christmas to be perfect. I can remember at least as far back as my teenage years, my constant evaluating of Christmas. Is this right? Is it christmassy enough? Is it perfect? Unsurprisingly this pressure didn't ease as an adult when organising my own family Christmas'. Surrounded by adverts, social media, pintrest and the like I was a ball of emotion, constantly disappointed in my efforts and experiences.

On my daughter's first Christmas I spent two hours walking around my village while she slept in pushchair, tearful and internally declaring myself a failure and Christmas a disaster. Ridiculous. A four month old baby who only sleeps in the pushchair, isn't going to change for one day. What I failed to see was the family I was surrounded by, the magic of Father Christmas reflected in my son's eyes and pure fact that I was alive.

That was last rubbish Christmas. That year I changed my perspective (with the help of some excellent CBT therapy). The following year I chilled right out, concentrated on my beautiful children, my family and enjoying the time. I went for a run on Christmas day, something I wouldn't have allowed myself in the past for not being Christmassy.

None of us will have a perfect Christmas tomorrow. We don't live in a John Lewis advert, children may tantrum, food might burn, loved ones might be absent. But my advice is to find the joy in the Christmas you have. Not yearning the one you'd like, the one you had, the one that someone else has. And if you are struggling I cannot recommend the Samaritan's enough 08457 90 90 90

It's good to talk

Or so the saying (and BT advert) goes. It has been a message widely promoted in recent mental health campaigns as a way of improving our mental health and reducing stigma. I myself have run and taken part in Time to Talk events aimed at promoting talking as a fundamental step in tackling mental illness. I have written on this blog and on facebook on the importance of talking and being open myself. And yet I'm not sure it would be true to say that I do in fact, practice what I preach. I have a very distinct memory of my admission to the Mother and Baby unit. Sitting in a small office, a psychiatrist asks me how I am today. My reply? "um, ok, sort of". Not even an understatement. Luckily the mental health professionals I have worked with have mostly been able to see through this very British response and dig deeper. I was in fact at crisis point, hallucinating on the edge of psychosis. It could be that this state of mind was to blame for my understated reply, but in actually it is very common for me and for others to reply automatically to these everyday questions. Everyday you will be asked "How are you?", "How are you doing?" and many variations on these. How many of us answer truthfully? Consider for a moment how our day is, our home or work life at that instant. Most of us will answer automatically, with a practiced response or smile that indicates that everything is fine, even when it isn't. I've often wondered why this is, and whether it is inherently a British issue, uneasy at sharing the inner depths of our lives with others. Which would explain why you wouldn't want to share your despair or joy with a virtual stranger on a bus, or even a work colleague. But it doesn't really explain why some of us, me definitely, do it with our friends and family. There is one group of people who I have observed don't do this and are happy, in fact grateful to share the ups and downs of their day with others. Many older people when asked the simple "How are you?" will often unburdern themselves of the stresses and strains of their day, their health, their relationships with family. It isn't always aprecciated by the asker, and yet I think it should be admired. I'm not suggesting that we share our life story with everyone we meet on a daily basis. But perhaps we would all feel a little less burdened if we could answer truthfully and admit when things are so good, when life is stressful and hard work. One of the reasons I imagine that people don't always share the truth is that they are fearful of the other person's response. We don't want to make people feel uncomfortable, or make them think less of us. But we are overthinking the talking process. The 'good' from talking comes in the unloading, the putting into real words the things in our heads, the feeling of sharing a load with someone else. It isn't a problem solving. The older ladies I have talked to on buses haven't expected me to come up with solutions to their health problems or their relationship with their son. They just want another human being to listen, to care enough to take some of that burden. So the next time you are asked or ask "How are you?" think about what you are really feeling and what you could really do to help someone talk.

Just keep running

Running is listed as part of my care plan with my Psychiatrist and care team. I run for all sorts of reasons; to keep fit, lose weight and so I can eat more cake! It allows me time in my week just to be me, alone. My days are noisy and busy, constant calls of "Miss, miss, miss" and "Mummy, mummy, mummy"; the continuous questions of a four year old and the angry frustrated shouts of a toddler. My mind is constantly juggling washing, toys, lesson plans, reports, school dinner money, calendars and events. But when I run I am just me. All alone with my thoughts. Aside from the therapeutic benefits and endorphins running for me is an analogy for my experience with mental health problems. Often people say to me "oh I couldn't do that". What they mean is they couldn't run 5k, 8k or 10k etc. Which isn't true. Very likely they couldn't stand up at that moment and run a full distance at a good pace. But over a few weeks of running/walking and building up pace and distance they could. Almost anyone can run, it won't necessarily be easy or always enjoyable, but it is definitely possible. And that is part of the analogy for me. In the depths of depression especially, the future is almost impossible to imagine. Convincing someone who is depressed that it will get better and they will feel well again, will be met with the same level of disbelief as telling the average person they can run a marathon. The hardest part of running is getting out there, getting your trainers on and getting out the door. It is a slow process, with slow but steady results. Some days feel amazing and you feel like you could run forever, powerful and free. Other days (and more often) it feel hard, heavy and you push yourself round with all sorts of promises and motivational music. It is often one step forward and two steps back, a new personal best, followed by a period of heavy legs and slow trudging. Week by week you may not notice, but suddenly you are running without stopping, increasing distance and not always feeling like you might keel over. In the same way life with mental health issues is about small steps, more often than not forcing yourself out of bed, out of the house, small achievements that feel meaningless at the time. Over the weeks these small steps increase, the good days begin to outweigh the bad and you begin to recognise yourself again. Sometimes you can do it by yourself, but often, like with running, you need coaches and friends, helping you along. People are important in my running life and in my mental health. I belong to Sweatshop Running Community and benefit from the amazing support and encouragement they give. I love running with people, even when we can't talk, because sometimes it is enough to hear someone else panting alongside you and motivate you to keep going! Park run is another brilliant support, a weekly 5k run that manages to be fully inclusive as well as challenging. In my life it is my family and friends that support and coach me. Sometimes pushing me, occasionally dropping back and simply travelling with me. On 7th September I am running The Great North Run for Rethink Mental Illness. They provide helplines and crisis care, advice on everything from diagnosis to housing, support groups for sufferers and carers, campaign for better awareness and so much more. I am running to raise money for the very important work they do, mental health services have very recently been called the 'Cinderella' service. But I am also doing it to raise awareness and speak out about the realities of life with mental health issues. If you want to sponsor me my link http://uk.virginmoneygiving.com/LizClothier And if you want to try running- when I first ran I got to the end of the road, out of breath and thought I might be sick. Now I can run 8k and soon more. If I can do it, anyone can!

Great expectations

For the first time in a long time I have been able to tell people that I had a great Christmas and New Year. No lying, no slight nod of the head with a strained 'ok'. Not that I don't like the season, in fact I love it, Christmas in particular- our decorations went up on 1st December this year. But perversely it is my love of Christmas and the new year season that leads me to have such a disappointing time each year. Not Christmas, but my expectation of all that Christmas and New Year should entail. Expectation, and in particular my expectations of myself have been something I have been working on for many weeks with my therapist. It is not just about Christmas, but my expectations invade many aspects of my life and leave me feeling like a failure. For many years I have felt like I have 'failed' at Christmas because it hasn't lived up to my ideal of what I think a family Christmas should be. What I have discovered, which is probably obvious to most people, is that it isn't necessarily my expectations that are the problem. There is nothing wrong with having high expectations of an event or yourself, in fact this outlook is encouraged by many in the life coaching business. No, the expectation is fine, it is the way I deal and process the reality if it doesn't live up to the vision that is causing the turmoil. It isn't much fun believing you are a failure at most things. It doesn't do much for your self esteem, and in my case it stops me from trying or continuing with new things. For much of my life I have simply not tried or quickly quit at anything that I am not immediately good or satisfactory at. That has ruled out musical instruments, languages, crochet and knitting- all things that require practice, little and often and at which most people start at a fairly low level. It means that I avoid situations where I might be asked to be 'creative' and make things, as I am useless at it and hate showing this. Not healthy. There are many other areas of life this trait has invaded, including Christmas, birthdays, holidays and days out. All deemed failures, and therefore me too, if they do not live up to the picture postcard ideal in my head. So what changed this year? I am going through the process of trying to reprogramme myself, so that I can deal with the expectation in a different way. It involves keeping a kind of journal, and constantly reminding myself of little phrases. This Christmas I did not get myself all knotted about what we did and when, and what is involved in a perfect Christmas day. Instead I let go, lowered my expectations; in fact made the expectations realistic. High expectations are good, unrealistic ones are just setting you up to fail. Which I was doing over and over. So I went for a run on Christmas day, because I wanted to and Christmas should be about doing things you like, not fitting in to a list of ideals. I watched TV and I hung out with my husband, sister and brother in law and didn't get twisted up about not playing a board game. Because it was fun chatting with them, and board games can be played any time. These might seem insignificant, or even a bit bonkers to many of you, but it has been so important to me. Not to over analyse everything and measure myself against what I am supposed to be or do. My only resolution for 2014 is to make my expectations more realistic, not lower, just achievable.

What does a mental patient look like?

This week two large corporations have been forced to remove Halloween costumes based on 'mental' or 'psycho' patients. Following a huge outcry on twitter and other social media, Asda and Tesco both removed these offensive costumes.

My initial reaction was one of complete disbelief. I couldn't fathom how such an idiotic and offensive decision could be taken today. But actually perhaps it isn't that surprising. On the face of it we are a accepting, politically correct society. We don't allow racism, we have laws against discrimination and we have certainly made significant progress on sexism. However, mental health still teeters on the line between offensive and acceptable humour.

Whilst outright discrimination may be taboo, there is an underlying sense that purveys humour and language that speaks of mental health issues in terms that are stereotypic.  'Crazy', 'psycho', 'going postal', amongst others, as well as a common assumption that extreme violence must mean an underlying mental health problem. The media often makes mention of the existence or not of mental health issues in an assailants history. Between the lines, although not said, we are supposed to assume that there must be a mental health problem to explain the atrocity. Recent cases in the US, for example the navy yard shooting, do exactly this.

I am not asserting that mental health conditions do not play a part in many violent crimes, but statistics show that people with serious mental health conditions are much more likely to be the victims of violence than the perpetrators. And yet films, books and TV continuously portray the bad guy with mental breakdown or condition. Some people with mental health conditions commit violent crime, but so do many men, many single people, many blonde haired people. To assume on these grounds would be seen as ludicrous.

There is a fear of mental health, but also an attitude of 'its only a joke'. It used to be acceptable to make jokes about the Irish, women, or the physically disabled. This attitude allowed discrimination and prejudice to pervade society and effect the treatment of these groups. These costumes passed through buyers and managers, they were deemed acceptable because of this humour rule. But this attitude causes serious damage to the view and treatment of people with mental health issues. Not on the surface, deeper; in throwaway comments, assumptions made about friends and employees. It makes people with mental health problems less likely to speak out in case they are seen as 'mad'.

The positive is the outrage, although I was deeply offended, I was also cheered with the outrage of others. It led to an opportunity to talk again about the stigma of mental health and photo campaign by Time to Change called "this is what a mental patient look like". And open conversations about mental health are always a good thing