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

One year on

This weekend is my daughter's first birthday.  With all the celebration there is another side to this important date for me.  The perinatal mental health team only looks after women who are pregnant and up to the first year of the child's life.  So I am bring discharged to the back to the community mental health team.

This handover is somewhat of a double edged sword for me.  On the one hand this is a good thing, it means that I am better, well on the way to being stable and well again.  However the perinatal team have been the the very best mental health service I have ever encountered, in fact possibly the best NHS service I have ever used.  They have kept all appointments, visited me regularly, looked after me with care and sensitivity during my inpatient stay.  Between them they rebuilt my confidence, got me back to work and helped me rebuild some normality in my family life.  They have laughed with me and cried with me, and got me psychological therapies that I have been waiting for for over three years.  I cannot express in words how wonderful they are and how grateful I am to them and all they have done for me and my family.

On the flip side community mental health services have been somewhat hit and miss.  There was the time that I was first referred to mental health services and spent months being pushed back and forward between different services- one claiming that I was too unwell to be seen by then and the other saying I wasn't ill enough.  I was referred twice for CBT and therapy and was lost on the list when the service reshuffled from South to South East to East.   At 32 weeks pregnant I changed Psychiatrist (after another reshuffle) and it was only then that I was referred to perinatal (despite the guidelines stating I should have been referred immediately).  And finally there was the community psychiatric nurse (CPN) who was brushed off my comments about hallucinating (it would cause a lot of paperwork) and reported me (wrongly) to social care against the advice of my perinatal CPN and psychiatrist.

In many ways I will be glad that this 'year' is over.  It is been the hardest I have ever known and has tested the limits of my mental and emotional strength, as well as my relationships with family and friends.  What I do know is that the year wold have been made much worse without the wonderful work of the perinatal team at The Mount.  They do amazing things every day with very little in the way of resources.  In the whole of Yorkshire there is one mother and baby unit which has five beds.  Five.  The next nearest is Newcastle of Manchester.  They didn't just hand out pills and feed me.  They nourished me, they supported me and they gave me the confidence to drag myself out of depression.  Mental health services are often described as the 'Cinderella service' and if that is true they are the fairy godmother, because they made so much our of very little. If only all mental health services could be so good.

Medication's what you need...

"Just keep taking the pills" is what my Dad says to me regularly.  Few people are surprised that I take medication for my Bipolar, it seems the obvious option.  Why wouldn't you?  If your brain chemicals are unbalanced, simply straighten them out with some drugs- balanced brain equals normal life.  It isn't quite that simple however, firstly because there are no specific drugs for Bipolar Disorder or in fact many of the psychotic mental illnesses including Personality Disorders and Schizophrenia.  In fact many, if not all the drugs used to treat and manage these mental health conditions were originally developed for other uses. Anti-convulsants, developed in the main to treat epilepsy, are still the most commonly used drugs used to treat Bipolar Disorder.  Medication for Bipolar Disorder is often a case of trial and error, and many sufferers will try several drugs and often end up with a combination of drugs to control their symptoms.  The most commonly used and oldest drug is Lithium, which is in fact an element rather than a compound.  It was first discovered to have behavioural effects on subjects in the 1950s, and yet we are still not entirely sure how or why it works for Bipolar Disorder.  And this is the same for many of the drugs used to treat Bipolar and other mental health disorders.  We know they work for some or all symptoms, for different people, but we are still unsure why.  What all the drugs have in common is that they all come with pretty significant side effects.

Side effects of drugs are common place, nearly all prescribed drugs have some other, often unwanted or unpleasant effect on the taker.  However the majority of us will only take medications for short periods of time, and for the most part side effects are manageable or avoided. Most people with Bipolar disorder will take a combination of medications their entire lives, from the point of diagnosis.  For me that was when I was 29.  So I potentially have another fifty years of medication to control and manage the symptoms of my condition.  It is the side effects and the impact they have on a sufferer's life that lead many people to stop taking the medication.  That might sound crazy (ha, ha!) to most people, to stop taking a drug that prevents significant mental illness.  But many of these drugs are physically damaging and cause side effects that day in day out are difficult to tolerate.  I can only talk of my personal experience, but three years in I am struggling with balancing the side effects with the benefits of the drugs.

On the surface many of the side effects may seem inconsequential, but added together, over a period of time they become frustrating.  I take two drugs at the moment, the first lithium which I started taking after my diagnosis, and venlafaxine, which I began in hospital after my daughter was born.  Lithium is my mood stabiliser, there is no set amount prescribed, as different people metabolise it at different rates.  In fact the line between therapeutic and toxic is narrow.  Lithium toxicity can cause kidney and liver damage, as well as thyroid disease.  For this reason I have regular blood tests to check my levels and my organ function.  It is unlikely I will take it for my whole life because of the damage it does.  It also make me very thirsty, because it is a salt; it makes my hands tremor slightly, especially in the mornings and itchy skin.  Venlafaxine is an antidepressant, it causes me to be hungry all the time.  By that I mean I eat a large, healthy meal and an hour later I am ravenous, a real craving hunger.  This means that if often causes weight gain.  It makes me sweat more (nice!), have very vivid and strange dreams, and if I am even an hour late taking it I get dizzy, brain shocks and feel sick.

These are manageable, except at the moment I am trying to lose weight.  My drugs mean the only way to do this is to be really, really hungry most of the time.  It is hard to concentrate when so hungry!  I am eating enormous amounts of fruit and low fat yoghurt, but it doesn't touch it!  These drugs meant I couldn't breastfeed my daughter, couldn't even really consider it.  I have to be very careful with alcohol, I get drunk much quicker and if I get too dehydrated I can go into lithium toxicity.

Soon I will hopefully be reducing the venlafaxine, and perhaps even consider a change all together.  But unfortunately for me most of the drugs come with the side effect of weight gain.  Which might seem a vain worry, but when you are overweight already, facing a lifetime of these drugs it becomes more than an irritation and yet another kick in the teeth from this diagnosis

What's in a word?

Do you consider yourself to have a disability? A simple question for most people, it appears on most equality monitoring forms.  From dentists to libraries, sports groups and employers, everyone wants to know your race, gender, sexuality and if you consider yourself disabled.  I imagine most people find this question straightforward, its obvious right?  Well, I always hover over that question, my pen moving from yes to no, my mind contemplating what it is exactly I feel, do I feel disabled? And more importantly, what will the impact be if I say yes or no?

Bipolar Disorder is, or can be, defined as a disability under the Equalities Act of 2010 (formerly the Disability Discrimination Act) if it impairs the sufferer in carrying out daily tasks.  For example getting dressed, interacting with people, making decisions.  But Bipolar Disorder is a broad diagnosis and so it must be evaluated for each person, it isn't enough simply to say Bipolar Disorder is a disability- it can be, if it effects an individual in a way that prevents them carrying out normal activities.  On that level then I am disabled.  There are periods of my life when I cannot carry out normal tasks, like dressing, or deciding what to eat.  Or even eating at all.

While logically I can look at the criteria for disability and read all the information provided by mental health charities about mental health disability, I find it hard to reconcile that with myself.  I don't feel disabled, I don't see myself as disabled.  But perhaps that is more to do with my perception of disability, or more likely connected to my need to be independent, to not need help from anyone.  Because that is the issue. Ticking that box, especially in the context of employment leads to the second question- do you require any assistance/help for your disability.  I am still coming to terms with the idea of asking for help, admitting that perhaps I can't do everything everyone else does without a little extra support. Disability for me means admitting that I need help sometimes, not something I find easy.

There is also an element of worrying about the consequences of ticking that box, of saying I am disabled.  What will an employer think when they see that, and worse that it is a mental health problem?  A probable assumption will be that I will have lots of time off, that I won't be able to handle stress, that I might "flip out". Technically employers aren't allowed to ask you medical questions until after interview, but they are allowed to ask the disabled question because it relates to interview. So what do I do- say yes and hope they don't just chuck my application in the bin?  Or no and worry that when it comes to the medical they don't question why I didn't say yes earlier?  I just can't believe that many employers wouldn't discriminate against a mental health disability.

Ultimately the problem with this question is that it is so closed.  A small tick box that requires a yes or no answer.  It doesn't allow for an explanation, all the positives that come from it, what I can do, as opposed to the things I struggle with.  Disability is a much bigger concept than a simple yes or no, it is a broad spectrum of identity, one that I am slowly beginning to accept applies to me.