This Week in Mentalists (47)

You know the secret of good presentation? Timing.

Anyway, it’s time for This Week in Mentalists.

Crazy Nurse has been discussing the Borderline Personality Disorder label with her psychiatrist.

I’ve gone on enough before about how I don’t believe it and its a load of crap, so I’ll keep it short. Seaneen over at mentallyinteresting.org says its a diagnosis they give you if you’re a women who self harms and you don’t fit any other DSM-IV for ICD 10 criteria. . . . in my case, I concur. I was never expelled from school for causing trouble, I’ve never been known to the police, I didn’t get abused as a child . . . I’m just fucked up in the head, end of. There’s no obvious reason why I feel unable to cope with life sometimes, or why I get depressed, or why I don’t have the willpower to ignore my disturbing thoughts. My life is okay – I have a supportive family, I have some amazing friends, I have a job. I live in the UK I have a roof over my head and am free to say and do as I please (human rights and all that)

Anyway, his thing was that I shouldn’t be so hung up on it, that potentially it was a diagnosis that could lead to me receiving certain services, and that he felt I did meet the criteria. I think I had kind of put the barriers up by this point; I was thinking “you don’t know me, and I don’t particular want to let you get to know me.”

Fighting Monsters considers the patient/professional divide.

A very good friend of mine, a child protection social worker, suffered from severe post-natal depression to an extent that she was off work for a considerable amount of time and unable to go back to the same position. She still suffers.

The people I work with and around use the services we provide. When I was doing my ASW course, one of the social workers had been a patient in a psychiatric hospital herself for an extended period and another of the students described to us all in minute detail, the effect that sectioning had had on his mother and his family dynamics since that time.

We often talk in terms of us and them – if it isn’t explicit then it is implicit. Who are we trying to fool? Perhaps it is easier to work within systems when there is a divide in place. When we empathise but not too much. Not so much that we relate to our own experiences.

We don’t talk about our own experiences of being a patient or a user of the services that we (or our colleagues in different boroughs) provide because it detracts but it does put things into perspective a little.

Mandy Lifeboats Ahoy comments on a conference about complimentary therapies.

Topics include:

• The keynote address will be given by Dr Lesley Storey, National Cancer Research Institute,
who will be addressing the consequences of ignoring research.
• Ethical considerations for complementary therapies
• Service improvement
• Nutrition
• A patient’s perspective
• Acupuncture in chronic and acute pain management
• Award winning rapid response complementary therapy team, Velindre Cancer Centre, Cardiff
• Using aromatherapy with multiple sclerosis
• Complementary therapies for chemotherapy induced peripheral neuropathy

Am I the only one who thinks there’s something vaguely funny about the idea of a rapid response complementary therapy team?

I have mental images now of somebody blue-lighting around to somebody’s house for an emergency Indian head massage.

“Quick! She’s looking a bit stressed! Break out the aromatherapy oils!”

…Anyway…

Experimental Chimp is finishing therapy.

Therapy didn’t make me better – it gave me the tools and support that I needed to do that for myself. And I am feeling much better now. Looking through my blog I see that recently I’m mostly been talking about things I’m doing and thoughts and behaviours I have used or will use deal with difficult situations and feelings. So I’m writing about going to London to see my neurologist or to get an MRI scan. And I’m writing about feeling in control of my finances and how I’ve set up a budget to keep track of them. I’ve written down my thoughts about how I can cope with being around my father at Christmas. A post from a couple of days ago talks about how I coped with difficult feelings that came up when I was going through some of my old stuff and found some things my ex-girlfriend had given me.

And here I am, thinking about my future. Until a few months ago, I never thought I’d have a future. And now that I can cope with things and manage my feelings, I think I can make it into a pretty great future.

The Shrink gives his thoughts on the thorny question of whether personality disorder is or isn’t a mental health problem.

Some people will see it as a disorder. This can be helpful, folk can then receive support and care. This can be unhelpful. People with personality disorder (especially F60.31 emotionally unstable personality disorder, borderline type) can receive malign care. Such a person behaves in a fashion that causes concern. Rather than this being their choice (arising in someone who’s not psychotic) it’s seen to arise through mental disorder (personality disorder). To manage risk, the concern necessitates appropriate management, so compulsory admission and compulsory treatment follows. No better? Then better add in more medication. Doesn’t work? Can’t stop it, there’s a mental illness there, it’s causing risks, we need to be seen to be managing it, best keep on with the drugs. The evidence is that personality disorder can be improved through psychological work, if it’s intense and there’s a high motivation for change. Some work suggests that if motivation to change is sufficiently high, the person effects change without contact from formal mental health services, anyway (using their own resources and support networks).
What can mental health services do for folk with personality disorder? What should mental health services do for folk with personality disorder?

One problems of pathologising behaviour is then the follow on from this. It’s not just a behaviour someone’s chosen, it’s pathology. So needs treatment. Admission, drugs, ECT, whatever. Not cured, well, more treatment, then. Still not improved? Then it’s treatment resistant so needs even more drugs, at high dose, in combination. I like diagnosis, it guides care, but diagnosing something as an illness when it isn’t can be really, really unhelpful.

Mental Patient About Town is going through depression.

All the usual symptoms are here, but the feeling of being overwhelmed is especially pronounced. Also the paralysis: lying in bed and feeling utterly unable to move.

My daily routine has revolved around sleeping most the day, a trip to M&S Simply Food on Earls Court Road, and more sleep.

Whenever I’m in public I fight not to cry. The slightest thing can set me off. Yesterday I found a discarded child’s shoe in the street and practically had a nervous breakdown right then and there. I need to avoid anything with a hint of pathos.

I found it very difficult not to cry when I saw my support worker a few days ago. He realised there’s a problem and phoned the consultant. He also gave me the number of the crisis resolution team, though it goes without saying that I’m not going to phone them: they are the last people you need to see in a crisis.

Not Another Nursing Student describes restraint.

Being restrained isn’t pleasant. Usually anywhere between three and five people will grab hold of a bit of you and pin you to the floor. There are training courses for this; it used to be C&R (control and restraint or care and response), now it is MAPA (management of actual and potential aggression, or something anyway). The people pinning you to the floor should have had this training, but lets be honest about the chances of that. It’s difficult to get time off the ward to do any training, and if you are present when your team are getting battered you are hardly not likely to intervene because you haven’t done the course. So, a few appropriately qualified people will be utilising the correct holds and techniques, while a couple of others will be standing on your neck. The reason I know it’s horrible (apart from the obvious knowledge that, well, it just must be) is that on several occasions during training I have been the one laid on the floor whilst several big burly men practised on me. The feelings of claustrophobia and vulnerability are pretty intense.

Mentally Interesting considers mental illness and personal responsibility.

I think, however, that you can take it too far. If something is explicitly caused by your illness, like you running around on top of a multistory deciding you could jump off (cough), or being depressed and pissed off at everyone and acting like a right bitch because of it even though you don’t mean any of the horrible things you’re saying (cough), or getting a ferry to Wales with your lunch money and worrying your parents sick, (COUGH) or telling people that you’re a best selling author/cousin of the Queen/disciple/general amazing light of the universe because you delusionally believe that you are (PHLEGM) then fair dos. And there is the more subtle side of it which is related to your moods. Screechingly obvious to say it but manic depression is a mood disorder and the moods can just often be caused by nowt and be horrible, and that’s an illness, it’s not the fault of the person (and even I know this when all I do is blame myself).

But if you get into the habit of, “It’s not me!11! It’s my BIPOLAR!” over every single time you act like an idiot, then not only are you a twat but you’re also buying into a victim mentality that will do you no favours. I had a brief acquaintance with someone who had, or at least claimed to have manic depression and every time they flew off the handle over a trivial matter they said it was because of their bipolar. This chap once claimed that his friend disagreeing with him “triggered a manic episode” (that seemed to last all of the hour in which he was guilting his friend) and I wanted to laugh in his face. I would much rather admit to acting like a prick if I was acting like a prick so that I can apologise for it.

Teenage Misanthropy relates explaining self-harm scars to others.

Things I have overheard (or have been said to me) about visible scars/cuts, plus my (mental, mostly) reactions:

* ‘Whoa.’ Yeah, tell me about it.
* ‘Jesus…’ No, it was me actually.
* ‘What happened to your arms?’ and variations. You know that already. They are what you think they are. So why the pretense?
* ‘…fucking demented…’ No mate, demented would be me at eighty-nearly-dead, dribbling down my front in a home. Demented would be having the carer have to tell me I’d shat myself. I’d have thought you’d have known about that last one, though.
* ‘You don’t do things by halves, do you?’ You’re a nurse, I thought you were supposed to have jargon for this kind of thing.
* ‘So how old are those?’ None of your fucking business.
* ‘Is that a burn?’ No, that’s an interfering cunt poking me in the arm.
* ‘You might want to clean that up before we meet [redacted].’ Good idea. If you hadn’t told me, I was just gonna stand there dripping blood on her.
* ‘Erm…’ Quite.
* ‘Alex is it true what I heard about…’ or ‘[redacted] is saying you…’ I wonder how you’d look with a broken nose.

But more often than not, just awkward silences. If you like halting conversations, I can’t recommend it enough.

The Wife of a Schizophrenic is unimpressed by education classes for people with mental health problems.

Firstly, I got the impression that there were specific courses for people with mental health problems, such as painting, dancing, yoga, “subjects that are therapeutic” as the lady put it. Are they suggesting that people with mental health problems can only benefit from “therapeutic” subjects and not academic ones? Do they assume that people with mental illness do not have the mental capacity to learn something more challenging?

Secondly, why are people with mental health problems being segregated by being given their own courses? Aren’t they just ordinary people like you and I?