Wednesday, 15 April 2020

TAKE NOTE: WHAT NOT TO SAY IN MENTAL HEALTH




Making sure that we're remembered, yeah
'Cause we all matter too
If the truth has been forbidden
Then we're breaking all the rules
So come on, come on
Come on, come on,
Let's get the TV and the radio
To play our tune again
It's 'bout time we got some airplay of our version of events
There's no need to be afraid
I will sing with you my friend
Emeli Sande:  Read All About It (pt III)

Here’s another blog post full of advice that stems from experience rather than academic qualifications… Having been under mental health services for almost eleven years, I think that rather than wear the anniversary as a badge of pride or see it as an achievement, I’d rather use it to help others avoid being under services for that long. Part of that means also attempting to help the service providers in ensuring that they don’t repeat some of the things they said – which I now see as mistakes – to me, to others.
If you read this post and at any point think ‘there’s no way anyone would say that!’ every single comment has been said to me by a professional of some sort; Police, Paramedics, Doctors, Nurses, mental health staff… Admittedly a lot of these comments were made over the entire eleven-year period and most services have drastically improved in that time, but that doesn’t take away from the fact these comments were wrong and that people should know not to make them.
So, here are some of the worst things that have been said to me around mental health:

“You don’t look (fill in the blank)!”
Stereotyping is forever rife in mental health; and particularly with specific diagnosis like Depression, Anxiety, Obsessive Compulsive Disorder (OCD), and Schizophrenia. Everyone has a pre-conceived idea of what someone who has a mental health disorder will ‘look like’ – people with Depression are beyond sad and sleep all the time, people with Anxiety are always having panic attacks, people with OCD always wash their hands, and people with Schizophrenia are constantly hallucinating and being delusional.
Having been in a psychiatric hospital that specialised in Personality Disorders, I’ve seen that for some diagnosis, it really takes specific training and knowledge to really treat someone with that Disorder with the respect and empathy that they deserve. Just to be clear, I think that this is wrong on so many levels and that it shouldn’t take numerous days and hours of education for a professional to be polite and non-judgemental of those with a mental health disorder; it shouldn’t matter what that disorder is.
So, my point with this comment is that everyone copes differently, and two people can have the same diagnosis, but their symptoms can present in different ways and their coping mechanisms with those symptoms can differ too. 


“You’re not acting suicidal”

I guess that this is a little similar to the first comment… This comment was made to me after two Psychiatrists had seen me laughing with the Police Officers who’d detained me under the 1983 Mental Health Act. The Psychiatrists had begun conducting their compulsory assessment under the Act and had asked me why I’d first been sectioned by the Police; I told them that the Police had found me after I admitted to the Crisis Team that I’d taken an overdose and then ran away. They asked why I’d overdosed. This might seem like a bit of a silly question because surely any overdose is a suicide attempt? Actually, there are accidental overdoses, there are drug overdoses that are a bid to ‘get high’ and sometimes I took overdoses as a way to self-harm and not actually because I wanted to be dead. I just wanted all the pain and suffering that came with swallowing handfuls of pills.
Now, I’m not about to tell you that you should be allowed to laugh when you’re suicidal; I mean the definition of suicidal is being ‘deeply unhappy or depressed’ but is it worth considering that some people cope with their unhappiness by overcompensating and having bundles of energy and making jokes? Of course, it’s rare and I can understand surprise at finding someone able to laugh at a dog video on YouTube but protesting that they want to die… I could also understand that this surprise might leave you querying their contrasting behaviour purely out of curiosity but that was not what was meant by this comment.
And the most annoying thing was, if I were to be depressed and hopeless, then how genuine that is, would be questioned by the professionals too!


“If you really wanted to die, you’d have done it by now!”
I mean, can you get much worse? The biggest problem I had when this comment was made was that in my poorly mind, it felt almost like a challenge. A dare. In fact, I think that even though my mental health is well right this minute, I can actually still understand why I would have interpreted the comment in that way… Why I’d think that I had to prove how suicidal I felt, and as though the only way they’d believe I was would be if I actually killed myself! It was a strange but yet somewhat understandable logic.
There could be a come-back to this comment from those who claim to be ‘suicidal’ yet say they would never actually take their own life; but with the definition of ‘suicidal’ being ‘… likely to commit suicide’ this could probably be argued against… Personally, if I say I’m suicidal then unless something/someone stops me, I’ll do something to end my life. I don’t use the word without understanding and appreciating the power that it holds; the impact it can have on mine and the lives of those who I say it to. The amount of… The scenario it can cause and the way it can influence how you’re treat. In all honesty, I think that shame on those who do use this word ‘lightly’ and without true meaning as it’s because of those few that those who are genuine, are questioned and doubted.
However, you have to leave room for the people who use the word without knowing its true meaning and because they feel unable to find another word to describe how they’re feeling and the thoughts that they’re experiencing.


“What’s wrong this time?”
It’s the ‘this time’ that’s the problem here. It can leave you feeling like a chore. A task. As though you’re all too often a bother or inconsideration to the person or to the service which they represent. It’s a difficult one because personally, I can recognize that I’ve used services – both psychiatric and medical – a lot and often, and I can understand others recognizing that, but I think that there’s a more appropriate and less offensive way of doing so.
There’s also a worry caused by this comment. The worry that there’s something ‘wrong’ so often that maybe they (professionals and services as a whole) will stop caring and will grow tired of your phone calls and appointments with you. Honestly, being under services for almost eleven years I’ve wondered whether the staff get fed up with me and are thinking ‘is she still on caseload?!’ And maybe they do think that, this is just about recognizing that it’s not something that’s appropriate to say out loud and to the service user.


“We’ve got poorly people we should be with.”
This is one of those things that someone says and you’re so dumbstruck by the audacity of it that you can’t function and form the words to give the response that you later think of! In the end, I’ve heard this so many times that it’s stopped having such a harsh impact on me and I now have the ability to give my comeback. Which is usually one of two possibilities: the first is ‘well please go and see them then!’ and the second is ‘funny that; since I’m an inpatient you’d think I was poorly too!’ The first comeback usually comes out of annoyance when I’ve been refusing medical treatment and the staff are pushing me to have it and then make this comment as though I weren’t wishing they would leave me alone. The second comeback is more about trying to claim back some self-worth and validate things for myself to remind myself that I don’t deserve to be spoken to in this way.
I once had an Anaesthetist tell me that he was having to prioritize treating me for a suicide attempt over seeing a child with Cancer. I was so angry back then at everything that had happened to me that I said, ‘that’s on your conscience, not mine!’ Looking back, it was true; a person has to take responsibility for their decisions and the priorities they hold, but I wouldn’t ever say it again! It was a harsh and spiteful comment to have made to him and I hadn’t been contemplating the moral dilemma he was facing and that he might have told me about it out of frustration and not purely because he wanted to upset me.
I also think that it’s a bit of a cheek to make this comment as though doubting that we (the service user) aren’t already thinking that professionals must have more important people to attend to than us! As if we aren’t already thinking that we aren’t worthy of their time, care, compassion, and attention! 


“You were doing so well!”
I’ve had this comment a few times recently. I haven’t talked much about it on social media. but a few weeks ago, I saw something about my abuser online and it really knocked my mental health to the point where my ten months free of self-harm went back to Day Zero. I was being wheeled into A&E by some paramedics and one of the Healthcare Assistants said, “we haven’t seen you for ages; you were doing so well!” At the time, I kind of laughed it off and told her what had triggered the self-harm; but like most things in my life, it hit me hard later on. I think it was because it just made me feel as though I was such a failure and disappointment to everyone in addition to already feeling like one myself!
Keeping track of how long it’d been since I’d last self-harmed was both a blessing and a curse; on the one hand it meant that I had a motivation to keep it going and being the perfectionist I am, it made me want to do better and go for longer and longer. The curse was that it also meant that when I did eventually self-harm again, I felt like an even bigger failure because I’d ruined my ‘track record.’ And because I’d kept a note, I knew just how ‘good’ that’d been!


“You know they’re hallucinations though, don’t you?”
As if I’m going to turn around and say ‘yes, I’ll stop acting as though they’re real now!’ I have been fortunate with my hallucinations though, in that afterwards – when the voices (my auditory hallucinations) have silenced and the rabbits (my visual hallucinations) are gone – I can recognize that they were never really there to begin with. In the moment though, when the voices are louder than my own thoughts and the rabbits are surrounding me… well how am I supposed to question the reality of that?! Even if the rabbits appear when I’m somewhere that it’s very unlikely would allow rabbits (like a Hospital)… Or if I’m all alone and there’s no one around that could be talking to me and saying the things the voices are saying… Even in those situations, I don’t question how these things could be happening; I just accept them as fact and cope with them – not always in a healthy, safe, and positive way, but I have to cope because I wholeheartedly believe them to be real.
I remember when I first had an auditory hallucination, I was leaving my weekend job after a stressful shift and a man said ‘you’re useless. Hurt yourself.’ He said it so close to my ear that he could’ve been whispering it from beside me; but when I looked around the nearest person was a girl and the nearest man was at the other end of the huge department store. After two weeks with the voice I attempted suicide for the first time. In time, though, I began hearing four different voices and each had their own personality so some professionals thought that they were parts of myself that’d been cut off from me dissociating during the abuse I went through when I was 15. Having sense made out of the hallucinations – and finding a reason for their existence – doesn’t make them any less scary and powerful though, in fact it makes me angry to think that it’s yet another hardship in my life that stems from what He did to me!
When I was an inpatient in the long-term hospital the staff had a disagreement over their response to my hallucinations. It stemmed from a Nursing Assistant (NA) chasing the rabbits from my room and capturing them with a net. The NA thought that they should accept that I thought they were real and do what they could to help, but a Nurse thought that would be ‘playing into’ the hallucinations and not teaching me to recognize that they weren’t actually there and that I needed help for that. I found the first more helpful though I recognized the latter as a healthy attitude too.


“You’ll regret self-harming when you’ve still got scars in years to come!”
Of course, self-harm isn’t always about cutting, but it does make up the majority and it was the context of this comment, so I’ll be referring to it as the method. They (the professionals) say this as though those of us who self-harm or who have self-harmed, will suddenly stop the coping mechanism at the thought of it leaving long-term visibility that it’s something we’ve resorted to. As though purely that thought is enough to take away all the emotional distress that has influenced our self-harm. As though the thought of having a scar will leave us convinced that self-harming isn’t the only/best coping strategy. As though merely saying this good enough to entitle them to their position of being our help and support. And as though they believe that saying this will actually help!
For me, I’ve always been saddened at the thought that I might not want short sleeves on my wedding dress because of the scars on my arms, but at the same time, I’m not ashamed of them and whilst I obviously realize there are healthier and safer ways to cope, I don’t regret a single cut because I know that at the time, it felt like the only way to cope with my thoughts, feelings, and experiences. I can’t regret them when they may be a part of what has kept me alive because I do think that had I not self-harmed, I might have done something worse; or it at least might have built up into something a lot more permanent. At the same time, I would NEVER and do NEVER endorse or promote self-harm as a coping mechanism!
My point is, as much as it saddens me feeling unable to have short sleeves and being worried that children will ask questions if they see my scars, none of that doesn’t matters when I’m so distressed that I feel it’s my only option. I realise that everyone who self-harms are in a different state when they do so, but for me; I don’t have the ability to consider the long-term consequences. Sometimes, I can mull over the fact that it might mean a trip to hospital but mostly, when I do this, I feel that I’d rather relieve my thoughts, feelings, and experiences by self-harming and have to deal with the aftermath when they’ve gone.


“Don’t worry; I’ve heard it all before!”
Usually this has been said when I’ve been reluctant to tell a professional something and this is their attempt to reassure me that it’s ok to tell them. I understand what is meant by this; that the person is mostly (and hopefully) genuinely saying it as reassurance and with the hope that you’ll confide in them. However, this can be – and often is – interpreted as being dismissive and too nonchalant, leaving the other person feeling as though what they have to say is unimportant as it’s a frequent occurrence. I’m sure that’s true – Psychiatrists, Psychologists, Police… they must all hear and see some harrowing things every single day/shift. The thing is, you/I don’t. My reply to this comment is usually ‘you haven’t heard what I’ve got to say before!’
It’s kind of like when someone says that there’s people worse off than you, I always think that it’s important to recognize that this ‘thing’ might be the worst thing in your life and that fact should – if anything – be validated, not dismissed. It almost leaves you feeling as though you must say something really life-changing and earth-shattering in order to make an impact and get a reaction. Hearing that the person you’re about to pour your heart out to has had a ton of people before you do the exact same thing is also quite condescending and patronizing; as though what you have to say is irrelevant and less important because it’s been said before.


“Have a bath to take your mind off it.”
I don’t think I’ll say much about this one because I wrote an entire blog post not long ago around this one comment and what to do when someone’s advice doesn’t help you… You can read it here, but the general idea is that advice like ‘take a bath’ can seem disproportionate and inadequate to just how distressed you are feeling. 


“You’re doing this for attention!”
I once heard Police talking about someone they’d just talked down from a bridge and they were saying that it’d been such a waste of resources because they ‘knew’ the person wasn’t actually going to jump! I remember thinking that I bet if that person had jumped regardless of all of the services being employed to talk them down, the Police would still be thinking it’d been a waste because it hadn’t worked! It’s like, in the past when I would self-harm or attempt suicide and people would ask why I hadn’t called the Crisis Team or spoken to someone to get help first but if I did ring them, I’d be accused of attention-seeking. Their attitude was that if I really wanted to self-harm or take my own life then I’d just get on and do it and wouldn’t be telling someone knowing that they would have to react! It felt as though I couldn’t catch a break!
I use past tense a lot on this one because it was said some years ago and hasn’t been said since I ended up on life support after a suicide attempt in 2012 and was hospitalized for two and a half years. So, I don’t know if services have improved their attitude on the matter or whether they just changed their attitude towards me because of what I did and the consequences I went through because of it. I don’t know if it was a bit of a wake-up call for them and made them sit up and realize that it’d gotten too serious to be explained away as ‘attention-seeking.’ I’d like to think that it was the former…

I hope that this post has given you (no matter who you are), some insight into the impact these comments can have on someone.