Sunday, 25 October 2020

EVERYTHING YOU NEED TO KNOW ABOUT LANGUAGE IN MENTAL HEALTH


As a Blogger, I obviously spend a lot of my time writing/typing and so I have a huge interest in language (not as academic as to succeed at English Language A Level though!) and – of course – especially where mental health is involved! There’s been a few instances recently around language and mental health that have really sparked debates between myself, my Mum, my friends, and my Support Worker, and they are what has inspired this post…

The Brave Debate

The most recent instance was when a ‘mental health advocate’ on Twitter tweeted: ‘Please stop telling people they are brave when they are just being themselves.’ I immediately questioned it; I couldn’t understand how someone could say that but then I thought on it… ok, so to me; there shouldn’t be a rule saying you can’t call someone brave. You should be able to say it and if that person is uncomfortable then respect their view and don’t do it again. And it’s not that I can’t understand why someone wouldn’t want to be labelled as brave; sometimes it can feel condescending – especially when you don’t feel that your ‘bravery’ is anything special, when you think that it’s just normal and how things should be done. This can also link into someone feeling that they aren’t worthy of this label and find being called it, upsetting because it reminds them of all the bad things, they think of themselves.

However, there are a lot of people out there (myself included) who thrive from being labelled brave and courageous because it encourages them to speak out more and continue their ‘brave’ behaviour. For me, it’s usually around talking about the rape and abuse I experienced and honestly? Having people appreciate and acknowledge how daunting speaking up about that can be, is such a motivation for me to continue doing so.

R.E.S.P.E.C.T

I think that the most important lesson to take from this bravery tweet and subsequent debate, is the importance of respect in language and how crucial it can be for having a positive, healthy, and safe experience when communicating with someone. A key method of respecting someone in your use of language is to allow the person to have control over any words you use which directly relate to them and/or aspects of their life e.g. how they have coped with trauma, any relationships they have, whether they experience hallucinations… It should be down to that person to determine how their experiences are referred to and how themselves and their actions are described and labelled.

There was another instance on Twitter recently where someone confronted another account for saying ‘someone with mental health’ when she believed it should have been ‘mental illness.’ Firstly, the account was referring to absolutely everyone because everyone has mental health. Secondly, it raises something that I think is prevalent in the mental health community, and that’s how to phrase your illness. Do you say mental health problems? Mental health difficulties? Mental illness? Mental Disorder? I seem to mix it up a bit and refer to it differently depending on the context of where it is being mentioned.

I believe, though, that even where someone only uses one term, they should respect another person’s preferences and not condone or judge someone purely for differing from your own views. I think that respect is already something that is very important in life, and particularly in mental health because there is so much discrimination and stigma against those with a mental illness that it can mean a great deal for someone to appreciate this and recognize just how special respect is in this area of life.

I think the importance I put into respect mostly stems from the abuse I experienced because my abuser was in a position of power and commanded a lot of respect from everyone who I debated reporting the abuse to. Literally everyone in my life looked up to him, thought him fantastic at his job, and were convinced that he looked out for me. It meant that when he told me that even if I reported him, I wouldn’t be believed, my response was ‘yeah, I know!’ It felt like he had everyone wrapped round his little finger and it made me very wary of anyone who is respected and in a position of power. I have lost faith in a lot of people and it has affected so many of my relationships with some people being – understandably – offended that I didn’t trust them when they had done nothing to deserve that attitude.

“That’s not what I meant!”

One reason some people differ on the wording they use around mental health is that they may hold a different understanding or meaning towards a particular word. In mental health, this can vary from ‘struggling’ to ‘recovery’ and everything in between!

Over time – and particularly recently – I’ve had to learn a lot about defining ‘struggling’ because I wanted to be able to tell people that I was finding something tough and difficult but I found that often people were assuming that meant I was also unsafe. So, I’ve had to develop a clearer meaning for that word when it comes to talking to people in my life, especially my Mum and professionals. It’s understandable that they would make that assumption though because a few years ago, ‘struggling’ would mean I was likely to self-harm or make a suicide attempt, but that has changed through my recovery.

‘Recovery.’ That’s another word with a variety of meanings and implications for different people. As a Service User, inevitably, there’s a lot of focus from professionals on ‘recovery’ and I definitely think that they don’t stress that it isn’t linear. That you don’t suddenly start ‘recovering’ and that it doesn’t just continue to get better and better! For some people, their definition of ‘recovery’ might mean having absolutely no instances of self-harm, but for others it can mean purely a reduction of using particularly unsafe coping mechanisms. There’s also the element that ‘recovery’ isn’t all about self-harm or suicide attempts! For me, labelling myself as being ‘in recovery’ has especially been about changing my thought processes and belief system. It’s about learning that self-harm isn’t the only coping strategy I can use, and that there are healthier, safer ways to react to the terrifyingly upsetting, almost constant, hallucinations. It’s also been about me learning to distance myself from the abuse and recognize that it’s a huge, important part of my story, but it doesn’t/shouldn’t define me and who I am. I think that the inability to define ‘recovery’ can be unhelpful at times because a person can be left wondering ‘am I in recovery now?’ or could consider themselves to be in recovery, and then question this when meeting someone with a different definition of it.

As an opposite to ‘recovery,’ another word in mental health which has numerous connotations is ‘crisis.’ There is no real definition of a mental health crisis because everyone’s mental health is completely different – even that of people with the same mental illness. For one person, a mental health crisis could mean hallucinating. For someone else it could be having numerous panic attacks. For another person, they might label feeling suicidal as a crisis. And having such uncertainty around an important – potentially life-changing – time of a person’s life, often leads to a person feeling an equal amount of uncertainty if debating asking for help or support. Especially when advised to contact their local Crisis Team! I mean, what if you ring because you’re hearing voices and you take up a phone line where the staff could be speaking to someone who’s stood on a bridge about to jump?! It can leave you questioning your worth and whether you’re deserving of help.

Trigger Warnings

In connection with words having a variety of definitions to people, this can often be a catalyst for accidentally triggering someone.

Firstly, I was once asked what I meant by ‘triggered’ and I was slightly speechless because I thought it was a universal word used by a whole host of people and not something with individual definitions! For me, being ‘triggered’ means that I’ve experienced something – whether it be smelling something, hearing a word, seeing a place… and it has reminded me of something bad, usually the abuse. But it isn’t just as ‘simple’ as being reminded… it can trigger me to go back in time. To go straight back to being that vulnerable fifteen-year-old being hurt and abused by someone everyone else looked up to. And everything I felt and thought at that time, comes rushing back and overwhelms me. The experience of being triggered, is something I wouldn’t wish upon anyone and that is why we try to use ‘Trigger Warnings’ in mental health related media content.

I think that the fact reading a particular word or seeing an image can have such a huge impact on you, is testament to just how powerful words can be – especially in mental health. They can influence how you think and what you feel and it’s something that, as a mental health Blogger, I’m very aware of. And whilst I have the attitude that I want to protect people from being triggered, there is some with the opposite thought process who believe that content shouldn’t be regulated or censored in this way. They think that triggering someone isn’t something to be avoided because that person should grow some tolerance with this content. They should have some strength to fight against being triggered and should be able to live their life without needing ‘special’ measures to be put in place around them. Some look at it as ‘molly-coddling’ and think that a person shouldn’t be shielded because that won’t always be possible in life.

It’s kind of like the reasoning behind ‘flooding’ as a therapy technique and it’s a big reason why the specialist psychiatric hospital used with me (you can read more about my experience of it here) by taking me back to the building in which I was abused. Honestly? It did make a difference. It was helpful. I’m not going to sit here and recommend it though – it was a step forward for my recovery, but it hasn’t completely stopped me from being triggered when I’ve had to pass the location on the bus or in a car. I think a huge help in the exercise was that I had been allowed to have my favourite (understatement!) Doctor come with me and a few other staff. And I was detained under the 1983 Mental Health Act at the time too, so the staff were allowed to restrain me and have me take medication. I don’t think it would have been at all effective if I’d gone in a more informal way with a friend or my Mum or someone.

I actually read a tweet recently and was triggered by its content to the point where I got in touch with the author of the tweet and asked, she add a trigger warning on any similar, future content. She apologised and added the warning. It’s probably one of a handful of times where I’ve spoken up about something like that and the main reason I did was because I know I’m not alone in finding those words triggering. And, whilst I was safe when triggered reading these words, I was certain there’d be others who might not be.

Finding the Words

I think I’ve been incredibly lucky to enjoy writing because it has definitely enabled me to find it easier than some people to put my thoughts and feelings around my mental health into words. Of course, there are times when I get writer’s block and struggle to create content, but when something is going on for me – if I’m feeling suicidal or experiencing hallucinations, for example – then I can usually find the words to write down… That wasn’t always the case though!

I stopped writing when the abuse started because I was so used to pouring my heart out in my writing that I was terrified I would just spill the beans about what was happening and someone would see it (and for so many reasons, I couldn’t report it). Not writing for so long – probably about four years – meant that when the hallucinations started and I made my first suicide attempt, I really struggled to put into words what was going on for me so that professionals could better understand and be better placed to help me. And I think my inability to do this was one reason (I don’t think I deserve full responsibility for this) why – for some time – I was labelled an attention seeker by Doctors, Nurses, and Police.  I mean, all they saw was a girl claiming voices told her to self-harm, going to get herself help and then running and causing a massive fuss/drama when everyone had to be called in to look for her. Or a girl attempting suicide, telling someone, and then refusing help for it.

Years after all of that, I could completely understand why professionals would look at those scenarios and think what they did of me. At the time though, I just felt completely misunderstood and therefore very alone with the certainty that if no one could know then no one could help. And if I didn’t get help, I knew I’d end up dead. Fortunately, I found the ability to write again and I wrote a letter to the Community Psychiatric Nurse (CPN) I had at the time, and explained that the hallucinations would instruct me to self-harm or attempt suicide and then when I did, they would be happy and go quiet. Once they were silent, I didn’t want to die or be in any kind of pain, so I’d go for help and doing so, would almost wake the voices back up and cause them to shout at me so loud that I felt I had no option but to run away or refuse that help. Once my CPN read it, she used it to inform my care plan for services to understand that I wasn’t attention-seeking. And after that happened, I was treat a whole lot better, and obviously it shouldn’t have taken me writing all that out for that to happen, but the point is that me finding the words, made a difference.

The Language of the Professionals

The first time I can remember facing rudeness from professionals around mental health actually wasn’t the occasions I mentioned around attention-seeking. It was when the Police transported me to the local psychiatric hospital instead of the medical hospital and when we got there they were told that they needed to take me to A&E because I wasn’t ‘medically fit.’ And the female Officer got back in their van where they’d left me and said, ‘are you going to stop messing us around now?!’ With it being only the second time, I’ve ever had an interaction with the Police, her rudeness really struck me because on the first occasion I was with them, the Officers were absolutely lovely! I didn’t realise that I’d actually been really lucky to have experienced that respect and kindness from the Police in a mental health crisis because back in those days, they were mostly very unhelpful for a lot of people.

The increased training/education on mental health for Police Officers has been a massive help in supporting them to understand how important their response is and how debilitating it can be if they show stigma or discrimination. Actually, when I was leading a mental health training session for the Police one of the Officers described sitting in hospital with someone in a mental health crisis as ‘babysitting’ and I immediately corrected him and explained (thought I don’t think I should have even had to!) why this terminology was so offensive to that person in the crisis.

It isn’t only the Police who make errors in the language they use around mental health service users, though. Another professional body I’ve found difficult in this area has been medical persons e.g. Paramedics or A&E Doctors and Nurses. The one word they use which still really… annoys? Yeah! Which still annoys me, is ‘superficial!’ I’ve finally come to understand that it is actually a medical term and it isn’t being said as an insult; they’re actually describing a wound – or at least, that’s always why it’s been said to me! For a long time, though, I took it to be a very dismissive word that meant what I’d done was insignificant and unimportant. And realised that wasn’t the case, doesn’t mean it’s necessarily easier to hear – it still makes me wrinkle my nose in annoyance. One time during a relapse, when I was being taken into A&E in an Ambulance, I asked the Paramedic if when he did the handover to the A&E Nurse he would be describing my self-harm wound as superficial. I guess I thought that it’d be helpful to have a warning but as it was, he said it was ‘definitely too deep’ to be labelled as that.

The Ten Worst Things Professionals Have Said to Me

* in no particular order! *

1.      “We’ll force you to do this!”

2.      “It’s only superficial!”

3.      “Why are you acting this way?!”

4.      “Cheer-up!”

5.      “Why do you like attention so much?!”

6.      “We should be doing something else!”

7.      “It can’t be that bad!”

8.      “You’re only young, you’ve got your whole life ahead of you!”

9.      “Think of what you’re putting your family through!”

10.  “If you were really suicidal, you’d have done it by now!”

“You’re such a hypocrite!”

I try to always be fair in life, and I think that if I can go on for ages about the wrong things professionals say, I should also shed light on the comments that myself and other mental health service users might make. I mean, there can be no lying or even deflecting from the fact that some people feel they are entitled to say things that they would encourage – and even ask – others to avoid. I think that it’s something we usually see with people of a different skin colour seemingly determining that anyone of their colour can use words which someone who is a different colour, can’t.

But it happens in mental health too, someone with a particular diagnosis such as mine of Borderline Personality Disorder (BPD) might feel they have the right to call themselves or someone else with the same diagnosis ‘crazy’ or ‘mental.’ Or some other descriptor of a particular symptom which others might usually use as an insult or some sort of criticism! I struggle to think of occasions when I’ve done this because as I said; try to always be fair… but I do understand that in doing this behaviour, the general thought process is kind of ‘if it’s our life then it’s ours to label as we please.’

I also recognize an important aspect of this attitude is control. Having control over what you’re branded. Because in mental health, all too often, labels come about completely out of the control of the person it is stuck to. They’re glued to people by Psychiatrists or someone else with a University degree and are sometimes very accurate yet somehow still feel insulting, discriminatory, and debilitating. Having the ability to own that label and make it into whatever you want, can be important for those who feel belittled by it.

Regretting & Apologising

I thought that this little section should go now because it sort of relates to everything I’ve been talking about; people holding different meanings to the same word, professionals using particularly unhelpful terms, people being branded hypocrites for their language…

I’m not a fan of regrets and I’d love to live life not having any of them, but I’ve come to see that perhaps they can be healthy? When I was talking to my local Crisis Team about something I greatly regret, they told me that so long as you’ve learnt from it then it shouldn’t feel like a mistake. If something positive has come from it then you shouldn’t wish it hadn’t happened…

Before the abuse, there were a few decisions where, if I’d chosen differently, it would have meant I hadn’t been in the building where it happened, and I would have never met my abuser. Now, how can I not regret that? How can I not regret the fact that those small changes would’ve stopped the worst thing that’s ever happened to me, from happening?! But then, I think of all the awesome things that have happened that wouldn’t have if I hadn’t been abused.

That’s my thinking behind regrets anyway – my reasoning for my thought processes around regretting language. It’s the reason why if I’ve said something online or even in person, and someone has gotten upset or reacted in a way that has made me question why on earth I’d made the comment, I’ll apologise profusely!

Apologies mean a lot to me, and I think it’s because I’ve never had an apology from my abuser who did the absolute worst thing that I’ve ever been through. Some people wonder why an apology for something like that would put any dent in what he did. For me, an apology is about taking responsibility for what you’ve done and recognizing how it has made someone else feel, and these are two things that are very important to me – not just with the abuse. When that instance on Twitter happened where someone made a triggering comment but hadn’t put a trigger warning, she apologised once I contacted her and it meant a lot to me that she could appreciate how I felt. And that I felt that way because of something she’d typed.

Writing an apology can often be very challenging, especially where the person you’re saying it to is extremely hurt or upset. It can almost feel that there are no words which would be good enough to make a difference to how the person is feeling. That there’s nothing adequate to really acknowledge just how much that person’s struggling and to really sum up just how sorry you are.

Underestimating Your Words

I guess that this little bit is relevant to the previous one because sometimes you can make a comment without really predicting or foreseeing the potential impact it could have on someone’s life. This is especially difficult where it’s in connection with the use of trigger word that has a different meaning to you as it does for another person. A word which means nothing to you and everything to someone else.

I think this is also something that professionals are very guilty of. Far too many times, I’ve found a professional say something that would influence my mood – and sometimes life – but because it’s something they often say in their line of work, they’ve become sort of immune to the power of it.

I’ve found it mainly happen in medical settings when I’ve had Doctors and Nurses tell me that I need some sort of treatment… One of the two biggest instances for this was in 2013 when I had escaped from a psychiatric hospital and attempted suicide. The Doctors were saying that I needed to be put into a coma and go onto life support because I was refusing the potentially lifesaving medical treatment and my liver was starting to fail. I felt really overwhelmed but it was just another day at work for them.

The second biggest instance was when the Plastic Surgeon told me earlier this year that the nerve damage, I’d caused by self-harming, was likely to be permanent. She (and this is nothing against her – she’s a lovely Surgeon!) said it so blasé that it almost made me feel silly for crying over it. Of course, as a Plastic Surgeon she probably sees a lot worse injuries and damage caused by self-harm; but I wanted her to know that for me, this was the worst it’d ever been. And when the other Surgeon told me that he thought operating wasn’t likely to make a difference or improve the nerve damage, he seemed surprised that I ran from the hospital in tears!

In terms of psychiatric professionals doing this, every single time I’ve been told that I’m being sectioned under the 1983 Mental Health Act, it has been just as upsetting as scary as it was the first time it happened. Yet the Psychiatrists and Social Workers (the people necessary to section someone) break the news to me, and then move onto the next person they need to assess like detaining me against my will is insignificant to their day. I guess, in the grand scheme of things; it is! But it’s important to me that they appreciate the huge impact their decision has on my life and the lives of those who love me.

Reasons Why You Should Speak Up

1.      To raise awareness of something that has had an impact on your life

2.      It can be therapeutic to talk about something that you’ve been thinking about a lot

3.      To educate others who might misunderstand the subject

4.      To give yourself the opportunity to get better help and support

5.      To protect others from experiencing any stigma or rudeness you have experienced

Speaking Out of Anger & Validating It

Speaking – or typing – out of anger is sadly something that occurs a lot in mental health because there are so many elements to it that can cause anger and frustration for everyone involved. I’d say that this is usually instances where sections of the 1983 Mental Health Act are concerned!  Or at least that’s when I’ve mainly experienced anger with mental health professionals and – in all honesty and fairness – myself!

Back when my mental health first deteriorated in 2009, I still had so much anger in me from the abuse because it’d only ‘ended’ two years before that. And that anger was topped with anger around how much I wanted to hurt myself and yet others were putting in so much effort to stop me doing that. It didn’t matter whether I thought of suicide as a punishment or as the only way to find peace, the professionals stopping me from achieving it, became my enemies and it felt like I was at war with them.

Then there were the occasions where I was badly treat by the professionals – labelled an attention-seeker, a liar, an inconvenience, dramatic… Probably my most angry moment was in 2009 when I was in a psychiatric intensive care unit (PICU) and my Key Nurse came in my room and was talking to me about the abuse and she just came out with: “I don’t blame you for thinking you deserved it, part of me would agree.” And I don’t know what changed inside of my but I literally jumped on her and started hitting her while she tried to press her alarm and staff came running, restrained me, gave me a sedative injection, and put me in the seclusion room!

Ironically, this huge display of anger and bad use of violence (I’m most definitely not proud of it!) ended up teaching me something quite positive! Not that it makes it all ok! Just… It taught me how helpful validation is for me and my mental health because when I found myself telling people what she’d said and what I’d done, the replies usually condoned the violence but also validated how angry I must have been. Especially the people who really knew me because they know I’m not a violent person – like, at all!

After learning how useful validation is, I’ve hugely encouraged professionals – particularly the Police in the training sessions – to use it as a communication skill when speaking to someone in a mental health crisis. I think that no matter what ‘crisis’ means for you; you more than likely feel lonely when you’re going through it. You more than likely feel like the only person in the world feeling the way you do and experiencing the things that you are. So, having someone – anyone – validate what’s going on for you in some way, can actually be a huge comfort and reassurance.

The Power of ‘No’

For me, I think the importance of saying ‘no’ is about having the ability to take charge and have control of the situation. And that has become important to me because of the abuse. With my mental health, ‘no’ has been particularly powerful and essential to me because of the 1983 Mental Health Act! I think that being sectioned is one of the most scary, saddening elements to psychiatric care. You know, doing therapy and talking about everything you’ve been through can be such an enormous challenge, but at least you can say ‘no, I want to end the session.’ There’s still an element of control there. Even when you feel pressured in some way into agreeing to do therapy.

When you’re sectioned, you literally lose so many of your rights. I mean, they usually give you a leaflet which details all the rights you no longer have, and the aspects of control services now have over your life! I think that the UK lockdown regulations have been a tiny bit of education for those who have no experience of the Mental Health Act. They’ve possibly instilled just a tiny bit of empathy for members of the general public to be able to contemplate and have a snapshot experience as to what sectioned inpatients experience. Rather than let the similarities trigger my memories of being hospitalised, I tried to use them as a reminder to make me more grateful for the freedom and rights I have now that I’m no longer sectioned. And sometimes it’s about the simplest of things as just deciding that you’ll go for a walk for as long as you want and at whatever time you want. As an inpatient, the staff have all the power and control to say ‘no’ to your request to do this.

Five Tips for Effective Communication in Mental Health

*in no particular order! *

1.      Be aware of who can overhear your conversation

2.      Manners cost nothing

3.      Don’t underestimate the power of the words that you might use every day

4.      Validate. Validate. Validate.

5.      Speak to others how you would like to be spoken to

The Importance of Thank You

Having my blog be so popular (I mean, we’re nearly on 800,000 so I can’t exactly deny that!), has meant that I’ve felt an enormous urge to thank every single person who’s taken the time out of their day to look at I’m NOT Disordered. Of course, not everyone will have liked what they saw, but it means so much to me that they’ve had some sort of reason to look.

It’s no secret that the number of readers I have matters so much to me and there are so many reasons why this is the case, but one of the biggest is that a blog’s popularity can help secure opportunities for the blogger to collaborate with other people, organizations, companies, and charities! I’ve definitely found that when approaching one of the above, you’re far more likely to get a ‘yes’ if they know your reader count. And whilst I recognize that the blog’s popularity is partly to do with the time and effort, I put into it, I’d get nowhere in this industry if it weren’t for my readers!

Another obvious thank you I struggle to put into words, is to my Mum, my Aunt, and my friends. Their unwavering support through my mental illness has been so essential in me finding motivation to continue fighting against the hallucinations, the urges to self-harm, and all the thoughts of suicide. At one point, I was struggling so much that I was really only staying alive for the sake of others because I didn’t want to upset the people who love me. To put that into a thank you for someone? Into a thank you that equals just how much it is meant? It feels impossible! But I endeavour to do it anyway!

And then there are the main organizations who have literally saved my life (some of them numerous times); Northumbria Police, the North East Ambulance Service, Northumbria Healthcare, Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, Richmond Fellowship, Newcastle Hospitals, and Cygnet Healthcare. And I mean, how do you thank someone for saving your life? How can you find some words that will equate to something so special and so powerful?