Posted in Advocacy, Personal Growth

Being Vulnerable

Thought I’d share something a little different today. The text below is directly copied from ruminations in my diary about being vulnerable (specifically online). Half formed thoughts and unanswered questions, which is kind of the point of what I was writing about – allowing an ‘unfinished’ image of self to be seen. I’ve thought about it more and this quote in particular resonated with me: ‘Vulnerability is the least celebrated emotion in our society’ ~ Mohadesa Najumi. I’m a growing, changing person whose views will inevitably change, but I don’t think I want to live holding back because I may think differently in the future. All we’ve got is now right? So this post is a little less about mental health, and more about the process of learning to be a mental health advocate (if I can allow myself that title!). Please enjoy this copy of my wandering thoughts:

‘I think I naturally ‘overshare’ a lot, though keep some things very hidden. And it’s part defence mechanism, but also part not understanding what’s meant to be hidden. I don’t see my ‘personal life’ as any more personal or precious just because it’s mine. It doesn’t really bother me if more people know, in fact sometimes that makes it more special to me. But is that just a need for validation? Or am I broken, or missing something – because I don’t seem to understand the idea of personal life in the way the messaging of the world does??

And also, of course I’m afraid of judgement. The biggest fears being that sharing I’ve had problems with alcohol – for example – will stop me getting a job in the future. But if no one speaks openly about these things then they remain something to be feared or judged. Right? Social media is so often used to show the ‘end product’ of healing, discovery, creation etc… the polished, acceptable version. But that’s not life! I’m ok being a flawed, growing person. I have to be because I always will be. I want to show that too. 

But is there a right and wrong way to do that? Or is that just more expectations? Or is social media in fact not suitable for that? Of course it will always be just a snapshot of life – does that mean we cannot snapshot the vulnerability too? Indeed – what is vulnerability? I feel we live in a culture where we are afraid to make mistakes, especially in changemaking settings. But mistakes are a part of life. It’s all very confusing, but I don’t want to be afraid of the journey of figuring it out. I choose to move forwards with love and acceptance.’

Posted in Advocacy, Managing Mental Health, Mental Health

Reframing Healing

We receive a lot of messages, consciously and subconsciously, about what healing is. I have my own opinions, some of which will be evident in this post, but I think one of the most important things to keep in mind is what does healing mean to you? There may be limitations to our ideas of a dream life, because we don’t live in a vacuum, but only you get to decide what your healing actually means and looks like. Unfortunately it’s something that is quite overlooked in a lot of mental health spaces, and we’re not often encouraged to really define it for ourselves. But that doesn’t mean we can’t. 

Personally, an important part in redefining healing for myself has been understanding what I’ve been taught about healing. A lot of what I’ve learnt is to see ‘getting better’ as this hyper-individualistic thing. We’re told that ‘getting better’ is about becoming a productive member of society again, going back to work full time, having more output, and living up to the expectations placed on us. A lot of therapy is often about this idea – it’s about mitigating the factors that get in the way of productivity rather than fostering genuine happiness. The idea of compliance and non-compliance in the mental health system is a huge part of reinforcing this and getting in the way of anyone who needs to stop and question whether this striving for efficiency under societal norms is actually what they need. 

We don’t live in a vacuum, so I think it’s only logical to suggest that we don’t heal in a vacuum either. And yes it is possible to have personal peace without those around you experiencing the same, but that’s not to say our healing is entirely individual. We are connected; we are even a part of nature. When bears hibernate or trees shed their leaves we don’t look at them and say they should be doing more, they should be doing better; we understand that they are in a season of their life. Yet we so often fail to extend this same understanding and grace to ourselves. We are a part of nature too, and so we are connected to those around us and every part of the world around us. It is only logical to think we should lean into this connection and these seasons to find peace. So I would say healing is community. Healing is working together. Not in order to fix or mend one broken individual, but to recognise what in our living, breathing system of life contributed to their pain in the first place, and to heal all of us. I’ve found that when I am held by a community, only then am I able to find my own inner peace. 

We also seem to see healing as this end destination – we arrive at ‘healed’ and then we continue there as before… until maybe we need to be healed again. But I don’t see it like this. Healing is an ongoing, every day process for me. Just like I see myself as a continually ‘recovering’ alcoholic, I also see myself as a continually ‘healing’ person. Partly because there are new challenges to life every day; partly because I have chronic mental illness; and partly because I see healing in a larger sense too, one of societal healing. That can be hard to conceive sometimes, or to not get wrapped up in. But I see it as a source of hope rather than a drain of hope. A source of power. That healing, as an ongoing, everyday practice, also means trying to help others and be connected with their struggles. Trying to learn how we can all work together to do better, to build better infrastructure, to break the chains and patterns of the past, to move forwards.

So what does healing mean to you? Does healing mean connection? Does healing mean going back to the life you had before? Or is that just the easiest life to imagine? Does healing mean productivity, or does it mean inner happiness and peace? What do you need to see that realised? Is healing individual, or collective, or aided by the collective? Is healing a destination or a journey? 

I’m not saying there’s one right way to redefine healing. It is personal in how it manifests in our lives, but the very fact that so many out there are healing and recovering shows that while it is personal, it is not individual. And I think the mental health system needs to recognise that too. 

Sending all of my love and support to you today xxx

Posted in Advocacy, Mental Health

Psychiatry and LGBTQ+ Rights

Psychiatry has throughout its history and still is very much linked with control and upholding societal standards. The view many people have is that at its core, even though it may be failing, the mental health system exists to help us be happier. And while it’s true there may be individuals in the system who wish this, the very structure is built around an idea of societal norm,  and returning people to acceptable states of being and productivity. Part of that history of western psychiatry has been its link to LGBTQ+ rights – or more specifically the denial of such rights and the pathologisation of the community as mentally ill. So here is a very brief overview of some of that history today. 

But first, why is this important? Well, the history and injustice of psychiatry is really important to understand because the way the system operates now is directly built on this, so we’re still seeing discrimination of all kinds. We can’t just fund a harmful system, we have to review it, build alternatives etc etc. If we do not understand this history we cannot engage in meaningfully informed conversations about what the future of mental health care might look like, because we risk making the same mistakes by perpetuating the system. 

So here’s some fast facts about psychiatry and gay rights:

  1. The World Health Organisation (WHO) didn’t declassify being gay as a mental illness until 1992. 
  2. They didn’t declassify being transgender as a mental illness until 2019.
  3. Between 1935 – 74 chemical and electrical experiments were done on gay men in psychiatric hospitals to try to change their sexuality in a process known as ‘aversion therapy’. Some men were made to do this to avoid going to jail for engaging in homosexual activity. Conversion therapy is still a practice in many places today, an ongoing demonstration of this abuse and trauma inflicted upon LGBTQ people.
  4. Being gay was also criminalised, as well as being classed as a mental illness, until 1973. This is a clear example of the direct link between psychiatry and criminalization. Under these laws over 100,000 men were convicted in the 20th century. One such example is Alan Turing who was forced to endure hormone ‘therapy’ to ‘cure’ him, or go to jail. He chose the former and was chemically castrated – as were many other men. It was not until 2017 that the UK offered pardons to the thousands of gay men convicted of abolished sexual offences, simply because of their sexuality. 
  5. Gender dysphoria and incongruence (for example) are still used to pathologise being trans – meaning they are terms that label being trans as some kind of individual mental defect, and means transgender people have to jump through hoops before they can access gender affirming care 
  6. 1 in 7 LGBT people avoid treatment for fear of discrimination nowadays 

The joint stigma surrounding mentally ill people and LGBTQ+ people means that they are seen as people to be feared, shunned, or fixed by many. And much of that stems from this history listed above. It is true that LGBTQ+ people are more likely to experience mental illness:

  • 52% experienced depression in the last year 
  • One in eight LGBT people aged 18-24  said they’ve attempted to take their own life in the last year
  • One in six LGBT people  said they drank alcohol almost every day over the last year.
  • Almost half of trans people said they have thought about taking their own life 

These statistics are unsurprising when we consider the intersectional nature of mental illness. It’s not something that exists in a vacuum, and although it may be experienced by an individual it is not an individual flaw. Economic insecurity, discrimination, exclusion, lack of support, homelessness, addiction – these all compound mental distress, understandably, and LGBTQ+ people are likely to suffer more with all of the above. But treatment often focuses only on the individual symptoms, and fails to address the bigger picture, which leaves LGBTQ+ people at even more of a disadvantage. And that’s without even considering the discrimination, homophobia and transphobia within mental health care, which puts an unreasonable expectation on LGBTQ+ people to trust the providers of their care when they haven’t been proven to be safe:

  • One in eight LGBT people (13 per cent) have experienced some form of unequal treatment from healthcare staff because they’re LGBT.
  • Almost one in four LGBT people (23 per cent) have witnessed discriminatory or negative remarks against LGBT people by healthcare staff. In the last year alone, six per cent of LGBT people – including 20 percent of trans people – have witnessed these remarks.
  • One in twenty LGBT people (five per cent) have been pressured to question or change their sexual orientation when accessing healthcare services.
  • One in five LGBT people (19 per cent) aren’t out to any healthcare professional about their sexual orientation when seeking general medical care. This number rises to 40 per cent of bi men and 29 percent of bi women

I think at the very least, LGBTQ+ people should be able to choose mental health care with professionals that reflect their lived experience, but this is so often not an option and as a result they are unable to engage with their care, and may even be blamed for it. But the history of LGBTQ rights is full of stories of community care and community love, and for a community that has good reason to be distrustful of authority figures, perhaps the key lies in modelling peer support and community care on the rich love of LGBT history. I don’t know all the answers; I have opinions, but I do not feel confident enough to say I definitely know what’s right. I do however know it’s time to move forwards and forge a new future. We’re going to get things wrong still, it’s inevitable, but maybe if we’re a bit more aware and intentional about mitigating harm, we can see a brighter tomorrow for mental health care, and the LGBTQ+ community. 

Sources:

  1. https://amp.theguardian.com/books/2015/jun/03/curing-queers-mental-nurses-patients-tommy-dickinson-review
  2. https://www.stonewall.org.uk/lgbt-britain-health
  3. https://www.talkspace.com/blog/mental-health-history-lgbtq-community/
  4. https://www.petertatchellfoundation.org/alan-turing-the-medical-abuse-of-gay-men/
  5. https://www.britannica.com/biography/Alan-Turing/Computer-designer
  6. https://www.gov.uk/government/news/thousands-officially-pardoned-under-turings-law#:~:text=Thousands%20of%20gay%20and%20bisexual,have%20today%20been%20posthumously%20pardoned.&text=The%20historic%20moment%20comes%20after,of%20consensual%20same%2Dsex%20relationships.
Posted in Advocacy, Mental Health

Write to MP About Mental Health System

Writing letters to our MPs about important issues can feel like hitting our heads against a brick wall. I get it. Our government is failing us in about every way possible at the moment while continuing to introduce increasingly more constricting and draconian laws that limit our freedoms and right to democracy. Nonetheless, I still maintain that there may be hope to be found in raising our voices. The more people that stand up against issues the harder it becomes to ignore – and it could even be argued that it’s up to us to believe in hope even when they aren’t giving us much reason to. One of the easiest ways to raise your voice is by writing to your MP. They may not be able to do anything directly or immediately, but they are our representatives and can bring our concerns to the table. Imagine if every person in your district wrote in about the same issue – it would be pretty hard to ignore. Anyone of any age can write to their MP, and you can even email them. 

Our mental health system is in crisis; it’s built on harm and it is perpetuating that harm. And it cannot be fixed just by increasing its funding – you can’t fund a broken system and expect it to fix itself. So we need to raise the alarm and raise our voices. Below I have written a very short template for writing to your MP about the mental health system. To use simply:

  1. Use this website to find out who your MP is and what their email address is: https://www.writetothem.com/
  2. Copy and paste the template below into an email 
  3. Replace the generic details in italics with your MP’s name and your own information 
  4. Add in your own message or questions 
  5. Hit send 

It’s that simple. And it may seem small, but you never know if the small individual actions we take will add together as a collective. It’s worth a try if nothing else. And remember, if they don’t reply or give a satisfactory reply, you can keep writing to them! Don’t let this be an issue that goes unheard. So here’s the template (just a general content warning for topics relating to mental health here such as suicide):

Dear [insert MP’s name],

I am writing to you today because I am incredibly concerned about the state of our mental health system. It is clear to me that the mental health system continues to fail all of us, especially the most vulnerable in our society. As I’m sure you’ll understand this is an incredibly serious issue, with people’s lives at risk. 

The suicide rate in England and Wales was 6.9% higher in 2021 than in 2020, a trend that has been continuing over many years despite supposed attempts by the government to address mental health issues. For example – the rollout and continued expansion of IAPT that is meant to provide early and easy access to psychological therapies but has since been found to be skewing their own data by several studies. The University of Chester found their actual recovery rate to be just 23% by their own measures (which can include clinically insignificant improvements) as opposed to their claimed 46%. However a large meta-analysis found that 23% of patients with depression spontaneously overcome their symptoms in three months anyway which would render IAPT irrelevant. Despite this it continues to be heralded as a success with no one speaking up about the failures and the people it leaves to the wayside. 

That is the most basic level of treatment and doesn’t even begin to reveal the long waiting times, criminalization of mental illness and failures of the Mental health act, abuse within inpatient treatment, how risk of suicide actually increases after inpatient treatment, lack of appropriate and individualised care, lack of any support for young people, or obsession with productivity instead of personal happiness in recovery. Even within the last six months we have heard about the cases of more young people who have died while in inpatient care –  Christie Harnett, Nadia Sharif, Emily Moore, Charlie Millers, Beth Matthews, and Lauren Bridges. People are falling through the cracks, and being actively harmed by the system. People are dying. It is unacceptable and it cannot be allowed to go on. 

[Insert any personal experience or thoughts here]

Therefore I implore you to research more into the truth of the mental health system and the harm it has caused to so many. And I ask you – what will you do, as representative of this community, to raise the voice of our concern about the mental health system? What will you do to push for change? What will you do to support the mental health of young people in this community? What will you do mitigate the compounding and intersectional issues with mental health (ie. racism, food insecurity, transphobia, poverty)? 

Thank you for taking the time to read this letter and I look forward to hearing your response, 

Kind Regards, 

[Insert your name, address, and contact information here – remember, without an address you will not receive a response!]

Posted in Advocacy, Mental Health, therapy

Issues with IAPT

Disclaimer: Before I dive into the issues with IAPT I just want to clarify that this blog is in no way intended to discredit anyone’s positive experience with IAPT or discourage anyone from using the service. IAPT could still be a piece in the puzzle of helping you find the right support. I am purely highlighting issues that some people face because everyone deserves to have a positive experience of mental health care – if the mental health system can’t adapt to different needs, then it needs to change. This post is about raising awareness of the gaps within that system, and the plaster solution that IAPT has become. Because we all deserve better – it could be you or any of your loved ones needing a more comprehensive, long term and personal care plan. And I would hope that the door was always wide open for you to receive the support you need.

With that said, let me give you an introduction to what IAPT is. IAPT stands for Improving Access to Psychological Therapies. If you are an adult and go to the doctor with a mental health concern, you are likely to be referred to this service as one of the first ports of call. It was rolled out in 2006 and there are now around 220 IAPT services in the UK. It offers patients a limited number (usually 6, up to 12) of sessions with a counsellor using CBT – Cognitive Behaviour Therapy. And it’s true that rolling out this service greatly reduced the 8-12 month waiting time for psychological therapy in 2005, which is great, but that doesn’t mean it provides a greater level of care. 

So let’s look at the information I’ve just noted. CBT focuses on changing thought patterns and behaviours of individuals – which by definition is not suitable for anyone who’s mental health is being impacted by the situation they are in. It’s true that CBT skills can be incredibly useful in helping us cope with day to day life, giving us the tools to reframe our experience so it becomes bearable and our thoughts less consuming. But that doesn’t mean it’s perfect by any means, nor suitable for everyone. For example many autistic people have likened the approach of CBT to gaslighting; it just isn’t suitable for application with neurodiverse thought patterns in many. For many others too it simply doesn’t provide the all round support they need – the therapy sessions are not designed to hold space for the person, explore route causes that will continue to be present, or brainstorm ways to change the situation they are in. It can provide people with a quick fix to a singular problem, but lacks a long term approach. 

However, it’s the only framework offered with IAPT, already excluding many from the help they need. Especially because if someone goes through with IAPT treatment they may be seen as already having support and having to face longer waiting times; likewise if they refuse to continue this raises the issue of non-compliance. Non-compliance is a complicated label used in the mental health system sometimes that essentially labels patients as unwilling to try and help themselves and makes it harder for them to access support, simply because the support they refused was not suitable or accessible to them. This is a systematic issue of not providing individualised care, but instead it is labelled as a personal fault and the burden is borne by the individual. 

Even for the people CBT framework does suit, the IAPT programme offers such limited sessions that it’s arguable how much long term support and healing they actually offer. 6 sessions is simply not enough in my eyes. What about the people with more complex issues? The people that learn slower? The people that need time to build a secure relationship with a therapist before they feel confident to start working with them? They are all being left behind by the existing IAPT service. 

None of this is surprising when we look at the roots of how the IAPT service came to be. In 2005 Lord Layard – an economist by trade addressing the economic costs incurred due to mental health crisis – and David Clark – a professor of psychology championing CBT – pitched their idea for IAPT to a board room full of government officials. They pitched it through the economic benefits that providing a cheap service that got people back to work could reap, easing the £12 billion cost of depression each year. Though I understand why so often proposals have to be pitched through an economic lens rather than a moral or social one, I do think it’s very sad. And I think in many ways shows why this system isn’t working. We’re approaching the issue of the mental health crisis wrong if we’re approaching it from a perspective of getting people back to work. Mental health doesn’t exist in a vacuum and is deeply intertwined with all aspects of society which we cannot simply ignore addressing when looking to help mental health. Furthermore, healing is not actually about productivity – this is considering healing through the eyes of someone else looking in on a life trying to define quantifiable proof of them getting better in a way that is palatable to society. Healing is internal and personal; our current mental health system does not recognise or allow space for this in our society. 

Nonetheless IAPT was heralded as an astounding success in the mental health sector worldwide for its quick rollout and wide reach. But in 2010 Dr Micheal Scott – a clinical psychologist at the University of Manchester – began to question the success of IAPT when assessing its patients. He was hearing many stories of patients with bad experiences of the programme who found it useless, dropped out, or pretended to be better to make it end quicker. He decided he needed to look further at how the effectiveness of IAPT therapy was being assessed in order to discover if it was really as great as it was claimed to be. 

The first thing of interest he discovered was that IAPT was responsible for collecting all the data on its own performance – there were no external reviews or assessments taking place. I think many of us will know that this is a bad scientific practice for collecting and understanding data – there should always be peer reviews. So he conducted an assessment to discover the true recovery rates. 

He began by reviewing the cases of 65 people. I’ll admit that’s not a lot, but stick with me here. Scott used various procedures for a robust review including in-depth interviews, diagnostic assessments, and evaluating medical records. His results showed that no matter the condition, only 16% could be considered as recovering. This is woefully below the 46% reported by IAPT themselves – and with good reason. IAPT’s method of assessing recovery rates only included those that completed treatment with them and neglected to count the half of patients who dropped out of treatment. The fact that half of patients drop out of treatment at all is a huge indicator that the programme is failing anyway, but the correct way to conduct research would be to include them in the data. By omitting them IAPT are artificially increasing their recovery rate. I would also add here that even their self-proclaimed 46% could be much higher with proper individualised, socio-culturally aware treatment plans. 

Scott’s admittedly small study isn’t the only one either. The University of Chester’s larger study found a 23% recovery rate, still much lower than IAPT’s claim. And that’s before even considering what IAPT deems recovery to mean. I’ve already explained that IAPT was built around the idea of getting people back to work, and so it’s unsurprising that the programme focuses on getting people back to what are viewed as functioning members of society rather than personally happy with their healing journey. 

This is seen reflected in how IAPT reviews patients progress. At the start of the therapy questionnaires are conducted that rate how depressed or anxious you are, and then again at the end of the therapy. If at the end of the therapy you score lower you are considered to have improved. If you scored just above the clinical threshold for depression at the start of the therapy (let’s say the threshold is 10 and you scored 11) and by the end of the therapy you score just below (let’s say 9) then you are considered recovered by IAPT. But in reality you’ve only dropped 2 points and are likely still experiencing emotional complications in your life! They’re now just not considered inconvenient enough to others to be clinically notable, but that doesn’t mean they aren’t hugely significant to you. You might not feel ‘recovered’ at all. And the scale is really sensitive anyway – you can move around 5-7 points simply by sleeping and concentrating a little better. 

Furthermore , IAPT doesn’t even conduct a control group meaning there’s no way to know if the 23% ‘recovering’ would have improved slightly without IAPT at all. In fact a recent meta-analysis (meaning examination of lots of data from different individual studies) showed that a total 23% of people suffering with depression spontaneously overcame their symptoms within three months without receiving any treatment. Which aligns with the 23% recovering from IAPT exactly, suggesting that the service is totally irrelevant. Yet it is often the only service offered to those struggling, many of whom will continue to struggle unsupported. Real lives are in the balance, and the system is trying to stick a plaster over the issue that doesn’t even work. 

This doesn’t even begin to touch on the deep issues for workers within the IAPT services, who are struggling hugely themselves and being crushed under a culture of form filling and goal hitting heralded above actually providing support. An ex-IAPT lead said, in an interview with James Davies: “To hit the waiting list targets we’d offer people some minor intervention but it was not what they really needed – it was what we could offer to get higher results”. And there lies the problem in a nutshell – people are not being offered the help they so desperately need. And how could they in a system that values goals, productivity and economy above people’s lives? How could they in a system that is built on societal expectations, harm, and conformity? How could they in a system that isn’t working to face the deep intersectional issues of the day? How could they in a system that is underfunded and in desperate need of reform? 

I recognise that criticising the mental health system is a complicated thing to do, because it’s where we hope to find help. But the reality is that it falls short. I do have hope it can improve; I have hope in our communities and our efforts to see better care. And I do know that despite a failing system people can recover – by their own standards – and live bright lives. But I know too it shouldn’t be so hard to get support, for anyone. 

So here are some calls to action! What you can do to help: 

  1. Most of the information in this post comes from James Davies’ book ‘Sedated: How Modern Capitalism Created Our Mental Health Crisis’. I would recommend that everyone read this book to educate themselves further 
  2. Sign up to Mind’s newsletter to find out about their campaigns for better mental health care 
  3. Write to your MP about the failing mental health system and demand care that is individually tailored, socio-culturally aware, and focuses on personal healing not productivity 
  4. Share this post and have conversations with people in your life about the mental health system – all change starts with a conversation 

Thank you so much for reading! Please let me know any thoughts or questions you have in the comments below. Sending so much love and support to you all today 🙂 

Sources:

https://www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/iapt#:~:text=What%20is%20IAPT%3F,with%20anxiety%20disorders%20and%20depression.

‘Sedated: How Modern Capitalism Created Our Mental Health Crisis’ by James Davies 

https://www.madinamerica.com/2022/06/uk-iapt-abject-failure/#:~:text=We%20identified%20a%20series%20of,of%20misdiagnosis%20and%20inappropriate%20treatment.

Layard, Richard (2005), ‘Mental Health: britain’s biggest social problem?’, paper presented at No. 10 strategy unit seminar on mental health, 20 January 2005 

https://www.mind.org.uk/information-support/drugs-and-treatments/talking-therapy-and-counselling/cognitive-behavioural-therapy-cbt/

Griffith, Steve, Steen and Scott (2013), ‘Improving access to psychological therapies (IAPT) programme: setting key performance indicators in a more robust context: A new perspective’ 

Whitford, H et al, (2012), ‘Estimating remission from untreated major depression: a systematic review and meta-analysis’

Posted in Advocacy, autism, Mental Health, neurodiversity

Misogyny and The Psychiatric Complex

I think nowadays more and more people are aware that sexism connects with and is compounded by other factors such as racism, economic insecurity, homophobia etc. However few people are aware of the links between misogyny and the psychiatric complex. I’d go a step further and say a majority of people are reluctant to examine or criticise the psychiatric complex at all. However this ignorance is harming the most vulnerable among us at their lowest points, and threatens to affect all of us should we experience a mental health issue (as an estimated 1 in 4 people will every year). So let’s have a brief look at the relationship between misogyny and the psychiatric complex:

Throughout history psychiatry has been used majorly to uphold societal values. As such the history of psychiatry is entrenched with sexism. The most obvious example of this was the epidemic treatment of ‘hysteria’ in women. Hysteria has been described from the second millennium BC, but it was not until Freud – a man – that it was officially considered an exclusively female disease, though it’s important to note women were disproportionately institutionalised for hysteria for hundreds of years before this. It may surprise you to know that it was not until the DSM-3 (the DSM is the leading book used for the classification and diagnosis of mental disorders) that ‘hysterical neurosis’ was deleted. 

The treatment of hysteria can be very generally described as using natural remedies to calm the nervous system until the renaissance period, notably the end of the 16th century. This is also notably where it became considered much more of a ‘female’ disease’. Around this time hysterical women would be treated by a physician interesting their fingers into genital organs to try and produce an orgasm and semen production (which raises serious questions about consent and abuse in the history of psychiatry which still pervade to this day. Some people considered suffering women to be witches or possessed with demons around this time also. For doctors at the time the uterus was their explanation for hysteria in women – claiming it caused them to be psychologically and physiologically inferior.

During the 16th century physicians and philosophers such as Thomas Sydenham, Rene Decartes, and Ambroise Pare started to recognise that hysteria was connected to the brain and other organs also, not just the uterus, but the idea of a uterine, female disease continued. For example, Joseph Raulin in the 1700s suggested hysteria was due to the fumes of big cities, so in theory it could affect both sexes but women were just weaker. 

Perhaps the most famous outbreak of hysteria is the Salem witch trials in 1692. Marion Starkey related it to more contemporary events after WW2 with the theory that classic hysteria was actually a reaction to social conflict and restriction, such as the puritanism in Salem. Note she’s the first woman mentioned. Much evidence would support that mental illness and the classification of it is intrinsically tied to the pressures of the world we live in, notably under hyper capitalist values nowadays, so I would not think it too much of a stretch to think that women during these times under such enormous pressure to conform would present symptoms of hysteria. But they were labelled as mad – their individual character was named as the problem, not as a symptom of a societal issue. And they were labelled mad by men. 

This general hypothesis of hysteria, especially during this period, seems to make sense in the majority of cases when you consider that women could be committed to mental institutions – which were comparable to jails at the time and arguably still are – by their male relatives simply for not conforming to the standards expected of them. The inhumane conditions in many of these asylums are well documented, and I personally think some treatments could be considered comparable to torture. As Angela Davis so eloquently put it: ‘Studies indicating that women have been even more likely to end up in mental facilities than men suggest that while jails and prisons have been dominant institutions for the control of men, mental institutions have served a similar purpose for women. That is, deviant men have been constructed as criminal, while deviant women have been constructed as insane.’

While psychiatry may have changed – yes, in some ways for the better and in some ways just more palatable to a modern society – its roots cannot be ignored as they are the foundation upon which modern psychiatry is directly built and this harm still exists. Let’s have a look at the current day now, through the lens of BPD diagnosis, aka Borderline Personality Disorder. 

Women are disproportionately diagnosed with BPD. There’s a 3:1 female to male ratio in the diagnosis of BPD which is quite pronounced for a mental disorder, and has led to speculation about its cause by professionals. However critics of the diagnosis have gone as far to say it is the modern day version of hysteria – a label extremely loaded with stigma that judges the emotional reactions of women. Think even of the title ‘personality disorder’ – the name itself suggests it is solely an individual issue, a defect of their character, not linked to anything in the outside world.

I write on mental health from a place of personal experience, and I will admit that because of this I am biased in how I view mental illness. There appears to be some research that genetics plays a factor in BPD for example, which would be an individual trait. However I believe it is essential that we also look at how the world as it is is unsuitable for people with that genetic component. Can we answer the question of whether that genetic and neurobiological component would present in the way it does if that individual was not subjected to trauma and systemic pressure? Perhaps not in full. But there is ample evidence that sociocultural factors affect mental illness, and that seems to be so often ignored. 

A sociocultural factor could explain why more women are diagnosed with BPD, as they often experience more pressures in the world to conform, and are more likely to be the victims of violence and assault that contributes to trauma in BPD. However the stigma surrounding BPD stemming from its symptoms may explain this too. Hypersexuality for example is a trait of BPD; being sexual as a woman is still less acceptable than being sexual as a man, so for example a woman’s behaviour may be labelled as hypersexual while for a man it’s just seen as a strong expression of his sexuality, or perhaps not even noticed at all. Likewise anger is also a symptom of BPD, and we are much faster to label women as problematic for expressing anger than we are men. So the social misogyny impacts when we start to consider a person’s behaviour as more than just odd, more than just problematic, but actually disordered. 

It would be unjust to write this article without drawing attention to the disparity in mental health care between races. Like aforementioned, psychiatry and misogyny are intrinsically linked with other social justice issues. If we ignore this intersectionality we are ignoring the full picture. For example, Black women are more likely to struggle with mental health issues, less likely to get treatment, more likely to be misdiagnosed, and more likely to be sectioned (an example of the criminalisation of mental illness, but that’s a story for another day). In fact detention rates under the Mental Health act during 2017/2018 were four times higher for people in the ‘Black’ or ‘Black British’ groups than those in the ‘White’ group, and 29% of Black/ Black British women experienced a common mental disorder in the past week, higher than for White British women or Other White women. Clearly we can see the link between the pressures and pain of racism to the experience of mental illness in Black women, and their subsequent further incarceration and abuse in the mental health industry. Likewise we can see a mirror image effect in the LGBTQ+ population – almost half of trans people (46 per cent) have thought about taking their own life in the last year, 31 per cent of LGB people who aren’t trans said the same. This is not a stand alone issue.

Another example of misogyny in the psychiatric complex is the recognition of neurodiversity in women and trans people. Early autism research was based on white boys from middle class backgrounds. Outdated tests, and a lack of understanding of how autism presents in other races and genders in the general population still result in late diagnosis or misdiagnosis of women and trans people everywhere. And here seems to be a good time to put all of this information into context – the misogyny in the psychiatric complex damages and ends lives. Whether from the trauma of institutionalisation from stigmatised diagnoses, or the pain of leading a life without understanding or accommodations, individuals and communities suffer every day. As a late diagnosed autistic myself I can attest to how painful it is to grow up being bullied, misunderstood, and confused without any path forward. I can’t imagine how different my life might have been if I had known I was autistic and had the resources to help me and my family as I navigated a world not built for me. And I had it easy! 

Yet if we take a look at neurodiversity through the lens of knowledge that gender is a construct, we can see clearly how much the pressures of the world to conform to gender norms affect people. I was taught to be a girl, while autistic. So the way my autistic brain processed that (for lack of a better phrase) was to make me mask so heavily I couldn’t see myself through it all. This is common in those who identify in genders other than male. The world taught me to be a woman and because I learnt to do it, in a system that ignores neurodiverse women, I had no idea how my brain worked. I had no idea who I was, and I was in pain. And to add a little history again, a major leader in the foundation of autism research was Hans Asperger – a man with well associated ties to the eugenics programme of the nazis. Asperger’s and autism aren’t different, but Asperger’s was used to basically say they were more intelligent, and therefore more worthy to society. These messed up roots run deep in all directions. 

However, diagnoses aren’t all great. In fact they can be downright damaging in themselves. As mentioned, a BPD diagnosis is highly stigmatised, and disproportionate in women. Having a diagnosis of any mental health issue or neurodiversity can lead to people’s experience being invalidated. If you’re labelled as mad, how can you ever convince someone you are sane? For one it can be very hard to get out of hospital and escape that system if you are committed, and extremely hard to report any abuses taking place there as they often do because concerns can simply be brushed aside as delusional, symptomatic. Any legitimate problems in interpersonal relationships can be labelled as a symptom. Any very real feeling is simply boiled down to a mental illness. Women – already more likely to experience violence – see their diagnosis weaponised against them when they try to report violence; and people with a mental illness are significantly more likely than the general population to experience violence!

The sexism in society and psychiatry doesn’t just adversely affect women and trans people though. It also affects men who are significantly less likely to come forward if experiencing a mental health issue. In 2021 men were three times more likely to commit suicide than women. And much of this can be traced to the stigma of men expressing emotions in fear of being seen as weak (translate: as fear of being seen as expressing a feminine trait). Everyone, including men, are being harmed by the systems men built. 

And yes, the modern psychiatric complex was built by men. Built on the foundations of male researchers at a time when women were denied an education, and continuing to be led by men. I’ll end on a story about how the DSM – that book used to diagnose mental illness – was created. The DSM-III was the version of the DSM that formulated how we see and diagnose disorders nowadays. It included innovations such as explicit diagnostic criteria and multidimensional diagnostic systems. But the formulation of it was hardly clear or scientific. Robert Spitzer was appointed editor of the DSM 3 and by his own admission the editorial meetings over six years between 1974-1980 were chaotic. New Yorker’s journalist Alex Spiegel reported that the psychiatrists invited would yell over each other, and the loudest voice tended to win out, while no one took minutes. People would yell out names of new diagnoses and possible checklists for symptoms, and if the cacophony in the room seemed to agree it would be typed out, set in stone. The diagnoses in that book still have very real implications for very real people nowadays, and diagnoses are removed and added in each edition following. It’s not an exact science; it doesn’t centre the lived experience of people.

If you take nothing else from reading this article I hope you remember this – sexism is systematic; it affects all of us in all aspects of our lives. But our distress, our joy, our love and our pain? That’s not just symptomatic of a system, that’s symptomatic of being human. 

Sources:

Posted in Advocacy, Happy Notes, Mental Health, Personal Growth

OHN Hopes for 2023 (and beyond!)

I struggle with the idea of New Year’s resolutions. After all, New Year’s Day is simply just another day. The sun will continue to rise and there will always be new tomorrows; new opportunities for change and growth – in fact it happens every day. However I do realise that years are markers of points in our lives and our developments, so I wanted to share some hopes and aims for this space in the coming year and beyond! In the interest of transparency, I don’t have a clear plan on how to achieve everything on this list. But I’m working on it. Just like I’m working on learning more and listening to more voices on mental health and its intersections every day. My hopes will change, my perspectives will change. And I am so glad to have all of you along for the ride. 

Thank you all so much for your support of this space and mental health advocacy in 2022. 

If you would like to be more directly involved with Our Happy Notes – whether on the blog, instagram, or something else! – please do reach out. I would love to hear from you! You can fill out the contact form on this website or email ourhappynotes@gmail.com 

So without further ado, here are the hopes for Our Happy Notes in 2023:

1. More tangible actions 

2. More pressures on governments and organisations 

3. Consistent blog posting

4. Regularly get back to how it started – distributing happy notes!

5. Create connections

Posted in Advocacy, Mental Health

Actions to Support Mental Health Nationwide

Here are some tangible actions you can take to support mental health in your community and nationwide, but there are so many more! Follow this blog to get notified of new posts and ideas in the future.  

Write to your MP

Imagine if everyone in the U.K. wrote to their MP in the morning demanding more mental health support. While it’s unlikely that will happen, small actions over time DO add up – it’s worth a shot. When writing to your MP make sure to mention mental health system reform, not just more funding. Writing and protesting other issues such as the cost of living crisis also supports mental health, as it is not a stand alone issue! 

Join the Young Voice Network at Mind

If you are aged 11-24 in the U.K. join this network! They constantly send through information and opportunities for young people to get involved and shape the direction of Mind and the mental health support for young people in a meaningful way. 

Protest

If you’re able to – protest. We don’t hear a lot about protests for mental health system change and support. But that doesn’t mean it doesn’t happen. CPA in London held several last year for example. And the protests and shows of solidarity for other issues such as Black Lives Matter and fair pay are all interlinked with mental health support too of course! If you want you could even set up your own protest or vigil. 

Promote mental health support at your school or work

Mental health support starts at an everyday level, and we can build communities of support. Have a look at the support available at your work or school, even your local community, and join meetings, boards, unions etc to demand better mental health support be available to fill the gaps. Suggest support groups in community centres, accommodations and counselling available at work – the sky’s the limit, and you are not powerless. Of course do not risk your own security to do this, but often a gentle conversation can be enough to plant the seed and get the ball rolling. 

Reach out to friends

Simply reaching out, offering a listening ear, and being non judgemental can make such a huge difference. If someone has been isolated for a while, welcome them back without criticism. Send a letter or a funny picture that reminded you of them. Just reach out. 

Educate yourself

Educate yourself on the intersectionality of mental health and the issues in our mental health systems today. Have a look at new ways of looking at mental illness and support. And always approach with an open mind. I would recommend always making sure you are listening to survivor stories too, not just psychiatrists or professionals. Because people living with mental illness are the expert on what it’s actually like to live with a mental illness. Being better educated can empower you to make changes in your life and community and to raise your voice. I’ll be posting more resources on this soon. 

Drop off some goodies at an inpatient ward

Being in inpatient mental health treatment can be a terrifying, traumatising, and lonely experience. Drop off some cookies and notes of encouragement if you can (nothing that poses a ligature or safety risk). Letting the people inside know they are not alone and that there is a world out here rooting for them with love is so so so important. 

Talk about it

Talk about mental health with your family and friends. Talk about how you are feeling, talk about the stigma, talk using the terms you are learning. And talk about the system and what you think of it. All change starts with a conversation. 

I know how hard it is to know where to start making a change when it comes to mental health. It can feel like we’re not allowed to question the narrative or talk about certain things. But there are actions that can be taken on a personal level and beyond. 

This is only part 1 – follow for more!

Posted in Advocacy, Mental Health

‘Bedlam’s’ True Horror History

Today’s post is the first that looks into the history of psychiatry and ‘treatments’ for the insane, mad, mentally ill and neurodivergent, through a brief overview of the history of Bethlem. I think it’s important to share and learn about this history because it helps us to better understand the foundations and influences on psychiatry nowadays, and therefore understand the problems and potential solutions within the mental health system, including abolitionist approaches. I hope you find this little guide to be informing, let me know if you have any questions in the comments! Just a quick trigger warning for psychiatric violence and restraints.

Bethlem Royal Hospital was one of the first lunatic asylums. It’s horrifying history has inspired lots of books, movies and TV shows, most notably Bedlam.

So the real life horror in its history should be evident, otherwise why would it inspire such horror stories? Yet often we don’t stop to wonder about such histories that informed modern day psychiatry. It’s important to learn about this stuff because the legacies can still be seen nowadays in abusive, neglectful, and ineffective systems.

Bethlem was originally founded in 1247, and was linked to the Church of Bethlehem. It’s foundations are muddied and muddled – it was first used to house alms and poor people with religious ties and with the aim to make money. This monetary trend is also something we still see nowadays in many areas of life, including in the mental health system and coupled pharmaceutical industry.

It’s not known exactly when Bethlem was first used for the insane but is frequently assumed that this was from 1377. Management was through ‘keeperships’, with essentially sole control. Jumping ahead a bit, during Sleford’s keepership at the hospital (1579-1598) the buildings fell into disrepair – ‘so loathsomly filthely kept not fit for any man to come into the house’

However, living conditions didn’t exactly improve. Into the 19th century many inmates were left to sleep on straw beds and only permitted to go the toilet in their cells. Simultaneously financial exploitation by head physicians was common from the 17th century onwards – they were getting rich while the people inside suffered. In fact, in the 17th century several patients were found to be suffering from starvation, and staff practices were found to be a significant contributing factor to this. Staff practices are often a main complaint by inpatients today as well – but they are far too frequently brushed aside; once you’ve been labelled as unstable it’s incredibly difficult to reclaim your power and have your concerns legitimised.

While it appears restraints and solitary confinement were used for the insane at Bethlem from the start (and still today!), not a lot is known about so-called ‘treatment’ in the medieval period. However from 1460 the transition to a specialist institution for the insane was mostly complete and more is known from then on. In the 1680s cold baths were introduced as a form of treatment, as were incredibly hot baths later. Patients were bled, blistered, then dosed with emetics (make you vomit) and laxatives indiscriminately during the 18th century.

Perhaps one of the most disturbing parts of Bethlem’s history is that from the 17th century onwards visitors could pay to come and gawk at patients like animals in a zoo. Can you imagine the shame and anxiety of having your distress put on show as amusement for others? How could anyone possibly heal in that environment? We can infer from this a part of the pattern of control and benefit from locking mad people away rather than a genuine care for them as individuals and a desire for them to heal.

There was even an ‘Incurables Division’ added 1725-1738; patients in here could never hope to leave. One approach was rotational therapy: a patient was put in a chair suspended from a ceiling and spun at sometimes more than 100 rotations a minute

Experimental (read: unsafe) treatments were also used on patients at Bethlem. Furthermore modern investigations have uncovered mass graves on the property, dug exclusively for those who died under care at Bethlem.

This barely scratches the surface of Bethlem’s horrifying history of abuse and exploitation. The hospital is still in use today and many patients are still voicing their pain and trauma from their time there – restraints are still used, as are forced medication, and mad voices are not respected. There’s even a museum of patient’s artwork there, and while some exalt this as them respecting the patient’s expression, I have to wonder to what degree is it a modern day version of gawking st misunderstood minds?

We may have come a long way, but there’s still a lot further needed to travel.

Sources:

https://www.huffpost.com/entry/bedlam-the-horrors-of-lon_b_9499118/amp

https://en.m.wikipedia.org/wiki/Bethlem_Royal_Hospital

Porter 2006, Whittaker 1947 

Porter 1997 

Andrews et al, 1997 

‘A view of Bethalem’ 4th December 1598, quoted in Allderidge 1979

Posted in Advocacy, Managing Mental Health, Mental Health, Personal Growth

Journey Through Panic Attacks

The first time I experienced a panic attack I was 11 years old. I had come home early from school that day with a headache and some other physical symptoms I now know were anxiety, and I had gone upstairs to have a nap before dinner. My mum came to wake me up when it was time to eat, but I must have been in the wrong phase of my sleep cycle because I awoke disoriented, thinking it was the morning. We’ve all been there when we wake up not quite sure what’s going on. So I thought it was the morning, and when my mum told me it was time to eat I responded asking about breakfast. There was some confused back and forth with my mum trying to convince me it was in fact dinner time, and still the day before, and I suddenly spiralled into my first panic attack. I don’t remember a whole lot of the details while it was happening, but I do remember how terrifying it was. I remember feeling like I couldn’t breathe; I simply could not get the air into my lungs. I felt faint, and sick, I thought my legs couldn’t hold me up. I don’t know if I had the thought that can come alongside panic attacks where you think you’re going to die, but I knew something was very, very wrong; I definitely thought I was going to faint. Somehow I ended up at the bottom of the stairs, gasping for air and sipping water out of a bottle cap (I think that was the only way I could manage to do it?) as it subsided, and I can still recall the exhaustion after that first one and how foreign it felt. My mum suggested it had been a panic attack, and at that point I didn’t know what that meant. I had no idea they would become such a huge part of my life. 

I have had many panic attacks since this day. I’ve also had some anxiety attacks, which are more prolonged and less intense, and I experience sensory overload too as an autistic young person. Sometimes sensory overload meltdowns and panic attacks can be hard for me to distinguish, and sometimes they overlap or morph into the other, but it’s helpful sometimes to figure out which is which as it can aid in the recovery process both long and short term – for example in a panic attack changing my jumper probably isn’t going to help and may not even be a possibility, but with sensory overload changing the material of my clothing or my environment may help it to subside or avoid it altogether when I feel it building. This year I have felt the strongest mentally overall that I have in a very long time, but I still have panic attacks. Some months I have none; others I have many. For example in May I had seven.

 It’s important to note that while I find the label panic attacks useful, it is a pathologised word. That means there is a certain medical connotation attached to it. However panic attacks are a total overload of our nervous systems; an explosion of tension and anxiety. We cannot talk about expressions of mental distress without recognising that they are often responses to a traumatic and stressful world, whether immediate results of a specific trigger or a build up over time. For example in May I was dealing with exam stress, difficult atmospheres at home, grief for my safe place, and more time on my hands. These all contributed to my spike in panic attacks I have no doubt. Other times I may make it to the other side of a stressful event and then experience panic attacks, almost like a hangover of emotions. It’s not an individual failure, but an understandable reaction to a difficult world. You are not broken for experiencing anxiety. You are not shameful for having panic attacks. 

I am a firm believer that to appreciate life fully we need to be able to laugh, even at the bad stuff. There are certain events surrounding some of my panic attacks that I find kind of hilarious looking back on and that helps me to deal with any embarrassment or regret surrounding them I may have. For example, I have terrible stage fright (despite being an actress, ironic I know). Before the final dress rehearsal for Bugsy Malone – my first show in a proper theatre – I had a panic attack in the wings. I was crouched behind a prop box in heels I could barely walk in and my tailored sparkly dress writhing my legs in pain and sobbing without air. It was a pretty desperate moment, though the juxtaposition itself is amusing looking back. The next thing I remember is a stagehand saying into their walkie talkie ‘can someone please come and remove the fire hazard from the wings?’. I was the fire hazard because I couldn’t move myself out of the way, and I was carried back to my dressing room by my director. Talk about a diva moment. Looking back I cannot help but laugh at the absurdity of the experience. 

That particular panic attack also showed me how loving people can be. I hope that someday everyone experiencing mental health issues gets to experience the pure love and support that I did that day. I had to go on stage just after recovering to do a mic check. I was so exhausted – my bones were heavy; the exhaustion of a panic attack travels to your core and can make you feel like your body isn’t your own – so all I could do was stand centre stage. The rest of the cast sat in the audience as I weakly sang ‘My Name is Tallulah’. Half way through the song I raised my eyes and saw that they were all swaying along, waving their hands in the air; at the end of the song they stood up and cheered and called out encouragement. It was beautiful. No one judged, no one whispered or pointed. They rallied and supported me. That’s what we all deserve. 

Another amusing panic memory was when I fell on my face in the mud on a rainy day trying to escape prying eyes and instead drawing them all to me; again, it wasn’t as embarrassing or well remembered as I feared it would be. Or when my teacher gave me their scarf to wrap around me and help me feel safer and I immediately snotted into it – I got to keep that for a while rather than immediately returning it. Or the time I went to get help while having a panic attack but there was already a girl in the office having a panic attack and it became like a queue for a very strange and unwanted product.

 I’ve been alone on bathroom floors, writhed my legs, hit my chest, backed myself into literal corners to try and feel a bit safer, thought I was going to die, taken off most of my clothes because I thought my skin was going to burn, and just general cried and made weird sounds while trying to breathe. Point of all of this is – I survived. And each one has become a little easier to recover from. The worst a panic attack will do is make you pass out; it cannot kill you. Remember that – it cannot kill you. If you are having one, it is horrible and tiring and painful, but you are safe. And if you are with someone experiencing one it’s ok to remind them of that; if you can recognise what it is and call it what it is. Tell them it’s a panic attack and that they are safe. Often it helps not to try and suppress it either but rather to ride it out, let it be. Because they are not the end of the world, but they are super scary and it’s ok to recognise that too. 

I hope that maybe reading this has helped someone feel a little less alone in their experience. If you’d like a more in depth guide on how I deal with my panic attacks let me know in the comments below! Sending love and support to you all today! Xx