Thursday, 18 August 2011

"Leave me alone...but not for too long." Privacy.

Last week I mentioned that I had my three grandsons staying for twelve days and I was experiencing a missing emotional need.

That need was one we all have at times. A need for a time of privacy. Some 'me' time. Some 'me' space. 

It's not about being selfish, it's about allowing the brain to slow down.

A time to rest the mind and body.
A time to recharge the batteries.

Like the cell indicator on a mobile phone. We all need to have a time to recharge, otherwise our batteries run out. And we are warned. Our body tells us. We don't listen to our cost.

But as with so many things in life, it's a case of not too little, but not too much. There are too many people, especially the elderly, experiencing too much 'me' time and feeling isolated.

So I'm going to take a break and catch up with me.  

My starting point will be this famous poem:

                        by William Henry Davies
    What is this life if, full of care, 
    We have no time to stand and stare. 
    No time to stand beneath the boughs 
    And stare as long as sheep or cows. 
    No time to see, when woods we pass, 
    Where squirrels hide their nuts in grass. 
    No time to see, in broad daylight, 
    Streams full of stars like skies at night. 
    No time to turn at Beauty’s glance, 
    And watch her feet, how they can dance. 
    No time to wait till her mouth can Enrich that smile her eyes began. 
    A poor life this if, full of care, 
    We have no time to stand and stare.


Saturday, 13 August 2011

How I saw it in 2003...a psychiatric unit.

This is as good an opportunity as any, to re-visit a piece a wrote in 2003. It will help put my 2011 views into context. 

I haven't changed anything in the piece. Eight years and hundreds of clients later,  I still stand by my observations. 

Featured in the Human Givens Journal Vol 10 No 1 , 2003

Not a Tissue in Sight
I read with great interest and enthusiasm the article in the last issue called “The urgent need for a human givens teaching hospital” (vol 9, no 4). I couldn’t agree more that we are crying out for such a facility. Over a period of five years, I worked on an acute psychiatric unit – private but with NHS beds – and, while it had many of the assets that Ivan Tyrrell described as desirable, (a beautiful setting, architecturally pleasing and with grounds and outbuildings of its own), what was lacking was effective help for its troubled occupants.
I became involved with mental health work by accident when, as a nursery nurse working for a local agency, I was asked to go to the unit to support a mother with postnatal depression. On my second day, the staff nurse asked if I would like to become a member of a bank of nursing assistants on whom they called when they were short-staffed. I thought the work would be extremely interesting, so I agreed. Little did I realise then that what I would see and learn would propel me into a totally new career as an effective therapist.
The unit catered for the whole range of acute psychiatric disorders – eating disorders, addiction, depression, schizophrenia, paranoia, bipolar disorder and so forth. I worked there fairly regularly, on both day and night duty, filling in when staff were off sick or on holiday leave. I enjoyed the hospital atmosphere. We all wore ‘civvies’; patients were called ‘clients’ and there was no institutional feel at all: the furnishings were attractive, the grounds cultivated and colourful, the walls hung with paintings and the rooms filled with plants. Almost all the bedrooms were single occupancy, with private shower and toilet.
I suppose my first surprise was that nursing assistants who worked ‘on the bank’ received little training, no supervision and were not included on the nvq programme. The only training was an initial induction including health and safety topics such as how to lift a patient, but not how to talk or relate to them. While nurses and assistants on the staff were participating in the supervisory support groups that were denied us, just a couple of us would be left to run the ward. Besides helping serve meals and ensuring people took their medication, my main duty was to act as a support to clients and my main ‘intervention’, as it was called, was to offer a shoulder for them to cry on. I might be asked to talk with someone for half an hour, accompany them on a walk to the shops or round the grounds or just sit with them. often I took my turn at close observation of a client ‘at risk’ of killing themselves or running away. Some clients had to have their whereabouts checked every 15 or 30 minutes. All nursing assistants took their turn at observation duty, which sometimes entailed just sitting in a corridor, ensuring that people thought to be at risk didn’t get out. I was never supervised once, either formally or informally. Even on my first day, I was left with an extremely challenging client and given no guidance; the staff just assumed I would cope.
On the whole, I found the work absorbing, although, with no training, sometimes I wondered about my effectiveness. Slowly, however, I became increasingly concerned by what I observed. There was a worrying reliance on the medication trolley and the longer I worked there, the more I realised how long patients tended to stay on the unit too. Often they remained for months on end and seemed to deteriorate, rather than improve, with some clients becoming nurse and/or doctor dependent. Clearly, there were long term clients who knew how to manipulate the staff. They would push at boundaries (for instance reneging on a contract not to drink alcohol or not keeping to an agreed eating regime) and be allowed to get away with it. With my nursery nurse training, this instantly struck me as wrong. One of the first things we learn when we set boundaries for children, is to be consistent.
I also became more and more struck by the fact that people tended to spend a great deal of their time being miserable, not helped by the emphasis on past events rather than looking for solutions. Clients either huddled away to cry on their own, sat in the communal areas or came in a distressed state to ask a staff member to be with them. We were just expected to listen while they cried, and murmur “There, there”, “It’s not as bad as all that” or suchlike. One woman would cry so protractedly, going over and over and over something in her past, that staff tried to avoid her. Even now, years later, if I should meet her in the street, I notice tears will come into her eyes as we speak.
When I did corridor duty, ensuring that no one who was at risk went out of doors, I would see clients go to what was called the ‘end of day’ group, where they would talk with a member of staff about what had not gone right for them that day. It was a time to unload (as if they needed any more unloading). I would watch them when they emerged and couldn’t help likening them to a line of monks in their habits – except, in this case, what they were shrouded in was misery or anger. Tears flowed easily (I was never present at such a group but I gathered that someone would say something woeful and it would set everyone else off). Some went straight to their rooms to self harm.
There was a TV room where people could smoke, and there many would sit, smoking, watching TV and looking miserable for most of the day. Sometimes a nursing assistant would engage someone in a game of scrabble or start a jigsaw, but, for the most part, people were left on their own. There were occupational therapy and psychotherapy sessions, music and art therapy or relaxation classes, but these were often cancelled because the person due to lead them was sick, on holiday or had gone to a meeting. Clients found this very frustrating. My abiding image is of people drifting – shuffling along the corridor between the smoking room and their own rooms. There were many hours of unproductively filled time. Clients saw their psychiatrist once or twice a week and were supposed to see a named nurse every day, but not many seemed to improve. While I privately questioned what I saw, I thought it must be due to my lack of relevant academic knowledge.
Some nurses, in conversation, might casually question the benefit of it all, but mostly they put up with it. Not one of them showed any interest in a flyer advertising a MindFields seminar, entitled “How to be an effective counsellor”, posted up on the staff room notice board. By that time, sometime in 1998, I was frustrated enough to be willing to spend my own money to go along, in the hope of learning something I could put to positive use. That seminar changed my life. I continued attending MindFields seminars and workshops, and quickly learned swift, reliable ways to help people overcome distress. I took the Human Givens Diploma course and now work in private practice as a human givens therapist. But, at the beginning, I was tentative in applying my new growing knowledge in the psychiatric unit where I still worked.
We used to have clients knocking at the staff room door, begging for medication when they felt they needed a top-up. Nurses tried not to give it before time, so people could be left in a extremely agitated state, not knowing how to get through the next half hour or 40 minutes until they came and pleaded again. I asked permission to try calming them with relaxation, and clients found it enormously helpful.
There was a man in the unit who had been a soldier involved in a conflict abroad and suffered severely from post-traumatic stress syndrome. I offered relaxation but he was wary at first. I soon found out why. At one of the group relaxation sessions, the nurse inducing relaxation, had instructed individuals to imagine a lovely, green field. The man panicked and ran out of the room in complete terror. It turned out that it was in a lovely, green field that he had very nearly been blown up by an exploding mine. I persuaded him to let me try to help him and, of course, invited him to visualise a peaceful place of his own choice (which turned out to be his bedroom at home). I also talked to him about the effects of emotional arousal and helped him reduce it by encouraging 7/11 breathing – breathing in to the count of seven and out to the count of 11. It was simple and effective, and he was pleased with both interventions. But I always made sure I received permission from the staff before trying any such thing, however minor.
One woman – I’ll call her Maria – was severely manic depressive. One day she started crawling over the furniture in the communal area, shouting and jabbering non-stop. The staff just left her to it. It was early days for me in my ‘therapy career’ but I knew about entering individuals’ reality as a technique for getting through to people who are psychotic. So I started nodding as she jabbered, as if she were talking sense. She was already clearly in her own trance state, so I decided to try a hypnotic suggestion. I said, “AS you carry on crawling over the furniture, you’ll notice that you start feeling more relaxed and sleepy.” Her movements slowed and she stopped on the sofa. I added, “You will go to sleep, waking up when you want to, feeling calm and relaxed.” She fell asleep almost immediately and, half an hour later, opened her eyes and went calmly back to her room.
I was highly encouraged by this small success. On another occasion, Maria had trashed her bedroom and bathroom. She was wandering the corridors, ranting that she had to get ready; people were coming to see her and she had to get the flat sorted out. Taking her at her word, I said, “Well, we’d better get your flat sorted out, then,” and walked with her to her room. It was in an appalling state – everything all over the place and talcum powder everywhere. But she set to, and cleaned the room in preparation for ‘the people’. I wasn’t confident in my new skills, at that time, so I didn’t make much of anything I managed to achieve. I did mention to staff that Maria had cleaned her room but no one was particularly interested. I was just a nursing assistant with no nursing or academic qualifications. Who was I to suggest something that might work?
A major restructuring programme took place and the one unit became two units with their own specialisms, because the mix of conditions hadn’t always been helpful to the clients. But, overall, the effectiveness of treatment appeared to change little. As I furthered my training outside of the unit, I knew I couldn’t work on the units anymore, without saying what I thought. So I wrote to the two psychiatrists, one psychologist, two staff nurses and four management staff, saying I had enjoyed my time at the unit but now felt something important was missing from the care. I said I thought every nurse and doctor should be trained in how to lower emotional arousal and in the use of therapeutic trance states. I donated a set of the organising ideas monographs to each unit but, although some thanked me, I do wonder if they have been read.
From what I know now, the negative aspects of the care that was offered in the hospital are probably common to the majority of such units to which people are routinely admitted (although staff to patient ratio is likely to be lower). Medication cocktails are administered that induce highly questionable side effects; emotional arousal is encouraged (in our case, boxes of tissues tended to be everywhere – bedrooms, dayrooms, the consultants’ rooms and corridor tables); and there is not enough to occupy people, so damaging introspection can hardly be avoided.
As a result of taking other observations into account too, in my own consulting rooms the walls are not white; the chairs are not institutional or placed towards the light; there is no large clock ticking loudly, at which the therapist keeps looking; and there is not a tissue in sight!
Good luck with the proposed human givens hospital.
Rita Leaman


Thursday, 11 August 2011

"Why?" Rioting and looting.

Plans eh? So much for using other people's words for the blog this week.  

With the rioting and looting that has taken place all over England this week, I cannot keep silent. If anyone wanted evidence of emotional immaturity, just read and watch the news. 

I will be succinct for a change.

I am not going to apportion blame. This particular jig-saw has many pieces. There is no one reason behind the behaviour on display. After all, for every person that can be shown to be 'deprived' in some way, there will be another who has experienced similar circumstances and not chosen to riot and loot. The question 'why?' is always interesting.

(In therapy, the question, "when does the problem not happen?" can be illuminating.)

I would just like to use these events to mention some of a person's principle needs again. 
  •      A meaning and purpose in life.
  •      Loving and being loved.                                                                                      
  •     Security in home, work and environment
  •     A sense of autonomy and control.
  •     A sense of community                                                                                                              
  •     The giving and receiving of attention.
  •     Balanced nutrition.
  •     A feeling of status and personal value.
  •     Fun and friendship.
  •     A sense of achievement coming from being stretched in what   we do and think.
  •     The need for privacy.

If someone is experiencing emotional health problems, the roots of the problems can usually be found in this list. 

It is vital that these needs are met to enable people to survive and thrive. If people cannot get these needs met in a healthy way, then they may look for getting them met in unhealthy ways. Unhealthy, anti-social and criminal ways.

I am in no position to say what has caused these riots and looting problems or why. But I will suggest that most of these people have been getting their needs met. But in an unhealthy, anti-social and criminal way.

Add some brain function into the mix, as in, 'emotional arousal causes stupidity' and the consequenses have been plain for everyone to see.

Now back to meeting the needs of my grandsons and the loss of one of my needs. I will write about that next Wednesday.


Sunday, 7 August 2011

Holiday reading - Chris Evans' 'fear is the killer'

I have three grandsons staying with us for ten days. I love having them, but it does mean that I can't find enough 'me' time for blog writing.

I believe in the following statement:
"Time is money, but the best thing you can spend on children, is time." Charles Colton.
And as you get older, time becomes more precious.

I'm going to use the next three blogs as an opportunity to post some words by other people.

Today, the Radio and TV Presenter, Chris Evans, wrote about his experience of bowel cancer. It is a disease in my family too. I agree with his views.


Wednesday, 3 August 2011

"You're mental!" No, I am not, I have a virus.

A feeling of deja vu came over me, as I read another news report on Myalgic Encephalomyelitis (ME). This can also be known as Chronic Fatigue Syndrome (CFS). Yet another article about whether it's a psychological disorder or a physical illness.

I do not condone the stupidity of violence and death threats. But feeling extremely unwell and being told that it all may be in your head eg: "You're mental", does raise people's emotions and 'emotional arousal causes stupidity'.

This is a tale of two women:

In May 1986, Ruth was 37, a mother of two children and a part timer worker in a supermarket. In fact her birthday had been part of a busy weekend organising a local fun run, 'Run the World' for Sports Relief. The run was a success, but Ruth felt physically exhausted after three weeks of concentrated organisation. The following week she started a cold.

The cold didn't go away as quickly as usual and two weeks later, Ruth's legs started to feel a bit wobbly, like jelly. No aches or pains, but something not right. Something she'd never felt before. She still felt tired, very tired.

Twenty years before, Ruth had been laid low with anaemia, so she knew what extreme tiredness felt like, but this tiredness was different. An all over fatigue with wobbly legs and now some muscles aches.

Ruth had to take sick leave from work and spent most of the day on the sofa.  Her arms were feeling like jelly too. She would make a meal for the family in the evening, but that was all she could manage. She felt a bit of a fraud, as Wimbledon tennis fortnight started and she could sit and watch it. Except she didn't. She lay for hours on the sofa dozing, doing nothing, not even interested in the tennis. She knew then that she must be very ill.

The GP did all the blood tests and heart tests too, but everything came back okay. Ruth was getting worried. She didn't seem to be able to think straight, her head felt like cotton wool and she couldn't finish sentences. She begun to think about Multiple Sclerosis.

The daily routine was the same. Get up to see the children off to school, collapse on the sofa, drive to local shop, get some food, cook a meal, collapse again. The ironing piled up and her teenage daughter was offered payment to do it. The garden was neglected.

There was going to be another royal wedding in July, this time between Prince Andrew and Fergie. Ruth had helped organise the Silver Jubilee street party and was fresh from organising the fun run. A neighbour rang the door bell. She asked Ruth, whether she could organise another street party. Ruth apologised, but said that she wasn't well enough. The front door closed and Ruth thought, "I don't care".

"I don't care". The words haunted Ruth. She had always cared. Now she didn't. It was at that point that Ruth recognised something was very wrong. Now her brain was affected too. 

A pattern was emerging. If Ruth was still, the jelly arms and legs felt okay. Then she would do a tiny bit of activity and the muscles would ache again. The feeling frightened her, so the temptation not to move was enormous, but she had to do something, even if it was only the evening meal.

Now it was August and the family had planned to go on a camping holiday around Europe. The GP told her not to go. Ruth didn't want to deprive the family of their holiday and told them that she thought they should go, but everyone was going to have do a bit more work than they usually did. The children were certainly old enough and didn't mind.

The holiday turned out to be a success. Ruth rested and on her return was feeling slightly stronger.  She went to the hairdressers. She was given a copy of Vogue, not a magazine she would normally read. There was an article on the Round the World sailor, Clare Frances. Clare had an illness called ME. She described her symptoms and something she described as brain fog. Ruth nearly leapt out of the chair. "This is me", she wanted to cry out. 

Tearing the article from the magazine, she took it to her GP, who said that ME was a possible diagnosis, but not much was known about it. Ruth was slowly getting stronger, but the GP told her that if her illness had been triggered by a virus, then it would be possible that if the virus came back, then so would ME.

Eventually Ruth returned to work, but any over tiredness, would cause the leg muscles to ache. This was frightening, as Ruth didn't want to go back to the state she had been in the summer months. So her recovery involved a great deal of 'two steps forwards, one back' and battling with the very real fear of the fatigue returning. 

Two years later, Ruth was climbing in the Lake District. 

The left leg muscles did ache every so often, but acted as a barometer for overdoing things, which has proved very useful.

Around the same time, a friend, Anne, had also developed a mystery illness. Her limbs ached, her head felt fuzzy and she, too, couldn't move off the sofa. Fortunately she didn't have to, as her mother was able to come round to look after her, when her husband wasn't around.  Every time Anne tried to do anything, the muscles would ache, so there was no point of doing anything at all. Her mother and husband wouldn't let her anyway. Not even make a cup of tea. Days, weeks and months of doing nothing at all. Anne developed clinical depression. Her ME and depression lasted for years.

So is ME just a psychological illness or is it viral illness? The arguments raged in 1986 and they are still raging.

Amongst the controversial, but proven treatments is 'graded exercise' and talking therapies. 

Every day, because she had to move, Ruth did some graded exercise. Due to the care the Anne received, she did not.  Every day, Ruth had a challenge to meet. The evening meal, 
made all but one night. Anne did not. Ruth was a naturally optimistic person,  Anne was a bit of a moaner. Naturally, Anne told Ruth that she had ME and that Ruth did not. 

Some people said that Ruth's family should have been more caring and done more to help. Ruth is very pleased that they did not. There's an expression, 'killing with kindness'. Maybe, with all the best intentions in the world, that's what happened to Anne.

A great many illness will have depression listed as a consequence. For instance, depression is often listed as a result of heart disease and cancer. Many people believe that because they've got one, they will have the other and there's nothing that can be done about it. I don't believe that to be true. 

It reminds me of an elderly relative, who lived with her unmarried daughter.  She developed shingles. A painful condition. The GP said it would last three years.  She took to her bed and stayed there for three years, waited on hand and foot by her daughter.

On the other hand, my father-in-law was an active man, became paralysed at the age of 55. Due to an overdose of some treatment, he then became blind. He cooked and did the gardening and had regular carers. He was never depressed, despite his wife slowly developing Alzheimers and having to go into a home. When age eventually led to a weakening of his arms and thus a need for residential care, he died after six weeks. No challenges, no point in living.

Any illness (and life event) can lower the mood and lead to large amounts of introspection. The person's needs will change and need to be attended to. Taking medication can alter the mood and taking more than one medication needs to be properly controlled. ( I always become weepy taking anti-biotics, but now recognise it's the medication, not the infection.)

I believe that most cases of ME/CFS can be attributed to a viral infection.  
I do not believe that ME/CFS is a psychological/mental illness.
I do believe that the fear of exercising and making matters worse, can override the necessity to do some exercise, even a little.
I do believe that how ME/CFS is managed by the patient, family and the doctors can make an enormous difference to recovery.
I do believe that any illness, including ME/CFS can lead to emotional problems. Fear being the primary emotion.
I do believe that mental illness, should be re-named emotional illness.

Remember, 'Life is a terminal illness'. It's how we manage the ups and downs of life that is the clue to survival.

If you hadn't already guessed, Ruth is me.