Survival ~ the final chapter

We all experience periods of stress, sadness, and self-doubt. ‘These don’t make us mentally ill, they define us as human.’ ~ Dr Howard Forman

An ‘illness’ like any other ?

To try to capture the idea of comparing a mental health issue like Manic Depression to a physical health issue, I feel this blog is helpful: “A mental health diagnoses is a label that is based on a consensus about clusters of experiences rather than laboratory tests … Difficult life experiences can mean a person can become extremely distressed. Blaming the brain creates a situation where people’s life stories are not heard, and the need for social justice is ignored” Flo Ballamy [1].

Anxiety / Panic Attacks

Back in 2004 I was experiencing severe anxiety / panic attacks. Some of these symptoms were rooted in childhood trauma. Diet can also be a factor. You have to be careful with caffeine, alcohol, sugar etc Hormones and iron levels may have played a part, as well as what was going on in my life at the time. I once ended up in an ambulance and in A&E due to the severity of the symptoms. When I got there no one explained what was going on. I got no advice and it happened again. I was prescribed the anti-depressant Citalopram to help with these severe symptoms. Initially the drug did seem to help but long term I’m left with more serious symptoms.

While I still suffer from anxiety, especially if tired, I rarely get dreadful panic attacks. I went for therapy at the time and it helped a bit. I was taught to accept panic attacks, instead of fighting them. Correct breathing is important and having the correct Oxygen/Carbon Dioxide levels in the blood. I have added a resource from Dr Aine Tubridy & Dr Michael Corry [2]. Both doctors are now deceased which is a great loss to this country.

Depression

“Emotions like anger, depression, and anxiety can undermine our success, but the answer is not in repressing emotions. Emotions need to move, and settle into calmer patterns so that they can reliably support our success with insight, energy, and joy” Deepak Chopra

“The deadliest thing that we can do when it comes to depression and anxiety is to ignore the deep underlying reasons why they are rising and continue to refuse to deal with them. It’s a terrible betrayal of the most vulnerable people” Johann Hari.

In an interview with Tommy Tiernan on RTE Michael Harding talked about Depression. His view is that Depression is normal and not an illness. “Depression, when it happens to somebody, is this amazing opportunity of growth. You are letting go of a whole cluster of narratives … you have woven them around you for years …. and in Depression, something breaks them, they can’t sustain themselves and they start to fall off you. You are letting go of yourself in some sense, the self you have constructed”. It feels horrible, like a death but is also a growth point. Michael Harding is a writer and columnist for the Irish Times. It was great that someone can verbalise what I experienced very recently.

If we search to see exactly what’s going on in our lives we usually find the cause of low mood and then we can try to work towards a solution. Not getting enough daylight can affect mood and leave a person with SAD (Seasonal Affective Disorder). In cold weather sitting beside a toasty, wood fire in my pot-belly stove lifts my mood. I feel grateful for it.

Loneliness and Mental Health

Johann Hari has written a very good book called Lost Connections [3, 4 includes interview]. “Far from being a defect, Hari argues that depression is actually a rational and self-preservatory response to the fragmentation of community life in the contemporary world” [5]. He writes that Loneliness hovers over our culture today like a thick smog. “Meaningful contact is something we are innately designed to crave … but our socio-economic system is predicated on individualism”.

In Ireland a Loneliness taskforce has been set up with the help of people like Senator Dr Keith Swanick. This is an extract from their report “Lonely people suffer disproportionately with mental health issues, cognitive decline, hypertension, and are more likely to be admitted for residential or nursing care … Loneliness is the public health crisis of this generation. The Loneliness Taskforce is seeking to increase awareness of the loneliness epidemic which exists across Ireland. We want to be the catalyst which sparks a nationwide conversation and encourages those who may be lonely to take the first step. We want to inspire the spirit of volunteerism, to connect communities and to equip people with awareness and knowledge of what loneliness is and how to deal with it. We want those among us who are experiencing loneliness to be enabled to seek help, and for that help to be readily available” [6].

The taskforce “recommended pilot projects be set up in rural and urban areas to combat loneliness. It said modules on loneliness should be developed for schools, and local and national organisations should be encourage to promote inclusion and encourage membership. It also recommended improved broadband connectivity and rural transport links” [7].

As someone that’s been on this planet for nearly half a century I have witnessed the demise of a sense of belonging and community spirit. In the 70s and 80s I grew up on a farm. Neighbours helped each other out. We met at Mass and in the local community hall, as well as visiting each other’s homes. Now I am unlikely to see my neighbours. While one was very good when I went through major surgery last year, they don’t call. Occasionally you get to speak to them. Recently a four year old, who has yet to be conditioned into this way of life, asked me “Do you have a birthday present for me?”. It was her birthday the day before. I gave her a nice book that I had in my collection.

Friends occasionally make contact on social media but with their busy lives it can be hard to meet up. In the last decade my family relationships have also disintegrated as they don’t seem to have any understanding of what I went through, with the exception of 1 or 2 cousins. I lost my career and find myself with a very limited social circle and with lots of time to myself. Sometimes that can be great as you get time to think, to read, to write or to go for a nice walk. But overall it’s quite sad that the world has come to this. A person can find themselves on the edge of society, not really feeling like they belong any more and wondering why to go on. Life needs purpose and meaning. I get meaning from reading, writing and helping friends with their children or helping out with younger nieces/nephews. As well as showing an interest in environmental and mental health issues on a local and national level.

Peer Support

“Peer support workers are typically individuals who have had personal lived experience of mental health issues and who now enjoy a good level of recovery. They are generally employed in a professional role to use their expertise and experience to inspire hope and recovery in others who are undergoing similar mental health experiences” [8, 9].

Before a person can become a Peer Support worker they need to have dealt with the majority of their own issues and need to constantly work on themselves. This is also true for therapists, counsellors and coaches.

Carers

If caring for someone who experiences mental health difficulties, the long term goal should be to enable that person and keep them as independent as possible, so that they do not become too reliant on someone else e.g. doing their own laundry, some cooking, housework / cleaning and having a diary to organise their week.


Carers need to look after themselves:

1. Take time out for you

2. Learn relaxation strategies

3. Know your limits – know what you can and cannot do

4. Ask for help – you don’t have to solve and manage every problem by yourself

5. Eat and sleep well

6. Solve one problem at a time

7. Find a support network

8. Plan for a relapse

These are Tips from FutureLearn course “Caring for People with Psychosis and Schizophrenia” [10].

Complementary Therapies

In order to reprogram the subconscious mind, you need to relax the body. Release the tension. Let the emotions go. Get to a state of openness and receptivity. Think good things about yourself” Louise Hay

Various complementary therapies can help with our emotional and physical well being, even if sometimes it offers temporary relief from distressing thoughts and feelings:

  • Massage

  • Aromatherapy

  • Acupuncture [11]

  • Reiki

  • Emotional Freedom Techniques (EFT) (tapping on specific points to release emotions) [12]

  • Bio-energy

  • Meditation

  • Buddhist Mindfulness Meditation [13]

  • Yoga

  • Bibliotherapy (the use of books as therapy)

  • Chiropractic therapy


“Misalignment of the spine (specifically the first, second or third  vertebrae) can cause pressure in the area of the brain steam which can  cause interference neurologically and chemically” [14].

For more long term benefits we need a daily plan for our well being e.g. Having a WRAP (Wellness Recovery Action Plan) in place can allow a person to create a wellness toolbox [15]. Tools that help you feel better and stay well. We also need to be aware of what triggers us and have a plan in place for how to deal with those triggering events.

When I make Yoga, Mindfulness and Meditation part of my daily routine I see more lasting benefits. When doing Yoga I use Youtube videos with Tara Stiles [16]. Sometimes routines get upset by life events so it is important to get back on track as soon as possible afterwards.

Music Therapy

I asked Music therapist Siobhán Nelligan what is Music Therapy?

“Music therapy support children with self-regulation and emotional expression through the creative process of music making. This is achieved within the context of an attuned therapeutic relationship with a trained professional”.

The organisations in Music Therapy include the Irish Association of Creative Art Therapists (IACAT) and the British Association for Music Therapy (BAMT). The Blue Box Creative Learning Centre in Limerick [17] and Every Day Harmony in Belfast [18] provide Music and Creative Arts Therapy services to children in Ireland.

Individual Care Plan

Individual care plans are written up for people who have been in a hospital setting. It is “a documented set of goals developed, regularly reviewed and updated by the resident’s multi-disciplinary team, so far as practicable in consultation with each resident. The individual care plan shall specify the treatment and care required which shall be in accordance with best practice, shall identify necessary resources and shall specify appropriate goals for the resident. For a resident who is a child, his or her individual care plan shall include education requirements” [19].

Autism and the tragic case of Oliver McGowan

Oliver McGowan died in hospital in 2016. Quote from Oliver’s mother Paula McGowan “Sadly my son, who had mild disabilities was given anti-pychotics (major tranquilizers) to treat his seizures and agitation even though we told doctors he was allergic to these medications. They caused his brain to swell so badly it was bulging out of his skull”.

To create awareness about what happened to Oliver, a petition has been set up ~

“My son Oliver was only 18 when he died in hospital on 11 Nov 2016. I believe his death could have been prevented if his doctors and nurses had received mandatory training. He had autism and a mild learning disability, and they weren’t trained to understand how to make reasonable adjustments for him.” [20].

Dr Gabor Maté

“When there is no enemy within, the enemy outside cannot hurt you” African proverb

In the last week of June 2018 a number of trauma and addiction experts were in Belfast at a Trauma Summit. Bessel van der Kolk, Dan Siegel, Gabor Maté and others. Dr Gabor Maté also gave some talks in University College Cork. Unfortunately I wasn’t at these conferences but I did get to follow it on Twitter ~ #traumasummit and #gabormatecork. I’ve been able to pick up some of the wisdom that was shared, which I hope is correct. It will mainly quote, summarise or paraphrase what he said.

  • The theme of the talk in Cork seemed to be around childhood development, the effect of trauma and addictions. Where there are addictions there is usually trauma.

  • Resilience is when something happens and you bounce back or even grow. Trauma is a restriction of the self to avoid feeling painful emotions.

  • Dr Maté debunks the idea that recovery must involve hitting “rock bottom”. People struggling with addiction don’t need negative consequences but positive ones. They need to see possibilities.

  • In the treatment of addiction, if you’re just working at stopping the behaviour, all you do is take away the means to self-sooth. You need to look at the person’s life and what caused the pain.

  • By acknowledging the link between addiction and trauma we help restore people’s ability to see the dignity in others. Only when compassion is present will people allow themselves to see the truth. Always meet people exactly where they are and work to reduce harm.

  • A person acts something out when they don’t have the words or the language to say. Those around them react to the behaviour rather than the message it’s sending.

  • What was lacking in the client’s lives is that nobody saw them, so we need to mirror back their essential qualities.

  • We don’t respond to what happened. We respond to our perception of what happened and we choose the worst possible scenario. The mind goes there automatically.

  • Knowing can be of three types ~ intellectual, from the heart or from the gut.

  • Diagnoses are only useful as pointers towards the type of trauma they indicate.

  • The most important work we do for others is the work we do on ourselves. To help a child to the best of your ability you need to be ok.

  • Build positive communities where young people belong.

  • If we sooth small children with screen time how will they learn to self-regulate ?

  • Coping mechanisms are meant to be short term states, not long term traits.

  • Guilt is a bird. It will land where you give it space. Just notice it and let it go.

  • Stress and social isolation increases cancer risk.

  • Authentically remain connected to the true self. There is no greater sadness than giving up who you are.

Soteria / Mosher

Dr. Loren Mosher learned how to listen and to attempt to find meaning in the distorted communications of his patients and their families [21].

He refers to Psychiatric care as “authoritarianism, the degradation ceremony, the induction and perpetuation of powerlessness, unnecessary dependency, labeling, and the primacy of institutional needs over those of the persons”.

Under the influence of the work of R D Laing between 1969 and 1971 Dr Mosher designed and implemented the Soteria Research Project. “Soteria is a Greek word meaning salvation or deliverance”. “the Soteria method can be characterized as the 24 hour a day application of interpersonal interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment”. Those that took part in the Soteria project were more likely to be living independently and had fewer re-admissions. “Roughly two-thirds of newly diagnosed persons with schizophrenia recover with little or no drug treatment in 2 to 12 weeks”.

“In 1984, Ciompi and his co-workers in Berne/Switzerland founded a first European Soteria house which continues to function successfully after more than 30 years. Eventually, the Soteria-idea spread out to Germany, Scandinavia and other parts of the world where it was realised under various forms” [22].

For people to have “Recovery spaces”, they need to be with supportive people who can tolerate, be patient and interact with the person in ‘Psychosis’. The idea of having crisis houses is built into the Vision for Change Irish mental health policy document (2006 to 2016) which is currently been upgraded [23]. “A crisis house is used for crisis intervention and for acute respite purposes … A crisis house is not an intensive treatment option but rather a place of refuge, of understanding, and of support for individuals in crisis. The facility is not restrictive and offers each user an opportunity to deal with issues surrounding their lives by accessing appropriate interventions such as counselling, family therapy, psychology, social work or other available holistic options as required… they may offer an alternative to in-patient care for a proportion of those who would otherwise be admitted to hospital”.


What would have eased the sometimes unbearable trauma I experienced over the past decade ?

  • A Soteria type house would have been a great idea

  • An Open Dialogue approach where I would be involved in the decision making around my own care

  • Been told the truth about what happened i.e. antidepressants coupled with stress brought on the severity of my symptoms

  • Less reliance on a biomedical / drug approach and short term use of tranquilizers

  • More training for General Practitioner doctors in the field of mental health (as I felt they were out of their depth)

  • Family therapy (as there is inter-generational trauma within the family and also damage from Psychiatry in the previous generation. Psychiatric intervention caused damage in relationships)

  • Introduction to WRAP (Wellness Recovery Action Plan) much earlier on

  • Less reliance by myself on self-sabotaging coping mechanisms and more regular work on my underlying traumas

To paraphrase advice from Ivor Browne, caring less about changing the world and more about saving myself should have been my motto. But then we all need some meaning and purpose in our lives. One thing I have gained is a vast amount of knowledge in the area of emotional wellbeing, as well as connecting to a lot of knowledgeable, honest people. This knowledge needs to become a part of my daily life practice.

A person should be enabled by the system and helped back to being a productive member of society. While ethical use of some tranquilizers can have a place in healing, it is hard to function if sedated with a cocktail of overused drugs long term. I gained 25 lbs in weight on those drugs but have managed to get back to my original weight after several years! I ran away from the mental health system in January 2012. I don’t recommend leaving the system until you have a good support system in place. The person that helped me most was the Occupational therapist Orla.

Appreciation of my Freedom is something I will work with and never take for granted. Through self-awareness I have the skills to care for myself one day at a time, to take a break if needed, to be more self-disciplined and to reach out in times of crisis. It was a battle for survival. I survived !

References

[1] Time to change for Time to Change? By Flo Bellamy, 2014 ~

http://discursiveoftunbridgewells.blogspot.co.uk/2014/01/flo-bellamy-does-diagnosis-simply.html

[2] What’s happening ? Am I dying ? (work of Dr Aine Tubridy and Dr Michael Corry, RIP) ~
http://wellbeingfoundation.com/panic-and-anxiety.html

[3] Lost Connections: Uncovering the Real Causes of Depression – And the Unexpected Solutions, Johann Hari, 2018 ~
https://www.amazon.co.uk/Lost-Connections-Uncovering-Depression-Unexpected/dp/163286830X

[4] Johann Hari: Lost Connections (recorded interview) ~
https://www.madinamerica.com/2018/01/johann-hari-lost-connections/

[5] Lost Connections review: Shedding the shame of depression ~
https://www.irishtimes.com/culture/books/lost-connections-review-shedding-the-shame-of-depression-1.3386584

[6] A connected Island ~ An Ireland free from loneliness, a report from the Loneliness Taskforce, 2018 ~
https://lonelinesstaskforce.files.wordpress.com/2018/06/loneliness-taskforce-a-connected-island-an-ireland-free-from-loneliness.pdf

[7] Loneliness Taskforce calls for funding of €3m to combat isolation ~
https://www.irishtimes.com/news/ireland/irish-news/loneliness-taskforce-calls-for-funding-of-3m-to-combat-isolation-1.3530467

[8] Recovery in Practice (Peer Support definition) ~

https://www.hse.ie/eng/services/list/4/mental-health services/advancingrecoveryireland/recovery-in-practice/

[9] Mental health Peer Support ~
https://www.hse.ie/eng/about/our-health-service/making-it-better/mental-health-peer-support.html

[10] Caring for People with Psychosis and Schizophrenia (next course in Sept 2018) ~

https://www.futurelearn.com/courses/caring-psychosis-schizophrenia

{ Sponsored by a drug company hence biomedical view ! But some interesting tips on how to help people who may have ‘paranoia’ etc }

[11] Traditional Chinese Medicine (TCM) as a Basis for Treating Psychiatric Disorders: A Review of Theory with Illustrative Case, Aung et al, 2013

“TCM-based therapies do provide relief for patients who suffer from anxiety, depression, PTSD, sleep disorders, and many other conditions that plague the human mind and spirit”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870484/

[12] Emotional Freedom Techniques (EFT) – Gary Craig ~

https://www.youtube.com/watch?v=jp5npsxYhY0

[13] Mindfulness featuring Jon Kabat Zinn ~
https://www.youtube.com/watch?v=zsxE7cv83X0

[14] The Mental Health Benefits Associated with Chiropractic Care ~
http://www.arcadiachiro.com/the-mental-health-benefits-associated-with-chiropractic-care/

[15] Wellness Recovery Action Plan (WRAP) ~
www.mentalhealthrecovery.com

[16] Flexibility and Range of Motion | Beginner Yoga With Tara Stiles ~
https://www.youtube.com/watch?v=4PgIfOOHwH8

[17] Creative Art Therapy for Children and Young People, Limerick ~ www.bluebox.ie

[18] Everyday Harmony, Music Therapy, Belfast ~ http://www.everydayharmony.org/

[19] Guidance Document on Individual Care Planning: Mental Health Services (Mental Health Commission document, April 2012) ~
https://www.mhcirl.ie/file/GuidanceOn_ICPMHS.pdf

[20] Petition “Prevent avoidable deaths by making autism/learning disability training mandatory” ~ https://petition.parliament.uk/petitions/221033

[21] “Soteria and Other Alternatives to Acute Psychiatric Hospitalization: A Personal and Professional Review” by Dr Loren Mosher ~
http://www.moshersoteria.com/articles/soteria-and-other-alternatives-to-acute-psychiatric-hospitalization/

[22] Soteria Berne: An alternative treatment of acute schizophrenia ~
http://www.ciompi.com/en/soteria.html

[23] Vision for Change ~
https://www.hse.ie/eng/services/publications/mentalhealth/mental-health—a-vision-for-change.pdf

Books by Gabor Maté

https://drgabormate.com/book/

* In the Realm of Holy Ghost ~ Close encounters with Addiction
* Hold onto your Kids ~ why Parents need to matter more than Peers
* When the Body says No ~ The Cost of Hidden Stress
* Scattered Minds ~ A New look at the origins and healing of Attention Disorder

Other Relevant information

* Loren Mosher M.D. talks about Soteria Project and non-drug treatments for Schizophrenia ~
https://www.youtube.com/watch?v=qnryFXxl7yU

* Music therapy for children and adolescents with behavioural and emotional problems: a randomised controlled trial ~
https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.12656

* Feeling negative emotions is not a mental illness, say Psychologists ~
https://www.independent.co.uk/life-style/health-and-families/healthy-living/negative-emotions-mental-illness-depression-health-crisis-pathologising-wellbeing-psychology-a8277251.html

* Yoga Nidra 20 Minute Guided Meditation ~
https://www.youtube.com/watch?v=7H0FKzeuVVs

* Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression, Brown et al, 2005 ~ https://www.ncbi.nlm.nih.gov/pubmed/15750381

* Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review, Wang et al, 2018 ~
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1736-5

* An inquest into the death of Thomas Oliver McGowan at Southmead Hospital revealed the medication “most likely” led to brain swelling ~
https://www.bristolpost.co.uk/news/bristol-news/heartbreaking-video-oliver-mcgowan-medication-1468148

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