Hope of Recovery and Healing

Recovery

To quote from Vision for Change (an Irish mental health policy framework document), recovery involves the individual “living a productive and meaningful life despite vulnerabilities that may persist, equipped with the necessary self-understanding and resources to minimise relapse” [1]. I believe that gets to the crux of the matter. If the person can understand what is going on in their life, become self-aware, recognise early warning signs, identify triggers, have a plan if problems escalate and make the necessary changes to get back on track, that will give them more control over their life.

Recovery and healing can mean different things to each individual. For me Recovery involves ~

  • no longer having serious symptoms or knowing how to manage them when they do arise

  • having a WRAP plan in place (Wellness Recovery Action Plan)

  • routine

  • daily work on physical / mental health

  • healthy eating

  • self-discipline

  • feeling I have meaning / purpose in life and something worthwhile to do

  • a few good friends

  • sleeping well, getting to bed on time and cutting out habits that affect quality of sleep

  • exercising

  • being content with life most of the time

  • learning to weather the ups and downs of modern life and the stresses

  • releasing negative beliefs about myself and replacing them with empowering thoughts and affirmations.

Wellness Recovery Action Plan (WRAP)

Recovery2

Having a WRAP plan in place can help a person who is experiencing emotional distress to stay well and to move forward. The 5 key concepts in WRAP are: Hope, Personal Responsibility, Education, Self-advocacy and Support [2, 3, 4].

A WRAP plan has sections on Triggers, a Wellness Toolbox, Daily Maintenance Plans, Early Warning Signs, When things are Breaking down, Crisis Plan and Post Crisis Planning.

WRAP can help the person identify triggers (events and/or reactions to people that can make their symptoms worse) and to list activities that can help the person feel better. It may also be important for the person to write a crisis plan, so that if the person finds themselves in a crisis it has been outlined what their wishes are [5].

It is vital to establish who is there to support a person in their recovery and to build on this if necessary e.g. family (depending on circumstances), friends, connecting to others in recovery or by attending meetings with mental health support groups (e.g. Grow) [6].

WRAP can even be used to help write an advance directive, where the person can specify such things as acceptable and unacceptable treatments including prescribed psychoactive drugs that work / have worked in the past and ones that don’t. And whether or not a person sees Electric shock treatment (ECT) as an option for them. Psychoactive drugs should be used ethically and short term in my experience. At the same time no one should stop or change prescribed psychoactive substances without talking to their prescriber or an expert in the field, due to the dangers of withdrawal.

Advance Directives

I have an Advance Directive. The following are the headings in the document I wrote:

1) People I do/don’t want involved in my care and treatment (I list the names)

2) Acceptable prescribed psychoactive drugs and why

3) Unacceptable treatment

4) What I want from my supporters when I am feeling badly

5) What I don’t want from my supporters when I am feeling badly

I have signed and dated it. I would like Advance Directives to become legal documents in this country.

In my experience I think that independent mental health advocates should be involved when people may need hospitalization and not family members unless specifically requested by the person. An Advance Directive is very important if a person has experienced mental health difficulties in the past or found themselves detained in a Psychiatric Unit. It could help improve the overall process, result in better outcomes and faster recovery.

When a person is been “sectioned” or detained they should have access to a solicitor / legal representation immediately, whether they are classified as “voluntary” or involuntary. Even access by phone. People deserve to be treated with respect and dignity when in a crisis. And to be told the truth about what’s happening to them.

References

[1] Vision for Change document (on HSE website ) ~
http://www.hse.ie/eng/services/publications/mentalhealth/mental-health—a-vision-for-change.pdf

[2] WRAP (Wellness Recovery Action Plan): www.mentalhealthrecovery.com

[3] WRAP App Demo: www.youtube.com/watch?v=0BK_jLMToeM

[4] WRAP Overview: www.youtube.com/watch?v=TnNmGyv1IHo

[5] WRAP Crisis Plan and Working Through Hard Times (including link to pdf) ~
www.mentalhealthrecovery.com/info-center/crisis-plan/

[6] GROW Peer Support mental health organisation ~ http://www.grow.ie

Other Resources that may be useful

* “GROWing towards recovery: a re-enchantment with life – Mike Watts” ~

www.youtube.com/watch?v=g08yo4Phwic

* Phil Fennell, Professor of Law at Cardiff University, looks at mental health legislation in Britain and elsewhere, and draws lessons for reform of Ireland’s Mental Health Act 2001. Phil was speaking at an Amnesty International Ireland conference on mental health law reform in March 2013 ~ www.youtube.com/watch?v=rDvah16UtaU

* Soteria ~ a network of people in the UK promoting the development of drug-free and minimum medication therapeutic environments for people experiencing ‘psychosis’ or extreme states ~ www.soterianetwork.org.uk

* Men’s Sheds ~ www.menssheds.ie/

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Therapy

“Knowing your true self is the greatest achievement you can obtain” Deepak Chopra

wordcloud

Psychotherapy is the treatment of emotional distress by Psychological means. Counselling is “providing guidance in resolving personal and psychological problems” (Oxford dictionary).

Having someone to listen non-judgmentally with compassion and empathy can improve emotional well-being. The world at the moment is quite judgemental and critical at times. Having a safe space to go to, where you can develop trust with a therapist, can give a person the breathing space to express their emotions, work through certain issues and come to some resolution. If an issue is unresolved that has caused deep hurt, it can continue to fester on a sub-conscious and conscious level. It may seem to be resolved, but certain things can trigger memories or make a person aware that the issue is still causing some distress.

The therapist may need to work with clients that are culturally different and to be aware of those differences. Therapy should be relatively non-directive. It can help the client develop self-awareness and a better understanding of themselves. It allows them to change specific aspects of their feelings, thoughts and behaviour that may not be serving them well. It can also help a person clarify some issues and make decisions. They may feel blocked or stuck. People have the capacity to understand their problems and the resources to resolve them. But sometimes they may need help realising that.

The therapist needs to be able to listen to verbal and non-verbal messages and their contexts. Confidentiality, genuineness and respect is also important. As well as identifying and exploring defense mechanisms.

If people can sort out some of their issues it is possible to live a more fulfilling, satisfying and productive life that has more purpose and meaning. Various areas can be worked with e.g. grief and addiction. There are different schools of therapy e.g. Gestalt, Regression etc. Different types of therapy are suited to different people.

The therapist would need to be comfortable with certain experiences and have a good understanding of them e.g. Hearing voices. To be able to help a person in ‘psychosis’ would require specialized training. The person in distress can be quite perceptive, even when they seem “out of it”. Family therapy may also be needed. If there is turmoil in a family this should happen early on before relationships break down or become more dysfunctional.

The person themselves is the true expert on their own experiences. Therapy helps a person make sense of their experiences and gives them personal responsibility for their own recovery. A psychological formulation process and the idea of personal narratives can facilitate the person in making sense of their experience [1].

This is a quote from a man I know who has a diagnosis of Bipolar and is benefiting from therapy ~

“we all carry life baggage, some of which we want to unpack, discuss, possibly even move on from. I think Psychotherapy gives me that space. I engage with it for that reason. Therapy is empowering, if you feel your family or community are not listening. It’s a gradual process for me, as much on my terms as that of the therapist”.

From another perspective “It is possible for therapy to do harm as well as good. It can be difficult to talk about painful issues. Sometimes people receive incompetent or inadequate therapy” [2, 3] There are regulatory bodies that set guidelines e.g. the IACP (Irish Association for Counselling and Psychotherapy) [4].

This quote is from a mother who lost her son tragically by suicide. He was only 17 years old and on an anti-depressant. “I think that the practice of many counsellors which involves pathologising grief is harmful and that, along with outdated notions of the need to sever attachment with the deceased, is the cause of harm. Exceptions would include counsellors or therapists who employ methods such as those of Dr. Joanne Cacciatore whose processes and understandings I have found personally helpful”. Joanne Cacciatore therapeutic interventions include narrative, dialectical and logo therapies, in addition to trauma focused therapies [5]

A Psycho-social approach to healing can help empower the person, develop emotional resilience and allow them to be a better and more content member of their family, community and society. The overuse of certain drugs e.g. major tranquilizers, can be disempowering and disabling. In the long run the Psycho-social approach can be more effective. That usually requires ongoing holistic work by the person on their physical and emotional well-being.

CBT (Cognitive Behaviour Therapy)

The biochemistry of the brain is influenced by our thoughts so we need to stay aware of our thought patterns. Negative self talk affects our mood. Techniques used in Cognitive Behaviour Therapy (CBT) can help change negative thought patterns into more positive ones. The Feeling Good Handbook has exercises that can allow the person work on CBT in their own time [6].

Life Coaching

Life coaching helps draw out from within a person what they would like to achieve in life. We have the answers to problems and difficulties within ourselves. Techniques and tools are used to bring solutions to light. Good coaching has a lot to do with knowing the right questions to ask. Obstacles, challenges, self-limiting beliefs and behaviour can be identified and overcome. It helps people set goals and time frames for achieving those goals. The coach has to park their own life experience and only occasionally gives advice.

Life can seem frightening and daunting for a person who has been through trauma and emotional distress. A person can become stuck in a rut. Life coaching can help them take more control over their lives, feel empowered and find purpose in life. Areas that people may need help with include motivation, structure and self-discipline.

Part of the process of life coaching involves listening intently to the person, with dignity and respect, in a non-judgemental way. And sometimes summarising and reflecting back to the person so that they gain a better self-understanding. People can have blind spots. Aspects of themselves that they may be unaware of but that may be obvious to others.

The individual can discover areas of their lives that are out of balance. Some balance in life can be restored, leading to a more fulfilling, satisfying and effective life. Coaching has the potential to help a person create a vision for their future and support in turning that vision into reality.

* Will add some more later about my own experience in therapy.

References

[1] Good Practice Guidelines on the use of Psychological formulation ~

https://www1.bps.org.uk/system/files/Public%20files/DCP/cat-842.pdf

[2] Understanding Psychosis and Schizophrenia ~
https://www1.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/CAT-1657.pdf

[3] When therapy causes harm ~

http://thepsychologist.bps.org.uk/volume-21/edition-1/when-therapy-causes-harm

[4] Irish Association for Counselling and Psychotherapy ~ www.iacp.ie

[5] Joanne Cacciatore and the MISS Foundation that helps grieving families ~

http://missfoundation.org/about/joanne-cacciatore

[6] The Feeling Good Handbook by David D. Burns, 1999

www.amazon.com/Feeling-Good-Handbook-David-Burns/dp/0452281326

Other Resources

Dr Michael Corry at 19 mins discusses the lack of training of Psychiatrists in the area of therapy ~ www.theenchantingvalley.ning.com/video/dr-michael-corry

Don’t Let Your Emotions Run Your Life: How Dialectical Behavior Therapy (DBT) Can Put You in Control by Scott Spradlin, 2003 ~

www.amazon.com/Dont-Let-Your-Emotions-Life/dp/1572243090

What Is Dialectical Behavior Therapy?

https://www.psychologytoday.com/therapy-types/dialectical-behavior-therapy

The Efficacy of Play Therapy With Children: A Meta-Analytic Review of Treatment Outcomes

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.472.68&rep=rep1&type=pdf

The Body Keeps the Score by Dr Bessel van der Kolk, 2015 ~
https://www.amazon.co.uk/Body-Keeps-Score-Transformation-Trauma/dp/0141978619/

The lifelong cost of burying our traumatic experiences ~
https://www.newscientist.com/article/mg22429941-200-the-lifelong-cost-of-burying-our-traumatic-experiences/

Waking the Tiger: Healing Trauma by Peter Levine, 1997 ~

https://www.amazon.com/Waking-Tiger-Healing-Peter-Levine/dp/155643233X

In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness

By Peter Levine, 2010 ~

https://www.amazon.com/Unspoken-Voice-Releases-Restores-Goodness/dp/1556439431

Peter Levine Demonstrates How Trauma Sticks in the Body ~
https://www.youtube.com/watch?v=fiq0sILHiJs

Conversation with Alanis Morissette & Dr. Peter Levine (includes discussion on Panic Attacks) ~
https://www.youtube.com/watch?v=wDK09A49tRU

Music and Madness by Ivor Browne, 2008 (see Chapter on “The Frozen Present”) ~

https://www.amazon.co.uk/Ivor-Browne-Music-Madness/dp/0955226120

http://networkmagazine.ie/articles/ivor-browne-frozen-present

8 Tips to Help Stop Ruminating ~
www.psychcentral.com/blog/archives/2014/02/16/8-tips-to-help-stop-ruminating

“The Power of your subconscious mind” by Joseph Murphy ~

www.amazon.com/The-Power-Your-Subconscious-Mind/dp/1614270198

A Straight Talking Introduction to Psychiatric Diagnosis by Lucy Johnstone ~
www.amazon.co.uk/Straight-Introduction-Psychiatric-Diagnosis-Introductions/dp/1906254664

My review of this book ~
https://www.amazon.co.uk/gp/aw/cr/rRZTSBCCI1MGDN/ref=aw_cr_i_1

Definitions

Family therapy “is a type of psychological counseling (psychotherapy) that helps family members improve communication and resolve conflicts” www.mayoclinic.org

Family systems therapy draws on systems thinking in its view of the family as an emotional unit. When systems thinking—which evaluates the parts of a system in relation to the whole—is applied to families, it suggests behavior is both often informed by and inseparable from the functioning of one’s family of origin”

https://www.goodtherapy.org/learn-about-therapy/types/family-systems-therapy

Logotherapy “was developed by neurologist and psychiatrist Viktor Frankl. … Rather than power or pleasure, logotherapy is founded upon the belief that it is the striving to find a meaning in one’s life that is the primary, most powerful motivating and driving force in humans” (Wikipedia).

Psychosocial relating to the interrelation of social factors and individual thought and behaviour.

A Perspective on Suicide

“Some days you will be the light for others and some days you will need some light from them. As long as there is light, there is hope and there is a way” Jennifer Gayle

Caring_for_myself

I am not sure what the solution is to the tragedy of suicide. People need to feel that are loved and belong, including working on loving themselves. They also need to feel their life has meaning and a purpose. Viktor Frankl, a holocaust survivor, writes about this in his book Man’s Search for Meaning [1, 2].

There are nearly always reasons for living, no matter how bad things feel. It is important that we give encouragement to others in our family and community [3]. Over the last number of years I’ve met some people who saw themselves as well meaning, giving all sorts of judgements and “insights” into my life. As well as criticism. Without any empathy or understanding about my life journey. This led to feelings of frustration and discouragement. Listening non-judgmentally would have been a lot more helpful.

For over 3 years I was prescribed the anti-depressant Citalopram to help with anxiety and panic (until August 2008). I now suffer from a condition called Tardive Dysphoria which I strongly believe is connected to taking prescribed psychotropic drugs in the past. Medical journalist Robert Whitaker has written about this [4]. I am a lot more prone to suicidal ideation since these drugs than before taking them. While some people may feel they have benefited from anti-depressants, for others they have caused major problems.

In the US these drugs have a black box warning due to the increased risk of suicide in younger people, especially when starting, stopping or changing the dosage [5]. Anti-depressants are way over-prescribed. They are very powerful, mind altering drugs.

In suicidal mode the idea that all the pain will end might feel good at the time, but whatever emotional pain a person is going through will pass. It is important to reach out to someone, even if they don’t feel like doing that at the time. I once heard a man who has been through suicidal thoughts say that he did not want to pass his pain onto other people. When someone takes their own life it is devastating for those in this person’s circle i.e. family, friends and the community.

There is probably a reason or something causing their distress. Maybe a multitude of things that seem to be going wrong at the same time. It is easy to get overwhelmed and to go into a state of shock/high anxiety when faced with what seem like unsolvable problems e.g. worrying about a mortgage.

If people feel suicidal they shouldn’t be afraid to discuss how they feel with someone they can trust, a helpline, the Samaritans (116 123) or a private therapist. If a person has a problem, there is nearly always a solution. Sometimes the advice of others is necessary, as the person may feel they are in a fog and cannot think clearly or see any solutions.

As a society and community we need to be more supportive of each other. People may need to look at lifestyle e.g. alcohol, nutrition, stress and the various aspects of their life. If doctors were to take a more Psycho-social approach, as opposed to a biomedical approach, I do believe we may see some progress. Or maybe those in distress need an alternative to going to the busy GP surgery that is dealing with such a wide range of medical problems.

A number of years ago, in a documentary that covered suicide, I heard a doctor say that if someone takes an overdose of medication, they can end up alive and brain damaged. Probably worse off that before the overdose. Knowing this may deter a person from taking an overdose. While not being judgemental of a person in a very distressed state, drowning in the sea, lakes, canals or rivers is also a bad idea. A person can end up missing for weeks, causing even more distress to their family, friends and those that care about the person in their community. Not forgetting the huge level of dedication, effort and time that can go into searching for the the body, sometimes in very cold, risky, dangerous and difficult conditions. From listening to a friend who volunteers with sub aqua search and rescue/recovery, the body can end up in a bad state.


ASIST (Applied Suicide Intervention Skills Training)

One of the things that has helped me in dealing with suicidal thoughts, while also giving me the skills to be able to help others, is ASIST. Applied Suicide Intervention Skills Training is a

“two-day interactive workshop in suicide first-aid. It is suitable for all kinds of caregivers … people responding to family, friends and co-workers. ASIST trains participants to reduce the immediate risk of suicide and increase the support for a person at risk. It helps them seek a shared understanding of reasons for suicide and reasons for living.

The workshop provides opportunities to learn what a person at risk may need from others in order to keep safe and get more help. It encourages honest, open and direct talk about suicide as part of preparing people to provide suicide first aid. Participants also consider how personal attitudes and experiences might affect their helping role with a person at risk” [6, 7].

Suicides Rise Dramatically with Increasing Psychiatric Care

While some people may have had a positive experience with the mental health system, I feel that it wasn’t a suitable place for me. I was never told at the time that my symptoms could be caused by anti-depressants. An ambulance and police arrived at my house with my family and I was locked away for 3 weeks. I had not harmed myself of others and had no intention to do so. I do feel that Psychiatric intervention harmed me as opposed to helped. The only aspect that did help was Occupational therapy and the therapist Orla who got me into a course with the National Learning Network and into a work placement, one year on from my nightmare with the system.

Danish studies has been done on the link between Psychiatric care and suicide. Extract from this article [8] ~ As the amount of involvement that people have with Psychiatric professionals and Psychiatric care increases, the likelihood that they will commit suicide rises steadily and dramatically, according to a study in Social Psychiatry and Psychiatric Epidemiology. Taking Psychiatric medications makes people nearly 6 times more likely to kill themselves, while having spent time in the previous year in a Psychiatric hospital makes them over 44 times more likely to kill themselves … an accompanying editorial suggested the findings more likely showed that “Psychiatric care might, at least in part, cause suicide.”

I am hoping that coroners will keep an accurate record of what prescribed medication that the person may have been on at the time they died. Whether they had recently started to take Psychoactive medication e.g. anti-depressants or stopped taking such medication. It appears that sometimes this information can be overlooked. As many deaths are not recorded as suicide, we do not have an accurate picture of the number of people in this country that take their own lives every year.

Be_kind_to_yourself

Wellness Recovery Action Plan (WRAP)

A few years ago I got to do WRAP training with the charity Suicide or Survive. This training combined with ASIST has helped build up my resilience which I need to face into each new day and week. Having a WRAP plan in place can help a person who is experiencing emotional distress to stay well and to move forward. The 5 key concepts in WRAP are: Hope, Personal Responsibility, Education, Self-advocacy (standing up for yourself) and Support [9, 10].

A WRAP plan has sections on Triggers, a Wellness Toolbox, Daily Maintenance Plan, Early Warning Signs, When things are Breaking down, Crisis Plan and Post Crisis Planning.

WRAP can help the person identify triggers (events and/or reactions to people that can make their symptoms worse) and also to list activities that can help the person feel better. It may also be important for the person to write a crisis plan, so that if the person finds themselves in a crisis it has been outlined what their wishes are.

It is vital to establish who is there to support a person in their recovery and to build on this if necessary e.g. family, friends, connecting to others in recovery or by attending meetings with mental health support groups (e.g. Grow).

WRAP can even be used to help write an advance directive, where the person can specify such things as acceptable and unacceptable treatments. Including prescribed psychoactive drugs that have worked in the past and ones that don’t and whether or not a person sees Electric shock treatment (ECT) as an option for them.

Reasons to Stay Alive

I’ve just re-read Matt Haig’s very good book “Reasons to Stay Alive” [11]. In severe Depression a person may feel there is no hope or future. Matt highlights how it can feel like you are inside a tunnel that is blocked at both ends. “You are walking around with your head on fire and no one can see the flames”. When he went through a major crisis he didn’t want to be dead. He just didn’t want to be alive.

Drinking and smoking too much can be a big factor. As can diet and not getting enough sleep. Matt suffered from Anxiety, Panic attacks and Depression and compared that to being in a swamp with whirlpools in it. He writes “Minds have their own weather systems. You are in a hurricane. Hurricanes run out of energy eventually. Hold on”.

He compares his symptoms of emotional distress to back pain “It doesn’t really help me, when the pain flares up, that millions of other people suffer from back problems”. He lists some of his “Weapons for the war” ~ writing, reading, talking, traveling, yoga, meditation and running. Some of the things that help him with panic include yoga, slower breathing, meditation, acceptance (“Don’t fight things, feel them”), live in the present and Love.

One person tweeted this message to him about suicide “The hole you’d leave is bigger than the pain you suffer by being”.

“The key is in accepting your thoughts, all of them, even the bad ones. Accept thoughts but don’t become them”. Writing about things your enjoy can help. And refer back to that when you don’t feel so good.

Conclusion

There are no easy answers to suicide. But I do feel, based on the number of suicides I’ve heard of recently, our approach doesn’t seem to be working. I think it is time that we get some honesty from those with the power to influence public opinion. Instead of drug pushing, we need to hear that the “chemical imbalance” theory was an elaborate marketing campaign that sadly is not based on fact or Science. Some celebrity doctors, in their rush to push the drugs, forget about the significant number of people that these drugs are not suited to. Some of us don’t metabolize the drugs very well ( I have discussed this in the blog on Genetics). A pill is not going to mend a broken relationship or bring back a job that is lost. Or help with the bereavement process. There is no pill that cures life. At most it is a temporary sticking plaster but not a long term solution.

And if someone does decide to go down the biomedical route, they deserve full informed consent about these drugs. Something myself and many others didn’t get. People in distress also need crisis houses to go to, as an alternative to Acute Psychiatric units. An example of this in the UK is The Maytree [12]. Such crisis housing is part of the policy document Vision for Change which is now over 10 years old [13]. We need a new plan and a new vision.

At the moment there seems to be a lot of emphasis on celebrity culture and hearing the stories of celebrities. While that can provide short term inspiration, in a crisis the person in distress needs to have their own set of tools and resilience to battle through a rough patch. There is also a danger when mental health is over talked in the media. Family and communities may feel that the issues are been dealt with and may not realise someone in their own circle is in distress and needs support.

Relationship_with_self

References

[1] Man’s Search for Meaning ~ Viktor Frankl
https://www.amazon.com/Mans-Search-Meaning-Viktor-Frankl-ebook/dp/B009U9S6FI

[2] Man’s Search for Meaning ~ Meaning as a Cure for Depression and other ills ~
https://www.psychologytoday.com/blog/hide-and-seek/201205/mans-search-meaning

[3] Viktor Frankl ~ Why Believe in Others ~
https://www.ted.com/talks/viktor_frankl_youth_in_search_of_meaning

[4] Tardive Dysphoria: Anti-depressants can turn mild/moderate Depression into a chronic condition ~
http://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria

[5] Antidepressant Use in Children, Adolescents, and Adults ~

https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273

[6] ASIST leaflet (Applied Suicide Intervention Skills Training) ~
http://www.hse.ie/eng/services/list/4/Mental_Health_Services/NOSP/Training/ASISTleaflet.pdf

[7] Information on ASIST training ~ http://www.yourmentalhealth.ie/get-involved/news-events/

[8] Suicides Rise Dramatically with Increasing Psychiatric Care ~
https://www.madinamerica.com/2014/09/suicides-rise-increasing-psychiatric-involvement/

[9] WRAP (Wellness Recovery Action Plan) ~ http://mentalhealthrecovery.com/

[10] WRAP App Demo ~ https://www.youtube.com/watch?v=0BK_jLMToeM

[11] Reasons to Stay Alive ~ Matt Haig

http://www.matthaig.com/reasons-to-stay-alive/

[12] Suicide sanctuary ~
www.maytree.org.uk/

[13] Vision for Change ~
http://www.hse.ie/eng/services/publications/Mentalhealth/Mental_Health_-_A_Vision_for_Change.pdf

Other links that may be useful

* Psychopharmacologist & Psychiatrist Prof David Healy “Time to abandon evidence based medicine?” At 6 minutes he discusses the hiding of negative data from anti-depressant clinical trials ~
http://www.youtube.com/watch?v=A3YB59EKMKw

* Promoting awareness of the dangers of anti-depressants ~
http://antidepaware.co.uk/

* The dangers of giving anti-depressants to children. Jake McGill (14) ~
https://www.independent.ie/irish-news/courts/mother-of-boy-14-who-died-of-selfinflicted-gunshot-wound-welcomes-open-verdict-inquest-34115868.html

* Community Action on Suicide Prevention Education and Research (CASPER) ~
Maria Bradshaw, mother of Toran Henry (Maria now lives in New Zealand) ~
https://www.independent.ie/regionals/wicklowpeople/lifestyle/maria-leads-suicide-fight-30596376.html

* Pysch drug link to violent episodes analysed ~ Article that discusses the Shane Clancy case. His mother Leonie Fennell works hard at raising awareness about the dangers of anti-depressants ~
http://www.irishexaminer.com/ireland/pysch-drug-link-to-violent-episodes-analysed-400571.html

* Cutting jail benzo use reduces violence ~

www.irishexaminer.com/ireland/cutting-jail-benzo-use-reduces-violence-215716.html

Harry Kennedy, head of the Central Mental Hospital, said that since they stopped prescribing the medication in their prison clinics, the suicide rates there had fallen.

* Denmark ~ “Antidepressant regulations tightened following suicide”:

www.cphpost.dk/news/antidepressant-regulations-tightened-following-suicide.8243.html

* Kerry coroner makes emotional plea over suicides ~
www.irishtimes.com/news/crime-and-law/kerry-coroner-makes-emotional-plea-over-suicides-1.1365157

* ‘Suicide remains a taboo subject, something few people are prepared to talk about’

www.youtube.com/watch?v=US-oM-wBBxI

* Life After Suicide BBC Documentary 2014 “Documentary. Angela Samata explores why some people take their own lives and how those who love them come to terms with the loss”.
www.youtube.com/watch?v=HdIxzeA1F2k

* For prescribers ~ Guide to Stopping anti-depressants ~
http://www.rxisk.org/guide-stopping-antidepressants/

* Website about psychiatric medication, how it functions and the withdrawal process ~
http://www.comingoff.com

When suicide comes in clusters ~ What can we do to prevent copycat suicides ?
www.psychologytoday.com/blog/media-spotlight/201208/when-suicides-come-in-clusters

* Alcohol and suicide, Kendall, 1983 ~
www.ncbi.nlm.nih.gov/pubmed/6648755

* Smoking and Suicide: A Meta-Analysis ~

www.ncbi.nlm.nih.gov/pmc/articles/PMC4938402/

* Suicidal Ideation and Suicide Attempts in Treatment-Seeking Pathological Gamblers ~
www.ncbi.nlm.nih.gov/pmc/articles/PMC3397475/

* Stages of Compulsive Gambling ~
http://www.elementsbehavioralhealth.com/addiction/stages-of-compulsive-gambling/

{ Note ~ What I discuss in part of this blog is my own experience and is not medical advice. We all have our own unique journey. Do not stop or change prescribed drugs without advice. Change has to be done slowly under the supervision of an expert, due to the dangers of withdrawal  }

An Open Dialogue around ‘Psychosis’

“The deepest hunger of the human heart is to be understood” Stephen Covey

Psychosis_hand

Cabiria, 1914 (from a silent movie by Giovanni Pastroni). Trying to capture how terrifying Psychosis sometimes feels like, which is difficult and the clip that goes with this photo reminded me of the experience.

In November 2014 I went to the launch of the lengthy report “Understanding Psychosis and Schizophrenia” by the British Psychological Society (BPS) in London. There I got to meet and hear from some of the top experts and clinical Psychologists in the UK. A revised version was published in 2017 [1].

‘Psychosis’ is a loss of touch with reality, which is usually temporary. Because the general population don’t understand it, they can overreact. The person themselves may feel quite confused & scared. Especially if it’s their 1st experience. It can involve unusual perceptions e.g. the person feels they are under attack from evil and the need to protect themselves. In my experience, how I protected myself was influenced by religious upbringing. I even started to go to Latin mass to try and calm my brain down ! While some would have frowned upon that at the time, for me it was a coping mechanism. I only occasionally go to church these days, usually to light a candle and to sit in silence for a while.

As an example of one of my “psychotic breaks”, in my last experience I decided that the town I live in, which is prone to flooding as it is built on a river, was going to become immersed in water. I checked into a hotel that was a few stories high & took a bus to a ‘safer’, inland county. At the time I was frightened. It wasn’t based on reality but could have been based on news reports and worries about climate change. Stress and lack of sleep would have been a trigger, plus the fact that I was still going through drug withdrawal. It took at least two years to get the main effects of long term use of prescribed psychotropic drugs out of my system and I was left with long term sleep issues, the effects of which I still feel to this day.

Psychosis can be triggered by anti-depressant use and severe lack of sleep / stress [2]. I had been on anti-depressants for anxiety / panic attacks for 3 years when I had a ‘psychotic break’ in August 2008. Other illicit drugs can also trigger psychosis e.g. skunk cannabis [3].

Trying to make sense of the symptoms can help. In the context of the person’s life. As through making sense of experiences or learning to process them, a person is more likely to recover.

Usually the people around you will not understand and may be unsupportive. I went through my last ‘psychotic break’ alone (2012). I would not recommend that but maybe getting through it alone is why I no longer fear it. There was also a Spiritual aspect to the experience and I wish I kept notes at the time to give me more insight into what I was going through. In my terrified state, particularly at night time, with no support around me, I used the online work of Sean Blackwell to help me through. “Bipolar or Waking up?” [4, 5, 6]. I do believe this was more of an awakening and a spiritual journey. A part of my own evolution as a soul on this planet.

A significant percentage of people hear voices and for many this is not a problem. If the person has voices that are distressing or ask them to harm themselves or others and the person finds this overwhelming, they would need help and support in coping with the voices. There are people who have managed to integrate their voices into their lives, without been affected negatively by them e.g. Eleanor Longden [7] , Jacqui Dillon [8] and Rai Waddingham [9]. Dutch Psychiatrist Dr Marius Romme has also done a lot of great work in the Hearing Voices Movement [10]. Some children also hear voices and may need support.

Others experience hallucinations. If the hallucinations affect a persons quality of life, including ability to work, sleep and relate with others, the person may need help in dealing with their experiences.

Open Dialogue

I’m a believer in the Open Dialogue approach, where the person should be involved as much as feasibly possible in decision making about their care or treatment plan [11, 12].

Open Dialogue includes the gathering of clinicians, family members, friends and other relevant persons for a joint discussion. It was started in Lapland by Jaakko Seikkula et al. It is also used in other countries eg the Parachute project in New York [13]. In West Cork a successful pilot project was implemented [14, 15]. It would be great to see widespread use of this approach. If a more traditional, backward approach is used it can lead to more dysfunction within a family and the fracturing of relationships, sometimes long term, in my experience. It is important to get the approach right at the start. Not everyone will want family involved in their care.

I write more about the trauma of what happened me in 2008 in the blog Anti-depressants are great, until you have an Adverse Drug Reaction, where I outline some of the things that would have helped at that crucial time. Because of the way people in ‘psychosis’ are treated, I ended up with Post Traumatic stress for the past 9 years. It has improved via therapy and hard work on my self, but it is something that will probably always be there are a protective force in my life. A hyper vigilance and a lack of trust in others.

Hence I have learned as much as I can about what is helpful when a person is in distress. I’ve dedicated several years to learning via reading, listening to audio/visual presentations (of experts I respect), courses, conferences and various short training sessions. A summary version of what happened to me can be found under Other Relevant Resources at the end of this blog.

During my first ‘psychotic break’ (where I had not harmed myself or others) I needed:

  • truth and honesty about the anti-depressant drug I was on & its adverse effects (2)

  • An Open Dialogue approach

  • Re-assurance that my stay in the hospital was temporary ( the survival part of my brain was convinced I would be there for a very long time, possibly forever. This left me in a very distressed and agitated state and naturally so)

In places like Finland, where they employ the Open Dialogue approach and where prescribed psychoactive drugs are not the main form of treatment, they have proven that recovery is possible. They use early intervention and involve the person in decision making. In general, instead of the person ending up on disability they end up back as productive members of society.

Below is now 88 yr old Prof Ivor Browne giving a talk in the National College of Ireland in 2015. As opposed to being “anti-drug”, Prof Ivor Browne believes in using the lowest dosage of tranquilizing drugs possible for as short a time as possible. Ivor explained that people need help in understanding the psychotic process. He also recognises the importance of therapeutic relationships, personal friendships and loving relationships, when it comes to healing from trauma and distress. What are referred to as “Anti-psychotics” e.g. Olanzapine, as mainly major tranquilizers.

Anti_psychotics

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’. Soteria is a network of people in the UK promoting the development of drug-free and minimum medication therapeutic environments for people experiencing ‘psychosis’ or extreme states [16].

If a person is a carer for someone in emotional distress e.g. A family member, the long term goal should be to enable the person they are caring for. It is important to keep the person 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. The carer also needs to take good care of themselves.

The public have learned to associate the word ‘psychosis’ with violence and there is not necessarily a link, unless drugs or alcohol are involved [17, 18]. That can include prescribed psychotropic substances or withdrawal from these drugs [19]. People in distress need hope that they can recover and heal. Education from reliable, unbiased sources is an important part of that healing journey. As are supportive and understanding people who can hold space for the person in distress. These support networks also need education around Psychosis, what is helpful and what is not. Being judgemental, getting into arguments with the person, being critical and dismissive of their experience is usually unhelpful. Trying to stay calm and creating a calm space for the person, where they are not over stimulated, might be helpful. Everyone is an individual and has their own unique journey and experience.

Note: This blog is not medical advice and is mainly based on my own experience. But also on my extensive interest and learning in the whole area. Do not stop or change prescribed psychotropic drugs without advice, due to the dangers of withdrawal. Any changes need to be made slowly, under the supervision of an expert in this field. At the start of my journey I was never given that advice from the ‘experts’ I was dealing with and this delayed my healing journey.

Minor and major tranquilizers did help me at times e.g. with sleep, which can help restore some normality. But overall, in hindsight, I found that the large cocktail of drugs I was on (over a 3 year period) fueled symptoms, as opposed to ‘curing’ them. “The ethical use of psychotropic drugs is perhaps the single most important aspect of Psychiatric care that requires urgent attention” Dr Phil Thomas [20, 21].

* waiting on approval to include extra tips on how to help people who are in psychosis and what doesn’t help. Also advice for carers on self-care.


References

[1] Understanding Psychosis and Schizophrenia, revised version 2017 ~

https://www.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/CAT-1657.pdf (Edited by Anne Cooke)

[2] Antidepressant-associated mania and psychosis resulting in psychiatric admissions. Yale study (2001) ~ www.ncbi.nlm.nih.gov/pubmed/11235925

[3] Smoking skunk cannabis triples risk of serious psychotic episode, says research

https://www.theguardian.com/society/2015/feb/16/skunk-cannabis-triples-risk-psychotic-episodes-study

[4] Am I Bipolar or Waking Up? Sean Blackwell, 2011

http://www.amazon.com/Am-I-Bipolar-Waking-Up/dp/1461178258

[5] Sean Blackwell’s work ~ www.youtube.com/user/bipolarorwakingup

[6] Corrina Rachel speaking to Sean Blackwell about Bipolar ~

~ www.youtube.com/watch?v=WLIeS6idzD4

[7] TED video by Eleanor Longden (Voice Hearing) ~

www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en

[8] Jacqui Dillon (Voice Hearing) ~

www.rte.ie/radio1/doconone/radio-documentary-sounds-mad-hearing-voices-psychology.html

[9] Rai Waddingham ~ http://www.behindthelabel.co.uk/

[10] Hearing Voices Network ~ www.hearing-voices.org

[11] OPEN DIALOGUE: an alternative Finnish approach to healing psychosis (by Daniel Mackler) ~

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

[12] A collection of resources on Open Dialogue and Open Dialogue practices ~

http://willhall.net/opendialogue/

[13] New York ‘Parachute’ programme for people with acute mental distress lands in the UK ~

https://www.theguardian.com/society/2015/oct/20/parachute-therapy-psychosis-new-york-uk

[14] Mental health pilot focus of Finnish film ‘Open Dialogue’ ~

http://www.irishexaminer.com/ireland/mental-health-pilot-focus-of-finnish-film-open-dialogue-393492.html

[15] A fresh approach to mental health ~
http://www.irishexaminer.com/lifestyle/features/a-fresh-approach-to-mental-health-396031.html

[16] Soteria ~ www.soterianetwork.org.uk

[17] ‘Mental disorders’ are neither necessary nor sufficient causes of violence ~ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/

[18] Dispelling the Myth of Violence and Mental Illness ~

https://psychcentral.com/archives/violence.htm

[19] Prescription Drugs Associated with Reports of Violence Towards Others

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015337

[20] Psychiatry in Context : Experience, Meaning & Communities by Dr Philip Thomas

https://www.amazon.com/Psychiatry-Context-Experience-Meaning-Communities/dp/1906254729

Dr Philip Thomas highlights the limitations of neuroscience in explaining Psychosis or distress. He also explores how Racism plays a key role in many black people’s experience of Psychosis.

[21] My review of this book ~ www.goodreads.com/user/show/46943899-anne

This review was published in the Journal of Critical Psychology, Counselling and Psychotherapy (Volume 16, Number 1, March 2016)

Other relevant Resources

* ‘I was unaware of potential adverse effects to my prescribed antidepressants’

https://www.independent.ie/life/health-wellbeing/mental-health/aines-story-i-was-unaware-of-potential-adverse-effects-to-my-prescribed-antidepressants-31218347.html

* One woman’s account of suffering from psychosis ~

www.todayfm.com/One-womans-account-of-sufferinbg-from-psychosis

* Course ~ Caring for People with Psychosis and Schizophrenia (pharma funded which influences the advice given) ~

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

* Intervoice (International Hearing Voices Projects) ~ www.intervoiceonline.org

* Hearing Voices Network Ireland ~
http://hearingvoicesnetworkireland.ie/

* The Icarus Project ~ http://theicarusproject.net/

* CRAZYWISE – Official Extended Trailer ~

https://www.youtube.com/watch?v=iKfQd0bk214

* Peter Lehmann “Recovery from Psychosis and Depression by Taking Psychiatric Drugs versus Recovery by Coming off Psychiatric Drugs”

www.peter-lehmann-publishing.com/articles/lehmann/pdf/recovery-from.pdf

* 8 Tips to Help Stop Ruminating ~
www.psychcentral.com/blog/archives/2014/02/16/8-tips-to-help-stop-ruminating

 * Adverse effects of Prescribed Psychotropic substances (e.g. the anti-psychotic Olanzapine) may be found in my initial blog “Some of the many useful links…”

Shortened version of Hysterectomy story

For quite a while I had been struggling with some female problems. My GP referred me to a gynaecologist who sent me for an ultrasound and hysteroscopy (procedure for looking at lining of uterus). Not long after the hysteroscopy the gynaecologist rang my GP to tell her that I needed a hysterectomy. I was sent for an MRI scan.

The next step was to meet with the surgeon, Dr. Astbury. We had already met in the cervical screening clinic. Towards the end of July I met with her and a clinical nurse specialist Joanne. The doctor listened without judging me which was important.

After a discussion with them and asking questions about a laparoscopic procedure, I decided to go ahead with an abdominal hysterectomy. In hindsight that was a good decision. I asked to keep my ovaries, if possible. My mood can get quite low at times and I didn’t want to be plunged straight into the Menopause. The surgery was scheduled for August 25th.

I discovered a good website dedicated to women going through hysterectomies called HysterSisters [1]. Leading up to the surgery I got a call from the nurse Joanne to ask how I was. She advised me to rest and eat healthily.

I continued to do daily Yoga to build up my strength. I improved my eating habits and cut back on sugar and lost about 7 lbs. I ate more fruit and vegetables (organic if possible) and invested in various supplements and herbs. I took Hemaplex which included iron, antioxidants and amino acids.

That paid off in the end as I didn’t need a blood transfusion. Luckily I didn’t loose too much blood from surgery. I took a good quality chlorella, magnesium, organic flaxseed oil, krill oil, garlic, cumin and turmeric. I would recommend giving up alcohol or reducing it to a minimum so that the liver can be at its peak for processing all the drugs that are given during and after surgery.

The day before the surgery I took the train to Galway and met with Dr Astbury. I signed an informed consent form and had been made aware of some of the risks. She said I would be given an antibiotic as a precaution, in case of infection. I was on that for just the first day.

I stayed in the hospital the night before and the doctor came around with some of her team about 8 am. I got into my gown and DVT stockings. I was wheeled across in my bed to the main hospital for surgery. I spoke briefly with the anesthetist. They froze my hand, inserted a cannula into a vein and that was all I remembered. I woke up in a certain amount of pain and with a nurse sticking various attachments to my body which agitated me. Dr Astbury came around and I seemed to settle and calm down.

The surgery had taken an extra hour as my womb was attached to my intestine due to some old endometriosis that I was unaware of. I was given some oxygen while they checked my pain levels on a scale of 1 to 10 and reduced my level of discomfort. I was brought to the PACU unit (Post Anesthetic Care Unit). The first night there was a sense of relief that this major surgery was over. I had many connections and monitors attached. My blood pressure and other vital signs were been constantly checked by an automated devices.

The next morning a nurse helped me out of bed to sit out on a chair. I had tubes and wires everywhere. I listened to some online meditations and healing on youtube. By afternoon I was wheeled in a bed from the PACU unit back to my room by a porter and kind nurse.

I got amazing care in St. Monica’s ward. For 2.5 days I was on a drip while my intestine started to work again. I didn’t realise that the bowel would be so affected by the surgery and was in a certain amount of pain. On the 3rd day it was good to be sitting out on a chair at 7 am. To avoid getting a chest infection regular deep breaths are necessary.

On the Monday I saw the physiotherapist who gave me very good advice e.g. pelvic floor exercises etc. On youtube I listened to cell healing, chakra healing, Wayne Dyer & Louise Hay. A mindfulness colouring book gave me something to do. And the book “The Healing Code” was a great help [2].

I was groggy from painkillers and the various drugs and had two balls of painkillers connected by fine tubes to my tender abdominal area, where there was a 9 inch incision along the bikini line. It was difficult to think straight or to remember things. Coughing or laughing caused some pain. Other basic biological functions took some time to return to some kind of normality.

I rested in my bed, wombless, listening to the occasional screams of babies coming into the world, as there was an emergency theatre down the corridor. I cried on the way into hospital and didn’t want to be there for major surgery. I also shed a tear on the way out. It was like leaving the womb without a womb. A cocoon. I felt I would never get such great care again. I had been minded like a baby.

Respite

After hospital I spent a week in respite while my body healed from major abdominal surgery that had cut through my core muscles and left me without my usual strength and independence. The large, carefully minded scar was healing well without any infection. In a world that is now full of antibiotic resistance luckily I didn’t get an infection [3, 4].

In respite, it was great to have an adjustable bed, railings, a lift and an adapted shower. On my first day in respite my GP came to examine me. I had some strange sensations in my legs from all the drugs and felt like I was walking on a trampoline. I continued to wear the DVT tights for a few weeks.

The nurses had me on a schedule taking various medications but eventually I needed to keep a record myself and develop a routine for taking pain medication & the anti-inflammatory drug Difene. I got off the drugs as soon as I could, while been sure to have my pain under control. Everyone is different, so this is not medical advice.

I went to see a good nutritionist called Linda in the town I live in. She gave me some advice e.g. I took Kefir to help build back the good bacteria in my gut and drank a green anti-oxidant smoothie with wheatgrass. When it came to inflammation I supplemented turmeric into my food, after I came off the Difene. Turmeric is a natural anti-inflammatory. Advice from a doctor or nutritionist may be needed when it comes to any contraindications.

I slowly tapered off the drugs. About 2 weeks after surgery I went home and out to a world full of highly sprung doors, where I needed to fend for myself most of the time. My next door neighbour was very kind when I arrived home. I was able to slowly and carefully do a certain amount of housework e.g. dishes and laundry. 3 weeks after surgery I was able for a 20 minute walk, with some rest along the way.

4 weeks on I had electrical zaps in my tummy after overdoing things. 6 weeks after surgery I went back to Dr. Astbury for a check up and thanked her for a job well done. I am very grateful for the work she did. While some people can be judgemental when I tell them various parts of my journey, she instead praised me for going for the test and the necessary surgery.

7 weeks on I still wasn’t really able for lifting a small backpack of groceries. My body let me know. I suggest waiting at least 3 months for any intimate relationships, which is the average recovery time for the internal healing.

As someone that’s been through a difficult decade, I had a new appreciation of people, doctors & nurses, the HSE and life in general [5]. Some therapy /counseling would have been helpful and/or a support group. The whole journey was a test of my own resilience that involved a lot of maturing and personal growth. A support group would have been helpful.

I need to stay focused on nutrition and take personal responsibility for my physical and emotional health on a daily basis, which at times can be a struggle. Functional medicine needs to play a bigger role in our health care system. Dr. Mark Hyman explains it well [6].

To conclude, overall I was very pleased with and grateful for the care I received from our health service. I have empathy and understanding about this ordeal. Some people understood the severity of the procedure and the impact it has, both physically and emotionally. Others were not very understanding.

To those that have supported me I am forever grateful. And finally, I am grateful for the skilled hands of the surgeon Dr. Katharine Astbury, her team, the nurses in St. Monica’s ward in University Hospital Galway, staff in Portiuncula hospital, those that looked after me in respite and my GPs.

 

Some links that may be useful

[1] www.hystersisters.com ( A website I discovered that was of great help e.g. On what to expect as the weeks progressed)

[2] The Healing Code & book ~ http://thehealingcodes.com/

[3] Antimicrobial resistance ~ http://www.who.int/mediacentre/factsheets/fs194/en/

[4] Antibiotic resistance could spell end of modern medicine, says chief medic ~
https://www.theguardian.com/society/2017/oct/13/antibiotic-resistance-could-spell-end-of-modern-medicine-says-chief-medic

[5] HSE information on Hysterectomy ~ http://www.hse.ie/eng/health/az/H/Hysterectomy/

[6] How Is Functional Medicine Different from Conventional Medicine?

https://vimeo.com/37277787 (Dr. Mark Hyman)

Other relevant links

* Louise Hay You Can Heal Your Life ~

https://www.youtube.com/watch?v=CTtmHvM1opo

* Flipping the Script on Menopause: Dr. Christiane Northrup & Dr. Kelly Brogan

http://kellybroganmd.com/flipping-the-script-on-menopause-dr-christiane-northrup/

* Marilyn Glenville on Hysterectomy ~

https://www.marilynglenville.com/womens-health-issues/hysterectomy/

In praise of the HSE ~ Hysterectomy in University Hospital Galway, 2017

“My old ways die like leaves in the fall, leaving me naked. Then I open to healing” Maureen Brady

For quite a while I had been struggling with some female problems. My GP referred me to a gynaecologist. An ultrasound was performed and that showed up some fibroids which I was aware of from previous check ups. The gynaecologist Dr De Tavernier wanted to do a hysteroscopy. I had been for regular smear tests and a colposcopy but the idea of a hysteroscopy scared me. As someone that’s been there for the birth of one of my nieces but has never had a baby. Granted writing these blogs has felt like giving birth at times !

I also had some trust issues with doctors because of a severe trauma that happened in 2008, in a different field. So I kept putting off the test, saying that I needed to work on my diet, which I never seemed to be able to change e.g. reduce gluten, sugar & dairy. Krill oil seemed to help. One day a Sudanese doctor gave me a scare story so I went ahead with the test. I watched a simulator on youtube before hand to try to put my mind at ease.

Not long after the hysteroscopy the gynaecologist rang my GP to tell her that I needed a hysterectomy. I was helping out with a friend’s 3 yr old child that day as he had a bad case of tonsillitis. He woke up around the time of the call from my GP and was crying inconsolably while the doctor was telling me that my womb had to be removed. There was a certain irony to it all.

I did manage to settle the sick child after that by cradling him in my arms, while the reality sunk in. This was the final curtain coming down on any possibility of being a mother. I have accepted this but notice I’ve become more aware of babies and pregnant women. They seemed to be everywhere after that ! When it comes to my maternal instinct I have nieces, nephews, little cousins and friend’s children to connect and help out with.

The next step was to meet with the surgeon. When I was told that it would probably be gynaecologist / obstetrician Dr Astbury, I recognised the name as we had already met in the Cervical screening clinic. I was sent for an MRI scan. Towards the end of July I met with Dr Astbury and a clinical nurse specialist Joanne. The doctor listened without judging me which was important. After a discussion with them and asking questions about a laparoscopic “less invasive” procedure, I decided to go ahead with an abdominal hysterectomy. In hindsight that was a good decision. I asked to keep my ovaries, if possible, due to very low mood (which I suffer from since taking anti-depressants for anxiety almost a decade ago! A condition called tardive dysphoria). I didn’t want to be plunged straight into the Menopause. The surgery was scheduled for August 25th.

I discovered a good website dedicated to women going through hysterectomies called HysterSisters [1]. Leading up to the surgery I got a call from the nurse Joanne to ask how I was. She advised me to rest and eat healthily. I’m not sure how well I rested as I started writing blogs which can be draining, but it’s something that was on my bucket list. The plan had been to write a book.

I continued to do daily Yoga to build up my strength. I improved my eating habits and cut back on sugar. I managed to loose half a stone in weight via the changes I made. I ate more fruit and vegetables and invested in various supplements and herbs. As I had been losing a lot of blood and that was taking its toll on my body, I took Hemaplex which included iron, antioxidants and amino acids.

That paid off in the end as I didn’t need a blood transfusion. Luckily I didn’t loose too much blood from surgery. I took a good quality chlorella, magnesium, organic flaxseed oil, krill oil, garlic, cumin and turmeric. I listen to functional medicine doctors on the internet, some of whom did extra nutritional training to help overcome their own health issues via holistic medicine and their influence helped build me up for surgery. Doctors Kelly Brogan [2], Rangan Chatterjee [3], Mark Hyman [4] and others. Over the years my friends Kris and Karen have been a wealth of knowledge when it comes to holistic health [5].

I didn’t manage to give up alcohol and would recommend giving it up or reducing it to a minimum so that the liver can be at its peak for processing all the drugs that are given during and after surgery.

The day before the surgery I did some final cleaning and preparation of my house (as I knew housework was going to be difficult for a few weeks), packed my belongings and headed to Galway on the train. I walked along the river Corrib that wet afternoon and took a taxi for the last part of the journey. I would normally call to the Cathedral to light a candle but didn’t get a chance that day. I got upset when I arrived, once the patient wristband was put on but managed to settle myself. I met with the doctor and told her I didn’t want to be there. She said that was understandable. I signed an informed consent form and had been made aware of some of the risks. She said I would be given an antibiotic as a precaution, in case of infection. I was on that for just the first day.

Corrib_walk

I stayed in the hospital the night before and the doctor / surgeon came around with some of her team about 8 am. I got into my gown and had DVT stockings on. A nurse had measured me the night before and provided me with these special stockings. I was wheeled across in my bed to the main hospital for surgery. D-day had arrived. I don’t remember been particularly nervous. I spoke with the anesthetist and had the choice of an epidural or a more localised anesthetic as part of the whole procedure. I choose the latter option. They froze my hand, inserted a cannula into a vein and that was all I remembered. I woke up in a certain amount of pain and with a nurse sticking various attachments to my body which agitated me. Dr Astbury came around and I seemed to settle and calm down when I saw a familiar face.

She explained a few things to me including that surgery had taken an extra hour as my womb was attached to my intestine due to some old endometriosis that I was unaware of. So the surgery had taken 2.5 hours. I was given some oxygen while they checked my pain levels on a scale of 1 to 10 and reduced my level of discomfort.

I was brought to the PACU unit (Post Anesthetic Care Unit). The first night there was a sense of relief that this major surgery was over. I was like a Christmas tree with so many connections and monitors attached. My blood pressure was been constantly checked by an automated device and my other vital signs were also been monitored.

The next morning a nurse helped me out of bed to sit out on a chair. I had tubes everywhere. I listened to some online meditations and healing on youtube. By afternoon I was wheeled in a bed from the PACU unit back to my room by a porter and kind nurse. In St. Monica’s ward I got amazing care from nurses Adrienne, Marie, Patricia and others.

A lot of emotions came up on the 2nd night and I found it more difficult that the first. Plus I have hyperacusis (severe sensitivity to sound) so the noise from the drip was like torture, even with earplugs in ! Hospitals can also be noisy environments.

For 2.5 days I was on a drip while my intestine started to wake up and work again. I didn’t realise that the bowel would be so affected by the surgery and was in a certain amount of pain from trapped wind. I regretted not bringing some natural peppermint with me. In hindsight, I also should have been a bit more careful with my diet in the days leading up to the surgery.

On the 3rd day it was good to be sitting out on a chair at 7 am. I was getting chesty and the advice was to take regular deep breaths. Because I’m not a smoker I was sometimes relaxed about that advice. The reality was I needed to work with deep breathing. A lady called Teresa that I was friendly with died in the main hospital that day. That upset me as I am very close to some of her extended family. She had also inspired me to keep moving with my procedure. I became very much aware of the preciousness of life.

On the Monday I saw the physiotherapist who gave me very good advice e.g. how to move correctly, lifting advice, pelvic floor exercises etc. On youtube I listened to cell healing [6], chakra healing [7], Wayne Dyer [8] & Louise Hay [9]. I also brought 3 of her books to the hospital. Louise Hay died on August 30th, age 90, on the 2nd anniversary of Wayne Dyer’s death. I also had a photo of evidence based healer Bruno Groening in the room [10]. A mindfulness colouring book gave me something to do. And the book “The Healing Code” by Loyd and Johnson (an MD) was a great help [11]. I recorded the healing prayer / mantra on my phone and listened to it regularly. I gave this book to another patient in the room beside me.

I was groggy from painkillers and the various drugs and had two balls of painkillers connected by fine tubes to my tender abdominal area. It was difficult to think straight or to remember things. Coughing or laughing caused some pain and I had to hold the area where I had the incision with something padded. Other basic biological functions took some time to return to some kind of normality.

I rested in my bed, wombless, listening to the occasional screams of babies coming into the world, as there was an emergency theatre down the corridor.

I cried on the way into hospital and didn’t want to be there for major surgery. I also shed a tear on the way out. It was like leaving the womb without a womb. A cocoon. I felt I would never get such great care again. I had been minded like a baby.

On the day I was discharged a friend Mal organised transport for me and we left Galway at 4.15 pm. There was a lot of traffic and I didn’t get to my destination until 5.45 pm. I felt tired after the journey and a bit tender.

Respite

I spent a week in respite while my body healed from major abdominal surgery that had cut through my core muscles and left me without my usual strength and independence. The large scar that was healing well without any infection reminded me of what I had been through. In a world that is now full of antibiotic resistance luckily I didn’t get an infection [12, 13]. I was very careful with the wound and minded it well. As did the nursing staff.

In respite, it was great to have an adjustable bed, railings, a lift and an adapted shower. The first night was an adjustment as I missed St. Monica’s hospital ward. On my first day in respite my GP came to examine me. I had some strange sensations in my legs from all the drugs and felt like I was walking on a trampoline. I was also wearing DVT tights in case of a blood clot and continued to wear them for a few weeks.

Pain control was an issue. The nurses had me on a schedule taking various medications but eventually I needed to keep a record myself and develop a routine for taking pain medication & the anti-inflammatory drug Difene. I got off the drugs as soon as I could, while been sure to have my pain under control. Everyone is different, so this is not medical advice.

I took a taxi to see a good nutritionist called Linda in the town I live in. She gave me some advice e.g. I took Kefir to help build back the good bacteria in my gut and drank a green antioxidant smoothie with wheatgrass. When it came to inflammation I supplemented turmeric into my food, after I came off the Difene. Turmeric is a natural anti-inflammatory. Advice from a doctor or nutritionist may be needed when it comes to any contraindications.

Green_smoothie

I was slowly tapering off the drugs and by September 4th I was taking 1 Difene, 2 Panadol and 0.25 Xanax (temporarily to help me with relaxation and sleep). By September 7th my friend Trevor, who drives a taxi, took me home. I was now in a world full of highly sprung doors and where I needed to fend for myself most of the time. My very kind neighbour Avril cooked me Lasagne, left fuel for the fire on my doorstep and moved a few heavy items for me.

I was able to slowly and carefully do a certain amount of housework e.g. dishes and laundry. 3 weeks after surgery I was able for a 20 minute walk, with some rest along the way, to visit an 89 year old woman who had a heart valve replaced in University Hospital Galway.

4 weeks on I had electrical zaps in my tummy after overdoing things. 6 weeks after surgery I went back to Dr. Astbury for a check up and thanked her for a job well done.

When I discussed wanting local anesthetics for the hysteroscopic procedure in Ireland (like they do in the US) and my concerns about morcellation used by other doctors to perform hysterectomies (thanks to the brave work of Dr Noorchashm and his wife Dr Amy Reed) she listened but didn’t make me feel inferior. I don’t work in the medical field but do a lot of reading and research.

7 weeks on I still wasn’t really able for lifting a small backpack of groceries. My body let me know. 8 weeks on I wasn’t truly ready for intimate relationships with my manfriend. I suggest waiting at least 3 months for that, which is the average recovery time for the internal healing.

As someone that’s been through a difficult decade, I had a new appreciation of people, doctors & nurses, the HSE and life in general [14]. It’s been a difficult few weeks. I probably needed some psychological support and did discuss that with the Community nurse but struggled on due to a traumatic experience with the mental health services in the past. Some therapy /counseling would have been helpful. I could always have tried to link up with therapist Ivor Browne who is now 88. But decided to give him some peace. He did send me a very supportive message while I was in hospital saying “Sorry to hear what’s been happening to you. I suppose every experience teaches us something but it’s no joke when you’re going through it. I just hope you are recovering well”. A man with a lot of patience and kindness.

Some of the Manic Depressive / Bipolar symptoms (triggered by anti-depressants in 2008) returned for a while but I was more aware of them now and able to stand up to them, while letting them go. Like the cover of a Dr Suess book [15]. Some morphine in the hospital also triggered my overactive brain and caused a bit of a high but I managed to balance that out by asking the doctor for some xanax very short term (seeing as benzos are addictive).

The whole journey was a test of my own resilience that involved a lot of maturing and personal growth. A support group would have been helpful.

I need to stay focused on nutrition and daily work on my physical and emotional health. As someone that trained in basic Anatomy, Physiology and Massage therapy and that worked in this field in the past, I do think that functional medicine and holistic healing needs to play a bigger part in our health care. I’m not sure if people understand the difference between modern medicine and functional medicine. Dr. Mark Hyman explains it well [16].

We live in a world awash with drugs, where antibiotic resistance is a major problem and where the flu vaccine may not be effective this winter, putting a major strain on the health service. I needed to work on my own immune system and self-discipline isn’t one of my strong points. I am far from perfect at times.

When in respite, my Irish teacher (Sr. Patricia from secondary school) bought me a jar of high quality New Zealand Manuka honey which was very kind and thoughtful of her.

As someone that’s been to a few public lectures in RCSI (Royal College of Surgeons) I’ve learned about the usefulness of more traditional methods when it comes to healing wounds and fighting infection [17]. I also went to a good lecture by Dr Anthony Cummins on ‘Evidence based medicine’ [18].

To conclude, overall I was very pleased with and grateful for the care I received from our health service. Now I can help others in similar situations. I have empathy and understanding about this ordeal. Some people understood the severity of the procedure. Others, particularly women, didn’t seem to fully comprehend the healing involved and the support required. Both physically and emotionally. Women who have had C-sections seemed to have some understanding e.g. my sister-in-law or the many women that have had a hysterectomy.

To those that have supported me, including cousin Linda, friend Erica, my aunts and others, I am forever grateful. And finally, I am grateful for the skilled hands of the surgeon Dr. Katharine Astbury, her team, the nurses in St. Monica’s ward in University Hospital Galway, staff in Portiuncula hospital, those that looked after me in respite and my GPs.

Go raibh maith agat.

GoRaibhMaithAgat

Some links that may be useful

[1] www.hystersisters.com ( A website I discovered that was of great help e.g. On what to expect as the weeks progressed)

[2] Kelly Brogan ~ http://kellybroganmd.com/

[3] Rangan Chatterjee ~ https://www.drchatterjee.com/

[4] Mark Hyman ~ http://drhyman.com/

[5] Karuna Flame Holistic health centre ~ http://www.karunaflame.com/karunaflame/

[6] Spoken Guided Meditation For Pain & Sickness, Relieve Pain Naturally ~
https://www.youtube.com/watch?v=_jD3VxSGM-k

[7] Chakra Cleansing & Activating Guided Meditation ~ https://www.youtube.com/watch?v=Y1xwtA6C2DQ

[8] Wayne Dyer ~ https://www.drwaynedyer.com/
[9] Louise Hay – Morning Meditation to Heal Your Body ~ https://www.youtube.com/watch?v=9YcCHonbyWU

[10] Bruno Gröning ~ https://www.bruno-groening.org/en

[11] The Healing Code & book ~ http://thehealingcodes.com/

[12] Antimicrobial resistance ~ http://www.who.int/mediacentre/factsheets/fs194/en/

[13] Antibiotic resistance could spell end of modern medicine, says chief medic ~
https://www.theguardian.com/society/2017/oct/13/antibiotic-resistance-could-spell-end-of-modern-medicine-says-chief-medic

[14] HSE information on Hysterectomy ~ http://www.hse.ie/eng/health/az/H/Hysterectomy/

[15] …Will You Please Go Now! Dr Suess book ~
https://www.amazon.com/Marvin-Mooney-Please-Beginning-Beginners/dp/0394824903

[16] How Is Functional Medicine Different than Conventional Medicine?

https://vimeo.com/37277787 (Dr. Mark Hyman)

[17] RCSI MiniMed Open Lecture Series 2013/2014 – ‘Wound Management …”

https://www.youtube.com/watch?v=yBYg2gzwMiI

[18] RCSI MiniMed Open Lecture Series 2013/2014 – ‘Evidence-Based Medicine’
Dr. Anthony Cummins ~ https://www.youtube.com/watch?v=mNn1StHwxmw

Learning from the History of Psychiatry

Hannah_Greally4Hannah_Greally_plaque 

“Those who cannot remember the past are condemned to repeat it” George Santayana

The RTE “Behind the Walls” 2 part documentary highlighted that we locked up more people in mental institutions in Ireland that any other place in the world a few decades ago [1]. “Research shows that 33,000 patients died in overcrowded and disease-ridden psychiatric hospitals between the late 1920s and early 1960s, with death rates significantly higher than in the general community” Carl O’Brien, Irish Times [2]. In Nazi Germany people with mental health issues were the first to be killed and the last to be recognised.

Athlone nurse Hanna Greally, experienced Post Traumatic Stress after spending time in England during WWII. She was sent into St. Loman’s hospital, Mullingar by her mother for “a rest”. She was admitted to the Psychiatric hospital at 19 and got trapped there for almost 20 years! Her birthplace is currently Murphy’s Law pub in Athlone with a plaque outside and her photo in the beer garden.

She wrote an excellent book called Bird’s Nest Soup [3]. The last line in the book is very poignant “I am now a sadder but a wiser woman, and one who can say with certainty that knowledge and FREEDOM are happiness”.

Sligo woman Mary Maddock and her husband Jim wrote a book called Soul Survivor [4] which gives a more recent insight into Psychiatric survival. Like many other sane people, Mary got caught up in the Psychiatric system in the early 1970s, after the birth of her 1st baby. With the help of people like Dr Terry Lynch, thankfully she freed herself from the mental “health” system. I’ve included a short video about her below [5].

I don’t think people truly comprehend what it’s like to be in a Psychiatric unit unless you have been there. “One thing you will find on Psychiatric wards that you won’t find on other hospital wards is a lot of people in various stages of tranquilisation … Psychiatry is the only medical specialty where considerable number of recipients of Psychiatric treatment consider themselves to be survivors of the actual system” Dr. Terry Lynch. Connecting to other Psychiatric survivors was a part of my healing journey.

Ivor Browne and how he helped me on my healing journey

Prof Ivor Browne has worked in the field of mental health for about 60 years. He has published a number of good books [6, 7]. A lot can be learned about the history of Psychiatry in Ireland in the last 60 years from Ivor’s great work.

While Professor Ivor Browne worked as a Psychiatrist, he is also a trained therapist, unlike most mainstream Psychiatrists who are trained in a biomedical approach and mainly prescribe drugs. Only a relatively small percentage of Psychiatrists in Ireland are trained therapists. In my experience this puts the human beings they are working with at a serious disadvantage and delays healing. “12 years of schooling and I can’t do basic therapy techniques … how did we get to this point where we as a field have become fixated on medications ?” Dr Daniel Carlat (Psychiatrist).

I first went to see Prof Ivor Browne for therapy in February 2012 for one intensive session and then he took me back in 2015 where I received about nine more sessions, including Regression therapy. The first time we met I was on 25 mg of Seroquel / Quetiapine, which is more or less the lowest dosage (it goes all the way up to 800 mg !). Ivor believes that anti-psychotic medication (mainly tranquilizers) should be used for as short a time as possible in as low a dosage as possible.

Having met doctors that seemed closed and programmed, I found myself sitting in front of someone who was very open-minded and didn’t dismiss some of the things that I said. He was able to “listen to my human story, validate my feelings and then offer an alternative perspective” to use a phrase from clincial Psychologist Lucy Johnstone. He worked in a very methodical way and gave me an action plan at the end, at a time when my life was lacking direction. He told me that I needed to “take back control of my life”. Whether I have or not over 5 years on is debatable. Life has been a struggle since mainstream Psychiatric intervention.

At the same time I’ve learned from my Tao meditations “No one can know you as well as you can know yourself. All that you can gain from a wise person is the assurance of some initial guidance”.

One of the important pieces of advice Ivor gave me was not to give my power away to other people, yet I seem to continually do so on a regular basis. It took me a long time to understand how not to give my power away and I’m still a work in progress.

While we are told by various campaigns to be open about mental health and to talk, we really have to be careful about who we talk to. While it’s not good to bottle up emotions and what we are thinking, if in distress, we also have to tell people on a need to know basis e.g. a therapist or a trusted friend. And to protect ourselves by maintaining appropriate boundaries and not over sharing with people in our social circle or community. At times however sharing how I feel has been a coping strategy, in dealing with distressing emotions.

Another way we give away power is explained in the 7 Habits of Highly Effective families [8] ~

Each time you build your emotional life on the weaknesses of others, you give your power away to their weaknesses so that your emotional life is a product of how they treat you. You disempower yourself and empower the weaknesses of others.

For example, I focused a lot on what I see as the cruelty of others in my initial treatment. Societies lack of good knowledge around mental health was a weakness that directly impacted my life. I invested a lot of energy emotionally in reacting to this injury. It particularly bothered me at night where I was left ruminating on past hurts. This was affecting my sleep but also taking up valuable head space. As well as causing me distress. It was disempowering. And still is sometimes.

I’m working on learning not to dwell on the hurt and distracting myself, so that my thought processes and energy can be spent on more productive things and on moving my life forward. Including the writing of this blog. I have accumulated a lot of important knowledge around mental health over the years and want to share that knowledge with others. If I had this knowledge back in 2008 when I went through a crisis, my healing process would be less painful and more successful. Thanks to all those who have helped me and who have been patient and supportive.

References

[1] Behind The Walls by Mary Raftery:

Part 1 ~ www.youtube.com/watch?v=PvxOon7CWZI

Part 2 ~ www.youtube.com/watch?v=LTOWZu0Gubo

Behind the Walls’ is a two-part documentary series charting the history of Ireland’s psychiatric hospitals. Part one lifts the lid on this vast system – during the middle decades of the 20th century, Ireland led the world in locking up more of its people per capita in mental hospitals, ahead even of the old Soviet Union.

This documentary reveals damning evidence of appalling conditions within the hospitals, information which was kept secret by the State. It also tells the remarkable story of Hanna Greally, locked up for almost 20 years, but who emerged to write about her experiences in the 1970s, becoming one of the very few to chronicle her experiences behind the walls.

Behind the Walls is a Misha Films production.

Produced and written by Mary Raftery”

http://www.rte.ie/tv/programmes/behind_the_walls.html

[2] Call to extend mother and baby homes inquiry to mental homes

https://www.irishtimes.com/news/social-affairs/call-to-extend-mother-and-baby-homes-inquiry-to-mental-homes-1.1833367

[3] Bird’s Nest Soup by Hannah Greally, 1971 ~

http://www.corkuniversitypress.com/Birds-Nest-Soup-Hanna-Greally-p/9781855942103.htm

There is also an RTE documentary about Hannah Greally ~

www.rte.ie/radio1/doconone/greally.html

Hannah_Greally

[4] Soul Survivor by Mary & Jim Maddock, 2006 ~

www.amazon.com/Soul-Survivor-Personal-Encounter-Psychiatry/dp/0954403029

[5] Mary Maddock: a survivor of ECT and decades of Psychiatric drugging ~

www.vimeo.com/87711795

[6] Music and Madness, Prof Ivor Browne, 2008

www.amazon.co.uk/Ivor-Browne-Music-Madness/dp/0955226120

[7] The Writings of Ivor Browne: Steps Along the Road, the Evolution of a Slow Learner

www.amazon.co.uk/Writings-Ivor-Browne-Evolution-Learner/dp/1855942194

Ivor Browne

[8] The 7 Habits of Highly Effective Families by Stephen Covey, 1998

www.amazon.com/Habits-Highly-Effective-Families/dp/0307440850

Other relevant information

Edward Shorter, Ph.D., author of How Everyone Became Depressed (Oxford 2013), is a social historian of medicine at the University of Toronto

http://www.dredwardshorter.com/ (includes podcasts)

Trailer for Meetings with Ivor documentary (which will air on RTE1 on 14.08.2017) ~
https://www.youtube.com/watch?v=uILm5nUoyJI

Article I wrote for a holistic magazine after going to see Meetings with Ivor ~
http://networkmagazine.ie/articles/meetings-ivor

Ivor with his son Ronan speaking to Miriam O’Callaghan on RTE radio ~

http://www.rte.ie/radio1/podcast/podcast_sundaywithmiriam.xml
(scroll down for podcast)

Pat Kenny interviews a young girl that Ivor helped called Ruth O’Doherty ~

www.newstalk.com/podcasts/The_Pat_Kenny_Show/The_Pat_Kenny_Show_Highlights/93403/

Musician Dylan Tighe speaking to Ivor Browne ~ www.mixcloud.com/corkmidsummer/talking-theatre-dylan-tighe-in-conversation-with-prof-ivor-browne-and-chaired-by-dylan-haskins/

{ Note ~ What I discuss in part of this blog is my own experience and is not medical advice. We all have our own unique journey. I also wish to thank my teachers from school that I’m still friendly with. Eileen & Tommy Moran and Sr. Patricia Kelly}