This Week in Mentalists – Bye Bye Liam Fox Edition

Zarathustra here, former editor of Mental Nurse, now co-blogging at The Not So Big Society.

Dr Fox was quite right to resign. He was rubbish at judging Pop Idol.

*watches the tumbleweed roll across the blog*

Okay, I’ll just carry on and do TWIM…

Triggers for self-harm.

Ermintrude2, my co-blogger at The Not So Big Society, has this to say on the NHS reforms passing the House of Lords.

Lansley’s Bill is pushing choice. Oh, you see, how wonderful it will be, he claims, when we will be able to choose which hospital we want to be treated in? Yes, that works great for routine surgery but there’s not much choice involved after a proverbial car crash. Choice is all well and good but it is a luxury of those who are able to express it.

I’m not knocking it – well, ok, I am a bit – but I have seen how the word itself has been warped in the field of social care and has been used to promote discriminatory practices which bypass those who are not able to make choices.

Those who can, choose. Those who can’t, are given the poorest services and it is those who are not able to exercise choice that often need much more support.

Neuroskeptic has an interesting analogy about mountains.

The official looked unamused.
“No. We’re here to help you, sir.”
“Help you to cope with the rigors of mountain living!” the other chimed in, helpfully.
“But… I don’t live on a mountain.”
“I’m afraid you do. Look – ” and the first official unfolded a large map. “Do you agree that there is a mountain, here?” and she pointed to a spot 10 miles down the road.
“Yes. Actually I just told you about i…”
“…and, do you agree that you live – here?”
“Of course, but…”

“So you do live on the mountain. The very ground beneath our feet right now is part of that mountain nearby.”
“No it’s not.” The man protested. “This is a valley, miles away. I mean just look outside. We’re clearly not on a mountain now, are we?”
“How old fashioned. That’s what we used to think. But, thanks to advances in geology, we now appreciate that these hills and valleys are merely a part of the mountain.”
“Yes!” the other said, whipping out a textbook and becoming increasingly enthusiastic. “You see, a mountain is merely a mass of rock, and this rock extends underground for a considerable distance… It’s impossible, really, to draw a line on the map and say categorically, this side is mountain, this isn’t. So ‘mountains’ are an arbitrary construct. ‘Hills’ are likewise just protrusions of the underlying mountain and…”

No, I’m not taking TWIM off on a hitherto-unexpected foray into geology. Neuroskeptic’s little story is an analogy of the spectrum view of mental illness.

There is a movement in psychiatry at the moment, away from a ‘categorical’ view of mental illness towards a ‘spectrum’ view. Mental disorders are not things you either have or don’t – defined according to some arbitrary cut-off. Rather, they’re things that everyone has, to some degree.

This has already happened, or is happening, to autism, schizophrenia, bipolar disorder, personality disorders, and more.

Now, the “spectrum” or “dimensional” approach has much to recommend it. It’s true that diagnostic cutoffs are arbitrary. It’s true that the categorical approach doesn’t capture the true degree of variation that real people display.

My worry is that these new “spectra” are, in practice, merely the old categories, just bigger. We still think of people as being ill or not-ill, although we may call it on the spectrum or off it. Worse, we still think of “ill” in the same way as we used to i.e. as referring to the most severe end of the spectrum. The only difference is that we’ve expanded the old category of “ill” to cover more people.

Confessions of a Serial Insomniac is going to the Mind Media Awards, where she’s nominated in the New Media category, and extends an invitation to…well, you lot.

So, mentalists of the UK. If you’re kicking about in the general area of the Home Counties in late November and fancy a pale ale or three with a sad blatherer with a Pot Noodle fetish, feel free to give me a shout. We’ll be in Laaaaaahhhhaaaandaaaaaahhhhnnnnn from Saturday 26th to Wednesday 30th November. Monday night is out, as it’s the awards ceremony, and on at least one of the other days I’ll be meeting a friend, but there’s flexibility in the latter if anyone is amenable to a Mini Mad-Up.

Purple Noise lists the reasons why self-harm sucks.

Taxi fares to and from hospital. No money left for sweeties, toys or stickers. =[

Bending down to stroke or feed the cat becomes a feat of agility and balance, as I'm afraid if I bend the wrong way something will ping open in a most inopportune manner [and, for once, I'm not talking about my bra].

It’s one thing to have healthcare staff bark instructions at you and sneer at your despicable attention-seeking behaviour. It’s quite another to have them confide in you. A doctor once told me about the day he considered suicide; Mad Tortoise Nurse [more about her another day] told me all about her despair at her teenage daughter’s recent self-injury. I sympathise, I empathise, but what the hell do you say? Especially when Mad Tortoise Nurse [more about her another day] says things like “I was so angry at her for being so stupid” and “I have to deal with stuff like that every day at work, I just want her to stop”. Cheers love.

Feeling guilty for considering taking a painkiller.

My living room looks like Carrie’s prom night, and I don’t have the energy to clean anything yet. Still, I’m thankful I no longer possess carpet.

Stuart Sorensen points out that the slogan “nobody’s perfect” applies to service users too.

But whilst it’s easy to excuse ourselves for the regular little errors that make up every day of our lives many workers in health and social care have difficulty extending the same understanding and forgiveness to service users. The next time you go into work take a random batch of care or support case files and look at the care plans inside. See how many of them have been discontinued as ‘unattainable’ after only one or two attempts. Notice also how many have stated goals set far too low because of an assumption that since the service user didn’t get it right every time they cannot be expected to attain meaningful goals.
Then apply the same logic to your own life.
Would you find your own support plans discontinued if the same stringent demands were applied to your….

  • Sobriety
  • Spending and budget management
  • Anger management
  • Compliance with medication regimes as ‘self-administrator of meds’
  • Smoking cessation (how many times did the ex smokers you know try and fail to stop before they succeeded?)

Sobriety…budget management…Yikes, I think I might have to discharge myself for non-compliance.

Sharon Howard from Day in the Life of a Busy Gal has a thought-provoking post on changes in self-identity.

I realised that this is a pattern in my life, one that is integral to my Borderline Personality (BPD) diagnosis. I adapt my personality to ‘fit in’ to a given situation or role, I am what people in that context expect me to be, but this is not a thing I do by choice it just comes natural to me and the reason for this is that it is the ‘unstable sense of self and identity’ one of the key diagnostic criteria for BPD. And once for whatever reason I am no longer in that situation, the person, version of me, who was there dies, vanishes and it is like she never existed at all. Even more so if there has been any kind of trauma associated with the reasons for ‘moving’ on as then all connections with that place and time are also cut dead. Sometimes I grieve for the passing if it had been a good time, other times I look back and just think ‘huh, so what’ .

But the worst part about it is it seems I am doomed to repeat these cycles, as I have since as far back as I can remember from early childhood I can picture ‘me’ social, with ‘friends’, picture me after that phase ends ‘me’ loner, reclusive, again as a teenager, again in early adulthood, again, again, again… Only a few close long-term friends, all others gone with the wind – those few close ones are the important ones, but the others left their marks in many ways – memories good and bad, trust and betrayal, closeness and distance. And each of them would describe me (if you were to ask) in different ways, those that see me as the quiet, shy, studious girl would not recognise the girl who others knew – confident , loud, life and soul of the party – precious few have seen/know that both are one and the same. this is the manifestation of unstable sense of self and identity – I do not know who I am, how can anyone else?

David McKendrick discusses personalisation in social care.

My first contradiction in personalisation is how we as social workers feel about it. There are many good things. Increased choice for service users, greater involvement, allowing more of the decisions to rest with the expert, i.e. the person themselves are a few but there are equally worrying aspects of it; the shift to free choice means potentially thin times for service providers, for LA’s they are often providers and purchasers. Purchasing services allows local authorities to promote services they feel have a “fit” with them either in delivery or ideology or both. A greater menu does not guarantee that not all of the dishes available are too your taste. So there can be a conflict right at the heart of the process.

Equally service user choice is (copyright @jaxrafferty) at best an illusory choice, a little like Henry Ford you can only choose what is made available and the making available comes with a series of choices and decisions you are not part of, so how much of a choice is it really?

Further there is the issue of shopping in Waitrose as Jose Murinho once put it. If your driver for buying care is to buy a lot at a low price this could precipitate a disaster, take for example respite care. This is often seen as high value, for obvious reasons. However it is also high cost (for similarly obvious reasons) so purchasers may avoid it. Equally LA’s may avoid it as it requires greater application to contractual obligations and regulatory arrangements so there is limited desire to purchase. The risk of course is that things get advanced and people need respite but then can’t access it. What appears to be a win win becomes a lose lose.

The Wildcard is an incredibly immature one. Well, it would be immature if it were not for the fact that we can all agree that there is NOTHING FUNNY AT ALL about an astronomy blog with the headline, “Uranus takes a pounding more frequently than thought”.

Hur hur…Uranus…

Uranus isn’t just gassy, it’s also tilted completely sideways


Needless to say, this sort of behavior is a bit strange for Uranus


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About Zarathustra

Trained as a nurse, currently working in Child and Adolescent Mental Health Services (CAMHS). Co-editing the Not So Big Society blog. May possibly be an incorporeal being called Phil Dore. All views expressed are in a personal capacity and not necessarily the views of my employer.

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