Friday, September 19, 2008

And whilst we're on the subject of Ignorance...

I recently attended a very boring and yet equally as interesting meeting for teachers involved in adult education. It was a compulsory thing for my friend, and I went along as her chauffer. There was much emphasis on completing paper work and carrying out risk assessments – if you’ve worked in education (or any public sector) you’ll know what I’m talking about. Before you ask, the buffet was naff.

There was a panel of various key figures who took it in turns to give a little introduction of their roles in the education service, followed by the usual “if you have any questions come and see me later” and “my number is in this leaflet” whilst waving bits of paper in the air. And then a lady stood up and said: “My name is Josephine Bloggs and my role is to make sure that adult education is accessible to people with physical disabilities or mental health problems”. That’s when the evening became interesting. She said that teachers obviously know about their own subject, but need to be taught how to cater for the needs of such ones.

Raising awareness in this way is something I would quite like to do – explaining what mental illness is and isn’t, a few do’s and don’ts, and how best to be supportive, that kind of thing – after all, they’re not training to become mental health nurses, so a lesson in biology is probably not required! I enquired about it later in the evening and although I was told that the CPT would be handling it, the lady took my number to pass on to another lady who would be directly involved in this. During our discussion there were a few points that sounded a little odd to me, and when/if the lady calls me I shall no doubt be asking for some clarification.

Firstly, I got the impression that there were specific courses for people with mental health problems, such as painting, dancing, yoga, “subjects that are therapeutic” as the lady put it. Are they suggesting that people with mental health problems can only benefit from “therapeutic” subjects and not academic ones? Do they assume that people with mental illness do not have the mental capacity to learn something more challenging?

Secondly, why are people with mental health problems being segregated by being given their own courses? Aren’t they just ordinary people like you and I?

Thirdly, I was told that one way I could help was by being a “buddy” for a mentally ill student. Please tell me that this is not a paid role. Do they think they need to enrol people to be friends with those with mental illness? How is the person expected to gain confidence in their own social skills if “buddies” are provided? How would you feel if you were assigned a “buddy”? Wouldn't you feel like they were saying “You're so awful no one will like you so we've asked someone to be your friend”?

These courses are designed for people with “mild to moderate” mental health problems. I have read that Schizophrenia is the most severe form of mental illness. So if this is how they view “mild to moderate” sufferers of mental illness, they must think Mr Man is a complete cabbage! So let me just clarify a few things about Mr Man…

  • His table tennis skills are improving all the time, which is one of the fastest thinking sports there is. He’d now like to train to become a coach.

  • He is very proficient in web design and computer programming, being able to program in at least 10 different programming and scripting languages, flash animations, and other things that I can’t even explain to you because I don’t understand it – all self taught.

  • He has an amazing comprehension of various forms of mathematics which I have never even heard of – again all self taught. He even created his own mathematical formula to work out the day of the week of any given date in history or in the future - which he can calculate in his head.

  • He has composed hundreds of pieces of music of many different styles.

  • Believe it or not he’s even made some new friends all by himself.

My teacher friend pointed out to me that although there are specific courses for people with mental health problems, anyone can enrol on any course. This is true, but only the teachers who are teaching the “therapeutic” courses specifically for the mentally ill are being trained to cater for the needs of those with mental illness - the other tutors merely received an information leaflet that was so general that it could apply to almost anyone whether they suffered from a mental illness or not. Who’s to say what is therapeutic? Yes, I would love to paint and dance and let the wind blow through my hair, but these things are not relaxing or therapeutic to Mr Man. (For those things, please see the list above)

I realise that not every person who suffers from a mental illness is like Mr Man, but I just feel the whole scheme is patronising at the very least. It would be much better for all teachers to be better educated about mental health issues as part of a national or even global campaign to reduce ignorance and stigma, and to start treating those with mental illness as ordinary people living with extraordinary illnesses, rather than continuing prejudice by treating them as something subhuman under the guise of being politically correct.

Still, it ticks all the right boxes so that they can receive their government funding.

Thank you to Mr Ian for providing this link for Mental Health First Aid.


Vicky Pollard said...

Having special classes for the mentally interesting surely flies in the face of all recent policy and thinking in mental health care. I thought it was all about people accessing mainstream education, training and employment, not being segregated off into their own special little rooms with their special little teacher to do "therapeutic" things?

Mr Mans Wife said...

Hmm... maybe the education service is a tad behind the times in our area Vicky?

I'd like this woman to ring me so that I can get some clarification, but I suspect they feel that they couldn't possibly learn anything from a complete nobody like me.

Anonymous said...

it would seem MMW that in an attempt not to appear ignorant of mental illness, they are being very ignorant. Do they think that people living with a mental illness want to make papier mache plantpots all day?
what a load of old snot. i am not a fan.

Polar Bear said...

Yes, i think such a scheme is very patronizing to the mentally ill.

It's very disheartening to think that some people still are so narrow minded.

Anonymous said...

I was first admitted to a psych unit in the end of my third week I was asked to go to OT where to my horror I was actually asked to make baskets out of raffia! Since then I have made baskets, painted candle holders, made splotchy paper, stained glass window things (plastic, not allowed glass) and have learnt to relax by lying on the floor in a room full of lights.....glad the degree came in useful then! Patronising...mental health professionals...surely not!

Mr Ian said...

I laughed. Sorry.
But if not I'd have surely cried.

In-hospital OT has been the standing joke of the service for many years. In 1995 I am not at all surprised - but things should have developed significantly now that OT (who historically have dealt with 'functioning' and focussed on physical ability) support and offer interventions in psychosocial techniques more and more nowadays.

If educational establishments are offering macrame - it's a start (yes it's a crap one - in this day you'd think they'd be reading stuff that wasn't written in the 70's) but, from such a turnip of a base, we can predict the outcome will be an improvement on service!
It sounds like a new venture and so it usually attracts those who are keen to set out their own philosophies and practices - sticking to things they're safe doing without really knowing why.

In a few years to come there will be a network of school-based mental health workers - followed by other educational establishments - and possibly a whole of government sub-department... targets... reviews... forums...

But at least it's on the agenda!

Anonymous said...

Ah you laugh Mr Ian but I forgot to tell you about the time an OT took me to the kitchen to show me how to make tablet (fudgey stuff) and then wouldn't let me stir it lest I use it to "harm" myself. Now I've been pretty low at times but I honestly never thought to leave this earth by flinging myself in a pot of hot sugar and condensed milk.

Mr Mans Wife said...

I agree Margery, it seems that they are trying too hard without educating themselves first. I wonder how many people will enrol? Thanks for commenting Margery.


I agree with your comment also, Polar Bear. The trouble is, the information is there for people to educate themselves about mental health, but only those who want it will take advantage of it. But it’s those who are most narrow minded who need to be educated, and they don’t realise it. Mental health education should compulsory in the form of first aid at least, as Mr Ian suggested previously. Thanks for your comment Polar Bear.


Anonymous, your experience is like something out of “One flew over the cuckoos nest”!! As Mr Ian has confirmed, I like to think that things have improved in the last 13 years on psychiatric wards, but relaxation and crafts are still emphasised on the ward – Mr Man has drawn pictures for me, made a mug for me, a card, a key ring, that sort of thing. I would never suggest that it is acceptable to treat individuals on the ward as simpletons, but to a large extent I would say that those on the ward are in an acute stage of their illness and often heavily medicated, so engaging in crafts is a way of providing activity for those who may not be able to think clearly. However, crafts aren’t everyone’s idea of a relaxing activity. Maybe they could actually ask patients what they want to do? Do you think anyone has ever thought of that? Thanks for your valuable comments Anonymous.


Mr Ian I hope you’re right and that this is the start of something better. But why are they always so flamin’ slow about these things? Honestly, you’d think we were living in the dark ages. Thanks for commenting Mr Ian.

Anonymous said...

Absolutely, when first approached by OT dept I was often reluctant but sometimes I did get kind of lost in what I was doing which was soothing but I think it is that all pervading feeling of being patronised that sits with me. In more recent times there has been more emphasis on exercise and rather more practical aspects of pulling out of a planning, going to the shops, even, in my case, practising communicating again. I just can't let go of the feeling of being "little" or somehow "less" in this alien environment that you find yourself in in hospital. I sometimes felt that somehow I was trying to please them.

Mr Mans Wife said...

Anonymous, that is exactly how Mr Man felt - that he was doing as he was told just to please the staff. He felt that if he didn't do what was expected of him they would accuse him of not trying hard enough to help himself, and yet when he joined in they told him "you can't feel that unwell because you join in with the activities"! He couldn't win!

I think the feeling of being "little" perhaps has more to do with staff attitudes rather than the activities you are asked to engage in. People underestimate how perceptive those with mental illness can be in picking up on other peoples feelings and attitudes towards them, and in many cases I think the attitude of staff is poor. No wonder the rest of society struggle to understand mental illness when those who work in mental health have a poor attitude themselves! I wrote about this previously here.

Mr Ian said...

I honestly never thought to leave this earth by flinging myself in a pot of hot sugar and condensed milk.
You're not manic depressive then? - as they have the greatest creative minds and would have several variations on this.
Incidentally, that tongue in cheek comment reminds me of attending a conference with the rather liberal minded and non-patronising Professor Thomas Szasz back in the day and a lady with self confessed bipolar gave a rather elaborate question on how MH professionals are so biased "because they view things from a 'normal' perspective and do not appreciate the influences of the disorder on the mind and how thinking is actually quite normal but the stuff in and out is not quite right and when it's not that bad it's different to how it really is but no one realises and people should remember that."
To which Szasz paused and politely said "I'm sorry lady but I'm not following your full question"
To which she replied without a pause:
"That's the trouble with you normal people is you think only on one level and far too slowly".

But why are they always so flamin’ slow about these things? Beats me. I'm one of those - do it now cos we're not stupid - and tweak it later.
A noble mentor of mine (he was a crap pt-psychiatrist but a good knowledge and experience source so I learned positive and negative things from him!) once told me, when discussing how to respond to people in counselling when you're stuck what to say and there were those long uncomfortable pauses (not the therapeutic pause but the one that showed you were clueless and lost). He recalled his psychoanalysis mentor's comment, which I think would do as well to apply to the model of change that frustrates us all:
Say there are 10 given options
One will be fantastic and absolutely the best.
Equally one will be the worst possible thing.
In between will still be 8 other options that do no harm but could be better.
Avoiding the bottom one should be easy unless you're a total idiot. Aim for any other and hope for the top one.
Service planning could well do with adopting the same model and stop trying to be "the best option" from the off, which it never is, while taking forever in silence to think about the plan. So what if it's only as good as option #2 - option #2 live is far better than option #10 still in the pipeline.

Anonymous said...

YS11 here. Yuck, where's the light at the end of this particular long, slimy, windy tunnel?

General awareness...I taught young adults for years, so I had opportunities to discuss mental health with them, and I particularly wanted them to think about schizophrenia, since they and all their mates were at the age when diagnosis is first made. By and large, they didn't want to know. Proud of their own academic success and the intellectual superiority that implied, they seemed to think that even thinking about illnesses that affected reasoning might be "catching." At best, a kind of "we try to be kind, but THEY are not like US" response. Aaargh.

Then the kids who trail along to our relative's workplace to gain brownie points or even course credit. They usually do nothing to participate, and they have so little experience of mental illness or contact with people who are open about mental illness that all they can do is stand and gape. I suppose gaping is a form of self-education...

And as for art courses for the mentally ill!!! Since I'm not on the receiving end, I suppose I shouldn't comment, but it seems that the channeling of "special education" services into arts is a like a flashing sign that says "We have no respect for the arts, and none for mental illness either." I DO know a young person with some learning difficulties (not mental illness, more like developmental difficulties) who has a freedom in visual arts that she doesn't have in other areas. But she doesn't need raffia-work, she needs to learn professional level skills, just a bit slower.

And then there's our relative - his concentration and academic learning started to slide in high school, and people kept consoling him by saying "Oh, you must be the artistic type." I really feel like crying when I hear that he's started an arts course - he has so little insight anyway, and then he gets people who don't know anything about art, music, or computers "teaching" him and telling him he's a genius, before he's even "done" anything. These "teachers" are not the ones who have to mop up after misguided phone calls to well-known professional artists or recording studios (not talking about the quality of music etc produced here, there *is* no music to be auditioned...), or the decimation of relative's tiny savings by spending up large on "professional" courses and equipment that he's unable to use. Of course, some educational service-providers take advantage of his lack of insight, but others are just too confused and unaware of his needs to be able to say "I can't teach you." Our relative regularly tells me that he has "mastered" this language or that complex field of knowledge by sitting next to somebody who knows about it, etc. His insight comes and goes, but he's driven by a desire to be praised for superior achievement (family history there rather than illness) rather than by a clear idea of what he wants to do, and what he needs to learn in order to do it. Another friend with a schizophrenic relative about as sick as our relative says the same thing - it's as if "Be famous lawyer" and "Wear sharp-looking suit" are exactly the same thing, and you can get to the cause by assuming the effect. Yet neither of them are really, really sick as far as schizophrenia goes - especially, they don't have really bad negative symptoms.

I know people say that mental illness can bring gains in creativity, but that hasn't been what I've seen with our relative. I feel that it might be more true for creative people who were already making use of creative thinking and creative skills before they got ill.

Our relative probably does need somebody who understands mental illness to teach him, and he couldn't manage in a mainstream class unless it was pretty self-paced. Typically, he fronts up to a local piano teacher and asks for lessons - he tells her (usually "her"!) what he can already do, but it's apparent that he actually can't do that. Teacher believes him at first, but becomes more and more confused at the lack of progress. The lack of progress in practical skills makes him feel that he would be "better" at composing rather than playing music, and of course, the more abstract his goals become, the harder it is for people he talks to ABOUT his goals to figure out what he actually can do or could learn.

Until his employer went bankrupt, he had a complex and responsible, but utterly predictable job. He can mostly use the skills he had before his illness became severe, and he can learn new skills, but has trouble even with decisions which are so simple that most people are not aware they are making them - so jobs that are usually regarded as absolute lower-end may involve too much decision-making and abstract thinking for him, while he can actually do a more narrowly specialised job slowly but well.

Anonymous said...

>>I sometimes felt that somehow I was trying to please them.<<

Anonymous' comment makes the point that "classes" tend to replicate the staff-patient power structure.

Maybe there could be more classes where patients teach THEIR skills?

-YS11 (sorry for long rant above...)

Anonymous said...

I have been in a four+ year relationship with a "schizophrenic" male and I have come to question the term schizophrenia and the whole of psychiatry in general. To me the problem is a matter of very low stress tolerance and excitability leading to lack of quality sleep. My boyfriend used to be on Risperdal 4mg for over 10 years Risperdal Consta 50mg for the last two in addition to 600mg of Seroquel. He has successfully gotten down to only 50mg of Seroquel only for sleep. I think the traits that were most useful in achieving this was his willingness to cooperate with me on establishing a regular sleeping schedule and eating a healthy wholesome diet (includes a lot of healthy fats like fish oil) that keeps his blood sugar stable. My boyfriend still has maladaptive responses to life's uncertainties and problems which can only be overcome with time, stable home environment, the support of a stable consistent partner or someone and wisdom that comes with maturity and experience. There is also a need to encourage independence and not dependency fueled by a mental illness label. I would say antipsychotic drugs are okay in situations of acute psychosis but detrimental over the long term. I am really delighted with my boyfriend's progress. This is not to say that this would apply to everyone. There are some who have feelings and desires that are not functional or acceptable to society which cause mental anguish. Also from a larger picture the world and life itself can be very difficult to deal with if one does not carry some illusions.

Mr Mans Wife said...

"So what if it's only as good as option #2 - option #2 live is far better than option #10 still in the pipeline"

Thank you for your comments Mr Ian. I happen to think it is as good as a number two, but probably in a different way to how you're thinking :)


YS11, thank you for your interesting comments. No need to apologise for the "long rant"! I do believe you even out-typed our friend Mr Ian! :)

That is so frustrating that even when people have the opportunity to be educated about mental illness, stigma stops them from really listening. I'd really love Mr Man to stand up one day and say "I have Schizophrenia" to all those people who think they know him so well and yet have no idea - real proof that people with mental illness are just like everyone else.

The arts is a funny one - on one hand many people with mental illness are very creative, but on the other hand the opportunity shouldn't be handed to them in a patronising manner. Art can be as challenging as any academic subject, so why are "art" courses offered and not academic ones? As you say, it shows a lack of respect for the arts and for those with mental illness. Art can be therapeutic for some, but maybe car mechanics is therapeutic for someone else?

Your experience with your relative just shows how everyone is different - Mr Man has never believed that he is capable of something he is not, but he has suffered very badly with negative symptoms.

I totally agree that patients should be able to teach their own skills. Now that is a great way to build self esteem, and you know, even when Mr Man was very ill on the ward, he seemed to come to life when anyone asked him a computer related question. A very good point YS11. Thank you for your comments.

piebuko said...

Every time, I come across any news with headlines like this, "Schizophrenic raped and hacked woman to death"
I frowned at the blazing word - Schizophrenic.
And I would wonder what you would say about that.

Anonymous said...

I think human beings are in love with labels. Sweeping everyone who has an episode of psychosis and with the trauma that follows it under the label of schizophrenic is pretty harsh and hopeless. Believe me I am not someone who is ashamed of being called schizophrenic or mentally ill. I am just in the unique position of having lead an independent life, that is, had a full time job, until I decided to have a relationship with a "schizophrenic" and eventually lost my job and became labeled as a schizophrenic myself. As most things in life can be boiled down to survival, I would say schizophrenia almost certainly has something to due with low stress tolerance, maladaptive responses to stress and life's uncertainties and problems, poor health habits leading to a total disruption of the sleep wake cycle. I think the best way to describe this is dreaming while awake. So called normal people have odd dreams in their sleep. So called schizophrenics have very poor sleep habits due to a variety of reasons leading to chronic insomnia and therefore becoming highly susceptible to the brain trying to resolve internal conflicts while awake instead of asleep through the dreaming process.

Mr Mans Wife said...

Anonymous, thank you for sharing your view point. I agree, we live in a world where labels are thrown at people far too easily, and I’m sorry if you feel that you and your boyfriend have been wrongly diagnosed.

I’m sure there are many causes of psychosis, and yes, lack of sleep can case hallucinations. I’m glad that you feel you have discovered the cause of these problems in your boyfriend’s case, and have been able to stabilise his condition through diet and adequate sleep. However, as you so rightly said, this would not apply to everyone. For most people diagnosed with Schizophrenia, psychosis is constant rather than being experienced in episodes. The diagnosis in itself is not what robs people of their independence, but the symptoms which they suffer, which are chronically acute and require medication. In Mr Mans case the correct medication has enabled him to regain some of his independence.

It’s interesting that you mention very low stress tolerance and a disrupted sleep pattern as a cause – I suffer from both of these and yet I do not suffer from psychosis. The theory of dreaming whilst awake is one that has been discussed previously in the comments section, and whilst quite possible it is unlikely that this is caused solely from lack of sleep – on the contrary, many people with Schizophrenia suffer from what is known as “negative symptoms” which can cause excessive sleep. There is still so much about the human brain that we do not understand, and we may never fully understand why some people suffer from psychosis. Although not ideal, medication is essential for many people. Of course, a healthy diet and regular sleep is essential for everyone.

Thank you for commenting.


Hi Piebuko, thanks for stopping by.

Yes, I am irritated and even angered by such headlines because I feel the diagnosis of the person is irrelevant to the crime they have committed, although in some rare cases the symptoms can cause a person to become violent either due to fear or delusional beliefs. (violence and schizophrenia is discussed more here) But no other illness or condition is portrayed in such a bad light by the media. If the headline read "Downs syndrome person rapes and kills" there would be an uproar.

Thanks for your comment Piebuko.

Anonymous said...

With regard to negative symptoms, I see them as symptoms of a bad reaction to the human condition. What do you do when you try to find your place in the world or even in your own family and you just face person after person who is motivated by power, money, sex, jealousy, need for possession, need for control with little regard to how their actions affect others or the earth and when everything is just so competitive? If you carefully examine the motives of so-called successful people and do not like them what should you do? In my case, I lost all motivation, withdrew and just slept a lot to pass the time. I think this is why schizophrenia outcomes are better in third world countries where things are less complex and more down to earth and family oriented. And I think that statistics show less schizophrenia in rural areas.
I also had one major relapse and several smaller ones after going off medication for my first psychotic episode. While I strongly believe that symptoms can be alleviated by proper social structure and healthy habits, I know there are some people who have something structurally, I mean biologically, wrong with their brain. Not to offend anyone but I mean more in line with conditions like epilepsy.

Anonymous said...

Btw, it is just not disruptive sleep patterns and low stress tolerance that I had before my psychotic episode but I experienced a traumatic event too.

Mr Mans Wife said...

Anonymous, I think most readers here would agree with you that many people who suffer from mental illness have a biological difference in the brain, so no offence taken there.

You seem to have overcome your problems very well and you are sure in your own mind as to the causes and how to manage your symptoms. I'm very happy for you that you have been able to do that. However, mental illness is not a "one size fits all" problem. Mr Man, and many others who comment on this blog suffer from serious mental health problems which have been difficult and complicated to treat. For these ones, negative symptoms are not merely a reaction to the competitive attitude in this world. They are real symptoms to a serious mental health condition, probably caused by the biological difference in the brain which you refer to.

As for third world countries having less mental illness -
a) are there really the facilities for people to be diagnosed?
b) when people in third world countries hear voices it is believed that they are being contacted by the spirit world, so do they even recognise mental illness?
and c) how well are cases of mental illness reported when villagers go to their local witch doctor for treatment?