Isolation - surviving on the desert island

'No Man is an island' the words of John Donne have never been more starkly in focus than during the current worldwide battle against a common invisible enemy. A virus has shown up the lies that tell us that we can be divided into different groups, that there is such an entity as 'them' and 'us'. An organism designed to attack human beings is currently ravaging every nation, every race, every creed, every age group, every shape, shade and form of humanity across the world.

I have often thought on and off about ideas of loneliness, isolation and solitude and the different qualities that each can bring to our experience.

At this very moment we are following government instructions to distance ourselves and to avoid social contact outside our homes. In reality we have been forced to put physical walls around behaviours which we have fallen into and which have always forced us into a kind of social distancing before we had a name for it. We have been forced in concrete terms to live out the reality of what impact dividing ourselves from the wider community and world outside our homes can have on us as human beings.

In thinking about what isolation and loneliness can mean to us as human beings I have found that it is helpful to have before me the complete sonnet from which the famous quote comes:

No Man is an island
Entire of itself,
Every man is a piece of the continent
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were as well as if a manor
Of thy friend's or thine own were:
Any man's death diminishes me,
Because I am involved in mankind.
And therefore never send to know
For whom the bell tolls,
It tolls for thee.

Nowhere is the fragmentation and division within our communities more evident than in our collective response to death. Death and grieving has increasingly become private and individual. One of the most visible impacts of the current outbreak within Northern Ireland was a realisation that traditionally, we as a people, were out of step with much of the UK as we continue to grieve as a community. Families reported the difficulties of facing death without our cultural gathering together not only in emotional and spiritual support, but also in the very practical provision of sustenance to the bereaved. In a sense, the culture I belong to has come face to face with the isolation felt when death comes to call and it is not felt as a wider community.

This pandemic in contrast to our modern response to death has been to reinforce Donne's words, 'Any man's death diminishes me'. If anything, in the regular displays of support for the NHS and the bringing of help by neighbours and community groups is bringing us back to the idea of shared grief, for the first time since WWII. There is a natural desire to care communally which has been stifled by the way we have developed our modern way of living.

We have been living in a fractured world, separated and isolated into political, cultural and religious ghettos. Never more so than in the last five years or so. The danger in this is in believing that I or we don't need anyone else. However, community is not just a good idea but is bound up in our very nature. I am made for connection and my humanity is somehow wounded when I fail to acknowledge this.

Death in reality is the great leveller. It is the one experience that every single one of us will face, young or old, rich or poor, educated or uneducated. It is also the one life experience through which we see starkly our shared humanity. Suddenly in the face of death we are faced with a sense of something sacred about human life, something which day in, day out, in normal times we are able to ignore.

The core issue with loneliness and isolation is that both of these states result from a lack of connection. As we socially distance we are challenged by the fact that it may not be the physical proximity of others that influences how lonely we feel. We all know the moments when we experience being 'lonely in a crowd'. I live alone, so it is not an effort for me to 'socially distance', physically it is easy for me to be on my own, isolated or lonely. Yet in this period of isolation I am feeling more connected to my family and friends than usual. This crisis is enabling people to strip away the masks of social niceties and busyness which means that interactions can be deeper. It's a waste of a video call to reply 'fine' to the question 'how are you doing?' We can see it as being an opportunity to share a uniquely common experience, to share how it has affected us and our families, to share how we feel about it. In short I am finding that this situation is creating time for us to be honest with ourselves and our loved ones. And our relationships are feeling deeper and more connected as a result. Or is that just me?

In offering some steps to take I think the most helpful thing I can do is share with you the gift of solitude. It is different from isolation and loneliness, in that it provides a uniquely spiritual time to reflect and be honest with myself, so that I can more effectively reconnect with those I love once I have come out of solitude:

'Solitude is the furnace of transformation, without it we remain victims of our society and continue to be entangled in the illusions of the false self. Solitude is the place of the great struggle and the great encounter, the struggle against the the compulsion of the false self, and the encounter with loving God who offers himself as the substance of the new self' (Henri Nouwen, The Way of the Heart)

This reflection from Henri Nouwen clearly focuses on a Christian perspective where solitude allows him to connect with his God. When we begin to reconnect following isolation caused sometimes by mental illness, or physical illness, periods of time when we need to regroup before engaging again with the society around us, it is important that we establish from whence our hope and meaning come. For me, as I have often said in this blog I find it in my personal faith in God. For others it may be other 'higher powers', but this is a starting point.

When we seek to connect or reconnect in a meaningful way with those around us, I have found another Rule of Living helpful to encourage me to connect honestly, it comes from the Northumbria Community and is encompassed in two words: Vulnerability and Availability.

In the coming together of communities at this time I have witnessed both vulnerability: NHS staff willing to risk their lives on the frontline, neighbours helping the elderly out in their neighbourhoods despite having to go outside their own cocoons. Availability means breaking out of our walls and making ourselves available by being authentic and offering to share our real selves with those with whom we come into contact. When you are facing an mortal enemy, the social fears and anxieties pale beside them. I can only relearn trust if I am willing to be both vulnerable to disappointment, or rejection and if I am willing to break my own sense of reticence to engage with people and make connections as much as a I can.

Ultimately, because I have a shared humanity and 'because I am involved in mankind, any man's death diminishes me'. However, when I recognise our shared humanity and join with others to address sometimes boring, practical issues together, sometimes saving actual lives, then I am most profoundly connected not only with the people around me, but with the wider world and creation of which I am an intrinsic and valuable part.

Intricate and inextricable knots

'O time, thou must untangle this, not I.
It is too hard a knot for me to untie!'
Twelfth Night - act II sc ii

I am not just a collection of interconnecting muscles, nerves, blood vessels and bone. On its own my body is a miracle of complex engineering, but within this body there are many complex chemical and electrical interactions and reactions all with different functions - perhaps I could see these as the fuel and lubricant which ensures the machinery keeps working effectively - there are hormones which determine my readiness for creating children, my moods, my appetite. Then there is the product of my mind, my thoughts, the core of who I am. This is indefinable in purely physical or chemical terms, although some argue that even the most complex of human interactions are just the result of biochemistry, I tend towards believing that there is something intangible, the essence of who I am, which I call the Human Spirit, or soul, so there is a spiritual side to consider.

When I consider all three aspects of who I am I recognise that there is no part of me that does not impact on the others. So when I fall over in the street, which I did recently, it is not just my hand which is hurt. That, it has to be said was the first part of me to connect with the shock of hitting the ground. In short succession, physical pain, was followed by a wave of grief - I wanted to cry. Then I caught sight of the shocked faces looking out of the bus window as it passed. Grief was replaced by embarrassment and then shame. Then my personality came to the fore as a kind passerby offered some help and I waved her away and too quickly got to my feet. The blood in my circulatory system was unable to keep up with what I, as me, wanted to do, so I nearly collapsed again, the physical working in opposition to my spirit. You get the idea - if anyone had asked me what part of me was hurting I could answer, honestly; my hand, my shoulder, my ribs, my knees, my pride, my sense of independence, my self confidence, my conscience (guilt for refusing a helping hand). Had I been taken for medical treatment only those parts of me which were evidently hurt would have been treated.

Too often we experience health services which treat only one aspect of our person. So we treat the 'flu, but neglect the emotional impact of feeling drained physically. The plaster cast, sets the bones and supports physical healing, but the emotional cost of a physical trauma is neglected until it becomes unavoidable.

I have been thinking about this silo approach to well being recently in regard to mental health and disability. Too often services and benefits tend to separate physical disability from mental illness or emotional challenges. This is why so many disability assessments have been running into difficulties and result in so many appeals which are overturned nearly 70% of the time. The reality is that 'seen' difficulties are the most easily identified and therefore treated or managed. It does not require a hard pressed NHS service to take time to investigate or have to spend time on treatment when presented with bruises or broken bones. When presented with emotional or mental distress, time is required as well as to change the approach from 'What is wrong with you?' to 'What is causing so much distress?'. The first question allows the professional to decide how to fix the problem, the second question opens up the need for a more long term intervention. Often Mental Health interventions are time limited when mental health issues require time and relationship, something that a six week hourly intervention cannot offer.

The thing is if you can help me to manage my emotional and mental responses to the physical pain or trauma I have experienced it is more likely that the physical therapies and interventions are likely to help me recover from or manage my physical challenges. Equally if you can help me address the physical causes of my exhaustion then I am more likely to be able to manage feelings of depression and anxiety.

I have been reflecting on my own recovery in these terms and recognising that persevering with looking after my physical health will help me to continue to manage my mental health. It is common sense, it also makes financial sense when applied to a resource-and-time-poor NHS. Yet I have to piece my recovery plan together from different silo'd teams under my own initiative. I am effectively the wellness hub for my own recovery.

When I worked within criminal justice I was privileged to be part of an multi-disciplinary team made up of police, nhs, probation and charities staff each working with individuals to address the complex factors which were stopping them from reforming and ending their offending careers. As long as an individual undertook to manage their own offending behaviour, our team would provide a range of support to help them with housing, employment, substance misuse, education etc. It was effective and when the people we were targeting were responsible for 80% of local car, thefts and burglaries was arguably an excellent investment. Even with the costs involved it was still cheaper than prison for most of the people we worked with.

What do I learn from this when applied to health? Well first there was a concept of 'end to end management' from the point of arrest to the point of end of sentence. Our team picked people up and worked with them through court, into prison, out of prison and to the end of licence or community sentence. If they re-offended they came back to the same team to begin again.

What if health and social care teams in hospitals and the community were integrated and worked in the same place? What if every person who has undergone significant surgery, or who is managing a significant physical disability has access to evidence based mental health well being practices as part of their recovery? What if mental health was seen as part and parcel of recovery from significant physical illness? What if we stopped separating off mental health units from the rest of the hospital except for those requiring the most intensive mental health support? What if we actually practised our interventions on both physical and mental health as if there were parity of esteem? What then?

Do Staff need to be Taught Compassion?

Sometimes I need time for blog posts to 'percolate'. The reasons vary, from me recognising that I need to consider the possible impact of what I am putting out there on others, to needing time to formulate my thoughts and feelings on a subject. I wanted to write about compassion in Mental Health settings since an incident before Christmas, but hesitated because my initial response was purely an emotional response to the distress of a friend. Before putting my thoughts in the public domain I needed to allow time and perspective before putting my thoughts down in black and white.

My friend is a diagnosed Schizophrenic who battles against his labels and the medicalisation of him as a person, who is more than his often disputed diagnosis. A few weeks before Christmas he suffered a major 'meltdown' - in his words. The first I knew of it was when he phoned me from the ward and asked me to visit him. This article could deal with the ongoing battles he has with his mental health team regarding his view of his auditory and other hallucinations or of his need for ongoing medication, but more than that I needed to highlight the lack of compassion he told me about on his admission to the PICU.

Over a period of some time he had been struggling with the increasing belief that he was a psychopath and therefore a major threat to those around him. He was terrified because he was convinced by these beliefs. Instead of understanding how terrifying these beliefs must be to him and the fears that they created in him about the threat he posed to those around him, some staff started to tease him, laughing about him being a 'serial killer' and even using the term 'path' when talking to him. 'Alright, path', 'harmed anyone recently, path?'.

It is a single individual incident involving one person that I know. What has concerned me most is the basic lack of human understanding and compassion for an individual clearly in distress and need. By definition, to be admitted to inpatient care in this day and age, indicates that by all clinical standards, this person is in urgent need of help. In the world outside I would expect the usual level of ignorance about mental health in general and Schizophrenia in particular, but inside a specialist Mental Health unit, surely even a modicum of professional pride and self respect dictates a better response than taunting a mentally ill man?

I try to be balanced in my consideration of such troubling incidents. I have tried to find reasons for members of staff responding in this way:

1) Stress and pressure - under-staffing, ongoing constant change and cutbacks, bring a weariness and cynicism, probably unthinkable in the early days of most of these staffs' careers?
2) Lack of adequate training about the symptoms and perceptions of Mentally Ill people who are in crisis?

Unfortunately, neither of these reasons adequately provides any acceptable rationale for the appalling lack of empathy and understanding displayed. I know in my twitter feed I can be political in my responses to the current state of the NHS, but I do believe that there is an ideological and moral battle going on for all of our public services. When patients, services users and others in need, stop being people and become units and target statistics, then the raison d'etre of our social care and health services is under severe threat.

If a person ceases to be a person, but becomes an obstacle to completing paperwork, or sitting in an office 'getting through a shift', it stands to reason that it is only a small step to not being able to see why you should 'waste' any human compassion on 'them'. And there it is: 'Them' and 'us'. There has been a rhetoric in public life which has separated us into 'camps' of rival 'tribes' of the 'deserving' and 'undeserving'. We are not in this together - or at least that has been the effect of much of the discussion in public around Benefits and other cuts to services. So the ironic comment that 'my job would be ok if it weren't for the people I work with.', ends up being a default which in turn

informs our actions towards 'those' people.

What most of the political rhetoric forgets is that for most staff in public services; NHS, Education, Criminal Justice, they did not enter a 'career path' or to seek 'progression', but most felt a vocation. Vocation cannot be conjured up, nor can its root motive, compassion, be taught or trained. I may attend any number of Mental Health Awareness training events, with input from service user perspectives, but if I fail to see the people I work with as worthy of compassion, then there is no magic bullet which will allow me to tick this off in my professional development portfolio.

Pity cries and walks away, it looks down on those in need. Compassion enters into the experience of the person in need and seeks to understand its causes and, in time, the actions which can be taken together to meet that need.

Don't get me wrong, compassion in public services costs those for whom it is the primary motivation. I would argue that the heart of compassion in many staff is why the NHS is the envy of the world. Day in and day out, committed, compassionate staff come along side the vulnerable and most hurting people in our society. This kind of response to need cannot be trained or imitated. You know it when you see it. I know when staff working with me are seeking to understand the roots of my distress. I know when staff are motivated by more than a pay packet or are just going through the motions. I know when someone, despite the limits of the system, sticks with me until, together, we find a way through to recovery.

I have been on both sides of public service and I know that when I meet staff who recognise our shared humanity, then there is a strong foundation on which therapy and medication can be built. Rather than mock the beliefs of someone in the throes of psychosis, humanity asks, 'What would I want someone to do if it was me?' Relationship depends on trust, therapeutic relationships begin with a compassionate assessment of another human being and their needs - some of them shared by all people, even me. If you view the people you work with as 'them' rather than 'us', maybe it's time for a change of career, or a holiday?

Middle Class, Middle Aged, but I have no voice...

I write letters and emails. Not just any letters and emails - I write to the Prime Minister, to MPs, to newspapers. Well I think I've done things back to front. I remember a teacher telling me in the 1980s that he thought we were the 'me' generation. We were 'Thatcher's Children' content with things as long as we had good prospects and expectation of a better lifestyle than our parents. Maybe we were apathetic, maybe it was just youth, but I didn't engage with politics outside of my duty to vote - oh yes, we did that. Beyond that I'm not sure that I was very radical at all for a young person.

Now I realise that I have strongly held views about the nature of society I want to be part of. It shames me that the current crop of 'leaders' are 'my age', 'my people'...except not a one of them represents me. I'm a middle aged, middle class woman and I don't feel I have a voice in parliament - what on earth does that say about our democracy?

So, I write letters. I am continuing a family tradition as I follow in the footsteps of my great Uncle Billy - or the 'Bold Horatio' as was his name in our family. He was a GP in Durham and wrote copiously to Mrs Thatcher, Mr Kinnock, The Times, anyone with influence. He had a collection of responses to be proud of, considered responses which showed that his point of view had been registered by an individual, rather than as part of some machinery of 'managing the message'. I waited for four months for a response from the Ministry of Justice only to be fobbed off with a regurgitated press release, rather than engage with any of the evidence based points I had made regarding the privatising of Probation. In fact, as I recall the letter from the PM's office had assured me, three months previously that my letter had been sent by them to the MOJ for a considered response.

My 'roar' of protest used to be a 'tut' followed by an eye roll. Now I've got my gander up and I have nothing to lose, so speak up I shall! Like the 'bold Horatio' I shall make a nuisance of myself and ask, if someone like me feels as if I am unheard, how on earth do others in society feel? And where did real leadership go? Is it just my age that makes me feel that they don't make MPs the way they used to? Where are the characters? Where are the politicians who have convictions and ideals? There is no colour, no nuance, no intelligence in political debate and that I think is not just a sign of me being a grumpy old woman, but is a sad reflection of the current state of our democracy.

It has been with surprise that I have found my voice, realising that it feels as if I am some sort of radical. The thing is I am fighting to keep well established parts of our welfare state - the NHS, a publicly owned and accountable Criminal Justice System, with a core belief in investing in people's capacity to change. It is frustrating to find that my battle is with a morally vacuous, intellectually bankrupt ruling class that is incapable of engaging in sustained debate. Instead, for years now, we have been fobbed off by some kind of unholy alliance between government and media.

So I will continue to write my letters and emails, in the hope that there may be someone in government today who actually knows the ideals that their policies represent. I am certain of my ideals, they have formed the backbone of this country since the end of the last war - how come I'm the radical? When did a compassionate society become too expensive? How did we end up being led by a bunch of public schoolboys masquerading as politicians? What real alternatives do we have?

Can we Afford to lose our Compassion?

I was bent nearly double as I tried to make my body fit the small opening made for me by a police colleague in the broken down door of a derelict pub. The stench of human detritus slammed into me like a wall as I inched forward into the blackness beyond. All of a sudden, a wave of nausea swept over me as I reacted to first the smells and, then the sight of the evidence of human degradation all around me.

“Breathe through your mouth” my colleague advised me and soon I became accustomed to my surroundings.

We were looking for a vulnerable young man, one of my ‘cases’. We were concerned for his welfare. He was a proficient petty thief, heroin user and someone many considered to be on the human scrapheap at the age of nineteen. We didn’t find him, in that den, one of his favourite hangouts, just soiled mattresses, empty junk food wrappers and the tell-tale signs of recent drug use.

We moved in silence wandering from one darkened room to another. Then, as my colleague and I scrambled our way back out into the winter’s gloom, the daylight hit me like the brightest noonday sun. Such darkness and filth as it would have been difficult to imagine. Yet Matt and countless others inhabit this netherworld in every one of our towns and cities. It has become all that they know and all that they think they are worth.

On the way back to the office I pondered what had been lost from his young life. He had been a promising footballer at the age of 11, and among the foul mouthed cynicism of prisons and drug dens he maintained an air of respect for others. He was devoted to his mother, who, at the age of 40, had met the ‘wrong man’ who introduced Heroin to their home. First he introduced her, then he introduced her son, to the great emotional blanket that enveloped both their lives – stole all that they had, and then left. Nice.

If I were to meet Matt in the street with his ‘chav’ uniform of joggers, hoody and battered hi-tops, what would I feel – would it be compassion or contempt? Would I be prepared to scratch beneath the surface?
He remains for me, one for whom I have a ‘soft spot’ simply because I could see his potential beyond the ravages of his drug of choice. My concern is that in the current climate where government ministers brief about ‘strivers’ and ‘skivers’ there is no room for us to invest anything of value or meaning into a life like Matt’s.

At the time I was working with him (before Cameron and Osborne began dismantling the welfare society) we offered him a place on an intensive multi-agency programme (comprising Probation Service, NHS, Police and Drug Charity staff members) whose main aim was to find ways to divert this prolific offender away from his need for drugs and to provide a pathway and the means to fulfil his potential.

The funding for such schemes – which targeted the 5% of criminals locally who committed 50% of acquisitive crime? Gone – replaced by ‘payment by results’ contracts with private companies such as Serco and G4S. Although, we had a proven record of significantly reducing re-offending rates. There was a cost, in time: average time on the programme, three years; in resources: each local team committed a full time member of staff to the core team of four (the police committed two neighbourhood police officers), we had a budget for ‘rewards’ such as interview suits, work boots and, on one occasion, Artists’ materials.

The concept of a Society in which all children regardless of birth would have the same access to Health, Education and Shelter was born out of the deprivations of World War. The politicians of the day were determined that the orphans, widows and wounded of our nation would not be neglected. There is an economic argument for cutting back on where resources are allocated. From what I can observe of the current round of ‘austerity’ this seems to be focused not on ideology with humanity at its heart, but on profit and loss as solely measured in monetary terms. The problem for the current government is that societal change relies on a desire to bring all members up to the same level of value. No one member of society is ‘worth’ any more than another.

I contribute as I am able and if that is more than my neighbour is capable of giving, then please share my over capacity with them…. Idealistic? Maybe, but the likes of Clement Attlee didn’t think so, and it did work in its very British way for so long.
Surely, there is enough inventiveness in this country to find a way to balance the books whilst maintaining a compassionate society with the ideals of education, health and welfare for all people regardless of background, upbringing or beliefs?