'Stop Being so Silly' Said the A&E Consultant

TRIGGER WARNING: This blog describes a distressing incident and discusses suicidal feelings and feelings of frustration and helplessness.If you are affected by discussion of these subjects, don't read on

It was early on a Sunday Morning during the Queen's Jubilee Bank Holiday weekend. I had implemented my Crisis Plan following a week of sleepless nights and five days of constant vomiting, which gave way to dry retching. I was not physically ill, but vomiting spasms were one of my most obvious symptoms, during periods of emotional distress.

I was feeling suicidal and needed help - desperately. I phoned the Crisis Team, as per my Plan and after ten minutes was instructed to attend the local A&E and ask to see a member of the Team as they were on site in my local hospital. So, I did as instructed and reported to the A&E reception, where the Receptionist was helpful and clear that I had already spoken to the team and had been told to report to them. So far so good. Thankfully, for a holiday weekend at 4.00 a.m. the unit was relatively quiet, just three others along with me in the waiting room.

The Triage Nurse, again was efficient and reassuring, I had continued to retch violently and had soiled and wet myself by this stage and so was in obvious distress. She was empathic and quickly ascertained that I was already open to the local CMHT and therefore was responding correctly to my Crisis Plan. Again, no regrets, relief that the plan was working. Then it went dramatically wrong.

Enter, the A&E Consultant. Opening gambit: 'Why have you come to the Emergency Department tonight?' I told him I was diagnosed recently with BPD and was experiencing a sustained period of emotional distress. Again, a long explanation about the building distress, finally admitting that I was feeling suicidal had contacted the Crisis Team and they had told me to report to them via A&E, could I please speak to them. 'No, you must speak to me' - cue frustrated banging of head against wall. 'You must stop being so silly and speak to me'. 'What is all this nonsense about suicide?''You are being very difficult and I'm not prepared to refer you on'. I decided to try pleading, 'Please, I don't want to explain anymore, I need to speak to the team, I have already spoken to them on the phone and they told me to come here immediately. That was two hours ago.' He again told me that talking about suicide was 'silly' at which point I exploded: 'Get this bastard away from me, I don't want to talk to him anymore'. Again, banging my head against the wall.

He continued to refuse to refer me on until I had 'stopped this nonsense and calmed down.' Then, a Staff Nurse and HCA appeared, alerted by my shouting, and quickly removed the Consultant. For the first time since speaking to the Triage Nurse, someone asked me if there was anything they could do to help me. It was the HCA. I was able to tell her about my soiled clothes. She quickly arranged some scrubs for me to change into and offered me a cup of tea. Then she and the nurse put me on a trolley and tried to get me to put my head down.

Within thirty minutes of their intervention, a member of the Crisis Team appeared and assessed me. She prescribed a sedative to stop the vomiting spasms and arranged a home visit from the Home Resolution Team the next day. Admission was never an aim of mine, as it is noted in my Crisis Plan that this is counter-productive unless there is an imminent risk of harm to myself. Having removed the Consultant and feeling listened to, my risk of harm had reduced significantly.I was allowed to go home at 6.00 a.m. and had a visit from the Team at home by 10.00 a.m.

The team responsible for my care had helped, but there seemed to be such a disconnect between their response and the response of the Consultant.

Given that the Receptionist and Triage Nurse had noted the involvement of the MH team, why did this man not recognise the fact that my case had a solution in place? Why did he feel that it was okay to belittle my response? Why did he not notice my physical discomfort and embarrassment? Given that I was dealing with BPD symptoms and risk of suicide attached to this condition, why did he not carry out a more thorough assessment of my suicidal ideation?

I guess there are no answers as to why, only he may know that. What worked in soothing my distress and stopping my self harming behaviour from escalating, was common sense responses to a human being in need. In a word, compassion.

The Alien in the Therapy Group

We sat down in a circle, me and five members of staff. I had been left on my own in the 'group room' while the staff sat in a side office drinking coffee and, as far as I believed, discussing me. suddenly I burst into tears. I felt like a five year old, in the wrong clothes, doing something wrong, in the wrong building, on the wrong planet. It didn't help that I was new to Mental Health services.

I was still working four days a week while attending this group every Tuesday, all day. I wanted so much to understand my condition and to be able to manage it better than I had managed it for over 40 years.

When I arrived at the centre I made myself at home, making a cup of tea and arranging enough cups for everyone, very unselfish and 'functioning'. I entered the meeting room which was empty so, eager to please, I set out eight chairs in a circle. After a while of sitting on my own in the circle I plucked up the courage to knock on the closed office door where the five staff were talking - I assumed - about me. So I knocked, they opened the door, looked shocked, then closed the door, without telling me what was happening or when the 'group' would start.

Then they started, the stream of endless judgements and negative thoughts: why am I the only one? I knew it I've done something wrong and now they're punishing me, they don't get me, they think I'm wasting their time, they think I'm a waste of time, I am a waste of time, just look, they can't be bothered to come out and see if I'm ok, I knew I was a waste of space.

Then 30 mins late, they paraded out of the staff room and entered the room. 'Oooh, someone's put the chairs out, that's nice. Wonder who thought to do that?' Ignoring the Alien in the corner. It felt odd in a 'Miranda' kind of way: me, alone sitting in a circle of eight chairs and once all five staff members sat down, I was still sitting isolated, with no one either side of me. And then the stream of powerful thoughts gave way to an overwhelming deluge of painful emotions: anxiety, humiliation, embarrassment,anger, frustration, confusion. One after another they crashed on me, as my sense of alienation worsened. Suddenly, the waves of emotion were out of control and my sobbing broke through the matter of fact (patronising) repetition of the agenda for the morning.

Instead of stopping the farce they proceeded as if the whole group were present. I was clearly very distressed by now, but none of the professionals (or the Service User consultant for that matter) seemed to have the common sense to enquire as to the source of my distress. Being someone who had not had very much contact with Mental Health services, despite struggling with BPD for over 40 years, I didn't know if this was typical and to be expected. All I was aware of was that whatever this process was, it wasn't helping me: I had taken a reduction in hours and pay to attend, committed myself to it for the next two years and THIS was making me feel WORSE - not in any expected therapeutic or cathartic way, but in a way that felt like I was being traumatised.

Suddenly, it seemed a member of staff noticed ME - the large eyes and green skin must have betrayed my presence! 'Maybe the number of staff here are making Alma feel uncomfortable'. No Shit Sherlock! Still, no one thought to ask me what was upsetting me to such an extent - not that I was capable by that stage of articulating anything resembling an accurate picture of what was going on inside me. Eventually, I was left alone with two members of staff, who then proceeded to deal with a recalcitrant child. No mean feat as, by that stage, my willingness to open myself up to further pain and distress, had disappeared.

Perhaps, professionals reading this may recognise the brick wall of resistance in my response. Perhaps, it helps to suggest that professionals don't try to break through this wall, by the time I have constructed it you would be on a hiding to nothing. I would suggest to staff how about acknowledging there is a problem in the relationship and suggest a restart.

I am glad to say that this false start did not put me off persevering with other treatments, but certainly, it reinforced a number of my defences and made it harder for me to open up to staff in succeeding therapy. I am also pleased to say that my experience of DBT has been positive, with staff being consistent, human and willing to acknowledge when they don't have the answers.

Here are some thoughts and suggestions for staff when dealing with someone feeling like an Alien in the Group:

1) Even if a service user presents as really together and confident - please don't assume that is the full picture. If I have been assessed as suitable for treatment then there must be more than meets the eye.
2) If you misinterpret the situation or a person's mood, don't be afraid to apologise, start again and ask for the person's help to understand. Above all listen to the response.
3) Be aware of how your locking yourself away in an office appears to patients, particularly from an individual person left in a group room. Remember, you are often dealing with people who are super sensitive to rejection, ridicule and paranoia.
4) Ask yourself how you would feel if you found yourself in the situation that seems to be distressing to the person you are trying to help - your answer may give you an idea what questions to ask.
5) If you are trying to get someone to open up who has closed down - please give them time to answer, don't jump in with your assumptions as these may well be wrong.
6) Even if you have some idea what is wrong, don't put words in the other person's mouth - all of us have our own ways of explaining things and even if you are close to the truth your experience will not be the same as mine.

Above all, show the person that they are not aliens, but individuals with real needs that deserve to be met and that merit the best of your skills and professionalism.

Fighting the Stigma

Even when meeting people as I leave my hospital appointments, my standard response to the polite, but empty question: 'How are you doing?' is typically either, 'not too bad' or 'fine thanks'. Oh yeah? So why the need to be going to the hospital?

Now, this is most likely partly to do with the cultural norm, I mean no one really means you to tell them how you actually are, do they? How any deviation to this norm is received depends on whether your decision to open up is related to physical health as opposed to mental health. So that, a response of 'Ok apart from this stinking cold' is much preferable to 'Been feeling really down for some time now.' I've been pondering the squeamishness we feel towards discussing mental health. We're different from previous generations, who didn't seem to be aware to any significant degree of emotional or psychological conditions, beyond 'bad case of the nerves', or 'eccentricity' or 'a bit funny'. I'm tempted to laugh, until I realise that actually, reading much recent media coverage, we haven't moved much further on in our understanding and stigmatisation of mental health conditions.

Spurred on by the work of organisations like Mind, Sane, the Black Dog Tribe and campaigns such as Time to Talk, I have been speaking to groups of people, trying to share my experiences of managing a complex mental health condition. I have been encouraged by the number of people for whom this has been a relief. So many people, struggling with depression, anxiety and other mental health conditions feel so, so isolated, because for so long so few people seem to have been able to be open about their own struggles. Again, and again so many have said to me 'I didn't know I wasn't the only one'. 1 in 4 people EACH YEAR suffer from a significant mental health problem ie a condition which requires the support and intervention of GPs, or Mental Health professionals. So if I am talking to 120 people that means that, on average, there will be 30-40 people suffering from a mental health issue at any one time.

Unless a physical illness is destined to be discussed on 'Embarrassing Bodies' I don't think that we are as reticent to discuss our physical ailments. Even then, I think the physical discomfort is likely to drive us to the GP, even men give in to pain discomfort, eventually. In fact, the typical response to telling people about my colds, sniffs, bugs and lurgies is 'Poor you, hope you're looking after yourself', which is nice!

We don't even have an 'Embarrassing Minds' equivalent, because it's easier to just pretend it doesn't exist. On all too rare occasions have I seen TV programmes which provide a small glimpse into something remotely resembling my experience of life, Bedlam, was one excellent example. It is remarkable, sadly, because of its rarity. More frequently, those who have emotional and psychological struggles are portrayed as 'outsiders', 'other than', 'not people like us'. The prime example at the moment is the portrayal of the residents of Benefits Street, most of whom are described in less than glowing terms. Notice the throw away comments about their mental health, such as 'Dee is on ESA because of her depression' dubbed over a scene showing her being narky with her kids. No further explanation of the 'Black Dog' that lives with every sufferer of depression.

I took nearly two years to tell people what I was struggling with Borderline Personality Disorder, (BPD)after I was diagnosed and started on the path to treatment. There were a variety of responses: total denial (Subscript: can't be true, you're too 'normal' and don't appear to be 'unstable'), minimisation (Subscript: No, you're exagerrating surely, why do you need to see a Mental Health Team?), ridicule (Subscript: Always knew you were a 'nutter' ha ha ha), disbelief (Subscript: I can't possibly be friends with someone with a mental health problem!). What all these responses have in common is that they are strategies to distance the responder from the Mental Health condition. If they can make me the 'odd one out' then they can live without fear of 'contagion'.

For people like this I would say: just as much as no one can predict accurately who will suffer from cancer, diabetes, virulent viruses; unfortunately, for us as human beings, we can never predict who is going end up suffering from a mental health problem in the future. In other words: IT COULD BE YOU! That's uncomfortable and bound to provoke anxiety - especially as mental health conditions and how they are managed are so seldom discussed in a well informed way, certainly not in the bulk of the media, or the political sphere.

Until those in charge of the debate, especially those in our government, actually engage in an intelligent and well informed way with the subject, there will be little impetus to improve the portrayal of mental health issues. Thankfully, under pressure from social media and certain individuals and organisations there is a small shift in the debate. However, the most powerful tool in this battle is the true stories behind labels and diagnoses and for this I am grateful to all the campaigning organisations.

Until it is as easy to discuss my mental health, as my physical health, on my better days, I will try to stick my head above the parapet and talk about the part of my humanity 'that dare not speak it's name'.

Tell Tale signs I'm Middle Aged #10

My 'top totty list' has aged with me. Suddenly, I find men in their fifties attractive.... yuck (says my sixteen year old self) oh yeah? Brad Pitt is nearly fifty, if he isn't there already... Jonny Depp... Mark Foster...(former Olympic Swimmer)...It's time for me to face it, I am ageing along with my favourite 'eye candy'. And suddenly, 'silver foxes' and 'lived in faces' pull on my heart strings.

Today's top totty, just doesn't do it for me... I mean, Beiber, Harry Styles, R-Pat - they are just children aren't they? No older than my nephews - nope I am embracing my attraction to the more mature man - I realise too that I am willing to accept 'cuddly' and home loving and settled in the men that appeal to me in real life. A bit like my current need for comfy slippers and pyjamas rather than silk and mules for my nightwear!

Yep, I know I'm middle aged, because my fantasy men have become like a pair of old slippers: a bit crumpled, familiar, yet still with a 'soupcon' of the original appeal.

Housework - the forgotten symptom....

My house I've realised reveals a lot about my mental health. When I'm up and when I'm down.... it's like a barometer of my emotional life. I remember a cartoon from my childhood with a dog called 'What-a-mess'. I loved that dog: I think I am that dog!

Most of the time my public face is usually fairly presentable, which is why anyone who looked inside my mind or my home (at times) would probably be surprised to see the extent of my inner 'What-a-Mess'. Someone asked me today, 'do you think that you have a problem with people thinking that you're competent and confident?' Now, I know he doesn't mean, that people find me so overwhelmingly competent and confident that they can't relate to me. I think he meant that people have a hard time accepting that I could be suffering from complex mental health issues. Maybe if I were more like What-a-Mess, ie people able to see the extent of my 'disarray' then there would be less questioning of the fact of my struggles and perhaps more acceptance when I need 'space' from people and the world around me.

The thing is, when people have entered my home (which has happened on just four occasions in the past year) it is obvious that all is not well in the 'State of Denmark'. In fact, I am rather ashamed of my 'bolthole'. I realise that using all my energy to manage my 'public face' leaves me relatively little energy to take care of my most important environment.

I am realising more and more that this reflects the biggest struggle I have as I move forward towards full recovery - a lack of self validation. My home reflects the value I place on myself. All my energy seems to be directed at maintaining my competent image to the world outside. Would I be better served letting out my inner 'What-a-Mess' to the world outside, or is the answer about finding more balance in my life, between my public and private lives?

Balance is always preferable to living at extremes of different spectrums. I don't have to choose between being What-a-Mess and Aggie and Kim, I just have to be able to invest in my home so that it is somewhere that does not generate negative emotions like 'shame'. My aim is to improve the environment to which I retreat from the world to recharge my batteries. To do so means that I should be trying to have enough energy left in each week to allow me to take care of myself: cooking, personal hygiene, housework, relaxation etc. In practical terms, I need to see my physical environment as being part of the nurturing relationships that are helping my emotional life.

I need my home to be a retreat, a nest, a safe place, when my mind and emotions are very much 'What-a-Mess'!

Don't forget your laughter muscle...

I'm a bubbly character.

For years, this was a handicap in terms of helping people understand my struggles with Mental Health. I mean, when you suffer from mental illness you're supposed to be 100% miserable all the time - right? Wrong. Just because life is a struggle doesn't mean that we lose our capacity to smile altogether - although there are periods of time when it feels as if life is drained of all colour and enjoyment. And there are moments when it FEELS as if the darkness that envelopes us will never lift. However, the reality of depression and distressing emotions is that they come and go in waves, some are more powerful and overwhelming, others are ripples on the surface of our lives.

Even at my lowest points I have found that I have never lost my wry view of the world and I have found myself laughing my way through therapy sessions focused on some of the most painful experiences of my life. It's a survival technique, one that kept me going through years when I was struggling without any diagnosis or support. Other people's perceptions of Mental Health is such that, due to my propensity to be able to laugh at myself and even the darkest of situations, most people who had contact with me at work or in other social situations would find it hard to accept that I suffered from periods of really black moods, brought on by my struggles with BPD and Clinical Depression. In fact, I lost a number of friends who thought I had taken some bizarre turn in my life when I shared my diagnosis with them. They couldn't reconcile the person they knew with their preconceptions of mental health conditions.

So, now that I'm recovering and am more on an 'even keel' emotionally, do I neglect my sense of humour because I no longer need a mask? My feeling is that my laughter muscle has always been there, it is a part of who I am, but now, rather than being part of my 'armour', it is anchored more and more in my enjoyment of life as it is. I have added it to my DBT skills and use it as opposite action - I mean really, how can I be angry (it used to be white hot and last for hours, if not days on end)when I see myself in the mirror in full flow? Laughter, releases so much tension, in so many situations (caveat: well chosen humour takes account of the needs and feelings of others). Laughing with others, too becomes opposite emotion, so my library of comedy programmes is extensive - an essential part of my 'recovery kit'.

Ultimately, I think that those of us who have seen the world through the prism of mental illness, have the ability to see the quirky and unusual in the world around us. How many comedians struggle with darker emotions? Those of us with BPD are also creative and dramatic, so we are able to see some nuances in life that others miss. When you're in the depths, don't forget your laughter muscle and if something makes you laugh, enjoy the feeling for that moment and observe how your laughter affects you physically as well as your emotions.

Pictures of the Aurora Borealis - Just WOW!

All of these photos can be seen at this site:
http://www.buzzfeed.com/ailbhemalone/breathtaking-aurora-borealis-pictures-from-scotland











When Living in Scotland I had the privilege to see the edge of the Northern Lights regularly. Just truly awesome!!