Month: May 2014

On mental health stigma, and working in a ‘nuthouse’

Quite often, I find myself being quizzed on my job by people I barely know. It’s gratifying that people sometimes find what I do interesting, but, in my experience, it’s often secondary to a problem they have had/someone they know has had. It’s indicative, I think, of the indiscriminate way mental health problems are experienced. There is no protection, really; not money or status or education or any of the things we hope will protect us from the torments of life.

And so it was that I spent a quarter of an hour chatting to some ex-colleagues about my work. Some years ago, I worked in another industry entirely, but I still pop in to the office now and again to say ‘hello’ to my ex-boss. Toward the end of my visit, I got talking to three former colleagues and one person who has joined the firm since I left. ‘What are you doing at the moment?’, one of them asked. ‘Writing m’thesis’, I promptly responded. ‘And what will you be then?’, came the question. ‘A doctor of clinical psychology’, I said. I explained that I was working at a hospital, doing whatever it is that I do and that I am due to qualify in the next few months.  My former colleagues knew that I worked in mental health; the unknown colleague obviously did not. And then came the ‘ooh, how INTERESTING!’ comment, expressed in the worst possible way. ‘What’, she said, ‘is it like working in a nuthouse?’

I am rarely flabbergasted but even I was taken aback. To my shame, when I recovered from the question, I stammered out a deeply ineffectual ‘well it’s hardly a nuthouse’ but I felt like I’d done the people who use mental health services a grave disservice. What I WANTED to say (as I squawked to a friend that evening) was something along the lines of ‘have some bloody respect for people who have experienced untold misery and have demons you can’t even begin to imagine’. Now that’s a bit of a crude statement, because not everyone I see has experienced untold misery and not all have demons (any more than we all have demons, that is). But I was furious at the implication that people who have mental health problems are raving lunatics, locked up for the safety of good upstanding citizens. This is nonsense. People with mental health problems – of whatever persuasion – are not the ‘other’. They’re your parents and friends and bosses and dentists and hairdressers. Notions of Victorian asylums persist, but, when you work in mental health, you get so used to being wrapped up in a woolly world, in which we try to be respectful and aware of vulnerability and the things people have experienced, that it can be rather a shock to encounter a question such as the one I was asked. I don’t think this person had any malign intent; she wasn’t the kind to overtly stigmatise someone with a MH problem, but its not really the overt stigma which is the biggest battle. Yes, it matters that people with MH problems can’t get jobs, for example. But it’s the everyday, insidious stuff which erects the biggest barriers. It’s the casual comments about ‘lazy depressives’ or ‘attention-seeking self-harmers’ or ‘fruitcakes’ , the kind of stuff you hear in the pub, which stops people talking about their own experiences. Interestingly, some of the research indicates that anti-stigma campaigns, which highlight how common MH problems are, actually result in an increase in stigma. Really, it’s the everyday disparagement which needs to be tackled but, if I’m honest, I don’t know you do that. I probably failed, frankly, and I’m still a bit embarrassed by it. If MH professionals can’t pull themselves together long enough to respond effectively to something as relatively minor, perhaps we need to rethink how we tackle something which has a huge impact on the likelihood of people seeking help when they need it. In the UK, we have shockingly high rates of self-harm, suicide and substance use, all of which are often related to unspoken difficulties arising from MH problems. If we could crack the stigma issue, maybe we’d begin to see a shift in these related problems. Sadly, ‘if’ is a big word.

On boarding school and parental responsibility

Another day, another Guardian piece. Try as I might (and goodness, have I tried), I can’t quite seem to extricate myself from the prison of news journalism. I have to all intents and purposes stopped reading newspapers, but once or twice a week I get lured towards something that looks noteworthy. Last week it was a rather good long read on returning to the boarding school which left the author emotionally shattered. I tend to like such pieces because I find people and the parts of themselves that they are usually wont to hide interesting. Put bluntly, I wouldn’t do what I do for a living if I wasn’t interested in the part of you which is emotionally and physically and spiritually shattered. It is one of the great ironies that I get my daily bread from the suffering of others. There is a blog post in that, but another time, perhaps.

Today, an editorial in the Observer and a letter from some two dozen of the great and the good suggesting that schools stop taking young boarders. Despite the best of intentions, I rather think they’re missing the point.

I find the notion of boarding school terribly fascinating. Partly this stems from a diet of Enid Blyton books as a child (incidentally, it was not until I was in my twenties that I first questioned the wisdom of giving an elephant an iced bun when it finally occurred to me that their natural diet probably didn’t involve anything quite so doughy). Partly, of course, it is the fascination with the unknown and in part it stems from knowing lots of people who boarded. So, anecdotally, what have I learned? Some loved it, some hated it. Some thrived, some left. Like almost anything, there is no single experience. Not exciting, as lessons go, but it is what it is. Some people I know would never send their kids to board, others would put them down for Harrow (or wherever) the moment they could.

The reason so many people (especially in psychology) are anti-boarding is that we worry about attachment. Put simply, attachment is the idea that we all need to feel safe and secure (physically and emotionally) if we are to thrive. It is difficult to lead a full and comfortable existence if you feel under threat or if there is no one to take care of you when you need it. You see it in small children, keeping one eye on their parent even as they play with their blocks. You see it in adults who call that one particular person when their world is falling apart. People need people, as a general rule. The problem is that losing attachment figures or having those relationships disrupted (by divorce, or death, or imprisonment, or being sent to board) can seriously damage your ability to establish new relationships. It is, perhaps, not surprising that the nation which invented the boarding school as we know it also had the stiff upper lip. I know all this. I know of ‘boarding school syndrome’. Yet I dislike the fact that the editorial and the letter place the blame squarely at the feet of the schools. Let’s be honest, private schools are not kidnapping children, parents are sending them away.

If you choose to send your kids to boarding school, that is your decision and you have to take some responsibility for whatever happens. I am actually quite sympathetic to boarding – I think it can make people incredibly independent and there is much potential to become your own person earlier on in your development. I think age three is young to send children away, but there’s no specific age at which it becomes okay. Some kids will be fine, others will be tormented by the experience for the rest of their lives. But the fact that someone sends their children to board says a lot. It might say that they are following a family tradition, or that they believe the education is better and the opportunities more varied. It might also say that they didn’t particularly want their children or that they don’t now how to parent them in the way they might like to. None of these suggestions is Gospel, of course; they are simply potential explanations for why you might decide on boarding school. I didn’t board, so I have no personal experience to speak of. Nor is this a judgement of people who do send their kids away. How other people parent is not my business, in general.

The other thing, of course, is that boarding schools are notorious as places where you may be molested and violated in all sorts of ways from a young age. The effects can be terrible, of course. But the way that people use this to argue against boarding is ridiculous. Yes, children sent to board may be at greater risk of some things than children not sent to board. But too often commentators on such issues seem to forget what can go one behind closed doors in suburbia. Don’t for a minute think that every person who sends their child to Rugby is sending him into the lion’s den and that you have the moral high ground over them for not doing so. If it is the case that parents see the beatings and all the rest of it as ‘part of being a man’, that says much about thought processes and the way that individual manages emotion, but it doesn’t make them a selfish monster who doesn’t give a fig about their offspring. Taking the moral high ground is a terrific position to hold if superiority is your thing, but it’s hard to walk a mile in someone else’s shoes. The truth is that many people have disrupted attachments and many parents will damage their children in some way, although most will survive relatively unscathed. Philip Larkin said it best, as ever, but there’s more than one way to skin a cat and there plenty of terrible things that can happen to a child aside from being sent to board.