Month: March 2015

On television

This is a departure from my usual posts but I thought I should perhaps chronicle one of the more ridiculous experiences I have had recently.

Yesterday I was on annual leave. At around half nine in the morning, I got a phone call from an editor at the Guardian (I write the odd piece for it) asking if I could send over something on the Germanwings air crash – the press has jumped on the fact the pilot had depression and there were some pretty awful headlines out there. I agreed and sent the copy over (it’s here, if you’re interested), then on I went with my day.

Later that evening, I was unable to concentrate on my novel, so I was, obviously, scrolling through Twitter. I received a message from someone at the BBC asking if they could call me. I agreed and they did. They asked if I would like to be on Newsnight. ‘Oh’, I said. ‘Oh I see’. ‘As a bonus’, she said, ‘Benedict Cumberbatch will be there.’ ‘Oh, goodness’, I said. So I said yes and they said a car would be with me imminently.

Now prior to this I had been loafing around. My evening plans had been shifted to another day and I suddenly realised that it was half nine, I was in a tangle of blankets and hoodies and that I was aiming to get to the BBC for 10.15.

Never have I got into a suit and some decent shoes so quickly.

Seriously. I went to an awards dinner earlier last week and I swear it took me an hour to get ready. Last night I acquired some kind of transient superhero status which allowed me to simultaneously do up cufflinks, put contact lenses in and shove my wallet into a bag. I was ready in ten minutes. If I could bottle that superpower and keep it forever I would. Instead I just had to pace about waiting for the taxi. Also I announced it on social media BECAUSE THAT’S WHAT WE DO NOW.

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Now I don’t know if any of you ever drive through central London, but trying to get from the badlands of South London to Oxford Circus in 30 minutes on a Friday night is borderline impossible. Brixton, Trafalgar Sq and Regent St were DRAMA (at least Soho was moderately entertaining). It took an hour and a half, which gave me lots more time to panic and ask the producer to see if she could keep Cumberbatch hanging around (look, I love Sherlock and his Frankenstein was some of the best theatre I have ever seen and I am not above fangirling). Also, it meant that I got to try to work out what the devil I was going to say, courtesy of the poor taxi driver who very kindly engaged with the whole process in the most charming way (sadly I couldn’t do any actual research because, obviously, my phone had barely any battery). Despite that, I discovered as we approached Westminster that I had some kind of quick-acting RSI in my right shoulder because I had been clutching the wretched thing for the entire drive.

Hilariously, the drive took so long that at 11.20 I got a call from a chap telling me my taxi was outside. I informed him that I was already in a taxi. Turned out that he was my return driver and that I hadn’t actually got to the BBC yet.

Anyway. New Broadcasting House is swanky and has lots of bright lights (it looks pleasingly like a glo-stick) but obviously it also has those bizarre sofas which are neither entirely comfortable nor entirely uncomfortable. Also, protip: if you’re going to rock up to the BBC, it’s a good idea to know who you’re meeting and what programme you’re doing. I knew neither. Nevertheless, I persuaded them to give me one of these:

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Obviously the poor lady at reception could make neither head nor tail of my handwriting. I refrained from asking of Cumberbatch because I was probably already getting odd looks. Bear in mind it was half eleven, I was knackered, I was a bit stressed and I hadn’t planned what I was going to say because I didn’t actually know what I was going to be asked. I have done TV a stuff a few times but I generally have more than ten minutes’ notice. Amazingly, though, I was once going to do a live show in North London and I had to be there for around 7.15. By half six my taxi had not arrived to pick me up. You won’t be surprised to hear that I didn’t make it.

Anyway, since I had missed Newsnight I was to be on shortly after midnight (several of my friends, bless them, who should really have been out having fun, were glued to the BBC News channel, which I find alternately pleasing and amusing). I was whisked into the bowels of NBC (or, rather, we took the lift to the lower ground floor) and I paced about a bit more, drinking water nervously but trying to look cool. Yeah. I actually had to ask the chappie shepherding me around what channel BBC News was on Sky, which obviously screams ‘ALL MY FRIENDS HAVE BEEN INFORMED OF MY IMPENDING APPEARANCE, YEAH?’. Tres cool.

And then, I was marched to the studio and had a minute or two to discuss the piece and then, there we were, on air. And it was ok. I felt like I was slurring slightly, which happens when I am tired, but aside from that, I thought it went pretty well. If you fancy it, it’s here. Yes I recorded it off a recording. I’m keeping it real:

And that was it. The return journey was far quicker, obviously, and in the end I had spent four hours on a five-minute interview. But it was exciting and I can’t pretend I don’t enjoy that kind of thing. Also it seems I’m finally reconciled to the fact I speak the way I do on film (though I don’t quite believe I speak like that ALL the time. I consider this my ‘TV voice’).

Telly – it’s less glam than it sounds, but more glam than most things. And I got to put on a decent suit, which I don’t get to do very often in my line of work. And I get to swan around saying ‘I WAS ON THE BBC, YOU KNOW’, though I’ll try not to do too much of that because my friends are very indulgent but they also might tell me to shut up at some point.

This post has not been remotely psychological, but, then, it’s not like I’ve got a remit (I’m not the BBC after all *snort*) so whatever.

I just wish my poor shoulder would stop aching. Super-quick, panic-induced RSI, brought on by the BBC. I should sue, really.

On judging your patients

The thing about working in mental health is that it can be appallingly easy to turn into an insufferable know-it-all. This is partly because the second you tell someone what you do for a living (and I write this as a psychologist, rather than a nurse or an occupational therapist, for example) they ask you lots of questions. This means that you get to feel very clever and wise as you discourse on the ’causes’ of mental illness, or as you briefly summarise how one accesses mental health services (no one ever asks how you access physiotherapy – they just trundle off to the GP. But mental health seems hidden in the shadows and no one ever seems to know that you usually need to trundle off to your GP if you’re worried). But very quickly, this can feed your ego. The fact is that many of us in health do have very specialist training and that we have worked damned hard to ‘make it’. I think people who ask about our work usually do so because of a genuine interest and often they expect some sense of expertise (though perhaps not pomposity). The problem, I think, is not so much in how we relate to the public at large, but how we relate to our patients.

To be perfectly frank, it’s really easy to end up with a mindset which informs you that you are, fundamentally, better than your patients. Often, we work with people with offending histories, with significant relationship problems, with addictions, with thoughts of suicide, with financial problems or with less education than we have. Think about how most of us get our sense of self; what make us feel good about ourselves – our physique, our job, our car, our hobbies, our salary, our partner, our house. If your lifestyle meets a certain set of social conventions it’s really easy to become superior, to see every patient as another set of problems You will almost certainly have seen a health professional who made you feel like that at some point – who made you feel small and stupid and insignificant. I’ve seen at least three like that. I hated them all. I never went back to see any of them. I had that luxury. Many don’t. Many get stuck with professionals like that; professionals they ultimately despise.

Much of this attitude is reflected in the ‘should’ attitude. ‘He should stop drinking’. ‘She should stop self-harming’. ‘He should lose weight’. Never mind that lots of health professionals drink too much, that many of us are overweight, that lots harm their bodies (and perhaps minds) through drug use – our patients ‘should’ do what we think they ought. One of the more vigorous campaigns of recent years has been the anti-smoking one – aside from the ban on smoking in public places, most hospitals are now smoke-free, which means that if you want to smoke you either have to walk miles to the nearest exit (hospital sites are often enormous) or you have to find a corner and hope no one sees you, much like a schoolchild, except you’re probably thirty years too old for school. And that’s just for the staff – there has been enormous emphasis on stopping mental health patients from smoking. This seems well-founded – people in MH services are more likely to smoke, to have poor physical health and to die earlier. But one thing that’s always struck me is that if I was often highly-stressed and if I didn’t have the things that keep me pretty solid – my job and my interests and regular holidays – I’d need something which took the edge off the worry. Most people who smoke say it takes the edge off – people who drink too much often say something similar – so would I smoke? Possibly. Would I drink? We know that one of the main reasons people drink is to deal with unpleasant emotions, so again, perhaps I would. On top of that, if I was an inpatient in a psychiatric ward I may well smoke just to pass the time. They are often not, it must be said, the most stimulating of environments.

So I am, evidently, sympathetic to alcohol and tobacco use because in my experience it is usually symptomatic of something deeper. I was thinking about this today because today I told several of my patients that smoking probably helped their mental state and that trying to reduce their tobacco use was probably unwise (as an aside, most people I see are in their 80s and a small part of me thinks that if you’ve been smoking for sixty years maybe I should just let you get on with it, especially if you also happen to – and brace yourselves here – enjoy it). I was muttering about this on Twitter earlier when the esteemed Alex Langford (@psychiatrySHO) asked what I thought of crack use as a coping mechanism. I told him that, fundamentally, I believe people cope in the best way they know how. I don’t think taking crack is how I would choose to cope with the things that make my life more difficult, but then, I have a lot of other coping strategies – I have friends and I write and i have the luxury of being able to pay for cinema or theatre tickets to escape my worries. Not everyone has those things and not everyone knows they exist. I grew up in a family in which alcohol was a no-no, so I never learned that it could make you forget your worries. That’s a relatively unusual experience, but the fact I don’t drink to forget doesn’t mean I’m better than someone who does drink to forget – maybe they have more to forget than I do. Or maybe I was just lucky enough to have a bigger bag of tricks than they.

But this goes for many things – self-harm is a coping mechanism for many people. So is eating. So is getting angry. So is telling people you’re considering killing yourself. One of the most awful phrases in mental health is ‘maladaptive coping strategies’ – a phrase I am ashamed to say I used to use before I really thought about what it meant. These days I try to be a little less sanctimonious. Most people do what they need to do to survive. If they’re hungry they steal. If they’re lonely they’ll try to find a way to be looked after. If they’re in pain they’ll find a way to express it. And if life has been so ghastly that you can’t express it through words or by asking for help, you need to be more creative, even if that has some negative consequences. A&E staff can sometimes be dismissive of people who attend following self-harm, but at the very least they will patch you up and provide you with something approaching care. Getting drunk might lead to a terrible hangover but at least you were free of your demons for eight hours. If you’re isolated and lonely casual sex can be a really good way of feeling loved, even for a short time – and, just for reference never, ever underestimate the importance of being touched by another living, breathing person, even if it does occur in less-than-ideal circumstances.¬†Getting angry and assaulting someone might land you in court, but at least you weren’t small and frightened and vulnerable to harm from another. The trouble is that not all professionals see it like that – for many, it’s a case of ‘do as I do’, or, perhaps, ‘do as I say’ (as I said, we’re not immune to coping in many and varied ways ourselves). What this frequently means is that we judge our patients; that we look down on them for not being good enough or trying hard enough – perhaps feeding right into their own fears about not being good enough and not trying hard enough. But more than that, we implicitly tell those patients that the mechanisms thy have learnt are incorrect, are unworthy. You know what? In my experience, many patients already think that, at some level. I don’t think it’s unreasonable for mental health professionals to provide something a little more sophisticated, a little more constructive and a little more compassionate.