On ‘secret diaries’

Secret diaries. The preserve of people who can’t tell you the truth, despite desperately wanting to. Sometimes they’re interesting because, if we’re honest, most of us are nosy and voyeuristic. Some are boring. I will never care what a financial analyst does all day (#sorrynotsorry). But the point of a secret diary is that it’s meant to reveal a mystery in some way. I am trying to think of one which was about someone in a mysterious profession but I can only think of ‘Girl with a one-track mind’ which is going to give you totally the wrong idea about me. Evidently I don’t read enough secret diaries.

BUT. The Guardian has a mental health series on at the moment, and it has featured a few secret-diary-expose-type-things. Yesterday (or maybe on Tuesday – I don’t know and it doesn’t really matter) there was this: ‘The secret clinical psychologist’s diary‘. I commented on Twitter (obvs) that I thought more could have been made of it. Now, I don’t know who wrote it, but I know someone wrote it. As I generally try not to be a douche (no, really, I try quite hard to be a non-douche) I am going to say why I thought more could have been made of it without being cruel.

I think psychologists do a lot. Really. I have been qualified a year and I do a LOT of work. That goes for every health worker I know. But to the outside world what we do is a mystery. Diaries like this are the way – anonymously – to explain it; to make people see that we do more than ‘talk to people’ and drink tea and hug it out. I don’t think the piece says enough about the consultation we do; the teaching; the supervision; the meetings; the paperwork; the demands of the clinical work. Only one clinical case is referred to. This might be because of confidentiality but I obviously don’t know. The final paragraph refers to inpatient work but no mention of this is made in the earlier part. Now obviously I don’t think this psychologist only saw one person in their working week, but the articles doesn’t make much mention of the sheer variety of the work. I am sure, also, that the time constraints are enormous and the pressures immense. In my view, it’s no bad thing to say that in the public domain. In fact, in the current climate, I think it’s essential. We are under siege but no one is listening. People in power think they can slash our resources without any impact on our wellbeing or the care we can provide our patients with. Well we can’t. Public sector staff are beyond stressed at the moment. The stats are freely-available. We need to publicise what we do so that the public at large gets a better understanding of it and of unsustainable it is.

You will see why I was frustrated, I hope.

I think it’s great when people want to do this stuff; I just don’t think we should be afraid of saying ‘we work damn hard in a job that can be difficult and stressful and exhausting and in which we see and hear appalling things’. Really, that’s all my frustration is: don’t play down what it is you do. We have a history of playing down what it is we do and I don’t think it benefits anyone.

I toyed with the idea of writing my own diary but there are issues. I can’t write it under my own name because I am easily Googleable and my patients might be traceable. I can’t write it anonymously because I have a very particular writing style and it would be patently obvious that it was my work. And I’m too lazy to make it up and invent patients (also I should be writing other things at this very moment in time so, you know, PRIORITIES.

So there we are. Sadly I can do nothing about the points I raise above but it’s really not for want of motivation. If you want to know the nuts and bolts of what I do, ask me. But, in case you’re interested in the more general stuff, here you go.

I work in an Older People’s Community Mental Health Team. Primarily I see people over the age of 75 but sometimes they’re younger. Many have dementia; some are low in mood or anxious. Some are in poor physical health; some are at risk of falling or vulnerable to abuse or exploitation. Most live at home but some are in residential care. I do some inpatient work, but that’s not the bulk of my clinical work. I have no consulting rooms so see everyone off-site. I cover an entire borough of London so I travel a lot.

I work with patients and their carers. Dementia can wreck entire families and often carers need support. They may be watching a loved one disappear before their very eyes and the strain is often enormous. Typically, I will try to help the person with dementia to manage their memory loss and I might also do some family therapy to think about the impact of dementia on relationships. Often I do assessments of challenging behaviour – not uncommon in dementia – and try to implement strategies to reduce the risk of harm to both the patient and their carers. Sometimes I talk to carers about the grief they are experiencing; about the difficulties of looking after someone who may no longer recognise them when they are still trying to maintain jobs and families and lives of their own.

Sometimes it is heartbreaking.

I use an eclectic therapeutic approach. Different approaches work for different people. I spend a day a week in a family therapy clinic and I am also training in family therapy. In addition to traditional therapy I also do neuropsychological assessments for dementia. These assessments can take up to eight hours to complete, plus time to score and write a report – possibly up to six pages of dense text. Sometimes I have the difficult task of telling someone they have dementia. I try to do this in the kindest way I can but it is never, ever easy.

A couple of times a month I am ‘on call’, which means I deal with all referrals to the team. I might have to deal with GPs or Social Services or do an emergency assessment. I am on the phone to Social Services a LOT. They all know my voice now. Sometimes patients or their families call because they are worried about something. Often, we can sort it out by telephone. Sometimes we spring into action immediately. Flexibility is the name of the game. It has to be.

Each day I have a team meeting to check how everyone’s diary is looking and to see if they are worried about any patients, or to see if they need a second person to accompany them on a visit. When you work in the community you need to make sure your colleagues are safe at all times, so there are multiple processes in place to make sure our whereabouts is logged.

On average, every week I will do two initial assessments with a colleague to see if the person has been referred to the team best able to help them. There is a lot of paperwork attached to these assessments, and more generally. Risk management is a big part of the job. In teams like mine, we see people who are often actively suicidal, or whose use of alcohol might place them or others at risk. Emergency meetings with Social Services are not infrequent. We will do whatever we can to keep people safe – we will arrange for smoke alarms to be fitted; for kitchens and bathrooms to be adapted so that people can stay at home for as long as possible.

I go to meetings. I have a weekly business meeting and referral meeting; I have regular supervision and I also supervise some of the work done by a couple of other people who are new to the team. This means that we have to prepare for all their clinical work, that we have to discuss it afterwards and that I have to go through all their reports with them. I enjoy it, and they are bright and keen to learn. I do some informal consultation with other members of the team if either of us needs some input around our clinical work. I am clinical lead for my team so I go to additional meetings to talk about non-clinical issues. Now and then I write reports to do with service development. If my colleagues are away I might visit their patients to make sure all is well.

I eat lunch at my desk, in a hurry, most days. Every day I take a book to work. Almost every day I end up discussing clinical issues or dealing with admin over lunch. Often I feel like I’m chasing my tail. Sometimes I realise I’m up do date with all my paperwork and I feel smug, but it never lasts very long.

That’s an average week, I think. I might have forgotten something, but you get the gist. And you will see, I hope, why I get frustrated when people undersell themselves, and us.

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On clinical psychology as part of the problem

It feels a bit trite writing this now.

Last week, (and believe me, I have never said these words before) I wanted to go to Birmingham. There was a conference I fancied going to, on the topic of ‘Power, Interest and Psychology’. The conference sprang from the ideas of David Smail, a deeply influential psychologist who died last year. I never met him but he wrote prolifically on ideas related to the causes of distress – not faulty genes or a lack of moral fibre, but a society in which power is distributed unfairly and in which humans suffer as a consequence. I love that stuff – the chance to think about the unequal structures we have created and the ways in which they can be dismantled; the chance to be (legitimately) angry; the chance to thrash the ideas out with friends and colleagues who are sympathetic to them. I didn’t make it because it was priced well out of my reach which, if anything, shows at least that the organisers, my professional body, retain some sense of irony. But I was going to write a blog, regardless. Then Paris happened and my thoughts were consumed with that. I have toyed with writing something on that – on being Muslim in Europe; on having spent my entire adult life being part of a group widely feared as potential terrorists; on the fact I am now more acutely aware of my Muslimness than ever before – but I don’t know what the point is. I wrote things after the London bombings and after Lee Rigby and after Charlie Hebdo and I don’t know what more there is to say aside from the fact that I am weary of it and I am increasingly feeling less safe as a Muslim woman and that I see no sign of any improvement.

So, in that context, you will see why it feels trite to write this now. But life does not stop because of atrocities and I am still a psychologist and I still think there is much to be done in the world of psychology. Those who know something of me will know that I struggle enormously with my profession. I think it is worthwhile, which is why I do it, and  I often enjoy it, but it is far from perfect and  I would be lying if I said we always got things right. I suppose my attempts to do things slightly differently – to organise conferences looking at social context and to be part of a group which contributed evidence for a DWP report on Workplace Capability Assessments – stem from this; from some sense that there is so much more to be done than spending the next forty years tackling only the resulting distress, rather than the root causes. I don’t believe in cure without some attention to the causes and I certainly don’t see myself as some kind of healer. I think there is value in the work I do with people but to be perfectly frank by the time I see them there is often so much damage that has been done that it cannot be undone. I may be many things but I am not a magician. I can do nothing about the fact some of my patients were brutalised by their parents; about the fact many were raped; about the children they have had removed; about the violence they have endured; about the bullying they have experienced. I can do nothing about the fact that they have grown up in a deeply unequal society in which being gay or black or poor or an immigrant is often stigmatised. I know that experiences such as these lead to distress – I mean, I have data to back it up, because apparently we can’t just think in terms of common sense anymore – but I see virtually no efforts to do anything about it. Instead, we only see people when their own resources have been entirely used up and they are in desperate pain and we might try to help but the blunt truth is that our systems can brutalize and damage people further. It’s an unpleasant thing to think and to write but it is sometimes true.

A simple example is children who are sexually abused. We know that these children are much more likely to: develop an eating disorder, self-harm, drop out of school, use alcohol and drugs, have violent relationships, end up in the psychiatric system and get a diagnosis of borderline personality disorder, which, until fairly recently, was seen as ‘untreatable’. Now, if you get a BPD diagnosis, you might get some form of help, though the cuts are wreaking havoc, frankly. But the thing is, for some people BPD is a really bloody awful diagnosis to have – think of it, a label slapped on you which tells you your very personality is deficient. I can’t say I’d be thrilled. But if you are a person who has been sexually abused and who has had lots of bad things happen to them as a result because your attachments are ruptured and you find relationships hard and you feel ashamed and guilty and worthless and you take drugs to numb those very painful feelings, you may well not get the help you need, no matter how much you ask for it, because, unless you have a BPD label, you might not be seen as ‘ill’ enough. So what’s the message mental health professionals give people? ‘Get worse, if you want any help. Show us how desperate you are for help.’

Our system, dear reader, is flawed.

But of course it’s more fundamental than that. As psychologists, my colleagues and I are highly trained. Many of us have three degrees; some four or five. We are trained researchers and clinicians. We understand health but we could probably hold our own in some areas of sociology as well. I lecture trainee clinical psychologists on the topics of social context and race and class and sexuality. We are highly skilled people, often with vast amounts of knowledge at our fingertips. We know the causes of inequality and emotional distress; we know that intervening early is more useful than doing so later on and we tend to have the networks and the credibility to use that knowledge for social good.

Unfortunately, for most of the past 100 years, we haven’t. It wasn’t psychology which campaigned for the civil rights movement; it wasn’t psychology which rioted at Stonewall. On the contrary; we were too busy being involved in the eugenics movement and ‘treating’ people for being gay, which was classified as a mental disorder. More recently, we have had the dishonour of being complicit in torture. My profession does not have a good record when it comes to fighting for the rights of the oppressed, the marginalised and the dispossessed. And even now, knowing the crimes that were committed by our predecessors, many of us are content to sit in our consulting rooms and our ivory towers, working with the tiny proportion of people who come through our doors. I don’t know if you have ever tried to access NHS psychology but it is not easy. There are too many people in pain and too few of us to be able to provide them with what they need. I have the luxury of being able to see people for six months at a time if they need it; maybe more. Many people I know have nothing like that flexibility because their resources are so stretched but ultimately it’s our patients who draw the short straw.

My job is full of ethical dilemmas. Do I see the lonely old person because seeing me is the only social contact they have and because it lifts their mood slightly? Or do I discharge them because I am not ‘doing psychology’ with them? I’m not sure what ‘doing psychology’ is, really – as far as I’m concerned, most of my job is simply talking to people and trying to understand their situation and how they came to be in it and trying to fathom a way we can help them change it. Sometimes we can’t change it but that doesn’t mean there is no value to my input. I can’t just discharge someone sad and lonely without any follow-up but other agencies are drowning in referrals and their waiting lists would make your toes curl. But I can’t see people unless I can justify my involvement and sometimes it is hard to do that when you are the only psychologist covering a massive borough and sometimes I have to, with regret, discharge them and hope I have done enough.

But there are the bigger dilemmas. Make no mistake – I earn my living because other people are in emotional distress; because life has battered them and they cannot cope. You may say that I am doing a ‘good thing’ by doing what I do and that I must be a ‘good person’ but, believe me, there is very little about me that is noble. I care about my work and about my patients but the fact is that the day we manage to eradicate inequality, oppression and societal violence is that day many of us will be out of a job. Of course, given our current policies, that day isn’t coming anytime soon, but that in itself is a concern.

I see my job in the way I see a charity. It exists to fill a gap. If a charity is effective, at some point it should cease to be necessary because the gap has been filled by advances in policy and practice and it should close down. If I and my fellow psychologists were doing what we should be doing – focusing on preventing sexual violence, war, substance use problems, torture, racial and gender inequality, homophobia – we would, hopefully, run ourselves out of jobs at some point. That would be a good outcome, societally. A world in which you don’t need mental health professionals is a world I would like to live in. But we don’t do it. We don’t fight the causes; we firefight the dreadful consequences. And the effects on us are terrible. Health professionals are prone to all sorts of mental health problems. And why wouldn’t we be? Imagine spending forty hours a week hearing of others’ pain and distress. Imagine doing that for forty years. Imagine what that does to your view of humanity. Imagine what that does to your relationships. Make no mistake: our jobs can destroy us.

So, in fact, our lack of action when it comes to dealing with the root causes of emotional distress serves no one. It doesn’t serve those who continue to be marginalised, oppressed and victimized. It doesn’t serve the people around them. It doesn’t serve us as professionals. It doesn’t serve society. It simply perpetuates the damage and the despair; it keeps rotten systems alive and it maintains a steady flow of people through our doors for decades to come.

It is an outrage and we should be ashamed.

On ‘straight allies’ and ‘straight queers’

Recently, I came across this:

Now I can’t say I have an opinion on the word ‘queer’, especially – I like it when slurs are reclaimed, because language is powerful and it can only have the meaning we allow it to have – but I’m not political over it. The ways in which minorities self-identify are myriad and wonderful and often unpredictable. I mash several identities – Muslim, British, Asian, East African – into one and I would be lying if I said that had always been simple. It has taken me a long time to gain some sense of my identity and to do it on my own terms. The thing with being a minority is that no one else can do that for you. It’s a conundrum you have to resolve yourself, no matter how much wrestling it takes.

Obviously some people help that process and some hinder it. You can never tell who falls into which camp. Bigots can anger you whilst fostering pride in your heritage whilst supportive people can fail to spark anything, intellectual or otherwise. It’s nice to be supported whatever your demographics, of course, but there’s a line between ‘supported’ and ‘patronised’. ‘Straight allies’? Really? It’s not sufficient for you to not be a bigot; you have to announce it to the world at large? And as for ‘straight queer’; well, that can just go hang. Would you call yourself a White Person of Colour (since that’s what we’re all expected to call ourselves now; thought I’m not quite sure when ‘Asian’ ‘African’ became so frowned upon.

It’s not that I want everyone to be bigoted. It’s great when people actively (or even passively) support equality; it’s even better when they are aware of their prejudice and bigotry and try to do something about it. But you don’t need to ‘come out’ as a ‘straight ally’ (seriously: just be nice to non-straight people and that will be sufficient. And don’t feel the need to make it all about you by ‘coming out’. It’s not about you.) and, frankly, if you can’t see that ‘straight queer’ totally colonises someone else’s identity, heritage and struggle in order that you can feel better about your own identity and heritage I’m not quite sure what else to say.

On working versus living

It is, I believe, National Work Life Week, which means that talking about work-life balance is currently in vogue. I am unfortunately not in vogue, because I have been thinking about writing this since August but, you know, BUSY. Anyway, I decided that I should probably get myself in gear and Write Something because it’s been an age.

Psychologists often talk of the work-life balance as something they aspire to but often fail to achieve. When I began clinical training, a reasonable chunk of the induction was spent talking about the demands the course would place upon us and the effort we would have to expend to retain life outside our jobs. Interestingly, it was noted that it was usually the trainees who had children – only one person in my cohort did – who made time for their real life, mainly because they didn’t have much choice.

Over the next three years, I watched my colleagues work during the evenings, at weekends, and on annual leave. This last one horrified me. I liked training because it meant I had huge flexibility – I could work on my thesis and case reports whenever I wanted, which meant I could also go to the cinema whenever I wanted. I can’t write or think at pre-appointed times, so when it was all useless and I could barely string a sentence together I’d wander off and try again when I was ‘in the zone’. It was marvellous. During my doctorate I went away more and saw more films and plays than I ever had before. I discovered opera. I read voraciously. I did, in some ways, have the time of my life, although my thesis did go ‘bang’ at one point so don’t think it was all plain sailing. But the point was that I knew it was just a job – a job I love and that I am good at, but just a job. I saw my patients and wrote my assignments and so on, so there was no way I was going to take annual leave to write a thesis. When my data analysis wasn’t working and I had to rewrite my entire Introduction I despised my research; having to forfeit leave to rework it would have made me impossibly angry and bitter. It was precisely because doctoral training was tough that I needed – not wanted; NEEDED – that leave. NHS annual leave entitlement is reasonably generous, but so it should be, frankly. I need those holidays to recover from the intensity of the work; to ensure that when I am working I am a good clinician, not a fed up, burnt out one.

The upshot is that when I go away, I REALLY go away. On annual leave, I am totally incommunicado. I don’t want to talk to anyone (after all, if I wanted to talk to people, I wouldn’t go somewhere they weren’t). I work a lot so I am entitled to some downtime. It is for these reasons that I frequently disappear from social media and ignore my emails for days on end. In the spirit of this, I went away over the August Bank Holiday to take in some country air. I rumbled back to London on the Monday and turned my phone on at some point that evening. What struck me was the number of people – mainly psychologists, because this is technically a psychology-related account, though you could sometimes be forgiven for thinking otherwise – were talking about actual psychology. Research and stats and theories and clinical practice and other stuff that made me want to ask why the hell they had nothing better to do with their time. And then I remembered that, in the not too distant past, I could have similar conversations that went on until 11pm, midnight – in fact, it sometimes seems as though the psychologists of Twitter only come out to play (or think, or disagree) in the witching hour. Not necessarily surprising – I do most of my thinking at night, and it is often then I have fewer distractions, but, really, do we not have better things to do with our free time than talk about work-related stuff? Every time I check Twitter I feel as though every other psychologist IN THE WORLD is more engaged with their profession than I am, but the fact is sometimes I don’t care enough to talk about it or write about it – as I said at the beginning, I’ve written nothing psychology-related in months; I have five papers languishing, awaiting revisions, because I can think of about five hundred things I’d rather do than write an academic paper that no one will read. Sometimes I just want to read a novel or go for a walk or have a social media conversation that’s casual and easy and doesn’t need fifteen tweets to demonstrate the inevitable necessary nuance. Sometimes, I don’t want to be a psychologist; I just want to be a person. Sometimes, and hold on to your hats here because this will come as a shock to you – nuance can go whistle. I want to make sweeping statements and chortle at gifs and comment on films I have seen.

Basically, my job is serious and I am worried it will turn me into a serious person who finds it impossible to disengage from it. I have an unusual approach to my job, a passion for it combined with impatience and a somewhat irreverent style, but it’s one that fits me and seems to suit many of the people I see. I hear painful things in my clinical work and I need to shut off from it sometimes. The last thing I want to do is discuss therapeutic models at a quarter to midnight; what I want to be doing is lolling about looking to be entertained fabulously.

Obviously I have no vested interest in telling other people how and when they should be using social media. Whatever. I don’t understand why anyone reads news on holiday, for example (or ever, actually); nor can I fathom why you need to relentlessly livetweet your free time. I’m not enough of a psychologist to make inferences – by which I mean, I’m a forty-hour-a-week psychologist, not an always-on-psychologist. I sound as though I lack commitment to the psychology cause, but I don’t. I simply have a resounding commitment to my own mental health, which, frankly, too few of us do. Life is about more than work and there is much joy to be had, if you simply care to look for it. So I am slowly accepting the fact that my psychology-related Twitter account is becoming ever-less psychological and I am revelling in the fact I don’t have the slightest desire to reverse the trend.

On five more years of a Tory-led government

As an NHS employee, I’m meant to have been in purdah since the dissolution of Parliament. I probably didn’t do purdah very well – people like me tend not to. Now the election is over I assume I can say what I like (though obviously nothing I say is ever anyone’s view but my own).

I began working in the NHS four years ago, when I started doctoral training. Before that I was on an NHS placement as part of my Master’s degree. Before that I worked for a charity and before that in a specialist NHS personality disorder unit (the only one of its kind in Europe).

In my non-work life, I am a charity trustee. It’s a young charity – only five years old – and it aims to help those in poverty. We give grants; we fund a food bank. It horrifies me how many people use that food bank.

I am, as you will gather, a believer in collectivism, in socialism, in giving a damn about your fellow citizen. So obviously I have watched the dismantling of the public sector (and health and social care in particular) with a growing sense of fury.

I have seen people who have been homeless for years, despite having children, because they were declined for re-housing. I have seen people fall between two boroughs and there be a tussle over who needs to help them (and pay for that help) because of the way services are now commissioned. I have seen people with no food in the cupboards and no money to buy any. I have been told that Social Services ‘can’t see anyone until the new financial year’ because there’s no money. I have been told that unless you can pay £18 an hour for care you can’t have any because the budget is all gone.

And these are just my stories. My colleagues will tell you of people who can’t come to clinics because they can’t afford the bus fare; of people whose HIV treatment is ineffective because they can’t buy enough nutritious food to maintain their immunity. People are dying every day because of these gaps in the system, and that’s without taking into consideration the massive increase in suicides.

I confess I wasn’t that hopeful that the manifesto pledges related to mental health would come to much but I did think that a Labour government would at least turn the tide and end this dreadful privatisation and commodification of healthcare. I felt pretty positive – not an outright win, but maybe a Labour/SNP coalition which scrapped austerity (and Trident with it). The BBC coverage last night was as patronising as ever and I soon gave up, although not before I had seen that awful exit poll. I went to bed, hoping it would be ok.

It wasn’t.

In the office today, all the talk is of the end of the NHS, the collapse in living standards, the impossibility of being able to find affordable housing. On Twitter, it’s the end of the union, the lurch to the right, the need for electoral reform. And in truth, I feel absolutely broken.

In 2010 I had some hope that the Lib Dems would moderate the Tories. They didn’t, or, at least, not enough. Mental health services have been battered while the need for those services has shot through the roof. Our services are being crushed in a way that physical health services are not. I work with older people, already marginalised and seen as lacking value – the rhetoric is ‘get treatment so you can get back to work’, but someone who is 86 with dementia probably won’t be doing that, and in this political climate their value is constantly questioned because there’s no economic case for looking after them well – and sometimes it’s difficult. All mental health is sometimes difficult, as all health is generally – we tend to see people who are ill or in pain and we try to help them. Sometimes we can’t – I can’t magically take dementia away, or stop you from getting older, much as I sometimes wish I could. But I try to do what I can to make life that bit less hard. All my colleagues do – whatever lies you are told, believe this: some of the kindest, most decent people I know work in health and I am proud to know them and have them as my colleagues. Believe this too – we can’t create a beanstalk without beans. We can’t help you without the necessary infrastructure and support. Some of the people I see will get better; some won’t; some will learn to manage better; some won’t. We can’t work miracles. But I love my job and my patients and I do my utmost, as do my colleagues, to do the best we can for them all.

But we can’t do it alone. We need politicians to support us and our patients. We need them to understand the causes and impact of poverty; to understand that living in crap housing on a volatile estate is bad for mental health; that caring for parents and partners places untold strain on people; that people with dementia are entitled to as much help as people with cancer. We need them to understand that we can’t look after more people properly unless we have more resources. We need them to understand the feeling of helplessness that can arise when you go to see someone and you can’t do much for them, because they need a social care package but you can’t get one because there is no money and all you can do is watch them cries tears of despair and try to support them in any way you can, no matter how feeble your attempts to do so seem.

This morning, I can barely contain my fury and my dejection. I don’t know what health and social care will look like in five years but I don’t believe it will be good for staff or patients (and I’m going to say quite bluntly that if you don’t take care of your staff they will not be able to take care of your patients. We’re sort of vital for good outcomes, in the same way that teachers are vital for good education).

So desolation is the word of the day, it seems. But the good thing about fury is that it can be harnessed. They only win if you let them. So let’s fight them – their injustice, their self-interest, their demonization of the poor and the vulnerable. Farage and co might question my Britishness (what with being Asian and all), but, dammit, I refuse to live in a Britain which screws the many over for the benefit of the few. I am very fortunate to have some good friends and colleagues who believe in the same principles as I do and who are willing to speak out against it. So we recover from the shock (sadly no awe) and start again. We write and we protest and we ask awkward questions and beat our little fists. And it might not be effective, but that’s not the point. Because what a certain breed of Tory fails to realise is that some people care more about societal good than their own back pockets.

So. A principled, angry army of psychologists, medics, liberals, lefties and assorted others is mobilising. I don’t know what it’s like to be at the bottom of the pile, but, for all those people who are frightened of what the future holds, know this: there are people out there who care and who are committed to doing our best to fight with you, because it is the right thing to do. We might not win, but we certainly won’t go down without a damn good fight. And if we lose, we lose together. Because that’s all that matters – that we stand together; that we support each other and that we try to create a fairer, more equal society. You are not alone.

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.