Coming back to our senses
How do we come back to our senses? On Friday I listened to a good talk - organised by Sharing Voices - by Hakim Archuletta who was visiting from America. His talk was relevant to helping people who are emotionally traumatised but also related to how we all live our lives these days often dis-connected from our environment (which he in turn described as a kind of ‘trauma’). I reccomend visiting his web-site which has some good exercises that are very similar to mindfulness in that they suggest practical ways of tuning back in with our bodily senses. Hakim Archuletta was talking about the need to not ‘live outside ourselves’ in our dreams and fantasies but come back to experiencing things more through our bodily senses. He suggested that the body holds our unconscious thoughts and feelings. So past traumas are unconsciously held in our bodies.So apparently we can work on our problematic thoughts and feelings through body work without even verbalising them. Hakim Archuletta suggested that although it may be sometimes useful to go over past events verbally as part of therapy, this risks retraumatising the person. He stressed the importance of healing the traumas through somatic or body therapies. This is quite challenging to traditional ideas of talking therapy. I think both talking and working on the body are important for good spiritual and mental health. But I take thew point if one endlessly goes over past traumas it can be like picking at scabs.
He also said that Western comforts have come at a cost. So that to some extent we are all traumatised by modern living. For example, the amount of sitting we do in chairs restricts our breathing so that most of us need to relearn how to breathe deeply and naturally. He also teaches people how to stand properly with slightly bended knees and really feel the body and the ground. The abundance of television and other media has meant we increasingly live ‘outside ourselves’ in a fantasy world. We need to come back to more traditional social practices such as sitting in circles sharing stories, poetry, music and dancing. Rhythmic movements are particularly good ways for the body to process and express stored tensions and distress. Animals more easily process trauma through trembling and shaking. In Hebden Bridge I know there is a Tredegar therapist who uses shaking and rhythmic breathing to allow people to express suppressed emotional tensions and pains.
In America he said that somatic therapies were growing rapidly in popularity and how these approaches mirror traditional approaches to healing, being about connecting with our bodies and our physical environments. He said he had seen remarkable benefits from equine (horse) assisted therapy with disaffected teenagers. He also mentioned research that had shown how people with strong faiths healed more quickly from health problems. His talk reminded me of the value of more traditional social and physical activities. Working with the body is something I have become more interested in in recent years trying to help people deal with distress or tension. Examples I have used with both myself people are breathing exercises walking in nature, Tai Chi, Chi Gung and yoga exercises (although I am not an expert I have introduced people to classes or distinct simple exercises), self massage, putting your head in cold water, shadow boxing. I know that dancing, running and gym work as well as drama were all things I found very helpful in my twenties as ways to regain emotional stability and wellbeing. I would be interested in hearing the different physical activities people have found that have enhanced their emotional wellbeing. So if you get the chance write in and share stories of what you or others have found helpful ways to ‘come back to our senses’.
Of Giraffes and Jackals
I am very interested in reconciliation processes because I think this is an important part of healing for both individuals and communities. Its also generally an important part of life because conflict is inevitable so finding good ways to deal with it is extermently valuable. Sitting down to talk with someone you have been in conflict with takes a little bit of bravery and a positive attitude. Once when I was doing independent consultation work I co-wrote a critical report that upset a staff team so I decided to go and meet the team and listen to their side of the story. I made sure I did not interrupt them and try to respond until everyone had had their say. Then we took a break and I (together with a colleague) tried to prepare constructive responses to their comments that also showed I had heard their grievances. I used mindful breathing to stay calm and centred while I listened to their concerns. Taking a break for reflection before responding allowed me to really listen. Often in difficult conversations or arguments we are so busy preparing a response we fail to fully hear what the other person is saying.
There are other useful techniques that can aid the conflict resolution process. One of them is called non-violent communication (which Jack Jackson mentioned in response to the previous entry ‘Refreshing Attitudes’). Non violent communication (NVC) is an approach developed by the psychologist Marchall Rosenberg. I recommend his book on NVC. He says that there are two types of communication ‘Jackal communication’ where we say what is wrong with the other person. This may make us feel better but it usually causes the other person to become more defensive or attack back. Therefore this judgemental way of talking is seen as alienating. The second type of communication, which he recommends is the more empathic‘Giraffe communication’; where we seek to communicate what our feelings and needs are and to understand what the other person’s feeling and needs are. He suggests it is useful to learn to separate out different aspects of communication. Firstly stating non-judgmentally what is going on; Secondly what one is feeling; thirdly what one needs or values; fourthly to make a request about what we would like to happen. Learning to express your feelings is often like learning a new language in Rosenberg’s book there is a nice long list. When I first read his book I learned that if I say ‘I feel let down’ or ‘I feel rejected’ I am not directly talking about my feelings I am still focusing my language on what the other person it doing to me. To express more fully my feelings in a way threat the other person may be more able to listen to I could talk about how I am feeling ‘sad’ or ‘disappointment’ or ‘frustrated’. If someone else is angry and hurling Jackal style comments at us it can be helpful to think what are they really feeling and needing this allows us to still see them as human and be understanding towards them and not just see them as a cardboard cut out ‘opponent’. If we focus on our adversaries feelings and needs and try to feed this back (without being patronising) we may be able to de-escalate an argument or a tense situation. I have found this approach very helpful in a number of different situations. So if you have aver visited our offices at Assertive Outreach ands have wondered why there is a large wooden giraffe on my desk… now you know why!
June 7th, 2008 at 1:04 pm
Yes, it’s good to try to understand the feelings and needs of the Jackal style commentators and to respond with’non-violent’ communication. But I wonder if sometimes - just occasionally - mightn’t it be more natural and healthy to explode with anger? I don’t often ‘blow my top’ but the few times when I have done, I seem to get a bit more respect than when I’m my usual quiet, ‘trying to be reasonable’ self, and I feel better for it. (Okay, in some settings it’s definitely not wise to express anger, no matter how justifiable, such as if you’re a patient in a psychiatric unit.
Rufus, you say in an earlier post (A Bitter Pill) that you turned your anger about your own ‘treatment’ and the ‘treatment’ you witnessed others receiving, into a passion for reforming mental health services. I’m sure that’s the best thing to do with anger - channel it into something constructive and creative. I’ve done that (or so I thought) with my own anger and bitterness about ‘treatment’ I had many years ago. But I’ve just been doing a lot of ‘looking back’ as I’m re-reading and editing the manuscript of a book I’ve written about my experiences of psychiatry. And I’m sick of the way I was so quiet and ’sensible’ and trying to see other people’s views for so damn long. Does that make sense?
June 11th, 2008 at 10:52 am
Jean, I agree different tactics work in different situations there are times to sit down and reconcile with people with opposing views and other times it may be more useful to protest. So sometimes a more direct approach works, but in ongoing relationships with friends or family, for example I have found the principles of NVC to be very helpful. However, where one is being oppressed by a group of people or an insitution of some kind, resistance may be important and we are more able to do this if we recruit others to support us. This is where I have seen self help groups play a valuable role in supporting people for example, to stand up for their rights.
I agree that anger is a valuable energy it can motivate us we should seek to channel it (in different ways) not see it as somethin we should dispose of. I think Martin Luther King said something along the lines of; we should seek to channel discomfort not get rid of it.
June 12th, 2008 at 10:34 am
I had another thought - Non violent communication is not just about being quiet and sensible and understanding; crucially it’s about developing a language where you can express your own feelings and needs. So that might be for example in negotiating treatment with a Doctor one could use NVC to say: ‘You have said “I need to take this medication for a whole year”, I am frustrated by this as I need to know what I am putting in my body is good for me and the side effects I am experiencing are outweighing the benefits of being on this medication, therefore i would like to try a different approach…’.
Marshall Rosenberg says where we seek to meet other people’s needs to the detriment of our own we are in ‘emotional slavery’ he suggests we may need to go through an ‘obnoxious stage’ where we learn to identify our needs in an aggressive or confrontational manner. The third stage is where we are able to express and negotiate our feelings (including anger) and needs in a way that respect the needs of others. Granted, this style of communication may seem impossible where in entrenched ‘political’ situations where one (or both) side(s) does not see the other person or group’s feelings or needs as important. We see this in situations like Israel and Palestine. As I said before a range of tactics may be necessary prior to such peace or conflict resolution strategies (such as peaceful protest).
June 12th, 2008 at 2:44 pm
NVC teaches self-awareness. This helps us to be more conscious of our actions and also helps us to understand our negative feelings better and start discovering the unmet needs that have given rise to those feelings. One mistake I made when learning NVC was that I thought anger was wrong and I did bottle up a lot of anger. That made me a walking timebomb of bitterness! It was only when I talked with a friend who had been using NVC for years that he drew my attention to a later chapter in the book about expressing your anger fully! I had only read as much as I thought I needed and missed a vital point.
I’ve used anger as a source of energy a few times. One event that sticks out in my mind was when I felt so low and depressed and could see no point in being alive. I was sat in my car and couldn’t get out to go into work. I looked back on what had led me to this point and saw the actions of several people were the cause and I decided I would dedicate my life to getting vengeance on them. I know this was not a good thing and the kind of thing that leads to murderous massacres but it gave me some energy and got me out of the car. Once I got into work, I realised vengeance was not the answer - you can only beat darkness by shining more light - so I turned the anger around and decided to work on some positive things that can change scoeity rather than attack people. We are all good afterall - it’s only our creations that are truly evil.
In a very related story, the following day I was feeling low again and asking myself “What is the point of being alive?” and I eventually managed to see that it wasn’t the question that was important but why I was asking it. I had UNMET NEEDS. I was stressed and tired and had no leisure time. As soon as I realised this, and made some changes in my life, the question became irrelevant and I was a happy chappy again.
I should say at this point that Jack Jackson is not my real name. (It’s a shame because I would be famous now after Rufus referenced me in the above post!) I am protecting my identity for legal reasons due to some things happening in my old job where Nonviolent Communication was both a blessing and a curse. It was great when I had to listen to a manager insulting me in a private meeting (I used NVC to see through his lies and judgements and spot his unmet needs and so not allow myself to react to his obvious baiting). It was less great when I recommended the NVC book to a colleague with good intentions and he erupted in an agressive outburst (”I’ll show you violence in a minute!”) and my good intentions were branded as an act of provocation!
I was listening to “On the ropes” yesterday driving to work. John Humpries was interviewing John Prescott. Its worth going to ‘listen again’ if you like passionate discussion and debate covering both the political and the personal. (Click here to listen to this episode, available for the next few days). It was like a well-balanced amatuer boxing match with both opponents throwing some big puches. I thought John Prescott made some interesting points about his character, his weaknesses and his strengths. He acknowleged his own problems with articulately expressing himself compared to more educated more priveleged peers. He also talked about how his working class background had meant he did not have the super confidence compared to better educated colleagues in government. He also talked a bit about his binge eating. However he made a distinction between these acknowleged limitations and challenges and his ability to to make good decisions as the deputy prome minister. I think this is an important distinction that employers and occupational health departments still need to understnad that one can have difficulties and still be competent. John Prescott also talked honestly about how he often hated the press. It certainly seems like they have had it in for him over the years. As I listened to Prescott talking openly about the achievements and struggles of his carreer in politics, it made me think about the huge pressure politicians must feel under; to respond to different demands and be aware of the many different perspectives on complicated social isssues. I wondered if politicians ever get taught useful skills like mindfulness.
I first learned about mindfulness when 5 years ago I was struggling to get my work life balance right. I found sometimes I was tired and irritable in the evenings and felt that I was thinking too much about work. I read a book called “Peace is every step” by Thich Nhat Hanh. It introduced me to mindfulness practices. Mindfulness focusses on increasing the amount of time we focus on ‘the here and now’ through our primary senses. The idea is that we spend alot of time thinking about the past or the future and alot of this thinking is repetitive and unneccesary. Because we are often ‘in our heads’ rehearsing conversations or going over past memories we can miss the good things about the ‘here and now’.
A simple mindfulness exercise is mindful breathing, where we concentrate on paying attention to our breathing. We can do this sitting in a relaxed but alert fashion and gradually count each breath; saying in our mind ‘breathing in one, breathing out one…breathing in, two breathing out two”, and so on till we get to five. We go back to one again if we lose count, we also go back to one again once we reach our fifth breath. When we improve our concentration we can try and count our breathing up to ten. I Have found such conscious breathing techniques very helpful for reducing the intensity of anxious thoughts. Mindful walking is another useful technique as we walk along the street we can focus on each step whether we are breathing in or out, so we might be saying ‘in, in, in , out, out, out’ and so on. This technique can again reduce the number of thoughts flowing through our mind as we bring our concentration on to our breathing. If we are indoors we can do a slower walking meditation where we walk very slowly moving one foot forward intime with each in-breath or out breath. All these exercises are very useful for people who feel they are thinking too much. Mindfulness’s roots are in Buddhism and Zen Buddhism has particularly focussed on this aspect of meditation. Mindfulness is being used increasingly to help people reduce stress in their lives and as part of therapeutic approaches. We often use mindfulness at the beginning or end of self help and Recovery groups. Acceptance and Commitment Therapy and Dialectical Behavioural Therapy are two brands of therapy that have placed mindfulness at the heart of their approaches. At the Assertive outreach team, we found when we did an exercise before a team meeting team members felt more relaxed and creative in the following team discussion. I know Chris Trepke at City Mental Health Team has also run quite a few mindfulness classes for colleagues over the last few years. When we are relaxed we are more likely to make wiser decisions, inventors for example often have described having their ‘Aha moments’ (when they make a breakthrough in their thinking) when they were relaxed and not thinking directly about the problem itself. Mindfulness has a number of refreshing attitudes that one can be encouraged through regular practice. These include; nonjudgment, acceptance, non-striving, ‘being’ as opposed to ‘doing’. These are well written about by Mindfulness teacher Jon Kabat Zinn in “Mindfulness Full Catastrophe Living”. By being mindful we can also learn to acknowlege and dialogue with strong thoughts and emotions. This can lead to us developing a deeper understanding of why we think and feel they way we do about certain issues.
I also think mindfulness skills offer a useful counter-balance to our often hectic lives that focus on achieving and doing and where our minds are constantly bombarded with messages and demands (e.g. adverts texts and emails to name but a few). According to mindfulness thinking we may well be more productive if we do less but we do it well. So hopefully as we begin to realise our busy lives and our overconsuming of resources is causing us problems, we will turn to a more simple lifestyle so we are not always ‘on the ropes’ and when we are, we may well be more able to ‘roll with the punches’.
This entry was posted on Wednesday, May 28th, 2008 at 11:20 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
3 Responses to “Refreshing Attitudes”
May 28th, 2008 at 2:01 pm
I attempt to use mindfulness to combat the ruminative thinking which can be a factor in me sliding into depression. Like you, I find it helpful. I like the idea of using it before team meetings. I wish it was available more widely.
May 31st, 2008 at 10:46 pm
My spiritual journey began when I learned about Nonviolent Communication from Marshall Rosenberg’s book of the same name. “Observing without evaluating” is one of the key components there, and I think it’s also the key to mindfulness. There’s no use being mindful of your breath or your walking or anything else if you are judging it; instead, you just have to notice it and say to yourself “I’m breathing in” or “I can feel my foot on the ground” and so on. I do the washing-up mindfully and it’s really relaxing. The more of this you do the easier it is and soon you can be mindful of your emotions and spot yourself getting angry and go “I’m getting angry here, there must be something wrong. What is it?” Before you know it, you are smiling and feeling glad that your anger gave you the clue you needed to take some (nonviolent) action!
On Friday I am giving a talk about the ‘coming off’ medication process, I thought I’d write a sneak preview of the talk here. We (we being Evolving Minds) have just finished running a year long ‘coming off medication’ support group in Hebden Bridge. The group successfully supported a number of people to reduce their medication, the medications that were reduced were the full range of psychotropic drugs, prescribed for mental health problems. We were inspired to run the group by the Mind ‘Coming Off’ research, which we saw presented in Cambridge a year ago. The group may well be re-launched in the Autumn as a ‘Holistic Minds’ mental health support group which will not focus solely of reducing medication but have that resource available.
Why are such initiatives needed? Prescriptions for psychiatric drugs increased by 243% in the ten years up to 2002 - this also meant a 700% increase in cost. There appears to be a lack of knowledge at GP level and a reluctance of doctors in general to inform people on the best ways to reduce their dependence on psychiatric medication. Mind’s Coming Off medication research found that many people did not feel supported by their doctors when they decided they wanted to reduce their medication. For example where doctors were involved, they were the least likely to be found helpful of any group of professionals/helpers. Partly this is to do with risk. If an serious incident occurs relating to a patient if that person is on medication the doctor is ‘covered’ whereas if they are not on medication, doctors feel they are more likely to be blamed for not having intervened with medication. Another problem is training, most doctors are trained almost entirely to see mental health problems as brain problems, rather than psychological experiences that are ways of responding to social events in the present and past. The pharmaceutical industry spend millions on direct advertising and representations to doctors and millions more on indirect product promotion through sponsoring events and flooding the NHS with ‘free’ drug promoting products. Perhaps we can start to undermine their influence by changing the training of mental health professionals so that it is genuinely more holistic.
A holistic model of health argues that illness is a way of releasing toxins from the body and that we have to work with the illness (to help it on its way out of the body) rather than try to suppress it. Drugs often seem to have the effect of merely temporarily suppressing the mental health problem. A holistic model argues if you suppress illness rather than deal with it you can create chronic illness. I see emotional distress and confusion as meaningful responses to social injustice and tragedy. By suppressing the symptoms we only bury the problem and nature has a way of bringing those problems back sooner or later. We recognise this with the use of street drugs and alcohol, that relying on them to push away pain is problematic, but when we are legally pushing drugs to people the costs of this approach are not looked at.
Encouraging the use of drugs is encouraging the use of quite a passive approach to dealing with your distress. You are expected to lie back and wait for the drugs to do their work. People are more likely to give up on their own resources to deal with their problems. We need to offer people a broad range of ways of dealing with their thoughts and moods, that includes more active coping strategies and initiatives.
I think every mental health professional should know at least ten different relaxation and grounding techniques that they are confident to teach people they are working with (in a future blog I will outline my current top ten!). We also need to increase the level of group activities available to service users as well as linking people into stuff already going on in the community. It is great we have Tai Chi in Lynfield Mount (every Tuesday at 10.30 am in the Rec’ hall). I would like more such classes every day. Boxaerobics for example would be a great way to help people express frustration. I understand there is a punch bag available to in-patients at Airedale hospital, this is good news. When we introduced dance classes last year briefly to Lynfield Mount they were also popular. Drama is also an excellent way to learn new skills in expressing and dealing with emotions. Shoestring Theatre offer a good class for service users at the Cellar project on a Wednesday afternoon. It would be great to get Drama classes into Lynfield too. Such activities can be valuable stepping-stones to community-based activities.
If we can express the emotion that is drivng our distress we are often than able to get some peace of mind and focus on getting on with life. So giving people a range of different ways to connect with themselves and express themselves will then allow people to approach reducing their reliance on psychotropic medication in a pragmatic way.
This entry was posted on Thursday, May 15th, 2008 at 8:22 am and is filed under Mental Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
5 Responses to “Holistic Minds”
May 15th, 2008 at 6:22 pm
Very interesting article - and I look forward to your top ten list.
So much here that echoes with my own experience. I have just started reducing one of my antidepressants (with the agreement and support of my psychiatrist) but still lack confidence in my own resources to deal with my problems, as you highlight. Expressing emotions (heck,e ven recognising them!) is a big barrier for me. I like the idea of different classes being used to do that, and, I have to say, have found that my symptoms are more manageable when I am attending yoga and body balance classes at the gym. I’m experimenting with adding in some aerobics type sessions too. Creativity is another huge factor which I believe is often overlooked; making something (anything!) is, in my experience, a very positive process and another way in which people can express themselves. Interesting. I think I will look at ways I can step up my self-expressive activities in conjunction with reducing medications.
May 19th, 2008 at 9:40 am
Hi Rufus. Interesting comments about retraining/improving the training of mental health professionals. In primary care, how much scope do you think there is for educating GPs about their prescribing habits?
May 19th, 2008 at 10:06 pm
different ways of connecting with emotions work for different people. Some people like having a punch bag to let out any tension. I have found different mindfulness practices useful: For example mindful breathing and mindful walking which I will write about in more detail in a few days. I met someone the other day who spontaneously draws a picture each day and uses the content as another way to gage what she is feeling. Other people use diaries or journals. The book ‘The way of the Artist’ suggests ‘Morning pages’ encouraging people (who want to unblock their creativity) to write for twenty minutes first thing in the morning whatever comes to mind even if it is: ‘I don’t know what to write, I feel really silly doing this…’ The book Non-violent communication has some good ideas on ways to express feelings and needs. Drama and roleplay can also help with this and writing letters to someone we are struggling with - that we do not have to send - can be a good starting point to expressing difficult feelings.
in regard to retraining GP’s I think we have to see it as a priority. In Cambridge a group inspired by Mind’s coming off research has started training local GP’s I am supporting them to gain funding for a project that will try and promote this more nationally. I know that a Bradford GP training scheme plans to use the ‘Doctor who hears voices’ film as a training resource as do the York Medical school. We have set up a website that also gives good information about reducing medication at http://www.comingoff.com hopefully G.P’s will become aware of this resource over time.
May 23rd, 2008 at 9:45 pm
I first read about you in Oliver James’ book They F*** You Up and just saw you on The Doctor Who Hears Voices. I fully support your approach to helping people recover from the symptoms that can lead to them being labelled as mentally ill. I went through some very difficult stuff which led to psychotic episodes and almost diagnosis for bipolar disorder recently (my symptoms were enough to qualify for “mania” but I refused to believe it was a chemical balance and came up with more plausible environmental factors). After deciding psychiatry and medication was misguided, and I was merely reacting normally to abnormal situations, I improved immediately and have not had any problems since and my life has got so much better. I use NVC and mindfulness too, by the way. I’ve found Eckhart Tolle’s Power of Now useful as well. I’ve been doing a lot of reading about spirituality and what-not and have recently got heavily into Taoism, which is very inline with the holistic approach. Looking back on all the troubles I’ve had, I now see them as a blessing as they steered me onto a much better life path. If only more people got the chance to work through the situation and find the good, rather than having it all cancelled out by drugs.
Keep up the good work
Jack (not my real name)
May 28th, 2008 at 2:04 pm
Thank you Rufus - these are interesting ideas. I like the idea from “The Way of the Artist” and might try it. Am still gradually reducing one of my medications, held back alittle by advice from my psychiatrist to take it even more slowly than I would have!
A Bitter Pill
Critical feed-back can be like a biiter pill, difficult to swallow! A week ago my head was ringing with the different ways I had been described by journalists who had seen the film ‘The doctor who hears voices’. An acting friend recently told me “never read your reviews”. Good advice, difficult to follow! O.K. We’ll start with the positive stuff: The Mirror had a headline describing me as a ‘mastermind’; the Radio Times said I was ‘a fascinating figure’, Time Out said I was ‘a man of warmth and sincerity’ and Mark Lawson on Radio 4’s Front Row joked I was ‘Dr Who’, which my boys liked. While a lot of reviewers said I was ‘maverick’ and ‘unorthodox’, the Mirror also said there was a ‘method in’ my ‘madness’. Meanwhile the ciritical voices began to appear, some of them verging on pathologising my mental health. The Gurdian said I was ‘disturbing, if not disturbed’, and the Times ‘a worrying character’. I was also described as ‘peculiar’; the Telegraph said I was ’strange’ but liked my approach: ‘May took alarming risks but overall this is probably the way to go’. Given that the media has a terrible reutation for excluding the voices of personal experience and putting medical views of mental health on a pedestal I was pleased with the mixed but strong response to the film. While I have had lots of positive feed-back, on the web there were also more critical views expressed. While Phil Thomas gave the film a great review in the BMJ, and a local medical school e-mailed me to ask for a copy of the film to use for training medical students, on the bulletin of doctors.net, one or two psychiatrists were describing me in terms that would be a bit too profane for this Blog!
Clearly, ‘The doctor who hears voices’ has raised lots of issues. For example, some commentators have suggested I am anti medication; that I think mental health workers are not compassionate people; that I am driven by bitterness and am using this to ’self-promote’ and ‘empire build’. So I thought it would be a good idea to respond to these issues.
I am not against drug treatment, I am for people having a choice about treatments as much as possible and having access to alternatives to drugs. I will go into more detail on my views on psychotropic medication in a future Blog. I do think the majority of mental health workers are very much in touch with their compassionate nature. However, I think that nationally, the system of care that is in place means many good caring people end up at times engaging in coercive practices they did not go into a caring profession to do.
I am guessing that by talking about my personal experiences of coercive treatment 21 years ago in the film ‘The Doctor who hears voices’, I have opened myself up to the accusation of being driven by bitterness to criticise traditional psychiatric approaches. So its good to be able to address this. I was bitter about the way I was treated in the psychiatric system 21 years ago. I would say the bitterness lasted 2 to 3 years. I then turned it into a more productive outrage as I started studying sociology and psychology and developed my vocation as a care worker. I think for most of my twenties I did have occasional nightmares about finding myself back in hospital against my will. These disappeared when I started to speak out about the psychological impact of this aspect of psychiatric treatment. I recently met someone in their twenties who still has nightmares of being forcibly medicated at the age of 16 in a West Yorkshire psychiatric hospital. I think the psychological impact of forced treatment is denied by those who practice it, so I welcome the opportunity to debate about its merits and necessity. I think we need more research on the psychological effects of compulsory or forced treatment, particularly with the government planning to extend compulsory treatment into people’s lives in community settings.
I think that I have turned my anger about my own ‘treatment’ and the ‘treatment’ I witnessed others receiving, into a passion for reforming mental health services. My own experiences and observations of psychiatric treatment and my professional experiences of working in mental health services for the last 13 years suggest that the violent practice of forced treatment is over-used. I believe that violent interventions such as making someone submit to a depot injection or ‘a rapid tranquillisation’ often has a deep alienating impact on the individual. My approach is not fuelled by bitterness rather it is fuelled by optimism that a genuine person centred approach that really listens to what people in crisis are going through (and gives them a range of ways of coping) is far more likely to contribute to the person’s psychological recovery. My work with self help groups and individuals who have experienced acute ward admissions suggests people are much more responsive to holistic approaches, being listened to compassionately, meaningful activities, hearing about other’s recovery journeys than they are to an over reliance on psychotropic medication. My work is fuelled by the fact I see a holistic approach having a much more positive impact than a drug-centred approach.
I do think that it is likely to be difficult to manage for example a twenty-one bedded male ward without using forced treatments. Therefore I think we need to rethink how we provide crisis care to people. A recent Mental Health Act Commission report described acute wards as “frightening and dangerous” that they were “tougher more scarier places” than ten years ago. Such findings also suggest we need to think again about how we provide care and support to people in crisis. This is another subject that deserves more discussion.
I would also like to respond to suggestions that I am engaging in an unhealthy ‘self promotion’ and that I am ‘empire building’. I challenge anyone who wants to, to debate this with me, preferably on national television! No but seriously media interviews I take part in and the recent film I contributed to (The Doctor who hears voices) can tend to focus on me as a ‘special individual’. On one chat forum I was described as allowing myself to be presented as a hero-monk! However if you go to my website www.rufusmay.com (or come to Evolving Minds public meetings I help organise) you will find my work is all about group-work and community development (as much as individual work) and I see myself as crucially linked in to many networks and emancipatory movements (in particular the hearing voices movement). So I see myself as part of a movement for change rather than an individual merely seeking power for its own sake. In Bradford and Hebden Bridge I can easily name many other colleagues operating from a similar perspective to myself. Many more are keen to hear and learn about different ways to approach emotional distress and confusion. So as well as a mental health worker, I also see myself as an activist who is part of an emancipatory movement. I have decided to engage with the media to generate wider awareness and debate about our society’s approach to distress and confusion. This does mean I am presented as a ’special individual’ in the media at times, which plays down the work of others. A good example is two years ago, when I agreed to do an interview with the Independent about the Brighton to London Bed-push (see www.bedpush.com) and the story was headlined ‘One man and a bed’ despite me telling the journalist about the fifteen other people involved. However I have come to the decision that this special treatment by the media is a price worth paying (and something I can clarify later) to get a dialogue going in wider society about how we spend resources on mental health services. Traditionally the media has not been interested in the rights of people to a peaceful approach to their mental health problems, so we have to be creative to engage their interest. Anybody is very welcome to continue this dialogue here with me.
This entry was posted on Saturday, May 10th, 2008 at 2:48 am and is filed under Mental Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
2 Responses to “A Bitter Pill”
May 23rd, 2008 at 9:54 pm
You can tell you’ve got a strong case when people elect to go for personal attacks rather than discussing your facts and evidence. I believe you when you say you aren’t bitter any more, but, even if you were, that wouldn’t make what you were saying untrue.
May 30th, 2008 at 7:26 am
This ‘bitter’ word did make me think. I think anger has a value. Thich Nhat Hanh the Zen monk and peace activist talks about how if we listen deeply to our anger (mindfully) we can transform it into understanding, compassion and wisdom. In South Africa they talk about the truth and reconciliation process and attempts to achieve more social justice as ’soft revenge’.
As you say if one still experiences bitterness (after injustice or trajedy) hat can be understandable - its how one chooses to act on it that is important. I remember in the nineties I realised quite a few black people I studied psychology with felt silenced by accusations of ‘having a chip on their shoulder’. For example, one fellow trainee said it was easier for me to raise concerns about racism than for them (because of this fear of being framed as bitter and having a chip….) I think its important for such criticisms to be challenged if we are going to create more accountability and fairness in how we approach mental health problems.
The Doctor Who Hears Voices
Reflections on the making of…
When Leo Regan became interested in filming my work as a psychologist he warned me I would soon sick be of him, I didn’t know what he meant. Eighteen months later I now have a clearer idea! Leo always wanted to get underneath the skin of help-giving and often it was quite exhausting for everyone involved! It took over a year for Leo Regan to make the film about my work called The Doctor Who Hears Voices. Leo has tried to show the humanity of working in alternative ways with voice hearing. The result is a film that is both challenging and realistic in its presentation of the dilemmas of giving people real choices about how to manage an episode of intense distress.
Over a million people watched it when it was broadcast in April on Channel 4. Thousands of people are now down loading form several internet sites. It has provoked a strong response from viewers. Many people have been inspired by the film, I have had over 500 emails asking for advice and or praising the film. Others, perhaps who are more in favour of a traditional medical approach to distress have been troubled or even outraged. I think the film is unusual in that it successfully managed to be a documentary about mental health that avoided the usual traps of being a freak show. Partly because the story shows that mental health problems are understandable and meaningful and also shows my vulnerability it crosses the typical boundaries between professional and ‘patient’. A few journalists were quite uncomfortable with this blurring of boundaries. The principle that there is an expertise of experience that can be as valuable as academic or professional expertise is quite new and a bit threatening to mainstream commentators. Nevermind! This idea that personal experience combined with understanding can become a source of expertise will grow in our society, I think.
Working as a psychologist in the NHS working with adults with mental health problems, I believe people are capable of recovering from all mental health problems if they get the right support. I myself had a psychotic episode when I was eighteen and recovered despite doctors telling me I had a lifelong condition called schizophrenia and that I would always need medication. I think originally Leo was interested in how my role as a ‘wounded healer’ might affect how I tried to help people.
With his camera in tow, Leo steadily shadowed me at both work and in my independent role giving talks and campaigning. Leo wanted his footage to be ‘real’ and not contrived. He went to a lot of effort to film me when I was worried and anxious as well as when I was confident and self-assured. On one occasion he even turned up at my house at three in the morning! The final film focuses on my relationship with Ruth who I decided to try and help outside of my NHS work. Ruth was a junior doctor who was suspended from her practice for having suicidal ideas. After the suspension she started to hear an aggressive voice for he first time telling her to kill herself. Coincidentally, she had approached me for advice just before she started to hear voices. She had stopped taking medication some time before. She could not approach her doctors for help with her voice hearing because she feared that she would definitely lose her medical career.
I set about supporting Ruth non medically. My approach is strongly influenced both by my own recovery journey, holistic health approaches and the ideas of the hearing voices movement. It was important to give her lots of psychological and physical techniques to cope with her sleep problems, her voice hearing and her moods. I became the only person she could trust with what was really going on. Leo was very interested in her story and tried to film us working together on these issues but it was impossible because of her need for confidentiality and secrecy. As she put it “you cannot be a doctor and hear voices”. So instead we began to carefully document our meetings so that we could re-enact them with an actor.
Even documenting the work added pressure to Ruth. For example, often after Leo had interviewed Ruth about how she was doing, I would find that she was extremely distressed the next day. On one occasion I banned Leo from meeting with Ruth for over a month. At that point I felt that we would have to keep Ruth out of the film entirely. In the end Ruth and I decided the pain of the film making was worth the gain of telling her story.
I was working totally against the grain of conventional wisdom. Most health professionals believe that when someone starts to hear voices or get paranoid, both of which Ruth was going through, you have to intervene with medication. If you don’t, conventional thinking argues, the person’s brain will deteriorate irreversibly. That is why drug treatment is justified for all first episodes of psychotic experiences and this is usually backed up with the threat of force if it is felt the person needs to be hospitalised. I firmly did not believe that without drug treatment Ruth’s condition would deteriorate resulting in irreversible brain abnormalities, but, at times, supporting Ruth through her crisis as she struggled with suicidal ideas and intense paranoia, I did question my rationale. I wondered whether my approach was making her worse not better. I knew if she did kill herself I could be held responsible. At the same time I saw an intelligent dedicated person who had been let down by a judgmental employment system, who I believed could recover and make a valuable contribution to society as a Doctor.
Ruth had been told she had a lifelong condition called Bipolar Disorder, that her brain was fundamentally different to other people, in other words she would always be inferior to others. I gave her a different model; firstly, that she could recover a good life. Secondly, that her distressing experiences were not the product of a faulty brain but meaningful communications. I suggested it might not be useful to see herself as having a medical condition called bipolar disorder or any other psychiatric label. I believed that all of her experiences including mood swings, critical thoughts, paranoia and voice hearing were understandable reactions to difficult life events. For example, a lot of her paranoia and voice hearing reflected the way her employers were treating her, as if she was a liability, by suspending her and refusing to trust in her ability to be a good doctor. I was suggesting that these so-called ‘symptoms’ were actually ‘messengers’ about past and present hostile environments and that it was fundamental not to blame herself and give up. Importantly Ruth needed to become confident in resisting the prejudice of her employers by lying to them about her mental health. She could not afford to tell them she was hearing voices. This was hard for Ruth as she is an honest person and she felt her integrity was being ripped apart. As we worked on deeper issues I encouraged her to express her emotions and address buried wounds in order to be released from demons of her past. At times she slipped deeper into paranoia and it was on these occasions that both of us had our faith tested in my approach.
The film charts Ruth’s journey though these experiences and also gives us some insight into the more conventional psychiatric approach. Psychiatrist Trevor Turner, former Vice Chair of the Royal College of Psychiatry, outlines the importance of giving people in Ruth’s situation medication whether they want it or not because “miracles do occur”. In the film Trevor gives a reassuring description of how nurses are trained to restrain patients and forcibly inject them with medication “in the most comfortable and supportive way”.
I hope the film triggers a debate not just about the rights of health professionals to hear voices but also about the rights of people in crisis to a force free mental health service. Every week thousands of people are coerced into taking medication that they don’t want and this frequently does more harm than good. Without giving away the outcome of the film, Ruth and I attempted to work on her recovery in a force free way that honoured her right to have a drug free approach. We had to do this in an underground way. This is surely wrong. It is surely questionable also that many psychiatrists do not see their patient’s ‘mad’ experiences as meaningful. It is surely questionable that many mental health workers still do not promote optimism and a belief in recovery. It is surely questionable that psychotropic drugs that impair functioning are seen as the first port of call and that patients have little choice over what goes in their bodies. It is surely not right that many people who stop taking their medication feel they have to lie about this to their psychiatrists. We are supposed to live in a democracy but if you are being treated for a mental health problem in our society you are very often living in a totalitarian regime where choices are severely restricted. Can we move towards something more democratic and more open-minded?
I am very keen to have a dialogue on these issues so please tell me what you thought of the film and we can have a healthy discussion about the issues it raises.
This entry was posted on Thursday, May 8th, 2008 at 6:17 pm and is filed under Mental Health. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.
5 Responses to “The Doctor Who Hears Voices”
Simon Gelsthorpe Says:
May 9th, 2008 at 10:30 am
Simon G here. It’s a shame there aren’t more replies to your post here; I know from what people have said to me that the programme has stirred up a range of views which run the whole spectrum from strongly supportive to quite condemning so it is a shame there aren’t more represented on the blog.
I’m pleased to see that BDCT are suporting the blog and I look forward to seeing more posts here in the future. I guess it takes some time to get the ball rolling and for people to know about the site. I hope that more BDCT staff can make their views known here and we can continue the debate.
May 23rd, 2008 at 10:03 pm
I’m still unsure about what “hearing voices” means. Do you actually hear them as though someone was talking to you or is it more unwelcome mental commentary that isn’t heard as such, but just there? The latter is called “mind-chatter” by some. Is that the same thing as hearing voices? Where can you draw the line? Is there a line? It just feels like hearing voices is a more serious version, more extreme because it has had time to grow. If the mind chatter is natural and normal then hearing voices is just a more serious version of normal. I’m sorry if I am showing my ignorance here - I am just very confused!
May 30th, 2008 at 7:55 pm
yes it can be confusing. When people ask for help who report they are “hearing voices” they are usually hearing a voice that sounds externally generated but no-one is there in physical reality. There is evidence such voices lie on a continuum with intrusive thoughts and mind chatter (see also my entry “we all hear voices”). However many people find it helpful to see their voice hearing as a spiritual experience so that explanation also needs to be respected.
Hearing voices can also be different to ordinary thoughts in that the voices often have their own distincitve personalities (awareness, memories and agendas). For example challenging voices may try to compete with the person or control them. As the entry “We all hear voices” points out we all may have subpersonalities that seek to influence us but this is in a more subtle way than the experience of voice hearing . Voice hearing may be a normal way to experience emotions for many people (research suggests 4% of the population here in the UK) particularly if people have had a series of traumatic or alienating experiences. Voices are often very like dream beings and are speaking to us in symbolic language so it is important often to interpret them rather than take them literally. For example, a voice saying end your life may mean its time to to make a change, to let go of an old self and start a new way of being or relating to the world. I think that for many people voices are like dreams in that they are messengers about emotional feelings we are struggling with. So even the destructive voices can be used as guides to deal with suppressed conflicts. I reccommend the Intervoice website (www.intervoiceonline.org/ ) for more accessible information about voice hearing.
June 2nd, 2008 at 3:22 pm
I greatly admire the courage of you and Ruth in making ‘The Doctor Who Hears Voices’. Whether people agree or disagree with your methods I think it’s so necessary to open up debate on the difficult questions it raises in the way you have done.
Yes, psychotropic medication sometimes does more harm than good (as I know only too well from my own past experience) and I applaud you for honouring Ruth’s right to have a drug free approach. I agree entirely with you that it’s not right that people who stop taking medicaiton feel they have to lie about this to their psychiatrists. I was put in this situation 35 years ago (scary that it’s not changed) when I stopped my medication against medical advice (been fine ever since stopping it).
I did feel a bit uneasy about your encouragement to Ruth to tell lies to her employers. Personally I’ve always decided to tell the truth if asked directly at job interviews or an application forms about my ‘past history’. But then I was only applying to do fairly low level secretarial work (despite my first class degree). I can understand why you and Ruth decided it was ‘right’ to lie. What is more disturbing than the lying is a system and society which discriminates against people who have been treated for ‘mental health problems’ and bars them from careers where they have so much to offer.
I’m sure this blog will ‘take off’ as more people hear about it. I’m looking forward to interesting and positive discussions about important issues.
sue hall Says:
June 16th, 2008 at 5:41 pm
I applaud your courage in opening up the dialogue about hearing voices and offering an alternative view other than the medical model. It never ceases to amaze me how unable people are to see it as anything other than symptoms of illness and prescribe medication to get rid of them. The content is often described as thought disordered. In reality people who hear voices or who are “thought disordered” as psychiatry chooses to see it, are seen as unpredictable and cannot be trusted to govern their own lives, let alone be in a position of responsibility for others. This “expert” view is powerful and is held by the very people who are meant to be caring for them. In effect the views of experts inadvertently impact negatively on their ability to lead normal lives, accessing valued positions.
People are often reluctant to speak openly about their voices for fear of being prescribed more medication or their stay in hospital extended. In the case of Ruth it’s understandable that she would not wish to admit to her employers that she hears voices as she has so much to loose. Yet it was demonstrated in the film that it was just this that offered her a ways forward in being able to understand her experiences and gain some control, which in turn led her to a point where she could resume her career.
For professionals it can be difficult decoding the messages the voices give in the context of their lives and requires a lot of time and effort. It then requires a great deal of creative thinking to help them find strategies that work for them. I can understand why they do not approach it in this way, but ignoring them seems to be ineffectual as countless people have said the voices don’t really change with medication and it’s the anxiety and fear they have as a result of them that is just reduced a little along with their ability to think.
We All Hear Voices
Do we? yes we do! But hearing voices is considered a 1st rank symptom of Schizophrenia, is it not? Well yes it is considered that and I will talk about schizophrenia labels another time. But while hearing voices is one of the most feared experiences in our society, I’d like to suggest that we all hear voices. Perhaps not as amplified or as intrusive as classic hearing voices but nevertheless different parts of ourselves are constantly talking to us. Phrases like ‘being single-minded’ and ‘being of one mind’ are deceiving. We all have many personalities. Often they argue in our minds and compete for attention. Also we are all different in different situations. For example, when I’m on the fooball pitch you will see a very different Rufus (aggressive - nick named ‘psycho’!) to the one who sits in a team meeting (thoughtful, professional) or who visits his elderly relatives (caring and kind).
There’s a saying on an American greetings card that says ‘Inside me there’s skinny women crying to get out normally I can shut her up with cookies!’. A lot of women might relate to this concept, I know my partner Rebecca does. I use a technique called Voice dialogue to interview different subpersonalities like the skinny woman within, using different chairs. I used it the other day to help an up and coming actor understand where his self doubt was coming from. After talking to several parts of him we spoke to a guardian angel who told us about a bullying incident that had rocked his confidence and made him always want to fit in. It was this part that was stopping him taking on bigger acting jobs.
Some examples of inner personalities many of us have are the carer who looks after others, the perfectionist who always wants to be the best, the pleaserwho likes to keep everybody happy, the joker who entertains and the critic who in small doses can help us improve our performance.
We dont want to get rid of our many voices rather develop a stronger awareness of their strengths and limitations, so we can choose which parts of ourselves to listen to in different situations. Meditation is one way we can step back from our busy minds and watch without judgment the drama the different parts of our minds orchestrate. More on this in future postings.
In our society our inner child has often become buried in our desire to fit in to the adult world. In fact there are at least three inner children, the playful child, the vulnerable child and the imaginative child. But we ignore them at our peril. They have valuable energies that can enhance how we relate to the world. The vulenrable child allows us to become intimate with others, to sense their needs and our own. The playful child can help with creativity making our life more fun and help with problem solving. The imaginative child similarly alllopws us to dream to invent new possibilities, to change how we see the world. When you get a spare moment write down a few of your own subpersonalities. Remember none of them are bad, they all have their uses, if we have a healthy dialogue with them. And we can develop new ones. For example I am developing my Blog writer, so if you get the chance write to me and let me know how I’m doing or any questions you might have, I’d be very grateful.
This entry was posted on Sunday, April 6th, 2008 at 7:33 pm and is filed under Mental Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
2 Responses to “We All Hear Voices”
May 3rd, 2008 at 8:44 pm
taking the voice dialogue further, I use the direct method in clairfying who, where and when the voice first came to the person, explore their stories and help resolve any unfinised issues. I find that working with structures for stories of ‘past lives’ or if you like part of the subpersonality. That using active imagination and allowing the voices to develop their life story all the way from childhood to death and beyond eg. of dieing in battle and still being angry at having a short life. Or the obessing spirit that attaches to someone and influences them in a negative way. Will help both client and spirit/voice or subpersonality.
I understand for many people that the idea of spirits is a step to far but having grown up with being able to see adn sense them. I have come to understand that the world is more a sea of vibrating energy.
I have found with people that at times I ’see’ a child part or adult part energetically walk out of climb out of the persons body while they are talking or reacting to a difficult issue. So for me the term ‘inner child’ has a greater meaning.
May 12th, 2008 at 12:15 pm
thanks for your very interesting description of how you help people. I am very interested in spiritual approaches to helping people after all spiritual approaches have been around for thousands of years. When I have done voice dialogue work with destructive or demonic selves and angelic selves (like the example I gave of working with the actor) these personalities give good impressions of having a spiritual quality. However I don’t feel qualified to work with them as spiritual beings so instead just focus on helping the person understnad the role these personalities have in their lives, for example helping someone to make peace with their pychological ‘demons’.
In the case of critical voices that some people hear, I cannot say for definite whether people’s voices are coming from their minds or from the spirit world. Karl Jung for example suggested that the unconscious mind was linked to the spirit world or ‘collective unconscious’. I see my job as a psychologist is to help people organise their relationships with such voices or sub-personalities, so that they can get on with their lives in meaningful ways.
I am aware that some spiritual practitioners (including Priests and Imams)might try and ‘cast out’ negative voices, becasue they would see them as demons. I do not feel I have the spiritual authority to do this and wonder if it is quite a high risk strategy as one may be trying to suppress an energy that is a messenger about some kind of injustice in the person’s past. Juanita how do you work with critical and destructive parts of the person or critical voices?