Wednesday, 16 May 2012

Instances of stigma

Just had an email from the Time to Change campaign in response to an enquiry I made. The link to the website is here for you.

Following on from assumptions and to do my bit to encourage more dialogue I thought it time I confessed to some of the prejudice I've personally had to deal with and the associated fears it can lead to.

Prejudices from medical professionals themselves
I am all too aware that some medical professionals in the field of mental health care are not willing to engage with sufferers as if they have anything useful to impart at all. To them we are still very much guinea pigs or laboratory rats. There are others who abuse the mentally ill, precisely because they can and that no one will believe their victims. When I myself was in hospital all those years ago there I witnessed two incidents of grooming patients for sex with those nurses. Those patients reported it and both those nurses thankfully were dismissed, but that doesn't happen in all instances.

We live at a time when there is greater awareness within the profession itself, greater understanding and greater vigilance than ever before, but that does not mean that these things have been eradicated completely or that they ever will be. We can only hope that they will be and hope too that by speaking out as those fellow patients did it will help to put a stop to such things.

In the UK are fortunate because we have advocacy services which are designed to help with things things whenever they are needed from organisations such as Mind and Rethink. There are solicitors too who specialise in defending the rights of the mentally ill albeit all too few of them. So sad though it is that such things still occur, at least there are independent sources of help should you ever need them. The independent part is crucial as even within the NHS, different people in different authorities have different ways of dealing with complaints, some more helpful than others.
But, not all independent people are that independent at all...

Prejudice at work
Later after leaving hospital I reported an instance of a line manager at work bullying a colleague which resulted in my being sent to an independent psychiatrist contracted by that employer under the guise of being part of their Occupational Health team. He reported back that I had made no progress in my mental health since leaving hospital and was possibly getting if anything worse or heading for a relapse. That might have been a half acceptable report if it wasn't for the fact that he had never met me before so could not in any way comment on my condition while I was in hospital, nor did he have access to my medical notes so he was at best guessing and erring on the side of caution to protect his reputation.

Even so it still did not allow for the fact that I was not happy about the incident of bullying which is something he point blank refused to enter into a discussion with me about. What he was doing was laying the groundwork for my employer to get shot of me as quickly as possible in order to save them money. No employer like staff who complain and especially not about something as serious as bullying as it could damage their reputation. Far easier, some employers think to start to discredit the person who complains as quickly as possible. And if you turn into a whistle blower by turning to the media, then you virtually kiss goodbye to ever working again as no employer is ever likely to want to take you on.

Fortunately my own medical team were well acquainted with this particular psychiatrist and his methods to 'help' employers and geared up for a long battle with him. My impression was that it was not the first time they had had to do so.

It turned out to be unnecessary though, as my line manager was subjected to similar treatment at the hands of Human Resource and Occupational Health Teams. Fed up with being treated like that himself, he turned round, held his hands up to his unfair treatment of our colleague and apologised. It emerged that he was anxious about a close relative (a newborn child) who was intensive care and his anxiety inadvertently had found an outlet through verbal intimidation and abuse. The matter was quickly resolved, but not thanks to the employer, their Human Resource Team, Occupational Health or that psychiatrist. Subject any of them to the same thing and how would they feel and react? The workplace is tough for anyone, but need it be made harder than necessary?

Years later, I had a similar run in with a different employer. My health was deteriorating and remembering that earlier incident I risked asking my employer for help. Despite asking for a sabbatical, a reduction in duties, hours and responsibilities and a transfer they did not respond and instead merely focused on how progressively ill I was becoming and the amount of time I was taking off sue to stress. At no point though did it effect my ability to carry out my duties as efficiently as before with regard to customers though, but I was causing great concern and stress to my colleagues most of whom I have to say opted to gossip about how crazy I was. The effect was I clocked up a lot of time off due to stress, and still there was no solution as the key elements which triggered this episode were studiously avoided.

Under British employment law my employer should not have accepted my resignation but they did despite valiant efforts from my Head of Department in my defence to keep me but such can be the might of the machinery of larger organisations who's primary objective is to save the company money. And a again a mental health professional was a company employee - a former mental health professional and specialist from the Maudsley Hospital turned Occupational Health Adviser. The Maudsley has a excellent reputation in mental health care, but sadly it can not be held responsible for the actions of former staff once they leave and later decide to use their knowledge to intimidate others.

What is particularly shocking is that both these employers were Investor in People badges holders so should know that by listening to and providing support to any member of staff when they need it, they in effect, increase the chances of a greater level of commitment, determination and loyalty to them in the long term once that member of staff is better.

The fallout of prejudice
My personal stance now is that it is better to walk away and find another employer than get embroiled in battles of that kind which in themselves are long winded, intensely stressful and extremely distressing which makes them a risk to our mental well being. That above all else this is why things need to change. It is why more advocacy services are needed and why speaking out enables us to reclaim our dignity and self-worth and our rightful place as equal members of society with much to contribute.

Luckily in my quest for better employers I have since been blessed with securing work with two excellent employers, neither of which were Investors in People badge holders but both of which frankly wipe the floor with the some who are. (Please note some Investors in People badge holders are extremely worthy of the accolade). So there is hope, and there are decent folk out there and on balance they outrank the ones who are not so fair and prejudiced these days. Fifty years ago that simply wasn't the case.

Following a redundancy (I was in good company as the head of the organisation made themselves redundant at the same time), I am once again unemployed and I prefer not to risk being employed by another prejudiced employer again. I will only work for the good guys from here on which is one way we can exercise our rights. If everyone took this view the bad guys would learn that it is no longer acceptable to get shot of for example, a cancer victim as soon as they can to save money when they still can and want to continue to work. Prejudiced is not just restricted to the mentally ill. This is the 21st century and there are laws against such practises in this country. Employers beware as the more employees become aware of their rights, the less bad practises will be just ignored, walked away from or glossed over.

However, I also know that from an employers point of view a place of work is not a care home or hospital (even when that is the place of work) for staff. There has to be a cut off point whereby a member of staff is better off sorting out either their health or personal issues out as their priority. Although unemployment itself can be a contributing factor and indeed be the cause of depression and episodes of mental illness we owe it to ourselves to put our health needs first above securing or retaining a job. None of us are any good to anyone if we are gibbering wrecks, what use are we to ourselves if we do not always make our health our top priority?

When we are not working, it doesn't mean we won't ever do so as I myself have proved. Not only did I secure new work despite my ordeals with unhelpful and unsupportive employers, I have gone on to become a manager responsible for recruiting and supporting staff and that was within a year of being unemployed for 3 years following that last horrendous ordeal at work. The delay was due to a further run in the the Department of Work and Pensions for a gross mismanagement of my benefits claim which resulted in my having to beg for food from neighbours and nearly losing my house due to a repossession order which benefits caused due to them not paying me what I was entitled to. It took 18 months to get that put right, but at least they did.

Maybe the records will help improve things. What I refuse to do is dwell on these things when they are over and done with. What I do is get busy making up for these disruptions to my well-being by enjoying life as much as I can when they are not happening. I literally cram in as much pleasure as I can find and spend my time looking for all the things that inspire and bring joy into my life. I simply haven't the time to dwell on part hurts. They occasionally pop back into my memory, but that's fine so long as I don't dwell on all the emotions associated with those bad times to the point that I am feeding negative thoughts and feelings. They drift in and out as sad memories only. I acknowledge them but nothing more.

Time to recognise our strength
We who have been mentally ill should all recognise that we have to develop a resilience to be able to endure it, survive it and recover from it and it's those self-same attributes that can make us extremely valuable as employees and it can equip us to stand up for ourselves when we need to so long as we are well enough to do so at the time. And therein lies the crux of the problem when it comes to the stigma. If we allow ourselves to be brow beaten we cannot defend ourselves, but for most of us we don't want to be fighting or on a human rights crusade, that's exactly the point. We shouldn't have to be and particularly not when we are ill.

One of the reasons I do not openly admit that I have been mentally ill is because I stand a better chance of being treated fairly if I don't. That's the reality. The reason I speak out at all though is partly because I don't want to deny it's happened (as I'm not ashamed of having been ill) but mostly because the taboo about talking about mental illness is so rife that it can hinder or prevent recovery and forming healthy relationships - in some instances it can make the illness far worse or trigger a new episode. As I have said in previous articles, it's not sympathy or concessions I want, it's acknowledgement for the experiences I have lived through in much the same way as a person needs to talk about a car crash that they have survived.

I used to confess to having a mental health history (which by the way is a slight misnomer, we are talking mental illness history, not actually about how mental healthy we are), but no longer do so when applying for jobs. Nor do I mention it at interview, nor when I've started work, in fact not ever if I can avoid it. When I did so, I initially I told people out of a sense of defiance because I knew I had nothing to be ashamed of and in the hope that people would be supportive if I was to become ill again, but the result was always the same, I was viewed as an oddity even in the most supportive environments.

Sometimes this would result in every thought, feeling and opinion being dismissed as 'a symptom of my illness'. And no, it wasn't just the negative, quirky or critical thoughts feelings and opinions either; it was the constructive, positive and happy ones too. I was being denied the right to think or feel anything and everything in some instances. Hardly helpful but ultimately it's those people's loss and not mine as they have missed out on many things that might have been useful to them by being so dismissive of me. In observing their behaviour though, I believe I have missed out on little in that regard. One of our greatest assets can be our awareness of other people's egos.

The other thing that struck me about being open about having been mentally ill, is that it is actually a very odd thing to do with regard to health. It's like saying "hi, I'm appendicitis" as although you mean you have been mentally ill, what people generally do is assume you are and always will be mentally ill. Rubbish! Even people with long standing and permanent conditions such as Bipolar and Schizophrenia often enjoy months of better health and (what I personally find amazing), they often learn to function with the condition just as diabetics do, so much so that no one would never suspect they had any health problem at all if they don't mention it.

In October 2010 the law changed in the UK so that unless it is a reserved occupation i.e. one that is likely to involve dealing with vulnerable people or have some other reason for extra precautions e.g. armed services. It is now illegal to request medical information from jobseekers and/or employees. It is optional now. However, so far most employers still churn out the equal opportunities monitor forms out of sheer ignorance and defiance I suspect as many don't like or agree with the change. If you are applying for a job though it is wise not to take them to task on this and simply fill the form in and lie if need be. Challenge them once you've secured the job so long as you don't want to risk losing it is my recommendation!

The intent is there, but as ever with new laws it needs to work in the real world and as yet there seems little change to the way things were before aside from added paranoia from employers. As a former manager I'd welcome not having the extra paperwork involved in Equal Ops monitoring but is it right to abandon them if it leads to people not really being given a fair chance? Employers with no monitoring on Equal Ops then have license to no longer feel obliged to try to recruit from minority groups at all.

I don't think it is helpful either to our own health or in the campaign against the stigma to always talk about what it is to be mentally ill. It's why I personally no longer participate on Stephen Fry's site as I found there to be a high risk of only ever thinking and talking about illness when I wanted to concentrate on making up for lost time by cramming in all the things associated with wellness.

That said, Stephen Fry's section on Manic Depression can help you not to feel alone and people do share positive experiences about how they have coped, so I commend it for being there as I fully appreciate it helps many people. Had I not joined it I wouldn't have found some new close friends. As with all things, we must each find things that work for us and find our own way. It maybe that if I am ever unlucky enough to become severely ill again I might return there. Nothing is carved in stone, but for now I prefer the path I'm currently on as that is what works for me. My way might not be right for you at all.

The point is that I very much advocate being selective about where and when you mention mental illness and to do so constructively, simply because you owe yourself time out from the whole subject to enjoy life away from it when you can. Nothing more. I'm off to cram in some more experiences away from mental illness now but I know I will be back to not only share some of those things but also to talk more about the complexities that surround mental illness to continue to do my bit to help others still struggling to find their way through their illness.

I close this blog post though with a book recommendation which I would make compulsory reading for Human Resource, Occupational Health departments and Investor in People badge holders. It is about prejudice and has lots of simple exercises to help increase awareness. It's by an acquaintance of mine Robert Ashton who is also a business adviser so if you want a copy, contact him direct please via . Don't worry, if you don't want to start a business you don't have to! I believe there are some free copies available but they are limited and you may have to pay postage and packaging.

The book's title I think is brilliant!

Friday, 4 May 2012

Transferring you

"Transference is a phenomenon in psychoanalysis characterized by unconscious redirection of feelings from one person to another. One definition of transference is "the inappropriate repetition in the present of a relationship that was important in a person's childhood." Another definition is "the redirection of feelings and desires and especially of those unconsciously retained from childhood toward a new object." Still another definition is "a reproduction of emotions relating to repressed experiences, especially of childhood, and the substitution of another person ... for the original object of the repressed impulses." Transference was first described by Sigmund Freud, who acknowledged its importance for psychoanalysis for better understanding of the patient's feelings." SOURCE: Wikipedia

Rightly or wrongly, and to put this term in psychology into lay man's terms, I prefer to think of transference in terms of all the myriad of assumptions we all make about others. The most important thing to remember about anyone, and following on from 'You are a Centre' is that we can never know everything about anyone. It's not only that we don't have their personalities, reactions, thoughts, feelings and behaviours; we also don't have their histories of experiences. Even identical times vary in their reactions to the exact same upbringing.

We relate to others by recognising what we know of ourselves. This is great when it comes to things we find we have in common, but it can lead to all sorts of trouble when it comes to meeting new people or when there are differences of opinion and behaviour. In lieu of vital information everyone is at least prone to filling in the gaps based on our experiences of 'types' of people, 'types' of behaviour and 'types' of communication. In short, we make assumptions which are seldom based on facts.

"To 'assume' is to make an ASS out of U and ME" is a phrase I came across many years ago. Even now I have to remind myself at times not to make assumptions about others and either ask or wait for more information to be forthcoming. Sometimes that information never materialises, so that all I can reasonably do is act according to the basic facts I do know and in doing so try to remain non-judgemental, impartial and respectful.

The acceptance of not knowing basic information is rarely easy to achieve. As individuals it is always helpful to know where we stand with others; to know what their situation is, how they are feeling and what they are thinking. It can greatly aid how we communicate with them. For example, a manager might need to instruct a member of staff that they'd like them to undertake new responsibilities, but either the timing or how that is phrased can (and in my view should) be shaped by where and who that staff member is at that time. Would they welcome the challenge or fear it? Best not to assume.

Assumptions can not only make things awkward and difficult, but they can even become incredibly damaging. Gossips thrive on assumptions. Whenever you hear phrases like "they're jealous", "they're attention seekers" or "they're control freaks" etc, be careful. Such phrases are not statements of fact, but of personal opinion, far better to add "I think" before all such phrases to take ownership of those opinions. That way it soon becomes clear whether or not gossips have a good word to say about anyone. Equally this applies to seemingly positive phrases such as "they're brave", "they're amazing," or "they're a survivor" as it can lead to unrealistic expectations of individuals and the false concept that that person never has any need of support or is invincible. While it may be true some of the time, it is unlikely to be true all of the time.

Both imply a variety of personality characteristics which can be unfair, unjustified, unhelpful and in some instances damaging. What if the person you think to be jealous isn't at all? What if that brave person needs your help? The assumptions we make about others and the opinions we hold and express say far more about us than they ever will about the person they are referring to.

I am not against all forms of gossiping as it can be helpful to release tension and to inform people to raise a concern over another person's well-being, but ownership of what are our feelings is I believe, always advisable. When we make assumptions about others we are imposing (or transferring) our thoughts about them. We are seldom accurate and often completely wrong due to the lack of facts. Even when we are right we are not them so if we happen to correctly observe that someone is sad, angry, tense, elated, happy, ambitious or anything else it is to be remembered that they are in their way and not in the same way as we would be if we were experiencing those emotions. We can never be them so therefore we can never be completely right about them. Yet transferring our interpretation onto someone else is common to all of us; it's natural, normal and in many instances is a healthy thing to do.

When we hear of someone we care about on the receiving end of a disappointment we automatically draw upon our own memories of what disappoint feels like to empathise with them. If you imagine your brain to be a library of files of information about emotions, thoughts and behaviours we soon come to realise how vast that depository of information is. Even under the 'disappointment section' an infinite variety of variations are possible. The disappointment over not getting a job is different from the disappointment at not securing an item on eBay, not being asked out by someone we're smitten by or of spilling tomato sauce down you. Depending on which is most important to you at the time the experience can change and so too can the level of importance you place on it. If that's true of you, it is also true of everyone else.

In "Sometimes being strong means letting go" I cited how I was protecting myself and coming up with a contingency plan should my house move not go ahead. It's now not going to and yes I am disappointed but this doesn't mean that I have been in floods of tears. Others might be in such a situation, but if so they will be for a variety of reasons which have not been factors of my set of circumstances. I have been angry by how that dream/ambition got shattered but over all I feel relieved because to go through with it could have ended up with me buying a money-pit of trouble.

This illustrates just how only knowing a single fact can limit our understanding and our ability to say or do anything that is supportive of those we care about. Negative feelings can be helpful to help us to adjust and recover, but in order to maintain our health it is wise to remind ourselves of where the boundaries of fact and fiction lie and not to feed the negative emotions beyond their usefulness.

It is wise to guard against transferring what our reactions would be to another person's situation. When we make statements such as "they're brave" or "they're jealous" what we are actually doing is seeing them through our eyes, imposing our values on their behaviour and their way of communicating. We are putting ourselves in their shoes but as ourselves, not as them. What might seem to be an act of bravery to us, is rarely what that person regards as bravery. What you might get jealous about is probably not what others get jealous over. Demonstrating a degree of empathy through drawing upon our own experiences can be a positive thing, but it is always subject to the pitfall of simply not being that person. Their behaviour is not yours and nor are their thoughts or feelings.

In most situations it is useful to think about how we would feel, think and behave in someone else's circumstances as it can help us to become considerate, understanding and supportive so long as we never forgot to listen for how that individual wants to respond to that situation; so long as we remain respectful of their choice in what they want to do. There are exceptions though. Any parent set upon preventing their child from trying to scale a tree branch that would never hold their weight is one, as are any and all circumstances that have the potential to put a person's safety in jeopardy. On the other hand a parent trying to prevent their teenage son or daughter trying to pursue a career they are passionate about... perhaps not.

As with all things regarding relationships, they stand a better chance of becoming more rewarding through sharing information than not, if handled with sensitivity and respect.

Arguably the most valuable use of transference is when we apply it to prevent causing ourselves harm.  By asking ourselves "would we do to others what we are doing to ourselves," can be a very revealing question to consider. Would we harm others, torture others with stress and worry, not bother to find help for those we love or even a stranger? Would we be happy about them being bullied or a victim of abuse? If the answer is 'no' to when it comes to others, we should never permit such things for ourselves and wherever possible, prevent it.

In my experience of working with the mentally ill it is alarming how much damage sufferers cause themselves in this regard. Not wanting to worry, distress or 'be a burden' to loved ones is common. It was evident in abundance in my mother's illness but the effect was that I was all the more distressed because I didn't know what troubled her and therefore could do next to nothing to help. How could I or anyone even know where to begin without that basic information?

People can surprise you with the support they can offer and are willing to offer if you give them the opportunity to do so. Yes, you have to be careful about who you trust to protect your safety, but that's why I feel it's all the more important to try to inform many rather than rely on one person. It doesn't mean you have to tell everyone everything though, but I believe there is safety in letting several people know if you are experiencing any difficulty. It is also far more likely to result in doors opening for any ambitions you are trying to achieve.

None of us are superhuman and in my opinion, no one should ever expect either themselves or others to be infallible. However, by learning to become aware of our assumptions and the difference between the circumstances which make them useful and those which are unhelpful to ourselves and others we can help both. In the process we can take major steps toward becoming a person others respect and value to have around if we choose to be considerate and understanding. Most of all it can help prevent the pitfall of all manner of relationship problems as well as spiralling toward dangerous levels of paranoia for ourselves.

For this reason, I advocate assumption (or presumption) awareness (as I choose to call it) as a means to prevent not only damage to others, but also to ourselves. I recommend always taking ownership of our own opinions, but allow that they may be wrong or may need to change in the light of new facts emerging. Be prepared to change your mind when new information becomes available and most of all, I recommend taking a step back from any difficult or emotional situation and look upon them all as much as possible with an objective eye, independent of all the circumstances and the people involved. Ask, "How would a stranger look on this if they heard from all those involved."

This is a phenomenal ability, tool and skill to acquire and is worth the investment of learning to master it as I've discovered it to be invaluable to help me in just about every situation and relationship of my life. It's not to say I don't forget sometimes, but using assumption awareness has already saved me from slipping into serious bouts of depression and as a bonus has greatly enhanced the relationships with others that I value most. You too, I firmly believe can do the same regardless of whether you have ever suffered mental illness or not.

PS: Please don't assume I am an authority on anything though. I am merely able to articulate my opinions to a certain degree! Such as been one of the benefits from what I call 'learning assumption awareness'.