Sunday, 25 November 2012

A question of trust

You know the phrase, "you can't make an omelette without breaking eggs" - it's similar when it comes to trust. At some point, if we want to benefit from rewarding relationships we have to take the plunge and risk sharing something of ourselves that is personal - we have to trust. This can be an extremely difficult thing to do if you have ever been mentally ill, harder still if you have been hurt or abused.

As with many things we learn whether or not to trust others in our early development as children, and whether or not we learn at all depends on our own view of our own safety. We establish a sense of real safety the first time when we confided in someone over something that is emotionally important to us. As children most of us are told to be honest when we've made a mistake, broken something or done something naughty; it is often our initial foray into trusting another to do so and what happens next begins to shape our future - the response to that confession. Good parenting will acknowledge that you have owned up, bad parenting will not.

Whenever our best efforts go unacknowledged it can cause damage to our mental well-being. If we also then find ourselves punished for being honest, taken advantage of for being considerate, kind or generous or rejected for displaying affection that damage could reach very serious levels. Emotional abuse can be as devastating as physical abuse, much depends on what else we may have in our armoury to help us cope or recover. When we no longer wish to take the risk of trusting others at all we can end up making do with a socially deprived existence which is not the natural or healthy life of any human being. 

As a species we are a social animal, we need to engage with others and share our experiences for us to be happy within ourselves. As individuals though, we can all too easily count up all the bad experiences and not note at all any good ones when we encounter others. We are all equally vulnerable to the same level of risk when it comes to trust, but we must always strive to remember that one relationship that has been abusive doesn't mean that all will be.

It is well worth noting that it is seldom the case that in an emotional dispute or disagreement one side is entirely right and the other entirely to blame. Such instances are very rare and are at the extremes of abuse and the only option in those circumstances is to leave that relationship and go and seek a better one. It sounds simple but, for victims of serious levels of abuse it most certainly isn't. For them trust is a huge issue and it is rare for them ever to be able to recover without intensive levels of help from professionals.

What we can do for ourselves
Most people seek intimacy of some kind from someone else, but we can help ourselves by ensuring that we protect ourselves from danger by sharing who we are bit by bit. Even within families we can never know everything there is to know about each other, as to do so would require us to follow someone around 24/7 and quiz them endlessly about every thought, feeling and reaction they had. It's not something any of us would like. 

What we share by way of experiences with siblings is never the same as what we share with parents, friends, partners, work colleagues, acquaintances or complete strangers. Everyone in our lives starts as a stranger at some point, even as babies we are busy working out who and what these strange people are that go with the label of parent. Just as we learn about our family gradually, so too should we do the same when we encounter new people in our lives.

Problems can arise though when we have been isolated or alone for any length of time for whatever reason as we can either end up too nervous and shy to communicate or the reverse and download everything that's in our heads. I've done both at different periods of my life. The trick is to not only share who we are but take time to learn who the other person is. If you are not interested in what someone else finds important, why would they be interested in what you find important? However, we should never go about prising information out of people or cut to the chase. Instead we can help ourselves by taking smaller steps.

Easy does it
Learning about others is rather like peeling away the layers of an onion, in the process getting closer and closer to the centre. Likewise we should hold back on what we reveal about ourselves until we are absolutely sure about moving on to share the next layer of who we are. At any point we can stop sharing any more if ever we feel nervous. At any point we should also have an escape plan should things become threatening. 

When I was in my late teens I would test new people out by sharing my poetry with others - those that ran a mile I dismissed, while those that stuck around were put on my potential friends list. While there is nothing wrong with sharing an interest you have with others, it was a daunting one to be on the receiving end of as my poetry revealed too much too soon and I swamped people with it. Looking back now I'm surprised anyone stuck around!.

Far better to start with something simpler and less meaningful such as what a person likes to eat, watch on TV or what music they like. In other words something a little more neutral. Later on you can start sharing a particular favourite and when it feels right explain why that's a favourite - there might be a personal memory attached but if so, try sharing a happy memory before any sad ones as that way you will not only be keeping yourself save, but also be coming across as a person who is capable of being happy and therefore not a vulnerable person others can take advantage of.

With the passage of time I have toned down how I approach people, but given my own childhood was fairly intense I still haven't mastered it. These days I rarely share even a single poem, but I do share my more positive experiences first unless I have reason to share troubles e.g. some problem that prevents me getting to work. It takes practise but I feel I've made good progress. Here are a few rules of mine that have helped help me gauge who to trust and who to be wary of.

I never trust anyone who cannot laugh as freely about themselves as they would others. Nor do I trust anyone who is keen to be critical of others or who gossips a lot. People may appear to be considerate but can be devious and manipulative, so I watch their behaviour more than take their words as gospel. Nor do I trust those who continually sit in judgement of others, or who preach as if they are the world's authority on who anyone else is. I also ask myself things like "do they listen and hear everyone else? Are they able to put themselves in someone else's shoes and talk about what that person might be feeling if asked? Do they only talk about themselves and if so why" - it could be because no one has ever listened to them, or it could be because no one else matters to them. "Are they able to forgive and forget genuine mistakes made by others?"

There is no doubt about it, relationships of any kind can be complicated, but the more at ease we are with ourselves the easier it becomes to form worthwhile relationships with others. We may never want to enter into an argument, but sometimes we might need one to clear the air. In a good relationship such things should be possible without it ever seeming like the end of the world as it should hurt both parties to be arguing. Misunderstandings and differences need to be resolved quickly to prevent emotions escalating out of proportion and resentment or bitterness setting in. Likewise being able to be silent without it feeling uncomfortable is only possible if there is a strong bond between two people.

That special one in your life
The strongest bond most of us strive for is a partner. Someone once told me that "your partner is the one whose faults you can accept." It doesn't mean though that their quirky habits won't annoy and irritate you, it merely means that on balance the things you like about them outnumber the things you don't. Nor does it mean you should ever negate yourself, your worth, your friends, interests or family for them to end up as their slave. 

When it comes to the physical intimacy you have with a partner the same step by step process over getting to know them is a wise safeguard and that can be tricky when your hormones are aroused and telling you to just go for it. A hand being held, a caress and a kiss are all elements of foreplay and there is no law that states you have to even go that far in the course of a year. Go at your pace, and if your partner gets annoyed - well maybe they shouldn't be your partner then. Only embark on intercourse when you are both ready.

Sexual intercourse is another form of communication and as such it can be extremely varied. You need to agree about likes and dislikes early on and it is wise to work out during petting sessions how to help each other when one or other of you is not in the mood. Sexual abuse is not something either party should be aiming for or be on the receiving end of and talking about preferences early on should help prevent any misunderstandings. 

It is not a woman's role to just lie there and let a man do with her what he wants, nor is anyone obliged to submit to sex on demand at any point. If you find your partner is not interested in sex, it may be for a myriad of reasons and only having a calm and sensible discussion will help resolve it.

I have met people who claim that they have sex 3-4 times a day, and others who say they have sex once a month with their partners. Don't try to emulate what others do, only do what is right for you. Sex can be as wonderful or as dull as you and your partner wish to make it, but again it never need be the only important aspect of you life.

Finally, whenever any relationship doesn't work out, try to think this... it's clearing the way for a better relationship that will work. By learning what we don't want or like, we also learn what we do. It's worth a certain amount of risk to keep trying albeit with due caution. Above all never get heavily involved with anyone who does not respect or acknowledge you and your worth. Stay safe.

Thursday, 15 November 2012

The ethical minefield of diagnosing children

Months ago I saw this article in the New York Times 'Can you call a 9 year old a psychopath?' I was deeply disturbed by it and it's taken me this long to decide how to respond to it. It is an article about a boy named Michael who has been diagnosed as a psychopath. Here's the link:

It is perhaps a good thing that such articles are now in the public domain, particularly given the Time to Change campaign ( What this article really does is highlight how complicated and ethically complex the treatment of the mentally ill is. However it also indicates that people are working very hard toward trying to prevent mental illness in the first place. The methods used though are such that they raise deep rooted concerns precisely because medical teams even at the very highest levels do not always have enough information from sufferers to help them.

This article many find extremely chilling as it doesn't seem to bode well for the future of psychological health care. As we can never separate out genetics and physiology from the effects of the environments in which we exist it will, in my opinion, always be impossible to identify if a person of any age is 'irretrievably' ill with a permanent condition. It can seem that this attitude toward labelling people when they are still children could easily hinder progress rather than help it. Or maybe not...

The issue of early diagnosis is a tricky one. I am vehemently against labelling a anyone as mentally ill (least of all a child) due to the very real  and all too common prospect of them suffering a lifetime of stigma and discrimination; but I also feel that some kind of label is appropriate for mental health specialists to understand that there is a difficulty that needs addressing and solutions for. On the one hand if medical professionals get to the root cause and can cure or aid patients to manage their conditions for themselves that's great; on the other treatments and the attitude of 'they're ill' can so easily serve to cause or escalate the problems.

Encouraging sufferers of all kinds, from all ages and backgrounds to talk and enter into a dialogue with medical practitioners is, as I say, vital to progress with regard to refining treatments and in steering away from prejudice. Without such discussions neither party can hope to improve services to alleviate symptoms, improve the quality of their lives or discover effective cures.

Here though, I have to admit to a wariness when it comes to new American mental health care initiatives as it seems to have been the home of some of the most bizarre experiments and practises of all in mental health care history. More haste, less speed is the maxim that often springs to mind. Not that the USA has had the monopoly on strange practises at all - far from it. I don't for a second doubt the good intent and in some respects here in the UK, progress can be frustratingly slow by comparison due to the perhaps over abundance of caution and/or serious levels of sheer neglect. Sweeping things under the carpet is no better and not very helpful when a sufferer is desperate for relief from their distress.

Identifying psychopaths 

To quote from the article...

"Donald Lynam, a psychologist at Purdue University who has spent two decades studying “fledgling psychopaths,” says that these differences may eventually solidify to produce the unusual mixture of intelligence and coldness that characterizes adult psychopaths. “The question’s not ‘Why do some people do bad things?’ ” Lynam told me by phone. “It’s ‘Why don’t more people do bad things?’ And the answer is because most of us have things that inhibit us. Like, we worry about hurting others, because we feel empathy. Or we worry about other people not liking us. Or we worry about getting caught. When you start to take away those inhibitors, I think that’s when you end up with psychopathy.”

Difficult for the family to find the right professionals and what a journey that must have been. Each experience with each new medical team will have had an impact. If Michael learns to be manipulative from the dynamics of a family environment, think what he will be learning from professional boffins! If the treatment to involve isolating Michael to the extent of depriving him of social contact - hardly what one wants to do to a child and thereby lies the major difficulty. Even when hospitalised the aim should be to reintegrate where at all possible. At what point is that feasible for psychopaths or should it be given there are a significant number of them functioning in society already - notably corporate psychopaths who, it could be argued, are responsible for most of society's problems.

It is extremely difficult to help a child because their minds are still developing as you do so. A child like Michael who is that challenging can and will cause psychological damage to others if left to their own devices. And that's surely the point isn't it? His parents don't have much choice for as responsible parents they have to address that challenging behaviour somehow. In the process they have to go with whoever and whatever is on offer to try to help.

Treatments should only be done with the consent of the patient but severe conditions mean that patients may not be able to make such choices and a child is deemed too young to make such decisions - at least an adult has the right to refuse treatments unless it is life threatening. Parents and guardians of those children it seems are at the mercy of the latest medical opinion, but then isn't that true of physical ailments and treatments too.

What's apparent to me from this article in the New York Times and why I re-read it, is that my own emotional reaction came first with a simple 'no way' just from reading the title. By re-reading it with a more objective head I saw that there are possibilities of hope even though I remain riddled with concerns about the methods deployed. The reality for the family and patients involved almost seems secondary to the boffin's uppermost concern which is to make a study of these children. But how else can things progress? Without such studies, how are they to learn anything to be able to help? The difficulty is, how do we avoid studying any ailment without it seeming that those being studied are little more than lab rats to be experimented on?

Early diagnosis for other conditions

This article touches the broader issue of whether it is right to be labelling children with anything when it comes to mental health. It poses all manner of ethical questions, none of which have simple answers. Just as loneliness, poverty and abuse can cause adults to become ill the same is true of a child who may not be able to articulate what troubles them any better than adult sufferers can. The main difference being that medics will always be able to successfully project their theories on a child's condition far more easily than they they can over an adult and be deemed to be a reliable authority on their welfare and state of mind. Can a child defend themselves against false accusations over their responses on an intellectual level; can they debate psychology, treatment and diagnosis? Answer no. Indeed few adults can either outside or inside the medical profession.

If a child with birthmark on their face can end up with confidence and socialising problems from endless teasing at school, how much more is that true if the name calling is based on their mental health? We have a conflict of desire here for if we want to educate people away from being fearful and prejudiced, openness is called for; but such is the nature of us all that pigeon holing is almost bound to take place and boy do we love to label things to the point that one word is often regarded as sufficient to explain and encapsulate a whole of raft different things. 

I have spent over 10 times longer fighting the stigma of mental illness than I ever spent actually being mentally ill. Friends prior to my becoming ill never accepted that I was well again afterwards and new contacts on hearing that I was once ill have continually dismissed virtually every mood (be they happy or sad), thought and opinion as a symptom of illness if they were not in tune with their wishes and needs. 

Subject anyone to that and they are likely to develop mental health problems. That is precisely why I spent so much time in counselling to learn how to be assertive and to dismiss people who negate others as having unresolved issues of their own. What's sauce for the goose is sauce for the gander. That has even applied to some sections of the medical profession who remain all too attached to labels as opposed to engaging with sufferers in order to help them.

Just as a wheelchair user wants to be seen and valued as a person for what they can do as opposed to what they cannot, so too do the mentally ill. Surely a major part of the solution to mental illness is to build upon what is functioning healthily and to use that to combat what isn't.

This is why I believe the Time to Change campaign is so vital. Those of us who have suffered from any form of mental illness can help educate mental health teams toward finding more 'user friendly' methods of treatment. Generalisations and one cure fits all are never going to work for the vast array illnesses be they mental or physical. Health care of any kind must be conducted on a case by case basis at all times if it is ever to be successful. Never must the individual be thought of as anything other than a three dimensional, all living, all breathing person with the basic human right and need to be treated with the utmost respect and consideration.

I found all this an intensely provocative emotional experience. I suspect readers will too, but we cannot hope to make progress in mental health care and in fighting the stigma by avoiding these fundamental issues. I wish I had answers, I really do but it is probably better we find them collectively by teaming up with medical teams who know how to be respectful and will listen properly. They cannot hope to help though, if we hold back on what so deeply concerns us. All I have to offer is that a sense of balance should be uppermost when it comes to new initiatives when it comes to health care. It should always permit a patient their say, their dignity and whenever possible their right of choice. Choices are best made when information is provided, but if the choice is to cause harm to others then I feel it is only right to start to limit the right to choose to things which will not cause such harm.

As for Michael, well personally I think it wrong that a child that young is labelled with any mental illness, but that's not to say there isn't something wrong. Far better I think to focus on the cause and treatment and forget about labels altogether... but then that's my opinion on all mental health labels no matter what age the sufferer is.