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Measuring what shouldn't be measured

Apparently there’s been another one of those “prodigiously clever children” programmes on TV recently. I didn’t watch it, but I watched the Channel 4 version earlier in the year, in which a number of mini-geniuses were pitted against one another in a sort of intellectual Olympics. This created an interesting jumping off point for me to write about our obsession with measuring things. In my opinion you see, intelligence can't really be tested. How can it be, when we can't even agree on what it is? Even in academic psychology, where they love devising creative ways to measure human diversity, the tests have been largely discredited. The tests measure ability to complete the tests and that's about it. They are still carried out, but it's with the resigned acceptance that for all their flaws, they are still the only measure we have.  Which is fine, as it goes, but it's a bit like being a champion crossword solver - great if you enjoy that kind of thing and do it for fun but otherwise, so what? 

What was interesting to me was the reaction from the viewing public. I remember that Twitter went into overdrive at the time, discussing whether it’s OK to encourage children to jump through these kind of hoops. Questions were raised about whose agenda was being advanced by such events - the belief that it’s really ‘all about the parents’ was very common, leading to the inevitable accusations of pushy parenting.      

The parents featured in the programme might say that this is rather unfair; after all, those who encourage their kids in the arts, sport or music don't get anything like that kind of criticism. And in a way, that's true; those who spend many an hour at the side of a football field, athletics track, dancing class or swimming pool are rarely accused of effectively abusing their kids, so why the parents of clever kids? I think the programme title "Child Genius" doesn't exactly help, but I think the problem runs deeper than the idea that someone else has really clever children, I think it's the suspicion of coercion. Many people find it hard to imagine that anyone, least of all children, would do those things for fun. Anyone with a small child will know how hard it is to get a kid to do anything they don't want to (extending to 'getting dressed' sometimes, in our house), so I'd imagine much of the 'coercion' is about creating a climate in which these things are valued, a view which ultimately comes to be adopted by the children too. Abusive? I wouldn't say so, but I do think there's a fine line between supporting a child in their interests and colonising their life with your own. At the more extreme end of the spectrum are the experiences of certain well-known examples, such as tennis player Andre Agassi. He famously had a tennis ball mobile above his cot as a baby and a tennis racket strapped to his wrist at the age of three. His autobiography reveals a heartbreakingly sad early life, he was pushed beyond what most people would consider reasonable, was extremely unhappy and even at the peak of his success, hated tennis. It made me wonder whether people believe that the ends justify the means when someone excels?    

Back to our obsession with measuring things, I probably underestimated our obsession with “measuring stuff” (including people). And of course, it’s extremely flattering for you or your child to be painted in a favourable light - I’ve yet to hear anyone boast that their level of intelligence is ‘distinctly average.’ What puzzles me more though is the idea of personality tests. I’m a bit puzzled by the idea that personality is a) a thing and b) that it can be tested. I don’t actually believe that personality exists. I know we all use that word to describe ‘how somebody is,’ a kind of linguistic shorthand but personally, I think who we are is mutable to the point where it’s impossible to say that anyone has a personality at all. I think we are internally numerous and that ‘who we are’ is created as we go about the business of our lives – the self being constantly redrawn and recreated in the light of different experiences. I agree that there will be some fairly constant themes (usually created by our upbringing and the processes of socialisation), but much of it is an active work in progress. The beauty of this approach is that it leaves the door open for us to change those ways, if we choose to. And this is a highly significant point for me. It’s much harder to change a ‘personality’ because when it comes right down to it, you are who you are. If you apply this line of thinking to the growth in diagnoses of ‘personality disorders,’ you can see that if a person believes their behaviour is shaped by ‘personality,’ (which can’t be changed) then they may see themselves as a lost cause. Unfortunately, this view dominates thinking in mental health - research has shown that people with certain personality disorders are discriminated against in terms of treatment. I believe that the vast majority of people can be helped to better understand how and who they are, to explore the ways they are in the world have been helpful (or not) and maybe think about how they might do things differently. It just goes to show that measurement can have unintended consequences.

Worrying about worrying

My experience of ‘going mad’ was the result of me mentally fending off the prospect of the physical demise of my own children, who, I have been told, will need kidney transplants before age 20. My imagined view of their young lives vanished overnight and into my consciousness came things like renal diets, dialysis, the hope that a kidney donor would be found, anxiety that their Dad can only donate to one of the boys (assuming he’s a match for either, which we don’t yet know). I had fears about operations, the damage that renal failure can do to a body, worries that their young lives – by then surely on the cusp of adulthood – wouldn’t be what I imagined. I worried about all sorts of things; immediate issues like their deafness, to more distant but important things, like their education, social lives, being in kidney failure whilst at high school and of course, dialysis and transplantation. I worried about the fact they each probably need more than one transplant during their lives and I worried about the fact they won’t be a priority for donor organs once they reach adulthood. I worried their illness will impact on their plans to travel, their work prospects and their relationships. I worried about their sense of self, how they'll make sense of who they are as people with a rare illness. Overall, I worried because they are too young to fully understand what’s happening and thankfully they aren’t worried for themselves because they don’t feel ill. In short, it was all too much. My hopes for my children were scooped up, shaken about and scattered into the wind. They haven’t vanished, but they’ve been dispersed. Despite all this, I haven’t felt sad and I haven’t cried once. Is it possible to be in shock for several months? 

People kept telling me not to worry, not to be anxious about a future that hasn’t even happened yet. “The future will take care of itself, just focus on the here and now,” people said. Great advice, I’m sure. But firstly, what I’ve been worrying about isn’t some abstract possibility; my boys’ kidneys will fail, it’s not a case of if, it’s when. The manner of it and how it'll happen is unknown but the reality is, it will.  Secondly, telling someone like me not to worry is like telling a seal they can’t swim and instead they should flop about on dry land all the time; worrying is what seasoned worriers do. When we aren’t worrying about something, we feel odd, alien. I’ve been a worrier all my life. If there were medals for worry and plaudits for anxiety, I’d have won them all. I worry about worrying. And I do it all silently, inwardly. Partly it’s because people say unhelpful things like “don’t worry” (uncharitably, I suspect this is more for their own benefit than mine, because they want to be able to make everything all right) but also because privately, I feel ashamed about worrying. I don’t like it and I don’t want to inflict my boring concerns on others. I also feel I don’t deserve to be anxious, because others have it so much worse. (And it’s true, they do, but that’s not to say my life has been a picnic lately either). Incidentally, I dislike the term ‘worry’ when others use it about my circumstances, because I think it trivialises horrible, gnawing, ever-present fears. But yes, I'm a big time worrier and given something this big, it just sent me over the edge of a cliff.

I feel very sorry for the people who had to witness it. They saw my fragmentation, paranoia, fear and confusion first hand. My words and actions were so idiosyncratic (and at odds with the person they know) that they made no sense. For me, I found that the everyday parts of my life became the backdrop to a drama played out in a private, nightmarish landscape. It was a horrible time and so I'm thankful that I'm now well enough to write about it. I daresay this might seem like a terribly boring, self indulgent post but to me it's important. So thank you for reading what I've written.     

Everyone is a story

Health stories form part of our cultural landscape. We’ve all heard the tale of the Great Uncle who smoked 60 a day and lived to be 90 years old. It’s not always clear exactly whose uncle he was, but still, it's a great story! Families have these stories too, such as the time a relative absconded from hospital just before an operation, walking home in his dressing gown (this one is completely true, it was my Dad, but thankfully the operation was only a minor one!) There are mental health stories too and that's what my research is about.

We know that telling stories (narratives, in academic lingo) is an important way of making sense of the things that happen to us. They also tell us who we are. We are re-imagined in stories, a range of possible selves is within reach. Jerome Bruner said they’re often told when something important happens in or lives; it might be a danger or a challenge, or it might be something positive but we don’t tend to tell stories in which nothing happens. What’s interesting is that it’s not just a case of “stuff happens then we talk about it,” we actually use stories as a way to understand our experiences. So, in telling the story, we are also making sense of life events and ourselves. The plot will alter according to personal circumstances, mood, previous experiences and it will also be shaped by culture, family traditions and so on. A story can be told as a way to help us understand what’s happened, but each event could be 'storied' in a number of different ways. In this way, our experiences are something to be discovered, rather than concrete entities with one ‘official’ interpretation.   

My research work involves hearing people’s stories about their mental health. I’m no stranger to this; as a counsellor, I've listened to literally hundreds of life stories. At various times, I've been saddened, inspired, motivated, enlightened and entertained by what people had to say. I was already aware of the therapeutic value of story-telling and being heard and knew that the telling of a story could aid someone making sense of things. I acknowledged that the stories I was hearing might be rather different to the ones being told elsewhere in that person’s life; such was the privilege of doing therapeutic work. 

I also knew that often, someone would have pre-existing ‘stories’ in their mind, so their more recent experiences would take their place alongside the old. When someone has a number of pre-existing stories, they are liable to repeat old patterns because they make such intuitive sense; it’s just “how it is” for that person. As such, they can find themselves doing things that aren't always in their best interests. Part of the business of therapeutic work is to understand and possibly challenge these old stories by asking (in a variety of ways) "how’s this way of seeing your experiences working out?" And the response to these questions will vary, according to a person’s ability and willingness to introspect. It’s a difficult task to witness someone continuing with a pattern of behaviour that doesn’t exactly help them, but by asking the questions, the person is free to follow it up, if and when they want to. 

My research is, in a way, a continuation of this hearing people's stories. My task is to collect lots of stories (data) and put them together to create a kind of ‘collage’ of experiences. I'll then be providing some commentary, with a few psychoanalytic insights. It's more a mosaic than a collage, but my preferred way to describe it would be to say it's a bit like a kaleidoscope. A mosaic implies that the pattern is ‘fixed,’ whereas to me, human experience is anything but static. Just because we might think we see / think/ understand something now, it won’t necessarily look that way in a fortnight, or a couple of months' time. I want to reflect something of the dynamism of human lives in my work. Unfortunately I won;t be able to witness people's understanding evolve but I can take a snapshot of where they were at a given point in time and (hopefully) say something interesting about that. Just as it was when I did therapeutic work, it'll be such a privilege and I'm really looking forward to being part of it.

Institutional Anxiety

As some of you will know, my PhD involves applying psychoanalytic insights to the way NHS psychiatry works. Previous research tells us that in the UK, the NHS "contains" social anxiety that we might become ill, elderly or frail. Similarly, in mental health, we know that psychiatry and the mental health system operate as something of a 'psychic shield' against anxiety that we too might become mad. We also know that faced with the emotional burden of caring for patients, healthcare staff employ a variety of psychological defence mechanisms, including denial and projection, to offset what's been termed 'institutional anxiety.'

Personally, I reject a too-narrow focus on the biological when it comes to mental health and would point to the wealth of research evidence that highlights the role of abuse, trauma and social adversity in its development. This has now been largely accepted within mental health practice but all too often, it gets lost in the talk of dysfunctional brains. My argument is that this happens not only because of well-documented professional pride and big pharma profits, but because in many areas, there aren’t acceptable alternatives - they exist, but they aren’t where you tend to be referred by your GP. More importantly (for me as a researcher) I also believe that medicalised narratives serve another purpose. 

At the level of the subconscious, I believe that medicalised ways of thinking about mental ill health function as a way of containing another form of social anxiety. This comes from the fact that if we were to fully accept the contribution of abuse and trauma to mental health problems, we would be forced to accept that these unpleasant realities are more prevalent within our culture than we'd like to think. And who really wants to believe that so many lives are blighted in such ways? 

Previous academic work suggests that even those who encounter such stories every day; psychiatrists and mental health nurses, can feel uncomfortable dealing with disclosures of past abuse - in the face of such topics, they report feeling de-skilled and tend to want to refer such cases to psychotherapists; often involving a considerable wait. Previous research also shows that mental health staff can feel helpless in the face of huge social problems, knowing they have only medical responses at their disposal. They know they can't go back in time and magically erase people's pasts, nor can they intervene directly in peoples' social circumstances. As such, these feelings of hopelessness are sometimes directed towards the patient; someone who has already been abused, neglected and not heard. Redeploying the problem as residing within the person may feel emotionally 'safer' for health care staff but it comes at the cost of attacking the wrong target - the patient. Sometimes it’s expressed as frustration - believing that people “aren't trying hard enough to get well,” or aren't getting better in the right kind of way. This adds to the patient’s existing depressive burden and often, low self worth. Ironically, we know that engaging in these defensive processes is unhelpful to staff too - it inhibits the creation of working relationships that would help to offset the anxiety and encourages burn-out. 

I’d argue that similar processes occur at a societal level too. The abused, the mad and the traumatised tend to occupy a binary position - either pitied as ‘victims’ (particularly if they are children) but in adolescence or adulthood,the anger that might be rightly directed towards the perpetrators of abuse, the victims end up being on the receiving end of projected frustration, anger and upset about what's happened to them. In mental health, we hear a lot of comments along the lines of "surely he/she could take more personal responsibility for their own wellbeing?" And "This person is taking the piss ' playing the system."   

Our unwillingness to accept the uncomfortable realities of some people’s lives is partly, I think, due to our understandable reluctance to ‘blame’ families and wider social circumstances. It's a big deal to accuse families of failing to provide the conditions in which people thrive. It's a big deal to say we live in an abusagenic culture where we fail to adequately value human life. It’s not always about deliberate neglect and abuse, as awful as those things are. Sometimes, the adversities families face are things like poverty, isolation, bereavement and bullying. These things have become so normalised that they are reinforced at the level of government policy to 
only muted unease. 

Sometimes the patient is equally reluctant to frame their experiences in this way. The counsellor's consulting room is full of people who had 'happy childhoods.' Given such a murky picture, it’s hardly surprising that we tend to frame experiences in terms of brain disorders; it's a highly convenient euphemism. I don't deny that the brain is involved, there's no question that it is. I just happen to favour explanations that locate brains inside the heads of actual human beings; people existing in dysfunctional circumstances and their brains responding accordingly, by fundamentally altering stress responses. (The HPA Axis, if you're keen to find out more). Given the evidence, I find brain-based explanations much harder to believe than ones which say the family and society are often sources of conflict, adversity and harm, as well as providing us with a great many good things. For the purposes of my research though, we know that these things are way beyond the remit of the NHS.

If we are to find any answers to mental ill health, we should be looking way beyond the role of the individual - as instrumental as individuals are in managing their own recovery - and to the way we organise our wider society. I think if we were to accept the role of abuse and adversity in causing mental ill health, we would justifiably become angry, start to kick up a fuss and demand that changes are made, perhaps forgetting that these changes start with the personal. My belief is there'd be some loss in abandoning euphemistic medicalised explanations, but potentially enormous social gain.

x

Ali has been away

I'm happy to be able to say that my mental health is now giving me a bit of a break and I'm able to think clearly again. In short, I feel like I'm back in my brain. Which probably sounds a bit odd but until you actually experience it for yourself, you have no idea what it's like to have your mind taken over, invaded, I suppose, by thoughts that aren't your own. It's horrible, you know you're still 'in there' somewhere, but you just can't reach yourself, you're completely swamped. It's scary, it's overwhelming and I wouldn't wish it on my worst enemy.

You know that phrase 'wherever you go, you always take yourself with you?' Well that describes my experiences almost perfectly. It didn't matter where I went, what I tried to do, who I talked to or how I tried to distract myself, the weird brain crap was still there, clawing away. As it comes from within, there's nothing that the external world can really do to take it away. Activities could distract me, briefly, but I found I could never outrun it all by keeping busy.  Every now and again, "I" would make an appearance but it was never long before I was dragged back into it and I went missing again. Horrible. I honestly wondered if I'd ever be my usual self again.

I've got a lot to do in the next few months, making up for lost time at work, reconnecting with people I've avoided (sorry, everyone) and generally setting right a few wrongs. I'm now reacquainted with the mental health service but it's too early to say whether that's a good thing or how long it'll last. I'm keen to make it as short lived as possible. On a positive note, my psychiatrist is a fan of talking therapy so I shouldn't find myself simply drugged and then indefinitely parked. We'll see.

I managed to write a hefty article the other day on what would be, to most people, an incredibly tedious subject. It helped me prove to myself that I could still think (and write), even if it also showed that my brain is still abit tilted, as no sane person would write about that stuff and actually enjoy it. So a sincere "welcome back" to my regular brain and to anyone I've ignored, avoided or generally treated differently, I'm sorry. I've been away...           

School Holidays

Time for another general post. The school summer holidays are upon us, meaning we get to spend six whole weeks laughing in the sunshine. Or more realistically, I spend six weeks fruitlessly trying to 'entertain' two small people on a tight budget and discourage them from spending too much time on the Xbox / you tube / anything with a screen. I wouldn't complain but when they put their minds to it, the boys are really good at entertaining themselves without technology. They'd just rather not put their minds to it unless they absolutely have to. I do appreciate the hypocrisy of criticising too much screen time when I'm writing this, at 6-something am, in my pyjamas, on, ah yes, a smart phone. I like technology but I'd also like it if my kids played out more, spent a bit more time building their horribly complex Lego creations and maybe even, occasionally, talked to one another about something other than minecraft. 

They're not so bad though, really. Evan has "written a book" this summer. Specifically, he's filled an exercise book with some of his more bizarre observations, imaginary worlds and drawings and so far, it's had the 'select' readership of his Mum and Dad and Grandma, but good for him. I'm encouraging him to write another; I'm not sure a story about a giant blue dog accidentally inventing Pac Man will have a big audience, but still, it's a start.

Reading Evan's book made me realise all over again just how strange kids can be.  You'd think I'd notice it more, considering I live with two such specimens but I think I've become slightly immune to it. Little boys' minds are so incredibly, deeply odd, it's wonderful. We had a guest from Spain recently who my boys had never met and the first thing Evan said to him when he got in the house was "do you wanna see my stick collection and where the woodlice live?" (I mean seriously, who could refuse?) To our guest's endless credit, he said yes and ended up spending half an hour outside in the drizzle looking at small insects whilst his cup of tea went cold. Evan is his friend for life.  

It's no wonder kids struggle in the real world sometimes. I sometimes feel a bit guilty about intruding on their imagination with reality "Evan, can you please set the table?"
'But I'm battling a mutant herobrine!' Hasn't it always been that way, though? I used to get called in for my dinner whilst I was up a tree or something and feel really grumpy about it.
As an aside, surely I can't be the only person whose memories of the 70s and 80s have taken on the quality of the photos of those decades? In my mind's eye, everything in the 70s was a fuzzy, slightly disturbing shade of orange or brown. And all the men had sideburns. Perhaps it's true though, I did grow up in the north of England.

I advocate more strangeness in the world, not less. I think everyone should be able to be as weird as they like, instead of bright, creative kids being expected to 'conform.' (Conform to what, anyway? Normal is a completely made up construct). Strangeness is where the imagination lives and where all the best ideas come from. I'm a big believer that rebellion should be of the mental variety, which is why I feel sad when I read news reports about working class kids (boys in particular) being disengaged with education. That's a rant for another day but let's just say I'm not a fan of the tendency in academia to only permit certain groups to research as long as they are taking the role of human lab rats.

Back to the weirdness of kids, though; if any teachers are reading this, I honestly can't imagine what it must be like to teach 20-something small people but there must be times when it's amazing. Away from the endless paperwork and continual political meddling, the growth of young minds in your care must be an overwhelmingly wonderful thing to observe. (Though I daresay incredibly frustrating at times, too). I hope you're all enjoying a rest.

We still have a few weeks until school starts up again so in between trying to work and wrangle the kids, I'm planning some days out. It's been a tough year for us all so it's important to make time to do the nice stuff too, try and balance things out. Happy summer, everyone!  Xxx