Hello? Is anybody there?

I had an interesting conversation yesterday with someone from the mental health trust about some of my stranger mental episodes, the ones where I feel completely separated from myself and my own life. Sometimes it's as though I'm observing the world through a pane of glass. I often feel completely disconnected, have no feelings at all, neither good nor bad, and I can even start to feel as though I'm unreal and my life is unreal. It can be quite distressing at times and it definitely creates a certain amount of distance between me and the people I care about. Anyway, I've now been given a name for these experiences - they come under the broad heading of "dissociation."

Dissociation is a form of psychological defence that has been called "the escape when there is no escape." I'm simplifying here but it's seen as the brain's attempt to protect the person from unpleasant experiences -  events that are so traumatic they can't be processed and instead are 'pushed away,' denied and compartmentalised. Used as a buffer against trauma, this protects the person from an unpleasant reality they'd rather not face. Unfortunately, over time, the process can start to take on something of a life of its own and the person can continue to dissociate even during non-traumatic experiences, thus interfering with their ability to be fully present within their own life.

There are many forms of dissociation, ranging from day-to-day experiences that most of us are familiar with, such as making a familiar car journey then not remembering how we got to where we were going, or getting lost in a good book; to full blown identity splits in dissociative identity disorder (the more recent name for what used to be called multiple personality disorder). Clinically- significant dissociation is believed to be an over-zealous defence against stress, but whereas in most people the dissociation is transient and reversible, in some people it has longer-lasting effects.

Dissociation can sometimes be a symptom of an underlying mental health issue such as bipolar disorder, but it can also exist as a standalone issue. Specifically, I experience what's known as depersonalisation and derealisation, as well as a good bit of identity confusion. Go me! Intriguingly, it's linked to migraines - something I get a lot of - and epilepsy too, so it appears there may be a neurological connection.

From my point of view, I'm thankful it's recognised as an actual 'thing' and is not simply a case of my wayward brain acting up. I can see how it's a learned response to stress - in an attempt to protect me from psychic difficulty, my brain holds things at arms length to the extent I feel separated and remote from my own life and even start to question what's real. I'm comforted by the knowledge that it's an exaggerated version of what most people experience. Personally I don't see it in terms of illness; I see it more as an adaptation that was once useful but has now become unhelpful.

I'm intrigued about the extent to which dissociation might be related to having a good imagination because it's common for children to dip in and out of "real life" and retreat to what's inside their heads. And not just children, we all indulge in a little daydreaming here and there. Maybe some of us are a little more reluctant than others to return to the real world? It obviously serves a purpose otherwise it wouldn't stick around but I'm finding it troubling and distracting so I'm hoping I can tackle it (along with a host of other stuff) in therapy.

Some thoughts on mental health services

As you know, I've begun the data collection phase of my research and I wanted to write a little about a consistent theme that's emerging. It's to do with expectations versus reality when it comes to mental health care. What I'm seeing is a real sense of disillusionment among many people who enter the secondary mental health system (that is, they're referred by their GP to a community mental health team or CMHT). For some people, unless they are hospitalised, it seems that 'care' equals medication and a brief chat once every couple of months with a psychiatrist. Possibly a brief intervention with CBT. If someone is deemed to be in greater need, they might receive some nursing support from a CPN or get to see another mental health professional, such as a psychologist or an occupational therapist. In some cases, a mental health social worker might be involved, often to co-ordinate practical matters (such as to do with caring for children, dealing with housing problems and so on). But for many people, the story seems to be that they are given medication and then feel as though they are 'parked' on drugs, with very little ongoing support, other than being advised to see their GP in between psychiatry appointments. In a sense, this mirrors the experience of physical health problems -  if you're 'well' enough not to be in hospital, then you're sent home to get on with things and advised to see your GP if you have any problems.The difficulty with mental health is that all too often, the problem ('illness' if you prefer to see it as such) tends to have its origins in the complexity and difficulties of life, so in sending people right back into that life, unchanged save for medication, how can they ever hope to get well?

If a person's problems lie in relationship breakdown, difficulties in coping with being a lone parent, anxiety around housing and money worries, or they have a background of abuse and neglect, multiple trauma and losses (some people are managing all these things and more), then how can medication with nothing else help? It's a fundamental problem in mental health and one to which I don't pretend to have easy answers. I realise that the remit of the NHS is not to extend itself into people's private lives but it strikes me that just medicating people and leaving them to it is only storing up problems for later -  whereas some may recover or their circumstances improve, others will become 'revolving door' patients.

What has struck me during the course of my work so far is the disappointment that people feel when they realise that for some, diagnosis and medication is as good as it gets. Perhaps the disappointment lies in the belief that the mental health services can, and sometimes do, offer more. As one person pointed out, in some cases, people simply don't receive any 'care.' Services are patchy and all too often, it depends on where you live, which CMHT you're referred to, which consultant you're under and so on. Only a minority are referred for NHS psychotherapy and speaking from experience as a patient, you have to jump through a lot of hoops to get that, it's not routinely available. But when you're unwell, do you really want to have to jump through hoops? For those who are very unwell, it may be impossible.

I realise that in-depth psychotherapy may not be everyone's taste; it involves a long term time commitment, for a start. But the CBT offering that was promised to transform the lives of many has proved disappointing. Again, some individual therapists are brilliant but others rely too heavily on the manual and ignore the real person sitting across from them. Many people are deemed unsuitable for IAPT on the basis they have more complex needs (I was one of those people). So what do they get? In my case, it'll be psychotherapy but as I've mentioned,for a variety of reasons, that isn't an option for everyone.

Some people say they need help with emotional problems, others need more practical support to help them get on with their lives. If it's not the remit of the NHS to act as a counselling or advisory service, or to do the work of social care,who fulfils those roles in our increasingly atomised society? The voluntary sector is already overstretched, with many services affected by cuts and needing to scale back (that's where they aren't having to close down altogether). NHS mental health services are organised in such a way as to discourage 'dependency, ' but the question is where else can people turn when there is genuine need? 

It seems that there's a gap between expectations and reality when it comes to mental health services and what you get is whatever's available, which is, in some areas, not a lot. A diagnosis, a prescription and told to see your GP in case of any problems, now go away and get better. It's nowhere near enough. 

My problem is not your problem

Having a mental health problem is a bit like being pregnant; people just love to appropriate your experience. Sometimes people talk about what’s happened to them as a means of showing solidarity, which I quite like, as long as it’s not assumed that my experience will automatically be the same. Unfortunately though, all too often this spills over into advice-giving. Oh yes *rolls eyes* people just love to offer their wisdom, whether or not it’s asked for. There’s often an agenda, whether the person realises it or not. Sometimes the agenda is explicit – “you know, things would work out so much better for you if you just…”or “if you try (whatever it is they happen to believe works).” That kind of thing. Unsurprisingly, I have a few things to say on this subject. Firstly, unsolicited ‘advice’ is unwelcome because, well, it’s unsolicited. If I want advice, I’ll ask for it, thank you very much. To assume I am in need of help or advice feels patronising, as though you don’t have confidence in my abilities to source the right kind of help or do what works for me. For all the other person knows, I might be doing it already, have already tried and rejected that approach or simply have enough ideas of my own, thanks. Such ‘helpful’ interventions assume all manner of things that the self-appointed advisor probably doesn’t know, but most importantly, it makes me ask “whose mental health is this?” Because last time I looked, it was mine. More than one ‘helpful’ person has asked me what medication I’m on, or what dose. And they have the temerity to act all offended when I tell them that’s my business. I know it’s well-meaning and I know you “just want to help,” but rather than impose your ideas on others, why not ask “is there anything I can do to help?” Or maybe, you know, offer your services as a listener. The details of my life are not up for discussion unless I choose to make them so. Just because something worked for you doesn’t mean it’ll work for me, or that I necessarily want to try it. I don’t need to be rescued; all I ask is that people be there for me if I need them and maybe just check how I’m getting on from time to time. If I want to talk, I will.

Another research plug

http://www.volition.org.uk/audible-thoughts-research-project-mental-health/