Friday, 29 March 2013

Missing: Spring

Easter weekend.  Really?!  It's come round so fast.  Where did the last three months disappear to?  And what has happened to Spring.  The weather in London first thing yesterday and this morning has been deceptive.  But it did the trick.  There was hope.  It was possible to be optimistic.  The getting-to-work always feels easier when the sun shows its face.  We've seen so little of it that one could be forgiven for forgetting what morning sunshine is.  

Begin at once to live, and count each separate day as a separate life.  

It's a good lesson in counting one's blessings.  I choose to live here.  After all.  Wouldn't live anywhere else.  Not just now, anyway.  So here I am.  And here we are.  And get on we should.  So I have been.  But it's been going pretty quickly.  In the blink of an eye it's the start of the new tax year.  How did that happen?  A lot has happened, and much has been achieved.  There is of course plenty that didn't quite come together.  The to-do list is still as impressively long.  But then this wouldn't be my life if it were any other way.

A break is on the horizon.  It's time.  I love my work.  It is an honour and a privilege to sit where I sit, and do what I do.  But self care is non negotiable in this profession.  Breaks are a matter of rhythm and routine.  The wheels have sped up recently, and this means that the brakes need to be checked, and the tyres kept nicely inflated.  After all, you can't give what you don't have.  It is my responsibility to see that my own house is in order.  In a metaphorical sense.  Obviously.  

Time goes by fast, and people go in and out of your life so quickly, so never miss the opportunity to tell these people how much they mean to you.  
Ralph Waldo Emerson

Wednesday, 27 March 2013

The power of we

Sometimes the simple things really are the best.  His chair was brilliant.  I was there with him, hanging on his every word.  Our stories are different, as they so often are, but it didn't matter in the least.  I heard exactly what I needed to hear.  And he got to do a bit of service.  He was right of course.  Everyone sat on a chair was, and is a miracle.  And miracles do happen. 

There's nothing mystical about recovery.  But there is lots that doesn't make a lot of sense.  It is a wise suggestion to keep things simple, as it could easily get way too complicated if I tried to think about it.  It's a program of action for good reason, too.  Sitting around, thinking about things, hasn't got many people very far.  And most of us need to get a very long way away from where we were.  So there is work to be done.  And guidance is offered every step of the way.  

But do the steps we should.  It's all there for the taking.  The language may be unfamiliar, but the evidence surrounds us.  From the moment we walk in.  People truly are interested in how we are.  And if we're not as good as we'd like to be, they'll help us get there.  Because, when you take the 'I' out of illness, and replace it with 'we' and you've got wellness.  Simples.    

Sunday, 24 March 2013

Mad, Bad and/or Dangerous: Side Effects (2013)

I am drawn to films claiming to portray issues pertaining to the work of fellow psych professionals, or mental health issues.  That was how I came to see Side Effects (2013).  That, and the fact that I'd seen (the brilliant) Arbitrage (2012) the previous evening. 
Side Effects has perhaps one too many twists. It's brilliantly clever, and I was utterly engrossed throughout. But there were some obstacles to overcome. The first of which was the believability factor. It simply wouldn't happen that way.
There is something known as Professional Indemnity that would have had a radical bearing on the story line - altering it substantially - albeit with consequently compromised drama. It was, I think, a great portrayal of someone with undiagnosed Personality Disorder. There was some minor and fleeting reference to an alternative diagnosis towards the end of the movie, when psychiatrist Jonathan Banks (played by Jude Law who, my fellow cinema-goers and I agreed, might as well shave his head and be done with it, as it's been receding for an eternity) throws the words Schizoaffective Disorder at his patient but this doesn't, I think, fit with what we'd witnessed for the preceding 100 minutes.

Schizoaffective Disorder is one of the more common and disabling mental illnesses affecting approximately 1% of the US population. This illness manifests itself through a combination of symptoms of schizophrenia and an affective (mood) disorder. Today, many believe that this disorder is a form of schizophrenia, though this may be somewhat of an ad hoc assessment.

The diagnosis entails that a person needs to have primary symptoms of schizophrenia (such as delusions, hallucinations, disorganised speech, and disorganised behaviour) along with a period of time with symptoms of major depression or a manic episode.
From the film's portrayal of Emily Taylor, the main character played by Rooney Mara, it would be almost impossible to diagnose Schizoaffective disorder with any confidence.  Law was adamant that his patient was not depressed, requiring her to fit the criteria for the bipolar subtype, for which the requisite episodic mania was only hinted at by her impulsivity.   
So, once again, we are faced by the difficulty of diagnostic criteria.  I hold the contents of my copies of both the DSM and ICD lightly.  It is infrequently that I ever feel compelled to consult either.  But that's not unusual, given where I sit, amidst my co-professionals.  Therapeutic outcome is not always determined by diagnosis.  Though a label can, for some, on occasion, be helpful. 
Jumping to conclusions is a perennial hazard of the job.  And one that is all too real a risk when working under pressure and without adequate guidance or supervision.  Inexperience often leads to assumptions.  Whatever one has most recently been reading about starts to show up in one's practice.  Suddenly everyone has borderline traits (including, from my perspective, Emily).  Caution should be a rule of thumb.  And consultation. 

Whether or not this will truly be Soderbergh's final flick we shall have to wait and see. In the meantime, Ablixa is not, and will never be, prescribed. 

Thursday, 21 March 2013

Breast Cancer Thriver. And her humble buddy.

Sunday was awesome.  I did not anticipate that we would ride for so long.  Charlotte probably didn't either. I feel certain that four laps would ordinarily take her a lot less time.  But she remains ever patient, and super supportive.  Her gentle words of encouragement, delivered with such heart and always at precisely the right moment, count for everything.  Particularly when I'm busting my lungs, not to mention my legs, trying to get up Broomfield Hill.  We rode around the Park four times.  Twice in each direction.  It was brilliant.  It was hard.  

I have a little over four months until my first ever cyclo-sportive.  One hundred miles on two wheels.  And I'm just a little bit scared.  There's no need.  Of course.  And little point.  Obviously.  Every ounce of energy needs to be wisely invested.  I simply need to concentrate on getting fitter, and hopefully faster.  My legs are strong, but they don't move terribly quickly.  "Push, and pedal...  Smile, a relax..."  This was something of a mantra I clutched on to as my best friend led the way up the (very) long (and painfully slow) hill climb towards Pembroke Lodge.  

Oh how these bikes inspire me...


Note to self:  Pink tape for handlebars...

Charlotte is, without a doubt, not simply a breast cancer survivor.  She is a breast cancer thriver...

It's super strange to think that only twelve months ago she was being pumped full of toxic chemicals, as she fought the first round of the battle against the vicious alien.  Chemical warfare was declared in earnest, in February 2012.  And there we are, cycling in the rain on a Sunday afternoon casually chatting about my intended training plans (and her more definitive race schedule for the season ahead).  Bizarre.  But true.

This is my life.  And what a wonderful life it is.  Our friendship is precious.  Charlotte is special.

And fast:  I was just about engaging the low gears to tackle our penultimate hill, now going anti clockwise from Kingston Gate, and she flew up it.  I barely caught my breath before losing sight of her blue GORE® jacket (the weather was not in our favour) and then reminding myself that Charlotte has been doing this a while.  And when it comes to climbing, experience counts for a quite a bit.  

I will get there.  Slow and steady.  There's no race to win, but there's money to raise.  Serious money.  Breast Cancer Care and the British Lung Foundation are my two chosen charities.  Breast Cancer Care for obvious reasons.  The BLF because of the structure and support they've offered my dear mother in recent years.  My breathlessness is a matter of choice.  Heart breakingly, hers is not.    

Onwards and upwards.  There's more work to be done in Richmond.  I need to learn how to repair a puncture.  And then the open roads of the South East beckon.  Kent and Surrey await.  And now I have a date in my diary.  The Pink Ribbon Ride on Sunday 12th May shall be my official practice.  60 miles around the Cotswolds from Blenheim Palace.  By then, the weather may or may not improve, but I sure as hell hope my riding has.


Tuesday, 19 March 2013

True colours

Mink, we agreed.  As opposed to mouse.  I've never possessed many mousey qualities.  I don't like them much, either.  

Carol is, to my mind, something of a genius.  She is my hairdresser.  But she is so much more besides.  Having highlighted my hair on and off for the last ten years, it has felt both strange and brilliant to get to know my own hair colour.

And I've even had compliments.  They concern me less than the sense of authenticity and alignment that accompanied the decision (and the haircut).  This is part of me.  Plain and simple, yet far from straightforward.  

I believe it to be the journey of a lifetime, to become the person you truly are.  Joseph Campbell said it was the privilege of a lifetime.  Ralph Waldo Emerson described it as the greatest accomplishment, to be oneself in a world that is constantly trying to make one into something else. 

I am a work in progress.  That much I know.  But today I feel truly comfortable in my own skin.  That's partly down to Carol.  And too many others, to name here.  I have found my tribe and have little need to follow any crowd.       

Friday, 15 March 2013

When a synopsis isn't enough: Rust and Bone (2012)

I had almost forgotten about this film, but I shouldn't have done - it was brilliant.

So, a guy loses his job and travels through France with his son.  His sister reluctantly takes him in (well, she feels obliged to do so).  He gets a job as a bouncer working in a club - where there's a fight.  Guy meets girl - who works with killer whales.  Girl has a horrific accident at her workplace.  Girl calls guy.  Guy takes her swimming - and then to bed.  His behaviour deteriorates.  He causes his sister to lose her job.  She asks him to leave - which he does - leaving behind the girl, and his son - again.  Guy's brother-in-law brings his son to him - young boy nearly dies in dramatic accident - but survives.  Guy and girl get back together...

The synopsis really doesn't tell the story that underlies this fantastic film in which one's emotions are pushed to the limit on more than one occasion.  It's challenging and thought provoking viewing that asks some important questions about our perceptions of disability, and reveals the true possibility of resilience and hidden resources to be found even in the most unlikely of places.  

Monday, 11 March 2013

When the fun has long gone but you can't stop

As a therapist with a special interest in our relationships with substances, it is important for me to remember the terrifying prospect that abstinence may represent to many people.  As someone who works with many gender and sexual diversity clients, I have noticed the overlap between those who might identify as belonging to a minority group and those who are primarily interested in reducing, or controlling their usage of drugs and alcohol.  From a therapeutic perspective, the distinction is all important.  The goals and objectives look very different for the client, and therefore for our work together. 

The Club Drug Clinic at Chelsea & Westminster Hospital and CODE at 56 Dean Street in Soho know this better than most.  Working with LGBTQ individuals who use substances requires an appreciation of the particular contexts in which drugs are being used.  Drugs have come to play an important part of the scene for many communities, and without this knowledge and understanding, therapeutic outcomes are likely to be significantly compromised.
Trends have changed over time.  And will continue to do so.  There are a multitude of different highs (and lows) out there.  Antidote have gathered some scary stats.  These are based on their actual experience of 9,000 contacts with LGBTQ people each year.  They support 800 people through treatment for substance misuse.  The biggest offenders of the moment are crystal meth, GHB/GBL and mephedrone. 

Contrary to popular belief, crystal has arrived and is running riot in the community.  In the last 7 years, use of crystal meth has shot up.  And it is being shot up.  High risk behaviours are common resulting in an explosion of HIV and Hep C.  Research is playing catch up but we do now now that GBL is highly addictive, and detox from it requires medical supervision.   
So, when is recreational use no longer any fun?  The 5 day 'weekend' is a reality for many people whose usage has far exceeded what it first was.  People are finding themselves crossing their own boundaries, and going further still.  The impacts and consequences may be the only memories they have. 

Common to all the work I have done around addictive processes, is the central position of shame.  As a practitioner, it is very often the shame that underlies the addiction (which I see as a symptom of the problem, rather than the problem itself) that needs to be addressed within the therapeutic encounter.  Should we bypass this and focus only on either stopping or cutting down, we run the risk of not only doing clients an enormous disservice; we may well take them to a worse place - in touch with the raw and perhaps long avoided shame, without the ability to adequately self medicate.  In doing work of this kind it is vital to not only know the score, but to be very clear, as therapists, about where we are choosing to position ourselves.


Wednesday, 6 March 2013

Entering the void

Mercifully, most of us will never have to experience the devastating cocktail of emotions faced by those left behind when someone close disappears.  As a society, we are not well equipped to conceive the impact that hits someone as they come to realise that someone they love is missing.  It is as though missing is still missing from our social and cultural agenda.  We are, I suspect, guilty of guarding against the unbearable. 
There is a void in the support structures available to the friends and family who plunge into an abyss of unknowns as, unlike many other struggles and difficulties that we have been forced to acknowledge, all too often, missing itself gets lost from the political agenda, leaving the pain of those who live this nightmare, unseen and unheard. 
Since joining the Services Team at Missing People a little over two years' ago, I have been thinking in some depth about supporting the individuals and families that the charity serves.  I have learnt so much, but still feel as though I know only a very little.  Mine is but a fragmented knowledge - I have been able to tentatively approach the issue, from an intellectual, analytical perspective and then withdraw, back into the safety of my life and the small but important network of certainties I seek to maintain within it.  I claim no expertise.  But I am proud to have been a part of the journey the organisation has been on, piloting a menu of emotional support in addition to and alongside their now very well established 24/7 helpline.
As a clinician, I can see very clearly the traps that might befall someone seeking to help those who have been left behind.  This is trauma, but not, necessarily, as we know it.  Resolution may, or may not, be possible.  There are no standards when it comes to missing.  The emotional journey defies logic.  There are few parallels, and therefore slim chances of any real frame of reference.  Some of those family members (the true experts) I've spoken to would contend that, unless you've been there, you're unlikely to be able to get there. 
So, do you need to have shared an experience, in order to support someone who is struggling with it?  I would dispute that you do, and know that I've received tremendous support from people who will, I hope, not come to walk many miles in my moccasins, but all had something of value to offer me.  You needn't have trod the particular path to appreciate the incline.  I guess it comes down to willingness to 'go there', and resilience to remain there with our clients, and truly bear witness to something we might experience as not just horrific, but unimaginably so.   

Sunday, 3 March 2013

Having made it to the other side

Arriving home, after a full day and a long week, to find my bedroom had been flooded was a nasty shock.  It took a little while to set in, and then a longer while to shift.  My bedroom is (ordinarily) something of a sanctuary.  A home within my home.  A nest.  A place to rest, relax, and re-calibrate   Seeing the water pouring in, through the ceiling, was another very unpleasant reminder of my powerlessness.  There was nothing, in that moment, that I could physically do to remedy the situation.  It was what it was, and I had to simply watch the water come through for the next three and a half hours.  Splashing, then splishing, then dropping, then dripping.  Water always finds a course.  This course was vertical - down onto my bed, my carpet, and everything around.  

It could indeed have been a whole lot worse.  Now, I can value the philosophical input I have received over the weekend.  It was not entirely welcome, to begin with.  A break-in would have been worse.  And fire worse still.  Life and limb remain intact.  Getting the electricity back on was something of a turning point; even without lights in my room, I could at least survey the damage, and mitigate some more by swiftly transporting belongings and keepsakes to the safety of the sitting room.

Squelch is both a sound and a sensation I have come to know well in recent days.  My room now stands empty.  My mattress acted as a large sponge, absorbing so much moisture it proved difficult to shift and left a river marking its path as it was tugged away from the disaster zone.  Carpets and underlay have since been stripped back to reveal the boards beneath.  I now boast a loft-style room and hallway.  Unforeseen re-modelling.     

Silver linings are, I believe, on their way.  In the meantime  catastrophising will get me nowhere.  Life happens.  To all of us, whether we're ready for it or not.  I am again reminded that recovery is always possible - but there is work to be done...

I have had an opportunity to refamiliarise myself with my possessions.  Their volume and variety.  The treasures.  And the tat.  In the face of a disaster such as this, perspective shifts and values are challenged.  What do these bits and pieces mean?  Why have I held on to them?  Shall I continue to carry them with me?  

Friday's flood has confirmed something I knew, but had perhaps forgotten - nature is a force to be reckoned with that should never be underestimated.  The elements, and water particularly, can be our friends but at times can threaten all that we hold to be dear and important.  There was however some faint amusement to be derived from spotting my training fins in the midst of the wet-ness.       

Friday, 1 March 2013

(Back) in good hands

It felt like coming home.  It had been too long.  And my back, neck and hips told the story.  There is such a powerful connection between the body and mind, to neglect one is to deprive the other.  The two must be nourished in tandem.  And so, as I lay there, concentrating on my breath and trying to go with, rather than against, I was reminded how important physical therapies are, alongside and complementary to, talking therapy.  I hadn't exactly forgotten, yet this felt like a revelation.  There is head knowledge, and there is body wisdom.  I guess I got a taste of the latter.  My spine will thank me.