An insight into mental health.... By Lisa Chalkley
Only connect the prose and the passion, and both will be exalted, and human love will be seen at its height. Live in fragments no longer. Only connect, and the beast and the monk, robbed of the isolation that is life to either, will die. E M Forster.
I have a head full of swirls and promptings, as well as headachiness, so I'm just going to write.
Mental illness and work - inspite of positivity around what can be done for people with chronic illnesses & disabilities, in terms of reasonable adjustments, I'm moribund about working. As my physical and mental health problems keep bouncing off of each like despotic ping pong players, the thought of finding work that produces enough to live on, while being able to tolerate the disruption of fluctuating conditions seems slim indeed.
While the goodness of work is repeatedly flagged up, with having a severe mental illness, I still imagine thatStuart Sutherland's book Breakdown is probably the most honest account of the struggles, resentment & pressure that occur, and he switched profession. He had the education, contact and skills to do that. Dr Tim Cantopher in his highly readable book Depressive Illness, The Curse of the Strong thinks that a positive sea change in employer practices, that occured first in the States, is washing up on these shores. That employers realise that it is conscientious and concerned hard workers who tend to depression and that it is to a corporations best interest that they do make reasonable adjustments to retain these staff. Although he notes that this better practice is not reflected in 'the Government and it's institutions, which are getting worse'. That is true in my own experience as I've watched more staff jump from the sinking ship of my mental health service then I have ever seen and even my GP is off - that it is the intelligent, vocal and empathetic is terrifying.
The health services and local government, the arts and education are where we have traditionally had our entry level, supported jobs. As there is less money in all these areas, the chances of their being the time, energy and resources to invest in people and the community - which may or may not bring financial returns - looks unlikely. The other prong to this is that those of us who prefer to work but can only realistically do it part time, to manage our mental and physical health problems and to have enough time and energy to keep the rest of our lives on track financially and socially are dependent on housing and council tax benefit, disability tax credits and other top ups to provide a living wage. Working in charities, social enterprises and other ventures with short term contracts and various uncertainties with fallow periods or being self employed is very hard work. Seeing well people with fantastic credentials and years of experience pootling along in part time work below their ability, or staying afloat due to marriage and owning property - well to me it says that by working very hard, you may be able to run to stand still. I see more people accruing debts rather than making gains of financial stability, and the dice are becoming more loaded as austerity bites.
I may be presenting to grim a picture, but these are the kind of worries that assail me when I awake a 5am panicking, as dutiful depressives do. But as I am getting older and accumulating more physical health problems, have less energy and losing the psychological protection of splitting, I cannot run around, overwork and throw myself into things in blase way, that allowed me to accumulate achievements against all the odds. Splitting is not a good thing per se - in fact it's most realistically seen as a survival strategy. It helps a child to survive the unsurvivable and like all these kinds of coping strategies, when they are used to cope in adult life, they aren't fit for purpose. It does nothing to solve the problem it is used against, so the original problem is there, it also accumulates additional problems of it's own.
Splitting isn't only the prerogative of people with borderline personality disorder, but if you have the diagnosis, it so often seems to be a part of it. In Richard Moskovitz's book Lost in the Mirror it's visually portrayed, well, as a mirror. We are notoriously unable to cope with criticism, but rather than arrogance, the dynamic is more akin towards the black and white experience of either we are perfect whole and shining, looking happily into the mirror or it is all smashed to pieces, the terrifying darkness and shards of danger auger judgement or punishment to terrible to bear. Our sense of self disintegrates, we may experience a sense of our life or external reality also fragmenting, and a chill of terror enters our bones. Not only are we a special hero or the worst of villains ourselves, but we also see others in this black and white way. As Lorraine Bell describes it:
….(seeing people as) a hero or villain, probably comes from your early experience. If an experience was too painful you may have blocked it out of your mind or memory so you can still feel good. Then when you feel hurt all the painful feelings flood back and it feels all bad.
This is often what happens when people suddenly want to self injure or become suicidal, with no trigger apparent to observers. It is also extremely exhausting to work through. If someone says something you take the wrong way, and your fantastic, esteem building job is suddenly a pit of potential hurt, control, abuse and rejection - you can intellectually 'know' that it's no different from the nice job with pleasant colleagues before lunch but totally immersion in a terrifying shadow world, where you're trying to behave consistently takes it out of you. In wanting to be liked and accepted desperately with borderline, we manage to even feel guilty ascribing critical and superior characteristic, or villainising others as well. Working to hard and subjugating our own needs to repair the situation leads us to struggle with terrifying feelings of anger and resentment, which threatens the connection we need.
As I said, this experience isn't the preserve of us with borderline and not all borderlines will have it as a core problem, I think those of us with personality disorders will, when we have a tendency, will have a polarized, writ large version and will experience it as a fundamental part of ourselves. This makes it more sticky and hard to shake. In cognitive analytical therapy it is seen as a reciprocal role, a learned pattern of relationship (we only learn 'self' through the experience of relationships) and this one is the neglected self in relation to the fantasy of perfect care. This can lead to baffling extremes of feelings, with no idea how we got there during a day and people may harm or abuse substances to keep a lid on the whole kit and caboodle to try and function and appear 'normal'. I think this makes people with this as a core problem, vulnerable in certain ways with others and especially with the Department of Work and Pensions (DWP) and Atos. These are complex problems, which require learning to nurture your neglected aspects of self and swapping your black and white thinking for shades of grey, being able to hold onto good aspects of relationships during the bad, owning your projections without beating yourself (or others) up, exploring new ways of being, with your self and with others.
As there is no criteria for mental health in the Work Capability Assessment (WCA), as nobody gives Atos, literally, for the struggles of many kinds of disability, let alone the Cinderella of mental illness. As the bizarrely named 'support group' contains neither a group or support of any kind, let alone trained. Really, ask anyone who attends this sub-group. I know people who have been categorised as 'able to work with support' who are barely able to survive the vicissitudes of their life and mental illness, who use extreme methods, such as harming by attempting to cut off parts of their body - becoming more ill but see it as their own personal failure rather than decreased security and increased pressure, from the swirl of political power plays that are making their lives more fraught by the day. Others will be vulnerable, who experience the neglect/perfect care role in less dramatic ways, as part of the disappoint and disenfranchisement posited by the role itself.
In Elizabeth Wilde McCormick's 3rd edition of Change for the Better, in 'I always pick the bad ones', she describes it thus:
We may notice patterns of feeling excited and carried away by meeting exciting others and having exciting experiences of which we have high hopes and often getting lost in the excitement. We project our ideal into the other person and become enthralled, secretly hoping they will offer all the comfort, love nurture and satisfaction we have never had. In doing so we become passive, vulnerable to being victim. Sooner or later the rosy spectacles come off and the person, ideology or group become just ordinary or worse, and we feel terribly let down, even abused by the loss of the projection of all our hopes. We end up feeling angry, humiliated, beaten, frustrated and let down. We can get cynical and bitter, fearing that all experiences are the same.
To anyone living or working at the sharp end of complex cases, it is blatantly apparent that the rhetoric of 'looking at people's strengths and abilities, not their illness or disability' is being used as a blunt weapon for cost cutting. It was the fiercely fought for challenge to stigma and inequality for mental health, but as with all things, it was a recognition of a realistic middle way. You don't ignore the illness, disability or struggles, you see the good bits too and make plans with it all held in mind. It's not negative to think it would be good for someone to work, but if it would plunge them into a mania or psychosis, what needs to be put in place to allow them to manage. It might mean they can only do 2 or 3 days, that they need meds, a support worker, safe secure social housing, assertiveness training and counselling once a week. Work isn't a 'cheap option' for the State, it might be, in some cases, but some people like me need structured, specialist and tailored support in order to work. Taking people's desire to belong, fit in and be needed plus their aspirations and dreams then placing them in untenable positions is like helping to shove lemmings off of a cliff.
I've seen psychiatrist's, doctor's, psychologists and support workers expert opinion ignored, where they're trying to keep their patient well. Very ill and distressed people ending up on wards, losing housing, getting into debt and ending up in intractable situations that they do not have the power or resources to extricate themselves from is of no benefit and saves no money what so ever. Dramatic or violent responses from a person desperately flailing around to be heard, seen or taken seriously are rubbish for everyone. Triggering of stress related illnesses and flair ups of chronic disease caused by working too hard to keep a myriad of balls in the air is boring, disheartening and esteem shattering. Ignoring the weaknesses and limitations of people may be giddying and exciting for all concerned at first, but the crash that inevitably comes, if able to be recovered from (and in some cases it won't) will cost, in every way imaginable. It is splitting being done at the level of policy, State and planning.
I don't know why I'm able to perceive my own cognitive defence of splitting clearly for the first time. My thyroid isn't working as well again and it leaves me morose and unable to see the shiny perfect mirror while I'm waiting for the medication increase to work. I started therapy over twenty years ago now. I use a mental health service, but it's not therapy based - I think the habits of trying to see and understand have become, well, habits. My ability to spend months running around while 'up' before crashing have long gone. But it had seemed such a fundamental part of my personality, that I felt that it was a problem somehow, that I had a hand in it but was unable to get any traction or move forward or change it - that the crashing fall with the immense emotional distress was so terrifying and horrible seemed to be part of my illness that visited me intermittently regardless. As the horrible bit was so horrid, it didn't seem possible that I would want a hand in it - but it was buried, many layers under in the framework of my personality. Like the peeling of an onion, there is the sense of an organic process that you can't hurry - one bit has to be seen, felt and understood to lay a framework to even begin to see the next layer underneath. I find this part of recovery like being given an odd christmas gift, it's use or ornamentation a puzzle - thanks life, thanks very much for that. Wondering where you can put it and how soon can you give it away.
Myself and some of my fellow sufferers of borderline, who after many a year are able to handle some criticism and share it with others, while feeling icky but not totally disintegrating encourage each other to find the middle way in things. We know when we're 'up' and happy and jolly and busy and fine. Well we know other people are experiencing us as tetchy, wired, brittle, fraught and strangely one dimensional. But when we feel bad, a bad that is a bottomless pit of despair and pain, well, it's always been one thing or the other - and none of us is daft enough to want to feel entirely shit. We aren't that crazy. Anyone who has glorious, exultant, shiny 'ups', struggles in giving that up. In the shades of grey of normality, it can be hard to feel the little happiness, as so often we're left feeling the grittiness of grief and loss and despair. Whoop - recovery, who wants that! And, to paraphrase Sheldon Kopp, we sit quietly having a coffee with each other and feel calm and content for 20 minutes and wonder how strange it is that it all feels worth it. We seriously discuss whether we should tell people who have just started out in therapy. Some of us have had such unremittingly awful lives and if therapy seems a way out, we all start at first by splitting. When we get well, we imagine, we'll feel fine all the time, jobs, houses, children, money - we'll get all of the things, if not even better, more glamorous versions of being seen, admired and belonging. If someone had told us we do bags of therapy per week, for years and we have all the same feelings and struggles but manage them a bit better - and definitely no rewards for enduring suffering, well, would anyone bother doing it for those few quiet moments of belonging and calm that fleetingly appear.
So I'm sitting around with my new recovery 'gift' of seeing that I can make a change in the black and white thinking, behaviours and experience that I always thought intractable. Or maybe I can do something, or maybe it'll just be 'seeing' it and then choosing to act on different beliefs while have to struggle along with the thoughts and feelings it stirs up *sigh* - more hard work. Or maybe it won't be hard work, arsing around doing mindfulness for over 20 years too may help me to melt it into something more pretty and fun. I'm fuming over the Government's decimation of health and social care, trying to balance my longing and fighting for better with the awareness that I can expect them to be perfect, ideal - that I'll have to settle with them being 'good enough'. In my persnickity, perfectionist defence against badness, that is bizarrely combined with administration and policy skills in my skull, what is going on now is so much lower than any definition of 'good enough', sensible, reality based - let alone the giddy heights of being vaguely wise governance. Working out how to keep kicking the Establishment in the shins and speaking up for others who can't speak up in the arena of public life -balancing it without neglecting myself or my voice, is a supremely creative act. I have no idea how to bring that about. The job that is in front of me, is to figure that out.
*Many Thanks
Jules
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Very helpful.
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