Thoughts / hope

Full or Empty?

On our recent family holiday away, I was somewhat concerned we might run out of things to talk about with each other. I’m not sure where this worry came from. We haven’t had too much difficulty over the past 35 years. Anyway, along our travels I found us a set of personality assessments, to help fill in the quiet times. And really help us to get to know each other.

Trudy relished in adopting the role - undertaking an incredibly empathic and curious psychologist persona - and the test she randomly selected for me was ‘How optimistic are you?’ This also excited her. I remember her saying something along the lines of “Yes! Here we will find out that Sam is actually not the happy, love and rainbows type person after all. And instead just a cold-hearted cynic.” Well, that’s what I heard anyway.

 ‘Optimism is the faith that leads to achievement…no pessimist ever discovered the secret of the stars, or sailed to an uncharted land, or opened a new doorway for the human spirit’. Helen Keller (1880 – 1968)

Helen Keller’s words reflect the popular upbeat concept of the word which has been gaining ground since the 1960s as an increasing body of research has demonstrated a consistent tendency of healthy successful people to think in generally positive ways.

When I was younger I was definitely a glass half full kind of girl. I nearly embodied all the different types of optimism around today. I genuinely expected that more good things than bad things would happen in the future (dispositional optimism). I was likely to attribute good events with permanence (likely to recur), pervasiveness (the ‘goodness’ will extend to other future events. Whereas bad events were impermanent and non-pervasive (attributional optimism). And a lot of my optimism was incongruent. It didn’t make sense that I presumed good things would happen over adversity, despite the probability of how life experiences happen (unrealistic optimism).

Our perspective on things influences pretty much happens. What happens to us in life is only part of the story; perspective accounts for what we see and the meaning we make of it.

And the more of life and the psychological atmosphere of our culture that I soak up, through news, journalism, social media and conversations with colleagues, clients, friends and family, the more my perception changes. It’s very difficult not to notice the images and stories of violence, abuse, dishonesty, manipulation and greed. Along the way, we are taught to protect ourselves we need to be on the lookout for what is wrong and to prepare ourselves for the worst.

We are taught to keep our doors, as well as our hearts and minds, closed up and locked tight.

It’s not all that surprising that my glass has appeared a little emptier over time. When the world feels under threat, we feel nervous. In general, we can remain optimistic when we feel like we can exert some influence on a situation, but it’s hard for me to feel that way all the time. It can sometimes feel easier to perceive that I have no influence at all on ‘the world’, leading to a feeling of powerlessness.

One of the key ideas though, is that the world is a fair and just place. Is it? When we look at the natural world, there’s not a lot of fairness there. Usually the biggest or the strongest wins, and fights are often to the death. Such crucial realism, doesn’t have to mean that we should give up all hopes for an optimistic outlook though. Because optimism has some real benefits.

Martin Seligman (psychologist of the positive psychology movement) investigated attributional style optimism and success in sales insurance. He identified the top quartile of attributional style optimists amongst applicants for jobs as life insurance salesmen (extreme optimists) and found those selected on this basis performed much better and stayed in the job for longer than salesmen selected using standard industry tests.

The same mechanism has been found to drive athletic performance both in individuals and team sports. Team performance can be predicted based on assessment of the attributional style optimism of team members and coaches.  The key to performance was perseverance in the face of failure, a product of attributing bad events to one-off, non-pervasive external causes as optimists do.

Research has also shown that optimism is correlated with many positive life outcomes including increased life expectancy, general health, better mental health, increased success in work, greater recovery rates from heart operations and better coping strategies when faced with adversity.

But there’s a downside to optimism too. Too much of this perspective can cause inattention to detail, failure to seek new information and selective inattention to unpromising data can lead us to poorly informed decisions. Apparently extreme optimists have much shorter term financial horizons, save less, work shorter hours, exhibit less financial self control and are less likely to pay off credit card balances than moderate optimists or pessimists.

Harmful risk taking has long been assumed to be a danger of optimism and there is some evidence to support this. Optimism is associated with rationalising beliefs, like for example that lung cancer risk is mainly genetic, most cases of it are generally cured and smoking for a long time without disease developing means they are less likely to be affected. The high general optimism of children, especially boys, seems to be a contributory factor to accidental injury which is the leading cause of death in childhood.

How do we manage all of this? How can we not fall into the hole of become crucial realists/cynical robots, whilst still accepting that not everything in the universe is rainbows and lollipops?

It might just come back to our perspective and our choices. We have the power to accept the things that we can’t change, find the things that we can, and pay attention to the positive or the negative things in life. And some of that is about choosing hope. Bring our awareness to the positive in difficult times is one of the definitions of hope. And according to Emily Dickinson, hope can inspire the good to reveal itself. We won’t find any of the good if we don’t go looking for it.

So, how did I go on the personality test? Pretty much in the middle. Let’s say it was almost half full.

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The argument against hope

So, I came across a concept this week which has blown my mind a little bit.

I read a book over the weekend which was hilarious and smart and for 203 pages I wholeheartedly agreed with every single point that was made. Every single point.

And then this happened.

The author mentioned that she unequivocally hates hope. That no good comes from it.

“Hope is a lie. Hope doesn’t work. Hope to be clear, doesn’t fix shit.”

Reflecting on time spent with an unwell ex-partner on a neurological ward in hospital she writes:

Even if few truly believe that pain can be treated with bone broth or a Tesla pendant, many believe in the medical power of hope. They believe that if a patient is not sufficiently ‘positive’ to believe in the possibility of a cure, however unlikely it is, then they are not prepared to live…

This is absolute bollocks, of course. Often nothing works at all. ..

These moments of hope serve only those of us in good health who do not care to see hope disappear.

It goes on. Like me, this author enjoys a rant.

Some of the ranting really resonated. There are probably a number of times we do need to be cautious with hope. Possibly during a break-up (as the author was experiencing), and maybe unrealistic hope in the face of terminal illness is unnecessary, but to be cautious all the time?

Turns out there’s some evidence that backs up her point a bit too.

Research, published in the Economic Journal, suggests that hope makes people feel worse. The researchers' starting point was what happens to the long-term unemployed when they reach retirement age. According to 25 years of German data, ‘retiring from unemployment’ delivers a significant increase in life satisfaction. It isn't explained by other factors, like a change in benefits, and the employed don't get the same boost when they retire. Nor, the authors argue, is it simply that other people judge the jobless more harshly. It's that when we're unemployed, there's always the hope of finding a job, and people "thus feel the permanent pressure to fulfil the norms of their social category… Ironically, it is hope that keeps them unhappy while unemployed, and it is only when hope fades that they will recover." Retirement means the end of hoping for a job, which feels like a release.

It’s possible that this odd notion sheds light on another mysterious but well-supported finding about trauma. As we'd expect, we take it harder when we become widowed than when we lose our jobs – but all else being equal, we actually recover more fully. It’s hypothesised that this might be because widowhood is irreversible. We’ve always got the hope of being happy again, certainly, bit no hope of changing our widow(er) status. Bereavement is a hope-free zone.

There’s a few out there who share the belief that if we give up hope we will be set free. John Ptacek, a US author, wrote of finding meaning through hopelessness after his wife's terminal cancer diagnosis: "Time spent hoping for happier days is time spent turning away from life." Derrick Jensen, an environmental campaigner, believes hope makes activism less effective since it involves placing faith in someone or something else to make things better, instead of doing what's needed yourself: "A wonderful thing happens when you give up on hope, which is that you realise you never needed it in the first place… you become very dangerous indeed to those in power."

However, I don’t know if this is abandoning hope all together. But finding the difference between false and realistic hope. And also attempting to find the degree of agency we have.

When confronted by the reality of the concentrations camps, Victor Frankl did not hope to dig his way out of his prison. That was not possible, and such hopes would soon have been thwarted. Instead, he controlled his own mind, and (probably) vaguely hoped for something realistic—that the war would end and he might be freed. That made the difference.

Abandoning hope all together is definitely not for me. Like all the good stuff, probably another of those things best enjoyed in moderation.

I have no hopes to become the world’s most famous Beatle impersonator. Or the next Dr Phil. Much better to hope that over time people with mental illness get access to the treatment they deserve. I hope that these little cards of ours might make someone feel just a little bit better. Or that someone experiencing an episode of mental illness can have enough hope to hang on through the dark times. Like I did.

Here’s hoping.

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The Hippo that Acknowledges Frustration

We made another card! It’s a card for anxiety disorders and this is what it looks like:

This card wasn’t born out of any clever psychological theory or any observed societal need. It was born out of the honest truth that when someone is experiencing a mental illness it can be really, really frustrating, sad and scary at times. And I’m not referring to the person who has the illness. I’m talking about everyone around them. This card was written for the card givers. (In the hope they’d still give them away to others).

Finding out that someone close to you has a mental illness can lead to any number of feelings and these feelings can have a serious emotional impact on you. Some loved ones might struggle to find a reason for the illness and wonder if they are in some way responsible, leading to strong feelings of guilt. People might feel angry and frustrated that this is happening, that the illness has become a dominant focus of life and disrupted the normality of the family or friendship group. It can be normal to feel confused as to what the hell is going on and what in the heavens this means. A lot of people report feeling a significant sense of loss and grief. It can be possible to begin grieving the loss of the relationship as it was and the life you had, the opportunities and plans that have now changed and to feel overwhelming sadness as to how much the person that they really, really love has been changed by their illness. Mental illness is still a stigmatised condition and for some people they might feel embarrassed or ashamed about what others might think of themselves and their loved one. And it’s scary. Loved ones are particularly likely to worry about what might happen to a person with a mental illness and if they will ever get better.

This exhaustive list of emotions is shit. But all of these, or a combination of a few, is a pretty common and normal experience for loved ones to go through when someone close to them has been diagnosed with a mental health condition.

As a supporter of someone with a mental illness, it’s really, really, really important that you acknowledge and talk about these feelings. Whether that’s with your own friends and family, a mental health professional or a support group. Acknowledging these feelings is the first step towards resolving them. It is important to understand that neither you nor the person with the mental illness are to blame for any of these events or feelings. They just are.

And with this in mind, I wrote this card. The aim was for the supporter to be able to say “OMG, this is just so shit. I am feeling awful and I know you are probably feeling worse and I just wish by magic it could all go away and we could go back to how it was”. But in a way that wasn’t going to make the person with the mental illness feel more guilty/alone/afraid/insert awful consequence of anxiety here. (Obviously I tried to keep it a bit upbeat/empathic/loving).

Because if you, as the supporter, can acknowledge and move past these common, yet horrendously awful and possibly destructive feelings and develop a more positive attitude, you’ll be able to be such a wonderful support for your friend or family member with a mental illness.

And really, really nice feelings can come from supporting someone too. So many people reflect on how their love for their friend or partner or relative deepens and a closer bond develops as they venture through experiences such as this. The new relationship you form with your loved-one can bring growth, deeper connections and learning for you both.

You can find the card here.

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Sending empathy, love and hope

Feedback from the ground (that’s you guys!) is that, buying a card for someone who is experiencing a mental illness is one thing. That perhaps is the easy bit. But writing and sending a card for someone experiencing a mental illness is a whole other story. This perhaps is the not so easy part.

Totally agree my friends. I still get a bit nervous or worried when someone I really like in my life is unwell. What can I say? Will I say the wrong thing? Will I be unhelpful? All valid points, thank you critical voice in my head. But do you know what’s probably worse? Knowing someone is unwell and not doing anything at all. Just pretending it’s not there and ignoring it all together.

Whilst everyone is unique and ultimately you know your loved one much better than me, here is a list of my general tips to fill in the blank spaces of your cards with compassion, empathy and hope.

  1. Try and use statements that show you recognize that your loved one is unwell. This is called validation. Validating someone’s feelings and their illness rather than shaming, questioning or trying to analyse it can make a difference. Statements such as “That must be very hard for you”, or “You are important to me. You matter to me and so do your feelings”, can be very comforting for the person experiencing a mental illness and has the potential to relieve them from some of the shame they may be experiencing regarding their experience.
  2. Often when people are experiencing a mental illness their brain is being a total bitch. In a nutshell it can really attack the person from the inside, skewing their perception of themselves and the world around them. This is an excellent opportunity to bring them back to reality. Or try anyway. Pay your loved one some compliments. Remind them why you really, really like them. For example, “Please don’t forget that I think you are a kind/ generous/beautiful/insert-nice-adjective-here person to be around.” If you’re loved one is very unwell they might not believe it 100%, but it’s never harmful to hear these things. 
  3. Let your loved one know that you’re not going anywhere. And then don’t go anywhere. Everyone fears abandonment on some level, but often the experience of mental illness can be particularly isolating and lonely. As someone who has had a mental illness, or three, the fear that people are not going to stay around for much longer as a result of being so unwell was a real and significant fear. Who would want to hang around someone who hasn’t been able to wear anything but tracksuits and leave the house in a week? If you can say “I am here for you and I’ll be hanging around too”, this might just bring a massive sense of relief to your loved one.
  4. Ask your loved one what you can do to help. The key word here is ‘ask’. This is important because it shows your loved one that you’re ready to assist them in their way. When they’re ready.
  5. Remind your loved one that what they’re going through is really tough and they are doing an excellent job. Something along the lines of “Be kind and gentle with yourself. You are doing the best you can”, is realistic and factual, but probably the kind of feedback that your loved one is not giving them self right now.
  6. Provide some statements of hope. Unfortunately mental illness often comes with other friends attached. Friends like hopelessness and helplessness. If you can provide some realistic words of encouragement and hope it might slightly lessen the impact these friends are having. Statements like “You can get through this experience. I believe in you”, can let your loved one know that you are hopeful for them, even if they are unable to be right at this minute.
  7. Write about a ridiculously silly and incredibly funny story. Sometimes when people are experiencing psychological pain they need something to laugh about. And just because they have a mental illness does not mean they have lost their sense of humour. When I was in hospital my sister used to send me ridiculous photos, texts, emails and updates about her day. Like how many biscuits she’d eaten. The sheer ridiculous of these frequent daily updates (and the phenomenal number of biscuits she could consume in a work day) eventually bought me to belly laughs.
  8. Tell them you love them. Do this repeatedly. This is probably the simplest, best and most important thing you can do.

These things can all be hard to say – or write – but if you can find something that comes from love, acceptance and empathy I think you’ll be right. Remember, they’re still just that person you really, really like. And if they’re experiencing a mental illness they’d probably really love to hear that from you.

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Chatting and dreamin'

I had the most beautiful conversation today.

It came from the pleasure of lunching with two of my favourite human beings. Whilst this is a reasonably regular occurrence, special shit went down today.

These two friends have been having some difficult times of late. One is experiencing symptoms of a mental illness and undertakes outpatient therapy and has begun taking prescribed psychiatric medication. The other has started seeing a psychologist for support with managing the effects of someone close to her experiencing a mental illness.

Now there’s nothing beautiful about the situations my friends are in. Both of their experiences have been difficult to watch. It’s so incredibly hard to see your loved ones in distress. And unfortunately neither of these situations is uncommon. Nor are these things are easily fixed. It’s a continual adventure of gains and setbacks.

But at lunch today, I took a moment just to observe what was happening. And it was divine.

We were all discussing aspects of our emotional health with vulnerability and honesty and openness. And there didn’t appear to be any shame involved. We didn’t feel the need to lower the volume of our voices, in order to hide our experiences from those around us. We offered each other advice and support with compassion, empathy and love. We felt safe. We discussed our own experiences of therapy and referred to each other’s therapists by first name. We came up with hypothetical conceptualisations and formulations of our own and other people’s behaviour. And my non-mental-health-professional friends used psychological terms fluently, sporadically AND correctly. Terms like “co-rumination” and “validation”. As I mentioned – divine.

There’s so many things that are special about this. Firstly, and most importantly, these two loved ones have acknowledged that they value their mental health and have been brave and courageous in asking for help and professional support. And my hypothesis on this, is that with time, they’ll reap the rewards. Secondly, I didn’t feel one little bit guilty. Guilty about burdening others with my emotional issues. Thirdly, it was so very, very easy to talk about these things. We switched between the achievements of potty training to our mental health to illegal internet browsing at work without any hesitation at all. And I think it was easy because we came from a place of love. We were open and honest and discussing these things in a place of no judgment.

Even though I reasonably regularly have conversations about my mental health with my loved ones, the frequency of these conversations is still rare. I’m so glad I took that moment to observe this experience in all its beauty, because otherwise it might have just passed us by. We’ve probably had other lunches just like this and I've probably had other conversations on par with this, but just not noticed how special it was at all.

So my dream is that all – okay, I’ll go with most – conversations about mental health are like this. Filled with honesty, love and empathy. Devoid of shame, judgment and fear. My dream is that conversations like this don’t just occur between three really close friends. But occur between friends, colleagues, acquaintances even.

Imagine if you could run into a distant relative down the street and when they asked how you were, you could explain that actually you’ve been experiencing some panic attacks and they’ve been quite horrific and you’re really struggling, but you’re seeking some assistance from a professional. And you’re not scared or ashamed to do that. Because the basic human reaction that you’re expecting is compassion and love and support.

Wouldn’t that be divine? I hope it happens in my lifetime. I’m so glad the conversation I had today did.

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A new depression card and another man's dogs

You may not be able to immediately tell, but this brand new card comes from dogs.

Pretty much everyone has heard of Pavlov. And his dogs. But there’s another important psychologist who had dogs too. And he didn’t treat them all that well.

In 1965 Martin Seligman began electrically shocking dogs in an attempt to expand on the research of Pavlov - the genius who could make dogs salivate when they heard a bell ring. For nerds, he was the brains behind ‘classical conditioning’.

Seligman’s study involved fear and learning. To condition the dogs when Seligman rang his bell, instead of providing the animals with food, he zapped them with electricity. And to keep them still, he restrained them in a harness. It was predicted that the dog would learn to associate the bell with the shock and then in the future (when released from the harness) the dog would feel fear when it heard the bell. And that fear would cause the dog to run away or show some other signs of mild panic when the bell toned.

Following the conditioning/bell-electric-zapping-time, the dogs were put back into a box with a small fence dividing it into two halves. It was expected that when the bell rang, the dog would jump over the fence to escape it. It didn’t. The dog just sat there and copped it. When they shocked the conditioned dog without the bell, nothing happened. Again, the dog simply lay down and took it. Interestingly, when the researchers put a normal dog into the same box contraption, when zapped it immediately jumped over the fence to the other side to escape it.

Unfortunately for some people who experience depression they are just like Seligman’s dogs. I know I was.

Like the conditioned dogs, who had learned more than the connection between the bell and the shock, some people with depression may believe that escape from possible shocks is futile. In other words they have somehow learned to be helpless. According to Seligman, people experiencing depression may feel that whatever they do will be futile and that they have no control over their environments. This is called ‘learned helplessness’.

Seligman proposed that individuals who - over the course of their lives - had experienced defeat or abuse or loss of control, learned over time that there was no escape. To the point that if an escape was offered, it wouldn’t be acted upon. Initially this theory didn’t really explain how people who hadn’t experienced negative life events ended up going on to experience depression, so Seligman added in some important cognitive or thinking style components.

Studies of people with depression reveal that when these people fail they often will give up and stop trying. Whilst most people will look for external reasons and factors to explain failures, people experiencing depression will hold much stronger views – “It’s my fault”.” I’m stupid.”

Imagine having to carry these thoughts around with you – constantly - whilst feeling – constantly - shit and sad. It’s not then hard to imagine that an extended period of these feelings and thoughts could lead you to giving in to despair and accepting this as reality. Learned helplessness is very closely linked to a loss of feeling in control.

In 1976 Langer and Rodin found that in nursing homes where conformity and passivity is encouraged and where every patients need is attended too, the health and wellbeing of patients’ declines rapidly. In contrast, the patients in nursing homes who were given choices and responsibilities remained healthy and active. This research was repeated in prisons, finding that if inmates were able to move furniture around and control the television this kept them from developing health problems.

When someone is experiencing depression, there’s a strong possibility that feelings of helplessness might begin to occur and may become totally overwhelming. Making small choices and achieving daily tasks, like getting dressed or having a shower, are the things that can hold someone back from the crushingness of learned helplessness. And for someone with depression these tasks are not just tasks, they are massive fucking achievements. When you can succeed at something small, harder tasks might feel more possible. But if you don’t notice what you’re achieving, everything will seem too bloody difficult and useless.

Remind your loved one that you can unlearn learned helplessness. Don’t let them give in to it yet. Celebrate ALL the achievements.

You can find the card here.

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The joys of therapy

For some weird reason most human beings prioritise their physical health over their psychological health. Take for example our teeth. There are so many things most of us do, to ensure good dental hygiene. We brush our teeth. And not just every single day, twice a day. We eat appropriate foods. We might use mouth wash. My Dad even flosses! And we’ll have regular check-ups at the Dentist and if something feels wrong in our mouth, we’ll make an emergency appointment with the Dentist. We do this, despite going to the dentist being one of the most despised activities on the planet.

Compare this to our psychological health. We all experience emotional injuries or pain ALL the time. Things like failure and rejection and sadness. And often they get worse if we don’t look after them or go off and get them treated. And mostly we don’t go and get them treated. Research shows that only 35% of people who experience significant mental illnesses seek treatment. And this is so very weird, because psychological treatment is not like going to the dentist. Seeing a counsellor/psychiatrist/psychologist or therapist is awesome!

 

There are so many wonderful things about therapy. Here is my first, of hopefully many, lists of why getting some counselling is purely fantastic.

1. You get a solid chunk of time, whether that be half an hour or an hour, to focus completely on yourself. Therapy is like an education course where you are the subject matter. Could anything be more interesting? You can explore yourself, go deeper into your current thoughts and feelings, or just sit and ‘be’ for a while (a pretty vital practice that often gets ignored).
2. You get to enhance your vocabulary. You can learn all these new convoluted and sophisticated terms to describe relatively simple behavioural phenomena. I don’t know where I’d be now, without being able to use the terms ‘dissociation’, ‘transference’ and ‘priming’ throughout the course of my day.
3. Therapy can be a dress rehearsal for life. You get to practice all the things that just seem way too hard in the real world. That’s right friends, I’m talking role plays and experiments, which means when you have to go out into the bright lights of work, social and family settings new patterns and behaviours don’t seem as terrifying.
4. You never, ever get told to stop crying. Or feeling whatever you’re feeling. On the contrary, you might be asked to explore the feeling or try and work with it. For so many people this is quite a different approach. Working through the shit feelings, the ones that usually get avoided and denied. Trust me, it’s really quite nice in the long run.
5. There is stack loads of research and scientific evidence behind talk-based therapies showing that it is effective for making painful experiences more tolerable. It’s a proven method for changing harmful thinking, relational and behavioural patterns. It’s also used to make good lives great. And I haven’t come across many people who don’t want to change anything about their life.
6. Your therapist can make you feel really, really normal. As an objective professional, they are really, really good at normalising base impulses and behaviours. Just the other day, when I was banging on about how difficult it would be for me to keep up a relatively new behavioural pattern forever, Dr M kindly reminded me that all humans have a fundamental issue with the concept of “forever”. Boom. Thanks Dr M. Correct, and weight lifted of my shoulders.
7. The therapeutic relationship is really one sided. And if you’re the patient/client/consumer, that’s in your favour. It’s a fascinating and intriguing experience being involved in such a relationship. A relationship where someone knows so, so, so, so much about you and you know nothing at all about them. To even up the balance, I like to invent things about Dr M. He’s a bird-watching hipster who is really a passionate geek at heart.
8. There’s someone who will hold all of your secrets. Without any judgement. Amazeballs.
9. It’s a really good opportunity for “aha” moments. If this was a cartoon, a light bulb would be in a thought bubble above your head. These moments are pretty awesome. When you come to a realisation of how everything has been fitting together and what might need to happen next. There is the potential here for transformation and enlightenment and just general life gets better stuff.
10. You get to be an explorer of one of the most complex and grandest things – the mind. And more importantly, your own mind.

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The sick brain?

At Hope Street Cards we’ve released a new card. This is what it looks like:


That’s right; this card is all about the neuroscience. That is, the science of the brain.

The world of understanding things doesn’t really seem to know exactly why and how mental illnesses exist and occur. Diagnosing a mental illness isn’t like diagnosing other conditions. There’s no blood test, no x-ray, no CT scan that can yield a diagnosis of anything mental health related. It’s much more difficult and it involves looking at a big conglomerate of complex factors that makes up an individual’s situation – the biology, the environment, the thinking, the culture, the relationships.

When it comes down to the relationship between mental illness and the brain it all gets pretty interesting. And even a little bit controversial.

The brain is AMAZING. It consists of billions of neurons or cells that must communicate with each other. The communication between neurons maintains all of our bodily functions, informs of us of pleasure and pain and lets us know when a bird has pooped on our head. The communication between neurons is controlled by the brain’s type and level of neurotransmitters. Neurotransmitters are the chemical substances that control and create signals in the brain both between and within neurons. Without neurotransmitters, there would be no communication between neurons. The heart wouldn’t get a signal to beat, our mouth wouldn’t know how to speak and our arms wouldn’t be able to react widely in an attempt to shake bird poop from our hair.

For quite some time it has been believed by numerous smart people that having a “chemical imbalance” or an imbalance of certain neurotransmitters within the brain was the main cause of psychiatric conditions.

Dopamine is one such neurotransmitter, which when found in the thinking areas of the brain can be considered the neurotransmitter of focus and attention. It is hypothesised that low levels of dopamine here can impair our ability to focus on our environment, stay on task or activities, or maintain conversations. Low levels of dopamine in these areas of the brain have been found to be prevalent in individuals experiencing Attention-Deficit Hyperactivity Disorder (ADHD). At the other end of the scale, extremely high levels of dopamine in the brain can cause us to lose our contact with reality. We can begin to develop unusual ideas about what is happening to us. We might experience delusions (false beliefs) and we might experience hallucinations of our senses. Not surprisingly then, medications that block the dopamine receptor work wonders in calming the psychotic symptoms of people with schizophrenia.

Serotonin is another neurotransmitter that has been identified in multiple psychiatric disorders. This neurotransmitter is a major regulator of things and is involved in a lot of bodily processes such as sleep, libido and body temperature. Most importantly it is commonly regarded as the chemical responsible for maintaining mood balance. Because of its’ role as a major regulator of things we often rely on serotonin a lot when we are stressed. Living in a high stress situation for a prolonged period of time, we use more serotonin than is normally replaced and prolonged exposure to high stress can gradually lower our serotonin levels. When serotonin levels are low, we experience difficulties with concentration and attention. Routine responsibilities can seem overwhelming. Sleep and appetite disturbances can occur and mood can reduce. Drug treatments, such as Selective Serotonin Reuptake Inhibitors (SSRI’s) a commonly used anti-depressant, have been found to have beneficial effects in people with major depressive disorder. These medications work by blocking serotonin-producing cells from reabsorbing a good portion of the neurotransmitter they secrete – as they normally would – leaving more of the chemical available for communication around the brain.

These drug discoveries resulted almost entirely from serendipitous accident though. And scientists went searching for the neurological roots of the medications workings after the fact. So we know that SSRI’s can work for treating depression in some people, but we still don’t know for sure that a shortage of serotonin is the cause of the depression.

And it appears that the research focus on neurotransmitters as the key cause of mental illness stopped producing any new findings long ago.

Despite not knowing the nature of the imbalance, the term ‘chemical imbalance’ has been argued to have made psychiatric disorders more palatable for patients and less stigmatising. If the cause of mental illness is our brain chemistry or our DNA, then it’s much more difficult for the person to be blamed for their symptoms. Advocates argue that stigma will diminish if we come to see mental health problems as biologically caused diseases, no different from diabetes or cancer.

Critics of the ‘chemical imbalance’ hypothesis claim that this hypothesis continues to be advanced only by pharmaceutical companies, with mammoth amounts of money going into possible pills that could bring their brain chemistry back into balance.

So does someone who has a mental illness actually have a “sick brain”? I don’t think we know for sure yet. We presume there is a ‘chemical imbalance’, but it’s uncertain as to what that imbalance actually is. We don’t know the exact biological nature of what is wrong when someone has a mental illness. And we don’t know for certain the exact mechanism by which medications or other treatments work.

I think we can say that someone’s brain is sick though to describe what we can’t scientifically explain. We know that something is not quite right in someone’s brain when he or she shows symptoms of bipolar disorder or schizophrenia or major depression. We know that certain chemicals might help to alleviate these symptoms. We also know that a mental health condition is probably caused by a range of things outside of the brain as well.

Like other body parts though, it’s entirely possible that the brain can also become a bit sick, or faulty, or imbalanced. Whilst it’s not the only factor contributing to the development of a mental illness, it’s an important one to note. If we acknowledge that there is a part of mental illness that is physically manifested, perhaps we will start to move from a narrative of blaming the person with a mental illness for being crazy or weak, to just being unwell. Because that’s what they are. And like all unwell people, they very much deserve to receive a card of support.

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Keeping your bubble safe

I really debated whether to write on this topic, mostly because by now probably every other person has said their piece. For better or worse. But in the aftermath of the events over the weekend and in the context of the horrors of what happens across the world on a regular basis, perhaps there is a couple of things we need to be mindful of.

From what I’ve read, the term ‘terrorism’ can be a difficult thing to concretely define. In the psychology world though, we often refer to terrorism through the concept of ‘psychological warfare’. The mechanism of action to terrorise the society may be a little different but the purpose remains the same. I’ll attempt to explain it. Terrorism is a form of political violence that is meant to send a message about a particular organisation or idea through violent victimisation or destruction. By design these acts induce terror and psychic fear (which is sometimes indiscriminate), but aids the activity of achieving maximum publicity and amplifying force (Marshall, 2005).

Terrorism and psychological warfare have been around for as long as anyone can remember. Throughout history, pretty much every military conflict has in one way or another involved some form of psychological warfare to disadvantage the opponent. But in today’s world, the rules of engagement in this type of mental battle have changed.

Because of the advances in technology, we have no idea what we might see, hear or learn when we turn on the television, pick up our phone or engage with our friends through social media. Unlike historical military battles, the effects of psychological warfare aren’t limited to the people involved or the countries and communities in which they took place. Nowadays we can all, in one way or another, become involved. Images of terror can trigger a visceral response no matter how close or far away from home the event happened. And the impact has the potential to be even greater too. To instil a sense of fear that is much greater than the actual threat itself.

Sometimes I like to think of each person having a psychological bubble around them. The bubble is made up of all their strengths, their range of coping skills, their beliefs and values and their past lived experiences and history. It’s a protective barrier that can help each person, in its own unique way, navigate through their experience of the world. And when things happen, the bubble reacts and transforms in different ways.


I spoke to a number of people over the weekend, who were feeling distressed about the news of what had happened in a foreign country half way around the world. And I felt it too. I felt sad and shocked and scared. And this is natural. As awful as it is, it’s natural to feel disturbed. And that’s because the majority of us are all beautiful human beings and in our bubbles we have the strength to feel empathy. Professor Haroun from the University of California says: “The human reaction is to put yourself in the situation, because most of us have good mental health and the capacity to empathise. We put ourselves in the shoes of the unfortunate.” So in essence, because we have the capacity for compassion for others, events such as these hurt.

Not only can it trouble the feelings in our bubble, witnessing an act of terror can also disrupt our belief system. There was a time when I was working closely with patients who were seeking asylum in Australia. It was not until then that I realised that how l had been so fiercely protected by the belief systems and values that were inside my bubble. I was fully aware that not everyone had the same values and social niceties as I did and I felt that as a result of my life experiences I had a reasonable grasp on reality, but when I heard the stories of extreme terror from these patients my bubble, my beliefs and values about the world I live in, became significantly challenged and violated. My bubble was significantly disrupted. And the result was an immense fear. Fearful in the sense that I was living in an uncaring and unsafe world because I was no longer ignorant to how low the bar of humanity was. And it took quite some time to learn to cope with that. To get my bubble back in balance.

The research suggests that the key to coping with psychological terror is to find a healthy balance. And most people do. Studies have shown that even in extreme disasters, the majority of people do not become incapable of functioning. While there may be initial shock and distress; people call on their personal strengths and those of their family and community. And for the most part, people recover and return to their normal activities.

We may not be able to prevent all attacks that occur, but there are some things we can do to protect ourselves and those we care about to find a healthy balance, protect our psychological bubble and ensure that we don’t become over-anxious about the possibility of terrorism. Because we are human, our decision-making skills can be impaired in times of extreme stress. So try and stay grounded in reality and seek out the reliable sources of news and information. And where possible don’t rush to make quick judgements on what might be incomplete or inaccurate information.

The Mental Health Association of NSW offers a number of practical suggestions to assist people living with the fear of terrorist attacks or other human-made disasters. These include:
- Find out where to get help in the event of an emergency
- Give and receive emotional support
- Keep in touch with the people you care about
- Offer help to others in the community

Additional suggestions can be found here. It is also possible that people with pre-existing mental health conditions may experience a worsening of symptoms in response to such events. Keep an eye out for any such loved ones and where possible try and provide additional support.

A strategy that has worked well for me in the past in ensuring my bubble remains strong and resilient is to seek out the hope. Hope is often the antithesis of fear. And so I find that by discovering (and sometimes it’s quite a search) the things that come from a devastating event that can add some hope back in to to my bubble helps to get my psychological health back in balance.

“When I was a boy and I would see scary things in the news, my mother would say to me, 'Look for the helpers. You will always find people who are helping." Fred Rogers.

So whilst our news feeds on social media, the opinion pieces on blogs and the background natter of the television continue to remind us of humanity’s atrocities, please look after yourself my friends. Try and keep your psychological bubble balanced, healthy and strong.

If you need to chat to someone:
Lifeline: 13 11 14
Beyond Blue: 1300 22 4636

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Don't call me 'mental' .... please.

I highly doubt this will be the only time I write on this subject, given the number of times I have banged on (and on and on) about it, time and time again. Language matters. Big time.

Language shapes how we see the world. This is true for everyone. And for everything. Our perceptions and expectations are shaped by the words we hear and use. They are part of the underpinning framework of our lives. The words we choose and the meaning we attach to them influence so much. Our feelings. Our attitudes. Our beliefs. Words can makes us feel happy, beautiful, ecstatic. Words can also make us feel miserable, angry, guilty.

“If thought corrupts language, language can also corrupt thought”  George Orwell.

But the great thing is that we have a choice over our words. We have full control over the language we use to describe ourselves, others and the world around us.

Historically, the world around us appears to have found mental health conditions and experiences difficult to confront, treat and talk about. It wasn’t that long ago that people who experienced mental illness were abused, removed entirely from society, subjected to un-anesthetised electric shock treatments and had parts of their brains removed through lobotomy procedures. And with these treatments and the complex issues regarding explanations of mental conditions came a range of language to describe such people: ‘lunatic’, ‘psycho’, ‘neurotic’, ‘maniac’ etc. Luckily with the progresses of psychology and psychiatry in both better understanding and treating mental illness, the language has changed over time, with the words used expressing the prevailing views of society.

“Language is the road map of a culture. It tells you where its people come from and where they are going”.  Rita Mae Brown.

But I think we’ve still got a way to go. Unfortunately the use of particular labels to describe people and their behaviours is still hanging around. The problem is that the use of a label often implies a separation of ‘us’ from ‘them’. And this separation can quite easily lead to the belief that ‘they’ are fundamentally different from ‘us’ and that ‘they’ even are the thing they are labelled. ‘They’ can become so different from those who do not share a negative label, so that ‘they’ can appear to be a completely different sort of people. Our use of language is revealing regarding the use of labels to distinguish ‘us’ from ‘them’.

Like I mentioned, I think this is improving, however for a long time it has been commonplace to label someone a “schizophrenic” instead of saying he or she is a person with schizophrenia. For physical illnesses things are handled differently and people will usually say, a person has cancer. The person with cancer remains one of ‘us’ and has an attribute, while the ‘schizophrenic’ becomes one of ‘them’ and is completely defined by the label we affix to the person. In this way, language can be a powerful source and sign of stigmatisation.

It intrigues me how people use labels to describe their experiences of mental illness. When I was working as a psychologist, it was something I would challenge clients on and the relationship between their choice of words and recovery was fascinating. When I was a patient in a psychiatric hospital, it was one of the things I most commonly ranted about to other patients in groups as to how I thought they should speak about their own mental illness.

From my experience, the three most commonly asked questions (with common answers) that are asked between inpatients in a mental health facility appear to be:

  1. What’s your name?
    1. My name is Sam/Andrew/La-ah
  2. Where are you from?
    1. I’m from Brisbane/Lismore/Timbuktu
  3. What are you here for?
    1. I’m depressed/anxious/bipolar/psychotic/crazy etc.

More often than not, patients described themselves in terms of their illness. So not only does the wider community place these labels on ‘us’, but sometimes it comes from the individual themselfl. But mental illnesses are not adjectives. And they are not ‘us’. I am not defined entirely by a disorder. Just as no one would ever say “I’m cancerous” or “I’m urinary tract infection”.

So what’s the best thing to do when talking about someone else’s mental illness? Be respectful. Taking the time and making the effort to show respect for people who may have different backgrounds, life experiences and cultures from our own can really improve our ability to communicate. Maybe spend some time becoming aware of your own beliefs, stereotypes and biases about people who have a mental health condition. Be aware that certain words and labels can hurt.

Remember that all people are people first and foremost. Rather than describe the person as their illness, describe them as a person experiencing a certain something. E.g. Sam is experiencing a mental health episode. Remember that a lot of mental illnesses are treatable and manageable and as such may pass. Probably best then not to stick a label on someone  for a condition that may not even hang around.

And why not ask your loved one how they’d like the mental illness to be referred to? That too can work.

“The limits of my language means the limits of my world” Ludwig Wittgenstein.

 

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