Friday, 3 May 2013

Asylum Mind

My own experiences of hospitalisation have been that of a being subject to a great power,  like so many, I had no words to describe it, nor the courage to question it. I understood the term ‘Therapeutic power’ (Dr Maxwell Jones) long before ever hearing it's name. Described by John Perceval and further confirmed in the of writings Michele Foucault we arrive at the notion of Asylum mind, described in the book 'The seduction of Madness' by Dr Edward Podvoll.

  • ·         Asylum mind embodies the idea that madness must be subjugated for recovery to take place. The mind of insanity must learn to bow before the superior power of reason and logic.
  • ·         Asylum mind preserves what is called ‘nonreciprocal observation’ One is observed without being able to observe properly. Mistakes, awkwardness, transgressions are catalogued, diagnosed and studied. One’s own observations are called unsound, resistance, arrogance, transference. Examination of one’s conditions or caretakers is prohibited a situation bound to evoke paranoia.
  • ·         Asylum mind treats madness as childhood. Relegates confines to the status of minors- intellectually, morally, judicially. A prejudice stemming from what has been called ‘damage theory’ that people in psychosis are under developed, arrested, deficient or defective. All of which have for too long excused insufficient care.
  • ·         Asylum mind manifests in an organisation of people whose hierarchy is based on a conviction of its moral sovereignty over the insane.
  • ·         Asylum mind sees spirituality as ‘religiosity’ and as dangerous to the welfare of the patient, here the ageless understanding of insanity as a spiritual crisis has been lost.
  • ·         Asylum mind poses itself as rescuer, to which one should be grateful and obedient.
  • ·         Asylum mind demands a confession to the error of arrogance and to the ancient crime of spiritual self exaggeration. The residue of guilt is to last far into the future, to be an armour and reminder against any excessive self presumption in the future.
  • ·         Asylum is fundamentally a medical space. Somewhere around the turn of the 18C medical specialists took complete responsibility for care of the insane. New territory sanctioned when the lunatic doctors were royally sanctioned to treat George III
  • ·         The asylum mind vision is that recovery cannot take place without sufficient inner self mortification and an attitude of apology.

Tuesday, 30 April 2013

This is my Church, This is where I heal my hurts

 After being diagnosed with one of those ‘severe and enduring’ mental illnesses many begin to define themselves by their psychiatric label. They may call themselves schizophrenic or manic depressive and in so doing often confirm the chronicity inherent to those labels. I am by way of being a martial artist and when I found myself subject to the mental health system, severely labelled, medicated and without hope, I fought a personal battle in a mental landscape, the battle to define myself.

  “Your true battle is with your own mind of discord”

Morihei Ueshiba

From the first class I was hooked, the principles and practice of Aikido fed a hunger which began in my childhood. I trained under my instructors as often as possible, even setting up a small dojo in my house where I could practice daily. In 1994 it was my honour and privilege to be asked to teach my first class and soon I began to make plans to set up my own local ‘Leeds’ class.

Just when, the elated moods began I am not sure or whether my fascination with spiritual aspect quickened the process or kept me well may never be known. The high mood increased over time until they were somewhat out of control. Hospitalisation followed and it was at this point that the true battle for which I had trained began. I was told, as I entered hospital that although not under a section of the mental health act, if I tried to leave I would be sectioned. It was explained to me that should I refuse medication I would be restrained and injected against my will, the power invested in the hands of those around me was horrifying, I no longer had any choice but to nod at the right time, remain silent and hope for a quick discharge. Within a few days of entering the ward I shuffled around dribbling, held my hands out in front of me unable to hold a drink without spilling it. I could not distinguish between illness and the medication side effects; this it seemed was how my life would be from now on.

After being discharged the adverse effects of too much haloperidol were still evident, if it were not for my wife I doubt I would have been discharged at all. I shuffled round the house with an ashen face set in a haloperidol ‘death mask’, there was nothing I could do for myself apart from sit on the edge of my seat like some withered emaciated ghost of who I had once been. A hungry ghost still haunting it's old life, lost  somewhere between desperation and longing, this was to be my lot.

A friend called, a fellow Aikidoka, he was shocked at what I had become. We talked briefly and then he took me outside. Tai no Henko he called out, a blending exercise in Aikido.

The founder of Aikido Morihei Ueshiba practicing Tai no Henko with Chiba Sensei

He grasped my wrist firmly, my body turned as he did so and I felt the authentic power of good posture and breathing, he allowed me to practice the exercise over and over and I began to feel strong again, a strength I thought was lost forever. I understood the role my Aikido would take in this battle. We practiced some sword exercises together and when he left I remained for some time lost in bokken suburi, a solitary exercise. The next day I was as before yet the memory of that authentic empowerment remained.

Eventually I returned to the dojo, this time with my eldest son by my side. I believe it is the training, discipline and respect martial arts demand which had fostered in me the spirit to challenge the stigma of living with a serious mental health condition and to face further relapse. My diagnosis defines me less than my martial art.

Through the course of my training mental health episodes have taken me away from the dojo, so it was to my great surprise and joy that the principal instructor of our club promoted me to the rank of Sandan, 3rd Dan, in December 2012. That day was a huge milestone in my recovery.

"Your heart is full of fertile seeds, waiting to sprout." Morihei Ueshiba

Friday, 1 April 2011

The birth of Recovery Leeds; by Recovery Leeds

I entered the mental health system just over 10 years ago, first as a patient, emphasis on the patience, then a service user and shortly after as a member of staff.

Conditioned by the usual messages welcoming me to a jobless and dysfunctional future, I had become a half being set to fail as both parent and husband. A hungry ghost, haunting my old life, surrounded on all sides by imaginary walls, infecting my surroundings with misery.

  " Encompassed on all sides with a thousand dangers, weary faint, trembling with a thousand a fleshy tomb, am buried above ground." 
                                                                          William Cowper

It is important to stress most of this stigma and negativity came from within. My wife was unfailing in her belief of healing, while others in their silence and empathic expressions only colluded with my own sense of loss, misery and hopelessness, heralding the dawn of an age of severe and enduring illness.

  After seeing a long, and I do mean long, series of locum psychiatrists all of whom confirmed my fears, it was during a CPA review that I first heard, spoken by a professional, the language of what I now recognise to be recovery. I was in no state to speak, sobbing so inconsolably those present must have wondered if I even knew what was going on, but this young doctor, Dr Watson, spoke of a return to my normal, of work and life as enjoyable once again. Outwardly I must have seemed unable to hear but inwardly his words gently lifted my face that I would hear them, engendering a sense of hope. The message was understood not in an intellectual sense rather as an experience in my heart, the budding of optimism following words which fell as seeds in my being, watered perhaps by my own tears.

  Later after beginning work as a Service User Development Worker within rehabilitation services in Leeds I found echoes of that message in the Psychosocial Interventions training I attended and so I did all I could to understand the concept of what has been labelled recovery. My first Google searches uncovered little; there was information about the Tidal Model together with advice on recovery of a model rocket. I gathered all the information I could and developed my own recovery resource, attaching documents to as many emails I could in the hope of growing the positive message I received on that day and the ensuing positive effect on my sense of hope. I gathered articles which fostered that same sense of optimism by listening with my heart. I then went on to collect items which might be helpful to organisations and the people working within them, those like I now found myself to be, privileged in supporting people with Mental Health challenges.
It was during a visit to my daughters school and reading information produced by their IT department that I realised how easy it would be to set up a blog, this would mean instead of sending people documents I could simply give them the blog address. I went home that evening and within a few short minutes, recoveryleeds was born. It isn’t a blog in the sense of an online journal or diary, more a place to find links and documents. In the body of the blog I have tried to place articles or even phrases which might interest or even inspire others.

  Just over a year ago I installed an add-on called Google Analytics, this provides information about how often the site is accessed and from where. Since then the blog has been viewed 2675 times in 83 countries spanning 6 continents. I have no financial investment in people visiting the site only the hope they will find some of the pieces in their jigsaw.

  It was suggested I write a short article about my blog for a magazine and I thought it a good idea to post it.

  My very best wishes in your recovery and those who you may have the privilege to support.  rl

Monday, 15 November 2010

The Way of Transformation

The man, who, being really on the Way, falls upon hard times in the world will not, as a consequence, turn to that friend who offers him refuge and comfort and encourages his old self to survive. Rather, he will seek out someone who will faithfully and inexorably help him to risk himself, so that he may endure the suffering and pass courageously through it. Only to the extent that man exposes himself over and over again to annihilation, can that which is indestructible arise within him. In this lies the dignity of daring.
Von Durkheim

 There is a field

Out beyond ideas of wrongdoing

and rightdoing there is a field.

I'll meet you there.


Thursday, 16 September 2010

Recovery – pie in the sky or a star?

Donna Kemp asks who ‘owns recovery’?

Recovery is everyone’s business. It seems to have been the buzz word for the last few years in mental health and is rapidly gathering momentum. Indeed, it appears to be morphing, growing arms and legs, changing its meaning and expanding its territory. Its mental health roots were firmly in the service users’ ground; it was something that service users owned – ‘you know what, despite what I’m going through with mental health services, of being care programme approached up hill and down dale, of being told what my needs are and what services and tablets can do to make me better, regardless of all of this, I can and I will have a life (so up yours!)’. It was empowering and liberating; it actually made sense and generated energy. Energy is contagious, get near it and you too will feel energised with recovery.

Everyone wants a piece of the recovery pie – it’s just so damned good! Mental health services are enchanted, a genuine bona fide tool for engagement, something that service users actually want to be involved with – a promised hope that is not a tablet or a weekly visit, whether you need it or not. Services are smart quickly picked up the new language, the new currency, developing recovery-focused services and offering recovery training. It is truly the age of recovery and the future looks rosy.

But the recovery baton has been taken rather than willingly passed from the user to the service. Yes, service users stay central to their support and care; yes, the ethos of recovery remains strong with collaborative working, but yes, the locus of control has shifted from the individual to the service. Like anything that you nurture and hold dear, to have it taken from you and given back is like the perpetual spare Christmas present, rewrapped and presented back as an original. Disappointed, you act surprised and feign gratitude, but it’s not right, the shine has dulled, it’s lost its energy and appeal.

Services have grabbed the tools from the recovery tool kit (marked ‘service users only’) and sculpted them into service-friendly instruments; paper heavy, but also oddly compatible with an electronic system – kind of – well, it will look better printed off. Take the Mental Health Recovery Star for instance. It’s all the rage, and rightly so. It’s good, it makes sense, it hits the mark, it’s visually pleasing and portable. For all of these reasons, it is fast becoming the tool of choice for measuring outcomes; commissioners are happy, services are happy, maybe even service users are happy at the idea that the ‘Star’ is stealing the show. But, it’s across the board, now everyone should have a recovery star with the outcomes measured regardless. It becomes mandatory, meaning that ultimately recovery is mandatory. You have no choice, you must ultimately recover and we will all be watching. We need you to recover, to show those positive outcomes; that means that you no longer need a service because you met the outcomes.

Congratulations, you just outcomed yourself out of a service. Now that may be great for some individuals, but frankly it fills some people with fear and confusion.  The rules have changed, services were always going to be there; to tinker with medications that must be taken; to keep on visiting come rain or shine; to remind people that they are too unwell to work at the moment; that going to the day centre is best. The rules have changed and it’s become time to fly the comfortable mental health nest that was filled with promises of foreverness.

To be clear, the paternalistic tendencies of mental health services are not acceptable. A shift in attitude and practice is evident, welcome and long may it prosper. Recovery-focused work with individuals is the right approach, but I would suggest affording caution to the wholesale use of one specific tool. This would be a move away from individualised service-user-centred care and support. Let mental health practitioners be creative in how they engage with people, give them a selection of tools to use, but remember that any craftsman will tell you that their own hand is their best tool – practitioners are fully capable of working with individuals to develop outcome-based care plans. As for recovery, it’s here to stay, but we need to consider the language and how we use it. It can have a paradoxical effect with some people, there is always the option of being maverick and actually using a term that the person you are working with uses: ‘getting better’ ‘getting back on the horse’ ‘feeling well’ ‘wellbeing’, ‘getting back to normal’; you never know, it could work.

Donna Kemp

Care Programme Approach Development Manager

Leeds Partnerships NHS Foundation Trust

Published in Mental Healt Nursing magazine Aug/Sept 2010 Volume 30 number 4