We sat on the balcony chatting. The view wasn’t majestic or awe inspiring as such, just looking over a courtyard, towards a high rise block of flats. The conversation ebbed and flowed, the wine went down and bit by bit we made sense of some work, some writing, a few small conundrums and challenges that we were variously facing. The space to our front opening up our minds and allowing room for the thoughts to emerge, some of them dropping and falling to the cobbles below, others taking flight as fully formed ideas.
Another day, another place. Training in a museum. A historic building, all sash windows and shutters. Dark and cool inside, a quiet, calm place to work with emotive content. At lunch we all emerged blinking in to the sun. The gardens of the museum providing a spacious oasis of green, inches from a bustling street. Allowing us to free our thinking and set out what we have learned and our hopes for our organisations.
A hot, airless room. Forty five minutes in to a hard work out of yoga. Sweating heavily and praying for the last few movements when the teacher suggests a headstand – something I’ve never even attempted. Patiently she talks us through it. A few grimaces around the room, a sheepish laugh from me but the encouragement is there. I move my mat to the wall for safety and slowly set up. I move first one leg and then the other. I can’t quite trust it and I swing back down.
The teacher adjusts my stance slightly and I try again. This time it holds. My legs go up and stay up. I’m fully inverted. For the first time ever in yoga my head fully clears. I lose any thoughts of being correct in my posture or where my breathing should be. Suddenly my head, heart and gut align and my conscious mind lets go.
I’m there, in the space between…..
I’m sure it’s just a suggestion in my mind but I’ve always sworn that I can feel when I’m home. The soft chalky soil of Dorset with the sharp hardness of flint woven through it seems to connect with me. The energy and history of my homeland rising up through the soil. I mean how many counties have their border designated a world heritage site?
This is the second blog inspired by a single podcast episode. The podcast concerned is “The one you feed” and focusses on personal development. In this episode I heard the quote “Fools seek from afar, the wise find truth beneath their feet”, now this makes sense for me in respect of my upbringing and the values instilled in me by my parents. Which is not to say my childhood was insular but more that it was rooted in age old truths and the rhythm of the seasons.
Last week I was reading various business and mental health articles, best practice, holocracy and patient care amongst them. Almost all of them seemed to be reaching out for an external solution, finding an answer in how another organisation had cracked a problem and trying to graft that solution on to their own situation. Now obviously working as a freelancer I guess I shouldn’t bite the hand that feeds me but I was concerned by this solely outward focus.
In my experience most organisations have vast pools of untapped energy and innovation within them. Yes, sometimes they need an injection of fresh thinking but in the main those people would shine and deliver if they were trusted, resourced and encouraged. I wonder what would happen if we looked for the truth where we stand, inside our own organisation, inside ourselves……….
…… and yes this is a picture of where I’m from, I’m stood on an Iron Age fort, grounded.
I open the box and withdraw the contents. I slowly and carefully read the guidance leaflet, turning the small packet over and over in my hands as I do so. I take a deep breath and push the tablet out of the little plastic blister, popping the foil. I neaten the tear, tidying the edges up as a delaying tactic. I can’t put it off any longer. I pop the tablet in my mouth and swallow it down. It’s such a small tablet I don’t have any trouble with it but I still pour a glass of water down after it to be sure.
I shouldn’t complain: I’ve had some sort of working diagnosis for over 20 years and this is the first time I’ve had to take the mood stabilising medication so common to others. Actually I say it is the first, I’m sure I’ve needed it other times but over the years a combination of alcohol, other poor coping strategies and occasional bouts of counselling have seen off the worst of it until my body somehow resets.
In recent years I’ve started to properly track my mood and also to reflect back over the past. I’ve noticed about a three-year cycle where I reach crisis point. This time I’d not recovered from the late 2011/ early 2012 crisis (a long term depressive episode) before I could feel a huge upswing. Normally I become relatively stable for a while but this time I’ve felt like a pinball, flung forward and bouncing off the world.
I was aware of this in late 2014 and I asked for more help with the racing in my mind. The clinicians agreed that help would be forthcoming, indeed I was offered a therapist in February. However he had no flexibility on available days and it would have left me unable to deliver a two day course, something which is a key part of how I earn my money so it was back to the waiting list. When that offer of therapy came about only two months after requesting help I was optimistic that I would be close to the top of the list for the next therapist. I was wrong.
Which left me at the Community Mental Health Team last week talking to a kindly locum psychiatrist who was willing to enact something I had discussed at the start of the year – starting mood stabilising medication.
In all honesty I’m ok about starting the medication. Yes it feels like a big step but also it is an essential step. As the psychiatrist put it, “you can pin your hopes on therapy but what will the wait do to you? We have something which may help you in the interim and we can start today.” I talked to him about the yoga, the cycling and the self care I do. He nodded and said, “well with all that effort and your symptoms still aren’t shifting then maybe you need some extra help”.
He’s right. I know he is right so this is where you find me, accepting the help.
When I was riding regularly a couple of years ago I had a favoured training route. I knew roughly where I was / needed to be in both distance and time terms for any given point. I also knew how to cut the route short or extend it depending on my fatigue. Since knee surgery and then a freak accident where I sliced my leg open on the chainring (don’t ask) I’ve struggled to ride consistently and comfortably. I’ve had the bike refitted for me and that’s helped but in many ways I’ve lost the ease and comfort I used to find from a ride. Which is an issue when you’re not allowed to run and you’re not a great swimmer.
On the last couple of rides I’ve had errands to run that have meant changing my route at the start. Rather than swing back on to my old tried and trusted (and pleasingly quiet) lanes I’ve struck out in new directions. With nothing other than a rough idea how the busy villages and towns to the south of me are laid out I’ve just turned the front wheel left and right as the mood takes me. This has led to a few errors and U-turns but also to many surprises – who knew there were so many llamas in the local area?
This weekend I was listening to a podcast and there was a quote which grabbed me, “If you’re not here now, you won’t be there then”. This quote was in my mind as I rode steadily along. I had a sense of remaining very connected to the present – not always the easiest thing for me with my mental health. The roads were full and I needed all my concentration at times but I found capacity to remain focussed and alert to what my body was telling me in terms of fatigue.
I’ve been wondering whether hearing the quote made my ride more “mindful” – a real buzzword / hot topic in both the mental health and business worlds that I inhabit. I guess the answer is probably – but more than that I was also conscious of the surrender of having no map and wearing no watch. If anyone had asked me where I was or what time it was I could only have answered “Here and now” which is such a rarity in this always on, constantly connected world. And you know what? I enjoyed it so much I’ll do it again and again.
As I write this blog I’m reminded that this is actually a lesson I had forgotten, one I remembered from a cartoon so I’ll reproduce that here courtesy of the excellent webcomic xkcd.com
By the end of the two days I had coached 10 people. All of them 1 hour meetings. Understandably they were focussed, intense sessions. However rather than being like a fast machine gun burst each had its own specific nature. Some were characterised by retrieving forgotten insights, others by big breakthroughs of thought. There were many laughs and a few tears. The majority of sessions were in meeting rooms yet we also walked and sat by the river, depending on the need.
Working within a mid sized organisation some of their stories overlapped and dovetailed, filling in blanks. It was an unusual glimpse of a workforce but also compelling and beautiful.
With only a little time between sessions I had to be mindful of my own wellbeing, managing my emotional state to be fully present for each client. The intellectual rigour was challenging but rewarding. Like a really tough work out where your muscles ache but in a good way. I was properly, pleasantly tired at the end of each day.
And in the middle of it all I got to attend a group coaching session with another coach. We went to the seaside. I was the only contractor in the group of employees there to learn about “Mindfulness Coaching” I lazily took my turn on the receiving end, building my strength for another long afternoon ahead. Luxuriating in the feel of the sun on my cheek, the wind in my hair and the sense of perspective that only endless sand and sky can bring.
Plenty of people have structures around what coaching is and many more about what it isn’t. I’d agree that this was certainly not a conventional weeks work for me. The only unifying strand was the stated intent of “Wellbeing”. How appropriate then that the experience also left me feeling nurtured and that I had grown a little.
Last week I attended a conference. Nothing particularly unusual in that. This conference had soundbites like “Dialogue is the embodiment of love” or “The three key principles of dialogue are openness, authenticity and unconditional warmth”. Again, regular readers know that I’m quite comfortable with a bit of cosmic wisdom so nothing scary there.
Except that this was a NHS conference, one talking about care for patients with symptoms of psychosis or diagnoses such as schizophrenia. Somewhere you’d expect the talk to be about the tension between psychiatry versus therapy, medication versus talking.
On stage were a broad mix of healthcare professionals ranging from consultant psychiatrists and psychologists through therapists and social workers to peer support workers and carers. They were there to talk about a trial going on in 4 trusts in “Open Dialogue”. This is an approach which has generated a lot of headlines about being “anti-psychiatry” or “pill-shaming” those on medication but the reality turned out to be rather different.
Without going too deep in to the science I want to reflect on a few key points. In the Open Dialogue model the patient is at the centre of the care and members of their family and / or social network are involved in “network meetings” with healthcare professionals (and again I include peer support workers and advocates in that definition, they are being trained alongside clinicians). The emphasis is on patient independence and recovery from day one (they try to see referrals in 24 hours). There is also an expectation that everyone’s views are valid – at one point peer workers were described as co-therapists and whilst for some people that will feel uncomfortable, to me it indicated the inclusive nature of the approach
Many of the speakers reflected on how different it was meeting patients in their own environment, amongst family and friends rather than isolated in a care setting. One of the key things they all seemed to feel was that this approach took more time at first but led to better conversations and decisions which saved time in the long run. There was an admittance that many clinicians are uncomfortable with patients in distress. So a large part of the training in dialogic processes focusses on trainees working on their own issues separately so that they could truly be present when it came to care giving. (One person even spoke of the need to “untraumatise” the NHS workforce). Additionally there was a strand which talked about clinicians being able to let go of having an answer or treatment ready but instead seeing their role as setting up a space where solutions can arise.
At this point I should declare a couple of conflicts of interest. Much of the work around this develops studies by Gregory Bateson, someone I greatly admire. Additionally I have gained a lot from many conversations with Julie Drybrough and from her introducing me to the work of William Isaacs who describes dialogue as “the art of thinking together”. An approach that I think is fundamentally important in this age of social media and digital thinking.
The other interest is that I am a patient under secondary care for my mental health. Someone who dreams of getting several professionals in a room at once to discuss my case. Someone who dreams of being able to co-design / co-create the care that I get. Someone who dreams of having a clinical response which acknowledges my own expertise in my condition. I just want someone to talk to me, not at me.
Obviously there is much much more to the debate than I am presenting here. The trial is still very new and I wouldn’t qualify for the care anyway but across the many people I spoke to in the room there was a genuine sense that this approach could benefit many people. I for one will be watching the trial with interest.
I guess I should be glad I saw the locum doctor. This supremely disinterested man who hadn’t bothered to read my notes before seeing me, even though I’d given the receptionist a detailed description of what I needed to discuss. If it wasn’t for him desperately trying to play catch up he might not have blurted out the wrongful diagnosis recorded on his screen.
I say wrongful (mainly because it doesn’t fit with my experience) but it might be what the Community Mental Health Team believe is wrong with me. Which perhaps would be fine if they had bothered to discuss it with me. Except they didn’t. Ever. The letter the locum quoted from was written a year ago.
I asked the doctor to print me a copy of it which to his credit he instantly did. On this letter they spelt my name incorrectly and later on referred to the psychiatrist being willing to see “David” again as necessary. Now I appreciate my middle name is David but bearing in mind the mess with my first name I think it unlikely they were covering all the bases.
I don’t want to go in the specifics of the purported diagnosis. It’s in the personality disorder spectrum and it’s fair to say that if it’s right I should more properly be being treated by the well known local hospital of Broadmoor rather than trying to re-access the secondary care functions of my local trust. However what it raises is the spectre of me explaining to a doctor that it’s incorrect and them seeing that disagreement with the diagnosis as a manifestation of the disorder, that I’m trying to manipulate their thinking. More rationally I know it could be a cut and paste mistake, after all, who is this David chap referred to in my letter? Either way it’s distressing and confusing.
At the root of this all is one word – trust. To quote the number one definition at dictionary.com “reliance on the integrity, strength, ability, surety, etc., of a person or thing; confidence“. So at a time when I can’t trust my own mind, the very people entrusted to look after me, so much so that their organisation is called a “Foundation Trust” have either confused several patient records, wrongly diagnosed me, or correctly diagnosed me and failed to treat me appropriately. It brings to mind the old mental health joke – “Just because you’re paranoid and delusional, doesn’t mean the government isn’t out to get you”.