Self-therapy

Needs must.

I’ve now been in rehab about three weeks. In that time I have formed two overall impressions. Of course, these could well be mistaken. Time will probably tell. But what I think I’ve got to say at this point runs as follows.

On the physical side, things are very good. I have been assigned physical and occupational therapists who strike me as absolutely outstanding. They clearly know what they are talking about at very high levels, and are implementing a regime which I think is already having noticeable effects. Nothing is ever quick in this process, but variations on vibration therapy, electrical stimulation, the use of silicon compression sleeves, bending me in ways that are highly uncomfortable but necessary, and a clear commitment to get as much out of my body as possible, seem to be working. These are early days to be sure, but I can have no complaints. Indeed, until recently my main gripe was that I wasn’t doing enough, and wanted more. Then on Friday evening I was so exhausted I had to go to bed early and needed painkillers to cope with muscle fatigue. I guess I should stop judging what I’m capable of against what I used to do pre-accident, and start just trusting the experts.

So on the physical side, it’s two big thumbs up from me. Or at least, it will be if progress continues and I can actually give two thumbs up one day.

Much more disappointing is the psychological side of things. Part of what’s gone wrong here is that I set the bar of expectations too high. Having had an outstanding psychiatric consultant come and speak to me on a regular basis at the Royal London Hospital, and who even followed up via video calls to keep in touch before I made it to rehab, I foolishly assumed this was the standard to continue expecting. Safe to say it isn’t.

Or perhaps it wasn’t so foolish after all. I’m not exactly advancing a controversial thesis when I say that it is widely accepted that mental health and physical health are tightly intertwined. We know that if people are doing well psychologically, they will do better physically. The reverse is also very much true. So given that I am now at what is reputed to be one of the most successful spinal rehab centres in the world, I took it for granted that here at least both sides - mental and physical - would be well integrated. Not so.

To illustrate, consider my weekly timetable. Every day I have scheduled sessions with occupational and physical therapists, and I’m now being introduced to extra sessions involving things like being made to artificially stand, beginning to get involved with rudimentary sport, and hopefully soon even hydrotherapy. Where, you might ask, is the timetabled slot for psychological support to go alongside physical recovery?Nowhere, is the answer. It simply isn’t factored in.

Now this doesn’t mean I haven’t seen a mental health professional since I’ve been here. You can indeed see them. The trick appears to be to have a full on breakdown in the morning in front of the nurses when they are trying to get you dressed. If that happens, then in the next couple of days something involving mental health will get pencilled on to your timetable. (Literally.) Or at least that’s how it worked for me on the two occasions I’ve had scheduled mental health engagements.

On the first occasion, I saw a senior psychiatrist, who took a lot of notes but seemed mostly interested in what pills he could prescribe me. Predictably, the conclusion was that I am already on the pills, so there’s not much to do there. He did give me some insight though. Having worked here for 10 years, he told me, he would say that about 80% of patients go on to lead lives that they find meaningful. So I did the maths quickly in my head. That means 20% don’t. That’s a one in five chance. For comparison’s sake, you have a one in six chance of losing at Russian roulette. Hence I would statistically be better off reenacting a scene from the Deer Hunter. Great. Thanks for the insight.

The other time that I got pencilled in to see a psychologist after a morning crisis it was almost like the gods had been reading my previous posts on here and decided to punish me for trying to take the piss. This time a young lady sat down with me. We had already gotten off to a non-ideal start when she saw me earlier in the day reading a book and commented that she doesn’t read novels, only psychiatry textbooks. But I let this pass and tried to see what would come of our session. It went as follows. I spiralled deeper and deeper into a negative reinforcement about how my life is ruined and everything I cared about is gone. Throughout this period her input was to repeat back to me things that I had just said, but in a sympathetic tone of voice. Rather than trying to stop me falling deeper and deeper into depression, she just sat there, mostly listening. After 40 minutes had gone by I realised that this wasn’t helping. In fact, it was definitely making me worse. Recalling that my previous psychiatrist had always intervened effectively and intelligently to halt such spiralling by getting me to pause and reconsider, I tried to channel her insights and called an end to the diatribe myself.

The honest truth is that it felt like I was speaking to a polite but unambitious student. That they were passively sitting there and largely deferring to what I was saying. Which, to put it bluntly, is pretty much the exact opposite of what I need. A little further investigation revealed what I suspected. This young lady’s training was in CBT, and she was getting ready to suggest the kind of entry level strategies I know don’t work for me because I have been round the goddamn block on this stuff for years.

Just let that sink in. Basic cognitive behavioural therapy. We are talking about a rehab centre in which every patient who comes through the doors is going through one of the most awful things that a human being can endure. It is a living hell, that one must wake up to every day, remembering everything one has lost, with the prospect of a stunted half life to follow (at least, this is how it feels). I refuse to believe that anybody in this centre is actually coping with it well. And yet psychological support is at best an afterthought, delivered on a reactive, not proactive, basis. I find it jaw dropping.

Indeed, I can’t quite believe what I’m seeing sometimes. There is a guy here on the ward that I am slowly developing a rapport with. (At the end of the day, we do have something in common; both of us are suffering every day for roughly the same reasons.) In the last few days, he has started to confide in me a little. He is struggling, stuck in cycles of despair. I get it,  because I have exactly the same thoughts he does. I’ve tried to let him know that I’m struggling too. Solidarity here matters. But what about the staff? Well, what they see every morning is this chap being polite, cheerful, and cracking jokes. He always seems like he’s doing okay. Right? Well, no. He confessed to me that just as I do, he despises mornings; that he finds the hour or so of having shit squeezed out of him before being washed by strangers utterly humiliating and degrading. He hates it here, and keeps going over and over in his head how a split second decision destroyed his life last summer. But on the outside, he’s laughing and joking. After all, he’s a man. Weakness is not acceptable, right? So the show must go on. And as far as I can tell, the staff buy the show every morning. But it is a show.

Which is striking when you think about it. The NHS literally runs campaigns drawing attention to the fact that people hide their mental health issues, and often it is those who outwardly seem okay who actually need the most help. Yet here in the heart of the NHS, in a place where I wager that literally every patient is going through psychological torment, this very truth seems blissfully ignored.

What would I do differently? Well for a start, I would make it a timetabled fixture that every patient can spend 45 minutes a week with an experienced mental health worker. Now i’m perfectly aware that many patients might sit there in silence. Men in particular may refuse to accept any help, at least initially. But some won’t, even if it takes them several weeks to begin opening up. And for those individuals, this could be a transformative lifeline. It’s a fact about human beings that the vast majority of them do better when they have somebody to speak to. Why not make an opportunity to talk a scheduled expectation every week?

I’m aware, of course, that the obstacle here is likely money. A rehab centre such as this must already be extraordinarily expensive in terms of the NHS budget. Scrimping on psychological care might seem like an easy save. But I suspect this is a false economy. Maximising people’s physical recovery is likely best achieved by enhancing their mental recovery too, after all. For all that politicians speak about integrating physical and mental healthcare, it is clearly not being done in one of the most outstanding areas of need. Probably I am just seeing in stark form the reality of how lowly mental health is prioritised in the NHS. And I also accept that I’m an unusual case. Three years ago I wouldn’t be writing this. The fact that I finally committed to therapy and paid for it privately just under two years ago radically changed my perspective. I now believe both that it is highly effective  (provided the person you are working with is a good fit for you), and that pretty much everyone would benefit from it. I think, however, that means I do have genuine insight here.

Yet such insight, if that is what it is, isn’t going to count for anything anytime soon. So what to do in the meantime? Well my new gambit is to try and therapize myself, by trying to work out what a good therapist would say to get me to rethink my perspectives, challenging me to break out of the black and white negative thinking to which I am prone.

Here is an example. Like my wardmate, I still find the morning routine of being manually evacuated and then washed by strangers an ordeal. But I am trying to change the way I think about it. Rather than seeing it as a humiliation, a different interpretation is that it is in fact an act of kindness. After all, this is not a fun job for anybody to perform on me. Furthermore, the people doing it are far from well paid. Yet they come in day after day, and do work that I would certainly never have deigned to do myself. Nobody is trying to humiliate me; their intention is to help. So rather than continuing to experience this daily reality as degradation, my hope is to eventually come to see it as, for want of a better word, an act of love. I’m not there yet. But I’m trying.

Or consider my habit of drifting off to sleep each night by telling myself that I only have to survive this for another couple of months, because once I leave rehab I can then find a way to kill myself. (I then tend to ponder how I plan to do it, largely depending on how much hand function I have regained.) Do I really mean it? Part of me wants to say yes, but that part has to explain why I still brush my teeth twice a day. This may seem like a strange question, but it’s an insightful one to pose to myself. That is because brushing my teeth is currently no easy task. It requires asking staff to find and then give me my electric toothbrush, strap it to my hand, turn it on for me, wait for me to do the best job I can, before helping me rinse out and spit in a closely held bowl. It would be far easier not to bother. Nobody else around me ever seems to. Yet if I really wanted to die, and planned to do so soon, why would I bother brushing my teeth? In fact, I know what the motivation is. Given how screwed my situation already is, I don’t want to add dental complications further down the line. Actually, I’m probably taking the best care of my teeth that I ever have these past months. So that means part of me, at least, plans on living. The voice I listen to as I go to sleep doesn’t, therefore, have the final word. A coping mechanism for use in the short term is not the same thing as a settled resolution, after all.

Finally, there is the need to plan ahead. Good therapists encourage you to reflect on what there is to live for, on a human being’s need for meaning. Ironically, I may have here stumbled across something. Assuming I do indeed survive this limbo and eventually pursue a life containing purpose, then one thing I think I would like it to include is finding a way to make it so that future victims of spinal catastrophe receive mental support on a par with the best physical help available. This is bolstered by the fact that I have recently come to appreciate that being kind to others is one of the best ways to also be kind to yourself. I wish I had learned this earlier. But better late than never: having something to live for doesn’t mean living only for one’s self. I’m no psychotherapist, that is for sure, but needs must. So for now I’ll try to therapize myself.