As I was reading this, the thought floated through my mind "this guy could become a therapist, or a campaigner for therapy for people in his circumstances, or both, or something similar...". In your last paragraph it sounded like you might have been thinking that too.
This is an extremely insightful comment. The NHS doesn't prioritize mental health at all, it's missing in lots of areas that you would think it was essential (rehab, serious accidents, brain injury) and the designated mental health services are all highly inadequate, due to poor funding, which leaves you with the poor inexperienced CBT woman saying what you just said back to you in a more sympathetic voice. I was thrown off my CBT course as my daughter went into hospital as an emergency that weekend and I didn't have time to complete the worksheet. I wish I was joking.
That said, writing can be therapeutic, I'm glad you have this outlet. I have 100's of thousands of words floating about in my computer, you are kind enough to share yours with others. Never feel obliged to, though, write as little or as much as you like. Hannah x
Kindness really does win every time I find in dealing with my mental health weasals. Currently wondering why my hubby bothers with being married to someone who is now effectively useless and grumpy with it. The reasons are a) he didn't marry be because I was useful in the first place but because he loves me, my glorious personality and loving heart of kindness (I'm paraphrasing) and b) he is incredibly kind and that is one of the many reasons I married him in the first place. Kindness for the win.
Wow, Paul... Your inner resourcefulness is mighty indeed.
You're spot on as regards the need for a structured, highly skilled mental health programme as part of daily rehab.
In the absence of such a facility where you are, can i suggest you might find a way to an online Zoom meeting with a therapist? I hear myself saying, "easier said than done." However, i am going to do a little investigating myself and see what's possible.
Your mindful twist on your morning routine brought tears to my eyes. As a nurse ( in a past life), i/we knew this was a very difficult yet necessary aspect of assisted care for all involved. As a carer/sister to my brother who became disabled in his 40's i gladly hear your outrage. And yes, there is kindness and co operation involved in the process. In the grand scheme it is all about Love in action but sometimes it's hard, if not impossible, to find access to that space. Your role is the most difficult of all....being trapped in a body that has to submit to exposure over and again at such a sensitive time in your healing and possibly beyond. (We always found the radio helpful). And as a facet of your daily new world psych care could help immensely.
Try not to underestimate for one moment the benefit of your listening to the stories of those alongside you in this cruel/tender experience. In another world this might be called co counselling.
Your writing brings great light into a shadow world rarely revealed.
Thank you. I'm sorry this suffering is happening to you. Please forgive my clumsy attempt to connect from a totally different world. I send love and blessings to you and those around you as you start into another round of the sun. 💚
I worked for the NHS in a variety of settings. Later I was employed on the regulatory side of the fence. A significant amount of change has occurred since I was professionally involved, though much of that change will likely be to the overall detriment of the service, due to a decline in funding and the scraping of mandatory targets that established a timeline for patients under certain circumstances. Added to that, there appears to have been a general decline in standards that cannot be directly attributed to a shortfall in funding. As a patient, I have witnessed things that wouldn't have been tolerated a decade ago, and that I would have absolutely called out as a member of staff. I will give a personal example: Following my most recent colonoscopy, instead of recovering on the ward I was brought into the staffroom. This occurred during the pandemic when barely anyone was allowed in the hospital without good reason, and there was less public scrutiny. It demonstrates the degree to which standards can slip when there is a perception that nobody is watching. Which brings me to the topic of mental health:
If the provision of heart or cancer care was currently at the same dismal level as the provision of mental health care within the NHS, it would be rightly recognised as a national scandal.
I once attended a public meeting where the head of the organisation that had been commissioned to provide community mental healthcare for the county, informed those in attendance that they lacked the resources to provide anything other than a bare-bones service. How could a blunt admission like that go unreported in the press?
They weren't lying either. The wherewithal to meet the sky-rocketing demand for mental healthcare does not exist. Local authorities are struggling as it is to meet their legal responsibilities for those with learning disabilities and autism. An attempt has been made to paper over the problem with Cognitive Behavioural Therapy. CBT can be effective in getting people to a point where they can grin and bear whatever mental health issues are affecting them. However, it does little, if anything, to address any underlying problems.
I have actually benefited from CBT. A few years ago I choked on some food. I cleared my airway by ramming my abdomen against the side of the kitchen table. It is baffling how calm I was throughout this, and afterwards, when I resumed eating as if nothing had happened. A few days later the shock caught up with me. I found myself unable to swallow solid food. I tried to address the problem myself and found that I couldn't. I lived on soup. Eventually I was able to secure six weeks of CBT, over the phone, as we were in lock-down. During one the first exercises, I burst out laughing and couldn't stop. Overall, CBT was very helpful in getting me to a point where I could eat normally again, albeit very cautiously. It has done nothing to address the underlying trauma which is still there.
I used to work in a hospital that currently has the capacity for around 700 patients. When I was there, that number was a bit higher, as more wards were open. Despite this volume of patients, many of whom were experiencing mental health issues, there was no psychiatric consultant based on site. There were a pair of psychiatric nurse practitioners who were on-call at certain times of day. I don't know their precise remit. I imagine they could administer appropriate medication, carry out mental health assessments, and make referrals. If an inpatient required the attentions of a consultant, they would have to wait until Tuesday afternoon, when a doctor from a nearby mental hospital would grace us with their presence. They would have time in their schedule to see two patients. That's two a week, out of a rolling population of around 700.
The 72-hour observation unit, where anyone who had suffered an extreme mental breakdown was sent, was a concern, though not one that was publicly acknowledged. I have no idea what it is like now.
I interviewed someone who was sent there after attempting to cut their wrists. They were discharged with the blood-stained item that they had used to inflict these injuries. I heard other reports of patients who had requested food and water being told by staff that there was a shop across the road from the unit, but that they would be sectioned if they attempted to leave. A middle-aged man followed a teenage girl around the unit and nobody did anything to stop him. A patient went berserk and became violent. The other patients retreated into a corridor, which was the only safe space.
The organisation I was working for managed to get representatives from all the local mental health charities together in a room to discuss what the core issues were, since we had no idea. A few weeks later my manager was ousted under dubious circumstances. I was told by the person who had facilitated his removal and occupied his role that mental health was too big a issue for us to focus on and we should instead redirect our attentions towards the pet project of one of the members of the advisory board.
Bearing in mind all that, you can at least be grateful that your demure psychologist didn't enter the room screaming “Didi mao! Didi mao!” at you.
It is imperative that you do not allow yourself to be paralysed and subsequently consumed by resentment and self pity.
I have PSC, which is destroying my liver, among other things, and will 100% kill me if nothing else does. Following the diagnosis, I became angry and nihilistic. To an extent I still am, though I manage these emotions better. Ironically, had I not fallen ill, I would likely be dead now anyway, as that was the way things were going.
One day I was sitting on a chair in a hospital corridor, waiting to be called for my out-patient review. I was watching the staff come and go. It occurred to me: There is work to be done here. After my condition had been stabilised with a bus-load of steroids, I volunteered at the hospital. Eventually they employed me. I worked all over that site and got to know it very well. Focusing on something bigger than myself and interacting with people whose problems made my own seem insignificant by comparison is what saved me. You are right. You need to give yourself something to do that lies within your present abilities, and that enables you to look beyond yourself.
It does not surprise me they tried to get you to do basic CBT, though it doesn’t fail to anger me any less. Even when it’s written all over your medical record that you do not want CBT for multiple reasons (if you search up CBT in my sent emails, you’ll get about 100 to the NHS with essays about how much I do not want CBT for my PTSD), they will still put you in CBT and then insinuate you’re the problem when you told them from the start you don’t like CBT. I’ve found the same issue with ‘corporate’ mindfulness- being told to appreciate the little things or live in the moment whilst the world seems to be collapsing around you is beyond patronising and invalidating. Why would you want to live in the moment? It’s shit! CBT sucks, and it sucks even harder when it’s not even trauma informed and to the level of a secondary school counsellor.
You, however, have excellent ‘therapy skills’, at least when you use them on other people. I preferred talking with you over my NHS therapist last year for the most part since you actually listened, and let me be sad when I was sad. I’m not trying to suggest the circumstances are the same, because they are clearly not, but you’re an incredibly emotionally intelligent person, and I hope you can give yourself the same patience as you gave me last year.
Something that stuck with me was your sponge stoicism metaphor. Being a sponge is absolutely exhausting, it’s easier to be a rock and let yourself erode you until you do not resemble your past at all, it feels like life would be easier to never look back and only focus on your current misery. But I know you know that this isn’t the way, and at some point some of the water will start to drain out the sponge and it will be marginally easier, but that’s still improvement (though then it’s avoiding getting in the Lamborghini to hell, which also takes a lot of mastery).
Hope you get hold of a good therapist soon, either NHS funded or privately.
My cousin Mike became a quadriplegic after an accident at 19. He went to uni then law school. He graduated 2nd in his law school class yet was rejected from jobs because he was in a wheelchair (this was in the 80s). They actually told him in the interview they wouldn't hire him because of his wheelchair. I wish Mike were still here to talk to you directly. I am not trying to send you a feel-good story because I know you are experiencing a hell few understand. I want to send you this story about Mike because he was such a big influence on my life. I just went by his law school today and thought about him. https://www.latimes.com/archives/la-xpm-1996-03-13-ls-46619-story.html
Thank you for this brilliant and insightful piece. Please keep writing. Seeing what is so hard and perhaps demeaning as an act of love is such a great goal. I hope day by day you get to feel that. Might feel like it’s a mountain to climb now but keep going and hope that your determined will and generous approach to life will be transformative.
Paul - the weight of all you said is upon me. It demands a totally honest response as for you nothing else will do - you need a no frills straight up response. You have rightly identified the complete lack of professional decent mental health support on the NHS - it’s down to luck and they push phone calls video stuff and the dread CBT at you - like you none of that is what I want - because you have experienced a good therapeutic relationship you have certainly picked up skills there revealed by your conclusion- that for now you will ask yourself to help you - reflect on what is ok not ok and so on. I do that too - call it following my feet not my head as deep down there we know . The suicide thing which you are so open about but you recognise for most people like the person who just sat there it’s either tick the box or ignore - for me it’s just there running alongside me and I’d say never going to be realised - I know that I need to live my life which is a gift however awful it’s been here and there , to the end - you seem so strong and so capable of reaching goals If I say this to you - don’t be frightened just don’t be frightened - have I said anything to help you at all - you are on the right track - keep on it.Thank you so much for telling and sharing this - me? Watching the telly what else!! Lots to think about but give yourself a break and watch some rubbish too - as I like to say take your pick! With lots of care Maddi in the tiny village deepest North Yorkshire xxxx ps thinking about the other guy too who hides his distress / is there a mental health charity like MIND available to help at all? Just a thought. Even a very basic support plan would help him just give him something to hold onto and work towards. Xx
Not all therapist are good. It is a marriage between the patient and the therapist. You should publicize this lack at NHS. Perhaps become an activist for mental health in that institution? Meanwhile, can you find a private therapist and work on zoom with her or him. It is very important as you say. And bravo that you reframe your thoughts to more positive ones. Reading your and Hanif's postings, i feel so helpless and keep you both in my heart.
As I was reading this, the thought floated through my mind "this guy could become a therapist, or a campaigner for therapy for people in his circumstances, or both, or something similar...". In your last paragraph it sounded like you might have been thinking that too.
This is an extremely insightful comment. The NHS doesn't prioritize mental health at all, it's missing in lots of areas that you would think it was essential (rehab, serious accidents, brain injury) and the designated mental health services are all highly inadequate, due to poor funding, which leaves you with the poor inexperienced CBT woman saying what you just said back to you in a more sympathetic voice. I was thrown off my CBT course as my daughter went into hospital as an emergency that weekend and I didn't have time to complete the worksheet. I wish I was joking.
That said, writing can be therapeutic, I'm glad you have this outlet. I have 100's of thousands of words floating about in my computer, you are kind enough to share yours with others. Never feel obliged to, though, write as little or as much as you like. Hannah x
Kindness really does win every time I find in dealing with my mental health weasals. Currently wondering why my hubby bothers with being married to someone who is now effectively useless and grumpy with it. The reasons are a) he didn't marry be because I was useful in the first place but because he loves me, my glorious personality and loving heart of kindness (I'm paraphrasing) and b) he is incredibly kind and that is one of the many reasons I married him in the first place. Kindness for the win.
Wow, Paul... Your inner resourcefulness is mighty indeed.
You're spot on as regards the need for a structured, highly skilled mental health programme as part of daily rehab.
In the absence of such a facility where you are, can i suggest you might find a way to an online Zoom meeting with a therapist? I hear myself saying, "easier said than done." However, i am going to do a little investigating myself and see what's possible.
Your mindful twist on your morning routine brought tears to my eyes. As a nurse ( in a past life), i/we knew this was a very difficult yet necessary aspect of assisted care for all involved. As a carer/sister to my brother who became disabled in his 40's i gladly hear your outrage. And yes, there is kindness and co operation involved in the process. In the grand scheme it is all about Love in action but sometimes it's hard, if not impossible, to find access to that space. Your role is the most difficult of all....being trapped in a body that has to submit to exposure over and again at such a sensitive time in your healing and possibly beyond. (We always found the radio helpful). And as a facet of your daily new world psych care could help immensely.
Try not to underestimate for one moment the benefit of your listening to the stories of those alongside you in this cruel/tender experience. In another world this might be called co counselling.
Your writing brings great light into a shadow world rarely revealed.
Thank you. I'm sorry this suffering is happening to you. Please forgive my clumsy attempt to connect from a totally different world. I send love and blessings to you and those around you as you start into another round of the sun. 💚
Good morning 😉🤷♂️
I worked for the NHS in a variety of settings. Later I was employed on the regulatory side of the fence. A significant amount of change has occurred since I was professionally involved, though much of that change will likely be to the overall detriment of the service, due to a decline in funding and the scraping of mandatory targets that established a timeline for patients under certain circumstances. Added to that, there appears to have been a general decline in standards that cannot be directly attributed to a shortfall in funding. As a patient, I have witnessed things that wouldn't have been tolerated a decade ago, and that I would have absolutely called out as a member of staff. I will give a personal example: Following my most recent colonoscopy, instead of recovering on the ward I was brought into the staffroom. This occurred during the pandemic when barely anyone was allowed in the hospital without good reason, and there was less public scrutiny. It demonstrates the degree to which standards can slip when there is a perception that nobody is watching. Which brings me to the topic of mental health:
If the provision of heart or cancer care was currently at the same dismal level as the provision of mental health care within the NHS, it would be rightly recognised as a national scandal.
I once attended a public meeting where the head of the organisation that had been commissioned to provide community mental healthcare for the county, informed those in attendance that they lacked the resources to provide anything other than a bare-bones service. How could a blunt admission like that go unreported in the press?
They weren't lying either. The wherewithal to meet the sky-rocketing demand for mental healthcare does not exist. Local authorities are struggling as it is to meet their legal responsibilities for those with learning disabilities and autism. An attempt has been made to paper over the problem with Cognitive Behavioural Therapy. CBT can be effective in getting people to a point where they can grin and bear whatever mental health issues are affecting them. However, it does little, if anything, to address any underlying problems.
I have actually benefited from CBT. A few years ago I choked on some food. I cleared my airway by ramming my abdomen against the side of the kitchen table. It is baffling how calm I was throughout this, and afterwards, when I resumed eating as if nothing had happened. A few days later the shock caught up with me. I found myself unable to swallow solid food. I tried to address the problem myself and found that I couldn't. I lived on soup. Eventually I was able to secure six weeks of CBT, over the phone, as we were in lock-down. During one the first exercises, I burst out laughing and couldn't stop. Overall, CBT was very helpful in getting me to a point where I could eat normally again, albeit very cautiously. It has done nothing to address the underlying trauma which is still there.
I used to work in a hospital that currently has the capacity for around 700 patients. When I was there, that number was a bit higher, as more wards were open. Despite this volume of patients, many of whom were experiencing mental health issues, there was no psychiatric consultant based on site. There were a pair of psychiatric nurse practitioners who were on-call at certain times of day. I don't know their precise remit. I imagine they could administer appropriate medication, carry out mental health assessments, and make referrals. If an inpatient required the attentions of a consultant, they would have to wait until Tuesday afternoon, when a doctor from a nearby mental hospital would grace us with their presence. They would have time in their schedule to see two patients. That's two a week, out of a rolling population of around 700.
The 72-hour observation unit, where anyone who had suffered an extreme mental breakdown was sent, was a concern, though not one that was publicly acknowledged. I have no idea what it is like now.
I interviewed someone who was sent there after attempting to cut their wrists. They were discharged with the blood-stained item that they had used to inflict these injuries. I heard other reports of patients who had requested food and water being told by staff that there was a shop across the road from the unit, but that they would be sectioned if they attempted to leave. A middle-aged man followed a teenage girl around the unit and nobody did anything to stop him. A patient went berserk and became violent. The other patients retreated into a corridor, which was the only safe space.
The organisation I was working for managed to get representatives from all the local mental health charities together in a room to discuss what the core issues were, since we had no idea. A few weeks later my manager was ousted under dubious circumstances. I was told by the person who had facilitated his removal and occupied his role that mental health was too big a issue for us to focus on and we should instead redirect our attentions towards the pet project of one of the members of the advisory board.
Bearing in mind all that, you can at least be grateful that your demure psychologist didn't enter the room screaming “Didi mao! Didi mao!” at you.
It is imperative that you do not allow yourself to be paralysed and subsequently consumed by resentment and self pity.
I have PSC, which is destroying my liver, among other things, and will 100% kill me if nothing else does. Following the diagnosis, I became angry and nihilistic. To an extent I still am, though I manage these emotions better. Ironically, had I not fallen ill, I would likely be dead now anyway, as that was the way things were going.
One day I was sitting on a chair in a hospital corridor, waiting to be called for my out-patient review. I was watching the staff come and go. It occurred to me: There is work to be done here. After my condition had been stabilised with a bus-load of steroids, I volunteered at the hospital. Eventually they employed me. I worked all over that site and got to know it very well. Focusing on something bigger than myself and interacting with people whose problems made my own seem insignificant by comparison is what saved me. You are right. You need to give yourself something to do that lies within your present abilities, and that enables you to look beyond yourself.
There is a UK Charity called MIND - they’re sure to be interested in campaigning...
I read many of my thoughts in here. Thank you, it's indeed very helpful.
It does not surprise me they tried to get you to do basic CBT, though it doesn’t fail to anger me any less. Even when it’s written all over your medical record that you do not want CBT for multiple reasons (if you search up CBT in my sent emails, you’ll get about 100 to the NHS with essays about how much I do not want CBT for my PTSD), they will still put you in CBT and then insinuate you’re the problem when you told them from the start you don’t like CBT. I’ve found the same issue with ‘corporate’ mindfulness- being told to appreciate the little things or live in the moment whilst the world seems to be collapsing around you is beyond patronising and invalidating. Why would you want to live in the moment? It’s shit! CBT sucks, and it sucks even harder when it’s not even trauma informed and to the level of a secondary school counsellor.
You, however, have excellent ‘therapy skills’, at least when you use them on other people. I preferred talking with you over my NHS therapist last year for the most part since you actually listened, and let me be sad when I was sad. I’m not trying to suggest the circumstances are the same, because they are clearly not, but you’re an incredibly emotionally intelligent person, and I hope you can give yourself the same patience as you gave me last year.
Something that stuck with me was your sponge stoicism metaphor. Being a sponge is absolutely exhausting, it’s easier to be a rock and let yourself erode you until you do not resemble your past at all, it feels like life would be easier to never look back and only focus on your current misery. But I know you know that this isn’t the way, and at some point some of the water will start to drain out the sponge and it will be marginally easier, but that’s still improvement (though then it’s avoiding getting in the Lamborghini to hell, which also takes a lot of mastery).
Hope you get hold of a good therapist soon, either NHS funded or privately.
My cousin Mike became a quadriplegic after an accident at 19. He went to uni then law school. He graduated 2nd in his law school class yet was rejected from jobs because he was in a wheelchair (this was in the 80s). They actually told him in the interview they wouldn't hire him because of his wheelchair. I wish Mike were still here to talk to you directly. I am not trying to send you a feel-good story because I know you are experiencing a hell few understand. I want to send you this story about Mike because he was such a big influence on my life. I just went by his law school today and thought about him. https://www.latimes.com/archives/la-xpm-1996-03-13-ls-46619-story.html
What are your published books about? I tried googling “books by The Punter”, but got no info.
I hope you’re encouraged by the fact that your audience is growing... or at least the LIKES are increasing.
Maybe you’re getting better at this??
Keep going!!
Thank you for this brilliant and insightful piece. Please keep writing. Seeing what is so hard and perhaps demeaning as an act of love is such a great goal. I hope day by day you get to feel that. Might feel like it’s a mountain to climb now but keep going and hope that your determined will and generous approach to life will be transformative.
Thank you. You are helping other folk as you are helping yourself. I want to cheer you on!
Paul - the weight of all you said is upon me. It demands a totally honest response as for you nothing else will do - you need a no frills straight up response. You have rightly identified the complete lack of professional decent mental health support on the NHS - it’s down to luck and they push phone calls video stuff and the dread CBT at you - like you none of that is what I want - because you have experienced a good therapeutic relationship you have certainly picked up skills there revealed by your conclusion- that for now you will ask yourself to help you - reflect on what is ok not ok and so on. I do that too - call it following my feet not my head as deep down there we know . The suicide thing which you are so open about but you recognise for most people like the person who just sat there it’s either tick the box or ignore - for me it’s just there running alongside me and I’d say never going to be realised - I know that I need to live my life which is a gift however awful it’s been here and there , to the end - you seem so strong and so capable of reaching goals If I say this to you - don’t be frightened just don’t be frightened - have I said anything to help you at all - you are on the right track - keep on it.Thank you so much for telling and sharing this - me? Watching the telly what else!! Lots to think about but give yourself a break and watch some rubbish too - as I like to say take your pick! With lots of care Maddi in the tiny village deepest North Yorkshire xxxx ps thinking about the other guy too who hides his distress / is there a mental health charity like MIND available to help at all? Just a thought. Even a very basic support plan would help him just give him something to hold onto and work towards. Xx
Not all therapist are good. It is a marriage between the patient and the therapist. You should publicize this lack at NHS. Perhaps become an activist for mental health in that institution? Meanwhile, can you find a private therapist and work on zoom with her or him. It is very important as you say. And bravo that you reframe your thoughts to more positive ones. Reading your and Hanif's postings, i feel so helpless and keep you both in my heart.
Very Insightful… thank you 😊.