An overview of some of the problems relating to having a Mental Health Condition.
I posted the first version of this about two years ago, recent experiance has caused me to read through and update it slightly (24-02-2017).
Note that some may feel that the mention of a specific political party towards the end of this post is out of place, but I can honestly say, they need mentioning!
1 The Problem Of Definition
1.1 What is a “Mental Health” condition?
The first hurdle faced by many people with Mental Health conditions is that, unlike say a broken leg, it is often extremely difficult for anyone else to see what the problem actually is. Sometimes it is even very hard to see there is, in fact, a problem at all.
Assuming that other people do recognise that someone has a problem, it is not always the case the person themselves will be aware of the exact nature and cause of the problem. Sometimes indeed they will not even be aware that it is a Mental Health condition.
There will also be cases where everyone agrees that a person has a Mental Health condition, when in fact the person is perfectly well and it is the prevailing attitudes of the society they live in that are the problem!
1.2 Yes, It’s Personal!
The fundamental thing to understand about Mental Heath issues is that they are personal, individual and unique to the person. With the exception of problems with underlying physical causes, such as tumours, it is impossible for anyone else to directly see the problem.
It’s inside your head and it’s all yours!
Which is not to say that the problems cannot be analysed and reasonably well understood by Mental Health practitioners. However, it is often difficult for even experts to accurately convey the reality of what their patient is experiencing to another person, particularly where that person has no prior experience themselves.
The result of which is that it is often very difficult for other people to understand and empathise with someone who has Mental Health conditions. It is not unusual for those close to the person with the problem to be at a total loss as to what to do to help. It normally requires some quite considerable time, and patience, for understanding to evolve.
1.3 If It Can’t Be Seen Is It Real?
One of the most difficult attitudes that someone with Mental Health conditions will come up against is the “It’s all in your head” argument. This implies that because the problem exists in the person’s head, which it is in a very real sense, it is not a real problem (irony intended).
This leads to the biggest social acknowledgement problems faced by people with certain types of Mental Health condition.
- “There’s nothing wrong with you (It’s all in your head)!”
- “Don’t be so silly!”
- “Stop Swearing! You’re not allowed to swear…”
- “Pull yourself together.”
- “You just need a routine.”
- “Why don’t you try doing something that’ll be fun?”
- “Just try to concentrate…”
- “Just sit still, it’s not that hard to do!”
- The worst thing you can possibly say: “Calm Down”
Trivialisation by Overuse
- Someone who’s simply feeling a bit down: “I’m depressed”
- Someone who just happens to like to keep their home or office tidy: “Oh, it must be OCD”
These are obviously just a very small sample of the sort of really helpful reactions and bits of insightful advice that are received on a daily basis by many people with very real problems to overcome. Often they spring from a genuine spirit of concern and/or wish to persuade the person at whom they are directed, that they do not have an insurmountable problem and that it can be dealt with very simply.
If directed at someone who does not have a Mental Health condition, and is indeed just experiencing a temporary difficulty or reaction to a specific event, they are often appropriate and fair advice.
Not at all so if the person to whom such gems are addressed does have a real problem, in which case the solution is very rarely simple, nor is it quick. Typically the problems are more complex than they may at first appear and the process of healing can take anything from weeks to a lifetime.
The difficult bit is knowing how to spot the difference. And the reality is that in many situations it might not be possible to tell in advance at all. So the best policy for anyone is to go very carefully with any pearls of wisdom they plan on imparting.
1.4 Ok, you do have a problem, but what is it, exactly?
Assuming a person’s Mental Health condition is accepted as existing, the next hurdle is developing an understanding of what it is. The first step is separating symptoms from causes. The next is ensuring that the apparent cause is not the result of some other underlying problem. There is also the question of whether the person has a single problem, a group of problems with a single underlying cause – or a set of entirely separate problems.
The point being that diagnosis in the cases of Mental Diseases and Disorders is often not straightforward and simply reaching a diagnosis, although the initially apparent symptoms may be obvious, can take an extended period of time.
2 The Variability Issue
Variability is a major concern faced by many people with Mental Health conditions. In terms of both the degree of severity and rate of change experienced with many conditions. It is, for example, quite possible to be going about your life in reasonable normality on any given day — but be utterly unable to function as part of society by the next. In reality there are obviously a huge range of levels and time scales, many of which can still seriously affect day to day life.
2.1 So Just How Ill Are You?
One of the social effects of this variability is that people often don’t understand the extent and nature of your problem. Most people with Mental Health issues will in fact try to keep their problems hidden from view as much as possible. This is largely due to the long standing prejudice against people suffering from any such condition.
2.2 When Your Condition Suddenly Makes Itself Visible
Assuming you have largely managed to keep your condition concealed, but then you suddenly have a particularly severe episode or relapse, it can then come as quite a surprise to the people you encounter everyday. This of course often makes things far worse, at least for a while, as your secret weakness is suddenly revealed for all to see. You are completely exposed at just the time when you are least able to deal with that.
2.2 Social In-Security
Unless the person is on a health-related benefit, the effect of this is to cause uncertainty and fear with regard to employment, home and even basic supplies and utilities. As one of the first casualties in these situations is usually communication, simply letting others know that there is a problem can be a significant problem in it’s own right.
3 Communication Breakdown
The first thing to fail when someone is having problems is usually the ability to communicate effectively. This takes many forms and is not a case of simply “not wanting to talk to anyone” as it is often described.
3.1 What Happens When The Silence Descends
The onset will often lead to a tendency to withdraw from normal interaction with others. This is both a symptom and an aggravating factor in a lot of problems people experience.
Then there is the increased feeling that people with whom you might otherwise communicate are in some way blaming you for your problems. It begins to feel that they see you as at fault for having such mental health issues. This has the effect of making you even more defensive and less likely to hold a rational discussion with anyone!
Eventually you are likely to reach a state where you will avoid all communication as far as possible – even in cases where you may be legally obliged to do so. In particular any avoid any situation where you feel you are being “judged”.
Where avoidance is completely impossible some people will tend be either very withdrawn, which is often seen as being uncooperative – or very agitated, which can appear aggressive to anyone not acquainted with your condition.
3.2 The Overall Communication Problem
When communication becomes a problem, everything becomes a problem. This is the key danger for people with Mental Health conditions.
This is the most common cause of avoidable death in people so afflicted.
It is also the reason so many people with Mental Health conditions end up in arrears with bills, taxes and other such things. Of course dealing with such things during, for example a bout of severe depression, is completely impossible. This usually leads to further problems as the debts build up and further increase the likelihood of the depression worsening. This leads to a cycle that is difficult to break.
Very often even official organisations, such as Town Councils, make the matter worse by sending threatening letters about things like Council Tax and end up adding ridiculously high “enforcement” fees etc., rather than finding out what’s wrong. This is more common than generally acknowledged, and is one of the things that urgently needs to be stopped.
4 Effect on Employment
For someone with a Mental Health condition, employment can be full of pitfalls and other horrors. In the first instance matching your condition to a suitable job, can be quite difficult.
It is also an area where a many very insulting things can be said about people with Mental Health conditions. Indeed recently members of the Conservative party have been guilty of extremely crass and downright disgusting statements regarding people with Mental Health conditions. As members of a party in government these are very serious offences.
Too often Mental Health conditions are related in people’s minds with lack of mental ability. This is one of the most heinous of discriminations against those with such conditions, as many are in fact perfectly capable mentally. They may have trouble with the kind of day to day crap that “normal” people find easy, but are sometimes able to handle concepts that the same”normal” people can’t. There is a huge degree of difference between individuals of course, but there is simply no excuse for suggesting that anyone with a Mental Health condition is worth less than anyone else. Once again the Conservative-led Governments of 2010- Present (2017) are guilty of serious derogatory and degrading attitudes, which have not been spoken out against by the Leadership.
4.1 The Employer
Certain Mental Health conditions can lead to periods during which a person may be absent from work, perhaps suddenly, and for varying periods of time. They will often fail to keep in contact with an employer, which leaves the employer in the situation of not knowing why their employee is absent and when — or indeed if — the employee will return. In cases where the employer does not have the resources, including understanding of the nature of the kind of condition that their employee is experiencing, it is often the case that the employer will seek to terminate employment at the earliest opportunity.
It is, in fact, probably unfair on employers without such resources to be expected to engage, or continue, the employment of someone when the more extreme forms of some conditions manifest themselves. This is particularly true of small businesses where the unpredictable absence of even one person can have a major effect on the day to day operation of the company..
4.2 The Employee
From the point of view of the person who is experiencing the condition this is an extra factor which is extremely likely to cause a worsening of the problem as a form of feedback loop begins to establish very quickly. The person will often feel they are “letting down” their colleagues and employer. This can quite easily lead to a deepening of the condition and an even greater disinclination towards any form of communication with anyone to do with their workplace. Once again the communication problem is the greatest one to overcome in the first instance.
5 The Role of The State
Unfortunately the Conservative (Lib Dems don’t really count as they are hardly noticeable) Government of 2010-2015 did a lot of direct damage to the Mental Health of both people with pre-existing conditions and can even be said to be responsible for the onset of conditions in others. Their attitude and language, or the language the Leadership has allowed to go unchallenged, has been both insulting and damaging to those with Mental Health conditions. The Current Conservative Government has continued and even worsened the situation.
It is the duty of Government to take steps to reduce contributing factors over which it has has control and to enable the provision sufficient and effective assistance for the treatment of those that it cannot directly influence.
Simple steps such as allowing people to register their predisposition to certain conditions with a central department that would respect patient confidentiality but would allow monitor the payment of things like rent/mortgage and Council Tax of anyone registered and act swiftly to intercede in order to prevent these from becoming a problem. In some cases automatically switching the person to the appropriate benefit automatically and ensuring that the situation is brought to the attention of the most suitable Mental Health treatment groups, who would then liaise with the monitoring department for however long it may prove necessary.
Vital to the success of any such scheme would be that it is operated for the benefit of those affected and never be used to attempt to coerce anyone into treatment. Persuading people of the the need for treatment should be entirely the province of Mental Health specialists (and family / friends / carers). This is because it can sometimes take a person with a Mental Health problem to accept that they need the help, but trying to force them can make the situation worse.
5.1 Not Making it Worse by being Illogical
The current government is absolutely guilty of this. I will not cover this here in this blog post. I am working on a further, more in-depth post on the subject.
5.2 Taking the Lead in Preventing Discrimination and Abuse
The Government has a central role to play in ensuring that discrimination against and abuse of people with Mental Health conditions is prevented. They have to take a strong lead, ensuring that it starts within Government itself! The Government needs to send an absolutely clear and unambiguous signal that this is unacceptable. It then needs to follow the words with actions to ensure that discrimination and/or abuse by the parts of Government, State or anyone else is not allowed to go unchallenged. The challenge must be immediate and robust.
Mental Health is every bit as real and important as physical health. It needs to be treated as such, while acknowledging that the treatment may sometimes need to be approached differently.
Detecting the onset of an episode of a Mental Health condition needs to be improved and action taken far more quickly. Confidentiality and Respect are absolute essential to the success of this.
If someone you know suddenly goes quiet, find out why. You may just save their life!