#googleeffect: mental health and employment prospects

In response to today's #googleeffect discussion on Twitter, sparked by this blog post by Erica Crompton on the Rethink Mental Illness site re: how being open about one's mental health may have an adverse effect on employment prospects.

I studied languages as an undergraduate, and as my year abroad approached, I applied for the popular British Council Assistantship scheme along with the majority of my peers. The scheme is the preferred option for the year abroad amongst language students the length and breadth of the UK and has an acceptance rate of something in the region of 97%. Being the young, naïve bug that I was, I declared my mental health history to date in the relevant box of the application form, attached the requisite medical documentation and sent it off. I then got on with what any self-respecting Francophile would do, namely lounging around in cafes smoking Gitanes, and daydreaming about the soon-to-be-realised prospect of lounging around in cafes smoking Gitanes in my adopted country, prefarably whilst being propped up by wistful wisps of men named Jean-François.

A short while later I received a lengthy email from the admissions team which I have abridged for your perusal below:

...as your application stands at the moment, there is a serious question mark as to whether the French authorities will accept it. The fact that a candidate suffers from or has suffered from drug overdose, anxiety and depression is something which any school employing a language assistant will require clear information about before they consider making an offer of appointment as all language assistants are in charge of classes of young people.

We will need a full report from the psychiatrist who treated you (giving the cause and history of the depression, and including details of the drug overdose), as we feel this will clarify the situation from the French authorities. Without this report, we cannot be sure they will accept your application.

I would very much appreciate it if you could ensure that the psychiatrist’s report reaches us no later than 31^st March. You must be prepared to meet any charges this report may incur yourself, since I am afraid the British Council does not have any funds for this.

You can probably guess what the outcome of the tedious exchange that followed was. Needless to say, I was indeed deemed a risk to myself and others, and the French authorities did not see fit to accept my application. Incidentally, I've since tutored French to young people with learning difficulties, become an ESOL mentor to a refugee and her child, and currently work as a bilingual nanny, the proceeds of which are funding my training to teach English as a Foreign Language. To the best of my knowledge, I've yet to scar a pupil of any age too deeply, although I am teaching the Five Kinds of Conditional this week, so I'll keep you posted. As for my year-abroad adventures, I managed to find a French university that would have me and, amongst other things, signed up for every theatre course going and found myself part of a trilingual troupe performing in France and Germany. To those who are as concerned as I was with the pressing effect of my rejection on my and Jean-François' nascent love affair, I can also safely report that I didn't do too poorly in this regard either. Not bad for a year's work.

The effect that the exchange with the BC did have, however, was to drive me deeper than ever into the MH closet. It confirmed my suspicions that being honest about my health would lead to being viewed with suspicion (what I like to call the susp-vicious cycle, ho ho ho). It also played a part in ensuring that I continued with the TRH approach (Trying Really Hard Not To Be Crazy, see down-blog), which, as anyone who has attempted it knows, does not have a tendency to end well.

It is my belief that until we reach a point where mental health issues such as mine and the thousands of others in similar situations are understood as what they are: chronic, manageable conditions, we will not see and end to the attitudes displayed in the correspondence I received above. The fact is that, whilst we must applaud the much freer and more open discussion of mental health over the last 20 years, there still exists a great deal of fear and ignorance around what certain conditions really entail. The words 'bipolar' and 'psychotic', for example, are often used to dismiss a person's behaviour, to set them outside the acceptable norm and label them as weird, or scary. As soon as we do this, as soon as we allow ourselves to give a knee-jerk reaction to a convenient buzz-word, we are essentially giving the OK not just to rejecting a person but to making them the subject of derision and, often, of ridicule. Scratch the surface of the email above, and it's not hard to fish out a couple choice examples: equating a suicide attempt to a “drug overdose” is poorly worded at best; however, implying that depression and anxiety could lead to my causing harm to my students is woefully ignorant. Similarly, the idea that all depression is subject to the laws of cause and effect, rather than being simply a state in which one exists for variable periods of time, betrays a lack of common understanding of a condition affecting a sizeable percentage of the population.

Given these attitudes, it comes as no surprise that many people choose, like me, to blog anonymously. To those who waive their anonymity, I salute you, and I hope that in the not-too-distant future there will be no need for any of us to fear the stigma to which open discussion of our conditions might give rise.

19 online...follow me!

So apparently I tweet now...follow me here if you fancy.  I will try my best to be entertaining!

Hot Cross Buns Ruined My Easter

Despite being fully possessed of as much emotional baggage and unpleasant childhood/adolescent happenings as the next basket case, I have always been reluctant to engage in any kind of talking therapy.  Blame it on the Yorkshire genes.  Recognising, however, that Being Northern was probably not going to cut the mustard as reasonable justification for continuing with my favoured coping mechanisms (consisting chiefly of vodka, self-harm and hiding under the duvet), I decided to pursue J's suggestion of a practical talking therapy that would help me address and combat my 'triggers' - things that set off a hypomanic or depressive episode - without delving too much into the realms of exploratory psychotherapy.   This turned out to be cognitive beahvioural therapy, or CBT.  CBT exploded onto the mental health 'scene' a few years back and swiftly established itself as the new millenium's therapy du jour.  It's supposed to help you look at the way that you think, identify unhealthy thought patterns and tackle them with the Power of Logic, gradually rewiring your brain until it dispenses with throwing spanners labelled 'EVERYBODY HATES YOU' into the works of your everyday life.  It's actually not a bad plan on paper, and it definitely works for some people - converts to CBT are zealous in their praise of it.  So, all things considered, it looked to be worth a shot.

There are many reasons why it didn't work out, not least the fact that my therapist (let's call her T) and I just didn't hit it off.  But I like to blame it on hot cross buns, partly because it makes for a catchy blog title.  Hot Cross Buns are, for the uninitiated, not the all-butter fruit n'spice bun forever immortalised in nursery rhyme.  They are homework sheets that you have to complete to chart how your mind and body react to bad or intrusive thoughts.  This handy key should help you differentiate:

Hot Cross Bun

Not Much Fun

It turned out that the act of recording my negative thoughts and actions, then analysing them with someone with whom I had zero rapport was not entirely conducive to better mental health. Couple this with my notoriously poor handwriting skills and you come out with hours' worth of exchanges that went something like this:

T: So you've written here....what does this say?
19: Oh, um, yeah that says 'clawing at my face'.
T:  Clawing at your face....mmmm.  OK.  And do you think that was productive?
19: Um...well, no but...
T:  No.  So what could you have done instead of that...that clawing, mmm?  Can you think of anything you could have done?  That could have been more productive?
19: Um...

And so on.

It is possible that events on the day of my first appointment have also clouded my overall view slightly.  By the time I had clad my flu-ridden body in several layers of mangy yet comforting jersey and dragged it the 20 minutes down the road to the hospital, the combination of ill-sweats, flu-shivers and the November drizzle's magical frizz effect had conspired to lend me the air of an escapee from the electro-shock room in One Flew Over The Cuckoo's Nest.  This uncomfortable thought was not quieted by the ominous iron bars on the windows of the squat building I had been directed to.  It was this building that was to play host to an event so ridiculously farcical as to have no place outside Sophie Kinsella novels, or 00s rom-coms starring Jennifer Aniston. As I schlepped woozily up the stairs and rounded the corner to the waiting room, I found myself quite suddenly nose-to-nose with A.  A from school.  A who is now a trainee clinical psychologist working in the hospital proposing to treat me, apparently.  Suffice to say that, in a VI Form common room perpetually one step away from descending into a scene from Battle Royale, A and I occupied diametrically opposed (and geographically literal) sides.  It was therefore natural that, in that hideous, car-crash moment of mutual recognition, and despite the fact that A was clearly now a medical professional and therefore this would never happen (would it?), all I could envisage was the Class of 97 gossip phone tree springing into action, poised to revel in the gory details of my inevitable demise. 

A aside (I wrote an email  to her supervisor explaining the situation and requesting that we didn't work together), I'm aware that at some point it might be a good idea to board the therapy train again.  But for the moment, I'm more than happy to put off discussion of my psyche and let the Lamotrigine do its work. At least until I can look in a baker's window at Easter without screaming, that is.

 



 








 

Diagnosis: Part One

October 2011

My most recent plan of action re: combating The Condition (Trying Really Hard Not To Be Crazy, or TRH – see above) had by this time comprehensively failed: all of my concerted efforts to train it or to (quite literally) beat it out of myself had ground to a halt in the face of the worst low I had experienced in years.  Whilst I don’t wish to bore you with unnecessary details/whine about my Inner Pain, it might be useful to have a little bit of context here.  Everyone experiences their highs and lows in different ways, and I guess mine are best described as types of noise, so I've outlined these below:

Ever so slightly cringy as it sounds, if I had to soundtrack my highs I’d choose the overture to Mozart’s Marriage of Figaro. It moves at breakneck speed, but in joyful, harmonic explosions which always resolve into perfect cadences. Whilst high, I have genuinely believed myself to be something approaching a superior being, operating at a higher level. I can feel my intellect sparking off ideas: stratospheric, beautiful ideas that make your humdrum world, your dull moral code, seem laughable. In my highest states, I have actively courted danger, exhilarated by the feeling of nihilism and by my proximity to destruction whilst simultaneously believing that nothing as mundane as the effects of physical reality could actually harm me. I also lose all ability to empathise when high – I am separated from the rest of the world, so why would the rest of the world be affected by my actions? The world moves too slowly for the speed I want to, NEED to move at. Physically, I can feel my heartbeat pulsating though my body and my skin fizz-crackling with energy. My head is filled with animated, chattering thoughts.

And so to the flip side of the coin. Most people think of depression as silence, a void. Mine is a cacophony featuring white noise and voices, my own and not my own, whispering, shouting, wailing my uselessness. These build to a crippling anxiety which I feel physically, like a fist around my throat and chest, making me pant. My stomach churns and instead of the world not keeping up with me, I become vertiginous, as though the world is a travelator rushing forwards and I am about to be thrown off. I try to get rid of the noise and voices in various ways – beating them out, clawing at my face and neck, burning them out with cigarette ends. The rush of pain brings momentary calm, and sometimes I can cry. Sometimes the exhaustion will let me sleep. The delusions here are not the symphonic ones above. The only peace I can find is in thoughts of death; of how and when. I wonder how quick being run over would be, I know that jumping in front of the Tube would be easy and instantaneous. I am convinced that everyone in my life would be better off if I were not here, that I’m an utter nuisance because my brain can’t function like a normal person, I can’t function like a normal person, can’t be relied on, can’t help anyone, can’t be useful. I’m disgusting and everybody is looking at me, realising it. I’m an awful person; worse than a waste because I actively drain everyone around me.

So. At the peak of the latest cacophony, I hadn’t slept in weeks, had been self-harming with increased frequency, had forgotten what it was like not to need headphones to drown out the voices, and D was beginning to wonder who had made off with his girlfriend. At this point, and with enough distance from my last fiasco of a foray into psychiatrics, I was forced to admit that maybe it might be possible that in the entirety of the medical establishment, someone might be able to shed a little light and a little relief on the situation.

In the event, speaking to J turned out to be a very different experience from my assessment seven years ago. He was the first person ever to explore my relationship with bipolar, which turned out to be a damn sight more complex than I’d imagined. It was also one of the most crucial steps towards coming to terms with my condition. Although it falls under the category of being a mental illness, most sufferers will tell you that they wouldn’t be without their bipolar. I am amongst them. As for many others, this 'illness' has been at least partially responsible for many of my creative and academic successes. Most bipolar people will tell you that being high is amazing; so amazing that however 'orrible the lows are, they have continually thought of them as pay-off for feeling more alive than the average person.  They will also, myself included, tell you that even at their lowest ebb they cling to the knowledge that they feel more, and more keenly, than most other people.

So it’s not as cut-and-dried as an exterior force that you want to fight. But neither is it – for me, at least – an exterior force at all. I’m told that some people develop symptoms of bipolar later in life, some in their teens, some even earlier. For me, it’s been a constant companion. I have no recollection of a time when my brain did not work in the way it does. In fact, it has come as something of a surprise, over the years, to learn that not everybody experiences a relationship with their brain in the same way that I do; still more that they often do not see their brain as something with which to have a relationship at all, but simply a functioning tool in their bodily machine.

It has also come as a surprise over the years that some other people have an objective, constant understanding of both themselves and of the world, indeed of reality itself, often based on a fundamental sense of self-worth.  For years, right up until I found myself in J’s office, I retained the certainty that nobody actually existed in this way. Surely no one really, actively liked themselves, or thought that their voice and opinions were genuinely more valid than the next person’s. They had just learned to act like that; trained themselves tirelessly into this unnatural way of thinking, essentially because they were stronger, better, and more efficient than I. It continues to astound me that there are countless numbers of people walking the planet who, though they appear quite ordinary to the naked eye, do not entertain the company of a voice in their head telling them just how shit they are most of the time. Who operate from a basic level of happiness with themselves; for whom social gatherings are always to be looked forward to as a source of good clean fun.  If this does not transpire, then it is generally for a solid, tangible reason rather than a sudden, overwhelming certainty that the people whom I have just met/ have no reason to dislike me/have been my closest friends for 10 years think that I am a twat, and with good reason, for I am fundamentally a useless specimen. When J probed me on this, I ended up realizing that for years and years, I had been like a slide projector: my outer shell remained the same, but a plethora of wildly contrasting selves whirled around on a reel somewhere inside me, being projected out onto the world in line with my mental state. No ‘self’ felt like a lie until my state shifted, at which point it becomes laughable to think that what I firmly believed only a moment ago could possibly be true, when its opposite was so mind-blowingly clear. In the same way as my interior self could shift, so the exterior world could change shape entirely at a moment’s notice. As the states and the selves shifted, I would berate my brain for not working properly, not seeing the Real Truth. I would also have windows of what may or may not have been clarity between these changing states and changing selves, in which I would become terrified of being crazy, my brain felt like an intruder, an enemy.

The upshot to all of this conjecture, however, is that - for better or worse - bipolar is a part of me. A part as fundamental as my hair colour. And, just like my very boring mousy brown, however much I might try to change it, it never quite matches the rest of me. I might like the change to ice white or auburn, others might like it, some might even be fooled into thinking it’s natural. But I know that it’s not real, and that it’s only a matter of time until the roots start to show.

Eating and Sleeping

There’s a tendency to think of ‘getting better’ as an all-consuming, quasi-spiritual journey, chock-a-block with euphoric highs, cavernous lows and grand revelations every verse end.  Unsurprisingly, I tend to think that in part, that's the bipolar itself talking.  Whenever I had entertained the idea of 'getting better', it had always been vague and romantic, though almost certainly involving a solitary journey somewhere far away, with plenty of tears and filterless cigarettes.  In reality, as J pointed out, what I was faced with was not a problem to be solved by drastic, short-term means, but a long-term condition.  This is infinitely more terrifying to my mind because it essentially means that there is no ‘getting better’ at all.  There is only patient, consistent management of what is there, and as you may have gleaned, patience and consistency are rarely adjectives that feature on the 'Profile' section of my CV (unless I'm seriously desperate and trying to lie my way into a book-keeping temp job).  

The idea that you are not going to ‘get better’ is a hard one with which to come to terms. On the one hand, the idea that there is nothing wrong with you can make you feel quite euphoric. Certainly I have felt vindicated at this notion – 'I don’t need ‘fixing'! I’m not crazy! Why are you all so terrified of extremes? BORING!!'  On the other hand, the idea that you have to live with this…thing, and everything that goes with it – the depressions, the instability, the uncertainty over whether you will ever be able to hold down a job, a relationship, a career, and not least the stigma that goes with it…that can be daunting. Especially when you’ve spent so long telling yourself that you can be normal, you’re just not trying hard enough. In a funny sort of way, that self-destructive attitude was a kind of protection I put up around myself. Basically, if you tell myself that it’s your fault you're not normal, then you don’t have to accept that you don’t have control over your brain. Because that is a scary notion. 

The moment I did accept this, though, was - as ever, when we face our fears - the first real turning point in my recovery.  Almost as soon as I had let myself admit that I didn't have control over my state of mind, strategies for gaining control were presented. These were and are, as it turns out, pretty mundane.  They consist of the following:

Take your medication.

Eat properly. 

Sleep properly. 

Exercise.

Repeat. 

Addicts and those in recovery from other conditions report much the same thing. My sister, S, who has suffered with eating disorders for most of her adult life, describes getting better as simply: 'doing what you did yesterday.'  

It's difficult to maintain a balance of any kind when you're used to living with constant, extreme changes of state.  As I write, for instance, I'm struggling to control my relationship with diet and exercise.  Having maintained healthy levels of both for a while, and feeling the positive effects, my natural desire was initially to push them to the extreme and enter a Triathlon whilst surviving on a handful of nuts and seeds and six cups of coffee a day.  This having inevitably failed, leaving me knackered, uptight and nursing an injured calf, my instinct is now to spend an entire month consuming nothing but cider and mini eggs from the comfort of my sofa.  I am fighting the urge, however, with the help of my unusually patient partner, D, whose encouragement and reminders to eat, sleep and generally not 'be a penis' are - touch wood - keeping me on the straight and narrow.