The World Health Organisation recently confirmed that mental Illness was set to become the biggest threat to human well-being in the twenty first century. Mental illness accounts for more disability adjusted life years lost per year than any other health condition in the UK. No other health condition matches mental ill health in the combined extent of prevalence, persistence and breadth of impact.
Modern Mental Health offers an alternative and thought-provoking perspective to the conventional and orthodox understanding of mental health and how to help those suffering with mental illness. The individual contributors to this book share a passion for needs-informed person-centred care for those people affected by mental ill- health and a deep scepticism about the way help and support is organised and provided to the 1 in 4 people in the population who at some time will suffer mental health problems. The chapters include a diverse and rich mixture of stark personal testimony, reflective narrative, case studies in user-informed care, alternative models of intervention and support, rigorous empirical research and a forensic analysis of mental health law-making. Although the overarching philosophy of this book is critical of contemporary psychiatric care, each chapter offers an individual perspective on an aspect of provision.
This book will appeal to social workers in mental health contexts as well as students on post qualifying courses and the Masters Degree in Social Work. Doctors, psychologists, psychotherapists, counsellors and nurses will also find much of value.
About the Author
Joanna Fox is a Senior Lecturer in Social Work at Anglia Ruskin University. Joanna identifies herself as a person with lived experience of mental ill health. Her lived experience plays a major role in her research, teaching and writing. Her PhD focuses on the carers' contribution to mental health recovery in the service user with schizophrenia, which will be completed by Summer 2013. Joanna has worked extensively in developing support services for carers, in implementing and supporting service user and carer involvement in social work education and in PPI in health care. Areas of expertise include: the use of concept mapping in research and teaching , mental health caring, and recovery in mental health. She teaches mental health on the social work course at Anglia Ruskin University.
Professor Lena Robinson PhD is Professor of Social Work and Human Services at Central Queensland University, Australia. Previously she was Professor of Social Work at the University of the West of Scotland. She is an international scholar, who has delivered guest/public lectures and conference papers in India, South Africa, Ethiopia, Singapore, Indonesia, China, Australia, Canada and United States. She has also worked at the Universidade de Eduardo Mondlane, Mozambique. Professor Robinson has published and researched widely in the field of race, ethnicity, cross-cultural psychology and social work practice. Her research interest is in the field of cross-cultural and cross-national research. It involves developing cross-cultural perspectives in psychology and social work. Her scholarship and international recognition in the area of race, diversity and social work practice is reflected in the invitation she received in 2001 from the Social Work Program at Central Connecticut State University, USA, to participate as a Fulbright scholar-in-residence. She has published several single authored books and has recently been requested to write a book on ‘International perspectives on mental health issues and minority groups’. She has published in refereed and professional journals and contributed chapters to major social work texts edited by leading academics in the field of social work theory and practice. She is a member of the Editorial Board of the Journal of Ethnic and Cultural Diversity in Social Work (from October 2003) and British Journal of Social Work (from January 2006-2010). She is currently involved in a number of research projects including an international study of mutual intercultural relations in plural societies and a study of suicide and parasuicide in India.
Keverne Smith was Course Director for BA Humanities at the University Centre, College of West Anglia, King's Lynn, from 2003 to 2011; this course was franchised from Anglia Ruskin University. His book, Shakespeare and Son: A Journey in Writing and Grieving, which examines the evidence that Shakespeare's later plays are affected by the loss in 1596 of his only son, Hamnet, appeared in 2011. He has also published articles on a variety of topics, including education ("School to University: Sunlit Steps, or Stumbling in the Dark?" and "School to University: An Investigation into the Experience of First-year Students of English at British Universities"), religious history ("To Sing or to Say: Dirges, Cymbeline, and the Reformers"), and studies of loss ("Tangled Up in Grief: Bob Dylan's Songs of Separation"). His special interest is in interdisciplinary studies, especially involving Social History, Literature, Education and Psychology.
Dr James Truemanis a Senior Lecturer in Mental Health at Anglia Ruskin University, where he is the course leader for the Approved Mental Heath Professional training programme, and theme leader for mental health law. Outside of his legal interests, a significant amount of his time is currently dedicated to leading and supporting the implementation of technology in education. His background is as a mental health nurse, with experience of working in both the NHS and private sector. His research interests include mental health legislation, professional, media and political discourse, and the history of medicine - commonly viewed through the theoretical lens of critical discourse analysis.
Heather Castillo worked for many years in Mind Organisations in Essex, developing Advocacy for adults with mental health problems. She was also instrumental in setting up one of the first advocacy projects in the country for children and adolescents with mental health problems. She has worked with adult Service Users, training and supporting them to become legitimate researchers in the mental health arena and her work with them regarding the personality disorder diagnosis was published as a book entitled Personality Disorder, Temperament or Trauma? Eight years ago she helped to set up, and became the Chief Executive of The Haven Project which is a Department of Health National Innovation Site for the support and treatment of personality disorder. She has published a chapter in The Art and Science of Mental Health Nursing, Second Edition entitled The Person with a Personality Disorder Open University Press. In 2011 she completed a doctorate about the process of recovery in personality disorder, a study that has begun to create a synthesis of human development and recovery theory, which is new and important for people with a personality disorder diagnosis. What is unique about this study is that the significances of the recovery journey in personality disorder have been defined by service users.
Steven Walker trained as a social worker at the London School of Economics and Political Science with a MSc. He qualified as a Systemic Psychotherapist in 1991 after studying at the Tavistock Clinic and the Institute for Family Therapy and Systemic Practice, London. He recently completed his MPhil in Child and Adolescent Mental Health. Steven has worked extensively for the past 30 years with children and families in the context of child protection and child and adolescent mental health. He has authored or co-authored Ten books- the latest being Walker, S. (2012) Effective Social Work with Children and Families- putting systems theory into practice, London, Sage, he has presented his research at many National and International Conferences- the latest at the 2012 European Conference for Dramatherapy and Psychotherapy on the subject of Fidel Castro's Childhood. Steven currently works for a charity offering a Counselling service for troubled young people.
R.D. Hinshelwood is Professor in the Centre for Psychoanalytic Studies, University of Essex, and previously Clinical Director, The Cassel Hospital, London. He is a Fellow of the British Psychoanalytical Society, and a Fellow of the Royal College of Psychiatrists. He spent many years working in therapeutic communities, and writing about them, including the book What Happens in Groups (1987); and he founded the International Journal of Therapeutic Communities, in 1980. He has authored A Dictionary of Kleinian Thought (1989) and other books and articles on Kleinian psychoanalysis. Observing Organisations (2000) was edited with Wilhelm Skogstad and is among a number of texts on psychoanalytic applications to social science. In 2004, he published Suffering Insanity, a book on schizophrenia in psychiatric institutions. He founded the British Journal of Psychotherapy, and Psychoanalysis and History. Currently he is completing Research on the Couch: Single Case Studies, Subjectivity and Psychoanalytic Knowledge to be published 2013; and a jointly edited book, with Nuno Torres, called Bion's Sources: The Shaping of his Paradigms (2013).
Tim French was until recently a Senior Lecturer in Mental Heath in the Faculty of Health, Social Care and Education, Anglia Ruskin University. He has had extensive experience working for the National Health Service in England as a Community Psychiatric Nurse and has spent time caring for people within in-patient settings. He is completing a Masters Degree within the Centre for Psychoanalytic Studies, University of Essex on the subject of Jungian Psychoanalytic theory and practice and is currently working for a Mental Health Trust in Eastern England.
Emma Kaminskiy is a Ph.D student within the faculty of Health, Social Care and Education at Anglia Ruskin University. Her research is exploring collaborative psychiatric medication management. She holds a MSc in Organisational Psychology from City University, London and has research interests in the areas of innovation, collaboration and mental health.
Nicola Morant is an applied social psychologist working in the field of mental health. She is an Affiliated Lecturer in the Department of Psychology, University of Cambridge, and an honorary Research Associate in the Research Department of Mental Health Sciences at University College London. She also works in a freelance capacity as a qualitative research collaborator on a number of mixed methods NHS-based research projects. These cover various areas of mental health including acute and crisis care, psychiatric medication management, supported work environments, early intervention services and mindfulness-based cognitive therapy.
Shula Ramon is emeritus professor of interprofessional health and social studies at Anglia Ruskin University, Cambridge, and Professor of mental health research at the University of Hertfordshire, Hatfield. A social worker and clinical psychologist by her training, she has researched mental health extensively and internationally, focusing recently on recovery issues, systematically involving service users in her research projects. Her recent publication is: Ryan, P., Ramon, S., Greacen, T. (2012) Empowerment, Lifelong Learning and Recovery in Mental Health: Towards a new paradigm. Basingstoke: Palgrave Macmillan
Hannah Walker was brought up on the Isle of Wight, where she also went to school. She was Head Girl and Captain of Sports, and won a place at Warwick University to read Philosophy and Logic. Reality intervened and she was commissioned into the RAF as a Personnel Officer. She won the Sash of Merit at Officer Training for being the most outstanding cadet and went on to serve in Germany, Gibraltar and various UK stations. Promoted to Squadron Leader at the age of 29, Hannah ended up at the Ministry of Defence in London, working in the Central Operations Staff. Hannah had the first of many breakdowns in London and was eventually diagnosed as being bipolar. She was unceremoniously chucked out of the RAF, got married and retrained as a psychotherapist and hypnotherapist. She did most of a degree in Applied Psychology and Computing before her head blew up again and she separated from her husband. Undaunted, she went to work in an acute psychiatric ward, where she managed to remain for 6 years, before being chucked out after yet another breakdown. She is the Chair of the Dorset Mental Health Forum, a pan Dorset charity which exists to improve the lives of service users in the county.
Hannah is the co-editor of the book “Our Encounters with Madness”, published by PCCS Books, which is becoming a set text for nursing students. She hopes psychiatrists might read it as well.
Read an Excerpt
Modern Mental Health
Critical Perspectives on Psychiatric Practice
By Steven Walker
Critical Publishing LtdCopyright © 2013 Heather Castillo, Tim French, Joanna Fox, R.D. Hinshelwood, Emma Kaminskiy, Nicola Morant, Shula Ramon, Lena Robinson, Keverne Smith, James Trueman, Hannah Walker, Steven Walker
All rights reserved.
A Survivor's Story
By Hannah Walker
My name is Hannah and I'm a survivor of the military mental health system, the NHS mental health system and a number of psychiatrists. I suffer from bipolar disorder and post-traumatic stress disorder (PTSD), and I was diagnosed 20 years ago. In this chapter, I will tell you some of my story.
I was adopted at four months into a loving upper-middle-class family who lived on the Isle of Wight. I have a sister, also adopted, who is six years younger than I am. Neither of us has ever wanted to trace our biological parents, because we were happy at home and didn't feel the need to go meddling. Both our adoptive parents are now dead, but they would have been quite happy had we wanted to seek our real mothers, but we thought not. No point.
I went to the local grammar school, and left at the age of 18 having been Head Girl and having collected a few O and A levels – nothing spectacular. When I was in the Upper Sixth, my best friend died; I later discovered that she had committed suicide. I had the first of what were to be many, many episodes of mania and depression after that event and had some time off school. The episode was curious – I didn't know what was happening to me and didn't really have the words to explain it to the GP. All I could tell him was that all the colours went bright outside, and I felt a rush of panic and fear as though I could no longer remain alive and deal with it. In that instant, I contemplated taking an overdose of painkillers – not so that I would die, but so that I could become unconscious and not have to feel the pain. I couldn't be alone, but I couldn't tell anyone what I was feeling as it was impossible to describe. The only time I felt 'well' was when I was driving a car. I slept with the light on as I couldn't bear to be alone in the dark with just my thoughts for company.
My parents hadn't any idea of what to do with me, so they sent me to my GP, and I tried to explain what had happened to me, without much success. He diagnosed an extreme grief reaction, without much in the way of a clue as to my illness. I became even more depressed and started self-harming, making up the most outrageous stories as to how I had cut myself. I spent hours with razor blades, slashing my arms to pieces, and telling the A&E Department that I had fallen through windows/dropped a glass which had shattered/been hit by a hockey ball. No one helped. No one asked me if I was OK – not even the medics who assiduously stitched me up every time. I was sent to an educational psychologist, but refused to talk to her as she had hinted to me that she thought I was self-harming. Far too ashamed to admit it, I reiterated my stories and told her that I was just very accident prone. She gave up.
I pulled myself together and carried on as though nothing had happened, which sowed the seeds of later episodes. I applied to join the RAF, having turned down a place at Warwick University to read Philosophy and Logic – having tried recently to read a book on philosophy, I can only say that it was for the best. I went to RAF Biggin Hill, the Officers' and Aircrew Selection Centre for a three-day assessment, and was accepted as a personnel officer.
In February, I joined the RAF as a cadet. The Officer Cadet Training Unit was at RAF Henlow in Bedfordshire – there were seven girls in a squadron of 60 people. It was hard and fast and we were pushed to the limits of exhaustion and beyond – I loved every minute. We carried telegraph poles up hills and down dales, using them to make bridges or stretchers, and falling, beyond tired, into sleeping bags at night. Classes were hard, especially for us new to the RAF (many of our number had come up through the ranks and knew all the stuff we were learning), and we had to assimilate information very quickly. I was extremely fit, but even I found it difficult. However, I graduated with the Sash of Merit for leadership, and was sent on detachment to RAF Gan, an island at the southern end of the Maldives.
We flew from RAF Brize Norton on a VC-10 to Cyprus, where we refuelled and went on to Gan. We arrived in the middle of a tropical thunderstorm. However, the weather cleared and we had a fabulous time in the sun – work was from 7.30am to 2pm and the afternoons were spent on the beach, water skiing or snorkelling. It was idyllic. Unfortunately, it was also due to close – transport aircraft had moved on and could get to Singapore and beyond without having to refuel at Gan, so it shut. However, the trip left me with an insatiable desire for more travel.
I did my professional training at the RAF College Cranwell; and after that I had a number of postings that weren't nearly as exciting as Gan. The MoD, RAF Stanbridge, Recruiting in Wales and Recruit Training at RAF Hereford followed, then RAF Coningsby, where I flew in a Phantom and a Lightning, and the Lancaster Bomber belonging to the Battle of Britain Memorial Flight. Germany next – two fantastic years – RAF Cottesmore and then, on promotion to Squadron Leader at the ripe old age of 29, RAF Waddington. I was considered a high flyer.
When I was 31, I was posted to the MoD as a military assistant to a general. It was a hard job, and we worked from 7.45am to well past 9pm. I didn't get much leave. And the episode that had been waiting to happen since the sixth form started to happen.
My personal life was a mess – I was having an affair with a married man and trying to do my job without it, or the relationship, suffering. With hindsight, I should have known something had to give, and give it did. After three years of punishing hours, and 18 months of waiting for the man to leave his wife, I started to come apart at the seams.
It began with not sleeping very well and feeling anxious all the time. I couldn't concentrate, and I couldn't see very well, strangely. Freddie, for that's what I shall call him, had left his wife and we were living together, but the Services take a dim view of extra-marital relationships, so it was all rather difficult. I began to be paranoid and to hear voices, and at that stage decided to go to the doctor.
I managed to walk in through his door and collapsed in a heap. I tried, as I had done at the age of 18, to explain my symptoms – anxiety, paranoia, low mood and lack of pleasure in anything – but once again, I didn't have the words. However, the doctor was marvellous and wrote me out a prescription for a drug that he said would help. It didn't, and I went back the following week. The doctor was a good man and gently said I needed to see a specialist. Ho hum, I thought – a shrink, I thought. Here we go, I thought.
I was referred to a very nice psychiatrist and went to see him the following week. Yet again I tried to explain my symptoms, and this time, someone understood. I said I had no pleasure in anything; that I couldn't concentrate and that I felt my life as I knew it had ended. I was bleak about the future and told him that I couldn't go on. He told me to imagine that my problems were a black dog – was the dog in the room, was it close to me? I replied that it was sitting on my lap, in an attempt to get him to see how near the edge I was. He prescribed an antidepressant called Lofepramine, and told me to take two tablets daily. He said he'd see me every week.
By this time, I had moved jobs as well, and now worked for an irritable civil servant. The only bright thing on the horizon was his PA – a 60-year-old woman who would frequently wear her second-best teeth to the office, saving her others for 'best'. She and I would repair to a local pub every lunch time and come back late, giving the civil servant palpitations. However, Freddie was too senior for him to take any action. He contented himself with telling me I was late, and I infuriated him by agreeing. Eventually, I went sick and never returned.
I saw the psychiatrist once a week thereafter. Initially, he diagnosed me with situational stress, then with major depression. Freddie, who had been promoted again, didn't really understand, but asked the psychiatrist to brief him once a fortnight to help him make sense of the whole thing. After a month or two, the psychiatrist asked me if I'd ever felt like this before, and I suddenly remembered my school event. He then asked me if I'd ever had what he called an exuberant mood and, thinking back, I replied that I had, indeed, on many occasions, interspersed with periods of being quite solitary. After some lengthy discussions, he diagnosed me with manic depression.
In a way it was a relief – at last I had something to hang my hat on; a diagnosis and a reason for feeling the way I did. I read up on it, and the more I read, the more it all made sense to me. I devoured books, including Darkness Visible by William Styron, House of Bread by Amanda Nicol and An Unquiet Mind by Kay Redfield Jamison. The psychiatrist gave me a letter with 'Manic depressive psychosis' written in it, so I could take it back to the RAF GP. How he knew I was psychotic was beyond me – I had never declared hearing voices, but he was quite right. He decided that the best thing would be for me to retire from the RAF on medical grounds.
This next bit is difficult to write. I was phoned up by a man I had previously called a friend, who told me that I was to be discharged under the same regulations as alcoholics and drug addicts – 'Services No Longer Required'. When I tried to explain that manic depression was a mostly genetic illness, and that I was in no fit state to discuss this, he told me that it was all my fault for falling in love with a married man. This gave me such a shock that I didn't really know how to answer him – at this stage of the illness I was feeling suicidal, and Freddie was away in the Far East. This 'friend' told me I had to go to RAF Barnwood and make a statement in my defence. I suddenly realised that I was being punished – Freddie was too senior to have anything done to him – and that the RAF was no longer the supportive employer that I had been used to. While I was flying high, there was no problem; now that I was on my knees, others were very quick to condemn me. I had crossed boundaries by being with Freddie, and the RAF didn't take kindly to it.
When one is invalided out of the services, one is entitled to a pension, enhanced and tax free if the reason for invaliding can be attributed to service. My psychiatrist had decided to invalid me; years later I discovered that he had been ordered to discharge me and that because I had committed 'social misconduct' I was to receive no pension. The RAF hadn't got the bottle to discipline me because of Freddie's rank – so they took it out on me by refusing to pension me off.
I was entitled to resettlement leave, and while on that, I slipped a disc. I went back to the RAF GP, only to be told that they would not treat me because I was being invalided. However, I couldn't register with a civilian GP because I was still in the RAF. Catch 22. So I struggled about, in agony, until I was discharged – I was immediately admitted to hospital and operated on the next day. To this day, because of the delay, I have trouble balancing on my right foot and my right calf is numb.
The sense of injustice was immense. I had given all I had to my career and to be summarily thrown out was devastating. I had no source of income and had to rely on Freddie for the simplest things – I, who had always earned my own living. We were living in Dorset at weekends and in London during the week; when I became too ill to travel, I stayed in Dorset.
I was referred to a new psychiatrist, who confirmed that I had bipolar disorder after she had spoken to the RAF consultant. I wasn't responding to the Lofepramine, so she changed my drugs – instead of feeling dreadful, I started to feel nothing at all, which was even worse. Freddie managed to finalise his divorce and we got married – he was still in the services, but was due to retire the following year. Despite desperately wanting to feel happy, I just felt numb and betrayed by the service I had loved.
I fought the RAF for a year. Letter after letter, phone call after phone call. During that year I began to feel more like myself, and Freddie and I were having fun. One day, I wrote to my old RAF psychiatrist, who had retired, and asked him for anything I could put in my next letter to the RAF. He responded with some fantastic quotes, which I forwarded. I got my pension – no word of an apology, merely a letter from some functionary giving me figures and saying that my illness was attributable to my service. At last, I thought, and went manic.
Freddie and I lived a happy life for a couple of years, going on holidays and spending a lot of time visiting friends. He was retired by now and had picked up a couple of consultancies. We bought a new house and did it up. I was happy – not manic and not depressed. We got two cats. However, the spectre – the Darkness Visible – was just around the corner.
I started a degree course in Applied Psychology and Computing Science, and lapped it up – I got a first in all subjects when I did my initial year. Freddie hated it – I refused to be the little woman in the home, where I felt unfulfilled and frustrated. Freddie's behaviour started to change; when I challenged him, he said that I was imagining it and that I must be getting ill again. It transpired that he was having an affair; not unusual for him – after all, he'd had an affair with me while married.
I cannot describe the betrayal that I felt. Freddie's delaying his divorce from his previous wife had partly been to blame for my breakdown when I left the RAF; I had given up a lot to be married to him and the needlessness of that rankled enormously. I gave him six months to change his ways and try to mend our relationship.
During that six months I had my first admission to a psychiatric hospital – I have had another 23 since. That initial admission was a complete eye opener to me with my rather sheltered background – mental illness is not a respecter of class. I discovered a lot of things, both about myself and about others – people who lived on the streets became friends and people who had the same diagnosis became confidants. I was terrified at first; I was put in a three-bedded dormitory with a small woman who never stopped puffing and a girl who regularly self-harmed (I hadn't done that since my teens). The main lounge was a nightmare – all the chairs had cigarette burns and the cues from the snooker table were constantly being broken in fights. The ward was a mess; long corridors and communal baths were of the essence.
I gradually got to know everyone. There was a row of armchairs in the foyer and that was where my friends and I sat, smoking furiously to pass the time. No one told me I was supposed to go to occupational therapy, but I was nevertheless reprimanded for not going. There was a drinks machine nearby, which was always being vandalised or tipped over by passing patients. The staff stayed in their offices, away from the patients, and very much left us to our own devices. We roamed the corridors and the grounds, looking for something to do.
The clinic was a modern add-on to a huge old asylum, built in the last century, which had been closed after disgorging its patients into the community or nursing homes. The old buildings were shut and boarded up, but easily broken in to by agile patients, such as myself. I and another girl set about our illegal task with determination, dodging the elderly security guards and making our way through the barbed wire. We broke in through a window and found ourselves in a long corridor with wards going off it and a massive ballroom at one end. The sheer size of the place overawed us. The wards still had broken beds in them and the old stained mattresses were rotten. We walked slowly around the place, feeling the ghosts of the long gone. The ballroom was enormous, with huge windows – branches grazed the glass from outside, giving a creepy background sound to our meanderings. The whole place was scary and we left in rather a hurry, again avoiding the guards.
Excerpted from Modern Mental Health by Steven Walker. Copyright © 2013 Heather Castillo, Tim French, Joanna Fox, R.D. Hinshelwood, Emma Kaminskiy, Nicola Morant, Shula Ramon, Lena Robinson, Keverne Smith, James Trueman, Hannah Walker, Steven Walker. Excerpted by permission of Critical Publishing Ltd.
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Table of Contents
ContentsList of Figures and Tables,
About the Authors,
Part One The Human in the System,
1 A Survivor's Story Hannah Walker,
2 Service-User Insights into Recovery in Personality Disorder Heather Castillo,
3 Exploring Shared Decision Making For Psychiatric Medication Management Emma Kaminskiy, Shula Ramon and Nicola Morant,
4 The Recovery Concept: The Importance of the Recovery Story Joanna Fox,
Part Two The Importance of Context in Psychiatry,
5 The Part Can Never Be Well, Unless the Whole Is Well Keverne Smith,
6 Being Disturbed: The Impact of Severe Personality Disorder on Professional Carers R.D. Hinshelwood,
7 The Psychiatric Stockholm Syndromme: The Emergence of Traumati Bonding in Mental Health In-Patient Settings Tim French,
Part Three Contemporary Developments and Reflections,
8 Culture and Meaning in Child and Adolescent Mental Health Steven Walker,
9 Racism and Mental Health Lena Robinson,
10 The Mirage of Mental Health Law Reform James Trueman,