NSUN network for mental health is an independent, service-user-led charity that connects people with experience of mental health issues to give us a stronger voice in shaping policy and services.
Going against the tide: a review of 'a disorder for everyone'
Going against the tide (Nicky Hayward reviews 'a disorder for everyone', an event which took place on 15 October)
The Saturday before last some friends and I made a pilgrimage up to Birmingham to a groundbreaking event situated in a stunning venue, appropriately named The Ark. This striking, yet oddly harmonious, statement of contemporary architecture richly complements adjoining nineteenth century St Laurence Church in Alvechurch. Mimicking a ship's prow, and designed to maximize the input of light, the award-winning building somehow conveys the sense of a vast sea-faring vessel in motion and a sanctuary of calm at the same time, while natural oak flooring and ceilings and the gallery reception rooms upstairs, reinforce a sense of being aboard a ship.
I knew in an instant that we'd come to a very special place. The fact that others besides us had travelled quite some way to be there (our 110 mile drive from Bath seemed quite local when we realised people had made their way from Edinburgh, Wales, London, all around the midlands and even Ireland) confirmed that the current opportunity was not one you come across every day.
The village of Alvechurch is the home of organiser Jo Watson who conceived the idea of A disorder for everyone, the event we were attending, after reading psychologist Lucy Johnstone's book: A Straight Talking Introduction to Psychiatric Diagnosis. Jo is a psychotherapist with twenty years of experience in her field. She has become increasingly concerned about the medicalization of human distress in Western culture and is on a mission to help turn the tide. The metaphor suggested by the venue might have been fortuitous, but the synchronicity certainly felt very apt. Jo to me feels like someone who is currently in the right place at the right time. I hadn't met her before the event, although we'd connected on social media a few months ago, but I immediately recognised her both from her profile picture and also her air of warmth, focussed attention and passionate engagement, alongside a quiet efficiency.
A buzz of anticipation and excitement was almost tangible as we walked in to the light and airy hall and collected our personalised delegate packs, laid out in the colours of the spectrum, which had clearly been assembled with consciousness and real thought; Jo's professional card, sporting its brave rainbow flag, neatly attached up front. I reflected, "This woman is a formidable networker, and powerful force for connection and change!"
Indeed, the whole day was stamped with the refreshing hallmark of fertile retreat: it felt as though we were pioneers, set apart (one of the definitions of 'Holy' I've always remembered) ... secular truth seekers, weary of the duplicity of our inherited culture, eager to help forge a new world order.
A few curious parishoners had come along to join counsellors, therapists, other professions in the field, survivors of mental distress and family members, and also the vicar's wife (herself a psychotherapist), all of us with a shared desire to delve deeper and try to understand more clearly the predicament of our times concerningconcepts of 'normality' and the vast amount of human-beingness that falls outside these. What's considered normal, we discussed later, varies of course from culture to culture; normality is, then, a socially defined concept. Once we understand that, we immediately realise that financial and political interests will inevitably play a large part in defining what's considered normal in neo-liberal Western states indulging in unashamedly capitalist practices.
For me, the day's emotional and intellectual voyage involved a meeting of secular, humanistic and broadly-speaking spiritual enquiry and celebration, as together we explored definitions of humanness and reflected that life's vicissitudes understandably have an destabilizing effect on our fragile sense of equilibrium in a world where the only certainties are taxes, change and death. We also contemplated the apparently incomprehensible nature of much of the current psychiatric response to those who eventually cave in under its pressures. Vested interests, as ever, define and dominate the industry that has grown up around the burgeoning need for emotional support, and those in need of sustenance and a helping hand to get back up on their feet are almost invariably started on powerful mind-altering drugs, which can cause far greater problems; potentially for life. In order to justify this policy, however, psychiatric practice needs to be based on some rationale, and currently this rests on the system of psychiatric diagnosis - labels conferred by doctors; supposedly a medical, and scientific, pronouncement. However, delegates were to go on to learn just how unscientific the diagnostic process is ... and how subjectively diagnostic categories themselves are arrived at as well!
The day's programme, which felt beautifully balanced, began and ended with the recital of poetry. First up, Jo McFarlane, Scottish survivor poet, treated us to memorized - and so, apparently spontaneous - dramatic renditions of poignant, defiant and tender poetry she and her partner Sally Fox had written, from their book Stigma and Stones. Among my favourites, were Unlabelled, The Trouble with Labels - which contains the reflection,
Our identity is a fragile layering of influence and experience
and depends on validation as to whether it stays tethered
to a shaky foundation
- and No Apology in Pathology, which begins:
They never say sorry when they get it wrong
even though you told them all along
That damn label is still stuck to me.
There really is no apology in pathology.
The women's arresting, ultimately relatable messages were conveyed viscerally in a winning mixture of dramatic delivery, comedy, razor sharp wit and choice vocabulary. One of poetry's main commentaries, it seems to me, is inherent in its economy: the necessity for brevity and apparent simplicity; the expression of meaning in a condensed format. The spaces on the page and silences around spoken words also speak volumes.
The irony, of course, is that the poets' words clearly demonstrated to the audience that these two young women (who have been effectively written off by the diagnostic system as aberrant, problematic, 'hard to reach', and challenging to have dealings with) are in reality perceptive, informed, intelligent, educated, rounded, responsible and immensely gifted to boot. Sally is also a talented visual artist.
The audience was palpably moved by Jo's performance, and I was struck - particularly, the more we learned she'd been through - by her clear concern to express gratitude for the help she had received over the years; to honour the decent and sincere staff that had managed to transcend the system's inbuilt restrictions, and not to criticize the existing services across the board.
Her concerns, and Sally's, however, were explored in the same matter-of-fact and unambiguous, measured tone as their expressions of appreciation and concern for balanced debate; something that lent their commentary added power.
As I mentioned earlier, the day had come about originally and been designed around the work of Clinical Psychologist Lucy Johnstone from Bristol, a senior member of the Division of Clinical Psychology of the British Psychological Society, author of a number of books and research papers and seasoned speaker. Consequently Lucy, a lecturer in a former incarnation, treated us to a depth and volume of pertinent information both before and after the break that, handled otherwise, could have been overwhelming and bemusing.
In essence, the first session consisted of a systematic critique of diagnosis, and a lively Q-and-A session. An academic as well as a clinician, Lucy presented a scrupulously detailed and reasoned assessment of the contemporary psychiatric categorization system and its history which left us all in no doubt that there is no scientific rationale supporting, or defence whatsoever for, the labelling processes that, effectively, go on to largely determine the life prospects of so many people whose difficulties bring them within the sights of mental health teams.
After coffee, we were walked through detailed and fascinating slides discussing potential alternatives to the diagnostic system. If you think about it we automatically conceptualize everything in life, in order to give ourselves the best chance of understanding it, whether or not we realise we're doing so.
We all need a sense of bearings; people who are trying to help others do as well. However, one key question is to what extent the currently dominant biomedical paradigm allows mental health staff to listen to the complex life stories their clients bring along, and whether or not we are prepared to listen, as individuals, professionals or as a society.
Psychology has a dark side to its history that's comparable to psychiatry's. But Lucy Johnstone, in my opinion, is someone with a keen social conscience who is ethically driven in dedicating her efforts to working towards finding better, more human ways of understanding emotional pain, acknowledging that our upbringing and our experiences as our lives go on have a real, and sometimes devastating, influence on our ability to maintain harmonious physical, mental and spiritual balance.
She focussed in particular on the process of psychological formulation – a possible alternative to diagnosis which, in common with other similar approaches, has the potential to allow service users to tell the stories behind their emotional distress.
In a slide entitled 'A shared hypothesis with meaning at its heart', she cited various definitions of this concept: ‘A formulation is the tool used by clinicians to relate theory to practice … Formulations can best be understood as hypotheses to be tested’ (Butler, 1998); ‘The lynchpin that holds theory and practice together ... at some level it all makes sense’ (Butler, 1998); '... a process of ongoing collaborative sense-making’ (Harper and Moss, 2003) and '... a way of summarising meanings, and of negotiating for shared ways of understanding and communicating about them’ (Butler, 1998). At the same time, she introduced the audience to the concept of 'trauma-informed therapy' - that is, therapeutic responses which bear in mind the realization that life itself is a traumatic process and that we would all eventually buckle under sufficient impact, although our stress tolerance thresholds differ and we don't all respond in the same way to adverse pressures.
So, without assuming anything, this approach bears in mind that life experiences can be sufficient to topple our fragile equilibrium and it's quite possible that any imbalances in thinking or altered mental/emotional states can be caused by unhealed wounding. So addressing that fact is likely to be liberating and helpful. Everything is explained much more clearly and comprehensively than anything I can say here, for those who would like to explore such matters further, in Lucy's book.
After lunch, we had a go together at team formulation - explored in an additional chapter in the 2nd Edition of the publication Formulation in Psychology and Psychotherapy, which Lucy edited with Rudi Dallos, and she described to us the advantages of adopting this approach. For example, obviously, enlisting a number of perspectives and supporting staff to be able to listen to the harrowing events of many people’s lives.
The day's formalities were rounded off with an emotionally arresting reading of organiser Jo Watson's poem I'm with her by local performance artist and poet in her own right, Jasmine Gardosi.In this passionate controlled explosion of emotions, the poet ( here, Jo Watson. Gets confusing!) pays tribute to Eleanor Longden, one of the leading voices of the Hearing Voices Network. Jo was initially inspired by Eleanor's TED talk, in which she declares that the important consideration is not what's wrong with people but what happened to them. I had tears in my eyes as the poem lurched era by era through the history of society's treatment of women's 'mental health' treatment, and I recalled particularly the way my mum has been treated since diagnosed with 'manic depression' in the 1960s - subjected to more than 50 years of polypharmacy, once imprisoned in a padded cell, given electric shocks through the brain and so on.
I can only quote a section of the poem here, so I've chosen a bit that includes the day conference's title:
... honestly - you’d be surprised
there's a disorder for everyone
& if YOU haven't been diagnosed yet
you just haven't been in the
saying the wrong things
to the wrong people
at the wrong time
arbitrary luck, nothing else
‘cause I promise -
there is a disorder for everyone
It's in the book
this is the place from where they all derive
All squashed in
hundreds of them - (all planned )
as supply and demand
doesn't work too well
without the demand bit
so our 'disorder' has to fit
we need the pills to cure it
be our defence
chemical compounds of modern science
that conveniently turn off
or tone down
& pharmaceuticals profit SO much they're
a-wheeling & a-dealing
Is this not an atrocity ?
Ok, so if this has whetted your appetite, the idea is to roll out this event again in different cities across the UK and Ireland too.
If you are interested in helping bring it to your own area, you need to contact Jo Watson. Her contact details are: Email: Jowatson03@aol.com Mobile: 07769158565. Twitter: @jwpsychotherapy.
Good news for Northerners! The date for the second A disorder for everyone event has already been set for Friday 10th March 2017 in Edinburgh (venue to be decided).
I nearly forgot to mention the centrally important fact, too, that Jo Watson also recently set up a Facebook group called Drop the disorder? You can read more about it in the article, Get off the sofa!, which Jo recently wrote for The Counsellors Cafe. At the time of going to press, it's already attracted nearly 1700 members in less than six weeks, and counting. Please join us there to access a rich supply of resources and thoughtful, constructive, supportive conversation and debate. Also to find out about upcoming relevant events and ways to better access an online community of like-minded thinkers.
I'll leave the last word on the day to Sue Brotherton, a parishioner, who told us that she bravely came along "with no idea what to expect or even knowing whether I would understand a word". Her verdict on the proceedings was enthusiastic. She reflected, "while the majority of the delegates were clearly therapists of some description, they were all very friendly and I certainly didn't feel out of place", going on to summarize the central message she was taking home in her own words:
"Being diagnosed with a trauma, labelled and treated with medication does not, in many cases, help or work and can even - and sometimes does - make the problem worse. But telling our story to someone about our trauma/problem who will listen with understanding, compassion and advice, so that in time we are able to cope, seems a much better way to me, and in a lot of cases works".