Jul 052014
 
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If, that is, we don’t do something first.

But first, a photo.  A badge of courage.  A statement of principles.  A declaration even, in times such as these, of battlecry proportions.

The principles of Bevan's NHS

(This photo and its text are, I believe, taken from a Bernadette Horton posting on a Unite the Union Facebook page – if other copyright owners also exist, please contact me for attribution or any other relevant action.)

So what different kind of illness am I talking about?  I’ve already posted recently on these pages about how – in a world of Snowden-like revelations – paranoia is becoming the default setting.  I left Spain in 2003, after a year of growing and ultimately debilitating paranoia, as I thought Microsoft was intervening my computer due to my work on OpenOffice.org – especially with respect to my desire to expand the software’s reach to Croatia.  And although these thoughts were clearly an illness at work, in the light of Snowden and everything we’ve discovered recently, it’s not beyond the realms of possibility that I was being tracked, manipulated and objectivised as well.

Who by?  Who knows!

The illness was real enough, but the causes may not have been as random as my diagnosis – carried out under the NHS of the day – ultimately chose to conclude.

(The problem with paranoia, at the best of times, is that you never know if the people who walk behind you are following you – or “following” you …)

So fast-forward to now.  And we see, all of a sudden, a new challenge to our mental wellbeing: the EU/Google “right to be forgotten” story – pounding, as it is, on our virtual doors and castle gates.  Whilst the NSA/GCHQ/Microsoft nexus was bringing us – indeed, has finally brought to a whole society – a virtual paranoia about as real as earlier centuries’ individual manifestations of sadly dodgy mental health, so the EU – alongside, in this case, Google (all on its lonesome, as befits behemoths everywhere) – has brought us a virtual memory loss about as real as any an Alzheimer’s could physiologically impose on us.  As search engines have taken away our ability to remember stuff without their help, once in such a position they – and others, presumably – have conspired to kick away the stools we’re been so happy to sit tall on.

This is why the real challenges ahead don’t only lie in what they wish to do to the principles of a society caring societally for its most infirm members.  They also lie in what hugely untransparent and opaque structures like our security services and our largest corporations do to normalise such consequentially infirm behaviours: from the paranoia Snowden’s world generates and validates in us to the inability to remember history – and therefore our progress and its stumblings – accurately, it’s quite possible that both attitudes will, in the future, become embedded in our psyches without our even realising it; without our even having the distance to acknowledge what’s happening.

To summarise then, in a tweet I didn’t send but which did serve to spark this post:

Time to forget “right to be forgotten”: whilst NSA/GCHQ bring us virtual paranoia, EU/Google hasten virtual memory loss.
Freedom to confuse.

As the man says: the freedom to confuse.  What a gloriously democratic right that is indeed.  And how magnificently they are taking the opportunity to do so.


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May 122013
 
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The Observer does proud this weekend those of us interested in all matters psychiatric, in three articles published here, here and here.

My interest comes from a personal involvement at a very early age and then during a mid-life crisis.  I was epileptic from 10 onwards and diagnosed paranoid schizophrenic from 41 onwards (just around the time of the Iraq War, in fact) – though interestingly the classification used by British psychiatry suggests that:

Similar disorders developing in the presence of epilepsy or other brain disease should be classified under F06.2

Which in turn says the subject may suffer from a:

Schizophrenia-like psychosis in epilepsy

No matter.  In my case the diagnosis has always been firmly full-blown paranoid schizophrenia, my GP politely refusing to contemplate any change.  I mention this because of one of the arguments used in the third Observer article linked to above, where a professional in favour of the current system of classification says:

[...] A classification system is like a map. And just as any map is provisional, ready to be changed as the landscape changes, so is classification. [...]

This is clearly not my experience, neither at the time of initial assessment nor in the years that followed that first assault on my sense and sensibility.  Meanwhile, in the second half of the article I’ve just quoted from, I find in Oliver James a much more sympathetic voice:

Yet 13 studies find that more than half of schizophrenics suffered childhood abuse. Another review of 23 studies shows that schizophrenics are at least three times more likely to have been abused than non-schizophrenics. It is becoming apparent that abuse is the major cause of psychoses. It is also all too clear that the medical model is bust.

And this:

[...] there is a huge body of evidence that our early childhood experiences combined with subsequent exposure to adversity explain a very great deal. This is dose dependent: the more maltreatment, the earlier you suffer it and the worse it is, the greater your risk of adult emotional distress. These experiences set our electro-chemical thermostats.

So does subsequent adult adversity. For instance, a person with six or more personal debts is six times more likely to be mentally ill than someone with none, regardless of their social class: the more debts, the greater the risk.

My own adult adversity was chronicled a couple of years ago in a short story I wrote.  You can find this story, if you are of a mind to read it, here.  I lay it down as the evidence I still need to provide in order that I might demonstrate I have no disorder except my epilepsy – and no illness except my savage reaction to madness around me.

As a young adolescent I remember something else too.  A book called “Sanity, Madness and the Family” entered my life and influenced me in boundless ways.  It seemed to hit a raw nerve, and much as semiotics and comparative studies at university later on, opened my eyes to a whole host of new ways of seeing.

Its thesis, if I remember rightly, was that much of what schizophrenics were accused of suffering from involved a series of collusive and horrendously denied acts committed by those who lived with and around them.  Films taken of family interviews showed the alleged schizophrenic at the centre of the discourse, with siblings and parents winking at each other around them.  In the face of a reality which was never shared it’s hardly surprising that someone might be described as delusional.

At the time of my own diagnosis, only my father had an opportunity to speak to the psychiatrist.  My wife, who spent most time with me in the year leading up to my collapse, never had the chance to put across her point of view. Hardly a holistic approach able to contain both biology and society.

The problem with maps, of course, being you can sometimes hold them upside down.

*

And so we come to my final question: what is the proper task of this complex discipline we call psychiatry?  To map and decide disorder, simply and dissectingly?  To assume that what we have amongst us are people who suffer from incomplete bodies, broken mechanisms and disabling biochemistry?

Or, alternatively, enter into a completely different landscape where psychiatrists comprehend that much of what is seen as disorder is in fact reaction and adjustment by perfectly sane beings painfully hurting from painful lives?  As James observes:

Britons and Americans have exactly twice the amount of mental illness of mainland western Europeans (23% versus 11.5%). Thirty years of Thatcher and “Blatcher” turned us into a nation of “affluenza”-stricken, shop-till-you-drop, “it could be you”, credit-fuelled consumer junkies. Personal debt – a major stressor for adults – rose from £200bn in 1980 to £1,400bn in 2006. After 1979, the amount of mental illness mushroomed.

Maybe sanity, madness and the family – in its environmental and reactive emphasis – wasn’t such a wild mantra, after all. It’s an old dichotomy, of course – but no less worth revisiting for all that.

Not after the shock to the system which neoliberalism has – more than manifestly – engineered.


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Dec 152012
 
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It’s really not my place to reach conclusions about the massacre at the elementary school in the US yesterday.

Not now.  Not, even, in the future.

But the following paragraph from the Guardian‘s report today did make me pause for thought (the bold is mine):

Lanza had attended Newtown high school, and the Associated Press said news clippings from recent years show him on the honor roll. Joshua Milas, a classmate who was in the technology club with Lanza, told AP he was generally a happy person but that he hadn’t seen him in a few years. “We would hang out, and he was a good kid. He was smart,” said Milas, who graduated in 2009. “He was probably one of the smartest kids I know.”

The only reason I dare to mention this tonight is because I saw, this evening, the following tweet from the film-maker Michael Moore:

The way to honor these dead children is to demand strict gun control, free mental health care, and an end to violence as public policy.

It’s the old old story which arose last year in Norway too.  Bad or mad – what is it really we are dealing with here?  But as someone who has suffered mental ill health, I have to say that I do dislike how the media automatically label these killers as necessarily mentally ill.  Yes.  I know that wasn’t Moore’s intention here – nor was he by any means the only one to allude thus – but, in truth, the idea we’re transmitting by such proclamations is that mental health sufferers are dangerous to others.  More often than not, they are harmful more to themselves than those around them.

Far more often than not, in fact.

Far too many labels out there as well.

So can’t we just step back from those impulses?

And if we must assume anything, assume that someone can be both smart and bad without necessarily being mentally ill.

In this way, we might help to understand that whilst guns don’t kill people, they sure make ordinary people under stress more likely to take the wrong decisions.  Decisions they will surely regret for the rest of their lives.

However long or, in the violent environment we seem to be building, more likely short those lives become.


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Mar 142012
 
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I’ve written before on the similarities between car ferries and international finance.  When disaster strikes slightly, it very soon becomes massive and unstoppable.  Just one small opening in supposedly carefully-sealed bow doors is enough to turn a ferry upside down in minutes.

For some reason I am reminded of the above post in two stories today.  First, an astonishing open letter – possibly the start of the longest corporate suicide note in history – which the New York Times publishes today, and which is penned by a senior Goldman Sachs executive who has just left the company.  It describes how in the opinion of the writer the company culture has changed so radically that whilst still clearly a customer-focussed entity, the customer in question has transmogrified from the external one of honourable yore to the internal managerialist corporate greasy-pole climber of our latterday times.

Second, and as a kind of synthesis of the above two links, I am minded to mention this story on Apple’s current iPhone experience in China, where it apparently finds itself being outsold three to one by its competitor Samsung.  Much is made of the tipping-point danger – shades of car ferries again – which operating systems and IT platforms have to labour under.

The pendulum swing between virtuous and vicious circles works thus: if developers believe your platform won’t succeed, they stop developing applications for it.  This then means end-users stop buying phones which use it – which in turn means, in the end, the platform contracts as was feared and is finally sunk in much the same way as the unhappy ferry of my first link.

So to the thesis of this post: the downsides of failure have become too great for society’s wellbeing.  In the name of competition and competitiveness, we are forcing people, teams, companies and societies down the road of an awful intellectual and emotional poverty.  In much the same way as we have recently become accustomed to talking about bad capitalism, perhaps it is now time we spoke of the concept of bad competition.

And if you feel this is going too far, just read this article from Reuters today.  That a third of all workers – as an average across the globe – should feel their work environment is sadly inappropriate for their mental health is something we should consider and remember when we talk of and sell the virtues of competition.

Bad competition versus good competition?  It’s time to have that discussion.


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Dec 172011
 
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I lived in two cities in Spain.  The first was Burgos in the north.  The second city was Salamanca, which, looking at the map, is sort of north-west of Madrid – but is in reality much closer in feel and mindset to the Portugal that it is located a bare hundred-odd kilometres from. 

I’ve written about my time in these two places on this blog a couple of times.  The first time I remember was here, when I described how my problems with mental ill health came about – problems which led to a nervous breakdown and a total reevaluation, for me, of what life should really be about.

The second story I told about Burgos in particular can be found here: it describes my reaction to the discovery of the Spanish stolen babies cases and how this led to me to reassess all the friendships I had blithely acquired at the time.

Sometimes, being a foreigner in a foreign land leads one to be totally oblivious of the most extraordinarily disturbing matters.  Other times, it can drive one mad (which it did for a short period in my case), as realities perceived are casually denied and healthy minds are slowly eroded.

In fact, my time in Spain was a before-and-after in a number of respects.  Not only before and after illness; not only before and after blithe friendship.  No.  There was also the technological side and the part this played in my decline.

Let me explain.  In Burgos, we had had an excellent Internet connection which allowed me to posit the idea of an online business.  I worked hard on a kind of iUniverse.com style of business for the Spanish market.  Then my wife lost her job, I began to lose my mind – and we retreated to Salamanca, my wife’s hometown, in 1999.  Retreated, that is to say, with a contractual telephone relationship to hand.  Or so we thought.

The following couple of years were an awful battle, living as we were at only fifteen kilometres from the capital city, to get a decent landline connection.  Even standard dial-up was beyond our supplier: they used instead what was called the Trac telephone – a primitive radio precursor to 3G with none of the virtues of the latter technology.  Stunningly, I managed to make it stay permanently online where no one else in the country even attempted to do so: I spent around three months fiddling with the command codes on my serial modem until – one day – I alighted on what seemed a magic combination.

But online or off, the connection was miserably slow.

You couldn’t set up an online publisher with such technology to hand.

And so I began to see the whole world as against me: we eventually managed to get a proper landline, despite the wishes of the local comunidad de propietarios (they didn’t like the idea of ugly telephone cables clogging up their housing estate), and even as one of them managed to convince a sub-contractor of his to drive a lorry through the initial installation.  But even here, they refused us ADSL (or whatever the fastest alternative was at the time).  The most they were prepared to offer was RSDI (ISDN in English, I think) – only to retire the offer at the very last moment, and after we had already paid for the special phone.  I still have that phone.  A €90 relic from an ancient age which I keep as a souvenir of pain.

Now it looks as if all this will finally be laid to rest – and closure of some kind will be achieved.  If all goes according to plan, on Monday we will finally have broadband ADSL at a house I spent more than a decade battling over.  In the meantime, I had to wrench my children out of their own home and culture, drag them to England against their will, and suffer the ignominy of a medical diagnosis which failed in all respects to take account of the real circumstances.

If, on Monday, we finally achieve what we have waited so long to acquire, then I shall weep long and hard as I ask myself why this could not have happened before.

And I shall remember all the good times we missed out on – as well as all the good times we had before and after.

For before and after, in another tale of two cities, is just as important as the now ever will be.


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Nov 272011
 
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This deserves to be read all round the world:

Paranoia, like mental distress, flourishes in the absence of a public culture. When ideas can be discussed freely among equals, we can revise and improve overly simple explanations – just as we can challenge unnecessary complexity and technocratic obfuscation. Individuals can change their minds, or shift the emphasis of their concerns, without feeling humiliated. They don’t have to do what many critics of conspiratorial culture demand and embrace the conventional wisdom about politics and economics, with all its absurdities and obvious failure of logic, evidence and common sense.

I am not starry-eyed about occupations and assemblies. And it is far too early to make confident pronouncements about what they mean – their meaning will only be determined by what happens in the years ahead. But there is one lesson that we can take from them – and it is worth bearing in mind, I think.

Public speech is good for us.

If this tells us anything, it is that a profoundly individualised society leads inevitably to a degraded state of mental wellbeing.  Not because of what, thus unleashed, individuals may do; rather, because of what, thus bound, they can’t share.  In another part of this fascinating text (the bold is mine), we are told that:

[...] A number of people have said that they found the experience of being in the assembly profoundly beneficial. One young woman who suffers from anxiety said that she spent an hour in Saint Paul’s before she realised that she had been symptom-free the whole time. People have had a chance to talk with others about politics and economics, and so about the shared conditions of life. They have been able to acknowledge their disquiet and to situate it in the social realm, rather than in their autobiography or in their brain chemistry. That in itself has been an enormous relief.

And this (again the bold is mine):

Part of the inhumanity of the current order resides in the widespread insistence that individual, rather than the social order, is the proper object of reform. In what amounts to an attempt to suppress our political nature, we are told that we must make ourselves acceptable to what exists, to what is inevitable. But troubles in our lives are not our individual achievement. The language and images, the built environment, the power relations that shape our experience of life, these all form part of what must be considered when we consider the puzzle of our own troubles. Sadness is not a private property.

Here, then, in these few short paragraphs, we have a startlingly breathtaking understanding of the problems which drive so many of us – a quarter, they say, along the length and breadth of our lifetimes – to real mental despair.  A figure which, they say, is also rising – and does not include those who simply rub along in desultory disengagement.

And so it is that we need socialism not for profoundly economic reasons; that, in the light of all that has happened recently, is clear enough to see.  No.  The real reason why we truly need more socialism is in order to frame with a manifest justice that battle in favour of our most common instincts and impulses – instincts and impulses which an individualising society has clearly repressed: that is to say, those overwhelming desires to socialise our needs to communicate, compare and contrast with others in supportive and safe public spaces.

They have substituted our public spaces with private spaces of public use; they have substituted our municipal towns and cities with globalised online communities run on the behalf of money and commerce; they have substituted our supportive environments of yore with medication and therapies galore.  How can it not be the case that we might become sad and depressive in such damnably isolating habitats – unable to do anything but locate our social suffering in the personal sin of the culpable?

If the #occupy movements are able to move us on at all positively in the future, it will be in this attempt to regain the power and healing nature of that natural area of socialised communication – that comparing and contrasting I mention above which make us well, connected and humane again in a way that no other system may achieve.

This is why we must remake our institutions.  This is why we must support #occupy.


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Jun 112011
 
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In my previous post I described how my twenty-year-old son with passport in tow was told he couldn’t buy a 15-rated film at a local supermarket because he was accompanied by his sixteen-year-old brother who, in the absence of the relevant ID, couldn’t prove his age.  A totally irrelevant and unsustainable request, of course.  The latter having nothing to do with the former.

Anyhow, to this post one of my brothers has just added a wonderful comment which includes this fascinating concept:

You and your family seem genetically pre-disposed to attracting ‘jobsworthy frustrated bureaucrats’ like horse shit is pre-disposed to attracting flies.

Let’s hope that the geneticists find the ‘Kafka gene’ soon so we can screen future generations from this terrible affliction.

Presumably, he means something along the following lines: the “Kafka” gene, in a very 21st century way, is what predisposes some of us to experience the world as a place full of inexplicable stupidity.  Another way, perhaps, in a strange kind of manner, of explaining what in different times and cultures we were inclined to define as “fate”.

If truth be told, I am unsure whether such a gene describes a reality or a perception – but never mind: in this frustratingly post-modern world, who cares any more if the tree makes a noise?  The essence of this particular issue surely lies in the undeniable fact that whilst some of us do experience the world as if we were suffering from the kind of genetic make-up my brother has so astutely identified, the rest of us appear to breeze relatively easily through life without so much as a madly bureaucratic entanglement on the horizon.

In my case I can mention an untold number.  From the time I wanted to start working in Spain (you needed a work visa to get a contract but without a contract you couldn’t get your work visa) to attempting to “import” my humble worldly goods in the face of the bizarre machinations of the Spanish port authorities (I remember on one occasion bringing a printer over the border and having to learn the importance of asserting, with the support and connivance of a kindly border official, that I hadn’t purchased this item but had, rather, been given it as a present); from the time we wanted to give our first-born a Croatian middle name (we were obliged to obtain confirmation from the then-Yugoslav embassy that the name was real and had no equivalent in Spanish) to the day I imagined that an existing contractual relationship with Spain’s main telephone provider would guarantee me a decent Internet connection fifteen kilometres from one of the most important cities in Spain (it didn’t, of course – whilst the frustration which built up over the following three years almost helped bring about my end); from the moment I fell ill with epilepsy and was considered by my GP to be faking it (I’m still on epilepsy medication almost forty years on) to the time I was judged ill enough to enter a psychiatric ward (see previous mention of Internet-connection grief and what this almost did to me) and was then informed on leaving four weeks later that I was only good enough for a maximum of two hours per week voluntary work (I immediately started working for a fast-food restaurant on 20-hour-a-week shifts) … well, I could go on.

But you’ve probably already had enough.

And, in any case, maybe we all could.  Perhaps, here, I am focussing too much on my own dramas – and not understanding enough that this disjunction between reality and perception, between what they say and what they mean, is a pretty common experience for awfully vast swathes of the world’s unhappier populations.

Oh yes, indeed, dear world – it would seem that many of us (though not all) have Kafkaesque genes.

And so it is that I begin to wonder if the “Kafka” gene as a tool to understand what happens to us can’t be applied to other areas of human endeavour.

How about progressive politics for example?  What do you think?  Are the left-wingers amongst us predisposed to understanding and relating to the world in these terms in a way that the right-wingers amongst us are not?  And does this mean we on the progressive end of the political spectrum are not only inevitably condemned to undergo longer periods out of power than in but also to suffer from a generally more uncomfortable upper hand – when, that is, on those very rare occasions, we are fortunate enough to have it?

If your genetic make-up binds you to a view of the world which releases upon you with great ease a sense of rank and outright absurdity, how can you possibly be comfortable with the implications of such power structures?

I know I can’t be.

Does that make me fit for a mental institution then?

What do you think?


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Jun 012011
 
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I’m not an evidence-based blogger.  I write quite calmly – but under the surface I am always far too angry to know how to communicate effectively with those who count.

So.  Evidence-based blogging is not my forte.

But this open letter to the Coalition government, first published online in the Guardian yesterday evening, provides even someone as emotional as myself with sufficient proof to convince someone as logical as yourselves that something very wrong is taking place at the very highest levels of power in this country.

This is how the United Nations defines our inalienable rights to mental wellbeing:

Q: What is mental health?

A: Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

In most countries, particularly low- and middle-income countries, mental health services are severely short of resources – both human and financial. Of the health care resources available, most are currently spent on the specialized treatment and care of the people with mental illness, and to a lesser extent on an integrated mental health system. Instead of providing care in large psychiatric hospitals, countries should integrate mental health into primary health care, provide mental health care in general hospitals and develop community-based mental health services.

Even less funding is available for mental health promotion, an umbrella term that covers a variety of strategies, all aimed at having a positive effect on mental health well-being in general. The encouragement of individual resources and skills, and improvements in the socio-economic environment are among the strategies used.

Mental health promotion requires multi-sectoral action, involving a number of government sectors and non-governmental or community-based organizations. The focus should be on promoting mental health throughout the lifespan to ensure a healthy start in life for children and to prevent mental disorders in adulthood and old age.

Whilst this is today’s reality in Britain, as per Liberal Conspiracy’s overview of the matter – and published today:

Regular readers will know my endless horror at the system of “assessment” in place to now determine whether or not someone is “Fit for Work”.

Run by ATOS, a private company charged with making impersonal decisions, the system uses a computerised, tick box questionnaire of just 15 questions that take no account of variable conditions, no account of consultant or GP based evidence and no account of pain or most symptoms.

In a recent survey, Mind found that an enormous 95% of respondents don’t think that they will be believed at assessment. Evidence abounds of mentally ill people being found “fit for work” simply because they manage to turn up at the assessment centre dressed and washed.

I have to say that my own experience of mental health assessment – a sad and traumatic moment in my life, conducted as it was under the alleged objectivity of GPs and consultants – left much to be desired.  But I was one of the very lucky ones.  I survived the diagnosis – and managed to put my life back together.  And this was under the previous system, where a supportive approach was supposed to be at the heart of the whole process.

Today’s Britain, however, seems aimed at making this almost impossible for the vast majority of sufferers. All part and parcel, in fact, of an attempt by those in charge to ensure that the poor and vulnerable in society will remain under the lock and key of a Darwinian capitalism at its very worst – and, it would seem, for evermore.

Coupled with the move to a free-market NHS, where presumably paperwork for patients at point-of-delivery will multiply a thousandfold, the strategy would appear to become clear: reduce the need to pay for care for those who are suffering severely by ensuring that form-filling and what we might term personal bureaucracy becomes a useful barrier to accessing such services (in my own particular case, for example, I only have to think of the mental pain I go through, even now, when I have to complete the forms to claim back my dental fees). 

Where in the world, I then ask myself, does a company propose winning over more potential customers by making it more difficult for the aforesaid individuals to use their products and services?  Unless, of course, the idea is to cherry-pick the profitable customers and, in true free-market style, absolutely forget about the rest.  You know.  Your granny, my auntie and the village idiot down the road.

*

I really fail to understand how even those who propose these changes are able to live with the daily burden of not squaring the obvious circles.  Most of them run large businesses – or are in contact with large businesses – whose main reason for existing is (supposedly) to satisfy the needs of external customers.

(Or, perhaps, not – as the case may be.) 

So would their shareholders sanction treating customers with such utter and despicable disrespect?  Would they approve of procedures and processes which were designed to make it easier for such companies to operate and more difficult for their customers to engage?

Maybe that’s what’s wrong with latterday capitalism.  The real customer of the vast majority of modern companies becomes the internal self-serving owners whose yearly dividends are far more important than any end-user’s experience.  And that is the model we are now imposing on our public services.

This is not Darwinian capitalism after all, not the survival of the fittest.  This is the survival of the incestuous.  The inbreeding of the hypocritical

And if you thought the public sector needed turning over, just wait until you experience the full force of the private at its most navel-gazing.


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Oct 102010
 
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A definition and a story, to celebrate World Mental Health Day.

This is the World Health Organisation’s definition of how it understands mental health:

Q: What is mental health?

A: Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

In most countries, particularly low- and middle-income countries, mental health services are severely short of resources – both human and financial. Of the health care resources available, most are currently spent on the specialized treatment and care of the people with mental illness, and to a lesser extent on an integrated mental health system. Instead of providing care in large psychiatric hospitals, countries should integrate mental health into primary health care, provide mental health care in general hospitals and develop community-based mental health services.

Even less funding is available for mental health promotion, an umbrella term that covers a variety of strategies, all aimed at having a positive effect on mental health well-being in general. The encouragement of individual resources and skills, and improvements in the socio-economic environment are among the strategies used.

Mental health promotion requires multi-sectoral action, involving a number of government sectors and non-governmental or community-based organizations. The focus should be on promoting mental health throughout the lifespan to ensure a healthy start in life for children and to prevent mental disorders in adulthood and old age.

That first paragraph is simply revolutionary.  “Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”  More individuals, organisations and companies should comprehend and factor its implications into everything they do and structure – both in the softer aspects of working relationships and human resources as well as the harder side of procedures, processes and working conditions.

If the big society idea were conceptualised to achieve only this, it would have my support.

It isn’t, of course.

But it could be.

Meanwhile, here’s the story of how I fell ill and experienced severe mental ill health some seven years ago now.

I still see it, even now, as something I experienced rather than something I suffered from.

You will only ever understand what I mean if you go through it yourself.  Sometimes, you are better for having visited no-man’s-land and barely returned than never having visited it at all.  You see others more kindly after getting to know your own demons.  For you realise they still have not faced theirs.

* * *

At the heart of the matter
by Miljenko Williams

I remember what happened in a curiously distracted manner. It’s almost as if I’m choosing not to remember. Impossible not to remember, though.

Impossible to forget.

Three moments in my life. Three moments when the world seemed to collapse around me. Three moments when I would beg to differ. No. Not a wonderful life at all. But at the heart of the matter, there is this abiding truth: whether we differ or not with what life has in store for us, we have no alternative. We must fight.

So is this a story of battle? Is this a story of war? Is war an appropriate metaphor? Can life ever mean an entire absence of peace, ever limit itself to a cruel persistence of vision?

You see, I was brought up to believe in the story of good versus evil. I was brought up to believe in truth. My mother is a Catholic. My father is an atheist. They are both believers in their own very different – and yet oxymoron-like – ways. There was so much belief infusing my childhood, like a sharply-smoked tea of distant origin. I was a membrane of the basest kind. Osmosis was my learning curve, my education, my tool. I refused to ask questions – for the answers seemed so obvious.

“What do you mean?”

“Can’t you see?”

“Not again!”

“Yet another thing to do …”

So that’s why only the questions seemed hard. But then questions always are.

*

It was 1992. War had reached Croatia. I was living in Spain. The city of Burgos, in fact. A beautiful city. Running through its centre like a peppermint stripe through a stick of northern rock was the verdant rio Arlanzón. Its banks were cloaked in thick meadow grass, sprinkled and cut back regularly to ensure perfection where nature resisted.

Modern men and women strive so violently to tame what is beautiful, untamed.

Burgos is a place of hot summers coupled with cold evenings that, even in the middle of August, require one to wear a jumper. A hardy people, los burgaleses.

Over one winter to visit, I remember my brother observing that in Burgos young women wore not short skirts but – rather – long belts.

A determined people, in fact.

My wife had a shortwave Sony. And so it was that I could listen to the BBC news as I sat at home with our one year old son. I was bereft of any understanding, any useful comprehension, about what was happening in the country my mother came from. Yes. It’s very true. We forget the things that hurt us and remember only the good, but the good we remember doesn’t really affect us – it’s only the things that hurt us and cause us pain which ever really hit home in the end.

We think we are able to ignore them but at some point they will jump up like a mental cobra of the soul and frighten us – as they surely should.

(Even a wonderful life is like that and, as I have already pointed out, mine has not been a wonderful life.)

And so it was that I was frightened. I am sorry to say, as I listened to the news, to the abandonment by the West of small countries which – a priori – should’ve known better (small countries which had no oil or other natural resources worth fighting over or defending), that I cried in the presence of our son on more than one occasion. He would not know why I am sure. Or perhaps he would. He now wants to work for the diplomatic service. Perhaps, in some small way, the injustices of that time have informed his understanding of the world.

Perhaps, in some small way, everything that goes around does indeed come around.

Perhaps, in some small way, justice can be done. Even if it must never be seen to be done.

So he cried and I cried. He cried because he was a baby and I cried because I was a man. He cried because his body didn’t digest his food properly. I cried because I couldn’t digest the news properly. At the heart of the matter, it’s not the heart that counts. At the heart of the matter, it’s the head. It’s heads that are turned and heads that turn the heads of others. A smile that glances off one like a touch of frost on one’s breath. A smile from afar is a cold beast – matter-of-fact and to the point. It’s only in close-up that a smile warms us up. Then it’s the eyes, not the mouth.

Then it’s the head that counts.

I can count the ways I fell in love with you.

Not because they are finite but, rather, because they are innumerable.

I fell in love with my wife and we got married.

Then in our third year of marriage, just as war came to Croatia, just as I couldn’t stop crying in the presence of my son, she came home one day with a simple headache and a box of paracetamol.

I do remember walking back with her from her school that day. Funny, isn’t it? Perhaps, in truth, the secret to living life is knowing when a bad thought is actually one you need to hold onto. A thought you need to treasure. A thought you need to learn how to love, for – maybe – the Lord believes it of use.

It was a hot day. A sunny day. A Monday, I think, as the fishmonger’s was shut and in Spain – at least at the time (I don’t know now; it’s been a while you see and things change as time passes, they change so very much) – the local fishmonger’s was always shut on Mondays.

It was a strange headache. It kind of hurt round the back. She went to bed at midday. She never went to bed at midday. She never went to bed unless it was night. Midday was for dozing on the sofa, after lunch; after the 3 o’clock news. Midday was unheard of. That’s why I was frightened. I wonder – now – what our son was feeling at the time. Though still mainly unable to speak, he was also surely unable to entirely misunderstand what we were saying to each other. What we were doing to each other.

A strange headache it was. Round the back, round the neck, round and round in circles that tightened.

She was in hospital by late afternoon.

The diagnosis was severe. Bacterial meningitis. The severest form of all, in fact. It really did seem too much.

And now my memory of how it felt begins to fade. It’s affected me for sure. I’m convinced that it’s still deep down there, waiting to jump up and strike me when I least expect it to, when I least need it to; or, maybe, essentially, in my lapsed and only ever partially infused belief system, when the Lord feels it may be most useful for me.

What do I know?

Why should I care?

Tell me that, at least.

Life seems, quite insubstantially, to be a series of random events that generate fear and apprehension in small beings of little relevance. And we spend most of our time trying to shape these events, even as we cannot; we spend most of our time trying to achieve a certain relevance that we can only ever define in terms of what we ourselves – quite futilely – judge to be fine. What we ourselves judge to be wise. We determine the rules of the game so that we can achieve our goals. But – in the mad rush to achieve this relevance – we forget how navel-gazing being judge and jury can be. For that is all we are. Judge and jury. And that is nothing. There is no virtue at all in defining what defines us.

*

She survived of course – but only because she’d suffered meningitis on two previous occasions, and had, in time (though not plenty of time), been able to recognise the symptoms.

“Two previous occasions?” you ask.

Well, indeed. There must be more to the story than that. And, of course, there is. After a certain and stiff period of recovery and antibiotics, it was revealed that the runny nose she seemed perpetually afflicted with (the runny nose which meant she went through as many Kleenex a day as those gorgeously sexy cigarette packets of black tobacco that almost everyone of any, even feigned, relevance seemed to smoke in that decade) was actually the liquid that was supposed to protect her brain from knocks and bumps. She had a hole in her nasal cavity. Congenital, almost certainly. Deadly, without a doubt. A multitude of earlier x-rays had failed to show up what the modern technologies of magnetic resonance discovered. When the man at the clinic in Palencia gave us the results, he smiled sadly. It was such a sad smile.

I remember the sadness in the smile you see. Even as I say I remember only the good; but, if truth be told, as I recount the story, I also remember quite a lot of the bad.

I wondered, afterwards, on the journey back in the ambulance to Burgos, what that smile meant. I didn’t say anything to my wife.

What can you say?

The surgeon then said we’d need to do a biopsy.

Biopsy?

Why?

Don’t we do such things for cancers?

Just a test we were told.

Doctors sometimes do the sorts of things we ourselves choose to do.

Is that because they’re human too? Is that because they can’t help getting involved, even as they know they shouldn’t?

So I suppose you want to know what the result was. Well. No cancer, actually. The sad smile from the man in the clinic in Palencia meant nothing in the end. A trailing thread of brain cells that had hung down into my wife’s nasal cavity – probably all her life – was the route that infection had taken three times in her life. And the surgeon said the solution – yes, the solution – was a rather dramatic operation. He put it in simple terms. She could either ignore what had happened and wait for it to happen again. And for sure, sooner or later, it would happen again. Or she could decide to have the operation.

So it was that I encouraged her to have the operation. I have a general and overwhelming belief in high-technology medicine, though, as you may gather, I find it difficult to believe in God. Yet, the former requires one to put one’s life in another’s hands even as the latter makes no greater demands. Why do I believe so easily in the tools of God where believing in God Himself is so very, very hard?

But I am digressing.

“The operation?” you say.

Aparatoso is the Spanish word the surgeon used on at least one occasion. I suppose “complex” is the most appropriate translation. But the word aparatoso is also used to describe multiple pile-ups where no one gets hurt. Is that what an operation means? Is that what medicine is all about? Is medicine always a series of accidents waiting to happen? Or is medicine, actually, like so much of modern life, a question of apparently accidental wisdoms which actually reveal our greatness, our ability – in the face of insignificance – to soldier on into the future?

“The operation?” you repeat.

The operation? This is how the surgeon described it to us. It involved peeling back the skin from my wife’s forehead from under the hairline to avoid visible scarring, drilling a hole through the skull on the left-hand side to allow for access, glueing the congenital defect with something the surgeon described as approaching a medical form of bog-standard super glue, and then putting everything back together again, much as Humpty Dumpty might rescue a kingdom.

In that description we have the full horror and awful wonder of our ability to soldier on into the future.

We had to wait for two weeks as my wife recovered from the meningitis itself.

In the meantime, I would sit at home and look at my wife’s dainty slippers and remember what it was like when we first met; and remember the times we went out for drinks and the times we spent walking through a park and the coach journeys from Burgos to her hometown of Salamanca; and fighting with my mother-in-law and trying morcilla de Burgos for the first time and visiting friends in Navarra and the sound of the street in the early morning; and the time we holidayed in Croatia and the time we were rained out for two weeks in Llanes and the good friends I made and then later the good friends I lost. And if my son was about, I would not cry. And when my son was asleep, I would sob quite uncontrollably.

So we went ahead with the operation.

And the operation was successful.

And the patient survived.

It took six months for her hair to grow fully back. It took years for it to lose its initial spikiness.

*

Yes. Reading back on this, it seems I remember rather more of the horror than I expected. If the outcome had been different, perhaps I would have chosen to remember differently.

At the heart of the matter, it’s the head that counts.

*

Over the next decade, I tried to set up a training empire and failed, lost money which didn’t really belong to me – or, at least, wasn’t mine to lose – and made and lost some very good friends.

My wife lost her job too.

We had to retreat from Burgos to Salamanca. We lived there from 1999 to 2002. We retrained and decided to pick ourselves up and brush ourselves off. We were going to do so many important things. We were shaping events, giving them a form, creating content, writing a narrative.

We were doing what all human beings with a little time to waste try and do.

We were playing games.

We were children again.

It’s so much easier to be a child. Time doesn’t hang heavy as yet. Except in the sense that sometimes it’s too slow.

Not like being a grown-up. When you’re a grown-up, time simply flies past. The less you have, the faster it gets. Time is not exactly elastic. It doesn’t rebound. For at the end, it simply snaps.

But at the heart of the matter, it’s the head that counts. And just as we were on the point of setting up an online publishing company, my mother-in-law, the one I always fought with, the one I could blindly see no virtue in, the one whose own mother had accused me of stealing her granddaughter away, the one who was invincible, the one who intervened in every act and family decision, the one who cooked so well, so completely, so correctly, so inviolably, the one who worried so much, the one who consumed Aspirina (but only the branded version) in much the same way as some children eat chucherías … well, she intervened once more. She intervened in a way no one could ever have foreseen.

She died.

She took six months to die. In the meantime, of course, she had space and room to organise her affairs. She bought each of her children a new car. We continued to go out for meals. Towards the end, she sat in a wheelchair. She needed help to eat. She was losing control of her bodily functions. Her speech was getting slurred.

She still sat at the head of the table.

At the head of the table is where it counts.

But she didn’t count any more.

She didn’t even know she was dying.

The family decided not to tell her. The doctors concurred.

Till the end, she thought it was a cyst in her brain. Till the end, she was completely unaware of the implications. Till the end, invasive brain cancer was simply not on the cards. Thus it was that her family were unable to say goodbye. They didn’t say goodbye. They couldn’t. When they could, it was too late and she was incapable of understanding the words. I wonder, now, if my son didn’t understand more when Croatia went to war and I cried him to sleep and watched my wife’s slippers sitting emptily at the end of the bed.

So my wife’s mother (sounds better than mother-in-law, sounds kinder) died of brain cancer just as we were planning to pick ourselves up and dust ourselves off.

My wife felt cheated. Years spent back in Salamanca had led her to the point of beginning to truly communicate with her mother. Things were on the point of being said; important things.

Not entirely generous things.

Now her mother was dying.

Now it was too late.

It wasn’t our decision not to say goodbye. Even that decision was taken out of our hands. Can you imagine what it is like to watch someone die for six months, to visit them every day, to perceive a daily deterioration – and never tell the truth? Can you imagine, at all, what living a lie for six months can be like? Everyone except the object of the lie knowing exactly where reality lies – and not saying. Not expressing their innermost feelings. And feeling that, in so doing, the right thing is being done.

I lost my mother-in-law and only saw the good things in her once the gaping hole that she left violently opened up behind her.

But then, as I have already pointed out, time – for her – had already snapped.

*

I thought I was going to be a great publisher. I studied with astonishing minds. Electronic publishing was on everyone’s lips. The future was ahead of me.

The future was ahead of us.

But, in time, the future also snapped.

It snapped for me and it snapped for my loved ones.

I have seen famous people describe a nervous breakdown. I shall not describe it here. It is too public a place and I am not very public a person. Or maybe I am but maybe this is no longer what I should do.

Suffice it to say that – once again – it was a fact that at the heart of the matter, at the centre of my soul, it was a head that broke down and brought me to the edge of despair. Despair is not always clearly so – and thus, here, it was to be the case. Perhaps the essence of a nervous breakdown actually lies in our inability to obviously perceive it. The world takes on a different flavour – but that flavour seems so real and absolutely tangible.

My breakdown involved me writing about Iraq and its lead-up. As I did this, I prepared my own internal battle of wills. I prepared my own killing-field.

Every morning I wrote. Every afternoon I posted. I was an early convert to the virtues of an interconnected world.

I believed the politicians when they said we had to make a difference.

I believed in invading the sovereignty of dictatorship.

How could I believe otherwise after the lessons of the Balkans? How could I believe otherwise after my beloved Croatia’s experience?

Coherence, above all.

Coherence is an evil thing. Coherence is anti-human. Coherence is an excuse not to follow a new idea. Coherence is a bond that ties us down to previous stupidities. Damn the coherent man or woman. Damn the coherent instinct in us all.

So what saved me? After all this, which, in fact, is nothing out of the ordinary, what served to rescue my soul?

At the heart of the matter lies my head. Our heads, our thoughts, are sword blades we balance tenderly on. They can serve to strike us down or reveal us; they can serve to hurt us or save us.

They can serve to attack us or defend us.

They are what makes us different from everything else.
____________________

Further reading: a different story about living with cancer can be found here.  Note the date of its writing.  My dear Tuga is, at the moment of writing today’s post, still alive, still sharing life – both its ups and downs, both its felicities and its hardships – with her beloved, loving and lovable family.

Her belief in God holds her steady and true.

I cannot ever hope to emulate her – but this does not, nor will not, stop me from admiring her.
____________________

18th May 2011 – an update: Tuga is still alive, an inspiration to us all.  More here.


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Mar 172010
 
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Went with my mother to the local hospital for her hip check-up today.  Kind receptionists and friendly doctor would fairly sum up the experience.

Happy mother would sum up the result.

Whilst waiting for my mother to finish, I was watching the BBC News from Wales on the flat-screen TV they had in Waiting Area 1.  An astonishing statistic remained with me for the rest of the day: it’s calculated that mental ill health is costing us £7.2 billion a year.  Costing the UK you say?  No.  Costing just Wales!

More on this story here.

Just imagine how much we could do with that money if we could save the sufferers of mental ill health their suffering.  Just imagine how we could improve the lives of that one in four individuals who will one day find themselves at the mercy of this hidden hand of illness.

This hidden hand people are so reluctant to talk about.

Evil stuff.

A society which is prepared to continue as is as it spends that kind of money on simply ameliorating the pain of so many people is clearly the source of real sickness here – perhaps, even, an example of such sickness itself.

Curious, also, how society values the ability of the proto-psychotic as they trample on others and merge companies into evermore unwieldy empires, when the objective is to make money for the select few rather than waste it on an overwhelming minority at the mercy of political and socio-economic structures over which they have little control.

(Or, alternatively, I might gently suggest, when such wealthy individuals act with the intention of winning elections from faraway climes.)


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