Highs and lows on the (you) tube – and the challenge of empathy.

Over the last few years some of you will have seen a viral video of a man singing along to Rhianna on the tube.  If you’ve not seen it, all the better, have a watch (below) and as you do just have a little think about what’s going on.  What are your first impressions of the singer and his audience?

The video was first recorded surreptitiously and posted on youtube in 2012, becoming a viral hit with over 2 million views.  What was his audience thinking?  For his fellow tube travellers we’ll have to entertain ourselves by interpreting their expressions.  Youtube however, gives us a little more to go on…. some people found the video amusing:

Trying so hard not to bust out in uncontrollable laughter

…others admired his confidence.

Lol. Kudos to him, as funny as it is, I do love how ppl have such cofidence in themselves to do such things. As its nit in the norm to sing aloud on the subway/rail, whether you have a good voice or not.

….some gave their support:

Awesome!  Keep on singing Alika.  Let the stiff upper-lipped boring people jeer all they like.  You are London.

….and sadly many others were just nasty or racist.  Youtube’s comments section can be a dark place.

Yet, few if any of the comments really indicate any attempt to question what was going on in the man’s head (beyond those who accused him of showing off).

So what was going on?  Well we don’t know exactly, but that man on the tube, Alika, has got together with Rethink (in a video) and the Independent (in an article) to tell us a little bit about what he was experiencing (Have a read and a watch, and perhaps compare your reaction to when you saw the first video).  As he tells us in the Independent.

That year [2012] a number of events in my personal life had taken their toll on my mental health. In just twelve months, my auntie died, my five year relationship crumbled, my savings were stolen, and two friends of mine were killed in violent attacks. It all started to overwhelm me, and I began to feel and behave differently.

I was going through depression, anxiety, manic episodes, self-harm, and voices and illusions in my head. But I kept it all to myself, and over time I became more withdrawn and erratic. Singing on the tube was a way to drown out my problems and escape. When you’re in the middle of a manic episode, you don’t think about what you look like or how you come across.

….A story very familiar to clinical psychologists working with bipolar disorder and psychosis.  While some of my clients become ill without any clear stressors, they are in the minority.  Most of the people I’ve seen have worked with have entered a manic phase following difficult life experiences.  Alika’s story may seem extreme, yet it’s not at all uncommon among clients with mania and psychosis.  We all have different breaking points, and these may depend on a mixture of our past experiences and our genetics.  Cities like London do not help, feelings of alienation, racism, insecurity and violence are not uncommon, and are a particular problem for those from less privileged backgrounds (black Londoners are at particular risk of experiencing psychosis, for possible reasons that need another article).

But back to the comments….  the comments for Alika’s Rethink video are in stark contrast to those in the original video.  There are not so many yet, but to give a flavour, here’s just one:

Brother am soo sorry when world star posted it people thought it was funny me being one of them if knew what you were going through i would have not even dare to laugh at that video.respect you for what you have done i too have anxiety when i am in public but its only getting better and better i will let my friends know about this soo they can apologize as well.:)

For me, this is a reminder that empathy is rarely automatic.  We are generally quick to judge by what we see on the surface, but rarely take the time to imagine what lies under the surface, to ask ourselves what might be going on for that person opposite us on the bus or tube, or even over the breakfast table.  We often jump to one conclusion and stick with it, that singing man is what?   Selfish?  Annoying?  Super laid back and open?  Cool?  Attention seeking?

As Alika puts it (kindly).

I don’t want to make people feel bad if they laughed at the video of me singing on the Tube. I can see the funny side too, but I’d like to move on now. Viral videos have a life of their own and capturing someone’s behaviour for a few seconds in a day doesn’t ever show you the full picture.

Jumping to Conclusions (JTC) is something that is supposed to be particularly common in people with psychosis, yet in reality, we all do it, all the time.  And just as it can be helpful for my clients to think of other explanations for their experiences, it can be useful for the rest of us too.  On a bad day, we may tend to jump to negative conclusions, which just make that day worse.  A classic example used in therapy is to imagine someone we know ignoring us when they walk past us on the street.  What’s going on?  On a bad day, well that person is clearly a total ass; on a good day, clearly they were preoccupied and did not see us.

Alika’s second video and article give us context, they give us a way of connecting to Alika.  Suddenly, Alika is no longer a cartoon but a deeper, three-dimensional character.  It’s no longer so easy to apply just one adjective.  Now we are forced to consider Alika as a person with a past, present and future.  It’s harder to be unkind, and easier to be kind.  We have understanding , we have empathy.

Alika was kind and brave enough to give us that connection.  The challenge is to make that connection more often and with less help.

Ascent into Mania…

In researching for a lecture on bipolar disorder, I came across this video.  It’s simply text, set to Samuel Barber’s Adiago For Strings (perhaps the ultimate emotional induction music).

 

 

It’s been posted by Brian Miller (Parhamscan, bminternet43), on his youtube channel .  It’s a relatively short film which covers a little of Miller’s early life and then details a manic episode, which led to his sectioning and hospitalisation.  Miller’s is a story that is perhaps familiar to many others with a bipolar diagnosis, although his first major manic episode was probably later than average.

For the mental health professionals, the video would probably make a great resource for bipolar support groups, teaching, ward groups and perhaps in individual therapy.   The comments below, as so many times when people share their experiences, reveal how valuable it has been for other people.

An interesting article about asylums and overlooked friendships.

Friern Barnet from wikipedia.
Friern Barnet from wikipedia commons.

In this short article introducing her forthcoming book: The Last Asylum: A Memoir of Madness in our Times, Barbara Taylor describes her experiences of living in Friern Barnet mental asylum.   If the article is any indication, the book should be fascinating.  The piece focusses on the friendships developed in psychiatric wards, something that Taylor feels has been totally neglected by researchers.  As Taylor describes:

Magda suffered terribly from black depression yet nearly always she would pull herself together to be with me. Usually I did the same for her. The obligations of friendship trumped madness – and this in itself could be a form of healing.

it may be that the friendships developed on psychiatric wards can be an essential part of patients’ recoveries.  Yet as mental health professionals we often seem confused as to whether to encourage such relationships, and indeed are sometimes very ambivalent.  We may often fail to capitalise on the potential healing ability of our patients’ relationships.  To my knowledge, we know little about whether these relationships are sustained out of hospital and what they mean to our clients.   Yet we know that having good social support is a key factor that mediates recovery (for instance in bipolar disorder), and we know that serious mental illness commonly wreaks havoc on a person’s social networks (e.g. this study looking at the impact of psychosis on social support), so we really should know…

 

 

Even more cartoons… this time about anxiety.

Thanks Maria for sending me this link to a buzzfeed page, with loads of great cartoons about anxiety.  I’ll not copy them here, as the buzzfeed page has already done the hard work.

One of them led me to a blog:

sad girl scribbles

by a girl called Gaby at virtualgirlfriend.tumblr.com, which contains a plethora of drawings touching different issues including anxiety and depression.

One of many that I particularly liked was this one, which deals nicely with the tension between wanting to abolish difficult feelings and needing emotions to be human:sadgirlscribbles-plantsPlants may not have feelings… but I think I’ve made a few plants look pretty sad.  They definitely look happier when they’ve had a little love and affection – or at the very least least sun, clean water and good food; all of which I can relate to.

Youtube Channel Review: Time to Change

Type: YouTube Channel: Time to Change
Highly Recommended Resource.

Time to Change is a campaign which sets out to end mental health stigma.   That’s a tough, but laudable goal (especially tough given the continuing level of irresponsible reporting by media such as the Sun newspaper) .

The campaign started in 2007 and is supported by the mental health charities Mind and Rethink.  In terms of online resources, Time to Change has both a webpage and a YouTube channel.   More broadly, Time to Change seeks to engage the general public through all forms of media, whether it be TV, radio, internet, magazines or poster campaigns.  I’m going to briefly discuss the YouTube channel today.

In short, it’s a brilliant resource.  Useful to everyone from mental health service users, through to teachers, families and indeed anyone who wants to know wants to understand more about mental health difficulties, be it their own or other peoples’.

The videos cover a large range of formats/styles and topics.   To take just a few examples:

  • Animations such as the one above, beautifully illustrating a young person’s experience of depression and recovery.
  • A mock horror film trailor, ‘Schizo’, which seeks to undermine traditional associations between mental health and violence).
  • Short, poignant and powerful mini-dramas, such as ‘The Stand Up Kid’, which explores the unseen impact of stigma in schools.
  • A silent film, ‘The 5th Date… time to talk’, complete with speech bubbles, which considers the sometimes scary experience of disclosing one’s mental health diagnosis to a date.
  • Endorsements and discussions from famous people who have been open about their difficulties such as Stephen Fry and Frank Bruno (who discusses mental health with his daughter, Rachel Bruno) .

Many of the videos are sorted into particular topics, for instance there is a section with five videos, all of which feature a different person’s experience of mental health and the workplace.  In total there are over 80 videos, and so far, every one that I’ve watched is excellent.   I’m going to try and work my way through the other videos,  there’s a lot of them, but they are generally very short, and all inspirational, so not a chore.

 

Youtube Bipolar Video – brief review.

Youtube Video Review: ‘Cutiepieforeverc’
Highly Recommended Resource.
Main topic: Bipolar.

Another brave testimony by a young US American lady.  In 16 minutes, ‘Cutiepieforeverc’ describes her experience of bipolar disorder.  Her first clear problems came when she went to college (away from home).  In common with many people who receive a bipolar diagnosis,  her first symptoms were lack of sleep (something it appears that she had always faced to some extent).  This led to a period of 2-3 weeks where she hardly slept and indeed felt very little need to sleep*.  During this period she engaged in a variety of ‘reckless’ behaviour including shopping sprees and late night runs (from which she was regularly picked up by the police).  It appears that she did not seek help at this point, this had to wait until the ensuing depression, which lasted around 6 months, led to her getting to ‘breaking point’ and contacting her mother, leading to her hospitalisation.    Although I don’t have research evidence to support this more generally, many of the young people I have worked with (or done research with) have experienced their first serious problems at college/university, and often in the first year.

‘Cutiepie’  details her hospitalisation as ‘the most horrific experience of my entire life’,  which is not an uncommon description, even from those who believed that they needed to go to hospital.  She worked out that in order to get out of hospital, she could lie and cover up her  depressive symptoms (that hospital may have made worse), which worked.  Again many people will recognise this catch 22 situation, of being stuck in a hospital that does not seem to be working for them, and needing to pretend that all is fine to leave the hospital.   She then goes on to discuss her journey to find a medication treatment that worked for her.  At the point the video was made, she describes feeling very settled and content with her life and medication.  She ends the video with some advice for people going through similar experiences:

  • Don’t ever settle for a medication that does not feel right and does not make you feel right.
  • Don’t ever settle for a doctor that does not want the absolute best for you.

Excellent Advice!  In my opinion, health professions should absolutely encourage their clients/patients to take control of their own treatment and encourage them to seek out (with guidance), what works best for them.

Overall, this video was a very clear and concise description of one young person’s experience of bipolar disorder.  ‘Cutiepie’, describes experiences that many people with a diagnosis of bipolar disorder or similar will be able to relate to, and as such this video would make an excellent resource for therapy groups or interested individuals.

*Sleep abnormalities are becoming one of the most convincing traits linked to bipolar disorder diagnoses, and emerging evidence suggests that early sleep problems may be a risk factor for the development of later mood disorder symptoms.  When I get time, I will try and provide some links to the latest research.

Youtube Channel Review: Rawsammi

Youtube Channel Review: Rawsammi
Highly Recommended Resource.
Main topic: Bipolar.

This is a great and brave resource.  Rawsammi (her user name) is a mid-twenties US American lady (I want to say girl, but is that appropriate?),  who has a diagnosis of bipolar disorder.  She’s posted dozens of videos, that cover everything from her experience of hospital, through to hyper-sexuality, the DSM-V and ‘taking responsibility’.  Rawsammi’s videos are delivered somewhat as a stream of consciousness, rather than being focussed and concise, but each video that I’ve watched contains useful information, emotion and humour.  The videos talking about her experience of hospital and the run up to hospitalisation are extremely open and honest, and I think could be extremely valuable to others who have had similar experiences.

It would take hours to go through all the videos and I don’t have time to review them all, anyone who wants to add their thoughts on any of the specific videos is more than welcome to comment below.

Beginnings

OLYMPUS DIGITAL CAMERA
Bogota, Colombia

Why, What, How?

Having spent many years avoiding doing anything like writing a blog, I’ve finally found a vaguely compelling reason to put my daily thoughts in print, or at least pixels.

What is that reason?

I’m doing some research for a pet project, and it has occurred to me, that as I very rarely finish pet projects, if this one is to be of any use to anyone other than me (or indeed, me), perhaps I should just write it up as I go along.

A project you say?

I do.  I’m researching internet resources that may prove therapeutically useful for people suffering from mental health difficulties, as well as for mental health workers and students In particular I am interested in those difficulties that are sometimes referred to as ‘severe and enduring’.  In practice this most often means diagnoses such as bipolar disorder, schizophrenia and personality disorder.

My interest stems primarily from wanting to have access to honest, accurate and diverse representations of different peoples’ experiences for use in a therapeutic environment.  When I first did a YouTube search several years ago to find a compelling video clip that would help communicate the experience of mania in a teaching session, I found very little.  Fast forward to the current day, and there is a growing wealth of experience represented on the internet, from brave, first-hand descriptions to the latest in academic thinking.

I was initially planning to trawl through the internet and make private notes on the resources I found, which I could then share with my colleagues and clients.  However, realising that most of my pet projects never see the light of day, I thought that  a blog was perhaps the way forward.

So how’s it all going to work?

No idea, right now, I’m just trying to work out what is possible within a blog.  Regardless, I’m very grateful to my good friend Ben Meghreblian for helping me set up this blog in superfast time.

I guess it will evolve with time, or simply be abandoned a few weeks down the line….

What I have decided is that:

  • It should not be about perfectly written prose.
  • It should, if possible, be readable, useful and interesting.
  • It should be a collaborative venture, open to contributions.
  • It’s an excuse for me to do something with all those random photos I take (so there may be lots of images with little or no clear relevance to their posts).

Bear with me!

“Up/Down” Bipolar Disorder Documentary

A film produced by Matt Stockalper and Kyle Gehring

The following is the first contribution to my attempts to provide a resource for those searching for mental health media for use in therapeutic settings (or indeed more generally).

“Up/Down” is a full length documentary (1h23m) about the diagnosis of bipolar disorder.  It is a well produced and well shot film, which involves interviews with the general public, psychiatric professionals, people with a diagnosis of bipolar disorder and family members.  For me, the strength of this film is very much the latter two sets of people.  The film begins by briefly surveying what bipolar disorder means to the general public and providing an introduction to bipolar disorder, before  progressing on to more detailed interviews.  For these later interviews, the producers have chosen a format whereby they ask each participant a number of set questions, and hence we get a variety of responses, reflecting the peoples’ diverse experiences of the bipolar spectrum.  The questions broadly cover each person’s experience of bipolar generally, as well as more specifically in the manic and depressive stages.

All the participants are US American, and this is perhaps reflected in the number of medications each participant is taking, the upsides and downsides of which are explored in a later section of the film.  One of the people interviewed also describes her experiences of ECT, with the pros (being shocked out of depression) and cons (very severe complications of memory loss).  Towards the end of the documentary, relatives of people with bipolar are interviewed and they discuss how it is to have a relative with bipolar disorder.

Overall I liked this documentary.  Although one never knows what has been lost or emphasised in the production and editing, the film appears to give space for each participant to express their own experience.   I feel that the film could be of interest/use to professionals, patients and relatives.

Some reservations.  I have some concerns  with regard to the introduction to bipolar disorder.  Primarily, it is perhaps too ‘factual’ in nature, when what is presented as fact is often actually rather controversial.

Diagnosis is always a difficult topic to deal with and in this film the validity and utility of  diagnosis are taken for granted; this is always going to be an issue for those, who like me, have concerns about the way in which diagnoses are used.  The film continues the tradition of treating disorders such as bipolar and schizophrenia as unitary and separable conditions, when the evidence for this is limited.   For example the brief history of bipolar disorder at the beginning of the film gives the impression (as many believe) that the distinction made by Kraepelin was a clear scientific progression (previously the disorders were ‘confused’).   It is an irony that although we know that there is little evidence for a clearcut distinction between these diagnoses, it is hard to talk about the experience of people who have these symptoms without using their diagnoses and we thus reinforcing the impression that we are discussing two independent, valid diagnoses.   On the other hand, the film clearly shows one of the benefits of diagnoses, by using the diagnosis of bipolar disorder, the filmmakers were not only able to easily select a group of people with similar (but not the same) symptoms and experiences, but also enabled me and others to easily find their film.

There is also a very controversial statement that ‘children as young as three have displayed signs of the [bipolar] disorder’, again perhaps reflecting that this is an US film, where very very early diagnosis and medication is not unheard of (very extreme examples include the treatment and subsequent treatment related death of a four year old).  The narrator also states that ‘Most psychologists and psychiatrists believe that it [bipolar disorder] is genetic’, which is far from the full story, and is to my mind, misleading.  Most of us may accept that the diagnosis bipolar disorder is highly heritable (and has a shared genetic component with schizophrenia among other diagnoses), but many of us are aware that the full story is much more complicated and that  heritability is a very misunderstood topic.

Documentary Timeline. For my own purposes, I’ve detailed some questions/points in the documentary along with the appropriate times (not at all complete)

Introductory Topics

  • History of bipolar disorder:  07.00
  • Childhood bipolar 8.30
  • Symptoms 09.00
  • Diagnoses, depression to mania ratios 10.00

Questions

  • ‘Could you give me a general explanation of how you felt before you were diagnosed?’  0h14
  • ‘And how long have you felt the symptoms of bipolar’  0h16.55
  • ‘What was this person like in a depressive episode and how did you react to it?’  1h06
  • ‘What was this person like in a  manic episode and how did you react to that?’  1h07.30
  • ‘How do you view bipolar disorder now after having been exposed to it personally?’  1h09
  • ‘Have you accepted the disorder as part of your life?’  1h12
  • ‘What are your thoughts and hopes for the future?’ 1h13
  • ‘What would you like the general public to know about bipolar disorder’  1h13.30
  • In your own words, try to sum up what it’s like to have bipolar disorder’  1h16.30

Other

  • A lovely description of bipolar disorder at 1h18.00.  Boat, anchor and kite metaphor.