Wednesday, 29 March 2017

In praise of our electric blanket

I’ve been worrying quite a bit recently – partly about family problems and work pressures, which I can do something about; and partly about the corrosive effects of Brexit and Trump, which I can’t do anything much about.  And then I’ve found myself worrying about worrying, which is more worrying still - and definitely not to be recommended.
So after discussing all this with my daughter Anna, I decided it’s time to look up my old wellbeing recipes, dust them off and see if they need any updating.
For those of you who don’t know, a wellbeing recipe is a list – a set of ingredients – of things which give you pleasure and help you feel better about yourself.  It’s not a fixed list. Wellbeing recipes vary from one person to the next, and for each person they can change over time.
My old recipe included some ingredients, like walking in the mountains and diving through waves in the ocean, which are great but not immediately practical for me at the moment. So I’ve worked out a new recipe, composed of ingredients I can use easily and often.
Here are some of the main ingredients:
·        A few minutes of mindfulness meditation every morning, using the Headspace app on my i-phone.  I’m following a set about anxiety at the moment, which is helping me to explore my sensations of stress without feeling I’m being swallowed up by them – imagining, instead of being caught outside in in a storm, that I’m safe inside a house watching the storm through a window.
·        The parkrun at Croxteth Hall on a Saturday morning gives me a great sense of wellbeing, especially now that I’ve managed to stop stressing about how fast I’m going and can enjoy the run for its own sake. There’s one section of the course, when sunlight glistens through woodland onto some ponds, which is magical. And running with my daughters is a huge bonus. 
  • My afternoon siesta, which I’ve built into my routine since my cycling accident, is a must-do these days. It stops me from wearing myself out, restores my energy, my memory and my creativity. Highly recommended!    
·        Watching detective programmes on TV with Sue has been in my wellbeing recipe for ages, and it still helps me unwind of an evening. Elementary and Inspector Lynley are our current favourites.
·        At the end of the day, I’ve started reminding myself of three things I’ve been grateful for - and one thing I’ve done well - during that day. They can be small or big things, it really doesn’t matter. This simple exercise, focusing on what’s gone well for me, does a great job of settling my mind down.
·        And finally, sliding under the duvet and into bed, with our double electric blanket turned on to full heat.  A wonderful, warm, comforting cocoon to snuggle into. Blissful, utterly blissful. Thank you, and good night.


Wednesday, 1 March 2017

Conducting an orchestra

A few months ago, I was elected Chair of the World Organisation of Family Doctors' (WONCA) Working Party for Mental Health.  

Yes I know, that is rather a mouthful!

But what it means in reality is this:  I now have the privilege of working with family doctors and their colleagues around the world, to help to improve the mental health of their patients. 

And it really is a privilege.... it's like being the conductor of a high quality symphony orchestra. There are so many excellent family doctors, doing so many important things in the field of primary mental health care -  it is exciting to hear them all, and to help people to work more effectively together.  

For example, in Brazil we are arranging a series of mental health training programmes for family doctors, based on the World Health Organisation's mhGAP programme.  In the Eastern Mediterranean region, we are working with many others to develop comprehensive community based mental health systems.  And in China and Eastern Europe we are finding new ways to help family doctors gain more confidence and skill in diagnosing common mental health problems. 

We are also acting as advocates for vulnerable groups in our communities, including people with severe mental illness, and asylum seekers traumatized by their experiences.

You can read more about us, and keep in touch with our activities and progress, through this link to the WONCA website



Friday, 16 September 2016

Love is not an apple pie

When I was a boy I used to worry that there wasn't enough love to go round.  I thought love was like an apple pie – good stuff, but there was only so much of it and then it was gone.

When I was born I sort of assumed (as much as babies can assume things) that I had all my parents’ love. Then my younger brother was born and I had to share their love with him. Only half a pie now.  And worse was to come. The next year another brother was born and my share of the pie went down to a third. Oh dear, what a disaster…..  

No wonder we used to fight so much. The arguments we had on Sundays over who had the most fizzy drink with our roast dinner were nobody’s business!

Luckily for me, I thought, no more brothers or sisters arrived to take even more pie away from me. A third of a pie was better than nothing.

But of course, I realise now that this is all nonsense. 

Love isn’t like that at all.  It’s not finite, it’s infinite. In fact, weirdly, the more love you have the more there is around to share.   

Another way of putting this – for those who like maths or game theory - is that love is not a zero sum.  My gain is not your loss.  My gain is also your gain.   Or, if you like chemistry, we can state that love (like gas) expands to fill the space available.

And we can build up our capacity for love through meditation, and practicing random acts of kindness.

Why am I thinking about this now? 

Well, it’s because I’ve just had a delightful cuddle this morning with Heath, my newest grandchild.

And a couple of weeks ago I was sitting in a (fortunately large) tent in the Peak District in the pouring rain with thirteen family members of various ages.  It was busy, noisy, chaotic, exhausting - and yet totally wonderful to be part of all those loving interconnections.

I’ve got so many grandchildren now it’s easy to lose count, but the brilliant thing for me is that it simple doesn’t matter. They are all equally loveable, and there is no sense at all in my old worry that I somehow have to cut that love into bits and share it around. 

Unlike the apple pie, there is plenty of love and always more to go round!

Sunday, 14 August 2016

Caring for ourselves

In the last four posts I’ve been thinking about suffering and hope –  ways to listen better to the suffering of others, how sharing brings the beginning of hope, the need to be thoughtfully positive, and how to offering practical hopefulness.  

It does work.

Darren’s been coming to see me for a while now.  He is still alive. He still mostly rants, and I still mostly listen, but there’s less booze and fewer fights in his life. He’s got a girlfriend and a dog, and his drumming skills have found outlet in two local bands – one with a possible recording contract. We’re both beginning to feel more hopeful.   

To be able to offer hope to people in distress, we need to take good care of ourselves.
With the frequent pressures we find in our own lives, whether its hassles within our families or problems in work – or an awareness of our own frailty and mortality in the face of traumatic accident or life-threatening disease – when we find ourselves trudging through treacle, we do well to recognize our own suffering and give ourselves the freedom to hope.  
I’ve written before about how helpful it can be  to create a well-being recipe, where you write down a list of all the ingredients of life that help you flourish, and then use them to build up something positive when you’re feeling down or harassed.
It’s good to refresh the ingredients from time to time.  Ironing shirts is still on my list, but I’ve added in mindfulness meditation, and parkruns are now part of my own well-being recipe.
And it is great to have fresh starts, to try out new experiences we’ve never had before. And what could be fresher than meeting my brand new grandson Heath, born just a few days ago – welcome into the world! 
For Heath, and for everyone: in those times when life gets tough and you’re suffering, I can’t offer you better words of hope than these, from Irish poet John O’Donoghue:  

"On the day when the weight deadens on your shoulders and you stumble, may the clay dance to balance you.

And when your eyes freeze behind the grey window and the ghost of loss gets in to you, may a flock of colours, indigo, red, green, and azure blue come to awaken in you a meadow of delight.

And so may a slow wind work these words of love around you, an invisible cloak to mind your life."

Saturday, 6 August 2016

Practical hopefulness

So far I have been writing about the importance of compassion, and about the best ways of being positive.  Now it’s time to think about what practical steps we can take to help a person in distress become more hopeful about their life. 

Of course, a lot depends on how much knowledge and skill we possess. Doctors, psychologists and mental health nurses, for example, have access to drugs or therapeutic techniques, which aren’t available for others.  Faith leaders and counsellors have status and training that can often be of particular benefit.

But we can all offer important, practical help. 

Two well-tested things that anybody can offer are Mental Health First Aid, and Psychological First Aid.  And then, with a little training, there’s Problem Management Plus.

Mental Health First Aid (MHFA) is helpful for anybody who is suffering from mental or emotional distress.  This graphic shows you the five main ingredients:

So, for Darren, I’m there to assist with his crises, like when he gets his sickness benefit turned down. I’m always willing to listen to his concerns and his worries. I give him information about courses and things he could do to improve his drumming skills. I offer him the choice of seeing the mental health team, and I encourage him to keep in touch with his friends even after they’ve had arguments.

If you want to find out more about MHFA, you can download a free app by clicking on this link. It takes your through the five steps and gives you lots of helpful suggestions.

Psychological First Aid  (PFA) is designed to help with communal suffering caused by disaster situations, such as the Ebola crisis in West Africa, or asylum seekers and refugees fleeing turmoil in Syria and Libya.  

As you can see from the next graphic, PFA has three key elements: Look, Listen and Link

It’s all about providing practical care and support and protecting people from further harm. It’s particularly useful for vulnerable groups, such as

·        Children and adolescents, especially those separated from their caregivers.

·        People with health conditions or physical and mental disabilities.

·         People at risk of discrimination or violence, such as women or people of certain ethnic groups.

PFA promotes people’s long-term recovery because it helps them to feel safe, connected to others, calm and hopeful. It offers social, physical and emotional support, so people are better able to help themselves, as individuals and communities.

 You can read more about PFA here, and watch a brief video about it here.


If you would like to be more actively involved, I suggest you learn about Problem Management Plus (PM+).  

PM+ has been developed by the World Health Organisation to help adults facing adversity.  It involves five weekly sessions and covering four main topics:

·        managing problems

·        managing stress

·        getting going and keeping doing

·        strengthening social support

It’s been shown to be effective in high, middle and low income countries. It’s similar to the Positive Thoughts Courses that Sue runs regularly.

And very importantly, it can be delivered by people with no mental health expertise, after a brief training.

If you want to find out more about PM+, click on this link. 
Next time: taking care of ourselves.

Sunday, 31 July 2016

Being positive

For most people, sharing their suffering is just the first step on the way out of the dark woods in which they find themselves.  Let’s now consider the relevance of being positive.

Expressing hope and optimism, and taking a positive approach to a problem, are usually more helpful than expressing doubt and uncertainty.

But we need to be a bit careful how we do this.  

If we are too cheerful too soon, before the other person has had time to tell their story, they may think we just don’t care or understand.  Here’s how Sinéad O’Connor puts it:

I went to the doctor and guess what he told me He said, "Girl, you better try to have fun no matter what you do.  But he's a fool.

 So, don’t rush in too quickly with your hopeful words.

Then we need to think what sort of positive approach is best to take.

I can think of at least four different ways. I may tell Sinéad that I’m an expert and can solve the problem for them; or that we can work on the problem together; or that she has the resources to manage it herself; or that her problem will get easier on its own, given time.  

These approaches all convey hope and optimism, but they are all very different.  We need to tailor them to the understanding of the person we are hoping to help.
For example, an expert approach might be more helpful if Sinéad believed she was suffering from a disease or an illness; but as she sees herself having problems with her relationships, a shared or time-focused approach is more likely to be helpful for her.

So it’s worth finding out how the person we’re hoping to help see things.

In any event, shaping the patient’s story in a more hopeful direction is likely to be valuable.

Talking with Darren, I aim to build on his strengths: his obvious intelligence and his drumming skills. 

And we can see hopeful shaping in this consultation between a doctor and a patient with muscular dystrophy:
P:    It's just quite painful and tiring and depressing.
D:   Yes, yes.
P:    and I've been really cold since I came back, just can't seem   to get warm so it's just very diff-, very depressing. Sorry.
D:   It's not easy to put up with, this, is it? You're obviously somebody, you like to keep very active and getting around the place and doing what you want to do.
P:    I just don't want it to be on top of me, and it feels like it's on top of me.
D: We've got to reverse that, haven't we? We can't get rid of the dystrophy, but you can be on top of it rather than the other way, rather than the other way round somehow.

This is a beautiful example of sensitive, person-centred optimism, which we can all learn from.

Next time – some practical steps to encourage hopefulness.

Sunday, 24 July 2016

Tears at the heart of things

Last week I wrote about how difficult it can be to listen to the suffering of other people. I also suggested some ways we can become better at that.  
Here's why this matters: bearing witness to suffering, giving a sense of being understood and accepted, is the first - essential – step towards finding hope.
I’d like to go back a couple of thousand years here, to get some help from the Roman poet Virgil, and his epic poem the Aeneid which describes the travels of Aeneas after the Trojan War.  
Stay with me, this will make sense in a minute!
In the first book of the Aeneid, we find Aeneas as a refugee, driven far from his home by the vicious ravages of the Trojan war. He is in Carthage, gazing at a mural in a temple, which depicts battles of the Trojan War and the deaths of many of his friends and countrymen. He is moved to tears, and offers a rousing tribute to his fallen comrades.
In the middle of this, he says: ‘sunt lacrimae rerum’.  
Yes I know, your Latin is probably a bit rusty, but don’t worry……
These three words - sunt lacrimae rerum - have been translated as either ‘there are tears for things’, or else ‘there are tears of things’.  The first version – tears for things - indicates the burdens we have to bear, the frailty of human existence, the ‘shit life syndrome’ people like Darren (who you met last week) experience. The second version – tears of things- indicates that things feel sorrow for our suffering - that in some sense the universe feels our pain.
But of course it isn’t one or the other. It’s both. Virgil is fully aware of the ambiguity and wishes to us to understand both meanings at the same time. 
So does the Irish poet and scholar Seamus Heaney, who translates the phrase as ‘There are tears at the heart of things.
And this is its richness and power. At that moment when I experience and express compassion for the suffering of the person in the room with me, both senses of sunt lacrimae rerum are simultaneously in play.  They can express pain, distress and suffering, knowing that – from me - they find understanding, compassion and safety. Our meeting place has become, momentarily, a sanctuary.  
Sometimes bearing witness to a person’s suffering in the face of overwhelming life experiences and difficulties, may be all that is possible, or necessary 

Listening to Darren, behind his angry ranting I hear a lost, lonely, frightened little boy. I want to give him a huge hug and bring him home with me, but I content myself with a friendly smile, a warm handshake, and an agreement to meet again soon.  
What’s your experience of bearing witness to suffering?