Friday, 29 April 2016

Merging Fact with Fiction - with Lionel Shriver

Verbatim notes from Guardian Masterclass with Lionel Shriver (4 April 2016).  Huge thanks to my long-suffering husband for bagging me a place on this, as a very early and thoughtful birthday treat!

Merging Fact with Fiction

Novels often incorporate non-fiction elements / research.  There is an art to this!
How is the use of non-fiction helpful?

  • If writing is intended to be realistic (i.e. not fantasy genre) then non fiction details help create “verisimilitude”, pinning the story to a real time and place
  • If details are off, then readers’ faith in the author will be destroyed (“the spell is broken”) – factual content needs to be accurate for it to be beneficial
  • Authors get lots of reader credit for getting details right
  • For example, a good route into creating well-rounded and believable characters is in thinking carefully about their jobs/occupations and doing requisite research (as you would do if choosing a profession in real life!)
  • Details like this come back to the writer in spades, by offering up potential conflicts, worries, protagonists… Too many novels take a person’s work-life for granted, characters become too domestic. (But DON’T make your characters writers – writers don’t do anything!)
  • Use non-fiction to edify and educate readers – they are grateful for this, especially those that struggle to digest traditional non-fiction. “Sugar coating the facts” of an issue or topic.
  • Even more important is self-edification.  Enrich your own life as you write.  Start to care about things.
  • With caution, you can use fiction to make a social/political point or champion a cause.  But you may have to disguise this a little – don’t preach!  Nobody likes being lectured to.

Some “Fields of Authority” that Shriver has used in her work:

  • Anthropology (in “Female of the Species”)
  • Rock n Roll drumming and US immigration system
  • Northern Ireland politics/troubles ("Ordinary Decent Criminals")
  • Population control/demography
  • Inheritance law/disputes
  • Professional tennis (“Double Fault”)
  • Foreign correspondents
  • School shootings/ Attachment Disorder (“We Need To Talk About Kevin”) (Interestingly, when I questioned Shriver about whether she did much research into child psychology for Kevin, she answered that actually she didn’t want to get too hung up about that.  The mother in this book didn’t seek professional advice or get any real answers about what (if anything) was wrong with Kevin, or their relationship, so she felt this gave the book more realism/authenticity).
  •  US health care system (“So much for that”)
  •   Economics / dystopian economics (“The Mandibles”, forthcoming).

Actually doing the research – some tips:
·         May be useful to “page through” some academic journals – try to find out what the most esteemed journals are in the field and where the main academic divides lie.
·         Remember: make up the people/places/things that you need to author (i.e. have complete control over – they are then in your complete authority)
·         Shriver claims she is not as obsessed with actual settings as other writers, and tends to fall back to places she knows/has lived in (e.g. NYC, London, Boston, Raleigh). But, even within a city such as London, there are LOTS of different worlds to explore.  Walk around a bit!
·         Use what you know.  Any unusual or faintly interesting experience is gold dust to the writer.
·         Look at places with a fresh eye when using it for fiction. Carry a notebook everywhere. Take photos.
·         Internet is normally primary resource – but BEWARE the Wikipedia novel!  It’s lazy and doesn’t work.  Don’t just “dump” information into your work – this is as bad as copying and pasting.
·         Use google maps (especially Street View) to get detailed information on places (and also Trip Advisor reviews, photos, etc)
·         But original experience (i.e. leaving the house!) is very important.  Sensory information can’t be gleaned over the web alone.
·         Make a commitment to the topic.  Buy an expensive book in the subject area.
·         Create little individual libraries for each book you write, as a tribute to your hard work.
·         Don’t procrastinate.  Don’t use research to put off writing the book.
·         Be active in your research, like writing in a notebook.

Other points:
·         When something requires too much explanation, it can distract from the story.
·         You can use a “Glossary of Troublesome Terms” (see “Ordinary Decent Criminals”!) to provide background information.  But do it in a classy, entertaining, unique style.  It should be part of the book.
·         Don’t neglect libraries.  Not everything is on the internet (especially for historical topics)
·         Your job is to tell a story.  Don’t weigh it down. Be judicious.
·         Don’t be a show-off.  Be impressive without trying too hard.
·         Treat the audience as an equal. 
·         Be artful. Don’t duplicate.
·         Try not to use information that will quickly date a book – try to write about something timeless or universal (even if you’re writing about something very topical, it can have a universal message).  For example, “So much for that” is no just about 2007 healthcare in the US, it is also about what it’s like to be terminally ill and facing death.
·         Remember – enthusiasm for your subject is contagious!
·         Deliver your information with style and attitude.  E.g. an extract in “Kevin” delivers some facts about real school shootings with accuracy, but also infused with (the mother’s) emotion.  The facts are delivered in authentic dialogue.  This makes it less “authorial” and more animated.  In dialogue, people trade in information, usually to a purpose.
·         Make it funny!
·         Inject your own perception/acuity/thoughts/interpretation – what do you conclude?
·         Disguise information as if your reader knows it already.  Flatter them.
·         Try to let some other views/dimensions into the book, even if you disagree.

Thursday, 28 April 2016

So you think you might like to work in perinatal psychiatry?

I was asked to speak at an event at the RCPsych today, encouraging more doctors to enter the perinatal psychiatry field.  Obviously I couldn't attend (being on the other side of the Atlantic!) but I sent over some thoughts in writing.  Please share with anyone who might consider this career.  Worldwide, we need many more perinatal psychiatrists (not to mention mental health nurses!).

Why choose perinatal psychiatry?

You've already studied medicine, and taken an oath to Do No Harm.  You are scientific and yet artful.  Pursuing the noblest of professions.  The world will always need doctors.

You are thinking about a career in psychiatry.  Perhaps you'd rather work with thoughts, emotions and behaviours than with blood and guts.  Be warned though - we psychiatric patients can still provide plenty of the latter!  Your tools in psychiatry will be your OWN mind, rather than the scalpel or stethoscope - how you communicate with us, what you choose to hear, how you evaluate the complex human pictures before you.  Are you good at managing chaos?  If you aren't yet, you soon will be.

You've come across the term "perinatal" and are curious to learn more.  What is perinatal psychiatry?  Might it be the path for me?

I'm not going to paint you a picture of roses and unicorns.  You are too clever to fall for that.  Instead, as someone who spent some time in a Mother and Baby Unit, I will give you realism. 

MBUs: inspiring, rewarding, emotional, tense, suffocating places.

Scenes of utter joy one minute (imagine a new mum looking into her baby's eyes and smiling at him for the first time!).
Hilarity (explosive poo crisis in room 2!).
Friendship (between patients thrown together in the most inauspicious circumstances - and, yes, the staff caring for them).
Heart break (the decisions that you - yes, you - may have to make will be life's hardest: removing babies from families; treating mothers against their will; deciding their problems are not psychiatric after all but social - and you have no drug or therapy for that).

But if you are considerate, calm, good at balancing risks, seeing the bigger picture, communicating with both the psychotic and their equally frantic family members, then perhaps an MBU could be the place for you to make a real and positive difference.  

Because if you help fix one severely mentally ill new mother (and I was one) then not only do you send her home but you give her and her whole family their life back.  You give the baby back his mum and the dad back his partner. You give each family a new start.  And rather than remembering the hideous psychosis and the fear and the distress and the panic of their postpartum days they will remember the care they received throughout it all.  They will get on with their lives, not just recovered from that spell of illness, but hopefully stronger and more able to cope with whatever life throws at them next. 

So - consider it.  Do not enter into it lightly.  But consider it.

Saturday, 19 March 2016

An open letter to Jamie Oliver

Dear Mr Oliver,

So happy to hear you are looking for a new cause to campaign on.  You must (justifiably!) be very proud of your work on school lunches, nutrition and now the sugar tax.  I have no doubt that your interest in the health and wellbeing of our country's children is heartfelt and genuine.  

But, please.  If you want to campaign on something - please don't start telling mums what type of milk to feed our infants. 

Choose the fight against child poverty and the punishing cuts to our welfare state.  We'll all miss it when it's gone - even IDS realised that. 

Choose the fight against the forced closures of local children's centres and libraries.  Hundreds of facilities are at risk, or have already shut their doors.  Turned over to properly developers, fitness chains and supermarkets.  These places were a lifeline to me when I was a struggling new mum.  Our communities need community centres.

Choose the campaign for better perinatal mental health services.  Help the Maternal Mental Health Alliance close the postcode lottery of vital specialist services like Mother & Baby Units.  Help us put in place trained mental health midwives and health visitors so we can reach more families and save lives.  

Choose Child and Young adult Mental  Health Services - everyone these days is aware of how shockingly underfunded CAMHS is.  Long waiting times, high thresholds and devastated families.

Choose to join the 1001 Critical Days campaign.  An incredible campaign working in Parliament to ensure the best possible services from conception to Age 2.   If even half of what they call for is put in place then a generation of children's lives will be transformed.

Choose any and all of this, and more. But please.  Don't choose milk.  I'm fairly confident most women out there are planning on feeding their babies milk.  Why should you care whether it comes from a boob or a bottle?  The difference it might make to an infant's life chances is so disputed I can only conclude it is negligible.  Unlike the list above.  Those causes - I know from bitter experience - are life changing.

Sincerely yours,


Saturday, 20 February 2016

My Baby, Psychosis and Me

Like many others involved in the campaign to raise awareness of, and improve services for, postpartum psychosis and other perinatal mental illnesses - I tuned in to BBC One's "My Baby, Psychosis and Me" earlier this week.  The documentary was aired as part of the BBC's #InTheMind season, and achieved both impressive viewing figures (for being on so late) and astonishing viewer reactions.  I gathered just a selection of the Twitter response to the programme in this Storify: 

A few days later, I wish to record some of my own thoughts on it all.  Before I begin I declare the following interests (baggage?):
1) I am a huge fan of Dr Alain Gregoire (the consultant in charge of the Winchester MBU, where the documentary was filmed) and his whole team.
2) Like the two women featured, Hannah and Jenny, I survived PP through being hospitalised for a significant length of time and medicated using powerful antipsychotic drugs.  I am hugely grateful to Psychiatry and the allied professions.

Ok, with that out of the way, let's begin our analysis...

We are introduced to Hannah and Jenny with no pleasantries.  They are both acutely unwell and in desperate need of a Mother and Baby Unit bed.  There were rumblings from some quarters of the audience about not knowing enough of the women's backgrounds, their history, their psychology.  But I think the filmmaker's approach in this case was to mirror reality: in a psychiatric emergency there is no opportunity for lengthy introductions or even so much as a how-do-you-do.  I liked the way the women came into the film: at the start they were their illness.  The psychosis in each case had largely consumed them, and it was the job of Dr Gregoire to find them again.

At times the film was almost unbearably sad.  It was during those times I, personally, retreated to the relative safety of Twitter and took a "social media management" approach to viewing the show.  My husband (who was in London, while I was visiting my family in Scotland) texted me to say how he thought I was "more of a Hannah psychosis than a Jenny psychosis".  I think he may be right.  I found Jenny's illness fascinating (the links to her bipolar, the ebb and flow of her mania, her paranoia)... But it was in Hannah that I really recognised myself: the sheer desperation, the terror, the restlessness, the crippling anxiety and self-doubt.  Watching Hannah in this state made me want to reach into my television and hold her tight and whisper intently into her ear: you will be ok.  You will get out of here.  You are a brilliant mum.  Hold on.  Hold on.  Hold on.

One thing the cameras didn't quite manage to convey (and perhaps this was deliberate) were the actual hallucinations.  Seeing things that are not there, hearing voices, experiencing the world completely differently from those around you, that is the nub of psychosis and the truly petrifying element of the disease.  I can only imagine that in those moments the cameraman was perhaps shepherded away.   In my own case, when I was "floridly psychotic" (how I love that term!), the other patients and any visitors to the ward would be ushered away to the safety of the communal nursery where the heavy door would clunk shut and a member of staff be on guard until it was safe for them all to come back out.

The cameras didn't capture these moments, but I'm sure they were experienced by Jenny and Hannah nonetheless.  And allowing a film crew to capture even just the recovery from this absolute Hell is a testament to their strength and courage.  We viewers were privileged to see ward round discussions (an absolute insight to the staff's continual balancing act of risk and recovery), the side effects and treatment effects of various medications, and even Hannah's experience of Electro-Convulsive Therapy (ECT).

I had seen ECT before but only in movies (remember Requiem For A Dream?).  Seeing it performed on Hannah "in real life" was gut wrenching and shocking.  But it worked.  And I kept thinking only how brave and determined she was: willing to try anything in order to just get better and be there for her daughter.  She wanted to die so much - and yet she desperately wanted her daughter to grow up with a mummy.  It was true incredible to watch.  And it seemed to work!

There have been a few comments online about how medicalised the programme was, with its focus on medication and ECT.  Yes, there was a lot of psychiatry on show.  But, again, I think this is realistic: postpartum psychosis is a psychiatric emergency.  There is a huge amount for psychology and other types of complementing therapy to do - but only after the PP is under control.  I personally would have loved a second part of the documentary, which went on to show the role of clinical psychologists, psychotherapists, family therapists, peer supporters, art therapists, occupational therapists and so on. But there was only an hour and given this was a documentary about the experience of PP it seems right that the focus was on psychiatry.  And what a psychiatrist!  I think even the most skeptical anti-psychiatry voices were won over by Dr Gregoire.
He explains his considered thoughts on mental illness and the brain so eloquently.  If even just a tenth of Dr Gregoire's compassion and understanding could be captured and inserted into every single health care professional we would go a long way to treating mental illness properly.  To achieving that "parity of esteem" our current government loves to speak about.

And I wish everyone could listen to Jenny's husband Henry as he speaks of his wife - how funny, how kind, how caring she is.  All of which is at first hidden by her illness.  I think Dr Gregoire and his staff "get it".

I was lucky to have just spent a day at the Winchester MBU where I witnessed first-hand how therapeutic the whole environment is.  Without compromising safety (always a huge priority in any acute mental illness ward) the staff are all trained and guided to be therapeutic at all times.  Every interaction is an opportunity for them, from taking a patient for a walk to the shops to helping them with baby's sleep routine at night.  The patients are encouraged to cook meals together (with the help of their very popular young Occupational Therapist), to take part in gardening projects, to do lots of messy play and crafting activities (with and without the babies).  None of this was captured in the documentary - it wasn't the focus - but I do wish to reassure any viewers who might be left with the impression that all the patients were treated with were pharmaceuticals.

I will leave it at that.  I'm off to watch it again on iplayer (still available here: ).  I want to watch it alone, with my smartphone switched off, and just let it all sink in properly.  

Saturday, 13 February 2016

Service user or service provider?

Over the last year or two I have forged a busy (if hardly lucrative) career in having been a former mental patient.  It's called being a "service user voice" or "patient representative".  I have attended workshops, spoken at conferences, commented on service specifications and care pathways, and reviewed services.  The health care professionals and managers involved are always keen to engage with us, but I'm not sure how meaningful it all is in practice.  I still read the same jargon and buzz phrases, week in week out:
Collaborative care.
Integrated pathways.
Ad infinitum.

As a result, I'm reaching the natural end of my contribution to perinatal mental health services - as a patient or service user. But I still want to make a difference. I genuinely want to transform the way perinatal mental health services are delivered.  I want to understand how this is done now, and how we can make it better.  And I want to help individual women and families along the way. 

In my personal life, we are coming to terms with our inability to have another child.  And I am thinking seriously about what to do with myself (besides the novel writing and MHFA training!) once The Boy starts school in September 2017.

Perhaps I am madder than I think, because I am now seriously considering a new career, at the advanced age of 35.

I am looking into the possibility of retraining as a mental health nurse, and starting a career in the NHS.  I have two degrees already (if you want my full CV: MA(Hons) Economics & Politics 2002, and MSc Economics 2005), so apparently I could even join an accelerated postgraduate entry programme (the PGDip in nursing with registration, mental health branch).

But in order to be accepted, I need to show almost 600 hours of "accredited prior learning and experience".  See, for example:

I have built up some relevant experience through all the patient rep work mentioned above, as well as the peer supporting I have done and Mental Health First Aid training.  But I need much, much more.

Can you or your organisation help?

I'm looking for flexible (due to childcare constraints) work experience placements in or around London, in mental health care settings (primary, secondary or tertiary; statutory services or third sector; traditional or alternative). 

In return you would get the services of a very enthusiastic and committed work experience student who has plenty of "lived experience".  I also have a full DBS, MHFA training and some specialist Perinatal MH training too.  I'm looking to do as much work experience as I can in the next two months, before our family goes away on secondment.  However my university application is not due to be submitted until June 2017.

If you would like to discuss please do leave a comment here, or message me on Twitter (@KatGrant30). Thanks!

Monday, 8 February 2016

In praise of "Woman's Hour"

My father-in-law is a fan.

Prime ministers are held in its thrall.

It provides companionship to thousands.

And as for me? It has schooled me on everything from sex and relationships, to child refugees, to work-life balancing, to the lives of tribal women around the world, to forgotten female scientists, to best lemon drizzle cake recipes.

The forty-five minute 10am slot on BBC Radio 4 is a fixture in my podcast library.  Having recently taken up (slow!) jogging, I am an avid listener.  Even while puffing away around the local park I am at once calmed and intrigued by Jenni Murray, Jane Garvey and their guests. 

It's hard to pin-point the attraction of the programme.  I like to think I'm a modern sort of woman, who's had a busy career and identifies as a feminist.  But I also love to bake, worry constantly about my parenting skills or the state of my marriage, and love to hear interviews with women leading interesting and unusual lives.

I would be beating down the door of BBC Broadcasting House, if ever they cancelled it.  But that does not look likely.  In fact, the Powers That Be have recently commissioned the superlative Lauren Laverne to host a "Late Night Woman's Hour" - like Jenni Murray with added sex chat and swearing.

Recent discussions have included "taboo subjects" like the menopause, and whether the idea of women "Having It All" is a myth dreamed up by advertising executives.  

It is quietly, politely, subversive.

Politicians understand its reach and importance (especially within the key pensioner cohort).   It does not present any party political bias (many assume it is "small c" conservative, but I see little evidence of this).  It simply holds its interviewees to proper account. Be they researchers presenting a new thesis on the cause of cervical cancer, a cabinet minister answering questions on departmental spending priorities, or a novelist explaining their inspiration for their new controversial book. 

This morning the Woman's Hour team tackled the issue of breastfeeding: why is it so hard for some mothers, and so easy for others?  What advice and support can help?  How long should babies be breast fed for, and in what situations might bottle feeding be a better option?  Among my "mum friends" (both in real life, and on social media) this is a hugely divisive issue.   For example, I strongly believe that the "Breast Is Best" message pushed onto me by the NCT and others throughout pregnancy was a contributory factor in my postpartum psychosis.  I sacrificed everything - my sleep, my well being, my peace of mind and finally my sanity - on the breastfeeding sacrificial altar.

It felt good to write in to Woman's Hour with a short synopsis of my experience.  I had hoped they might read it out on air, and that my words could help other mums listening in.  I know my story would be in safe hands with the Woman's Hour team.  They always take care to present all sides of any debate.  They give practical, sign-posting, advice and information.  This morning was no different.

So, if you have never tuned in or downloaded their podcast, please give them a go.  I promise at the least you will be mildly diverted. And at best it could be a real eye-opener.

Thursday, 4 February 2016

Secondary infertility

Or - the post I hoped I'd never have to write.

The infertility charity RESOLVE defines it thus:
"Secondary infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. The birth of the first child does not involve any assisted reproductive technologies or fertility medications."

It doesn't seem to be talked of as much as primary infertility, or the decision to remain child free.  You have a biological, naturally-conceived child, so how can you say you're infertile?

Well, yes, on the face of it I don't exactly look infertile, running around after my three year old clutching baby wipes and snacks.  But infertility has been in my life ever since we started to try for another child two and a half years ago.  And now this merry dance is over: my ovaries simply don't have any eggs left in them.  Elvis has left the building.

We are left to grieve.  To wonder Why? To blame ourselves and each other.  To be angry at the doctors for giving us so many promises and false hope.  To laugh at our younger, contraceptively-minded, selves.  To hold our son tight and tell him sorry, so sorry, oh how sorry we are that we can't give him a brother or sister.

Since I last wrote about our longing for "Number Two" we did indeed decide to give the fertility clinics a shot.  We naively thought our odds were good, given how awesome our kid is and how compatible our gametes clearly are.  A few false starts later and we finally got down to the IVF business a few weeks ago.  From our first follicle monitoring scan I knew we were in trouble.  The numbers did not bode well: two, possibly three, developing follicles in the right ovary and none visible in the left.  Ok, perhaps they are just slow to develop?  No, by the time the consultant decided to do the collection we were still talking about a maximum of three follicles.

As I learnt to my bitter disappointment today, follicles don't always mean eggs.  They couldn't find a single one, and they aspirated every last inch of my two ovaries.

I don't want to put anyone off having IVF treatment.  The clinic could have handled things better, but I am glad we gave it one last shot, and at least I can lay it all to rest and accept that another biological child is not in our future.

We are going to take our time to regroup, to recover.  And then we will pick ourselves up and count our blessings and look to the future.  Who knows? That future may even involve a child already born, who could be looking for an adoptive family in years to come.