Toddler triumphs & tribulations

For one of this blog's starring characters, he's not had a post all to his own for a while.  So please allow me to indulge myself, and all my proud mummy instincts, and tell you how The Boy is getting on.  At the ripe old age of (almost) 21 months...

Triumphs 

He's a real people-person.  He lights up whenever he sees any of his doting relatives, neighbours, friends - even the friendly bin collectors!  In turn, he has the unknowing ability to light up whichever room he enters, and bring a smile to the most hardened of toddler-haters.  He (unlike his mum) has a fabulous recall for names and faces, and will always remember who belongs with who.  For example, if you mention two family members we are on the way to visit, he will quickly pipe up with the name of the third.  

He's a confident boy.  As long as Bubby (that's me) and Daddy are a few steps behind, he is quite happy to march straight on in: to parties, to trains, to parks, to strange houses, shops, anywhere!  He can (in a matter of moments) work out exactly where the mischief and fun can be had in any given situation and activate that mischief immediately.

Which leads us on to his laugh.  His naughty, cheeky, wicked giggle that ranges from a wry little cackle to full-blown, body-convulsing, head-tossing, hysterics.  It is impossible not to join in.  

The Boy is a natural entertainer, and loves nothing more than inventing new ways to make us laugh with him.  If he falls over, it's funny.  If something spills - hysterical.  It's hard to view these misfortunes negatively when our boy thinks they are the funniest things ever.

From the moment he wakes up in the morning, he is "on".  He arrives in our bedroom, at any time between 6 and 8am, all ready for the day's fun to begin.  And waiting for Bubby and Daddy to rub their bleary eyes and haul their tired asses out of bed is so frustrating!  At the moment he likes to climb aboard a sleeping person's tummy shouting "see-saw, see-saw!"

He has a growing band of toddler friends.  A fledgling gang of mischief-makers.  He has one particular girl friend (he calls her "Chaz") who he is alarmingly obsessed with right now.  Every morning, he will talk about her and wonder when he is going to see her next (luckily for him, he normally does see her every day).  He also loves his cousin (8 weeks his senior) and will distribute hugs and kisses liberally.  When does a sweet toddler kiss deteriorate into a snog??

He is at that stage where certain objects hold a lot of fascination.  The highlight of his week is the Tuesday morning rubbish and recycling collections.  He is fixated at the moment with lorries - ranging from small flat-beds to concrete mixers, dumper trucks to Eddie Stobarts.  The grannies are currently competing in some sort of arms race to present him with the best, most realistic, most coveted lorry-type toy - so his collection, now fuelling the obsession, is growing by the week.

Apart from lorry types, I do try to teach The Boy useful things that might set him on his education path: colours, numbers, shapes, that sort of thing.  He humours me, but plainly he will remember what he chooses and thinks me a fool for those repetitive counting songs and the like.  Instead he always manages to surprise me by coming out with something I haven't tried to teach him.  So I've started not to worry so much, and allow him to tell me what he's interested in knowing about.  With words such as "What?" and "Why?" gradually entering his vocabulary this is becoming easier!

For example, with his language development, he will often pipe up with something I haven't actively "taught" him but which he clearly just likes the sound of: "see you soon!" added to every "bye bye", for example.  "Ready" yelled up the stairs when he is waiting to be taken out to the park.  

Which leads us swiftly on to...

Tribulations 

The downside of this spongelike language accumulation is that he also picks up words you'd rather he didn't... "Oi!" is the worst at the moment.  I was indignantly trying to work out who the culprit for this was, until the husband pointed out I was shouting "OI!!" to the cat who was attacking my feet.  Oops.

The Boy's sociability is a joy, but he hasn't quite yet acquired the people skills to go with it.  When "Chaz" comes around to play he will pet her and kiss her, but then isn't able to read her signals that she would rather he didn't smash his hands into her face and push her into a shrub.  Oh dear.  For every adorable toddler cuddling moment, his parents are standing guard, ready to intercede when necessary.

This vigilance applies especially to his encounters with other people's babies.  He loves all babies, doesn't really matter that they might only be a month or two younger than him.  But with really little newborns (especially precious first-borns!) we have to watch him like a hawk: he loves to point out their little "nose", "mouth", and "eyyyyyyyyyes".  There have been few local babies fortunate to have escaped an eye poking by this over-enthusiastic baby-observer.

Finally, a word on clinginess.  The Boy is more than happy to go off and play with anyone, just as long as Bubby or Daddy are somewhere in the vicinity.  He will happily go run and hide behind a tree, but he will pop out in seconds to check we are still there.  This is something I treasure at the moment, as I know this "circle of security" will only grow and grow until by the time he's 17 he's travelling the world and neglecting to call home!

The Boy is so full of life and fun, that my heart swells when I think of all the good cheer he brings to the world - and the future that awaits him in it.

Afternoon tea at The Goring

Last week The Husband and I finally used our vouchers for afternoon tea at The Goring Hotel (expiring this month, as they were for my birthday last year!).  You may not have heard of The Goring, but you might remember it from the Wills & Kate wedding three years ago: the Middleton clan took over the whole hotel for Kate's pre-wedding preparations (complete with specially-constructed press black out canopy).  I can see why they chose it: discreet but sumptuous, tucked away down a Victoria side street near Buckingham Palace.  Unlike some of the Park Lane monstrosities, you could easily miss it.

As soon as we walked through the door, I knew it was going to be a treat.  It was blissfully cold, a real urban escape from the sweltering London heat.  Sat in the old-fashioned lounge area was a welcome contrast from the dazzling sunshine outside.  We of course had to upgrade to the "Bollinger Tea" option: only £10 more for a large glass of champagne (poured from magnum) and an equally ample plate of strawberries and cream.

Tea-wise, I chose my favourite post tea - Silver Needles - and the husband went a little off-piste with Jasmine Flowers.  Both were excellent, and refreshing.  We enjoyed our strawberries, before being presented with a completely superfluous but utterly delicious "amuse bouche" of lobster and crayfish with a clear tomato jelly.

But enough of the pleasantries, bring on what we've all come here for: the tiered cake stand!

The sandwiches were simple and old-fashioned, and I think we enjoyed them all the more for that.  We demolished two plates of cucumber, egg, chicken and ham finger sandwiches in very short order.

The scones were light and fluffy, and again served simply: Devonshire cream and both raspberry and strawberry jams.  Why mess with perfection?

The top tier was reserved for the pastries.  I think just about all the skills of a 5-star pastry chef were in evidence here: macaroon, caramel, chocolate tempering, frangipan, mousse, choux and sponge.  Universally delicious (if quite a sweet plateful, we certainly couldn't manage more than one plate, even though it was technically "all you can eat").

Just as our thoughts turned to rolling ourselves home, they then brought out two sherry trifles for good measure.  Well it would be rude not to, surely? 

I would highly recommend The Goring as an afternoon tea option.  We have many fine hotels in London, with a similar line in high-end teas, to choose from.  The Goring doesn't quite have the glamour of The Savoy or The Berkeley, or the theatre of The Ritz, but it does a traditional tea (with a few lovely extras) very well.  No fuss, just exquisite surroundings, service and teas.

Suicide - what's the big idea?

I started a course of psychotherapy three weeks ago.  I'm fortunate to have found a local(ish) perinatal psychologist who seems adept at working through trauma: the sessions have evolved into a form of PTSD treatment.  To facilitate this, my homework task this week has been to go through the medical notes and letters I was given during my inpatient stay in the Mother and Baby Unit, and try to remember how I was feeling at the time.  As regular readers will be all-too-aware, I talk about my psychosis experience often and openly: to the extent that I have become quite detached from the memories.  Sometimes, it is as if I am recounting events that happened to a different person.  As if it never happened to me, and to my son.  

The first stage of the PTSD treatment is to re-establish the memories, the events, as real experiences that happened to me.  To be honest, the results of this exercise have been too dark and too distressing to publish here on the blog.  However (as I mentioned briefly on twitter) I'd be happy to share my written thoughts privately, particularly with any Health Care Professionals or psychosis sufferers, if you send me a message.

I just want to explore one specific theme here: suicidal ideation.  The word "suicidal" was peppered throughout my notes.  This came as a bit of a shock, I explained to my therapist, as at no time in my illness did I want to kill myself.

We don't generally like to talk about suicide, as a rule.  It's uncomfortable, upsetting and, well, plain awkward.  So to find the word staring back at me, in black and white, was difficult.  I thought about The Boy, and how he might feel if he ever reads that his mum was "suicidal" in the days and weeks following his birth.  No, it wasn't quite like that son.  You see, mummy's brain was playing tricks on her.  It wanted her to think that bad things were happening.  Really bad things.  She thought she was being tortured, and no end was in sight.  She was so scared of all the terrible things happening, that she would rather have died.  She even thought that if only she died, perhaps the rest of the world could be saved.

Quite literally, I wanted put out of my misery.

Do you see the difference?  I didn't want to die, not at all.  It was not "Goodbye, cruel world" but a desperate search for an escape from the unending torture my brain was tricking me into experiencing.  I couldn't live in the psychotic reality I inhabited: a world where I was slowly suffocating, for eternity, in a small locked room.  Or where I had caused the end of life on earth.  I would have gladly chosen death over that.

Psychosis is a cruel disease.  It plays on our worst fears, and turns our most gruesome nightmares into chilling realities.  If I tried to explain it to the most twisted cult horror film director, he would not be able to begin to recreate it.  

When I read about a person suffering a psychotic episode who went on to kill themselves, I feel acutely sorry for them.  When psychosis is involved, it's not necessarily an act of severe depression (someone "wanting to die").  In my (very limited) experience, it's the act of someone petrified, perhaps thinking it's their only escape.

As I read my notes, and see the words staring back at me, all I can think now is just how lucky I was to have been in such a safe place, under one-to-one observation and 24-hour nursing care.  It's one (very important) reason why we need to ensure access to such facilities for anyone (not just new mums) experiencing extreme psychosis.

The day we joined the National Trust

With each passing milestone, you think you've reached adulthood: learning to drive, voting in an election, having genuine ID, getting a sensible job, moving in with the boyfriend, owning a car, owning a Dyson, getting married, owning a whole load more stuff, having a baby... You have the worry lines, the creaking joints and the sensible shoes.  You are more likely to choose a nice dry sherry over a vodka mixer...

But nothing says "Grown Up" quite like buying yourself membership of The National Trust.  Yes, today The Husband and I finally succumbed to the lure of pleasant family days out and cream teas, shelled out almost 100 quid, and stuck the precious oak leaf sticker to the windscreen: 

With a trip to Cornwall coming up soon, it made complete financial sense (we will easily claw back the £100 cost with a few visits to the expensive Cornwall properties, not to mention free beach parking).  But really, it just felt like we were saying a final farewell to youth.

Good friends had invited us to meet them at Polesden Lacey (a convenient half-way point for us all):

Polesden Lacy is a handsome Edwardian mansion, nestling in the Surrey Hills, not too far from Chessington World of Adventures.  To be honest, we never even went into the main house, but we made extensive use of the cafe facilities and the beautiful grounds.  

We taught The Boy how to roly-poly down a grassy bank (he loved it so much he was soon roly-polying in circles on the flat!).  We played in the forest-set playground and we sauntered through meadows.  It was great just to allow the kids to run around freely.  In Central London we are always so wary of traffic you can't take your eye off The Boy for a second (even in parks, The Boy is always the one playing by the playground gate!).  A couple of streets away from us there is a poignant reminder of this responsibility, in the form of some teddy bears tied to a lamppost in memory of a young boy who ran out in front of a lorry.  But here there was such an expanse of fields and parkland we could let The Boy find his own boundaries.

Having gotten the membership pack, we will have to make sure to make the most of it.  We need to find more places for The Boy to run wild at.  What are your favourite National Trust properties for young children?

Remembering the First World War: the re-opening of the Imperial War Museum

When we moved to our current neighbourhood two years ago, the main local landmark promptly closed down (I'm sure the two events were not connected).  The Imperial War Museum has been closed for an extensive (£40 million) refurbishment, and is about to re-open, just in time for the centenary of the start of WW1.

For a few weeks there, I was worried the team were not going to deliver.  The hoardings remained stubbornly in place, the builders looked casual (to say the least) and every day as I walked past the building site they didn't seem they would ever move on to "finishing touches".  But I have to say, as today the site was visited by the Duke and Duchess of Cambridge, the IWM seems to have finally pulled out the stops and dusted itself off.  There will be a "soft" opening tomorrow (Friday 18 July) before the Big Day on Saturday, from 10am.

But what can we expect?  

Well, let's start with the amenities.  First and foremost, there is a brand new cafe area (run by Peyton & Byrne) that opens out to the parkland on the Kennington Road side of the building.  This should prove to be a big improvement on the previous offering, and should really help connect the impressive building to the equally impressive grounds it sits in.  The famous atrium, in the heart of the building, has been deepened and reconfigured with "iconic" large objects (Spitfires, tanks etc).  We should also expect improved buggy/wheelchair access and more educational and group visit space.  All of this is good news for local (and visiting) families and community groups.  Hurrah!

But the "meat" of the refurbishment was always the Great War.  This August marks one hundred years since the start of WW1, the war that was supposed to end all war.  From this modern-day vantage point it seems right that the IWM should become The home of WW1 memories, artefacts and lessons. And so visitors will also be treated to a new exhibition, "Truth and Memory: British Art of the First World War", and its brand new First World War Galleries (displaying over 1,300 objects - many of which have never been seen before).

There is just too much to see to be mentioned here.  As a wife and mother my eye is immediately drawn to the "At all costs" exhibit, which explores how a total war on the battlefields meant also a total war on the home front.  Women stepped into new roles in factories, hospitals, transport and agriculture - a movement which, although for the worst of reasons, gave women a new-found sense of capability and responsibility which eventually helped lead to universal suffrage.  

(c) IWM

And even children helped the war effort, as tenderly displayed in a 9 year old's letter to Lord Kitchener:

(c) IWM

("Dear Lord Kitchener,

I am an Irish boy, 9 years of age, and I want to go to the front.  I can ride jolly quick on my bicycle and would go as despatch rider. I wouldn't let the Germans get in.  I am a good shot with a revolver and would kill a good few of the Germans, as I am very strong and often win a fight with lads twice as big as myself. I want a uniform and a revolver and will give a good account of myself... ")

I'm not sure how our children today could fathom what total warfare consisted off, but perhaps a walk though the IWM's reconstructed "trench" might help them understand.  With a Sopwith Camel fighter plane swooping low overhead, and a Mark V tank looming above, projected silhouettes of soldiers (and a soundscape) will evoke the drudgery, discomfort, danger and comradeship which characterised the experience of a British "Tommy".

For those who would like to explore the role and legacy of women in WW1 further, there is an exciting (ticketed) event on 16 September 2014 at 7pm: "In Conversation with Kate Adie: The Legacy of Women in the First World War".

IWM London, Lambeth road, London, SE1 6HZ

Tel: 020 7416 5000

IWM.org.uk

 

Mental Health First Aid

Here are some personal reflections of the two-day workshop I attended, accredited by Mental Health First Aid (MHFA) England.  This is a relatively new course, originally developed in Australia, with content approved and written by MH professionals and charities.

The stated aims of the MHFA course (see: http://mhfaengland.org ) is to equip attendees to:

- spot the early signs of a mental health problem 

- feel confident helping someone experiencing a problem

- help prevent someone from hurting themselves or others 

- help stop mental ill health from getting worse

- help someone recover faster 

- guide someone towards the right support

- reduce the stigma of mental health problems.

These skills are discussed under four main course topics:

• What is mental health?
• Suicide
• Anxiety and depression
• Psychosis

So far so good.  I duly signed up (after having noticed some twitter chatter between @BipolarBlogger and @ProjectLibero about #MHFA instructor training they were both doing).  I thought the course might be useful for my PANDAS peer support group, and especially the MBU hospital visiting I was doing.  So, with my charity/peer supporter/lived experience hat on, I found myself in a room full of HR professionals.  For the first time since leaving my City job over three years' ago, I was sat in an office meeting room, with course materials and PowerPoint and expensive-looking stationery.  

I was pleasantly surprised by how genuinely interested the HR managers seemed in the course material, and how much they wanted to help the many, many, workers who end up in front of HR with a mental illness, or in mental distress.  With 1 in 4 adults expected to experience a mental illness during their lifetime, MHFA is acutely relevant to all work settings, large and small.

Day 1 first covered some general information on mental health and mental illnesses, before devoting the afternoon to the topic of depression, and suicide.  Depression is one of the most common mental health conditions, but certainly no less serious for that.  We learned about both risk and protective factors.  And, importantly, what can be done as a friend, colleague, manager (or even sympathetic stranger) to help someone struggling with symptoms such as low mood, inability to concentrate, tearfulness, and anhedonia (inability to take pleasure in things).

We were introduced to the course's main mneumonic: ALGEE.  This technique/model came up again and again, across many different conditions and scenarios.  In the context of someone experiencing a depressive episode it looks like this:

Assess risk of suicide or self-harm

Listen non-judgementally

Give reassurance and information 

Encourage the person to get appropriate professional help

Encourage self-help strategies.

(Source: MHFA England manual, 2013, p33.  For more information on the history of ALGEE see the Australian MHFA site here: https://mhfa.com.au/cms/what-we-do )

Some more traditional "first aid" techniques were taught in a discussion of suicide, and suicidal thoughts and actions.  (We try to steer away now from using criminal terminology such as "attempted" or "committed" suicide.). There is another mneumonic, CPR, which is particularly useful in the assessment (by a non professional first-aider) of suicide risk:

Current plan 

Prior behaviour

Resources.

(Source: MHFA England manual, 2013, p35)

An important point I noted from this session is that it is a myth that people who talk about suicide never actually go on to do it.  But it is very unlikely you will make the situation worse by talking about it.  Rather, listening non-judgementally and validating the person's feelings and distress can go a long way to making them feel less hopeless and alone.

Even within a room of mentally well people, we felt our attitudes to suicide change over the course of the day.  It's hard to describe in words, but I think the change was attitudinal: we came away less likely to judge someone who wants to end their own life.  Instead of the usual "how could you do it to your family?!" / "Think of the pain you will leave behind!" reactions, we might instead say something like "I'm so sorry, you must be feeling awful to want to do this.  It must be really, really, hard for you".  It's a subtle but important shift.

Day 2 focused on anxiety (a wide range of conditions from General Anxiety Disorder, Panic Disorder, PTSD, through to the very commonly misunderstood OCD), and then psychosis (another wide range of conditions including bipolar disorder, psychotic depression, schizoaffective disorder and schizophrenia).  We learned a lot about the features (symptoms, risk and protective factors) of these conditions, as well as practical techniques for helping someone in the grips of an anxiety or panic attack, or indeed hearing voices or otherwise losing touch with reality.

No surprises that the ALGEE technique could equally be applied in these cases.  With some important additional emphases on keeping all parties safe from harm during a psychotic episode.

The material was brought to life through a variety of group exercises and videos.  This was particularly effective in a hands-on "hearing voices" exercise, and in an actor's incredibly realistic portrayal of psychosis.

I would urge anyone to take the MHFa course.  In particular I would imagine it to be useful for line managers, carers, volunteers, peer supporters, teachers or anyone who is keen to be able to support someone through a mental health problem.  The course is quite prescriptive in its content (it has to be, in order for participants to receive the accreditation). But it is wide-ranging enough to cover the most likely scenarios and eventualities.  My special interest is in perinatal and maternal mental health, but I think I can apply the tools learned here to this.

Verdict: highly recommended.

If you would like further information on MHFA (including upcoming courses) please visit: http://mhfaengland.org/ 

Mind Maps: stories from psychology

Today, we took The Boy to one of his favourite South Kensington museums (Science) in order that mummy could attend an exhibition I've been interested in seeing for a while:

"Mind Maps: Stories from Psychology, explores how mental health conditions have been diagnosed and treated over the past 250 years.

Divided into four episodes between 1780 and 2014, this exhibition looks at key breakthroughs in scientists’ understanding of the mind and the tools and methods of treatment that have been developed, from Mesmerism to Electroconvulsive Therapy (ECT) and Cognitive Behaviour Therapy (CBT) bringing visitors up to date with the latest cutting edge research and its applications."

It's not a huge exhibit, and you can easily complete it in half an hour while the baby naps (hah, I wish!).  There is free admission (and it is open until October 2014).  It is informative and accessible, but I have to admit it left me wanting to know more ("Er, isn't that the whole point of museum exhibitions...?" - Ed).

I came away feeling that we had an interesting collection of artefacts to look at, loosely grouped by the contemporaneous state of psychological thinking.  But I wanted it spelled out: how has our understanding of depression, say, or schizophrenia changed over the years?  I learned the names of the big pioneers of psychology and psychiatry down the years, and their key professional advances, but I'm not sure I learned how it all joined up.

And it's a fascinating subject.  Today's physicians (and their beliefs) are unrecognisable from their 18th century counterparts.  In the field of depression, for example, we have come a long way from Burton's "The Anatomy of Melancholia".  Through "nervous spirits" and "weak 
mindedness", through the chemical imbalance explanation (and resultant pharmacology), the biopsychosocial model and beyond ("Diatheses-Stress" model, anyone?).  And in schizophrenia too: we have moved away from demonic possession (or divine punishment), through a bodily humour imbalance, through Freudian theories of childhood trauma, and now our modern acceptance of psychosis as a biological disease of the brain.  The disease is not new, but our understanding of it is.

Only from the brain springs our pleasures, our feelings of happiness, laughter, and jokes, our pain, our sorrows and tears … This same organ makes us mad or confused, inspires us with fear and anxiety… —Hippocrates, The Holy Disease

Madness comes from God, whereas sober sense is merely human. - Plato, Phaedrus (quoting Socrates)

Another gap in the exhibition, for me, was the patients themselves.  Who were they, and how were they treated beyond the couch/operating table?  How did people with mental illness survive and 
live in the world?  And when the various treatments were finished - ECT, mesmerism, pharmacotherapy - what happened to the patients next? 

We learned a lot about how scientists have "mapped" the mind, and discovered more about brain matter and nerve impulses, but I didn't think the exhibition explained how this emerging science impacted (if at all) on the lives of patients.  We are told of the different "treatments" meted out to them, but not the "care".  And if there is one thing I've learned as a mentally ill patient, it is that mental health care is much more fundamental to quality of life than any individual treatment. 

This early advertisement for "electropathic belts" for the overcoming of "weakness" gives a tantalising glimpse into social attitudes towards "hysterical women":

But what was life really like for the hysterical? The weak? Were they institutionalised and hidden away, or did these archaic treatments mean they could live in the world normally?

The one thing the exhibition makes clear is just how experimental the treatment of mental illness can be.  Has always been.  In an exhibition full of electrified frog legs and melancholy rats, human beings are the ultimate laboratory animal.  Mary Shelley was inspired to write Frankenstein, we learn, after witnessing an operating theatre performance of electric shocks on a fresh corpse.  In this context, pharmaceutical and psychotherapy advances seem enlightened.  But whether we are any closer to understanding how they work is another matter.

Further reading:

"Post-Prozac Nation: The Science and History of Treating Depression" By SIDDHARTHA MUKHERJEE, April 2012, New York Times

"Cornerstones in the history of major depression" in "Research and treatment approaches to depression" by Ma-Li Wong & Julio Licinio, Nature Reviews Neuroscience 2, 343-351 (May 2001)

A Brief History of Schizophrenia: Schizophrenia through the ages.

September 8, 2012 by Neel Burton MD

Breastfeeding - and me.

I've really been enjoying taking part in the "#PNDHour" weekly twitter parties, created by the wonderful @PNDandMe.

Tonight's chat is all about breastfeeding (BF) and mental health, and is hosted by the equally wonderful Jenny from "Birth ROCKS London".

I have the sneaking suspicion that I won't be able to fully convey my thoughts and experiences of BF in a succession of 140 characters. So here is a blog post (mind dump!) to which I can refer anyone to read, should they wish.

I especially do not want to offend anyone who has managed to successfully BF (hurrah!) or for anyone to get the impression I am against BF.

Allow me to set the scene...

During my pregnancy (the blissful ignorance phase of motherhood, for me!) I was certain that I would BF my baby.  I had paid attention in the NCT's special BF class, and we had armed ourselves with everything a BFing mother and baby could ever need: breast pads, nipple creams, nursing bras, nursing tops, a series of beautiful modesty scarves, and even a gorgeous new armchair set up in the nursery.  I imagined many a blissful hour spent happily in that chair, nourishing and comforting my newborn son.

I had devoted approximately two minutes to preparing for the possibility of having to formula feed (FF).  We had bought on impulse (it was only 50p!) a second hand sterilising unit from a nearly new sale.  And I had also bought a starter pack of bottles, as well as a breast pump.  No actual formula, because of course my baby would only ever drink expressed milk from a bottle.  I hadn't even learned how to properly work the steriliser, let alone anything around how to prepare a feed.

Fast forward to the birth aftermath (you may have read "A Letter to My Midwife" which basically tells our birth story).  Despite being 5 days sleep deprived, seriously anaemic (70% blood loss) and shell-shocked from a near-fatal C-section  I was still determined to have that precious first skin-to-skin and to begin our BF journey.  

The birth may have gone all kinds of wrong, but we were both alive and surely we could now put it all behind us and start BF as we meant to go on?

Sadly, no. Not quite.

Not one health care professional warned me, but it was highly unlikely I was going to successfully BF after such a physical trauma.  I tried, and tried, and tried.  I became neurotic about my baby's lack of nourishment.  And, sure enough, the hungrier the poor boy became the harder it was for him to feed.  

Even after my first psychotic episode, I still insisted upon BF and would stay up all night, every night, in the postnatal ward wishing in vain for my milk supply to come in properly.  Not one midwife suggested that perhaps my sleep was more important (a huge trigger for psychosis, as anyone with any basic mental health training is taught).  Not one person offered to feed my baby while I tried to sleep, or eat a proper meal, or get some fresh air.  I'm not saying that this could have avoided the full-blown postpartum psychosis that followed a few more days later.  But it might have helped.

A specialist mental health midwife, intervening during those desperate postpartum days, might just have been able to overrule the relentless drive to promote BF in the maternity wards.  She may have been able to explain to my concerned family (while my own mind was increasingly confused and agitated) that what mattered more for The Boy and me was for mummy to get some precious rest.

But no, we were eventually discharged home.  Still desperately trying to BF.  And on a collision course for A&E and psychiatric inpatients.

Fast forward a couple more days, to the Mother & Baby Unit...

Specially trained psychiatrists immediately put paid to my BF hopes and dreams.  They even advised my family not to allow me to express my milk, in order to reinstate BF later.  Nope.  It was important for me to be quickly medicated, and not to have any more stressors (such as pumping milk every two hours).  I was too psychotic to know what was going on, but I know now that this was exactly the right decision.  

My little baby thrived on FF - first by the different staff in the MBU, and then by me (as my psychosis receded).  He fed and slept beautifully and was sleeping through the night from about six weeks.

I am full of regrets, but I am thankful for the professionals who took the hard decisions for me.  My mental health had to be prioritised over my wish to BF.

And, it is possible to have a lovely FF experience.  I have only ever fed my son in my arms, cradled against my chest, me holding the bottle.  It is very much a BF substitute. 

And we have had many a blissful hour spent happily in that chair, nourishing and comforting my (now not-so-newborn) son.

Everyone's Business

Why I'm supporting Everyone's Business...

I'm going to share here three quite specific, personal, examples of why I support the Maternal Mental Health Alliance's "call to A.C.T.".  I wish them all the very best in their meeting with ministers Dan Poulter MP and Norman Lamb MP today.  This really isn't rocket science, to any of us who have been through a perinatal mental illness.

In brief (you can read the full call to A.C.T. on the campaign website, here):

"To make sure women receive the perinatal mental health care they need, we must ensure the following:

• Accountability for perinatal mental health care is clearly set at a national level and complied with.
• Community specialist perinatal mental health services meeting national quality standards are available for women in every area of the UK.
• Training in perinatal mental health is delivered to all professionals involved in the care of women during pregnancy and the first year after birth."

Accountability

I have already written (here) about the frustrations of tracing the accountability for mental health services and spending.  NHS England is such a complex organisation that we need Ministers (such as messrs Hunt, Poulter and Lamb) to take direct responsibility for this service.  They can start by intervening to stop any further closure of Mother and Baby Units.  And then they can go on to ensure that ALL areas of the UK have access to these essential facilities.

Lucie Holland today made the case for MBUs so eloquently.  If her sister Emma had been admitted to one (none existed in her home town) then she may well have recovered from her severe postnatal illness.  She was "treated at home" and she never recovered.  

I know how lucky The Boy and I are.  And that's the reason I speak out so willingly (to Channel 4 news, and now Good Morning Britain) about the need for MBUs.  I am speaking for Emma and for all women and children who were failed by the current postcode lottery.  If the Prime Minister and his health ministers are not responsible, then who is?

Community

In my (brief) discharge home from the maternity ward (before I was admitted to the MBU), I received daily midwife visits.  Unfortunately, this meant I was visited by well-meaning but hopelessly ill-equipped professionals.

I was slowly losing my mind, unable to sleep, anxious to the point of derangement, and all these midwives wanted to know was how The Boy was latching on, and whether my C-section scar was healing well.  Needless to say, we lasted less than 48 hours at home before rushing to A&E and admission to the MBU.

A specialist perinatal service might just have helped.  If anything, even when we were still in the post-labour ward at the hospital, they might have been able to "overrule" the breastfeeding targets and insist that my mental state (and sleep) was given priority over my fixation on trying to breastfeed my son.

I know that nobody could have prevented my psychosis, but I do know that a specialist perinatal service could have helped my family and I understand what was happening to me.  We got to the MBU in the nick of time.  The next day I was completely psychotic again.  If this had happened while at home, I'm not sure what the outcome could have been.

Training

Even with a specialist perinatal service, I strongly believe that all midwives (and health visitors) must undergo some basic training in mental health, and in particular mental distress.  One midwife, when I struggled to explain how tired and anxious I was, suggested that I "take a nice warm bath, with the baby". Er.... What?!  Let me explain.  I had not slept in 10 days.  My brain was shutting down.  I was too scared to hold, change, undress or even look at the baby.  And she wanted me to get into a bath with him.  This was terrible, terrible, terrible, advice.  I understand she meant well, but if she had just noticed the crazed look in my exhausted eyes perhaps she would have advised me differently.

I'm not saying that basic mental health training can fix everything.  But it's got to be a starting place.

Good luck in your meeting today Maternal Mental Health Alliance.  It really is Everyone's Business.

Some thoughts on mental illness...

The online mental health sector ("community"?) is, as a rule, brilliant.  Supportive, informative, campaigning, stigma-busting sort of brilliant.  

But there are just a couple of matters I would like to get off my chest.  I've not really thought these things through, and they are both quite nebulous subjects, so I write this more as a discussion starter and would love to hear your views.

1. Mental health <==> mental illness?

Within both the mainstream media and the mental health sector there seems to be a confusion in the usage of the terms "mental health" and "mental illness".  Quite often, it seems to me, the former is used when we mean the latter.  My own view is that we need to be clear and specific.  But we also need to widen the discussion to encompass both the mentally well and the mentally ill. 

I remember one of the tweets during the inaugural "#MHMonday" twitter chat.  It was along the lines of "only people with mental illness would want to chat about mental health, so the distinction is immaterial."  No!  EVERYONE has mental health.  Everyone has a very important stake in mental health services.  Therefore discussion should not be limited to just those with a diagnosis of mental illness.  

Excluding the mentally healthy from the conversation is illogical.  Mental illness can come and go, and can feature widely different symptoms and problems.  Sometimes it is very obvious and visible, but often it is quite hidden.  Mental illness strikes at random, and is no respecter of previous medical history, or privilege, or current happiness or state of mind.

There isn't a "cancerous" and a "non-cancerous" population, and there isn't "mentally ill" and "mentally well" either.  To think otherwise is to somehow segregate the mentally ill, as if they are a different type of people, more prone or susceptible.  Weaker, even.

We know this isn't the case.  And as more and more of us (including politicians, sportsmen, business leaders, entertainers) choose to tell our stories of mental illness  this can only become more obvious.

Normalising mental health and mental illness in this way, might encourage more people to pay as much attention to their mental wellbeing, as they do their physical health.  It also might encourage more people to care about the "car crash" which is the current state of mental health services.

And all of this needs to begin at school, in the classroom.  From schools, to the workplace, to social situations, we aren't that great at talking about mental health and this needs to change.

2. There is a spectrum of mental illnesses, with some more ill than others?

It seems to be an innate human characteristic to compare ourselves with one another.  From keeping up with the Jones to getting ahead at work or winning on the sports field.  So it's no surprise that even within the mental health community, some people are judged to be "more" mentally ill than others.  Some voices are given more weight, and (for sure) some illnesses are given vastly more resources.

Having now experienced full-blown psychosis, I do think a little differently about my previous mental illness (chronic depression and undiagnosed bipolar affective disorder).  I am as guilty as anyone of downplaying the more chronic illness, as somehow less severe or less warranting of attention.  I rarely write about my depressive episodes here on the blog, and I am incredibly fortunate that they are becoming a more distant memory.

When in the throes of postpartum psychosis, I was lucky to have round-the-clock specialist nursing care and access to renowned perinatal psychiatrists.  When struggling though bouts of debilitating depression, by contrast, I had the occasional GP consultation, followed by a prescription for some pills and (on one occasion) a self-help "book prescription"CBT.  

The psychosis was horrific, that is true, but if you asked me to choose between a month-long psychosis or a decade-long depression battle I really think I would choose the psychosis.  I asked The Husband what he would pick if he could choose a mental illness for me, and he too picked the psychosis without hesitation. But he did stress that he would only ever choose that if he could be assured of the same level of care.  Untreated psychosis is undoubtedly more risky than untreated depression.  I lived essentially untreated for about 15 years with depression.  I very much doubt I could have lived for 15 days with untreated psychosis.

So it comes down to this: each mental illness presents different treatment challenges, and symptoms. Some illnesses require intensive care while others may be able to wait a little longer (just as in physical healthcare).  But they all warrant treatment.  It is scandalous how little care there is for people with long term mental health conditions.  We have more intensive and better-resourced care for acute illnesses like psychosis because the immediate risks (to themselves and to others) are much more obvious.  Psychosis is ugly, loud, and extremely frightening to witness.  The voting, tax-paying, public does not want to be confronted with psychosis in their neighbourhoods, so it is treated quickly (I am not at all saying treatment is perfect, far from it, but it does exist).  But depression and anxiety... Well, for the most part they don't seem to bother anyone else, so lets just offer them a cheap, one-size-fits-all, remedy and send them on their way.

The result?  Years and years of human suffering and pain and lost productivity and socio-economic outcomes.

So yes, there is a spectrum of mental illness.  This is a biological and psychological fact (the brain is a weird and wonderful thing!).  But far more worrying is that there is also a spectrum of mental health care.  Not only are some people waiting too long for treatment, but they are not getting treatment at all, or the wrong sort of care.  The door to mental health care swings open only if you are violently unwell (at real risk of harming yourself or others), or if you are sectioned under the Mental Health Act (hence why some well meaning doctors have admitted using this as a blunt-edge tool to gain access to services for their patients).  

Until this changes, my family and I will continue to be thankful I had psychosis, and continue to pray that my depression days are over.