Heathrow to Kovalam, Kerala, India April 2013
The flight was uneventful, a boozy sleepy journey filled reflections and dreams of what had happened and what was to come. Cocooned in decadent luxury i took time to think about the last few years and how come at 51 I was now retired. Though the final confirmation of my redundancy had come like a bolt from the blue it had been a twisting roller coaster of a ride to get there.
Going Mental...
I'm afraid you'll have to take my recollections of this period of my life with a large pinch of salt, not because i'm ashamed or trying to deceive you or myself but because for a large chunk of time i was clinically diagnosed as "a bit mental", deeply depressed and even a touch psychotic at times. For info "Mental" is a word I use often to describe the state of mind I was in, I know its a word, like the "N" word, that shocks some people but I'm on my own personal crusade to reclaim it for those of us who have "had a period of poor mental health" rather than as a term of abuse or as an exclamation of fun and excitement used by the young e.g. "We had a mental time on holiday!!!" i.e. Do they really mean wandered around aimlessly, cried a bit, slept a lot, thought about self harming, couldn't sleep, lost all interest in stuff which had previously given them pleasure, moving or speaking more slowly than usual, change in appetite or weight, constipation, unexplained aches and pains, lack of energy or lack of interest in sex? (list paraphrased from NHS Choices symptoms of depression). I know 18 - 30 holidays can be tough but not that tough, even if you got there by Ryan Air!Back to the M word, I look forward to a time when we fellow depressives can greet each other with the words "Yo! Mentalist, what's happnin' " However as with the "N" word its a greeting reserved for us mentalists to use and not for you "sane folk".
The NHS Choices website describes depression and its symptoms as the following
"...depression can be complex and vary widely between people. But as a general rule, if you are depressed, you feel sad, hopeless and lose interest in things you used to enjoy. The symptoms persist for weeks or months and are bad enough to interfere with your work, social life and family life."
I can't talk for how it will affect you or those you love but its not a bad description. I love the bit that says it "interferes" with your work, social and family life. No Shit Sherlock, at its worst it "interferes" like a hangman's noose interferes with breathing. Another bit that's also true is that it can vary widely between people, (as a dyslexic I read widely as wildly, a subconscious slip?).
In my case it literally took away my ability to speak.
A common misconception, one I also held, was that when someone is as depressed, "absent" or withdrawn, as I was, their thinking processes have slowed up or stopped which is why they are taking longer to respond. Certainly for me this couldn't have been further from the truth, the voice in my head was constantly in a state of furious internal discussion, so much so I couldn't get a word in edge ways yet alone force those words out into the world. I was as my psychiatrist helped me discover over thinking everything or "in a state of fugue". The best i can do to describe it is as follows. Imagine being in a party where everyone was talking at once, important, witty conversation, the sort that's fun but slightly intimidating because you aren't sure if what you want to say is interesting or good enough to chip in with. None of the participants make eye contact with you and you have no idea how to interrupt. Then multiply the speed and volume by ten. All I could do is hope at some point one of the "in head party goers" would need to pop out for a wee or need to fill their glass giving me time to speak. At which point, since popping to the loo or bar only takes a finite period of time, even to my ears i'd come out with some parable or short Yoda-esque comments such as "Ahh... when negotiating contracts care must we take" to try to explain what I was thinking or wanted done all of which were delivered with a disproportionately scary intensity and importance.
So why did i go mental? There are three usual suspects, my upbringing, the circumstances in which I found myself and genetics. The first being summed up by a message and answer scrawled on a wall in a psychiatric unit "My Parents made me a mentalist!!!" and the reply "If I sent them the wool would they make me one too?" The second, shit happens in a chaotic world and trying to make sense of and "knowing" you can control it is more mental than being depressed. Thirdly, everything we do and are results from preordained DNA maps which determine our neural pathways and neuro-chemical make-up (back to "it was my parents", just not their fault).
In my case, I prefer the perfect storm theory, all of the above coming together at a point in space and time. Add in that we have got to where we are by learning how to react and behave by a process of positive and negative reinforcement and Bob's Ya Uncle, Mental!!! (At this point i'd like to point out I don't have an Uncle Bob, mental or otherwise, its just a figure of speech, but if I had i would not have publicly outed him as a mentalist in my blog).
I'm not going to go into two of these bits here, my early childhood or my families genetic mental health state for two reasons. The first being both are unremarkable as a child I wasn't beaten with a stick forced down the mines or locked in a cupboard, mostly i was just a moderately bright kid from a working class family who liked watching TV. (Blue Peter and the trade test transmissions on BBC2 in COLOUR have much to answer for). Nor do I have any more mentalists (out and proud!!) in my family than average.
The second being there are some parts of my life which are mine, not proud or ashamed of them just that they are mine. I cuddle them at night in bed and if you are expecting me to recount tales of my mental bedroom antics you are reading the wrong person's blog, more 50 Sheds than 50 Shades of Grey.
It was work life that buggered me up for a while and how I had learnt to cope with it. I was 48, Assistant Director of Primary Care for one of the largest primary care trusts in England. I had a budget of over a third of a billion quid and team who had a rough idea what they were doing. (Note of explanation for non-NHS managerial staff - Due to the goal hangers, see previous blog, no one in the NHS knows exactly what they are doing. From watching Horizon its a bit like in quantum theory where you can't know the exact mass, position and energy of an electron at any one point in time. Having a team bright enough to have a rough idea is rare and I was blessed with such a team). True some were playing out of position due to the last NHS reorganization, the NHS's take on the equal opportunities interview also has much to answer for, but they were there. I was in responsible for the operational commissioning of primary care for just over a million folk, i.e GPs Dentists Pharmacy and optometrists and some other bits round the edges. Two other folk were responsible for mental health and hospital commissioning respectively, both of whom also had a much better than average understanding of how the NHS worked in Devon, and for the most part it did . Life was good, or should have been. The problem was the management and commissioning of services was split into two, not the usual acute care/primary care tussle we were all used to and manged our way through but "The Strategic Modernization Agenda" and the operational. The use of capitals in the previous sentence is deliberate. The Executive Management Team were responsible for the strategic modernization of healthcare in Devon. The three of us were responsible for day to day running, fire fighting, and converting the strategy in to reality. So far so good... sort of makes sense... EMT met weekly, formulated grand designs all with the best intentions based on Department of Heath policy, white and green papers were discussed, pondered upon and in the true spirit of shakeholderlyness shared with other laudable organisations. Working in Partnership and Inclusiveness became objectives, everything was about doing it together, consultation ruled, no longer would things be done in Isolation!!! BRILLIANT!!!
Only on slight problem, never, not once in the entire time I was in the job was this vision of Utopian cooperation discussed with the three of us or how it related to the day job, we who at least nominally had the operational control of all of the cash. Curley, Larry and Mo weren't the only three stooges.
I am totally committed to inclusive working, but maybe its just me, after all I am a mentalist, but I'd have thought it would have been an idea, just an idea to include a couple or three of folk in the Executive Management Team Meetings who were a little more grounded? Like I said, may be its just me but in the quest to banish isolated working we had been totally isolated. Isolation is where folk get sent as a punishment and this was punishing, Curley, Larry and I had built our reputations such as they were as shrewd and pragmatic problem solvers, not afraid to ruffle the odd feather. Battle hardened negotiators we were ready and wanting to make a difference. I think the penny finally dropped for me that the emperor was stark bollock naked when i was talking to a very senior and experienced commissioner who told me of his experience of being sent to negotiate with a local hospital on next years budget. This guy had been there, worn the T-Shirt and knew exactly how it was stitched together, the perfect choice to go and make changes. Only thing he lacked was a bottom line, he had no idea what he was mandated to do, so he did what he thought best, negotiated hard and long, managed to free cash up to make improvements elsewhere in the system and in what the hospital was currently doing only to have the whole thing turned on its head at the next EMT. Partnership as an objective is pants. If its the best way to get something worth having, great, but as an objective fosters abusive relationships.
So this is the mental health shipping forecast, a deepening depression was forming over Devon and unknown to me a storm front was heading straight for me.
In addition to the run of the mill keeping the budget straight, making sure the folks working in GP land were ok and playing the usual political management meetings merry go round one of my jobs was to oversee professional standards. Every year a number of GPs and Dentists go through a rough patch, not many but a few. I'm not going to go over the what, whys or whos of my time as Asst Dir. not only would that be totally unprofessional it would be unfair. One of the things about my job was in exchange for the money at the end of each month I had to learn to bite my tongue, it puts you in a glass house so folk can throw stones at you from the outside, if you throw one back, you get cut twice.
To make it worse it also put me in a room often alone with very upset people, people who no matter what they may or may not have done you grow to like, understand and feel for. Its hard sometimes not to think there but for the grace of god go I, even where the circumstances are "of their own making" often the system they work in conspires to reinforce their behaviors. If you are interested in why GPs and other healthcare professionals sometimes struggle this is an excellent read. http://www.support4doctors.org/detail.php/58/managing-stress-as-a-doctor?category_id=15&subcategory_id=524
In short its because the job picks the people, certain personality types are attracted to becoming a GP and the very things which make them a "good" GP are the same traits which can get them into trouble.
I have a similar problem, one thing i can do is sit in a meeting and "feel the room" in psychobabble its called transference. I absorb the emotions of the room, it means in negotiation i can relate to and shift perceptions, its a common gift (in my case also a curse) for senior managers, particularly those of us who are dyslexic. We use it to emotionally anchor facts into our memory - no need for notes, it gives context and meaning to stuff and allows us to remember detail others capture on paper. But there is a price, unlike notes it harder to put them down. The emotions come home with me, and don't fit in a draw in the office. Most of my working life i've been able to deal with this by end-of-day rituals, I don't mean i sacrificed a goat or cast flowers onto moving water every Friday, not every Friday anyway. I just spent ten mins to half an hour phaffing about, listening to the radio on the drive home, Radio 4, PM with Eddie Maier worked for me for a while.
But this was a perfect storm brewing.
oh well its time to go and get dinner sorted, I'll continue later.
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