Lock-Down and Mental Health Treatment

People with significant mental health issues are having their health sacrificed to the welfare of a different group of people, and they are unlikely to be given the help they need when the emergency is over.

Ultimately, with the exception of a few details relating to my Christian world view, I refuse to judge whether or not the UK government has been right to place its population under virtual house arrest (it is only legal to leave your home for a few very specific purposes like buying food) in response to Corvid-19.  I am glad I am not having to make the decisions.

However, as someone with long term depression and traumatic disorder problems, it cannot be avoided that I am being made seriously ill by the consequences to me of the restrictions.  And while this is slightly qualified by the fact that those of us for whom this is the case are still vulnerable to the collapse of infrastructure, as someone who is at very little risk from the disease itself, I am being made significantly ill by policies enacted primarily for the sake of the health and well-being of a different group of vulnerable people.

People often seem to underestimate depression – or rather, I think they confuse the minor forms with the severe, and assume that all depression is a matter of a bit of low mood which could do with a little bit of counselling and self-help.  It is quite right those things should be provided, but on the other hand, the fact that some people only need a bit of cream for their skin rash does not mean that all skin cancer is dismissed as a minor illness for which only minor measures are needed!

Given my tendencies, I have reached a point where I am desperately trying to process my emotions enough for the situation not to result in further traumatic disorder, but to keep them calm enough that the depression does not put me in hospital.  Though I’ve been out walking every day, I am concerned that I’m starting to develop a real (and potentially persistent) fear of going out, and I’m really struggling with my self-care, to the point that social services is having to step in to assist.  I am too fragile to communicate with people much, and this is particularly frustrating as it cuts me off from a lot of online things that would be helpful if I was well enough to access them.  And though I am doing my best, and hoping it may be possible to find ways of coping, the chances are that my health is only going to get worse the longer the restrictions continue.

The fact that it is like this for me may be a result of idiosyncrasies in brain structure that result from hypermobility disorder, though I am not sure how well established that suggestion is.  In any case, it is an illness like any other, not a matter of wilful weakness or simple ineptitude.  It can be responded to badly – in much the same way as a diabetic can choose to try to be careful with food or not – but it isn’t a choice or a failure merely to suffer from it.

At the present moment, I have excellent medical care (without which I would be much worse) in managing the immediate symptoms, from my GP, to whom I am extremely grateful.

However, there is a reasonable likelihood that I will develop long term problems – problems that do not ease with the easing of pressure – damage that will go on crippling and harming my life indefinitely, and this is not the province of a GP.  Even if I personally don’t develop long term issues, it is a reasonable assumption that there will be people who do.

What has been done has been done in an emergency situation, and as I say, I refuse to judge whether they are right or wrong to do it.  But the fact remains that there is a population of people whose health and wellbeing are being sacrificed primarily for the sake of the health and wellbeing of a different group of people.

When the emergency is over, will those who find that long-term damage has been done to their mental health by the precautions, receive prompt, automatic, adequate, expert care?  Or will there be no resources for them?  When they have suffered horribly in order that the health service may care for others with what is perceived to be a more urgent need, will they find, when that urgent need lessens, that they are the priority and that they will, without having to fight for it, receive the same care?  Will the health service then set up “field” mental health units and take on more staff to deal with the illnesses of trauma and depression and any others caused by what has been done by the government to deal with corvid-19?

From my previous experience, it is reasonable to project that the answer will be “no”.  We will probably be left to our ongoing suffering, perhaps with a little bit of very limited, non-expert counselling, and such as our GPs can do with medication.  Having been made ill by the precautions taken for others, we are likely to be abandoned to suffer from that illness.

Seriously, whatever else is right or wrong here, not regarding the serious mental health illnesses caused by precautions against the coronavirus as being due the same weight of medical assistance, is not right.

Cherry Foster

 

The car crash-coronavirus analogy again – and the reception of the Precious Blood

The withdrawal of the Precious Blood from Anglican congregations due to coronavirus seems to lack consistency when it comes to the way we handle different types of risks.

At time of writing, the death count among those positive for coronavirus in the UK is published as 21*.  And without a miracle, it is clear that the number of deaths is going to rise, though hopefully we will come out of this and find fewer people have actually died of it than of the seasonal flu.  (This doesn’t mean I’m not aware this particular epidemic presents some peculiar challenges not involved in the case of the flu).  Taking sensible precautions against infection has a role in helping the death count to stay low.

The hope that the numbers will be statistically low does not mean those deaths do not matter.  I am sorry for people’s loss, and I will be praying for those who have died of it and for all others who have died in the last few weeks (of whatever cause), that they may rest in peace and rise in glory.

However.  1,784 people died on the roads in 2018, and those deaths are not less important.

When driving a car, you don’t drink too much alcohol, you fasten your seatbelt, and you refrain from using a hand-held mobile phone.  At least, I hope people do and don’t.

Do people say: “is my journey absolutely necessary?” or “It is incredibly selfish for anyone to make a car journey because it might put others at risk.”

No.  We take sensible safety precautions and we don’t hesitate to make the most trivial of journeys.

But when it comes to the Precious Blood of Christ, who resigned His equality with God to be born Incarnate, to live, suffer horribly, and die, in order to give us that most precious and unbelievable gift and the life and love that is received through It, do we take sensible precautions – make perhaps a few careful changes to exactly what we are doing – and carry on receiving?

No.  We say: “it isn’t necessary for validity.”  “It’s selfish to ask to go on receiving because it might put others at risk.”  We treat Him as if receiving Him in the completeness of His gift was an emotional indulgence – was more of an emotional indulgence than a car journey for a Saturday afternoon trip to a tea-room.

How can we respond like that if we believe what we say?

Cherry Foster

 

 

N.B.  I would ask anyone responsible for the policy or for implementing it to appreciate that this is a cry of perplexity and anguish, and an appeal to rethink the importance of what is being denied – to Him, as well as to us – it is not an accusation of deliberate hypocrisy.  I come out as INFJ on Myers-Briggs: I genuinely tend to be both coldly technical and passionately emotional at the same time.

*Lest I spread alarm and despondency: this is as yet a tiny fraction (0.018) of those known to have it in the UK, and as they are testing the more serious cases (i.e. the people more likely to die), the number of people in the UK who have got it who have actually died is almost certainly comparatively tiny.  Not that deaths don’t matter.  Just that it is not a cause for panic.

A Coronavirus Statistic in Proportion

 

Car Crash, source wikimedia commons, copyright to attribution
Photo source: Wikimedia Commons

Yesterday I went to a hospital appointment on the bus.  With hand sanitiser in my pocket and trying to sit where I was less likely to be coughed over.

I took the same level of precaution when travelling a couple of days after Christmas.  While I’m not medically a person with high risk, the fatigue side of my disability tends to mean minor infections incapacitate me in an annoying way.  And the mental consequences of quarantine are not necessarily minor.

I picked up an abandoned newspaper, which was – among other means of spreading alarm and despondency – trying to make a thing of the fact that more than 1000 people had died of coronavirus in Italy.

I am sorry to hear that – it isn’t good, and I’d rather people didn’t die and others didn’t have to mourn their loss.

However, the average number of excess winter deaths per day in the UK (five year average ending 2017, which was the most recent I could find) was more than a 1000 (3).

The highest number of influenza deaths in a single week in the UK (5) in the year 2017 to 2018 was 14,010 (3), i.e. about 14 times a thousand.  (The influenza that year had an unusually high mortality, however).

And 1,784 people were killed on the roads in the UK in the year 2018 (4), with 26,610 killed or seriously injured.

Coronavirus?  Fasten your seatbelt.  Take sensible, evidence-based precautions.

But don’t panic.  There is no reason to expect a zombie apocalypse.

Cherry Foster

 

  1. Retrieved from the Wikipedia article as I know no Italian.  The reference given is^ “La popolazione legale del 15° Censimento della popolazione”. http://www.istat.it (in Italian). 19 December 2012. Retrieved 18 September 2019.
  2. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/2011censuspopulationestimatesfortheunitedkingdom/2012-12-17
  3. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/excesswintermortalityinenglandandwales/2017to2018provisionaland2016to2017final figure 3.
  4. https://www.gov.uk/government/statistics/reported-road-casualties-in-great-britain-annual-report-2018; first link
  5. The population of Italy at a census taken nine years ago (2011) was 59,433,744 (1), of which between one and two thousand is a tiny fraction.  In a census taken in the same year, the population of the UK was 63,182,000 – a little higher (2), meaning that the Italian deaths from coronavirus are similarly slightly higher proportionally to all the UK statistics quoted here.  Not being good with typing long numbers correctly, I haven’t tried to work out each figure as a percentage of the population to remove the approximate nature of the comparison – I’d probably make mistakes – but the figures to do it are here if anyone wishes to try it.  If you do, I’d be really interested to know what the answers are.

N.B. I am having trouble with links 2 and 3: the reference is what is in my address bar for those pages, but there seems to be something about it which I don’t understand.  However, searching for the relevant phrase should bring up the pages.

How to assist a disabled stranger without killing them…

All right, that is an exaggeration, but it isn’t as much of an exaggeration as I’d like it to be. I am incredibly grateful to live in a society where the main danger of having a disability is being accidentally knocked under a train by a person who was “only trying to help”, rather than that of being attacked and killed by someone who wants a disabled person’s body parts to use in a magic spell.

However, it is also true that as a culture we lack “manners” for offering and declining/receiving help in many situations, to a point where it is a serious problem, causing actual danger, loss of functionality or confidence, and mutual social resentment.

Here are some (obviously somewhat limited) suggestions about how to offer assistance without doing anything damaging or inappropriate.

Stop.  Think.  Ask.  Respect.

 

Stop:

Don’t panic. Disability is a fact of life, not an emergency.

 

Think:

Take your mind off the disability and note something else that is human about the other person. Are they wearing a wedding ring, a university hoodie, or the latest fashionable hairstyle?

Do they look as if they want help, or are they just getting on with life?

Is offering help at this moment going to make things harder rather than easier for them? If someone has visual impairment needs, wait until after the station announcements. If someone is in a wheelchair, do not move the wheelchair ramp they are trying to go up in order to be able to stand where you can speak to them!

 

Ask:

This stage is about establishing whether or not the person would actually like help.

If you think the person might want assistance and you are able to render it then:

Try to avoid rushing headlong towards someone – this can come across as threatening. We cannot read your minds either! You might be coming to offer help – or you might be rushing towards us with a knife…

Respect personal space generously.

Ask verbally if they would like help.

Never randomly grab or touch someone or their mobility aids without interacting with them first*. At best it isn’t appropriate – it leaves them with no polite way out of the situation if you get it wrong – and at worst it is extremely dangerous – as when someone has poor balance and they end up being knocked off the platform into the way of an oncoming train.

Open ended questions such as “would you like assistance?” are often best. Imagine your work colleague is swearing at their computer, or that you are a shop assistant not sure whether a customer wants to browse or wants to be served. This avoids the awkwardness involved in saying “would you like me to help you across the road?”, followed by an utterly blank face and the words, “What? I wasn’t trying to cross the road”!

Avoid starting with questions or statements which assume the other person wants help. Examples would be “which bus are you trying to catch?” and “I’m going to help you around this sign.” Make sure possible answers to your question include a polite “no, I’m fine, thank-you”.

Don’t pester. Repeat the question once in a slightly louder voice, if you think they might not have heard it, and if they ignore you, then leave them alone. They may need to concentrate and demanding their attention will make things worse.

 

Respect:

Remember, people with disabilities have the same autonomy as anyone else. They are entitled to decide to walk down the street without assistance – and get their feet wet in the puddles or whatever – no matter how stupid the person offering the help thinks they are being in refusing!

If the person says “no thank-you” to help, say something like “have a good day” and leave them alone at once. Don’t press them. I understand why people do, but the harassment value of that can become a problem, particularly when we’re talking to the 6th person to offer help in 8 minutes! In that type of situation, we need to be able to say no thank-you quickly and get on with what we are doing, without having to spend ages arguing about it.

If the person says “yes” to help, try to do what they ask as much as possible.

If you aren’t sure what they want you to do next, questions like “how would you like to do this?”; “do you want to take my arm?”, “would it help if I held your stick?”, are generally completely fine. People tend to get good at explaining what they need done.

 

Cherry Foster

 

 

*With visual impairment, I think this problem arises partly because it genuinely is appropriate to touch a person with VI with whom you are interacting more than you would someone fully sighted. This is because it is a way of using a different sense to compensate for the absence of vision.

However, while it is appropriate to use touch more when interaction has been established, in my opinion it is actually less appropriate to try to establish an interaction with a person with VI needs by touch, due to the fact that they may not know you are there.  (Unless they are also deaf – I have no idea what it is appropriate to do in those circumstances, as none of my “ask verbally like this” stuff can be assumed to work in that case. In the UK, people who are also deaf will often add red stripes to their white cane to alert people to the need for a modified response).

A letter to a hospital

Non-judgmentalism includes not judging when the issue is moral standards we believe in.

[I wish to raise a concern] about policy stated in a notice in the waiting room which I felt raises legitimate concerns about whether the paramount priority of patient care is being maintained.

The notice said that the hospital would not allow patients to refuse treatment from a particular member of staff on racist grounds, and that any refusal of treatment on such grounds could be considered refusal of treatment altogether.

I was horrified to find that any patient of yours refuses to be treated by a particular person for such reasons. Racism is very wrong, and its ongoing presence in our communities is rightly a deep concern.

However, I was more horrified that a hospital would consider responding to the problem in this particular way. Granted, patient care requires politeness and mutual respect, and I think it is quite reasonable to insist that no one responsible for their actions uses certain types of language within the hospital. But this is different from removing the patient’s autonomy to ask for a different doctor irrespective of whether their reason is good or bad.

For one thing, it creates a practical problem, at the minimum being a cover for incompetence, and at the worst, an abusers’ charter. Suppose a woman (or a man) believes that a doctor (or other member of staff) is using medical access to her body as a cover for groping her sexually, and that doctor is of a different race.

Such a policy puts her in a situation where if she requests to be transferred, but cannot prove a complaint, she is liable to be accused of racism if she requests to be treated by someone else. This may prevent her receiving treatment or trap her in a situation where the price of treatment is submitting to abuse. In cases where a person is not happy with the doctor’s competence, playing the race card to block their access to another doctor is likely to be even easier, as such concerns are often instinctive rather than analytical. The only way of preventing this is not to regard the patient’s possible reasons for making the request as a relevant factor.

I would also ask whether refusing someone treatment because they are being racist is really any different, in theory, from refusing a pregnant woman treatment because she refuses to marry the father of the child. The precise similarities and differences of the two cases are interesting, but the question is worth asking. It is usually argued that it is right for medical practice to aim to be non-judgemental about moral issues.

I appreciate the awfulness of racism, and the fact that the policy is a natural reaction to it. However, I think in the case of a hospital, it is necessary to stop at insisting that people must not be verbally or physically abusive, and not to reduce the autonomy of patients to make choices about who treats them.

 

Any thoughts, further arguments for this position, counter-arguments to it, or experiences of (probable or indisputable) racism in such circumstances, or of being accused of racism, or being unwilling to make a request for a different reason for fear of being accused?  It is hardly a simple question.

Cherry Foster

An Annoying Irony

Person-who-does-at-least-have-the-decency-to-be-frank-rather-than-clandistinely-spiteful:

“You told me you couldn’t do X, but you just did Y.  I can’t see how that makes sense.  People who can’t do X didn’t ought to be able to do Y either.  I’m not going to adjust for you or assist you any more, because it’s obvious you’re just a horrible person pretending to have a problem.”

Person-with-unconventional-physical-limitations (a.k.a. a disability):

“So, instead of rejoicing that my difficulties are less than you thought they were, and that you didn’t have to make the adjustments you seem so much to resent on that occasion, you accuse me of pretending because my physical limitations differ from your assumptions about how they ought to work?

“Let’s look at this logically, if rather over-simplistically.  It isn’t possible for someone to do what they aren’t able to do.  It is possible for someone to not do what they are able to do.  The only way in which I can make my condition look as if it fits incorrect assumptions of how it ought to be is to not do things which are perfectly possible.

“Therefore, what you are saying constitutes a social requirement to malinger.  If I do not pretend, I will be accused of pretending!”

 

Cherry Foster

A Question of Value

Conventional feminism and real freedom

Suppose someone takes their daughter, or a young friend, to a social gathering*. This young woman is conscientious and high-achieving, and she’s at the stage of thinking about what she wants to do with her life, or, better still, about how she can best serve given her God-given temperament, interests, and talents.

At this gathering, she meets and talks with two women in their late sixties, one of whom has recently retired after being a consultant doctor for many years, and the other of whom has spent her life as the stay-at-home mother of her three children and as a housewife and homemaker.

On the way home, discussing these conversations with her grown-ups, would you expect both these women to be held up as role models for her? Would their different life choices be regarded as equally good ways for her to consider using her gifts and talents by her teachers, her parents, her school careers advisers?

Freedom, I think, would mean having the choice between paid work or traditional woman’s roles equally valued, advocated, supported, and respected.  Not a situation where girls are pushed into medicine and engineering in order to prove someone else’s political point!

We seem to have an odd tendency as a culture to say nice things about stay-at-home motherhood when directly challenged, but to talk and behave the rest of the time as if it was a waste of people’s time and talents, which no intelligent girl or woman could possibly “want” to engage in.

The acceptance that stay-at-home motherhood is not the right way for every family to do things, and the insistence that it isn’t a laudable ambition for a young woman** who’s drawn in that direction to “want” to occupy herself chiefly with the daily care of her family, are very different things.

Cherry Foster

 

*Or suppose, being at the stage I’m describing, you go to a social gathering, etc. I couldn’t write it to include that grammatically without it being hopelessly confusing.

**Or for a young man.  The gender specific language here is chiefly because I am trying to make a point specifically about women and feminism, not because I think stay-at-home fatherhood is wrong, or that it should be off the map.  I am not an egalitarian but a complementarian: I don’t want men who are suited to usually feminine roles, or women who are suited to usually masculine roles, to be prevented by prejudice or convention from doing them, but I don’t think it helps to try to obliterate the tendency of some roles and tasks to devolve more to men or women.  Rather I think, where relevant, a masculine or feminine environment should be aware of its tendencies and understand what it needs to do to welcome and include members of the minority gender.