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

 

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

On Healthy Eating from a “Picky” Eater

Some practical and theoretical comments

800px-Basil_and_Organic_Tomato_Soup wikimedia commons copyright to attribution
Tomato Soup. Source: Wikimedia Commons

As a child I was taught I was morally depraved because of the way my body reacts to food.

And while I am sure there is plenty of excellent scientific advice in something like the NHS’s dietary advice, the overarching approach drives me crazy because, ultimately, the human body is not a machine, but a complex, living, dynamic, organic aspect of the human person. I don’t need to know that it is generally more ideal to eat vegetables whole than pureed. I need to know what to do given that I mostly can’t.

“Don’t listen to your body”* is surely the worst food rule of all. The human body, which is an integral part of the person, deserves respect. Brother or sister ass should not be force-fed and cursed for not acting exactly as wanted, but gently and respectfully trained, with empathy and kindness and acceptance of real limitations of whatever kind.

It isn’t clear exactly what my physical difficulties are – probably sensory defensiveness (it is likely I have sensory processing disorder of some type; certainly I have dyspraxia), and possibly also some sort of mild swallowing difficulty and/or general digestive sensitivity**.

The worst problem I have with eating an adequate diet is that I am pretty much literally incapable of eating most cooked vegetables, at least in any quantity, and I don’t find it comfortable to eat raw fruit either. I also have a lot of difficulty with new foods. Texture seems to be the most significant issue, in that I can eat soft mashed potato quite happily, but cannot eat more than a few mouthfuls of the firmer sort without my body reacting as if I was trying to eat soil or cloth. I also over-react to strong or strange flavours and odd flavour/texture combinations.

I’d emphasise that I’m not a nutritionist and what follows is not intended to be scientific dietary advice: it is a set of things I’ve found work for me personally on the vexed question of fruit and veg, which I hope may be a useful starting point for others with similar issues with this food group.

 

Small portions of new foods; avoiding creating an acquired dislike by pushing it to a bad physical reaction.

Eating slowly; and keeping a glass of water or other drink by while eating.

Coleslaw – particularly bland coleslaws with a lot of dressing and finely shredded carrot and cabbage. I can’t cope with carrots and raisins together, though. Try cheese coleslaw if lack of protein is a problem too.

Salad leaves with dressing – I find most dressings fine, so long as they change the texture. Salad cream is my personal favourite. Squeezy mayonnaises tend to have a better texture than those that come in jars.

Red onions with salad cream.

Cream of tomato soup. I’ve had varying success with other cream-of soups. I am more tolerant of tomatoes and onions than I am of most vegetables.

I’ve had a certain amount of success taking tinned soups with whole vegetables, that I couldn’t eat as they were, and putting them through a blender until completely pureed.

Eating soup with bread greatly increases my tolerance of the texture of the vegetables in the soup. Dryish, crusty bread works best for this.

Strained vegetable broth. Cook vegetables to death so all the nutrients end up in the water, and then strain them out of the water and either use the water in further cooking, e.g. gravy, or eat as soup. (Search for vegetarian alternatives to bone broth for recipes. Bone broth may be worth trying too, given it is supposed to be nutritious, though strictly speaking it isn’t part of the vegetable hegemony! Be cautious with it, though – it made me quite sick when I took in too much too soon, and that’s apparently not unusual, even among those who find it helpful long term).

Fruit/fruit and vegetable smoothies. Typically, I use banana and other fruit blended in milk and yoghurt, with ground flax and chia seeds, and added cereal or wheat bran for fibre. And a spoonful of cocoa and/or spices. This is one of my favourite approaches, as the texture and nutrition can be varied a lot. It’s also possible add raw eggs (check they are safe in your area), and/or nut butters, if extra protein would be useful.

Smoothie bread pudding. Instead of using raisins etc. among the bread, blend bananas and strawberries, cocoa and spices, with the milk and eggs, pour over the bread, and bake as normal. This gives a very smooth texture. It makes a good frozen dessert too, though it needs to be allowed to soften for a few minutes out of the freezer before eating.

Brown bread, wholegrains, wheat bran, and other cereal sources of fibre.

Baked beans.

Most tinned beans, chickpeas, and lentils, in moderation and mixed with other foods. Pureeing beans and using them in a sauce or coating on meat works quite well. I can’t take green beans or peas at all, except for pureed peas in soup. Rice and meat/fish salads tend to be quite good with beans or lentils.

Small portions of fresh fruit – however much can be eaten without discomfort. I tend to assume that eating one segment of orange, one slice of apple, half an apricot, two grapes, is better than not eating any. I don’t do this much at present because I live on my own and it would run to a lot of waste, but it may work within a family setting.

I find fresh pulpy fruits, such as mango or banana, easier to take in than fresh juicy fruits like apples.

Real fruit yoghurt. Puree fresh or frozen fruit with plain yoghurt – and spices/cocoa/vanilla essence/instant coffee/honey etc. if desired. Using fruit that’s currently frozen and eating straight away gives a different texture. In theory using pureed fruit should work with frozen yoghurt and ice cream as well.

Relishes and pickles. Again, probably not ideal. But sandwich pickle and sandwich spread and burger relish do generally contain real vegetables, and the way they are prepared and eaten tends to be relatively friendly to texture problems. I usually eat chips with relish rather than ketchup.

Vegetables combined with bread and meat or bread and cheese. I can eat a lot of fresh salad in a burger that I would have no hope of eating on its own. Similarly, I can eat peppers and tomatoes and onion in unusual quantity on pizza, or in a sandwich with bread and cheese. I also get on quite well with things like chopped onion in tuna mayonnaise sandwiches, though I find it tends to be necessary to chop vegetables quite small (use a food processor). I’ve found that the trick with this is to add the size of portion I can eat comfortably and no more, even if all the textbooks are screaming at me that I must, must, MUST eat a larger portion.

Stewed fruit, and stewed fruit desserts such as crumbles.

Tinned peaches and apricots. These generally have a softer texture than fresh.

Dried fruit, such as raisins and apricots. I like eating dried fruit in tart, plain, Greek-style yoghurt. Raisins and dark chocolate drops in yoghurt are one of my favourite desserts.

 

Cherry Foster

 

*Clarification: I mean listen to the body as a whole, not gratify immediate sensual preference without thought. There is a difference between the mind behaving like a slave-driver towards the body, and its behaving like a group leader towards a valued colleague. Interestingly, I am using the same underlying structural reasoning in my approach to food and healthy eating (i.e.: respect the body as part of the person) as I do in relation to chastity (sexual ethics), and I think that is probably correct.

**It is possible to have a physical difficulty without the explanation being clear! The explanation explains the causes of the pre-existing physical difficulty, rather than the difficulty being brought into being by the explanation. Our social culture has a strong tendency to treat disability as if it was the explanation and not the thing explained, and to treat anything unexplained as if it was unreal.

Fear the Smear

When I was sixteen, I received letters from my medical practice desiring that I should come for tests for Chlamydia.  They wouldn’t leave me alone on the subject when I came in for visits on other matters, either, though to do the doctors justice, I think they did put a stop to that after I protested.

It is true that I haven’t kept those letters, but as I remember it, nowhere did they acknowledge that it is actually possible not to have sex, and that if you do not have sex, the risk of sexually transmitted diseases is usually negligible, and certainly not worth either the unpleasantness of the medical tests or the use of NHS resources.

I requested an opt out several times, which was mostly ignored. Whether it was accepted in the end, or whether I simply “timed-out” on the screening programme, I have never been quite sure.

But my relief was short lived, because shortly afterwards I started receiving demands that I should come for smear testing for cervical cancer. There was no opt out with the form; on requesting an opt out, the surgery demanded that I sign papers saying I understand the risk.

Perfectly. There is none. I have never been sexually active.

In this case I think the relevance of that was just about acknowledged somewhere on the letter, but not sufficiently to alter the actual attitude encountered in a significant way.  The letter that came back from the opt-out request didn’t say, for example, “are you in one of these low risk categories?”. It assumed you must be high risk and must have this risk shoved blatantly in your face before you persisted in your ill-chosen course of declining screening!

I appreciate that the people pushing these screening programmes mean well. But it seems to me that there is a failure to consider the wider picture regarding the attitudes and norms they are actually promoting.

The medical system in the UK doesn’t regard telling people to eat fruit and vegetables as judgemental. They don’t assume that they should encourage people to go on smoking while putting lots of testing and early intervention programmes in place for the likely health risks. But instead of suggesting that people shouldn’t have promiscuous sex for the sake of their health*, they put resources into trying to support people in doing so – and talk as if saying “no” responsibly was not possible.

Could there be anything more disempowering and dehumanising to women (or to men) than treating sex as if it was something that just happened to you? Something over which you have no control or power of decision? Something you don’t have to take responsibility for the consequences of? Something you can’t say “no” to?

Yet how can we continuously talk about sexually transmitted diseases without acknowledging the possibility of sexual abstinence as the best way of not catching them, without sending exactly those messages?

I want to encourage other people for whom these tests for sexually transmitted diseases are not relevant to stand up against the “wrong to refuse” attitude, and to say “no” with confidence. In refusing these tests, we are rejecting a set of values which, however unconsciously advocated, is extremely sinister.

 

 

 

*It is true that I have a traditional Christian view of sexual ethics that goes beyond the single dimension of the risks to physical health, but what I’m interested in here is the inconsistency of the response of our medical system regarding the health risks of different types of physically unwise conduct. The English education system as it was when I came through it was doing exactly the same thing – sending the message that anyone who abstains from promiscuous sex is so peculiar it need not be acknowledged as a possibility – but that was more than 15 years ago and I don’t know how things have changed.

Edit (14/5/19) I should add, I think, a clarification: I don’t object to screening programmes for (primarily) sexually transmitted diseases being made available, at least not for the reasons stated here (probably not at all, but medical prevention issues are complex, and I reserve judgement in as far as I haven’t been into other issues).  What I am suggesting is wrong are various attitudes surrounding these tests and the way they are promoted.  (I hope they don’t refuse to check smokers for smoking related cancers: I see that as the closest equivalent).

I would also add that I think the whole question of how much pressure the medical profession can put on people to have or not have any sort of treatment/tests without compromising the principles of consent should probably be discussed more.