The Meandering Social Worker

wandering : wondering : learning

Archive for the tag “mental health”

The role of capitalism in mental illness

Those who know me know will know how passionately I will agree with this article from Red Pepper: we are in an ‘epidemic’ of mental illness and the cause is the caustic society in which we live.  The greed and isolationism caused by the capitalist system serves an infinitesimally small number of people at the top of the tree who benefit financially from the ever increasing flow of goods and money around the world.

But as we have known for quite some time now, the acquisition of yet more goods has not brought the rest of us happiness that lasts longer than the addictive rush of a new purchase, or the advert telling us we need to buy some other new thing which will miraculously turn our lives into utopia.

Having travelled extensively in developing countries where this obsession with possessions has not yet achieved the grip it has in the so-called developed world, I have seen that this type of ‘poverty’ has not yet destroyed their families and communities.  They are relatively poor in that they don’t have the latest wide-screen TV or iPhone; their lives are not perfect, but they still have homes and shelter and warmth, they still have food, and they still have their relationships with their friends and families.  (Note I am not talking about communities and countries where poverty is causing real physical hardship and starvation.)

This transition began in the 18th Century with the Industrial Revolution, of which Britain was one of the forerunners, but the real shift came at the beginning of the 20th Century, with the work of Edward Bernays, Sigmund Freud’s nephew, from which developed the modern advertising industry.  It’s a long watch (nearly 4 hours) but the documentary, The Century of the Self is enlightening.

But the question for all of us is how we can use this research, this knowledge, to overcome our own mental health frailties and support others who are also struggling.  We cannot turn the clock back.  We cannot undo what has been done.  We won’t get rid of the over-production and over-consumption of goods that is destroying our planet as well as our mental health, not to mention the lives of the oppressed workers in slave labour factory conditions.  At least not quickly, easily or without a lot of pain.

But we can start to understand the impact of our consumption led, consumerist world, challenge our own lives and work to help others to understand.


Austerity and mental health

Since the election in May 2015, when the Tories won their surprising overall majority in the House of Commons (despite only securing c.37% of the actual vote), I’ve been following with interest and concern the developments on the budget, welfare and austerity measures.  We finally got some figures out of the government regarding the death toll (possibly) relating to benefit sanctions.  Many if not most deaths cannot be directly related to sanctions but the circumstantial evidence is compelling.  Rather than try to repeat much of what has been written elsewhere I recommend this article from the New Statesman which brings it all together rather succinctly.  Whether we work in mental health services or not, social workers, medical staff and others in the caring professions have been seeing first hand the devastation of austerity.


A Life Lost in Thought

The Man Who Couldn’t Stop: OCD, and the true story of a life lost in thought by David Adam, 2014, published by Picador

David Adam is not an ‘academic’ writer.  However he is an established British writer, mainly on the subjects of science and nature, which make him well placed to write this well researched book even without the autobiographical element.  The book is written for the lay reader – anyone interested in the subject, perhaps because they think they or a friend or a relative might be ‘a bit OCD’ – but is just as valuable to the social care professional whether working with the young or the old, with or without recognised mental health problems.

Adam explains the difference between an obsession (thought) and compulsion (action), looks at the history of OCD, how the DSM classification has changed in recent years, the role of the brain in OCD, and the eccentric behaviours of people who if they were still alive today may well find themselves diagnosed with OCD.

One of the things that comes out Adam’s writing is the emerging recognition that OCD is another spectrum disorder and that rather than each disorder being distinct in its own right there is some overlapping: some of the behaviours linked to autism may be seen in OCD; whilst there is no known cause for OCD it is often triggered by a single traumatic event that might result in PTSD in someone else; intrusive thoughts, that lead to the compulsive behaviours, can be compared to schizophrenia, although the reactions might be different.

A key point Adam makes clear is OCD is not just about repetitive hand washing or checking ovens are turned off or doors are locked.  There are many other behaviours symptomatic of OCD that are not so visible: some may attract attention such as skin-picking (causing damage and scarring) while others might be almost un-noticable to most people, such as maladaptive daydreaming and endless counting.

Woven through the factual information is Adam’s own story, giving the reader a real insight in to what it is like to live with OCD.


Turning Tides – maybe

Following the Conneticut massacre, and amidst the debates on gun law and gun controls in the US, a quote recently appeared on Facebook:

Reagan quoteAt first glance it might seem that Reagan has a good point, but is it that simple?  Certainly over the years there has been a move towards ‘rights’ rather than ‘responsibilities’ and a decline in the individual being held accountable for their actions, as excuses are made, “he had a bad childhood”, “she was drunk”.

Coming from a different angle, members of the Australian Social Workers’ Association produced a cartoon several years ago.  A small group of professionals: social workers, teachers, police, and medical professionals, were depicted with the caption, “We are responsible for the death of that child.”  The second image was of a large group of people representing society as a whole with the caption, “We are responsible for the death of that child.”  The final picture was of a stereotypical “bad man”, with the caption, “It was my hands that beat the life out of that child.  But I am not responsible for her death.”  If anyone still has a copy of that cartoon (with the accurate quotes), I would love to have a copy to post here.

That cartoon was a reflection on how social workers experienced society’s reaction via the media following a serious incident, usually leading to the death of a vulnerable person.  It wasn’t an unrealistic depiction.  In the UK, when a child dies, enquiries are held, files are analysed, professionals are interviewed and individuals, in this case the professionals, are held accountable for their role and actions.  Often though, it is only the front line social workers who are subjected to castigation in the press.  Maybe it’s because health professionals and the police are seen as the “good guys” they are permitted a little failing occasionally.  Nobody wants a social worker calling at their door.  When the mother of one of the 10 year old boys who shockingly murdered Jamie Bulger in Liverpool back in 1993 said, “I told the (education) welfare (my son) wasn’t in school”, her words were reported but little comment was added as to her role in her son’s generally poor school attendance.  Society, as presented through the media, is selective about the individuals who are called accountable for their actions.

The tide may be turning a little.  Following the death of Baby P in England in London, England, in 2007, the enquiries were still held, the role of the professionals still investigated, but with a tone of shock there was recognition in the media that the parents of Baby P committed the actual neglect and abuse against their son and did their utmost to lie to and conceal the truth from the professionals who were engaged in trying to ensure their son’s safety and welfare.

The individual should be accountable for his actions[1].  But what of the role of society?  In the words of John Donne, “No man is an island.”  Individuals are members of society, together they make up society.  Society makes the laws that enable society to function as a whole.  Perpetrators of crimes are members of society.  Relatives, friends and neighbours of perpetrators of crime are members of society.  Among them will be some who recognise laws are being broken, criminal acts are being committed, that the human rights of other individuals are being violated.  Society as a whole has a role to play in the prevention of transgressions against society, not least because unless they do the “professionals” may not know there is a problem until it is too late.

Shortly after the Connecticut shootings, my heart went out to the woman who wrote her blog entitled “I am Adam Lanza’s mother”[2].  Not literally, but metaphorically.  Her own child has serious behaviour problems.  At times he is a sweet natured child.  At other times he becomes a monster.  She knows, as his mother, that her soon to be adolescent son will be a risk to society when he is an adult.  He could be the next Adam Lanza.  She has sought the help of professionals and has received and accepted the help given.  But under existing US legislation no-one, including her, can prevent her son from refusing to take his medication (which regularly happens) or one day going out and legally buying guns that are readily available in supermarkets, shopping malls and downtown stores, and using those guns to maim and destroy.

Professionals, whether front line workers, managers, employers, are society’s representatives, doing the work of society, to protect the vulnerable members of society on behalf of society.  They are also members of society themselves.  They have the responsibility to do their jobs to the best of their ability within the guidelines of their profession and the laws of their country.  They have the responsibility to make proper use of supervision to discuss cases and work related issues, to recognise and understand their strengths and weaknesses, and to identify new or refresher training to help them in their work.  Their employers have the responsibility to ensure that supervision and training are properly provided and that workers are not exposed to unrealistic work expectations and caseloads.  They are society at work.

Society as a whole may not be guilty when individuals choose to break individual laws.  But modern society is a fluid entity, impacted on by outside forces beyond its control, a changing thing that as a whole has a duty to protect its own welfare, for the sake of future society.  When it becomes obvious that society’s norms and laws are not protecting society in some way, and society chooses not to respond, leaving more laws to be broken, more crimes to be committed, more individuals to be harmed, more lives to be lost, then society is guilty of not protecting itself or its members.

This is the challenge facing the US today.  Each time innocent children get killed in a school shooting, society has to ask itself if that shooting could have been prevented and how.  Restrictions on gun ownership; more security in schools; more guns in schools to prevent shootings in schools (as proposed by the NRA); better recognition of mental health problems and better mental health care, particularly for the poor and uninsured: just some of the options up for discussion.

If society as a whole does not succeed in coming to some kind of resolution that works when problems such as this arise, then society as a whole may be considered guilty by default of not taking action to prevent the law being broken, and harm being done, in the future.

[1] There may be exceptions, such as victims of certain crimes.  For example, someone who is exposed to the drug scopolamine loses all power of individual thought and can be easily persuaded to carry out crimes on behalf of another person.  Like the date rape drug Rohypnol it may be given to the victim without their knowledge.

Sling Blade

It’s an old film (1996) but I’ve only just seen this Award winning classic budget movie directed by and starring Billy Bob Thornton.  It’s one of those classic experiences of watching movies on long flights.  But this one had me glued to the screen.

In a nutshell, the main character Karl was incarcerated for 25 years for the murder of his mother and her lover after he found them making love on the floor.  At 12 years of age he at first thought he was protecting his mother from attack but then realised she had been a willing participant and killed her too.  A shockingly sad childhood emerges as Karl, rejected by his family from an early age, remembers living in the shed, isolated except for the occasional Bible study with his mother; at six he finds his still alive but discarded newborn baby brother wrapped in a bloody towel and buries him in a corner of the garden.  Barely educated Karl nonetheless has a natural skill in repairing lawnmowers even as a child.

The film centres on Karl’s experience of being released from the “state nervous hospital”, declared cured of murderous intent.  Rejected by his father he is helped to find a job repairing lawnmowers.  Befriended by a boy of about 12 he is offered a place to stay with the boy and his mother Linda.  They become, for Karl, the family he never had, and the potential parallels between the lives of the boy and Karl are evident.  Unfortunately the mother’s boyfriend Doyle is a violent drunk who hates both the boy and Karl, who he openly calls a ‘retard’.  Karl does not respond to the boyfriend’s taunts but is protective of the boy who has befriended him.  Despite his Biblical convictions, he takes action in the only way he knows how in order to protect the boy and in a premeditated act he kills the boyfriend before calling the police to hand himself in.

Much is made in write ups of the film of the acting skills of Billy Bob Thornton in transforming himself into the hulking figure of the “slow-witted” Karl.  Yet there are two things from the film that struck me most.  One is a line from the final scenes – back in the “state nervous hospital” another inmate asks Karl about life outside.  As he looks out of the window he says, “It was too big out there”.  The second is the underlying message of the file – how we can so easily misunderstand the motives and intentions of others; how easily we can miss the heartfelt reasoning behind actions; and how important those childhood experiences can be on the outcomes of the adult life.  Food for thought.  And a film deserving of the acolades.

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