Thursday, 24 July 2014

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.

Wednesday, 23 July 2014

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.

Saturday, 19 July 2014

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?


Wednesday, 16 July 2014

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
 


Sunday, 13 July 2014

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 DepressionBy SIDDHARTHA MUKHERJEE, April 2012, New York Times



Wednesday, 9 July 2014

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.