A fair number of clients describe very similar problems. They’re constantly tired, or very edgy and unable to rest; teary, stressed and not coping. What used to be small problems have become insurmountable. They’re irritable, panicky and can sometimes behave in ways that seem beyond their control leaving them feeling ashamed, stupid, defensive and angry.
As well as taking these symptoms seriously in a psychological sense I’ll also ask them to visit their GP to request some blood tests.
Full Blood Count (FBC)
This measures your general health, including how much iron you have in your blood. Anaemia – a lack of iron – can make you feel exhausted, short of breath and cause palpitations. Shortness of breath and palpitations are also symptoms of panic attacks.
Low levels of magnesium and calcium can cause panic attacks.
An FBC will show if you have any underlying infections which will make you feel tired and less able to get through the day.
Thyroid Function Test
The symptoms of an over- or under-active thyroid are very close to the symptoms of anxiety or depression. An overactive thyroid can also result in mood swings, insomnia, persistent tiredness and weakness, and the classic symptoms of a panic attack, palpitations, nervousness and irritability.
A Blood Glucose Test
GP’s generally offer 2 types of blood glucose (sugar) test for people who are not showing overt signs of diabetes: the fasting glucose which shows what is happening to your glucose levels after 8 hours of not eating, and the HbA1C which shows what your average glucose levels have been over the past three months.
Type 2 diabetes is increasingly common and can lurk for years before it’s diagnosed. Some of the symptoms of it are tiredness, depression, and the classic symptoms of a panic attack: anxiety, sweating, palpitations, trembling. If your blood sugar suddenly drops, as it can do in diabetes, you can also feel irritable and bad tempered.
These tests are performed at the same time with just one needle and take about 20ml of blood in total.
Once you and your doctor get the results you will both have a much better idea of what may be causing you to feel psychologically unwell. Even if you have a clinical diagnosis of depression, anxiety or panic disorder, get these tests done. Physical causes of symptoms are notoriously ignored in people with a mental health diagnosis. And as with any medical issue if your GP is unhelpful get a new GP.
There’s an intimate link between the body and the mind and just by attending to what the body needs, whether that’s more or less thyroxin, iron or just water, we can improve and sometimes even cure what seem to be emotional problems. If you have an underlying physical problem that you don’t know about therapy can help you be more motivated to attend to your health so that you eat better food, exercise and drink water more regularly, but this will not address a problem thyroid gland, low iron or diabetes.
You never know, you may be able to avoid therapy altogether!
Tomorrow is the big day and I’ve yet to meet anyone waiting for their results who isn’t anxious. For young people this is an especially critical time because so much depends on it. Whether or not you get into the university that you want to. Whether or not you leave home. How you’ll compare to your peers.
The hours up to 8am tomorrow can feel unbearable but there are a few simple things you can do to manage your stress.
Most importantly, move around. It doesn’t matter if the movement is housework, going to the gym, taking the dog for a walk whatever it takes to get the air moving in your lungs and to build up a bit of a sweat. Stress releases adrenaline and the purpose of adrenaline is to make your muscles more efficient for escaping or fighting. If adrenaline just hangs around in your body you will become irritable and restless. If it comes to it, just jump up and down on the spot until you get breathless. If any of that breathlessness is because you’re laughing at yourself jumping up and down on the spot, so much the better.
From now on any time you feel anxious, use the adrenaline that is produced by your anxiety.
The next most useful thing you can do is have a drink of water. Just water. Not juice or coke or alcohol. There’s a link between even very slight levels of dehydration and anxiety, so rule that out. And have a glass of water every hour or so.
Now, spend 30 seconds breathing properly.
Stand up. Plant your feet firmly on the floor. Imagine a thread pulling you gently upright from the crown of your head.
Breathe in through your nose and imagine that you’re filling your lungs from your belly button upwards. Your tummy should move, then your chest, but not your shoulders.
Let the air move into your body and then gently let it flow out again. Again, your tummy should move then your chest, and your shoulders shouldn’t move. The in and the out breath should take about 12 to 15 seconds.
That breath is how you should be aiming to breathe all the time. From your belly button up as your breathe in. From the belly button up as you breathe out. Simply breathing like that will ensure that you’re not breathing shallowly and too quickly, in a way that can actually bring on a panic attack. If you’re breathing effectively your voice should become a little deeper. If you hear your voice getting high pitched you know that you’re not breathing effectively.
Slow down. Plant your feet flat on the floor. Breathe.
This kind of breathing will slow your thoughts down and help you get things in perspective.
The only admin you can do between now and then is to get the email address and phone numbers of the universities you want to go to, and those of your insurance choices
The UKAS Track website will freeze from 6pm today. For what it’s worth, I’d leave it alone now. You’ve already changed everything you need to. It doesn’t update at midnight and won’t be open until 8am tomorrow.
UCAS’ social media team will be around from 6am and the contact centre opens at 7.30am for enquiries. There’s no point in spending any more time with the website until then.
So get some things in place from now until you pick up your results.
Try not to make alcohol one of them.
Timetable in a couple of exercise sessions – yes, a couple! - and if you can do them with a friend so much the better. Go swimming, go for a run or a long walk. Do some sit ups, press-ups or planks. Do the washing up, cook dinner, clean the windows, walk the dog, try to make the expenditure of energy meaningful. If you can’t find anyone to do exercise with just do it by yourself. Exercise will help you sleep better tonight, so put your heart into it.
Plan a good evening meal, something that has a decent amount of protein in it. Tryptophan is an amino acid, one of the building blocks of protein, that aids sleep and combats anxiety. You’ll find good levels of tryptophan in nuts, tofu, meat – especially turkey – eggs, cheese, beans, lentils and oats. Plan your breakfast around this list too.
Set an alarm, right now, to remind you to breathe properly for 1 minute every waking hour. That’s a total of about 12 minutes. About 50 good breaths.
Find a good distraction and immerse yourself in it. If it’s an outdoor distraction that’s great. If it’s outdoors with friends, even better. If it’s gaming, well so be it, just don’t turn into a slob. Drink water. Get away from the screen to eat a good meal. Run up and down some stairs once in a while. And stop around 10pm at the latest.
Be kind to yourself.
There may be some very critical voices in your head telling you that your life will come to an end if you don’t get the results you need, that you didn’t work hard enough, that you’re a disappointment to your family and to yourself.
Perhaps you didn’t work hard enough. There’s nothing you can do about that now. You can determine to work harder from now on. That’s all anyone can do.
When I did my A levels a friends mother wouldn’t talk to him for 3 days because he didn’t get the results she wanted him to get. We all thought she was cruel and wrong. 30+ years on, knowing all about the causes of punishing behaviours I still think she was cruel and wrong.
If your family or anyone else punishes you for not getting the grades you need they too are cruel and wrong. There’s no point in punishing you. Punishment – including passive aggressive sighing “It’s OK. I know you did your best,” ie "I know you're not very clever," – is not going to alter your grades.
Some families look to their children to lift them out of poverty. In countries where that is a matter of survival pressures are different but in the UK getting good grades is not a matter of life and death. Your parents may well have made sacrifices to get you through education. That’s what parents are meant to do.
What people who take A levels are supposed to do is to work hard enough to get the best grades they can without driving themselves mad. Anorexia, bulimia, depression and anxiety have exploded in young people. That’s a price that’s just not worth paying for A grades. For anything at all.
Breathe in and out properly twice RIGHT NOW!
Then go and get a drink of water.
A woman caught me as I stumbled on the bus yesterday. I sat next to her and she said, “We’ve all got to be kind to each other now,” and something extraordinary happened between us.
I held her hands. If you don’t live in London you may not know how utterly bizarre it is to hold a strangers hand on a bus. It’s unusual to make eye contact! But this woman was radiating something powerful that compelled me to take hold of her hands.
“What did you vote?” she asked. I’m old enough to remember when it was considered incredibly rude to ask how a person voted, but I answered her anyway.
“I voted UKIP,” she said and turned to look me straight in the eye. All I could think of to say was, “Why did you do that?”
“My next door neighbours are on benefits and they work cash in hand,” she said, clearly wanting my response. It’s not the most insightful or professional thing I’ve ever said but what came out was,
“Don’t you think that’s wrong?” she asked, and I said that they probably had very good reasons for taking the terrible risk of being caught. “But they’re from Iran or Iraq or somewhere, and I’ve had cancer and I work. Don’t you care that they’re on benefits?”
I told her I couldn’t care less and asked her where she came from - English wasn’t her first language. She said her mother and father were from different nations and that she was from yet another. “My boys tell me the same,” she said, “They say that what my neighbours do is none of my business.” We looked at each other, holding hands very tightly, and then she got off the bus.
I was dumbfounded. The whole interaction had taken about 3 minutes.
It would be foolish to extrapolate an entire theory from that short connection, but isn’t there something about her anxiety, her desperate need to understand, that’s reflected in the national response to the election? She won’t be the only person to have voted against her own interests – a non-White, not-affluent woman who has had cancer – because her need to punish, to punch down, to harm people who are more vulnerable than she is, is greater than self preservation.
An accumulation of other stresses would have preceded this outpouring and perhaps the election was the final straw. I have no idea. But it seems to me that the single most important thing that this woman said, that goes beyond politics and ideology, beyond feeling gleeful or shocked or devastated at the outcome of this election, is the very first thing she did and the very first thing she said to me:
She caught me when I stumbled.
She said, “We’ve all got to be kind to each other now.”
I had to stagger in to work today, feeling like hell and dosed up on Lemsip. If you’re self employed, as I am, you’ll be aware of the pressure to choose between staying in bed and paying some bills, and today I just had to get on with it.
That said, I was also able to come home two hours later and sleep, then continue to do a little bit of work from the comfort of my sofa. That’s a blessing. For the previous two days I’ve done nothing at all even though there’s a never ending ‘must do’ list. There always is. A few days away from it won’t kill anyone.
One of the questions I ask most of my clients is, “What’s the worst that will happen if you don’t go in to work?” Their response is usually to smile, look sheepish and say something along the lines of “Nothing much.” The pressure to keep attending work is astonishing. Just having your body in the office seems to be the single most important aspect of employment, rather than any work you might do. One of my clients* left his employer after a review where he was told his work was, ‘Exceptional, we can’t fault it,’ but he mustn’t listen to the radio on headphones. Why? Because his employers need for control was poisonous.
For this client, after finally realising that he was being bullied every day handing in his notice a couple of days later was the right thing to do. He had the backing of his family and enough savings to see him through 6 weeks of job seeking. For him, it was worth visiting his GP to get signed off, taking a week or so to rest and recover from an absurd work environment, and then get on with finding a new job.
The ideal way of dealing with a job you hate is to find a new one while letting your current employer pay your wage. What makes that difficult for many people is that they won’t admit that their employer is toxic. We tend to bitch and moan about work without doing anything about it, whether that’s looking for new employment or talking to a Union, and wait until something so preposterous happens that things begin to spiral out of control. I’ve had a number of clients who’ve denied anything was wrong until they’ve been assaulted at work. Denial is not just a river in Africa.
*Identifying details have been changed.
Part of my training as a nurse was to spend time on a mental health ward so in 1983 I was sent to what was genuinely a bin. One of the women there had arrived as a child when the building had been a Work House. There was an elderly man with Alzheimer's, a 16-year-old young woman with alcohol problems, several young people with learning difficulties and about 20 other people with diagnoses that I knew nothing about.
Young doctors practiced electro-convulsive ‘therapy’ on the elderly woman. Every couple of days the elderly man was dragged naked and shouting through the ward and made to stand in a bowl by his bed where water was poured endlessly over him as he became increasingly distraught. The 16 year old young woman was sedated every time she challenged the staff on the basis of what she was actually feeling, which was often. In retrospect she was being punished because the staff felt threatened by her obviously splendid intellect. One of the young women with a learning difficulty was offered voluntary work at London Zoo but the staff laughed at her, saying that the idea was as stupid as she was and they prevented her going. All the women were sexually assaulted by some staff and some patients.
Aged 18 and stuffed with the high moral ideals of my nursing school I imagined that this was an urgent problem. It was only because I was a gobby teenager who didn’t know better that anything got done: none of the managers and just one of the (very senior) teaching staff took me seriously. The school of nursing protected me and two members of staff were sacrificed. Nothing changed. I kept banging on about it until one of my teachers said, “What do you want? Blood?” I was flabbergasted that the alternative to dealing with grotesque abuse was perceived to be killing someone and at that point began to learn to shut up.
News that staff knew about Jimmy Savile’s abuse of patients shouldn’t come as a surprise. We know that people - often very senior, generously paid people - find it easier to punish less senior people than to take whistle-blowers seriously. We know that whistle-blowers are treated with absolute contempt and ill treatment, not just by managers but also sometimes by relatives of abusers.
DBS checks are a waste of time and a horrific waste of money. What actually protects vulnerable people is a culture, not of suspicion but of openness and transparency where every person from the most senior manager to the youngest student are expected to speak out about what they see. That culture is supported by a policy that has to be followed if someone alleges abuse: it's a statement on the poverty of where we are now, that a policy has to drive people towards transparency.
I wasn’t the only student nurse on that ward but when I spoke to my peers about what we were seeing I was told that we were only there for 6 weeks, that it wasn’t that bad, that the staff knew what they were doing, that they didn’t want to risk a good review, that they were frightened. Just a kind of non-specific, generalised fear. As if the sky might fall on their head.
Every sphere of employment is full of bullies. Often, those bullies are out of their depth and anxious because they’ve been promoted on the basis of ticking some boxes in a selection process rather than because they are actually suited to their role. How many of us would admit that, turn down the big wage and move somewhere where we might be happier? But that’s their business. What is our business – your business too – is to ensure that we safeguard people who are weaker than we are. It’s not just in healthcare; it’s in offices where you have the power to make someone’s life worse.
The energy that you will have to use to protect yourself from knowing that you have made someone live without heating, without a home, without dignity will exhaust you. The people around you need to tell you that you’re doing the right thing because they’re doing it too. If this kind of behaviour makes you feel uncomfortable, take note. Leave if you can’t change the culture. If it makes you feel powerful, if you’re just following orders, you really do need support to stop.
A good part of my working week is spent in other people’s offices where I've noticed that there are little signs telling people how to use a microwave, what the fridge policy (a fridge policy!) is, reminders not to steal and that in the event of a fire they must leave the building to avoid being burned to death. In one office there were 14 full colour, laminated notices telling people to come to work on time, not to pour boiling water on toddlers, to avoid spreading infectious diseases, the sink policy – yes, really - that time in the kitchen was being monitored, and that staff attendance was under review.
This in an organisation that "doesn't have the money" for a box of tissues.
I'm a big fan of Health and Safety legislation, it really is necessary to tell people that hot water is hot, but Health and Safety is not the issue in an organisation that feels it necessary to watch how long individuals are spending in a kitchen.
The private sector doesn’t seem to have the same issues. People there somehow know how to use a fridge without needing a policy. It's not that people who work in the private sector are any brighter than people who serve the public, far from it. It’s more that initiative is more likely to be nurtured rather than treated with suspicion and organisational vision tends to be wider than what’s happening in a microwave.
Work in the public and voluntary sectors is too often reduced to a Kafkaesque model of not-work where flair and imagination are perceived as suspect and personally threatening. In the private sector innovation, ideas and positive critique are more likely to be welcomed.
I've worked in places where little children bellow and cry too much while stressed workers scream nursery rhymes at them. The staff have obviously gone through training and got appropriate qualifications. The staff ratios are legal and the toilet-cleaning rota is managed very well, everything is fine on paper and that's all that matters. Sickness rates and staff turnover are costing an arm and a leg but the funders are content with the reports sent to them. Funders tell organisations what they expect to hear and then organisations repeat it back to them including, incredibly, sending them ‘case studies’ instead of saying, “No, we will not send you a case study because that would be entirely inappropriate.” Instead, organisations make case studies up.
It's true that many people are put into positions of responsibility that they are not worthy of and they can have a profound effect on the people working under them. It's an irony that those people who don't feel anxious about being competent at their job, who believe they're indispensable to the organisation, are more likely to be so comfortable at work that they feel no need for personal development. Similar problems arise when a leader isn't confident enough to lead but just keeps doing what they're told rather than saying, "Why do we need to be told not to scald children? What's going on here?"
Writing a fridge policy is not a good use of anyone's time. Any organisation that needs a fridge policy has far, far greater problems than manky yoghurt.
Psychiatry has often been used as a tool of state control. People who have been inconvenient or low status or cost too much to care for have been brutalised for centuries, so last weeks 'kite flying' announcement that people who are unemployed and mentally ill may be forced to attend some kind of therapy or have their benefits stopped has precedent.
Throwing an idea out without a formed policy behind it is called 'kite flying' because the people proposing it want to see how such an idea might fly. Will we rejoice that unemployed people are being further required to perform more hoop jumping or will we boggle at what a ludicrous bit of nonsense this is?
Ethically, it's a non-starter. When we begin compelling adults to have medical procedures we enter the world of ethical committees and High Courts: particularly because psychiatry has been used to abuse people compulsion in it is treated with enormous caution. This is not to say that it doesn't occur but when it's used it's almost always in a situation that is considered life threatening. People who are not sectioned but who are so depressed or anxious that they cannot work are not a threat to themselves or others.
We have evidence of what happens when we put a government agency - ATOS - between a patient and their GP. The suicide rate increases and the financial cost of appeals outweighs any savings made. The emotional cost to patients and their families is often catastrophic. There's no reason to believe this new scheme will be any different.
Therapeutically, counsellors know that a person who has been sent to therapy by a spouse, employer or parent is unlikely to do well. Therapy should never be a punishment or way of controlling someone, it has to be freely chosen. Yes, offenders are often compelled to attend therapy and what happens is that a majority learn the language of contrition rather than positively learning much about their motivations and their effect on victims.
So we know that compelled therapy is ineffective. We can also add that if this dreadful idea was ever to be implemented it would be limited to six or so sessions, which is barely enough for someone who is mildly unhappy let alone someone with a mental health diagnosis. The waiting list - already enormous for NHS and most agency therapy - would make it unmanageable and we can guess that, just as with CBT, many of the people trained for this project would not actually be therapists at all, but technicians on a budget and under pressure.
So what might the purpose of this dreadful scheme be? Would people compelled to have therapy be removed from the official numbers of the unemployed? This is what happens to people who are compelled to join other unemployment schemes so that the numbers of unemployed and particularly long term unemployed fall, on paper. If ministers wanted to help people with mental illness back to work they need to give appropriate funding to existing mental health services and reopen the services that closed because of reduced funding.
But we live in a period of time when it's not quite acceptable to throw stones at the mentally ill, yet we are encouraged to pour scorn on them if they are also unemployed. If the public mood likes the idea of punishing people who are so profoundly unwell that they have resigned themselves to living on around £100 a week then this will no doubt happen. At the very best, it will offer therapy to people who have not been able to access it. At worst it will offer dreadful non-therapy from ill-trained, ill-motivated non-therapists.
This idea slunk off in shame in 2009: there's no good reason why, 5 years later, it shouldn't slink off to die.
If you live in London the start of the working day can be absolutely dismal. There is another way! And as long as employers don't subvert this life-enhancing concept by making staff wrap their ties round their head and jump up and down, this kind of event could alter the way we approach work.
"The [wildly successful] nerds who run IT businesses are much less interested in the "suit and tie" approach to business and much more willing to experiment with any idea which they think will keep their staff enthusiastic and creative."
Watch the Channel 4 News report here. Watching this 3 minute video will set you up for the day!
Mindfulness works. Its venerable parent, meditation, works. Exercise works and most of us find dancing a damn site more enjoyable than running in the rain. Add human connection, no matter how fleeting, and you've got a recipe for joy.
Let me know if you go to one!
I had to sit down to listen carefully to a radio programme this morning, discussing this news. A growing number of school age children are still wearing nappies.
The assumption is that that it is underclass parents, people who can barely drag themselves from their filthy pits to tend to their almost-inhuman offspring, who are responsible for this epic neglect. Those people who called in to the radio programme to talk about their personal experience of this phenomenon felt they don’t have enough time because they're at work. The research suggests their attitude isn't limited to people who call radio programmes.
They work all week and on their days off they don’t have the energy to commit to this very basic task. They can’t bear the thought of having to clean up the inevitable and quite normal mistakes that occur during toilet training so they don’t bother. Helping their child move from an infant stage to that of an appropriately independent and capable child takes a couple of weeks, and these parents can't spare that time.
Quite obviously, the majority of parents from every background manage to toilet train their children. I’d propose that a parent who cannot manage to care for their children should have Social Service involvement whatever their background – the excuse that you’re too tired after work to bother with your own children is preposterous.
There are any number of employers who would happily work their employees into the ground and resent any workplace legislation that gets in the way of making a profit. I’m suggesting that if an employee feels under such profound pressure that they cannot take time off work to toilet train their child then something is dangerously out of balance. Dangerously. Even the DWP doesn’t insist that a lone parent work until their youngest child is 7 years old.
But there’s so much greater status in being employed rather than being a single parent on the dole. At what point does caring about your status become more important than caring for your child?
Happy St George's Day, a day to appreciate the many, many benefits we have as people living in a first-world economy.
The World Service broadcast a particularly interesting piece last night, on how France Must Change. High unemployment, a State-bound economy in the doldrums, strikes, laughable working hours, and now – get this! – legislation that prevents employees from responding to work emails after 6pm! What an outlandish and economically naive country.
Strange then, that France is ahead of our own Hard Working, endlessly striving, entrepreneurial economy, second only to Germany in Europe and fifth in the world. In a survey out today comes the news that “Britain has the lowest quality of life of 9 major European countries."
France has the highest quality of life.
The weather has something to do with it as does our naturally cynical nature – we expect to be treated badly and so it comes as no surprise when we’re treated badly – but here’s a chilling analysis:
“We may still be enjoying the fourth highest household income in Europe, but the high cost of living means we are living to work.”
Person Centred counselling has a useful principle called the Locus of Evaluation. It proposes that when we’re allowed to remain in touch with how we genuinely feel we can make good choices; good for ourselves and good for the people around us. This is called The Internal Locus of Evaluation. The External Locus of Evaluation develops when we’re told how we must feel and criticised for feeling differently from the people around us. We have to ignore our genuine feelings to continue to be valued. People who function from an External Locus of Evaluation continue to look to people in authority to decide how they must feel and often feel absolutely dreadful, even if they determinedly continue to believe they are content with the way things are. You can read up on the theory here.
On Sunday the Mail felt it would be profitable to send an undercover reporter to a food bank and, despite noting that the reporter was asked lots of questions about his circumstances, recount that he walked away with £40 worth of groceries, unquestioned. In the past that would simply have added to the sneering disgust of the nation but this time it resulted in £35,000 in donations to the Trussell Trust.
Times and nations are not going to change much. Against all the evidence, as a country we’re going to continue believing that the French are lazy and on the verge of economic collapse whilst we lead the world in toughness and fiscal wisdom. But, as the Daily Mail incident demonstrates, individuals are now more than ever capable of effecting change. I’d propose that the conditions that bring individuals to the point of collapse are those that we are experiencing now. We’re being told one thing – that food banks are stupidly supporting evil people to lie around laughing at the Hard Working Tax Payer – when we know something very different – that food banks are a symptom of an unequal society, that the more unequal the society the more miserable society becomes and that we have the lowest productivity in the whole of the G7. Social media is a tool that individuals use to subvert propaganda, but attending to the messages that we constantly berate ourselves with is another, more difficult matter.
It can be profoundly sad and even disturbing to understand that many of the beliefs we hold dear are nothing but empty words, to realise that the way we've lived to this point has been largely meaningless and for someone else's benefit. It takes time to understand how it happens at all, but if you find yourself wondering about this kind of thing then you're ready to explore it. There's a lot to cherish in the English (and British) way of being, we'd be foolish to reject all of it, and there's a lot that needs to be examined too.
*Written by Cecil Rhodes, who left England at the age of 9.
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