Talking and eating

category: TTCFebruary 5th, it seems, was Time to Talk Day — part of the long-running Time to Change campaign led by mental health charities Mind and Rethink. The idea of the day was that everyone should take 5 minutes to have a conversation about mental health.

I sort of missed it, in that I didn’t realise the day was meant to be special until late in the evening. By that time I’d probably spent hours talking about mental health anyway, just as I do on any typical day.

But, as it happens, that day was special for me because I’d had an opportunity in the morning to talk about my own mental health. Following my recent heart attack I’d had a follow-up appointment with a nurse specialist, and during that appointment I did mention the depression that I’ve suffered from, on and off, since the attack.

So had I inadvertently taken part in Time to Talk Day anyway, by having a conversation about mental health that I wouldn’t ordinarily have had? In an important sense, no. Surprising though it may seem, that conversation about depression wasn’t a conversation about mental health.

Leg health

To understand why, it’s useful to think about a different kind of situation in which things are clearer. So let’s spend five minutes talking about leg health.

A while ago, I noticed that one of my car’s rear tyres was a bit flat. I know it has a slow leak, and I keep a foot pump in the boot to deal with it occasionally. So I pumped it up a bit before driving off. Using the foot pump is hard work. It wasn’t long before the muscles in my legs were sore.

Was I suffering from a leg health problem? No. Muscles always feel sore when you work them unusually hard for a while. That’s the way muscles are meant to work.

It would be a mistake to confuse sore muscles resulting from unusually hard activity with a medical condition like a broken leg. In the first case, the leg is working the way legs are meant to work. In the second case, the leg is working abnormally.

Indeed, there’s an important reason to avoid this kind of mistake. If you put the idea around that sore muscles are a medical condition, and confuse everyone about it sufficiently, clinics that deal with real medical conditions ranging from torn ligaments to broken bones, and worse, will become clogged with confused people whose legs are working perfectly normally.

In the worst scenario, clinics might find they prefer to treat people whose legs are working perfectly normally (because treating them is cheap and they recover nice and quickly), and people with real medical conditions won’t get the care they need.

Mental health

If you understand the issue with leg health, it’s not very hard to understand the same issue with mental health. The language is different, that’s all.

Suffering depression following a life-threatening event is an example of my mind working normally, just like suffering sore legs following unusual activity is an example of my leg muscles working normally. So my conversation about depression wasn’t a conversation about mental health.

Depression is particularly confusing because the same word is used to mean normal reactions to life’s events and also to mean abnormal mental conditions that need medical treatment. When someone says “I’m depressed” you can’t immediately tell whether that’s an aching muscles kind of depression or a fracture kind of depression. The only way to tell is by talking about it in more depth.

So, was Time to Talk Day intended to encourage that kind of in-depth discussion? Unfortunately not.

At this point, the Time to Talk Day video is instructive, and at only 44 seconds in length it’s worth watching in full:

It’s obvious that mental health isn’t ever mentioned by anyone in the video. It’s only in the caption near the end. Conversations in the video go like:

“So, how are you feeling?”

“Thanks for asking. I’ve had some tough mornings, but I’m feeling better today.”

And this is the complete conversation. Presumably the implication is meant to be that “some tough mornings” are a mental illness. That’s clearly…er…insane.

The video, and in some ways the Time to Change campaign as a whole, deliberately portrays ordinary everyday life as illness. Just as with leg health, there’s an important reason to avoid this kind of mistake. If you put the idea around that tough mornings and the like are a mental illness, and confuse everyone about it sufficiently, clinics that deal with real mental illnesses will become clogged with people whose minds are working perfectly normally.

Time to Change claims to be an anti-stigma campaign. That is, it claims that people suffering from mental illness are being treated differently just because they are ill, and it would be better to treat them just like anyone else. We should treat everyone in the same way as we treat people who are well.

The trouble is, we really do want the NHS to treat people differently depending on whether they are ill or not. We don’t want NHS clinics clogged with people who have no more to complain about than some tough mornings. We don’t want the NHS to ignore illness and pretend everyone is well. Time to Change tends to promote the opposite effect to the one it claims to want, by encouraging the idea that everyone is ill and illness is something it’s best to ignore.

Eating

Coincidentally, the day before Time to Talk Day I sat in on a support group for people with eating disorders, their family members and carers, run by the charity Beat, which runs these support groups all over the country. I was very impressed, but in some ways a bit confused.

I was very impressed by the friendly and supportive atmosphere in the group. Even people new to the group seemed to find it easy to fit in straight away. Yet there was also a depth of knowledge and experience from some of the group members who have spent years dealing with these bewildering, distressing and sometimes fatal illnesses. My recommendation probably counts for very little, but I’d thoroughly recommend these groups to anyone who has an eating disorder or who’s trying to help someone with an eating disorder.

I was a bit confused by the tales some people in the group told of NHS treatment, which sometimes seemed to me to be uncaring and clinically ineffective. Eating disorders can be very serious conditions, and it upsets me to think that our NHS doesn’t always provide good treatment to people who suffer from them. It wasn’t immediately obvious why the NHS would choose to behave like this.

My confusion lasted until the next day, when I thought through the implications of Time to Talk Day. When ordinary everyday life is portrayed as illness, it seems to me that this can result in people who are so seriously ill that their lives are no longer ordinary getting pushed aside.

A “How are you feeling? Thanks for asking” kind of conversation falls insultingly short of what’s really going on for people with serious mental illness. Even within the NHS, professionals sometimes seem unaware of this. That could explain why they sometimes don’t seem to care, and they sometimes seem content to provide treatments that don’t work.

It’s ironic that, just as the idea of parity of esteem for mental health and physical health seems to be taking hold in some circles, there’s a successful campaign to downgrade mental illness and pretend it’s no different from everyday life, a campaign that may be degrading the quality of care in the NHS (even though it probably benefits Mind and Rethink).

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About Rod

Chairman of the Gloucestershire charity Suicide Crisis, Vice Chair of Relate Gloucestershire & Swindon, and an enthusiast for public involvement in the NHS.
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2 Responses to Talking and eating

  1. Thank you for taking the time to visit the BEAT group and for your interesting thoughts.

    I can’t agree that “the NHS” (and surely such a huge organisation as the largest employer in Europe can’t just be considered as a whole) is “choosing” to let people with eating disorders down. All the clinicians I have met in our journey, even those I have absolutely loathed, have been desperately trying to provide the best possible treatment for their patients according to their own beliefs and training as to what that is. Undoubtedly there is wastage and bad planning as there is in any organisation (or household) and we do as a society have a duty to watch out for them. In particular in the field of eating disorders, loosely worded and poorly conceived “prevention” initiatives would certainly not be any priority of mine. There’s a very real danger that events such as “Eating Disorders Awareness Week” http://www.b-eat.co.uk/support-us/get-involved/eating-disorders-awareness-week/ will be much like the Time to Talk initiative and take away real understanding from the general public rather than add to it. Without doubt there will be at least one misleading and possibly dangerous article in the Daily Mail in the week.

    However I don’t see that as the reason why CLINICAL SERVICES are struggling. NHS psychiatric services aren’t over-run by the worried well, they are struggling to provide any kind of diagnostic, let alone treatment, service to the sick.

    One problem in Eating Disorders is that there really isn’t enough evidence yet as to what IS the best treatment, and that, patients being individuals and the illness being complex, it isn’t likely to be the same for everyone. It’s the same with cancer or any other complex illness.

    Another is a lack of resources. Mental health care has been an underfunded afterthought since the beginning of the NHS and before. Eating Disorders are misunderstood conditions even among the mental health care profession (for a start they’re not even listed as mental illnesses in such places as the GP Quality Outcomes Framework). Are patients who fall more neatly into diagnostic categories or who do not have comorbid conditions which make treatment more difficult, easier to treat? Absolutely? Are they being seen at the expense of more difficult patients? Occasionally perhaps, but surely people who are fortunate enough only to have one condition at a time and to respond to the first line treatment need and deserve NHS care. Hard working clinicians need and deserve a straightforward case or two as well, and this is from someone whose family as a whole definitiely did NOT respond well to the evidence-based first line treatment we were given. Are patients who are not really ill at all being treated by the NHS at the expense of those who are? No, and I doubt they will be even after Eating Disorders Awareness Week

  2. Fiona Marcella says:

    By the way, in linking to the BEAT site for EDAW I was trying merely to advertise it, not to suggest that any of the sillier outcomes of the week will come from BEAT. They won’t. But there are plenty of others poised to use the week to talk Barbie Dolls or body confidence instead of the real, sometimes fatal, mental illness that Eating Disorders are

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