Can Some Treatment For Mental Health Problems Make Issues Worse?

Peanuts are a great source of protein, anti oxidants, and have been shown to be beneficial to heart health. When I eat a peanut, my heart throws a little fiesta in celebration and uses every ounce of peanut to make itself extra awesome. When my imaginary friend Jimmy eats a peanut however, he explodes and turns into a bucket of water (Jimmy has a very severe imaginary peanut allergy. Don’t worry though, I gave him an imaginary unicorn to ride on as compensation for his unfortunate condition). 

Clearly then, sometimes, things that are supposed to be good for us and that are supposed to be beneficial to our health don’t work for some people, and the same can be said of mental health treatment. 

Now before I get carried away I would like to express that I am VERY grateful for all of the mental health treatment I have received over the years, even the things that haven’t worked out, because they have taught me what kind of things do and don’t work for me. I know I am very fortunate to have had so much and such a variety of support, as there are all too many people out there who don’t get any treatment at all and that is heartbreaking. Anyone suffering with a mental health condition should be able to access treatment, end of discussion, so I am not saying “screw all of you people who have never had any help, I have had some unhelpful help so pity me”. 

Instead, I think it is important to look at some aspects of mental health treatment that can maybe cause more problems than they solve so that we can improve that treatment and make it better in the future. It is all well and good to say “all treatment is good treatment and you should just take it no matter what” but if we did that we would never move further in the ways people with mental health problems are supported and increase the benefits that support can bring.

Hundreds of years ago, people with what we might potentially diagnose with mental health problems, were seen to have evil spirits lurking inside of them and were treated by having a drill shoved through their skull to let the spirits out. If nobody had ever stopped to think “hey, maybe this bashing people about the head isn’t very helpful after all”, we might still be doing that today (which would make my weekly trip to my psychologist even more terrifying), so although I don’t think anything around today is as detrimental as head drilling, I have personally found some treatments to be quite problematic. In this post I therefore I want to be seen as looking at the peanuts and trying to keep all the goodness in whilst getting rid of all that stuff that turns imaginary people like poor Jimmy into imaginary buckets, rather than as throwing all the peanuts into the bin and declaring them all to be useless. 

I am sure there are a lot of people out there who can attest to treatments that have been more detrimental than helpful in the sense that a lot of times, group treatments and inpatient settings can be rather triggering. I have known many people who have picked up behaviours from other people they have met in hospital, but I think this is less a problem of the style of treatment and more a problem with the competitive/comparative nature of certain illnesses themselves. It would be unrealistic to say that everyone who is ever hospitalised should be kept in a separate room away from other potentially triggering patients because that isn’t real life, there are always going to be people who trigger you no matter where you are, and the key is to learn to deal with and manage that. 

When it comes to problems with treatment however, an important example for me in terms of an actual treatment style that made things worse for me, was a certain inpatient unit I was in for my eating disorder, and their extreme “this is the most important thing ever” focus on weight. 

Before I went to that unit, I did not weigh myself, nor did I care about the number of kilos on the scale or what my BMI was. 

My eating disorder was all about how I saw myself in the mirror and how I felt inside. Some days I would struggle more because I “felt” and saw myself as extra disgusting, whereas other days I would do better because I maybe didn’t feel as terrible about myself. 

If I had been weighing myself during those times, there probably wouldn’t have been much difference between the numbers shown on the scales on the days that I “felt massive” compared to the days I “felt not as bad”, like I said, it was all subjective and all internally measured by my emotions as apposed to any little plastic square I could stand on that would then flash numbers at me. Ok, I counted calories obsessively, but when it came to weights, numbers were irrelevant to me, and if you had told me what I weighed it wouldn’t have had any meaning to me. 

During my first inpatient admission for my eating disorder however, all of that changed, and it is since that admission that my eating disorder has progressed to the point where my it is still concerned with how I feel but also obsessed with the number on the scales and the great significance “what that means” (spoiler alert: it means very little nothing at all in terms of a person’s self worth or value on this planet. That kind of thing is instead measured by how lovely you are to people and whether or not you are one of those cheeky people who puts an empty carton of milk back in the fridge just to destroy someone’s morning hopes of a bowl of Coco Pops. THE MILK CANNOT TURN CHOCOLATEY IF YOU DON’T LEAVE ME ANY MILK).

I understand that in eating disorder treatment it is important to be aware of weight to a certain degree for various reasons (not that the weight of someone with an eating disorder will tell you how ill they are or how physically at risk they are of serious complications), but in this unit, weight meant EVERYTHING and every number on the BMI scale had a significant consequence to it. It would have been one thing if there was a rough weight band stage thing to use as a guide, but instead of that each number specifically told you what you were allowed or not allowed to do. 

Some I could vaguely understand. There was a weight at which you were allowed to do yoga for example, a weight at which you could go bowling, and a weight at which you were given permission to walk around the grounds. It is the more arbitrary number obsessions that I think should have been focused more on the individual and their struggles/progress, rather than simply basing it on silly numbers. For example there was a weight under which you were not allowed to pick your own food at lunch and instead had to keep your fingers crossed that the nurse wouldn’t pick the one option that you genuinely hated for reasons outside of your eating disorder, a weight at which you were allowed to pour your own milk into your cereal, even a weight you had to reach to earn the right to spread butter and jam on your own toast. 

Again I get the importance of this, very early on in treatment people may be unable to spread an acceptable amount of toppings on their toast or decide what option to chose at lunch so that extra support may be warranted, but who is at what stage should not have been decided by weight alone. 

For example what if someone who was severely unwell came onto the unit above the weight of toast spreading privilege. Was it fair to leave them wrestling with the marmalade on day one just because their weight was a few digits out? And what about people who mentally progressed very quickly and although they came in at low weights were able to manage marmalade responsibility before their weight reached acceptable levels. I knew of several people whose bodies struggled to gain weight no matter what they ate and they got frustrated in feeling mentally held back by not being allowed to spread their own toast or pick from the options at lunch themselves, skills that would have been beneficial for them to practice to carry out responsibly. 

Obviously if they had started demanding dry toast and a celery stick for meals it might not have been the best idea, but neither is holding people back or pushing them forward simply because of a number that doesn’t measure the mental part of the mental illness. 

Like I said, before that admission, weight was not a concern, but ever since then, what I weigh has always been significant, and I still think of my personal weight as a measure of how well I am to some degree, regardless of the mental struggle. Even now I still see those weights as the “well enough to spread jam” weight which allows my head to use these opportunities when I am at these weights to convince me that I am “ok now” (clearly when one has the ability to spread jam on one’s own toast it means that a person is fully recovered and needs no other progress to enable a healthy life…YAY EATING DISORDER LOGIC.) It just seems a bit confusing to me how so many therapists and eating disorder services over the years will tell you to “ignore the number” and tell you that “it doesn’t matter”…yet then go on to measure your level of wellness by that number and dictate your rights accordingly, showing that it actually matters and means a lot…contradictory much? 

The second example of treatment that I personally think caused more problems than it solved was my first admission to hospital when I was about 11. Admittedly I needed to be there, my OCD behaviours were controlling my life, everything was completely out of hand and someone needed to step in, but remember I was a scared 11 year old suddenly waking up in this mental hospital and  living away from home for the first time. I needed treatment yes, but primarily, I needed mental support, and that wasn’t what I got.  

My shower and soap rituals were instead physically controlled by means such as locking me out of the bathroom and stealing my soap. Now, exposure therapy for things like OCD is a very valid method of treatment, you are scared of something, you expose yourself to it, people help you through that exposure with support and you keep practicing until it isn’t scary anymore. 

Problem was, I had nobody to help me work through that exposure, all treatment was physical and ironically there was no mental support whatsoever despite the fact it was a mental hospital. 

Therefore, instead of working through my problems, I was just traumatised for weeks and left to struggle alone in absolute terror, so naturally, when I went home, I was not a fan of psychologists and would refuse further treatment. Had they worked with rather than “on” me, I would have trusted them and would have seen them as people I could work with to get through my problems, but in my 11 year old brain that experience taught me that therapists were nasty people who take you away from your parents, lock your bathroom, leave you to suffer alone and then send you home with all the mental pain you had before plus a little bit of bonus anxiety. Consequently, there were several years where I refused to see therapists and would lock myself in our home bathroom when they came to visit, refuse to go to clinics, or “forget” to leave lessons when they came to visit at school for sessions (that’s right…I hated therapy so much I voluntarily stayed in Maths lessons that I was allowed to get out of…MATHS!)

It has taken a long time for me to get to the point where I can trust therapists again, actually talk to them, see them as humans rather than soap stealing villains, and still every mention of exposure therapy sends me bananas because my first bad experience of it has not left me excited to give it another go… 

So, can certain kinds of mental health treatments actually make a person worse? Well, yes, and though I think it is important to try new things and approaches, it is equally important not to label all treatment as helpful and to be able to critique the bits that maybe aren’t as helpful and could use a bit of a rethink so that we can improve them, keep the good and edit out the bad, or else we would still be in the time of drilling people in the head, and nobody wants that. By all means use a drill to put up a nice painting or build a table, but when it comes to my noggin, I would rather you kept all power tools at a safe distance. 

Take care everyone x 

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The Difficulty Of Eating In Public When You Have An Eating Disorder

To the average person the idea of going out to eat is a pleasant one, and when someone suggests going out for a coffee and a piece of cake in a local cafe or out to dinner at a fancy Italian restaurant, the usual reaction would be “Why yes what a lovely idea”, or “of course! I think I shall order the lasagne”.
To someone with an eating disorder however, it is likely that the idea of eating food out will be a terrifying one, reserved to the realms of nightmares rather than sweet dreams, and if you are anything like me when it comes to life with my eating disorder, it is likely you would rather dance a tango with a giant hairy spider than go out to “grab a bite to eat”. It is for this very reason that when I was in ward round this week and I was told that I had to go out to a local coffee shop for a snack with a member of staff, I started to wish there was a chance to whip out my dancing shoes and go to a ballroom with an enormous arachnid instead.

It is silly really because like I said, as a rule people generally enjoy going out for food (even if, like my mum, that is simply because you don’t have to wash up at the end of the meal), but for me there are so many things to be scared of and I don’t think people realise just how many things there are to worry about when it comes to going out for something to eat when you have an eating disorder rampaging in your frontal lobes.

First off there is the difficult task of looking at a menu and choosing what you are going to eat. Alright you may have to make some food choices in the home or out at the supermarket, so choosing food shouldn’t be a sudden and new experience, but at least with that kind of thing you can plan far in advance and prepare what you are having yourself so you know exactly what the meal comprises of. When you are eating out however, the ability to plan everything and control each stage of the process is whipped out from under you quicker than a slippery yoga mat on a vaseline coated floor. Ok, nowadays most restaurants and cafes tend to have menus online so in a sense you can prepare for what you are going to attempt and do not have to make a choice on the spot, but even if you make a choice from an online menu you can never guarantee that what you decide on will be available in the branch of the restaurant that you visit in particular. What if you have your heart set on the roasted aubergine spaghetti and then get to the table only to be confronted by a waiter breaking the news to you that they are all out of pasta and severely lacking in terms of aubergine supplies? What if you get your head all psyched up to tackle a chocolate muffin with multicoloured sugar strands and then find that the muffin man got caught in a traffic jam on the way to deliver his cocoa rich rainbow sprinkled delights? HOW CAN ONE RELAX AND MAKE A DECISION WHEN THE WHEREABOUTS OF THE MUFFIN MAN AND AUBERGINES ARE ALL UNKNOWN?

Then again, what if the aubergine harvest has been plentiful and the chef can prepare your chosen dish? How are they going to prepare it? How much pasta will they use? Will there be oil? Will there be butter? How will it be arranged? Will the sauce be served on top of or mixed into the spaghetti? Exactly what kind of concoction should you expect? Also what if you can’t even get that far and can’t make a decision as to what to have in the first place, either because there are too many options or not enough safe ones? When it comes to people going to restaurants a little bird told me (a very little bird. about half the size of Tweety Pie to be exact) that people chose what they “fancy,” but again when you have an eating disorder and find most of your decisions controlled by calories and grams of fat, what exactly does it mean to “fancy” something?

Even when food is chosen and aubergines can be found in abundance, the worries don’t end because then you have what I would say is the hardest thing about going out for food and the thing that I worried about most after this news about a snack out had been broken to me: eating in public. Indeed the choosing from a menu worry wasn’t even what made me anxious about the excursion as when I went out for snack with my nurse I actually took the food with me to the coffee shop from the hospital (not that that is technically allowed in terms of coffee shop table taking up without making a purchase regulations, but when you are terrified and have an eating disorder you don’t give a damn about the rules!), so it wasn’t the menu issue but the eating in public part that was troubling me.

Truth is, when I eat I prefer to do it in private because even though I am well aware that other people have too many things on their minds and in their lives to have space to think about what is on my plate, I am always paranoid that everyone around is looking and judging me for every mouthful that I consume. Why do I care what random strangers have to say about my choice of snack of an afternoon? I have no idea. Why do I think that a business woman on her lunch break or a student cramming for an exam over an espresso and a laptop, care about whether or not I eat a hobnob? Who knows, but regardless of the reason, I do care and I care a lot. For other people I do not see the act of eating as something to be ashamed of at all but when it comes to me there is something so guilt and shame filled about it that the idea of eating in public is sort of how I imagine the idea of showering in public would feel to most people, aka self conscious and like you want to throw a sponge and curl up in a ball so nobody can see you.

No matter what you do or what you eat, it feels like everyone is staring at and judging you, even if you can see for a fact that others around you may even be eating more than what you have on your plate and are not actually looking anywhere near your direction. When I was out for snack there were plenty of people busy reading papers over plates far fuller than mine, yet still I thought that they were somehow looking at me with some kind of laser vision and thinking that I was greedy for attempting what I had before me. It was so bad that just to get through the snack I had to close my eyes and play that childhood game where you imagine that because you can’t see other people ,they can’t see you either (side note: it is surprisingly hard to eat a snack when you can’t actually see it…).
Somehow I got through it using my head down, eyes closed, just keep munching method but still it was a horrendous experience and one that I am not planning to repeat in the near future or ever if I can help it.

Overall then, though it would seem that the idea of eating out in public, either for a snack or a meal, is some kind of treat to be looked forward to, when you have an eating disorder, it really isn’t that simple a task nor is it a particularly enjoyable one either. Like I said, I know I for one am not going to be attempting such a thing again voluntarily simply because even without the ordering stress and malarky it is the actual act of eating in public and being judged (however irrational that thought may be), that causes all of the anxiety. A snack out in a coffee shop may be a piece of cake physically, but in practice I can assure you that it certainly isn’t! PLEASE DON’T EVER MAKE ME DO IT AGAIN!

Take care everyone x

EatingPublic