Wednesday, 23 June 2010

Turning 30.

I feel I should write something about turning 30, as I am about to do so in July. I don’t dread it but it is a bit of a mile stone, so here is a ramble on my thoughts.

For me turning 30 is the next big step after turning 18 and becoming an adult (21 didn’t mean much in all honesty). I feel I am now a proper grown up, an adult, responsible and I do grown up things. Don’t get me wrong I still do immature things and have my silly moments, but I do own a house, I have a career and I have debt. They are grown up things, right?

I know it is incredibly cliché but I do think I now know myself better, I have “grown as a person” (I actually shuddered as I wrote that). What I mean by this is that at the age of 18 you think you know it all and the world is your oyster, at 30 you are more realistic (well I am anyway). I have cemented some beliefs and opinions, and on some of those opinions I even think I have enough knowledge to argue my point. The thing is, that I don’t think it is necessarily the fact I am almost 30, it could have taken me until I was 31 to feel like this, or I could have felt it earlier. A lot has happened in the last few months to make me feel more comfortable with my sense of self, but I know that my life experiences also had a lot to do with it, the ended relationships, the times at university, jobs, and the choices I have made. The only way in which this is linked to me turning 30 is that at this point in my life I have chosen to reflect on the last few years, as I believe may be a bit of a tradition.

In all honesty when reflecting there is a tiny sense of fear. Have I done enough by this age? But then I am rational now. I used to have a list of things I wanted to achieve by the time I was 30. I will embarrass myself and tell you what they were and then explain how I feel about them now (I’m hoping I will get them straight in my own head and feel ok).

- Goal 1 – Be married by the time I am 30 (it was actually by my late 20s). This was one of those dreams I had when I was 18, when life was simple. Of course it would be easy to meet a man, fall in love and be married by the time I was 30. In reality it is not, don’t get me wrong I have thought I have been close, I have been in committed relationships, they did of course end for various reasons. I now realise (as I have blogged about before) that not only is love not that simple, but that I’m not even sure I feel the need to get married anymore. I would like to meet someone and be in love, who wouldn’t? But I have enjoyed my recent spell of being single. I no longer feel the need to do what is expected of me by society (not all of you I know), I just want to be happy, and right now I am.

- Goal 2 – Have my first child at the age of 30. Yet again another dream from when I was younger. I thought having a child at the age of 30 was the ideal age. I could have established a career and had some fun, and have a child before I am too old for it to be a more difficult process and I had the energy. Again as I have got older I have realised that I am not even sure that I want children. I’m not sure I don’t either. I think it will depend on if/when I meet the right person and how our life grows together. I like the idea of the freedom of not having children, in that I can be selfish and live my life how I want to, without the added responsibilities. But I also know the great rewards from having children. For now I am happy with my 14 nieces and nephews and 4 god children (yes my friend does know I am an atheist, but we have agreed it is about moral guardianship and being close to the children). I get the benefits without the responsibilities. Some of my family and friends do seem to judge me, asking “When are you going to have kids? You need to find a man.”. To me this is just wrong, to rush into having children or a relationship is dangerous, I know for some people it does work, good for them. But for many it is the beginning of the end, without the right foundations these things can go wrong and be a struggle (I know they can go wrong even with the right foundations). So for this particular goal, what will be, will be, I’m in no rush. And if it doesn’t happen, I can live with that.

- Goal 3 – Have a career. Not an unrealistic goal I feel. I was always determined to go to university and I did. I was the first person in my extended family to do so. After university I was lost for a while. I chose to do psychology and then found I could not access an assistant psychology post as I got a 2:1 and didn’t have a wealth of voluntary experience as I had to work my way through university, so had little spare time. So I drifted unsure what to do, working in retail (the careers advice at university really should have been better). Until I stumbled upon an advert in the local paper for mental health nursing training. The rest is history. I have a career. I have progressed within it gained promotions and I am really looking forward to the way my career is going to change in the next few months as our services are developed. Job done. (I did also want to earn my age, as a pipe dream, which would mean I should earn 30k now. I don’t, I guess I shouldn’t have chosen nursing if it was about the money. I am happy with my choice).

- Goal 4 – Own a house. I do. I would say job done on that score except it is not that simple. I have a huge financial commitment hanging over my head. Times have changed, this may not be such a good thing. With the economy the way it is I actually probably owe more on my house than it is worth. I hope that as the economy improves (and I hope it does) things will change. This does put me in a difficult position. I have itchy feet, I want to move to London or even Manchester (where I went to university). I crave the independence and adventure. To find a job there wouldn’t be too hard as I have 6 and half years of experience and a lot of extra training, but I have a house here. Perhaps my rush and desire to own a house was flawed. It is too late now. I will have to wait it out or look at other options if I do ever seriously decide to move.

They were my goals. I don’t think I have done too bad, or at least I have reassessed my goals and what is important to me. So turning 30 is not so scary, it is not too old to do anything. I now try not to have such fixed goals, but to be happy. I have realised more recently that I have been more happy as I have had more fun experiences. It has not been about possessions, money or having things, or even babies. Experiences have given me memories, but before that they have given me excitement in the build up and the opportunity to meet new people. I have just started reading Prof Richard Wiseman’s 59 Seconds: Think a Little Change A Lot and my suspicions have been confirmed in the research cited within the first couple of chapters. People are more happy if they have more fun experiences rather than if they have material needs met. It is also about connections with people and giving to others where you can (not necessarily money/gifts but time and compliments). This is how I plan to continue.

So in summary, I haven’t achieved my goals I wanted to by the time I was 30, but I don’t care. My goals have changed, I have changed. I look forward to the adventure of the coming years and try my best to not see it as a ticking clock where the time is running out. I aim to make the most of all the time I have, after all none of us know how long we have (yes, you may be a little bit sick in your mouth thanks to that mushy outburst). Thanks for reading my ramble. I do feel better now. See it worked.

Oh and it may be worth pointing out that I have avoided the traditional 30th birthday party with my twin sister (yes she is annoyed so I have to go to Alton Towers with her the week before). I am spending the weekend in London having some comedy adventures with some lovely people I have met over the last few months. Then on my actual birthday I am going to the #PreciousLittle live podcast party, where I hope to meet more new people and I am pretty much guaranteed laughs and beer. Perfect.

Tuesday, 15 June 2010

In Touch With Reality?

Last night I went to Skeptics in the Pub in Sheffield, where Professor Chris French was speaking around the subject of memory and cognitive processes in relation to anomalistic psychology and the paranormal. It was a very interesting but what followed stirred my interest further. It was something that was said in the Q&A after, Chris said “It is not always a good thing to be in touch with reality”, this is an idea I want explore in this blog. It was discussed last night and I will dip into the ideas mentioned there but it inspired me to think further about it.

The main idea discussed was that reality is based on a spectrum and is largely culturally grounded. I’m sure some people in the world would consider someone who believed that some wine was the actual blood of Christ, or that shouting at the sky would make it rain are totally delusional ideas, yet with cultural relevance of a tribe or religion they make some sense. I am not saying they are logical or have any grounding in evidence, just that you would not have someone sectioned under the Mental Health Act for it.

I will warn you, I go a little off topic here, but I will be back...

This was how it was discussed last night. It is in fact more serious than you might consider, when people are detained under the Mental Health Act for the first time it is initially for a period of assessment, this can be 72 hours (if brought on a section 136 or 135 by the police to a place of safety, or already an inpatient, requiring further assessment by another doctor and a social worker) or it can be up to 28 days (Section2). Of course there are other sections of the Mental Health used to detain patients in hospital for longer periods, but the initial decision/diagnosis of a mental health problem should be done in that brief period. The reason why there is a period of assessment is that there can be many reasons for the appearance of what some people may consider a “mental health problem”. For someone to even get put on a Section 2, 3 health professionals (and or a nearest relative) must agree that it is the appropriate course of action.

Unfortunately, it can often be the use of drugs or alcohol, where use of or withdrawal from can lead to psychotic symptoms. Sometimes, particularly in the elderly an infection or illness can produce such symptoms. In such cases it is often found that once cause is established and treatment started the condition rapidly improves (although not always with drug induced psychosis, as repeated episodes can lead to slower recovery, prolonged illness and a diagnosis of schizophrenia) further detention in hospital is not usually necessary.

In other cases, and here is why I am on this topic, an interpreter needs to be sought and explanations looked into for behaviours that have or are still occurring. I have seen cases where clinicians have believed phrases/actions to be evidence of psychosis, but with further knowledge found that they are actually expressions of grief/religion in other cultures. In our catchment area there are a lot of refugees/asylum seekers, this means that not only do we get a large variety of languages/cultures to understand but also a lot of people who have been through traumatic events and may seek mental health services. Understanding such cases, does take some time and digging for relevant information. The reason I bring this up, is that we should all be aware of our own cultural biases. What we may judge as abnormal or even insane behaviour may be perfectly “normal” (for want of a better word) in another culture, just as some behaviours we see as everyday things may be perceived differently in another country. We should all make an effort to be aware of such perceptions and judgements. I am as guilty as the next person of such bias; even the other day as I tucked into my sausage sandwich, I was shocked at my friend Geoff for eating okra and chilli for breakfast with his fingers, but in Ghana that was perfectly normal. (A less extreme example I know, but I am aware of confidentiality issues).

Now back to reality (I mean back on topic)...

As stated before it should be seen as a scale, and in fact some loss of touch with reality can be a good thing. As Professor Chris French said last night, you or I have an unrealistic optimism; we believe good things will happen in life (lottery win, pay rise, better job, or fall in love) where as when it is looked at depressed people have it more accurate than us. I don’t want us to all get depressed, optimism is good, but it is not based on facts and figures, on evidence, therefore it is not based on reality. Yet it is a cultural norm, for thousands and thousands of people to play the lottery every week, something I believe some cultures would neither approve of nor understand when you consider what could be done with that kind of money. I want to continue to hope for a better job/life but I have no evidence it will happen (I do not however believe in fate, I do believe in consequences and coincidences, and if the right ones occur I may have some unexpected wonderful experiences, I choose to look at life this way instead of the pessimistic way).

Some people like to be a little eccentric, different, odd maybe. And in my opinion (and I am sure there are numerous references for it) there are people who like being “a little bit mad” (I know not a PC term, but let me explain).There are people with personality traits that do not fit “the norm”, they may appear a little odd, sometimes make people uncomfortable, but they get on with life and do no one any harm.

I have met several patients who have had mental health problems for a number of years, this is something they learn to cope with in their own unique ways, yes we offer advice, support, education and medication, but they still have to cope on a daily basis. Occasionally we may suggest a new treatment to a patient, at this point I have had discussions where a patient has to consider what it would be like to not “have voices” or fixed beliefs, something which can be frightening and incomprehensible, especially if they cannot remember how they were prior to being unwell. Some people as they recover have even reported missing their “voices” (not all auditory hallucinations are negative or abusive, some are supportive although this is less common) a sense of loss. I know this is more about coping with change and regaining “touch with reality” but we must consider that it is not always what the person wants it is sometimes what society wants, and therefore a much more difficult transition.

People with Bipolar disorder often report that they like being “slightly high”, that is just on the edge of a manic episode, and why not? There is elevation of mood, motivation, energy, creativity, a lack of need for sleep, however as mania worsens there is even less sleep and a detrimental effect on health including irrational behaviours (which can include spending, sexual dis-inhibition, mood swings, aggression, risk taking). There is point at which mania is for some people, rather nice, imagine an overwhelming optimism and belief in your own abilities (not necessarily an accurate belief), unfortunately health professionals and relatives (and many patients) know this stage does not last and that medication and support are needed to stabilise the condition or treat the full manic episode, this can mean a substantial period in hospital.

I know I have wondered off topic (again) from what we discussed at Skeptics in the Pub, into mental health but as was stated last night, being in touch with reality or not is absolutely fine, what matters is how it impacts on your life and the lives of those around you. You cannot believe you have the right to run the streets with a machete demanding things, and I’m sure there would be concerns if you would not leave your house due to fear of alien attack, to the point where you did not buy food. But for some people to believe in a man sitting on a cloud in the sky watching over them and they go to a building to talk or sing about this, or really believe that next week they might win the lottery if they are “lucky”, then fine, I can tolerate that. I can’t say it is logical or an opinion I share (although I have been guilty of buying random lottery tickets infrequently, even though I know the maths), but sometimes I may hold such beliefs even with flawed logic. A little blind optimism goes a long way (sometimes).

As a skeptic the way in which I find this unacceptable is if someone is provided with evidence for/against such beliefs (or fails to provide any evidence, but state they know it is true), and then they continue to hold their views. If a patient at work were to introduce me to the alien that had abducted him, or show me the implant via an x-ray, then of course I would believe them and help them barricade themselves in a suitably protected place, I would not give them anti-psychotic medication. I do jest slightly, there are extremes, believing in aliens is not necessarily evidence of mental health problems (I remain agnostic about them I have seen no evidence they exists, but am aware that there are probabilities suggesting it is possible). It is where there is significant impact on life despite a lack of evidence, where such beliefs are detrimental to a person’s or other people’s health or safety that steps need to be taken, whether it be the diagnosis of a mental health problem or correction of a flawed cultural system (e.g. the way in which religion impacted on and still does impact on education).

As stated at the beginning of this very long ramble, it all depends on cultural relevance as well as impact on daily life and other’s lives. I don’t think I do ever want to be truly logical all of the time, like some kind of Vulcan (yes I know they are fictional too). I like my occasional naivety, my small irrational beliefs. I do still press the button at a pedestrian crossing over and over, knowing it will not make the lights change faster. I don’t mind that some people hold stronger irrational beliefs than me, I do mind if it gets the way of people’s health or well being, so someone believing in faith healing for example and avoiding medicine in order to seek such “treatment” and encouraging others to do so, I cannot condone at all and I would openly object to. Yes, in an ideal world everyone would be a skeptic, but I don’t think we can be, nor should we be logical about everything all of the time, a little loss of touch with reality can be quite refreshing.

Thanks if you made it this far, feel free to correct me, disagree, agree. (please don't be too harsh I am poorly today).