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Features

Sanity at work

Simon Parke

Would we ever dream of treating our bodies in the way we treat our minds? In the run up to Mental Health Week, Simon Parke argues that de-stigmatizing therapy in the workplace and society will ultimately restore a 'golden thread' that leads to the soul.

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From the moment Michael walked through the door, his attitude offered a challenge. It was as though he was saying, 'I'm depressed, I have been for all my 45 years on earth, I've given upon myself, physically and mentally and there's nothing that you as a therapist can do about it.' I allowed him his hostility and cynicism, the scene reminding me of a story in the gospels where Jesus asks an invalid of 38 years whether he actually wants to be healed. I did agree with Michael on one point: there was nothing I could do if he'd given up on himself, which was presumably the concern for Jesus as well.

But I questioned whether he really had given up on himself entirely. After all, he'd chosen to come and see me which suggested a small spark inside him still hoping to become a bonfire of well-being.

'The spark's gone out,' he'd said.

'Your presence here suggests otherwise,' I replied. 'This is the act of a hopeful man.' I also said that I didn't agree with his self-description: 'You say you're depressed, Michael, but you're not depressed, you're experiencing depression, and there's a difference. The one describes an all-consuming state, a sickness to your very core and allows no hope. The other accurately describes the feelings felt, which is important but views them as passing cloud. The cloud feels solid and real but it has neither substance nor permanence and behind it is blue sky. You are blue sky, Michael, through which the cloud of depression passes.'

BLUE SKY THINKING

In this optimistic mood, mine more than his, we went on to talk about his childhood. At the root of most depression is a closing down on unacceptable feelings, particularly our anger. We considered why he might have closed down on his feelings. Throughout our time together, 50 minutes, there was a part of Michael who remained determined to be unhealed, quick to dowse any light with gloom. But there was another part who could glimpse the blue sky, and when he did he smiled.

In one way, it was just another session with a client. But what was unusual here was this: when our time was up, Michael shook my hand, left the room and returned to his desk at work. We'd met on his company premises, in time paid for by his company. And I had five others from the company to see that day, employees who had signed up for a session.

It didn't just happen. I work for a social enterprise that exists to take mind help into the work place. This particular company had been suspicious at the outset. As the CEO put it: 'I don't want my work force all finding themselves and going off to Tibet!' But he kindly allowed me to talk with his employees on the shop floor and said if there was a take-up, he'd support it. Within two hours of me speaking, for ten minutes at lunch time, all six available places were taken and five out of the six were men. So are we beginning to take our mental well-being more seriously?

CRISIS PREVENTION

The idea behind this venture is to offer something that works in the preventative sphere before the problem becomes a crisis, in the same way that we go to our doctor for a check-up. Spot a symptom early and serious danger is often averted, and it's the same with talk therapy. We seek safe, insightful space in order to listen to ourselves, see ourselves, understand ourselves before a sense of discomfort becomes a full-blown emergency.

And we could push the doctor analogy further as we consider mental well-being, because the plain truth is this: we don't treat our physical bodies in the same way as we treat our minds. We wouldn't think twice about going to the doctor if we felt unwell physically. Yet if we're unwell in our minds - which we all are to a degree, with depression, anxiety or some unspecific discomfort which keeps us awake at night - we somehow imagine it will cure itself or that there's nothing to be done. We go to the gym to keep physically fit. But what do we do to keep our minds well - minds that so determine our happiness?

The NHS struggles with mental health. Last year, the London School of Economics published an illuminating report called 'How mental health loses out in the NHS' , in which it argues that underinvestment in mental health represents 'the most glaring case of health inequality in our country.' And the statistics produced are both revealing and worrying. Among people under 65, for instance, nearly half of all ill health is mental illness. In other words, nearly as much ill health is mental illness as all physical illnesses put together.

DISABLING DELAYS

The report also reveals that mental illness is now generally more debilitating than most chronic conditions. On average, a person with depression, like Michael, is at least 50 per cent more disabled than someone with angina, arthritis, asthma or diabetes.

So mental pain is as real as physical pain and it's often more severe. Yet only a quarter of all those with mental illness are in treatment, compared to the vast majority of those with physical conditions. As the report says, 'It is a real scandal that we have six million people with depression or crippling anxiety conditions and 700,000 children with problem behaviours, anxiety or depression. Yet three quarters of each group get no treatment.' Using technology, we can offer antibiotics to the suffering; but to cure depression requires time which is a harder commodity to find - and to pay for. So despite the advances made by the 'Improving access to psychological therapies programme,' the majority of those experiencing depression and anxiety still wait more than six months.

Nature abhors a vacuum and this hole in human care has been filled by drugs, usually courtesy of your GP. Wise? Your doctor knows what to do if you have the flu but if you're anxious or depressed? With only ten minutes to offer you amid their busy day, tranquillisers are seen as the only solution for those with mental health issues. There are currently an estimated 1.5 million people addicted to prescribed tranquillisers and sleeping tablets such as Valium, Temazepan and Mogadon.

THE GOLDEN THREAD

But two things should be noted here. Firstly, these drugs are only meant to be a short-term intervention lasting a few weeks, after which time they dangerously addictive.  As MIND states on its website, 'Since 1988, the guidelines have stated that they should be used for 2-4 weeks; however, doctors have ignored these guidelines leaving many patients on them for months, years and decades.'

And secondly, tranquillisers are not only addictive but also against healing, cutting us off from the feeling where our true healing lies. Our feelings are the golden thread leading us back to the source of our pain. When our feelings are numbed, the golden thread is cut and with it, the path to our healing. In the short term, we may be very glad of this numbing and those around us may breathe a huge sigh of relief.  But the long-term cost to our well-being is high. We are numb to the root of our problem and in some ways, numb to life itself. I recently listened to a man who had been addicted to tranquillisers for ten years and could really remember very little of that time. He was particularly sad to miss his children growing up.

One of the most healing aspects of talk therapy is the gift of safe space, which is surprisingly rare in our lives. It is certainly rare at work. Many organisations include some form of line-management and supervision in their employment structure. One aspect of this is to set targets for the employee, while another is to pick up on problems at work - and in the hands of a good manager, such meetings can be helpful. But we won't mistake this for safe space.

UNSAFE SPACE

I remember when I was a priest in the Church of England, the bishop was both our pastor and line-manager, an impossible combination and one that ensured significant dishonesty when meeting. Someone who has power over your career is neither safe nor a neutral space. Quite apart from anything else, your line-manager may be your biggest problem. That is certainly true for one company employee I saw recently. She described her boss as an emotional mess, increasingly drug-dependent and struggling with her job. My client felt that she did most of her boss' work, while earning £10,000 less. Supervision tended to be a frustrating and resentful space rather than a safe space.

But it's not just at work where safe space is at a premium. Friends, partners and family may not always be the safe space we need either, each with their own agendas. Freud said the analytic gaze must be 'without memory and without desire.' This will be hard for those close to us who may feel threatened by our issues or keener to solve them than understand them. Or perhaps our partner will simply decide their way is best, end of story. I was in one company recently where an employee called Dave told of a forthcoming house move:

'My wife and I moved into this house six months ago and I love it. But when we rented it, we agreed that if she didn't like it there, we'd move back to our old house. Well, she says she doesn't like it, so now we're going to move back. We'll have to buy somewhere smaller, because prices are higher. And I don't want somewhere smaller, I like the space we have now. We have one son and another on the way. Why are we moving back to something smaller? This could have been somewhere we could stay for 20 years. Still, we agreed, so I suppose we have to go. She doesn't like the idea of settling anywhere, she says the idea makes her feel ill.'

NOTICING EMOTION

It was important for Dave to notice how angry he was. He had a history of violence, picking fights until his late teens, but never thought of himself as an angry person. Now in his late 20s, his fighting days are done but his anger still sits inside him like a volcano waiting to explode. His initial attitude towards the house business was: 'It's fine, what will be will be.' But like a dog gnawing at a bone, he returned to it again and again as we spoke. He was furious and this was better noticed than not noticed.

We reflected on the origins of his anger and what he could do with it and what events tended to spark it. We noted that his wife ignoring his wishes was very hard for him, with loud echoes from his childhood where his wishes were also treated as nothing. Did he return to his work desk a happier man after our meeting? I don't know but he returned there a wiser man, more aware of the inner forces at work. And what we're aware of has immediately lost some of its power to hurt us.

I hope that was also true for Sylvia, who heads a department in a company and has three children to look after, aged three, five and 41. Almost half of all working women, 44 per cent, take time off in their career due to mental health problems and as I listened to the life that Sylvia juggled, it was not hard to see how she might become one of them. She began by saying how supportive her husband was but that wasn't the story that emerged. She described a man unable to face the truth about his own business. He was self-employed, which not only left Sylvia as the main bread-winner but had also forced them to move house away from her place of work. This meant she had to sleep on her sister's sofa three days a week, away from the family home. Meanwhile her husband was falling out with her friends and only stopping his tantrums when she put her foot down. I said he sounded like a stroppy five year old.

'Yes, she said. 'My sister says I have three children to look after.'

PUNISHING VOICES

Sometimes in talk therapy we're helped not by learning about ourselves but by learning about someone close to us, whether a business colleague or, in this case, partner. People can have a profound influence on our lives and space to reflect on relationships is precious. And sometimes we suddenly see why we're finding things so hard. One positive outcome may be that we stop punishing ourselves. My experience of myself and others is that we're not good at giving ourselves safe space, all too ready to judge ourselves, blame ourselves, punish ourselves: 'Oh, it's my fault, if only I could be better!'

It's remarkable how many victims blame themselves, hard-wired in this practice from their past. Blaming voices from our childhood have now been internalised. The original voices may have gone but they remain inside our head as though we now speak them ourselves. They are alien voices put inside us by another - but we've unwittingly adopted them and imagined that they represent our true self. No wonder we find it hard to give ourselves safe space! But this need not be so. As one client said to me recently: 'I'm learning, when I come away from a difficult work meeting, to ask: how much of that was down to me?' Prior to this, she always blamed herself if someone else was angry.

SAFE FROM OURSELVES

So sometimes the therapist is offering people safe space from themselves. It is a strange line to write but is endlessly true. This is how it was for Sylvia who was quick to blame herself for everything. Why? I hope it was also encouraging space for her, highlighting how much she has achieved along the way but also how much she has carried. And while on one level we solved nothing - her situation was the same when she left as when she arrived - she could at least now see her situation clearly. The truth is sometimes uncomfortable but it's better known than unknown, because once seen, it can be held, reflected upon and understood. As Jesus is recorded as saying in the gospel of John, 'The truth shall set you free.'

The bread and butter work of the social enterprise I represent is to take mind health into the work place, to offer accessible space to people who might not have made it happen themselves. But the bigger calling is to normalise the subject of mental health in society as a whole, to create a climate in which we respond to mind pain as quickly as we respond to physical pain.

On my last visit to a company, five out of six of those who came to see me were men and none had considered seeing a therapist before. And perhaps the cost of looking after our mental wellbeing is not as high as people imagine. The LSE report on the NHS and mental health quoted earlier estimates that the lack of attention to this area adds at least £10 billion each year to the cost of health care. Overall, they believe that the treatment of mental disorder would effectively cost nothing given the savings further down the line, both in time not taken off work and the physical ailments that are connected to mental illness.

RELIGIOUS SICKNESS

And where is the church on this? Mental health is not always high on religious agendas. There's sometimes the sense that it's somehow disrespectful to God to take too much care of your mind; that our mind is some untouchable entity, virgin land, that must be left alone, forbidden territory for believers:  'Trust God, pray more and everything will be fine' is the unspoken message. But there's nothing virginal about our mind and on the other side of the coin is the question: if we don't know ourselves, who we live with daily, how can we possibly claim to know God, who is elusive at the best of times?

I reflected earlier on people who hear the judgemental voice from the past, the voice of self-punishment and self-blame, replayed now as their own voice. How difficult it is for a believer not to hear that as God's voice, yet how mistaken they are when they do. Once we understand the voices inherited from our upbringing, we free God to be God rather than some dull echo of our difficult past. One definition of prayer is us offering as much as we know of ourselves to as much as we know of God. It is a definition that is at once kind and challenging.

And so we return to the shop floor, and someone leaving their work desk to go and reflect on their life for 50 minutes. They don't know what's going to happen and they've never done this before, all of which makes them the bravest of the brave. Will it do any good? They don't know. But somewhere inside there's the sense that the truth can make them well, even if it's difficult truth. So they push open the door, we greet each other.

I say, 'This time is your time and if it matters to you, it matters to me.'

They say, 'I really don't know where to begin.'

And then they do and somehow it makes all the sense in the world. As one employee said recently:

'I don't know why I didn't do this years ago.'

NOTES

1  Download the LSE report:  'How mental health loses out in the NHS': http://tiny.cc/negzrw

2 MIND web page on tranquiller addiction: http://tiny.cc/yjfzrw

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