Baring our bones – the importance of writing and talking openly about our experiences of mental… Baring our bones – the importance of writing and talking openly about our experiences of mental illness, and the emergence of a #metoo movement of our own. The shame has lit the way. I was quite invisible until a few years ago, when an article I wrote about mental health shaming within my own profession of clinical psychology (https://thepsychologist.bps.org.uk/threat-coming-inside-house) was published in The Psychologist magazine. I wrote about how I had noticed on social media that some of the most vicious shaming, directed at those who had plucked up the courage to write about their own lived experience of mental illness, came from mental health professionals themselves. I also referred to a study that showed how clinical psychologists with lived experience are afraid to speak up at work about their difficulties, and that the shaming comes from members of my own profession. The cruelty is the point. After my article came out, the slow but steady drip drip of mental health shaming I had previously experienced immediately became a torrent. Replies to my posts seethed and squealed with anger and bitterness, as though my personal account had somehow been read as an attack on those who had dismissed my article (which I suspect they had not in fact read) as evidence of my ‘biomedical extremist’ (sic) bias. Shaming was a theme: I was described as drugged, a drug pusher, drugging my children, a psycho, personality disordered, a narcissist, and playing the victim. Oddly, I was accused of harming survivors, even though my article was largely based on my own survival, and that of service users whose adverse experiences with psychiatry I had quoted at length. Since then, the shaming has continued, although these days it has receded to a very slow trickle rather than a roar. Sometimes it is overt, crass, and shrill, a kind of fire and brimstone reminiscent of the ranting of a peripatetic whisky priest, but at other times it seems a sort of verbal D flat, embedded in a quasi-philosophical discourse led by pretentious professors who drip with disdain at those deemed weak for succumbing to mental illness, and who rail at the power wielded by psychiatry and the medicalisation of ‘normal distress’. I would emphasise that my allies who are currently receiving care from mental health services are also subject to exactly this kind of shaming and this often has an adverse impact on their mental state. Even declaring in their bios that they are mental health patients and/or disabled provides no immunity from mental health slurs. I have seen my friends and colleagues frequently described as ‘borderline’, ‘narcissistic personality disorder’, ‘exhibiting the dark Triad personality’ ‘cluster B’…all the while railing against the validity of formal diagnosis and even the reality of mental illness itself. We are not the real target. I am not well known, I am not an influencer or a public figure. I am a ‘nobody’, just a woman with a distant history of mental illness. The things I care most about in my life are my family, my writing, my small private practice, and my advocacy for people with mental illness to be heard, not silenced. To me, this is quite a modest focus, which, on the surface at least, appears uncontroversial and almost quaint. And yet, every day on twitter, someone from the self-defined anti-psychiatry network will comment that I’ve either opened up too much and am therefore unfit to be a clinical psychologist, or I’ve not opened up enough and am guilty of creating a false narrative. I have noticed a pattern on social media where my followers and colleagues are frequently described as ‘liars’ for talking about their mental illness, their ADHD, their Autism, and their cancer diagnoses. Our detractors know nothing about us apart from the bare bones that they see on social media, and they selectively attend to those comments that reinforce their anger at us, appearing not to notice when we discuss quite explicitly the challenges we have had with mental health services. It is as though they spray our tweets with a cognitive Luminol, highlighting only the evidence they seek, rather than the complex context in which it is embedded. If the Luminol doesn’t show up anything, then they will create their own evidence, distorting our messages by cutting and pasting, or describing our first person accounts of our experiences as merely irrelevant anecdotes. They will gnaw on a tweet like a bone, and they will work on it until they can find even a speck of dried marrow in it. I apologise (for failing to provide them with the salient information to which they feel so entitled). I initially felt intimidated and even threatened by these comments, worried that they would upset my family and my patients who follow me on social media. But what concerned me far more was that my followers, the majority of whom suffer longterm mental illness and/or physical disabilities (and do not have a fraction of the privileges that have been bestowed on me throughout my life) might infer that by opening up about their lived experiences, they, too, will become targets of hate and malice for the non-crime of having lived experience of mental illness and, even worse (in the red-rimmed eyes of our detractors), seeking effective treatment for it. Paradoxically, perhaps I should be flattered that their responses often include demands for me to strip off more of my skin, right down to the bone. It is possible, I suppose, to see this extraordinary level of curiosity as a form of compliment, possibly unintended, as they dedicate such a major part of their “one wild and precious life” to scrutinising our tweets behind blocks, taking the time to save them in their photo albums, and then posting them as screenshots (which often have been doctored or tampered with, but never mind). I apologise to them for my inconvenient and incomplete narrative as a mental health professional with lifelong experience of mental illness in myself and in my family: past, present, and future. I also apologise for being unwilling to strip myself down sufficiently to reveal the chaos, the damage, and the harm that arose from a childhood frequently darkened by the shadows and storms of our father’s severe mental illness, which no doubt played a significant role in precipitating my own experience of psychosis as a teen. Why haven’t I just served them a cocktail of the cliché of biology, trauma, and psychedelics that were such key components of my breakdown, and be done with it? The reason I have not done so is that I don’t believe they have the capacity to bear it. Given the extreme sensitivity and squeamishness they display whenever I mention medication, ECT, or the importance of holding on to hope, I really do not believe they have the stomach to read about many years of overdoses, suicide attempts, ambulances and repeated hospitalisations, or the harrowing drama of attempted parricide that my siblings and I still repeatedly recall, illuminated as if by flashes of lightning, and which continue to be profoundly and indelibly imprinted on our psyches forever. No, I don’t think that my detractors could handle that, and so I continue to withhold the vast majority of my experiences and narrative from their peeping Tom eyes. I understand that I have let them down by refusing to put my entire life up for grabs. But I never got a copy of the invisible contract they appear to have written, stating I am fair game. I always thought the ‘fair game’ policy belonged to a famous church cult, the same one that was responsible for a relative’s death many years ago. I also naively believed that referring to medication as poison, and claims that psychiatrists should be tortured and executed was cultish, as it reminded me of a friend whose medication was tossed out of a speeding automobile by the wild eyed leader of the cult known as The Family, whose actions became irreversible steps in hurling her to her eventual death. Can you see where this is going? Their efforts to silence you reveals their fear of your power. The attacks, not surprisingly, emanate from a group who deny the existence of mental illness, deny the value of psychiatric treatment, and who substitute formal terminology with archaic words and descriptions, often including slurs that I have not heard since the 1960s. Much of the time, the verbal abuse misses its mark simply because mental illness is so stubborn, it really does not GAF about anyone’s opinions. People will seek psychiatric treatment if they need it, regardless of what @ProfessorQuack or @Psychiatryismurder has to say about it. What does matter a lot, however, is that these sustained and repeated efforts to invalidate a person’s individual personal memoir are a form of silencing. The critics’ words are an orchestrated and deliberate act to snuff out our deeply personal histories, and to stifle and break the fledgling courage shown by each and every individual who takes the first brave step to write about their deeply painful and often dramatic experiences. That is the wound that they inflict. I have gradually come to realise that the enormous and repeated efforts to silence those of us who speak up have helped me not only to recognise the potential power I have, but also to realise how that very power arises from my ability to write about my experiences as a mental health professional with extensive, intergenerational, lived experience of mental illness. I am not a confident writer, and I believe that confidence would actually be detrimental to my work. What I do have is fear, and the ability to face that fear and to write and be open in spite of it. My mantra when I face the blank page is “I’m going to totally fail at this, but I’m going to do it anyway.” I know that if anyone has read past the first couple of lines of my essays, they have engaged, and whether they love it or hate it or just shrug after they read it, they’ve taken note of my experience. The deeper we go, the brighter the light is when we surface. I endeavour to become braver and bolder in writing about mental illness, but in order to become so requires repeated delving into many dark realms of my life. I aspire to be like the spelunker who takes the risk of diving into the deep, dark, echoic caves, but returns to the surface with a treasure from the past. The fear we constantly try to overcome is driven by the possibility that during our exploration we may find ourselves pinned down by a falling 30 pound rock, or we find that our route, lit only by the limitations of our small headlamp, becomes so narrow that we are trapped, breathless and panicky. We cannot let our fear stop us from exploring the cave, and that is why we need courage. Our solidarity and mutual support is an essential source of our courage. Me too, you too, us too. We are not alone. As a woman, I am more likely to be a target on social media, by both men and women. This is not just my own biased impression. The facts are that, as women, we are more likely to be targeted, especially through shaming. Women are also three times more likely to develop mental illness during our lifetimes. So if you consider women who write about our experiences of mental illness on social media…well, you do the math. For me, my inspiration and resolve comes from those courageous women who have been here before me. Writers who have been bold and gutsy and fearless enough to bare their souls in order to communicate about mental illness to a sceptical public. Gilman, Woolf, Plath, Wurtzel, Jamison, Kazen, Saks….all trailblazers who cleared the first paths and whose books have provided signposts for us to follow. More recently, I have derived courage from the examples of a diverse range of writers including Linda Gask, Rebecca Lawrence, Laura Delano, Rachel Aviv, Kai Conibear, and bloggers/writers such as Lisa Wallace, Cara Lisette, Tania Gergel, Hannah Belcher, Bella Mackie, Sarah Bailey, Eleanor Mandelstam, and so many others, patients and professionals, who have taken the risk of plunging into the icy and shark infested waters of making their stories public in the age of social media. Staying hopeful, incurably so. Despite the efforts to crush our morale, most of us remain hopeful, maybe even incurably so. We are quite a tribe, and we do not let our differences become obstacles to our sense of community. Our experiences are extremely diverse, but we find communality in our sense of “I’ve been there, too.” We need to set our own goalposts. If our writing enables just one reader to nod and say to themselves, “Me too, I’ve been there”, then that is the reward that awaits us as we tear ourselves open in order to write about our experiences of mental illness.

#mentalhealth #mentalillness #mentalillnessstigma Baring our bones – the importance of writing and talking openly about our experiences of mental… @DrAnnieHickox

Baring our bones – the importance of writing and talking openly about our experiences of mental… Baring our bones – the importance of writing and talking openly about our experiences of mental illness, and the emergence of a #metoo movement of our own. The shame has lit the way. I was quite invisible until a few years ago, when an article I wrote about mental health shaming within my own profession of clinical psychology (https://thepsychologist.bps.org.uk/threat-coming-inside-house) was published in The Psychologist magazine. I wrote about how I had noticed on social media that some of the most vicious shaming, directed at those who had plucked up the courage to write about their own lived experience of mental illness, came from mental health professionals themselves. I also referred to a study that showed how clinical psychologists with lived experience are afraid to speak up at work about their difficulties, and that the shaming comes from members of my own profession. The cruelty is the point. After my article came out, the slow but steady drip drip of mental health shaming I had previously experienced immediately became a torrent. Replies to my posts seethed and squealed with anger and bitterness, as though my personal account had somehow been read as an attack on those who had dismissed my article (which I suspect they had not in fact read) as evidence of my ‘biomedical extremist’ (sic) bias. Shaming was a theme: I was described as drugged, a drug pusher, drugging my children, a psycho, personality disordered, a narcissist, and playing the victim. Oddly, I was accused of harming survivors, even though my article was largely based on my own survival, and that of service users whose adverse experiences with psychiatry I had quoted at length. Since then, the shaming has continued, although these days it has receded to a very slow trickle rather than a roar. Sometimes it is overt, crass, and shrill, a kind of fire and brimstone reminiscent of the ranting of a peripatetic whisky priest, but at other times it seems a sort of verbal D flat, embedded in a quasi-philosophical discourse led by pretentious professors who drip with disdain at those deemed weak for succumbing to mental illness, and who rail at the power wielded by psychiatry and the medicalisation of ‘normal distress’. I would emphasise that my allies who are currently receiving care from mental health services are also subject to exactly this kind of shaming and this often has an adverse impact on their mental state. Even declaring in their bios that they are mental health patients and/or disabled provides no immunity from mental health slurs. I have seen my friends and colleagues frequently described as ‘borderline’, ‘narcissistic personality disorder’, ‘exhibiting the dark Triad personality’ ‘cluster B’…all the while railing against the validity of formal diagnosis and even the reality of mental illness itself. We are not the real target. I am not well known, I am not an influencer or a public figure. I am a ‘nobody’, just a woman with a distant history of mental illness. The things I care most about in my life are my family, my writing, my small private practice, and my advocacy for people with mental illness to be heard, not silenced. To me, this is quite a modest focus, which, on the surface at least, appears uncontroversial and almost quaint. And yet, every day on twitter, someone from the self-defined anti-psychiatry network will comment that I’ve either opened up too much and am therefore unfit to be a clinical psychologist, or I’ve not opened up enough and am guilty of creating a false narrative. I have noticed a pattern on social media where my followers and colleagues are frequently described as ‘liars’ for talking about their mental illness, their ADHD, their Autism, and their cancer diagnoses. Our detractors know nothing about us apart from the bare bones that they see on social media, and they selectively attend to those comments that reinforce their anger at us, appearing not to notice when we discuss quite explicitly the challenges we have had with mental health services. It is as though they spray our tweets with a cognitive Luminol, highlighting only the evidence they seek, rather than the complex context in which it is embedded. If the Luminol doesn’t show up anything, then they will create their own evidence, distorting our messages by cutting and pasting, or describing our first person accounts of our experiences as merely irrelevant anecdotes. They will gnaw on a tweet like a bone, and they will work on it until they can find even a speck of dried marrow in it. I apologise (for failing to provide them with the salient information to which they feel so entitled). I initially felt intimidated and even threatened by these comments, worried that they would upset my family and my patients who follow me on social media. But what concerned me far more was that my followers, the majority of whom suffer longterm mental illness and/or physical disabilities (and do not have a fraction of the privileges that have been bestowed on me throughout my life) might infer that by opening up about their lived experiences, they, too, will become targets of hate and malice for the non-crime of having lived experience of mental illness and, even worse (in the red-rimmed eyes of our detractors), seeking effective treatment for it. Paradoxically, perhaps I should be flattered that their responses often include demands for me to strip off more of my skin, right down to the bone. It is possible, I suppose, to see this extraordinary level of curiosity as a form of compliment, possibly unintended, as they dedicate such a major part of their “one wild and precious life” to scrutinising our tweets behind blocks, taking the time to save them in their photo albums, and then posting them as screenshots (which often have been doctored or tampered with, but never mind). I apologise to them for my inconvenient and incomplete narrative as a mental health professional with lifelong experience of mental illness in myself and in my family: past, present, and future. I also apologise for being unwilling to strip myself down sufficiently to reveal the chaos, the damage, and the harm that arose from a childhood frequently darkened by the shadows and storms of our father’s severe mental illness, which no doubt played a significant role in precipitating my own experience of psychosis as a teen. Why haven’t I just served them a cocktail of the cliché of biology, trauma, and psychedelics that were such key components of my breakdown, and be done with it? The reason I have not done so is that I don’t believe they have the capacity to bear it. Given the extreme sensitivity and squeamishness they display whenever I mention medication, ECT, or the importance of holding on to hope, I really do not believe they have the stomach to read about many years of overdoses, suicide attempts, ambulances and repeated hospitalisations, or the harrowing drama of attempted parricide that my siblings and I still repeatedly recall, illuminated as if by flashes of lightning, and which continue to be profoundly and indelibly imprinted on our psyches forever. No, I don’t think that my detractors could handle that, and so I continue to withhold the vast majority of my experiences and narrative from their peeping Tom eyes. I understand that I have let them down by refusing to put my entire life up for grabs. But I never got a copy of the invisible contract they appear to have written, stating I am fair game. I always thought the ‘fair game’ policy belonged to a famous church cult, the same one that was responsible for a relative’s death many years ago. I also naively believed that referring to medication as poison, and claims that psychiatrists should be tortured and executed was cultish, as it reminded me of a friend whose medication was tossed out of a speeding automobile by the wild eyed leader of the cult known as The Family, whose actions became irreversible steps in hurling her to her eventual death. Can you see where this is going? Their efforts to silence you reveals their fear of your power. The attacks, not surprisingly, emanate from a group who deny the existence of mental illness, deny the value of psychiatric treatment, and who substitute formal terminology with archaic words and descriptions, often including slurs that I have not heard since the 1960s. Much of the time, the verbal abuse misses its mark simply because mental illness is so stubborn, it really does not GAF about anyone’s opinions. People will seek psychiatric treatment if they need it, regardless of what @ProfessorQuack or @Psychiatryismurder has to say about it. What does matter a lot, however, is that these sustained and repeated efforts to invalidate a person’s individual personal memoir are a form of silencing. The critics’ words are an orchestrated and deliberate act to snuff out our deeply personal histories, and to stifle and break the fledgling courage shown by each and every individual who takes the first brave step to write about their deeply painful and often dramatic experiences. That is the wound that they inflict. I have gradually come to realise that the enormous and repeated efforts to silence those of us who speak up have helped me not only to recognise the potential power I have, but also to realise how that very power arises from my ability to write about my experiences as a mental health professional with extensive, intergenerational, lived experience of mental illness. I am not a confident writer, and I believe that confidence would actually be detrimental to my work. What I do have is fear, and the ability to face that fear and to write and be open in spite of it. My mantra when I face the blank page is “I’m going to totally fail at this, but I’m going to do it anyway.” I know that if anyone has read past the first couple of lines of my essays, they have engaged, and whether they love it or hate it or just shrug after they read it, they’ve taken note of my experience. The deeper we go, the brighter the light is when we surface. I endeavour to become braver and bolder in writing about mental illness, but in order to become so requires repeated delving into many dark realms of my life. I aspire to be like the spelunker who takes the risk of diving into the deep, dark, echoic caves, but returns to the surface with a treasure from the past. The fear we constantly try to overcome is driven by the possibility that during our exploration we may find ourselves pinned down by a falling 30 pound rock, or we find that our route, lit only by the limitations of our small headlamp, becomes so narrow that we are trapped, breathless and panicky. We cannot let our fear stop us from exploring the cave, and that is why we need courage. Our solidarity and mutual support is an essential source of our courage. Me too, you too, us too. We are not alone. As a woman, I am more likely to be a target on social media, by both men and women. This is not just my own biased impression. The facts are that, as women, we are more likely to be targeted, especially through shaming. Women are also three times more likely to develop mental illness during our lifetimes. So if you consider women who write about our experiences of mental illness on social media…well, you do the math. For me, my inspiration and resolve comes from those courageous women who have been here before me. Writers who have been bold and gutsy and fearless enough to bare their souls in order to communicate about mental illness to a sceptical public. Gilman, Woolf, Plath, Wurtzel, Jamison, Kazen, Saks….all trailblazers who cleared the first paths and whose books have provided signposts for us to follow. More recently, I have derived courage from the examples of a diverse range of writers including Linda Gask, Rebecca Lawrence, Laura Delano, Rachel Aviv, Kai Conibear, and bloggers/writers such as Lisa Wallace, Cara Lisette, Tania Gergel, Hannah Belcher, Bella Mackie, Sarah Bailey, Eleanor Mandelstam, and so many others, patients and professionals, who have taken the risk of plunging into the icy and shark infested waters of making their stories public in the age of social media. Staying hopeful, incurably so. Despite the efforts to crush our morale, most of us remain hopeful, maybe even incurably so. We are quite a tribe, and we do not let our differences become obstacles to our sense of community. Our experiences are extremely diverse, but we find communality in our sense of “I’ve been there, too.” We need to set our own goalposts. If our writing enables just one reader to nod and say to themselves, “Me too, I’ve been there”, then that is the reward that awaits us as we tear ourselves open in order to write about our experiences of mental illness.

#mentalhealth #mentalillness #mentalillnessstigma Baring our bones – the importance of writing and talking openly about our experiences of mental… @DrAnnieHickox

Wellness, bootstraps, and gurus: the new toxic mental health cheerleaders. Toxic positivity, the sunny side up mindset that has a dark side Recently on twitter, a follower tweeted about their severe mental illness and the evidence-based treatments that they had found beneficial. It was a poignant and modest thread, written with great candour and vulnerability, and had clearly resonated with many other mental health patients who replied with affirmative responses, suggesting that for many, the tweet had evoked a ‘me too’ resonance with them. However, one of the responses particularly struck me. The reply did not acknowledge the personal experience in the original tweet, nor did they wish the tweeter well in their continuing recovery. Instead, they immediately suggested that the person should have tried to get out of bed earlier, go for a daily run, eat healthy food, and ditch their meds. Just for good measure, they also recommended they should have tried a yoga class. I like to imagine that the person who wrote the reply meant well, and genuinely believed that, if only the original tweeter could go back in time, they might have benefited so much from this wholesome (if pedestrian) post hoc advice, and would never have needed to see a psychiatrist or take prescribed medication. When challenged gently about their apparently high minded attitude, they responded with ‘it worked for me’. Well intentioned advice, perhaps, but also unsolicited, unhelpful, and coming from a single authority (“Because I say so”). To me, the brief message in the reply reflected a school of thought in psychology which advocates that people with mental illness should steer clear of conventional evidence-based treatments and should instead seek alternative approaches to relieve their ‘distress’. Proponents of this view usually denigrate evidence-based practice and express a ‘life is tough, get over it’ view of mental illness, or what I call the ‘bootstraps method’. Rather than use the term ‘mental illness’, they prefer to talk about normal suffering/distress caused by social and economic pressures and power imbalances. To anyone who has a history of mental illness (in my own case, adolescent psychosis and its prelude and aftermath), the positive Pollyannas do not motivate, cheer, or give hope. Instead, their cloying, syrupy, unsinkable buoyancy translates into a shutting down and silencing narrative that, to the recipient, feels a lot like shaming and gaslighting. It’s the bootcamp coach whose ‘in your face’ exhortations come with a serious case of psychological halitosis. Three types of toxic positivity: 1) Wellness toxicity, 2) Bootstraps toxicity, and 3) Guru toxicity. Wellness Toxicity promotes the idea that if we only looked after ourselves a bit better, we can dodge mental illness entirely. Adherents of this view tend to thrust a litany of salutary ideas at us which, as in the example above, are usually unsolicited, and come with a strong whiff of privilege and ableism. Firm favourites tend to be the very dog-eared suggestion, ‘Have you tried mindfulness?’, often accompanied by suggestions such as: Have a bath Drink some tea Go for a run Try these supplements (including an I/V drip of vitamins (as you relax on your white leather sofa, overlooking the California coastline) Meditate Join a hot yoga class Dry brush your skin followed by an infrared sauna Eat a diet consisting of line caught wild salmon, Paleo foods, fasting, raw food, green goop, or perhaps even a cocktail of your own urine. The aim of Wellness Toxicity is to take your health and then sell it back to you, primarily by suggesting remarkably mundane and/or expensive suggestions that would be out of reach for most people with serious mental health conditions. Bootstraps Toxicity is a popular social media trope among mental health professionals who have drifted away from the governance of regulated mental health services and created a brand that depends on persuading vulnerable people that they know what’s best for them. It can also be found among motley academic philosophers, cult-church members, and lay tweeters who enjoy reminiscing about the past hardship they claim to have suffered and how it made them stronger. You may find them writing books with titles that suggest suffering is its own superpower source of strength, and/or advising us that if we haven’t yet gotten to the root of our problems, we just aren’t working hard enough. Think Nietsche mixed with your worst nightmare PE teacher and add a dash of EST training. Bootstraps Toxicity can also come in various guises, and often presents as a supportive but tough love cheerleader who has our backs. We simply need to buck up, follow the Nike approach, and ‘just do it’! Bootstrappers often say to us: ‘If therapy isn’t painful, it isn’t working’ ‘Push through the pain/depression/fear/inertia and you’ll be a hero’ ‘Your fear is a superpower, man, tap into it!’ ‘Your tears are the best detox ever!’ ‘You need to dig deeper to get to the root of your issues. Keep digging!’ (deeper into your pockets). Bootstrap cheerleaders keep you captive with exhortations that breaking down is by far the best thing that ever happened to you, and they are going to accelerate the process with a psychological or spiritual bootcamp which, once they’ve finished with you, will leave you so relieved that you'll be swimming in serotonin. Guru Toxicity may appeal to those of us who can remember the ‘70s, when emerging alternative psychological therapies declared that mental illness is simply a myth or a imaginary construct, created by psychiatry and its puppeteers at Big Pharma and, oh by the way, our suffering is really a spiritual, meaningful, or even normal experience that simply reflects the crazy world we find ourselves in. It isn’t an illness, it’s a response to the capitalist system and societal power structures that insidiously impact on our instinctive search for meaning. According to advocates of Guru Toxicity, our behaviour is simply an unconventional and misunderstood expression of our resistance to these pressures. They lure us onto a path that they, and only they, can lead us along to find true spiritual meaning and a sense of wholeness and healing from our fractured self. They know best, and their approach requires that we submit ourselves to their control, gradually steering us further and further away from established (evidence based) treatments. Guru Toxicity comes in plausible sounding guises, which may sound progressive and modern, but are usually found among some of the most unscrupulous therapists around. Like bootstraps toxicity, its leading lights encourage a deep dive into our psyches, our childhoods, our parenting, our birth circumstances, and even our previous lives. If you can’t recall having ever suffered trauma, don’t worry, they will keep excavating til they find it, or may even create some for you, via: Re-birthing Trauma Therapy Psychedelics Past Life Regression Cult pyramid schemes promising transformation by battling immortal evil aliens Usually only available from private psychotherapists (and away from pesky professional regulators, bearing in mind that anyone at all can call themselves a psychotherapist or counsellor) they steer the vulnerable away from doctors, clinicians, and even their own families, and into a range of treatments that demand no evidence of efficacy or safety and rely upon the individual’s vulnerability, need for direction, and desire for an identifiable, reductionist, answer to complex problems. Toxic positivity is inherently stigmatising and ableist All three forms of Toxicity can present together, in varying combinations. All three tend to seduce the patient with a message of ‘trust me, I’m not a (real) doctor’. Toxic positivity dismisses any sense of trust that the individual might have in themselves, with the soothing suggestion that there is nothing wrong with them (except that they require hours of expensive quackery that can only be provided by the particular therapy master). These alternative approaches are dangerous. They try to instil the vulnerable person with the view that the concept of mental illness is a taboo, a make believe concept, akin to fairy tales or Santa Claus. They reject and invalidate the value of the individual’s own lived experience, and seek to reset and redefine even the deepest suffering, including psychosis, as normal, cathartic, reactions. By removing the familiar (albeit dry and uncharismatic) terminology of medicine, they shut down the conversation, and with it the risk of dissent, hesitation, or doubt by the person who entrusts their most precious possession, their mind, to the new Psych-Sherpa. If you are not grateful and happy that the true nature of your difficulties has finally been identified by this single, powerful, therapist, then you are at fault, you haven’t yet understood, and you will need to work even harder to get to the root of your difficulty by trusting someone who is ultimately leading you away from effective care and into a reeking swamp of pseudoscience.

#toxicpositivity #alternativetherapy #mentalillnessstigma Wellness, bootstraps, and gurus: the new toxic mental health cheerleaders. @DrAnnieHickox

Wellness, bootstraps, and gurus: the new toxic mental health cheerleaders. Toxic positivity, the sunny side up mindset that has a dark side Recently on twitter, a follower tweeted about their severe mental illness and the evidence-based treatments that they had found beneficial. It was a poignant and modest thread, written with great candour and vulnerability, and had clearly resonated with many other mental health patients who replied with affirmative responses, suggesting that for many, the tweet had evoked a ‘me too’ resonance with them. However, one of the responses particularly struck me. The reply did not acknowledge the personal experience in the original tweet, nor did they wish the tweeter well in their continuing recovery. Instead, they immediately suggested that the person should have tried to get out of bed earlier, go for a daily run, eat healthy food, and ditch their meds. Just for good measure, they also recommended they should have tried a yoga class. I like to imagine that the person who wrote the reply meant well, and genuinely believed that, if only the original tweeter could go back in time, they might have benefited so much from this wholesome (if pedestrian) post hoc advice, and would never have needed to see a psychiatrist or take prescribed medication. When challenged gently about their apparently high minded attitude, they responded with ‘it worked for me’. Well intentioned advice, perhaps, but also unsolicited, unhelpful, and coming from a single authority (“Because I say so”). To me, the brief message in the reply reflected a school of thought in psychology which advocates that people with mental illness should steer clear of conventional evidence-based treatments and should instead seek alternative approaches to relieve their ‘distress’. Proponents of this view usually denigrate evidence-based practice and express a ‘life is tough, get over it’ view of mental illness, or what I call the ‘bootstraps method’. Rather than use the term ‘mental illness’, they prefer to talk about normal suffering/distress caused by social and economic pressures and power imbalances. To anyone who has a history of mental illness (in my own case, adolescent psychosis and its prelude and aftermath), the positive Pollyannas do not motivate, cheer, or give hope. Instead, their cloying, syrupy, unsinkable buoyancy translates into a shutting down and silencing narrative that, to the recipient, feels a lot like shaming and gaslighting. It’s the bootcamp coach whose ‘in your face’ exhortations come with a serious case of psychological halitosis. Three types of toxic positivity: 1) Wellness toxicity, 2) Bootstraps toxicity, and 3) Guru toxicity. Wellness Toxicity promotes the idea that if we only looked after ourselves a bit better, we can dodge mental illness entirely. Adherents of this view tend to thrust a litany of salutary ideas at us which, as in the example above, are usually unsolicited, and come with a strong whiff of privilege and ableism. Firm favourites tend to be the very dog-eared suggestion, ‘Have you tried mindfulness?’, often accompanied by suggestions such as: Have a bath Drink some tea Go for a run Try these supplements (including an I/V drip of vitamins (as you relax on your white leather sofa, overlooking the California coastline) Meditate Join a hot yoga class Dry brush your skin followed by an infrared sauna Eat a diet consisting of line caught wild salmon, Paleo foods, fasting, raw food, green goop, or perhaps even a cocktail of your own urine. The aim of Wellness Toxicity is to take your health and then sell it back to you, primarily by suggesting remarkably mundane and/or expensive suggestions that would be out of reach for most people with serious mental health conditions. Bootstraps Toxicity is a popular social media trope among mental health professionals who have drifted away from the governance of regulated mental health services and created a brand that depends on persuading vulnerable people that they know what’s best for them. It can also be found among motley academic philosophers, cult-church members, and lay tweeters who enjoy reminiscing about the past hardship they claim to have suffered and how it made them stronger. You may find them writing books with titles that suggest suffering is its own superpower source of strength, and/or advising us that if we haven’t yet gotten to the root of our problems, we just aren’t working hard enough. Think Nietsche mixed with your worst nightmare PE teacher and add a dash of EST training. Bootstraps Toxicity can also come in various guises, and often presents as a supportive but tough love cheerleader who has our backs. We simply need to buck up, follow the Nike approach, and ‘just do it’! Bootstrappers often say to us: ‘If therapy isn’t painful, it isn’t working’ ‘Push through the pain/depression/fear/inertia and you’ll be a hero’ ‘Your fear is a superpower, man, tap into it!’ ‘Your tears are the best detox ever!’ ‘You need to dig deeper to get to the root of your issues. Keep digging!’ (deeper into your pockets). Bootstrap cheerleaders keep you captive with exhortations that breaking down is by far the best thing that ever happened to you, and they are going to accelerate the process with a psychological or spiritual bootcamp which, once they’ve finished with you, will leave you so relieved that you'll be swimming in serotonin. Guru Toxicity may appeal to those of us who can remember the ‘70s, when emerging alternative psychological therapies declared that mental illness is simply a myth or a imaginary construct, created by psychiatry and its puppeteers at Big Pharma and, oh by the way, our suffering is really a spiritual, meaningful, or even normal experience that simply reflects the crazy world we find ourselves in. It isn’t an illness, it’s a response to the capitalist system and societal power structures that insidiously impact on our instinctive search for meaning. According to advocates of Guru Toxicity, our behaviour is simply an unconventional and misunderstood expression of our resistance to these pressures. They lure us onto a path that they, and only they, can lead us along to find true spiritual meaning and a sense of wholeness and healing from our fractured self. They know best, and their approach requires that we submit ourselves to their control, gradually steering us further and further away from established (evidence based) treatments. Guru Toxicity comes in plausible sounding guises, which may sound progressive and modern, but are usually found among some of the most unscrupulous therapists around. Like bootstraps toxicity, its leading lights encourage a deep dive into our psyches, our childhoods, our parenting, our birth circumstances, and even our previous lives. If you can’t recall having ever suffered trauma, don’t worry, they will keep excavating til they find it, or may even create some for you, via: Re-birthing Trauma Therapy Psychedelics Past Life Regression Cult pyramid schemes promising transformation by battling immortal evil aliens Usually only available from private psychotherapists (and away from pesky professional regulators, bearing in mind that anyone at all can call themselves a psychotherapist or counsellor) they steer the vulnerable away from doctors, clinicians, and even their own families, and into a range of treatments that demand no evidence of efficacy or safety and rely upon the individual’s vulnerability, need for direction, and desire for an identifiable, reductionist, answer to complex problems. Toxic positivity is inherently stigmatising and ableist All three forms of Toxicity can present together, in varying combinations. All three tend to seduce the patient with a message of ‘trust me, I’m not a (real) doctor’. Toxic positivity dismisses any sense of trust that the individual might have in themselves, with the soothing suggestion that there is nothing wrong with them (except that they require hours of expensive quackery that can only be provided by the particular therapy master). These alternative approaches are dangerous. They try to instil the vulnerable person with the view that the concept of mental illness is a taboo, a make believe concept, akin to fairy tales or Santa Claus. They reject and invalidate the value of the individual’s own lived experience, and seek to reset and redefine even the deepest suffering, including psychosis, as normal, cathartic, reactions. By removing the familiar (albeit dry and uncharismatic) terminology of medicine, they shut down the conversation, and with it the risk of dissent, hesitation, or doubt by the person who entrusts their most precious possession, their mind, to the new Psych-Sherpa. If you are not grateful and happy that the true nature of your difficulties has finally been identified by this single, powerful, therapist, then you are at fault, you haven’t yet understood, and you will need to work even harder to get to the root of your difficulty by trusting someone who is ultimately leading you away from effective care and into a reeking swamp of pseudoscience.

#toxicpositivity #alternativetherapy #mentalillnessstigma Wellness, bootstraps, and gurus: the new toxic mental health cheerleaders. @DrAnnieHickox