What do I look for in non-fiction mental health writing?

After much deliberation, I have decided to split this post into two. One about non-fiction, one about fiction. These are just my thoughts about the topics, what I look out for and enjoy whilst reading.

For the podcast, we have now read 17 books that would come under the heading of non-fiction memoirs, autobiographies, biographies, journals, self-help etc. A list of them can be found here.

The things that I look for are:

  1. Additional research on mental health conditions
  2. Accuracy in symptoms, treatment and therapy outcomes
  3. Practical tips that can be applied in life
  4. Emotive language to help you understand the topic
  5. Use of storytelling techniques
  6. Current trends and statistics
  7. A clear message
  8. Personal experiences
  1. Additional research on mental health topics

Even though I live with a variety of mental health conditions (Borderline Personality Disorder, Generalised Anxiety Disorder, Major Depressive Disorder and Binge Eating Disorder). I know what it is like for me to live with them, but I wouldn’t have the knowledge or understanding to talk on everyone else’s behalf!

Just because one person experiences something in one way doesn’t mean someone else will. So having a deeper understanding of the mental health issue you are talking about above what you have personally experienced is helpful for the reader. E.g. I loved the way that the books we have read on Bipolar are all different with how they have experienced the mood fluctuations and often say that this may not be the case for everyone with Bipolar Affective Disorder.

2. Accuracy in symptoms, treatment and therapy outcomes

One thing that sometimes gets to me is the unrealistic expectations that some books give their readers.

“Read this book and your anxiety will be cured”. If only it was that simple.

I think making sure that you have your facts in order is important. There is nothing worse than over promising and under delivering particularly when it comes to mental health. Even if it sucks to say that you may need therapy for years (I myself have been doing therapy for over 6 years and still need help).

3. Practical tips that can be applied in life

I like practical tips that I can use in my life day to day to help with my own personal wellbeing. Gratitude lists (Stop Thinking Like That by Jason Hyland) and Doughnut Moments (The Resilience Doughnut – The Secret of Strong Adults by Lyn Worsley) have been so helpful that I continue to use them today.

4. Emotive language to help you understand the topic

I find that books are the one way that I can live in someone else’s shoes for a short time. So using language that helps draw on my empathic side is great. As a result of reading all these books I think I have a new appreciation to what it is like to be living with certain mental health conditions.

5. Use of storytelling techniques

Now, this is something that I am finding challenging with my own writing endeavours but feel is important. Whilst I have been working on my own mental health memoir about my own struggles I have come to realise not everyone will be that interested in some of the things that happened to me. But this can be changed with the style I choose to write it.

Ensuring that there is a strong plot (beginning, middle and end) draws people into your story and even adding dialogue (particularly in a memoir) can really enhance the enjoyment. An example of this can be seen in Love and Remission by Annie Belasco.

6. Current trends and statistics

This can be incorporated into any kind of book but I find this particularly interesting in non-fiction books. It adds to the understanding of the context of a mental health condition.

Understanding the difficulties being faced by the modern health care system, the rates of inmates imprisoned who are experiencing mental health conditions and male suicide rates all give an indication of what is happening. For me when I read some of these statistics it not only shocks me but also prompts me into wanting to do more to try and help the situation.

Fantastic examples include: Insane: America’s Criminal Treatment of Mental Illness by Alisa Roth, The Stranger on the Bridge by Jonny Benjamin and Also Human: The Inner Lives of Doctors by Catherine Elton.

7. A clear message

There are often a few things I want to get out of reading books about people fighting mental health issues, one is the realisation that I am not alone. Nor is it anything to be ashamed of. For years I hid my mental health and never really felt what I may consider the “truthful” me. So finally realising that I am not alone has helped so much. There is a community out there that I feel I can talk openly about what I am going through and that has at times been a life saver.

Hope is another big thing that I want to get out of a book and is something I hope that my book will eventually provide to others. Although as I write this it makes me feel like a fraud. Historically mental health issues were dealt with by people being institutionalised but a lot has changed and there are so many new treatment options available. If I can some how offer hope to someone with the message that life with BPD can get better than that is something I would love to be able to do.

8. Personal experiences

The last thing that really relates to self-help is the incorporation of the authors own personal experience. If you are making suggestions about things that I can do to improve my wellbeing then I would like to know that you have tried them and are still using them!

If you expect me to get up everyday run 10 miles, drink a green smoothy and meditate for 8 hours I probably am not going to do it because it’s not achievable. But if you can give me an idea of how changing a thought pattern or incorporating more compassion into your life has changed things then I am up for that.

So, this is my list. As I read more books I may come back to it and update it with other things that have jumped out at me. But this is my first attempt of actually identifying things that I liked, and I have to admit it feels a bit weird!

Until next time remember it’s okay not to be okay and if you not okay talk.

It’s been a while

I feel really bad that I started my blog and then stopped so abruptly, but at the time I had no idea why. It took me some time to figure it out and I finally had that light-bulb moment this morning. My declaration about how I was going to create a list of tips on how to create and write characters with mental health issues was so large in scope that I think I scared myself.

Who am I to tell people how to write characters about mental health issues? I am a fraud, and no one should listen to me, I am no expert.

So, I put it off. After compiling all the research about what others had said and identifying what I thought was important, I just couldn’t bring myself to actually sit down and write it out. The effort I had put in wasted.

Whilst I still feel the same fraudulent emotions, I am trying to frame it to myself differently. For the podcast I have now read 36 books varying from fiction, memoirs to self-help. Not to mention all the other books I have devoured, which I have to admit I have lost count (what can I say I like books). I still don’t think I can ever consider myself an expert I need to read more! But, is there something I can offer myself or others? In reality all I have is my own opinion, my likes and dislikes and nothing more.

So, that is what I intend to write about. Tomorrow I will post my personal preferences, my own ideas on how to write such characters because after all I think I do have something to contribute as I talk about it on the podcast what can’t I write about it.

Please forgive me if you have been waiting to see this (although I am not sure anyone is reading this stuff and to be honest I probably would do it anyway if it is just for me). But, due to my nature I feel an overwhelming need to apologise. If not to real people but to myself. I promise this post is on the way. Hopefully this will be the first of many, the kick up the backside I need to actually get on with it and write about the things I find important.

I have had a case of the green-eyed monster with how prolific Becky has been at posting on her brand-new blog. I don’t want to feel this unwelcome sensation of guilt and shame that I am failing myself.

So, I am back and will hopefully be writing about stuff I find interesting. After all, how can I figure out who I really am if I don’t explore things that interest me!

School of life – Know Yourself: Cards for self-exploration

I bought these cards from a famous London bookshop that is a place I absolutely have to visit whenever I am in the area.  Laurence has to be strict with me so that I don’t go overboard, or I would take the entire store home with me!

On one such trip, I discovered The School of Life, an innovative company with products dedicated to the development of emotional intelligence internationally.

I purchased a couple of things one of which was the Know Yourself Prompt Cards.

The box contains 60 cards all asking a different question for individuals to be able to understand themselves better.

For most people, if you asked the question who are you? They can generally provide a response. However, it is really those around us that have a better understanding of who we really are [1]. Sometimes we are just unaware of our own shortcomings and character traits and even if you think you know who you are it doesn’t mean that you will not learn more about yourself.

But for some, this question feels them full of dread and I have spent many hours trying to figure out who the real Sydney is. It is really difficult particularly if you are suffering from a mental health condition, such as Borderline Personality Disorder. So, this was the main reason I picked these up, maybe these could help in my quest for self-discovery.

So, I am going to pick a card at random each week and write about it. I need to remember that some of my response may change over time but hopefully, this will be a good starting point.

I am trying to write a book and it has become apparent that character development is extremely important (at least that is what I gather from all the books I have read) and I worry because I am oblivious about who I really am how am I meant to write convincing characters?!

 

So here is card 1 of 60:

  • If I was a kind of weather, I’d be snow (because I love snow and you can make things out of it!)
  • If I was a piece of furniture, I’d be a comfy overstuffed armchair (because there is nothing more relaxing than sitting in a chair with a good book)
  • If I was a make of car, I’d be I have absolutely no idea! I guess something that no one would notice (because I don’t want to draw attention to myself) but then I asked Becky and she suggested I would be a yellow car! Not exactly inconspicuous but certainly shows my love of the yellow car game.
  • If I was a piece of music, I’d be something sad and melancholy played on strings (string music is a huge part of me and causes such joy, I absolutely love Zoe Keating)
  • If I was a kind of food, I’d be Spag bol (my comfort food which could be spiced up if needed)
  • If I was an animal, I’d be a cat (because I like my own space and only want affection on my terms!)
  • If I was a kind of font, I’d be Wingdings because who knows what that is actually saying!

 

On the back of the card, there is a brief description of the reason for that question.

“Because the self is nebulous and shapeless, we can sometimes best grasp key bits of our identities via metaphors and analogies. The animal one can be particularly revealing.”

I would love to see other people’s answers and if you have any insights into the answers I have given! Help me out by leaving a comment below. The more information I can collect the better!!!

 

[1] You are probably wrong about you, Psychology Today (Accessed 2018) https://www.psychologytoday.com/gb/blog/the-science-success/201208/you-are-probably-wrong-about-you

 

 

How do we talk to others about suicide?

Suicide is still considered a taboo subject to discuss, some people think that by not talking openly about it people are less likely to take their own life by suicide.  However, there is little evidence to prove this and research has found that talking openly about suicide allows people who are vulnerable to feel heard and supported within their community [1, 2].

The statistics associated with suicide are particularly difficult to read, worldwide over 800,000 people die by suicide each year equating to 1 person every 40 seconds [3] and even though there has been a reduction of 3.6% seen in the UK between 2015 and 2016 with 5,965 recorded deaths due to suicide [4] there is still more that we as a society can do

Which, leads me to my question – how should we talk about suicide?

When I was at my lowest point all I wanted was for someone to ask me how I was, not in that polite kind of way, but how I was REALLY feeling. I wanted someone to hear me and I wanted someone to empathise with what I was going through. But no one did. Other than Laurence and Becky no one really saw the chaos that was me. They were scared of me, the volatility of my moods and trying to reduce my angry outbursts was their priority. So, having any kind of open conversation would not have worked out too well for anyone involved.

Try selecting and removing or editing the caption, now you don’t have to be careful about selecting the image or other text by mistake and ruining the presentation.

So, therefore I think the question should be broken down even further:

  1. How do you talk generally about suicide?
  2. How do you talk to someone who you think might be having suicidal thoughts?

1. How do you talk generally about suicide?

Preconceived ideas about suicide

This is important because if you feel that people who attempt suicide or have died by suicide are weak, selfish, cowardly, attention seeking, and a whole host of other negative opinions then you need to look more into the research and the why’s. Myths surrounding suicide are rampant and are unfounded. In my opinion, if you feel this way don’t approach someone who is having suicidal thoughts – it is not fair on them. If you have these opinions, please put them aside to help the person who is suffering.

Suicide is not weakness and never will be. Try thinking about suicide and dying by suicide as a result of a person being in so much pain that they see no other way of dealing with life. 

We as a community have the responsibility of supporting that person – and not putting them down. They are entitled to their thoughts, feelings and emotions and we should be guiding and encouraging them to seek help rather than adding to the situation they find themselves in

Be compassionate, be responsible and think about the language you are using about suicide.

For a general discussion, it may help you to find some kind of prompt that leads you into a discussion on suicide. Or you could just start talking about emotions and feelings – for me when I am talking generally about suicide I use my own past experiences but if you haven’t ever felt suicidal, then please don’t make it up you could do more harm than good. I personally would feel like you were mocking me making the situation worse.

Language

The words that we use have power and certain words that are often used in association with suicide apply their own stigmas [5]. So, when speaking about suicide please avoid the following words:

  • Committed suicide
  • Successful suicide
  • Completed suicide
  • Failed attempt at suicide
  • Unsuccessful suicide

Use instead:

  • Died by suicide
  • Suicided
  • Ended his/her life
  • Took his/her life
  • Attempt to end his/her life

A huge benefit of blocks is that you can edit them in place and manipulate your content directly. Instead of having fields for editing things like the source of a quote, or the text of a button, you can directly change the content. Try editing the following quote:

Remember that we are all human and will more often than not make mistakes, if you do, apologise and use a different term, learn from the experience and move on. Your guilt and shame about using the wrong language will not help the situation.

Don’t Judge

Whatever the reason is for suicide or a suicide attempt don’t criticise it or make a judgment about it. For example, someone said to me recently something that made me start. Whilst talking about another person in crisis they said, “something as silly as £10,000 debt made a person feel suicidal.” At this point, I spoke up and suggested that the use of language suggested they were judging that person’s situation and if it had come to this point it probably wasn’t silly to them. We have no right to place our own judgments about another person’s emotions.

2. Approaching someone who may be feeling suicidal

Signs

People who are feeling suicidal may exhibit warning signs about their thoughts and you may notice that there is a change in their behaviour.

Rethink Mental Illness provides the following list [6]:

  • becoming anxious, irritable or confrontational.
  • having mood swings.
  • acting recklessly.
  • sleeping too much or too little.
  • preferring not to be around other people.
  • having more problems with work or studies.
  • saying negative things about themselves.

There are some signs that suggest someone is more likely to try suicide. These include:

  • threatening to hurt or kill themselves,
  • talking or writing about death, dying or suicide, or
  • actively looking for ways to end their life, such as stockpiling medication.

But remember you know this person and may see changes in behaviour that are not on this list so trust your judgment.

Starting the conversation

Whilst researching for this post I came across this very helpful information page written by the Samaritans about starting difficult conversations and think that it is very useful. They suggest the following [7]:

  1. Find a good time and place
  2. Ask gentle questions and listen with care
  3. Use open questions e.g. when, where, what, how
  4. Find out how someone is feeling
  5. Check they know where to get help
  6. Respect what they are telling you and don’t pressure them – all of us want to fix things, offer advice but it is better for them to make their own decision
  7. Don’t panic if you say something wrong
  8. Show you understand
  9. Look after yourself – it is important to remember that when you approach someone about suicide it may bring up a range of emotions in yourself

Assessing the risk

There are several questions you can ask to assess the person’s risk of attempting suicide but remember that if someone doesn’t want to answer you or they do not tell you their real thoughts then it may be difficult to prevent the individual from taking their own life. Even trained clinicians including The Secret Psychiatrist have not been aware of a person’s intention and she is a highly trained psychiatrist.

Questions you could ask to assess the risk [8, 9, 10, 11, 12]

  1. Have you made a suicide plan? How specific is the plan? Do you know how and when you will attempt suicide? (PLAN)
  2. Do you have what you need to carry out your plan? (do they have access to pills, insecticide, firearms…)? (MEANS)
  3. Do you know when you would do it? (TIME SET)
  4. Do you intend to attempt suicide (INTENT) e.g. Have they carried out any acts in anticipation of death (e.g. putting their affairs in order).
  5. Have you been using drugs or alcohol? (can increase impulsivity)
  6. Is there anyone available to support you? (family, friends, carers…)

If the attempt seems imminent then you need to address the situation by calling emergency services, going to hospital and not leaving that person on their own.

Suicide is preventable and by talking openly about it in general or by specifically approaching someone you are worried about will help in reducing the number of deaths each year from suicide. We shouldn’t be afraid – it is common to have suicidal thoughts and we as caring human beings have the ability to help. By reaching out and speaking to someone about how they are truly feeling you are showing that person that they are not alone. Whilst I can’t say with any certainty that if someone had asked me if I was feeling suicidal that I would not have made attempts it certainly would have gone a long way in making me feel less alone.

References

  1. Dazzi T., Gribble R., Wessely S. and Fear N. T. (2014) Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16):3361-3
  2. S. Office of the Surgeon General, National Action Alliance for Suicide Prevention. 2012 National strategy for suicide prevention: goals and objectives for action. Washington, D.C.: HHS; 2012. https://www.ncbi.nlm.nih.gov/books/NBK109906/#introduction.s5
  3. WHO (2014) Preventing suicide: A global imperative http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/
  4. Office for National Statistics Suicides in the UK: 2016 registrations https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2016registrations
  5. Beyond Blue Suicide Prevention https://www.beyondblue.org.au/the-facts/suicide-prevention/worried-about-suicide/having-a-conversation-with-someone-you’re-worried-about/language-when-talking-about-suicide
  6. Rethink Mental Illness: How to support someone with suicidal thoughts https://www.rethink.org/carers-family-friends/what-you-need-to-know/suicidal-thoughts-how-to-support-someone/signs
  7. Samaritans: Difficult Conversations https://www.samaritans.org/difficultconversations
  8. Assessment of suicide risk in people with depression
  9. http://cebmh.warne.ox.ac.uk/csr/clinicalguide/docs/Assessment-of-suicide-risk–clinical-guide.pdf
  10. Suicidal Thoughts & Behaviours Mental Health First Aid Guidelines https://mhfa.com.au/sites/default/files/MHFA_suicide_guidelinesA4%202014%20Revised.pdf 
  11. Reducing the risk of suicide: a toolkit for employers https://wellbeing.bitc.org.uk/sites/default/files/business_in_the_community_suicide_prevention_toolkit_0.pdf
    MHFA England (2016) Adult MHFA Manual, Two Day Course

The power of words – Should we be talking about suicide?

Trigger warning: frank discussion about suicide.

Recently some prominent figures have died by suicide and subsequently, the media have been reporting their stories. People such as, designer Kate Spade, chef Anthony Bourdain and reality TV star Sophie Graydon are some of the most recent prominent people who have ended their own lives.

There has been an outpouring of grief and compassion towards these people by most. However, there are still too many people who are extremely ignorant and negative about the pain that these people would have been going through to take such drastic action.

In the immediate aftermath discussions of suicide and suicide awareness skyrocketed but this effect is only ever temporary. Yet today only a month after the media exploded with reports of Kate Spade’s death the discussion has once again disappeared and been swept away. Only to be brought back to the public’s attention when the next famous figure makes the decision that life is just too much.

So, I have to question how do we keep the discussion going?

There is still so much stigma associated with discussing suicide people feel that merely discussing this taboo topic will result in the incidence of suicide increasing. Therefore, researching this topic is difficult, researchers are expected to not cause harm to participant’s and studies need to be approved by ethics committees, so, asking questions that may increase suicide rates are extremely problematic.

However, current research looking at people talking or asking others about suicide have yet to find that there are any significant increases in people ending their own life. In some cases, evidence has shown that asking someone if they have contemplated ending their own life has been beneficial in reducing suicidal ideation [1, 2].

Yes, there has been research that has shown that actively reporting the details and methodology used for suicides has increased the likelihood of copycat behaviour, known as modelling in the psychology world [3].

Which is why several media guidelines have been prepared as the media’s portrayal of suicide can influence copycat behaviour under particular circumstances. One set of guidelines – the Mental Health Media Charter details the best way to report mental health issues. This charter is probably one of the most accessible for media outlets and bloggers alike because it is short and to the point.

The Mental Health Book Club Podcast is actively trying to raise awareness of mental health and associated issues including suicide and its prevention.

I have been there, not only have I at times experienced suicidal ideation (which I have to admit is much less these days) and my own attempts at taking my own life, I have come to realise that regardless of people discussing the topic I would have made the same decision. Maybe if someone had raised the question, and depending on who they were, I may or may not have felt comfortable enough to discuss my feelings. Even if I hadn’t, I would have at least realised that someone had noticed my distress (although I had become extremely adept at hiding it).

So, keep talking mental health, my next post will be about ways to talk about suicide with others.

[1] Dazzi, T.  Gribble, R.  Wessely S. and Fear, N. T. (2014) Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine 44: 3361-3363

[2] DeCou  C.R.  Schumann M.E. (2017) On the Iatrogenic Risk of Assessing Suicidality: A Meta‐Analysis, Suicide and Life-Threatening Behav. doi:10.1111/sltb.12368

[3] Definition of modelling (2018) https://psychologydictionary.org/modeling/

[4] Perkis, J. and Blood, W. (2010) Suicide and the news and information media: A critical review http://www.mindframe-media.info/__data/assets/pdf_file/0016/5164/Pirkis-and-Blood-2010,-Suicide-and-the-news-and-information-media.pdf

The power of words – Should we be conscious of the words we use when talking about mental health?

“Words: So innocent and powerless as they are, as standing in a dictionary, how potent for good and evil they become in the hands of one who knows how to combine them.” Nathaniel Hawthorne

Words have power, you only have to think back to your time in the playground and someone used words to bully you. I don’t know about your parents but mine constantly reminded me that sticks and stones may break my bones, but names can never hurt me, was a complete lie.

Those words still hurt me today over 25 years later and pop back into my mind when I am feeling particularly low.

Applying this to everyday life I am beginning to realise that the words I am using when I talk about mental health may need some conscious thought. I don’t want to offend, I don’t want to cause other’s distress and I don’t want to feel the shame associated with causing someone else to feel bad. I equally don’t want to be adding to the stigma associated with mental health.

So here are my top tips I am going to apply when I am talking about mental health (including my own) for what I have learnt so far:

  • The way mental health is discussed is constantly changing – the words that may have been used to describe a situation in the past are not necessarily the most descriptive or accurate now, it is our responsibility to look at what words are being used and if we agree with their use.
  • Mindful discussions of mental health – we need to be conscious about what we say, think about the consequences of the words before they come out but also don’t bet yourself up if someone challenges you as it is another opportunity for us to learn
  • Tone – the way we say things is equally important to the use of words if you use a particular tone that can be observed as being insincere or dismissive means that no matter what you are saying the discussion could be harming others.
  • Word choice – now this is often extremely difficult, what words can be used? In what context are you using them? We wouldn’t say “I feel so cancer filled today” but people do say “I am so depressed today because [insert sports team] lost their game last night.” It shows flippancy and fails to understand the full extent of depression. I hold my hands up and admit that I am guilty of such things, such as making statements like “I think Laurence is on the Autistic Spectrum” or “don’t be so OCD” without fully understanding the implications.
  • Honesty – if you are not sure about something then ask, if you are talking to someone about their mental health then they will probably feel like you are respecting them by acknowledging you don’t know everything. I don’t know how many times I have tried to explain borderline personality disorder to someone – I never take offence I am often flattered that the individual feels able to ask.

I think I will add to this over time, as well as additional information on the do’s and don’ts of writing characters in fiction with mental health conditions (although I am struggling with feeling qualified enough to make such a list) but I can identify my opinions about what I prefer when reading fiction!

Starting the Mental Health Book Club Podcast

After being diagnosed with Borderline Personality Disorder in 2012 the first thing I did after getting out of the hospital and having some time to reflect on what was happening was to reach out to the world of books. My mission was to learn as much about this mental health issue as possible and I consumed endless words from fiction to non-fiction, internet articles and online support groups. Some were really helpful and others not so much! Shortly after the BPD diagnosis Is was blind-sided with the news that I had relapsing-remitting multiple sclerosis and my life fell apart. The only thing that really remained was the fact I always had my nose in a book.

For those of you who don’t know much about MS, it is a condition of the central nervous system where the immune system mistakes the cells that insulate nerve cells – the myelin as bad and attacks it. Resulting in problems with coordination, eyesight, balance, pain, fatigue, numbness, heat sensitivity to name a few. Once again, my life was turned upside down and for someone who had no clear idea of who they were and the need of changing countries (I was about to apply for citizenship in Australia) I ended up back in the UK struggling.

I meandered around for two years feeling lost and alone and trying to figure out what I wanted to do with my life. In summer 2017 after my husband introducing me to the world of podcasts I started to feel excited again. The wealth of information available was immense but yet no one was talking about books with mental health issues and so for some crazy reason I thought maybe I could do that!

So once again I turned to one of my favourite past times – books, blogs and now podcasts to find out how to start a podcast. I jumped in purchased a microphone and learnt how to use Audacity for editing and jumped straight in.

I twisted Becky’s arm and thankfully she agreed to join me as a co-host and we are now up to Episode 41 and closing in on our one-year anniversary.

Yet, I felt there was still something missing and then came up with the idea of this blog. Whilst I am not an expert on writing or mental health, I still felt that for people who want to write about those with mental illness they should do so in a way that doesn’t aid the stigma that people like me have to face as a result of their mental illness.