A Few More Thoughts from a Psychiatric Ward

Perhaps one of the most crushing realisations as the end of a period in a psychiatric hospital approaches is that you are not suddenly going to wake up one day and find all is ‘back to normal’. Instead you are taking another step, entering, bit by bit, into all the varied contexts that make up daily life.?

It’s in starting to take these steps that I feel drawn to try to give word to some thoughts that have pressed themselves upon me over the past months. I am not sure how clearly I can capture these ideas, but, as my stay in hospital will soon come to an end, it felt timely to give it a go.

Being hit by a period of debilitating illness (I imagine it is likely true for physical as well as mental), you are very quickly confronted by the fact that this has implications that extend far beyond your own self.? You become deeply and acutely aware of the impact of this illness on those dearest to you, those people you had thought your role was to protect, support, or walk hand in hand with. Whether as a son, a father, or a husband, you can find yourself consumed by guilt and fear about the disappointment, upset, and disarray your situation has caused. Have you thrown the lives of your children off course? How will your spouse be able to carry all that this new situation entails? What will your friendships now look like? Will you always be seen as vulnerable by others? Will you ever be able to return to spaces in which many people come together?

It goes without saying that this guilt is at best counter-productive and at worst, seriously detrimental to your ability to find the strength to take the required steps. However, what this guilt does tap into is the realisation that (mental) ill health is not an individual challenge. The web of connections between you, your family, your neighbourhood and community, are all in some way affected, and this web of connections in turn has a profound impact on the experience of you and your family.

At the most basic, a period of illness is likely to have a tremendous impact on those closest to you. The normal routine and patterns of life are thrown in the air and reformed, relationships taking on new forms. This can provide an arena for profound development. But it also brings pain, loss, and confusion. Suddenly a family is in need of a whole new level of support. In a very concrete way, the illness has ramifications beyond the nuclear family. Those around the family, community members and extended family, form the essential shell in which a family is either supported and nurtured, or sidelined and cast aside to their own devices (and every shade of support in between).?

The support provided by these next layers includes practical assistance certainly. Yet it is so much more. It seems to call on the ability of those around the family to be comfortable enough with the family's pain and discomfort that they feel able to stand alongside and ask what is needed In this way somehow (mental) health is not an individual question alone - the community in which one lives also experiences a recasting and reforming of the pattern of relationships.

Community, naturally, means different things to different people. What I am thinking of at this moment is a community place - people bound by their close physical proximity, but otherwise perhaps sharing little obviously in common. While the support of a far flung community is undoubtedly valuable, the immediacy and concreteness of those living within walking distance is unique. My wife has described the power of the support from and conversations with other mothers at school, the messages and flowers from families who live close by, the practical support of those youth who offered themselves to support with whatever is required.? The role of community is keenly felt, both in its presence and its absence.?

Thanks to my wife’s openness about what was going on, a whole new conversation has opened up with a wider pool of people. It is striking how many others have faced profound challenges around their mental well-being. Clearly, very many people are suffering.

As I’ve sat in hospital these months, and received the support and love of my family, I have become acutely conscious of the role of community in health not as an abstract phenomenon but as a very real and tangible force. Luckily I find myself in a setting in which the healthcare institutions value the role of community in recovery - but this seems to be barely scratching the surface of the profound role of community and the social environment.

Atmospheres

Which brings me to my recent contemplations on the social environment. With the end of hospitalisation approaching, I? cautiously start the work of placing myself back in settings outside the hospital: work, community, friendships. As I’ve taken these steps I have become keenly aware of the effect of different contexts. The spaces which leave me energised and eager to take the next steps are those which are marked by love, in which I am seen not as vulnerable but as someone who has something to offer, and in which accord and companionship can be found. On the other hand, spaces in which there is criticism or discord (regardless of where it is directed), have a profound effect on my whole being, leaving me tense, unhappy, and exhausted. In fact, I find being in situations in which there is any talk about others in a negative way, or tensions between people, almost intolerable.?

Now, there are two ways of looking at this, both of which contain, I think, truth. On the one hand this can be seen as a sign of vulnerability brought about by my current condition. On the other hand, it can be viewed as a natural reaction to settings that grate against our aspirations as humans. I began to wonder: do such settings not affect us all much more than we are aware of? Is it not true that environments like this always left me uncomfortable, but at this moment the effect is brought crashing to my attention?

This is not a call to avoiding critical thought or engaging in the clash of ideas in the search for truth. It is not suggesting that a false happiness is needed, or superficial spaces in which difficult things are avoided. Rather it is to do with the atmosphere of spaces, and the attitudes and forces at play. You can palpably feel the impact of spaces in which the prevailing atmosphere is one in which, despite whatever differences of views are held, there is a desire to find a collective way forward and where a love for one another’s shared humanity is powerful enough to dissolve the barriers of difference.? Of course, this is not the most prevalent experience. But hope can be found in conversations in which people are willing to ask: what are the kinds of interactions we wish to be fostering? what does it look like to regard everyone here as having something to offer? how do we overcome bitterness, apathy, or envy and see one another as of one family?

As I gather in strength, I trust I will be able to navigate the diverse contexts and situations life brings without extreme reactions. But I hope I hold clearly in mind the profound effect of the social environment. I hope it helps shape how I interact with those around me. I hope that in some years time we can speak somewhat more confidently about what characterises communities that foster health, and support those in ill-health. Much, I am certain, can be learned from the vast array of cultures and communities around the world, but surely also much will need to be learned from the efforts of individuals, families, and those around them, navigating the concrete challenges brought to the fore by mental ill health.