Sunday, 7 October 2018

Working at being of good cheer again


My last blog post here heralded in the summer and now, somehow, whether you judge these things meteorologically or astronomically, either way it is undeniably autumn. My family's summer became a blur, with my wife becoming unwell in July, her being diagnosed with a serious illness and then spending most of August in hospital 49 miles away. She is now thankfully at home with me, but needing ongoing support and treatment.  

People often don't know quite what to say. One friend emailed me in sympathy, referring to our situation as a "predicament", which seemed something of an understatement. A predicament is a troubling, embarrassing or ludicrous situation. To us, it seemed my wife's illness was a catastrophe, a calamity. Another colleague, sending best wishes, referred to my wife as my "beloved". This seemed quaint and completely apt. What had happened was not that my wife and I had found ourselves in a predicament, but that a calamity had befallen my beloved.

In the midst of all this, though I have found some solace in reading books and listening to music, it's not surprising that I have not felt much like engaging in my own creative activity over the past three months. I have neglected my blog, and had little appetite for writing, songwriting, performing or other means of self-expression. My own wellbeing has, of course, been affected by concerns about the health of my beloved and this has, in turn, affected my creativity. There is a paradox inherent in the relationship between creativity and wellbeing: while it's true that participating in creative activity generally enhances wellbeing (Stickley, Wright and Slade, 2018) it's also true that creativity calls for a level of equanimity (Sawyer, 2012). So, on the one hand, Shaun McNiff (the pioneering art therapist and professor of expressive therapies) is right to suggest "art and creativity are the soul's medicines – what the soul uses to minister to itself, cure its maladies, and restore its vitality" (McNiff, 2004: pxii-xiii); on the other hand, people are more likely to be creative when they are well-balanced (Sawyer, 2012) and enjoying a positive mood (Amabile et al., 2005) or, as Mozart once described it, "when I am completely myself ... and of good cheer..." (Vernon, 1970: p.55).  

This is not meant to be an excuse for a lack of creative activity – it's simply an acknowledgment that crises such as serious illness in the family can impact on the emotional wellbeing of the whole family and that this needs to be regained before we can fully partake of the healing power of art and creativity. But, here I am writing once again ... and it feels good.

References
Amabile, T. M., Barsade, S. G., Mueller, J. S. & Staw, B. M. (2005). Affect and creativity at work. Administrative Science Quarterly, 50 (3), 367-403.
McNiff, S. (2004). Art heals: How creativity cures the soul. Boston, Massachusetts: Shambala Publications.
Sawyer, R K. (2012). Explaining creativity: The science of human innovation. (2nd ed.) Oxford:  Oxford University Press. 
Stickley, T., Wright, N. and Slade M. (2018). The art of recovery: outcomes from participatory arts activities for people using mental health services. Journal of Mental Health. Feb 15:1-7. doi: 10.1080/09638237.2018.1437609. [Epub ahead of print]. Available at: https://www.tandfonline.com/doi/full/10.1080/09638237.2018.1437609
Vernon, P.E. (1970). Creativity. Middlesex: Penguin Books.

Sunday, 17 June 2018

Midsummer madness and obstacle golf


Around this time of year, readers of this blog may well be enjoying - or preparing to enjoy - a summer holiday. Whether it's a modest 'staycation', a more exotic trip or just a few snatched moments relaxing in the outdoors, it's good to make the most of - in the words of the old song - "those lazy, hazy, crazy days of summer."

For those working in mental health, summer brings, along with its pleasures, its own particular challenges. For example, while most people's mood is improved by more sunlight and milder weather, some mental health practitioners observe people with bipolar disorder may be more prone to manic episodes in the summer. Could this be a manifestation of what Shakespeare called 'midsummer madness' - a temporary insanity attributed to the heat of the sun or the phases of the midsummer moon? Those working with younger adults sometimes report an upsurge in psychotic episodes which they relate to increased cannabis use as the music festival season gets underway. And then, of course, there is the increased risk of photo-sensitivity and dehydration which can have serious consequences for service users taking psychotropic medication. There's a lot for  practitioners to think about in these summer days, which could cause more haziness and craziness and leave little time for laziness.

This time of year always reminds me of those long, childhood summer holidays when my brother and I would while away time on the putting green. Neither of us grew up to have the slightest interest in golf yet those games of miniature golf kept us happy for hours. A variant of mini-golf was crazy golf, which seemed to delight in causing the players to put or chip the ball over, under or through various impossible obstacles. On a recent visit to Keswick in the Lake District I was pleased to see they still had a crazy golf course but surprised that the sign announced it as 'Obstacle Golf'. I imagined the heated debate that might have taken place in the local council chambers:
            "We can't call it crazy golf anymore. That's insensitive to people with mental health issues."
            "What about obstacle golf? After all, that would more accurately describe the nature of the game without using a term disparaging of psychological distress."

Perhaps renaming crazy golf as obstacle golf gets to an even deeper truth. Part of mental wellbeing is the ability to maintain equanimity whilst skilfully navigating life's obstacles. It is the obstacle course of life that makes people ...crazy. So let's all try to approach the gradients, mazes and tunnels ahead with calmness and good humour, to acknowledge their inherent absurdity and, nevertheless, endeavour to play the game.

Monday, 7 May 2018

Welcoming the new arrival


Academic books are not normally published with any great fanfare. Authors of fiction may, if they're lucky, expect signing events at their local bookstore or perhaps a launch party with champagne. But the writer of a scholarly work - "high protein nonfiction" as William Germano (2005, p.123) describes it - has to settle for a more modest welcome into the world for their creation. No academic book is going to be a bestseller and the lucrative sale of film rights is an even less likely prospect. Nevertheless, after years of research and long months of writing and editing, it is still something of an event when the newborn book arrives and the proud author finally gets to hold the pristine complimentary copies in his hands.

I remember when my firstborn book was delivered amid the mundane mayhem of domestic life. It was a Saturday afternoon and the carpet-fitters, having just conspicuously botched an ill-fitting piece of carpet around the fireplace, then decided they needed to completely remove the front door of our house, just as the postman arrived with the long-anticipated parcel. Of course, in the confusion, I wasn't able to savour that special moment when an author's first book is published. Later in the day, I tried to take time out to admire the look and feel of the finished product, but then life got in the way again as my teenage son announced he had just had his bike stolen. A day that had begun with the chaos of incompetent carpet-fitters ended with police officers' boots on our new carpet as they took a statement.

My latest book arrived, thankfully, amid less drama. Publishing nowadays is a very global affair so the book had already travelled halfway round the globe before landing eventually at my house. Commissioned - and written - in England, with series editors based in Switzerland and Denmark, contracts were drawn up in Switzerland, copy-editing took place in India before the book was printed in the Netherlands and dispatched from the distribution department in Germany.

I arrived home from work to be told a parcel had gone to the next-door neighbour. As I collected the package I resisted the temptation to brag to the neighbour that this wasn't any old order of books - it was my new book. Instead, I thanked her and returned home quietly to admire the new arrival. My wife had thoughtfully decorated the house with congratulations banners and balloons and my son had kindly made a playlist of celebratory songs to mark the event. Even if there was no book-signing or fancy launch party at least, this time, I was able to cherish my new book without the distractions of carpet-fitters or bicycle thieves.  

Reference
Germano, W. (2005). From Dissertation to Book. Chicago: University of Chicago Press.


Saturday, 3 March 2018

Wellbeing lessons from living Danishly

The Year of Living Dangerously was a 1982 Australian film about a love affair set in Indonesia during the overthrow of President Sukarno. Helen Russell cleverly punned on the film's title when she wrote her (completely unrelated) 2015 book about her experiences of living in Denmark – The Year of Living Danishly

The book's blurb explains: "When she was suddenly given the opportunity of a new life in rural Jutland, journalist and archetypal Londoner Helen Russell discovered a startling statistic: the happiest place on earth isn’t Disneyland, but Denmark, a land often thought of by foreigners as consisting entirely of long dark winters, cured herring, Lego and pastries. What is the secret to their success? Are happy Danes born, or made? Helen decides there is only one way to find out: she will give herself a year, trying to uncover the formula for Danish happiness..."

Russell's book is a light-hearted and entertaining read but the belief that Denmark enjoys a high level of wellbeing is supported by good evidence. In 2006-7, Huppert and So measured the prevalence of flourishing across the (then) 22 countries of the European Union (Huppert & So, 2009). Data from 43,000 adults was surveyed to ascertain the percentage of Europeans who could be said to be flourishing. It was found Eastern European countries tended to have lower levels of wellbeing while Scandinavian countries enjoyed the highest.

So, studying what can be learnt from the Danish way of life could be a very valid exercise. Helpfully, at the end of The Year of Living Danishly, Russell provides her Top ten tips for living Danishly. These might be summarised as:

1.     Trust others (more) - avoid unnecessary stress by trusting others more which, in turn, will improve their behaviour
2.     Get hygge - Enjoy the cosy, simple pleasures of life
3.     Use your body - Move more, exercise more
4.     Address the aesthetics - attend to your environment, enjoy good design and clean, tidy everyday surroundings
5.     Streamline your options - Reduce the stress of too many options by adopting simplicity and freedom within boundaries
6.     Be proud - Take ownership of something you and your community do well and celebrate it 
7.     Value family - reach out to relatives and put your family and friends first
8.     Equal respect for equal work - Caregiving and breadwinning are equally important
9.     Play - a playful, creative activity is a worthwhile occupation at any age
10.  Share - sharing makes life easier, and, even if we can't easily influence our government to create a Danish-style welfare state, we can begin by being more neighbourly.

Russell's list may seem a bit flippant or fanciful but it has much in common with the wellbeing 'five-a-day' produced by the New Economic Foundation (NEF) - an evidence-based list of five actions to be incorporated into day-to-day lives to promote wellbeing (Aked et al., 2008). The NEF's list was:

               Connect
               Be active
               Take notice
               Keep learning
               Give

It's worth reflecting on how much we incorporate these actions into our lives. The NEF wellbeing 'five-a-day' and Russell's Top ten tips for living Danishly are worthy of serious consideration. It seems there is indeed much more we could learn from the land of long dark winters.


References
Aked, J., Marks, N., Cordon, C. & Thompson, S. (2008). Five ways to wellbeing: The evidence. London: New Economics Foundation.
Huppert, F. (2008). Psychological well-being: Evidence regarding its causes and its           consequences. London: Foresight Mental Capital and Wellbeing Project.
Huppert, F. & So, T. (2009). What percentage of people in Europe are flourishing and what
characterizes them? Cambridge: The Wellbeing Institute, Cambridge University.
Russell, H. (2015).  The year of living Danishly. London:  Icon Books.

Tuesday, 30 January 2018

Using arts in the training of healthcare professionals


Today I 'attended' my very first webinar (- for the uninitiated, a seminar conducted over the Internet). Hosted by the European Forum for Primary Care the webinar featured Mehmet Akman (a Turkish academic working in the field of primary care and based at Marmara University School of Medicine) who spoke about 'Using arts in the training of primary care professionals'.

Mehmet's presentation was underpinned by four key points:
1. Art, especially literature, is helpful for handling values rather than facts, ambivalence rather than reductionism, dealing with a world where not everything can be explained by experiments;
2. Art creates a stimulating environment for professionals to express their feelings and thoughts regarding different aspects of human nature and themselves in a reflective manner;
3. Art has a potential to support developing an ability to respond to human needs during clinical work;
4. When used for professional development, arts can have instrumental functions (e.g. better recognition of visual signs, developing skills to deal with uncertainty,) and non-instrumental functions (e.g. personal development, new ways of thinking beyond the biomedical perspective.) The latter can be achieved through sessions in which the intrinsic value of art can be retained.

In the discussion that followed, it was acknowledged that Mehmet had focused on doctors working in primary care but that all of this could apply equally to other healthcare disciplines, other specialisms. I suggested that a logical consequence of using creative arts and humanities in the training of healthcare professionals was that these professionals might then go on to use these approaches in their direct clinical work with service users and carers. As one of the other participants pointed out, occupational therapy has a long and honourable tradition of using creative arts as part of practice. There is no reason why creativity can't be a positive influence in healthcare more generally and I'm grateful to Mehmet and his colleagues at the European Forum for Primary Care for reminding us of this.

Tuesday, 28 November 2017

Wellbeing in three strings – Dulcimers in Malvern

Elgar statue at Elgar's birthplace
(c) 2017 Tony Gillam 
This autumn I spent a musical weekend in Great Malvern, the picturesque Worcestershire town at the foot of the spectacular Malvern Hills. Malvern has a connection with the composer Edward Elgar (1857–1934.) His music is said to have been inspired by walking and cycling in the countryside around the hills, and the Post Office in Great Malvern was, in his day, a piano shop where he would give piano and violin lessons. He and his wife Alice are buried in St Wulstan's Church in nearby Little Malvern.

Malvern, then, was a fitting location for a weekend of music-making. The music, on this occasion, was not pianos and violins but dulcimers, the event being a gathering of the Nonsuch Dulcimer Club – a UK-based organisation for anyone interested in hammered or mountain dulcimers. Now, for the uninitiated, I should say a bit about these instruments. Dulcimers are part of the zither family of string instruments and are struck or plucked. The hammered dulcimer is a trapezoid shape and is played with 'hammers' of wood, cane or bamboo. A mountain dulcimer, on the other hand, is a completely different instrument. Sometimes called an Appalachian dulcimer (as it was developed in the Appalachian mountains in the late 18th century) it's a descendant of a variety of fretted zithers brought to America by European settlers. The mountain dulcimer is played on the lap and strummed or plucked. I've been playing the mountain dulcimer – not always very competently – for about thirty years and recently discovered (and became a member of) the Nonsuch Dulcimer Club.

Great Malvern from the Priory Tower
And what has all of this got to do with creativity, wellbeing and mental health? Well, quite a lot actually. First, there's the strange fact that, of the two hundred or so members, three – including myself – are both mental health nurses and mountain dulcimer players. But it goes deeper than this...

You may be familiar with the five-a-day campaign to encourage healthy eating. Taking its inspiration from this campaign, in 2008 the New Economics Foundation's Centre for Well-being developed a similar set of five evidence-based actions that the public could easily implement to improve personal wellbeing (Aked, Marks, Cordon, Thompson, 2008). Their wellbeing 'five-a-day' recommended five actions to be incorporated into day-to-day lives to promote wellbeing. They are:

•           Connect
•           Be active
•           Take notice
•           Keep learning
•           Give

My weekend in Malvern was a great example of all five. Over a weekend of workshops and concerts, we were able to connect with other dulcimer players. We made and renewed friendships. We were active – in the sense that we didn't just talk about the dulcimer but played it. Some took the opportunity for some walks in the beautiful surroundings of Malvern; some even danced. We took notice, of our surroundings, of our own and each other's playing. We kept learning new tunes, new techniques, (thanks to the skill of the talented tutors.) And we gave – we shared stories and songs, in an open stage concert, in snippets of useful information or insights.

An Appalachian or
mountain dulcimer
Malvern was originally a spa village and became a destination for the 'water cure'. First the Georgians, and then the Victorians flocked there for the curative and restorative qualities of its spring water. But the 'cure' of the dulcimer weekend was less to do with Malvern water (good as it still is) but with the enjoyment of a restorative dose of connection, activity and shared learning. Such brief periods of respite from the stressful humdrum of workaday life can enhance feelings of what Seligman (2011) calls positive emotion. This includes feelings of happiness, contentment, enjoyment, curiosity and engagement ...and all this from playing an instrument with only three strings.

References
Aked, J., Marks, N., Cordon, C. & Thompson, S. (2008). Five ways to wellbeing: The evidence. London: New Economics Foundation.
Seligman, M.E.P. (2011). Flourish: A new understanding of happiness and well-being – and how to achieve them. London: Nicholas Brealey Publishing.

Friday, 27 October 2017

Not just surviving but thriving

Mental health has been in the news recently with the publication of a report from the Department for Work and Pensions and Department of Health. Thriving at Work: a review of mental health and employers  sets out what employers can do to better support all employees – including those with mental health problems – to remain in and thrive through work. The 84 page document makes recommendations for employers, for the public sector and for government.  

What is interesting is the emphasis on thriving. The authors, (Lord Dennis Stevenson and Paul Farmer) state: "we start from the position that the correct way to view mental health is that we all have it and we fluctuate between thriving, struggling and being ill and possibly off work" (p.5). There are similarities, in this analysis, with Keyes' (2002) view of wellbeing as a continuum, with flourishing at one extreme and languishing at the other. We are flourishing – or thriving – when we are enjoying positive emotion and good psychological and social functioning, whereas languishing is associated with emptiness, stagnation and despair.

Earlier this year, to coincide with Mental Health Awareness Week, the Mental Health Foundation published its own report Surviving or Thriving? The state of the UK's mental health. The Mental Health Foundation is a UK charity dedicated to addressing the sources of mental health problems so people and communities can thrive. Like the Stevenson/Farmer review, Surviving or Thriving? makes some helpful recommendations, including 'ten steps we can all take to thrive' and 'five steps for a mentally thriving UK'.  Both reports are well worth a detailed read for, as Surviving or Thriving? warns:
"current levels of good mental health are disturbingly low. The barometer of success of any nation is the health and wellbeing of its people. We have a long way to go before we can say that we are a thriving nation. Although we have made great strides in the health of our bodies and our life expectancy, we now need to achieve the same for the good health of our minds" (p.6).

References

Keyes, C.L.M. (2002). The mental health continuum: from languishing to flourishing in life. Journal of Health and Social Behavior, 43, 207-222.

Stevenson, D & Farmer, P. (2017).  Thriving at work. The Stevenson / Farmer review of mental health and employers. London: Department for Work and Pensions and Department of Health.

Mental Health Foundation (2017). Surviving or Thriving? The state of the UK's mental health. London: Mental Health Foundation.