Unhearing: the act of not hearing

I’m resurrecting this blog post from 2013 to support the #NHSChangeDay 2015 #TimetoChange campaign.

It’s not easy having mental health problems, especially when you don’t feel you can tell anyone. It’s also difficult being an NHS employee with mental health problems. I come from a place of being an NHS mental health professional and manager with mental health problems. I hope this story might help others.

Heart woolI wear my heart proudly on my sleeve. I used to think that made me weak, vulnerable, over-emotional, ‘flaky’. It’s something I’ve battled with for many years: a self-diagnosed flaw.

Yet I might  just have turned a corner. That’s why I’m dipping into this new world of personal blogging. I’m learning to reframe my emotionality as a strength: it’s who I am and what makes me ‘me’. I’ve always been an emotional sort; I feel the physical pang of an emotion before my brain has chance to process the meaning. I am a deep thinker, an empathiser, an intuitive, a creative. I love nostalgia, good times and laughing. I’m terrified of loneliness, loss, failure and rejection. I don’t think I’m all that unusual- I’m just no longer afraid to tell it like it is. I hope, that through my blog, I can give one or two others the courage to wear their heart with pride- to be open about their mental health or understand a loved one or friend just a little bit better. This is what Helen Hutchings @TeaandTalking has done for me. If you don’t know about Helen, look her up on Twitter or read this newspaper article. Helen is my inspiration. More recently, Lisa Rodrigues @LisaSaysThis  spoke out  publicly about her battle with mental health problems whilst still holding down her high profile role as CEO of Sussex Partnership NHS Foundation Trust. I know just how hard it is to speak out, and I don’t have nearly as much resting on my shoulders as Lisa did. Lisa is now campaigning for #TimetoChange and is leading the NHS Change Day 2015 campaign.

Wearing my heart on my sleeve is my statement of intent as to how I go about living my life. It is primarily a form of communication about one’s internal and emotional world. It relies on being able to articulate and demonstrate feelings through words, gestures and behaviours. If we are brave enough to communicate our feelings and thoughts, we need to be received, heard, acknowledged, validated…accepted. This brings me to the theme of my maiden blog- unhearing: the intentional or unintentional act of not hearing or not wanting to hear the true meaning of what is being said.

Unhearing is my term for people, or systems, that chose not to listen, don’t want to hear, or pretend to hear whilst intentionally ignoring the message or sentiment. It can also be unintentional, a result of foregone or erroneous conclusions drawn from our own bias and misperceptions. This is a theme that is experienced all too often for those with mental health problems, their families and carers. Not only are our inner worlds and emotions some ofCovey the hardest things to articulate and share but they are also the hardest things for others to hear  too. I want to share with you my experience of unhearing.

In 2006, I had a stint at medical school. I’ve always wanted to be a medic, but my later teenage years were blighted by mental health problems which left me short on the grades to get into med school as a first degree. Taking route B, I gained a place on a graduate entry programme to medical school. I was in my late 20s, newly married, excited and confident that I had a new career within my grasp. I was expecting to work hard, really hard, study to the small hours, get stressed out with exams and the sheer volume of information overload. I didn’t care- I was going to become a Doctor and fulfil my ambition. I wasn’t expecting what happened at the end of my first term: a sudden relapse into the deepest depths of depression and suicidality.

I have had a longstanding history of depression since my teens, so fluctuations in mood was nothing new to me; but what followed was a period of despair and desperation and chronic unhearing. I knew I was on a fast decline, but swept it aside, putting it down to being away from home and feeling anxious about forthcoming exams. I was becoming increasingly withdrawn, I had stopped eating and cried myself to sleep every night. Although I loved my studies, I berated myself for not working harder, faster and smarter: I saw myself as failing and in a split second of despair, did something in an attempt to end my suffering. I regained consciousness in A&E and was swiftly flooded by that all too familiar deep emotional pain, so intense, that I sobbed to the doctor who tending to me. After hearing my plight for help, he put his notes and pen down on the end of my bed. In that fraction of a second, I was convinced I’d been heard. I had hope that someone was trying to understand my suffering and that there was someone or something out there that would be able to help me. “You are a medical student…” he started, “…we’ve all done things in our past which we regret…”

What followed is a blur but I know for sure that I was unheard. I was transferred to a ward for the night- to recover and “pull myself together.” I had been told that my actions that night could potentially damage my career and that I was being “helped” by minimising the negative consequences on my future. In other words no further offer of help ensued, and I was discharged back into the wrath of my crisis, with nothing more to show than a 24 hour stay in hospital.

I would like to think that this experience was unique, but I am saddened to hear of more and more cases not all that dissimilar to mine. How often do people try their utmost to make themselves heard, tell it like it is, but still feel unheard? We don’t always have words for our pain and at the depths of our despair, it can be near on impossible to be articulate and specific about our innermost experiences. It’s like a baby crying. We can see and hear their upset, but it’s not always clear what they want. We have to use our intuition and instinct to make an educated guess that they need feeding, a cuddle, a clean nappy, a sleep.

The message of this blog is to challenge you to hear- I mean really hear  those people who may need your help. Use your instinct, intuition, emotional intelligence- call it what you like, but if someone tries to tell you something, be there for them and listen. Don’t make assumptions but check out your understanding with them- feedback to them what you’ve heard and validate their experience. If we can all do this in our day to day lives, we create the right conditions to enable others to wear their heart on their sleeves. If we fail to do this then we become one of the unhearing who put up the barriers and feed the stigma against undisclosed emotional distress and mental health problems.

Helping someone with mental health problems and distress isn’t about helping them to neatly package it back into a box, and tightly re-sealing the lid. You might think that’s what they need and want, but in my experience, that is a short-term fix to enable them to limp on until the next crisis. I wish someone had let me keep my lid off for longer, long enough to get the treatment and support I needed. It makes me wonder whether putting the lid on someone’s suffering is more about the onlooker’s discomfort.

We don’t need to profess to be therapists, psychiatrists, healers or saviours. We just need to listen and hear. Time to Talk provides some great tips on how to talk to someone about their mental health and be there for them:

  • Take the lead
  • Avoid clichés
  • Think about body language
  • Ask how you can help
  • Don’t just talk about mental health
  • Don’t avoid the issue
  • Give them time
  • Find out more

It took me many years to feel heard- far too many years, but the best experience of being heard have come from my peers- other people with lived experience whether they be  – healthcare professionals or not. I still don’t feel heard at times, but I’m getting better at re-stating myself, and making sure I’m not unheard. That’s why it is so important that we all take ownership for how we receive others- you could be in that privileged position of being the first person to hear them.



Out of my head

“Better out than in!”

Well, that’s what I’ve always been told. Be it a worry, a problem, a sneeze or something far less ‘savoury’, getting it ‘out’ is good!

I started blogging last year. It felt awkward, stilted and I wasn’t sure how I’d be received so my ability to write from the heart was stunted by anxious & self-critical thoughts. The stark reality is that I’d ‘bigged’ it up to be something far more significant than it really was. I was just one in many millions of bloggers sharing their mental ruminations…a mere speck of dust, but to me, it was monumental. That’s because it felt so personal, raw and vulnerable.

So why is this any different?

It isn’t. I haven’t really changed, nor have my thoughts. It’s just that I now feel that my ponderings are just as valid and equally as acceptable as any other. I’ve been to a fair few conferences, expos and workshops over the years. With all due respect to the speakers, I rarely hear anything that is radically innovative or divergent in its thinking. What I do hear though is passion and an unshakeable commitment to values and vision. It’s not necessarily what you do, it’s how you do it. Take Dr Kate Granger as an example. Her wish is that all health and social care professionals introduce themselves to their patients. It’s that simple! #hellomynameis campaign is all about one person’s determination to change behaviours and attitudes and try to rebalance the relationship between care giver and receiver. We’re not talking life biographies by the bedside but something that is so fundamentally humanistic and inherent that we’ve somehow managed to lose it. Kate is making significant strides in putting this right through her unwavering passion and commitment. This is what I’m talking about. People who do things from the heart and the head.

Out of my head 

This has become my new personal project. I am going on a journey to push myself outside of my cerebral comfort zone and to translate some of my ‘head stuff’ into tangible actions and outcomes.  We all possess latent talents and skills that are only ever discovered when we stumble upon them by accident, muster the courage to try something new or get backed into a corner where we have no other option than to ‘perform’. Now I’m not saying that writing or blogging is my talent; judging by the amount of time it takes me to write 1000 words, I’m pretty sure it’s not. This blog will be no more than a candid and organic attempt at sharing the development of my personal project and journey with others who may resonate in someway with what I say.

I would like to think that my talent lies in the thoughts, ideas, values and visions that are trapped inside me. The reason they are trapped is complex, but I reckon I could break it down to three very common fears that are deeply rooted in most of our core beliefs:

  • Fear of humiliation: I may be laughed at, ridiculed, humiliated or patronised.
  • Fear of failure (others): I may be criticised, told I’m wrong or may look silly if I don’t achieve.
  • Fear of failure (self): I may start to believe the nay sayers, I may believe I cannot do it.
  • Fear of rejection: I may not be heard, accepted or acknowledged.

NHS Change Day 2014

My pledge for NHS Change Day 2014 was to, “Do something on a daily basis that takes me out of my comfort zone.” This project is an extension of this very pledge.

My friend and ex-colleague, Charlie frequently reminded me, “If you always do what you’ve always done, you’ll always get what you’ve always got!“. So now is the time to change that. There are so many wise and inspiring quotes that back this up,

“It is better to try and to fail than to fail to try and forever experience the inestimable loss of what might have been.” (Unknown)

 “The probability that we may fail in the struggle ought not to deter us from the support of a cause we believe to be just.” (Abraham Lincoln)

 “Vision without action is a daydream, and action without vision is a nightmare. Your heart is free, have the courage to follow it” (Melchor Lim)

 “If you are always trying to be normal, you will never know how amazing you can be.” (Maya Angelou)

It was this last quote by the inspirational and late Maya Angelou that was the one that really gave me a kick up the bum to do something (thanks to @PilgrimPip for posting it on Twitter).

Comfort zoneSo what next? Well, that’s for me to decide, as I said, this is very much a personal project. It is about having courage to speak out, a conviction to believe in my ideas and opinions and not be afraid to voice them. The humility to realise I will get things wrong, but the self-confidence to not dissolve when I do hit criticism or resistance. It’s the bravery to challenge and the willpower to stand strong when others may humiliate or doubt. This isn’t about being right, winning the argument or being stubborn. This is about respecting and valuing my own integrity, intelligence and insight.

The School for Health and Care Radicals taught me so much about personal effectiveness and change agency, particularly the concept of self-efficacy (a belief in our ability to make something happen). I think you’ll find that this becomes a recurrent theme in many of my future blog posts. I truly believe that when armed with the courage of our own convictions, we can make truly amazing things happen.


Working out loud about Working Out Loud

I’ve heard lots of people tweeting and talking about Working out Loud or #WOL over the last year or so. It’s one of those things that I haven’t really gone to great lengths to understand: not because I’m not disinterested: far from it. I think it’s because I’ve accepted it at face value and have applied a common sense, intuitive approach to understanding its principles and practice, I guess I’ve taken a heuristic or ‘laxidazical’ approach. On one level, I think that’s fine and probably what many busy people do. With the advent of #WOLweek from 17-24 November, I wanted to challenge my preconceptions and possible misconceptions about WOL in public, and it couldn’t get much more public than in a blog.

My take on WOL

To me, WOL is like having a massive, public projection screen of all those things that remain “unspoken” in your head. Off the top of my head, I can think of the following things that may come under this heading:

  • inner thoughts & ruminations
  • imagery & visualisations
  • values
  • beliefs & biases
  • attitudes
  • mental models
  • experiences, stories & narratives
  • heuristics
  • scripts & schema (our experience of what we think we will happen next based on heuristics)
  • tacit knowledge
  • explicit knowledge

I’m pretty comfortable with sharing this kind of inner-thinking. I’m a Cognitive Behavioural Therapist, so compared to many others, I am more likely to express my thoughts and feelings more readily and frequently. It’s also second nature for me to invite others to do the same (sometimes to their annoyance!).

There’s more value in the process than in the final product…

My take on WOL was to ‘make public’ the processes that I went through when doing any particular piece of work or task. This could be done by talking about it with others, showing my ‘workings out’ on paper (usually mind maps), or broadcasting it via Twitter. I remember back in my GCSE school days, we were told to always show our ‘working out’ (how we arrived at our final answer). We also got marks for using the right kind of process to derive our answer, even if the final number or equation was incorrect. This, to me, epitomses WOL. It’s not so much about the final destination i.e. the product, but about how you got there, why you went there and what influence you along the way.

Faulty thinking patterns vs WOL

One thing that has bothered me is the sense of vulnerability that WOL could stir up. Noticing how I felt when I let people into my private thinking about how I was approaching a project and why I had chosen to do it that way was revealing. I’ve always been a bit of a perfectionist with a fear of ‘getting things wrong’. The very nature of opening myself up to questioning and challenge from others (albeit well intentioned) was most certainly out my comfort zone. Sharing an unfinished piece of work, a draft, rough sketching or outline was (in my mind) almost tantamount to failure [faulty thinking pattern]. As harsh as this may seem, I’m fairly sure that others feel the same way, and as such, this becomes a blockage for fully embracing WOL and indeed any other method where you relinquish control in someway e.g. co-production. Of course, the only remedy for this fear is repeated exposure, and the ability to capture and challenge negative [faulty] thinking which is most often grounded in a long-held core belief rather than in fact and reality itself.

WOL back in context

So, back to WOL as described by John Stepper, @johnstepper author of ‘Working out Loud: The Book‘ (due in February 2015).

John describes 5 elements of WOL, and I have revisited these to re-align my thinking and approach for the next 5 days of #WOLweek.

  1. Making your work visible
  2. Making work better
  3. Leading with generosity
  4. Building a social network:
  5. Making it all purposeful

My personal purpose for #WOLweek will be to get into a more ‘comfortable’ place when it comes to receiving feedback and challenge about my work. I think I can sometimes come across as a bit defensive, and that is understandable considering my tendency towards faulty thinking about criticism and failure.

I’ll give you an example. Just yesterday, I wrote a piece on a new topic that was previously unfamiliar to me, but after a fair amount of reading, I felt confident that I had got a good grasp on it. I sent off the document, feeling pleased that I’d assimilated my knowledge into a piece of writing that was congruent to my style and also accessible to a variety of readers. What is really interesting is that the feedback I received was that I hadn’t quite grasped the topic. The feedback was given in a really open and non-judgmental kind of way, but all I could hear being said was, “You’ve got it wrong!” (of course, those words were never used). I then turned to the original paper on which the piece was based, re-read it and checked out my assumptions. Now the really puzzling thing for me is that I am still interpreting the topic in exactly the same way as before.

What does this mean? Well, we came to the conclusion that this was a really interesting experience. If I hadn’t have written this piece in complete faith and confidence that I knew what I was talking about, then the discussion would never have happened. Nor would the other person have realised that I had a different take on it to them. Rather than anyone declaring they were right or wrong, we have agreed that we need to take this conversation further and wider. Only by exploring and being truly open to a diversity of viewpoints and thinking can we ever gain a heightened appreciation. Furthermore, if we don’t include others in this exploration, then we are holding on to knowledge and opportunities which may be of benefit to a whole host of people.

My #WOLweek

IMG_0414.JPGI have tweeted and posted an open invitation on Yammer to my colleagues at NHS Improving Quality (NHSIQ) to join me in a  #WOLcircle (something else that is new to me). I want to be able to join with 3-4 other people from my wider team at NHSIQ (not those I usually work with) to bring regular WOL to our practice through a virtual #WOLcircle using an enterprise network such as Yammer, or a social network app e.g. Whats’app. I’d like to engage with people at NHSIQ because we are a diverse and widely distributed team who very rarely get the chance to work together and share projects. I’m also new to NHSIQ, having only started in my post in September. This will help me to build a small social and personal network within my organisation, learn about others’ work and their associated work programmes, share my work and the work of the Horizons Group, and of course, challenge some of my anxieties about WOL.