mental health – Trish Thinks…

It’s Freaky Friday All Week (Final)

For five days in July 2022 I swapped lives with my children. This is the record of our experience.

LIFE SWAP DIARY
Part six

Last Day: Friday

The food has been delicious, but the housekeeping has been somewhere between minimal and non-existent. We are under pressure because we have a friend, Brian, coming over for dinner this evening. I stomp around pointedly muttering about monetary rewards and their direct relationship to performance levels. This doesn’t work and myself and John both begin shouting. Soon all five of us are shouting, vacuuming, dusting and sweeping piles of toys under rugs. Our dinner guest arrives just as we have finally pulled it all together. Mary has been simmering beef chilli in the hotpot all day and whipped up some rice and homemade guacamole to accompany it. Michael and Seamus have set the table on the terrace nicely and sit chatting to our guest and fetching us drinks while we wait for dinner. Five minutes after Mary serves up it starts to rain. No one can be bothered moving the whole shebang inside, so we take turns to huddle under our canopy and I notice with alarm bright orange and green rivulets pouring off the edges. So the paint wasn’t waterproof. Oops.

The final task of the week is to do the dishes, after which they are free to watch inane cartoons until they lose consciousness and reawaken into normal life in the morning. But instead they stick around. The rain eases off and we light a fire. Brian shows Michael how to use wax to keep a little stick-torch alight. We’ve been playing with fire all week, what’s a few more hours?

The food and fun were spectacular but neatness is not their strong suit

Aftermath: Back to Porridge

It took a day or two of slipping back into the comfortable bed of old habits to appreciate what had really changed during our adventure. I can’t say that I was surprised by how well my children could cook and clean. I knew they were capable of that. The biggest surprise was myself. I hadn’t realised until I stopped how relentlessly frustrating, stressful, exhausting and downright depressing it is to try so hard to manage another person’s life. To schedule a week. To organise a day. During our experiment there was a subtle shift in responsibility that had nothing to do with whose job it was to do the dishes. I didn’t see it until my books were stolen in the train station. I was so upset with myself for forgetting them, I sort of froze for a moment before I even started looking for them. It was Mary who organised the search party, assigning us each a section of the station. She took charge. Her brothers followed her lead in a symphony of perfect cooperation. In case you think my kids are just saints, or freaks of nature let me say with haste that this is usually not the case. We have suffered protracted bouts of sibling rivalry. Hours of teasing, arguing and fighting. I’ve also wasted hours on lectures advocating personal responsibility that were intended to engender the kind of initiative I saw that day, to no avail. I had expected this initiative and responsibility to show itself in clean bedrooms and walked dogs, all on cue and in fulfilment of clearly communicated expectations. And I had often been disappointed. So what was different now?

The most common and fundamental mistake we make in bringing about change is to focus first on changing other people’s behaviour instead of looking first to ourselves. The missing ingredient my kids needed to really practice responsibility was for me to let some of it go. Giving your children a job is easy. Backing off and letting them carry out in their own way is harder. Doing it badly. Doing it wrong. Doing it as quickly as possible and then watching cartoons for four hours. It’s all infinitely better than not doing it at all. This can be hard to swallow in a culture where both children and parents are constantly under surveillance and constantly being judged. But kids, please! Give the grown ups another chance. We can eventually learn to back off. We just need some practice.

Séamus finds space to relax without well meaning parents trying too hard to entertain him

It’s Freaky Friday All Week (5)

For five days in July 2022 I swapped lives with my children. This is the record of our experience.

LIFE SWAP DIARY
Part Five

Day Four: Thursday

I am practically begging to leave the house. My usual strategy in summer is to spend as much time as possible outdoors, for several reasons. It’s healthy and wholesome. It means less tidying and cleaning up. It keeps everyone entertained. It keeps me entertained. The kids have been so happy to be left to their own devices and so busy working at cooking and laundry that they have barely left the house at all. Over a lovely brunch of potato waffles and Mary’s homemade Moroccan spiced beans I float the idea of a trip to town to tempt them outside. They agree to head off with me on the train to pick up a book I have ordered after they finish cleaning up. Yes! Freedom!

While they are doing the dishes I impulsively start to do something I’ve been thinking about for a while. We have a white tent-canopy over part of our balcony so we can air-dry our washing even when it is raining. I have long fantasised about decorating it with paint. Giving it a bit of colour and adding a Jackson Pollock vibe. I lay the canopy on the ground outside, get some of the kids’ acrylic paints and start to spatter. Before long the dishes are abandoned and everyone is getting involved. Once we’ve squirted some of every colour in the house Michael suggests adding footprints into the mix. I can’t resist, but accidentally go into automatic responsible-for-the-mess mode and bring a bucket of water outside to ensure everyone washes off their feet (and paws) before they hit the carpet. When we have finished there are multiple paint stains on the paving stones that look very much like they are never coming off. After a half-hearted rinsing attempt I abandon it and we head off to collect my book.

Once in town Séamus decides to have a tantrum in the first shop we enter because he doesn’t have enough pocket money to buy the toy he wants. He does something he hasn’t done for around two years- lies down on the floor in full brat mode. I am consumed with silent rage, but icily determined to get the book I have waited weeks for. I make an impulsive and unusual move. No bribes, not threats, no dire warnings about “consequences”. I wait for him to get bored on the floor and stand up and then I take them to the nicest coffee shop in town and get them hot chocolate. They are visibly confused. I explain that this week is a holiday for me too. Not just from the dishes and the laundry, but from being in charge and directing everyone’s behaviour. I tell them I really, really want to get my book (Fearless by Catrina Davies) before we go home. We get to the bookshop and somehow have a lovely time browsing for ages. As well as my long awaited book I pick up another on David Hockney (John’s favourite artist) as a surprise. We make it to the station on time for our train without the usual huffing, puffing and rushing. We even have ten minutes to pop to the loo before the train comes!

Our modern art installation ‘Hung Out to Dry’

Of course I leave my book bag hanging on a hook in the toilet stall. I realise I’ve done so five minutes before our train is due. We go back and search the toilet to no avail.

We ask a member of staff who tells us that a book bag was handed in. It’s my bag alright, but the expensive David Hockney book and Fearless are missing although some school books remain. The book thief has admirable literary and artistic taste. Of course we miss the train. The kids are surprisingly sympathetic as we wait for the next one. And patient. Strangely so in fact. Waiting an extra 30 minutes for a train after a long hot day with a four year old should be a nightmare, but he sits peacefully and quietly. It dawns on me that the usually constant background drone of sibling bickering has been absent all week.

I get home exhausted, but very thankful that I don’t have to make dinner because I want to hoist our paint splatter canopy back up before John gets home. He might find our little foray into modern art a bit more acceptable if it doesn’t involve any DIY work on his part.

For dinner we have vegetable curry with homemade naan bread. This proves to be the first culinary mishap of the week for Mary as the naan dough is too sticky to roll out. I show Mary how to add extra flour gradually to make it less sticky. It feels more like an exchange of know-how between equals than my usual lecture “On How to do Everything Correctly”. The line between helping kids and doing it for them has become increasingly blurred of late. The experiment has really helped me find that line again.

It was hard to adjust to all the free time at first but I managed

It’s Freaky Friday All Week (4)

For five days in July 2022 I swapped lives with my children. This is the record of our experience.

LIFE SWAP DIARY
Part Four

Day Three: Wednesday

Although I only had a few beers last night and got to bed fairly early, I somehow wake up bitterly hungover. There is a patch of sand at the bottom of my shower tray that has been there since Monday. A toilet roll the dog ripped up has been strewn about the stairs for two days now. They left the wash in the machine yesterday. I suppose the cooking and laundry are running well because everyone likes to eat and have clean clothes, but it turns out no one else really cares about general messiness but me. But I can’t bottle it up any longer.

The dam has burst and I’m giving verbal prompts all over the place. I explain about washing left in the machine too long and the lingering smelliness that ensues. They decide to rewash it before hanging out. That will be a total of 2 washes complete in three days then. Not ideal. I do approximately two a day during term time. Without school uniforms the summer laundry schedule is a bit more forgiving, but not that forgiving.

Michael practices Zen and the Art of Dish Minimisation

Lunch is a joint effort with all three helping. They make tuna wraps. John pops in from his “office” in the garage for a bite and is obviously starving, having been hard at work all morning. He is trying to be a good sport and praise their efforts, but they don’t quite seem to grasp that as the tallest in the family by a foot and by far the most athletic he definitely needs more food than the rest of us. John, myself and everyone else even down to little Séamus are served the exact same portions. Luckily little Seamy can’t finish his and John jumps at the chance to wolf it down.

Even MasterChef Mary can’t keep it up every night of the week as salmon en croute goes puff by Wednesday

I think everyone is a little tired at this point, and at dinner time Mary forgos her usual gourmet adventures for a quick-and-easy chicken burger and chips. She serves up all our burgers pre-dressed with salad and sauces according to our individual tastes on one big wooden board and plonks down a ginormous bowl of chips. No plates or cutlery. Dishes are for chumps and those who never have to tidy up after themselves. We fall asleep in front of a movie apart from Michael who goes on a 4 hour lego binge constructing what amounts to an entire village in his room.

It’s Freaky Friday All Week (2)

For five days in July 2022 I swapped lives with my children. This is the record of our experience.

LIFE SWAP DIARY
Part Two

The Challenge Begins

Day One: Monday

I open my eyes and grope for my phone to check the time- 9AM! I can’t believe how long I’ve slept. My generalised diffuse compulsion to “get things done” usually has me first up in the morning. When I emerge from my room there is a lot of sitting around watching cartoons going on and breakfast seems to be every man for himself. This is smart. Why start messing up the kitchen when there are a further two meals to prepare and clean up for today? I ask why there are no piles of breakfast dishes and snort with a mix of admiration and dismay when Mary responds that they had toast and tea in the kitchen, leaning over the sink to cut down on dishes. Genius! They even rinsed out their cups instead of piling them in the dishwasher. It’s sterling work, but why didn’t the little darlings ever think of this when I was chipping congealed weetabix out of a stack of bowls every morning for years?

For lunch Mary serves up pastrami rolls with sundried tomato and spicy olives. She pays much more attention to presentation than I would and even a sandwich suddenly feels like a treat. For afternoon entertainment they suggest afternoon tea and biscuits with a nice quiet read, and of course I am happy to oblige. The promised screen time limits for me have not been mentioned. Nor has the threatened homework. It seems that as long as I am not hanging over their shoulders telling them to switch it off they are suddenly not too fussed about what I am doing. I find myself with an unprecedented amount of time to answer texts, follow links and even watch videos I have been sent. This normally has to wait until after about 10 at night when absolutely everything else is done and all the people who messaged me are in bed. I’m using my new-found bucket of free time in part to write up my diary of each day. Mary looks over my shoulder and asks what I am writing. When I explain that I’m blogging about what we are up to she shakes her head, dismissing it as “a bit too… American”.

For dinner they have planned to cook spicy prawn and pepper kebabs. After chopping garlic and preparing various seasonings for about 20 minutes Mary pulls out the wooden skewers to assemble the kebabs and realises that because they are made of wood and have been in the cupboard some time they have gone mouldy. I bite my tongue and resist the urge to jump in with suggested solutions. I’m assuming she will need to change the menu. Instead she asks me to visit the corner shop to buy more skewers. I can see in her eyes as she asks that she is aware that I am often hit with a stream of complaints when I ask her to pop to the shops for a forgotten ingredient while dinner is on. I acquiesce graciously to her request and immediately leave to get the needed item. She is grateful and a moment of understanding passes between us. We have a delicious dinner.

Having had their fill of ipad and cartoons in between their one laundry load and the cooking and cleaning of two meals they ask to go to the beach with the dog. When we return I put on a movie and no-one objects, except Michael who goes downstairs to watch the cartoon of his choice alone in his room. Not something I usually approve of, but hey, he’s the boss now. They stay up until 11pm and are too tired to object when I suggest they might want to switch off and go to sleep. It doesn’t matter too much that they are up late as there’s no unbearable woman to wake us all up in the morning early to make sure we have time to eat, dress, run, walk the dog and do yoga all before 10am, and as I drift off I feel immensely grateful for that.

It’s Freaky Friday All Week

For five days in July 2022 I swapped lives with my children. This is the record of our experience.

LIFE SWAP DIARY
Part One

April 2022: The Proposal

I call the troops (Mary, 12, Michael, 9 and Seamus, 4) around the table for a family conference. I have been banging on relentlessly for years about the need to develop independence and practice self-care skills. I’m aware that the term self care is more often associated with duvet days, probiotics and mindfulness meditation these days. But you have to walk before you can run, so I’m focusing on staying alive stuff like cleaning, cooking and washing. I’d like to think that if I banged my head and lost consciousness they could keep it together to phone an ambulance and tidy the house for me before it arrives. So far this self-sufficiency training has met with very mixed success, but I’m about to put my money where my mouth is. I’m not at all sure how they will take it.

“What do you think about swapping lives for a while?” I ask. They look at me quizzically. “How would you guys like to be in charge for a week?” Now they look hunted. I’ve piqued their interest but they are almost sure it is a trap. “You three will be in charge of running the house: cooking, cleaning and laundry. Myself and Dad will do your jobs: running to the shop for milk and bread, walking the dog, clearing and setting the table.” Their first reaction was to ask if they can impose screen time limits on us. It immediately seems like a deal breaker. They don’t seem at all intimidated by the idea of running the house, but unless they get to throw their weight around dishing out orders they are not sure what is in it for them. I don’t see why not. I hate being chained to the computer all the time. I’m very happy to have a week off. Their Dad, John, is a very different story though. He is a self-employed artist who runs his own website. They are very resistant to the idea that Dad’s screen time is necessary as it puts a roof over our heads. Banning it would therefore make us homeless. I gallantly offer to make up for Dad’s selfish bread-winning-by-computer by saying that in addition to my strict screen time limits, they can give me homework.

May 2022: The Preparation

We agree some basic ground rules, and dangle a monetary incentive. The princely sum of 50 euros is up for grabs for a job well done. I fill them in on what it is I do all day when I am at home. Laundry must be washed, hung on the line to dry, then make its way to each person’s room neatly folded. Meals must be provided, meeting our usual standards of reasonable nutritional value (so no ordering take away for the week, or living on crisps). Dad and I will provide a stocked fridge and larder, and a small budget for items like milk and bread that need to be bought during the week. The dishes must be done and kitchen kept clear and clean enough to prepare food.

Cleaning of bathrooms and vacuuming should take place, with an obligation to keep the place tidy enough to get things done. Cook, clean, tidy… and that’s it. I will take on their usual burden of entertaining four year old Seamus and generally keeping him out of the way while they do the big jobs. Simple. What could possibly go wrong?

Early July 2022: The Final Countdown

As we get closer to doomsday Mary starts to ask questions and make lists. This is a dead giveaway that she has started to take things seriously, and to get genuinely interested in this project. She is a born list writer. Without any formal police training she has somehow intuited that pedantic notetaking can be much more intimidating than force. Food is her immediate concern. Recipes are consulted and shopping lists drawn up. Mary is a good cook and has been capable of making a family meal solo since age 11. She’s ambitious though, and I wonder how far into the week the salmon-en-croute-with-garlic-and-herb-butter mentality is going to go and whether I should stick some emergency fish fingers and beans on that list.

I had intended to leave the house in tip top condition the night before, with all the laundry baskets empty, but this has not happened. We decided to spend the day at the beach instead, so I’m scrambling frantically to clear the decks at 10.30pm before we go to bed. Earlier this evening we visited the local budget supermarket to finish off the shopping list for the week. Because we stayed at the beach so late we found ourselves pedalling off up a hill under grey skies, rushing to beat the rain in a caravan of bikes and scooters to get there before closing time. At the crest of the hill, just as the first raindrops began to splatter us, Michael shouted out “this is fun!” without a trace of irony. It’s not a sentiment he has ever expressed about a supermarket trip before, and though I’m getting really pretty nervous about the whole experiment by now I feel hopeful and even a little bit excited about it too.

Will the real Rosenhan pseudopatients please stand up?

If you have taken more than a passing interest in psychology, at any level, you have almost certainly come across the Rosenhan Experiment in which 8 pseudopatients claiming to hear a voice were admitted to psychiatric hospitals and diagnosed rapidly and fixedly with various psychotic conditions. Even if some other aspects of your course (like hand calculation of correlation coefficients for example) left you cold, I’m willing to bet this piqued your interest. As a lecturer in mental health I speak about this study to students at least 3-4 times each year, and I have yet to tire of it. If anything, my fascination deepens.

Although most students are familiar with the main thrust of the study and its outcome, it is so familiar that most don’t go and read the original paper in full, which is a pity. They miss some juicy details, like the ways in which the patients’ every behaviour was interpreted as pathological in the medical and nursing notes. “Patient engages in writing behavior” illustrates neatly how context is all important in our perception and interpretation of behaviours as symptoms. The “oral-acquisitive nature of the syndrome” of schizophrenia was the supposed cause of patients loitering outside the canteen before meal times on a ward where there was quite simply nothing else to do.

My favourite detail is that the great Rosenhan makes an error in describing an everyday statistical concept in this paper! There is hope for us all (I will post a lollipop to anyone who can find it).

Although the paper is largely descriptive, there are some interesting numbers in there too. For example, the mean number of minutes per day that the hospitalised patients had contact with psychologists, psychiatrists or physicians was 6.8. This figure includes the admissions and discharge interviews as well as group and individual psychotherapy sessions. The 8 patients collectively were administered 2,100 pills. Despite all but one of the pseudopatients striving to be released after the first day the length of hospitalisation ranged from 7 to 52 days and many retained a diagnosis of “schizophrenia in remission” on discharge.

Publication of this paper in 1973 caused a lot of controversy, with psychiatrists defending the validity of their diagnostic systems and pointing out that many medical illnesses can be feigned without causing us to doubt their validity.

Psychologists have generally embraced the study as a powerful demonstration of the biasing effect and stickiness of diagnostic labels. For some it may be perceived to bolster the argument that using a medical model to research and treat mental health difficulties just doesn’t work. That it is still being discussed and articles being published on how it is represented in textbooks is testament to the enormity of its influence in this field of psychology.

David Rosenhan passed away in 2012 after a long and successful career, finishing at Stanford. The pseudopatients (“three psychologists, a pediatrician, a psychiatrist, a painter, and a housewife”) have to my knowledge never been identified or come forward. I would love to hear from them, or their friends or relatives in the case that some of them have passed away. There was also a ninth patient who violated the ground rules by giving false information outside the claim to hear a voice in his admission interview.

So is the infamous Rosenhan Experiment a damning indictment of psychiatric diagnostic systems that still exist today, a merely historical embarrassment that serves to demonstrate how far we have come, or a gimmicky but unscientific reminder that doctors are human too, and can be fooled like the rest of us?

What do you think?

Update to this article: In November 2019 Susannah Cahalan published a must-read book (The Great Pretender) for anyone interested in this topic, suggesting aspects of the study were fraudulent. Thanks to the commenter who mentioned this book.

How can we address mental health stigma at work?

Interest in the stigma surrounding mental health difficulties has been increasing amongst researchers and health practitioners, and with good reason. Experiencing discrimination and negative attitudes as a result of mental health difficulties can lead to social isolation and reduce the chance of recovery. Those who have experienced psychosis have even been presented by the media as dangerous , with some sufferers describing the prejudice they have faced as worse than the symptoms themselves. This stigma can have a serious impact on all areas of life, as well as on business and employment, both for individuals and for the wider organisational culture.

Much effort has rightly focused on calls for funding to decrease stigma and improve attitudes. However, if the budget were to double, or even triple, tomorrow would we know how to spend it? How much do we know about which specific attitudes are most harmful to well-being and recovery, and how to change them? Researcher John Read, along with Clinical Psychologist and voice-hearer Jacqui Dillon have questioned the efficacy of many well-intended campaigns to reduce stigma that have been based on promoting the idea of equivalence of mental illness with physical illness. The “illness like any other” approach can lead to decreased stigma around help seeking, but can also lead to a reduction in the perceived potential for recovery and an increase in perceived dangerousness and unpredictability . One 1997 study (harking back to the dark days of the Milgram Experiment) even found that emphasising biomedical ‘illness’ type explanations leads to a higher amount of ‘electric shocks’ administered to a research confederate posing as someone who had experienced mental health difficulties. Still other researchers have found that concentrating on whether mental health difficulties are ‘real’ biological illnesses or not has no impact on stigma at all (as did our own online experiment).

And then we have the equity versus equality debate. Is our goal for employers and colleagues to be ‘blind’ to cognitive and emotional problems the way we might talk about being ‘colour blind’ when it comes to race issues? Or is it more about providing the necessary supports to increase individual performance and fulfillment at work for individuals who might have specific needs? Mental Health issues are covered under the term ‘disability’ in employment legislation in Ireland. Are those affected comfortable with the perception of their experiences as a disability?

What are your thoughts on what reduced mental health stigma should look like in employment? And what are your ideas on how we can get there?