Writing “Recovering from Psychosis: Empirical Evidence and Lived Experience”: Some Reflections

I started writing my soon to be published book (eek!) “Recovering from Psychosis: Empirical Evidence and Lived Experience” way back in the summer of 2012, and today handed my completed manuscript over to my critical readers for their commentary. So I am in the last throes of this piece of work – a little bit over 2 years of work.

I’m excited and nervous to get their feedback. It’s challenging to think that others are going to read and reflect on what I have written and proffer their expert opinions on the material. Writing this book has been a long undertaking – emotional at times, grueling in places when it felt like it was never going to end, and an education in terms of understanding first-hand what’s involved in publishing an academic book. Certainly its not something to be taken lightly – and there all kinds of hoops to jump through in the process that I had no inkling of when I sent my proposal off to Routledge 2 years ago.

I’d completed a survey for the publishers on pre-registration mental health nursing textbooks and noticed in the email that they were open to proposals of new books. I realized I did have something in mind to write and completed their initial form outlining what I had in mind. Then a sample chapter (the introductory chapter that is now Chapter 2 of Recovering from Psychosis) was put together and reviewed anonymously. I was really pleased to get such positive comments back from the anonymous review – my writing is not devoid of merit after all! This then led to the negotiation of the contract and setting a deadline (which moved several times as the enormity of the task set in).

Recovering from Psychosis isn’t just a review of the state of empirical evidence, although it does do that, it also explores my own lived experience of overcoming this devastatingly potent condition that tore my life into bits in my early 20’s. I was aiming to write something that synthesized the more ‘objective’ academic review of our understanding of psychosis with a testimony of my experience as it relates to this. So when I reviewed the range of treatments I included relevant aspects of my own experience of these. When I wrote about recovery and research into it, I reflected upon my own battle and growth from the experience of psychosis. What I hadn’t really anticipated was how powerfully emotional that would be. Indeed I had some sleepless nights and some reliving of those darker days, and this has made me even more grateful for where and who I am now 20 years after the episodes I reflect on in the book.

This is far from the ‘definitive account’ of psychosis because of the individual nature of the personal experience. There are certain commonalities and themes in the experience of psychosis that are present in my account that will undoubtedly resonate with others who have had the challenge or are living through the enormous challenge of psychosis. In terms of the review, already portions of it are losing their contextual edge because research continues into refining our understanding and capabilities to work meaningfully and productively with it. It also presents, I hope, a robust critique of the limitations and disadvantages, if not dangers, of the ‘recovery’ approach as well as summarizing what we can gain from this perspective. I expect that later editions will be able to address advances and changes to our knowledge about psychosis, although I’m hoping I won’t have to write a second edition too soon!

If you are considering writing, or are just embarking on writing a book something I’ve learned about the process is this. You’ll pretty much always think what you’ve written is rubbish, and first drafts tend to be raw in the first instance. Be prepared to revisit stuff, rewrite stuff and detach yourself from the process as much as you can. Getting into a disciplined routine of writing really helps – so if you can join a writing group that meets regularly, and sets up a space where everybody gets their heads down and hammers some words out – this is a ‘must’ do. Looking now at what I’ve written with some distance almost feels like an ‘out of body’ experience – did I really write this? It’s not too shoddy after all. Others will be the best judge of what you have written and you may be surprised what they think of your stuff. Certainly they are never going to know unless you commit some words onto the page and see what happens!

“Parity of Esteem, No Health Without Mental Health” : Political Sloganism

I found myself tweeting this the other day, in amongst tweeting about book writing and the excitement of new Dr Who episodes and Great British Bake Off:

— Stephen Williams (@MHNurseLecturer) September 10, 2014

Looking at governmental interventions that have affected mental health we have had years of NHS staffing cuts, resource cuts, bed losses, ‘back door’ privatisation and rhetoric and tokenism. Take Nick Clegg’s  recent pledge (not a good word to associate with Mr Clegg – notorious as he is for reneging on promises) of a £50M ‘boost’ into mental health research. What does this actually do for the much vaunted ‘parity of esteem’? Well firstly from a research perspective it could help maybe fund a few randomised control trials worth of studies. This may improve understanding or enable a new therapy to be trialled. As for what this would do for the experience of the service – next to nothing I would imagine. So this kind of pledge strikes me as nothing more than a misguided and empty political piece of misdirection. Sort of – don’t look at what a terrible dangerous mess this is all in, look at the offer of shiny-shiny money – aren’t we caring and doing something about it after-all?

Remember this one? Liberal Democrats 2010 Electioneering Slogan.

 

Let’s also consider this idea of ‘parity of esteem’ – that mental health which has pretty much from its inception within medical and health care practice always played second-fiddle to physical health services in terms of image, funding and priority. Perhaps it seems, at first glance, laudable to call for a parity? When I first heard the phrase it immediately seemed to me that this was going to be another bit of ‘rhetoric’ that would never translate into meaningful action – i.e. raising resources and funding for mental health services. The disproportionate cuts between acute services and mental health services seems to bear this assumption of mine out. (See  http://www.bbc.co.uk/news/uk-england-sussex-26530733, http://www.bbc.co.uk/news/health-25777429, and http://www.bbc.co.uk/news/health-27942416 for examples of how cuts demonstrate that ‘parity of esteem’ is a hollow political promise).

Given the potentially devastating impact that mental health difficulties can have on a person’s well-being, life circumstances, relationships, emotional state, livelihood, physical health, citizenship, personal security, status, longevity and employability is it reasonable to suggest that ‘mental health’ should just be ‘on a par’ with physical health? I’m bound to argue that in some respects addressing mental health difficulties should be given priority according to its own needs and impacts, in its own right. This might mean that it needs funding above and beyond acute and physical care and that calling for a ‘parity of esteem’ is doing mental health and healthcare in general a disservice. Is acute and physical care necessarily getting the attention, funding and resourcing it needs and deserves? Somehow I doubt it given the shear depth and breadth of the services encompassed. Equality is not necessarily about “treating everybody equally”, it’s more about making adjustments that enable those persons needs to be met – tailored to obstacles that are present within that person’s life circumstances.

Ok, extended grumbling over – as you were!