Everyday madness

Do you ever get days where you look at a chair, and then say the word “chair” to yourself and wonder how those things can be connected, the object and some random sound we make with our mouths? Or you are driving down the motorway and suddenly think “I’m propelling myself along in a metal box in some arbitrary location on a big blue sphere that is in itself a tiny arbitrary point floating in a massive pattern of spheres that make up the universe” and then wonder why it is we’ve developed such a complicated and unequal society that fills all its time with busy work in the pursuit of status and possessions? I do. I’m pretty sure lots of other people do to. But I’m not sure I’ve ever checked. It isn’t an easy conversation to start as our thoughts are so subjective that there is always the possibility that explaining them to someone else they would just assume we were a bit crazy, whether in the informal lay use of the word, or in a mental health setting as being symptoms of disordered thinking. So what is normal and what isn’t?

Do you ever feel a compulsion not to tread on the cracks in the pavement, or to salute a magpie to ward off bad luck? Do you feel a sort of temptation to set off fire alarms, pull the emergency stop on trains, or open the emergency exit on planes? Do you feel a compulsion to reply to your satnav? Do you ever lie in bed wondering if you locked up for the night? Do you ever go back to check if you locked the door or turned off the cooker or your hair straighteners after you’ve left the house, or phone home to hear the answerphone to be sure the house is still standing? Do you get transitory urges to drive off the road, or into pedestrians or obstacles? Or to jump in front of trains or traffic? Or to throw your keys or phone off a bridge or out a window? Or have a transient desire to do something shocking like swear in church, laugh at a funeral, flash at your boss, stab someone when you are holding a knife, throw your drink in someone’s face? Get images of the harm or death of a loved one? Or unwanted thoughts about sex? If you do, you are far from alone as these are commonly experienced intrusive thoughts that are reported by 90% of the population.

When we had a thread about normalising unusual thoughts, members of the forum gave even more random examples. One person didn’t like the way sunflowers looked at her and once threw her chips at one and ran away laughing. One person heard music coming out of the back of her head, whilst another heard the doorbell repeatedly ring. Another person warns her husband that she might have an urge to kill him during the night. One person can’t shake the idea that cows are just playing dumb and have been gossiping about her before she arrives and will continue when she leaves. One imagines flying insects are like dirty old men rubbing their hands on their thighs. Another sometimes has to put her hands out in front of her to check for glass doors she hasn’t seen when walking down the pavement. Many report urges to do cartwheels, handstands or forward rolls at work or in public. One constantly made bets with the devil in his head in which the wager was years of life-expectancy. One shouts obscenities loudly into the wind whilst cycling along. Quite a few of us anthropomorphise inanimate objects, from imbuing toys with personalities, to feeling sorry for dented tins, weak seedlings, or the families of insects we kill.

Three people feared seeing dead bodies when opening toilet cubicles, and one would imagine worst case scenarios like people dying in fires. One had the sense a person was standing next to them that they could catch glimpses of out of the corner of their eye. One asks ghosts to disappear before turning on the the lights if she returns home after dark. One can’t look in the mirror in case something comes out and eats her, and quite a few can’t look out of windows after dark. Several adults are afraid of monsters under the stairs or bed, or snipers/wasps hiding in low windows. And many people have particular rules about counting or numbers, such as wanting the volume to be on an even number or a multiple of five. Many people have strong desires for neatness or order, including one with a desire to tuck in other people’s clothing labels if they are visible.

Three people report that “If I’m somewhere important where my phone really does need to be on silent I wont just turn it to silent mode. I don’t trust it. I’ll turn it off completely, take the battery out and store the battery and the phone is separate compartments of my handbag. Just in case the battery decides to be sneaky, ‘falls’ into the phone, the phone switches itself on, turns to loud mode and horror of horrors – rings”. A fellow clinical psychologist explained that as a child “I wouldn’t look through a dark window once I was in bed, as I believed that we were experiments/pets and that the world got rolled up when we were asleep for cleaning, and that if any of us pets/subjects found out about it we would be removed from the world/pet enclosure/experiment”. Another was convinced he had telekinesis and could make his lampshade rock from side to side.

And then there are numerous sensory distortions. Some people reported feeling their time was going faster or slower than the rest of the world, or feeling like they were very small or large compared to usual. Quite a few people reported synaesthesia (sensations from other modalities, like seeing the months of the year as having a shape, or letters as having colours). Many people get “earworms” where particular pieces of music play repeatedly in their heads at certain times. Some have a continuous internal radio station of music, which they walk, chew or tap along to.

Personally, I get what I used to call “sicky vision” as a kid. If I have even a mild fever I don’t like the textures of certain things, so wallpaper with vertical bits of string or wood-chip can look ‘itchy’ or things that are crinkled can look ‘spiky’. I don’t really quite have words for it, but they become uncomfortable/stressful to look at. It is an exaggeration of the trypophobia I get at other times (an exaggerated disgust sensation from looking at organic holes – but please don’t google it unless you have no problems with disgust at all, as you may also get an unexpectedly strong reaction). As a result I struggle with the appearance/feel of my own intermittent and fairly mild pompholyx eczema, and when I had to put ointment on my children and husband’s extreme outbreak of chickenpox a few years ago I could see/feel the texture every time I shut my eyes for weeks, and it even prevented me from reading text comfortably as it would distort into bobbles!

So what is it that distinguishes all of these odd thoughts, compulsions or sensory distortions from those which get labelled as psychosis or OCD? I think there are a few distinguishing features. First, the impact of the thoughts and experiences on us: If we are otherwise functioning well in our lives, and are able to notice, accept and dismiss the thought or experience, then they are not intrusive enough to be framed by us or others around us as problematic. Second, the meaning we give to them: If we understand them as transitory, or as a reaction to stress, exhaustion or particular circumstances (or substances) we can apply more self-compassion and are less likely to be scared by the experience or to feel they are outside of our control. Likewise the variation in meaning given to unusual experiences in different cultural group (whether a source of insight, or a sign of possession or black magic, for example). Thirdly, these thoughts/experiences are more likely to be present and construed as symptoms in people who have already got complicated lives and multiple stressors, or are subject to prejudice. With a history of trauma, a lack of coping skills, the stress of socioeconomic deprivation or within certain cultural groups, the response to such experiences may be more overt or distressed, and may compound other problems. Finally, some people are already visible to professionals or in medical settings that make diagnostic labels more likely.

When a CP from the forum described the experiences and behaviours I have listed above to various professionals working in adult mental health services, the assumption was that the person described would surely be a patient with psychosis or OCD. Many were surprised to hear that these were descriptions from healthy adult professionals working in mental health who have never had diagnostic labels applied to them. However, interestingly, when the same question was asked of carers, they were much more empathic and less judgemental and made no such assumptions.

I was reminded of the seminal Rosenhan study in which eight researchers were admitted to inpatient services as pseudo-patients to study the environment. The admissions were triggered by describing auditory hallucinations, but as soon as they were admitted they no longer feigned any symptoms. Nonetheless, all were given psychoactive medication, and seven of the eight were given a diagnosis of schizophrenia that was assumed to be in remission by discharge (the other was diagnosed as ‘manic depressive psychosis’). Again, the patients recognised that the researchers were imposters, but the staff pathologised ordinary behaviours to fit with their pre-existing beliefs about the nature of psychosis (including describing the researcher’s note taking as “pathological writing behaviour”). Rosenhan and the other pseudopatients reported an overwhelming sense of dehumanisation, severe invasion of privacy, and boredom while hospitalised. Interestingly, a hospital then challenged the research team saying they could recognise any fakers easily. Out of 193 new patients in the study period, the staff identified 41 as potential pseudopatients, with 19 identified by two or more members of staff. However, no pseudopatients had been sent at all. Rosenham concluded “it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals”.

It is another salient reminder of how easy it is to make negative judgements about people according to very superficial distinguishing features, and how much it is part of human nature to fear difference. Whether we are judging “schizophrenics” as a group, or Syrians, or Republicans, or Muslims, or benefits claimants, or European immigrants, or the people who voted Leave in the EU election, it is easy to make assumptions about people that we outgroup and to forget that we are all human, and all trying to do the best we can in our own circumstances and based on our own experiences.

Our own quirks of thought and behaviour are another good reminded that we are not so different. Mental health diagnoses are convenient labels for clusters of behaviours and reported differences in how people think and feel. But they reflect much bigger stories than just our biology. And people are still people.The baby pulled from the rubble in Aleppo could grow up indistinguishable from my child, if they had the same life experiences. The person with the label of psychosis, the scars from self-harm and substance misuse and the long stay in the mental health unit, would have had a different life path if they had been born into different circumstances. Likewise you and I would likely show equal levels of distress if we experienced similar trauma. As Jo Cox put it so well, we have far more in common than that which divides us.

Bedtime routine: The gift that keeps on giving

Of all the things I’ve done as a psychologist who is also a parent, the one I am probably most proud of is my bedtime routine. As I watch other people struggle to get their kids to sleep, or hear about the struggles of kids that keep getting out of bed or will only sleep with a parent present, I feel very grateful of the fact that mine always go down like magic.

The secret recipe started in infancy. After a difficult start with premature twins born before they had a suckle reflex, and six months of having to spend an hour feeding each of them every four hours (meaning we got a maximum of 2 hours sleep at a time), we turned a corner. At six months, we were told by our health visitor that they no longer needed milk in the night and could manage without a feed from the time we went to bed to 7am. So after a late feed at 11pm or midnight we got back our night. There were a few nights with some crying before the new routine was established. The first night pulled on all my emotional hooks, so I went to check and found they were fine and soon settled with me there, so the next night I was able to resist going for the ten minutes it took for the crying to peter out. Two nights later and it was quiet from midnight to seven am and we got back our unbroken sleep and our sanity. Soon after we saw that they were not taking much, if any, milk at the last feed and we were able to withdraw any room service from 7pm to 7am. By then, my night time routine was already in place.

Once baths are done, pyjamas are on and teeth are brushed, the kids get into bed and we make the room darker by closing the blackout curtains. I used to wish them goodnight using the same little rhyme every night, and then move straight to singing. Now they are older, when there is time, we normally have a little chat about the day and read a story – this is one of my favourite Mummy times, as we talk about all kinds of interesting things. Our conversations range from why some children are mean, to where petrol comes from, to why there is war in Gaza, to whether religious beliefs are true or just stories that some people believe and some people don’t, to how families have different configurations, why their second cousin had a brain tumour, or how flowers come back after the winter, or why some people are homeless. I’ve got a strong belief that if they are old enough to ask a question they are old enough to have an honest answer, no matter how difficult that answer is to articulate in simple terms for me as an adult. They have this insatiable thirst for knowledge, and often bring up what they have learnt at other times.

Whenever we have these discussions, my kids amaze me with their compassion and desire for fairness in the world. I still remember being told by a serious-faced four year old that we needed to “send a load of postcards to people in Israel and Palestine to tell them to look after and re-build schools, so that everybody can learn about how to be kind to others, no matter whether they believe in the Hanukkah God or the Eid God”. They were even younger when they explained how they want us to buy things that create employment in less developed countries, because most people have food and houses in England, but the people in other countries would want jobs that let them feed their families. And I remember how nonplussed they were to hear about gay marriage and how they couldn’t understand the examples of prejudice that kept coming up on the news because “its not right to be mean to people because of the colour of their skin or who they love”.

Then after our serious discussions and perhaps a bit of reading (Harry Potter and Rebel Girls seem to be favourites at the moment) it is time to wind down to sleep. Then quiet time begins. That signals that it is no longer the time to have a conversation and anything except the most urgent questions need to wait for the next day. I sing a few songs that they have chosen and a few old favourites, and within 15 minutes they are asleep. If we’ve had a busy day and we are out late, I can skip right to quiet time and go from active to asleep in the same time-frame. Friends and family members are often amazed, but I say its the best example of behavioural conditioning ever. I can even make the kids yawn by singing the same song in the middle of the day!

Of course it isn’t always perfect. If one of them is poorly, or I have been away too much in the week for work, they might stir and say “don’t go Mummy, sing an extra song” or they might wake in the night and come down for a cuddle or some medicine. But we always meet that need as quietly as possible and then return them to bed. Because when they sleep well, and we get quiet time as adults to wind down and catch up as a couple, the whole household is happier. We can flex the routine enough to stay up late for a special occasion or to give a little extra time on weekends or holidays, but we also flex the other way and start winding down earlier if they are tired and irritable. The kids even say “Mummy can we have an early night tonight as I’m feeling a bit tired and I want to have enough energy for swimming tomorrow?”

I know there is a lot of debate about ‘controlled crying’ but the few nights in which we ignored some crying at six months have reaped rewards ever since, and we have a happier family as a result. Of course, it won’t work for everyone. There are plenty of children who are more difficult to get to sleep than ours, but my advice would be to have a very clear routine, to start as young as possible, to be very calm as a parent throughout, and to persist through the difficult bit as quietly and calmly and consistently as possible. Because sleeping well helps all members of the family to regulate their emotional state better and have more positive experiences throughout the day as well as at night. I know I’m happier and more able to focus when I’ve had enough sleep, and the same is true for all members of the family.