The way society gives care shapes how we ask for care…….and that is where we need to focus our attention if we want to meet the needs of everyone

For my children the news we were moving to Canada for three years came entirely out of the blue. It was a tough call. Shock them, but contain them as their parents – giving them the impression we were calm and confident that this was the right decision for the family. Or include them in the long and protracted decision making process; and let them see how uncertain we actually were.  Worse still, give them the impression they might have a say when we knew that, as the grown ups, the decision had to be ours. Rightly or wrongly we chose the first option.

We moved to a frozen land – Toronto experiencing one of its hardest winters on record. It did not mix well with devastated kids. Snow did not mean jingle bells and sledging. It meant frost bite within two minutes of exposure. We knew no one. We had no car. It was not fun.

In those early days the one light in the darkness was ‘Chapters’ on Bloor Street. A fantastic book shop filled with stories to escape to; and where we could visit familiar friends – Harry Potter, Percy Jackson, Matilda, and even Pinocchio – a rediscovered favourite from years gone by – to name but a few. It was a magical place located in an Art Deco theatre that had retained many of it’s original features. The Proscenium arch, the stage, the ornate mouldings, the occasional row of red velvet seating to pour over pages of a favourite book, a children’s section in the dress circle…… The kid’s loved it and we went there most days after school. The dog was even allowed in.

After only three weeks the notice came that it would be closing in a couple of months. We were as devastated as the locals who had enjoyed it as part of their neighbourhood all their lives. We joined hundreds of them one Monday evening to campaign against the decision. A temperature of -25 kept no one away such was the love for this place.

The CEO of Indigo, the parent company, came in person to face our wrath. She was close to tears herself. She told us it was her favourite store too; but it was making a huge loss. The footfall relative to the square footage was simply not viable in an age when online purchasing of books was the option of choice for most. She asked how many of the hundreds gathered before her had bought a book here in the last six months. She didn’t shame anyone by insisting on a show of hands.

 

My children had spent their entire Christmas spending money there. (They hadn’t had presents as we were flying a few days after Christmas and our luggage allowance was at it’s limit. Santa had thought he had been so clever bringing them snow boots and head phones which they could wear on the plane. Relatives were under strict instructions to only give money so they had nothing to pack, and plenty to spend across the pond).  Of course we were rare. One scared and lonely family with freshly exchanged dollars and nowhere else to go was not going to keep a business afloat. With no anonymous corporation to rail against we all went home; our donkey tail’s between our legs.

Within weeks there was a date for closure and we also knew what was going in its place. Shoppers Drug Mart – a Canadian pharmacy chain that included food, make up, seasonal goods, and magazines. At least they promised to retain the aesthetic features of the theatre. My son was devastated – it held no appeal for him whatsoever. My daughter, on the other hand, was quite excited.

It was true. She had spent many hours in the smaller Shoppers Drug Mart this would replace. She perused the confectionary, the toys, the medicines, the magazines, but it was the first aid section that really caught her attention. Plasters, ointments, bandages, and straps would fascinate her for what seemed like hours. If ever she was ‘lost’ I would always find her in this aisle. She would often slip an item into my basket – either for something that was ‘hurting’ or ‘just in case.’

I didn’t challenge it. I knew it was her way of getting care when she needed it most and in the best way she knew how. Leaving home and family and friends behind had been incredibly hard. And yet she was also happy, enjoying the new school, the new friends, and the new city to explore. It was confusing. She was hurting on the inside and an outward symbol, like a plaster, made it easier to express when mostly she was also having fun too.

She would often go into school with a band aid (a Canadian term she quickly learnt along with closet and running shoes), or a bandage or a wrist strap. Luckily her teacher was very nurturing and knew exactly what she needed. She would spot the area of ‘pain’ immediately; ask if it hurt and say “I hope it gets better soon”. She would follow up with “Come and sit by me and (insert another child’s name). We need help sorting out the (insert a practical task). She was brilliant.

As we settled as a family, and our sense of belonging grew, my daughter’s need for an outward sign of her pain diminished. My son had managed his distress in a completely different way. Perhaps because he was older; perhaps because he could put it into words more easily;  perhaps because it was more clear cut for him. “I hate it here.” And “you always told us family and friends are the most important things in life and now you have taken us away from them all”. Unlike my daughter, there was no confusion for him. He expressed his feelings with perfect clarity, and directed them entirely at the root source of the problem. Us.

I tell this story because I have been reflecting a great deal about the dominant narrative of the medical model for mental distress in our society; and more recent alternatives brought into the foreground by the Adverse Childhood Experiences research and the publication of the Power Threat Meaning Framework. Suddenly, it may seem to some, there is a different way of thinking about ‘mental illness’ or ‘disorder’. For many, this is a welcome relief. What happened to them as a child or even as an adult, is explanation enough for their distress. It is not something that is inherently wrong with ‘them’ that is the problem, as a disorder implies, but rather, how they have been treated or the experiences they have been through in life.

For others, however, this is a very challenging perspective and does not fit at all with their understanding or their experience. It feels invalidating, and makes their difficulties somehow less real. A mental disorder fits much more readily with their reality, and demonstrates far more clearly how tangible and severe their experience is. Both are right. No one is wrong. Their experiences, and need for explanation and intervention of a particular nature, are just different.

In respect of my daughter would it have helped to say her plaster was not necessary or the ‘right way’ of asking for help? Absolutely not. That would have made her feel invalidated and even ashamed. Was her pain real? Absolutely yes. Would it have helped my son to suggest he needed plasters or ointments so he could get the same sort of help for his distress? Absolutely not. Are there times when a response afforded to physical pain helps with emotional distress? Of course. Is that the answer regardless of the root cause? No. Does empahty and emotional connection help whatever is at the root? Yes.

For some very important and valid reasons the way in which my daughter sought the help she needed resulted in her receiving exactly what she required. And for some very important and valid reasons it has been easier for society to respond to physical pain; and the concept of ‘illness’ or ‘disorder’ when it comes to emotional pain. The problem with this is that it always locates the problem in the person; rather than allowing for the more complex reality that a number of factors, internal and external, interact and vary according to the individual and their unique circumstances.

I make this point because when it comes to mental health there are radical differences between the emerging facts; historical and societal narratives; personal experience and personal meaning. All of these have a part to play in how we understand distress; how we respond to distress; and how we ask for help with distress. There is a great deal of untangling to do in sorting out what is the most helpful way forward and, of course, like all things human, it may vary radically between one person and another, and one set of circumstances and another.

There is room for all narratives, all explanations, and all experiences. The important goal is to aim for fair and equal access to the evidence in it’s broadest sense; freedom to choose; and respectful and open discourse. The challenge is bringing everyone along with the potential for learning that all perspectives provide. After all we have a very long way to go in our understanding of what it is to be human.

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