Making sense of a PhD. What do I do as a PhD student?

Most people know that doing a PhD will lead to gaining the title of Dr, but most people don’t actually know what a PhD student does day to day, year to year. This blog just identifies my own journey through a PhD and how I learned what it means to do a PhD along the way.

How did I get onto a PhD?

In order to get onto the PhD I made an application through sending a cover letter, my CV and also my qualifications to the University, having seen a recruitment advert for the PhD on twitter. I was invited to a 25-minute interview with a panel of 5 including 3 of my current supervisors, an academic and a service user. The PhD topic was in the field of psychology and developing the evidence base for service user involvement work in clinical psychology training. The panel told me they would each ask a question and so I knew I had 5 minutes to answer each. This blog details my PhD interview experience.

What is this blog about?

This current blog is about my experiences of making sense of the PhD and what I did once on the PhD. The blog details the sense making of year 1 of the PhD and then is grouped into my empirical studies that I conducted continuously from year 1 through to year 4 of the PhD.

Year 1.

The first year of the PhD I was following the wave of optimism and positivity, having been successful at interview for the PhD. This helped curb any initial challenges that the PhD would bring for some of my journey. Now that I had actually got onto the PhD, what did I do now? The PhD was something I had applied to do, that already had a pre-created research proposal linked to the grant application that my supervisors had previously applied for. Although on the first day when meeting with the supervisory team I realised there was a lot of flexibility and we were all keen to shape the research area together that meant we could take it in a different direction, as long as we kept to the initial context of service user involvement and mental health training.

This meant that I needed to do some wider research on the subject area and psychological theories that might be applicable to understanding the subject I wanted to explore better.

The first 3-4 months involved a lot of reading journal articles on the subject, thinking about research questions that we might want to answer and my own experiences of being a service user and how this insight might lead to understanding others with similar experiences.

After a lot of reading and discussing what interested me, we decided that we would seek to understand the identities within the field of clinical psychology training as I was an expert by experience for a clinical psychology course, and my supervisors clinical psychologists or research psychologists within clinical psychology training, meaning we each were already experts in the field.

My interests have long spanned social psychology and clinical psychology, with me scoring highest on these modules in my undergraduate degree. Therefore it seemed perfect that the PhD would combine these different fields. I came up with a research proposal and ideas for empirical studies that were structured around social identity theory. These were progressed and developed along the PhD journey as my understanding of identity progressed and an understanding of the direction of the research. This progression will be detailed in this blog so you can see how through the process of the PhD and its direction changes and moves forward. This led to the process of designing, conducting and analysing research across the process of year 1 to 4.

Being an independent researcher whilst also working collaboratively

The process of the PhD meant I became an effective independent researcher and directed and led the research work but also learned to work with others in the team, to collaboratively create a PhD that was important and novel. Through the process of the PhD I realised it was a collaborative process and that it is a general requirement that supervisors have the opportunity to review and help refine written chapters, which is something that differs from undergraduate and masters work. This is something I needed to get used to as receiving feedback and edits to your work can feel defeating, and you might feel like your work is not good enough. However, you have a supervisory team in the PhD for a reason, in order to support and challenge you to produce the best work you can. The PhD is usually a collective group effort, which is why you experience group work in undergraduate assignments prior to your PhD. However group work in the PhD can be challenging because your supervisors are not just committed to your work, but they also have full time jobs and other research and PhD students and doctoral students they are supervising. It requires a balance of support from supervisors, independent working and also proactively chasing up supervisors and giving them deadlines you expect them to feedback on your work by, so they can prioritise your work.

My PhD: An exploration of emerging identities within mental health, education and research

I will now talk about the different areas of my research that were conducted across the entirety of the PhD, through first learning about the process and then becoming more expert in the field through conducting the research and through learning from the experiences of participants through the data. I went from making observations of myself and moving from service user to expert by experience, to moving beyond the self and a motivation to see whether those same observations occurred in the real world and other people.

Year 1 – 4

Study 1. A systematic and narrative review: Understanding the identity of lived experience researchers and providers

The first step in the PhD was to conduct a systematic review of the literature to understand what studies had already been done in the area in order to understand how my PhD could identify a novel contribution to the literature. The area of service user involvement has many different ways it is referred to such as expert by experience, patient and public involvement, consumer involvement, user involvement, survivor involvement, peer work, etc. and this led to a challenge in capturing the population through a diverse set of search terms. Another challenge was to also identify a research question for the systematic review that had not already been done, as well as a research that had already been done so there was enough research in the area to be included within a systematic review.

            The first year was overwhelming  trying to do this, and I felt as though I hadn’t achieved that much – but doing a review is a process and all the reading and understanding of the nature of the literature in my field meant that this would help me when I was ready to do the review. I was also reading up on different methodologies to do systematic narrative reviews and figuring out what methodology I would apply in my own. I also helped undertake another PhD student’s systematic review that supported me in learning how to do my own.

            It’s been a process – I didn’t do and finish my review until my final year of the PhD. However, the process of learning throughout the PhD meant I was able to do it effectively when I was ready. This chapter is also one of the best in my PhD where I come up with a novel conceptual framework to understand the identities of lived experience researchers and providers through the EMERGES framework acronym, identifying Empowerment, Motivation, Empathy of the self and others, Recovery model and medical model, Growth and transformation, Exclusion and Survivor roots as themes related to identity development in lived experience researchers and providers. It involved group work again, and a multidisciplinary team of lived experience researchers and providers, academic psychologists and clinical academic psychologists. The pre-print of the review can be found here: https://psyarxiv.com/gjh2c/

Year 1 – 4

Study 2. A Social Construction of Identities in UK Clinical Psychology Training

My second study in my PhD involved understanding how groups in clinical psychology training (experts by experience, expert carers, trainee psychologist and experts by qualification) constructed their identities. This was influenced through the first stage of social identity theory, self-categorisation. The idea was that through focus groups we could recreate the social groups of individuals within clinical psychology training to effectively be able to observe their identities.

            By the end of my first year I had applied for ethical approval and attended a University ethics committee review to ensure the research did no harm to participants. A semi structured interviewing schedule was developed with key stakeholders and the supervisory team. I read about how to conduct focus groups and by the end of my second year I had conducted four focus groups with a total sample of 26 participants taking part, of which 8 were trainee psychologists, 7 experts by experience, 7 expert carers and 4 experts by qualification. Some of the focus groups were also moved to being held online due to the context of COVID-19 and a global pandemic.

            This piece of research was analysed through social constructionist and critical realist epistemology thematic analysis. The analysis process had been identified prior to the conduct of the focus groups in order to ensure the analysis fit with the type of dataset we would have and what it was compatible with. Thematic analysis does not impose a particular type of approach for analysis and so we could be flexible with what we used that was relevant. As a research team we decided that social constructionism would be appropriate in understanding how identity is constructed that can be understood through the language and interactions between members within the focus groups. I spent some time reading on thematic analysis and social constructionism. This supported in coding the data through this lens. I began by immersing myself in the datasets, through reading and listening to the focus groups. This then led to coding meaningful segments of the data and then developing themes and sub themes, and these were evaluated with the supervisory team before being labelled. This has been written up into an empirical study and currently needs to be reviewed and amended based on supervisory feedback.

            The themes found that identities can be understood through multiple identities of personal and professional identities that are sometimes actively separated to reduce burden of lived experience. Sometimes they are integrated to be authentic and for disclosure and sometimes they permeate each other without realising. These identities can also be visible and invisible. There were also learner and expert identities in each social group. There were motivations to rebalance the power between groups within clinical psychology training. It was also found that these different social groups had them and us divisions between them, motivating groups to want to connect and reduce barriers so that groups within clinical psychology training could work together more effectively.

            What I have realised about qualitative research is that analysis and interpretation of the data can be subjective but having an expertise into the field through my expert by experience role and my supervisors being experts in clinical psychology training helped with identifying themes relevant to the field. Through reflective and reflexivity on my position in relation to the data reduced the subjectivity of the interpretation of the data.The qualitative process is also an iterative process that requires multiple rounds of feedback from supervisors in order for the study to be written in a way that can be understood by others outside of the field. This requires developing your writing to have clarity so you are able to tell a logical story that can be understood by all. This study will be written up for publication too.

Year 2 – 4

Study 3. How do trainee psychologists identify with their trainers? Developing a reliable and valid measure of identification in clinical psychology training.

Following application and acceptance of ethical approval from the university, this study was conducted to develop an in-group identification measure to understand how trainee psychologists identify with their trainers (experts by experience, expert carers, trainee psychologists and experts by qualification) through affective and cognitive processes. This study is my quantitative chapter and explores the second stage within social identity theory, social identification, that is responsible for identity formation. In this study we created an in-group identification measure for the context of clinical psychology training.

            The idea of the study came from a reflection that trainee’s whose mental health was important to their identity would identify more with experts by experience (people who teach trainee psychologists from their lived experiences), which was though would facilitate their learning and positively influence common factors in their clinical skills.

            The measures adopted for use incorporated cognitive and affective processes of identification and separate mental health and professional measures of identity. These different psychometrics were administered to a sample of 108 trainee psychologists to see how they identify with experts by experience, expert carers, trainee psychologists and experts by qualification. It was found that even though the psychometric was a two-factor measure of identification covering affective and cognitive processes, we also found a third factor encompassing the idea of an evaluative type of identification. This evaluative factor meant that when trainees identified with their trainers they felt negatively affected when their trainers were criticised or negatively affected in their roles.

            We also found that trainees identified cognitively with trainees and experts by qualification, as that was their predominant aspired identity and identified less with experts by experience and expert carers. This may have been because there was less prevalence of mental health identities and carers within the trainee population.

            The research involved an exploratory factor analysis that I knew how to do due to my MSc. However it also involved a confirmatory factor analysis that I self-taught myself how to do through reading research and also identifying training videos on youtube. This study has been written up and drafts are currently being reviewed by supervisors and amended by myself prior to submitting to a journal.

Year 3 – 4

Study 4. Developing a supervisory guide for lived experience researchers and providers

Study 4 is the final study in my PhD that I also applied and received ethical approval for. The learning from across each study conducted in the PhD such as the EMERGES framework from the systematic review, findings from the focus group and also in-group measure and survey, helped identify the broad range of issues that lived experience researchers and providers have to navigate relating to their identity.

            This study brought these themes together and asked lived experience researchers and providers, a sample of 19, to place 54 identified themes on a grid based on their usefulness to them as topics to explore in supervision. The research took a Q sort methodological approach that identifies the subjective responses of participants. At present I have collected all the data and still need to do the analysis of the research.

            The analysis is a mixed methods approach that brings together demographic, contextual survey and Q sort data to understand their responses and a type of factor analysis specific to Q methodology. The factors identified will be profiles of particular types of lived experience researchers and providers that group similar themes together. Through identifying profiles of these different lived experience researchers and providers will enable us to understand unique subjective needs for supervision as lived experience researchers and providers. The research has involved researching and understanding the methodology, recruiting participants and now requires me to analyse the data and write up the study for feedback from supervisors and amend prior to submission to a journal for publication.

Year 1- 4

Theoretical basis of identity chapter

The application of the theoretical basis of identity has informed the design and interpretation of the research. It was therefore important to have a theoretical chapter of the identity theoretical basis including social identity theory, identity theory, intersectionality and liminality. However, through an understanding of the theory meant that identities of those in clinical psychology training and lived experience researchers and providers needed further clarity and exploration, justifying a focus and rationale for this PhD. It was important to have an understanding of the theoretical evidence base from the beginning, but which I learned more about across the four years.

A history of service user involvement

I also have a chapter that provides a historic timeline of service user involvement that details the treatment of service users from being shackled in Bedlam and having no power and being actively oppressed and coerced in the past to now being active participants in decision making regarding their healthcare and contexts where they are experts by experience where they have the power to shape training of healthcare professionals, research and policy, consequently transforming their identities. This therefore means there is a requirement to understand how this change in their roles affects their identity providing a rationale for this PhD.

Challenges

There are multiple additional challenges the PhD student might go through such as imposter syndrome that typically affects PhD students from minority backgrounds. The idea of doing a PhD also puts a lot of psychological pressure on the student and the expectations of them from themselves and others. The PhD in Psychology is also often a research endeavour that is unique to the individual, and in my case I didn’t belong to a lab group, and so it is difficult to develop a support network. The context of COVID-19 also means the PhD student is further isolated from support from their university. Mental health is also significantly worse in graduate PhD students. Therefore, even though there are work pressures these other additional challenges the PhD student might face makes the process of doing a PhD even harder. Whilst it is acknowledged the first year can be empowering and enabling, the second and third year are usually filled with imposter syndrome and the valley of shit (the idea that there is a lot to get through with insurmountable challenges along the way) to the fourth or final year that is pure adrenaline and requires productivity. Therefore the nuance of a PhD journey can generally only be understood by those doing a PhD or recent PhD graduates. Supervisors who may have done a PhD may to some extent have moved past and forgotten these experiences so understanding can only really come from peers.

Summary and conclusions

This is a blog that identifies the process of doing a PhD through a reflection of my own experiences and activities in conducting my PhD. Hoping it gives some insight into the research process and what is required of a PhD student, particularly in the context of Psychology. The challenges include identifying a novel research question, developing novel ways to measure the answer. It also requires a balance of working independently and collaboratively.

Only through the process of conducting a PhD and going through it, do you find out what it means to do a PhD. This means that support can be found through those who are also PhD students and others that may be researching or working in your field of interest. It is generally expected that those outside of a PhD context or academia do not understand the pressures on the PhD student or the day to day, year to year challenges a PhD student goes through. This blog might go some way in supporting others to know what it means to do a PhD, using my personal experiences as a PhD student, as a case example, to learn from.

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The language of service user involvement

It takes years of experience to be fluent in the language of service user involvement. There are likely to be misinterpretations of what it means to integrate lived experience into professional spaces and some researchers or clinicians not understanding the point of engaging in conversations to integrate lived experience and how it might benefit the research or the service.

The very language and labels used to describe service user involvement is varied and diverse, with some labels enhancing privilege and power of the service user, which lies in contrast to what it historically means to be a service user or consumer and being seen as passive recipient of healthcare.

Service user involvement can refer to individuals performing roles such as patient representatives, experts by experience, service user advisors, lived experience practitioners and lived experience researchers, amongst other labels. These labels perform a function and make it easier for experts by qualification to see the lived experience in the room and to draw on our experiential expertise. The exclusiveness of these labels limit our expertise to experiential knowledge of services and mental or physical disability and which may sometimes detract from the professional aspects involved in performing these roles and undermine the complexity of  performing these roles.

Within these roles we have to navigate personal and lived experiences, negotiate power dynamics, dilemmas of representativeness, queries of fitness to practice, ethical dilemmas in research or clinical decisions that might impact people like us, queries over our authenticity as service users due to professionalisation of our roles and our representativeness, not to mention the emotional labour and burden these roles place on us. However, the labels used to describe us do not convey the complexity of the roles and identities we negotiate. 

Through the process of my involvement as an expert by experience in a consumerist context (not a democratic and survivor led context), I have been given a voice by others to share and reflect on my experiences and perspectives relating to clinical practice and research processes. I have been empowered through these positions and have learned the diverse language used to describe this kind of work. I have also learned the language of working with the service provider and learning to convey my points to benefit other service users but in a way that makes sense and is understood by service providers, aligning with their agenda of cost-effectiveness, bureaucratic issues, benefits to clinical practice and research. Words expressed that do not meet with the agenda of the service provider often go in one ear and out the other, even if they are said and heard, they do not fit with the purpose of the agenda of the research or service.

Overtime like all in different occupational roles, we become skilled and more expert in our roles. This is the same for experts by experience, who for example, go from wanting to share their personal stories of mental or physical disability and of using services, to thinking strategically for example, thinking about how research methods might need to be thought about more ethically and how this might impact other service users.

The very process of service user involvement, learning what it is about, how you can allow learning from your own experiences so that service providers and research studies can learn from has been a language and culture which we are creating and shaping together. Different groups nationally and internationally are creating methods used to engage in this type of work, and this is happening in parallel to one another, rather than together, and so this results in a diversity of labels, language and research areas and processes within this type of work.

I think it is a difficult language to engage in because everyone has their own understanding of what service user involvement looks like and sounds like. Often the spaces are occupied by service users who are articulate and confident and can reflect effectively on their experiences. Often the voices who may be more chaotic may not be represented and excluded from the process. The language is also understood better by some experts by qualification than others, and so experts by experience need to justify their place in the room and shout louder to be heard in spaces that are service led.

This all makes for the case of experts by qualification engaging in conversations with experts by experience to listen to their needs and wants and to support in manifesting outcomes based on their suggestions. All service providers and experts by qualification need to do more to understand the language of service user involvement and seek to ensure service users’ voices are given spaces to speak and are heard and listened to, resulting in meaningful outcomes and actions based on our perspectives.

The language of service user involvement is also likely to change, with different experts by experience, survivors, disability activists and service users speaking different dialects of the language, but that we all belong to the same community and have the same interests and motivations that connect us in wanting to make a difference.

Fast Forward through the years: A Foreword for NCAP

I had the opportunity to write the Foreword to the recent NCAP report. The whole report can be accessed through this link that details early intervention service provision for patients with first episode psychosis in England:

NCAP 2020/21 report

The consuming schema of the PhD

Whilst undertaking this PhD research, I relapsed back into my Psychosis and became consumed by it. The idea of someone doing a PhD may bring to the surface ideas of competency and intellect, amongst many other things. However, the idea of mental illness is always perceived as mutually exclusive to those undertaking a PhD. Some individuals in the lives of PhD students cannot understand why someone who is undertaking a PhD would become unwell because, according to their perception, they are highly successful and should therefore not be suffering in any way. The schemas that are associated with doing a PhD do not assimilate mental illness into the mix. These schemas do not only affect family and friends but also mental health professionals. 

When I tried to access some services for mental illness I was met with “but you’re high functioning and doing a PhD.” Therefore, I must be ok. These stereotypes or schema that others make sense of the PhD student impact exclusion from services and increased barriers to help and treatment. The injustice of the system and the disempowerment I felt through a lack of empathy and compassion meant that it fuelled my desire to make a difference to the system and other mental health service users who encounter exclusion within the system. 

The idea of recovery means something different to every individual and I apparently fit with a “recovery identity” because I was so high functioning and had managed for so long without the support of services. This idea of recovery was actually masking my illness and how unwell I was.             

Through the injustice of the system and the lack of support, I was motivated to better support myself, through talking with friends and family about my mental health and gaining support from them. I was also motivated to make a difference to other mental health service users through the research, and it helped me re-engage with the PhD and how it could make a difference to people like me. 

Why is doing a PhD difficult? All the unexpected reasons.

I haven’t written about my experience of working on my PhD much, but when I tell people I’m doing one they have certain ideas and understandings of what it means to do one and there is a common theme, that it is particularly difficult. Their understandings point to how a PhD requires a certain amount of intelligence and expertise and the work and research is particularly difficult and high level. Even though this might be the case to some extent, this is not the reason most PhD students find doing a PhD particularly difficult, although it is but for other unexpected reasons which I will go on to explore.

Imposter syndrome

As soon as I got on to my PhD project I thought that it would be taken away from me because they’d realise I wasn’t competent enough to complete one and they’d realise this. This imposter syndrome occurs commonly in postgraduate students and is almost symptomatic of the context of academia. However, it is particularly aggravated and triggered when you are a minority within academia and when you do not see other faces like yours in these spaces. For example, working class, ethnic minorities and those with mental health experiences are likely to experience imposter syndrome, although to be honest it probably affects all academics, some just hide it better than others. Imposter syndrome, this was the first difficulty I encountered in my steps towards a PhD. Other manifestations of this include, the second year slump or the Valley of Shit that is spoken about by other academics that is also likely to occur when you get to the second year. It basically means you see how much you have left to do, and how little time you have to get it done. This leaves you paralysed and unable to move ahead without first travelling through the difficult bits.

Social isolation

So the next difficulty I encountered whilst doing the PhD was of social isolation, this was probably exaggerated by the impact of COVID and the pandemic. However, some PhDs are particularly isolate experiences. For example, my research area is quite specific and therefore original, so there are fewer academics researching this at my University and therefore difficult to connect with others and speak about the research, but it is important to know there is a world out there that understands and is already exploring the field. Moving to a new city and having to try to establish connections was important to me but maintaining these connections during a pandemic was particularly difficult. However, most PhD students I know experience these difficulties and so this is something that connects us, even if our research areas are different.

The Supervisory relationship

So doing a PhD is something that you don’t do independently, which some how makes it harder I think. Having supervisors to guide you and develop and construct the research is important to ensure the quality of your work and also its development through discussion and collaboration. However, what makes this difficult sometimes is receiving critique and feedback to develop the work. Everyone in academia is more or less a perfectionist, this is kind of a requirement to ensure the work is of high quality, but it can also feel like the critique of the work is a critique of you. I know a lot of PhD students also find this aspect of the PhD one of the most difficult. Different supervisors also bring different knowledge and expertise but will also vary in their styles of supervising, so some can be more hands on and others more laid back. This can also impact the way you work with them, and is an unexpected source of difficulty. Getting on with your supervisors is important, but when there are different personality types it can be particularly more challenging. It is important to remember that you have the same goal, to get the PhD to the right standard. Also, changes to the supervisory team can also particularly impact the PhD student negatively but it can also mean that a new supervisor may add a sense of motivation and drive towards the PhD that gets you out of a bit of a rut and begin to make progress.

Publish or Perish

Another expectation of doing a PhD is a drive to get publications. This is all well and fine, we knew this when we set out to do a PhD, mostly. However, what makes this process more challenging is the constant comparison to other PhD students and how much they are publishing, achieving or disseminating at conferences, webinars etc. This makes life much harder. Know that your PhD is your journey alone, and that everyone else’s PhD is different and therefore publications will come at different times. The perish part of the system means that some will succeed in academia and others not based on levels of publication, an understanding of this makes life even harder. There is also pressure to find results that are original and significant in nature in order to publish, and if you don’t then obviously you perish.

External factors

So the person doing a PhD doesn’t just become superhuman or immune to life stressors when they start doing a PhD. Although some friends or family will suddenly forget that you still have that mental health problem that you struggled with prior to when the PhD came your way.

Other external factors such as trauma, family life, relationships and bereavements can all and still do affect someone doing a PhD and this is something that PhD students struggle to contend with, but there seems to be a lack of understanding from others that we still do experience these problems, even if we are “high functioning” and doing a PhD.

PhD students and other graduate students are also significantly more likely to suffer from mental health issues due to all of these factors and the lack of support that is available to PhD students is minimal and can be problematic.

Fear of the Future

Everyone who you know outside of academia feels that doing a PhD will lead to some form of success. There are certain expectations of what job you will get afterwards. This is a fear for a lot of PhD students, what do we do afterwards? Do we stay in academia, if we can, or do we run away as fast as possible from a context in which job security is precarious, especially during this pandemic. What do we do next? I guess we just have to finish this PhD before we think of the future.

What to do now?

All of these factors, and there are probably others that PhD students experience, are symptomatic of the toxic environment that is academia and makes life harder for the PhD student. To help the situation it is important to talk with peers and friends and maintain connections and talk about how you’re feeling in your PhD so you can gain that support and continue with the work. These unexpected difficulties are common to the PhD student, but not to others that don’t know them and therefore hopefully this blog can begin to encourage more of a conversation around this. We all probably experience these difficulties so sharing and discussing this is important.

To my lovely mother

Meri pyaari Ma,

I just wanted to write a thank you note on this Mother’s day to my Mum and reflect on some of the main things we’ve been through together as Mother and daughter. Ten years ago was one of the most difficult times for me and my family. I was making a Mother’s day card for Mum in a mental health hospital whilst under their care and my Dad was being treated for Cancer in an Oncology ward at the same time that I was unaware of.

The image of the card I made was a heart with a halo made out of pearls, like a necklace, Mother of Pearl.

I had just returned from Thailand after a month there and I had become consumed in my Psychosis as I have mentioned in previous blogs. My flights back to England had been delayed as I had been kicked off some flights due to the presentation of my psychosis and the things I was saying that I believed to happening. Anyway, when my Mum and Uncle got to the right airport to collect me I just fell into my Mother’s arms and cried with relief after two to three days of not eating or drinking anything and being hypervigilant for the entire journey home. I knew I was safe now and that was everything I needed.

I know it was a really difficult time for you Mum, having to organise to get three buses to visit me and my Dad in different hospitals in Leicester and then travel back, or organise a lift from family members. I’m so sorry I said I didn’t want you to visit me sometimes to the staff after you made all that effort. I will never forget your unconditional love and support and how you kept coming back to see me and when I did want to see you you brought me some strawberries and some chaat papdi and all the other great things you made the time and effort to go to.

Ten years on, I still need you and me and my Dad are both doing fine and that is mostly down to you. You fix our hearts and our heads and we are so grateful.

Thank you Mum.

The many manifestations and mutations of psychosis

In the context of covid-19 and lockdown and the added complication of covid-19 and its new variants it has been a difficult time for a lot of people regarding their mental health. The structure and pattern of my psychosis is consistent across most relapses, mostly encompassing the idea of being humiliated or others spreading misinformation about me. The many manifestations of my psychosis tend to be similarly structured and follow this pattern, which makes me realise and identify that it is just my psychosis. However, during lockdown it seems to have mutated and manifests in a way that has parallels with covid-19 and its new variants. It is more difficult to shake and harder to manage and take control of. My delusional beliefs have become stronger and more fixed and it has been quite a distressing time. Despite following similar patterns in the way it is structured, it is more dangerous as it has taken longer for me to be in control of it. It has also been more difficult to identify it as psychosis due to mutating and manifesting in a slightly different and more lethal way. 

The context of Covid-19 has brought with it its unique challenges that have impacted on the usual way that individuals might contain their mental health and psychosis. I find that I used to rely on social contact to fact check and challenge any ideas of paranoia. However, lockdown and limited social contact has limited my ability to use my coping mechanisms (maybe maladaptive) to contain the psychosis which has begun to spiral.           

I find that because the psychosis has adapted and become more challenging to control it will take coping mechanisms and health strategies that I need to actively seek and apply. Much like the additional strategies that we are taking to control the spread of corona virus and contain it, I need to develop additional strategies to also look after my mental health. I made a list that I am going to explore to actively cope with the new challenges that this manifestation and mutation of psychosis has brought and see what helps reduce its impact.

We know that mental health is related to physical health, but there is great variation in the way mental health professionals such as psychologists and psychiatrists think of these things. I find it helpful in understanding my psychosis as a mutation that has adapted and that this is influenced by social context, psychological wellbeing and biological processes. By attributing a similar conceptualisation as Covid-19 to my psychosis helps me realise it is not my fault and that I have some level of control over protecting myself from the condition. The structure of my psychosis is similarly patterned but its sequence has mutated so it will take more effort for me to challenge it.

I know moving forward that there may be other mutations and manifestations of my psychosis but by taking necessary precautions to look after myself and be pro-active in terms of self-care will support with this.

Its not a particularly inventive list (so let me know if you have any other cool things you do) but so far on the list if anyone was curious and needs some ideas of how to look after yourself and mental health:

1. Writing blogs
2. Art work
3. Reading
4. Netflix and TV
5. Baking
6. Meditation
7. Exercise
8. Listening to music
9. Take some time out
10. Online/youtube classes

The dormant disorder

Even though people can see I’m quite high functioning, despite them knowing I have Psychosis, I think it’s difficult to see that I am consciously in constant resistance to the Psychosis manifesting itself again. I think of it like a dormant disorder. It is always there, waiting to find its way back and there is a risk of it taking over my mind and making it my reality again. 

The demise and spiral back into psychosis can happen really rapidly. There are certain triggers in my environment, certain coincidences, certain phrases, posts on social media, that thing that presenter on tv said, or topics of conversation that can feed it and give it life again.

When relapsing the psychosis is very real to me and everything I perceive confirms and evidences my beliefs and it is difficult to challenge this. I think of it like confirmation bias, everything in the world that I perceive confirms the beliefs that I am having, no matter how bizarre those beliefs are.

Currently working on a PhD has been motivation to be in control of my mental health and a reason to actively work towards staying well. However, my mental health and the rest of my life are not independent of each other and they can affect each other.

When I am well I am generally symptom free, except for maybe some concrete delusional beliefs that are ever present but these are manageable in day to day life. However, it’s the dormant psychosis that I always worry about. What if it comes back and I lose control over my perception of reality again.

Things that allow it to remain dormant and asleep in the back of my mind are unconsciously and consciously (depending on how active my psychosis is) being able to apply skills learned through CBTp, eating well, sleeping well, and taking my medication. These are the things that promote my recovery and diminish my sleeping psychosis and allows it to remain the dormant disorder.

I want to remain consciously aware of my reality and perceive it with clarity whilst I constantly work on diminishing the dormant disorder so it has less strength and impact over my life.

Some individuals are able to live a positive life alongside their symptoms of psychosis, but personally I want to finally put my psychosis to rest. I don’t know if this is achievable, but I can fight it and armour myself against it, keep it weak and fragile and in the back of my mind through the tools I already have.

Made a deal with God

I’m a British Indian from a very traditional Indian family. My mother is a devout Hindu Punjabi and the entire household knows it. In Hinduism, or my very basic understanding of it is, there are different Gods responsible for different things. Therefore, if you want a certain thing like prosperity or protection you pray to specific Gods by chanting specific mantras. These demi- Gods are a part of one whole. What it seems like is that we make deals with Gods if we want certain things. It’s like a trade-off, we will make a donation to a charity, do something good for the homeless, go on a pilgrimage, or chant a mantra 108 times so we get what we want. The cultural traditions that have translated from Hinduism has changed its essence and meaning.

My Mother’s beliefs relating to religion affect the whole household. So when you’re a British Indian having grown up in England, in a different culture with different attitudes and beliefs towards life, it is difficult to live with someone who has very different beliefs to you. It has definitely caused a lot of unnecessary arguments and conflict in our household as a result.

Most Hindu Indians when they are born get a horoscope made, which marks their birth and time as well as where each planet was at that time in order to make predictions about your kismet and destiny later on in life. Most Hindus, especially in India, will refer back to these horoscopes when they have some bad luck and consult Pandits who provide guidance on what to do to reduce the impact of negative energies on your life.

Mine predicted that there would be a period of bad luck during a specific time frame, when I had my first episode of Psychosis and this was correct, which reinforced my Mother’s beliefs and further enhanced her anxiety behaviours around performing certain religious rituals and mantras to reduce the influence of negative energies and bad luck on my life. This is an understandable reaction given her beliefs and I can see why my Mother enforces her beliefs on us, to protect us, but it just feels difficult to live with.

Sometimes we find meaning and relief in certain actions and beliefs. However, attributing someone’s mental illness as a result of kismet suggests their experiences are out of their control and that their fate is written and permanent. By attributing suffering or mental illness to bad luck or something in your horoscope undermines the role of life experience and trauma and therefore it is difficult to live with someone with such a difference in belief. By making deals with God gives you a certain level of control over the direction of your life and reduces that anxiety over a situation. It’s just I’m not completely sure I believe in this.

There is the idea that therapy and support should be culturally specific, but when your own beliefs lie on the periphery of both British and Indian culture with many subsets within that culture it is difficult to find someone that truly understands you and your experiences. There is then also the risk of a therapist or psychiatrist pathologising your understanding of suffering based on cultural beliefs as further reinforcing your own mental illness.

Finding ways of understanding my experiences in a way that incorporates both my British and Indian identities is essential.

Gaining some kind of control and agency in life that frees you from the determinism of fate only comes from making deals with God.

The upside down tree

This is a tribute to my Grandparents who are now together in a beautiful garden somewhere.

The first time I heard about the upside down tree was at my Grandma’s funeral, last week. It is the idea that our roots are based in the sky or heaven and that the main purpose of our life is to return to that truth. Our life is about nurturing the tree to develop fruits and life in this world, but that our existence is based in a higher realm and our aim in life is to be conscious of this and to return to this world when we are ready. This religious and philosophical idea has helped me process my Grandmother’s death.

My Grandad’s name is Chaman, which means garden in Hindi, and he died 11 years ago, and he and my Grandma created a life for their children, grandchildren and great grandchildren. We are the branches and fruits of my Grandparent’s lives. They looked after us, fed and watered us, we were the flowers in their garden on Earth.

I see my Grandma’s death as my Grandad picking the most beautiful and grown flower in his garden to join him in his world.

The upside down tree joins us all and we will remain connected in life and death through the roots and branches that connect us.

Reflections of a service user advisor

Being a service user advisor for the National Clinical Audit of Psychosis (NCAP audit) has been a great experience where I have been empowered to use my expertise as someone who has experienced psychosis to shape and influence the NCAP audit and the service user survey. The team have involved me from the very beginning, and I have been valued and included within the conversation regarding what is important to patients using early intervention services and how we might consider measuring this. Working with the team I have felt like an equal member and not perceived any kind of hierarchy.

The entire team have valued my perspective and I feel like I have been able to provide a perspective that represents my experiences of services as well as find ways of incorporating other voices and experiences in the conversation. We have done this through service user reference groups affiliated with rethink, as my experience is not the only experience and other patients may have alternative perspectives and experiences and the NCAP team have considered that within the audit too.

I have been involved in all aspects and stages of the NCAP audit and attend every implementation and steering group meeting. I have especially been involved in the design of the service user survey. The service user survey measures the experience of patients that use early intervention in psychosis services. This was an important area of research to conduct to see what patients actually think of the services they experience and is placed in contrast to other areas of research that have sought to measure the outcomes of service provision on patient outcomes, and instead  the survey really places the service user experience at the heart of the audit.

I was involved in designing the survey including what we wanted to measure that were important things for patients using these services and then also how we measured them. I was particularly interested in measuring whether patients felt heard and understood by their team to see if care was person centred and empathetic to patient needs and I stressed the importance of an item measuring this as I felt this would be important to all patients. The entire team as well as rethink service user reference groups were also involved in identifying which items to include within the survey. The survey felt a very much coproduced effort and my voice as a service user advisor wasn’t the only voice that shaped this. We hope that it measures things important to patients using services and helps us better understand how patients in different regions across the UK experience services as well as the individual experience of them.

I have also been involved in processing of the data and assessing queries relating to data that we have collected that may be ambiguous such as qualitative feedback left for a quantitative measure. I have been involved in discussion about how to use this data whilst respecting the confidentiality and privacy of patients filling this survey out and as a service user advisor have been involved in all of the decision-making process around this.

I was also involved in disseminating the coproduction of this survey at a conference at the Royal College of Psychiatrists and I was given the freedom and autonomy to discuss its development and honestly speak about my experience of involvement with this. In addition, I have supported with the publication relating to the audit released this year.

Overall, it has been a great experience being involved in the audit and we as a team have coproduced the audit and survey that will hopefully give us insight into the needs of the population and what needs to change and improve, by listening to the patients that matter the most.

My Decade

The Missing Piece

I’m a PhD student in Psychology researching the different groups involved in clinical psychology training and whether they function as a whole or as separate group identities. This is important in understanding the nature of such groups and also how these different groups can be more integrated and work together better. The research therefore has a purpose of better connecting these groups so that clinical psychology training can be more effective and cast an insight into how trainee identities can better connect with the people that train them, including service users, carers and clinical psychologists. I have also been a part of a service user and carer (Expert by Experience) group prior to undertaking this PhD so I have a certain amount of “insider” knowledge on the nature of such groups. However, as a researcher it is more about observing from an unbiased and objective position the behaviours and identities that emerge within interactions between people. I have therefore had to learn not to pre-empt what findings might occur, often predicting this based on my prior understanding of these groups, and instead try to remain objective going forward.

My research as a PhD student in Psychology is an interesting position to be in, it almost lies outside of the periphery and boundaries of each trainer in clinical psychology (Expert by Experience groups, trainees and Clinical Psychologists) and therefore should theoretically support me in being objective. My research is regarding identities involved in clinical psychology training including service users. I have also been a service user and involved as a trainer in clinical psychology previously. My identity is therefore strongly tied to my research area and feels like the research is an extension of the self and it is difficult to separate the self from the research.

My PhD identity is somewhat of an outsider in each group I am connected to, for example the Expert by Experience group I am linked to potentially do not regard me as an Expert by Experience as I largely speak about the PhD research to them. I therefore feel that maybe my identity as an Expert by Experience may not be as visible there and this makes me feel disconnected from the group and affects my sense of belonging.

Another aspect of my research is about understanding the identities of Clinical Psychologists. Two of my supervisors are Clinical Psychologists and my primary supervisor is a Research Psychologist, all of which teach on the Clinical Psychology doctorate. This is another dichotomy as they are linked to Clinical Psychology training, and again I do not feel connected to this as my role is as a PhD student in research psychology. Therefore navigating the many identities involved in clinical psychology has been an interesting process, as well as negotiating and managing my own identities and understanding where I fit within this.

My research is therefore important in terms of finding the mechanisms that better connect different groups and identities so that people can feel like they belong and are a part of something. My research will therefore hopefully be the missing piece that will provide insight into the key mechanisms that allow people to relate and connect with one another and better learn from each other.  Moving through the PhD I am hoping I will get a better understanding of my unique position and identity and how I fit into the role and the wider world of clinical psychology.

The job interviews that changed the course of my life

So some of my friends have asked me how I got onto a PhD because they are interested in getting onto one themselves. So I thought I’d elaborate on my journey to beginning one.

I had completed a BSc in Psychology and then a Post Graduate training programme in mental health nursing. This gave me so much experience working with clinical populations in various different settings. However, I found I was more interested and better suited to the academic side of training and wanted to work in research so I began an MSc in Psychological research methods. This MSc was crucial in getting on to the PhD. Not just because it was a tick box exercise in getting to my goal but to actually learn the skills to be able to conduct research in an effective way.

A couple of months prior to graduating from the MSc I was job hunting. I went to several interviews including a research assistant role, a clinical trials research officer role and an assistant clinical research psychologist role. I was rejected from all of these roles but I thought I’d comment on the nature of the interviews and my experience of them. I did, however, luckily get onto a PhD that was perfect and fitted directly into my areas of interest and my own expertise. Everything happens for a reason. I will also reflect on the PhD Interview and the questions I was asked.

Interview 1

The research assistant role was for an NIHR qualitative research project run in Nottingham University. I went to the interview and there were three interview panellists, all of whom were white. This was the worst interview I had experienced. They used a qualitative approach and an exit strategy methodology to carrying out the interview. They asked me about 15 questions on my experience related to the role, but they also kept asking me to expand on my answers, even though I had given them fully formed answers. It was challenging to say the least. It is a good methodology to use to make sure the candidate you give the role to has enough relevant experience and the questions easily located my inexperience within the area of qualitative research methods. I knew I was not going to get the role, but I was disappointed anyway.

Interview 2

The next interview was at Sheffield University for a clinical research trials officer. The panel was again all white and there was three of them. I was asked to conduct a 5 minute presentation at the start of the interview about a research project I had conducted so I decided to talk about my systematic review into culturally adapted CBTp in treating psychosis in BME populations in the Western world and majorities in the Eastern world. This went well and they seemed interested in my research. In terms of the rest of the interview I think it went well but I was informed that on any other occasion I would have got the role but others with PhDs and slightly more experience had got the role. I’d also been criticised for over-emphasising the value of my MSc project on The God Complex in relation to the Big Five and they felt that somehow I was critiquing The Big Five dimensions that had so much evidence backing it up. They had completely missed the point of my research, but anyway I’m not bitter! They also told me about the research position and it sounded really different to my expertise and areas of interest so maybe it was a good thing I didn’t get it!

Interview 3

The next job interview I went to was for an Assistant clinical research psychologist at the University of Oxford. I had previously been informed that I was on the reserve list for an interview. About two days before the interview date they informed me that I had got to the interview stage. I had a day to organise a hotel and travel to Oxford and also prepare for the interview! There was a panel of three and again they were all white. I was very nervous for this interview, probably mostly because it was at Oxford! As well as the fact I’d had very little time to prepare! The panellists took it in turns to ask me questions and the questions were around work experience working with patients with psychosis, application of theory in explaining psychosis and also research I had done in relation to psychosis. I think because of my nerves I didn’t communicate effectively but I got into the swing of things as the time went on within the interview. At the end of the interview they went through some checklists including a question on whether I had a driving licence, which I didn’t. Once the interview was over I had to score some assessment tools such as anxiety measures as well as measures assessing for positive and negative symptoms of psychosis. I then had to use these to write a letter to a community psychiatric nurse regarding the scores of the patient within the scenario. I found out the next day that I had given a good interview but the fact I couldn’t drive would have made the job difficult to do within Oxford. They did however tell me to apply to other roles with them that did not require driving. It was a small win, and great experience for an interview.

By this time, after many other applications to jobs, I was starting to feel deflated about my ability to get a role in research, as well as one in an area that I was genuinely interested in.

Where did you find out about the PhD and how did you prepare?

I’m quite active on twitter and it’s a great place to follow academics and researchers within your areas of interest. I went to explore twitter and someone had re-tweeted a PhD in Psychology into service user and carer informed therapeutic common factors in mental health service delivery, at the University of Liverpool, which was fully funded! The link led to more information about it on findaphd.co.uk. It looked so interesting and an area that I had experience in because of my work as a service user advisor, mental health nurse and research experience through my MSc. I went and applied and had to write a personal statement, send my transcripts and references along for consideration. I found out a month later than I had been shortlisted, a week later found out that I had an interview for the week after. I was super excited as it felt like all of my experiences were relevant to the PhD. I arranged a mock interview at my current University in Leicester to prepare as well as asking psychologists who I knew at Leicester to give me some tips to prepare. The psychologists told me to read up on the research area and read papers relevant to the area as well as think about how and why I fit with the role. I also tried to think of all potential questions they could ask and tried to think about what I would say in response to each of those questions, as well as think about how my expertise, work and research experience could be applied in answering them. Within the information the PhD supervisors had sent about the interview process they said the interview would last 25 minutes and there would be a panel of 5 including a service user. The panel consisted of my now three supervisors, another psychologist at the university and a service user. At the beginning of the interview they told me they would each ask one question, so I knew I had 5 minutes to answer each question so I gave comprehensive answers.

PhD Interview

Question 1: Tell us why you want to do this PhD and why in Liverpool?

This was a motivation question and I was able to talk about how my work, research and personal experiences related to the role and my interest in it. In terms of Liverpool I spoke about how the University is linked to the Russell group universities and as a consequence is excellent in its conduct of research. I also talked about a conference I knew that was going to be held in Liverpool related to the field of the PhD and how it would be great to present the PhD at that conference. I also spoke of my sister who is also doing her PhD at Liverpool, and how I had a support network moving to a new city.

Question 2: Tell us about your experience that’s relevant to the role.

I spoke of my work as a service user advisor, expert by experience, mental health nursing as well as my research in my MSc. (I elaborated on each of these different experiences and used examples from each)It meant I knew how to work with service users and carers as well as understood the clinical world from a mental health practitioner position.

Question 3: Tell us about a service user involvement research paper you have read, that inspired you.

The third question was more challenging. I had read a few papers relevant to the area by the people in the room, so the pressure was on in communicating their own work back to them. I chose a paper and talked about it. It was a paper where the research was qualitative in nature about how a service user involvement group went from consultation to collaboration through the application of a human rights based approach. The study had been interesting because the methodology was flexible and responded to the way the service users wanted to conduct their research, amongst other things. I then reflected on how the PhD process would also be quite fluid and require flexibility and how that’s something I wanted to strive to work towards.

Question 4: What are the key competences of therapists in clinical practice? (Something to that effect – can’t quite remember!)

I talked about the common factors framework that was discussed within the research proposal they had sent me and how things like empathy, person centred skills and being non judgemental was important competences of therapists but how developing a common factors framework model related to what service users feel is important was essential.  I don’t think I answered this question as comprehensively as I would have liked but I was clear, concise and to the point. The fire alarm then went off at some point within the interview! However, I knew how important this interview was and remained calm. It went off a few minutes later!

Question 5: What is reliability and validity?

This question was the last question. Fuck, it’s a statistics question. I knew I didn’t want to screw this up as the interview had gone so well up until this point. Statistics wasn’t my strong point but my MSc had filled in the gaps within my knowledge. I could do this. I talked about internal reliability when creating a psychometric tool as an example and how it’s a measure of consistency and replication of items reflect sensitivity in measuring what you think they are. Statistical measures of this were things like a cronbach’s alpha rating. I then spoke of face validity that I described as being a surface level assumption of whether something measures what you think it would, according to common sense. Then I spoke of convergent and discriminant validity that helped inform the validity of your current construct based on things you would expect to be related and unrelated.

Do you have any questions?

That was the end of the interview. I then asked a few questions, as I was genuinely interested in the research. I asked the service user to what extent service users had been used in developing the PhD research proposal and also asked about the origin of the research. I thought I had screwed this up because the service user felt put on the spot, but then I opened it up to the rest of the panel to also answer the question. In later conversations with my supervisors they felt this was one of the things that made me stand out from the competition, how I had interviewed the service user in my own interview! I then asked about when the PhD would start and also when we’d find out about the outcome of the interview – They said in a couple of hours!

Reflecting on the process

After the interview I met up with my sister in her lab and we went to lunch and I discussed how the interview had gone with her. I think generally I felt positive after the interview and felt I had given comprehensive answers and had communicated effectively. However, later I started overanalysing and unpicked each question and how I had answered it. I felt I had waffled a bit in the first question and then not given such a full answer in one of them! However, on the whole I think I’d done my best and felt more positive than I did negative.

I received a phone call off my primary supervisor a few hours later on the same day, on the train home, to tell me I’d been successful and offered the PhD. I was so pleased (Ecstatic), to say the least!

These are a collection of my interview experiences and those were the five questions that changed the course of my life. I think I’d developed more confidence over time and the experience of each interview, even though they were rejections, supported me in successfully getting onto my PhD.

I just wanted to document these interview experiences because I think that certain job roles are a better fit and you will generally tend to get the roles you have more direct experience in and that you have an interest in. I found that with this PhD it was the perfect opportunity because my experience gave me expertise in many different areas related to the PhD project, including service user involvement, research and mental health service delivery.

Hope this is helpful to anyone wanting to get onto a PhD in Psychology and keeps you motivated, even through the disappointments, to keep going and pursuing your goals.

The Reliability and Validity of Imposter Syndrome

To start with, there is no originality in this blog post but is just a collection of reflections on my experience of starting a PhD and the experience of Imposter syndrome.

Imposter syndrome is not a new phenomenon but it is thought to manifest itself in certain individuals who experience some form of success, for me this would be gaining a place as a PhD student.

Often those who experience Imposter syndrome feel as though they do not deserve to be a PhD student and that their work is not good enough and they will be found out and lose their place. This type of cognition is common in those with the syndrome. The signs of the condition tend to usually present themselves in similar ways in those affected. It is distinct from developing mental health problems but is also related to encouraging low self-esteem, reducing confidence, increasing perfectionism and working harder.

The imposter syndrome also tends to emerge in individuals in academia that are: underrepresented; come from ethnic minority backgrounds; have experience of mental health problems and/or are working class. I meet all of these aforementioned criteria so I am the perfect candidate to suffer from this syndrome. These variables tend to act as catalysts that influence a sense of not belonging within the world of academia and not feeling good enough.

The very nature of being involved in academia suggests you are around people who are experts within their field, are intelligent and communicate their research articulately. It is somehow both encouraging to see these experts talk about their research and its importance within their field but at the same time someone’s prestige or expertness tends to disempower the listener who feels a lack of knowledge within the area. This is ironic as through listening to experts you should gain and fill the gaps within your knowledge base but for some reason it seems to make me lose my confidence and leads to thoughts of how I do not know enough, or as much as them.

The PhD I applied to was a competitive process and my grades on my Undergraduate degree in Psychology were definitely not the reason I got to interview or get the PhD (A low 2.1) as I had suffered severely with a mental health condition at the time. It probably helped that my Masters degree in Psychological research methods was at a Distinction level and probably compensated for my first degree and I also had a PGDip in Mental health nursing at a Merit level. I also had experience as a Mental health nurse and an Expert by Experience role that was directly relevant to the PhD. Despite me having some credentials to justify gaining a position as a PhD student I still dwell on my undergraduate degree and its significance. (I do, however, personally feel a sense of pride in gaining my undergraduate degree as it was through a time in my life that I was sectioned under the mental health act and diagnosed with Psychosis and despite this I achieved my degree through this adversity). I do still hold the belief that I am still not clever enough, or as clever as my peers. This blip in my CV and results probably encourages my experience of the Imposter Syndrome and the belief in myself that I do not deserve this place on the PhD.

In Psychology it is important to check your research for reliability and validity. In some respects reliability is when a variable being measured in one individual appears the same in another individual and is replicated. Validity is measuring something in a way that accurately reflects what is being measured. My experience of Imposter syndrome has occurred in many academics before me and is manifesting itself within me in the same way.

I was even asked within my interview about what reliability and validity meant to me and to explain it to the interview panel. I think I even took a minute to compose myself for this question as my relationship with statistics in my mind was poor due to my low grade in my undergraduate degree, but my MSc had definitely filled the gaps in my knowledge and I was able to answer the question with some effect, drawing on methods within psychometric tool development and how to measure internal reliability, face, discriminant and convergent validity.

My imposter syndrome is probably rooted in my own projections of what others think of me in addition to the unrealistic expectations I place on myself, to prove my worth to others. Maybe I am just trying to prove my worth to myself.

I think to overcome my Imposter syndrome I need to remember that I got the place for a reason, that I do not need to prove myself to anyone nor myself and that I am good enough and that no one is perfect.

My experiences reliably reflect the world of academia and everyones’ unique experience of Imposter syndrome are validated by the existing research within the field that explains its likely manifestation within certain demographics, including myself.

Psychosis to Psychology part 2

Since a young age I thought I had always wanted to be a Psychologist since I experienced childhood bullying, consequently becoming anxious, depressed and paranoid. I received Psychological therapies and Psychiatric treatment in a CAMHS service and realised it was crucial to my recovery and I made my mind up to work in the field in the future to have that kind of impact and make a difference to service user lives.

Fast forward a hard and difficult set of years I did my BSc in Psychology but I was obsessed with having a social life as I hadn’t had the best of friendships when I was younger and I went a bit off the rails. I also stopped taking my medication and had no therapeutic support leading to my unresolved issues rearing it’s ugly head in the form of psychosis. I experienced olfactory and auditory hallucinations that were derogatory towards me and this stopped me attending classes. Least to say I didn’t perform very well in my first two years of university. I decided university wasn’t for me and I took a year out. I told the university I was going to travel and volunteer and I’d be back the following year, which was agreed. However when I did go travelling my psychosis came with me and as discussed in my previous blogs I was completely detached from reality and I was sectioned on my perilous return to the Uk from Thailand.

After being sectioned, assessed and treated I was diagnosed with Psychosis and supported through an Early Intervention in Psychosis service by psychologists, psychiatrists, nurses and occupational therapists. I thought I’d like to work in such a service in the future and this motivated me to complete my degree that following academic year.

I heard things from my student peers and course staff of how competitive clinical psychology training is to get onto and that only individuals with the best grades and experience would be successful at achieving this. I did however perform significantly better in my final year and was awarded a 2.1, thankfully!

I wasn’t getting anywhere with job applications until I landed a role as a support worker in a learning disabilities service where I learned key skills of how to engage and support young people and encourage them to learn life skills.

I later trained to be a mental health nurse on a postgraduate programme and was inspired to apply by my mental health team. I learnt so much as a mental health nurse about the NHS service and about the many roles within a multidisciplinary team. I also learned both physical health skills and mental health skills to support service users I worked with in a range of settings including acute mental health wards, rehabilitation wards, eating disorder units and home treatment teams. I learned so much, however the training was difficult and I became mentally unwell a few times throughout the course of the training. I was supported by both peers and tutors who valued my lived experiences and encouraged me to continue with their support and belief. However I soon realised the role aggravated my mental state and potentially was triggering of my own experiences as a service user on a mental health unit. I realised I was more interested in the academic and theoretical side of mental health and pursued a career in psychological research so I could still make a difference through research that serves to improve service user lives.

I applied to do an MSc in Psychological research methods which gave me all the skills I needed to be a scientific researcher. Skills that I hadn’t learned at undergrad due to my mental state and skills that were at more of an advanced level. I realised that research was my niche and it was something I enjoyed and I could in an ideal world research my interests. I also felt like I’d learned so much and that was in part due to the teaching but also through the conversations I had with my fellow students discussing certain statistical methods and applying it within psychological research. I didn’t think I would enjoy the MSc as I had struggled at undergrad level but I think because I had a better mental state and I committed to it and worked hard I took so much valuable learning from it and achieved a distinction.

Whilst doing my mental health nurse training I also worked as a Service user reference group member at Leicester university for the doctorate in Clinical psychology where I helped make the course more meaningful for trainees and I was encouraged to create my own teaching session where I shared my personal story, as well as this I also interviewed candidates for the course and helped coproduce a conference. I realised I really enjoyed this work and was interested in the process behind service user involvement and the kinds of skills service users need to have to perform such a role as well as the kinds of skills psychologists need to have to work with service users in this context and other contexts.

My MSc was coming to an end and I applied to many positions including research assistant posts, assistant research clinical psychology posts and clinical trials officer posts that I got invited to interview for but was rejected at the final hurdle. I’d also got rejected from the clinical psychology doctorate earlier on in the year and wasn’t sure if I should apply again as it is so competitive.

However I found a PhD in Psychology on findaPhD.com relating to service user involvement and I got excited. The project looked great and I took a leap of faith and applied. I was so invested in the research project and really wanted to be a part of it so was nervous awaiting a response from the University of Liverpool. I did however receive great news about a month later after applying that I was shortlisted and that was the first hurdle complete. Then I was invited to interview a week later with a panel of 5 people, 3 were going to be my supervisors and a service user was also on the panel. I used the week to prepare for the interview and get advice from psychologists who I knew about what to expect in a PhD interview for Psychology. I also used the University’s career service to have a mock interview to prepare and practice.

The interview drew closer. I felt like my whole life had been gearing up towards this point, the research was on service user involvement which I had tonnes of experience in, my research skills from my MSc would be useful within this PhD context and my psychiatric nursing experience meant I knew how to work with staff and service users. The interview went surprisingly well, even though a practice fire alarm went off mid interview, but it did not last long! I got a call about two hours later saying they wanted me for the PhD in Psychology role.

What I have realised from my journey so far is that you have to follow your strengths and your interests which will lead you to doing something you find peace in. As you can see things have been up and down on this journey from psychosis to psychology but I’m making more progress and the journey towards my PhD starts here.

More detail of my mental health journey begins in Part one of Psychosis to Psychology which can be found here: Psychosis to Psychology Part 1

Happy Diwali

The friends and family test

The friends and family test is an NHS initiative to seek feedback from patients regarding the quality of care their relatives receive. It seems to be useful because it enables service providers to receive knowledge of areas that are in need and allows them to be advised on methods of improvement that are service user and carer led. This helps the service better meet patient needs and comes from a place of care and compassion.

I always feel like it would be interesting to get that kind of feedback about what my friends and family think of me and what they would say to me. However, no one really likes to hear home truths about themselves, only the positive stuff maybe!

My mental health has been a literal friends and family test, which has placed a strain on my friendships and relationships. I have lost certain friends for various reasons, but part of that is due to ignorance regarding psychosis and the stigma and negative connotations associated with it. I also feel as though some of my friends do not fully understand the condition or the impact it has on me as they have not experienced it and sometimes feel this creates a barrier between us. My close friends are aware of my condition and allow and enable me to talk about my experiences however much I want, although I know it gets annoying sometimes, to the point where I’ve been saying things repetitively on a loop to a friend and asking them for reassurance over the course of a few hours!  It helps that some of them are also mental health nurses.

My family and wider family have been supportive throughout my life. I know a lot of them were concerned about me when I was younger when I became more quiet and when I began to isolate myself but I wasn’t at the point where I could talk about my experiences of bullying and mental distress. I kept it inside and felt as though I was alone. That mentality changed after my first episode of psychosis where I realised just how much support I had from my family members who were concerned and extremely supportive and wanted to understand. My mental health has definitely placed a strain on my family and is something that concerns my immediate family as they realise the day-to-day impact it has on me. Its not easy to live with mental illness but it is also not easy to have to live with someone who has a mental illness and so I value the unconditional support I get from all family members.

It is the friends and family who know the ins and outs of your life and understand ways to help you in times of need. Therefore initiatives that are friends and family led are essential in shaping services in mental health.

Having mental illness has definitely tested my friendships and relationships and has been the ultimate friends and family test leaving those in my life who give me strength and love. Thank you to you all, I appreciate it.

Freedom

Freedom is to not be shackled by the shadows of the oppressed or the perpetrators

Freedom is to be able to avoid the nazar of others who stifle your existence

Freedom is to be able to live your authentic self free from judgement

Freedom is just to be.

Immersed in reality

Technology is being more and more embedded into our everyday life with the idea of making life easier for society, but is something that makes life harder for me and maybe others. It seems as though the reality of the situation is that technology is being immersed into everyday life and it is harder to separate ourselves from it. We are all constantly using our phones to communicate with others whether we are in the company of others or not, liking Instagram images, liking Facebook posts, being available constantly to other people even behind closed doors and scrolling through an endless amount of nothingness.

Reality now seems to be experienced through a filter rather than in person. It seems to be clouding our vision of the truth. Individuals are making up their own narrative and developing an image they want to sell to their social network through the kinds of things they post about and the kinds of hashtags they use. It’s enabling people to develop their own brand and identity and sell a version of themselves who they are happy with that is their most interesting self that appeals to others and that will be better liked and shared. The majority of posts always tend to be positive, rather than mundane or negative, contributing to the idea that their reality must always be a good one and that they are never unhappy. This is worrying because it creates a false picture and negatively impacts people who feel they should be happier by doing things other people are doing like going on more holidays, going out more, or trying more places to eat out at. I can’t help but notice the presence of social media and technology seems to be promoting more and more consumer behaviour and more and more unhappiness amongst people. It also seems to be impacting my mental health negatively.

My mental health seems to be escalating through the idea that my thoughts are being captured. For example what I google is being recorded to find out more data about me and what my likes are to help motivate appropriate consumer adverts to be targeted at me. I find this makes me paranoid about how much monitoring and observations we are all under. However, the reality of the situation is that this is not a sign of mental illness because this is real life and data is being used by certain companies to promote consumerism in this way.

I also find anywhere where technology is becoming ubiquitous and integrated and harder to detect is a trigger for me. For example, Lecture halls with recording capturing functions lead to thoughts that others are trying to capture my original ideas and general conversations. I find I am vulnerable when I realise I’ve spoken about things that leave it open to misunderstanding on recordings which could be misinterpreted. Another example are houses that are SMART with CCTV for example, where I may be filmed without my consent is another concern for me.  I wonder if people will be more vulnerable to these kinds of thoughts more and more as technology becomes more and more embedded and difficult to see its presence.

Technology is definitely making life easier in some ways but the psychological impact it is having amongst certain people is undeniable. I guess it is about learning how to live in a world that is and will be more technologically led and understanding the impact this will have. We don’t really know how much we use technology as it is a part of everyday life but when it is less visible and when we don’t realise it is in the background is something we need to be concerned about.

Martha or Martyr

Everything seemed like it had led to this moment. Everything that I had experienced before, all the knowledge I had accumulated, all the bad things that had happened to me, all the good things, just everything. There was a reason behind it all and this moment in time was it. Everything seemed to make sense now, I had a purpose and I was going to make a difference and change the world. I was seeing the world differently, with a new outlook, that somehow I had not experienced before but it was so real and seemed to be the truth. My previous perception of the world was somehow a lie and other people around me had not awoken to this truth, so it was my responsibility to change that and save them.

For some reason I had started to believe that there was going to be an attack in Bangkok international airport. The way the airport staff were acting, their nuances and gestures they were all making signalled it to be so. The seed had been sown. They were part of a bigger conspiracy to destroy Thailand and their kingdom. I started believing that the threat was imminent but what could I do on my own? There were thousands of people within the airport, what if they were all in trouble when they got on their flight. No one was safe. The reason they took me off my flight was because they knew I knew too much, confirming my beliefs. I could not let the death of so many people weigh on my mind.

I believed I would die that day.

I had been standing up within the airport for some hours. I could see people using their mobile phones and I believed they were filming me and broadcasting footage of me across the world. I became distressed and attempted to take their phone off them to see what they were looking at which was met with awkward reactions, dirty looks and a pulling back to retrieve their phones.

I also saw multiple people with blue passports, for some reason this fed into my delusional beliefs and that the only safe people were the ones with these blue passports. I started this lecture and speech about the dangers that were occurring and the bad things that were happening in the world. I needed to alert people to what was about to happen. This drew weird looks and curious attention towards me, but no-one seemed to be changing their behaviour or reacting to what I was saying. Were they really that brainwashed that they couldn’t see the reality or the truth of the situation?

I knew I needed to alert the public so I used Facebook from a computer room within the airport that you had to pay to use. I relayed all my concerns and distress about what was happening, or what I thought was happening, and I expressed that I was going to be a Martha. What I had meant was that I’d be a martyr, but I’d spelt it wrong, and I would sacrifice myself for the greater good. I’m not sure if people knew what I meant but there was definitely growing concern over what I was experiencing from my Facebook friends. I started to believe a bomb was about to fall on the airport and that people needed to leave. I believed the end was near. I felt out of control and all I could do was raise awareness. I had come to terms with dying, as I wasn’t allowed to board a plane and meant I was going to die as a result of the attack on the airport. I had come to terms with it.

Psychosis can change your reality and lead you to experience the world differently and in my case it had me believe that this was the end. I knew I was going to die that day. This truth was terrifying. I was ready to meet my maker.

Years on, I am still here and have realised that psychosis was the thing brainwashing me but now I have control over it and know that mental illness is not worth dying over.

The Studio

This blog post will be a work in progress and will be regularly updated with artwork I have created. My mental health has deteriorated recently and so one of the methods i’m using to relax is to keep my mind focussed and distracted by drawing and painting to take my mind off my worries and anxieties about the things outside of my control. My friends recently bought me an art set for my birthday so it’s about time I used it and started experimenting.

The Teal Tiger 2  – Veenu Gupta – 2018

Rainbow Tiger – Veenu Gupta – 2018

Shades of Tiger – Veenu Gupta – 2018

The eye of the tiger – Veenu Gupta – 2018

The White Peacock 1 – Veenu Gupta – 2017

The White Peacock 2 – Veenu Gupta – 2018

The White Peacock 3 – Veenu Gupta – 2018

The White Peacock 4 – Veenu Gupta – 2018

Geisha – Veenu Gupta – 2008

Selfie – Veenu Gupta – 2018

Wallpaper self – Veenu Gupta – 2018

Blue era selfie – Veenu Gupta – 2018

Travelling through Thailand

It was such a beautiful disaster. It’s hard to think how somewhere so wonderful could have had such a devastating effect. I guess it wasn’t the place I was in, that wouldn’t have changed anything. It was my mind, and no matter where I was I believe I would have experienced my Psychosis. My mind was overwhelmed by the things that had happened to me in the past and it just happened to have manifested itself in Thailand. I did have some good moments there to remember fondly though and here are a few from my 4 weeks in the country in 2011. Yes, some questionable outfits and a questionable haircut.

Even though these photos show a peaceful and serene perspective of what I encountered in the period leading up to becoming unwell they do not reflect the real destruction of my mind and the way I experienced the world in Thailand later on. The irony is that my camera broke during this period and this accurately reflects how broken I became. Maybe I was never meant to remember the bad times and didn’t capture them on camera. However, it would have been interesting to see the images from that time and how different they varied from my experiences which were detached from reality.

The Robots in the system

If we think of healthcare as a system and a machine then the workers of it are the robots that carry out duties within this process. Training of these robots is systematic and standardised so each robot can respond effectively. The robots’ functions are to carry out their tasks for the day in the easiest way possible for themselves and their patients. Algorithms and problem solving are day to day tasks in order to respond to patient needs. Some of the robots may operate in order to ensure the flow of patients through the system is efficient and other robots may be more developed and treat their patients humanely with emotion. Others are trained to be empathetic and individualise treatment but care is still delivered through pre-identified systematic methods of working.

It feels like healthcare professionals are being churned out by the system in order to fill vacancies within the healthcare sector. The robots are concerned with their own agenda and do not realise the impact of themselves on the patient. (I am just basing this on a bad experience and I am aware of tonnes of healthcare professionals who are human and carry out their work with real emotion and compassion).

I was expecting a phone call from a GP who was going to inform me of a referral to a community mental health team in order to have a review because my mental health is deteriorating. I had certain hopes and expectations of what would come about due to this phone call and was hoping to be referred to some form of therapy. However, when I answered the phone the GP informed me that the consultant psychiatrist had suggested to the GP to adjust my medication by increasing it. I was very disappointed by this outcome, partly because I had been reviewed by a faceless robot who had not even wanted to conduct their own individualised assessment of me and had systematically treated me like a statistic they could not add to the numbers on their caseload. There was no emotion, care or compassion. Medication was the easy answer that did not involve any further input or stretch the services any further.

I understand that services are stretched and that healthcare is under a lot of pressure but when you are on the receiving end of such services, being informed of pressure on services as an excuse for your lack of treatment just isn’t what you want to hear and is not a helpful response. I guess I was just disappointed by the system.

I have refused the increase in medication which was a choice I was able to make and have decided to re-calibrate my mental health on my own. I have also referred myself to counselling and a CBT therapist at my university and I will hopefully learn ways of how to cope better through this.

I have been high functioning for a long period of time and managing my mental health well. However, now that I am in need of some help the system does not acknowledge this, ironically due to how well I have managed previously. The system isn’t shaped for those who look like they are managing but underneath are struggling. If you are not suicidal or psychotic it is very difficult to access services due to the demand on services and effects of prioritisation. Patients should not be faceless statistics but engaged with in a human, kind and compassionate way with a focus to meet service user needs. Unfortunately the robots in the machine work through logic and numbers as opposed to emotion. I guess I just feel let down by the system, but I know i’m not the only one.

The Cogs in the fog machine

So as you may have read in my previous blog my mental health has decided to deteriorate. As a consequence I decided to explore various interventions and psychological tools to prevent a full blown episode. I am off the Care Programme Approach (CPA) which means that I no longer have access to mental health services as easily or efficiently as I would like because I have been highly functioning and living in recovery of my psychosis for a long period of time without any support. However, because it is now more increasingly difficult to access services when I am in need of them I have decided to look into self-help ways that may help promote recovery and prevent relapsing.

Cognitive behavioural therapy (CBT) is a highly popular and effective way of thinking that has benefits on many mental health conditions such as anxiety, depression as well as psychosis so I thought I would see if I can use this to help manage my symptoms and see if it is achievable to learn the process of CBT without the support of a psychologist.

The process involves being able to identify maladaptive ways of thinking, our cognitions, that act as cogs within our brains that influence the mechanics of our thinking. The idea is that thoughts, feelings, physical symptoms and behaviours are all related and that the initial thought has an effect on the others. Therefore if we can change the initial cog in a positive way it will have a positive influence on the other areas respectively.

The diagram shows the types of cognition I tend to have every time I become unwell and the feelings, behaviours and physical symptoms that occur as a response to these cognitions. The idea of CBT is to challenge the thought and then as a consequence it will invoke an alternative response and different more positive feelings, behaviours and physical symptoms will occur.

By identifying the similarities between each relapse and trying to overcome it it will hopefully help prevent further relapses.

The idea is that if I can change the core belief, the cognition that people are talking about me and spreading rumours it will prevent the other feelings, behaviours and physical symptoms. It all sounds so easy, but how do you actually change a core belief?

CBT is not just about identifying the cognitions you have but it is also about challenging them and finding evidence to confirm or disconfirm the theory that your cognition upholds.

So I got thinking of various interventions I can use to intervene at the cognition stage which may help others too if they are having any unhelpful thoughts that affect them day to day from thinking clearly.

Interventions

• Remind yourself that these cognitions are a sign of you becoming unwell and they have no basis in reality because previous relapses you have had similar thoughts and they turned out to be a symptoms of your illness and therefore were not real.
• It wasn’t real in the past so its unlikely to be real now
• I have overcome this before so I can do so again.
• Knowing that no evidence doesn’t mean there is evidence out there to confirm the theory but that it means the theory is null and has no basis in reality.
• Practice mindfulness and learn to let go of negative thoughts, but be kind and compassionate to yourself and know that with practice this will get easier.
• Check in with friends or family about the thoughts you are having and ask them what their realistic opinion on it is. Sometimes hearing someone else’s view can put things into perspective.
• Learning to value yourself and understand that there is no reason people would be spreading rumours about you.

The ideal outcome

After these interventions at the cognition stage it should hopefully come to light that the feelings I have are healthier and will be the opposite of the diagram where I will hopefully feel more resilient, more in control, more confident and have a better self-belief. My behaviours will also be healthier where my relationships and friendships will be better and my ruminative thinking will be kept in check. This will hopefully have an effect on the physical symptoms too.

Other interventions that I have considered will be to be referred through my GP to a Community mental health team in order to review my medication and which will also hopefully give me access to psychological therapies in order to manage my mental health better and learn ways of coping.

I also asked friends who work within the field of mental health the kinds of interventions I should use and their ideas were the basis of this blog.

But for now I will focus on learning to challenge my maladaptive core beliefs and this will be an investment into my mental health because in theory it should hopefully prevent me relapsing in the future.

Hopefully by looking after the cogs of my mind the fog will lift and I will be able to think a lot more clearly and my mental health will run like a well oiled machine.

History repeating itself

When I was bullied all of those years ago it made me paranoid that the bullies were talking about me, making rumours up about me and thinking up new ways to humiliate me. This became my schema and template from which to understand all of my friendships and relationships in that timeframe. It was always on the basis of mistrust.

Having moved on past the bullying I have realised that in times of stress and increased anxiety that the past starts to show its face again and history starts repeating itself.  When the thoughts are triggered I go back to the time I was most vulnerable and re-live my past as my imagined reality. I revert back to assuming the worst of people and that they are somehow out to get me, and spreading lies and rumours about me. For example I will assume that anyone laughing about something is definitely laughing at me or if they are whispering they are more than likely talking about me.

I don’t want people thinking negatively about me, probably as a consequence of the previous bullying and the need to be liked by people, and this makes it even harder to deal with the inherently programmed cognitions that people are assuming the worst of me, even if these thoughts have no basis in reality.

I never want to go back to the worst time in my life but environmental cues and triggers invoke the same thoughts and feelings and my mind transports me back to that time unconsciously. I automatically interpret my surroundings based on my younger self’s unhealthy and destructive understanding of the world.

I have not learned from the past about how to overcome these thoughts and sometimes they overwhelm me, but the past cannot be forgotten. However, It can be understood differently and by reprogramming my thoughts and challenging those inherent beliefs I will finally be able to move on. This will be something I will be working towards so I can finally leave the history in the past where it belongs.

Looking forward

Only looking back do you see how far you have come.  Having reflected on my past experiences of having been bullied in childhood, leading to the manifestation of psychosis that emerged in adulthood, I have realised that these experiences have definitely influenced my journey through this world.

Over this past year I have engaged with my past experiences through this blog and reflected on them retrospectively. I had decided to write at least a blog every month this year in order to raise awareness of mental health issues, it’s the only new years resolution I’ve actually committed to but it was definitely worth it.

My experiences have inspired this blog and turned something very negative into something positive. It has given me control over how I think of these experiences and inspired me to turn them into written pieces of work that I have creative license over. The accounts reflect the very real experiences I went through, even if they were largely occurring just in my mind.

The Teal tiger as a blog has been cathartic to write and it has helped me understand and process what I have been through. At the same time I hope it has helped dispel the myths surrounding mental health issues and raised awareness to those who don’t have personal experience of mental illness and those who don’t work in the field of mental health. I also hope it has been an interesting read.

These experiences have changed me as a person, they have shaped my career choices and they have made me passionate about a subject area that means so much to so many and I feel like I belong within this field.

I wouldn’t change my past because it gave me a purpose and it has been a very unique and interesting path to tread, even though at times it has been very difficult.

However, I feel as though I have now left those previous issues behind, although I know they are there somewhere in the background, but I know I can finally move on and look forward.

Thank you for joining me in travelling through time and on my road to recovery.

Thank you so much for your loyalty and readership.

The Teal Tiger

Dear whom it may concern,

I do not know what name you go by, or where you reside but I hope that you can hear my heart.

I do not know how best to get in contact with you, I have been trying to reach you for so long to find the answers to my concerns and each request has been left unanswered.

When I was younger I didn’t believe in you because I thought if you existed you wouldn’t have made me go through all the bad things that had happened to me on my own.

Having overcome these things with great difficulty and still working through other issues I have realised that these experiences have made me who I am today but I am still working towards being the best version of myself I can be. I don’t know whether this was your vision or whether this was chance and things just worked out this way but I am a better person as a result.

I am grateful for all the people you have placed in my life at the right time to support me in my times of need.

These experiences have given me a purpose to support others who are afflicted and struggling. I have become a kinder person as a result of the adversity I have faced.

I still do not understand why there needs to be so much pain and suffering in the world but maybe we will learn something from this or maybe not.

My journey to this point hasn’t been easy. I hope to have a better understanding and more insight into your world and I hope you give me the strength to travel down the path of my choosing.

Please send me some form of response so I know you are listening.

Look forward to hearing from you.

Yours faithfully,

The Teal Tiger

Warrior or Worrier?

Warriors are people that battle through adversity and keep going. People with mental health problems are warriors because they are constantly and persistently fighting against the worries that threaten to break them. It takes a lot of energy and determination to do this and sometimes it can get too much to handle. Thoughts like “I am not good enough” or “things will never get better for me” spiral around in my head and I am constantly trying to overcome these thoughts. Every day can be a battleground in my head as well as in the real world.

I don’t know what other people’s experience of mental health is but what I do know is mine. I am constantly dealing with a thousand and one thoughts at any time and I find it difficult to concentrate on just one thing. People will describe me as a worrier but it just feels completely normal to me now. I feel guilty if I am not worrying about something because sometimes I feel the worrying will somehow help me keep in control over the problems I have, which is an illusion.

I am constantly fighting and am at war over these thoughts that sometimes become out of control and begin to overwhelm me.

We developed the ability to worry for a reason and there is a purpose to it. It can have its advantages and is a survival mechanism alerting you to dangers around you in order to protect yourself from harm. However, worrying excessively is futile because it does not achieve anything and means that we are constantly thinking of things that cause us anxiety and maintains these negative thoughts within our head.

What can help though is the army of friends, family or mental health workers such as mental health nurses, psychologists and psychiatrists available to you who are able to support you with things like CBT to break the cycle of worry and help you get through it. Sometimes we need to retrain our thoughts to be healthier and enable us to acquire the strength and tools to think differently and carry on.

Every warrior has an army behind them and remember that you are not alone and the support is out there.

Keep fighting. Don’t worry, you’ve got this.

Fly away home

Birds will always come back home when it is their time to. Something about the environment that is familiar and supportive and appropriate to their needs of that season draws them back, and no matter what happens they will always find their way back. Home will always be home.

During my travels in Thailand I did have some good times but the negative sadly probably outweighed the positive stuff because of the long lasting impact it had on my mental state.

I was on the island of Koh Samui in Thailand trying to get some rest and relaxation after a crazy time in Bangkok with some great people who I met whilst out there. Whilst on this island for some reason I started feeling the people within the residence in which I was staying were out to get me, poison me and were going to kill me. My mental state was probably due to the fact I hadn’t eaten or drank anything properly for days and I was hallucinating because of this. The residence manager there informed me that my passport visa had expired and that I needed to go home or sort this out.

I became friends with some guys who showed me the island on the back of their motorbikes but I also became friends with a middle aged guy there called Frank who was German and we drank ceylon tea together most nights. He was a bit eccentric and often talked about time travelling and I think he even gave me some documents about how to do this, I still don’t know whether he was serious. Anyway, I seemed to trust this guy and because I was feeling quite paranoid if I left this part of town I asked him to get me some money out of my bank account and gave him my debit card to do this. Obviously a very stupid thing to do but it was my only option to get some money to pay for my hut on the beach as well as buy a ticket for a boat trip and taxi to get to Bangkok to fly back home as I knew I wouldn’t be able to stay in Thailand any longer.

The journey to Bangkok was long and I was alert and hyper vigilant all of the way. The boat trip made me think the ocean was really vast and all consuming and that I would never make it. Getting off the boat there was a man holding a sign with a name that vaguely looked like my name, they must have spelt it wrong, and I sat in the back of this man’s taxi all the way to the airport hoping he was taking me to the right destination and that he was not going to kill me or harm me along the way. I made it to Bangkok  International airport safely, now I had to navigate the airport whilst being psychotic and this was extremely difficult.

I purchased a ticket for a flight back to the UK and managed to get on the plane, but I had left my backpack – which didn’t really have anything important or valuable in – in the airport but I still had my rucksack with me with all the essentials in as I’d gotten fed up of carrying this huge weight on my shoulders.

I walked onto the plane and the noises of the engine made me quite unsettled and I thought it was unusual and it triggered thoughts in my mind like this was not normal and it must be the effect of a bomb on the aeroplane and that I needed to make everyone aware of this in order to save them. I voiced my concerns and I appeared quite anxious and distressed whilst on the plane before lift off. Passengers who witnessed my behaviour complained to the staff on board the plane and I was asked to get off the plane by three members of staff who dragged me off the plane and taken to security in the airport who complained there was something wrong with my backpack.

I was not allowed back on the plane. I ran away from security but then they followed me and put me in the back of their truck and drove me around the outside of the airport under restraint. I can only think the reason why they drove me in the truck was to calm me down but I thought they were going to take me somewhere to kill me. Anyway, they brought me back to the airport and I think they called the UK embassy to help me. I spoke to someone on the end of the phone and told them how all of Thai airways were corrupt and that they were going to kill everyone in Bangkok and I needed to save everyone from this. The person on the end of the phone was very diplomatic and realised I was mentally unwell and tried to support me. I think they also connected me to phone calls from my family and my cousin as my phone was not working.

I remember someone telling me to just do what they say so you can get home quicker. I was advised I needed to have medical clearance before I would be able to fly out again. I walked to the medical department in the airport as if I thought I was walking to my death but because my family had said I needed to do this, I did this because I trusted their judgement although I was extremely frightened that they were wrong. It felt like I was making a huge sacrifice.

I had been given medical clearance, I think, and so I tried to purchase another ticket home but my debit cards were not working and I only had so much cash with me. The UK embassy advised me that I needed to arrange a western union transfer from my family. It really was the worst day ever.

After my ticket was purchased I went and waited for my flight but I could not help feeling frightened and paranoid. After a very long time of waiting, maybe 6 or 7 hours of standing up in a very rigid position having had no food or fluids, I boarded my flight and flew home.

The flight was tough. I had learned my mistake from last time, I was not going to voice my concerns and maybe if I behaved and stayed quiet no harm would come to me or anyone else. The air hostesses kept making weird noises and clicking things that fed into my delusions. I was sitting next to security but he could see I was distressed even though I was not speaking but I was hypervigilant, alert and for some reason trying not to move too much. He placed his hand on my hand to help calm me down because he could sense I was distressed and it helped me to relax a bit. Maybe he also knew about the conspiracy and he was there to help.

After a very long flight, I got out of the airport and at arrivals was my mum and uncle and I just broke down and fell into my mum’s arms and cried and cried with relief that I now felt safe and the worst was over, although this feeling of safety didn’t last long. They had been waiting for a very long time as they assumed I was coming home at the time of my initial flight and were concerned I had not arrived yet, but they were unable to contact me as my phone was not working.

I was nearly home, i just needed to get there to be safe but my paranoia and delusions came with me on the journey in the car home, the other cars on the road were following us and their engines were unusually loud. It was Thai people keeping an eye on me as I knew too much about them.

I had finally flown home, but the shadow of my mental illness followed me too. I still did not feel safe even though I was back with my family and even though I was at home in my familiar surroundings I perceived things so differently. I did not feel safe despite the four walls surrounding me. I was a caged bird trapped by my mental health in a home that no longer felt like my own.

Allergic to life

Sometimes I wonder if i’m just allergic to people, situations, places or life in general. This is probably what my anxiety tells me. My anxiety disables me because it makes me feel I cannot do the things I want to because of how loud these thoughts are in my mind as well as impacting my confidence. It also increases my heart rate and physical responses, like an allergy would.

Allergies are when your body overreacts to a foreign body. I think this is similar to anxiety, where your reaction is disproportionate to the circumstance you encounter. It is the body’s way of gaining control over the situation and you may develop physical and mental symptoms in response to a stimulus. I find I have more control over my physical health and allergies than I do over my anxiety.

As a mental health nurse I know that physical and mental health impact each other and I have realised how true this is through my own personal experiences.

I am allergic to a lot of different things including peanuts, artificial colour, dairy and alcohol. Yes, it sucks a lot! I think that I have become more conscious over what I eat and drink and make sure I don’t become unwell because of my diet.

It is difficult going to a new country and managing your dietary needs where the cuisine is so different to your own.

For example when I was in Thailand I feel that my allergies and my preoccupation with food led to me becoming unwell because it fed into my delusional experiences there relating to my diet. Thai food is generally cooked in peanut oil and they include a lot of peanuts in their dishes too so I think looking back this affected me eating the food there and also led to beliefs that people were poisoning me whilst there.

I think for these reasons I wasn’t eating properly which led to my mental state deteriorating as you need a certain amount of calories and nutritional content to function and I didn’t have an adequate amount of food or fluids.

My allergies are something I can control through knowing what I can and can’t eat and I know that with a bit of psychological work on myself I will work out how to manage my anxieties by being able to identify what my triggers are, but this will be something to work towards.

Maybe once I am able to manage my anxieties I will feel less allergic to the situations around me but for now I will find ways of coping that help me relax and quieten down the thoughts of anxiety to fight off that physical and mental reaction to stressors.

The positive and the negative

Positive and negative symptoms of psychosis is a term thrown about in mental health services and it is just one example of when clinical terms can be used out of context and used inappropriately with patients who might not understand.

Positive and negative symptoms of psychosis doesn’t mean what you would think it does. Not all symptoms of psychosis are negative and not all symptoms of psychosis are positive. That’s not what it means.

What it actually means is that positive symptoms are parts of your illness that have manifested themselves in the form of additional experiences such as hallucinations, delusions or bizarre behaviours.

Negative symptoms are things that take away from who you are that were not present before the psychosis so they can be things like apathy, lack of motivation, depression, slowness, lethargy, and lack of concentration.

Mental health professionals often throw around mental health jargon whilst communicating with each other but sometimes it can be pushed onto patients too and it can be unhelpful.

I remember the first time I heard this phrase and I wondered how anything related to psychosis could be considered “positive” as it had such an extremely negative impact on my life.

It is important to explain what you mean to patients so they know you understand that they are going through a tough time and that you are not belittling their experiences by describing them as having positive symptoms as this could be confusing for someone to understand.

Some patients are experts in mental health and will understand these terms when used in context and others will not. It is extremely important to talk to patients at their level and appropriate for the context in which they’re in.

Sometimes thinking of a patient in clinical terms can make it easier to categorise the patient and respond with appropriate solutions but it can also increase the distance and act as a barrier between patient and professional and can get in the way of compassionate care.

It can be difficult to shake the jargon off but rather than referring to a patient’s condition in a medicalised way, based on positive and negative symptoms, and instead referring to their symptoms in the way the patient relates to them is probably more helpful in understanding the patient and what they are going through. In response this helps the professional to provide support that is meaningful. It also makes the relationship between patient and professional more therapeutic and equally balanced in power.

Positive and negative symptoms are both debilitating and really serious for the patient so it is essential to add to a patient’s quality of life rather than take away from it. This can be done by avoiding using phrases that undermine patients’ experiences and instead using language that is enabling rather than disabling.

Travelling through time

My mind is a time traveller. Memories hold onto the past. My conscious mind makes sense of the present and I dream of my future.

I honestly believe that my past experiences of having been bullied have made me who I am today. They have had both a positive and negative effect on me and continue to do so.

It has impacted me in little ways for example I’m rubbish at cooking and doing the food shop because I spent most of my childhood worried and anxious because of my mental Illness which stopped me from doing these things.

 Also earlier experiences of trauma and decreased self worth from being bullied have stayed with me in my present. For example, I am more insecure and likely to be affected by uncertainty and stressful situations now.

I have come to understand why I went through what I did and why I am still affected to some extent by it through the stress vulnerability model.

 The stress vulnerability model means that people who have been exposed to more stress early on have less capacity to deal with stress later on. For example vulnerability can be described as if you had a bucket and it was filled with stress. The more you have the more likely it is to spill over. This can be filled with genetic predisposition, stressful life events such as trauma, bullying, alcohol and substance abuse, abuse, homelessness and the list goes on. The more stressors you have the more your bucket is likely to increase vulnerability to developing mental health problems. 

Obviously you may ask why those who experience stressful situations later on in life have more capacity to deal with these situations and this is likely because their past experiences and templates from which to understand the world are much healthier and their tolerance is higher because their bucket starts off empty, or more empty in comparison.

We also know that early experiences such as trauma or abuse affect people and their development. They are more likely to have unhealthy relationships because the template for which they understand relations is poor in the first place.
 So it is almost unfair because if your life starts off poor then it is likely to continue to stay that way. This can be described in things like the attachment theory where your earlier experiences of relationships are more likely to mirror later relationships.

It also affects things like education. For example if you are at school and you’re affected by your mental illness then your grades are likely to be affected which will in turn affect future prospects. I had to leave university during my undergraduate degree because it became too difficult to carry on. I did return and complete my degree after a hospital admission and this shows that recovery and mental health are important to succeed in life.

However, just because something has happened in the past does not mean that it is forgotten. It stays with you and impacts your life and will continue to do so if you think of it in the same way.

Time is definitely a healer and growing up and looking back at your experiences can help you understand what you went through and how to let go and move on from it.

Psychological therapies are like time travelling, you revisit places and situations you experienced and you look at moving forward through thinking about what happened to you in a different way. This is essential in letting go.

 Part of my identity now is my mental health experiences and what I have been through but it does not mean I have to be stuck in that time and I am allowed to move on and be happy on my journey to recovery.

I look back at my experiences and realise they shaped me and gave me a purpose to help others with mental health problems and also made me more kind and understanding. Time changes everything and I am in a better place than I was before and I hope in times to come I will be in an even better place.

How do I know you are who you say you are?

My family became concerned over my mental state when I returned from Thailand because of my unusual beliefs and behaviours. I began to think my family were imposters, had delusions that I was being monitored by cameras, that there were spies listening in on my life and that there was a major cover up conspiracy relating to the portrayal of life reported in the news. For these reasons my family called for help.

My family looked different to me, maybe this was partly because they were all extremely anxious and worried about my mental state and partly because I hadn’t seen them for about 5 weeks. For some reason I started believing that they were Thai people in their bodies that were trying to harm me. I was on my own.

I was in a very heightened state of emotion and because my family did not understand my predicament or what I thought was my reality, I started to believe that nobody else could see what was really going on. I felt extremely stressed because I needed to solve this conspiracy and without help this was near enough impossible.  It was a really frightening time because I thought that the people monitoring me would kill me to protect the secrets of the government. I did not know who to confide in and who to trust, I was on my own with this huge burden and purpose, but all the while I was trying to do the right thing and ensure people knew the truth.

At times, due to various different interactions, I started to believe my family had started to believe in what I was saying and I had started to trust them a little bit. This made me think that I was finally making progress in my mission, which as a consequence made me lose myself deeper in those beliefs. I think in reality my family thought that something dark had happened to me, which is why I had become mentally unwell.

They called the doctor and two doctors came to assess me that week. One of the doctors was our family GP who looked slightly different because I hadn’t seen them in a while so my visual senses were making me think that even though I recognised this doctor I wasn’t entirely confident that it was really him and not an imposter who looked like him. I think I even claimed during the assessment that he looked different and had put on some weight.

The crisis team came around that week, they were two social workers who were approved mental health practitioners. They were there to offer an independent assessment to the doctors in order to see if I needed help from inpatient services. Having two outsiders coming into my home to assess me was scary because I wasn’t sure they were who they said they were. I still had concrete beliefs that people outside were trying to harm me and I wasn’t sure of the identity of these two new individuals. They were either here to harm me or they were sent from an unknown source that had sent them to aid me in my mission. I had believed they would come to me earlier but maybe they had their own agenda, could it be them? Could I trust them? Wouldn’t they speak a code word to let me know who they were without everyone else knowing so I knew I could trust them? I had to work out who they were to gauge my next move. Initially they said that they wanted to take me into the hospital where I would be able to have a safe place to stay and get help that I needed on a voluntary basis, but how was I to be assured that they wouldn’t take me somewhere else to kill me?

My psychosis reared its ugly head. I started questioning who they were. I asked them to show me their identity badges with their names on and their job roles and places of work. They agreed and complied to show me them. However, I started exclaiming that anyone could wear an identity badge and claim they worked for the NHS, but how could I actually be sure? They then said there was a phone number on the back of their badges that we could ring to check they were who they said they were. I then said I wanted to ring the phone number, to which they then said that the phone line was only open between 9-5 and that now it was 7pm we wouldn’t be able to get through to them. My sister remembers me saying “well that’s convenient now isn’t it.” It was quite a comical moment but I was deadly serious. This, to me, confirmed they were lying and that they couldn’t prove their identities. I started shouting my paranoid beliefs about them. This paranoia and my suspicions about them relayed to these workers that I was completely psychotic and that I needed urgent support under the mental health act, and would benefit from being sectioned in order to be assessed and treated in hospital.

One of the workers helped my mum to pack some things for me to take while the other one stayed with me in the room, to ensure I didn’t escape. An ambulance was called and I was transferred from my home to an NHS acute ward which would be my home for 4 weeks.

I felt completely out of control and scared of my ultimate destination. I couldn’t trust anyone, not even my family because they believed what these social workers were saying. I stepped out of the house and allowed them to take me away, I felt as though I was ready for my death that was awaiting me.

Control or Freedom?

During my psychotic episode it felt like I did not have any inhibitions to my behaviour. I would say whatever was on my mind without any filters, I would behave in an emotionally driven way, my interactions with others were also disinhibited and I had no concept of morals or what was socially acceptable. It felt very freeing and liberating. It was a dangerous way to be because I had no control over myself, I don’t think I was myself but I was free. It made me feel confident and powerful. I liked this feeling and I became more of my real primitive self and less of the self that feels I need to have control over everything I do.

I remember more of what I experienced in Thailand than my ability to remember what happened yesterday. I think this is because I was fully engaged with my senses at this time and everything was vivid, in high definition colour and more heightened. Also my experiences were not being dulled down by medication.

I am not sure if I am me, on the medication or off the medication but being on the medication helps me have some control over my psychosis and gives me more quality of life and recovery from my condition. As a consequence I am more concerned with being in control over my health rather than feeling free and myself.

I hope to find a balance between control and freedom but sometimes I feel that these concepts are binary, and that you can only have one or the other.

My relationship with social media

After secondary school I moved to a college where I managed to move out of the social circle that bullied me. I made real friends with the other children and life was getting better.

Now that I actually had friends my main priority was to have a social life and foster friendships. I think because I didn’t have proper friends before I was more concerned with maintaining the friendships I had now. This was probably the main concern for most teenagers at the time too.

I would spend all day with my friends at school and then we would all log on to MSN and talk to each other until the early hours of the morning, even on school nights.

I found myself unable to cope with school work because I didn’t give myself enough time to complete it, as I was becoming obsessed with going online and chatting to my friends. School work was not my priority. I only studied the day before my GCSEs.

My use of the messenger service affected my self worth and happiness. Through this I gained instant gratification when the responses I got were quick and fast. I’m pretty sure my brain got a shot of dopamine when I was messaged.

This ended up affecting my mental state too though because I measured my friendships in terms of how much or little my friends spoke to me online. I would become upset if I didn’t get an instant reply and took it personally and interpreted it as if I meant less to my friends than others. I had an unhealthy relationship with the messenger service and also my friends on there.

I remember my parents becoming frustrated by how much time I spent on there and they secretly asked one of my cousins who was technologically savvy to put a timer on the computer for how long I spent online so it would shut down the service after a specific time period. They didn’t tell me they were doing this. It is funny looking back that they had to resort to this but it made me quite angry at the time.

When I struggled to understand why the system kept shutting down I became really angry that it wasn’t letting me talk to my friends. My friendships were on the line. If I didn’t talk to them today then surely our friendships would mean less and suffer as a consequence. I became really upset and distraught. It felt like the end of the world. My reaction showed that my relationship with the messenger service was extremely unhealthy; my family could see this, but I couldn’t.

Later, when MSN became less popular I joined Facebook and I became more concerned with the number of likes I got for my statuses and posts and also about the number of friends I had on there. It was the same sort of addiction I had for MSN that presented itself slightly differently and my happiness and self worth were measured through the success of my posts and statuses.

Although I had an unhealthy obsession with social media, this addiction would enable me to get the help that I needed when I was in Thailand.

Social media has its benefits and makes it easier to talk to friends from across the world, reducing the distance between people and enabling you to maintain a connection. While I was in Thailand and had become psychotic my phone and bank cards were not working, and so social media enabled me to connect with friends and cousins through Facebook, from a computer café in the airport. I was extremely psychotic and was communicating my delusions and experiences over social media. This was concerning my friends and family who became worried over the things I was claiming had happened to me. Through this connection my friends and cousins were able to raise the alarm for my parents who were not on social media that I was in mental distress in Thailand and that I needed help. It was a way of maintaining communication with me but also to get me help that I needed.

When I became well I was embarrassed and ashamed of the entries I had made online of the psychosis I had experienced and how contacts on Facebook had witnessed my demise into a full blown psychotic episode. Once you post that status you have put a self of you out there and it is hard to take back. Real friends and family, who knew me, knew that I wasn’t myself and they managed to seek help for me.

Social media had both a negative and positive impact on my life but I am now able to utilise it in a healthier way. My main reason to use it now is to raise awareness of mental health issues and reduce stigma surrounding it by purposefully sharing my experiences with others. I feel more in control of my use of social media now however, I think I still get that instant gratification when I get a like on Facebook. It is easy to start thinking that the number of likes or followers equates to the success of the post and also how successful I am as a person, when in actual fact this is an illusion and my self worth and happiness is not and should not be measured by this and is not a reflection of what others think of me.

My relationship with social media is much healthier now and my real life relationships are too. Social media is now an integrated part of our lives but it is important to know when to switch off from this to experience life as it should be experienced, in real life face to face encounters and not through a phone or computer screen.

Through the looking glass

When I was at primary school I viewed myself as a confident, happy, young girl and was friends with everyone, so it seemed, but things changed when I went to secondary school. I would see myself differently in the future.

I had never experienced anyone being unkind towards me and I did not understand the social dynamics that changed when moving schools.

I became victim to bullying. I was always quite conscientious and liked to participate in class, answering questions by putting my hand up.

I don’t quite know if that was the reason I started being bullied but it snowballed. One person bullying me led to multiple people bullying me and suddenly it felt like everyone who mattered (my social circle) were being horrible towards me.

The children would throw rubbers at my head from behind whilst sitting in class, stick post it notes on my back with horrible comments on and call me names. I remember one person who I accidentally brushed past said that they now needed to wash their hands with soap and water.

As a child I did not know how to process all of this. I reflected on all of this treatment and it made me think there must have been a reason for the bullying. I began to think I was somehow ugly, unworthy and some how inferior compared to all of my classmates.

I didn’t want to go to school. I thought that this would be my life now and could not see a way out and this made me think I was stuck and this problem would not go away.

Days seemed really long. Having to deal with the constant thoughts that you are ugly or a freak on top of other children actually saying this to me was a huge weight on my shoulders. I started believing that if these other kids thought this about me then everybody would think this about me.

I found it difficult to walk down the street. The bullies’ voices of you’re ugly, you’re a freak played around in my mind.

I started looking at people to see what their reaction was of me, whether they reacted in a good or bad way. But this reinforced my own beliefs about myself. That I was a freak.

I became paranoid that others were thinking I was ugly and I could not face the world. I wanted to die and for this pain to be over. I also at this point started to self harm with the intent to die.

I started looking in the mirror a lot and thought my face was the problem. The bullies must have seen something I couldn’t see. I tried to look at my face in different sections to see if there was any abnormality. I couldn’t see anything but there must have been something wrong else why would they bully me? I would spend hours in front of the mirror after school. This was not normal behaviour so my parents started getting worried.

I viewed my face in a warped way and tried to figure out what was wrong. I also really wished I could have a face transplant because I genuinely believed this would solve my problems, but at the time this didn’t exist.

I also started to blame my parents for giving me this face. It was their fault. If they hadn’t have made me so ugly I wouldn’t be being bullied. I started getting angry more often and behaving badly towards my parents and shouting and being moody.

I had long hair back then and started to wear it down in front of my face when walking around town if I had to go with my mum. I also started scrubbing my face to make it better. My skin became red raw and I developed some scars because of this which would take a few years to heal.

I think I put a lot of emphasis on what the bullies thought of me and the bullying impacted my self esteem, my self belief and my confidence.

The bullying led to me developing some inherent beliefs about myself that would impact me into adulthood and it would leave me vulnerable to mental health issues. It was the start of my paranoia.

I never properly faced the bullies and I don’t know if they know the kind of impact they had on me. However, reflecting on my experiences I know that this early experience impacted my life and made me see myself differently.

I have always wanted to get back to the happy confident young girl I was and as I have processed and let go of the trauma in my life I am slowly regaining my lost personality. Although the tough times were hard, they did teach me to be more accepting and kind and it has changed me in a positive way.

I now look in the mirror and see a grown up young woman with faded scars and I am proud of who I am and who I’ve become. Although deep down there are still those negative beliefs about myself that have left their mark on me and continue to influence me in visible or invisible ways.