First Aid in Mental Health

Joy Melville

• Publisher: Taylor & Francis
• Year: 2018
• eBook ISBN: 9780429796517
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Originally published in 1980, First Aid in Mental Health offers a clear, helpful and sympathetic guide to the nature of mental illness and the kinds of help and treatment available at the time. Joy Melville looks in particular at: warning signs, medical help, schizophrenia, anxiety and stress, depression, post-natal depression, anorexia, elderly mentally infirm, patient's rights, treatment, and supplies not only a practical and sensible account of the nature and problems of mental illness, but also the reassurance that the sufferers and their families are not alone and help is available.

1

Warning Signs

The onset of mental disturbance can be so gradual that one may be unaware that anything is going wrong. It is, nevertheless, important to be able to recognise warning signs – the earlier treatment is started, the less likelihood there will be of admission to hospital. There is also the possibility that the symptoms mask a physical illness.

Early signals of mental ill-health will vary according to the particular illness and are illustrated in more detail in the specific chapters later in this book. But there are general changes in behaviour that act as a serious signal that something is wrong and help is needed. The case which follows illustrates how one girl’s mental ill-health developed.

The girl concerned, in her early twenties, advertised for a flatmate. She told the girl who answered the advertisement that she wanted company, and had been seeing a psychiatrist for depression – a depression, she explained, which rendered her unable to tell the difference between a cold, snowy day and a warm, sunny one. Everything she saw seemed to be in black and white, with no colour.

For the first year or so that she was living there, the flatmate did not notice any change in the girl – though she went out as much as possible because she did find the girl rather depressing company. However, the girl seemed to improve after her psychiatrist decided to take her off all drugs. After two or three months, though, a gradual change took place in the girl’s behaviour.

‘It started with her obsessive tidyness,’ said the flatmate. ‘If I ate a biscuit, she would follow me round and tidy up the crumbs. Then she would move a biscuit from one plate to another and wash up the first plate. She would ask people to tea at weekends and buy masses of food, but stayed out in the kitchen herself, clattering away, washing the floor, and bringing in ever more food. If you said, “Come and sit down and have a cup of tea, she would get furious and say, “This is my flat, I’ll do what I want, don’t you boss me around.” Although I was out quite late in the evenings, she’d still be up when I came in at midnight. She’d stay up till 4 a.m. ironing, or so she’d tell me the next morning. She would take an hour to iron a blouse, and would be in every evening, ironing, washing, sewing.’

The first really strange happening, in the flatmate’s eyes, was when the girl announced that there was a poltergeist in the flat and that it had flung the clock over to the other side of the room. She wrote ‘Hate, hate, hate’ on her memory slate, and said that this, too, had been written by the poltergeist. Then she started writing on the walls and on the back of doors – one door was filled with the initials of the flatmate. She talked of ‘them’ and said that there was a conspiracy against her; by keeping the radio on very loud, she .tried to drown out the voices menacing her. At one point she attached a rope from her bedroom door to the front door, writing on it ‘keep out burglars’, then tied some apple and cheese to the front door for, in her eyes, further protection.

The flatmate asked if she was telling the psychiatrist about her feelings of a conspiracy and the messages and, despite the reassurance from the girl that she had, suspected this was not the case. The flatmate did not like to interfere, although she was aware that it was only since the girl had been taken off her drugs to counteract depression some months previously that her behaviour had become increasingly bizarre.

‘I would try to phone her during the day to make sure she was all right,’ said the flatmate, ‘but she would take the phone off the hook because she would sleep during the day and then wake up at night and want to talk at 3 a.m. She would talk very loudly, and play the gramophone loudly, I’d hear it even through my closed bedroom door. The neighbours were amazingly tolerant of the blare once they realised she was ill. I’d never know what to expect when I came home: whether she would be sprawled out asleep on a chair, or out, or “high”. She wouldn’t eat unless I prepared it for her and then she would gulp down an enormous plate in seconds. It couldn’t have done her any good and she remained thin.

‘She went out one day and bought nearly £300 worth of cosmetics; and another day she borrowed £5 to go to the supermarket, and came back with three or four bags and a supermarket wheeler absolutely full of large packets of soap powder and bread. She must have used her credit card. The food in the fridge began to go bad, but, when I tried to take out some fermenting yogurts that were absolutely brimming over, she said she might want them. The spin drier was full of mouldy clothes, and so was the washing machine. Then she bought a rabbit, locked her own bedroom door, and slept in a tiny room along with the rabbit. The smell became awful, right through the flat. Her room was full of muesli, rabbit leavings, lettuce, piles of clothes, old bread, train tickets – once I saw five train tickets all to the same place in Surrey, all dated the same day. She must have gone back and forward all day long.’

At this stage, the flatmate felt that she could cope no longer. She went to the girl’s own doctor to explain the situation. Although he could not, ethically, discuss a patient, both he and the area psychiatrist considered that the girl should be compulsorily admitted to psychiatric hospital. The girl had no relations, and it required a social worker to agree to the compulsory admittance (see Chapter 9 on patient’s rights). The flatmate was told that the social worker was coming to see her and, when she did, behaved very calmly. Although the social worker agreed the girl was very thin, and saw the writing on the walls, she put the girl down as hyperactive and would not sign the compulsory order. When she left, said the flatmate, the girl ‘burst into hysterical laughter and said, “That wasn’t a social worker.”’

After that, nothing happened. The flatmate felt she could not leave as there was no one to look after the girl, but became progressively exhausted and depressed herself. Her work was disrupted by phone calls from the girl, and so was her sleep at night. But as the girl would not accept that she was mentally ill, or go into hospital voluntarily, or see the doctor, there was no way to give her treatment. Only after she left the flat and started staying in hotels, running up, over some two months, large bills which she could not pay, was a compulsory order signed.

GENERAL SIGNS

Many of the signs of growing mental ill-health are much less noticeable than the case above. A member of the family, for instance, who is normally active at weekends, may start lying in bed all morning – and this will then begin to extend to weekdays. Or he may change from spending a reasonable time in the bath to lying in it for two or three hours. Sometimes a person who was formerly neat and tidy may cease bothering to put things away and start to neglect her appearance. Or someone will become more and more withdrawn, staying for long periods in his room and rarely speaking to others in the family. One woman said, ‘For many weeks now, I have done nothing but sit alone in my room. I have no inclination to find work or take part in any social activities. I do not seem to have an interest in anything and have more or less lost touch with my family and friends. I have almost lost the will to go on living and have no sense of purpose whatsoever.’

Patterns of waking and sleeping can also change. One mother said, ‘My son would not tell me what was wrong. But he just stayed in bed all day and stayed up at night.’ And a teenager, talking of her father, said, ‘He wakes at about 4 a.m., and walks about the house, then falls asleep in the chair as soon as he returns from work.’

Occasionally, a person’s character seems to go into reverse: quiet people may become aggressive; the extroverts may become withdrawn. It is puzzling and worrying for relatives. ‘My middle-aged son becomes very manic and overactive at times,’said one woman. ‘But this wild behaviour must be a cry for help; he is by nature the opposite of violent or aggressive. He is demoralised by this condition and I fear will get more and more subject to these episodes, if only as a means of escaping from what he cannot cope with in ordinary life.’

A girl, in talking of her brother, said: ‘There has been a great change in his personality. He gets into a terrible temper about the slightest little thing I or anyone does that annoys him. All his friends have fallen away. He was always houseproud, but now the flat is neglected and he seems unaware of how dirty it is. I tried to tell him he was ill, but he flew into a terrible temper and said he was all right.’

‘My teenage daughter, who was always shy and withdrawn, now has outbursts of temper,’ another woman said. ‘She stays up in the chair all night and goes to bed at 7 a.m. She’s full of obsessions, always looking at her clothes and hands, vacuuming the bedroom for hours, and will not have the door open.’

Constant tears are an obvious sign that a person is not coping. ‘I can be reading a book and, for no reason at all, I just burst out crying,’ said one woman. Another, who mentioned that she too cried a lot and often thought that she was going mad because of her inexplicable feelings of fear, said that her friends and relatives were losing patience with her ‘because I’m either crying or just can’t make conversation, or sit without talking’.

One girl, whose boss sent her home on a number of occasions because she ‘kept bursting into tears, could not understand what was the matter with herself. ‘Nobody in our family had ever had a breakdown: I simply did not know it existed. I was living in a large house in Harrow with five other girls, one of whom I disliked intensely, and was very unhappy. None of them seemed to realise there was anything untoward in my behaviour. Yet, from what I remember, it was weird. For instance, I believed .that my mother, who lived in the country, was up in London. My flatmates would get me to ring her, to prove that she was still in the country; but as soon as I rang off I would believe she was in London again/I also had a mania for writing everything down. It got to the point, where, if I told something to a flatmate, I would not believe she was listening, so I would write it all down and ask her to read it. I also began to think there were burglars in the house. I went shopping one morning, but had to come back because I thought all the shop assistants were against me.

‘My mother was worried sick because she kept getting these peculiar, hysterical phone calls. But none of my flatmates said anything. I suppose ignorance was the answer. They had never come across it .before and did not know how to deal with it.’

Shortly, after this, the girl caught an infection, which brought matters to a climax. She went home, was lucid in the mornings, but became worse as the day wore on. She did not know the people around her, and imagined they were taping her conversations and following her around. She finally became violent and was admitted to hospital. She was told that had she been treated at the onset she would not have had such a severe breakdown.

The tension and stress that had triggered off this girl’s condition were also present in another case, that of a schoolteacher. He was, at the time, a housemaster and had been given additional responsibility at school. He was also spending a great deal of time learning the organ. His wife was pregnant and, lacking enough money to decorate the house, they were doing so themselves. He became hyperactive, corresponding with eminent musicians, and becoming overexcited when dealing with colleagues, whom he was having difficulty in handling. Neither he nor his wife was aware of these warning signs. He began to get increasingly worked up; he saw sinister implications in the various political events of the day, and in the comings and goings of his colleagues. He began to have grave doubts about the merits of teaching at public school. When he happened to go on a train journey and came across a colleague on the same train, he thought it was all part of a conspiracy against him. Finally, at a dinner party he and his wife gave one evening, he became very disturbed and excited and, to the distress of his wife, broke it up. She suggested he should see a doctor, which he refused to accept. Only when a colleague suggested this did he do so. The doctor prescribed tranquillisers, but this did little good. The teacher remained disturbed all that day, and finally made an improper phone call to a girl he knew. He revisited the school, as he felt he needed further help from his colleagues, and the deputy headmaster persuaded him to become a voluntary patient in a psychiatric hospital.

In another case, a man was aware of the warning signs of mental disturbance. ‘I knew two people who had breakdowns,’ he said, ‘and from knowing them I could see the signs in myself. They made me aware of oddities in myself, and made me think about things that I regarded as normal.’ He realised, for instance, that he was avoiding certain situations. One example was dropping out of day classes, which his boss had given him permission to attend. His marriage had broken up, but his wife then had a bad motor accident. The strain of going to see her daily began to tell. He could not bear anyone to come near him. He would come in from work on Friday night and not go out for the whole weekend except for half an hour’s shopping. He sat doing nothing at home. After tranquillisers proved useless, his doctor referred him to a psychiatrist.

Most people find it hard to detect, in themselves, the signs of a coming breakdown. Fiona Hulland, when at MIND’s Advice and Information Service, said, ‘I have had men phone me up from a payphone, weeping, who are still trying to hold down their job, and talk about their state in terms of not being able to concentrate. They feel their ability to do their job is slipping and they are incredibly concerned about that. They say they can’t tell their doctor about their problems, but that they need help to sort out what is happening to their life.’

Relatives, partners, flatmates and colleagues – as the above experiences show – are aware of any alteration in behaviour. A colleague at work, for example, will notice out-of-character changes: unpunctuality, a person drinking too much at lunch time, an inability to stop working, difficulty in relationships in the office. Someone living in the same house will notice obsessive behaviour worsening, or less and less food being eaten. A relative will notice a gradual withdrawal from reality.

WAYS OF HELPING

If a person is suffering from the more serious forms of mental disturbance – like hallucinations, losing touch with reality, extreme paranoia, the hearing of voices – psychiatric help is required. But sometimes in the case of people who are not functioning, are unable to cope any longer, or are very depressed, it is possible for laymen to help them.

Sometimes an outsider will see that a person is fighting a losing battle against stress, and can warn him of this. Practical help can be important here – like talking over office decisions with a colleague, or helping a post-natally depressed mother with the washing up or cleaning.

Many people are not only unable to speak to their doctor about how they feel; they cannot confide in anyone. Because they disguise or deny their feelings, it is hard to know how to help. To ask someone who is obviously depressed, for example, or becoming obsessive, if there is anything you can do to help, is asking to be snubbed. Yet it is important that people persevere in offering help, particularly as far as listening is concerned. Fiona Hulland, when at MIND said, ‘If you have spoken for half an hour to someone who is very depressed, and you feel you have not given them any help, they invariably say, “It’s been wonderful to talk to some...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Introduction
• 1 Warning Signs
• 2 Medical Help
• 3 Schizophrenia
• 4 Anxiety and Stress
• 5 Depression
• 6 Post-natal Depression
• 7 Anorexia
• 8 The Elderly Mentally Infirm
• 9 Patients’ Rights
• Appendixes