Sunday, 24 April 2011

ISCHP and a Good Friday for an Ethnographer to be in Dubai

I am posting this blog before having breakfast and making my way to the airport to come home from what has been one of the best conference trips I have been on in a while. I am in Dubai now, after arriving from Adelaide where the International Society of Critical Health Psychology held their 7th Biennial conference. The conference was chaired by the indomitable Wendy Stainton-Rogers. She is a fearless lady and takes no prisoners.

There were some other influential colleagues in attendance as well, Professor Raewyn Connell who presented on the psychological dimensions of social transformation, often using examples of her own personal journey of transformation as a trans-gendered woman. This was the first time she had described publicly this journey. The openness and inclusion to be found in the presentations and discussions was unusual and made for some lively debates – it was these debates and discussions that are often missing in the busy-ness of our everyday academic lives, and yet are precisely what we, as academics, should be facilitating more often.

There was an extremely good Pecha Kucha session where the presentations were outstandingly brilliant, both in content and style of presentation. The use of images, voices and music was stunning. Each session was perfectly timed to 6 minutes and 40 seconds, and although some presenters had many more slides than the normal 20 slides, each were delivered within the automated time frame. It gave me renewed enthusiasm to try this approach again at future School Development days. In a similar vein, were two sessions that allowed individuals the platform for five minute challenges (again the sessions were timed). These challenges could be about current problems, aspirations for the future, or just to start a debate going. Again I will try and use this approach at future School Congress (or whatever replaces them in the new Governance framework).

And so it was coming back home that brought me once again to Dubai for a couple of nights. I arrived on Good Friday and once unpacked, thought about doing some work and enthusiastically took my lap-top to the pool. This is one of those so called infinity pools, three floors up and with a glass wall that perfectly merges the pool with the sea beyond – both of which were brilliant blue. It seemed churlish not to use the opportunity to consider developing an ethnography of pool behaviour. All was revealed (well nearly all in some cases), but it struck me that it was a great place to witness the behaviours of others and to try to make sense and understand the significance of these behaviours for the individual and families. – I made lots of notes and will write up – but that is for tomorrow.

In terms of human behaviour and the significance this has for our self and for others, two of the presentations from the conference stood out for me in illustrating this. One was from New Zealand and the other from Japan. Both used vivid, uncompromisingly graphic and emotionally moving images of the absolute devastation wrecked by the earthquakes and tsunami. Yet both these presentations were using the images to show what it was that people in both these communities and from across the world were responding to in terms of human kindness, generosity and in the facilitation of hope and opportunity for others.

Easter is traditionally the time of renewed hope for the future. Yesterday I was fortunate to travel 140 meters upwards in just 14 seconds in the Burj Khalifa tower. This wonderful building is truly impressive. It is the tallest building, and the tallest free standing structure in the world. It has the highest number of floors of any building and the highest outdoor observation deck in the world (Empire State Building you really need to get your act together) and the 140 meters travelled in 14 seconds – travelling in the longest single continuous elevator in the world was impressive. 10 metres travelled every SECOND! Spookily, you did not feel a thing until your ears popped at around floor 56.

The trip up gave me a 360 degree view of UAE and what appeared to be a huge commitment to how a new future was being successfully built against the back cloth or some very traditional ways of doing things (and the in a very inhospitable environment of sand and heat).

Likewise, in the UK, Easter will for some be embedded in religious celebrations, others will turn their attention to DIY. Such stores make a great deal of money as people start to redecorate, remodel the garden, and generally start on the repairs put off during winter. So for all of the readers of this blog who might be doing something like this over the Easter weekend, just spare a thought for those still grappling with the reclamation of their homes, communities and lives, and in so doing please just send out a message of understanding and support.

Sunday, 17 April 2011

The Wizard is Back in Oz

I first went to Australia ten years ago to speak at a conference on service user involvement in mental health. The paper - The Being and Doing of Mental Health Nursing: Users Perceptions became the basis for a book entitled Using Patient Experience in Nurse Education. The book inspired the hugely successful service user, student and carer conference we ask all student to attend at the beginning of their nurse and midwifery education and training with us. And 10 years later I was on my way back to Australia and where this story started. Despite the long journey involved, I was looking forward to returning to Adelaide to present my current work at a mental health conference.

Ten years ago I flew directly to Singapore, had three hours in a transit lounge and then flew on to Australia. These days, and one DVT later, my body isn’t so resilient or so forgiving. So it was a six hour flight to Dubai, an overnight stop and then a twelve and half hour flight to Adelaide. On this occasion I flew with Emirates, who have the most amazing collection of films and music to entertain passengers on these long flights. Interestingly, their 100 best albums mirrored my personal Ipod collection, so it was almost home from home, not sure why Leonard Cohen didn’t feature, maybe people these days don’t like his music.

I found it amazing that I could be in a plane that is travelling at nearly 600 mph, 33000 feet off the ground and all I had to do was press a screen and gain access to thousands of songs from my youth. I must confess to leaving my computer in the overhead locker and being totally self-indulgent for the twelve hours and listening to song after song that for me evoked so many good memories. I bought my first LP when I was 13 (1968) – Jimi Hendrix Electric Ladyland – and there it was on the menu of cd’s. I am amazed at how quickly (over the last 10 years) airlines such as Emirates have embraced new technology for the benefit of their passengers. I am sure we need to being do the same with our approaches to education and health care practice.

It is still a long journey and tiring. However, you do get to meet some interesting people along the way. When I first went to Adelaide, one of the people I met was Julia who in a different life became the Director of our Postgraduate Directorate when I took over as Head of School. This time, In Dubai I met Alli, who trains fighter pilots for a living. He chained smoked (no smoking restrictions in UAE) his way through an evening’s conversation where we discussed politics, his love of all things British, the state of the world economy and of course my relationship with the ubiquitous Manchester United football team. I have lost count of the number of people over the years who I’ve told that I really don’t know Sir Alex personally.

One of the albums on offer was the remarkable What’s the Story Morning Glory (by Oasis). As well as being a great collection of music, the title track always reminds me of 5am in the morning. Wherever and whenever I travel I always wake up just before 5am – even on trips like this where you gain and lose time as you travel. Interestingly, on the first trip to Alidade, some of the people I met presented work on the impact of circadian rhythms on people’s mental health.

I am writing this blog on the eve of the conference, which promises to be a very interesting one. This time I am presenting some work on risk and control in society and the impact this can have for some people with mental health problems. One of the issues I explore is Jeremy Benthams concept of the panoptican, and how sometimes therapeutic relationships are felt to be compromised by the sometimes bounded nature of care and containment. My new found friend Alli didn’t have any such problems. In an account reminiscent of Michael Moores’ Fahrenheit 9/11, he talked about how they trained their fighter pilots not to think about the fact they are killing other humans beings when they fire their missiles at targets. Partly this involved reinforcing the fact that the targets were selected away from the battle field, and the missiles guided by information relayed through satellites. Not a good use of new technology and it was somewhat frightening stuff.

Sunday, 10 April 2011

A room with a view, but why is it sometimes difficult to see what’s there?

Last week I was on a brief holiday, re-charging my batteries in the tiny village of Roosebeck, in the South Lakes. The house I stayed in looked out over Morecambe Bay. Roosebeck is up the coast from Ulverston, and when the view was clear, it was possible to see Blackpool Tower on the horizon. However, there weren’t many fair weather days!

On the first morning I climbed up to the Hoad Monument in Ulverston. This is a 30m tower that sits at the top of Hoad Hill (133m) and it is one of the most iconic symbols of this part of the North West of England. If the weather is clear, there are 360o panoramic views of the Furness Peninsula, Morecambe Bay and the Southern Lake District to be had. However, when I got to the top, these surrounding areas were shrouded in mist and they were all but invisible.

And so it continued, apart from one morning when I was able to lay in bed and watch the most magnificent sunrise I have seen in many a year, for much of the time Morecambe Bay remained obscured by low lying rain clouds. The vibrant world that I knew to be there was turned into an unyielding, impenetrable greyness.

Problems with taking in a view was a bit of a theme while away. I was taken aback by the very intrusive reporting on the M11 crash of Monday morning – I did not understand why we were given a bird’s eye view of the devastation brought about in this accident. A film taken by a helicopter flying up and down the crash site was repeatedly shown throughout the news bulletin. It was an almost voyeuristic view of what would inevitably be a life changing event for all of those involved (directly and in-directly). Of course it is possible to argue that as individuals could not be identified from the helicopter view, such reporting was acceptable. However, the report left me feeling very uncomfortable and my thoughts go out to all those who will be affected by the accident.

The piece on the accident was followed in the news by the announcement that the UK Government plans to reform the NHS would be temporarily paused so that additional views might be canvassed, and where necessary adjustments made to the proposals. What fascinated me about the piece was the way in which those interviewed regarding the proposals appeared to become more un-knowing (and less bothered) about what the proposals might mean for them, the further away from Government they were. So by the time they report featured patients (sitting in a GP surgery), the views being expressed were characterised by perceptions of powerlessness and a wearying sense of ‘what will be will be’.

The problem appears to be a familiar one – the inability to communicate what the changes involve, what the impact is likely to be and the reasons for making the change in the first place. In fact one could easily substitute University Fees for NHS Reforms and arrive at the same conclusion. I am more interested in the NHS Reforms however. Many years ago I started my PhD looking at the way in which GP Fundholders used various forms of relationships to negotiate and take advantage of Margaret Thatcher’s introduction of a quasi- internal market for the NHS.

Towards the end of my PhD journey, the Conservatives were removed from power and Tony Blair swept in with a large majority and  hell bent on dismantling the NHS internal market. Out were to go GP Fundholders, and in were to come PCG and PCT’s. For six months or so, I had a very difficult time trying to avoid the thought that my study was now worthless. Thankfully, I had a very wise supervisor who walked along my path with me for for a while. And of course the reality was that whilst the language changed, and much money was spent on restructuring the NHS, the internal market continued and was possibly more successful than anything Margaret Thatcher could have ever hoped for. I also got my PhD.

I think the latest proposals to make further structural changes to PCTs and the Strategic Health Authorities do not appropriately reflect the contribution made by many managers and non-clinical staff in achieving the progress that has been made in the NHS over the last two decades. Whilst my own studies have shown that GPs will be able to commission the services required in the future, they will only be able to do so with the right kind of managerial support, leadership and infrastructure being available to them. Of course gaining access to these services might be just as difficult in the future as it can sometimes be now. I have been trying to get an appointment with my GP for nearly three weeks  – without success. No matter, working on the principle that 85% of the problems that result in us consulting a GP are self-limiting, I have given up trying to secure an appointment and moved on.

Friday, 1 April 2011

Good Enough Mothers and Great Colleagues

This week I listened to a colleague having a mother – son conversation. It sounded beautiful, yet after the call was finished my colleague described how difficult it had been. I could only say that whatever was going in their world that had caused the difficulty, sons will forever love their Mothers, come what may. It might take time for relationships to become sorted, but they nearly always do. And this is the weekend when both sons and daughters have the opportunity to show their Mothers this love. I believe this special relationship, (a Mother and her child) the Mother, provides the safe ‘container’ we all need in order to learn, fail, succeed and develop as independent individuals.

In psychoanalytic theory, the term ‘container’ is associated first and foremost with the development of the concept of projective identification. It was Melanie Klein who introduced the idea of containment, and Wilfred Bion who referred to it as an inter-personal phenomenon.

In the mother – child relationship, the child projects into the mother parts of the self that are intolerable and full of anxiety. The mother becomes a ‘container’ for the projected parts of the child. Where the mother is aware of what has been projected into her and does something to alleviate her child’s distress, it is possible to say that the mother has contained what was projected. And this is precisely what I witnessed in my colleagues telephone call to her son.

For me I believe this process of mother – child relations can be seen in the therapeutic encounter, and likewise, it can be seen in the way organisations such as our School are able to handle conflict, disappointment, jealousy, and other high expressed emotions.

I have written elsewhere about this, and used another one of my favourites thinkers Donald Winnicott and his notion of the ‘good enough mother’ when thinking about the organisation providing containment. In an organisational sense a ‘good enough container’, is one that can) like a mother or therapist, contain the anxiety-arousing parts that originate both within that container, and/or projective identifications originating in the organisations environment. Given the turbulence and changes occurring within our School, College, University and operating environment, the need for us all to contribute to providing a space that provides, emotionally, psychologically and psycho-dynamically, a ‘good enough container’ has never been more important.

Many thanks to all of you who, showed in lots of different ways last week, that you were there for me.