Interview With Professor Tanya Bryon

Liam Butler interviews Clincial Psychologist Professor Tanya Bryon

15 August 2014

Liam Butler

The Skeleton Cupboard $34.99 www.macmillan.co.nz is Professor Tanya Byron's account of her years of training as a clinical psychologist, when trainees find themselves in the toughest placements of their careers. Through the eyes of her naive and inexperienced younger self, Tanya shares remarkable stories inspired by the people she had the privilege to treat. Gripping, poignant and full of daring black humour, this book reveals the frightening and challenging induction faced by all mental health staff and highlights their incredible commitment to their patients. Powerfully moving and beautifully written, The Skeleton Cupboard shares the tales of ordinary people with an amazing resilience to the challenges of life.

Question One

Tanya your book on the experiences that made you a clinical psychologist has been described by broadcaster Dr Michael Mosley as offering 'profound insights into the human condition'. What do you think makes older people happy?

Respect.

Within our elderly populations we have a wealth of life experience and wisdom that as a society we waste by not harnessing it.

In our youth obsessed cultures where ageing is rendered invisible and something to be avoided at all costs, the elderly become invisible, unheard and not given the respect many deserve given their own life experiences and wisdom.

By ignoring our elderly, our seniors, we are wasting a valuable resource as a society. So many mistakes could be avoided, difficulties managed early on, lessons learnt without huge social and individual cost. Many mental health difficulties come from isolation and helplessness and we have seen an upswing in rates of diagnosis as communities have broken down and families live apart. Old fashioned community living where neighbours knew each other and helped with each other's difficulties plus the sense of family built around the most senior members meant a time when the struggles and challenges of life were often managed and supported via a network, a community.

For example I meet many young parents clinically who are struggling with children who won't eat or sleep to the degree that it is having a profound effect on family functioning and these people have no support. The older generation would be a powerful source of advice and support in these situations but are not consulted because they are not embedded in the family structure. We value and deify those with wealth and youth and in doing so our values are completely upside-down.

Question Two

The misuse of drugs and abuse of alcohol plays a significant part in the agony of some of the most socially isolated people. Do you have any tips for older people who are at their wits end with worry about their partners or children's undiagnosed addictions?

A useful way of thinking about addiction is to use the model: The Stages of Change proposed by Prochaska and Di Clementi in 1983.

Many families can identify that their loved one has a problem with addiction before the addict themselves has accepted it. This means that the addict is in a state of ‘precontemplation' ie they are just not thinking about their self destructive behaviour or owning their addiction. It is at this stage that conflict really arises as families battle hard to get their loved one to take responsibility for their behaviour. A ‘pre contemplator' needs to be safe as their behaviour often becomes risky and so damage limitation strategies need to be put in place e.g. no access to funds to feed the habit, the family themselves getting professional support and advice.

Families often tread on eggshells around an addict - afraid to ‘set them off'. However often families can unwittingly be collusive in maintaining the problem and so boundaries need to be imposed which may include a partner and children moving out in order to protect children and also highlight the gravity of the situation and provide a potential ‘wake up call'. Once an addict is thinking about change then families must be prepared that this will be a bumpy process of acceptance and denial. Again boundaries need to be enforced with assertive compassion and professional support sought.

Once the addict is in treatment and so can explore the issues underlying the addiction, families may need to be part of the therapeutic process and a non judgmental stance taken by all involved. Lapses may occur but these need to be seen as learning moments where the addict can see where the significant and entrenched triggers to their addictive behaviour lie and be supported to not allow the lapse to become a full blown relapse. Families need to arm themselves with knowledge and the older generations often do not understand the substances that their loved one is using. There are many useful websites including: http://www.health.govt.nz/your-health/healthy-living/addictions/alcohol-and-drugs

Question Three

You mention the fear associated with Dementia Related Aids. For older people who want to put their time and money into caring for the most vulnerable what do you recommend they do?

To be truly effective when giving time and money to those more vulnerable and in need, those offering help must find a population or organisation that has meaning to them.I would never advise specific charities or organisations over others but as a Consultant in Child and Adolescent mental health I am concerned that our younger generation is presenting with increasing rates of mental health difficulties and that prescription drugs given to the young is alarmingly on the rise. As well as vulnerable children more likely to breakdown due to neglect and abuse in early life, most children today are often raised in captivity: in an over supervised and risk averse manner where adults who have become paranoid about safety often deny them the fundamental freedoms so necessary for the development of emotional resilience. We live in societies defined by health and safety often driven by fear of litigation - we see this in schools for example where children and young people have less freedom to explore and take managed risks as part of their learning.

Therefore my passion is the well being of the upcoming generation and as an advocate for the young who often are not given a voice, I believe that the elderly have powerful resources both in terms of wisdom and life experience and potentially financially to make a difference for children who are presenting in greater numbers in crisis. There are many excellent charities but I also champion the value of local grassroots initiatives that work at a community level and this is where the online world offers a gateway to find the best fit organisation for those who want to make a difference and support those these fortunate.

Question Four

It is good that more older people are now seeking care for their psychological well being as well as their physical well being. How can an older person who has never visited mental health professional know that they are purchasing the service that is right for them?

We do not view mental illness in the same way that we think about physical illness. In fact, I believe in general we don't like and fear mental illness - we don't want it in ourselves because it frightens us, and we have no time or desire to really engage with it in others except as something to gawp at and to define ourselves against. For the older generations the stigma around mental illness was stronger and more entrenched when they were growing up and also the availability of help, treatment and support was significantly less than it is nowadays. I do work clinically with elderly people and often find that they have been struggling for many years, perhaps most of their lifetime, with mental health difficulties because they were too ashamed to seek help and saw their difficulties as a personal flaw.

Research tells us that we all have the possibility to be mentally il in the same way as we do to succumb to physical illness. Indeed the WHO estimates that 40% of all lifetime difficulties and disabilities are underpinned by mental health problems. There is no shame in this and help seeking is courageous.Working as a mental health practitioner is an extraordinary privilege. Over the last 25 years of my career as a clinical psychologist I have met extraordinary people who have had the courage to seek professional support for their mental health challenges.

To seek help for physical illness can be terrifying but something that most of us do with very little thought as it is ‘acceptable' to consult medical practitioners when bits of our bodies feel broken. However when I meet those in the grip of mental health problems many come to me much later than the onset of their difficulties, gripped by shame - the stigma of mental illness rendering them anxious and helpless.

We live in a world defined by anxiety. Twenty-four hour, multi-platform news media keeps our fear alive as we watch and hear endless stories of tragedy and trauma. Stress infuses every waking moment as we work unhealthily long hours or panic in the face of mounting debt. Anxiety - the fight/ flight/ freeze response is an inbuilt instinctive reaction to threat; we feel in danger, we prepare to run or to fight or if totally gripped by panic, freeze rooted to the spot. As blood flows to our heart, lungs and muscles, parts of our brain unnecessary in that moment of survival switch down, including our frontal cortex, our rational, thinking brain. No time to hang around and ponder, only to react and stay alive. However, if we feel that our minds are ‘breaking', we panic and that acute anxiety pulls us away from our rational problem solving ability so that we become aggressive to those who show concern, or we withdraw, or just freeze feeling powerless and helpless. Add in a large dollop of stigma-induced shame and suddenly the actual difficulty is infused with additional layers of mental slurry and we feel our sanity is leaving us; we fear that we are going under.

In my job I attempt to empower people to make the journey through the chaos into clarity - to understand themselves, to feel ownership of the story that explains how they got to where they find themselves. Narrative is powerful. We use stories to teach children important life lessons and we ask questions to understand the behaviour of others. The ‘what' and ‘why' of life is essential to us making sense of an often very confusing world.

In my book THE SKELETON CUPBOARD, I write the stories of some of the incredible people I met when training to be a clinical psychologist. Through their narrative I attempt to show how powerful understanding can be in a process of acceptance, of healing. And, as a then naïve, young woman in my early twenties, I also show how my own narrative is so important within the process as my anxiety sometimes gets in the way of my thinking. I felt that I couldn't write a book about the difficulties and issues of those I treated without also owning my own otherwise the book would just reinforce the us/ them stigma surrounding mental health (some are sane and some are not) which I don't believe exists.We all can get overwhelmed at times and we all can struggle mentally as well as physically. By understanding our own narrative and by sharing openly with others we empower us all to feel able to talk openly and get support for the time in our life when we feel mentally challenged as we are able to do when we are physically challenged.

That's called living a life and every life has a story.

To find the best practitioner to open that narrative to I advise the same care taken if someone was seeking the best surgeon to perform a complex operation for a physical health problem. Get the professional qualifications of the therapist or mental health practitioner and check them against their professional body (eg www.psychology.org.nz/). Also ask them to explain their approach which they must be able to provide an evidence base for.

Question Five

Throughout your book you describe families that are experiencing significant distress. In your training you learnt that you can not save every one. For people who know that a family is in turmoil due to family members being subjected to psychological or physical violence do you think they should inform the appropriate authority? And how can they work out what they might be able to do to help?

Violence (physical, psychological or emotional) is unacceptable and destructive both to the victim and the perpetrator. I have worked with families who feel helpless and powerless in the face of what they think or know is happening. Many families don't want to get involved but they have to ask themselves whether they are colluding with the problem by knowing about it but also allowing it to continue. Fundamentally if children are involved or witness to the violence then there is an automatic duty of care towards them that we all hold and if a family cannot find a way to protect the children eg by making the perpetrator leave the home or enabling the victim and children to move away, then authorities must be involved. See: http://www.police.govt.nz/advice/family-violence/help.

Sometimes the violence can be part of a very dysfunctional and enmeshed relationship and so it may also be that the victim is trapped in a destructive cycle and unable to see a way out or will take a violent partner back after a separation and so the cycle if violence continues. Again if a family cannot reason with their loved one then they may have to step in and call the authorities eg the police to contain a potentially dangerous situation. This can be a very difficult thing to do but may be the first step in freeing the victim and perpetrator from what could have become a sado mashochistic relationship and help them begin to think about the dangers inherent in that relationship for both of them.

While I do not condone violence in any form, as a clinician I endeavour to take a non judgmental stance and look beyond the actions and think about what is going and why - this is the only way that change can be facilitated. For families where emotions are running high this can be, understandably, extremely difficult to do and so professional support may be useful for those helplessly watching loved ones caught in a violent relationship to think through what they can do and why, however painful it would be, it is necessary and helpful.

About the Clincial Psychologist Professor Tanya Bryon

Professor Tanya Byron is a clinical psychologist and a professor in the public understanding of science, specializing in working with children and adolescents, with twenty-five years' experience. A journalist, author and lecturer, her books include The Skeleton Cupboard and The House of Tiny Tearaways. She writes regular columns for The Times and Good Housekeeping and is a broadcaster for BBC television and Radio 4. With Jennifer Saunders she co-wrote a BBC comedy series. She lives in London with her husband, Bruce, and two children, Lily and Jack.

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