If I were to call out language that stigmatises mental illness every time I came across it on social media, I’d be posting about it every couple of days. But no matter how called for I may feel it is, I don’t want to douse my readers in a bitter diatribe that often. I also enjoy a break from being told to shut up or get over it by people who don’t agree with my assessment of stigmatising language. So I’ve let it go for a while.
But I came across the following facebook post recently, which hit a nerve and left it throbbing for long enough to drive me to the keyboard:
Now, I don’t like the word lunatic – but that is the least of the problems with this post. And as much as I’d like to agree with the sentiment, I have to ask:
What does this post imply about those of us who live with severe mental illness?
It equates us with people who believe and propagate fake news. The most pejorative label for people who don’t believe in climate change, the author of that snippet could come up with was to portray them as mentally ill.
Anti vaxxers, people who don’t believe in Covid 19, or who don’t believe in climate change don’t have those beliefs because they are mentally ill. They believe them because they are poorly informed and possibly brainwashed.
So, let’s not conflate pathological delusions experienced as a symptom of mental illness with people who are just misinformed and who refuse to delve into some scientific research.
I live with Bipolar 1 Disorder, and have experienced delusional thinking as a symptom of this illness. I not only believe in climate change, I am very concerned about it. I believe the overwhelming benefits of vaccination outweigh the few risks. Covid 19? Of course it exists. Donald Trump? Ten of my posts wouldn’t be long enough to list the reasons he has to go.
And yet when I jump onto social media I am bombarded with posts that tell me that the best way to insult the people who believe the opposite of the truth is to call them mentally ill, and thereby imply that if you live with mental illness you are in the same category as people who can be brainwashed.
Delusions caused by mental illness are completely different to the overconsumption of, and belief in, fake news. By labelling all of the people who don’t believe in scientific proof as mentally ill you insult and dismiss the many people who live with mental illness and who are critical thinkers who do believe in scientific evidence.
I can only speak from my experience of delusional thinking, but here’s what I know:
Delusional thinking isn’t a contagious false belief system you are indoctrinated with. True delusional thinking as a symptom of mental illness is completely involuntary. You don’t choose to experience it. It sweeps in on the coat tails of an illness that fundamentally changes how you interpret the truth.
For me, delusions are accompanied by mania which at its worst tilts into psychosis. The inside of my head feels as though I am riding a rollercoaster that’s on fire. I don’t sleep. The first time it happened, I tried to convince everyone of the truth to my malignant belief system. And in my experience true delusions due to mental illness resolve with antipsychotic medications.
The chances are your average antivaxxer or climate change conspiracy theorist will not change their beliefs if you dose them with antipsychotic medications.
So, If you read the post above and shrugged your shoulders or like several of my facebook friends gave it a like, let me rewrite it for you and see if you change your mind. Here goes:
‘If you believe all of (sic) world’s scientists got together to fake 7000 climate studies as part of (sic) elaborate hoax, you are not conservative you are a cancer patient. We have to stop treating people brainwashed by right-wing propaganda as political actors and start treating them on an oncology ward.’
Uncomfortable yet? You should be because the implication that people who live with cancer are idiots, is as ridiculous as it is insulting.
So why is it ok to equate my serious mental illness and the fact that I have at times spent months in a psychiatric hospital to me being an ignorant conspiracy theorist?
One morning, a few years ago my heart thudded against the tight metal bands strapped around it. Adrenalin ping ponged through my system. I was out on a run, and the air hummed with a kind of malevolent electricity. I sensed something terrible was about to happen. And it did. I was heading down the hill when I saw them. Severed limbs, pale and bloated – tossed carelessly in the gutter.
My breath lurched in and out of me as I stood and stared in horror. Should I call the police?
Then insight broke through and with it a reality more terrifying than the severed limbs. I didn’t need the police. The limbs were sandbags. I sprinted inside, hit the call button next to my bed and clenched my eyes shut while I waited for a nurse.
When he popped his head in the door, I opened my eyes and said:
‘Can you please page my doctor. I’m starting to have visual hallucinations and delusional thoughts.’
He went and, having paged my psychiatrist, returned very quickly with a cupful of antipsychotic medication. I gulped it down and waited for the jumbled sharpness inside my head to soften and slow.
If this had been my first experience of psychosis I may have been terrorised by the severed limbs (and worse) for longer. I may have tried to tell other people about what lay in the gutter at the bottom of the hill. But it wasn’t my first experience.
I had admitted myself to hospital several days before with precursor symptoms. Speeding thoughts, pathological irritability, non existent concentration and short term memory. I was in hospital waiting, the potential for psychosis hovering darkly over me. So, when it descended I knew what was happening. And that insight got me treatment quickly and saved me from the embarrassment of a family member, nurse or doctor having to convince me I was delusional.
Developing insight usually requires multiple episodes of illness and hard, proactive, psychological work. You have to dig around inside yourself to learn what are normal feelings and behaviours for you and which ones herald the onset of illness. The hard work of gaining insight is even more challenging for anyone who hasn’t had access to effective early management of their illness.
And no one ever has insight into their first episode of illness because that first episode hijacks you. It catapults you from being someone who could always trust the contents of your head to those contents not only being unreliable versions of the truth, but sometimes your worst enemy.
And unlike experiencing symptoms of a physical illness you can’t just lie back and expect others to know you are sick. If you are vomiting or have a nasty cough your suffering is obvious to everyone. You don’t need insight to tell your family or your doctor about what is going on with you in order to get the help you need.
With a mental illness, painful symptoms are often expressed as behaviours. They can mercilessly present you to the world as:
negative, unmotivated, slow, shuttered, insecure, nervous, scattered, indecisive, irritable, unfocussed, unintelligible, uninhibited, nonsensical, lost, delusional, racing, jittery, and more.
In part insight means learning to recognise that what can feel like personal failings are just symptoms of an illness. You have to internalise this before you can translate what is going on with you for the people around you.
But regardless of how someone manages their mental illness, they won’t do so successfully in the long term without insight. Or they will rely heavily on others to tell them when to seek help.
I absolutely loathe anyone else speaking for me in any area of my life, but particularly when it comes to my Bipolar Disorder. So, doing the work to gain the insight was and continues to be non negotiable for me.
My psychiatrist and I now communicate very efficiently. He doesn’t waste time asking about how my family think I’m going because he knows he will get the most accurate answer directly from me. I can recognise and name the symptoms I’ve gotten to know so well over the last 14 years.
I am practiced at translating overwhelming feelings into symptoms. For example, I know now that when my life feels as though I am running through chest high water with concrete boots on that is depressive symptoms setting in, and if I ignore them, the water will continue to rise.
My symptoms will always affect me, and they will always hurt when they flare into life. But recognising and naming them shrinks the overwhelming into the manageable. Insight has built a safety barrier between me and this illness. It ensures I can see that even though I may live with its symptoms, those symptoms have nothing to do with who I am.
Last week was breastfeeding awareness week, and the irritation I feel when I see strong pro-breastfeeding messaging flared. I usually bite my tongue and suppress my politically incorrect opinions about this emotive subject. I don’t care about how anyone chooses to feed their baby. But I do care that the ‘breast is best’ myth is still being drip fed to (especially first time) mothers like a sugary subtle poison.
Fourteen years ago I had my first baby. I lapped up all the breastfeeding propaganda from the hospital antenatal classes and my antenatal yoga classes. Because I trusted these sources.
And they didn’t exactly feed me falsehoods. But they did imply a mother who switched to formula before she had exhausted every possible option to keep breast feeding was not doing the best for her baby. Posters in the maternity hospital told me that exhaustion, blood streaming from cracked nipples and tears streaming down your face were all worthwhile prices to pay to feed your baby this liquid gold.
After going into thirty three hours of labour on two hours sleep, my daughter was delivered by caesarean. I fell asleep as I was being stitched up. The midwives wasted no time. I woke with a start, in recovery to find my baby attached to my left breast. It was so important to these midwives that my baby attached ‘immediatley’ that they didn’t even do me the courtesy of allowing me to wake up before making this most intimate of introductions.
The focus on the holy grail of establishing breastfeeding in the maternity hospital was so strong that I sat up for three hours at a time thinking I was feeding my baby, when she was comfort sucking for most of that time. It left me exhausted and my back a wall of pain from sitting in the ‘feeding chair’.
Now, if that were the worst of it, I would have probably gullibly pushed through all further discomfort to establish and continue breastfeeding. Had I succeeded, I would have probably felt proud of myself. And after being told time and time again children who are breastfeed are healthier, smarter, more empathetic, and more likely to poop rainbows, I may even have been arrogant enough to attribute all of my daughter’s future, health, smarts, and empathy to my valiant efforts to persist with breastfeeding. (She has yet to poop out a rainbow – but I can live with that.)
But within a week of her birth, whether or not I breastfed was injected with some desperately needed perspective. She was at home with her father, contentedly guzzling formula while I was tipping my breastmilk, tainted with antipsychotics, down the sink in the Special Care Unit of a private psychiatric hospital. I had come down with postnatal psychosis and I was clinging to my life with my fingernails.
To my credit, I quickly forgave myself for ceasing my ‘breastfeeding journey’ 7 days into motherhood. And I didn’t look back. I had been too sick to ever be riddled with the guilt I saw in other mothers who had been less unwell but had also made the smart choice (for them) to stop.
But we shouldn’t need extreme circumstances to justify feeding our baby formula to anyone. Breastfeeding is a personal choice. Nothing more. Nothing less. But our society has turned it into a religion. And it’s opt out not opt in. We are all automatically given anti formula education classes antenatally and then baptised in breastfeeding once the baby is born.
The high priests of this religion are lactation consultants and midwives who set ironclad commandments and rule with fear. The fear of harming our babies with our actions.
The pressure to breastfeed is a known contributor to and risk factor for developing perinatal mental illness. Mental illness that can leave a baby motherless if it is severe. Unlike the maternity hospital midwives, the nurses in the mother baby unit in the private psychiatric hospital I was an inpatient in don’t pressure new mothers about how to feed their babies.
But they do spend a lot of time undoing the damage done by overzealous midwives and lactation consultants who have bullied new mothers into believing they will hurt their baby if they consider formula anytime earlier than as a last resort.
For my second baby I had one breastfeeding aim: Get some colostrum into him. He went onto formula at day 7, just like my daughter. And just like my daughter, now you wouldn’t be able to pick what he was fed as a baby.
Breastfeeding is cheaper than formula feeding. It is more environmentally friendly. It is the safest and most convenient way of feeding a baby in a third world country and/or if you don’t have regular access to clean water or formula. If your baby is premature and/or has underlying health conditions for which a paediatrician has recommended breastfeeding or expressed breast milk, then – for that baby – breast is best.
But if your baby is full term, healthy, you have access to clean water and can afford to buy formula, then (beyond the first few days’ worth of colostrum) whether you choose to formula feed or breastfeed is as irrelevant to your baby’s wellbeing as the colour of your underwear while you’re doing it.
A few weeks ago I took part in an ABC radio national interview about my experience with ECT (Electroconvulsive Therapy). A psychiatrist and two other people who had had ECT were also interviewed. I am very happy I got to contribute to such a balanced, informative, digestible piece about a psychiatric treatment that is shrouded in stigma and false information. Highly recommend a listen when you get a moment.
Kanye West is unwell again. Hurtling through a manic Bipolar episode while the world laughs. And as someone who lives with Bipolar 1 Disorder, I feel for him.
In the early years after my diagnosis, during one manic episode (while hospitalised) I started discussing my sex life with strangers. My friend who was visiting me steered me gently away.
Kanye doesn’t seem to have anyone to steer him away, gently or otherwise.
Kanye is a wealthy, influential man, who probably has access to the best mental health care available. But I don’t believe his problem is accessing top quality care.
His problem is that he lacks insight and no one around him is game to have the difficult conversations with him. The conversations that point out that while he may be a brilliant artist when he is relatively stable, when he develops manic symptoms his brain needs a break from the world, and the world is not entitled to its contents.
Instead, when Kanye becomes unwell his mania is left to run free.
He has been open about his choice not to take medication to help manage his Bipolar Disorder. That is his right. Medication doesn’t work for or agree with everyone.
But he seems to be unaware that to successfully manage this illness without medication, you need to employ other strategies. You need to hone your insight. And if your insight when you are unwell is shaky, you need a mental health directive.
This means sitting down with your doctors and people closest to you when you are well and discussing how you would like to manage your symptoms when you are unwell. And if you experience manic episodes, one of the most basic requests may be to not have access to the media – social or otherwise – while symptomatic. Why?
Because mania can gobble up your inhibitions, make you see the world through a paranoid lens, and sprout delusions of grandeur.
Kanye recently gave an interview to Forbes magazine during which he rambled for four hours, to this effect:
‘…They want to put chips inside of us, they want to do all kinds of things, to make it where we can’t cross the gates of heaven. I’m sorry when I say they, the humans that have the Devil inside them. And the sad thing is that, the saddest thing is that we all won’t make it to heaven, that there’ll be some of us that do not make it.”
“Clean up the chemicals. In our deodorant, in our toothpaste, there are chemicals that affect our ability to be of service to God.”
If Kanye were a homeless man on a street corner sharing these ideas with the world, the interviewer from Forbes magazine would probably have walked past quickly, maybe shuddering at such overt insanity.
Instead that interviewer sat and listened to him for four hours. Noted down delusional quote after quote and then published an article in which they even describe Kanye’s lack of awareness:
‘If it all sounds like a parody, or a particularly surreal episode of Keeping Up With The Kardashians, West doesn’t seem to be in on it.’
Of course West isn’t in on it! He is walled off from reality by illness.
Did that interviewer ever pause to consider why much of what Kanye was saying made no sense? I suspect (with disgust) that they were fully aware their high profile subject was mentally unwell, but chose to exploit him while he was most vulnerable.
I have written thousands of words I thought were brilliant, while in the grip of mania. But once my symptoms recede, I am relieved no one else has read these largely nonsensical word vomits. Because if they had, that would invalidate the quality of my writing when I am healthy.
But Kanye’s word vomits are out there for all the world to snidely pick at, to brand him a rambling idiot and someone to be sniggered at.
At the time of publishing this post, headlines announcing Kanye’s withdrawal from the presidential race are emerging.
I understand stress and sleep deprivation are a president’s companions for most of their time in office, that pushing through is a corner stone of juggling the demands of the job.
Stress and sleep deprivation are the perfect fertiliser for Bipolar episodes to flourish. Bipolar episodes, once active, can’t simply be pushed through. They have no respect for deadlines or work demands – let alone international or national emergencies.
Whether Kanye recognised the risks of pursuing the presidency himself or whether someone in his circle came forward to have the hard conversations and steered him gently away, I am relieved for him.
The strands in my children’s heritage are tightly intertwined, multicultural, and impossible to untwist from each other. History labels their predecessors perpetrators and victims, depending on which of their ancestral branches you examine.
A photograph of my maternal great grandmother hangs in my hallway. She looks serious. In mid 1920s Warsaw. Dark haired and dark eyed. My grandmother, aged three or four, stands next to her in a light dress, their arms linked.
My maternal great grandmother was too attached to her country. Fatally so. To me, she is a cautionary tale of the danger of fastening yourself too tightly to one part of the world.
But I only know fragments of her story:
My grandmother (in the light dress) was about nine or ten when she emigrated from the Jewish ghetto in Warsaw to Australia with her parents.
Shortly after their arrival, my great grandmother looked around at the vast, bright country she found herself in and decided it was too foreign for her. She pressed some coins into my grandmother’s hand and sailed back.
In doing so she inflicted a lifetime of trauma on my grandmother and signed her own death warrant. Her life was erased by the Holocaust that ripped through the country she chose over her daughter. A daughter who would be orphaned in the vast, bright country at twelve, when her father died just a couple of years later.
My parents’ wedding photograph also hangs in my hallway. Taken in Duesseldorf, 1971. My mother’s dark hair. Dark eyes. My father’s white blond hair. Blue eyes.
I was born in Germany, lived in Saudi Arabia from ages one to five and returned to Germany just before my sixth birthday, in time to start school.
Many German born children of my generation were infused with guilt. We read When Hitler Stole Pink Rabbit by Judith Kerr in primary school. The older grades took school excursions to former Nazi concentration camp sites. This shameful chapter in Germany’s history was rightly not denied or underplayed.
And the whole world pointed its finger at us. At least it felt that way when I moved to Brisbane with my family aged thirteen.
Almost as soon as I started school, a chunky, pimply, blond boy in my year began greeting me with a Nazi salute and yelling ‘Heil Hitler!’ every time he saw me. The other kids stared as though I were personally responsible for Hitler’s actions. Each time it happened I was swallowed by a boiling pit of mortification and anger.
I already owned my German guilt. Guilt with a twist. The country I’d been born in, whose language I spoke flawlessly, that was home to all of my friends, whose seasons, landscapes, and culture I loved, had in recent history been responsible for the genocide of my mother’s family’s people.
My guilt and that knowledge had already curdled uncomfortably inside me, before that boy began hurling the only, and highly offensive, reference point he had for German people, at me.
My maternal grandfather’s Jewish roots can be traced back to 16th Century Portugal. It is one half of where my children’s dark eyes come from. Their high foreheads and cheekbones travelled from Latvia and Germany via my father. The shape of their chins can be traced back to English ancestors from my husband’s family.
My children are both first and seventh generation white Australians.
It is messy alright.
My ancestors didn’t happen to be in Australia when white people invaded and began inflicting trauma that is still ongoing on the First Nations People. But my husband’s predecessors landed here as missionaries ten years after the first fleet.
Does any good ever come from entering a foreign country aiming to convert its peoples to a belief system not their own?
I don’t believe so. No matter what the intent.
And no matter how much I love the descendants of those missionaries, my guilt echoes around that family history. It feels similar to the guilt I felt as a German child of the early eighties.
Yet, guilt on its own achieves nothing unless it pushes us towards acknowledgement and action.
Over the last weeks I have researched and asked advice from people with Aboriginal or Torres Strait Islander heritage on wording an acknowledgement of Country and its First Nation Peoples to include in my book. I am so grateful for their time and knowledge.
I am still working on the exact wording. But I plan to include this (slightly reworded) content from an acknowledgement by the Climate Justice Union:
‘I appreciate I have much to learn about the oldest continuous living culture. I am listening, seeing, and learning.’
We are all capable of listening, seeing, and learning – in some form.
And when my children look at their own hallway photographs one day, I hope they will be proud of their incredible hybrid vigour, know where they came from, but also that they are honoured and should be thankful to travel safely over Aboriginal and Torres Strait Islander lands.
Aside from a call to the poisons information centre, three visits to the dentist, one to a paediatric physiotherapist, one to my psychologist, recalcitrance and poor behaviour from me and my children, it also included a near fatal accident.
I nearly killed a young man at the beginning of this week.
And I did not want to write about it. The shame and incomprehension of this close call burn me in waves. But this incident bore a loud message, which I did want to write about.
On the first day back of school after months of lock down, I hadn’t planned to drive my children to their schools. We are walking distance from both. But time does strange things on school mornings. It slithers away at warped speed and suddenly, the window to comfortably walk to school on time slams shut. So, I drove them, on the proviso that this was going to be an exception.
Driving conditions during isolation have been muted. The amount of traffic diminished to that of a tiny country town in the middle of the night. School traffic ceased. Work commuter numbers slashed.
On that first day back at school, cars converged on the local streets and clustered around the schools like flies on a carcass. Drivers were filled with more emotion than a regular school drop off warrants. Joy. Fear. Dread.
My feelings? Happiness over the end to at home learning mixed with mild irritation at not having managed to get both kids out the door on foot on time. And once I’d dropped them, an urgent need to get back home and away from the chaotic traffic.
Impatience bloomed. I decided to make a right turn from a side street onto the main road across two lanes of traffic, to get me home more quickly than a series of left turns would have. The car in front of me went during a break in traffic in the first lane and was let in by a driver in the second lane.
I could see the same driver in the second lane holding a space for me to cross. So, I went.
I don’t remember if I glanced to my right to check the first lane was still clear. But the moment I slammed on my brakes and a young man on a red motorcycle had to swerve to avoid me, is burnt into the pit of my stomach.
I am a careful driver. In over 25 years on the road I have never had a serious accident. I have never driven drunk or while under the influence of prescription medication or non prescription drugs. I don’t text and drive. I was not sleep deprived or sick that morning.
So why this serious error in judgement?
But there was more to it. While we have been in isolation, our worlds shrunk to our homes and occasional short car trips on empty roads, it has almost been like a lengthy period of hospitalisation.
I know from all the times I have discharged from hospital after weeks inside that just because I am out of hospital, my life doesn’t just snap back into place. I have to put the pieces of it carefully back together.
Re-entry into the world after isolation is the same. Our reflexes are slower. We are more vulnerable to chaos.
I am not nostalgic for isolation time. I don’t want to regress into the woolliness of those early iso days, drifting down deserted streets, staring perplexed at empty toilet paper shelves surrounded by people with harried expressions behaving as though the world was ending.
I will be very happy to never again step into the uncomfortable ill-fitting role of someone attempting to assist with my children’s at home learning.
But the jolt of re-entry has been a wake up call. A wake up call that I need to take the time to consciously reintegrate after this most bizarre episode of ‘home hospitalisation’. My brain and body need some adjustment time. My children’s brains and bodies need some adjustment time.
Perhaps the most poignant aspect of my near miss accident happened immediately afterwards. The young man on the motorbike pulled over and came up to my car. I wound down the window ready for, and feeling deserving of, his abuse and anger.
He didn’t abuse me or even swear.
He asked: ‘Did you not see me, because that was really close?’
All I could say was: ‘No, and I am so, so sorry. I am so sorry.’
I will never forget the young man’s face, his emotional intelligence and compassion in an adrenalin soaked moment. And I will never forget his parting words:
‘Be careful out there.’
We need to collectively ‘be careful out there’ as we re-integrate after isolation or we will misjudge situations and possibly make fatal errors.
The other lesson learnt the hard way by another member of the family this week (and one I doubt has anything to do with reintegration) was not to open a tube of superglue with your teeth.
I never considered my mental health as part of the decision to have a baby, because when I first fell pregnant within a month of trying, I had never experienced mental illness.
The pregnancy was uneventful.
Then I went into a thirty-three hour labour on two hours sleep. This severe sleep deprivation and the swirling hormone levels woke a slumbering monster, a genetic predisposition, which ensured that by the time my baby was one week old, psychosis had wrenched me away from reality. I found myself in the Special Care Unit of a private psychiatric hospital trying to explain my way out of my delusions, while my husband and mother cared for my daughter at home.
I am not home schooling my children at the moment.
That implies a level of competence that far exceeds my attempts to provide a bit of supervision while they do what could pass for some form of schoolwork.
In fact, what I am doing could no more be called ‘home schooling’ than calling what my children’s teacher does when they are at school, ‘veterinary surgery’.
The new educational arrangements have made me ask myself this over the last week:
Are there any professions (apart from teachers) who are being asked to convey how to do their whole job to the general public in a very short time, using only online resources? I can’t think of any.
Yet suddenly teachers are expected to translate their university degree and years of practical experience into a format that parents with no training or experience in education can apply to their unwitting children at home.
And there will be some parents who will anticipate the same results as when their kids are being taught at school by the teacher.
I accepted a long time ago that I have no interest in the intricacies of how my children’s education is delivered. And I am not expecting to suddenly become enthusiastic about it, just because external circumstances have changed.
I do care about my children’s education. But my role and the teacher’s role in providing that education are clearly defined and there is little overlap.
I view these as my roles:
To love my children unconditionally and make sure they know it. To set clear boundaries for them. I am privileged to be able to afford to feed them, clothe them, and buy their educational resources. To do my best to allow them a good night’s sleep in a room free of devices, during the school term. To offer them a decent breakfast and a packed lunch, or at least the ingredients to make them. To offer them support in completing homework or schoolwork set by their teacher.
And to make myself available for communication with their teachers at any time.
I regard teachers with awe for the job they do. I know from friends who are teachers the high levels of empathy, patience, resilience, and emotional intelligence, among many other skills, they draw on to do their work well.
I also respect my children’s teachers enough not to encroach on the territory of their expertise.
When I attend parent teacher interviews, I only tend to ask four questions:
‘Does my child seem mostly happy and engaged? Is their behaviour appropriate? Are there any areas they are falling behind in? And, Is there anything else you would like me to know?’
Do you know what I never ask about?
The curriculum. Because I trust the teacher to know it inside out.
I feel for the parents who ask in depth questions related to the curriculum during parent/teacher information sessions, because right now they may struggle with the concept that they can’t single handedly provide their child’s school education at home, no matter how much they research the curriculum.
From an epidemiology point of view, at the time of writing, I believe the best place for my children is at home. But at the same time, my care factor for the quality of my children’s academic education ranks way below how much I care for not only my mental health, but the collective mental health of my family.
I acknowledge that while the two cares might not be mutually exclusive for many households, in mine – they don’t always sit well together. I may be biased by my own life experience, but that experience tells me this:
If my children fall behind in the curriculum, I am confident they will eventually catch back up to where they each normally sit. And they won’t be alone in that experience.
Yet if I tried to deliver the full curriculum to my children at home, I would transfuse the stress of my unsuccessful attempts into them. Over time, their mental health would suffer. Mine might suffer to the point of me having to be hospitalised again.
It would make as much sense as my children’s teachers attempting to perform surgery on their dog with only my online instructions to guide them through.
So, the alternative of my children having to work harder to catch up when this is over feels fairly benign. And this doesn’t mean they are doing nothing now. It just means I don’t hold myself to the unattainable standard of replicating my children’s in school educational experience at home.
And I could be way off here, but I imagine whenever I eventually return my children to their formal school based education – their teachers may prefer those children with their mental health relatively intact and their academic knowledge lagging, rather than the other way around.
(Additional note: The veterinary surgery analogies were drawn from my experience of working as a small animal vet.)
Long before Covid-19 arrived, vets and vet nurses were quiet, hard workers who didn’t complain about less than ideal working conditions. And, possibly unbeknownst to most of the pet owning public, for many veterinary staff, challenging working conditions were the norm.
Since this crisis hit, these essential workers are not getting much opportunity or airtime to communicate the difficulties they currently face at work.
The advent of the Covid-19 pandemic has put the challenges of veterinary work on steroids.
I know a bit about what it takes to work in this industry.
I fell in love with veterinary work at fifteen, when I started volunteering at a local vet clinic. I wiped down tables, cleaned cages, and held animals. Then I started work as a casual junior vet nurse on Saturday mornings.
I committed the second half of my teenage years to the tunnel visioned hard work it took to get into veterinary science at university.
I worked as a small animal vet for twenty years, in many different practices in Australia and the UK. Working conditions ranged from excellent to atrocious.
Thanks to my experiences, I know this:
Vets don’t talk about their work stresses outside their own tightly knit vet circles. Some of us don’t even confide our struggles to our colleagues. We talk about our cases in detail for hours, but many of us still cringe at opening up about the state of our mental health.
Our clients get our kindness, our compassion our sympathy our skills our knowledge, our communication skills. But they never see our vulnerability. They don’t understand how high our risk of burn out (borne of caring too much and being overworked and undervalued) is.
They don’t see that when we walk through the door of the clinic our rostered working hours become irrelevant because we give ourselves over completely to everyone else who walks through that door after us.
Our clients don’t feel our pain when we lose yet another amazing member of our profession to its sky-high suicide rates.
I am currently taking a break from veterinary work while I concentrate on writing and mental health advocacy work. But I have many vet friends who are out there working and hurting.
I have spent the last couple of weeks collecting descriptions of work life from some of my (currently working) veterinary friends and contacts, because I believe that for the veterinary profession to survive this pandemic with its collective mental health relatively intact, the pet owning public needs to know about the difficulties its workers face at this time.
Here are some of the (summarised, paraphrased, and quoted) insights these vets generously shared with me:
On Covid-19 Regulations:
Some aspects of veterinary work make social distancing between staff impossible. For example, it is not feasible for a nurse giving a wriggly, excited puppy a cuddle and a vet looking in its ears with an otoscope, to be 1.5 metres apart.
Some of the protocols necessary to minimise the risk of Covid-19 transmission, such as contactless consultations (where the owner waits outside the clinic in their car, the pet is transported inside by a nurse in PPE, the vet examines the pet and then phones the owner to discuss further diagnostics or treatment), severely hamper efficiency and slow everything down.
Vets are used to working as efficiently as possible:
‘Normally I would type the history while the owner is in the consult and do an exam in between taking notes. Now I can only do one of these things at a time.’
Contactless consultations also limit a vet’s ability to read their client’s body language during the consultation, which can interfere with effective communication between vet and client.
Pets can be more anxious when separated from their owners. This may mean it takes longer to perform a physical exam, or it may be impossible to do as thoroughly as the vet would like.
Covid-19 level cleaning recommended between consults is more labour intensive and takes longer than usual.
Downsizing or closure of a practice due to further restrictions or a Covid-19 infection will have negative effects on the practice’s financial stability very quickly.
‘The nature of small to medium sized veterinary practices even in normal times is to run with incredible efficiency, but still on very low margins. They cannot sustain even mild to moderate downturns. They will not survive and jobs will be lost long before the drop of 30% revenue occurs required to be eligible for the Job Keeper Payment.’
Locum vets are particularly vulnerable to job loss now. As practices work to minimise the risk of a Covid-19 infection in their permanent staff, many locum vets are having their shifts cancelled, and are facing the financial difficulties and mental health challenges that come with job loss.
Vets are also more aware than ever of the financial constraints facing many of their clients.
‘It is super sad when you see a client who wants to do everything for their pet, but they have lost their job and can’t afford it. It breaks my heart. I am doing a surgery at a 25% discount tomorrow. The client didn’t ask for it, but I feel so sad for them.’
‘I feel even more conscious of the usual dilemma we have in vet practice of having to mix financial discussions with emotive ones as most people are understandably a lot more stretched financially right now. But veterinary practices are also under a lot more financial stress and if our invoices are not paid, there won’t be a vet for clients to take their animal to.’
And now more than ever vets are at risk of being on the receiving end of their clients’ financial frustrations.
‘I’ve already been abused in the car park once this week and I am preparing myself for a lot more of that to come as the stress is almost palpable in the air.’
On Mental Health
Vets often hold themselves to a very high standard. Under sub optimal working conditions that pressure will increase stress levels further.
‘Veterinary practice is already an emotionally draining vocation with highs and lows every day. Our staff feel responsible for their patients and care for our clients. And it goes against the grain to just drop our standards of care because of what’s going on. So, we are not going to start cutting corners.’
Many clinics have split their staff into two or more teams to reduce the chance of the whole clinic having to close if one staff member contracts Covid-19. This means vets and nurses may be working under short staffed conditions and even longer hours than usual:
‘The phones are ringing constantly. We hang up and pick up the next one. I am answering dozens of phone calls daily as a vet, as well as being my own anaesthetist, recovery nurse, and doing the usual vet things. And right now none of us have regular access to our stress relieving hobbies.’
Splitting staff into teams at work usually also means no contact between teams outside of work.
‘There were genuinely tears after the last ‘normal’ shift as people realised they may not see some of their friends for weeks, months even.’
Before Covid-19 brought added work stressors with it, vets were already at a high risk for mental ill health. This knowledge weighs heavily on many of us:
‘I’m concerned that abuse of controlled substances will increase and don’t even want to think about the suicide issue the veterinary industry already faces.’
Vets appreciate the many clients who are doing the things that make their work less stressful, such as practicing social distancing, being patient when things take longer than normal, and assessing what might constitute an essential phone call.
For example, now is not the time to phone your vet clinic for a lengthy discussion about which breed of cat you should get.
‘If the public can show extra understanding towards vets and vet nurses that will only be a good thing. We are not the only profession under strain but the pressures we are under are very real. Everything is taking longer so people need to be patient.’
‘We place a lot of blind faith in the honesty of strangers at the moment…I feel angry when I hear of my colleagues having got to the end of a consult only to have a client mention that they just came back from a cruise a week ago.’
‘Thankfully 99% of our clients are understanding and adhering to protocols without complaint, but I don’t think they quite understand how hard everything is for us right now.’
‘The shortage of equipment is tricky – no hand sanitiser, limited paper towels and gloves. It makes it hard to follow the guidelines to use hand sanitiser between every patient. Some human medications we use are in short supply, which will be hard to explain to clients when their pet’s medication needs to be stopped suddenly.’
‘We have also been asked to supply a list of things we can donate if needed – such as ventilators, propofol, midazolam, and surgical gowns and gloves.’
What is getting us through?
Now more than ever, humour, teamwork and appreciative clients balance out the challenges of veterinary work.
‘On the positive side of things, I work with a group of amazing humans and the way we all have each other’s backs has definitely shone even more so in recent times.’
‘On the upside we have always been good at the ‘make do and mend’ mentality. Also, we were born for this – we just need to pretend every person is a parvo puppy!’
(Parvovirus is a highly infectious, potentially fatal viral infection, most common in puppies, and requires full isolation nursing.)
‘Our team are amazing and have chosen to pull together with a plan to fight and minimise risks to client and staff safety, mitigate risk to the business and work toward sustainability.’
‘We have had wonderful support from our clients and community who have commended us for our initiatives during this pandemic to ensure both human and animal welfare,’
To conclude I will reach for words one of my close vet friends passed on to me. Even though upper management of veterinary practices, can be notoriously out of touch with the needs of its veterinary workers, this directive from the upper management of my friend’s practice encapsulates perfectly what I would want all vets working through this pandemic to hold close to each day, and what I would want all veterinary clients to be aware of and respect:
‘Throughout our career, veterinarians have always put our patients first, then our clients, then ourselves. In this pandemic, we must put our safety and the safety of our nurses and support staff first.’