Category: The Nitty Gritty

Self Caring When You Are Self Hating

No one ever told me that self hatred would be the thing that stopped me functioning. We talk about depression and anxiety, but their most powerful associate hides in us all. If you have too much of it self hatred is potent. Hating yourself can stop you from getting dressed, eating healthy foods and it can make you punish yourself. The truth is that if you completely loathe who you are it becomes impossible to live in between the lines and complete basic tasks.

The only weapon you can use in combat against self hatred, I’ve been told, is a compassionate approach. It sounds straight forward but if you are a sack full of self deprecation it is really difficult to face the world. By making an effort to self care you can stop yourself deteriorating physically and emotionally.  So you have to make yourself do things that might help- like having a bubble bath or going for a walk outside. You’ve got to do what it takes to make your body feel loved; even if your brain tells you that it isn’t deserved and you feel drained

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Self care can range from maintaining the basics of being alive (keeping yourself hydrated, fed and rested) to more creative methods (like putting on some nice moisturiser or buying yourself a treat). It can also mean doing things that simply need doing for the sake of your wellbeing- like tidying up, making phone calls or booking a GP appointment.

I’ve not mastered self care yet. Some days even doing something I really want to do feels painful. Sometimes I feel like I can’t be in my own skin. It doesn’t feel right treating myself nicely when my skin is crawling and I feel so disgusting. But it is a skill that I, and everyone else, should learn. So right now I’m going to try and look after myself until I feel a bit better. If you are feeling bad right now I challenge you to do the same.

A mouse sitting in a chair with her cup of tea and toenails painted. Copyright.

What things do you do to self care?

 Did Somebody Say DBT?

Recently I’ve been having assessments to see if I’d benefit from a therapy programme that uses DBT and Mindfulness. After many worksheets and conversations I have been put forward for a full programme. This means one skills group and one 1:1 session a week for about a year.

What is DBT?

Dialectical Behaviour Therapy is all about breaking down negative and destructive cycles and creating better ways of coping for yourself. It has foundations in Mindfulness and Cognitive Behavioural Therapy and allows people to develop a more in depth understanding of their negative thought and behaviour cycles. It involves practical skills of how to take action to avoid dangerous behaviour. It is also about helping you to accept your struggles as part of the make up of who you are, but not your whole definition.

The Assessments

What came over very strongly during the assessments was how much hard work DBT involves. It means two sessions, plus my CPN appointment and then homework on top- every week! From what I gather it seems the skills need to be practiced near constantly (even when they aren’t required) in order for them to develop into instinct at times of need. It’s about acknowledging the problems you have, why they may be valid, why they may not, and finding strategies to overcome them.

During the assessments I had to talk about some very difficult things that I find painful. The assessment is important because it ensures that you are suitable and will benefit from the therapy. I think the wonderful Ruby Etc. shows the trouble in seeking help from services perfectly in this diagram. In mental health services you are either ‘too mad’, ‘or not mad enough’. Luckily(?) for me during this assessment it appears I struck the middle ground.

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I’ve wanted for a while to include more help and advice on Upside Down Chronicles. I’d like to be able to share skills and strategies with others and enable people to try techniques for themselves. I know how hard it is to get the help from services, so maybe getting second hand skills from UDC might just help someone. Obviously I’ll be writing as a person experiencing the therapy- not as a therapist or expert myself.  I don’t know when there will be a space for me to start the course, but I am very excited to be finally offered some formal help.

If you want to have a look and a head start, the book the programme uses has been published online for free here.


School Refusal Is Far More Complex Than Just Truanting

On Thursday I was honoured to be asked to speak to a group of young people who, for one reason or another, are unable to attend school regularly. They meet in a brightly painted bungalow ominously named as home of ‘The Prevention Services’. There were five young people all facing very different issues to do with school- bullying, anger, frustration and fear being the main reasons for not regularly attending. This general anxiety surfaced in the form of long absences and sometimes exclusions.

Talking to the group was great. As someone who had a lot of trouble attending mainstream school because of intense anxiety I knew what I would have wanted to hear in their position. I told them that they may be terrified of school but they should never, ever, be terrified of learning. Hatred of school does not equal hatred of learning, and if you keep learning there is a way through the tangle of school refusal. I hope I was able to be of some use to them.

It was hard to imagine these bright, quirky and talkative young people not thriving in school. We talked about the problems in the school environment; it is too big, with too many people and holds too greater focus on discipline. One young person spoke about anger problems and how in mainstream teachers would rile up the situation more by using discipline rather than redirecting or calming down the rage. Since moving to a specialist unit this young person has access to these strategies and enjoys learning much more. Before the unit they had been excluded a dozen times. Not everyone’s anxiety showed through acting out and anger, for some it caused them to turn inwards- too scared to speak to anyone or walk through the gates.

The young people’s idea of an ideal school was surprisingly achievable. A more college-like setting where staff respected students and vice versa. They would want to be treated as individuals with different learning styles. The classes would be small and with more hands on practical learning. There would be more support because, to my surprise, some of the young people had made it to year 9 without knowing if there was any pastoral care in their school at all.

The project involves making an animated film in order to explain to professionals the miriad of reasons why a young person might not be attending school. This sounds like it couldn’t be more needed. We started styling objects out of plastercine. We made a foreboding looking school gate and a young person contributed a skull on a stick to place next to the gate. Across the table a young person made a plastercine noose. I saw how not attending school could be both a necessity and an agonising decision to make as they are intensely aware of the pressure it puts on their families. They feel immensely guilty and sad. At the end of the session taxis pulled up to take the young people back to their education providers. One young person who had pre-arranged to go home instead due to an injury went wide eyed:

“Is that taxi for me? I won’t go. I’m not going. I can’t.”

“They’ll kidnap me.”

School refusal and low attendance is not straight forward. These are not ‘bad kids’. They have anxiety, precarious home lives and aren’t equipped with strategies to get through. School adds steam to the pressure cooker. School refusal is far more complex than many would believe.

How To Fear Food Fight

 

Step One

Listen to your gut instinct. Not anxiety’s gut instinct. Yours. We’ve heard enough from anxiety. Is this food something you would like to eat? Have you eaten it before or want to try it? If you answered ‘yes’ move on to step two.

Step Two

Do it. Think no more.

… Okay, it isn’t quite as easy as that, but go for it. Find an accomplice to aid you in your tasty mission. Enjoy it. Don’t talk yourself out of it.

Step Three

By far the hardest. Do not let your mind fool you into believing this is a big deal. It isn’t. There will be things you regret in your life but in twenty, thirty, forty years time you will definitely not be regretting eating this. It will not play on your mind until your old age. The feelings you have now can be interpreted as anxiety… or excitement. You are rubbing anxiety’s face in the freedom you have found. And that is exciting. Either way this feeling is temporary. This will pass.

Distract yourself, listen to music or watch a film, read a book or go online. Do not waste a moment on anxious thoughts. If you find yourself getting anxious reread the previous paragraph.

Step Four

Later, record somewhere what you have achieved. Keep it and use it as evidence that anxiety is wrong. Nothing bad happened. Anxiety may have made you feel rubbish, but that is not the food’s fault! Your anxious reaction will get less and less if you keep fighting it. Keep challenging and gaining new territory from the anxious dictator and you will conquer. Some battles will be harder than others, but if you keep fighting you will come out on top.

Do Mental Health Awareness Days Actually Work?

Do they raise awareness or just give an opportunity to talk about how ill we are?

This year during a tsunami wave of Awareness Days for various mental health causes I found myself conflicted. As a blogger I feel almost obliged to write a summary of my story, list diagnoses and maybe share a selfie in aid of the cause. It’s what I’ve done previously along with many other bloggers, so why not this year?

This year I feel a bit sceptical over how much good some of the awareness campaigns are doing. In particular I think any social media campaigns on such days should be looked at carefully. I see a lot of people sharing their stories of mental illness in statuses and people who also suffer commenting on or sharing them. The mental health Twittersphere is enormous and very tight-knit. Sharing makes individuals with mental illness feel less alone, which is fantastic, but the message is not reaching far outside of the mental health community itself. Online communities are so important for supporting those with mental illness. On events like World Mental Health Day how do we spread the message to those who aren’t looking for it?

According to TV Licensing 68% of the UK usually eat their evening meal in front of the TV. I’m really disappointed to not see any major documentaries shown to mark World Mental Health Day. A documentary on a major channel during prime time that someone not clued up on mental health might catch on a whim, would be really effective. Assemblies in schools which all students, mental health savvy or not, have to sit through. Big public events that  a stressed or distressed passerby might stumble across. These are great examples of awareness raising events. It is so important that we target those who don’t already know about good mental health.

There seems to be confusion in distinguishing between ‘mental illness’ and ‘mental health’- with some even using the terms interchangeably. On a mental health awareness day surely we should be stressing the health. Mental health and illness are not the same thing, in fact they are opposites. On an awareness day of mental health we should ideally see more articles and posts about how people keep, or try to keep, mentally healthy. Messages of encouragement, things that helped during struggles, symptoms you might feel too ashamed to seek help for, resources, support services. There is, after all, much more to gain from learning how to be mentally healthy than sharing what happens when you are not.

On social media are we being a little bit self serving? And is that a bad thing? Several Mental health tweeters responded to my call for a discussion on whether these days actually do what they say on the tin. Some even find the days overwhelming due to the influx of mental illness/health posts.

@bordeline_OK: "I worry that any "x day" ends up highlighting difference, not improving parity of care/esteem, not destigmatising, not removing barriers."@OCPDme: "On this account, the tsunami of MH awareness tweets was overwhelming."

@gerbillady: "Maybe on social media it enables people with mental health difficulties feel less alone. Depends what you mean by work."@WhiteCaneGamer: "If it takes a million tweets just to help one person who needed it, then let the tweets fly."

@AshleyCurryOCD: "Overall does it make impacts on improving access to right help and support from local servicesI think @AshleyCurryOCD sums the situation up well. Does it make an impact on improving access to services? In most cases no. I think our attention needs to shift to this as a goal. We should push for mental health to be a subject everyone knows about and make sure there is help so that everyone can gain it. We should support those with mental illness and treat mental health with the same urgency as physical health. People should be able to share their stories whenever they need to. There should be a day for mental illness awareness and visibility for people to learn compassion towards people with mental health problems. Days for awareness of individual mental illnesses are a fantastic idea and they should be just as well supported as the bigger events. Mental health is so important, and how to gain it should be public knowledge.

I Know You Feel Down Right Now

But I promise that it is okay for you to feel like this. You don’t have to pull yourself together.

I know everything is too fast and you feel too slow. The world hurts you every time you leave your bed. You feel pain physically and mentally as you bound between every anxiety-made impossibility. You feel completely awful.

So I want to tell you something: it will get better. Even though it doesn’t feel like it now and it sounds like a cliche: this feeling will pass. You couldn’t feel any worse at the moment so the only way is up. I can’t tell you when or how your mood will shift, but it will. Remember that you have a 100% success rate of surviving every tough day life throws at you. You are a fighter.

Look after yourself. The more you care for your mind and body the quicker they will recover for you. It is like having a pulled muscle. Maybe you overdid it. There are ways to make the pain lessen and you will (at the very least) feel just a little bit better than you do now. Even if you think you will never heal completely because the depression is longterm, try to master the baby steps. I’m not going to tell you to do anything radical for a ‘cure’. I don’t want you to go vegan or meditate or ‘find yourself’ in a desert. I’m just going to tell you to fuel your body with good quality food. Even if you can only manage a little bit. Drink water or juice to flush out your brain. Even if you can’t leave the house, open your window, open the curtains and get some air.

Make yourself feel nice. Get in the bath and wash your hair, brush your teeth and all the other things that you do before you go out somewhere swanky. Don’t worry- you don’t have to actually go out. Just make yourself feel great in a clean pair of PJs with awesome smelling freshly-shampooed hair. Practice painting your nails or use really nice moisturiser. Make your body feel special.

Breathe. Dearest person please breathe. Every now and again count your breath, breathe longer out than you breathe in and pause for a second in between. Get music in your ears, happy and sad. Scribble in a notebook. Re-watch anything you fancy. You need to look after yourself right now. Do the things you wish you had time to do. Invest time in yourself.

Find a cuddle. Even if it is just with a blanket or a teddy. A pet or a person, get a hug. You feel numb right now but other people can still feel you. You are still with the rest of the world, no matter how much it feels like you aren’t.

You are never alone. So many from all over the world, past and present, have been where you are right now. Find them. Get on social media, read books and watch documentaries. People are out there. The internet is a fantastic resource and people going through similar experiences can provide amazing support for each other. There will be people in the same dark place as you and also people who have escaped it using methods that you don’t know about yet. Knowledge is power so learn from them. Don’t cut yourself out of the real world though, keep talking to your friends and family even if it feels like you have nothing to say. Tell someone you trust how you feel and you will find even the most unlikely people have suffered with mental ill-health.

I might not see your face or know your name but I care about you. I don’t know if you are like me: with the knowledge that you will to and fro between this place and a better one for the foreseeable, or if this is the first time that you have ever felt this way. Either way it is frightening. I can validate here and now that what you are feeling is really tough to deal with. I don’t know the details of your situation but I know you feel broken and it really hurts. You have survived every day in the past that you thought you couldn’t. I know that you can do it again today.

Moving Community Mental Health Team In Pursuit of Help

Moving across borders within the NHS is somewhat like going on a pilgrimage for treatment. Before you go you are promised that things are brighter on the other side: more resources, more funding and more staff. My voyage -from an area which didn’t have a pot to put pessimism in as far as mental health services are concerned- was tough. The new team didn’t pick my case up for over a month. The team I had moved from, clearly glad to see the back of me, didn’t send any notes over at all. They probably burnt them all in a bonfire to celebrate my departure. Frustratingly this means I haven’t received the findings from the psychological assessment which I waited six months to complete. Three hours of shaking and crying and no one seems to have bothered writing it up. Ho hum.

One thing I have discovered about moving is that community teams like to do their own thing. They trust their psychologists and their psychiatrists, so even if you come brandishing a 100 page assessment they will likely still want to conduct their own. I’m in a bigger team now, so thankfully the waiting times are shorter. I’ve also, for the first time since leaving CAMHS nearly a year ago, been granted a community psychiatric nurse- something that a staffing crisis caused short supply of in my original county.

So I have a community psychiatric nurse, or CPN. A CPN’s job is to work with you towards recovery or towards getting some form of therapy.  They know about medications and, hopefully, all the symptoms you experience. They are generally very useful people to have on your side.

When… Let’s call her *Sue… Turned up she had no knowledge of my background. No transfer notes and no discharge summaries- she didn’t even know that I had been out of children’s services and inpatient for six months. Nevertheless I was very glad to see her, with visits every fortnight and her specialism in mental health rather than social work she is the first mental health professional I’ve had regular appointments with since inpatient.

Being in a bigger NHS trust certainly has it’s benefits as there are more support groups and, though still not many, a lot more resources. Coming out of the first meeting with Sue I had a psychiatry and psychology referral- something which took an age to get in my old trust. Over the last few weeks I have been trying to get to know her as my CPN and tentatively hoping that the support won’t fall to pieces beneath me- a process I am too familiar with.

Obviously it is a drastic decision, one that is pretty hard to research, but if you are in a rural area and a smaller trust it might be worth looking into moving to a bigger area. You are playing with fire as if the area is too big and not split into separate teams the service might be swamped with high demand. It’s also worth remembering that you can ask for a referral to a suitable consultant anywhere in the country through your GP. If you live in or near a city I have found that they tend to have better resources with and without the involvement of NHS mental health services. Some have excellent services a like crisis cafes and support groups. Our NHS mental health resources are a postcode lottery, it needs to change.

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Mental Health Service Transitions – It’s No Fairytale

Cinderella finally felt like she was growing into her glass slippers. She had found her diagnosis, a psychiatrist who ‘got’ her and she was awaiting therapy. The beautiful recovery she dreamed of was on the horizon.

…But then…

The clock stuck twelve and before cinderella knew it she was different. She didn’t look it and she didn’t feel it, but according to everyone else she was. Cinderella had turned 18 years old and now legally an adult she was told to battle her illness alone. Her mental health team disappeared overnight- replaced with a harsher adult services team. They couldn’t see Cinders as regularly and had even longer waiting lists for therapy than CAMHS did. Things that she was encouraged to do in CAMHS she got angry letters about from adult services. Suddenly Cinderella was lost. She was just as ill as before the clock struck 12- she had the same symptoms and felt the same- but suddenly she had no help. She had to get a grip but she was slipping. She was now on her own.

This is the story that many young people find themselves protagonist to when they turn 18 within children’s mental health services. The handover to adult services can be baffling, abrupt and overall more harmful than helpful. As it is Children’s Mental Health Week I wanted to talk about this issue as not everyone has the happily ever after of walking away from CAMHS and never looking back. For those left in the system the transfer can make them feel lost and abandoned.

There is a growing campaign for an 18-25s transitional period between the two services. What a dedicated service in this area could achieve would be phenomenal. Young people could have their appointments grow slowly further apart to avoid sudden changes and subsequent feelings of abandonment. The responsibility in care could shift slowly to the young person when they are post-18. This transition stage could also be really valuable for learning necessary skills for adult life in a way that is conducive to mental wellbeing as a whole. In the transition young people could move care team one practitioner at a time- first key worker, then psychiatrist and therapists so that the process is gradual. A more in depth series of Care Plan Approach meetings could take place with both adults and children’s services to discuss what the young person found useful in CAMHS and how that can be carried over for the future. Medication could be altered during the transition by both psychiatrists. Particularly if a young person has been with CAMHS for quite some time the psychiatrist-patient relationship is infinitely valuable. Young people with mental health problems don’t all send out the same red flares therefore longstanding professionals who can smell the smoke make all the difference. Changes to medication should be made subtly and with respect to the young person and the lifestyle they need to uphold whilst dealing with possible side affects. Being 18 is stressful enough with exams and uni approaching and all the responsibilities that becoming an adult brings. It seems counterproductive and cruel to change an 18 year old’s care so dramatically at such a challenging age.

When I moved from Children’s to Adult care I found the difference in practice frightening and it led me to wanting to discharge myself from the service altogether. I was told that I was the only person that could make myself better and all carers were instructed to blank out my symptoms until I pulled myself together. Not only is this upsetting but it is dangerous. The work CAMHS had done to slowly build my trust in professionals was gone within a few dreadful meetings with the Community Mental Health Team. Young people turn 18 and drop out of the system, not because the system has cured them but because it has broken them too badly. This is not good enough.

Cinderella could have gone to A&E six hours before she became an adult with self injury and depression. As a seventeen year old she would likely have been admitted. Six hours after turning eighteen she would be sent home. Do we really believe that a magical chemistry takes place on an eighteenth birthday- rendering a child able to take on all their struggles alone? I don’t think so. It’s important that there is a true transitional phase so that this problem doesn’t occur in 25 year olds instead. It’s not that young people are not responsible- it’s that the difference in practice is so dramatic there is a canyon between the two providers.

Extra reading-

Emerging Practice: Examples of Mental Health Services for 16–25 year-olds

 

All About Restraint

What is restraint?

Restraint is a physical intervention to de-escalate a potentially dangerous situation and protect everyone who could possibly be involved. This includes protecting the person from endangering themselves or other people. A restraint is non-violent and should only be applied as a last resort. If it is applied violently or needlessly it is not restraint- it is assault. 

I will talk about restraint in the context I am most aware of- acute mental illness.

When is Restraint Necessary?

Restraint may be necessary if a person is an active risk to themselves or others. Depending on the situation different restraint techniques can be adopted. For example there are methods to disarm somebody with a weapon, prevent someone from kicking out and injuring surrounding persons or doing something to harm themselves. Techniques like talking, distraction and diversion should be used first.

Having someone restrain you is frightening. I’ve been there. The distress that could be caused by the restraint should be carefully weighed against the distress and harm that would be caused by not intervening. The intervention should be protection never punishment. 

Sometimes medication needs to be administered to a person in a restraint in order to end the need for force as quickly and easily as possible. Sometimes this is done through injection as it is unsafe for tablets to be forced into the mouth of a patient held in a restraint.

Charities like Mind have clear cut guidelines on restraint and are calling for an end to be brought to face down methods. This is the most dangerous kind of restraint as breathing can easily be inhibited.

NICE Guidelines State:

“Sometimes people with mental health problems may need to be controlled or restrained by staff when in hospital, or have treatment without their agreement (such as medication to calm them down quickly). This should be a last resort. If this happens to you, it should be done by trained staff, and preferably by staff you know and trust. They should act with your best interests at heart and will make sure you are safe while using minimum force.”

But aside from this there is very limited legislation on what is and isn’t allowed when it comes to physical restraint.

What is it like to be in a restraint?

I have been in a lot of restraints. They would happen when I lost control of myself and was endangering my life with self harm or suicide attempts in hospital. I’m lucky enough not to remember a lot of them, one good thing about my condition is the dissociative ‘brain blanks’. There is a point where you are suddenly not in control of anything anymore and there are people on top of you. Moving you and communicating between themselves in a language you don’t understand. Sometimes my response was anger to the sudden enslaught and other times it was relief. A restraint does rescue you from yourself when you aren’t safe to be in the driving seat anymore.

Sometimes on the ward a large beanbag patients named ‘fat boy’ was involved to stop kicking and flailing limbs. Sometimes restraint was traumatic- a group of staff you barely know coming into your room and pinning you to the floor feels like an attack however with the right staff I wouldn’t fight as much because it felt safe. I always knew during this time that my body was out of control. I wanted to hurt myself and I wanted them to let me get on with it because that was the only way I could see the situation getting better.

I’ve been in bad restraints. Ones where I’ve come away with black bruises on the tops of my feet or muscle strains from being pulled around. Restraint was common practice on my first unit, happening several times a day with some staff using it as a first response to any sign of trouble. Most of my restraints were justified by my dangerous behaviour towards myself, but there are many situations that could have ended much better with a calm chat and a hug. It’s these ones that stay with me.

Restraint being used too frequently, like in my case, is a bad thing. When I moved to another unit with a more appropriate attitude towards the practise I was confused. For six months I had become used to my inner battles being resolved by third party restraint. To be doing the same things as in my original unit but with no restraint from staff felt dangerous and scary. I went from being restrained sometimes multiple times a day to not being in restraint at all. It makes me realise how grateful I am to the good staff at my first unit for making clear that the restraints were a rather unpleasant strand of my treatment that I’d get through and that they wouldn’t let anything happen to me. I am increasingly thankful too for *Cheery Lodge, because if I had been discharged straight from *Heron into the community I would have without a doubt died from the sudden lack of protection from my mind’s demands for danger.

Over time I’ve become a master in restraint myself. I can’t pin myself to the floor but I’ve learnt how to talk myself down; how to de-escalate situations and how to compromise with my mind. My body was being overrun by my mind, it was doing what the literal ‘head office’ told it to do by hitting the destruct button. That girl who was thrashing around on the floor is still there some days, but her body restrains her now. My body, brain and I keep the thrashing internal. Some days it’s harder than others. I suppose we all have to learn how to restrain ourselves one way or another.

A year ago today I moved unit via secure ambulance to *Cheery Lodge. I cannot thank the people there enough for giving me a base and support. Recently a member of staff from the unit I was moved from a year ago was suspended for misuse of restraint. More about my (surprisingly hilarious) transfer can be read here.

Mental Illness and The Goodreads Choice Awards

Recently I was checking out the results of the Goodreads 2015 choice awards and something caught my attention. In the category of Young Adult Fiction there was something a bit ‘samey’ about the books on show. On closer investigation eight of twenty books had mental illness/suicide centric to the plot. In short- If you are a fictional character in the Goodreads Choice YA Awards there is about 40% chance you are mentally ill.

One part of me chirrups: “This surely must mean young people are more accepting !”. But then the cynic in me groans that this of course depends heavily on how accurate the portrayal of mental illness is in the books. I’ve read stories where the serial killers are mentally ill and it is just a plot device to make them appear all the more threatening- like mental illness is an exotic spice to throw into an otherwise unappetising dish. These young adult titles aren’t like that though. The mentally ill characters are the ‘goodies’ of the tale; the protagonists, the much loved family members. So are we now seeing mental illness as an appealing character trait? If so there are many who haven’t heard the news.

I think we need to talk about the very real threat of mental illness becoming ‘cool’ amongst young people. We are getting there with raising awareness of the problem but we should also bear in mind how we could put more effort into profiling a solution. Wellbeing. Looking after yourself, positive thinking, healthy lifestyles. They don’t ‘stop’ mental illness striking but they can give you stronger armour against it. Alas, teens who make sure they get enough sleep and have a good work-life balance do not make very interesting narratives to follow; but perhaps the amount of mental illness in these titles indicate we have a problem emerging.

I know of schools that have a self harm epidemic on their hands; where young people are injuring themselves for means other than their own emotional release. In some classes it spreads through friendship groups as a trend or a badge of honour. It’s risky for all involved and it’s often the people that leave their wounds hidden behind jumpers and their mouths shut that need to be reached out to the most. What we don’t know is whether these books are so popular because teenagers are idolising mental illness or because, perhaps more worryingly, they see themselves in the ill characters.

Are characters with mental illness deeper and more mysterious than ones without? In the real world I don’t think this could be further from the truth. There is nothing ‘mysterious’ about me sobbing, or ‘deep’ about medication knocking me out every night. I haven’t read the books so cannot critique the portrayals but the prevalence of mental illness in the list struck me. It can’t be coincidence. Is it awareness or glorification? Where is the line between the two? Does mental illness guarantee a juicy plotline?

If you are interested in reading a book with an accurate portrayal of living with a mental health condition I would fully recommend Holly Bourne’s ‘Am I Normal Yet?’. It is to date the best book I have been able to find showing what it is really like to live with OCD. I’m hoping to read the eight books on the list to see if I can work out why ugly mental illness might be so popular.