Domino effect

The day-to-day difficulties that I face are, by and large, insignificant in the grand scheme of things and I often berate myself for fretting over trivia. However, giving myself a pep talk about retaining a sense of perspective doesn't necessarily keep anxiety at bay. And a succession of minor woes can, in fact, have the same negative effect - cumulatively - as a single, much larger one. 

Last month, my woes began when I took my car in for its MOT. In spite of a low mileage and a solid engine, I always expect some repairs to be needed; it is, after all, 18-years-old. What I didn't expect was that it would take seven trips to the garage to effect them.

The mechanic had to work through a number of possible fixes that took days to complete, so, every morning, I left the car with him and waited with bated breath for The Call. Would today be the day he'd finally resolve the issue, or would it take yet more work that might prove too costly to warrant keeping the car? 

The stress mounted, as I waited to find out whether I'd end the month with or without four wheels. A catalogue of mishaps and errors contrived to drag out the process: a critical piece of garage equipment broke; the supplier forgot to order a part; then, when the part finally arrived, it was damaged.

On visit No. 4, I decided to wait while he carried out the work. An hour and a half later, I'd put my back out from sitting in an awkward position to work at a table in the garage's reception. Within 48 hours, the pain was so bad that I could hardly move from kneeling to standing.

I began taking the strongest possible painkillers...which, within a further 48 hours, had triggered stomach problems. My back was so bad that I couldn't turn over in bed, and concern about my car vied with gnawing indigestion to keep me awake - the resulting insomnia didn't help the situation.

Eventually, two weeks of garage visits - and £500 - later, my car was patched up and back on the road, and my own 'repairs' were also well under way. 

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None of this was either life-threatening, or even permanently life-altering, and I'm certainly fortunate compared to many. Sometimes, though, reminding yourself that others are in a worse predicament is of no help. 

Katie Piper, who was the victim of an acid attack and who spoke at a conference I attended a few years ago, talked about this. Apparently people frequently preface conversations with her by saying 'Of course, my problems are nothing compared to what happened to you...' She always tells them that they shouldn't play down their own feelings and experiences, and she pointed out to us that there were plenty of people worse off than her.

There are times when life can get even the most optimistic person down: perhaps we just need to acknowledge that and be a bit kinder to ourselves when it happens.

Crisis point

While I'm no fan of the new Labour Party leader, Jeremy Corbyn, I was pleased to hear him raise the question of failing mental health services at his first Prime Minister's Questions (PMQs) last week. 

Mr Corbyn had taken the unusual step of inviting members of the public to tell him which issues they wanted him to bring up and more than 1,000 people raised concerns about mental health care. This seems to be an existing area of interest to Mr Corbyn, who attended an NHS mental health trust fundraiser on his first full day as Leader and appointed a Minister for Mental Health to his Shadow Cabinet.

One respondent apparently described the services in her area as being 'on their knees', echoing many of the participants in the BBC's recent mental health debate.

During this debate, a young woman who had suffered from anorexia nervosa told how she had contacted both her GP and local hospital when she weighed just 4 stone (25kg). However, she had been advised that her Body Mass Index* - weight-to-height ratio - needed to be lower before they could help her, ie she would have to lose yet more weight! By the time she finally secured treatment, she was just 3.5 stone (22kg). 

Another participant in the show had received the same 'advice', and recent research by the eating disorder charity, Beat, indicates that these are not isolated incidents. It's absolutely mind-boggling that this sort of thing happens at all. 

Imagine applying the same approach to physical ailments. If eczema covered 25% of a patient's body, would they be turned away until the proportion was 50%? Would medical staff allow conditions such as anaemia or an over-active thyroid to get wildly out of control before treating them?

People are often less sympathetic towards those with a mental, rather than physical, illness. No wonder, when the same disparity even appears to exist within the medical profession - or, at least, within its treatment protocols.

At PMQs, Prime Minister David Cameron admitted there were problems with some mental health services and agreed the Government could do more. However, he went on to say, 'We will not have a strong NHS unless we have a strong economy.' 

A key way to boost the economy is, of course, to get more people back into work - including those with mental health problems. For many, however, that won't happen without proper treatment.

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One comment during the BBC debate was that mental health care is in danger of becoming a 'crisis-only' service. For the sake not only of the individuals concerned, but also the country and its economy, the government must reverse this decline as a matter of urgency. 

We may be in a catch-22 situation, but surely we'll never be able to fix anything, until we fix the state of the nation's health?

*An index used to ascertain whether someone is under- or overweight, calculated by dividing their weight in kilograms by the square of their height in metres.

Loop the loop

While the exact cause of OCD has yet to be identified, studies by neuroscientists indicate that it may have a biological basis. The BBC's Horizon programme 'OCD: A Monster in my Mind' took a look at some recent research and I found one experiment particularly interesting.

Electrodes were placed on the hands of people both with and without the condition and mild electric shocks administered if they provided the incorrect response to images presented to them: one picture correlated to their left hand and the other their right, and they had to tap a panel with the corresponding foot.

After a while, the electrode was removed from one hand. Although participants were aware that they no longer needed to tap the matching foot to avoid a shock, those with OCD continued to do so. The explanations each of them gave later as to why they had carried on tapping were always along the lines of 'Just in case' and 'Because it seemed better to.' A clear parallel, therefore, with the 'reasoning' behind compulsions. 

Scans conducted during this experiment showed that, in those with the disorder, there was a higher level of activity in the region of the brain known as the basal ganglia. In this area, messages are sent backwards and forwards in a series of 'closed loops' and the hyperactivity noted in some of these is what makes it hard for sufferers to filter out certain thoughts.

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These loops are part of an evolutionary safety mechanism, related to looking for hidden dangers, but in OCD sufferers, there seems to be no natural stop to this. However, the programme introduced viewers to a technique called Deep Brain Stimulation (DBS), which it is claimed can provide some control.

We met a Dutch woman, Nanda, who was housebound by her obsessions and compulsions, even after 14 years of cognitive behaviour therapy (CBT), which is the recognised treatment for the condition. Such extreme cases, where all else has failed, are candidates for DBS in the Netherlands - the procedure is not available in the UK - where it has apparently brought relief to 60% of the 50 patients treated, with some going into complete remission.

This procedure involves implanting an electrode in the brain, which is hooked up to a battery pack stitched into the patient's chest. The pack allows the electrode to be 'tuned' to reduce the hyperactivity in the basal ganglia. Nanda felt an immediate reduction in her anxiety levels, although, at the close of the documentary, fine-tuning was still required to address her symptoms completely.

While her doctor hopes that this treatment could assist with other mental health conditions, at present the electrical stimulation affects a relatively large area of the brain and work is ongoing to find a way to target specific neurons.

Expert feedback to the show, on social media, indicated a high level of scepticism as to the efficacy of this very invasive, and potentially risky, treatment and commentators reiterated the fact that CBT delivers a successful outcome for most. The programme did acknowledge that the mind can change the way that the brain functions, without the need for extreme surgical intervention.

For me, the lasting image was of those never-ending brain loops. It seems some of us really are just wired differently!

Pros(e) and cons

Being a perfectionist renders decision-making extremely difficult and that was never more true than when I was working towards publication of my novel. 

Finalising the content was the first major dilemma. My writing group had raised many issues: from simple continuity errors to more subtle questions, such as whether a particular character should show more emotion.

Although I'd made a lot of revisions, I'd chosen to add some points to the 'I'm not sure about this' list that I'd begun following initial feedback from agents and other writing professionals. 

Ahead of every redraft, I reviewed this list and ummed and ahhed about which of the advice to adopt. Input from others can leave any writer confused; given my personality type, I felt as if I was drowning in a sea of uncertainty.

Submitting the final manuscript to the publishers wasn't the end of my tribulations. I still had to draft acknowledgements, an author biography and back cover 'blurb', and agree the cover design. I sought guidance from friends and fellow writers, which only led to more confusion, as conflicting advice streamed into my inbox.

Now that my novel is in print, of course, all of the decisions I made along the way - whether right or wrong - are irreversible. My problems still aren't over, however, as new challenges have emerged. 

Over the last few months, I've focussed on promoting my book and have quickly discovered that putting yourself out there means giving up a degree of control.

While I was gratified that one newspaper had run my press release word for word, I was dismayed to see that an advertisement had obliterated the last line of each column of the article; the flaw niggled at me for days.

Another piece was based on an interview and included some joky comments I'd made in passing that I thought made me sound silly. I realised that while you may not be able to influence how other people present you, you can - and should - monitor what you say in the first place.

Even participating in written author interviews has brought problems, in spite of the fact that I've had complete control over these. OCD sufferers tend to mull over, and worry, about things they've said, wondering, for example, whether they might have upset anybody.

And so I've agonised over my responses, especially to questions such as 'What advice would you give to new writers?' It feels as if I'm suddenly in a position of, if not power, at least responsibility, and I fear giving the wrong answer. In reality, there's no such thing - my writing experience is unique and personal to me. 

None of the publicity has been bad, however, and I'm grateful for all of it. Fortunately, it's early days in my media career and what I've learned so far is that I still have a lot to learn!

And my efforts are paying off, with 178 books sold via retailers in the first two weeks after release and 61 sold face to face to date - thank you to everyone who has supported me. Now that my novel has a readership, it makes all the struggles worthwhile.

You can read the feature here and the article - without the missing lines! - here.