Dangerous Thinking

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This is the blog of Dr Iain Bourne, specialist trainer in crisis mental health. It represents no more than occasional, random and personal reflections on all issues on violence, suicde, self-harm, psychosis and trauma – and life! I hope you (friends, colleagues, course participants, clients and people I may never meet) may find the time to contrtibute.

Being Different in Different Places

I’m in Belfast again. In  fact I am in Bristol Airport so often that other travellers are beginning to recognise and talk to me! This time I was stuck in a “Speedy Boarding” Easyjet queue that was slower than the “Slow” queue. I suddenly was aware that my bag was vibrating and had to dis-assemble my whole violence bag – full of weapons and blood soaked clothes to switch off my electric toothbrush – in full public view. Airport security saw nothing – but seemed very interested in selling an elderly, confused person their unique plastic bag for£1.00 – just in case she was about to set up an elaborate chemical laboratory in in the toilet and send us all to kingdom come!

I can recognise that I am about to rant, so I’ll stop now before I become the worst version of angry old man!

Till later!

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The blood is boiling …

Despite my violent antics during training courses and my more mysterious side – I am now genuinely on the warpath! I’m in Trowbridge and although its hot here – the group I’m working with are a pleasant and genuine group of people – it has nothing to do with them. Someone, however,  has crossed me tonight – a bully – and I am on the warpath!

I can feel my fingers tingling, and I know I won’t sleep tonight. Goodness knows what state I’ll be in by tommorrow morning.  Unfortunately (or fortunately – however you see it) I can’t get to this person (people) right now as I’m not in Bristol. I have, however, called them and told them that I’m on my way and I’ll call on them tommorrow when I get back.

While I feel like letting rip, I think the COLD approach may be more effective. These days I tend to scream and shout a lot, causing a lot of fear and flurry. But I recall when I ran St. Elizabeth’s – no one could ever recall me screaming or shouting, but many recalled the coldness of my anger.

It was, as it is now (with my training) all an act.

But now it’s for real and it’s not the time for ranting – that’s what they’re expecting. Instead I’ll let them squirm – say little and stare a lot – and when they’ve backed themselves into a corner, I’ll go for the kill! These guys are way out of their depth!

Listen to me – Gangsta Bourne! Well may be I’m a bit of a scaredy cat – but I they don’t know that and I think I’m a far better actor than them – and this is my business!

And actually, I am angrier and more upset right now than I can recall for a long time.

It leads me on to who could be in danger. No-one, other than those involved,  so most of you are safe. But if someone crossed my path and wouldn’t back of, there might be a war. I think about being in Belfast – most people, even during the Troubles – were probably safer there than they would be in most parts of the UK.  But if you were in the wrong place at the wrong time …

When I go to war – sorry – looking for reconcilliation – tommorrow night, it has to be tactical. I also need to know what I require to withdraw. I can be silent and menacing, but they have to have let out too.

You can catch up with this thrilling next installment – if I’m still alive – tomorrow!

Personally, I hate this stuff, I hate the feeling that hangs around, and I just wish this stuff didn’t have to happen. It’s my business – violence – but but I wish it’d stop and people  could just be left alone to get on with their lives.

Filed under: General, Violence, , , , , , , ,

Being in a Queue

I’m in Belfast again. In  fact I am in Bristol Airport so often that other travellers are beginning to recognise and talk to me! This time I was stuck in a “Speedy Boarding” Easyjet queue that was slower than the “Slow” queue. I suddenly was aware that my bag was vibrating and carefully started to investigate – acutely aware that the same bag mostly contained various weapons and blood-soaked clothes. A blood-stained knife fell out in the process of turning off my electric toothbrush. Smiling profusely and trying not to sound too Iranian I apologised and pushed everything back into my bag (which actually also has bloodstains on the outside).

The man behind me in the queue then starts talkling to me about the length of the queue! He clearly thinks that the knife is not an obvious topic of conversation but that we are kindred spirits because we have a mutual waiting experience.

Actually,  he was South African, as is my mother. So we had a good discussion about SA. It moved onto sport and I realised I had torn loyalties. I am British, but if it comes to supporting England or Scoitland it will always be Scotland (my dad was Scottish) – but actually I probably have more South African blood than anything else. The Lions are in SA right now, but I want them to win. Yet if the Springboks came here – I think I would want them to win … unless they were the favourites in  which case everything changes.

I have a strong feeling about all of this – its just that I don’t know what it is!

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Where am I? A confession.

Okay so these reflections are becoming increasingly infrequent. Somehow it makes me think of a young man called Farouk. I met him on my way to Syria and onto Iraq. He was one of our group of travellers – Hosein, Rebwa, Farouk and myself. Farouk was very quiet and Hosein (a psychotherapist at the Maudsley’s Traumatic Stress Clinic) told me he had suffered terrible traumas both in Kurdistan and on his exile. He was returning home. He told me that he had been studying for some years, I think, at London University but still had to complete his Master’s thesis. When I asked why, he told me that although he was nearing it, he hadn’t yet found an appropriate dialectic. My honest (thankfully unexpressed!) reaction was “For goodness sake just do it and then get on with your life.” I had a similar reaction when my partner was doing her doctorate and more recently when my younger son was struggling to write up his thesis. I like to think I have an ability to look at the bigger picture – “this thesis (or whatever) is not your life, it’s the membership card to live your life!” But for Rebwa it was his life – an opportunity to successfully say in his own words, in the way he wanted to say it – what he had learned. My partner and son also, I think sought for an ideal against my cynical pragmatism – and better people for that. Actually, I am no better/worse – however you look at it. I could have written books on “Difficult, Disturbing and Dangerous Behaviour” several times over, but like Rebwa, this book would have to be the book of my life – and may be for that, I will never find the appropriate “dialectic.” This has become a bit of a confessional – and I had better stop before it all spills out! Do you know where I am? I am in Maynooth, County Kildare, Ireland. I am in a suite of rooms reserved for very important priest-like people – not for the likes of Travelodgers like me! At this very moment, in the most important theological college in Ireland, the biggest child abuse scandal in history is being discussed by the Catholic Church. This scandal is about “do what I say, not what I do.” Well actually, a lot more than that! – but I needed something snappy to sign off with – blow!

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Milton Keynes – part two

Well I woke up this morning in MK and the sun was out. So I set off following my gridlike map. It is a compleetely surreal experience. You never see more than four people at any one time and they are always walking at right angles to one another – and always at the same calm, but business-like pace. No slouching, no running – and they are all smartly dressed. At first I thought that this was SimWorld, then I started thinking about the Stepford Wives. I believe I am really good with maps and directions, but its incredible how quickly I got lost. The trouble is there are no landmarks and if you turn around, you can’t be sure that you’re still walking in the same direction – a bit like walking in a desert. Spookier still, the first set of people I asked directions from were a group of young people from the YMCA – the place I was trying to get to. They apparently thought I might be the new securuty guy! Further along a car stopped by me and asked if I was going to the training and immediately gave me directions. How did he know who I was – do I look like a trainer as well as a security guy – are there no other courses happening in MK? At this point, I decided that I was in the Truman Show!

It’s very leafy and in some ways I quite like its slowness, space, and other-worldliness. It reminds me of small town provincial USA. The group were not at all Stepfordwivian – but I still don’t know what you call a person who comes from MK!

Filed under: General,

How do you interpret behaviour?

The events below happened earlier this year, I’ve delayed pubilication as I wouldn’t want anyone to know the identities of the key players (other than myself – doh!)

We all consciously, but mostly unconsciously observe or notice things about others. Mostly it’s a casual observation but what if it’s not? You can say it’s their business, or give some polite feedback.

Well here’s a situation – I’m delivering a course on Dangerous Behaviour and a young female participant immediately announces that “no-one will get anywhere near me- believe me!” I interpret this as meaning “don’t mess with me.” Participants point out that if you get get on a tube (London Underground) you can’t avoid physical contact – yet she defiantly asserts “Believe me! It won’t happen.” Paradoxically she seems to be drawing everyone’s attention to a no-go area.

This is a training course, not group therapy, so I’d be happy to let it go. However, she pointedly looks out of the window, huffs and puffs, looks at her finger nails and storms out as soon as each session ends. Curiously, she always returns almost exactly two minutes after each session begins.

I experience some pressure because she is exhibiting difficult behaviour – and I’m supposed to be the expert, but I don’t want to humiliate her in front of her colleagues and yet she is always unavailable during the breaks.

I don’t work for this organisation, but I am torn. Whatever this woman’s issues, I have concerns for anyone who might depend upon her – her own children, clients – and for her. Do I walk away and say nothing? But I don’t know what I am dealing with and am I acting inappropriately?

Cowardly I said nothing all day. Yet I sensed that I was walking on egg-shells all day long – because of my uncertainty. At the end I thought it was one of my worst courses.

As she left, she did say “thank you” which surprised me. Afterwards I sheepishly asked the Training Organiser is there had been particularly negative course evaluations. To my astonishment, this woman, who many people in the department felt was “difficult” – thought that the course was “brilliant!”

I am not trying to blow my own trumpet. My first concern is that although this woman may be my advocate, and I should be grateful, she is also a support worker – and quite frankly, if I had any need for help, she would be the last person I would want anywhere near me. Given her employers cannot be unaware of the problem – what is my responsibility during and after a training event – to her, the training group, the organisation, her clients … and cowardly, myself?

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Milton Keynes

I’ve been all over the world, but for tonight, for the first time – and I have no idea what to make oif it! Up until this evening I have been dependent on the views of others – which have always been highly polarised. Some seem to love it, others hate it. Now I understand that the area in question is what I am going to call Gridland – as opposed to the nearby areas.

Actually, its nowhere near as bad as I thought it would be – a bit like a leafy out of town retail park. I’m staying in the Central Travel Lodge which is exactly like every other Travel Lodge worldwide – which is fine. So I went out for a meal and avoiding my tendency to walk around for hours before picking the worst place in town to eat – I walked into the first place I could find “The Silk Road Restaurant.” Hmmm – a culinary and cultural confusion. Clearly an Indian/Bengali restaurant that wants to satisfy everyone – so they also do Thai, Chinese and Japanese food as well. I decided to play safe, and as I wasn’t starving went for the Biryiani. I was warned that it was very mild – actually it was more like rice pudding! Is this Compromise City or am I going down the wrong track?

What do you call a person from Milton Keynes – a Keynsian – sounds like an economist – a Miltonian – reminds me of cleaning babies bottoms . I should discuss this with my wife – she’s an expert on “Identity.” I have nowhere near enough evidence to understand the complexities of this place.

Tomorrow I may learn more. There must be some young people here as I will be working for the MKYMCA – are they Stepford Kids, the Kids from Hell, or just like kids everywhere else. I suspect the later – but wouldn’t it be exciting to discover that I’ve just entered the twilight zone?

Watch this space!

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St…St..Stuttering Suicide Statistics

Sorry folks – I’ve not blogged for a while. Since moving sites I’ve been wondering what its all about – and then I was listening to a famous author (so famous that all I remember was  being told she was famous) saying that we all have loads of incredible ideas in our heads, but the only way to be a writer – is to write! So, though there appears to be little in my head right now, I thought I’d experiment – and just write!

The one thing that does readily spring to mind is a recent posting on the IMPACT News site (www.dangerousbehaviour.wordpress.com) by Dr Keith Hawton regarding Suicide Rates. I met Keith many years ago and he was a really nice man. Clearly he is seen as the foremost expert in the UK on suicide and self-harm. My only gripe is that while he is very solid and careful, he rarely breaks new ground – his work is very conservative.

And reliable. So when I read his latest piece (see IMPACT News) I was dismayed. I have been trying for some time to sort out the mess of suicide statistics – only to find that reliable Doc Hawton offers us a completely different and contradictory set! I’ve been spun into a whirlwind of panic and confusion. However, after I settled down, I am begining to see some hope. Keith says that suicide is the 9th most common cause of death – I have always been told that it is the most common for men and third more common for women. Astonishingly he proclaims that the unemployed are no more likely to kill themselves than the rest of the population – I thought that the evidence was overwhelming!

But this is where statistics can make you go crazy. Are we talking world-wide, Uk, Europe? Are we talking all age groups, or a specific age group? Are we including all deaths or premature deaths? Are we talking about statistics based on death certificates, or research? Its a minefield!

I remember as an undergraduate reading a book called (I think) “How to lie with statistics” – how apt! None the less if you avoid the specific quarrels – it is true that the suicide statistics do reveal a great deal about the underlying forces/ingredients that culminate in a suicidal act.

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Fight, Flight, Freeze?

A large part of responding to highly charged and potentially very frightening and dangerous situations lies in our ability or otherwise to harness our body’s emergency systems. Failure to do so can lead to either panic, tonic immobility, or unchannelled and uncontrolled reactions. Coloquially we often talk about Fight, Flight or Freeze Responses as an potentialy inevitable and unavoidable outcomes.

However, if we look at what ethologists have found, it would seem that the picture is somewhat different and more complex. In the first instance it appears that the order is wrong. The first autonomic reaction is not Fight, but Freeze, then Flight and then Fight. Well, I hear you say, “how are Flight or Flight possible when you are already in a Freeze state?” The answer seems to be that what we colloquially refer to as Freeze is actually something else altogether – Fright, or tonic imobility, the body shutting down and becoming rigid.

What ethologists call Freeze is actually a state of heightened awareness or hyper-vigilence where the body temporaily “freezes” while information about the threat is gathered – a state of heightened awareness and readiness, rather than immobility. The normal reaction following is that of  Flight – and Fight only takes places when Flight is not an option (note, that with humans, pride and other psychological processes may prevent flight).  However, if fight is also not a realistic option, then Fright or tonic immobility sets in.  Finally Faint becomes the last option.

Faint,  however, occurs under situations of prolonged duress and refers  to situations where the pain or horror becomes so overwhelming that the brain disconnects as an act of survival. Distancing, blunting, avoidance, denial, pretence – dissociative processes.

So what we call Freeze, is actually Fright and our primary instinct is not Fight or Freeze/Fright but Flight (get me outta here). These reactions appear to be spontaneous and autonomic – and out of our control. DDDB training, however, is based not on cortical thinking, but limbic processing – and suddenly it becomes clear that the protocol must be about managing oneself rather than the aggressor. The skill has to be about managing internal processes in micro-seconds.

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Well I’m in Nottingham at the moment delivering a course on Suicide & Self-harm – Razor’s Edge! Coincidentally as I was about to start the group I received an e-mail (see www.dangerousbehaviour.wordpress.com) about the threefold increase in young people contacting ChlidLine feeling suicidal. Obviously this may be a reflection of ChildLine’s success in connecting with some of our most disenfranchised and desperate young people – but you can’t help feeling that things aren’t getting better. Yet all the other statistics tell us that suicide rates are declining across all age groups (only exception being women over 75) in the UK. So what’s going on?

Well, I think the first thing is not to be blinded by figures and to understand what they mean. Probably both Childline and the official statistics are roughly right even though they seem contradictory. Suicide rates are about death rates/fatalities. Feeling suicidal is not the same as being suicidal. So we are looking at two different things.

Blimey! As I’m writing this, in my hotel room, with the TV news in the background – I’m hearing the same thing – that ChildLine (East Midlands) is reporting a “two-fold” increase in young suicidal callers and that four out of five callers are female! Synchronicity! Well the pieces are beginning to fall into place. The suicide rate among young people 15-24 is 5:1 male:female in England and Wales, yet all indicators suggest that young women in this age group attempt rather than complete suicide acts twice as often as young men.

Now clearly people who eventually kill themselves have usually made multiple attempts before they die – so all signs have to be taken seriously. However, at any one moment in time, feeling suicidal is not the same as having decided to die. Youth suicides are exceptionally tragic, but they are not the most at risk groups in the UK. For women the suicide rates go up with age and accelerate in the over 75s – sorry if your a woman reading this, it’s just bad news! For men, there are peaks and troughs – despite the publicly held view that adolescents are most at risk the figures tell us something else – it’s the 25-34 years olds, then if you survive that, the over 85s. Well all that’s a bit debatable – but interestingly women are least likely to die following a suicide attempt between the ages of 15-24, but most likely to make a suicide attempt at that same time. It comes back to what I was trying to say – they are not the same thing.

Obviously, one can and often does lead to the other. One could interpret the Childline figures as hopeful rather than despairing. These young people know where to go with their problems, they have some hope that someone could help them, they have not given up, they realise that their situation is desperate. Obviously if all that is thwarted they could cross from feeling suicidal to being suicidal. This group, however, tend not to call Childline, the Samaritans or anyone else – they feel alienated and hopeless (can’t conceive of anything ever getting better). They may have had multiple run-ins with the mental health system and lost faith with it – they are further down the line.

Well I could go on, but what am I saying? Clearly young people need to be listened to and many are having a real hard time. Things are likely to get worse in the near future as the recession hits leading to fewer prospects and potentially greater parental discord. Childline is clearly an essential service, but don’t let that deflect us from the fact that it is the children who don’t contact Childline that are most at risk, and that there are virtually no services for the adult suicidal population. It’s the tragedy of our times that the suicide death rate doubles that of deaths on the road (RTAs).

And I’m worrying about bricks hitting my car – sorry I haven’t told you about that – but pales into insignificance!

Filed under: Self-Harm, Suicide, , , ,