HIV Transmission: No “Good AIDS/Bad AIDS”, just people

HIV-TestingAs a newly appointed HIV psychologist, I’ve been taking some time to better inform myself. I’ve been reading NAM’s Living with HIV and this in itself has provided an opportunity to examine societal (and my own) prejudices. I notice my own resistance to reading the book on the bus. Will people assume I have HIV? Will they assume I’m promiscuous or a drug-user? As a young white woman, perhaps I’ll engender pity, probably the victim of an assault or an infected blood transfusion? Why does it matter to me if people make these assumptions?

As we come to the end of HIV testing week and prepare for World AIDS Day (1st December) HIV is very much in the media. An article interviewing Silvia Petretti of Positively UK really stood out to me

“How did you catch HIV?

I find this question very judgmental. Whether I say that I got HIV by selling sex, injecting drugs, from my husband or my mother in the womb, this puts me in a category.  Either I’m an innocent victim or somebody reckless, who got what they deserved – as the coverage around Charlie Sheen seemed to suggest. It’s the reason so many women living with HIV shy away from the media. It doesn’t matter how I got HIV. It matters how I live with it.”

To me, this quote gets to the heart of our attitudes towards HIV. When we find out someone has HIV we want to know WHY. We associate HIV with sex and sex always gets our attention. Perhaps this curiosity is born out a society that devours salacious celebrity gossip and online rumours, but often there seems to be a darker side to it. Underlying the question is a sense of placing blame. Who is at fault? How did they allow themselves to be infected?

But do we really have a right to know someone’s transmission story?

Although certain groups are at greater risk of HIV, sometimes people just get it and it’s hard to pin it down to something they did or didn’t do. Many people have the virus and don’t know their status and with a late diagnosis it becomes increasing difficult to establish how it was transmitted. Many people living with HIV don’t know how they contracted it, and have to live with this uncertainty.

If a gay man contracts HIV is it easier for us to condemn his sexuality and “irresponsibility” rather than try to understand and relate to his experiences? Perhaps it is easier for us to cope with the possibility that any one of us could catch HIV, by thinking that it only happens to “bad” people.

Petretti mentions the media coverage of Charlie Sheen’s disclosure of his HIV status, which falls a bit too close to the BrassEye’s satirical sketch on “Good Aids/Bad Aids”. In the mock-documentary Chris Morris admonishes a gay man for having “bad AIDS”, the kind that’s your fault for getting.

NB – This is a very dark comedy and could potentially be offensive or triggering. 

 

Sheen’s disclosure could be a turning point in attitudes towards HIV – an image of a public figure living well with the virus. For many their image of someone with HIV was born out of 80s campaigns and they view HIV very much as a death-sentence. Many people don’t know that with good treatment adherence, viral load can be undetectable (meaning that you can’t pass the virus on, even if you have unprotected sex) and life expectancy is only a little less than that of the general population. Media has instead focused on his lifestyle, making assumptions about how he contracted the disease. With good treatment, many people’s immune system is supported so they don’t go to develop the infections associated with AIDS. In many ways, people can live ordinary lives, aside from regular medication and review appointments.

Charlie Sheen

Charlie Sheen, the most recent celebrity to speak openly about his HIV positive status

This early newsreel from 1982 is particularly moving, released before HIV was really known about. It describes a form of “cancer” that seems to be affecting gay men. This is before HIV-stigma set in and it was seen as an illness rather than a judgement on someone’s life choices.  As our understanding of the virus has increased, so too have stigmatising attitudes that criticise and exclude.

We have no right to know how people contract HIV, that is their own story to share as they see fit. Condemnation and pity are both unhelpful responses. Attitudes towards HIV limit people from getting tested and disclosing their status, which increases the risk of transmission. Although HIV is often transmitted through sexual contact, in many ways it is comparable to other infectious diseases. It’s a long-term condition and if treated appropriately, it should enable the person to live a “normal” life and not endanger any other person. There is no “good” or “bad” AIDS, no more or less deserving. When we can detach ourselves from our seedy fascination with knowing the hows and the whys, we can allow ourselves to take a step back from our ingrained prejudices. Then we can really see the person.

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Being a Healthcare Assistant : Value & Experience

The term ‘healthcare assistant’ (HCA), ‘support worker’, nursing assistant and ‘care worker’ (and others) are used to describe staff would work to meet the care needs of patients in health and social care settings such as hospitals and residential homes. The job does not usually require a qualification and involves tasks such as assisting with washing, dressing, toileting and feeding, as well as sometimes engaging in other activities and daily tasks with service-users. It’s not a well-paid job, the hours are long and the work often tiring and repetitive  Sometimes agencies may provide staff, meaning that different staff will work in a setting each day, although many sites also have permanent staff.

Is this people’s image of care workers? Image from Parliament.uk

Care-workers have had some bad press in recent years. Winterbourne View shed some light on how staff caring for vulnerable adults are often lacking in training and supervision, and how in some cases these enables abuse to go undetected. Following the Stafford Inquiry, it was recommended that nurses spend additional time working as healthcare assistants to help them to be more compassionate and in touch with the ‘fundamentals of patient care’. Nurses have been very critical of this proposal but personally, I think all staff in healthcare would benefit from spending some time working ‘on the front-line’. Working in this kind of role can give you a greater understanding of the needs of the patients and a sense of the work of the people who provide the majority of the care for our country’s most disabled, unwell and vulnerable.

My first job out of university was was a healthcare assistant at a private hospital for adults with long-term and severe mental health problems, often with additional physical health needs and ‘challenging behaviour’. I was bright-eyed and interested in mental health, but I don’t think I had a clue about what the job might involve. I’d never cared for someone else before, unless you count babysitting and tending to hungover friends. It wasn’t long into my first day that I was filled with an over-powering urge to leave and never return. The building was over warm and was filled with a strong smell of cleaning product not quite masking that of human waste. I could hear yelling and residents walked the corridor slowly, giving me unnerving stares. The prospect of helping an aggressive man change his incontinence pad was somewhat terrifying.

The work was eye-opening and exhausting. I didn’t always like working there, but I still could my time at the hospital as one of my most valuable working experiences, and it has really shaped my perspective and professional identity today.

Getting to really know people. When you spend all day with someone, from helping them get out of bed and get washed, right through to the end of the day, you get a sense of their life that just isn’t possible in a once weekly session. I enjoyed the times I had a chance to sit and talk to residents about their lives, or to do activities with them. I liked the continuity I had with people, that I could get to know them, and them me. It was frustrating when other professionals would come in and talk as if they really know someone, when they’d barely spent any time with them.

Disgust, dignity and disability. As far as a first job went, there was far more contact with bodily fluids than I was expecting. But I think it significantly raised my threshold for disgust. It stopped really bothering me. And I hope that if I need it, there’s someone around to help clean me up too! What I found far harder was having so much exposure to how disabled and narrow the lives of the residents could be. Often there wasn’t a plan for residents to get better or leave, and many had deteriorating conditions such as dementia. One of the worst jobs I had was assisting a woman with Huntington’s who was progressively losing control of the muscles of her body, to smoke a cigarette. She wasn’t really able to suck and inhale, so she had the cigarette attached to a tube-like device, the inside of which was  coated in a black tarry substance, saliva and dirt from where she had dropped it. This device frustrated her, so she’d try and hold the cigarette, but her fingers were too weak and she’d drop it, burning herself. When I tried to take the cigarette and return it to the tube she’d yell and swipe at me. She was slowly dying but all she wanted was a smoke, and my job was to help her do it. It felt really harrowing, and it made me think about how small all of the things in my life that bother me are.

Lack of support. I had very little relevant experience, other than a psychology degree (which doesn’t prepare you much for working with a real-life person) and I received minimal training. I had a few days learning how to restrain someone and other staff quickly showed me how to wash, feed and transfer particular residents. And then they left me to it. Getting everyone out of bed, washed and breakfasted took me pretty much up to lunch, when it was almost time to start all over again. Nurses tended to stick in the office or the pharmacy (I know not all nurses do this, but it was mostly the case where I worked) and weren’t around when I needed their help, I was often left on my own or with other HCAs who on the whole had pretty low morale. The treatment I received from other professionals was often condescending and dismissive, I felt like the lowest rung in the site. I received minimal supervision, and when difficult or upsetting things happened at work there was no one to talk to about the experience. Apparently there’s a high-turnover for staff in these roles and I’m not surprised, though it must be very difficult for residents to see staff they get close to continually leaving and being replaced with new faces. The high demands placed on me to support basic needs such as washing and toileting left little time to go beyond this and engage in more personal and creative work with residents. I rarely even had time to look at people’s files, even when they had a substantial risk history, as if it wasn’t important for me to know much about the person I engaged so intimately with.

Many care-workers probably have better experiences than I did, the hospital I worked for definitely had some problems, but having talked to others I don’t think my experiences were all that unusual. HCAs and similar staff do the jobs that the rest of us are glad we don’t have to do, and receive little recognition for it. It’s a tough job and not everyone can do it. I’ve met staff who were truly brilliant, but the lack of  respect (not to mention pay) you receive on the job does limit how likely it is that skilled staff will stay in a post. These people need to be celebrated and given further training so they can develop in the role. The residents and patients deserve better. Though I found the job a useful experience and it helped me get further posts, I probably wasn’t the right person to be providing that sort of care to people with such particular needs. I tried to do my best, but I wasn’t experienced.

Now I’ve moved up a few pay-bands and I don’t have to clean up anyone’s vomit and it’s been a long time since anyone hit me at work. But my experience on the ward is still with me, and I often find myself drawing on it and using it in examples at work. It’s definitely impacted on how I think about healthcare, other staff and my own professional responsibilities. Though the work was tough, I definitely don’t regret doing it. Sometimes I even miss being in that community environment and having more time with patients (it seems as I develop more skills I get less and less time with the people I’m learning to support). I don’t think being a healthcare assistant/support worker/similar should be seen as a ‘lowly’ job that’s beneath the other professions. It’s not a job just anyone could do, and it takes a special kind of person to do it well. Unfortunately this isn’t reflected in the pay and  training attention that people in this roles often receive. For someone thinking of starting a career in healthcare I think you couldn’t have a better starting point, and you’d actually be at a disadvantage for skipping over it. It’s an enriching and insightful experience that I know I come back to again and again.

 

Electronic Selves – Professional and Personal Identity Online

Peter Steiner’s famous New Yorker cartoon

I blog and use twitter in a pseudo-anonymous fashion. By that I mean that I don’t put my full name on either account. I haven’t gone to great lengths to conceal my identity, but I do feel an advantage to not being too identifiable on the internet. Recently the GMC stated that doctors on twitter should use their real names, which sparked some debate about the kind of candid and honest communication that this might shut down. It’s said that nothing on the internet is truly private and I do have anxieties that my personal life and writing might somehow impact negatively on my career and clinical work. On the same hand, I wonder what opportunities I cut off by maintaining an alias. I’ve been having a chat about this with some friends who also blog about personal experiences, both as professionals and service-users.

Self as a writer. I love writing. Perhaps there’s something somewhat exhibitionist about writing about my life on the internet for strangers to read, but my writing style has always drawn on my own experiences, often mixed in with more factual information. I do enjoy sharing my own stories, it’s the only thing I can really claim any expertise in and makes my writing something unique and my own. My writing serves as a space for my own reflection, but I also hope to inform other people and draw attention to topics that I feel are important and lend my voice to debate. So for me writing is personal, but also a form of communication, providing a resource to others and a form of activism. It’s also something I enjoy and an outlet from my day-job, which can be quite stressful! Many online writers, especially those who write candidly about more controversial topics (think Belle du Jour) use an alias, it can be less restrictive and give the freedom to write without worries about how it might impact the rest of your life. Blogger LandslideGirl is a psychology student who also has experience of mental health problems.She mentioned the freedom that comes from writing anonymously, which I definitely agree with, “My twitter account is something I use in both a personal and academic sense.  On twitter I identify myself as both a psychology student and a person with mental health issues, although again I don’t have my real name on it.  There are several people from ‘real life’ who follow me, but it allows me a greater degree of freedom than facebook which is so closely linked to my identity.  I find that on twitter I can have the best of both worlds. “ 

Sharing personal experiences – self as patient (and as regular human being) – I write about my general life but something I’ve used a lot is my experiences with mental health problems and using mental health services. Reflecting on these times helps me to understand and learn from them, but I also think I can have a role in helping other people to understand what it can be like to have a mental health problem and be in treatment, for other people who might identify with me and conveying messages about hope, recovery and growth. I also have the benefit that I’m also a mental health professional, so in some ways I can talk both ‘languages’ and I can talk about my experiences in a way that’s accessible to the people who might work with someone like me. I guess I’d hope to foster understanding on both sides.

LSG uses her blog in a similar manner, I wanted my landslidegirl blog to be somewhere that I could write about the things that effect me, and tell my backstory, from a more reasoned perspective, rather than a daily update… I haven’t linked my blog to my personal identity, although if someone read it who already knew me they would work out that it was me without too much difficulty.” There can be something quite therapeutic about sharing experiences in such an open forum, but we’re both aware of the possible consequences of this.

Rufus May – Out and Proud

There are some mental health professionals who have spoken openly about their own experiences of mental health problems, Rufus May and Marsha Linehan are two good examples of this. They’ve been praised for their honesty, but it is noticeable that both ‘came out’ at a point when they were quite established and respected in their careers. I don’t have that luxury, I’m still getting on the ladder and I don’t know how people who might employ and work with me might respond to my disclosures. Similarly, I’m encouraged not to reveal a lot of personal informations to the clients I see in practice. It depends on the model of therapy you work with, but generally self-disclosure is considered to often be unhelpful to the therapeutic relationship and process. I don’t know how other professionals who have a lot of personal information about them in the public domain manage this, but I am wary that knowing details about my experiences might be detrimental to my clinical work. I have tight privacy settings on my Facebook to limit colleagues and clients seeing pictures of me falling over drunk in fancy-dress (not that I do that, obviously…).

Lyssa is a family and marriage therapist who blogs. Her blog is a personal one (often very personal, she recently shared her engagement photos and her erm… reflections on her bowel movements). However, she does mention her job, although not in the same detail that I do. mentioned this also, “In terms of personal disclosure with clients, I like to think that I am comfortable being fairly open with my clients when they ask me directly about my life.  I like Yalom’s take on being honest and open with clients…..because change is all about the therapeutic relationship, and I think being genuine can only help that (as long as the main focus stays on the client, of course). I suppose if a client found my blog and then brought it up in session, I might be embarrassed, depending on what the client thinks about it all.  At the end of the day, it’s just me, and my clients can take that or leave it.”

Talking about work – self as professional. Another side of my writing is often writing about issues and ideas that come to me from my clinical work, things that strike me as interesting, things that make me laugh and sometimes things that make me really sad. I’ll sometimes use examples from the people I see in my work. I am mindful of confidentiality and I don’t use names or identifying details, but I sometimes mention the type of problems I’m working with or things people have said to me. Given I don’t have my name or where I work linked to any of my accounts, I don’t think it’s possible to actually identify individuals. A lot of the people who follow me on twitter and some of my readers seem quite interested in what my day-to-day life as a mental health professional involves and I hope to give a sense of that. I’ve read quite a few other anonymous twitters and blogs that similarly offer snapshots of a professional’s life. If I was identifiable online, I’d need to really edit my online content to remove these references. Similarly references to colleagues. Sometimes I write about controversial and contentious topics, and I often take a critical view on current mental healthcare. If I was more identifiable online I wonder if there would be any issues with expressing views online that might not be in line with the views of the organisations I am involves in (such as the NHS, my university). At the same time, whilst my writing isn’t identifiable, it limits my ability to share it within my professional and academic network. LSG also mentioned fearing negative outcomes that come from writing candidly (and sometimes negatively) about the systems we work within, “During the placement year of my degree I worked in a clinical psychology service and I faced considerable stigma created by the clinical team.  This was something that I felt strongly agrieved about and wanted to write about, but I decided not to, on the off chance that somehow it got back to them.  So yes I am careful about what I write.  I’m more conscious than ever of keeping my comments quite general and not naming names.” 

Lyssa does mention her job, although not in the same detail that I do. I asked her about how she manages this professional/personal identity boundary, “My colleagues don’t know that I blog. I try to keep my personal and professional lives separate as much as possible….while still blogging about personal stuff. For instance, I post really personal stuff on Facebook but, as a rule, I do not have Facebook friends who are current coworkers of mine. And yes, I do use pictures of myself on my blog, but I try not to describe exactly where I live and I don’t use my full name, in hopes that my blog will be less searchable by people who may know me in the real world (like clients).

Real-life’ self – academic discourse. In my work life, I’ve published a paper and hope to put more out, in terms of research papers and other professional comment. This work has my full name on, the same one I use at work, so if colleagues and clients were to google me, this is what they might come up with (and hopefully not pictures of me drunk on my birthday). Although what they’d find would be very little in comparison to the amount I’ve written on my blog, and online conversations I’ve had with service-users, activists and professionals (both anonymous and those that identify themselves online) and other campaigning. But my ‘real-life’ identity probably packs more clout, I can communicate through a wide professional network and have the associated prestige and respectability of the organisations I’m a part of. My opinion perhaps carries more weight than that of an anonymous blogger and maybe I’m able to have more impact in this role. But this identity remains unconnected with articles I’ve written about sex and pornography, more frivolous pieces on lingerie and fashion and twitter rants.

So in addition to the roles I juggle at work, I carry about these different ‘selves’ with me. They start to blur into each other as I have real-life friends who read my blog and follow me on twitter, I have fellow trainees (who straddle a blurry area between colleague and friend) on my Facebook where I sometimes post my writing, not to mention photos. On my twitter I communicate with a range of professionals who I really respect, but if we came into contact in a professional environment, would I let them know who I am? Recently some staff from my university have followed me on twitter, and I’m pretty sure for people who already know me, I’m pretty identifiable online.

I doubt the NHS has the funds to do a Lisbeth Salander-style online check on me, and airing a few controversial opinions and having a good time is not exactly illegal. I don’t think I break confidentiality in my writing, but am aware that others might see it differently so am mindful of it. Even if my clients aren’t identifiable, it perhaps communicates something about my profession and how we share information if I’m seen to be writing about people I work with. I’m undecided about whether I want to come ‘out’ as a wounded healer and professional with lived experience of mental health problems, and I think it’s something I’ll probably leave to consider later in my career when I’m in a more stable position job-wise.  And if clients found me online? That would be a difficult issue, but I don’t think impossible to manage. I’d like to be an empty vessel to take on their projections and unconscious phantasies, but at the same time, I am a real person and it’d be unrealistic to act as though I have no life beyond the clinic walls. Like Lyssa says, I’d probably be embarrassed, but this is me, and my writing and my past experiences are part of who I am.

Thanks to Lyssa and LandslideGirl for their help! Go check them out, they’re great. I’d welcome any other opinions and views from others who struggle with this personal/professional interface and the dilemmas the internet and disclosure bring up.

Stop-Motion: Tim Andrews’ ‘Over The Hill’ Photo Project

Rosie Hardy

I’m often drawn to art that draws on ideas about the brain, mind and mental health, and the combination of these. Tim Andrews’ ‘Over The Hill’ project is one that I’ve followed for some time and I feel it speaks a lot about identity and illness, as well as creativity and pushing the boundaries of portrait photography. Tim was diagnosed with Parkinsons in 2005, when he was 54. A couple of years later, he answered an advert in Time Out from a professional photographer looking for people to pose for nude pictures. The experience was enlightening and prompted him to respond to other adverts, and he took to Gumtree to find other photographers to capture him. Now his project includes a couple of hundred different photographers, from students and amateur hobbyists to well-known professionals such as Rankin, who have all photographed Tim in their unique way. The pictures range from candid portraits to monochrome nudes, vibrantly styled pictures and more surreal and bizarre imagery. I was already familiar with some of the photographers Tim has worked with and I like seeing how they incorporated him into their signature-style.  As a photographer myself, the images offer me inspiration for the myriad of different things one could create with a model (as well as thinking about getting in front of the lens!).

Miss Aneila

On his blog Tim documents his experiences with each of the photographers. What comes across is his real passion for art and how much he enjoys getting to know the different artists and being a part of their work. It’s fascinating seeing the many different ways that they have represented him, sometimes in a very intimate manner, sometimes more fantastical. One of the most noticeable features of Parkinson’s is the motor tremor that individuals develop. Given this, it’s interesting how the images often give such a picture of stillness and of peace. They’re static representations, frozen micro-second captures of someone who’s life must be rippled with hard to control motion. Parkinson’s is unfortunately a neuro-degenerative condition for which there is no cure, and given the subject matter you could imagine that the project could be quite depressing, charting the body’s decline. However, as Tim takes encounters a wider range of photographers, travels to further locations and creates ever more striking images, he tells a story of someone pushing to get the most out of life.

Justyna Neyring

Rekha Garton

Interview with Tim in the Times here

Doctors stole my baby! The curious phenomena of the phantom pregnancy

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This morning newspapers carried the story of a young Brazilian woman who is taking legal action against a hospital, claiming they have stolen her baby, or covered up its death. She entered the hospital visibly pregnant, complaining of abdominal pain and vaginal bleeding. She was anaesthetised for an emergency c-section, but woke up without a baby. The hospital are claiming that this was a case of ‘phantom pregnancy‘.

V.S. Ramachandran describes the bizarre phenomena of pseudocyesis or ‘hysterical pregnancy’ in his book ‘Phantoms In The Brain‘. The body develops many of the physical signs of pregnancy, accompanied by a strong belief that the individual truly is pregnant. Individuals may experience swelling in the abdomen, changes in menstruation, depositing of fat around the belly and lactation, amongst other symptoms. Often it will only take an in-depth examination from a medical professional to discern that a foetus is not present.

In some mammals such as cats and dogs, pseudo-pregnancy is more common and has been linked to the continued presence of the corpus luteum, which causes the signs of pregnancy. In humans the condition is believed to be psychological in origin and to relate to an overwhelming desire to have a child. Pseudocyesis is however, rare today. In the late 1700s, one in 200 pregnancies were believed to be ‘phantoms’. Now the incidence is closer to one in 10,000. This has been linked to changes over time in the pressures on women to conceive and give offspring, as well as advances in scanning techniques. In the modern age, an ultrasound can easy confirm a pregnancy. In previous centuries women might receive little education on pregnancy and childbirth and would have had little way of confirming a pregnancy other than going on outward physical signs. Many would have had little contact with a midwife prior to the birth. Indeed, often presenting the women with the ‘evidence’ of her (un)pregnancy is enough to resolve the condition. The pregnancy is not staged by the woman (though many people have lied about a pregnancy for secondary gain, few are actually capable of manipulating their own hormonal levels or altering the position of their spine). Men too have been seen to develop some phsyical symptoms in a ‘sympathic pregnancy’ (otherwise known as Couvade Syndrome), although this tends not to be accompanied with the same strong belief of pregnancy.

Pseudocyesis appears quite strange, although it has some similarities with the better known ‘placebo effect’ (when individuals’ health improves when they believe they are receiving treatment, regardless of whether the treatment is active), offers a fascinating insight into the way our minds can control our bodies, seemingly beyond our conscious awareness.

Layane Santos displays her visibly swollen belly

So what is happening in the case of Layane Santos? If, as she states, she had previously had an ultrasound that confirmed the birth, this would be convincing evidence that she really was pregnant.The hospital claims to have run tests before the ‘delivery’ that showed she was not carrying a baby. It is therefore a little questionable as to why they are not revealing these results, or why indeed they chose to anaesthetise Santos at all. If she was indeed not pregnant, the evidence of such should be straight-forward.

Undoubtedly the couple very much wanted a child and were quite invested in the pregnancy (as many couples are). A Brazilian newspaper claims that they had “already named their daughter Sofia, moved to a bigger house and had spent $3000 on clothes and furniture for their first child“. In pseudocyesis, although the pregnancy is not ‘real’, the news that one will not have a baby is obviously very distressing and there may be disbelief, given the many physical symptoms, that they were not pregnant.

It seems unlikely that a hospital would ‘steal’ a child, but while the hospital withhold details of their tests, it cannot be confirmed that Ms Santos was not pregnant. I shall be watching this case with interest…

(Images from GoogleImages)

Layane Santos

Unmentionables: Talking about sex in the healthcare setting

'The Sessions', in which a disabled man sees a sex worker, draws attention to the desire for individuals with disabilities to enjoy a sex-life

‘The Sessions’, in which a disabled man sees a sex worker, draws attention to the desire for individuals with disabilities to enjoy a sex-life just as much as the able-bodied.

Doctors, psychologists and other healthcare professionals, both in mental and physical health, are used to talking about difficult subjects. Bowel movements, terminal diagnoses, suicide and self-harm, tricky topics are a standard part of the job. Yet somehow when it comes to sex, many struggle to find the words or avoid the topic all together.

Sex, whether defined by sexual acts, more generally as intimacy or in many other ways, is an important human need. It contributes highly to individuals’ quality of life. On Maslow’s famous Hierarchy of Needs it comes only after physiological and safety needs in terms of importance. I think I can go as far as to say that changes or difficulties relating to sex are common to the majority both physical and mental health problems, whether they relate directly to the symptoms (e.g. impact of pain and limb weakness on sex positions, hypersexuality in mania) or are secondary to medication used to treat the problem or further consequences (such as impact of taking on a sick/carer role, self-consciousness relating to skin conditions). Anti-depressants are very widely prescribed, yet often information on the (common) sexual side-effects is left to be read in the small print. I’m reminded of a quote from Ben Goldacre on SSRIs,

“ I’m trying to phrase this as neutrally as possible, I really enjoy the sensation of orgasm. It’s important to me, and everything I experience in the world tells me that this sensation is important to other people too. Wars have been fought, essentially, for the sensation of orgasm.”

Stroke for example, is a condition where sexual dysfunction has been well documented. Yet in research speaking to rehab staff, they rarely brought the topic up with clients and on the occasion when it was brought up, staff often felt embarrassed and uninformed (McLaughlin & Cregan, 2005). Reasons given for staff not approaching the topic also included fear of upsetting clients and there has been other research suggesting that (often unconscious) stereotypes relating to sex, relationships, illness and disability, play a role in this silence. Although sex problems have been particularly highlighted in stroke, there is evidence that these staff attitudes and difficulties exist in a variety of settings and in relation to many other conditions. Whilst working in a clinic for Chronic Fatigue, I approached staff about the possibility of including sex and relationships as a topic to include in a psycho-education group, and was met with quite a dismissive response. It was too sensitive, and time was needed for other important areas. However, a friend with the condition informed me that on a service-user forum, the sections relating to questions and advice about sex were by far the most used. Service-users often have to go and seek out their own information because professionals fail to provide it.

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Closet Skeletons – Halloween Inspiration

Photo by Pauline Darley. 

It’s less than a month until the dress-up event of the year (Purim excluded), it’s the Goth Xmas, it’s Halloween! And I have already begun scheming about outfits Some of the best/funniest costumes I see each year are based on recent cultural references (who’s going as one of the Avengers, Effie Trinket or Christian Grey this time?) or an extremely poor taste zombie version of a recently dead celebrity. Or this could be a chance to, Mean Girls-style, wear your most revealing costume under the guise of fancy-dress (teenage sex-worker seems to be a popular choice year on year). What are you planning on wearing? (What do you mean you’d not thought about it yet?!)

Personally, I think I’ll be going for something a bit more elegant. At the moment I’m drawing on my love of things anatomical and considering going for something with a skeletal-theme (though not day-of-the-dead sugar skulls, they’ve been done rather to…death).

 I’ve completely fallen in love with this embroidered body-suit from Marchesa. The detail is beautiful and I like how the sheer fabric shows off the body, whilst juxtaposing the bones on the outside, a gilded exo-skeleton. I’d like to wear this under a low cut dress, so the golden ribs would show across the chest (or wear it on it’s own to a rather wilder party!). Kirsten Stewart wore a dress from this collection to the Snow White and the Huntsman premier.

Other beautiful examples of the skeleton in fashion are this amazing leather harness from Zana Bayne (this too would look good over or under something more floaty and feminine. NSFW image here. I’m particularly taken with the detachable arms (complete with ulna and radius) and finger-harnesses.

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