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I recently watched Nadiya’s very moving account of her experience in battling anxiety. The programme is still available on iPlayer and is well-worth watching , living up to all the site’s description of it claims:

Since Nadiya Hussain won Bake Off in 2015 she’s rarely been off our screens. But behind the scenes Nadiya suffers from extreme anxiety and debilitating panic attacks, which she’s had since childhood. For decades, she has kept her anxiety a secret, ashamed to speak out.

She’s never had a proper diagnosis but thinks she has an anxiety disorder, and with around 5 million people suffering from the condition in the UK, Nadiya is not alone.

In this one-off documentary for BBC One, Nadiya sets out to find the cause of her anxiety, exploring the most effective, available treatments, whilst having therapy herself, in the hope of managing her anxiety.

. . . .

Raw, open and honest, this documentary will speak to the millions of people in the UK suffering with anxiety disorders, shining a light and starting a debate about an increasingly pressing issue.

At the time of writing, I’ve still to catch up on David Harewood’s story, but intend to do so as soon as possible.

By some strange coincidence, when I was copying a presentation to a memory stick, I discovered a letter I’d written to someone I was working with who was battling anxiety. The feedback I gave, on the basis of work we had recently done, was very similar to that given by Nadiya’s therapist at one point. My letter dates from 2002 and I have absolutely no idea why it was on the memory stick. I thought it worth sharing here, with all identifying content removed.

I have been doing some thinking since the last time we met.  It seemed a good idea to put down on paper the core ideas that we developed over the last two sessions.  So here goes. If I don’t make things clear, we will have a chance to discuss it next time and we can improve on this first draft.

On the 26thof June we talked about the idea that the original horrible events were like an explosion and that the experiences that you have had since, at least in some respects, are more like echoes of the original explosion rather than new explosions in themselves.  We talked about how important it is to be able to distinguish between a new explosion and an old echo.  They can sound very much alike under certain conditions and at certain times. Distinguishing between them can be very difficult.

In the session that we had on the 2ndof July, I felt very strongly that we had moved further down a very constructive road.  This was very encouraging.

We drew a diagram – in fact two diagrams – which sought to capture what was happening.  We also sought to capture what might be a good antidote to the vicious circle that was carrying you down a spiral of negative feelings into increasingly horrible experiences.I include copies in computer form of those two diagrams.  I would also like to make some comments on those diagrams in case the explanation is easier to follow than the picture.

We agreed that as things presently stand, if nothing changes, you are caught in a vicious circle.  We agreed that the experiences that you have are very negative and very stressful. The stress that they create in you brings about very negative feelings which are often very powerful.  These are predominantly feelings of anger and fear. These negative feelings make your mind more vulnerable to further negative experiences of the kind that triggered the stress in the first place.

On the day, we discussed how the idea that these people who were so abusive of you in the past now have absolutely no power whatsoever to do you real physical damage by mental means.  We agreed that, no matter how the experiences you are having may have been triggered or instigated, they are mental events that cannot produce physical damage. Therefore, even if they are all a product of these other people’s activity, because it is all taking place in your mind no physical harm can result.

In the diagram I drew on the board and subsequently handed to you I realise that I have probably put this idea in the wrong place.  I have corrected that with the diagram you will see with this letter.

As I see it now we can turn the vicious circle into a creative spiral by placing this thought immediately after any stressful experience of those mental phenomena that are troubling you so much.  So, basically, if you have a negative experience immediately follow it by the thought: “These experiences can do me no physical damage whatsoever. I am safe to completely ignore them.”

This should effectively begin to reduce the degree of stress you experience, particularly if you find that idea credible.  If you don’t initially find it very believable it’s my view that repetition will make it increasingly credible as time goes on.  The effect of this will be to reduce the stress, which will in turn reduce the negative feelings, which will in turn reduce your vulnerability of mind, and which will ultimately reduce the intensity and frequency and probably the negativity of the experiences.

Obviously, and this was missing from clear expression in the first diagram, we cannot anticipate all conceivable things that might stress you other than these experiences.  So, there may be times when you will experience some kind of stress in your environment – for instance witnessing a car accident.  This increase in stress will momentarily cause an increase in the negative feelings, a consequent increase in your mind’s vulnerability and a probable increase in the negative experiences that are causing you such a problem.

However, if you can immediately realise that this increase of stress is the cause it will help. You will have the confidence to continue to assert the main idea. Because these experiences can do you no physical damage there is no need to keep on paying them attention, no need to worry about them. It is safe to ignore them. If you can do this you will cut off these experiences at the root and they will begin to fade and wither once more.

Our next meeting will give us a chance to go over the letter and make any alterations that can improve its usefulness. Once we have got a letter to which we both agree you might consider whether it’s useful to give your key worker a copy so that when you meet with her she can help you apply what we have planned.

I look forward to seeing you next time to discuss this letter.

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Suffering is life.

(Thomas Szasz quoted by James Davies in Cracked – page 276)

I threatened in an earlier post to republish this one. Here is it.

I was walking back from town one day when my phone pinged. It was a message telling me my book was ready for collection from Waterstones. I was puzzled to begin with then the penny dropped. Just before my birthday someone spotted that I had scribbled, in my list of books to buy, the title of Cracked by James Davies.

I turned round and headed back to town again. When I picked up the book, for some reason I wasn’t impressed by its cover. Maybe the words ‘Mail on Sunday’ put me off, though Wilf Self’s comment helped to redress the balance.

Anyhow, for whatever reason, I didn’t get round to reading it until after I’d finished Rovelli’s Reality is not What it Seems. I’ll be doing a short review of that later, possibly.

Once I started Davies’s book I was hooked.

I’ve already shared on this blog a review of Bentall’s book Doctoring the Mind, which brilliantly, for me at least, brings the more grandiose pretentions of psychiatry back to the earth with a bump. I quoted Salley Vickers’ verdict:

Bentall’s thesis is that, for all the apparent advances in understanding psychiatric disorders, psychiatric treatment has done little to improve human welfare, because the scientific research which has led to the favouring of mind-altering drugs is, as he puts it, “fatally flawed”. He cites some startling evidence from the World Health Organisation that suggests patients suffering psychotic episodes in developing countries recover “better” than those from the industrialised world and the aim of the book is broadly to suggest why this might be so. . . .

I summarised my own view by praising ‘its rigorous analysis of the misleading inadequacy of psychiatry’s diagnostic system, its powerful and carefully argued exposure of the myths surrounding psychotropic medications and their supposed efficacy, and its moving description of the critical importance of positive relationships to recovery.’

The Davies book also covers much of this same ground and is equally compelling. What needs to be acknowledged is that he also takes the argument to another level towards the end of his book. He is concerned that we are exporting our Western model with all its flaws to country after country and goes on to explore other implications as well.

In the chapter dealing with the export issue he first summarises his case up to that point (page 258 – square brackets pull in additional points he has made elsewhere):

Western psychiatry has just too many fissures in the system to warrant its wholesale exportation, not just because psychiatric diagnostic manuals are more products of culture than science (chapter 2) [and have labelled as disorders many normal responses to experience], or because the efficacy of our drugs is far from encouraging (Chapter 4), or because behind Western psychiatry lie a variety of cultural assumptions about human nature and the role of suffering of often questionable validity and utility (Chapter 9), or because pharmaceutical marketing can’t be relied on to report the facts unadulterated and unadorned [and its influence has helped consolidate the stranglehold of diagnosis and a simplistic psychiatric approach] (Chapter 10), or finally because our exported practices may undermine successful local ways of managing distress. If there is any conclusion to which the chapters of this book should point, it is that we must think twice before confidently imparting to unsuspecting people around the globe our particular brand of biological psychiatry, our wholly negative views of suffering, our medicalisation of everyday life, and our fearfulness of any emotion that may bring us down.

I can’t emphasise too strongly the value of reading through the details of his treatment of all these other aspects. I am of course aware that physical medicine, even though there are biological markers for diseases in this sphere unlike in mental health, has not been exempt from the disingenuous manipulation of data and unscrupulous marketing methods practiced by the pharmaceutical industry, as Malcolm Kendrick’s book Doctoring Data eloquently testifies, but the scale of that abuse is dwarfed in the arena of mental health – and I mean arena in the fullest sense of that word: the battle here is damaging more ‘patients’ and costing even more lives.

Davies’s examination of exactly how this exportation of the psychiatric perspective is coming about is also disturbing and compelling reading. He adduces for example how skilfully drug companies have learned to read the reality of cultures into which they want to make inroads with their products, how effectively they target key figures in the prescribing hierarchy of professionals, and how astutely they now reach out to the public themselves so they will go to their doctors and request what the drug company is selling – all this to detriment of the many ways the social cohesion of the receiving culture has often (though not always, of course) been supporting those who are suffering from some form of emotional distress.

Where he takes his case next, in Chapter 10, I found both compelling and resonant. He is in tune with Bentall in seeing the importance of supportive relationships but, I think, explores that aspect somewhat more deeply.

He repeats basic points, to begin with (page 266):

What the evidence shows… is that what matters most in mental health care is not diagnosing problems and prescribing medication, but developing meaningful relationships with sufferers with the aim of cultivating insight into their problems, so the right interventions can be individually tailored to their needs. Sometimes this means giving meds, but more often it does not.

He then quotes research done by a psychiatrist he interviewed (page 267). Using two existing MH teams, Dr Sami Timimi set up a study comparing the results from two groups, one diagnostic, the usual approach, and the other non-diagnostic, where medication was given only sparingly, diagnosis was hardly used at all, and individual treatment plans were tailored to the person’s unique needs.’

In the non-diagnostic group the psychiatrist spent far more time exploring with his clients the context of their problems.

The results were clear (page 269):

Only 9 per cent of patients treated by the non-diagnostic approach continued needing treatment after two years, compared with 34 per cent of patients who were being treated via the medical model. Furthermore, only one person from the non-diagnostic group ended up having to be hospitalised, whereas over 15 people in the medical-model team were referred for inpatient hospital treatment. Finally, the non-diagnostic approach led to more people being discharged more quickly, and to the lowest patient ‘no-show’ rate out of all the mental health teams in the county.

Davies also interviewed Dr Peter Breggin, a US psychiatrist who is critical of the medical model. Breggin explained his viewpoint (page 279):

Most problems are created by the contexts in which people live and therefore require contextual not chemical solutions. ‘People who are breaking down are often like canaries in a mineshafts,’ explained Breggin. ‘They are a signal of a severe family issue.’ .  . . . For Breggin, because the medical model fails to take context seriously – whether the family or the wider social context – it overlooks the importance of understanding and managing context to help the person in distress.

Davies quotes Dr Pat Bracken as singing from the same hymn sheet (page 273):

We should start turning the paradigm round, start seeing the non-medical approach as the real work of psychiatry, rather than as incidental to the main thrust of the job, which is about diagnosing people and then getting them on the right drugs.

It’s where he goes next that I found most unexpected but most welcome to my heart. He leads into it with an interview with Thomas Sasz just before his death at the age of 92 (page 276). He asks Szasz, ‘why do we believe as a culture that suffering must be removed chemically rather than understood in many cases as a natural human phenomenon, and possibly something from which we can learn and grow if worked through productively?’

Szasz’s response is fascinating:

Our age has replaced a religious point of view with a pseudo-scientific point of view. . .   Now everything is explained in terms of molecules and atoms and brain scans. It is a reduction of the human being to a biological machine. We don’t have existential or religious or mental suffering any more. Instead we have brain disorders.

Davies summarises Szasz’s position on psychiatry (page 277): ‘It had become deluded in its belief that its physical technologies, its ECT machines and laboratory-manufactured molecules, could solve the deeper dilemmas of the soul, society and self.

Bracken’s view on this brings in capitalism (page 278):

What complicates things more is that we also live in a capitalist society, where there is always going to be someone trying to sell you something… In fact, some people would argue that capitalism can only continue by constantly making us dissatisfied with our lives.… You know, if everybody said I am very happy with my television, my car and everything else I’ve got, and I’m perfectly content with my lifestyle, the whole economy would come shattering down around our ears.

He continues (page 279):

What we customarily call mental illness is not always illness in the medical sense. It’s often a natural outcome of struggling to make our way in a world where the traditional guides, props and understandings are rapidly disappearing… Not all mental strife is therefore due to an internal malfunction but often to the outcome of living in a malfunctioning world. The solution is not yet more medicalisation, but an overhaul of our cultural beliefs, a reinfusing of life with spiritual, religious or humanistic meaning with emphasis on the essential involvement of community, and with whatever helps bring us greater direction, understanding, courage and purpose.

Unfortunately psychiatry, as with economics according to the writers of Econocracy, is failing to train psychiatrists in the adoption of a critical perspective on their own practice. So, he concludes, the pressure to change perspective has to come from outside the psychiatric system. He quotes Timimi again (page 285):

The things that get powerful institutions to change don’t usually come from inside those institutions. They usually come from outside. So anything that can put pressure on psychiatry as an institution to critique its concepts and reform its ways must surely be a good thing.

So, it’s down to us then. For me, promoting this book is a start. We all need to think, though, what else could be done, whether as a patient, a volunteer, a friend, a family member, an MP, a clinician or simply a citizen.

Currently, help is often tied to diagnosis. One psychiatrist quoted in this book is concerned that if categories of mental disorder are not confirmed as diseases, services will never be funded at the required level, the level, say, at which cancer services are funded. Surely, though, if opinion shifts to a tipping point not only the greater humanity of non-diagnostic treatments but also their relative cost effectiveness must carry the day in the end. But opinion will only shift sufficiently if we all play our part.

I know! I’ve got it.

You all could start by reading these two books. How about that?

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I ended the previous post with a quote concerning the influence of diet.

What has become abundantly clear is that what we eat affects many aspects of our health. A recent book[1] on psychobiotics explores one previously underestimated area to demonstrate the truth of this. A Guardian review pulls out the main points in detail including such statements as ‘Over the past decade, research has suggested the gut microbiome might potentially be as complex and influential as our genes when it comes to our health and happiness. As well as being implicated in mental health issues, it’s also thought the gut microbiome may influence our athleticism, weight, immune function, inflammation, allergies, metabolism and appetite.’

The inescapable conclusion, as all the researchers are keen to point out, is ‘that no matter how repetitive the advice, and difficult to achieve in the west, a varied diet rich in fresh vegetables and fermented foods such as sauerkraut, along with exercise and stress management, is the route to sustained gut (and general) health.’

Self-help

For reasons which modern medicine has made increasingly clear, Bahá’ís are prohibited from using alcohol and other mind altering substances: ‘Experience hath shown how greatly the renouncing of smoking, of intoxicating drink, and of opium, conduceth to health and vigour, to the expansion and keenness of the mind and to bodily strength.’[2]

We are also enjoined to take good care of our health ourselves in other simple ways, beyond just diet. ‘You should certainly safeguard your nerves,’ Shoghi Effendi says, ‘and force yourself to take time, and not only for prayer and meditation, but for real rest and relaxation….’ [3]

With great prescience he also emphasises the critical importance of sleep: ‘Regarding your question: there are very few people who can get along without eight hours sleep. If you are not one of those, you should protect your health by sleeping enough. The Guardian himself finds that it impairs his working capacity if he does not try and get a minimum of seven or eight hours.’[4]

It wasn’t until I recently read Matthew Walker’s Why We Sleep that I came to realise just how vitally important sleep is to our health. It pulls together evidence for the importance of sleep at every stage of life, and spells out in detail the damage lack of sleep causes not just to memory and concentration, but also to the health of body and brain in a multitude of ways: to name but a few, by raising the risk of Alzheimer’s, diabetes, stroke, heart attack, and cancer as well as by reducing the efficacy of the immune system. More of that in my next post.

Lucretia by Rembrandt

More Challenging Aspects

Other important points to bear in mind when helping those who are ill or whenever we are ill ourselves include the spiritual dimension of our being specifically, and not just prayer and meditation. ‘Abdu’l-Bahá explains that ‘The connection of the spirit with the body is like that of the sun with the mirror.’ The spirit or soul cannot be damaged by what damages the body nor helped by what cures it: ‘Briefly, the human spirit is in one condition. It neither becomes ill from the diseases of the body nor [is] cured by its health.’[5]

There are many reasons why factoring this in might enhance the way we treat others and the way we look at our own illness. Staff and relatives, if they believed in the soul, would find it even harder than they do to treat a comatose patient like an object rather than a human being. I also would find it easier, to some degree at least, to cope with a life impairing illness if I believed that I had a soul. These benefits do not, I know, amount to proof of the existence of a soul. I’ve dealt with that evidence at length elsewhere. What I believe this evidence strongly indicates is that, just as I cannot prove I have a soul, science cannot prove I don’t. To believe in a soul is as rational as not to believe in one: given the demonstrable benefits of belief to quality of life I know what side of this argument my money should be on, even if I didn’t already accept the reality of the soul.

An even more complex issue, which I have also dealt with at length elsewhere on this blog concerns pain and suffering. Shoghi Effendi gave this response to a question: ‘As to your question concerning the meaning of physical suffering and its relation to mental and spiritual healing: Physical pain is a necessary accompaniment of all human existence, and as such is unavoidable. As long as there will be life on earth, there will be also suffering, in various forms and degrees. But suffering, although an inescapable reality, can nevertheless be utilized as a means for the attainment of happiness. . . . Suffering is both a reminder and a guide. It stimulates us to better adapt ourselves to our environmental conditions, and thus leads the way to self-improvement. In every suffering one can find a meaning and a wisdom. But it is not always easy to find the secret of that wisdom. It is sometimes only when all our suffering has passed that we become aware of its usefulness.’[6]

The final tricky point concerns my previous professional vocation.

As I have explained elsewhere and will be republishing later, I am acutely aware that psychiatry has its limitations, which psychiatrists do not always recognise. Davies marshals a wealth of evidence in support of this contention.  If a mental health team acts as though all they really need to know is the diagnostic label, and what they suppose is the completely effective medication that goes with it, and all they have to do is make sure the patient swallows enough tablets, the outcome will be poor at best and potentially life-damaging at worst. If on the other hand, they take into account, not just the label and the tablets, but also the whole person and their context, working in consultation with the service user to create a recovery plan within the framework of a genuinely multi-disciplinary team, then the evidence suggests the outcome will be good and the recovery more stable.

This means that Shoghi Effendi’s cautious advocacy of psychiatry is music to my not necessarily objective ears: ‘Psychiatric treatment in general,’ he says, ‘is no doubt an important contribution to medicine, but we must believe it is still a growing rather than a perfected science. As Bahá’u’lláh has urged us to avail ourselves of the help of good physicians Bahá’ís are certainly not only free to turn to psychiatry for assistance but should, when advisable, do so. This does not mean psychiatrists are always wise or always right, it means we are free to avail ourselves of the best medicine has to offer us.’[7]

I’ll leave you to read my subsequent posts if you need to know more about my personal views on that one.

Hopefully this has been a reasonably clear helicopter view of the Bahá’í position on health and wellbeing. I think I’ve gone on long enough in any case. I’ll stop hear and catch my breath. I don’t want to precipitate a heart attack.

Footnotes:

[1] The Psychobiotic Revolution: Mood, Food and the New Science of the Gut-Brain Connection by Cryan, Dinan and Anderson.
[2] (Selections from the Writings of ‘Abdu’l-Bahá Sec. 129, page 150)
[3] 
(In a letter written on behalf of Shoghi Effendi, 23 November 1947 to an individual believer)
[4] 
(In a letter written on behalf of Shoghi Effendi, 15 September 1951 to two believers)
[5] (‘Abdu’l-Bahá, “Some Answered Questions”, pp. 228-29)
[6] 
(In a letter written on behalf of Shoghi Effendi, 29 May 1935 to an individual believer)
[7](In a letter written on behalf of Shoghi Effendi, 15 June 1950 to the National Spiritual Assembly of the British Isles)

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At the end of October  published an excellent article in the Guardian which further reinforces the scepticism about psychiatric diagnosis that I have explored earlier on this blog. She succinctly makes what is a key point for me:

. . . the DSM [Diagnostic and Statistical Manual] only focuses on . . . “symptoms” and does not take into account the individual’s context. This in itself is a value judgment.

Below is a short extract. For the full post see link.

Psychiatric diagnosis must serve an ethical purpose: relieving certain forms of suffering and disease. Science alone can’t do that.

How do we decide what emotions, thoughts and behaviours are normal, abnormal or pathological?

This is essentially what a select group of psychiatrists decide each time they revise the Diagnostic and Statistical Manual of Mental Disorders (DSM), considered a “bible” for mental health professionals worldwide.

The DSM was first published by the American Psychiatric Association in 1952 to create a common language and standard criteria for the way we classify mental disorders. It’s now used around the world by clinicians, researchers, insurance and pharmaceutical companies, the legal system, health regulators and policy makers, to name a few.

Now in its fifth edition, revisions have gradually expanded the number of mental disorders, while also removing some as understanding or values change. Over the years many of these amendments have courted controversy.

These days, criticisms of the DSM are that it medicalises normal behaviour such as fidgetiness, noisiness and shyness.

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A DWP disability assessment questionnaire. Photograph: Alamy

In yesterday’s Guardian there was yet more evidence of the distressing and shameful  failure of our benefits system to understand the very real needs of those coping with mental health problems. Adam Jacques, the disabled husband of a claimant, writes movingly of his experience of his wife’s acute distress at being refused access to the personal independence payment system:

There’s nothing quite like witnessing your wife tumble through a gaping chasm, to see that there’s something rotten at the heart of a welfare assessment system. From what we experienced, the wrong people are doing the wrong assessments with the wrong tools, using incorrect assumptions. And it left me reeling: how could this happen to my wife? I discovered that her experience is just the calamitous tip of a PIP-denying iceberg.

Below is a short extract: for the full post see link.

My wife tried to kill herself in March. She took an overdose – while I was watching TV in the next room. Cue, in short succession: 30 minutes of heart-stopping panic, a nerve-jangling ambulance trip to A&E, an admission to a secure mental health unit, and a longer stay recovering in a crisis house.

Acute episodes such as this can be a recurring reality for someone with a longstanding mental health condition. From her battles with depression and struggles to get out of bed in the mornings, to anxiety so overpowering that a trip on a bus triggers a blind panic, for my wife (let’s call her Bea) life is a titanic battle to stay afloat. She experiences overwhelming feelings of worthlessness, guilt and impulsive urges to self-harm that can flood her mind and distort her thinking. Socialising with friends is hard, while work in the past year has been out of the question. But she’s also incredibly smart, funny, kind and brave.

Mental health is complex, but something simple triggered Bea’s overdose: a devastating letter from a “decision-maker” at the Department for Work and Pensions (DWP), informing her that her claim for personal independence payment, a disability benefit, had been unsuccessful. She’s not the first, and won’t be the last, to experience the dismissive treatment that people with severe mental health conditions can undergo when accessing the benefits system. And PIP, as the benefit is called, is one of the worst offenders.

PIP is supposed to offset some of the extra costs of a disability. Applicants are evaluated by health workers from the private firms Atos or Capita, who forward their assessments to a DWP decision-maker – who scores you on “daily living” and “mobility” (you need at least eight points for each to qualify). Currently nearly 3 million people claim some element of PIP, and my wife expected to be one of them. As did her benefits adviser, an NHS psychiatrist and a psychologist. So, armed with a dossier of supporting medical documentation, Bea applied. That was last November. I’ve seen glaciers move faster. . .

I discovered that her experience is just the calamitous tip of a PIP-denying iceberg. While the DWP claims it doesn’t operate quotas to save money, figures released in April, covering just six months of 2016, showed an enormous expansion in claimants receiving zero points, up to 83,000. That’s only 10,000 fewer than in the previous 12 months.

This raises huge concerns about the assessment process – especially given that, when rejected by the DWP, 65% of applicants who appeal to a tribunal get the ruling reversed. A panel of welfare experts told the work and pensions select committee earlier this year that the whole process was “inherently flawed”, with medical evidence often ignored by officials during the initial assessment.

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Kloey Clarke at home in Devizes, with her son Seth. Photograph: Adrian Sherratt for the Guardian

This week more disturbing news has broken concerning the way our society treats mental health problems compared with physical illness.  flagged this up in a Guardian article last Wednesday. He stated:

The evidence is mounting that people with mental health problems in particular are being failed by PIPs, with claimants reporting that the new system takes no account of the needs of people with conditions ranging from schizophrenia to severe depression. Figures released by the DWP in October showed that complaints about the PIP assessment process increased by 880% last year. The number of complaints that were upheld rose similarly dramatically, by 713%.

Below is a short extract: for the full post see link.

Kloey Clarke, 28, from Devizes in Wiltshire, has had severe anxiety and type II bipolar disorder for six years. “I’m scared to leave the house,” says Clarke, who does not feel emotionally or physically stable enough to hold down a job and relies on her husband for care and support. “I have a constant fear of dying. I can’t socialise and I can’t communicate outside [the house].” For four years, Clarke depended on a Disability Living Allowance (DLA). The DLA was replaced by Personal Independence Payments (PIPs) in 2012 – and phased in from 2013 – but she was receiving them for less than a year before she was reassessed by the Department for Work and Pensions (DWP) and told she no longer qualified.

Clarke believes that the assessment for PIP is aimed at people with physical disabilities and does not account for mental illness. “I was asked if I could walk 200 metres unaided. No, I don’t need a stick or an aid, but I do need my husband or someone with me. Can I talk to people face to face? I talk to my family when they visit, but can I speak to strangers? No.”

She has had panic attacks as a consequence of losing her benefits, she says, and her family is now struggling financially. They have had to visit food banks twice since being rejected for PIP, but Clarke’s pride has stopped her from going more frequently. “I just find it so degrading. I don’t feel as if I should be there. I feel that, if I just had what I deserve, then I wouldn’t need to be in that place; I wouldn’t need to take food from, say, homeless people.”

Clarke’s marriage and her relationship with her children are suffering. “I’m useless to them, I’m not half the mum that I could be. I haven’t got enough funds. The government has no idea what these types of assessments do to people with mental health [issues]; how much it takes to walk into that room and talk about something so personal and then be told you aren’t ill enough.”

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