WFOT Position Statement Human Right's

We were told to read the WFOT Position Statement on Human Rights which has the purpose of stating the World Federation of Occupational Therapists (WFOT) 'position on human rights in relation to human occupation and participation.' When I was reading it for some reason the fact that the word 'occupation' was in nearly every line just made me think about the word and everything that is attached to it. Maybe it is also to do with the fact that I have been exposed to so many different definitions and explanations of the word that I still do not really know what it is, which is weird because I am studying to be an Occupational Therapist.
 Here is examples from the paper to illustrate what I am talking about:

'People have the right to participate in a range of occupations that enable them to flourish, fulfil their potential and experience satisfaction in a way consistent with their culture and beliefs'

'People have the right to be supported to participate in occupation and, through engaging in occupation, to be included and valued as members of their family, community and society'

'People have the right to choose for themselves: to be free of pressure, force or coercion; in participating in occupations that may threaten safety, survival or health and those occupations that are dehumanising, degrading or illegal'

This paper is speaking from an Occupational Therapy perspective and because we are Occupational Therapist then we may say it is obvious why occupation comes into everything and is so important. But I don't actually think it is that obvious because why occupation? Why is occupation so important? And quite honestly what is occupation? Most people don't fully understand occupation and how rich the word occupation actually is which is okay but us as OT's owe it to ourselves and our clients to understand this concept of 'occupation' that is central to our field of practice. WFOT defines Occupational Therapy as a 'profession concerned with promoting health and well being through occupation' so our therapy is THROUGH OCCUPATION. Because of this we should view humans and their occupation through very different eyes compared to the rest of the world. Instead of looking at a client and thinking this person has poor range of motion, poor memory, grade 2 muscle strength etc we think or at least we should think what are the occupational problems so what are the difficulties that they are having in order to be engaging in what they want to or need to. But when occupation is so hard to define or pin point its not that easy to identify these 'occupational challenges' that the person is facing.
 
All occupational therapists dread the question 'what is occupational therapy?' and I believe this is the reason why we hate it. Because occupation can be simple but at the same time it can be so complicated. Occupation can be defined as 'anything that people do'. There plain and simple. But then what is anything and why do we do that anything or in what way or when do we do that anything. We should be the one's that understand the complexity of occupation. Occupations are not just something that happen to us, we engage in them in a very active sense.
 
I think one of the big problems with us as OT's is that we get stuck in this literally 'active' sense of occupation so we think ah but you just sitting there you not doing anything. But one does not need to be physically doing something in order to be 'actively' involved in an occupation. We may look at an old man sitting staring out a window thinking as doing nothing and not being engaged in an occupation. But him sitting there thinking about his childhood and memories from his youth well that is an occupation.... Ya not so simple anymore... What is also complicated about occupation is the exact same occupation for example going for a run can be very different in terms of meaning, purpose and importance for two different people.
 
Something that can help this pickle about occupation and its importance is an example I saw where an HIV positive patient measured his health in terms of his occupations. He was not interested in his CD4 count and all the rest but instead identified his health status in terms of his changes in occupation, his occupational patterns and the occupations he could and couldn't do. I find that interesting because that is actually how we should be viewing people and their illness as OT's. But because occupation is so hard to pinpoint we often move towards treating memory or treating muscle strength because it sometime seems easier but at the end of the day we are beyond those individual components of memory, tone, joint range, coordination etc we are the bigger OCCUPATION picture and we need to not be afraid and allow ourselves to view the world through different eyes and make use of our very specialised skills and expertise. But easier said than done.. its not that simple

"MEDIA'S DAMAGING DEPICITIONS OF MENTAL ILLNESS"

 

Movies provide us with endless entertainment and there is not many people that can say they don't like to get under a warm duvet on a cold day, make some popcorn and watch a marathon of movies. Many movies have portrayed mental disorders or have had mental disorders as underlying themes, some paint a great picture of what these disorders are truly like but most paint an unattractive and inaccurate picture. You may be wondering why this is a problem because "It's just a movie right?" but research has proved that most people get their knowledge and perceptions about mental illness from these types of movies. This results in them having this fear of and discrimination towards people with mental illness feeding directly from the perspective they have had painted from them in their minds from a movie they have watched. These movies don't only cause damage to the viewers and their perceptions, it also leads to discrimination of people living with mental illness as a result of the stigma that has become attached to it.

 

We were requested to do an essay on a movie depicting a mental illness focusing on how accurately the movie depicted the particular mental illness with reference to the DSM IV criteria. I did mine on Silver Linings Playbook and below is the essay that I wrote. It should give some insight into the issue that I am talking about here. Quite honestly though if I weren't studying OT I would not know any better and my perception of mental illness would be the one was given to me from the media. So here it is:

Silver linings playbook is a film about a man, Pat, who snaps upon discovering his wife in the shower with another man and in pure rage beats the man almost to death. As a result he loses his job and is sent to a mental health facility when it is discovered that he has undiagnosed bipolar mood disorder. After eight months of treatment he is released from the facility into the care of his mother and father. He soon learns that his wife has left him and obtained a straining order against him after the violent episode. He is determined to get his life back and to reconcile with his wife. The main focus of the analysis will be on how the main character Pat displays symptoms common in bipolar mood disorder during the film.

People with bipolar disorder can experience both manic and depressive episodes due to the fact that it is a mood disorder that involves both ends of the spectrum. Pat displays characteristics typical of a manic episode throughout the film. The following are common symptoms displays during a manic phase:

• “Excessive happiness, hopefulness, and excitement
• Sudden changes from being joyful to being irritable, angry, and hostile
• Restlessness, increased energy, and less need for sleep
• Rapid talk, talkativeness
• Distractibility
• Racing thoughts
• High sex drive
• Tendency to make grand and unattainable plans
• Tendency to show poor judgment, such as impulsively deciding to quit a job
• Inflated self-esteem or grandiosity - unrealistic beliefs in one's ability, intelligence, and powers; may be delusional
• Increased reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs, or ill-advised business decisions)

Some people with bipolar disorder become psychotic, hearing things that aren't there. They may hold onto false beliefs, and cannot be swayed from them.” (Goldberg, 2012)

At the beginning of the film Pat is in denial about his illness which is a common symptom for patients with a mental illness and serves as a defence mechanism for them. It is very common for patients in the recovering process to begin lacking in compliance with their medication as they begin to feel better. This is not only an issue of denial but also a lack of intellectual insight into their condition. For patients with bipolar it is hard to find a reason to take medication if they do not have insight into the fact that there is something wrong with them. This is displayed by Pat in the movie through actions such as spitting out his pills when no one is watching, arguing with his mom about going to therapy and saying “I am not sick, I do not want help” as well as when another character in the movie who is also mentally ill says to him “I’m like you” his reaction is one of pure shock and offense as he does not believe that he has an illness and is “crazy” like her. These all display to us that Pat is in denial and is extremely defensive when it comes to accepting that he has a mental illness - he does not think he is sick, he is angry with his doctors and does not want their help and believes that he can beat his illness on his own which tells us that he has decreased intellectual insight into his condition which is a typical symptom of bipolar disorder. (Watkins, 2012)

During a manic phase patients can present with an elevated mood and hyperactivity where they have delusions of grandeur, meaning they have an inflated self-esteem and feel they are invincible and are superior to others. This leads to characteristics such as having a decreased need for sleep, channelling of their increased energy into a particular behaviour or task as well as disturbances of speech such as flight of idea’s, pressured speech and loosening of associations. In the film Pat has no desire to sleep and stays up all night reading only sleeping for short periods of time when he does go to sleep. Pat also runs excessively. He goes for extremely long distance runs every day during which he wears a black plastic bag so that he can sweat more in order to lose weight which he explains is so that he can get into shape for Nikki his ex-wife. Pat also displays disturbances in his speech as throughout the film he talks incredibly fast rarely stopping to take a breath. He is also grandiose in the film which is evident in a particular scene in the movie when he passes the comment “Maybe people like me, Dani and Tiff (all characters in the film with mental illnesses) know something you guys don’t know. Maybe we understand something you guys don’t”. This displays that he believes he is superior and has some form of “super power” that the average normal person does not. These indicate to us that Pat meets the criteria for mania as he does not sleep, he is grandiose and he has pressured speech.

Patients experiencing a manic episode not only have impaired intellectual insight but also impaired emotional insight. This can be combined with impaired judgement resulting in behaviours and features such as not considering other people and their feelings, not understanding the consequences of their behaviour and often being intrusive and tactless. These particular characteristics are very evident in the film. Pat upon finding his wife in the shower with another man nearly beats the guy to death. This seems like a perfectly normal and explanatory reaction to such a situation however it is his reaction to the situation afterwards that shows us that his behaviour is abnormal and is characteristic of a manic episode. After being released from the facility Pat believes he is going to get Nikki his ex-wife back, he lacks insight into the situation and does not understand the consequences of what he did. He cannot recognise that what he did was over the top seen through his confusion and disbelief as to why his ex-wife would have a restraining order against him. He believes he can get her back by simply reading every book in her syllabus. Pats impaired judgement and emotional insight is also displayed when he gets angry about the ending of one of the books he was reading and consequently wakes his parents up in the middle of the night and throws rage at them because of this frustration. It is acceptable to get frustrated over a book however it is inappropriate to throw the book through a window, wake up your parents and scream and shout at them about it. Pat also makes inappropriate comments to people such as when asking another character about her husband’s death he up right says “how did Tommy die” and saying blatantly to his friend that “his marriage is a f**k up” and  “you are the problem”. This therefore clearly displays Pat’s inconsideration, tactlessness and lack of understanding of the consequences of his behaviour on other people. (Watkins, 2012)

Often during a manic episode patients can be emotionally labile meaning their emotions fluctuate randomly often resulting in unpredictable moods that can be explosive and aggressive. Pat during his rage over the ending of the book hits his mother and ends up in a tussle with his father after which he suddenly breaks down and cries. Another situation where this symptom of mania comes in is when he accompanies his brother to a football match during which his doctor, who he happens to bump into there, gets into argument with a group of men resulting in Pat getting involved in an aggressive fight with these men due to him being unable to contain his anger. 

As previously stated bipolar mood disorder involves both ends of the mood spectrum. Throughout the film Pat only displays symptoms characteristic of a manic episode but there is no alternating to periods of depression. Pat never goes through a period of isolation, loss of interest in activities, suicidal ideation or feelings of extreme worry and emptiness. The movie only hints that he may have been in a depression previous to his admission into the facility when he is sitting in his psychologists room and explains how the week before the incident with his ex-wife having an affair he called the cops and told them his wife and the history teacher were plotting against him which he himself states was not true but was actually a delusion. It is common for people in a depressive state to experience delusions however Pat’s particular delusion of paranoia is only one indication and there is not enough evidence to say that he experienced a period of depression.

The film therefore creates a good picture of the manic side to bipolar disease however it does not capture the entire spectrum of what bipolar disease is in terms of the alternating from mania to depression on a cyclic basis. This may give viewers who have limited knowledge about mental illness an incorrect perception of this particular disorder. In this film it could be said that Pat is in actual fact just experiencing traumatic stress after the incident that happened and is therefore experiencing a manic episode as a result of this. Bipolar mood disorder has its name because of the two “opposite sides” it has to it and so the film needed to include both of these in order to truly depict this mental illness. (Stewart, 2013)

 

A question that makes you think is worth asking

This week has had its challenges one of them being a big test we wrote but the bigger challenge for me this week was to do with some stuff at home. I have been living in a flat with my older brother for the last two years. We have always been close in our own way, he looks out for me all the time and I genuinely am proud to be his little sister. However when you living together things do not always run smoothly. For a while now we have not been seeing eye to eye and both of us have just been living around one another not with one another. Family is of great importance to me and when something isn’t right it weighs me down and I guess this thing with my brother has been doing just that for quite a while. It’s been a tough year for me in terms of varsity work and unfortunately its meant that a lot of my time is spent at my desk working. It’s really hard to explain and make those around you understand all the work that you have to do and what exactly it is that we do as OT’s. So my brother’s natural response to me working all the time is ‘you work too hard’, ‘you always so stressed and miserable’ and ‘you stress for nothing it’s not that bad’. I’ve become so frustrated with his ignorance that I just gave up with him completely, hence the situation of the two of us merely existing together in one flat. But this week when one of our usual fights began I just could not take it anymore and in between many tears I told him everything. Things that have been happening at varsity, my prac, my clients, how I hate living away from home, how hard it is to try and balance everything that has been slapped onto my plate. And all of a sudden I could just see my brother’s eyes being opened to everything that I had been fighting to tell him over the last few months. Shortly after this I was reading stuff on the internet and an article came up with a whole lot of pictures and the title “A question that makes you think is worth asking”. This were two of the

pictures:

 

 

 

 

 

These pictures made me think…. What have I done to make those that I love understand what is happening in my life? What have I done to show them the love I have for them? If I had just spoken up and said something would my brother and I be in the position we have been for the last few months? What has he done as my elder brother to try and help me? And one day when I am old, my parents will not be around but my brother probably will be. He is the only brother I have and is something like varsity work worth that much that it can get in the way of a relationship with a sibling. My soon to be career means the world to me but in the midst of it all I am not only a university student, I am also a sister, a daughter and many other things. I tend to forgot that sometimes.

DOUBLE CHECK

Almost a week ago now nearly 30 people were killed in an accident in which a trucks brakes apparently failed. It has been part of everybody's conversations this last week and its no wonder because it really was a horrific accident that has left many questioning as to what went down that very evening.... I am not talking about this accident on my blog for the reasons everybody else is talking about it for but rather because it got me thinking when watched it and after doing midterm demo's on prac yesterday, here is the footage of the accident, it is not a pretty sight but if you can please try have a look at it.

https://www.youtube.com/watch?v=aB-9VtMiXqE

Its unbelievable how quickly and out of nowhere that truck enters and wipes out everything in its way, literally within a second it comes in and takes over. Well when watching that I had to think to myself when I did my drivers license test a few years ago before pulling off from a robot one was required to check left and right. Now after doing your license and having been a licensed driver for some time you think you know it all and never do you look before you pull off. You trust that everybody at that intersection is just going to obey the rules and nobody is going to be coming through that intersection when you pull off. Well for those drivers of the cars that got taken out by that truck had they maybe hesitated for a second longer and looked to their left and right to check before they pulled off they probably would have seen that truck coming at the high speed it was and therefore would've stayed put and not pulled off. Yes this does seem silly but its kinda true. Sometimes we just assume and we do not double check or make sure and its often those very times that we don't make sure that something goes wrong. And then you end up kicking yourself afterwards, why didn't I check, if only I had made sure....

Well that just about sums up where I am at after my demo yesterday. You can never be too sure is the lesson I learnt. After a treatment session goes well I think to myself why did I get so stressed and worried about it, I need to just relax. But the truth is all that stress and worry helps because it makes me check and make sure all is well, it makes me prepare 110%. So for me, just like the drivers of those cars, maybe that one time they didn't check and make sure the coast was clear was the one time they needed to. I am kicking myself now but it was a lesson for me and I will never make that mistake again.

Look left, look right and look left again, you can never be too sure.

Bittersweet...

So midterms presentations have come and gone and after all of it I am left with many different feelings about it all…. First let me start at the beginning. When I first got my client I really battled with deciding what treatment to do with him. He was not as “bad” as the other clients. He did not have this long term intense alcohol or drug problem, he did not completely lack any insight into his problems and he did not come from a broken or dysfunctional home. I sat for hours on end trying to figure him out, researching, thinking about this thinking about that and doubting myself the entire time until all of a sudden it all just made sense to me and I had this clear picture of what I needed to do with him. But I worked hard, really really hard at everything to do with this client and his treatment. So when I did my presentation I did everything I could to paint the picture that I had in my head for the people listening so that they could understand my client and what he needed the way I did. Receiving the positive feedback that I got from the supervisors gave me such a happy feeling inside but also this feeling of a huuuuuge relief. Relief that what had made sense in my head had made sense in the heads of professionals. What I was even happier about was that what I had been doing with my client was right which meant I was helping him and making a difference which for me is the biggest reward.

But now two days later after thinking about all that happened on presentation day I am feeling a little scared and worried. Now that I have set this standard for myself, what happens if in finals I do not achieve what I did now?  I don’t want to be the person who goes backwards when everyone else shows huge improvement. Maybe I had it easy this time?.... I am going to do all I can, work twice as hard if I have to to understand my new client the way I understood this one because that feeling of just knowing what to do and how was incredible. Maybe I should be seeing this as a challenge to myself to outdo my last performance, take it to the next level.

So mixed feelings about presentation day but from another perspective it was a great day of learning. Although we all stress ourselves out about it, at the end of the day it’s just a day to figure out where you went wrong, where you went right and why which is a great opportunity so that we can do what we need to to improve for finals, when it really counts. Seeing what the others students have been up to at their prac sites was really interesting and it was great for us to see where they were going right or wrong for next year when we find ourselves at those placements. I personally just feel there is too much negativity around midterms and maybe we should start being grateful that we get a chance to ‘mess up’ and be told why so that we can fix it….