We can do more than survive, we can flourish

By Steve Carter, Mental Health Promoter, Mental Health Foundation

Few Cantabrians will have failed to be moved on reading John McCone’s article (The Quake’s Long Term Toll – Press 5/11). As with much of the best writing it holds a mirror up to our own experiences, giving me permission to admit that I am emotionally and physically exhausted. My long term relationship has ended and some of my closest friends are no longer here, having fled in the face of the disaster. There are days when I feel alone and adrift in the face of an overwhelming and continuing event sequence.

The truth is that none of us can answer the complex range of questions we face. We instinctively know that this is the case and feel the need to relinquish some sense of control but we are not sure how or when this might be possible.

One response is to focus increased attention on our work, as if that might keep the wolf from the door, but even then we risk “hitting the wall” and facing the inevitability of the ‘disillusionment phase’.

I have spent this year reflecting on the veracity of the work I do at the Mental Health Foundation. Mental Health Promotion is not a service response to individual mental illness or distress but takes a wider approach that embraces all the things that support mental health and wellbeing for all members of society. To establish the difference between the two, we assert the use of the word ‘flourishing’. A concept borne out of the positive psychology movement, flourishing is a state where people experience positive emotional affect, positive psychological and social functioning most of the time. When someone is flourishing they feel good and they function well.

Even without the presence of specific diagnosable symptoms, it is clear that the opposite is emerging across Canterbury right now. At the heart of the disillusionment phase is a mental malaise, characterised by tiredness, de-motivation, emotional emptiness. Don Elder captured it perfectly: “I was no longer thinking clearly, performing well in my job or functioning usefully for those around me.”

Flourishing is not just a measure of happiness or life satisfaction or positive thinking. It accounts for the harder aspects of life – grief, anger, frustration – and indeed incorporates them as a necessary part of a broader understanding of psychological and emotional functioning. Could a focus on flourishing be one answer to the phase into which we are moving? Professor Margaret Barry of the World Health Organisation Collaborating Centre for Health Promotion Research might well say so. She has said that “positive mental health is a key asset and resource for population wellbeing and the long-term social and economic prosperity of society”.

The Mental Health Foundation advocates for the use of the ‘5 Ways To Wellbeing,’ an evidence-based framework for the development of positive mental health at population levels. Our work across New Zealand builds upon work done for the UK Government by the New Economics Foundation (NEF), which aimed to develop a ‘mental health equivalent’ of the established five plus a day fruit and vegetables campaign. The project gathered together the results of an international meta-analysis of multi-disciplinary studies to offer a simple and effective set of messages to support the development of positive mental health and wellbeing. They are messages that everybody can relate to: Connect, Take Notice, Keep Learning, Give, Be Active.

The earthquake sequence gives us a unique insight into the effectiveness of strategies such as these. We know that, in the year since September 4, evidence of trauma, including PTSD, depression and other psycho-social impacts have not reached the peaks that were immediately expected. Indeed, it is of enormous significance that statistics from the Office of The Coroner show a reduction in the levels of deaths by suicide in Canterbury over that period.

Of course, the debate will continue about the exact reasons for this, but it is not unreasonable to suggest that what we have seen within our families and our neighbourhoods and communities over the last year strongly echoes the scientific evidence placed before us by the NEF framework. There have been huge outpourings of giving and voluntarism in response to the quakes; people are connected more strongly through shared experience; we are learning new things about ourselves and the world around us all the time; we are all out there, putting in the hard yards; and, at the heart of it all, we are thrown into a situation where, day-to-day, gratitude for small mercies and glimmers of hope for the future may well be the most profound and simple things that prevent us from crumbling.

But as the phase shifts into disillusionment and recognition of the daunting journey ahead, this work can not rest on immediate resilience-building. Questions have to be asked about the maintenance of fortitude among the people of this city. It has been suggested that suicide levels will return to their pre-quake levels once things “return to normal”. Are we really going to accept that as inevitable? What kind of “normal” is that? We are told that the disillusionment phase is “to be expected”. Will we just allow ourselves to capitulate, to accept that we are powerless in all this?

I would not be so glib as to suggest this is an easy task, a simple matter of imagining it all away. I have days when getting out of bed is a struggle. We have seen many heroes over the last year, but it is certain that each one of them will have a point where they need to attend to their mental health needs or risk breaking.

Whilst a focus on our own wellbeing can be empowering and cathartic, there are also broader responsibilities. At population levels, we must engineer situations to enable people to access these tools for themselves. How do employers recognise and support the mental health needs of all their staff? How are our educators assessing and responding to the psycho-social needs of children and their families? How much importance will be placed on mental health and wellbeing when strategic decisions are made regarding the rebuild?

This isn’t just about the immediate aftermath. We have survived this far and we can feel proud of that. It’s not even about negotiating the tricky emotional waters of the disillusionment phase we are told is to come. We actually have a unique opportunity to leave a legacy for the future generations that will live, work and play here. We have the power to define a “new normal”. Is it really so foolish to believe that we can make Christchurch a flourishing city?

The above was originally published in The Press on 21 November

Shaken to the core

It was when I threw my bike across the garden in an explosion of rage that it hit home that I wasn't coping quite as well as I had been telling everyone (including myself). 

Ten days after the devastating February 22nd earthquake had thrown buildings to the ground and made rivers of the streets, it was time to own up to my emotions.

I live in the East of Christchurch in New Brighton, one of the 'hard hit' areas. We had no power, water or sewerage for over a week and all around me streets were filled with water, cracks and liquefaction silt. But I have a camper van and the freedom camper mentality to match.

I have a gas cooker and a full 9kg canister. I have candles, matches and a battery-powered radio. I had dug a latrine and set up a rain-trap within 12 hours of the quake, and, while my kitchen was a mess and much of it was strewn across the floor, I still had shelves full of dry goods, preserves and tins, and my edible garden alone could feed us for weeks. 

I have 12V chargers for everything, so I can charge my swanky new smart-phone in the van and, after two days, I realised I could hook into the lifeline that was Facebook. 

I've been spinning my survival response as “just like camping” and my situation as something “I have been training for half my life”.

Others are much worse off than me and much less prepared for the days ahead. I have hooked directly into impromptu support systems in my neighbourhood and painted myself as the calm, practical one that people can turn to in a crisis. I've even had the cathartic tears, unbidden and repeating for the first couple of days as shock rattled my body and mind. It's good to get it out. I'm okay, right?  Handling it…

But then I tried to pump up those tyres on my bike, the bike that is the best way to get around these cracked and broken streets. I was doing it with what turned out to be a faulty valve and air was coming out faster than I could pump-pump-pump it in.

Suddenly I exploded. 

The bike went across the garden, the pump followed, narrowly missing smashing a window - as if there's not been enough damage already.  My head was fizzing.  I was out of control, screaming expletives, racked with tears of rage, frustration, survivor guilt and grief at the devastation wreaked upon my city, my home.

No, I'm most definitely not handling it…

All the information, everything I reel off in my professional role, tells us that this is 'normal'.  But this is not 'normal' for me. Sure, I am more upfront with my emotions than a lot of people – I have learned to express, rather than bury, my feelings – but not this incendiary rage, something I believed I had transcended during the years of my recovery, left behind a decade in the past. Nor indeed all the other things that began to become apparent to me:

• I have had days of absolute impotence, frozen, staring into space, unable to walk beyond my front gate. 
• I've been snapping at my partner as she returns home, frazzled herself from a day working as a physiotherapist in the harried mainstream healthcare system. 
• I have had other angry meltdowns that reduced me to tears of frustration. 
• I have even had my garden rake sitting at my front door, ready to tackle any bogus EQC assessors or looters brazen enough to try it on at my house. I'm a card-carrying pacifist!  I don't allow my life to be driven by fear!

No, this is far from “normal”.

What it is, however, is to be expected. We are all dealing with an unprecedented situation. 

Loss - of life, of livelihoods, of the very fabric of our city. 

Lack of control – when will a simple switch flick on a light?  When will a tap deliver fresh water? 

Fear and uncertainty – not for a far-off, postulated recovery, but for what will happen tonight or for what tomorrow might bring.  We are living day-to-day, hand-to-mouth. It isn't really like camping. It's not a bourgeois frippery.

If you, like me, are feeling these strong emotions (or you know somebody else who is showing similar signs) and you do not know how to respond, the first thing to do is to accept that they are to be expected.

You are not going mad

You are not “going mad” (whatever that means) and you should neither deny nor hide the pain you are feeling. Face it, embrace it… and then tackle these emotions head on.

As a tai chi devotee for many years, I have a bank of tools from which I can draw that will help me to breathe properly and to help myself find a centre of calm. 

You may not think you, too, have such tools, but they are readily available to you and simply-applied. Check out this wonderful post from my colleague Grant Rix, for practical advice for you and your family, young and old.  And once you have achieved a certain calm, there are also simple, scientifically-tested methods for beginning the rebuilding of your wellbeing and that of those around you. 

Winning ways work!

The Mental Health Foundation uses an approach called “Five Ways to Wellbeing” and you would do well to read this post here (scroll down) for useful suggestions at this difficult time.  I've been talking about it in the abstract for long enough. Now it's real… and I can tell you from first-hand experience that it works.

I got out and connected with others and I am giving what I can to assist in the clean-up.  I spent a day helping a friend take deliveries of water containers, buckets for toilets, drinking water and other necessities to Avonside.

I delivered fresh fruit and aroha to young families in the Aranui area.

I visited the local marae and pledged my support to the hard-hit Maori community across the river from me. People living in neighbourhoods piled high with silt and running with stinking sewage couldn't believe I was there. I faced incredulous questions:

“You're from Brighton? What are you doing here? Isn't it munted over your side of town?” 

I saw heartfelt gratitude and inspirational stoicism and resilience. I came away from a hard day's physical and emotional work re-inspired about my life, my circumstances and about the fortitude of this finest of cities.

The aftershocks continue to rattle and there's a long, uncertain road ahead, but this is my home. This is where I live and where I can be of best use. 

If I can look after Number One, find that oasis of calm in the midst of all this chaos, then I can also be a useful part of the wider recovery, the rebuilding. A part of the future.

And if I can do it, then so can you.

I can be changed by what happens to me, but I refuse to be reduced by it
Maya Angelou

Ka mate te kainga tahi, ka ora te kainga rua
When one house dies, a second lives

Steve Carter, Mental Health Promoter, Mental Health Foundation