Death, Dying, Bereavement, Loss, Guilt…

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Death, Dying, Bereavement, Loss, Guilt…

…the list goes on if we acknowledge all the multifaceted aspects of the death of someone close; a parent, a partner, a sibling, a child, a close friend…and again the list continues.

“Bereavement is the objective state of having lost someone or something. Grief refers to the emotions that accompany bereavement. Mourning is the behaviour that social groups expect following bereavement.” (Walter 1999:xv)

This blog post is about the process of bereavement from both a personal and academic perspective. Many years ago, I learnt all about the sociological aspect of death and developed an understanding as to why some people choose to lay flowers for a person unknown who has dies, or participate in widespread grief for again someone they did not know personally. Throughout my studies and contact with others, I learnt about the practices of some funeral directors and the process of registering a death and obtaining probate. The theory was sound but actual experience was lacking…until June 2014 when my Mother died suddenly. Theory had no choice but to become practice; I entered the world of form completion, ensuring that my Father contacted the correct people and filled everything in properly. I learnt how relatives react when you tell them that there will not be a wake, (my Mother’s sister reluctantly spoke with me on the phone at Christmas, the first time since I had told her my Mother had died and she has not spoken since). I also learnt that a nice funeral can be obtained for less than £2K despite what the media have you believe. Oh and I also know all about probate and the valuation of assets. These things I learnt whilst grieving and watching the support my Father was being given by neighbours and relatives whilst I had none – it was expected that I would cope and get things done.

As far as the outside world was concerned, I did cope, function and provided practical support to my Father, yet in reality I resembled the graceful swan paddling frantically to stay afloat. In around November I crashed, though I doubt anyone noticed because, as Erving Goffman described it, I am very good at “presentation of self in everyday life”, I continued to outwardly function. Early 2015 I received an email from a friend who described a similar feeling and then in March I bumped into someone I occasionally see who was going through the same thing. All of us of the age when parental death is to be expected and having a surviving parent to organise/care for/listen to others show concern for. All of us were grieving yet felt alone as ironically we all perfect the art of the graceful swan.

In 1969, Elisabeth Kübler-Ross, a Swiss psychiatrist, published ‘On Death and Dying’ (reprinted by Routledge in 2009), in which she introduced ‘5 Stages of Grief’. These stages form the theoretical aspects of death and dying and whilst useful from an academic perspective and that of the medical profession, I have discovered from experience that they do not necessarily work in reality (no disrespect intended if they have been helpful to you).
Stage 1 – Denial and Isolation
Stage 2 – Anger
Stage 3 – Bargaining
Stage 4 – Depression
Stage 5 – Acceptance
(Kübler-Ross 2009)

Until attending a recent conference examining the process of death and the criminal corpse (I will discuss this in another blog), I was feeling very frustrated at not neatly fitting in or being obliging to the Kübler-Ross stages; my private trajectory was not compliant. The first keynote speaker, whilst referring to the stages proposed instead GMT, Grief Mean Time. This struck a chord with me, there appeared either, overtly, or covertly a set time- frame for each stage and by now I should be over the death of my Mother. Having considered this expectation I propose an alternative, Grief ME Time – there is no time limit for each stage as every individual is different and recovery is timed on an individual basis (see previous blog for reference to this in respect of health care).

As a child, I looked forward to the annual junior school outing to a local museum. We viewed dead people wrapped in cloth (Egyptian Mummies) and relished (unofficially) counting the fleas on the dead animals! This memory was recalled on a recent visit to the British Museum and their special exhibition of 8 Mummies (Ancient lives and new discoveries). The first, Gebelein Man, was clearly a mummified person without wrappings – he looked just like my Mother resting in the foetal position. It was at this point that I began to make reflective notes or write down my thoughts and feelings about the exhibition. I was a voyeur taking pleasure in the death of another, I was not looking at facsimiles of ‘coffins’ or wrapped bodies but viewing the remains of a human being, abet save from the first, was not clearly identifiable. This felt wrong yet I continued. Perhaps this was meant as some kind of remembrance; the time I spent at the exhibition was symbolic of the time I did not spend with my Mother after she had died.

Death, dying, bereavement, grief….each word is a separate discursive event yet when combined become one. The experience is different but the similar or even the same. The term ‘anticipatory grief’ is often used to describe the process of grieving for a life once lived of someone close who has a terminal diagnose or a life limiting condition. It is as though those left behind are supposed to be relieved and able to live their life again. For some this might well be the case but for others GMT is vitally important. When someone dies suddenly, irrespective of age, it is a shock. If the person was elderly, is it supposed to be ‘a blessing’ and the relatives are expected to get on with things. Well, from my perspective, this is a load of $ollocks – the death of a parent is no more a blessing than that of a child irrespective of prior relationship with the parent.

I miss my Mother, though I do admit that if given the choice I would have preferred it this way with my Father being the surviving parent. I am angry when I go to the GP surgery and the lovely HCA asks me how my Dad is when she is taking MY blood pressure. I struggle to smile nicely at my Dad’s neighbours when they tell me “how well he is doing” yet fail to ask how I am. The person who conducted the funeral has visited him twice yet not once sat down with me.

I am the graceful swan who epitomises Goffman who needs some GMT.

I am not alone but silence and societal expectation separates us.
Goffman – https://www.youtube.com/watch?v=6Z0XS-QLDWM [accessed 27 May 2015]

Kübler-Ross E (2009) On Death and Dying Routledge: Oxon

Walter T (1999) On Bereavement: The Culture of Grief Open University Press: Buckingham

‘Patients’ Experiences Following Major Illness or Injury’

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(I have chosen this image as I feel it reflects the journey into the unknown that patients go through.)

Reflections based upon my attendance at a day conference ‘Patients’ Experiences Following Major Illness or Injury’ on 24 March 2015.

These are my personal reflections based upon information discussed and shared throughout the day. I will be mentioning only one speaker by name and will provide links to his important work, but will respect the requested anonymity that on occasion was requested. As a sociologist I am passionate in making academic research accessible and so will try an avoid using academic language or discourse where possible; please forgive me if I lapse at times!

The focus of the day was to introduce the findings of research conducted using secondary data* taken from healthtalkonline regarding how hospital patients felt their experiences post major illness or injury related to their previous expectations, both explicit and implicit. Discussions focused around the communication of medical staff and societal expectations of recovery; both of which I will expand upon later. (*Secondary data is data that has been previously collected and anonymised then stored for researchers to use later. This means that the research team in this instance did not interview people themselves. I will be discussing the pros and cons of this particular method at the end.)

If you google ‘getting back to normal’ (without quotation marks), the first link is one to a NHS website that unhelpfully mentions simple surgery such as gallbladder removal only takes a week to recover from whereas major surgery such as a hip replacement takes a couple of months! Whilst I am sure the author of the website is trying to be helpful, putting a timescale such as one week creates expectations upon the patient, their family, and perhaps more importantly their employer who could be become suspicious if the employee is taking longer off work. Recovery does not necessarily mean someone can return to his or her normal life or pre-operative state. For some, such as those awaiting joint replacement it is hoped that their new joint will mean their recovery results in a better life; but for those whose hospital stay is not planned due to a heart attack or major injury, life might not be the same and a period of readjustment both physically and psychologically is needed. These issues were the focus of discussions within the conference with many delegates reflecting upon their own experiences of being discharged the day after an operation and being given a sick note for two weeks; an implicit reference to the time expected for complete recovery. The medical profession cannot be blamed for not giving patients more explicit timescales because once discharged from the ward, the nurses no longer see the patient and so cannot know the reality and clinic follow-up appointments can be as long as six weeks later. It is hoped therefore that this research project will assist in informing professionals of the reality faced by patients once discharged from hospital. An excellent example of this was a patient included in the research having been told they would be in plaster for six weeks followed by two weeks of physiotherapy believed, quite naturally, that after eight weeks they would be better. The timescales given by medical staff was explicit but had an implicit meaning.

The data used covered the period 2003-2012 comprising of the following specific conditions/illness: heart attack – 44, intensive care – 37, leukaemia – 39, injury requiring an overnight stay – 45. Within the interviews, participants made specific reference to: the event, their understanding of the event, physical and emotional experiences, interaction with health professionals, challenges of being at home, social support (friends and family not welfare), impact upon their relationships, financial implications*, employment, “getting back to normal”/”almost normal”/”new normality”. (*Welfare as in benefit payments were not part of the research due to the time period of the data set and changing regulations – financial implications are also very individualistic to the illness and individual.) There was also a reference to the difference between illness and injury; whilst no illness is pre-planned, there is a trajectory that most patients will travel from pre-diagnosis, diagnosis, treatment, and hopefully recovery, whereas injury is sudden and unexpected.

An interesting finding from the research was the emphasis by patients upon the process of “recovery as work”. To recover needs work whether it be daily exercises and not just with the physiotherapist, managing as new dietary regime, changing to a more active from the previous sedentary lifestyle, reading and processing the information leaflets given, and perhaps the most important activity of acknowledging self-identity throughout. Whilst this was explained with specific reference to the previously mentioned conditions, it still I feel has resonance with many others. Heart attack – getting better, starting to exercise, change of diet; leukaemia – learning how to avoid infection; intensive care – regaining mobility, accepting why the person was in intensive care (some are pre-planned, others are not), acknowledging and seeking help for hallucinations; injury – adjustment to change of physical ability, pain, mobility, seeking help for why the injury occurred. All of these need “work” by the recovering patient and acknowledgment by those around, including the medical professionals. Many expressed a sense of shock as to how long it took to recover, the great intention to exercise daily quickly became a lack of interest as the results were not as they had implicitly or explicitly been led to believe; they started to feel a failure and a “bore” to their family and friends. The older we get the more likely we are to know someone who has had X or even had X ourselves, how often therefore do we say, with good intentions, “oh when so and so had X they were back at work in four weeks”, or similar? A point I feel it is important to reflect upon – comparing one person with another is not necessarily very helpful, however good the intention!

‘Recovering from critical illness’ was a presentation led by Dr Stephen Brett, an intensive care consultant and academic researcher, (some of his work is available on open access so just google him as I am not sure if this link will work! http://www.trialsjournal.com/content/15/1/38). I will be focusing upon what Dr Brett discussed as I feel it is vitally important work and relevant I feel to all of us. “Leaving ICU is the start of a journey”, a patient is not discharged home from a stay in intensive care, they move to a ward but their stay, irrespective of length is something they remember for a long time yet rarely get the opportunity to talk about. A reason for this is that their memory is often distorted or they wonder if it was a memory or dream/nightmare. They can have acute skeletal wasting due to lack of movement and muscle having been used to provide fuel for the organs, which also results in a loss of memory, attention, executive and linguistic/numerical function – all of which is difficult to quantitatively measure due to being patient specific. Delusions are very common and can still be impacting a patient two years later; these can vary from the patient being convinced they had got a divorce whilst in ICU to having been abducted by aliens – none of which are a laughing matter for the patient and those who care for them. Dr Brett, along with colleagues, recognised that patients leaving ICU needed follow-up care from specialists within the field irrespective of other disciplines involved in their care and as a result offers patients the opportunity to return to a clinic where post-ICU issues can be discussed without the person feeling “silly” and solutions offered. Anecdotally this has helped patients and provided useful evidential data – of course, the attendance at clinic is voluntary and so the information gleaned is skewed toward active participants.

It is not possible to discuss all the issues covered by the conference, but I feel the following example to be an excellent summary of the dilemma facing both the medical profession and society at large. The gender of the patient is known, but to further protect their identity I shall refer to them as ‘the person’ or ‘X’.

X had a prolapsed disc and undergone surgery. Six weeks post-operatively they returned to work only for there to be complications resulting in further surgery due to a loss of leg function. It took three years of rehabilitation for the person to be able to walk again. The secondary data interview reports that the one of the worst experiences was discharge from the hospital once an issue with the bowel had been ruled out resulting in their GP referring to a private hospital for the second operation to be carried out. Five days post-operatively the patient was discharged “in bits” with analgesia but not knowing what to do and was discharged by physiotherapy “against my will” when still unable to walk six months later. The person reported not being able to function at home, do normal things and watched the Olympics by lying on the floor. During this period, family relations began to strain with the partner working reduced hours and this in turn impacted negatively upon their child. X was seen by everyone as ‘disabled’ and they returned to work five months later but found the journey exhausting. Occupational health eventually formulated a nine-month plan for a return to work full time. The person doubted whether they would ever get back to normal and had to create a new normal, which progressively became like the old normal. X concluded that they would have appreciated a proper projected recovery period as they (and society) has set unrealistic goals = failure to achieve = self-failure.

It is this aspect of “self-failure” I now turn to. I am certain this notion is something that is familiar to everyone in some format. Expectations are given to us regarding all aspects of our life; I am a failure at being a domestic goddess yet I still watch those television programmes that make me feel even worse. Issues regarding health, illness, and recovery are much more serious than this. Returning to my earlier point about knowing someone who had a particular operation who recovered quickly, or the totally unrealistic recovery portrayed on the television especially medical dramas. It would be useful if Casualty and Holby showed a discussion regarding what not to do once home immediately after a heart transplant or broken limb, but of course, script writers would see this as boring. At least in The Archers, a character returning home after a nasty accident has not been working at full capacity! I digress, but the media does have a part to play in how we perceive our own recovery goals and that of others especially when sports people return to their sport almost immediately following a nasty injury.

I began with the information regarding recovery of one week after gall bladder surgery and referred to this information as being unhelpful. Documented recovery times are themselves a paradox, whilst it is useful to have an idea in order to alert medical professionals when something might be wrong, the time scales need to account for individuality and how well the patient was before hospitalisation, their age and the nature of their employment (if applicable). The problem of course is that we compare ourselves with others and do not wish to become a burden upon others so struggle on – “Hello X, how are you?” “Oh very well/ fair to middling thank-you, how are you?” and so the conversation goes, especially between people in a GP waiting room!

Returning to the issue of secondary data for those unfamiliar with the concept. Researchers who use census data are using secondary data, the statistics have been gathered by someone else who imputed the information and made it available, this is known as quantitative data. Qualitative data however is the quality information provided in interviews. Some interview transcripts are provided to other research bodies after any identifiable information has been removed. I can testify that researchers when using interview data gathered for their own research do work extremely hard at removing any identifiable trace – I am currently on the advisory group for a piece of research and haven’t been able to identify a case recently presented at a conference, despite trying hard to do so. This unidentifiable information is stored and can be accessed at a later date as is the case in this specific research. The downside or con of using such data is that the questions answered might not fit exactly with the new project and there is no opportunity to re-interview the participant for clarity or further answers. Conversely, the pro or upside is that there is no emotional involvement between the researcher and the participant especially when researching difficult experiences; in this instance, the reference to a specific hospital and/or doctor has been removed so the researcher is not learning information that might influence their own behaviour. An example of this might be hearing that Dr X was rude and hospital Y was dirty, and the researcher awaiting an appointment with Dr X at hospital Y or even being friends with them. The data is used without emotional influence, though of course is open to a varied interpretation by different research teams.

The ‘take home’ message of the conference was that patients are people who are individuals and whose circumstances vary from the patient who had the same operation/procedure etc on the same day. Recovery is a two-way process but realistic goals need to be set by the medical profession based upon the individual and not the perceived norm.

Apps that spy: are they good or are they bad?

There appears to have been much disquiet within my twitter time line regarding an application a well-known charity has created that enables users to be alerted if anyone they follow on twitter uses words or phrases related to possible suicidal ideation.

I have read the updates information on the charity website and apparently it is possible to have your tweets opted out of the app. I am however concerned and share the reservations some people have regarding intrusion but also the responsibility – what to do if you receive an email alerting you that someone you do not know in real life and cannot contact is distress.

Not wishing to comment on the charity and their intentions, which I am certain are only for the good, I am going to discuss this via tweets relating to #TheArchers. For those not familiar with twitter, the use of the hash tag # preceding a word or phrase is a brilliant way of connecting with other people who are tweeting about the same thing. Okay, some of you might not be aware of a fabulous BBC Radio 4 programme called The Archers; it is broadcast Sunday-Friday 19:01-19:15 with a Monday-Friday repeat 14:01-14:15 and an omnibus on Sunday 10:00-11:15. It is a drama programme based around a farming community in a fictitious village called Ambridge, though for those of us who have been weaned on the programme and are avid listeners and/or tweeters, it is not fiction but reality.

It is the reality issue I wish to focus upon because yes, it is fiction but deals with real issues and enables people to tweet about the programme whilst mindful of their own personal experiences, sometimes shared with others online, at other times kept private. #TheArchers hash tag contains a myriad of tweets and is a safe space for people to express their stresses and tensions of the day. As my research interest is discourse analysis I have been asked by potential followers on twitter if I analysed their tweets and my answer is always no, life is far too short, though yes I do read and reflect as many others do. It is therefore not my intention to highlight individuals or embarrass anyone; instead, I will mention general themes in particular those in which I partake.

Should anyone devise an app to detect murdering psychopaths with sadomasochistic tendencies who believe children should be beaten would have a field day with tweets in #TheArchers time line!

A while ago, there was an excellent storyline regarding workplace bullying. The bully was an odious character and I was not alone in expressing the need to insert a red hot poker somewhere painful; in real life the episode of Blackadder where this is alluded to by the Bishop of Bath and Wells gives me the chills and I cannot watch medieval films as I am squeamish. An app however would highlight me as having ‘problems’ and would not detect the sarcasm or irony within my tweet directed at a character in a radio drama.

A few years ago, a character called Nigel came to a sudden end whilst on the roof during a windy evening taking a banner down. His widow Elizabeth is a drama queen and many of us were very unsympathetic towards her sudden bereavement; does this imply that in real life the tweeters are unfeeling and horrible human beings? Of course not, but an app might not realise this. There are many occasions when we tweeters suggest certain characters ought to inspect the roof especially in stormy weather, this is in the hope that the said character will fatally fall off; again are we people who disregard safety and wish harm upon others, I doubt it, but an app might not realise this.

There is a serial nymphomaniac in the village who has a demonic child, well actually all children of Ambridge are demonic and no, devil worship is not really on the agenda, but would an app know this? Over the years we have made fun of her and some even post pictures of a turkey baster when discussions relating to the father of her child are mentioned. Helen is now involved in a relationship and initially much fun was had with #TheArchers hash tag regarding this; however things have now changed. The scriptwriters are using the relationship to highlight psychological domestic abuse so the tweets have changed in format. No longer are they sarcastic, but concerning. People are discussing domestic violence, a very serious issue and are suggesting things Helen should do. Yes, we all know that we are not advising Helen; instead, we are signposting for each other.

As with the workplace bullying, #TheArchers tweeters have moved from sarcasm to care for each other through the medium of a radio programme. This is twitter at its best.

Many people I follow on twitter listen to #TheArchers, we laugh together, are sarcastic and bitchy together during those precious 14 minutes Sunday-Friday yet the rest of time we are so different. An example of this is death and dying. Recently my time line moved from discussing recent family member deaths within our own lives and the genuine pain of loss, to an annoyance a character had not died and then returned to supporting each other. I know my #TheArchers tweets reflected my own recent loss and having the ability to step back was extremely helpful. An app would not know this.

My concern therefore is context, how does this charity app distinguish between a real cry for help or expression of desperation, and a tweet relating to a radio or television programme? I understand the age group it is aimed towards is the generation that thinks it strange I walked home from school across a park having said goodbye to my friends at the school gate and not communicate with them again until the next school day. My world of youth did not consist of a mobile phone and shock horror there were only three television stations; excitement was John Noakes cooking on Blue Peter and being radical was watching Magpie on ITV. The target group are those who communicate constantly by text and online devices, in other words, they are more likely to know the people who are in distress and know how to contact them or know others who can do so. If the app assists young people to help each other and openly discuss mental health issues without stigma then it is a good thing; if it spies unnecessarily upon people and causes alarm to followers then it is not. I suppose time will tell, but it is not something I will be downloading.

Issues relating to mental health are being discussed more openly now and this can only be a good thing. The ability to let off steam, express feelings and have deep discussion within the medium of twitter are important and I just hope that this app does not detract from the insights I have personally gained from learning from others and the support I have been given, especially recently. Apparently, this app will email the followers and the tweeter; surely, this will make a person feel embarrassed and less likely to be open again? If this were the case then I would judge the scheme to be a failure especially if targeting the generation who have been raised upon airbrushed images of so-called perfection and reality television as a way to become famous and successful.

Anyway, they are my thoughts, and if you do tweet #TheArchers, do please continue and I promise you I am not conducting research on your tweets, I am responding just as everyone else is; a murdering psychopath with sadomasochistic tendencies who believes children should be beaten… but only whilst listening to #TheArchers!

ACCESS, ACCESSIBLE, ACCESSIBILITY

 

 

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Hello Blog, I’ve neglected you in print, but not in writing.  My excuse is simple; I have had access issues.  Access is a strange word as it can mean different things to different people and the context can vary.

The access problem I have had is forgetting my password and the reset link not sending an email.  Yes, I have now remembered it!  This got me thinking of the areas within my life, which are controlled by access or permissions or enablement.  Access to a website is enabled via a password giving permission to enter the site or in the case of academic journals, read more than the abstract.  What happens though when the process we are led to believe is simple yet secure breaks down?  What words do we use when requesting a new password or enquiring why we cannot benefit from full usage of a site?

A few years ago, I had this problem.  The final modules for my most recent MSc required reading additional material and communicating with fellow students via Moodle, a new venture for my institution.  My login should have enabled me access these additional areas, only it didn’t!  Not being a defeatist, I contacted the IT bods who decided that it was a disability issue (I told them I could not access) that I could not read the screen.  Next step was speaking with the post-graduate office; foolishly I again used the magic word ”access”.  It took a year of me using the analogy of asking a colleague to collect some files from the back seat of your car and giving them your house keys.  Eventually a bright spark twigged and said, “Oh you mean permission?”

If an academic institution only uses one definition for “access” then what hope is there?!

So to access many aspects of day-to-day living from banking to reading newspapers online, a password is needed, or a PIN (note not a PIN number – you can’t have a personal identification number number!), these give access in order to enable the site.  Passwords however are a pain, yes, I understand why they are used, but remembering them without writing down is becoming increasingly difficult.  I know I am not alone in groaning/screaming/muttering rude words when the site requires upper and lower case letters, at least one number and at least one symbol, oh and needs to be at least 48 characters long!  (Fine, I’ve exaggerated that last bit, but you’ve been there!)  Online security bods righty tell us not to use the same password for everything, or have it resemble our address, date of birth etc.  Dear Security People, we can remember those!  In addition, don’t get me started on mother’s maiden name, first school, and first pet – it does not a genius to find out those.  Incidentally, I lie when inputting that data!

If communication is rapidly moving towards a digital discourse, then access is important.  I am now shifting my discursive positioning to access as in accessibility and enablement.

On 20 September 2013, the BBC website highlighted the importance of ensuring that technology is accessible for people with disabilities – http://www.bbc.co.uk/news/technology-24171027 .  I suggest this should in fact be ‘accessible for everyone’ as a disability is not always evident and there are many people who require short-term assistance in the form of lessons enabling them to benefit and not be frightened of technology.  Enablement however is expensive, you only have to search for a mobile telephone with big buttons to see this – if you haven’t then do and join me in anger that they are specifically marketed towards older members of society and cost a fortune.

In returning to my heading, access, accessibility and accessible, I was delighted to read of the successful court action of wheelchair user Doug Paulley regarding the travelling on public transport, specifically buses http://www.bbc.co.uk/news/uk-england-leeds-24214346 .  A bus having a wheelchair symbol on the side is useless if a user is denied access thereby denying the access to the same destinations as other passengers.

Access, permission, enable, are all different words and are used collectively or individually.  The meanings are different and also the same, dependant upon the context.  If you have read this far, then thank-you and I would like you to remember this thought for future reference.

The next time you have forgotten your password/PIN, consider those for whom access is being denied due to technology or ignorant indifference.

 

Rewire Your Brain For Love

Whilst I have not been paid to write the post, in the interest of ethics, I was sent a free copy of ‘Rewire Your Brain for Love’ by Marsha Lucas.  The nature of aquisition has not influenced my discussion of the book.

Marsha is an American psychologist writing in an intelligent engaging style rather than the ‘everyone is in therapy’ American sitcom genre.  The book therefore is not a self-help panacea for all ills and a feel good read; instead, using her qualifications as a psychologist, Marsha takes the reader on a journey of exploration into how all brains function and react.

It is important to read and carefully digest the information in the first section and not read in one session.  The book is about re-wiring existing circuitry, rather like the electrician conducting a safety check and taking action where appropriate rather than gutting the property!  Marsha provides a guide in using what is in-situ, thereby not perpetuating any sense of failure the reader might already have.

The electrician, or expert, who carries out the re-wiring is the reader through the practice of meditation, or more specifically, mindfulness.  Marsha discusses briefly the scientific evidence surrounding the practice of mindfulness and whilst not directly referencing the sources, I have such reports in academic journals and can attest to the efficacy suggested.  Like anything though, it needs regular practice to work and Marsha explains this through reference to a patient previously introduced.  The case studies are utilised effectively and are easy to associate with in the UK.

This is not a book for those who want or need immediate answers, instead you need to engage and process in order to accept yourself and your ability to re-wire you own brain.

WHY I TWEET

Before tweeting, I was a nosey reader, but only for a few months whereas I’ve been reading blogs for many years and thinking “I really ought to do something”.  Well, here I am!

So, why do I tweet?  The short answer can vary on a daily basis, so I’ll give you the long version – I love it.  Someone is generally about for a quick natter or ‘water cooler conversation’ about a radio programme (Radio 4 or World Service), television (not reality), books, and of course, the weather.  If anyone had told me that the ain of any day (apart from Saturday) was to be re-tweeted or favourite by The Archers twitter account I’d have seriously doubted their sanity…but hey, as one grows older, one gains pleasure in such things!

Apart from brief interactions with people I would not otherwise meet, Twitter is a great educational resource.  Free academic journal article links are often tweeted by Sage Journals and many academics tweet links to their blogs.

So, why am I now blogging?  Well, apart from feeling guilty at reading lots of blogs and failing to act, I want the opportunity to write and share more than the restriction of Twitter allows.  I make no apology for my intention to blog intellectually at times and referencing materials only accessible via academic portals, but hope to remember to indicate this at the beginning.

I have an interest in Mindfulness Meditation, and this will be the subject of my next blog.