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Mentally Interesting: Anxiety or heart attack?

When mental and physical health collide.

Can you tell if your pain or symptoms mean you have a physical or mental problem?

Our presenters often delay getting medical help because of this and worry everything will be put down to mental ill health.

Plus, guest Helen Moulinos from POHWER explains what advocacy is, and describes how she learned to speak up for herself and her mentally ill father from very young. She is also a 9/11 survivor.

With Seaneen Molloy and Mark Brown. Produced by Emma Tracey.

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email ouch@bbc.co.uk

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35 minutes

Transcription


Mentally Interesting Episode 713 January 2022bbc.co.uk/ouch/podcast
Presented by Mark Brown and Seaneen Molloy
MusicFeaturing upcoming clips.
Seaneen - This is mentally interesting from Â鶹ԼÅÄ Ouch. We’re Seaneen Molloy and Mark Brown and we’re here on your Ouch feed throughout January 2022. 
Mark - We’re friends. We’ve known each other for ages. We both experience mental health difficulties and we absolutely love talking about them. On this episode we’re going to be talking about the relationship between mental health, physical health and how that relationship is a bit more like a sitcom bad marriage than it is like a beautiful romance.
Seaneen - And always there’s a guest. This time we’re welcoming Helen Moulinos and she’s going to talk about how you can stand up for yourself and what it’s like living with post-traumatic stress disorder.
Mark - And of course, wait for a it, at the end of the episode, as ever, there’s going to be a new wonderful exciting feature. But you’re going to have to listen till the end to find out what that is.
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Today we’re talking about physical health when you experience mental ill health, and mental ill health when you experience physical ill health. That is an absolute mouthful to say and it is even more of a mouthful to live through. I don’t know about you but when I don’t feel well I often really, really struggle to work out whether it’s my mental health that’s rubbish or whether it’s my physical health that’s rubbish. And sometimes I just can’t tell the difference at all. I get quite anxious about stuff, and since my sister died I’ve been having far more health anxiety than I ever had before. And I’ve also been having far more indigestion. And the thing about indigestion is you think heart attack.
Seaneen - You mean heart attack, don’t you? 
Mark - Yeah absolutely. The symptoms of indigestion and the symptoms of heart attacks are really similar. And I just find it super, super, super difficult to talk about the kind of intersection of the two, because it all happens in your body; your brain is part of your body. Well, usually, unless you're in one of those science fiction films and it’s in a jar somewhere. But things like panic attacks are physical things. I really, really struggle with like mood and exhaustion as well.
Seaneen - 
You mean cancer?
Mark - Yes! [Laughter] I can’t tell whether I’ve got depression or terminal cancer. At 3 o’clock in the morning it’s really difficult to find the correct point between the two. I find it really hard to admit to being ill, so I do the ridiculous thing of dragging myself around like a character from the Walking Dead, one of the dead ones, and then waiting for someone else to tell me I’m ill. And when you’re an adult other people don’t really tell you that you’re ill.
Seaneen - Speaking of which I’m doing this podcast with my brain full of snot and my chest full of cough. When I started I wanted someone to tell me that I’m too sick, that’s like I’m giving responsibility over to you because I don’t trust myself in terms of knowing my own physical health. 
Mark - Yeah, in the production meeting we just went, oh it’s all up to you Seaneen, don’t you worry, if you don’t feel…
Seaneen - Don’t leave it up to me. I’m mental!
Mark - Well, that’s the thing, isn’t it? If you’ve experienced challenges with you mental health things like depression, things like anxiety, things where what’s happening in your head isn’t necessarily what’s happening that other people can observe it can be really hard to go, actually this is definitely a physical thing. So, I’ll do the ridiculous thing of spending four or five days going, oh god, I feel so tired, oh maybe it’s because I’ve got flu, maybe I’ve got an underactive thyroid, maybe I’ve got an overactive thyroid. And then someone will go, so how much sleep have you had in the last week? I’ll be like, oh two or three hours a night. They’ll be like…
Seaneen - Maybe something to do with it.
Mark - …you are such a prawn. Sit down, have yourself a bar of chocolate, maybe just have a sleep. The whole challenge talking about mental health, and physical health to an extent, is you’re finding ways of describing things first to yourself and understanding them, but secondly to other people. When I’m trying to explain how my mental health feels to a colleague or a friend goes, so how are you doing, and I go, well I’m doing okay. And then they go, are you sure? You look a bit ill. And then what happens is I try and explain what I’m actually feeling and it just turns me into the world’s shittiest poet. It’s like it’s coming up to SAD season, so seasonal affected disorder season, so I generally tend to kind of slow down and stuff like that. If someone says, how are you feeling? I should just say, oh I’m feeling tired. But I’m no, I feel like an autumn tree full of Victorian ghosts. And people go, well what do you mean? it’s like…
Seaneen - It's self-explanatory really.
Mark - Yeah, I experience SAD so around this time of year I feel like I’m living under a massively heavy embroidered eiderdown that’s just getting heavier and heavier and damper and damper and more and more covered in mildew. People go, okay, so you’re all right then? and I go, yeah, yeah I’m fine. 
Seaneen - I am a lot less lyrical than you I think. How have you been feeling? I feel rubbish. I feel like pants.
Mark - It does come from growing up in a situation where mental health really wasn’t talked about at all. Half of what I say is meaningless, I’m saying it just to reach you. To quote John Lennon, it’s like trying in some ways to make contact with another person so I can get some sense of how it feels to be me inside. My problem growing up was explaining sometimes in so much depth that other people would go, uh-huh, yeah, no that sounds terrible. Actually I’m feeling a bit weird now myself. Actually yeah, I’m just going to go home and go to bed. You’re right, the universe is meaningless. It’s awful. 
Seaneen - My body’s weird; when I am struggling mentally it tends to send a plague. It’s almost like it’s trying to slow me down. 
Mark - Frogs? Locusts?
Seaneen - In my case I get hives or shingles. Because I remember once when I was kind of manic and with all the attendant stuff like I’m not sleeping, I’m being that person that people move away from on the bus, it was the first time I’d ever had shingles and it was all over my body. I went to see like a walk-in clinic about it – this was when I was lurching around central London being mad – and explained what it was. And she said, ‘you seem a bit unwell to me’ kind of trying to be polite about it. She said she thought it was like my physical health trying to slow my body down. And I feel like that does happen. But also it makes it hard for me to separate when I am physically ill or whether it’s my body trying to stop me being mental. 
You were talking about earlier, am I having a heart attack or is it indigestion, I’ve had that so many times; there have been one or two times I’ve had to phone an ambulance, and I wasn’t sure whether I was having a heart attack or whether it was anxiety. And yeah, it was anxiety, but it also meant that when I did start getting more regular heart stuff, I’ve had palpitations and stuff, it took ages for me to go and see a doctor about it because I was just worried they were going to just say, you’re anxious, go away. I hate going to the doctor. I hate seeing my notes flash up on the screen and I can see my little diagnosis boxes. Now at least they don’t ask about self-harm every single time I go. But it used to be if I went to the doctor for anything physical they would ask me about self-harm. A couple of times they would ask me to whip my sleeves up and I’d be like, what. 
Mark - Excuse me?
Seaneen - Yeah, excuse me, I’m here because I have chronic diarrhoea or something like that. But it does really put me off going to get any sort of help. And I think that’s probably quite true for a lot of people with mental illness. People die younger, 20 years younger than the average, and I think a lot of that is because we just don’t want to see a doctor. And there’s also the fact that people with mental illnesses are often on medications that have side effects which are never explained to you. You might get like a leaflet but you don’t know that this medication is going to give you diabetes basically, or with antidepressants can cause heart issues or make heart issues worse. Like technically you’re meant to get a check every year, but I’ve been on antipsychotics for 16 years basically, on and off – on at the moment – and I only just had my first ever diabetes check. I’m fat as hell because of medication basically. I should have had these checks before. And I only got this check this time because I had diabetes in pregnancy. So, I think there’s an unwillingness to go and get help, but there’s also an unwillingness from doctors to actually pay any attention to the physical health of people with mental illness, because I guess it’s not as immediately life threatening. 
Mark - With my physical health I always feel like someone is going to tell me that I’ve done this to myself. 
Seaneen - Yeah. 
Mark - And that it’s all my fault. And admitting to having not looked after myself seems like a very, very terrible thing to do. Which kind of interacts with being unwell where it’s much more difficult to look after yourself. 
When I was younger I was much more laissez faire about my health, and I was probably much more ill. But also because I didn’t feel like I had that much that I wanted to live for. And as I’ve got older more and more I kind of think I would love to have as many years on this Earth as I could possibly have. And then as if by special delivery, a big cardboard box of shame and guilt and anxiety arrives, and I’m just like, oh my god, what if I’ve spoiled my body forever, what if there’s something I didn’t do 20 years ago and now I’m going to be absolutely ruined. 
Seaneen - Yeah, I kind of think that way as well. But I think I have actually wrecked my body. There was just stuff I didn’t get any help for when I should have done, for fear of being misunderstood, like years ago when I had bulimia like very badly. People, if you don’t know bulimia, it’s when you throw up food or use laxatives; and I did both. That’s had a long-term effect on me because it led to physical health problems. I still suffer from some of those physical health problems. It’s affected my blood pressure and it has wrecked my teeth, like big time. And it's basically where I started getting problems with my throat. It took me ages to go and see a doctor about it, and when I did they practically applauded me because I’d lost loads of weight. So, all the doctor had seen was a fat woman who lost weight, rather than someone who had a mental health problem that was causing her physical issues. And that’s kind of overshadowed a lot of my physical healthcare. The weight gain I had has been caused by my mental health because the medication that I take made me put weight on. But then every time I go to get any help for physical stuff, or even sometimes mental stuff, it comes back to my weight. Yeah, it’s tricky.
Mark - It sounds absolutely bloody horrible.
Seaneen - There’s too much of a one size fits all thing about what being healthy actually means. Being healthy is different for different people. It kind of bothers me in mental health, but specifically around eating disorders. Fundraising and let’s get healthy together stuff it’s all really focused on exercise numbers: do a 10k run or do 10,000 steps or have a no-sugar week or whatever. And I think it’s pretty counterproductive. For some people that’s not healthy; that is their unhealthy, that is the bane of their life. For some people it’s healthier not to do exercise; it’s healthier to have the bag of crisps at lunchtime, it’s healthier to stop counting. And I think that’s a problem generally with society that it has an idea that this is what healthy means, when for lots of people that is not what healthy means.
°Ú²Ñ³Ü²õ¾±³¦±ÕÌýMark - You’re listening to Mentally Interesting from Â鶹ԼÅÄ Ouch. If social media is your thing we’re Â鶹ԼÅÄ Ouch on Facebook and Twitter. And if you subscribe to Ouch on Â鶹ԼÅÄ Sounds you’ll never miss an episode again. 
Seaneen - We have a guest. We’re delighted to have Helen Moulinos with us. She is the CEO of POHWER, which has a H in it, so P-O-H-W-E-R. It’s a UK organisation which helps disabled people get their voice heard. And Helen’s mentally interesting too, as are most of our guests on the show, and she has her own experiences which she’s going to chat about. Hello Helen.
Mark - Hello.
Helen - Hello Seaneen, hello Mark.
Mark - First question, Helen, lovely to have you on the podcast, is: why is the organisation called POHWER?
Helen - POHWER stands for People of Here Want Equal Rights, wherever here may be. Originally when it was set up in 1996 we were a small Hertfordshire based organisation, so the H back then stood for Hertfordshire. It was started by a group of people living with mental health and disability who were tired of people talking about them, tired of not being consulted about decisions that impacted them, and tired of their human rights not being upheld. So, those founders who were really keen to ensure people had social justice in their lives that spirit still runs through our organisation today, which is 25 years old this year.
Mark - How did you get into doing the stuff that you do?
Helen - Probably I’m just finishing my third decade of working. I have always lived with mental health since I was a very, very young woman. For 31 years I have been engaged as a campaigner in a variety of causes, starting as a youth activist supporting people with HIV and AIDS rights in New York.
Mark - Wow. 
Helen - Moving into mental health. And I think I just got to this place where I thought I needed my job to reflect my values. I needed to channel my passion and my energies. As many people who live with mental health, I’m not always in control of my own mental health or my own fate, but the opportunity to run an organisation which helps 400,000 people get the social justice, have their rights upheld in public institutions, was just too good to pass up really.
Seaneen - So, for people here who don’t know what it means, what is an advocate and what can they help with?
Helen - Sure. So, what an advocate can help you to do is first of all provide you with information. Information in the right hands is very, very powerful. So, what are your rights, what are you entitlements, what are your choices in any given situation – and we’re talking here about mental health and really healthcare. So, in that context an advocate, for example, could help you to raise a formal complaint with the NHS. An advocate could help to support you, to accompany you to a meeting for example with the NHS. An advocate can also help if you’ve been detained under the Mental Health Act, they can help you with tribunals that may come up, they can help you to understand your human rights and safeguards that apply to you, and really how you might raise an appeal. If you lack mental capacity they can support you with a range of other things. 
Mark - Sometimes you have no idea what good care or good support would look like. Where do you find that kind of tipping point? 
Helen - If you’re unsure, am I being mistreated, you can actually ask an advocate that question: I’m unsure about this, this doesn’t feel quite right, am I entitled to this, do I have these rights, should I be expecting something different. An advocate can help with that. An advocate can help you to speak up for yourself or to help to structure your thoughts or views into a way. Because sometimes when we’re emotionally in a situation it’s hard for us to be able to articulate what that is. I don’t know about you, Mark and Seaneen, but sometimes if I’m in a crisis I just have gobbledegook coming out of my mouth and I don’t really know. 
Mark - It's all rubbish and I’m rubbish and it’s all rubbish, it’s terrible, help.
Helen - Exactly. So, having someone who’s almost a sounding board to be able to do that. Sometimes it takes a third party in a room to challenge someone in a public service and say, hold on, you know what the rights are, you know what the laws are, my client actually is entitled to this support. And sometimes it is about someone else championing your corner to be able to say those things. So, I think asking yourself can an advocate help me, do you need information, do you need options, do you need a sounding board, do you need just somebody you can talk to in a safe, independent space who isn’t affiliated with the person you’ve got a problem with – that’s what an advocate can do.
Mark - That sounds absolutely mint and wonderful and I would like to sign up for an advocate now, thank you. [Laughter] You’ve set out the store, so great for advocacy; what are you experiences of being your own advocate in your own life or for people in your life that you’re not professionally working with?
Helen - So, I live with depression, PTSD, I’m single-sided hearing and I live with dyslexia. And these are all part of the colourful tapestry that make me who I am. And some of those things are really easy for me to manage on certain days and some of them are much harder for me to manage. And I think when I look at my own life I have felt very hopeless, very helpless, not listened to, talked over, fobbed off.
Mark - Yeah.
Helen - And I think a lot of our listeners will be listening to this and going yeah, completely relate to that. 
Mark - Yeah, it is our kind of constituency I think.
Helen - Yeah. To be honest I’ve gone through all the emotions over the years: I’ve been really super angry; I’ve been super aggressive. I think I cycle through all the characters in Winnie the Pooh: I go from Eeyore to Piglet to Christopher Robin, back to Pooh. I really want to channel Tigger but I don’t think I have the mental health for it. Tigger for me is that mentally very happy person, which I can never become. 
Seaneen - A lot of people find Tigger really annoying though.
Helen - Tigger is really annoying, let’s be honest, right.
Mark - He’s a right bouncy prawn.
Helen - Absolutely.
Seaneen - Chill out Tigger.
Helen - Exactly, he’s a smug person, smug, smug person. 
Seaneen - Eeyore for the win all the way.
Helen - Eeyore for the win definitely, definitely. But yeah, I think I just got tired of finding new ways to advocate for myself. And education and information were the most powerful things for me because once I actually started to understand what I was entitled to boy, did I become a right old pain in the side for doctors and other people. And I think that was important. 
I had a father who lived with OCD and schizophrenia who died about a year and a half ago.
Mark - I’m sorry.
Helen - Oh no, it’s okay, he had a very long life. But as a young woman – I’m going to say this with a lot of love and humour – I used to spend a lot of time in the emergency room with him because he was often in the emergency room because that’s part of what he was about. And the number of people who were just incredibly cruel and horrible to him, the number of places he was banned from and shut out from, he became almost like the boy who cried wolf. And what was really sad to me was when my father was finally diagnosed with all these things that he had spent a lifetime living in fear of he told me he’d never been happier. He said to me, ‘I finally have cancer and a heart condition, isn’t it wonderful?’ And I thought that was so sad to me that his entire life he had sort of spent waiting for that to happen, and he was so relieved when it did. 
Seaneen - Yeah, I can understand that. 
Helen - But that’s I think my earliest experience of being an advocate for someone else, not just myself, actually feeling just like I had to be the champion in the room if no one was listening to my father. And I certainly have felt that for myself and others as well.
Seaneen - You mentioned that you have PTSD. And we’ve never actually spoken about PTSD or complex PTSD on our podcast before. Is it all right to ask, how did you end up with PTSD and how does it affect you day to day?
Helen - I am a 9/11 survivor. And so following 9/11 I ended up moving to the UK ten days later. I had a job offer the day before 9/11 so I was moving to the UK. And then found myself in a foreign country alone, not knowing what was happening to me. And having lived with depression I knew that monster quite well, but suddenly I was experiencing a whole host of other things. I was experiencing really heavy hallucinations. For example walking down a London street I would suddenly have a flashback of images, sounds, smells, just for seconds in the strangest places, like in Sainsbury or something. And they were coming thick and fast the images. And I thought I had lost my mind; I didn’t know what PTSD was. I was in a professional job where I was just trying to get on with things to deal with what I’d seen. And to be honest I kind of carried on. I remember I’d sit with co-workers and have these sounds and all this stuff going on and I was too ashamed to tell them that I was actually seeing things because I didn’t quite know what to do. I went to see a GP who diagnosed me with PTSD and put me on a regime of support and medication. We tried different things. It was a bit touch and go there for a while. But PTSD now 20 years on from 9/11 affects me slightly differently. So, I still have hallucinations but not as frequently; they appear like once a year or something. I never know. It’s always something like the sun shining in a certain way or a certain noise or a smell that will trigger me. And it passes as soon as it comes. That’s actually quite manageable.
What happens when I’m unwell, my mental health is unwell, or if I’m exhausted and not looking after myself is the whole world does feel like they’re on attack. So, I become over-sensitive, I take things really personally, I deeply internalise them, I catastrophise, and actually I just feel things much more personally and much more deeply than I would if my mental health was all right. 
The biggest impact the PTSD has had on me is actually that cycling in and out of crisis. And it’s perceived crisis rather than real crisis, do you know, sometimes? 
Mark - Yeah. 
Seaneen - Yeah. So, how do you manage then day to day?
Helen - Oh yeah.
Seaneen - Is that the big question? It’s a big question for all of us.
Mark - A massive one, isn’t it?
Helen - Structure I find is really important in my life. And it’s about not too much structure, so not too regimented. But I think for me a good day is actually getting out of bed and saying to myself I’m still alive. And a really even better day is one where I’m smiling and actually connecting and feeling the world and experiencing the world. After 9/11 it took me some time to find humanity in simple things and belief back in the world. I think support is important. So, we talked about the importance of medication and counselling. Routines vary from person to person. But also I know the two of you don’t love exercise, I actually really like exercise, and not in a way you might think; so I’m not superwoman, I’m the middle-aged fat bird at the back of the class. But I think rather than go into those settings and say, I’m going to be as fit as all these amazing young people in front of me or these healthy people, the way I look at it is – I know this sounds strange – but since we’ve come out of lockdown I learnt to do a burpee. It took me a year, and that might make people laugh.
Seaneen - A burpee?
Helen - A burpee, I did a burpee.
Mark - What’s a burpee?
Helen - A burpee is a thing where you squat down and you kick your legs out in a very athletic way, like a push-up. You end up in a sort of push-up position, but you start in a squat position, kind of kick your legs out. It’s taken me a year of practising that every day. Now, to most people they’ll be laughing, they’ll be like gosh, how unfit is she. But let me tell you I felt pretty good about it, and I felt really good to be able to do a plank. And I know this sounds strange but those small goals in my life or learning to cook a certain dish give me self-esteem and confidence and self-worth, and they’re things I can control. 
Mark - I suppose being the best that you can be is different from being the best, isn’t it?
Helen - Yes. The best that you can be, exactly, and that’s exactly right. And I think also, lastly, being unapologetic about telling someone that I’m in crisis.
Seaneen - Thank you for sharing all that. 
Mark - Thank you for that Helen. That was absolutely amazing. And just to finish off, where can people find out more about POHWER?
Helen - Sure. Thank you for having me first of all. So, you can go onto POHWER’s website which is www.pohwer.net. I think that would be the first port of call. Or you can call us on 0300 456 2370.
Seaneen - °Ú²Ñ³Ü²õ¾±³¦±ÕÌýThis is Mentally Interesting from Â鶹ԼÅÄ Ouch with Mark Brown and Seaneen Molloy. Our email address is ouch@bbc.co.uk and you can subscribe to Ouch on Â鶹ԼÅÄ Sounds.
A massive thank you to Helen there for chatting to us and sharing so much about herself as well. As well as very helpful tips for anybody who needs to get their voice heard.
Mark - And now [siren and whistles] it is time for our magnificent, wonderful, unheralded new feature. Da, da, da, da, da! What is this amazing feature, Seaneen?
Seaneen - Well, Mark, you and I are from a very long lineage of madness and I wanted to talk a wee bit about madness in history and a specific phenomenon I find really fascinating. I want to talk to you about the Tanganyika laughter epidemic, which was an epidemic in 1962 where suddenly at a girls’ boarding school three girls started laughing, and that was how it began. And it spread throughout the entire school which had 160 pupils. People were laughing for up to 16 days. They couldn’t stop laughing, and the teachers weren’t affected, and it caused the school to close. Then the laughter spread; it spread out to the village, then it spread to villages beyond there. Eventually it affected 1,000 people and it closed down 14 schools. And then just stopped. 
Mark - The reason why I was a bit quiet when you were talking there, Seaneen, is because as soon as you started talking about the laughing delusion and mass hysteria I started laughing. And I thought oh my god, have I got it.
Seaneen - Oh no, missed it!
Mark - Schools are amazing for hysteria like that because when I was at school at least once a term there would be the rumour going around that the kids from the next school along, our rivals, were going to turn up and smash everyone’s head in. And it would happen once a term and everyone would get really, really excited, and all the teachers would start getting cricket bats and snooker cues out of the staff room. And then it never happened. And I looked it up and it’s really quite common for schools to have experiences of really transmissible ideas. In the 70s in the UK it was really common for schools to have the rumour that skinheads were coming to break the school up. And then it kind of changed once it got to the late 70s and it was punks were going to come. And then by the time I was at school it was just the local rival school. So, what was going on there do you reckon?
Seaneen - There are different opinions about this but I think you’re right about the transmissible ideas, like contagion. I find it so interesting like mental health contagion, it’s happened throughout history, like the dancing plague of 1518. Have you heard of that?
Mark - Tell us more.
Seaneen - It just happened. Strasbourg in France, so one person started dancing and then 400 people ended up dancing and joining in. And this was in the middle of July, so hot, and people just danced until they died. I think these things happen from stress, you’re kind of stressed out, and the way you release stress is usually by some sort of paradoxical reaction like giggling or moving around, like twitching or whatever, so like dancing. And I think in a setting like a school where there’s a kind of expectation of how you should behave, you have to be good, you have to be quiet, you have to listen, you have to sit up straight, you wear your uniform.
Mark - You have to fight the skinheads. 
Seaneen - Yeah. That kind of stress on you is probably a lot greater than it would be at home.
Mark - But also as well like thinking way back to the start of this episode and what we were talking about, in some ways it feels like it fits very well with anxiety, like not being able to tell the difference between indigestion and needing to have a good burp and having a heart attack. Once you get that idea fixed in your head that something is up or that something is happening it can be really hard to shake off that experience. That’s where I get, not laughing, hysteria, but late at night being unable to shake the idea that I am terminally ill, until I go to sleep and wake up and the situation is different. So, I can see how that kind of mutually reinforcing almost like lower-level panic, because it happens again with schools and…
Seaneen - Can I tell you something that happened in my school?
Mark - Yeah. 
Seaneen - I went to a Catholic convent school in west Belfast and it sounds totally made up but we actually had is the Virgin Mary statue crying kind of thing. 
Mark - Really?
Seaneen - Yeah. We had a Virgin Mary statue in the grounds of the school, and one of our nuns had died and one person had said they saw the Virgin Mary statue crying. And this idea spread throughout the school of the crying Virgin Mary statue. Basically the same thing replicating from France, Saint Bernadette and spring and stuff. It’s amazing how these things spread. And they’re very culturally bound; like a Virgin Mary statue crying in part of south London or whatever is not going to have the same kind of grab on people as it does in a Catholic school in west Belfast which has a strong identity of being like a Catholic area and stuff. 
Mark - I read a book called Crazy Like Us, like apologies for the word crazy, by Ethan Watters, which is about the globalisation of mental ill health. His argument is that depending on where you live in the world you have what are called like symptom repertoires or disease repertoires, so things are expressed in certain ways in certain cultures depending on where you’re from. And his argument is that because of the growth of the internet, but also the growth of kind of international mental healthcare, local specific expressions of something become globalised into the American and European definition of what a health condition is. So, things like fainting disease used to be common in some countries, and then that became reclassified when psychiatrists from those countries travelled to the US, the centre of psychiatry, into anorexia. And then suddenly there wasn’t any fainting disease, and everything was described in terms of anorexia rather than something else. 
And I think that’s one of the challenges with mental health stuff, going back to you being a terrible poet and trying to describe internal symptoms, you find ways of expressing something that sound correct, but those are influenced by your culture and what there is around you. It's a fascinating, fascinating thing, but it really, really, really mashes your brain when you start thinking about it because it leads you off into a weird area of philosophy, like is language the same as the thing it describes?
Seaneen - It would be good to do a podcast just on this. 
Mark - Yeah, we could do a very, very long one.
Seaneen - A Crazy Like Us podcast. 
Mark - [Music - ] Thanks for listening to Mentally Interesting. We are Mark Brown and Seaneen Molloy.
Seaneen - If you’d like to get in touch with us email ouch@bbc.co.uk, or search for Â鶹ԼÅÄ Ouch on social media. You can also subscribe to Ouch on Â鶹ԼÅÄ Sounds. 
Mark - We’ll be back soon. Bye.
Seaneen - Bye. Love you!
Mark - Bye.
Seaneen - Three rings, bye. 

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