Moving away from the notion of ‘me’ and ‘them’

Many of the participants discussed how they felt different from others in society.

They viewed themselves as a distinct category and did not see themselves as one of ‘them’. This was in part, as a result of the perceived stigma that they received from others in society:

It’s hard cos I’d like to get out more but I don’t know the area and I’m by myself and there’s a lot of strange people about whose got discrimination against mentally ill people (Ann).

Out of all of the participants, it was Ann who described most openly the discrimination she faced because of her psychosis, and also her desire to be without these symptoms which distinguished her from others. For Ann, it was her voices that caused her to be different from others in society, and PA was one way that she found to combat these voices:

5.3.3.1 Moving away from the notion of ‘me’ and ‘them’

Helping social re-integration Developing a new sense of self Confidence

Having hope for the future 5.3.3.2 PA as treatment

Chemical release Stress release

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But the mental illness it’s like it wants you, you look at yourself and you think I want to be better, but you get this sense inside you what says I’ll never be like anybody else… but here if you try and conquer your voices and overcome them that is probably the best way – exercise (Ann).

Ann appeared to see the psychosis as like a distinct object, something external that has attacked and kidnapped her self, invading her body. I can see that to acquire an unwarranted illness, which you often feel you have no control, can leave you feeling disempowered and downhearted. However, in the quote above Ann described how she felt low because she felt different to other people in society, rather than because of the illness itself. Although for Ann there was no obvious physical sign that she was different from anybody else in society, to me it seemed that her voices were a sign that she was different from the majority of the population. PA was therefore one way to be without this difference.

For some of the other participants, undertaking PA allowed them to be like one of ‘them’ because they were doing an activity that ‘they’ do. It was seen as a

‘normal’ activity like washing, dressing, going to work, eating out:

I like coming to the gym, I like idea of getting in the car, it’s like going to work and then coming to the gym and getting in the gym and everybody else is doing it as well, so it must be good you know if they’re all eating in a certain restaurant it must be a good restaurant (Larry)

It was as though Larry wanted to be seen doing an activity that was perceived as normal. It was almost like it was reinforcement for Larry that PA was something positive that he should be doing because others in society were doing it.

Helping social re-integration

Engaging in a social world through PA was perceived by some to be the first step in recognition of recovery and ‘being normal’:

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I’m actually saying hello to those people in the street, or instead of feeling really shy and anxious and put my head down, I’m actually looking at them or, been cued into how people work so if you notice that they’re not looking at you you look away (Paul).

This quote from Paul followed a description of how walking up the hill to where he lived was becoming increasingly easy, after a gradual increase in PA and engagement with the world. It was as though this participation in walking enabled him to focus on his body, in this case eye contact. This focus on the body brought with it recognition that he was once again engaging with others in the social world, which also produced a sense of achievement.

Some of the participants viewed PA and sport as integral to society and it was perceived that through re-engaging in sport they would re-integrate into this society and begin to feel equal:

I’m bloody 33 and it [sport] gets you back into society. Society is largely about sport, I think a lot of people go to gyms, a lot of people play football, squash, badminton… and it gets you back into proper normal life, with non SUs… both for your well-being and everything… I’m not just talking about the sport… learning how to live again (Paul).

Sport was an important part of Paul’s life before he became ill, therefore this re-integration through sport was incredibly meaningful to him. However, not all of the participants were as involved in sport before their illness took a hold of them. Some of the participants would not feel comfortable going to ‘mainstream’

sport and PA groups, because of the perceived stigma. For them, going to a group for others with mental health problems reduced the isolation felt and for some people an integration into this society with people with mental health problems is better than being alone. Diane described how she preferred to go to an aerobics class for those with mental health problems rather than to a class for

‘normal’ people:

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Meeting other people with mental health problems, knowing that you’re not on your own with it, really even though they might have a different problem to you, it’s like knowing that there are other people out there (Diane).

Developing a new sense of self

During times of severe illness, participants felt that their self was in turmoil, their experiences were often described as though their self was lost or was in a battle with their mind. PA helped them to develop an identity in which they felt

‘normal’; for some participants this was the recognition of a former sporting self, for others it was a recognition of a self without the entrapments of mental illness. In both circumstances it appeared to help settle the troubled relations in mind and self:

It’s [being competitive at football] a little touching of the old self, which is something I need to do, perhaps on more occasions (Tom).

For some participants, sport was an integral part of their life prior to the diagnosis of psychosis and for them it was an element of an old self that still existed in the new self. It was part of themselves that they could understand; it was not alien like aspects of their mental illness, medication and change in environment. Equally, it was part of themselves that they saw as being ‘normal’

or was an activity that helped them to feel ‘normal’:

One thing I seem to remember from the training session was physical pain, not sadomasochism but physical strain and pain brings you back to yourself …. I could grab hold of myself whereas I was being taken over by my strangeness’s… I was scared by myself, it was getting totally insane, it was scary so I had to do something to try get myself some kind of normality (Tom).

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For Tom, it was the physical pain associated with PA that made him focus on his body as object. This focus on his body reminded him of his self, he could escape the strangeness - his estranged self.

For those participants who did not perceive themselves to be active prior to mental illness onset, being active can still form part of their new identity. Larry perceived PA as a way of developing himself. He perceived that if PA was part of his routine, and part of his self, that he would be able to cope better with life’s challenges:

Well if you’re exercising you’re developing yourself, I mean mentally so it’s just another arrow in your cover that develops and then I’ll develop myself in other ways and it all adds to a better thing, at the moment things have been pretty bad but because I’ve developed myself ...it is not as scary and when I hit a bad patch I can sort of weather it out until the weather changes (Larry).

Larry had knitted PA into his self and into his armour which helped protect against the self becoming estranged.

Confidence

Some of the participants, but interestingly most of them men, associated an improvement in strength and fitness with an increase in confidence. Larry described getting fitter as a self-improvement, because he was getting fitter he felt more secure in himself and less vulnerable:

You work out don’t you, then you get fit and then when you get fit…you get a confident feeling and I feel more secure because I’m fit…you’re a bit more robust and I think well I know it has a knock-on effect (Larry).

Howard also described how being strong gave him confidence. However, it was not just about being strong it was also about developing a skill and being good at that, it was about developing himself, developing a strength of character, a

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mental strength. He held the belief that developing the fitness of the body developed the fitness of the mind and getting better at this skill provided him with confidence in himself:

It’s like gaining confidence you know I don’t think anybody likes to be a pushover, softie when you have a proper workout on a punchbag, it’s just like it makes you, honestly, truthfully it makes you feel a lot harder (Howard).

A description of feeling good appeared to often be described because the participants had achieved something of which they had taken control. They had done something which they could be proud of which developed themselves.

However feeling good for some of the participants was described alongside looking good. For these participants there was a physical reminder that they have mastered something which they set out to achieve.

I feel as though I’m working towards looking good in my clothes.

Looking good when I go out, people don’t look at me and think

‘god isn’t she fat’ which is what they used to do before which has added to my bipolar… (Tina).

Losing and maintaining weight was frequently discussed, for Tina this weight loss made Tina feel more accepted by those without mental health problems.

She felt less judged because she looked like somebody who was perceived to be more socially acceptable, and it was because of her own hard work that she felt better.

Overcoming the negative symptoms can also increase confidence, through achievement. Ann described feeling like a ‘winner’ when the voices were successfully ignored and put in their place. It’s overcoming negative thoughts and the constant battle with the mind, the greater the battle, the greater the achievement. The effort Ann puts in to fighting the voices is rewarded with being symptom free:

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When you’re doing it [physical activity]…my voices will try and put me off, but I’m like ‘fuck off’ and then you feel like you’re the winner (Ann).

Hope for the future

A lot of the participants described how their achievements in PA have provided them with more confidence or a more positive outlook. This positive outlook also encouraged people to think about their future:

Because I feel good about myself I want to do more, like I’m looking at things like I’ve always wanted to do… I’m like ‘I really want to do it’, I look good, I want to do it I feel better, I’m exercising I feel as though I’m at a stage of me life where everything’s coming together (Tina).

PA appeared to provide hope for the future, not only because of the improved confidence in their perception of self, but also because it reminded people that they were capable of achieving something. As they successfully undertook PA in one context, the participants often felt that they could move on to another challenge. PA provided a rung on the ladder to help people achieve their ultimate aspiration – normal life and paid employment.

5.4.3.2 PA as treatment

Some of the participants explicitly used PA as part of their treatment programme. It was not something which had been prescribed but was something which they had chosen to add to their treatment plan alongside medication and for some psychotherapy.

Chemical Release

One way in which participants believed that PA could develop them was through the release of ‘good’ chemicals into their body. It was as though the perceived good chemicals could counter-act some of the negative chemicals released into the body from either medications or the illness itself. For example, Mike discussed chemicals a lot during his interview and believed that adrenaline and

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endorphins were released during PA, which helped him cope with the knowledge of the perceived bad chemicals released into his body from the medications:

I try and have it with the medication so I’m like a normal person, instead of feeling really drowsy or feeling like you’ve got too many of these chemicals I just try and keep it just like normal (Mike)

Mike had read a lot about his psychosis and appeared to take particular interest in the chemicals involved. Because of this he had also researched PA, had read about adrenaline and endorphins and believed that these were released. The chemicals released by PA were seen as natural, they were produced naturally by the body it was not an unwanted extra pumped into the bloodstream, like medications.

Stress release

A number of the participants described how PA was used as a way to release stress and the associated negative thoughts. Stress was described as something which appeared to have become physically realised:

It [PA] releases your muscles, cos when you’re stressed it goes into all your muscles and that, I read in a book, it makes knots in your muscles and...it’s like I used to get massages...but these days I don’t because I think I don’t need it no more ‘cos I’m not that poorly any more, but when you’re exercising and you’re stretching and that, you can feel all the tension leaving you (Ann).

This quote left me pondering, what does Ann feel actually leaving her? Can a person actually feel tension leaving? Ann made sense of this perceived release of tension through knowledge acquired from books. It made sense to me that stress inhabits the body, including the muscles. A release of stress appeared to be reinforced by the visual and actual felt sensation of sweat and its associated heat. As though being hot and seeing sweat being excreted contained the perceived negative thoughts and symptoms:

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It’s a release of all the negative stuff that I’m thinking...because I do it, and as I’m going along on the treadmill...you get hot don’t you because you’re exercising, you’re body’s working and it releases those chemicals… and I just think to myself ahhhhhh [relaxing sound], it’s like a stress release (Tina).

This theme outlined how PA helped people to create a new sense of self, one that enabled them to be seen like others in society. For some, this new sense of self incorporated a former ‘sporty’ self, whereas for others PA aided development of their ‘normal’ self to make them feel stronger and more likely to cope with challenges. For those who felt comfortable PA allowed them access to engage with a mainstream world, however for those who perceived that others in society would judge them for their illness, undertaking PA helped re-integrate them into a social world, reducing isolation. In addition, PA was seen as a natural and normal treatment which can help to combat some of the perceived negative factors associated with their illness.

PA provided participants with a tool to take control over aspects of their self which they were not satisfied with.

5.4.4 Dance as if no-one is watching