One of the projects I was involved in at the end of last year was the roll out of collaborative care plans to the inpatient directorate of my local NHS trust for mental health and learning difficulties care. It is a project I really believe in and to give it the best chance we could of reaching it’s potential we gave all staff day of training in the process of supporting people to articulate the goals that are important to them and then working through steps that can move towards them. As part of the training I talked about my own experience when the start of the pilot had allowed the whole team to take my goals and experiences seriously and allow me to move forward with an approach in which I was confident. Before that every time that approach was jointly care planned with someone other members of the team would come in and scrap it in favour of what they ‘always did’. This not only failed as it had before but left me with no trust whatsoever in the staff team and basically no hope.

As well as telling my story I spent time in small group discussions and observing team members trying to use the process on goals of their own. Many staff took the opportunity to ask me questions and tell me of their experiences. Some of these were about collaborative care planning but many were just about the experiences patients on the wards. Some scared me. Yes I do remember being in hospital. I especially remember some of the scary painful and devastating moments. Just as in the rest of my life strong emotion make my memories more vivid and I remember things as I experienced them, not as staff believe that they ‘really’ were. My responses in the future are influenced by those memories and staff who honestly believe that someone very unwell will not remember what was done to them in the future are working from a dangerous misconception.

I also listened to a lot of staff expressing their frustrations and distress over the lack of progress of particular patients in their care. The conversation would begin something like this:

“We have this man on our ward and he just will not eat anything except an occasional bit of ice cream and it can’t be good for him. He’s been here for weeks and we’ve tried…”

then would come a long list of interventions sometimes as many as one for every day that the team had worked with the person. These would span the whole range from caring and supportive to deceit, coercion and sometimes down right force. At the end of the list these caring professionals would look desperately at me and ask:

“What have we missed? What can we do that will make him eat and be well?”

In those trainings time was limited and I could only stress the importance of time, and that this was a person not some kind of puzzle or problem that needed the right password to make them do as the staff believed that they should.

I think of some of those workers and their distress and frustration often. Their fears and battles have gone been around for many many generations. Because of that, for all those who, for whatever reason, are trying to care for someone who is experiencing mental distress,I want to tell the story of the Tigers Eyelash. In some countries it is a bear, but in Japan it is a tiger and it was a tiger when I heard the story from the work of Clarissa Pinkola Estés.

There was once a man and a woman who met and fell in love, got married and lived happily together until the day when the man went off to war as a soldier. The woman left behind kept their farm going and waited desperately his return trying to keep the black fear that he might die first locked down tight so it wouldn’t paralyse her.

When she heard that he was on his way home for good, whole and well, her excitement knew no bounds. She counted the days to his return, planning, saving, buying and cooking to make him a welcome feast of all his favourite dishes. On the day of his return she waited at their gate imagining how they would hold each other and let all that had happened melt away. When she saw him coming down the hill she ran to him, just as she used to when he returned from a long day in their fields.

But today was different. Her husband started when she came close and flinched from her loving touch drawing himself away with a tight expression and a strange look in his eyes. Hurt she led him to the house and the food she had lovingly prepared. Her husband tied a mouthful of rice with an expression as if he was eating ash then drew himself away into the corner. She pointed out his favourite foods asking him to at least try the lovely things she had worked so hard to prepare but got no response. Eventually, hurt and frightened, she demanded that he eat something at least to keep his strength up and her gentle and loving husband lashed out with all the ferocity of a cornered bear flinging dishes at the walls and roaring curses so that the woman fearing for her safety ran from the room as the meal and life she had dreamed lay shattered on the floor behind her.

The days that followed were the worst she could remember. Her husband seemed dangerous and unpredictable. Blank and uncommunicative most of the time responding in terror to things that she couldn’t see and lashing out angrily when she tried to take care of him or offer him comfort. In despair the woman went over the hill to the next village to consult a wise healer.

The healer was crouching by the fire in his hut when she arrived and told her story.

“You are both in a lot of pain.” he observed staring at her with eyes that seemed to look deeper than she really wanted anyone to see. “There are a number of paths open to you. What is it that you want to do?”

The woman thought of the misery of being at home in constant fear of being attacked in a violent rage and of her frustration at being unable to help her husband feel better and her dreams for his return.

“I just want things to be back the way they were before.”

“That is not a path that is open to any of us.” the healer observed gently. “Each experience we have changed us into a new person that can no longer fit exactly into the life we had before it. You are not exactly the person you where before your husband went away nor should you be. He is not who he was before he went to war and neither of you are the people you were before he came home again. The disappointment that things could not just melt away has changed both of you. There are paths open to you but in many ways they are more like streams. Like it or not they will move you forward. If you go on as you have been things will move forward for better or worse, or you can chose another path.”

The woman thought of her husband’s bony frame and the way he refused to eat. She thought of his increasingly violent responses to her care and the times when he acted as thought he was fighting for his life and threatened to kill the ghosts attacking him. She feared the places her current path seemed to lead.

“I have to do something different.”

“Do you wish to leave?” asked the healer.

“I can’t do that.” snapped the woman. “That’s my husband.”

“That path is open to you.” the healer’s tone felt like a rock crushing her chest. “It may not be an easy path, there is censure from others there, loneliness, feelings of failure, change and upheaval but also new starts that may be safer than your life now. You must consider it. If not now there may come a time when it is the best path for both of you, if only you have the courage to take it.”

The woman hunched her shoulders and wrapped her arms around herself. Was the healer saying that her husband was beyond help? Was he saying that she herself was not up to the job of helping him when that was her role as his wife? Even that she was causing her husband harm in her attempts to fulfil her duty and keep him alive, cared for and loved? For the first time in days she let herself dwell on memories of the man she had fallen in love with and the grief bit deep.

The healer, who had been watching her intently till now, leaned forward and stirred the embers at his edge of the fire.

“That time may come.” he repeated “but right now I think there may be another path open to you if you want to take it. It will also not be easy but it make take you to a place where you and your husband can build something between you in the future as you have in the past.”

The woman jerked her face towards him.

“What? There is a way to make him better? What can we do?”

The healer looked so stern as he stirred the fire that for a moment the woman was afraid that the answer was no and that there was no cure. However a thoughtful look past over his face and then a confident smile as he replied:

“Yes I think there might be. There is a potion that I can brew though it needs some rare and precious ingredients. In particular it needs an eyelash of the mountain tiger and this I do not have. However if you would be willing to climb the mountain and procure the eyelash than I will see that anything your husband asks for is found for him until you return and the potion can be brewed.”

“I’ll do it!”, the woman assured him filled with hope and excitement from having something to do that could finally mend things.

She grabbed the travelling cloak, a cooking pot and some provisions and set off through the farmland that covered the lower slopes of the mountain until she reached the boundary wall beyond which the land hadn’t been shaped by humans.

Here the ferns that she had worked so hard to weed from their farmland all these grew thick and higher than her head. When she plunged in among them they towered over her head so she had to fight her way through them, uncertain if she was moving in the right direction or being fooled by undulations in the ground. A few time she found places that she had already fought her way through and knew she had somehow gone backwards.

The ground began to rise steeply, although those tough ferns grew as high and as dense as ever. Underneath them she felt hot and stifled and when she forgot and tried to use one to pull herself up the never ending slope it cut into her palm. It seemed as though the slope was never ending and she should give up but she pulled from her mind an image of the time that she and her husband sat companionably together watching the sunset and told herself that every step she took was one step closer to being able to do that again.

As she climbed the day grew hotter. Sweat trickled down her brow and into her eyes. Flies buzzed around her making her skin crawl. She batted at them but they buzzed louder and louder around her head.

“Incompetent.”

“Not good enough.”

“If he dies you’ll be to blame.”

“If he kills someone you’ll be to blame.”

“Do as we’ve always done or you’ll have no defence when things go wrong.”

“Go back and go on as you were.”

Tears stung in the woman’s eyes and fear crawled in her belly but she pressed on on the path she had chosen determined to see it through.

She climbed on until the ferns became shorted and disappeared along with the flies in the cooler air. Ahead she saw the mountain rearing up even more steeply but almost before she had time to feel overwhelmed by the task the view was swept away by a pummelling mass of grey cloud and a ferocious wind whipped icy daggers of rain and hail into her face as though to drive her back the way she had come.

The woman squared her shoulders and began to on into the wind repeating over and over to herself:

“I can do it, I can do it, I can go the way I want!”

She fought against the wind with every ounce of strength she had yet the higher she climbed the stronger it grew until all the strength she had could only keep her standing where she was. Unable to move forward she stood her ground sure that if she stayed form and showed her courage by doing the right thing the wind would ease up and let her continue.

But the wind didn’t care about the woman’s quest or how she thought it should be done. It was what it was and it’s reason for being was to roar through this storm. All it saw was another obstacle to whip around and it did so with an energy that burned against the woman’s skin.

It was taking everything she had to keep holding her ground against the intensity of the wind and soon the woman’s energy began to desert her. The next big buffet knocked her off balance and she stumbled back down the path flailing across it in a vain attempt to keep her footing before crashing onto the skin shredding stones of the path.

She lay there for a time crying in exhaustion and defeat. There was no way up the path and her quest had failed. Then she began to think. This close to the ground she barely felt the blast of the wind at all. Maybe she could wait until the wind dropped? The cold in her limbs told her she couldn’t afford to wait and see if that ever happened. Was she going to give up and abandon her quest? Her quest to get the tigers eyelash to cure her husband?

It struck her then, her quest was to get to the tiger and get the eyelash. It didn’t matter what path she took up the mountain to get there. Trying to force her way against the wind was a waste of her time and energy, she could crouch low and traverse the hill never clashing head on and probably succeed instead.

It was a long walk. Much longer than the path if she had been able to move on it at all but at last the woman saw the tiger lying in the mouth of his cave. There he was magnificent eyelashes and all and the woman was sorely tempted to simply rush up and grab what she needed without wasting any more time. However she was wise enough to know that, like any other creature, the tiger would object. He might kill her while trying to defend himself or decide that she would provide several days of meals and hunt her down as she tried to take his eyelash back to the healer.

Meals… That could be the answer. The woman moved away from the tiger and found an empty nook in the rock where she could shelter and go through her provisions. With almost no trees this high building a fire was not easy and nor was finding good places to set her snares but over the next day she put together a meal to tempt a tiger.

When it was ready she waited until there was no sign of the tiger at the mouth of the cave, raced across and dropped the food a little distance from the tigers home before racing back to her own outcrop to wait. When the tiger came to the mouth of the cave he instantly smelt the food that had appeared as if from nowhere. It puzzled him and he approached warily checking and double checking the area, sensing a trap. Several times he returned to the safety of his den without even reaching the food but eventually he felt sure and safe enough to taste it then polish it off. The woman breathed a sigh of relief and began to work on the meal for the next day. Then the next. Each day she left the food and moved away but not quite as far as she had the day before.

It didn’t all go smoothly. When she cooked one of her most delicious meals the tiger hated it so much he thought he had been poisoned and wouldn’t touch any of the food she left for days. Seeing cackling birds taking off with her offerings day after day the woman felt frustrated and angry with the tiger and his irrational fears but she reminded herself that just because she liked and enjoyed particular things didn’t mean they felt or tasted good to a tiger and that he had not asked her to come near his lair. So although she may have stamped a foot and waved a fist or two at those cackling birds she was careful not to turn her anger on the tiger.

Then there was the day that the woman grew impatient and stayed much closer to the cave than she had the day before. After all she told herself, the tiger has had all these weeks to get to know me, I have worked hard to feed him and I have an urgent quest. We need to hurry things along.

When the tiger came out and saw her there he froze. Seeing his fear the woman realised that to him any human was a terrifying threat. He remembered humans that had hurt and harmed in his past and a few titbits of food were nowhere near enough for him to trust that she was somehow different, especially when she was so near his home. She saw that he was poised to abandon the home where he felt safe and run into the mountain where he might not survive and if he did she would never find him. Feeling horrified she ran back beyond her outcrop to give him all the space she could and crouched shaking in her nook hoping and praying that he would chose to remain. It was two days before she dared to invade his space even to out out food again and when she did he seemed even warier than before and her progress back towards the cave was painfully slow.

But slow though it was it was progress and finally the day came when the woman was able to place a meal the tiger had enjoyed a day or so ago outside his home and wait right beside it as he came out to eat. The tiger was a little skittish but the woman had used too much time and patience to break his trust now so she waited until he had eaten then spoke.

“Was it good?”

“Umm” said the tiger in his deep growling voice “Yes… yes it was good…”

He looked at her warily.

“You have been putting food here all these days?”

The woman nodded.

“I didn’t ask you to… I didn’t even invite you here. So why do you do that?”

“I am on a quest to help my husband to recover and I need something from you to complete it.”

The tiger backed up half a step back towards his cave.

“An eyelash! Please great tiger may I have one of you eyelashes to make the potion to cure my husband?”

The tiger paused.

“I mean you know harm. I have fed you all these days to let you see that it is safe to trust me and it is so important, please great tiger.”

“Well…” mused the tiger “You have fed me, and it has mostly been good, and it is true you have not yet harmed me when you could have tried and you have given me the respect and dignity due to a fellow creature by asking me for what you wanted instead of taking it by force…

The woman twisted her fingers in her top so tightly that the material cut into her skin.

“Yes” said the tiger squaring himself. “Yes you may take one of my eyelashes. But do it quickly and then go from here and do not come back or send anyone else hunting me or I will know that you are no different to the others who come hurting and killing here.”

Gasping her thanks the woman reached out and plucked the eyelash from the tiger, turned and ran from his cave. She ran for the path where the wind that she had tried to fight now leant her speed as she careered down the mountain in it’s icy embrace. When she reached the ferns she plunged on through them not even noticing the flies in her excitement. Even when she lost her footing and fell the distance she slid on her side took her closer to her goal. She barely stopped to close the gate in the wall before she was off pounding through the farmland faster than she had run since she was a young girl, all the way to the house of the healer who was crouching by his fire as she burst through the door.

“I have it!” she cried “I have the tiger’s eyelash”

The healer raised his head and a strange look passed across his face. A lump of ice crashed through the woman’s stomach.

“My husband! What has happened to him? What did he do?”

The healer shook his head reassuringly.

“No no. He is not well and his life is hard but the skills that brought him home to you were more than enough to keep him from giving or taking serious harm in the place he feels safest while you were gone. You found the tiger? You have an eyelash? Tell me how you came by it.”

As the woman excitedly told her story the healer smiled and nodded in approval more and more often until finally she brought out the eyelash and breathlessly dropped it into his outstretched hand. The healer picked it up between his thumb and forefinger turning it towards the light.

“Yes you have certainly done well.” he said and the tossed it into the fire where it was instantly consumed.

The woman gasped in horror and turned on him.

“What! What did you do? After all I did! All my effort. I worked so hard and so long. I did everything I could and you destroyed it!

The healer patted the air with his palms down,

“It’s all right.”

“It’s NOT all right! How could you? You promised! I did as you asked and it was supposed to make everything better and now you’ve burned it you evil old man!”

“It is all right.”

The healer repeated with such a towering authority in his voice that it brought her up short.

“It’s all right.” he repeated more gently. “The tiger didn’t ask you to come and feed him but you did it because you desperately wanted his eyelash and knew that to get it you must first earn his trust. Your husband has not asked you to magic away the changes his painful experiences have made but you desperately want to because you love him and want to make a life with him again. You learned many lessons on the mountain and in earning the trust of the tiger. If it is the path you chose then go home and what you did for the tiger, do that for your husband.”