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When I first began to meet other service users, one thing that struck me was that they seemed slightly more self-obsessed than other people, except politicians and actors, of course.

Experience has taught me that there are two reasons for this. We are used to explaining ourselves many times over, particularly to gatekeepers of services and service providers: our peculiar needs and individual preferences, our physical or psychological symptoms. On a day-to-day basis, we have to communicate levels of detail that would seem strange in everyday conversation.


For example, with a severe physical disability, I need to tell my carers if I need to have a bowel movement. This is not normally part of everyone else's dialogue (except men's). Friends of mine with a learning difficulty often have to ask people to write down appointments so that their helpers can ensure that they are in the right place at the right time. Men excepted again, this isn't usual behaviour. Colleagues with a mental illness often feel that they have to explain how their conditions limit what they can do, so that people don't think they're just being rude when they refuse invitations.

Sometimes, I get so used to talking about my physical needs and difficulties that it becomes my main topic of conversation, and that's a difficult habit to break. And nobody takes the question "How are you?" more seriously than I do, at times.


And so to the second reason for such self-involvement. When you have a long-term condition, it's easy, sometimes necessary to be in a constant state of vigilance about one's health. I know, for example, to pay a lot of attention to pain, because this may lead to pressure sores, which can have fatal consequences. People with mental illnesses have reported that they often get warning signs that their condition is about to get worse. If things play on our minds so much, it is hardly surprising that we end up talking about them as well.

Sometimes I think it's surprising that we ever forget ourselves enough to have fun...