Thank you for noticing.

She was listed for a minor surgical procedure on my list. I called out her name in the waiting area and escorted this pleasant, middle aged lady into a cubicle for her pre-anaesthetic check-up. We both sat down at right angles to each other. She had an unmissable racoon’s eye on the right side of her face. I looked again. Just to be sure. It was there in its fading pinky-blueness. She was in hospital for a totally unrelated reason but I ventured into asking, “What happened here?” pointing to the eye.

‘Oh. I had a run-in. Couple of weeks ago.’

“A run-in with what?”

‘You know … It’s okay. I don’t want to talk about it.’

“Have you spoken to anyone about it?”

‘Yes. I am okay. I really don’t wish to speak about it.’

“That’s fine. How are you doing today?”

We went ahead, staying focused on preparing her for the upcoming procedure.

I took a moment to call the Safeguarding department of the hospital. They said that it was normal for people suffering abuse, to not talk about it for a long time. They advised us to signpost her verbally. A written set of resources might make her more vulnerable, if discovered by the wrong set of hands.

Two women are killed by a partner or former partner every week in England and Wales.

One in five people suffering domestic violence will plan or attempt to take their own lives.

One in eight of all female suicides and attempts in the UK are due to domestic violence and abuse. This equates to 200 women taking their own lives and 10,000 attempting to do so due to domestic abuse every year in the UK. That’s nearly 30 women attempting to complete suicide every single day. 

Men endure domestic abuse too. This can include physical violence, as well as emotional and psychological bullying, sexual violence or financial control and abuse. 

It is living hell. An invisible prison. Isolating, with no one to confide in.

It takes great courage to speak. It’s often ignored. Many suffer in silence.

Survivors do come in contact with health and social services but disclosure is difficult.

If done right, it is life changing. Appropriate response is invaluable.

Front-line staff must recognise signs and highlight issues.

It is important to ask and act.

After her procedure, I went to see her in the Recovery room.

“Have a nice evening.” She said. “Thank you for noticing.”

Resources:

https://www.rcn.org.uk/clinical-topics/domestic-violence-and-abuse/general-resources-and-support

What do I do with this thing?

It churns inside me all the time. This thing does not settle. It does not sit still. It burns my tummy, wets my thirsty eyes, parches my tongue and pokes its elbow into the longing in my heart. It doesn’t rest and doesn’t allow me to rest. It kisses my forehead, only to kill me with its kindness. It stays with me, no matter where I go – to the park, to work, on a bike-ride, at my desk, in the kitchen. It seeps into my words. Into the movements of my hands. Into the mirror. Into the songs, I choose. Into tea and toast. There is no getting away from it. It pervades my silences and my sleep.

I wish it had never appeared but it has. It wish it wasn’t mine but it is. The problem is, it won’t leave me alone. Not for the briefest of moments. In a Stockholm Syndrome way, I hold on to it and defend it. How I wish it wouldn’t tear me up so mercilessly.

What do I do with this thing?

Once I heard a Therapeutic Writing Coach say: Name it. Claim it. Tame it. Re-frame it. Proclaim it.

‘Re-frame it’ stayed with me. It does not mean I tell myself false pacifying stories but encourages me to see it for what it is, beyond the drama. Grief, as love that has no place to go. Longing, as the other side of the coin of love.

If I don’t transform it, I will keep transmitting it and I don’t want to do that.

(Resource: Therapist and Writing for Well-being Coach

Nigel Gibbons : http://www.nigelgibbons.co.uk/About-Me.htm)

Meeting old friends for the first time.

Meeting old friends for the first time. In at least three dimensions. Sharing a physical space together, not just a bland rectangular screen. Actually holding hands.

“Gosh! You’re for real!”

The sparkling smiles of recognition mixed with disbelief. The hugs offering heart to heart resuscitation and healing. Sitting down side by side on the sofa, sharing stories, tea and cake.

A year ago, this could have been fiction but last weekend it was fact. While volunteering at a retreat for Bereaved parents hosted by The Compassionate Friends, we finally met people we’ve only ever seen on Zoom. It was held at the simple and serene Woodbrooke Centre, a Georgian manor house in Selly Oak, Birmingham with tall trees, beautiful flower beds and a family of geese perambulating the grounds, intermittently honking. It is a Quaker centre and has a poster in the main foyer which reads “Nameless helping the Nameless”.

The garden in front of the main house has a labyrinth mowed into it. Early on Saturday morning, birds were singing and the light was inviting me into the open. I decided to walk bare feet into the center of the labyrinth. I took my shoes and socks off at the edge of the circle. As soon as I started walking, it turned into an extremely mindful experience as the ground was littered with geese droppings.

The silence in that place was sweet and the views a treat. We talked about the importance of finding meaning. We shared the joys and challenges of taking the inward road. We watched a film and sang together. We wrote from our hearts and created pretty little candle holders for our kids from jam jars at the crafts table. We cried and laughed, reassured that in this company, it was completely acceptable to do both, sometimes simultaneously.

A pleasant exchange. Giving and receiving with compassion. Understanding. Belonging. Learning. Holding the utter magnificence of life in one hand and the absolute devastation in another. That’s what this game is all about, I guess.

Who is telling me not to do this?

“You want to write a book? Who do you think you are? Why would anyone spend any time or the money on it? Who’s interested in reading your stuff? You will expose your inner life unnecessarily. You are not a writer. Don’t pretend to be one. Your book will simply prove your mediocrity to everyone. Even if you manage to write it, who will publish it? I think you will have to go the self-publishing route.” Oh no! This voice in my head. In any case, I don’t have time. Nor the talent or the imagination. I don’t feel inspired. I am not in the right frame of mind. There’s too much else going on. I am struggling with ‘structure’. It’s serious and solitary hard work. As the story is still unfolding, we haven’t reached the end yet. So, how can it be finished? When I sit at my desk staring at a blank page, I freeze. I don’t know what to write about. It’s too big a job and the hospital is keeping me so busy. On top of that, there are unending chores that need done. The summer has finally arrived and I should take the time to enjoy that. The list of excuses goes on and on. There is so much I don’t remember accurately anymore. How do I put that in words? I am up against this project when I want to flow with it. The book wants to come from a place of love. Not angst. I need to take it easy. Breathe. Gently ask my inner critic to come back later, when I am on the second draft. For now, leave me alone with these blank pages. Let me see them as friends who want to help me be fully expressed. I need to learn to connect with my anxious heart, soothe it and be fully present here at my desk. Right now. And start, regardless. Go to the kitchen. Make a cup of coffee. Water the money-plant. Return to the study. Look at the man in a blue and white base-ball cap walking with his tan Labrador in the park across the road. The round green trees and the clear blue sky. I put on the soundtrack of Human’s music on Youtube – a spectacular film by Yann Arthus-Bertrand, music composed by Armand Amar. (https://www.youtube.com/watch?v=uog4eCZTUX4) I am but a dot on this enormous picture inside which I live. Connected with everything. Not separate. In my heart, can I trust myself to be a tiny part of a greater process? Trust myself. Show up every day and work with the mystery. Trust myself.

What are the chances . .?

It was Tuesday, not my usual day to be working at St Thomas’ Hospital.
It was lunch-time and there was time enough for a proper break, which was extremely rare.
I was able to physically leave the Theatre complex for fifteen minutes, which was usually impossible.
I wanted to clear my head, so I went to the cafe, looking for a seat by a window. I was in my raspberry scrubs, wearing my most expensive necklace which is a green lanyard with my ID batch. The round table by the french doors had three chairs, of which one was occupied. I asked the older gentleman if I could share his table and he didn’t mind. As I sat down I noticed that his left arm was heavily bandaged. My curiosity got the better of me and I asked, ‘What brings you here?’
He looked straight at me and replied, “I tried to die.”
‘I am sorry you found yourself in that impossible place. Must have been terrible. Are you getting the support you need?’
“Yes. They’ve been very good here.”
‘I am glad.’ I paused to wonder if I should tell him but the words left without my permission.
‘You know, I lost my son to suicide a few years ago.’
His gaze connected with mine like a laser beam and his eyes moistened.
Softly, almost apologetically, he stated “When you are in that place, you can’t think about other people.”

Pause.

“Here comes my wife.”
Holding two paper-glasses and a brown paper bag, she joined us and placed one of the glasses in front of him. She took out a Jubilee cupcake from the bag to share.
“Have you traveled a long way today? I asked, shifting gear.
‘Sussex. Straight train. Not too bad.’
“Beautiful part of the world!”
‘Yes. But we lived in Australia for eighteen years which was really pretty. We came back to be with the children.’
“Nice. I wish you all the very best. I must get going now.”

‘Us too. Our appointment is in fifteen minutes.’ she said.
‘You take care’. He said, making that eye-connection with me again.
“You too.” I looked straight at him, nodded, smiled a polite smile and walked away.

(Resources for attempt survivors, their families and friends:

https://www.sprc.org/livedexperience/tool/resources-suicide-attempt-survivors-their-families-friends)

God bless America.

Following the Sandy Hook school shootings in 2012, the Conservative commentator Anne Coulter provocatively proclaimed that “Guns don’t kill people. The mentally ill do.”

“The United States sees an average of 32 000 handgun-related deaths per year (as per this paper published in 2015), and firearms are involved in 68% of homicides, 52% of suicides, 43% of robberies, and 21% of aggravated assaults. Far from the national glare, this everyday violence has a disproportionate impact on lower-income areas and communities of color, and is widely held to be the cause of widespread anxiety disorders and traumatic stress symptoms”… the stigma linked to guns and mental illness is complex, multifaceted, and itself politicized, in as much as the decisions about which crimes US culture diagnoses as “crazy” and which it deems “sane” are driven as much by the politics and racial anxieties of particular cultural moments as by the workings of individual disturbed brains. Beneath seemingly straightforward questions of whether particular assailants meet criteria for particular mental illnesses lay ever-changing categories of race, gender, violence, and, indeed, of diagnosis itself.”

“Persons in the United States live in an era that has seen an unprecedented proliferation of gun rights and gun crimes, and the data we cite show that many gun victims are exposed to violence in ways that are accidental, incidental, relational, or environmental. Yet this expansion has gone hand in hand with a narrowing of the rhetoric through which US culture talks about the role of guns and shootings. Insanity becomes the only politically sane place to discuss gun control. Meanwhile, a host of other narratives, such as displaced male anxiety about demographic change, the mass psychology of needing so many guns in the first place, or the symptoms created by being surrounded by them, remain unspoken.”

“Mass shootings represent national awakenings and moments when seeming political or social adversaries might come together to find common ground, whether guns are allowed, regulated, or banned. Doing so, however, means recognizing that gun crimes, mental illnesses, social networks, and gun access issues are complexly interrelated, and not reducible to simple cause and effect. Ultimately, the ways our society frames these connections reveal as much about our particular cultural politics, biases, and blind spots as it does about the acts of lone, and obviously troubled, individuals.”

Ref: American Journal of Public Health. 2015 February; 105(2): 240-49.

Mental Illness, Mass Shotings and the Politics of American Firearms by Jonathan M. Metzl, MD, PhD and Kenneth T. MacLeish, PhD

PMCID: PMC4318286

PMID: 25496006

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318286/

The world is less beautiful without you.

I am told it’s common for those at the end of their tether to believe that everyone would be better off without them. I don’t know if Saagar believed that but if he did, I want him to know that’s not true. They are far from ‘better off’. They hurt for as long as they live. They try to keep walking, with their painful unanswerable questions shouting in their ears. They make repeated futile attempts at forgiving themselves for their real and imagined, seemingly unforgivable mistakes. They try to uphold a light of hope for themselves and others, inside the well of their desperate darkness. They try to find purpose and meaning in their lives, when they can hardly move from one breath to the next.

Three years back I went traveling to the USA and Australia, as a Churchill Fellow, to find answers to a few of my unanswerable questions. I met some amazing people and learnt a lot, some of which I shared on this blog in October 2019. For the last two years, I have been compiling my findings with the aim of producing a report. It has been a challenging task and has taken a lot longer than I thought it would, thanks to the multiple distractions of the last couple of years.

The report has now been published and I am delighted to share it here with you. It is called ‘Bridging the Gaps in Suicide Prevention’ . I hope it will inspire compassionate ways of dealing with human fragility. I hope it will reach all those who can influence change from within – governments, communities, professions and hearts of individuals. I hope it will keep our hopes alive, for a well-connected, understanding world.

Report: https://www.churchillfellowship.org/ideas-experts/ideas-library/suicide-prevention-efficacy-of-multisectoral-approach-and-bereavement-support

Invitation to the Circle of Remembrance

Towards the end of 2020, a series of phone calls with mums and dads from the USA, Australia and the UK resulted in the formation of an on-line peer support group that has met every other Saturday evening for an hour and a half. The first meeting was held in the middle of January 2021. We’ve recently had our 32nd meeting. The group provides a warm space for sharing and offers non-judgemental listening and understanding. It provides a fertile ground for post-traumatic healing and growth. We call it CORe: Circle of Remembrance.

The loss of a child is different from other losses. The purpose of CORe is to honour our children, to create an opportunity for sharing our inner and outer experiences and to seek tools and mutual understanding for establishing a firmer ground of compassion, from which to live our new lives.

Over time, I have come to appreciate my need for a tribe to belong to. Other people who are also living through the loss of their child validate our experiences, witness our pain and help us feel less alone.

After many years of trying to make sense of something so treacherous, I now know that it is impossible to make any sense of it. However, I also know that it’s possible to create a new path for ourselves. A path of learning and peace.

It has been an honour for Si and me to facilitate the CORe group of roughly 20 friends and witness their journeys. The rich, life-sustaining conversations and friendships within the group are a delight to be a part of.

It therefore gives me great joy to invite bereaved parents to a new group that will meet on alternate Wednesdays from 7.00 – 8.30 pm (UK time). Please visit the website of CORe (link below) for more details and testimonials and sign up if you would like to join.  In our experience with the Saturday group, the upper limit to attendees is 25. Once we have about 15 members, we’ll get started. The tentative start date is 4th May 2022.

https://www.core-community.com/

Two lessons

“He loved me in the purest sense and I loved him. That’s how he kept me alive.” says Marsha about Ted, a catholic priest.

This relationship taught her two important things that she applied to her work as a therapist for seriously suicidal people. She wrote about these things and taught them to her students, the future generation of therapists.

  1. ‘I was unable to say thank-you then. Now I can.’

If you’re giving unconditional love to help someone cope with the hell they are in, if you’re holding them emotionally and physically, don’t interpret their absence of ‘thanks’ as a sign that you are not giving them what they need. You probably are.

2. ‘Keep loving them.’

When someone sees no point in living, they are like someone walking in a mist. They don’t see the mist. They don’t see that they are getting wet. If you’re walking with them, you may not see it either. But if they have a pail of water, you can collect the water that was mist, in it. Each moment of love adds to the mist, which adds to the water in the pail. By itself, each moment of love may not be enough. But ultimately, the pail fills up and the person in hell can drink that water of love and be transformed.

Like Marsha, I know this to be true. I’ve been there and drunk from that pail.

(Inspired by Marsha M Linehans’s book: ‘Building a life worth living’.)

I was so wrong.

I thought that if his doctors would have recognised how sick Saagar was, they would have known that the best thing to do was to refer him to the Psychiatric services. They would admit him to the hospital, look after him and keep him safe.  He would recover fully, return home and resume his life as normal – play the drums, read and speak French, play cricket, go out with his friends, go to the gym, make me laugh till I had tears in my eyes and soon, return to University.

Now I know, that I was so wrong at so many levels.

  1. Recognise?

The GP didn’t think his condition was life-threatening, even after he told him it was. How much more obvious did it have to be? They didn’t believe him. If at all they did, they didn’t take him seriously. Or maybe they simply didn’t know what to do.

GPs are not trained or supported in looking after suicidal patients.

  • Refer?

If they would have made a referral to the Mental hospital, he would have waited for a long time to be seen. Maybe he would have died while on the waiting list, like many others.

GPs are dis-incentivised to make referrals to specialist services in various ways.

  • Admit him to the hospital?

No chance! That would not have happened as there would have been no beds. If there were beds, there would have been others much sicker than him, ahead of him in the queue.

Hospitals have very poor capacity and very high thresholds for admission to inpatient beds.

  • Keep him safe?

490 patients died while detained under the Mental Health Act in the year up to March 21. At least 324, for non-COVID reasons.

Ref: https://www.bbc.co.uk/news/uk-politics-59336579

Being an inpatient does not mean –  safety.

  • Recover fully?

Many patients report traumatic experiences while admitted to mental hospitals. The treatment is often not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support.

There is little understanding of what the patient needs, to recover.

(Ref: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/experiences-of-inpatient-mental-health-services-systematic-review/C5459A372B8423BA328B4B6F05D10914)

I am presently reading a book – ‘Building a life worth living’ by Marsha, M Linehan. She is the psychologist who developed Dialectical Behavioural Therapy, to help suicidal individuals to build their lives. Much before she did that, she was a seriously suicidal and self-harming young adult.

I am learning so much.

Marsha M Linehan – Author of ‘Building a Life Worth Living’