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/

… and your name is?

S A A G A R.

In Delhi, it was simple and sweet.
In Belfast, it was a problem. It had to be pronounced slowly with exaggerated lip movements and spelt out clearly. Still, it was uttered in all kinds of ways – Segaar, Sega, Saaga, Sags, Sagsy-wagsy. It is after all, a proper noun. “As long as you call him with love, you can call him anything.” I would say with a smile. But of course, it was his name. Not mine.

At the age of 7, one day he came home from school and said, “Can’t you change my name to Aran or something?” I felt for him but laughed. What else could I do? I asked him if something happened at school that day, if someone said something hurtful and he just picked up his soft grey elephant and cuddled it.

I told him the story of his name. I was 24 when I got married. My in-laws lived In Chennai. We visited them a few months after the wedding and one evening we all visited a place called Besant Nagar beach. That was the first time my eyes fell upon the expansive ocean. On the map this water body had the boring label, Bay of Bengal. The vision of a dark blue shimmer below meeting a pale blue glow above in a clean, delicate, straight line made everything else disappear. Its calm, its rhythm, its enormity, its subtle dance, its grace and openness pulled me in. All conversation faded away and there I was, completely soaked in the bliss of the ocean. My soul soothed. My body relaxed. My eyes quenched. My heart happy. I was in love. In that moment, I knew that if we ever had a son, he would be called, ‘Ocean’: Saagar. I reminded him that his name was Saagar because his heart was as expansive and as beautiful as the ocean. He smiled and gave me a tight hug.

As he grew older, he came to own his name. He came to live it. The waters of this ocean ran deep. They appeared placid on the surface but strong currents ran underneath. All I saw was the steady flow of gentle waves, rhythmically lapping against the shore through the seasons. It oscillated with the moon but the high tide was never too high and the low tide was never too low, until one day it was.

Come home, my darling.

I still hear the key turning in the door from the outside and you stepping in. Can you believe it? I still see your face, darkened by the sun. Dressed in your cricket whites, you drag your massive cricket-bag-on-wheels behind you by your left arm.

“Did you take the sun-screen with you?” I ask.

“Yes, it’s in the bag.”

“Did you actually put it on?’

 “Mamma, I’m hungry.”

I still wait for you to join us for dinner. I cook the foods you like, especially on your birthday: spinach-paneer for mains, chocolate mousse for dessert. I wonder what you’d be doing in this realm if you were here. Job? Girl-friend? How silly! Isn’t it? I can’t help it. It’s involuntary. It’s got something to do with the heart. With longing. With missing. With love. It’s not supposed to make sense. You would have had a good old chuckle at my expense if you were here. But you are not and I am. How random is that?

I still remember the first time I felt you elbow-ing or knee-ing me from inside my tummy, as if we had an inside joke between us. I remember holding all three kilos of you in my arms for the first time. I couldn’t believe you were for real. You were all mine. Now my arms ache with emptiness. Is this real?

Do you miss me sometimes?

Happy birthday my darling.

Heaven

It will be the past

And we’ll live there together.

Not as it was to live

But as it is remembered.

It will be the past.

We’ll all go back together.

Everyone we ever loved,

And lost, and must remember.

It will be the past.

And it will last forever.

                      – A poem by Patrick Phillips, on the New York subway.

(“Ghar aa” is a Hindi phrase that means “Come home”)

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

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’

Thank you Prime Minister.

Recently, our highly respected Prime Minister declared there was a need to treat ‘problem drug users’ with ‘compassion’ by investing in rehabilitation. In the same breath, he said that his government would  ‘wage a war’ on drugs by removing passports and driving licenses from drug-users to tackle drug-related crime. He rightly emphasized that drugs were really ‘bad for society’.

Little surprise that he said absolutely nothing about the invisible drug that is freely available in shops and restaurants and can easily be found in homes, clubs and pubs. Many of us use it everyday even though it causes severe social, financial and health damage. As good friends, family and colleagues we often encourage each other to use it, while thinking nothing of using it ourselves. Some of us go as far as taking offense, when someone declines our offer to use it. Yes, alcohol is a drug. It is a depressant, even though it can fool us into thinking and feeling otherwise. It causes more than 60 types of diseases and injuries.

[Courtesy: Science Direct : https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/ethanol-effect%5D

Alcohol use, particularly heavy use and dependence is directly associated with suicide in three ways:

(1) through its dis-inhibiting effects, it emboldens people to attempt suicide

(2) individuals with Alcohol Use Disorders are at an increased risk of suicide as compared to the population at large

(3) alcohol consumption co-relates with suicide rates, all over the world.

Thank you dear PM for giving us a chance to think about our relationship with ‘drugs’, especially at this time of year which can be difficult for some and over-festive for others.

I wish you good company, much fun and laughter now and always. May you be blessed with lots of cake.

(by Charlie Mackesy from “The Boy, the Mole, the Fox and the Horse”)

Ref: Suicidal Behaviour and Alcohol Abuse:  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872355/#b26-ijerph-07-01392

Pendulum swinging too far.

He: “In the present climate, this doesn’t look good. Does it? Two white men, Clifford and I, leading this place.”

Me: ‘I think it’s great as you both know your stuff and work well together. Also, the organization is gaining strength and reputation under your leadership. Give it at least another year before you change anything. Everyone’s happy.’

He: “Yes, but … it doesn’t look good.”

Me: ‘What do you mean? Who’s looking? So long as the job is done well and the purpose of the organization is served, I don’t see the problem.’

He: “Yes, but, could I ask you to be my Deputy?”

Me: ‘Oh. Me? Hmm. What does the role entail?’

He: “I will find out the details and let you know.”

Me: ‘So, you are offering me a role and you don’t know what it is?’

He: ‘Yes. But I’ll let you know very soon.’

Me: “If you don’t know what the job is, how can you offer it to anyone? How can you know that I am capable of doing it?”

This was wrong at so many levels. Don’t use people to make you look good. See beyond their ethnicity and gender and think about the job at hand. Think about their abilities and aptitudes. Remember meritocracy? Would you have a doctor or a lawyer or a car mechanic or an architect look after you only because they had particular demographics or because they had the right credentials and were bloody good at their jobs?

Moreover, my colleagues would know that my promotion had little to do with my capabilities or performance and everything to do with the fact that I am a ‘woman from a minority community’. It would be insulting. No. Thank you.

We are one race – the Human race. Each individual, fully deserving to be seen as their unique self, way beyond their gender or color or creed. Let’s not loose the plot altogether.

A report and a film.

A report published last month by National Child Mortality Database (NCMD) identifies common characteristics of children and young people who die by suicide between 1st April 2019 and 31st March 2020. It investigates factors associated with these deaths and makes recommendations for policy makers.

Every child or young person who dies by suicide is precious. These deaths are a devastating loss for families and can impact future generations and the wider community. There is a strong need to understand what happened and why, in every case. We must ensure that we learn the lessons we need to, to stop future suicides.

Key Findings:

-Services should be aware that child suicide is not limited to certain groups; rates of suicide were similar across all areas, and regions in England, including urban and rural environments, and across deprived and affluent neighbourhoods.

(No one is immune.)

-62% of children or young people reviewed had suffered a significant personal loss in their life prior to their death, this includes bereavement and “living losses” such as loss of friendships and routine due to moving home or school or other close relationship breakdown.

(Saagar was unable to return to his life at University due to a new diagnosis of a mental illness.)

-Over one third of the children and young people reviewed had never been in contact with mental health services. This suggests that mental health needs or risks were not identified prior to the child or young person’s death.

(Saagar had been in contact with Mental Health Services but they discharged him as soon as he showed signs of improvement. They did not follow him up. His GP was unable to identify his high risk of suicide despite his Depression scores being the worse they could be for at least 4 weeks.)

-16% of children or young people reviewed had a confirmed diagnosis of a neurodevelopmental condition at the time of their death. For example, autism spectrum disorder or attention deficit hyperactivity disorder. This appears higher than found in the general population.

(Saagar did not.)

-Almost a quarter of children and young people reviewed had experienced bullying either face to face or cyber bullying. The majority of reported bullying occurred in school, highlighting the need for clear anti-bullying policies in schools.

(At his Primary school in Belfast, his peers called him ‘Catholic’. He didn’t know what it meant but he knew it was not right. This went on for more than a year before I found out. When I spoke to his class teacher about it, she denied any problem.)

The film ‘1000 days’ tells us about Saagar and what we have learnt from his life and death. I am not sure what or how much the policy makers and service providers have learnt or changed but we have learnt and changed a lot and here we talk about that. The film is presently available on-line at the Waterford Film Festival (Short Programe 6), till the 15th of November at the link below. Please take 20 minutes to watch it if you can. You will learn something too. Each one of us can make a difference.

https://waterfordfilmfestivalonline.com/programs/collection-jlvwfxb8ctq

Mum’s not the word.

He didn’t want to go. The new school was an hour’s drive from home. His bags were packed. Each piece of clothing had been labelled, “Baxter 289”. Each set had been neatly marked and packaged – rugby, cricket, football. He was getting ready to leave for the most prestigious Boarding school in town. Nothing less would do for a seven years old lad from such a good family as his. It was for his own good. This precious boy needed a proper education, even if he had to be separated from his sweet mum, wrenched away from his big house on the hill and the fields all around, his playground. This was unquestionably the right thing to do and it was being done. They would make a proper young man out of him. 

His mum knelt beside him in his room, combed his curly brown hair back from his forehead and kissed him there, gently. She looked at his freckled face and spoke apologetically, “I’ll see you at the weekend my darling.”

“I don’t want to go Mum.” He said, looking straight into her big blue eyes.

“I know sweetheart. But once you get there, you’ll have so much fun. You won’t want to come home” she said.

He looked at her face, his eyes now pleading. She felt an ache in her chest and looked down and away at the green Persian carpet.

“Don’t send me away. Please. I promise to be good.”

“My sweet, sweet child. Your dad only wants what’s best for you. Let’s not keep him waiting in the car.”

She held his hand and walked him out into the sunny afternoon of that last Friday in August. The sun was keeping the car warm even though all the windows were open. The day looked like it ought to be a happy one.

It was never the same again.

Forty years later.

He wanted to come home for Christmas. The Government had locked everyone in their homes because of the bugs. He lived in the big smoky town full of bugs. She still lived in her lovely big house on the hill in the open, clean and green countryside.

“It’s not as bad as they make it out to be Mum. We are well and strong and so are you. Nothing will happen. Don’t worry.”

‘I do worry darling. Let’s meet once this season of calamity is over.’

“I would really like to spend Christmas with you.”

‘Yes. That would be nice but I am not sure. The government has not given permission yet.’

“They really should. If they don’t, that would be more of a political decision than a scientific one.”

‘The Government only wants what’s best for us. Let’s not disobey the rules.’

That sounded familiar. He was seven again.

— — — — — — — — — — — — — — — — — — — — — — — — — —

Ref: How early maternal deprivation changes the brain and behavior? by Masa Cater and Gregor Majdic

EJN – 18 April 2021: https://onlinelibrary.wiley.com/doi/10.1111/ejn.15238