empathy

Day 575

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‘Everyone’s better than me’
‘I’ll never be good at anything’
‘I’m not as clever as my friends’
‘I’m fat’
‘I’m ugly’
‘I’m hideous’
‘Everyone hates me’
‘Other people at school tell me to die’

Lack of self-worth is driving increasing numbers of young people to thoughts of suicide, according to national charity PAPYRUS Prevention of Young Suicide. Young people need to be taught that good relationships with others start with their own self-care. PAPYRUS is calling for more general mental wellbeing sessions in schools and awareness by society in general, to help young people begin to build a positive self-relationship. As well as the basics – getting enough sleep and rest, fresh air and exercise, eating well – we need to teach young people how to deal with negative put-downs.

Contacts made with HOPELineUK helpline services last month increased by 130% over April last year. Lack of self-worth is now a dominant theme and increasing numbers of much younger callers (around 11 plus) say they are not good enough.

“We must all watch out for invitations from young people that say ‘I need help: please ask me how I am feeling’,” urges Ged Flynn, CEO of Papyrus. “Talking about suicide is not easy, but society needs to toughen up. Young suicide is everyone’s business. Talking about it does not make it more likely happen – and it can save young lives.”

Day 571

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Two things tend to greatly suffer in mental illness- creativity and human relationships. Sarah Wheeler believed this as she lived with Borderline Personality Disorder and Depression. She set out to create a space that was open-hearted, connecting, non-judgemental, creative and safe – The Dragon Cafe on Borough High Street in London. And it is exactly that – a little bit of heaven for those who’ve been in hell.

Sarah set up “Mental Fight club”. It’s mission is to put on imaginative events for people of all mental health experiences. Every event seeks to connect our inner and outer world and ourselves to one another, whoever we may be. It is no wonder that I intended to be there only for a couple of hours but ended up spending more than double that time, feeling totally relaxed and quite happy.

All visitors are called patrons. Each one is important. You don’t have to do anything. You may do some art, read poetry, dance, sit around and chat, drink tea, have some heavily subsidized, freshly cooked vegetarian food or have a nap on a bean-bag in the Quiet Room.
I will definitely be back there next Monday.

From our conversations it was clear that it is the focal point of many lives. It gives them hope, some thing to look forward to and a strong sense of acceptance and belonging. These are basic human needs that are so often unfulfilled.

Maybe mental illness is not a disease of the brain, but that of society.

This poem by Ben Okri is one of Sarah’s inspirations:

An illusion by which we can become
More real.
A moment unremarked by the Universe,
By nature, the seasons or stars.
Moment we have marked out
In timelessness.
Human moment.
Making a ritual, a drama, a tear
On eternity.
Domesticating the infinite.
Contemplating the quantum questions,
Time, death, new beginnings,
Regenerations, cycles, the unknown.

Day 388

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Depression is not one thing. It is not just sadness.

The opposite of depression is not happiness. It is vitality.

There is a total lack of interest in anything. The smallest of tasks seem like climbing a mountain.  For instance, answering the phone or getting food out of the fridge, putting it on a plate and eating it.  The person suffering from it knows that it is ridiculous and yet they are in the grip of it and cannot seem to find a way around it.  Often it is accompanied by acute anxiety – being afraid all the time without knowing what of. The state of anxiety is often more unbearable than depression and it too can last for months.

While we think that the person with major depression must be shrouded in a grey veil and cannot see things clearly, the person often feels that a veil has been taken away and they can see clearly. When their mind tells them, “You are NOTHING! You are a NOBODY!”, they believe it. But, their “truth” lies.

I wonder what it must feel like to be diagnosed with a mental illness. It must force one to completely rethink one’s identity. Who am I?  How does this illness and the meds affect my integrity and character?  Are these medications making me someone else?It must be very confusing.

The science behind the treatment choices for depression is still very primitive considering that it is one of the leading causes of disability in the world and people die of it everyday.

Our vocabulary is poor as we have don’t have words to describe various degrees of depression. A rainy weekend is depressing as is not wanting to live anymore.

“Depression, the secret we share” is a TED talk by Andrew Solomon. It explores the issue in great detail through his personal experience, explores treatment options and gives hope.

Day 382

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UK has the highest rate of self-harm in Europe.
About 1 in 10 young people have self harmed.
It is nearly 3 times more common in women than men.
The highest number of calls made to Childline are from 12 year old kids self harming.
At least half the people who end their own lives have a history of self harm.
Around 200,000 episodes of self harm present to hospitals per year.
Many people who self harm do not seek help. Hence they are not reported or recorded.

What Self harm is not :

-Attention seeking behavior.
-Manipulative
-A selfish act
-Done for pleasure
-A group or sub-culture activity
-A copy-cat response

Why is it done?

A release or distraction from emotional distress.
An expression of anguish.
An act of survival – a way to postpone suicide.
A form of self-punishment for feeling ‘bad’ or ‘dirty’.
A way of feeling’in control’
To feel real or alive if they have been feeling numb.
Difficulties in problem-solving
Low self-esteem
Anxiety/Depression
Eating disorders
Difficulty coping with anger
Difficulty dealing with sexuality.

What to do if someone is found self-harming?

  • Stay with the young person and if necessary, take them to A&E.
  • Monitor closely
  • Use Strengths and Difficulties Questionnaire  to make a judgement on mental well being.
  • Ask about suicide
  • Administer first aid
  • Advise them to get help: GPs/Psychologists/Psychiatrists/CAMHS 
  • Introduce them to self-help strategies

What not to do:

  • Do not blame them or make them feel guilty
  • Take them seriously
  • Do not act shocked even if you are
  • Avoid panic or anger
  • Be patient. It can be very hard for them to talk about it.
  • Don’t dismiss them as manipulative / attention seeking.

Day 348

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If anyone you know came to you and said,

“For the last few weeks I have noticed that nothing gives me any pleasure; I don’t feel interested in anything; I feel quite hopeless and I sleep all the time. Some days I can’t sleep at all and feel terribly restless and fidgety; I feel wretched about myself all the time and hardly feel like eating anything. I feel really tired and can hardly focus on anything. This has been getting worse for a few weeks but for the last 2 weeks, almost everyday the thought has occurred to me that I would be better off dead or hurting myself in some way. All these things have made it extremely difficult for me to do my work, take care of things at home or get along with other people.”, what would you think?

They are suffering deeply.

This is what a PHQ-9 score of 27/27 looks like.
This day last year, my son’s score was 27/27.
It had been 19/27 two weeks prior but had since risen.
I had noted the deterioration in his state of mind.
The words my son could not utter, he indicated on paper.
He was suffering deeply but sadly his suffering was not acknowledged by the professionals who we trusted to care for him.

If clinical judgement had been astute enough, we would have picked up on it and possibly turned it around – escalated care, reviewed medications, reviewed dosages, taken him to A&E.

If a patient with diabetes had a dangerously low blood sugar or another one with Hypertension had a sky rocketing blood pressure, would we just ignore it?

The investigation report mentions the PHQ-9 test as a ‘blunt instrument’. If that is the case, why is it used so widely? Why is it a well-recognized monitoring tool for patients with depression? How can it be ignored when a patient has the highest possible scores?

A baseball bat is a blunt instrument. But it has its uses. It can take a team to victory and crack a skull.

In the light of what I know now, it is not surprising that my son died of severe depression. In fact, it is surprising that he hung on for as long as he did.

Just because the patient is sitting and talking to us and there are no lumps and bumps, no obvious bleeding or pain, does not mean they are not suffering. They are slowly dying in front of our eyes. Their suffering is so unbearable that they will do anything to get rid of it. They are ashamed of it and can’t bring themselves to talk about the extent of it.

We need to learn to pick up on subtle signs.

When it comes to suicide, prevention is the only cure.