Day 989

Accidental findings

The_ACE_Pyramid

In the mid 80s, Dr Vincent Felitti ran an Obesity clinic in America. Many people enrolled and hundreds of pounds were shed by them. But he found that the drop-out rate from his programme was as high as 50% despite good results. He did not understand this and went back to look closely at patient notes.

“I had assumed that people who were 400, 500, 600 pounds would be getting heavier and heavier year after year. In two thousand people, I did not see it once. When they gained weight, it was abrupt and then they stabilized. If they lost weight, they regained all of it or more over a very short time.”

The turning point in Felitti’s quest came by accident. He was running through yet another series of questions with yet another obesity program. How much did you weigh when you were born…when you were in first grade…when you were in high school…when you first became sexually active…

One female patient replied – “Forty pounds” and broke down in floods of tears, “I was four years old.” He found similar common themes emerging from various stories and went on researching this subject for the next 25 years.

The obese people that Felitti was interviewing were 100, 200, 300, 400 overweight, but they didn’t see their weight as a problem. To them, eating was a fix, a solution like IV drug user calls a dose a “fix”.

Eating made them feel better. Eating soothed their anxiety, fear, anger or depression – it worked like alcohol or tobacco or methamphetamines. Not eating increased their anxiety, depression, and fear to levels that were intolerable. For many people, just being obese solved a problem. In the case of the woman who’d been raped, she felt as if she were invisible to men.

Felitti went on to further explore the  impact of childhood trauma on people and coined the term – ACE, Adverse Chilhood Experience. He found a strong co-relation between the number of ACEs and early death.

aceslist

acedepression

Film: https://www.youtube.com/watch?v=v3A_HexLxDY

 

Day 987

download-1

Dancing with Rumi

The Papyrus AGM this morning brought together many people with the same vision – to keep every young person safe and happy. The numerous hurdles on ground made my heart sink. This is too big a task. It’s too much for me or anyone else. But, I am not alone and they are not alone. We are together. Most of us in the room had been touched by suicide and were carrying our pain boldly around, hoping to use this massive emotional energy to reduce further pain in this world. Bit by bit we will keep planting seeds of hope. One person at a time, we will keep smashing the stigma. We will keep taking small steps and keep walking without looking fearfully into the distance. 

The Journey

Wake up lovers, it is time to start the journey!
We have seen enough of this world, it is time to see another. Though these two gardens may be beautiful,
let us pass beyond them and go to the Gardener,
let us go prostrating like a torrent to the ocean.
Let us journey from the vale of tears to the wedding feast, and bring the colour of blossom to our pale cheeks.
Let us journey home, our hearts trembling
like autumn leaves about to fall; in this world of dust
there is no avoiding pain or feeling exiled.
This path is full of trials, we need companions
let us join their caravan and let love be our guide.
We have stayed home, scared like mice
but we are lion cubs, let us roar like lions.
Let our soul turn into a mirror,
that passionately wants to reflect Beauty.
Let us begin the journey home.

  • By Rumi.

Day 983

How many?

download

“Work out how many vulnerable children there are in this country today…Four months, 12 experts, 500 pages and four spreadsheets later, and our answer is: we don’t know.”

The report produced by the Independent Jersey Care Inquiry into the abuse of children in the Island’s care system over seven decades was published yesterday. The findings were shocking:

  • Having their hair forcibly cut off
  • Having their mouths washed out with soap
  • Spending long periods in an isolation room
  • Having fat from a frying pan poured over them
  • Being punched and slapped
  • Being sexually abused
  • Live electrical wires applied to legs
  • Being hit with a pre-war army stick with a metal end
  • Being beaten with nettles as a punishment for bedwetting

The “Jersey way” is a term used to describe a system where “serious issues are swept under the carpet” and “people avoid being held to account for abuses”. However, Jersey is not the only place in the world where this has been happening and still carries on.

Studies show that children and adolescents in care are at greater risk of suicide and attempting suicide than those who are not in care. Rates of suicide attempts and hospital admissions within this population were highest before entry into care and decreased thereafter. Health and social care professionals should be made aware of this research. The care home experience is a prominent risk marker for suicidal behaviour among teenagers and young adults.

 

 

Day 982

images

Many years ago in India it was traditional to keep the best nibbles like almonds and cashews stored away, for guests, often under lock and key. I understand the same practise was common throughout the middle east and in many house-holds in Europe. Although in Europe it translated to the best whiskey and brandy.

Many of these traditions have their roots in the honoured position of a guest. In Hindu belief system, God can arrive at our doorstep in any form and hence it was imperative to treat all guests, friends or strangers with great respect.

This attitude is not limited just to things. It sometimes transfers to people. While there is nothing wrong with honouring others, it does not have to be at the cost of dishonouring ourselves or those closest to us. Things may be in limited supply but love and respect are not. It’s not unusual to see people treat their friends in the best possible way and their spouses and children in the worst. Everyone else’s mistakes are easily forgiven but slightest mistakes of close family members are made to look far worse than they are.

I have learnt to honour myself and those close to me as much as a guest. Said ‘God’  resides in me and my dear ones too. Besides,  I love almonds.

Day 979

“Helping others is the way we help ourselves”
-Oprah Winfrey

Simple ideas change the world. A Clinical Psychologist, Dr Charlie Howard was taking a walk around her area. Having recently had a child, she was looking for her next “thing”. She asked random people what would make a difference in their community. “A Problem-Solving Booth right here on my street” answered a young man in the queue in a sandwich shop.  “A place where people can go with the stresses in their head and where we can help each other”. The idea was genius and Charlie’s head built on it quickly. “Maybe we could try one here?” Charlie suggested, “we could do it together”. The young man smiled at Charlie and said “yeah maybe” and then his phone rang and he ran off down the street. No one knows his name and no one has seen him since. He probably has no idea just what his throwaway words have since inspired.

Problem-Solving Booths are a great way to bring members of the community together to have conversations that they might not otherwise have, by helping each other with their problems. One chair is for the “Helper”, the person listening to the problems. The other is for the “Helped”, the person describing their concerns. The aim of the Booth is that people swap roles regularly as we all have both the potential to have problems as well as to offer help.

Thrive London is a citywide movement for better mental health for Londoners supported by the Mayor of London and the London Health Board. Problem-Solving Booths have become the local arm of Thrive and we’re working out what they are, what they do and what they can do, with everyone we meet from street to street, borough to borough and organisation to organisation. It’s cool.

Watch this space!

 

Day 978

Primum non nocere- First do no harm.

Doctors could save lives by breaking rules on privacy.

Screen Shot 2017-06-29 at 22.23.06

This is a point worth making again and again and again and again and as many times as it takes. Few excerpts:

Hamish Elvidge, father of Mathew – “Before my son took his own life, he had only just been discharged as a low-risk patient, despite coming in as a high-risk patient that very same day after a suicide attempt. At no point were his family involved in any part of the process. There is a chance that, had the hospital decided to share information with his family, our son would still be here today.”

“Confidentiality is far too embedded within the medical profession. The default position has to be one where you have to explain why you haven’t involved the family.”

Prof. Appleby said: “Psychiatrists should feel able to use their clinical judgment on where the balance of patient safety and confidentiality lies. Families are devastated when they discover too late that their loved ones had been talking to professionals about suicide.”

Professor Sir Simon Wessely, president of the Royal College of Psychiatrists, said: “In my experience, if doctors make well- justified, well-recorded decisions to share information in the best interest of a patient who is in suicidal crisis, consistent with their professional codes of practice, this will be understood, respected and upheld in courts of law.”

 (Source: The Herald_Congress17_suicide story.pdf)

 

Day 963

Wysa

A young couple, committed to making a difference used their love and  intellect to create Touchkin, Artificial Intelligence for proactive care, integrating behavioural health into medical practice.

Tom Insel, a psychiatrist from National Institute of Mental Health (NIMH), the world’s largest mental-health research institution, spoke frankly about how MH services and research were failing to help the mentally ill. He openly dismissed the DSM (Diagnostic and Statistical Manual of Mental Disorders). At any given moment, roughly one in seven of the world’s 7.5 billion people is struggling with mental illness. “We’re not going to reach all those people by hiring more psychiatrists,” says Insel. But we might reach them with smartphones.

In one of his talks, Insel was sharing the intricacies of the delicate workings of the brain.   Someone interrupted him and said, “You don’t get it. The house is on fire, and you are discussing the chemistry of the paint”

Jo Aggarwal, one of the developers of Touchkin says:

“This line from the article resonated deeply with me. It’s a familiar sentiment – one many of us in development have had in conferences on employment, education, conflict. They are all at some level connected to the base fire that engulfs our world today – that of mental health. Until this fire is brought under control, we don’t have a hope for any of the rest of it.

His dramatic move lends credibility behind the idea that phones may be the answer. Identifying issues using smartphone behavior is powerful, though it can feel creepy. But detection is not enough. In our trials at Touchkin, phone sensors were able to predict depression in people with diabetes to a 90% accuracy, and went a long way in getting the physicians convinced to integrate mental health into their regimen. But only 1 in 30 people diagnosed went on to take treatment for the depression.

It said to us – “The house is on fire, the fire brigade is missing, and here we are saying how accurate our fire alarms are”

Wysa the emotionally intelligent penguin willed itself into existence somewhere along the way. It was a side feature created between ‘formal’ projects to improve accuracy. Taken by how people reacted to the prototype, we all kept working on making it better… in three months it crossed a threshold. It started changing lives. Last month, 3 people wrote in to say it saved their life, it is what is keeping them from suicide. Over 50,000 people talked to it anonymously, and thousands of them wrote in to us to say how much it meant to them.

Unlike the Stanford psychologists creating Woebot- we have no hypotheses around Wysa. It is evolving entirely based on what works for its users. It has evidence-based techniques, but everytime we add more tools or advice or tips we get users telling us to just let them talk to Wysa, and not to underestimate how much of a difference that makes.

“The fire in the house, is in our brains. The fuel is the language of the conversations we have inside our head. “

We started out, like Insel, trying to detect the fires… Wysa is leading us to try and put a fire extinguisher in everyone’s pocket. Any pretence of our own hypothesis went out of the window when the first person wrote in to say it saved their life. Now we are following it to see where it goes.

Like us, like Tim, there are many unwitting recruits to this fight.

Rick Little started fighting it as soon as he graduated college. So many of my friends… Sangeeta Mahajan who lost her son to suicide and has dedicated her life to preventing it for others. Anjana Ajay who is changing others lives after healing her own Stage 4 cancer by focusing on healing her mind. Bhavana Issar who is doing amazing work at Caregiver Saathi.Pooja Goyal who is creating resilience in pre-school children and their parents, bravely facing all the storms that come her way. Archana Aggarwal Sarda has made emotional support a way to get intl level diabetes outcomes in rural children, long before she realised that she was doing it.

None of them are psychologists. They each have options of more comfortable, lucrative ways to spend their time. They are all powerless to not do this. “The house is on fire. Once you see it, and you realise that you can stop it spreading, it is hard to do anything else.”

11078077_10152678753741035_8566229743541697060_n