“I have opened a door that can never be shut. How will I ever get her to trust me again?”
19 out of 20 people who attempt to end their lives will fail.
These survivors will be at a 37% higher risk of suicide.
Anger, shame, guilt, fear, minimization and avoidance are few of the reactions they evoke.
The taboo associated with the act might make them feel even more isolated. Their families may not know how and where to access support for themselves and their loved one. The ones closest to them may feel drained, stressed, exhausted and let down. The trust between the two might be deeply damaged.
Their relationship might reach an all time low, just when it needs to be solid.
Both need to take responsibility for their own well-being and that of each other.
“Terrible poverty causes brain damage”, says Charles Nelson, a professor of neuroscience and paediatrics at Harvard Medical School.
In 1989, when the communists were overthrown in Romania, 170,000 children were abandoned and were living in government-run institutions under very poor conditions. Nelson and his team started studying them in the late 1990s. They found that the kids were deprived of key experiences during critical periods of development. Babies lay in cribs for their first year or more and their visual experience was limited because often the ceilings were painted white. There was no one to talk to them and care-giving was limited, so they were deprived of psychosocial stimulation. Their physical growth was greatly stunted too. The kids were very very small.
“We had a rule: no crying in front of the kids. But I can’t tell you how tough it was.”
The team wanted to find out if high-quality foster care for these kids could rectify the negative impact of poverty they might have. They recruited a sample of 136 kids, from 6-31 months of age and randomly assigned half of them to high quality foster care. The other half remained in institutional care. Foster parents from Bucharest were volunteers who had been intensively screened and interviewed. They were paid a small wage and provided with material support such as toys and diapers. The families were closely monitored by social workers.
Two years into the study they found that across the board, the kids in institutions lagged behind in language development, IQ and mental well being. The prevalence of anxiety and depression were reduced no matter how old the kids were when they were placed in foster care.
They are now about 16 years old. Those in institutions are starting to experience significant mental health issues such as psychotic disorders and paranoia. 20 of them showed a sharp drop in IQ from the age of 12.
One year following this research, the Romanian government passed a legislation banning the institutionalisation of children below the age of 2 years unless they were severely disabled. They also started government foster care.
This is a classic example of science giving rise to political will to improve lives of kids.
UK’s Child Poverty Action Group reports that 3.9 million children in this country live in poverty at present. This means more than one in 4 children are growing up in families with less than 60% of the median income. In the US, 15 million children live below the poverty line. Western levels of poverty may not be anything close to the hardship endured by many in developing countries but it has long lasting detrimental effects on the physical and mental health of children.
With a strong political will, child poverty can be alleviated but despite setting goals and targets, our government is spectacularly failing to deliver. Dealing with child poverty and its life long consequences is not a matter of political choice but that of moral duty.
(A sculpture by Ruth M, who lived with Bipolar Disorder, expressing her depression)
In the 1940s, mental hospitals were places of isolation and confinement, probably closer to prison than hospital. Netherne, in Surrey was seen as a progressive asylum at the forefront of waves of reform and development for nearly 50 years, till the eventual closure of the British asylums. They enthusiastically adopted physical treatments, now viewed as barbaric- insulin coma therapy, electroconvulsive therapy and lobotomy, then seen as optimistic approaches to treatment.
Edward Adamson (1911-1996) was a pioneer of British Art Therapy. He encouraged and collected the paintings, drawings and sculptures by people compelled to live in Netherne Hospital between 1946 and 1981. He describes that many people who came to his first lecture there had shaved or bandaged heads, bruised faces and black eyes, following brain surgery.
Adamson started collecting art during his early visits when a man on a locked ward gave him the first of his several drawings done on toilet paper with a charred matchstick. He later met other people on the wards who would have had no personal possessions, working with whatever materials they could find to create something for themselves.
The Adamson Collection has 6,000 of these works of an estimated 100,000 when he retired. The collection is seen as unique in the history of art therapy of the reforming psychiatry of the 1950s and 60s, collected by an artist rather than a psychiatrist, with a strong representation of works by women. Above all it is a memorial to all those who suffered in the asylums and to the human need to express.
“Edward Adamson practiced art as healing before there were ever terms or labels like ‘Art Therapist’. Being with him for anyone was therapy and yet he didn’t play at clinician, but rather served so sweetly as a supreme friend, ‘there’ for those who had none other. There were for Edward no patients. I think that is why so many lost people in his care found their way back to themselves. Adamson’s was an alchemy of the highest sort.”
– Rebecca Alban Hoffberger, Founder/Director American Visionary Art Museum, 2011
A bereaved mum’s lament: Went out for dinner with friends. What could go wrong? All went well until there was talk of an acquaintance of one of the guests who is suffering from a debilitating mental illness. They had tried to take their life but survived. The guest herself is a breast cancer survivor. She said that she had visited the person and said “did they not realise how hard she had fought to live and there they were throwing away their life”. Its a shame she didn’t appreciate just how hard the other person was fighting to stay alive … my son lost that fight. When will they realise Depression is as dangerous and potentially fatal as cancer. You know when you are stuck in a situation when its just not appropriate to make a fuss but you want to scream “How ignorant are you ???”
From the individual level, right through the media, the regulatory bodies and up to the government, we are all ignorant. Mrs May speaks of parity between physical and mental illnesses, ie. both being given the same importance. Many others have talked about it before her but we are miles away from it.
The Ebola Outbreak in West Africa was a public health emergency of international concern and we heard about it everyday, non-stop on the radio and TV from 2014-2016. 1 person was infected with the virus in the UK and fortunately there were no deaths from it. 1 person dies every 2 hours by suicide but it is not mentioned in the media. Public health England are not particularly concerned. Suicide claims 4 young lives every day but it’s no big deal.
Imagine a middle aged man presenting to his doctor with severe chest pain and being sent home with pills that take 3 weeks to work. I am sure the GMC would have something to say about that. A young man presents to his doctor with debilitating depression together with a strong desire to end his life and he is sent home with pills that can potentially make suicidal ideation worse and the benefit, if any might be seen in 3 weeks. The GMC finds that acceptable practice.
1 in 4 patients present with a mental illness to the NHS and only 10-12 % of the NHS budget is spent on mental health.
Survivors of physical illnesses proudly claim bravery and wear their survival as a badge of honour whereas those surviving mental illness hide in corners feeling ashamed.
The acceptable faces of mental illness are Dementia and Alzheimer’s disease. This is apparent from the t-shirts worn at charity events, walks and runs. I hardly see anyone running in support of Bipolar Disorder research or British Schizophrenia Foundation or Borderline Personality Disorder Charity.
Things most resistant to change are cultures and mindsets.
Parity of esteem?
We have aeons to go!!!
She is a Professor of Psychiatry at the Johns Hopkins University. She is an international authority on Manic-depressive illness. She writes about her own struggles with the illness since her adolescence. She recounts the slow and painful mastering of her illness through knowledge, courage, medication, self-discipline and the power of love. Her work has helped save countless lives. An excerpt:
“At this point in my existence, I cannot imagine leading a normal life without both taking lithium and having had benefit of psychotherapy. Lithium prevents my seductive but disastrous highs, diminishes my depressions, clears out the wool and webbing from my disordered thinking, slows me down, gentles me out, keeps me from running my career and relationships, keeps me out of a hospital, alive, and makes psychotherapy possible.
But ineffably, psychotherapy heals. It makes some sense of the confusion, reigns in the terrifying thoughts and feelings, returns some control and hope and possibility of learning from it all. Pills cannot, do not, ease one back into reality; they only bring one back headlong, careening and faster than can be endured at times. Psychotherapy is a sanctuary; it is a battleground; it is a place I have been psychotic, neurotic, elated, confused and despairing beyond belief. But always, it is where I have believed-or have learned to believe-that I might someday be able to contend with all of this.
No pill can help me deal with the problem of not wanting to take pills; likewise, no amount of psychotherapy alone can prevent my manias and depressions. I need both. It is an odd thing, owing life to pills, one’s own quirks and tenacities, and this unique, strange and ultimately profound relationship called psychotherapy.”
Psilocybin is the active hallucinogenic compound in ‘magic mushrooms’. It was banned in the 1960s but recent preliminary research has shown that it may have potentially beneficial effects in patients with anxiety and depression. The subjects for this research were cancer patients, 40-50% of whom will have a diagnosis of anxiety and/or depression.
A team at Johns Hopkins in Baltimore conducted studies where patients were randomly administered the drug or a placebo. They were then encouraged to focus on their internal experience. Those who received Psilocybin had a significant improvement in depression, anxiety and mood disturbances. They also showed a higher level of optimism, a better quality of life and acceptance of death.
The main feature of the experience was a feeling that everything is connected. People felt they’ve learnt something that is of deep meaning. It caused a change in their value systems, in how they approach life and interact with other people. Some patients described the experience as a spiritual awakening.
The single feeling of connectedness with everything is the key to well-being. Many spiritual practices aim to manifest this feeling of oneness with all creation. My beloved spiritual leader Sri Sri Ravi Shankar says, ‘From somebody become nobody and from nobody become everybody.’