Patient safety

Day 310

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This time last year, he was nearly ‘normal’ as he had responded really well to Olanzepine (Zyprexa), the antipsychotic medication. He was under the care of the Community Mental Health Team and everyone seemed happy with his progress.

I was relieved but was still reeling from the effect his behaviour during the episode of hypomania had had on me. That was proper psychosis, as defined by the medical dictionary – radical change in personality and a distorted or nonexistent sense of objective reality, caused by delusions and hallucinations.

I phoned the mental health team as I wanted to know more about what it means for us a family if our son has this type of an illness. The psychiatrist said, ”it could just be a one off.” That left me none the wiser, not knowing what to expect next or what to watch out for.

What came next was a gradual onset of low mood, him spending a lot of time by himself, him coming back from his placement abroad in 2 days as he was unable to function, upside down sleep pattern, difficult to talk to as he would barely speak much and a neglect of his appearance. He went to the gym everyday but I noticed that the time he spent there became shorter and shorter. Shaving his beard seemed like a herculean task to him.

I did not know it then but that was psychosis too – Psychotic Depression.

People with psychotic depression may be humiliated or ashamed of their thoughts and try to hide them. Doing so makes this type of depression very difficult to diagnose.

But diagnosis is important as its treatment is different to that for nonpsychotic depression. I suppose this is the kind of thing that specialists would know. I was only a layperson when it came to mental illness.

Day 300

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Edwin S. Shneidman (1918- 2009) is considered to be the father of contemporary suicidology. While working at the LA Veterans Administration in 1949, he was asked to write condolence letters to widows of two victims by suicide. He researched the two cases at the LA County Coroner’s Office and there was led to a vault of suicide notes. He never looked back and became a pioneer.

His passion in life to understand suicide was only equalled by his love of Melville’s Moby Dick (1853). Moby Dick itself is an extraordinary study in suicide.

Shneidman makes 3 interesting clarifications on suicide:

  1. The first is that the acute suicidal crisis (or period of high and dangerous lethality) is an interval of relatively short duration – to be counted in hours or days, not usually in months or years. An individual is at a peak of self-destructiveness for a brief time and is either helped, cools off, or is dead. Although one can live for years at a chronically elevated self-destructive level, one cannot have a loaded gun to one’s head for too long before either bullet or emotion is discharged.
  1. The second concept is ambivalence. The paradigm of suicide is not the simplistic one of wanting to or not wanting to. The prototypical psychological picture of a person on the brink of suicide is one who wants to and does not want to. He makes plans for self-destruction and at the same time entertains fantasies of rescue and intervention. The dualities of the mind’s flow constitute a cardinal feature of man’s inner life. One can no longer ask in simple Aristotelian way, “Make up your mind.”  To such a question a sophisticated respondent ought to say: “But that is precisely the point. I am at least of two, perhaps several minds on this subject.”
  1. Most suicidal events are dyadic events, that is, two-person events. Actually this aspect of suicide has two phases: the first during the prevention of suicide when one must deal with the “significant other,” and the second in the aftermath in the case of a [completed] suicide in which one must deal with the survivor-victim. Although it is obvious that the suicidal drama takes place within an individual’s head, it is also true that most suicidal tensions are between two people keenly known to each other: spouse and spouse, parent and child, lover and lover.

He believed that suicide is preventable.

“We might say that if we have learned anything from our decade of work on this topic, we have learned that, happily, most individuals who are acutely suicidal are so for only a relatively short period, and that, even during the time they are suicidal, they are extremely ambivalent about living and dying. If the techniques for identifying these individuals before rash acts are taken can be disseminated, and if there are agencies, like the Suicide Prevention Center, in the community that can throw resources in on the side of life and give the individual some temporary sanctuary, then after a short time most individuals can go on, voluntarily and willingly, to live useful lives. We know that it is feasible to prevent suicide.”

It’s good to know that experts think so too. I feel a little less crazy. 🙂

Day 286

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Ignorance is a good thing.
It allows for wonder, exploration and learning.
Not knowing something and having an insight about it, is healthy.

For instance, let’s say there are 2 doctors. One of them has been practicing for 30 years and the other one has recently qualified. When the former sees a patient, he is highly unlikely to doubt his judgement. The latter however, is more likely to admit that it might be worth taking a second opinion as his experience is limited. Which one of these two is better for the patient?

My son was unwell. I knew.
How unwell? I did not know.
For at least 4 weeks before he died he was severely suicidal. I did not know. I was told by his doctor that the drugs would kick in soon and I trusted him. I read up about it but did not find anything to make me think differently. I did not seek a second opinion. Was that ‘willful ignorance’ on my part? Did I not want to know? Although it was painful to watch him suffer, that last month was beautiful. We spent a lot of quality time together – going for walks, cooking, going to the gym, for movies, dinners and drives, talking, being silent and watching TV together. I will always treasure that time. It was special because I was relaxed while taking care of him. I was blissfully oblivious of the fact that he was so close to the edge.

Is ignorance bliss?

Day 279

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It was fancier than I thought it would be.

Broadcasting House was intimidating but once we stepped in we were met with nothing but politeness and sensitivity. They even arranged for a taxi to pick us up. I am not used to being so spoilt.

The cups of tea were much needed and lovingly offered. The inside of the premises were as modern as the outside of the building was old. A multitude of wall mounted flat screens, computer terminals, autocues, cameras and all kinds of efficient looking people walking around with headsets and hand-held radio sets filled the space in an elegant manner. I am not even sure of the proper names for some of the things that were there.

There were many interconnected corridors, mostly dotted with what seemed like a lot of make-up rooms. I was guided into one of them where a lovely lady called Julia made me BBC camera worthy.

I was at the studio for the live screening of a 17 minute slot on ‘Suicide’. There were 3 other panelists who shared their stories. Very moving and insightful. Although the format was informal, I was glad to note that the conversation had a definite suicide awareness and hence prevention emphasis.

On getting home from work, with slight nervousness I turned the TV on to watch the recording of the programme. I was happy but sad. I would have much preferred to spend the morning with my son at home. I wonder where the strength comes from! One part of my brain says, ”This cannot be happening. It is terrible!” Another says, “Something has to be done about this.” Yet another part is just vacant and wandering and watching the other two combat each other. The result varies from minute to minute.

I don’t know how I carry on.

It must be ‘Grace’. It is bestowed upon us for no particular merit. It flows through me as a result of the blessings of my parents and my Guru, the love and best wishes of near and dear ones, the support of all you good people out there and the good deeds of my fore-fathers and my son.

The first 17 minutes of the programme might be of interest to you.

Day 278

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Suicide is a permanent fix to a temporary problem.

It is preventable.

The thought is complex, confusing and overwhelming.

It can affect anyone.

It does affect many of us –men and women, young and old.

It is nothing to be ashamed of.

It is not insurmountable.

It leaves behind utter devastation.

It sends out warning signs.

We’ve got to watch out for it.

Watch out for it as individuals, as friends, as family, as schools, as work places, as a society, as a country and as a world.

It strikes when no one is looking. It is devious and cunning.

It narrows down the mind to one and only one possibility when many exist.

It claims our most sensitive, creative and beautiful gems.

It defies the youth of the young and the wisdom of the old.

It drives us against our very grain.

Please let us not let it win.

Let us listen. Let us talk. Let us open up and reach out.

It’s ok to be vulnerable. Inside, we all are.

Suicide, suicide. Go away! Don’t come back another day.

I am honoured to be invited to participate in a TV show about suicide prevention tomorrow morning on Victoria Derbyshire’s talk show on BBC2 between 9.15-9.35 am.