Project Eighty-four and more

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84 life-size statues of men were seen standing at the edge of tall buildings in central London in late March representing the same number of men lost to suicide every week in the UK – a hard hitting visual project aiming to bring this tragic loss out into the open from behind closed doors.

Common threads emerged from articles published in April:

“Students more likely to kill themselves” in the Times: Researchers from a Hong Kong University analysed the ONS figures and found that the number of university students in Britain increased by 5 per cent between 2012 and 2016. The total number of suicides among students increased by 32 per cent, from 139 to 183 deaths. A think tank said that a law banning universities from contacting the friends and family of students who are struggling should be revisited.

The number of first year university students reporting mental health problems in UK Universities has risen five fold in 10 years. A combination of increasing awareness of mental health issues, a lowering of the taboo previously attached to mental health services, mounting debts, homesickness, loneliness and a greater sense of anxiety about the future may be some of the reasons for it. Some vice-chancellors still think that mental well being is not the business of universities and it’s just about developing the mind. But developing minds means nothing unless students settle down well in their new environment and be ready to learn.

According to recent ONS statistics on loneliness, people between 16-24 are at the epicentre of the loneliness epidemic in the UK. More so than the elderly. Women were found to be lonelier than men. Other variables were renting a home rather than owning one, being single or widowed, having poor health and feeling disconnected from the local community.

In an article entitled “Doctors knew my son was suicidal. I should have been told before he died” in the Guardian, I raise this question yet again: Is confidentiality more important than helping someone at risk to stay alive? Is it correct for a father to be informed by doctors after the death of his son,”Now that he is dead I can tell you that this was not his first attempt”?

Is it?

 

Rule 12: Pet a cat when you encounter one in the street

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In difficult times, it’s important to hold on to something sustaining, like a sparkling crystal in the darkness, like the sweetness of stroking a cat or a dog. Take every opportunity to make life easier, lighter.

Let a tragedy be only tragic and not absolute hell. There is a big gap between the two. Like the difference between someone lying on their death bed and someone lying on their death bed surrounded by their family yelling and screaming at each other. If we didn’t make worse the terrible things that there are, if we could just put up with the terrible things that exist, maybe we could make the world a better place.

The motivational speaker and Clinical Psychologist, Jordan B. Peterson speaks about his latest book – “12 rules for life. An antidote to chaos.”  He says he wrote it for himself as much as for anyone else.

“You set an ideal and find that there is a long way to go. It is a constant readjustment. There is also something positive about that. It’s not that there isn’t such a thing as a good person. Our idea of what constitutes good isn’t right because a good person is one who is trying to get better. The real goodness is in the attempt to get better. It’s in the process, to use an old cliché.

The central figure of western culture is Christ. He is the dying and resurrecting hero. What does that mean psychologically? Well, it means that you learn things painfully. And when you learn something painfully, a part of you has to die. That’s the pain. When a dream is shattered for example. A huge part of you has to be stripped away and burnt. And so, life is a constant process of death and rebirth and to participate in that fully is to allow yourself to be redeemed by it. So, the good in you is that process of death and rebirth, voluntarily undertaken. You are not as good as you could be. So, you let that part of you die. If someone comes along and says, there’s some dead wood here. It needs to be burned off. You might think, well that’s still got a little bit of life. When that burns it’s gonna hurt. Yes. Well, no kidding. Maybe the thing that emerges in its place is something better and I think this is the secret of human beings. It’s what we’re like. Unlike any other creature, we can let our old selves die and let our new selves be born. That’s what we should do.”

When asked if he falls short anywhere in his book, he says,
“Until the entire world is redeemed, we all fall short.”

Source: Synopsis of the book: https://www.nateliason.com/lessons/12-rules-for-life-jordan-peterson/

Turn the page…

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The wisdom of Paulo Coelho:

“One always has to know when a stage comes to an end. If we insist on staying longer than the necessary time, we lose the happiness and the meaning of the other stages we have to go through.
Closing cycles, shutting doors, ending chapters – whatever name we give it, what matters is to leave in the past the moments of life that have finished.

Did you lose your job? Has a loving relationship come to an end? Did you leave your parents’ house? Gone to live abroad? Has a long-lasting friendship ended all of a sudden?
You can spend a long time wondering why this has happened.

You can tell yourself you won’t take another step until you find out why certain things that were so important and so solid in your life have turned into dust, just like that.
But such an attitude will be awfully stressing for everyone involved: your parents, your husband or wife, your friends, your children, your sister.
Everyone is finishing chapters, turning over new leaves, getting on with life, and they will all feel bad seeing you at a standstill.

Things pass, and the best we can do is to let them really go away.
That is why it is so important (however painful it may be!) to destroy souvenirs, move, give lots of things away to orphanages, sell or donate the books you have at home.

Everything in this visible world is a manifestation of the invisible world, of what is going on in our hearts – and getting rid of certain memories also means making some room for other memories to take their place.
Let things go. Release them. Detach yourself from them.

Nobody plays this life with marked cards, so sometimes we win and sometimes we lose.
Do not expect anything in return, do not expect your efforts to be appreciated, your genius to be discovered, your love to be understood.

Stop turning on your emotional television to watch the same program over and over again, the one that shows how much you suffered from a certain loss: that is only poisoning you, nothing else.

Nothing is more dangerous than not accepting love relationships that are broken off, work that is promised but there is no starting date, decisions that are always put off waiting for the “ideal moment.”

Before a new chapter is begun, the old one has to be finished: tell yourself that what has passed will never come back.
Remember that there was a time when you could live without that thing or that person – nothing is irreplaceable, a habit is not a need.
This may sound so obvious, it may even be difficult, but it is very important.

Closing cycles. Not because of pride, incapacity or arrogance, but simply because that no longer fits your life.

Shut the door, change the record, clean the house, shake off the dust.
Stop being who you were, and change into who you are.”

It’s become a ‘thing’.

For a thousand days I wrote every day. It wasn’t a ‘thing’. That’s just what I did. I didn’t worry about who read it and why. It didn’t matter how good or bad it was. I just did it. Then I slowed down to writing roughly once a week.

Now, I think about writing. I talk about writing. I look up ‘writing’ on the internet. I consider on-line courses. I buy books on writing. I worry about writing well. I listen to podcasts of interviews with famous writers. I am on the lookout for writing tips in newspapers and magazines. I wonder what it must feel like to write properly every day. I envy those who can. What I do very little of, is write. I believe I repeat myself endlessly. I say the same things again and again. I forget things that are important. I hardly know any juicy big words. Why would anyone be interested in what I have to say? English is my second language and I can’t fully express myself in it anyway. My imagination is limited. I haven’t read enough books. I have no writing qualifications. Ms Confidence has evaporated and Mr Self Doubt has surreptitiously crept into her space in the vacant apartment of my psyche.

One ‘expert’ on you-tube suggested the way forward is to just write 3 full A4 sheets every day. She said,”… best not to think too much. Just put down on paper whatever comes to mind”. She called it a ‘brain dump’. She promised that over time it would start to make sense. It would become a story in your voice.

Maybe it’s time to go back to writing everyday. Maybe it’s time to start  my “big fat” book 🙂

PS: My favourite book on writing is ‘On Writing Well‘ by William Zinsser.

 

Confidentiality versus Life

Three years back I joined a club no one wants to be a member of. I became a parent who lost their beautiful child to suicide. He was 20. I didn’t think it was possible. I trusted his doctors to take good care of him. I trusted they would tell me if there was a real risk of him dying, given I am his mother and was his prime carer. I thought they had the expertise to identify and address ‘crisis’ when they saw it. Suicide was not in the script. It was not supposed to happen. I turn the fact of his sudden traumatic death over and over in my head and it makes no sense.

There are hundreds of distraught and bewildered members of this club. Common themes emerge from their stories. The commonest one is:

“They knew our child wanted to end his/her life but they didn’t tell us anything about it.”

Who are they?
Decision makers – Medics. Universities.

Why?
Because he/she is over 18, hence, technically an adult.
Their ‘confidentiality’ is paramount.

Is it?
Is it more important than helping them stay alive?

The Hippocratic oath states:
“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”

According to experts[1], these are the essential components of an effective suicide prevention safety plan:

  1. Discussing the reasons for living
  2. Safe environment
  3. Identify distress triggers
  4. Removing ways to harm yourself
  5. Activities to calm/lift mood or distract
  6. Contacts for general support
  7. Specific suicide prevention support
  8. Professional support
  9. Emergency contact details
  10. Personal commitment to follow safety plan

Most of the above cannot be implemented without the help of carers and families if the person in question is seriously unwell. This has been recognised by the Department of Health, Royal Colleges of Psychiatrists, GPs and Nursing along with The British Association of Social Workers and The British Psychological Society. Together they published a consensus statement entitled[2] “Information Sharing and Suicide Prevention” in 2014, the same year that my son, Saagar Naresh[3] passed away. It clearly states that practitioners should disclose information to an appropriate person or authority if this is necessary to protect a child or young person from risk of death or serious harm.

“If the purpose of the disclosure is to prevent a person who lacks capacity from serious harm, there is an expectation that practitioners will disclose relevant confidential information, if it is considered to be in the person’s best interest to do so.”

This is still not being practised. The world of medicine is a conservative and defensive one. Until the regulatory bodies, NHS Trusts and the Government come forward to reassure practitioners that their decision to share information appropriately will be supported by them, nothing will change.

While the world carries on, innocent youngsters die from lack of support and understanding from the very people who are best placed to help them. PAPYRUS, a UK charity dedicated to prevention of young suicides[4] demands that information be appropriately shared with carers and families by all who take care of vulnerable young people at risk of suicide.

Confidentiality versus Life. It’s a no-brainer.

References:

[1] https://www.healthcareconferencesuk.co.uk/news/newsfiles/alys-cole-king_1219.pdf

[2] https://www.bl.uk/britishlibrary/~/media/bl/global/social-welfare/pdfs/non-secure/i/n/f/information-sharing-and-suicide-prevention-consensus-statement.pdf

[3] www.kidsaregifts.org

[4] PAPYRUS (https://www.papyrus-uk.org/)

Treatment versus Care

In her entry to this year’s BMA News Writing Competition, a consultant psychiatrist relates the experience of her postpartum psychosis and explains that, although grateful for her treatment, something was missing from the care she received.

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The Human Factor

I am a consultant psychiatrist. Two years ago, I had a taste of my own medicine.

Three sleepless nights after the birth of my daughter, I became acutely ill. I slowly realised I couldn’t sleep — something strange was happening. Within six hours, I was experiencing a kaleidoscope of symptoms — elation, fear, heightened senses, delusions. I wanted to kill myself and my daughter.

Postpartum psychosis is a medical emergency and a consultant perinatal psychiatrist was at my house within the hour. I literally ran to her ward in my socks, my mum running behind, having forgotten her shoes too.

My first night was terrifying, but the staff were fantastic. As I rode an emotional rollercoaster, they reassured me, calmed me, gave me the sedation I desperately needed. Soon, I settled into a mild mania. Though at times it was very scary, I was fascinated. I noted with curiosity how my brain behaved. I felt great love for my daughter, and beneficence for my fellow man. I enjoyed all the activities the ward had to offer.

Five weeks later I was happily home. But what goes up, must come down. Gradually, I became unsettled, filled with self-doubt. I became convinced my baby was autistic. The anxiety became intense, and I considered suicide. My consultant coaxed me into hospital again. ‘It will only be two weeks,’ she promised. ‘I think you need to start lithium.’

You cannot breastfeed on lithium. One day I was connected with my baby, the next she fed from a bottle. My heart broke as my breasts filled to burst. It was a symbolic change, from wonderful to awful. She smelled wrong, artificial. I began a tiresome regimen of sterilising, preparing and cooling bottles, when all the while my baby yelled, to my great shame. As if in protest, she vomited spectacularly after every feed.

This time, the ward seemed an unfriendly place; swelteringly hot, noisy, tedious, excessively rule-bound. The other patients seemed uninteresting and depressing. My eldest son was bewildered: he wasn’t allowed on the ward. Why wasn’t mummy coming home? He became rejecting and oppositional. My heart broke some more.

I begged for leave but developed extreme insomnia and could not get well. I remember one night getting up, sitting down, and getting up again for seven hours, unable to decide whether to wake my baby for a change. A burly nurse was recruited to force me unceremoniously to move to a room near the nurses. I was told I would be sectioned if I tried to leave. An informal patient, I was allowed out for only half an hour each day.

I told my consultant I wasn’t depressed, her ward was the problem. ‘You’re depressed’ she repeated, implacably, and brought in a second-opinion doctor. I was desperate to leave as soon as I arrived, yet those two weeks became two months.

Having a mental illness is one of the most disturbing and frightening experiences one can ever have. The rug is truly pulled out from under your feet. Suddenly you are somehow lesser, rendered powerless. I was one of the lucky ones. I knew what was happening, and was more able than most to speak up for myself. I got treated very quickly. Many don’t.

My consultant was a former colleague of mine, a peer. She was kind but paternalistic, and my care became a battle of wills. She believed her plan was faultless and that her ward was entirely beneficial. She conducted her ward rounds like job interviews and treated me like an adolescent. I watched helplessly as she pathologised my normal behaviour and denied promises to get me to comply.

We were fragile mothers, but were often shamed like naughty children for not ‘doing the right thing’, sometimes berated across the ward for all to hear by opinionated nursery nurses with little sensitivity to our mental state. Mothering a screaming baby during an intense crisis of confidence was a tortuous task, yet it was rarely considered that our babies were exacerbating the problem. Scared and disturbed women were managed by intimidating rapid response teams.

I lost trust in them, I hid symptoms. One night I nearly killed myself but never told.

I now can understand how my patients feel when they say they no longer want to go back to ‘that place’. How lack of insight guides them away from reminders of restraint, coercion, scrutiny and endless questions. How it is difficult to trust people who don’t treat you as fully human.

Despite all the positives and the expertise in my care, an important element was missing. Care needs to be more than medication, therapies and keeping people safe. Now I’ve had a taste of my own medicine, I always ask: ‘What is this like for you, what do you really need to help you get well?’

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A life sentence.

The best part of being human is to be able to feel stuff. All kinds of stuff. The world seems to be forever in pursuit of happiness in more money, more holidays, more clothes, more children and so on. The elusive ‘happiness’ is put on hold until the ‘more’ arrives, soon to be followed by more ‘more’.

In a week, it will be 3 years since Saagar died. For days I have been feeling this day approaching like a huge oil tanker which is going to squash my dinky little boat. This inauspicious day should be removed from all calendars everywhere for all the years ahead. It should be obliterated, erased, deleted and destroyed.

I think back on this time three years ago, trying to understand how Saagar must have felt. I try to find words for the thoughts and feeling that he could not verbalise. I lament the fact that no one could read his body language. I admire him for coping with his state of mind with patience and dignity. I look at his face-book post from this night. It was a full moon. He said ‘big ass moooooon innit”. I marvel at his ability to appreciate beauty. I remember how funny he was. I get a smile on my face. I promise myself never to take one moment of those 20 years for granted. Each of them was a blessing. Yes. It’s true that this feels like a life-sentence sometimes. Yet, I know I am blessed.

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“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
― David Foster Wallace