Saturday, 4 January 2014

A Mental Health Problem...Or a Life Problem?

The last few days have seen a lot of commentary on young people and suicide. Opinions have been polarised. On the one side we have those who see youth suicide as a willful, sulky act of throwing in the towel at the first of life's storms, on the other we have those who see youth suicide as the inevitable outcome of untreated mental illness. One side maintains that there's a plentiful supply of helpful help, if only those pesky kids would 'fess up to their positivity deficit. The other other calls for more resources, more counselling, more understanding that mental illness is just the same as physical illness, best treated through therapy and medical care.

 My own view that people, mostly adults, have used the figure of Donal Walsh to hide behind, and from his shadow to finally say what they've always privately thought; that people who commit suicide are selfish eejits. Or maybe the word eejit is too kind. That people who commit suicide are morons, or callous, heartless individuals who put their own feelings before those of their families.

Donal Walsh was an intelligent and articulate young man.  That his poise and bravery were mixed with the simplistic world view of an adolescent makes his statements and his television interviews even more, not less, poignant.

I watched this interview on Youtube, having heard it discussed in the staffroom and it felt like I had been slapped in the face. Not by the child in the interview chair, but by the credence given to his views by the host, and by extension, the national broadcaster. Donal's own life, his own story and his own experience, including that of the substandard conditions in Crumlin Children's Hospital, should have been ample material for the interview. But RTE were greedy : the conflation of  teenage cancer and teenage suicide made for television gold. Why, if you wanted to discuss suicide on a talk show would you choose as your guest  a very, very young person, who has had no immediate experience of the issue and who has issued a public statement that makes this inexperience clear? Why? Where was the voice of reason? Nowhere in the building, and not working in the HSE either, given their unfathomable notion that it'd be a good idea to show a video (which features Shutterstock pictures of good-looking models "living life")in schools. Yes, in schools, to schoolchildren many of whom who had lost an immediate family member to suicide. Who might have been thinking thoughts along those lines themselves. Thoughts that the video neatly alliterates as "tough times".

The Saturday Night Show is an entertainment show, and O'Connor is a chat-how host and journalist, not a psychologist or health-care professional. That some-one, somewhere in the HSE thought that video was a good idea and enough people agreed that it was a good idea, is astounding. It can lead only to the conclusion that they share the views of the RTE production team. The views that people who commit suicide are clueless morons who are unaware of the existence of mental health professionals. I've only just watched that video, only learning of its existence on @ancailinrua's blog. It's chilling. The voice over wouldn't seem out of place in a Sensodyne ad. "We've all known the pain of toothache...."

I have kept quiet on this issue, feeling in common with many others, that it's a bit out of order to be pointing out the flaws and over-simplification of a teenager's views. The Irish instinct  to "mol an oige.." is based on sound reasoning as is "ni thagann ciall roimh aois". We are held back even more by the knowledge of Donal's tragically young death.

But it is this reticence that those who throw stones from behind Donal Walsh's shadow were counting on. People who relished the opportunity to "ditch political correctness" and call those selfish morons what they are. The tables are turned now, they might say in glee. Now it is the naysayers, the people who say "now, hang on, let's not get carried away" who appear to lack compassion, or even decency.

So I'm a bit late in commenting on this, though it's been on my mind on and off since May. I've never listed "courage" as one of my attributes and I'm wrting this on the coat-tails of other commenters, most notably this article by James Cussen.  Also of note are    and  .

I'm going to take a slightly different note from these commenters who have all focused on the lack of understanding shown to those with mental illness, and on the assumption that suicide is a "choice". There is another assumption at work here. The assumptions evident in the material from RTE and the HSE are that mental illness doesn't play a part in suicide, but the counter-assumption seems to be that mental illness is the only factor in suicide. That all people, including young people, who commit suicide, or attempt suicide, or even think about suicide are mentally ill. Even if they don't realise it. The solution in their minds is more services and resources for medical therapy; psychotherapy (particularly Cognitive-Behavioural Therapy) and/or drug therapy, but definitely therapy.

I've thought a lot about my own experience of suicidal feelings in the past few days. I attempted suicide on two occasions. One at twenty-two and again at twenty-four. I was a bit older than the target audience of the "Live Life" video but still fairly immature. The first occasion was just after I'd been discharged from my first stint in a psychiatric hospital. Release from psychiatric hospitalisation is one of the life-events most associated with suicide. Not just because of the obvious link (and there is a link, I don't dispute that) between mental illness and suicide but because the transition into the outside world is excruciatingly painful. Hospital does not prepare you for the outside world. It prepares you for hospital. My first admission was like an induction into the life of a mental patient; I learned fast (I'm a quick learner) how to comply, how to agree, how to demonstrate "insight" into my condition, how to cope with the quick-slow-slow-quick-slow pace of my brain on medication. The shakes. The weight-gain. None of these skills are any use in the real world. In fact, they're a hindrance. When I asked my consultant for a diagnosis, she said "nervous breakdown". I'm not sure what she wrote in my notes.

The second time was two years later. I wasn't officially a patient then but I'd attended A&E the previous week after, well, let's call it a parasuicide event. This time I was determined. This time I'd get it right. Except I didn't. Now I can say "thankfully, I didn't". Then it was more like "oh no". I'm not going to say I was mentally ill. Does that mean that I'm accepting that what I did was a choice? That I was just a spoilt child who couldn't appreciate the gift that my life was? Did I try to put an end to my days, as the French say, because I was too lazy to ask for help, or was it, as so many otherwise intelligent people seem to suspect, because I didn't even know that there were services designed to help me?

A driver in my attempt was my terror of those same services. The terror of being locked up, without my freedom, without my clothes, without any say in what happened to my body. Another driver was the guilt I felt, and the bewilderment, that if what everybody had always told me was true, that I had a good brain, and everything going for me, and the world was my oyster, then why was my life such a train-wreck? Why couldn't a be a credit to my family instead of a drain and an embarrassment? I could see my friends all about me, "living the life" as we said back then, a grim precursor of the HSE's facile slogan. Why was I so useless? I had messed up and gotten on the wrong track, there was no going back. My future would be one of hospitals, doctors  and dole queues, and in the end I'd die young anyway, because I'd kill myself. I'd kill myself anyway so I Might as Well get it Over With. That night I don't think I could imagine a future even of hospitals and treatment. I'd had a falling out with some-one on whose good opinion I had staked what was left of my self-worth. I was empty. Telling me to "ask for help" would be like telling a stranded motorist to just drive to the nearest petrol station.

In the end, after years of revolving door admissions and countless failed medications, they concluded that I didn't have any identifiable mental illness. I was just "emotionally immature". I had "issues". How then did I end up so long in the system? Because I decided as a teenager that I needed help, I went looking for help and being the bookworm that I am, by the time I got help I'd internalised the symptoms and signs of what might be wrong with me. There was definitely something wrong with me, I felt.

To get back to that night, when I was twenty-four, and to paraphrase Nigella Lawson,  I don't think I had a mental health problem. I had a life problem. I didn't need therapy to retrain my negative thinking or drugs to rebalance my neurotransmitters. At that stage my life was in such poor repair it needed a complete over-haul. My life was a mess and needed complete remodelling. No-one's been able to do that but me, and it's taken a long time. I have a therapist that I see occasionally, when things get tough, but it's to help me cope, not to "fix me".

I'm sure there are young people today who are in situations similar to the one I was in. Where diagnosis with a health problem is the last thing they need. There is a tendency to extrapolate from an adult's reaction to receiving a diagnosis to that of a child. The adult's reaction to diagnosis is one of relief. It gives hope that once identified, their illness can be cured. Also, as we age, more and more of our contemporaries have health complaints. It's no biggie. To a teenager the opposite is true. Diagnosis is not a relief, but confirmation from a trusted source, that they are, indeed,  "different". That there's something wrong with them. We need to tread really, really carefully and only diagnose mental illness in young people where there is justifiable cause. Framing "tough times" thoughts as mental health problems can exacerbate the problem. Mental illness because of physiological causes cannot have increased so much in the past few years, unless there's something in the water they're not telling us about, and so cannot be assumed to always be player in suicide. Cussen writes that there are other causes of mental health problems, such as racism and homophobia, but surely there the mental health problem is in the mind of the prejudiced person. If some-one discriminates against me, mocks me, or makes me afraid to live life as who I am, I am almost bound to suffer psychologically. This suffering does not give me a mental illness.

One of problems of  the mental health approach to psychological distress in young people is that it's a case of one-size-fits-all. Many young people just need some-one to talk to. Maybe just once, maybe some-one to just listen and not offer any advice whatsoever. For these young people talk about mental health is premature and uncalled-for. Talk about a mental health problem and it is sure to appear. Put the idea of depression in the minds of young people and the next thing you know they're logging on to and finding out all about it. Have the designers and promoters of these websites never heard of the confirmation bias?

For other young people at risk of suicide, framing their problem as a health issue is treading too lightly. A health issue is something that you tackle while trying to get one with the rest of your life as normal. A young person's distress could be from a much bigger source than his or her own physiology: from a home-life lived in the shadow of addiction and/or violence, from a history of abuse, from a failure to learn the basic skills of living. Defining the situation as one of mental health locates the focus inside the young person himself or herself. We have to ask very, very seriously if this is helpful.

We have to ask the question; is this a mental health problem or is this a life problem? Life problems can be small, or massive. They can be temporary and self-limiting, or they can be permanent.

When I was in secondary school we had a religion teacher with a great video collection. Week after week we'd watch films with a message in the av room. Most were true-life movies and one that sticks in my head is the story of a carefree teenager who jumped off a pier into too shallow water and broke her neck. Being paralysed taught her valuable lessons and the last scene showed her addressing a huge lecture hall, from her wheelchair, telling the audience how they should live. There was no discussion afterwards but I remember being deeply unsettled by the film. What was its message? There was another film about a boy who was deaf. It seemed to me even then that we were given the message that our health was a kind of defect, that kept us from real understanding. We should think very carefully before we hold up those afflicted by great difficulty as role models for young people who have yet to encounter much difficulty at all. We should look first to our own lives, our own example, our own example and testimony lived out every day in front of them.

I would much rather that instead of a video campaign telling young people to cop themselves on and thank their lucky stars they don't have cancer, we could see a campaign aimed at parents and teachers reassuring them that their own empathy and understanding is more than enough, more often than not and that mental health services are there as a last resort, not a first port of call.

And if we've learned one thing from how social media-users have reacted to the "LiveLife" campaign is that Mental Health Awareness has the capacity to decrease empathy levels and nip maturing faculties for compassion in the bud.

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