Archive for the ‘guest posts’ Category

Today’s guest post is by my friend Eleanor, a business analyst, and breaks down the phenomenon of suicide ideation: how it can happen to people who experience depression, and how it is a manageable and curable symptom when reported early. Tellingly, she notes that the main emotion she felt when mentioning her own suicidal symptoms to a healthcare professional was embarrassment. As she puts it, with wry humour, “I’ve had three children and more internals of all varieties than most people have had hot dinners, including a colonoscopy and an endoscopy. But thoughts of killing myself – now that’s embarrassing.”

Eleanor is very happy to share her experiences – and does so with the insight and clarity that belongs to her profession – so that her testimony can help others to recognise and deal with this distressing symptom. She blogs more about balancing work, mental health and other concerns here. I’d recommend taking a look, there’s some interesting reading.

Removing the Power of Fear

Embarrassing. That’s my first reaction at having to discuss thoughts of suicide. I’m sitting in front of the doctor, trying to explain that I’m worried about what happened when I came off the pills, because I went so far downhill so quickly, and I stutter and hesitate over the word ‘suicidal’. I’m trying to explain to my husband of 23 years, who has been with me through my mental health issues all along, how I feel, and I am actually embarrassed and reluctant to say ‘I’ve wanted to kill myself’. I’m sitting with a close, empathetic, non-judgemental friend, trying to explain what has happened to me, and I cannot say ‘my life was in danger’ – I end up saying ‘my health was in danger’.

I’ve had three children and now suffer from colitis. I’ve had more internals of all varieties than most people have had hot dinners, including a colonoscopy and an endoscopy. You would think there is nothing that I couldn’t discuss with my doctor, and actually, on a physical level, there isn’t. But thoughts of killing myself – now that’s embarrassing.

And yet, it’s a known side-effect for some people of coming off the antidepressants. It’s sometimes a symptom of the depression itself. It’s (blindingly obviously) life-threatening, dangerous, and needs to be discussed. Yet every time I try to talk about it, I feel that I’m over dramatising things. That I’m making a big fuss about nothing. That people will withdraw from me, judge me, start to avoid me. This is over and above exactly the same issues with talking about the depression itself – it’s as if, having burst through that hurdle, I have come up against yet another brick wall.

So let’s drag this out into the open. Because it’s such a taboo subject, I have no idea if my experience is the same as other people’s, but here’s what happens for me. Suicidal thoughts/feelings come in two varieties. There’s the feeling that is an extension of the blackness, the futility, the anhedonia (fabulous word – the feeling that nothing nice will ever happen again), and that inability to cope with getting out of bed in the morning. It would be easier to be dead. Life is too hard – I could go to sleep and never wake up, because I don’t want to have to wake up and feel this way.

This is what I experience when I’m depressed and a long long way down. It’s passive, really – I feel so bad I couldn’t motivate myself to do anything about it. It’s thoughts of death, of suicide, but there’s no energy or action behind it. It’s a symptom I’m very familiar with, and usually, what it does motivate me to do, is go to the doctor.

But the other type of feeling is far far more scary. It’s the desire to actively take steps to end my own life. This is what happened to me this summer, as I tried to ramp down my dose. I wasn’t actually on Seroxat, which is the type of antidepressant usually associated with the danger of suicide, but it definitely was all about the dose of Sertraline I was on rather than anything else going on in my life. I sat in the garden one day, in the beautiful summer sun, looking at the plastic swing hanging off a branch of a tree, and thinking ‘I could easily use that to hang myself’. I imagined doing it. Just like I imagined driving the car into a lorry or stepping on the electric rail. There was no logic to it – no, this is too hard I want it all to end, no thought of the consequences, and actually, no desire to be punishing myself for my faults – not ‘I don’t deserve to live because I’m rubbish’, which is something else I’m familiar with. It was a primal urge to end my life, to destroy my body to the extent that life could not sustain. For no reason.

Now depression as a mental illness (rather than the logical reaction of feeling very miserable due to events that actually happen), can be reasonless – or at least the reason is all to do with hormones and chemicals messing with your brain. But there is still a twisted logic to what I’m feeling and how I’m reacting. I feel terrible on a very basic level, so I see things through a lens of negativity, find everything too difficult to cope with, judge myself, get into that vicious circle – there’s a trail. Steps that other people can follow if I describe it to them. Not this. This was something else entirely. And I do think someone has to experience it for themselves before they understand. I certainly didn’t quite understand before.

I’m still here. I did not kill myself. I cried a lot, went to the doctor, and for the last month at least I’ve been stable and, actually, reasonably happy, when car problems and knackered plumbing allow. But the doctor still has me on a monthly checkup, and quite rightly so. When I saw her recently, and expressed my worries about how bad I had felt, she explained that for people with several depressive episodes in their lives, rather than one or two, this tends to be a pattern, and suicide is a real, serious danger for such people trying to come off the tablets. It’s not clear whether it’s a side effect of the tablets, or whether, like a diabetic who has stopped producing insulin altogether, the body simply cannot produce the right chemicals to keep the brain stable. Either way, I am never ever allowed to come off the tablets again. She won’t let me, my husband won’t let me, I won’t let me. Hopefully I will never feel that way again.

But, I remain astonished at how hard this is to talk about. Actually the whole mental health area of my blog started because I was unable to express to my loved ones directly what was going on in my life. My blog has many functions… to document for myself what I’m experiencing, to vent, to materialise my thoughts, which can rationalise them and organise them for me, and to share with others who might be experiencing similar issues, or know someone who is. And writing down what I can’t get out of my mouth coherently is a very important reason for me to blog.

I was suicidal this summer. I felt the urge to die. I overcame it – but I now understand why some people kill themselves, why they can’t stop themselves from doing it, why they never make it to a place where they can get help. In these cases it’s not what you’d think. It isn’t ‘because’ of anything.

And for all it’s embarrassing, shaming, distressing, uncomfortable to talk about suicide and the different ways that suicidal thoughts can manifest, we must. We have to drag this out into the open so that those who experience it know they’re not alone, and that actually, like any other symptom that might turn up on Embarrassing Bodies, the doctor has heard it all before and knows how to help; so that those whose loved ones experience it will understand a bit more about it, not blame themselves, not judge their family or friends; to remove another level of the stigma of mental health problems.

Dragging the fear out into the open removes its power – so let’s remove the taboo and the stigma, remove the power and the pressure and the embarrassment, and put suicidal thoughts back in its rightful place – distressing, worrying, horrible to have, but in the end, just another nasty, and treatable, symptom of an illness.

Today I’m delighted to introduce this article which was very kindly volunteered by Prof Patricia Casey, Professor of Psychiatry at UCD and consultant psychiatrist at the Mater Hospital in Dublin. I love this article – as Professor Casey says, it is not “political correctness gone mad”, but “instilling basic respect for those who have personal difficulties and health related problems”.  The story I alluded to yesterday shows that we haven’t even got that far yet, alas.

I’d like to thank Patricia Casey for her work with this and with no further delay continue with the article. I think it’s a message we can all pay attention to.

Language and Stigma

Words speak volumes, in every sense. Not only do they convey our own personal messages to others but they are also a reflection of the values we hold in our culture on particular topics. Take our attitudes to those with physical disabilities – in the past we referred to them as “spastics” or “cripples”. And those with intellectual disabilities we called “imbeciles”. Originally these words may have had a benign meaning but over time our use of these terms shifted, because the intent behind them changed from being simply an agreed descriptor to one that connoted derision, mockery and dismissal.

These terms were applied to specific groups marked out for this treatment – in other words these individuals were stigmatised/branded because of some aspect of their appearance (physical disability, height), character (learning disability, mental illness) or tribe (age, sex, race). And it was society at large that identified the groups who should be the butt of this disdain, thus enabling the words to reflect the cultural understanding of these domains and reinforcing them also.

Many groups who once were victims of such prejudice no longer are and this in part is because the words are no longer acceptable to society as a whole – so terms like spastics and imbeciles are no longer acceptable when describing people with physical or intellectual disabilities. Just as we no longer refer to “n***ers” or “midgets”.

Yet the one group still singled out for derisory and negative stereotyping are those with mental illness. Research shows that those with mental illness experience more stigma than any other illness group. This has practical implications for how we regard them and behave towards them. It also means that discrimination in employment is an ever present reality.

The public’s attitude to mental illness is complex and ambivalent. On the one hand reams have been written and spoken about ending the stigma and attitudes directed to those with mental illness when, at the same time, society regards many of the treatments for those with mental illness with disdain. This particularly applies to the use of medication. Furthermore, while lip service is paid to respecting those with mental health problems, the language used in public discourse is negative and even derogatory.

The headlines in our newspapers scream words like ”psycho” to depict somebody who is violent, reinforcing the belief that mental illness and violence fit hand-in-glove. Using the term “schizophrenic” to describe somebody who shows two sides to his personality is an inaccurate usage of this diagnosis since those with schizophrenia do not have, what is mistakenly called a “split personality”.

Words in common parlance for those with mental illness include “looney”, “basket case” and “nutter”. One study of young people in Britain found 240 derogatory words used by young people to describe peers who experienced mental health problems. Comedians regularly lampoon the mentally ill with few objections being raised as do children’s cartoons. For example a study of Disney animations found that 85% of them used terms that were reported as denigrating and inaccurate depictions of characters with mental illness.

“Political correctness gone mad” I hear you say. Well – no. Discouraging words that are offensive is not a deliberate attempt to hamper communication because of a political ideology but an attempt to alter the disdain and disrespect that such words embody and the grave offence and hurt that they cause to those so named. It is about instilling basic respect for those who have personal difficulties and health related problems. But its reach is much greater. It is directed to challenging and ultimately altering inaccurate beliefs about some members of society, whose lives are blighted as a result of these perceptions. We should do all we can to alter the casual use of language that offends or brands some group.

Even within the specialty of psychiatry itself, professionals sometimes use terms that do not necessarily give offence but are irritating to those to whom they refer. “Service users” or “clients” were introduced as a supposed non-paternalistic way of describing “patients” while others speak of “survivors” or “users”. Yet there is now an abundant body of research identifying the terms preferred by those with mental health problems.

One recent study published in The Psychiatrist (a journal) used a sample of over 300 people attending psychiatrists. Interestingly their term of choice was “patient” when they are consulting doctors or nurses while “patient” or “client” was equally acceptable when dealing with social workers or occupational therapists. “Service user” was disliked overall while a minority wished to be referred to as “survivors” or “users”. The comments provided by the participants in this study were instructive –“I am NOT a user of any kind”, “I would like [to be] referred to as a patient but I feel I am trying hard to be a survivor”, “I do not like client – it is reminiscent of prostitutes”.

The commission of these verbal lapses is not in the same league as the use of stigmatising or pillorying language but if the profession preaches respect then it should respect the wishes of our patients rather than foisting our beliefs about terminology on them.

Language is ingrained in our culture and it is a powerful tool in conveying and reinforcing our beliefs and attitudes. On present evidence the terms used relating to people with mental illness are discomfiting and unsettling.