Psychiatrists’ social contract

Last weekend I had the opportunity to attend the annual World Psychiatric Association (WPA) Congress, which was hosted in Cape Town this year. Over the next few weeks I will be sharing some of the keynote addresses from the Congress.

The Contract between Psychiatrists and Society

In Gujarat, Western India, there is a holy place where many people with mental illnesses go to pray because they believe if they do so they will get better. Some years back, a team of psychiatrists and other medical and health experts set up an initiative where they worked closely with the faith healers at the site with a view to sharing their expertise and helping heal the patients.

The healers engaged closely with the religious leaders, and slowly started administering medical assistance through them. By building up the relationship, the patients, through the healers, started trusting them and accepting their medical input and, in some cases, medication. This co-operative arrangement had yielded great results.

This touching anecdote formed part of the opening address at the World Psychiatric Association Conference by WPA President Dinesh Bhugra, on the contract between Psychiatry and Society.

“The key message to be taken from this is that psychatrists should work together with communities and respect patients,” said Professor Bhugra.
“We should not feel threatened or criticise people for being different. Those are individuals who believe in what they do. We need to find ways of working with them to deliver what our patients would expect.”

In other words, said Professor Bhugra, a key resource in working in this tumultuous and changing world is for psychiatrists to “think out of the box”.
“In Gujarat, they spent two years working with faith healers, getting rid of their fears and concerns, working out, ‘This is what I can do, this is what you can do, let’s work together.’
“People feel threatened by the unknown so co-operation and understanding are essential.”

The same principle applies in Africa, where many people consult traditional healers before seeking medical assistance.

A key part of the contract between Psychiatrists and Society, said Professor Bhugra, is to work out where the boundaries are. We need to ask ourselves, what is it that society expects me to do in treating mental illness, and in return, I, as the Psychiatrist, want the professional freedom to be able to get on with the work, be able to self-regulate, to have sufficient resources and to have respect for what we do.

“The point is that we need to think about services … and that, rather than patients coming to us, we need to be where the patients are. If patients go to a temple or holy mosque, we must be there, rather than saying, ‘come to us’.
“But, both sides should be clear as to what is expected of each other. While we advocate for our patients, similarly, society should listen to me, and say, ‘Here is a person with expertise’.”

Video: My talk at #ChangeMakers 2016

Greetings strangers, I apologise for the deafening sound of crickets in my eight-month absence from the blog. For my first post back, I am taking the easy way out by (just) showing you a video of my talk at this year’s Lead SA Change Makers Conference, held on Saturday 20 August. The conference being about leadership and inspiring social change, my talk attempted to link the concept of leadership with the need for us to change the conversation about depression from one of stigma and shame to one of understanding and compassion. Watch the video and let me know what you think:

The keynote address at the conference was given by Advocate and then-Public Protector Thuli Madonsela, while some of the other speakers were UCT Deputy Vice Chancellor of Research and Internationalisation Mamokgethi Phakeng, Unilever Corporate Affairs Director Sibonile Dube, former CEO of the Steve Biko Foundation Nkosinathi Biko, 2015 Lead SA Hero of the Year Marlon Parker, and Heal The Hood’s Emile Jansen, who won this year’s Lead SA Hero of the Year Award. Needless to say, they all were phenomenal and I came away moved, inspired and blessed to have been there. You can read a summary of the day’s talks on the Lead SA website or watch the videos of their talks for yourself on the Lead SA channel on YouTube.

What goes through your mind before you jump in front of a moving train?

Recently some friends of mine lost another close friend to suicide. By all accounts, he was a warm, smart, handsome guy with many friends who loved him. Although he had been through very rough times recently, no one had any idea that he had been feeling that low. His friends struggled to understand what he had been thinking and how he had reached that point without anyone knowing. I know that many of my friends and family had the same questions after my suicide attempt, so I’m going to try to explain my state of mind when I jumped in front of that train. Hopefully it will give you some insight into the minds of the people in your life who struggle with depression. Here goes.

Done. By the time you start planning your suicide, you are just done with the seemingly continuous upward battle towards a happiness that feels more and more elusive the longer you chase it. I felt that I had done everything I could think of to fix the constant ache inside myself and nothing was working. I had run out of options and could not think of anything more to do except to just end it once and for all.

The struggle every single day just to survive and not be discovered a fraud or not to lose a grip on everything was exhausting. I couldn’t face the prospect of going through this for the rest of my life, endlessly hoping for that one day when everything would fall into place and I could live – not fight, just live – a day that might or might not ever come. I couldn’t keep wearing the mask of being “fine, thanks”. I was weary and drained. I just wanted to go to sleep and never wake up – to have some relief, some rest, and to no longer worry that at any moment I was going to screw up.

Over the years, I had never reached out for help, because I thought it was my own problem, that no one else – friend or therapist – would be able to say something that would fix it all. People often confided in me and I enjoyed listening to and supporting them. Every time I thought of revealing my own struggle to anyone, however, I decided against it, because I knew that they had problems of their own and I didn’t want to burden them with mine as well – especially if there was nothing that they could about it. It was my responsibility to figure it out myself. I never considered that if I had given anyone the choice, they would have been honoured and pleased to support me.

What-goes-through-your-mind-before-you-jump-in-front-of-a-train

By the time I was planning my suicide, I had reached the conclusion that removing myself would be better for everyone – my parents wouldn’t have to take care of me if I returned to Cape Town from London without a job, my friends wouldn’t have to keep making the effort of trying to connect with me through my impervious walls that deflected any attempts at sincere and meaningful conversation.

Towards the end, just before my suicide attempt, whenever I considered talking to a friend or asking for help, I also wondered how I could justify to them that I had never come to them with this before. How could I have let it get this bad before trusting them to support me? Would they even believe that it was so bad that I was genuinely contemplating suicide, given that I had never spoken of my depression to anyone before? I didn’t want to seem like a drama queen who was only looking for attention.

None of these thoughts may seem rational to you, but that does not mean that they are not completely reasonable to someone with depression. Such mental illnesses distort your view of yourself and your relation to the world.

I remember a few months before my suicide attempt, a close friend of mine actually opened up to me about a breakdown that he’d had a few years earlier. He had even been on medication for depression for a while. Listening to him in that moment, I thought, “Yes! That is how I feel. I get it!” I wanted to confess all to him, but then decided not to, because I thought to myself that if I spoke to him then, just after he had bared his soul to me, he would not believe me. He would think that I was making light of his struggle by turning the attention on to myself and being patronising about something I actually knew nothing about. That made it difficult to talk to him then – but it was much harder trying to explain it to him a few months later, when he came to see me after I had lost both my legs in my suicide attempt and he asked me, “I told you my story; why didn’t you tell me yours?

Now that my depression has been diagnosed, I have been on medication and had monthly therapy sessions for two years. I still have some of the anxiety and self-esteem issues that I did before and they still affect the way I live my life to some extent, if I don’t remind myself that worrying about things beyond my control is futile. These issues no longer overwhelm me, however, and I feel capable of living a good life. Perhaps the biggest advantage to me is being able to acknowledge my depression as a real illness that I can control. It is not my own failure, flaw or weakness, just a condition that I must manage. I can recognise which of my fears and insecurities are unfounded and so disable them.

Humbling and scary as it is to admit my mental disorder, it is also liberating and rewarding to live an honest and frank reality with the people in my life. That I got this chance to start again makes me one of the blessed few. Suicide is not a choice, it is the conclusion to an illness that is left untreated. We need to make it okay for anyone to ask for help before that chance is taken away from them.