Thoughts of a Depressive Diplomatist

As some of you know, I am supporting Movember, the annual effort to raise funds and awareness for men's health issues.  The focus is on prostate cancer, testicular cancer and mental health issues.

It's the latter which I've had issues with, and is the the reason I support Movember - particularly this year, when we're all feeling issues of isolation.

Movember have shared some notes on mental health and suicide prevention here.  What I'd like to flag is ALEC.

ALEC is a mnemonic which provides a model for 'talking to your mates about mental health'.  It's a handly primer for raising this difficult issue with anyone you might be concerned with

A - Ask.  Ask how they are feeling.  "You don't seem yourself lately - are you OK?"  Be prepared for the answer "I'm fine" and to bring up the reason you ask.  If you've noticed something in particular (they've been withdrawn, haven't been as active on social media, etc) it's worth mentioning.  

L - Listen.  Having asked the question, give the person the chance to answer and pay attention to the reply.  Odds are that you're not going to solve the problems that they raise, but it will help them to share them with someone else.  Ask follow-up questions that might help the person to focus on what's at the root of the issue.  "That's can't be easy.  How long have you felt that way?"

E - Encourage.   Encourage action.  Help them focus on things that might help.  Have they felt like this in the past?  If so, was there anything that helped then?  It might help to get back into a routine despite lockdown - patterns of sleep are particularly important.  Are there other people that they trust and who they can talk to?  Is it time to talk to a doctor?

C - Check-In.  Having had the initial conversation, keep in touch and follow-up with prompts if necessary.

And before anyone asks, "I'm fine".  I've found winter lockdown more difficult than the one earlier in the year (which, I must admit to quite enjoying), but my mental state is OK.  

I'm getting out of the house most days and am in contact with people through social media.  As those who follow the blog know, I'm getting quite a lot of on-line RPG gaming done.  Like a lot of gamers, I've really discovered the benefits of Discord, Zoom, et al this year.  I'm getting more oportunities for gaming now than ever before.  And as we all know, gaming is good for mental health.  Of course, I miss sitting down at a table and playing face-to-face, but I've made contact with a lot of new people and do really enjoy the sessions I take part in.

Thank you for reading this.  If anyone wants to contribute to my Movember fundraiser, you can do so here.

 

In blogging circles there is a widely held theory (proven I think), that if you title your post 'TITS!  BOOBIES!!!  MORE TITS!!!' you will get record hits.  I think with this post I'll probably prove the corollary ;-)

I found the coverage of Robin William's suicide interesting.  For a while he was almost literally the poster boy for male depression, such were the number of memes (like the one I shared the other day) that his death sprouted.  In the media there were a lot of very thoughtful articles and reports about how depression, self-harm and suicide were hidden epidemics affecting the male population.



Yet, old tropes still came up.  I can imagine editors sitting around saying "But what did he have to be depressed about?  There must be another story here."  So, as in the beginning of 'Citizen Kane', we seemed to have reported set out to find reasons.  We got the old 'Tears of the Clown' stories with articles about how depression is the price of comic genius (just as alcoholism is the price of being a writer; or serving in Flanders is a required qualification for writing poetry); we got articles about how divorce and property deals had whittled away his fortune.  And then came the statement from the family that Williams had be diagnosed with Parkinson's Disease: and you could practically hear a collective sigh of relief - "Of course he was depressed."  The articles about mental health dried up.

Well I'm sorry, that's not how it works.  Depression isn't logical, and suicide especially isn't.  It would be nice if it was: the we'd only have to identify what was bothering someone and remove it, then they'd be able to snap out of it and pull themselves together.  As if...

Of course if you have worries it all adds up, but depression strikes everyone, millionaires and members of supportive families just as it affects the unemployed, the homeless and the lonely.  And that's not even to mention Anxiety, which I'm not going to touch on.

And now a happier story

This isn't something I'm involved in, but news of it popped into my Facebook feed this afternoon.

The Aftermath Gaming Club in Norwich will be running a 24-hour gaming event in aid of WAAC, starting at 10.00am on Saturday 23 August and lasting 24 hours.  Details here.

WAAC is 'Wargamers All Against Cancer' set up after a wargamer's mother was diagnosed with cancer.  It is raising money for Macmillan Cancer Support - details of WAAC can be found on their Just Giving page, where you can make donations (they're already very near their £3,000 target, hopefully they will make more).

The death of Robin Williams has brought to the fore something I have touched on before - problems with mental health.

Some stats

• The worldwide suicide rate is 15 in 100,000 people - in the EU is is 17.5; in England it is 10; in both Northern Ireland and Wales it is 11; and in Scotland it is 20.
• Suicide is the most common cause of death in men under 35.
• Men are three times more likely to kill themselves than women.  This surprises some - despite or because of the fact that women are more likely to seek treatment for depression (29% compared to 17%).
• Britain has the highest rate of self-harm in Europe - 400 per 100,000 people.  People who self-harm are at a much increased risk of death by suicide.

All these stats come from the Mental Health Foundation report Fundamental Facts.  


In the UK, the Samaritans provides confidential emotional support 24/7 to those experiencing despair, distress or suicidal feelings.  They can be contacted by telephone, email, letter and face to face.  If you need to, talk to them.
Good luck and good mental health.

I've occasionally used this blog to talk about my mental health problems, though of late I've tried to avoid too much personal info.

Things for me are fine at the moment, but reading the post from the Laughing Ferret about his own recent problems has struck a chord.  I don't think I would be as brave or articulate as he is, but much of what he says chimes with my own experience.

I hope he won't mind if I quote:

Knowing that some regard a depression sinking as a character flaw, or as not real, or as whining, only makes it even harder to deal with in trying to get out of it.  It takes more stress points. It is easy to say "my leg was broken, but it's healed now" but "I was in a depression black hole, but I'm out now" has a whole host of added burden applied to it by the culture.  It is a lot like a broken leg.  Saying it is broken isn't whining, it isn't a plea for attention, it's just pointing out the fact.  It is nice to have someone give condolences, it can be appreciated, but where no one would think that saying 'I hope your leg gets better' would actually help it get better, people do seem to think saying "I hope you feel better" should have an affect on someone who's depressed. Wish it were so, but it isn't.  That helps someone who is sad, but not someone who is depressed. The two states are very different. Which I don't think is understood by a lot of people, since many people use the phrase "I feel depressed" when they don't-what they feel is sadness, which is bad, but it isn't the same as depression.   But knowing well-wishers often have an expectation that their well wishes will help, it becomes almost an extra burden for the depressed person (at least I have found it so for me) and so makes it less likely to draw attention to the problem, to avoid the additional weight. Not that it isn't appreciated abstractly, just that it can't help at that time.

Excuse the break from usual service, but I feel in need of a rant...

As the title of this blog suggests, I have mental health problems.

I heard depression described as a seagull/statue illness: somedays you're the seagull, and somedays you're the statue.  Well today, I was the statute and life made the deposit on me.  I'm pleased to say that I seem to be coping quite well though.

I've been on long-term sick leave for some time.  My eligibility for Statutory Sick Pay ended on 29 August, and today I found out that 'in accordance with your conditions of service (paragraph 10.4 of the NJC for Local Government Services, national Agreement on Pay and Conditions of Service)' my employer will cease to pay me altogether from 12 September.  So that's me without any visible means of support then...  

In the meantime, my employers are resistant to me returning to work, despite me indicating over two months ago that I was prepared to go back.  They wanted a psychological review and so sent me to a specialist in eating disorders.  Have I ever had an eating disorder or has it ever been suggested?  No.  But it's well-known that anyone can deal with depression...  At least my line-manager has stopped giving me unsolicited lifestyle advice.

So this morning I had a 90-minute 'phone call with the Department of Work and Pensions.

After that - having sworn off the booze - I took the dog for a long walk and for three cups of coffee at the Red Roaster.  (I had the coffee, he had a half a flapjack and the adoration of other customers.)  It helped.



Talking of mental health (and I was considering blogging about this before - it's not an indication of how my day's gone), today is World Suicide Prevention Day.  The World Health Organisation says that suicide is the 13th most common cause of death (more common than murder or war) and that for every death for suicide there are twenty attempts.  Here in the UK, the government has announced the investment of £1.5m in research into suicide prevention and support to bereaved families.  Apparently, the suicide rate is highest among men aged 35-49, men are three times more likely to commit suicide than women, and there were 4,200 suicides in England in 2010.  More needs to be done to prevent this, and £1.5m doesn't sound a lot to me.

In the UK, the Samaritans provides confidential emotional support 24/7 to those experiencing despair, distress or suicidal feelings.  They can be contacted by telephone, email, letter and face to face.  If you need to, talk to them.

Good luck and good mental health.

Today is the anniversary of the death at the age of 80 of the soldier-poet Siegfried Sassoon in 1967.

Probably his most important piece of writing was the Soldier's Declaration, written in July 1917.

I am making this statement as an act of willful defiance of military authority because I believe that the war is being deliberately prolonged by those who have the power to end it. I am a soldier, convinced that I am acting on behalf of soldiers. I believe that the war upon which I entered as a war of defence and liberation has now become a war of aggression and conquest. I believe that the purposes for which I and my fellow soldiers entered upon this war should have been so clearly stated as to have made it impossible to change them and that had this been done the objects which actuated us would now be attainable by negotiation.

I have seen and endured the sufferings of the troops and I can no longer be a party to prolonging these sufferings for ends which I believe to be evil and unjust. I am not protesting against the conduct of the war, but against the political errors and insincerities for which the fighting men are being sacrificed.

On behalf of those who are suffering now, I make this protest against the deception which is being practised upon them; also I believe it may help to destroy the callous complacency with which the majority of those at home regard the continuance of agonies which they do not share and which they have not enough imagination to realise.

Sassoon faced court-martial, but Robert Graves intervened, giving the authorities the get-out of declaring the Sassoon was suffering mental illness.  He was accordingly sent to Craiglockhart Military Hospital, where he was treated and befriended by W H R Rivers and met Wilfred Owen, on whom he was to have a great influence.

The Craiglockhart War Hospital

Craiglockhart War Hospital for Officers was established in 1916 in the requisitioned Craiglockhart Hydropathic Institute, near Edinburgh.  It specialised in the treatment of neurasthenia ('shell shock').   Rivers  wanted his patients to talk about their experiences and face their fear and the horror of what had happened to them - the ‘talking cure'.  In doing this Rivers became a life-long friend and mentor to many of his patients (including Sassoon).  He conducted three sessions a week with Sassoon, in which he also tried to get him to return to the battle front. Rivers considered shell shock to be an illness and treated all of his patients as individuals who needed special care. He also had ethical concerns about his role - he felt that curing patients was problematic when they would be returned to the front line, where he believed they would be in danger of having another breakdown.

Rivers, Craiglockhart and the talking cure are at the core of Pat Barker's excellent Regeneration Trilogy - with Sassoon as a major character in the first novel and Owen's fatal return to France featuring in the last.

Rivers' back-story is fascinating.

Rivers at Craiglockhart

Born in 1864, William Halse Rivers Rivers was the son of a Church of England priest, who had a side-line in speech therapy (one of his patients was the Revd Charles Dodgson), his uncle was the founder of the Anthropological Society (later the Royal Anthropological Institute of GB and Ireland).  William had a stammer and lacked visual imagination, both of which were to inform his later works.  He had intended to attend the University of Cambridge to study classics, but the necessity of earning a living led him to medicine, which he studied at London University  He application to join the RAMC on graduation was rejected on health grounds, instead he decided to go to sea as a ship's surgeon (a popular route for medical graduates in the nineteenth century).  On graduating as a MD and becoming a FRCP, where he began specialising in neurology and psychology.  He worked at Barts, the National Hospital and Guy's before being appointed to a lectureship at Cambridge, where he became a Fellow of St John's.

In 1898 Rivers headed the Torres Straits Expedition.  Initially he studied colour-perception among the islanders in comparison to Europeans (sensory perception was a preoccupation of the Cambridge psychologists at that time), but his collection of islanders' genealogical  information for genetic purposes turned his mind to ethnological and anthropological questions.  Rivers was to pursue his anthropological enquiries with expeditions to Melanesia in 1907-08 and 1914-15.  After his time at Craiglockhart, Rivers was attached to the Royal Flying Corps.  In 1919 he returned to St John's, and died on 4 June 1922 after being taken suddenly ill.

His death prompted Sassoon to write  'To A Very Wise Man':

I

FIRES in the dark you build; tall quivering flames
In the huge midnight forest of the unknown.
Your soul is full of cities with dead names,
And blind-faced, earth-bound gods of bronze and stone
Whose priests and kings and lust-begotten lords
Watch the procession of their thundering hosts,
Or guard relentless fanes with flickering swords
And wizardry of ghosts.

II

In a strange house I woke; heard overhead
Hastily-thudding feet and a muffled scream...
(Is death like that?) ... I quaked uncomforted,
Striving to frame to-morrow in a dream
Of woods and sliding pools and cloudless day.
(You know how bees come into a twilight room
From dazzling afternoon, then sail away
Out of the curtained gloom.)

III

The Rivers Centre at the Royal Edinburgh Hospital is a clinic, established in 1997, for the treatment of Post Traumatic Stress Disorder.  There are several charities aimed at helping veterans with PTSD; in the UK these include Combat Stress and Healing the Wounds.

Wilfred Owen

I've not left myself much room to talk about Wilfred Owen (a patient of Arthur Brock rather than Rivers).   Perhaps I shall do so come 4 November.  For the time being, here is one of his best poems, the draft of which Sassoon famously amended:-

Anthem For Doomed Youth

What passing-bells for these who die as cattle?
Only the monstrous anger of the guns.
Only the stuttering rifles' rapid rattle
Can patter out their hasty orisons.
No mockeries now for them; no prayers nor bells,
Nor any voice of mourning save the choirs, -
The shrill, demented choirs of wailing shells;
And bugles calling for them from sad shires.

What candles may be held to speed them all?
Not in the hands of boys, but in their eyes
Shall shine the holy glimmers of goodbyes.
The pallor of girls' brows shall be their pall;
Their flowers the tenderness of patient minds,
And each slow dusk a drawing down of blinds.