Tuesday, October 23 2012
The University Times
Mental Health Supplement
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Starting the conversation
Inside
Hannah Jean Ryan Editor
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t’s Mental Health week. While that will (pardon the pun) pass over most of your heads, Mental Health week is important. It’s an opportunity to raise awareness of Mental Health problems, inform people about support services they can rely on in times of need and encourage people to talk openly about Mental Health. This supplement, the first in The University Times to be devoted exclusively to the topic of Mental Health, plays a small but significant role in that process. One in three, or one in four of us will experience Mental Health problems during our time in college. Perhaps you found the ‘little fish-big pond’ transition particularly overwhelming in First Year, or you found it hard to adjust to having an actual workload in fourth year. You might have gone through a particularly shattering break up. You may even have received a diagnosis of a Mental Illness and are trying to come to terms with that. For those of you lucky enough to have escaped serious Mental Health difficulties, perhaps you have a girlfriend who has struggled with depression, or a friend who has battled with ADHD. Some of you may have been bereaved by suicide. However tenuous your connection to mental ill health, it is time that you become aware that people around you may be struggling. We can’t wave a magic wand and vanquish mental difficulties, but we can develop a sense of collective responsibility. That means educating yourself about mental health so that if you, or someone you know starts having a hard time, you’ll know how to react appropriately. None of us really knows how best to deal with mental ill health, but there are some basic starting points. If a friend has the courage to open up to you, you can accept them for who they are, believe what they say, and listen. Listening involves empathy and paying attention. You don’t need to understand, and you don’t need to provide solutions, you only need to be physically present to make someone feel less alone. If you feel you’re not equipped to deal with an issue, you can guide someone to professional support services. More than that though (and this is where this supplement comes in) you can talk about it. Opening a dialogue about mental health means talking about it with respect. Our language is permeated with stigma towards the mentally unwell. I’m pretty sure only last week I called a particularly erratic bouncer, ‘an absolute f**king psycho’. This needs to stop. We may toss around words like, ‘crazy’ and ‘schizo’ as playful banter but we wouldn’t dream of using similar racial epithets, and such language, frivolously used, can be painful to someone who’s suffering with mental ill health. Instead, we can try to talk about mental health constructively. This aim of this supplement was to bring together personal stories, opinion, features and discussion about mental health and what it means to us. I must particularly commend those who have submitted personal stories- regardless of whether they were written anonymously, writing about a personal health issue takes immense courage. This is our first time to publish a mental health supplement, and I hope it will inspire others to write about mental health in the future. We may not get it right the first time, and we certainly won’t cover all issues, but it is vital that we begin to discuss and debate mental health in college, and this is a start. Breakthroughs in college journalism may not seem important, but what we do in this little microcosm resonates in wider society. Publishing articles on this small scale is part of an urgent wider societal movement to break the silence around mental. Changes in attitudes comes from the top, and in any society, people look to leaders when forming their views. If you can excuse me for being elitist, many of you will go on to hold positions of responsibility and authority in law, journalism, science, business, academics and myriad other fields. How you speak about mental health will influence others. While we’re still young and principled, we need to learn how to talk about mental health. Please talk, it’s important.
My Fearless Father A psychologist argues that suicide victims are isolated, strong willed but never weak - a theory that has helped Stephen Martin to understand his own father’s death
Coming to terms with Trich A student shares her experiences of coping with the mental health disorder trichotillomania
The scarlet letter of mental illness Hannah Jean Ryan analyses the social stigma which has hampered progress on mental health awareness.
Learning to cope What happens when college doesn’t turn out to be the best four years of your life?
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‘It’s Ok to talk, but it’s not always easy’ Stephen Garry Student2Student Chair
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t’s tough to think about isn’t it? The idea that we may not always be at our best. The idea that not everything’s working out the way we planned. The idea that despite our best efforts, nothing’s changing. Static, stuck in a rut, going nowhere. It doesn’t really bare thinking about. But it’s a reality. A reality we know all too well. Each and every one of us at one point or another has felt helpless, lost, cut adrift. And then we talk about it. And as if by magic, the simple act of talking to another human being about what we’re going through alleviates so much of the pressure that’s been weighing over our heads for so long. It’s a hot topic now, Mental Health Awareness and Stigma Reduction. It’s this new ‘trend’ that’s got a lot of momentum behind it amongst our age group. I’ve spent a long time trying to get the message out there that it is OK to talk; to a friend, a supporter, a mentor etc., but I never really practiced what I was preaching until recently. You’ve seen all the campaigns, you’ve read all the leaflets, you’ve watched all the videos, but none
Reaching out for support can be hard, but it goes a long way toward ensuring positive mental health of it can express how beneficial it is to simply talk to someone about what’s going on. Letting your guard down I suppose. It’s great when you can find the right person (not the person that thinks a) you should just cheer up or b) you should just drink the issues away), the person who’ll simply listen. The person who can let you talk and talk for hours and then give you their honest and informed opinion if and only if you ask for it. If that’s the person, then you might just have yourself a solution to the problem that’s been eating away at you for so long. We’re always told that it’s OK to talk, and it is. It’s not easy though because negative attitudes towards mental illness and mental ill-health still persist. In a recent TED talk, comedian Ruby Wax spoke of her experiences with depression. After a breakdown during her daughter’s school sports day, she was institutionalized. One would have expected that she would be inundated with well wishers, cards and flowers. But all she got was ‘a couple of phone calls telling me to perk up. Perk
up; because I didn’t think of that.’ Many describe the experience of mental ill health as being accompanied with a certain sense of shame. You don’t have scans, you don’t have x-rays, you essentially don’t have the evi-
should be treated equally, and we’re right in doing so. At a very basic level though, it’s a lot more daunting to reveal personal insights than to take some cough medicine but the feeling you get from sharing your burden,
dence that people seem to need to prove that you’re sick. Wax asked the poignant question; ‘Why is it that every other organ in the body can get sick and you get sympathy, except the brain?’ We talk a lot about how Mental Health and Physical Health
is probably better than the feeling of shaking that nasty flu. So why is there often no sympathy? Why should we need to prove that we’re sick to the nosey people around us? We shouldn’t really. It’s up to us to look after our own Mental Health, just like our
physical health. Jogging maintains the latter, talking the former. It’s not only OK to talk, it’s pretty much essential. Why shut yourself off from the world on the basis of a problem that so many of us go through at varying levels throughout our lives? Connecting with another person is one of the most fundamentally beneficial and easy experiences in life. Think of those s**t days where you’re not at your best as like a little cold, except the medicine is discussion and the dispensing chemist is a friend. Perhaps the best thing about all of this is that the options for who you want to talk to are endless. A friend, a professional, another student (Peer Supporter), a Welfare Officer etc. We’re not always at our best. It’s alright not to feel OK. Talk often, share your experiences, don’t be afraid to ask for help and shake that mental ‘cold.’
Losing a Loved One: An Insider View Laura Daly Contributing Writer
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ast August, I lost a dear friend and cousin. He was the same as you and I, excited about college, just finished the Leaving Certificate, full of life, into sports and very much liked amongst his friends and family. On the 23rd of August, many lives changed. On this day my cousin ended his life. The whole community was in despair. There are no words imaginable to describe my aunt; she lost her son and one of her best friends. To lose someone who has so many aspirations, so many talents, qualities, and their whole life ahead of them, it is an awful shame to think of what he must have been going through. Everyone was
shocked; the main question going through people’s minds was WHY? We will never know why, all we know is that his pain and suffering has stopped. However, that pain in my heart, the pain in the heart of my friends and my aunt, will never cease. This pain is impossible to describe. The tears, the heartache, the suffering that occurred during and
following his funeral were immense. The thought that this could have been prevented sends shivers down my spine. That if only he had opened up to a friend, to his mom, to his dad, even to me. I ask you to please evaluate your own thoughts; do not keep things bottled up. There is always someone out there who is
‘We will never know why. All we know is his pain and suffering has stopped’
willing to help. A person you may interact with every day may seem fine in your presence, but you may not know what could be going on in their minds that they are keeping private. It is important to know that there are people out there willing to talk and want to talk. No one wants to see someone going through problems on their own. You can easily turn to a friend or a family member and discuss whatever you need. Mental Health Week really wants to portray that IT IS OK TO TALK. There is a Student Counselling Service which is located on South Leinster Street where the staff will be more than happy to discuss any issues. There is also S2S (a student helpline run by students for students) or you could arrange a meeting with your tutor.
My fearless father myself lay sleeping in rooms a few feet away. The details of my dad’s death are, even now, very painful to me and my family. But the details,
whom Joiner calls “suicide survivors”. Since his father’s death, which took place while he was away at college, Joiner has dedicated his
suicide,” says Joiner. “Just like heart disease, if you understand it, you can prevent it.” Joiner’s theory is that those who kill themselves not only want to die, but they have learnt to overcome the instinct for self-preservation. The desire for death, he says, is composed of two psychological states: a perception of being a burden to others (a belief that one has ceased to contribute in useful ways to life), and a feeling of not belonging (social disconnection and isolation expressing itself through a devastating sense of aloneness). Neither of these states, on their own, is enough to instil the desire for death, but together they produce a desire that can be deadly when combined with the acquired ability to enact selfinjury. Suicide victims, Joiner says, “work up” to the act by getting used to danger, fear and pain. They may do this in different ways. They engage in reckless behaviour, cut or otherwise
Joiner argues, are crucial. Since my dad’s suicide I have spent the years largely burying it, rarely discussing it, especially among those most affected by it: my family. Each of us retreated into the cell of his or herself, nursing grief, guilt, sometimes despair, anger, resentment and bafflement, which are, usually, among the emotions for those
professional life to becoming an expert on suicide – for the past 16 years as a scientist studying, researching and seeking answers as to why people destroy themselves. He’s now one of the foremost authorities on the subject. “There’s an idea that suicide is a mode of death that stands apart from others, but there are clear reasons why people die by
hurt themselves or make repeated suicide attempts. Others may have a history of accidents or medical procedures and still others become hardened vicariously. Physicians, for instance – who have an elevated risk of suicide – are exposed daily through their work to pain and suffering. Eventually, self-injury and dangerous situations become
A pyschologist argues that suicide victims are isolated, strong willed but never weak - a theory that has helped Stephen Martin to understand his own fathers’s death. Stephen Martin is a postgraduate student in Trinity. His article first appeared in the Times of London.
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y dad was shot in Peckham. Which, if you’re going to get shot in Britain today, appears to be the most likely place for it to happen. After a violent altercation with another man in a pub, a car drew up alongside my father as he walked home and a double blast from the weapon of choice, a shotgun, shattered his kneecap – and his life. This shooting took place in the Sixties and was to lead, partly, I now believe, to his suicide 16 years later. Until recently I had never seriously considered it a major factor in his death. The change in the way I now look at my dad’s death comes because of a compelling book, Why People Die by Suicide, by Thomas Joiner, the Bright-Burton Professor of Psychology at Florida State University. He has presented a cogent theory that he contends frames all suicides. It’s a theory that seems to solve the how and the why of a mystery that has been unresolved in my mind for 25 years. But Joiner’s book is made all the more striking by what has, in part, driven him to produce it: the suicide of his own father in circumstances uncannily similar to my dad’s. In the middle of the night Joiner’s father drove his van to the car park of an industrial estate and, just before dawn, climbed into the back, cut his wrists and then pierced his heart with a large knife. My dad, between 6am and 8am, took a large knife from the kitchen, got into the bath at his new home in Peckham, South London, and cut his throat while my mother, one of my sisters and
unthreatening and mundane, according to Joiner, making suicide easier to carry out. “Some people think that those who commit suicide are weak,” Joiner says. “It’s actually about fearlessness. You cannot do it unless you are fearless, and this is behaviour that is learnt. The truth may be unsettling – it is about fearless endurance of a certain type of pain. Perhaps this will demystify and destigmatise suicide and perhaps even the mental disorders associated with it.” Joiner’s theory explains why seemingly disparate groups of people, such as anorexics, athletes, prostitutes and doctors, have higher than normal rates of suicide. The lifestyles of all of these people expose them to pain – either their own or others – and can harden them against suffering. Here’s where Joiner’s theory brings me back to my dad’s shooting when he was aged 44. I believe now that it was part of the process that had inured him
to pain and injury. Two years after the shooting he had the leg amputated, not because of the pain, which was acute still, but because it made it difficult to sleep. He took the loss phlegmatically, I thought, although it meant the end of his trade as a painter and decorator. Before the last war my dad was set for a career as a professional
footballer. He twice broke his leg. As a gunner in the Navy, between the ages of 19 and 26, he saw brutal wartime action. He was tough, physically fearless, confident, but prone to bouts of weekend pub drinking and possessed a quick temper, although he was gentle with his family. A year before his death my dad took early retirement from a clerical job. And, more than I realised, coping with his disability had become worse. I suspect now that he was probably suffering from a depression, undiagnosed, for the last 12 months of his life. The first warning we got of that was when he went to a park and took an overdose of sleeping tablets six weeks before his death. Joiner’s father had left the company that underpinned his adult identity as a good provider and successful businessman and, in the grip of a depressive episode, had gradually withdrawn from family and friends. A former marine, his father had a tolerance for pain demonstrated in many accidents that befell
possibly head off that period when mental illness can lead to a lethal conclusion. With knowledge of Joiner’s theory we may, just possibly, have been able to prevent my dad’s suicide. But it’s a big stretch. I know now that his attempted suicide was merely miscalculation. The desperate method by which he did destroy himself tells us that. It was the act of a man determined to “succeed” where he had once failed. His attempt was not, as one doctor inanely told me at the time, just a “plea for attention”. White men present the highest risk group of all suicides in Western countries. They kill themselves at a rate of 4 to 1 compared with women, though women tend to attempt suicide more often. In the US, for instance, older white men are most at risk of suicide (my dad was 62, Joiner’s 56 when they died). Female lack of “success” is believed to be means-driven. Men have more access to lethal ways of destroying themselves; and they become more
him. About one million people kill themselves every year around the world. The number in Britain was 5,671 adults (those under 15 not included) in 2005. To put that last figure in proportion, compare it with UK road deaths: about 3,201 (in 2005). Yet when did you see a public information campaign aimed at suicide prevention? Suicide is the great taboo. Within my vision, as I write this, there are at least two other close colleagues who are suicide survivors, but none of us has ever spoken of it to each other. When asked how my dad died I often used to answer, maybe implying judgment, that “his heart gave out”. One recent study revealed that 44 per cent of suicide survivors lie about it, yet they will tell the truth about other deaths, by accident or disease. After Joiner’s book was first published his university was afraid to put the subject and the word “suicide” on the cover of its magazine, though it ran an article inside. What Joiner’s theory gives, it seems to me, is a model to
isolated than women. Suicide is less likely among black men compared with white, probably because of social support and religion within ethnic groups being stronger. Critics of Joiner’s theory accuse him of overreaching in framing a theory to fit all suicides, and that, while rigorously and scientifically researched, his book is too loaded with heartfelt anecdotes about his father’s death. Joiner tells me: “Either I am correct, in which case I am not overreaching by definition, or I am not correct, in which case much can be learnt by researchers showing exactly how I am wrong. It is rare, I suppose, for a personal book to have much scientific value, but not impossible. The creation of theories can come from anywhere, though the testing of theories has to conform to the rules of science.” In searching for answers to my dad’s suicide so many years after the event I am motivated by thoughts about the future. My eldest and youngest sisters have both been afflicted with serious
‘Joiner’s theory explains why seemingly disparate groups of people have higher than normal rates of suicide’
depressive illness since our dad’s death. Thirteen days ago, in a depressive episode, my youngest sister took an overdose of sleeping drugs. Only the timely intervention of my middle sister, and later police, ambulance, A&E staff, and the Maudsley Hospital team, prevented another tragedy befalling my family. Joiner’s model, I believe, helped to alert me to the danger. Sadly, despite repeated warnings from me that my sister was an imminent risk, there was a lack of response and resources from some of the professionals connected with her case. The fight is ongoing to prevent further harm. During that crisis, her 25-year-old daughter asked me, searingly, if it was inevitable that she too would suffer a mental illness similar to that of her grandad, aunt and mother. The clinical response appears to
about suicide may help to prevent others reaching a lethal end in the future. This is why Thomas Joiner wrote his book. And why I wrote this piece. — Why People Die by Suicide, by Thomas Joiner, published by Harvard University Press, £16.95. The paperback edition will be published on October 26, £10.95. How to prevent suicide: ‘Collect new friends and keep old ones – it’s powerful medicine’ If you feel suicidal or you fear that someone you know is feeling that way get professional help immediately. Call police and ambulance services if necessary. There are also phone helplines, listed above, with trained volunteers who will listen and help you. Professional intervention during suicidal crises is the key to saving people, says Professor Thomas Joiner. “Regarding prevention, I think the big thing is to
be: possibly, but not inevitably. While there is probably a genetic predisposition for mental illness in my family, it is not preordained, but the odds are greater than for those without this background. A family history of suicide appears to contribute about a twofold increase in risk. Approximately 95 per cent of people who die by suicide experienced a mental disorder at the time of death. Yet most people with mental illness neither attempt or commit suicide. What I can confidently tell my niece is that a greater knowledge
be aware of the risk factors in my theory [being a burden, a failure to feel you belong, exposure to violence or pain] and to use them as warning signs to urge and persuade people to access treatment and to adhere to it. “Once people are stabilised in treatment, the theory suggests that the main ways to keep the patient interested in life is to engage them socially and to encourage activities that imbue a sense of contributing to others or to society. Often people say ‘I can’t think of anything’. Marsha Linehan [a US psychologist] has composed a list of activities
‘Just like heart disease, if you understand it you can prevent it’
people can do – hundreds of things, which, collectively, have a power that surprises if people will only commit to regularly trying them. “I’m no advertising exec, but if I wanted to do a campaign to prevent suicide, I might start with something like ‘Collect new friends and keep old ones – it’s powerful medicine’. But accessing and adhering to treatment (either cognitive behavioural psychotherapy and/or antidepressant medicines) are so important that thinking about other things can be counterproductive at times.” In his book Joiner says that professionals who deal with suicidal crises would do well to focus on a patient’s sense of being a burden and lack of belonging. These elements are more amenable to short-term crisis intervention than treating lethality. Techniques such as symptommatching in order of seriousness and the development of a crisis-card can often take the the edge off intense negative moods. Symptom-matching simply involves listing disruptive feelings and emotions. The patient ranks these in terms of the most upsetting. Concrete proposals are made (eg, treatment for insomnia, relaxation for general distress, pleasant activities to combat depressive symptoms). These are not intended to solve the problem or even change it much, but to take the edge off the problem so that the patient is better able to tolerate the crisis. Psychotherapy, which is focused on amending negative thoughts about self, others and the future (cognitive therapy), is the leading treatment, Joiner says.
The scarlet letter of mental illness Hannah Jean Ryan Editor
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he World Health Organisation has declared stigma the “single greatest barrier” facing people with mental health problems. Stigma can be defined as, “a mark or token of infamy, shame or reproach”. The etymology of the word can be traced to ancient Greece, where it derived from the custom of cutting, burning or searing a mark on the skin of a person to identify them as somehow contaminated or blemished. Throughout history, various groups of people have worn their stigma as a conspicuous and physical sign on their person- from the paupers who, under the 1697 Poor Law were forced to wear cloth to humiliate them for taking Parish relief, to the yellow Star of David, imposed on the Jews in order that they may be more efficiently
persecuted and, ultimately, exterminated. The mentally ill, as a minority group, have always worn a mark of stigma. This mark has not always been visibly borne, but it has always been felt as a tangible reality. Like other, more visceral signs of stigma, it has always carried with it an inherent meaning of degradation and shame. Though we may flatter ourselves that our modern society is enlightened, stigma and prejudice against the mentally ill are omnipresent. Even within the walls of our prestigious university, where liberal and progressive attitudes are often regarded as a badge of intellectual sophistication, mental ill health and mental disorder remain shrouded in secrecy and silence- despite the fact that, as a demographic, we are one of the most vulnerable groups for the development of mental illness. If statistics are to be believed, mental disorder is virtually ubiquitous. One in
three, or one in four on campus will struggle with it during their time here. What that means is that this is not something that is happening to someone else, in some convenient elsewhere, it is happening to you, your friends or your girlfriend. Yet the paradox remains that, besides the desperate, sprawling graffiti on the backs of toilet doors, mental ill health is not a part of our conversation- either within the lofty chambers of the GMB or
in any meaningful way. While we continue to ignore mental illness, we make those with mental ill health feel that they have something to hide and be ashamed of. This is not only painful and isolating, it is potentially detrimental to their recovery; the longer a person remains reticent about their illness, the poorer their prognosis. Moreover, this tacit intolerance of mental health problems is palpably sensed and internalised by the
without. We may talk about sex with unabashed crudeness, and we may denigrate venerable academic theories with the singular arrogance of the young, but neither in our coffee shops nor in our dorm rooms do we talk about our mental struggles
mentally unwell, who are invariably their own worst stigmatisers. Arts Block etiquette dictates that we greet acquaintances with hysterical delight and talk about parties in sparkly superlatives. Online, Facebook lets us maintain an illusion of leading
‘Mental ill health and mental illness remain shrouded in secrecy’
perpetually productive and hedonistic lifestyles beautifully, by allowing us to meticulously cultivate and project only our most airbrushed versions of ourselves. There is little room for the dark side of human experience in our culture. Thus, difficult feelings are suppressed, leading to alienation and shame. When we’re talking about illnesses with clinical symptoms that commonly include feelings of profound inadequacy and social disconnection, this insidious form of stigma is tantamount to social poison. Why do we stigmatise? One reason is fear. We perceive the mentally ill as irrational and unpredictable, so they constitute a threat to our fundamental motivation to preserve the integrity of our fragile social worlds. On a deeper level, we fear that peering into the mind of the mentally unwell might force us to recognise vulnerabilities in ourselves we’d rather not confront. It is a truism
that we revile most in others that which we hate most about ourselves; when we shun a mentally unwell friend, we are really rejecting a part of ourselves that threatens our own stability. Another reason is misconception. The roots of stigma are invariably bedded in misconception, and in the case of mental illness, the soil is dense and deep. Few of us would still believe in the commonly debunked myths (e.g. that the mentally ill are potentially dangerous) but the most pernicious of myths are the ones we hold implicitly, and of these, the most common is that the mentally ill are constitutionally weak or somehow responsible for their plight. We’d be loathe to admit that when friends complain of anxiety or depression, part of us dismisses them as pessimistic, moany or self-indulgent. Part of us congratulates ourselves for withstanding lesser battles with optimism and resilience, and smugly wonders why their minor rejections and commonplace hassles seem ‘such a big deal’. Part of us then still attributes mental ill health to a deficiency of character. In their endeavours to debunk the myth that the mentally ill are somehow at fault, journalists have tended to over-rely on neuroscience in representations of mental illness. Depression is called ‘a brain disease’ and family history is pointed to for evidence of a genetic link. While most illnesses have an element of genetic predisposition, anyone with a passing interest in psychology knows that the ‘nature-nurture’ debate is a false dichotomy; mental ill health- any mental event, for that matter- is a response to a complex interaction of biology and environment.
- these are as real as the weather - AND EQUALLY NOT UNDER ONE’S CONTROL. Not one’s fault.’ If you want to reduce stigma, teach people about control. It won’t dispel all misconceptions about mental ill health, and it certainly won’t eradicate stigma overnight, but it is, I think, a good place to start.
55%
of young Irish people say they have significant experience of mental health problems, either themselves or through someone close to them
is different from bipolar disorder and a broken mind cannot be equated with a broken leg. If you break a leg or strain an ankle, you damage bone or ligament. Bone does not have a concept of identity and ligament lacks the capacity to fall in love, or grieve. In mental illness, the part that is damaged is that which is most fundamental to our humanity- our sense of self. The analogy is reductive and inadequate, and negates the peculiar complexities of psychiatric disorder. In the long run, it will never convince
‘Mental ill health - any mental event, for that matter- is a response to a complex interaction of biology and the environment’
The false assumption is that, if an illness is not purely biologically determined, it must be partly under the control of the afflicted. Anticipating this, campaigns targeting stigma perpetuate simplistic analogies with physical ailments. ‘Would you ignore your friend if she broke her leg?’ ‘How would you react if your boyfriend had cancer?’ Frankly, I would react differently. Cancer
an educated public. Campaigns rely on short cuts because dispelling misconceptions means educating, and it is impossible to educate the public on the infinite complexities of the mind. While I give major kudos to Med and Neuro students for memorizing endless facts, confusing coordinates and pretentious Latin names (Right Dorsolateral Prefrontal
Cortex, anyone?) as they master neuroscience, understanding the infinite complexities of the human mind takes more than knowing your serotonin from your noradrenalin. So how do we educate the public? Short of rolling out undergraduate psychology courses to Junior Infants, boosting their ‘emotional literacy’ with ‘self-care’ classes and meditation workshops and adding ‘Resilience to the classic three ‘R’s’, sufficient education is unfeasible . What we can do is identify some of the key fallacies underlying our thinking about mental illness and target them. The key fallacy, as I see it, is the perception that the mentally unwell are in control. Campaigns often appeal to our empathy by asking, ‘haven’t you ever felt blue’ or emphasise the universality of mental health by reminding us that, ‘everyone goes through a rough time’. This is a mistake. While we have all ruminated over lost friendships or obsessed over inconsequential exams, when someone becomes mentally unwell something goes quite catastrophically wrong in the mind. Most people think, “Sure, I’ve felt like shit, I’ve been down, I’ve been anxious- what’s the big deal?” In true depression and anxiety, there is a devastating loss of control. Normal thought processes are severely distorted as a girl who in a well
state might be pragmatic, energetic and diligent falls pray to torturous despairing thoughts and lost motivation. Unlike in those of us who have felt a little mentally precarious after two weeks of frantic cramming and sleep deprivation, factors have conspired in such a way that she has truly lost control. To make matters worse, she has absorbed the message that she should be capable of banishing negative thoughts and hopeless feelings without professional help (the self-help industry perpetuates the idea that, with the right tenstep guide we can overcome any psychological speed wobble). Thus, her awareness of this loss of control leads to immense frustration and compounds her feelings of self-blame. This loss of control is crucial to understanding mental ill health. If there is no control, there can be no blame, and without blame there can be no stigma. Stephen Fry put it eloquently when he responded to a suicidal fan’s desperate plea for help. In his letter, he wrote matter-of-factly: ‘Here are some obvious things about the weather: It’s real. You can’t change it by wishing it away. If it’s dark and rainy it really is dark and rainy and you can’t alter it. (…) It really is the same with one’s moods. The wrong approach is to believe that they are illusions. They are real.
20% believe friends would distance themselves in reaction to a mental health problem
50%
of people with mental health problems have stopped themselves from having a close romantic relationship due to fears of rejection on grounds of their illness
44%
of young males would not know what to do if someone close to them was experiencing mental health problems
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Coming to Terms with Trich Trichotillomania is a disorder in which sufferers pull hair from their head. Here, a student who has suffered from the disorder shares her experiences.
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very day since the age of 17, I went to great lengths to make myself look like everyone else, to make myself look normal. Each morning, I would get up early and go to the mirror, taking extreme care not to bump into anyone beforehand. I would spend at least fifteen minutes applying eyebrow pencil, coloring in the bald patches on my eyebrows, trying to make them even and look real. I could never reveal why I was missing clumps of hair. If someone were to notice, I’d tell them I had over-plucked, and laugh it off. It’s easier that way. I have Trichotillomania (or Trich), a disorder in which sufferers pull hair from their head,
‘I kept my pulling a secret for years. I felt so much shame’
eyebrows, eyelashes, pubic area, face, arms and legs. 2-4% of the population suffers with this disorder. Of this small percentage, few are willing to talk about it, and of the general public, even fewer know what it is. It took three years of pulling before I typed the words ‘hair pulling’ into Google. It was only then that I read my first definition of Trich – ‘a self-induced and recurrent loss of hair’- as well as being met with a myriad of photographs of people like me. I kept my pulling a secret for years. I felt so much shame. I was ashamed I had bald patches and that these patches were because of something I was doing. I was ashamed that I couldn’t stop. I was ashamed that I was lying about why my hair was disappearing. I was ashamed that sometimes, I didn’t want to stop. I think I was too afraid to really try to stop – there were days when the only thing that would take the edge off my anxiety was
when I was pulling. It’s comforting. Even when it’s painful, even when my fingers were sore from the action of pulling, it was still soothing. I really believe that if more people spoke about their experiences with Trich, sufferers would be more likely to talk about it. There are few things worse for a person with Trich than to have someone ask: ‘why don’t you just stop pulling?’ I used to ask myself this daily. The truth is, I didn’t think I could ever stop. Sometimes I didn’t want to stop. Often, the only thing that eased my anxiety was pulling, so why would I want to risk becoming more anxious? It got to the stage where the most simple of tasks required planning. For example, I’ve been involved in athletics since I was twelve years old. Cross-country has always been my favorite season, but unfortunately for me, this takes place during the winter months, and winter in Ireland means more rain. When training, I could never relax. Even when there was no rain, I sweated when I ran. Any type of moisture makes eyebrow pencil smudge, and when my eyebrow pencil smudges, so too did my makeshift eyebrows. Even showering was a big deal. I had to always make sure I had eyebrow pencil in the bathroom with me, and I had to spend extra time fixing the towel on my hair so that it covered down to just above my eyes. I could never go swimming. I’d panic if someone hugged me and my face rubbed off their shoulder. It might seem vain, but the shame is so great that I’d do anything to hide my secret. If I were staying
I attempted to find out more information on Trich by borrowing a book from the Library. I typed the word Trichotillomania into the search bar, and was met with less than a handful of results. No books were available in the Library, so I ordered one from Stacks. When I eventually got to read it, there was no real information on Trich, only tips for therapists on the types of questions to ask clients. I only kept the book for about 20 minutes, carefully hidden in my biochemistry textbook in case anyone saw me with it. I had the excuse that ‘our neurochemistry lecturer mentioned something interesting in this book and I wanted to look it up’ on the tip of my tongue, in case someone happened to see the book. If I was questioned further, the lecturer mentioned ‘something on neurotransmitters, but I can’t find the page’. I couldn’t relax until I’d swiftly returned the book and made a quick exit from the
in someone’s house, I’d get up several times during the night to make sure I had some semblance of eyebrows. I remember one day in College,
Library. That’s how much shame I would feel; I was afraid that someone would see me with the book, and somehow put two and two together. I was petrified of
‘I had to always make sure I had eyebrow pencil in the bathroom with me’
someone realizing that I didn’t, in fact, just keep over-plucking my eyebrows, or that I wasn’t just
life. On the point of self-mutilation, I’ve read in several places that it’s not the same as hair
fond of eyebrow pencil and that’s why I always had some on me. About a year and a half ago, I told my mom and, although I couldn’t see it then, things slowly began to improve. My mom made an appointment for me to see my GP. This was extremely traumatizing – I still hated talking about having Trich - but she was so understanding and comforting and didn’t make me feel like I was over reacting, or play down what was going on. My GP referred me to a counselor – the thought of which was petrifying. I’d never been to counseling and I really didn’t know what to expect. Unfortunately, I had a less-than-ideal first session with this counselor. She told me I was self-mutilating and asked me again and again to define Trichotillomania, as she’d ‘never heard of it before’. The last thing I wanted to do was explain to a professional why I was sitting in front of her. I think my trip to her was one of the most traumatizing experiences of my
pulling. I pulled as an outlet for my anxiety, sometimes I pulled because I could feel a physical sensation around the root of my hair, and sometimes I pulled because I felt like I had to pull a hair – if it was different to other hairs, then it had to go. I never pulled with the intention of altering the way I looked (albeit, this was the end result). I never went back to that counselor. I was eventually referred to the Dean Clinic and things kept improving for me. For anyone who may be seeking private intervention, I cannot recommend the Dean Clinic enough. All of the staff are kind and professional, and the whole set-up normalizes going to counseling. The receptionist, especially, made my bi-weekly trips to Sandyford almost enjoyable. He was so friendly and was so normal that I could have been buying a paper at my local Spar. The staff were all so normal, they didn’t look at you like you were different, or like there was anything wrong
‘It’s soothing to know you’re going to a place where you won’t be judged’
with you. They are just really nice people, with no judgment. It’s soothing to know that you’re going to a place where you won’t be judged for anything. In the Dean Clinic, I had CBT, or Cognitive Behavioral Therapy. I had never heard of CBT until I started counseling, but my counselor explained it all to me. CBT involves self-monitoring, and finding a link between thoughts, actions and behaviour. As part of the self-monitoring, I had to keep a diary. This was hard, as it meant I had to acknowledge what I was doing, and how often I was doing it. What I found most helpful, was knowing that there was a professional person who I’d have to see every two-or-so weeks, who would be keeping an eye on my progress. CBT takes a bit of effort, but the end result is completely worth it. The staff in the Dean Clinic and my GP, were all fantastic in the sense that they knew what Trichotillomania was, and exactly how to deal with it. It was unfortunate that my first expe-
I have long pull-free periods – something I didn’t think possible before I got help. I really believe in this year’s Mental Health Week theme that ‘it’s ok to talk’. Things didn’t get better for me until I began to talk, and I’m not sure if things could have gotten better had I kept everything to myself. To anyone reading this who is suffering with Trich or any other disorder, I really would encourage you to talk to someone. You don’t have to do it today or tomorrow, but some time in the near future, please talk to somebody. It does get better and there are so many wonderful people out there who can help you. If you met me today, I bet you wouldn’t know that this is part of my story. Maybe not many people have Trich, maybe not many people know what Trich is – I have Trich, I know what Trich is and I’ve overcome Trich. I wrote down my story, partially to raise awareness on Trichotillomania, but mostly because if I had read someone’s story, it would have
rience with a counselor was so negative, and I really think it could have been avoided, if there was just more information available on Trichotillomania and other rare disorders. Even in the waiting room of the Dean Clinic, there were no books or leaflets on Trichotillomania, but there were books on most other disorders. I don’t think they simply chose to omit books on Trich from their room, I don’t know if there are many books on Trich. I think there’s a real need for everyone - and not just GPs, counselors and other professionals working in Mental Health - to be aware of rare disorders. For me, anyway, websites such as the Trichotillomania Learning Centre, the section on Trich in Kids Health and even looking at videos of sufferers on YouTube helped me. It was comforting to read about other peoples’ experiences, and actually see some of these people. Even if the content wasn’t always positive, it was nice to be able to relate to someone who’s going through a similar thing to you. I can now proudly say that I’m in control of my Trich. It has been, and probably always will be, a big part of my life. I haven’t stopped pulling completely and I don’t know if I ever will, but
made a world of difference to me. I hope my story helps someone, and at the very least I hope it spreads some awareness on Trichotillomania. A note on why I decided to remain anonymous: I’ve been contemplating putting my name here ever since I decided to share my story and write this article. A friend recommended that I weigh up the pros and cons of using my name, and I did just that. I wanted to put down my name, mostly to practice what I preach – I’m happy to share my story and I was afraid that by omitting my name, it would make it seem like I was afraid of putting my name beside it. I chose to write this anonymously because, even though I’ve been dealing with having Trich properly for almost a year and a half now, and although I’m making great progress, I’m still not there yet. I needed to know that I’d be ok, regardless of the response this article gets. I hope that, in spite of leaving my name out, by sharing my story I’ll spread some awareness on Trichotillomania and help sufferers see that you can beat Trich.
‘I can proudly say that I’m now in control of my Trich’
The Thinspiration Phenomenon Owen Sheehy Contributing Writer
P
eople who eat are selfish and unrealistic. Skinny people get better jobs. Starving yourself is an excellent example of willpower. These three mantras are just an example of the tips given in a “70 reasons not to eat!” feature on a popular pro-ana (pro-anorexia) website. These “thinspiration” websites (this term also includes pro-mia/pro-bulimia websites) form an online community where individuals suffering from eating disorders can celebrate their weight loss, encourage each other to lose even more weight by sharing tips, and introduce new people to their way of life. Many of the users of these websites live by the motto that “Anorexia is a lifestyle, not a disease”. The detrimental psychological effects of these websites have been well established, with numerous studies demonstrating that the use of these websites is linked to low self-esteem, negative or warped body image and excessive striving for perfection. Most mental health professionals would be in agreement that these sites are inherently dangerous, thus questions arise regarding the best way to combat them. Earlier this year, Tumblr made the controversial decision of banning all blogs centred around thinspiration. Leaving the issues of censorship and freedom of speech aside, this still may have been a bad idea. Casilli, a French sociologist, describes the so-called “toothpaste tube” effect, whereby the banning of these blogs only serves
to move them onto different online platforms. This leads to a restructuring of the thinspiration community, forming denser and more sporadic clusters of users online. The end result of this is that the communities become more vigilant and secluded, making it harder for concerned parties to intervene. Thinspiration sites have perhaps gained an unparalleled level of notoriety in terms of their damaging psychological effects, but there are many more types of websites that pose dangers to mental health. The most worrying of these would probably be the sites that allow users to find like-minded people with whom they can form suicide pacts. It’s
with these sites, as simply banning them isn’t going to work. Contemporary studies in the field are now calling for a move towards dialogical online communication between mental health professionals and at-risk individuals. Providing unidirectional advice about mental health in a didactic manner just isn’t good enough anymore. Much of the danger of these thinspiration and suicide sites comes from the fact that they provide an active community that will engage an at-risk individual; therefore any preventative or therapeutic online resources also needs to replicate this engaging effect. One article suggests that clinicians get into
quite harrowing to see the casual nature of posting on these sites, with people being as straightforward as to state things like “I want to end my life ASAP, NYC area”. Worryingly, one of the responses to this thread was “I want to end it all too - mind if I bring my baby daughter?”. When things like this happen, maybe it’s time to question the extent of our internet consumer culture. We live out so much of our lives online now, and expect that all of our needs can be satiated following a quick browse. However, to think that we now also have online mediums that will facilitate a quick and easy suicide is pretty damn disconcerting. We need to develop more sophisticated strategies for dealing
the routine of engaging their patients in a dialogue regarding their Internet use, while steering them in the direction of preventive sites. An example of an online resource that engages users in dialogical communication is the online listening service that was launched last month by the student-run organisation Niteline. This is a non-judgemental and non-directive instant messaging service that gives students an outlet to discuss any issues that may be troubling them. The bottom line is that the online world just represents another domain in which we need to be mindful of protecting our mental health. This internet thing really is serious business.
‘These sites provide an active community that will engage an at-risk individual’
some students’ experiences of mental health. It’s graffiti on the back of old contraception posters, scrawled on tiles or written openly on the back of bathroom doors. These brutally honest confessions of bulimia, self- harm, suicide attempts, self-image and sex are in stark contrast not only to what we are told to expect of college but also to the bright society and promotions posters that don the Arts Block walls and notice boards. What does it say about people and student’s perception of college if they feel that a bathroom is the only place to express such fears? It adds to the idea that if we aren’t experiencing college the way we think we should, it is down to our own failings and that these have no place in the main stream college consciousness. And in reality, if they
Learning to cope What happens when college doesn’t turn out to be the best four years of your life? Anonymous
I
don’t think I was alone among Fresher’s of 2010 when I assumed that my time in Trinity College was going to be the best four years of my life. Sitting on my bed reading the Fresher’s information pack that I had been sent, I remember my eyes widening in surprise at the sheer amount of societies I could join, the details of the nights out organised for the coming weeksall with implication that this, my first week in Trinity, was going to be the start of four years that later I would give anything to live over and over again. And arriving in Trinity, there initially was nothing to dispel the expectations that had been built up around college. It was everything I had been told it would be; posters and stands all fulfilling expectations about the college opportunity. My expectations were those that we have all been exposed to from secondary
school, dreaming classes’ away thinking of the freedom of college. The idea of college is broadcast as one where, for the most part, you work hard and party harder. With the Leaving Certificate year openly acknowledged as the most difficult year in the life of a young person, is it any wonder that the rhetoric around the college experience has developed the way it is? The freedom, independence and fun that is associated with college is driven home to us through phrases like the “best years of your life” while we struggle through (seemingly) the “most difficult”. Although there is nothing wrong with having preconceived ideas about college, what is important is to think of how these expectations can, ironically, cause people to feel more isolated within the college sphere. Growing up with the expectation of college that we do forces us
‘The truth is that college isn’t always the best four years of people’s lives’
to expect certain things of ourselves. What happens when we can’t live up to our own anticipations? Why do so many people suffering with mental ill health during their college years express it in the terms; “I should be having a good time”? It is in part due to the fact that we internalise the perception of college as the best years of our lives and when it isn’t living up to these insanely inflated ideas, we feel as if it is our fault? The truth is that college isn’t always the best four years of people’s lives. One final year student recently told me that he used to feel that if he wasn’t participating in the college nights out and generally getting involved, he wasn’t really a “student”. The college experience isn’t a positive, flat universal one but why does it seem to only be portrayed as such? There seems to be little in the way of dispelling the images people have of student life. In fact, student problems seem to be perceived as not having enough money for cheap drinking and Tesco not stocking enough noodles. Take a trip to the Arts Block bathrooms on the third and fourth floors and you’ll see heartbreakingly honest confessions of
‘What happens when we can’t live up to our own anticipations?’
did, it would probably have a wholly positive effect on widening perceptions of college, especially for incoming students. Surely people need to be more aware of the multiplicity of the college experience? It would help to reduce the pressure to have the best years of your life and therefore reduce the stigma attached to mental health in college. “College isn’t always the party people think it is”. Stephen Fry is quoted saying this on the new Niteline posters. In the Arts Block these posters are on the stairs, not hushed away in the bathroom to be written over but similarly not occupying the same space as the posters displaying society events, offers and opportunities are. They are the bridge between. And it’s the same in trying to raise awareness of mental health in college. It’s no longer hushed away never to be spoken of but, equally, it isn’t main stream. And there is no reason why it shouldn’t be. Just like the NiteLine poster, it’s frustratingly close but regrettably not quite there yet.