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When
Jack Nicholson’s character in One Flew Over the Cuckoo’s Nest agreed to enter an
asylum instead of going to prison, he thought it was the easy option. As he soon
discovered, it wasn’t; but what about the millions who live with mental health
disorders everyday? One Confidential reader gives a very personal account of living with depression and other disorders.
For those who have not experienced the dull thud of depression that never stops or the eternal cutting
glass of paranoia, questions pertaining to mental health can be a mine field of the unthinkable, the unaskable and fear. No one wants to see their loved ones suffer but often it is impossible to know what is best to do, or even where to start. The above story is true, it was lived through by the person writing this article. There is far more to the story of course but as with many sufferers of depression or any of the countless other disorders of the mind, it is only when this kind of grand
gesture is made that anyone - including the patient
- knows that something is wrong.
No one is beyond the reach of mental disorders; celebrities such as Britney Spears, Amy Winehouse and Kurt Cobain - despite their wealth - are not immune, but having celebrity poster boys and girls like these however, does little to ensure that the malaise is better understood.
We don’t see Britney Spears and think bi-polar, we see Britney Spears and think Car Crash: Amy Winehouse; junkie and Pete Doherty, worse. At times, society can seem uninterested in understanding that something might have caused these patterns of behaviour, something other than excesses of indulgence brought on by privilege; it attaches stigma to its sufferers, calling them mad or bad or both and creates fictions about both patients and carers that stop people from seeking help for fear of what might be said of them.
This article is written to shed some light on the things that trigger, worsen and sustain these mental disorders.
It starts slow and gets slower still as it worsens; time can appear to stop and life - usually bound so tightly with clocks - gradually grinds to a halt. We all have bad days, but as Dr Omran, consultant psychiatrist at Bahrain Specialist Hospital explains, “pathological depression is classified by ~ series of bad days that extend beyond a fortnight and fluctuate little in intensity.” When depression sets in, its symptoms stay with you. Aside from the feelings of hopelessness and helplessness, patients can suffer a lack in concentration and appetite, their feelings of isolation lead to anxiety about all aspects of life: their work or studies suffer and decline and the patient feels guilt about their doing so.
This is depression and it affects between five and seven per cent of Bahrain’s population according to Dr Omran. “It is more common amongst females,” he says, “because of greater levels of hormones and the cultural limitations enforced upon them in this region.” It is a disease, just as flu is, and can be treated. “With treatment,” Dr Omran says, “over half of all patients who seek it recover and return to living a normal life.”
Science understands that the feeling of depression is caused by a chemical imbalance in the brain’s neurotransmitters, that sometimes chemicals in the brain are not sent where they are supposed to be sent or that sometimes, too much is sent, or too little, Neurotransmitters are chemicals in the brain that act as the brain’s interpreter; they transmit information from neurons to cells elsewhere in the brain known as receptors. There are several types and it is not fully understood how they work but what is clear is that the location of the receptor plays a significant role in what action each neurotransmitter takes and the ultimate effect of its action. Generally, neurotransmitters can be said to relay, amplify and modulate the neuron’s signals.
What this means is that a neurotransmitter such as Dopamine regulates many of the functions of the brain, including important roles in behaviour and cognition, motor activity, motivation and reward, sleep, mood, attention and learning. Serotonin, another neurotransmitter, is involved in the inhibition of anger and aggression, mood, sleep, sexuality and appetite. An imbalance in either of these could lead to disrupted sleep, lack of motivation, anger or sadness: depression.
Depression is treatable with drugs and a range of talking therapies. Dr Omran stresses that each patient is different and will respond to different treatments in differing ways. “Some need only antidepressants and others respond better to counselling. In many cases, a mix of the two is required.”
Society attaches stigma to patients with mental health issues and often they will not seek help because of them. “In this region especially”, Dr Omran asserts, “cultural norms often dictate that you will be branded as mad for talking to a psychiatrist; we are called quacks and people think that drugs we use will make everything worse.” The same is true throughout the world; the man on the beach did not seek any help until after waking in hospital, he thought be could deal with it himself, thought too that it would go away. And he self medicated, with alcohol and drugs, thinking that there lay all of his answers. Tariq drinks coffee like it is the last ever cup and smokes cigarettes until they go out. He was diagnosed as bi-polar when he was twenty four, which was probably too late, but still better than never at all. He too has a history of excessive drink and drug misuse. “When I was depressed, I was so tired all the time. I had no energy and wouldn’t even get dressed or shave; I took pills to wake me up and drank to bring me down.” It is a common cycle, one that Dr Omran calls substance induced mental disorders. Does an abusive relationship with drink and drugs lead to mental disorders or are those afflicted by a mental disorder more drawn to chemical excess? Certainly, in Tariq’s case, he feels that it was the latter. “When I was a kid, it felt like I reacted differently to other people, that my emotional responses were different.” By his late teens, however, he was smoking cannabis and drinking and his emotional responses to anything were already indistinguishable and inseparable from those induced by the drugs.
The opposite of depression is mania and people who fluctuate between the two states are referred to as being bipolar. Britney Spears is perhaps the most famous person to be discussed in these terms at the moment, but history is peppered with people deemed as being bipolar. Winston Churchill referred to his depression as his ‘black dog’ and Vincent van Gogh’s self harming - he cut off his ear and sent it to his lover - followed the now well charted roads of bipolar behaviour.
Tariq attempted suicide once as well, by means of slashing his wrists. He says that, “the sight of all the blood scared him” and that he “bandaged himself up and wore sleeves all summer. No one said anything, and I didn’t talk about it either.” Speaking to Tariq is to hear a tale of years of suffering in silence. He talks of periods where he felt too scared to leave the house and others of “literally climbing the walls.” In phases of mania he applied for bank loans and “partied until it was all gone.” Depression would quickly follow, he says, because he felt scared about not being able to pay back the loans and then guilty because his “family had to bail him out”. At times he seems melancholy in speaking about his experiences and others, manically obsessing over detail. His behaviour was deemed strange by his family and friends, he says, but not so far removed from the usual modes of behaviour so as to spark attention.
That changed in 1997, the year he was finally admitted to hospital. Following a period of mania - the details of which he is unwilling or unable to recall - “A little white van arrived at the house,” he jokes. “I felt good in the van, thinking that this was going to be a fresh start. I was looking~ forward to receiving treatment.”
The treatment wasn’t easy. Over the years he has endured longer and longer stays at Salmaniya’s Psychiatric Hospital as well as treatments with lithium. This, he says, helped. More than ten years later, he is still being treated as an outpatient and takes his medicine everyday, something that he accepts he will be doing for the rest of his life.
He is married and has a five year old child; he leads as normal a life as possible. But the spectre of his illness will never leave him. There is much to suggest that a predisposal to mental health problems is genetic, that one generation gifts the malaise to the next and Tariq is concerned. “It is seven times more likely that my child will be bipolar.” He is confident though that he and his wife will be able to deal with it if it comes. ‘My wife has supported me, has helped me and has stayed with me; people do understand when they take the time to understand.”
In Bahrain mental health provision is good in comparison to many other places in the Middle East. That Salmaniya has a dedicated hospital shows how seriously the authorities take it here. A report published by the Ministry of Health in 2006 showed that over 85,000 patient days were spent in the hospital. The same report highlighted “an increase in mental disorder patients due to population increase and the difficulties in coping with changes in the new world of technologies.” It also pointed out that, “the services have become more accessible” due to higher levels of awareness. This can be viewed as being in contrast to other authorities within the region. As one resident who has a schizophrenic brother affirmed, “here it was easy; he [her brother] was treated as an outpatient, they prescribed his pills and he would return there every month for treatment and assessment. In other countries we have lived in, he would just have been locked up at home and received no help at all.”
Mental health issues affect everyone, not just those related to a schizophrenic or suffering from depression. The authorities are playing their part and the private hospitals offer effective treatment. What is stopping progress in the field is an outmoded and outdated stigma that prevents sufferers from seeking the help that is available to them. As Tariq points out, “I agreed to speak about all this because I want the people reading to see that people with these problems are still people; they have families, jobs and people that love them. There is help is available; all you have to do is ask.”
Names have been changed
Article provided by Bahrain Confidential.