Are you a good person?

Are you kind to fellow humans—and all creatures great and small?

Do you support worthy charities, help those in need, and do good work?

Or do you have a dark side? Is there part of you that wants to lie and cheat and manipulate situations to your advantage? Are you interested in enriching yourself—even if that comes at a cost to others?

The answer is: All of the above. In the fine words of that great philosopher Paul McCartney: There is good and bad in everyone. Humans are capable of astonishing acts of courage and bravery, but under certain circumstances we might be utterly spineless, cruel, greedy or depraved. To deny these things in you—what Jung called the shadow—is to project them unconsciously onto others.

“I’m a good person,” a client said. But all around her—her husband, her children, siblings, parents, neighbours, immigrants, foreigners—were bad. This construction of the world left her lonely and disengaged, holding on only to her sense of superiority. She came to therapy when it came crashing down.

“I’m the bad guy?” says Michael Douglas at the end of the movie Falling Down. Robert Duvall, the cop aiming his pistol at him on the Santa Monia Pier, nods. 
​
“How’d that happen?”

A few weeks ago my therapist sent me a link to an extraordinary song that explores these themes. Hi Ren went live on YouTube on December 15 last year. When I first saw it, it had surpassed 5 million views. Today it’s reached 8.2 million and it's rising super fast. Word of mouth: This is the song of our time; a human anthem.

It starts with Ren, wearing a hospital gown, being wheeled into a semi-derelict room by a man with a pig’s head and a bloodied butcher’s apron. Ren is obviously a patient. He too is perhaps feeling derelict and abandoned—and powerless too in the hands of those charged with his care.

He starts playing the guitar.

It’s beautiful. An acoustic guitar. A pleasing melody. The incongruity of the surroundings. But he’s tugging at the nylon strings a bit hard. A bit twangy. Aggressive considering the sweet Flamenco notes that fill the room.

Then Ren opens his mouth and the melody is joined by a wail of wild, high-pitched half notes. It is otherworldly. It is perhaps something like the human mating call before we learned to speak, or the dawn chorus in Hades. We are drawn to this—we willingly enter his beautiful madness.

And then the rapping starts.

In his famous Red Book, Carl Jung attempts to commune with his own soul.

“ ‘My soul, where are you? Do you hear me?' he starts. 'I speak, I call you – are you
there?’ ”

In this piece of work, Ren opens with a salutation from his shadow to his ego.

“Hi there, Ren,” he hisses. “It's been a little while, did you miss me?”

This is the opening salvo in a blistering verbal assault from Ren’s inner critical voice.

Replies Ren:
“I’ve been taking some time to be distant,” he explains.
“I've been taking some time to be still.
“I've been taking some time to be by myself since my therapist told me I'm ill.
“And I've been making some progress lately,
“And I've learnt some new coping skills”

The critical voice is extremely skeptical:
“Ren, you sound more insane than I do,” he says.

He mocks Ren for imagining that some standard course of treatment—take another pill, the sound of white noise, a 10-step program—will make any difference, and ridicules his musical ambitions.

The argument hots up until the critical voice thunders his authority. He is the snake in Eden. Lucifer. Antichrist. Mephistopheles. Satan.
“I am you, Ren, you are me.”

Who is Ren actually? Where did this guy come from, this Keats-with-guitar? You could be excused for imagining he just picked up a guitar one day in a psych ward and discovered his madness instinctively knew how to play and had something to say.

Ren Gill was actually a talented musician in his youth. He started out making beats in his bedroom at 13, then went on to Bath Spa University to study music performance. One day in 2009, busking in his hometown of Brighton, he was spotted by a talent scout and snapped up by Sony Records.

The childhood dream swiftly turned into a nightmare however. Ren woke one morning feeling utterly lethargic, drained, and aching all over. He started having panic attacks. He’d stay in bed. He said: “My life changed overnight, I woke up one morning feeling like I'd been spiked—my personality disappeared.”

He entered the mental health system. He was put on antidepressants. Antipsychotics. It's not hard to imagine the kinds of interpretations psychology offered up for his illness—he was probably told for example that he was depressed, suffering from low self-esteem, bipolar, afraid of success, delusional, paranoid, mad. In some cultures he would be considered possessed, in need of an exorcism.

​The truth, discovered many years later, was that he had a longstanding untreated case of Lyme disease, the complications of which still impact him today. Ren’s health problems were not manifestations of some inner psychic conflict. He was bitten by a tic.

He has struggled. But perhaps the struggle, the suffering, is integral to his genius.

In the final stanza, Ren refuses to back down, and stands to face his demon:
“I go by many names also,
“Some people know me as hope,
“Some people know me as the voice that you hear when you loosen the noose on the rope.”

I’ve watched Hi Ren countless times now, but this passage, this lone shriek in the cold, silent void of a long and desolate night, this absolute guttural refusal to quit, still reverberates. This is courage. And if you going to live, stand in the fire, sing at the top of your lungs! Ferocious, persistent, immortal! 

The Hollywood movies might leave it there. The good guy narrowly defeats the bad guy, the evil forces are vanquished, and the credit roll as a beautiful melody transports us back to our lives.
 
Critical self
I have worked with many clients whose lives are made wretched by an invisible sargeant major who subjects them to a permanent harangue of negativity. It can come as quite a shock to discover that some of the nicest people are often subject to a totalitarian inner form of government—a brutal, relentless inner monologue that is with them 24 hours a day.

Perhaps it is an internalised strict parent, sibling, school bully, racist, sexist, homophobe, ableist. The child who is abused by a parent may conclude that love and abuse are indivisible. Lorna Smith Benjamin describes masochism as a gift of love to the original abuser.

Perhaps you experienced a traumatic event or time in your life, one that was so terrible it couldn’t be processed so was instead dissociated, divided up into images, sensations, stray thoughts and emotions. You bury these fragments in a deep hole at the far of the garden, but to your great dismay they keep coming back. The past reverberates in the present. Time in itself does not necessarily heal.

I’ve also met people who might have had perfectly idyllic childhoods yet still berate themselves mercilessly for every bone-headed move, bad-hair day or dumb remark. Perhaps your critical voice starts out by alerting you to where you might have room for improvement, acting in your best interests, but over the years it can become domineering and disempowering. 

Incidentally, if “the voice” is more than a thought or a feeling but is experienced as an actual, heard voice, some people might conclude that you must be mad, possessed and probably dangerous. And while such voices may point to the consideration of psychosis, it does not prove it. Many people hear voices at times for a variety of reasons.
​
Therapy might enable a client to develop a greater awareness and understanding of their inner critic. We might imagine it is an actual person—what age, gender? Remind you of anyone you know? The client might have a conversation with their critical voice. It can be useful to think of humans as being made up of multiple “selves,” lots of disparate strands in the tapestry. They all inhabit our being in a loose confederacy. And the client might find some other sentiments in this “community of selves” that can challenge and counter the inner bully.

The shadow
Sometimes, however, therapy attempts to go to far in expunging any negativity or nastiness. Jung argued we not born pure, but whole. We cannot edit ourselves to be merely good. We can never be untethered from our shadow. In Memories, dreams, reflections, Jung called the shadow—“everything that the subject refusers to acknowledge” about themselves (1995: 418).

Pure goodness becomes insipid. Heaven, with no shade, is no place for humans—a place, as David Byrne sung, where “nothing ever happens.”

Anyone who denies their inner propensity for evil as well as good will find that it manifests itself in unanticipated ways.

To make light—to live—is to cast a shadow. This is a chiaroscuro world. 

Artists, poets, writers, musicians, comedians, people who bring light to the world, must also experience darkness. 

And the shadow, by the way, doesn’t always have to be something bad. You might disavow your own brilliance, or talent, or potential for success. The more a person identifies with and invests in one polarity, the greater the opposite polarity grows in the shadow. 

We don't like bad stuff. The child who has not yet learned to tolerate and accept anger will hand it off, screaming at the grown-up: “Why are so angry with me?"

Any emotions, beliefs or characteristics that don't fit with your carefully-crafted, social media-ready self-image are simply projected onto others. Your partner—that's the easiest place to start. Then there are family members—one sibling is often cast as "the bad one"—neighbours, that asshole at work, men, women, black people, white people, those people over there, others.

The targets for projection and scapegoating are plentiful. Twitter is a very shadowy place indeed.

Writes Robert A. Johnson in Owning your own shadow: “Probably the worst damage is done when parents lay their shadow on their children...If a parent lays his shadow on a young child, that spits the personality of the child and sets the ego-shadow warfare into motion."  (1991: 34).

So how do you find your shadow? Ask yourself: Who do you judge? Your enemies, the people you dislike the most, have much to teach you. For they are you.

Projecting your shadow isn't just bad for others. It's bad for your too. Continues Johnson: “To refuse the dark side in one’s nature is to store up or accumulate the darkness; this is later expressed as a black mood, psychosomatic illness or unconsciously inspired accidents. We are presently dealing with the accumulation of a whole society that has worshipped its light side and refused the dark, and this residue appears as war, economic chaos, strikes racial intolerance. The front page of any newspaper hurls the collective shadow at us. We must be whole whether we like it or not” (1991: 26).

You want world peace? To start with, stop pointing accusatory fingers every which way, and instead take a look inside.

If we can own our shadow we can develop some conscious control over it, rather than have it unconsciously express itself in disastrous ways. And if we can accept that we are all flawed, vulnerable, insignificant, ignorant, that life is hard but also beautiful, that not one person on this planet knows how or why we are here, then we can perhaps be more empathic, more forgiving, kinder. We can greet each other. The words “human” and “humility” come from the same root, the Latin word “humus,” meaning earth or ground. We are not celestial beings. We return to the earth. Ashes to ashes, dust to dust.

”No one can escape the dark side of life,” writes Johnson. ”The balance of dark and light is ultimately possible—and bearable” (1991: 15).

Let's dance 
At the end of Hi Ren, this remarkable young man puts the guitar down, looks right into the camera and delivers a powerful soliloquy.

“It wasn't David versus Goliath,” he says, “it was a pendulum eternally swaying from the dark to the light. And the more intensely that the light shone, the darker the shadow it cast.
​
“It was never really a battle for me to win, it was an eternal dance, and like a dance, the more rigid I became, the harder it got. The more I cursed my clumsy footsteps, the more I struggled. And so I got older and I learned to relax, and I learned to soften, and that dance got easier. It is this eternal dance that separates human beings from angels, from demons, from gods. And I must not forget, we must not forget, that we are human beings.”

BE A MAN

Help is a four-letter word: men and suicide

News comes this week that the suicide rate for middle-age men with mental health issues has risen by 73 percent since 2006. “The problem is not simply that they don’t seek help – they are already under mental health care – so we have to understand better the stresses men in this age group face,” says Louis Appleby, formerly the government’s mental health tsar and who leads the national suicide prevention strategy.

This is in keeping with a general significant rise in male suicide over the past decade—although curiously not in Scotland, which has seen a decline—while the incidence for women has remained constant. The male suicide rate is the highest since 2001. The suicide rate among men aged 45-59, 25.1 per 100,000, is the highest for this group since 1981.

So the question is why? There are plenty of economic reasons: the recession, falling income, “zero-hour” contracting, debt, unemployment.

But there is another reason. Judging by the way he tends to be represented in our culture, a “real man” is supposed to be: strong, logical, heterosexual, attractive, virile, successful, young, deep, powerful, wealthy, rugged, hard, active, white, decisive, potent, funny, brave, knowledgeable, determined, ambitious, autonomous, rational, unemotional (though anger is desirable in certain circumstances). And under no circumstances is he to ask for directions. Ever.

“Eros” dominates the female psyche, while males are governed by “Logos.” From an early age, little boys learn they must “repudiate all that is soft, vulnerable, playful, maternal and ‘feminine’ ” writes Andrew Samuels.

Many grow up to remain as little boys sequestered in grown-up bodies, destined to labour under the limitations of what Moore and Gillette call “Boy psychology.”

“Boy psychology is everywhere around us, and its marks are easy to see,” they write in King, Warrior, Magician, Lover. “Among them are abusive and violent acting-out behaviors against others, both men and women; passivity and weakness, the inability to act effectively and creatively in one’s own life and to engender life and creativity in others (both men and women).”

Men learn to keep their relationships with other men on a superficial level. Acceptable topics: sports, cars, humour, women (as sex objects); unacceptable ones: sadness, loneliness, confusion, despair, love, joy, beauty, wonder. And men’s relationships with women stereotypically revolve around conquest and control. Writes Meg Barker: “This can mean that they don’t have a close, supportive relationship with anyone.”

To be whole, we must learn to embrace all aspects of our selves, and for men that means the female archetype within, what Jung called the anima, while at the same time not diminishing the strength of our true malehood, which some of the more extreme branches of feminist philosophy would like to completely eradicate or, perhaps we might say, emasculate.

Part of being human is acknowledging your vulnerability, your suffering, your sadness, your despair. Admitting your weakness—and asking for help—paradoxically requires great strength.

The consequences of not doing so are dire: Men are more than three times as likely than women in the U.K. to commit suicide, or be alcohol-dependent. Men are 20 times more likely to be sent to prison.

Increasingly, there seems to be less of a stigma about seeking help. Almost one person in five in the U.K. has consulted a counsellor or psychotherapist. Maybe you’ve considered it but are not sure. Watch this short film written and narrated by Alain de Botton. And try it. Sometimes in life you have to take a risk.

Most of my counselling clients are men. They are all different, but they all want a richer, fuller, more meaningful, more colourful life. They want to love and be loved. It’s not always easy. But they fight for it, every day. I think of each of them as incredibly courageous.

Real men ask for help.
—John Barton

DYING WITH DIGNITY

In America in 2009, there was a proposal for Medicare, the government’s health insurance program for the elderly and the disabled, to provide end-of-life counselling. There was an outcry—Republican vice presidential candidate Sarah Palin for instance screeched about  the spectre of government-sponsored “death panels” deciding when the game was over for hordes of frail and befuddled elders. It became a divisive issue that threatened to derail President Barack Obama's health care law.

This week, Medicare finally announced that it intends after all to proceed with end-of-life counselling. There were only a few murmurs of dissent. If the proposal is accepted, the elderly and their families will be able to have conversations with doctors and nurses in advance about what kind of care and interventions they want as they face the final curtain—and what they don’t want.

Giving people greater control over their death seems like an eminently sensible idea. Just because we have the technology to extend life with with a roomful of machines, tubes and drugs doesn’t always mean that’s the right thing to do, especially when the person involved has clearly expressed their desire not to “live” in this way.

A civilized society should help people to die with dignity. In some countries that means not just withholding excessive though potentally life-saving treatments but actively allowing doctor-administered death, especially when the person is suffering or in great pain from a terminal illness. Switzerland has allowed doctor-assisted suicide since 1942. Voluntary euthanasia—where the doctor actually administers the fatal dose at the patient’s request rather than merely prescribing it or handing it over to the patient—was made legal in the Netherlands in 2002, but only under strict criteria. The patient's request, awareness and level of suffering must be clear and sustained, suitable information and consultation must be provided, there must be absence of reasonable alternatives, doctors must consult with other doctors and they must report euthanasia to a review committee. Belgium followed the Netherlands later in the year, followed by Luxembourg in 2009 and, this year, Canada and Colombia.

The practices of assisted suicide and voluntary euthanasia are both illegal in the U.K., but that may change. According to a 2007 survey, 80 percent of Brits are in favour of giving terminally ill patients the right to die with a doctor's help.

In the U.S., a Supreme Court decision left rulings about assisted suicide to the discretion of individual states. Oregon swiftly passed a law allowing doctors to prescribe lethal drugs for people who have been given less than six months to live. Washington, Montana and Vermont now have similar laws in place.

Opponents of such laws are concerned that they could be abused. A compliant or confused parent for instance might be coerced into literally signing their life away by uncaring offspring who are eager to get their hands on an inheritance as soon as possible.

“I don’t want to be a burden,” the elderly often say.
“Ok, well sign here then,” the heartless son or daughter might reply.

But the problems, the violations, the abuses, do not alter the principle. Just because some people might exceed the speed limit, jump a red light or drive without a license does not mean that all driving should be banned.

We have some choices in how we live. Perhaps an enlightened government can offer some choices in how we die, too.

Medicare plans to pay for end-of-life counseling
From the Boston Globe:

Medicare, the federal program that insures 55 million older and disabled Americans, revealed plans Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.

The proposal will be open for public comment for 60 days, but it is expected to be approved and take effect in January. If adopted, it would settle a debate that raged before the passage of the Affordable Care Act, when Sarah Palin labeled a similar plan as tantamount to setting up “death panels” that could cut off care for the sick.

Medicare’s plan comes as many patients, families, and health providers are pushing to give people greater say about how they die — whether that means trying every possible medical option to stay alive or discontinuing life support for those who do not want to be sustained by ventilators and feeding tubes.

“We think that today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team,” said Dr. Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid, also known as CMS, which administers Medicare. “We think those discussions are an important part of patient- and family-centered care.”


U.K. NEWS

Will George Osborne's budget give our children Hikikomori - Japan's new mental health problem?
Mirror.co.uk:

George Osborne's budget will create a generation of young people too scared to leave their bedrooms and rendered mute by fear of the future, according to a British expert.

They will be suffering from Hikikomori a condition believed to affect as many as ONE MILLION Japanese.

Symptoms include hiding away from society and only interacting with the world to surf the Internet and reading fantasy literature.

The Chancellor's plans to limit the living wage to those aged 25 and older, along with scrapping grants to university students, increasing fees in line with inflation and cancelling housing benefit for 18-21 year olds are all likely to make matters worse.

Hikikomori is a huge problem among Japanese youth and can lead to people locking themselves away from the outside world for months and sometimes years on end.


Children's mental health must be cared for. Or the consequences will be dire
From former minister for mental health Paul Burstow, in The Guardian:
 
The chancellor tells us that he is putting into law the obligation to generate budget surpluses in the “interests of our children”. But the axing of funding for children’s mental health in the service of economic dogma will condemn a generation of young people to a life of misery for want of the right mental health support in their early years.

Half of life-long mental illness has its first signs and symptoms in the teenage years. Poor maternal mental health can have profound consequences for them, for their children and their children’s children. The LSE put a figure on this of £8.1bn.

Yet while one in 10 children and young people has a treatable mental illness just one in four receives treatment. It is a shocking indictment of our mental health services.

• School accountability triggering pupil mental health problems, research warns (The TES)

• Exam focus damaging pupils' mental health, says NUT (BBC News)

 
More provision needed for mothers during pregnancy and after birth
Medical Xpress:
 
More research is needed to improve the identification and treatment of women with perinatal mental health issues, according to a new editorial co-authored by Professor Susan Ayers, the lead of the Centre for Maternal and Child Health Research at City University London.

Along with co-author Judy Shakespeare, from the Royal College of General Practitioners, Professor Ayers' article highlights how between 10 and 20 per cent of women suffer from mental health problems during this period, costing the NHS £1.2 billion a year. The editorial is published in the journal of Primary Health Care Research & Development.

Mental health problems can arise in pregnancy or after birth and most commonly consist of anxiety, depression, post-traumatic stress disorder (PTSD) following a difficult birth and stress-related conditions such as adjustment disorder. Severe postnatal mental illness, such as puerperal psychosis, is less common, but is one of the leading indirect causes of maternal death.

U.S. NEWS

Researchers: Vampires are people, too, and need as much psychotherapy as the rest of us
From the Washington Post:

Vampires are real. No, not the impossibly perfect Cullens in the "Twilight" movies or tortured but well-dressed souls in CW shows. But human beings who self-identify as vampires and may drink blood or sleep in coffins. And these people need as much psychotherapy and medical help as the rest of us.

That's the conclusion of a study by D.J. Williams, director of social work at Idaho State University, and published in the July issue of the peer-reviewed journal Critical Social Work.

Williams and his co-author, Emily E. Prior, a researcher at the College of the Canyons, interviewed 11 vampires from across the United States and South Africa and found that they were reluctant to come out to clinicians because they were fearful about being labeled as being psychopathological or "perhaps wicked, and not competent to perform in typical social roles, such a parenting."

However, he noted that the people he interviewed "seem to function normally, based on demographic questions concerning their psychiatric histories, in their social and occupational roles, and some have achieved considerable success in their chosen careers."


WORLD NEWS

India: counselling reveals anger, helplessness
From The Hindu:

Counselling sessions of the victims of the child prostitution case revealed their anger and helplessness at their precarious plight.

The victims are believed to have told counsellors arranged by the Child Welfare Committee that they were angry with themselves and with those who had pushed them into prostitution.

They reported feeling guilty and disoriented, and having haunting memories and an inability to remain calm according to information from the sessions overseen by the CWC.

Apart from the anxiety about the future, there was also fear about being recognised in public.


VIEWPOINTS

Sex therapy is making its way into couples counseling, and it's about damn time
From Lea Rose Emery, in Bustle:

Some “renegades” in the field of couples therapy are bringing sex into counseling, The New York Times reports. Although couples therapy and sex discussion may seem like obvious bedfellows, discussions of sex have often been, counterintuitively, absent during couples counseling. The reasons for this may be that the two arenas, couples counseling and sexual counseling, developed as completely different strains, meaning that overlap between them was limited. Often relationships counselors often have no sexual training, as there are currently no requirements for sexual education in traditional counseling licensing.  And the opportunities to receive sexual training are limited. According to The New York Times there ”is only one certification program for sex therapists, the American Association of Sexuality Educators and Counselors, which means aspiring sex therapists may find access to courses and supervisors a challenge.” 
But luckily the increased acknowledgement of the importance of sex in relationships may help change this. Some therapists are now “emphasizing the importance of good sex in relationships and sometimes suggesting the radical idea that couples fix the sex before tackling other issues”. This makes me so happy. 

 
Psychiatric drugs are false prophets with big profits. Psychiatry has been hijacked
From Robert Berezin MD, Mad In America:

We have repeated the same mistakes over and over again, and we are doing so today. It doesn’t seem to matter that the chemical imbalance theory has been discredited. It doesn’t seem to matter that the multibillion dollar pharmaceutical industry and its influence peddling in academic psychiatry has been exposed as financially and scientifically corrupted and manipulated. The drug companies have engaged in study suppression, falsification, strategic marketing, and financial incentives. A complete picture of the studies that pretended to validate antidepressants has now emerged which confirms that they do absolutely nothing. (See – “No, it’s not the Neurotransmitters, Depression is not a biological disease cause by an imbalance of serotonin.”) It rakes in a whopping $70 Billion a year for the drug companies. Unfortunately once people embrace a false belief it is so hard to think clearly again. I’m told its irresponsible to be so extreme. A thoughtful psychiatrist would use both drugs and psychotherapy. Apparently this sounds reasonable in today’s climate. Doing harm is never reasonable.
Human struggle is now, and always has been, the real issue. The very idea that drugs can cure what ails is an insult to the human condition.


The magical healing power of caring and hope in psychotherapy
From Allen Frances in the Huffington Post:

There are three consistent research findings that should make a world of difference to therapists and to the people they treat.

First, psychotherapy works at least as well as drugs for most mild to moderate problems and, all things being equal, should be used first.

Second, a good relationship is much more important in promoting good outcome than the specific psychotherapy techniques that are used.

Third, there is a very high placebo response rate for all sorts of milder psychiatric and medical problems.

This is partly a time effect -- people come for help at particularly bad times in there lives and are likely to improve with time even if nothing is done. But placebo response also reflects the magical power of hope and expectation. And the effect is not just psychological -- the body often actually responds to placebo just as it would responded to active medication.

These three findings add up to one crucial conclusion -- the major focus of effective therapy should be to establish a powerfully healing relationship and to inspire hope. Specific techniques help when they enhance the primary focus on the relationship, they hurt when they distract from it.

A sad story last week about the suicide of a British soldier who suffered terrible injuries from a roadside bomb blast in Afghanistan.
     Private Bradley Paul of the 1st Battalion The Mercian Regiment severed an artery in his neck and had multiple bone fractures from the explosion in Helmand Province in November 2012. He was airlifted home and spent more than a year undergoing physical rehabilitation.
     “Through the usual strength of character we all came to love about him and with the love of those around him he made a good recovery,” says the Go Fund Me appeal page set up to raise funds to pay for his funeral.
     But the psychological wounds, less visible than the physical ones, became impossible to live with. On February 17, he was found dead at his home in Timperley. He was 23.
     It had been a “silent struggle” according to Paul’s infantry platoon commander, Captain Chris Middleton. “He was a great character in the platoon. He was one of the guys that the other lads looked up to and respected. He was physically and mentally very strong and he had a very good sense of humour.
     “As the front man of his patrol every day, Brad carried the weight of responsibility for lives of his mates on his shoulders every time he stepped out the gate.”
     The government sends people like Paul off to the dark places of the earth, often for highly questionable purposes. They witness death, destruction, massacres, unspeakable acts of barbarism. They suffer great injuries. They see friends killed right in front of them. They kill.
     Then they’re supposed to come home, keep calm and carry on as normal. Help with the school run, go to the cash and carry, Saturday night at the movies. “As you were, soldier.”
     The return to civilian life can be some kind of nightmare. Everything looks roughly the same, yet everything has changed. You find you can’t go home again. You’re still at war. No one has prepared you for peace. There’s a good chance you’ll end up in prison, or homeless.
     The Armed Forces have presented you with a cruel double bind: your experiences in the military might have damaged you psychologically, but you’ve been trained that you’re supposed to be tough and resilient and self-reliant—someone who doesn’t tolerate vulnerability, let alone ask for help. You’ve been chewed up, spat out, and now left to cope on your own. Thanks a lot for your years of service, your courage, your sacrifices—now go away.

Red alert: Post-Traumatic Stress Disorder
Trauma is an unbearable, horrific fact of life. As with Bradley Paul, the suffering is usually silent, the wounds invisible. And it doesn’t just happen in war zones, far away. “Trauma happens to us, our friends, our families, and our neighbors,” writes Bessel van der Kolk in The Body Keeps Score. “One in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; one in three couples engages in physical violence. A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit.” The statistics for the U.K. aren’t quite the same--1 in 20 British kids have been sexually abused, for example; domestic abuse will affect 1 in 4 women in their lifetime—but still shockingly high.
     Trauma can cause a broad range of distress. There is traumatic stress, there is post-traumatic stress, and then there is full-blown Post-Traumatic Stress Disorder. PTSD is a prolonged reaction to a traumatic event; it can also be triggered many years later. The Diagnostic and Statistical Manual of Mental Disorders (DSM), which has included PTSD since 1980, lists potentially traumatic events as combat, sexual and physical assault, being held hostage or imprisoned, terrorism, torture, natural and man-made disasters, accidents, and receiving a diagnosis of a life-threatening illness. Sometimes, however, events that seem quite small and insignificant to the outside observer can be profoundly traumatic. Most people experiencing a trauma do not develop PTSD—some helpful factors, writes Babette Rothschild in the seminal trauma book The Body Remembers, are: preparation for the expected stressful event, if possible; a successful fight or flight response; good developmental history, belief system, and internal resources; prior experience; and good support from other people.
     PTSD is, like most psychological disorders, highly variable in its presentation of symptoms. But those symptoms are generally horrendous, dangerous and hard to resolve. It’s as if the traumatic event is still happening, right now, with your body responding as it did at the time, on high alert—heart pounding, fast-breathing, adenaline flooding the system. Another common symptom is dissociation—a shutting down; a kind of escape when there is no escape. Common dissociative symptoms include amnesia, fragmentation of identity, and feelings of detachment and unreality about one’s self, body and environment.
     The DSM claims that a complete recovery happens within 3 months in half of PTSD cases, but that “some individuals remain symptomatic for longer than 12 months and sometimes for more than 50 years.” In fact, PTSD requires a lengthy, painstaking spell of support and psychotherapy. It takes time to build the necessary trust, and then time for the delicate process of revisiting the hideous trauma, physically and emotionally re-experiencing it, arriving at some kind of accommodation or resolution—what Peter Levine in Waking the Tiger calls a “renegotiation”—and starting to heal. The story is told and retold, imagined and reimagined. The losses are mourned. The trauma is named, described, spoken out loud. “Without a voice,” writes Kim Etherigton in Trauma, the Body and Transformation, “our body finds other ways to speak for us.”
     Rothschild stresses the importance of “braking and accelerating” during the work with a therapist—the client gently revisits elements of the original event at their own pace, and if things become too overwhelming, one or both of you hit the brakes: slow down, do a breathing or mindfulness exercise, change the subject, stop. The potential for retraumatisation—the very opposite of healing—is great. Much more ammunition is needed to fight the enemy within than some Citalopram and a handful of sessions of CBT.
     It’s particularly difficult work because the clients often feel highly ambivalent about it.  The tendency for veterans is to downplay the problem and not seek help. Counselling is a foreign land for many of those who have served in the Services. How could a counsellor—especially a mere civilian—possibly help? They surely couldn’t even begin to understand what you’ve witnessed, the things you’ve done. What could they know about being in a constant state of super-anxious, hypervigilant high-alert, waiting to attack or be attacked at any moment. The fear of crowds. The rage. The isolation. The sleepless nights, the flashbacks. The urge to escape into drink, drugs, gambling. Or dissociation: the memory loss, the blackouts, those disturbing episodes where you find yourself in another town, miles from home, with no recollection of how you got there, or why. The powerful undertow of suicidal thoughts.
     In her research on veterans’ experiences of psychological therapy, Camilla Stack concludes: “Practitioners working with ex-military clients should gain an understanding of military society and culture and appreciate its lasting influence, particularly in terms of power dynamics. They should be sensitive to significant cultural differences between the military and civilian worlds, and watchful for the concomitant risks of misunderstanding and judgment.”

The politics of trauma
The U.K.’s the Ministry of Defence (which has had its moments as the Ministry of Attack) has been reluctant to recognise PTSD, because it doesn’t want to pay for treatments or damages or otherwise be held responsible.
    “It suits the MoD to minimise the numbers in order to reduce the extent of liability,” Tony Gauvain told The Guardian. He is a retired colonel, psychotherapist and chairman of the charity PTSD Resolution. (Another charity, founded 95 years ago, is Combat Stress , which provides specialist clinical treatment and welfare support to UK veterans suffering from a range of psychological injuries like PTSD.) “But given the numbers of people suffering symptoms now, and the latency of the condition likely to result in increasing numbers, there would seem to be a determination to avoid admitting there is a problem.”
     How many deeply traumatised people, victims of domestic abuse, rape, violence, torture, organised crime, terrorism, wars—the old kind and the new, more insidious kind—are walking on the earth today, right now, in pain, having received no treatment at all? Very many. Trauma work, writes Judith Herman in Trauma and Recovery, is political because the sufferers are generally the oppressed, and the oppressed usually have no voice. The truth does not come out. There is no reconciliation. Human wrongs are not righted.
     “Moral neutrality in the conflict between victim and perpetrator is not an option,” writes Herman. “Like all other bystanders, therapists are sometimes forced to take sides. Those who stand with the victim will inevitably have to face the perpetrator’s unmasked fury. For many of us, there can be no greater honor.”

The most famous, most iconic tortured artist—the original—is Vincent van Gogh. Today, he would probably be diagnosed as bipolar, or possibly schizophrenic. He had psychotic episodes, he was sectioned, and he allegedly cut off part of his ear (though some believe Gauguin was the slasher). Van Gogh spent his final year in an asylum. He committed suicide. His paintings seem to telegraph his inner turmoil. The stars on the canvas burn too brightly. Each brushstroke appears laden with madness.
      Does a true artist have to be a tortured genius? Must there be some psychological crossed wiring, some gaping brain lesions, or a too-hot neurotransmission system to allow such acute sensitivities to the outer world and the inner world of the imagination? Or is the torture the effect of heightened creativity rather than the cause—does it all take its toll? Do creators see and feel too much? Is art a gift—or a curse, consigning the artist to drown in angst and absinthe in a lonely garret? Is art only good if its creator suffered?
     On her Brain Pickings site, Maria Popova writes on the relationship between creativity and mental illness, quoting extensively from the book The Creating Brain: The Neuroscience of Genius by Nancy Andreasen, which casts a forensic eye over such evidence as Van Gogh’s letters or Sylvia Plath’s journals or Leo Tolstoy’s diary of depression or Virginia Woolf’s suicide note. In a study of the Iowa Writers Workshop, Andreasen found the majority of the writers “described significant histories of mood disorder that met diagnostic criteria for either bipolar illness or unipolar depression.” She concluded that psychological distress is indeed allied to creative genius (but to be successful it must be overcome). And that creative people are in fact different, superior beings. She writes: “Although many writers had had periods of significant depression, mania, or hypomania, they were consistently appealing, entertaining, and interesting people. They had led interesting lives, and they enjoyed telling me about them as much as I enjoyed hearing about them.”
     I don't agree on either count. Creativity is not some kind of special neurosis bestowed on the chosen few. It is instead like love—a good, healthy and universal part of being human. Anyone can access that incandescent, transcendant energy that can fuel our waking moments—and lots of our sleeping moments, too. You don’t need to be a genius—nor class A drugs—to see with kaleidoscope eyes.
     “No matter what your age or your life path, whether making art is your career or your hobby or your dream, it is not too late or too egotistical or too selfish or too silly to work on your creativity,” writes Julia Cameron in The Artist’s Way, which argues that accessing creativity is akin to a spiritual awakening—anyone can plug into some kind of cosmic or divine grid of “spiritual electricity.”
     For Betty Edwards, author of Drawing on the Right Side of the Brain, becoming creative is simply learning how to see. “You may feel that you are seeing things just fine and that it’s the drawing that is hard. But the opposite is true ... By learning to draw you will learn to see differently and, as the artist Rodin lyrically states, to become a confidant of the natural world, to awaken your eye to the lovely language of forms.”
      There are plenty of sane, ordinary, even rather boring people who are also highly creative artists, writers and poets. (Conversely there are also plenty of people who suffer who don’t create anything.) Years ago, one example of a seemingly untortured artist, the novelist Kurt Vonnegut, told a packed auditorium that every person in the room probably had the imagination to write a serviceable novel. The only difference, Vonnegut said, is motivation: very, very few actually do it. (Probably just as well—the world hardly needs more mediocre novels.) So why do those that create do what they do? Why does anyone spend months or years labouring over many thousands of words that almost certainly will never have an audience? Where does the motivation come from?
     It is here that a little bit of madness can give us a push. It’s possible that being a little unhinged or conflicted, with a slightly cracked heart, can provide a call to create, to search for meaning, to try to make sense of it all. Freud regarded art as another “royal road to a knowledge of the unconscious activities of the mind,” like dreams. Creative pursuits can be enormously therapeutic for dissatisfied, distressed or damaged souls. It is an outlet, a form of expression for those without a voice. And there have also been studies linking creativity with bipolar-type people, the intense exhilaration of manic highs perhaps providing not only the raw materials to build a palace in the sky but also the energy to put it all together.

Three days after Christmas, at 2.30 in the morning, 17-year-old Leelah Alcorn was walking along Interstate 71, a few miles from her home in Ohio. She stepped out onto the tarmac, was hit by a truck, and killed.
     She had arranged for her suicide note to be posted on her Tumblr account that evening. “I’m never going to be happy with the way I look or sound,” the note said. “I'm never going to have enough friends to satisfy me. I'm never going to have enough love to satisfy me.” Alcorn described in the note how she had felt “like a girl trapped in a boy's body” since the age of four, and at 14 came to identify herself as a transgender female, when she discovered, to her immense joy, that such people existed, and she was not alone.
      In the aftermath of Alcorn’s death, a lot of criticism was levelled at her parents, described as conservative Christians who could not accept their little boy’s sexuality and desire to be a girl. It's understandable that such a scenario would be difficult, potentially devastating, for any parent. But Alcorn's parents responded to her coming by taking her out of school and enrolling her instead in an online academy, cutting off all her access to social media, and taking away her phone.
      The note continued: “Either I live the rest of my life as a lonely man who wishes he were a woman or I live my life as a lonelier woman who hates herself. There's no winning. There's no way out.”
      The suicide note went viral—until the family asked for it to be removed from social media a few days later. It inspired vigils for Alcorn in cities across America and internationally, too, including in Trafalgar Square last month. It sparked a general raising of consciousness of the plight of transgendered people the world over.
     The facts:
• Although the word “transgender” wasn’t invented until 1971, transgenderism is not some contemporary fad—it’s as old as humanity. Elagabalus, Roman Emperor from 218 to 222, was said to be transgendered, and in ancient civilisations, “two-spirit” people were often called on to perform religious or cultural ceremonies;
• An estimated 2 to 5 percent of the population experience some degree of gender dysphoria;
• About 1 in 12,000 males and 1 in 34,000 females undergo gender reassignment;
• 90 percent of transgendered adults have experienced discrimination at work;
• 50 percent have been raped or assaulted by a partner;
• 41 percent have attempted suicide;
• 20 percent are homeless;
• Trans women have a 1 in 12 chance of being murdered—or 1 in 8 for trans women of colour.

Dire straits
One of Alcorn’s despairing parents’ strategies to make their child “normal” was to send her for “conversion therapy,” which claims to be able to change a person’s sexual orientation.
     This kind of thing was quite common back in the day, when techniques included hypnosis, testicular transplants, electric shocks to the genitals, masturbatory reconditioning, spiritual damnation, and prayer. It was as effective then as it is today, which is to say not at all. It’s a practice that’s fuelled by a certain kind of religious fundamentalism and has been derided as a ridiculous and doomed attempt to “pray the gay away.” A consensus has finally emerged that homosexuality is not some kind of aberrant pathology, an abnormality in need of a cure, though this took a long time: It was only removed from the Diagnostic and Statistical Manual of Mental Disorders as recently 1973, and even made a brief reappearance—“ego-dystonic homosexuality”—in 1980.
     Says the American Psychological Association: “The idea that homosexuality is a mental disorder or that the emergence of same-sex attraction and orientation among some adolescents is in any way abnormal or mentally unhealthy has no support among any mainstream health and mental health professional organizations ... efforts to change sexual orientation through therapy have been adopted by some political and religious organizations and aggressively promoted to the public. However, such efforts have serious potential to harm young people because they present the view that the sexual orientation of lesbian, gay and bisexual youth is a mental illness or disorder, and they often frame the inability to change one’s sexual orientation as a personal and moral failure.”
      Conversion therapy is already illegal in New Jersey and California; attempts to ban it in other states—Virginia, Illinois, Maryland, Minnesota, New York, Washington, Ohio, Florida, Wisconsin, Hawaii and Rhode Island—have thus far been voted down or withdrawn. Oklahoma has recently been vying to position itself as the nation’s most homophobic state by proposing a law that would protect the right of its citizens to waste their money on attempting to force their children to stop being gay.
     Even China is more enlightened: a court in Beijing recently ordered a private counselling center in Chongqing to apologise and pay compensation to a 30-year-old man for providing him with “gay cure” treatment, and ordered all ads for similar services to be removed from Baidu, China’s equivalent of Google.
     In the U.K., an alarming 2009 study found that out of 1,328 therapists surveyed, 222 (17 percent) had attempted to change the sexual orientation of at least one client, and 55 of them would continue to do so. The issue received much greater attention with the case of Leslie Pilkington, a Christian counsellor who attempted to “cure” undercover journalist Patrick Strudwick; in 2012 she was struck off the register of her professional body, the British Association for Counselling and Psychotherapy. The following year, health minister Norman Lamb called conversion therapy “abhorrent,” something that has “no place in a modern society,” but said there were no plans for a ban.
      Last month, NHS England and more than a dozen leading organisatons released a memorandum of understanding on conversion therapy. Guidelines will be published—GPs are not to refer patients for conversion therapy and no-one employed by the NHS can provide it. And just this month, a consensus statement was released, a unanimous condemnation of thee practice from all the leading counselling, psychotherapy and psychology bodies. Lord Black, the Executive Director of the Telegraph Media Group, has campaigned for a ban, and a 2013 motion calling for a government ban on conversion therapy for under-18s was signed by 55 MPs.
      Some more stuff:
• Stephen Fry meets the founder of the National Association for Research & Therapy of Homosexuality, Dr. Joseph Nicolosis: click here.
• “Pray the gay away—exposed”: Amusing sex education vlogger Laci Green speaks out: “Gender and sexual orientation exist on a broad spectrum,” she says. “There’s no normal. There’s only more common. Failure to accept this simple fact has serious consequences”: click here.
• Some experiences of conversion therapy in the U.K.: “It’s really sad I spent three years of my life trying to do something that was impossible”: click here and click here.
 
Fix society
Leelah Alcorn’s suicide note ended: “My death needs to mean something. My death needs to be counted in the number of transgender people who commit suicide this year. I want someone to look at that number and say ‘that's fucked up’ and fix it. Fix society. Please.”
     Alcorn’s story does mean something. So do recent stories like the gender reassignment of Olympic gold medal decathlete Bruce Jenner, and former boxing promoter Frank Moloney, and the stories of famous trans people like Chaz Bono, Eddie Izzard, Danny La Rue, Chelsea Manning, Jan Morris and Grayson Perry—to name just a very few.
     On January 20, 2015, Barack Obama became the first American President to mention transgender people in the State of the Union Address: “Condemn the persecution of women, or religious minorities, or people who are lesbian, gay, bisexual, or transgender.”
     If you or someone you know might need help with transgender issues, there is now plenty of good information online, starting with the NHS, the American Psychological Association; for further information, here’s a list of useful resources.
     As for conversion therapy, a change.org petition to ban it in America—called “Leelah’s Law”—now has more than 340,000 signatures; another White House petition received more than 100,000 signatures in January, meaning President Barack Obama’s administration must formally respond to the request. The #BornPerfect campaign took their case to the United Nations Committee Against Torture. One way or another, conversion therapy seems to be inexorably heading for retirement in the therapeutic curio cabinet, along with skull drilling, lobotomies, leeches, and various treatments for “female hysteria.”
     Therapy (and life) isn’t about trying to make yourself become someone you’re fundamentally not. It’s not about trying to change other people, either. Better to be who you are—and let other people be who they are, too, as opposed to who you think they should be. Whether we’re part of the mainstream or we live more towards the margins of one bell curve or another, we all want acceptance and freedom. We all want to live in a fair, inclusive and peaceful society rather than a prejudiced, oppressive and violent one. A society that doesn’t condemn some of its teenagers, consigning them to life and death on a very lonely highway.

Despair goes digital
Therapy is 50 minutes spent sitting (or lieing) in a sombre room talking to a mysterious chin-stroking professional. Right? No! Sometimes therapy does actually manage to break out of the consulting room. There is counselling at home, in schools and in workplaces. There are drop-in counselling centres, counselling cafes near and far, therapy in taxi cabs, sidewalk psychotherapists. And then of course most counselling takes place quite naturally, for free, in the community, from family, friends, colleagues, spiritual leaders—or strangers in the checkout queue.
     Increasingly, too, technology is providing new, alternative forms of help. You don’t have to call the Samaritans—these days you can email or text if you’d prefer. There are some really good online resources including websites offering self-administered help. There are mental health apps. And there is social media—a global audience of fellow travellers to support and be supported by.
    Two stories from this week:

• #timetotalk: Is social media helping people talk about mental health?
More people than ever before are talking about mental health online.
Whether through blogs, videos or tweets, candid conversations about mental illness can be found across the spectrum of social networks we interact with on day-to-day basis. According to a survey by Time to Change, released for Time to Talk Day, 47% of people aged 21 and under said they find it easiest to talk about their mental health problems online (compared with 49% who said face to face and 4% who said over the phone).
Mental health charities have long known the benefits of social media. Mind has its own social network called Elefriends, Time to Change regularly hosts blogs on its site and, just last week, a new platform for videos on mental health called It Gets Brighter was launched. (The Guardian)

• R U There? A new counselling service harnesses the power of the text message
Depression is common among teens, and its consequences are volatile: suicide is the third leading cause of death for Americans between the ages of ten and twenty-four. In that same age group, the use of text messaging is near-universal. The average adolescent sends almost two thousand text messages a month. They contact their friends more by text than by phone or e-mail or instant-message or even face-to-face conversations. (The New Yorker)

Other stories
• Suicide in America
Over 40,000 Americans took their own lives in 2012—more than died in car crashes—says the American Association of Suicidology. Mondays in May see the most incidents. The rates are highest in Wyoming and Montana, perhaps because guns—which are more effective than pills—are so common there (see chart). Nationally, guns are used in half of all successful suicides . . . Making it slightly harder to kill yourself is also surprisingly effective. American pharmacists still sell painkillers loose in pots, enabling people to pour the whole lot down their throats in one movement. This is unwise. After Britain switched to blister packs in 1998, which require you to punch pills out one by one, deaths from overdoses of paracetamol (the active ingredient in Tylenol) dropped 44% in 11 years. (The Economist)

• Corrie star “abandoned by friends over mental health”
Coronation Street star Beverley Callard has revealed how friends distanced themselves and 'abandoned' her after learning of her battle with depression.
The actress, who plays Liz McDonald on the ITV soap, said people battling mental illness should be encouraged to share their fears with those close to them.
The 57-year-old, who has fought depression and attempted suicide in the past, told BBC Radio Manchester it was easy for sufferers to feel isolated and alone. 
‘I had one person say to me, and we'd been friends for a long time, "I don't think we should see each for a while because you're not yourself and you're not good for me",' she said.
'We actually got way beyond that, but at that time I felt abandoned by lots of people - and I think many people do.'
Beverley said she believes the stigma attached to mental health issues can prevent people discussing their problems with family and friends.
She said: 'We say to someone "how are you?" but more often than not we actually don't wait for the answer.
'If you just get the feeling that someone you know is suffering is sad say, "how are you? Do you want to talk about it?" (Daily Mail)

• “Meaning-Centered” group therapy beneficial in advanced cancer
Meaning-centered group psychotherapy (MCGP) is effective for reducing psychological distress and improving spiritual well-being in patients with advanced cancer, according to a study published online Feb. 2 in the Journal of Clinical Oncology.
William Breitbart, M.D., from the Memorial Sloan-Kettering Cancer Center in New York City, and colleagues examined the efficacy of MCGP to reduce psychological distress and improve spiritual well-being among 253 patients with advanced cancer. Participants were randomized to manualized eight-session interventions of MCGP or supportive group psychotherapy (SGP). Patients were assessed for spiritual well-being and overall quality of life as well as secondary outcome measures before and after completing treatment and at two months after treatment. (Doctors Lounge)

• Bicycles aid counselors at Kakuma refugee camp
Kakuma refugee camp hosts more than 170,000 refugees from about 12 African countries, with the largest populations having fled Somalia, South Sudan and Sudan to avert violence and famine. Jesuit Refugee Service has provided services in Kakuma since 1994, and is currently the only organization in the camp that provides psychosocial support.  
Jesuit Refugee Service Eastern Africa provides individual and group counseling, runs a specialized facility for the protection of women and children suffering from sexual and gender based violence (SGBV) and implements a mental health program that provides education and life skills for refugees with learning disabilities.
As part of JRS psychosocial services in Kakuma, 540 refugees serve as peer counselors for more than 2,000 fellow refugees. In addition to the direct service provided those being counseled, the peer counseling program also serves as leadership development for counselors as they strive to improve their own community. This is in line with our mission of accompaniment, working with instead of for refugees, empowering them to lead their own communities, transforming their own realities. 
Despite efforts of peer counselors, one of the biggest issues they face, especially women, is lack of safety when traveling to and from the counseling site in the sprawling refugee camp. Peer counselors, many female, walk long distances through what is essentially a large town to reach refugee families needing psychosocial care. Bicycles allow counselors to travel more quickly and safely around Kakuma and to reach many more families. (Jesuit Refugee Service)

• Mental health in Lebanon
 “There is tremendous need for mental health services in Lebanon. What’s changing is that people are more open to receiving psychiatric care,” says LAU’s new head of psychiatry, Dr. Elias Rizkallah Abou Jaoude, who is helping set up the School of Medicine’s new psychiatry service and residency program . . .
What is somewhat unique to Lebanon, however, says Abou Jaoude, is medication addiction and post traumatic stress disorder (PTSD) “because of the ease with which people can buy medication without prescription and the endless traumas that people in this population are subjected to.” (Lebanese American University)

How was your week? Did you survive “Blue Monday”? The third Monday of January has supposedly been “scientifically” proved to be the most depressing day of the year. The warm glow of Christmas (another myth) is now a distant memory, the credit card bills have arrived, your New Year’s resolutions have already all fallen by the wayside. You’ve lost your mojo. There’s nothing on TV. It’s raining.
     The Blue Monday equation has been thoroughly debunked. Not everyone suffers from “Seasonal Affective Disorder.” Not everyone despises grey days, wind and rain, despite the TV weather forecasters’ habitual insistence on deciding for us what constitutes “good” weather and what we are to accept is irrevocably “bad.” Not everyone wants to live on the Costa del Sol, or San Diego, where you feel like people could do with a little rain in their lives.
     There is some evidence that springtime/early summer is actually a much sadder time of year. This is when suicide rates tend to peak. If you’re feeling empty or desperate or dead inside, it can be painful indeed to see the world come alive again, with fields and foliage (and people) emerging from hibernation and suddenly blossoming into ripe fullness. The noonday sun can be too bright, too exposing.
     In “Tulips,” Sylvia Plath wrote of the calm, wintry peace of her hospital bed being ruined by the arrival of a bunch of flowers from a well-meaning visitor. The tulips are “too excitable”; they suck the life from the room (and her):

India: world leader in suicide
About 800,000 people commit suicide worldwide every year, of which 135,000 (17%) were in India in 2010, though Indian suicide rates are likely grossly underreported—one study put the figure at 187,000; another report claims 258,075 people committed suicide in India in 2012, more than any other country in the world (though to be fair, only China has a greater population). Poisoning (33%), hanging (31%) and self-immolation (9%) were the primary methods used to commit suicide in 2010. Unlike in the West, the majority of suicides in India are committed by young adults—the under-30s—with two-thirds being male. “Family problems” and “illness” are the leading causes but as with any developing country, the high suicide rate in India can be partly understood as being the result of socioeconomic deprivation. More than 11% of all suicides in India are committed by farmers, many of whom are struggling financially.
     Mental distress can of course pay a visit upon the affluent, the seeemingly-privileged, too. In their 2009 book The Spirit Level: Why Equality is Better for Everyone, authors Richard Wilkinson and Kate Pickett demonstrate that the more unequal a society, the greater the health and social problems—poorer health (and mental health), more obesity, larger prison populations, more teenage pregnancies, lower levels of literacy, and so on. “Inequality seems to make countries socially dysfunctional across a wide range of outcomes," they conclude. And these societal ills in unequal states are not concentrated just among the poor but are significant across the board. The Scandinavian countries and Japan tend to do well; the U.S. (and the more unequal U.S. states), the U.K. and Portugal fare poorly. India's extremes of inequality are notorious—only a dozen years ago economist and philosopher Amartya Sen wrote that two-thirds of Indian women and a third of Indian men could not read or write—and are most vividly apparent in its cities, like Mumbai, where beggars, businessmen, paupers and princes are thrown together in close quarters, where gleaming glass-and-steel offices and hotels rise up above the shanty towns at their feet--more than half of this wealthy city's 14 million people are slum-dwellers. No wonder many find living in such circumstances too hard to bear. And mental health service provision in India is woeful according to a a recent Human Rights Watch report, "Treated worse than animals."
     Yet curiously, suicide was the only social marker Wilkinson and Pickett found which was worse in more equal countries. They partly attribute this to the idea that in more collectively-minded societies, you might be more inclined to blame yourself when things go wrong rather than The System or other people or the world in general—the book notes that suicide is often inversely proportional to homicide.
     Regardless, suicidal ideation can be indiscriminate, as shown by wealthy, talented stars like Philip Seymour Hoffman and Robin Williams, who both took their own lives this year, In August, The Guardian's Dean Burnett wrote a blog post about the suicide of Williams, specifically addressing those who describe such an act as “selfish" (or “cowardly” or “taking the easy away out"). That it is none of these things should be obvious, but the post hit a nerve, and has been shared more than 432,000 times. “A brilliant but tortured individual has taken his own life, and this is a tragedy," wrote Burnett. “But levelling ignorant accusations of selfishness certainly won’t prevent this from happening again. People should never be made to feel worse for suffering from something beyond their control."
     Suicidal thoughts can plague a broke farmer in Kerala, a bereft celebrity in Hollywood, or anyone in between. They can come to a relative, a friend, a colleague, a neighbour. They can come to you and to me. Anyone with suicidal feelings needs support, reassurance, care and contact—not condemnation and incarceration. With the legal change in India and the generally compassionate response to Williams' death, maybe, by small turns, the world becomes just a little kinder.

• If you are feeling suicidal, or if you know someone who is, please:
—talk to someone: a family member, friend, colleague and your GP:
—call the Samaritans: tel: 08457-90-90-90: www.samaritans.org;
—go to the section on suicidal feelings at Mind's website to understand more about what might be going on with you, causes and ways of coping;
—click on my Help page and find access to other immediate support.

• Short-term counselling ‘could reduce repeat suicide rates by 26 percent’
A new study led by researchers from the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, suggests that short-term psychosocial counseling could significantly reduce rates of suicide attempts and deaths among individuals who have already tried to take their own lives. (Medical News Today)

• Nurses warn of cuts in mental health services causing strain
Staff cuts and bed shortages are leaving mental health services “under unprecedented strain” says the nurses’ union. The Royal College of Nursing says there are now 3,300 fewer posts in mental health nursing, and 1,500 fewer beds, than in 2010. At the same time demand has increased by 30%, the RCN said. A Department of Health spokesman said mental health was a “priority” for the government. (BBC News)

• Clegg to establish cross-government taskforce for mental health services
Nick Clegg will on Monday pledge to take mental health out of the shadows and to end “outdated attitudes” by establishing a cross-government taskforce to improve services across the country . . . the deputy prime minister will say that more needs to be done to target help at the young after figures showed that three children in every classroom have diagnosable mental heath conditions. He will say that only a quarter of people with a common mental health problem receive treatment while 90% of prisoners have at least one mental health disorder. (The Guardian)

• Pulling together to extend the lives of people with serious mental illness
Each year, 12,000 people with serious mental illnesses, such as schizophrenia or bipolar disorder, die prematurely from heart disease – on average 20 years earlier than the general population, which gives them a similar life expectancy to the 1950s. In addition, 18,000 people with common mental health problems such as anxiety and depression will also die early. This connection between physical health and mental health was noted in the British Medical Journal as long as 60 years ago. Yet only last year the Mental Health Foundation reported that NHS physical health and mental health care were largely disconnected, and that, though integration was supported in principle, it was not delivered in practice. (The Guardian)

• Human rights abuses leave a third of Libyans with mental health problems
“Widespread and gross” human rights violations in Libya, including disappearances, arrests, torture and deaths, have left nearly a third of the population suffering from mental health problems as violence and lawlessness continues, according to a new report . . . Research by Dignity – the Danish Institute against Torture – shared with the Guardian, paints a devastating picture of the human consequences of the regionalism, tribalism and factionalism that have wracked the north African country since the overthrow of Muammar Gaddafi three-and-a-half years ago. (The Guardian)

• Canada: men's psychological wellbeing in the workplace—addressing an unmet need
Mental health problems in the workplace are a growing public health concern, costing Canadian companies $20 billion annually. Researchers know that women are twice as likely to suffer depression than men — but that does not mean men are immune to depression. A new Canada-wide research project, led by the University of Calgary, is the first to specifically target men in the workplace to address their attitudes towards e-health solutions for mental health. (ucalgary.ca)

• Psychiatrist to the Taliban tells all
Afghan psychiatrist Nader Alemi spent many years counselling militants struggling with the effects of war. He was even summoned to see the second-in-command to the group’s spiritual leader, Dr Alemi told the BBC World Service’s Outlook radio show.
     Mullah Akhtar was hearing voices and screaming in his sleep, suffering from delusions and not recognising those around him.
     “This man had been on the front line for goodness knows how long, and seen goodness knows how many people killed in front of him,” said Dr Alemi.
      “All those explosions and screams may still have been echoing in his head, even sitting in the comfort of his office.”
     Others would visit Dr Alemi for depression or anxiety, and he would offer them counselling or medicine to ease their symptoms. (NEWS.com.au)

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