Mental health notes 

The statistics capture a grim situation - there is a death due to suicide every 40 seconds. There will be a couple of families permanently affected by the time you're done reading this page.

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• Mental pain aka 'Psychache' manifests across a spectrum for people suffering from mental illnesses and keeps advancing on the spectrum if left untreated over the longer term. In its extreme form, it could even push the sufferer to suicide.

• Psychache is as real as physical pain. Infact, mental illnesses could be described as physical ailment affecting the mind, brain and body. Most of us have only had a glimpse of psychache - say when you had to suddenly brake your vehicle or when you're tensed - heart racing, sweating, feeling out of control, anxiety etc. The stark difference plays out for people with mental health issues when such life's normal situations aggravate to abnormal levels in their imagination and they feel a loss of self-control.

• The psychache for a person with mental illness is typically triggered when they are alone and unoccupied. Also, they may misconstrue the physical sensations as heart attack etc. and be unable to explain the psychache and its physical manifestation.

• Just because a person is outwardly 'normal' or looks happy, it cannot be assumed that the person cannot suffer from mental illness. For a person to be mentally ill, they do not have to speak gibberish, run on roads with torn clothes, or have convulsions lying on the floor. Infact, they could be highly functional individuals with high intelligence, creativity and outward appearance of being happy most of the time.

• Almost 90% of people who commit suicide have some kind of prior mental illness. Suicide is a completion event of a mental illness that has not been addressed or controlled. The day of the suicide are the last few drops which has led to the cup overflowing metaphorically, even though we tend to naturally fixate on the events of the last day.

• It is a common understanding that Depression and other mood disorders are the number-one risk factor for suicide, but alcohol and drug abuse – even without depression – are a close second.

• There is a lot of misplaced shame and stigma associated with mental illnesses and suicide. Common stereotypes about a person dying by suicide are emotional weakness, attention-seeking, selfishness, malingering, immorality, and betrayal of family and friends. For the surviving family members (especially spouses) and close friends, there is an imagined and sometimes real perception of an accusatory undertone from people at large that the suicide victims were indeed depressed due to the doing/ undoing of their near and dear ones. None of the these stereotypes reflect the true picture. Mental illnesses and suicide are as un-willful and involuntary afflictions as Cancer, Heart Attack, Brain Stroke etc., period!

• The family and friends who are left behind grieving after their loved ones take their own life, complain of the immense pain inflicted by a person who has died by suicide. But if it is extrapolated further, none of them are in as much pain and/ or their fight or flight mechanism is operating so as to not give up their own life. Therefore, this should give an indication about the depth of pain and the level of breakdown in mental faculties, the person from mental illness was suffering which prompted them towards such an extreme step.                 

• Mental illnesses could afflict anyone. It could be you or your loved one too and therefore, there is no need to stigmatize such dire conditions or any consequence resulting from such disclosure at the workplace or otherwise. There may be few dimwits who may misuse this information or such kindness from the workplace, but such effort is still worth the precious lives which could be saved.

• One should not try to solve mental illnesses with common sense or positivity or home-based treatment. There is a reason that the facilities for clinical diagnosis exist and its best to seek professional medical help immediately. As you keep delaying diagnosis and medical treatment due to your inherent fear of stigma, ignorance, medical quacks, positivity, uncertainty, unknown outcome, the concept of fate, etc., the illness keeps increasing, the medical treatment becomes long drawn and chances of treatment not working and/ or adverse event increases.
• I wonder now why we only had 'Physical Education' and not Physical and Mental Education' during our schooling.
• As I've come to understand, anxiety and depression are almost polar opposites i.e. anxiety is worry about the future whereas depression is due to distressing experiences or events in the past. But both could feed into each other and ruin the present.
• People who suffer from such mental health problems are seldom able to articulate in words for other people (who may have no clue about mental health issues) to make sense of how they feel and their symptoms. Also, the experience per se is many a time lost in their telling. Most of the time, such people even if they are able to recall the traumatic experience, tend to logically deduce that a traumatic event which happened years ago, cannot have anything to do with current symptoms. 

• If you remove all the medical terminology like OCD, Bipolar, Depression etc. and try to generalize for the purpose of layman understanding, most cases of mental illnesses boils down to childhood mental trauma (like physical, sexual, neglect, abandonment issues etc. converting finally to mental trauma). Ofcourse, there could be situations where the capture of mental trauma could happen at a later stage of life too. 

• It is important to differentiate the origin of anxiety experience for arriving at a medical prognosis and determining the treatment options - whether Cortex-based or Amygdala-based. One way to identify the origin is by recalling what was actually happening just before the anxiety episode. If you were focusing on specific thoughts or images, then it is likely to be cortex-based. Whereas if a particular object, location, or situation suddenly elicits an involuntary anxiety experience, it is more likely to be amygdala-based. Cognitive Behavior Therapy (CBT) is considered to be quite effective for treating Cortex-based anxiety. For amygdala-based, exposure therapy through the flooding technique is considered to be more effective. 

• It is imperative to take care of the mind through meditation, brain through medications (if circumstances warrant) and body through yoga or other physical activities. All the benefits from these activities, feed into each other and thereby provide an overall sense of well-being. 

• The treatment usually requires a good therapist who can create a safe space for you, REALLY listen to you in a non-judgmental way releasing the frozen mental trauma from your body, and encourage you gradually towards recovery.

• Still trying to learn the concept of 'Acceptance' of life happenings and events, as is. I won't deny that on most days in the past few weeks, I have thoughts revisiting me of why I couldn't see it coming, why my wife couldn't share her pain with me, why I didn't make more efforts to understand her pain, why our love wasn't enough, why did she let go when everything was going on so well for us etc. What helped was - understanding medically what happened, reading books and watching videos on overcoming grief, thinking about how I could honor her (for e.g. this website), memorialize her, how could I support people in similar pain.
• As a part of trying to find my peace, I've reflected deeply and extensively on the reasons that may have prompted my wife towards such an extreme step, but the answers only come in the form of scenarios which have varied probabilities of being correct. It might sound inane, but a highly probable scenario could be that her early trauma remained inside her without release and it used to surface and aggravate her negative feelings whenever she was tensed (undiagnosed OCD). To the point of suicidal ideation due to cognitive fusion i.e. confusing negative thoughts with reality. But what I feel about the last day is - either a ferocious anxiety attack due to relapse of Pica behavior or she tried to fight the compulsion of Pica behavior, which used to calm her mind earlier.   
• I heard an interview of Gabor Mate, an acclaimed author with a medical background, who seemed spot on about common personality patterns in patients with chronic illnesses (like autoimmune diseases): .I) automatic concern for the emotional needs of others by suppressing your own; II) A rigid identification with duty, role and responsibility; III) Repression of healthy anger ie just being able to say - Stop!! you're in my space. Get out! But nice people who never get angry don't express this and are trampled upon due to not stressing their boundary; IV) Have two potentially fatal beliefs: a) you are responsible for how other people feel; b) you must never disappoint other people   
• Another interview quip - if the people suffering from anxiety/ depression weren't loved for who they are, they're going work hard to be liked - to please everybody - never say no, take everything on, have the above two fatal beliefs. Everyone's gonna like them but nobody is going to love them because they don't know the real you. Added to these are the social pressures like dressing or being like everybody else. Abiding by all of this gets you depressed because the pain of not being yourself is too much. Well, how do you get back to yourself - the good news is that the self that you abandoned, never went away and is still inside you. It is talking to you through your emotions and your body. And at some point you've a decision to make - as a child I had no choice, when there was a conflict between attachment and love, I had to choose attachment. But as an adult, I don't have to anymore. And if I'm authentic I may lose some of my attachments, some people who liked me before won't like me anymore. But who would you rather have in your life - them or yourself? 
• What happens after suicide and the coping strategies for suicide survivors: 

i) Three important questions that might trouble you in the immediate aftermath (assuming no additional pain and trouble with laws) and their answers are: 

      a) What will happen in the future? - Only let your mind think about the next ~30 minutes for the first few days and what you need to accomplish immediately - answer questions, listen to a trusted aide only, eat food etc.
      b) What's the point of living? - I gotta live for my parents/ rest of the family as they would lose it too if I went away. 
      c)  Why should I eat? - eating is a biological process and no point in letting your anger/ pain be directed at food. 
 

ii) You’ll have a lot of ‘why’ questions - why did they do it, why me, why didn’t they love their life enough etc.. Its normal for your mind to throw such questions - Put all these questions on paper and answer them yourself. You have most of the answers inside of you. Just don't be harsh to yourself while answering due to guilt - better done after 2-3 weeks post-facto. You may not be able to get 100% closure but 60-70% is good. Moving towards religion/ spirituality (meditations/ yoga/ text etc.) may make you feel better and provide some answers to such esoteric questions.
iii) Try writing a letter to the departed soul and express whatever was left unsaid - not necessary to share it with anyone if you don't feel comfortable.
iv) Important to have private therapy sessions and join a suicide survivor's safe space to help you process your feelings and learn from other people's experiences.
v) Mental illnesses is just like any other insidious human ailment. Therefore, even more important to discuss it and disseminate information, instead of avoiding the topic and stigmatizing it. 

 

In contrast, as Sadhguru, says and I'm trying to reframe here - that there has to be a balance in discussing about suicide (post death) - a bit of sympathy with a hint of disdain. Otherwise, suicide will enter the social fabric/ structure and people will start giving up on life, whenever a minor event occurs not upto their liking. But mental health experts believe that suicide is fundamentally not an easy act and most people who die by suicide suffer deeply before they carry out the act. 

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Tags - Pica, Celiac, Sprue, OCD, Obsessive Compulsive Disorder OGC, RLS, eating paper, mental illness, trauma   

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