suicide
Mental health in a time of pandemic
Well, twelve months ago, as we headed towards Christmas, who’d have thought 2020 would be a year like no other? Were you truly savouring each family hug, each shared celebration, each freedom? I certainly wasn’t. We took it all so much for granted, didn’t we?
But plenty of evidence has been emerging that the mental health of the nation has deteriorated during the pandemic, and that’s on top of already soaring mental health issues. One only needs to think isolation, job insecurity/loss, uncertain future, economic hardship, fear of disease and death, bereavement, domestic abuse, cancelled medical appointments/operations, etc etc, to understand why. And official reports bear this out. We heard in September on World Suicide Prevention Day of the serious effect on men’s mental health of lockdown, and now this month, a coroner in Wales has highlighted the tragic suicides precipitated by the profound and detrimental effect of the pandemic.
Recognising the stresses, lots of organisations are offering informative and/or therapeutic sessions online to help people combat the associated effects, some generic, some focused – relaxation techniques, mindfulness, breathing exercises, coping strategies, that kind of thing. I’ve dipped in to some myself, and as well as helping the participants to understand the legitimacy of what’s happening to them, these opportunities enable wider social connections to be made. Just chatting, or simply listening, to those who admit to also feeling beleaguered by developments, can be a comfort in itself.
Then there are the amazing events being streamed online, making uplifting experiences and cultural events accessible to so many more than would normally travel to expensive shows or courses. Ballet, opera, drama, concerts, masterclasses, demonstrations, tutorials … something for pretty much any interest. And again I’ve personally availed myself of these opportunities. It’s so heartening to see and hear artists and experts, actors and athletes, craftsmen and academics, turning their own troubled times to good effect by sharing their expertise with the masses – drawing, running, playing musical instruments, creating beauty, and so on. A bonus for both sides.
The recent doorstep musicals project is a case in point. West End actors have set up Doorstep Productions in a bid to bring theatre to ordinary people in streets across the UK, simultaneously entertaining and lifting their spirits, whilst helping out-of-work actors whose jobs have dried up as theatres are forced to close. Big names like Andrew Lloyd Weber and Cameron Mackintosh are backing this initiative. Heart warming. And the Dundee Rep have just begun to bring their production of A Christmas Carol to the streets of a select nominated few too.
It all says much for the fighting spirit of the nation, doesn’t it? and the resilience of individuals, and the kindness of strangers. I want to add my thanks to everyone anywhere doing their bit to boost morale and unite our nation. In these days of dire health statistics, economic crisis, and uncertainty over Brexit, news of individual or collective positive endeavour or heroism or compassion is a real tonic.
Words words words
Cartoonists, journalists, feminists, politicians, the world and his wife, are pitching in to the incident on the tennis courts this week, where Serena Williams took exception to her treatment by the umpire in the women’s final of the US Open Tennis tournament. She smashed an expensive racket in public in her frustration, and accused the umpire of being a thief. She was heavily penalised. The rights and wrongs of her tirade, the whole issue of gender equality, are not the topics I want to home in on here; what has got me thinking in all the fallout from this, though, is the power of words and the baggage that comes with them. Serena clearly read much more about discrimination into what happened than I saw.
Also this week the media spotlight has also been on death by one’s own hand: National Suicide Prevention Week 2018. The importance of taking care with the words used has been highlighted – not saying ‘commit’ suicide, for example; not ignoring subtle cries for help. Such deaths are a tragedy whichever way you look at them, but understood with much more sympathy today than they were in the past. When I was growing up, we were told to ignore taunts and bullying. ‘Sticks and stones will break my bones but names will never hurt me‘ was the response to childish angst. But of course, we now know this is patently not true. Words DO hurt. Far more deeply that a swift slap or punch. They can seriously, sometimes irrevocably, damage your health. Mental stress can be every bit as debilitating as physical ailments, perhaps even more so. Certainly my own scars from psychological onslaught are much deeper and recurrently painful than those from any bodily trauma.
So words are powerful beasts. As the Biblical writer James says in a poetic description on control and careful speech: ‘… no man can tame the tongue. It is a restless evil, full of deadly poison,’ and he concedes, no one has completely mastered his own tongue. And that adage IS still true. Who hasn’t regretted something they’ve said; and felt the burden of not being able to recall or erase those words? Salutary lessons all.
Which brings me to the written word. Authors do at least know the importance of the right word in the right place. I have a row of lexicons on my desk, as well as everything the internet has to offer, to help me choose wisely. Like Oscar Wilde and his famous busy day taking out and putting back a comma, I can sometimes agonise for ages about a word or phrase, take it out, put it back, tweak it, change it, before I can move on. But who can factor in the inferences and prejudices of the reader for whom those very same words can be laden with meanings and accusations and slurs and judgements unseen by me? To minimise the danger of being inadvertently (sometimes it’s deliberate, of course!) misunderstood or causing offence, I draft in a range of experts and readers to examine the text for inaccuracies or infelicities which have escaped me. Invaluable allies.
But hey, I must get back to my serious editing – I’m working to a tight deadline this week. Third draft and a further 13,000 words to lose, so a way to go yet. I find a specific target helps to concentrate the mind, making me focus on every word to see if it’s pulling its weight; actually hunting for as many as possible that are just coming along for the ride. Which again highlights the issue I started with. Words count.
Festival time
So far we’ve had a humorous take on Shakespeare (a World War II version of the classic play, All’s Well that Ends Well); an intriguing and delightful performance around the Tudor queens (by an American troupe!); a clever skit where Sherlock Holmes and his associate Watson, vie with each other to solve a crime in which Holmes himself is the supposed killer; an exploration of the issues of entrapment and abuse through a dark re-imagining of the infamous Grimm’s fairytale Rapunzel. Our teenage granddaughters, with their own cascades of beautiful hair, proving themselves observant, insightful critics and excellent company. Still to come: a wartime tear-jerker, a drama (paying homage to CS Lewis) exploring life and death decisions, a contemporary musical storytelling about the life of John the apostle viewed from his prison, a costumed Austentatious, and an adaptation of Pilgrim’s Progress. Good times.
But for me personally the highlight of my week was a special session at the Book Festival under the banner: Staying Well, which incidentally also explored the concept of entrapment. Male suicide has increased significantly over the last twenty years and statistics for self harm in the UK are the highest in Europe. My current novel revolves around mental health issues, so this one: Stepping Away from the Edge, was a definite must.
Two of the three speakers have themselves suffered from severe depression. Debi Gliori is a writer-illustrator of children’s books and she has created a wonderful collection of pictures which portray how she feels while depressed – feelings which can’t be captured in words, she says. Her talk was illustrated with these magical drawings. Author Matt Haig has captured the horrors of severe mental illness in words. His book, Reasons to Stay Alive, is receiving widespread acclaim. In the Garden Theatre Tent, he also relied on words and his own palpable emotion to speak about his suicidal experiences. The third speaker was psychologist Rory O’Connor who heads a team at Glasgow University specialising in suicide, and his talk gave the stark statistics and facts and latest thinking about both self harm and suicide.
It was fantastic to see the importance given to mental illness at this international book event – an excellent line-up of speakers from both sides of the couch; an extra long slot (90 minutes instead of the usual 60); a large audience listening sympathetically and contributing sensitively; a team of specialists available afterwards in the Imagination Lab for anyone with specific issues or questions (a steady stream of people headed in that direction in spite of the late hour).
As I stood admiring the magnificence of Edinburgh at night I couldn’t help but be glad that it was this city that had been the setting for another step towards equality between physical and mental illness.
Going gently into that good night
Until this week I have to admit that I’ve never watched the soap, Coronation Street. But there was so much hype about Monday’s double bill featuring the suicide of a character called Hayley Cropper, that I felt compelled to see it. After all, exploring real moral questions through fiction is what I’m all about.
For those of you who don’t know, (as I understand it) Hayley (once Harold) is a transgender person who survived local prejudice, married cafe owner Roy, and developed pancreatic cancer. Monday was the day she had resolved to end her suffering by taking a self-administered (don’t even touch the glass, Roy) cocktail of drugs. 
Roy is hoping against hope that when it comes to it she’ll change her mind and they’ll have longer together. ‘There’s still joy to be had.‘
I came to this my first episode without any emotional attachments to the Croppers, but the whole scene was handled so gently and sensitively that the millions of viewers for whom this represented a personal tragedy must have found it harrowing. It felt as if we were in that flat with them. The touching last conversations … Hayley’s struggle to iron Roy’s best shirt so he turns up respectably clad for her funeral … Roy’s decision not to have a ‘special’ on the cafe menu on this terrible day … the anxiety and concern of the neighbours … all provided heart-wrenching pathos to the last hours of this desperately sick woman. I haven’t been party to her struggles over the past few months but I have seen other real people die of this horrible illness, and in a way their suffering overlaid Hayley’s for me. Seeing her quiet smile as the music of Vaughn Williams’ The Lark Ascending stole through the room, listening to her settled resolution, watching her determined drinking of that fatal cocktail, the peaceful waiting – I was willing all the assorted well-wishers not to disturb their precious last hours together. This was a moment for absolute privacy and solemnity. And from where I sat, ITV got most of it right.
Whatever we think of the issue of assisted dying, or suicide, or the right to die, this programme provided a useful vehicle to promote discussion. Of the tragic situations for which there are no good options. Of the emotional and physical impact of terrible diseases. Of our responses, our prejudices, our beliefs. Of the current law.
And indeed, Lord Falconer, the former Lord Chancellor, is currently working towards launching another bid in real life to legalise assisted dying under certain clearly specified conditions which will reopen the hornets’ nest for sure. So, hats off to another screenwriter and to ITV for bravely raising the issue in such a way as to get ordinary people thinking about these vexed issues for themselves. If you cared about Hayley’s plight, if you were angry with her for doing what she did, if you threw things at the TV, if you wrote to ITV complaining about their depiction of a suicide … then spare a thought for those for whom such dramas are lived realities. What would your answer be?
A safe distance away I might share another such challenging film production – but that’s for another time. Today belongs to Coronation Street.
The Universe versus Alex Woods
I’m happy to report that the new computer is flying along and overall I’m loving it. Still a few things to get the hang of, but happily writing my blog is not one of them. So here goes.
As you may (or may not) recall, I went to hear Gavin Extence speaking at the Book Festival in August. He wasn’t actually talking about his book, The Universe Versus Alex Woods, (he was presenting the case for assisted dying in a debate) but nevertheless, I bought a copy – of course I did; it’s his version of my Right to Die! And I’ve now finished reading it.
The Universe Versus Alex Woods (perfect title, by the way) is very readable, touching and amusing, and I enjoyed it, but it wasn’t what I was expecting. Extence says himself he didn’t set out to deal with assisted dying; he wanted to write about this teenager who’s had a difficult life who goes on to perform an act of unconventional selfless heroism.
Which probably accounts for the structure. We know from the outset that Alex Woods is connected to Mr Peterson when he’s stopped at Dover customs with an urn of ashes and 113 grams of marijuana, but it takes Gavin Extence 100 pages to get around to the two meeting. And another 100 pages to present the kernel of the story. First we must get to know Alex Woods: details of his extraordinary accident (hit on the head by a 2.3 kilogram meteorite travelling at 200 miles an hour) and the consequences of his resultant epileptic fits, his puny person, his zany mother, bullying, difficult relationships, his own bizarre responses, his regular sparring with big moral questions and social niceties.
We know far less about Mr Peterson, a rather bad tempered but grieving widower, very attached to his dog and his books. He and Alex are thrown together when Alex has to do penance for a crime he didn’t commit, but they discover mutual interests and develop a strange but warmly wholesome relationship. Through Alex’s eyes Mr Peterson becomes a sparky character given to wise words and robust common sense.
So, although Alex is a teenager, below the age of accepted moral competence, he is the only person Mr Peterson confides in when he develops the intractable neurodegenerative disease, Progressive Supranuclear Palsy. It’s a heavy burden for Alex to carry.
PSP might well ring vague bells for you. Remember the real-life case a few years ago, plastered all over the papers, headline news on TV, of the doctor, Anne Turner, who left 100 letters saying, ‘By the time you read this I’ll be dead‘? She’d already nursed her husband through something similar, and she was determined not to linger with it herself. Her three grown up children accompanied her to Switzerland where she drank a lethal dose of medicine. Her decision and the reactions of her family and the authorities were all replayed on TV.
Anyway, Mr Peterson knows he’s destined to lose his ability to take action before too long and he’s mapped out a pathway for himself. Only things don’t go according to plan, and Alex becomes embroiled in his exit. The police characterise Alex as vulnerable – ‘intelligent but extremely naive, and possibly disturbed,’ brain damaged, fatherless, friendless, with a mother of ‘dubious credentials and capabilities‘. He’s easily manipulated, his ‘ethical abilities‘ have been ‘compromised‘. The media spin him into a violent sociopath with an inability to feel emotion, the product of a sinister religious cult, with a troubled record as a young teenager.
Mr Peterson’s unsound judgement is beyond doubt in the eyes of the press: he’s psychologically damaged by the conflict in Vietnam; he’s recently bereaved; he’s been sectioned and incarcerated in a psychiatric ward after attempting suicide; he’s been fraternising with a minor … they weave all sorts of innuendos through this inexplicable relationship.
We, of course, know the reality. Both Alex and Mr Peterson are into moral decision-making in a big way, analysing things in private and together to tease out the right course of action. As the old man says: ‘Don’t ever surrender your right to make your own moral decisions, kid.‘
Mr Peterson sums up his predicament succinctly while he’s still in the psychiatric ward after attempting suicide: ‘I don’t want to die, kid. No one wants to die. But you know where I’m heading a little down the line. My future’s already written. If I don’t want to face that, there’s only one way out.’ And later: ‘I have a life worth living at the moment and I might still have a life worth living six months from now. Even a year from now. I don’t know. But what I do know is that sooner or later the balance is going to tip. Sooner or later I’m gonna have a life I can no longer bear. And by that time, chances are there won’t be a damn thing I can do about it. I’ll be in some kind of hospice. I won’t be able to stand or speak, let alone take the necessary steps to end it all. That’s what’s unbearable.’
And Alex understands that: ‘Knowing that there was a way out, and that his suffering was not going to become unendurable, was the one thing that allowed Mr Peterson to go on living, much longer than he would otherwise have wanted. It was the weeks leading up to our pact that were shrouded in darkness and despair; after its inception, life became a meaningful prospect once more.’
This is an ambitious debut novel. Extence has delved deep and wide – into human relationships, epilepsy, meteorology, astronomy, tarot card reading, mathematics, theoretical physics, literature, classical music, neurological disease … Some aspects I found rather less than convincing – the accident, the escape, the ending; but for the most part he has woven an intricate and compelling story. And he’s gone right to the kernel of the ethical debate, so this book sits comfortable in my list of novels dealing with assisted dying.
To be or not to be: anorexia? or abortion?
With Over my Dead Body about to go to the printer, my mind keeps straying to the next novel. I’m simply itching to get going again. If you’re a follower of my blog you’ll know I keep a pile of folders with ideas and plots and topics for the future, and this time I’ve whittled the choice down to two: one about abortion or one involving anorexia. No shortage of material for either.
So you’ll understand why my eye honed in on two articles in Friday’s news. First up: Women who have nine abortions. Nine? Wow.
In a former life, as a healthcare professional, I very occasionally cared for women who were having abortions. Actually, I’m old enough to have witnessed the effect of backstreet and DIY abortions in the years before the Abortion Act was passed in 1967, coming into effect in clinical practice in 1968. None of us would want to go back to that horror, I’m sure. Women died and were horribly mutilated. Health care staff were traumatised.
After the procedure became legal in the UK, I personally elected not to be active in the termination process, or to wish to know why the women had chosen this path, but I had no reason not to look after them as patients. Most were distressed and chastened by the experience, and I’ve known some who went on to develop mental health problems as a consequence. Only rarely did I encounter women who were using abortion as a form of birth control. But even with this background, the week’s statistics have still shocked me.
A Department of Health report shows that a total of 185,122 terminations of pregnancy were carried out in England and Wales last year. Of those, more than 66,000 were repeat procedures. Over 4,500 had had at least four abortions, 1,334 were up to at least their fifth termination, and 33 women had had nine or more. Just pause for a moment and think about that – the loss of life … and the effect on these thousands of women … and on society. Is this an acceptable set of statistics? Is this what the Bill was all about?
The second news item featured the other end of the scale: the Irish abortion Bill, otherwise known as The Protection of Life during Pregnancy Bill. Back in ‘my time’ I was aware that women secretly came over to Britain from Ireland to seek the help they wanted because there was an absolute ban on terminations over there. They still do apparently (about 4,000 last year according to Irish Department of Health figures) – the sheer scale of today’s abortion-tourism was a revelation to me.
Twenty years ago their Supreme Court ruled that women in Ireland were legally entitled to a termination if it was necessary to save the mother’s life, but six successive governments since have failed to introduce legislation to enforce this. Until now. This week. July 2013. 46 years after the UK allowed legal terminations.
It was the much-publicised death of 31-year-old Savita Halappanavar from septic shock last autumn after being denied an abortion, which precipitated this latest attempt to make the procedure legal in certain circumstances: where there is risk to life or the woman is suicidal. And please note, we’re not talking about frivolous reasons or social convenience here; we talking about life-or-death decisions. Nevertheless, the debate has been and remains a hotly contentious issue, involving nasty things like open aggression and death threats and letters written in blood. Even Mrs Halappanavar’s grieving husband has been sent hate mail by anti-abortion activists.
This is groundbreaking stuff in Ireland. Parliament has been in an uproar, with resignations and expulsions and threats of excommunication from the church. Lobbying groups are threatening to bring court cases to challenge this new law. Even though, as it stands, this Bill only helps a very limited number of women. Those who are pregnant as a result of rape, those with fatal fetal anomalies, those who simply can’t face the prospect of another child, are not included in this legal entitlement. What would you say to that?
So yes, the subject remains an ongoing hot potato. Lots of ethical issues to grapple with. Many indeed that might get me into big trouble too were I to write about them! Only question is, will this be my ninth novel? Or will I take on anorexia? I’m still swithering.
I confess at the moment I’m really tempted by the eating disorder and all its ramifications, only that didn’t hit the headlines this week. And I have a title for that book already!
As good as Jodi Picoult or your money back?
Time to return to the topic of that sticker I mentioned a few weeks ago, as seen on The Midwife’s Confession: ‘As good as Jodi Picoult or your money back.’ Similar to the one on my own latest novel: ‘If you like Jodi Picoult you’ll love Hazel McHaffie.’ Seeming even more relevant now because at my book launch last week I was introduced as ‘Scotland’s Jodi Picoult’!
Question is: Is the comparison a good or not so good idea?
I confess I’ve only just discovered Diane Chamberlain, the author in question. My daughter gave me one of her books for Christmas, and I bought a second one on the strength of the blurb on the cover. I read them both in four days during the Christmas holiday break.
The resemblance is obvious from the outset – before you even open the book. The pretty feminine covers. The personal challenge: ‘A lie will save one family, the truth will destroy another. Which would you choose?‘ Both very Jodi Picoult.
So what about inside? Was this author as good? Would I be due a refund? Should I be glad or sad that my own latest book has a similar slogan?
Tara, Emerson and Noelle are close friends, so the two younger girls are devastated when Noelle is found dead after taking an overdose of pills. But as they sort her possessions and talk to other people, facts come to light which show them that the Noelle they knew was a fiction.
When they unearth a letter revealing a hideous secret, they are torn by indecision. If they tell the truth it would destroy a family; but by maintaining the lie they would be perpetuating the grief of another. Add to this a twelve year old with recurring leukaemia loaded with steroids and fighting for her life; a dead baby; surrogate pregnancies; and you have a flavour of the intense emotional and psychological undertones of this story.
The multiple first person voices style is very Picoultesque, but there the similarities end. No court scenes or legal ding-dongs. No stereotyping. No homespun philosophising. Indeed, Chamberlain’s psychology is altogether much more convincing and less contrived than Picoult’s. Not surprisingly perhaps since she’s a trained psychotherapist.
So what of the second of her books that I read? Breaking the Silence is written very differently. All in the third person too. Instantly I feel a lift of spirits. Here’s an author who rings the changes. Who’s not formulaic or predictable. No rut in sight. My kind of gal.
The story weaves between the present for astronomer, Laura Brandon, and her daughter, Emma, and the past life of former nurse, Sarah Tolley, now an old lady with Alzheimer’s.
Moments before his death, Laura’s father makes her promise to visit Sarah, who’s in a retirement complex, but whom she’s never even heard of before. As a consequence of her doing so, however, Laura’s husband commits suicide. Her five year old daughter, Emma, witnesses the shooting and now refuses to talk and is clearly terrified of men. On the advice of a child therapist, Laura contacts Emma’s biological father, Dylan Geer, a hot air balloonist, who was unaware of her existence but becomes mesmerised by this mute child.
But as this father-daughter relationship blossoms, Laura becomes increasingly obsessed by the stories emerging from Sarah’s fading memory. She starts to unravel a tale of love, despair and a terrible evil that links them all.
Chamberlain’s training and experience in psychology have given her a genuine understanding of how people tick, how relationships work, helping to authenticate the actions and reactions of her characters. They ring true. Having had to observe professional confidences herself (like me), I think she understands the capacity of some people in positions of trust to bear a hefty burden of secrets, and the inability of others to do so. Lies and deceptions play a large part in both books.
Chamberlain says of her novels that they are ‘part suspense, part mystery, part romance and one hundred percent family drama.’ A fair assessment. The suspense and mystery elements keep the pages turning effortlessly. I was particularly gripped by the stories of the CIA government approved mind-control experiments that took place in the 50s and 60s in psychiatric hospitals in the US, about which I’d heard but never understood in this intensely moving way before. No wonder this was the inspiration for Breaking the Silence. Very clever.
But I must confess the coincidences in both books stretched my credulity somewhat, especially in The Midwife’s Confession. OK, they tidied up the story lines but they lacked plausibility for me.
So, will I be reading more Chamberlain? Probably. (And keeping my fingers crossed that she doesn’t pall like Picoult.) Will I be claiming a refund? Happily, no.
What then of that controversial sticker: did it help or hinder? Well, it meant the book caught in my antennae initially, which was good. Although for anyone who really doesn’t care for Picoult, it could have had an unwarrantedly negative impact. So swings and roundabouts there maybe. It also made me compare the two authors throughout, which had pluses and minuses for Chamberlain. But for me overall Chamberlain came out of it well.
And for Saving Sebastian? At the moment the jury’s still out. Time will tell. And your input … please!