For Saakya, with love.

Trigger Warning: This post contains material about LGBTIQ+ issues and mental health. Anyone reading this who feels upset or distressed: call 1333/0717639898 or 0112696666 to talk. These are helplines that are operating in Sri Lanka. 

I’ve met you briefly while reading your uncle’s book ‘ Sainted Blue, Painted Black’ a few years ago; which describes the day you first saw this world with all it’s beauty and ugliness. Your uncle says you were ‘screaming blue murder’ as you made your way into the world and it’s almost as if he knew, how strong and unafraid you would be.

Your experience at the Colombo International School has stirred a great deal of discussion and debate around rights, identity, and freedom. I am not here to add my two cents, but I feel the need to put down what’s in my heart. LGBTIQ+ rights in Sri Lanka is something that we need to look at deeply, energetically and with empathy just like we must address the rights and needs of people with disabilities, persons living with HIV/AIDS, and of those who are simply ‘ different and diverse’. I believe that rights are for everyone, no matter what sexual orientation or gender identity you identify with and your story really brings out how prejudice and discrimination trickles down from the very people who are responsible for the well-being and growth of other people. Individuals and organizations who have it in their job description and/or mandate to be inclusive, multi-culturally sensitive and diversity friendly continue to actively discriminate others based on sex, gender identity, sexual orientation, religion, ability etc. This does not happen only in the education sector, but in healthcare services, workplaces, state organizations, law enforcement agencies and in most other public spaces. I often notice that we are quick to cast blame on ‘ society’ for a great deal of things including stigma and inequality. Who is society? What is society made up of? Who creates ideas that exist in society?. I will leave you, the reader to ponder a moment on these questions.

As much as Sri Lanka is rich in culture, diversity and also has a rich sexual history; archaic laws, toxic heteronormativity and unchallenged patriarchy creates hatred and feelings of disgust towards those who are divergent. I believe, as a person who works in the field of mental health in Sri Lanka that discrimination and prejudice experienced by those who are outside the normative framework and the lack of space for those outside the gender binary leads to a great deal of psychological distress and hinders the individual’s ability to feel well and safe. This in turn pushes back an important Sustainable Development Goal (SDG) which is health and well-being for all. People are being left behind. Rights that are not respected, freedom that is restricted because of a different sexual orientation and/or gender identity, and identities that are suppressed often does lead to mental health and psychosocial problems. How do these SDG’s then apply to our current social context?

As a LGBTIQ+ affirmative mental health professional and as an ally of the LGBTIQ+ community, I stand with you, Saakya. You are also an inspiration for others who identify with varied sexual orientations and gender identity. It is important to state here that our rhetoric and discourse must not only be about sexuality and gender, but about identity.  We must talk about the assertion of who we are as human beings. We must rethink and reimagine our heterosexual privilege and re-examine the gender binary again and again.

So, Saakya, keep screaming blue murder. I’ll join you in the fight.

 

With love and pride,

Nivendra

 

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Depression: Unpacking the black dog

‘It’s just a phase’, ‘just get over it’, ‘think positive’ are often expressions used to jerk someone out of a state of persistent sadness, a pervasive lack of enthusiasm and joy, which is depression. This is an illness, just like diabetes and heart disease and it affects both the mind and the body. Each individual has a different experience of this mental health problem. Depression is not ‘a phase’ someone goes through, and ‘snapping out of it’ most often does not work. There are approximately 322 million people around the world who live with depression, and the World Health Organization has stated that by 2020 it will be the leading cause of disability around the world.

There are several misconceptions about depression that exist in our society. There is a belief that feeling sad and being depressed is the same thing. We all feel sad at different times in our lives, but the sadness is often not persistent. However, feeling low and sad is seen to be persistent in depression. A person living with depression does not have to experience it for his/her entire lifespan. It is an illness that can be treated. It is not just the young or the elderly that are vulnerable. We all have a vulnerability towards developing depression or another mental health problem. No one is excluded.

Major depressive disorder (MDD) is a common type of depression that we often find around us. A period of two weeks where one experiences low mood for most of the day, and displays a lack of interest and pleasure in daily activities along with other symptoms can be diagnosed with MDD. Dysthymia lasts for two years or more and is usually described as mild depression. It is also known as Persistent Depressive Disorder. Post-Partum Depression (PPD) is a form of depression that can occur weeks or months after becoming a parent. Atypical Depression is another subtype of depression where a person with depressed mood can brighten up in response to positive events. Other key symptoms include increased appetite, weight gain, and sleeping more than usual. Psychotic Depression is a serious form of depression that requires urgent medical attention, that can bring about delusions hallucinations along with other symptoms of depression.

Causes of Depression

There are many known causes of depression. Genetic predisposition and biological factors like changes in brain chemistry can put a person at risk of being depressed. Childhood factors like trauma, neglect, early loss of a parent, unstable home environment etc can be risk factors. Stressful life events like unemployment, divorce, relationship breakdown, being diagnosed with a terminal illness, bereavement, and abuse can also be factors that can bring about depression. Biological conditions that affect brain functioning, hormonal issues like thyroid malfunction, menstrual and menopausal related issues can also cause depression. Alcohol and substance misuse that is comorbid with other mental health problems is also associated with depression.

Signs and Symptoms

Low mood, persistent sadness along with loss of interest in daily activities are vital signs of depression. Sleep difficulties and changes in appetite are also signs to watch out for. Feelings of guilt, worthlessness and emptiness are common complaints from those experiencing this illness and constant fatigue, aches and pains, and general slowness in daily functioning are also commonly reported. Low sexual functioning is another symptom that can be observed and those living with depression may develop thoughts about harming themselves. It is of vital importance that treatment is sought early, if and when the signs mentioned above are observed in a loved one. Early treatment increases the likelihood of better outcomes.

Coping with Depression

 There is a great deal of professional support available in Sri Lanka for the treatment of depression. There are Psychological Counsellors and Psychologists who provide talk therapies to help people cope with and overcome depression. Psychiatrists are medical professionals who support those experiencing depressive illness with medication and other medical interventions. Befriending organizations provide face to face, e-mail and phone based befriending, for anyone who wishes to unburden themselves and find options to help them cope. It is also important to consider Ayurveda and Homeopathic remedies, which are often neglected as potential treatment methods.

Physical activity and regular exercise are great strategies to cope with depression as activity elevates mood and helps one feel better. Adequate family support and maintaining relationships with people in our lives, though we might feel like isolating ourselves is also important. Pursuing hobbies such as photography, music, art, dancing and hiking can be effective mood boosters. Religious activity and prayer can be helpful coping strategies and most importantly setting realistic and achievable goals and taking baby steps towards them can really contribute towards recovery. Depression is treatable, and anyone living with depression can live productive and fruitful lives.

 

 

 

 

Psychoses- what caregivers need to know

‘ Psycho’, ‘ Psychotic’, ‘ Lunatic’ etc are words that we are used to hearing and reading in movies, books, amongst our family and friends etc. However, how often do we stop to think about what these words really mean, and whether they should be used or not?. The often derogatory and disrespectful words above are commonly used to describe a health problem called psychoses or we also use the term ‘ Schizophrenia’ to refer to the same.

So, what is psychoses? 

Psychoses is a serious health problem that affects one’s thoughts, perception, emotions and behaviour. It is becoming increasingly common in Sri Lanka, and it is difficult to say what exactly causes it. There can be a multitude of biological, psychological, environmental and social factors that can cause psychoses, and it can happen to anyone from any social background. It does not affect only people from lower socio-economic backgrounds, it affects everyone.

How do I know if my loved one/friend is affected by psychoses ?

Ask yourself the questions below.

  • Have there been significant changes in my loved one’s behaviour?
  • Does he/she appear to neglect usual responsibilities related to school, work, home and social activities ?
  • Does he/she appear to be overly agitated, confused and aggressive?
  • Has his/her personal hygiene, grooming etc been neglected?
  • Has my loved one developed fixed false beliefs that are not shared by others in your family, community and culture?. Does he/she seem to be suspicious of others, and often act frightened?
  • Has my loved one talked about hearing voices that are not really there or seeing things that no one else seems to see?
  • Does he/she seem oblivious to the fact that they may be experiencing mental illness?

Key messages to caregivers 

  • If you have noticed one or more of the symptoms given above, seek medical help early. Early treatment often leads to positive outcomes for the individual. Psychiatrists can be consulted in most private and government hospitals.
  • Your loved one is not ‘ crazy’, ‘mad’, or should not be put in the ‘loony bin’. They have a health problem, which can be managed with appropriate treatment and care. The above words are derogatory and disrespectful, and contributes to existing stigma and discrimination. Everyone must be treated with dignity.
  • It is not your fault or your loved one’s fault that they are experiencing a health problem.
  • Do not attempt to convince your loved one that their beliefs or experiences are nonsensical and unreal. Be supportive, and do not collude with their perceptions and beliefs.
  • Do not laugh at or ridicule your loved one due to their illness. They need your love and support.
  • Ask about suicide- ask early and ask often. Asking can help save a life.
  • Provide a conducive environment, with minimal stress, and adequate social support. Do not criticize or be hostile towards your loved one.
  • Help them have a healthy lifestyle with adequate sleep, exercise, and good dietary habits.
  • Help your loved one avoid alcohol, and other substances including prescription drugs.
  • Comply with recommendations made by your loved one’s doctor about treatment, and it is important that medication is taken as advised by a health professional. Do not start new medication or stop medication without consulting your family member’s doctor.  

People living with psychoses can lead very productive and fruitful lives with proper treatment and management. They are capable of engaging in a job, studying, and contributing to society. They can engage in social activities and can be included in weddings, family outings, and other community events. People experiencing psychoses are not dangerous.  Isolation does not help. No one likes to feel left out.

Caring for someone with psychoses can be difficult and painful. It is of vital importance that you take care of yourself. Take breaks, engage in activities that you enjoy, and seek support by talking to those close to you. You are not alone.

Need to talk?

Sumithrayo – 0112692909 between 9am-8pm.

CCC Line- 1333 between 9am-9pm.

Shanthi Maargam- 0717639898 -24hrs.

 

 

 

Depression- what caregivers need to know.

Depression is a major public health concern around the world and it is known to affect 1 in 4 people in their lifetime. 322 million people live with depression globally, and we also know that by 2020 depression will be the leading cause of disability in the world.

Enough with the numbers, already.

We all have bouts of the ‘ blues’ and feel sad and miserable on occasion. This is not depression. As human beings we are allowed to feel sad, angry, irritated and just low, and this doesn’t mean that one is depressed.

So, then, what is depression?

Depression is a health problem that affects the body and the mind. It is an illness just like diabetes or hypertension. It is not just a ‘ passing phase’. It is difficult to say what truly causes depression, but it is often a combination of genetic, biological, psychological, environmental and social factors. It is a mixed bag really. There is no one reason as to why your loved one/s may experience depression.

Identifying depression in your love one/s

Ask yourself the questions given below.

  • Does he/she seem low most of the day for a period of two weeks or more?
  • Has he/she lost interest in things they enjoy doing?
  • Are there sleep difficulties? Is he/she sleeping well?
  • How is my loved one’s appetite?
  • Are there complaints about aches and pains, headaches, and constant fatigue without an apparent cause? Are these complaints increasingly frequent?
  • Does my loved one talk about feeling worthless, useless, a burden, a waste of space etc?
  • Does he/she have difficulty getting out of bed in the morning?
  • Is he/she talking about life being not worth it, or about wanting to die?

Key messages for caregivers

  • If you have noticed the signs above in your loved one/s, they may be experiencing depression. Seek help early for better outcomes.
  • Depression can be treated.
  • Not everyone who is depressed requires medication. Some people can recover through psychotherapy, positive family support, etc.
  • It is important that you loved one is assessed by a competent mental health professional before deciding on treatment.
  • Those who are depressed are not ‘ lazy’, ‘ attention seeking’ or ‘silly’. They have a health problem.
  • Your loved one needs to be involved in decisions made about treatment and care. They require your support.
  • Ask about suicide- ask early, ask often. Asking does not make people want to end their lives. Asking can save a life. ‘ Are you thinking about ending your life? ‘ Do you have thoughts about suicide’, can be questions you can ask.
  • It is important not to isolate your loved one. Involve them in social gatherings, family functions etc. People with depression can live very productive lives.
  • Take care of yourself. Take breaks. Seek support.
  •  Keep faith and be hopeful- because there is light at the end of the tunnel ( it’s true, no matter how cliched it sounds).

What your loved one does not want to hear

  • “Aney-  stop overthinking men”
  • ” Get a move on”.
  • ” Oh, just snap out of it”.
  • ” Don’t get worked up for nothing men”.
  • ” You’ll be fine- you are just sad”.

You get the gist, right?

There is a shortage of mental health professionals in Sri Lanka and this is a fact. So, the family becomes so very important in the recovery of those with mental health problems. You as a caregiver/friend have a vital role to play in your loved one’s journey towards wellness and recovery.

Need to talk?

Sumithrayo – 0112692909 between 9am-8pm.

CCC Line- 1333 between 9am-9pm.

Shanthi Maargam- 0717639898 -24hrs.

 

 

 

For those left behind

‘ She has committed suicide’. 

‘I never wanted to believe it. I told everyone including you that it was an accident. I was lying to my self too’. 

‘Coz she was never that type of a person. I was feeling guilty of myself. Being her best friend I couldn’t save her. I was three minutes away from her but I still failed. I was lying to myself right throughout that it wasn’t a suicide’.

‘sigh’. 

 

I received this text message two hours ago from a dear friend who recently lost her best friend to suicide. It struck a chord in me and with the recent deaths by suicide that have taken place in Sri Lanka, it got me thinking about the impact suicide has on those who are left behind, on those who survive. What happens to them? What happens to us?

A death by suicide, when it occurs,most often shatters the existing status quo of a family, community and society.  It’s like being tossed around in a whirlpool, I suppose. All that we once believed in is shattered and those of us who are left behind often have to pick up the pieces, and piece together a fabric of something that possibly could help us find some solace, barely.

I remember how I cried when a classmate from my Bachelor’s course in India, took her life, when I was far away, in Norway. I couldn’t be there with the rest of my classmates. There weren’t any pieces to pick up. Nothing to hold on to other than Facebook messages sent by classmates, and a few photos that were online.

My friend found her.

The guilt of surviving, shame, feelings of regret, anger, abandonment, emptiness and a whole plethora of feelings come gushing through, maybe not immediately, maybe later, and maybe not at all- there is no one way of feeling about something so ambiguous like suicide. You might ask the question ‘ why’ or you might not. You might wonder what you did wrong, of how you could have saved your loved one’s life, of that one thing that could  have made a difference, but from a different point of view, it might seem pointless to think about it at all, I don’t know. But, what I do know is that it is okay to feel, whatever you feel- because they are your feelings and it is important that what you feel is acknowledged. However, silence sometimes becomes convenient for some and although deafening, a  way of coping for others. Feelings tend to go unacknowledged and unheard, leaving a survivor of suicide in a mass of isolation, heaviness and despair. There is a ‘wall of silence’ that erects itself around an individual or  family who has lost a loved one to suicide and in Sri Lanka, we often see the stigma and shame surrounding suicide only making the wall taller and thicker. It doesn’t have to be that way, and we as a community have the power to change that.

It is important not to isolate individuals and families who have experienced loss due to suicide, even though it might seem rather daunting and confusing to think about ‘ what to say’. I’ll get to that in a moment, but reaching out and not waiting for survivors to reach out is a great way to start. They may not want to talk, or even look at you, but it’s your presence that matters. It takes away the isolation and emptiness.  It is often not immediately after a loss that the most support is needed, but it is when a month or two has passed and people slowly begin to forget. People gradually begin to trickle away, and contact with the community decreases, and this is when you can help sift through the debris. You don’t always have to say much, but checking in regularly, and creating a permissive environment for feelings to be expressed can go a long way in someone feeling supported and cared for. I must also bring in the use of language when talking about suicide. ‘ Died by suicide’ rather than ‘ committed suicide’ is an useful way to talk about suicide. It makes it seem less like an offense or a crime. ‘ Took his/her own life’ can be used instead of ‘ completed suicide’. ‘ Ended his/her life’ can be used and not phrases like ‘ a successful suicide’. You get the gist right?

Are you a survivor of suicide loss?

What can you do to cope in the aftermath of a loved one taking his/her own life?

  • Try not to isolate yourself.
  • Speak about your deceased loved one with other members of your family and friends. Share positive memories you have of the person you lost. It is okay to acknowledge that the person both lived and died.
  • Use creative mediums like journalling, art based activities etc to work through your feelings. Psst, you can also speak to a mental health worker.
  • Keep your loved one’s memory alive- photos, letters, memento’s etc can be used to help you through the process of grieving. The person may have died but can still live on in your memory.
  • Allow yourself to cry, to express emotions, even difficult one’s like guilt, shame and regret. They also need to be acknowledged.
  • Take care of yourself- get adequate sleep and nutrition.
  • Seek support- there is no shame in doing so,

 

Where can you seek support?

Sumithrayo- No.60B Horton Place, Colombo ( 0112692909). 9am-8pm.

CCC Line- 1333.  9am-9pm

Shanthi Maargam- 0717639898. 24hrs

 

 

 

 

 

 

 

 

The Pain Behind the Pride : Student Suicides at Monash University,Malaysia

I was strolling around the Sunway Monash Campus in Malaysia, last week while on holiday. It was a beautiful campus, with everything a student can possibly ask for. There were tall buildings that boasted of fine intellect and academic rigor and you could almost smell the cortisol floating around while students were prancing around ‘ checking the boxes’. However, I also felt a certain eeriness while inside the campus because of another reality I was aware of. Unnoticed and hidden under the pride and acclaim of everything Monash claims to be, is a dark cloud of pain and anguish- student suicides.

I won’t go into the details here, out of respect for those who lost their lives and their families, but there have been quite a few  students who have taken their own lives while and after studying at Monash University, Malaysia. A number of them-international students. However, apart from ‘regretfully’ releasing statements, there appears to be little else done via the university to work towards suicide prevention.

While walking around campus, and while using public transport i.e. the BRT, I saw lonely eyes glued to mobile devices and computers and I couldn’t help but wonder about how their hearts were. What were they feeling?. Were they feeling at all?. Did they have someone to tell them that they are loved and cared for- or was their worth solely based on how academically sound they were. I was thinking about those lives lost to suicide. What were they like? What were their stories? Who did they leave behind?

What do we do with the residual traces of what’s left behind? The lingering vapor of hearts riddled with pain,guilt and loneliness, about low grades, failed exams, friends who have failed them and families who have shamed them.

We have two choices;

  1. To pretend that it never happened and move on with our lives.
  2. To create a more compassionate world collectively.

I obviously advocate for the second choice.

A few pointers for students studying at Monash,Malaysia and their parents

For parents:

  1. Expectations! Expectations! Expectations!- Manage them.
  2. Check on your son/daughter often. You are not being a pain in the behind, just a  caring parent.
  3. Ask after their mental health- not just whether they are eating well or not.
  4. Teach your child about coping with failure and learn some of that yourself.
  5. Provide options not dead-end’s.

For students:

  1. Check on your friends often. A simple ‘ how is your day going?’ would do.
  2. Take your eyes off your smart phone and look someone else in the eye and let them know that you care.
  3. As much as it looks ‘cool’ to make someone else feel like ****, it’s way cooler to help someone out. It doesn’t take much of your precious time.
  4. Quit laughing about suicide and poking fun at people who may talk about wanting to harm themselves. Help them seek support.
  5. Please stop the ‘hate’ on social media and on pages like this. It only adds to the pain.
  6. Take care of your mental health as much as you do your physical health.

For Monash, Malaysia and other universities around the world: 

  1. Check on the well-being of your students- not just their attendance and grades.
  2. Reach out to students who may be having trouble adjusting and actively support them. It really does not take up too many resources.
  3. Include life skills and coping skills education in your curriculum. A degree is not just a piece of paper it is also about life.
  4. Identify suicide hotspots on campus and take measures to prevent further suicides from taking place.
  5. Talk about suicide prevention in your campus and do not just slip difficult conversations under the carpet.

 

Here’s to a healthy, compassionate world.

 

 

 

 

 

 

 

 

Staying well O’er the season

December is a month of joy, colour, bonding and giving or at least that’s what we’ve learnt over time. However, this might not be true for everyone, and hey, it does not have to be the end of the year, for life to be extra joyous and merry. So, what I am really trying to get at is, that December, and everything that comes with it may not always bring happiness and contentment. It could for some, be a very stressful month, and for some, extra lonely.

There is the commercial buzz around this time of year, where people are racing for time, to finish their shopping, and to get some of that spring cleaning done. Santa’s prancing around the streets, gigantic Christmas trees popping up around the city and general bonhomie is what one would notice, at least on the periphery. We however tend to sometimes forget that there is also another side to Christmas and of course the dawning of a new year which is around the corner (Gulp!). I decided to pen down this article, to acknowledge the often-unacknowledged side to the season in Sri Lanka and to share some thoughts on how to cope with the niggles that come with it.

There is a hype of activity around this time of year, and a great deal of pressure for some to part take in the festive cheer. A whiff of consumerism is in the air, with shops beautifully decorated, whippy adverts on television and of course those provocative discounts and sales. Television shows portray love filled families, sitting around crackling fires and gobbling down turkey. Radio hosts (some of them) are extra cheery and bubbly. While I am totally for joy and happiness, I also know that parents may feel pressured to buy gifts for their children, people may feel obliged to host the ‘party of the year’, and for others, the season might bring with it the necessity to guzzle down spirits, in order to belong and to feel bonded. December can be a very lonely month for certain segments of society and this could also bring about bouts of depression, anxiety and cause high levels of stress.

It’s okay, to not feel as bright and cheerful as you are supposed to feel. You are not defective, just because you do not feel like donning your best, and celebrating. You, my dear friend, don’t have to snap out of the sadness you feel, just because it is Christmas. You can say ‘no’ to a party you are invited to, and for you beautiful parents out there, you are allowed to not buy your child the most expensive gift this year. You are also important, and your well-being is as important as everyone else’s. You can give yourself permission to take a break. It is not a catastrophe, to not put up a Christmas tree at home, or to not bake at your best this year. Balancing your reality versus expectations you, and others have of you can be a way of staying well, this season.

We are vulnerable sometimes to developing mental illnesses and some may be already diagnosed with a psychological disorder. A few simple strategies can prevent the onset of mental health issues or the exacerbation of already existing illness, especially in this time of year.

  • Create a balance of activity and rest into your day.
  •  Get enough sleep and try keeping your sleep cycle in place.
  • Watch the alcohol and other substances – you do not always have to drink or get high, to be merry.
  • Be aware of certain triggers that cause distress (i.e. a Christmas movie, portraying a warm family- while this can provide comfort and hope, it can also bring about difficult feelings).
  • Reach out and give some of your time to others who may want some company this December.
  • Keep a tab on your expenditure so that you can minimize the stress of over-spending. You can use a worksheet like this to keep track of your expenses.
  • You are allowed to talk about the difficult stuff, it doesn’t’ always have to be cheery.
  • There is support available in Sri Lanka, even during Christmas and new year’s.

 

So, folks, I wish you a mindful and peaceful Christmas and a hopeful new year.

 

Stay well, and keep each other well.