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DR MAX THE MIND DOCTOR: For years I have been helping people in despair … this is what I have learned

“The problem with brushing things under the carpet is that they are still there, and someday someone will lift that carpet and the only thing that you will feel is shame and shame.”

These are the last words written by Caroline Flack, who took her own life last week.

They’ve been haunting me since I read them after the TV presenter’s family published the unpublished Instagram post, in which the 40-year-old moved the agony she had experienced and the struggle to cope with her problems.

When someone takes their own life, the first question for those left behind is why. And when that person is seen as beautiful, talented, successful, rich and loved, the tragedy can seem even more inexplicable.

The second, painful question for the relatives is: was there anything I could have done to stop it?

The last words written by Caroline Flack, who took her own life last week, have been haunting me since I read them after the TV presenter's family released the unpublished Instagram post

The last words written by Caroline Flack, who took her own life last week, have been haunting me since I read them after the TV presenter’s family released the unpublished Instagram post

The widespread assumption is that Caroline’s suicide was a reaction to her impending trial – she was accused of abusing her friend Lewis Burton – and the subsequent fall-out that had seen her resign from her work on Love Island, the hugely successful show of ITV with which they had become synonymous.

Her somewhat blocked love life and the impact of social media – the trolls and critical remarks that drew her controversial role over the years – have also been discussed as a factor.

But I have a message for readers based on my clinical experience talking to dozens of people who feel suicidal and with their relatives: never assume anything about what causes someone to take their own life.

Yes, Caroline was a public figure who had welcomed millions of people – most of them young – into their lives. But we did not know her and it is presumptuous to think that we can understand her mental unrest and the reasons for it.

The widespread assumption is that Caroline's suicide was a reaction to her impending trial - she was accused of attacking her friend Lewis Burton - and the subsequent fallout

The widespread assumption is that Caroline's suicide was a reaction to her impending trial - she was accused of attacking her friend Lewis Burton - and the subsequent fallout

The widespread assumption is that Caroline’s suicide was a reaction to her impending trial – she was accused of attacking her friend Lewis Burton – and the subsequent fallout

Speculation as to why someone takes his or her life is dangerous because it offers an over-simplified story of cause and effect.

Indeed, the Samaritans warn against suspicions on social media or in the press, because there is a wealth of strong evidence that suicide can be “catchable” – it can cause copycat behavior.

This does not mean that we should avoid suicide, far from it. But it must be handled with care so that vulnerable people do not receive the wrong message from often well-intentioned attempts to bring suicide to the attention.

And I do worry about how people with suicidal tendencies can respond to the wall-to-wall coverage – however understandable – of Caroline’s death.

Suicidal feelings are terrible and paralyzing, but they pass. Treatment and support is available and people need to know where to find it. And while they sometimes feel that their friends or family are better off without them, the bleak reality is that the impact of suicide on loved ones is devastating and can cause long-term suffering for those left behind.

I have worked in A&E for many years to talk and assess suicidal people. When I started, I was wary and reluctant.

What if I said something insensitive or stupid? What would I do if they told me that they were considering injuring themselves?

But over time, I began to appreciate that much good can be done by talking about it – people will drop the pretension and be honest about how they feel.

Sometimes that’s all they need. Just talking about those feelings is enough.

Each A&E department has access to mental health professionals 24 hours a day, every day of the year. Anyone who feels vulnerable to self-harm or experiences suicidal thoughts can walk in and ask to talk to someone.

I absolutely believe that there is always another option for suicide, no matter how desperate, isolated, worried, sad or overwhelmed a person may feel.

They just need to know where to find help – and that is a responsibility we all share in looking out for others.

Finally, we may have to take into account the advice in another Instagram post from Caroline: “In a world where you can be everything, be friendly.”

For confidential support, call the Samaritans on 116 123, visit a branch or visit samaritans.org.

It is not wise to kick patients out

As a physician who has been attacked multiple times, I welcome powerful responses from managers to ensure the safety of staff.

Health Secretary Matt Hancock announced this week that NHS staff may refuse to treat patients who exhibit sexist, homophobic or racist behavior from April.

This is because figures show that staff who have experienced bullying, harassment or abuse have risen by a quarter in five years.

During my service I was spit upon, shouted, beaten, kicked and even held hostage. I have also arrived at the receiving end of homophobic abuse.

Health Secretary Matt Hancock announced this week that NHS staff may refuse to treat patients who exhibit sexist, homophobic or racist behavior from April

Health Secretary Matt Hancock announced this week that NHS staff may refuse to treat patients who exhibit sexist, homophobic or racist behavior from April

Health Secretary Matt Hancock announced this week that NHS staff may refuse to treat patients who exhibit sexist, homophobic or racist behavior from April

Violence against personnel is not tolerated in the NHS and perpetrators must know that their behavior is not acceptable.

But refusing to treat them is not always the answer.

Once in A&E I heard a patient verbally abusing a gay nurse. Other personnel intervened and the nurse was led away while someone else intervened to look after the man.

The staff acted professionally, but made their disapproval clear.

The man clearly felt uncomfortable. After his treatment, the sister he had abused sat next to him. They had a sincere discussion and the patient apologized profusely.

When he was fired, he embraced the nurse and later returned with chocolates. Would the same have happened if he had been kicked out?

Why human touch is essential

I have previously written on these pages how important human contact, especially touch, is for our mental well-being and physical health.

So I was not surprised by research presented this week at the American Association for the Advancement of Science meeting, which showed that newborn babies can experience problems without human touch when they grow up, even in adulthood.

Newborns to be kept in an incubator may struggle with sleep, stress and emotions at a later age – but babies with similar treatment needs, but who also get some skin-to-skin contact or ‘kangaroo care’, are not confronted with the same problems.

While this is an important factor to consider in treatment plans for babies, I also wonder what impact human contact has on older people, especially in healthcare facilities that do not receive many visits from their relatives.

Their need for touch is completely neglected – reduced to washed, dressed, altered or reversed by nurses who often wear gloves.

We think of the physical needs of these patients, but what about their emotional needs?

Dr. Max writes … The Happy Place podcast with Fearne Cotton

The podcast from presenter Fearne Cotton is a relief. She interviews famous people about their mental health and focuses on what makes them happy.

From Hillary and Chelsea Clinton to Dame Kelly Holmes, Fearne’s podcast is compelling and sometimes incredibly moving.

It gives a real insight into the human condition, while ultimately it is uplifting and life-confirming.

The podcast from presenter Fearne Cotton is a relief. She interviews famous people about their mental health and focuses on what makes them happy

The podcast from presenter Fearne Cotton is a relief. She interviews famous people about their mental health and focuses on what makes them happy

The podcast from presenter Fearne Cotton is a relief. She interviews famous people about their mental health and focuses on what makes them happy

Ban the quacks

I welcome the Professional Standards Authority (PSA) move to ban homeopaths who offer quack treatments for autism.

NHS medical director Stephen Powis has gone one step further and said the Society of Homeopaths should not provide medical advice at all.

Although I don’t believe in homeopathy – a pseudo-scientific system of alternative medicine – I have nothing against people who use it if they choose.

The problem here is that the ‘treatment’ of autism that some homeopaths offer is based on the belief that vaccinations cause this.

This idea came in a now discredited study by the disgraced physician Andrew Wakefield, who suggested that the MMR shot was behind an increase in autism.

It is quite right that people who control such myths can no longer practice.

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