Sunday, 8 November 2009

Sadness, stigma, suicide, and having the blues for Levi Strauss

This week I planned to write about my thoughts of an extraordinary example of an administrative fiat that I  stumbled across this week. It was a relatively simple thing, nothing more than an attempt to ensure that people turned up on a regular basis to a series of important meetings. When I read the missive I was reminded of that old saying about taking horses to water but not necessarily being able to make them drink. I felt the approach was almost certainly doomed to failure because it was essentially aimed at the heads and not the hearts of colleagues in bringing about change. I have published about this subject before, but as important as these issues might be, other events drew my thoughts somewhere else and I want to leave this discussion for now and perhaps return to it in a future blog.

The first and most significant event that changed my mind about what to write about was what occurred at Fort Hood this week. The tragic consequences of the army psychiatrist Major Hassan attacking his fellow comrades at the army base in the US reverberated around the world. It is too early to know if his actions were a consequence of religious extremism, psychological problems, a mental illness or a combination of all three factors. It is clear is that there were a number of behavioural changes and out of the ordinary occurrences to Major Hassans everyday life that might have alerted others to the fact he was having problems. From across the Atlantic, reading about the story, it seemed incredible that nobody noticed anything. But then I thought again. In reality there would of course have been enormous difficulties for anyone to make an appropriate intervention if and when they noticed something was wrong.

He was after all a psychiatrist and a doctor. Doctors hold a privileged position in most societies. As individuals most of us will listen and take note of what doctors have to say. What they have to say is often perceived as being inviolate and unchallengeable. Indeed, for many nurses, being able to appropriately challenge their medical colleagues in the course of their practice is still a very difficult thing to do. The hegemonic power doctors enjoy is often strongly institutionalised and supported within and outwith the many organisations of health and social care. We may have come a long way since Steins original thinking around the Doctor – Nurse Game, (others might say we haven’t) but it can still be difficult for the nurse to be seen as a equal professional in a system that is very clearly weighted in favour of medicine.

So perhaps it is not surprising that other colleagues in Fort Hood did not or could not do anything. Challenging the very embodiment of society’s number one sanity assessor would be an almost impossible thing to do. For me, the situation takes me back to the age old question of: Quis custodiet ipsos custodes? (who guards the guards?). Plato talked about them (possibly doctors, but certainly the professions) looking after themselves, and they would be able to do so because of a heightened sense of vocation and desire to serve others. It is certainly true that governments all over the world have struggled to deal with the countervailing power relationships between the State and Medicine in resolving these dilemmas. More regulation is not the answer, arguably, more and better education probably is.

The desire for education can be found everywhere. I received a request this week to facilitate an educational conversation with colleagues who were struggling to understand how best to respond to another colleague who was experiencing mental health problems. This approach appeared to me to be entirely genuine and well intended. I will have the conversation, and I am pleased to do so. I believe it will be as much about helping others better understand themselves, and to do so in relation to understanding the mental health of their colleague. Such a conversation can only be a good thing. Mental illness still brings with it a stigma reaction, usually born out of ignorance and unfounded perceptions. For example, people with a mental illness are likely to be murderers and violent, or that if you talk to some who might be contemplating taking their own life it will make them more likely to commit suicide.

The Golden Gate Bridge opened in 1937, and since this time, one person every two weeks has gone there to commit suicide. I mention this sad fact, partly to start the conversation about the nature of suicidality, and partly in addressing comments made in response to my thoughts last week about conference attendance. I hope we can develop the debate about conference going further. We need to think a great deal more about how we engage with new technology particularly in rethinking about such activities as attending conferences. However, parking that debate for one moment, there was a good point made last week in the response. This was around continuing to ensure we find better ways of sharing experiences, whatever this takes. This may continue to be through conferences, publications, or educational conversations, or blogs like this one, and I hope I didn’t imply anything different. As was noted in the comment, sometimes it can be difficult to predict the impact of attending a conference and meeting others in a different place. Finally, and with a somewhat sad symmetry to these thoughts, I note it was announced this week that Claude Levi-Strauss had died.

Levi-Strauss, was widely considered to be the father of modern anthropology. He was born on Nov. 28, 1908, in Brussels, Belgium. He studied in Paris and went on to teach in Sao Paulo, Brazil, and conducted much of his research from there. Levi-Strauss was awarded honorary doctorates at universities, including Harvard, Yale and Oxford. The very first overseas trip I went on as a new member of MMU was to Sao Paulo. This was part of an EU funded project that required meetings to be held in South America and Europe. During what was an immensely exciting trip, my subsequent interest and passion in anthropology was born. The life work of Levi-Strauss helped me (and I am sure countless others) with my studies of human behaviour and thinking. He also was a great believer in how conversations help all of us better understand each other.