Odd socks stamp out mental health stigma

Odd socks for mental health, photo supplied by www.grow.org.au

My choice to wear a matchless pair of socks today was a deliberate tribute to Mental Health Week. Odd Socks Day is just one of the many events sponsored through October to remind us that one in five Australians suffer a mental health disorder in any 12-month period.

I’d never heard of Odd Socks Day, but spotted a flyer in a café somewhere and tucked it away for future reference. It’s a national anti-stigma mental health campaign now in its fourth year, using odd socks as a metaphor that anyone can have an off day.

Despite the fact that the majority of people visiting GPs are consulting them about mental health or psychological issues, those with physical ailments are not confronted with the same level of discrimination, stigma and social shame.

Young people are particularly vulnerable to stigma. Research in 2016 uncovered some alarming facts about stigma and what an obstacle it is to people trying to recover from a mental illness. Headspace found that 26% of young people aged 12-25 would not tell anyone if they had a mental health problem and 22% would be unlikely/very unlikely to discuss it with their family doctor.

Fifty-two percent of young people (12-25) identified with having a mental health problem would be embarrassed to discuss the problem with anyone and 49% would be afraid of what others think.

The Royal Australian College of General Practitioners recently found that 62% of people (via the traditional 10-minute consultation), were seeking support for mental health disorders.

The most common mental health ailments likely to afflict people are depression, anxiety and substance abuse. Sadly, many people struggling with depression use drugs and/or alcohol to self-medicate, often with negative results.

In my former work life, the notion of taking a ‘mental health day’ was anathema to your average hard-bitten journalist, for whom the deadline reigns supreme. But in recent years the previously taboo subjects of depression and suicide are now being freely publicised and debated. The hidden cost of not properly dealing with workplace mental health problems is now an $11 billion problem for Australian commerce. There is now an argument that $1 spent on mental health services equates to a ROI (return on investment) of $2.30. So why aren’t we spending?

If there is one indicator to show how stigma and mental health ratio is shifting, it is the NRL ‘casualty ward’, which lists rugby league players and their injuries. Through the season I recall at least six players said to be having counselling for ‘psychological’ or ‘personal’ issues, the latter covering a range of non-physical traumas. Dragons half Ben Hunt spoke candidly to the media this year about seeing someone to help overcome a slump in confidence. Armchair critics (virtual bullies) did not help Ben’s situation, with a steady stream of vitriol posted on social media.

Suicide is often the end-game for people fighting ongoing battles with mental health disorders. Australia’s standardised statistics on suicide are not as high as some (11.7 per 100,000 people). Lithuania (28.6) and South Korea (26.3) head the World Health Organisation list, but Australia is nonetheless in the list of 10 countries with a suicide rate in double figures and has been for a decade.

In Australia, men are three times more likely to commit suicide (17.8 deaths per 100,000 people) than women (5.8 deaths per 100,000 people). More than 75% of all severe mental illnesses occur prior to the age of 25, and youth suicide is at its highest level in a decade.

The telling statistics revealed by the Royal Australian College of General Practitioners clearly show that the system is under untenable strain.

Author Jill Stark wrote about it in a Sydney Morning Herald opinion piece – ‘What happens when the answer to R.U.O.K is no and there’s nowhere to go?’

Stark wrote from a first person perspective, after  fronting up to a GP with what she suspected was an acute recurrence of anxiety and depression. She was handed a form to fill in – a routine step in such a consultation, so the GP can make a more objective assessment of the patient’s mental health state. As Stark related, she scored 25 ‘mild to moderately depressed’ and was prescribed medication (after first being asked if she was suicidal).

The answer was no, but on the way home Stark reflected that should she indeed want to kill herself, she’d been prescribed with something well-equipped for the job.

As Stark bluntly pointed out, the time for wristbands and hashtags has passed. Doctors need the financial support Medicare can bring by allowing longer consultations for patients with complex psychological problems.

“As a matter of urgency we must stop rationing psychological services to 10 subsidised sessions per year,” she wrote.

So that was Jill Stark, wearing her odd socks in public. Bravo.

People like Jill who are having an acute mental health crisis need expert support at least once a week for as long as the crisis lasts.

The Black Dog Institute reminds us that 45% of Australians will experience a mental illness in their lifetime. One in five mothers with children younger than two will be diagnosed with depression. At 13%, depression has the third highest burden of all diseases in Australia (burden of diseases refers to financial cost, mortality, morbidity etc).

The World Health Organisation (WHO) estimates that depression will be the number one health concerned in both developed and developing nations by 2030.

That gloomy prediction was no doubt behind the WHO’s decision in 2013 to introduce an eight-year plan to change the direction of mental health in its 194 member states. The plan’s main objectives are to:

  • strengthen effective leadership and governance for mental health;
  • provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
  • implement strategies for promotion and prevention;
  • strengthen information systems, evidence and research.

Global targets and indicators were agreed upon as a way to monitor implementation, progress, and impact. The targets include a 20% increase in service coverage for severe mental disorders and a 10% reduction of the suicide rate in member countries by 2020.

These are noble aims, but as the WHO observes, it requires effective leadership and governance to implement meaningful change.

Odd Socks Day is one of the rare light-hearted efforts to raise awareness of mental health. Grow, the organisation behind the campaign, runs an in-school peer program that helps young people support each other through their issues.

The overall cost of unmanaged or mismanaged mental health in the Australian workplace is approximately $11 billion a year, according to Dr Samuel Harvey. Dr Harvey, a Black Dog Institute consultant, leads the workplace mental health research program at the school of psychiatry for the University of New South Wales. He was the lead author for research published in The Lancet which found that workplaces that reduce job strain could prevent up to 14% of new cases of common mental illness from occurring.

Quite clearly, we all need to pull up our socks, odd or not, and change our attitude. If only 35% of Australians in need are actively using mental health services, we need to do more than ask R.U.O.K.

Resources: Lifeline 13 11 14, beyondblue.org.au

FOMM back pages:


Bipolar disorder and gout

Empty chair at Baroon Pocket Dam – Photo by Bob Wilson

This may seem an odd way to approach an essay about bipolar disorder, but I had forgotten that lithium was at one time prescribed for gout. Not that I’ve ever had gout, but a couple of relatives who do have it tell me it is not something you would wish upon your worst enemy – or even Donald Trump. Gout is a painful inflammation of joints caused by an excess of uric acid which forms needle sharp crystals in the joints, hence the pain.

The conventional solution is medication and avoiding rich, fatty foods. Traditional medications are allopurinol and colcochine although some GPs and naturopaths recommend low doses of lithium combined with vitamin C to make uric acid soluble and easier to expel from the body.

The point being, very few people would stigmatise gout-sufferers for taking medication to ward off the acute pain that comes from an attack. Yet lithium is the drug of choice dispensed by psychiatrists when diagnosing someone with bipolar disorder. The latter is very much a stigmatised condition. However, as we will see, some famous people are working to ‘normalise’ it through documentaries and speaking tours.

Author Edward Shorter traced the history of lithium in an article published by PubMed Canada and archived by the US National Library of Medicine:

A London internist, Alfred Baring Garrod, recommended lithium treatment for gout after discovering uric acid in patients’ blood. This was in 1847, 12 years before Garrod wrote The Nature and Treatment of Gout and Rheumatic Gout.

Lithium, a naturally occurring mineral, was used to treat mania in the 19th century, particularly in Denmark, but did not emerge as a mainstream treatment until 1949, when Australian doctor John Cade was credited with re-introducing lithium to psychiatry.

Despite the development of pharmaceutical alternatives (valproate, lamotrigine, carbamazepine), it is still regarded as the ‘gold standard’ for mood stabilisation and treatment of major depression.

The gout sufferer, meanwhile, simply has to cut down drinking beer and avoid purine-rich foods (such as red meats, offal, some seafood and Vegemite). His or her sanity is unquestioned. If asked (say at a barbecue with friends and neighbours), they will freely talk about their swollen joints; knobbly elbows and inflamed big toes may even be shown.

No such empathy for the approximately 727,300 Australians (about 3% of the population), with some form of manic depression/bipolar disorder.

In 1980 the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), changed the classification system to bipolar disorder, a more clinical and less emotionally loaded term than the stigmatised ‘mania’ or ‘manic’.

Stigmas die hard. There are hard-to-shake myths, worst-case scenarios magnified in the press and on current affairs TV, which focus on the tragic cases that fell through the cracks in the system. We form fixed ideas about the mentally ill, shying away from people we see as ‘odd’.

I started exploring the subject (it’s Mental Health Week after all), after watching Stephen Fry’s Not So Secret Life of a Manic Depressive 10 Years On. Fry, originally diagnosed with the less disruptive form of bipolar (cyclothymia), made a controversial documentary series a decade ago where he interviewed well-known bipolar sufferers including actor Richard Dreyfuss. The psychiatric profession was generally dismayed with Fry’s (then) stance against taking medication.

In this update, Fry is diagnosed with bipolar 1 (the more serious type in which sufferers may have psychotic episodes) and he starts taking medication, although confessing to self-medicating (as many sufferers do); in his case with alcohol, diazepam or sleeping pills. In the hour-long ABC documentary, a range of people with bipolar disorder are interviewed and the nature of their disorder is laid bare. There’s a young woman who became a paraplegic after jumping from a balcony (in her manic state she thought she could fly). There’s a chef whose wildly swinging moods are endangering his job and his home life who finally decides to stick with lithium.

Although bipolar disorder afflicts only 3% of the population, the odds are that only 50% of these people will be able to hold down a job.

People who plainly don’t understand mental illness may react badly on seeing an apparently healthy 20-something man wandering around in the middle of a working day. Because he is taking medication to quell the various strands of his illness, he is not talking to himself, acting oddly or accosting people. But he is still (invisibly) unwell.

“He’s got two arms and two legs hasn’t he? Tell him to get off his arse and find a job,” some might say.

Ah yes, so he’s a ‘leaner’ not a ‘lifter,’ a polarising notion recycled in 2014 by former Treasurer Joe Hockey (borrowed from the lexicon of Liberal Prime Minister Robert Menzies).

As Fry’s documentary shows, some bipolar sufferers have ‘normal’ friends who support them through the worst of their illness and stick around during the well times.

Others not so fortunate retreat into their own heads while their friends may drift away. Fortunately, there are support groups which can help people struggling with the feeling they are on their own.

It is easy enough to find long lists of famous people who have ‘come out’ and declared themselves bipolar and one would hope this helps to push stigmas and myths into the corner.

Surrealist painter Edvard Munch (who painted “The Scream”), is on this list, so too Beach Boy singer-songwriter Brian Wilson. The late Spike Milligan owned up to it, as did former NRL star Andrew Johns and a long list of composers, writers, comedians, actors and celebrities.

Margaret Trudeau, mother of Canadian Prime Minister Justin Trudeau travels the world speaking out against the stigmas and myths surrounding this admittedly confronting disorder. If you are my vintage, you may remember reading about Margaret in the popular press, hanging out at nightclubs with famous rock stars and generally not living as one might expect of the first lady of Canada (then married to Prime Minister Pierre Trudeau). In hindsight, those florid 1970s reports of Margaret jiving at Club 54 with Mick Jagger and the Stones typify a person in the throes of a typical bipolar manic phase: disinhibition, impulsive behaviour, risk-taking, spending sprees and so on.

In a lengthy interview with Will Pavia in the Sydney Morning Herald, Trudeau, now 68, at one point began to talk about her passion for bringing mental health issues into the spotlight. From February to June she travels, campaigning about brain diseases, depression and her experiences of living without the medication she now takes. Trudeau says she is helping to break the last great taboo – “The thing people are most afraid of talking about”.

At which point Pavia observes: “She is certainly not afraid to talk about it. She talks at a rate of knots…if this is Trudeau on mood stabilisers, what must she have been like, for all those years, when the mania struck?”

Great question, Will, one which reminds me of an older chap I know who was diagnosed with bipolar in the 1960s.

“I took the lithium and after a few months I felt great so I said, Doc, I don’t need to take this anymore. At which point he looked at me and said: “Don’t be a f***’ng idiot!”

(What I wrote last year):                    

rainbow-lorikeet-02And on an entirely different note, Bird Week starts on Monday 17th October- you’re invited to spend 20 minutes one day next week to count (and name, if possible) the birds in your backyard- check it out at this website. To get you started, this is a Rainbow Lorikeet – common, now that the Bottlebrush is flowering. (Ed.)


Talking to the empty chair

Chair on beach Jasleen Kaur

A good few decades ago, I’m having time off work; my more attuned friends describe it as ‘having a rest from his mind’.
Friends have come to visit. Some kind of coincidence, the four of them – all psychologists – sitting around the table on the back veranda. I’m wearing the top half of a pair of pyjamas, a Sulu (Fijian garment) and slippers. I’m doped to the eyeballs – diaze-something, a blobby sponge soaking up everything and feeling nothing.
The overwhelming memory is of these four psychologists, having a quiet glass of wine in the late afternoon, looking at me with this kindly detachment, a bit like a vet examining an old dog whose time has come.

Time to talk to the empty chair

Apparently it’s Mental Health Month in New South Wales – a bit of an improvement on raising the issue for a week, like elsewhere, then forgetting about it for the rest of the year. NSW Mental Health Commissioner John Feneley was making a case in a Sydney Morning Herald column on Monday asking people to think about people with serious mental health disorders – schizophrenia, bipolar disorder and unrelenting forms of depression – and try to get over the instinct to avert our eyes.
One in five Australians suffer from some form of mental health disease – be it one of the basket of ailments usually described as neurosis (depression, anxiety, OCD, phobias) or long-term psychotic disorders like schizophrenia.

So let’s talk about neurosis and remember we’re talking about a sliding scale here. When it comes to dealing with what my mother’s generation called ‘an attack of the nerves’, most of us take the medication the GP gave us and lie down until the feeling passes. Not going to work really helps.
Once you understand the nature of a panic attack and no longer feel you are going to die on the spot, a brown paper bag is a handy accessory.
Some decide they need to talk to someone about the root cause, so flick through the yellow pages looking for a registered psychologist. It shouldn’t be hard – there are 32,766 registered psychologists in Australia. There are many more whose expertise is not endorsed by the Psychology Board of Australia so they hang out the ‘counsellor’ sign.
I have had a few fruitful adventures with counsellors of one kind or another – talking to the empty chair, picking up the heavy rock (and putting it down again).

Blessed are the toast-makers

Psychologists know which buttons to press. Whenever I get up late at night for a snack, I still remember what one counsellor said about this nervous habit.
“What would happen if you didn’t eat toast?”
Before eventually ‘seeing someone’, I took refuge in daily journals in which I had been scribbling since the early 1970s. (Executors have been instructed to build a Charles Dicken-style bonfire with these diaries). Interesting now to find references to a ‘periodic head-check’ which was my way of dealing with psychological problems – to have an imagined conversation between your addled self and an older, wiser, sober self. The following is for entertainment purposes only; it may be a figment of the writer’s fertile imagination and should not be construed as advice, medical or otherwise.

Searching for Dr Zeitgeist

Dr Zeitgeist: It’s been a while.
BW: “Looks like rain – probably will.”*
Dr Z (consults file): Hah! You quoted Eeyore last time you were here. Is he a permanent fixture in your life then?
BW: (turns to examine his bottom) “It’s not much of a tail, but I’m sort of attached to it.”*
Dr Z: (aside) Did you know Disney has trademarked the names Pooh and Eeyore?
BW: But, but, – they belong to our childhood!
Dr Z: Anyway, I digress. What brings you here today, apart from the turned down mouth and slack-shouldered look of the long-term depressive?
BW: I take pills for that – this is more of an existential angst.
Dr Z: (steeples hands under chin) How so?
BW: Well I hear the ADF has carried out 9 ‘strike missions’ in Syria, adding to the general mayhem over there and at the same time we’re agreeing to accept only 12,000 of the 9 million Syrian refugees. I feel bad about that.
Dr Z: This is sublimation on your part – you are finding other reasons for your feelings of despair instead of confronting the root cause.
BW: Do you seriously think I’m going to get into this with several thousand readers looking on?
Dr Z: If you don’t use it, you lose it – very important at our age to remember that. Now, what’s really troubling you?
BW: I lie awake in the early hours of the morning, turning things over and over, like flipping pancakes.
Dr Z: So you ruminate?
BW: All writers ruminate. It’s how we write. And I don’t want to burn the pancakes.
Dr Z: But you’re not happy about it?
BW: I’d rather be asleep.
Dr Z: When you do sleep, do you dream?
BW: Do I dream! Technicolour, with music, dancing girls…
Dr Z: Tell me about one of these dreams.
BW: I have this recurring dream where I’m back at work and nothing is working out and I’m sort of aware, even though I’m asleep, that this is absurd because (a) it’s the last place in the world I want to be and (b) I was actually very good at the work.
Dr Z: (claps hands lightly and exclaims Mein Gott!): Classic! So this was the last time in your life you had great responsibility and success?
BW: I guess so.
Dr Z: You need to look at your life now and you may find an area of great responsibility where you are not having much success.
BW: I have this other dream where I’m driving too fast and my feet won’t reach the pedals or the brakes don’t work.
Dr Z: Do you go off a cliff into the ocean – dashed to pieces on the rocks?
BW: I thought maybe I’m trying to do too much for no good reason and need to scale down and take control of my life again.
Dr Z: Ah, like that line in your song where the swaggie staggering around in the desert has only one book, ‘The Theory of Control’.
BW: Sent you a copy, did I?
Dr Z: How’s the album going anyway?
BW: I think it’s what they’d call ‘a critical and artistic success’.
Dr Z: Have you seen the documentary, Searching for Sugar Man, about the singer-songwriter Rodriguez?
BW: He flopped in the US but was bigger than Elvis in South Africa, though everyone there thought he was dead. Meanwhile, he’s living in the USA and he didn’t know about any of it.
Dr Z: And then he was found and made famous again in South Africa, after giving up his dreams of a musical career and spending his life as a construction worker in Detroit.
BW: And we’re talking about this why?
Dr Z: I thought the analogy wouldn’t be lost on you, or your readers.
BW: Well, good to catch up, Dr Z. It still looks like rain.
“However, (brightening up a little), we haven’t had an earthquake lately.”*
*quotes from The House at Pooh Corner by A.A. Milne