Death of motorcycle champion Robert Dunlop - a fatal attraction to risk?

Fans defend dangerous sport

The death of motorcycle champion Robert Dunlop reminds us again that risky behaviour has a huge attraction for people and maybe for men in particular. He died in an accident during a practice session for the North West 200 in Portrush last Thursday evening. Next day on the Liveline programme on RTÉ, caller after caller lined up to defend the sport while acknowledging the recent deaths of motorcyclists and of Dunlop's brother Joey in 2000. The basic message was that people who get hooked by the sport wouldn't want to live without it. Do they get addicted to the adrenalin rush? Following his death, his widow Louise said Robert Dunlop knew the sport would one day kill him.

"He was prepared to accept the risk," she told The Irish Independent.

"He had to be in the thick of it himself. That was just his way."

"The lights have gone out for us," she added. "Nothing will ever be the same."

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Nuala O'Faolain dies age 68

I was sorry to read of the death of Nuala O'Faolain just before midnight, 9th May 2008, last night at Blackrock Hospice. Her interview with Marian Finucane a month ago startled and touched many people. It also tore away the veil of "don't talk about it" that surrounds terminal illness. It is some consolation that she died in a hospice where the experience would have been made as painless as possible. I hope she found some peace towards the end.

RTÉ's report of her death is here.

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And here is the rest of it.

Depression alone cannot explain murder-suicide of Flood family in Clonroche

Depressed people rarely engage in physical violence towards others

Text of my article in The Evening Herald, Friday 2nd May 2008:

Depression and anxiety are the twin scourges of our emotional world but society views each of them very differently.

It's 'alright' to be stressed out - in some settings it may even be the done thing to complain about stress on the idiotic grounds that if you're not stressed you're not working hard enough.

But it's 'not alright' to be depressed and people with the condition often keep it to themselves for that reason. Some, for instance, will not state on an application form for life insurance that they have suffered depression because they fear they will be denied cover.

That said, it is unlikely that depression, or depression on its own, could account for acts such as the murder-suicide of the Flood family in Co Wexford.

It seems reasonable to suppose that some level of delusion, perhaps including hallucinations or voices, could have provided the impulse for the tragedy.

Depression involves a debilitating mixture of low mood, negative thoughts and fatigue. The sufferer loses interest in his or her usual activities.

Depression can arise as a reaction to life events. The birth of a child, for instance, can be followed by post-natal depression. Grief can turn into depression. So can a sense of helplessness or of being trapped in an unhappy relationship.

Researchers believe depression has increased over the past one hundred years. The reasons for this are not clear but depression may be the price we pay for our increasingly sedentary lifestyle. We no longer 'work off' negative moods or feelings and we have too much time to brood which, in itself, can trigger or prolong depression.

People suffering from depression generally begin to seek help by going to their GP. The GP will probably prescribe medication and may also refer them to a counsellor. Counselling can be very effective in helping people to overcome depression and to change the thinking patterns or circumstances that may have led them to become depressed in the first place.

Depressed people are the last you would expect to indulge in violence. Indeed, some psychologists believe that people become depressed because they turn their anger in on themselves instead of inflicting it on others.

This, again, is why we need to be cautious about attributing the terrible events in Clonroche to depression in the father. As a report in yesterday's Evening Herald pointed out, it is highly unusual for a depressed person to kill someone else.

But there is, as we all know, a strong link between depression and self-harm including suicide. Sometimes this happens when the depressed person starts to feel better because it is only now that they have the energy to carry out the act. This, obviously, is a point at which counselling can be crucial.

Many depressed people also turn to self help groups such as Aware, Grow and Recovery. These can provide a real lifeline for people with depression, especially for those who cannot afford private counselling fees.

The most important step to take in depression is to seek help whether from a counsellor, GP or self-help group.

This is not as easy a step to take as it may seem. A considerable amount of prejudice against persons with mental health problems persists, as research by the National Office for Suicide Prevention revealed last year. The researchers found that 52 per cent of people interviewed did not believe people with mental health problems should be working in jobs such as medicine. One third would be uncomfortable talking to a person with mental health problems - completely ignoring the fact that they have probably talked to people with mental health problems quite often without knowing it. Thirty nine per cent thought the public ‘should be better protected’ from people with mental health problems.

We all get a touch of the blues from time to time. Very often depression lifts by itself but when it persists people should seek help - we need to make it easy for them to do so.

Aware has a helpline at 1890 303 302 and has self-help groups throughout the country. The Samaritans are at 1850 60 90 90. Grow is at 1890 474 474. Recovery can be contacted at 01 6260775.

Nuala O'Faolain opens the way for other terminally ill people to say how they feel

This is the text of my article which appeared in The Evening Herald on Monday, 15th April 2008. Please note that many listeners found listening to the interview distressing. A transcript is here on the Irish Independent website. O'Faolain is author of Are you somebody, Almost there, My dream of you and The story of Chicago May.

[Note: Nuala O'Faolain died on 9th May 2008]Many people have wondered if Nuala O’Faolain’s interview with Marian Finucane on RTÉ Radio One on Saturday was distressing to persons with terminal illness. I would suggest that the interview was distressing to all of us but potentially comforting as well, two reasons.

The first is that we all have a terminal illness because, like her, we will all suffer death though not all of us will know about it at the time. The second is that people with terminal illnesses are expected by society to face the end in a particular way, namely with serenity, yet for many this is not the way they want to do it.

The bleakness and despair in her interview struck home particularly, I think, because it echoed that awful bleakness that a person can feel when they are awake alone in the middle of the night and the gloomiest of thoughts come to haunt them.

Nuala brought that bleakness into the light of a Saturday morning when most of us do not want to be reminded of it.

Psychologists say that one of the great crises we face in our lives is the realisation that we are going to die. We all know intellectually that one day we will die but it can take decades for us to feel the full force of that realisation. It can be triggered by the death of another person, even somebody we do not know very well.

When the realisation happens, we must come to terms with a reality that shakes us to foundations. Some people respond to the reality by denying it. They aim for eternal life on earth and take any treatment that promises to prevent the inevitable. Others become depressed or anxious or turn to drink or drugs. Most of us, I think, take the realisation of the inevitability of death as a wake-up call suggesting that we had better get on with doing the things we wanted to do in life.

In her interview, Nuala sound like somebody whom that realisation only hit six weeks ago when she got her diagnosis of terminal cancer. She is trying to cope with the realisation and the reality at the same time, an enormous demand on any human being. In saying that, I realise that I am presuming a great deal and that I may be entirely wrong.

One of the ways we deny the reality of death is to expect other people to die with a smile on their lips. Nearly twenty years ago, Therese Brady, who was then director of post-graduate training in clinical psychology at University College Dublin, complained about the expectation that people should face the death in ways that everybody else approved of. She developed the bereavement counselling service for the Irish Hospice Foundation. People who were dying were expected to do so in line with the expectations of a society which had, she said, “outlawed distress.”

It seems to me that by outlawing distress we have denied dying people the right to talk about this most significant of events. How often is the person who is dying told, when they want to express their feelings about it, “Don’t be talking like that, shure you’ll outlive us all”? What does it feel like, I wonder, to have to put up with that sort of nonsense when you are trying to make sense of your own death?

We will all face death in our own different ways. What Nuala’s interview has done, I hope, is to give permission to those who wish, in the words of Dylan Thomas, to “rage, rage against the dying of the light” to go right ahead and do so regardless of how the rest of us feel about it.

I wish Nuala some comfort in her journey.

Still driving the cattle - men as stubborn as mules in the face of illness

This is the text of my That's Men column in The Irish Times on Tuesday, 1st April, 2008. A collection of That's Men columns will be published by Veritas this summer.

I have a childhood memory of my father insisting on driving cattle along the road to a mart in Kilcullen even though it was raining and even though he had been diagnosed with pleurisy.

By “driving” cattle I mean walking after them with a stick and a dog while they headed up every side-road they encountered.

I don’t know what the treatment for pleurisy is but I’m pretty sure that walking after cattle in the rain is, as they say, “contra-indicated.”

But my father got into that stubborn state that men get into about these things and was quite determined that pleurisy was not going to deter him from selling cattle regardless of the consequences.

As it happened, there were no consequences. He survived both experiences.

Nevertheless this type of behaviour in the face of illness is, I think, a particularly male thing and I was reminded of my father’s stubbornness on reading of new research from Holland and the US on how couples react to a diagnosis of cancer.

The researchers found that if one member of a couple is diagnosed with cancer, the woman suffers more distress than the man. Even if it was the man who had the cancer, it was the woman who was the more distressed, according to a report on the research in the Psychological Bulletin.

"In practical terms, breast cancer patients are going to be, on average, more distressed than their husbands; but the wives of prostate cancer patients are going to be, on average, more distressed than their husbands," according to the study’s lead author, Professor Mariët Hagedoorn.
In coming to their conclusions, the researchers analysed 43 studies from around the world on distress in couples with a cancer diagnosis.

I wonder if this has something to do with men’s resistance to “giving in” to illness? I have very often heard women shaking their heads at their husbands’ reluctance to go along freely with the treatment laid down by the doctors.

In many cases, though of course not all, it is left to the wife to oversee the medication regime, especially if it’s complicated. If the doctor needs to be spoken to, that is left to the wife as well.

Some of what is going on here is a power struggle, I suspect. By accepting that you have an illness – cancer, pleurisy or anything else – you are putting yourself in a weak position in the sense that you are not the big, strong man you are expected to be.

Now along comes your wife with concern, advice, medication and an eagle eye – a caring eagle eye certainly, but an eagle eye nevertheless. This must be resisted in the same way that Superman must resist anyone who might suggest that he expose himself to green kryptonite.

But how do you resist? Why, by only grudgingly agreeing to take your medication, by forgetting out-patient appointments and by insisting on driving cattle along the road in the rain.

This behaviour is also linked, I think, to the “it’s only a flesh wound” scenario in the movies. A bad guy fires a bullet through the hero’s shoulder, an experience which would knock most of us into the day after tomorrow. Not our (always male) hero. “It’s only a flesh wound,” he declares and carries right on, fighting the good fight, perhaps with a fainted female slung over the good shoulder. When it’s all over there’s not a bother on him, except for the bullet holes in his shirt – and with luck that fainted female remembered to bring her sewing kit along.

By the way, that study also found, perhaps surprisingly, that cancer patients in general suffer only moderate levels of distress when compared with the general population.

"Only a minority of cancer patients suffer clinically significant distress," according to Professor Hagedoorn. "The myth that all cancer patients are distressed gets in the way of getting the proper attention to those patients who do become significantly distressed and who could benefit from a clinical intervention."

But that’s another story. Meanwhile, what about all those stubborn men? We are, of course, in the 21st century, the era of the New Man so all that stuff really belongs to another age. We new men would never behave in such a silly way.

Would we?

Got an opinion? Comment here.

Caring not only a female role - four out of every ten carers is a man

Photo by Sea Frost (Flickr)

This is the text of my That's Men column which appeared in The Irish Times on Tuesday, 25th March 2008. A collection of That's Men columns will be published by Veritas this summer.

What’s your image of a typical carer? It’s probably of a woman looking after a family member and in most cases you would be right.

But census figures show that about almost 40 per cent of carers are men. For these, as for their female counterparts, caring has certain negative consequences but some of these consequences may be different for men.

For instance, research in Northern Ireland has shown that 24 per cent of men looking after a dependant at home suffer “a severe lack of support” (the quote is from a booklet published by Derry City Council) compared to 15 per cent of women.

This suggest to me that women are more likely than men to keep in touch with a friend who has had to get heavily involved in caring. Perhaps it also means that men’s friendships are more likely than women’s to be linked to the workplace – if so, then a man who has to give up work to care for, say, his wife or a parent loses not only his income but also his social network.

Maybe we men need to follow the example of women and do more to stay in touch with friends who disappear into the world of caring.

The research from Northern Ireland shows that both male and female carers experience “a great deal of stress” to a greater extent than those who are not involved in caring – 17 per cent as against 9 per cent. Note that we’re not just talking about stress here, but “a great deal of stress” and we could expect general stress levels among carers to be higher than 17 per cent.

In Northern Ireland, 49 per cent of those caring for someone at home have a long-standing illness themselves, possibly an indication that these carers tend to be older.

Illness contributes to stress, of course, but I suspect there are many other sources of stress for carers, male and female. For instance, family members have a tendency to leave the carer to get on with it – it’s so much more convenient to say “Sure isn’t he great?” and to maintain a safe distance than to help out. The carer notices this and resents it but often lacks the assertiveness to insist that other family members play their part.

Then there are the endless battles with authority to get social services – a nursing or home help service, for instance. And there are the long hours in A&E waiting to be seen, waiting for an X-ray, waiting for a bed.

And the person being cared for may not help. If you were a contrary, awkward, impossible so-and-so all your life you’re probably not going to change when you need long term care. And some previously reasonable people can actually get contrary and demanding when confined to bed. Pity the poor carer who bears the brunt of it. (Memo to my kids: cut out this article and read this paragraph to me if I ever get like that. Better still, go live in Manhattan and keep out of the way).

Because women are seen as more capable and caring than men, I suspect that male carers are in a better position to get help from the social services. I also suspect that men are more reluctant than women to ask for such help, which cancels out the advantage they would otherwise have.

Caring can be based on love, duty or both. I expect that caring based on love can be very fulfilling, though tinged with sadness if the person being cared for is not going to recover. Caring based on duty is, it seems to me, a far more stressful proposition.

Love or duty, men or women, carers get only a fraction of the support and recognition that is owed to them by our society. I wonder if this is because caring is perceived to be something that is done by an army of invisible women who can be ignored?

And I wonder would this change if caring also began to be seen as a men’s issue? Perhaps it would – but whether it would or it wouldn’t, caring is, indeed, a men’s issue too and this will increasingly be the case as our life expectancy goes up.

Got an opinion? Comment here.

In this Sikh family, schizophrenia was no bar to being an affectionate father

When Sathnam Sanghera was growing up in Wolverhampton his father suffered from undiagnosed schizophrenia and spent hours and hours just watching TV during the day. He never brought his son fishing or showed him how to ride a bike.

But, writes Sathnam in his book If you don't know me by now (Viking, 2008) "The best offering a fathe can make his children is himself, and in this respct mine was fantastic. He was always around. He was there at breakfast and at teatime.....And he also walked me to school every day. Several times a day, in fact: he would be with me on the ten-minute walk from home to school in the morning; on the ten-minute walk back from school to home at lunchtime; on the ten-minute walk from home to school at the end of lunchtime; and on the ten-minute walk back from school at the end of the day."

When, at the age of seven, he started primary school, "I was old enough to make my own way. But when, on my first day at primary school, Dad appeared at the front door as usual - five minutes early, staring at his watch, repeatedly checking his pockets for his housekeys, as usual - I took his hand gratefully."

The full title of the book - about growing up in a Sikh family - is If you don't know me by now: a memoir of love, secrets and lies in Wolverhampton and it is published on 6th March.

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A mindfulness approach to chronic pain

This is the text of my That's Men for You column published in The Irish Times on 19th February 2008:

I am always reluctant to write about chronic pain and about psychological approaches to coping with it. This is because it is so easy to patronise people who are in pain when you are not in pain yourself.

Chronic pain is pain that can only be managed – it isn’t going to go away completely. As a person who is a coward when it comes to pain, I cannot imagine what it is like to have to cope with this torment day in and day out.

There is some research into psychological approaches to pain which offer the possibility of improving one’s way of coping with pain and that may be of help to readers in this situation. These involve acceptance and meditative practices.

Why in Heaven’s name should you accept pain? You shouldn’t, in my opinion, if the doctor, the physiotherapist or the chemist can help you to get rid of it. But if the pain cannot be made to go completely, the methods described here may help.

People who are in pain can be said to suffer from two types of pain. The first is the pain which arises from their injury or illness. That pain is largely, perhaps completely, outside their control. The second is the emotional distress which they feel because of the physical pain. It is this second type of pain that acceptance and some meditative practices can help to reduce.

Last year, researchers from NUI Maynooth, NUI Galway and the University of Almeria, Spain, published research showing that people subjected (willingly) to electric shocks had a greater level of endurance if they accepted the shocks instead of trying to distract themselves from them. This, though a small scale study, seems to confirm what many have believed for a long time about the importance of acceptance in dealing with pain and, indeed, with much else in life. The report on their research appeared in the journal, Behaviour Research and Therapy.

Mindfulness meditation has been used for years now at the University of Massachusetts Medical Centre to help people live with chronic pain and stress while experiencing a higher quality of life than before. Dr Jon Kabat-Zinn, who runs the pain clinic, has published an account of his work in the widely-available paperback Full Catastrophe Living.

Mindfulness involves continually bringing your awareness back to what is going on right now whenever it strays off into the past, the future or into fantasy. It sounds easy but it takes more practice than you might think.

In mindfulness you accept the pain that is inevitably there while expanding your awareness of those parts of your body that are not in pain, of the room around you, of other people and so on. This is not a substitute for medical treatment – it is something you do alongside medical treatment.

Blue Sky based in Dublin and run by people with a Buddhist and medical background offers a low-cost course based on Kabat-Zinn’s work.

Here is a simple, four-part mindfulness exercise to give you an idea of what the use of a mindful approach might involve:

1.
Notice your breathing. Notice your posture. Notice the points of contact between your body and the chair, floor, ground. Notice your clothes touching your body.
Every time you drift into thinking, just return to noticing your breathing.

2.
If you feel pain, notice the pain without getting involved in thoughts about it. Notice how the intensity of pain rises and falls but rarely stays the same.

3.
Notice the area of your body that surrounds the area of pain. Notice how that area is tensed up. Imagine that you are breathing into that area and allowing it to relax.

4.
Now, as well as your body, notice the room you are in. Notice how your pain is part of your experience. It is not your total experience. Now notice your breathing again.

Exercises like this do not, of course, get rid of the pain. Instead they are meant to help you to cope differently and to reclaim parts of your life and experience that the pain has overshadowed.

Fall in the suicide rate for young men in the UK - but more young women use dangerous methods

When I read the headline on the BBC website about the fall in suicide among young men in the UK I thought I had come across a reason to hope that in one society, at least, a way had been found to tackle this painful problem.

Well, it has and it hasn't. The suicide rate for young men in England and Wales is at its lowest level for 30 years, the report says. But this isn't due to a change in attitudes. "One key factor has been a cut in toxins in vehicle exhaust fumes because of catalytic converters - making it harder for people to kill themselves," it says.

Still, it's a good outcome but how long will it be before young men turn to more dangerous alternatives? Young women seem to be doing this already, with a dramatic rise in hanging. Could this, I wonder, be an unintended consequence of measures that made it more difficult to put together a large supply of paracetamol? Nevertheless, suicide rates among young women are at their lowest level since 1968.

Suicide is an extraordinarily complicated issue but the UK figures suggest that in Ireland we can hope to get the figures down by a variety of measures - even if those measures and their possible consequences are far from straightforward.

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Eighty per cent of Irish teenagers meet the guidelines for normal weight

Photo byTodd Ehler (Flickr)

I sometimes wonder if the obesity debate is getting out of hand. When doctors are busy alarming us about an "obesity epidemic" are they counting in people who are simply overweight? And are they, and the media, taking account of those who are naturally heavy?

Research reported in the Irish Independent suggests that 19 per cent of teenage boys have weight problems or are obese. The figure for girls is 17 per cent.

But the actual rate of obesity is eight per cent for teenage boys and six per cent for girls, the report says. And four out of five teenagers are within normal weight guidelines, according to Prof Michael Gibney from the Institute of Food and Health at University College Dublin.

So we're not all obese and the country is not sinking under our weight.

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Rural suicide figures suggest urban life not as unhealthy as we assume

We often think of life in cities and towns as unpleasant, hurried, stressful and therefore unhealthy - but the latest suicide figures from Co Clare suggest we may be wrong.

Last year, according to Gordon Deegan's story (premium content) in The Irish Times, 17 people (16 male) took their own lives in the county. This exceeds the number of deaths (12) from road accidents.

Of the 17 suicides, 11 took place in rural areas and 10 during the summer months. This is puzzling because we also expect a stronger sense of community in rural areas than in cities and towns - and community protects against depression.

Does anyone have an explanation?

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Men are missing from doctors' surgeries - and from health policy

I suspect many men would say women go to the doctor at the drop of a hat. They seem to regard the doctor as a friend whom they mean to see quite often. We men, on the other hand, see the doctor's surgery as a place to be avoided at all costs - no need to present yourself there until you've had a distressing disease for at least a couple of years. Even then shure what's the hurry? Well, it's just possible - maybe more than possible - that their willingness to go to the doctor is a key factor in helpling women to live longer than men. This article on the website of the Men's Health Forum England & Wales suggests that many more men could live longer if we saw our doctors more often and if health policy aimed to take our needs into account. In Britain it is now law that the health service take the needs of the differing genders into account but it's a new law and we don't know yet how effective it is going to be. But at least they're trying.....

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Gout - an under-rated and exceptionally painful man's disease

Image from irishhealth.com

Gout tends to be treated as a bit of a joke, seen as a well-deserved affliction of lords and kings. Of course, the majority of men who have gout are in neither category. This Guardian article by Martin Kettle graphically explains the awfulness of this male disease - and the comments to the article are informative too.

For a more technical article on gout, follow this link to irishhealth.com.

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Sarah Carey and the silence of the lambs

Photo by racka_roadrunner (Flickr)

I may make part of my living out of counselling and this attack on therapy from Sarah Carey's GUBU blog may date from before Christmas but it's still too good to miss. She wends her way from a lamb falling down a river bank to childhood memories of farm pets and from there she launches a broadside at the therapy business. Her basic thesis is that you might be better off allowing your mind to repress the bad memories from the past instead of dragging them up and upsetting yourself with them. She might be right too - my basic training is in Reality Therapy which sees the solution to our problems as lying in the present and the future and which, as an approach, stays out of the past as much as it can. Anyway, never mind me - read her article here which is more fun and wittier than anything I'm likely to come up with.

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Link between depression and heart disease needs our attention

Photo by Adoodi (Flickr)

Poorer outcome for depressed patients

This is the text of my That's Men for You column in The Irish Times on Tuesday, 18th December:

The link between depression and heart disease is not often written about, perhaps out of fear of causing distress to people with one or the other of these conditions or with both. But to remain silent about the link is to deprive people of information that could save their lives.

The latest research, from Columbia University’s College of Physicians and Surgeons, confirms earlier findings that people who are depressed following a heart attack are significantly more likely to die during a follow-up period than heart patients who are not depressed. This outcome has been found in follow-up periods ranging from six months to more than six years in different studies.

Other research suggests that people who are depressed are more likely to suffer heart illness in the fist place than those who are not depressed.

Quite how it works is not clear. One theory is that in depression the brain’s regulation of the production of sticky platelets in the blood is impaired, that this brings about an increase in the production of the platelets and that this in turn can lead to an event such as a heart attack.


Effect on behaviour
However, It is also possible that the poorer outcome for depressed people following a heart attack is related to the way depression affects their behaviour. For instance, people who are depressed can find it difficult to motivate themselves to exercise, to take their medication or to modify their diet. If they are smokers, then giving up smoking will be far more difficult when they are depressed. All of these things, let’s face it, are hard enough to do when you’re not depressed.

In these instances, one can see how easily depression can leave a person more vulnerable to future heart problems.

What matters in all of this is to understand that depression is a real issue that needs to be taken very seriously after a person has a heart attack or develops another heart condition.

Depression not surprising
We need to remember that when you have a heart attack your whole view of yourself, your health and your life changes. So it’s not surprising that for some people this leads to depression.

One can also see how a person who led a very stressful life before a heart attack could become depressed afterwards at not being able to give the same energy to the issues about which he or she was stressed. If they have had to give up the work they used to do, then the emotional impact can be very, very strong.

It is important, if somebody close to you has heart disease, to recognise that depression may cause them to fail to exercise or to fail to comply with their medication or dietary requirements.

In such a case the issue of depression should be raised with the GP who may refer the person to a counsellor. If you prefer to contact a counsellor directly you can get the name and telephone number of an accredited counsellor from the Irish Association for Counselling and Psychotherapy at 01-2723427.

Exercise and mood
It is also helpful to encourage the person to carry out faithfully the exercise regime prescribed by the hospital or by the GP. Aside from the physical health benefits, exercise is known to improve the mood and is an important ally in the fight against depression.

I have directed this advice to people close to the person with depression because it can be hard for the person who is depressed to motivate himself or herself to do these things.

But if you have had a cardiac problem and you are not depressed, follow that exercise regime that the doctor advised: it will keep you in good shape psychologically as well as physically.

I’ve used the word ‘link’ in talking about depression and heart disease throughout this article because what we seem to know is that there is a very definite link between the two but what we don’t know is exactly how that link works.

There is, nevertheless, a link which is all the more reason for doing something about depression instead of letting it drag on and on - especially the wake of heart disease.

Separation and unemployment contribute to suicide, report suggests

Photo by Bethany L King (Flickr)

New Irish report on suicide

Connections with other people constitute an under-valued source of psychological well-being. As we become more individualised - not knowing who our next-door-neighbour is, spending more time in our own rooms with our own technology and so on - we ignore, at our peril, evidence of the links between isolation and mental ill-health. Further evidence for that link was reported in The Irish Times on Tuesday 27th November by Barry O'Keeffe.

"Separated men and women have high suicide rates, far higher than married people, according to new figures published last night," O'Keeffe wrote. "The figures also show that unemployed men are four times more likely to take their own lives than men in employment.

"The suicide rate of women who were unemployed was five times higher than that of women in employment. Women who were 'engaged in home duties' had a similar suicide rate to the employed.

"The report, which was launched last night in Dublin by Dr Jimmy Devins, Minister of State for Disability and Mental Health, was compiled by the National Suicide Research Foundation. Commissioned by the HSE National Office for Suicide Prevention, it examined deaths which occurred in the Republic in 2002. Of the 1,800 deaths into which an inquest was held, 495 were recorded as deaths by suicide.

New data
"The researchers were given access to what is known as form 104 for the first time. This is a form which gardaí complete for coroners' inquests to determine the cause of death, when such deaths are thought not to be through natural causes.

"'It is the first time that Irish data has shown separated people to be a high risk group,' said Dr Paul Corcoran, deputy director of the National Suicide Research Foundation. 'It is worth looking into, in terms of suicide prevention as the number of separated people in Ireland is increasing.'

"Dr Corcoran said the study of inquested deaths was the first time such data had been separated out from general data collected by the Central Statistics Office (CSO)."

Highest rates are in young men
As in traffic deaths, overall, the study found that the highest rates of suicide were among young men, according to the report.

In general, two-thirds of men who died by suicide did so by hanging, whereas for women, the most common forms of death by suicide were hanging, drowning and drug overdoses.

On the issue of whether alcohol was involved, Dr Corcoran said the data was not reliable, as it seemed at odds with generally accepted data on suicide, ie alcohol dependence seemed to be underestimated as a factor.

The report found that an above-average number of deaths happened on Sundays and Mondays. It said accidental deaths peaked on Sundays, whereas suicide deaths peaked on Mondays.

For each of these categories, the rate was at least 20 per cent higher than average on these days. Suicide deaths were least common on Wednesdays and Thursdays, with 17 per cent fewer deaths than average.

Link to spring and summer
The data demonstrated that suicides peak in late spring and early summer (April to June). Dr Corcoran said people would expect such deaths to occur more in winter, but these findings bore out similar studies around the world. It also found that about half of suicide deaths occurred around the home of the deceased, compared with 26-30 per cent of the accidents and homicides.

"The data indicated that a final communication - generally in the form of a written note - was made in 30 per cent of suicide deaths.

Dr Corcoran said the data was limited in respect of occupation of the deceased. However, he said, there seemed to be a high rate of suicide among semi-skilled and unskilled workers, including builders' labourers, assembly line workers, security guards and bar staff.

He cited Australia where a major initiative had been launched to target young men in the building industry, where it was thought that issues such as bullying had led to suicides. "We should consider launching similar initiatives here," he said.

Forms not satisfactory
The data was based on the 104 forms, which are completed by gardaí for inquests, giving details about the deceased and the facts surrounding the death.

Dr Corcoran said it was not the fault of the gardaí, but these forms were not always satisfactory. The report recommends that some changes be made in these forms to provide more accurate information.

In addition, Dr Corcoran said some different mechanism needed to be developed to collect more in-depth information on the medical and other contributory factors associated with suicide.

Perfectionism linked to a range of emotional problems.

Perfectionism may be responsible for more emotional and mental health problems than we think, says this article in the New York Times.

Link:

Perfectionism - Psychology - Mental Health and Behavior - New York Times

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Early death risk for men in routine jobs, statistics suggest

Men in routine jobs, such as bus drivers and refuse collectors, are more likely to die early figures show, says this BBC story. The Office for National Statistics data showed routine workers were 2.8 times more likely to die by the age of 64 than high-level managers.

Link:

BBC NEWS | Health | Bus drivers' 'early death risk'

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Accepting your death and talking about it to those who will stay behind

(This is the text of my That's Men for You column in The Irish Times on Tuesday, 20th November 2007)

Channel 4 programme points the way

A man in his 70s who spent most of his life in the practice of Zen Buddhism recalled an encounter concerning death.

It had occurred many decades previously when he was training under the eye of an old-style Zen master. He had been contemplating the subject of death and had become rather comfortable with it, thanks to many hours of meditation.

Foolishly, he informed his Zen master that he no longer feared death. The master responded by jumping on top of him – they did that sort of thing in those days – and commencing to strangle him.

The attempt went on until the student had almost lost consciousness. Luckily, he had previously spent some years at sea and had learned how to take care of himself. He managed to land a punch on the jaw of the master and to free himself.

When he regained his breath, he berated the master for almost killing him.

But, the Zen master replied, I thought you told me you had lost your fear of death?

I presume the Zen master was trying to convey, in a way which would be barred by health and safety regulations nowadays, that if you say you have lost your fear of dying you are probably fooling yourself and anybody who believes you.

Death in other cultures
The dread of death seems to be common to people in Western cultures but this isn’t always so elsewhere. There’s a tribe in Micronesia in the Pacific Ocean which believes that everyone dies at 40. Even if, after reaching 40, you are walking, breathing and talking, you are still, essentially, dead. I apologise, by the way, to anybody who is staring down the barrel of the Big Four Oh but do remember that this is Micronesia we’re talking about.

Far from struggling against the idea, people over 40 seem to see the whole thing as a form of retirement. For instance, they don’t work as hard anymore. After all, they’re dead. What do you expect?

This acceptance of death and dying is found in many Buddhist traditions too. Indeed, in those traditions in which there is a belief in reincarnation, the ambition is to get to a point at which you can finally die and don’t have to be reincarnated anymore. That’s an attitude most of us in the West find baffling except when we’re sitting in a traffic jam on the M50.

In facing our own deaths, there is the question, if we know it is coming, of what to say to those who are closest to us. Many men, I suspect, would be inclined to take a sort of stoic attitude to it and to speak about it as little as possible. We would try to be good, strong men who are not going to upset other people by talking about our deaths. But in fact, talking to our partner and children could help to ease the pain for everybody.

The Mummy Diaries
These thoughts were prompted by the Channel 4 series, “The Mummy Diaries” about how mothers facing death through terminal illness interact with their children. The first programme in the series was reviewed by Olive Travers in last week’s TvScope so I won’t to into the details here. But essentially it seems to bring great comfort to children and partners if the mother talks to them about what is going to happen and if they gather up memories for after her death (these include letters, to the children, memories, advice for their future lives and so on). In other words, the whole family becomes involved in what is happening to one of its members.

It all seemes so much healthier than denying that anything is going on at all and keeping everybody isolated in their own world of pain and fear.

The final programme in the series is on Channel 4 next Thursday night. It’s worth watching. None of us knows when we might have to deal with the issues it raises but the approach it promotes has an enormous value, in my opinion, not only for mothers but also for fathers who are facing death through a terminal illness.

High Death Toll After Severe Urinary Complications In Men Over 45

As many as one in four men admitted to hospital with acute urinary retention will die within a year, finds a study published on the British Medical Journal website.

Link:

High Death Toll After Severe Urinary Complications In Men Over 45

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