Mental Health Month “HIV/AIDS”

I decided to write about HIV/AIDS during Mental Health Month because whilst mental health and HIV/AIDS has a relationship, there are many other diseases and conditions with more of a relationship than HIV/AIDS and mental health. So more is talked about say, Alzheimer’s and mental health, Parkinson’s and mental health, menopause and mental health, etc.

As a neglected relationship I wanted to talk about the links with mental health and HIV/AIDS as much as anything, to be mindful of this fact; HIV/AIDS may be less of a world scourge than it was in the eighties and nineties but it has by no means gone. In fact, many who work in the field believe it is only a matter of time before the current cocktail that keeps HIV/AIDS as a manageable disease for the majority, will start to fail and require further research and medication. Additionally though we are on the cusp of a quasi-cure it would not in its current state, be do-able for the vast majority, most particularly, the poor. In addition, HIV/AIDS speaks to a larger issue, that of the continual zoonotic transmission of a disease from animals to humans (or equivalent).

Recent studies demonstrate, the rate by which potentially fatal pandemic diseases can be transferred interspecies, is far higher than previously thought. Researchers believe it is a matter of time before another HIV/AIDs style disease, will occur and spread. Whilst we may dismiss this as fear mongering, history shows us otherwise. Considering this and the history of HIV/AIDS the entire subject requires more in-depth analysis to ensure if this happens, all those infected are offered treatment rather than the select who can afford the Big Pharma monopoly prices.

If India had not stepped in, the ten million who died in Africa (and the number was in actuality far higher) would have continued to climb. If a Western country were to lose ten million to a disease, there is no way the monopoly of Big Pharma would have been permitted and as with the Anthrax scare the patent would have been lifted on the medication to ensure everyone had access to cheaper generic versions of the drug. India told this to the WHO years beforehand and offered to help those struggling countries like africa by supplying generic medication as less than one dollar a day, WHO and effectively, the Western world, ignored them and millions died.

Now the WHO and others are trying to force countries like India into not producing generic versions of existing medication in order to save lives. This at the behest of the already massively profiting pharmaceutical industries of the Western world. Profit it seems, literally comes before lives.

What does this have to do with mental health?

Having a disease like HIV/AIDS has a myriad of outcomes, not least a deleterious effect on our well-being and mental well being. Even if the disease is ‘managed’ the trauma of having a disease that is communicable, stigmatized and life-threatening, alongside the inevitable connection to sex, drugs, homosexuality and other stigmatized and judged things, causes a great deal of psychic stress.

When our bodies are unwell our minds are unwell.

Living with a disease like HIV/AIDS or hepatitis C can literally cause depression.

Surviving a disease like HIV/AIDS can cause similar issues known as ‘survivors guilt’ and the suicide rates both during the AIDS crisis AND afterward were extraordinarily high for this very reason.

Some people in power at the time felt that saving Africans was not a priority because quote; They would not know how to read the instructions on the medications, they would not take the medications properly, they would possibly cause the medication to work less effectively and even cause the virus to mutate and become resistant and put everyone else at risk’ so they chose to ignore the plight of Africa and other countries. It was essentially the worst kind of racist discrimination possible. On the other extreme, China did a disservice to their citizens by ignoring the problem saying they had no problem and thus, permitting no discussion or help.

Back to mental health. Imagine if you had HIV/AIDS today, would you feel ‘okay’ about it? Even if you had medication (with its side-effects) and you knew you may live a relatively normal life span? It would still affect you in so many ways, you would have to inform anyone you were intimate with, you would have to consider it when having children, you would have to let those you worked with and your insurance know. Even if you did not see it as a stigma, some people invariably would (because people love to judge) wouldn’t that cause at the very least, some anxiety and possibly other mental health issues?

A friend of mine contracted Hep C during college, he was deeply ashamed and despite therapy he ended up being celibate. That may be an extreme but it’s also one example of how illness, disease, viruses, and medical conditions can exacerbate mental health even when they don’t do so biologically like Parkinson’s does.

Many years ago after a sexual assault I was told my assaulter was HIV positive. I didn’t at that time have any idea of prophylactics for those exposed to HIV. Fortunately a professor of mine did and she told me where to go. I think to this day, if I had not met her, told her, and she had told me where to go, I may today be HIV positive. Maybe not a big deal if you are, but when you are not, a huge deal, which speaks to how people really feel about HIV/AIDS.

Taking the prophylactics which are basically the HIV/AIDS medication, for six weeks, demonstrated to me and gave me more empathy for, those who have to take them for the rest of their lives. They talk about how good they are at extending and maintaining life but they are rough on the body, and having to take quite a few every day, as well as the cost, is all round hard. I learned then, firstly never take your health for granted, secondly never judge someone else because you don’t know what they are going through and third, we in the Western world have an innate privilege that other countries do not have and we take it for granted.

The six-week supply of medication at the time cost around $3,000. Most of the world doesn’t earn that in a year.

This is going to happen again. And when it does, more will die and more will close their eyes to this because it’s not on their door step. We choose whom we empathize with and it’s almost a trend. If everyone else is donating we donate, if nobody cares, we don’t care, en mass this is our approach to charity and change.

HIV/AIDS hasn’t gone away. Other diseases will come that are possibly more devastating. It impacts entire generations, kills and destroys entire family trees, obliterates the ‘luxury’ of considering mental health fall out afterward because resources are so precious. Think now how many are dealing with mental health issues concerning the death of half of their families from HIV/AIDS and have no resources.

We see mental health treatment as a luxury because in many ways that’s what it is. And this is wrong. The domino effect of poor untreated mental health issues, causes loss of productivity and health, it is a vicious circle, if we ignore it, we do so with the knowledge ignoring it costs us more in the long run.

Stigma alone, social exclusion, judgement, blame, condemnation and fear, can strike illness in the heart of any sufferer. Suffering in silence, unable to share your diagnosis freely, even with the protection of the law, makes those with such diseases feel they are not the same as everyone else and in some ways that ‘secret’ they carry does set them apart. Imagine for a moment how that feels? Many of us cam emphasize somewhat, we may carry our own secrets, but that one is a pretty big secret and a heavy burden. We can help with that burden just by being good to those we meet, aware that we never know the extent of their burden.

When the next HIV/AIDS comes around, I hope everyone will stand up and demand that Big Pharma not prevent the treatment of all sufferers in all parts of the world. Your economic status or skin color do not reflect what your level of care should be. The only way this changes is if we, the people, change it by not ignoring what the inequality occurring in other parts of the world in part, due to our economic monopoly.

Mental Health Month “Suicide”

The first time I was personally touched by suicide, a friend’s mom took her own life, her kids found her in the bath, I heard about it second-hand around the age of eight. I remember thinking how I would feel if I found a family member dead, and I tried to be nicer to my friend whose mom had died. I remember other kids said things about how the mom was selfish for doing it, I didn’t join in, there was even then, a part of me that didn’t see it that way.

The second time I was personally touched by suicide, my grandfather took his own life. He overdosed on Valium and was found the next morning when he hadn’t come down for breakfast. He was an artist and a long time Depressive, but despite that, everyone was shocked that a man still in his prime would consider death a better option. I remember people saying; “What a waste, he was so talented” and “How selfish, he had two children and a wife.” Although I didn’t think it at the time, I now wonder, does that mean it’s not selfish if you have no one? Is it more understandable or acceptable if you are not talented? Again, how things are phrased can stick with you.

At the time I saw my grandmother trying to come to terms with it. She ended up drinking the pain away, and developed an addiction to drinking for many years before she joined a cult and through this new-found sense of belonging quit drinking and became happy once more. Whilst we didn’t particularly like her being part of a cult we were glad for her restored peace of mind, but when I think back on it now, I also think we were relieved, we didn’t have to look in the face of grief anymore, everyone wanted to get on with things.

And that’s the hardest part of suicide, how people cope or do not cope after the fact.

Who is left behind, what fall-out carries on sometimes for generations.

One of the first questions a therapist asks is if anyone in your family has committed suicide, there is a reason for that. People whose family members commit suicide have a far higher risk of committing suicide themselves. Some have postulated whether this is ‘learned behavior’ or ‘permission granted’ or biological/in our DNA.

I can definitely see why people who have relatives who commit suicide would go one of two extremes. They are either going to be the last person to commit suicide, because they know first-hand its fall-out, or they may feel that because someone close to them did, it gives permission for them to follow suit. I can also see how some people are genetically at higher risk because something within their DNA makes it more favorable than for others. This doesn’t seem so very different from say, the God Gene.

There definitely are, as with addicts, two camps, the person who just won’t kill themselves under any circumstances and those who will. We may never quite know why, there may be many factors that go into that, but the people who are ‘at risk’ versus those who are not, are often hard to distinguish because in many ways they may both exhibit the same symptoms.

Many times I hear people say that those who commit suicide are ‘weak’ and ‘selfish.’ I have never thought they were. I see no good coming from condemning someone who was sad enough to take their own life. If we do it to discourage others, well it’s not really working, and whilst I would never advocating encouraging anyone to commit suicide or over-justifying those who do, I see no good in criticizing them after the fact. They made a decision, they chose to do it, who are we to say they are weak?

At the same time, we all hope someone will find the ‘strength’ or conviction to keep living. Nobody really approves of suicide except in extreme cases such as euthanasia for those who are suffering and in agonizing pain. Even then, in America, this is a very divided subject with those against, believing no murder is justified including the taking of ones own life, whilst others, often those who have seen it personally, can attest, some terminally ill people have the right to end their suffering.

So if we look at suicide of ‘healthy’ individuals, where do we place the depressed and the mentally ill on that scale? In some Scandinavian countries there have been people who have petitioned the Government to be euthanized based upon mental-illness. This has sparked outrage among those who believe this is tantamount to murder, and in no way qualifies as a terminal illness. Technically mental illness is rarely terminal although many ways, mental illness accompanies terminal diseases and exacerbates their symptomatology.

But even without being terminal, can mental illness ever be ‘bad’ enough to warrant or justify the taking of ones own life? And if we open that flood gate, how do we close it again?

I don’t claim to know the answer, I’m not sure anyone knows the answer yet but the side of suicide we don’t consider as often, isn’t just prevention or reason(s) behind suicide, but the aftermath.

Another friend of mine lost her mother to suicide. If I had to say, without hesitation I would say she became a more responsible, compassionate person as a result. But that doesn’t negate the extreme pain she still feels with the loss of her mom. Given a choice, every day she would wish for her mom’s return over any compassion she may have. The positives cannot outweigh the negative reality of losing someone you love.

If her mom had been deathly ill maybe she would have held a different view, I have never asked her, but either way, it is hard to imagine being ‘okay’ with someone’s suicide. That said, when Brittany Maynard committed suicide (euthanasia) in Oregon a while back I was profoundly moved by her videos and writing on the subject prior to her choice to end her life. Still very young and with a beautiful family, Brittany was terminally ill and knew in a matter of months she would be in excruciating pain and there was no cure and only awful suffering.

Many people condemned her for ‘taking the easy way out’ or ‘going against the will of God’ but I recall admiring her so much for her resolve and strength. I simply could not imagine making that choice, let alone going through with it. Her family moved to another State where Euthanasia is legal in order to be eligible and she made her plight and story public in an effort to educate people on the right to die. I believe in the right to die in part because of her efforts to show it is not the same as suicide.

With depression and other mental illnesses that are not responsive to treatment, it is not hard to imagine why people can be pushed to the brink and wish to end their lives. Should we consider euthanasia for severe cases of mental illness? Currently I don’t think we should but I recognize I may change my mind as more information becomes available. When I stop and think about living with say, Schizophrenia and other illnesses your entire life, in misery, without respite, and medications not working, I can definitely see why someone may wish to end their life. So why do I hesitate in condoning suicide or euthanasia in those cases?

Maybe because whilst we see mental illness as a disease, it’s not terminal and until something is actually ‘definitely’ going to take your life, we have this belief that there is hope, and we should not end our life based on feeling badly. Is this dismissive? I would say in some instances, yes, because there are chronic pain conditions that may include mental disease, that it could be argued, are as devastating to someone as a terminal illness. Perhaps we should give everyone the ‘right’ to choose if they live or die, and I would agree with this except for a worry that sometimes in certain mind-sets we don’t have the right objectivity to ‘choose’ without bias.

Mental illness is one of those biases. When you are mentally ill you can really see the world through a different lens. If you have not ever experienced that, believe me when I say, one day you can feel hopeful, the next it’s like the color was sucked out of the world and the pain you feel inside is unbearable and often without any cause. When that goes on for a prolonged period of time each day can be agonizing. It is definitely understandable that when people feel this way they may contemplate suicide.

The argument against this is – people typically commit suicide or attempt suicide when they are panicking or have calmly given up (the two extremes) they either panic that they will never feel differently and ‘stop the pain! stop it now! stop it any way you can!’ or they feel reconciled to their fate, they do not believe it will ever change, and so they give themselves permission to let go.

Perhaps that is why the very young and the very old are the two groups most likely to take their own lives.

As mentioned earlier, there are many who no matter how bad it got, would never commit suicide. That isn’t necessarily anything to do with personal fortitude or strength, it may be a genetic proclivity, or several factors, but they often perceive those who take their lives as inexplicable. They cannot and will not understand, and they feel understanding is condoning. I would argue, understanding is NOT condoning it’s understanding. We need more understanding.

Mental illness is not always visible, so we often do not know someone is suffering from it until it’s too late. Signs to look for include giving away what we own, a sudden sense of peace and feeling good, high anxiety and stress and the bequeathing of things previously withheld. Of course that’s not going to ensure you accurately predict whom among us is at risk, because just like in the film 13 Reasons, so many people exhibit signs and so many do not, and that’s no guarantee of anything. Additionally suicide can be a sudden choice, you literally realize in a moment and bam, it’s too late.

One population aside teenagers that I believe will increasingly be at risk for suicide is the elderly. More so because our grandparents social security and pensions were more robust than ours will be with some exceptions. It is simply more expensive to live nowadays and the money we will need to live even relatively well in old age, is often more than we can save and invest. Poverty and loneliness are two of the main reasons the elderly choose to take their lives. The third is illness. This can include mental illness. We sometimes believe the value of a person’s life diminishes with increasing age, but every life should have the same value.

The elderly have less resources than teens and in a way, less hope, because they are ageing toward death, whereas a teen has their entire life ahead of them. Sometimes hastening ones death can seem a good choice, to end suffering, loneliness, worry, financial concerns. The elderly can feel they are a burden, they can feel they are not wanted in our ever busy society that highlights youth. Additionally, are we ready as a society to take care of the many who will devleop dementia, which often carries alongside it, chronic depression? Is loading an eighty year old with heavy duty medications and antidepressants all we can to do help them?

Caregivers of the elderly will also experience mental health issues as a result of the hard work they do. Presently elderly patients are over medicated and have less resources for talk-therapy or other treatments. It is deemed simply easier to stick them on a lot of medications and hope they’ll die than treat their suffering compassionately and with an understanding their lives, however long, still hold value. Is it any wonder then that so many elderly are at risk of suicide and premature death? As long as we judge people based on their economic ‘worth’ and believe the elderly ‘had their time’ we will never improve this and rates of elder-abuse will grow.

So whilst we can do more to look out for people, we will never prevent someone from committing suicide if they are absolutely set on doing so. What we can do is save the ones who do not wish to and need a reason not to. It may seem absurd that anyone should really want to die, but there will always be people who do, they find different ways, they take risks, they drive their cars too fast, they may join a terrorist group. Often very unhappy people choose suicide by proxy, by putting themselves in danger and waiting to see if it will take them.

Suicide and mental health are always going to be interrelated and there is a lot the people around those people can do to prevent a successful suicide, but ultimately the best we can do is not judge those who die, for what possible good comes from that? Sometimes the hardest thing in the world is to try to understand why someone did what they did. Sometimes there is nothing to understand. But with understanding we can learn, whereas if we simply condemn, we learn absolutely nothing.