A cry for help

By Rehan Khan*. Published in Bahrain this Month (August 2004) The phone rings and is answered. “Hello, how can I help”? Caller “I’m hopeless, useless (starts to cry). No one cares about me! I’m going to kill myself.....” How would you respond to a call like that? Most of us would probably freeze, like a dazed rabbit in front of car headlights. The volunteers of The Helpline are put in this situation daily, as they take calls from people of all nationalities in Bahrain who are feeling depressed, isolated and hopeless.

Vani Krishnan, founding member of The Helpline and also Honorary President of the Indian Ladies Association (ILA) says “Our 27 volunteers are there to listen, we’re not professional counselors, but we aim to help the caller help themselves. Often if you just listen to someone who is depressed half their problems go away”. She says that callers to The Helpline are from the low paid workers community, but also increasingly from middle class and upper middle class families. For the latter two groups, who are made up of foreign workers and Bahrainis she says “Their problems stem from having certain aspirations in life which have not been achieved, as well as an increase in family and marital problems”.

For Psychiatrist, Dr Shameera Rehman based at the Ibn Nafees hospital, this is also reflective of the patients she deals with. “When your capabilities and your aspirations do not match, then this can in some cases lead to depression”. This is also the thinking of Clinical Psychologist Oliver James, who contends that “When expectations outstrip real outcomes, we feel either aggressively resentful or depressed. If reality falls short of our high hopes, we either blame ‘the system’ or ourselves. Whichever it is rates of depression and violence rise as a result, and we finish up feeling like losers”.

It would seem that an increasing number of individuals are setting unrealistic aspirations for them selves and then failing to achieve them. This trend has been closely correlated with the rise in individualism as Madeleine Bunting in her book “Willing Slaves: How the Overwork Culture is Ruling Our Lives” argues. She says that our work and private time has become more individualised. Our shared and collective experiences, such as the daily family dinner which was an opportunity for the family to bond and debrief/ counsel one another, have become decoupled as we increasingly start to live in our own time schedules. This rampant individualism cripples any collective effort to solve social and family problems. For Krishnan in the cases she deals with, the ones who get extremely depressed and consider suicide are the ones whose social situation has pushed them into becoming “loners, stuck in a rut and isolated from any family or other support network”.

The result is that few people have time to sustain human relationships. This has an impact on positive behaviour modelling, which Dr Rehman stresses is critical for personal development “People, especially children learn by modelling their behaviour on others. It's been shown in research that violent musical lyrics can affect behaviour. Communication is very important in solving problems. Parents tend not to reinforce good action, but only say something when the child has done something wrong. Equally for adults good communication skills are necessary for solving inter-personal problems, such as marital ones”.

Dr Rehman also emphasises the psycho-social factors at play in a person's life. She says “There may be some genetic factors that contribute to depression but these may not be enough to cause it. However if there is an ‘exit’ event like the death of someone close to the person it may spill over into depression, if they also happen to be genetically vulnerable. Equally ‘entry’ events like birth (post natal depression) and marriage may also have an impact”.

Can it really be that unrealistic aspirations, the rise of individualism and psycho-social factors that isolate individuals are all contributing to making depression the number one disease in the world by 2020? This all seems such a far cry from when thinkers such as John Maynard Keynes in the early part of the twentieth century predicted that the twenty-first century would be the ‘age of leisure’. In fact government planners in the UK in the 1970’s were concerned that with so much automation, people would have too much free time. For philosophers such as Aristotle and Plato the amount of leisure time a person had to think and ponder over real issues in society reflected their level of freedom. It was the currency by which your status was measured. Now the harder someone works reflects their status – keeping that inbox down, taking those mobile phone calls even when on holiday. We seem to be living to work, rather than working to live.

Both Krishnan and Dr Rehman contend that one of the ways to treat mild depression is to first listen to the person. “If someone calls you in distress they don’t want you to jump in and give your two-bits worth. At that point you need to express concern, make empathetic statements. Let the patient talk it through” says Dr Rehman. “Its important that the social network the person is in fully supports them with practical measures, such as looking after the children or taking them for walks. This collective effort contributes to the patient's recovery” she adds.

Clearly as a friend of mine recently pointed out to me, ambition is good. The saying ‘reach for the stars and you may get to the moon’ still holds. However ambition should not be confused with uncontrolled individualistic aspirations, which often tend to be material only. The acquisition of which makes you hungry for more. And the inability for many to acquire in the first place, leaves them feeling depressed, isolated and hopeless. In this situation Krishnan says “Our volunteers aim to help people restore their confidence and self-esteem. For our callers it means so much to know that we are here to listen and care”. The Helpline is a positive effort in dealing with a by-product of modernity. However a collective effort to cure the root of the problem, our insatiable appetite to consume, would perhaps be a better longer term strategy, rather than trying to deal with the outcomes once they rear their ugly head.

* This article was first published under the pen name of Osman Idris.