The Last Session

He glanced at his watch.  She was late.  Sighing, he got up from the chair and walked over to the window where he stood gazing out at the street below.  Where was she?  She was supposed to be there ten minutes ago.  Was she with him again?  The last time she was late, she had run into Devon who persuaded her to have a coffee with him and she didn’t show up here until almost half-hour later, apologizing profusely.  Fortunately for her, he didn’t have any other appointments for the afternoon so he was able to see her but he had advised her not to be late again.  And now, she was late again and most likely, Devon was the reason.

He closed his eyes as jealousy ripped through him.  Dragging his fingers through his hair, he made up his mind that he couldn’t continue seeing her.  Today they would have their last session and then he would refer her to a colleague.

It was his sister who had referred her to him and when she walked into his office, he should have realized that he was heading straight toward the slippery slope.  He tried to remain detached and professional as he listened to her talk about her relationship troubles with Devon, a young man she had been dating since high-school but as the weeks went by, he found himself wishing that she would do them both a favor and end her relationship with Devon.  She deserved better.  She was beautiful, smart and had so much going for her.  She didn’t need to be in this dead-end relationship with a man who clearly didn’t appreciate her.  She had so much love to give but she was giving it to the wrong person and that drove him crazy.  Whenever he thought of Devon, anger and jealousy consumed him.  He doesn’t know how lucky he is.  If I had an incredible woman like Ramona, I would treat her like a queen.

He turned when he heard the door open and his heart leapt when he saw her standing there.  She came over to where he was.  “You’re late,” he said unnecessarily.

“I’m so sorry I’m late,” she said, looking anxiously at him as she quickly removed her leather jacket.

He couldn’t prevent his gaze from traveling over her.  She was wearing a black turtleneck sweater, a knee length red skirt with knee high black boots.  Her hair fell in thick waves of curls about her face and shoulders and for one maddening moment, he wanted to bury his face in them.  Abruptly, he walked over to the chair where he remained standing until she sat down on the sofa.  “We only have twenty-five minutes for the session so we’d better get started.”

She sat with her hands in her lap.  “Twenty-five minutes isn’t much time,” she said.

“You were supposed to be here thirty-five minutes ago.”

“I’m sorry.”

“Let’s not waste any more time with apologies and talk about why you’re here today.”

“I saw Devon at the café yesterday afternoon and—”

“Did you arrange to meet him there?”

“No, I went to get a cappuccino and he was there.”

“Did you leave the café after you bought the cappuccino?”

“I was about to when he came over to me.”

“What did he want?”

“He just wanted to say hello.”

“And after he said hello, did you leave?”

She shook her head, beginning to look uncomfortable now.  “Well, we left the café together.”

“Where did you go?”

“We walked back to my flat.”

“What happened when you got there?”

“He wanted to come upstairs but I told him that it wasn’t a good time.”

He tried to remain calm and pragmatic.  “So, the only reason he didn’t go up to your flat is that it wasn’t a good time.  The last time we spoke, you indicated that you wanted to end your relationship with him but it seems to me that you had an opportunity to do so yesterday but you didn’t take it.  It is obvious that you still have feelings for him and don’t want to make a clean break.”  He glanced at his watch.  “Your time is up.”

She looked upset.  “Already?”

“I’m afraid so.  Before you leave, I have something to tell you.”

“Yes?”

“This is our last session.  I will arrange for you to see my colleague, Mike Harris.”

She looked at him as if he had just given her devastating news.  “But why?” she asked.  “I’ve gotten so used to talking to you and you know so much about me.  Why do you want me to see someone else?”

“I don’t think I can help you.  You need someone who would be more objective.”

She got up from the sofa and went over to him.  “Jackson, please, I need to continue seeing you.  I promise I won’t be late again.”

He felt himself weakening when he stared up into those beautiful brown eyes and he wanted to reach up and pull her head down to his…Muttering under his breath, he sprang to his feet and went to stand behind the desk, putting as much distance between them as possible.  “I’m sorry, Ramona, but I think you would be better off seeing another therapist.  I will have the office get in touch with you.”

She stared at him for a long moment and then, stifling a sob, she grabbed her jacket and handbag and bolted from the room.  He stood there, trembling as he fought the temptation to go after her.  He believed he had done the right thing–the sensible thing yet why did he feel rotten?  He had to take a few moments to collect himself before he was able to see his next client.

He was packing up to leave when the door opened and his sister walked in, her expression a mixture of censure and concern.  He looked at her in surprise.  “What are you doing here?” he asked.

“Jackson, what happened between Ramona and you this morning?” Noreen asked him.  “She came to my office in tears.”

He continued what he was doing.  “I told her that I couldn’t continue with our sessions and I recommended that she started seeing Mike.”

“Why did you do that?”

Without looking up, he confessed quietly, “I’ve done something that a therapist should never do.  I fell in love with her.”

“And your solution to this problem is to send her to someone else?”

“I can’t continue seeing her when there’s a conflict of interest.  Do you have any idea how hard it is to sit in that chair and listen to her talk about another man?  I get so jealous that I can’t think straight.  She deserves to be helped by someone who can be objective.”

“She said that you were upset with her for being late.”

“Yes, I was.  I thought that she was with him—”

“Well, you were wrong.  It’s my fault that she was late.  I offered to give her a lift but wanted to stop by the cemetery first to put flowers on Tom’s grave.  Today is his birthday, you know.  He would have been fifty-three.  I spent a longer time than I intended and we had to rush over here.  Poor Ramona was mortified and was afraid that you wouldn’t see her.  I wanted to come up with her and explain why she was late but she declined my offer.”

“Okay, I was wrong about why she was late today but the fact remains she’s still hung up on her boyfriend even though he treats her like…” he broke off as he found himself getting upset.  “Let’s face it, Noreen, I’m in love with a woman who wants to be with a man who doesn’t deserve her.  Such is life.”

“Is that what you believe?  You believe that Ramona wants to be with Devon?”

“Yes.” The word came out as a strangled whisper.  It was torture loving and longing for someone he couldn’t have.

Noreen touched his arm, her eyes searching his face and seeing the pain etched in its features.  “You’re wrong about this too,” she told him quietly.  “Ramona doesn’t want to be with Devon.  She broke up with him weeks ago.”

Jackson stared at her.  “She broke up with him?” he repeated, looking puzzled.  “But why did she continue to come here and talk to me about him if she ended their relationship?  It doesn’t make any sense.”

“People do strange things when they’re in love, Jack.”

“In love?  Are you saying that–?”  He shook his head.  “No, you must be mistaken.  She may have broken up with him but she’s still carrying a torch for Devon.  That’s why she’s been coming and talking to me about him.”

“I’m not mistaken.  She told me herself.  She kept coming to your sessions because she wanted to continue seeing you.  And when you told her that you were referring her to another therapist, she was devastated.  She didn’t tell you how she felt about you because it would be another reason for ending your sessions.  She was in quite a state when she came to my office.  I gave her a lift home.”

He raked his fingers through his hair, trying to digest what he was hearing.  His heart wanted to believe that Ramona loved him but his mind kept resisting.  “This is probably transference.  You know when a patient transfers his or her feelings to the therapist…”

“I know what transference means, Jack.  I don’t believe that it applies here, though.  Ramona is in love with you.  Why don’t you go over to her flat and tell her how you feel?  Put both of you out of your misery.”

“I’m afraid, Noreen,” he confessed, his voice a bit unsteady. “I’m afraid to hope and believe that she could love me when she has loved him since high-school. I’m afraid that he will always be between us.”

“Jack, love is a funny thing.  We can’t help whom we fall in love with. Sometimes, it works out and sometimes it doesn’t.  But, love is like the ocean.  It can be calm or rough, shallow or deep but we can’t know unless we venture out and get our feet wet.  Don’t let fear prevent you from following your heart.  Life is too short for fears and doubts…and regrets.”  She sighed.  “What I wouldn’t give to have my Tom alive and with me.”  Tom, her husband of thirty years had passed away five years ago, leaving behind their three children and her.  “Go to her, Jack.”

Heart racing, he decided to take her advice.  “All right,” he said.  “I’ll go and see her now.  Thank you, Noreen.”

Noreen smiled and her eyes seemed a bit moist.  She reached up and hugged him tightly.  “Don’t mention it.”  They walked out the office together and parted ways in the parking lot.

He sat in his car for a few minutes, wrestling with himself and then he pulled out of the parking lot, heading for the highway which would take him to Ramona.  Twenty minutes later, he was standing outside of her flat, his heart pounding hard.  His hand shook as he raised it to ring the bell.  The door opened and she stood here, staring at him.  How he longed to take her in his arms.

“I didn’t think I would see you again,” she said in a trembling voice.  Her eyes were red from crying.  She stepped aside so that he could go in.

“I’m sorry about today,” he said after she had closed the door and was facing him.  “Noreen came to see me and she explained why you were late.”

“I wanted to be early,” she said.  “I couldn’t wait to see you.  I was looking forward to spending an hour with you but because I was so late, I got to spend only twenty-five minutes which went by so quickly.”

“My next appointment was in ten minutes.  Noreen told me that you broke up with Devon.  Why didn’t you tell me?”

She glanced down at her hands which were twiddling with a crumpled tissue.  “I was afraid that if I did you would stop seeing me and—and I couldn’t bear that.”

“Why Ramona?” he asked huskily.

“I love you,” she murmured, still holding her head down.  Her heart was racing.  She wanted to throw herself in his arms but uncertainty about his feelings for her held her in check.

His fingers clenched into fists as he fought the urge to take her in his arms.  “What about Devon?” His faceless rival hovered between them.  “Did you see him yesterday?”

She nodded.  “Yes, I did but it didn’t transpire the way I told you.  I went to the café to meet my friend, Brandi and he was there.  We spoke for a while and then he left.”

“So, all that stuff about him wanting to go up to your flat, that wasn’t true?”

“It’s true but it didn’t happen yesterday.  It happened a long time ago when we were on and off and before I started seeing you.”

“What about now?” he asked, his expression tense.  “Do you still have feelings for him?”

She looked up then, her eyes wide as they met his.  “No.  He and I are finished.  I don’t love him.  I don’t believe I ever did.  It was an infatuation which died when I met you.”

He swallowed hard.  “I want to hear you say that you love me again.”

“I love you.”

“Say my name.”

“I love you, Jackson.” She moved closer to him.  “I love you so much that the thought of never seeing you again was unbearable.”

He pulled her into his arms, his eyes dark and stormy.  “I love you too, Ramona,” he muttered thickly.  “You have no idea how much it pained me when you ran out of my office.  I wanted to come after you but I thought about Devon and…”

She raised her hand and touched him gently on the lips.  “Let’s not talk about Devon anymore.  He’s my past and you’re my future.  And now we have the present.”  She trembled when he held her hand and pressed his lips into the palm before he bent his head and kissed her.  Cupping his face between her hands, she responded wildly.

For several minutes, they exchanged hungry kisses and then she drew back to gaze up at his flushed face.  “Does this mean that you’re no longer my therapist?” she gasped.

“Yes.  Today was your last session.”

“Being with you is all the therapy I need,” she murmured before she pulled his head down to hers.

 

Women and Mental Health

May 1-7 has been Mental Health awareness week.

One in three Americans struggles with mental illness but the rate is much higher in women.  Research shows that women are 40% more likely to develop depression than men.  It is not clear why mental illness is more common among women but doctors have come up with a number of possibilities.

Discrimination, Trauma and stressful life experiences

Trauma is common among women with half of them experiencing some form of trauma in their lifetime.  One in four women have faced an attempted or a completed sexual assault.  Reportedly, one in three are abused by a domestic partner.  Gender discrimination, violence and mistreatment undermine a woman’s mental health.  Stress is a predictor of mental illness.  Women juggle housework, kids even while working fulltime.  They report that they have to work harder to get the same credit as men and worry about the gender wage gap.  They have to deal with sexual harassment and discrimination in workplaces where these are commonplace.  These challenges can significantly affect a woman’s ability to cope and her self-esteem.

Hormonal Issues

Women produce lower quantities of serotonin than men due to differences in hormone levels and this deficiency can lead to mental health issues such as depression and anxiety.

Pregnancy, Birth and Parenting

41% or women suffer from some form of postpartum depression.  Some of them are overwhelmed by the demands of parenting, especially in the early days.  I remember that there were times when I felt that I was drowning–in over my head.  Once I even cried out while I was holding my toddler.  Thankfully I had God and a very supportive partner.  It helped when he came home and I had an adult to talk to. Not all women are as blessed.  Research shows that women who don’t have supportive partners, experience traumatic births, live in poverty or a highly stressed will most likely develop postpartum depression.  

Gender bias is another problem women face.  Some research suggests that doctors tend to label women’s symptoms as emotional while taking the men’s symptoms more seriously.  So, a woman who reports that she is experiencing chronic pain to her doctor might be labeled as depressed.  This happens because we live in a world where gender discrimination exists and women are seen as more emotional and less rational.  

In many countries, the way health workers spoke to the women made it difficult for them to disclose their psychological and emotional distress.  And when they worked up the courage to disclose their problems, they were either over-treated or under treated by many of the health workers.

I read in an article in The Globe And Mail that women are getting the prescription that is available more often than the treatment they need.  They are getting medication to solve their problems even when science finds that treatments such as psychotherapy is equally or in some cases more effective without the side effects.  Bias in mental health care is a hindrance to women, preventing them from getting the proper help they need.  Not much effort goes into researching how drugs affect female patients.  While drug companies like to bombard women with their pills, most of their clinical trials have been dominated by men.  And the ironic thing is that the disorders most commonly diagnosed in women such as depression, anxiety and insomnia are the ones most likely to respond to therapy.  Most women are likely to prefer therapy over drugs.  

According to Dr. Marina Morrow, a Simon Fraser University psychologist who studies gender and mental health, “Women aren’t getting access to the range of care they need.”  She believes that an effective approach to this would be to include medication when necessary but in also offer therapy, peer support and pinpoint what social circumstances lead to the illness.

It has been argued that therapy is the safer, more effective and cheaper choice.  The authors of a 2015 study by Canadian and U.S. researchers concluded that, “There remains no sound justification to prescribe drugs without first trying therapy.  Dr. Cara Tannenbaum, scientific director of the CIHR Institute of Gender and Health, believes that “the way we fund therapies in Canada does not make sense right now.”  She wrote a letter to Quebec’s health minister to make the point that even if 20 per cent of seniors with insomnia received Cognitive Behavioral Therapy (CBT) with is used to treat insomnia, the cost-savings to the system could be in the hundreds of millions, based on the potential falls that would be avoided.  Therapy saves on costly and debilitating falls and hip fractures.  

We live in a country where medication is favored over psychotherapy and women are more likely than men to be prescribed antidepressants and sedatives as seniors and as a result they are at a higher risk of suffering from adverse effects.  Hopefully more women and those in the medical profession will speak out against the bias that is prevalent in the mental health care.  Doctors and those in the health care system need to give women more choices when it comes to treatment.  It’s their health so they should have the right to determine how they want to proceed once they have been diagnosed.

Mental Health Crisis in India

More than 50 million people in India suffer from a mental illness.  In 2011, India recorded the highest rate of major depression in the world at 36 per cent.  According to doctors, roughly 10 per cent of India’s population suffers from depression – MGMH

 

Women with mental illness are treated as less than human.  They are dumped, abandoned and abused.  If there are any signs of mental illness, a woman is put in a mental hospital with no chance of getting out.  Men can go back home while women are there for life.  In the following video, we meet a woman whose husband had her institutionalized although she had no history of mental illness.  Here’s a story of a mentally ill woman whose husband built a case against her so that he could get custody of their children after divorcing her.

It is not surprising that women suffer from depression at higher rates than men.  They have to deal with gender inequality, violence, lack of paid employment, lack of education, excessive spousal alcohol use and poverty.  Mothers are blamed for the birth of a female child and many face pressure to have male children.  Women are diagnosed with schizophrenia later in life, oftentimes, following the birth of their children.  The children are often removed from the ill mother’s care and this results in further distress for her. Indian women have higher rates of suicide than women in most developed countries and a higher rate of suicide compared to men in India.  Depression is one of the most common reasons for suicide among Indian women.

Mental health in India carries with it a stigma, especially if the person suffering from mental illness is a woman.  According to MGMH (Movement for Global Mental Health), in rural India, it is common to see people taking their children to temples and faith-healers instead of hospitals and doctors, especially in cases of mental health.  Mental health was something that was talked about in hushed tones.  Thankfully, it is no longer being swept under the rug.  People are coming forward.  Deepika Padukone stunned her fans last year when she admitted that she suffered from anxiety and depression.

At the time the news broke, she was one of the most sought after actresses in Bollywood. It took tremendous courage for her to disclose her illness, especially since people diagnosed with mental illness face discrimination.  Deepika has since launched the Live Love Laugh Foundation to raise awareness about mental health issues and as a result many celebrities were inspired to come out in the open and address the need to talk about mental health.  Varun Dhawan admitted that he was depressed during the making of Badlapur and Honey Singh revealed that he has been undergoing therapy for bipolar disorder.

Sadly, those living with mental illness are victims of a cruel fate.  They are often locked away and stripped of their basic human rights in state-run institutions that are under-staffed. In an article, titled Mentally Ill Suffer a Horrible Fate in India posted on the site for Deutsche Welle (DW), most state run mental hospitals are in deplorable conditions. The National Human Rights Commission (NHRC) reported that out of the 43 government mental hospitals in India, less than half a dozen are in a “livable” condition”.

There are doctors in charge of these hospitals who have no business being there.  “These doctors don’t understand the intricacies of a psychiatric illnesses and the comprehensive care the patients require,” said a psychiatrist working in a state-run mental hospital in Uttar Pradesh.

And in the midst of the crisis of hospitals not providing the conditions and care the patients need, are quack healers who are profiting from this.  According to a study by Dr. Shiv Gautam, former superintendent of Jaipur Mental Hospital, 68 per cent of the mentally ill are taken to faith healers before a psychiatrist.  “The reason, besides superstition, is that most general medicine doctors fail to diagnose psychiatric illness,” Gautam said. “A mentally ill patient displays symptoms which superstitious people believe are paranormal,” he added. “Such patients are tortured, chained and used for extracting money from their families.”  Hema, who was suffering from Schizophrenia was believed to have an evil spirit.  Her family took her to Datar Sharif Dargah where she spent a year locked up.  It wasn’t until her condition deteriorated that she was brought to Dr. Gautam.  In 15 days, she began to improve and a month later she was normal.

In other cases, the mentally ill are subjected to one of these horrific ordeals:  whipping, caning, inhaling burnt chili smoke, having their eyes smeared with chili paste or having their eyes branded with red, hot coins.  There are laws banning this practice, however, many dargahs and temples keep the patients chained.  Some of them spend the rest of their lives like this.  In 2001, 26 patients perished in a fire at a dargah in a coastal village because they couldn’t escape the blaze since they were chained.  What a horrific and senseless tragedy.

Families of mentally ill people opt for dumping them.  This means that they are dumped into an asylum where the conditions are not fit for a human.  When an illegal asylum was raided, they found thirty-five men and six boys living in inhuman conditions.  The stench from their unwashed bodies and the excrement drove neighbors to alert the health department.  Naked and chained inmates were discovered, dumped there by their families after they paid the asylum owner.  Some of these poor souls were found crawling in their excrement, some even consuming it.  On their bodies were marks of torture.  Some had surgical scars on their backs, leading to allegations that the asylum had links to kidney theft.  78 patients had entered the asylum but only 41 were found during the raid.

Other patients are dumped in jungles or forests ranges.  Their families pay lorry drivers to drop them.  Women and children are among these victims and in some cases, the females are raped by the drivers before being dumped.  Social activist Murugan S. who has rescued countless mentally ill people from the streets, cautions us not to judge the families by calling them cruel.  Instead we are to examine what forced them to take such extreme measures.  He believes that system needs to change.

Part of the solution is raising awareness.  The suffering of the mentally ill has been brought to our attention. It is out in the open.  The next thing that needs to be done is to show the superstitious and fearful society that mental illness is nothing to run away from or to be ashamed of.  The person suffering from mental illness needs love, support and most importantly, proper care so that he or she can live a normal life.

The government needs to put something place to ensure that patients are placed in reputable, sanitary facilities that will provide the care that they need and to ban the operation of illegal asylums and the practice of dumping.  Quack healers should be banned from profiting from other people’s suffering.  Husbands should not be allowed to institutionalize their wives if there is no record that they have mental illness.

No one wants to be mentally ill but it is a reality for many people and what they need is to know that they have a platform where they can talk about what is happening with them. Here in Canada, we have Bell Let’s Talk, a wide-reaching, multi-year program designed to break the silence around mental illness and support mental health all across the country. It has done so much to fight the stigma of mental illness and encourage people to get involved in educating themselves and others.

It is my sincere hope and prayer that something will be put in place in India so that attitudes toward mental illness would change and those suffering from it will have a platform where they would not be judged, dumped, abandoned or discriminated but supported and be treated with dignity and open minds.  In the meantime, let’s keep talking and raising awareness.

Talking is the best way to start breaking down the barriers associated with mental illness – Bell, Let’s Talk

 

Sources:  Vice News; Movement of Global Mental Health; Wikipedia; Deutsche Welle

Writer and Philanthropist

My mother’s favorite novelist is Catherine Cookson.  After I read a few of her books and watched movies based on them I became a fan too.  Her characters seemed so real and no wonder–her books were inspired by her deprived youth in North East deEngland, the setting for her novels.

Catherine’s story is as intriguing as the stories she wrote.  She was the illegitimate child of an alcoholic named Kate Fawcett, she grew up thinking her unmarried mother was her sister, as she was raised by her grandparents, Rose and John McMullen.   She married Tom Cookson, a teacher.  Tragically, she suffered four miscarriages and had a mental breakdown.  It took her ten years to recover.  She also suffered from a rare vascular disease, telangiectasia, which causes bleeding from the nose, fingers and stomach and results in anemia.

Catherine took up writing as a form of therapy to tackle her depression, and joined Hastings Writers’ Group. Her first novel, Kate Hannigan, was published in 1950.  She became the United Kingdom’s most widely read novelist, with sales topping 100 million, while retaining a relatively low profile in the world of celebrity writers.  She remained the most borrowed author from public libraries in the UK for 17 years, only losing the title in 2002, four years after her death.

Thanks to her craft Catherine became a multi-millionnaire.  She supported  causes in North East England and medical research in areas that were close to her heart.  She also donated more than £1 million for research into a cure for the illness that afflicted her (Wikipedia). 

With affluence Catherine concentrated on philanthropic activities to support the less fortunate. Catherine Cookson created a trust at the University of Newcastle with a committed amount of £ 800,000. The self titled Trust is dedicated towards the progress and research in the field of medical sciences and provides medical support to the underprivileged. Besides this Catherine Cookson also contributed £20,000 for the Hatton Gallery of the University and £32,000 for it’s library (http://www.catherinecookson.net/).

Despite the challenges and tragedies in her life, Catherine Cookson reached out to help others by using the money she made from the sales of her books. The plight of the less fortunate and the underprivileged moved her to do something to make life easier for them. 

Writing helped Catherine to get through her dark hours.  It is my hope and prayer that if you are going through something, that you will find the help you need to cope.