It has been a while since I posted. I thought it would be useful to discuss a few topics that have arisen.
The vexed question of “mental health”. For some time I have been concerned that “mental health” is used as a synonym for our responses to any situation that does not appear to be positive. Recently, for example we have been told the counselling is available for those who voted Yes in the referendum! Should we provide counselling for those who voted for the party that loses the next election?
It seems, as a society, that we do not acknowledge that sometimes people are unhappy, disappointed, resentful or hurt without this being regarded as a “mental health problem” therefore amenable to “counselling”. The fact is that life is full of disappointment, it is difficult to see what role counselling has to offer in those situations. This leads to the next issue that I have been pondering recently, resilience.
I have seen a number of older people recently who have experienced a variety of trauma including transport accident, medical mistakes, dog attacks amongst others. What has impressed me has been the attitude of getting on with it, “it is what it is”, “I have to deal with what I’ve got”.
I saw a man recently. Kevin is now aged 66 and had bowel cancer 20 years ago requiring a partial resection, chemotherapy and radiotherapy and he has been in remission since then. He was recently diagnosed with low-grade prostate cancer and was advised to have a prostatectomy. It was suggested that a robotic prostatectomy rather than an open procedure would lead to less trauma, fewer complications and less time off work.
Unfortunately the operation led to a bowel perforation with the development of a recto vesical fistula that was unrecognised for weeks. He developed peritonitis and had further major surgery. He developed leakage of urine through his anus. He had a colostomy fitted and then a nephrostomy but the perforation to his bladder could not be repaired and so his bladder was removed and he now has an artificial bladder created from part of his small intestines draining into another bag. It is two months since his last operation.
He has not had any psychiatric or psychological treatment, he has no current healthcare providers and takes no medication. He deals with his bags himself. He is looking forward to go back to work as a driver as he is not able to return to his previous work that involved a good deal of lifting and carrying. He is at times frustrated about what happened but tries to put it behind him and intends to make the best of the rest of his life.
Do you think he has a mental health problem? I thought he was annoyed by the complications that had occurred, he had lost some trust in his doctors, he was frustrated by having a colostomy and a urine bag but denied being depressed or anxious. Of course he wished he had not had the initial procedure but that was “water under the bridge” and he did not dwell on it.
I thought he was a great demonstration of resilience and did not have a diagnosable psychiatric disorder..
The other issue that has come up as being Covid. We hear so much about how damaging Covid has been to individuals and the community and I have no doubt that is true. I have been intrigued however that none of the people I have been assessing over the last two years have a claim centred around Covid. Indeed many of them found the lockdowns beneficial as they were already experiencing anxiety away from home and the lockdowns made them feel more normal. Of course for some the lockdowns were difficult.
I will be interested to see whether or not Covid issues emerge over the next 12 months or so. As RSI was the fashionable condition in the 90s and bullying seems to be the current fashionable complaint, it may be that Covid takes over that role!
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