Psychological Support Essential for Trauma-Affected People
The director general of the Office of Mental Health, Social Affairs and Addiction at the Ministry of Health said crises affect common mental health disorders, including anxiety, stress, depression and worry, and that indicators related to these problems rise after crises occur.
According to Ambassador Arjan, quoted from Sharq, "We have come from many wars, we have carried many stones". The voice of a newly middle-aged man rings out in the amphitheater hall of the psychiatric hospital. A writer who talks about the difficult years of his life; From severe depression, mourning and separation, and from the days when he had to choose between continuing and ending his life's journey. But now he talks about his sufferings to invite others to listen and talk; Even if the conversation is not necessary, even if it is unpleasant.
On the third day of mental health week, many people have gathered in the amphitheater hall of Rozbeh Psychiatric Hospital in Tehran; A part of the hospital staff, officials and psychiatrists and among them, those who have come with a bag of suffering to tell about their lived experience, such as Parisa Valentina Poyanrad, a social activist and a mother who lost her two young children to suicide within three years. On the poster of the World Mental Health Day, it is written: "Hearing lived experiences; Real voices, real change. In the corner of the poster, a phoenix with orange, yellow and green feathers is engraved; A bird that is reborn from the ashes. This image is a reminder of the efforts of people who are looking for a way to continue living after experiencing suffering and loss.
Prisa Valentina Pouyanrad goes behind the podium and tells about the mourning of her children. He is a psychologist and researcher, runs a non-governmental organization to support children, and despite his professional familiarity with mental issues, he talks about the accusations he heard after the death of his children: "Why you? You are a psychologist. you know They told me, don't tell your child committed suicide. Why not say?". He talks about the pain he experienced in the absence of his children and how he gradually started taking care of himself. More than a year has passed since her daughter's death before she was able to talk about this loss. He says about a promise he made to his daughter in the last moments; As the only person allowed to go above him, he vowed to do whatever he could to help young people struggling with trauma: "I promised to hear the voices of other young people." He says that he has held grief workshops many times for families who have lost their children to suicide and continues to do so.
Hamid Salimi, a writer, has also been invited to this ceremony to narrate his lived experience of life with mental injuries. According to him, he wrote his first screenplay at the age of 19 and that screenplay was turned into a series. Salimi talks about the days when he lost his father, the most important support in his life, and he found himself at the bottom of a well from which he could not find a way out. According to him, at that point there were two ways forward: transfer the suffering to others or turn it into an opportunity for change. He chose the second way, abandoned screenwriting and turned to teaching.
He says about the necessity of accepting psychological injuries and acknowledging the suffering of others: "It is okay if we accept and admit that we have psychological injuries. We have to see each other, give ourselves the chance to talk, the chance to be weak, to be allowed to break. Don't be ashamed to cry, sometimes resign from some roles. Next, Salimi points to the image of the phoenix on the poster; A bird that burns in the fire and is reborn: "Being a phoenix is very beautiful, but when you pass through the fire, a part of your skin must have been burned, you must have been injured, and the place of those wounds and burns must be painful to caress." He continues by emphasizing the importance of dialogue: "Everyone you see in front of you has returned from many wars, everyone you talk to has carried many stones. Recognize the sufferings of others. Don't attack each other with words in cyber space, words have bones and when they hit someone else they cause pain. There is nothing wrong with psychological trauma. Don't pay attention to the words on Instagram that instead of therapy, I drink coffee or bring a cat and... Don't run away from conversation, even unnecessary and unpleasant conversations.
Outside this hall, however, many people are involved in sufferings that sometimes they don't even have the ability to talk about them. For some of them, moving on with life means coping with anxiety and depression; For others, trying to maintain relationships, pay living expenses and find a way to access mental health support. Among the economic pressures and the consequences of social crises, even the opportunity to talk with others has been limited for some. Shahla is a 40-year-old, educated and employed woman who has experienced many losses in the past years. Due to his profession, he regularly faces stress and anxiety, and he says that the presence of a psychotherapist in his life has prevented him from falling: "If it was not for my therapist in some periods of my life, I would definitely not be alive or I would not be the person I am now."
In the past years, Shahla has gone through periods of anxiety and depression, she takes medicine, and now she feels that her mental strength has weakened: "I feel that even my other medicines are not as effective as before. My tolerance is very low, I have become aggressive and nervous, and I feel these changes completely." He also sees changes in his interactions with his friends and acquaintances; According to him, people's tolerance has decreased, they pass each other less than in the past and respect each other less. Shahla considers part of this situation to be due to frustration; Frustration that the more you try, the less you get.
"I've never been as bad as I am now," she says. Shahla has the experience of going to a psychotherapist and talks about the effect of conversation on her mental state, but now the issue is not only access to someone to listen; He is no longer able to speak: "I have to say that I don't even feel like talking anymore. There should be teams that look out for people, especially people with a history of depression or taking medication. People often do not take mental illnesses seriously. While mental illness can act like cancer. "Cancer destroys cells, and mental illness leads to the destruction of a person."
Crises that linger on
Mohammadreza Shalbafan, a psychiatrist and director general of the Office of Mental Health, Social and Addiction of the Ministry of Health, says that crises affect common mental health disorders, including anxiety, stress, depression, and worry, and after crises, indicators related to these problems increase. According to him, the reports and surveys conducted during this period also indicate an increase in stress, depression and anxiety in the society. Meanwhile, groups such as children, teenagers, the elderly, people with a history of mental disorders, disabled people, and pregnant women may be more vulnerable in critical situations and get deeper effects from these conditions. Shalbafan emphasizes the necessity of a more detailed examination of the state of mental health in society and conducting a new survey to measure related indicators: "Psychiatric disorders are determined by national surveys of mental health. In all countries, these surveys are carried out with intervals between seven and 10 years. In Iran, the last survey was conducted in 1401 and its results were announced. But it seems that according to the conditions of the country and the necessity and need for policy making, it is necessary to conduct the next survey sooner."
Shalbafan, last year during the mental health week, mentioned the comparison of two surveys conducted in the past 10 years: "The comparative examination of the results of the first and second mental health surveys in the last decade indicates that the prevalence of mental health disorders has increased in Iran. The results of the 1390 survey indicate that 23.6% of Iranians suffer from at least one psychiatric disorder, while the rate of Iranians suffering from at least one psychiatric disorder has reached 25.1% in the 1401 survey. The incidence of mental disorders increased by 1.5% during the 11-year period between the first and second surveys, which indicates the need to pay attention to mental health. Also, another study conducted in 2019 shows that the rate of Iranians suffering from mental disorders is about 29%. In the survey of 1401, it was found that depression is the most common mental health disorder in the society with 13.7% and therefore it is at the top of psychiatric disorders. The prevalence of mood disorders is 16%, which includes depression, bipolar disorders, and other mood disorders. Also, the total number of anxiety disorders, which includes things like panic disorder, anxiety, etc., is 13.7%.
Narratives of citizens about their mental state and those around them provide a picture of the sufferings that flow in everyday life; From worry about the future and exhaustion caused by economic pressures to the difficulty of accessing medical services. However, to assess the prevalence of mental disorders in society and its changes, accurate data and valid surveys are needed. "Mohammed", 24 years old and a master's student in anthropology, describes the situation of the people with one word: "homelessness". His entry to the university coincided with the protests of 1401 and now he is studying in the critical conditions of the war.
He says that he has to see life as compressed; It becomes difficult to plan long-term for the future and feels that life is shrinking: "It's like life is shrinking." Among his friends and acquaintances, Mohammad knows many people who use anti-anxiety and sedative pills. He tells about a trip where he saw all kinds of pills on the table. According to him, the high cost of psychotherapy has made many people around him reduce the number of sessions, go to cheaper psychotherapists, or give up treatment altogether: "It's hard to persuade people to go to a psychotherapist, because it's expensive. For this reason, they often turn to pills; It is less expensive and quick to respond." The use of psychiatric drugs among those around Muhammad has also brought another concern; Access to some medications has become difficult in recent weeks, and some consumers are concerned about their supply. In this regard, Shalbafan says that the entry of people into the cycle of drug treatment should be checked along with the necessity of taking the drug correctly. According to him, two points are important; The drug must be taken under the prescription of a psychiatrist, and in many cases, drug treatment must be accompanied by psychotherapy. He emphasizes: "Generic anti-stress and depression drugs are not drugs to be seriously concerned about, but the advice is to avoid arbitrary use. "The fact that a friend or a family member used it and got results can't be a reason for using it, but it can be good data for a psychiatrist to prescribe." However, Muhammad's problem is not only the cost of treatment or medication; Even when people are advised to talk about their suffering and difficult experiences, there is always no one to listen, she says. Family and friendly gatherings, which can be a safe space for conversation, are themselves involved in a crisis. Many of his friends also spend most of their time at work due to economic pressures and do not have a chance to talk. "People have become homeless," he says. They don't have anything from the past to hold on to, they don't have anything from the present to control the situation.
They are standing under the rain and there is no umbrella to save them." The high cost of mental health services is one of the barriers to accessing treatment; Besides that, the question arises as to how much telephone counseling services can help people in critical situations. Here, Shalbafan says that the 190 mental health counseling line is responsive from 8:00 a.m. to 12:00 p.m., but this system is not designed for long-term psychotherapy. People who need continuous services can refer to comprehensive health centers or Siraj centers. Mohammad has a different experience of contacting this system: "I waited for a long time for an answer, but I didn't get an answer. These systems are for before the crisis, otherwise it cannot help people in that short period of time. Maybe if someone intends to commit suicide, this system can help, but the point here is that someone who wants to end his life, for example, does not get help from anyone to stop him. After all this, trust and culture have not been built to use these services. Mohammad's experience, along with the explanation of the Ministry of Health official, raises a question about access to support services; To what extent are these services available when needed and can people trust them in critical situations?
When you can't say bad things anymore
"Nargis", a 36-year-old woman who says that she always talks about her good and bad mood with others, but for some time now, she no longer has the desire to talk about her bad mood. In friendly groups, he thinks that the capacity to hear these words has decreased and he does not find the possibility of such a conversation at home. He says: "People are in such a bad mood that one cannot talk about their problems at all. That's why I always try to laugh and spend those few hours with my friends.
But when I step in the house, it's like that mask is removed and I become a sullen and depressed person. Lately I don't like to go home or I try to go late." Narges used to visit a psychotherapist regularly and was satisfied with her sessions, but she abandoned the treatment due to the high costs. Now he takes help from artificial intelligence to talk and cope with his mental condition: "Sometimes I feel that artificial intelligence has filled the place of a friend for me. I am constantly talking to it and I am very satisfied." He also feels the increase of aggression among his friends and considers economic pressures as one of the main factors of this situation. Narges says that she used to travel, camp in nature, buy clothes or go to cafes and restaurants to improve her mood, but now it is difficult to even meet the usual expenses of life. He asks: "How can you be in a good mood in this situation?" How can anxiety and stress be reduced?". The war has also added to his worries: "Every time there is a sound, I jump up and get scared.
I keep imagining that there is a war and rockets are raining." Narges says that after the end of the rocket rain, her anxiety increased; The anxiety that he said he did not feel so strongly during the rocket rains. He continues to talk about the failures that he believes have affected the lives of many people around him: "You can't get into a relationship, you can't get married and have children, you can't start a new job. All this directly affects the mind, and how else can you expect a healthy mind?". Nargis's experience raises another issue: when access to psychotherapy becomes difficult due to cost, what tools do people use to find a space to express their concerns? Can conversation with artificial intelligence fill a part of this void? Shalbafan does not completely reject the use of these tools. He says that artificial intelligence has access to extensive information and may perform well in answering general questions, but when it comes to the personal experience of people and their complex psychological issues, the answers may be stereotyped and repetitive and cannot replace expert intervention. Emphasizing the importance of human communication, he says that people need face-to-face communication, not just communication with a tool that lacks human emotion. According to him, the use of artificial intelligence in the field of mental health is also a subject of discussion in different countries and is not an issue specific to Iran.
Shalbafan continues to emphasize the importance of dialogue in critical situations; A conversation that takes place in a safe space and away from judgment. He says: "Man needs to speak in a place where he is not judged, where there is a human view about him and where he is respected. Of course, we should be careful not to expect specialized performance from non-specialists. According to this psychiatrist, family can be one of the most important sources of psychological support.
Listening without judgment, not comparing people to each other, and respecting their experiences are among the factors that can help them talk about their situation. However, problems such as anxiety and depression are not always resolved by talking with family or friends, and in some cases, the intervention of a psychologist or psychiatrist is needed. Shalbafan believes that the society needs to hear more narratives of experiences related to mental health; Both the narrative of people who live with psychiatric disorders and the experience of those who got positive results from seeing a psychotherapist.
According to him, these narratives are still not very prominent in the public space. From wall to wall in the amphitheater hall of Rozbeh Psychiatric Hospital, loud music is heard. The sound is from the back yard; where happy men and women are standing next to the chairs, clapping, shaking their bodies and cheering; Women wear pink and men wear blue. They are a number of hospitalized patients who, on that day and hour, have been away from the closed space of the ward for a few moments; From the days that may have passed with anxiety, restlessness and unspeakable sufferings, for a few minutes, something outside of their sufferings has occupied them.