Dr Miranda Foon

PSYCHIATRIST: Dr Miranda Foon

KAVITA was still coming to terms with her sister-in-law’s sudden death when she suffered another traumatic blow—the suicide of her elder sister, Sita.

“It happened on June 20, 2010. No matter how hard I try, I could never forget it because the day before—June 19—is a holiday, so whenever that day comes around, I’m reminded of my sister,” Kavita says with a heavy sigh.

She recounts her sister’s story slowly and deliberately—as if she were reading a medical report.

Sita was obsessed with her health, so much so that she visited a list of doctors and specialists as long as her arm.

She would call her nephew who is a medical doctor and ask a series of questions until her phone calls ­became overwhelming.

Sita was convinced she had ­cancer, but no doctor found evidence of such.

She followed a rigid diet and lost a lot of weight, as a result.

Kavita now believes her sister’s obsession with her health was a ­cover-up for an unspoken pain; she was desperately lonely and depressed.

“She was retired and lived by herself, and although she would interact with us regularly, I think she sometimes felt like she was a burden. She didn’t have companionship or anywhere to go when the day came, so she fell into a state of depression,” says Kavita.

It all culminated on June 20, 2010.

Sita was a creature of habit: she was an early riser and would leave her doors wide open in the mornings.

So when her tenants noticed a locked house with no sign of Sita, they grew suspicious and called her sisters, one of whom had an extra set of keys to Sita’s home.

Kavita was the first person inside Sita’s place, where she discovered her sister’s lifeless body.

The image is forever burnt into Kavita’s memory.

“As soon as I saw her, I knew that was it,” she says. Sita was 62.

Kavita believes her sister would have still been alive today, had she sought treatment for her depression.

The most important

cause of suicide 

Mental illness—depression in particular—is the most important cause of suicide, says psychiatrist Dr Miranda Foon.

When Foon began as an intern on the General Medicine ward more than 20 years ago, heart attack was the most common cause of death.

Today, the most common cause of death in the world is depression and mental illness.

According to the World Health Organisation (WHO), 450 million people are affected by mental disorders which include depression, anxiety disorder, bipolar disorder and schizophrenia, among others.

Despite its prevalence, mental illness remains taboo.

Because of the false interpretations about mental illness, many people feel shame and hide their illness instead of seeking professional help that can actually save their lives.

Foon has encountered professionals who suffer from depression who are afraid to admit it or seek help because they consider it to be a weakness.

The stigmatisation of depression and discrimination of people with mental illness is a tale as old as time.

Centuries ago the common belief was that people with psychological disorders were possessed by evil; they were therefore ostracised by society and locked away in asylums.

Despite the advancements made in the understanding of the brain and mental health over the decades, false beliefs persist which would explain why the St Ann’s Psychiatric Hospital is often referred to in jokes as “the madhouse”.

This stigmatisation lies in a lack of education, knowledge and ignorance, says Foon, who has worked in the field of psychiatry in the public and private sectors for more than two decades. Foon has worked over the years to bring mental illness out of the shadows.

“Depression is no different from having diabetes or hypertension,” says Foon. “If you have diabetes, it’s because you have a problem with the amount of insulin in your body; if you have depression, it’s because of an imbalance in the production of serotonin in the brain. Can it be cured? Yes, it can be cured—many patients have been cured. Many.”

Mental illness is being underestimated, to the detriment of future generations, says Foon.

From her decades of experience in the field of psychiatry, Foon has seen enough cases where families have overlooked depression in their children.

“I know of persons in the medi­cal field whose own children were suffering with depression and they didn’t know. It was only when the school began to call because the child started giving problems—threatening to kill himself and others and fighting in class—that they brought the child to me. It was a clear case of depression,” she says.

Depression manifests differently in children than in adults. In most cases, irritability is a tell-tale sign that a child is depressed, but parents often dismiss that ­behaviour as just a “phase”.

That’s why educational campaigns about depression and mental illness are so important, Foon stresses.

She recommends parents take their child to a psychiatrist if they observe he or she is angry, upset and withdrawn.

“As the saying goes—it’s better to be safe than sorry,” says Foon.

Because misconceptions about depression abound, part of Foon’s job involves sorting fact from fiction.

Too often depression is often confused with sadness, she says.

However, sadness is an emotion one experiences on learning, for example, that their relative has Covid-19, whereas depression is a pathology—an imbalance of serotonin.

And one of the features of depression is suicidal thoughts.

Foon explains that depression is also taken for granted because ­unlike a broken arm wrapped in a cast or a missing leg, depression is not always visible to the naked eye.

Mental health crisis 

To understand how a depressed person feels, imagine that you have fallen into a deep, dark wet manhole that’s covered with three metal rods. You cry out, but your screams for help are drowned out by the sound of traffic, people and music.

“That’s what depression feels like,” says Foon.

To think that millions of people around the world feel that way every day is a sobering thought, she adds.

Yet the fact remains that mental illness is getting progressively worse in adults and young people, she says.

The Caribbean Public Health Agency (Carpha) stated that the current pandemic is having a major impact on people’s mental health and well-being, including those who have existing mental illnesses.

Untreated depression can have several consequences besides suicide. For that reason, Foon treats her patients as vigorously as she would treat any one of her family members.

Although Foon and her colleagues are facing a worsening mental health crisis in this country, compounded by inadequate mental health professionals and resources, and a lack of education around the issue, she refuses to fold her arms.

Foon continues to promote awareness about mental illness, in the hope that it would motivate those suffering in silence to urgently seek professional help.

Her message is: there is nothing to be ashamed about.

Foon recalls the early years of the AIDS crisis, when those who were diagnosed with the disease were so stigmatised that it was believed that touching someone with AIDS meant you could contract it.

Almost four decades later, we know more about HIV and AIDS thanks to public awareness campaigns.

Foon is confident that awareness programmes designed to increase people’s understanding of mental illness can result in a change in view points and lead to positive action.

The media plays an important role, she adds.

And people in public life who open up about their own struggles with depression can empower others to do the same.

But there is something each of us can do right now to help those struggling to cope under the heavy weight of depression, says Foon.

“Be supportive of one another,” she urges.

If you are having suicidal

thoughts, contact Lifeline:

800-5588 (toll-free),

231-2824 or 220-3636.

In the final instalment of

“The Strain of Suicide” series, next week’s article will focus on the people and organisations that have made suicide prevention their mission.

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THE MINISTRY of Health has reported one additional Covid-19 death, bringing the local toll to 98.