Issue link: https://maltatoday.uberflip.com/i/1192401
14 maltatoday | SUNDAY • 15 DECEMBER 2019 INTERVIEW Before turning to the topic of self-harm: the ongoing political crisis appears to have increased stress and anxiety levels across the country. In your practice as a psychotherapist, have you encountered any evidence of this? Yes, in a number of ways. I am unaware of anyone seek- ing psychological help spe- cifically for anxiety related to the crisis; but at the same time there hasn't been a cli- ent who hasn't mentioned it. There is a feeling of general stress, which inevitably has an impact on people who are al- ready in therapy for different reasons… regardless where they stand on the issue itself. It's a bit like breathing in, but not being able to exhale. Situations like this have an impact, also because the anxi- ety is felt on a national rather than a personal level. It affects some more than others, but things like this tend to over- shadow a lot of other issues. So people need to find ways to support themselves though the crisis; to cope with the stress as best they can. The question then becomes: how long can people keep coping, until something finally gives? All this comes at a time when there is already evidence of increased anxiety among the public. Last month, statistics emerged to suggest that self-harm and suicide attempts have dramatically increased, especially among young people. In this consistent with your own experience in the field? The statistic quoted in that article – three to five daily suicide attempts – is a scary figure, for a country the size of Malta. But there are other indications that anxiety is on the increase. The number of people I am referring to psy- chiatrists is getting higher: such cases would require a much faster intervention, that can be provided through medication… because therapy is more of a long-term ap- proach. So things are certainly becoming more acute, in that sense. Could this be partly due to an increase in awareness of mental illness in recent years? That is probably a part of it, but I don't think it's all that big a contributing factor. If you look at the last 20 years – which is more or less as long as I've been practising – cer- tain social structures have changed. People have less in the way of support struc- tures from families; not be- cause families are unwilling, but because everyone is really stretched, both time-wise and money-wise. Stress levels have increased, but people are not finding the same level of support they might have found in years gone by. So I wouldn't say it's just awareness. In fact, aware- ness is probably rising be- cause the phenomenon itself has increased. The pressures on people are way higher than ever before… The statistics suggest that self-harm, in particular, has increased to worrying proportions. At the risk of asking an ignorant question: what sort of problem would drive people to want to hurt themselves? We have to make a distinc- tion between self-harm and suicide attempts. Suicide, by definition, is the ultimate form of self-harm. But a per- son who self-harms is not necessarily suicidal. Nor will it always be a precursor to an actual suicide attempt. Often, suicides tend to come out of the blue... at least, for the peo- ple surrounding that person. Self-harm, on the other hand, is a different phenomenon. Why would people choose to hurt themselves? The rea- son many people give is that it provides some form of re- lief from an emotional pain. It gives the suffering some kind of physical shape, which also allows for the possibility of re- lease. But for others, the sen- sation of pain is preferable to feeling nothing at all. People who are feeling numb might resort to self-harm in order to create some form of stimu- lus… on the basis that 'any- thing is better than nothing'. There will also be cases – not very common – of children who are very neglected, and because of that will not have many social skills… but will continue to seek contact. They might prefer to be in a fight with someone, than just being alone on the playground. Be- cause at least, there'll be some kind of social contact. Sometimes, however, self- harm also comes from guilt and shame. So it's a very com- plex subject, and I think we need to really approach it by, first and foremost, trying to empathise: whether we un- derstand what these people are going through, or not. How does one to approach the phenomenon from a therapy point of view? The first thing, when dealing with something like this ther- apeutically, is to speak very openly about it, and to create an atmosphere in which the client feels they are not being judged. So I might ask some- one 'are you self-harming?', or 'are you thinking of killing yourself', with the same tonal- ity as the question: 'where do you work?' Because as soon as people feel they can talk open- ly about it, and that somebody is listening… then the healing process can begin. Earlier you mentioned that referrals have increased. This, in turn, suggests that the number of cases requiring medical intervention are on the rise. Are we therefore also looking at an increase in mental illness? I'll leave it to others to de- fine 'mental illness', because terms like that can be very loaded. But basically, if we're talking about levels of stress, then yes: the phenomenon is certainly on the increase. And this is something that also comes out when I talk to col- leagues. It's not just my own experience, or my own prac- tice. It is something that is be- ing noticed across the board, and in all the helping profes- sions. And it's not just stress: the frequency of intense panic attacks is also growing. Anxiety has always been a phenomenon in psychother- apy; up to an extent, it is an unavoidable part of the hu- man condition. So it has al- ways been one of the classic scenarios that gets presented as a leading problem. But the intensity is on the rise. To give a generic example: a Recent statistics indicate an alarming increase in self- harm and suicide attempts showing up at Mater Dei's emergency department. Psychotherapist MALCOLM TORTELL argues that coping with anxiety has become a leading challenge for today's society Coping with anxiety Raphael Vassallo rvassallo@mediatoday.com.mt