World Health Day

Today, April 7, is World Health Day. Since 1950, the World Health Organization has celebrated this day annually and takes the opportunity to focus attention on important aspects of health. This year’s theme is ‘Let’s build a fairer, healthier world for everyone’.

There are a few works in the collection of the National Gallery of Victoria which depict patients – most of them showing people in extremis. However, a cartoon by Australian illustrator and political cartoonist, Will Dyson, connects with my past profession. In the cartoon we see a composed, rather stiff young woman being introduced to a friendly, but somewhat hulking and simian individual. Her closed eyes and tentative outstretched hand indicate a wariness in ‘looking below the surface’ of her psyche. And despite the kindly expression and willingness of her unconscious to greet her, it is obvious that, as the woman’s conscious and unconscious are so dissimilar, it might be a tricky encounter.

In my work with adolescents with mental health issues, I was struck by how often this disconnect was played out. This transitional period is a time when significant developments take place and much of the time and energy is spent in ‘strengthening’ ego defences to mediate between id driven instinctual impulses and the stricter, more ‘repressive’ and conscience-oriented superego. The struggle which I witnessed, particularly with youngsters who had experienced trauma in their earlier years, could be extremely gladiatorial.

 Yesterday, I was contacted by a young woman who I first met 15 years ago, when she was 14 years of age. As a young adolescent she had suffered greatly and was ‘out of control’ with rapidly diminishing options. No longer at school, she was in danger of being homeless, and her father (she no longer had contact with her mother) was unsure of his capacity to provide a safe place for her. Desperate for stability and certainty, any hint of abandonment annihilated her sense of self and led to self-destructive behaviour.

This young person (who was dealing with Complex Post Traumatic Stress Disorder) and I ‘tussled’ through, ‘near death’ experiences, inpatient admissions, and out of home placements for many years – with both of us wondering what the likelihood of her survival would be. Progress was slow and opportunities wasted but … over time we found a space where she could think positively, rather than act dangerously.

My retirement from work was a potential problem but we maintained regular, less frequent contact and established a supportive mentoring arrangement. When COVID thwarted catching up, issues of abandonment reappeared and resulted in me writing her the following story:

‘Once upon a time long ago in a distant country there lived a sad young girl.  She was sad because no one had ever shown her the love she needed.  Her parents were too busy fighting with each other to remember that she existed, and her older demanding sister was too concerned with herself to be of any use.  As time went by the girl became lonelier and sadder.  The only way she could get noticed was to get angry, because when she shouted and got red in the face, people were reminded that she was around – and there was plenty to shout about!  Of course, this created its own problems for the sad girl because nobody likes a ‘shouter’. 

Her father, who was a Mr Fixit, (when he wasn’t a Mr Idontwanttoknow) tried many things to stop the girl shouting.  One day he took the girl to a market and they came across a stall of ‘Genie lamps’.  “Do these things actually work?” asked Mr Fixit.  “We haven’t had any complaints, and nobody has asked for their money back” replied the stallholder.  “They are guaranteed to provide light in the darkest tunnel for up to ten years – and if they are looked after and valued – who knows, they might last even longer”.  They had tried everything else and even though the girl was more than suspicious she agreed to carry the lamp with her to see what would happen.

The first time when she rubbed the lamp and the genie appeared she was both startled but unconvinced.  She had read about genies and this one wasn’t at all what she expected.  He seemed rather odd and ‘not very professional’ – more like an uncle than a powerful figure. Despite thinking “this is another load of shit”, the girl decided to listen to this strange genie.

“How can you make my life better?” she asked. And annoyingly, the genie replied: “I can’t make your life better”.  “Well then, what can you fucking do?” shouted the girl.  “Well” the genie answered “I can listen to your complaints and try and understand; and I can offer advice and make suggestions about how you can make your life better; and I can help you and others get to know you better – things like that”.  The girl couldn’t see how this might help at all, but as she had no other options, she figured she would give it a try.

For a long time, it didn’t seem to help much. She often found the genie downright annoying.  As far as the girl could see he didn’t understand, gave unhelpful advice and interfered when he shouldn’t have.  She would often get angry with him and shout at him telling him how stupid and useless he was.  But strangely, her shouting didn’t seem to affect the genie in the way that it bothered other people and he usually popped back up to be just as irritating.  Slowly the girl began to see that she didn’t need to shout to get people to listen and this made the genie happy.  It was a small step but a very important one. 

The girl continued to be sad and lonely but gradually she started to feel safer and more confident in the world.  As the years passed and she felt a bit better about the possibility of a future, ideas came to her about how she could speed up the process.  Impatiently she would ask the genie about places she could go to find happiness; or jobs she could do; or people she could settle down with.  Often these ideas were whims and not clearly thought out.  The genie didn’t think that a life as a circus performer with someone out of jail would end well – but this ‘lack of support’ for the girl’s choices did not dissuade her from pursuing adventures which ended with the predictable and inevitable – “I told you so” from the genie.

The ten years flew by and it was amazing how much the girl had changed.  She was rarely angry, often thoughtful and caring and considerate of others. People around her responded enthusiastically to her energetic and optimistic approach to life.

For her part, the girl was anxious that time was running out on the ten-year guarantee that came with the lamp.  She still carried the lamp with her but did not rub it as often – partly because she didn’t need to, and partly because she didn’t want to wear the genie out.  The girl thought he had been looking a bit ‘below par’ and seemed ‘grumpier’ than he used to be.

On one fateful day she challenged the genie about why he was not as useful and did not seem as interested in her life.  The genie tried to explain that he was doing the best job that he could, but this didn’t satisfy the girl.  She felt hurt, and angry, and bereft that the genie, who had been so much part of her life, might not be there for her.  For a while, the girl and the genie were estranged and he thought hard about how to tell the girl that she would be able to manage without the lamp on a regular basis.  He decided the best way to do this was to tell the girl a story.

By now the girl was more reflective and sensitive to others and she read and re-read the genie’s story. While the girl clearly understood that the genie’s abilities were wanting and waning, what she didn’t understand was that over the ten years, he had been transferring his energy into her so that eventually she wouldn’t need him.  She had learned so much about herself and the world that she only needed to remind herself of the discussions she had had with the genie to know that his wisdom was now inside her. Of course, she would still be able to see the genie and share her experiences with him – but she really didn’t need the lamp because she had become a genie herself.’

My now (not so young friend) is currently living independently and working as a support worker for people with disabilities where her sensitivity and compassion are highly valued. She is a great advocate for her clients and has a clear map of what she would like for her future. Her ability to make meaningful connections is impressive and she has established a workable relationship with her (not so workable) family. And when she contacts me, it is to think through options or seek advice … which she even acts on! (She was delighted that I was wanting to share her story on World Health Day).

In order to ‘Build a fairer, healthier world for everyone’, the World Health Organization encourages us to focus on a single health challenge which has ‘global’ impact. Getting in touch with the forces that ‘drive’ our feelings and actions (meeting our unconscious) requires bravery, perseverance and trust. I want to thank my friend for her willingness to take on the challenge.