Ahmed Hankir’s Story
Hi everyone, I hope you are all well. I'm Professor Ahmed Hankir, a consultant psychiatrist in Canada and an honorary visiting professor at the School of Medicine at Cardiff University in the UK. I identify as a wounded healer. As I said, I'm a consultant psychiatrist, a mental health care provider, and also a mental health care receiver. I was a psychiatric patient. I am a person living with a mental health condition, a survivor, and that, of course, is nothing to be ashamed about.
I want to thank the Global Mental Health Action Network for providing me with this platform to contribute to this event. Thank you, Dr. Antonis, and your team. Persons often ask me how we combat mental health-related stigma. I mean, it's ubiquitous, it's everywhere. Where do we even begin? I think a good starting point is the human heart and to be brutally honest with yourself and to engage in introspection and identify any stigma that might be inside you and reject it. Also, by providing persons living with a mental health condition a platform to vocalise our views, it should be nothing about us without us in relation to the provision of mental health care services and challenging mental health-related stigma. However, it often seems that it's everything about us without us. We refuse to be silenced any longer. We have voices, we can speak for ourselves, and we will be heard.
My talk is going to be about how we can harness the power of creative writing and storytelling to reject mental health-related stigma and humanise persons living with a mental health condition. Many persons, including myself, feel like we are being dehumanised. We can harness the power of storytelling to humanise persons living with a mental health condition because a story is data with soul. I want to share with you all my book, "Breakthrough: A Story of Hope, Resilience, and Mental Health Recovery," released in April. It is available to purchase in major retailers, bookstores like Waterstones, and online on Amazon. It traces my story as a person of colour.
In the UK, the acronym used is BAME (Black, Asian, and Minority Ethnic), while in North America, it's BIPOC (Black, Indigenous, and People of Color). People of colour are overrepresented in mental health care services, and it can seem that the narrative is whitewashed, excluding the voices of persons of colour living with a mental health condition. This book is an opportunity for me to reclaim my narrative and share my story in my own words. I poured my heart and soul into this, aiming to humanise and dignify persons living with a mental health condition. I found it cathartic.
“If this was about physical health, there would be outrage. Because it's mental health, there's a deafening silence. Stigma is a major barrier, so we need to reject it.”
Now, I will read some extracts from my book and share some reflections and insights, emphasising that we need to reject stigma. Stigma is a major barrier to mental healthcare services, causing many persons to suffer in silence despite the availability of effective treatment. This is unacceptable. Repetition is emphasis: many persons living with a mental health condition continue to suffer in silence despite the availability of effective treatment. If this was about physical health, there would be outrage. Because it's mental health, there's a deafening silence. Stigma is a major barrier, so we need to reject it. How do we do that? The evidence is clear. Making social contact with a person living with a mental health condition is crucial. When you meet us, you discover that we have hopes, fears, strengths, vulnerabilities, and dreams like everyone else. You discover that we are human beings. We must be involved in the design, development, and delivery of mental health services and anti-stigma campaigns at every level. Here goes an excerpt from my book.
I start with a quote from Dylan Thomas: "Do not go gentle into that good night, but rage, rage against the dying of the light." Poetry defies a single interpretation. For me, this means we, persons living with a mental health condition, are being stigmatised, dehumanised, shunned, and discriminated against. But I will not go down without a fight. I will fight for my human rights and the rights of persons living with a mental health condition.
If living with a mental health condition has taught me anything, it's that the cognitive capacity of the mind to receive and conceive ideas is something that should never be taken for granted. There have been periods in my life during which my mind was so shattered that it was unable to comprehend, concentrate, or produce any meaningful or coherent thoughts. Reading a book, let alone writing one, would have been impossible during those trying times. I am immeasurably grateful and extremely fortunate to have recovered and regained my cognitive powers. Recovery was a gradual, slow, and painful process that took many years. I was one of the lucky ones. Far too many continue to experience severe symptoms despite their efforts.
I think of people living with bipolar affective disorder, schizophrenia, and schizoaffective disorder, held captive by delusions or tormented by voices and visions, those with severe mood fluctuations, and those with dementia and other neurodegenerative conditions. My heart breaks for persons with eating disorders, which have the highest mortality rate of all psychiatric disorders, and for those with anxiety disorders like OCD and PTSD. Not enough is being done for people living with these cruel conditions. There is not enough awareness, specialist support, social care, or mental health care available. The quality of care is often poor and inadequate.
Human rights violations and stigma against persons with severe mental health conditions and psychosocial disabilities are major issues and a stain on our collective conscience. A government is judged by how it treats the most vulnerable. By this measure, the government has failed spectacularly. We need to do more. We must do more. People living with severe mental health conditions deserve better. More resources and high-quality, accessible specialist support must be provided. I dedicate this book to those who cannot express their thoughts due to the severity of their symptoms and to those who can speak out but are stigmatised and shunned. This book is dedicated to the voiceless, those ridiculed and silenced. Our hearts grieve for you and go out to you and your loved ones. You are the true mental health heroes and deserve so much more than a dedication. I hope this book raises awareness of your plight and your dignity and grace as you continue to fight and rage against the dying of the light.
“Seeing harrowing images of dead bodies and fearing for my family's lives, I felt powerless and overwhelmed, developing a mental health condition so severe that I had to interrupt medical school and repeat two years. When I needed care and compassion the most, I received ridicule and rejection.”
When I was reading this, I felt a crescendo of emotion, remembering my dark and lonely place and how hopeless I felt. If you had told me then that I would recover and become an author sharing my story, I would never have believed you. It reminds me of the importance of hope. Planting the seeds of hope in the hearts, minds, bodies, and souls of those we care for is crucial. Recovery is a reality for many, though not for everyone, due to the inadequacies in support for those with severe mental illness.
Some other thoughts that crossed my mind while reading my book include the importance of humility. The best psychiatrist I ever met was not actually a psychiatrist. I pay tribute to him, Professor Jed Burn, a surgeon who provided me with an endorsement for this book. In 2006, my hometown in Lebanon was bombed. Seeing harrowing images of dead bodies and fearing for my family's lives, I felt powerless and overwhelmed, developing a mental health condition so severe that I had to interrupt medical school and repeat two years.
When I needed care and compassion the most, I received ridicule and rejection. The symptoms were severe, but the stigma was far worse. Professor Burn listened, dignified me, and provided a safe space. His humility was evident in his words, tone, body language, and non-verbal communication. He didn't place himself on a pedestal, unlike some in the medical and psychiatric professions. We need more humility in mental health care, medicine, and the world.
That was a reflection that I wanted to share with you all. As I said, I'm a person of colour, I'm a man of colour, and we can't be naive. We can't be oblivious to the fact that racism is real. It exists. There was a survey conducted by the British Medical Association with a decent sample size of at least 1,000 participants, doctors. 75% reported that they were victims of racism. We know that mental healthcare services are overrepresented by people of colour. You are more likely to be detained under the Mental Health Act if you're Black compared to if you are not Black. You're more likely to get a psychiatric diagnosis with schizophrenia, more likely to be started on antipsychotics, and less likely to receive psychotherapy. To say that racism doesn't at least play a part is not true. That's something else we need to address in mental healthcare: racism. I spoke about the stigma, the discrimination, the importance of humility and connection.
Often, when I'm working in emergency psychiatry, for example, when I was an SPR at St. Thomas Hospital in Westminster, in central London, you get the phone call from the psychiatric liaison nurse about a person who has been placed under a 136, a police power section 136. The nurses think this person meets the criteria to be detained under the Mental Health Act. When I meet them, these persons are often lonely, isolated, and socially disconnected. I talk about the importance of connection.
It's not the quantity of those connections; it's the quality. All we need is one high-quality connection, and the persons receiving care from me in a mental health crisis don't even have that one connection. That's heartbreaking. That also reminds me of how I draw more on my personal experiences, my personal expertise. Persons living with a mental health condition can identify as an expert by experience, an expert by personal experience. If you're a mental healthcare professional, like a consultant psychiatrist, you can be considered an expert by professional experience. If you're a mental healthcare professional living with a mental health condition, you can identify as an expert by personal and professional experience. The acronym we coined is EPPPE.
At 2:00 in the morning, when I'm providing care to a person in a mental health crisis, I don't draw on my professional experience and expertise as much as I do on my personal experience and expertise. There's reciprocity as well. I'm not the only person who feels it. I've had persons receiving care from me say that I'm the first psychiatrist they feel they can connect with, to have that kind of authentic connection with. It's because I draw on my personal experiences and expertise. It's not entirely a disadvantage. Don't get me wrong, the symptoms can be debilitating. I was in a dark place. I don't ever want to go back to that dark place. I just want to be clear about that. I don't want to romanticise this, but my experiences have made me more insightful, empathetic, and driven. I feel like I have authentic connections with persons receiving care from me. That's what I draw on at 2:00 in the morning, for example. It's not written in the psychiatric textbooks. I remember talking to a person living with a mental health condition, and I said to him, "At the moment, it seems to me you're existing and not living." He didn't make eye contact with anyone, but when I asked him that question, he made eye contact with me and nodded his head.
Another powerful anecdote about racism, specifically Islamophobia, is that, unfortunately, like anti-Semitism, these are growing problems we need to combat collectively. In the psychiatric intensive care unit, I was asked to see a patient. They were about to administer rapid tranquilisation and had physically restrained him. I heard someone say, "He's a terrorist." He was holding a copy of the Holy Quran. I don't know who said it, but they were about to chemically restrain him. I said, "Please stop. Let me try to connect with him." I said, "Salam, peace." That's the first time he made eye contact with anyone. He didn't respond but made eye contact with me. I said, "I noticed you're carrying a copy of the Holy Quran in your hand. Does reciting from the Quran comfort you?" He nodded his head. I invited him to recite the Fatiha, the mother of the Quran, in unison with me. He accepted my invitation. While reciting Fatiha, tears streamed down his face, and he deescalated. He was exhausted and fell asleep afterwards with a smile on his face, without the need for any rapid tranquilisation.
This illustrates how Islamophobia has infiltrated mental healthcare provision. There was a member of staff who whispered, "He's a terrorist," just because he's Muslim or holding a Quran. Dr Michelle Funk at the World Health Organization is passionate about an alternative approach to mental health grounded in a human rights framework. In Merseyside, a trust has zero coercive practice recorded. Maybe Dr Funk has a point that we don't need coercive practice in mental healthcare. Talking to someone on a human level, having humility, and connecting on their level is crucial. Sometimes, that's literally sitting on the floor with them.
“I'm inviting you to stand in solidarity with us, to contribute to this cultural revolution that empowers, dignifies, and humanises persons living with a mental health condition.”
I don't have all the answers. I'm sorry if I've said anything that has upset or offended anyone. That was not intentional. I want to be receptive to your feedback and comments because I want to incorporate the feedback. I hope the words I'm sharing are coming from a good place, and we can all grow together. We need to provide the highest level of care to persons living with a mental health condition.
Thank you for joining us. When this moment becomes a memory, please reflect. I hope I was able to engage both the mind and the heart. We can harness the power of storytelling. When this moment becomes a memory and you reflect on it, you have an opportunity to be an agent of change. You can reject the stigma, combat the stigma, or perpetuate it. Perpetuating stigma isn't an option. It's incumbent upon all of us to reject the stigma. I'm inviting you to stand in solidarity with us, to contribute to this cultural revolution that empowers, dignifies, and humanises persons living with a mental health condition. Thank you again, and please protect your minds and hearts.
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