25 February 2022
I sometimes watch Foreign Correspondent on ABC TV and by chance on 15/2/21 I came across this excellent programme on loneliness in Japan.
The ABC correspondent there looks at loneliness in the Japanese population from older folk dying alone, to younger people simply withdrawing from society.
Some of the older ones had no family or jobs. Some of the younger ones were so pressured to succeed and felt that they had failed, so simply withdrew from society. It seems that the pressure on kids all to be CEOs is an absurd and unachievable objective.
I am not sure that the situation in Australia is as bad, but I thought about some of my patients and could think of half a dozen immediately. With some of them , I am one of the only two or three people in the world they have any contact with, their relationships are tenuous.
None of them started with mental health problems. Here are some examples:
A 60 year old man worked for a security company looking after an insurance company. He was doing surveillance for them, but it took over his life as he was contacted 24 hours a day for various crises. Case management employees having conscience over what they were doing had to be rescued from self-harm in the toilets. Enraged claimants with refused claims threatened to blow up the company offices with cans of petrol. He saw staff high-fiveing as some claimant got a derisory settlement when they deserved and needed a lot more. It went on like this for years. When he said that he could not do this anymore he was treated as badly as any of the people he had dealt with. He told me this story, and I had hoped that with his considerable management skills and experience, he could be put into a less stressful position. But he deteriorated. Everything reminds him of the corruption of the world. He is estranged from his wife and they communicate with post-it notes on the frig. He goes for a walk at 11 at night so he will not have to speak to people in the street. One son has stuck by him and visits daily, and will build him a self-contained unit in his new home.
Another patient is a 62 year old ethnic taxi driver who was so badly bashed 11 years ago by a gang stealing his takings that he lost an eye, has never worked again and never recovered mentally or physically. He was divorced; lives alone and sometimes will not even answer the phone.
One is a 42 year old foreign student who came to study theology, wanting to become a pastor. Her English is not great. She is a trifle unworldly, and thought that the world is basically kind and people look after each other. She had a casual job in a motel and her boss asked her to move a bed down the stairs between floors. She said it was too heavy and she could not, but he threatened to sack her. She did it and got an injury to two discs in her back. She was frightened to have surgery, so was in agony for a couple of years and eventually agreed. She had minimal surgery, which was not successful. The insurer decided that she was not complying with what they wanted so refused to pay her. She was effectively broke and homeless, so an old lady from her church offered her a bed and food. But she lives a long way away and up a drive that is hard for my patient to walk up. She was effectively trapped. As a foreign person she did not even have Medicare for the minimal psychological help it offers (6 visits a year). Her mental health deteriorated and she shunned all outside contact, and would not even answer the phone. She has gone home to her family- I can only hope she improves there.
One is a 39 year old from a religious and teetotal family with a high sense of ethics. He was a top salesman of a computer company and became aware that they were ripping off some customers. He drew this to management’s attention, but they declined to do anything and he was labelled a whistleblower. Management supported him by putting out an email asking that he be supported for his mental health issues. He felt that this ostracisation was the end of his career, because he had asked them to behave ethically. He was certain that no one in his tight top group will now employ him, so he withdrew and started to drink to lessen the pain. His family then rejected him because of the drinking and his sales friends are estranged also. The psychologist gives him Cognitive Behavioural Therapy exercises and I try to get him to drink less and somewhat ironically counsel him that you cannot withdraw from the world merely because the baddies generally win. He lives alone, answers the phone and is just able to do his own shopping, but is not improving much.
These are just some examples that I know. Coasting home as GP at least keeps you in contact with life. The point is that many people have broken lives, but just keep living. None of these examples have done anything wrong themselves. Is a sense of ethics a mental illness?
As everyone has to ‘look after themselves’ in a consumer-oriented society, more people will fall through the cracks, especially as the gap between rich and poor is enlarged by pork barrelling which puts resources into areas that need them less, tax breaks for the rich, subsidies for private schools and private health insurance, derisory welfare payments, and insurers allowed simply to refuse to pay without penalty.
People need basic support with universal housing and universal health case. They need jobs or at least occupations and an adequate income to survive. And we need outreach and support services that can be called upon.
When people say, ‘There are not enough jobs’, they are taking nonsense. Anyone can think of many worthwhile things that need doing. And there are plenty of people who would be happy to do them. The problem is that in a world where nothing can be done that does not make a profit, a lot of things that need doing are not done. That is where the policy change are needed. We cannot simply look at the money and see to what level existing activities can be maintained. We need to look at what needs to be done, and then work out how to achieve it. We need to decide that everyone has a right to live and those who have a good life will live in a better society if everyone can share at least a basic quality of life. There has to be recognition that the ability to be profitable need not be the overwhelming criterion for what is done. Tax may go up, but if there is real re-think of priorities, it is not likely to be all that much.
The link to the ABC program that initiated this tirade is below.