By Dr. Mark Devonish

Today I wish to initiate a national debate on mental health. Guyana is one of the countries in the world that is deeply affected with persons who have mental health issues and the associated suicide
Recently, I learnt of a former medical colleague who is battling mental health illness. The individual is a gifted doctor who is now a vagrant on the streets with no support from healthcare professionals or the Guyana Medical Council. Whatever happened to duty of care? In St. Lucia where I worked, a young and gifted colleague committed suicide because of mental health illness because of lack of support. Also in St. Lucia, I had a former colleague who is battling mental health illness with no support. He too is a vagrant on the streets. I saw a video of a young lady experiencing a mental health crisis at UG and some folks on social media found it funny. These are just a few unfortunate examples. The evidence is that doctors are at higher risk of mental health illness and suicide because of the nature of our jobs.

I am not at liberty to divulge the mental health illness of any of my colleagues but I do wish to share my own battles. I have chosen today, May 17 to disclose this since today is my late mother’s 35th death anniversary and her 66th birthday. I wish to educate the public about the relationship between childhood psychology trauma and mental health illness. I also wish to highlight the deep-seated ignorance of mental health illness in Guyana, the prejudice and stigma we experience hence the main reason why many patients keep their diagnosis private. What I am going to write is no easy task. I wrote several letters to the editor with a view of sharing my mental health battles, only to email the editor to request it not be published. Today I have taken the painful decision to be open up about it because I feel I owe it to my fellow patients to be their advocate.
I suffered from mental illness since I was a teenager. The tragic death of my mother when I was too young to understand the finality of death was a major factor, and being abandoned by a useless father further compounded this childhood mental trauma. My aunt did a great job bringing up five orphans but at the tender age of 22, she was not equipped to deal with that massive responsibility. I applaud her for her efforts and owe her a great debt of gratitude.

ATTEMPTED SUICIDE
As a teenager, I had to be hospitalised for one week for attempted suicide. I am not sure what transpired during my inpatient stay, but I was referred to a psychiatrist. I went to my appointment and became scared with what I saw: a crowded clinic with patients in varying stages of mental distress. I exited the clinic and vowed never to return. My former colleagues in medical school and internship must have suspected something was wrong because of my mercurial mood.

I migrated and my symptoms of highs and lows continued. Insomnia, paranoia and the associated irritability was a pattern of behaviour. One of my consultants, within a year of me migrating to the UK, recognised that I needed help. I was forced to seek help and was diagnosed with bipolar affective disorder which I likely had since I was a teenager. I was ashamed of my diagnosis and would never discuss it. The negatives are many but I rather focus on the few positives, namely, increased creativity and higher than average intelligence by many who have it. Many past and present brilliant scientists have it. Many great writers have it. Many Grammy and Oscar winning artists and actors have it. Some psychiatrists argue it is the price that humans had to pay for higher intelligence when compared to our primitive ancestors.

In 2015, I once again attempted suicide. I drove my Audi TT Quadro sports car into a parking lot of cars. Anyone who knows about Audi Sports would tell you they have powerful engines. My car was written off. Four other cars were written off in the process. I was stopped by hitting into a wall. I immediately regretted it but lied it was an accident. Clearly it was not. At that time I was off sick for 11 months as the medical council investigated my mental health. No clinical concerns were ever raised; it was always my pendulum of moods.
Today thankfully, I am better on medication and I do receive the support from my employer, medical council and my psychiatrist (medical supervisor) who all recognised me as an exceptional doctor who needed help. The support was instigated in 2016 by the medical council in the form of legal undertakings since despite the investigations I continued to refuse the necessary support because like most mental health patients, I refused to accept my diagnosis. In retrospect this was the best thing to have happened and started as the impetus for me to be open about my diagnosis with those close to me.

MENTAL ILLNESS
I started with my former QC buddies via our WhatsApp group. The circumstance under which this information was shared was after an army captain shot his girlfriend fourteen times dead. They were of the view that mental illness caused him to do so but I argued that his actions demonstrated clarity in his thoughts, so he was not impaired by mental illness. I further argued that maybe he has concurrent mental illness but it played no role in his actions. I then informed them as a doctor, but more importantly as a patient who has mental illness, it is more likely that violence would be directed at us than vice-versa. That was when they knew for the first time and it took lots of courage on my part to disclose it.
After my disclosure their reactions were shocking. I will outline the many bad experiences which is asymptomatic of the ignorance of mental illness in Guyana and the great prejudice that mental health patients experience on a daily basis.

Immediately after I disclosed my diagnosis there was an incident where 106 candidates took the driving theory test but 207 passed. In all likelihood, the additional 101 passes were sold. Some of my affluent colleagues boasted of their parents buying their drivers licences when they were teenagers. I argued that as someone who grew up in poverty, I was never afforded such privileges from the police. I then continued by stating anything could be bought in Guyana – even justice. Many of my colleagues were displeased with my last statement and one of them attacked my mental health and said, “doc go take your meds.” In my humble opinion, my argument was rational and was not influenced by my mental health. I was deeply hurt because of the betrayal of my trust but also more importantly, I was battling the recent tragic death of my younger brother. As a result, I took a break from the group but was persuaded to rejoin.

Last year May, Guyana had its first carnival. I was not in agreement with the carnival but kept my views to myself until one of my colleagues brought it up for discussion in the group. I argued that carnival is a very bad idea since it is the poor who would be exploited for the benefit of the rich. Providing carnival loans to impoverished people to party is highly irresponsible. The consequence of such an action is that many kids will go hungry until the next paycheck. I postulated that to take the poor out of poverty, such loans should be provided for small investments in businesses and their children’s education. One of my colleagues took umbrage with me, stating that kids will go hungry and directed an offensive remark at me. He described me as ignorant and foolish and questioned where I got such statistics and facts from. I then argued that in view of the fact that the carnival was less than 24hrs previously, then such statistics would not be available but to get a better understanding, one can extrapolate from other celebratory events, for example Christmas. Many people spend beyond their means, take loans and take home appliances and furniture on credit. The result is that those items are repossessed a few months after Christmas since they cannot afford to make the payments. Many kids go to school hungry as a result. I then advised my former colleague, who called me ignorant and foolish, that as an aristocrat who was brought up in a cocoon of privileges, he would not have had such experiences hence could not understand my position.

ATTACKS BY COLLEAGUES
Another colleague, who witnessed when I was called ignorant and foolish, took offence that I referred to said colleague as an aristocrat. She told me so in no uncertain terms but ignored his offensive insults directed at me. I responded by asking her when was she elected and inaugurated as the President of the Aristocratic Defence Union. Others got involved. One said that I am a narcissist who indulges in ‘gaslighting’. Another one told me I have ADHD. I suggested to her being a google psychiatrist do have its limitations which she should recognise. Another told me I should go smoke some weed. Something I never did in my life. They were all having a go at attacking my mental health because they were incapable of countering my argument. I sarcastically but politely requested to know if those defending the aristocrat were all members of the newly-formed Royal Society of the Protection of Endangered Aristocrats. The mental health attacks intensified. The statement that hurt the most was what the last person said. This very individual, a few months previously told me “doc go take your meds.” No one reprimanded him then. As a result, he repeated it then used the American phrase “drop mic”. For him I had special words. I knew he was not good enough to attend university despite attending QC, so I suggested to him that now he has dropped the mic, he can pick up a few books, read a few journals, attend a few academic conferences and attend a few professional development classes. I then reassured him that once he has completed those, which may take a few years since he may need breaks from candy stand at the corner of Flathbush Avenue, I will afford him the opportunity of debating my 10-year-old daughter, my bipolar creativity with words at its best.

I subsequently informed all of those who attacked my mental health that they are not my intellectual equal since rather than engaging me in a debate, they resorted to argumentum ad hominem attacks. In my opinion, the fact that I came from a family of beggars and thieves, I should have known my position on the intellectual food chain and should not have been this intelligent, articulate and witty. The irony is that the bipolar they attacked give me the edge in creativity in expression that they clearly were unable to rebut. My bipolar they saw as a curse became my oratory creative weapon.

To further reinforce the ignorance of this group I would highlight an unrelated incident. One of my Indo-Guyanese colleagues who live in Canada and is a Muslim shared with the group discrimination experienced by his daughter. I suggested that as a black person living in a predominantly white Western society these things will happen but it is important to address them in a dignified manner. Some in the group – all Indo-Guyanese – became offended and said that they are not black they are brown. I suggested the next time they pass through JFK and are stopped for “special” treatment, they should inform the immigration officers that they are not black but they are brown. Intelligent but yet worldly foolish.

Ralph Ramkarran, who is the father of one of my former QC buddies, who attacked my mental health, also did the very thing. I had reason to question his credibility after the no-confidence motion since he changed his earlier legal opinion of 34 votes being required for the passage of the NCM. I respectfully argued that with his credibility in question, it is reasonable to question any further legal opinions he offered. I also highlighted the fact that if he were a professional witness being cross examined, then any lawyer worth his salt would have destroyed him on the witness stand. Because of my letter, he and his younger son, the President of the Guyana Bar Association, called me a lunatic on social media. In my opinion, his eldest son shared my diagnosis with them hence the reason for the ad hominem attack. It is shocking that a senior council, former speaker of the house, a man old enough to be my father and a man who aspires to be president of a country which has the highest rate of mental health illness and suicide in the world, would make such an offensive statement. I once respected Mr. Ramkarran as an elder statesman but after that ad hominem attack, I lost all respect for him. This became evident via my subsequent letters on him. As a result of this ad hominem attack I do not think Ralph Ramkarran and his political party ANUG is deserving of any Guyanese’s vote, a country in desperate need of leadership with a mental health crisis.

With the help of my employers and the medical council, I became the first from my batch to pass the MRCP (UK) in record time. I became the first from my batch to become a consultant in the UK, the first from my batch to become a specialist in the UK, the first from my batch to become a fellow of a royal college (FRCP Edin), the first and only MRCP PACES examiner from Guyana and possibly the Caribbean. I was recently nominated for the FRCP (UK) fellowship.

RIGHT SUPPORT
My point is that with the right support, mental health patients in Guyana can live productive lives. The government should urgently develop policies to address this very serious national issue. The public needs to be educated. The public needs to understand that mental illness is not dissimilar to physical illness. Laws should be passed to protect mental health patients from discrimination. It should be mandatory that employers have systems in place to support employees affected by mental health illness.
Finally, do please permit me to wish my mother a happy birthday. Today is 35 years since I witnessed your painful death. Mom, your death was not in vain since your death motivated me, against all odds, to become a doctor and a patient advocate.