Dear friends and colleagues of the AUB community,
Welcome to the October edition of President's Perspective in which, for this and future editions, we explore important aspects of life at AUB and in the wider world; this month, our growing mental health crisis and the new
AUB Mental Health Council which we launched on October 9, the day before
World Mental Health Day.
In Ken Kesey's 1962 classic
One Flew Over the Cuckoo's Nest, a fellow inmate explains to protagonist Randle McMurphy why patients/prisoners are forced to repeatedly hear the same tune played at volume on the psychiatric ward's PA. “We seldom hear the radio. The world news might not be therapeutic." This ironic observation from the height of the Cold War seems equally apt during our current year of global misfortune, 2020. With Lebanon in the grip not just of COVID-19, but a succession of calamities, from an economic collapse to the world's worst man-made disaster this year on August 4, it is as if our circumstances have become entirely detrimental to our mental health.
Lebanese people have been frequently described as resilient. For decades Lebanon and its people have suffered from wars and violence, from third-rate infrastructure and an absence of governmental planning and oversight, but this vibrant and irrepressible society has repeatedly bounced back to recover its joy of life and fellowship, even if political divisions have remained deeply rooted.
But the mood has changed.
Dr. Joseph El-Khoury described it in his recent
France24 interview as a “collective malaise and sense of loss" which he witnesses every day at his AUBMC psychiatry clinic. “We tend to see people who can't handle [it] at a personal level and require support... but I can assure you that talking to any Lebanese you are going to find signs of anxiety or depression and that is not the Beirut or Lebanon we are used to."
Today's teams of psychiatrists, clinic psychologists, nursing staff, and psychotherapists happily represent more enlightened and evidence-driven approaches than in Kesey's time and—although there is much we still do not know about the brain and nervous system—advanced imaging, data gathering, molecular biology, and empirical science have given us a vastly improved understanding of mental illness and its treatment.
Department of Psychiatry has emerged as a powerful engine for collaborative and impactful research, contributing at a general level to our understanding of conditions such as schizophrenia or substance abuse, working across the lifespan, and tackling local contexts and specific populations, such as refugees, civilians in conflict, LGBTQ communities, or healthcare workers. As a clinician and researcher, departmental chair
Fadi T. Maalouf's goal is to improve access to mental healthcare by making it more available and more affordable, and educating populations to help destigmatize the idea of mental illness.
A sickening blow
It has been proven that, for people prone to mental health issues, if you experience three major stressors during your lifetime, say divorce, bankruptcy, and serious illness, that is when you are
most likely to develop psychological symptoms requiring treatment. We have had a lifetime of major stress events in a single year. Even in isolation, psychiatrists say an event like the port explosion would likely have a major impact on mental health in the community.
A sudden, unexpected catastrophe; a threat to life so massive people in all parts of Beirut feared the incident was on their doorsteps; the personal injuries and loss of property; the post-blast social media diet of doomsday-like video clips and images of human suffering and urban devastation—and to top it all the discovery it was avoidable but for the incompetence and irresponsibility of people in authority.
We know from research that when such disasters happen it can leave half of those affected with acute stress symptoms, with about 20 percent suffering chronic effects. One tenth will likely develop post-traumatic stress disorders needing treatment. In the context of August 4, that means tens if not hundreds of thousands of individuals of all backgrounds and ages with serious emotional scars. One cannot help wondering, when will Lebanon be allowed to bring up a generation which has not experienced trauma on such a grand scale?
Globally, the disease and sense of alienation and isolation wrought by COVID-19 amidst a deeply polarized world has also contributed to a rise in mental illness. Data suggest the effects of the
pandemic have increased not only divisions and death, but badly impacted people's and communities' sense of mental well-being. So now is the right time for AUB to step up and be counted, in the face of an ongoing economic, social, and mental health crisis in which the port blast was just the latest chapter.
By launching the AUB Mental Health Council (watch launch video), co-led by Dr. Maalouf and Dean of Student Affairs Talal Nizameddin, we have brought together our experts from the departments of Psychiatry and Psychology, the Employee Health Unit, the Wellness Program, and the Counseling Center at the Office of Student Affairs with the stakeholders whose responsibility is the well-being of our students, faculty, and staff. We are determined to provide free, walk-in (or dial-in) counseling services, not just for students, but all for our faculty and staff as well through the Employee Assistance Program, and we are going to be more joined together so no one slips through the safety net.
Our goal is to change the entire culture around mental health at AUB and—building on that—to change attitudes towards mental health in Lebanon and the region. We will see a full program of academic activities as well as psycho-educational initiatives and awareness campaigns.
And let us make one thing crystal clear. People suffering from mental illness are not at fault and there should be no stigma attached to them. According to the
Global Burden of Disease study produced by the Institute for Health Metrics and Evaluation in the US, 10.7 percent of the world population had a mental disorder in 2017, that's 792 million people. Lebanon has an even bigger burden. At some point in their lives, a full quarter of the Lebanese population will suffer from a mental disorder and—most alarmingly—90% of them neither seek nor receive any medical help for their condition.
We are under no illusions that ours is a monumental task, one which will require a sea change in the provision of mental health support, in education, and in public attitudes and awareness. The stigma associated with mental illness in this and many other societies is deeply embedded, centuries-old, and will be difficult to eradicate. We at AUB are determined to change this in a durable and effective manner. Over the last five years, we have already transformed our own student services in terms of outreach and provision of counseling and referrals. Today we launch our efforts, working towards a comprehensive approach that includes our faculty and staff, to send a clear signal to the whole of society that better mental health must be a priority.
Fadlo R. Khuri, MD
If you think you or someone you know may have a mental or emotional problem, please schedule an appointment to receive AUB's confidential services via firstname.lastname@example.org (for employees) and email@example.com(for students).