Advocacy

…abusers of the elderly include the relative or caregiver who denies access to regular food, hospital visits, drugs and general care, the in-law who constantly belittles and taunts the older adult living in her/his child’s home, to the government official who is in charge of disbursing fund for that aged pensioner. Old age is a phase in life associated with changes in social roles and capabilities. Lax muscles, memory loss and other aging processes set in, not forgetting the elderly’s predisposition to health challenges. Nevertheless, everyone hopes for long life in good health. Plans for this golden age differ from person to person, but generally most people just hope for a peaceful retirement or aging process. While this may occur in other climes, it remains largely aspirational in these parts. However, elder abuse, is one unspoken blight of the aging process. How much of our transition from a people with a culture of strong social support systems to an increasingly individualistic society contributes to the gradual neglect and abuse of a vulnerable section of our population? The context for this question was recently provided by reports on social media of a young man who flogged his grandmother, whose witchcraft he believed was responsible for his perceived misfortune. As bizarre as the recent case may appear, it is not an isolated occurrence. Over the years, there have been cases of the elderly being accused of witchcraft and in dire cases lynched. Europe’s witch hunts of the 16th and 17th centuries easily come to mind. Mental illness has been implicated by researchers in the latter period as cause for the gruesome execution of tens of thousands of people, following claims and suspicions of witchcraft. One might argue that these events occurred when mental illness was poorly understood and insist that such actions no longer occur in societies. It is deeply disturbing when acts that remind us of man’s inhumanity to man still occur in the 21st century. Prevailing levels of ignorance of the needs of and disregard for the elderly, makes it necessary to shed some light on elder abuse. Perhaps, it is important to be reminded that they are at a phase in life when their health deteriorates, cognition declines and common mental health conditions, such as depression or dementia, may manifests. Dementia is a mental illness characterised by progressive, usually irreversible affectation of memory, intellect, personality and behaviour. The individual experiences worsening forgetfulness, usually of recent information. As the condition progresses, memories of older things and events are forgotten and sufferers often appear confused. They struggle to remember names of familiar people, things or landmarks, and wandering tendencies may ensue. Sufferers may experience situations where they erupt violently from the frustrations of not being able to carry out their previously routine activities, such as dressing up or feeding. As the illness worsens, defecating and urinating on self become the norm. All these may manifest as bizarre and worrisome behavioural patterns perceived by caregivers as being deliberately stubborn, mischievous and inconsiderate. Thus, providing the platform for abuse of the elderly. It is not uncommon to see a depressed, elderly woman confess to events which she knows nothing about. However, before we get machetes and sticks out, excited over catching another witch who has been exposed, it helps to consider that such “confessions” might be the effect of feelings of guilt or delusional beliefs arising from depression… Depression is another condition which the elderly struggle with and has been described as common in this age group, considering that this stage is fraught with losses (loss of loved ones, social roles, certain body functions) and major upheavals. Interestingly, depression in the elderly does not usually present itself with sad moods, as seen in younger adults. It is usually characterised by vague body pains and aches. Some researchers have postulated that the recurrent complaints suggestive of arthritis might just be symptoms of depression. Memory problems, changes in sleep and appetite, social isolation, increased dependency and thoughts of death are a few of the symptoms associated with depression. It is not uncommon to see a depressed, elderly woman confess to events which she knows nothing about. However, before we get machetes and sticks out, excited over catching another witch who has been exposed, it helps to consider that such “confessions” might be the effect of feelings of guilt or delusional beliefs arising from depression and its consequent cognitive distortions. Certainly, the snippets of a confused, dementing aged woman confessing to atrocities must portray a fascinating view. But may we continue to choose to disregard the reality of someone suffering from impairment of brain functions resulting in the gradual inability to carry out major, yet presumed simple routine activities? Perhaps, if all these were viewed from the perspective of the brain being erased gradually, one will empathise better and begin to push for better treatment of the elderly. These symptoms are however not comprehensive symptoms of dementia or depression but only give a glimpse of the helplessness of the elderly when coping with mental health challenges in our society. Now, back to the young man’s action, I daresay that anyone who flogs a vulnerable, helpless elderly woman, regardless of blood ties reveals a great deal of the individual’s personality traits or the possibility of an underlying disorder in the abuser. However, before I get on my high horse and begin to castigate the young man who might actually need an evaluation beyond legal justice for assault, let us attempt to understand the phenomenon referred to as “elder abuse”. Noteworthy is that neglect of the elderly, whether deliberate or accidental, has been identified as a form of elder abuse. Can I then assume that types of neglect include: failure to regularly check on my aged ones in the village or countryside as it is now referred to; not calling regularly… Going by the WHO’s definition, elder abuse can be a single or repeated act or lack of appropriate action, occurring within a relationship, where there is

Avoid the gory details of the act, methods and locations; avoid repeated use of images which display the means or faces of the affected individual. Preferably report the consequent trauma and emotional devastation felt by their survivors, the vacuum left behind and probably the attendant hardship that ensues in some instances. The reportage of suicide should underscore the fact that suicide can be prevented… The World Mental Health Day is marked every 10th of October. This year’s theme revolves around suicide ― the taking of one’s life, with this fatal outcome being a deliberate intention. Unsurprisingly, domestic media reports of each incident of suicide border on the sensational. Different reasons account for this. From pure naivete and the shock of learning of an event perceived to be alien to our culture, it may seem appropriate to report such a seemingly interesting event. Against the widely reported “fact” that Nigerians are regarded as some of the happiest and resilient people on earth, these reports raise questions about how much is myth, misconception or the consequence of changing dynamics. For others, it is an opportunity to draw attention on a social media platform. Usually just a click on the ‘send’ button is all that is needed to disseminate information. There is also the possibility of a trained professional eager to carve a niche for herself in the field of journalism, regardless of the consequences. So, why should the consequences of suicide coverage be an issue of concern, when all the disseminator wants to do is to inform? What readily comes to mind is the “Werther effect”. A phenomenon where there occurs an increase in the imitation of a widely publicised suicide. This concept was coined from the novel The Sorrows of Young Werther by the German writer Johann Wolfgang von Goethe, where the leading character dies by suicide in the name of love. Sequel to the book’s publication in 1774, over three dozen young men took their own lives in circumstances similar to that of the protagonist. This phenomenon is synonymous to suicide contagion or copycat suicide. It has been established over the years that the more sensational the portrayal of a suicidal act, wherein the details such as the method, the location and the events that surrounded the act are well elaborated, especially when a renowned individual is involved, a spike in occurrence is observed. This imitative behaviour has been observed to spread quickly and spontaneously, among young adults usually. It has also been suggested that the glamorisation of suicide by the media may influence and motivate similar actions in susceptible individuals to contemplate or outrightly complete it. There is the question of why so much hullabaloo over reportage of suicide plagues the mind. After all people die daily and it is not reported with so much fuss. What then makes the topic of discuss spectacular, such that each one discovered results in people going through pain to ensure it gets some degree of review? Could it be its intentional nature that makes it uncanny and sensational? Howbeit, a life is lost and people are bereaved, and just as we are sensitive to the demise of others, which occurred from a gamut of causes, we should also consider the families and loved ones of individuals who died from suicide when reporting the event. It is bad enough that they have lost someone. To be constantly reminded and stigmatised consequent upon the demise of their loved one might just be a pain too much. If we intend to curb this growing menace, then it is high time responsible portrayal of suicide is ensured by regulatory bodies for traditional media organisations and the encouragement of sensitive reportage by self-made journalists who are oblivious to the adverse impact on family and loved ones. Some might say this suicide thing is starting to sound like a cliché, however for a doctor or a mental health practitioner, suicide or attempt at the act is an emergency that results in the mobilisation of resources to ensure that the individual gets appropriate care, and this involves the collaborative effort of both professionals and non-professionals. It is therefore not surprising that the World Suicide Prevention Day on September 10 and The World Mental Health Day chose the same theme this year, of “Working Together to Prevent Suicide”. It is no longer news that suicide is among the top-20 leading causes of death globally across all ages and the second leading cause of death among youth aged 15-29 years, or that over 800,000 people worldwide die by suicide annually. Every 40 seconds, one person will die by suicide and for every suicide, an estimated 20-25 people would have attempted it. One wonders how many more people have entertained suicidal ideas or thoughts. Mental illness is one of the most important causes of suicide, and depression, a major contributor to these. Perhaps what may be news to some is that for every act of suicide, about 135 people are affected by their death, which makes an estimated 108 million people who have lost someone to suicide worldwide. It is important to note that people bereaved by suicide are referred to as suicide survivors. These data, in my opinion, are conservative, considering the fact that suicide is under-reported in countries like Nigeria, where stigma greatly affects survivors’ willingness to admit to death by suicide in the family. Thus, this phenomenon is mostly concealed, but for the advent of social media. In recent times, the print and electronic media have ensured that incidences of suicide are reported at such rapid speed, with the gory details splashed all over on an almost daily basis, making it difficult to ignore. Pictures are splattered over social media as statistics for suicide jingles or seminars. Mouths wag and judgmental statements are made in loud whispers. Beyond the increased number of cases consequent upon the sensational reportage, empathy and the feelings of the survivors should be taken into cognisance. We need to remind ourselves that a tragedy