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精神健康的計時炸彈 | A Mental Health Time-Bomb
約翰百德 (John BATTEN)
at 9:31am on 25th November 2019


圖片說明:

年輕的旁觀者在太子港鐵站外的8.31「紀念壇」不安地交叉雙腿站立,攝於2019年9月25日。圖片由作者提供。




(Please scroll down for English version)


四個月來有關持續示威的交談、評論和吵鬧之中,也有關於香港「精神健康」的討論。除了街頭公演的憤怒,城中的其他心理層次卻在個人與親友、家人、同事和學校被私下處理。不絕的示威加上政府放棄履行責任,不採取任何方法解決現時的政治危機,令市民都感受着不同程度的無望:這種憂慮其實與分手和摰愛離世後所體驗的創傷類同。

瑞士精神科醫生伊莉莎白.庫伯勒 – 羅絲的臨終病人研究發現,病人面對死亡時會經歷五個內心階段。庫伯勒–羅絲的學說也適用於面對創傷式生命式改變的人(如香港現時所面對的)。這五個哀傷的階段分別是:否認、憤怒、討價還價、抑鬱和接受。這些階段不一定順序進行,而且能以不同強度的情緒出現。

過去四個月來,我們所有人都體會過與示威相關的憂慮,而且即使自己沒有參與示威,單單看電視已經非常不安。香港電台在最近訪問了香港精神科醫生廖廣申,廖醫生表示病人的病徵包括失眠、抑鬱,甚至有輕生念頭。他補充:「連場示威將會對特區市民造成長遠傷害,而且會影響一整個橫切面的人口,包括示威者、學生、旁觀者、記者、看電視的市民,還有警察。」


然而,大部分香港市民都不會因為自己的情緒或創傷後症候羣即時向精神科或專業人士求助。另外,香港的精神健康服務經常因為不足而為人詬病,精神科醫生更是長久以來都缺乏的人力資源。在這些情況下,很多市民將需要獨自承受或應對示威相關的憂慮和迷惘情緒。正在面對本身生命階段轉變的青少年更為敏感。其中,家裏、親子、同代人、同齡人和不同政見人士之間的氣氛,都可以是引發壓力和衝突的地方。當然,在現時瀰漫社會的政治氛圍中,保持克制忍讓特別困難,但這卻是處理任何家庭緊張關係所必要的態度。

面對香港繁忙的生活壓力,我們都有自己的對策,而同樣的對策亦有助對抗與香港示威相關的憂慮。在沙士期間,戶外散步有益身心,到郊野公園一遊有助心理上令抽離市區環境和沙士所致的心理恐懼。同樣地,在現時連場示威之中,為自己安排一些「中場休息」時段應該可以減低心理壓力。因此,刻意關掉智能電話或電視,暫時不看新聞、不接觸社交媒體的最新動向和直播,你便可重新掌握要不要得知最新示威消息的選擇控制權。能夠「掌控」新聞接收,避免事件發生時的即時震驚,在心理上是令人舒然的。

讓自己沉醉於自選的「另一個世界」,同樣可有益身心的方法,你可以享受運動、遊戲、音樂、瑜伽、閱讀、賽馬、看電影或者是小旅行。雖然這些活動效果可能只會很短暫,但都可以讓你得到即時煥然一新的感覺。


我自己的簡樸經歷為例,我在6、7月大部分時間因為想緊貼示威與政治的最新發展而停止了日常閱讀。結果我的思想和日常生活愈來愈受示威新聞主宰。我想起了庫伯勒 – 羅絲的五個哀傷階段,明白自己和很多人一樣,因為身邊的政治紛擾和和示威受創。結果我減少觀看直播視頻,再次拿起小說,並選擇在圖書館的寧靜環境中工作,最後讓心理重新建立方向。

村上春樹的《海邊的卡夫卡》中,十五歲的害羞男生卡夫卡離家出走,他聰明地領略到圖書館是尤其包容接納的開放之地,他說:「從小我就常在圖書館的閱覽室消磨時間。小孩子不想回家的時候,能去的場所很有限。不能進酒吧,不能進電影院。剩下的場所僅有圖書館。不要入場費,小孩子獨自進去也沒人說三道四。可以坐在椅子上盡情看書……好比我的第二個家……」

如果我們找不到「另一個世界」或「第二個家」來在精神上逃離香港現時的政治風波,便很容易受被淹沒的感覺和抑鬱影響。大部分人最終都可以「捱過去」、讓「事過境遷」和「繼續向前」,所以仍能在現時政治紛亂之間運作。然而,其他人可能會因為現時事件而受嚴重影響和創傷。眾所周知,要察覺心理脆弱的徵狀可能極為困難。除了明顯的精神病行為,我們也應留意身邊人有否展現行為、習慣、思想上的嚴重改變徵象,包括與家人和朋友疏離,又或者提及世界末日或甚至自殺。這些警號可以是簡單一句「真希望我不在這裏」─ 以上種種都可以是自殺傾向或嚴重精神健康問題的初步迹象。

我們每一個人都有自我傷害和嚴重心理憂慮的潛在可能。在香港現正經歷的政治危機中,我們有需要真誠溝通和主動關心身邊友人、同事和家屬的精神健康和安全。香港的「精神健康」可以影響所有人,不論他們持有哪種政見。在未來數月以至數年,城中的暴力示威可能會成為某些人腦中揮之不去的入侵性閃回畫面和噩夢,可確診為創傷後症候羣。香港現時面對的政治危機遠遠不只於街頭示威和政府的政治惰性,也是未來隨時爆發的精神健康計時炸彈。


原文刊於《明報周刊》,2019年11月7日



A Mental Health Time-Bomb

by John Batten


Amongst all the talk, commentary and fuss of the last four months of protests, there has also been some discussion about Hong Kong’s ‘mental health’. One aspect, people’s anger, is openly acted-out on the streets, but other layers of the psychology of the city is privately dealt with by individuals themselves and within and between their interpersonal relationships with friends, family, work colleagues and at school. As the protests have continued and the government abdicates its responsibility to implement solutions to the current political crisis, people have experienced various levels of hopelessness: anxiety similar with the traumatic grief experienced after a relationship break-up or the death of a loved-one.

In her studies of the terminally ill, the Swiss psychiatrist Elisabeth Kübler-Ross formulated a model of the five stages of grief a person experiences when told they have a terminal illness. Kübler-Ross’s model is also applicable to anyone who is experiencing a traumatic change in their life – such as now happening in Hong Kong. Kübler-Ross’s five stages of grief are: denial, anger, bargaining, depression and acceptance. These stages don’t necessarily run in chronological order and can be of a varying intensity of emotional moods.

We have all experienced protest-related anxiety over the last four months, and, even if we are not participants in the protests, just watching television can be disturbing. In a recent RTHK radio interview, Hong Kong psychiatrist, Liu Kwong-sun, said that his clients were suffering from insomnia, depression, anxiety and suicidal thoughts. He added that “the protests will cause long-term damage to people in the SAR, and it would affect a cross-section of the city, including protesters, students, bystanders, reporters, people watching the news on television and police.”

However, most people in the city will not seek immediate psychiatric or professional assistance for the emotional or post traumatic syndrome disorder (PTSD) symptoms they experience. Besides, Hong Kong’s mental health services are scandalously limited, and the city is chronically short of psychiatrists. Under these circumstances, many people will suffer or cope with protest-related anxiety and their confused emotions largely alone. Teenagers and young people, going through their own life-stage changes, are especially sensitive. In particular, the atmosphere in the family home, between parents and their children, with their respective generational, age and differing political viewpoints, can be a place of tension and conflict. Tolerance, of course – especially difficult in the current fraught political and social atmosphere – is a necessity when dealing with any home and family tensions.

We all have strategies to cope with our busy Hong Kong lives and day-to-day stresses, and the same strategies can be useful to counter Hong Kong protest-related anxiety. During SARS, walking in the open air was beneficial, but equally, going into a country park was to mentally remove ourselves from the urban environment and the psychological fear of SARS. Likewise, during the current protests, self-organized ‘time-out’ from the protest atmosphere should ease mental stress. So, turning off the news, and not watching social media updates and ‘live’ broadcasts – by intentionally turning-off your smartphone or television – should give some control to choose whether to know or not know about the latest protest news. Being ‘in control’ of the news is mentally refreshing, as you will avoid the shock of events as they happen.

Also, particularly beneficial is to immerse yourself in a chosen ‘other world’ through physical exercise, playing games, music, yoga, reading, horse-racing, watching a movie or taking a short holiday – to allow instant, albeit possibly temporary, rejuvenation.

In a simple personal example, during most of June and July, I stopped reading books because I wanted to be up to date on the protests and political developments. Increasingly, the protest news dominated my thoughts and daily routine. I was reminded by Kübler-Ross’s model that I – like others – was traumatized by the political chaos and protests around me. By simply reducing to watch live protest video feeds, to read novels again, and choosing to work in the quiet environment of a library, I re-orientated myself into a better mental state of mind.

In Haruki Murakami’s Kafka on the Shore, Kafka, a shy 15-year old, runs away from home but wisely understood that libraries are special, open places of acceptance, he says: “Ever since I was little I’ve loved to spend time in the reading rooms of libraries….Think about it – a little kid who doesn’t want to go home doesn’t have many places he can go. Coffee shops and movie theatres are off-limits. That leaves only libraries, and they’re perfect – no entrance fee, nobody getting all hot and bothered if a kid comes in. You just sit down and read whatever you want. I’d devour anything and everything….The library was like a second home….”

If we can’t find that ‘other world’ or a “second home” to mentally escape during Hong Kong’s current political crisis, then feelings of being overwhelmed and depression may affect us. Most of us will eventually ‘pull through’, ‘get over it’, and ‘move on’, so we can function during the current political crisis. Others, however, are seriously affected and traumatized by current events. Signs of mental vulnerability can be notoriously difficult to spot at the time. Besides obvious psychotic behavior, we should be on the look-out for such indicators as serious changes in behavior, routine and thoughts, including isolation from family and friends, or, talk about the end of the world or of suicide – identified by using such simple language as, “I wish I wasn’t here” – all these can be the first signs of a suicidal tendency or serious mental health issue.

We are all, potentially, vulnerable to self-harm and serious mental anxiety. Honest communication and actively checking the mental health and safety of our friends, colleagues and relatives is really needed during Hong Kong’s current political crisis. Hong Kong’s ‘mental health’ affects everyone, no matter their politics. In months and years to come, the city’s violent protests might re-emerge for some as recurring intrusive flash-backs and nightmares, with a diagnosis of PTSD. Our current political crisis is so much more than today’s streets protests and the government’s political inertia – it is also a future ticking mental health time-bomb.



This opinion piece was originally published in Ming Pao Weekly on 7 November 2019. Translated from the original English by Aulina Chan.

 



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