TW: suicide, self-harm, racism, police killings, transphobia, involuntary hospitalisation
A couple of months ago I wrote a post about a flurry of (bad) newspaper articles on OCD and COVID-19, and as I wrote it, I wondered – how long is this new-found enthusiasm for mental health topics going to last? Cynic that I am, I suspected a panic-fuelled rush into mental health awareness by people and publications who have not previously given much space to the topic was unlikely to go well, or add up to much.
Because a lot of this really was a headlong rush into complicated and difficult topics by people who had not given this enough thought. Remember that journalist who wanted to interview people who thought the then-new recommendations on handwashing were giving them OCD? Skimming the Wikipedia page would tell you that’s a bad take.
And that approach was pretty typical. Sure, there were pieces on how the pandemic would affect people who were already living with a mental health condition. But many of these were not good.
And there was a lot – I mean a lot – of attention on people experiencing new mental health issues, and articles that emphasized the novelty of the present situation.
Now is the time, we were told, to focus on mental health.
Certainly there were people dealing with new mental health issues because of the pandemic, and those people deserve help and empathy.
But the choice to focus on that group erases the fact that some of us were here already.
It also divides the world into two: the Normal People, who are Just Stressed About the Virus; and the Not Normal People, and our troublesome, dysfunctional brains. And it shines the spotlight – as is so often the case – on the concerns and problems of the Normal People.
For that matter, when those newspaper articles discussed the new mental health problems of the Normal People, they were almost always discussing a certain group of conditions, most commonly of all anxiety and OCD. Why?
Literally we are only bringing up OCD because it is associated with hand washing and the WHO told us to wash our hands.
Anxiety, maybe, makes more sense. People currently do feel anxious.
But really, there is no reason to assume that the stress of the pandemic would lead to a spike in particular conditions. Stress affects people variously.
So where are the think-pieces on COVID-19 stress potentially triggering bipolar or schizophrenia?
Is there really a good reason pandemic stress would definitively not trigger a bipolar or schizophrenic episode? Did we just forget about those disorders? Or are they being excluded from the mental health discussions around the pandemic because they are the Scary Disorders?
Symptoms of distress have also been covered unevenly.
There has been some discussion of suicide, fuelled by suggestions that there might be a spike in deaths by suicide due to the pandemic.
Yet in the wave of newspaper articles on mental health and the pandemic, there has been almost no discussion of the symptom of self-harm, despite how common a symptom of distress that is.
Never mind, maybe another fifteen articles on the relaxing properties of scented candles and the mental health benefits of exercise will sort us all out.
Or perhaps not, because – good news! – it’s all fine anyway. The New York Times has bravely reported that rates of serious mental health issues are not likely to go up because of the pandemic. Hurray?
Usually, I would be on board to celebrate the fact that rates of a kind of illness are steadying, even if not actually declining. But the world in general has a bad habit of disregarding, diminishing, and demonising mental illnesses. That article feels less like “it’s great there won’t be more of this specific kind of pain” and more like “thank god we won’t all be turning into those weirdos.”
And in any case, the suggestion that rates of serious mental illness will not go up because of the pandemic does not mean things are fine.
The pandemic is only one part of the world right now, even as some days it feels like it is the only thing happening. Black people continued to be killed by police, including Black disabled people. Trans people continue to have their very right to exist called into question. Discrimination, harassment, assault, and murder of members of minoritized groups seriously harms the mental health of members of those communities.
And as we talk about mental health, we should also talk about problems in psychology, psychiatry, and mental health services, like that time a guy got involuntarily admitted to a psychiatric facility for calling out his employers for racism.
There have been mental health problems, there are mental health problems, there will continue to be mental health problems in future. We need to be talking about them – all of them – as well as their causes and the problems inherent in their treatment.
Did we only care about mental health when we thought it would affect the Normal People? Now that – maybe – most people might be mostly ok, is it still mental health o’clock? Or did we go back to not caring?
Because, really, if you only cared about mental health when you thought it might affect the Normal People, you never really cared at all.
Content warning – the following post includes a discussion of suicide and self-harm.
As the US and Canada have been marking Mental Health Awareness month, and the UK begins to mark Mental Health Awareness week, there have been many tweets and posts and articles of various kinds. This post is about a specific kind of Mental Health Awareness post. You know the ones. The posts that tell us mental health awareness is about taking care of ourselves. To be kind to ourselves. To make some time for us. Take a bath. Meditate. Smell the roses.
Self-care is fine. Self-care is good. But this is not what Mental Health Awareness should be about. Mental illnesses are a serious reality for many people, the level of ignorance surrounding these topics is massive, and the avoidance of certain issues is engrained because of the stigma that surrounds them.
That stigma regarding mental illness, and mental health, harms people. It harms people by making them feel that the pain they go through is shameful. It harms people because they feel they cannot ask for the help and support that they need. It harms people because they left with the feeling that what they are going through is a judgement on who they are as a person, rather than an issue that can be dealt with through treatment and support.
This stigma needs to end, and it will not end by making lists of our top-ten most relaxing bubble-bath ideas.
This is not an article about self-care, it is not a post designed to make you feel better, about yourself, or anything else. This is a post about the hard conversations that need to be had around mental health.
We need to talk about suicide.
A recent death by suicide that attracted attention was the death of an ER doctor who had been treating coronavirus cases. That death was one of many. Suicide is the 10th leading cause of death in the US. Worldwide, around 800,000 people lose their lives to suicide every year. There are also many people who live day-to-day with suicidal ideation, not necessarily making a plan to end their lives, but rather living with thoughts that they might.
Talking about suicide can be hard. What is an appropriate way to discuss suicide? When and how do you raise this issue with someone you are concerned about? How do we walk a line between avoiding the topic entirely, and constantly, intrusively, monitoring people we are concerned about? There are guides out there for how to do this, and more of us should familiarise ourselves with them.
We need to talk about self-harm.
Self-harm is a common symptom of distress. It is also a symptom that is heavily stigmatised. People who self-harm are too often labelled “attention seekers,” rather than people suffering distress. Survivors with visible scars commonly have to deal with other people’s reactions to and discomfort with those scars. One mental health advocate has said that this is like her own body being considered a trigger.
Here, too, there are guides for how to talk about self-harm. Most importantly, sufferers have said that being spoken to and about with respect and empathy is key.
Suicide and self-harm are just two topics from a long list of things that need more attention in discussions of mental health awareness. There are other important subjects that should be tackled this month, like how mental health services are failing people of colour.
Mental Health Awareness Month is not a time for putting soothing quotes about self-care over a photo of the beach at sunset. It’s a time for hard conversations about serious issues.
For Mental Health Awareness month, and Mental Health Awareness week, don’t take a relaxing bath, or take up flower arranging, or go for a calming walk. Instead, commit to reading articles and listening to podcasts by disability and mental health advocates that tackle difficult subjects.
Mental health awareness isn’t easy, but it can save lives. So make yourself aware.
One of my favourite things to do in the world is to go to Moscow’s Tretyakov Gallery. I go every time I am in Moscow, and every time I go, I visit the same paintings. The paintings that I love, I love for themselves, but sometimes also for the stories attached to them.
One such story is the creation of Isaak Levitan’s famous Vladimirka.
In the summer of 1892, so the story goes, Levitan and his wife were walking in the Russian countryside, wondering at the natural beauty around them. They came across a peaceful road, and walked along it, taking no particular note of it. It took a little time for the significance of the road to dawn upon them. This road that they had so casually happened across was the infamous Vladimirka, the road along which those sentenced to penal servitude would walk at the start of their long, hard journey to the labor camps in Siberia.
Siberian labor camps might now be more popularly associated with the Soviet regime, but the Russian Empire had been sending convicts East since the seventeenth century. In 1865, Nikolai Leskov published his novella Lady Macbeth of Mtsensk, which ends with the main character, Katerina, making that journey as part of a train of convicts. The long walk to Siberia, and the road along which convicts walked, was already well known by the time Levitan and his wife came across it.
Their realisation entirely rewrote the scene for them, and would inform Levitan’s eventual painting of the road. What initially seemed to be a picturesque corner of sleepy rural Russia transformed in the instance of their revelation into something much darker.
Isaak Levitan, Vladimirka, 1892. A landscape painting of an unpaved road stretching to the horizon through flat, green, countryside, with a cloudy sky above. Image source: Wiki Commons
I have always loved this story, in part because of its acknowledgement of how the violence of Imperial Russia was woven into the fabric of the land, but also for its metaphorical richness.
Just because you can see a thing does not mean that you understand its significance.
I was reminded of Levitan and his road because of recent articles and comments about reactions to the pandemic. There has been much judgement of other people’s actions, reactions, and inactions. Is it better to talk about the situation, or avoid the topic? To continue a normal schedule, or reject normality as past its time? Is it better, is it possible, is it right, to rest, or to work? What does it mean when someone reacts differently to this situation than we do?
There are many things that could be said on this topic. But I think Levitan and his road have something to tell us here.
Right now, we are all Isaak Levitan. We all experience other people’s reactions to the present situation as artefacts external to ourselves, that we come across by chance as we follow our own path. Our initial reading of those reactions may then be like that of Levitan’s initial reaction, of seeing the Vladimirka, but not immediately grasping what he had found.
Levitan was able to go beyond his initial impression of the road, and commit to a painting that both expresses the natural beauty of the scene and strives to convey the melancholy of that place of violence.
Levitan saw a beautiful landscape, and came to grasp that it was also a scene of horror. As we come across other people’s reactions to the pandemic, we come across reactions that might be totally other to our way of processing the situation, reactions that might immediately strike us as meaning one specific thing. Yet how they may seem to us from the outside is not necessarily how they feel to the person experiencing them. Sometimes what looks like a beautiful scene can, from another perspective, be revealed as a convict road.
Can we accept that others’ lives may not be what we initially perceive them to be? Can we acknowledge that we all begin as the Levitan calmly walking in the country, and aim to become the Levitan who created the Vladimirka?
As historians, sometimes we come across documents that in form are run-of-the-mill, but whose contents is exceptional. One such document is an autopsy from 1644, performed on a body whose cause of death was visible, and fairly straightforward. The question then becomes, why conduct this autopsy? The answer to that reveals a tale of dynastic machinations, religious controversy, and a thwarted attempt to flee Moscow.
But to get there, we need to begin with our unusual autopsy:
“153 г. Сентября въ 5 день. По Государеву Цареву и Великово князя Михаила Федоровича указу и по присылке королевичева доктура, Аптекарского приказу доктуры Венделунусъ Сибилистъ Еганъ Беловъ Артманъ Граманъ, ездили на посольской дворъ и досматривали у умершово королевичева кравчево раны и тотъ кравчей раненъ изъ пищали рана подъ самымъ правымъ глазомъ и оне доктуры въ ту рану щупомъ щупали а пульки не дощупались потому что рана глубока а то подлинно что пулька въ голове.
На обороте: Такова скаска дана боярину Федору Ивановичю Шереметеву.»
“1644 [7153 by the Old Russian calendar], 5th September. By the order of the Lord Tsar Grand Prince Mikhail Fedorovich and by the request of Count [Valdemar]’s doctor, Apothecary Chancery doctors Wendelin Sybelist, Johann Belau and Hartmann Graman went to the embassy’s compound and examined the wounds of a dead servitor [kravchii, something like a cupbearer] of Count [Valdemar] and that servitor was wounded by a pischal [a firearm similar to a rifle] directly under the right eye and they, the doctors, probed that wound with a probe but the bullet was not detected [in this way] because the wound is deep but the bullet is genuinely in the head [of the dead servitor].
Reverse: Such a report was given to nobleman Fedor Ivanovich Sheremetev [head of the Apothecary Chancery].”
Readers of modern Russian will immediately detect one oddity here: the use (and spelling) of the word “skazka.”
The meaning of the word “skazka” has changed substantially over time. Whereas in modern Russian “skazka” means a fairytale, in early modern bureaucratic Russian the word meant something even closer to its literal meaning “something that is said.” A skazka was report that initially delivered by being spoken, even if it was then written down.
The Apothecary Chancery, early modern Russia’s official medical department, commonly used such oral reports. As we can see in this document, many of their doctors were foreigners. They could speak their reports aloud (usually in Latin) to an interpreter, who would render it into spoken Russian, so that a secretary could then write down the report in Russian. This was a standard, if somewhat convoluted, procedure.
Autopsies were also a fairly standard part of the activities of the Apothecary Chancery. The department carried out such examinations when there was a suspicion that the individual had died from an infectious disease, and so assess if Moscow might be hit by an epidemic.
The luckless servitor examined in 1644 had not died from an infectious disease, but rather a gunshot wound. So, why did the department, and the Tsar, care?
The servitor in question worked for Valdemar Christian, Count of Schleswig-Holstein. Valdemar was the son of King Christian IV of Denmark, yet he was not eligible to inherit the Danish throne. His parents’ marriage was morganatic, an arrangement where someone of higher status could wed someone of lower status, but the spouse and their children would not have access to titles.
Valdemar, then, was a royal in search of a throne.
Enter Tsar Mikhail Fedorovich of Russia. Mikhail Fedorovich had only one son, Alexei Mikhailovich, not an ideal situation for the first ruler in the newly-established dynasty of the Romanovs. Mikhail Fedorovich also had several daughters, so he proposed a deal to the Danish: if Count Valdemar came to Russia and married the Tsar’s eldest daughter, Irina Mikhailovna, Valdemar would be second in line to the Russian throne and Russia would have a new ally in Denmark. Valdemar found the deal attractive, and in 1643 he travelled to Moscow to arrange the marriage.
Yet this was not so simple.
Valdemar was Protestant, Irina was Russian Orthodox. Could the two marry without one converting? Should – or could – Valdemar convert? This question was hotly debated by the Danish delegation, Russian courtiers, and Russian Orthodox churchmen. Even the King of Poland – keen to throw up roadblocks in Russia’s path to a new ally – weighed in to claim the conversion was impossible.
Negotiations broke down, but Mikhail Fedorovich was not inclined to allow Valdemar to leave. So, one night in early September 1644, Valdemar and his retinue snuck out of their compound, and attempted to flee Moscow.
This did not go well. Somehow Valdemar’s plans were discovered, shots were exchanged, and Valdemar and his men ended up back in their Moscow compound.
Well, most of his men.
These were the circumstances under which Valdemar’s luckless servitor was killed. He was shot, in the face, in front of multiple people.
Why perform an autopsy on a person whose cause of death was so well known? It would have been phenomenal if the Apothecary Chancery’s doctors had discovered that the man with a gunshot wound in his face had died from some other cause. But they did not.
This document does not directly answer the question of why autopsy this servitor for us directly. But the circumstances point towards a probable answer. The most likely solution is that the autopsy was a part of an official reaction to the incident, perhaps even a part of some official response to the Danish.
This was not the end of the story, at least not for Valdemar.
Despite the total breakdown of negotiations over the marriage, Mikhail Fedorovich insisted on keeping Valdemar in Moscow. It was only after Mikhail Fedorovich’s death 10 months later in July 1645, and after substantial pressure was applied to the Russian court by the Danish, that Christian IV was finally able to extract his son.
Why conduct this autopsy? Because, in the case of deaths linked to diplomacy and royal circles, some dead bodies were more political problems than they were medical mysteries.
1644 autopsy, Russian State Archive of Ancient Documents RGADA f. 143, op. 1, ed. kh. 141. Published in N. E. Mamonov, Materialy dlia istorii medistiny v Rossii, 4 vols (St Petersburg: M. M. Stasiulevich, 1881), i, pp. 62-63. The version I use here is that published by Mamonov. The English translation is my own.
Alexander, John T. Bubonic Plague in Early Modern Russia: Public Health and Urban Disaster (Oxford University Press, 2002).
Dumschat, Sabine, Ausländischer Mediziner im Moskauer Russland (Stuttgart: Franz Steiner, 2006).
Griffin, Clare. "Bureaucracy and Knowledge Creation: the Apothecary Chancery." In Information and Empire: mechanisms of communication in Russia, 1600-1850 ed. Simon Franklin and Katherine Bowers (Open Book Publishers, 2017), pp. 255-285.
Oparina, T. A. Inozemtsy v Rossii XVI-XVII vv. (Moscow: Progress-Traditsiia, 2007), pp. 55-81.
Rock, Stella, Popular Religion in Russia: Double Belief and the Making of an Academic Myth (London and New York: Routledge, 2007), p. 78.
Unkovskaya, Maria, Brief Lives: A Handbook of Medical Practitioners in Muscovy, 1620-1701 (London: The Wellcome Trust, 1999).
As the novel coronavirus COVID-19 outbreak has progressed into a pandemic, people have had a lot of feelings about OCD. There have been any number of newspaper articles on this, as well as statements by government officials and comments by individuals on social media. Why? What possible link could there be between a respiratory illness and an anxiety disorder? The answer, as is annoyingly often the case with popular discussions of OCD, is hand washing.
Some people have written articles about how hard it is to have OCD right now, what a major impact a pandemic is having on OCD sufferers. And it is. For people who suffer from certain specific variations of OCD.
Hand washing, along with excessive concern over cleanliness and germs, are OCD symptoms associated with one kind of OCD, contamination OCD. And in fact, not everyone with contamination OCD necessarily compulsively washes their hands. That subset of the condition is bigger than one symptom, just as OCD itself is more than one manifestation of the disorder.
Other people, inexplicably, have decided that OCD is the solution to life’s problems. The minister of health of New Zealand. An OCD specialist based at Stanford. Both *recommend* OCD as a response to COVID-19, claiming that OCD compulsions around hand washing and distancing yourselves from others are what is needed to combat the current outbreak.
I have read all the guidance provided by major public health organisations like the WHO and the CDC. And you know, none of them tell people to develop a disabling anxiety condition that might compulsively force you to stay away from others and wash your hands repeatedly. The public health advice is to wash your hands in specific situations, once, for 20 seconds each time. That is not OCD.
The second group of people, those *recommending* OCD are worse, but, honestly, I am tired of both kinds of people. I am tired of people claiming my chronic anxiety disorder is a magical cure for COVID-19. And I am also tired of people rubber-necking the pain of people with OCD.
When the outbreak started, highlighting that it would be hard on people with contamination OCD in particular was a legitimate point. But that point has been made. And made again. And again. And again. What, now, is the point of writing such an article? What will people do after they have read it? Will they do something to support people with anxiety conditions? Or is it just voyeurism, an opportunity for people who do not have OCD can cry about how sad they imagine our lives must be, then go right back to what they were doing before?
Journalists, I do not need yet another pity party about OCD. I send back your invitation, unopened.
There are articles that should be written right now about COVID-19 and OCD. Because alongside the well-publicised cases of mental health professionals and government ministers making bizarre claims about the “benefits” of OCD during the present crisis, there are also the usual jerks, who on any day of the week would proclaim themselves “sooo OCD” for tidying their closet once a year. Except now they have been told to wash their hands, and they have heard that OCD means washing your hands. So there is a wave of comments, on every social media platform out there, of all the ignorant people misusing OCD to mean they kept their distance from people and washed their hands once in a while. And that’s also been great to read.
Why not write that article, journalists? Why not discuss how ignorance of a major mental health condition has been further fuelled by the present crisis? Why not take people to task for claiming that an anxiety condition would help people survive a pandemic? Why not ask OCD sufferers how other people’s oblivious comments are affecting them? Why not discuss how conflating public health advice to follow specific guidelines regarding hygiene and physical distancing with the symptoms of an anxiety condition is irresponsible, especially during a global pandemic? Why is no one writing about how ignorance of OCD hurts both sufferers of OCD and everyone trying to cope with the COVID-19 crisis?
Any number of people want to write about how our brains are a problem, and isn’t that sad. No one seems to want to write about how ableist comments on our condition are a problem, not just for us, but for everyone.
My brain is not the issue here.
Now go wash your hands like the WHO told you to.
For the first post on my new blog, I want to share a little document that raises some big questions, and then utterly refuses to help answer any of them. In 2009-2010, I was in Moscow, sitting in the Russian State Archive of Ancient Documents in Moscow doing my PhD research. I was working my way through the catalogue of documents from the Apothecary Chancery, early modern Russia’s official medical department. As I did so, I came across a record of a patient noted as suffering from ручной блуд, the premodern Russian phrase for masturbation. So clearly I ordered that document up. The entire case file was one sheet of paper.
The case file is so short, that I can give you the whole of it here:
"166-ого Апреля въ 12-й день, в Оптекарскомъ Приказе жилецъ Иван Чортовъ въ роспросе сказалъ, что у него ручной блудъ, а учинился у него тотъ блудъ въ те поры какъ он былъ десяти летъ, и съ техъ местъ и по се время у него тотъ блудъ.
И дохтуръ, смотря Ивана Чортова, сказалъ, что тотъ блудъ учинился у него отъ порчи и от кручины и какъ онъ Иванъ учалъ быть в возрасте, и тотъ блудъ сталъ ему не въ мочъ и отъ того ему учинилась кручина; а которые люди бываютъ в шесть летъ и у техъ людей тотъ блудъ отъ порчу-жъ бываетъ; и тотъ блудъ у него лечить мочно только ему будетъ тяжело и лекарствъ много надобно, потому, что тотъ блудъ многими леть застарелъ и вскоре излечить ево не мочно."
"12th April 1658 [7166 by the Old Russian calendar], zhilets Ivan Chortov said when questioned, that he has manual fornication, and that fornication began with him when he was ten years old, and since that time he has had that fornication.
And the doctor, examining Ivan Chortov, said that that [manual] fornication began with him from a curse [lit. spoiling] and from melancholy and when Ivan came of age that fornication was not under his control and because of it he had melancholy. And there are people who are six years old and amongst such people that fornication occurs because of a curse. And it is possible to treat that fornication, only it will be hard for him [Chortov] and many medicines will be necessary [to treat this] as this fornication has grown old over many years and it will not be possible to cure him quickly."
I am here deliberately trying to leave the seventeenth-century Russian as close to its original phrasing as possible. Readers who know modern Russian will see the oddness of the syntax and phrasing of this document, written before Peter the I, Alexander Pushkin, the Bolsheviks, and others, had transformed the language into the one we use today.
For the historians of sexuality and medicine, it is important to note just how Chortov’s masturbatory habits are described. Блудъ, the word I translate as fornication, is an Old Russian and Old Church Slavonic term for inappropriate sexual contact. Literally translated, Chortov’s problem is here called “manual fornication.”
Also importantly, Chortov does not have an active verb here. He is not described as masturbating, engaging in masturbation, or any similar verbal phrase. Rather, he “has” masturbation, that masturbation began, using a reflexive verb. The very grammar of the piece removes any possible agency from Chortov in his masturbation, a lack of agency also underlined by the comments of the doctor.
There are hints of other stories in here.
The text repeatedly mentions кручина, melancholy or great sadness. This might, perhaps, even be interpreted as a reference to sin. Certainly masturbation was considered a sin by the Russian Orthodox Church; Eve Levin has written about the specified penances for it in this period. Yet we do not get a direct mention of a religious involvement in Chortov’s file.
The word порча, literally spoiling, gestures towards witchcraft, as that term was commonly used in Russian witchcraft trials of the seventeenth century to mean a curse. Yet, unlike the witchcraft trials discussed by Valerie Kivelson, here we have no particular individual accused of witchcraft, no specifics as to the magic supposedly performed, and no trial.
The very fact that this case ended up in the medical department is intriguing. Michael Stolberg has written about evolving attitudes to masturbation in early modern Western Europe. According to Stolberg, there was a shift in the late seventeenth and early eighteenth century, from a primarily religious view of masturbation as a sin, to a more medicalised view of it as an affliction. We might perhaps want to include this document in that trajectory, but that is complicated by the fact that this is the only Apothecary Chancery document to mention masturbation.
This casefile, then, is full of intriguing possibilities. It hints at attitudes to sex, ideas of sin, the practice of magic, the role of medicine. Yet, ultimately, it refuses to take us very far on any of them.
1658 examination of a man suffering from masturbation thought to be brought on by witchcraft, Russian State Archive of Ancient Documents (RGADA) f. 143, d. 2, ed. khr. 344. Published in N. E. Mamonov, Materialy dlia istorii medistiny v Rossii, 4 vols (St Petersburg: M. M. Stasiulevich, 1881), iii, p. 705. The version I use here is that published by Mamonov. The English translation is my own.
Kivelson, Valerie. Desperate Magic: The Moral Economy of Witchcraft in Seventeenth-Century Russia. Cornell University Press, 2013.
Levin, Eve. Sex and Society in the World of the Orthodox Slavs, 900-1700. Cornell University Press, 1989.
Michael Stolberg, ‘The Crime of Onan and the Laws of Nature. Religious and Medical Discourses on Masturbation in the Late Seventeenth and Early Eighteenth Centuries’, Paedagogica historica, 39 (2003), 701- 17.