Danuta Wasserman, psychiatrist: ‘In a brain with suicidal ideations there is a lot of anxiety, a lot of ambivalence, and a lot of anger’

Never has mental health been in the spotlight to such an extent. There is more social awareness than ever about the impact of emotional distress and in consulting rooms and research labs scientific knowledge about how to prevent or treat it is increasingly advanced. But mental health problems are still on the rise. “The problem is that governments do not allocate sufficient budgets to the prevention and treatment of people with mental illnesses,” says psychiatrist and researcher Danuta Wasserman, president of the World Psychiatric Association and professor of psychiatry and suicidology at the Karolinska Institute in Sweden.

There is no magic wand to prevent poor mental health, but there are indisputable guidelines that minimize the risks. For example: well-being, freedom from hunger and poverty, gender equality, clean drinking water and access to green spaces, Wasserman lists, while pointing to the stream of sunlight entering through the huge windows of the Palace of Justice in Palma de Mallorca, Spain, where her interview with EL PAÍS is being held. Wasserman continues to tick off some of these protective shields: physical exercise, good nutrition, proper sleep, peace, justice… “Wars are terrible for mental health. Not only for the people who are affected by the war, but also for the soldiers and the people who carry out the bombing,” says the researcher, who is visiting Palma de Mallorca to participate in a joint congress held by the Spanish Society of Dual Pathology and the World Association of Dual Pathology.

These are complex times and the worldwide figures regarding poor mental health speak for themselves. Wasserman, of Polish origin but based in Sweden since the late 1960s, turns to her cell phone and pulls up a PowerPoint that lays out the situation: 13% of the world’s population live with a mental health problem, mostly anxiety and depression but also developmental disorders, attention deficit hyperactivity disorder, bipolar disorder and, to a lesser extent, behavioral disorders, autism, or schizophrenia. In minors, 8% of children and 14% of adolescents also suffer from some kind of mental pathology.

Question: What does this 13% mean, and what do you think of this percentage?

Answer. I think it could be worse, because mental health problems depend to a large extent on economic and social factors. It’s not just our genes. For example, suicide depends on both genetic and environmental factors and the interaction between them: simplistically, you can say that genetic factors are about 50% responsible and environmental factors are also about 50% responsible. However, in others, it may be that the environment is more responsible and, particularly, it may be that a poor economic situation has an enormous influence. It is to be expected that, after the pandemic, economic conditions are improving, but not in all countries. At least in Sweden we still have very high interest rates, which puts a burden on households, and we do not know when they will decrease or increase. We depend, to a large extent, on the global economy, on what happens in the U.S., China, Russia, India... It doesn’t just depend on one country.

Q. In Catalonia, for example, a study revealed that suicide attempts increased by 50% after the lockdown.

A. It is not the same everywhere; suicide attempts increased among families with very poor relationships because interactions — bad interactions — increased. But, in other families with good interactions, mental health improved because they spent more time with each other. We know that in France, in some centers, attempts increased upon returning to class among children who were bullied in schools there were no anti-bullying programs. When they were at home, they felt better. Therefore, it depends on the surrounding factors.

Q. What is happening now?

A. Among young girls, suicide attempts and other self-destructive behaviors are increasing, and probably the reason is that they are very present on social networks and learn from each other instead of learning from their parents, their teachers, or their healthy peers about how to resolve tension or anxiety problems. They are influenced by self-destructive behaviors.

Q. Do you think the relationship between children and screens is toxic?

A. Yes. And the paradox is that it is both toxic and beneficial, because they can learn a lot of positive things, but also those destructive behaviors. And, unfortunately, this always happens in children who have worse conditions at home, and not only economically because they can come from both rich and poor families. What I mean is that they don’t have enough contact with their parents, their grandparents, or other relatives. They are more vulnerable because, for them, this [social networks and screens] is the only solution. And, in the end, they see nothing but these destructive solutions.

Q. What happens in the brain of a person who has suicidal ideations, or attempts suicide?

A. In these brains there is a lot of anxiety, a lot of ambivalence, and a lot of anger. If you can decrease the anxiety and anger — if you can make that ambivalence less powerful — you can help that person. So, what is the most important thing to buy time with the suicidal person? Sit and maybe not talk, but be close. Maybe he doesn’t want you to touch him, but you can give him a blanket or a warm meal to comfort him. There are a lot of physiological mechanisms going on in the brain: you have a lot of anxiety, so there are a lot of different signals, substances that circulate through the brain and push you to act or do something immediately. Therefore, environmental responses are extremely important: don’t leave the person alone, provide emotional and physical comfort, and try to listen.

Q. Can suicide rates be interpreted as a sign of the mental health of the general population? Nordic countries often come out at the top of the happiness rankings, but at the same time they have high suicide rates.

A. It’s a paradox, yes. Because we have good social systems, but at the moment we are very lonely. There is a very good American study, in the state of New York, where they have a very ambitious suicide prevention program and they were interviewing patients who had felt suicidal, and they asked: ‘What helps you?’ And they said a space to be, to feel that they were welcome, that someone cared about them... They didn’t necessarily ask to talk or to get therapy, but rather that someone cared about them. That’s why I say the wellbeing factor plays a role, but the loneliness factor does as well. In countries where you have large families and extended families, even if you are not very well off, you have low suicide rates because there are always people around you and they can take care of you in many other ways.

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