‘In life I want to go beyond surviving... I want to thrive’

Dr Ahmed Hankir delivers a unique and powerful insight into mental health recovery in his candid new memoir. By Áine Toner

ABELFAST-BORN medical professional’s memoir examines mental health services and stigmas from the perspective of a psychiatric patient and consultant psychiatrist.

Breakthrough, the candid memoir written by Dr Ahmed Hankir, reveals the obstacles that nearly shattered his dreams of being a doctor and his journey to recover from episodes of severe psychological distress.

Born in Belfast with his twin brother and raised in Dublin, Dr Hankir is a recipient of the World Health Organisation’s Director General’s Award for Global Health in honour of his work campaigning for mental health destigmatisation and humanisation of persons living with a mental health condition.

“When I say humanisation, says Dr Hankir, speaking to Belfast Telegraph from his home in Canada, “it can seem to me, and certainly to many other persons, that persons living with a mental health condition are being dehumanised. And what I mean by that is that our human rights are being violated and that we are not treated like we are human beings.

“I tried to raise awareness of the fact that many persons are being dehumanised, are being brutalised.

“Where can that happen? Well, for example, in psychiatric hospitals, where we might be at the receiving end of coercive treatment, for example, against our will.

“It’s not just that, for example, [affecting] the person with mental health conditions... In popular culture and segments of the media, [and] in film, that can be the perpetuation of negative stereotypes that we might have — for example, a proclivity for violence — but the reality is that we are far more likely to be the victims of violence, as opposed to the perpetrator. We are human beings, we are fallible, we are vulnerable, we have hopes and fears and dreams like everyone else.”

For Dr Hankir, treating the person rather than merely seeing their condition is vital.

“I can speak on behalf of myself. It’s an integral ingredient of my identity. I’m more than just my condition.

“It’s definitely an important part of a provider and but it’s not who I am and it doesn’t define me as a person; I’m not limited by my mental health difficulties.”

Honest throughout, Breakthrough touches on Dr Hankir’s breakdown at medical school, something which he still thinks deeply about to this day.

“There’s not a day that goes by that I don’t think about what happened,” he says, recollecting the episode 20 years ago.

“You live with that trauma continuously to influence your mental health and your interpersonal relationships and your functioning and you try to learn from it as best you can. It was triggering. It did stir up a lot of emotions. It was difficult.

“The mind mounts different defence mechanisms — suppression, repression. I guess, sometimes we try to forget about what happened because it’s too distressing.

“But then there are certain stressors that contribute to the resurfacing of traumatic memories. You try your best to process those traumatic memories.

“Maybe that’s the purpose of therapy. You need to kind of try to process that unresolved trauma, and it’s only through making the unconscious conscious that we can, I guess, let go and move on. But that’s a lot easier said than done.”

In his memoir, Dr Hankir cites the need for more than prescription pads to help those with mental health difficulties, touching on topics such as treatment options, human rights and non-pharmacological approaches.

“I am not anti-medication; I am a physician, a psychiatrist, I’m a professor.

“I don’t deny that but there are persons who will say that there’s no such thing as a mental illness or a mental disorder or a mental health condition. There’s no biological basis. You don’t need medications; if anything, medications make things worse.

“Respectfully, I would disagree with that.

“I accept that there are side effects; there are adverse effects.

“These are powerful psychiatric drugs, psychotropic medication. It’s important to accept that psychiatric drugs do have adverse effects, which can be severe.

“The flip side is that they can be highly effective, but I think that the threshold for prescribing psychiatric drugs is too low.

“There’s so much that we can do before we get our prescription pads out.

‘We are not treated like we’re human beings’

“Things like lifestyle interventions, increasing the amount of physical activity that you do and improving your diet. Something like social prescribing, for example, so just kind of immersing yourself in nature.

“We talk about social connectivity as well and participating in social activities in the community, even therapy. The importance of therapy, in my opinion, can’t be overstated.

“Sometimes it doesn’t matter how much medication you take or what medication you receive, unless you process the unresolved trauma it will continue to influence your mental health and your functioning and your interpersonal relationships.

“So there’s so much more that we can do before we get our prescription pads out — I am definitely an advocate of that.”

Over the past few decades, we’ve come a long way in how we view and talk about mental health, but stigma remains, affecting personal and professional lives to areas of self-confidence.

“There are some mental health conditions that are more stigmatised than others,” says Dr Hankir, “for example, schizophrenia or psychosis.

“I would say that the most stigmatised condition is borderline personality disorder, also known as emotionally unstable personality disorder.

“Somebody referred to me as a stigma warrior, which I thought was very flattering, but in the book I didn’t actually say what type of mental health condition I was diagnosed with. That was deliberate, partly because I think that psychiatric labels can be helpful. But they can also be unhelpful. Once you receive that label, you can’t shake it off. Often people have these preconceptions.”

Though he says we have made progress and are more “honest, open and transparent” about our mental health experiences, there remains a lot of ground to cover.

“Let’s just say you’re a white girl and you identify at neuro-divergent, as opposed to neurotypical, if you have autism or ADHD,” he says.

“I don’t think you’re perceived as a threat. But if you’re a man of colour and you’ve been diagnosed with psychosis or schizophrenia, I think the initial reaction would be: ‘Oh, my God, this person is violent. This person is going to harm me.’

“I think that’s how these kind of negative stereotypes persist in segments of the media, in film and in popular culture. So I think there are multiple factors that contribute to how a certain mental health condition can be perceived. That depends on who has that condition, I guess, and when.

“Maybe people are more accepting in certain parts of the world than they are above others, but why is the male-to-female suicide ratio three to one? What is contributing to that? What has contributed to that?

“I think it’s a lot easier for us to perceive girls and women as victims, but not men. We don’t perceive men as victims; generally we perceive them as perpetrators of abuse, whether that’s domestic abuse, physical abuse, sexual abuse. How can we feel sorry for men? I think that difficulty of having empathy for a man living with a mental health condition, I think that’s contributing, in my opinion, to the male-to-female suicide ratio of three to one.”

In December 2023, the suicide deaths in Northern Ireland 2002-2022 report was published. It detailed that there were 203 deaths by suicide registered in 2022, with the age-standardised suicide rate reducing from 14.3 deaths per 100,000 in 2021 to 12.3 deaths per 100,000 in 2022.

Dr Hankir, who won the Who Cares Wins Caroline Flack Mental Health Hero Award, praises mental health champion Siobhan O’neill and her advocating of trauma-informed care, in part linked to intergenerational and unresolved trauma stemming from the Troubles.

In Breakthrough, Dr Hankir describes himself as a survivor — and he explains why.

“I would say I was psychologically tortured, that my mind was mutilated — all these are very intense words, but I wouldn’t say that I’m exaggerating.

“It still shocks me to this day, how I managed to, I guess, emerge from that dark place and, yeah, it almost killed me. I can’t deny that.

“I do identify as a survivor, but it seems like the expectation is that you can’t achieve more than mediocrity, persons with a mental health condition, that the most that we can achieve in this life and the most that we can hope for is to survive. And, dare I say it, I want to go beyond surviving... I want to thrive.

“I actually have explicitly said I identify as a survivor, but I won’t settle for that. I want to go above and beyond that, for sure.”

His parents, he says, have fond memories of their time in Belfast — “They get very nostalgic and that obviously influences my perception”.

He, meanwhile, reminisces of a talk given at Queen’s University Belfast pre-covid where he felt “a very authentic connection” with both the city and Northern Ireland as a whole.

“Even though I don’t have memories of Ireland, it still has such an important role to play. It’s a fact that that definitely influences my identity.”