Thursday 18 April 2019

Patricia Casey: 'For the families of a missing person, the grief is difficult to resolve'

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Stock photo

Patricia Casey

'When last seen she was wearing a brown sweater and blue jeans. She has blond shoulder-length hair and a pale complexion. She is 5ft 2 inches I height and of slim build". Heart-rending descriptions such as this are common and may be on the increase. Over the past year, I have been struck by the huge number of such descriptions on news and social media.

In Ireland, the number of people reported missing to the Gardai, at the end of 2014, was over 9,000 annually - in comparison to almost half that number in 2004. In Britain, the annual figure is 250,000. More than half of these are under the age of 21.

It is unclear if this perceived increase is real or if it is the case that we are hearing more about this distressing behaviour as a result of the ubiquity of the internet and a greater willingness to report a missing person to the Gardai. This, coupled with a voraciously eager media ready to run with the story, may be the actual reason for this seeming increase. Broadly speaking, those reported missing are divided into those who do so intentionally, the largest group, and those missing not by choice, but involuntarily.

According to the British charity Missing People, 80pc of missing people have mental health problems. As a psychiatrist, I have dealt with several families whose loved ones disappeared involuntarily. In other words, the person who left home was not consciously making an active decision to do so.

Included in this group are those who are kidnapped or abducted. Some, tragically, may be murdered. Others may have wandered away from home as a result of dementia, learning disability or amnesia secondary to a major traumatic incident. The latter category is termed dissociation and it happens when there is memory shutdown as a protection against the experience of a major psychic insult. This may include overwhelming debt, sexual abuse or other violations.

Depressive and psychotic illnesses such as schizophrenia and bipolar disorder can also cause dissociation. The person is often discovered wandering aimlessly and without any recollection of who they are or where they live. This type of involuntary amnesia is captured very well in the movie The Bourne Identity. Sadly, some missing people will have been the victim of accidents that claim their lives and if there are no witnesses they may not be found, or they may be serendipitously discovered after a lapse of time.

About two thirds of those who are reported as missing have done so voluntarily and intentionally, although this does not mean they want to. Indeed, the decision to leave home in this way is an indicator of problems either in the home, in the family or in the person. The motivations are variable and may be the result of difficult relationships at home. Instead of seeking help, the young person deals with it by running away. Avoidance is a classic method used to prevent distress. Others, particularly females, run away with partners while some go missing under the influence of substances such as alcohol or illicit drugs. They may drift into homelessness. Escaping domestic violence is a clear motivation among some women, while others just want to start a new life.

For the families of a missing person, the realisation that the person is missing is terrifying. Taking the first step and reporting it to the police is fraught with doubt because they do not know if the person has simply "taken time out" and is perhaps with a friend or is truly missing. As time passes without the return of their loved one, many issue public calls to the person. As the months and maybe years wear on, the grief is difficult to resolve and families describe themselves as "stuck in time".

The mourning rituals that follow a loss through death are not available. There is the fear of never seeing the person again on the one hand, while continuing to have hope on the other.

Uncertainty is one of the great stressors that hangs over them, torn between the mixed emotions of anticipation, sadness and uncertainty. When people are bereaved through natural death they are enabled to let go of their loved one over time but that step is not available to those whose family member is missing. They also have to deal with the practical implications that follow when a breadwinner is missing, when the person's name is on the mortgage or if there is a joint bank account.

Thankfully, over 90pc of those reported as missing are found safe and well within a few days. Because of the centrality of mental health issues among those who go missing, it is crucial that on return home they have a psychological assessment. Otherwise, there is a possibility that history will repeat itself and absconding will recur, leaving a trail of frustration and sadness behind.

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