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Prurience review – come and join the self-help group for porn addicts

Chris is our group leader, a sandy-haired man sporting a baseball cap and a caring smile. He wants us to talk about the first time we saw pornography. People in the circle shift uncomfortably in their seats.

Nobody wants to catch Chris’s eye. Slowly, people begin to speak. Somebody tells of finding the builders’ stash of magazines hidden in a skip, another talks of a boys-only school trip to Holland and discovering adult channels on Dutch TV. An older man, Rick, makes the point that, for his generation, a first sexual experience often came before widespread exposure to porn.

The cabaret star Christopher Green’s Prurience, originally developed with the Sick! festival, describes itself as “an experiential entertainment about porn”. But that’s not all it is. Green is testing the limits of theatre, the role of audience participation, the line between the real and fictional worlds, and just how much he can muck around with the audience’s heads. He has form in this department, most notably with The Frozen Scream, a disappointing immersive-theatre collaboration with the novelist Sarah Waters at Wales Millennium Centre in 2015.

Prurience ‘founder’ Amelia Atkins joins the session.


Prurience ‘founder’ Amelia Atkins joins the session. Photograph: James W Norton

Unlike that project, this is no horror show. Quite the contrary – it’s often very funny and genuinely discomforting, largely because the dramaturgy is much sharper and tighter. It immediately solves the crucial central problem of so much immersive theatre in justifying our presence in the piece. Punchdrunk deal with it by putting the audience in masks so we become shadows at the spectacle. In Prurience, we are all participants in an Alcoholics Anonymous-style therapy group for porn addicts founded by former porn actor Amelia Atkins (played brilliantly on film by Pippa Winslow), whose stick-on face of permanent concern makes her look as if she is suffering from a really bad case of constipation.

You leave your bag and your inhibitions at the door, stick on a name badge, help yourself to herbal tea and biscuits (“for those who haven’t yet dealt with their sugar addiction”) and allow yourself to sink into the welcoming world of self-help groups. We are invited to join in the group singalong and shut our eyes and raise our hands if we have ever run along a street for the sheer joy of it, or sat on the edge of our bed and cried. What’s fascinating is how prepared people are to play along, even though the entire thing has a lightly satirical edge. We are drawn in almost without realising it.

Soon we move on to the sharing: there’s a young biochemist who believes that his erectile dysfunction is a result of watching too much porn from the age of 11 which has shaped his neural pathways. And there’s a woman who gets off from watching gay male porn, although she draws the line at fisting because it reminds her too much of her job as a vet.

But gradually it becomes apparent from the fixed smile of Chris — played by Green himself — that there are rumblings of discontent among regular attenders at the group. What is its function? Is porn addiction a real thing? Are therapy groups such as Atkins’ Prurience merely cult-like money spinners, part of a capitalism conspiracy that on one hand sells us porn and then tries to sell us the apparent cure? Maybe porn, food, drugs and social media have simply become a substitute for the other certainties – such as faith – that we used to believe in.

Prurience shares similar territory with David Hare’s 2000 Royal Court play My Zinc Bed in the way its raises the possibility that therapy groups substitute one kind of addiction for the addiction of public confession and how it inspects whether anyone really wants to be totally cured of desire. But it is way more interesting than Hare’s play because of the way it genuinely tries to marry form and content. We are sitting in a room pretending we are in a therapy group that is discussing people’s disconnection from the real world because of porn. It’s a piece of fiction about an addiction that some scientists dispute even exists.

If you want an idea of just how discombobulating the entire experience is, suffice to say that the post-show discussion doesn’t take place where you might expect. There were a few dislocating moments when I genuinely considered the possibility that everyone in the room was an actor apart from the five people I knew.

Prurience doesn’t entirely succeed in keeping all the balls in the air, but at its fiendish, exhilarating best it makes you question not just attitudes to porn but how we experience reality.

Prurience review – come and join the self-help group for porn addicts

Chris is our group leader, a sandy-haired man sporting a baseball cap and a caring smile. He wants us to talk about the first time we saw pornography. People in the circle shift uncomfortably in their seats.

Nobody wants to catch Chris’s eye. Slowly, people begin to speak. Somebody tells of finding the builders’ stash of magazines hidden in a skip, another talks of a boys-only school trip to Holland and discovering adult channels on Dutch TV. An older man, Rick, makes the point that, for his generation, a first sexual experience often came before widespread exposure to porn.

The cabaret star Christopher Green’s Prurience, originally developed with the Sick! festival, describes itself as “an experiential entertainment about porn”. But that’s not all it is. Green is testing the limits of theatre, the role of audience participation, the line between the real and fictional worlds, and just how much he can muck around with the audience’s heads. He has form in this department, most notably with The Frozen Scream, a disappointing immersive-theatre collaboration with the novelist Sarah Waters at Wales Millennium Centre in 2015.

Prurience ‘founder’ Amelia Atkins joins the session.


Prurience ‘founder’ Amelia Atkins joins the session. Photograph: James W Norton

Unlike that project, this is no horror show. Quite the contrary – it’s often very funny and genuinely discomforting, largely because the dramaturgy is much sharper and tighter. It immediately solves the crucial central problem of so much immersive theatre in justifying our presence in the piece. Punchdrunk deal with it by putting the audience in masks so we become shadows at the spectacle. In Prurience, we are all participants in an Alcoholics Anonymous-style therapy group for porn addicts founded by former porn actor Amelia Atkins (played brilliantly on film by Pippa Winslow), whose stick-on face of permanent concern makes her look as if she is suffering from a really bad case of constipation.

You leave your bag and your inhibitions at the door, stick on a name badge, help yourself to herbal tea and biscuits (“for those who haven’t yet dealt with their sugar addiction”) and allow yourself to sink into the welcoming world of self-help groups. We are invited to join in the group singalong and shut our eyes and raise our hands if we have ever run along a street for the sheer joy of it, or sat on the edge of our bed and cried. What’s fascinating is how prepared people are to play along, even though the entire thing has a lightly satirical edge. We are drawn in almost without realising it.

Soon we move on to the sharing: there’s a young biochemist who believes that his erectile dysfunction is a result of watching too much porn from the age of 11 which has shaped his neural pathways. And there’s a woman who gets off from watching gay male porn, although she draws the line at fisting because it reminds her too much of her job as a vet.

But gradually it becomes apparent from the fixed smile of Chris — played by Green himself — that there are rumblings of discontent among regular attenders at the group. What is its function? Is porn addiction a real thing? Are therapy groups such as Atkins’ Prurience merely cult-like money spinners, part of a capitalism conspiracy that on one hand sells us porn and then tries to sell us the apparent cure? Maybe porn, food, drugs and social media have simply become a substitute for the other certainties – such as faith – that we used to believe in.

Prurience shares similar territory with David Hare’s 2000 Royal Court play My Zinc Bed in the way its raises the possibility that therapy groups substitute one kind of addiction for the addiction of public confession and how it inspects whether anyone really wants to be totally cured of desire. But it is way more interesting than Hare’s play because of the way it genuinely tries to marry form and content. We are sitting in a room pretending we are in a therapy group that is discussing people’s disconnection from the real world because of porn. It’s a piece of fiction about an addiction that some scientists dispute even exists.

If you want an idea of just how discombobulating the entire experience is, suffice to say that the post-show discussion doesn’t take place where you might expect. There were a few dislocating moments when I genuinely considered the possibility that everyone in the room was an actor apart from the five people I knew.

Prurience doesn’t entirely succeed in keeping all the balls in the air, but at its fiendish, exhilarating best it makes you question not just attitudes to porn but how we experience reality.

Prurience review – come and join the self-help group for porn addicts

Chris is our group leader, a sandy-haired man sporting a baseball cap and a caring smile. He wants us to talk about the first time we saw pornography. People in the circle shift uncomfortably in their seats.

Nobody wants to catch Chris’s eye. Slowly, people begin to speak. Somebody tells of finding the builders’ stash of magazines hidden in a skip, another talks of a boys-only school trip to Holland and discovering adult channels on Dutch TV. An older man, Rick, makes the point that, for his generation, a first sexual experience often came before widespread exposure to porn.

The cabaret star Christopher Green’s Prurience, originally developed with the Sick! festival, describes itself as “an experiential entertainment about porn”. But that’s not all it is. Green is testing the limits of theatre, the role of audience participation, the line between the real and fictional worlds, and just how much he can muck around with the audience’s heads. He has form in this department, most notably with The Frozen Scream, a disappointing immersive-theatre collaboration with the novelist Sarah Waters at Wales Millennium Centre in 2015.

Prurience ‘founder’ Amelia Atkins joins the session.


Prurience ‘founder’ Amelia Atkins joins the session. Photograph: James W Norton

Unlike that project, this is no horror show. Quite the contrary – it’s often very funny and genuinely discomforting, largely because the dramaturgy is much sharper and tighter. It immediately solves the crucial central problem of so much immersive theatre in justifying our presence in the piece. Punchdrunk deal with it by putting the audience in masks so we become shadows at the spectacle. In Prurience, we are all participants in an Alcoholics Anonymous-style therapy group for porn addicts founded by former porn actor Amelia Atkins (played brilliantly on film by Pippa Winslow), whose stick-on face of permanent concern makes her look as if she is suffering from a really bad case of constipation.

You leave your bag and your inhibitions at the door, stick on a name badge, help yourself to herbal tea and biscuits (“for those who haven’t yet dealt with their sugar addiction”) and allow yourself to sink into the welcoming world of self-help groups. We are invited to join in the group singalong and shut our eyes and raise our hands if we have ever run along a street for the sheer joy of it, or sat on the edge of our bed and cried. What’s fascinating is how prepared people are to play along, even though the entire thing has a lightly satirical edge. We are drawn in almost without realising it.

Soon we move on to the sharing: there’s a young biochemist who believes that his erectile dysfunction is a result of watching too much porn from the age of 11 which has shaped his neural pathways. And there’s a woman who gets off from watching gay male porn, although she draws the line at fisting because it reminds her too much of her job as a vet.

But gradually it becomes apparent from the fixed smile of Chris — played by Green himself — that there are rumblings of discontent among regular attenders at the group. What is its function? Is porn addiction a real thing? Are therapy groups such as Atkins’ Prurience merely cult-like money spinners, part of a capitalism conspiracy that on one hand sells us porn and then tries to sell us the apparent cure? Maybe porn, food, drugs and social media have simply become a substitute for the other certainties – such as faith – that we used to believe in.

Prurience shares similar territory with David Hare’s 2000 Royal Court play My Zinc Bed in the way its raises the possibility that therapy groups substitute one kind of addiction for the addiction of public confession and how it inspects whether anyone really wants to be totally cured of desire. But it is way more interesting than Hare’s play because of the way it genuinely tries to marry form and content. We are sitting in a room pretending we are in a therapy group that is discussing people’s disconnection from the real world because of porn. It’s a piece of fiction about an addiction that some scientists dispute even exists.

If you want an idea of just how discombobulating the entire experience is, suffice to say that the post-show discussion doesn’t take place where you might expect. There were a few dislocating moments when I genuinely considered the possibility that everyone in the room was an actor apart from the five people I knew.

Prurience doesn’t entirely succeed in keeping all the balls in the air, but at its fiendish, exhilarating best it makes you question not just attitudes to porn but how we experience reality.

Sierra Leone: teenage girls are dying from unsafe abortions and risky pregnancies

I recently saw a girl in clinic with terrible complications following a caesarean section. The operation had been botched and she had an infection around her uterus. She was in terrible pain and critically unwell. This was in the children’s clinic; the girl was 14 years old.

This scenario is all too common. She is just one of the thousands of adolescent girls estimated to have become pregnant this year in Sierra Leone. In 2013 the country had the 7th highest teenage pregnancy rate in the world, 38% of women aged 20-24 had their first baby before the age of 18. Sierra Leone is by no means an exception. Worldwide teenage pregnancy is a huge issue, 11% of births globally are to women aged 15-19, with the majority of these taking place in low- and middle-income countries.

From a medical point of view, teenage pregnancy is terribly risky. Teenage mothers are estimated to be 40-60% more likely to die in childbirth. Their babies are 50% more likely to be stillborn or die shortly after birth than babies born to mothers in their 20s.

Terrifying medical complications aside, it can be devastating socially and economically for adolescent mums. In 2015, when schools in Sierra Leone reopened after the Ebola crisis, the minister for education banned visibly pregnant girls from school and sitting exams. This discriminatory ban persists and has been strongly condemned by, among others, Amnesty International.

A “bridging system” was started where girls can seek alternative education elsewhere, but the disruption remains huge. Often girls will be prevented from sitting exams and need to repeat a whole year of school, meaning many will not go back at all. This discriminates against the girls, but not the men who get them pregnant. After giving birth they face continued problems reintegrating into their schools of choice.

During the recent Ebola crisis teen pregnancy rates rose in Sierra Leone by an estimated 50%. This rise could give insights into why the country’s teen pregnancy rate is so high. A factor highlighted as being behind the spike in pregnancy during the Ebola outbreak was extreme poverty, with girls reportedly having sex in exchange for water, food or other forms of financial protection.

What can be done to help these girls? This problem is complex with many driving factors.

The UK is one of Europe’s great success stories with reducing its high teenage pregnancy rate. Improved sex education and access to contraception and changes in social norms are credited with this drop. Can any of the lessons learned be applied in this context?

Improving knowledge of and access to contraception is certainly important. Access to contraception in Sierra Leone is limited; an estimated 16% of women in Sierra Leone use contraception and this figure falls to 7.8% for teenagers. Safe access to abortion for girls who do not want to continue their pregnancy is essential. In Sierra Leone, the country with the world’s worst maternal mortality, abortion is illegal in nearly all circumstances and unsafe abortion is estimated to account for 10% of maternal deaths. This will only be compounded by Trump’s enactment of the “global gag rule” which has a disastrous effect on funding for organisations working for women’s reproductive rights.


The girls themselves will never be the key to reducing the teenage pregnancy rate. There has to be buy in from the men

However, assuming that knowledge about and access to contraception would end this problem is deeply misguided. It puts all of the onus on to the girls not to get pregnant, it assumes they have the option of making a choice. Even when contraception is available many of the girls are not empowered to insist on its use. This approach ignores the wider societal contexts that drive the high teenage pregnancy rate. A recent report by the Secure Livelihoods Research Consortium highlighted some of the inadequacies in current programming.

The girls themselves will never be the key to reducing the teenage pregnancy rate. There has to be buy-in from the men, and a change in attitudes that currently accept the concept of teenage pregnancy. Currently, a lot of work being done on this issue focuses only on the girls. Addressing the attitudes that perpetuate teenage pregnancy is difficult and there are few programmes that do this at the moment. It is easy to pick out and identify the teenage women, but harder to involve the men who could potentially impregnate them.

The high adolescent pregnancy rate, in Sierra Leone and around the world, jeopardises the achievement of the sustainable development goals (SDGs). The SDGs focus specifically on reducing maternal mortality, improving health for all ages and promoting women’s rights. Teenage pregnancy is a threat to the realisation of all those goals and so meaningful efforts to reduce the appalling rate are essential to making any progress.

In the hospital where I work, a teenage pregnancy support group is going on. Girls receive education sessions. Efforts are being made to find them jobs and reintegrate them into the school system. The excitement of the girls is palpable. Many of them have come from situations where they are not shown any respect, but now they are being empowered to take control of this important part of their lives.

This month the UK government hosted Family Planning Summit 2017 to recommit to this global issue, announcing that the UK would increase international development spending on family planning from £180m per year until 2020 to £225m per year until 2022. Governments from countries around the world came together to make commitments to improving women’s access to family planning. In the face of Trump’s regressive change to US policy, putting women’s reproductive rights at the centre of the international community’s agenda is of great importance.

Sierra Leone: teenage girls are dying from unsafe abortions and risky pregnancies

I recently saw a girl in clinic with terrible complications following a caesarean section. The operation had been botched and she had an infection around her uterus. She was in terrible pain and critically unwell. This was in the children’s clinic; the girl was 14 years old.

This scenario is all too common. She is just one of the thousands of adolescent girls estimated to have become pregnant this year in Sierra Leone. In 2013 the country had the 7th highest teenage pregnancy rate in the world, 38% of women aged 20-24 had their first baby before the age of 18. Sierra Leone is by no means an exception. Worldwide teenage pregnancy is a huge issue, 11% of births globally are to women aged 15-19, with the majority of these taking place in low- and middle-income countries.

From a medical point of view, teenage pregnancy is terribly risky. Teenage mothers are estimated to be 40-60% more likely to die in childbirth. Their babies are 50% more likely to be stillborn or die shortly after birth than babies born to mothers in their 20s.

Terrifying medical complications aside, it can be devastating socially and economically for adolescent mums. In 2015, when schools in Sierra Leone reopened after the Ebola crisis, the minister for education banned visibly pregnant girls from school and sitting exams. This discriminatory ban persists and has been strongly condemned by, among others, Amnesty International.

A “bridging system” was started where girls can seek alternative education elsewhere, but the disruption remains huge. Often girls will be prevented from sitting exams and need to repeat a whole year of school, meaning many will not go back at all. This discriminates against the girls, but not the men who get them pregnant. After giving birth they face continued problems reintegrating into their schools of choice.

During the recent Ebola crisis teen pregnancy rates rose in Sierra Leone by an estimated 50%. This rise could give insights into why the country’s teen pregnancy rate is so high. A factor highlighted as being behind the spike in pregnancy during the Ebola outbreak was extreme poverty, with girls reportedly having sex in exchange for water, food or other forms of financial protection.

What can be done to help these girls? This problem is complex with many driving factors.

The UK is one of Europe’s great success stories with reducing its high teenage pregnancy rate. Improved sex education and access to contraception and changes in social norms are credited with this drop. Can any of the lessons learned be applied in this context?

Improving knowledge of and access to contraception is certainly important. Access to contraception in Sierra Leone is limited; an estimated 16% of women in Sierra Leone use contraception and this figure falls to 7.8% for teenagers. Safe access to abortion for girls who do not want to continue their pregnancy is essential. In Sierra Leone, the country with the world’s worst maternal mortality, abortion is illegal in nearly all circumstances and unsafe abortion is estimated to account for 10% of maternal deaths. This will only be compounded by Trump’s enactment of the “global gag rule” which has a disastrous effect on funding for organisations working for women’s reproductive rights.


The girls themselves will never be the key to reducing the teenage pregnancy rate. There has to be buy in from the men

However, assuming that knowledge about and access to contraception would end this problem is deeply misguided. It puts all of the onus on to the girls not to get pregnant, it assumes they have the option of making a choice. Even when contraception is available many of the girls are not empowered to insist on its use. This approach ignores the wider societal contexts that drive the high teenage pregnancy rate. A recent report by the Secure Livelihoods Research Consortium highlighted some of the inadequacies in current programming.

The girls themselves will never be the key to reducing the teenage pregnancy rate. There has to be buy-in from the men, and a change in attitudes that currently accept the concept of teenage pregnancy. Currently, a lot of work being done on this issue focuses only on the girls. Addressing the attitudes that perpetuate teenage pregnancy is difficult and there are few programmes that do this at the moment. It is easy to pick out and identify the teenage women, but harder to involve the men who could potentially impregnate them.

The high adolescent pregnancy rate, in Sierra Leone and around the world, jeopardises the achievement of the sustainable development goals (SDGs). The SDGs focus specifically on reducing maternal mortality, improving health for all ages and promoting women’s rights. Teenage pregnancy is a threat to the realisation of all those goals and so meaningful efforts to reduce the appalling rate are essential to making any progress.

In the hospital where I work, a teenage pregnancy support group is going on. Girls receive education sessions. Efforts are being made to find them jobs and reintegrate them into the school system. The excitement of the girls is palpable. Many of them have come from situations where they are not shown any respect, but now they are being empowered to take control of this important part of their lives.

This month the UK government hosted Family Planning Summit 2017 to recommit to this global issue, announcing that the UK would increase international development spending on family planning from £180m per year until 2020 to £225m per year until 2022. Governments from countries around the world came together to make commitments to improving women’s access to family planning. In the face of Trump’s regressive change to US policy, putting women’s reproductive rights at the centre of the international community’s agenda is of great importance.

Sierra Leone: teenage girls are dying from unsafe abortions and risky pregnancies

I recently saw a girl in clinic with terrible complications following a caesarean section. The operation had been botched and she had an infection around her uterus. She was in terrible pain and critically unwell. This was in the children’s clinic; the girl was 14 years old.

This scenario is all too common. She is just one of the thousands of adolescent girls estimated to have become pregnant this year in Sierra Leone. In 2013 the country had the 7th highest teenage pregnancy rate in the world, 38% of women aged 20-24 had their first baby before the age of 18. Sierra Leone is by no means an exception. Worldwide teenage pregnancy is a huge issue, 11% of births globally are to women aged 15-19, with the majority of these taking place in low- and middle-income countries.

From a medical point of view, teenage pregnancy is terribly risky. Teenage mothers are estimated to be 40-60% more likely to die in childbirth. Their babies are 50% more likely to be stillborn or die shortly after birth than babies born to mothers in their 20s.

Terrifying medical complications aside, it can be devastating socially and economically for adolescent mums. In 2015, when schools in Sierra Leone reopened after the Ebola crisis, the minister for education banned visibly pregnant girls from school and sitting exams. This discriminatory ban persists and has been strongly condemned by, among others, Amnesty International.

A “bridging system” was started where girls can seek alternative education elsewhere, but the disruption remains huge. Often girls will be prevented from sitting exams and need to repeat a whole year of school, meaning many will not go back at all. This discriminates against the girls, but not the men who get them pregnant. After giving birth they face continued problems reintegrating into their schools of choice.

During the recent Ebola crisis teen pregnancy rates rose in Sierra Leone by an estimated 50%. This rise could give insights into why the country’s teen pregnancy rate is so high. A factor highlighted as being behind the spike in pregnancy during the Ebola outbreak was extreme poverty, with girls reportedly having sex in exchange for water, food or other forms of financial protection.

What can be done to help these girls? This problem is complex with many driving factors.

The UK is one of Europe’s great success stories with reducing its high teenage pregnancy rate. Improved sex education and access to contraception and changes in social norms are credited with this drop. Can any of the lessons learned be applied in this context?

Improving knowledge of and access to contraception is certainly important. Access to contraception in Sierra Leone is limited; an estimated 16% of women in Sierra Leone use contraception and this figure falls to 7.8% for teenagers. Safe access to abortion for girls who do not want to continue their pregnancy is essential. In Sierra Leone, the country with the world’s worst maternal mortality, abortion is illegal in nearly all circumstances and unsafe abortion is estimated to account for 10% of maternal deaths. This will only be compounded by Trump’s enactment of the “global gag rule” which has a disastrous effect on funding for organisations working for women’s reproductive rights.


The girls themselves will never be the key to reducing the teenage pregnancy rate. There has to be buy in from the men

However, assuming that knowledge about and access to contraception would end this problem is deeply misguided. It puts all of the onus on to the girls not to get pregnant, it assumes they have the option of making a choice. Even when contraception is available many of the girls are not empowered to insist on its use. This approach ignores the wider societal contexts that drive the high teenage pregnancy rate. A recent report by the Secure Livelihoods Research Consortium highlighted some of the inadequacies in current programming.

The girls themselves will never be the key to reducing the teenage pregnancy rate. There has to be buy-in from the men, and a change in attitudes that currently accept the concept of teenage pregnancy. Currently, a lot of work being done on this issue focuses only on the girls. Addressing the attitudes that perpetuate teenage pregnancy is difficult and there are few programmes that do this at the moment. It is easy to pick out and identify the teenage women, but harder to involve the men who could potentially impregnate them.

The high adolescent pregnancy rate, in Sierra Leone and around the world, jeopardises the achievement of the sustainable development goals (SDGs). The SDGs focus specifically on reducing maternal mortality, improving health for all ages and promoting women’s rights. Teenage pregnancy is a threat to the realisation of all those goals and so meaningful efforts to reduce the appalling rate are essential to making any progress.

In the hospital where I work, a teenage pregnancy support group is going on. Girls receive education sessions. Efforts are being made to find them jobs and reintegrate them into the school system. The excitement of the girls is palpable. Many of them have come from situations where they are not shown any respect, but now they are being empowered to take control of this important part of their lives.

This month the UK government hosted Family Planning Summit 2017 to recommit to this global issue, announcing that the UK would increase international development spending on family planning from £180m per year until 2020 to £225m per year until 2022. Governments from countries around the world came together to make commitments to improving women’s access to family planning. In the face of Trump’s regressive change to US policy, putting women’s reproductive rights at the centre of the international community’s agenda is of great importance.

I’m a paramedic who has considered suicide and I’m not getting support

When I was 15, a teacher found me during lunch break and asked if she could have a word. Confused, as I was generally well behaved, I followed her to the office. I was told that a close friend of mine had been found by his parents that morning hanging in his bedroom. He was in intensive care at the local hospital but his family had been asked to prepare for the possibility that he would die shortly. Growing up, the ideas of major depressive illnesses, self-harm and suicide were almost entirely foreign to me.

People often ask whether this was what motivated me to enter healthcare at 17 and eventually land in my current position as a paramedic by 20. Frankly, I don’t know. What I do know, though, is that while suicide was a foreign concept to me at 15, it certainly isn’t now.

Almost a quarter of ­ambulance staff have post traumatic stress disorder, according to research published in the British Medical Journal, and about one in three suffer from mental health problems. Statistics are hard to come by, but reports of paramedics killing themselves suggest suicide in the profession is a problem. The Age in Australia reported that the rate of suicide among paramedics for the year to April 2010 was about 20 times higher than that of the general population.

I require antidepressants daily to numb thoughts of self-harm and suicide. I was diagnosed with major depressive disorder nine months after starting work with the ambulance service. When I attend call-outs to patients in a depressive crisis or who have self-harmed, it is like looking in the mirror. When resuscitating patients who have tried taking their own lives, it is akin to looking at what could have been.

It was after one such callout to a young man who had hanged himself in the living room to be found by his wife and young child, that I broke down.

I was in the middle of my fifth 12-hour shift, I had just had to pronounce a man not much older than myself deceased, counsel a grieving wife, assist the police with their investigations and ensure appropriate members of family and friends were coming to be with her. Having never called in sick in five years, I radioed the operations centre and asked them to stand me down as I would be going home for mental health issues. I was weeping, I was trembling, I was unsafe to continue working.

I will never forget the words that came back to me through the radio that night. “But there are calls waiting, can you not just wait until your days off?”

After explaining I was no longer safe to work, I was begrudgingly allowed to return home. I sat in silence for hours. The emotions of every patient I couldn’t save, every patient who had tried to hit me, every patient who had shouted at me while I worked to save them or their family came crashing over me like a wave.

Publicity around paramedic suicide generally focuses on the traumatic aspect of life on the road. What is either less known, or perhaps conveniently ignored, is the pervasive culture in ambulance services seemingly designed to incite suicide. Rostered 12-hour shifts which almost never finish in under 13 hours; missed meal breaks to attend more calls; threats to place poor performance markers on our record if we book ourselves unavailable to use the restroom more than once per shift; and, of course, frequent exposure to trauma most people will experience just once in their life are some of the stresses of the job.

Rather than immediate referral for six sessions with a psychotherapist, available to all employees, any request for help is almost universally met with the question: “Are you sure this is the right career for you?” This is followed by almost daily phone calls hounding for a return to work and questioning our commitment to the communities we serve.

This leads to any paramedic in a mental health crisis feeling unsupported and, worse, feeling they are weak. The worst part is, we all believe it subconsciously. We are afraid to take days off for mental health, fearing what our colleagues will think, fearing they will think we are weak, fearing what management will do. It is this dark undercurrent in ambulance services that continues to push paramedics to take their own lives rather than face their mental health problems.

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

If you would like to contribute to our Blood, sweat and tears series about memorable moments in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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I’m a paramedic who has considered suicide and I’m not getting support

When I was 15, a teacher found me during lunch break and asked if she could have a word. Confused, as I was generally well behaved, I followed her to the office. I was told that a close friend of mine had been found by his parents that morning hanging in his bedroom. He was in intensive care at the local hospital but his family had been asked to prepare for the possibility that he would die shortly. Growing up, the ideas of major depressive illnesses, self-harm and suicide were almost entirely foreign to me.

People often ask whether this was what motivated me to enter healthcare at 17 and eventually land in my current position as a paramedic by 20. Frankly, I don’t know. What I do know, though, is that while suicide was a foreign concept to me at 15, it certainly isn’t now.

Almost a quarter of ­ambulance staff have post traumatic stress disorder, according to research published in the British Medical Journal, and about one in three suffer from mental health problems. Statistics are hard to come by, but reports of paramedics killing themselves suggest suicide in the profession is a problem. The Age in Australia reported that the rate of suicide among paramedics for the year to April 2010 was about 20 times higher than that of the general population.

I require antidepressants daily to numb thoughts of self-harm and suicide. I was diagnosed with major depressive disorder nine months after starting work with the ambulance service. When I attend call-outs to patients in a depressive crisis or who have self-harmed, it is like looking in the mirror. When resuscitating patients who have tried taking their own lives, it is akin to looking at what could have been.

It was after one such callout to a young man who had hanged himself in the living room to be found by his wife and young child, that I broke down.

I was in the middle of my fifth 12-hour shift, I had just had to pronounce a man not much older than myself deceased, counsel a grieving wife, assist the police with their investigations and ensure appropriate members of family and friends were coming to be with her. Having never called in sick in five years, I radioed the operations centre and asked them to stand me down as I would be going home for mental health issues. I was weeping, I was trembling, I was unsafe to continue working.

I will never forget the words that came back to me through the radio that night. “But there are calls waiting, can you not just wait until your days off?”

After explaining I was no longer safe to work, I was begrudgingly allowed to return home. I sat in silence for hours. The emotions of every patient I couldn’t save, every patient who had tried to hit me, every patient who had shouted at me while I worked to save them or their family came crashing over me like a wave.

Publicity around paramedic suicide generally focuses on the traumatic aspect of life on the road. What is either less known, or perhaps conveniently ignored, is the pervasive culture in ambulance services seemingly designed to incite suicide. Rostered 12-hour shifts which almost never finish in under 13 hours; missed meal breaks to attend more calls; threats to place poor performance markers on our record if we book ourselves unavailable to use the restroom more than once per shift; and, of course, frequent exposure to trauma most people will experience just once in their life are some of the stresses of the job.

Rather than immediate referral for six sessions with a psychotherapist, available to all employees, any request for help is almost universally met with the question: “Are you sure this is the right career for you?” This is followed by almost daily phone calls hounding for a return to work and questioning our commitment to the communities we serve.

This leads to any paramedic in a mental health crisis feeling unsupported and, worse, feeling they are weak. The worst part is, we all believe it subconsciously. We are afraid to take days off for mental health, fearing what our colleagues will think, fearing they will think we are weak, fearing what management will do. It is this dark undercurrent in ambulance services that continues to push paramedics to take their own lives rather than face their mental health problems.

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

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