Mental Health

Have you been having low mood for unexplained reason? Have you been waking up early than you should, and find it hard to return to sleep again? Do you find yourself struggling with persistent negative thoughts about yourself or others that you know don't come from you? Is your loved one suffering from chronic anxiety and you don't know how to help him/her?

Welcome to the world of Mental Health.

I have just completed 6 weeks of work in the Mental Health ward, and i have but only a glimpse of the desperation, darkness and depravity of human hearts.

Everyday we see people with schizophrenia, delusional disorder, eating disorder, depression, anxiety, borderline personality disorder, obsessive compulsive disorder etc.

The chronic schizophrenic who is starving himself to death because he believes he has no guts (his weight dropped from 76kg to 37.9kg over 6 months); the lady who sought comfort in self-harm and frequently cuts her chest and breasts and inserts objects into her wounds; the soft-spoken, constantly-avoiding-eye-contact lady who was raped by her father at the age of 14 and carried a child whom she has not met since birth; the stout, bulky man who always points his fingers to the sky and speaks to the 'someone' and told of secrets from the Devil that he is not allowed to disclose; the young attractive woman who is totally disinhibited and is sexually inappropriate toward everyone including other male patients; the mildly obese lady who struggles with pathological compulsive thoughts of suicide (and carries it out most of the times), the guy who suffers from drug abuse, marital breakdown and depression; and the list continues...

There are so many things i want to share about my experience with these mentally ill patients and i don't know where to start.

People don't become mentally ill overnight. The days, weeks, and even years leading to someone's first presentation to Mental Health ward are always worth exploring. We learned so much about a person when the person starts to divulge his past, his childhood, his family, his relationships etc. I find a recurring pattern in a lot of the depressed patients: if someone has been abandoned by one of his parents at an early age, the impact on his/her sub-conscious is massive and it manifests in so many different ways when the person grows up.

My consultant always tells me: it's easy to arrive at a diagnosis. It's easy to just prescribe medications for the mentally-ill. What is difficult is getting to the heart of it: why did this person become unwell? Almost everyone gets criticised every now and then, why only this lady has a mal-adaptive way of responding to criticism by cutting herself? So many young people take illicit drugs, why only this person became psychotic as a result of it? A lot of working couples send their kids to child-care centres during day time, why only this lady becomes so suddenly obsessed with the safety of her son, who despite frequent reassurances, insists that the son's safety is in jeopardy? Every day, people get hurt, relationships break up, workers lose their jobs, why only this special group of people end up in hospital for the common assaults faced by everyone?

Throughout my 6 weeks in the ward, i have grown close to some of the patients. Their stories fascinate me. In contrast to a lot of the older doctors/consultants who roll their eyes and let out a huge sigh whenever a patient says he has died 5 times and has half a million in his bank account, my eyes perk up and i am fascinated. I want to know why this person thinks this way. I want to listen to his stories. I want to see what his inner world is like, if he would let me.

RH and I. No one believed him when he said he had half a million in his bank account, until he proved it. 

Before I started my mental health rotation, I must admit that i was quite skeptical about people with mental illness. Partly because of the chronicity of the illness, partly because my own experience in that my father has been suffering from depression for the 30 years and he is not getting any better, I kinda think that people with mental illness are pretty much hopeless. I mean seriously, you don't expect a person who has been staring into spaces, drooling and talking to the 'invisible' person to one day sit next to you and discuss about the politics or academics or whatever people talk nowadays, do you?

However, i found that i could not be more wrong in this aspect. Mentally ill patients do get better. They do return to an acceptable level of functioning which allows them to be integrated into our society. I have personally witnessed a lady in her fifties who was brought to the ward completely psychotic and mumbling gibberish and throwing magazines into every room, who after 1 week of treatment, became mentally sound again. We sat down later on and had a normal conversation and she was telling us how she just 'lost' it because of too much stress in her life. I saw a similar guy who was floridly delusional and psychotic with extremely poor self care and hygiene, who after some time of treatment, improved remarkably, and though he still has pressured speech and blunted affect (common for schizophrenic), his thinking is very much normal like you and me. I have seen depressed women having the motivation to live again, suicidal young men regaining their will to live and are determined more than ever to save their marriage and work for a better future.

Of course, not all mentally ill patient get well. Many continue in their perpetual cycle of recovery and relapse. They get psychotic, come to the ward, improve, gets discharged, only to return to mental health ward again 3 weeks or 3 months later. Some patient don't ever improve at all. They never gain insight. As a matter of fact, the percentage of patients who eventually become well is much smaller than the group who continue in their illness.

JD. The day of discharge - after he spent 41 days in the ward. 

Medications, obviously, is only one part of the answer. Often times, mental illness begins in the heart and mind of a person. If the trigger persists, the illness starts to spread to other parts of the body, i.e the physical. His sleep starts to be affected, so is his appetite, energy level, concentration, daily functioning. These physical disturbances, in turn cause a person to sink deeper into his emotional abyss. When a mental illness reaches this stage, it's not only the emotional and psychological part that you have to treat, but also the physical part. And this is where medications come in. Medications fix the physical symptoms, and places the person in a position where he or she can start tackling the emotional/psychological part.

If one of your loved ones is suffering from mental illness, i have the following to say to you.

Firstly, you are not alone.

Secondly, your loved one is not the only person suffering too. There are many people out there who are suffering from mental illnesses eg depression, anxiety, obsessive-compulsive behaviour that we don't know about because we never shared them. There is still a lot of stigma and discrimination of the mentally ill in our society today.

Thirdly, don't do this alone! Don't fight the battle alone. Seek help! Find a private psychiatrist, speak to a psychologist, a counsellor, or a close friend. If medication is necessary, don't feel bad about taking it. Lots of people need medication to pull them over the acute phase. And once they feel better, which normally takes about 6 months to 1 year, they can start weaning the medication off.

Fourthly, as much as you can, involve different groups of people whom you trust. Doctors, all the members of the family, close relatives and friends, church, other people who have walked the same path before. Someone who is mentally ill cannot be isolated from the rest of the society. Being isolated may feel like a good coping mechanism initially, but it will do more harm to that person in the long run as he or she loses the connection and interaction with other human beings that are so vital in the recovery.

Unfortunately in Malaysia, Mental health is an extremely under-developed specialty and we really have so much more to improve on. There is very little awareness on the illness amongst the general public and as doctors we tend to shun it as much as we can, preferring to deal with other simpler diseases like hypertension and diabetes because they are measurable and seemingly more treatable.

I hope everything i have written is of some help to some of you.

My prayer is out for anyone who is  suffering from a mental illness. You are not alone. God loves you despite of your illness. He sees the real you, and He wants to heal you, if you would let Him.

A movie about a lady with borderline personality disorder starring Angelina Jolie.

Girl, interrupted (some meaningful dialogue)

Susanna [talking to the psychiatrist]: Explain what? Explain to a doctor that the laws of physics can be suspended? That what goes up may not come down? Explain that time can move backwards and forwards, and now to then, and back again, and... you can't control it? 

& 

Lisa: You know, there's too many buttons in the world. There's too many buttons and they're just- There's way too many just begging to be pressed,they're just begging to be pressed,you know? They're just - they're just begging to be pressed, and it makes me wonder, it really makes me f***ing wonder, why doesn't anyone ever press mine? Why am I so neglected? Why doesn't anyone reach in and rip out the truth and tell me that I'm a f***ing whore, or that my parents wish I were dead?
Susanna: Because you're dead already, Lisa! No one cares if you die, Lisa because you're dead already. Your heart is cold. That's why you keep coming back here. You're not free. You need this place, you need it to feel alive. It's pathetic.
Lisa: [falls down to her knees and screams]
Susanna: I've wasted a year of my life. Maybe everyone out there is a liar. And maybe the whole world is "stupid" and "ignorant" but I'd rather be in it. I'd rather be fucking in it than down here with you. 

Angelina Jolie starring Lisa (left) and Winona Ryder starring Susanna (right)