APRIL 12 — Yesterday, I held the hand of a 75-year-old gentleman suffering from a chronic autoimmune disease that attacks his nerves. In the last few months, he had lost most of the strength in his legs, sapping his ability to walk, and now, it had progressed to his arms as well.
He cannot feed himself, he told me. His fingers have become so clumsy that he is no longer able to even turn the pages of a book. In the middle of our conversation, he burst into tears, weeping loudly as he told me how he no longer wants to live anymore.
Now, it is terrible to watch anyone cry, but to see an old man—a person who has already gone through so much in his life—sob openly was devastating. Through his tears, he said to me: “I don't want to be a burden to anyone.”
I know those words. I am used to them. I have heard thousands of variations of them in my career. In his darkest, lowest moment, this elderly gentleman still thinks of the welfare of his family, of his elderly wife who has spent many days and nights accompanying him in the hospital. “She is old,” he said. “She should be resting, not struggling to care for me.”
A few years ago, I was asked to see a young schoolteacher in the Orthopaedic Ward. I was told he took a knife and sawed his wrist down to the bones, severing the tendons, nerves and blood vessels, and it was only due to timely intervention that that man survived at all.
His wounds would heal, but he would never play the guitar again. I asked him why he did it, and he told me a voice commanded it. He said it felt like someone took over his body, and he was helpless to stop it as the owner of that "voice" carved up his arm.
I share these two stories because I want to illustrate the breadth of situations that would drive people to hurt themselves, or even take their own lives. It could be a moment of impulsiveness after a fight, or after years battling some mental illness like depression or schizophrenia.
It can be well-planned out or even involuntary. With schizophrenia for example, sufferers sometimes experience what we call passivity phenomena. That is when people feel that some part of themselves—their feelings, urges, thoughts or actions—is under the control of another person or agent. Like the schoolteacher I mentioned above.
So, when I heard that a speaker talking to schoolchildren at the Sri Kuala Lumpur School allegedly joked about a K-Pop star's suicide, I was appalled. I was not present at the speech, and even though some Sri KL students have relayed the gist of his jokes to me, I do not wish to repeat them (but, it was bad enough that the school apologised to the student body for them).
However, thanks to some conscientious Sri KL students who publicly criticised said speaker on Twitter, I saw firsthand what the speaker had to say about about mental health, and bore witness to his non-jocular statements about the suicide of Jong-hyun:
“The dude was fragile. Don't be like that. Period.”
“That's very philosophical, but just don't like some kpop dude who kills himself bcos he can't deal w life.”
“And my point was that if u kill yrself you're fragile. That's it. Cheers”
“And I request u to get a life. And don't kill yrself like a spoilt celeb”
“I have the right to voice my opinion that it's stupid to kill yourself, and even more stupid for others to say it's 'brave' or 'noble.' Deal with it, okay? Bye”
In summary, according to this speaker addressing youths at Sri KL and then on Twitter, people who kill themselves are “fragile” and “stupid.” Now, I want to be very clear I am not expressing offence at the jokes he made in that speech I did not hear. What I want to do is address his central message as it was presented on social media.
What the speaker said wasn't new. For the longest time, mental illness and suicide were considered to be some kind of moral failing, character flaw, or mental deficiency. Thirteenth century philosopher and theologian Thomas Aquinas even wrote that killing oneself is “unlawful” and considers it a “sin.'
This is why we often hear people tell depressed or suicidal persons to “toughen up,” or “think how others have it worse, you ingrate” because they think it is a choice of behaviour. Sometimes, people would straight up tell a depressed person to “snap out of it” or “stop being depressed.”
As we understand more and more about how our minds work in recent decades, this paradigm of mental illness as a moral weakness that one chooses for oneself have shifted into one that views mental illness as... well, as a condition that isn't anyone's choice or fault.
Depression for example, is increasingly being recognised as a biological disorder with recognisable dysfunction in the chemical signals in our brains, and heritable genetic factors. Newer studies link inflammation in the brain with suicidal thinking, and actual structural changes have been documented in the brains of depressed individuals.
In other words, depression and other mental disorders are just as real as any other illnesses. We don't approach someone with diabetes or cancer and tell them to stop having diabetes or cancer, do we?
Yet, we continue to expect people suffering from mental illness to “toughen” or “snap” themselves out of it.
Because society at large continues to characterise suicidal people as “fragile” or “stupid,” perpetuating this moralising attitude towards suicide and mental illness, it creates an obstacle that stops people from readily associating themselves with this weakness, “fragility” or “stupidity.” thus, stopping them from accessing the help they desperately need.
In fact, in one of the speaker's published defences online, he said he wanted to associate suicidal ideation with stupidity because young people (like those he was speaking to) wouldn't want to be considered stupid. Now, we in the mental healthcare community call this obstacle “stigma.”
As Sarawak Welfare, Community Wellbeing, Women, Family and Childhood Development Minister Datuk Sri Fatimah Abdullah said a couple of days ago at the 5th Sarawak Mental Health Conference, “Stigma prevents people from seeking help for any mental health conditions they may have and remains the biggest barrier in the nation’s goal to improve mental healthcare in Malaysia.”
In summary, stigmatising mental illness using denigrating epithets like “fragile” and “stupid” can cost lives. This is not the attitude towards mental illness and suicide that should be taught to our kids. To look back to the two stories I shared earlier, should we dismiss their thoughts and acts of self-harm to be evidence of “fragility” or “stupidity”? I hope you disagree.
I do, however, agree with one of the speaker's sentiments: While we take care to avoid contributing to mental health stigma, we must also avoid glorifying the act of suicide as well.
Luckily, it seems that some of the Sri KL teens have the right idea about how we should handle such a serious issue in spite of what was taught to them, and these are some of the things they said in response to the speaker:
“I for one found the talk to be very inappropriate and the choice of words he used were just very harsh. Although I've never been through depression or had any suicidal thoughts, I think it will really affect students who actually do suffer from these symptoms.”
“I just hope you realise how great of an impact words can have and we should think before we speak.”
“Dr, I understand where you are coming from, but the way you phrased your words during your talk today was rather insensitive and inappropriate. The message could have gotten across much more effectively if your points were made without belittling suicide victims. Hope my constructive criticism helps.”
We have been fighting mental health stigma for a long time now, but this display of maturity, empathy and kindness from these young men and women gives me hope that inch by inch, we may yet overcome it in the future. And I also praise their courage, because it takes courage for someone so young to stand up to a figure of authority asked by their school to address them, and tell him that he needs to do better.
Postscript: While I was writing this, the speaker had issued a public apology on Facebook for his behaviour, and deleted his combative tweets. He does, however, maintained his message on what he calls “anti-fragility” in his apology (with, I believe, sincere intentions), which moved me to complete this essay. I intend to educate to the best of my ability, and have no wish of heaping more condemnation on the speaker.
* Dr Kok Sen Wai is a Sarawakian medical officer with five years of experience in psychiatry.
** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.