Mental Illness a social disease.

 

I always wonder, is mental illness a social disease? That is, the lot of our society? 

Today’s paper is a sobering read - “Spike in calls to SOS last year as more in distress amid pandemic.” 

Suicide calls are up. From 33,387 in 2019 to 39,492 in 2020. Calls enquiring about mental health are up too - from 2,143 in 2019 to 2,719 in 2020. The average number of calls peaked from July 2020 to February 2021 at 243.2 as compared to 79.9 in August 2019 to January 2020. 

The trend is clear - “more needed help during pandemic.”

The papers also wrote about the mental dilemma of a working mother of two, Jenny (not her real name). With a toddler and an infant to care for, Jenny was struggling to cope. “Each time Jenny, who is in her 30s, coaxed one child to sleep, the other would cry again. While she was at her wits’ end, her husband, a healthcare worker, was at work completing an overnight shift.”

At one point, Jenny called her husband and said: “You better quit your job now or I’m going to divorce you.” She even thought to herself this: “If I jump, maybe my kids would be happier. Maybe I could finally rest.”

The good news is that Jenny had sought help with a psychiatrist and was diagnosed as suffering from post-partum depression. With medication, she is currently on the mend, recovering with help from a loving community, caring and watching over her.

 

This is what Jenny said: “Don’t be afraid to ask for help. It’s okay to prioritise yourself, because when you do that, it trickles down.”

I find it curious that she describes it as “it’s okay to prioritise yourself, because...it trickles down.” I wonder, what image are we expected to project in society when it comes to marriage, motherhood/fatherhood, the workplace, or when we age and grow old, becoming more dependent on others? 

Does self-prioritising take a backseat against the grain of these expectations clamouring for our time and attention?

The reality is. some people will never need much help from others because of a padded life, good genes and fortune, or a community that is always there. But, they are few and far between. 

As the pandemic has shown, the society like ours is set up in a way that some expectations can gradually isolate and strangle a soul of hope, meaning and purpose. Here is a list of them for identification. 

The expectation that we must prove ourselves at all costs. The expectation that we are only loved if we produce bankable results, whether in schools, at work, in a marriage and/or parenthood. The expectation that if they can do it, so can we, regardless of whether we are gifted different. The expectation that to be strong is to dismiss (or conceal) weaknesses, or ignore our body’s and mind’s cry for help. And the expectation that past failures will never be forgotten, and never to be repeated. 

Alas, the attention we give to them and the false bravado we put up with them often corner a soul into a life of pretentiousness and self-devaluation. Or, as Jenny so admonished, “Don’t be afraid to ask for help. It’s okay to prioritise yourself.”

The observation of the chief executive of SOS, Gasper Tan, is rather apt here: “The feelings of loss and confusion, coupled with the prolonged stresses from navigating the uncertain employment market, can overwhelm individuals with intense feelings of hopelessness and helplessness.”

The paper also recounted another story of an undergrad, Andrew (not his real name). One morning, he woke up and was overwhelmed with this urge to kill himself. His parents drove to his dormitory immediately and “took him to see a therapist.” 

Andrew said: “Every second of life was tortuous. I could not eat or sleep, and there were days I was so weak I could not walk.” 

Now, Andrew has taken effective control of his life and he has this advice to all: “The important thing to know is you’re not alone. It’s just whether you have the courage to seek help, and to continue seeking help.”

I guess mental illness is a real struggle from within. It is an invisible struggle. From the outside, you are fine. But from the inside, you are fast losing the fight. 

Imagine a fight ongoing and you are helpless to put an end to it. Everyday, you experienced internal shouting and screaming, voices that are meant to torment you, and no one else. 

And unless you share with your loved ones, they will never know, or are deprived of the opportunity to care and cry with you. Those are voiceless screams from within that you can’t seem to escape from, unless you take that plunge to end it all. What only you can viscerally sense as a devouring reality is somehow designed to relentlessly drive you off the edge. 

As novelist Stevie Smith puts it: “I was much too far out all my life, and not waving but drowning.” 

Let me just say that I believe a major part of the problem is that mental illness is a social disease, that is, it is the price we pay for the material successes we pursue quite relentlessly, and that subtly changes society.

 

The psychology of money turns us inward, driving us away from one another, because while envy may rot the soul, success alienates us as a whole. The income gap is a status gap is a social gap is an emotional gap is a deafening gap.

When we valorise qualities the world endorses freely like the pursuit of self-interest as the way to wholeness, the religion of self-enrichment as a virtue and the thrill of hyper-competitiveness to get what we want, we turn society into an endless race, where we are too distracted to stop and share, to wait and bear, and to touch and care. 

This social disease isolates us all, causes us to chase unrealistic expectations and makes us put our self-worth on things superficial, impermanent. This dog-eat-dog world rev up our animalistic (tribalistic) instincts; thus the baser part of us prevails over the better angels of ourselves. 

Honestly, this social struggle for sanity is inherent in our system. As the proof is in the pudding, so is one of the cure in society. The incremental goal for the vulnerable is to prevent them from moving too far out in their own life. And even if they do, to consciously create a life-affirming community that is always looking out for them, looking out for that wave from a distance, in the active hope of saving a soul from drowning.

CS Lewis - Joy forevermore.

Yesterday, I received news from a friend, sharing that someone he knows and treasures deeply has a cancer relapse.

It was a painful news since his friend has been fighting it for so long, and at one time, seemed to have overcome it. They have also been praying for her, and though his friend was delivered then, it now seems like the affliction has returned.

My friend thus questioned his faith. He asked me, “where is God in all this? Is he there?”

This morning, I thought about him and the noted apologist CS Lewis. He too fought for his dearest wife, Joy, for five years. She had bone cancer. She succumbed to it after a long battle. 

Considered a giant of the Christian faith, one who wrote scores of books about it, even inspiring many who have become great apologist of the faith, CS Lewis was himself tormented to the core. 

He once said that "death of a beloved is an amputation." He did not say "like an amputation". It's neither a metaphor or analogy - its viscerally real to him. He was not mincing his words here. It is not armchair philosophizing. It’s real. It’s pain. It’s amputation.

Ever the effervescent author, CS Lewis wrote a book about it entitled A Grief Observed. He had to disguise the authorship for fear that people might be shaken by the unravelling and brutal honesty in the book. 

CS Lewis felt deeply that the book challenged all his preconceived and idealistic pronouncements about the faith. And for a moment, in the eye of the storm, CS Lewis lost his apologetic mantle, resilience and persuasiveness (at least it seems that way), which he had excelled so well in with the books he had written about defending the faith. 

Here is what made it so painful: CS Lewis loved Joy. He wrote that she completed him. Notwithstanding her previous marriage and 2 sons, he found in her a love that stands closest to the love he has found and experienced in God. They were in fact inseparable. Two peas in a love pod. She encouraged him, inspired him and transformed him. Joy was joy indispensable to CS Lewis. 

After her passing, CS Lewis took her two sons in. He treated them as his very own. He also kept his faith, yet at one point of the book, he blamed God for misleading him up the garden path of hope and then, squashing it with one cancer diagnosis after another. Can you blame him?

However, coming to grip, he wrote this, "We were promised sufferings. They were part of the program. We were even told, "Blessed are they that mourn," and I accept it. I've got nothing that I hadn't bargained for. Of course it is different when the thing happens to oneself, not to others, and in reality, not imagination."

I myself saw the same mortal reality in the eyes of my loved ones when they stood beside the bed of another before he breathed his last breath. When my brother-in-law finally let go after more than 7-year battle with cancer in October 2016, the collective souls in the room collapsed. For that moment, our collective faith was silenced, as we witnessed the passing of a life. Indeed, for those years before, we all trekked up the garden path of hope, but it was not meant to be a long tenure in a place of healing. 

However, after all the pain CS wrote that “God has not been trying an experiment on my faith or love in order to find out their quality. He knew it already. It was I who didn’t. In this trial He makes us occupy the dock, the witness box, and the bench all at once. He always knew that my temple was a house of cards. His only way of making me realize the fact was to know it down.”

Alas, CS Lewis grew stronger in the faith and understanding after Joy's departure. You can say that he lived out the dark, cold bowels of his writings, every vowel of it. And he passed away soon after his beloved's demise, but his belief stood firm (and inspired many, till today).

He was better for it (so to speak) because he confronted (unavoidable) pain, consorted with it for a while due to the fragility of humanity, but broke away from it for the unsurpassed eternity that lies before him. It is one eternal desire he wished never to extinguish.

This was the endearing apologist’s own words: “You never know how much you really believe anything until its truth or falsehood becomes a matter of life and death to you. It is easy to say you believe a rope to be strong and sound as long as you are merely using it to cord a box. But suppose you had to hang by that rope over a precipice. Wouldn’t you then first discover how much you really trust it?”

Indeed, CS Lewis tested his rope. And it stood the test of time, pain, grief, trials and even death. 

So I return to my friend’s plea for a miracle in the life of another. It is a young life full of promises, full of hope. I too join him in prayer, pinning for a turnaround, that is, a much longer tenure in the garden of hope and overcoming. 

In a life, there is always hope. And we cling on to it, resting on the knowledge that the hand, upon which a life emerges, is also the same hand that offers life both in abundance and for eternity.

 

The suicide of a loved one - surviving the loss.

I feel comforted to read that Prof Chong Siow Ann, a psychiatrist and vice-chairman of the medical board (research) at the IMH, did not give easy answers to why people commit suicide. 

In his article “Living after a loved one commits suicide”, let me fast forward to his conclusion, which I thought would unveil some 5-step or 10-step solution to the issue. But it didn’t. 

He wrote: “And we should continue to talk openly and widely about mental health and what is it that makes us despair and question the meaning of life to the point of wanting to end it, and more importantly, how we can pull ourselves and others from the edge of that abyss.”

Of course, I would expect Prof Chong as a psychiatrist to give advice to his patients on addressing depression and stress which are the most common causes of suicide, but in the article, he did not give any advice, just observations and understanding. 

Because if you think about it, a life is a journey and this journey is filled with stories, and these stories come with layers after layers of most times raw and unprocessed emotions at every crossroad, which are personal and intimate to the sufferer. And this is made even more complicated by the fact that no two lives or experiences accumulated are alike. 

Therefore, an advice to one may not apply to another, and an advice at one point can lose its effectiveness or resonance with the same person when he or she is at another point of his/her life or crossroad. 

The journey that is life is too complicated to be resolved by a series of seminar or a 5-day life-improvement camp or a few interrelated sermons on a Sunday.

But I have to say that the focus of Prof Chong’s article is the suicide survivors, and no, it is not written for those who have passed on, but those left behind. 

He wrote: “many people think the term “suicide survivor” refers to those who have tried unsuccessfully to kill themselves, but it actually refers to family members, friends, co-workers and mental health workers who have lost someone, with whom they had a close relationship, to suicide, and whom the suicide has also traumatised in various ways and to varying extent.”

To the suicide survivor, he is left with the stinging guilt and stigma of not being able to help to step in at the right time and place to save the life he loves deeply. 

Prof Chong wrote: “That act of self-destruction is, after all, also an act of abandonment and rejection and a reproach that somehow you were not powerful enough, had not loved enough or were special enough to keep that person from choosing death over everything and everyone else.” 

Most times, if not all the time, it is the whys that haunt the suicide survivor. While the pathologist performs a post-mortem on the deceased and it generally takes just a day to confirm the cause of death, the suicide survivor does his for almost a lifetime to find the whys of it. 

His post-mortem is not only to find the whys but also to struggle with the anger, the pain, the guilt, the blame, and the self-reproach. And not only that, the suicide survivor, according to Prof Chong, has to deal also with being the “object of gossip, morbid curiosity and speculation” about why the loved one committed suicide. 

Admittedly, most of it may be imagined or exaggerated, but the suicide survivor’s compromised mind often plays tricks on them and the bitter regret or mental script for not doing enough will always come back to them in some form or another even when they have thought they have moved on. 

In the article, Prof Chong quoted this apt observation by Dr Edwin Shneidman, founder of the American Association of Suicidology: -

“The person who commits suicide puts his psychological skeleton in the survivor’s emotional closet - he sentences the survivor to deal with many negative feelings and to become obsessed with thoughts regarding his own actual or possible role in having precipitated the suicidal act or having failed to abort it.”

And that explains why many of them become victims themselves. “Research has shown that suicide survivors are more prone to developing symptoms of depression and post-traumatic stress disorder; they are more liable to get into accidents and develop alcoholism, physical illness and a variety of problems.” 

...and I suspect one of the problems is the contemplation of ending their own life too. 

Lesson? I think life for the living and those thinking of ending it is, most times, too complex to be captured in one or two well-intended advice or seminar notes. 

At this juncture, let me bring up another relevant news today to illustrate my point. 

Mr Henry Antoine Nicolas Sebastien, 34, recently received the Public Spiritedness Award at a ceremony at Clementi Police Division for saving a teenager’s life. 

It happened on 4 Nov at Skywalk, Sentosa Island. The assoc game director of Ubisoft saw the boy “perched atop the metal ledge of the bridge” and he seemed to be in great distress. According to Henry, he also looked “extremely tense”. 

Henry then distracted him by speaking to him for 15 minutes while his wife called the police. At one moment, Henry “lunged forwards and grabbed the teen by the waist...Henry then held on to the distressed and sobbing boy, until the police arrived on the scene.”

One passerby said: “The teenager is lucky that there was a Good Samaritan who was there to save his life.” (Ms Christine Yap).

Henry shared the same sentiment when he said upon receiving the award: “I am happy and humbled. I was just in the right moment, in the right place, at the right time.” 

Well, being there at the right moment, place and time is often what it takes to save a life contemplating suicide. And ironically, it was the same for the boy who wanted to jump down the Skywalk. 

For him, I believe it is also the perfect storm of being at the right moment, the right place and right time for him to resolve in his mind and heart to end his life. When that perfect moment comes, it usually takes either a nudge or a grab to end or save a life. 

But not every act of suicide crosses the path of the timely presence of a rescuer. Hundreds of successful suicide are committed every year and none of them were as lucky as the boy Henry met that fateful day. And who is to ensure that the perfect storm would not happen also in the future to go either ways? 

After all’s said, the most ironic question is, how do you save someone from himself? 

For them, the right to live also comes with the right to end it and the reasons for it is too multivariate for enumeration. 

Most times, even the suicide survivors are helpless to prevent or stop since they too cannot be present at that point when the living is helplessly hijacked by that compulsive-possessive act to take his own life. 

So, in the end, Prof Chong’s conclusion is the best way forward, and let me repeat it here: “we should continue to talk openly and widely about mental health and what is it that makes us despair and question the meaning of life to the point of wanting to end it, and more importantly, how we can pull ourselves and others from the edge of that abyss.” 

Hopefully, this continual talk and openness, and this search for the meaning of life and how it can empower one to overcome his or her demons can save more lives in the future. 

And my takeaway from it all is to never take anything for granted. I can never be too sure of anything, or anyone, including my own loved ones. 

My relationship with them can never be on autopilot, left to its own devices. For this reason, intentional living is more than just being aware of how I feel, but how others feel about how I feel, and how it affects them for good or bad. 

And I strongly feel that everyone of us has a responsibility towards life, and every conversation we have with our loved ones, every unspoken word even, ought to be not only consciously evaluated by us but also consciously acted out to make sure that it encourages a soul towards life, and not condemn him or her towards, well, otherwise. Cheerz.

I have learned that no matter how bad things are...

I have learned that no matter how bad things are, you can always make things worse. 

If pain is inevitable, then misery is optional. Pain like suffering comes unbidden. 

But they often do not stay for long. Once the bad news is announced, or the bad event comes, they - like messengers - take their leave. 

They bid you farewell. They have done their part. Their work is complete. The rest is up to you. In their departure, what is often left behind is either misery or hope, helplessness or resilience, resignation or resolution. 

I believe a time is given for mourning. A time for reflection. A time for grieve. After that, it's time for recovery. You can either make it better or make it worse. 

You can ruminate until it hurts. You can sleep all day and refuse to move a muscle. You can mope and sulk to attract pity. You can play the victim and soak up the attention. You can make it worse by refusing to make it better. 

Your choice counts. Your response is invaluable. Your resolve matters.

When you have hit rock bottom, it is often said that the only way to go is up. But many are forgetting that rock bottom is a breeding ground for false comforts too. 

Many will seek solace in staying down instead of drawing hope in standing up. 

To many, wallowing in "rock bottom" is a form of negative rejuvenation where hopelessness and helplessness take turn to demoralize the victim down a vicious spiral of restless desolation. 

So, if the mother of invention is necessity, then the mother of overcoming is proactivity. We take control of the messiness in our life and set things right once again. 

It is a tough undertaking no doubt but every step forward is nevertheless a step that deeply empowers. Falling flat or falling forward is still our choice. 

What makes the crucial difference is a choice that is invested to change our life for the better. The changes may be small, seemingly insignificant, but the circumstantial forces rallied around that one act of proactivity contain the power to break down many walls that conspire to cage us in. 

Never underestimate the power of positive chain reaction. 

Viktor Frankl, a survivor of the Nazi occupation, in his bestseller "Man's Search for Meaning" made this observation:- 

"We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in numbers, but they offer sufficient proof that everything can be taken from man but one thing: the last of the human freedoms - to choose one's attitude in any given set of circumstances - to choose one's own way." 

So, yes, times can indeed be bad, no sweat. You are there to make it better. 

Let me end with this reminder. 

There is a crack in everything that God has made. The crack is to allow His light to enter; or else, we would be in a very dark place. 

This light seeks to lead us to the rock that is "higher than I" where we can stand above the trouble waters. It is a place of hope, a place of faith, a place of blessed assurance. 

But the journey to the rock starts with a crack. It starts with our surrender. It starts with letting go and not holding on. It starts when we return to the innocence of a child and not become entrenched in the arrogance of a religious scribe.

As T.S Eliot puts it in "East Coker":-

"In order to arrive at what you do not know

You must go by a way which is the way of ignorance.

In order to possess what you do not possess

You must go by the way of dispossession.

In order to arrive at what you are not

You must go through the way in which you are not.

And what you do not know is the only thing you know

And what you own is what you do not own

And where you are is where you are not."

To me, that is faith. Not arrived faith, but journey faith. Not righteousness declaring, but imperfection overcoming. And not riches in appearance, but riches in the eternal hope of His reappearance. Amen. Cheerz.