Disorders of the mind are among the most misunderstood and can have a devastating impact on a person's quality of life. According to the latest nationwide study spearheaded by the Institute of Mental Health in 2016, 1 in 7 people in Singapore has experienced a mental disorder in their lifetime. Mental illness is a general term for a group of illnesses that may include symptoms that can affect a person's thinking, perceptions, mood or behaviour and can strike anyone at any time, making it difficult for the person to cope with work, relationships and other social demands. Some of the main groups of disorders include mood disorders, anxiety disorders, psychotic disorders, personality disorders, eating disorders, trauma-related disorders and substance abuse.
Unfortunately, many individuals with mental health issues are forced to keep their condition under wraps because of the taboo surrounding mental illness. Persons with mental disorders are often stigmatised by society. A survey conducted by the National Council of Social Service (NCSS) in 2016 found that most people agree that more needs to be done to reduce societal stigma of mental illnesses, yet they are also reluctant to accept them at an individual level. The social isolation makes it harder for those suffering to get the help they need. They may be reluctant to seek treatment, or not follow the prescribed course of medication for fear of being found out. Indeed, according to the same IMH study, the proportion of the people with mental disorders who were not seeking help remains high, and a significant treatment gap remains.
Schizophrenia, for instance, is quite possibly one of the most stigmatised mental disorders. If you think it's all multiple personalities and murderous whispering in one's mind, you're severely misinformed. According to the people the Karyawan team spoke to, the stigma and fear involved when someone mentions schizophrenia can be discouraging.
Society looks at schizophrenia either with indifference or fear, both of which are borne out of ignorance and this is probably and largely due to the sensationalised stories portrayed in the media. There are even cases where individuals are abandoned by family due to lack of understanding, just like our interviewee, Alif
Alif, a 27 -year-old who was diagnosed with schizophrenia last year, was kicked out of his own home by his family. His divorced parents and siblings are not willing to care for him so he is now seeking shelter in a psychiatric rehabilitation home.
"I was diagnosed with schizophrenia in 2018 when I was 26. I had a violent dispute with my dad in a public space. He reported me to the police and the authorities then sent me to IMH. That was when I was officially diagnosed and was prescribed medications immediately. I was warded for about two weeks before they finally referred me here to this care centre, " Alif said.
Schizophrenia is a mental illness that affects a person's sense of reality. A person with schizophrenia may develop false beliefs of grandeur or persecution (delusions), or experience sights, sounds, smells, and tastes or touch that others do not experience (hallucinations). Such symptoms make it difficult for sufferers to distinguish between what is real and what is imagined.
When the effect of schizophrenia hits, it is a struggle for Alif to hold on to his thoughts and put them together in a coherent manner. At the height of his last psychotic episode last year, Alif was convinced that there was a war going on in Singapore.
"I started remembering stories that later became delusions. All my thoughts followed a storyline where I eventually believed that Singapore and Malaysia were going through a war. I also heard voices telling me that my family was in trouble," he said.
Alif also shared that he has stopped taking his medications. "I took the prescribed antidepressants for a few months.I was constantly drowsy and tired. I've stopped my oral medications now but still take my routine jabs. They make me feel drowsy and fidgety too," he said.
The team asked him if finding employment has been tough given his diagnosis. He shared that he did not disclose his health status as he worries that it might jeopardise his chances of getting a decent job. According to him, stigma is still one of the largest challenges plaguing mental health.
While there have been improvements in awareness and acceptance, this is certainly not the case for all workplaces. When asked, Alif spoke of his hopes of getting out of the care centre and moving on with life. He said, "I just want to finish my studies, get a good job and move out of the care centre. I want to get married. I'm working on my Nitec certification now so on some days I will attend school. I wish my friends would visit me here. I didn't celebrate Hari Raya last year. I spent it at the care centre . My parents are separated. My biological father won't let me live with him. My stepfather doesn't like me. So I have no choice but to stay here until I can support myself."
The Karyawan team also spoke to a close friend of Alifs, Hafiz (not his real name), who saw the gradual changes that happened to Alif over the years.
"He was a well-groomed guy and a very talented football player. Everything spiralled down last year since his divorce. He started to behave oddly in public, no longer seemed to care about his appearance or social pursuits, and always looked tired. None of his family members seemed to care for his well-being and his relatives do not acknowledge him when they see him outside," Hafiz said.
The team’s conversation with Alif highlighted the struggles that a person with a mental disorder has to go through on a daily basis. Employment opportunities are perceived to end the moment you reveal your diagnosis. Friends may walk away, never to hear from them again. And the worst feeling is knowing that your family does not always know how to support you no matter how much you need them.
Family can play an important role in helping to keep their affected family members supported and oriented to reality. According to studies, families, as primary caregivers for persons with psychiatric disability, are increasingly recognised for their potential role in fostering mental health and well-being. The recovery paradigm in mental health acknowledges families as important players in the recovery process. Before they can be properly supportive, however, they must first understand that some of the actions are not intentional on the part of the people with the disorder, who are in many ways victims more than anything else. They need to accept that mental illness, in this instance, schizophrenia, is a disorder of the brain just like diabetes is a disorder of the body.
Unfortunately, Alif is not the only person who does not have family support. We spoke to Rahman (not his real name), aged 44, also diagnosed with schizophrenia.
“After leaving primary school, I worked as a waiter and cleaner. In 2017, I was caught by the police because I took my sister-in-law’s cat and threw it down from the 14th storey. The cat died. I don’t know how the police found out but I was arrested. They sent me to IMH and I was diagnosed with schizophrenia. I was warded for about four months before being transferred to the centre that I’m currently staying at now. The hospital asked if I was still hearing voices. I said no even though I was still hearing them because I didn’t want to continue staying at the hospital,” Rahman shared.
Rahman is currently working at the care centre as a cleaner. He is paid $1.50 per hour for four hours which adds up to $6 a day. Rahman shared that there are other jobs available at the workshop in the care centre but they pay only $0.20 per hour. According to him, he is not allowed to work outside the centre because he is ‘sentenced’ there until 2020.
When asked about what a typical day at the centre is like, he shared, “There is nothing much I can do at the care centre. Once I’m done with work, I’ll just wander around. I do get lonely at times. My family doesn’t visit me here and they won’t let me live with them. My relationship with my dad hasn’t been good since young. However, I have a lot of friends here and they treat me well.”
During the interview, Rahman suddenly started talking to himself. According to him, the voices were telling him something. It went on for about five minutes before the interview could resume. When asked about the voices, he said he had no idea what was said because it was in another language.
The team asked how he copes with the voices he hears and he said, “I will talk to them. Sometimes, I will ‘zikir1’ to distract myself. I started to hear more of these voices ever since I started taking my medication. Once, I went out to buy four bottles of detergent but the voices told me to throw them away and I did. When I go to the gym at the centre to exercise, the voices will tell me not to. Sometimes, they will ask me to throw the cats down again.”
According to the next interviewee, the biggest misconception about mental illness is that people tend to view it as a sign of weakness that people should just be able to ‘get over’.
We spoke to Nadia (not her real name), a 22-year-old who was diagnosed with Anxiety Disorder in 2014. She had anxiety as a young child and would avoid crowds and public trains. She was also briefly bullied in school, which made her anxiety worse.
Nadia was eventually referred to IMH and diagnosed with anxiety disorder after she had a major anxiety attack in school one day which caused her to faint.
“When I was there, I didn’t tell the doctors that I was also hearing voices. I lied because I did not want to be warded. I felt like dying at that time. I was prescribed medications but I am no longer taking them because I can’t think when I’m on them, and my work requires me to move around. The medications make me feel worse, not better. And you tend to depend on them. I’ve also stopped seeing my doctors although they’ve been wanting to do a follow-up,” Nadia shared.
Our conversation with Nadia revealed that childhood trauma was a major contributor to her anxiety.
“I went through a rough childhood. I was bullied when I was younger. I was also sexually harassed. I didn’t tell anyone because everyone was busy with their own lives. And who would believe me? It happened at the staircase and there were no CCTVs at that time, unlike now. I kept it from everyone until late 2014 when I eventually told my sister and the rest, except my parents,” she shared.
Nadia also shared that she hears voices at times. “The voices usually tells me things like I'm always a burden, I'm not good enough, and it’s always my fault. I’ve ever acted upon it by cutting myself. When I see blood, it relieves me. It makes me feel better through numbing my pain. I am better now. I know how to handle it better. My attacks are random and often comes at night or when I’m alone, overthinking something. I’m a workaholic and that is one way I cope with my anxiety. I also listen to music and talk to someone to distract myself from these torturous mental thoughts,” Nadia shared.
With respect to how society perceives people with mental illness, Nadia shared that more needs to be done to raise mental health awareness.
“Many think those with mental illness are crazy psychotic people that would run up to you and kill you. But the fact is, we're just normal people like everyone else, who are as conscious of our feelings and emotions. I think society needs to educate themselves on mental illnesses instead of assuming. And to the people out there with mental illness, do not be afraid to go out. Stay strong. Not all days are bad. It's just how you react to it. If you think negatively, your day will be negative. If you think positively then it'll be good.
Surround yourself with positive people who encourage you. Don’t be affected by what people say about you. Do not be afraid to seek help from counsellors or your families,” she said.
It’s difficult to empathise with those who have a mental condition if you or the people around you have never experienced it. It could lead to the ‘othering’ of people with mental health disorders. Let’s not forget that those suffering from mental illnesses are also people with emotions, hopes, dreams, and challenges just like the rest of us. Let's not forget that they are suffering from a serious mental health condition, yet most are living capably through it. They live a normal life, for the most part at least, and they want their opinions to be heard and respected.
Mental illness may not typically leave marks, scars or bruises on the body, but can be even more debilitating than some serious physical illnesses. It takes a community to support and build a mental health-friendly society. Like other patients, those with mental illness need the support and help from the people around them to get better. Although some may act in ways that seem unexpected or strange, we should remember that it is the illness, and not the person that is behind these behaviours.
Nabilah Mohammad is a Research Officer at the Singapore Children’s Society. She holds a Bachelor of Science in Psychology and a Specialist Diploma in Statistics and Data Mining. Her research interest includes understanding the lived experiences, challenges and needs of the vulnerable and marginalised groups.