Mental Health: The Basics and How You Can Help
By: Neesha Marie Lopez
According to the National Morbidity Survey, three out of every ten people in Malaysia are grappling with mental illness today.
Speaking at the media workshop on mental health, Dr Gayatri Gunasagaran, Country Medical Lead of Pfizer Malaysia observed that many of these people refuse to acknowledge the fact that they have mental illness or need to seek treatment.
She added that it is therefore important to to reduce the fear and stigma surrounding mental health issues.
The media workshop on mental health featured three speakers: Dr. Ng Chong Guan, Vice President of the Malaysian Mental Health Association, Dr. Michael Ang Jin Keat, Committee Member of Malaysia Psychiatric Association and Senior Lecturer in University Putra Malaysia, and Datin Dr. Ang Kim Teng, Secretary General and Former President of Malaysian Mental Health Association.
The opening words of the media education workshop
The issue that the speakers highlighted on that day was the myth that mental illness is a sign of weakness. According to Dr. Ang, many people tend to think that those with mental health problems were because they are too weak to face the harshness of life. In fact, mental health issue is defined as a medical illness which affects thinking, emotion and behaviour. Most importantly, it must cause functional impairment. This means that the person affected is unable to go about their daily routine.
There are also people who think that mental illnesses are only for a certain age group, however, mental illness does not discriminate. Anyone of any gender and age can get a mental illness, therefore it is important for everyone to know what are the common mental health issues and the mental health landscape in this country.
Common Mental Health Issues
According to Dr. Ang, the three most common mental health issues in Malaysia are Schizophrenia, Depressive Disorder, and Bipolar Disorder. The common criteria needed for a diagnosis of any kind of mental illness are that the symptoms must be present for at least two weeks and as mentioned above, must cause functional impairment to the individual concerned. However, each type of mental illness has its own symptoms.
Perhaps the most misunderstood mental illness out of the three, schizophrenia is characterised by hallucinations (auditory or visual) and delusions. These delusions may be comorbid with other symptoms such as catatonia (abnormality of movement and behaviour) and disorganised speech. Common delusions that people with schizophrenia have are:
Delusions of persecution – the idea that one is being attacked or hunted.
Delusions of grandeur – the idea that one is better, smarter or stronger than they really are.
Delusions of reference – the idea that anything around them is about them or a message to them.
Some might wonder if the delusions are simply the imagination of those with schizophrenia. In actual fact, they are very real to the person. Imagine someone standing beside your ear all day and whisper, sometimes shout, about how you are doing everything wrong. That is what those with schizophrenia face every day, and such hallucinations can be very distressing.
Despite its many symptoms, psychiatrist often have a tough time diagnosing someone with schizophrenia. The difficulty lies in the fact that there are a variety of symptoms and the severity of each varies from person to person. Researchers have categorized the symptoms into two groups – positive and negative symptoms. Positive symptoms refers to symptoms that are added on to one’s personality or usual functioning. Delusions, hallucinations and disorganized speech fall under positive symptoms. Conversely, negative symptoms are those that reduce one’s usual functioning. These include anhedonia (lack of pleasure), avolition (inability to initiate or persist in activities) and alogia (relative absence of speech). While there are medications to help schizophrenics manage their condition, there is no ultimate cure and the unfortunate reality is, these people will have to live with their condition for the rest of their lives.
Depression is a condition characterised by a constant feeling of unhappiness. It is the most common mental illness among the three highlighted in the talk. It is common for people to mistake depression as an extreme form of grief. However there are stark differences between the two. What differs depression from grief is whether or not the feelings of sadness causes functional impairment or not. To illustrate the point, if a person has lost his grandparent and is feeling sad the whole day, yet is able to have his meals and go to work, it is likely he is simply experiencing grief. However, if that person not only feels sad, but is also unable to get up in the morning and has no motivation to even care for his own basic needs, it may be that he is having depression.
Like schizophrenia, the severity of depression varies from person to person. However, one can differentiate severe depression from mild depression based on these symptoms: feelings of guilt and worthlessness, suicidal ideation, irritability, and anhedonia. Sometimes these feelings of emptiness is described as “watching paint dry”. All this is not to say that there is no need for those with mild depression to seek treatment. It isn’t like the flu where if you leave it alone, it will go away by itself. Depression is extremely crippling, and despite its prevalence, it is still highly misunderstood. Strangely enough, compared to schizophrenia which is often over-exaggerated, depression is often downplayed or trivialised. Some consider depression as attention seeking or simply being dramatic. In fact, depression is neither of those things. It is very real to the person, and is very crippling. Fortunately, depression can be managed. Make no mistake, depression may not totally go away. However, as long as one seeks help, the condition is certainly manageable.
Originally known as manic-depressive order, bipolar disorder is characterised by an intense feeling of happiness or euphoria, and intense feelings of sadness. The name comes from the idea that both feelings involved are always at the extreme end, or poles. Both extremes of emotions are difficult to handle. When one is feeling euphoric, it exhibits in extreme behaviour – lack of sleep yet not feeling tired or a grand flight of ideas which may lead to overconfidence in unrealistic plans and an attempt to carry them out. For example, a person during an euphoric state may clear out his bank account to buy the best sound equipment for a recording studio with the certainty that he will earn his money back from the artists coming to record in his studio. On the opposite end, the depressive moods exhibit in the form of classical depressive symptoms – extreme sadness, anhedonia and feelings of guilt.
Bipolar disorder, like schizophrenia is often exaggerated. A common misconception about this disorder is that the person changes his mood as often as every half hour or so. In reality, the person’s euphoric or depressive states can last weeks or months at a time. As some people have more severe mania episodes than others, researchers have divided bipolar disorder into two types, based on the severity of mania. Bipolar I is characterised by more severe mania episodes while bipolar II is characterised by more severe depressive episodes. Despite its dizzying mood swings, bipolar can be managed, as long as one seeks professional help.
Importance of seeking help
According to Dr. Ang, the dreaded outcome for all three disorders is suicide or accidental deaths. It is likely the latter is more related to bipolar disorder. He mentioned that 40% of schizophrenia patients have attempted suicide, and 10% of that number usually succeed. Unfortunately, a stigma against mental illness is still prevalent in Malaysia, and those with mental illness are left to either sink or swim by themselves. It is likely that part of the reason why the stigma exists is that unlike physical illnesses, it is hard to pinpoint one cause for mental illnesses. Dr. Ang mentioned that although there still isn’t a general consensus of the causes, genetics and substance abuse are common factors in an increased risk for mental illness. He also reiterates that seeking professional help is the best way to help those with mental illness. Furthermore, he stressed that we need to be more empathetic towards those who share that they have a mental illness. For example, telling a person with depression to “get over it” never helps. They know their feelings do not make sense, it is just that they have no control over it. Therefore, regardless of the severity of the disorder, the sooner one seeks help, the better. Finally, along with support from their communities, those with mental health issues can manage their condition and lead a relatively normal life.