10 Things Malaysians Would Be Embarrassed They Didn't Know About Mental Health
12 Nov 2017
10 Things Malaysians Would Be Embarrassed They Didn't Know About Mental Health
It’s difficult to have a productive discussion about mental health in Malaysia, partly because it’s difficult to find someone who understands enough about mental health to have a productive discussion in the first place. Our understanding of the mind today is at approximately the same place as a doctor’s understanding of the heart 200 years ago. But this doesn’t mean that we know nothing. Over the years, we have found that our brains are more flexible, astounding, miraculous - and fragile - than we have ever known it to be. Psychology has taken science into the realm of the mind, and under that harsh light of science, we are finally beginning to understand, however little, how our mind works, what makes it tick, and what exactly happens when it breaks down. But despite these substantial and lucid findings, many of us, not only Malaysians, but people all over the world, even in educated circles, still don’t seem to grasp the nature of mental health suffering. This misunderstanding ultimately leads us to discrimination. In this age, discrimination is a dirty word. Discrimination belonged to the old days, when we were younger and more foolish. Today, we like to think that we are beyond discrimination. We use this word when we are talking about the great intolerables: racism, sexism and religious intolerance. But is there a group whose rights we have overlooked? Can we be guilty of discrimination without our knowledge? The answer, unfortunately, is yes. Which leads me to my first point: 1. When it comes to Mental Health, Malaysians discriminate more than we think This is a fact: Malaysian health insurance policies do not cover the cost of psychiatric services. Not only does this make it significantly more expensive for sufferers to seek help, but we have to understand that this is also a kind of barometer to how Malaysians perceive mental health. The barometer reads: Mental health is not a part of health. 80% of our professionals report that among their patients, family is the biggest discriminator, followed by friends and employers. What does this statistic mean? Well, everyone has family and friends. After considering the fact that the National Health & Morbidity Survey reported in 2015 that 1 in every 3 Malaysians suffer from mental health issues, we invite you to look closely at your relationships. Look at the person on your left, then look at the person on your right. Among the three of you, one is statistically a sufferer. It could be your brother, or your sister, or your parents. It could be that friend everyone knew had some trouble at home, but which no one addressed or brought up. It could be you. Are you aware of this? Have you given proper weight to this person’s troubles, even if this person is you? Or have you instead, dismissed this person’s complaints as just complaints? Have you given this person your understanding and your kindness? Or have you been ignorant? Look closely. Look and see. Just like that, we discriminate. It’s not our fault. Society has a way of instilling its values and beliefs in us without our control. But it will be undoubtedly our fault if we choose to remain ignorant when we have the choice to be informed. Reader, it is you I address. Now is the time to make that choice. Read on.
2. The Problem is Real, and it is Deep
This ignorant discrimination of sufferers has another name. It is called the Stigma of Mental Health. It is based on ignorance, it culminates in discrimination, and it results in suffering. Malaysia unfortunately has widespread stigma against mental health sufferers. This is true even amongst the more affluent social class and the educated.
As mentioned earlier, as of September 2016, it is estimated that 1 in 3 Malaysians suffer from a mental health issue. This wasn’t always the case. In 1996, studies demonstrated that only 10.6% of Malaysians were affected. In 2013, this number moved up to 20%. We can see that we are following a trend that can be observed the world over: mental health suffering is increasing.
Despite this trend, it is reported that 61% of Malaysians believe sufferers are to be blamed for their illness, and the most spectacular of all: 76.5% of Malaysians believe that there is no such thing as mental health.
What have we been doing? Psychology as a science was born 138 years ago, in 1879. Mental health is one of the most critical determinants of our happiness and our lives, and more than three quarters of Malaysians don’t believe in it? Where are we headed? Moving forward, we can only expect more and more sufferers, not less. The problem is real, and it is here to stay, irrespective of what we think about it. We can accept the knowledge Psychology grants us, or we can continue in ignorance.
3. What is Mental Health?
It’s time to find out. What exactly is mental health?
Just like how our bodies aren’t perfect, our minds aren’t perfect as well. There are times when our body performs optimally, and there are times when it performs horribly. Our mind is exactly the same. There are times when our minds are in top form. When this happens, work is engaging and fulfilling, relationships are valuable and beneficial, and life is just all around good.
But we have all experienced times when our minds have refused to cooperate with us. Anger, stress, helplessness and other overwhelming emotions dominate our consciousness, and we find our lives falling apart.
Perhaps, instead of a dry definition, people might understand mental health better if it were presented in the following way:
How does one handle the normal, everyday stresses of existence? How does one maintain healthy relationships with family and friends? How does one achieve a satisfactory, productive and happy life? What is the next step I should take in my life? How do I eat better? How can I get over the regrets of my past? How do I achieve my goals? How do I better manage my finances? How do I restore a meaningful relationship with my spouse?
These are the questions that psychiatrists and psychologists try to answer for their clients. Realize that these questions do not address the specific issues of a particular group of “mentally ill” sufferers. Why, these are just the questions that regular people ask themselves everyday. Regular people like you and me, who sometimes, when things get tough, need an answer to the questions of life.
4. There is no Health without Mental Health
It’s time for us to look at the evidence and admit to ourselves that we have been wrong. This requires a sober, humble analysis of psychological evidence, as well as a rigorous categorization of what is a mental illness and what is not.
The first preconceived notion we have to banish is the idea that health and mental health operate in isolation. This is a false view of our body and our mind. There is no health without mental health, in that a person might have a perfectly healthy and functioning body, but to the extent that his mind is afflicted by depression or excessive stress, he cannot be considered fully healthy.
This definition will help us to understand better what the field of psychology and the role of psychologists are. They are a different kind of doctor, operating on a totally different science, with it’s own methods and rules, but with the same aim: to improve our health. The therapy room to the psychologist is like the surgical table to the doctor. They aim, first and foremost, to help people live better, more satisfying, more productive lives.
5. If I go for Therapy, I'm "Crazy"
This is a very common and unfortunate notion, even and especially amongst educated Malaysians. There is the misconception that people who go for therapy and people who visit psychologists or therapists are “crazy”, “psycho” or “gila”. This misconception is a direct manifestation of the Stigma of Mental Health at work in the mind of the accuser.
Do we accuse a man who has broken his arm when he visits a doctor? No we do not. In fact, we would take him there ourselves if he refuses to go. So when a man who suffers from deep depression and suicidal thoughts seek the professional help of a psychologist, why do we treat him differently? He is only trying to get help for his illness, the same way the man with the broken arm seeks help for his injury.
This is most important to keep in mind if you are the person who possibly needs therapeutic help. Because of the Stigma of Mental Health, most people in Malaysia who suffer from mental illness have convinced themselves one way or another that they don’t. They just think that they are “stressed” or “sad”, and if someone suggests that they go visit a therapist, they get offended and they say: “I’m not crazy!”
This is a dangerous way to define mental health, because it prevents people from seeking treatment. People who visit therapists are not crazy! They are responsible individuals who are intensely self-aware of their own situations, and are actively seeking aid for their condition.
6. The Insane Asylum is just a Prison with a Fancy Name
In a very similar sense, because of the terrible stigma surrounding mental health in Malaysia, our mental health institutions, that are supposed to be psychiatric clinics in the hands of professional clinical psychologists, are actually the insane asylums where the mentally ill are kept for “treatment”.
Fortunately, some inroads have been made recently. We are all familiar with “Tanjung Rambutan”, our nation’s first, biggest, most famous (or notorious), mental institution. In the small town of Tanjung Rambutan is Hospital Bahagia. A mental institution unlike all the stories we usually hear.
The truth is this: in the old days, when mental illness could not be explained, and were thus feared, mental asylums were built not to cure the mentally ill, but to confine them from society. Locking them up in a prison without ever having to see them again is the convenient blindfold that everyone can wear in pretense that such a problem doesn’t exist.
A recent study reported that even after some patients have been discharged from the hospital in full health, none of their family members came to pick them up. After sending them home post-treatment, the family even locks the doors and windows pretending they aren’t at home.
These days, institutions like Hospital Bahagia have begun to practice more wholesome approaches to mental health by engaging patients with the inclusion of their families to aid in the recovery process. Modern methods to therapy are also being practiced, and it seems that Tanjung Rambutan’s darker past is in the process of being redeemed.
In the meantime, we as Malaysia’s citizens should emulate the example of our intelligentsia by educating and informing ourselves about the true nature of mental health, mental illness and the people and institutions that are helping us fight this problem.
7. Bomohs and Folk Healers Harm more than Help
A long time ago, our ancestors saw that occasionally, a member in the community would act in ways that would be considered “abnormal”. Unable to explain how this could happen, they bridged the gap of their uncertainty with their beliefs. Early man widely believed that these behaviours had a supernatural source; spiritual possession or sorcery or the displeasure of the gods. Thus, they very reasonably responded with equally mystical treatments; exorcisms, incantations and prayer.
It is important to note that our ancestors had an excuse to believe the things they did about mental illness: they had no other way of knowing that it was a natural breakdown of the mind, not demonic possession, that resulted in the erratic behaviour of the mentally ill.
Now that psychology has found the truth, Malaysians have less and less excuses to continue clinging on to ancient beliefs concerning mental health. Yet, this is still a critical issue that we as a nation are facing. Misinformation and false belief results in the proliferation of patients seeking the help of bomohs and folk healers instead of professional, accredited clinical psychiatrists.
A study conducted in Pahang in 2010 revealed that 54% of mentally ill patients had at least one contact with a traditional healer prior to consulting psychiatric services. Our Health Minister Datuk Seri Dr S.Subramaniam said: “Around 2 in 3 mental illness patients here turn to witchdoctors, bomoh or priests to cure themselves.”
It would be no problem if the Bomohs and Folk Healers actually understood psychological practice, but oftentimes their spiritual treatments exacerbate the situation, and the patient is left worse off than before. It is critical that we spread awareness among Malaysians that mental illness is more a problem of the mind than the spirit, and the correct way to fix a problem of the mind is to consult a doctor of the mind: the psychologist.
8. Our Daily Language Stereotypes Mental Health
Funnily, there are some terms used in professional psychology that have become common terms used in everyday language. When used in the professional sense, the term means one thing, but when used in the colloquial, everyday sense, the word means quite another, and when used in this way, it clearly demonstrates our ignorance in mental health. “Oh I’m so depressed today.”, “Hey don’t be OCD.”, “Man today I’ve been so bipolar.”
These terms are thrown around so much that their validity is devalued further. The advice received by the sufferer from society usually follows a similar vein: “Get over it.” or “Stop trying to attract attention.” Employers do not recognize the severity of mental illness, and so they never take a legitimate case seriously.
What actually happens is that we attach to the sufferer a particular set of labels. These labels then direct our attitudes towards them. And just like that, we discriminate. Make no mistake: Our society discriminates against the mentally ill. We might not even be aware of the discrimination, or we might think that we are above it, but it is there. Not so obvious for some, and more so for others, but it is as difficult to destroy as racism or sexism.
9. The First Step on the Road to Recovery is the Hardest
While all this information is useful to someone who wants to learn more about mental health. It is the most helpful to the person who believes that he or she has a mental health illness. It’s important to realize that, according to these definitions, you aren’t a freak. You are someone who deserves compassion and help.
Surprisingly, taking the first step to recover oneself is sometimes more difficult than curing the illness itself. The first step requires two things:
- Knowledge. You have to learn, be informed and aware of what mental health really is. Once you distinguish it from the stigma, you are free from ignorance.
- Humility. You have to be honest with yourself. You have to ask yourself questions and answer them truthfully and in complete honesty, only then you will realize whether you mentally healthy or not.
10. Support Malaysian Psychologists!
Malaysia has a fledgling field of Psychology. Our collective understanding of mental health is definitely not where it’s supposed to be, but we’re making slight improvements. We’re slowly getting there.
At the moment, Malaysian Psychologists who are registered for clinical practice number only in the hundreds. The ratio of specialists to populace is a staggering 1:140,000 people. Professionals point out that this is a far cry from the World Health Organisation (WHO) recommendation of 1:50,000 people. Although we’re improving, we’re still far, far behind in terms of psychiatric service accessibility.
There is a trend among our fresh graduates of psychology too. These young students filled with knowledge and potential don’t end up being psychologists, but executives and managers in Human Resource divisions in the private sector. While that role is also important, we have to appraise the mental climate of our country and see what roles are more needed compared to others, before committing are efforts there.
We have to support Malaysian psychologists and spread awareness about the stigma of mental health, so that in the future, we can expect a healthier, happier populace, as well as greater accessibility to anyone who might need help! Visit our mental health therapy centre SOLS Health! We connect clients to mental health and nutritional services with an emphasis on combating the stigma of mental health. We even provide subsidized fees to clients from households that earn below a certain level of income.
written by Lucas Chen, Communications Manager, SOLS 24/7 Malaysia, November 2017
E-mail: lucas.c@sols247.org
