Managing Diversities
Don’t Call Us Siao

“Aren’t you scared? Mad people are violent!”

“Are they all tied down to the bed?”

“Do you hear a lot of shouting and things being thrown around?”

“How to talk to people with split personality? They don’t know what they’re saying.”

These are not uncommon responses I receive when I reveal that I work with persons with mental illness. While my social work education has given me the privilege to study about, and eventually work with this population, not many have been accorded this chance. Hence, many misconceptions, just like those I have illustrated above, continue to persist.

It is then not surprising why many persons with mental illnesses are reluctant to step forward to seek help. The Singapore Mental Health Study conducted in 2010 found that most people with mental illnesses did not seek help promptly — the average time taken to first seek help ranged from 5–14 years.

The large lag time before sufferers seek professional help is unfortunate given that the majority have the onset of their illness when they are in their 20s. While some sufferers manage relatively well without treatment, most do not. As such, they then spend a significant portion of the prime of their lives living in much mental torment.

Although there are a myriad of reasons why people choose not to seek help, interactions with patients have led me to conclude that the stigma of seeing a mental health professional, and the implications of doing so, are the biggest deterrents to people stepping forward for help.

At this juncture, most employers are still not open to the idea of hiring people with mental illness, regardless of whether they are seeking treatment. Being such an invisible illness, persons with mental illness often do not receive the same compassion that a person with a physical illness, for example, stroke, receives. In fact, many are misunderstood as “violent”, “lazy” and “anti-social”, leading to social exclusion. Beyond that, there is a greater fear that the mental illness will come to define who they are.

Doing away with labels

Imagine a society where each individual was labelled thus: “Catherine the divorcee”, “Matthew the single parent”, “Gideon the deaf and mute man”. Even supposedly good and well-respected labels, “Joey the doctor” and “Phoebe the Ox-Bridge scholar” are such narrow views of an individual.

Similarly, viewing persons with mental illness as “that schizophrenic lady” and “the teenager with bipolar” forces them into a life that becomes characterised by the illness alone. Society, including mental health professionals, should attempt to rethink persons with mental illness as people with problems — just like every other individual, rather than stick a label on them so quickly.

As with everyone else, persons with mental illness have other parts of their personalities that make up their identity. Through the course of interacting with many persons with mental illness, I have come to realise that “Chris the schizophrenic” is as much “Chris the guitarist”, “Chris the accountant” as well as “Chris the father”.

The inclusive society of tomorrow

Giving them a chance to develop their identities beyond their mental illness would mean integrating them within our communities — physical communities (our neighbourhoods), work communities (in jobs) and social communities.

Many would argue that institutionalisation is still necessary. I would agree that it is for those with active thoughts of harming oneself, and others. However, the majority of people with mental illnesses should be living amongst us.  While I have seen such cases in some communities, these are few and far between, with many communities still shunning persons with mental illness. Families with members who have mental illness often deal with the problem alone. They eventually burn out and refuse to take the individual home — resulting in unnecessary institutionalisation.

The beauty of living, working and playing in the same community is close physical proximity, which allows for first-hand observation of their struggles, triumphs, hopes and fears. This, in turn, grows our empathy towards persons with mental illnesses.

It would, however, be naive to assume that this inclusive community can be built by simply changing our mindsets towards those of us with mental illness. Building an inclusive community takes a deliberate effort at the individual, communal, as well as governmental level. At the individual level, it would mean things as simple as being aware of early relapse symptoms. On a community level, grassroots organisations can look at the specific needs of the population of mentally ill. While on the governmental level, policies should look towards moving services for persons with mental illnesses into the community, instead of centralising these services in psychiatric institutions.

That being said, the person with mental illness cannot remain passive in this process. There is first a need to acknowledge that help is needed, and be willing to share what kind of help exactly. After all, the person with the mental illness knows his illness best, and there would be no better person to educate society than the sufferer himself.

Letting angst-filled teenagers remain as they are

As Singapore society works on becoming more accepting towards those with mental illnesses, a worrying trend that we have seen in other societies is that there is then a risk of the medicalisation of everyday problems. Robert Whitaker in Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America put it succinctly: “If you expand the boundaries of mental illness… and you treat the people so diagnosed with psychiatric medications, do you run the risk of turning an anger-ridden teenager into a lifelong mental patient?”

To prevent this from happening, it would be useful to have persons from different disciplines coming together to look holistically at a patient, instead of just psychiatrists making diagnoses. In diagnoses that are debatable, psychological as well as social interventions can be attempted before jumping into the pharmacological ones.   

“Just call me Chris”

That aside, there is much to look forward to. Singapore society has made strides forward in the disability sector. The Enabling Masterplan, a five-year national road map which looks at how persons with disabilities can be empowered to reach their potential, has resulted in positive changes in education, employment, and the physical environment — thus collectively shaping a society that is increasingly sensitive to persons with disabilities. Several other initiatives such as hosting of the Paralympics have also served to cement the commitment to include persons with disabilities.

As such, I know and am hopeful that society can be caring and inclusive towards persons with mental illness. However, that change needs to start with you (yes, you — the one who’s reading this). The next time you hear of a friend, colleague or neighbour suffering from a mental illness, instead of sniggering behind his/her back, approach the person gently and start a conversation. It does not have to be about mental illness — the person, and his or her life, is more than that. Perhaps you will then no longer see him as “Chris the schizophrenic”, just “Chris”.

Joanne Chen is a social worker at the Institute of Mental Health and works with offenders with mental illnesses.

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