by Danielle Lim
‘I look at him sitting at the table, between the certificates on his left and the ashes on his right, between the past on his left and the present on his right, between success on his left and brokenness on his right, between the hope of a bright future, on his left, and the courage to keep going, on his right. My uncle. An ordinary man. Some would say an unsuccessful man. Many would say, a mad man. But for me, I will remember him with his smile and the small, beautiful sounds he has echoed into my life.’
TWENTY-FOUR years ago, I looked at my uncle as I wrestled with the predicament that his mental illness had put him, and our family, in. The lines above, taken from my memoir, ‘The Sound of SCH’, depict the struggle to make sense of his life after he developed schizophrenia.
When my uncle had a mental breakdown in the 1960s, my grandparents had no idea that he had become unwell. Even when diagnosed much later, treatment at Woodbridge Hospital (the former Institute of Mental Health) was rejected by my grandmother. My mother became his caregiver for the next thirty years, and I spent my growing years watching the loneliness that defined his life, as well as the despair that the circumstances often brought to my mother.
Awareness, treatment and support are better today than during my uncle’s time. Still, the challenges that come when a person crosses from being mentally well to unwell are very daunting. If a word can be associated with this baffling class of illnesses, then that word, to me, is “silence” – the silent onset of illness, the silent suffering of the one afflicted, and the silent despair that family members endure.
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The Silent Onset of Illness
Unlike many forms of physical illnesses, mental illness cannot be seen. The changes in the brain and mind, while often occurring over a period of time, also often occur insidiously. If cancer is called “the silent killer”, perhaps mental illness can be called “the silent destroyer”.
Diagnosis of mental illnesses can be difficult. Psychiatrists I have spoken to have shared that because the human brain is so complex – with a hundred billion neurons and several hundred thousand synapses per neuron – two people with schizophrenia can present with vastly different behaviours and symptoms. There isn’t a precise “test” that doctors can administer to measure the “level” of mental well-being, unlike how we can take a blood sample to measure levels of cholesterol or haemoglobin.
It is usually through changes in behaviour that family or friends start wondering if something is amiss. Yet the amorphous nature of such illnesses often means that the whole process of ascertaining what exactly is amiss can take a while.
The Silent Walk Alone
My uncle’s illness took a long time to be discovered when it struck him in his twenties. His life changed completely – he lost his job and friends, became a sweeper, and spent the next thirty years living a lonely life. Yet, he never complained, and was never violent.
Whilst studies show that around 90 per cent of those with mental illnesses do not become violent, there is a general perception that mental illness is associated with violence. There have been steps forward in how mental illness is viewed and treated, and in how recovering patients are supported in their efforts to reintegrate into society. Even so, it may be difficult for us to imagine what it is like to walk the path of a patient.
A doctor once told me that mental illness is the only illness where suicide rates go up when medication starts becoming effective. Therein lies the irony, that when patients become well enough to realise they have a mental illness, they find it such an unbearable sentence that they would rather end their lives.
Schizophrenia strikes about one in a hundred people. Every day, a child is born in Singapore who will suffer from schizophrenia, and the onset of illness is usually between the ages 15 and 30. In other words, it strikes young. I once had a student who was doing well in her studies but who often missed classes, the reasons for which I was not told. I only found out much later about her struggle with mental illness. She probably did not want the people around her to know of her condition. Sadly, such silence typically surrounds the response to having a mental illness.
I know of many who have recovered and who now lead meaningful lives. Recovery is possible, especially with early treatment, and with support from loved ones and the community. Family members, in turn, need support.
The Silent Despair of Loved Ones
As Professor Chong Siow Ann mentions in his article “Mental illness: Caregivers are forgotten collateral damage” (The Straits Times, 29 November 2014), the burden of the illness falls not only on the patient, but also on the caregiver and family members. Treatment and recovery can be a long, difficult and uncertain process. The helplessness, anxiety and caregiver stress of loved ones are often overlooked.
Acceptance of the diagnosis is itself difficult. Perhaps because there is still an entrenched social stigma associated with such illnesses, coming to terms with the diagnosis involves an intense inner struggle. How does one accept that one’s spouse or sibling or child is not “normal” and may be seen as “crazy” or “mad” by people around?
After reading my book, a friend told me that her brother had schizophrenia, and that he took his life years ago. She then said, “Please keep this a secret.”
Organisations such as the Caregivers Alliance have been set up to support caregivers of those with mental illness. Such support can make all the difference in enabling caregivers to push on. Many caregivers themselves become depressed, buckling under the weight they have to carry.
My mother did not have such support as she took care of my uncle for over thirty years. At one point, she had to take anti-depressants. I admire her for what she has done, and I salute all caregivers.
Those with mental illness and their loved ones walk a very difficult path. If we can dispel some of the silence surrounding mental illness, perhaps they can stumble a little less on their journey.
Danielle Lim is the author of ‘The Sound of SCH: a mental breakdown, a life journey’, a memoir which won the Singapore Literature Prize (non-fiction) 2016.
This article is part of a series to shed light on mental illnesses. Read the other piece here:
Featured image by Sean Chong.
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