June 25, 2017

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depression

by George Khoo

I saw the signs a couple of months before my daughter’s wedding. The year running up to this point had been rough. I was feeling upset, tired, irritable and angry almost every day. I teared up easily and was constantly thinking negative thoughts, sometimes even suicidal ones.

Even though I was so tired most days, I wasn’t able to sleep properly, often waking up in the wee hours of the morning. How I felt added to my fatigue, frustration, hopelessness, guilt and feelings of worthlessness.

While the truth that I was clinically depressed started to sink in, I was probably still in denial and hoped that with time, rest and exercise, things would improve. However, it just got worse and the low moods and negative thoughts persisted.

Part of the reason for not seeking help early was because I’m from the medical profession. I felt that admitting that I needed help would not reflect well on me – a healthcare provider who’s not even able to care for himself.

 

How did it get this bad?

It wasn’t the volume of work that affected me most but the issues in my relationships. I have always tried to live peacefully with my fellow man and it’s not in my nature to confront others. However, the leadership roles I’ve taken up at work and in my church have increasingly put me into situations that require confrontation.

I had patients that year that I expected would be grateful to me but turned around to question me on the wisdom of the recommendations I had made with their best interests at heart. I had a colleague who was pushing me to pursue something I was not comfortable with. And I had to confront people who had made wrong choices and required disciplinary action. Meanwhile, in church, a man told me to my face that he wanted me to step down as a church leader.

The worst was when a leader at work, unhappy with a policy I was trying to revise, accused me of being more interested in systems and policies than in caring for patients. I had spent sleepless nights worrying for my patients and trying to get them good healthcare and while what the leader said was absurd, it really hurt to hear him say that to me.

All of this played into my feelings of worthlessness and frustration, causing me to feel even more irritable and upset than I already was.

 

An unusual sense of loss

At some point, however, I realised that these were not the only causes for what I was feeling. It dawned on me that a big factor was the prospect of ‘losing’ my precious daughter once she gets married. That year, we must have attended close to 10 other weddings and I dreaded going to them because they just reminded me that soon, I was to give away my own daughter. Each wedding became more and more difficult to attend and the worst was the one two weeks before her wedding. I teared throughout the wedding thinking of what it was going to be like on that day!

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I was unable to make sense of how depressed this made me feel until I read Unmasking Male Depression by Archibald D. Hart:

“Then there was the time when my first daughter was going to be married. I found myself quite depressed a few months before the wedding. Finally, it dawned on me that my little girl was saying goodbye to me in favour of a young man who was not part of me. Like it or not, being excited for my daughter was not enough to overcome my sense of sadness. I was facing a loss that could never be replaced. There were those who said to me, “You’re not losing a daughter but gaining a son-in-law.” What a ridiculous idea! What I was losing could not be counterbalanced by what I was gaining. Every father of a daughter knows that a son-in-law does not equal a daughter!”

Coming across that passage was like hitting the jackpot (not that I play). Finally, someone understood how I was feeling – he had been through the same thing and knew how I felt.

 

Getting help

I finally plucked up the courage to make an appointment with a psychiatrist to confirm my own suspicion. I needed to know for sure, to be fair to my family and my loved ones. In any case, I had reached a point where not much else mattered and I wasn’t bothered about the stigma associated with taking anti-depressants 

I had reached a point where not much else mattered and I wasn’t bothered about the stigma associated with taking anti-depressants

I was put on Lexapro (escitalopram) and during my review, three and half months after my first appointment, my psychiatrist doubled my dosage. I was definitely feeling better in terms of having less frequent thoughts of hopelessness and a stop to the suicidal thoughts but I was not “walking on clouds”. About a week later, I distinctly remember waking up one morning and thinking: “Oh, this is what it feels to be normal?” That morning, after many months of feeling down, moody and negative, I felt that burden lift. My medication was working well.

The other thing that helped me greatly was reading the Bible and other Christian literature on depression and burnout. I found them to be great in creating self-awareness and for self-therapy.

 

“I believe that I shall look upon the goodness of the Lord in the land of the living! Wait for the Lord; be strong, and let your heart take courage; wait for the Lord!”Psalm 27:13-14

“Despite being a dedicated gospel-hearted Christian who preached grace, the truth is that I was dangerously close to living a gospel of works, not grace.” – Christopher Ash, Zeal without Burnout

“The surprising truth is that the person who pauses long enough to refresh his soul along the way actually becomes more alert, more alive, more efficient.” – W. Phillip Keller, Strength of Soul

 

The other main factor on my road to recovery was the tremendous support given to me by my beloved wife and family. At the end of our family holiday, six weeks before my daughter’s wedding, I decided to be open with them at the airport while waiting for our flight back to Singapore. I am thankful that they took it very well and were very encouraging.

My wife, who knew my struggles all throughout, was a pillar of strength when my whole world was crumbling emotionally. She is not only my best confidante and my best friend, she also makes me laugh and reminded me to rest. She was ever patient with me when I was negative and moody and even scratches my back to help me sleep! God gave her the strength and grace to put up with me.

It’s been a two and a half year journey and while my psychiatrist has encouraged me to try weaning off the Lexapro, I realise that as long as I am in my current role, in church and at work, it would not be possible. I have tried weaning it off but have had to go back on my medication rather quickly. Nonetheless, my dosage has halved and my recovery has been steady.

Having been through the worst periods has helped me to be more disciplined about taking regular breaks. Now, I take a week off every three to four months and am intentional about observing the weekly Sabbath as a time of rest from work. As the writer Christopher Ash puts it in Zeal without Burnout, “God needs no day off. But I am not God, and I do.”

 

Stigma

I have chosen to be open about the fact that I am still on anti-depressants because there is a need to remove the stigma associated with it. In Singapore and in this part of the world, to be on anti-depressants is still very much taboo. Thankfully, I work in a Christian organization that fully understands and supports my stand. However, other employers may not be as understanding and that is probably one of the main reasons why people do not speak up – the fear of losing their jobs or not getting one should they be honest.

While it is probably too idealistic to expect no discrimination at all, I hope that we can help employers be open to accepting applicants with a history of mental illness but are stable on medication. They should be at least considered in the same way as those with other chronic illnesses such as hypertension or diabetes. As long as they are capable of performing the tasks and do not pose a danger to themselves or others, they should be given equal opportunities.

“The lines have fallen for me in pleasant places; 
indeed, I have a beautiful inheritance. – Psalm 16:6

 

Dr George Khoo is a general practitioner in his late 50’s and serves as the Medical Advisor for a Christian organisation. George is married to Mabel and has two grown up children, both happily married. George and Mabel have a newborn grandchild and are expecting a second within the next few weeks.

 

Featured image by Sean Chong.

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Trying to understand depression? TMG offers a prelude to our upcoming content on mental illnesses with this primer by Winnie Lim..

by Winnie Lim

A FEW days ago, I told a roomful of people — both strangers and friends — that I am chronically depressed and suicidal.

Notice the present tense. I am still chronically depressed and suicidal. I am pretty certain people don’t really believe me. I look like I am the furthest away of being a person you would think is thinking of ending her life every other week, if not day.

That is the whole point though.

There is no telling how someone with chronic depression and suicidal tendencies should look.

Before I go on, I want to make it clear that what follows is entirely my personal telling of my story, I am not speaking on the behalf of all depressed and suicidal people, because they have complex conditions — they cannot be reduced to one person’s story.

I have had countless people tell me that I have so much light on my face, that I am full of life. I tell them paradoxically, I have so much light on my face, and I am full of life, precisely because I think about killing myself all the time.

Life becomes a choice. It is not something I am automatically wired for, just for mere survival. Every single day, it becomes a fight. Do I want to live?

When I was younger, that answer often came back with a flat “no”. I did not want to live. Life was meaningless, often tedious. I did not understand why I had to exist.

I consider myself lucky. I had a few years when it all went away, out of my thirty-plus years of living. I stopped questioning my existence and I had thought I was recovering from my chronic depression. I know of many others who are less fortunate. They had never seen a day of light.

I now know. My depression and suicidal tendencies will likely not go away, ever. They are always there, just waiting. It takes only a split second to feel that sinking feeling all over again.

Life has gotten a lot more complex and also simpler. I have stopped looking at life in binary terms: do I want to live or die? I started to understand I could want to live and die at the same time.

I have learned to see nuances between being neurologically depressed and psychologically depressed. They are intrinsically tied, some would say they are one of the same. Yet I have some days when I know I am experiencing shitty emotions not because I have an unbalanced psyche. I know that is just my neurological system malfunctioning because I was not careful about up-keeping it through sleep, diet, and movement. I exert an extraordinary amount of effort just to be relatively functional. I know I cannot fight the hormonal imbalance during my monthly menstrual cycles. Once a month, I just try to let myself be. If I am weepy, I just let myself weep. I keep myself away from people because I know I have magnified reactions to everything.

Some other times, I know it is my un-excavated emotions that are affecting my physical health. Unexpressed emotions, repressed grief, denial of some sort, overwhelming sadness or triggers of old wounds. If I don’t address them in some ways, I start to fall physically sick.

Once in a while, I cannot deal with myself. I have overwhelming melancholy and I let myself go. I start to binge eat. I hide from the world. It snowballs. I start losing all perspective. My hormones and neurons are all over the place. My emotions are out of whack. There seems to be nothing left in me. I cannot move. I feel like dying. All that pain, it can just go away.

Else, I could be experiencing one of the most balanced periods of my life, and yet I experience moments of existentialist suicidal tendencies. I think of dying not because I am sad or numb or empty. I think of dying because intellectually, I question all of this. Yes, my life could be amazing and it could have meaning, but so? It is a rabbit hole.

I can tell myself: it is the process, the journey, the love, the evolution. I can look at it spiritually. But what if I just don’t care — about spiritual growth, about human evolution, or anything?

Sometimes, it is not the pain that drives me closest to death. It is when I am at my most sane self, and I find tiny moments in between when I just simply don’t care.

Here is what keeps me alive. I cannot find it in myself to end my existence knowing that people would have to spend the rest of their lives dealing with it.

How can I be someone who knows what it is like to carry so much pain and be the same person who delivers exponential pain to people I love?

So I try. I try to live. Since I don’t see the point of survival, I try to be brilliantly alive. My life has to be extraordinary, on my own terms. It is not enough for me to merely exist.

And I am curious. I love to create. As much as part of me is borderline suicidal all the time, I am curious about what I can make out of this. When life itself is not an incentive, it can be incredibly freeing, because I have a lot less I am afraid of losing. For me, it is not about losing money, people, reputation, it is about losing my will to live, so I am unafraid of most losses just so I can feel truly alive. It is easy to quit that cushy job or make a seemingly insane decision when the other side of the equation is feeling like I want to end my existence.

In a parallel universe, if I didn’t know people love me, curiosity and the desire to create may not be enough to sustain my life. It is also not enough to live just knowing that people love me. Both are essential in keeping me alive.

I deeply empathise with those who end up taking their lives successfully. I am even envious. I know what it is like. To exist at that brink, to feel so much pain that even the mere thought of death is a relief.

Or to feel so numb that nothing is capable of being an incentive to live. Or to look at humanity sometimes and be like, “really?”.

I am not sure if I will always be capable of reasoning. To be reminded that people love me, so I just can’t. But I have also lived through moments when I am not capable of remembering. To be so overwhelmed that I don’t give a shit about my curiosity. I understand why some people make that choice.

Yet it breaks my heart each and every time I know of someone ending their lives. I understand, I empathise, I am envious, but I still get so heartbroken. Life is not binary. The world is less without them. We have lost permanently, what these lives could have brought to us.

People get all confused when I tell them I am chronically suicidal and depressed as though I am describing the weather. Maybe some of them think I am doing it for the attention.

It is important to reduce the stigma, the misconceptions. There are so many others out there who are less lucky than me. I have been blessed with people who love me. I never used to know, but I have lived long enough to know, to be capable of knowing what love feels like. There are some of us who do not experience that. Some of them are unable to express the weight they are carrying until the deed is completed. They are afraid to be judged, censored, dismissed.

We wouldn’t judge someone for telling us that they have diabetes or any other long-term chronic illness. Why do we not acknowledge the life-long suffering of people whose brains are attempting to eat away every single bit of them?

We tell them it is not real, to get over it. If they could, why would they choose to tell us about it, even though they know how they are going to be seen?

The chronically depressed/suicidal people I personally know are the most empathetic, generous, creative souls I have known. I shudder to think what I, individually would have lost if life had taken them away from this world. I would be so much less without them. I don’t know who I’ll become if I thought that I was alone.

It makes me really upset and angry when we lose people this way, especially young humans who haven’t had a chance to experience a fuller spectrum of life, or for reasons that can be mitigated — bullying or trauma. They experience all that pain and they think, that is it. Why live? They think they are their wounds. They think their wounds make them unworthy of life.

And there are some of us who because of unjust circumstances, never ever got to get a hold of this condition. They did not get to experience anything else other than pain. They have never gotten the breaks I have been given.

I am not sure if I would still be alive if I didn’t make the decision to visit San Francisco in July 2011. If I didn’t have that one single friend who told me it was okay to be me, when I was in my early 20s and numb. If I didn’t fall in love when I was 15. If I wasn’t afraid of heights when I was 10. If sleeping pills were accessible in Singapore. If I didn’t start to meet people who saw me beyond my pain and chaos.

I was an extremely pale shade of myself for two decades of my life. My life only truly turned when I hit 30. Even then, even now, it is still questionable.

I discovered agency — that I was capable of making choices. I can now choose to live. I felt back then I was forced to buy into a life I didn’t want, now I am capable of consciously choosing to live. I started to see myself and accept myself, only because people saw and accepted me first. I learned more about my condition. It started to feel more like a blessing and a curse, instead of just seeing it as a lifelong affliction.

I have accomplished a lot. For my work, for the people in my life. My accomplishments are not to be seen in my resume. They are to be felt. This is the life I consciously choose.

But if you, the reader, have in any way derived value from me — whether through this post, through something else I have written or made, through my love or friendship, through something I am not even aware of; think about all those times I chose not to die; think about the ones who are still trying to make that choice.

Think about the ones who have chosen the other way. Think about what we as a whole, may have lost, or are still potentially losing. Because we saw them as less. Because they are afraid to tell us. Because they didn’t know we love them.

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Winnie was a multi-disciplinary designer for 15 years. In 2015, she decided her life was not sustainable as it was, so she embarked on a journey to discover a new way of living. In her spare time, she works on interactive narrative experiments at http://lucent.space, and intends to spend her life on three areas: individual power, mental health and education. She has been publicly writing about her suicidal tendencies and chronic depression since 2011, in a deliberate effort to reduce stigma and challenge perceptions. You can read more of her writings on Medium, Twitter and her website.

This article was first published on Medium.

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Featured image by Natassya Siregar.

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SET your kid up for a life of depression, anxiety and suicide today – be a pushy parent. An NUS study published in the online Journal of Personality in March 2016 showed that children were more likely to develop maladaptive perfectionism – being overly critical about themselves – if their parents were overly intrusive. What’s that mean, exactly? The study, which started observing 7-year-olds, used the example of a parent who, while instructed to help their child, would retract a move their child made in a problem-solving game or tell the child what to do, which would signal to the child that what they did was not good enough.

Follow-up studies were conducted at ages eight, nine and 11. Children with pushy parents were twice as likely to develop high and increasing levels of negative perfectionism.

Is this a causal factor for the rise in mental illnesses we are seeing in society today? How do we lower this risk? Assistant Professor Ryan Hong, who led the study, said that parents should praise the child’s achievements before addressing mistakes, let their child learn from mistakes, avoid blaming their child for not living up to parents’ expectations, and refrain from comparing their children with others.

In other news, Mindef and MHA will pay for the insurance coverage of all NSFs and NSmen from July 1. This coverage is for a $150,000 limit for group term life and group personal accident insurance underwritten by Aviva. The coverage is for the period of national service, reservist stints and official volunteer duties, but the option to purchase Aviva group term life and personal accident insurance remains open to all servicemen.

Insurance was previously optional for SAF servicemen and MHA NSFs had their premiums deducted from their allowance. While having the G pay for insurance was one suggestion mentioned by the Committee to Strengthen National Service, it was not mentioned in any reports if this decision was linked to any recent incidents, including the accidental death of Dominique Sarron Wee.

This one man takes playing dead too far: Nordin Ibrahim impersonated a dead man to try to claim $52,000 in the deceased’s CPF account. Wheelchair-bound Nordin and Sufian Alwe were close to Mr Yacoob Ismail and took his passport while cleaning out his flat after his death in January 2013. Nordin, 44, then impersonated Mr Yacoob, 63, and nominated Sufian as the beneficiary. He fooled CPF officers because he could answer background questions about Mr Yacoob accurately.

The scam was uncovered a month later when Nordin and Sufian returned to the CPF office to ask about the nomination details. The duty officer then noticed that the nomination in question had been made two days after Mr Yacoob’s death and the pair were arrested.

Nordin has been sentenced to six weeks in jail and will appeal.

 

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by Wan Ting Koh

AN ACCOUNTING manager at luxury watch and jewellery firm Chopard was convicted earlier this month (Dec 1) for stealing money from her firm and covering it up. Her crimes are falsification of accounts, using the benefits of criminal conduct and criminal breach of trust.

Chew Siew Lang, 53, had siphoned $11.2 million from the company over six-and-a-half years, but she is hoping to get a lighter sentence by pleading psychiatric illness: impulse control disorder.

It is a disorder characterised by impulsivity and a failure to resist a temptation, urge or an impulse that may harm oneself or others.

Chew isn’t the first to cite this mental disorder in court. Earlier this year, a Japanese air stewardess with the same psychiatric disorder was fined $7,000 for stealing from shops in Paragon earlier this year in a 30-minute shoplifting spree. Satoko Otaka, 27, stole $2,346.14 worth of items, including postcards and vegetable stock.

Her defence: major depressive disorder in addition to kleptomania or a recurrent urge to steal.

For mental illness to be considered in court, said Mr Colin Liew, senior associate at TSMP Law Corporation, there usually has to be a causal link between the mental illness and the commission of offence to show the relevance of the mental illness to the act. He said that a mentally ill person might be “unaware of the nature or the wrongness of what he is doing”.

Tito Isaac & Co LLP senior associate Jonathan Wong said an offender’s mental disorder is always a relevant factor when considering his sentencing and it can often be a “mitigating factor that is considered by the Court…especially if it diminishes the offender’s moral culpability for the crime”. That is, if he or she couldn’t quite help committing the crime.

But there is a flip side. Said Mr Wong: “The mental disorder can sometimes be an aggravating factor that requires the Court to impose a heavier sentence, such as in a situation where the offender’s mental abnormality makes him a danger to society and which would therefore justify a longer period of imprisonment in order to protect the public.”

This got us wondering – what other mental afflictions have been pleaded in the courts here and what effect does it have on sentencing? So, we did some research. Here are seven other examples and what the judges said about their disorders.

We have decided not to name those who have already served their sentences.

Bipolar disorder

A condition marked by mood swings with alternating periods of elation and depression.

A former lawyer who embezzled legal fees of $12,900 from her firm was convicted in May 2013 for six counts of criminal breach of trust and for practising without a certificate. This was because in 2010, she had pocketed legal fees from four clients instead of depositing it into the clients’ accounts of the firm, as required by law.

Originally sentenced to nine months in jail, she had her jail term slashed to just two days on appeal to the High Court a year later. Justice Tay Yong Kwang said that her case was “exceptional” due to her long history of bipolar disorder, a mental condition characterised by mood swings. So he said that the woman should not be judged the same as an “average clear thinking lawyer”, as her condition might have affected her judgement.

Her fine for acting as a lawyer after her practising certificate expired was also reduced from $6,000 to $1,500.

Depressive disorder

A condition in which a person’s persistent feelings of sadness and worthlessness are so severe that they interfere with daily life.

Dinesh Pillai Reja Retnam, 31, a drug trafficker who was originally sentenced to death, had his sentence changed to life imprisonment due to his mental condition.

The first drug convict to escape the gallows due to a mental disorder, Dinesh was psychiatrically assessed to be suffering from depression when he was caught trafficking 19.35g of heroin in Dec 2009. He had been paid RM200 (S$80) to carry the drugs across the Causeway.  A medical examination also suggested some degree of organic damage to his brain.

Dinesh was first convicted on April 14, 2011 and sentenced to hang. He lost his appeal and a separate application against his conviction and sentence in 2012, but with changes in the law stating that drug trafficking offences no longer always mandate death penalties, his lawyer Eugene Thuraisingam applied for a re-sentencing and succeeded in getting Dinesh a life term. The judge deemed Dinesh less responsible for his actions due to his mental condition.

Fetishism

A condition in which a person has a sexual fixation on non-living objects.

In this case, the object of fetishism was a wallet. Low Ji Qing is a 47-year-old former executive with an economics degree who went on a stealing spree to satisfy his fetish for the smell of leather wallets in 2011.

He was convicted with taking wallets from nine women over an eight-month period but was spared a prison sentence and placed on three years’ supervised probation instead. Before this stint, Low had been jailed four times since 1986 for stealing to satisfy his craving. He was only diagnosed with a psychiatric condition in 1996.

The last time he was jailed was in 2010, when he was sentenced to 10 years’ preventive detention for theft. According to a psychiatric report that emerged in the same year, Low began sniffing his sister’s wallets and belongings at the age of seven. As he grew older, he began to have recurring sexual urges and fantasies involving his sister’s wallet.

Low’s lawyer Josephus Tan, said his client’s crimes were triggered by his inability to cope with his mental disorder. He said Low had been seeking treatment, and had shown he could be rehabilitated if given a chance.

So Low was given the chance to stay at a crisis centre for men to be treated under a probation order. District Judge Soh Tze Bian told Low: “I note this case is quite serious. You have committed many offences. Make sure you complete the probation successfully, otherwise you will be brought here to be dealt with for these offences.”

But it seems that rehabilitation was futile as Low went on to commit thefts that got him jailed in March 2013 for 13 months. More recently last year, Low stole a wallet and mobile phone from a woman’s bag in an unattended trolley at Giant hypermart in VivoCity.

This time, he lost his appeal to the High Court in April this year and got sentenced to three years in jail. But he has appealed for a shorter term, arguing that his condition has improved.

Paedophilia

Paedophilia is a psychiatric disorder in which an adult or older adolescent experiences a primary or exclusive sexual attraction to prepubescent children, generally aged 11 years or younger.

Odd job worker Kelvin Lim Hock Hin was a serial sex offender who was convicted of sexually abusing five boys, aged eight to 13, between October 1995 and September 1996.

Even though he was diagnosed with paedophilia, Justice T. S. Sinnathuray still served him a 40-year jail sentence in Sept 1997, saying that the 29-year-old offender had to be removed from society for a long period of time. This was because doctors said the chances of his doing the same thing again were very high. Lim had been jailed twice before; 15 months in 1988 and 32 months in 1993. He had been released from his second jail sentence only to commit the current offences within three months of his release.

The judge also said that while Lim was suffering from a mental disorder, he was in control of his own actions. Lim appealed the sentence but the Court of Appeal turned him down. Then Chief Justice Yong Pung How and Justices M. Karthigesu and L.P. Thean, told him: “You are a menace to society; you should be put away for a long time”.

CJ Yong added: “Even if paedophilia is an illness, we reject any suggestion that the sufferer cannot help it and therefore carries only a diminished responsibility for his actions. There is no evidence that paedophiles cannot exercise a high degree of responsibility and self-control. The learned judge found that the appellant had a choice of whether to commit paedophilic offences against the victims, and chose to do so.”

Voyeurism

Voyeurism is a psychosexual disorder in which a person derives sexual pleasure and gratification from looking at the naked bodies and genital organs or observing the sexual acts of others while remaining hidden.

In 2013, a former labour relations officer, then 29, was initially given 30 months’ probation by a district judge when he was convicted of filming an up-skirt video of a woman at IMM shopping mall, for the possession of 10,574 obscene videos and  for filming his victims as they showered in his girlfriend’s home.

The judge placed considerable weight on the fact that the man was diagnosed with voyeurism and concluded that deterrence should not take precedence over rehabilitation. Aggravating factors highlighted by the prosecution, including the use of recording devices, multiple victims including children, premeditation and elaborate planning, should “be given little weight in light of the fact that the accused was suffering from a psychiatric condition at the material time”.

The prosecution appealed and in March this year, Justice Chan Seng Onn described the probation sentence as “manifestly inadequate”. He said that voyeurism is “merely a clinical description of what is essentially a perverse behavioural option and it does not deprive a person of his self-control”. He was sentenced to 16 weeks jail instead.

Borderline personality disorder 

A mental illness marked by unstable moods, behavior, and relationships. Similar to bipolar disorder but more distinct in mood swings.

In March 2010, Mark Chow, a former actor and model agency owner who was diagnosed with this illness was fined $6,000 instead of getting a heavier sentence because he had touched a woman’s chest – for only a fleeting moment. His lawyer Subhas Anandan, pleaded for leniency saying that his client had been undergoing psychiatric treatment since 2004.

He also tendered two medical reports, one which noted members of Chow’s family had records of mental illness and one which diagnosed Chow with borderline personality disorder.

As the man could only pay $2,000 of the fine, he was given four weeks jail. But that wasn’t the end. Upon appeal from both the prosecution and defense, he had his fine replaced with a nine-month jail term in Aug 2010.

In his judgment, Justice Steven Chong said the man had molested the woman for more than two minutes and had “displayed no remorse even though he had touched her all over her body, and had claimed trial even though CCTV footage showed him touching her…It was a deliberate act that was not committed on the spur of the moment”. He was refunded the $2,000 fine he had paid earlier.

But his mental disorder did spare him from caning. Justice Chong said that although the man’s personality problems and substance dependence have no direct relevance to the commission of the offences, he took them into account in sparing him from the rotan. “In my judgement, the longer custodial sentences that I have imposed are sufficient punishment for his offences.”

Paranoid Schizophrenia 

Paranoid schizophrenia is a subtype of schizophrenia in which the patient has delusions or false beliefs that a person or some individuals are plotting against them or members of their family.

Sujay Solomon Sutherson, murdered his mother Madam Malika Jesudasan by stabbing her in the neck and slitting her throat with three different knives three years ago. He was suffering from paranoid schizophrenia and had been warded in the Institute of Mental Health for his condition periodically since 2006.

He was sentenced to life imprisonment in September this year for culpable homicide not amounting to murder. In giving her judgement, Judicial Commissioner Hoo Sheau Peng said that “if the accused’s illness cannot be controlled, he would remain an unstable, unpredictable and dangerous individual” and that “was not satisfied that the accused’s illness could be sufficiently managed outside an institutional setting, and that he would remain a danger to the public at large for the foreseeable future”.

On Sujay’s need to remain in an institution, JC Hoo considered how his illness would be difficult to treat outside an institution, as Sujay had the “capacity and ability to conceal symptoms of his illness from those around him” which meant that it “would be extremely difficult for any treatment regimen to be enforced unless he received close supervision and regular medical attention.”

“I had no doubt that left to his devices, the accused would default on his treatment and medication…The best treatment for the accused would be for him to be in a facility where his consumption of antipsychotic medication can be supervised, observed and enforced where necessary,” JC Hoo said.

The last consideration which factored into the judgement was the lack of post-release plan for the care of Sujay.

Said JC Hoo: “In cases involving individuals with mental disorders, an important consideration is the presence of strong familial and social structures for the enforcement of the prescribed treatment regimen outside of a controlled environment such as that of a prison…there were no indications that there would be anyone who would be able or willing to take care of the accused upon his release, let alone provide any guarantees.”

 

 

Featured image Depression by Flickr user Victor, CC BY 2.0.

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