Tag Archives: Suicidal

<心理追兇Mind Hunter>男主角马国明是精神分裂吗?

备注:我一直很认真花时间在我的网站写有素质的文章,这篇的题材可能归属娱乐版,但是我的态度与提高心理健康意识的主张不变!

已经有一段时间没有追看港剧,直到出现这部和心理学相关的电视剧,分别被几个朋友问说我有在看吗,说不错看而且还有问题要我解答,所以我在一个星期多把28集看完了。

不交代剧中的内容和角色。只是昨晚因为家人还在看,提起主角Dr Chong(心理学家钟泰然博士 — 是的他不是医生,他不能开药,他被称为Dr 是因为 PhD博士学位,不是medical doctor),说他是精神分裂症(schizophrenia),有幻觉(hallucination),可以看到听到他已故女友。我想了一下,他总是在点起烟的时候对方才出现,看起来真的有点像是刺激物引致的幻觉(有些药物和毒品确实可能引起幻觉,可能但不一定引致精神分裂症)。

说真的,看这部电视剧的过程中,我从没想过他可能有精神分裂。虽然我满怀期待最后编剧导演给我一个交代,一个诊断,这名心理学家患有的是什么心理问题(可是没有。No, 我不认同他是反社会人格障碍 antisocial personality disorder!)。对我而言,他的表现是grieving,悲悼(因为失去所爱的人的悲伤),长久下去,可能形成抑郁(depression)。当然,就像我常和病人说的,接受这些悲伤,你刚失去生命中这么重要的人/感情,你要是不悲伤不难过不哭泣,我才要担心才想治疗你。所以抑郁也是正常的。或许大部分人会说,悼念五年,也太久了。可是以陪伴丧亲者的角度来说,悲悼其实没有期限,有些人要几个月,有些人几年,周围的人能做的,就是陪伴。

回到主题,最后Dr Chung不再和其他人联络/接触,情绪崩溃,独自走上末路(其实他有没有死,结局没有交代)。这其实对我而言,或多或少地确认了我的判断,他是悲悼过度而抑郁。如果你只是悲悼,一般不那么抗拒周围的人,你还是可以继续生活、工作或学习等,并接受其他人的陪伴,但是哀悼与抑郁的一线之差(really just a fine line!),在于你开始抗拒其他人,开始封闭自己(有一幕他的警擦朋友和社工朋友说已经很久没有看到他了,另一精神科医生好朋友也已经反目成仇)。

所以我的看法与分析,他不是精神分裂。

最后还是有一点相当欣赏这部剧的地方,在于催眠那段,社工朋友童月因为过度惊吓,出现暂时性失忆,Dr Chung说催眠可以看到平时看不到的事,原本太远的距离太小的事物,在催眠中可以变近放大,当时我的心里在说“放屁!为什么误导观众”,很开心最后发现那只是他的手段,用来骗童日。只是这个操作(manipulation),真的很难让人不觉得他是反社会人格…. 不过!从剧中很多地方不难发现,他其实很在意别人的感受,也尊重别人的权益,反社会人格,是不会在他30-40岁突然出现的…

识别自杀的预警信号

自杀预警信号量表(临床应用)

  • 过去自杀企图(Previous suicidal attempts):包括家庭成员的自杀史,将显示对方可能熟悉把自杀当成解决问题的方式。(10分)
  • 家庭精神问题史,或目前有精神问题的诊断(包括人格障碍,含或不含自残行为)。(9分)
  • 毒品或物质滥用史(毒品和酒精可以使一个人失去理性,也可以被用来压抑情绪)。(8分)
  • 抑郁,对未来感到绝望、无助。(7分)
  • 童年遭受虐待或严重创伤。(6分)
  • 孤立自己、疏远其他人,与家人没有建立良好关系、没有联系。(5分)
  • 最近经历丧生或丧失,分离、离婚、失恋。(4分)
  • 患有危及生命的疾病或慢性身体疾病(如,癌症、艾滋、老人痴呆症等)。(3分)
  • 经济问题。(2分)
  • 失业。(1分)

把所有分数加起来,超过9分显示自杀的可能性,这时候要确保和对方明确的讨论自杀的念头,以及是否已经有计划。

重要贴士:

  • 很多人把“讨论自杀”视为禁忌,但是问对方“你是否有自杀念头”并不会使对方更想自杀。相反的,坦诚真心地一起讨论反而会使对方觉得自己被理解、自己其实并不孤独。
  • 可以用一些比较开放式的问题,比如“你对未来有什么想法?”,对方可能没有那么直接地说“我希望我可以这一觉睡下去再也不会醒来”。
  • 注意对方对未来或目前的情况(尤其困境)的无助感、绝望感、悲观想法。
  • 注意一些非言语的信号,比如把个人财物托付给别人,或安排身后事。
  • 自杀的念头与自杀的计划并不同。很多人在一生当中都会想过“自杀”,但是并不打算付诸行动。同样地,可以问对方,“你是否有计划怎么去进行?”,一旦发现对方有了计划(比如,想好了以什么形式比较快捷不疼痛,或把孩子送去妈妈家后独处时容易怎么做等),务必着手处理(必要时报警、送院让他留院接受治疗)。
  • 如果对方曾经企图自杀,这会是显示他将来可能再做出类似行为的最重要信号。

 

请珍惜生命,给自己一个重生的机会。若有困扰可联系:

心灵扶助协会 (The Befrienders)
热线:03-7956 8144/ 03-7956 8145
www.befrienders.org.my

马来西亚生命线协会 (Life Line Association Malaysia)
热线 :03-4265 7995
http://lifeline.org.my/cn/

马来西亚博爱辅导中心 (Agape Counselling Center Malaysia)
热线: 03-7785 5955 / 03-7781 0800
http://www.agape.org.my

Every Brilliant Thing

“If you live a long life and get to the end of it without ever once having felt crushingly depressed, then you probably haven’t been paying attention.”

“Every brilliant thing” is a one-man show about …depression. It was actually introduced by a friend who subscribed to Befrienders’ page on facebook and noticed the play. And it’s a comedy (the big guy sitting next to me had been laughing real hard) (yes the comedy is about depression), also interactive. It will run till this Sunday, tickets and details are available here. (Spoiler alert: I’m sharing my thought about it, I guess it’s better not read it till you have seen it, that’s if you intend to go for it.)

Firstly it’s the quote above. I noticed I asked myself inside, “have I not been paying attention?” Have I? Have you? Perhaps I haven’t lived long enough (haha). Although I doubt the validity of this quote, I love it still. It reminds me of living mindfully, which is what most people including me lack nowadays.

This spontaneously brings me to my second thought. When the actor, as a teenager, realised how much easily he felt happy as a child. How most if not all of us, when we were little, notice joyful things, act out our joy, feel happy and contented easily and casually. It’s like being happy ‘naturally’ is exclusive for children. When you get into adulthood, you lose that and have to deal with a lot of disappointment, depression, fear, sorrow etc. But why so? Perhaps as an adult we can also appreciate little brilliant thing better? Like having a friend close enough to ask him/her to check if your teeth have got broccoli on them?

Oh yes I forgot to mention that “Every Brilliant Thing” is about this boy who wrote a long list of everything worth living for after discovered that the mother attempted ending her life. So yea, every little, brilliant thing. In no order of preference, the first item was “ice cream”, the 7th item was “people falling over”, the 201th “hammocks”, the 1092th “conversation”, 1655th “Christopher Walken’s hair”. Does such list help? I personally do not think it helps if you wrote it for someone who’s suicidal, but it would be helpful if the person is motivated enough to create such list for him or herself. One of the problems is probably “will she be able to notice?” The mother ended her life still, despite all the efforts of the boy.

Then this Samaritans’ Best Practice Suicide Reporting Tips was mentioned, it’s about what the Samaritans advises journalists on how to report suicide news. If you briefly go through the list, you will probably immediately find out that our reporters do not follow the tips at all, sadly. Yes and each time shortly after a celebrity or a famous person killed him or herself (a widely publicised suicide) the suicide rates peak. (So hey one of the reasons I have stopped reading news, is that they can be really depressing nowadays). Perhaps including some sources of support at the end can be really helpful. In Malaysia, you may call the Befrienders any time 03-79568144/5 or email sam@befrienders.com.my (visit their website here). 

One final thing that made me “nodded” during the show (friend said she noticed I had been nodding a lot – it’s really just a habit, like when I’m giving talks I tend to look for this kind of audience… those who nod a lot!), is when someone says to you “you should find someone to talk to, a professional one”, you think you know yourself best, you know mental illness best, you know it all, why would you need to seek professional help, that person can’t know you better than you do etc. But really, there must be reasons for someone to say that to you, and there really can’t be any harm done for you to speak to someone. Just bear this in mind, don’t get defensive.

I wasn’t happy at all with the show starting really late (written in the email to be there 45 minutes early and the show didn’t start till 30 minutes after its scheduled time, that was really a long wait!). But I do quite enjoy it, consider it my first experience on one-man show (is Derren Brown’s considered as one?).

Must we help/save the person despite his/her will?

I recently called a sister of a new patient to check how the patient had been doing with the medicine and whether his state had improved, and came to know that the patient hung himself that very morning.

I’m not sure if I’m too sensitive, but I’ve received this kind of news considerably frequent in my job, the sister just didn’t sound sorrow (of course some people hide their emotions very well). In fact she later said that it was a relief not just for the patient, but also for the family.

The patient has 4 siblings who are all married with children. Their parents have passed away for few years. He was the only single and he lived on his own. Though the sister went to see him thrice per day, bringing him food and taking care of him. He had suffered from depression for many years, also done ECT quite a few times. The sister always did her best to help him. She said some siblings had given up on him, but she wouldn’t.

Now that he is gone, she just felt a weight off her shoulders. Then she started to wonder if she had done wrong all these years.

If it meant suffer to live longer, do you still want him to live longer? Just because people all should live as long as they can? Or just because you think it’s your duty to help him to live longer? So you would feel better? So you wouldn’t be blamed for not helping him if something happened? You could say that you tried your best? So you go against the person’s will (partially the illness), you save him no matter what?

It is a bit similar to those family members of terminally ill patient who decide and some even beg the doctors to save the patients, but when you really check, a lot of those sufferers would rather leave in peace, stop the pain and the carers’ suffer, than going through all those operations and chemicals and injections and medication and machines, while at the end still leave, in pain and with holes all over the body.

So what’s considered as selfish act here? And what’s considered right? Who can decide it? Who is the one to make the decision?

Related read: Can we allow a severely depressed patient to make the decision?

A supposed-to-be successful and inspiring insurance agent

He became a millionaire in his early 30s, although primarily an insurance agent, he was known with his skills in investing. He had a wife and a daughter. They went on holidays all over the world every year.

In his mid thirties, he got depressed and suicidal, due to stress of work and some other problems. He attempted suicide several times, buying ropes to hang himself, overdosing himself on drugs but was always found early enough to save his life. Perhaps this wasn’t how his life meant to be.

His family took him to temples, hoping that the power of religion could help him to recover. They were told that the money he’d earned was “dirty money” (money obtained unlawfully or immorally). So by instructions, he went to China and donated almost all his money to the temples. At this point, the wife left him. He got even more depressed, he didn’t recover donating his money away.

Recommended by friends, he seek professional help and came to see psychiatrists. After weeks of medications and a course of ECTs, he got better. On the following years, his condition was maintained with medication. He would come to see doctor once he felt unwell. He rebuilt his career and became wealthy again. He even supported his ex-wife financially, although he also soon got married with another woman. Over the years he had had another 2 courses of ECT at times of difficulty.

He even went on press to talk about mental illness. He shared his stories including his suicidal attempts and helped raising the mental health awareness in the public, telling others not to discriminate them, but also encouraging those with mental illness not to give up, motivating them to seek help actively, telling them it’s recoverable, and they have the opportunities to lead a normal and fulfilling life just like him and anyone else!

He wasn’t just a normal successful insurance agent, but also one of the most motivating and inspiring speakers in the town.

Years later, in his mid 40s, he got into some troubles. This time he didn’t come back to see doctor, he checked himself in a hotel, jumped off from the window of the washroom in his hotel room. There ended his colourful short life.

People may think someone as motivating as him couldn’t and shouldn’t end his life that way, but it’s based on a true story. When the illness hits, it really hits, no matter who you are and what you are. Perhaps for cases like this, maintaining on medication and education on relapses are utmost important, including educating patient’s immediate family.

Supports for family members in grief

Sometimes when we don’t hear from a patient for long, we’ll start worrying about them, especially if they are depressed, or worse, with suicidal caution. But too many patients come and go every day in the clinic, it could be difficult to remember everyone.

Sometimes I think we wouldn’t even know if and when a patient ends his or her life, unless we read it from the news or the family member contacts us.

Yes family member does contact us and tell us about the news when it happens, not all the time, but they do. And one main reason they usually call us and inform us regarding the patient’s suicide, is that they want to question us.

“He’s been taking the medicine prescribed by the doctor regularly, how did this still happen?”

“How come the medicine he was prescribed with wasn’t helping?”

“The last time when she went to your clinic, did doctor say anything? Did she say anything?”

Yes, I understand this and that (sometimes I think they just need someone or something to point their fingers at). But we’re only an outpatient clinic, all we can do is not much, though we do try our best including using phone calls or emails to reach and support them in their daily lives.

The sister was in tears when she called. The last time I heard from the sister was almost a year ago. She said he’s gone, their brother, the six sisters’ one and only brother. He jumped off from the balcony of an apartment.

They still couldn’t accept the truth.

And no, she didn’t call to question us, to blame it on us. She called to ask if she and the other sisters should come for an appointment as they are all feeling really low and depressed.

She was explained that they can certainly come for an appointment if they feel the need, but this is part of grieving, absolutely normal for people to feel depressed, guilty, lost, empty, angry … And the duration of this period could be few weeks, or even up to few years (some research suggested 4 years as an average of grieving period after losing a love one). Some people can function absolutely well during this period (though never take that these people are cold-blooded, they just deal with loss differently) while some need to take some time off or even go for professional counselling services or help.

Sometimes it’s the part that we often overlook – the needs of the immediate carers and family members of our patients – alive or dead.