Tag Archives: Suicidal

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.

How much courage does one need to jump off a building?

There are various ways people can use to end their lives, but when it comes to jumping from height, it always makes me wonder how much courage it requires to take that step, and do they regret as they are falling down before hitting the ground? Are they terrified? Do they think about going back?

This is the third patient in the past 3 weeks.

The first two both were longstanding depressed patients, both had attempted suicide in their history, so though it was heartbreaking, at least it didn’t shock us as much as the one who chose to jump off from an apartment far away from his house this week.

He had been diagnosed with paranoid schizophrenia for years. Never a negative person, he could function well in work and with family, maintaining with medicine.

Nobody would have anticipated that. Not even his caring sister. And with the method he chose to terminate his life, he does show how determined he was.

So never think that people with depression are the only ones who would attempt suicide.

So never think that those who think about suicide would always mention it before the attempts.

So never think that long-term mentally ill patient without previous suicide attempt are very unlikely to commit suicide.

Also, never think the reason everyone suffering from mental illness end their lives due to their mental illness, there are still various other possible explanations, and suffering from mental illness, is just one of them.

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

She’s gone, on Tuesday (more about this patient here: Depression & ECT).

As written on my previous post (link above), she underwent a course of six ECT and got much better. During the past year, she did voluntary work, travelled around (to South Africa, Japan etc). Every time she came back for follow up and saw me in the clinic, she had this big wide smile on her face, including the last time I saw her, last week.

Past few weeks she’d been calling me a lot, since her house renovation, which put her under some pressure. Then slowly all her negative thoughts came back. Lacking drives, lying down a lot, negative and suicidal thoughts, all returned, like how she was before the course of ECT last year, despite the increase of her anti-depressants.

She started to ask if she should come for another course of ECT. We kept helping and supporting her, and supporting her extended family to support her. Last week she asked again. And finally the consultant psychiatrist had also agreed that she should undergo ECT. When she was told that she could have it, she became hesitant and indecisive again. So she came for consultation and was told that she could take her time to think about it, and if she wanted it, she could call us and we’d arrange it (of course we also arranged what she should/could continue doing every day).

Few days later she rang me in the clinic, telling me she’s feeling much better, just did voluntary work in the temple. She was feeling quite positive and thought she’d make it. So much relief in me.

Few days passed and I was busy. This morning I heard from her cousin. She was gone, with medicine and half a bottle of herbal liquor. When they found her (the patient lived alone in KL, her family couldn’t reach her on phone all weekend long and came all the way from Malacca to see her), she was still conscious, but with white foam coming out from her mouth. They called the ambulance. But the patient refused to get into the ambulance. The medical staff said it’s against the law to force someone into the ambulance, so they left! The patient went back to sleep later and …”rests in peace”, as the way her cousin put it.

Is it right for us to leave the decision of whether to do ECT with her? Should we be the ones who make the decision for her? Could we be the ones?

Is it right for the ambulance staff to leave, just because the person refused to? Despite knowing that she most probably need a stomach washout, is it right that they let her make the decision herself?

Is she capable to make these decisions? She’s severely depressed, despite the medication, could she judge and reason then decide?

Practically I’ve always been told that we can’t really make any decision for patients, all we can do is to explain the options, treatments and procedures to the patients and family (if applicable). But how if they’re single and suicidal, with not much familial support? Are there exceptions? Can we push them to go for ECT?

What a patient learnt from Robin Williams’ death

Got a phone call from a long-standing depressed patient who is now maintaining well with medication, the first thing she asked me,

“Do you know the American actor who committed suicide?” (I personally dislike the phrase “committed suicide”, it sounds like they deliberately chose to do it, like “committed a crime” which I don’t quite agree – they didn’t willfully choose to do it, although it may appear so)

“He’s also suffering from depression [like me], right? Why would he commit suicide?” Back in year of 2004, this patient had had ECT done due to her depressive mood with suicidal ideation. I think she understands how that feels, very well.

“Perhaps nobody has paid enough attention or has realized someone like him, a comedian who brought so much laughter to the world, can be so severely depressed.” I also told her that I didn’t know much about his biography (his personal life, history with addictions etc), that was just my guess, but I kind of think that his death must have triggered a lot of thoughts in the field of mental health.

“Imagine a celebrity like him, with that much of fame, popularity, wealth, well-liked by the world. He, too, suffered from depression [or bipolar?] just like you, and many on the streets. Just that they may not show it, but they may cry alone in the corner in their room, or their symptoms are at residual at this point”

“For mental illness, it’s so much harder [for people to understand and sympathize], unlike high blood pressure, gastric, cancer etc. You get a report, a figure telling you and everyone else that something is not right. It’s like boarding a bus with a plaster bandage after a fractured ankle, people would offer you a seat. If you take away the plaster but still suffer the fracture and pain internally, would people still offer their seat? And if you ask they may even think that you fake it! Being depressed is sort of like this, only you know it best.”

“So I should really not care about what my relatives said [of me taking those medicines] and be so grateful. My depression is all under control now. Occasionally when it hits me I’ll just meditate or do some exercise. My son bought the family this house. All 3 of my children are finishing their studies and doing good…

People may think you own the world and should be so delighted, but deep inside you want to just end your life! So let’s just be grateful, show more love, understanding and respects!”

15/8: A comic of what somebody else learnt from Robin: I want to live.

Leading a Normal Life after Recovery?

Part I:  Teenage Schizophrenia (the same topic person as below)

Few days ago the father rang us. The patient is now in ICU in a general hospital. She attempted suicide taking over 200 tablets of medicine. As she usually wakes up late in the day, so the father wasn’t concerned that she’d been in her room all day. Till that evening when the father was thinking to bring her some food, and found out that she was covered in urine on her bed, and was unconscious.

Over the past few months, she had got so much better with medication, no longer spending all her time pacing in her house, talking to herself or swearing at her younger siblings. Her father was even able to get a tuition teacher for her, and later the patient even requested to go back to schooling. They were looking forward to seeing patient going back to lead some “normal life” just like any other teenagers. The only thing is probably that she’s spending a lot of time looking at her phone (don’t you think this is also a common feature of a “normal” teenager nowadays?!)

Then this happened. She tried to kill herself and is still unconscious. The father could only guess that as the new academic year is starting soon, patient couldn’t manage the stress and intended to avoid it by ending her life. She went to school to collect the text books the day before. The younger sister said the patient asked for a cut blade from her, but she didn’t give it to her.

Quite often we may think that the patient is ready for a normal life once the active symptoms of mental illness is not presented, yet it is very difficult to judge whether or not the patient is ready psychologically, to go back to the society, to face other so-called normal people and function normally just like others.

What can we do about this? What can we do for them? What can family do to get them prepared to go back to the society, if they can ever achieve it?

Depression Following Stroke

His wife came to us after the husband had a stroke. She is very concerned as the patient has had an elder brother who committed suicide after being depressed for years.

She is worried that her husband will do the same as he is currently staying in a hospital doing physiotherapy, being emotionally unstable, agitated, and very bad-tempered. He keeps to himself most of the time, makes no social contact with others, and cannot tolerate the least of any physical discomfort (e.g. sore throat, skin itchiness).

The wife is very keen to bring patient to consult a psychiatrist, yet he is not ready for it at all. If he ever knew that he’s taking any of the psychiatric related medicine he will get so mad. So the wife has been putting medicine in his food and drink. What’s difficult is his poor physical condition, due to the stroke he needs to do a lot of physio, but the medicine is making him drowsy and sleepy. In addition he’s having high blood sugar, high blood pressure and high cholestrol, so whatever kind of medicine that may raise any of these he can’t take it, especially his blood sugar is always sky high.

The wife spends almost 24/7 by his side to look after him. One day their only 15-year-old son made a call to her, saying he missed her and was very anxious about sitting for PMR (exam), he wanted her to pray with him over the phone. The wife decided to discuss with patient, told him to let her to go home and see the son, the patient agreed. However, when the wife wasn’t around, patient went up to the 13th floor of the hospital and attempted to jump down.

When he is okay, he is okay (what kind of sentence is this?). When he’s having a slight of bodily discomfort, he wants to end his life. Nobody really knows what he’s thinking, not even his wife. But he’s very upset and irritated being hospitalized, not being able to earn money and function like normal. What’s worse is his only sister and her family, who lives just next to him but have never come to visit him at all. So the wife seems to be the only connection he has, and when the wife isn’t around, all kind of negative thinkings float in his mind…

“She no longer wants me” “She doesn’t want to care for a sick person” “I’m useless” “Nobody cares about me”

Having a strong supportive family connection is something very essential in the recovery of mental illness. Yet unfortunately he has a brother who left him due to depression, and a sister who lives next to him but built a wall in the middle of two houses.