When I was doing my master back in the uni, I remember one of the presentations I did was about substance induced schizophrenia. That was just about 4-5 years ago, but I can’t quite remember the details, though I’ve always remembered that one of the triggers of schizophrenia was illicit drugs, I had a diagram in my powerpoint showing how much it contributed to the population with schizophrenia and related illness.

After starting to work in the clinic in KL, I’ve encountered quite some patients who have had a history of taking ecstasy pills or other drugs and have led to psychotic episodes. For the majority of them, their family members took charge and managed to stop them from continuing taking illicit drugs (by stopping them from mixing with so-called “bad friends”, moving to different or new environment, cutting off their finances, threatening to cut off their relationship with the subject etc).

Recently I’ve had this big man, who has had a long history of taking aramine and ecstasy pills, and is seeing the psychiatrist for his anxiety (no, he didn’t show signs of psychosis). He once told me that everyone has their way to release stress, some people go exercise (like me), some go shopping, some watch movies, some do gardening, some just need a good sleep, and for him, he hangs out with his friends, singing karaoke, and… taking pills, spending their nights high. During Chinese New Year, he could be drugged for over a week continuously. Though on normal days, he works, he goes gym (hence he’s called big man, as he’s not just fit, but muscular – like a staff always says, he doesn’t look like a typical drug abuser), he looks after his wife and children. Oh yes, I didn’t mention that he has a family. The wife is lovely, supportive, and all good qualities you can expect from a traditional Chinese woman.

Each time he tries to quit the pills, he would experience a moody state which lasts for two to three weeks, with fears, insomnia. Normally the psychiatric medicine that he’s taking will bring him back to normal and functional. The last time I heard from him after Chinese New Year, he said this round he would definitely quit it, he would stop seeing those friends (I later learnt that it’s much harder because one is actually his business partner), he wouldn’t want to have relapse again and again, and he doesn’t know when those drugs are going to destroy him (his brain/mind), and his family… because the wife said if he takes it again, she’s leaving him (I still remember he said “妻离子散”, such powerful words). I believed what he said, for I know how much he loves his wife.

On last Monday I encountered a motor vehicle accident and had to take the day off. On this very day, big man’s sister called up to the clinic saying that he was really unstable, as the wife brought the kids back to her parents’ house, big man was threatening to cut his wrist (which he did later on). The family members were advised to admit him to psychiatric wards in general hospital. On Thursday when I was at work, big man came with his father (who is also our patient but is in good remission and maintaining with a minimal dosage). The wife called to tell me what had happened this week. She said big man has become really paranoid and delusional recently, always suspecting that she is unloyal to him. On the Sunday before, he went outstation with his business partner (aka one of the bad friends), and spent the night being high, and had called her on 5am, questioning her about the man she kept, threatening that he would do her harm when he came back later. On the next day, he beat her up after being really angry for “what she has done behind him”. That’s the day she had to run away from him with the children, even after he sliced his wrist twice, she didn’t go back, she knows the children’s safety is the utmost important and her husband is not her husband anymore.

What the man presents, is what we call Morbid Jealousy, or Othello Syndrome (an old case study here). He was never delusional or paranoid during the years he was seeing us. He was just having anxiety and fear over some life issues, and is a perfectionist. I believe morbid jealousy is related to paranoid schizophrenia or other psychotic illnesses, and so I can’t help thinking the links between his history of substance use, and the development of his morbid jealousy. From a lot of cases that I have observed, suffering from schizophrenia or other mental illness don’t usually make your partner leave you, quite often the partner can even tolerate morbid jealousy despite how frustrating it can cause and how destructive it is to the relationship; but being mentally ill, having addiction yet refused to go into rehabilitation, and beating wife, that’s the bottom line for any woman, I believe.

N.B. this post was written in March 2016. According to the sister, big man passed away jumping off from a building at the end of March, after calling the wife and speaking to her.