Tag Archives: Suicidal

Who are Permission-Givers?

In the News, Issues & Debates

(This is a “follow-up” post on Should you listen to your shrink’s advices? – Do check that out if you haven’t already)

There are some obvious permission-givers, especially when we were young. Like I might ask my mum if I can have the chocolate bar, you might ask your dad if you can buy that toy, we ask our teachers if we can go to the bathrooms etc. So parents and teachers are some permission givers in the early years of our lives (for some, this can last for many more years).

Other than that, we probably seek permissions from different authorities, like when we are applying for visa to visit Russia, applying to cross states in Malaysia during movement control order (MCO), applying annual leaves from the company HR…… In a sense, we are asking for permission to do something too.

There are also some random ones in everyday life, like when a smoker asks if s/he can smoke there, a stranger with a tray of food asks if s/he can share your table in the food court…… So we all can be permission givers too, in minor, unimportant, everyday things.

What is important, is when some doctors, experts in some areas, scientists and researchers are also giving us permissions to do certain things. When food scientists found that there is no direct link between eating eggs and cholesterol levels, they reversed the decision on limiting how many eggs we can eat each day/week, and hence they give us permission to eat more eggs every week, without worrying so much about its impact on our cholesterol levels. Or, when doctors say you should not eat processed food and should do some exercises every week, they are also giving us permissions to do and not do certain things. Similarly, like in my previous post, my client’s shrink advised him to give up studying, this is yet another example of getting permission to quit.

In fact, when your parents swear in front of you, or smoke gracefully or enjoy drinking on the couch, do you realise that they are also giving you (subtle) permission to do so? When some cool kids in the school wear some fancy outfits, smoke cigarettes like an adult, they, too, are giving you “subtle” permission to do the same, to imitate them, to be cool and defiant like them…

Each day, there are a lot of things influencing us this way, affecting what we think and how we feel then how we react to certain things. Have you heard that suicidal acts are contagious? Marilyn Monroe’s death was followed by a temporary 12% increase in the US’ suicidal rates. In Hong Kong, the night after singer Leslie Cheung (張國榮) ended his life, there were 6 suicide attempts within 9 hours. If you look into all the deaths caused by suicide of some important figures and the subsequent suicide rates, you’d unavoidably found the impact of all these front page stories and news headlines.

Yes, them too, are permission-givers. If Robin Williams can do so, why not me? It’s true for a lot who are already suffering and perhaps having depression. This is their way of communicating, not by words. So this sort of permission, is only given to certain people, in certain situations. Not everyone would receive the same message (and permission) the same way. Sometimes, it’s not even conscious.

News about suicides resulted in an increase in an single car crashes where the victim was the driver. News about suicide murders resulted in multiple car crashes in which victims involved both drivers and passengers. Stories about young people committing suicide resulted in more traffic fatalities involving young people. Stories about older people committing suicide resulted in more traffic fatalities involving older people. News coverage of a number of suicides by self-immolation in England, prompted 82 suicides by self-immolation over the next year. The permission given by an initial act of suicide, isn’t just a general invitation to the vulnerable. It is a highly detailed set of instructions to certain people in certain situations.

So what can we do about this?

Be aware of it. Be aware of how you are affected by the news you watch every evening, the CCTV clips that were circulated on the social medias… You could have perceived the permissions, on top of some major life events, hormonal changes, interpersonal issues… It can end badly. But just be aware of this, the possibility of it. Pause for a while if you can, talk to someone if you can.

Please give yourself a second chance. Malaysia suicide hotlines:

The Befrienders
03-7956 8144/ 03-7956 8145
www.befrienders.org.my

Life Line Association Malaysia
03-4265 7995
http://lifeline.org.my/cn/

Agape Counselling Center Malaysia
03-7785 5955 / 03-7781 0800
http://www.agape.org.my

If you come across someone who’s suicidal: https://huibee.com/2020/05/somebody-you-know-is-suicidal/

In the News: Man Jailed for Attempted Suicide

Depression, In the News, Issues & Debates

Quite speechless with things like this still happening in Malaysia:

The Star: Jobless man jailed for trying to kill himself

Instead of providing any direct or indirect help needed, people are being jailed for attempting to end his or her life… I wonder what happens when this person is back in the society.

And what does this sentence serve? To warn people not to kill themselves, and if you really want to do it, make sure you don’t come out alive as you would be jailed?! (*Sarcasm* that really isn’t what I’m trying to say).

Please give yourself a second chance. Malaysia suicide hotlines:

The Befrienders
03-7956 8144/ 03-7956 8145
www.befrienders.org.my

Life Line Association Malaysia
03-4265 7995
http://lifeline.org.my/cn/

Agape Counselling Center Malaysia
03-7785 5955 / 03-7781 0800
http://www.agape.org.my

If you come across someone who’s suicidal: https://huibee.com/2020/05/somebody-you-know-is-suicidal/

Somebody you know is suicidal…?

Depression, Treatment Approaches

COPYRIGHT ©2016 Cengage Learning

Although there is no one best way to approach a situation where suicide may be a possibility, the guidelines that follow may be helpful:

1. Treat the person as a normal human being.

2. Don’t consider the person too vulnerable or fragile to talk about the possibility of suicide. Raise the subject yourself by asking the person directly. For example, “It sounds like you are feeling depressed. Have you been thinking about harming or hurting yourself or committing suicide?”

3. Show the person you care about them even if you don’t know them very well.

4. Help the person talk about and clarify the problem. Those who are depressed may have difficulty pinpointing the problem and may feel frustrated and confused.

5. Listen carefully. People who are considering suicide are in mental and/or physical pain, although you may not be able to guess the type of pain or the source of the problem. Be there to help the person talk about the issue. You don’t need to fix the problem.

6. Suicide is often viewed as the final solution to an overwhelming problem. The person who is depressed may have difficulty sorting out alternative solutions to the problem(s) he/she faces.

7. Encourage the person to seek professional assistance. Crisis hotlines are available in many communities. If an immediate danger of suicide exists, do not leave the person alone. If the crisis seems to be improved for the moment, be sure you have a plan of action regarding professional help before leaving the person. Have the person promise to call you before doing any harm to him/herself. Offer to accompany him/her to see a mental health professional.

8. If the person refuses help, you may need to contact someone close to him/her such as a family member to share your concerns.

9. Maintain contact with the person.

Please give yourself a second chance. Malaysia suicide hotlines:

The Befrienders
03-7956 8144/ 03-7956 8145
www.befrienders.org.my

Life Line Association Malaysia
03-4265 7995
http://lifeline.org.my/cn/

Agape Counselling Center Malaysia
03-7785 5955 / 03-7781 0800
http://www.agape.org.my

N.B. The guideline is adapted from Cengage Learning’s materials. This week I’m teaching Mood Disorders and Suicide in the Abnormal Psychology module. I’m going to tell the students to share some suicidal prevention information, hence I’m also doing this myself.

Aid-in-Living & Aid-in-Dying

Depression, Issues & Debates, Treatment Approaches

I talked about Euthanasia (or “mercy killing”) about two years ago. This is from Wikipedia about the Act in Netherlands,

[…] euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient’s request, the patient’s suffering (unbearable and hopeless), the information provided to the patient, the absence of reasonable alternatives, consultation of another physician and the applied method of ending life.

– Euthanasia in Netherlands

It doesn’t just apply to physical illness, but also mental issues, as long as the criteria (including those abovementioneds and some other) are fulfilled.

Whereas in the state of Oregon, they have Oregon’s Death and Dignity Act (ODDA). The decision will be assessed by at least two qualified psychologist or psychiatrist, that the person is capable of making such decision and to rule out impaired judgement due to psychiatric illness. In other words, people who suffer from psychiatric or psychological illness will be denied of this aid-in-dying, because the illness can cause impaired judgement.

The interesting thing is, when asked, most psychologists and psychiatrists said they are not qualified to complete this death-with-dignity evaluation (1/3), or they will refuse or refer to another colleague (53%).

I mean… psychiatrists and psychologists are trained to prevent suicide (talking about us therapists and clinical psychologists). Doesn’t this Act put clinicians in the Oregon state in a very awkward position, if s/he is called upon to carry out the assessment? They would be thrust into a position of being part of this physician-assisted-suicide…

But then the other thing is also that I always believe that any chronic illnesses, especially those that grow in severity over time, if nothing is done to them, will quite often lead to depression. Be it mental, like suffering from OCD for 15 years or more or Panic Disorder for few months or more, or physical illness like arthritis or cancer, we see that people’s emotional wellbeing and quality of life can really deteriorate over time. So how about the chances of the person having quite severe clinical depression, and hence they will be denied of the aid (in Oregon but not in Netherlands)? Wouldn’t this apply to most if not all of the people who’re requesting for the aid?

In Malaysia “active” euthanasia is strictly illegal. But we’ve heard about animals being euthanised by the vets, by the state governments, by some animal societies etc. The restriction isn’t much (if any), the decision doesn’t seem as difficult (surely still very difficult if it’s by a pet owner but still incomparable to that of a human’s)… Why? Especially when humans decide to do that, most of the time, isn’t it for the benefits of ourselves? (governments can’t let the stray pass the disease, owner can’t see their pets suffer or no longer able to look after it etc).

Please give yourself a second chance. Malaysia suicide hotlines:

The Befrienders
03-7956 8144/ 03-7956 8145
www.befrienders.org.my

Life Line Association Malaysia
03-4265 7995
http://lifeline.org.my/cn/

Agape Counselling Center Malaysia
03-7785 5955 / 03-7781 0800
http://www.agape.org.my

关于自杀的迷思与误解

Basic & General, Depression, Treatment Approaches, ,
  • 问别人会不会自杀，会导致其真的去自杀？

这是很多人担心的。但是根据研究(Mathias et al 2012)，原本有自杀意念的人，并不会因为被问了而更想自杀，除非问的方法本身有问题（比如带有挑衅、取笑意味等）。

很多有自杀念头的人，被以关心的方式问了后反而觉得“终于有人可以和我谈论这件事”。

  • 会叫的狗不会咬人，说要自杀的人不会真的自杀？

研究显示，想自杀的人都曾经透露过与这个念头相关的信息，甚至2007年何金针的一项研究显示，三分之二进行自杀行为的人，一个月前曾求助于专家或助人机构。过半的自杀者在自我伤害前都曾经向他人求助。

当有人表达自杀念头的时候，切记不要将它当成玩笑。

  • 因为怕痛，自杀未遂的人不会再自杀？

这也是错的。多数自杀未遂者、自杀企图者，再次企图自杀，有1%在一年内会自杀（成功）而死，10%在10年内会自杀而死，一辈子来说，有20%的自杀未遂者会再企图自杀而死。自杀未遂后，更需要更多关怀，尤其发生后的三天，到下来的几个月。

自杀未遂者在企图这么做后，更容易有各种身体或心理问题。自杀企图者的平均寿命比其他人短30年。喝酒自伤者容易有消化系统相关的问题，药物滥用者往往与精神疾病有关等等。

Should your therapist give you advice?

Depression, Issues & Debates, Treatment Approaches, ,

“What? Isn’t that what I go to therapy for?”

No… Not really. Psychotherapists and counsellors are normally taught not to give advice (for important decision making) to their clients. We do not want our clients to become dependent on us, instead, we guide them and equip them with the skills to think more rationally, realistically and in ways that are helpful to them.

I remember there are few occasions when clients first came to see me, and they told me about how previous psychiatrists/therapist/counsellors had advised them to do certain things like leaving a boyfriend or a job or moving house etc, how they still ruminating about it today and still don’t think it was the right thing to do. Here, I’m not blaming the therapists or consultants. It’s both ways… Because quite often, clients want quick fix, they want the answer now… And the therapists feel the urgency to help and provide the quick fix.

But there are times when we do give advice, and that’s on severely depressed clients, and on suicidal prevention. We do advice the subject and the family around him/her what to do.

Also, I do provide psychoeducation to family members of most of my severe OCD clients. In a sense, sometimes there are family members who cannot rationalise how they are reinforcing the OC symptoms, then I will just advise them what and what not to do.

So right, your therapist should be there to teach you how to fish (how to solve your problems, how to handle your negative emotions, how to make decision etc), but not to just keep giving you fish. If it’s the latter that they are constantly doing (it’s quite normal to do it in the beginning of the therapy or when your condition doesn’t allow independent decision), at some point you are going to realise that you can’t live without them…