Tag Archives: Suicidal

Every Brilliant Thing

Basic & General, Depression

“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?

Issues & Debates,

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

Clinical Case Studies, Depression

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

Basic & General, Issues & Debates

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?

Clinical Case Studies, Issues & Debates, Schizophrenia & Psychotic Disorder

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.

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/

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

Clinical Case Studies, Depression, Issues & Debates

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?