Dirk De Korne, For The Straits Times

My friend's tragic run of depression

-- ST ILLUSTRATION: MANNY FRANCISCO
-- ST ILLUSTRATION: MANNY FRANCISCO

It's time to remove the stigma attached to mental disorders - they are illnesses, not character flaws.

John (not his real name) and I met for the last time a few weeks ago. As usual, we did a weekly jog after work. When we had finished our run, and dried ourselves, he gave me a selfie-stick. He had recently received it at a dinner-and-dance at his work.

Selfie, a self-made portrait of yourself, was chosen as the 2013 Dutch word of the year. My English spelling checker does not recognise the word. Or is that because there is usually at least one other person besides the photographer in a selfie? We might better call it a "wefie".

John, however, preferred pictures of scenery. Or fish. So he happily gave away his stick. But we needed to try it out first. And so what turned out to be my last moment with John was captured in a wefie of the two of us, taken at 8.47pm in parking space 147 at the Botanic Gardens.

Then, Dead Body Found Near Park In Punggol Road, said page 10 of this newspaper on Feb 15. That was the body of my friend. He was 45 years old. He died after an overdose of medication.

On the day of his death, my wife and I had been living in Singapore for exactly two years. We had actually met John before that - in church when we were here for a two-week orientation for my new job. We felt a connection and he even saw us off when we flew home.

That was the start of our friendship. He and his wife made us feel at home in Singapore.

He arranged for a trustworthy housing agent and helped us to find a nice block in Clementi. We shared many meals and enjoyed fellowship in what we called our "238 community", referring to our table number at the Old Airport Road Hawker Centre.

Not everything in his garden was rosy. From his student years on, he had suffered from severe depression. With a daily intake of medication, things could go well for months only to suddenly take a downward spiral. Anxiety and uncertainty came together in his gloomy weeks during which he blamed himself for not taking care of his wife.

One of the last WhatsApp messages that we shared was about jogging: "Hi John, would you be able to run Thursday?"

"No. Anyway, this week I am quite drained so trying not to over exert myself. Some symptoms of anxiety and brain fog showing up. Pray with me."

We will never have a run again. He has finished his earthly one.

Off the tracks

HIS death has called my attention to a topic that I had often been thinking about during my journey with him: the terrible stigma associated to mental illness.

Whenever I asked a taxi driver to take me to the Institute of Mental Health (IMH) to visit John during one of his many admissions, they would look at me twice.

The fact that the buildings are off the beaten track (in Buangkok Green), away from daily life, does not help people to easily understand what is going on there.

Compared to diagnosing and treating bodily ailments, dealing with mental issues of the self are not as straightforward.

Mental disorders are, however, chronic medical illnesses just like heart disease and diabetes. Research shows there are genetic and biological causes for mental illness, and often they can be treated effectively.

Many have told me that Singapore is so stressful that depression must be a result of that. I am not a psychiatrist, but the specific causes of mental illness are not yet fully understood. Stress and factors such as genetic predisposition and abnormalities in brain chemicals are possible contributing factors.

Studies show that mental illnesses are not that uncommon. A 2012 study by Associate Professor Chong Siow Ann and colleagues at the IMH showed that one out of 17 Singaporean adults is suffering from a major depressive disorder.

And in 2009, another study by Dr Alvin Liew and others of 600 children, aged between six and 12 years, reported that 22 per cent of those surveyed indicated they harboured suicidal tendencies.

While medication plays a great role in the treatment of mental diseases, the role of (continuous) therapeutic sessions and social activities is, at the least, important too.

Regulations that enable employers to send their afflicted staff for these sessions in a flexible manner would be more fruitful than full medical leave or hospitalisation as the only options.

A mental illness is an illness, not a character flaw. It has nothing to do with being weak or lacking willpower. Although people with mental illness can play a big part in their own recovery, they did not choose to become ill.

Someone's religious faith can be protective and supportive when it comes to mental illnesses. That was true for John.

On July 7 last year, during one of his dark periods, he messaged me: "I know the Lord will make provision for me and my family. He has holden me by my right hand. But I still can't help feeling anxious. Confused and perplexed."

However, Christians can also be discouraging to patients if they relate mental illness to a lack of faith or a result of specific sins. Mental health is related to spiritual health but the two are not equivalent and the causality is limited.

As Christianity is growing in Asia, more work is needed to develop local Bible-based views on mental health and the relation between medical and pastoral care.

A very good friend

JOHN'S life has taught me that someone with a mental issue can be a very good friend. Yet, at his funeral, I was surprised to find that many seemed to understand so little about what he was going through.

As the Singapore Association for Mental Health (SAMH) advises, we can do much to support our suffering family or friends. This includes: learning about the disorder and the recovery process; being hopeful, respectful, encouraging and supportive; not dismissing emotions.

Understand the person's perspectives and offer hope; encourage the person to seek and sustain professional treatment; do not ignore comments about suicide. Work together with the help of professionals to reduce the risk of suicide; revise expectations and set realistic goals; and practise good self-care.

Former United States president Bill Clinton said once: "Mental illness is nothing to be ashamed of, but stigma and bias shame us all."

If sharing my friend John's story here - with the consent of his family - can be helpful in advancing such understanding, our "wefie" was not taken in vain.

stopinion@sph.com.sg

The writer is a Dutch health scientist working in Singapore.