Fighting and understanding the Woodbridge stigma

from http://www.singaporeangle.com/2007/02/fighting_and_understanding_the.html

"He is a leprous man, he is unclean," says Chapter 13 of Leviticus in the Bible.

Science has proven leprosy to be nothing more than a chronic infection of the Mycobacterium leprae. This puts leprosy in the same league as illness such as tuberculosis, pneumonia, strep throat and sinusitis, which are all bacterial infections. Of course, such knowledge was not available at the time the book of Leviticus was written, thus resulting in the stigmatization of leprosy and discrimination against lepers.

Mental illness probably suffers the same fate as leprosy. Modern science has proven mental illness to be biological disorder of the brain. In fact, as the term itself suggest, it is an illness, and not some mysterious condition. With proper treatment, most mental patients do recover and can lead perfectly normal lives. Yet, even in a modern country like Singapore, mental illness is still generally viewed with a discriminatory attitude.

Part of the problem could probably be attributed to history. In the past, those suspected to be afflicted with mental illness would be sent to an infamous place called Woodbridge Hospital. I have not seen the actual grounds, but from pictures and some of the structures that have been preserved at the current Institute of Mental Health (IMH), the place resembled more of a maximum security prison rather than a hospital. This probably stigmatized mental illness by giving the perception that mental patients are dangerous and need to be locked up with the tightest security possible. The term Woodbridge also became a local derogatory reference term for mental illness.

Having interned at IMH for three months last year, I managed to learn a lot more about mental illness. The most important realization that I took away from my internship is that those who suffer from mental illness suffer double compared to other diseases. The reason is because the sufferer is tormented in the brain but shows no physical symptoms, unlike many other diseases. This leads to the people around the sufferer to make mistaken assumptions, such as thinking that the person is just "acting weird" or throwing tantrums. Instead of providing care and support, those around the sufferer may very well deride or ridicule the person, adding to the misery of the illness.

Mental diseases are not just confined to the stereotypical image of a violent person with a chopper who goes around hacking people for no reason. There are a wide range of mental disorders, such as anxiety disorders, mood disorders, eating disorders, impulse control and addiction disorders and personality disorders. Not everyone who suffers from mental illness is going to go around hacking people with a chopper.

Not only is mental illness misunderstood, the severity of its impact on society is also underestimated. Illnesses such as cancer, heart diseases and diabetes often hog the limelight, perhaps because these diseases are quickly fatal if left untreated. However, in comparison, the societal burden of mental illness is greater. Mental illness is usually not fatal, but it incapacitates the person, making the person unable to function normally. Not only is the person unable to contribute to society, that person has to be taken care of by society until the end of his/her lifespan. Barring the onset of other diseases, those suffering from mental illness can probably live as long as any normal human being.

According to the World Health Report 2001 issued by the World Health Organisation, four of ten leading causes of disability worldwide are neuropsychiatric disorders, accounting for 30.8% of total disability and 12.3% of the total burden of disease. In the same report, it is predicted that depression will become the second leading cause of the global burden of disease. In addition, major depression is often linked to suicide, and if we take suicide into account, the burden associated with depression becomes much greater.

In Singapore, it was found that 16% of Singaporeans struggle with some form of mental disorder. While the figure is not a cause for alarm yet, it should be a cause of concern. Our employment landscape is changing, with job insecurity on the rise, even for well-educated professionals. It was highlighted in parliament earlier this year that there is an increase in older PMETs (professionals, managers, executives and technicians) being retrenched. This is a potential cause of a future increase in mental disorders such as anxiety and mood disorders. The middle class squeeze is also another potential cause.

The good news is that mental illness is treatable, with good rates of success. The U.S. based National Alliance on Mental Illness states that "70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports." With an appropriate treatment plan tailored for the individual, the impact of mental illness can be mitigated enough for the person to "find a satisfying measure of achievement and independence." In fact, the earlier the diagnosis and commencement of treatment, the better it is for the mentally ill because it can potentially prevent undesired consequences such as suicide.

Data from the World Health Organization indicates that in 2003, Singapore had 346 cases of suicide, of which 214 were males and 132 were females. The highest rates of suicides for both genders were in the working-age groups. While it would be a stretch to conclude a causal link between the workplace and suicide, there is perhaps some correlation between workplace stress and suicide. Prolonged period of stress can lead to depression, which can in turn lead to suicide. While early intervention might not prevent every case of suicide, at least some cases can be prevented, particularly in cases where stress has degenerated into a critical psychiatric condition.

Mental illness is also not properly understood in the context of crime and punishment. A relatively recent case saw the courts increase the punishment for a person who was diagnosed as suffering from mental disorder. It appears that the stigma of mental illness has led to a denial of its existence as a genuine medical problem. While it is not in the interest of this article to delve into an in-depth discussion of mental illness and the law, perhaps some recognition from the courts that mental illness is a valid mitigating factor can help in reducing the stigma on mental illness.

What can Singapore do to address the issue of mental illness? The Health Promotion Board already has a mental health education programme in place. Local media have given a fair amount of relatively unbiased coverage on the illness. However, the stigma of mental illness still persists. Job applications typically require applicants to indicate if they have had a history of mental illness. Few companies have policies in favour of employing people with mental illness. The root of the stigma indeed runs deep.

Reducing the stigma of mental illness is a long term battle. Given that our society has already come to develop some commonly held misconceptions of mental illness, it would be a delusion to think that the problem can be eradicated easily. A starting point of the long term battle could be in education. The Ministry of Education (MOE), with advice from IMH can develop a comprehensive education package on mental illness, just like how the sex education package was developed. In educating the young with facts about mental illness, they will grow up with the right knowledge about mental illness, which in turn will bring out change in how society will view mental illness in future.

In addition, the Singapore National Employers Federation (SNEF) and the National Trade Union Congress (NTUC) should take the lead in de-stigmatizing mental illness. The SNEF can encourage employers to adopt a more friendly policy towards those who have suffered mental illness, while the NTUC can help those who have suffered mental illnesses to find jobs and defend them against discrimination by employers. Since the SNEF and NTUC play big roles in the employment landscape in Singapore, their support in the fight against discrimination of mental illness in the workplace would have a more lasting impact than any non-governmental organization's efforts.

In order to successfully combat the stigma of mental illness, aside from understanding the very nature of mental illness, the next and perhaps the most important step is to give those who have suffered and recovered from mental illness a chance to prove that they too are productive individuals like any other "normal" person. Perhaps a parallel can be drawn to the popular story of Christopher Columbus.

Had Columbus not been given the chance to set sail, people would not have known that the earth was round, and not flat as previously assumed. Similarly, if we don't give people who had recovered from mental illness a chance to work, we will not know that mental illness is just but a treatable disease, and that these people are just as capable as anyone else.

Acknowledgements:

Many thanks once again to the writers of SingaporeAngle for providing insight comments, as always. Special mention to Bernard Leong as well for reminding me to finish up this article that had been put on the backburner for a while.