Not all doctors are prepared to manage mental health illnesses. Let alone family members. I knew at least a few doctors, my own batch, who once said, ‘nak sgt mati, terjun je lah’. To them, mental health is all just in the head and that what these patients are experiencing are merely pettiness and poor resilience. It is very difficult for this particular group of doctors to accept that these people are suffering physiologically as well. It takes an empathetic doctor to sit with this patient and explore the symptoms. In a fast-paced world with medicolegal implications lurking around the corner, empathy can be hard to train.

I have always thought that it is brave for someone to admit that they are unwell mentally and seek help for it. People with depression have anhedonia. They have poor appetite and sleep quality. It is not because they are not trying, but because something is always in the way of their recovery journey. A patient once described that she was actually ready to leave the world by paying off all her debts and decluttering her things. She noticed that the duration of her low mood got a bit longer than usual. It was no longer during the premenstrual period but almost every 2 weeks. Not only that, she was experiencing uncontrollable bursts of rage from time to time over small disputes happening at home and at work. She was beginning to hallucinate. It was either her name being called or doors being slid open when they were not. Or doors being closed shut when no one else was at home. She forgets things easily and tells the same stories all over again. But then at other times, she sometimes wonders if the things she knows about a person or an event are really true or if the ideas were something she conjured in her monologues before, and accepted by the brain as a fact. This went on for at least 6 months.

At one point, she contemplated the least painful way to die as she felt that her support system had crumbled. She felt that her husband was slowly pushing her to the edge so that SHE would be the one filing for divorce to get out of the painful marriage. The spouse also kept the kids close to him, probably as an attempt to win their favour in case there is a battle of custody. Not knowing that she was prepared to give it all up in return for her life. Every behaviour is deemed a nuisance and unnecessary by the spouse. Soon, heartfelt conversations are no longer shared because the patient doesn’t feel safe and supported. Everything just comes back to her for either being ‘stupid’ or ‘weak’. As a result, the partner would narrate the situation to the kids, in what he thought was a harmless manner, portraying the patient as an incompetent mother who has no brains to figure things out on her own.

The last time I met her, she was still refusing to start her meds as she felt she could still manage her emotions and that she could still function at work. She said she just needed someone to talk to without passing judgment. She is also refusing a CT Brain – I wanted to eliminate as many organic causes as possible. She was confident that if there was anything wrong with her brain, she would experience relentless headache and nausea. Or her limbs would just give way.

I hope that her resilience and protective factors would shield her from self-harm or suicidal attempts. I am rooting for her to still have a chance to have a seat in Heaven in the Hereafter.