In this month’s Real Talk segment, we have decided to talk about a topic that has been frequently discussed in the past few months: mental health.
The nation has recently been startled by several attempted suicide cases which has given rise to a myriad of discourses regarding the necessity of acknowledging mental health issues in Malaysia. With increasing pressure to decriminalise attempted suicide, many people are urging society to normalise discussions about mental health and break the stigma of it being a shameful matter. According to the National Health and Morbidity Survey 2019 (NHMS), 424 000 Malaysian children are experiencing mental health issues, indicating that they are most likely suffering in silence. Deemed as the “hidden epidemic”, the increasing rates of untreated mental illnesses in Malaysia are affirming the expectation of it being the second largest health problem in 2020. Hence, this article will be shedding some light on how mental illnesses have come to be socially stigmatised.
Perceptions Regarding Mental Health Throughout History
Although we have always heard the recurring justification for the lack of mental health awareness being social stigma, we have never truly delved deeper into discovering why such stigma exists. Hence, in order to do so, looking back at our precedent perceptions concerning mental health is essential to comprehend our societal beliefs that have been shaped by those before us.
Throughout history, mental illnesses have commonly been differentiated into three categories: supernatural, somatogenic (biological), and psychogenic (psychological). In the early times, mental illnesses were mainly attributed to supernatural origins, with the belief that possession by demonic beings, curses and sinful conduct were the main reasons one suffered from them. This is the first incidence where we see that people blamed those suffering from mental health issues for their illnesses, truly believing that it was a burden they would deservedly have to bear. Hence, those who diverged from the social norms were usually labeled as evil and defying the goodness of society, a common case of “us versus them”, as they would collectively shun out those they deemed as an outcast due to their mental health issues. This is the start of the stigma around mental health.
During prehistoric times until the Middle Ages, those who manifested abnormal behaviors were believed to have been controlled by evil spirits or gods, as they would be taking actions against the common religion. As a way of treating this, they would perform trephination, the process of creating an opening in a person’s skull to release them of the evil spirits, which would then make them return to their normal behavior. A 13th century text also expressed the idea that trephination administered on epileptics was beneficial as it would let out the humors and air which would then evaporate. This procedure was not only painful, but it could also cause brain damage, infection, blood loss, hemorrhages, and death. Greek, Hebrew, Egyptian and Chinese cultures also believed that mental illnesses had supernatural causes although their treatment methods were different. They practiced the act of exorcism, which is often depicted in horror media today, which included prayers, flogging, starvation, noise making and ingestion of bad tasting drinks to drive the “evil spirits” out. Repentance was also regarded as a method that would cure them of their “evil”.
The belief that mental illnesses had biological causes emerged with Hippocrates’ (460-377 B. C.) theory that mental illnesses arose from brain pathology and could also be caused by hereditary factors. He theorized that mental illnesses were a result in either deficiency or excess of humors. Plato seconded this notion and declared that the mentally ill were not at fault for their behaviors so they should not be punished. Although this notion clearly supported the normalization of mental health discussions by treating it just as seriously as one would a physical injury, this acceptance soon faded by the late Middle Ages. With the rise in plague and famine, people attributed these disasters as the devil’s work, so any abnormal behavior was instantly correlated to superstition. Common conditions during this time were group hysteria (mass madness), lycanthropy (the belief that one is possessed by animals, resulting in the imitation of their behavior), and tarantism (the uncontrollable desire to dance and jump). This was one of the main justifications for the persecution of witches, who were believed to be possessed by the devil.
With the development of the humanist movement, The Renaissance showed more humane ways of treating the mentally ill. A prominent figure would be Johann Weyer, a German physician who publicly denounced witch hunting practices, which contributed majorly to its decline. The emphasis on psychological factors led to the emergence of asylums, refuges for those who required mental health care. Although the initial intents were positive, they soon began to degrade into inhumane treatments akin to jailhouses or torture houses. An example of this would be London’s Bethlem Hospital (also known as Bedlam) where patients were chained up and put on display for tourists.
As we progressed towards the Reform Movement, mentally ill patients were seen to be treated with more dignity and empathy as the conditions of asylums bettered and they were more accepted in society. In the 20th and 21st centuries, the psychological concept was further consolidated with Freud’s theory of psychoanalysis to treat hysteria, which was a major phenomenon in those times.
However, some of these negative perceptions have still been retained within society, leading to individuals fearing to speak up about mental health. Supernatural themes are still evident until today, with people blaming mental illnesses on demonic powers, resulting in them seeking out ineffective treatments and further contributing to the social stigma. This can still be seen in the Malaysian society whereby people are resorting to treatments from shamans known as “bomohs” due to strong cultural beliefs.
Looking back at history and its inhumane treatment towards those who are mentally ill gives us a better understanding as to why our current society is so reluctant to speak up about mental health. It does show us that we have progressed as a society, but it should still serve us as a lesson about how we may regress if we do not continue addressing this issue.
Misconceptions About Mental Health Disorders
Even though we have come a long way from the Freudian stigmas and public humiliation associated with mental illnesses, there are still skepticisms and misconceptions about the legitimacy of mental health and its treatments. Let us shine a light on some common myths about the apparent monster under our bed, that is mental health.
Myth 1: People with mental illnesses are considered weak and defective, they can ‘just get over it’ if they try harder.
Mental illness is not a sign of weakness, nor is it a condition that someone chooses to have. There are many causes that contribute to mental health problems. For instance, instead of just genetic influences, it can be caused by a physical injury or disability, and even life experiences such as trauma or a history of abuse. Putting things in perspective, instead of mislabelling them as weak and defective, they show a mark of strength and perseverance against incredible odds in their lives. Instead of discriminating and shunning people with mental health disorders as “chronic underachievers”, what they need instead are encouragement and support.
Myth 2: Seeking help or treatment for mental illnesses is shameful and a sign of weakness.
With the negativity that has always been connotated with mental health issues, many people with mental health problems suffer in silence and are reluctant to seek the help that they need. This stigma also creates self-doubt and shame in people as they fear being labeled with a mental illness and mistakenly believe that their own condition is a sign of personal weakness, or that the individual should be able to control it without help. However, seeking counseling and getting the proper treatment can help them to gain insight and education on identifying and reducing symptoms or irrational patterns of cognition that may interfere with normal daily functions in their life. This can also help an individual to overcome destructive self-judgement and rebuild their self-esteem through recovery.
Myth 3: All people with mental illnesses cannot live a normal life and they are not able to keep a steady job or take care of a family.
This may be true only for more severe forms of mental illnesses, but the majority of people who are suffering from mental health problems can be high functioning and manage to live just as active or productive lives as others, while meeting work requirements and fulfilling their responsibilities for their families. With effective treatments, such as having the right medications or undergoing psychotherapy, it can further result in lower absenteeism and increased motivation and productivity.
Myth 4: People should be afraid of those who are mentally ill, because they have a propensity to be violent and unstable.
Only 3% to 5% of violent acts are attributed to individuals with a serious mental illness. The proportion of people living with mental health problems who are violent is extremely small, in fact, factors such as drug and alcohol misuse in people are more likely to cause violent behaviour. People with severe mental health issues are 10 times more likely to be victims of violent crime than the general population. But, many people are worried about seeking help because of the fear and stigma of being perceived as violent and dangerous.
Myth 5: People develop mental health disorders because they are not spiritually strong enough.
In Malaysia, there is a strong cultural perspective linked with spirituality. If an individual develops mental health problems, they are assumed to be weakly rooted spiritually. However, anybody who rationalizes that mental health is determined by the level of spirituality an individual possesses, truly does not have the sufficient knowledge to understand what mental health is. Mental health problems do not discriminate based on our religion or how spiritual we are, it affects everyone, even children. Although the exact origin of most mental illnesses is not known, ample amounts of research showed that many of those conditions are products of the interaction and combination of biological, psychological and environmental factors.
Why Are People Afraid of Speaking Up about Mental Health?
The meaning of an ‘illness’ refers to deeply rooted attitudes and beliefs a culture holds about whether an illness is ‘real’ or ‘imagined’, and has real consequences on whether people are motivated to seek treatment. Mental health may not be culturally recognized as a ‘real’ illness, and may be treated as something that does not exist, especially in Asian countries. The smorgasbord of mental health disorders are disregarded as merely ‘life’s ups and downs’. People may be afraid to come forward about their mental health disorder, because no one may take them seriously and they may be waved off as being ‘attention-seeking’ or ‘dramatic’; and it is so common to avoid incorporating the topic of mental health in everyday conversations. In many Asian cultures, there is a lack of mind-body dualism, but mental illnesses are just as every part real as physical illnesses, which can be incredibly serious and potentially life-threatening as well. Thus, it is just as important to start treating the symptoms as early as possible. For instance, the treatment for diseases such as cancer does not start when it reaches Stage 4. The same goes for mental health conditions where treatment for depression does not start when the individual is suicidal and on the edge of a cliff, nor anxiety where treatment starts when the individual is already experiencing panic attacks.
At the same time, cultural stigmas and lack of understanding mental health in Asian families prevent young people from speaking up and seeking help. There always has been a renowned brand of shame and pride in many Asian communities. This shame disallows us from speaking about our mental health with our family because it is perceived as immensely degrading, and our pride builds a facade upon shame for those outside the family. This particular behaviour is called ‘hiding up’. According to a psychologist, Ben Tran, hiding up is a dangerous combination of hiding your mental illness from the community and not seeking treatment for the illness itself as well. As a consequence, we are told to follow the unspoken rule of ‘putting on a good face’ and taught to bury our feelings deep down to maintain social respect and our reputations, rather than bringing these conversations about mental health to the forefront. This is why people refrain from speaking up about their mental health issues, to shy away from the cacophony of judgements and criticism, and the notion of bringing dishonour or embarrassment to the family; as there is always criticism and judgement going about when someone comes forward with mental health issues, which leads to further stigma and discrimination.
On the contrary, it is arguably understandable why parents in the Asian communities do not see why mental health disorders are more complex than just another obstacle in life. A large proportion of the problem is rooted in the cultural stigma where mental health disorders are also seen as a sign of weakness of character in many Asian countries. Just like how good achievements are reflected positively on the individual and on the family, having any form of mental health issues is associated with failure on both the individual and the family lineage. A person’s social standing is binded to the reputation of the family; and their actions are a reflection of the family’s parenting. Therefore, most parents may develop a mentality that their children are just not being grateful and appreciative of their parents’ hardships and sacrifices enough. But, most children are also profoundly aware of their advantageous circumstances compared to their parents, which makes it harder to reach out to their parents because they might disregard their feelings as invalid, and won’t get the treatment they need. Therefore, parents and families need to disconform to the cultural stigma and start listening empathically to their children when they are crying out for help.
Speak Up & Speak Out
Despite the countless progression, work and efforts in raising awareness and infringing light upon mental health, there is still stigma and judgement surrounding it. This stigma is so deeply ingrained and entrenched in Asian culture, it is not surprising that we are afraid to talk about it because judgement and criticism are unlikely the reaction we need when we are trying to get better. It is also onerous to change the minds of many and unlearn something we have experienced for such a long time. However, judgement from others almost always stem from a lack of understanding, rather than information based on facts, and people fear what they do not understand. Thus, every small step in destigmatizing the topic of mental health and helping to educate others, be it through movies and shows, support groups or even starting by speaking up about mental illnesses, can make a colossal difference.
Due to the stigma associated with mental illness, many are hiding up, struggling alone and living in silence about their mental health disorders. This prevents them from seeking the right treatment they deserve, which can lead to dire consequences. The healthcare system has also long separated physical and mental health. But it is time for us to change that, by speaking up about how we feel mentally, can have a tremendous effect on how we heal physically. Opening up about mental disorders is the most effective way of fighting the stigma around it. The more people who share their experiences, the more people will be educated about mental illnesses and understand what they really are. Nonetheless, more acceptance will flourish and courage will be instilled in others who are facing similar situations.
Speaking up about mental health disorders is an action that is not in any way related to the concept of weakness, instead it takes a lot of courage from an individual. Hopefully, together, we can all continue to raise dialogue within our community and change the cultural perspective and awareness towards mental illnesses. The goal of speaking up about mental health disorders is not to change the act into something that is not courageous for anyone anymore, but more so, an act that everyone can be courageous enough to do.
If you find yourself struggling with your mental health and need assistance, please do contact any of these hotlines:
Sunway University Crisis Hotline: 018-3893220
Befrienders Hotline: 03-7956 8145, firstname.lastname@example.org
Sols Health: 6018-664-0247, email@example.com
Life Line Association Malaysia: 03-42657995, firstname.lastname@example.org
Relate Malaysia: email@example.com
All Women’s Action Society (AWAM): 03-7877 0224, firstname.lastname@example.org
Malaysian Mental Health Association (MMHA): 03-2780 6803, email@example.com
By: Julia Rosalyn and Lynn Hor