A few days ago, a good friend called me up to inform me that she had just tried to kill herself, unsuccessfully. She woke up that morning wanting to kill herself, and so she looked for her father’s gun, or a bottle of sleeping pills that she could overdose on. Fortunately she couldn’t find the gun and also failed to find sleeping pills.
I told my friend keep in mind that her desire for self-termination is a temporary one. It will pass. I told her that it’s the result of a major depression and that, if she just holds on to life for the next 24 hours, we’ll be able to find a doctor that could help her. And thank God, we did.
She is now under treatment for major depression under the care of a psychiatrist. This column is dedicated to her and others who are struggling with the same situation.
One serious flaw in Filipino culture and society is the long-standing notion that people who are mentally ill should be laughed at or feared. This produces a stigma towards mentally ill patients that discourages them and their loved ones from seeking treatment.
As a result, people with mental illnesses get worse—and if they happen to have major depression, they can end up dead from suicide.
We Filipinos, in general, have to learn that mental illness is simply that: an illness that requires treatment. Getting depressed says nothing about a person’s character, self-worth, competence or inner strength.
Filipinos’ overall ignorance about mental illness is creating a health crisis. According to the website of the Natasha Goldbourn Foundation (a private organization dedicated to helping persons with depression):
“The Philippines has the highest incidence of depression in Southeast Asia. In 2004, there were over 4.5 million cases of depression reported in the Philippines. Three per cent of Filipinos are clinically diagnosed as depressed. Of the ninety depressives, only thirty will seek help. The other thirty will suffer the symptoms but will be ashamed to seek help, because of the stigma associated to the illness. These symptomatic would rather keep it to themselves and suffer in pain and in silence. The other thirty will suffer the symptoms not knowing what is wrong with them.” (“What is Depression?” http://ngf-hope.org/about-depression/what-is-depression/)
Here are some other interesting data on depression, from the World Health Organization: 1) Depression is one of the ten leading causes of the global burden of disease. It is ranked at number three as of 2004 and projected to go up to number one by 2030; 2) Depression affects some 121 million people around the world ; 3) Around the world, an average of almost 3000 people commit suicide every day; 4) For every person who completes a suicide, 20 or more may attempt it.
People living with chronic depression or bipolar disorder are not “weak”—in fact, they could be stronger than others because they are dealing with daily torments that might break so-called “normal” people.
Going beyond “Sisa”
Filipinos’ stereotypical notion of the “sira-ulo” or “luko-luko” is forever linked to the Jose Rizal’s novel “Noli Me Tangere” where the character Sisa goes insane after losing her two sons. She laughs one moment and cries the next, walking and wailing through the town, calling out her sons’ names.
Notice how this brings to mind a thousand bad school plays where student actors wail, “Crispin!”… “Basilio!” With such a stereotype for mental illness, it’s no wonder that Pinoys are generally clueless or amused by the “sira-ulo.”
Classic Filipino filmmaker Gerry de Leon even made an entire movie on Rizal’s Sisa character, eponymously titled Sisa in 1951, starring the great Anita Linda. De Leon won the award for Best Direction while Anita Linda was declared Best Actress in that movie. Clips of “Sisa” are on YouTube: http://www.youtube.com/watch?v=GZBTIV6WOB4
Crispin and Basilio—the sons of Sisa in the 1951 film “Sisa” by Gerry de Leon. Now we can really ask, “Where are you, Crispin? Where are you, Basilio?” as we wonder who these child actors were.
But you see, most people with mental illness are not like Sisa. Most of them are not like the taong-grasa, who are suffering from schizophrenia and chronic psychosis. Most people who struggle with mental illness look perfectly normal. Many of them may not even know that they have depression or bipolar mood disorder.
Some of them—I kid you not—are celebrities and politicians. Believe me, if you know the symptoms, you can just look at how these people are behaving on television and you can tell that they need medication.
Hollywood stars like Jim Carrey, Sting, Catherine Zeta-Jones and Ben Stiller have been open about having bipolar disorder. Personally, my best bipolar idol is none other than Princess Leia:
In the Philippines, we’ve had a few movie stars admit to having depression or bipolar disorder, including Snooky Serna, Cita Astals, and Lyka Ugarte.
The apparent “normality” of people with mental illness is what makes suicide surprising to the victim’s relatives and friends. Most of them had no clue that their friend or relative was already suicidal.
Depression, especially major depression that leads to suicide, is an illness. There’s nothing to be ashamed of if one goes through it. Should a diabetic be ashamed of his diabetes? Of course not. It’s the same with depression.
Depression is a medical condition that can be treated, ideally with a combination of medicines and psychotherapy. If you suspect that you or a loved one is depressed, do not hesitate to consult a mental health professional—usually a psychiatrist or a clinical psychologist.
You may ask, what’s the difference between the two? A clinical psychologist is trained to treat mental illness using psychotherapy techniques. Usually a clinical psychologist is not licensed to give drug prescriptions. A psychiatrist, on the other hand, is a medical doctor who prescribes medicines and also uses psychotherapy techniques.
Some experts are of the view that combining psychotherapy and drugs is a more effective means of treating major depression and other mental illnesses.
I would lean towards that view: going by my personal history, taking medicines for major depression is an effective and much faster treatment when dealing with a suicidal patient. Psychotherapy is slower but a patient still needs it to learn ways of coping with the mental illness in order to prevent future suicide attempts.
Deciding/attempting to kill oneself is really a sort of acute psychosis. This is why timely intervention is important. Since it is acute, it can be intense, sudden, yet short-lived. There’s an impulsive quality to it.
Being able to intervene in time—preventing or stopping the suicide attempt–is crucial because once the acute psychosis passes, the desire for self-harm, for self-termination, also passes. Then further treatment with psychoactive medication and psychotherapy is possible–and necessary to prevent future suicide attempts.
Sometimes, the universe, luck, God, fate, etc. intervenes. As mentioned in my friend’s case, she tried to kill herself using her father’s gun that she knew was somewhere in the house. She couldn’t find it. Thank God her dad was at least very responsible about keeping the gun out of reach.
In another case, the patient, a male college student, was in his dorm room, already poised to stab himself in the chest with a big-ass pair of scissors–when a close friend of his knocked on the door.
I was raised as a Roman Catholic, and while I am not really devout or religious, I believe that both that male college student and my friend are alive today because of fortuitous circumstances arising from God’s grace.
Suicide First Aid
When a loved one or a friend tells you that he or she is considering suicide, how do you respond? To know what to do, you need to get the Philippine “Suicide First Aid Kit”. It is now available from the Foundation AWIT:
You may download this suicide first aid kit—essentially a brochure of important guidelines—from the Foundation AWIT website at this link: http://www.foundationawit.com/project3.1.html It’s a PDF file with an English and a Tagalog version.
What if a friend or a loved one tells us that he or she wants to kill himself or herself, or has actually attempted it—and we have no immediate contact with a psychiatrist? The best, most immediate option is to GO TO A HOSPITAL E.R.
Whether or not the patient has actual injuries from the attempt, go to the E.R. Any suicide attempt is considered a medical emergency, whether there are injuries or not. So, go to the E.R. if you or a loved one has made such an attempt.
Uncontrollable thoughts of self-harm or suicide, plus weeks of insomnia, lack of appetite, feelings of isolation, unhappiness and despair–all of these are signs that a person has a major depression that could be fatal. So if you (or a loved one) are experiencing all these, yes, it’s a good idea to go to the E.R. as well.
After emergency treatment, getting admitted to the hospital for a major depressive episode is a wise move.
In the hospital, nurses are alerted to the patient’s sucide attempt and they will be put on Suicide Watch. This is a standard monitoring process where the patient is routinely checked at 15- or 30- minute intervals to make sure the patient does no self-harm and makes no further suicide attempt.
If possible, go to a hospital E.R. that has a resident psychiatrist (not all hospitals have one)–two hospitals that definitely have resident psychiatrists at the E.R. are The Medical City and St. Luke’s. I don’t know about the others.
I have done that, myself. During one of a few episodes I had 6 or 7 years back, I was on my way to work when I suddenly had uncontrollable thoughts of self-termination. I called a psychiatrist-friend and was told to go to the E.R. I went to St. Luke’s Medical Center in Quezon City. I was given an anti-depressant and allowed to stay in the E.R. until the episode passed. I went to my psychiatrist at the soonest opportunity.
You think you’ve got problems? Try having your mind go off on a wild ride to oblivion while you observe yourself, helplessly, as you climb up the stairs of the LRT, with a dispassionate intention to jump off the station.
Strangely, a person in the act of attempting suicide might not be feeling anything at the moment. The person doesn’t even think of whether what he’s going to do will be painful or not. He’s just dead inside. He’s on auto-pilot. All he has is a matter-of-fact, an almost routinary, rather dull resolve to get it over with.
To those of you who know what I’m talking about and have lived through it: we are survivors. Don’t let your survival, your new chance at life, amount to nothing. You survived for a purpose. A purpose greater than your pain and your suffering.
We all live. We all die. You are a survivor. Make the rest of your life count.
For help in dealing with depression, you may call the following hotlines:
HOPELINES (Natasha Goldbourn Foundation) at 0917-572.HOPE (4673); 0917-558.HOPE; 0917-852.HOPE; 0917-842.HOPE; (+632) 211-1305; (+632) 211-4550; or go to the Natasha Goldbourn Foundation website at: ngf-hope.org
In Touch Community Services: (+632) 893-7606; (+632) 893-7603;
Dial-A-Friend (+632) 527-1743; (+632) 525-1881