On Surfacing A Hidden Epidemic

By: Mitz Serofia

(This speech was delivered during the launching of #MentalHealthPH-Iloilo Chapter last June 30, 2019)

LET Me start off by giving you a simple multiple-choice quiz. I promise I won’t be giving failing marks. I just want you to give your answer as honestly as you can.

First question: What do you think happens every 40 seconds? A) Someone swipes right in Tinder; B) A plane leaves an airport; C) A person kills himself.

Second: Who among these persons most likely has a mental health disorder? A) A 40-year-old housewife; B) A 16-year-old high school student; C) A 27-year-old nurse.

Finally: Who among these persons will most likely die first? A) A person with HIV; B) A person with depressed mood; C) A person with prostate cancer.

Allow me to reveal the answers as I tell you the story of one patient I came to know by the name of Jay, a 20-year-old call center agent. For the past month since we saw him in the outpatient department, he told us he has been feeling funny—he could not seem to understand what he is feeling. He used to be an outgoing person, did well in school, and has a loving single-parent mother. He loves his two younger siblings more than anyone in the world. His best friend, Mica, would say he is as fine as any of their group of friends. But these past days, Jay told us that he finds himself locked up in his room most of the time, living mostly in the “dark of his past”. Having trouble sleeping, he would spend most of the night awake, endlessly scrolling his social media feeds. At times, he would sob out of the blue, reject the calls of his best friend, and cancel his work schedule at the last minute. With an ounce of energy that he’s left, Jay, together with Mica, decided to see us in Philippine General Hospital, a three-hour commute from their hometown in Cavite. Two hours after our interview, Jay was diagnosed to have major depressive disorder.

On that day as well, we also diagnosed a 40-year-old housewife as having bipolar disorder; a 16-year-old high school student as having general anxiety disorder; and a 27-year-old nurse as having schizophrenia. It goes without saying that, indeed, no one is spared from the possibility of suffering from mental illness. It can cut across ages and socioeconomic profiles, and affect even the people that make you laugh and those who care for mental health patients themselves.

We sent Jay home that day with a prescription and a follow-up date. Jay said he is committed to getting well and will cooperate with us to help him get back on his feet. Two weeks later, Mica comes back to the clinic. She signs up for consultation. She goes to us sobbing, as if in a call for help. Mica told us Jay jumped off a building three days ago.

 

Jay was gone, just like that.

 

While still processing the shocking news in a mere second, we were asked by Mica a question that I would come to rekindle every time I see the likes of Jay, “Doc, saan po tayo nagkulang?”

Three days ago, Jay joined 35 others who die from suicide all over the world every day—that translates to someone succumbing to an “unwarranted” death every 40 seconds. Meanwhile, Jay also has gone farther ahead than our other patients with complicated illnesses in the crowded wards of PGH. In the absence of appropriate support—both medical and social—depressed patients like Jay can just take their life the next day, whereas a patient with HIV, for example, as scary as that illness sounds, still has more or less 5 to 10 years left to live a symptom-free life, a comfortable arm’s length away from the devastating complications of AIDS.

I reflected on Mica’s question and began to ask her: “Was Jay taking the medicines we prescribed him? Did he tell his mother about it?” Mica responded, “Pang-isang linggong gamot lang po ang binili niya. Kapos daw po kasi. Ayaw din po niyang mag-alala ang magulang niya kaya hindi niya po sinabi.”

 

“Saan tayo nagkulang?”

 

Jay’s story is a sore reflection of our many inadequacies to help the likes of him suffering from mental illness. Times are changing. But it seems as if we are also at a time of altering contradictions. We’re wealthier than ever, but unhappier than ever. We’re more prosperous but more depressed. We have faster ways to go places or communicate with one another but we’re even faster to complain about it, too. We have more solid data that a mental health disorder is a form of illness, and yet we are also quicker to label it as a form of human weakness. Our health department knows more than ever that half of health is mental health, but they are also more comfortable to allocate a measly 5% budget for it out of a hundred for our health expenditures.

These contradictions have to change. For Jay. For all of us.

Now you might ask, what could have been the cause for Jay’s depression? In Medicine, we were taught that there are different ways of looking at mental disorders. The most popular is the biologic model which assumes that all symptoms are rooted at some dysfunctions of the brain, like a genetic imbalance of neurotransmitters or brain chemicals, and thus are treated medically. Another is the psychodynamic model which looks at cracks in our past that may be crucial to the interactions of our id, ego, and superego. On the other hand, the sociocultural paradigm views symptoms in relation to our relationship with the social structures that make up our life space such as family and loved ones. And finally, the behavioral paradigm which assumes that problematic behaviors have been learned as a result of aversive events and are maintained either because they lead to positive effects or because they avoid deleterious ones.

These notions tell us that there is always the other side of the coin to every story—four sides in this case to be exact. To answer the cause for Jay’s mental illness requires us to understand his totality as a human person, starting from his biology, upbringing, personality, culture, and his social spheres. Sounds like a lot, doesn’t it? And yet many of us are too quick to cast our judgment upon them like we know them inside out. Truly understanding human totality is a necessary element to get rid of our stereotyping tendencies and slowly strip off the stigma that cloaks our concept of a psychiatric diagnosis. This, I believe, is the first step towards creating a mentally healthy environment.

The World Health Organization (WHO) defines mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. Basically, it is not really just about having or not having a psychiatric disorder. But in reality, in our country, if we are to use that definition by WHO, it would mean having to grapple first with the social injustices that we face day in and out, whether at home, school, work, and in our immediate communities.

Let’s take for instance the case of John, a registered nurse in the Philippines. For two years now, John has served as a volunteer nurse in a private hospital, working almost every day but only earning approximately 8,000 pesos a month. No-work, no-pay, no holidays. He said he loves his job, but where patient demands are high and human resources are low, John becomes easily stressed out, now contemplating if he is still willing to do the work he loves any longer at his personal and family’s expense. Is John living a life conducive to his mental health? Absolutely not.

On the other hand, in the United Kingdom, where my sister works as a nurse, well-compensated financially, with leave days and opportunities for professional growth, sending an email to excuse her from work simply because her dog died and she’s mourning, perfectly works. She returns to work the next day with messages of condolences from her colleagues. You see, if she ever did that here, her manager would have probably laughed at her and eagerly gave her a salary deduction.

The contrast between countries is too stark you would think that we really have a rotten system here, but, if anything, this makes us realize that mental health—or health in general—is, after all, a development issue. Until our country builds itself from the rubbles of poverty and the whirlpool of bad politics, the ideal definition of mental health, as in the UK and other developed nations, remains an aspiration. Until that time, John and Jay will have to live their lives wanting acceptance, growth, security and support from the very institutions they grew up in. Until that time, a tooth ache will be better treated than a depressed mood.

Our mental health is a continuum. My sister’s case, John’s and Jay’s represent that. We clearly see one person living her life to the fullest, a person almost losing it, and someone who eventually did. And because it is a continuum, while we all have the tendency to spiral up or down, there are no dead ends. A psychiatric diagnosis, is not the end-all and be-all of things. I know of patients and friends who come out of the experience stronger and wiser, living their life to the full. Being afflicted with a mental illness can be scary but you can only be scared of something you don’t know, right? I hope you understand it better now, so you can turn that fear—whether directed inwardly or out—into empathy. The world needs more of it than ever.

Indeed, these are changing times. With the introduction of the Philippine Mental Health Law (RA 11036), there is certainly much to expect for the improvement of mental health services in the country. But in the same way that the Philippine AIDS Prevention and Control Act of 1998 struggled to curb the rising cases of HIV-AIDS nationwide, the Mental Health Law will most likely share the same fate if we keep this matter hidden beneath physical aches, and we keep on hiding from social scrutiny. A law is only a tool for directed social change—the burden lies heavily upon us to make it work.

Dear friends, what I want—what we all need—is for us to be in solidarity with one another as we fight a hidden enemy that resides in each of us—the myths, misconceptions, false judgments, and stigma we unknowingly nurture from deep within. My talk today has done nothing but served that purpose. I can only wish that the very words I have spoken have shaped or will shape a more deliberate understanding—not just awareness—on mental health and why it is—and should be—everyone’s concern. Remember, we can only fight and defeat a hidden enemy as soon as we acknowledge the fact that it is not. We can hear it; we can feel it, and I guess that is enough.

Dr. Mitz Serofia is a general physician in a district hospital in Aklan. He is part of the Global Shapers Community-Iloilo Hub and founder of Project KaleidosCOPE, a youth-based mental health program.