Shame is a terrible thing.
It forces us to hide who we are, what we have and how we feel.
It scares and it scars.
It makes us think that people are looking at us and judging us, when very often, we don’t realise that they may be struggling with their own inner demons. It fools us into thinking that the opinions of other people matter more than our own opinion of ourselves.
That fear is insidious and it is poisonous and it is all around us.
In Singapore, one in every seven of us will suffer from a mental health condition at some point in our lives. Yet look around you: Of all your friends and family members, loved ones and acquaintances, how many do you know have shared openly about their mental health journeys?
That’s because together with that shocking statistic comes another grim reality: Of all of us who have a mental health condition, three-quarters suffer in silence. That’s right, three in every four people who have a mental health condition don’t do anything about it, often until it’s too late.
Part of it is to do with a lack of awareness – some people don’t realise that they are clinically depressed, for example. But the same 2016 Singapore Mental Health Study by the Institute of Mental Health (IMH) gives the other top reason that those with mental health conditions do not seek treatment.
They are worried about the stigma.
Physical illness versus mental illness
We don’t seem to have this same problem sharing when we fall ill physically. We can easily share with our friends and colleagues that “Oh, I have the flu” (or more accurately nowadays “oh I got three days MC cos I’ve got a sore throat and the doctor gave me a Covid swab.”).
That’s because in our social norms, it has become acceptable to talk about such conditions.
A lot of it is to do with education. And the stories that come with it.
For example, back when less was known about cancer, patients were often shunned because people thought that it was contagious (it is not). Nowadays, those who have been diagnosed with cancer, while still acknowledging the seriousness of the disease, often feel safe enough to share their condition with friends and family.
The illness is “the enemy” and the support group rallies around the patient against it.
(On a side note: We need that same level of education and acceptance for HIV-positive people. The science has advanced but the social stigma remains, say some advocates.)
Not so for mental “illnesses”. Too often, we see a person with a mental health issue and we ostracise them as “other” – we don’t differentiate between the condition and the individual.
Stories have power
How we talk about mental health conditions matter. Transparency is key but too often we fall for titillation instead. The stories that we hear are the stories that shape our understanding of the issues.
The stories that we hear in the news sometimes over-sensationalises the mental health aspect, especially in crime and court cases.
How many times have you read that a person guilty of ill-treating their domestic helper was “depressed”? Even in the recent tragic death of Myanmar national Piang Ngaih Don, it was reported that her employer Gaiyathiri Murugayan was diagnosed with major depressive disorder and obsessive compulsive personality disorder, “both of which substantially contributed to her offences”.
Headlines like this still catch your attention. And you might remember how Shunfu Mart’s “sovereign woman”, who was charged with flouting circuit breaker restrictions, was remanded at IMH for observation.
Titillating no doubt, but stories like these do no favours for those who want to have a frank discussion on mental health conditions.
As Anita Fam, president of National Council of Social Service (NCSS) says: “We believe that the media is and can be instrumental in influencing and changing attitudes and behaviour, educating and encouraging people to think differently about mental health, and to be aware of the problem of stigma associated with mental health conditions.”
“Even if the news is about a person in distress or a person who seemingly displayed outrageous behaviour, he or she is still a person, and he or she deserves dignity and empathy instead of discouragement or embarrassment.”
Or as Club HEAL programme coordinator and Beyond the Label ambassador Sumaiyah Mohamed explains: “Often, stories with a stigmatising headline do not make the reader empathise with people with mental health issues or highlight their strength after struggle. Even if the news is about a person in distress or a person who seemingly displayed outrageous behaviour, he or she is still a person, and he or she deserves dignity and empathy instead of discouragement or embarrassment.”
In other words, let’s flip the script on talking about mental health conditions.
That’s why it is great that organisations like the Resilience Collective have set up photography exhibitions to share stories of mental health recovery through visual imagery. And why sites like The Tapestry Project publish personal journeys of those who are learning to live with depression.
And also why we at The Pride focus so much on telling positive stories of those dealing with mental health conditions.
Words have power
I have to confess. Even after 20 years in journalism, I am still guilty of being insensitive when trying to use the correct terms sometimes. I often find myself googling what is the right way to refer to a particular group of people and some of my friends (you know who you are) have become used to random texts from me asking “eh, is it okay to refer to this group like that ah?”
That’s because the language of inclusivity is constantly evolving. When I told a friend that I was writing something about labels, she excitedly sent me a link to an excellent article on people-first language versus identity-first language.
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Here’s a quick TL:DR (although I urge you to read it in its entirety). “People-first” language means you say something like “a person with diabetes” rather than “a diabetic” or “a person with schizophrenia” rather than “a schizophrenic” or heaven forbid, “a schizo”.
“Identity-first” language put the condition before the person. For example, a “deaf person” is the preferred term to use rather than “hearing-impaired”, largely because many deaf people do not consider their lack of hearing a disability so much as it is a description.
But this comes with a big caveat: It is probably best to ask the person involved how they would like to be addressed. For example: “Person with autism” or “autistic person”? That’s another discussion altogether.
Complicated right? So usually I fall back to my tried-and-tested advice: “Dunno? Just ask lah.”
We have the power to change the stories
But sometimes we don’t get the chance to ask. Sometimes we don’t get to speak with a person from a particular group who can tell you their preference on how to be addressed. That’s why it is good that NCSS recently released a guide on the words and phrases that should be avoided when talking about mental health conditions.
The guide is meant for journalists and those who work in media but it is a very useful (and readable!) resource for any one of us.
Han Fook Kwang, Editor-At-Large at The Straits Times says in his foreword to the guide: “The problem with stories that stigmatise people is that readers stop looking for the whys and hows because they have already formed their stereotyped views. When this happens, it not only harms the person being reported on but is also a great disservice to the reporters’ otherwise good work.”
The essence of journalism is story-telling. It reflects the current condition of our society, but it should also espouse an ideal to which we should aspire to. In other words, journalists should tell stories of what we are, and what we hope to be.
Executive director of Silver Ribbon (Singapore) Porsche Poh says that more people will come forward to seek help if the conversations on mental health are done in a more positive manner.
“If you keep linking mental health conditions with crime, it is less likely for people to want to share openly about personal challenges in case the public draws negative conclusions. Conversely, if there are more positive reports, for instance, an individual with a mental health condition becoming a successful leader in a sector, that may lead to a positive spiral and encourage people with mental health conditions that they can lead a productive life,” she explains.
As Beyond The Label ambassador Jeremy Chan tells me: “When one has come into a better place, sharing is a form of catharsis, a release of the strong emotions through the recovery journey and caregiving. But even more so, sharing encourages and gives hope to those walking in similar darkness, to let them know that they are not alone.
“The more we share our own experiences, shame around being a person with a mental health condition, or as a caregiver to one, slowly goes away. It’s okay to be not okay.”
It’s my hope that one day, our society will mature to a level that we can say to our family or friends that “hey, I’m not feeling too good mentally. I think I should check myself in to IMH for a stint to get back on my feet”, or “I’m going through a tough time and I think I need to see a psychiatrist”, with the same equanimity that we have when we say “hey, I think I have food poisoning, I’m going to see a doctor.”
No shame or stigma involved. Simply “I have a condition. I’m going to get it looked at. It’s going to be okay.”