Thursday, February 26, 2009

Depression: a Crime, a Mental State, or a Disease?

Be forewarned. This is a very long post! ;)
"Mental health professionals and physicians are careful and deliberate when evaluating their clients for clinical depression. It takes more than just tearfulness or a feeling of sadness on the part of the client to indicate the presence of depression." - Quoted from All About Depression website.
Clinically, depression is diagnosed either based on DSM-IV or the ICD criterion. There's a PDF file to refer to (or download) if you want to know more (or if you're brainier than I am and you think I'm not providing you enough to satisfy your 'thirst of knowledge'). :) Basically, both approaches include 8 similar symptoms for diagnosis of depression:
  1. depressed mood
  2. loss of interest
  3. decrease in energy or increased fatigue
  4. sleep disturbance
  5. appetite disturbance
  6. recurrent thoughts of death <- Related to my discussion.
  7. inability to concentrate or indecisiveness
  8. psychomotor agitation or retardation
The ICD-10 has two additional symptoms:
  • reduced self-esteem or self-confidence
  • ideas of guilt and unworthiness (DSM-IV combines inappropriate or excessive guilt with feelings of worthlessness which is qualitatively more severe than loss of self-confidence or self-esteem)
A combination of symptoms above defines the diagnosis of depression. I think that's enough for an introduction. :D

I was drawn upon a newspaper report about labelling suicide attempt (or rather, a failed attempt, since a successful attempt doesn't need us to prosecute the 'offender' because s/he has died) as an offence. The report refers to the NST news article.

First of all, I must admit that I'm not a law geek. So I do not know many points of law. However, as much as I could gleam from that case, I think as long as if one only think of suicidal thought, even plan it, but not actually execute the plan, you are okay (from the point of law). But if you cross the line, meaning actually attempt suicide or execute the plan to commit suicide, and then failed and get caught, condolences (on your failed attempt, and get caught at that) you have just committed a crime!

Secondly, I admit that I'm not a psychologist or a counselor. So, I don't know a lot of things about what I'm going to write next. However, this is my piece of mind. The law enforcers sometime blind in one eye, they forget the one part of a human! Which part is that? The mind and soul. If the law enforcers believe that the law is to prevent or discourage suicide attempt, they should do a lot of mind and soul searching themselves. As A. Asohan wrote, "You need to spend more time talking to people who have given up on life." Yes, you do, and I don't think suicidal people give a damn about jail term! Interesting article by Asohan, I suggest you to read it.

Well, perhaps they will be ashamed to try it again (because of the publicity), maybe even prevented to attempt another suicide (because of the (improbable and almost impossible) 24/7 monitoring), maybe even stop the suicidal thought (because all they want is out of the world, and perhaps prison can be considered otherworld?), in some case, may even be given counseling or religious guide (I think our current prisons have this. I hope.)...

My friend said to me depression is a state of mind (a bad one). Said who? He, a self-proclaimed positive thinker, no offense intended, ;) definitely thinks too lowly of suicidal people. :( Web definition for State of Mind are:
  • a temporary psychological state <- My friend's view.
  • cognitive state: the state of a person's cognitive processes
I don't deny that state of mind (e.g. negative thinking) do contributes to depression, in fact, the biggest cause for depression (Again, I'm speaking from ignorance of psychology knowledge!), apart from external sources e.g. stressful events (usually involves losses e.g. loss of loved ones, income, hope, health, support, and many other things...) or changes, usually things we couldn't control, or at least almost beyond our control.

It is my belief that not everyone has the privilege to have a solid (and positive) state of mind (or mental state), or grows up in the positive environment, or have caring and supportive family/friends/community, life without any worry, etc... Some barely can eat a meal everyday, many loss their breadwinners and loved ones so sudden that hopelessness overwhelms them, workers find themselves suddenly unemployed because of bad economy or unconsidered employers or even due to act of nature e.g. fire... How much stress can we put on ordinary people to push them over the edge?

Many people are having Major Depression and having suicidal thought but only a smaller percentage actually attempt or even successfully commit suicide. Why is that? My (unfounded) opinion is:
  1. They do not have "good" mental state, always in negative thought, which feeds the depression like pouring oil to a flame.
  2. What makes it worse is no one is able to detect it, or rather, no one really look for it. How can someone look beyond the soul and mind themselves? All we can do is to look for circumstantial evidence e.g. the symptoms mentioned above.
  3. Even worser, we alienated them because of the "unattractive behaviour" as projected from the depressive symptoms.
  4. They, of course, due to their "incompetence" to think for themselves, will reject the people around them and become withdrawn, sort of shut themselves from others who try to reach them.
  5. Not all of us have good upbringing. Children grow up in religious or happy or supportive family certainly less likely to become depressive. If the child is happy, sometime money (or lack of it) may not even be a problem!
  6. Religion somehow gives that extra anchor to the mind and soul making one more adaptable to change and endurable to stress.
  7. The teacher/lecturers giving good and memorable advices and good friends' companionship certainly help.
  8. The community can help, if only most of them will not look to lowly of depressive people, or not care-less, or treat any mental condition as something sinful or dirty or beyond their dignity!
  9. If all beyond our ability to help, the professionals and authority can intervene. No, I don't mean put them in the jail. :) I mean counseling and therapy, to stop the suicide attempt before it starts. And more, they can step up the education about mental health so that everyone will know how to detect or to know how, when and where to get help.
  10. Other things we can do are to remove or at least lessen the source of depression. Sharing certainly lessen the burden (physical and psychological) of the 'unfortunate' ones... The authority has the power to do this, the community too, to some degree, friends and family are the best people to share grief or laughter...
In the end, is it a sin if someone does not have a good mental state, where external influence can drive one over the edge? Is it a sin if someone has "incompetent" mind because of bad mental state, causing one to attempt suicide? An act caused by a condition defined as disease, and an incompetent mind drives one to attempt suicide, is there a crime? I would like to say, if and only if, the suicide attempt might also kill others then it is a crime e.g. kill & suicide. Granted, perhaps her/his mind maybe incompetent/crazy, a kill is a crime but an attempted suicide is a disease gone bad (and need help).

Thank you for reading these crap! :D And please forgive my bad English. :) Cheers! ;)

An accurate diagnosis of a mood disorder such as major depression or bipolar disorder requires a thorough evaluation by a qualified mental health professional. This is a first step towards obtaining appropriate treatment.


Uncle Lee said...

Hi KY Chua, nice of you to drop by.
You sure have an interesting posting here.
Wow, I learned something today, scary too.
I guess must laugh more, huh?
Laughter always a good obat, I believe.

You keep well and have a pleasant Sunday, Lee.

KY Chua said...

Thank you. ;)

GregChai said...

i enjoy reading, thanks for sharing :D

KY Chua said...

You're welcomed. ;)

日月神教-任我行 said...
This comment has been removed by a blog administrator.