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Musicals for mental health

THIS edition of Merely Playing belatedly commemorates World Mental Health Day, which falls annually on 10 Oct. According to an article in theSun, an estimated 450 million people around the world suffer from mental illnesses such as depression, schizophrenia and bipolar disorder. It added that in Malaysia, some 400,227 patients sought psychiatric help in government hospitals in 2008.

This was an increase of 15.6% over the 346,196 people who sought treatment in 2007, according to a New Straits Times report. The report also cites statistics from the third National Health and Morbidity survey conducted in 2006, which revealed that 19.5% of those between 70 and 74 years, and 14.4% of those between 16 and 19, were more prone to having mental health problems than other age groups.

The report further said that mental illness was the leading factor in the increasing worldwide suicide rate, with one death every 40 seconds. In Malaysia, the rate has increased to between nine and 12 persons per 100,000 people, compared with just eight in the 1980s. The rate among Indian Malaysians was more alarming, at between 30 and 35 persons out of every 100,000.

Some facts and figures, courtesy of the Malaysian Psychiatric Association:

MythYoung people and children don’t suffer from mental health problems.

Fact13% of children in Malaysia aged between five and 15 years suffer from a mental health disorder that severely disrupts their ability to function at home, in school, or in their community.

MythPeople with mental illnesses can work low-level jobs, but aren’t suited for really important or responsible positions.

FactPeople with mental illnesses, like everyone else, have the potential to work at any level depending on their own abilities, experience and motivation.

MythMentally ill persons are dangerous.

FactThe vast majority of people with mental illness are not violent. In cases when violence does occur, the incident typically results from the same reasons as with the general public, such as feeling threatened or excessive use of alcohol and/or drugs.

MythPeople who need psychiatric care should be locked away in institutions.

FactToday, most people can lead productive lives within their communities thanks to a variety of support, programmes, and/or medications.

I have had two close friends clinically diagnosed with bipolar disorder, the more recent of which just weeks ago. In the latter situation, it appeared to be hereditary, as my friend’s mother also has the condition. I remember the challenging times my friend and his father went through as his mother was hospitalised, and how important it was for them to receive the support and understanding of friends and family.

With my friend undergoing the same thing, having to be treated in the hospital for his condition, it makes me once again aware of the importance of social and familial support. More importantly, it makes me realise how necessary it is for one to have a greater understanding of these mental health conditions rather than jump to conclusions and judge, especially when mutual close friends are hurt — emotionally or otherwise — as a result of one’s mental distress.

What is normal?

MythA person who has had a mental illness can never be normal.

FactPeople with mental illnesses can, and do, recover to resume normal activities.

Normality, writes Prof Dr T Maniam in his article What Is Normal?, is a contentious issue: “We all deviate from normal to a greater or lesser extent.” But he goes on to list, broadly, how a regular state of upset can be distinguished from a depressive disorder:

The illness or emotions cause distress to the sufferer and sometimes to others;
There is evidence of dysfunction, that is, an interruption to an individual’s daily activities;
These is an observable scope of deviance, i.e. how starkly the individual’s behaviour differs from his or her regular behaviour;
The individual’s behaviour poses a danger to the self or to others; and
These symptoms have been occurring for a protracted period of time.

“Sadness and distress following the death of a loved one is normal,” Maniam writes as an example; but it is a warning sign if “the bereaved person continues to be severely distressed for years, and daily functioning is compromised.”

Next to Normal

In the critically acclaimed musical Next to Normal, which opened on Broadway in April 2009, a family is tested when the mother is diagnosed as being a bipolar manic-depressive. The musical explores the fallout of the central character Diana’s condition, focusing, as a New York Times review says, on “the pain that cripples the members of this suburban family”, and “gives full weight to the confusion and ambivalence that afflict not only Diana but also everyone around her.”

In the face of wild mood swings, hallucinations and the lure of suicide, Diana goes through rounds of psychotherapy, mood-altering medication cocktails, and even shock therapy. The audience learns that she is haunted by memories, and delusions, of her son Gabe, who died as a child. Her husband Dan yearns for a better life; while her daughter Natalie is bitter as she is overshadowed by both her mentally ill mother and her dead brother. Oy.

Next to Normal, which won Best Original Score
and Best Lead Actress in a Musical at the 2009 Tony Awards

Depressing as it sounds, critics have called Next to Normal a “beautiful” depiction of a family facing the travails of mental disorder. These characters learn that overcoming their troubles would require support, acceptance, and letting go. An exchange between Diana and her daughter Natalie towards the end of the show contains these moving lyrics:

I don’t need a life that’s normal
That’s way too far away
But something next to normal
Would be okay
Yeah, something next to normal
That’s the thing I’d like to try
Close enough to normal
To get by

Most of us go through life feeling “normal”. But let us remember, reflect and strive to educate ourselves on those whose lives are directly affected by mental ill-health, as well as those affected by a loved one with any sort of mental condition.

Nick Choo will tell the story of his other friend who was diagnosed with bipolar disorder in a forthcoming edition of Merely Playing.

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