Hidden Mental Illness

Some may have hidden mental illness
By Teh Jen Lee

ABNORMAL behaviour by their loved ones, such as insomnia or paranoia, has prompted more families here to seek help from their doctors.

Psychiatrists welcome the move because sometimes these patients, who suffer from 'hidden mental illness', may not even know that they need help.

The possibility of such situations was highlighted recently in Hong Kong when a man threw his niece from a high-rise apartment before leaping to his death.

Hong Kong police said that the man could have a hidden mental illness as he suffered from insomnia.

Doctors say that family members and friends who notice abnormal behaviour can raise the alert to counsellors or psychiatrists before the affected person's condition becomes worse.

Dr Ang Yong Guan, who heads the Action Group for Mental Illness, has seen an increase in the number of family members who come to see him because they are concerned over the strange behaviour of their loved ones.

He said: 'Family members have come to see me first to describe the affected family member's behaviour. If, from history, it's very clear that he is suffering from a condition, we would advise them on what to do.

One case a month

'In the past, I would see a case like this once every few months, but now it's at least one case a month.'

Commenting on the Hong Kong case, he said: 'I think the key phrase is 'hidden mental problem'. Insomnia was a symptom of something not quite right. What the diagnosis is we don't know.

'However, if he didn't tell family members, they would not have known. Sometimes, people don't have any symptoms at all. I call this hidden morbidity - you're sick, but you're not aware that you're sick.'

He has come across people who have paranoid disorder, but they are not aware of their illness or they deny they have an illness.

'By virtue of their paranoia, they blame others. So they don't see the problems in themselves. That's more worrisome. They walk around with paranoid thoughts and beliefs. They have no insight into their illness. They are like walking time bombs.'

He gave the example of Mr Soh Eng Sim, who was diagnosed with a paranoid disorder 10 years ago.

Mr Soh, who published a book last year entitled Returning Home about his experience, only came to acknowledge that he had an illness after extensive efforts by his friends and ex-colleagues to reach out to him.

For example, they arranged a dinner with Mr Soh and invited Dr Ang along so he could make a quiet assessment of Mr Soh.

The increase in family members and friends coming forward for help could be due to more awareness of mental health issues, said Dr Ang.

He added: 'Early intervention has borne much fruit. For example, we would do a house call to talk to the patient. We may not mention that we're psychiatrists; we just say we're doctors.

'Creativity is involved in engaging such patients to help them realise that they have a problem and need help.'

Another psychiatrist, Dr Lionel Lim, has seen a similar increase in family members seeking help.

'Compared to 10 years ago, awareness has increased. So I see about 15 to 20 per cent more family members stepping forward to ask for help. It's a good thing,' said Dr Lim, who has been a psychiatrist for over 20 years.

Don't draw conclusions

But it's important that family members do not interpret the symptoms and draw their own conclusions.

'Those conclusions may not be accurate. For example, someone staring out of the window may be interpreted as sad. But it could be all sorts of things.

'While it's good for them to come forward, they should refrain from interpreting the symptoms. Just report the facts,' he said.

And of course, nothing beats having the person himself come in to seek help.

Dr Lim said: 'Ultimately, I think the fear of seeing a psychiatrist is greater than actually talking to one. Once we can overcome the first fear, the rest is not that difficult.

'Many people don't mind talking to a counsellor or a psychologist. But whether it's a counsellor, psychologist or a psychiatrist, the key to treatment lies with whoever is in the best position to help the person.'

Mr Joachim Lee, director of Tampines Family Service Centre, which provides counselling services, has also seen an increase in the number of pro-active family members.

Mr Lee said: 'Last year, we saw at least 20 such cases. The year before, it was about 10 to 15. More are coming in concerned that their loved one is acting strangely or harming themselves.

'When they come in, we teach them some self-care methods - how to help themselves and their loved ones. We also try to arrange a meeting with the affected person. If medical help is needed, we give them psychiatrist contacts.'

This story was first published in The New Paper on Jan 17, 2009.