Much food for thought here

This in­tro­duc­tion to men­tal ill­ness in Malaysia is flu­idly writ­ten and ac­ces­si­ble to a wide range of read­ers.

The Star Malaysia - Star2 - - READS - Re­view by SUBASHINI NAVARAT­NAM star2@ thes­tar. com. my

FOR Malaysians who don’t have to deal with men­tal ill­ness, facts about treat­ments are im­ple­mented through a labyrinthine web of le­gal and med­i­cal ad­min­is­tra­tion and how the at­ten­dant so­cio­cul­tural forces play out in the lo­cal con­text might not be fore­most on their minds.

Hanna Alkaf ’ s Gila: A Jour­ney Through Moods & Mad­ness is a slim vol­ume of per­sonal sto­ries, expert tes­ti­monies and check­list re­sources that brings up these un­pleas­ant facts that most would likely ig­nore.

For ex­am­ple, we learn that Sec­tion 309 of the Pe­nal Code crim­i­nalises a per­son for at­tempt­ing sui­cide, which means, as Hanna states baldly, “if you don’t suc­ceed in killing your­self, you could be ar­rested in­stead”.

Con­sid­er­ing how se­ri­ously the state takes sui­cide, how­ever, one might won­der why a na­tional sui­cide reg­istry lost its fund­ing and ceased op­er­a­tions. Its last recorded data that Hanna cites in this 2016 book is from 2007.

Hanna be­gins the book with a dis­claimer: it’s not a com­pre­hen­sive aca­demic text, but more of a com­pi­la­tion of per­sonal sto­ries from peo­ple who are liv­ing with men­tal ill­ness, in­cor­po­rated with re­search drawn from Hanna’s in­ter­views with spe­cial­ists and med­i­cal professionals within the field.

The book is sys­tem­at­i­cally or­gan­ised with chap­ter head­ings that give the reader an idea of the topic at hand, with each chap­ter pro­vid­ing a vivid de­pic­tion of peo­ple who have experienced all man­ner of symp­toms in re­la­tion to bipo­lar dis­or­der, de­pres­sion, anx­i­ety, and schizophre­nia, among oth­ers, in ad­di­tion to Hanna’s re­search into treat­ments and re­sources about a par­tic­u­lar di­ag­no­sis.

Among the peo­ple the reader meets in this book are Visha, liv­ing with schizophre­nia; Azlan, liv­ing with bipo­lar dis­or­der; Veera, liv­ing with an anx­i­ety dis­or­der; and Tiara, deal­ing with panic dis­or­der and de­pres­sion from the time of pri­mary school, where as a Bangladeshi stu­dent the racism and os­traci­sa­tion she re­ceives at the hands of Malaysian stu­dents and the so- called au­thor­ity fig­ures, the teach­ers, trig­gers episodes from the young age of 11.

Then there is Zed, who at­tempts sui­cide twice, and Kim, who has schizo- af­fec­tive dis­or­der, a com­bi­na­tion of symp­toms of schizophre­nia and an af­fec­tive ( mood) dis­or­der that ren­der her un­able to get out of bed for days at a time.

The peo­ple Hanna in­ter­views also talk about their treat­ments – Azlan, for in­stance, was placed in a psy­chi­atric ward. Kim had to en­dure elec­tro­con­vul­sive ther­apy ( ECT), a process, Hanna writes, that Kim “ab­so­lutely de­plored” be­cause she wasn’t taught how to cope with the ram­i­fi­ca­tions of the treat­ment.

As Kim says, “I’d get up and my head would feel a lit­tle sore, a lit­tle painful, and I’d re­alise that I’d for­got­ten lit­tle things here and there, lost lit­tle pieces of my­self.”

Los­ing pieces of one­self is the key is­sue with ECT, although it seems to be a treat­ment rec­om­mended often enough that another per­son in­ter­viewed in this book, Hafiz, was at one point on the re­ceiv­ing end of 12 to 16 ECT ses­sions a year ( this was after he had en­dured in­sti­tu­tion­al­i­sa­tion, where, un­able to sleep and hav­ing manic episodes, he was beaten with sticks by the staff on a nightly ba­sis un­til he passed out).

The per­sonal sto­ries are har­row­ing, but Hanna’s book re­ally be­comes il­lu­mi­nat­ing when it de­tails the chal­lenges psy­chi­a­trists and psy­chol­o­gists face in a cul­ture that is steeped in reli­gious fun­da­men­tal­ism, bour­geois ma­te­ri­al­is­tic val­ues and “spir­i­tual” so­lu­tions that are far re­moved from the orig­i­nal con­text of an­i­mist or pa­gan forms of be­lief.

This is a toxic mix that means men­tal ill­ness is often ig­nored, ex­plained away, deemed “nar­cis­sis­tic or at­ten­tion- seek­ing” be­hav­iour, or left to the de­vices of char­la­tans of­fer­ing so­lu­tions that are use­less at best or abu­sive and trau­ma­tis­ing at worst.

Sim­i­larly, Hanna’s ex­plo­ration of asy­lums in foren­sic wards for men­tal ill­ness in places like Hos­pi­tal Ba­ha­gia in Tan­jung Rambu­tan, Perak, shows that even mod­ern med­i­cal treat­ments are tainted by a le­gacy of abuse and out­right bru­tal­ity and vi­o­lence.

These clos­ing chap­ters ad­dress the is­sue of the in­sti­tu­tion­al­i­sa­tion of the crim­i­nal and the home­less, which is prob­a­bly vast enough an area to be ad­dressed in a sep­a­rate book de­voted just to this par­tic­u­lar topic.

It is shock­ing and heart- rend­ing, as when we learn that cheap labour is ob­tained from pa­tients in foren­sic wards, who are paid RM1 a day to raise crops on land or RM3 a day to work in the hos­pi­tal canteen.

One of the first fe­male di­rec­tors at Hos­pi­tal Ba­ha­gia since its in­cep­tion in 1911, Dr Ruby ( in full, Dr Ha­j­jah Rabai’ah Mohd Salleh) high­lights these so­lu­tions as a sign of how the hos­pi­tal helps its pa­tients rein­te­grate into so­ci­ety, but one won­ders if rein­te­gra­tion is pri­mar­ily based on the premise of who is able to earn a liv­ing.

Hos­pi­tal Ba­ha­gia also has a ward for the home­less and the el­derly who have nowhere else to go, but there’s only so much hos­pi­tals can do.

As Hanna notes, pro­grammes by the So­cial Wel­fare Min­istry like Desa Bina Diri ( the name be­ing a cruel irony) place the home­less and des­ti­tute – many with men­tal ill­ness – in cage- like rooms with no ac­cess to the out­side for at least the first week of re­mand­ment, mean­ing they sleep, eat, and at­tend to their body’s needs in that one room.

One of the con­di­tions for be­ing re­leased from Desa Bina Diri is the su­per­vi­sor’s ap­proval based on the res­i­dent’s abil­ity to sup­port them­selves; i. e. get a job.

It’s hard, then, to see these places not as re­ha­bil­i­ta­tion cen­tres but as in­tern­ment camps for the non- pro­duc­tively em­ployed.

One won­ders if one of the key so­lu­tions to men­tal health is­sues in Malaysia might be to work to­wards a so­ci­ety with a more just eco­nomic sys­tem where peo­ple don’t have to prove their hu­man­ity by earn­ing a liv­ing first, thereby en­sur­ing that treat­ment of both men­tally and phys­i­cally ill peo­ple are not con­tin­gent on their “use­ful­ness” to so­ci­ety in terms of whether or not they are able to sell their labour.

These are deep and com­plex top­ics that can­not be ad­dressed at length in Gila, but Hanna’s book does pro­vide im­mense food for thought. As an in­tro­duc­tion to men­tal ill­ness in Malaysia, the book is smooth, flu­idly writ­ten, and very ac­ces­si­ble.

It also shows the hand of an editor who has stream­lined this book to be as rel­e­vant as pos­si­ble to many read­ers.

It’s well worth a read and an often dis­tress­ing view of the kind of so­ci­ety Malaysia cul­ti­vates with re­gards to how it treats its most vul­ner­a­ble mem­bers.

Author Hanna Alkaf will speak about ‘ English, Singlish, Man­glish’ at 7pm on Sept 10 at the Black Box in Pub­lika ( No. 1, Jalan Du­ta­mas 1, So­laris Du­ta­mas, Kuala Lumpur). Her talk is part of Cooler Lumpur, a mul­ti­dis­ci­plinary fes­ti­val cu­rated by PopDig­i­tal that includes talks by au­thors. Look out for more de­tails on the fes­ti­val in

Star2’ s Reads pages next week.

Photo: Ger­ak­bu­daya

Gila: A Jour­ney Through Moods

Mad­ness Hanna Alkaf Ger­ak­bu­daya En­ter­prise, non ction

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