LET me begin with a memory.  

Last year, I attended a wedding dinner in Singapore. It was a marriage of two dear friends and many guests had travelled from near and afar to celebrate their union.

Weddings, for the most part, are joyous occasions. But the atmosphere that night was scarred by a single text message, received just as the bride and groom walked into the banquet hall. As I scrolled down, the noise dimmed and the air grew thick and suffocating, as if someone had thrown a huge, invisible blanket over the hall.

A childhood friend, someone whom I had known since I was nine, had run away from home that morning and taken her own life in a hotel room.

In the following days, I tried to recall what memories I had of my friend. Ironically, the last time we had seen each other was also at a wedding, where she had been a bridesmaid.

She had appeared happy. I remembered her laughter as we, together with other friends, posed for a photograph with the bride. I remembered how, with a smile that brought forth the characteristic dimple on the left cheek, she asked if we could all go out for supper after the wedding to celebrate.

But there were darker details to my friend’s life – details she chose to reveal only to me and a few other close friends. How, for instance, she had been fighting depression and other issues. How, for the longest time, she had avoided seeking professional help for fear of being stigmatised.

Stigma stops sufferers from reaching out

According to the World Health Organisation, more than 800,000 committed suicide every year, representing a global mortality rate of 16 per 100,000 or one death every 40 seconds.

In the last 45 years, suicide rates have increased by 60% worldwide and experts predict that by 2020, the rate of death will increase to one every 20 seconds.

In Malaysia, the National Suicide Registry reported suicide rates of 1.18 per 100,000 in 2009. However, the data relies on medically certified suicides. Experts believe that unofficial figures could be much higher, as much as 25% more than official figures, since suicides in Malaysia are often not medically certified.

The reason for this is primarily because suicides are often under-reported because of the shame associated with suicide and mental health problems.

In Malaysia, mental illness remains heavily stigmatised.

From a personal and family-related standpoint, our family values and the way we are brought up teach us to judge emotional struggles as “weak” and trivial, instead of accepting and dealing with them in a positive light.

This judgmental attitude also overlaps largely in the public sphere, although certain civil society groups and youth-based groups have been trying to increase public discussion and spread awareness.

Days before she committed suicide, my friend had sent me a text message. She spoke of how it was still hard for her to come to terms with her condition.

“I think I’m struggling more now because I’ve been battling this (depression) for years, and I’m still not well. It takes a lot of effort to make a lasting change, and this year I feel a lot of hopelessness and pointlessness creeping up on me,” she said.

Many people mistakenly believe that suicides happen without warning. In fact, statistics show that most people who attempt suicide try to communicate their distress or suicide plans to someone. About 80% of the time, people who kill themselves have given definite signals or talked about suicide.

But in communities where stigma reduces mental illnesses to a largely “invisible” disease, it is extremely difficult for a sufferer to reach out and ask for help.

This makes intervention all the more crucial. Recognising the warning signs and extending help in a sensitive way may well save a life of a person entertaining thoughts of suicide.

Unfortunately, in Malaysia, the engrained aversion to discuss about mental health issues openly has perpetuated a culture of misinformation and ignorance about mental illness, including awareness and knowledge of support practices.

In her expression of distress, could my friend also have been sending an unspoken signal that she was planning to commit suicide – even a silent plea for help?

I hesitated to confront her that night, to ask if suicide was on her mind. Instead, I tried to offer hope, by telling her that change wasn’t easy but that she had come very far. I encouraged her not to give up, but to keep pressing on for herself and her loved ones.

What was holding me back? Was it a fear of opening up a dark conversation? Or was it sheer ignorance, and lack of awareness that led me to neglect the signs?

Awareness and sensitivity

Two weeks ago, the world reeled from the sudden deaths of Kate Spade, the iconic fashion designer, and Anthony Bourdain, a chef and storyteller.

Spade and Bourdain belonged to a society where, for the most part, there is a culture of openness in talking about mental illness – yet they, too, succumbed to their inner demons, and became part of this dark statistic.

Suicides are the extreme end of the spectrum. In reality, we all struggle with mental health issues from time to time. However, few of us will speak about it because of fear of being judged and scorned. Instead, we decide to bury our emotional struggles and “just get on” with it.

But “just getting on” is a short-term coping strategy, not a long-term solution. As humans, we thrive the most when we are able to relate and be honest about our emotions – whether the emotions be happiness, joy, sorrow or strife.

Living as we do in a community, we should be able to relate to and support those who may be facing mental health issues. While the government’s duty is to ensure that mental health treatments are readily available and effective, true suicide prevention begins at the grassroots level – in schools, at the workplace, within families and households.

The time is ripe to normalise the discourse on mental health issues, by creating more education and open exchanges on mental health.

A good place to start would be for local communities to organise regular forums and discussions on mental health topics, and have informal social meetings, where those with mental health issues can gather to share their burdens and seek support.

Underlying these actions, there must be a collective desire to change the way mental illness is commonly perceived. We need to move away from judging those with mental health issues as strange and unspeakable, towards treating them with empathy – as ordinary people with treatable conditions.

Cultivating awareness and sensitivity will surely be unnatural and challenging at first. But as long as we remain afraid to open up honest conversations about mental health issues, our society will continue to be riddled with stigma – the same stigma that renders us ignorant about how to support others, and keeps sufferers from seeking the help and treatment they may need.

It is only when we as individuals start doing the hard work of shifting the dialogue that true change can begin. I, for one, strongly believe that the current generation is capable of doing this.

For the sake of those whom we have lost, and those who may be struggling in silence, we must take this responsibility seriously. Let us not wait any longer for another tragedy to strike before we start to act. – June 19, 2018.

* Lim Su Lin is a Policy Analyst with Penang Institute in Kuala Lumpur. She graduated in 2013 with a degree in History from Cambridge University. Her research interests lie primarily in psychosocial health and wellbeing. She explores these in the context of making recommendations to improve social and development policies. The long-term goals of her work are to advocate for more equitable outcomes and reduced inequalities in society.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.