Madness and the Media
For many years, while driving past the south side of the moat on my way to the Airport Plaza, I have been intrigued at the sight of the huge building that is called SuanPrung, It’s rare to ever see anyone in the garden or the car park in front of the building, which, for me, adds to the eeriness that psychiatric hospitals have held over me ever since I visited a suicidal friend who’d been sectioned back in the early nineties. A physical impairment causes sympathy in me, while a mental impairment causes confusion and puts me on edge. I am probably not the only one out there who becomes awkward or is ill at ease when in the presence of someone who has obvious mental problems. Is it the danger aspect? Is it being conscious of the ‘psychopath’ that is on TV and in the papers? Or is it just not knowing how to react or communicate?
For most of US, we have only experienced the wards of psychiatric hospitals vicariously through the media — One Flew Over the Cuckoo’s Nest, Twelve Monkeys, Beautiful Mind, or more horrifically, Frankenstein (90’s version), Silence of the Lambs and Session 9 (although you don’t see patients in this film, the feelings evoked by a disused ward and voice recordings of patients, is enough to give anyone nightmares). It’s easy to see how derogatory names like ‘Looney Bin’ and ‘Funny Farm’ came about. It’s also easy to see where our innate fear, distrust and lack of sympathy come from.
Beautiful Mind and One Flew Over the Cuckoo’s Nest, while not exactly degrading psychiatric patients, still portrayed them as ominously dangerous — not to mention the frightening tyranny of the doctors and treatment methods they use. I suppose that is Hollywood and I shouldn’t expect anything but easily digestible super sensationalism. Even though I decry Hollywood, there’s no doubt it’s done a number on me. And so it was with these scenes, prejudices and generalisations lurking in my head, that I went to visit SuanPrung to see for myself if the place was a chaotic mad-house full of seminal fluid marksmen, paranoid geniuses and ego-maniacal murderers.
I was introduced on arrival to Dr.ParitatSikpakit, deputy director of the hospital. I was half expecting to meet a bespectacled, serious looking man with a grey beard — another generalisation. The doctor looked very youthful and had a boyish smile, so I was surprised when he told me he’d been working at SuanPrung for twenty years. The hospital was first built in Lampang seventy years ago, and moved to Chiang Mai eleven years later. It is the only one of its kind in the North of Thailand, though there are clinics scattered around the provinces where SuanPrung’s doctors regularly visit to check on out-patients. There are 600 beds in total, and at this moment in time, 500 of them are in use. The place is much bigger than I first thought. The building you see from the road is only the facade of an enormous 50 plus rai plot of land that houses many buildings, shaded rest areas and land for the cultivation of plants and vegetables. Woman and men are separated, and there are also buildings for patients who can afford the thousand baht a day cost for private care. “Do you have seclusion wards?” I asked. “Yes, for patients who are dangerous, we put them in locked areas and they are supervised.” “Are many patients dangerous?” “No, only about 15% are under strict supervision all the time, and those are mainly new arrivals for their first few weeks. Violence doesn’t occur often, and when it does we can easily deal with it without the help of the police.” You got the distinct impression that the doctor felt he had nothing to fear from his patients, even as he told me that a man was admitted two weeks ago for bludgeoning his wife to death during an epileptic fit.
“It’s different in the west,” he went on to say, “mental illnesses have different ways of manifesting themselves depending on cultural variances. In many cases in Thailand if the person is depressed or very stressed, the illness takes a somatic form; maybe the patient feels sick and can’t eat. Many of our western patients display violence as a manifestation of the condition. It is the norm in the west to express emotion outwardly, while in Thailand we tend to hold things in; not lose face. It’s sometimes hard to treat western patients just because of the cultural differences, which affects the way they deal with mental illness.” The doctor told me that few patients were foreigners (only two or three at a time), most of whom stopped taking their medication on arrival in Thailand, or not replenishing their supplies during travel. He also explained that some westerners find it hard to adapt to such a different culture, and the anxiety of being abroad can lead to depression, especially when everyday responsibilities, such as work and family are taken away; “this can lead to too much time on their hands to do nothing but drink alcohol and sleep. Some of our foreign patients have problems with the women over here – they misunderstand the girls or are taken advantage of.” A recent foreign patient of his had been committed to the hospital after violent outbursts in public and a subsequent attempted suicide. His Thai girlfriend had run off with another guy.
Social Stigmas and Buddha’s 12 Steps
When DrParitat started the job 20 years ago, no one would go near the position. He ascribes this to the stigmas behind mental illnesses and spiritual ramifications, such as belief of spiritual possession and fear that a mental hospital would become a breeding ground for ghostly entities. Since he started the job he has dedicated his time to developing the hospital and improving awareness of mental disorders throughout the north. The problem as he sees it is that many people in Thailand, especially in the countryside, are ‘mental illiterate’. In the past, people would diagnose a mental illness as a karmic defect or sometimes a spiritual possession. “We would go around all the villages in the north trying to locate people who needed our help; 10 years ago, we would find someone who had been locked in a cage or a small room in nearly every village. The locals would use traditional methods to cure them, like offering gifts of chickens and wine to the spirit so it might release the victim from a demonic grasp. It’s taken years for us, travelling from village to village to help these suffering people and educate the elders.” That’s a macabre thought, an autistic child imprisoned like a captured animal and the villagers running around his cage holding squawking chickens to the sky. Whoever said electrocuting the brain was disturbing?
DrParitat’s team of 200 nurses and 14 doctors have, over the years, through training seminars and visiting villages, managed to greatly improve awareness and it is unusual for such archaic methods to be used these days. “We have clinics in the villages now; not only do we take care of the in-patients in SuanPrung, but we travel out to the villages regularly to visit out-patients, as well as train medical health workers throughout the north on how to spot mentally ill patients. The wards in the hospital are separated into a two-tiered system – geographically, and by age or illness – if a doctor looks after, say, the Lamphun patients in the hospital, he will also take charge of the out-patient clinics in Lamphun.” Since the Princess’s son, Phum Jensen, returned to Thailand with autism, awareness of the disease has grown considerably. Before Phum tragically drowned in the Tsunami in 2004 there were screenings throughout Thailand for autism. Inexplicably, the doctor has found that most cases of autism occur in wealthy families. I mentioned to the doctor that, paradoxically, mental illnesses are often only a luxury of the middle and upper classes, while he hypothesised that the idiosyncratic behaviour of autism might have something to do with the child’s parents coming from similar intellectual backgrounds. It’s no secret that upper class families usually breed with members of the same class; but can this lead to autism? The Autism Society of America makes no such claims, only that, “There is no known single cause for autism, but it is generally accepted that it is caused by abnormalities in brain structure or function.” In the UK in 1966 statistics show that only 1 in every 2,222 children were autistic compared to 1 in 110 in 2004, although research in ’66 was not what it is today, scientists still believe that autism is on the rise, and no one knows exactly why.
30% of patients in SuanPrung are there because of alcohol and drug addiction related illnesses, while another 50% suffer from depression and anxiety – often encumbered by alcohol abuse. I was shocked to hear that so many patients were in because of drugs and alcohol. I am still a member of the old school opinion that if you aren’t barking like a dog you are not in need of psychiatric care. I had also spoken earlier with DrPairatBuksachalikunakorn, associate professor of Psychiatry, CMU. He was very adamant that Thai society was failing to integrate into the modern, materialistic world. “The move from the country lifestyle to the urban lifestyle has had a very negative effect on our people, which is why we are seeing many cases of depression, stress and alcoholism.” Both doctors blamed alcohol as ‘a quick fix’ to a deeper underlying problem, and went on to say that alcoholism was rife in the north and a main culprit to the causes of mental illnesses. Hearing this I thought of the trendy, subliminally sexy beer ads at the cinema and the ubiquitous sponsoring of alcohol in sports. The people of Thailand; the world in fact, are up in arms about drug abuse, which in comparison to alcoholism is infinitesimal, and yet drinking is still a right of passage. Why no war on booze? It must be that small matter of the billions of baht generated through alcohol that line the pockets of the already loaded, who incidentally, are all very pally with the smug politicians who are selling these hard-line ethics…oh yeah, and the fact that the people who are telling you what is right and wrong to put in your body don’t mind a tipple, either. There are help centres for alcoholics, an AA in McCormick hospital helps mostly westerners. Doctor Pichai of the Military hospital in Bangkok has been working on developing the 12 steps programme with a Buddhist approach. There are also websites and help centres in the states that incorporate Buddhism into the twelve steps. A site I found by Rod Butcher had the twelve steps translated. 1. All life contains suffering and unsatisfactoriness (Buddhist) – we admitted we were powerless over alcohol, that our lives had become unmanageable (Christian). Following Buddha’s Noble Eightfold Path translates something like the Christian’s giving yourself over to God deal. The doctor did say that meditation is being used at the hospital as a treatment; most Thais already know how to meditate and it helps considerably in diminishing mental conflict. But as doctor Pairat of C.M.U pointed out, Thais are becoming more and more materialistic. Personally I find it hard to believe that people would give up their possessions when you see every day how much emphasis is put upon owning cars. Who’s going to give up their brand new Toyota Vigo 3.0?
“Some of our patients have at one time or another attempted suicide; they come here when they have failed,” added DrPairat (CMU) who had told me prior to visiting SuanPrung that the suicide rate was rapidly on the increase in Thailand, especially with men aged 20-25. The rate in Chiang Mai, Phayao, Lamphun and Lamphang is three times higher than the rest of Thailand. Both doctors agreed that one of the reasons was a consequence of rapid cultural, political and social changes inherent in this area. “Attempted suicide is higher among women,” said DrPairat, “but successful suicide is higher in men.” According to ManoteLotrakul of the department of psychiatry, Mahidol University, hanging is by far the most common way of committing suicide, closely followed by the consumption of agricultural chemicals. Suicide was at its highest during the economic depression in 1999 when the unemployment rate went up to a staggering 5.3%, compared to the 2% in ’96. It’s thought at this time that over 1,000,000 Thais lived below the poverty line. Although the rate of suicide fell in the new millennium, DrPairat said it is now on the rise again. The only psychological autopsy study in Thailand was done in the Chiang Mai province. A part of Manote’sarticle, a survey conducted by Tantipiwatanaskul and Visrutratana, revealed that the five most common precipitating factors are HIV infection (20%), alcohol related problems (18.7%), marital discord (17.8), illness (17.8) and financial problems (15.8).
Mask Face and the Princess of Scotland
The other 20% of patients in SuanPrung are mostly schizophrenics. DrPairat said that three factors have to be taken into consideration in the causes of schizophrenia — social, biological and psychological. He was also quick to emphasise again that the decline of the family unit and encroaching materialism can lead to this disease. Whilst walking with DrParitat in the gardens at SuanPrung he told me that, “Even DTs (Delerium Tremens) can send someone into a terrible psychosis; we had to administer 1000 mg of Valium to a patient recently, just to stop him shaking.” He also told me about a patient who thinks she is a Scottish Princess, and I couldn’t help but laugh. “I’m sorry,” I said, but you must admit that some schizophrenic or dual personality disorders can sound amusing.” I was put in my place when the good doctor explained that these people suffer immensely, mostlybecause things they perceive as real are not believed by others. It’s not the fact of the delusion: it’s the loneliness and isolation. On the flip side, I thought, don’t scores of people say they hear God’s voice? There is no evidence of a God — yet maybe they don’t feel the same anguish because their beliefs are consolidated and credited by the church.
For some disorders the patients are given powerful drugs to subdue them. While walking around the grounds I met a few ladies who sang me a tune, and I kind of enjoyed it, though admittedly I was still slightly on edge. It was the expressions on some of the women’s faces: I asked the doctor why so many mental patients had that inscrutable, vacant look. “We call it mask face, it’s because of the drugs.” There is something very chilling about the moniker mask face — that blank look has always aroused the feeling in me that I’m looking at a shell encasing a detached mind. “Even though we would like to council all our patients as much as possible, sometimes we just don’t have the time and resources, so drugs have to be administered instead.” For patients with the most intense disorders, electro convulsive therapy (electric shock treatment) is often used. Contrary to general belief, including my own, this treatment is still widely used, in the west as well as in Asia. “Because of certain movies and the media, this treatment is seen in a very negative way, but it actually works. The media doesn’t show the successful side of this kind of the treatment,” he explained.
“Of course we use a lot of drugs, we don’t always have the best drugs, but we make do. There’s not enough funding to buy the latest drugs on the market and it’s pointless to ask for any more from the government.” Whatever the doctor may say about under-funding, the facts, according to the World Health Organisation (WHO), state that Thailand spends far more of its health budget on mental health than most other Asian countries. (Thailand 2.5%, Nepal 0.08%, Japan 0.49%, Malaysia 1.5%).
“What about psychoanalysis, do you apply that in treatments?” I asked, hoping to unearth some interesting details: case studies of patients in psychoanalysis make good reading material. “No, we do not. We take a cognitive approach, in that we try and teach the patients to understand their problems and by understanding them, they can overcome them. Our aim is to get the patients to a point where they can leave here and carry on with a normal life; we teach them practical things like farming so they might be able to work once they leave.”
I felt real pathos with DrParitat, and his enthusiasm to help his patients and educate and raise awareness among the population impressed me. He is also the director of the Samaritans, which is at the moment available only for those who speak Thai. He hopes to set up an English speaking service soon.
SuanPrung did not consolidate the generalisations I have formed through my life, neither did it write a sensational article. I didn’t get to see unhinged killers and I wasn’t privy to any outlandish outbursts. Still, according to the doctor these things occasionally happened. It can’t be an easy job, working with people who remain on a different wave length all the time, trying to get through to them. Attempting to sort out the lives of relentless substance abusers and having to witness relapse after relapse. Then again, he looked and seemed happy. Was it ‘mask face’? I doubt it. With the explosion of popular culture in Thailand and the capitalist monster having found a home in this country; with mind deranging hooches being consumed perpetually and the whiff of consumerism on every street corner – DrParitat is definitely going to be a busy man.