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 un-pleasant 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 Malay-sian 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.