SINGAPORE: Even in preschool, Jodee Kua was picked on “quite a bit” by her classmates. And it did not take much, like stealing her seat or making fun of her, to make her burst into tears.
“It was easy to just push that button,” said Ms Kua, now 21. “Once, I had some chee cheong fun sauce on my face, and it became a joke to the whole class. So I cried.”
In primary school, she had self-esteem issues. To cope, she started to cut herself, at the age of 11.
“I didn’t know there was such a thing as depression. I didn’t know self-harm was a thing … that it was in a way a problem, and shouldn’t be done,” she recounted. “To me, it was just cutting.”
Studies suggest that depression – the most common mental illness in Singapore – may affect up to 18 per cent of youths here. And if not treated adequately, it has a propensity to persist into adulthood.
In the documentary Facing Depression, three young Singaporeans opened up about how they found coping with adolescent life difficult, and their struggles with depression, anxiety and self-harming behaviour.
THE PAIN ‘BECAME APPEALING’
According to the Samaritans of Singapore, the troubled youths who reach out to the organisation cite mental health issues, academic pressure and relationship problems at home and in school as their greatest sources of stress.
This is because of the great amount of time a child spends in both environments, explained senior clinical psychologist Wong Hui Yi, from the Institute of Mental Health’s department of child and adolescent psychiatry.
Ms Kua, for example, started feeling the academic pressure at her elite primary school, where expectations were high. She first engaged in self-harm after a poor mathematics test result.
“My mum was like a math genius, so I felt as if I was terrible at this (maths) and wasn’t getting any better at it,” she said. “It kept spiralling downwards.”
Thinking she was stupid, she cut herself as a form of self-discipline. She said:
With every careless mistake I made, I’d inflict pain one time, so that I'd remember not to do it again.
Eventually, it became something she did every time she was stressed. She had so many scars on her hands that she had to hide them from her teachers.
Her self-esteem was so low that she disliked having her photo taken and did not even want to look at herself in the mirror when she brushed her teeth.
At secondary school, she was ostracised because she was always feeling sad after her first relationship failed, when she was 13. And in a girls’ school, where “popularity is important”, being alone was a “very bad thing”.
Regarding such friendship issues, Dr Wong said: “Among the pre-teens and the teens, the peer group becomes so important that they’re an excellent source of support, but at the same time they can be a source of much stress.”
So it was for Ms Kua, who tried to cope with her depression through exercise and by confiding in a friend. But in her last year of secondary school, self-harm became her form of emotional release.
“It's like how when we get caned, we feel the pain and we don't want to let this happen again,” she said. “Subsequently the pain just became appealing.”
Children and adolescents who commit self-harm do so for various reasons, noted Dr Wong. For some, it is a way of coping with “very intense psychological pain”. She said:
They feel some relief when they inflict physical pain on themselves.
"That’s a very unhealthy way of thinking, but to them it’s a way of control. They certainly need help.”
A typical teenager undergoes a difficult part of life trying to become an adult because it exposes teens to different kinds of life situations they had not experienced before, said The Resilienz Clinic’s medical director and consultant psychiatrist Thomas Lee.
“Throwing tantrums or being moody may be one of the ways they cope. But the hormonal changes kind of add to the picture,” he added, explaining that these affect how the teens feel and behave.
While the effects of oestrogen and testosterone on the brain are complex and not fully understood by scientists, what is known is that these two hormones can affect one’s moods.
For teens who are already facing some life challenges, these fluctuations in hormones and brain chemicals could make them susceptible to depression, said Dr Lee.
In teenager Jane's (not her real name) case, her behaviour started to change at the beginning of Secondary Three last year. She would wake up crying “uncontrollably”, said her mother.
Getting her ready for school was a “hassle”, and when she reached, she would sometimes hide in the toilet, cry and call her mother to say that she was scared and did not want to be there.
“It was heartbreaking. For the record, she called me eight times within two hours in the morning,” said Jane's mother, whose eyes reddened as she related the episode.
At first, she wondered whether her daughter was calling for attention. “But there was never a lack of attention at home because we were so close,” she said, describing her 15-year-old as having been “quite emotional” since young.
Jane herself realised something was wrong when she stopped talking and hanging out with her friends, and started losing her appetite and dreading school more and more. “I felt as if I was drowning,” she shared.
Sometimes I got better, and it was as if … I found a log and could float with that. But after that, it was as if another wave came and hit me. It’s like a roller-coaster.
While everyone has unhappy days and mood swings, a prolonged and intense mood swing, which may even last for months, could indicate depression, said Dr Lee.
“If these changes start to affect the kid’s life, academically or his relationship with the peers or parents, then we have to start considering whether this kid is having depression,” he added.
‘MY BRAIN BROKE’
Mr Chia Xun An’s depression started when he was 10, triggered by an asthmatic episode and having sore eyes, which changed his appearance and affected his self-esteem.
The situation at home did not help. Money was an issue, and for a few years, his family had to live in his maternal grandmother’s home. This resulted in frequent arguments among the adults, which took a toll on him.
He had difficulty sleeping and would even hit his head against the wall at night.
“They always say that depression is marked by low mood most of the time,” said Mr Chia, now 25.
I tried my best to get rid of it, but unfortunately life had other plans. I really hit rock bottom – I thought I had lost hope forever.
Diagnosed with major depressive disorder, he had to repeat a few years at school. But he worked hard to cope with his emotions, got into a polytechnic at the age of 19 and was discharged from his condition.
“I just wanted to live life … to be like everybody else and break free from my past,” he said. “I was adjusting. I felt that I was finally reaching that sense of normalcy.”
In his final semester in 2013, however, things took a turn for the worse. He started seeing scribbles and lines that were not there and hearing voices in his head that kept repeating, “Burn, burn, kill, kill, die.”
He had never experienced these symptoms before. “It was terrifying,” recalled Mr Chia, who tried to fight off the depression, telling himself he did not want it to happen again.
“But it got worse and worse,” he said. “I finally felt a shift in my mind … My brain broke. I finally lost control.”
He dragged a chair to the front of the classroom, sat down and rambled for half an hour. He cannot remember what he said, but because of the relapse, he had to repeat his final year.
“Sometimes when things like this happen, you just wish people would be more understanding,” he said. “But they didn’t really get it, they didn’t really see the severity of it or maybe they thought I was bluffing – I don’t know.”
DEPRESSION ISN’T TRANSIENT
Ms Kua’s turning point also came at polytechnic. With a new environment and new friends, she was feeling happier and her self-harming habit was seemingly a thing of the past – until one day when she started to experience bodily pains.
To handle the pain, she grabbed a penknife off her table without thinking and cut her wrist so hard that it bled profusely.
“The doctor said, ‘You were 0.1mm from the artery. A little bit more pressure, and you may not have been here today,’” recalled Ms Kua, who was 18 years old then.
She could not understand why she lost control, since she thought she was happy, had things to strive for and reasons to live. Only then did she seek help for her depression.
Dr Lee noted that many people, including parents, believe that depression or a change in mood “is just something that’s transient, or it’s some character defect”.
But it’s not. Depression is very much a medical condition … which definitely needs treatment.
As for Jane, she has her mother to thank for recognising that she had a problem, sitting her down and discussing why she was constantly feeling frustrated and crying. Together they ruled out cyberbullying, unhappiness at home and boyfriend issues.
The girl said: “I knew there was something wrong – it could be depression or anxiety. But reading about the symptoms and actually feeling them yourself are very different things.”
It was not long before she told her mother she wanted help. She was diagnosed with clinical depression and has been getting help since February last year.
Looking back, Jane thinks her illness came about because all her friends went to another class after streaming at the end of Secondary Two and because of anxiety about her Higher Chinese course.
She also thinks the stigma to seeking treatment means “people who are sick aren’t getting the help they need”. She admitted: “I was very ashamed of having to see a doctor.”
A 2010 Singapore Mental Health Study found that the average time taken to seek help for major depressive disorder is four years, and Dr Lee agreed that stigma is “a very big obstacle” here. He added:
(Another) very, very common reason is denial. Parents may think that the kid is just not feeling well … and hope that the kid will become better.
“The other thing is that, even if they may really want to (get help), they may not know how to or where to get the help.”
There are generally two kinds of treatment: Antidepressants and psychotherapy. The latter involves a trained mental health professional exploring the issues that caused the depression in the first place.
The health professional would guide the children towards what they should do when faced with certain kinds of adversities, shared Dr Lee.
This includes teaching stress management skills, such as breathing exercises and muscle relaxation, as well as other coping strategies like sports and reading.
Full recovery is possible, especially with support from the parents and other family members, said Dr Lee. But for some patients, certain setbacks, challenging situations or difficult relationships can trigger their depression again.
“The whole purpose of therapy is to really teach these kids how to handle those situations or similar situations better in future,” he added.
For Jane, slime-making and having a pet have helped her cope with her depression. “I had wanted a dog for the longest time ever. And she’s a blessing,” she said.
“When I’m sad, she lies beside me and falls asleep. And it makes me a little bit happier. She doesn’t talk, but she gives me a lot of love.”
Ms Kua, on the other hand, has turned to dancing, especially hip-hop.
If she has a bad day, she would be dancing with “a lot of hard energy”. But if she is feeling sad, she would “do movements that I could relate that emotion to, and it would leave my body”.
“Dance is like the friend I never had – my perfect friend. It doesn’t judge; it never leaves you unless you choose not to do it,” she said.
She is now working at the IMH as a peer support specialist, helping others with their recovery journey.
Meanwhile, Mr Chia is actively raising awareness about mental illness. He has been volunteering with Over The Rainbow, a charity promoting youth mental wellness, and has self-published a book about his experience with depression.
An undergraduate today, he is working on a second such book. His parents, who did not understand his depression for a long time, have finally accepted him for who he is.
And in doing outreach work in the community, he wants to spread the message that it is a medical condition that can be treated and managed with a support system.
“I’ve been particularly vocal about stigma and discrimination. And by doing that, I hope that things will change,” he said. “I hope that in future, individuals with mental health challenges can face it without fear and without being alone.”
*Editor's note: An earlier version of this story identified Jane. We have updated the story following the family's subsequent request not to name her. The story's headline has also been changed from the earlier version.
Watch this episode of Facing Depression here. The four-part series addresses misconceptions about how depression affects working adults, women, children and the elderly.
Read about the demons and stigma working adults must battle, and about the loss, loneliness and killing pain of elderly depression.
Where to find help:
Institute of Mental Health’s Helpline: 6389 2222
Samaritans of Singapore Hotline: 1800 221 4444
Singapore Association of Mental Health Helpline: 1800 283 7019