Founder's own personal experience

Written as My Preface for my PhD thesis in Suicidology,
Australian Institute for Suicide Research & Prevention,
Griffith University, Queensland, Australia, 2022
It all started in the year 1991. By 2021, it would be approximately 30 years I would have been struggling with mental health concerns and my serotonergic condition.

I was diagnosed with major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) by a psychiatrist following the successful completion of my first year of undergraduate studies in Economics. I was also experiencing unwanted suicidal thoughts at the time (of which at times, it can become quite extreme). In addition, I engaged in non-suicidal self-injury behavior for the first time in my life (it’s probably more in the 30s and early 40s).

People saw the behavior as unusual because in Kuala Lumpur, in Malaysia, where I grew up, people seldom saw a psychiatrist, and there were not many mental health services available in the community. Thus, seeing a psychiatrist means that one is presenting with a severe psychotic illness. In the local language, mental illness or disorder is called “sakit jiwa” or “soul disease” or “illness of the soul.” Words like mental or psychological health concerns were seldom heard of or understood then.

At age 21, the use of words such as depression and OCD were unfamiliar to me; they were also not discussed openly. I started searching for information on my own. I did not dare tell anyone, partly because I was uncertain about sharing my personal experience with other people. We were also going through the early stages of the Information Revolution. In Malaysia, we hardly heard of or have not heard of valuable sources of information such as Google Search or the Internet. Thus, I did my search in my university bookstore. I went through every book that had the word depression or OCD. There were limited resources for understanding the nature of psychological disorders, as listed in the current diagnostic manuals.

I did not know who to talk to. Finally, I called Befrienders and got an appointment to see a Befriender. That was in 1991. There were no websites and internet, or WhatsApp chat in Malaysia. I went to see the Befriender face-to-face. He gave me courage to consult a psychiatrist. Then, I went home and told my parents I was going to see a psychiatrist. The psychiatrist asked me whether I have thoughts about suicide in our first private session. Then he has a private session with my father. My father came out and told my mother that I have thoughts about suicide. I think there were some elements of shock and concern.
The psychiatrist who treated me at the time prescribed imipramine and Anafranil. SSRIs (Serotonin Specific Reuptakes Inhibitors) such as fluoxetine (Prozac) were not widely used in Malaysia. There were also many unconfirmed reports about the positive impact of Prozac. Following careful consideration, I decided to explore the benefits of Electro Convulsive Therapy (ECT) to manage the essential symptoms of depression (MDD).

Electro Convulsive Therapy (ECT) involves administering electrical currents to the brain as the person is under general anaesthetic. I was informed that I would function adaptively after treating the brain “hormonal” imbalance that caused my symptoms. However, what I learned after a few months, was that they were referring to serotonergic dysfunction. Armed with this information, I took a break from my second year in the university to undergo the treatment as I had difficulty concentrating on school-related activities. Based on my strong motivation for learning and the relief from the treatment, I completed the 2nd year final exam successfully. I graduated together with the same cohort of university course mates.
Fast forward 30 years, I am 52 years old at the time of this writing. I am married, and we have a son who is 11 years old. I am semi-retired from my work as a Financial Consultant. However, I continue the active search for the effective management of MDD and OCD. I never regained my whole adaptive levels of functioning, as I had expected.

I learned later about the term serotonergic dysfunction; I also asked my current psychiatrist about its impact. He confirmed that I might be experiencing some serotonergic dysfunction (and probably inadequate neurotransmitters). However, he noted that the term is non-specific and that most health care professionals use the American diagnostic system [the DSM] to diagnose depression, OCD, and general anxiety disorder. As far as I could understand, it meant that my body had not produced enough serotonin (and maybe a few more neurotransmitters), and therefore my brain could not fully function as I had expected. That explained in part why I might not have regained my usual level of functions despite the rigorous ECT treatment.

Being from a low-income family, I was motivated to work harder than my peers to earn a living. That period of my life spanned almost 20 years (1992 to 2015) after graduating with my Bachelor of Economics degree. I took a part-time distance learning course in Masters of Business Administration while working after that. I refocused my resources on my relative strengths. Consequently, I was awarded a state royal award with the title “dato” in 2010 for the contributions I made to the state and country.

It is worth noting that I continued to struggle with a range of negative emotions, areas of psychosocial functioning, memory, general anxiety, social anxiety, intrusive thoughts, unnecessary mental rumination and often questioned my own self esteem and self worth. On many days, it was a struggle to wake up, and to patiently wait for the brain hormones to adjust themselves to an acceptable level of equilibrium. Sometimes I felt so helpless. Therefore, I decided to undertake a Masters of Psychology online course in 2000 to learn more about enhancing my physical and emotional wellbeing.

I quit my financial consultancy job in 2015, and in 2016, I learned that universities do have courses on topics such as thanatology and suicide. From 2016 until now, I have been working on the China Suicide Research Project, and subsequently, I started my Ph.D. programme. I went to China in 2016 and started the China Suicide Project with University of Shandong Centre of Suicide Research and Prevention, which is still ongoing today. I have learned a lot from a group of colleagues, friends, and associates. This Ph.D. pursuit is partially to learn more about myself. I have learned that there is no known cure for most severe mental or psychological conditions. Thus, I maintain adaptive (partial) functionality by taking my daily dosage of Prozac (SSRI), Anafranil (TCA), Cymbalta (serotonin-norepinephrine – SNRI), Brintellix (serotonergic, noradrenergic, dopaminergic, cholinergic, histaminergic and glutamatergic neurotransmitters), and Rivotril (tranquiliser).

As of this writing, I continue to experience cycles of depressive mood disorders (sometimes even daily), fluctuating suicidal ideation, psychache, hopelessness, social disconnectedness, loneliness and other negative emotions. Often, I have difficulties handling stress-related situations, anger, and relating empathically to other people’s emotions. Most of these conditions are assessed and managed within secondary prevention programming.

This knowledge has brought me some relief—first, being presented with formal diagnoses. Second, the limited scope of the efficacy of treatment for mental or psychological concerns. Regardless, I hope that researchers would continue to develop drugs or treatment modalities that could effectively manage severe mental and psychological disorders.

I am now almost homebound due to severe feelings of social anxiety and difficulties experiencing several positive emotions. These concerns are compounded by the fact that Malaysia is currently enduring severe strains managing the COVID-19 crisis. Not being attached to a busy day-to-day work routine creates a void filled with feelings of depression, helplessness, and anxiety-related cycles. Difficulties with effective emotional connection, psychosocial interactions, developing relationships, and other internalizing stressors create a heavy void for me. Therefore, spending time reflecting and writing my lived experience has been therapeutic for me. Another important reason for undertaking the work, at this time, relates to the fact that I have compensated for these concerns by burying myself in my scholarly activities. In addition to my work, I have drawn comfort from my spiritual beliefs, faith, and practice. Fears about the impact of mental health have been addressed partially by the attention given to the world-wide pandemic. Many people are now opened to talking about and actively seeking treatment for mental or psychological concerns.
It is worth noting that my health concerns did influence the choice of my Ph.D. topic. In recent years, I have learned that many of my personal distal and risk factors cannot be changed or easily influenced by me. However, to stay alive, I look toward exploring protective factors that I have ignored previously in my life or did not even know are protective factors. My wife and my son, my sister, and my mother are the great pillars of my life. They are protective factors and, at difficult times, provided me with some reasons for living. They helped me live. The knowledge that I have gleaned from the journal articles to earning my Ph.D. also serves as a protective factor by helping me to understand my mental and physical concerns. Taken together, I have come to appreciate that psychological constructs such as psychache and hopelessness were close to me. I did not know what they meant previously. I also learned about the various protective factors. It demonstrates to me how vital certain protective factors are to human beings. I have benefitted substantively from them.

Thus, the Ph.D. is also an advocacy of searching for protective factors, and to continue living. I hope to complete my Ph.D., although academic research and publications and pursuing a PhD in suicidology has never crossed my mind before when I was growing up. I hope I can graduate and continue my work in suicide research. That way, I hope it can motivate me to continue living meaningfully and reach out to other people who are also struggling, regardless of nationality, gender, age, race, or religion. I am happy if my work can help anybody in any mentally challenging situation. I realized that neurotransmitters and mental disorders are blind to creed and colour. To learn about suicide is to learn more about myself, the world, and the future.
I also realise different people affected by serotonergic situation may have different challenges, and may affect them different during different life cycles and external challenges. I also realise it is important to identify the risk factors (trigger) of depression and suicidal ideation and the protective factors (including consciously working on factors that work for the individual).

Thus, sensitivity towards and delicate management of my risk factors (and other causal factors) and enhancing strength of my protective factors are important day to day activity. Sometimes, it can be like mood disorder … it can be like a daily struggle kind of thing. Some days, things can get pretty challenging. I hope to persevere and I hope that I do not need to die by suicide.
12 February 2022
Bob Lew
Australian Institute for Suicide Research & Prevention