Wrestling with demons and stigma: When depression puts careers on the line

SINGAPORE: Outwardly, his wife and two young sons are his sources of joy. He seems a regular family man when he’s with them. What is less apparent is that Mr Mak Kean Loong struggles to feel emotions like happiness.

“In the past few years, I think I’ve never even felt that emotion,” said the bespectacled 38-year-old, who speaks with the numbed air of a tired man.

At first, they all thought he was “just becoming extra introverted”. It was, in fact, his descent into depression. And just a year ago, he came close to leaving them without a husband and father.

“I didn’t tell my wife,” he said. “If you want to end your life, why would you tell someone close to you, right?”

“The first part of the process was to bring my boys and my wife out for a good meal, for them to have something to remember me by. I felt nothing but pain.”

He didn’t go through with the suicide. But soon after, through a “mutual agreement” with his employer, he quit his job as an infrastructure engineer with a technology firm to focus on his recovery.

And it’s that loss of that part of him that sits bitterly.

It does hurt when I see people in office clothes. I know I’m currently not a part of that. That identity has been taken away.

About 7 per cent of Singapore’s workforce has a history of mental illness. The Singapore Mental Health Study 2010 found that Major Depressive Disorder affected about 159,000 adults here during their lifetime.

In cases like Mr Mak’s, the illness makes holding on to a career a stressful battle – one that for some necessitates putting on a mask at work, or facing rejection from employers. In the documentary Facing Depression, four Singaporeans candidly share their experiences. (Watch the episode here.)

PERCEIVED AS A ‘HEADACHE’ AND ‘WEAK’

One of the main battles they must fight is perceived stigma among employers.

This was illustrated to Mr Mak last year, when he went public with his illness by blogging and drawing comics online about depression.

He thought sharing his problems would get across a message about what depression is and how to help people suffering from it. But an ex-boss warned him that if his industry knew of his depression, he would be “marked”.

There are people who’ll say, ‘You have depression – are you sure it’s not going to come back? I don’t think I want to employ you.’

“Or, ‘you need to go and see the doctor more often – I think I’ll pay you less’,” said Mr Mak squarely.

Mr Lim Yufan, who has had depression for half of his life, knows what it is like to live in fear of judgement.

“Besides my first job, I didn’t tell my employers and colleagues in my subsequent jobs that I had depression,” said the 30-year-old. “I was afraid that it would lead to things like them not being able to trust me to do work.”

Even so, his depression did affect his work: He had to take leave frequently and was unable to stay in a job for long, some as briefly as a month.

Half of his bosses, he said, showed that they were not understanding of depression, his reason for resigning. “One of them said, ‘Yufan, you’re a total headache. You gave me such a headache because of this.'”

Underlining the effect bosses can have – whether or not they know an employee has depression – L P Clinic consultant psychiatrist Pauline Sim said: “If you have a demanding boss with a perfectionist trait who can only focus on negativity and cannot empathise, then it’s very difficult for the individuals.”

In Mr Mak’s case, his supervisors allowed him “time and space to recover” – a few months.

“But as a new hire and with the extended time that my recovery would take, we came to a mutual agreement that perhaps it would be better for me to quit,” he said.

Stigma does not start nor stop with employers, however. The national Mind Matters study in 2015 by the Institute of Mental Health (IMH) found that people with Major Depressive Disorder are more likely to be perceived as “weak not sick”.

STRAIN OF HIGH EXPECTATIONS – AND DISAPPOINTMENT

Yet, even a strong person can succumb to depression. Take the example of Ignite Tennis Academy co-founder and head coach Jaime Wong.

At the age of 12, she was Singapore’s youngest tennis champion. She became the youngest member of its SEA Games team a year later.

“I didn’t handle losses very well. After I lost a tennis match, I could get upset for hours, and weeks even, and not talk. I think I was quite the embodiment of our culture of excellence and, sometimes, even perfection,” said Ms Wong, now 35.

I was so used to winning. All through my life, I was the best at almost everything I did. And I think that was a big part of how I could fall into depression.

It started from an accumulation of factors: She got hurt emotionally in a relationship; a chronic disease was causing inflammation and infection to her digestive system; and then the club her academy was based in closed for redevelopment.

“We had to move to Changi Beach Club, and we lost 90 per cent of our clientele,” she recounted. “Everything that could have gone wrong went wrong. Because of that, I fell to the lowest of lows.”

Mr Lim was also a high achiever when he was studying in a top secondary school, where “expectations were high, naturally so”.

In Secondary Three, he was a conductor in the school’s symphonic band and a “pretty good” trumpet player. It gave him “recognition, a sense of value and purpose”.

But when his grades fell below acceptable standards, his conductor position was at stake. “I was kind of pressurised, mainly from myself, to get my grades up,” he said.

He became increasingly anxious about his academic performance and suffered his first major depressive episode. “It included just the very thought of going to school.”

For Mr Mak, depression first struck in 2006, a year before his first child was born, and after disappointments and people issues at work.

“Whenever I end up doing things that seem to clash with my core values, I find myself slowly eroding away,” he said.

“One was when IT was used in company politics … Oftentimes, IT as a department is used to further the personal agendas of people within the company. Whenever that happens, I always struggle with myself.”

After three years, a period when he was “quite high-functioning”, he thought he had fought off depression. But he slipped into a mild depressive disorder known as dysthymia. This lasted far longer, marked by constantly low spirits and low self-esteem.

GOING UNTREATED AND UNRECOGNISED

Despite the negativity enveloping him, Mr Mak did not see his dysthymia symptoms as a problem. This is not uncommon – it is hard for people to recognise depression, noted Dr Sim.

Mr Chris Tan is another example. He had a stroke in 2005, which caused him to limp and lose agility in his left hand. He “kept crying” after he was discharged, but did not know that was a sign of depression.

After he was diagnosed, he realised that he might have been struggling with depression even since secondary school. “There was a lot of conflict between my parents over money,” explained the 45-year-old.

His father was a fishmonger, and “it was a very hard life”. “I never got to know him very well while growing up,” he said.  In 2003, his father was diagnosed with cancer. He died within a year, and Mr Tan still cannot forgive himself for what happened back then.

“I received a call from my mum, early in the morning. She said something was wrong with my dad,” he recounted.

“I told her not to exaggerate the matter. I just changed into my work clothes and drove onto the CTE. I was going to work, until the second call came. It was from the ambulance driver.”

Pausing to compose himself, he said: “I hate myself … This is an issue I’m still working out with my counsellors.”

He now makes appointments at the IMH whenever he feels “a big dip” coming, and also sees a peer support specialist who overcame depression. But few people seek treatment or think to do so in the first place.

When asked where clinically depressed patients should seek help, 54 per of respondents in the Mind Matters study said family and friends.

And of the 7 per cent of Singapore’s workforce with a history of mental illness, only two in 10 sought treatment, according to Professor Chong Siow Ann from the IMH, who shared this finding at the Regional World Health Summit 2013.

Ms Wong, for instance, “masked” her depression by pouring all her energy into work. But that backfired. “I was slave-driving the kids, pushing them really hard, and some of them were crying on the court,” she recalled.

“I used to say to parents: ‘These kids come here to improve, they don’t come here to have fun. If they want to have fun, then do it elsewhere.’

I was very hesitant and unwilling, for a long time, to seek professional help – and be labelled as someone who is crazy maybe, and unable to control herself.

TO THE BRINK AND BACK

Dr Sim is all too familiar with patients who “put up a front”. She said: “That’s sad because when they can’t cope, that’s when you hear of cases of people hanging themselves or jumping down.

“Under normal circumstances, most people would live and fight to live. But when you’re depressed, you just want the pain to stop.”

With nothing seeming to work for Ms Wong, the feeling that there was “no reason to live” set in until she “completely lost it” one night. She got into her car, and then along Dunearn Road, she floored the accelerator.

“I just stepped on it. Eventually, I reached Rochor, and I realised I was still alive, and it was just crazy,” she said.

I realised what I had done – that it was so selfish of me because I didn’t think of the consequences of my actions, not just for myself.

“If I didn’t go out with the big bang I had intended, what would’ve happened to the people who would have to look after me if I had got hurt or, what’s more, the people I could have potentially hurt?”

The Registry of Births and Deaths shows that about half of the suicides in 2016 occurred between the ages of 20 and 49. And more men than women committed suicide.

Mr Mak nearly did the same, after a severe depression hit him last July. His wife Tan Phay Shing saw that he was “really sinking”, as he was hardly talking and was “lost in his own world”.

But even she had no inkling of what he had planned when he took her and their sons out for a last meal. Tragedy was averted because Mr Mak promised himself one last chance: One phone call to the IMH emergency number, just before the end.

“I told myself I wouldn’t be the first to hang up. So if the line got cut or no one spoke to me, or if someone had hung up on me, then I’d have proceeded,” he said grimly.

He was on hold for 10 minutes. Finally, someone picked up. He was advised to check himself in at IMH, and was admitted that night.

This is one of the reasons people with psychological issues should not be stigmatised, noted Dr Sim. “If people get help, they can function as per normal,” she said.

“If they get help, there’d be fewer tragedies.”

LEARNING HOW TO COPE

Besides early intervention and medication, what Dr Sim advises is to “have a very balanced life” and get one’s priorities right. But this is easier said than done, in a country with the world’s longest working hours.

The average worker here clocked about 2,370 working hours in 2016 according to Manpower Ministry data, compared with 2,069 hours in South Korea and 1,713 hours in Japan.

Dr Sim thinks working adults should ask themselves this: If they should collapse, who would really miss them?

“Depending on how important you are at work, you may get three bows, some condolence money and maybe a wreath – if you’re more famous, perhaps an obituary or people sending you off, and that’s it,” she said.

But the people who continue to grieve and are affected are your loved ones.

Mr Tan, who was “consistently able to hit and exceed” his sales targets at work before his stroke, found that his depression acted up when he tried returning to corporate life. He was fired, and his career came to a standstill.

Now a freelance translator, he is struggling on but learning to cope, while living up to the responsibilities he feels at home, like giving his mother a monthly allowance. “It’s not the figure, but it’s a gesture,” he said.

“Whether I’m able to master the symptoms and live as productive a life as I can, to me, is a good definition of recovery. That means I don’t lose my personality and I’m still able to function as a son, brother or even an employee.”

For Ms Wong, who suffered from depression for over a year, embracing a faith has helped with her recovery. She has not been on antidepressants since 2014.

When people heal through spirituality, said Dr Sim, they realise “everything we have is loaned to us, that it’s not about I, me and myself”.

She added: “When you see that you’re part of a whole, you learn to view things differently.”

Help, and hope, can come in many forms as Mr Lim, too, has discovered. For example, his gym workouts make him “feel alive” and, sometimes, even forget that he has depression.

He now has an online store, selling collectable toys, so he does not face the “pressure of having to answer to somebody”. His figurines also give him a “set of ideals to cling to”, such as justice and equal treatment.

“These superhero origin stories begin with tragedy: Batman, when his parents died; Superman, when his planet was destroyed. It gives me a bit of hope that from my personal situation, I can come out stronger,” he said.

Meanwhile, Mr Mak is reassessing what he wants out of work. “I don’t search for the highest-paying jobs. I just would like my work to make sense to me,” he said wistfully.

“But with the depression, I’ve come to realise simple things are fine. To put it bluntly, being alive right now is more important than anything else.”

He has been told not to set a timeline for his recovery. His wife, a baking instructor, is the family’s breadwinner for now. And he relies on his family as the reason to continue fighting depression.

“I make sure that she knows where I am and what I’m doing. I hold myself accountable to her also,” he said.

Watch this episode of Facing Depression here. The four-part series addresses misconceptions about how depression affects working adults, women, children and the elderly.

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