Death, life and a state of mind
He got into it by chance, but has now devoted his life to studying suicide
TODAY newspaper
Jasmine Yin
jasmine@mediacorp.com.sg
1 September 2007
English
(c) 2007. MediaCorp Press Ltd.
DURING his 39 years in private practice, psychiatrist Chia Boon Hock tells me, 90 of his patients have committed suicide.
That little detail, revealed eight minutes into our conversation at his clinic, leaves me somewhat at a loss for words. Ninety in 39 years - that's at least two suicides a year.
Doesn't he find it disturbing if he fails to save a patient?
"You feel uneasy because you wonder, 'Could we have prevented the suicide?' à There's always something you think you didn't do right..." his voice trails off.
"In the early years of my practice, I must now admit, I did not do enough to prevent my patients from committing suicide. During that time, we knew little about how to assess the suicide risk of our patients and how to manage those who are at high risk."
The 71-year-old pauses.
Then, he adds, matter-of-factly: "You feel sad, but you don't get that emotional and cry, lah. Our duty is, if we can prevent a suicide, we will try to. We do our best, but there are a lot of things beyond your control."
After having spent over 30 years poring obsessively over stacks of suicide case files at the Coroner's Court, Dr Chia has come to this conclusion about life: Life is "logical" because there is a reason and cause for every action.
And every action, including suicide, is influenced by factors ranging from genes to family background, disease and even luck.
"Suicide is a morbid subject but at the same time, it is very interesting. I have learnt a lot about life while researching on suicide. I feel that things can easily go wrong for any one of us," Dr Chia says, leaning forward in his chair at his clinic in Tanglin Shopping Centre.
Very often, patients who commit suicide suffer from unbearable psychological or physical pain. They feel hopeless that there is no sight of relief for the pain and that there is no other way out but death.
"They don't want to be such a burden to their family and want to kill themselves - that's what we call rational suicide. Sometimes we feel, maybe it's their right. Sometimes, when they have already killed themselves, you think: 'If I were in their shoes, most probably I wouldn't mind dying.' But don't get me wrong, it doesn't mean I approve of euthanasia."
As a psychiatrist, Dr Chia, who has seen more than 5,000 patients with various problems, tries to show them that things are "not just in black or white, but many shades of grey in-between".
He recalls how a young patient in his 20s wanted to kill himself after falling out of love. After six months of counselling and treatment, which included a prescription drug to help him sleep, the patient turned up at his clinic, beaming with the news that he had a new girl in his life, Dr Chia says, chuckling at the memory.
Perhaps because his job requires him to hear out - as well as sort out - patients' woes, it comes as no surprise that the Korean drama buff is drawn to characters who overcome adversity in reel life, such as in the recently-ended Be Strong, Geum Soon! drama series on television.
For someone who is now a familiar face at local and foreign conferences on suicide, Dr Chia did not consciously set out to be a "suicidologist" - one who specialises in suicidal behaviour and prevention.
He was led into this particular field in the late 1960s "by chance" following a request from Dr Tsoi Wing Foo, his friend and former colleague at the former Woodbridge Hospital, to do research on the then little-known subject.
Dr Tsoi and sociology professor Raiz Hassan had received permission from the authorities to study the suicide case files from the Coroner's Court.
When he first started looking into the files, Dr Chia says: "I didn't have any idea what I should be looking for. All I knew was to collect as much data as I could."
But the father of two became "so absorbed" by what he had read in those files that he went back of his own accord to do more research from 1969 to 1976.
He has not stopped researching. Recently, Dr Chia teamed up with the Samaritans of Singapore to look into suicide cases between 2000 and 2004. He has also co-written a paper with his doctor daughter on notes left by suicide victims.
Having spent all these years studying suicide, how would he describe the situation in Singapore?
"Suicide rates in Singapore fluctuate, but they remain relatively stable and are not increasing. These rates are a good index of the amount of 'suffering' occurring in our society. Thus, it is important to monitor them."
Dr Chia doesn't just look at cases deemed "suicides" but also those classified as "open verdict". By combining the figures in these two categories, Dr Chia notes that the rates have not increased in recent years - 573 in 2003; 558 (2004); and 494 (2005).
"Certain suicidologists think that it is a more accurate and reliable indicator if you combine suicide and open cases. When they study suicide trends, they also study open case rates because they think suicides can be hidden in the undetermined category," he explains.
While much can be done to stop people from killing themselves, the Hong Kong University medical graduate believes that there is no way to completely eliminate suicide. "As long as there is suffering, there will be suicide."
And while there may be greater awareness of the factors that drive people to take their own lives, and even sympathy for them, suicide will always be taboo in society.
"Suicide is not a natural death, so there will be regret, stigma and those who think they have done wrong (to the victims)," Dr Chia explains.
Still, he is glad that suicide, as an issue, has grown in importance over the years. These days, it's not just psychiatrists, but also others, such as psychologists and social workers, who are keen to know more about suicide - this has given rise to the term "suicidologist".
I ask Dr Chia if he prefers to be known as a suicidologist instead of a psychiatrist.
Shaking his head, he declares: "It doesn't matter. I am a psychiatrist who is interested in suicide."
Now, working on his latest paper on the trend of suicide in Singapore for the past five decades, Dr Chia says: "It has taken me 37 years of reading and studying to understand why people commit suicide. Things which used to confuse me have gradually fallen into their places."