Convict Kanpitak "Moo Ham" Patchimsawat's case has once again put the spotlight on the need for Thais to address mental disorder by seeking professional help before it gets out of control.
The 20-something son of a businessman and former Miss Thailand Sawinee Pakaranang crashed his car into a group of people waiting at a bus stop, killing one, eight years ago. He had his sentence recently reduced, from 10 years and one month to 25 months, because of a mental disorder.
While refraining from directly commenting on this case, psychiatrist Dr Apichat Jariyavilas said people's emotions are often triggered by mental assumptions.
"Road rage can be experienced by both the emotionally stable and unstable," he remarked.
"Customarily, drivers who experience road rage are already irritable people who loose their temper easily. They might also have problems with controlling their impulses and may have pre-existing stress. These factors can trigger road rage, but not to the point that they have to let off steam by doing something drastic.
Then there are people who suffer from a range of mood disorders, such as bipolar and impulse control disorders," added the specialist. When people suffering from such disorders are put in the same situation, they might react with a higher level of aggression. Drug abuse and alcohol usage in both groups can only exacerbate an already explosive situation because the individual is less conscious of his or her own actions.
"Prior to seeking psychiatric help, family members and friends of psychiatric patients can be supportive by being more empathetic towards them. It has to be gradually put to them that their symptoms, if not treated, can be detrimental to not just them but also outsiders. Such individuals require a good listening ear. If all you do is castigate the patient for his or her 'bad' behaviour, this could work against them. Mental disorders are treatable and should not be considered a stigma," the doctor explained.
Kleptomania (failure to resist the urge to steal), pyromania (failure to resist the impulse to start fires), explosive disorder and pathological gambling are a few other psychiatric illnesses that can lead to criminal acts if left untreated.
As humans, Dr Apichart noted that our ability to restrain our impulses or urges helps to set us apart from other species and demonstrates our psychological maturity. However, most of us take the ability to think before we act for granted. But this isn't simple for patients who have issues with controlling their impulses.
"People suffering from impulse control disorder sometimes cannot resist the urge to do something harmful to themselves or others," he stated. "Impulse control disorders can include addictions to alcohol, drugs, eating disorders, compulsive gambling and intermittent explosive attacks of rage and more."
It is interesting to observe that a handful of these disorders, such as intermittent explosive disorder, kleptomania, pyromania, compulsive gambling are similar in terms of when they begin and how they progress.
"Generally, a person experiences growing tension or arousal prior to committing the act that characterises the disorder. While in the act, the patient most likely will experience pleasure, gratification or relief. Afterwards, the individual may blame himself or might feel regret or guilt."
Dr Apichart explains that patients with the aforementioned disorders may or may not plan the act, but the action customarily fulfils their immediate, conscious wishes. Obviously, the majority of these people find their emotional disorders highly distressing and encounter a loss of control over their lives.
The behavioural expert suggested that some of the signs to look for in patients is severe anxiety, depression, obsession and compulsion. Aggressive behaviour, especially without guilt, should also be observed closely.
Nevertheless, he said that the best way to determine whether a person is having a bad day or is suffering from a mental disorder is by consulting a psychiatrist. Practising mindfulness daily is another way to help to get emotionally strong.
Dr Apichat said five of the most common disorders found today in Thai society are phobia, substance dependence, major depressive disorder, generalised anxiety disorder and schizophrenia.
"Mental disorders can happen at any stage of a person's life. Drug and substance abuse and mood disorders can be detected from early teens to adulthood. Family environment plays a huge role in the mental health of a person," he said.
"Getting treated early is the key to a happy life. People with untreated psychiatric illnesses have a quality of life that is abysmal. Mental disorder often impairs a patient's ability to function properly in social settings, causing relationship problems and alienation, among other things. Patients can also lose out on career and educational opportunities because of their inability to use reasoning and other mental functions. There is also mounting evidence that clinical depression takes a serious toll on physical health."
The longer individuals with disorders don't address their condition, the more uncertain their prospect for long-term recovery becomes, the doctor added. Recent studies have suggested that early treatment may lead to better clinical outcomes, while delaying treatment leads to worse outcomes. In Thailand, the age of mental patients seeking psychiatric help is getting younger, which is a step in the right direction.
"Another point that needs to be made clear is that most individuals with psychiatric disorders are not necessarily violent," he said. "Although a subset of people with psychiatric disorders commit assaults and violent crimes, research is still ongoing about how much mental illness contributes to this behaviour and how much substance abuse and other factors do."
Dr Apichart concluded by saying that mental disorders are neither necessary nor sufficient causes of violence, it is a highly recognised fact that the major determinants of violence still continue to be socio-demographic and socio-economic. However, that does not mean that people neglect their emotional health. The good news is that there is medicine and therapy to help patients control these disorders.
