Saturday, 25 December 2021

Mental Health: Misperceptions, stereotypes can negatively affect people who have mental illness

On Wednesday, the Committee of Privileges heard the expert testimony of Dr Christopher Cheok, a psychiatrist, on whether former Workers' Party MP Raeesah Khan's psychological faculties were impaired when she made her statements in Parliament (Raeesah didn't have any mental disorder that would lead her to lie: IMH expert, Dec 23).

While he assessed her to be of sound mind, many misperceptions and stereotypes were put forth to him over the session.

As co-founder of the Total Wellness Initiative Singapore, and a mental health researcher, I feel it would be pertinent to expand upon some of the issues that surfaced.

First, dissociation is not a mental illness. It is a symptom that may be an indicator of a mental illness.

In the case of Ms Khan, Dr Cheok said she did not have post-traumatic stress disorder and did not suffer from dissociation between Aug 3 and Dec 3.

The more significant issue here was the multiple attempts to associate dissociation with lying and false memory creation, or characterise it as something which could be turned off and on at will.

These suggestions do a genuine disservice to individuals who experience dissociation and who may suffer from its effects.

It further stigmatises and casts unfair aspersions on them as individuals.

Second, symptoms of a mental illness do not equate to having a mental illness. To preface this statement, it should not matter if you have a mental illness, but symptoms alone are not sufficient for a diagnosis of one.

When psychological or psychiatric assessments are conducted, function is often a critical variable considered in deriving a specific diagnostic outcome. Dr Cheok put it best when he said "many people living in our urban society would undergo different stressors from work, family life and society in general, but just because you have certain stress and emotional symptoms doesn't mean you have a psychiatric disorder".

Lastly, high-profile cases such as this - in which the entire nation and perhaps even people outside of Singapore are watching - tend to influence the existing narrative regarding mental health and illness disproportionately.

I hope that people who write about such issues, talk about them or even consider using them in such situations, will do so responsibly.

We should be careful of colouring other people who experience mental health conditions in a particular light for the sake of furthering our agendas.

People consuming related media should also be critical and make their own decisions only after they have gone through the source.

Mental illnesses do not discriminate or stigmatise, and neither should we.

Jonathan Kuek Han Loong

Committee of Privileges: Raeesah Khan testifies again on 22 Dec 2021

Raeesah Khan didn't have any mental disorder that would lead her to lie; Raeesah of sound mind when she testified: IMH expert
Psychiatrist assessed her to be 'mentally fit' when she made statements in Parliament
By Goh Yan Han, The Straits Times, 23 Dec 2021

Former Workers' Party MP Raeesah Khan did not suffer from any significant psychiatric disorder that would have impaired her ability to speak truthfully in Parliament, a medical expert testified before the Committee of Privileges yesterday.

Instead, Ms Khan was assessed to be of "sound mind" and "mentally fit" and "present" to make the statements that she had in Parliament and before the committee between Aug 3 and Dec 3, said Dr Christopher Cheok, who is acting chief of the department of forensic psychiatry at the Institute of Mental Health (IMH).

In a sixth special report released by Parliament yesterday, Dr Cheok said Ms Khan did not suffer from any psychiatric disorder that would predispose her to telling untruths.

Dr Cheok, who is a senior consultant at IMH and a psychiatrist by training, assessed Ms Khan last Friday and Monday with her agreement after the committee invited her to undergo a psychiatric assessment.

This came after Leader of the Opposition and WP chief Pritam Singh suggested in his testimony about two weeks ago that the committee call for a psychiatric evaluation of Ms Khan, whom he said may be predisposed towards lying due to her mental condition of "disassociation", the committee noted.

WP chairman Sylvia Lim and vice-chairman Faisal Manap had also made several assertions with regard to Ms Khan's mental condition in their evidence to the committee, said the report.

Ms Khan, who last month admitted to lying in an anecdote raised in Parliament related to sexual assault, had said that she herself had been a victim of sexual assault.

In his evidence, Dr Cheok said it was a normal reaction for someone who had gone through a traumatic experience to continue to have some anxiety when speaking about the topic. This did not mean the person would be mentally impaired or incapacitated.

In Ms Khan's case, while she might have continued to feel upset about some of these memories, her judgment and decision-making capacity were not impaired, and she was of sound mind.

Dr Cheok also said that Ms Khan did not have post-traumatic stress disorder and did not suffer from dissociation between Aug 3 and Dec 3.

Besides the two occasions when he assessed Ms Khan, Dr Cheok also interviewed her husband and reviewed the relevant recordings of Ms Khan speaking in Parliament on Aug 3, Oct 4 and Nov 1, as well as her testimony before the committee on Dec 2 and 3.

When asked about Ms Khan's mental state on Aug 3 when she first mentioned the anecdote that contained untruths in Parliament, Dr Cheok said the speech was neither delivered impulsively nor as a result of dissociation or any psychiatric disorder.

It was possible that such untruths could be told as a result of bad judgment rather than because of any mental illness, he added.

In his assessment, Ms Khan also did not suffer from any significant or material dissociation between Aug 3 and Dec 3.

He explained that in layman's terms, dissociation is a symptom, not a medical diagnosis. It refers to the loss of the integrative function of the human mind, and may also be experienced by normal persons in different situations, such as deep prayer meditation or hypnosis.

Ms Khan had told him that her psychotherapist said she might have dissociation.

"Based on his conversations with Ms Khan, Dr Cheok did not believe that she fully understood what dissociation was," said the report.

Asked by WP MP Dennis Tan how to reconcile his findings on Ms Khan's mental health with the evidence of WP leaders that she would get emotional whenever her sexual assault was mentioned, Dr Cheok said a sexual assault is "one of the most traumatic experiences someone would ever go through".

Dr Cheok added: "(Being emotional) is a very understandable, very normal reaction from a survivor of a sexual assault.

"I would be very surprised if anyone can speak about their sexual assault, plainly, carelessly, without emotion, I think that is even more abnormal than being emotional when talking about their sexual assault."

While Dr Cheok did not deny that Ms Khan had some symptoms of being psychologically traumatised, he was of the view that the symptoms did not reach the threshold of a psychiatric disorder.

Asked by Mr Tan if it was nevertheless possible that Ms Khan's judgment could have been affected by the trauma - in a way that caused her to have "false memory creation" - Dr Cheok reiterated that Ms Khan did not suffer from dissociation.

In his assessment, when Ms Khan spoke of her assault, she was not affected to an extent that caused her to lose her mental capacity.

He was also asked by Mr Tan whether a person who is suffering from trauma, while still generally high functioning, could be capable of sending out a message that selectively contained a lie.

Dr Cheok said that while possible, there also may be other explanations why a person may give a falsehood. In the specific context of Ms Khan, Dr Cheok disagreed with this possibility.

WP leaders had, in their evidence, agreed that most of a message Ms Khan had sent to her aides following a meeting they all attended on Aug 8 was true, but also contained an untruth - specifically, that they had told her to take her lie in Parliament "to the grave".

Raeesah Khan says Workers' Party leaders were 'out of line' to use mental illness to discredit her
By Justin Ong, Political Correspondent, The Straits Times, 23 Dec 2021

It was "extremely out of line" for Workers' Party (WP) leaders to portray her as emotionally and mentally unstable in events relating to a lie she had told in Parliament, said former WP MP Raeesah Khan.

Ms Khan was testifying yesterday to the Committee of Privileges investigating her over her Aug 3 lie in Parliament, when she had fabricated details about the police's handling of a sexual assault case.

She came clean to WP leaders on Aug 8, explaining that she had lied because of the personal trauma of being sexually assaulted, and admitted to her lie in Parliament on Nov 1. She resigned from WP on Nov 30.

On Nov 29, Ms Khan had told a WP disciplinary panel that her therapist said she "might" have symptoms of post-traumatic stress disorder, which could lead to dissociation - a mental health condition where a person disconnects from his thoughts and feelings.

"But I never said that this was something that I was going through," she said yesterday.

WP chief Pritam Singh had earlier told the committee on Dec 10 that Ms Khan's dissociation could have prompted her to lie in a text message to her aides saying the party's leaders had told her to take her lie "to the grave".

Ms Khan had sent this message on Aug 8 after she met Mr Singh, WP chairman Sylvia Lim and vice-chairman Faisal Manap.

Yesterday, Minister for Culture, Community and Youth and Second Minister for Law Edwin Tong, who sits on the committee, said the impression he got from the trio's testimonies was that Ms Khan had been very emotionally affected on Aug 8, and was unable to have a conversation on the issue.

"If I was not able to have a discussion on this issue, then why would I have been left on my own to make a decision as they have claimed, which is not what happened?" said Ms Khan, referring to Mr Singh saying he had asked her to take ownership and responsibility of the lie and clarify it.

"And to use mental illness as a way to discredit someone, I think, is extremely out of line."

She later reiterated the same point when asked about Mr Singh's version of events of Oct 4, when Law and Home Affairs Minister K. Shanmugam pressed her in Parliament to provide more details of her allegation against the police.

The Leader of the Opposition had recounted that Ms Khan had met him and Ms Lim late that night in a "dazed, distraught" state, and eventually "completely broke down".

"(Mr Singh is) trying to paint this picture of me as being emotionally or mentally unstable," Ms Khan said yesterday.

"Which, again, I think is completely out of line, and hopefully there is a testimony that would say that I am of sound mind."

She added that she had been stressed but was not crying then.

As Speaker of Parliament and committee chair Tan Chuan-Jin brought the hour-long hearing to a close, the former WP MP asked to make a statement.

"I think talking about mental health, especially in this day and age, is very sensitive," she said.

"And to use it to discredit someone, I think, sets back our movement to work on mental health and... to encourage people to seek help when they need."

Pritam Singh never gave directive to clarify my lie on Oct 3: Raeesah Khan
By Tham Yuen-C, Senior Political Correspondent, The Straits Times, 23 Dec 2021

Workers’ Party chief Pritam Singh never used the words “take ownership and responsibility” during their Oct 3 meeting, Ms Raeesah Khan told a parliamentary committee on Wednesday (Dec 22).

Mr Singh had instead asked her to stick with her narrative rather than come clean on the untruth she told in Parliament on Aug 3, Ms Khan added.

The former WP MP gave this testimony during her third appearance before the Committee of Privileges, as she answered questions about an Oct 3 meeting she had with Mr Singh.

Sticking to what she told the committee on Dec 2 and 3, Ms Khan refuted claims by Mr Singh that he had expected her to set the record straight in Parliament and had made this clear to her by Oct 3.

During the one-hour hearing on Wednesday, Ms Khan also said repeatedly that she was telling the truth and that she will not lie under oath.

Ms Khan's conduct is under scrutiny by the committee after she told a lie in Parliament during a speech on Aug 3 about having accompanied a sexual assault victim to the police station.

Ms Khan had claimed that the woman had been driven to tears by the insensitive questions of the police. But on Nov 1, she admitted that she had heard the anecdote in a support group she was part of as a survivor of sexual assault herself.

During hearings before the committee, she said she had confessed the lie to her party leaders by Aug 8 and had been told by them to continue with it.

She also said that at an Oct 3 meeting, Mr Singh had told her that he would not judge her if she kept to the narrative.

Mr Singh has denied saying this. He told the committee on Dec 10 that when he met Ms Khan on Oct 3, he had told her that he expected her to take "ownership and responsibility" of the matter, and this meant that she was expected to tell the truth.

Mr Singh said Ms Khan became uncomfortable upon hearing this, so he said "I will not judge you, (which) meant I will not judge you if you take responsibility and ownership".

Asked about Mr Singh's testimony, Ms Khan said: "This is the first time I've heard him say these words."

She added that her former party leader "did not give any directive to clarify the lie in Parliament".

She said: "He said that if I were to continue the narrative, he would not judge me."

Mr Singh had earlier testified to the committee that he was “shocked” Ms Khan had claimed that no one else was present when they had the Oct 3 conversation because her “whole family” were at home that night.

Asked about this by the committee, Ms Khan said that what she meant in her earlier testimony was that no one else was present at the conversation between her and Mr Singh as they were seated in a corner of her home.

She confirmed that her parents, husband and her brother were at home during that time.

She took issue with Mr Singh's suggestion that she was uncomfortable with their conversation that night, saying: "I was never uncomfortable... I was in my own home."

After their conversation on Oct 3, Ms Khan would go on to lie in Parliament again on Oct 4 when questioned about the anecdote by Home Affairs and Law Minister K. Shanmugam.

During her exchange with Mr Shanmugam, she had texted Mr Singh to ask him what she should do.

When Mr Singh was asked about this text message by the committee, he had said that there could have been no doubt that he expected her to set things right.

But Ms Khan told the committee on Wednesday that she had texted Mr Singh because she "was unsure of what to do".

"I thought that he would say just continue... because that was the conversation that we had the night before," she said. When he did not reply to her text message, she went ahead to continue lying as they had discussed, she added.

That night, Ms Khan met Mr Singh and WP chairman Sylvia Lim at Mr Singh's office in Parliament House. Mr Singh and Ms Lim had both told the committee that Ms Khan said during this meeting that perhaps there was "another path" - to tell the truth.

Explaining what she meant, she said on Wednesday: "I was hoping for a clear directive... to either tell the truth or to continue (with the lie)."

In response to Ms Khan’s suggestion, Mr Singh testified that he said rather angrily during the Oct 4 meeting that Ms Khan had chosen her path by lying again that day.

Ms Khan told the committee on Wednesday that she did not respond to this statement that night as she was shocked, given the conversation on Oct 3 during which "there was no intention or directive from his part to tell the truth".

Mr Singh and Ms Lim had also given evidence describing Ms Khan as distraught and in tears during the Oct 4 meeting.

But she denied this, saying that while she was stressed, she was not crying.

She also took issue with Mr Singh's characterisation of her state of mind: "He's trying to paint this picture of me as being emotionally or mentally unstable, which again, I think, is completely out of line and hopefully there's a testimony that... I'm of sound mind."

On Wednesday, Ms Khan was also asked about a Nov 29 meeting she had with the WP's disciplinary panel set up to look into her conduct after she admitted to her lie in Parliament on Nov 1.

Ms Lim’s notes from the meeting indicated that Mr Singh had told Ms Khan: “Before Oct session, I met you... I told you it was your call.”

Mr Singh said he did not use those words on Oct 3, but had told her she had to take responsibility for her lie.

Ms Khan confirmed that the words in Ms Lim’s notes were what Mr Singh said to her on Nov 29. But she added that Mr Singh never presented her with a choice on Oct 3, but had instead told her that if she continued with her narrative, he would not judge her.

“He did not put it forth as saying you can either tell the truth or you can continue with the lie,” she said.

Raeesah Khan insists Workers' Party chief Pritam Singh had told her to keep up her lie and 'take it to the grave'
By Justin Ong, Political Correspondent, The Straits Times, 23 Dec 2021

Former Workers' Party (WP) MP Raeesah Khan has stuck to her account of the opposition party's leaders advising her to keep up a lie she made in Parliament that ultimately led to her resigning from the party.

She insisted, in her testimony to a parliamentary committee, that WP chief Pritam Singh had used the words "take it to the grave" during an Aug 8 meeting where she admitted to him, WP chair Sylvia Lim and vice-chair Faisal Manap that she had lied in the House on Aug 3.

Testifying again before the Committee of Privileges investigating her conduct for fabricating details about the police's handling of a sexual assault case, she also refuted evidence previously given by the WP leaders to the committee.

Ms Khan, who was elected as an MP for Sengkang GRC last year, also disagreed "completely" with Mr Singh's earlier statements that she had told a "complete, utter fabrication" and a "bare lie" by saying the WP leaders had advised her to take her lie to the grave.

In video footage released on Wednesday (Dec 22) by the committee, she gave her version of the events of the Aug 8 meeting.

At the meeting, Ms Khan had explained that she lied because she had undergone a traumatic episode as a victim of a serious sexual assault herself.

"After I made that admission (about the lie), there was of course discussion about my well-being, which I think (was) rightly so because I had just shared a very deeply personal experience that I've had," she told the committee on Wednesday.

"And the discussion that followed was that we would not pursue the matter further. And, like in my message, Mr Singh used the words 'take it to the grave'."

Ms Khan was referring to a text message she sent to WP members Loh Pei Ying and Yudhishthra Nathan shortly after the meeting, where she said the party leaders had "agreed that the best thing to do is to take the information to the grave".

Minister for Culture, Community and Youth and Second Minister for Law Edwin Tong, who sits on the committee, then sought to confirm that the words "take it to the grave" had come from Mr Singh, who is Leader of the Opposition, and were spoken in the presence of Ms Lim and Mr Faisal.

"Are you very clear about that? Is that your recollection?" he asked.

Ms Khan said: "Yes, I'm very clear… It is not a phrase that I would usually use. So it did not come from me."

According to the committee's first report issued on Dec 3, Ms Khan had alleged that the WP leaders had, during this meeting, advised her to "continue with the narrative" she falsely gave on Aug 3, and that if she and the party could "get away with it", there was no need to clarify and tell the truth - even if the matter was brought up again.

Mr Singh, Ms Lim and Mr Faisal have all disputed her account in their testimonies to the committee, saying they never directed her to lie.

Mr Singh has said that he opted to give Ms Khan time to deal with the matter and to speak to her parents first.

On Wednesday, Ms Khan said she did not recollect him telling her to inform her parents, "not in the slightest".

Mr Singh has also acknowledged that he did not take any steps from Aug 8 to Oct 3, to get her to correct her false statement.

He had also told the committee that the WP leaders were shocked, sympathetic and more concerned about Ms Khan's well-being after she revealed her sexual assault to them.

Mr Faisal said the three WP leaders were overwhelmed, and that there was zero discussion relating to the lie from then on.

Ms Khan on Wednesday told the committee that this was not her recollection.

"I think (Mr Faisal is) downplaying what the discussion was," she added.

Asked for her response to Mr Singh saying she was lying, Ms Khan said: "I disagree completely. I've come here to tell the truth. And I've made an oath to do so as well. And I've never strayed from that."

The committee also noted in its report on Wednesday - the sixth so far - that Ms Khan and the three WP leaders then proceeded on Aug 8 to discuss a statement on topics of female genital cutting and polygamy which she had also raised in her speech on Aug 3.

"Contrary to how she was characterised as being emotionally unstable, she felt that she was of sound mind as shown by her being able to discuss the statement at length," said the report.


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