Hidden trauma: mental illness exacts unseen toll on loved ones

It’s midnight when she has cajoled her 42-year-old son to sleep. Then she rushes to change her 44-year-old daughter who has wet her pants.

To say that 71-year-old Ngo Thi Nam has her hands full would be an understatement.

As soon as lays back on her bed, she jumps again. The noise coming from the next room is loud. "Don't worry Cuong, mommy is coming!"

Mummy rushes over, hands trembling as she opens the door to the room, which is always locked and covered with foam. Its windows are made of wire mesh, leaving only a small opening to give food and drink. Her son, Nguyen Hung Cuong, calls his room a "dog house" in his more "normal" moments.

Cuong had called out to his mother as he always does when he wakes up at all odd hours. If Nam does not appear, he will start banging his head against the iron door. For the last 16 years, after a traffic accident damaged his brain, he has been screaming, smashing things, and only occasionally recognizing people around. He can't distinguish between day and night. Nam has to grab some sleep whenever her son does and be awake whenever he is.

Vietnam, mental illness, mental disorder, mental health, depression

Nam comforts Cuong, who has been suffering from a mental illness for 16 years after a traffic accident damaged his brain, at her house in Bac Giang Province. Photo by VnExpress/Hai Hien.

Nam keeps her son locked most of the time, only letting him out to bathe once every two days. Each time she does that, she asks her her younger brother, who lives next door, to help keep an eye on him. Cuong often runs around. Once he fell into a pond. Another time he banged his against a wall and had to go to the emergency room. Each time he his brought back to his room, Cuong puts up a fierce fight.

"Once my son screamed and clung so hard to the door that three of his fingernails got detached, causing blood to splash everywhere. I could nothing but cry on seeing his bewilderment because he didn't know the pain."

Nam lives in Xuan Bieu Village, Xuan Cam Commune, Hiep Hoa District, Bac Giang Province.

About a month ago, Cuong climbed onto his bed, hit his head against the non-cushioned part of the wall, causing blood to spill and losing consciousness. Since then, Nam also has to tie her son’s hands and spoon feed him to protect him from himself. She also moved her bed from the front yard of her house into Cuong's room. He sleeps on the bed while the mother sleeps on the ground.

Next to the "dog house" is Cuong's sister’s room. Nguyen Bich Hanh was born normal, Nam says, but the bigger she gets, the more she is afraid of strangers. At 14, Hanh was diagnosed with depression, which then descended to an uncurable psychotic illness. The girl once cut her mother's legs with a knife and hit her father's head with a hammer.

Having lost her husband before her son’s accident, for nearly 30 years, Nam has shouldered the burden of her mentally ill children by herself. This also means that she has been living on tenterhooks for nearly 30 years.

"There was a time when I was taking a shower and suddenly heard Cuong calling out for me. Since I was afraid he would hurt himself, I quickly put one leg inside my pants and rushed out, but fell down."

Currently, the three of them live on Nam's meagre monthly pension of around VND3 million ($130), plus an additional allowance of VND540,000 ($23.42) for each disabled child. She has thought many times of admitting Cuong to an institution, but cannot afford it. She loves him too much anyway. "Now I keep him locked up like this for easier management. If I let him free, I have to be afraid of Cuong harming my neighbors."

Vietnam, mental illness, mental disorder, mental health, depression

The Mental Health Department at Hanoi’s Bach Mai Hospital. Photo by VnExpress/Hai Hien.

Mostly undetected, untreated

At a recent workshop to develop a National Plan for the Prevention and Control of Non-communicable Diseases for 2021-2025, a health ministry representative said that about 13.5 million people, accounting for 15 percent of the Vietnamese population, suffer from mental disorders.

According to Dr. Lai Duc Truong of the World Health Organization (WHO), out of 13.5 million people with mental health problems in Vietnam, up to 70-80 percent go undetected and untreated. These patients are a burden for families and some seriously ill people are a risk to the community.

Dr. Nguyen Doan Phuong, head of the Mental Health Department at Hanoi's Bach Mai Hospital, said that the reason for so many untreated mental patients is the lack of specialized staff, the absence of a care center for mental disorders and the symptoms being easily confused with symptoms of other diseases. In addition, because of the stigma involved, the patient's family members avoid examination by psychiatrists, resulting in delayed or avoided treatment.

"People with some mental disorders have a high risk of recurrence. If these are not detected and timely interventions made, they can endanger people around them as well as themselves," Phuong said.

Life on the edge

Under the eaves of a building at the National Institute of Mental Health, Nguyen Van Tinh, 70, was about to step out to buy food when it started raining. The man with silver-streaked hair did not rush back inside. His eyes were fixed on the stream of people coming in and out of the hospital, some with umbrellas, others without. The hospital was as busy as his hometown market in a mountainous district in Thanh Hoa Province.

Hong, his wife, was in the poison detox ward of the Bach Mai Hospital after she drank some herbicide. After more than ten days of taking care of his wife, Tinh was used to the hustle and bustle here, but a leg injury sustained in a past accident troubled him, especially because he had to constantly go up and down the stairs to buy things like rice and water.

Two years ago, Hong had suddenly developed a chronic headache. She did not get better after taking different kinds medicines and the sickness got worse after she started taking some herbal medicines.

Ever since she fell sick, Hong has become very irritable, and curses her husband and breaks things. If her husband says anything aloud, she tells him to stop shouting and scolding her, and if he speaks softly, she thinks he is saying bad things about her. Tinh feels like he is living next to a bomb that can explode at any time.

In the middle of last year, their children took Hong to the hospital and the doctor advised a mental health check at a bigger hospital. Doctors there concluded that she was clinically depressed and are treating her as an outpatient.

"I still think that this disease will be controlled with daily medication. If I knew she could do something dangerous, I would have been more careful and helped her better," Tinh said.

To this day, he does not know why she tried to commit suicide.

Vietnam, mental illness, mental disorder, mental health, depression

Nguyen Van Tinh spends his days these days walking up and down the stairs as he takes care of his wife at the Mental Health Department in Hanoi’s Bach Mai Hospital. Photo by VnExpress/Pham Nga.

The morning of the day Hong drank the herbicide, he was feeding chickens when he heard a loud sound and ran to check. He found his wife frothing at the mouth in the middle of the house. After two days in the emergency ward, she regained consciousness, but no one dared to ask her why she did it. After her health recovered, the doctors transferred her to the Mental Health Institute for treatment.

Even though the worry about the danger of his wife's life has receded, Tinh worries about what rumor and gossip will do the rounds among his neighbors about the incident. In his hometown, depression and mental illness are still a taboo disease despite its wide prevalence. The damage that depression can cause to human health is ranked second after cardiovascular diseases.

According to the WHO, nearly 800,000 commit suicide every year as a result of depression. Up to 85 percent of people who commit suicide are from low-income and middle-income countries and are not treated for the condition.

But another huge part of the problem that goes mostly ignored, especially in countries like Vietnam, is the trauma that caretakers of the patients suffer.

Tinh rues: "They will think I was bad husband, that’s why she tried to commit suicide. But my children tell me to ignore what other people say as long as they believe in me."

When the rain stopped, Tinh dragged his painful leg back to the department after getting the things needed. He does not know how long he will have to stay in the hospital this time and how he will move on from the incident.

However, when his wife is awake, he walks with her around the hospital, the two laughing together like when they were in love more than 40 years ago.

Nam does not know what the future will bring, but she still loves her children dearly. Pushing her hands through the small opening and trying to feed her son, she says: "Cuong, you have to eat well then take a nap for mommy, ok?"

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