Making a Mental Note
It’s an invisible tormentor that rivals any physical injury, yet, mental health issues remain largely misunderstood and unnoticed — even by sufferers themselves.
Mental health is a tricky subject. Today, we wouldn’t expect a stigma to still exist – thanks in part to celebrities like Selena Gomez and Velda Tan being so open about it. But in a study done in 2014 called Mind Matters: A Study of
Mental Health Literacy, it was revealed nine out of 10 Singaporeans surveyed believe that people with mental ailments “could get better if they wanted to”.
In April, Prince Harry shone a light on what happens when you don’t properly understand and treat mental illness, as he got particularly candid about his own experiences. He spoke of “shutting down all of my emotions for the last 20 years… [and being] close to a complete breakdown on numerous occasions.” Two months later, the 32-year-old Prince jetted into Singapore and continued his crusade to shift people’s general aversion to mental health issues, urging Singapore’s youth to speak out. “It’s important for guys like you to bang the drum and encourage others. If you can just help one person not have to go through what you went through and suffer in silence, then you’ve saved a life.”
The Singapore Mental Health Study 2010 identified Major Depressive Disorder (MDD) and Obsessive Compulsive Disorder (OCD) as two of the top common disorders locally – so, in a bid to help us all understand them better, we’re taking a look at these illnesses, and what we, as a society, can do to help and understand those who suffer from them.
– A societal problem
For 10 years starting in her late 20s, Charlotte* refrained from going out whenever possible. Why? Each time she’d leave the house, she would feel “contaminated” and need to wipe down the house on her return. The process would culminate in the bathroom, where for the next seven agonising hours she would scrub the four walls and herself free from germs.
The now 39-year-old is not alone. According to a 2010 study by the Institute of Mental Health (IMH), about one in 33 Singaporeans are affected by OCD in their lifetime. Often dismissed as a personality quirk, OCD is in fact, a severely debilitating illness, marked by obsessions – unwanted, persistent urges that trigger intense distress. Jeanie Chu, Clinical Psychologist at The Resilienz Clinic, adds that it’s especially important to realise that obsessions aren’t always physical, such as cleaning rituals or setting things in perfect order. Instead they
can be “thoughts zipping through their minds, which we cannot see”.
OCD causes the mind to revolve around certain themes, with the dread of contamination and disease taking top spot. Irrational fears of harm – “did I switch the stove off ?” – are another. An urgent need for symmetry and patterns is famously documented in the life of Japanese artist Yayoi Kusama, who uses repetitive visuals to “obliterate” the hallucinations in her head.
When does a seemingly innocent habit of double checking things (did you send that text to the right person?) become an indicator of OCD? Frances Yeo, Consultant Psychologist at Thomson Medical Centre says the difference is that with normal day-to-day habits, “people do not feel anxious once they’re completed. Compulsions however, are repetitive behaviours that arise to get rid of said obsessions or to reduce anxiety”.
– What the word really means
“Being depressed” is a common phrase these days, but unfortunately, using the term as a casual descriptor makes actual clinical depression a difficult topic to get across. Known as MDD (major depressive disorder), clinical depression refers to symptoms that cause significant impairment to your life for over two weeks on an almost daily basis.
Elizabeth Ho, Consultant Psychologist at The Resilienz Clinic, warns against using the term loosely, because not only does it take attention away from people who are truly struggling with depression, but it could also become a self-fulfilling prophecy. “Your body might start conforming to this selflabeling,” she explains. Similarly, Dr Joel Yang, Clinical Psychologist at Mind What Matters explains that “if a person continually believes they are less capable [than others] due to their mental condition, then their resulting actions might make it harder for treatment and recovery”.
In 2006, Nicole Kay was a fresh graduate, making the transition from studying to working. Around the same time, her now-husband proposed, and her parents also filed for divorce. It was a lot to take. “I found myself working overtime when I was just into the second week of work. I’d fall sick every two weeks which was extremely frustrating. Being on frequent sick leave piled on the stress of having to catch up with work. There was also the pressure of maintaining a good impression in front of my new boss and colleagues. Quitting never occurred to me because I wanted to support my family financially.”
As the pressure continued to build; she started having suicidal thoughts and was eventually diagnosed with MDD and Generalised Anxiety Disorder (GAD). Although apprehensive about the side effects from medication, Nicole found the right medication, and started Cognitive Behavioural Therapy (CBT), which, she says helped her understand her condition better.
– Adding to the complications
It is not unusual for people to suffer from more than one disorder, which can make recovery complicated. Charlotte, for instance, was diagnosed with depression and OCD in 2003, but left the latter untreated, unaware that they were two separate conditions. Eleven years on, too exhausted to carry out the compulsions, she finally checked herself into IMH.
Dr Yeo has seen similar cases, like a woman whose postnatal depression lead to obsessive compulsive disorder. Already unable to turn off the lights after she’d washed her hands, pregnancy intensified her anxiety and depression. Post-delivery, she obsessed over her baby’s milk bottles and clothes, insisting that people washed themselves before touching the baby, and going so far as to wipe down her husband’s wallet.
The Singapore Association for Mental Health (SAMH) also sees clients with a combination of developmental disorders, including ADHD. These are manageable as long as there is a proper balance of medication, therapy, a better understanding of the affliction, self-help and support.
Why is there still social stigma?
While an increased public awareness of mental health issues, early detection and better medication give people with mental health issues a better chance at a normal life, they still encounter social stigma and false perceptions.
One thing experts have noticed is that there are two main ways people adversely affect those suffering with mental illnesses – sometimes without even meaning to. Complying with their disorders can be one of the problems. For Charlotte, her family would obey her OCD requests – such as where they could walk or when to wash their hair. But says Jeanie Chu, “People don’t realise that engaging in compulsive actions on behalf of the sufferers creates a co-dependent relationship, which fuels the obsessive compulsive disorder.”
Unfortunately, there are also problems when people do the opposite. When Nicole shared her illness with a friend, she found herself brushed off, and eventually became estranged from that person. Almost every expert in this story mentions patients who have been similarly brushed off by friends or relatives. Dr Ho, for instance, has heard of cases where family and friends say things like, “I’ve been depressed before, you’ll get over it,” or “just do something to make yourself happy and you’ll be fine”. Family or friends sometimes do not take sufferers seriously, even after they have expressed suicidal tendencies.
Dr Yang adds that in many workplaces, taking leave and opening up about mental illnesses is still deemed unacceptable. Even among doctors, he says, there are disagreements. “There are others in the medical and allied health lines who don’t believe in certain mental illnesses, simply writing off some of these symptoms as malingering.”
There can also be a delay in getting treatment. This is not good in the long term. “A delay may lead to more pronounced changes within the brain, which affects the patient’s confidence and ultimately makes it more difficult to get better,” explains Palanivelu Sendhil Kumar, Consultant at the Department of General Psychiatry at IMH.
While Singapore’s economic success is definitely something to applaud, it also makes the country a fertile ground for stress, which can quickly turn into a disorder when it becomes overwhelming and interferes with daily activities. While the causes of mental illness can’t be narrowed down explicitly, the fact remains that “anyone, at any age, is susceptible,” says SAMH. To this end, IMH is in the midst of consolidating its second Singapore Mental Health Study (SMHS) – comparing findings with the 2010 study and identifying patterns, which will then help guide national policies on mental health needs.
Stronger moving forward
Unlike physical injuries, mental conditions are invisible. If you suspect a friend could be suffering from one, here are a few things you can do:
Firstly, listen closely to their feelings.
Try not to give solutions. Instead gently advise them to get professional help early. Offer to accompany them if you can.
Check in on them when possible, to see how they are coping.
The future can be bright, despite setbacks. Nicole experienced a relapse in 2015 and had to start taking antidepressants, mood stabilisers and sleeping pills again. She felt like she had failed herself. Fortunately CBT had taught her that such thoughts were signs of cognitive distortion, and she eventually stopped blaming herself. Nicole has turned her experiences into TheTapestryProject.sg, a site that welcomes mental health sufferers to share their experiences and get encouragement.
Similarly, Charlotte had to take baby steps to conquer OCD. She practiced leaving the house or going out with her mother – and while she sometimes still feels “dirty” from being outside, she also feels empowered. She now works part time at a jewellery shop and volunteers as a Peer Support Specialist at IMH. “While the process [of recovery can be] prolonged, the end result seeing patients back on [their] feet is enormously satisfying and worth all the effort,” says Dr Kumar.