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.

CLEO (Singapore) - - ADULTING -

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 TheTapestryPro­, 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.

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