I came to know this long-standing patient’s son when I first came to work. As the patient (mother) is always relapsing, despite taking a full dosage of anti-psychotic and anti-depressant medicine, once in a while she’ll be relapsing – non stop complaining, talking, moaning, thinking about her son who passed away two years ago, restless, agitated… And so the son will always have to contact us to ask what to do regarding patient’s condition.

After 3-4 years seeing psychiatric doctor, the mother who is at  her 70s has “roughly” maintained on the same condition, not really getting much better, but also never get too bad. But some episodes of “moaning” still happen once in a while. Every time she comes back for review, the doctor gives back the same medication, only adjust it once in a while (when patient has some other physical or health concern; when patient is getting much worse; when certain medicine is not in stock). The family starts to question each other, whether it’s still right to continue seeing a psychiatric doctor, whether to continue with all these types of medication.

Deep inside they understand that they can’t let the mother stop all the medication, she’s definitely not well without those tablets and liquids. But spending so much money each month, they’re really desperate to see the mother getting better, having less episodes of relapses. Then the son rang us, told us their concerns. They know the doctor is good, and has treated so, so many patients from different parts of the country and the surrounding countries like Singapore, Indonesia and even Vietnam etc. But maybe this isn’t just what the mother need?

He said the mother never opens up with the children, never want them to know her worries and problems. The children all know that she’s worried, having ruminations, but the mother gets agitated if they prompt and ask further. The son now asks perhaps they need someone who’s good in this to talk to her, to help her open up, to know what she thinks about her eldest son who passed away, to know why she’s moaning and complaining, on top of the medicine she’s taking. Maybe she needs more than the medicine?

I’ve written a common problem of seeing psychiatrist in General Hospital (see: Bipolar Disorder). Quite often doctors have no time but to prescribe back the same medicine to patients, even when patients’ conditions have changed… But having looked at this case, perhaps it could also be a problem in private practice!

Too little good doctors, too many patients in need, too little time, so what happen?

Dear Teachers, how are you doing? 

“I can’t teach. I want to stop teaching. I am not going to teach again for the rest of my life.” Ms S is a young graduate who just started to serve as a primary school teacher for a year. She loaned from the government and hence has to serve the government for at least 5 years. She visited us few months ago, after starting to teach for just over half a year, with her parents and a sibling, being fearful, and with crying spells. Over the few months medication treatment she got just slightly better, still able to teach, but always having crying spells. The mother is very concerned and lost, as she doesn’t know what to do if the patient can’t handle her life and her profession, yet she will have to do it due to the bonding. The only time the patient got significantly better was during the long year end school break. Now that few days after the school starts, same thing is happening.

Ms S is not an odd case. I have a friend Ms M who yesterday just told me that she has stored up so much positive energy during the long school break, but just less than one week after the school began, she has used up almost 80% of her energy and feeling all exhausted and frustrated, and in need of a break again.

Few days ago there was another teacher who is a patient of the clinic since 1990s, came to the clinic to collect medicine, and requested for 3-days MC (medical certificate). The school has just started that week when she came, and she was already not looking forward to the year of teaching and is trying to avoid to go to school whenever possible.

This year another patient who has been teaching for over 20 years has also taken a year leave after discussing it with her husband and doctor. When this patient first came to us, we all thought that she was just overly-anxious (she called us almost every morning since her first visit, in need of a lot reassurance). But few months later she was found suicidal by a psychiatrist in Singapore. Since then, just like Ms S, she started to feel that she can’t teach, feeling fearful and anxious about it, and thus decided to take a gap year.

These are just a few examples. Recently we came across quite a numbers of patients who have teacher as their profession. Of course I’ve known some happy and dedicated teachers, but I wonder whether something is wrong with the society, school, teaching system, that put so many teachers in such massive pressure, and make those who can’t handle it so depressed, fearful, anxious, suicidal… getting unwell psychologically.

It’s definitely a well-respected profession, but perhaps they also need more attention, better/revised welfare, some help, monitoring and supervision.