She started picking hair since standard 5 in primary school, and the problems got worse over the years, especially when she was under pressure. She had seen a few counsellors, also skin specialist, and was given injection on the scalp and prescribed medicine. Finally her parents decided to take her to consult psychiatrist, and within two months she got better with some SSRIs and anti-anxiety drugs. She then stopped taking the medicine. Her hair was growing again.

Few days ago the mother called up, saying her problem is back. When she was sweeping her room, she could see hair all over her bed, pillows and on the floor. The mother asked if we could provide phone counselling to help her (without using medication, as it was causing drowsiness).

This kind of request is not untypical here. Asian people (including myself) tend not to take so much western medicine, and avoid it as much as possible. I can understand that. But the girl’s trichotillomania (hair pulling) problem has a biological components.

Most mental or psychiatric illnesses have a biological component, whether it’s depression, anxiety, OCD, psychosis (obvious!) etc. Sometimes it depends on the type of illness, sometimes on the individual, sometimes it depends on which episode (which means for the same individual, she could have a biological trigger last year but this time it’s a pure psychological triggered episode), sometimes it’s a mix of both. For a person who suffers from very bad OCD, medication can probably reduce his symptoms of 30-50%, but still leaving symptoms that would still interfere with his life, so for this part he would need psychological interventions.

So I explained to the mother that she needs medication, pure counselling may relieve her symptoms to an extend, but not all of it. Because when something is wrong biologically, she would need medication to help her, whereas psychological interventions can help her to reduce her anxiety and stress, and to learn to cope with stress, mood swing, etc.

The best treatment for her would be both medication and psychological interventions, and a good combination is in fact the best and most effective treatment for a lot of people and for many mental illness and psychological problems, unfortunately nowadays this is not the kind of service provided anywhere.

拔毛癖

她从小学五年级开始拔头发，多年来问题一直恶化，特别是面对很大压力的时候。她看过几个辅导师，也见过皮肤专科，并接受头皮注射和处方药。最后，她的父母决定带她去咨询精神科医生，吃了一些SSRIs(抗抑郁)和抗焦虑药，在两个月内情况就好转了。然后她就自行停止服药，头发也慢慢长出来了。

前几天，母亲打了个电话来诊所，说她的问题又回来了。当她帮女儿打扫房间的时候，看见床上，枕头，地板上都有头发。母亲问我们是否可以提供电话咨询辅导服务来帮助她（不使用药物，因为药物使她很疲累）。

这种要求在这里绝对不是非典型的（意即典型!）。亚洲人（包括我）普遍不爱吃西药，能免则免。这点我可以理解。但这女生的拔毛癖不是简单的心理问题，她的起因含有生物因素。

大多心理和精神疾病的起因都有生物成分，无论是抑郁症，焦虑症，强迫症，精神病（显然!）等。有时它取决于疾病的类型，有时针对个人，有时取决于哪次病发（就算是同一个人，她去年发病可能是因为生物因素，但这次却是心理引起的），更多时候是两者混合。对于严重的强迫症病患，药物也许可以减轻他的症状的30-50％，但剩余的症状仍然会干扰他的生活，所以对于这部分，他需要心理治疗。

于是我向她母亲解释她需要来见医生和吃药，单纯辅导或心理治疗可以缓解她部分的症状，但不是全部。因为当头脑里的传输物质出错了，她需要药物来帮助她，而心理治疗可以减轻她的焦虑和压力，并学会应对压力和生活的变动，情绪波动等。

最好的治疗方法是结合药物+心理治疗，其实对于很多人和大部分精神疾病，结合治疗都是最好最有效的方法，可惜在现今这却不是多少地方找得到的服务。