Monthly Archives: May 2017

Neutral Pure-O

Most people know that Exposure Response Prevention (ERP) is the main intervention used for Obsessive Compulsive Disorder (OCD). So the rationale is pretty simple here, say we have a patient who is afraid of contamination (obsession) and wash his hands excessively (compulsion), we do some preparation work and can then start the ERP by exposing him to dirt without letting him to wash his hands (response prevention). This is normally done on a very gradual manner (with the patient’s consent and enough preparation work beforehand, so it is definitely not forcefully done to him). And of course in reality the OCD cases are barely as straightforward and simple as this, but this is the general principle.

With pure obsession, i.e. those without any compulsive behaviour, it’s all in their minds, things can get a bit harder, but still, it’s possible. Some commonly seen pure-O are (1) relationship obsessions (discussed in my blog else where as “morbid jealousy” which might or might not be the same condition), (2) sexual obsessions, (3) religious obsessions, (4) violent obsessions, (5) neutral obsessions.

So let’s take a recently seen man as an example here. It started once when he drove past a church, and somehow a sexual related thought popped out in his mind, he couldn’t bear himself having such “dirty” thought in a holy place, and since then, whenever he goes passed any holy places, he will suppress his mind from coming out with any “dirty thoughts”. And as we all know that our minds don’t work this way, the more you try to push some thoughts away, the more they bounce back and pop up.

ERP is possible for such pure-O cases. After the initial preparation work including psychoeducation, motivation building and mindfulness training, they are exposed to those thoughts that they have been avoiding, in those places (based on the items in the hierarchy). So it works similarly for all different types of pure obsessions, be it relationship, violent, religious or sexual (in certain cases where direct exposure is not possible, it will have to be done in imagination, and by watching videos etc).

However, how about neutral obsessions? What the patient has could be some really simple, random thoughts, which might be inconsistent, but they might be spending hours and hours thinking about these random stuff. Like a young man I saw couple months ago, who reacts to any thought his mind comes up with, e.g. “why does the universe work this way?”, “how do my ears listen and my brain comprehend what others say?” etc. I couldn’t really carry out typical ERP to him, since those are really random topics and they can be completely different every time. So I needed him to start thought defusion exercises, mindfulness meditation (then he dropped out…). I believe this is the best way for neutral pure-O, though I understand how difficult it’s to increase their motivation to keep practicing until they see the effects (did have patients in the past who were surprised by how quiet their minds can be after such exercises – and this is just a bonus, as it’s not the intention or purpose of such practices).

Do enlighten me if you have better psychological intervention for neutral pure-O. And I hope all the OCD sufferers out there will not give in to the illness!

<心理追兇Mind Hunter>男主角马国明是精神分裂吗?

备注:我一直很认真花时间在我的网站写有素质的文章,这篇的题材可能归属娱乐版,但是我的态度与提高心理健康意识的主张不变!

已经有一段时间没有追看港剧,直到出现这部和心理学相关的电视剧,分别被几个朋友问说我有在看吗,说不错看而且还有问题要我解答,所以我在一个星期多把28集看完了。

不交代剧中的内容和角色。只是昨晚因为家人还在看,提起主角Dr Chong(心理学家钟泰然博士 — 是的他不是医生,他不能开药,他被称为Dr 是因为 PhD博士学位,不是medical doctor),说他是精神分裂症(schizophrenia),有幻觉(hallucination),可以看到听到他已故女友。我想了一下,他总是在点起烟的时候对方才出现,看起来真的有点像是刺激物引致的幻觉(有些药物和毒品确实可能引起幻觉,可能但不一定引致精神分裂症)。

说真的,看这部电视剧的过程中,我从没想过他可能有精神分裂。虽然我满怀期待最后编剧导演给我一个交代,一个诊断,这名心理学家患有的是什么心理问题(可是没有。No, 我不认同他是反社会人格障碍 antisocial personality disorder!)。对我而言,他的表现是grieving,悲悼(因为失去所爱的人的悲伤),长久下去,可能形成抑郁(depression)。当然,就像我常和病人说的,接受这些悲伤,你刚失去生命中这么重要的人/感情,你要是不悲伤不难过不哭泣,我才要担心才想治疗你。所以抑郁也是正常的。或许大部分人会说,悼念五年,也太久了。可是以陪伴丧亲者的角度来说,悲悼其实没有期限,有些人要几个月,有些人几年,周围的人能做的,就是陪伴。

回到主题,最后Dr Chung不再和其他人联络/接触,情绪崩溃,独自走上末路(其实他有没有死,结局没有交代)。这其实对我而言,或多或少地确认了我的判断,他是悲悼过度而抑郁。如果你只是悲悼,一般不那么抗拒周围的人,你还是可以继续生活、工作或学习等,并接受其他人的陪伴,但是哀悼与抑郁的一线之差(really just a fine line!),在于你开始抗拒其他人,开始封闭自己(有一幕他的警擦朋友和社工朋友说已经很久没有看到他了,另一精神科医生好朋友也已经反目成仇)。

所以我的看法与分析,他不是精神分裂。

最后还是有一点相当欣赏这部剧的地方,在于催眠那段,社工朋友童月因为过度惊吓,出现暂时性失忆,Dr Chung说催眠可以看到平时看不到的事,原本太远的距离太小的事物,在催眠中可以变近放大,当时我的心里在说“放屁!为什么误导观众”,很开心最后发现那只是他的手段,用来骗童日。只是这个操作(manipulation),真的很难让人不觉得他是反社会人格…. 不过!从剧中很多地方不难发现,他其实很在意别人的感受,也尊重别人的权益,反社会人格,是不会在他30-40岁突然出现的…

识别自杀的预警信号

自杀预警信号量表(临床应用)

  • 过去自杀企图(Previous suicidal attempts):包括家庭成员的自杀史,将显示对方可能熟悉把自杀当成解决问题的方式。(10分)
  • 家庭精神问题史,或目前有精神问题的诊断(包括人格障碍,含或不含自残行为)。(9分)
  • 毒品或物质滥用史(毒品和酒精可以使一个人失去理性,也可以被用来压抑情绪)。(8分)
  • 抑郁,对未来感到绝望、无助。(7分)
  • 童年遭受虐待或严重创伤。(6分)
  • 孤立自己、疏远其他人,与家人没有建立良好关系、没有联系。(5分)
  • 最近经历丧生或丧失,分离、离婚、失恋。(4分)
  • 患有危及生命的疾病或慢性身体疾病(如,癌症、艾滋、老人痴呆症等)。(3分)
  • 经济问题。(2分)
  • 失业。(1分)

把所有分数加起来,超过9分显示自杀的可能性,这时候要确保和对方明确的讨论自杀的念头,以及是否已经有计划。

重要贴士:

  • 很多人把“讨论自杀”视为禁忌,但是问对方“你是否有自杀念头”并不会使对方更想自杀。相反的,坦诚真心地一起讨论反而会使对方觉得自己被理解、自己其实并不孤独。
  • 可以用一些比较开放式的问题,比如“你对未来有什么想法?”,对方可能比较间接地说“我希望我可以这一觉睡下去再也不会醒来”,或直接地“我想死”。
  • 注意对方对未来或目前的情况(尤其困境)的无助感、绝望感、悲观想法。
  • 注意一些非言语的信号,比如把个人财物托付给别人,或安排身后事。
  • 无论任何时候,只要对方提起自杀,都请认真对待。
  • 自杀的念头与自杀的计划并不同。很多人在一生当中都会想过“自杀”,但是并不打算付诸行动。同样地,可以问对方,“你是否有计划怎么去进行?”,一旦发现对方有了计划(比如,想好了以什么形式比较快捷不疼痛,或把孩子送去妈妈家后独处时容易怎么做等),务必着手处理(必要时报警、送院让他留院接受治疗)。
  • 如果对方曾经企图自杀,这会是显示他将来可能再做出类似行为的最重要信号。

 

请珍惜生命,给自己一个重生的机会。若有困扰可联系:

心灵扶助协会 (The Befrienders)
热线:03-7956 8144/ 03-7956 8145
www.befrienders.org.my

马来西亚生命线协会 (Life Line Association Malaysia)
热线 :03-4265 7995
http://lifeline.org.my/cn/

马来西亚博爱辅导中心 (Agape Counselling Center Malaysia)
热线: 03-7785 5955 / 03-7781 0800
http://www.agape.org.my