Category Archives: Clinical Case Studies

How is Morbid Jealousy diagnosed?

Her son wants her to see me, thinking that the mother couldn’t let go of the past, and has always been picking fights so much that the home is never felt peace. So she came.

When I asked about her relationship with the husband, she said they are always fighting. “Which couple wouldn’t? We face each other 24/7. We live together, work together, go out and in together. It’s normal right (that they fight all the time)?” I tried to imagine, being married for about 40 years, facing each other 24/7, yea, perhaps she’s kind of right (deep inside I still don’t feel right, especially if there is only “fight” between them). So we continued to talk about her children, grandchildren, work, neighbour, leisure etc. And I figured that her life is all about this family for the past few decades, she’s never seen the world outside, and she feels miserable in the family, that she’s sacrificed so much for the family but is not treated fairly and nicely by the members in it. So I helped her to find out what she used to love when she was young, and wanted her to look into engaging in these activities again.

What concerns me took place during our second session. She said she has nobody to talk to about “these things” for the past so many years. “Even if I said it, nobody believed me, they all think that he’s a perfect dad.” She told me the husband is always flirting other women, including her own sister, their maid, neighbour, and now daughter-in-law. I was slightly shocked, because I’ve heard a lot about the family from the son, in my mind, her husband is a traditional but good dad, except that he’s bad tempered and uses swear words when he’s angry. But I listened on.

She gave examples. She told me a few incidents that she observed. She even questioned the husband when things happened. But that only led to arguments, as the husband always denied it, and the children always sided their father. She felt alone, unfairly treated, and disappointed. (What do you think at the point?)

Some of the incidents she observed are: the husband peeping the maid while the latter is taking shower; the husband’s hand gesture was very close to the daughter in law’s face which she deems very inappropriate as a (asian, traditional) father-in-law; the husband used very gentle voice to speak to the daughter in law; the husband was chatting up with her sister. It’s mainly surrounding in themes of this sort.

She has told me not to tell her son or anyone about these. She doesn’t want to spoil their father’s image, and she knows nobody would believe what she says anyway, because they are never really there, she’s the one who spends so much time with him. She also thinks the husband will “lose face” if these things are broken out in the family.

When I was listening, I had “morbid jealousy” (read more here) in my mind. But at the same time, I know it’s also possible that the husband is really “that kind of person” (sorry for being judgmental, I’m a woman, haha). It’s not quite possible to confirm either way, unless I have a third party in the family who can tell me more, but I’m not allowed to share these with the members in the family since that would break confidentiality and trust.

So I’m going to continue digging without causing suspicions in the family. I’ve seen quite some cases of morbid jealousy in the past few years, the diagnosis is always confirmed with the statements of the spouse and/or family. Is this diagnosis possible without presence of another party?

Do email/whatsapp me if you suspect that you or your partner might have the condition, or you would like to know more about the treatment. There is also a quiz you can do here!

N.B. I’ve noted this else where in my blog, but I think it’s important to again emphasise that all cases under my “Clinical case studies” category are written either agreed by the patient and family OR modified/combined so that it’s not possible to trace back to the person. 

Positive Symptoms of Schizophrenia: A Patient’s View

She was referred to me by a consultant psychiatrist, diagnosed as schizophrenia, and taking some medication for the past few years. She is compliant with the medication, even though the medication makes her struggle to wake up every morning. She has a job. She completed a degree few years ago, and has been able to hold her job most of the years despite her illness.

I remember during our first session we talked quite a lot about the symptoms of schizophrenia. She used to have paranoid delusion (suspecting that a fellow friend from the uni is following her and trying to do her harm etc), but now has only auditory hallucination (hearing voices of the ex-coursemate).

The consultant psychiatrist and I always thought that she had good insights into her symptoms and illness. Until it was the 4th session, she disclosed that she never thought she had any illness. Why was she taking the medicine? Because it helps her emotionally, feel calmer. I suddenly realised that it was true in her case, because her antipsychotic drugs have never reduced/ceased her voices.

Sometimes it seems that the voice is like a friend to her. We have discussed that if there is no way to remove the voices right now, how she can live with the voices, and she seems ok with it (sometimes). But after more discussion, I realised that her problems with this voice is because the voice broadcasts her thoughts. She always thinks that others can read her mind, and it’s due to this voice. She can live with this voice if there is no way to get rid of it, but she can’t live with this voice telling everyone else her thoughts…… (she gave quite some good examples of others knowing her thoughts and responding accordingly, and she thinks all these were too much a coincidence).

She believes that the voice in the mind is machinery operated, and this machine is controlled by the ex-coursemate. Once during a breakdown, she even went to confront the person, and the person denied having done that to her. Now when she’s relatively well, she thinks there is no point to confront the person, because the ex-coursemate would surely deny (and she wouldn’t believe that).

From the Psychology’s perspective, both delusion and hallucination are common positive symptoms of schizophrenia. They also tend to happen together.

From the client’s perspective, it’s more complicated than that. Because she doesn’t think they are two separate symptoms of an illness. They are one thing, the voice (hallucination) broadcast her thought (mind being read – delusion).

I surely didn’t attempt to argue with or convince her that it was just her illness. I’m not being irresponsible or denying my job and role as her therapist (I can and will still help her in many other ways), but consider this carefully, is there any point at all to do that in her case? (especially that she’s almost fully functional and is taking her medicine regularly and attending therapy session monthly). After all, who knows she might be right and I might be wrong? Who says everything I learnt in my degrees must be right when the so-call anti-psychotics are not ceasing/reducing her positive symptoms? Who is the expert in one’s illness?

 

Additional knowledge:

Positive symptoms of schizophrenia: Delusion, Hallucination, Racing thoughts

Negative symptoms of schizophrenia: apathy, lack of emotion, poor or non-existent social functioning

Cognitive symptoms of schizophrenia: disorganized thoughts, difficulty concentrating and/or following instructions, difficulty completing tasks, memory problems

Peeping Tom on social medias

No matter how much we study, learn, read, practice (see clients), we barely feel what we learnt is enough. As the world advances, as new technology becomes common, new psychological problems appear too.

They were married last year after being in courtship for 5 years. It all seems fine, their marriage, their relationships, their marriage, their families, their sex lives. Until half a year ago, she realised that her husband was peeping the lady living next door, a married woman with two children. The husband would use every opportunity to peek at her, apparently after understanding her routine, like when she’d be hanging clothes at the balcony, when she’d leave home for work etc. Sometimes they are having meals, the husband notices the timing that the neighbour is coming home, he’d go upstairs to peek. This is his current status.

Previously he has been peeping her on social medias. He searched for her and followed her online, few times a day, he would visit her page just to look at her posts and activities. She is not the only target, according to the wife, he also peeks at a few other women, all beautiful ladies, including the wife’s colleague, a lady that works in the same building with him, . He doesn’t chat with them, but only “watching” them online, few times a day.

Initially he denied it when the wife confronted him. But when all the evidence is showing up, he admitted that he has always had this fetish, for a long time, before they even met each other. But he said he loves her, he only peek at them, he doesn’t and wouldn’t do anything else. He promised to change, but was soon caught by wife to be doing it again, and again.

The wife is confused. What problem does he have? Personality problems? A hidden bad habit? Psychological disorders? OCD? Sexual disorder? She searched through the internet trying to figure it out. But there laid no answer.

Indeed, it surely is an unhealthy behaviour peeping into other’s lives (through social medias) few times a day, every day. So undeniably it’s a psychology disorder, one that’s appearing following technology advancement, as when facebook wasn’t available we can’t peep into one’s life the way we do now on facebook, instagram, twitter etc, right?

The closest I can get to, is Obsessive Compulsive Disorder (OCD). There is certainly compulsive behaviour that he does, though we don’t know the obsessive thought underlying these behaviour/rituals based on the wife’s description. It also does seem that, like many other OCDs, that the problem is worsening.

How does this differ from “traditional” peeping tom / voyeurism? Are they under the same category? Does doing it digitally or online make it less severe and obstructive? Should the treatment differ? How about digital or porn addiction? Aren’t they similar in some ways too?

Problem-Focused & Emotion-Focused Copings

She didn’t think that she would need any professional mental help. That’s why she only came after quite a few months her colleague introducing our clinic to her. She realised that she is talking to herself, cursing, mumbling, and in this persistent low yet agitated mood.

It’s not difficult to understand why she’s in such state. She has a job herself and has four children, the second child is epileptic and can’t tolerate western medication, so she suffers from recurrent and unprovoked seizures. She lives with the husband and his family, including the mother in law, who doesn’t get along with her and is always criticising her. The husband’s brother works for the husband, and has recently moved in to their house with the wife and two dogs. She wasn’t happy that nobody sought her opinion regarding this. What’s worse is the brother in law and wife who never take proper care of the dogs’ hygiene. They live there for free, and never help out in any house chores. Sometimes they even use her car to take the dogs out, leaving the car seats with fur without cleaning. The mother in law would get in the way if she tried to say anything to the brother in law.

How about the husband? She’s been married to the husband for over a decade. The husband doesn’t care about all this. He usually comes home late, and is often drunk. She said he has been found to have mistress many times, some lasted for few months, some years. So this has left her in such paranoid state, is consistently suspicious that husband has another mistress yet again, and is always trying to track and check everything. So she lives in this house with her children, with almost no support and help, and with people who seem to always make life difficult for her.

What do you think? …? …?

My first reaction was fairly direct, “Why is she still there?” Yes she did mention that when outsiders look at her, most would think that she seems to lead such a happy and complete life. Is she?

Has she recognised what her problems are? Is she able to solve these problems effectively? Perhaps she can solve some of these, how about the remaining issues? Can she cope with them? Can she see the way out at all?

I do not think medication is going to do her much good, if any. I’d say this is why everyone should learn problem-focused coping strategies and emotion-focused strategies. Have you heard the famous inspirational by Reinhold Niebuhr,

Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

For me, it is telling us to solve the problems that are within our control (effective problem solving!), and for those stressors that we can do nothing about, we accept it (building psychological resilience, mindfulness, thought defusion, acceptance of negative emotions etc). And of course, what comes before, is the insight, the wisdom to identify the problems in your life and know to which category they belong to!

Psychosis to Depression?

It all started in December last year. She presented some elementary hallucination, poor sleep at night, poor concentration and drowsiness in the day. She wasn’t hearing voices, but some knocking sounds (similar to when one is knocking the doors).

So she sought psychiatric help, was put on antipsychotic and stimulant (Ritalin, normally prescribed for ADD, ADHD or narcolepsy). Her symptoms soon got much worse, seeing ghosts(?)., talking irrationally and was then brought to general hospital, where she was put on more antipsychotic drugs.

Few weeks later, her family took her to see another private psychiatrist doctor after she was discharged. The consultant diagnosed her with bipolar disorder, based on the fact that she was once an outgoing and independent person, and prescribed her with Lithium.

Throughout the few months under the care of the psychiatrists, she took and tried many medication including antipsychotic pills, she gained over 20 kgs. She gets really depressed about her weight. For when before the first episode end of last year, she bought some slimming pills online, which acted as appetite suppressant. That was when she was 20 kilograms lighter than what she is now. She wouldn’t even want to look at herself in the mirror, when she thinks about her weight, she thinks life is meaningless. She doesn’t know how she has got here and how to find the old self. She has been unable to work for 10 months now.

It all started mild. She has no family history of mental illness. The team can’t help suspecting those slimming pills that she took, which could affect and alter her brain and nervous system. Of course we wouldn’t know whether there is a cause effect relationship for definite here (and we would never know), but it is important that you know what pills and medicine you are taking, those that you buy online, and those that you are prescribed by professional doctors. I am not saying that everyone should question his/her doctors and the diagnosis and prescription, but when in doubt or think that something is not right, seek a second opinion. Also, do not believe everything that’s said on the internet, but sometimes online resources might provide us with some basic and guidance.

Grieving the death of a child

It is a very sad story to tell. I guess any parents can try to relate, but will never understand how it is like to lose a child, no matter what the age of the child is when it happens. It is also an experience no parent would want to go through.

Saturday is their family, the wife and her family’s. Husband wasn’t around. So she took her daughter to join her mother, brother and sister for dinner. There were also children of her brother and sister. They squeezed in one car to get to the place for dinner. The brother who drove the car parked the car opposite of the restaurant, and they had to cross a major road with 3 lanes each direction. So the group got off the car and crossed together, with another uncle who was also there. They thought it was clear and safe. But everything happened just in split second, a motorcycle sped passed, her daughter and her were hit. Her legs were injured, she couldn’t move, and she can’t see where her daughter was, as she was dragged by the motorcycle to few metres away. The brother brought the daughter to the hospital nearby immediately. She was sent to hospital later.

The husband rushed to the hospital after receiving the news. He knew thing is bad seeing the wife in the wheelchair and daughter no where to be seen. She was shaking. Husband tried to keep himself calm thinking there are probably many decisions to be made.

Daughter was then pronounced dead.

She was 6 years old, and would never grow older than that. The only child of this couple, was going to start primary school in a few months. They were also planning for another conception this year, bringing a little bro or sis to her.

Now she couldn’t even go home. Husband has to live on his own while she stays with her family. It was too much to bear when she goes home, the girl was literally everywhere, all the memories, that she cannot bear, with chest discomfort and burning sensation in the head. She is trying to do some work. But all she wants is to hide in the bedroom and read or write. She reads about grief and loss. She writes to her. She visits the cemetery with her favourite food and talk to her. She blames herself that the family is now broken because of her. She took away his daughter, she took away his family.

He continues to work, forced himself to go back to the home with all the memories, the home that’s no longer like a home. He even forced himself to drive past the spot where the daughter was taken away. But he takes alcohol and cries every night when he’s on his own. He blames her and her family, for not being cautious enough and crossing dangerously, for not dropping the kids and the elderly at the restaurant then only look for parking space. He thinks it’s their negligence that took his daughter’s life.

It’s been more than 3 months.

For a journey of grief, 3 months is nothing. If you ask someone who lost his or her child 20 or 30 years ago, s/he would tell you that the pain is still there, the hole is still there, there is still something missing that can never be filled. But perhaps by now s/he is able to handle this empty space, and has a little smile on his/her face when s/he thinks about the lost angel.