Category Archives: Depression

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.

美丽的网红(网络红人)

我还没第一眼见过她,柜台帮她登记的同事就已经通过电话告诉我,“她真的很漂亮!陪她一起来的男士也超帅!”

一方面期待看到她,一方面心里”默默地自卑”。

她的话不多(有些患者一走进来,我可能连问问题的机会都没有),通常答案都很简略,或者想很久,但是答不上来,最后还是“我不知道”。过程中,她透露自己的一些过去,恋爱史,陪她来的男士只是朋友,她目前单身,已经五年了。也说到为自己过去的行为感到沮丧后悔,想忘记它们,通过催眠消除它们(没办法直接做到);再提到未来,觉得迷茫,工作迷茫,交不到男朋友也迷茫。

这点让我好奇,以她的外表,拜倒石榴裙下的观音兵肯定不少,她说有自己喜欢的人,但都爱玩,不想认真。而她,希望安定、谈一场细水长流的恋爱(几年前的她也曾经比较爱玩,但是已经过去了)。可是要嘛她对对方没有意思,要嘛对方只把她看成”玩“的对象。五年前分手的时候,也是因为对方还不想定下来,还是很爱玩,和其他女生暧昧,去夜店夜归等,两人不停吵架最后女生提出分手。她觉得男生是不可能专一的,最后能回家就好。

这让我想起很久以前和一个朋友的谈话,说她的一个朋友,不停地爱上有妇之夫,每次都很受伤,下一次却也还是重蹈覆辙;另外一个朋友也是,每次总爱上playboy,每次都被玩弄,身心受伤,但还是没有从中吸取教训。我们最后觉得,有些女生,总是会被一样的人吸引,总是会爱上类似特质的人。

这个个案中的女生,是个网红,拍很多养眼美丽的照片,网上的追随者与粉丝很多。男生会怎么看这个女生?(就会有男生说,有些女生只适合玩在一起,娶回家的绝不会是这类)而这个女生又会怎么看对她有意思的正经男生?又或者,她的生活圈中,有这类男生而同时又是她会喜欢的吗?会不会她总是不会看上所谓正经、或者想认真和她安定下来的男生?大家想想自己的过去,会不会觉得总是被类似特质的人吸引?

说到这里,想起最近一个好朋友的妈妈过世了,我不停在担心她的表现(太坚强),会不会是没有和自己的情绪接触(not in touch with her emotions)。毕竟东方国家,从小就被教育把负面情绪压抑,从来没有机会感受和接受。这个女生,也给我一样的感觉,总是“美美的”,没有什么表情,她的情绪起伏不大,笑容很浅,说到自己最难过的事情,也只掉了一点泪,就算我说,可以哭,可以难过,可以和这个情绪感觉相处…

或许你很羡慕有些非常漂亮的人,但是,有时候没有这点特质,反而让你的人生更顺利、更有优势。虽然我也还是会羡慕她长的如此赏心悦目,但也就只是单纯的羡慕,和更懂得感恩。

心理问题/精神疾病病友互助小组(吉隆坡/巴生)

在国外,不管是什么疾病,互助小组(support group)都是蛮常见的,比如抗癌勇士、强迫症患者等。过去也曾有好一些病人问过我,在马来西亚有这种小组吗… 所以在这里我提出一些意见,有兴趣或有其它看法的人,欢迎联络我…

互助小组类型:

  1. 抑郁症、情绪障碍
  2. 强迫症
  3. 焦虑与焦虑相关障碍
  4. 精神分裂,妄想、幻觉相关障碍
  5. 照护者、患者家属

什么是互助小组?做些什么?

  1. 每个月或每两个星期见一次面,大约一小时
  2. 认识和你面对一样或类似问题的人
  3. 轻松讨论一些主题(由我引导)
  4. 彼此分享、鼓励、支持、学习

语言

  1. 英语
  2. 中文/广东话

地点

  1. 吉隆坡欧阳专科医疗所(Jalan Pudu)
  2. 巴生Manipal Hospital Klang (Bukit Tinggi)
  3. 巴生河流域一代的咖啡馆

必要条件:

  1. 病人的意愿(不是被逼的;愿意出席、参与、讨论、分享、聆听)
  2. 至少三人才能进行
  3. 尊重其他人、尊重隐私权(不泄露其他人的隐私)
  4. 承担费用(行政、材料、场地等)(若有)

目前这只是初始阶段,如果你有什么意见和想法、或者有兴趣参与的话,请留下联络方式,也可以电邮 hello@huibee.com 或致电/whatsapp 017-2757813

英文版本:http://huibee.com/2017/08/support-groups-in-kl-klang/

Support Groups in KL / Klang

I’ve been asked about support groups quite a few times and been thinking how I can start this. It’s definitely something very common in western countries, I’m not sure how it will work here in Malaysia. Now I’m proposing the idea here, and for anyone who reads this and is interested in any of the support groups, please get in touch, let me know what you think and how we can start this and get it going!

Support groups for:

  1. Depression or mood related problems
  2. OCD (Obsessive Compulsive Disorder)
  3. Anxiety or stress related problems
  4. Schizophrenia and psychotic related disorders
  5. Carers (immediate family etc)

What is it? How does it go? What do we do?

  1. Meet monthly or every fortnightly for an hour or so
  2. Getting to know people who share the same or similar problems
  3. Casual discussion following a theme that we set (led by me)
  4. Sharing, supporting and learning among/from each other

Languages:

  1. English
  2. Mandarin / Cantonese

Venues:

  1. Klinik Pakar Au Yong, Jln Pudu, KL
  2. Manipal Hospitals Klang
  3. Some cafes in Klang Valley?

Requirements:

  1. Patient’s willingness! (is not forced by others to join us; willingly attend, participate, share and listen to others)
  2. At least 3 to form a group
  3. To treat others with respect and maintain confidentiality
  4. To share the cost of a small administrations/materials/venue fees (if any)

These are just some ideas for now, if you have some ideas or are interested, please do leave your contacts (email or contact numbers) below or get in touch by emailing hello@huibee.com or calling/whatsapp 017-2757813

<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…