Category Archives: Issues & Debates

LGBT in Malaysia

Everyone has been talking about the change of government since the GE14 in May. Yet my blog seems so cold about this whole shift as if I don’t care, because I have not mentioned it at all so far, but this does not represent how I personally feel about it.

This morning I heard on the 89.9 BFM regarding LGBT in Malaysia. Some were hoping that with the new government, “something” can be done for this minority group. Today I’m not commenting on the Sharia (Islamic) law or how pervasive the discrimination towards LGBT is in Malaysia, I’m writing this as a psychotherapist who works in private psychiatric clinics and private hospitals. I do not represent one or any of them.

In the year of 2007, statistics showed 8% of the Malaysia population thought that homosexuality should be accepted, while in 2013 there was 9%. One of the lowest rates of acceptance in the world.

I’m pleased to see some of them appearing on the newspaper and in the public sharing their stories occasionally. But those were just a very small percentage of the people. From time to time, the clinic and myself received phone calls and emails from people suffering from them. They do not contact us because of mental distress, they get in touch because they want us to “change them back to normal.” They do not want themselves to be like this.

Yes you can set up any law to control their appearance in the media or even in the public. You can also stop them from entering your country. You can prosecute them for cross-dressing and other behaviour. Your law enforcers can also assault and humiliate them however they like it without getting into any trouble. etc. etc.

You can pretend that you don’t see them and disallow them to appear anywhere you don’t want them to be seen, but they don’t just disappear. They suffer. They continue to suffer. In silence. They seek help from private services like us. They avoid the general or government hospitals. Many of them even never speak to their family members about it. They do their best to hide it.

No I’m sorry I can’t change them back to normal. Because who is there to decide what is normal and what isn’t. Not me. Not you either. I can help them though, with all the anxiety and depression that stem from the discrimination and problems in their everyday lives.

So I’m really hoping that whatever laws and regulation the new government may come up with, consider each of these unique individuals, how the interests of the public and theirs can be served, and how can there be less suffering for all. And for the public, I’d really like to urge everyone to be more open, you don’t have to accept them or like them or befriend them, but just bring an open heart and mind, and see what happens.

 

Related read: Can we help with Sexual Orientation “Issues”?

Why do I need Psychotherapy on top of Medication?

Case 1:

My OCD client. She used to take medication many years ago, and has stopped after her condition was well under control and they were planning for pregnancy. The symptoms came back quite aggressively during her pregnancy, but with the support of her husband and family, she didn’t take any medication till her delivery, then she found me. We started psychotherapy (mainly mindfulness and Exposure Response Prevention) few months back, if you ask her what her advice was based on her experience, she would tell you, “I should have started psychotherapy when I was taking medication. That was when my symptoms were less intense with the medication, and the exposure would have been much easier. That way I could learn the techniques and use it later when I no longer medication. I wasted the opportunity. When my symptoms returned and I couldn’t take medication, I don’t know what I can do at all. I struggled till my baby was delivered.”

Case 2.

My anxiety client. She was referred to me by a psychiatric consultant, when we first met, she was rather cheerful and calm, and was tailing off the medication instructed by her doctor. Then she never came back for follow up. Till two months later, she texted me saying she had been so anxious and was unable to sleep for the past nights. We had our second session where she learnt some coping skills. When I followed up with her over the phone, she told me she was much better practicing what I told her to, and was able to sleep. Another month gone, and I received her text again saying she was under much stress and worrying a lot. She asked if there was anything she could do to stop worrying and being so anxious about things. I told her to come back for a follow up session.

 

Psychotherapy doesn’t work like tranquiliser. You pop the pill into your mouth, within 15 minutes or so you get much calmer. Psychotherapy doesn’t work like anti-depressants either. You take the medication regularly for few weeks, your depressed mood, your anxiety and OCD symptoms subside significantly.

However, psychotherapy equips you with coping skills and techniques, if you practice regularly, it becomes YOURS. You become your own therapist. When you spot the early warning signs and symptoms, you can treat yourself, without medication, without any wait.

So when you get much more stable after taking medication, it’s always good to start psychotherapy, which help you tail off medication more easily, understand yourself and the illness better, and prevent future relapse better.

Psychological problems or Social/familial/educational issues?

I’ve had quite some worried parents approaching me, telling me about the behaviour of their children – how these youngsters stay at home, not working/studying, not contributing to the family/society, simply playing games or spending all their time online browsing or social-media-ing.

I used to think this is some psychological problems that I can do something to help. But as I progressed and when I looked at those generations before us, I see that it’s becoming a “trend”, that arises due to the development of our society.

Such problems never occur in our grandparents and parents’ generations. Why?

If they didn’t work hard, they were likely to starve to death, they probably wouldn’t survive. The big environment and society are in such a position that “you have no choice, you work, or you die.” (slightly exaggerated – but if you really approach them and ask them, this was indeed how they felt). So many of them worked hard, come up with great ideas and achieved great things.

What about the children of those parents that approached me?

Their parents are generally well-to-do, white collars, giving the best to these kids, best education, best material life, best experience etc. The kids get what they want, without much effort or any hard work. Why would they want to work (hard)? Why would they not just enjoy life? Why wake up at 6am, stuck in the traffic, do things that he might not enjoy for 8 hours every day? – while he can sleep in all he wants, do what he wants, while still get everything he needs to survive and also everything he wants?

I know this saying is rather simplified. But really, if you think I’m pointing finger to their parents, no I’m not. It’s how the society has developed into, of course more importantly there are problems with our education, when children think all they need is doing well in exams and nothing else. This is worse in the Eastern, Asian, Chinese societies, because parents, as long as they are still alive and capable, look after and even pay for their children, including adult children.

What can we do about this? What can parents do about this? How can I help the children of these worried parents? Or instead how can I help these worried parents to simply stop worrying about their adult children? And perhaps then the problem is solved? Because sometimes we care too much that this love does more harm than good.

 

Disclaimer: I surely ain’t talking about every youngster out there are like that, there are many that work hard (or not) and have great achievements…

Has OCD started as an Evolutionary Advantage?

It is kind of obvious that it is?

Checking is good, double-checking is good, tidying up is good, washing is good, trying to be perfect is good, counting is good, being attentive is good, thinking thoroughly is good, requiring precision is good, getting reassurance is good … …

From the evoluntionary perspective, are people who are attentive, careful, clean, thoughtful (etc) more likely to survive? Obviously, yes? It’s very much needed in ancient societies, as survival skills.

How if these careful people get married and have children? Do they produce even more “careful” children? And then next generation, and next, and next…

And it’s not just the genes from both lines of the “careful” ancestors, but also the upbringing environments provided by these attentive parents, they certainly continue to reinforce such behaviour… We were taught many of these acts as children, by our parents, older siblings and teachers in the school, weren’t we?

Then as the behaviour continues to be reinforced and developed and advanced… there you go, OCD? (This is just a hypothesis)

It’s just my random thought… But we are surely seeing more and more OCD clients in our clinic these days. Not just that, it’s got harder and harder to treat as well (the illness has got more stubborn and sticky).

Imagine that this theory is somewhat 70% true (another 30% of factors that’s beyond the knowledge of this psychologist in the modern days), OCD is going to get stronger and stronger, right? It can become a real big (detrimental) issue, especially in Asian culture…

What can we do? How do you bring up a child that strive to be better and better, but not aiming to be 100% certain for everything s/he does?

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.

Non-Binary People with Gender Dysphoria

We know there are male and female in this world, we also know that there are some people who are born a boy but deep inside feels like ‘he’ should be a girl, and vice versa. DSM-V calls them Gender Dysphoria (or Gender Identity Disorder?).

Have you heard of the non-binary (NB)?

I think this is a good read, to come to understand we never want to see the world in only Black or White, having dichotomous or All-or-Nothing thinking. It applies to gender too. There are people who feel they do not belong to either.

Yes, Non-Binary People Experience Gender Dysphoria

I’m just hoping to raise some awareness here. So that mental health practitioners can be more sensitive, and perhaps one day, the public, too.