Category Archives: Issues & Debates

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.

Seeking mental health help leaving permanent record?

This thing has been ongoing from day one I started my job, it is usually with parents who are a bit concerned taking their children to get professional mental health care services, whether it is psychiatric, psychology, counselling services.

Their main concern is that this will leave permanent record/impact on the patient, affecting his/her future education and career opportunities and developments. So I have met parents who wouldn’t take their child to see us, or parents who argue over it, or parents who wouldn’t register their child’s name in our system and want us to use and call their (parents’) name instead.

I’m not sure what happens in government hospitals. But as far as I’m aware, all of the information we hold here in our systems is private and confidential. Unless we have the consent of the patient (or of the guardian for children or those that are less capable), or it is required by laws, we can never disclose anything to anyone, no matter if it’s their spouse, parent, supervisor from workplace or faculty head from college. I’d always add that if the patient has a very high risk of harming the self or others, we might need to do something about it (it’s often contacting the next of kin, which is a contact provided by the patient, who is already aware of patient’s condition and aware that s/he is seeing us).

So I can’t emphasise enough that seeking professional mental health care and help will not leave you with any permanent damage and record. If you allow the condition and symptoms to worsen, things can be a lot worse than what it is now.

However, with the patient’s consent, we do write medical reports, stating the patient’s mental condition and functionality. A medical report usually serve a specific purpose, like when one’s trying to apply for insurance (written to insurance company), trying to take a gap year from studies or work (written to his/her college or workplace), trying to change teaching location (written to ministry of health) etc. This is the part we can never guarantee. For insurance company, I would just hope that they deal with those reports professionally. And for a college, a company or a government department that holds one’s medical report, it does seem possible to leave a permanent record and affect one’s future. I remember there was a student requested to have a letter written to her favour, and few years later contacted us again to ask if it is possible to write another letter to waive off the previous letter… Surely it is not possible. Even if you’re now healthy and fit (even with 0.0001% chances of relapse), your previous record becomes your mental history, it doesn’t disappear and can never be removed that way. So, do take a deep consideration, before you request for any report submitted to anyone anywhere.

<心理追兇Mind Hunter>男主角马国明是精神分裂吗?



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)。


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…