She has an over 11 years history of depression with obsessional ruminations, and insomnia, and has maintained relatively well on medication, after a course of 6 ECTs.

She is the 7th of 8 siblings, with no family history of mental illness. Her parents divorced when she was still a child, she lived with her mother who doesn’t really care about her. At young age she was unfortunately raped repeatedly by a relative and his friends. She never really mentions it to others, most of the time she can pretend like it never happened to her before.

She is a hairstylist who works from home. So sometimes when there’s no customer she’s spending a lot of time alone at home. One of her elder brothers sometimes helps her financially, knowing that it costs her a lot to take psychiatric medicine long-term. She has once tried to follow up in the general hospital, but after taken one dosage of the medicine prescribed by the hospital doctor, she spent the whole night trembling and crying, feeling the head spinning. Since then she’s never thought to go to the general hospital (N.B. here I’m not saying that psychiatrists from GH isn’t good, but most of them aren’t Chinese, so there’s a language barrier there, which can cause problems in diagnosis and prescription).

She’s always complaining of head and neck pulling sensation. It’s worst when she can’t sleep well. She spends most of the time being worried about this pulling sensation, although nothing wrong was found physically when she went for check-up.

Sometimes she can be very obsessive, being worried about the same thing continuously, asking similar questions repeatedly, needing a lo of reassurance. She’s currently much better with medication, and with a lot of counselling she can slowly accept occasional poor sleep and insomnia (What to do if I can’t sleep well?).

Adverse childhood experience is always a risk factor for many mental illnesses, but also a perpetuating factor.