Monthly Archives: May 2020

Somebody you know is suicidal…?

Depression, Treatment Approaches

COPYRIGHT ©2016 Cengage Learning

Although there is no one best way to approach a situation where suicide may be a possibility, the guidelines that follow may be helpful:

1. Treat the person as a normal human being.

2. Don’t consider the person too vulnerable or fragile to talk about the possibility of suicide. Raise the subject yourself by asking the person directly. For example, “It sounds like you are feeling depressed. Have you been thinking about harming or hurting yourself or committing suicide?”

3. Show the person you care about them even if you don’t know them very well.

4. Help the person talk about and clarify the problem. Those who are depressed may have difficulty pinpointing the problem and may feel frustrated and confused.

5. Listen carefully. People who are considering suicide are in mental and/or physical pain, although you may not be able to guess the type of pain or the source of the problem. Be there to help the person talk about the issue. You don’t need to fix the problem.

6. Suicide is often viewed as the final solution to an overwhelming problem. The person who is depressed may have difficulty sorting out alternative solutions to the problem(s) he/she faces.

7. Encourage the person to seek professional assistance. Crisis hotlines are available in many communities. If an immediate danger of suicide exists, do not leave the person alone. If the crisis seems to be improved for the moment, be sure you have a plan of action regarding professional help before leaving the person. Have the person promise to call you before doing any harm to him/herself. Offer to accompany him/her to see a mental health professional.

8. If the person refuses help, you may need to contact someone close to him/her such as a family member to share your concerns.

9. Maintain contact with the person.

Please give yourself a second chance. Malaysia suicide hotlines:

The Befrienders
03-7956 8144/ 03-7956 8145
www.befrienders.org.my

Life Line Association Malaysia
03-4265 7995
http://lifeline.org.my/cn/

Agape Counselling Center Malaysia
03-7785 5955 / 03-7781 0800
http://www.agape.org.my

N.B. The guideline is adapted from Cengage Learning’s materials. This week I’m teaching Mood Disorders and Suicide in the Abnormal Psychology module. I’m going to tell the students to share some suicidal prevention information, hence I’m also doing this myself.

To those who “found” homosexual family members:

Issues & Debates, , , ,

Please read slowly, take your time to think about it, and maybe come back again and again in a few days. If I am wrong, you can leave a message to correct me…

  • What kind of person, what gender, and which person does one like, are things that happen naturally, and in fact it is not one’s “choice”. We can’t choose the gender of the person we like, whether you’re heterosexual or homosexual, it’s not within your control. Think about your experience in the past, didn’t it simply happen naturally?
  • If you want him/her to change, please step into his/her shoes, imagine you want to force yourself to change your sexual orientation, what would happen? How’d you feel? Isn’t it painful?
  • You want him/her to be healthy and happy, right?
  • Adults without homosexual tendencies will not be deceived or pushed or influenced to become homosexual. (If that happens, it is probably because s/he was originally that way, but s/he was confused or could not face or be honest with him/herself, so in this case s/he was only pushed to become honest with him/herself and people around him/her).
  • Maybe s/he was not homosexual previously, maybe s/he had imagined her/himself marrying with the opposite sex since childhood, and even had been in a relationship with the opposite sex for a few or many years, but there are many people in this world who love “that person” instead of “the gender”. And the books, stories, cartoons, and people around us that we have contacted since childhood are almost all heterosexual, so those fantasies do not mean anything. Many people cannot accept that they are homosexuals, but choose to pretend to be so-called “normal people” (and many realised that’s even more painful).
  • Maybe you think your “common/usual” road is easier for him/her. So, do you want him/her to take a hard but happy road, or an easy but unhappy road?
  • Underlying your worry and advice, even anger and blame, are all concerns and love, because you know that road might be really difficult, on behalf of him or her, I’d like to say thank you. But no one has ever guaranteed that heterosexual relationships and marriage will be easier and happier. It is better to ask her/him to strengthen him/herself and improve his/her ability to deal with stress and cope with things, so that s/he can take this path that seems harder, so s/he is equiped with the ability to handle opinions and criticisms.
  • They told me that what others think about them is not important at all. For them, the most important person is you. Your approval and acceptance are more valuable than anything else. Every day, they are looking forward to the day when they can be honest with you.
  • Ask him/her to promise you: continue to explore and understand him/herself with a curious & open mindset, continue to grow and become more mature every day.
  • Ultimately, what you want most, is to see him being healthy and happy, right?
  • I want to tell you that if s/he had a choice, s/he’d also choose an easy way generally recognized by the society… But, have s/he had a choice?
  • I hope that you will be willing to learn and meet a wide variety of people in this world with a curious and open mind, meet them, learn about them them, get along with them, accept different people, and even like them. They are just different from you some way or the other, but they are not bad. Just because they are different from most people, it does not mean that they have psychological problems. And they strive to live, to learn about themselves, and be themselves, as hard as you do.

Thank you for reading. I’m sure they appreciate it.

Psychological Immune Neglect

Anxiety Disorder, Obsession & Compulsion, Treatment Approaches

Early last week I experienced some flashers and increase of floaters in my left eye, which as I knew, could be signs of retina tear or worse, retina detachment. I got quite worried about the eye, but was quite reluctant to go to the hospital straightaway during this movement control order due to Covid-19. At that time I had stayed home for more than 3 weeks without leaving the front gate.

Just like many of my clients, I googled to understand more about the symptoms, possible causes, treatments, and prognoses. I also started to imagine if I had only my right eye left, how my life was going to be, how long it would take me to adapt. I thought about relearning a lot of skills that require the coordination of both eyes, like touching the finger tips of each hand, driving and playing badminton.

I noticed how my family was worried about me. Normally my parents have the tendency to delay doctor consultation and treatment, and prefer the natural ways of healing, but this time it didn’t happen. At one point, I realised it seems that I was the only one who was still more chilled about it. (I mean of course I know the severity, but at the same time I was observing the symptoms closely and I didn’t wait for more than 3 days till I saw an ophthalmologist).

This reminded me of some books and research I came across long time ago. People often underestimate their emotional resilience and ability to adapt. People without a disability rate the utility or value of life with a particular medical problem significantly lower than those who actually live with the disability. For example, blindness is thought to be much worse by those who have sight compared with those who have lived without sight for years. (refer to Gilbert et al., 1998).

I mean, I had taken some time to imagine what might happen, and even done a little practice pretending it happened. If what I imagined really came true, I have had some time to be prepared for it, and to adapt to that psychologically first. So to me who has been experiencing all this, things seem easier (mind you, it isn’t that easy as I have to sleep sitting for 1-2 months). But for people who only imagine it, it all appeared harder.

This is something I often want to explain to my clients, especially those with generalised anxiety and OCD, those who over-worried about what might happen in the future. Things often seem much harder when you imagine it, and people have the tendency to underestimate the ability of adapt and cope! So I often say, “When it really happens, you will do just fine. Of course it’s not going to be easy, but believe me, You Will Adapt!” (What more, quite often the things they worry won’t happen anyway).

Immune neglect doesn’t just lead to more worries about things that people believe they won’t adapt, but also have big impact on our important decision making, this might include decisions to seek medical testing, get divorced, or file for personal bankruptcy (refer to Hoerger, 2012). Do have a thought about these examples!

So really, believe that you will adapt if unfortunately what you worry about really happens.

(To those who care about my eye: At the time of writing, my left eye is still in the beginning of a recovery process following laser procedure to treat the three retina tears. I’m still seeing a lot of floaters (and blood) in the left vision.)

電視劇《我們與惡的距離》

Issues & Debates, Review - books movies series, Schizophrenia & Psychotic Disorder, ,

最近因為新冠病毒和行動管制令，終於有時間看台灣這部拍得好寫實、令人好多感悟和痛心的10集電視劇《我們與惡的距離》。

這是過程中我有的一些很深很深的感觸和領悟（劇透，想看還沒看的話不要往下讀了）：

（一）：李媽說：“全天下沒有哪個父母要花二十年養成一個殺人犯！”我哭了好久。是的，兒子是個殺人犯，大家普遍都怪到父母身上，不能教養不要生，不能照顧培育不要生… 可是也用一樣的教養方式，為什麼妹妹曉文反而堅強不屈？真的都只能怪到父母身上嗎？

我甚至在想，身為一名心理咨詢師，要是我的孩子犯了大錯（或也一樣成了殺人犯），社會會放過我嗎？社會本來就對特定職業人群有特別的要求，如老師、醫生、藝人、政治家等。這其實也沒錯，可是有時，有些父母悉心照料，有些父母工作繁忙（像Johor的蠻多孩子都是祖父母養大的，因為父母都去新加坡了），有些父母每天吵架暴力，有些父母爛賭酗酒（讓我想起有個患者的爸爸，問她為什麼還不死？她死了他也不會傷心，反而會開心再也不用給她錢了）… 可是不是每個酗酒的父母的孩子都長成一個樣，更不是每個悉心栽培的都成功養出龍鳳，不是嗎？我不是要允許父母推卸責任。可是就像在五六十年代，你的孩子要是精神分裂（思覺失調），母親肯定要被怪罪的。可是後來已經發現並不是這樣的啊… 沒有單一的原因的嘛。

（二）你或許是受害者的家屬，也就是受害者了，但那不代表你可以“替天行道”懲罰加害者和其家屬。李小明被處決後，喬安姐決定派攝影團隊跟蹤大芝，那一刻，我真的無法接受。因為我以為喬安終於可以放下了，不懷恨地諒解大芝為何辭職，甚至以為兩人可以坐下好好聊聊。她那麼做的當下，真的把我搞崩潰了。（是自己太天真，導致落差太大，抽離不出來）

當天夜裡，看完那集後，我寫下“無論你多恨一個人，你也不能傷害對方和他的家屬”。我希望自己記住這點。尤其大芝其實也是事件中的受害者之一，憑什麼她什麼也沒做錯卻被如此對待。受害者家屬或許還可以理解，更甚的是那些完全事不關己啃著瓜子的網民、媒體、大眾，人人都在補刀撒鹽………

（三）這就把我帶到第三點：加害者的家屬。我們從來沒有站在加害者的家屬的角度去看待事情對嗎？我們一直、一直都只在關注受害者和家屬的失去、悲痛。家人被殺害確實太可憐。可我認為，這部劇拍得最好的地方，就在於允許觀眾以加害者家屬的角度去體驗、承受。他們也真的很可憐。而如果像劇中最後，加害者家屬與受害者家屬能那樣坐下來面對和發洩，那其實真的很好很好（這要是真的，會讓我很羨慕台灣）。對雙方而言，那需要多大的勇氣和心胸…

（四）其實這部劇的重點，都是透過媒體傳達的。我倒沒有什麼要多說的，台灣媒體的整體型態，似乎已經是個“病態”很久很久了，久得人民也或許習慣，而也又愛又恨。媒體的責任其實真的很大，外加現在還有網民………. 人人都能當法官判罪！感覺“很棒”，不是嗎？

（五）最後來到我的重點：精神疾病。患有精神疾病的人，包括思覺失調 (Schizophrenia) 或躁鬱症 (Bipolar disorder) 的人，都不比常人更容易有暴力行為。請你把我的上一個句子，再看一遍。他們傷害他人的機率，並不比你我傷害他人的機率來得高（他們其實因為長期吃藥、患病的壓力、幻聽或抑鬱等因素，比常人更可能傷害自己）。可是過去的電影、電視劇、報章等，都愛把他們和暴力或變態行為相連…

而剛巧，我在提筆之前，看到這則台灣新聞：要求复合遭拒绝‧男子砍伤15岁少女获刑。文中提到“律师辩护曾男有强迫症、焦虑症等精神疾病，有到医院就诊纪录，但却并未按时服”。我了解在大部分國家，患有精神疾病的人如果犯了什麼，都會受到一定的保護，或許被就醫治療，或許被判處的刑法會較輕。而我不知道各位律師是不是就因為這樣，可以“總是用”（我說的誇張了哈）精神疾病來辯護。這樣呈現在媒體中，感覺上像是“患有強迫症、焦慮症的人會砍人”，不是嗎？？？………… 狗屁不通！！！是的，患有思覺失調或妄想症的人，可能出現幻覺 hallucination、妄想 delusion（像劇里的思聰，幻聽是他聽到的聲音的部分，妄想是他老懷疑別人偷拍竊聽他等），有時會分不清哪個真實哪個是幻覺，有時會自言自語，或在他人無法理解的情況下而變得很抓狂(／frustrated)。像我的一些患者，會聽見聲音叫他去死，去跳樓等。可是如果你用“強迫症”、“焦慮症”，這真的真的太離譜了。我可以建議各位律師的是：給專家評估邊沿型人格障礙… 或一些較少見的人格障礙等。也真的希望媒體努力把一些錯誤的信息糾正過來，畢竟這也是你們的責任之一。