Category Archives: Clinical Case Studies

生态&气候变化焦虑

几年前,我从马克那里听说,英国大学的一位同事专长治疗“生态焦虑症”患者,那至少有 3 或 4 年前了。当时我有点惊讶,然后我只是耸了耸肩,没有继续深思。 (注意:我不会对很多事情耸肩……)

我有两个选择不生育的家庭成员,因为他们两认为孩子们会在这个星球上受苦,这又是几年前的事了,是的,他们今天仍然没有孩子。每当我想到要孩子时,我个人也会考虑多年以后这地球是否还适宜居住等方面的问题。

就在 12 或 13 年前,我有一个德国朋友会因为其包装方式,不在 Tesco 购买 Kinder Bueno 巧克力威化棒,用上太多塑料了!即使她喜欢 Kinder Bueno,但她也只会买一块 100 克简单包装的巧克力。

从那时开始,我渐渐发现自己对塑料非常敏感,尤其任何一次性丢弃的东西。当我来到新加坡生活时,我遇到了困难。作为一个自豪的马来西亚雪兰莪州人,我们的杂货店和购物商场在 5 年或更早以前就停止提供塑料袋,保丽龙(聚苯乙烯)也被禁止使用,我在日常生活中几乎看不到它们。但是塑料袋和聚苯乙烯在新加坡随处可见(没有记错的话,一个新加坡人平均每年制造四十几吨的垃圾)。

快进一年在这里生活,我开始比较少去意识到气候和环境相关问题。当我看到灾难相关的新闻时,尤其是极端天气的新闻时(森林野火、旱灾、水灾等),我仍然会想它,但后来我有意识地分散了自己的注意力。也许我在逃避。我不确定如果我更深入地思考它,我是否也会变得非常焦虑。

生态焦虑,怎样才算是个问题、才需要寻求帮助?

这篇文章是为了认可我们心理学家和治疗师了解这件事的一个时代的开始,因为在过去的两个月里,我看到有两个患者因为生态焦虑相关问题和症状来找我,他们在 Hogg 生态焦虑量表上的得分都偏高。然而,重要的是,我们不应该将正常的担忧或顾虑病态化。目前 DSM-5 中没有特别列出生态焦虑,我也认为它不应该被列其中。当焦虑变得持续性和压倒压迫性,而且开始影响正常运作和日常生活时,那就应该寻求专业的帮助。问题是,当然,如果它以积极的方式影响你(例如,意识到碳足迹和塑料无所不在然后决定停止乘搭飞机或购买塑料包装的巧克力和蔬菜等),那么我们需要考虑的是,这个人过这样的生活时的情绪状态和感知幸福感。我记得我曾经工作过的大学国际办公室女士不坐飞机,她会坐火车去任何她想去的地方,不管它有多远。我会说她喜欢这么做,这样做可以增强她的整体幸福感,她也以此为傲。

不得不说,对一些有环保意识的人来说,生活在一个还没有采取多少适当措施的发达国家是蛮痛苦的。即使是普通老百姓和小企业主所做的也比我所说的政府要做得多很多。

无论如何,这是一段漫长的路。任何一步都是一步。当我得到他们的许可时,我可能会写更多关于我的患者的生态气候焦虑的内容。

My own Journey with Eating (disorders)

Recently I’ve been seeing three teenage girls (as individual clients) for body image and eating related issues. This reminds me a lot about my own journey of eating disorder, which I wasn’t aware of back then.

It was during the years when I was still doing my undergraduate in the UK. I remember asking my friend who lived with me to keep my chocolate bars for me. For example, I could get a pack of 5 snickers bars, and asked her to only “release” one to me each day after dinner. I also remember chewing food and then spitting them out just so they don’t go into my digestive system and make me put on more weight. (I obviously love myself enough to not purge?)

This usually happens to people who are highly disciplined, or thought they have great self-control. So imagine how we feel when we can’t control yet another binge or compensation that follows. But the fact is, for people who don’t even care, they wouldn’t be worrying so much about working hard to compensate for the food that you just stuffed into your body. So no, it’s not about being disciplined and/or having self-control.

It’s also NOT about willpower. The physical and emotional restrictions (with your discipline and control) actually make them worse. I used to eat only 6 to 8 apples for the whole weekend (both Saturday and Sunday). As I was working so it’s easier to not focus on food. I remember feeling my heart beating very hard when I lied on the bed in the end of the day. I can still recall the feeling even today. These restrictions, likely lead to more binging later. From an evolutionary perspective, food was scarce back then, and when you starve, chances are your body wants you to eat as much as you can the next time you encounter food!

It is also double rewarding – when you binge you normally feel good and then right after awful and guilty, then you purge and feel great again. From a behavioural perspective, you are never punished but even rewarded, you are a lot more likely to do it again next time, and this is what makes it really difficult to change as over time it gets reinforced more and more strongly.

I wonder how many people suffered or have suffered from this and never talk about it (or realise it). If you watch the Crown you would have seen Princess Diana’s binging and purging behaviour too, and this definitely isn’t something people would do or share or talk about in public. The student that I am seeing wouldn’t tell anyone about it, not even to her mum whom she shares everything with (yet the mum was also always restricting herself and wanting to lose weight all her life). Another one was referred by the college clinic to see me, and it took her 4 months to eventually arrive at my room. And myself too, I don’t think I told anyone about this, although the thing is I wasn’t even aware that my relationship with food was problematic. And looking back, the problematic relationship started way earlier in my childhood, when I always ate with my older siblings who can swallow food in lightning speed!

I believe I would never properly recover from my bulimia if I weren’t a psychology graduate. Imagine me doing psychology learning about all the types of eating disorders but never thought that I was living one. I realised it much later. But my relationships with eating can still be unhealthy sometimes. Ultimately, what really helps me are:

  • Always taking time to savour food
  • Urge surfing
  • Postponing the wishes for another cookie or chocolate (As long as I managed to postpone it, I almost always forget about it later)
  • Physical activities, doing them in a not-for-compensation way
  • Being with my family
  • Or at least have people around me when I eat!
  • Eating enough (not restricting myself!)

Share your tips too!

Is being a perfectionist good/bad?

She’s only 15, and has been doing great academically in all the subjects all her life. It’s probably not wrong to say that she is one of the top students in her country, that’s also why she received a scholarship to receive better education in a different country.

Now being in one of the top colleges in the world, she is struggling to still be the best. But she doesn’t give up. She sacrifices her sleep just so she can catch up. After all this is a very different education system from the ones she was in.

After 6 months of persistent trying, she still doesn’t see much of any results. She cries. She feels like a zombie. She wants her family to be proud of her. She needs to be the best. She wants to be perfect, in all subjects, in her writing, in her presentation, in every piece of work that she produces. But it’s not happening…

She told me “I never see perfectionism a bad thing. I always thought it’s good. Why is it bad?” She believes she’s where she is today thanks to her perfectionist trait, or she wouldn’t have worked so hard and strived so hard.

But over time she starts to see that this trait is pulling her down, is creating a lot of self-doubts and criticisms in her mind, is affecting her work, is stopping her from functioning properly, is preventing her from enjoying studying that she always loves, is making her depressed and feeling hopeless.

I guess for many of us, we were all once there, weren’t we? I remember how I was like in high school, the lucky thing is I managed, and that’s mainly because I wasn’t studying in the top school in the world. But many students who do very well but come from an underprivileged background struggle when they receive scholarship and get into a top school. It’s hard for them to see that being top in their country might not mean anything once they are here. Some people give up, some people try persistently; some people see some results, some never.

Most people are usually rewarded as a perfectionist, at least initially, like in the first one or two decades of their life. So it’s natural that we see and experience the benefits and sense of achievement being one. But it’s either now, or later in the university, or when we are in the society, that we see how academic results don’t matter, how being a perfectionist alters your worldview and reduces how you could have enjoyed life and things along the way.

For the perfectionists, only the results matter. But life isn’t like that, because the ending of life is always the same, life is about the processes. Still, you can strive to be excellent, strive to become better than yourself yesterday, but not to be flawless…

But, will young students see that?

Eco-Anxiety / Climate Change Anxiety

A few years ago, I’ve heard from Mark that a colleague from the college in the UK works with people who suffer from “eco-anxiety”. It’s at least been 3 or 4 years. Back then, I was a little surprised and then I just shrugged. (Note: I don’t shrug at many things…)

I know a family member who wouldn’t have kids because they think the kids are going to suffer on this planet, again this was quite a few years back, yes they still don’t have kids today. I personally consider this aspect too whenever I think about having children.

As far as 12 or 13 years ago, I have a German friend who wouldn’t purchase the Kinder Bueno chocolate wafer bar at Tesco due to the wrapping, how each of them is wrapped, and then a pair of them is wrapped in yet another plastic. She would just get the bar of chocolate, all 100g in one wrap, even if she likes the Kinder Bueno.

I find myself being very conscious about plastics, anything that’s single use and disposable. I had my struggle when I came to live in Singapore. As a proud Selangorian, our grocery stores stopped giving out plastic bags 5 or more years ago, polystyrene has also been banned, I hardly see them in my daily life. But plastic bags and polystyrene are here everywhere in Singapore.

Fast forward one year living here, I realised that the climate and environmental related issues have crossed my mind much less than before. When I watch news of disasters, especially due to extreme weather, I still think about it, but then I consciously distract myself. Perhaps I’m denying it. I’m not sure if I will become quite anxious too if I go deeper to contemplate it.

Eco-anxiety. When is it becoming a problem? (Image from coloradu.edu)

But this post is to acknowledge the start of an era for us psychologists and therapists to learn about the matter, because I have seen two clients who came to me due to eco-anxiety in the past two months, both scored relatively high on the Hogg Eco-Anxiety Scale. However, it’s important to note that we shouldn’t be pathologising a normal concern or worry. At the moment eco-anxiety is not listed in the DSM-5, and I don’t think that it should. The reason people should seek help is when the anxiety gets persistent and overwhelming, and that it starts to affect their normal functioning and daily lives. The thing is, of course, if it’s affecting them in a positive way (e.g. being conscious about carbon footprint and plastic uses that the person stops flying on a plane or buying chocolate in a plastic wrap), then we would need to reconsider the person’s emotional state and perceived wellbeing when leading such a life. I remember my university international office lady that I used to work for doesn’t take flights, she would take trains to go anywhere she wants, however far it is. And I’d say she enjoys it, and it enhances her general wellbeing doing so.

However, here is some countries, it’s quite a struggle for the people who are environmentally conscious to live in a first world country who isn’t doing much, yet. Even the people and small business-owners are doing much more than the government I’d say.

Anyway, it’s a long journey. Any step is a step. I might write more about my clients when I have their permission to do so.

减肥是终身事业?

照片取自这里

她的减肥事业,从青春期开始。其实从小也胖,但因为长得可爱,所以也不觉得自己的体重或身型有什么问题。直到十五、六岁的时候,发现周围的朋友身材都纤细,穿什么都好看,哪怕长得比她还矮的,拍照看起来也比她“高挑”。就这样,她开始觉得自己胖,下来的几十年,就在各种瘦身、减肥、节食、运动、产品和配套中渡过。

她给我发电邮的时候是她已经过了40岁的生日,从事物理治疗,结了婚,有个儿子。她和先生想要多一个孩子,可是多次流产、人工受孕也一直失败,医生说她必须减肥才能再试,否则就得放弃剩余的冻卵。挣扎了快两年,她看到我的网站和视频,就来联系我了。

她说,因为自己的身型,尤其在生了儿子以后,她已经自卑很久了。周围不再有朋友,因为她完全躲开大家,深怕自己的身材成为大家的笑话。而她的事业也不发展了,“没有物理治疗师可以这么胖的”。每次照镜子的时候,她就觉得自己恶心,渐渐地也不照镜子了。这些社交问题、工作问题、自卑心理等,常常使她陷入低落的情绪,而最能快速使她脱离低落情绪的方式,就是吃… 她常常可以一口气把6、7个包子吃完。尤其在独处时,她更是会不断的吃,可能把一条面包、几包薯片、巧克力等都往嘴里塞,来安抚自己的情绪和自卑感。不用说,撑饱以后,马上的自卑、恶心、嫌弃、罪恶感就会涌现… 然后不断地陷入这样的恶性循环…

第一次跟她见面做评估的过程中发现,她很不自信(敢言,assertive),总是“别人优先”而忽视自己的感受。她没有办法拒绝别人的要求,她的生活充斥着许多她不想做、不愿意做的事,不管在家里还是工作都一样,而每次她无法更敢言地拒绝他人,过后就会躲在车里或家里吃,来安抚自己的情绪。

她希望我可以帮她减肥、可以再次人工受孕,她也希望自己可以开始运动、可以控制饮食而不是被饮食所控制,她也希望自己的健康状况可以改善,尤其因为肥胖而引致的各种问题,她希望自己的自信可以有所提升,更爱自己一些,不再那么自卑,并且能够继续发展她的事业。

我用接纳与承诺疗法(ACT)开始和她治疗,然后才开始用催眠(Hypno-CBT),这个过程中,她变得更自信,更敢言,而这个自信不只是对他人,也包括对她自己,比如当心里想“再吃一个包子吧!明天再减!”,她有能力坚决的对自己说”NO!!”。这个过程中,她发现她原来不只无法对他人说不,她也无法对自己说不,总是太过随波逐流的活着,没有主见,没有目标,没有坚持… 除此之外,咨询开始的一个月后,她的体重每星期稳定持续减少 0.5-1kg,主要因为她不再被食物所控制,而且有能力更经心的感受真正的“饥饿”和经心的享受食物和进食,而不是盲目的“吞”!她还发现当她经心的进食时,其实原来她一点也不爱吃包子,以前却可以一次过吃下至少6-7个。她变得更了解自己的感受和身体的感觉,学会更疼爱自己,做对自己的身心有益的事。三个多月后,她对我说,这个治疗和探索的过程让她发现,其实她根本不想要多一个孩子,她想要专注的把儿子带大,这才是她真正想要的,所以虽然体重减轻了,她或许在两三个月可以再次尝试人工受孕,但她在更了解自己后,有能力做出她自己想要的决定,而先生也支持她。

很多人减肥很希望快速地看到成果,用许多极端的方式去节食或花很多钱去瘦身中心等,但是很多时候一旦停止,体重就快速反弹,甚至比先前还重还胖。我不反对人们断食、节食、运动,但是很多时候,减肥需要的是一个身心的重新调整和治疗,包括从身体,也包括从心理,而不只是只从一个层面下手,效果或许不快,但它会持久,因为就像心理治疗过程中你学到的任何技术,它都会帮助你变成自己的治疗师,继续应用这些技术帮助自己…

Differences between public relationship and secret affair

And why do people keep going back for it.

The obvious difference there is that one is public and usually widely accepted, be it by parents, family, friends, colleagues, general public and also the law, whereas the latter is secretive and usually not known by anyone else, and if known, is usually frown upon.

Public Relationship/Marriage Secret Affair
Public & common Secret
Widely approved Frown upon
Bound by law & religions No
Right thing to do (ethically) Morally/ethically wrong but biologically?
No longer fun after the first few months usually Usually more exciting and fun
Need to work harder to keep it going Effort yes but make it even more exciting?
Involve more responsibility Involve less responsibility from both
Might be wrong biologically but it’s to keep society going?Not necessarily polyamory

The question here is, why do people keep going back for it? I have come across a number of times when people seek help for related issues. Like a recent client Mr Chin, who is married for more than 20 years with 3 almost grown up children, but recently was “dumped” by a girl 18 years his junior and had been together for the past 10 years. Yet according to Mr Chin, they have broken up a few times during the past 2-3 years, as the girl finally thought that she wanted a normal relationship and marriage and a family, then few months later, came back to him, saying that the “normal” relationship didn’t work. Mr Chin was very confused, because the girl knew from the very beginning that he wouldn’t be able to give her anything normal, their affair would always be secretive, why did she come back to him? Each break up took him at least few weeks of sleepless night, and as he was recovering, she’s back asking to be back together. Why?

I told him the answer is pretty simple, she will find no “normal” relationship that’s as rewarding as the one you have given her, and as long as she keeps comparing you with her “new” guy, she would come back to you. Secretive relationship is always more fun and exciting, involving much less responsibility, on top of that, he’s much older and mature, and much more financially stable than most likely any other guy she’s now seeing, it’s not difficult to guess why she comes back to a wiser and more mature and pampering man, right?

Normal, public relationships are mostly boring after the initial few months, we all know it. We have to work (quite hard) on it to keep it exciting and fun. Or we accept that this the normal routine, and we treasure the companionship and family love we have, as we grow old together. But for people who have been through long term secret affair, and are used to the excitement (like the celebrity always dodging the paparazzi, which actually makes the secret affair more exciting, more rewarding and even stronger), and then at some point hope that they can find a normal, public relationship like that, it’s just hard… People need to recognise that, and actively learn to be in normal relationship, and work for normal relationships to work… Or else, it’s hard for it to go beyond the first few months.

Whichever position you are in, speak to a professional someone (relationship/marriage counsellor/therapist, psychotherapist), it’d help! Mr Chin, if the situation permits, would tell you that he’s so glad to have spoken to me and how working together with me helps make sense a lot of things, and saving his marriage and general wellbeing.