Category Archives: Depression

What a patient learnt from Robin Williams’ death

Depression, Issues & Debates

Got a phone call from a long-standing depressed patient who is now maintaining well with medication, the first thing she asked me,

“Do you know the American actor who committed suicide?” (I personally dislike the phrase “committed suicide”, it sounds like they deliberately chose to do it, like “committed a crime” which I don’t quite agree – they didn’t willfully choose to do it, although it may appear so)

“He’s also suffering from depression [like me], right? Why would he commit suicide?” Back in year of 2004, this patient had had ECT done due to her depressive mood with suicidal ideation. I think she understands how that feels, very well.

“Perhaps nobody has paid enough attention or has realized someone like him, a comedian who brought so much laughter to the world, can be so severely depressed.” I also told her that I didn’t know much about his biography (his personal life, history with addictions etc), that was just my guess, but I kind of think that his death must have triggered a lot of thoughts in the field of mental health.

“Imagine a celebrity like him, with that much of fame, popularity, wealth, well-liked by the world. He, too, suffered from depression [or bipolar?] just like you, and many on the streets. Just that they may not show it, but they may cry alone in the corner in their room, or their symptoms are at residual at this point”

“For mental illness, it’s so much harder [for people to understand and sympathize], unlike high blood pressure, gastric, cancer etc. You get a report, a figure telling you and everyone else that something is not right. It’s like boarding a bus with a plaster bandage after a fractured ankle, people would offer you a seat. If you take away the plaster but still suffer the fracture and pain internally, would people still offer their seat? And if you ask they may even think that you fake it! Being depressed is sort of like this, only you know it best.”

“So I should really not care about what my relatives said [of me taking those medicines] and be so grateful. My depression is all under control now. Occasionally when it hits me I’ll just meditate or do some exercise. My son bought the family this house. All 3 of my children are finishing their studies and doing good…

People may think you own the world and should be so delighted, but deep inside you want to just end your life! So let’s just be grateful, show more love, understanding and respects!”

15/8: A comic of what somebody else learnt from Robin: I want to live.

When you get old…

Anxiety Disorder, Clinical Case Studies, Depression

She usually calls me a few times a week, especially when she first came to see us.

This is a woman in her late 70s. She has 3 daughter, 2 married, one lives in Singapore and another in the UK. She lives with her youngest daughter who is still single. Although she does her best for her mother, her work is usually very busy and occupies most of her time during the week.

This woman has problems getting into sleep, so she used to take alcohol to aid sleeping. Then she had problems with her heart arteries and had to go for coronary angioplasty twice. Since the discharge her physical health deteriorated. She can no longer move around freely like she used to be, take alcohol the way she wanted it, do her daily chores like going to the market, cooking, visiting friends, walking around etc.

She spends most of the time alone in the house, not doing much. She can’t do much work as she feel her limbs have no strength (to even take up a pot filled with water). She isn’t interested in watching TV or reading papers. The elder daughter bought her an iPad and tried to teach her playing games and using Skype to connect with her grandchildren overseas, but she gave up learning half way. What’s worse, now that she isn’t allowed to take alcohol, she couldn’t sleep at all, could only sleep for few hours taking sleeping pills.

She sees no purpose of her life, and thinks very negatively. She can’t see hopes and meaning of her life. Whatever suggestions and advice made to her, she finds excuses to dispute them (symptoms of depression). When I told her how negatively she has been thinking, and all this negativity comes from her illness, not from herself; and when she’s well, she wouldn’t behave, think and feel this way at all, she doesn’t believe it – she sees no “negativity”, she thinks all these feelings and thinking are completely normal, anyone in her shoes would experience the same cognition and emotions.

In some countries the suicidal rates in the elderly are very high, I don’t have the statistics in Malaysia, but I’m sure there’re quite a number of them suffering in silence. Asian cultures place enormous value on filial piety which includes caring for the elderly (especially parents) when they can no longer look after themselves, but still, this is not always possible, so it’s important to have a plan in mind, whether it’s to have a partner with you (not necessary a spouse) and look after each other, to live in the old folks house with the others, or get a private carer.

But while you’re still young, look after your physical and mental health, be prepared for it before you get there, and take good care of your body now so that it’s fit for you to go a long way!

OCD or Body Dysmorphic Disorder

Anxiety Disorder, Clinical Case Studies, Depression, Obsession & Compulsion

“Why wasn’t I born pretty like some people?”

“What’ve I done in my past life to be born this ugly?”

“How am I going to live with this face?”

“I’m growing older and going to be even uglier. How do I live till then? Can I just kill myself?”

“Why can those people cope with their ugly look and live like nothing happens, but not me?”

This is a defaulted case who now follow up with General Hospital due to financial constraint.

She is in her late 40s, married with two teenage sons, having long standing mood disorder, very preoccupied and worried with her look, thinking about cosmetic surgery. She thinks she’s very, very ugly, and ugly people should kill themselves.

From the outsiders’, she’s actually quite tall and has a reasonably pretty face.

When she walks on the streets and see some women who’re less attractive, she’d be thinking, “how do they live with that look? Why didn’t they just kill themselves?”

She said people teased her. Telling her not to speak to them since she’s so ugly. She can’t bear people’s remarks about her look and appearance.

Her husband and two sons are very supportive, always trying to comfort her. So are her siblings. But she couldn’t get rid of this obsession from her mind. Whether she’s doing something or not, her mind consistently reminds her that she’s ugly. She also tries to do some meditation, but that doesn’t calm her down and release her stress at all.

In a conversation with her for about 30 minutes, she asked over 10 times of “Can ugly people live? Are you sure? Really? They can live till old being so ugly? They don’t have to kill themselves? They must be suffering isn’t it? Why do they bother to live?”

Then few minutes later, she’d be asking all of these questions over again. This suggests some level of OCD, but her obsessional is to do with her look. She also appears to see things very negatively, which may indicate her dysthymic mood, if not depression. In fact when I asked her a few questions, I realized she is almost completely incapable to see things positively, optimistically, and be grateful.

This was when I gave her a task – to write down a list of 30 items “Anything I have that others MAY be jealous with”, I easily gave her over 10 examples (you have healthy limbs; your husband loves you; your sons listen to you; you’re tall; you can see; you get to arrange your time; you can taste food; there’s electricity supply at home; I’m able to pay the bills etc etc).

When she started to ask those “ugly persons should kill themselves” kind of question, I reminded her about the task, and she told me, “there’s nothing anyone will be jealous about me”, couldn’t recall any of the examples I gave her few minutes ago.

So this is a severe obsession with her own definition of “ugly look” and some degree of depression. Before we help her, what  could be the diagnosis?

Nobody’s fault

Clinical Case Studies, Depression

The wife has requested to divorce earlier this year.

This is a husband who has no bad habits, and has not done anything guilty to the wife and their 3 daughters. He has supported the family financially and mentally from day one.

Why is the wife unhappy about the marriage? Frequent rows? Personality? Wife having affairs? Too boring?

They have their first daughter about 10 years ago. One year later the wife is pregnant again, and one day when she was already 8 months pregnant, the husband called the wife, and needed the wife to do something for work urgently. The wife did it as requested. And that was the day, the baby boy was born prematurely, … then passed away one day later.

In the next 5 years they have another two baby girls. But the wife couldn’t let go of it, the one and only baby boy. She blames it all on the husband, even after 8 years, can still never forgive him. She thinks the husband ruined her day and hence the water broke earlier. She thinks if the baby wasn’t born prematurely he wouldn’t have died.

She could be right. But is the husband not feeling guilty about it? Will the husband want his baby boy to die? If he knew that could happen, even on the slightest chance, will he still want the wife to do that?

OK well we can’t judge whether one’s guilty just by saying he has no motive to do so, because people do make mistake accidentally, just because you somehow kill this person accidentally, doesn’t make you guilt-free.

Now every day the wife is picking on the husband, moody, bad-tempered, and getting angry over little things. She tried to take some chinese herbs medicine, but the traditional chinese med doctor said her condition is getting so bad that she’d have to see a psychiatrist for a faster effect and action on her condition. The husband also tried to bring her to see Clinical Psychologists and went through a few sessions. But still, she couldn’t let go of the incident, and is putting the marriage and the family’s happiness at stake.

Nobody’s fault isn’t it? But when you step into her shoes you may understand why she’s feeling and behaving this way. Yet I feel so sorry for the husband and 3 daughters.

When traditional chinese medicine and psychotherapy (quit half-way) failed, will medicine help this family?

Guilt Feeling

Clinical Case Studies, Depression

She’s newly wed, just half a year ago. But she isn’t happy, as she’s involved with another man, after the proposal, before the wedding.

Few months after her wedding, the husband found out about the affair, by then she has already separated from the man. The husband also chose to forgive her about it.

This makes her feel worse. Within few weeks she was getting more and more depressed. She thinks she ruins their marriage, their lives. She would rather the husband being angry. She knew the husband loves her so much that he can forgive her about it and hopes that nothing like that will ever happen again.

But she feels so sorry, can’t get over with it and slowly develop depression, with agitation. The better the husband treats her, the worse she feels, and the worse she treats the husband back. The husband thinks he must have done something wrong, but doesn’t what to do to help with their relationship. Their marriage is at stake.

The root of the problem is her guilt feelings, that has to be spoken out, to a professional with the husband, that has to be solved, before any other problems it has caused can come to an end.

So speak out, when you feel sorry or guilty, depressed or sad, angry or agitated, you may not know what you’re doing, and may cause things to happen that make you regret for the rest of your life.

Why Depressed?

Clinical Case Studies, Depression

She has a son and a daughter with a husband who loves her. She works in a department store where she enjoys working. They have a maid who does housework for her and helps looking after the kids. The husband is quite successful running his business and so they are quite free financially. Her life is probably one of those that many would be so jealous of.

Yet she is our patient here, depressed with agitation and poor sleep, depending on Stilnox for years. She can even understand the above points and was analysing her life with me, and asked me back the reason of her being depressed. “I’ve many things in my life. My boy is very cute and I love him a lot. I like my job. I have nothing much to worry about, I don’t understand why I’m always feeling sad, feeling like jumping off the building with my kids…”

On Christmas eve she gave me a call. She said she saw that her company staff were celebrating Christmas, everyone is happy, feeling Christmasy, in the festive mood. Everyone BUT her. “I feel bad. Why can’t I feel happy like them? Am I abnormal? Why am I like that?” She feels she is the contrast of the others. On one hand she feels depressed in herself, on the other hand, she feels she’s abnormal because she can’t feel happy like them, and this “abnormal” feeling makes her guilty and feel even worse.

One of her previous psychiatric doctors gave advice to her husband, telling him not to bring her out on any festive periods, as she would feel even worse in happy crowds.

As I talk to her, I can see that she’s someone who is grateful. She’s often very thankful with one simple phone call made to her to ask her how she’s been, how her day has been. So why is this lady so depressed? Even with medication, it’s only sufficient to maintain her mood, not to make her worse, but also doesn’t make her mood raised, after all these months. What’s worse, the people surrounding her have the same questions, and they scold her, criticize her; her mother, friends, colleagues, family members question her, why can’t she be happy and grateful with her life? 

She wonders the same. Is it in the gene? Family background? Growing up environment? Nature or nurture or both? Which one more? How can we find the root of the problem and help this lady?