Category Archives: Issues & Debates

Useless Psychotherapy?

Basic & General, Issues & Debates

For some people, I’d admit yes, psychotherapy can be quite pointless for them. For example, some therapists like to keep their clients coming to see them weekly for years, and yes I mean yearS, I don’t see the point. No matter how big the issue or problem a client has, it’s barely beneficial for the client to attend therapy sessions over 2-3 years. Sometimes it gets habitual, or some clients get attached to the therapist and literally can’t live without him/her.

Psychotherapy is supposed to let clients leave with confidence to sort their own problems and live their lives, with the necessary skills, motivation and direction. Well, supposed.

But recently, I came across some medical students who think talking to their mothers or friends equal to doing CBT (Cognitive Behavioural Therapy). I don’t know what people learn in their medical degrees, but really? That’s what the mother told me. He thinks he was already having psychotherapy session after a long talk with his mother regarding his obsession and anxiety issues.

Well, I do think mothers are one of the best healers on earth, whatever their backgrounds and educational levels, they seem to be so empowered and empowering. But really? Is that all you need to get out of your OCD and anxiety? So what do we psychotherapist / psychologist / therapist do then? Go home to find our mothers and look for solution?

My two cents, try to gain a bit more knowledge before you settle down with a solution or conclusion. Sometimes you may suffer through a difficult path for many years only realizing that it was your ignorance that causes all your suffer.

N.B. Sorry for the sarcasm. It’s only applicable to a very small number of people.

Related: Is psychotherapy for me? (it doesn’t tell you what psychotherapy is)

Can we help with Sexual Orientation “Issues”?

Issues & Debates, , , , ,

It seems to get more and more frequent that we’re getting emails (but not other means of communication, just usually emails) asking about sexual orientation problems, or even worse, asking us to “fix me, as I don’t want to be a gay”. Whereas, some are children of successful entrepreneurs, who can’t accept their children’s homosexuality, and asking us to “cure it”.

I’m not a scholar or researcher in this area, so my view here is rather subjective (and personal), but it’s through plenty of my involvement with people who identify themselves as homosexuals, which include closed friends, acquaintances, friends of family, clients, family of clients.

For those who see sexual orientation itself as the problem, I’d always tell them that it’s not a problem to fix, and I don’t think it can be fixed no matter how hard people try, even with professional helps (there are exceptions, those are not to be discussed here).

But that doesn’t mean that we can’t help, that it’s wrong to look for help from us, in the mental health professions. We help people to lead healthier and more contended life, dealing with the anxiety and depression associated with their sexual orientation.

And not just that, sometimes we also help with familial issues related to it. Like an adolescent who came with his very traditional-minded parents. Initially everyone thought that the parents couldn’t accept that their only son is a gay, but it was later found out that parents were trying to “stop” him because they were so worried about the kind of pressure and social stigma that the son would face being a gay for the rest of his life, and it all had nothing to do with the sexual orientation itself; whereas the son, was also so worried about how his parents would feel, and how they could face their extended family members etc. They care about each other, but they didn’t use the right way to communicate, so together, they learnt to face the barriers together, supporting each other.

This is just one of the positive examples. Although the society seems to get more open nowadays, there’re still a lot of people who suffer behind the scenes. So do seek help, whether or not you think your sexual orientation is the problem, there’re people out here who’re like you, and there are people who will be able to help, just perhaps not in the way you expect.

People often leave here being still the same person with the same orientation, but feeling much more empowered to handle the stress and anxiety associated with it, and more motivated to lead the life the way they want.

 

不能确定是社会越来越开放, 还是实际数字真的在增加, 最近越来越常收到电邮, 问关于性取向 (sexual orientation) 与同性 (homosexuality) 问题. 更甚的是, 有些人是希望我们把”问题治愈”. 有些则是一些企业家, 不能接受自己的孩子是同性恋, 而要求我们 “改正”它.

虽然我不曾着重研究这方面的课题,但是身边有着不少朋友和病人等, 所以算是相当有经验处理相关问题. 一般我都会告诉他们, 性取向, 并不是一样你很努力就能改变的东西, 很多时候, 只是把它压抑着而已.

但是这并不代表你不能来找我们帮助, 不代表求救于心理科 (psychology) 或精神专科 (psychiatry) 就是错的, 因为我们可以协助你面对和处理性取向所带来的压力 (stress),焦虑 (anxiety) 和抑郁 (depression).

不只是这样, 我们还可以帮忙调和与家人的关系与问题. 之前有个青年男生与思想非常传统的父母一起寻求帮助. 一开始大家都以为父母肯定是不能接受他们的独子是个同性恋, 但是深入了解后才发现父母其实非常担忧儿子未来要走的路, 所面对的压力和歧视, 他们的反对, 只是希望儿子有个平坦一些的路和未来, 不用受那么多苦. 而儿子, 同样也感到非常痛苦, 但担心的不是自己所要面对的, 而是父母所会受到的亲戚朋友乃至社会的压力与污言垢语. 他们彼此互相关心着, 所以在沟通以后, 开始学习一起面对一切困境.

所以请一定要寻求帮助, 不管你觉得问题是性取向本身或者其它连带问会餐题, 都会有人和你一样面对着一样的问题, 也会有人可以帮助到你, 只是可能方法不是你想象的那样.

很多人在结束治疗时, 还是那个同性那个一样的性取向, 只是他们已经学会了如何面对和克服一切, 并朝向他们向往的人生.

Mental Health: Truth-Telling VS Information Withholding

Basic & General, Issues & Debates

Should patients with mental health issues and their family members be noticed and explained about everything on their mental illness, diagnosis, treatments etc?

For Truth-Telling:

  • Most patients want to know. Studies found that most patients would want to know everything about their illness. Though not so sure what happens when they really discover “everything”.
  • Make informed decision and consent possible. Only when the patients know the full story that they can make a personally meaningful decision.
  • Building trust. If the doctor intendedly hides some information or lie to the patient and the patient finds out later, the patient will less likely to trust the doctor.
  • Lying is impractical. Chances are at some points patients are going to find out more through other people or means.
  • Avoid incorrect information found. When patients aren’t told enough about their illness or treatment, they may search for it themselves (e.g. google it) and find some information that may not be irrelevant or applicable to them.
  • Patients feel respected. Clinicians can always explicitly ask for patients’ preference.

 

For Information Withholding:

  • When everything was explained to patients/family, they may not accept the truth, lose hopes or become demoralised (e.g.” Chances are you may need to depend on medicine for the rest of your life”).
  • Some patients may deliberately state that they do not want to know more.
  • Patients become too mentally disturbed after knowing the truth that they harm themselves.
  • Patients/family feel stigmatized, being labelled as e.g. “schizophrenic”, “manic”, “mentally ill”
  • Family giving up their support to the patient knowing that it’s a long journey.

In the news: Mum killed for asking son to take psychiatric medication

Issues & Debates, Schizophrenia & Psychotic Disorder

I heard this news on the radio this morning. It just somehow worried me wondering whether it was one of our patients, and I had this mother in my mind.

She used to consult doctor on behalf of her adult son and collect medicine for him. All the while she brings medicine to her son but according to her, the son doesn’t think he has any problems. The son isn’t very keen to take those many tablets and liquids, but she can always make him take them.

Recently she insisted to bring the son to come to see psychiatric doctor, despite the son saying he has no problems. She said he’s willing to come. But hey, if you think he has no problems, why would you come to see a psychiatrist? Are you being forced to come?

In our job we came to know a lot of family members who have to supervise the patient’s medicine. Though we never encourage forcing patients to take medicine. So this morning when I heard this news I was worried about some old parents who are very caring but also too anxious and sometimes stubborn being involved in this kind of tragedy.

We are not asking you to stop caring about your mentally ill family, but sometimes they’re no longer themselves when their mind is taken over by the psychiatric illness, you don’t know what they’re going to do, you can’t make usual expectations as if they are not sick. So please seek professional help! And no, you don’t have to take them with you, or force them to come with you!

TheSunDaily: Mum killed for asking son to take medication

I’m Lunatic!

Basic & General, Issues & Debates, Schizophrenia & Psychotic Disorder

I learnt this word – lunatic – from one of my patients. The first time I heard it, he was saying to me “you’re lunatic!” I didn’t know the meaning, but I thought it was related to “lunar”, so I was thinking the word may be saying someone whose emotion fluctuates a lot (just like how the moon changes every day). Of course he was just having fun by saying that.

But that day I heard it a second time, and checked it online later, the online free dictionary says:

1. Suffering from lunacy; insane.
2. Of or for the insane.
3. Wildly or giddily foolish: a lunatic decision.
4. Characterized by lunacy or eccentricity.”

At the same time coming out from the search is a BBC News – “How offensive is the word ‘Lunatic’?” and it mentions that the word originally “referred to a kind of insanity that recurred according to the cycles of the moon“. Hahaha so I was right to think about the moon, but still get the meaning wrong. It reminds me of Dragon Ball (hahaha) and other werewolf movies.

Anyway, it was inappropriate to use the word to “normal” people. But when my patient said that to me [jokingly], I [jokingly] said back “You’re lunatic too!” He just laughed and continued to repeat that I was lunatic…

My whole intention of this post wasn’t actually about introducing the word “lunatic”. It’s in fact an introduction…

I realized there have been quite a number of this so-called “mad” people in my life, mainly due to my work. I have also been talking quite a lot about stigmatization people hold towards those suffering from mental health problems. Whenever I thought about helping and standing up for these people, my patients come across my mind.

I thought I no longer hold these stigma and prejudices like everyone else. And I was wrong. The other day I went to Wood Green, and there was this man, I probably have seen him a few times, who was talking loudly in front of Morrisons, what he talked makes no sense. I avoided standing too close to him like everyone else, but undeniably I think he was mad, he was dangerous. (although I work in a forensic ward, but no, people with mental health problems are no more likely than “normal” people to commit crimes, or to hurt others!)

No matter how many “mad” people I have met, and how much fact about “mad” people I come to know, when I walk on the street I behave like everyone else. I’m not saying that I’m wrong behaving this way. But I realized I can only be confident to work with people with mental health problems, in a safe environment or, with patients I already know for a period of time, in any environment. I don’t have the ability to approach a [“mad”] stranger on the street and attempt to help him/her.

What can we do about this? Create a safe environment any and every where, change everyone’s attitudes towards the mental illness and the people who suffer from them.

How do we achieve that?

N.B. This post was first published in huibee.blogspot.com by the same author, when she was still working in the North London Forensic Service, UK

Supportive Family VS Inconsiderate Patient

Clinical Case Studies, Issues & Debates

When this man got really depressed with suicidal thoughts, the sister took him in to live with her family in her living room, looking after him, bringing him for treatment, and giving him all kind of support and warmth.

The sister has a son and a daughter. Initially they are all very helpful towards this uncle, especially the daughter, buying him everything he had asked for, and bringing him around for tours.

Over the past few months the man has got much better, and maintained well with medication. He has some savings from his past business work and EPF. The sister has been planning to send him back to hometown where their eldest sister has a house for him to stay in and spend his life. Afterall it’s not so convenient to stay in her house’s living room with her husband and children.

However, the patient used all kind of excuses to delay the date to go back to hometown. He doesn’t want to go back.

One day, the sister saw some receipts falling out from the patient’s trousers. She went through them, and saw that the patient has been travelling to casino, almost every day, and those were the receipts of him changing gambling chips with cash, some RM500-RM1,000 which made up a total of over 10,000 ringgits worth of money spent in the casino in just the past 2 weeks. It appears that the patient has been going to gamble once he has got better with treatment and medication.

She knows her brother has a long history of gambling before he got depressed. But she didn’t know the brother has been doing that behind her back recently, while lying to her saying that he was following his friends to do sales in different states. She was disappointed and felt betrayed, with all those supports she and the family have provided him with, this is what he has brought himself back to.

Just when the sister was thinking to confront the patient, she came to know from her nephew that the patient was keeping a knife with him.

She surely doesn’t want anyone in the family to be hurt, but she is then stuck in the dilemma of how to persuade the brother to go back to hometown without confronting him. She doesn’t regret to have offered help and provided a place for her brother, because she believes that’s how family should be like, but now, she doesn’t know what to do…

Sometimes we see a lot of family who give up on those mentally ill patients (especially longstanding ones), and because we weren’t them, we couldn’t speak for them, we also couldn’t call them selfish. However, when we have those supportive and caring family members, it doesn’t mean they can then wish for reciprocal favour.

What would you do if it were you?