Category Archives: Issues & Debates

Online Dating Addiction

Clinical Case Studies, Issues & Debates, Unclassified Disorders

He said at first he was just going on online dating sites as he was feeling a bit lonely (though he didn’t use the word “lonely”, that’s just how I interpreted it). He is in his 30s, works in bank, bought a house last year and living on his own. He has rather limited social life as his work occupies almost all his time (13-14 hours a day, sometimes more, weekend too!) 

He went on multiple dating sites to increase the chance of meeting “the one”, some popular sites and some not so, but he’d make sure there’re at least some [female] users in the country (well, it’s still not so common a thing in Malaysia). He said some dating sites had literally no female users in his area.

Over the months he chatted with so many girls. At any one time he could be chatting with 3-4 girls on 2-3 different dating sites. “As long as they responded. But I do filter – religions, ethnicity mainly. The rest, it doesn’t matter, but I do check their pictures. I don’t talk to those without pictures. Who knows you may be talking to an old man or…”

But to my surprise, when I asked how many he had met in person. “None. We’d always mention about meeting in the future, or doing something together. But I never do it. Initially I thought it was due to my work. Well, at least that was the excuse I gave myself and them girls. But slowly I realized I had no intention to meet any of them.” ??!!

“I only enjoy talking to them, flirting with them, perhaps imagining how things would go with this particular girl in the future (then with another girl in “another future”). They fill my time, which isn’t much, anyway, due to my commitment to work and house loan”

“I feel good. I laughed genuinely, and I’m sure I made them happy, and they’re also laughing, giggling in front of the phone. It uses up my leisure time and I constantly feel accompanied, day or night. This one stops writing back? Fine, there’ll always be next and next, next one. So my problems of being alone and not having much social life are solved. Why still bothered to meet up? Especially it probably would often lead to disappointments anyway.”

“I know I’m not the only one being this way. Some people met up and found someone that they’d regularly see, but they continued to surf the dating sites and flirt with others. Why stayed committed when you have so many more constantly waiting for you [in your phone]? They said this more often happen in guys, but I think the girls are doing it, too, but perhaps in a more discrete way.”

I didn’t bring up the word “addiction”. I’m not even sure whether this is ordinary or unhealthy or… At the time of writing he’s still on dating sites, happily. Hopefully I get to come back to update this post as of what happens to him in the future…

Here are some of the interesting experiments done on online dating sites:

Pretty woman with ‘worst dating profile ever’ still got dates

Cruel Intentions: How I Hacked Tinder And Got 2015 Matches In Under 17 hours

OKCupid: We Experiment on Human Beings!  (The site did various experiments on its users!)

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.

Young Pedophile

Issues & Debates

They’re right. People often say how concerned they are with sex-offending, especially with young children. We feel heartached knowing some adults get raped or children get sexually abused.

But what do we do to young teenagers who come to realize that they’re pedophiles but have never acted on it? Do they necessarily develop into a child molesters? Were we the ones who allowed that to happen?

Read this:

You’re 16. You’re a Pedophile. You Don’t Want to Hurt Anyone. What Do You Do Now?

It kind of reminded me of the patient who visited the clinic last year, the guy who spied on others compulsively (case study: Compulsive Voyeurism). It was such a courageous act for him to come for help. But how many of those with an “unconventional” addiction or compulsive behaviour actually seek help?

And how much help have we provided them with? On top of our judgement, stereotypes, prejudice…

Is Meditation for you?

Basic & General, Issues & Debates

The patient called up to ask about her diagnosis, saying she’s applying for a meditation course (V******), and she’d have to clarify all her illness and past medical history, and also the type of medicine she’s taking and what they’re for.

This patient recently had a relapse and came back to us. She made the call just few days after the visit.

This is a course completely non-commercial. The participants only have to do some donations after the 10-day course, so that the course can continue to benefit others (especially if you find it beneficial, you’ll probably like to donate more, so more people get the benefits). It teaches some mindfulness training, and you explore yourself and your mind “deeply”. (to understand the course better you should visit their website or contact the relevant personnel, it’s not the focus here).

In the past there have been patients from the clinic who went for those meditation courses, whether they are commercial or not those courses usually lead people to a better, calmer self with clearer insight and mind. But unfortunately, quite a few of them had a relapse after attending those courses. Some of them have to quit half-way.

I’m not saying that those courses are bad, since mindfulness training and meditation are found to be beneficial for most people; but they may not be suitable for certain group of people, e.g. those who have a mental illness history, or still currently take medication or undergo psychotherapy for their psychological problems. This is especially the case when the problems are psychotic related or based as their psychotic symptoms (e.g. visual/auditory hallucinations) may be exaggerated during meditation. An assessment by the attending clinician may be more appropriate before going for it.

Body Integrity Identity Disorder (BIID)

Clinical Case Studies, Issues & Debates, Obsession & Compulsion, Unclassified Disorders

If you were a surgeon and someone came to you asking you to amputate his leg, for how much he is suffering deeply due to this leg and for no physical health reason, what would you do?

The thing is if you don’t do it, they may DIY. One practiced first, he got rid of part of his finger as a prelude to amputating his leg. Another one laid on the train track and let the train run over his limbs. One more shot his legs off with a gun, etc.

Just like Gender Identity Disorder (GID), “body integrity identity disorder hypothesises that a normal function, which is your comfort in how your body fits together, has gone wrong.” When they envision themselves, the image is without the limb, the limb makes them feel “incomplete”.

Do they all desire an amputation due to BIID or a sexual fetish? An obsession with amputees and amputations?

“Here was a perfectly healthy man with a perfectly healthy leg. Yet he went under the knife voluntarily, in a foreign country. He trusted a surgical team that worked under a cloak of deception. How much must a man suffer to come to this: lying by himself on an operating table, attended only by strangers, in a small, obscure hospital thousands of miles from his home in America?”

Is amputation the only way out? Is it ethical?

Look at some case studies and the history of BIID here (a long read): This is what it is like to be at war with your body – the compulsion to be free of a limb is no imagery illness

Related study: Modular cognitive-behavioral therapy for body dysmorphic disorder: A randomized controlled trial

Is this Morbid Jealousy? – Social Media

Clinical Case Studies, Issues & Debates

We talk a lot about trust in relationships. It’s like the fundamental of any relationships, it’s probably quite easy to lose it with one small action in a few seconds, but to rebuild it can take ages, or forever.

This is a young girl born in 1990s. She knew her current boyfriend of 4-months through an online game then moved on to social media. After meeting each other, they also exchanged phone numbers and start to connect through Whatsapp.

She doesn’t want to be a control freak. But she recently realized that the boyfriend seems to be less caring. Sometimes they don’t talk to each other for whole day. She thought they should still be in the honeymoon phase, how did it end so fast? Sometimes she’d see that her boyfriend was last seen early in the morning on Whatsapp, but he didn’t talk to her, so who did he talk to at such early hours?

So one day when they were out dating, she found a chance to check on his phone, and found this girl’s phone numbers who the boyfriend appeared to be chatting with quite often on Whatsapp.

She wrote down the girl’s numbers, and added it to her phone book. So now the girl’s whatsapp account also appears on her phone. She started to monitor when the boyfriend and this girl are online, whether they are online on the same time, and whether they’re last seen on the same time (one of Whatsapp’s features, it tells you when the contact last online/seen). She’s getting almost obsessed with this checking, especially when she found that they appeared to be online at the same time so often.

At the end she confronted the boyfriend, and ended the relationship, without even finding out that the guy was really cheating. She couldn’t stand it, couldn’t stand the fact that the guy MAY be chatting to somebody else so often, and what’s most, she couldn’t stand her own checking behaviour. She knew when there is no trust in a relationship, the relationship will never work.

Sometimes I’m really not so sure if social medias bring us more benefits or hazards. When people sit in front of each other but do not look at each other, do not talk to each other, but look at the phone and chat with the persons over the phone. Is this still considered as social interaction? Perhaps it isn’t a bad thing when people use it to know more friends and to look for companions, but now people even use it to check on partners, is this still a healthy act?

Is what she does considered morbid jealousy? Can social media now function as a tool to check on partners?

(See more about morbid jealousy and a clinical case study here.)