Category Archives: Issues & Debates

Who are Permission-Givers?

In the News, Issues & Debates

(This is a “follow-up” post on Should you listen to your shrink’s advices? – Do check that out if you haven’t already)

There are some obvious permission-givers, especially when we were young. Like I might ask my mum if I can have the chocolate bar, you might ask your dad if you can buy that toy, we ask our teachers if we can go to the bathrooms etc. So parents and teachers are some permission givers in the early years of our lives (for some, this can last for many more years).

Other than that, we probably seek permissions from different authorities, like when we are applying for visa to visit Russia, applying to cross states in Malaysia during movement control order (MCO), applying annual leaves from the company HR…… In a sense, we are asking for permission to do something too.

There are also some random ones in everyday life, like when a smoker asks if s/he can smoke there, a stranger with a tray of food asks if s/he can share your table in the food court…… So we all can be permission givers too, in minor, unimportant, everyday things.

What is important, is when some doctors, experts in some areas, scientists and researchers are also giving us permissions to do certain things. When food scientists found that there is no direct link between eating eggs and cholesterol levels, they reversed the decision on limiting how many eggs we can eat each day/week, and hence they give us permission to eat more eggs every week, without worrying so much about its impact on our cholesterol levels. Or, when doctors say you should not eat processed food and should do some exercises every week, they are also giving us permissions to do and not do certain things. Similarly, like in my previous post, my client’s shrink advised him to give up studying, this is yet another example of getting permission to quit.

In fact, when your parents swear in front of you, or smoke gracefully or enjoy drinking on the couch, do you realise that they are also giving you (subtle) permission to do so? When some cool kids in the school wear some fancy outfits, smoke cigarettes like an adult, they, too, are giving you “subtle” permission to do the same, to imitate them, to be cool and defiant like them…

Each day, there are a lot of things influencing us this way, affecting what we think and how we feel then how we react to certain things. Have you heard that suicidal acts are contagious? Marilyn Monroe’s death was followed by a temporary 12% increase in the US’ suicidal rates. In Hong Kong, the night after singer Leslie Cheung (張國榮) ended his life, there were 6 suicide attempts within 9 hours. If you look into all the deaths caused by suicide of some important figures and the subsequent suicide rates, you’d unavoidably found the impact of all these front page stories and news headlines.

Yes, them too, are permission-givers. If Robin Williams can do so, why not me? It’s true for a lot who are already suffering and perhaps having depression. This is their way of communicating, not by words. So this sort of permission, is only given to certain people, in certain situations. Not everyone would receive the same message (and permission) the same way. Sometimes, it’s not even conscious.

News about suicides resulted in an increase in an single car crashes where the victim was the driver. News about suicide murders resulted in multiple car crashes in which victims involved both drivers and passengers. Stories about young people committing suicide resulted in more traffic fatalities involving young people. Stories about older people committing suicide resulted in more traffic fatalities involving older people. News coverage of a number of suicides by self-immolation in England, prompted 82 suicides by self-immolation over the next year. The permission given by an initial act of suicide, isn’t just a general invitation to the vulnerable. It is a highly detailed set of instructions to certain people in certain situations.

So what can we do about this?

Be aware of it. Be aware of how you are affected by the news you watch every evening, the CCTV clips that were circulated on the social medias… You could have perceived the permissions, on top of some major life events, hormonal changes, interpersonal issues… It can end badly. But just be aware of this, the possibility of it. Pause for a while if you can, talk to someone if you can.

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

If you come across someone who’s suicidal: https://huibee.com/2020/05/somebody-you-know-is-suicidal/

你相信陰謀論嗎？

Issues & Debates, ,

首先，什麼是陰謀論？

“在其他解释更有可能的情况下，将事件或现实情况解释成邪恶而又强力的集团或个体在背后密谋。支持者一般相信行为者具有政治动机”－維基百科。

從2020年初2019新冠病毒疫情的開始，就常聽見許多不同的陰謀論，包括病毒的起源，包括真實的染疫和死亡數據，包括一些國家的目的，包括馬來西亞出現第三波疫情的原因等等，好多好多，而且我身邊就有這樣的朋友，偶爾聊天就會在討論這種論說。

我記得初期我會說，“我不是個會相信陰謀論的人，除非很明顯的事實證據擺在眼前。否則這麼相信和猜測並沒有意義。”

“可是你看，這麼巧先發病的國家是他們，但….，有可能咩？ ” 或者 “這麼巧出現第三波，然後國家進入緊急狀態，所以…，好像很奇怪喔！”

當陰謀論的倡導者得不到他們想要的反應時，就會開始呈現許多的“證據”…

要知道，這世界上的許多事情，你要硬是把他們牽連在一起，甚至連成因果，是完全可以輕易做到的，畢竟人的大腦，常常在做這樣的事，我們的神經，每天都在連結和溝通。

可是，研究學家發現：

想想也是不難解釋的… 只是很多時候這些陰謀論的信徒，卻很篤定自己就是因為“批判性思考”才會相信陰謀論… 你覺得呢？

Should you listen to your shrink’s advice?

Clinical Case Studies, Issues & Debates

I have been writing for so many years, but I think this is the first time I’m using the word “shrink” (a.k.a. psychiatrist)?

At the first glance the answer is obvious, of course! You are seeing a psychiatrist, what is the point of seeing one if you do not listen to his/her advice? Right?

I remember when I first started to practise, this lady Ms Ana told me that she no longer see Dr X, and was still regretting the advice he has given her, including leaving her job and boyfriend. I remember this very well, as she was my first few clients. And I remember in school we were taught not to make decision for our patients. So whenever possible, we guide them and provide them with good grounds to make informed decisions (whenever possible).

Two months ago, I came to know that an old client has decided to quit his college study. I know how much the boy loves and struggles to study (it was complicated given his backgrounds and childhood experience). The father didn’t agree, but the boy insisted that it’s a final decision. Few days later, the boy contacted me saying that he’d like to have an online session with me. I was hoping that this is what he would like to discuss – the decision of giving up study.

“That decision is final. I want to see you today to discuss my future options as I’m feeling a bit lost now” He made that clear from the beginning. But I brought the topic back, since his current problems of “feeling lost now” is completely related to this decision, and should be part of the considerations when making THE decision.

As I explored things with him, I came to realise that it’s his psychiatrist who told him that “If you don’t stop studying, your condition is going to be worse. You are going to be taking more and more medications. You should just stop now, you can’t handle the stress.” He told me he had to stop because of what he was advised.

I was surprised, immediately Ms Ana is in my mind. And that is another Dr X there, who is making life decision for his patient. Instead of showing the patient what options he has, he was telling him what to do without the next step. I don’t mean that this is a bad advice, I know this boy is under a lot of stress and he’s getting overwhelmed, but the decision is not his. He didn’t “own” the decision, he only thought that’s what he was told to do.

I quickly helped him to recall some other decision he has made based on the shrink’s and the mother’s advice, which he told me he has regretted some time ago. I told him that’s what going to happen some time later, “You are going to come back and tell me – I didn’t want to quit, but the shrink told me to do that! I paid the school fees! I love studying!” He was quiet, knowing that is true.

“He even told me that if one day I regret, I can go back to blame him.”

Of course you can go back to blame him, he doesn’t lose a hair from being blamed. But what about you? Your life change completely… Because of what he said.

There is always an easier path, which is quitting (giving up). Whatever you are doing right now that gives you a lot of stress, be it studying, working, exercising, running full marathon, HIIT, baking a birthday cake, getting a driving license, seeing someone romantically, raising a child etc, whatever I mean whatever, there is always another easier route – To QUIT. And you know what, it’s easier to advice anyone else to quit, to take the easier paths, because the paths laid ahead are easier to be taken (compare: prepare someone to take up a huge challenge vs prepare someone to stay relaxed and do nothing). But I often try not to do so, because I know once I do that, now s/he has someone who verified his/her decision to give up, a professional someone, completely valid and reasonable to give up now.

Each day this professional someone can give 10-20 advices like this, just so their patients get better mentally, experience less stress. It’s not wrong for them to do that, but you need to recognise that it’s your life, not theirs, they can ask 20 patients to give up their studies every day without feeling anything, but when your life is permanently transformed and your life history completely changed, you are the one who should be responsible for it, not anyone else, not even your parents. So be an adult and OWN your decision, you can listen to everyone else’s advice, but the final decision is yours, you can go back to blame them when you regret, but that’s not going to change the fact at all.

情绪困扰时，你首先怎么反应？

Issues & Debates, Treatment Approaches,

当您感到失望、恐惧、悲伤、沮丧、无聊、缺乏安全感、激动、烦恼、生气、痛苦、压力……时，您做的第一件事是什么？

“什么？我感觉不到到它们。”

“我不知道自己的感受是什么。我感觉像个机器人。我感到麻木。我什么都感觉不到。”

有时在我看来，人类似乎已经失去了感知主要情绪的能力，尤其是“负面”或困难的情绪。

确实，如果一只苍蝇站在您的手上，您摆动手尽快赶走它。如果洗衣机坏了，您想丢弃它，买一台新洗衣机。如果您的房间尘土飞扬，则需要清理干净。

这就是我们在外在环境中所做的事情。我们可以删除这些“负面”的东西。然后问题就解决了。但是，我们的内在，情感和心理世界呢？也能这么做吗？

当您感到悲伤时，可以摇头以摆脱悲伤吗？当您感到沮丧和失望时，是否可以将它们简单地堆放在垃圾箱中？当您觉得缺乏安全感和担心时，您可以清理它们吗？

不，你不能。这种方式不适用于内在世界。因此，我们尝试压制它，加以制止，并尽可能逃避它。 “不要哭，不要难过。” “别生气”这也是我们很多人从小所受的教导。确实，小时候，我们可能以为成年人可以控制自己的情绪，他们可以按照自己的意愿停止悲伤或生气。好神奇，不是吗？

以这种方式成长，以这种方式相信事物，我们怎么感觉感受呢？我们如何了解自己的情绪？我们怎么可能理解情绪背后的信息？所有的情绪都会给我们一些信息，无论是正面的还是负面的情绪。

当我们感到无聊、悲伤、沮丧等时，我们通常会转向我们的手机。也许回复一些whatsapp消息，也许玩我最喜欢的游戏，也许在instagram或instastory上滚动一些帖子。是的，智能手机可以似乎可以解决许多问题。至少我们不再有同样强烈的痛苦情绪了。

进而…？我们不再感受。我们只是在期待欢乐或正面的心情（而它们并不会持久）。我们不再理解出了什么问题，我们忽略了情绪所带来的信息。我们感到麻木，甚至以为麻木就是大家生活的方式。有些人转向酒精和毒品，至少他们不会感到如此麻木。

如果可以的话，请尝试在接下来的两到三天内注意一下解锁智能手机时的感觉（除了回应铃声以外）。当您拿出手机时，您是否会在逃避一些麻木，沮丧，失望，悲伤，烦恼，恐惧，担心等？好不好停下来留意自己的感觉与感受？您的身体有什么感觉吗？有什么不舒服不自在的吗？请花一些时间注意并确认它们。然后有意识的“决定”下一步要做什么。或许可以什么都不做，只是和情绪待着…

被压抑的创伤事故？

Anxiety Disorder, Issues & Debates, ,

在中国做培训的时候，发现学生蛮常喜欢问关于“创伤” (trauma) 相关的问题。过去几十年，创伤是心理学里一个很“夯”的课题，许多抑郁、焦虑、人格障碍 (personality disorder) 等心理与精神疾病，都会被与创伤事故做联想，并以此角度去谘商与治疗－－这其实没有太大问题（虽然在认知行为的角度，我们更多去关注“维持因素”，而不是问题的起因）。可是随着心理知识通过网络、自助书籍等的普及化，现在连一个7、8岁的孩子，到没有受过高等教育的70、80岁的长者，都会开始说自己“受到了创伤“。换句话说，“创伤”这个词，开始被“滥用”，不适当的应用。这就有些类似好多年前开始，“忧郁”被滥用一样，后来“我有点强迫”也开始被普及化，然后现在，“创伤”也是。

当然对我来说，心理知识，尤其有科学依据的心理学知识的普及化，一点问题也没有，它增加了社会对患有心理相关问题的意识、的关注，并能让人们提前寻求帮助，以及减少偏见和歧视等，这并没有问题。问题在于，传统上，弗洛伊德派系（Freudian) 的理论，相信人们的大脑在经历重大创伤事故时，会启动防御机制(defense mechanism)，比如抑制(repression)，把不合理的信念、痛苦的记忆等，在你无意识、不自觉的情况下隐藏它们，以期完全忘记它们。

而这才是我今天想要关注的主题：这种被压抑、被忘却的创伤，存在吗？

我想不少心理学家都会异口同声说：“当然存在！” 以前的我也是。可是这里，我想提出几个“疑点”，让把它看成理所当然存在的人，稍微的再考虑一下下…

（一）以过去许多经历较为重大事故（如：战争、被性侵强奸、地震、911事件、恐怖袭击、攫夺等）的人过后出现闪回(flashback)、失眠等症状而被诊断为创伤后应激障碍(Post traumatic stress disorder, PTSD)，这些事故其实被更强烈的记住，并不断在脑海里“重播”，所以才会导致情绪激动、焦虑等症状。这似乎显示：经历创伤事故的人，是会更强烈的记得这些事故，而不是忘却它、压抑它？

（二）有些时候，这些创伤事故发生在我们懂事以前。在孩子还未懂事前（4、5岁之前），他很可能根本不以为意，并不知道这是“创伤性的”，或许带来一些不舒服、不自在的感觉，但是后来随着时间的飘逸过去了，多年后长大了，可能因为一些环境或电影情节，再次想起，这时候才了解当时那是什么，但在不懂事的情况下，这能算是“被压抑的创伤”吗？

（三）与（二）相关，婴儿遗忘症(infantile amnesia)，显然也不是“被压抑的创伤记忆”。因为在我们未懂事以前，几乎所有经历都没有被编码 (encode) 进入我们的长期记忆 (long-term memory)，那就没有所谓的无意识压抑了。虽然其实近几年有些研究似乎发现，学语言以前长期记忆的编码方式，与逐渐掌握语言后的编码方式不同，而导致我们在学会语言后，无法“复取”(retrieve)旧有编码的记忆。

（四）许多所谓的创伤事故，多年后在治疗，尤其催眠过程中被“记起”。在美国，这甚至导致家庭关系的破裂、引起诉讼，与家人对薄公堂。可是这里的问题是，记忆的可塑性很强，它不是文档，可以每次打开来看却还保持一样，我们的日常经历、听说的故事、看过的电视电影情节、做的梦、幻想的事情等，都会影响我们的记忆。记忆并不是事件本身，记忆是加入了许多我们的经验、想法、情绪、知识等的事件，可以与原本的事故相差甚远，甚至，毫不相关，完全是虚构的。许多研究已经证实了这件事：我们可以虚构出“事实”，并强烈相信它就是事实。所以，如何“证实”这些被发现的压抑创伤事故的虚实？？

您怎么看呢？

注：我无意淡化遭遇创伤事故的人的痛苦，这篇的内容主要在谈论“被压抑”后“被发掘”的创伤经验。临床上，我还是有在针对大小创伤事故做治疗的。

What do you do when you’re experiencing difficult emotions?

Issues & Debates, Treatment Approaches

When you’re feeling disappointed, scared, sad, low, bored, insecure, frustrated, agitated, annoyed, angry, upset, pain, stressful… What is the first thing that you do?

“What? I don’t even feel them.”

“I don’t know what I’m feeling. I feel like a robot. I feel numb. I can’t feel anything.”

Sometimes it appears to me that humans seem to have lost the ability to feel primary emotions, especially the “negative” or difficult ones.

Indeed, if a fly stand on your hand, you want to get rid of it ASAP by sway your hand. If your washing machine is broken, you want to get rid of it and buy a new one. If your room is dusty, you want to clean it up.

This is what we do in the external, physical world. We remove these “negative” things. And then problem is sorted. But, what about our inner, emotional and psychological world?

When you’re feeling sad, can you get rid of it by swaying your head maybe? When you’re frustrated and disappointed, can you simply chunk them to the bin? When you are feeling insecure and worried, can you just clean them up?

No you can’t. It doesn’t apply to the internal world this way. So we try to suppress it, fight it off, avoid it as much as possible. “Don’t cry, don’t be sad.” “Don’t be angry” This is what we were taught too. Indeed as a child, we probably thought that the adults can control their emotions, they can stop being sad or angry as they wish.

Growing up this way, believing things this way, how do we still feel? How do we still know our emotions? How do we still understand the message behind the emotions? All emotions give us some messages, whether it’s positive or negative.

When we are bored, sad, frustrated, upset etc., we commonly turn to our smartphone. Maybe reply a few whatsapp messages, maybe play my favourite game, maybe scroll a few posts on instagram or instastory. Yes, smartphone is such a life saver. At least we don’t feel the same intense painful emotions anymore.

And then…? We no longer feel. We are only anticipating joyous mood (which never lasts). We no longer understand what’s wrong, overlooking the message brought by our emotions. We feel numb, and wonder if that’s the way of living. Some people turn to alcohol and drugs, at least they won’t feel so numb.

If possible, try to spend the next two to three days noticing how you’re feeling whenever you unlock your smartphone (perhaps except when it’s in response to a notification alert). When you reach out to your phone, are you avoiding some numbness, frustration, disappointment, sadness, annoyance, fear, worry, etc? How about taking a pause and noticing how you’re feeling? Any sensation in your body? Any discomfort? Just take some time to notice it and acknowledge it. Then “decide” what you want to do next. It can be nothing…