For many people, when they hear the word ‘Psychiatrist’, it would instantly conjure up an image of a doctor prescribing medicine for someone with a mental health condition. This is true to the extent that a psychiatrist is a medical doctor who has undergone training to become a mental health specialist. While prescribing medications are indeed part of the treatment process, what really goes on in between – from the first session to the very end?
On your very first session, your psychiatrist will most likely spend 1-1.5 hours with you to gain a better understanding of what you’re coming in for. Mental health conditions can be a touchy subject for many, and it is understandable that you’d feel hesitant to open up to a complete stranger right away. However, trust that your psychiatrist has your best interests in mind, and will do his/her best to provide optimal treatment. Don’t be afraid of being judged for your symptoms, rest assured that the psychiatrist’s office is a safe and non-judgemental space. The psychiatrist will want to know as much as you’re willing to share, and being honest with your psychiatrist will be extremely helpful for an accurate diagnosis and the development of an effective treatment plan. Just as what you’d expect when you seek a General Practitioner for physical conditions, your psychiatrist would start off by asking broader questions such as, “What brings you here today,” or “How can I help you?” For some individuals, especially if it’s their first time at a psychiatrist’s, open-ended questions like these may be nerve-wracking. You may feel a little overwhelmed, not knowing how to start or where to begin. However, there are no hard and fast rules as to how the session should flow. Simply communicating your symptoms and your concerns would be a great start, and your psychiatrist will guide you through the interview.
Your psychiatrist will also run through a history-taking process, paying special attention to your medical history, family history, your current lifestyle habits and general patterns of sleep. It is important to let your psychiatrist know if you’re on certain medications, as some may have side effects that may fuel certain mental health conditions. Avoid downplaying or dismissing any information related to your physical or mental wellbeing, the clue to an accurate diagnosis may very well lie in the details. As such, going for your first session prepared with a complete list of medications, dosages, and your compliance with them can be very beneficial. Many studies have also shown that genetics play a role in mental health disorders. If you have a family member who suffers from a psychiatric issue, be sure to let your psychiatrist know for him to have a clearer idea of the situation. If need be, your psychiatrist may also ask permission to speak with other family members.
Depending on the patient’s circumstance, the psychiatrist may conduct a physical check-up if necessary, or possibly laboratory tests to exclude other possible causes for your condition. These are done to confirm that what you’re experiencing are not due to other medical conditions which may give rise to similar symptoms. Hence, if your psychiatrist asks for these procedures to be carried out, don’t feel too worried! Questionnaires to further assess your symptoms may also be given, so do make sure to answer them as truthfully as possible.
Depending on the complexities of your condition, medication options or other forms of treatment may be prescribed. If you are given medications, the psychiatrist would counsel you on how you can tell if the medications are working. Over the course of your recovery journey, take note of how subtle changes to the medications made by your psychiatrist affects you. Do they stabilise or improve your condition, or do they seem to send you on a downward spiral? How have you been feeling since you started taking them? Whatever the outcome, keep your psychiatrist in the know of how you’re coping. In the same vein, it is very important that you do not adjust your medications on your own without seeking professional advice! Patients may get impatient if they’re not seeing the desired change after a while, but constant and unregulated changes can cause undesirable fluctuations, potentially worsening the situation. We need to understand that there could be catastrophic, life-threatening consequences if we do not take them seriously.
In general, psychiatrists usually work closely with psychologists and therapists, as some mental health conditions are best treated with both neuropharmacological support and psychotherapy. Thus, your psychiatrist may also refer you for psychotherapy if deemed fit. Depending on the level of care required to address the patient’s symptoms, psychiatrists may recommend treatment programmes if more intensive care is needed.
We are no strangers to feelings of anxiety – at certain stages of our lives or in particular situations, we would have experienced anxiousness and worry with relation to our careers, studies, relationships and even our environment. However, anxiety levels may go beyond the healthy norm for some people, and may instead develop into anxiety disorders that may have a debilitating effect on their lives. According to the American Psychology Association (APA), an individual who suffers from an anxiety disorder is described to have “recurring intrusive thoughts or concerns”, where the duration and severity in which the individual experiences anxiety could be blown out of proportion to the original stressor, resulting in undesirable tension and other physical alterations. In this article, we will be exploring a few types of anxiety disorders as well as how they can manifest within us.
Generalised Anxiety Disorder (GAD)
Generalised Anxiety Disorder is a psychological issue characterised by persistent and pervasive feelings of anxiety without any known external cause. People who are diagnosed with GAD tend to feel anxious on most days for at least six months, and could be plagued by worry over several factors such as social interactions, personal health and wellbeing, and their everyday routine tasks. For example, an individual with GAD may find himself experiencing headaches, cold sweats, increased irritability and frequent feelings of “free-floating” anxiety. Others may also experience muscle tension, sleep disruptions or having difficulty concentrating. Often, the sense of anxiety may seemingly come from nowhere and last for long periods of time, therefore interfering with daily activities and various life circumstances.
In contrast, Panic Disorders are characterised by the random occurrence of panic attacks that have no obvious connection with events that are co-occurring in the person’s present experience. This means that panic attacks could occur at any time, even when someone is casually enjoying a meal. Of course, panic attacks could also be brought on by a particular trigger in the environment, such as a much-feared object or situation. Some individuals have reported that panic attacks feel frighteningly similar to a heart attack, especially with the rapid increase in heart palpitations, and the accompanying shortness of breath. Other symptoms also include trembling, sweating, and feelings of being out of control. With these panic attacks bringing on sudden periods of intense fear and anxiety, it can be exceptionally terrifying when these attacks reach their peak within mere minutes. However, a notable difference between a panic disorder and GAD is that an individual diagnosed with panic disorder is usually free of anxiety in between panic attacks.
Obsessive-Compulsive Disorder is a disorder marked by patterns of persistent and unwanted thoughts and behaviours. Obsessions are recurrent thoughts, urges or mental images that cause anxiety. On the other hand, compulsions are the repetitive behaviours that a person feels the urge to do in response to an obsessive thought or image. One common example often exhibited in films is where an individual has an obsessive fear of germs. This person may avoid shaking hands with strangers, avoid using public restrooms or feel the urge to wash their hands way too frequently. However, OCD isn’t purely limited to feelings of anxiety due to germs. OCD can manifest in other ways as well, such as wanting things to be symmetrical or in perfect order, repeatedly checking on things (“Did I leave my stove on?”), or the compulsive counting of objects or possessions. While everyone double-checks their things and has their own habits, people with OCD generally cannot control their thoughts and behaviours, even if they are recognised to be rather excessive. They can spend at least 1 hour a day on these thoughts and behaviours, and will only feel the much-needed brief sense of relief from their anxiety when they perform their rituals. As such, OCD can be exceptionally debilitating to one’s mental health.
Social Anxiety Disorder
Persons with Social Anxiety Disorder, or SAD, experience high levels of anxiety and fear under particular or all social situations, depending on the severity of their condition. They are often afraid of being subjected to judgement, humiliation or rejection in public, causing them to feel embarrassed. As such, individuals with SAD may feel extra self-conscious and stressed out, and try to avoid social situations where they might be placed at the centre of attention.
A phobia involves a pathological fear of a specific object or a situation. This means that one may experience intense anxiety upon encountering their fears and will take active steps to avoid the feared object. Phobias may centre on heights(acrophobia), birds (ornithophobia), crowds and open spaces(agoraphobia), and many others. People with agoraphobia, in particular, may struggle to be themselves in public spaces, for they think that it would be difficult to leave in the event they have panic-like reactions or other embarrassing symptoms. In severe cases, agoraphobia can cause one to be housebound.
In Singapore alone, 10% of the population is plagued by anxiety disorders – one of which includes Social Anxiety Disorder, or SAD for short. And on a global scale, approximately 4.5% of the world’s population – 273 million people – are estimated to experience anxiety disorders as of 2010. Commonly misunderstood to be merely an over-exaggerated form of shyness, Social Anxiety Disorder is much more than that. Individuals with SAD experience symptoms of anxiety or fear under particular or all social situations, depending on the severity of their condition. For some, even doing the simplest day-to-day activities in front of others can cause extreme worry of being judged, humiliated or rejected. However, some research has also suggested that SAD may be especially manifested in individuals that have ongoing medical, physical conditions such as Parkinson’s Disease, obesity, facial or bodily disfigurement (including amputees), and any other sort of conditions that may cause one to look different from the norm.
What are the symptoms of SAD?
When people with Social Anxiety Disorder are surrounded by others or have to carry out a particular action around them, they may:
Feel nauseous, experience an increase in heart rate, tremble, blush or sweat profusely.
Be unable to make eye contact with others, move and act rigidly, or speak in an overly soft tone.
Feel extremely self-conscious, as though others are judging their every move.
Easily feel awkward, embarrassed and stressed out in social situations.
Find it extremely difficult to be themselves around others, especially strangers.
Have anxious thoughts such as, “I’m sure they won’t want to talk to me again,” or “Do I look plain stupid right now?”
Apologise excessively, even when there is nothing to apologise for.
Avoid conversations, such as by using their mobile devices or plugging in their headphones.
Avoiding situations where one might be placed at the centre of attention.
The list of symptoms above is not exhaustive, but we need to recognise that they may cause extreme distress to these individuals. For them, it can be tremendously helpful and relieving for them to seek treatment for their condition, more specifically through Cognitive Behavioural Therapy (CBT).
Cognitive Behavioural Therapy is a well-known form of therapy in the mental health profession. Considered to be a form of short-term therapy, CBT is usually delivered in a time-limited manner, often over the course of 8 to 12 sessions (although this may vary from person to person). Once the symptoms are reduced and the individual is well-equipped with the necessary skills to cope with anxiety triggers or social situations in general, treatment can be finalised. As it is not possible to change or alter emotions directly, CBT aims to tackle any maladaptive, limiting thoughts and behaviours that fuel or contribute towards agonising emotions. This, therefore, lowers the extent of anxiety that one goes through and instead, developing a sense of self-efficacy.
First off, CBT encourages individuals to open up and to be truthful regarding their automatic, instinctive (negative) thoughts so that they can work hand-in-hand with therapists to analyse the logic behind them. During the sessions, therapists will work to identify the assumptions (and their validity) that these people hold, which might be causing unnecessary anxiety or fear. Proper reasoning and clearing up of assumptions can be done by asking clients to do some self-assessment and to provide possible reasons as to why they maintain such assumptions. By doing so, therapists can then assess the situation and present evidence contrary to their beliefs.
Another aspect of CBT includes ‘Decatastrophising’. One common thinking pattern found in people who suffer from anxiety issues is ‘Catastrophising’, which is the act of imagining the worst-case scenario and magnifying the bad in any given situation. CBT helps to counter such a mindset by helping these individuals prepare for the feared consequences, as well as to cope with their unhealthy ways of thinking. For example, therapists and clients will go through certain ‘Challenge Questions’, such as:
“Has anything this bad ever happened before? How likely is it to happen now?”
“What makes you confident that your feared outcome will actually come true?”
“What is the best outcome that can happen in this situation?”
These are just a few examples of ‘Challenge Questions’, but they can certainly be beneficial in helping to ease feelings of anxiousness and to calm the individual. In some way, this can also decrease an individual’s inclination to avoid seemingly triggering social situations.
Tying in with ‘Decatastrophising’, another technique introduced during CBT is ‘Reattribution’. ‘Reattribution’ is a method which challenges the negative assumptions held by the individual by considering the possible alternative causes of events. This is particularly advantageous for people who, in most situations, perceive themselves to be the cause of problem events. For example, this can mean having a discussion on the evidence which proves that the individual is/is not the cause of the problem. Eventually, this will help to tackle ‘Automatic Negative Thoughts’, excessive self-blame and worry.
Of course, in order for the treatment process to be carried out more effectively, some therapists do assign “homework” to their clients. This is to say that clients are encouraged to apply CBT principles in between sessions, and are tasked to self-monitor and focus on implementing tips and processes when dealing with actual situations. By monitoring their emotions and making a conscious effort to calm themselves through methods discussed during sessions, these individuals will eventually develop the much-needed skillsets to cope with emotionally-draining social environments.
A combination of cognitive and behavioural therapeutic approaches, CBT has been proven to be an extremely effective treatment method for anxiety disorders, including SAD. In fact, the skills you learn in CBT are practical and highly applicable, and hence can be incorporated into everyday life to help you cope with future stresses more effectively. As such, if you or a loved one is struggling with SAD, do seek treatment as it will ultimately benefit you in the best way possible.
As a child, how did adults around you react whenever you expressed your feelings? Did you grow up receiving that subtle message to wall up your emotions so they don’t get the better of you, or become anyone else’s burden? Childhood Emotional Neglect (CEN) is a topic often overlooked, and many fail to realise that it can eventually manifest into mood disorders or anxiety disorders if not dealt with appropriately.
Childhood Emotional Neglect occurs when our caretakers or parental figures fail to respond to our affectional needs suitably during critical stages in our development. An individual who grows up experiencing emotional neglect may experience a pattern of having his or her emotions being disregarded, invalidated or downplayed by others. While many of us may wonder, “What kind of parent doesn’t pay attention to a child’s emotional needs?” In reality, some parents may not actually realise that they have been shutting their child(ren) out emotionally. In Asian societies in particular, some parents are commonly labelled as “authoritarian” or “tiger parents”. These people may in fact perceive themselves to be giving the absolute best to their child, enforcing strict discipline and ensuring that their offsprings are well-equipped with the best skills to succeed in life. However, young children and teenagers may instead be overwhelmed by such demands, and feel as if their feelings were never considered or understood. Whilst we mentioned its prevalence in Asian societies, it is key to note that it is not merely limited to these children – many worldwide experience it too, making it an exceptionally important subject. With emotional neglect being a common feature in the childhood of many, it can become an undesirable shadow that follows us throughout our lives – eventually leading to undermined happiness and the lack of an authentic sense of self.
Delving into the matter at hand, Childhood Emotional Neglect (CEN) can come in two forms – active and passive CEN. Active CEN is when parents or caregivers actively act in a way that dismisses or denies the child’s emotions. For instance, a boy is sent to his room for crying over the death of his pet fish, and his parents complain of having an overly-dramatic son. When the child is being denied of his sadness and is receiving the message that his behaviour is unreasonable, this forces the child to grow up hiding his feelings, and at times struggling with fear and shame of his own emotions. On the other hand, passive CEN occurs when parents show a lack of care or validation regarding the child’s emotional needs. When parents fail to notice when the child is angry, upset, hurt or anxious, this gives off a subliminal message to the child that his feelings are irrelevant or not worthy of note. In any case, both forms of CEN are clearly detrimental towards one’s mental health.
Albeit not having a test or questionnaire that can help with a diagnosis for CEN, there are certain “symptoms” of CEN that may surface, be it in the later parts of one’s teenage years or adulthood.\
For one, individuals who have experienced CEN may find it difficult to prioritise their wants and needs, even if it’s something that would bring them great joy. It is innate for us to have desires and to just be aware of what we want and need. However, for someone who grows up having his feelings invalidated and cast aside, it could become a natural thing for him to keep his desires to himself. As such, even if opportunities do come along, these people would often fall through the cracks, most probably due to their inability to request for it upfront, or by allowing others to seize it instead.
CEN also causes one to start projecting any feelings inward, regardless of whether they are negative or positive ones. People who have experienced CEN are particularly predisposed to turning feelings of anger inwards, as they never learnt how to be comfortable with their emotions, nor how to handle them in a healthy manner. It is often said that nothing good comes from bottled-up feelings, and that is absolutely true.
Having pent-up feelings also mean that these individuals are not likely to seek help or lean into their support systems whenever things get tough, making them feel all the more isolated and vulnerable. Even at times when they are feeling deeply challenged by certain life events, they find themselves trying to cope all on their own, leading to unhealthy stress levels and anxiety. Unsurprisingly, the constant feelings of shame and inability to get in touch with one’s emotions will eventually lead to one losing sight of his or her strengths as well. As a result, poor self-esteem is sometimes a consequence of CEN.
While many individuals, including adults, fail to recognise the impacts of childhood emotional neglect on their lives due to its subtle nature, it is important that they get themselves back on track – to regain true happiness and greater self-esteem. You might have grown up devoid of your own emotions, but you need to recognise that facing them head-on will ultimately help you to cope with life events and for you to regain your sense of self.
Alcohol. A beverage that many people enjoy drinking; be it for socialisation or as an escape from reality. However, it is also a beverage that can harm your health and adversely affect many lives. Indeed, alcohol abuse has become increasingly rampant, where it is one of the leading causes of disease and death, with 5.3% of all global deaths and over 200 diseases and injury conditions resulting from the harmful use of alcohol. Worryingly, it is also a phenomenon that has affected Singapore, with 9.6% of Singaporeans engaging in binge drinking (as of 2016) and an increasing number of Singaporean young adults battling Alcohol Use Disorders (AUD). As such, alcohol abuse has become a growing cause of concern.
There are many reasons why alcohol consumption is increasing. Alcohol consumption has been perpetuated by the media in recent years, with an increase in advertising and marketing of alcohol. For instance, in Australia, people are exposed to about nine alcohol televised advertisements every month. In turn, exposure to such advertisements causes alcohol consumption to be glorified and promoted, where people have unrealistic positive expectations towards alcohol, believing that it boosts one’s mood and invokes cheerfulness and confidence. Additionally, alcohol consumption has also increased due to peer pressure. Be it a work engagement or partying with friends, people often find it hard to say no to alcohol, as that rejection may cause disapproval among colleagues or friends. Thus, many people engage in risky drinking behaviour to socialise and develop their relationships.
However, a more significant reason behind alcohol consumption is feelings of anxiety or having anxiety disorders. People with anxiety disorders have 2 to 3 times the risk of having alcohol use disorders (Smith & Randall, 2012). Many people tend to use alcohol to reduce social anxiety, as they believe that alcohol is an excellent aid to speak up and gain more confidence around others. Similarly, people use alcohol as a form of self-medication to overcome anxiety symptoms and stress, relying on it as a coping mechanism. However, contrary to popular beliefs, alcohol exacerbates rather than alleviates anxiety symptoms. This worsened anxiety makes them drink more and have more alcohol-related problems, which causes further anxiety and stress.
Alcohol abuse also causes anxiety. Drinking alcohol builds a tolerance to de-stressing effects of alcohol. This creates a temporary sense of relaxation but later leads to feelings of depression and anxiety. This is because the prolonged use of alcohol can act as a stressor and activate the body’s stress response system, changing neurotransmitter levels in the brain and causing an increase in stress and anxiety. As such, alcohol can worsen anxiety symptoms.
Therefore, anxiety and alcohol abuse tend to fuel each other in a vicious feed-forward cycle of co-occurring addiction and anxiety, which is difficult to break out from. As such, integrated treatment for both anxiety and alcohol use should be readily available.
There have been existing parallel or subsequent attempts to treat both anxiety disorder and AUD (i.e. treatment for anxiety disorders first, followed by AUD). However, studies have found that parallel treatments have caused worse alcohol outcomes compared to just seeking one treatment. This is possible because the cognitive load of receiving two separate treatments may be confusing or overwhelming for people, causing them to feel anxious or turn back to drinking as a coping mechanism. As such, these type of treatments causes a “co-morbidity roundabout”, which is a metaphor of mental health problems resurfacing when attempting to tackle substance disorders (and vice versa), thus failing to break out from the vicious cycle of these co-morbid disorders. Therefore, it is clear that both anxiety disorder and AUD are inter-related issues, and an integrated treatment approach is vital to tackle both disorders.
Stapinski et. al. (2015) carried out an integrated treatment for comorbid social anxiety and AUD, where participants undergo both Cognitive Behavioural Therapy (CBT) and motivational interviewing. Moreover, it involves core components such as building coping skills, developing alternative reinforcers and preventing relapse. This provides participants with useful skills such as enhancing social support networks, correcting misconceptions towards the benefits of drinking, reducing avoidance of social situations and developing healthy coping skills to manage triggers for drinking or anxiety.
This study took place over ten 90-minute sessions, where 117 participants with both social anxiety and AUD took part in this study. 61 of the participants received integrated treatment (both AUD and social anxiety) and 56 of the participants received treatment for AUD only. Results showed that both treatments enabled a great reduction in alcohol use and dependency. However, participants that underwent the integrated treatment were observed to have a greater decrease in social anxiety symptoms and a greater increase in overall quality of life. More importantly, these results remained constant even after a 6-month follow-up. This means that integrated treatment has long term effects on overall functioning and quality of life.
While the above has proven that integrated treatment is indeed useful in overcoming social anxiety and AUD, the road to recovery is a long and arduous journey, where there are a lot of physical and mental challenges suffered by both the clients and their families. Hence, these issues could be more easily overcome or even avoided if there are early intervention and support to at-risk youths.
Over the years, the number of youths drinking alcohol has increased. According to the Avon Longitudinal Study of Parents and Children (2004), the number of youths that engage in binge drinking increase tremendously between the age of 18 and 21 (from 18% to 35% respectively). Furthermore, 18-year-olds who drank alcohol as a coping mechanism or who had anxiety disorders were 1.8-3.8 times more likely to drink. Both groups had a greater risk of transitioning from low-risk alcohol use at age 18 to high-risk alcohol use at age 21.
There are many motives that may drive youths to drink alcohol. A primary reason is that youths are at a phase where they are transitioning to adulthood. Adulthood brings more stress and anxiety due to changes such as new relationships; along with new responsibilities and challenges such as living in a dormitory and budgeting. Additionally, this phase of life also provides youth with more autonomy and drinking opportunities (e.g. clubbing, drinking games). With these drastic changes in life, youths often drink to enhance positive moods, socialise with others, conform to social groups, or as a coping mechanism to overcome stress or anxiety. This causes harms associated with alcohol to peak in early adulthood, emphasising the importance of early intervention to avoid these detrimental consequences.
An ongoing programme called “Inroads Study” (Stapinsky et. al., 2019) aims to provide early intervention to youths with anxiety disorders and AUD. It seeks to enhance anxiety coping skills and address coping-motivated drinking. Moreover, this programme is specially tailored to make it more relevant and appealing to youths. This includes making the programme available online, which is preferred by youths as it is more convenient, affordable and reduces stigma. Participants can freely access online therapy sessions and modules about tackling challenges often faced by youths. Thus, such interventions can address the interconnections between anxiety and alcohol use, as well as reach out successfully to youths in a relevant and appealing manner.
Prevention programmes are also forms of early intervention that may benefit younger youths (i.e. 13- or 14-year-olds) that have a ‘high-risk’ of developing substance disorders, even if they do not currently have a substance disorder. It is vital to identify early onset of problems faced by youths and nipping them in the bud, providing them with early support and teaching them relevant life skills. This prevents problems faced by youths from developing into more severe adulthood problems such as substance disorders, chronic mental health problems and delinquency.
One such prevention programme was organised by Edalati & Conrod (2019), who first identified at-risk youths through the Substance Use Risk Profile Scale; where those with higher levels of certain personality traits (e.g. sensation seeking and negative thinking) were at higher risk of abusing substances before the onset of use. Afterwards, these youths attended coping skills workshops, CBT and motivational interviewing. Results showed that the programme proved effective in reducing alcohol use, alcohol-related harms and emotional and behavioural problems (i.e. symptoms of anxiety and depression). This shows the importance of early intervention and prevention programmes.
In conclusion, it is apparent that there are interconnection and the longstanding link between anxiety and alcohol use, where this co-morbidity can cause huge effects on one’s physical and mental wellbeing. Thus, this raises the importance of integrated treatment, allowing both conditions to be resolved at the same time. Furthermore, early intervention is extremely vital to offer support to youths and prevent potential disorders from occurring. More importantly, all this shows that alcohol is not the answer to relieve stress and anxiety, and can only serve to exacerbate rather than resolve our problems. Thus, such action could be done to reduce excessive alcohol use in our society, such that harmful usage and effects of alcohol could be prevented.
Smith, J. P., & Randall, C. L. (2012). Anxiety and alcohol use disorders: Comorbidity and treatment considerations. Alcohol Research: Current Reviews, 34(4), 414–431.
Stapinski, L. A., Rapee, R. M., Sannibale, C., Teesson, M., Haber, P. S., & Baillie, A. J. (2015). The clinical and theoretical basis for integrated cognitive behavioral treatment of comorbid social anxiety and alcohol use disorders. Cognitive and Behavioral Practice, 22(4), 504–521.
Golding, J., & ALSPAC Study Team (2004). The Avon Longitudinal Study of Parents and Children (ALSPAC)–study design and collaborative opportunities. Eur J Endocrinol. 151, U119-U123.
Stapinski, L., Prior, K., Newton, N., Deady, M., Kelly, E., Lees, B., Teesson, M., & Baillie, A. (2019). Protocol for the Inroads Study: A Randomized Controlled Trial of an Internet-Delivered, Cognitive Behavioral Therapy-Based Early Intervention to Reduce Anxiety and Hazardous Alcohol Use Among Young People. Journal of Medical Internet Research, 8(4), 1-14.
Edalati, H., & Conrod, P. J. (2019). A Review of Personality-Targeted Interventions for Prevention of Substance Misuse and Related Harm in Community Samples of Adolescents. Frontiers in psychiatry, 9, 770.
There isn’t consensus in the scientific community about whether Kubler-Ross’ five stages of grief is rooted in empiricism. Although much vaunted in popular culture, if you’ve experienced grief and resolved it in your own way, you’ll know that grief is an organic process that is by no means neat or orderly. It’s deeply unique to each individual, and this article is designed to hopefully help you through whatever loss you have experienced in the recent past.
The five stages of grief, which Kubler-Ross first postulated that terminally ill patients experience are: Denial, Anger, Bargaining, Depression and Acceptance. Denial in this context encapsulates a perfectly normal response to a tragedy, and is exactly what you would imagine – it’s simply a refusal to believe that “this bad thing is happening to me”. After reality sets in, and the sobering realisation that the tragedy has occurred is impossible to ignore, Kubler-Ross observed that people often display frustration, which culminates in Anger. Once that Anger has dissipated, people often move on to Bargaining, which is the hope that they can somehow extricate themselves from their dire straits and obtain the balm of a different circumstance. Notwithstanding the success of the earlier bargain, Depression follows, which is self-explanatory. The final stage of Acceptance is the sanguine realisation that nothing will change their situation.
If you are currently going through your own grief and taken a step back to evaluate how you are processing it, you might have noticed some incongruencies between the model and your experience. That’s perfectly natural because there has been some criticism levelled at the Kubler-Ross model in that there is confusion over description and prescription. This means you shouldn’t take it as a rule, no, or feel inadequate or “bad” that you aren’t “properly” grieving. We hope that what follows in this article will provide you with some breathing room to let your grief take its own course, and helps you handle a tragedy with the right tools.
Grief is a loss. It’s your prerogative to define what grief is to you, and even something as banal as losing a cherished item from your childhood can precipitate feelings of loss. So, you shouldn’t wall up these feelings behind what society has proscribed as appropriate. We’re talking about you here, not anyone else. It bears repeating that your grief is unique because of a multitude of factors, for those of you who don’t want to accept that it is your right to give yourself the breadth to grieve – your upbringing, your culture, your faith, your parents, the list is endless. So give pause and slip into your own rhythm of grieving.
To help ensure that you do not slip into the common fallacies that can disrupt your grieving process, we’re going to list some of the pitfalls that ensnare people and prevent therapeutic processing of grief.
1) If you don’t show an outward display of grief such as crying, you aren’t “sad”
Just like the shortcomings of Kubler-Ross’ model, while crying is seen as a “socially acceptable” way of demonstrating sadness, it isn’t applicable to everyone. You may have been brought up to avoid tears at all costs, perhaps due to tough parenting or some childhood trauma, or you may not wish to “affect” others with your grief. No matter the reason, you should know that physiological responses to grief vary widely depending on your circumstances. Shock, numbness, anger, even hysterical laughter – just about anything is permissible in the initial, very private stages of your grief.
2) If you don’t “get over it” within an “acceptable timeframe”, you aren’t good enough
Although your family members or people in your community may react to and resolve their grief earlier than you, you need to know that it is by no means healthy to affect the fragility of such a process by introducing the pressures of comparison. Some people simply have better coping-skills than others or are more inured to unhealthy thought processes that hold them back from the therapeutic management of their grief.
3) You feel like you need to “protect” loved ones from your grief, so you turn inwards
We keep emphasizing that grief is individual to everyone – this should tell you that there is no circumscription to how you handle it. Even though it might feel selfish to display your feelings openly because you think less emotionally able loved ones shouldn’t have to deal with your pain, remember that there is nothing shameful about the old adage, “Shared joy is double, shared sorrow is halved”.
There are some simple coping mechanisms that you can use to help yourself through the process. Although the low mood is a given after the heartache of a tragedy or loss, and you might not feel willing or able to pick yourself up and carry on, remind yourself of the wisdom of eating and sleeping right. Drugs and drink might seem the most accessible ways to insulate yourself from poor mood, but these indulgences, in the long run, are hindrances to sustaining your mental well-being.
If you feel like the person you have lost needs to be remembered, you can do so in the solitude of creative expression, or you can choose to gather loved ones to laugh about cherished memories. If there’s one scenario where laughter in the face of loss is wholly acceptable – here it is! Whether communal or solitary, there are many ways you can raise someone up in loving memory – honouring them and helping yourselves.
Find solace in your old routines. If you’re hurting after the failure to gain acceptance into a school of your choice, it may help to remember all the things you did well before that gave your life meaning and structure. At the worst of times, it helps to fall back on old patterns if only to hang on to some stability.
Lastly, know that there is a difference between clinical depression and the normal response to grief. You should be aware of critical signs or symptoms in both yourself and your loved ones that may indicate depression. For example, if you notice that your loved one isn’t eating or sleeping properly after a long period of time, or is displaying reckless tendencies such as driving dangerously or overindulgence in addictions, it may be time to seek professional help. Although many people can get through grief without the help of a mental health professional, when it all gets too heavy to handle, you may consider seeking grief therapy. Some of our clinicians are specifically trained in grief therapy, such as Joachim Lee or Winifred Ling.