CNA interviewed Dr. Joseph Leong about why some people become bystanders when their loved ones abuse their maids. He highlighted a “power differential” in which the maid abuser is typically the head of the household. Read on to find out the details.
Dr Joseph Leong & Dr Sean David speaks with an editor at Expat Living about Burn out. Read on to find out the details.
We’ve all been there – wired on coffee, exhausted, struggling to keep pace with hurdles and deadlines, before hitting the inevitable brick wall. When can we identify a state of “burnout”, and what does psychology have to say about it? We asked DR JOSEPH LEONG and DR SEAN DAVID from Promises Healthcare about this as current mental health issue.
What does being “burnout” mean in a clinical context?
Joe: Burnout is an occupational phenomenon. It’s not classified as a medical condition but conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficiency.
While we recognise that students and homemakers can also suffer similar anxieties, burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life. Sean: American social psychologist Christina Maslach, who is well known for her research on occupational burnout, stated: “What started out as important, meaningful and challenging work becomes unpleasant, unfulfilling and meaningless. Energy turns into exhaustion, involvement turns into cynicism, and efficacy turns into ineffectiveness.”
The behavioural manifestations of burnout may be procrastination on tasks; “presenteeism” at work, which is when a person is present at work while they’re disengaged or unwell; sleep and appetite disturbances, or even maladaptive coping methods such as increased smoking and drinking.
If burnout is not addressed early or adequately, it can lead to other mental health issues including major depression, anxiety disorders or even escalate to the severity of suicidality or illicit drug use. This will inadvertently have a profound impact on the afflicted person’s social and family life.
Is there treatment for burnout? What “work hygiene” or mental habits can be cultivated to help keep our cogs turning?
Sean: The first step is to recognise when one has reached a stage of burnout, and not brush aside their inability to function due to just “stress”. Increasing awareness of the warning signs of impending burnout and avenues of help internally within one’s company, and externally using community resources or virtual self-help is important. Psycho-education reduces the stigma associated with seeking help for mental health conditions.
The second step is to analyse the specific causes of burnout for that unique person’s life situation. There are systemic and individual factors that can predispose, precipitate and perpetuate burnout.
The third and most crucial step is to take action and make lifestyle changes in accordance with the identified root causes of burnout.
Prescribed medications by doctors to aid sleep or relieve anxiety may also be abused. This can result in addiction. The first step is awareness that this could happen to anyone despite the belief that one knows their limits.
Joe: Some people cope by drinking, smoking or taking some pills to solve their “ills”. These coping strategies may temporarily relieve distress but are not healthy long term and can do more harm than good.
What distinguishes a clearly appropriate medical-use case from an addictive dependency on prescribed medication?
Joe: Chronic distress should be managed in a holistic way rather than self-medicating. Seeing a therapist or a counsellor to learn new skills or change one’s thinking would be helpful.
Appropriate medication use is within the doctor’s prescription weighing the indication, benefits, alternatives and risk of using or not using.
One should be honest with the use of medications and not doctor-hop or collect various medications from different doctors without revealing what was given by another doctor. Bringing all the medications during the consult will help in active use of the medication and reduce the dependency on medications.
How can employers instil and facilitate better mental health practices? How can we negotiate healthier working styles with our bosses and colleagues?
Joe: I recommend a frank discussion about what is working well and what is not. A person will do well with tasks where he or she is strong and interested in doing them, whereas other tasks may cause too much distress and dysfunction.
Sean: Fostering a positive and supportive working environment is encouraged, for example, allowing employees to have autonomy over their job scopes. Trusting them to make appropriate flexible work arrangements, especially if they are parents or care-givers, can ensure better work life balance and happier employees.
Encouraging an open discussion with employers about work strengths and weaknesses can also result in a better allocation of suitable work tasks. Employers can distribute responsibilities fairly at work and put in place multisource feedback channels to keep the effectiveness of work policies in check.
Finally, reminders from company HR for employees to use up their annual leave benefits instead of the repetitive cycle of carrying forward leave may ensure that employees take adequate rest in the work year to recuperate.
Seeking help for “being stressed at work” might seem outlandish to some. What can you share with readers to change their mind?
Joe: Think about it as executive coaching or career counselling. If the job is not a good fit and has caused physical, emotional, psychological and social distress and dysfunction, changing to another department or a better job may be a better outcome in the long term.
Sean: Seeking help is not a sign of mental weakness but instead a bold action taken by you to see a change, and find fruitful meaning in life.
In the words of BKS Iyengar, “Change is not something that we should fear. Rather, it is something that we should welcome. For without change, nothing in this world would ever grow or blossom and no one in this world would ever move forward to become the person they’re meant to be.”
Three Steps Out of Burnout
#1 Recognise when you’ve reached a stage of burnout, instead of brushing aside your inability to function due to just “stress”.
#2 Analyse the specific causes of burnout for your own life situation. There are systemic and individual factors that can predispose, precipitate and perpetuate burnout.
#3 The most crucial step is to take action and make lifestyle changes in accordance with the identified root causes of burnout.
Promises Healthcare is a multidisciplinary mental health clinic with a team of psychiatrists, psychologists, therapists and executive coaches (and a rehabilitation physician) who take on a diverse and multidisciplinary approach to treatment. Care and wellbeing of patients is at the heart of the service, and treatments are based on the latest clinically proven protocols in the field of neuroscience and psychology.
Dr Joseph Leong believes that recovery is possible for anyone. He looks beyond finding the best combination of medications to recommending talk therapy and psycho-social rehabilitation and community partnerships.
Dr Sean David Vanniasingham is experienced in general psychiatry, addiction medicine, and neurostimulation treatment. He is a firm believer in the biopsycho-social model approach in the holistic and recovery-oriented care of his patients.
Visions by Promises is the addictions treatment arm of Promises Healthcare, providing recuperative care programmes such as one-on-one counselling, group therapy, an intensive outpatient program, specialist groups, family therapy and medical detox.
Both bipolar disorder and schizophrenia were considered severe mental illnesses with no recovery in the past. This is not true in modern psychiatry as we have developed more effective treatments such as medications (psycho-pharmacology) and psycho-social interventions (psycho-therapy and psycho-social rehabilitation) which help patients improve their quality of life as well as reduce symptoms and restore function.
Bipolar disorder and schizophrenia may have similar symptoms which are disturbances in thinking, feelings and behaviour. The major difference is that bipolar disorder is classified as a mood disorder whereas schizophrenia is classified as a psychotic disorder. Mental healthcare professionals make diagnoses based on reports of patients, caregivers, or other information sources as well as observations made during the assessment interview.
Experts have also formulated that schizophrenia and bipolar disorder may be a spectrum disorder with schizophrenia on one end and bipolar disorder on the other end with schizoaffective disorder in the middle of the spectrum.
What is more important however is not the exact diagnosis alone but rather the identification of symptoms so that treatment can be effectively targeted at the relief of the symptoms, restoring function and improving quality of life. This targeted symptom approach has proven to be one of the most effective ways of helping persons recover from these brain conditions.
Let’s discuss some of the common symptoms –
Delusions, which are untrue, unshakable, and unshared beliefs which can exist in both brain conditions.
For example, delusions of persecution which are beliefs of being targeted, being followed, being sabotaged (persecutory) are common in schizophrenia while delusions of grandiosity such as believing that they are particularly important persons and have special powers or ability to save the world (grandiose delusions) are more common in bipolar disorder. For persons with schizoaffective disorder, they might have both persecutory and grandiose delusions at the same time. It also has an underlying co-occurring mood disorder.
Hallucinations which are perceptual disturbances such as hearing voices which are not heard by others, seeing, smelling, tasting or feeling things which are not present are more likely to happen in schizophrenia.
Severe mood swings and manic episodes where the person has fast speech and high energy levels are associated with abnormal spending, socialising, exercising, or expanding businesses with the need for very little sleep over a few days and weeks are more likely to happen in bipolar disorder.
More than half a century ago, most persons suffering from these brain conditions were isolated and confined to asylums as there were no effective treatments until the discovery of medications that can change brain chemistry. Neurotransmitters which are chemicals responsible for brain and other bodily functions were discovered. Noradrenaline, serotonin, and dopamine disturbances were more likely causes in bipolar disorder while dopamine imbalance was a more probable cause of schizophrenia. See https://dana.org/article/neurotransmitters/
The Help Of Modern Medicine
Modern psychopharmacology offers an array of medications which can act on various neurotransmitter sites in the brain. Several medications and several rounds of adjustment and fine-tuning may often be needed to achieve stabilisation with medications with relief of symptoms. This is best done collaboratively with the patient, psychiatrist, and caregiver at the consultation with all the medications brought in for review.
Adjusting to a new medication through an effective therapeutic trial may take at least 2 weeks, starting with the lowest dose and increasing dosing to a maximised symptom relief dose over 2 months.
Medications need to be taken daily to be effective, and this is best done using a pill box and with supervision from a loved one. Medications are served by nurses in the inpatient hospital setting who ensure that the correct dose is directly observed to be taken by the patient – however, this is often lacking in the outpatient setting leading to the return of the symptoms causing distress and dysfunction.
Bipolar & Schizophrenia Treatment Methods
Comparing bipolar disorder and schizophrenia to other brain conditions may be helpful in understanding how one can better achieve remission and recovery.
Epilepsy is a brain condition where there are electrical firing of neurons causing disturbances in thinking, feeling and behaviour. To stay in control of oneself, the doctor may recommend various combinations of anti-epileptic medications to prevent another seizure. In fact, the model of kindling in epilepsy has been used to understand mental health treatment in this highly readable resource essay –https://aeon.co/essays/should-the-kindling-concept-direct-mental-health-treatment
If you speak to someone with experience with epilepsy, they will tell you about ‘warning signs’ and the ‘confusional state’ after a breakthrough seizure.
Similarly, for those struggling with bipolar disorder and schizophrenia, one becomes more aware of ‘warning signs’, and ‘confusional states’ through direct feedback from loved ones who are observant and psycho-educated by healthcare professionals. Charting, monitoring and sharing your experience are key to success in achieving remission and recovery. Use this mood chart and share it with your mental healthcare professionals for more in-depth analysis –https://loricalabresemd.com/wp-content/uploads/2017/12/Personalized-Mood_Chart.pdf
Symptoms management starts with monitoring your symptoms and the response to the treatment – what makes it better, what makes it worse, whether it is mild, moderate or severe. The frequency, intensity and severity can be charted so that effective treatment of psycho-pharmacology (active use of medications) and psycho-social interventions (psycho-therapy and psycho-social rehabilitation) can be targeted to achieve the best outcome for you.
Recovery Is Possible
Your mental healthcare professional can coach and pace you so that it will not be overwhelming. Recovery starts with taking it one day at a time. Be gentle with yourself. Learn to trust and entrust your healing to people who care about you. Learning from feedback as well as charting, monitoring and sharing your experience with loved ones – trusted family or friends or co-workers greatly enhance effectiveness.
Atomic habits by James Clear is an excellent book which illustrates the importance of charting, monitoring and shaping your habits, on the premise of improving 1% daily leading to more than 365% improvement in one year. This is Youtube illustrates how that can happen – “How to become 37.78 times better at anything”.
There are many services available at Promises Healthcare and Community Partners which can help reduce symptoms, restore function, and improve quality of life. Recovery is possible and becomes a reality with appropriate support and adequate skill training. With the right help and support, persons in recovery can live meaningful and satisfying lives.
Here are some real stories that illustrate many facets of mental health and recovery: