The basic characteristics of all religions are similar. There is a firm belief in a higher unseen power who is the supreme master.
Religion and Spirituality, Is There A Difference?
Religion Is an organized system of beliefs, practices, rituals, and symbols designed to facilitate closeness to the sacred or transcendent (God, higher power, or ultimate truth/reality).
Spirituality is the personal quest for understanding answers to the ultimate questions about life, about meaning, and about the relationship with the sacred or transcendent, which may (or may not) lead to or arise from the development of religious rituals and the formation of a community. Spirituality is thus a more inclusive concept than religion.
Mental Illness In The Middle Ages
The idea that religion and psychiatry have always been in conflict is still very prevalent. Today, most people believe that in the medieval ages, most mental disorders were considered as witchcraft or demonic possession. People with mental disorders were recognized as different and treated in various ways. Early medicine men, considering such individuals to be possessed by demons, introduced a technique called trephination, which Involved drilling a hole in the head of the individual to let evil spirits out of the body. Many other civilizations independently developed such a procedure. For example, among the remains of the Incas in Peru are skulls with holes and trephination devices. The treatment of mental illness deteriorated in the late Middle Ages and remained poor through the eighteenth century. As the medieval years progressed, insanity became linked to witchcraft and demon possession. Those considered to be possessed with demons were exorcised. This ritual, performed by a priest, would call upon the demon to come out of the individual and to transfer itself into an animal or inanimate object. Both the Greeks and Romans thought that the mentally ill were capable of causing major social problems, as well as harm to themselves. They made provisions for guardians to take care of the insane. Realizing that these people could hurt themselves or others and could destroy life and property, laws were passed that set specific guidelines. Since there were no lunatic asylums, people with mental illness were a family responsibility. The seriously impaired were restrained at home, but others were permitted to wander in the hope that evil spirits might fly out of them.
Certain saints were thought to be more active in the domain of madness. In northern France, the shrines of Saint Mathurin at Larchant and Saint Acairus at Haspres were known for healing. In Flanders, now Belgium, citizens of Geel developed a shrine to Saint Dymphna that became a hospice to house the mentally ill. During the early years of the Middle Ages, the community took care of the mentally ill. Later, hospices, then asylums were developed to house them. London’s Bethlem asylum—better known as Bedlam—was founded in 1247, making it one of the oldest institutions of its kind. The term “bedlam” became associated with chaos, confusion, and poor treatment, which reflected the general attitude toward mental illness at the time. It was only in the nineteenth century that scientists and society began to reconsider deviant behaviour from the perspective of mental illness rather than as a manifestation of evil spirits.
Religion And Psychiatry
Persons with mental disorders can sometimes present with symptoms such as hyper-religiosity (manic episodes as part of bipolar disorder) or delusional beliefs such as possessing godly or religious powers. Rates of religious delusions in schizophrenia remain high. These symptoms and signs need to be carefully assessed by mental health professionals. Certain groups in Christianity such as Pentecostal Christians “speak in tongues”, which is not a symptom of mental illness, but an expression of their religious beliefs. “Speaking in tongues” is mentioned in the Bible.
In the last two decades, rigorous scientific research has been done and published in mainstream medical and psychological journals. David B. Larson, Jeffrey S. Levin and Harold G. Koenig were some of the authors. They have conducted a series of studies looking at the relationship between religious involvement and mental health in mature adults, either living in the community or hospitalized with medical illness. Since then, many other researchers have produced a large body of research that has usually, but not always, shown a positive association between religious involvement and mental health.
According to the Harvard psychologist, Gordon Allport, a person’s religious orientation may be intrinsic and/or extrinsic.
Extrinsic Orientation Persons with this orientation are disposed to use religion for their own ends. Many find religion useful in a variety of ways – to provide security and solace, sociability and distraction, status and self-justification.
Intrinsic Orientation Persons with this orientation find their master motive in religion.
Other needs, strong as they may be, are regarded as of less ultimate significance, and they are, so far as possible, brought in harmony with the religious beliefs. Having embraced a creed, the individual endeavours to internalize it and follow it fully. Usually, the intrinsic orientation is associated with healthier personality and mental status, while the extrinsic orientation is associated with the opposite. Extrinsic religiosity is associated with dogmatism, prejudice, fear of death, and anxiety, it “does a good job of measuring the sort of religion that gives religion a bad name.
Physical health: Religiousness was related to decreased smoking and alcohol consumption. Religious commitment and participation seemed to affect longevity, as well, especially in men.
Suicide rates were consistently found to have a negative correlation with religiosity. In Hinduism, if you take your life prematurely, you have to suffer in the next birth. Most research findings support that religious affiliation, especially participation, lowers the rate of alcohol consumption. Being religious results in more hope and optimism and life satisfaction.
Belief Systems, Cognitive Framework
Beliefs and cognitive processes influence how people deal with stress, suffering and life issues.
Religious beliefs can provide support through the following ways: Enhancing acceptance, endurance, and resilience. They generate peace, self-confidence, purpose, forgiveness to the individual’s own failures, and positive self-image. On the other hand, they can sometimes bring guilt, doubts, anxiety and depression through an enhanced self-criticism. ‘Locus of control’ is an expression that arises from the social learning theory and tries to understand why people react in different ways even when facing the same problem. An internal ‘locus of control’ is usually associated with well-being and an external one with depression and anxiety. A religious belief can favour an internal ‘locus of control’ with an impact on mental health.
Public and private religious practices can help to maintain mental health and prevent mental diseases. They help to cope with anxiety, fears, frustration, anger, anomie, inferiority feelings, despondency and isolation. The most commonly studied religious practice is meditation.
It has been reported that it can produce changes in personality, reduce tension and anxiety, diminish self-blame, stabilize emotional ups and downs, and improve self-knowledge. Improvement in panic attacks, generalized anxiety disorder, depression, insomnia, drug use, stress, chronic pain and other health problems have been reported. Follow-up studies have documented the effectiveness of these techniques.
Role of the Psychiatrist
During assessment, the psychiatrist should be able to determine whether the religion in the life of his patient is important, has a special meaning and is active or inactive. Four basic areas should be remembered when taking a spiritual history.
Does the patient use religion or spirituality to help cope with illness or is it a source of stress, and how?
Is the patient a member of a supportive spiritual community?
Does the patient have any troubling spiritual question or concerns?
Does the patient have any spiritual beliefs that might influence medical care?
The clinician who truly wishes to consider the bio-psycho-social aspects of a patient needs to assess, understand, and respect his/her religious beliefs, like any other psychosocial dimension.
The idea of becoming mentally incapacitated is often so frightful that most people simply avoid the issue. Discounting the various other ways someone can lose control of their mental faculties, in Singapore, 1 in 10 people above 60 will succumb to dementia and 3.6% of people will suffer from obsessive-compulsive disorder, 1 in 50 people will experience a psychotic episode at some point in their lives, and 1% will suffer from schizophrenia, all conditions that might precipitate the loss of mental faculties. It’s a statistic that we’ve not brought up to alarm you, but simply to help you decide if you have someone in your life you trust to protect your interests, in the realm of your personal welfare, and property and affairs.
You simply have to be above the age of 21, by law in Singapore, to appoint one or more “donees”, who are people you trust “to make decisions on your behalf, in your best interests”. You, as the appointer of your donee(s), are known as the “donor”.
The Ministry of Social and Family Development suggests that it is beneficial to make an LPA as a protective measure against any untoward happenstance as it relates to your mental well-being. It is obviously best to decide what the best permutation for you is while you are capable of making rational decisions on your own behalf. Broadly, your appointed donee(s) will have control over one or both of the following aspects of your life: your personal welfare; and your property and affairs.
The LPA is designed to safeguard your interests, so it grants you the latitude of choice in deciding if: you want a single donee, whose powers are defined in Part IV of the Mental Capacity Act, or multiple donees. In the event that you decide that you would prefer multiple donees, you also have the power to decide if you will allow any one of them to act alone in making a decision on your behalf, or have them come to a consensus on undertaking a decision.
The difference between LPA Form 1 and LPA Form 2 is that LPA Form 2 allows you to appoint more than 2 donees, more than 1 replacement donee, or grant your donee(s) customised powers above the general powers with basic restrictions that donees are granted under LPA Form 1. LPA Form 2 requires the services of a lawyer.
After you have decided what’s best for you, and filling upLPA Form 1, or LPA Form 2, which you can do with the help of a lawyer, there is a “critical safeguard” in place to ensure that the LPA is not made under duress. This means that your LPA form will have to be witnessed and certified by an LPA certificate issuer, which can be:
At its most elemental level, people avoid the risk of failure for one simple reason – it hurts. Every single person has experienced failure. If you were to interpret failure by its definition in the dictionary, “the neglect or omission of expected or required action”, wouldn’t you, as a child, have stumbled along the way to achieving those long strident steps you take when strutting along the sidewalk? Yet, nobody feels ashamed of failing to learn to walk as a toddler. Why’s that? You could say that no-one in the right mind would expect that of a human child – we aren’t deer, or gazelles that need to shake off the afterbirth and walk – or risk predation. Our success as a species which put us at the top of the food chain negates that need. Fear is a function of the amygdala, yet failure isn’t. There’s a distinction here that we need to be mindful of. If you’re a parent or have access to YouTube, you’ve probably noticed that there’s an innocence in children that can be quite uplifting to watch, as they try multiple times to succeed at a simple task. They don’t puff their cheeks out and sigh in despair, or bury their heads in their hands. At most, they demonstrate frustration.
Shame is learned behaviour that children integrate into their developing moralities, either from being taught or through observation. Studies done on athletes have shown that perceived parental pressure (or pressure from authority figures) have deleterious effects on how sportspeople experience and interpret failure. Simply put, the fear of failure is a construct of how societies function. For some people, the avoidance of shame that failure brings weighs too heavily on them, and that is the crippling fear of failure. Dr Guy Finch puts this rather more succinctly: “fear of failure is essentially a fear of shame”. How then, do we begin to become more self-aware in the face of these deeply ingrained avoidance mechanisms to start building our best selves?
After all, overcoming fear of failure is all about reversing negative thought patterns, and Cognitive Behavioural Therapy (CBT) is designed to help you identify the underlying belief that causes a negative automatic thought (which in turn guides the feelings that come with it).
With the help of a qualified mental health professional, which can be anyone from a trained psychologist, psychotherapist or even psychiatrist, you can be empowered to break the circuit of the pervasive vicious cycle of negativity that prevents the unfettering of fear of failure’s heavy chains.
For instance, think of each deeply held criticism that you can’t let go of as a block in a Jenga game with your friends and the tower represents your thought life as a whole. Even though you’ve suffered through failure after failure, you can’t seem to jettison them from your psyche. Can you imagine a game of Jenga that doesn’t end in peals of laughter? It seems that some re-evaluation is needed to turn the way you handle each soul-sucking gut-punching failure from the darkness of your room. The grip of negativity steadying your trembling hand, an extension of your mind, putting each block up on autopilot because you believe you are not good enough. Instead, we suggest turning the lights on, invite someone you trust into your sanctum of despair, to play the game of Jenga with you. As you ease into their presence, you’ll begin to notice that the tower doesn’t look so intimidating anymore. It’s no longer just a congealed mess of all your shortcomings and toxic thinking, but a simpler thing that can be deconstructed. If each block represents a negative conviction you have about yourself that is too painful to touch, reach for the piece that looks more well-shorn and polished (which represents a perceived positive character trait or accomplishment that you hold dear). Put it back on top of your tower. It is yours, isn’t it? Or perhaps let your confidant handle that splintery block.
Of course, we all know that Jenga isn’t all laughter and grand gestures. There’s physical tension and the cogitation of making the right choice so the tower doesn’t crumble prematurely. Maybe you aren’t too good at Jenga. That’s fine. But if you start thinking of this special game of Jenga as a collaborative effort instead of a competitive one, you’ll start getting the picture. Who would you like to invite to collaboratively play a game of Jenga?
Sagar, S and Stoeber, J. Perfectionism, Fear of Failure, and Affective Responses to Success and Failure: The Central Role of Fear of Experiencing Shame and Embarrassment. Journal of Sport and Exercise Psychology, 2009, 31, pp 602-627.
Vasantham (Mediacorp’s Tamil & Hindi TV Channel) studios reached out to Promises Healthcare’s Senior Clinical Psychologist, S C Anbarasu, in the name of bringing greater mental health awareness to the Indian community in Singapore.
In En Ullae S2 episode 9, we are introduced to an exuberant boy, who upon closer inspection is revealed to suffer from Attention Deficit Hyperactivity Disorder (ADHD). Is he beset by developmental issues, or is there a more benign explanation? Senior Clinical Psychologist S.C. Anbarasu opens the episode with a parsimonious explanation of ADHD – simply, people with ADHD are distinguished by a lack of ability to pay attention, and appear to have vast amounts of energy, hence, ‘hyperactivity’.
In a dramatisation, the boy’s mother wears an expression of bemused exasperation – the problems began even before his birth. Prolonged labour (which occurs after 18 – 24 hours), and a possible Caesarean section heralded the coming of a “problem child”. Anusha Venkat then recalls how, at the age of 2 or 3, she came to the realisation that her son’s inability to focus was far more prevalent than what she observed in other children. Even a couple of seconds of concentration seemed to be a hard ask. He couldn’t remain placated long enough to complete any task. At the childcare, teachers baulked at how he pinged from corner to corner of the room.
Anusha reveals how a serendipitous discovery that Carnatic music could calm him down enough to remain in one spot for more than 10 minutes. A breakthrough! Anbarasu explains that while a child suffering from ADHD can disrupt classroom proceedings, it is pointless to use force to discipline them. ADHD can make someone feel like they are “constrained within a container” if they are impelled to do a task in which they have no interest. Instead, they expend their energy reserves by indulging in some other activity – like running around and being a little menace. For parents who are unaware of ADHD as a mental health condition, seeing their child act out can be scary. In fact, Seelan (the boy protagonist) went undiagnosed at age 3 – doctors merely offered that most children are, well, rambunctious tots at that age. It takes a diligent parent to make a reasoned conclusion that their child may suffer from ADHD. Seelan was given assorted tasks to complete, with his attention span closely watched, even who he liked or disliked in class was logged.
However, Anbarasu recommends that care must be taken to conduct a diagnosis per the Diagnostic Statistical Manual (DSM-5). First, the test must be conducted on children below the age of 12. While school-going children come with a larger raft of observable behaviours due to differences in environment (home, school, etc), Anbarasu admits that is is not easy to chalk up roughhousing or rowdiness to ADHD when those are developmentally appropriate behaviours for a child. Apparently, six or seven are ages when an accurate diagnosis is reached easiest.
Aside from Carnatic music, Seelan’s attention span was helped by repetitive menial tasks like peeling potatoes, chopping ladies’ fingers and carrots. Anbarasu acknowledges that dealing with ADHD in children is a time-consuming task because they aren’t able to complete tasks as quickly as their peers. He calls on parents to pick up the slack – strategising holistic ways to help their child, both at home and in school. It’s a collaborative effort between teachers and parents to then carry out an agreed-upon strategy.
All is not doom and gloom, however. Seelan is observed to play with Lego building blocks for hours on end, despite not performing in the classroom. Anbarasu calls this ‘hyper-focus’. It is a state of mind wherein the mind eliminates noise that potentially distracts them from the task at hand, a sort of “perk” if you will. We are cautioned that encroaching upon this state of hyper-focus can exacerbate emotional issues and precipitate anger. People with ADHD are victim to ‘emotional dysregulation’, which may manifest from frustration in perceived inability to complete tasks satisfactorily. Seelan was unable to appreciate the benefits of delayed gratification, getting restless and upset if things didn’t go his way. Anbarasu explains that this results from emotional dysregulation as well.
At some point, Seelan faces potential expulsion from his class due to the complaints of other children’s parents. Especially in Singapore, where grades are paramount, a poor academic performance which results from an inability to work with a child’s ADHD can be distressing to parents. The teeth-gnashing frustration can make parents feel helpless, and Anbarasu suggests that these situations call for a consultation with a professional therapist who will elucidate the behavioural issues at hand. This gives parents more information to plan future steps. Parents of children with ADHD also attract stinging criticism from other parents. They might feel inadequate in their roles as nurturers and mentors. Anusha has accepted this to be a part of life, chortling as she muses that “you can’t change people”. Whatever the case, it isn’t fair to fault parents for a child’s ADHD. Or the child. Anbarasu clarifies that ADHD is a neuro-developmental disorder – in other words, that’s just how the cookie crumbles. Blame should not be apportioned. Anusha recalls how Seelan used to behave like an attention hog – in its absence, tantrums would be the order of the day. According to Anusha, dealing with instances of emotional dysregulation like this is challenging, especially if you have to deal with the needs of your child while observing social propriety.
Every child’s circumstances are different, so Anbarasu recommends that care be taken to evaluate if danger is imminent. Shouting for a little is perfectly OK. Deal with them after they have thrown their fits because anger is not conducive to receptiveness to advice. Anbarasu is careful to eschew the notion of a “cure” for ADHD. Rather, he says that it is “treatable”. Whether with medication or psychotherapy, or a combination of the two.
Children with ‘combined-type’ ADHD are challenged in a triune of areas – attention, hyperactivity and impulsivity. For these cases, neuropharmacological support is required, to aid concentration and retention of information in class. If the ADHD is not as pronounced, therapy alone could manage the condition. For parents who are especially harrowed by their child’s condition, they should know that there is ample evidence in favour of managing ADHD through the concurrent administration of medication and therapy. On top of psychiatric interventions, there are support groups inside and outside the classroom for parents who are overly stressed.
The episode closes with the narrator speaking over clips of Seelan looking positively cherubic. The viewer is called on to spare the snide remarks, replacing them with positivity, understanding, and “plenty of support”.
If you’ve been pottering around the Promises Healthcare’s ‘Our Team’ page, and are new to the world of mental health in that you’re considering making the leap to seeking help from a mental health professional, it’s our hope that this casual guide to demystifying the titles, designations and dizzying abbreviations that adorn each profile will point you in the right direction.
For starters, there’s one thing that each of our mental health professionals have in common. They all possess at minimum a Master’s level certification in their discipline, so you can be assured of all their competencies.
As we’ve shared in a previous article, a psychiatrist is at their core a medical doctor, which certifies them to prescribe neuropharmacological support – i.e., medication.
But of course, psychiatrists more often than not do indeed possess relevant counselling and psychotherapy certifications, because being well-versed in the craft of patient care in the mental health sector does help them delve deeper into the minds and psyches of their clients, and assist them in skilfully and empathetically overcoming boundaries that some clients may consciously or unconsciously put up that stymie the therapeutic process.
Prescribing the most effective neuropharmacological support is buttressed by the psychiatrist’s skill in interpersonal communication, both verbal and non-verbal. Psychiatrists often describe themselves as observers, but it goes without saying that navigating these one-on-one interactions requires input from their side of the desk. While you might think that psychiatrists have reached the peak of the career trajectory of a mental health professional, keep in mind that by no means should you think of a psychiatrist as the fount of all mental health knowledge. Think of the ‘helping’ professions encompassed in the form of a large tree, rooted in a common desire to help people in need and supported by a trunk of science and evidence based knowledge , from which grows different branches representing the many ways in which mental health professionals can help someone in need – certain disciplines are applied more rigorously in helping certain conditions or situations. This is why Promises is described on our page as a multidisciplinary team of mental health professionals. Your treatment plan is provided by our team, and under the shade of our tree, you will be prompted to reach for certain branches – but at the end of the day, it is your choice to pick the leaves which seem most lush to you.
Psychologists differ from psychiatrists in one key authority. They are not medical doctors, and therefore cannot prescribe you medication. You’ll notice that our stable comprises a good number of clinical psychologists – so, what exactly are they, and how can they help you? Clinical psychologists possess doctorate degrees in psychology, and are imbued with the ability to cater to clients who suffer from any number of the discombobulating disarray of mental health conditions which sadly, are still negatively stigmatised in society. Think schizophrenia, bipolar disorder, depression, and their ilk. A clinical psychologist can make a diagnosis for you, if you think you are suffering from a mental health condition. Using the tools in their arsenals which they are trained in, such as psychometric testing, intelligence testing, personality testing, and much more, their diagnoses are firmly rooted in evidence based science. You could then make the logical conclusion that if they deem your condition treatable with medication, they would refer you to a psychiatrist. There’s a lot of symbiosis going on in our clinic!
The difference between Counsellors & Psychotherapists
We’ll deal with counsellors and psychotherapists next, because the two fields are very much intertwined, aligned in some facets, while possessing in granular detail key differences. Counselling and psychotherapy are both broadly concerned with betterment of clients in need, and there is significant overlap in the goals of either mode of therapy. Now, on to the differences, which will help you better distinguish which leaf you’d like to choose. First, there is a temporal difference between the two in both the length of treatment and how far back into your life each mode of therapy delves into in order to solve your current issue.
Counselling, on one hand, tends to favour clients who are more self aware and sensitive to their emotions and thought processes, and need a helping hand in unpacking a recent difficulty or life altering experience that they wish to resolve. This is rather unlike psychotherapy, rooted in a humanistic tradition – some may refer to it as height psychology, a term which gained currency during the time of Abraham Maslow and his espousement of self-actualisation. Psychotherapy, in this sense, takes a long, lingering look at a person’s past, life changing experiences, deep seated traumas and neuroses, or any relevant factors – all to help a client gain mastery of self (self awareness) and challenge them to enact the necessary life changes that lead to self improvement. You might well think of counsellors more as “advisors”, and psychotherapists as the “life guides”. Of course, detract nothing from both disciplines – their practitioners chose their specialities precisely because they fit into their world-views and probably, because they thought that they were good at it!
How do you choose?
Of course, given the array of therapeutic modalities and mental health professionals, we understand that choosing the right leaves can be a bewildering experience. That’s why we feel it’s best that you browse the profiles of our therapists, read their biographies and see which of them you feel most comfortable seeing. In the near future, Promises Healthcare intends to refine and streamline your selection process by having a list of issues or conditions that you are having problem(s) with – your input will then guide you to the mental health professional in our team that is best equipped to deal with your issues. For now, take a deep breath, sit back, read, absorb, think with clarity about what you want to deal with, and pick one to make an appointment with. Choosing the right therapist isn’t a one hit wonder – it takes time and patience, but rest assured that we’ll do our best to help you in that regard.
This episode of En Ullae touches on psychosis. This case study was about a man who had developed schizophrenia and became obsessed with the ‘spiritual safety’ of his partner. The building tension served to demonstrate the dangers of ignoring the symptoms of psychosis, which his partner was predisposed to do, in her untoward position as the long-suffering partner in a dangerously unstable relationship. Dr Jacob characterised psychosis as rooted in an unshakeable belief in false delusions – people who suffer from the condition are often willfully blind to reason, which he cautions against trying to impose on them when the time is inclement.
Prem, the unfortunate man with all the symptoms of hallucinatory schizophrenia, began to cast an evermore imposing spectre in the relationship, causing much distress to Rani. His delusions began to take such a toll on their relationship, with even the good tidings of a baby in the oven twisted into a string of abortion by Rani, afraid that he would bring harm to her and any prospective child she would bequeath upon them – he professed to see the child as a harbinger of doom, as the embodiment of the devil. Midway through the episode, the viewer is treated to the appearance of two ambiguous personalities – a man and a woman, whose blue lanyard faintly conveyed some sense of authority. We are left uncertain as to their actual responsibilities – they are at times quizzical, unwilling to manifest the “good cop, bad cop” trope. No matter, it is not the point of the episode to further entangle the convoluted plotlines – they serve as plot devices which encourage Prem’s own narrative to unfold – to the end, he remains stolidly convinced that his stabbing of Rani had taken her to a better place, the expression on his face almost beatific at times.
Dr Jacob, at this point, sees fit to caution the viewer against harshly attributing homicidal tendencies to persons with psychosis. He presents the statistic that even less than 15% of homicides are perpetrated by people mentally unsound. Noting the prevalence of drug use and antisocial tendencies that colour this 15%, he confidently steers the viewer away from making too quick a conclusion – it is in everyone’s best interest to step back and evaluate statistics grounded in good science, instead of leaping to the easy conclusion that Prem was beyond rehabilitation.