If you’re considering seeking help from a mental health professional / psychiatrist, there’s a pretty good chance that you’ve realised there’s help out there that can assist you with whatever concern you have on your mind. Your mind may be in disarray, but remind yourself that whatever stigma against seeking mental help may exist in your mind, it’s there because of your lived experiences – created by the culture you live within. There’s absolutely nothing wrong with wanting to get better, or better yourself, and to feel constrained by some vague idea of what it means to be “a man” or “a strong woman” is unwarranted.
If you’re fearful of revealing your innermost thoughts and feelings to a stranger (by virtue of it being your first visit), keep in mind that your psychiatrist is first and foremost a doctor, bound by the Hippocratic oath, and second, believes in the value of offering a non-judgmental listening ear through their training and moral code. If that doesn’t comfort you, you should be aware of legal constraints that exist in your favour to protect the information that you share with them. Notwithstanding of course, if there is reason to believe you intend to injuriously harm yourself or another.
Because of the anxiety that may roil your thoughts, it may do you well the night before to sit in silent contemplation and pen down the reasons or thoughts you intend to divulge. Having a concrete list to bring into your psychiatrist’s office will help you ground yourself and serve as a reminder that you’re there for good reason – to get help. Nothing to be ashamed of, nothing to hide, nothing to unconsciously lose behind a preponderance of mistrust or other self-serving attitudes. Your psychiatrist’s office is a safe space.
If you feel that all this is a hard ask, consider bringing along someone whom you trust and knows you well, with your best interests in mind. They can serve as a calming influence that soothes your inner turmoil. Furthermore, they might be able to helpfully point out if there are discrepancies between what you tell your psychiatrist and the truth of the matter.
When you step into your psychiatrist’s office for the first time, you will most likely be greeted with an open-ended question such as “How may I help you today?”, or “What’s been bothering you?”. It’s normal to feel overwhelmed by the variegated ways you can choose to answer their greeting, especially if you have issues with how you are perceived by others. But remember, this is their way of getting to know you, especially since they have nary a clue of why you may have decided to make good on your appointment.
Because of the time constraints on your visit (your psychiatrist’s office is a place of business after all), you can expect them to try their best to elicit responses through a line of inquiry that their best judgment will allow them to evaluate and cohere into an accurate as possible diagnosis of your mental condition, if you are indeed suffering from one. No psychiatrist is a soothsayer or mind-reader, and you should be aware that the help you receive will very much be preponderant both the truthfulness of your responses and the skill of your psychiatrist, who is also trained in reading cues and tells that they feel will help them make a diagnosis.
As your visit comes to a close, based on the personal proclivities of your psychiatrist, you can expect a number of permutations to happen. They may prescribe you medication, if they feel confident in their diagnosis. They may point you towards psychotherapy or counselling (the difference between the two we will delve into in another post), they may prescribe both the former and the latter, or they may hold off on either if they feel that they cannot in good conscience do so.
Of course, it is very much your right to evaluate for yourself if the synergy between your initial choice for a psychiatrist is optimal for you. If you feel comfortable with them, do feel encouraged to continue on course, or if not, seek out another psychiatrist per a trusted friend’s recommendation, or look online for one that seems more promising in terms of a potential therapeutic alliance.
Ultimately, don’t forget that your psychiatrist has your best interests in mind. They are committed to formulate a treatment plan for you that runs parallel to your values and is in line with your goals.
Promises Healthcare is committed to providing mental health services to those in need, and has realigned how we provide these services in light of the current COVID-19 pandemic. Not only do we practice strict social distancing in the clinic, we have a new teleconsultation service up and running. This may be a blessing for those who are not yet comfortable with in person visits. Simply visit our main website and visit our teleconsultations page.
Alternate services of help are also provided by the Ministry of Health & National Council of Social Services in the public health and non-profit sector respectively. The Minister for Health has also written in response to a question regarding the use of Medisave for mental health therapy and counselling treatment: “No Singaporean will be denied access to necessary and appropriate healthcare because of an inability to pay.”
Anxiety, stress, and fear are common emotions people experience through the course of everyday life. Anxiety disorders, on the other hand, go beyond our daily worries and fears. Stress and pressure is subjective to each person – anxiety disorders can induce heavy stress and pressure, and these feelings can become more intense over time. Issues that crop up for anxiety disorder sufferers range from anodyne to hair-raising. For example, some people are terrified of meeting new people and having to interact with strangers, while others suffer panic attacks when memories of past traumas surface. The most common types of anxiety disorders are diagnosed as:
Panic Disorder (PD)
Generalised Anxiety Disorder (GAD)
Social Anxiety Disorder (Social Phobia)
Agoraphobia (Perception of certain environments as unsafe, with no easy escape)
Obsessive Compulsive Disorder (OCD)
Post Traumatic Stress Disorder (PTSD)
Not only are there psychological symptoms, people dealing with anxiety disorders may also experience a litany of physical symptoms such as insomnia; inability to concentrate or relax; heart palpitations; gastroenterological issues; and sexual frustration, among others. When all these problems start impinging on one’s behaviour, mood and thoughts, life can start to feel like a slog through quicksand. A once “normal life” now appears out of reach, and getting there again can feel like a Sisyphean task.
What makes people suffering from an anxiety disorder seek out substances?
It’s important to understand a little more about addiction before dealing with this question. Addiction is indubitably a very uncomfortable disorder, and that’s characterising it mildly. For a “preference” to devolve into full blown addiction, a person must keep making the same conscious decisions every day, day after day, that facilitate indulgence in his or her vice – in spite of a mounting cornucopia of problems. Maintaining an addiction certainly is tiresome. People suffering from addiction make these choices because their addiction serves them a purpose. Concomitant discomfort is tolerated in light of perceived benefits garnered from substance abuse.
A parsimonious way to think about addiction is to assume that it is a simple cost-benefit analysis. For someone struggling with an anxiety disorder, the allure of a “quick-fix” in the form of a suitable drug or drink is hard to ignore. What may begin as a misguided attempt to ameliorate paralysing fear can eventually develop into a fully-fledged addiction. With this in mind, it is now a lot clearer why substance use disorder (SUD) is a co-occurring psychiatric disorder that is one of the most prevalent among people with an anxiety disorder. The most recent and largest comorbidity study to date (with over 43,000 participants), the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), found that 17.7% of respondents with an addiction problem also had an anxiety disorder.
Ironically, the problem with the “solution” of substance abuse is that the ”solution” hurts more than helps. It can often exacerbate the anxiety disorder – which becomes ensnared in the convoluted mess that is addiction. Thus comes the slippery slope of anxiety, substance use, and elevated tolerance.
Chronic dependence is the likely consequence of this chain of events. For example, a person who suffers from social phobia might employ stimulants or anxiolytics to engender artificial confidence during a social situation. This can feel liberating, exhilarating, even, for someone who has spent a lifetime on the sidelines. The folly in this endeavour lies in the eventual normalising of this ‘chemically induced courage’ – if you turn it into a precondition to interacting with other human beings, you will only succeed in erecting progressively more imposing barriers in a completely self-defeating, tautological situation.
Are there psychotherapies out there that treat anxiety and addiction together?
Diagnosing a mental disorder in a person who also suffers from an addiction is challenging.
It may be hard to determine which came first, the addiction or the anxiety/depression. A clinical history, which is triangulated with loved ones, teachers and others may assist to know which came first. In any case, both the addiction and the disorders have to be treated at the same time. Otherwise, if untreated, the anxiety and depression may lead to the resumption of drug or alcohol use. Cognitive behavioural therapies (CBT), meditation and mindfulness therapies, experiential therapies and medication can assist to address both compulsive behaviour and anxiety and depressive disorders.
A trained and experienced mental health professional can help you navigate your addiction recovery journey to ensure that you get the best possible outcome within the guidelines of your values and needs. While this article is about substance addiction, you will find that our team of psychiatrists, psychologists and therapists have the expertise and experience to work with a variety of addictions, and mental health issues such as anxiety disorders.
In this episode En Ullae on Postnatal Depression, Dr Jacob Rajesh shed light on what some still view as a taboo reaction to what society views as a blessing – the birth of a child. Postnatal or Postpartum Depression is marked by a dip in mood, emotional turmoil, sleeplessness, and changes in eating habits. It can haunt a mother who has borne her flesh and blood for over a year, or the pall might lift after just two weeks.
This episode started out light and buoyant, with scenes of carefree courtship. But the fortuitous chemistry of an arranged marriage that might have heralded exemplaries of the nuclear family, under different circumstances, was to be tested by the wife’s struggle with Postnatal Depression. The coming child would serve as a lightning rod, bringing strife into the relationship. Even before the little baby girl’s conception, the couple disagreed on whether to have one – but cultural pressures enveloped the mother with a pained acquiescence with living up to the status of an “ideal mother” – at odds with her inner values, although she scarcely knew it. Dr Rajesh noted that the immense pressure of a cultural belief in the Indian community that a child was “God’s gift” would serve only to create uncomfortable dissonance within a mother who is not ready to bear fruit.
At some point during one of their many arguments, the husband even goads his partner with the suggestion of abortion, despite the medical impossibility of aborting a 6-month old fetus in Singapore. The child, inevitably emerging from the womb, healthy, would only highlight the difficulties that the couple would face.
Dr Rajesh was quick to point out the boorish behaviour of the husband, noting that in such situations, the support of family members, especially partners, is crucial in alleviating the symptoms of Postnatal Depression. Dr Rajesh went on to warn potential mothers that past depressions were risk factors and that difficulties during the birthing process that might, for example, warrant emergency Caesarean sections, would prove additional risk factors.
The working mother and father were presented with additional difficulties simply by virtue of the husband and not being able to support the wife when needed. Her slow descent into Postnatal Depression began with the naggings of a vague sense of agitation, exacerbated by tiresome nights and a feeling of malaise. Eventually, she would begin comparing herself to an idealised version of what a Mother should represent, having taken care of relatives’ kids at the age of 13, she felt she had no excuse for her failures. Dr Rajesh noted that the unfortunate situation should serve to highlight the dangers of an internal dissonance that would only elevate the crisis. At her nadir, she even contemplated the act of suicide, pulled back from the edge by her maternal instinct. Her child’s cry saved her.
In these situations, Dr Rajesh made clear that she should ideally have been separated from her child, for the family’s sake and checked in to a mental health clinic for treatment. Luckily for them, her husband initiated contact with his own mother, seeking her assistance in caring for the baby. Taking pressure off the mother in situations such as these is of critical importance, who has to learn that she needs time and space to soothe her own mental health crisis. The health of the family unit is somewhat predicated on the stability of the maternal figure, so such a step makes a whole lot of sense. Much attention needs to be shone on the precariousness of these unfortunate situations, so that other prospective mothers are aware of the risks and the steps they can take to avert such crises.
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.
S C Anbarasu shared on the En Ullae episode on Obsessive-Compulsive Disorder (OCD), which featured an actor playing the role of Bala, a well-educated 29-year-old man who struggled with the disorder, bringing his mother to exasperation at times – because as an outsider looking in, she simply wasn’t equipped to understand the condition. Kartik Anand, a social worker who has dabbled in theatre, retold his very personal conception and experience of living with the disorder, albeit with a great deal calmer than “Bala”. The two narratives played off each other, the contrast in each man’s tone and manner starkly laying out the case for sensible treatment. OCD, according to Anbarasu, is a condition that is treatable – with medication and/or therapy. This, he let on at the close of the episode, as a rather stirring montage of Kartik’s achievements on the stage served to remind viewers the uncharitableness of stigmatising people suffering from mental disorders. I haven’t been diagnosed with anything in the DSM-V, but I definitely couldn’t do what Kartik’s done in the field of arts!
Broadly, OCD “traps” an individual within the pounding negativity of unintentional, “dangerous”, recurring thoughts. It exists on a spectrum, where the diagnosis is made upon examination of the severity of four key symptoms. An obsession with cleanliness and avoiding contamination, intrusive thoughts that may be disturbing in nature, fixation on symmetry and order, and desires to harm others that leak forth the yawning chasm that is the mind. OCD affects all aspects of a sufferers’ life – relationships, career, friendships, family, because when undiagnosed and untreated, it is, for lack of a better word, insidious. For Kartik, the weekends were not a source of solace – the dread of his intrusive thoughts running amok kept him clamouring for the steady humdrum of office life and its banal distractions. Interestingly, the episode went out of its way to hint that a mind plagued by OCD shouldn’t simply be viewed as a byzantine web of horrors – both “Bala” and Kartik, upon noticing an injured pigeon, were ensnared by their empathy for the distressed creatures. “Bala” felt the expiration of the pigeon’s nasty, brutish and short life as if it were a weight he had to carry, while Kartik battled his obsession with cleanliness by tending to the bird, risking contact with the animal’s blood. Empathy and bravery. Anbarasu emphasised the importance of finding out if comorbid disorders (a medical term in psychiatry for someone that has more than one mental disorder) were also present, because of the difficulty of diagnosis. In the final third of the episode, the viewer is meant to empathise, or at least sympathise with “Bala” – who unravels in a frenzied spiral of intrusive thoughts. Plagued by visions of harming his closest friend, or a pretty waitress he’d spotted, he is driven to hallucinations as bizarre as his showerhead turning into a snake.
Caught in a cycle of insomnia and isolation, his thoughts overwhelm him to the point of complete breakdown – he melts into the comforting bosom of his mother, all the while cognizant that he is a 29-year-old man. The tragic tale of “Bala” remains unresolved, but serves to inform the public that it is of the utmost importance to get a potential sufferer into treatment if the symptoms’ severities warrant it. Anbarasu brings the episode to a close, by using “Bala” as a cautionary tale – if you are experiencing such symptoms, or notice a loved one behaving similarly, seek professional medical help from a trained therapist, psychologist, or psychiatrist. It is a treatable condition, and with the right help, your life could be as full as Kartik Anand’s.
In this episode of the Health Check podcast, Dr. Winslow reveals that he suffers from attention-deficit hyperactivity disorder. No-one would begrudge you your raised eyebrows, least of all him. After all, it is precisely his duty to educate you about ADHD.
Dr. Winslow joined journalists Joyce Teo and Ernest Luis at The Straits Times’ podcast studio, where the duo court the expertise of medical professionals to inform and enlighten. Armed with myriad perspectives, Dr. Winslow availed his own brain to help demystify ADHD.
It wasn’t until Dr. Winslow began to see the parallels between his childhood behaviour and those of his clients with ADHD, that he realised he too had the disorder. It didn’t seem to bother him too much – he laughs at being chided by his son’s teachers for his pride in his son’s ability “to pass exams exactly the same way” as he did, without paying attention in class.
Dr. Winslow says that in the brains of people with ADHD, communication between cells is difficult – that’s how they are more likely to lose focus, become distracted, or give in to impulses. Singapore’s regimented education system doesn’t help either. Students with ADHD face real disadvantages, in their inability to sit through lessons, and in the way educators see those who refuse to (or simply can’t) pay attention for long stretches.
Dr. Winslow recalls being forced to run laps around the school as a child by his teachers, who had hoped to wear his indefatigable energy down into submission in time for class. He admits that it worked surprisingly well. ADHD can be managed, as he would learn.
It is unfair to say that ADHD is “not a real disorder”, and that one merely needs to “concentrate on overcoming it”. That just doesn’t make sense. ADHD is a medical condition that can be tackled with correct tools and the right will. Dr Winslow says it’s possible to address the few big symptom groups (Hyperactivity, Impulsiveness, and Difficulty with Distractibility) with practical advice in the right contexts. For example, you might teach your always-tardy child about time management with to-do lists.
Dr. Winslow says parents should try and come to terms with their child’s ADHD, or risk more worrisome aspects spilling over into adulthood. Adult ADHD often comes packaged with low self-esteem, where inability to complete tasks due to inattention becomes internalised as laziness in a self-defeating cycle.
Overcoming ADHD is easy, says Dr. Winslow, when you understand this maxim: “The more you understand the complications brought by your limitations, the more you can do to manage your symptoms.” It’s an expansion of the classic “knowledge is power”.
Once you begin to appreciate the ADHD brain for its quirks, advantages become more apparent. The meandering thoughts of people with ADHD often help them develop novel solutions to problems – “thinking outside the box”.
The doctor’s recommendations? Don’t panic, try to understand ADHD, and don’t forget the fish oils!
Listen to the Health Check podcast over at The Straits Times website, or search for it on your favourite podcast platform.
Psychosis can be a debilitating experience for individuals experiencing it. Hearing voices or thinking unusual or disturbing thoughts is common in psychosis. Having psychosis makes it difficult to figure out what is really happening and there is a break from reality. It results in individuals not being able to do the things they usually do—such as going to work or school and enjoying time with friends and family. Family members may also struggle as to how to help their loved ones through these experiences.
The truth is that psychosis is a treatable condition. Treatment for psychosis is provided by healthcare professionals and support groups. This involves a number of different approaches which include medication, therapy and peer networks. At Promises we provide support through doctors, Counsellors and Case managers. There are peer groups in which our clients attend to hear the shared experiences of individuals who have lived through periods of psychosis. So do know that help and options are always available.
At Promises Healthcare, we are committed to helping you through your journey to recovery. Please contact our clinic for inquiries and consultations.
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