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”.
Written by: Dr Mark Toh, Consultant Clinical Psychologist
It is a reality that we can choose our friends. If at times we find them annoying, we can always choose to make adjustments or even terminate the friendship if needed. But unfortunately, we cannot choose our family members. As such, it can be a challenging and sometimes very difficult situation when family members are emotionally unhealthy and they have not sought help to address their own difficulties.
Instead, by having to live with them as members of the same family, they become a regular source of mental distress. This can pose a particular burden for minors, or those still dependent on the difficult member as the financial source of living, or during the current coronavirus lock-down imposed by the government when family members are confined together. In some cases, especially when violence and harm is a possibility, these unhealthy members can become damaging or dangerous and more drastic action may need to be taken to promote safety.
For the child, this may be confusing if the source of difficulty from parents are due to attempts to parent or from inappropriate control. Or they may have siblings who like being bossy to their siblings. Here are some signs to consider in trying to differentiate healthy from unhealthy behaviours from difficult family members.
They are always blaming you while not accepting their own responsibilities.
Individuals who engage in unhealthy relational behaviours often have difficulty taking ownership for contributing to the problems that emerge between each other during disagreements or conflict. Their need to blame others is usually a defensive response against accepting their own guilt or responsibility for their fault or wrong in the situation.
They are always critical towards you.
Unhealthy family members also often present themselves as critical. This goes beyond a simple discussion to point out about errors if or when you or someone else has made them. But it appears more as a pattern or their habit in regarding you as a target of contempt. Words that undermine your character are often expressed. It is also often expressed regardless of the many accomplishments you may have achieved. It is often an expression of projection that reflects deep resentment or the unfulfilled wishes of the parent on a family member. Sometimes it is a resentment shared between both parents and projected on a child who they have identified as the “scapegoat”. The scapegoat in unhealthy families are usually children who are targeted for blame because the parents need to fault the child to avoid taking ownership of a problem.
They are dismissive of your feelings.
A healthier family is more prone to being encouraging or supportive especially in difficult times. But the unhealthy family member is often unconcerned of your feelings or even your opinion. The extent of their dismissal of you may show up as disagreement with you even if you are right. In severe cases, if you attempted to approach them to resolve a disagreement, they may even resort to convincing you as the problem. In this focus, they could convince you to see that you are the problem rather than to problem-solve in search of a solution that has mutual benefits.
They often make threats.
Physical altercations are not the only signs when the relationship or behaviour is unhealthy. Making threats especially when repeated is often employed as a means of control. This is going beyond anger which is a common feeling within long-term relationships. Anger is a sign when someone feels offended, frustrated or hurt. But the use of threats goes beyond anger to become an instrument of intimidation or domination, and a misuse of power. It is a common behaviour of abusive individuals.
They are controlling.
There is a difference between control from healthy parenting and unhealthy parenting. Healthy parenting is focused on what is in the child’s best interests. When discipline is exercised, it is done to facilitate learning for the child. In unhealthy parenting, control is displayed more because it is primarily attentive to the parents’ wishes and not in the best interests of the child. This is often expressed when the parent becomes forceful and induces fear on the child so that the parent can feel powerful or have his or her way. This control can also be applied between couples or siblings. The family member is expected to take the role of submission in their engagement for the controlling person to be pacified.
Additional signs for concern in this area is suggested by (a) prohibition of personal decision-making that is good for the family member, (b) issues of appropriate concern are denied from being raised for discussion, (c) material resources such as money or food are used to manipulate the family member towards submission, (d) there is direct restrictions into personal choices pertaining to clothes, appearances, spending, friendships, or even use of time, and (e) there is an opposition towards the family member becoming independent, to be separated from the unhealthy individual, or for the family member to be individuated (mature to become their own person) over time. Between couples, a controlling spouse is often violating the boundaries of his or her spouse. It is as if the controlled spouse is not allowed to be free to exercise his or her own choices.
They confuse punishment with discipline.
Discipline is the means to teach someone to abide by a code of conduct, or correction for a child to learn right from wrong. But for the unhealthy individual, punishment or discipline occurs when there is no lesson to be learned. It shows up usually because the person is unhappy for some reason. Their need to lash out is their attempt to vent out their anger or rage even if it becomes hurtful to others, and they feel justified conducting themselves this way. At other times, this punishment is expressed through passive aggressive behaviours when “silent treatment” is employed instead of yelling or shouting. Or the punishing behaviour is excessive and disproportionate to the action or event.
Unhealthy parents take sibling rivalries or ‘misbehaviour’ to the extreme.
This usually occurs when the unhealthy parent is resentful of all his or her children. They may feel that having children (or marriage) have become a personal cost to them because of the responsibilities required for the care of the children. They feel prevented or deprived of their freedom and so the children or family member are to blame. Or this could show up with a parent showing favourites to one child over the others. In the course of sibling rivalry, the unhealthy parents is revealed by (a) blaming one child more severely over the other and consistently, (b) humiliating the scapegoated child, or (c) the unhealthy parent experience the sibling rivalry or conflict as a personal or vindictive act against the parent.
Strategies for Coping with Unhealthy Parents or domineering spouses and/or siblings
It may be a sad reality that parents can consider themselves parents simply because the infant is born following his or her physical birth. But beyond the biology, the emotional maturity, readiness or mental health can often be found lacking in parents to create the healthy conditions for the infant to develop or thrive. Controlling family members who are narcissistic in nature are also more interested in their control than the well-being of others. When family members regularly display the above behaviours, there is a need for concern. Given the potential for mental distress, developmental disruption and suffering, the following strategies may be essential to assist in coping.
Know that you are your own person.
Although you may share some traits or the same family name with your parents, remember that you are not 100% of the same people who raised you. If you recognise that your parents are emotionally unhealthy, understand that you do not need to follow their same values or behavioural patterns. When you realise that you have been hurt by them repeatedly and their use of authority serves their own interests over your needs to develop in a healthy way, be ready to break away from their self-serving values to work towards a healthy development for yourself. Explore to find healthy models of functioning among others to seek their influence over your lives rather than what is practiced at home.
Create space for your own emotions to nurture your own sense of self.
The unhealthy parent, spouse or sibling often do not respect your personal boundaries. They may deny your personal space or your feelings because they are preoccupied with their own. They may not discuss matters out or they may attempt to deny an essential part of who you are. While they deny how you may feel in their relationship with you, this does not mean you cannot acknowledge or express your own feelings by blogging or journalling.
Find supportive relationships elsewhere.
When your family members have made themselves unapproachable, you can turn to others for support instead. Friends, teachers, counsellors, or colleagues are often available to relate to who engage with a healthier appreciation for you. You do not need to go through difficulties alone. So find a support system from those who appreciate you for who you are and who value you in the person you can become.
Understand that your parent, spouse or siblings may have narcissistic tendencies or a self-serving biases so set your expectations low in conversations with them.
Unhealthy parents, spouses or siblings highlight the need to understand mental illness. Having to engage family members who have already discounted you, or hold you in contempt is often more reflective of them than of you. For this reason, understanding if they have a narcissistic or anti-social personality or tendencies is useful to recognise their biases. You may wish to have deep, meaningful or respectful conversations with them. But since this is not possible for those who are narcissistic or anti-social in nature, keeping exchanges brief and light is best to minimise stress or conflict.
Be prepared to employ diversion tactics in conversation.
Being diversionary may not be appreciated in social circles. But if your family member is controlling or looking for conflict, having a mutually respectful conversation may not be possible. As such, their attempts to dominate or argue can be diverted. For example, if they choose to criticise your choice about what you bought, you can note their comment while affirming your choice. Then this can be followed up by you changing the topic. This may allow you to have some control while you may be under attacked.
Recognise the traits that make you an easy prey.
For some, the need to dominate can be influenced by their perception that you have difficulty standing up for yourself. Their view that you are unable to be firm in protecting yourself may appear as an invitation to them to bully or dominate. Learning to stand your ground will help to establish yourself as deserving of respect.
Expect their angry response but do not surrender to it.
Your attempts to hold your ground or establish personal boundaries may be seen as a threat to the controlling parent or spouse. They see it as a challenge to their need to dominate or control. As such, anger can be employed as their weapon. It is important to not be paralysed by the person and to remember that you still have power. This power may not be accepted by them but you have power nevertheless. You can continue to pursue what is clearly in your best interests despite the threats and anger they express. Choosing the right timing to pursue your interests with them may be required. Or being able to refer to the credibility of someone else with authority on the subject may be helpful to borrow these views to help you to hold your position.
Aim to be self-sufficient and independent.
The need to establish your healthy sense of self and personal integrity is important. Your own mental health depends on it. In the face of parents or family members who are clearly focused against your best interests in pursuit of their own interests, you can set goals to be financially independent in order to become autonomous with what is needed to establish your own integrity and identity. Unhealthy parents often employ money as a means of keeping the child dependent. As such, learning to budget and be self-financing will help to establish your independence from them.
Do not accept abusive behaviour and the effects of it.
Recognising the signs of mistreatment from abusive parents, spouses or siblings should allow you to feel the anger you have reason to feel. Often these people may also engage in seduction or manipulation to downplay their dysfunction and hide their mistreatment of you. Being able to recognise their self-serving bias and the potential damage that this can create is important to not allow them to justify it. If their mistreatment is justified, it is more likely that you could minimise the damage and practice it yourself.
If the abuse is persistent or violent, be prepared to get help and seek shelter and protection outside the family.
This is hard to do for children but the sad reality is that some parents are poorly prepared to parent or they are mentally ill when they decided to have children. It is a sad and tragic reality that children have died from neglect, abuse or mistreatment while in the hands of their parents or caregivers. Children have been starved, exploited, tortured in the hands of violent, mentally ill parents. This has also occurred between couples as indicated by one spouse being regularly abused by another. Abuse can be physical, emotional and/or sexual, and they can happen between couples and on children within a marital or family system. If only one parent is aggressive or violent, the other parent has to be prepared to seek shelter to protect themselves or their children. If in the case of one parent being violent and the other parent ignores the child being abused, the children need to be protected from both parents.
This article is a call to alert those who may be suffering within families. Tragically, there are hidden dangers that vulnerable family members may be exposed to. They may already be suffering in subtle or obvious ways at the hands of unhealthy, abusive or emotionally damaging family members. Our collective concern for the weak calls out for us to be sensitive to when this danger is present within our community to protect the vulnerable among us.
References:
Faubion, D. (2020, Apr). Toxic family dynamics: the signs and how to cope with them.
Chen, C. (2015, Feb 25). What to do when the toxic people in your life are (unfortunately) your parents. The Huffington Post.
Streep, P. (2016, Dec 14). 8 strategies for dealing with the toxic people in your life. Psychology Today.
Thorpe, J. (2015, Sep 18). 7 tips for dealing with toxic parents. Bustle.
Anger is a response most of us have when we feel our territory is being threatened. This is a primitive reaction from our days as cavemen (and cavewomen) when a wild animal was nearby! This reaction has not quite been removed by modern civilisation. When something threatens our security, the brain responds to it with a fight or flight reaction. The body releases adrenaline which causes changes in the body. The heart pumps faster, breathing gets faster, blood gets diverted to the legs and arms so we can run or fight back. The blood flow to the reasoning part of the brain is lessened so that thinking becomes difficult. Nowadays there are no saber tooth tigers coming out to attack us which require us to fight or flee. However the body’s response to a threat remains the same and, unless we find ways to discharge the energy or change our perceptions, the fight response will persist.
Powerless!! That’s the situation most people find themselves in at the moment during this Covid-19 Pandemic Circuit Breaker. From the home maker, who has to see her family all day long to the child who wants to have his friends over; teenagers who are restricted in their activities with peers to husbands who have to adjust to being at home with no break! Cabin fever is setting in and many are not coping well. Add to that mix an addiction that is running rampant in the household and you have a powder keg ready to blow!!!
What can family members do at this time to stay sane and not get embroiled in another power struggle or argument with the addict in the house. Anger that luxury during normal times is just magnified as all of us are forced to Stay Home. A simple request turns into a huge event; an innocent comment gets misinterpreted; and even demonstrations of concern become fuel for accusations of being manipulative or controlling. What to do??
Most family members of addicts or dysfunctional families (most of us can attest to being in this category), have resorted for a while now to manage, manoeuvre, save or guilt trip. This comes from a place of love and fear. However having time apart has always been a great diffuser of tension. Now faced with a Stay Home situation things can get stressful. Once free to go out, meet friends, go to the gym and pursue our life goals, we find ourselves having to don a mask and stay six feet away from each other, with frequent temperature checks thrown in! Yes we know it’s for our own good but just how do we go about removing that sense of irritation or frustration?? What’s wrong with me? I never used to get SO upset?? Being stuck at home we ‘step on the toes’ of others or they inadvertently step on ours.
So here are some possible ways to cope…..
1. Walk away and discharge the energy
Going for a walk, or a run and getting away from the source or trigger for our anger is one option. Moving away and giving vent to the energy is what we need to do. Digging in the garden, washing dishes, scrubbing the bathroom tiles or polishing the furniture is a great outlet for this energy. Shredding newspaper is another excellent technique. After which you could turn the strips into Papier Mache pulp and create an art project. One woman wrote that she would pull out weeds and imagine she was pulling out her husband’s hair! This is called Detaching.
2. Practice Deep Breathing and Self soothing
This taking in of deep breaths, helps bring more oxygen into the body and to the brain. Especially important is the frontal cortex where our reasoning happens. Improved brain function helps restore some calmer thinking. Follow this up with doing something good for yourself such as listening to some music you like, dancing, playing a game on your phone, doing a craft or even having a nap. Seld care is important when you have to deal with a loved one suffering from an addiction. We often say, “Put on your own oxygen mask before you attend to others.”
3. How Important Is It?
Ask yourself this question. After walking away and breathing for a bit, consider how the event figures in the larger scheme of things. Does this event require action right now or can it wait? Do I need to say what’s on my mind right now or can I pause and say it later. Often I ask myself these questions- Does it need to be said? Does it need to be said by me? Does it need to be said by me now?? By the time ive asked myself these questions, my good sense would have returned and I can leave it for another time.
4. Respond not react
After calming down, consider a way to communicate which is kind and thoughtful. Say what you mean, mean what you say, but don’t say it mean. I’ve heard this said by someone- “Try to say it in ten words or less!” Haha! Most of us have communication patterns that escalate tension! So, try this for a change.
Another great tool is the acronym – T.H.I.N.K. Before I speak I need to THINK.
Is what I’m saying Thoughtful, Honest, Intelligent, Necessary or Kind. If not take a piece of Masking tape and place it nearby. This helps as a reminder to keep my mouth shut.
When all else fails, go talk to someone you trust and let it out. A friend in need is a friend indeed. Or seek one of many support groups or counsellors to help you cope. Whatever the case, we are all in this together! So don’t suffer alone. There are many helplines and people available to support you such as the ones listed below.
“Good relationships keep us happier and healthier, period”. That’s what Robert J. Waldinger unequivocally says is the clearest message of the Harvard Study of Adult Development. It’s what may be the longest study of adult life that’s ever been done, having been started in 1938. The lives of 724 men were followed since they were then teenagers, a group which included men like former President of the United States John F. Kennedy.
Waldinger says they learned three big lessons about relationships. Social connections are apparently really good for us. People who are more socially connected to family, friends or the community are happier, physically healthier and live longer than those who were less connected. The experience of loneliness, he says, turns out to be “toxic”. People who are more isolated than they would actually like to be turn out to be less happy, with their health declining earlier in mid-life. Even their brain functioning declined earlier.
The number of friends and social connections you have also doesn’t mean much if the quality of those connections aren’t good. Living in a high conflict marriage is probably worse for you than getting a divorce. Waldinger found that good, warm relationships are “protective”. Searching for a predictor of health and happiness in old age, he found that it was the people who were most satisfied in their relationships at age 50 were the healthiest at 80. Even physical pain is magnified by the emotional pain of poor relationships, says Waldinger.
Good relationships don’t just mean that we will stay physically healthier. Good relationships also translate into sharpness of mind at old age. It turns out that being in a securely attached relationship in your 80s means that your memory will stay sharper, for longer, compared to those in relationships where they felt they could not count on the other person. Your marriage also doesn’t have to be completely smooth sailing. Even if you bicker constantly, what really matters is that you feel you can count on your partner.
It’s human nature to seek a quick fix to happiness, but the possibilities on how to foster good relationships are practically endless. And in doing so, you’ll probably have a lot of fun along the way.
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.
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