In this episode En Ullae on Postnatal Depression, Dr Rajesh Jacob 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 Jacob 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 Jacob 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 Jacob 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 Jacob 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 Jacob 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.
Workplace mental health is becoming an attractive proposition for employees and employers alike. Having a mentally healthy environment can help employees become happier, more productive and motivated individuals. Yet, mental health issues are often swept under the rug, simply because they can be touchy subjects to handle. In Singapore, the Health Promotion Board (HPB) drew from data culled from 1000 respondents, and found that compared to an n representative of Singapore’s general population, the mental well-being of working adults was found listing – 13% more worse off, to be exact. In addition, another survey also found that 1-in-6 working adults experience “a relatively high level of stress”, compared to 1-in-10 non-working adults who expressed the same concerns. This stark contrast makes us wonder – Does working for ‘The Man’ make us miserable? Does that mean we can curtly reply “Money”, when the interviewer wants to know why we want that job?
Singapore is notorious for a fast pace of living, a country where your career helps to define you. With career advancement already firmly ensconced within our list of priorities (for the average Singaporean, at least), many tend to devote a good part of their waking hours to work, with less and less time being set apart for leisure and recreation. It makes sense then, that we should look to the workplace as a concept just as deeply implicated in our happiness (or lack thereof) as home and family.
Employers who pay scant attention to the mental health issues of their employees will soon find that such a business model doesn’t pay long-term dividends. In fact, it may end up costing them – there are countless studies out there detailing and actually quantifying the monetary costs of poorly managing workplace mental health. Intuitively, we’ve already known this without having to be told – if the only free time you’re allotted for a restroom break has to be taken during your 10-minute lunch, then you’ve probably seen fit to leave your bootstraps in the toilet. Employers, too, know the sting of cynical, burned out employees making full use of paid medical leave.
In this case, not only does the organisation have to pony up the employee’s sick leave entitlement, they also have to incur the opportunity cost of the work the employee would have contributed if they were present and productive. The organisation thus suffers financially. Moreover, mental health issues can precipitate workplace bullying and harassment. Employees may start feeling disempowered, demotivated and dissatisfied with their jobs. The overall workplace morale takes a plunge.
In light of this, we have to acknowledge that we, more often than not, overlook an extremely important factor which makes or breaks the mental well-being of employees in the workplace.
I am reminded of the movement of person-centered decision making in the workplace by the pithy saying: “Nothing About Me Without Me”.¹ It serves to remind people that even though individuals with mental health issues may be deprived of 100% lucidity and perspicacious decision making abilities, others should, as a principle, accord them the same respect, and not make any decisions without consulting with them. This is especially so if these potential choices might affect the employee’s quality of life. When making considerations which may impinge on another’s life, it’s only good manners to make sure that everyone affected is a stakeholder.
Mental health issues tend to attract the kind of hushed conversations that we want to avoid. It’s simply improper to gossip about such deeply personal issues. Conversations regarding the affected individual shouldn’t take place without their “blessing”, either. If I were to take a charitable interpretation of such water-cooler talk, I might say, after all, people may not know the right approach to handle these situations, or they may simply be misguided in their good intentions!
Some useful guidelines for professionalism at the workplace. If you are, for example, a HR-manager and suspect that an employee of yours requires help with a personal mental health issue, do not:
Apprise superiors of his condition without seeking his permission first
Try to “ease his burden” by lessening his workload in an attempt to “help” him cope with his condition without consulting him beforehand
Instead, as soon as any discussion is started about the individual, he should be brought into the fray and not be left in the dark. The point here is about giving back control to the person in question, and allowing him to understand that he is still equally respected regardless of his mental health.
What happens if these pointers are neglected? Unfortunately, diminishing the employee’s workload without consulting him first may chip away at his sense of self-worth, since he is stripped of the ability to demonstrate his capabilities. Moreover, having your superiors talk about you behind your back can in some ways, make you feel discriminated against for having a mental disorder. This breeds a sense of distrust amongst colleagues, which erodes the fabric of work cooperation. Not respecting someone’s dignity and right to make decisions can also hinder his/her mental recovery process. Needless to say, such workplace environments are deeply unprofessional outfits which detract from productivity and dignity.
We should thus focus on what we can do to make our workspaces better places, and mentally healthier ones. We should start taking “Nothing About Me Without Me” seriouusly. We need to start recognising its importance to a well-oiled outfit and how it helps foster pride and dignity. In fact, we should help this principle take root at the organisational level, such as including people with past experiences of mental health issues in the development and expansion of workplace mental health policies, or seeking their input when it comes to planning activities in service of mental well-being. Policies centered on transparency and proper communication should also be developed as adjuncts to ensure that the organisation is committed to making sure employees’ voices are heard when it comes to issues of mental health and their careers. If more organisations are willing to take these steps, there’s no doubt our workplaces will slowly become more conducive and nurturing environments. How is your company contributing towards making your workplace a mentally healthier one? Share your thoughts in the comment section below, so we’re all better off for having heard these ideas.
¹ Golding, E. and Diaz, P. (2020) Mental Wealth. New York: Morgan James Publishing.
Two days ago, I read an article about mental health in schools, and how the school system was falling short of providing mental health support to students. The article began with an anecdote which illustrated how even teachers, who are charged with spreading good values sometimes behave in ways which hinders progressive movements like the destigmatisation of mental health issues in society. Not only did this teacher discount the legitimate need for psychiatric medication that some people have, he also made off-colour remarks about suicide. Given the increased scrutiny the Singaporean education system has come under, and the fact that it has been an exacerbating factor in the suicides of some children and adolescents, his remarks were remarkably insensitive at best.
Mental health should never be trivialised, and is most definitely not something that is to be joked about. Behaving like that teacher flies in the face of efforts to bring to light the importance of mental health to the functioning of a healthy society, not to mention the lives of people who do have mental health issues. Last year, nominated Member of Parliament Anthea Ong addressed Parliament¹, musing about how Government had called for greater efforts to combat diabetes, when in fact more people were afflicted with a mental disorder than diabetes. The costs that mental health issues impose on our healthcare system is no laughing matter, and the attitude held by that teacher was indeed regrettable.
Talking about mental health in such flippant and cavalier ways detracts from the ability to talk openly about it. There’s no denying that there is still a stigma around mental health. We, as a society, can help to overcome these barriers by speaking out about the importance of mental health, and by leading by example – we should all strive to speak in an open-minded and accepting fashion about it. It is this very stigma that often prevents people from seeking treatment, or worse yet, even recognising that they are suffering from a mental health condition. We don’t see it happening, because we are often unable to live the lives of others, but the stigma often drives people further into isolation, which has harmful effects on their condition.
In the first place, people who struggle with mental health problems often find it hard to open up about their conditions, or talk about it in ways that other people can understand. It’s with great difficulty that they finally get around to reaching out and asking for help, and unfortunately, even these efforts can be rebuffed if people don’t know how to respond. While it’s true that the onus is on people who have mental health conditions to reach out for help, their personal responsibility should be matched by the wider, shared responsibility we have to each other – to look out for one another, and to pay attention to the signs that someone we know may be suffering from a condition. We need to nurture safe spaces, where the topic of mental health is neither trivialised nor discounted. These safe spaces are essential for sharing, listening, and often are indispensable places for people to offer care in a supportive environment.
Apart from families being the ‘caring nucleus’ of a child’s life, the school environment is an invaluable place from which children derive a solid sense of security that produces strong values. The close ties that children forge with their school teachers and peers help to serve as preventive measures against the seeking out of destructive or maladaptive alternatives. Children are made to feel safe, when they can develop the anchors of strong, meaningful connections to groups as they explore and discover the wider world. It’s in these supportive environments that children learn how to trust others, and learn that seeking help from others isn’t a risky proposition. This is exactly why we need to educate people about the dangers of trivialising mental health, which is especially corrosive when school teachers perpetrate such backward attitudes.
Yet other barriers exist. Sometimes, even if the peers of school children with mental health issues are fully supportive, there simply isn’t enough information on how to get their friend the help that they need. This information vacuum detracts from well-meaning efforts, breeding fear and uncertainty about how to offer support.
It’s my belief that the move by the inclusion of mental health to the refreshed Character and Citizenship Education (CCE) curriculum is a highly commendable one. Teaching about empathy and helping skills is a grassroots move that promises to have far-reaching effects in building a resilient and caring society. Inculcating these positive values in impressionable young minds is definitely a step in the right direction, especially when these soft skills form the bedrock of a more inclusive society in which mental health is less stigmatising. On top of these efforts, in 2022 the Ministry of Education wants to bake this movement of inclusivity into the curriculum – creating a structured “peer support” environment where elected student leaders promote mental well-being is a great platform from which we can springboard discussion about thornier mental health issues.
Parents have also pointed out that that access to the internet does raise legitimate concerns about having children ‘misdiagnosing’ or ‘labelling’ themselves inaccurately – the torrent of information that the internet opens children up to also unfortunately raises the potential of false or misleading information. With this in mind, it becomes imperative for the Singapore education system to create structured guidance for students to learn how to identify and recognise the needs of themselves and others.
Even as a parent yourself, the complexity and range of severity of social-emotional/behavioural needs can be bewildering at times. It’s always okay to reach out for comfort and advice if you feel overwhelmed!
Requiring that potential job applicants declare their mental health conditions on hiring forms is now considered discriminatory.
In a much-needed move that’s been hailed by mental health advocates across the island, the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) has updated its guidelines to better advance the meritocratic underpinnings of Singapore’s economy. Prior to this change, TAFEP had already nixed disability declarations on job applications – abolishing mental health declarations takes this principle to its logical conclusion.
In a firm but fair recommendation, TAFEP advises employers against asking potential hires for personal information “such as their mental health condition”, unless there is a “job related requirement”. Further, if employers are to seek information that may be seen as discriminatory, the onus is on them to elucidate the necessity of that information.
This isn’t toothless rhetoric – employers who flout the guidelines risk exposing themselves to enforcement action by the Ministry of Manpower.
Such measures are invaluable beachheads in the fight to destigmatise mental disorders, a movement which has gained traction among some Members of Parliament. Last year, Nominated MP Anthea Ong called on the Government to make mental health a national priority, pointing out that more people (1 in 7) were afflicted by a mental disorder than diabetes (1 in 9).
More Singaporeans are being diagnosed with depression, anxiety, and alcohol addiction, as evinced by the 2016 Singapore Mental Health Study (SMHS), with numbers increasing since the first and inaugural SMHS in 2010.
The relevant authorities encourage you to report work-related discrimination by calling 6838-0969 during office hours or visit www.tal.sg/tafep
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.