promises, Author at Promises Healthcare
ENQUIRY

Ask A Child Psychologist: S C Anbarasu on Children’s Mental Health

child psychologist singapore

S C Anbarasu, child psychologist at Promises

Senior Clinical Psychologist and child psychologist S C Anbarasu was featured on Yellow Pages Singapore’s Ask A Doctor series, which decided to engage him to answer some questions about children’s mental health issues because of increasing awareness about the effects of Singapore’s education system on their mental well-being.

He answers questions on how to recognise stress in children, Singapore’s education system, child suicide rates here, recommendations on this pressing issue, and more.

Read the full interview on the YP SG website.

How You See ADHD Defines It For You

How You See ADHD Defines It For You

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.

Dr. Winslow’s 15-minute Clinic on Addictions

Dr. Winslow’s 15-minute Clinic on Addictions

Dr. Munidasa Winslow was recently invited onto The Straits Times’ fortnightly healthcare podcast, Health Check. On it, journalists Joyce Teo and Ernest Luis discuss health issues with prominent medical experts, seeking to promote health and debunk myths. And for a deeper dive into addictions, who better than the effervescent Dr. Winslow, often described as a ‘pioneer of addiction medicine in the Asia-Pacific’.

Dr. Winslow ploughed right in, rejecting the “just say no” rhetoric that characterised ham-fisted anti-drug campaigns of the 1980s. Speaking from an addict’s perspective, he got his hosts laughing when he quipped that addicts would long have overcome their self-destructive tendencies if “just saying no” actually worked!

He went on to note that addictions largely fit within two categories, the ‘substance’ addictions (drugs, alcohol, etc.) and the ‘behaviour’ addictions like sex and gambling addiction. Dr. Winslow highlighted that the World Health Organisation had for the first time classified compulsive sexual behaviour disorder (CSBD) as a mental disorder in 2018. Interestingly, during the early stages of Singapore’s Institute of Mental Health’s sex addiction treatment program, he noticed a common thread amongst those who sought help. Most of them had strong value or belief systems, or religious tendencies. He said these people would realise that in acting out their compulsions, they “were not acting according to [their] own value system”, causing them “internal pain and emotional discomfort”.

Why then do people get addicted if addiction is so uncomfortable? Dr. Winslow says that one’s addiction first has to serve a function, such as the intoxicating allure of power in an otherwise downtrodden existence, or the erasure of feelings for someone deeply dissatisfied with life. And yes, he says, certain people are indeed more likely than others to fall into addiction. For example, people with ADHD who often have impulse control issues, or people who have suffered sexual or emotional traumas previously.

To listen to Dr. Winslow provide succinct answers to a whole host of addictions-related questions, entertain his hosts with light-hearted anecdotes, and shed light on misconceptions about his field of expertise, click here, or search for “Health Check” on your podcast platform of choice.

How to Help Someone Struggling with Addiction

How to Help Someone Struggling with Addiction

Helping someone close to you who is struggling with addiction can be a long and painful journey with plenty of heartbreak. It’s not just the person who is anguished – people who care are often put through hardship too. Friends and family may experience issues with their difficult behaviour; they may bear the brunt of their financial impropriety; and may even be affected by legal woes. At times, all this seems so overwhelming that you might be tempted to turn a blind eye out of sheer exhaustion. However, sweeping addiction under the rug ultimately leaves all parties worse off. The decision to try and get help for someone whom you care about is never easy, and yes, it takes lots of love, patience and strength.

With your support, the person you care about has a far greater chance of recovery. Every person or situation is unique, so the recovery process is never linear – expect ups and downs, from sobriety chips to relapses. Throughout it all, it’s always important to stay positive and hopeful that things can, and will get better. 

The first step you can take is to educate yourself about addiction. The more you understand this condition, the better you’ll be able to help. And the very fact that you’re reading this means you’ve already taken this first step. As you read on, you’ll discover six tips on what you can do to help a loved one struggling with addiction. I’ve found that these principles always bear reminding – simple enough, but easy to lose sight of in the thick of it all.

  1. Create a compassionate environment

This can be hard to do especially if you feel hurt and betrayed by the person with addiction. However, it’s important to keep the broader goal of recovery in perspective amidst the frustration. You should remember that addiction is neither a choice nor a moral failing – instead, addiction is a disease.

Establishing trust and compassion will nudge them to start thinking about change. I believe that compassion forms the bedrock of addiction recovery, especially with its role in healing shame. Addiction and shame are two sides of the same coin – shame may lead to addiction, and addiction most certainly breeds shame. Compassion, then becomes imperative in the recovery process, and acts like an antidote to treat the poisonous effects of shame.

Even if they don’t share their suffering with you, or outright deny their suffering, don’t stop yourself from trying to soothe and comfort them. As impatient, disappointed and angry at them as you may feel, pause and imagine how they must feel about themselves! Yes, they may appear nonchalant, or defensive about their addiction and shame. But as you catch sight of even the most fleeting glimpse of their vulnerability, your intuition tells you there must be a lifetime’s worth of self-disappointment, shame, unworthiness and anger, all roiling against the walls they put up.

We’re all worthy and deserving of love – especially those who feel unloved. Work on being empathetic. This means putting yourself in their shoes. Make your support known to them. Make your support accessible.

Above all, don’t forget to have compassion for yourself.

  1. Get support for yourself

Having a family member, a spouse, a partner or a friend with an addiction can often feel overwhelming. It’s healthy to acknowledge that helping them can be very stressful for you too.The person with addiction isn’t the only one who needs psychotherapy or counselling. Caregivers, hospice workers, counsellors and therapists all need therapy – you definitely shouldn’t deny yourself self-care either. If you’re going to support them with your best efforts, it’s crucial that you stay in-touch with your own mental health. Remember the point I made about compassion earlier? Well, compassion isn’t easy. If you’re not in the right headspace, you just might end up breeding resentment and causing friction. By focusing on your own well-being and reaching out for support, you’ll be in a far better position to help them when they are finally ready to receive your support.

You’re not alone. Many others have loved ones with the same addictions. Many others face the same painful issues that you face everyday. There are groups out there that will help you cope, and there are resources for you to draw from. All you need to do is reach out to a professional. Visit https://www.promises.com.sg/services/addictions/ to discover what the compassionate people here can do to support you.

  1. Set boundaries

While compassion is key, it is critical that you set limits for yourself and the person you’re supporting. You may instinctively want to shield them from the consequences of their own actions, but doing this only enables their addiction.

What does it mean to enable an addict? Enabling them is turning a blind eye to substance use or the addictive behaviour in your home, because it’s “safer than sketchy places”. Enabling them is covering for them because their “job was on the line”. There will never be impetus for change if you always swoop in to save the day. Setting boundaries may seem harsh and even counterintuitive, but they underpin a healthy, loving approach. Try to also have a frank and open discussion about boundaries, and how they serve everyone’s best interests.

  1. Have realistic expectations

I mentioned the ups and downs of the recovery process at the beginning of this post. So, if there’s only one thing that you should expect going in, it’s that it won’t be a smooth ride! There are obstacles to overcome – they may be in denial about addiction; they may fear the implications of seeking help (e.g losing their job, going to prison); they may feel embarrassed and angry with themselves; they may feel unworthy of help. These are just a few stumbling blocks you may have to navigate at first.

You can nag and harangue them about their addiction, but those words will go unheeded. Most people with addiction use addictive behaviour as a way of coping with stress, so you’ll likely be exacerbating tensions – which drives them to seek refuge in addictive behaviour.

Instead, continue to hold them accountable to the boundaries you’ve mutually agreed to and offer your support in the treatment process. Be prepared if boundaries are crossed, and if promises are broken. Relapses are part and parcel of the recovery process. 

 

  1. Be supportive of their treatment, and don’t forget to have fun

It isn’t only the person with addiction that has to reorient themself for lasting and meaningful change to happen – you’ll probably have to as well. Just as supporting them is tough on you, it’s probably just as hard or even harder for them to overcome addiction. No matter what treatment method they decide to go with, they need to know that you have their back, and that you respect them for it. After all, acknowledging that help is needed is a huge step in itself! In fact, the first step of the twelve step Alcoholic’s Anonymous program is this:

we admitted we were powerless over alcohol—that our lives had become unmanageable.

Milestones (no matter how small) are worth celebrating. This helps keep your loved one motivated and committed to change. Recovery can be scary, so metaphorical hugs (or real ones) can be really reassuring.

People struggling with addiction often experience a decline in physical and mental well-being. Establishing a structured routine that incorporates healthy eating habits and a fitness regime is beneficial. You get to help them replace unhealthy behaviours with new joys and activities, and have fun together in the process!

  1. Remain positive and hopeful

It may seem almost impossible to stay hopeful when you learn that addiction, as a chronic disease, will stick around for the rest of their life. But it is important to remember that addiction is treatable. Addiction feeds off hopelessness, so be careful not to feed it. Regardless of where in the process they’re at, remain optimistic. If proper groundwork has been laid, the only way to go is up. If they have yet to seek help, they are likely to eventually do so with your ongoing encouragement. And if they have already started on their treatment journey, your unwavering support will help them stay committed.

Alternative Depression Treatment: Transcranial Magnetic Stimulation

Alternative Depression Treatment: Transcranial Magnetic Stimulation

Non-Medication, FDA Approved Depression Treatment

Targeted magnetic pulses stimulate brain regions implicated in depression

Depression is a complex and nebulous beast. More than 264 million people worldwide are afflicted with the disease, and you or a loved one might be experiencing the crippling dysfunction of depression. Here’s where TMS comes in. It’s a technology which employs magnetic stimulation of brain activity to treat physiological and neurological conditions, borne out of a need to more effectively treat depression.

Over a decade ago, the United States Food and Drug Administration approved the use of transcranial magnetic stimulation to treat depression.1 Since then, TMS has become the most widely adopted method for brain stimulation, overtaking electroconvulsive therapy and deep brain stimulation. In 2012, a study demonstrated that regardless of the number of antidepressant medications that failed depressed clinical subjects, TMS delivered a consistent rate of response at 60%, and a remission rate of 40%.2 Even if you’ve been disappointed by numerous rounds of antidepressants, there is hope for you yet.

TMS delivers targeted magnetic pulses to the left dorsolateral prefrontal cortex – an area of the brain responsible for establishing positive feelings and inhibiting negative emotions generated by limbic structures such as the amygdalae. In depressed people, it is this part of the brain that shows the greatest sign of weakness or under-activity. Essentially, the precept of TMS is to stimulate neuronal activity by inducing an electric current in the prefrontal cortex.

So, you might well think of TMS as exercise for your brain – helping it achieve ‘balance’. During TMS therapy, which lasts for forty minutes a session every weekday for four to six weeks, there’s very little you actually have to do. The clinician might ask that you do some questionnaires to help him gauge the efficacy of the treatment and the extent of your depression, but that’s about it. All you have to do is sit in a chair alert and awake, and possibly make some small talk – if you are so inclined. When the electromagnetic coil fires, you’ll hear a series of clicks and there’s a small chance you may experience slight discomfort (think mild headache), but your clinician will have some aspirin ready.

As TMS is a non-invasive, non-drug therapy, you won’t have to muddle through the litany of possible side effects that come with antidepressant medication. Nor will you have to subject yourself to electroconvulsive therapy (inducing a medically controlled seizure while you’re under general anaesthesia). TMS is a remarkably well-tolerated procedure with benign side effects. In fact, it’s safer than current antidepressant medication – the seizure rate of TMS is 0.001%, compared to antidepressants’ 0.1% (a conservative estimate). You’d be a hundred times safer. Treating depression with medication is often an inexact science – trial-and-error, hit-or-miss. Drugs interact with your entire physiology. Unintended consequences and attendant side effects are part of the territory. In contrast, TMS interacts with the targeted area of your brain only, tapping into the network of its electrical circuitry. The markedly low number of side effects3 which can occur during TMS compared with drug therapy means it is a rational, sensible choice if your antidepressant medication isn’t working – there’s no need to complicate your mental health journey with another stressful round of antidepressants and their consequences.

 

The side effects of anti-depressants are numerous.

TMS isn’t just used to treat depression. Since the pulses can target different areas of the brain and the configuration of those pulses adjustable (scientists have discovered that modulating pulse frequencies has an effect on the change in neuronal activity), it stands to reason that it will show promise for treating other physiological or neurological conditions. In fact, TMS has catalysed a wave of clinical trials around the world that explore its efficacy in diverse disease states including autism, epilepsy, migraine, tinnitus, stroke recovery, schizophrenia, insomnia, Parkinson’s and Alzheimer’s disease.

If you’re considering TMS therapy, our experienced clinicians will work with you to formulate a holistic treatment plan with your values and goals in mind. You can discover more information about TMS therapy and if it’s a right fit for you over at the TMS Singapore website.

1More, A. (2019, August 28). Transcranial Magnetic Stimulator Industry 2019 Global Market Growth, Size, Demand, Trends, Insights and Forecast 2024. Retrieved from https://www.marketwatch.com/press-release/transcranial-magnetic-stimulator-industry-2019-global-market-growth-size-demand-trends-insights-and-forecast-2024-2019-08-28

2Carpenter LL, et al. (2012). Transcranial Magnetic Stimulation (TMS) for Major Depression: A Multisite, Naturalistic, Observational Study of Acute Treatment Outcomes in Clinical Practice. Depression & Anxiety 29(7):587–596.

3Janicak, P.G and Dokucu, M.E. (June 2015). Transcranial magnetic stimulation for the treatment of major depression. Neuropsychiatric Disease and Treatment. 2015:11, pp 1549-1560