Depression Archives - Promises Healthcare
ENQUIRY
Managing Grief

Managing Grief

There isn’t consensus in the scientific community about whether Kubler-Ross’ five stages of grief is rooted in empiricism. Although much vaunted in popular culture, if you’ve experienced grief and resolved it in your own way, you’ll know that grief is an organic process that is by no means neat or orderly. It’s deeply unique to each individual, and this article is designed to hopefully help you through whatever loss you have experienced in the recent past.

The five stages of grief, which Kubler-Ross first postulated that terminally ill patients experience are: Denial, Anger, Bargaining, Depression and Acceptance. Denial in this context encapsulates a perfectly normal response to a tragedy, and is exactly what you would imagine – it’s simply a refusal to believe that “this bad thing is happening to me”. After reality sets in, and the sobering realisation that the tragedy has occurred is impossible to ignore, Kubler-Ross observed that people often display frustration, which culminates in Anger. Once that Anger has dissipated, people often move on to Bargaining, which is the hope that they can somehow extricate themselves from their dire straits and obtain the balm of a different circumstance. Notwithstanding the success of the earlier bargain, Depression follows, which is self-explanatory. The final stage of Acceptance is the sanguine realisation that nothing will change their situation.

If you are currently going through your own grief and taken a step back to evaluate how you are processing it, you might have noticed some incongruencies between the model and your experience. That’s perfectly natural because there has been some criticism levelled at the Kubler-Ross model in that there is confusion over description and prescription. This means you shouldn’t take it as a rule, no, or feel inadequate or “bad” that you aren’t “properly” grieving. We hope that what follows in this article will provide you with some breathing room to let your grief take its own course, and helps you handle a tragedy with the right tools.

Grief is a loss. It’s your prerogative to define what grief is to you, and even something as banal as losing a cherished item from your childhood can precipitate feelings of loss. So, you shouldn’t wall up these feelings behind what society has proscribed as appropriate. We’re talking about you here, not anyone else. It bears repeating that your grief is unique because of a multitude of factors, for those of you who don’t want to accept that it is your right to give yourself the breadth to grieve – your upbringing, your culture, your faith, your parents, the list is endless. So give pause and slip into your own rhythm of grieving.

To help ensure that you do not slip into the common fallacies that can disrupt your grieving process, we’re going to list some of the pitfalls that ensnare people and prevent therapeutic processing of grief. 

1) If you don’t show an outward display of grief such as crying, you aren’t “sad”

Just like the shortcomings of Kubler-Ross’ model, while crying is seen as a “socially acceptable” way of demonstrating sadness, it isn’t applicable to everyone. You may have been brought up to avoid tears at all costs, perhaps due to tough parenting or some childhood trauma, or you may not wish to “affect” others with your grief. No matter the reason, you should know that physiological responses to grief vary widely depending on your circumstances. Shock, numbness, anger, even hysterical laughter – just about anything is permissible in the initial, very private stages of your grief. 

2) If you don’t “get over it” within an “acceptable timeframe”, you aren’t good enough

Although your family members or people in your community may react to and resolve their grief earlier than you, you need to know that it is by no means healthy to affect the fragility of such a process by introducing the pressures of comparison. Some people simply have better coping-skills than others or are more inured to unhealthy thought processes that hold them back from the therapeutic management of their grief.

3) You feel like you need to “protect” loved ones from your grief, so you turn inwards

We keep emphasizing that grief is individual to everyone – this should tell you that there is no circumscription to how you handle it. Even though it might feel selfish to display your feelings openly because you think less emotionally able loved ones shouldn’t have to deal with your pain, remember that there is nothing shameful about the old adage, “Shared joy is double, shared sorrow is halved”. 

There are some simple coping mechanisms that you can use to help yourself through the process. Although the low mood is a given after the heartache of a tragedy or loss, and you might not feel willing or able to pick yourself up and carry on, remind yourself of the wisdom of eating and sleeping right. Drugs and drink might seem the most accessible ways to insulate yourself from poor mood, but these indulgences, in the long run, are hindrances to sustaining your mental well-being.

If you feel like the person you have lost needs to be remembered, you can do so in the solitude of creative expression, or you can choose to gather loved ones to laugh about cherished memories. If there’s one scenario where laughter in the face of loss is wholly acceptable – here it is! Whether communal or solitary, there are many ways you can raise someone up in loving memory – honouring them and helping yourselves. 

Find solace in your old routines. If you’re hurting after the failure to gain acceptance into a school of your choice, it may help to remember all the things you did well before that gave your life meaning and structure. At the worst of times, it helps to fall back on old patterns if only to hang on to some stability.

Lastly, know that there is a difference between clinical depression and the normal response to grief. You should be aware of critical signs or symptoms in both yourself and your loved ones that may indicate depression. For example, if you notice that your loved one isn’t eating or sleeping properly after a long period of time, or is displaying reckless tendencies such as driving dangerously or overindulgence in addictions, it may be time to seek professional help. Although many people can get through grief without the help of a mental health professional, when it all gets too heavy to handle, you may consider seeking grief therapy. Some of our clinicians are specifically trained in grief therapy, such as Joachim Lee or Winifred Ling.

 


Photo by Claudia Wolff on Unsplash

Mental Health Awareness Panel Discussion feat. Dr Rajesh Jacob & S C Anbarasu

Mental Health Awareness Panel Discussion feat. Dr Rajesh Jacob & S C Anbarasu

On May 16th 2020, Dr Rajesh Jacob, Senior Consultant Psychiatrist & S C Anbarasu, Senior Clinical Psychologist, were invited to be a part of a Public Education Talk: ‘Mental Health Awareness Panel Discussion’ by the ‘Migrant Workers Singapore’  group – a migrant workers community platform.

The discussion touched on a wide range of Mental Health conditions that they are concerned over; explained what they are and how one could cope or be a support.

We encourage you to hit the ‘play’ button to view the video.

 

Mental Health Awareness Panel Discussion

So if you feel anxious, depressed, stressed, or even suicidal? What can you do? Too many people suffer in silence and don’t seek help! Come join a conversation about mental health issues! Our experienced panel will consist of mental health professionals from various disciplines, a Senior Consultant Psychiatrist, Senior Clinical Psychologist from Promises Healthcare Clinic, and an Assistant Head of a Family Service Centre! The panel will be moderated by Casework Manager of SG Accident Help Jevon Ng, an advocate for mental health and wellbeing. Our panel members all have a lived experience of mental health and will be answering questions from the audience.audience participation is encouraged. Please click the link below to join the webinar: https://us02web.zoom.us/j/83397902082Date: Saturday, May 16 2020Time: 4:30 pm – 6:30 pmEvent Categories: Raise Awareness Organizer@Migrant workers Singapore Support by SGcare Physiotherapy Clinic

Posted by Migrant Workers Singapore on Saturday, 16 May 2020

An Interview With Dr. Mark Toh – Coping with Video-Conferencing Fatigue 

An Interview With Dr. Mark Toh – Coping with Video-Conferencing Fatigue 

Dr Mark Toh is a Consultant Clinical Psychologist @ Promise Healthcare.

Is there a reason why these virtual meetings are so exhausting? How is video calling different from face-to-face meetings in terms of mental load?

There have been many changes placed on us as a result of the government’s attempts to create social distancing between one another in response to the threat of COVID-19 in Singapore. For the employed, perhaps the most significant change involves having to work at home instead of working out of our regular workplaces away from home. Accordingly, the necessary attempts to communicate at work have now to be moved online since face-to-face meetings at work have been prevented. The result of having to conduct our regular conversations and discussions previously in the workplace to the online format means that facing the laptop to attend to vocational as well as social in one location becomes the common practice instead. There are certain characteristics of this practice which leaves users of video-conferencing fatigued: 

(a) Previously at a regular meeting often at a conference site, the meetings carry a bigger social bearing. At a virtual meeting, this social bearing is reduced to what is visible only on a screen. Instead of the opportunity to scan the room previously which allows our eyes to adjust and therefore cope with eye strain, virtual meetings mean our gaze is now focused only on what is confined within this screen. We have to stare at this screen and then process everything we hear or see often over a protracted period within a certain frame. As a result, there can be visual overload and mental strain.

(b) Virtual meetings also require more effort than face-to-face meetings. We have to work harder to process non-verbal cues such as facial expressions, the tone and pitch of the voice, and body language. In contrast to face-to-face encounters, virtual meetings require more effort to assess social and personal meaning because of the context. According to Dr Gianpiero Petriglieri, an associate professor of Organizational Behavior at INSEAD, there is a dissonance that emerges during virtual meetings because during this interaction between participants in this format, “our minds are together when our bodies feel we’re not.” This dissonance or disconnection causes people to have conflicting feelings which add to the fatigue. This makes it difficult for people to relax into the conversation naturally. 

(c) Dr Marissa Shuffler, an associate professor of industrial/organizational psychology also describes the fatigue that can come from being watched because the camera is physically and constantly focused on us. In natural social settings, this does not happen. During virtual meetings, people can feel they are on stage and therefore, they feel the social pressure and are expected to perform. The larger the group, the stronger the pressure.

(d) There is also the stress that comes from delays on phone or conferencing systems or when the screen freezes. Glitches in the application of technology put pressure for the participants to ensure that relevant or significant information is not missed out, or to avoid misunderstanding information from what has been communicated. This becomes harder to slow down to clarify when there is a group meeting out of concern that questions could be seen as interference within a tenuous electronic connection.

(e) Visual overload and fatigue that comes from constant online viewing occur not only if meetings are long or frequent with its inherent stresses. The restriction to home has also placed reliance on engaging other activities online, eg. taking classes, ordering food, maintaining social connections outside the immediate family. If there is a practice of over-reliance on the computer screen to attend to other interests, the physical effort to position ourselves at a prolonged period in front of this screen can also create fatigue.  

(f) The strain that comes from virtual meetings can be accumulative when meetings are arranged close to one another. Since the worker is already confined at home, virtual meetings can easily be scheduled one after another. The meetings can appear to be executed efficiently. But there may not be any mental breaks in between.  

(g) Dr Petriglieri also noted that meeting online creates stress from being reminded that the familiar context has been disrupted by the pandemic. We are all coping within a crisis that has taken the lives of the elderly and the vulnerable in society and endangers our well-being. It is also stressful in the fact that we are used to separating different relationships such as family, friends or colleagues. But now they are all happening within the same space. The self-complexity theory posits that individuals have multiple aspects about themselves –context-dependent social roles, relationships, activities and goals–and we find this healthy. When we find this variety reduced, we become disoriented and become more vulnerable to negative feelings. Over a prolonged period of the self-quarantine, he notes the effect: “We are confined in our own space, in the context of a very anxiety-provoking crisis, and our only space for interaction is a computer window.” 

How do you alleviate the exhaustion that comes with virtual meetings? Are you able to share a few tips or suggestions?  

In light of the stresses and strains of increased virtual meetings as outlined, I would suggest the following:

(a) limit the video calls to only what is necessary; this implies that it is important to take breaks from electronic devices, in general, to avoid over-reliance on them and the subsequent emotional effects from excessive use,

(b) allow for the option to turn off cameras on yourself to be involved and/or face the screen off to one side so that you can concentrate without feeling the pressure to be on camera,

(c) plan breaks in between virtual meetings so that the body and mind have a chance for a break, eg. getting the body to move and stretch increases blood flow and reduce mental fatigue,

(d) if virtual meetings are unavoidable and long, learn to practice the 20-20-20 rule: every 20 minutes, takes 20 seconds to look at something 20 feet away. Remember that the electronic devices are our tools and not our master. 

 

What can bosses or organizers of these meetings do to facilitate these meetings so people don’t leave the meetings feeling exhausted? (While taking into consideration, the time spent on these meetings, or the feelings of the attendees)

It may help to start the meeting by quickly checking in to each other’s well-being. Being ready to acknowledge that the virtual meetings are unusual and that working at home means having to accommodate other family members inconvenienced by the pandemic invites everyone to be mindful about coping collectively with the current disruption. Secondly, consider if virtual meetings are the best way to work. To prevent information overload, would sharing files be more effective? Or the use of the phone to communicate may be a better device in many cases if there is only simple information to share. Thirdly, it may help if the meeting agenda is clearly defined and the end of the meeting is outlined at the start to reduce mental fatigue. Can the meetings be brief knowing that other meetings may be required? If meetings are prolonged, plan for breaks.

 

What can attendees/employees do to reduce the number of hours spent on video calls? (for example, what they can say to their bosses, or to keep track of the time so everyone is on track)

There needs to be increased education all around related to this topic of fatigue that comes from increased video-conferencing. It is a condition exacerbated by changes at work because of the pandemic. Employees should know their limits. If they recognize when fatigue sets in from excessive computer use, they should limit themselves from relying on their electronic gadgets throughout the day. Research has already shown that excessive computer use is correlated with depression. With more apps available online, there is an increased potential to become more dependent on electronic devices already. During this pandemic, the pressure to depend on the computer through increased virtual meetings is intensified. It is times like this when the wise among us would learn to separate the benefits of computer use from its downsides.

In light of this knowledge, employees can be more proactive to define the perimeters in which they would like to have virtual meetings conducted. If they recognize when fatigue will set in because of prolonged virtual meetings, they can ask to clarify (or specify) to their managers how long the meetings will take to monitor their mental and physical strain. In cases when prolonged virtual meetings are unavoidable, they can clarify if permission can be given to practice adjustments such as moving around as a way of coping with eye strain or from limited mobility experienced during the meetings, avoid the direct exposure to the camera, mute the calls to focus on listening or take breaks after every hour. At times, a person may have to prepare for any interference from young children who find it hard to ignore the presence of the parent at home.  

 

How do we instil positivity in our working lives, when the line between work and home is so blurred right now?

The pandemic and the subsequent quarantine is experienced as a period of adversity to some people. The emotional distress that comes from being quarantined has been recognized as common during this period. Common symptoms of this distress include fear, sadness, numbness, insomnia, confusion, anger, stress, irritability, post-traumatic stress symptoms, depressive symptoms, low mood, emotional exhaustion and emotional disturbance (eg. paranoia, anxiety). More specifically, people are faced with the disruption to the routines they have set up to cope with their stressors before the imposition of the quarantine. Distress is experienced because of the effect of the disruption on their autonomy, their sense of competence (being in charge of their lives to cope with their lives), their connectedness and their sense of security. It is a test on our resilience and ability to cope.

At the same time, the very challenge of this situation also provides us with the opportunity to develop our resilience. The first step is to understand and remember that these circumstances are temporary and not permanent. Pandemics happen but they are not frequent in history. Secondly, realize that there is a way to cope with the circumstances. As such, coping with this current situation is priority. I would suggest the following:

(a) Establish a routine for yourself (and that of your children). By creating a structure to attend to work and recreation, you start to organize and occupy yourself with addressing your daily needs as well as that of your family.

(b) Be as active as possible to maintain a fitness level physically, mentally and relationally for yourself and with your family. This also helps to battle against boredom. There are exercise videos online which you and your children can participate together to exercise as well as bond together. Also, for a personal project, you can ask yourself, “What will it take for me to become physically and mentally and relationally stronger as a result of this crisis?” Be curious about how to grow your resilience and to nurture the best version of yourself. Or as a parent, create a project to help your child develop resilience in their own lives and ask, “How can I help my children become physically, mentally or relationally stronger as a result of this crisis?”

(c) Deal with boredom by creating projects that self-nurture, eg. start a hobby or clean out your closet. Competing personal tasks provide a sense of purpose and maintain a sense of competency despite the external circumstances. Creating plans daily offer a focus on accomplishing what is important to your well-being.

(d) Communicate more to avoid isolation as well as cope with boredom. This can be an opportunity to nurture relationships if you are in quarantine with family and to strengthen social bonds with them, or with your support group. Remember that kids may be stressed too from this experience. More time together can provide opportunities for increased play to increase bonding. Games are useful means to bring fun into your relationships and to develop socially besides your entertainment. It can also become a reminder that the family is safe and coping together.

(e) Be informed without being overwhelmed to cope with the anxiety that comes from the unknown. The Straits Times newspaper provide a useful daily update so that you can monitor the threat of the virus rather than obtaining information from cable news. There is much information on the virus today locally and globally so be careful not to become obsessed with the topic.

(f) If you find that your distress is becoming more intense, consider support for your mental health. Your mental health is very important for your daily and long-term functioning. Different places may offer telehealth support where you can consult a therapist or mental health professional. Some services are available online and they can be reached through email, phone calls, texts or video calls.

 


Photo by Gabriel Benois on Unsplash

Youth Depression in times of COVID19 Pandemic: How Can We Help?

Youth Depression in times of COVID19 Pandemic: How Can We Help?

Youths these days have a lot on their plate. Teenagers have to cope with the highly competitive education system, and the fresh graduates are worried about employment opportunities or career advancement. Coupled with the need to maintain good relationships with their friends and family, these individuals may be experiencing high levels of stress. Some people do thrive well under stress, but what happens when stress levels exceed the healthy range? For those who are unable to cope, chances are their mental wellbeing would take a toll.  

 

With young people unable to attend school in person regularly or go into the workplace during the circuit breaker, they might have felt increasingly isolated due to the lack of face-to-face social interaction over this extended period of time. Furthermore, having to fight for their own space while at home with their family members may have caused some conflict and frustration for some. Undoubtedly, cabin fever may have also kicked in for some of them. Although circuit breaker measures have recently been eased, youths may not be able to adjust back to the norms as easily as one might expect. Reports have shown that it is expected that more youths will be prone to developing mental health issues such as depression due to the various implemented COVID 19 pandemic coping measures. 

 

Depression is one of the world’s leading mental health disorders, and youths have become increasingly prone to it. Studies have shown that depression affects up to 18% of Singaporean youths. People with depression may turn to self-harm or experience thoughts of suicide. These are often methods they adopt in order to cope with their difficult emotions. According to the suicide prevention agency Samaritans of Singapore (SOS), suicide remains the leading cause of death among youths aged 10 to 29 in Singapore, and as of 2018, 94 of them had succumbed to suicide. In order to curb the rise of depression cases among youths, it is important that we are able to identify the early stages of depression. Doing so will allow them to seek treatment earlier and to help them get back onto their feet. Depression, if left untreated, will severely impact people’s lives in a negative light, causing personal, educational and familial difficulties. 

 

Here are some of the most common symptoms of depression that you should look out for (not exhaustive): 

 

  • Extreme sadness and low mood
  • Lack of interest in activities once enjoyed
  • Lack of self-worth
  • Increased lethargy
  • Experiences sleep disturbances and loss of appetite
  • Poor concentration and impaired memory
  • Sense of hopelessness and helplessness
  • Excessive self-criticism and self-blame

 

If you notice a friend or family member of yours showing such symptoms for long periods of time, perhaps it is time to seek help from a professional mental health expert. 

 

But how can we first better support troubled youths? When it comes to dealing with depression, individuals with mild depressive conditions could adopt self-help strategies such as trying to maintain a balanced diet, to pick up on relaxation techniques, embark on daily gratitude journaling exercises (e.g. 3 things I can be thankful for today) and get some exercise in, even if it’s just a stroll around the estate or exercises from ATHLEAN-X™ or Athlean-XX for Women. Try encouraging them to live a healthy lifestyle and maybe create a ‘Daily Wellness Plan’ – a list of little and big things they can accomplish on a daily basis to comfort and keep their moods up. However, it is key to take note that even though their depression may be perceived to be mild from a third person’s point of view, we should never make assumptions as to what they truly feel on the inside. We should never, under any circumstance, tell them to “snap out of it”. It is very important for us to be patient and listen to what they have to say if they do approach and confide in you. Stay empathetic and show your concern for the individual. Acknowledge and respect their feelings and worries. Listen actively by using active listening skills. Encourage them to join mental health support groups like those conducted by PSALTCare – journeying with others that are going through similar struggles can encourage social healing.

 

On the other hand, for those coping with moderate to severe conditions, we might need to encourage them to seek a multidisciplinary approach to recovery like psychiatric help and look to taking medications, with supporting psychotherapy or counselling sessions and support groups. They might also be afraid of the stigma attached to seeing a Psychiatrist or what would transpire in that session. Try to assure them that there is nothing to be ashamed of. In fact, it is a lot more common in Singapore now, and a trip to the Psychiatrist is as straightforward as seeing your family doctor.  Alternatively, these youths can book appointments for psychotherapy first. With appropriate treatment and support, it is entirely possible for them to move on and lead a more productive and happier life. Here’s a questionnaire that is widely used by Psychiatrists to help determine depression to help you with next steps decisions: www.mdcalc.com/phq-9-patient-health-questionnaire-9

 

If you or anyone you know are struggling and are unable to cope with the post-lockdown blues, we strongly encourage you to get professional help.  Do not hesitate to contact us when necessary. 

 


 

References:

  1. Teen Mental Health: Depression (Accessed 22/05) 
  2. CNA: Under pressure at home and in school, youths battle depression (Accessed 22/05)
  3. Photo by Yuris Alhumaydy on Unsplash