In an article titled “Drug syndicates get crafty as supply disrupted, prices spike”, Andrew da Roza, addictions therapist at Promises Healthcare, told Straits Times reporter Zaihan Mohamed Yusof that “anecdotally”, the costs of illegally imported prescription medication and illicit drugs have risen, “although supplies appear to be available”. Mr da Roza goes on to say that he has noticed that some drug addicts are managing withdrawal symptoms and cravings by substituting their drugs of choice with alcohol, new psychoactive substances and over-the-counter medication. The article also mentions that people may seek alternative methods to obtain illicit substances as supply chains are disrupted – such as turning to the Dark Web to get their needs fulfilled by mail.
It wrote that we (Promises) have seen a 25% increase in visits to the clinic “because people are having a harder time managing compulsive behaviours such as substance abuse, smoking and gambling during the circuit breaker period.”
If you are having trouble managing an addiction, you should know that Promises Healthcare has kept its doors open all through the pandemic in service of promoting mental health. Further, in keeping with social distancing measures, our clinic is also offeringteleconsultations in place of regular visits. Support groups have also moved meetings online, which are going ahead as scheduled – on platforms like Zoom instead of physical gatherings. Do contact us for more details.
Episode 7 of En Ullae S2 is a harrowing tale of Ramesh’ descent into utter despair due to his alcohol addiction. After the lilting trill of a happy alcohol buzz wears off, people in the throes of addiction often experience a sense of bitterness and desolation. It’s an artificial stimulant that when consumed, releases endorphins, neurotransmitters that promote a feeling of euphoria and help reduce stress.
Some instances of alcoholism are undergirded by an anxiety disorder, according to Dr Rajesh Jacob. He posits that people attempt to “treat” symptoms of anxiety by self-medicating with alcohol, ameliorating the discomfort of social situations through chemically induced disinhibition and happiness. They become chattier, and won’t choke during conversations – an alluring prospect for chronically anxious people.
Ramesh, now advanced in age, wistfully recounts how he fell into alcoholism. At 15, he and his friends would entertain themselves with drinks and idle chatter at a ‘kopitiam’, a Singaporean colloquialism for ‘coffee-shop’. Dr Jacob reminds us that despite being a stimulant, long term alcohol abuse invariably leads to depression or anxiety. Alcohol addiction can stem from a variety of factors – from the ‘angry, drunk father’ to early over-exposure to alcohol, and everything in between. Hassan Mansoor, a recovering alcoholic, confesses that his first foray into Bacchanal pleasure was during his secondary school years(junior high) for you Americans). He doesn’t remember the time with rose-tinted glasses, though – his adolescent years were marked by incessant violence, physical altercations and poor academic performance. He’d thought it made him look “cool”. Beer, whiskey, “Boon Kee Low”, “Paddy”, its name derived from its roots as a rice wine, and “Deer”. All of them cheap highs.
We’re then treated to a vignette in which a listless Ramesh, rake thin, gets into an argument with his doe-eyed girlfriend over whether wine should be drunk at lunch. Both of them are adamant that they hold the moral high ground – Ramesh, with his insistence that wine is “not hard liquor”, and Reena, with the awareness that his alcoholism is ruining not only their relationship but himself. We learn that the long-suffering Reena has tolerated Ramesh’s equivocations and excuses for four years, and she’s at the end of her tether.
(Click on the link for a version with English subtitles. Remember to click on the ‘Settings’ button to reveal the English subtitle selection. https://www.mewatch.sg/en/series/en-ullae-s2/ep7/954631 ) Dr Jacob explains that genuine awareness of an alcohol problem can only legitimately come from within, and external criticism is met with a wall of anger and irritation. In the early stages of alcohol addiction, one usually does manage to induce some level of happiness. As the disease progresses, drinking no longer “feels good” and chemical dependence means that consumption is imperative to avoid withdrawals. Alcohol withdrawal symptoms include hand tremors, which can set in as quickly as 4 – 6 hours from the last drink, insomnia, anxiety, psychological cravings, palpitations and sweating. Alcohol addiction is a vicious cycle, according to Dr Jacob.
Most people suffering from alcohol addiction start off with social drinking, which isn’t a problem in itself. However, addiction is a chronic, progressive disease which Dr Jacob measures with three factors of varying severity: drink frequency, duration of drinking, and cravings. Ramesh admits that his family life and relationships suffered. Getting blackout drunk was a nightly affair, which left his wife paranoid of his infidelity, when in fact he was unconscious in a ditch somewhere. He wouldn’t remember the events leading up to the loss of consciousness, a form of anterograde amnesia. Eventually, his wife takes out a Personal Protection Order (PPO) against him, the Singaporean variant of a restraining order.
The spiral into full throttle addiction isn’t a pretty sight. Just being in the presence of his drinking buddies would catalyse a night of binge drinking, invariably followed by a hangover in the morning made all the more unbearable by guilt over the slow rot of his cherished relationships. Work performance suffered, many a medical certificate was sought, culminating in joblessness.
Dr Jacob explains that addiction leads to productivity impairments at work. A sure sign of dependence is the need for a drink in the morning to curb tremors and imbibe him with enough energy to perform as a barely functioning alcoholic. Day drinking and surreptitious alcohol breaks are common. When in active addiction, one’s happiness (in the form of craving relief) takes precedence over that of others, and empathy goes out the window. Ramesh is reduced to a pitiable state, cajoling once close friends to spot him the occasional tenner – in their eyes, he is reduced to a shadow of his former self. Now jobless and without an income, he burdens his children with the restitution of his loans – he is now too functionally impaired to perform any meaningful work. His wife is now the sole breadwinner, and the guilt in his voice is apparent, even today.
Ramesh only manages to stop drinking for some length of time at 48 due to chest pains. After a successful heart bypass, he turns to drink again. Then comes the second bypass, which he sullies with an infection brought on by his inveterate drinking. Alcohol and heart medication should not be taken together, but his addiction blinds him to a sanguine truth. It is only after last-ditch surgery is performed that he cultivates some restraint, managing to abstain from drink when he recuperates for a month in the hospital. He is 68 when he finally gets into recovery.
All manner of physical ailments accompanies alcohol addiction. “From the head to the feet”, Dr Jacob says. The brain is atrophied such that fits, falls, bleeding, subdural hematomas and dementia become common. Liver cirrhosis brings about jaundice and bloody stool. Peripheral neuropathy, a feeling of pins and needles in the hands and feet arises from damage to nerves outside the brain and spinal cord. Even sexual performance suffers. If diabetes is comorbid, the body becomes much poorer at sugar control.
Dr Jacob recommends a ‘biopsychosocial’ model for treating alcohol addiction. “Bio” refers to medical treatment in the form of total abstinence (detoxification) and medication. “Psychosocial” refers to psychological counselling to treat addiction, medication to reduce cravings, and therapy sessions with the family. In short, a treatment model that aims to target likely risk factors for relapse.
Nobody takes their first drink and thinks, “This’ll be the death of me”. Fortunately, if people suffering from alcohol addiction take a step back and consider their mind, their physical body, and their loved ones, and combined with proper support and therapy, recovery is possible.
This episode of En Ullae touches on psychosis. This case study was about a man who had developed schizophrenia and became obsessed with the ‘spiritual safety’ of his partner. The building tension served to demonstrate the dangers of ignoring the symptoms of psychosis, which his partner was predisposed to do, in her untoward position as the long-suffering partner in a dangerously unstable relationship. Dr Jacob characterised psychosis as rooted in an unshakeable belief in false delusions – people who suffer from the condition are often willfully blind to reason, which he cautions against trying to impose on them when the time is inclement.
Prem, the unfortunate man with all the symptoms of hallucinatory schizophrenia, began to cast an evermore imposing spectre in the relationship, causing much distress to Rani. His delusions began to take such a toll on their relationship, with even the good tidings of a baby in the oven twisted into a string of abortion by Rani, afraid that he would bring harm to her and any prospective child she would bequeath upon them – he professed to see the child as a harbinger of doom, as the embodiment of the devil. Midway through the episode, the viewer is treated to the appearance of two ambiguous personalities – a man and a woman, whose blue lanyard faintly conveyed some sense of authority. We are left uncertain as to their actual responsibilities – they are at times quizzical, unwilling to manifest the “good cop, bad cop” trope. No matter, it is not the point of the episode to further entangle the convoluted plotlines – they serve as plot devices which encourage Prem’s own narrative to unfold – to the end, he remains stolidly convinced that his stabbing of Rani had taken her to a better place, the expression on his face almost beatific at times.
Dr Jacob, at this point, sees fit to caution the viewer against harshly attributing homicidal tendencies to persons with psychosis. He presents the statistic that even less than 15% of homicides are perpetrated by people mentally unsound. Noting the prevalence of drug use and antisocial tendencies that colour this 15%, he confidently steers the viewer away from making too quick a conclusion – it is in everyone’s best interest to step back and evaluate statistics grounded in good science, instead of leaping to the easy conclusion that Prem was beyond rehabilitation.
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.
Amongst lawyers, one of the leading causes given for mid-career abandonment is burnout. Promises Healthcare partnered with the Law Society of Singapore for a two hour professional development seminar aimed at addressing this issue by providing legal professionals with practical stress management strategies.
The President of the Law Society, Mr. Gregory Vijayendran, delivered the opening address to an eager crowd stating, ‘Burnout is one of the elephants in the room that we (legal professionals) need to address…Today we will talk about it.’
Dr. Munidasa Winslow, Executive Director and Consultant Psychiatrist at Promises Healthcare, shared an engaging and thoughtful presentation. He outlined why lawyers are so prone to burnout, how they can identify the early warning signs, and how to prevent burnout. Dr. Winslow also spoke about how lawyers in the areas of family and criminal law can develop compassion fatigue and suffer from vicarious traumatization.
Mr. Paul Seah, Senior Partner at Tan Kok Quan Partnership, presented ten key points on how lawyers can create work-life balance. He touched on generational differences, particularly among millennials and senior lawyers, and encouraged young professionals to identify their priorities and set their boundaries firmly to avoid burnout.
Here are some key takeaways from the seminar:
Burnout is a serious problem that can lead to adverse physical and mental health and has a detrimental impact on families, relationships, friendships, and careers.
Whilst stress is a part of everyday life, high levels of chronic stress will lead to exhaustion and burnout.
Prevent burnout by engaging in active self-care on a daily basis.
Being willing to seek help is not a weakness but a sign of strength, self-respect, and professionalism.
The responsibility for preventing burnout falls on individuals as well as the organization in which they work. Individual changes should be supported by changes in workplace culture led by senior management.
Contact Promises Healthcare if you or your organization would like to learn more about navigating professional burnout and managing stress. We provide individual training, employee assistance programs, as well as workshops and seminars for groups.
Although society has made some headway in reducing the stigma and misinformation about general mental health issues, the public’s understanding of self-harm remains decades behind. Let’s debunk some common myths about adolescent self-harm.
Myth: ‘Self-harm means cutting right? Only emos and goths do that.’
Self-harm refers to a range of behaviours that are purposely inflicted to cause damage to the body. It can include cutting, but also refers to scratching, picking at wounds, burning, pinching, hitting, head banging, and minor overdosing. Self-harm can also be in the form of excessive risk-taking that is above and beyond typical adolescent risk-taking.
It is a misconception that only ’emos’ and ‘goths’ self-harm. Although self-harm can be part of adolescent subculture experimentation, it is more often a sign that a teenager is experiencing unmanageable distress. Self-harm becomes a way of coping with distress that provides temporary relief from emotional pain.
Myth: ‘Self-harm is all about attention-seeking. If a person was really depressed enough to cut themselves then they would probably just commit suicide.’
Self-harm is not about attention-seeking. It is often a secretive and private behaviour. For a teenager, self-harm is a way of coping with unmanageable distress, and can be a medium to communicate that distress to others. Self-harm should never be dismissed as attention-seeking.
A person who cuts themselves is not necessarily suicidal. Cutting behaviour can be suicidal, non-suicidal, or a mix of both. It is important to remember that suicide risk is not static. A teenager who displays non-suicidal self-harm can become suicidal at another point in time.
Myth: ‘I can punish my teen so that they stop self-harming. That will solve the problem.’
Punishing a teen for self-harming does not solve the problem. Cutting is a symptom of a deeper issue – unmanageable distress. Stopping the cutting via punishment may actually worsen their distress, especially if the teen lacks healthy and effective coping strategies.
Here are some suggestions for what you can do instead of punishing your teen:
Written by Leeran Gold, Psychologist in our Forensic Service.
At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life and find renewed hope. If you or someone you know needs mental health support, please contact our clinic for inquiries and consultations.
For after-hours crisis support contact your local mental health service or emergency services.
In Singapore: IMH 24-hour helpline +65 6389 2222, Ambulance 995.