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Chronic Stress Management: Why Am I Feeling Exhausted All The Time?

Chronic Stress Management: Why Am I Feeling Exhausted All The Time?

Are you feeling tired most of the time despite having a good night’s sleep? Are you constantly feeling low energy and unproductive? These are just a few of the typical symptoms pointing towards unhealthy levels of stress. Constantly feeling worn out could be an alarm that your body is sounding – a message that it is overwhelmed and unable to keep up. Undeniably, we often put ourselves in a constant heightened state of alertness, especially in such a fast-paced society. Our sources of stress may differ, from high-pressure jobs to challenging and taxing relationships. Stress affects everybody – even if you may not be physically attending to any particular concern, allowing it to occupy your mind frequently and fretting over it can contribute to chronic stress. Without proper management and control, chronic stress puts pressure on the body and will ultimately wreak havoc on your physical and mental health.  

 

As a natural biological response to demanding circumstances or situations, our body releases hormones such as cortisol, a stress hormone. Alongside adrenaline, cortisol helps to fuel your body’s ‘fight-or-flight’ instinct whenever a crisis surfaces. A stressor may be a long term one, such as the routine stress related to the pressures of school, work, family, and other daily responsibilities, or short-term occurrence brought about by a sudden change, such as losing a job, illness, or facing dangerous situations. In an ideal situation, when an individual faces a trigger, the adrenal glands in the body secrete cortisol and a complex hormonal cascade ensues, preparing the body for the ‘fight-or-flight’ response. Following that, cortisol inhibits the production of insulin in order to increase the uptake and usage of glucose so that more energy is made available to the surrounding muscles. Arteries will also be narrowed, increasing the heart rate and forcing blood to be pumped harder and faster around the body to help you confront the immediate threat. Once the individual resolves and addresses the situation, negative feedback kicks in and hormonal levels will then fall back to the norm. 

 

With this said, when we are constantly under high levels of stress, our alarm system doesn’t turn off. This means that our body is continually in high-gear and cortisol levels will remain high, to the point where it becomes harmful. Small doses of cortisol are safe, and in fact, is important for your health as it also serves to regulate your metabolism and blood sugar level amidst other key functions. However, in the case of chronic stress, constantly high levels of cortisol take a toll on your body’s resources, leaving you exhausted. Over time, continued strain on your body from stress may contribute to serious health problems. Hence, there is a need for us to tackle the root of the problem and ensure that we manage our stress levels to reduce the risk of negative health effects.

 

You might have been advised to change your lifestyle for the better at least once in your life by a family member or a friend – and we cannot stress this enough. It is essential that you learn to live a healthier lifestyle, which includes stress reduction and learning to manage your hectic schedule. If you continue to live an overly-demanding way of life, it is highly likely that you may succumb to chronic stress or worse, other mental health issues such as anxiety or depression. Moreover, can you imagine how hard your adrenal glands will have to work in order to continue producing sufficient stress hormones? Needless to say, the high cortisol levels will also impact your physical health and lead to other conditions such as digestive problems, high blood pressure or sleep issues. This results in a vicious cycle – with less sleep, the more exhausted you feel. 

 

Working on stress reduction can be as easy as doing deep abdominal breathing exercises, and incorporating meditation. Schedule regular times for these and other healthy and relaxing activities. They are simple, cost-effective, and are readily available. In this highly technological age, there are many applications available on your devices to further assist you in such activities as well. On the contrary, if you feel that you aren’t quite the kind to sit down and meditate, you can also opt to do some physical exercise to help boost your mood and improve your health. Organising activities with your friends such as playing a game of badminton or volleyball can help you to keep your mind off things, and at the same time, seek the social support you need when necessary. Of course, exercising alone is perfectly fine too, the main point is that exercising produces endorphins – chemicals in the brain that help alleviate stress by acting as natural painkillers.

 

Watching what you ingest is also equally important. For example, for heavy coffee drinkers, try to cut down on caffeine. Although the threshold for caffeine might differ for every individual if you notice that your excessive caffeine intake is making you jittery or on the edge, consider cutting down on it. Instead, you may want to replace it with other beverages that have a calming effect, such as chamomile, lavender or peppermint tea. Drinking a cup of warm milk before bed can help you get a better night’s sleep too. In addition, you might want to consider eating foods such as avocados, which are known to offer omega-3 fatty acids that can help reduce stress and anxiety. However, we should always remember that everything should be consumed in moderation. 

 

Last but not least, learn to say no, and only commit to responsibilities that you can cope with! Although not all stressors in your life are within your control, some of them are. It is crucial that we manage what we have on our plates, and not bite off more than we can chew. Try to be mindful of what you have accomplished at the end of the day, not what you have been unable to do. Juggling many responsibilities at once can leave you feeling disheartened and overwhelmed, and this increases your stress levels unnecessarily. 

 

Sometimes, despite numerous efforts at self-help, some individuals may still find it hard to cope with their high levels of stress. If you are overwhelmed by stress, ask for help from mental health professionals, as therapy is also a way to help you navigate through and overcome your stress. 

 


References:

https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response (Accessed 01/07/2020)

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The link between Anxiety and Alcohol Use; and Implications for Treatment and Early Intervention Especially In Youths

The link between Anxiety and Alcohol Use; and Implications for Treatment and Early Intervention Especially In Youths

Alcohol. A beverage that many people enjoy drinking; be it for socialisation or as an escape from reality. However, it is also a beverage that can harm your health and adversely affect many lives. Indeed, alcohol abuse has become increasingly rampant, where it is one of the leading causes of disease and death, with 5.3% of all global deaths and over 200 diseases and injury conditions resulting from the harmful use of alcohol. Worryingly, it is also a phenomenon that has affected Singapore, with 9.6% of Singaporeans engaging in binge drinking (as of 2016) and an increasing number of Singaporean young adults battling Alcohol Use Disorders (AUD). As such, alcohol abuse has become a growing cause of concern.

There are many reasons why alcohol consumption is increasing. Alcohol consumption has been perpetuated by the media in recent years, with an increase in advertising and marketing of alcohol. For instance, in Australia, people are exposed to about nine alcohol televised advertisements every month. In turn, exposure to such advertisements causes alcohol consumption to be glorified and promoted, where people have unrealistic positive expectations towards alcohol, believing that it boosts one’s mood and invokes cheerfulness and confidence. Additionally, alcohol consumption has also increased due to peer pressure. Be it a work engagement or partying with friends, people often find it hard to say no to alcohol, as that rejection may cause disapproval among colleagues or friends. Thus, many people engage in risky drinking behaviour to socialise and develop their relationships.

However, a more significant reason behind alcohol consumption is feelings of anxiety or having anxiety disorders. People with anxiety disorders have 2 to 3 times the risk of having alcohol use disorders (Smith & Randall, 2012). Many people tend to use alcohol to reduce social anxiety, as they believe that alcohol is an excellent aid to speak up and gain more confidence around others. Similarly, people use alcohol as a form of self-medication to overcome anxiety symptoms and stress, relying on it as a coping mechanism. However, contrary to popular beliefs, alcohol exacerbates rather than alleviates anxiety symptoms. This worsened anxiety makes them drink more and have more alcohol-related problems, which causes further anxiety and stress.

Alcohol abuse also causes anxiety. Drinking alcohol builds a tolerance to de-stressing effects of alcohol. This creates a temporary sense of relaxation but later leads to feelings of depression and anxiety. This is because the prolonged use of alcohol can act as a stressor and activate the body’s stress response system, changing neurotransmitter levels in the brain and causing an increase in stress and anxiety. As such, alcohol can worsen anxiety symptoms.

Therefore, anxiety and alcohol abuse tend to fuel each other in a vicious feed-forward cycle of co-occurring addiction and anxiety, which is difficult to break out from. As such, integrated treatment for both anxiety and alcohol use should be readily available.

Treatment

There have been existing parallel or subsequent attempts to treat both anxiety disorder and AUD (i.e. treatment for anxiety disorders first, followed by AUD). However, studies have found that parallel treatments have caused worse alcohol outcomes compared to just seeking one treatment. This is possible because the cognitive load of receiving two separate treatments may be confusing or overwhelming for people, causing them to feel anxious or turn back to drinking as a coping mechanism. As such, these type of treatments causes a “co-morbidity roundabout”, which is a metaphor of mental health problems resurfacing when attempting to tackle substance disorders (and vice versa), thus failing to break out from the vicious cycle of these co-morbid disorders. Therefore, it is clear that both anxiety disorder and AUD are inter-related issues, and an integrated treatment approach is vital to tackle both disorders.

Stapinski et. al. (2015) carried out an integrated treatment for comorbid social anxiety and AUD, where participants undergo both Cognitive Behavioural Therapy (CBT) and motivational interviewing. Moreover, it involves core components such as building coping skills, developing alternative reinforcers and preventing relapse. This provides participants with useful skills such as enhancing social support networks, correcting misconceptions towards the benefits of drinking, reducing avoidance of social situations and developing healthy coping skills to manage triggers for drinking or anxiety.

This study took place over ten 90-minute sessions, where 117 participants with both social anxiety and AUD took part in this study. 61 of the participants received integrated treatment (both AUD and social anxiety) and 56 of the participants received treatment for AUD only. Results showed that both treatments enabled a great reduction in alcohol use and dependency. However, participants that underwent the integrated treatment were observed to have a greater decrease in social anxiety symptoms and a greater increase in overall quality of life. More importantly, these results remained constant even after a 6-month follow-up. This means that integrated treatment has long term effects on overall functioning and quality of life.

Early Interventions

While the above has proven that integrated treatment is indeed useful in overcoming social anxiety and AUD, the road to recovery is a long and arduous journey, where there are a lot of physical and mental challenges suffered by both the clients and their families. Hence, these issues could be more easily overcome or even avoided if there are early intervention and support to at-risk youths.

Over the years, the number of youths drinking alcohol has increased. According to the Avon Longitudinal Study of Parents and Children (2004), the number of youths that engage in binge drinking increase tremendously between the age of 18 and 21 (from 18% to 35% respectively). Furthermore, 18-year-olds who drank alcohol as a coping mechanism or who had anxiety disorders were 1.8-3.8 times more likely to drink. Both groups had a greater risk of transitioning from low-risk alcohol use at age 18 to high-risk alcohol use at age 21.

There are many motives that may drive youths to drink alcohol. A primary reason is that youths are at a phase where they are transitioning to adulthood. Adulthood brings more stress and anxiety due to changes such as new relationships; along with new responsibilities and challenges such as living in a dormitory and budgeting. Additionally, this phase of life also provides youth with more autonomy and drinking opportunities (e.g. clubbing, drinking games). With these drastic changes in life, youths often drink to enhance positive moods, socialise with others, conform to social groups, or as a coping mechanism to overcome stress or anxiety. This causes harms associated with alcohol to peak in early adulthood, emphasising the importance of early intervention to avoid these detrimental consequences.

An ongoing programme called “Inroads Study” (Stapinsky et. al., 2019) aims to provide early intervention to youths with anxiety disorders and AUD. It seeks to enhance anxiety coping skills and address coping-motivated drinking. Moreover, this programme is specially tailored to make it more relevant and appealing to youths. This includes making the programme available online, which is preferred by youths as it is more convenient, affordable and reduces stigma. Participants can freely access online therapy sessions and modules about tackling challenges often faced by youths. Thus, such interventions can address the interconnections between anxiety and alcohol use, as well as reach out successfully to youths in a relevant and appealing manner.

Prevention programmes are also forms of early intervention that may benefit younger youths (i.e. 13- or 14-year-olds) that have a ‘high-risk’ of developing substance disorders, even if they do not currently have a substance disorder. It is vital to identify early onset of problems faced by youths and nipping them in the bud, providing them with early support and teaching them relevant life skills. This prevents problems faced by youths from developing into more severe adulthood problems such as substance disorders, chronic mental health problems and delinquency.

One such prevention programme was organised by Edalati & Conrod (2019), who first identified at-risk youths through the Substance Use Risk Profile Scale; where those with higher levels of certain personality traits (e.g. sensation seeking and negative thinking) were at higher risk of abusing substances before the onset of use. Afterwards, these youths attended coping skills workshops, CBT and motivational interviewing.  Results showed that the programme proved effective in reducing alcohol use, alcohol-related harms and emotional and behavioural problems (i.e. symptoms of anxiety and depression). This shows the importance of early intervention and prevention programmes.

In conclusion, it is apparent that there are interconnection and the longstanding link between anxiety and alcohol use, where this co-morbidity can cause huge effects on one’s physical and mental wellbeing. Thus, this raises the importance of integrated treatment, allowing both conditions to be resolved at the same time. Furthermore, early intervention is extremely vital to offer support to youths and prevent potential disorders from occurring. More importantly, all this shows that alcohol is not the answer to relieve stress and anxiety, and can only serve to exacerbate rather than resolve our problems. Thus, such action could be done to reduce excessive alcohol use in our society, such that harmful usage and effects of alcohol could be prevented.


 

References:

https://www.mentalhealthacademy.co.uk/dashboard/catalogue/the-link-between-anxiety-and-alcohol-use-implications-for-treatment-and-early-intervention

Smith, J. P., & Randall, C. L. (2012). Anxiety and alcohol use disorders: Comorbidity and treatment considerations. Alcohol Research: Current Reviews, 34(4), 414–431.

Stapinski, L. A., Rapee, R. M., Sannibale, C., Teesson, M., Haber, P. S., & Baillie, A. J. (2015). The clinical and theoretical basis for integrated cognitive behavioral treatment of comorbid social anxiety and alcohol use disorders. Cognitive and Behavioral Practice, 22(4), 504–521.

Golding, J., & ALSPAC Study Team (2004). The Avon Longitudinal Study of Parents and Children (ALSPAC)–study design and collaborative opportunities. Eur J Endocrinol. 151, U119-U123.

Stapinski, L., Prior, K., Newton, N., Deady, M., Kelly, E., Lees, B., Teesson, M., & Baillie, A. (2019). Protocol for the Inroads Study: A Randomized Controlled Trial of an Internet-Delivered, Cognitive Behavioral Therapy-Based Early Intervention to Reduce Anxiety and Hazardous Alcohol Use Among Young People. Journal of Medical Internet Research, 8(4), 1-14.

Edalati, H., & Conrod, P. J. (2019). A Review of Personality-Targeted Interventions for Prevention of Substance Misuse and Related Harm in Community Samples of Adolescents. Frontiers in psychiatry, 9, 770.

https://www.who.int/news-room/fact-sheets/detail/alcohol

https://www.straitstimes.com/singapore/alcohol-abuse-worse-among-younger-people

https://www.drugrehab.com/addiction/alcohol/peer-pressure/

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How to Build Positive Relationships

How to Build Positive Relationships

Strong social connections are vital to our mental and physical wellbeing – they help us navigate stressors and give us the courage to overcome the challenges that we face. Positive relationships are pivotal for an individual’s happiness, productivity, and form the foundation of a person’s support system. As such, we must not take these relationships for granted. Instead, we need to learn how to continue building and maintaining such positive relationships with others.

 

As an overall guideline, a good way to start is for us to adopt the “Above and Below the Line” thinking.  Has someone ever told you in the heat of an argument that you have “crossed the line”? In every domain of life, there’s a line, and we all intuitively know where “the line” exists. In any given moment, we are either living Above the Line or Below the Line.

 

When we are “below the line”, we are constantly angry, closed, and looking for blame and excuses. When we are operating out of fear, we withdraw from our connections, which causes us to become estranged from others, and pull ourselves back emotionally. In such cases, try gathering the courage to connect with what you’re afraid of. Although this could turn out in both good and bad ways, it will be worth a shot. At least you will then be able to confront the grip of toxic fear and bring forth behaviours and beliefs that are above the line. Anger, on the other hand, causes us to blame others or the situation we’re in, while at the same time creating excuses for ourselves. At times, we can even move into a state of denial. In order for us to start living “above the line”, we need to be more mindful of our emotional state. This could mean being more sensitive to the context and perspective of others or the situation. When we are “above the line”, we are operating out of love, understanding, and appreciation in order to tackle anger and take ownership of what’s happening. Acknowledge that pushing the blame on others continually will wear you out, and will eventually take a toll on your relationship. Moreover, remind yourself to be less prideful and try giving others credit instead. Focus on gratitude for those around you,  and start showing appreciation for their contributions and positive impact on your life. 

 

When we choose to live “below the line”, we fall victim to the biases that influence our perception, thereby impacting our relationships in a negative way. Such biases may include:

 

  1. Egocentrism

Egocentric behaviour often stems from inadequate awareness of the self. This becomes limiting in the sense that we become embedded in our own point of view rather than attempting to understand the perspective of the other person. Egocentrism can often lead to feelings of anger and frustration, and severely impacts our capacity to deal with others in an appropriate manner.

 

  1. Fundamental Attribution Error

Fundamental Attribution Error is the tendency to explain others’ behaviour and actions based on internal factors. This means having a cognitive bias to assume that someone’s behaviour is dependent on the personality of that person. When we overemphasise personal characteristics and qualities and choose to ignore situational factors when judging someone else’s behaviour, we become increasingly narrow-minded, making it difficult for us to resolve situations in an efficacious manner. For example, if a road user cuts into our path while driving, our initial thought might be that the driver is a “jerk”, or someone who is highly impatient. However, we fail to consider the possibility that the driver could have been rushing a passenger to the hospital. 

 

  1. Naive Realism

Naive realism is the tendency to believe that we view everything around us objectively and those other individuals who disagree with our viewpoint must be uninformed, irrational, or biased. This also causes us to be self-righteous and narrow-minded. 

 

  1. Confirmation Bias

Confirmation bias describes the tendency of individuals to seek evidence that confirms and reiterates a previously held view. A classic example of this is the belief that women are poor drivers compared to men. We pay particular attention to the gender of such poor drivers and cherry-pick evidence that reinforces the idea of the poor motor skills of women.

 

As much as possible, we should try staying away from living “under the line”. When we fall victim to such biases, our perceptions become clouded, causing us to be incapable of handling our social connections well and in a healthy manner. Try staying away from negative emotions, and be more open-minded and understanding of the other party and the situation at hand.

 

So, how can we make the shift and start living “above the line”? Instead of living in fear, anger and pride, try living in courage, faith and love. Gather the courage to improve yourself, and take tiny steps every day. Reflect on the personal qualities and weaknesses that you think you need to work on and make the effort to change. If someone gives you constructive feedback, take it! Focus on self-improvement and don’t let pride and arrogance overcome you. Have faith in yourself and in the relationships you share with others. Believe that relationships can be worked on and salvaged, even if they are on the rocks. Lastly, give and spread love. Love will bring out the greatness in yourself, and the best in others. Show the people around you that you genuinely care for them, and that you appreciate their presence. Positivity will certainly go a long way and bring individuals closer together.

 

Above all else, perhaps you could ask yourself a simple question when tackling any situation in a relationship: Is your intention to help or to hurt? If you are willing to take the step to be more mindful of your intentions, then you’re already on the road to building and maintaining positive relationships. The more you practice, the better you’ll get. On the other hand, should you require any further guidance, don’t be afraid to reach out to us.

 


References:

Dr. Justin Coulson, How Intention Builds Positive Relationships, video recording, Mental Health Academy
<https://www.mentalhealthacademy.co.uk/dashboard/catalogue/how-intention-builds-positive-relationships>. (Accessed 24/06/2020)

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What is Depression & How to seek help?

What is Depression & How to seek help?

Depression has been portrayed extensively in pop culture and media, from R.E.M.’s hit song “Everybody Hurts”, to the television series “13 Reasons Why”. The phrase “I’m so depressed” is thrown around casually when someone has had a bad day or when they can’t get their favourite brand of ice-cream. But what is depression, really? How does it affect us, and can it be treated?

If someone was recently fired or lost a loved one, it would be natural to feel grief at such events. However, grief is not depression. Depression is classified as a mood disorder that causes unusually low moods for an extended period of time and may impair one’s ability to function at work and at home. Grief or other stressful situations may sometimes trigger depression, but unlike grief, there is often no discernible cause for the hopelessness and despair a depressed individual feels. Depression affects everyone differently, and factors such as one’s family background, environment, or physical state can impact their chances of developing depression, and how severely it impacts them.

Depression has a variety of symptoms that can vary in intensity, including;

  • Low mood;
  • Loss of interest in typically pleasurable activities;
  • Sudden weight loss, or gain;
  • Changes in appetite;
  • Sleeping too much, or too little;
  • Restlessness or being slowed down;
  • Lethargy;
  • Feelings of worthlessness, or excessive guilt;
  • Inability to concentrate;
  • Recurrent thoughts of death or suicide.

Individuals who display five or more of these symptoms over a period of at least two consecutive weeks may be diagnosed with depression.

There are several different types of depression, with the most common being Major Depressive Disorder (MDD). According to a study conducted by the Institute of Mental Health (IMH), 1 in 16 people in Singapore have experienced MDD in their lifetime. Major depressive episodes last about eight months and have a 70% chance of recurring within five years, though this varies with each individual.

There is also Persistent Depressive Disorder (PDD), also known as dysthymia. This type of depression can last for several years, with symptoms receding for no more than two months at a time. PDD is much harder to spot, as the symptoms are often not as severe as MDD. Due to the length in which PDD affects individuals, friends and family may eventually brush it off as part of their personality. Others may think that they are just naturally “gloomy”, or “introverted” and “withdrawn”. Some individuals may also experience major depressive episodes while in the midst of PDD. This is known as double depression.

If any of the above sounds like they might apply to you or someone you know, you may be wondering “what can I do?”. The first step would be to speak to a mental health professional, who can properly assess the situation and make a diagnosis if necessary. They can then recommend a form of treatment. However, there is no “one size fits all” treatment. It may take many tries to find one that works for you. To help find that, here are some proven methods of treatment.

Medication

Antidepressants prescribed by psychiatrists help to stabilise one’s mood by adjusting specific parts of their brain chemistry. SSRIs are the most commonly prescribed class of antidepressants and help to boost the effects of serotonin in the brain. Antidepressants take time to produce full effects so don’t be discouraged if you don’t experience any effects immediately. However, if the antidepressants do not work after an extended period of time, or produce unpleasant side effects, speak to your psychiatrist about changing medications. When taking antidepressants, be sure to adhere to the prescribed dosage in order to see the best results. There is a common misconception that if someone feels better after taking antidepressants for a while, they can stop taking it immediately. This is not the case, and can instead cause their mood to suddenly crash back down again. If you are feeling better after taking antidepressants, speak to your psychiatrists, and together you can work out a plan to reduce the dosage of antidepressants.

Therapy

While medication can help to reduce symptoms of depression and improve one’s mood, they may not cure depression. Speaking to a counsellor or therapist can help to uncover underlying issues that are causing distress. The therapist can then focus on addressing these issues and equipping you with appropriate techniques to cope. Contrary to what is depicted on television, therapy does not involve lying on a couch and talking about your childhood. It is important that you feel comfortable with your therapist and develop a relationship with them where you are able to share openly about your struggles. One of the most commonly used forms of therapy is Cognitive Behavioural Therapy (CBT), which takes a goal-oriented approach to tackle negative behaviours or emotions.

Other forms of treatment

Aside from talk therapy, some individuals may find it helpful to find new ways of expressing the emotions that they are struggling with. This could be done through art therapy or psychodrama. Psychodrama allows individuals to explore different roles in a safe space using actions as well as words. For those worried about the side effects of taking medication, there is Transcranial Magnetic Stimulation (TMS). TMS Therapy is a non-invasive treatment that uses strong magnetic pulses, similar to those in an MRI, to stimulate areas of the brain that are underactive in depression.

Unfortunately, even with the wide variety of treatments available, the majority of people suffering from depression do not actually seek professional help. In many cases, this is due to the stigma associated with mental illness and the fear of what others may say. People with depression are often told “just stop being sad”, or “you should be happy, you have so many things to be thankful for”. So they hide it. They struggle each and every day and they hope that they’ll just get better on their own. But that makes the process so much harder. Support from friends and family is crucial in the recovery process.

Depression is a disease that can happen to anyone. It could happen to the quiet kid that sits in the corner. Or to your best friend who’s always been bubbly and lively, and now seems like someone else that you can barely recognise. But just like other diseases, it is possible to recover from depression with the right support from friends, family, and therapists. So be kind to one another, love one another, and when things get tough, be there for one another.


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Bipolar Disorder: You Too Can Walk In Recovery

Bipolar Disorder: You Too Can Walk In Recovery

With the recent revelation of American rapper, Kanye West, being diagnosed with Bipolar Disorder, the condition has been brought into the spotlight. The term ‘Bipolar’ (meaning “two poles”) signifies the polar opposites of emotional highs and lows. As the name suggests, Bipolar Disorder is characterised by episodic, extreme mood swings in which the individual experiences intense mania and severe depression. Formerly known as ‘Manic-depressive Illness’, the disorder is a fairly common, yet serious mental health condition. 

 

For individuals struggling with the disorder, manic episodes can last days to weeks and are often associated with hyperactivity, an irritable mood, rapid thoughts, increased recklessness, or an exaggerated sense of self-esteem and power. On the other hand, a depressive episode can last weeks to months. In this phase, individuals may experience increased restlessness, a loss of interest in activities (including those that they usually enjoy), poor concentration or disrupted sleep patterns. In more severe cases, these people may also possess suicidal thoughts and behaviours. 

 

In order to help us better understand the condition, we interviewed Deborah Seah, a peer support specialist at Psaltcare.  

Deborah Seah

Deborah started experiencing extreme mood swings in her early primary school years. Having known that her paternal family had a history of mental illness, she identified that her condition was most likely to be genetic. However, she had chosen to suffer in silence until 2 decades later, when she sought psychiatric help for postnatal depression and work-related burnout. At that point, she was diagnosed with Bipolar Disorder as well as Generalised Anxiety Disorder. For Deborah, the disorder reigned control over her life – straining her relationships with her loved ones. Before her diagnosis, others could not understand why she was being so unpredictable, and her erratic behaviour had unfortunately caused numerous misunderstandings.

 

“It was very challenging to manage my mood swings at the tender age of 8,” she shared. “When I was experiencing my highs, I would talk very fast, have tremendous amounts of energy, get very excited, or become easily irritable and agitated. On the other hand, when I was experiencing my lows, I would feel very sad and experience low energy levels. I could cry for hours or days over trivial matters and be even suicidal at times. The experience of dealing with bipolar disorder consisted of feelings of helplessness, hopelessness and loneliness as I could not predict or control my emotions and energy.” Deborah’s experience with bipolar disorder led her to face an identity crisis – being confused over her contrasting “personalities”, and not knowing which was the real her. 

 

Just like any other mental condition, there are bound to be misconceptions of the Bipolar Disorder, especially if people don’t open up and address it. One such misconception is that individuals struggling with Bipolar Disorder are incapable of managing their mood swings. However, Deborah takes this as an opportunity to debunk such a sentiment: “After a certain point in time, I’ve arrived at a higher level of self-awareness towards my early warning signs, and it has enabled me to gain self-mastery over my condition. When my mood or energy level starts to dip, I’m aware of what could effectively help me to increase my mood and energy. When my mood or energy level is overly high, I know that I need to be extra mindful of not going into overdrive.”

 

While on the road to recovery, Deborah made a commendable effort in helping herself cope with the disorder. This included reading up on the condition proactively to ensure that she could better achieve self-mastery. Of course, finding a silver lining and staying positive is essential over the course of recovery. Keeping up with articles on others’ success stories and breakthroughs helped her to stay hopeful and confident that recovery is not impossible. 

 

Being highly motivated to make headway towards recovery, Deborah knew that she needed to make changes to her lifestyle. For starters, Deborah:

 

  1. ensures that she keeps to a good sleep routine and to have sufficient rest
  2. adopts a healthy lifestyle by having a balanced diet and staying active through exercise
  3. stays in a conducive environment for recovery where all potential triggers are removed as much as possible.

 

She also notes that her Christian faith has played an essential part. Daily prayer and spiritual devotion helped her to calm her mind and provided her with the much-needed inner peace. However, Deborah stresses that one should not brush aside the idea of peer support or psychiatric intervention. The active use of medications coupled with peer support contributed to the turning point in her recovery, and restored any lost hope when the future was seemingly bleak. Connecting to like-minded peers can help one explore new coping strategies and stay on a personal wellness plan.  

 

“Upon knowing my diagnosis, my family took the initiative to purchase books on Bipolar Disorder to understand my condition better,” Deborah recounted. “My family gave me space when I needed it and continually held hope for me even when I gave up on myself. They didn’t pressurise me to make quick progress on my recovery but assured me that they genuinely only wanted me to be happy and that is all that mattered to them. I was deeply touched by their love and concern for me and felt motivated to work hard on my recovery because I realised that they would always be affected whenever I’m suffering.” Through her experience, Deborah holds a strong belief that the hope and support from her loved ones had an immeasurable, significant impact on her, and encourages those who are also supporting their loved ones with mental conditions to stay hopeful. 

 

As of today, Deborah has made promising progress and is well on her way towards achieving mental wellness. After consistently attending a Recovery and Wellness Sustenance (RWS) Workshop at IMH, Deborah graduated with a certificate of participation. Recognising that she benefited much from the workshop, she returned as a Mentor to co-train the subsequent class of peers. In addition, Deborah also completed a module conducted by the National Council of Social Services (NCSS) and was involved in the facilitation for the 3rd and current 5th batch of Peer Support Specialist (PSS) training. She said, “It gave me confidence and reinforced my own recovery as I pay it forward and encourage my peers in their recovery journey. Moreover, it has equipped me with effective coping skills to deal with my mental health condition and it brought my recovery to a higher level.”

 

To end off, Deborah hopes to pass on an important message to the readers: “To me, there is no shame to be on psychiatric medication or seeking psychiatric help. Just like how people with diabetic conditions need to be on insulin while some people who are asthmatic need to be on Ventolin, people with psychiatric conditions need to take psychiatric medication too. Resilience in Recovery requires these 3 things: Courage – to embrace the past, Gratitude – for the gifts of the present, and Hope – to make the most of the future. I believe that everyone can recover from a mental health challenge, as long as he or she does not give up hope because I am the Evidence of Recovery myself! Everyone recovers at their own pace, just like every flower blooms in its season – let us hold the hope for our loved ones and for those who are battling mental health challenges by cheering them on and being their source of support to believe that recovery is indeed possible.”

 


References:

https://www.healthhub.sg/a-z/diseases-and-conditions/49/topics_bipolar_disorder (Accessed 01/08/2020)

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml (Accessed 01/08/2020)

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The Online Environment (Internet) and Suicide

The Online Environment (Internet) and Suicide

Thanks to the Internet, a global communications network, thousands of host servers worldwide are connected, making instantaneous and interactive sharing of information effortless and uncomplicated. But is the ease of access to information necessarily a good thing? There is increasing evidence that the Internet and social media may influence suicide-related behaviour, and hence the freedom of information may do more harm than good. 

 

The Internet and social media have become fundamental in the way many people communicate and share opinions, ideas, and knowledge – alongside a multitude of information on the topic of suicide that is readily available. Social media coverage of celebrity suicide, which is unfortunately on the rise in current times, increases the risk for prosuicide behaviour of vulnerable individuals. One concern is the contagion effect where people are triggered to act as a result of learning of the death or self-harm of others that they identify with or admire. The glamorising of such stories can normalise suicide and present it as acceptable and unproblematic, leading to a rise in imitational suicides. The Internet also provides a source of information for people to obtain how-to descriptions of suicide and lethal ways of killing themselves.

 

But that’s not all there is to it. As we dig deeper, we find that the Internet also allows for cyberbullying, the formation of suicide pacts, and even suicide challenges including the infamous ‘Blue Whale Challenge’ – the Internet’s deadliest suicide game. Youths, in particular, are the ones most vulnerable and susceptible to caving into such pitholes – the very generation that is possibly the most in touch with the Internet. Suicide is the shortcut that a large proportion of people with mental health conditions (e.g. depression) succumb to if they aren’t able to cope well – yet, it isn’t an issue that we address much. To look out for one another, we should try to understand how these pro-suiciders think and act, to help them through their difficulties as fast and as much as possible. 

 

There are mainly two categories of suicidal internet users – “Lower Severity Use” and “Higher Severity Use”. These categorial names refer to the extent to which these individuals use the Internet to find out about the act of self-harm or suicide. People that fall under the “Lower Severity Use” category are usually just conducting “pessimistic browsing” – a stage in which they are still uncertain about suicide, but are distressed enough to want to know more. They mostly navigate through the web haphazardly, trying to find stories or others to whom they can relate. They enter broad search terms, and randomly click on whatever appears at the top of their newsfeed. In summary, these people are still struggling to make sense of their feelings. However, a critical distinction between this group of individuals and the other is that people under “Lower Severity Use” actually flit between prosuicide content and online sources of help. Their uncertainty regarding suicide enables them to be more open to rethinking their actions, be it joining online peer support forums or attaining self-help resources. Perhaps the broad search terms they enter on Google could have also played a part in uncovering various methods of treatment.

 

Unfortunately, this has been proven otherwise for those who fall under the “Higher Severity Use” category. Individuals in this group are much more troubled and perturbed – so much so that they conduct “purposeful researching”, and are no longer as open to receiving online help. These people turn to the Internet to identify, evaluate and choose suicide methods. They research and learn about the effective implementation of each plan, and subsequently acquire the means to carry out the suicide attempt. Part of their research also includes evaluating different factors such as the speed, effectiveness, pain level and technical instructions for them to carry the suicide method. What types of household items can be used for suicide? How much drug constitutes an overdose? What would be the appropriate height to jump to death? Such thoughts fill the heads of these individuals, and the same things are searched up online for them to make a successful suicide attempt. Regrettably, a handful of them also makes use of websites that were never meant to encourage suicide, some of which include professional websites such as WebMD. The published notes on symptoms of overdosage etcetera on such sites could lead some individuals to deduce the amount needed for a successful suicide attempt. This, coupled with the ease of purchasing medications over-the-counter or online, could very well lead to undesirable consequences. 

 

You might wonder, is there a link between the two categories? The answer is yes. Many a time, people start with “pessimistic browsing” before they move on to “purposeful researching”. The decision and will to pursue the act of suicide comes during the transition from former to the latter. The haphazard online navigation, or what was once considered rather “purposeless”, could become addictive. These sensitive and vulnerable individuals could find themselves roped into a cult of negativity, being enticed and increasingly drawn to the provoking and graphic content online. Subconsciously, they will start searching things up more frequently, and their suicidal thoughts and motive escalate. Eventually, they will find themselves under the “Higher Severity Use” category.

 

Above all, we should be concerned with protecting our loved ones. If we sense that a friend or family member is contemplating suicide or is vulnerable to the suicide-promoting influences of the Internet, seek help from a professional i.e. a counsellor, a psychotherapist or psychologist, immediately. As time passes, there is a higher chance that their initial help-seeking thoughts will be displaced. They will start validating their self-harm and suicidal thoughts and will expose themselves to more suicide content. Suicide isn’t okay, and should not be portrayed as an acceptable response to distress or difficulties. Never downplay the seriousness of suicide and delay help. Trust me; You will be doing anyone at-risk a vital service by persuading them to seek professional assistance.

 


 

References:

Dr Lucy Biddle, 2019, Tackling Challenges of the Online Environment and Suicide-related Internet Use, video recording, Mental Health Academy <https://www.mentalhealthacademy.co.uk/dashboard/catalogue/tackling-challenges-of-the-online-environment-and-suicide-related-internet-use>.   (Accessed 16/06/2020)

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