Senior Clinical Psychologist, Henny Tan, was interviewed by the popular YA YouTube channel, LadiesFirstTv (Titan Digital Media) about the stigma a person might face when being identified as having a mental illness.
Click on the red play button to watch this 13min 24 sec video.
Written by: Henny Tan, Senior Clinical Psychologist
Most of us look forward to the festive season. After all “‘tis the season to be jolly”. It is a time for family and friends to be gathered together, often with the accompaniment of special treats and food. However, this may not always be the case for individuals who struggle with eating disorders.
Across various cultures, food is a unifying cultural thread, and eating is a huge and important part of our social lives. Oftentimes we forget the pervasiveness of food in our everyday lives. Have you ever considered how integral the role of food is in building social connectedness and relationships? We catch up with friends over meals and have informal business meetings over coffee. We also celebrate important occasions and milestones over food. The phenomenon of foodstagramming (a term used to describe the act of taking pictures of one’s food and posting it on social media), or “the camera eats first”, also dominates our social media.
As a result of the emphasis that is being placed on food, individuals with an eating disorder may feel tremendous stress and anxiety partaking in food-focused family traditions and gatherings with friends during the holiday season.
Eating disorders are a category of psychological conditions that manifest themselves in persistent and unhealthy relationships between body image, food, eating and exercise. They usually develop in adolescence and young adulthood and are often associated with a whole host of distressing thoughts and emotions. Eating disorders can affect people of all ages and of any race, gender or body type.
Some types of eating disorders include:
A daily struggle for someone with an eating disorder is worrying about what and how much they will eat, how to burn off the calories consumed. When faced with an abundance of food choices and especially food that they do not commonly eat or labelled as “bad”, such worries become exacerbated. For example, someone with binge-eating urges may find it difficult to control their eating during such situations, leading to increased feelings of guilt and shame, as well as negative beliefs about themselves that come with these feelings.
Obligations to attend various parties and gatherings will also likely disrupt everyday routines such as meal timings and exercise. In addition, structured meal plans that may be essential for someone at a specific stage of eating disorder recovery may also be impacted when dining with others.
The holiday season is also a time when we are faced with expectations from family and friends to be happy and relaxed, and to indulge in food. However, for individuals with anorexia nervosa, they may find it extremely difficult to finish their food when family is watching what they eat, or may feel pressured when others are encouraging them to eat larger amounts of food, which can lead to feelings of shame and guilt. Asking someone if they have eaten is often a way of showing we care, but for someone with an eating disorder this could potentially trigger a whole slew of body-image related thoughts. Additionally, stress may also come in the form of worrying about how to manage comments from others about how they look or what they are eating or not eating.
Individuals with eating disorders tend to feel isolated as they may withdraw from social gatherings as a way of coping with the deeply rooted fear of being negatively evaluated by others. During the holiday season where gatherings involve many more people, this fear can become intensified. They often find it hard to express their anxieties and struggles to family and friends, while at the same time feel unable to escape such situations, resulting in them feeling overwhelmed and detached.
Given the challenges that someone with an eating disorder might face during the festive season, it is important to be proactive and plan ahead to make it easier to transition into the holidays. Friends and family can also be a significant source of support.
Written by: Dr Mark Toh, Senior Consultant Psychologist
This is an important concept that helps to explain certain interactions within relationships better. Relational patterns and rules between family members within the family system dominate how individuals interact and engage with one another. These rules are often silent, unconscious or multi-generational in nature. Within this system, the family operates according to some ‘thermostat’ which sets the ‘desired setting’ for how each member is expected or required to function. The functioning applies to how situations or people are viewed, how much self-disclosure is welcomed or permitted, how personal or interpersonal difficulties are addressed or not, how disagreements or secrets are to be dealt with, or what relational values are being promoted. Families in different cultures may operate with certain predictable rules or patterns, eg. within families sensitive to shame, avoidance or non-verbal disclosure, communication is often practised. Tapping into the honest emotions of members over time tends to reveal the ‘temperature’ within the family system.
Families nurture the psychological ‘birth’ of the sense of self within children during their childhood. In the process, parents shape within their children how young children will engage themselves (intra-personal relationship) to function in later childhood and adulthood (inter-personal relationships). Healthy relational patterns and appropriate rules are important to foster healthy emotional development towards an important psychological milestone for children: healthy identity formation. Because these patterns and rules are so fundamental in the shaping process, it is important for parents to understand how they can shape their children towards this healthy identity. If not, the child could begin a life-long struggle from having accepted an identity that is diffused, confused or distorted in nature. This is usually accompanied by secondary effects of this outcome, eg. a pattern of difficult or troubled relationships with others. This usually adds additional distress to the sufferer and to those who relate to them.
Instead of understanding interactions within relationships along a linear continuum where there is a definitive start and end, circular causality opens up to appreciating the relational context where interactions can be examined between two events in more useful detail. With an understanding of circular causality, understanding the interactions between two or more individuals can better reveal where an interaction can get stuck. This pattern occurs in all relationships but it is especially within ongoing relationships where being stuck in a negative cycle can lead to particular disappointments, hurt and pain. For children, unhealthy patterns and rules within families can undermine the child’s emotional development over time.
Circular causality is particularly useful to explain conflicts between family members which can become persistent and damaging. Persistent hurts can undermine relationships and lead to how negative expectations of each person are viewed and engaged with over time. They are a concern because of the prospect of children’s sense-of-self being hurt or damaged within certain family systems. Therefore, careful attention is usually necessary in understanding the attribution of cause-and-effect of what is problematic between family members.
Individuals attribute cause and effect or causation in situations and within relationships. Linear cause and effect of A 🡪 B 🡪 C are defined by a specific start and end point. Individuals who operate from understanding relationships based on linear causality tend to assume that problems are caused and maintained by the other individual’s beliefs, biology, emotions or other abnormal factors within the individual, i.e., they are self-generated. Therefore, solutions are found when the individual in question changes their beliefs or emotions within them to respond differently to the situation.
In contrast, circular causality refers to the reciprocal relationship between two events. Family members influence each other in a continuous process within a feedback loop. A vicious cycle is often present when two or more family members have relied on unchecked assumptions to carry out their attributions of cause-and-effect in the situation. The perspective of reciprocal relationships stems from the foundations of cybernetics, which refers to the regulatory action where one part of the system impacts another. Events usually do not happen in isolation. There is a feedback loop which tend to result in a new equilibrium. It is more that A 🡪 B 🡪 A.
Susan refuses to go to school and goes into her room. Mom and Dad raise their voices and lecture her. When they raise their voices, Susan isolates. Mom and Dad’s frustrations or anger heighten Susan’s need for isolation, and Susan’s isolation heighten Mom and Dad’s anxiety, and therefore their escalation.
For parents who operate on assumptions of linear causality, their perception can easily overlook other reasons to explain the child’s original presenting problem, eg. Susan may be bullied at school, she has an unhappy relationship with her teacher, or she may be afraid of facing exams but is afraid to tell anyone. Parents who operate based on linear causality tend to see their child as the source of the problem, and to overlook their contribution or other reasons leading to the child’s presenting problem.
Instead of being quick to judge the situation as the child choosing to misbehave, parents should focus first on establishing a safe, trusting relationship with their daughter before their intervention. They can raise concerns about what their child may be fearful of with empathy. The following statement could be as follows, “Hey Susan. You usually would enjoy attending school. But something unpleasant or uncomfortable may have happened to make you afraid of returning to school. I remember that when I went to school, I have at times been uncomfortable going to school because I was afraid of meeting someone I did not like, or having to face an exam I was not prepared for, or having to face a teacher who was mean. Can you tell me what is going on for you at school that you are uncomfortable facing? I will like to help you.”
John struggles in completing his homework and his poor grades. The father Mr. Lim responds to him with harsh criticism. Hurt and demoralized by his father’s criticism, John does not put in his best effort at school. His father’s criticism then intensifies and John puts in even less effort to learn.
Family difficulties are often not rooted by a simple mistake made by the child (mistakes are common for children and instrumental for how they learn). In this scenario, the father’s response to John may be reflective of how Mr. Lim was regarded as a child himself by his own parents when he was growing up. Criticism then is an extension of how he was treated as problematic as a child (to regard himself as stupid, inadequate, irresponsible) so as to repeat the cycle here. Without knowing all this history, John becomes hurt and angry against his father’s accusation. He can try to defend himself and retaliate with, “I am not useless. You are.” Mr. Lim who is outraged by John’s apparently disrespectful reply can bear down on John for what he considers to be John’s defiance to intensify his attack: “You are not only useless but disrespectful.” This pattern can then set up a loop that becomes self-perpetuating or self-reinforcing based on their view of each other. John is seen by his father not only as stupid or irresponsible, he is also viewed as disrespectful and defiant. In turn, John sees his father as unloving and hurtful whom he needs to distance himself from. If they had a positive relationship earlier in John’s life, this relationship can deteriorate over time if the underlying issues are not addressed.
In reciprocal relationships, circular causality is often revealed in the course of the interplay between emotional experiences, false or valid expectations and eventually how we experience each other. It often reveals how one or both parties perceive and interpret their individual world, and there is usually a historical reason behind their perception. Our current experiences, perspectives and approach to relationships are often already influenced or shaped by our previous significant relationships with our family-or-origin and culture.
[ In this situation, Mr. Lim should be advised to consult a child clinical psychologist when he sees no improvement with his son’s behavior. He needs to be alerted to the importance and quality of the parent-child relationship in impacting the child’s self-esteem, emotional conditions for what children need to thrive and the nature of the unconscious. If Mr. Lim was armed with the appropriate knowledge and possibly obtain personal help to address his relationship with himself as defective or inadequate, he could approach his son with, “Hey son. Studying in Singapore can be challenging or difficult. The workload can be heavy and the material can be difficult. I struggled with it too when I was a student. What struggles are you facing at the moment?” ]
In the midst of ongoing conflicts between parents, their child Ben develops anxiety because the two people he loves appear to be hurting each other. Ben acts out with anxiety and/or depression, eg. temper tantrums, excessive withdrawal from school or play, trouble at school. This draws the attention of his parents who attend to him. In the process, their own conflict decreases. From this, Ben learns that he can influence his parents’ conflict through his anxiety.
Circular causality helps to explain why family members may be stuck arguing about the same subject every time through communication traps or failures. Understanding cause & effect on a linear perspective in relationships can result in an artificial understanding: one cause & one effect or multiple causes & the same effect. In this scenario, Ben’s parents may wish to see Ben as having difficulties coping with school. Their solution may be to improve Ben’s responses to become more resilient. But if Ben attempted to communicate his difficulties with his parents’ conflict, they may not wish to believe that they contribute to his struggles. In so doing, they fail to capture the root of the problem for what it is. A child’s struggles may be defined by their parents because the child’s limitations reflects the parents’ limited emotional insights on themselves or their children. This lack of emotional insight and understanding is often expressed through circular causality to reveal that children can be misunderstood often and that the parent-child relationships can often be negatively impacted. The parents’ own limitations are often overlooked in the situation.
Repeated over time, the negative rituals expressed in circular causality can be locked in place by ignorance, emotional hypersensitivity, defensiveness, contempt for one or more family members, hopelessness, hurt, anger, blame, fear and avoidance or stonewalling. Emotional cut-offs may be used frequently. If this happens, the effects of circular causality in an unhealthy family system can be experienced as intolerable. If there was previously a positive bond that bound the relationship, it can now be worn down by pain and the relationship may become damaged.
In this situation, the parents should consult a clinical psychologist familiar with children and family issues when they notice their child struggling with school or presents with anxiety in the midst of their conflict.
Raising healthy children require establishing healthy relationships and healthy boundaries. Because the goal of raising healthy children is so worthwhile and essential to their future growth and success, parents need to be concerned that their relationship with their children are not defined by misunderstandings and conflict which are painful. To foster family unity and raise healthy children, three important values and practices are essential to promote certain patterns and rules in the family system:
References:
American Psychological Association. (n.d.). Apa Dictionary of Psychology. American Psychological
Association. Retrieved October 22, 2022, from https://dictionary.apa.org/circular-causality
Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen theory. W W Norton & Co.
Expat life and moving around the world places a great deal of stress on children. DR REBECCA GIESS and DR MARK TOH from Promises Healthcare share how parents can help them adapt to new environments and people.
Rebecca: They suffer mostly from homesickness, and grief from losing friends, extended family and familiar places. In a new country, they find it difficult to fit in and feel a sense of belonging. They have a fear of missing out (FOMO) on life back home.
Mark: They perceive a threat in relocating. Extended family and friends represent the emotional resources the child depended on, and the disruption in daily routine affects their emotional security and stability. This is an important and largely overlooked stressor. How children experience this, and how prepared they are for the change, is based on their relationship with their parents.
Rebecca: It can be difficult for children to know how they are feeling or how to express it. They may exhibit anti-social behaviours by breaking the rules or defying expectations. Tune into your child to uncover the underlying emotional triggers, and what they might need emotionally from you.
Mark: For children under the age of eight, there may be more crying, moodiness and irritability, complaining about school, expressing worry, or becoming withdrawn and clingy. There may also be regressions such as thumb-sucking, temper tantrums or toilet accidents, despite being potty-trained.
Children aged seven to 10 may worry about their health or family and express anger and irritability. They may also pin negative labels on themselves. Some of these behaviours may manifest at school more than at home.
Preteens may be more reactive to the demands and stress of the new school, complaining about the different system or classmates. They could become withdrawn, have more incompleted homework, or have declining grades.
Mark: Teenagers will miss their friends, prom, graduation and sports pursuits – the rites of passage – and they may feel their sense of identity being stripped away. They may display depression, anxiety, irritability, apathy and withdrawal, which increases their sense of isolation.
Those who feel ready to be independent may feel trapped with their family. They blame their feelings on the relocation and start to resent the family for it.
If the teenager is close to completing Grade 12, consider allowing them to graduate before they relocate.
Rebecca: Create space and guidance for their emotional experiences. Parents can validate and normalise their emotions by saying things like: “It makes sense.” Or: “It’s normal to feel sad or stressed.”
Don’t place any expectations on how your child “should be feeling”. They feel what they feel. Parents can help them label their emotions and work out how best to manage them.
Talk to your child about becoming a “third culture kid” – someone who spends a portion of their developmental years in another country. There are several benefits and challenges worth understanding and planning for.
I recommend parents read Third Culture Kids: The Experience Of Growing Up Among Worlds (Pollock, Van Reken & Pollock 2017).
Mark: Children are looking for safety and security. With younger children especially, this depends on how close they are to their parents. Pay more attention to any work or social activity that might threaten this bond. Parents must remain accessible to the child, meeting regularly, exploring and discovering the country together and having fun in the process.
They should also assess how they themselves are coping, and if they might be unintentionally neglecting their child’s needs.
Mark: Help children to set up their room. They are more likely to embrace their new home when they know that their needs are being met predictably. Parents should be ready to share their personal feelings and discoveries to encourage their children to communicate as well.
Create routines that bring everyone together. Playing games encourages bonding. Team games, where discoveries can be made individually and shared collectively, are particularly useful. In the process, the family learns about each member together.
Rebecca: Therapists are trained to work with children experiencing anxiety and depressive symptoms due to adjustment difficulties. Children are rarely completely open with their parents and may do better in a non-judgmental safe space.
Mark: A therapist looks at both the child and family’s wellbeing. How is each person in the family coping? If there are individual or collective difficulties uncovered, the therapist could help them get unstuck.
Dr Giess has extensive experience in working with teenagers and parents. She also helps adults address severe and chronic mental and physical health issues, and is trained in couples relationship counselling.
Dr Toh treats troubled children and their families and helps them to address their challenges. Helping parents to parent well is also a concern for him. He also works with couples and individual adults, as well as individuals with personality disorders.
Promises Healthcare is at #09-22/23 Novena Medical Center, 10 Sinaran Drive. Contact the team at 6397 7309.
Written by: Andrew da Roza
Deciding to see a therapist is a big step – and staying in therapy requires a commitment to effect real change.
It is not surprising that many hesitate before starting therapy.
Some may be wondering how talking to a stranger can change their lives for the better.
They may not know which therapist they ought to approach – and what they should be looking for in a therapist.
Others may hesitate because they are anxiously thinking ahead: “what happens if I don’t like the therapist?”; “what if the therapist doesn’t understand my struggle?”; “what if I don’t think that enough progress is being made?”.
They may also be wondering if they can change their therapist and if they can have more than one therapist.
If you are struggling with these questions, thankfully, there may be some answers that put your mind at rest and give you the confidence to seek a therapist and engage in the healing process.
Most clients can articulate why they wish to seek therapy – and have clear ideas about what is causing them distress or difficulty.
Clients with clinically diagnosable mental illnesses may have already sought help from a family member, friend, doctor, psychiatrist or religious leader. They may have even “Googled” their symptoms.
If specialist help is needed, choosing a therapist with the relevant qualifications and experience will be the first step.
In addition, you may wish to choose a therapist you are more likely to be comfortable with based on the therapist’s language ability, gender, culture and so on.
Research has shown that the positive connection a client makes with their therapist accounts for 36%-50% of the changes clients experience as a result of treatment. (1)(2)
Sometimes called the “therapeutic alliance”, this is experienced by clients as liking and trusting their therapist.
Some will bond strongly with therapists if they demonstrate empathy, warmth, unconditional regard and respect. They would like their therapist to be open, non-judgmental and curious about the clients’ struggles – to have a strong desire to “walk in the clients’ shoes”.
Such clients make good progress in therapy when they feel understood and heard – as well as valued.
Others may seek therapists who are good communicators and are well informed about the issues the clients are facing. They tend to bond with therapists who are able to impart and discuss information; offer practical suggestions; articulate action plans, goals and timelines; and support the clients in their motivation to take action to effect positive change.
Many also seek insights into themselves, their emotions, the ways they react to people or situations; and their perspectives and intrusive thought patterns.
By being more present with what arises in themselves, they seek to take more control over their own lives – to respond to people and situations instead of habitually reacting to them – and to accept and let go what they cannot control.
These clients appreciate therapists who can assist in self-discovery. Therapists who are able to help articulate their “inner worlds,” and to reframe them. Therapists who empower them to navigate this “world” with more ease and confidence by playing to their strengths, rather than dwelling on what they perceive as their weaknesses.
Interestingly, studies have repeatedly shown that the type of therapy used for individual therapy (such as cognitive behavioral therapy, psychoanalytic or psychodynamic therapy, dialectical behavioral therapy, person centered therapy and so on) has only a marginal effect on the outcomes of therapy (3)(4)(5).
So, the key to choosing a therapist involves articulating what you expect from therapy and your therapist, and what kind of person you think will best meet your emotional and other needs.
It would be helpful to articulate what you want the therapist to do (and not do); and what your end goal or “vision” for therapy is. You can do this by first asking yourself the question: “what changes am I seeking that will make a real positive difference in my life?”.
Many benefit from putting all this in writing and bringing it to the first therapy session to discuss it with the therapist.
On the first meeting with a therapist, some clients – though this may be rare – simply do not like or trust the therapist, or that they do not have the experience or knowledge to assist them.
It also sometimes happens that a client feels that the therapist is not present or really hearing the client’s narrative.
Worst still, they may see the therapist jumping to conclusions – or solutions. They may feel disrespected and “unheard” – and that they are being left behind, while the therapist is “racing” ahead of them.
Other clients may feel that the therapist is judging them or telling them what to do, think or feel – and not to do, think or feel. The clients may feel anxious, disempowered, dismissed, angry or offended.
If this happens to you, let your therapist know. If you don’t see any change in their approach, rest assured that changing therapists is likely to be helpful.
One situation that you may wish to avoid though, is changing therapists regularly. This is because continuity in therapy is one of the keys to progress.
Therapy is very much a journey.
Whether the goal is self-discovery, empowerment, executing action plans to change behaviour, building confidence, or managing anxiety or depression. The journey has stages, and keeping the same guide on this journey is likely to facilitate progress.
If you are in the middle of your therapeutic journey, and you wish to change therapists, it would be helpful to articulate clearly why you want to do this.
Is the therapeutic bond broken – and cannot be fixed? Is there little or no progress in your clearly articulated goals? Have you changed the goals and discussed them with your therapist – and it is clear that the therapist will not be able to assist?
Some clients simply feel that therapy has become “stale”; or they feel as though they are attending therapy to “tick the box” and to show others that they are willing and able to change.
Whatever the reasons, write them down. Discussing them openly and honestly with your therapist is likely to help.
If you wish to make a change, ask the therapist for a referral to another therapist, and give permission to the current therapist to brief the new therapist. You may wish to join in this discussion.
This is more likely to ensure that your therapeutic journey continues without disruption.
One situation you may wish to be conscious of, is changing therapists solely because the therapeutic work has become difficult. “Jumping ship” may not be the answer.
There is no doubt that therapy can be very challenging – perhaps the most challenging thing you have ever done.
The challenge could arise because the insights are uncomfortable (or even painful); the changes in behaviour require a lot of motivation to sustain; a change in perspective seems counterintuitive; or because the anxiety, intrusive rumination or low mood seem relentless.
Changing therapists may not be the answer – and may simply delay or disrupt the difficult therapeutic work ahead of you.
It is likely to be more helpful to articulate these challenges, write them down and discuss them with your therapist.
Some clients may need more than one therapist.
A client may have an individual therapist who assists the client on their own personal journey.
They may also have a couples’ therapist to address their relationship with their partner. In that event, the therapist treats the couplehood as “the client” – and provides equal support to both parties and works towards their joint goals.
Other clients may also have a family therapist to address the relationships within the family. Again, the therapist will see the family as “the client” and assist with the family goals.
Couples and family therapists tend to provide specific modes of therapy, which have proved effective for couples and families.
In the case of individual, couple and family therapy, in most cases, it is generally considered unethical and a conflict of interest for one therapist to play all three roles.
The therapist cannot best serve the client’s, couples’, and family’s interests while wearing all three “hats”.
Once a therapist tries to do this, they may (for example) feel obliged to keep secrets from one person in the couplehood or others in the family. This may reinforce the unhealthy dynamics of secrets and deceit that brought the clients to therapy in the first place.
Conflicts of interest create confusion, anxiety, anger and disappointment for clients.
Keeping to ethical boundaries is more likely to ensure that the therapeutic journey is not sabotaged.
Unethical conflicts of interest also arise if a client is seeing two different individual therapists.
Broadly, therapists are obliged to decline to see a client if they already have an individual therapist they are actively working with.
Having two therapists engaged in the same work exposes clients to confusion, anxiety and conflict, and is likely to disrupt a client’s progress in their therapeutic journey.
If you are considering seeing two therapists for individual therapy, it would be helpful to clearly articulate why you think this will assist – and to discuss this openly with the therapists.
Some clients may change therapists to “find the right answer”; the “best answer”; or the answer that fits their “view of the world”. That “view” may be the same “view” that has been causing them the trouble – and motivated them to seek therapy in the first place.
All this is worthy of open and honest discussion and exploration.
Another situation in which other therapists may be involved occurs when a client has an individual therapist and also attends group therapy. Group therapy can be a very effective way to continue the therapeutic journey, once progress has been made in individual therapy.
Again, therapists commonly use specific modes of therapy for groups.
If you are working with multiple therapists, it is helpful to let them know who else you are working with, and what goals you (e.g. as an individual, couple or a family member) have agreed to pursue with the other therapists.
From time to time, it will assist to share with your therapists what you took away from the other therapy sessions, how the sessions are progressing and what plans you have agreed with the therapists.
It is always open to you to ask the therapists to communicate with each other and to coordinate treatment.
It is also your right to maintain confidentiality and not to coordinate treatment – but “dovetailing” these different therapy sessions is more likely to help optimize your outcomes.
The Promises Healthcare website provides assistance to clients to identify their issues and provides photographs, names, languages, qualifications and experience of the specialists who can assist: https://promises.com.sg/about-us/our-team/
We hope that you will be able to find the right help from us.
Written by: Dr. Joseph Leong Jern-Yi
Both bipolar disorder and schizophrenia were considered severe mental illnesses with no recovery in the past. This is not true in modern psychiatry as we have developed more effective treatments such as medications (psycho-pharmacology) and psycho-social interventions (psycho-therapy and psycho-social rehabilitation) which help patients improve their quality of life as well as reduce symptoms and restore function.
Bipolar disorder and schizophrenia may have similar symptoms which are disturbances in thinking, feelings and behaviour. The major difference is that bipolar disorder is classified as a mood disorder whereas schizophrenia is classified as a psychotic disorder. Mental healthcare professionals make diagnoses based on reports of patients, caregivers, or other information sources as well as observations made during the assessment interview.
Experts have also formulated that schizophrenia and bipolar disorder may be a spectrum disorder with schizophrenia on one end and bipolar disorder on the other end with schizoaffective disorder in the middle of the spectrum.
What is more important however is not the exact diagnosis alone but rather the identification of symptoms so that treatment can be effectively targeted at the relief of the symptoms, restoring function and improving quality of life. This targeted symptom approach has proven to be one of the most effective ways of helping persons recover from these brain conditions.
Let’s discuss some of the common symptoms –
Delusions, which are untrue, unshakable, and unshared beliefs which can exist in both brain conditions.
For example, delusions of persecution which are beliefs of being targeted, being followed, being sabotaged (persecutory) are common in schizophrenia while delusions of grandiosity such as believing that they are particularly important persons and have special powers or ability to save the world (grandiose delusions) are more common in bipolar disorder. For persons with schizoaffective disorder, they might have both persecutory and grandiose delusions at the same time. It also has an underlying co-occurring mood disorder.
Hallucinations which are perceptual disturbances such as hearing voices which are not heard by others, seeing, smelling, tasting or feeling things which are not present are more likely to happen in schizophrenia.
Severe mood swings and manic episodes where the person has fast speech and high energy levels are associated with abnormal spending, socialising, exercising, or expanding businesses with the need for very little sleep over a few days and weeks are more likely to happen in bipolar disorder.
More than half a century ago, most persons suffering from these brain conditions were isolated and confined to asylums as there were no effective treatments until the discovery of medications that can change brain chemistry. Neurotransmitters which are chemicals responsible for brain and other bodily functions were discovered. Noradrenaline, serotonin, and dopamine disturbances were more likely causes in bipolar disorder while dopamine imbalance was a more probable cause of schizophrenia. See https://dana.org/article/neurotransmitters/
Modern psychopharmacology offers an array of medications which can act on various neurotransmitter sites in the brain. Several medications and several rounds of adjustment and fine-tuning may often be needed to achieve stabilisation with medications with relief of symptoms. This is best done collaboratively with the patient, psychiatrist, and caregiver at the consultation with all the medications brought in for review.
Adjusting to a new medication through an effective therapeutic trial may take at least 2 weeks, starting with the lowest dose and increasing dosing to a maximised symptom relief dose over 2 months.
Medications need to be taken daily to be effective, and this is best done using a pill box and with supervision from a loved one. Medications are served by nurses in the inpatient hospital setting who ensure that the correct dose is directly observed to be taken by the patient – however, this is often lacking in the outpatient setting leading to the return of the symptoms causing distress and dysfunction.
Comparing bipolar disorder and schizophrenia to other brain conditions may be helpful in understanding how one can better achieve remission and recovery.
Epilepsy is a brain condition where there are electrical firing of neurons causing disturbances in thinking, feeling and behaviour. To stay in control of oneself, the doctor may recommend various combinations of anti-epileptic medications to prevent another seizure. In fact, the model of kindling in epilepsy has been used to understand mental health treatment in this highly readable resource essay – https://aeon.co/essays/should-the-kindling-concept-direct-mental-health-treatment
If you speak to someone with experience with epilepsy, they will tell you about ‘warning signs’ and the ‘confusional state’ after a breakthrough seizure.
Similarly, for those struggling with bipolar disorder and schizophrenia, one becomes more aware of ‘warning signs’, and ‘confusional states’ through direct feedback from loved ones who are observant and psycho-educated by healthcare professionals. Charting, monitoring and sharing your experience are key to success in achieving remission and recovery. Use this mood chart and share it with your mental healthcare professionals for more in-depth analysis – https://loricalabresemd.com/wp-content/uploads/2017/12/Personalized-Mood_Chart.pdf
Symptoms management starts with monitoring your symptoms and the response to the treatment – what makes it better, what makes it worse, whether it is mild, moderate or severe. The frequency, intensity and severity can be charted so that effective treatment of psycho-pharmacology (active use of medications) and psycho-social interventions (psycho-therapy and psycho-social rehabilitation) can be targeted to achieve the best outcome for you.
Your mental healthcare professional can coach and pace you so that it will not be overwhelming. Recovery starts with taking it one day at a time. Be gentle with yourself. Learn to trust and entrust your healing to people who care about you. Learning from feedback as well as charting, monitoring and sharing your experience with loved ones – trusted family or friends or co-workers greatly enhance effectiveness.
Atomic habits by James Clear is an excellent book which illustrates the importance of charting, monitoring and shaping your habits, on the premise of improving 1% daily leading to more than 365% improvement in one year. This is Youtube illustrates how that can happen – “How to become 37.78 times better at anything”.
There are many services available at Promises Healthcare and Community Partners which can help reduce symptoms, restore function, and improve quality of life. Recovery is possible and becomes a reality with appropriate support and adequate skill training. With the right help and support, persons in recovery can live meaningful and satisfying lives.
Here are some real stories that illustrate many facets of mental health and recovery: