Think of the following scenario: you have friends over at your place and you serve them drinks. Before they can place their cups on your beautiful coffee table, you exclaim and dart out coasters underneath the ice-cold glasses before the first drop of dew can drip on that expensive rosewood. Your lightning-fast reflexes have intercepted what would have been a disaster. Your friends are startled at first, then they laugh and tease you. They say you have OCD – obsessive-compulsive disorder.
This, or a similar instance, may have happened at some point in our lives before. We tidy up a mess in the presence of others, or when our belongings are organised ever so neatly, and we end up joking about OCD.
But in truth, OCD is far from such behaviours that could be written off so light-heartedly.
A person with OCD will have compulsions – they feel the need to perform certain repeated behaviours to reduce emotional distress or to prevent undesirable consequences. These compulsions are so intense that they cannot carry out other daily routines without acting on them. Some common ones include:
Excessive washing or cleaning – They fear contamination and clean or wash themselves or their surroundings many times within a day.
Checking – They repeatedly check things associated with danger, such as ensuring the stove is turned off or the door is locked. They are obsessed with preventing a house fire or someone breaking in.
Hoarding or saving things – They fear that something bad will happen if they throw anything away, so they compulsively keep or hoard things, usually old newspapers or scraps of papers which they do not actually need or use.
Repeating actions – They repetitively engage in the same action many times, such as turning on and off a light switch or shaking their head a numerous number of times, up 20 to 30 times.
Counting and arranging – They are obsessed with order and symmetry, and have superstitions about certain numbers, colours, or arrangements, and seek to put things in a particular pattern, insisting to themselves that the layout must be symmetrical.
When Does OCD Become Chronic and What Should You Do If That Happens?
OCD is a chronic disorder, so it is an illness that one will have to deal with for the rest of his or her life. It is difficult to tell when the disorder becomes chronic, as it presents the individual with long-lasting waxing and waning symptoms. Although most with OCD are usually diagnosed by about age 19, it typically has an earlier age of onset in boys than in girls, but onset after age 35 does occur.
A cognitive model of OCD suggests that obsessions happen when we perceive aspects of our normal thoughts as threatening to ourselves or to others, and we feel responsible to prevent this threat from happening. These misperceptions often develop as a result of early childhood experiences. For example, a child may experience living in a dirty and dusty environment, while being subjected to some form of trauma at the same time. He associates a lack of hygiene with suffering from the trauma. At a later stage in life, he may start to feel threatened upon seeing the unhygienic behaviours of someone he lives with, be it his parents, romantic partner, or flatmates. This leads to the reinforcement of the association and to the development of his beliefs that suffering is inevitable when unhygienic conditions are present, giving him compulsions to improve these unsanitary conditions through washing and cleaning.
If one is affected by OCD to the extent that he or she is unable to hold down a job and to manage household responsibilities, then there is a need for clinical treatment as the symptoms have become severe. Like in the above-mentioned example, recurrent and persistent thoughts of dirt will give the individual compulsions to neutralise these thoughts, resulting in repetitive washing, and checking behaviours. This causes distress and significantly affects one’s functioning.
When OCD has become a chronic illness, through a formulation of intervention strategies, the psychologist should extrapolate the client’s pattern of behaviour and expect a positive prognosis for functional improvement.
How Can OCD Be Treated?
A person diagnosed with OCD may seek treatment through a treatment plan that consists of cognitive strategies. These cognitive strategies involve consciously implementing sets of mental processes in order to control thought processes and content. Through these cognitive strategies, we can examine and restrict the thoughts and interpretations responsible for maintaining OCD symptoms. This is conducted in the initial stages of therapy.
Thereafter, Exposure Response Prevention (ERP) methods are carried out once a client is able to understand and utilise these cognitive strategies. ERP requires the client to list out their obsessive thoughts, identify the triggers that bring about their compulsions and obsessions and rate their levels of distress on each of these. Starting with a situation that causes mild or moderate distress, the client is exposed to their obsessive thoughts and simultaneously tries to resist, engaging in any identified behaviours that they have been using to neutralise these thoughts. The amount of anxiety is tracked each time the process is repeated. When anxiety levels for this particular situation eventually subside, over several repeated processes, and when they no longer feel significant distress over this situation, the same method is repeated for the next obsessive thought with the next level of distress.
A client who is able to demonstrate strength in coping with the symptoms has a better likelihood for sufficient recovery.
OCD is Becoming More Prevalent in Singapore: How has it Been Accepted in Society?
In recent years, OCD has topped the list of mental disorders in Singapore, with the greatest number of people experiencing it in 2018, compared with other mental illnesses.
The disorder has been found to be more prevalent among young adults than those aged 50 and above. In terms of socio-economic status, OCD is more likely to occur amongst those with a monthly household income of less than S$2,000 than those who earn above that amount.
It has also been found that the prevalence of people experiencing OCD at least once in their lifetime is higher in Singapore than in South Korea, Australia and New Zealand.
In addition to becoming more prevalent, people who experience OCD are also becoming increasingly reluctant to seek psychiatric help or counselling, making matters worse. There is some acceptance of the condition as normal and trivial by society, because people who do not understand the disorder well enough misconceive OCD as a quality of being clean and tidy, as being clean and tidy is usually seen as a good thing. This misconstrual by society is dangerous for the undiagnosed, and their condition will further deteriorate if they continue to put off addressing their disorder.
The disorder will get worse if treatment is ignored, and there is a need to realise it in its early stages through observing how one’s life is being disrupted. Awareness about its onset of symptoms is important.
Scientists believe we are essentially wired to connect with other people, to socialise and build relationships with others. Indeed, we are all a profoundly social species as our drive to connect with others is embedded in our biology and evolutionary history. But what makes a healthy and meaningful relationship? A healthy, functional relationship usually involves a few characteristics, and trust is undeniably a key one. A relationship can’t last without trust for a number of reasons. We won’t dispute the cliché, “Breaking someone’s trust is like crumpling up a perfect piece of paper. You can smooth it over but it’s never going to be the same again”.
Building trust in relationships doesn’t occur overnight, it happens over time. Trust can be defined as having confidence, faith or hope in someone or something. But in another sense, trust can also mean believing that the other party will act in our best interest. With that said, let’s take a closer look at how we can learn to build mutual trust between ourselves and others in our personal and even work life.
“Say What You Mean And Mean What You Say”
Trust is fundamentally built on integrity, transparency and truthfulness. We trust those that stay true to their words and follow through with their actions. Perhaps it is also our instincts for self-protection, honed evolutionarily over centuries, kicking in. We pick up easily on red-flags and are particularly attentive to the proverbial boy crying wolf. Afterwhich, we learn to adjust our expectations and behaviour, doubting others and trusting them less in order to avoid getting hurt or being let down. Even the smallest of lies, when told frequently over time, will erode the level of trust between individuals. Actions speak louder than words – don’t allow yourself to give empty promises. Learn to keep to your promises and refrain from making commitments you are unable to honour. Be clear of what you have on your plate. In fact, if you are unable to commit to a request or a favour, have the courage to turn others down and explain your situation. Everyone would be worse off if you had promised something but was unable to follow through with it. In addition, avoid saying things that don’t actually represent your feelings. Hiding behind a facade may give others the feeling that you are being manipulative, and that you have an ulterior motive. This will make you appear unreliable and untrustworthy.
Demonstrating consistent behaviour is key to maintaining a trust-based relationship with anyone, whether friends or colleagues. This means constant communications, being clear with your expectations, and being there for others during both good and bad times. How would you feel if a friend of yours is always there when things are going smoothly, but is the first to go off the radar whenever things get rough? Or if she bad-mouths you or reneges on her promises? It goes without saying that we will start trusting these people less over time, having known that they are not likely to support us when we need them most. Regularly showing your loved ones that you are there for them whenever they need support and care will go a long way in building and maintaining a healthier and stronger relationship.
Respect is key in any relationship, and it builds trust by illustrating to others that you value them. If it helps, think of respect as the common denominator in any relationship. People come from different backgrounds and are brought up to believe in different viewpoints. Disagreement or arguments often happen not because we have different opinions, but often because of the way we put our views forward. Often, our trust in and relationship with others are broken because we are being treated with condescension or contempt instead of the respect we all deserve. Likewise, we should always extend basic courtesy to the people around us and respect their right to an opinion.
Watch Your Body language
Did you know that over 50% of communication is non-verbal? Our body language is a form of non-verbal communication. Simple nonverbals that project openness and warmth can include a genuine smile, eye contact, an open body posture and coming down to their level. Moreover, this also ties in with the previous topic of respect. When talking to others, be present in the moment. Sometimes, we focus only on the words we use but neglect what our nonverbals are projecting. All too often, we try to multitask – and sometimes this means that we use our phones while sitting in front of someone else who’s talking. While we are used to multitasking in such a fast-paced era, simple gestures such as taking some time away from our phones and providing our full attention to others when necessary can help us to build mutual trust and respect.
Work on Your Emotional Intelligence
Emotional intelligence can play a huge part in building trust, since it can give you greater insight into how others may be feeling about certain situations. This allows you to be better able to show authentic empathy and give them the support they need. Honing your emotional intelligence will take time, but it can be as easy as making an effort to examine how your words and actions will affect others before executing them. When people feel that you genuinely care for and recognise their feelings and needs, they will find themselves trusting you more. Of course, it is best that you follow through on ways to support them apart from active listening in order to strengthen the trust.
As mentioned, trusting relationships aren’t formed overnight. However, trust is integral to any healthy relationship. Without it, the relationship will end up being shaky and deprive you of emotional security. If you ever feel that a relationship between you and a loved one isn’t working out, and that it is barely kept afloat, it might be a good idea to seek the appropriate help and counselling.
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;
Loss of interest in typically pleasurable activities;
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.
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.
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.
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 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:
ensures that she keeps to a good sleep routine and to have sufficient rest
adopts a healthy lifestyle by having a balanced diet and staying active through exercise
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.”
“I’m depressed”, “I need help”. How do you react when a friend of yours approaches you, hoping to seek help and comfort? In a society that unfortunately stigmatises mental health issues, many of us are most likely incapable of tackling such situations appropriately. Sadly, people would feel a sense of awkwardness, then attempt to shrug it off by changing the topic. Worse still, some may distance themselves from their troubled peers – being unsure as to how they can help and would rather stay away. To date, mental health issues are considered taboo, and many would prefer to avoid talking about it.
Unsurprisingly, it has come to light in recent times that mental health is ranked second in a study conducted on concerns among Singaporean youths, amid others such as employment opportunities. At the fundamental level, we’ll need to be more informed on how we can assist those around us to seek help from mental health professionals when things get hard, and how we can better support them to cope with their condition. The reason behind this is that many would favour talking to their friends before all else instead of consulting a counsellor or a therapist. Besides the stigma of having to seek therapy, the trust and bond between friends nudges them to find comfort in their peers, allowing them to express themselves more easily. To a certain extent, we are at the frontline and act as the safety net for our troubled friends, thus exponentially increasing the need for us to be more mindful of how we respond and act.
What are some good steps to take if you know that your friend needs help? The most helpful thing you can do if they choose to open up to you is to simply listen. When someone approaches you to tell you their problems, it is extremely important that you lend them a listening ear and to hear them out. This will mean the world to them, for it probably took them quite some time to gather the courage to speak up. Set aside some time to provide an open and non-judgemental space for them to be fully transparent with you. It is vital that any distractions are limited, so that they are assured they have your full attention. Revealing their deepest, private thoughts to someone else is never easy, and when they choose to, it will be greatly beneficial in knowing that the other party truly cares for them.
With that said, let your friend take the lead in the conversation. Let them take control over what they’re willing to share, and what they’re not willing to. We have to understand that ultimately, they have the right to guard their personal feelings and privacy, and we should never, under any circumstance, force them to reveal matters that they aren’t ready to talk about. Don’t put unnecessary pressure on them and let them talk at their preferred pace. You could very well be the first person that they have been able to open up to, and it is crucial that you do not break the trust and confidence they have in you.
Oftentimes, people may tend to get overly-absorbed in the conversation, and take on the role of a “therapist”. Unknowingly, they may start to second guess or make assumptions as to what is wrong, and subsequently jump into conclusions with a possible diagnosis or solution. However, hold your horses – bear in mind that you are neither a trained therapist nor a psychologist. Don’t label them with what you think is going on. Focus on providing them with a reliable listening ear or a shoulder to cry on instead.
Providing words of comfort may seem easy enough – but there are pitfalls in which we often walk into unintentionally. “Things will be better tomorrow”, “I felt the same when I…” Such words are rarely made out of malice, but rather because it is easier to fall back on such overused expressions whenever we struggle to find the right words. However, this could backfire, as the underlying tone may come off as dismissive, unhelpful or even judgemental. Instead, validate their feelings and thoughts. Assure them that you will be there whenever they need someone to talk to, and that it is okay for them to feel what they feel. Moreover, avoid making comparisons between their experiences and yours. Every individual’s journey is personal and unique to them – try to make the conversation less about you and give them a space to express themselves freely.
Focus on how your friend is coping as the conversation carries on, and be alert to any red flags. If it becomes obvious that your friend needs help dealing with emotional issues or a mental health problem, talk to them about receiving proper treatment from a mental health professional. It may be tough to start such a conversation as a person’s culture, family background and experiences may influence their perception about seeking help, which makes such a topic about therapy an intense and personal one. Initially, you may expect some resistance, as they might feel a sense of shame and failure. Remember to reassure them that receiving therapy is not a sign of weakness, but rather a sensible way to deal with their troubles. If possible, simple gestures like offering to accompany them to their first session can also be comforting, for they will be less likely to feel abandoned.
Being patient with them is key, even if your friend is rejecting professional help. Your conversation may have started getting them to consider it, even if it doesn’t mean seeking help immediately. Try to see things from your friend’s perspective and just be there to support and encourage them. Doing this will help facilitate on-going deep and meaningful conversations, and can make your friend more receptive to reaching out to you and for professional help in the future when they are ready.