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.
There isn’t consensus in the scientific community about whether Kubler-Ross’ five stages of grief is rooted in empiricism. Although much vaunted in popular culture, if you’ve experienced grief and resolved it in your own way, you’ll know that grief is an organic process that is by no means neat or orderly. It’s deeply unique to each individual, and this article is designed to hopefully help you through whatever loss you have experienced in the recent past.
The five stages of grief, which Kubler-Ross first postulated that terminally ill patients experience are: Denial, Anger, Bargaining, Depression and Acceptance. Denial in this context encapsulates a perfectly normal response to a tragedy, and is exactly what you would imagine – it’s simply a refusal to believe that “this bad thing is happening to me”. After reality sets in, and the sobering realisation that the tragedy has occurred is impossible to ignore, Kubler-Ross observed that people often display frustration, which culminates in Anger. Once that Anger has dissipated, people often move on to Bargaining, which is the hope that they can somehow extricate themselves from their dire straits and obtain the balm of a different circumstance. Notwithstanding the success of the earlier bargain, Depression follows, which is self-explanatory. The final stage of Acceptance is the sanguine realisation that nothing will change their situation.
If you are currently going through your own grief and taken a step back to evaluate how you are processing it, you might have noticed some incongruencies between the model and your experience. That’s perfectly natural because there has been some criticism levelled at the Kubler-Ross model in that there is confusion over description and prescription. This means you shouldn’t take it as a rule, no, or feel inadequate or “bad” that you aren’t “properly” grieving. We hope that what follows in this article will provide you with some breathing room to let your grief take its own course, and helps you handle a tragedy with the right tools.
Grief is a loss. It’s your prerogative to define what grief is to you, and even something as banal as losing a cherished item from your childhood can precipitate feelings of loss. So, you shouldn’t wall up these feelings behind what society has proscribed as appropriate. We’re talking about you here, not anyone else. It bears repeating that your grief is unique because of a multitude of factors, for those of you who don’t want to accept that it is your right to give yourself the breadth to grieve – your upbringing, your culture, your faith, your parents, the list is endless. So give pause and slip into your own rhythm of grieving.
To help ensure that you do not slip into the common fallacies that can disrupt your grieving process, we’re going to list some of the pitfalls that ensnare people and prevent therapeutic processing of grief.
1) If you don’t show an outward display of grief such as crying, you aren’t “sad”
Just like the shortcomings of Kubler-Ross’ model, while crying is seen as a “socially acceptable” way of demonstrating sadness, it isn’t applicable to everyone. You may have been brought up to avoid tears at all costs, perhaps due to tough parenting or some childhood trauma, or you may not wish to “affect” others with your grief. No matter the reason, you should know that physiological responses to grief vary widely depending on your circumstances. Shock, numbness, anger, even hysterical laughter – just about anything is permissible in the initial, very private stages of your grief.
2) If you don’t “get over it” within an “acceptable timeframe”, you aren’t good enough
Although your family members or people in your community may react to and resolve their grief earlier than you, you need to know that it is by no means healthy to affect the fragility of such a process by introducing the pressures of comparison. Some people simply have better coping-skills than others or are more inured to unhealthy thought processes that hold them back from the therapeutic management of their grief.
3) You feel like you need to “protect” loved ones from your grief, so you turn inwards
We keep emphasizing that grief is individual to everyone – this should tell you that there is no circumscription to how you handle it. Even though it might feel selfish to display your feelings openly because you think less emotionally able loved ones shouldn’t have to deal with your pain, remember that there is nothing shameful about the old adage, “Shared joy is double, shared sorrow is halved”.
There are some simple coping mechanisms that you can use to help yourself through the process. Although the low mood is a given after the heartache of a tragedy or loss, and you might not feel willing or able to pick yourself up and carry on, remind yourself of the wisdom of eating and sleeping right. Drugs and drink might seem the most accessible ways to insulate yourself from poor mood, but these indulgences, in the long run, are hindrances to sustaining your mental well-being.
If you feel like the person you have lost needs to be remembered, you can do so in the solitude of creative expression, or you can choose to gather loved ones to laugh about cherished memories. If there’s one scenario where laughter in the face of loss is wholly acceptable – here it is! Whether communal or solitary, there are many ways you can raise someone up in loving memory – honouring them and helping yourselves.
Find solace in your old routines. If you’re hurting after the failure to gain acceptance into a school of your choice, it may help to remember all the things you did well before that gave your life meaning and structure. At the worst of times, it helps to fall back on old patterns if only to hang on to some stability.
Lastly, know that there is a difference between clinical depression and the normal response to grief. You should be aware of critical signs or symptoms in both yourself and your loved ones that may indicate depression. For example, if you notice that your loved one isn’t eating or sleeping properly after a long period of time, or is displaying reckless tendencies such as driving dangerously or overindulgence in addictions, it may be time to seek professional help. Although many people can get through grief without the help of a mental health professional, when it all gets too heavy to handle, you may consider seeking grief therapy. Some of our clinicians are specifically trained in grief therapy, such as Joachim Lee or Winifred Ling.
“I forgive you.” while on the surface seems to be an innocuous word and easy to say. But in reality, it’s one of the most difficult words to express in our human language. A few years ago, a middle-aged man angrily dragged his 13-year-old son to our clinic, it turned out that Mr Zhang (pseudonym) had discovered his son hiding in a corner of his room smoking, and slapped the boy hard in a fit of anger. Even after being scolded the boy was recalcitrant and didn’t even feel remorseful. In her efforts to appease the situation at home, his wife suggested bringing the son to see a counsellor.
On that day, I happened to walk past the therapy room. I could only hear the loud arguments between the father & son, and loud sobbings of the mom. Just as I stepped into my office, my office phone rang. It was an urgent call from my colleague, the therapist, who alerted that the situation was getting a bit out of hand, and asked for my assistance in the therapy room. Upon arriving at the scene, I could hear the son’s angry retort, “You’ve never loved me since young, why are you trying to control me now? All you’ve ever done was scolding me. So what if I behave myself? Would you even notice?”
It took more than an hour to calm all parties down. After which, I carefully interviewed both Mr Zhang and his son, and I finally got to the root of why the situation had become so tense between father and son.
It wasn’t the 13-year-old boy who had caused the breakdown in their relationship. The issues stem from painful experiences when Mr Zhang was growing up. Mr Zhang had grown up with an abusive father who was not only alcoholic and chain-smoked, who often vented his anger on his wife and children. As a result, Mr Zhang made a vow from young to never touch alcohol and cigarettes. Unfortunately, his demeanour also became very stern with hardly any smile on his face and had high expectations with his own children. Why did it become like this? It was because he had never forgiven his own father. The deeply buried hurts had made him prone to irritability, and thus he didn’t know how to praise or encourage his own child, and only knew strict discipline as his way of bringing up his child. Moreover, his biggest worry had been over his child coming into contact with alcohol and tobacco.
Mrs Zhang explained, her husband was a good man, but was a man of few words, and was not good in expressing his feelings. She knew that he really cares about the child, but it was a pity that communication was poor between the father and son. As a result of a craving for his father’s love and experiencing scolding and punishment from young, the boy had grown to become more rebellious in recent years.
In fact, Mr Zhang’s father had quit smoking and drinking for many years. However, as a result of the poor relationship between Mr Zhang and his father coupled with a break in communications for more than a decade. Mr Zhang couldn’t come to terms with my conclusion initially. But for the sake of his own son, he finally agreed to receive counselling. After several months, he finally understood the root cause. He asked me, “I’ve finally understood that the root cause of my frustrations was the unresolved anger and hatred towards my own father, but what should I do after so many years?”
Fortunately, one day his mother decided to visit their grandson together with his father. Although he felt embarrassed initially, Mr Zhang struck up his courage, squarely faced his dad and said: “I forgive you.” This simple yet miraculous sentence seemed to untie the knots of anger and hurts between Mr Zhang and his father. From that day onwards, Mr Zhang began to smile more frequently face and he could finally express his love fully to his son.As a result, his son stopped being rebellious. Not only did he stop smoking, but also paid more attention to his studies.
As a psychiatrist, I’m truly happy for this family and admire Mr Zhang’s courage in forgiving his own father. They continued with counselling for some time, and finally mended their father and son relationship that was formerly broken.
Therefore, forgiving others is also giving ourselves a chance to receive complete healing.
I am a self-confessed introvert. And I’m also an addict.
I was recently cajoled into attending a Psychodrama session. I’d heard things about it – years earlier, my then significant other lauded the raw emotional exploration her sessions afforded her. I encouraged her, it was good for her. Personally though, I found the idea of a group session’s ability to evoke genuine emotion alien. It was the antithesis of who I was.
I had never enjoyed group sessions. I hated them. The introvert in me screamed (silently) in indignation at being forced into a room with my peers, lorded over by therapists who would extol the heaven-sent power of vulnerability, hanging it over the heads of us sullen detainees. They would espouse connectedness with others, openness. To me, these were just unattainable states of being that I could never actualise. The years wore on, and I plodded along, entwined with my precious, thorny, addictions. Prison, pricey rehabs abroad. I took care to never bring my real self along to the banal group therapies – I merely presented them with an alter-ego. Faking it to get along. Or “faking it to make it”, in the parlance of addicts like myself who would say or do anything to achieve a discharge.
I was living an entirely unremarkable life, losing friends and embarrassing myself.
Then, I experienced a seismic shift in circumstances. To represent it as merely ‘mandated’ would be to deny gravity to what had happened. I had run afoul of the law again, and paid my penance with a 9 month long “drug rehab”. I got out, and three months later I was a year clean. Still, I wasn’t happy. I had done no soul searching, nor had I even begun to scratch the surface of my addiction, always lurking in the shadows. Of course, a large part of my reticence towards accepting sincere nudges in the direction of help could be attributed to personal and moral failings. But why was I the person that I was? That’s when I decided to attend a psychodrama workshop at the urgings of my boss, a sweet girl whose genuine concern had initially confounded me. Why did I acquiesce? To understand myself, I guess. So, I went in with an open mind.
Psychodrama is about exploring internal conflicts, by acting out emotions and interpersonal interactions. I wasn’t inclined to be the center of attention just yet, so I left other enthusiastic participants to play the protagonists. The director, a bubbly personality whose sharp wit was tempered by insightful, genuine empathy, herded a roomful of clueless attendees with a deft hand, schooling us in psychodrama’s basic concepts. I made myself small in the corner and watched as our director doubled volunteers, acting out scenes from their lives, giving voice to their unconscious. Revelatory perspicacity was the order of these moments. I watched as they were mirrored, experiencing themselves from the outside, drawing from a nonjudgmental pool of collective consciousness. I watched as roles reversed – mothers became their daughters, and wives their husbands. All of them seemed edified, comforted, even. Misty eyes and rivulet strewn faces, sighing into closures when none previously seemed possible. There was a woman pained by a frightful trauma, her repressed malefaction she seemed so sure she had committed driving her to seek expiation from whom had ceased to be able to give her any. From the outside looking in, I was sure her wound was self-inflicted – we all knew this, but one’s own guilt is deeply personal, often insidious. As her situation percolated in my mind, so did my own guilt. I hadn’t wept when I learned of my father’s and sister’s departures, I hadn’t wept at their funerals, I hadn’t wept at their memorials. I hadn’t needed to, because I had my addiction. Now, without the pernicious warmth of substances, these losses became some therapeutic cynosure of a starting point. I had begun to understand myself, through others. The cynic in me finally realised why, across addiction recovery literature, syllabuses are almost invariably characterised by the motif of benefits accrued by group therapy. I think it owes something to the collective experience of humanity, that no matter your guilt or your shame, there are people out there who have lived congruent experiences. It may seem cloying and mawkish for me to say that no-one is truly alone, but it’s true.
COVID-19 has posed a challenge to everyone, and those more physically vulnerable in our community clearly need our care and attention.
There are also people whose mental vulnerability deserves equal care.
Mental illnesses such as depression, anxiety, and addictions are exacerbated by a pandemic crisis in multiple ways.
Collective family and community fears are (in themselves) contagious; and the constant bombardment of medical and financial bad news, can leave those with mental illnesses lost in a cascade of negative rumination and catastrophising.
The mentally ill and people with addictions commonly have compromised immune systems, and suffer stress or substance, tobacco and alcohol abuse related diseases – leaving them wide open to severe pneumonia with acute respiratory distress symptoms – and other complications from COVID-19.
Isolation, separation and loneliness – caused by working at home and social distancing – are perhaps the worst contributors to: low mood; agitation; irrational fears; moments of panic; self-disgust; resentment; anger; and even rage.
People whose ability to pause, use reason and find practical solutions can be severely compromised. They may find themselves bereft of the motivation, and ability to engage in even the simplest tasks of self-care.
Added to this, listlessness, boredom and frustration can lead to despair. Then self-harm and suicidal thoughts may arise, take hold, and even overwhelm them.
Those in recovery or active addiction may also turn to their compulsive and impulsive behaviours of choice, to sooth and find momentary respite from the moods and thoughts that have hijacked their mind. Triggers, urges and cravings may become relentless and unbearable.
The solution may begin with finding a way out of isolation.
Starting the journey out of this darkness can start with talking to people who can demonstrate unconditional positive regard, show kindness and compassion, and help reframe the situation. Such people can assist those suffering to put a name to and validate their emotions.
In short – therapy can help!
In times of COVID-19, working with a therapist via teleconsultation can be effective using ZOOM, Skype, WhatsApp video and FaceTime.
Although the calming and soothing sensation of the physical presence of a therapist is absent, for those in isolation – distraught with shame and despair – Internet enabled therapy can prove a lifeline.
Isolation can be further broken, using similar Internet methods, by attendance in recovery groups such as Alcoholics Anonymous, Narcotics Anonymous and Sex and Love Addicts Anonymous – all of whom now hold Zoom meetings in Singapore.
These Zoom opportunities in Singapore are supplemented by Zoom, Skype and telephone conference meetings in Hong Kong and Australia (in Singapore’s time zone) and in the U.K. and the US (during our mornings and evenings).
Having broken the isolation, the second step therapists can provide is guidance and motivation towards self-care. This would include tapering or abstinence from the addictive substances or behaviour. A well thought through relapse intervention and prevention plan, specifically tailored to a person’s triggers, will also assist.
Triggers may be particular places, situations, people, objects or moods.
The acronym “HALT” is often used by those in recovery; which stands for the triggers of being: Hungry; Angry; Lonely; or Tired.
When these triggers arise, people are encouraged to
HALT their behaviour;
breathe deeply, with long outward breaths;
think through consequences;
think about alternatives;
consult with others; and
use healthy tools to self-soothe.
Daily mindfulness, meditation, exercise, sleep hygiene, healthy eating and following a medication regime are important aspects of self-care – and for some suffering mental illness – these actions – and time – may be all they need to find their footing again.
Luckily, the Internet gives a vast array of possible self-care options, including things to distract us, soothe us and improve us.
Everything is available from: calming sounds and music; guided meditations; games; home exercise, yoga and tai chi; self-exploration and improvement videos; video chats with loved ones; to healthy food delivery options. They can all be had with a few keystrokes.
Today we live at a time when suffering from mental illness and addictions is commonplace. But we also live at a time when the solutions are literally at our fingertips – if we only reach out for them.