Hello all,

This is People Psychological Solutions. We are a private psychological practice located in Mont Kiara, Kuala Lumpur.

The purpose of this thread is to offer quality advice and answers to any mental health-related questions that you may have.


THE PSYCHOLOGIST IS IN SESSION

To give you a background of myself: my name is Alvin Tan Kuan Sean, and I am a clinical psychologist here in Malaysia. I am currently managing two private psychological practices, and had started up (and exited) an online counseling app platform. I have presented at two TEDx events speaking on mental health. You may look up my membership (CP1-0087) on the Malaysian Society of Clinical Psychology (MSCP) registry. My profession is governed by the Allied Health Professions Act 2016. I will be the one attending to your questions.

In my daily work routine, I consult clients typically presenting with mental health issues, such as depression, anxiety, substance abuse, and others. The services that I provide are mental health assessments and counseling. I am aware that it can be confusing, and even overwhelming, in seeking the right services or to have the right knowledge in managing mental health issues faced by you or your loved ones.

So, I am here to provide guidance and resources in order for you to get started.


HOW IT WORKS

1) You may post your question by replying to this thread, or you may PM this account directly. All PMs will be treated as confidential, and you will remain anonymous.
2) I will provide answers only in this thread. This includes any PMs sent to this account. I will try my best to suit the answer to the individual, but with due consideration that this is meant for public consumption. So, the answers provided will cater to the general audience to benefit from as well.
3) All answers will be evidence-based. Clinical psychologists are trained from the scientist-practitioner model, in which we only practice guided by research.
4) I will log into this account and answer to this thread within a 48 hour period from the last time I had come online.
5) As volume of questions may be unpredictable, I may not be able to attend to all questions. I will be picking questions which I find are most relevant, or providing an answer to a few questions in general. While I will most definitely provide a response in this thread within a 48 hour period, but I am not obligated to provide a response to all questions.

Important disclaimer: All information provided here is not a substitute to receiving professional mental health services. If you are at risk of physical harm to yourself or others, kindly seek out immediate help from mental health services, government hospitals, or the relevant authorities. I, and any organizations that I represent, will not be liable for your personal safety. If you have questions regarding a prescription that you are on, kindly seek advice from the psychiatrist consulting you instead.

I am hoping that I can be helpful to Internet folks on here. Looking forward to your questions. Ask away!

Thanks for creating this thread. Since no one has said anything here, let me get the ball rolling. Although I do not have any obvious mental health issues at the present that I am aware of, I believe that few of us have a 100% clean bill of mental health. As such, are there simple diagnostics questions/tests to gauge one's mental health to uncover any underlying issues?

Good evening,

That is a great question! Thanks for being the first.

Before answering your question, I'd like to offer the bigger picture of mental health, and then getting into the details of the need for a diagnostic test.


Common Mental Disorders (CMD)

When we are thinking of the general population who are in good mental health, we are considering the majority of the population (the Average Joe/ Jane) who has generally got on with life with minimal or some (but manageable) emotional difficulties. However, at some point in time, a stressor may have triggered a diagnosable mental health issue. Typically, this mental health issue arises from:

a) predisposing genetic factors (e.g. a family history of depression), that is combined with
b) environmental factors, such as early trauma, or stressors such as job loss, marital conflict, a break up, financial issues, and so on.

A mix of these factors could develop common mental health issues, such as depression and anxiety. Lifetime prevalence (meaning, chances of getting a diagnosis for either one of these) are rather common. So common, in fact, that these two groups of disorders are known as Common Mental Disorders (CMD).

The famously quoted National Health Morbidity Survey 2015 by MOH Malaysia offers a glimpse of how common mental health issues are in Malaysia. 29.2% of Malaysian are experiencing some kind of mental health issue. While the national survey did not offer diagnostics, but rather a screening, it offers a glimpse of how our modern society are really a stressed out bunch.


Meeting Diagnostic Criteria

We now know that mental disorders such as depression and anxiety are common. How do we know if we are feeling low or instead have clinical depression? Experiencing difficult emotions are part of everyday life, but one key feature to determine whether or not it meets a diagnosis is the impact such difficulties have on the person's daily functioning. It is worthy of professional evaluation if the person's functioning is impacted in at least 2 main areas of their life. This may include:

* Physical: Not practicing adequate self-care and hygiene, not managing daily health habits, such as eating/ sleeping.
* Occupational: Not attending to work responsibilities, not being able to hold on to a job for long, getting into conflicts with colleagues
* Social: Frequent relationship conflicts, withdrawing from social roles

A good gauge of whether or not a person should seriously consider professional help is how much he/ she notices concrete, observable parts of their life isn't going along well for a longer period of time (few weeks and more).

The reason why I'd think it's much easier to consider more concrete aspects of life functioning is because we may not be very good in observing our own mental health. For example, we know that Asians frequently mistaken their mental health issues as physical discomfort/ complaints. It is rather common to see in our healthcare system of people coming in with a variety of physical pain or discomfort, when what they are actually experiencing is a CMD.


TL;DR

1) About 3 out of 10 of Malaysians are experiencing a mental health issue (it's common).
2) Depression and anxiety are common. It might be the "new new normal" at some point in the future.
3) We aren't too good at figuring out our own mental health (perhaps, it's best to refer to a mental health professional to assess you instead). Of course, with some training and therapy, this ability improves tremendously.
4) What you can assess more accurately though, is your level of functioning in your day to day life. This can include how you are taking care of yourself, your social roles, and/ or your occupational roles. If you find that things have been falling behind and you've been rather overwhelmed in catching up, perhaps seeking a mental health professional can be a good idea (such as People Psychological Solutions! ).

Hope this helps!

Good evening, LYN!

You may feel confused with the kind of choices that you have with regards to the type of mental health professional that is available in Malaysia.

In brief, here are the main competencies of each type of professional:

Clinical Psychologist
mental health assessments (including stardardized testing like IQ tests)
diagnosis
psychotherapy (otherwise known as "counseling").

Psychiatrist
mental health assessments
diagnosis
prescribe medication (otherwise known as "pharmacotherapy")

Note: although psychiatrists are primarily trained from the medical model, some do provide psychotherapy.

Registered Counselor
counseling


There are other variants involved in the field, but the above are the main ones. Note: Life coaches, NLP practitioners, hypnotherapists (unless with clinical background) are not considered mental health service providers.

You may read more into the details of the above here: https://people.my/clinical-psychologist-psy...lor-difference/

Hi Mr. Alvin. Thanks for your volunteering service.

Do you think it is possible for someone to have split personality (DID) and that the coexistent personality is anti-social?

I mean personally I think I have recovered from the anti-social personality and no longer felt that I have fragmented identities. But how do you evaluate someone if the person has a split personality which is anti-social, and how do you know if the person has recovered?

Hullo there, BigW!

Hope you're doing well.

To clarify, when you say anti-social personality, do you mean a type of person who'd prefer to stay in/ not mingle with others? Or, do you mean a person who shows disruptive behaviors in society, such as Antisocial Personality Disorder? Common terms may be different than ones used among mental health professionals.

Dissociative Identity Disorder (DID)

To give an overview to all readers here, Dissociative Identity Disorder (DID) is a mental disorder to which a person has separate personality altogether. It is as if multiple people are living in one body. It is most commonly depicted in movies.

It is a highly contested diagnosis, due to a variety of reasons to elaborate here. Firstly, there is evidence to show that such "multiple personalities" could be unknowingly acted out by the patient, as opposed to it being actual, multiple personalities in one body (in medical terms, this is called "malingering"). However, there is evidence to also point that it can indeed be an actual diagnosis, with most patients having experienced a history of childhood trauma. An example of an article on this can be read here.

There are no known effective treatment, other than one, which shows a treatment duration of a very long time (years) to fully integrate these personalities into a single functioning one.

In performing an assessment, it is important to differentiate between a variety of different experiences a person could have in order to come up with an accurate assessment on whether someone indeed has DID. Some of what I can think of are:

1) PTSD
2) schizophrenia.
3) "out of body" experiences such as derealization or depersonalization.

It is wise to not conclude about having a diagnosis without first consulting a mental health professional to undergo an in-depth assessment. Since this is only a post online, I am unable to conclude any diagnosis or an assessment of your condition. There are many explanations of why a person feels like they have multiple personalities, without actually having the diagnosis.

Your answer

But, reading more into your question, I do not think that this is what you mean. Rather, it sounds like what you're saying is that you have different "sides" to you, one which is your usual self, and another which is more "anti-social". Do correct me if I'm wrong.

To provide an answer on whether or not someone has "recovered" from a mental health issue, is to go back to the fundamentals of human functioning. That is, a person is mentally healthy if he/ she is able to integrate into society, perform their social roles meaningfully (e.g. hold a job, maintain family and friendship ties), and able to manage their own self (e.g. physical health, hygiene, self-care). This is most important, and should be the goal of the mental health professional when consulting their clients. Labels and diagnoses are secondary.


Hope this helps!

Good evening, folks.

Feeling depressed?

As what was mentioned in a previous post, depression is very common. It is considered a Common Mental Disorder (CMD). It is so common, that it is theleading cause of disability worldwide.

So, I think, it's more important now that the conversation moves towards normalizing such a common thing. Feeling depressed? OK, there is no shame to be open with this, because in all likelihood, the people around you have also felt or will feel depressed at some point in their lives. Whether they are willing to admit it is another thing.

What's more important now is to gain access to knowledge and resources to help cope and recover from such an illness. Psychotherapy/ counseling or pharmacotherapy (medication) has been found to be effective in treating depression.

On the other hand, some practical steps to consider:
1) Get yourself moving. Exercise. If you are completely sedentary, starting with a 5 mins walk is already a big improvement.
2) Get connected to others. Talk to others just for the sake of talking. It doesn't have to be about how you're feeling. It can even be about who's going to be the new PM, for example
3) Allocate time for fun or learning a new skill. If all you're doing is work and nothing else, pin down 1 hour on the calendar per week to do this. Identify what activity that would be. Make yourself do it.
4) Work your way up in increasing 1 - 3 over time.

I understand that you'll feel sluggish, demotivated, and find it difficult to get started on things when depressed. If that is so, these works better when there's someone working through the details with you, such as a therapist.

I'm sure there's more to your depression than just applying those few steps. But, I think these are pretty evidence-based to begin with. Exercise, socializing, and doing pleasurable/ mastery activities have solid science in terms of improving a person's depression.

Working with a therapist would instead allow you to work on the other jumbled up parts of what makes the depression overwhelming.

If you're keen to understand more deeply as to what causes depression, here's an article I wrote about causes of depression: https://people.my/what-are-the-signs-of-dep...what-causes-it/

Have a great evening, folks. Stay safe!

Good evening, folks.

Once a week, the team gathers to have a meeting just to learn and further develop their clinical skills.

I presented on the topic of depression and men in this week's meeting. This included fact finding and reading up on latest research prior.


DID YOU KNOW:

Depression is reported in about half of men compared to women. For example, 2 women will report being depressed but only 1 man. BUT...

Suicide rates among men are 4x more than women.


WHY IS THIS SO?

The fact is, men display more externalized issues much more than women. "Externalized" here means that issues that can be seen and/ or felt on the outside. This includes alcohol abuse, anger issues, and physical pain. Through a man's upbringing and social expectations placed on him, he has learned that being a man means not showing signs of weakness. If a man is upset, it is instead shown on the outside, through acts of aggression or physical illnesses. Or, he can choose to self-medicate by abusing substances.

There are a few frameworks in mental health that tries to explain this phenomena, namely calling it "masked depression" or "masculine depression".

Men experience a lot of pressure to "be a man". And society tells him that it is not okay to be sad. So instead, he becomes angry. What we are learning through science is that beneath the surface of an angry man, is instead a sad man.


WHAT CAN BE DONE ABOUT IT?

If you are a man and this post speaks to you, I'm on a journey of wanting to normalize having feelings and being a man at the same time. I have just started a support group for Malaysian men. It will be a safe space for us to chill, talk, and share our thoughts and feelings. This is how it should be

Care to join me? It's an FB group, so click here to join: https://www.facebook.com/groups/supportgroupformenmalaysia

Good evening, fellas.

To follow-up from the previous reply, I had shared about how depressive symptoms differ between men and women. Men demonstrate less help-seeking behaviors, and is less likely not to recognize depressive feelings. Instead, men tend to demonstrate more anger, irritability, and hostility when depressed.

If your are a male and suspect that you may be depressed, you may assess for these signs instead (source):

* Anger, irritability, or aggressiveness
* Feeling anxious, restless, or “on the edge”
* Loss of interest in work, family, or once-pleasurable activities
* Problems with sexual desire and performance
* Feeling sad, "empty," flat, or hopeless
* Not being able to concentrate or remember details
* Feeling very tired, not being able to sleep, or sleeping too much
* Overeating or not wanting to eat at all
* Thoughts of suicide or suicide attempts
* Physical aches or pains, headaches, cramps, or digestive problems
* Inability to meet the responsibilities of work, caring for family, or other important activities
* Engaging in high-risk activities
* A need for alcohol or drugs
* Withdrawing from family and friends or becoming isolated

Hope this information was helpful!

Good afternoon!

If the two replies above regarding men, mental health, and depression is too much to read, here's a video instead:

Hello, I have a question for you.

For context, I've been diagnosed with depression before and had to deal with suicidal ideations in the past, though I have been able to handle it better now. My question is about something new that I am experiencing.

Recently I have been feeling very unworthy, as in lack of self worth. Along with a splash of loss of interest in my work and in activities I used to enjoy. Even libido has gone down quite significantly. This has been going on the past 3-4 months perhaps. I am able to dive head first into working out and getting physically fit however, so that is a welcomed distraction.

Is this a different manifestation of the depression? Or is it something new and different that I should be aware of?

Hi, Npad.

Great question.

Two main features of depression are:

1) depressed mood
2) anhedonia

Either one of these must be fulfilled in order to further assess for clinical depression.

Anhedonia refers to a loss of interest or the inability to experience pleasure from activities that would've otherwise activated such feelings (interested/ pleasurable). This is because when a person is depressed, the brain's reward centres isn't as activated like how it would be when the person is not depressed. As a result, the person doesn't feel motivated in doing things (because doing things isn't rewarding - no pleasure/ no interest).

So, what I'm trying to express here is that being depressed doesn't only mean depressed mood (e.g. crying, overwhelming sadness all day), but could also come in the form of lack of motivation/ lack of interest.

Further to that, feelings of worthlessness, overwhelming feelings of guilt, a loss in sex drive (related to anhedonia), fatigue, irritability, can all be possible symptoms of depression.

Feeling down (like how we would every now and then) or actually meeting criteria for a depressive episode would be determined by a mental health professional. Generally, a mental health professional will look to see if you fulfill the criteria and if it is significantly affecting your life's functioning.

Either way, depressive episodes can come and go, and can be considered a rather common mental health issue (see above post regarding common mental disorders). The key here is to be able to develop awareness when such feelings come, what to do with them so that it can be managed, and to be able to live a satisfying quality of life thereafter. The point of assessment or diagnosis is just that - to understand what the client is experiencing in order to start helping him/ her.

When you've developed the wisdom in being aware of the fluctuations in your mental health and how to effectively manage it, you'll be in a good place

It's also great that you're keeping fit - it's one of the most effective ways of combating depression. Keep up the good work!

Hope the above answers your question

Good evening, fellas!

As a follow-up to the above on the topic of depression, I'd like to chip in a word or two regarding the benefits of exercise.

Oftentimes, people seek modern solutions, but disregard the basics. You'd need to first know how to walk first before running, right?

This is the same when we experience mental health issues, such as depression. How many of us actually consider having in place basic health habits as part of our "treatment plan"?

Oftentimes, when a client comes in feeling depressed, not only are they most likely going through a variety of social stressors, e.g. a break up, job uncertainty, etc., but in all likelihood, their lifestyle habits will also be out of whack. They may have been eating unhealthily, having way too much alcohol to drink, chronically not getting enough rest, and/ or living a sedentary (no exercise) lifestyle.

First order of business in treating depression would likely be to assess their daily activities, and making adjustments to them. We call this "activity scheduling" and "behavioral activation".

This includes increasing the amount of exercise that you are doing on a weekly basis. If you are sedentary, the goal could be to increase it to 20 mins/ week, and working your way up from there. This goes the same with setting aside time purely for rest/ sleep.

The reason this is important is because mental health is also your physical health. They are both related. Taking care of your physical health would also contribute to your mental health.

TL;DR Exercise is good for your mental health. Start small, and work your way up in increasing your physical activity.


Here's a journal article on benefits of exercise for depression (skip if you don't like the science stuff): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/

Good evening all,

Many may be curious or confused about how counseling ("therapy") actually works. It may feel quite strange that two people would sit together, as one listens while another talks about his/ her personal issues.

But, while there may be too much detail of how therapy works and what happens (it also depends on what type of therapy is conducted), I would like to share 3 very practical takeaways from therapy:

1) You develop skills in managing things in life that are otherwise overwhelming. E.g. you learn how to break down your problems into smaller, manageable parts; you learn how to evaluate the advantages/ disadvantages to the decisions that you make; you learn how to communicate what you truly think/ feel to loved ones, etc.

2) You bring down your emotional reactions by having someone you can trust and views the matter objectively. We tend to catastrophize and think in extreme biases, causing unwanted emotional reactions and hurtful actions to others around us. Having someone listen to you objectively and non-judgmentally allows you to process through these emotions and why you felt that way. From there, you have more objectivity over the options that you have, and to be able to undertake decisions which are best for you.

3) You learn about what you are going through. Most of the time, we may be confused about what our thoughts, behavior, or emotions mean. When we learn about, for example, the symptoms of anxiety, and that the funny physical reactions that we have are in fact a normal experience (e.g. I'm actually anxious, it's not because I'm getting a heart attack) can be relieving. Through this, we become better educated and prepared to manage them better.

So, I hope that this offers you some clarity as to what to expect when you sign up for a counseling session!

nice thread you have here sir... keep it up...

All the best Mr. Alvin.

Thank you for the kind words of encouragement, the both of you above!

Was starting to think that it's getting a little lonely in here, haha

This prompted me to look up the effects of verbal encouragement on performance.

Relationship Quality = Better Mental Health?
Relationship building plays a big role in a person's mental health. In fact, a recent study on the effects of relationship quality on mental health during the COVID-19 pandemic found that relationship quality plays a protective role for better mental health. The stronger the relationship quality, the better the mental health.

I was wondering how do we improve relationship quality? Perhaps we could be a little more kind to others, would that work?

Words of Encouragement
What about words of encouragement? Does it help others around us by being more encouraging? This study found that verbal encouragement actually helps with a physical performance task. So, it makes sense that coaches are often screaming at the top of their lungs to the athletes (maybe adding some nicer words would be good )

Conclusion? For better mental health and performance, invest in building quality relationships and place yourself in the presence of supportive people. You too can help others by encouraging others (like me)!

Have a great day!

Dear TS,

Thanks for a truly informative thread 👍

In your opinion, is it possible for some one to fake mental illness say schizophrenia? I do know of one shady character that's supposedly schizophrenic and has given no ends of problems to the family members.

I doubt the persons illness due to the following reasons

1. Ability to drive up to hundreds of km from one state to another without any issue. Arrives at destination safe and sound. I asked and the family members confirm the person doesn't even have a single traffic summons!

2. Displays problem solving abilities or rather cunning when the situation demands it. For instance when the friends and family have planned to get the person committed, the fella somehow gets wind of it and acts out even worse to create a scene or run away. Going out for dinner, miraculously no problems to tag along

3. And when committed once, actually followed the program and took meds. Appeared to have recovered but once discharged reverted back to crazy in an instant

The family is keen to help but to me as an outsider It does seem abit suspicious. However as an outsider, I also don't have much of a say

Thanks in advance

Hi there 9m2w,

Thanks for the question.

To clarify, when you say "committed", you mean to say that his family had wanted to admit him into an institution?

Based on my understanding of your post, you are asking if his behavior is indicative of schizophrenia or a behavior which is otherwise normal (but not considered good behavior according to societal norms, such as being manipulative).

While it may be difficult to ascertain if he indeed fits the diagnosis of schizophrenia or is otherwise manipulative, as I believe this should be done in-person by either a psychiatrist or a clinical psychologist, what information I can provide here is instead about schizophrenia. With better understanding of schizophrenia itself, perhaps it gives you a better understanding of his behavior.

Schizophrenia

Oftentimes, when people think of a person who is "crazy" or "mentally ill", this is what they have in mind (although, there are way more common mental illnesses such as depression and anxiety).

The diagnosis of schizophrenia is characterized by a combination of either:
1) hallucinations (e.g. perceiving with your senses things that aren't there, such as seeing or hearing things that others don't),
2) delusions (a belief that isn't real, e.g. a paranoid delusion could be something like aliens are trying to send secret messages to me through the TV),
3) disorganized speech (e.g. incoherence, derailing from topic)
4) catatonia (e.g. rigid movements, such as staying in an awkward position for long periods of time)
5) negative symptoms (e.g. a "lack" of emotions, speech, or thoughts)

These symptoms are termed psychotic symptoms. Psychotic symptoms may also occur under different circumstances, such as while under the influence of drugs or occurring along due to other mental health issues, such as being depressed.

Why could he still function "normally" if he has schizophrenia?

On to your question: if it is indeed true that he has schizophrenia, these psychotic episodes may come and go. Or, they could be in varying degrees of severity. While there could be people who have severe psychosis and have to receive ongoing support their whole lives, there are many schizophrenics who are able to live normal lives just like you and I with the right treatment or environment. Or, there could be people who have had a psychotic episode at one point in their lives, and it went away, never coming back.

In mental health, we expect that a person's functioning improves or deteriorates due to a variety of factors, such as the stressors that they are facing in day to day life, the coping skills that they have, or their physical health. What we are more concerned about is in improving a person's functioning so that they are able to participate in society and live meaningful lives.

In short, he could very well be "normal", or he could be "not normal". This could change at any point in life, as life itself is never constant. But if the person or people around him are distressed, what can be the focus is on everyone's mental health instead. What could be the actions needed to make things better? How do we learn to cope being around one another? What's the best step needed to eventually live a life that we are able to enjoy? Perhaps these questions are worth investing effort into.

Hope my sharing gave some insight!

Thanks! Really explains alot. When I say committed yes I meant admitted into an institution. And when admitted I was told the person was diagnosed with schizophrenia (however this is not first hand information, since I was informed from a relative who heard from another hence it might not be 100% accurate description of the illness).

The issue is distressing as its affecting a good family friend. Seeing their family affected is quite disheartening and not being able to do anything is pretty tough on me and my family for that matter. Like I said as an outsider, difficult for me to say anything.

Oh yeah and just another thing I found very peculiar. This person had a tendency to go out and cause a scene at public places. It took all the family members combined efforts to keep the person indoors, even then it doesnt work most of the time. But during MCO, without any hesitation, said person stayed indoors and complied. To me this was the red flag that it was fake. Anyway just sharing this last tidbit, no need to analyse. You've done alot as it is

Thanks once again!