Some time back, I decided to pitch a story about mental health because I felt I had to. I didn’t know how best to broach it. Should I toss in statistics? Should I share quotes from people going through different types of stress and how they managed to climb out from the soul-sucking pit? What was the point I was essentially trying to make?
I’m not alone in feeling that we need conversations on the subject. In recent years, there has been more promotion towards the awareness of mental health. Mental health is a multi-faceted cocktail of many things. It includes our emotional, psychological and social well-being. It affects and determines how we think, feel and act. It’s important because it defines how we handle stress, relate to others and make choices. Many factors contribute to our mental health issues – biological factors, such as genes or brain chemistry, life experiences, such as trauma or abuse.
Tan Wen Xiang is a senior occupational therapist at the Mindset Learning Hub, a collaboration between the Singapore Association for Mental Health (SAMH) and conglomerate Jardines. The work done here is important, training people in recovery and people at risk in vocational roles and employment needs – allowing them to gain Workforce Skills Qualifications training. The folk there were prime examples of how broadly mental health disorders can be manifested.
Under the Diagnostic and Statistical Manual of Mental Disorders (DSM), there are over 200 different mental disorders or illnesses. As Wen Xiang puts it, no two people are the same and even if both have been diagnosed with depression, the external manners in which the two may exhibit it may be very different. Wen Xiang has been working in the mental health sector of Singapore for nearly 14 years now and his role as an occupational therapist lies in breaking down simple tasks that someone with a disorder thinks they cannot accomplish.
“Some tell me that they want to get a job but are unable to deal with the anxieties placed on them,” he shared. For anyone who has spent a lifetime accepting that “stress is part of life” and you “just deal with it”, the idea of not coping is difficult to understand. I ask if there’s a way to explain mental health.
His analogy, albeit simple, is perhaps the easiest way to accept the many different facets of mental health. “Imagine your mental health as a bottle. The stressors of everyday life is water that you pour in – work issues, family, girlfriend, finances, and what have you. Now, imagine that you have little holes at the bottom of the bottle. These are de-stressors – a good support network of friends, family, or maybe you do sports, or just that you compartmentalise well. All of this stops the bottle from running over.”
Wen Xiang pauses and says, “Now, imagine someone else whose bottle is smaller, might have had trauma growing up, may not have friends or family to talk to. There aren’t holes at the bottom or the holes are too small. That bottle is going to overflow.”
This overflowing bottle analogy is a good way to understand the extreme ends of mental health disorders. Take the men and women currently learning or training at the Mindset Learning Hub. The emotional breakdowns and subsequent acceptance that something needs to change has allowed them a new outlook at life. Some are learning to work in cafes, slowly building confidence and strength to face what we easily take for granted on a daily basis.
For the high-flyer CEO role, however, it might be hard to relate to. A lot of us, myself included, tell ourselves that we “thrive on stress”. We all know someone we admire from afar. He’s constantly on the go, running several businesses with a family to tend to. And we think, “I’ve no idea how he does it.” I ask Wen Xiang if his clients (or beneficiaries as the nomenclature goes, avoiding labels that deem those affected by disorders less than) tend to be the sort that have already experienced breakdowns.
He smiles and reiterates his point that the issue of mental health is incredibly broad. “I’ve had clients who believe that he’s the son of gods. Fully functional, able to do work but delusional, and I’ve also had clients who are working in law firms, top of their game. All they want sometimes, is to just talk to someone about their work stress,” he explains. “There’s no one size fits all and there are many, many ways to have a mental disorder and to get better.”
What might seem like just a “phase” for some, could very well be classified as a disorder. As Wen Xiang tries to explain, “We all get sad. For some of us, it lasts an hour. For some, a day. Imagine being sad at something for the next six months and just losing all energy because of it.”
And therein lies the dilemma of mental health.
The need to classify when something is wrong but rightly so and enough for it to be a disorder. As many diagnosed patients have said, “Imagine you’ve sprained an ankle and you’ve to explain exactly how much it hurts, how long it’s hurt for, why it hurts – all while your boss keeps telling you ‘maybe it’s just a phase.’” For those who are in the “pink of mental health”, this may seem a tad absurd. Some grow up in well-adjusted families, have plenty of love from those around us, never take on too much, never think too much and just seem to be the right amount of happy all the time.
For plenty of others, that just isn’t true or achievable.
Since he was young, Greg (not his real name) always felt that he had something to prove to those around him. From gaining the admiration and love of his parents, to the respect of his peers, it stemmed from a deep-rooted inferiority complex.
“In hindsight, you could say it was immature. Like, I was comparing myself to those better than I but still wanting to be first. It’s not just competition but a rigid ego,” he shared. Referred to a school counsellor, he realised that school was an avenue to seek attention from peers, an act to compensate for not getting it at home. It was only in National Service, a few years later that Greg fully felt the brunt of his disorders. The bottling up of his emotions, and the constant denial that anything was wrong with his mental health, eventually cumulated and the bottle overflowed.
“There were quite a few external factors. I was doing my service while trying to support my family and going for night classes. I was reported to have done some things when I had an emotional breakdown. It was a disassociative episode and there was an entire chunk of my memory that was gone,” Greg shared. The repercussions were obvious. The people around him didn’t believe him, saying that it seemed like a convenient excuse to escape punishment.
His time in therapy has taught him plenty – about himself, and the way his mind works. “I had to learn not to take on too much, or just to say no. I also had to learn that at the end of the day, I need to process how people treat me without having my own expectations. A lot of it is having to understand how I think,” Greg rationalised.
In learning that and constantly on the prowl to nip any triggers in the bud, Greg now helps out at SMAH in the mobile support team, a group of volunteers that do home visits to people in recovery or at risk. It’s something I’m learning the more I talk to the folk who have undergone counselling or therapy at the Mindset Learning Hub. In their position where they’ve learnt to manage or overcome their issues, many are teaching others in turn.
I ask Wen Xiang how one goes about broaching the subject of change with a person who has approached the Mindset Learning Hub and he replies that it’s a tricky one but a lot of it lies in helping the client understand what is holding them back from say, achieving happiness and breaking down that (what would feel monumental to them) task, step by step. “Plenty of times, I’ll ask them ‘What makes you happy?’ and you’d be surprised how few people know what makes them happy. They’ll retort ‘Why don’t you tell me?’” Wen Xiang shared.
From then, it’s a slow self-exploratory process. It often involves the need to dislodge a multitude of bad habits that one is conscious of as well as the need to form new habits. It’s fitting that Aristotle’s quote sits in the Hub’s reception area. “We are what we repeatedly do. Success is therefore not an action, but a habit.”
Can happiness truly be formed out of a habit? And in this very real rat race that most of us are part of? I ask Wen Xiang using the example of the average working adult in Singapore. The one who sits in the office from nine to five every working day, commutes home for an hour, has dinner then binge-watches the latest shows. It’s a terrifying reality for the majority of our population and as the nihilistic meme accounts would have you believe, what life essentially is.
“Does that destress them? If it makes them happy, why not?” Wen Xiang goes on to explain that once again, everyone takes to situations differently and it’s how we identify with ourselves and our thought processes that keeps us mentally and emotionally stable. If a person were to binge-watch shows for the sake of distracting themselves from thinking about their life, then it might be a sign of depression. If they’re happier after watching the shows and ready to take on a new day of work, that’s just life.
I switch the topic to something a little more results-based and ask what most people he sees are diagnosed with. The answer is comparable to that of a study done by the Institute of Mental Health back in 2010, stating that Major Depressive Disorder outranked most others. The understanding of depression is still scanty. It’s something Wen Xiang feels strongly about. The societal stigma of depression tends to be that it’s just feeling sad and people get through it.
I liken it to the people who insist a migraine is merely a slightly stronger headache, when in truth, it feels more like someone has slammed a pick axe through your skull. It’s precisely this discussion that society needs to pick up fast.
In 2016, IMH completed its Mental Health Literacy Study that focused on social perceptions and stigmatisation of mental illness. The study suggested that there was considerable stigma towards individuals with mental health conditions, which could hinder such individuals from seeking treatment. Wen Xiang shared that for those suffering from such issues, and especially those out in the working world who have achieved a life, the fear is that this stigma would cost them their life.
How we think of ourselves and others is one of the biggest factors into the pursuit of a healthy mind. Jim, another person in recovery at the Mindset Learning Hub shares that one of his biggest lessons that came through was to stop thinking (and assuming) what others were thinking of him. “It’s dangerous because you get into a loop. The first part for me was really to just accept that you’re not doing well. You need to see a doctor and you need to get better,” he shared. After the first hurdle, he has to continue to accept himself as being in the process of mending, learning to process his thoughts and delaying the immediate reactions to them. I ask Jim if the public is something he gets scared of and he laughs saying, “How am I different from anyone else?”
It’s a sentiment echoed by Wen Xiang, that people suffering from mental health conditions are like anyone else dealing with a sickness and just like any sickness, can vary on how tough it is on an individual. The only difference is that, most of the time, you don’t see it. The study conducted by IMH concluded that 9.3 per cent of Singapore residents would have at least one mood or anxiety disorder at some point in their adult lifetime. For Major Depressive Disorder, it affected one in 17 people.
Like many topics we’ve covered in AUGUSTMAN, whether it’s migrant workers and understanding their plight, or giving a voice to the elderly, the conversation on mental health is about changing the way we discuss it. The deaths of several celebrities in the past few years has done a little to open up that discussion, what with the general public understanding that hey, even celebrities with their mega-mansions and entourage of adoring fans find it hard to handle the pressures of mental health issues that plague them.
We’ve seen a change, of course. Like using slurs for migrant workers ignorantly (“I didn’t know that was racist!”), people need to understand that writing someone off as ‘crazy’ only does harm and seeks to undermine the reality of conditions.
I think back to former relationships and how easily we joke after it has run its course. Telling friends “Yeah, she was crazy, man” without carefully considering that someone may have had issues beneath the surface. It’s the same as a parent warning a child that some “scary Indian man” will catch them if they do wrong. All we’re doing is establishing stereotypes and making it harder for people to admit they may have issues. There is a lot of pressure on companies and policies as well to understand what constitutes health. Many times, we’ve heard stories of staff not wanting to disclose a traumatic incident and having to fake medical certificates so as to not draw attention.
Some forward-thinking companies have started practising “mental health days” where one can take without fear of the stigma and it’s high time we start breaking out of the shells of the taboo. Maintaining one’s own mental health is perhaps the bigger question at times. Wen Xiang himself says that the clients that come in for counselling or therapy know that seeing a professional is a last resort. Most of the time, they try to pick up hobbies, sports and deal with their issues themselves.
He sees it as poking holes in the bottom of your bottle as best as you can. Talk to friends, talk to family, talk to people you trust. Sharing emotional stress loads with the ones you love – not for advice or how to solve work stress, but as a way of unburdening one’s self.
Men, of course, tend to have it a little worse in that department and the need to maintain a strong front (after years of trying to emulate dear ol’ Daddy), more often than not, harms than it does do good. There’s a school of thought that men convert feelings they deem more “feminine” such as sadness or feeling vulnerable into anger and pride. I know I, for one, have.
Going into the new year, I can only hope that if anything, more honest conversation can be had. Head out for a beer with friends and even if everyone seems to be smiling and laughing, maybe just ask the guy beside you in an honest manner, “How are you?” It’s not much, but it’s a start.
