THE RIGHT FRAME OF MIND - IMH
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F E B R UA RY- M AY 2 0 2 1 A M A G A Z I N E O N M E N T A L H E A L T H BODY DYSMORPHIC DISORDER When a distorted self-image has debilitating effects THE RIGHT FRAME OF MIND Strategies you can adopt to maintain positive mental health in the year ahead
8 04 Live Well How pets are helping people cope with the isolating impact of COVID-19 lockdowns. CONTENTS FEATURES F E B R U A R Y - M A Y 2 0 2 1 REGULARS IFC-Ad 8 FOCUS Back-to-basics strategies for maintaining positive 4 LIVE WELL mental health in the What’s new in mental health year ahead. research, and tips on maintaining your mental well-being. 12 14 Body dysmorphic disorder is a mental health condition that 16 MY S AY goes far beyond insecurities and *9(ƺóÀÀáËÈÛ?íÀ self-obsession. Professor Chua Hong Choon looks back on changes in Singapore’s mental healthcare landscape PROFILES over the years. 3 I SERVE 18 ASK THE EXPERTS What she lacked in formal music IMH clinicians answer training, Ms Yong Fong Ling made up your questions. for in passion — all so she could share the joy of music with IMH patients. 19 IMH SCENE A round-up of news and events 12 A L I FE I N MY D AY centred on mental healthcare. Depression might have interrupted his life, but Mr Ivan Lim took the łĩőőĂäàĆƅäŅäĢÚä pause in positive stride to rebuild L A S T PAGE ANSWER: The 5 differences below a better life. 20 BEAUTIFUL MIND Be aware of the ill-effects of the over-consumption of news, especially bad news. “People with body dysmorphic disorder tend to over-focus on details, but are unable to process visual information in a holistic manner or see the big picture.” DR JACKKI YIM Senior Clinical Psychologist, Department of Psychology, IMH Turn to Live Well, page 7, for the puzzle. Tu INSTITUTE OF MENTAL HEALTH .. FEB - MAY / 01
volunteer . I SERVE HITTING THE EDITORIAL MESSAGE Right C H A RT I N G YO U R OW N : Note What she lacked in formal music MS YO N G FO N G L I N G training, Ms Yong Fong Ling F E B R UA RY- M AY 2 0 2 1 CO U R S E TO W E L L N ESS A M A G A Z I N E O N M E N T A L H E A L T H made up for in passion — all so Volunteer, IMH Ringers e know it is important to look after our mental health, but BODY DYSMORPHIC DISORDER she could share the joy of music W with IMH patients. When a distorted self-image has what exactly constitutes mental wellness? People often debilitating effects equate this with the absence of a diagnosed mental Interview KEENAN PEREIRA THE RIGHT M a i n p h o t o K E LV I N C H I A health condition, but in reality, it incorporates broader FRAME OF MIND Strategies you can attributes such as having a positive mindset, a strong support adopt to maintain positive mental health in the year ahead Imagine clinched >> IF YOU WERE TO VISIT IMH network and coping skills to handle the stresses of daily life. With this the ÜvÀ³ in mind, our cover story (pages 8-11) presents a ’roadmap’ for mental Excellence at APEX 2020 ON A SATURDAY MORNING, you ܨ¨®ÃÃƛ(ÀƜâ³Ëܨ¨ï®È½Ã³ÀvÛ®v¨v®Ɯ˨® might hear the sound of simple but resilience and maintaining a healthy outlook in the year ahead. Editorial melodic tinkling resonating from one of The importance of looking on the bright side cannot be Lalitha Naidu the rooms. The source of this music is a understated. There are those who may suffer from depression or Ting Mei See resonator bar, a percussion instrument anxiety disorder for instance, but still have positive mental health Pameline Kang that relies on teamwork and coordination attributes which enable them to cope well. An example would be Contributors between its players, who — in this case ³ËÀ4*®9âvâ½À³ï¨Ɯ9À*Ûv®4ƜܳvÃÈó®È³® Ronald Rajan, — are long-stay patients of IMH. Meet head on, and seeks out happiness wherever he can. His story Dennis Yin, Denyse Yeo, Striking A Chord With Patients the IMH Ringers, the hospital’s resident (pages 12-13) also outlines the importance of early intervention. Koh Yuen Lin, Keenan IMH runs music-based programmes Pereira, Kelvin Chia resonator bar group. The IMH Ringers is In this issue, we also shed light on body dysmorphic disorder to help patients enjoy the therapeutic (pages 14-15). Far from being a case of vanity, this lesser-known the brainchild of Ms Yong Fong Ling, a ®ïÈóÈvÀÈÃƛSî¨ËƝ C i r c u l a t i o n C o o rd i n a t o r data analyst who has been volunteering at condition can lead to social isolation and even self-harm. Often, Chris Ngiam those who grapple with it may not be aware that they have a the hospital since 2013. simple was also an advantage for me,” she DÀËÀ¨ Long-stay medical issue that warrants proper attention. Ms Yong’s journey began when she recalls with a laugh. patients learn to play ÜvÀ®ÃÃÃv®½³ÀÈv®ÈïÀÃÈÃȽƛÈÈÀ®Èv¨v¨È¨ÈÀvâ A publication by noticed how much her younger brother Eventually, Ms Yong settled on the hand-drums and percussion will not only help dispel the prevailing negative attitudes and beliefs, enjoyed his weekly volunteering sessions resonator bar, which is ideal for a musical instruments under ËÈv¨Ã³®³ËÀvȳÃvÈȳ³³ÀÜvÀv®®ïÈÀ³ at the hospital. This led her to join him ensemble. Each member is given a bar that the guidance of a trainer. early intervention. This is something that Professor Chua Hong Choon in organising various activities for the ½¨vâÃvý﮳ÈƛS⽨vâÈÀ®³ÈÜ® emphasises in a special interview (pages 16-17) to mark the end of his patients, including arts and crafts, festive it is their turn, and the notes come together to decade-long tenure as IMH CEO. Here, Prof Chua talks about the work Very Special Outstanding Editorial consultant celebrations, outings and sports. “We form a tune. “The initial sessions were tough, he and his team have done in building community partnerships to IÀ³ÀÀÃƪ_O?Iƫ³À wanted to have a range of programmes because everybody was so excited and would improve support for those with mental health conditions, as well Run by IMH’s Occupational as how patients themselves have been empowered to play a to cater to the patients’ varying needs just play when it wasn’t their turn,” she says. and interests,” she explains. “There But Ms Yong persevered and taught patients Therapy department. greater role in their well-being. So as the Year of the Ox rolls in, we applaud wasn’t a music-focused activity and simple musical concepts like rhythm and Patients are professionally Copyright © is held by the ȳÃç®È³Àï®È®Èv¨ publishers. All rights reserved. I thought it would be fun for them.” pace. To shore up her own skills, she read up coached in singing and Reproduction in whole or in part health landscape, as well as everyday without permission is prohibited. Music, she felt, could also teach patients extensively on music theory. These efforts performing skills, and often Singaporeans who are proactively Printed in Singapore by KHL skills like teamwork, self-expression paid off and the IMH Ringers are now regular hold public performances. Printing,www.khlprint.com.sg. taking charge of their wellness. May MCI (P) 111/08/2020 and communication. performers at hospital events. “Performing you be surrounded by positive for an audience was another challenge to vibes for the rest of 2021, Every care has been taken in the Hearts in production of this magazine, but IMH the A JOURNEY OF DISCOVERY overcome,” says Ms Yong. “The players would Harmony and beyond! publisher, and its employees assume no responsibility for any errors, inaccuracies In 2017, Ms Yong raised the idea of starting be distracted by the crowds and noise, so I had A volunteer-run or omission arising thereof. Opinions the musical group and was met with to remind them beforehand to just look at me expressed by contributors are not choir for long- necessarily those of IMH or the editorial enthusiastic support from IMH’s volunteer and play as they do during rehearsals.” stay patients. Happy reading. consultant, Mediacorp. The information manager. The next thing to do was to pick The experience of forming an interest produced is for reference and educational purposes only. As each person’s medical an instrument. Ms Yong wanted the group group has strengthened Ms Yong’s connection the editorial condition is unique, you should not rely on the information contained in this to be as inclusive as possible. “Some may with some of the long-stay patients. “They team magazine as a substitute for personal medical attention, diagnosis or hands-on treatment. If you are concerned about any health matter, please consult your family be more musically-inclined than others, but I didn’t want to turn away those who are interested but less musical,” says remember my name and are always excited to see me,” she says. “The COVID-19 pandemic and its resulting restrictions forced us to put HHA AWARD Ms Yong was a recipient of the 2020 Healthcare Humanity Award (Volunteer physician or healthcare professional. vȳÀâƫ³ÀÀèðÃÃvȳ®v®³ÀÈà Ms Yong, who admits to having no serious the IMH Ringers on hold but I’m itching to improve the lives of IMH’s long-stay patients musical background apart from “dabbling” to go back and see my friends at the hospital through activities such as IMH Ringers. FO R M O R E I N FO R M AT I O N / / V I S I T W W W. I M H .C O M . S G O R W R I T E TO U S AT E N Q U I RY @ I M H .C O M . S G in the guitar and drums. “Keeping things again. It is my second home now.” 02 / IMAGINE .. IMAGES BY GETTY IMAGES INSTITUTE OF MENTAL HEALTH .. FEB - MAY / 03
STAYING ON TOP, MENTALLY WELL! Researchers from the University of completing a series of tasks. Before the THE ROOTS OF L I VE California, Davis, did just that and session ended, they were told they could Kindness found that mothers have a big role to play. Examining the behaviours donate their tokens to other children in need. At the same time, mothers answered With the year-end of 54 mother-child pairs, the ¿ËÃȳ®ÃÀvÀ®ÈÀÛÜó®½vÈâƜ compassion and love. researchers found that children festivities and who had experienced more Sï®®ÃóÜv³ÀÀ¨vȳ® traditional season compassion, love and empathy between children’s generosity and their from their mothers were more socialisation experiences. "Compassionate of giving behind us, willing to be generous to others. mothers develop emotionally close The children involved in the relationships with their children while it might be worthwhile to ÃÈËâÜÀïÀÃÈÈÃÈvÈÈv³ providing an early example of prosocial consider the origins of our four and invited back two years later. At both orientation toward the needs of others," generosity. > stages, the children were given 20 tokens for researchers said. The perfect gift Experience Singapore You don’t need to travel overseas to The mystery of the perfect gift may derive more happiness from have an unforgettable time — start right have been solved — at least for children their experiences. here in Singapore with these activities: aged 12 and above. New research by Lead researcher Associate PET the University of Illinois at Chicago suggests that giving them something Professor Lan Nguyen Chaplin believes it has to do with the memory capacity > HYDRODASH Test your ninja warrior skills at Singapore’s PURSUITS The number of they can experience actually makes them happier than receiving a material of younger children. “Young children do love experiences ... However, for ïÀÃÈưÛÀð³vÈ®v¿Ëv½vÀ§ƛ https://www.sentosa.com.sg/en/ pets in Singapore object. Published in the International experiences to provide enduring things-to-do/attractions/hydrodash/ in 2019 (including non-registered and Journal of Research in Marketing, happiness, children must be able to a adopted animals): the research compared the level recall details of the event long after > FLIGHT EXPERIENCE’S BOEING 737 of happiness children derived from it is over,” she said. Take to the skies with Flight material goods versus that from Sv®§Ë¨¨âƜÈÀÃv¿Ë§v® Experience’s Boeing 737 simulator, experiences. The results showed that vÃâïáȳ¦³ÈÀ³ÀÃƛƿSv§ which is used by actual pilots as well! > DOGS: how old a child was had an effect on pictures or videos of family walks, ÈȽÃƝƨƨîv½³ÀƛðÈá½À®ƛ³ƛÃƨ 111,500 how they viewed certain gifts. Children between the ages of three and 12 playing in the snow, and birthday parties," she added. "Children are likely ½vÃƨųůųưÃ˨vȳÀưðÈà derive more happiness from material to appreciate those experiences more > HEADROCK VR Enter the world of things, whereas older children if there is something to remind them of virtual reality at HeadRock VR, the event.” an escape from the everyday. > CATS: https://www.headrockvr.sg/ 85,100 Furry > SNOW CITY SINGAPORE Zip up your parkas and chill out at Snow City Singapore. > SMALL MAMMALS: http://www.snowcity.com.sg/ (hamsters, guinea pigs, rabbits) > WILDLIFE RESERVES Heroes 92,300 SINGAPORE Get close to Source: The Business Times nature at Wildlife Reserves Singapore’s four nature parks. >> The secret to coping during the COVID-19 crisis? Dr Young. From interviews with 32 people, she found https://www. A furry friend. The isolating impact of the pandemic that more than 90 per cent of respondents said that wrs.com.sg has led many to seek the comfort of a pet at home. touching their pets both comforted and relaxed them. Photo courtesy of www.wrs.com.sg Dr Janette Young of the University of South Australia Many also noticed that their pets seem to know when observed that there has been a global surge in pet their owners could use a cuddle. This wasn’t limited adoptions and purchases during lockdowns. She to dogs and cats, added Dr Young. Birds, sheep, q©yu³³³¦y¦yq©e¿³ypyy˳³e³e¦y³ horses and even reptiles provided similar comfort. brings at a time when human touch is discouraged. "In the era of COVID-19, social distancing, sudden "Pets seem to be particularly important when people are socially isolated or excluded, providing comfort, lockdowns and societal upheaval, our pets may be the only living beings that many people are able to touch > All attractions listed above can be redeemed with SingapoRediscover Vouchers. companionship and a sense of self-worth," said and draw comfort from,” she said. 04 / IMAGINE .. IMAGES BY GETTY IMAGES INSTITUTE OF MENTAL HEALTH .. FEB - MAY / 05
L I V E WELL! TIPPING the SCALES REDISCOVER RESILIENCE An online survey of some 3,500 The full extent of the COVID-19 pandemic’s impact individuals by Ohio State University and on our wellness may prove a mystery for years online health portal Everyday Health to come. But early research suggests that it has has unearthed some interesting trends done more harm than good, with a global survey about the state of resilience. qË©³e³³e¦©¦³yue³q·³peq For instance, researchers have found that on physical activity and eat more junk food. a passive “it is what it is” mindset is more prevalent in less resilient people. They also Carried out by researchers at the Pennington tend to overthink or overanalyse issues. Biomedical Research Center in Louisiana, US, Meanwhile, those who are more resilient are the study surveyed almost 8,000 adults less resigned to their situations and are able to across the world. keep their problems in perspective. The survey Researchers observed that the general v¨Ã³³Ë®ÈvȳÛÀv¿ËvÀÈÀ³Àý³®®Èà decline in healthy behaviour during the had over-estimated their levels of mental and emotional resilience. lockdown was fairly common regardless of With a growing canon of research geography. More people led more sedentary highlighting that higher levels of resilience are lives, as the stay-home directives sharply directly related to better outcomes when living reduced daily commuting needs. But even through a crisis and improving emotional and when people did exercise, it was often at a physical health, it is more important than ever lower intensity than before the pandemic. Giving in to cravings was also a common theme, with the consumption of sugary drinks and snack foods EXERCISE (WITH) CAUTION to focus on building up our resilience reserves. Fortunately, resilience can be built through constant practice. Start with these tips from The #HYGGE way of life ³®Ë½ƛSÃÈÀ®ÃÈὨv®ÈÀÃvÀÀÃƺ³ÈÀï®®Ɯ the Health Promotion Board: The hygge hashtag on Instagram has led to nearly seven which showed that about 27 per cent of respondents gained weight 150 minutes of physical activity million posts — proof of the growing global obsession with ®ÈvÀ¨â³®ÈóȽv®ƛSÃïËÀÜvÃÛ®À a week is all you need to lead a > BE OPTIMISTIC among obese respondents. healthier lifestyle, according When dealing with setbacks, focus on this centrepiece of Danish culture that has been linked to But there were some bright spots as well: about 17 per cent of respondents to the Health Promotion Board. the positives instead of dwelling on the a reduction of stress and increase in overall well-being. said that they had lost weight, pointing to the fact that the lockdowns led them negatives. Being optimistic can also improve As the nation gradually lifts to discover new ingredients and look for ways to cook healthier meals at home. your problem-solving skills, as it helps you If the term (pronounced hoo-guh) relaxing than harsh and cold The results of the study were published in Obesity. COVID-19 restrictions, team-based focus on the possibilities instead of ÀvÃóÀ¿ËÃȳ®ÃÈv®v®ÃÜÀÃƜ white light. Find comforting sports such as basketball, football, the problem. ÀƺÃv¿Ë§®ÈÀ³Ëȳ®ƝÈÀÀà fabrics and choose casual and dragonboating can be safely to the art of getting comfy and cosy wear whenever you can. Dealing with resumed. > ADD OBJECTIVITY Ƴv®Èè³³Ãï®È³®v®Ã > WITH GOOD COMPANY When faced with a setback, it's normal to that everyone sees hygge differently. body shaming > REACH OUT: strong, capable and resilient, Those who prefer working think that the situation is worse than it Ultimately, hygge is about who you Nurture relationships that allow When comments about your regardless of size. out alone can continue to use Being on the receiving actually is. Objectivity allows you to see choose to surround yourself with you to feel supported and heard. body become too personal, end of offhand turn to trusted friends > PRIORITISE YOUR HEALTH: public stadiums, dance studios, things in perspective and prevents you and what you choose to spend your Enjoy precious bonding time by comments about your and family members for Take steps to improve your gyms, indoor sport halls and from making a mountain out of a molehill. time doing. Here are some common hanging out with a small circle changed body can emotional support. physical and emotional of close friends or loved ones. swimming complexes; just elements that can help you get make you feel less- well-being. Take time off > TAKE A BREAK started on your hygge journey: > GET COOKING > EMBRACE POSITIVE social media if it is triggering remember to book a slot before than-secure. Here AFFIRMATIONS: Remind negative thoughts about Giving your body and mind a chance to Freshly-baked foods have heading down and follow safe > AT HOME are tips to take yourself that you are your body. ÀvÀv®¿Ë½â³ËÜÈÈ®Àâ been shown to be some of the distancing guidelines. Dim the lights and light some it in stride: needed to face your problem head-on. warmest, most hygge-inducing candles in the evening. Research has shown that warm yellow scents around, so warm up the light is often perceived as more oven and get baking! THIS IS WHAT The effects of loneliness — such as the increased internally-directed thoughts such as łĩőőĂäàĆƅäŅäĢÚä͢ LONELINESS risk of cognitive decline and dementia — are widely reminiscing or imagining social experiences,” Can you LOOKS LIKE known. But exactly how loneliness presents in the said the study’s lead A B brain is less clear…until now. Scientists from McGill author Dr Nathan spot 5 University in Canada have found that people who are struggling with loneliness have brains that are Spreng. “This heightened focus on self-reflection, #KNOW differences distinct from the general population. According to and possibly imagined THIS between their research, the brains of lonely people featured social experiences, would Loneliness kills; literally. these two According to the 2015 a higher volume of grey matter in the default naturally engage the pizzas? Singapore Longitudinal network, which is the part of the brain responsible memory-based functions Ageing Studies headed by for processes like reminiscing, future planning, of the default network.” the National University of REFER TO THE imagining and thinking about others. The results of their study Singapore, seniors who live C O N T E N T S PA G E "In the absence of desired social experiences, were published in Nature alone are 1.7 times more FOR PUZZLE likely to die prematurely than ANSWER lonely individuals may be biased towards Communications. seniors living with others. 06 / IMAGINE .. IMAGES BY GETTY IMAGES INSTITUTE OF MENTAL HEALTH .. FEB - MAY / 07
Going back 01 Embrace Challenges 2020 offered a stark reminder that each passing year brings its own set of cover story . FOCUS to unique challenges that can upend our lives. Predicting or avoiding change isn’t always possible, so Ms Wang suggests shifting our mindset instead. “Learn to groom a growth mindset,” she advises. “Tell yourself that you can choose to ®ÈÀ½ÀÈȳÃÈv¨Ã³Àí˨ÈÃÈvȨvv³â³ËvÃv®³½½³ÀÈË®Èâȳ thrive — instead of just survive — and any failures that you face will be lessons to learn from to do things differently.” We’re well into 2021, and our resolutions Practise mindfulness to stay in the present. “We cannot NOTE THESE TIPS TO HELP YOU NAVIGATE NEW to live better may have taken a backseat as CIRCUMSTANCES AND SITUATIONS: change the past nor have we arrived at the future, so the the stresses of daily life seep in again. Make it a Visualise your thinking patterns to understand how you present is what we should focus on,” says Ms Wang. This point to return to the fundamentals of wellness approach problems. One way to do this is by journalling means shifting mental gears to get out of our old ways of thinking, feeling and acting, and focusing on what is here and prioritise positive mental health. regularly: writing down the ideas swimming in our right now. head allows us to get a grasp on them and identify Te x t K E E N A N P E R E I R A i n c o n s u l t a t i o n w i t h M S J E M I E W A N G , C l i n i c a l P s y c h o l o g i s t , D e p a r t m e n t o f P s y c h o l o g y, I M H unhealthy thinking patterns that lead to rigidity and Practise self-compassion, especially in a time of rapid pessimism. “We can then set an intention to focus on change. Realise that adapting to change isn’t easy and gratitude, personal strengths, or the positive aspects acknowledge that you did the best you could. “Ignore the ake your mind back to the start of the Department of Psychology, Institute of Mental Health of our circumstances. This can assist us in proactively overly critical voice of self-judgment and be as kind to modifying the way we view and handle challenges,” says yourself as you are to your loved ones,” advises Ms Wang. T year: did you make a resolution to lead (IMH), shares, you can make a conscious effort to a better, healthier life? If you did, you develop and maintain positive mental health at any time Ms Wang. This is a journey and you’ll get better over “We deserve kindness, warmth and care — the same are not alone — changes to improve our of the year. time. The key is to start at some point. qualities we offer to others we care for.” >> health and quality of life are among the Achieving positive mental health needn’t be an most common resolutions made at the dawn of a new uphill or gruelling task, as Ms Wang explains. It starts year. But in the weeks that have passed, we may have with going back to the basics of ourselves: how we deal already neglected to prioritise our mental well-being, with change, how we care for ourselves and how we which is central to living better. Don’t be disheartened build healthy relationships with those we love. Here, though — as Ms Jemie Wang, Clinical Psychologist, Imagine looks at ways to get started: A Positive Spin Remember that positive mental health encompasses more than just the absence of mental disorders. It is possible for a person with a diagnosis of mental illness to have a high level of positive mental health. Conversely, people who are not diagnosed with a mental illness may fail to prioritise their mental well-being. For instance, an individual who regularly works long hours, feels overwhelmed by commitments and neglects self-care may not have the best mental health. FIND THE In 2012, IMH developed a Positive Mental Health (PMH) instrument — an assessment tool to measure PMH RIGHT PACE in the local population — as part of the Singapore Mental Health Study. It comprises six components that Overwhelmed by the tasks at influence our well-being and contribute to positive mental health. Read on to find out more about them: home or work? Breaking up your workload into smaller General coping: (³ÜÜÀvÈȳvÃÈÀÃÃ˨³ÀíË¨È Personal growth: OÈÈ®³v¨ÃÀðÈà mental buckets is a way to situation matters. “Tough times don’t last, tough people ³®ƺó®ï®ƜÀ³v®v¨Èâ avoid feeling burned out; the do” may be a cliché, but it’s rooted in truth. When facing to take control of situations. Being buckets can be: a challenge, we might feel stretched for a period, but open to new experiences will help us like a rubber band, resilience allows us to bounce learn new things about ourselves. If back. To build resilience, think positively and engage in things don’t go as planned, don’t be An urgent pile pleasurable and relaxing activities. discouraged. Failure is a part of life — what is more important is to learn from Interpersonal skills: Strong bonds and good our mistakes instead of dwelling relationships will help see us through life’s ups and on them. A not-so-urgent pile downs. Building such bonds requires skills like empathy and communication. Put these to good use by making Global affect: Positive moods are indicative of emotional time for family and friends. stability and vitality. But positive moods, like all others, are transient. “We need to understand that our brains A pile you can take on Emotional support: It can be natural to withdraw later in the week from others when facing a tough time. But the emotional vÛvǼ®vÈÛÈâvÃƺƜv®È®È³ïávȳ®vÈ®Ãƛ support that family and friends provide can give us the Thus, we need to develop the ability to focus on what Think about your tasks before you dive assurance of feeling loved and wanted, and lighten is pleasurable or meaningful,” says Ms Wang. “Look for into them, so you can plan and prioritise our load. ³½½³ÀÈË®ÈÃȳè³Ü³Ü®v®ÃvÛ³ËÀv®ïv¨ them better. experience. Stay with the experience for a breath or Spirituality: Spiritual and religious practices and beliefs can ÃÀÛvÃv³½®v®Ãv®®ðË®³ËÀvÛ³ËÀƛ longer, fully sensing it in your body, and focusing on what feels good about it." INSTITUTE OF MENTAL HEALTH .. FEB - MAY / 9
FOCUS . cover story 03 Declutter Your Life Humans are hardwired for connections and we “Out with the old, in with the new” is often heard around the start of a new year, as people begin pyy˳©©qe decluttering their physical spaces. This is a positive move, as several studies have shown that ©ye³¦³·©¿¿yŪ© physical clutter can increase levels of stress, sap ¦³e·q³eu©·© energy, lower productivity and have an overall negative impact on our well-being. ¦y©eÀyƇpyůC·e³Â qe©ye³¦³e³e©y¿ŪeË© 02 Set Aside Time Clutter, however, can take many shapes and forms. More than just following those Marie Kondo-inspired eu·©³·©eÀe³Àe©u for Self-care home organisation tips, Ms Wang recommends ¦©³¦³¿yy³eye³ůƑ going a few steps further to remove digital clutter MS JEMIE WANG, Clinical Psychologist, Department of Psychology, IMH We know self-care is important, and unhelpful relationships from your life as well. but what exactly is it? For parents juggling domestic and professional responsibilities, self-care can be something as simple as splitting chores with their family members The Social Network so they can carve out some time for themselves, while teenagers may HERE ARE SOME A Digital Detox Prioritising positive mental health also ï®v®®³ËÈÜÈÀ®Ãȳv ACTIVITIES YOU entails taking a closer look at our social life. CAN START WITH: It is not unusual to be bombarded by boost. Those who are more visual may RELAX, TAKE IT EASY ®³Èïvȳ®Ã³®³ËÀÃvÀȽ³®Ã Some relationships, like those with loved ones who support, enjoy the soothing nature of art and be • Reading stressed by the thought of a Sudoku BREATH FOCUS IS A throughout the day. inspire and uplift, should be given more attention, says • Listening to music HIGHLY EFFECTIVE WAY Ms Wang. Conversely, there are relationships that cause puzzle, while the opposite may be true While some of these — like text messages from loved ones — are for the numerate among us. • Gardening OF COMBATTING STRESS. unnecessary stress and seem to be rooted in negativity — for • Meeting friends for coffee/tea TRY IT BY TAKING LONG ŁŠƐŭƓƧðŢƧ̶ƧļŭƛěƓ슣ŢēŁŢĴƯƛŭijǡðƛļƛðŗěƛðŢēƛŭČŁðŗŠěēŁð͢ŗŁŔěƛͣ instance, hyper-critical people in our lives who create a sense • Watching movies/TV AND SLOW BREATHS. add little to our lives. “These interfere with our cognitive processes WITH EACH BREATH, of inadequacy or even defectiveness in us. Ms Wang’s advice for The underlying principle of self-care • Meditation H I GH by reducing our attention and focus, and can also adversely affect GENTLY DISENGAGE ST R E SS, dealing with these? Actively speak up for your own well-being. is to identify and meet our personal • Sports our psychological well-being and stress levels,” says Ms Wang, who YOUR MIND FROM H I GH C O ST “Be discerning of what has been said to you. Then take charge needs, be it for rest, connection, or self- • Walking recommends a “digital detox”. The term might frighten some, as DISTRACTING THOUGHTS of the situation by expressing yourself in an assertive manner expression. These needs can be broadly AND SENSATIONS. JUST Singapore spends it conjures up images of an entirely disconnected world. In reality, and drawing your boundaries with them.” But steer clear of the categorised into ones that are physical, A MINUTE OR TWO CAN $3.1 billion on Ms Wang shares that a digital detox can be as simple as setting psychological and social in nature. HELP YOU FEEL LESS stress-related temptation to become a recluse and avoid people altogether, as illnesses annually. boundaries and limits, rather than giving up our smartphones entirely. “Each person’s needs differ greatly and OVERWHELMED AND this may make us feel lonelier and sadder. Instead, reach out to STRESSED. Source: The Straits Times positive sources of social support when you need it. Accept ÈÀƺî³³®ưÃçưïÈÃưv¨¨Ã¨ưvÀ SET BOUNDARIES > It may be useful to designate spaces solution,” says Ms Wang. “We should try the help they give — needing or accepting help is not a sign such as the dining table and bed as “no smartphone” areas, so to engage in at least one activity that of weakness. you can practise mindfulness while eating and resting. is pleasurable or relaxing to us every day. This will help us better handle Taking long, slow IMPOSE TIME LIMITS > Most apps, including Instagram breaths can help life’s stressors and manage our mental, and Facebook, now come with daily reminders that can help you to disengage emotional and physical health.” your mind from control the time spent on them. “These apps can give you curated distracting thoughts. and false depictions of other people’s lives, which can affect our self-esteem and self-worth,” explains Ms Wang. ACCORDING TO A 2019 SURVEY, BEEP BEEP The average 3 10 smartphone user gets 46 IN SINGAPOREANS polled said they did not know how to relax. PUSH NOTIFICATIONS Source: Todayonline EVERY DAY. Source: Business of Apps 10 / IMAGINE .. IMAGES BY GETTY IMAGES
A LIFE IN MY DAY . interview seek help, I was in the least glamorous Music has always been a felt they couldn’t speak to anybody state ever, and the incongruity of it part of my life. It allows me to about their condition due to the made me chuckle. However, my friend express my emotions and makes stigma that surrounds it. But there was trying to lighten things up, as me feel comfortable with my own are many ways you can get help. If the topic was probably too serious feelings, be they positive or negative. you’re not comfortable talking to for him to take. This was in 2001, and Even before my diagnosis, I always someone about your feelings, try though there was some level of mental listened to Sergei Rachmaninoff’s apps like Wysa* on mindline.sg. It’s health awareness among the general Piano Concerto No. 2 in C minor a chatbot that takes the form of a public at that point, most people were whenever I was feeling down. It friendly little penguin and helps you still not entirely comfortable talking starts off grandly and then goes process your feelings. I tried it and about it, especially if it struck too into a very heart-wrenching second thought it would be useful to someone close to home. Having an incomplete movement, before ending with a who is a bit shy or embarrassed to knowledge of mental health issues triumphant third movement — talk to another person about his or makes it an uncertainty that is I always feel like I am going through her mental health condition. Help is frightening — like ghosts! So some all the emotions that I need to available and accessible — and you are of my friends stopped hanging out express while I am listening to it. never alone, even if you think you are. Downside with me out of this fear of the Incidentally, he wrote the piece after unknown. They might have thought: he came out of clinical depression “Oh this person has mental health and dedicated it to the physician ÃÃËÃƜÈð½³®v®³ who helped him get back on his feet. *Wysa: An emotionally intelligent Up completely crazy.” I don’t know if he wrote the piece to AI chatbot that individuals can chat Depression might have interrupted help people with depression, but it with and use to access a wide range “Wah, you actually went certainly speaks to me. his life, but Mr Ivan Lim took the of self-management and cognitive (to get diagnosed)? It’s pause in positive stride to rebuild behavioural therapy exercises. Wysa can going to be on your records Surrounding myself with a better life. I n t e r v i e w K O H Y U E N L I N P h o t o s K E LV I N C H I A permanently!” some said. But while people who have a positive be found on mindline.sg, a Singapore- developed stress management and seeking psychiatric help seemed like effect on me – mentors, friends, coping website that consolidates âïÀÃÈÀ³ËÀÃƜÈÜvÃv¨Ã³â¨vÃÈ family — is important. Conversations access to many carefully-selected resort. It was something I had to do, with my wife and just sharing a laugh local resources, including a clinically and I cannot imagine what might have with her, talking to friends who know validated self-assessment tool for become of me otherwise. My mother what I am going through and can emotional well-being. — an educator who is quite in tune sense if I am not in a good state of with mental health issues and now a mind, or even just receiving a text very progressive grandmother to my message from a friend asking how M R I VA N LI M ó®Ƴ¨½ï®ÈÀȨ½ƛ I am… all these help to keep my state And the diagnosis was a realisation of of well-being in check. When you 54, Author what was happening. I accepted it for have a big enough support network, and musician what it was, processed it, and did what they will look out for you. You don’t was necessary to get better — I took my have to be ashamed about needing medicine daily, managed my feelings this network either, for you are part bout 20 years ago, I had my mother found me alone in the visiting bars and clubs — which was what and quit my job to avoid clubs and bars. of somebody else’s network too, A a great career as an entertainment journalist and was becoming increasingly study, in a stupor. I was so deep in the situation that I didn’t recognise what was happening to me, but she saw the I needed to do for my work at that point. The psychiatrist said to me point-blank: “Then maybe you should change your and can serve as a pillar of strength as well. well-known as a writer. On the personal signs and made arrangements for me job.” So I did that. It prevented me from When you have a big My advice to those going front, I was doing well too. I was living in to see a psychiatrist the next day. The going down the road of alcohol abuse, enough support network, they through depression is to a three-storey home, owned a car, and psychiatrist had a long chat with me. and it made it easier for me to recover know that it’s okay to not was in a happy marriage. Yet there was He later diagnosed me with depression from depression. will look out for you. You don’t be okay. I have lost a number Ivan is now re-married and runs an independent art and editorial business an emptiness within me and I was getting and put me on medication. have to be ashamed about of friends through suicide as a with his wife, with whom he has a teenage son. He is also a classical increasingly unhappy and reckless. I told one of my closest friends I was drinking heavily, and even got into Through the discussions with about my diagnosis. His response needing this network either, for result of depression, and every incident came as such a shock. guitarist, and performs with 3am Music Collective, a local music group that a car crash while in a drunken state. my psychiatrist, I came to realise was: “Wow, you are so Hollywood!” as you are part of somebody else’s I have met exuberant personalities writes and produces songs to raise awareness and promote acceptance Things spiralled to the point where my that alcohol actually made me feel lousy. wife and I decided to get a divorce. One I had to remove myself from situations though depression was something trendy and something only celebrities network too, and can serve as a with so much to look forward to and live for, yet they ended up killing of mental health issues. day, in the wee hours of the morning, that required me to drink, including would have. In reality, when I went to pillar of strength as well. Ɯ themselves — perhaps because they 12 / IMAGINE .. IMAGES BY SHUTTERSTOCK INSTITUTE OF MENTAL HEALTH .. FEB - MAY / 13
focus . BODY DYSMORPHIC DISORDER More On the other hand, men are often more It impacts the individual’s than just Interview DENYSE YEO preoccupied with their build or muscle in consultation with D R B H A N U G U P TA , tone, and tend to engage in excessive everyday life, and that is the Senior Consultant, training at the gym, overuse protein difference between BDD and vanity Department of Mood supplements and even abuse steroids. and Anxiety, IMH; and DR JACKKI YIM,Senior Between the sexes, common merely being vain.” Clinical Psychologist, symptoms include an extreme DR JACKKI YIM, Senior Clinical Psychologist, Department of ½À³Ë½vȳ®ÜȽÀÛðvÜî Department of Psychology, IMH Psychology, IMH // their appearance. Says Dr Yim, “They in treating other conditions such as Photos GETTYIMAGES Body dysmorphic have a strong conviction of a defect depression and anxiety. Recovering patients are more in disorder is a debilitating in their appearance and that they look Cognitive-behavioural therapy aims touch with reality, and do not avoid ugly. They believe other people judge to educate individuals with BDD on their óv¨ÃÈËvȳ®Ã³Àv³ËðvÈÀ mental health condition SEEK HELP The condition can them in a negative way. And they often condition and challenge them to reframe appearance. They are more aware and that goes far beyond improve with correct engage in repetitive behaviours — such their unrealistic negative thoughts about comfortable with going out to meet insecurities and treatment and their appearance. It also teaches them people, says Dr Yim. And it is critical support. vÃÈÀâ®È³ïá³ÀȽÀÛ self-obsession. ðvÜƳÜvÀÛÀâí˨Èȳ³®ÈÀ³¨ƛƸ to refrain from repetitive, compulsive that once patients learn to manage Other signs include comparing their behaviours and encourages them to face their condition, they continue to use appearance with others. Those who have their fears, says Dr Yim. For instance, she these tools to keep their condition BDD tend to underestimate their physical recalls telling one patient who worried in check. >> APPEARANCE IS attractiveness and overestimate other excessively about acne not to apply any Dr Yim advises those who suspect EVERYTHING, or so the cliché people’s attractiveness, which is why they makeup, then have lunch with her friends that they are suffering from BDD goes. For most of us, our concern feel anxious or distressed, says Dr Yim. and see whether they judged her or symptoms — or know of someone ³ÛÀÈÜvâܨ³³§ÃðÈ®ƛ` They often avoid social situations. And Ãvv®âÈ®ƛ:³È®v½½®ƳÀ who is — to seek help. “Don’t let forget our physical imperfections they tend to seek cosmetic procedures, friends had not noticed, and their lunch unfounded fears about treatment get once we turn away from the mirror. although it is important to note that not took place without incident. Dr Yim says, in the way of reducing your suffering And worrying about our blemishes, everyone who does this suffers from BDD. “The purpose is to help them reach a v®½À³Û®â³ËÀ¨ƛ%ÛÈÀvÈ®È features or weight does not disrupt Although the exact cause of BDD conclusion that what they interpret or a try. You have nothing to lose and our daily activities. But for people is still debatable, studies suggest È®§È®³ÈvËÀvÈƛƸ ÛÀâȮȳv®ƜƸÃÃvâÃƛ with body dysmorphic disorder (BDD), a combination of different factors, Èïávȳ®ÜÈÈÀv½½vÀv® has not been studied at full scale, but co-morbid depression, more than 60 per including environmental and biological takes over their lives completely. They v½À¨®vÀâÃÈËââÈ:vȳ®v¨ cent reported having suicidal thoughts, reasons. “The condition seems to University of Singapore suggests a and around 24 to 28 per cent attempted often shun social interactions and, in develop in people with extreme self- ZOOM CALLS AND BDD: The key is to moderate the use similar prevalence here, says Dr Bhanu suicide. “As it’s unlikely that BDD goes away of video conferencing tools. Here extreme cases, do not step out of the consciousness and self-focused The good, the bad and the ugly %˽ÈvƜO®³À³®Ã˨Èv®ÈƜ½vÀÈ®È by itself, it’s vital to seek treatment as early are some additional tips to manage house — sometimes for years — to avoid attention, and who may have been teased one’s mental health and well-being being seen or potentially ‘judged’ on of Mood and Anxiety, IMH. “At our tertiary vý³Ãè³ÀÈÈÀ³ËȳÃƜƸÃÃvâÃƛ These days, video conferencing tools from the UK-based Body Dysmorphic or bullied in their childhood or adolescent ÈÀ½ÀÛðvÜÃƜÜvÀ³È® centre, we see very few cases, which is like Zoom play a key role in connecting Disorder Foundation. years and do not seem to have overcome probably due to sufferers not seeking SPOTTING THE SYMPTOMS with the outside world. Yet, video unnoticeable to others. If they have to ÈƜƸÃvâÃÀ%˽Èvƛ:ËÀ³Ã®Èï calls can have a negative impact on • Follow a daily routine including meals, go outside, they do so at night when help or not recognising it as a psychiatric Typically, the onset of the disorder starts exercise and self-care activities. research also points to differences in people with BDD. In the US and Europe, others are asleep. “BDD is not about ³®È³®ƜƸÀ%˽Èv®³ÈÃƛ at adolescence, before the age of 18. BDD many are reporting that video calls, • Speak to someone among your social brain function related to the processing BDD is, however, a serious issue. can affect both men and women, although where participants see a thumbnail of connections and support networks. Ûv®ÈâƜƸ¨vÀïÃÀ2v§§fƜO®³À of visual and perceptual information. themselves, aggravate their condition Clinical Psychologist, Department of If left untreated, it can result in about 40 per cent of BDD sufferers are men • Keep your mind and hands occupied Says Dr Yim, “People with BDD tend to and worsen their already-poor body complications including depression or, and 60 per cent are women. Women tend to image perceptions. “While using video with your hobbies. Psychology, Institute of Mental Health over-focus on details, but are unable to (IMH). “It’s a mental health disorder, worse, suicide. According to Dr Yim, report more severe symptoms, and usually calls could be triggering for people • Continue to follow your process visual information in a holistic with BDD, spending less global studies have found that 70 per have more areas of concern, such as skin treatment plan if you which has a substantial impairment on v®®À³ÀÃȽÈËÀƛƸ time interacting with have one. the day-to-day functioning of those cent of people with BDD suffer from imperfections, facial features and hair. their loved ones and • Engage in sorting vîÈƛ*ȽvÈÃÈ®ÛËv¨ƺà friends and more COPING WITH THE time on social media activities that relax the everyday life, and that is the difference At our tertiary centre, we see very DISORDER due to COVID-19 brain, such as organising your cupboards. ÈÜ®v®À¨â®Ûv®ƛƸ restrictions may few cases, which is probably due The condition can improve with correct treatment and also intensify • Use an internet tracker to be aware of these unhealthy your screen time. DEBUNKING THE MYTHS to sufferers not seeking help or not support. This often involves thoughts,” says • Consider unfollowing any unhelpful Often underreported, BDD affects Dr Yim. about two per cent of people recognising it as a psychiatric condition.” a combination of medication and cognitive-behavioural ®ðˮó®Ã³v¨vƛ worldwide. In Singapore, the disorder DR BHANU GUPTA, Senior Consultant, Department of Mood and Anxiety, IMH therapy, which is also used 14 / IMAGINE .. IMAGES BY GETTY IMAGES INSTITUTE OF MENTAL HEALTH .. FEB - MAY / 15
MY SAY . interview From my early A J OU R NEY days of leadership, Change, OF I have emphasised the need to empower Collaboration our patients, so they can be more involved in their treatment and and hope As he moves into a new role, IMH’s former Chief Executive P ROFESSOR C H UA HON G CHOON take ownership of their mental health and recovery.” ~IJǶČĚƑProfessor Chua Hong Choon looks back on Former Chief changes in Singapore’s mental healthcare landscape over 1njěČƯƧŁdžěijǠČěƓ̶ concerns as well as raise awareness of IMH (2011-2021) mental health issues. “VOE is a triangle: the the years. I n t e r v i e w K O H Y U E N L I N P h o t o C O U R T E S Y O F I M H voice of the patient, the caregiver, and that of the medical professional. Only when these he posting to the Institute of designing a doctor’s rest room, where many voices are equal can we get a more balanced T Mental Health (IMH) in 1993 was something Professor Chua Hong Choon had eagerly logistical and scheduling discussions were held,” shares Prof Chua. “As a young doctor, I had the opportunity to participate and be view of what is going on,” says Prof Chua. IMH also started employing persons in recovery as peer support specialists to work anticipated. “After medical school, I did my involved in making these decisions. I like alongside psychiatrists, nurses and allied housemanship followed by medical rotations to think that it helped me to see early in my health professionals in various departments in the Neurosurgery and Neonatology career that change is a constant, and it can and programmes. They use their lived departments. The Neurosurgery posting got be harnessed for betterment.” experiences to give hope and inspire others me interested in psychiatry and I really wanted As someone with a naturally positive who are in a similar situation to overcome to go to IMH to learn more,” recalls Prof Chua. attitude, Prof Chua always sees the silver ÈÀ®Èv¨v¨È³®È³®ÃƛƷ*﮽³½¨ However, while he looked forward to joining lining in challenging situations. Take for dealing with mental illness amazing,” says IMH, some friends and acquaintances displayed example the quarantining of all of IMH’s to transition Singapore’s mental healthcare (iPACE) programme. “With community-based patients as weak and helpless,” he says. Prof Chua. “They go through a tough time general disappointment. “They said things like patients and staff after a false alarm during from an institution-based care model to one vÀƜ³ËÀ½vÈ®ÈÃvÀ®³¨³®À³®ï® “From my early days of leadership, I have because their emotions and thinking are ‘What a shame — you have such potential for the 2003 SARS outbreak. “It was a major focusing on the community, recovery and within our hospital. This calls for a system of emphasised the need to empower our affected in a way that you and I may not v³³vÀÀƺƜƸÃvâÃƛƷ*ÈÜvÃvÀðȳ® incident but it led to positive outcomes,” he integration. Then one of the deputy leaders communicating with the different parties in patients, so they can be more involved in be able to fully comprehend, yet they of the prevalent stigma surrounding mental says. “As a result of that episode, there was in IMH, Prof Chua was part of a team tasked our network so that patients’ needs are taken their treatment and take ownership of their strive to recover and go on with their lives. illness at that time. There were a lot of a heightened awareness of the vast number to research and draft the blueprint, which care of,” he shares. mental health and recovery. Just as we put They want the same things as any of us: misconceptions then, too, not just about of vulnerable patients and staff at IMH, and introduced several programmes that tapped Under this programme, case managers our community partners on an equal footing, meaning, purpose, relationships, to be people with mental health issues but also the a greater emphasis on infection control and on ground resources like schools, general in IMH serve as a bridge between patients, we also needed to rebalance our relationship part of the community. They are no different healthcare professionals who treated them. the physical health of the patients here.” He practitioners and community services to community partners and the healthcare team. with our patients.” and these desires are not diminished. There For instance, people used to think that the also shares that in-house medical services promote the prevention and early detection They keep in close contact with discharged The Voices of Experience (VOE) is much that we can learn from them. I’ve behaviour of mental health patients would rub and facilities were set up within the hospital of mental health issues as well as enable patients and outpatients, monitor their programme, launched in 2014, is a step in learnt a lot from my patients.” off on psychiatrists and healthcare workers.” in the wake of the incident to handle any continuity of care for discharged patients. condition, and connect them to the various this direction. It gives patients, caregivers similar situations in the future. “Sometimes, “We had the resolve to do this, but social services and resources available and other advocates a platform to share their Seeking Change unexpected things happen, and you need to realised that we didn’t have that many to them. This has been instrumental in Despite the discouraging response from those grasp the opportunity to make the best out ƹÀ®Ãƺⳮȳ®ï®Ã³È³Ã½Èv¨ƜƸ improving continuity of care for patients around him, 1993 proved to be an exciting year of it.” he recalls. “So we set out to build a network with severe mental illness — the iPACE for Prof Chua — and one that would shape his approach to how IMH provides care. “It was Building a Community of community partners, and actively helped them become stronger in terms of mental programme has resulted in more than 90 per cent of such patients returning for follow- THE BEST OF TIMES After 10 years as CEO of IMH, Prof Chua has a time of change. The hospital, then known In Prof Chua’s view, a holistic and multi- health awareness and capability to be able to up treatment after their discharge and staying taken on the role of CEO at Khoo Teck Puat as Woodbridge Hospital, was going through agency approach is needed to promote do more to support individuals with mental well in the community. Hospital and Yishun Health from 1 February a big move to our new premises in Buangkok mental wellness and manage mental health issues.” 2021. He looks back fondly at his time in Green Medical Park. In this state of transition, health issues in the population. To support the expanded reach and the To Inspire and Empower IMH. “My relationship with my colleagues ®³ÈÀîïv®ÈË®ÀÈv§®³ÀIÀ³Ëv in IMH has shaped who I am today. I treasure there were a lot of opportunities to improve or The National Mental Health Blueprint, different agencies involved — from partners the friendships forged and the lessons learnt. even come up with new ways of doing things launched by the Ministry of Health in 2007, to patients — Prof Chua spearheaded the was giving patients a voice, which he sees as It has been a great privilege to work with — from procedures for seeing new patients to was a landmark development in this respect. development of the Integrated Patient a vital component in the ecosystem at IMH. so many passionate individuals to improve services we provided and even small things like *ȳÀÈv§³®³vïÛưâvÀ½¨v® Assessment & Continuous Engagement “Mental healthcare is not about treating our mental healthcare and awareness in Singapore,” he says. 16 / IMAGINE .. .. IMAGES BY SHUTTERSTOCK INSTITUTE OF MENTAL HEALTH FEB - MAY / 17
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