What’s the difference between mental health and mental illness?

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There are many local news stories which implicate mental health issues. But rarely an explanation about the mental health issue involved.

We use the term “mental illness” to refer to medical conditions including schizophrenia, depression, and bipolar disorder. Other times, we use the term “mental health” to refer to the same things.

But there are conceptual differences. WHO defines mental health as “a state of complete physical, mental and social well-being, and not merely the absence of disease“. That means that mental health is also about our immune system, physical health indices, life satisfaction, and psychological wellbeing, as well as our capacity to regulate mood and manage emotions, ability to manage daily stress, resilience, and coping mechanisms for dealing with stressful events.

The collaboration between mental health professionals and the police service (e.g., a UK pilot scheme) is a step in the right direction. Education is of course a reliable way to address mental health awareness issues at the workplace.

But what information is available about mental health in Singapore? A speedy search on google for local information about individual mental health issues and concerns yields at least one relevant website. Here’s a cheat sheet:

1. Stress
HPB lists the impact of stress on our physical and mental health: SAMH has useful tips for managing stress levels.

2. Depression
HPB lists symptoms to look out for: Insights into myths and misconceptions here.

3. Eating disorders
AWARE offers an FAQ on eating disorders here.

4. Anxiety
HPB offers an overview of anxiety, including symptoms and treatment options.

5. Obsessive Compulsive Disorder
HPB lists the symptoms of OCD.

6. Alcohol Dependence
NAMS lists the warning signs.

7. Gambling Problems
NAMS lists the signs to watch out for and offers a tool for self-assessment.

8. An Addiction to Gaming
Among the signs is the use of gaming as a means of escaping problems and the act of concealing game playing from family and friends. Read this NAMS overview.

9. Substance Dependence
Watch out for these behaviours in your co-workers (NAMS).

10. Schizophrenia
Schizophrenia is defined by IMH as “a disorder of fragmented mental processes”. Click here for more information.

11. Dementia
Working adults are increasingly faced with the challenges of juggling work and caregiving roles: Alzheimer’s Disease Association and HPB have fact sheets.

12. Learning Difficulties
Employees are also often parents who may have children with learning difficulties at school. Attention deficit (hyperactivity) disorder or ADHD information is available on Spark, while dyslexia assessments are available through the Dyslexia Association of Singapore. Autism resources are abundant at the Autism Resource Centre.

The International OCD Foundation has a useful fact sheet on hoarding. Finally, Singapore Focus on the Family offers advice for families faced with bullying at school, while the Media Literacy Council has information for individuals experiencing cyberbullying and AWARE has advice for personal protection orders and family violence.

Information is power. Don’t be afraid to use it.

Unsuitable behaviour

It’s the story of “the suitor who won’t take no for an answer” (Straits Times, 11 March 2014).

Boy meets girl. They go on a couple of dates. On date #3, they discuss marriage and children. Jealous, possessive, and manipulative behaviours surface. She stops answering his calls. But he continues the incessant phone and text campaign. She closes her facebook account and opens a new one—twenty times. He calls her at the office, turns up at her workplace, verbally abuses her family on the phone and online, sends her flowers at her home to let her know that he knows where she lives. She makes numerous formal complaints. But the damage is done.

At what point should we do something about it? Let’s rewind.

Boy meets girl. They go on a couple of dates. On date #3, they discuss marriage and children. Sharing one’s views about marriage and children. Yes, one expects to have that discussion at some point. But talking about getting married at date #3? Jealous, possessive, and manipulative behaviours surface. Alarm bells start to ring. One would think about not having any more to do with this person. That’s exactly what happens. She stops answering his calls. But he continues the incessant phone and text campaign. She closes her facebook account and opens a new one. Wait. Doesn’t this sound a lot like bullying?

The official definition of bullying is “a situation where a powerful bully intentionally harms a vulnerable and isolated victim through repeated hurtful behaviours that can result in damaging consequences” (Singapore Children’s Society). Said another way, it’s when someone does something with the intention of hurting someone else, more than once. In fact, online bullying is up for discussion today—”Let’s start an open conversation about bullying” (Today Online, 11 March 2014). So it’s not a story about a “suitor”, but about a “bully”.

Legal protection is one thing. But the real issue is the mental health and emotional wellbeing of the person who has been bullied and/or been the subject of harrassment.

There is much consensus that bullying has negative consequences in terms of poor physical and mental health: Bullied children are at risk for depression and have poor self-worth (CNN, 17 Feb 2014), while harrassment puts adults at risk for depression and post-traumatic stress disorder (www.livescience.com).

So what can we do about it?

Writing a letter to the bully to communicate that the behaviour is unwelcome, is an important first step. Writing down all encounters factually (supported by audio-video documentation and copies of any written correspondence) with dates, times, witnesses, and location details, in chronological order, is equally important.

In the meantime, we can reduce the negative effects of bullying and harrassment by taking some extra steps:

1. Change your mobile phone number and give it out to your close friends and family. They have your interests at heart. So they will understand that you need to do this.

2. Carry a second mobile for work and activate caller ID. You could redirect your direct dial office phone to your new mobile number and use voicemail to screen your calls.

3. Request that your telco block your telephone numbers from being displayed on the called party’s phone (e.g., the Caller Number Non-Display option).

4. Ask everyone to email you rather than call you (you can call them back).

5. Set up a new alias email address at work with your initials instead of your full name.

6. Set up a new personal email account. Give it out sparingly, as least initially.

7. Open a new facebook account, choosing the privacy settings which allow only friends of friends to search for you and only friends to message you and access your newsfeed, pictures, and posts. Choosing a profile picture and profile name which conceals your identity, declaring fewer pieces of information about yourself (e.g., contact details, your social networks, the city you live in, the schools you’ve attended), and adding friends judiciously are all key to playing a successful cat and mouse game. 

8. Allow only trusted friends and family to access your contact details and online status on messenger platforms such as  whatsapp.

9. Change your routines by choosing a different route to work or by leaving home or the office at different times.

10. Ask your extended family to call before coming to visit. Make arrangements so that you’re not the first to arrive when you meet your friends on social occasions.

4 Things Every Woman Should Do And Know

It appears that we currently lack information about the effects of medications and dosage recommendations which are appropriate for women (see this recent report from HealthDay News). But there are many other aspects of women’s mental and physical health for which much information is available, but for which awareness is often lacking. With International Women’s Day just a day away, we propose four things you can do to get up to speed this weekend:

1. Build your professional and social network

Research supports the role of a social network for mental wellbeing at the workplace and at home. The New Zealand Chamber of Commerce has an “Inspiring Change – International Women’s Day 2014” breakfast networking event aimed at inspiring personal and career growth held at Raffles Hotel on Monday, 10 March 2014, while the Singapore Committee for UN Women has a “I am fabulous and I inspire change” cocktail networking event at the Grand Park Orchard on March 6th. Those seeking inspiration can join a sharing session with Dr Aline Wong as part of the “Be inspired, create positive change” campaign by WINGS.

All this might be a bit much for the person who doesn’t really like talking to strangers. Joining an interest group like the Nature Society will open doors to opportunities for making new friends. Gym membership, signing up for a language, dance, painting, or pottery class, and volunteering with animal shelters will also offer more opportunities to meet like-minded individuals. Here’s a list to help you get started (Expat Living also has suggestions).

2. Make time for yourself

Self-care is the fancy way of saying that we need to look after ourselves in order to stay psychologically healthy. This includes the running, dog walking, park connector cycling, spinning, kick-boxing, trampolining, healthy eating, and spa-pampering that we do every week. It is the mindfulness that everyone’s thinking about these days (“How to fight stress? It’s all in the mind“, Straits Times, 3 March 2014). It’s also the family meals and kite-flying picnics that we’ve been having with our loved ones.

And if you’re not been doing any of these, there’s no time like the present. The iLight festival at Marina Bay (Timeout has the scoop) starts this Friday 7 March 2014, while the Mosaic Music Festival celebrates its 10th year, running for a fortnight at the Esplanade starting 7 March 2014. Looking forward, Shylock, Portia and other Venetians transform Fort Canning for its annual picnic event in April: Shakepeare in the Park.

Clawing back time from work responsibilities may however be a job of its own—it may be time to put your assertiveness skills to the test. Learning to say no is a skill that takes practice. In the meantime, some girlie and parenting life hacks may come in useful. So are these useful links, particularly if you’re new to Singapore.

3. Be aware

Aware celebrates International Women’s Day with a Facebook campaign to promote gender equality. Recent media attention also puts the spotlight on workplace bullying (“Facing up to bullies at the workplace“, Straits TImes, 24 Feb 2014) and ensuing legislation (“New harrassment law could be enacted soon in Singapore“, CNA, 26 Feb 2014; “Stalking now an offence under new anti-harrassment bill“, Today, 4 March 2014).

The impact of bullying on employee mental wellbeing is well documented: “The Richie Incognito Case: Workplace Bullying or Just ‘Locker Room” Culture?‘”, APA, 21 Nov 2013, Workplace Bullying: Applying Psychological Torture at Work“, “Bullying in the workplace“, Psychology Today. A zero-tolerance policy at the workplace is key to helping employees maintain their mental wellbeing, as well as sustain employee engagement and productivity. It helps too, if employees recognise bullying behaviours and know the steps to take to protect themselves from the negative effects of bullying.

4. Knowledge is power 

Someone who collapses after running a marathon almost always seems to be a man (e.g., 2XU Compression Run). At least that’s what we get from the news. But statistics show that “women are just as prone to heart disease” as men (Straits Times, 7 May 2013; read this article by the Singapore Heart Foundation). Furthermore, women who experience high levels of stress are reported to be particularly vulnerable. Breast and colorectal cancers are among the top cancers for women in Singapore (based on figures from the Singapore Cancer Registry) but there is evidence to suggest that these and diabetes are preventable with fruits, veggies, whole grains, and an active lifestyle.

Newspaper reports about men with depression appear more often than those about women with depression, potentially fueling our use of the availability heuristic. As a result, we may think that depressive illnesses are more frequent in men than women. In fact, it is the opposite (here’s why); moreover, it’s widely acknowledged that mental illnesses affect women differently from men (the US National Institutes of Health has useful fact sheets).

You can do something about it. Even if you’re only reading about it (e.g., from the US National Women’s Health Resource Center; Women’s Health (Department of Health and Human Services); US NIH’s Women’s Health Resources). It’s a good start!

Postscript. There is local funding to promote women’s health at the workplace, though it does not quite provide for all the items on this wish list. Enjoy!

Staying safe

reading the signs

Cyberstalking’s a word that’s frequently bandied about in the news.

But the real deal really does hurt. These recent reports (“Leandra Ramm’s cyberstalker gets 3 years’ jail“, CNA, 20 Dec 2013; “Cyber stalking case: American singer harassed by Singaporean has written an e-book about it“, Straits Times, 4 Dec 2013; “Singaporean who cyber-stalked US singer Leandra Ramm jailed 3 years”, Straits Times, 20 Dec 2013) bring to light the psychological consequences of exposure to online harassment: symptoms of post-traumatic stress disorder (“He kept me in a virtual prison”, Straits Times, 23 Dec 2013).

But it can be suggested that two emails of harassment, of any nature, are already one too many. Actually, two too many. Given the serious consequences of cyberbullying on mental health, it’s important to know what to do in that situation.

The case above also raises the issue of being alert to situations in which interactions involve hurtful communications and unhealthy relationships. We may not be stalked by someone with an antisocial personality disorder, which as defined by the Mayo Clinic, is “a type of chronic mental condition in which a person’s ways of thinking, perceiving situations and relating to others are dysfunctional — and destructive“, but we may have come across or had to deal with someone who, to some degree, shows poor respect for others, lacks compassion for others, and is manipulative towards others. It may be someone we spend time with regularly (Psychology Today offers advice on how to gently let go of a toxic friend). It could be someone with whom we have had only online contact with. Either way, we need to recognize a situation for which we want to do something about.

A CNN report offers advice on how to deal with stalkers on the Facebook platform (“How to handle a cyberstalker“, CNN, 21 July 2010), while Yahoo has general tips for dealing with a cyber stalker. And WikiHow has an excellent step-by-step guide. The advice from www.bullyingonline.org succinctly states, the first rule is not to engage. It’s excellent advice, but in this digital age, you can protect yourself with one more thing you can use to your advantage: Emails can be automatically filed in a folder you’ve created specifically for the purpose of a) not reading it and b) documenting all correspondence, using keywords in a rule or filter in your email client. The canned response function on gmail is one such example. Finally, the Association for Progressive Communications (APC) offers wonderful advice we should heed. Stay safe!