Showing posts with label My Coping Strategies. Show all posts
Showing posts with label My Coping Strategies. Show all posts

Tuesday, February 12, 2008

Correcting my faulty thoughts / thinking patterns

One of the discovery I made from reading some self-help book and through some of my counsellings sessions with some counsellors, was that I do have some faulty thinking patterns which may have either contributed to some relapses of clinical depression in the past or worsened their symptoms. These faulty thought patterns are most prominent during my relapses of depression.

These are not just occasional thoughts but a rigid thinking pattern which I was not conscious or aware off. Though at times I realized that I was not thinking correctly, but most of the times I wasn’t aware that some of my thought patterns were incorrect as they were so much a part of me. It is only recently through the relapse in Dec 2006, when I sought professional help and started reading deeper into depression, that I came to the realization.

I thank God for enabling me to see these faulty thought patterns more clearly now and enabling me to slowly learn how to recognize them, challenge them and correct them by using the Word of God so that I can think more biblically and live for the glory of God.

I am still trying to recognize some of these faulty thinking patterns. I know that sometimes I do have quite a number of the faulty thinking patterns that is listed in the articles below. I am also quite a perfectionist which means my expectation of myself can be rather high, and indirectly I stressed myself up unknowingly. I am also not an assertive person. I have problem saying “no”. So I also put myself through a lot of difficulties or take on more than I can handle. I used to have difficulty relaxing or taking breaks. In some sense, I am a workaholic. I am also fulfilling the role of care-givers in quite a number of context, and having little respite. All of the above or the combinations of some of these, could well have weakened my body and mind, and lead to the relapses of clinical depressions.

I will try and share more about my own experiences when I am more clear about them. But in the meantime, I will just share the following excerpts from a few people whom I found to be very useful and instructive :

1) Dr David P Murray in Lecture 3 “The Condition” of a series of 6 messages on “Depression and the Christian” said:

“Perhaps, the most obvious symptoms of depression are the unhelpful patterns of thinking which tend to distort a depressed person’s view of reality in a false and negative way, and so add to the depression or anxiety.

While we often cannot change the providences we have passed through, or are passing through, we can change the way we think about them so as to present to ourselves a more accurate and positive view of our lives, and so lift our spirits.

We will focus on ten false thought patterns which reflect and also contribute to the symptoms of depression. We will summarise each thought habit, and look at three examples of each, one from ordinary life, another from our spiritual life, and another from the Bible. The Biblical examples are not necessarily examples of depressed person but they are examples of false thinking often present in depression.

It is important to see how our depressed thought patterns affect our ordinary life; and even more important to see how that is then carried into our spiritual life. It is almost always that order in which our thoughts are transferred – false thinking in ordinary life is eventually transferred into our spiritual life.

1. False extremes

This is a tendency to evaluate our personal qualities in extreme, black or white categories – shades of grey do not exist. This is sometimes called “all-or-nothing thinking”.

Life example: You make one mistake in cooking a meal, and conclude you are a total disaster.

Spiritual example: You have a sinful thought in prayer, and conclude that you are an apostate.

Biblical example: Despite most of his life being characterised by God’s blessing and prosperity, when Job passed through a time of suffering he decided he must be an enemy of God (Job 13:24; 33:10)

2. False generalisation

This happens when, after experiencing one unpleasant event, we conclude that the same thing will happen to us again and again.

Life example: If a young man’s feelings for a young woman are rebuffed, he concludes that this will always happen to him and that he will never marry any woman

Spiritual example: When you try to witness to someone you are mocked, and you conclude that this will always happen to you and that you will never win a soul for Christ.

Biblical example: At a low point in his own life Jacob deduced that because Joseph was dead, and Simeon was captive in Egypt, that Benjamin would also be taken from him. (Gen.42:36). “All these things are against me,” he generalised.

3. False filter

When depressed we tend to pick out the negative detail in any situation and dwell on it exclusively. We filter out anything positive and so decide everything is negative.

Life example: You get 90% in an exam but all you can think about is the 10% you got wrong.

Spiritual example: You heard something in a sermon you did not like or agree with, and went home thinking and talking only about that part of the service.

Biblical example: Despite having just seen God’s mighty and miraculous intervention on Mt Carmel, Elijah filtered out all the positives and focussed only on the continued opposition of Ahab and Jezebel (1 Kings 19:10).

4. False transformation

Another aspect of depression is that we transform neutral or positive experiences into negative ones. Positive experiences are not ignored but are disqualified or turned into their opposite.

Life example: If someone compliments you, you conclude that they are just being hypocritical, or that they are trying to get something from you.

Spiritual example: When you receive a blessing from a verse or a sermon, you decide that it is just the devil trying to deceive you.

Biblical example: Jonah saw many Ninevites repent in response to his preaching. But, instead of rejoicing in this positive experience his mood slumped so low that he angrily asked God to take away his life (Jonah 4:3-4).

5. False mind-reading

We may often jump to negative conclusions which are not justified by the facts of the situations.

Life example: A friend may pass you without stopping to talk because, unknown to you, he is late for a meeting. But you conclude that he no longer likes you.

Spiritual example: Someone who used to talk to you at church now passes you with hardly a word, and so you decide that you have fallen out of her favour. But, unknown to you, the person’s marriage is in deep trouble and they are too embarrassed to risk talking to anyone.

Biblical example: The Psalmist one day concluded that all men were liars, a judgment which on reflection he admitted to be over-hasty (Ps.116:11)

6. False fortune-telling

This occurs when we feel so strongly that things will turn our badly, our feelings-based prediction becomes like an already-established fact.

Life example: You feel sure that you will always be depressed and that you will never be better again. This, despite the evidence that almost everybody eventually recovers.

Spiritual example: You are convinced that you will never be able to pray in public. Again, this

despite the evidence that though difficult at first, with practice almost everybody manages it.

Biblical Example: Anticipating the opposition that Jesus would face in Bethany, Thomas falsely predicted not only his own death there but also that of the Lord and the other disciples (John 11:16).

7. False lens

This is when we view our fears, errors, mistakes through a magnifying glass, and so deduce

catastrophic consequences. Everything then is out of proportion.

Life example: When you make a mistake at work, you conclude, “I’m going to be sacked!”

Spiritual example: You focus on your sins from the distant past in a way that leads to continued feelings of guilt, self-condemnation, and fear of punishment.

Biblical example: When Peter sinfully denied the Lord, he not only wept bitterly but decided that as his mistake was so spiritually catastrophic, there was no alternative but to forget about preaching Christ and go back to catching fish (Jn.21:3).

8. False feelings-based reasoning

In depression we tend to take our emotions as evidence for the truth. We let our feelings determine the facts.

Life example: You feel bad, therefore conclude that you are bad.

Spiritual example: You feel unforgiven, therefore conclude you are unforgiven. You feel cut off from God and so conclude that you are cut off from God.

Biblical example: At one of his low points, David felt and so hastily concluded that he was cut off from God. “I said in my haste, I am cut off from before thine eyes” (Ps.31:22).

9. False “shoulds”

Our lives may be dominated by “shoulds…” or “oughts”, applied to ourselves or others. This heaps pressure on us and others to reach certain unattainable standards and causes frustration and resentment when we or others fail.

Life example: The busy mother who tries to keep as tidy and orderly a house as when there were no children is putting herself under undue pressure to reach unattainable standards.

Spiritual example: The conscientious Christian who feels that despite being responsible for meals and raising children, that she ought to be at every prayer meeting and service of worship, and also reading good books and feeling close to God.

Biblical example: Martha felt deep frustration that Mary was not fulfilling what she felt were her obligations and complained bitterly about it (Luke 10:40-42).

10. False responsibility

This is when we assume responsibility for a negative outcome, even when there is no basis for it.

Life example: When your child does not get “A” grades you conclude that you are an awful mother. The reason may be instead that your child has a poor teacher or that his gifts are not of an academic nature.

Spiritual example: When your child turns against the Lord and turns his back on the church you assume that, despite doing everything you humanly could to bring him up for the Lord, it is all your fault.

Biblical example: Moses felt responsible for the negative reactions of Israel to God’s providence and was so cast down about this that he prayed for death (Num.11:14-15).

IMPORTANT

1. False thinking patterns are compatible with being a Christian.

2. False thinking patterns will have a detrimental effect on our feelings, our bodies, our behaviour, and our souls; usually in that order.

“For Christians, depression hardly ever has a spiritual cause…In Christians, spiritual effects follow from the depression, and seldom the other way around.”

3. One of the first steps in getting better is recognising these false thinking patterns which do not reflect reality.

4. While we can do little if anything to change our providence (our life situation), we can change the false way we may think about our providence.

III. FEELINGS

Obviously, these unhelpful false thought patterns are going to give you unhelpful emotions and feelings. If you are always thinking about problems and negatives, or imagine the future is hopeless, or think everyone hates you, etc., then you are going to feel down very quickly. Your feelings about ordinary life and your spiritual life are going to reflect what you think in each arena (Prov.23:7).

Here, we shall briefly look at some of the emotional symptoms of depression. And, as with the area of our thoughts, let us honestly examine the area of our feelings in order to consider whether our emotions are related to a depressive tendency or illness. Also, as with the area of our thoughts, in this area of feelings we shall also highlight Biblical examples of true believers also experiencing such emotions, in order to show that such feelings are compatible with being a true believer.

1. Do you feel overwhelming sadness?

Everyone feels sad and down from time to time, but depression-related sadness is overwhelming and long-term. It often results in tearfulness and prolonged bouts of unstoppable sobbing.

Biblical Examples: Job (Job 3:20; 6:2-3; 16:6, 16), David (Ps.42:3,7).

2. Do you feel angry with God or with others?

A common characteristic of depression, especially in men, is a deep-seated and often irrational irritability and anger.

Biblical Example: Jonah (Jonah 4:4,9), Moses (Num.20:10-11).

3. Do you feel your life is worthless?

It may be that despite your life being highly valued by others, and despite you being useful to others and to the Lord, that because of your distorted view of yourself you feel your life is worthless. Indeed you may feel your life is just a burden to and a blight upon others.

Biblical Example: Job (Job 3:3ff), Jeremiah (Jer.20:14-18)

4. Do you feel extreme anxiety or panic?

“In anxiety, the person often overestimates the threat or danger they are facing, and at the same time usually underestimates their own capacity to cope with the problem.”[3]

Biblical Example: David (1 Samuel 21:12), disciples (Matt.8:25)

5. Do you feel God hates you and is far from you?

Although to any outside observer your past and your present may be replete with examples of God’s good favour towards you, you feel that God has either become your enemy or else has given up on you. You feel as if you are in spiritual darkness

Biblical Examples Job (6:4; 13:24; 16:11; 19:11; 30:19-23, 26), Jeremiah (Lam.3:1-3).

6. Do you feel suicidal or do you have a longing to die?

Biblical Examples: Job (Job.3:20-22; 6:9; 7:15-16), Moses (Num.11:14), Elijah (1 Kings 19:4)

These deeply depressed feelings are movingly articulated for us by the depressed Charles Spurgeon, when commenting on the experience of Heman in Psalm 88.

“He felt as if he must die. Indeed he felt himself half dead already. All his life was going, his spiritual life declined, his mental life decayed, his bodily life flickered; he was nearer dead then alive. Some of us can enter into this experience for many a time have we traversed this valley of death shade, and dwelt in it by the month together. Really to die and to be with Christ will be a gala day’s enjoyment compared with our misery when a worse than physical death has cast its dreadful shadow over us. Death would be welcome as a relief by those whose depressed spirits make their existence a living death. Are good men ever permitted to suffer thus? Indeed they are; and some of them are even all their lifetime subject to bondage….….It is a sad case when our only hope lies in the direction of death, our only liberty of spirit amid the congenial horrors of corruption…. He felt as if he were utterly forgotten as those whose carcasses are left to rot on the battle field. As when a soldier, mortally wounded, bleeds unheeded amid the heaps of slain, and remains to his last expiring groan, unpitied and unsuccoured, so did Heman sigh out his soul in loneliest sorrow, feeling as if even God Himself had quite forgotten him. How low the spirits of good and brave man will sometimes sink. Under the influence of certain disorders everything will wear a somber aspect, and the heart will dive into the profoundest deeps of misery.”

2) And in Lecture 4 “The Causes“, Dr David P Murray wrote:

2. Psychology (the way we think)

In Lecture 3 we looked at 10 false thinking patterns which contribute to depression. It cannot be emphasised enough how vital it is to learn to recognise these unhelpful thoughts by prayerful self examination. It is also important and useful to note that some of these habits of thinking may be involuntarily absorbed or learned in early life and so may be deeply ingrained. When we feel down, or when we are stressed, these latent false thinking patterns tend to occur more frequently and tend to dominate. This can often lead to depression, worsen an existing depression, and, if persisted in, make recovery from depression so much harder. Sometimes, the Church can reinforce or add to false thinking patterns by over-emphasis on the negatives in the Bible and in people’s lives, or by setting standards of commitment which may discourage or depress those who are unable to attain them.

3) In Lecture 5 “The Cures“, Dr David P Murray wrote:

2. Correct your false thoughts

As we have noted throughout these lectures, one of the most common contributory factors to depression is wrong and unhelpful thoughts. Many Christians, who wouldn’t dream of viewing God’s Word in a false way, yet view God’s world in a false way. As they view themselves, their situations, and their relationships with others, they tend to dwell on and magnify the negatives and exclude the positives. This distorted view of reality inevitably distorts and depresses their mood. Christians are obliged to challenge falsehood and distortions of reality, especially when found in themselves. In the appendix to this lecture you will find two questionnaires to help you do this. The first is to help you examine your thoughts, and the second is to help you challenge your false and unhelpful thoughts. Questionnaires such as these are recommended for use by many Christian and non-Christian psychiatrists. They may look a bit strange to you, and you may wonder, “Is this not all just psychological mumbo-jumbo?” However, I would like to show you here how each step is grounded in Biblical Christian experience. In Psalm 77 we have a perfect example of Asaph investigating and challenging his thoughts with God’s help, in order to raise his mood and spirits. There are also slightly more abbreviated versions of the same biblical strategy in Psalm 42, Psalm 73, Job 19, Habakkuk 3, etc. So, this is not “psychological mumbo-jumbo”, but true Bible-based Christian experience. Let us look at Psalm 77 to prove this.

Download the following file :

asaph.pdf

To be continued ….

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns

Counselling/Talk therapy/Psychotherapy

Actually, besides medication, counselling / talk therapy / psychotherapy / Cognitive Behavioural Therapy is one of the most important tools for a person with bipolar or depression to get well. Cognitive Behavioural Therapy (CBT) which is a form counselling with a focus on understanding how our thoughts affect our behaviours. Bipolar alternates between 2 extreme mood swings ie. mania and depression, and our thoughts and behaviours are shaped by these mania and depression episodes which can at times be very confusing. CBT helps to make sense some of these confusions, and help to pick up skills to manage these mood swings so that one can be more functional.

Through CBT, I do realize that I have quite a number of character traits and faulty thought patterns which might have contributed or aggravated my relapses. I will share more about it in my next post on the topic “Correcting my false thoughts”.

I am also quite a perfectionist which means my expectation of myself can be rather high, and indirectly I stressed myself up unknowingly. I am also not an assertive person. I have problem saying “no”. So I also put myself through a lot of difficulties or take on more than I can handle. I used to have difficulty relaxing or taking breaks. In some sense, I am a workaholic. I am also fulfilling the role of care-givers in quite a number of context, and having little respite. All of the above or the combinations of some of these, could well have weakened my body and mind, and lead to the relapses of clinical depressions.

At the moment, I am not seeing any professional counsellers. I do seek my Pastor’s counsel and some other friends or family members’ counsels when necessary. I also read books and internet articles to understand my condition better and how best to manage it. Thank God that there are a lot of resources available on the internet. One such website is Bipolar and Depression Support Alliance which has very useful information on symptoms, treatment, resources, etc etc.

When I was first diagnosed with depression in January 2007, I have benefitted from a group of counsellors at Counselling and Care Centre, Singapore. I am thankful to God for providing me with a team of very compassionate, kind, understanding and encouraging Christian counsellors who are trained to manage bipolar, depression, OCD and other brain condition. My time with my counsellor, Sarah, was most meaningful and useful. Sarah and her team were helping me to trace the history of my relapses in the past 18 years which I could remember better, the possible causes of them so that I can learn to manage my illness better. That was actually a journey of self-discovery, of knowing God, myself and others better. Each session with Sarah and her team have yielded some positive results. Accumulatively, these knowledge of self and God’s mercies in them, are changing my life in many wonderful ways. Thank God! My counselling session ended in April 2007 when Sarah who was a trainee at that Centre completed her training. I am deeply indebted to Sarah for the help that she has rendered to me. They have been invaluable to me as I journey on.

I have tried out some other counsellors and am, in particular, indebted to Dr Spencer Lee and Yvonne Ying of Association of Christian Counsellors of Singapore for their valuable helps for some weeks in July and August 2007. They are most compassionate and helpful.

The above counsellors are all trained in cognitive behavioural therapy, etc and they have been helping many people who suffer from depression, bipolar and other mental illnesses. The reasons why I sought their help, besides receiving pastoral counselling from my Pastor, was because I needed someone who understands mental illness and therefore able to help me to manage my illness and symptoms. I am thankful to God for providing them at such times when I needed them the most.

Now I am not seeing any of these professional counsellors but just receiving pastoral counsellings from my Pastor, elders and brethren in my church. I am learning to look to God and use other available means too ie reading God’s Words, prayers, medications, regular exercise, Omega-3 fish oil supplements, learning to manage stressful situations in my life, learn to pace myself more slowly and realistically, learn to take breaks and to relax whenever necessary, etc.

I have written 2 emails to Sarah and a tribute to her as follows:

——

Dear Sarah,

Warm greetings to you in the name of our merciful Saviour and Lord Jesus Christ!

Just a short note to thank you and your team for the help and support you are giving me as I seek the Lord’s guidance to understand and manage my condition better. I really appreciate what you are doing to help me. Your sincerity and warmth really touched my heart. Though we have met only for 3 sessions so far, I thank God that I have been helped by every one of the session. I appreciate what we have been able to discuss so far and the way you & your team are helping me to see things from a different angle. I am learning to be more thankful daily!

I thank God for His goodness and mercies in leading me to your centre and placing me under you and your team. The care and helpfulness of all of you and the other staffs at your centre really impressed me. Thank God for using all of you to help me and others who are in need of help.

May God continue to use you, your team and all the staff at Counselling and Care Centre for His glory. May all of you continue to be used in many wonderful ways to help others and especially God’s suffering people. I am praying for all of you too.

Many thanks again for your enthusiasm to help me and your prayers. It is one of the factors that gives me a lot of encouragement and motivation to come for the sessions. I thank God for you. May you continue to serve our Lord joyfully and faithfully for His glory.

Wish you and your family a blessed Chinese New Year.

With sincere thanks & prayers,
Nancie
15 February 2007

——

Sarah’s reply to me:

Dear Nancie,

Warm greetings to you too in the name of our loving and gracious Saviour, Lord Jesus!

Thank you very much for your lovely, thoughtful and heartwarming email. I am touched by your gracious gesture. It is a privilege to be used by God to extend His presence for His precious ones. And you’ve been a great joy to come alongside with. I thank God too for you and for giving me this privilege.

I am greatly encouraged to hear that you have been helped through our sessions. Your words give me impetus to continue and persevere in the work with and for others in the offering of presence and support .

Thank you for praying for us and your continual prayer support is much appreciated. Glad to hear that you have experienced the help of prayers. Indeed, our Lord is the source and the enabler of all we do. All praise and glory to Him!

I shall relay your email to my team. I am sure each one will be encouraged by your words.

Wishing you and your family a Blessed Chinese New Year too.

With grateful thanks and prayers
Sarah
21 February 2007

—–

Dear Sarah,

Thanks for your kind and encouraging reply! Glad that the email has encouraged you. Thank God.

May you and your colleagues continue to press on in the good work that you are doing for God’s glory. I know your work can be very difficult and draining at times. I am glad you work in a team and can discuss and pray with your colleagues. Do take care and may our Lord continue to bless your labours in Him. May you continue to find much joy in helping and supporting others.

Looking forward to see you again soon on Monday, 26th Feb 2007 for our next session! Trust our Lord will continue to bless our time together. Many thanks again for all your help and support.

“For God is not unrighteous to forget your work and labour of love, which ye have shewed toward his name, in that ye have ministered to the saints, and do minister.” Hebrews 6:10

“And let us not be weary in well doing: for in due season we shall reap, if we faint not.” Galatians 6:9

With appreciation,
Nancie

A Tribute to my Counsellor, Sarah

16 April 2007 was my last session with my Counsellor, Sarah because she has ended her training attachment and will be returning to her actual work. I am grateful to God for placing me under Sarah’s care for the last 3 months (since 29 January 2007). I would like to express my deep appreciation and gratefulness to Sarah for helping me to embark on a new journey in my life which is changing my life and my relationships with God and the people in my life in many wonderful ways. Sarah, I will never never forget you. I thank God always for you. I hope you get to read this Tribute I have written especially for you. May God bless and keep you.

Dear Sarah,

Warm greetings to you in the name of our beloved Saviour and Lord Jesus Christ!

Thanks once again for your prayers, listening ears, counsels and encouragements. I have learnt much from our sessions together in the last 3 months. Thank you for your willingness to help me and to go along this journey of self-discovery with me. I will forever thank and praise God for you and your team in the way our Lord is wonderfully using you to help me.

I am thankful to God for causing our paths to cross in such a wonderful way at Counselling and Care Centre during your training sessions there. Surely this is not by coincidence but by God’s providence that I should be seeking help at this particular point of time and you should be under attachment there.

I am grateful to God for hearing my prayers and provided someone like you who is very gentle, caring, sympathetic and encouraging to be my Counsellor. You always see something positive and encouraging that God is doing in all my difficult trials. You constantly seek to help me to see the many mysterious outworking of our faithful God, Who loves us dearly and gave His Son for us, in the various paths I have gone through in the past or are going through now. You have helped me to discover some faulty patterns in my thoughts and feelings which have affected my life and various relationships for so many years. Thanks for slowly helping me to recognise these faulty thought patterns, and change these faulty ways of thinking to more biblical ways, by God’s grace. These are beginning to have such tremendous effects on my life, my relationship with God and others around me. I am thankful to God for providing such a help in you and your willingness to walk through this difficult journey with me. By God’s grace, each session yields some positive outcome. Accumulatively, these new discoveries of self and God’s mercies in them, is beginning to change my life in many wonderful ways. I do look forward to each session with you because I get to know myself better each time, can see more clearer God’s love, mercies and faithfulness and am enabled to improve in my relationships with various people, and also learning to improve in managing the various challenges in my life. Thank God for His mercies and faithfulness!

I trust that when you return to your actual work environment, God will continue to use you to be a blessing to others in need just like the way you have been to me. I have no doubt at all that they will be blessed as I am in their acquaintance with you. You are a very special person who is always gentle, kind, encouraging, uplifting, full of faith and hopeful in the Lord. I will never never forget you and hopefully, by the grace of God, will never forget the precious lessons I am now learning through our sessions together too.

Thank you for sharing my joy and sorrows as I recounted my past history to you. I could sense the deep anguish and pain you feel for me in all my sorrows and trials, and also your delight and joy with me in all my joy. I felt very privilege that you cared for me in this way and I thank God for your kind friendship. It is a tremendous source of strength and support to me in this difficult trial. I know you are praying with me and I want to encourage you, as well as give praise and Glory to God, for His faithfulness and mercies by assuring you that the Lord in His faithfulness is strengthening me each day as I look to Him. Thanks for helping me to identify some of the possible causes of the relapses of my illness and discuss with me how I can better manage them. The many precious lessons we have learnt together in the past months is helping me now to cope better with my illness, with the various challenges in my life, and improve in my relationship with God, my church, my family and people around me. Praise God!

It was hard for me to say goodbye to you yesterday, being our last session together but I know it was necessary in God’s sovereign plan for us. I wish we can remain as friends and keep in touch always. But as you have explained to me that due to some professional ethics, yours and my contacts have to be restricted to this centre and as yesterday was our last session together, our contacts have to terminate there too. I hope I will get to meet you again one day, if God wills, on this earth or if not then, by His mercies, in Heaven when we both see our Lord face to face.

Please take care. I will remember you in my prayers always. May God keep you in His loving care always and bless you in all your various callings. May He continue to make you a blessing and encouragement to His suffering children.

With sincere thanks and prayers,
Nancie
17 April 2007

———————-

Contact Information for Counselling Helps

i) Counselling & Care Centre
Block 536 Upper Cross Street
#05-241 Hong Lim Complex
Singapore 050536
Tel: (65) 6536-6366
Fax: (65) 6536-6356
Email : info@counsel.org.sg
Webwsite : www.counsel.org.sg

ii) Association of Christian Counsellors of Singapore
c/o 422-A Telok Blangah Road
Singapore 098848 (Near Grace Methodist Church)
Tel: 6274-7480 Fax: 62760024
Email: info@accs.org.sg
Website: http://www.accs.org.sg/

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns

Support Network

I realize through this illness, the importance of having the support and prayers of my family and friends, besides professional helps from Doctors, Counsellors and Support Group. The people I love, and who love me, will see me at my best. When my symptoms reappear, they may see me at my worst.

Whenever possible, I will share with them my illness. I give them articles, pamphlets and books to read about bipolar disorder so that they will understand that my behaviour is not always under my control. It will also help them to understand why I am sometimes so different.

A friend recently told me that he used to wonder why I was at times very warm and friendly but at other times very cold and indifferent. After understanding my illnesses and different mood swings, he was able to understand why. He is very compassionate kind and understanding. He even offered me a listening ear should I need to talk to someone when I am feeling down.

My Doctor suggested to me recently, that I should tell my family and friends that I am like a bear :-) For certain period of time in a year, I will hibernate :-) Bears hibernate during winter in which they pass the winter in inactive.

I thank God for my family’s understandings and concerns. I thank God especially for the prayers and encouragement of many of my friends, especially those from my church and 2 sisters from Canada. I am also grateful for the many kindness they have extended to me especially in giving love gifts very generously to me so that all my medical and other expenses are covered during this period of recuperation away from work.

I thank God that I am in a community of people who love God and love me, who accepts me in my illness and weaknesses, and continue to extend their love and friendship to me. To the Lord and to them I owe a debt I cannot repay. I can only pray that God will bless them and their family with rich spiritual and temporal blessings, and continue to provide for their every need. I will also strive to live for God’s glory and to serve Him and His people, to the best of my ability, as the Lord enables me. To God be the glory!

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns

Leisure, Hobbies or Recreation

I am beginning to understand that it is important to take short breaks every now and then. It is also important to schedule leisure time or time for creation whether on my own or with my family and friends. I also began to enjoy my hobbies better and develop new ones.

Walks

I enjoy taking brisk walks or just simply walk at the beach or a garden. Now I realized that in the past I led life that is too busy and imbalance. I didn’t have time to go for walks. Even if I do, I do not know how to enjoy it. But recently, I have begun to enjoy walking in a different sense. I am enjoying walks and nature. I enjoy looking at flowers, trees, plants, birds, cats and other animals. I sometimes enjoy watching people too :-)

I love to look at little children playing or doing things. I look at their reactions and facial expressions. Children are very lovely and we can learn a lot from their little life :-)

Photography

As I began to enjoy walking, I also began to pick up photography. When I go for my walks, I saw and appreciate God’s creation in many different ways. I started to use a digital camera to capture some of these precious moments. I am often awed by the beauty of God’s creations and they remind me of His majesty.

In particular, I love to go to the beach and watch the waves. Somehow, they have a soothing effect on me. I am reminded that our light affliction is but a drop of water in the seas of God’s mercies.

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns

Learning to cope with stress

One of my triggering factors in past relapses of depression seemed to be stress and strain. I am a bit of a perfectionist. So my expectation of myself can be rather high. Unknowingly I put a lot of stress on myself to get a piece of work done well. I will also experience more disappointments when I can’t do well or things do not turn out the way I wish it to.

I also have difficulty being assertive and so am often caught in very difficult and stressful situations and yet not able to find a way out. I have problem saying “no” and feel obliged to take on more than I can handle.

When I am manic, I also misjudged my ability and tend to do more or take on more projects than I can manage.

When stressed, I will experience physical symptoms such as jaw pain. I often mistakenly thought it was toothache but repeated visits to dentist revealed no tooth decay. Dentist suspected that I clenched my teeth when I am stressed. I am not conscious of this but he said this is typical of his patients who suffer from stress or depression and they clenched their teeth unknowingly.

I also began to experience tension headache recently when I am stressed or strained. I will also experience extreme exhaustion.

I am coping by using the following:

1) Try to keep to a regular hours or routine to ensure that I get enough sleep every day.

2) Learn to be more aware and recognize early symptoms that I am being stressed up. The jaw pain and tension headaches are warning signs that I can’t ignore anymore. In the past, I can endure them by just taking pain-killers for months, but now I know these are warning signs and I must do something about the situations in my life.

3) Pray and seek God’s grace, wisdom and strength. Once I recognized that I am being stressed up, I will pray and seek God’s grace to cope. I will pray for wisdom to handle the situation I am in better so that I may glorify God and serve Him in it, and not cause further harm to my health or worsen my symptoms.

4) I learn to plan and be more organized. I learn to draw up long-term and short-term plan with the reminder that God willing He will enable me. Setting long-term or short-term plans help me to work towards some goals. I used diaries or calendars to help me with these. Once I put these down in writings, I can develop more realistic goals and be more ready to work towards them.

I keep track of appointments in a diary so that I do not missed them especially my mother’s medical appointments and my own.

I also sought to keep my room and my house more organized by categorizing my things and storing them in respective places. Not being able to find some of my things can at times be a great stressor. Being more organized at home helps me to find my things faster and is less stressful.

5) I try to lower my expectation of myself, others and situations. I learn to be contented with lesser things. I learn to forgive myself and others when things don’t work out the way I wished they would. I learn to be kinder to myself and to others when we failed. I learn to look to God and not to self or others because we will always fail and we have many weaknesses. But God is unchangeable.

6) I learn to communicate. I learn to share with others my struggles or difficulties. I learn the value of brain-storming to find solutions to problems. I learn to ask for prayers and counsels whenever necessary.

7) I learn to relax and slow down or take breaks whenever necessary. When I feel tired, I learn to listen to my body and take a rest. I tried to take short breaks in between my tasks. I have a habit of sitting for hours doing my tasks. I am often very engrossed. Wrong posture and lack of rest or breaks can bring about stress unknowingly. I learn to take small breaks to drink or stretch myself.

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns

Mood Tracking and Journalling

One of the best coping strategies, suggested by professionals and patients alike, is using a mood chart to track my own episodes and symptoms. A mood chart can be a preventive tool to help identify early warning signs for relapse, a record for physicians and family to help assess the efficacy of different medications and treatments, and a therapeutic tool to organize a person’s daily routine and improve awareness of illness.

I found keeping a Mood Diary (download mooddiary.pdf) and a Mood Chart very useful. I used a chart to keep track of my mood for the day, whether it is up or down. I also use a Mood Diary to record my activities throughout the day and I rate my mood for each activity. Increasing number of downs on my Mood Chart or Mood Diary is a red light for me to take action, re-examine my lifestyle and make changes, if necessary.

I also use a Journal to write down my thoughts, feelings and reflections. This can be very therapeutic. I find writing to friends to share with them my experiences can also be very therapeutic. So is developing this blog to share with you and other readers :-) Thank you for lending me a “listening ear” :-)

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns

Research and Readings

I found it necessary to read up as much about my illness as possible in order to understand it and how it has affected me or is affecting me or will affect me.

I did a lot of my research and reading through the internet. I am thankful for the vast amount of information and resources available on the internet. I do realize that I have to be careful and cautious of what I read. Some information may not be true.

However, generally I found a lot of useful information and tools on the internet.

Some of the websites that I found to be very informative are as follows:

Professional Helps

1) Depression and Bipolar Support Alliance

http://www.dbsalliance.org/site/PageServer?pagename=home

This website has many resources on mood disorders, steps for recovery and practical tools for coping.

To be continued......

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns

Omega 3 Fish Oil Supplements

Thank God that through the kindness of 2 church friends, Arthur Koh and another friend, I am able to take Omega-3 fish oil supplements on a regular basis. Omega-3 fish oil is said to help with bipolar disorder. I read some information and book on this subject. I believe Omega-3 fish oil will help my condition to improve in the long run and provided I take them regularly.

Andrew L. Stoll wrote a very excellent book entitled “The Omega-3 Connection: The Groundbreaking Omega-3 Antidepression Diet and Brain Program”

omega_connection.jpg

SYD BAUMEL did a review of “The Omega-3 Connection” as follows:

The Omega-3 Connection: The Groundbreaking Omega-3 Antidepression Diet and Brain ProgramBy Andrew L. Stoll

Simon & Schuster, 2001

Hardcover, 304 pages, $35.50

available at Amazon.com

Reviewed by SYD BAUMEL

Fat (the dietary kind) is hot stuff. And on the cutting edge is the relationship between the grease on our plates and the molecules in our brains. Harvard psychiatrist Andrew Stoll is helping to define that edge. In 1999, he was lead author of a study that suggested megadoses of fish oil could dramatically improve the course of severe bipolar disorder (also known as manic-depression). Fish oil and flax oil are notable for being the major dietary source of the hottest fats of all, the omega-3 essential fatty acids. They’re the focus of this thoughtful, fact-packed book.

The Omega-3 Connection is divided into two parts. In Part I, “The Omega-3 Deficit,” Stoll begins by recounting how he and a colleague tumbled to the clinical potential of the omega-3s in the early 90s. They had set out to comb the literature for safe substances that share the physiological effects of mood stabilizing drugs like lithium and valproate (Depakote). To their surprise, omega-3 fatty acids were the best fit. In time, they discovered that “omega-3 fatty acids were . . . safer than valproate and lithium: they had few side effects, and, in my [Stoll’s] practice, at least, they have become one of the most frequently prescribed ‘medications’ for patients with mood disorders.”

Stoll follows with a superb primer on dietary fats and the specific role of omega-3 deficiency in undermining physical, mental, and neurological health. He puts this into evolutionary perspective, explaining how modern changes in animal feed and the human diet have all but drained the omega-3s from our ancestral diets while radically boosting the intake of the physiologically complementary – and antagonistic – omega-6 fatty acids.

The heart of the book, and the bulk of Part I, details the connections that Stoll and dozens of other scientists are making between this omega-3 deficit/omega-6 excess and a diverse range of psychiatric and neurologic diseases and disorders. “The case we present to you is not yet solid,” Stoll cautions. “Many more studies are needed.” But with such a consistent pattern in the research, it’s hard not to be concerned about the apparent hazards and inspired by the therapeutic possibilities Stoll lays out in tight, “evidence-based” detail. Consider some examples:

  • The developing human fetus is an omega-3 sponge, capable of depleting the mother’s reserves to build its own omega-3-rich nervous system. There is evidence that if a pregnant woman hasn’t enough omega-3s, she will be at increased risk of potentially fatal eclampsia and her baby will be more likely to enter the world prematurely, at low birth weight, and with a faulty nervous system, among other handicaps. That same omega-3 deficiency could psychologically depress the mother during pregnancy or cause postpartum depression or psychosis later. Stoll describes a study from the U.S. National Institutes of Health: “Across the board, nations with high levels of fish consumption . . . had the lowest levels of postpartum depression,” and vice versa.
  • Considerable evidence implicates omega-3 deficiency as a risk factor for any kind of depression. While controlled clinical trials of omega-3s for major depression are underway, Stoll has experimented less formally. When he added fish oil or flax seed oil (also known as linseed oil) to the regime of antidepressant-resistant patients, “five of sixteen responded at least partially, and four of those experienced marked improvement.”
  • Stoll discusses the aftermath of his groundbreaking controlled trial of fish oil for bipolar disorder. “To date, I have used, or consulted on the use of, fish oil in the treatment of hundreds of patients, usually using it in addition to lithium, valproate, and other mood stabilizers. For those with milder forms of the disorder, and rarely in more severe cases, I have used the omega-3 fatty acids alone.”
  • There is intriguing evidence that road rage and other acts of impulsive violence, as well as simple hostility, could be fuelled in part by a lack of omega-3s. In one study, Japanese scientists found that exam-time pressures created increased signs of hostile ideation in medical students – unless they’d been taking supplements of DHA, one of the three main omega-3s. Upping the ante, Stoll writes that “researchers studying violent criminals have . . . documented a defect in the biochemical system responsible for carrying DHA into the brain.” He cites an NIH colleague who therefore suggests that “higher than normal doses of omega-3 might reverse the trend.”
  • Twenty years ago, researchers first noticed many clinical similarities between omega-3 deficiency and attention deficit hyperactivity disorder (ADHD). “Most striking,” Stoll notes, “some 40 percent of those with ADHD had low levels of omega-3 fatty acids in the blood.” Researchers at Purdue University later found that ADHD children appear to require a much higher omega-3 intake than other children to achieve normal body levels. The Purdue group is now conducting a trial to see if DHA will relieve ADHD. [UPDATE: Disappointingly, a Mayo Clinic study has since found no advantage of DHA over placebo for ADHD children. However, an Oxford University study did find that a broader spectrum supplement of essential fatty acids did improve ADHD-type symptoms in children with learning disabilities.]
  • One research group has found the same kind of powerful correlation between omega-3 intake in different countries and schizophrenia as others have found for depression and heart disease. In preliminary reports, supplementation with EPA (another major omega-3 fatty acid), but not DHA, has had modest to dramatic clinical effects on schizophrenic patients.

What would a self-help book be without a “plan”? In Part II, “The Omega-3 Renewal Plan,” Stoll delivers chapter and verse on how to follow a fat-smart diet and use omega-3 supplements to, one hopes, prevent or treat the conditions reviewed in Part I. (For vegetarians, linolenic acid, the simpler omega-3 essential fatty acid found abundantly in flax, hemp, and a few other plant foods, may suffice. Though Stoll doesn’t mention it, algae-derived DHA supplements are also available.) There are even 25 pages of recipes, from Tabouleh with Walnuts to Lemon-Herb Flax Butter.As with many “latest breakthroughs,” the omega-3/brain connection isn’t really new. As early as 1981, a Harvard-trained physician named Donald O. Rudin began publishing papers and books presenting his theory and evidence that a modern Western epidemic of omega-3 deficiency is wreaking havoc with people’s health – bipolar disorder and schizophrenia being two of the worst symptoms. Commendably, Stoll credits Rudin for his obscure, yet pioneering contribution.

If you’ve ever wished for a book that could be called “Your Brain on Fats,” you’ve come to the right place.

Syd Baumel is the author of Dealing with Depression Naturally. For an excerpt from his chapter “Separating the Good Fats from the Bad,” click here.

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns

Exercise

During my recent relapse of severe depression in July 2007, due to various reasons my condition was unstable despite medications, and I was advised by many kind friends to do regular exercise besides taking medications. My physician, Doctor Pauline Sim and my pastor, Pastor JJ, both also encouraged me to do regular exercise. They suggested brisk walkings. I tried to do so but as I was still very depressed, I didn’t have much motivation or energy to walk for long. I also found it difficult to find a suitable place to go for walks. I didn’t feel like travelling anywhere. Near my home there is a very big and nice Garden but I dare not go alone for fear of safety. So I tried walking around my housing estate neighbourhood. But I found it very stressful to watch out for bicycle riders, traffic lights, cars, etc.

My Pastor suggested that I tried more vigorous exercise. He mentioned some exercising facilities near to some housing estates. He also suggested joining a gym if there is one.By the merciful providence of God, an all women’s gym just started near my home in Nov 2007. I have joined this all women’s gym, All Shapes Ladies Fitness Centre for a special promotion trial of 3 months from mid-Nov 2007 to mid-Feb 2008, in order to build up my body and strength it. For the special promotion trial, I only need to pay S$150 for 3 months (ie. S$50 per month) and I am allowed to use their facilities at any time between 7.00am to 9.00pm daily. There is a trainer throughtout the day.

I usually go early in the morning from about 7.30am to 8.30am, Monday to Friday, whenever possible. I do brisk walking (and now some jogging as well) for 45 minutes to strengthen my heart and build up my stamina. I also do some weight training to strengthen my muscles. Sometimes I use their stationary bicycle or cross-country ski. I have also tried their circuit training once.

I am grateful to All Shapes’ Director - Nelam, Gym Supervisor - Wani and other trainers and members of All Shapes for the kindness and encouragements to do exercise regularly. They knew about my illness and encouraged me that regular exercise will help my illness to improve. They do have members who are also suffering from depression and other illness such as cancer, etc and their health have improved through regular exercise

I thank God for His faithfulness and provision of this means in my restoration. When I first joined All Shapes, I was still very depressed and stayed at home most of the time. I dreaded going out and meeting people. But the motivation to get well and the encouragements of Nelam and the trainers at All Shapes, gave me the courage to step out of my home daily to get some fresh air and to exercise. Meeting the trainers and other members at All Shapes helps me out of isolation, and slowly ease me into the society again.I am beginning to appreciate the good effects of regular exercise. It not only strengthens my body, it also strengthens my mind. A few days after going to the gym, I began to experience symptoms of hypomania. I was able to reduce the dosage of my anti-depressant shortly after I started the regular exercise. Now after 2 months of working out at the gym, I am able to go off the anti-depressant. Thank God!

All Shapes Ladies Fitness Centre also has another branch at Joo Chiat besides the Woodlands branch near my home. The owner, the trainers and members are all women. Their emphasis is on health and healthy living, and not so much on losing weight or looking good. The latter are the bonuses.

Their charges are also very reasonable and affordable to most people with average income. If you or someone else is interested to know more about them, do visit their website at:

http://www.allshapes.com.sg/

I also began to enjoy brisk walking around my neighbourhood and walks in gardens or beach. I am beginning to enjoy God’s creations in many wonderful ways.

Recently, I also began to enjoy photography as well. When I go for my brisk walk or go to the beach or to the garden, I like to take photographs of natures and I am learning to appreciate the beauties of God’s creations :-) Now I realized what I missed in the past when I was too busy and no time to walk.

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Contact Information

All Shapes Ladies Fitness Centre

1) All Shapes @ Woodlands
268 Woodlands Centre Road #04-09
Woodlands Point Singapore 738931
Tel: 6366 8687
Fax: 6366 8418

2) All Shapes @ Joo Chiat
20 Joo Chiat Road #04-01
Singapore 427357
Tel: 6440 9308
Fax: 6440 9309

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns

Balance Lifestyle

Through this illness, I came to the realization that I was leading a lifestyle that was terribly imbalance in the past. My days consist mostly of work, home and church. I was also often fulfilling the role of a care-giver with little respite. I do not do exercise regularly, do not consciously eat balanced meal, have little time for relaxation or recreation, and did not take time to learn how to manage stress in my life.

I am learning that it will benefit me if I have a more regular patterns of daily activities including enough sleep, eat a balance meal with some supplements if necessary, and have regular exercise and physical activities plus developing meaningful relationship and friendships in my life. And learning to manage the stress in my life better and take breaks or have time of relaxation and recreations.

I am benefitting from a combinations of the above. I will share about them in subsequent posts :-)

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns

Medical Helps

Some people are apprehensive of seeking medical help as they did not want to be put on medications due to the side-effects of medications. Some may not want a diagnosis by the Doctor or Psychiatrist.

For a long time, I didn’t want to seek professional or medical helps. Partly because I didn’t know or didn’t think my condition is a medical illness. Partly because I believe as a Christian I should weather the episodes by looking to God and waiting on Him alone.

It was during a very severe relapse of clinical depression in Dec 2006, through the encouragement of my employer and colleagues, that I was led to seek medical help as I was extremely suicidal and could not cope with my work and life. Thank God that by His mercies I reacted well towards the medication. After a week of being on an anti-depressant (fluoxetine or common brand name Prozac), I began to feel better. I was more functional and able to continue with my work. I did experience some side-effects of the medications such as dry mouth, constant waking up in the night, etc but I got over them after sometime.

In my experiences thus far, it is most important to find a good doctor/physician/psychiatrist.

Find a good doctor

I thank God for providing for me a very good lady doctor early in my endeavour to seek medical help, through the recommendations of my employer who knows this lady doctor. I was treated by Dr Pauline Sim of LP Clinic in Singapore. Some details on her Clinic are given at the end of this article.

Dr Sim is a very concerned and kind psychiatrist. She always has a smile on her face. She listens attentively to my description of my symptoms and experiences. She reassures me that with the right medications and other helps, my condition will improve and I can lead a close to normal life and be productive. She is always very positive, hopeful and encouraging. I thank God for using Dr Sim to help me.

For some months after I first got better in April 2007, I did attempt to seek medical help from a hospital where I can get subsidized fees for consultation and medications, due to financial constrain. But somehow I find it difficult to really communicate with this male doctor. He is a very nice doctor and genuinely concern for his patients. I somehow prefer a lady doctor and due to other reasons, especially a bad relapse recently, I saw it as providence and of necessity to make a switch back to Dr Sim when the Lord provided for me financially through the kind love gifts of some church friends. Thank God that my condition has improved tremendously under Dr Sim’s care once again. Dr Sim not only monitor my medications and adjust the dosage accordingly, she also taught me how to recognize early symptoms, how to adjust my medication when necessary, how to arrest a relapse or shorten an episode by using other coping strategies. She is equiping me to handle this illness so that I can be more functional.

I realize that it is important to find a good Doctor as well as a Doctor that I can work together with on a long term basis. My Doctor is my partner in treatment and recovery. It is important for me to find a Doctor that I can speak openly with, who will listen to me and emphatize with me, who will offer helpful suggestions and be invested in my recovery.

This illness is not like other illness where a Doctor just need to know the symptoms and then prescribed the standard medications. Bipolar illness is a life-threatening and chronic illness that affects different individuals in different ways. It is there necessary to find a Doctor who is willing to understand me, my make up and personality, how this illness is shaping or effecting my life and help to work with me on the medications that will help me to function more stably in the long run. A Doctor who is willing to explore with me the possibilities of my relapses or the causes of worsening symptoms and advise me how best to manage my medications and illness. This I have found to be possible with Dr Sim’s help.

I thank God for His kind provisions of love gifts through various friends in my church who gave of their substance anonymously and very generously. It is with this merciful provisions of God through them that enable me to continue treatments with Dr Sim.

Medications

When I was first given anti-depressant in Dec 2006 during a severe relapse of depression, I was reluctant to take the medication. Though I have taken the first step to seek medical help, I was nevertheless still very apprehensive as to whether I should be taking medication. I was not sure whether as a Christian, I should be relying on medication to get better or I should just pray and wait for God to restore me.

I hold on to my medication for 1 month. During that 1 month, I tried self-help techniques besides praying to God daily for deliverance. I tried to walk every afternoon during my lunch break. I attempted to challenge my negative thinking patterns. Depression tends to cause my thoughts pattern to become very negative. I tried to do things that I enjoy in the past. But none of these things helped very much. At the end of the 1 month, I was still very depressed. Finally, I decided to give the medication a try. I thought to myself, could my condition really be a medical condition? I have tried other ways. Why not give these medicine a try?

Thank God that by His mercies, just about 1 week after starting on 20mg of fluoxetine every morning, I began to experience its effect. The medicine didn’t cure me of depression but it lifted me up to a more functional level. I was able to cope better with my work and life. I am learning that medication cannot cure me. But during a severe relapse of depression, anti-depressant can help to lift me up to a level that I can function and then make use of other helps. I did experience side-effects such as dry mouth, waking up in the night several times, etc etc but I got over them after sometime. Generally, it has helped to shorten my episode of depression. Without medication’s intervention, I will have to go through it for at least 3 to 6 months, or even a year or two, as there is a cycle to it. It is possible to get well without medication, but it takes a longer time and much suffering during the waiting.

I was on the anti-depressant for some four months when some happy things began to happen in my life. I discovered some of my late father’s markings in his Bible and Hymnal, revealing the possibilities that he might have known something of the saving grace of God or possibly he has trusted in the Lord as his Saviour. I was thrilled at this discovery. I have prayed for my father’s salvations for years and though at times he has indicated his trust in God, I have no assurance of his salvation when he died of heart failure in April 2001. I was overjoyed in this wonderful discovery and cherish the hope that he might be with the Lord now and that I may see him again in eternity.

At this same period of time, my mother visited my church for the first time. She is not a Christian and has no desire to go to church. But upon the kind invitations of some church friends, she finally visited my church and heard the Gospel preached. She enjoyed the friendship of many of my church friends and she know some for them for many years already as they have visited us in the past years.

These 2 events brought so much joy to me that I find myself not able to sleep much at night for many nights. I often sleep for about 3 hours only and then I will wake up feeling very excited, happy and with many thoughts. I have racing thoughts and felt the urge to type our my thoughts and feelings. I also talked very fast at times. So I started writing to my friends and I developed my website to share about my illness and God’s goodness. This happened for a few weeks and I was extremely exhausted to the point of almost collapse due to the exhaustion.

When I was finally able to meet up with my Doctor, I explained my experiences to her. She immediately told me that I cannot be on anti-depressant alone as I am prone to bipolar disorder as I was experiencing hypomania symptoms. She immediately gave me 2 other medications ie. mood stabiliser (lamotrigine 25mg, brand name Lamictal) and anti-psychotic (quetiapine 25mg, brand name Seroquel) to be taken every night. She also asked me to stop the anti-depressant as I was hypomania at that time.

Ever since then, I have been on Lamictal and Seroquel. My Doctor told me that I will need to be on Lamictal for lifelong as it is able to stabilise my mood in the long run and lessen the mood swings. I will need Seroquel also as it helps to prevent relapse of depression in the long run. But whenever I fall into severe depression, I will still need to take anti-depressant in order to be lifted up to a more functional level. Lamictal and Seroquel will not lift me up when I am in severe depression. But they act as maintenance medication and can help to prevent future relapses if I manage my condition better.

I am currently on 100mg Lamictal and 25mg Seroquel every night. I hope one day I can manage my illness so well that I can be on lower dosage of medication or without them eventually. But I know that at this point of time, I still need to continue with the medication in order to be more functional. Although the medication have their side-effects, at least they helped me to be functional. Without the help of medication, I will still be in severe depression and will have to wait for the cycle to run its course before I can function.

The frightening truth was that my condition has worsened over the years. My interval of my relapses were closer and my symptoms were more severe and less bearable. I believe that medication and other helps will help me to get better and cope better. So I am learning other coping strategies too. I will share more in my next post :-)

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Contact information :

Dr Pauline Sim
Consultant Psychiatrist
L P Clinic Pte Ltd
Provides psychological services for adults and children
Mount Elizabeth Medical Centre
3 Mount Elizabeth Suite #05-01
Singapore 228510
Tel: (65) 6735-4526
Fax: (65) 6735-4527

Consultation Hours:
Mon - Fri : 8.30am - 5.30pm
Sat: 8.30am - 1.30pm
Sun & PH : Closed
After Off Hrs: (65) 6535-8833

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My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns