Mental health

The holiday blues – tinsel and tears

Summer holidays are starting. I have learnt to close my practice doors in the middle of December. Partially because of increased family commitments, but also because everybody is so out of their routines that they miss their appointments or get the times wrong. During the December holidays, routine psychiatric work falls apart and emergency work picks up. We cannot compare holiday blues and stress to clinical depression and anxiety. It’s like comparing a cold to incapacitating flu. The emergency work I handle seems to be triggered by increased alcohol and substance abuse, less sleep than usual and financial stress. There is…

Cape Town folk believe in mental health

Cape Town is a city that’s blessed to have its heart as a nature reserve. And Cape Town residents relish opportunities to appreciate it. When it’s hot we are on Cape Town’s beaches. When its very hot we hike in her forests. And when the wind blows, we go fly a kite. Every year the Annual Kite Festival is hosted by Cape Mental Health (27-28 October) Its message is simple- “we all have a right to fly.” The right to explore our abilities and live our best life. That is why they are my favourite charity.

People who will destroy your life (and how to avoid it)

In my work, I come across a lot of pathos and suffering. People endure incredible pain, surviving only because of love from families and friends. My experience is that most people are flawed human beings, just trying their best. After being in this business for a while, I have come to realise that there is a small minority of people who repeatedly make it very hard for the rest of us. There is much pain in the world, and most of it is perpetrated by the same 10% of humanity. If you come into the crosshairs of one of that…

When psychiatrists get it wrong.

To get diagnosed with a psychiatric illness is a big deal. Mental illnesses are often chronic and may require heavy medications, each with their own problems and side-effects, to stabilise. Labels such as schizophrenia or bipolar mood disorder carry with them the weight of stigma and poor prognosis. Further, when you are fragile and vulnerable, it’s very painful to be misunderstood; especially if it’s by the very people you turn to for help. It is very, very important to get the right diagnosis when you visit a psychiatrist. But psychiatrists, myself included, can get it wrong. Mostly, we have gotten very…

The lowdown of living with Borderline Personality Disorder

Historically, the border of Borderline Personality Disorder (BPD) refers to the edge of neurosis and psychosis. That unstable area which is always hysterical or mad. It is classified as a personality disorder. Personality disorders are considered fixed throughout life and not amenable to treatment. Unlike psychiatric illnesses such as schizophrenia or bipolar mood disorders, which are considered chronic but responsive to treatment. It is a very bleak view of BPD. Because of this, when I was doing my specialist degree, many psychiatrists felt that it was pointless telling a patient of their BPD diagnosis, that it would just add to…

The happiness enigma

A patient recently came into my practice and pleaded: “I just want to be happy.” I was touched. Afterall, who doesn’t want to be happy? It was such a seemingly small and reasonable request. I felt that I was letting her down by saying that I could not guarantee happiness. That happiness is a state of wellbeing that encompasses living a good life and has to be self-generated. As a psychiatrist, I could help her with her thieves of happiness. Those forces which thwart her attempts to be happy. In this patient, it was the unholy triad of depression, poor boundaries…

Inflammation: the brain on fire

A patient came in very upset. She was suffering from headaches and joint pains. She had been to various physicians and had several tests done. She was told that her pain was due to her mood disorder. She felt that she wasn’t being taken seriously, that her doctors wrote it off as “all in her head”. The reality is that mental illnesses can make you physically ill, and physical illnesses can trigger a psychiatric illness. The common pathway is inflammation Inflammation is your body’s response to insult and injury. It is normal and necessary. It’s when a part of your…

The first psychiatric visit

When I see patients sitting in my waiting room for the first time, they often look embarrassed and ashamed. Most are anxious. I thought that if I demystify the first psychiatric visit,  it will help with these awkward feelings. A psychiatrist is just a medical doctor who specialised in illnesses of the brain. A visit to a psychiatrist is very similar to visiting any other specialist. I will never ask you to lie on the couch. (A psychoanalyst might. Psychoanalysis is a specific form of therapy, usually only offered to people who are in a therapeutic process.) I cannot read…

Parenting with a mental illness

Parenting is hard. We have to keep our children safe and fed; we have to attune to their emotional needs. We sacrifice everything for them: our time, our money, our sleep. And we wouldn’t want it any other way. Having a mental illness is hard. Sometimes getting out of bed is daunting. Acutely self-regulating one’s emotions is impossible. Reality might, at times, become a vague concept. Nobody asks for or deserves a mental illness. It is a painful and often incapacitating disability. When my patients hear that they have a diagnosis of serious mental illness, say bipolar mood disorder or…

Facts on Fasting

Somewhere along the line, we got the message that three meals a day plus snacks is the healthiest. That if we let ourselves get hungry we risk binging to catch up on – and then overshoot – our daily calorie requirements. We know that breakfast is the most important meal of the day and we must not skip it under any circumstance. The idea behind breakfast is that we are hypoglycemic in the mornings, so need breakfast to get our metabolisms going. It seems that we have to once again change how we think about food. Current evidence supports the…

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