Mental health

New routes to resilience- lockdown 4 and beyond.

Day million of the lockdown and no end in sight. This week has felt particularly rough, with many of my patients really struggling. I think that part of the reason, as we settle in for the long haul, is that previous effective coping strategies have not been useful our current situation. A salient feature of my most robust and resilient patients is the sense that they can make effective future plans. They can make a adjust for any of life’s challenges. Part of my job has always been to help my patients get control in their lives, to help them…

Week one of lockdown: reflections from the couch

On 16 March President Ramaphosa declared a state of emergency. A full lockdown followed soon after. In South Africa you cannot walk your dog, nor pop out to buy alcohol or cigarettes. Psychiatrists have responded by being as freaked out as everyone. For the last 200 years, psychiatrists have used “The Container” as the boundary for their work. It is the committed time and a safe space within which my patients and I explore the hard stuff. A safe space is as important to a psychiatrist’s work, as a sterile environment is to a surgeon. It can be done in…

Anxiety myths busted

Anxiety is a cluster of psychological and physical symptoms. The psychological symptoms include feelings of dread, fear and being overwhelmed. Patients having a panic attack tell me it feels like they are going to die or go insane. Physical symptoms manifest all over the body: racing pulse, sweating, blushing, irritable bowel, irritable bladder, shaking and muscle tension. Anxiety is normal. It makes us look both ways when crossing the street. It becomes abnormal when the sufferer starts worrying and dreading everyday situations.It can start making it difficult to work, attend school or socialise. When it starts making someone’s world small, stops…

What if depression was not an illness of the brain?

At med school, I learnt that depression is an illness of the brain. When we properly treat it with the correct medication, we restore imbalances and patients get better. Depression as a brain illness is a useful model. Many of my patients come seeking help, deeply ashamed of their depression, as if it is a character flaw. When I say that the brain is an organ and can get sick like any other organ in the body, it often helps to get past all the judgemental, self-critical chatter. The longer I am in this game, the more I realise that…

Is Gaming addictive?

I put this question to a group of 12 year old boys and to a group of parents. As to be anticipated, the points of view of the two groups were passionately opposed. The boys felt that gaming was a valid hobby and that the top gamers are akin to top sportsman. (Indeed, it is proposed as a 2024 Summer Olympics gaming event). They said that gaming was a sociable stress reliever, that it kept their reflexes fast and their thinking faster. I must confess, I posed the question to a particularly nice and well-adapted group of boys. They were…

Help! My daughter (or son) has borderline personality disorder

Parenting is challenging. Every parent (hopefully) wishes to raise their child into a successful adult. Someone who can be self-reliant and live life to their full potential. Someone who can find happiness and growth in a solid relationship, and then effectively parent their children in the future. Borderline personality disorder traits can be traced back to early childhood. The disorder has a strong genetic component. There are brain abnormalities detected on neuroimaging. All of this is evidence that borderline personality disorder is a disorder of the brain, not just a psychological disorder. Salient features of this disorder are: Emotional dysregulation (extremely unstable…

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…

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