Mental health

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…

The spirit of community

Simon and Garfunkel sang “I am a rock, I am an island” in the 60’s. Concepts like autonomy, self-reliance, winning and individuation have all been useful in carrying mankind forward. “Tall poppies” are no longer cut down, but celebrated. You no longer have to feel bad for being ambitious beyond your circumstance, or for putting yourself first. The pendulum might have swung out a bit far; there has been a cost to this kind of mindset. Loneliness and isolation are on the rise. In a US survey, the number of adults with zero confidants has tripled since the 80’s. Adults, especially…

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’s the deal with dreaming?

My patients often ask me about dreaming. Why do we dream? Is dreaming important? What does my dream mean? Many cultures would not dream of questioning the relevance of dreaming. Aboriginal tribes have “Dreamtime” which they feel connects them to all time; past, present and future. Some of the Native American tribes highly regard dreams as a source of information and guidance. Scientists have long wrestled with the question of why we dream. Sigmund Freud, who wrote “The interpretation of dreams”, said that dreams were the “highway to the unconsciousness”. He felt that by examining our dreams, we would understand our…

Dementia. Darn, it’s on the tip of my tongue

I am taking a break over the holidays. For the next four weeks, I will be republishing a few of my favourite blogs. I’ve noticed an alarming thing lately, although I should not be surprised. My patients are growing older. Teenagers I was helping with their self-destructive behaviours two decades ago are now anxious mothers. Anxious mothers whom I met 20 years ago are now looking at retirement. It shouldn’t be surprising; I am getting older too. So is the rest of the world. Life expectancy has been steadily increasing worldwide over the last two decades. This is largely…

Let’s talk about food

I am taking a break over the holidays. For the next four weeks I will be republishing a few of my favourite blogs. In continuing with thoughts about selfcare, I would like to talk about food. I hosted a dinner party the other night and there was a vegetarian, someone who was Banting-it and a gluten intolerant guest. We generally agreed that Trump was a disaster, wailed about corruption in SA politics and lamented the drought. But when we got to food, the opinions clashed and arguments got heated. I bet that Mrs Cavewoman host did not have these problems.…

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