Serious mental illness

The Public’s guide to dealing with psychosis

I was speaking to a friend recently. She said that she was accosted by someone while walking on the greenbelt. He was delusional and feverishly trying to engage her in a grand scheme. She felt uncomfortable and was unsure of how to deal with him. A patient of mine works in a bank. She dreads when a particular client comes in because he always demands to speak to her outside, “where the cameras aren’t watching”. She too feels uncomfortable and is unsure how to respond. One of my medical colleagues was giving a talk at a restaurant which opened onto…

The rawness of panic attacks

My patients tell me that panic attacks are not pleasant. They describe it more as sheer terror. They fear dying, losing control or going insane. Panic attacks come on hard, peak fast and usually pass within the hour. They create such a fracture in the sufferer’s psyche that the hangover feeling of having been overwhelmed and the fear of another attack can put a dampener on life plans. Panic attacks can happen to anyone. It does happen to about 10% of us. If they recur and the sufferer starts making their life smaller to avoid situations which might trigger an…

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…

Why can’t I shake this recurrent depression?

By the time patients come to me for the treatment of their depression, they have often been sick for some time. When we go into the history of the illness, it becomes clear that most have been depressed before.  If you have had two episodes, more than likely, you will have a third one. If you have had three episodes, there’s a 90 percent chance you will have a 4th. It seems that a single episode of depression is more the exception than the rule. The greatest predictor of a relapse of depression is stopping antidepressant treatment. More and more evidence…

Drained of all colour: What is depression?

Depression is a difficult concept to understand. We use the term loosely every day: “that movie was so depressing,” or, “I feel so depressed when I think of Cape Town’s water situation”. In this context depression is a normal, healthy part of the human experience. From an evolutionary perspective, depression could even be normal and necessary. Consider the baby bear who lost his mother. First, there is crying and wailing  (separation anxiety), in the hope of calling the mother to him. Then there is silent resignation and withdrawal (depression). The cub curls into a ball and barely moves, so as…

Suicide – the truth about Romeo and Juliet

Suicide Prevention Day was 10 September. Since then there have been an average of 23 reported suicides in South Africa per day. Tragically, teens are increasingly at risk, as Cape Town recently bore witness. I am happy to see that recent suicide media coverage is mostly compassionate and sensitive. The message behind Suicide Prevention Day was “a minute to save a life” – that you can save someone’s life by checking in on them. Unfortunately, suicide is also a magnet for sensationalism. Facebook and social media flare up when a suicide occurs within a community. Excessive coverage of celebrity suicides…

The public’s guide to dealing with psychosis

I was speaking to a friend recently. She said that she was accosted by someone while walking on the greenbelt. He was delusional and feverishly trying to engage her in a grand scheme. She felt uncomfortable and was unsure of how to deal with him. A patient of mine works in a bank. She dreads when a particular client comes in because he always demands to speak to her outside, “where the cameras aren’t watching”. She too feels uncomfortable and is unsure how to respond. One of my medical colleagues was giving a talk at a restaurant which opened onto a…

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