Family Constellation

by The Mind Faculty

constellation3.jpg

Family constellation is an effective form of therapy that can help you uncover the underlying dynamics in which you are involved in. It is an alternative therapeutic method that has a systemic approach to restore balance and peace in the family system through acknowledgement and acceptance. It can also be used within a corporate context.  It helps you to look into the possible blockages with your different relationships to release them and help you reach your full potential.

Using representatives, the therapy enables us to ‘see’ the dynamics in a particular issue. In an individual session, these representatives are in the form of tokens or dolls.

The type of token the client chooses, and the way in which the client arranges the token in relation to themselves and the other tokens offers insight into the systemic relationships present in their life. In group therapy, the representative will be the other participants in the group.

We talk to Dyani Thiruchelvam, our speech therapist and Family Constellation counsellor about this groundbreaking new therapy:

Family Constellation is based on the concept ‘Seeing is Freeing’. Would you be able to clarify what that means?
Quite often, we can be faced with problems that we do not want to face. We may not be able to see the truth because we are blinded by distractions or what we think is normal based on societal norms.

When the client sets up a constellation, they can ‘see’ the relationships between the parties involved or the issues faced. By acknowledging what is and allowing oneself to ‘see’ the situation as it is, the path to resolution begins.  

What is your favourite part about Family Constellation?
My favourite part would be the final step in the constellation when everything has been resolved. I love seeing my client feels the ‘peace’, ‘lightness’ and ‘relief’ from working through the issue.

One of the best things about the constellation is that it enables us to express what we need to without actually having to ‘say’ things to the other people involved. That is why the use of tokens and representatives is such a crucial part of the process. It is also another reason why family constellation is so versatile and be used in almost any setting.

How would the family constellation work in a business setting?
In a business setting, people may want to look at the organisational structure to see what the relationships are like and if there are any blockages within the team that may be affecting the business’ success. For example, if there are financial / cash flow problems, the constellation allows us to look into the relationships surrounding this issue – whether there are conflicts within the team or if the division of labour is not working. There are many aspects that we could look into.

Business constellations are set up similar to family constellations. We need to identify the issue and things connected to the issue. Then, I facilitate the process for the client to set up the constellation and we examine this together to identify any potential breakdowns in order to find a resolution.

Does Family Constellation work well in conjunction with other therapies?
FC can work well with many modalities. However, if you have done a constellation with one issue, you would not work on that same issue again with another modality.

Upon saying that, if the constellation brought to light some other issues that may require further release, other modalities such as (but not restricted to) EMDR and EFT could work.

It is also important for the client to allow themselves time to process what they have experienced after the constellation and to not do too many constellations all at once. I would say that clients prefer to do one constellation a month. In between, they may work on other issues using different modalities.

Does the client have to have a particular issue in mind or can the constellation reveal blockages that they were not aware of?
It is always best to work on a particular issue. However, it is also very possible to just look at oneself in a constellation to see if everything is in balance.

Featured Practitioner: Reena Clare, Art Therapy

by The Mind Faculty

Complex emotions require a complex response. For those of you not in the know, art psychotherapy combines talk therapy with art. This mode of therapy adopts a doing-thinking-feeling approach. It gives you a different medium to explore your thoughts and feelings. In an art therapy session, our art psychotherapist, Reena Clare, will help you explore different issues such as grief, dementia, anger and children with special needs.

This is particularly useful for those who find it hard to articulate their feelings.

We sit down with the fabulous Ms Reena to talk about our favourite creative expression therapy:

What inspired you to choose art therapy? Were you artistic as a child or was there an ‘aha!’ moment?
I found it a unique way of communicating and was very interested in the way in unveilsthinking and feeling from a unique angle

What is your favourite medium to work with and why?
I enjoy using batik dye. The results always surprise me and it is delightful.

 You are a certified practitioner in Children’s Accelerated Trauma Treatment (CATT). How can art help us to heal from trauma?
Art help gives a special language to trauma that may not be easy to talk about: it may be challenging to describe or that we may not yet understand. For some, using art  can make talking about this trauma feel safe. CATT uses a arts-based method that is a adaptation of the ‘rewind technique’ – which is used to assist the recovery of PTSD (post-traumatic stress disorder) that has symptoms such as flashbacks, nightmares and anxiety.

Are there any simple ways that we can introduce art therapy into our lives? 
I recommend an art journal. Anyone can start this on their own. Get a sketch book with no lines just plain good empty paper. It can be big or small enough to carry around. Date your entries and avoid tearing any page, even the ones you are not happy with – at most, cross the page. In this you can doodle, draw, paste images, write, scribble – do anything – no rules – you can say anything – no restrictions. Make use of symbols for thing your feel are too personal to explicitly put down. Take away the pressure of filling up a whole page or making things look ‘nice’ – just let it flow.

What has been the response to creative arts therapy in Malaysia? Where do you see it in five years? 
Clients have responded to it very well. Initially people are not sure if is only meant for children or those who can draw, however once they experience a session, they will realise that age and art ability are definitely not barriers to benefiting from art therapy.

I expect there will be more and more awareness of what art therapy is and what it can do. I hope to see art therapy exhibitions more frequently held as it will and empowering form of sharing. Now I can see some pioneering cooperate companies, health organizations and educational institutions engage art therapy, and in 5 years this will increase as it reaches the masses.

Ms. Reena Clare has a Masters in Art Psychotherapy from the University of Hertfordshire. She is a qualified Art Psychotherapist and a certified practitioner in CATT. She has worked in London with various clients including those living with mental health diagnosis, special needs, bereavement, dementia, addiction and physical health conditions in the NHS, Westminster Arts, Kids Company and The European Reminiscence Network. She has sound experience working with children and adolescent on various art-fronted projects. 

Drug Addiction and Rehabilitation in Malaysia

by The Mind Faculty

Drug addiction is a serious public health problem, and is a growing concern in Malaysia. From 2011 to 2015, there are more than twenty thousand people undergoing treatment and rehabilitation in Malaysia. It has a serious impact on the individual, their loved ones as well as the community. Contrary to popular belief, drug addiction is not a choice or a sign of weakness. It is a chronic disease because the drug use has changed the structure and the function of the brain.

Addiction is a complex but treatable disease. Our drug treatment programs work closely with the individual to curb their compulsive drug seeking and use, with a focus on relapse prevention. We work closely with Solace Sabah, a clinical rehabilitation centre in East Malaysia, to help our clients re-integrate with their lives and their loved ones. There is a full expectation of recovery.

We chat with Mithun Kumar, the head of marketing at Solace, about the different resources available to us here in Malaysia.

It is a common misconception that drug abuse is a ‘weakness’ or a ‘choice’. Would you be able to clarify this? 

Around the world, this notion of drug abuse or addiction being a weakness or lack of willpower has been very common; people simply don’t understand why someone can have such a compulsive drive to use drugs even when it causes them harm. Today, science has shown us that addiction causes this weakened state of impulse control. Addiction is a brain disease, and there is research available to support it. When people are in ‘active addiction’, it is no longer a choice because their brain’s reward-mechanism has been hijacked. It should be treated as any other disease.

When drug use gets out of hand, it is not only the individuals but also their friends and family who suffers. Are there any warning signs that we can look out for to prevent this? 

Absolutely. Addiction has tremendous social bearings. The friends see it first, the family realizes later, and eventually medical and police personnel from the community come in when it really gets out of hand. Usually when a family or friend discovers addiction, it is already too late. Then they go into a cycle of “I can solve the problem” by reasoning, arguing, fighting and taking steps on their own to stop the addiction. The key here is not prevention but “intervention”. Being aware of the addiction and seeking professional help for their loved one. There are many ways you can identify someone with addictive traits.  You can read a detailed article on our site here.

The first step of recovery is admitting that you have a problem. During the ‘intervention’, the friends and family of the individual persuades them to enter treatment. Could you explain the importance of an intervention? How would you stage an effective intervention?

The importance here is, to whom are you admitting to? This is not to the family, police or medical personnel, but to oneself. Most addicts are in a state of denial: they feel they don’t have a problem. This is where an intervention plays a very important role. Using techniques of Motivational Interviewing and past experiences, we can help the person achieve this self-realization and decide that they need help after they accept the addiction. You can read more about how Solace Sabah conducts intervention here.

After undergoing rehabilitation, what are high-risk triggers for relapse? Are there any ways to minimize and prevent this?

Triggers are the stimuli that make an addict want to use again. They originate from the addict’s memory in active addiction. Triggers can be any sensation: sights, sounds, smells and touch. At an emotional level, triggers could be: anger, sadness, depression, anxiety and fear to name a few. The most common triggers would be social settings such as friends or places where they abused before. Early recovery is a very vulnerable time for triggers. This is the reason why recovering addicts need to rely on professionals and their program of recovery to overcome these hurdles.

If you or someone you love is experiencing substance abuse problems, please get in touch with us or Solace Sabah. 

Mindfulness for Stress, Anxiety and Wellbeing

by The Mind Faculty

Have you suffered from restlessness, erratic sleep, weight problems, a weak immune system, finding it difficult to stay focus or feeling as if you have lost control?

Our popular Mindfulness workshop helps us to cope with problems that are all too common in our modern life. Stress, depression and anxiety are symptomatic of this frantic and chaotic world. Clinical studies have show that a mindfulness-based training program alleviates stress, improves overall health, and helps manage pain and chronic illness.

What is Mindfulness?

Mindfulness is a skill that enables us to pay attention to what is happening in the present moment with increased awareness of our thoughts, feelings and body sensation with open curiosity.

Our Workshop

Our mindfulness program combines the clinically proven Mindfulness-based Stress Reduction (MBSR) and Mindfulness-based Cognitive Therapy (MBCT) for the prevention of depression relapse. It also incorporates skills training in mindfulness, stress physiology and cognitive awareness. It trains participants to develop and draw on their inner resource to bring about focus, balance, coping strategies, stability and wellbeing.

This five-week intensive is held over eight weeks. It includes:

- 6 guided Mindfulness meditation audios
- Mindfulness training manual by UK Breathworks
- Complimentary follow-up evening sessions at The Mind Faculty (subject to availability)
- Support via Whatsapp Chat group and other online media

A certification of completion will be awarded upon completion of the course. This meets the requirement equivalent to the basic eight-week modern Mindfulness training as a foundation training to attend Mindfulness Teacher’s Training at UK Breathworks.

What to expect

Each session consists of experiential leaning through guided mindfulness and meditation exercises.

Session 1: Breaking Anchor
Anchoring Ourselves in this Frantic and Unpredictable World

Session 2: Mindfulness of Body and Stress
Coming to Our Senses

Session 3: Mindfulness of Emotions
When Your Buttons are Pressed

Session 4: Mindfulness of Thought Patterns
The Pleasure of Small Things

Session 5: Mindfulness of Self Compassion
Put Your Own Mask On First

Session 6: Mindfulness for Others
The Tender Gravity of Kindness

Session 7: Mindfulness for Interactions
Dancing in the Rain

Session 8: Mindfulness for Life Worth Living

One-day Intensive: Putting it All Together
Making it Matter to You

Testimonials

"Mindfulness training by Mr. TY Ko has completely turned my life around."

"TY Ko deeply embodies a well understood, insightful and highly developed mindfulness practice tailored to the needs of stress and vulnerabilities. The beauty and efficacy of his teaching lies in the masterful balance of simplicity, clarity and gentleness combined with skillful care for the needs of his participants. I have been richly fed by this training and my health and sense of wellbeing has vastly improved.”

It will be facilitated by

Mr. Ko Teik Yen is a fully accredited Mindfulness teacher to run the UK Breathworks Mindfulness for Health, and Mindfulness for Stress courses. He is also founding director of Asia Mindfulness and the LCCH Therapy Center at Pantai Hospital KL. He is also the author of the book Parenting 2.0. He has treated clients with anxiety, depression, chronic pain, panic disorders, phobias and other chronic illnesses

Are you interested?

 We will be running our popular Mindfulness workshop throughout the year. Email us <enquiries@themindfaculty> to find out our availability. Upon registration, our facilitator will get in touch with you. This is an opportunity for you to ask any questions you may have about the program or to voice any specific needs you may have about joining the course. Each intake is small to ensure that you have one-on-one time with the facilitator.

GoodKids @ The Mind Faculty

by The Mind Faculty

We are excited to welcome GoodKids to The Mind Faculty. GoodKids is a social enterprise that helps youth at risk using performing arts.

Our youth is often unmotivated by non-conducive learning environments, which focus on academic excellence and not on developing interpersonal skills. It’s hard to pay attention when learning is based on routine not interaction. 

GoodKids provides an alternative and interactive learning environment using a combination of Performing Arts and Counselling. Using a variety of creative techniques, GoodKids will help your kid learn in a fun and interactive way.

The learning approach combines several different techniques:

Introduction to Music helps to improve attention span and promote creativity.
Percussion and Body Percussion will improve coordination and team participation.
Emoting and Acting builds confidence and addresses anxiety.

Throughout the program, you will: 

- Develop creativity
- Discover strength and weaknesses that help character building
- Learn various coping mechanisms
- Demonstrate teamwork and leadership
- Develop good communication and interpersonal skills

GoodKids is geared towards individuals who are below 21 years of age. Aside from providing a new learning experience, it is especially suitable for: 

- Have a high level of anxiety
- Are hyperactive
- Are seeking treatment for bipolar disorder, schizophrenia and OCD
- Are seeking treatment for substance abuse
- Are seeking treatment for depression
- Want to improve their coping mechanisms
- Have problems working in a team or tolerating others

Spaces are limited. We want to keep each group small so that our facilitators can spend quality time with each individual and every voice can be heard. To register interest, please contact us: +603  6203 0359 / enquiries@themindfaculty.com 

What is Eye Movement Desensitisation Reprocessing?

by The Mind Faculty

Image via Pinterest

Image via Pinterest

What is Eye Movement Desensitization Reprocessing (EMDR)?

This breakthrough psychotherapy was designed to help patients overcome the devastating effects of post-traumatic stress disorder (PTSD). This can occur after experiences such as physical or emotional abuse, rape, car accidents or military combat. It has been proven to help people experience the benefits of therapy that use to take years.

Using eye movements, it helps the brain to re-process a traumatic situation.

How we experience physical trauma is similar to how we experience physical trauma. For example, if you have a cut, the body works to close the wound. If there is a foreign object in the cut, or there are repeated injuries, the wound remains open, and continues to cause pain. This is similar to mental trauma. When we experience a disturbing event, it can cause blockages or imbalances in the system. Therefore, we are forced to re-experience the trauma. Using EMDR, the practitioner can help the patient to remove the black, and let the healing begin.

How does it work?

The goal of the therapy is to process problematic experiences, and reframe them in a positive light. It is an eight-phase protocol that will you resolve any negative emotions, feelings and behaviors caused by these experiences and leave you with emotions, understanding and perspectives that will lead to healthy and useful behaviors.

The therapy uses eye movements to help re-process the information. This is connected to the biological mechanisms involved in Rapid Eye Movement Sleep. It was discovered by Dr. Francine Shapiro, who found that emotional and behavioral symptoms resulting from disturbing experiences tend to resolve naturally when a person allows his or herself to recall various elements of a memory while engaging in lateral eye movements. Therefore, this can help the patient to process a trauamtic memory and disturbing feelings, and change the meaning of the painful event on an emotional level.

For example, a rape victim can shift from feelings of horror and blame to “I survived, and I am strong.”

It uses a three-pronged protocol, involving to the patient’s past, present and future. It pays attention of traumatic memories, and past related events. It also focuses on current distressing situations, in order to develop the skills and behaviors required for positive future action.

Who does it work for?

It has been proven to be effect for PTSD. It has also been successful in treating the following conditions:

  • Panic attacks
  • Complicated grief
  • Dissociative disorders
  • Disturbing memories
  • Phobias
  • Pain disorders
  • Performance anxiety
  • Stress reduction
  • Addiction
  • Sexual or physical abuse
  • Body dysmorphic disorders
  • Personality disorders

Via EMDR International Association, EMDR Institute, EMDR Humanitarian Assistance Program

Mindfulness - What It Is & What It Is Not

by Mr. Ko Teik Yen, Clinical Hypnotherapist & Mindfulness-based Psychotherapist

Image via Bahman Farzad

Image via Bahman Farzad

What is Mindfulness?

Mindfulness, as defined by Jon Kabat-Zinn who introduced Mindfulness Based Stress Reduction (MBSR) 30 years ago, is “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.”  Mindfulness is a learnable skill that enables us to pay attention to what is happening in the present moment with increased awareness of our thoughts, feelings and body sensations with open curiosity.

Thousands of peer-reviewed scientific journals prove that mindfulness reduces pain, anxiety, enhances mental and physical wellbeing and helps people deal with the stresses and strains of daily life. Many healthcare centres in US and Europe now prescribe mindfulness meditation to help patients cope with the suffering arising from a wide range of diseases such as cancer pain, heart disease, diabetes and arthritis. It is also commonly used for back problems, migraine, fibromyalgia and a range of auto-immune diseases such as lupus and multiple sclerosis, as well as being effective for long-term conditions as chronic fatigue syndrome and Irritable Bowel Syndrome. Clinical trials also demonstrated that mindfulness significantly reduces the anxiety, stress, symptoms of depression, irritability and insomnia that can arise from chronic pain and illness. 

Hence, more and more people worldwide are attracted to learning how to relate to their experience with mindfulness.

Due to my own personal experience as well as my work with over 500 students and clients, I have encountered some common misconceptions surrounding what Mindfulness is. I will clarify this in hopes that it will help you to stay at ease and be clear when you practice.

Mindfulness is not about being calm or attaining any special state of mind.

We often expect mindfulness will bring us peace or calm and relaxation.  This highlights our human tendency to want pleasant experiences and to push away what as unpleasant or average. We want something, we don't get it and then we're unhappy. We think it’s not working or we’re doing it wrong.  

We start to judge our experience and ourselves.

Although it’s true that you can experience a sense of peace, calm, or relaxation while practicing mindfulness, these are not guaranteed outcomes. Mindfulness is simply about noticing whatever experience we're having now, including all the thoughts, feelings or physical sensations that are a part of it.

Mindfulness can significantly reduce stress but it’s not about stress removal

Rather than remove stress, mindfulness helps us to learn to relate to stress differently. It may seem implausible that something as simple as listening to sounds or paying attention to our breathingcan help us learn to respond to experiences in a healthy way, but it’s what science is showing and what people are saying (and it’s certainly my experience and many others).

There is now over 30 years of research with adults showing that mindfulness helps with stress by changing our relationship to it.

Mindfulness is not the absence of thought

Instead of aiming for an empty or blank mind where no thoughts exist, we learn the skill of becoming aware of our thoughts, without necessarily doing anything with them. By just noticing thoughts, we learn how to unhook ourselves from our identification with them. This is different from pushing thoughts away. It’s how we related to our thoughts, not the absence of them.

Mindfulness is not about being complacent

Acceptance does not mean agreement or complacency. It means acknowledging whatever’s going on, which is a good idea because it’s already happening. We take action to change situations when appropriate – for our well-being and the well-being of others – but we do so out of compassion and understanding versus reaction and frustration.

Mindfulness is not just about the mind

Although mindfulness has the word ‘mind’ in it; it is not only about the mind and thoughts. It is about being aware of our emotions, feelings and bodily sensations and ability to remain open to it (emotionally, mentally and physically) even in difficult moments. Hence, mindfulness includes also open-heartedness or some described as, ‘heartfulness’.

Mindfulness is not a form of spiritual escapism

The practice of mindfulness enables us to stay fully present in the moment, right here right now; be it during pleasant and unpleasant moments. Mindfulness is the exact opposite of spiritual escapism. It is through the practice of mindfulness that we learn to trust ourselves, our body and our life to unfold itself in situations that are beyond our control.

Mindfulness is not the same as meditation

Mindfulness is a state of being in the present moment with open curiosity and kindness. Meditation is the practice that enables us to be more mindful in the present moment.

Hence, mindfulness meditation is a formal practice to be mindful especially when we are busy in our daily routine. It is about bringing mindfulness to our daily life and not the end in itself. As such, mindfulness meditation is the vehicle not the destination. There are also other informal mindfulness practice e.g. mindful walking, mindful eating, and mindful drinking.

Mindfulness is not religious

Mindfulness practices are useful for all people, regardless of their spiritual or religious backgrounds or beliefs. It’s a human experience that utilizes awareness, kindness and compassion that is within us all.

Mindfulness is not a silver bullet

When we’re under stress or going through a difficult time we might look for ‘techniques’ to help us cope better. Mindfulness works, but it is important to approach it with the right attitude. Based on many years of research, it is well established that in order to fully benefit from mindfulness training, the best approach is to practice consistently.  

What are the differences and similarity between the modern, secular mindfulness training compare to traditional meditation?

In general, the principles are similar; keeping in mind that the modern, secular mindfulness training has its roots from the traditional meditation practice with thousands of years of wisdom. The major differences perhaps are the approaches that the modern, secular mindfulness training adopted; flexible, non-hierarchical, less ritualistic, encourages self-exploration, linking the practices to brain science as well as human psychology and physiology; making it so much approachable and accessible to the general public. 

Hypnosis Can Improve Sporting Performance

by Joyce Hue, Clinical Hypnotherapist

Athletes spend hours strengthening their muscles, building upon their stamina and refining their technique for the big game. The fitter and healthier they are, the better their performance.

Mental strength is just as important as physical strength in sport. Like a muscle, the mind can be conditioned and strengthened for optimal performance. Hypnosis for sports performance is an excellent way for mental training and it can help you become an athlete who shines above the rest. 

Simply put, hypnosis helps an athlete to focus better and visualize success. This process of programming the mind allows one to make a better connection between the body and the mind. In fact, these two entities are dependent on one another. If you are mentally tired, your immune system weakens and you will fall physically sick. Thus in this situation, if we can make your mind sharper and more focused, your body would become more efficient. 

Athletes like Tiger Woods, Kevin McBride and the Swiss Ski team are said to be users of hypnosis for sports. Even the USA Navy SEALs uses visualization techniques.

Hypnosis is a powerful tool that can change the way you think. If you think you are not good enough, then you won't be good enough. This negative thought could stem from a childhood experience. For example: “I am too fat to run”. This thought is reinforced, as you get older until it eventually becomes a belief. This affects your performance. By using hypnosis, we will reframe your thoughts to make healthier more positive ones. You can program yourself to be more motivated, to enjoy working out or to see yourself succeed. 

Hypnosis can help you to improve the actual skill itself. By visualizing and imagery processes, the therapist would guide you to see the target more accurately, feel the muscles working in your body or hear the sound of the applause as you score that goal. As Napolean Hill once mentioned, "Whatever the mind can conceive and believe, the mind can achieve."

Consequently, hypnosis is a perfect tool to help you improve your sports performance. You could be a professional athlete striving to perfect your skills, or an active person who wants to maximize your body's potential. The key lies in learning how to manage your mind. This modality may work immediately for some; others will find that their levels of performance gradually improving after a few sessions. If you are playing an individual sport, hypnosis helps you to focus and concentrate better on your own athletic abilities. In a team sport, hypnosis can be a group activity that allows team members to be more energetic and unified for success.

 Overall, hypnosis & visualization can help you to:

  • Improve confidence and self- belief
  • Induce deep relaxation and calmness
  • Increase motivation and dedication
  • Guide one through visualization and focus to imagine success
  • Remove negative thoughts or beliefs
  • Maintain composure and overcome distractions
  • Boost energy levels and stamina
  • Assist in recovery and pain management
  • Helps healing process through visualization

Postpartum Depression

by Professor Philip George, Consultant Psychiatrist

Image via Kristy G Photography

Image via Kristy G Photography

What is Postpartum Depression?

The baby is here. You should feel happy and relieved. Now that there is another little one in your life, your life as a family is complete. You feel fulfilled as a woman now that you have experienced pregnancy and childbirth. There will be joy, excitement and new adventures as you watch your baby grow.

However, all you feel is sadness, anxiety and self-doubt. You worry about whether you are being a good mother and feel intimidated when other mothers give advice on baby care. Deep down, you wonder if there’s something wrong with you because you somehow don’t feel the happiness, fulfilment or excitement other new mothers do.

The good news is that you are not alone. Depressive symptoms after childbirth, commonly known as postpartum depression, are extremely common. In 700 B.C., Hippocrates described the symptoms in great detail.  

Although childbirth is considered a natural process, it is nevertheless a serious physiological and psychological event for mothers. A woman’s mind, body and spirit have just been through 9 months of pregnancy, culminating in the birth. Hence, some women may need more recovery time than others.

After childbirth, the new mother’s body will be all haywire because of the dramatic changes in circulating hormones. She may still be in pain for several weeks but she will also be exhausted, caring for the new baby and breastfeeding. There is so much to do now with a new addition to the family, and she has little time to care for herself.

On top of the physical recovery, a new mother also struggles with changes in her perception of herself, relationship with others and her new role. There are also social changes – income levels, societal status and a loss of freedom. All these snowball into a huge burden which some women find overwhelming, leading to depression.

There are three categories of Postpartum Disorders: Maternity Blues, Postpartum Depression and Psychotic Depression. The first is the mildest category, and most women overcome it successfully soon after childbirth. The latter two warrants more attention. 

Maternity Blues

This is a common condition affecting 50-80% of all new mothers. It usually begins right after birth and can last for up to 14 days. Common symptoms include mood changes, tearfulness, anxiety, irritability and feeling tense.

Maternity blues can be caused by hormonal changes, anxiety about childcare and problems with breastfeeding.  Usually no medication is required; all the mother needs is a lot of reassurance and family support. Practical advice, such as how to bathe baby, breastfeed, change diapers, swaddle or baby massage helps make the new mother feel empowered and confident.

Postpartum Depression

This affects up to 20% of new mothers. This manifests in feelings of sadness, hopelessness, helplessness and worthlessness. New mothers may lose interest in normal passions and feel unable to cope with their new responsibilities due to low energy, low drive, poor attention and concentration.  

Some mothers may feel guilty, inferior or even, suicidal. The feelings are usually worse in the mornings. They may experience a loss of appetite and sleep disturbances. Some present instead with physical symptoms such as bringing their healthy babies to the clinic repeatedly.

Postpartum depression can stem from:

  • Hormonal changes
    There is a sharp drop in oestrogenand progesterone that are normally increased 10x during pregnancy. There are changes also in plasma cortisol, the stress hormone occurring at this time.

     
  • Psychosocial factors
    This can include feelings of inadequacy regarding childbearing

     
  • Ambivalence towards pregnancy
     
  • Low self-esteem
     
  • Interpersonal issues
    This can include marital relationships or mother-daughter problems

     
  • Financial problems
    This can arise from additional expenses

     
  • Obstetric complications

Interestingly, many women with postpartum depression do not recognize they have an illness, thinking that they are just having the blues. Many associate depression with false notions, such as that it is untreatable and there is a stigma associated with treatment.

If left untreated, postpartum depression can lead to :

  • Disturbed mother-infant relationship
  • Marital tension
  • Psychiatric morbidity in children that manifests at a later stage
  • Vulnerability to future depression
  • Suicide and/or infanticide (killing of baby) 

Treating Postpartum Depression

In managing postpartum depression, the psychiatrist will first investigate social factors and mobilise support. In mild cases, this is often sufficient. The new mother will also be connected to self-help networks and groups for material, emotional and physical help.  Mothers who have had the same experience can share their experiences. 

In more severe cases, antidepressant medication, psychotherapy and/or Electroconvulsive treatment may be recommended, whether independently or in combination. A combination of drug treatments with psycho-social interventions is known to have the best results.

Antidepressants need to be taken for at least 3-4 weeks before any improvement can be seen. Once they feel better, the medication needs to be continued for at least 6- months to prevent a relapse. Mothers who are breastfeeding will need to discuss with the doctor about the safety of the medication.  

Psychotic Depression

Psychotic depression is similar to postpartum depression, but in addition mothers will have delusions (false beliefs) and hallucinations (false perceptions). This includes the feeling that ‘someone’ or ‘something’ is watching or disturbing them. Patients may also show gross abnormalities of speech and behaviour.

Psychotic depression is considered a Psychiatric Emergency and needs inpatient treatment. It is a severe and life-threatening condition, and the patient must be closely monitored for suicide and/or infanticide. Fortunately it is not very common, affecting only 0.2% of new mothers.

Factors that lead to psychotic depression include:

  • ormonal changes
     
  • Out of wedlock baby
     
  • First child
     
  • Caesarean birth
     
  • Perinatal death (stillbirth or neonatal death)
     
  • Psychiatric history
     
  • Family history of psychiatric illness

Treating Psychotic Depression

It is treated with Electroconvulsive Therapy, or a combination of antipsychotics & antidepressants. Most patients often recover but will need further monitoring as they may cause problems to the family.

Some women may blame the child for their condition, and anger from the family could be projected to the child. On the opposite end of the spectrum, some women become overprotective of the child. Counselling is necessary to handle the topic of future pregnancies.