I’M STILL HUMAN
Understanding Depression with
K I N D N E S S
Dr. Phang Cheng Kar (M.D.)
Published by KL Buddhist Mental Health Association
Copyright © by Dr. Phang Cheng Kar, M.D.
Altruistic Rights Reserved
1st edition (2012) – 3000 copies
2nd edition (2013) – 5000 copies
3rd edition (2017) – 3000 copies
4 th edition (2021) – 3000 copies
NOT FOR SALE
Reprint for free distribution and charity purposes
is encouraged & permission can be obtained from the
publisher at firstname.lastname@example.org
This is a book on mental health, not a religious book.
Any reference to Buddhism, it is general in nature
and only reflects the universal value of kindness.
This book should not be used as a substitute
for consultation with medical or mental health
professionals if you are suffering from depression
or any other psychological illness.
Online versions of this book are available
in 3 languages at the following link:
Comments by reviewers
This book has come together for all of us to learn about life – accepting,
loving and living meaningfully. All three parts of the book describe the core
components of a human being: Part 1, “Mind, knowledge, understanding,”
Part 2, “Heart, tears, pain, acceptance,” and Part 3, “Coming together,
kindness and love will prevail.” I have experienced tears, love and healing as
I was reading this whole book. Thank you Cheng Kar, Jasmine and everyone.
This book will reach deep into the hearts of many people, as it speaks the
truth about love and life.
Ms. Low Mi Yen
Director of Turning Point Integrated Wellness;
Vice President, KL Buddhist Mental Health Association.
This is an excellent book, with very useful and practical tips for people
suffering from depression, as well as for their caregivers. Dr. Phang is
correct in identifying kindness as the key to understanding depression.
Patients with depression need to be kind to themselves in order to overcome
this illness. Family and friends need to exhibit kindness in dealing with
patients suffering from depression. Jasmine’s journey through depression is
very touching and brings out a positive message - there is light at the end of
the tunnel, and people with depression should seek help and can recover.
This book also provides essential information on activities that are
conducted for “understanding depression with kindness.” All these efforts
are very practical and useful in giving hope and support to caregivers and
patients with depression who are looking for help, kindness and
Professor Dr. Sherina Mohd Sidik
Universiti Putra Malaysia.
Jasmine had shown great courage in sharing her seemingly endless
suffering from depression during the past two years. She knows she is not
the only one facing the agony of depression. With her readiness to reveal her
struggle and ways of coping, it will encourage those who suffer in silence to
come forward and seek help. In this book, Dr. Phang has given a
comprehensive yet easy to understand guide for those who need help and
are offering help to the depressed.
Ms. Yeoh Kim Yeok
National Population & Family Development Board;
T-Lotus Support Group Coordinator.
The book is well-written by a "clinically-passionate heart" psychiatrist to
educate patients to understand depression and have better coping skills in
life. I also recommend this book for clinicians or therapists to improve their
communication skills in dealing with patients and their families.
Dr. Firdaus Mukhtar
Senior Lecturer, Clinical Psychologist & CBT Therapist,
Universiti Putra Malaysia.
Great book! Extremely well-written! The book is simple, precise and
practical. It provides clear guide for clients with depression, their family
members, helpers and general public. A very much needed book in this
challenging era. Congratulations and well done!
Dr. Lee Chee Siang
Registered & Licensed Counselor,
Wellness Program Director,
Turning Point Integrated Wellness.
As the saying of the Maori people goes, “What’s the most important thing in
the world? It’s people! It’s people! It’s people!” Thank you to Dr. Phang for
this very informative and ‘people-oriented’ book - I’m Still Human. Certainly,
he is a psychiatrist who sees beyond his patients’ illness and reaches out to
them with his compassionate heart. Most importantly, he guides them to be
kind to themselves while coping with depression. Jasmine’s transformation
through kindness is a wonderful lesson for us. I’m delighted to say that this
is a must-read book for all.
Dr. Tee Bee Chin
Psychiatrist & Head of Department,
Department of Psychiatry,
Kulim Hospital, Kedah.
The author uses simple yet illustrative descriptions to guide the readers in
understanding the ‘what and how’ about depression. I like how he
incorporates information and insights about depression both from
professionals’ and patients’ points of view. This enables readers to better
understand depression from different perspectives. It also has useful
suggestions on dealing with depression and the depressed. I must
congratulate Dr. Phang on another of his great piece of work. I would highly
recommend this inspirational book to you.
Ms. Liu Moy Yub
Clinical Psychologist/Clinical Supervisor,
Centre for Psychological & Counseling Services,
Depression is a complicated disease and not merely an emotional problem.
It takes special skill and talent to dissect this complicated disease into
something simple and practical; Dr Phang has done it very well. He can read
the minds of people in our community and address their concerns about
depression. He is kind, honest and humble in sharing information – reading
the book is like having a good friend sitting beside and guiding us. There are
many stories and case reports in which most of us could identify with. I am
sure that this book will benefit anyone who is kind enough to spare some
time reading it. I will definitely get a few copies of the book and keep one for
Dr. Hazli Zakaria
Senior Medical Lecturer & Psychiatrist,
Universiti Kebangsaan Malaysia Medical Centre.
PART 1: Understanding depression
• What is depression? - 1
• What depression is not - 3
• What are the symptoms of
depression? - 4
• How painful is depression? - 10
• Depression and suicide - 11
• How common is depression? - 12
• What should I do if I or somebody has depression? - 13
• Who should I consult for professional help? - 16
• How can I get help from mental health professionals? - 20
• 12 ways to encourage a person to seek help - 26
• What is expected in the psychiatrist’s consultation room? - 30
• What to expect from a counselor or clinical psychologist? - 32
• What is the cause of depression? - 35
• How is depression treated? - 40
PART 2: Jasmine’s journey of depression
• Jasmine’s journey of depression – 44
PART 3: Kindness amidst depression
• 10 ways to cultivate kindness
for coping with depression
• 12 ways to be kind to people
with depression – 107
• Be mindful of false kindness
• 20 FAQ’s during depression treatment – 114
• What should I say to support a person with depression?
• Forum for understanding depression with kindness – 153
• When depression is recurrent – Mindfulness-based
Cognitive Therapy (MBCT) – 162
PART 4: Jasmine’s journey of recovery
Jasmine’s journey of recovery
• Further reading on depression – 198
• Acknowledgement – 200
• About KL Buddhist Mental Health Association – 202
• About the author – 203
• Books, CD’s & online resources by the same author – 204
It is an honor and privilege to write this
foreword. I have come to know Dr. Phang Cheng
Kar as a kind and compassionate Buddhist
psychiatrist who has done Dhamma work for
more than ten years, in particular the formation
of the Kuala Lumpur Buddhist Mental Health
Association (BMHA). This book adds to the list of
books, CD’s and products Dr. Phang has generously produced for
the public. He helps us to understand mental illness and to find
relevant information to address our suffering.
This book provides a deep perspective of the multidimensional
aspects of depression. It also covers the various treatments
involved. A particularly useful part of the book is a list of ways to
encourage someone with depression to seek help. It also
demystifies what happens in the consultation room of a
psychiatrist. For those who suffer from depression, the story
written by a patient of her journey from hopelessness, suicidal
thoughts and self-harm to gratitude for her treatments, new
discoveries and final full acceptance of her illness, is most touching.
An exceptional aspect of this book, not available in most self-help
books on depression, is Part Three. This section helps the
depressed to cultivate kindness towards themselves. The depressed
need not label themselves as weak or feel alone. They can learn to
forgive themselves and others by practicing compassion. This is a
Buddhism-influenced way of transforming depression into wisdom
and it is practical and most beneficial during the recovery
phase. This should also assist in the prevention of relapse.
Also, 20 Frequently Asked Questions (FAQ’s) used during
depression treatment will help many patients and their
relatives. The DVD attached to the book consisting of a forum on
depression presented by BMHA with Venerable Kumara, clinical
psychologist Ms. Low Mi Yen and three patients is worth
viewing. Finally, a further reading list is thoughtfully added to
complete this comprehensive book.
This book will help not only those who suffer depression, but also
their relatives and professionals in the field.
Dr. Tan Eng Kong
(MBBS, MPM, FRANZCP)
Consultant Psychiatrist & Analytic Psychotherapist;
Director of Metta Clinic, Sydney, Australia;
Founder President of YBAM (Young Buddhist Association of Malaysia) &
AABCAP (Australian Association of Buddhist Counselors & Psychotherapists);
First Director of Training, Buddhism & Psychotherapy Professional Training
Course of AABCAP;
Former Chairman of Training, Psychoanalytic Psychotherapy Association of
20 th August, 2012.
When Cheng-Kar asked me to write a foreword for
his latest book, I immediately accepted the
invitation as I knew this would be a task that I
would do with great pleasure. I have known
Dr. Phang for more than five years now. I first met
him while I was a visiting professor at the National
University of Malaysia (UKM), and he was in his
final year of training as a psychiatrist. We shared many common
interests, especially mindfulness-based psychotherapy and evidencebased
practices in psychotherapy. Our journey in mindfulness and
psychotherapy, in particular Cognitive Behavior Therapy (CBT) has
expanded our application of the Buddhist concept of mindfulness into
“meta- mindfulness” in psychotherapy. The expanded concept of metamindfulness
in psychotherapy provides a good ground for this book -
I’m Still Human: Understanding Depression with Kindness.
Dr. Phang Cheng Kar (M.D.) is a psychiatrist and also a practicing
Buddhist. This kind of combination is very unique indeed among
mental health workers. This uniqueness is clearly reflected in the way
he helps people suffering from mental health problems. It also allows
him to produce many practical books, useful DVD’s and self-help
materials for people with mental health problems and for the general
public to prevent mental suffering. This book - I’m Still Human - is
another excellent addition to his achievements.
The book suggests that depression is treatable and people with
depression can, and in fact, should get help early. Another
important part is that it demystifies not only depression itself, but
also the way to find and communicate with mental health
professionals in Malaysia. A case study written by a former patient
has enhanced the usefulness of this book. Perhaps the greatest
strength of this book is Dr. Phang’s use of kindness and compassion
as tools for combating depression. This combination of Eastern
(Buddhist) and Western (psychiatry) knowledge in combating
depression is natural given Dr. Phang’s background training and
current practices. I am optimistic that this book will be wellreceived
in Malaysia and that many people will benefit from it. Both
sufferers of depression and their caregivers will find this book easy
to read and very useful in helping them deal with depression.
We started our journey five years ago and I am sure our journey
will continue into the future. I have benefited from our journey and
I am sure many people will benefit from this book.
Tian Po Oei
Emeritus Professor of Clinical Psychology,
The University of Queensland;
Director, CBT Unit, Toowong Private Hospital, Brisbane;
President elect, Asian Cognitive Behavior Therapy Association (ACBTA).
26 th August, 2012.
This book is joyfully dedicated to all my patients, especially
Jasmine, who suffer from and cope with depression. Thank you for
sharing with me all the experiential knowledge about depression.
Without that, this book will not feel so ‘real.’ Many people are
unaware that they suffer from depression. This book unmasks the
many myths about depression. The book is published for free
distribution to benefit those who are struggling with depression.
I’m sure that it will help many people: the depressed, their
caregivers, relatives, and friends as well as readers in general.
In this fast-changing, a highly competitive society where the interpersonal
relationship gets colder, people are increasingly stressedout.
Furthermore, many people have an unhealthy lifestyle that
predisposes them to depression. Therefore, this book also
introduces ways to reduce stress, such as relaxation exercises and
healthy food habits. Prevention of depression is better than cure.
I wish to dedicate this book to every reader who comes across this
book. By the power of this good deed, may all beings be free from
depression and live happily.
I wrote this book with Jasmine to commemorate my
10 th year of service, caring for people with mental health disorders.
Wherever I go, there're many people with emotional suffering.
People who seek help in my clinic for depression are also
increasing. Therefore, it’s time that we have a simple and practical
book to guide those who are struggling with depression.
Many books have been written on depression. This book is unique
in three ways: 1. It focuses on the practical aspects of depression in
a local Malaysian setting, e.g. how to encourage a depressed person
to seek help, 2. It emphasizes the humanistic aspects of depression,
e.g. how to cultivate kindness for coping with depression, and
3. It has an experiential part by Jasmine, our ‘depression journalist,’
who brings you through her depression and recovery journey.
This book is not a comprehensive textbook on depression. But it
will be a kind and useful companion to those who suffer from or
care for people with depression. You’ll notice that I've written this
book in a conversational style. It’s intended to be that way so that
it’s more personal and inspiring.
If you’re ready, kindly turn over to the next page, and the book will
soon be ‘reading you’…
In the midst of winter, I finally learned that
there was in me an invincible summer
- Albert Camus -
What is depression?
Depression is a serious psychological illness which affects
the way we THINK, FEEL and BEHAVE. It’s more than just
occasional low moods, which is part and parcel of life. In
depression, the feeling is more intense, persistent and it interferes
with our functioning at work and home.
It’s important to understand that depression is an illness just like
diabetes, hypertension or cancer. This right understanding
facilitates early treatment and recovery. Depression is an illness
• There are recognizable signs and symptoms (page 4).
• There are known causes, e.g. genetic, hormonal, excessive
• There are associations with biological changes in the body,
e.g. lack of serotonin for nerve transmission in the brain.
• There are mental health professionals, e.g. psychiatrists and
psychologists who specialize in the treatment of depression.
• There are psychological tests for depression, e.g. Beck
• Depression can be treated with medicines, e.g.
The names used by doctors, scientists and psychologists for
referring to depression as an illness are: “Major Depressive
Disorder,” “Major Depression,” or “Clinical Depression.”
Depression damages the functions of cells in the brain (neurons)
What depression is NOT!
• It’s NOT pretending or faking.
• It’s NOT laziness or a bad habit.
• It’s NOT a sign of weakness.
• It’s NOT due to spiritual
disturbance or charm.
• It’s NOT something that you
can easily snap out of.
• It’s NOT that you are crazy or psycho.
• It’s NOT occasional sadness or
stress like Monday morning blues.
What are the symptoms of depression?
The main features of depression are a persistent feeling of
sadness, loss of interest in activities, and tiredness. Below is a
depression checklist to find out if you or someone you know may
have depression (other symptoms of depression are in the
For more than 2 WEEKS have you? Tick √ in
1. Felt sad, down or miserable most of the time?
2. Little interest or pleasure in doing things?
If you answered “YES” to either of these questions, complete the
symptom checklist below. If you didn’t answer “YES” to either of these
questions, It’s unlikely that you have a depressive illness.
3. Feeling easily tired or having little energy?
4. Poor appetite or over eating?
5. Sleep disturbance - trouble falling or staying asleep
OR sleeping too much?
6. Moving or speaking so slowly that other people could have
noticed OR being so fidgety or restless that you have been
moving around a lot more than usual?
7. Feeling bad about yourself OR that you are a failure OR
have let yourself or your family down?
8. Trouble concentrating on things such as studying, reading
the newspaper or watching television?
9. Thoughts that you would be better off dead OR of hurting
yourself in some way?
Add up the number of ticks (from 1 – 9)
for your total score:
What does your score mean?
(Assuming you answered “YES” to question 1 and/or question 2)
• 4 or less: Unlikely to have a depressive illness.
• 5 or more: Likely to have a depressive illness
(This is particularly true when the symptoms are
significantly interfering with your functioning at work or
How does a depressed mind think?
People who are depressed often have these negative thoughts:
• I’m useless
• I hate myself
• Nobody understands me
• I’ve let people down
• What’s wrong with me?!
• I’m a total failure
• I don’t think I can go on
• My life is in a mess
• I’m a burden to others
• I wish I were a better person
Interestingly, almost everyone who is depressed has similar
thought patterns. That’s what I repeatedly hear in my clinic – the
‘lyrics’ of depression. It may be in a different language - but the
content is the same. This reinforces the fact that depression is an
illness with predictable patterns of thinking, feeling and behaving.
People who are depressed also often complain about physical
symptoms which include:
• Headache and dizziness
• Nausea and dry mouth
• Stomach discomfort
• Constipation or diarrhea
• Muscle aches and pain
• Shortness of breath or trouble breathing
• Heart beating very fast
• Tightness at the chest region
• Trembling or shaking
• Sweaty palms
• Numbness or tingling sensations
• Restless and wanting to move around, etc
These are also commonly known as the physical symptoms of
‘stress’ which often (but not necessary) come with depression. The
word ‘stress’ is a general term to refer to any mental and/or
physical tension. When stress is excessive, due to whatever reasons
(stressors), it can lead to depression, a well defined and specific
psychological illness. That’s the relationship between stress and
depression – depression is more than just stress.
Due to the physical symptoms, people who are depressed often go
‘doctor shopping’ - consulting various medical specialists for
investigation. This is usually followed by the typical explanation,
“There’s nothing wrong with you physically,” or “Mmmhhh…this
could be due to psychological factors,” before referring you for
Depression is a ‘systemic disease’ – it affects the brain and various
organs in the body. It’s associated with neurotransmitter (brain
chemical), neuro-hormonal (blood chemical) and neuroimmunological
(immune system chemical) changes. That’s how it
affects physical health and leads to ‘doctor shopping.’
Though the basic symptoms of depression are the same, it has
unique features in different populations (Table 1):
Table 1: Unique features of depression in different populations
Special features of depression
• Tend to perceive it as a sign of weakness.
• Less likely than women to acknowledge and
express the feelings of sadness or
• They tend to complain about fatigue,
irritability, sleep problems, and loss of
interest in work and hobbies.
• More likely to appear in the form of violence,
reckless behavior (e.g. reckless driving), and
substance abuse (e.g. alcohol, amphetamine).
• Higher risk of completed suicide than women.
• Associated with hormonal factors, e.g.
premenstrual syndrome, postpartum
depression, and perimenopausal depression.
• More likely than men to have excessive guilt,
sleep too much, overeat, and gain weight.
• There is a risk of ending life together with the
• Irritability is the predominant symptom.
Unexplained body aches and pain are also
• ‘Bad’ may actually be sad – depression
manifests in the form of disciplinary
problems, e.g. truancy, smoking, drug abuse.
• Often associated with bereavement,
loneliness, health problems, and loss of
• Tend to complain more about the physical
rather than the emotional symptoms of
depression. Irritability is also common.
For further assessment or if you are concerned about any of the
mentioned symptoms, please consult a medical doctor or mental
health professional (i.e. psychiatrist, clinical psychologist,
counselor). Remember, depression is treatable and effective
treatments are available. The earlier you seek help, the better the
How painful is depression?
It’s not uncommon to hear patients with
depression express that the pain of depression
(e.g. no mood, hopelessness, tiredness,
restlessness) is worse than the pain of any
physical illness. Some even physically hurt themselves, e.g.
cut their hands with a blade to induce physical pain; the physical
pain distracts them from the emotional pain. According to World
Health Organization (WHO), depression will be the 2 nd most
disabling illness by 2020. Because of the tremendous suffering
associated with depression, it’s not surprising that some people
choose to commit suicide to end depression. Please don’t do that -
you don’t need to continue suffering. Depression is a treatable
illness – get treatment early. Soon, you will be well and moving on
Depression and suicide
If I had no sense of humor,
I would long ago have committed suicide
- Mahatma Gandhi –
According to the National Suicide Registry, there are on
average two cases of suicide in Malaysia every day. From overseas
studies, more than 90% of people who die of suicide have clinical
depression or another mental illness (e.g. schizophrenia, substance
abuse). Having major depression is a risk factor for suicide. Up to
50% of people with depression have suicidal thoughts. About 15%
of people hospitalized for depression kill themselves. Other risk
factors of suicide include previous suicidal attempts, family history
of mental illness or suicide, being male, substance abuse, chronic
physical illness, and keeping firearms at home.
Warning signs that someone may be thinking about or planning to
commit suicide include:
• Always talking about death.
• Having signs and symptoms of depression, especially
• Visiting and contacting people to say goodbye.
• Making statements like, "It will be better if I’m no longer
around," or “Soon, I’ll be gone…”
• Making preparations to die, e.g. making a will, indicating
preference for one’s funeral, giving away valuable
• Tendency towards unnecessary risky behavior that could
lead to death, e.g. driving at high speed and without seat
• Sudden and unexpected switch from being very sad to very
calm or happy (relieved as decision has been made to die).
Suicide is preventable. Early recognition and treatment of
depression prevents suicide – you can make a difference.
How common is depression?
Depression affects about 10% of the Malaysian adults (1 in
10 persons). Depression affects people at all ages; it’s 2-3 times
more commonly reported in women than men. Despite being so
common, there is relatively little awareness of depression; as many
as two thirds of people with depression don’t realize that they have
depression. As for those who realize, there’s often delay in
appropriate treatment due to a social stigma on mental illness. So,
you are not alone – be kind to yourself and seek help immediately.
What should I do if I or somebody
It can be difficult to take the first step in seeking help. If you
think you or someone you know has
depression, talking to a general practitioner
or family doctor is a good place to start. A
general practitioner can discuss treatment
options and can do a medical assessment to
rule out whether other conditions, e.g. thyroid
disorder may be responsible for a person’s symptoms.
If you are concerned about someone with depression, it can be hard
to know what to say or do. Here are some tips:
• 1. Talk to the person about how they are thinking, feeling and
their experiences. But try to talk about something casual first
(e.g. weather, news, family, TV) before going into their problems.
Talking about their problems may be intimidating especially
when trust and rapport are not established yet.
• 2. Lend them a pair of listening ears. Sometimes, a person may
not be seeking advice, but just needs to express his concerns. Be
empathetic, and just let them ventilate their thoughts and
feelings or cry (you can offer tissue paper). At times, giving
advice, especially prematurely, may invalidate their feelings,
make them feel more useless, not understood and cause them to
further withdraw emotionally.
• 3. Use open-ended statements such as, “So, tell me
about…how…and what happened after that?” Show in your facial
expression, body posture and tone of voice that you really care.
These ways of asking require more than a “yes” or “no” answer
and can be a good way to facilitate conversation.
• 4. You may not need to talk much. You can easily facilitate the
conversation by ‘M.I.Y.A.O.W?’ – “Mmmmm… I see… Ah ha… Ya,
it’s horrible… Oh, like this… Wow, you’re so strong… What
happened after that? What do you plan to do?” Feel free to
change the sequence of M.I.YA.O.W?, while nodding
intermittently to indicate that you’re caring and paying attention.
• 5. It’s unnecessary to pressure yourself to give a solution; after
all, not all problems have a solution. Often just spending time
with the person is good enough to convey the message that we
are trying to understand and care – that’s already therapeutic.
• 6. If the person refuses to talk, respect the decision and get back
to him or her at another time. You may say something like this,
“I know that you’re going through a tough time and don’t feel like
talking now. But I wish to let you know that I care for you no
matter what happens. When you feel like talking or think there’s
something that I can do for you, feel free to contact me…”
• 7. Due to the nature of depression, some may talk in a way which
unintentionally annoys you – negative, repetitive, blaming,
stubborn. Remember, that’s part of the illness (they are suffering
yet can’t get it out) – take deep breaths, relax and be patient.
When you are calmer, you can respond better; if not, you’ll
probably react negatively and get sucked into their depressive
• 8. Take good care of yourself. Supporting someone with
depression can be very demanding and tiring. So, make sure that
you take time off to look after yourself. Otherwise you too may
end up with depression. When you are mentally refreshed, you
can care more effectively – be kind to yourself while caring for
Who should I consult for
As it’s much easier to access the service of a
general medical practitioner or family doctor, this is a
very good start for those with depression. All
general practitioners know about depression.
They can do an initial assessment and advise
you on the treatment plan. If the depression is
mild, they may choose to treat you themselves in the clinic. If the
depression is more severe, they’ll probably recommend you to a
mental health professional (psychiatrist, clinical psychologist or
counselor) for further assessment and treatment.
Who are you referred to? When depression is serious or requires
more thorough assessment, it’s more helpful to consult a
psychiatrist (a medical doctor specializing in psychological
medicine). This applies in the following situations:
• Elderly (> 60 years old).
• Having multiple medical problems, e.g. stroke, diabetes.
• Having suicidal thoughts, plans or attempting to commit
• Have psychosis, e.g. hear invisible voices, religiously
preoccupied, suspicious of others.
• Very poor appetite, lose a lot of weight, not drinking.
• Significant impairment in social and occupational
functioning, e.g. unable to work or hiding in the room most
of the time.
• Disorganized behavior, e.g. talk nonsense, gesture
• Verbally abusive or physically violent, e.g. throwing things
and hitting people.
• Medicines or medical certificate (MC) for leave are required
(as counselor/psychologist won’t be able to provide this).
When depression is less severe, clinical psychologists or counselors
can offer various types of effective talk therapies, e.g. personcentered
therapy, problem solving therapy, marital therapy,
interpersonal therapy, relaxation training, and cognitive behavior
therapy. One main difference is that they don’t prescribe medicines
If you are not sure of who to consult, get advice from a general
practitioner for a start. Don’t worry too much about consulting the
right person. Clinical psychologists and counselors are able to
recognize severe depression and recommend you a psychiatrist for
more intensive treatment. On the other hand, psychiatrists often
work with clinical psychologists and counselors for the benefit of
patients, especially in terms of talk therapies.
Who to consult also depends on the available of services. Over all,
as of 2018, there are very few psychiatrists (about 400) and clinical
psychologists (about 150) in Malaysia. There are more registered
counselors (about 8000).
Due to limitation of resources, we can’t always have the best; but
we can always make the most of whatever is available.
Here’s a simple description of the overlapping roles of various
mental health professionals in Malaysia:
• Psychiatrist: a medical doctor who specializes in the
diagnosis and treatment of mental illness, e.g. depression,
schizophrenia, bipolar disorder.
• Clinical psychologist: a psychologist (with at least a master
degree in clinical psychology) who specializes in the
assessment and treatment of mental illness (including
• Registered counselor: a person (with at least a bachelor
degree in counseling and is registered with the Malaysian
Counselor Board), who is specially trained to attend to your
psychological needs, e.g. work stress, relationship issues,
which may or may not be associated with depression.
For a list of mental health and psychiatric services in Malaysia
(psychiatrist, clinical psychologist & registered counselor), you may
go to the links below:
Directory of psychiatric services*:
Directory of counseling & psychology services*:
Source: Malaysian Mental Health Association (MMHA).
How can I get help from a psychiatrist?
Here’s what you can do if you wish to get help from a psychiatrist. If
you prefer an early appointment (within a day or
week), a preferred day and time for consultation,
and a regular doctor present each session, I suggest
that you go for private psychiatric services. Referral
letters are not necessary.
If you prefer treatment at a more affordable professional fee, I
suggest that you go for psychiatric services in government
hospitals. All major government hospitals have psychiatric services.
You’ll need to bring a referral letter* from a general practitioner or
family doctor to get an appointment date – you may not be seen
immediately unless the situation is serious and urgent attention is
needed. The waiting period depends on the patient load of the
hospital; it can be up to 1-2 months.
* A referral letter is a letter which is usually written by a medical
doctor, recommending you to seek further help from more
specialized medical service. If the referral letter is from a
government hospital or clinic, the fee for the first consultation in
government psychiatric service may be lower.
In government hospitals, you may be attended to by a medical
officer in psychiatry instead of a psychiatrist. A medical officer in
psychiatry is a qualified medical doctor who assists psychiatrists in
the hospital. Don’t worry if you are not attended by specialists; they
always work as a team to attend to your needs.
If your friend or family member is having severe depression, needs
urgent attention and may need ward admission (e.g. suicidal,
endangering others, not eating or drinking), it is advisable to bring
them to the accident and emergency (A & E) department of the
nearest government hospital. A referral letter is not necessary. It
may not be helpful to bring them to a private hospital as most in
Malaysia don’t have in-patient psychiatric service (psychiatric
ward) at the moment.
It’s OK to consult a private psychiatrist first (for convenience sake),
followed by a transfer to government psychiatric services. This is
often the case when one needs to save cost for consultation and
medicines. No problem, but don’t forget to request your private
psychiatrist to write you a referral letter with your diagnosis (name
of your illness) and the medicines that you are on. Not all the
medicines that you are taking are available in government
hospitals. But replacement with similar medicines is usually
Table 2: Private versus government psychiatric services.
1. Earlier appointment date.
1. Later appointment date unless
for serious or emergency cases.
2. Referral letter is not necessary. 2. Referral letter is necessary.
3. You get to choose your doctor
(e.g. one who speaks the same
language). You will be attended to by
the same doctor each visit.
3. You may not get to choose your
doctor and may be attended to by a
different doctor every visit.
4. You will be attended to
by a psychiatrist.
4. You may be attended to by a medical
officer who assists a psychiatrist.
5. Consultation and treatment
fee is more expensive.
5. Consultation and treatment
fee is much cheaper.
6. Psychiatric ward is not available
if hospitalization is required.
6. Psychiatric ward is available in main
hospitals if hospitalization is required.
7. Service is usually only
available during day time.
7. Service is available 24 hours.
After office hours, psychiatric services
are still available but at the accident &
emergency (A & E) department.
8. More expensive medications
8. More expensive medications
* Private psychiatric services in Malaysia:
**Government hospitals with psychiatric services in Malaysia:
Source: Malaysian Psychiatric Association (MPA).
For a comparison of private versus government psychiatric
services, kindly refer to Table 2.
Note: The information provided is applicable only in Malaysia.
Mental health and psychiatric service system in other countries
may be different.
5 steps to getting help from a counselor
or clinical psychologist
1. Call and check out the services available. You may explore the
• Type of services (i.e. individual, couple, family, psychological
assessment, children, adults, etc.)
• Registration and getting appointment (i.e. how to register,
whether referral letter is needed, how to schedule
• Qualification of the therapist (counselor, clinical
psychologist, specialization, e.g. family therapist, play
• Length of the session (i.e. first session, follow-up sessions),
charges and payment method (i.e. payment by session or
package, cancellation policy, etc.)
• Others: availability of trainee counselor or clinical
psychologist, discount for services, location of the place,
facilities of the centre (e.g. car park).
2. Choose the service after thorough consideration.
It’s important to ask yourself the 4 ‘W‘s & 1 ‘H’ questions:
• Which setting are you comfortable to receive service in?
NGO’s, government hospital or private centre?
• What kind of service are you looking for? Marital therapy,
family therapy, cognitive behavior therapy, etc?
• Where is the place for therapy? It’s important to find a place
which is easy to access in order to increase the probability of
you attending therapy.
• Who would you like to see? Any preference for gender, age
group, ethnic, language, expertise, years of experience, etc
• How much is the consultation fee? How much can you afford
to pay? Any alternative which is free or more affordable?
3. Register yourself for the service. Taking action to step out and
get help is the biggest step in healing. After the registration, give
yourself a big hand for your courage to invite positive changes to
your life. If you are seeking counseling or psychotherapy at a
government hospital or clinic, you may need to get a referral letter
from a medical doctor for registration of service.
4. Schedule the first appointment. Normally, your therapist will
contact you to make an appointment for the first session via phone
or emails. If you don’t receive a call within one month after your
registration, you may call to check on the progress of your
registration. While waiting for the first appointment, it’s normal to
have anticipatory anxiety. Take repeated slow deep breaths and
assure yourself, “Don’t worry too much, you are on your way to
recovery – it will be a fruitful learning experience.”
5. Attend the first appointment. Be clear on the location of the
centre and go out earlier to avoid unpleasant situations, e.g. late
due to traffic jam. Bring the necessary documents (i.e. identification
card) for the administrative purpose. Prior to seeing the therapist,
you’ll be guided to fill out some forms (i.e. basic information about
yourself, consent for service, psychological questionnaires). You
can check with the administrative staff if you have any concerns.
When your name is called, therapy will soon begin…Yeah.
12 ways to encourage someone with
depression to seek help
• 1. Repeatedly assure them, “Having depression doesn’t mean
that you are weak. It probably means that you have been strong for
too long - we care for you, we want you to be happy, let us help
you.” Reassure them that willingness to seek help is a sign of
bravery - courage is not the absence of fear; it’s acting in spite of
• 2. Having someone in the family or community whom the person
respects and trusts, e.g. pastor, monk/nun, ‘ustaz/ustazah (Islamic
religious teacher), family doctor, good friend to encourage them
will likely make the session more successful. Repeatedly and
consistently convey the message, “Depression is not weakness; it’s
• 3. Share with them that there are many people who have
depression, including many celebrities and successful people. If you
have gone through depression yourself, you may also share your
experience if you are comfortable with it. Here are two You Tube
clips on famous people with depression:
- Celebrity depression
- Idols who suffered depression & anxiety
• 4. Seek help from a general medical practitioner or family doctor
first. Due to social stigma, this is more acceptable than consulting a
mental health professional. Seeking help from a counselor may also
be more acceptable than a psychiatrist or clinical psychologist.
• 5. Seeking help from a private mental health professional may be
more acceptable because you get an earlier appointment (within a
day or week), a preferred day and time for consultation, and the
availability of a regular doctor in each appointment.
• 6. Expose them to pamphlets, books, magazines, talks, CD’s,
websites, etc. that are related to depression and mental health.
Hopefully they will have a better understanding of depression and
are willing to seek help soon.
• 7. It’s OK not to use the word ‘depression.’ Let them know that
we are seeking help for sleep difficulty, poor appetite, body aches,
tiredness, poor concentration, etc – which are part and parcel of
depression. Also consider the use of other more acceptable terms,
e.g. ‘emotional flu’ or ‘severe stress,’ or ‘mood disorder.’
• 8. Educate them that they will not be sent to a psychiatric
institution, e.g. Hospital Bahagia (previously known as Hospital
Tanjung Rambutan). The majority of patients in Hospital Bahagia
suffer from schizophrenia - not depression. Schizophrenia is a much
more serious mental illness characterized by hallucinations (e.g.
hearing invisible voices), delusions (e.g. false belief that people
want to harm them), disorganized speech (e.g. talking non-sense),
and disorganized behavior (e.g. walking around naked).
• 9. Remind them that whatever they tell the doctor is kept strictly
confidential. No clinical information will be released without a
patient’s consent, unless in emergency situations (e.g. suicide). Be
aware of social stigma - don’t unnecessarily reveal information to
friends, family, neighbors or colleagues.
• 10. At the moment in Malaysia, no insurance policy covers
psychiatric treatment. If financial constraint is a concern, seek help
from mental health services in government hospitals. The total
consultation and medication fee in Ministry of Health's hospitals
(e.g. Kuala Lumpur Hospital, Kajang Hospital) is RM5 for follow-ups
and FREE for first visit; but referral letter from a government doctor
is needed. It's more in University's hospitals (e.g. UKM and UM
Medical Centre) - about RM 50. If financial constraint is still a
concern, one may seek help from the hospital's medical social
welfare service through the doctors in the psychiatric department.
Try to convince a person with depression that having depression
and not being able to work is more ‘expensive’ in the long run.
• 11. Help to arrange appointments; remind them when the
appointment date comes. Provide transport and accompany them
for the consultation. Help them to relate their experience to the
doctor, collect medicines, get the next appointment date, and
remind them on treatment compliance. These may seem simple but
require enormous effort when one is depressed. Depression is
painful – try to make it easier for them.
• 12. Be kind and understanding to them. Try to gently explore the
reasons for not seeking help. The reasons could be individual, e.g.
believing that it’s due to punishment from God. It could also be a
perfectly understandable one, e.g. unpleasant experience with
previous psychiatrist. When we understand, we are able to care
What is expected in the psychiatrist’s
Don’t worry – all will be well.
In your first visit, the psychiatrist will:
• 1. Welcome and offer you a comfortable chair.
• 2. Have a friendly chat with you to get to know your
• 3. Enquire about signs and symptoms of depression and
other psychological disorders.
• 4. May clarify and confirm the signs and symptoms with
your friend or family* (only with your consent).
• 5. Help you to identify the factors that contribute to your
• 6. Do physical examinations and blood investigations* if
necessary, e.g. a thyroid hormone disorder may contribute
• 7. Educate you and your friend or family on depression.
• 8. Ask about your previous treatments for depression.
• 9. Propose a treatment plan – medicines or/and talk therapy.
• 10. May monitor your progress with certain psychological
questionnaires*, e.g. Patient Health Questionnaire (PHQ-9)
& Generalized Anxiety Disorder (GAD-7).
*Not all psychiatrists do that or it may not be necessary at times.
This entire session may take up to between 30 minutes to an hour,
depending on how busy the clinic is. Subsequent clinic follow-ups
will usually take a shorter time. Sometimes, more than one session
is required to complete the above-mentioned.
It’s OK for you to cry or break down. Your psychiatrist will know
what to do to support you. Have a good cry and you’re on your way
to recovery. It’s also OK if you’re not clear about your experience –
it’s your psychiatrist’s role to guide you – don’t worry, it’s going to
What to expect from a counselor or
These are some of the things that you may expect from your
counselor or clinical psychologist depending on your needs and
types of therapy:
• Help you to explore and understand your problems.
• Help you to understand your depression better.
• Perform some psychological tests, (e.g. personality test) to
help you know yourself better.
• Recommend some dietary or lifestyle changes, e.g. exercise.
• Teach you certain relaxation exercises, e.g. deep breathing.
• Teach you certain skills, e.g. communication, time
management skills, parenting.
• Guide you in solving your problems, e.g. academic stress.
• More specialized therapy, e.g. grief counseling, cognitivebehavioral
therapy, interpersonal psychotherapy, art
As counselors and clinical psychologist are not medical doctors,
they will not:
• Give you medicines
• Give you medical certificates (MC)
• Perform medical tests, e.g. urine, blood, X-Ray
• Do a physical examination, e.g. check your heart
Kindly be reminded:
1. Be open and honest with your therapist. Therapy is not
about listening to your therapist, like attending an
educational talk. It’s an active process whereby both of you
need to work together to address your issues. Therefore, it’s
important to address your concerns about the therapy
process if you experience any discomfort.
2. Follow up on the therapy session. Consistent attendance
in therapy is important to enable an effective and
collaborative working relationship with your therapist.
Update and discuss your progress from time to time.
Therapy is a process that requires commitment from both
you and your therapist.
3. Terminate the therapy session. A final session can be
suggested, either by you or your therapist, after achieving
the purpose of the therapy. At times, earlier termination
session can be suggested in order to accommodate you or
your therapist’s needs. In the termination session, your
therapist will facilitate you to review the therapy process
and provide resources or recommendation for your selfhelp.
If you need ‘booster’ (refresher) sessions later, you
may get a new appointment date – you won’t be rejected.
Do psychiatrists practice counseling and psychotherapy?
Most psychiatrists in Malaysia do some basic counseling and
psycho-education on your illness (i.e. depression) and medication
(e.g. antidepressant). For more thorough counseling and
psychotherapy work, they will usually recommend you a counselor
or clinical psychologist. A few psychiatrists do practice more
thorough and specialized psychotherapy, e.g. cognitive behavior
therapy, psychodynamic psychotherapy.
What is the cause of depression?
“Depression” is just a label for anyone who experience the
signs and symptoms mentioned earlier. But the
factors contributing to a person’s
depression are often unique and
multiple. Identifying the factors
is important as some of them can
be modified as part of treatment
(e.g. abstaining from alcohol).
Among the common factors contributing to depression are:
• Genetic inheritance.
• Chemical imbalance in the brain, e.g. serotonin and
• Hormonal imbalance, e.g. hypothyroidism.
• Negative automatic thoughts.
• Long term use of certain medications, e.g. steroid,
beta-blocker (a type of high blood pressure medicine).
• Family, marital and relationship problems.
• Past physical, sexual and emotional abuse.
• Job and financial difficulties.
• Studies and exam-related stress.
• Chronic medical problems, e.g. stroke, diabetes.
• Personality, e.g. low self-esteem, easily anxious.
• Death or loss of a loved one.
• Political instability and natural disaster.
• Substance abuse, e.g. alcohol & cannabis.
• Vitamin deficiency, e.g. folic acid & B12.
• Inability to cope with positive change, e.g. graduation,
promotion, getting married, moving to a new house.
• Other mental illness, e.g. obsessive compulsive disorder.
Sometimes, it’s useful to classify the ‘cause’ under ‘R.T.M.’
• Risk factors – what causes someone to be more vulnerable
or have higher chance of getting depression, e.g. strong
family history of depression (genetic influence), past sexual
and emotional trauma.
• Triggering factors – a recent stressor that precipitates or
starts off an episode of depression, e.g. recent divorce and
child custody issues, financial difficulty, examination stress.
• Maintaining factors – what causes someone to have poor
recovery from depression, e.g. poor compliance with
medications and counseling, ongoing alcohol abuse, anxious
Understanding the various R.T.M. factors explains why some people
become depressed but some don’t (despite having similar
stressor/triggering factor, e.g. divorce). It’s because some have risk
factors (e.g. family history of depression) and some don’t. On the
other hand, some with a certain risk factor (e.g. family history of
depression) may not get depression as they are either free from or
able to cope with the triggering factor (e.g. divorce). The R.T.M.
concept also explains why some recover well from depression but
some don’t (due to the presence of maintaining factors).
It’s much more important to know
what kind of person has a disease
than to know what kind of disease a person has
- Sir William Osler -
People with serious and long-term physical illnesses are at higher
risk of developing depression. Depression often worsens the
outcome of physical illness, e.g. feelings of hopelessness affects
compliance with cancer treatment. Conversely, people who are
depressed are more likely to develop physical illness. So, mental
and physical illnesses are inter-connected and affect one another.
For some people, the cause of depression can be mainly biological,
e.g. due to genetic inheritance, neurotransmitter or hormonal
imbalance. They may experience sudden mood swings without or
with just mild psycho-social stressors in life. Because of that, they
are often unkindly judged as ‘mentally weak.’ This is unfair – it’s
like to scolding a person with back pain and spinal problems for not
being able to carry heavy things. Please be empathetic and kind to
Right understanding of the ‘causes and conditions’ of depression is
important; it affects whether a person will seek help early and the
choice of treatment plan. Instead of a sign of personal failure, it’s
more helpful to understand depression as a natural consequence of
various factors (e.g. brought up in a dysfunctional family, having
stroke with impairment, terminated from job recently) – one will be
more likely to accept and seek help.
When we are in a situation with similar factors, we’ll very likely be
depressed too. It’s natural, just like weeds growing when the
conditions are suitable. So, depression is impersonal and you are
not alone. Be kind to yourself and seek help immediately.
Besides ‘cause,’ there are several protective factors; factors in a
person’s life that promote mental health and well-being. Research
in positive psychology is exploring more on these factors, which can
be promoted to prevent and cope with depression:
• Good family and social support.
• Positive mental attitude, e.g. positive thinking, hope,
• Physical exercise, smile and a sense of humor.
• Having a sense of meaning and purpose in life.
• Practicing religion and spirituality, e.g. prayer, meditation.
• Positive emotions, e.g. gratitude, savoring life’s joys.
• Random act of kindness or selfless service.
• Engaging in activities that involve one’s signature strength
(unique abilities, e.g. organizing, cooking, sewing).
• Effective communication and good social skills.
• Effective coping skills, e.g. stress and anger management.
How is depression treated?
Effective treatment of depression should be individualized
according to the factors contributing to a person’s depression. The
following treatment methods have been shown to be effective:
• Antidepressant medicines.
• Counseling and psychotherapy.
• Electro-convulsive therapy (ECT).
• Other non-medication strategies.
Antidepressant medicines: Since depressive symptoms are
associated with lack of serotonin and noradrenalin in the brain, one
of the ways that antidepressants work is by increasing these
The most commonly prescribed class of antidepressant is selective
serotonin reuptake inhibitor (SSRI), which includes Fluvoxamine
(Luvox), Sertraline (Zoloft), Ecitalopram (Lexapro). Antidepressant
is prescribed by a psychiatrist or any other medical doctor. It’s very
important to have proper understanding of antidepressants:
• Antidepressants have very low potential for addiction.
• Antidepressants aren’t sleeping pills or tranquilizers
although they can help with sleep and have a calming effect
(also used in the treatment of anxiety disorders).
• Antidepressants don’t make us violent, uninhibited (e.g.
talkative, sexually preoccupied) or become zombie-like.
They improve mood and allow us to make positive changes
in the way we think and act.
• Antidepressants don’t cause brain damage or memory
problems – it improves concentration and memory.
• Antidepressants don’t cause kidney or liver failure when
taken according to a doctor’s recommendation and with
• Antidepressants take a minimum of 2-3 weeks to work.
• Antidepressants need to be continued for at least 6 months
after you are well.
Although it’s generally safe, antidepressant shouldn’t be taken
conveniently like panadol (i.e. easily bought over the counter, taken
only when it’s necessary, and without monitoring). IT MUST BE TAKEN
ACCORDING TO A DOCTOR’S RECOMMENDATION & MONITORING.
Counseling and psychotherapy: This includes psycho-education
on depression and its treatment. It also includes various types of
effective talk therapies, e.g. person-centered therapy, problem
solving therapy, cognitive behavior therapy, interpersonal
psychotherapy, grief counseling, art therapy, marital therapy, etc.
Regarding what to expect from a counselor and clinical
psychologist, kindly refer to page 32).
Electro-convulsive therapy (ECT): ECT involves passing a small
amount of electrical stimulus through the brain over a brief period
(less than a minute). It’s given under anesthesia in a specialized
setting and usually reserved for severe depression, e.g. actively
suicidal, refusal to eat or having severe psychosis. Despite having
bad press, ECT is life-saving in severe depression. However, for
effective treatment of depression in the long term, ECT should be
used together with medicines, counseling/psychotherapy, and
other non-medication strategies.
Other non-medication strategies: family support, regular
exercise, exposure to sun or bright light, healthy and balanced diet,
sleep hygiene (page 128), contemplative practices (e.g. yoga,
qigong, meditation), relaxation training (page 130), depression
support group, prayer, etc. The non-medication strategies and
issues about medications will be covered in more detail in part 3 of
the book (under 20 FAQ’s during depression treatment).
It’s important to discuss with your mental health professional on
your choice of treatment, as we have different needs and views.
Their role is to guide you on treatment options; instead of forcing
their opinions on you. You got to take charge of your life and make
decisions; of course, with guidance.
The next part of this book (Part 2) is the diary of one of my many
patients (Jasmine) who is coping with severe depression. She’ll
bring you to visit the realm of depression. It’s going to be an
experiential and inspirational journey; way beyond the mere listing
of symptoms (which has been covered in Part 1). It represents hope
that, after the journey, one will understand depression better, seek
help immediately (if it’s not done yet), and be more courageous in
combating the storm of depression.
Have a wonderful journey…
Jasmine’s Journey of
When your fear touches someone’s pain,
it becomes pity; when your love touches
someone’s pain, it becomes compassion
- Stephen Lavine -
Follow me IN…
7. Gloomy Evenings
8. Suicidal Thoughts
10. My Struggle with Medicines
11. Electro-convulsive Therapy (ECT)
12. Not My True Self
13. The Story of Pothole
14. You Are Not Alone
15. New Discoveries
16. Let’s Be Friend
17. A Grateful Journey
18. Thank You
~ Introduction ~
I’m an introvert with a pessimistic personality. I didn’t
realize I was depressed until I visited a general practitioner about
two years ago because of my horrible mood swings and I cried most
of the time without any reason. Most terribly, I had very frequent
suicidal thoughts. I was then referred to a psychiatrist for further
treatment. In the psychiatric clinic, I was given a set of depression
questionnaires to answer and interviewed by the psychiatrist as
part of thorough psychological assessment. The psychiatrist
confirmed the depression and I was disappointed with the
Up to this point in time, I still wonder whether I really suffer from
depression, despite having two doctors confirming the fact. I’ve
doubts, plenty of it - I keep thinking that it’s just me instead of
depression. I feel very confused, lost and of course, depressed.
There are times that I break down and cry. I feel like I’m at a
crossroads, not knowing what to do and how to get out of this
I’m grateful to my psychiatrist who encourages me to write down
my experience along the journey through depression. It’s a
therapeutic assignment for me and also to benefit others with a
similar experience. Dr. Phang, thank you for your continuous trust,
hope and inspiration.
This is certainly a very challenging assignment as it’s painful to pen
down the stormy journey of depression. My tears flow like a river;
my heart oozes with ‘blood’ of sadness. After every chapter of the
journey, I got to make extra effort to sooth myself.
Nevertheless, I’ve no regret in taking up this challenge. I now know
that I’m not alone; there are many others with similar experiences. I
hope that my sharing can help others to have a better
understanding of depression. May you be at peace with your
depression, able to cope with it and move on meaningfully with life.
Last but not least, thank you for your interest and time spent
reading my journey.
~ Hopeless ~
My life is like a withered flower! No dream, no hope, no
future. There is only one color in my life - GREY!
When I have a relapse of depression, I feel completely hopeless and
useless. Feeling frustrated, I wonder why my life has to be this way.
What is the point of living if I’m going to feel terrible like this
repeatedly?! No matter how diligently I take the medicines, how
best the psychotherapy, how great my psychiatrist is - there is no
point in moving on. Once again, I’m unable to see the rainbows of
life. I’ve been crying almost every night. I beg God to answer my big
“WHY?!” But there is no answer.
My hope for a complete recovery is gloomy. I don’t dare to hope and
ask how well or soon I can walk out of depression. There are too
many obstacles in my life. I’m tired of fighting; I’m getting weaker
Many times, I feel that my life is like a burning candle amidst the
winds of hopelessness. The flickering flame will vanish any time
and the candle is expiring. When will I be gone too?
I like the song, “End of the World,” by Skeeter Davis…
~ Useless ~
This is my healing diary that I use to compile all the valuable
advice and encouragement given by my psychiatrist for me to cope
with depression. It’s some sort of a reference book in my life for
battling with depression.
I love the diary - it’s life-saving. But it’s also sometimes stressful to
read this diary, especially when I have a severe depression relapse.
“Why?” you’ll probably ask. It’s because I find myself useless for not
being able to practice correctly according to the suggestions given
by my psychiatrist.
I truly understand that my psychiatrist has done a great job by
trying endlessly to treat my resistant depression. Yet I can’t make
the best effort to walk out from depression. I’m so useless, I’m not
even a good patient, and I’ve disappointed so many people in my
life (besides my psychiatrist).
I notice that I’ve been so useless since young. I’ve always failed to
reach my goals in life!!! I always behave like an ostrich when facing
problems; avoiding, hiding and running away. “Jasmine, you’re
completely useless! 100% useless! - no doubt about that,” I often
tell myself. I hate myself so much…
~ Guilt ~
Very often, I’m not a good mother. I feel guilty whenever I
can’t perform my role as a mother well. I often lose patience with
my kids when I need to guide them in their studies. The same goes
when they are playing loudly. I know that they are just kids (it’s not
their fault), but I just can’t tolerate them. I’ll yell at them when my
mood is horrible. I even cane them badly for their misbehavior. I’m
also losing interest in being with and playing with them. See, I’m
such a terrible mother, I’m sure you’ll agree with me.
Two weeks ago, my mood was swinging terribly and I needed a
quiet moment for myself. As usual, I hid myself in the room. At that
moment, my little daughter came in and talked to me. Like a mad
woman, I lost control completely and chased her out of my room.
My daughter was stunned and frightened by my inexplicable
She cried and said, “Mummy, what has happened to you? You don’t
love me anymore? I’ll be very sad if Mummy doesn’t love me
anymore. I feel you don’t love me nowadays,” in a pitiful voice. I was
saddened by her words and immediately hugged her tightly.
My poor little darling, how could I treat you so cruelly? What has
happened to me? I’m becoming a monster. I felt extremely guilty at
the moment and immediately responded, “Mummy is very sorry
and I didn’t mean to hurt you. I love you forever.” I feel like
shouting and confessing all my sins to the world. Please forgive me
(if you think that I’m still worthy of requesting for forgiveness). My
heart feels extremely painful and regretful for hurting my daughter.
She is just six years old.
I’m an evil mother. I can’t forgive myself for hurting my kids. But,
HOW?! I feel very irritable when my mood is down. I feel like the
demon is eating up my love for my children whenever I hurt them…
~ Burden ~
I always feel like a huge burden to my family and best
friends, despite trying to think and say that I’m not. I always feel
bad because I’m holding everyone back, and making their lives
more difficult and miserable.
Everyone is busy with their lives including my husband. How much
time can they actually spend with me? How much patience and
tolerance can they have for me? Deep down inside my heart, I know
the answer very well. No one is interested to listen to problems
over and over again. Nobody is patient enough to understand and
accept my mood swings. In fact, I don’t think anyone can really
understand my feeling. Sometimes, I can’t even understand and
Strangely, I even feel like a burden to my psychiatrist for giving him
a hard time when my emotion gets out of hand. I feel frustrated and
fed-up with myself when I’m not be able to cope with my negative
emotions. I run madly around the horrible maze; finding a solution
to stop troubling people. I feel guilty towards my psychiatrist for
always troubling him with my problems, although it’s his
responsibility to treat my illness and he’s OK with that (that’s what
he always assures me).
Several times, I was thinking of ending my life so that I don’t have
to burden those people whom I care about. Perhaps, I’ll have peace
of mind (R.I.P.) when I leave. My loved ones will feel sad but at the
same time relieved…I’ll feel relieved too…isn’t that wonderful?
~ Weak ~
One of the main reasons why I have depression is due to my
pessimistic personality; low self-esteem, lack of self-confidence,
inferiority complex, negative thinking. That’s me - Jasmine.
I have been like this since young; only became worse when I was
diagnosed with depression. I hate this personality; I hate my life,
myself, the entire me. It’s like a big rock that I have to carry
wherever I go. Because of this, I’m at risk of depression relapse
over and over again – it’s so painful. I would honestly and
confidently (at least about something in life) say that NO PAIN IS
WORSE THAN MENTAL PAIN!!! I would rather suffer physical pain
than mental pain. Even childbirth pain was more bearable as it was
just over a short period of time.
My life’s journey is like sailing on the sea without direction. My
mind is always full of question marks about life; never-ending
questions with no satisfactory answers. With my inherent
weaknesses, I’m completely lost, stuck and have no way out.
Combating depression is like sailing on a rough sea with strong
wind and waves – it’s so scary. Complicated by my pessimistic
personality, I strongly believe that it’s never easy to get well and
remain so, despite the continuous support from my psychiatrist.
The road to recovery from depression is long, tortuous and thorny.
It’s is full of potholes. Worse still, it often feels like I’m going
off-track or even backward instead of forward. And I got to restart
the journey from square one – it’s so frustrating and tiring. I really
hate this journey! When can the journey be ‘game over’?
~ Gloomy Evenings ~
Generally, people like the moments when evening comes. It’s
time to stop work, return home to relax and spend time with family.
However, it’s a different story for me. When the sun is down, my
fear starts to creep in.
I feel very scared when the sky gets darker. The same thing
happens when the weather is gloomy. End of the day feels like the
end of the world to me. The shadows of hopelessness, helplessness,
loneliness, listlessness – all take turns to haunt me as the sky
Every evening, it’s a time for battling with depressive storms. As the
storm comes, it brings with it all the unpleasant memories of the
No matter how hard I try to stay calm in the storm, I’m usually the
loser. When that happens, I’ll normally retreat to my dark room,
lock myself in and cry profusely. Yes, crying does help to release the
~ Suicidal Thoughts ~
Life is indeed full of suffering and very painful!!! How long
more can I bear with it? Continue or just give up? This is the scary
question that visits my mind on and off.
Thoughts of suicide keep flashing in my mind. It tells me that the
game is over and I’m the loser. It’s time for me to give up, stop
striving and rest in peace.
Are you afraid of dying?
I’m not. But, I’m concerned about my kids. I neither want to leave
them behind nor let them live without a mother. It would be very
painful for them. Finally, I thought of bringing them along with me
wherever I go – including the graveyard. I know it’s very cruel and
unfair to the kids. I don’t want to do that. But I really have no other
choice?! There’s no way out.
I’ve been contemplating various ways of committing suicide. I’m
making preparations to leave – a final good-bye. I’ve told my best
friend to liaise with my hubby on my choice of decoration during
the funeral ceremony. Finally and luckily, I’ve decided on an
alternative, one that is less drastic (next page).
Whenever I think of ending my life, I feel sharp pains in my heart,
like being stabbed with a knife repeatedly. My mum will feel very
sad when I’m no longer around. Will she? I think so; I’ll feel very sad
if my daughter ends her life. But, do I have a better choice? Maybe it
will be better for everyone in the long run…
~ Self-harm ~
I know I’m not supposed to kill myself to end my pain. But at
the same time, the pain is really unbearable. Finally, I discovered a
way to get relief from my emotional pain - SELF HARM.
In order to reduce my mental pain, I harm myself physically (i.e. I
violently pinch myself or to shower in high temperature water) to
induce physical pain. The physical pain helps to divert my attention
from the mental pain which is much worse. Whenever I can’t cope
with my mental pain, this self-harm tendency will crop up; it’s
becoming a habit.
I understand that this is not the healthy way. But I don’t know of a
better way. I would rather have physical pain than mental pain.
Nothing is more painful than the mental torture of depression - I
can’t stand it, I’m so helpless.
I’m sad and mad with myself for having such a crazy habit. I’m
regretful every time I physically hurt myself. “But, that’s better than
ending my life,” I console myself….
~ My Struggle with Medicines ~
No matter how many times my psychiatrist explains to me
the effectiveness of medicines, I still feel very reluctant to take them.
Compliance with medicines is a big issue for me. Despite repeated
assurance from my psychiatrist that the medicines are important
and safe for me, I still doubt. I’m worried about side effects. I’m not
sure whether the medicines will work for me. I still sometimes
doubt that I have depression. So, even if the medicines work for
depression, it may not work for me as I don’t have depression.
Maybe it’s a big mistake on the part of my well-intending
psychiatrist; wrong diagnosis.
I used to cry when I had to take medicines. As the medicines
entered my body, I thought to myself, “Why do I have to suffer from
depression?! Why me?! Why do I need to take medicines?! Why
can’t I stop my medicines?! Why?! Why?! Why?!” As you have
probably guessed, I have never gotten satisfactory answers.
Several times, I managed to convince my psychiatrist to reduce my
medicines. Unfortunately, I had very bad relapses and almost ended
up killing myself. Now, I realize that medicines are not everything;
but they are essential together with other treatments for
depression, e.g. psychotherapy, family support, exercise, nutrition,
Nowadays, instead of condemning my medicines when I take them,
I have learned to consume them with a positive mental attitude.
When I put the medicines into my mouth, I radiate positive
thoughts to my medicines, body and mind. And I try to bless them
with love and compassion. It’s not easy, but I’m trying. I’m sure
many of you who are depressed, reading this, share similar
experiences. I truly know how you feel. But please don’t give up –
we shall go through this together – we are not alone.
I wonder when I can reduce my medicines again. I’d better not
think this aloud, or else my psychiatrist will be very upset with
~ Electro-convulsive Therapy (ECT) ~
“Twinkle, twinkle little star, how I wonder what you are. Up
above the world so high, like a diamond in the sky,” I was crying
like a baby while singing this song.
It was so lonely and scary in the psychiatric ward. All the patients
had some form of mental illness and they looked so pitiful. Some of
them were hostile due to their illness and needed to be restrained
on the bed so that they couldn’t harm themselves or others. “This is
temporary and for their own good, while waiting for the medicines
to work on them and cure them,” assured my psychiatrist.
Due to my severe depression and attempted suicide, I was advised
by my psychiatrist to go for a series of emergency and life-saving
treatment known as Electro-convulsive Therapy (ECT).
ECT is a safe and effective treatment for certain mental illnesses
especially severe depression. During the ECT, while one is asleep
under anesthesia, a small amount of electrical current is passed
through the brain within a minute. This current causes a
therapeutic seizure that ‘charges up’ the entire brain in a positive
way, including the parts that control mood, energy, appetite and
I was warded for two weeks for the ECT. After some time, I
managed to make friends with some patients in the ward. They
were not as scary as when I had perceived them earlier. Gradually, I
got to know some of their life stories; many of which were more
pathetic than mine. Many of them had nobody to care for them at all;
no friends, no family members, and not even a proper place to stay
or food to eat. I’m so lucky compared to them; I have a wonderful
family, a good psychiatrist, access to expensive medicines, able to
join a depression support group, etc. It’s an eye-opening and
priceless experience to be in the psychiatric ward…
~ Not My True Self ~
“Trust me, Jasmine. You are in a severe relapse state! We
need to add a new medication…please allow me to do that,” said my
psychiatrist as I struggled in the quicksand of depression.
During my depression relapse, I felt completed defeated and
devastated; everything was back to square one. My mind was full of
negative thoughts, all that you can think of, including the various
reasons that I should kill myself. Out of concern, my psychiatrist
insisted that I should increase the number of medicines that I was
taking (I hate that).
I had no choice but to listen to his professional and genuinely caring
advice. The new medication caused me to be “abnormal” for a few
days; I slept most of the time as my body needed time to adjust to
the new medication.
However, I also noticed other strange and ‘uneasy’ feelings besides
the sleepiness. The new medication made me feel calmer. The mood
was better with less negative thoughts. But I felt weird with my
new self as I was so used to the Jasmine with negative thoughts and
horrible feelings. That really prompted me to contemplate deeply -
Who am I? Which is my true self? Who is Jasmine?
Well, I got to admit that my doctor is right and I’m glad that he’s
right – medicines are not everything but they are very important!
~ The Story of a Pothole ~
This is a meaningful story shared by my psychiatrist. It serves as a
reminder whenever I fall into the depressive POTHOLE again.
Once upon a time, a lady, always fell into the same pothole in a
familiar stretch of road while walking along it. She sought help on
how to avoid falling into the pothole again. She practiced all the
methods diligently and never gave up.
It took her a very long time but she finally conquered the pothole
and ‘RECOVERED.’ This is her eight-stage journey of recovery:
1. Walked on a road... fell into a pothole...totally unexpected...pitch
dark and scary...didn't know what to do?!?!
2. Walked again on the same road and fell into the
pothole...surprised that she fell again...but at least now she
realized the reasons that made her fall again into the pothole...
3. Walk around the pothole a few times...yeah, able to avoid falling
for awhile...but finally still fell into the pothole...felt frustrated,
but able to learn new ways to avoid the pothole...
4. Walk around the pothole anxiously many times without
falling...yeah-yeah...but still stuck around the pothole without
moving on along the road...
5. Able to walk around the pothole with no fear...and then moved
on along the road...but didn't know where to go...”what should I
do if I’ve no fear or depression?”
6. Able to walk around the pothole confidently...and then moved
on along the road happily towards a meaningful
destination...but at times still felt that something was missing in
7. Able to walk past the pothole confidently many times...one day,
saw someone with similar problem...but was sad as she
couldn't help the person and others to 'cross over'...
8. Able to walk along the path meaningfully...and helped many to
walk meaningfully as well...she was also grateful to
the pothole that had taught her many meaningful lessons in life.
“Don't give up. We’ll walk and grow together,” said my psychiatrist
numerous times, giving me hope and inspiration. And I wish to say
the same to you as well – let’s journey along together. Many
discoveries await us…
A journey of a thousand miles begin with a single step
- Lao-tzu -
~ You Are Not Alone ~
Always remember that you’re not alone in coping with
depression. Please seek help from mental health professionals
(psychiatrist, psychologist, counselors) if you notice that you have
the following depression symptoms persistently for more than two
weeks and it’s affecting your daily life.
• Depressed mood or crying spells
• Loss of interest or pleasure in most activities
• Significant weight loss or gain
• Sleeping too much or not being able to sleep
• Slow thinking or movement that others can see
• Fatigue or low energy
• Feelings of worthlessness or inappropriate guilt
• Loss of concentration or indecisiveness
• Recurring thoughts of death or suicide
I’m blessed to have a professional and experienced psychiatrist
with me along the journey of depression. I hope you too can find a
good doctor and treatment for yourself. I feel less lonely these days
as I’ve a group of supportive friends with me along this journey;
some of them also have depression like me. We hold one another’s
hands tightly as we overcome challenges and discover happiness in
My psychiatrist always reminds me that with each battle with
depression, I’m becoming stronger and stronger. He often says,
“Everything happens with some good purpose.” Well, I certainly
never asked to be depressed. But since I already have it, I might as
well make good use of my experience for growth, thus sharing and
building a better world.
~ New Discoveries ~
2 October, 2011 – A gloomy day and the depressive storm was
coming. “I must not surrender. I must do something to protect
myself,” I reminded myself. I managed to do something this time –
Throughout the activity of pulling weeds in my garden, I finally
understood that the mind is also like a patch of garden. I discovered
that my mind garden is full of weeds too. I never bothered to pull
out the weeds. Worse still, I “fertilized” them. That’s how I ended up
as the hopeless, useless, weak and depressive Jasmine.
I remember clearly that my psychiatrist told me that besides pulling
weeds, I need to plant good seeds in my mind garden so that the
flowers and fruits of happiness can grow. I did as advised but was
impatient; I dug out all the seeds before they had a chance to sprout
I do a lot of good deeds (e.g. community service) and things that are
conducive to healing of my depression (e.g. exercise, learning about
parenting, etc). People compliment and thank me for what I do for
them. But I always feel that I’m not good enough - I blame, criticize
and find fault with myself.
To avoid a depressive relapse, I got to constantly remind myself,
“You are good enough,” echoing the advice from my wise
“Whatever you are doing is not perfect but good enough – keep it
up and you’re on your way to recovery. But you are too impatient
for the seeds to grow. You dig out the seeds and scold the seeds,
‘Why aren’t you growing?!’ You doubt whether the person who
recommended you the seeds was right after all. You doubt whether
the seeds will ever grow – trust me, they will surely grow, just be
patient,” said my psychiatrist. He’s right and I’ll never forget that.
It’s an important realization.
While reading a self-help book on cognitive behavior therapy (CBT),
I had another important realization - I can’t depend on my
psychiatrist too much. I’m responsible for my healing. He can only
guide but not support me all the time.
Through my reading in CBT, I also gradually discovered that my
depression is actively fed by my
negative and unhelpful thinking
patterns, which I’m learning to
transform. If you are interested to
know more about CBT, you can look
for this book, “Fight Your Dark
Shadow – Managing Depression with
Cognitive Behavior Therapy,” by
Dr. Tian P.S. Oei.
~ Let’s Be Friends ~
Do you know how much I hate you? I’m very angry and upset with
you for intruding into my life. You have spoiled everything,
especially my happiness in life. Worse, you bring along your
‘friends’ - hopelessness, helplessness, uselessness, loneliness and
guilt. They take turns to visit and torture me – it’s terrible! Do you
know how painful I feel whenever your friends visit me?! I hate you
so much for making my life horrible!
I’m frustrated and don’t know how to deal with you. I’m so helpless;
I can only hide in the room and let you torture me. Don’t you think
you’re very cruel? You can’t do this to me – it’s unacceptable!
But do I have a choice?
In order not to let you to hurt me further, I have thought of a way –
TO BE A FRIEND to you. If I can’t beat you, at least allow me to
make peace with you. Are you OK with that?
I’m sorry that I didn’t take care of you since the first day we knew
each other. Sorry for being rude to you as I always chased you out
from the door of my heart. From today onwards, I promise that I
will try to welcome you and your ‘friends.’ Kindly introduce them to
me; I wish to know them better. I want to befriend them.
Thank you for coming into my life. You mean a lot to me; you make
me stronger and wiser. Because of you, I learn to love myself more
and be stronger. I can also share ‘our story’ and ‘relationship’ with
others. It’s so nice that we can work together to benefit others.
I’ll not be down and sad when you visit me again, I promise. I
believe that everything happens with some good purpose. I might
not understand it now, but I have faith that it’s just a matter of time
that the understanding will unfold itself.
I’m sure you will guide me towards a more meaningful life. Who
knows – because of you, I will have a chance to help people with
depression and other mental illnesses one day. With your presence,
I learn to treasure life more. I’m grateful to have you with me in this
life’s journey. You’ve given me an opportunity to see things clearer
and better – the pathway to happiness.
I love you, my dear depression.
~ A Grateful Journey ~
It has not been easy in my journey of recovery from
depression. I have made so much effort in getting out from the
depressive pothole every time I fall into it. It’s sometimes very
tiring. But it’s is a fruitful experience - I notice that I’m getting
stronger and wiser, yeah.
I’m grateful that I’m still alive in this world and able to write
this to share with you. I’m grateful to my psychiatrist,
Dr. Phang for rescuing me from death several times – deeply
appreciated. As recommended by my psychiatrist as part of therapy,
I’m counting my blessings every day – that’s equivalent
to nourishing the good seeds in my mind garden.
I got to be honest and admit that many of my challenges in life are
not resolved yet. The shadows of depression still visit me
occasionally. But I’m grateful that I’m more resilient now. I’m
grateful that I’m part of the KL Buddhist Mental Health
Association’s Stress, Anxiety & Depression (S.A.D.) Support Group
(a.k.a. T-Lotus). I’m grateful to associate with the T-Lotus members
as they always lend me a pair of listening ears, and motivate me to
move on whenever I’m afflicted by emotional flu.
Perhaps some of you may be surprised or even think that I’m crazy
when I tell you that I’m grateful that I have severe depression. No
doubt, there’s a lot of pain – deeper than the deepest ocean. But
there’s no regret.
I’ve learnt a lot about the illness. I’ve come a long way in battling
with depression. I have experiential understanding of depression.
I’m able empathize easily with those are suffering from depression.
I’m also able to use my little experience to share with others and
contribute to a better world.
Amidst the sufferings, there’s enough hope in life – I’m glad that
there’re rainbows after rain. I know that it may rain again. But it’s
OK. I’ll learn to sing in the rain while waiting for the rainbows to
appear – that’s good enough!
~ Thank You ~
My journey through depression has been the biggest
challenge of my life. I would like to take this opportunity to extend
my sincerest gratitude to my psychiatrist, Dr. Phang for being with
me throughout this painful and unforgettable journey.
I would also like to extend my appreciation to my loving husband,
wonderful kids, dear family members, T-Lotus support group
buddies and good friends for their continuous support and
shoulders to cry on. Thank you for always being there for me.
Last but not least, I thank you for spending your precious time to
read about my journey. May you be well and happy.
(Feel free to contact me to share your experience in coping with
let’s follow me OUT…
Note: Permission has been acquired from Jasmine
to share her journey through depression in this book.
Kindness amidst depression…
Kindness is the language which the
deaf can hear and the blind can see
- Mark Twain -
Hello, welcome back from the realm of depression. I’m sure
you had a wonderful journey with Jasmine, our depression
journalist and tour guide. By now, you would have acquired the
basic information on depression (Part 1). With Jasmine’s (Part 2)
and your personal experience, you would have also acquired
experiential knowledge on depression. It’s time that we move on
with more strategies to cope with depression.
It was mentioned earlier that there are
several protective factors that can help us
to prevent and cope with depression. One
of them is kindness and its related
positive qualities. Part 3 of this book will
emphasize the application of kindness
and other effective self-help strategies to
speed up recovery from depression.
depression into wisdom and compassion…
Let’s march forward, transforming
10 ways to cultivate kindness for
coping with depression
Supported by research in positive and humanistic
psychology, kindness and related positive qualities,
e.g. compassion, peace, gratitude, gentleness,
patience – are all helpful in healing of
depression. They buffer the pain of depression,
facilitate recovery, promote wisdom, and prevent depression
relapse. On the other hand, negative states of mind, e.g. anger, guilt,
grudge, frustrations, discontentment will maintain or worsen
depression. Below are some suggestions on how we can cultivate
kindness for coping with depression.
1. YOU ARE NOT ALONE:
Remember that depression affects one in ten persons. It’s a
natural consequence of various risk factors and stressors that you
are going through. If I’m in your shoes, I’ll probably have
depression as well. This positive mental attitude is important as
thoughts of, “Why me?! Why only me?!” often create a sense of
frustration and isolation that worsens depression. Not surprisingly,
people who participate in a depression support group often feel
relieved, when they discover that there are others with similar
Depression is painful but
I’M NOT ALONE – Yeah!
2. YOU ARE NOT WEAK:
Be kind to yourself; don’t criticize yourself – you’ve suffered
enough. When we have depression, it doesn’t mean that we are
weak; it probably means that we have been too strong for too long.
It’s quite common to hear patients say,
“Doc, I don’t know why I’m like this now… (sighing). I wasn’t like
this previously. I was a positive and happy-go-lucky person. I’m the
eldest in the family and I used to support all my siblings. My friends
and colleagues often come to me for advice when they have
problems. Now…..(crying), it’s different, I’m so useless…”
Ms. E has just started work in a new company. She’s having a
stressful time adapting to her new work environment. Her father
left the family and her siblings are overseas. When she returns
home, she has to take care of her mother with severe anxiety and
Mr. C has diabetes mellitus, cholesterol problem, and suffered a
stroke. He’s also unemployed and financially tight. Recently, his
teenage son showed bizarre behavior and may have schizophrenia.
Ms. J needs to work to support her family. At the same time, she has
to take care of two family members at home; a mother with
Alzheimer’s disease and a sister with mental retardation – both are
unwell and quarrel every day.
Madam O is a dedicated school teacher; her students like her very
much. She’s having a difficult time at school due to a heavy
workload and interpersonal problems with some
colleagues. Recently, her beloved husband passed
away due to kidney failure. While grieving over the
loss of her husband, she has to support her children
who are still schooling.
Are they strong or weak?
Yes, they are indeed very strong. It humbles me when I listen to
their unique experience behind the diagnostic label of ‘depression.’
While listening emphatically to them, I often think to myself:
“Would I be able to cope like them if I’m in similar situations? I’ll
probably be depressed too, more than enough reasons to be
People who don’t understand depression may say that you are
weak. Ignore and forgive them for their ignorance – they don’t
know what they are talking about. They’ll probably understand
when depression visits them one day. Meanwhile, be kind to
yourself and be patient with them.
Be more kind & gentle to yourself
3. FORGIVE YOURSELF:
People who are depressed often feel guilty over trivial
matters. They actually haven’t done anything really wrong and
totally unforgivable. That’s often the nature of a depressed mind.
This can even develop into a more serious symptom known as
‘delusion of guilt’ – a fixed and false belief than one has done
something wrong or sinful (despite everyone thinking otherwise).
Tormented by guilt, a depressed person may think:
“I don’t deserve to get well”
“It’s punishment from God – I shouldn’t get well!”
“I must go through the suffering – it’s my bad kamma/sin”
“I’m useless. Not only that - I’m evil too”
“It’s not depression. I’m a bad person! – no point taking medicines”
I’m sure you can see how guilt easily interferes with depression
treatment. You may use the ‘F.A.R. 2’ formula as a guide to make
peace with guilt:
F – Forgiveness.
• Ask for forgiveness from those whom you have hurt.
• Ask for forgiveness from God or divine beings.
• Remember that God is loving and forgiving when you
A – Aspiration
• Make an aspiration that you will not repeat the mistakes.
• Ask someone respectable, e.g. priest to be a witness to your
R – Remedial action
• Try to compensate - ‘right’ the ‘wrong.’
• E.g. donation or voluntary service to orphanages if you feel
guilty over past abortions.
• Ruminating over how bad or evil
you are is not helpful –
do something useful instead.
R – Rejoice over the goodness in you
• To err is human, but we have
done good things in life too.
• Make a list of all the good things
and review them periodically.
• Depression causes memory bias –
you’ll tend to remember the
bad things more
than the good ones.
• Getting an opinion from a trusted friend helps to put things
It’s OK to feel guilty (part and parcel of depression). Don’t feel
guilty for feeling guilty - double guilt – you’ll get sucked deeper into
the black hole of guilt. Instead, learn to cultivate ‘F.A.R. 2’ and move
on with life.
It’s important to remember that forgiveness doesn’t mean we
approve of our mistakes – they’re still mistakes. Forgiveness is
about making peace with the past so that we can move on
meaningfully with life – for ourselves and loved ones – it’s an act of
Story: One evening an old man told his grandson about a battle that
goes on inside every person. He said, "My grandson, the battle is
between two wolves inside us all."
"It’s a terrible fight and it’s between two wolves. One is evil – guilt,
anger, envy, sorrow, regret, greed, arrogance, self-pity, resentment,
low self-esteem, lies, false pride, ego – he has all of them." He
continued, "The other is good - he has kindness, joy, peace, love, hope,
serenity, humility, benevolence, empathy, generosity, truth,
compassion, and faith.“
“The same fight is going on inside you - and inside every other person,
too," said the old man wisely. The grandson thought about it for a
minute and then asked his grandfather, "Which wolf will win?" The
old man simply replied, "The one you feed".
So, starve guilt and feed kindness - depression will R.I.P. (rest in
4. FORGIVE OTHERS:
Forgiving others doesn’t mean that
we approve of their mistakes. We forgive
others because it’s an act of kindness to
ourselves; it helps to free us of our emotional
pain and move on with life more easily.
It’s useful to forgive others. Or else, we’ll be hurting ourselves as
harboring grudges and revengeful thoughts is unpleasant and
detrimental to happiness in the long-term. Depression is already
painful enough – don’t add more suffering to life, “Holding on to
anger is like grasping a hot coal with the intent of throwing it at
someone else; you are the one who gets burned,” (adapted from a
Buddhist saying). “Getting angry at someone is actually punishing
ourselves for another’s mistakes,” said Master Cheng Yen, echoing
the same message.
Forgiveness is always easier said than done. Here are some ways to
make it more manageable:
1. Empathize with the person. He or she may be having problems in
life or even in depression. That’s why he’s so mean to others –
only unhappy people ‘like’ to hurt others.
2. Touch the ‘good seeds’ in the person – nobody is totally terrible,
e.g. a nasty female boss may be a caring mother.
3. Remember that we have made and learned from mistakes too –
to err is human and I’m still human. Be generous and offer them
the altruistic gift of forgiveness. After all, it’s not our duty to
punish others; we have more meaningful things to do in life.
4. Look for hidden lessons in the hurt, e.g. because someone has
betrayed us, we are more cautious in trusting others. We also
learn to cherish genuine friendships more.
5. Find your own happiness, e.g. by always counting the blessings in
life. When we are happy, it’s much easier to forgive.
Don’t wait anymore, be kind to yourself
and get yourself a gift for depression today
– by forgiving others.
5. COUNT YOUR BLESSINGS:
Yeahoo, life is wonder-full;
Let’s ‘google’ the wonders…
- Zhen-Phang –
Depression causes memory bias. Due to
‘state dependent memory,’ we tend to
recall the horrible things in life instead of
the happy ones. Unpleasant events tend to
stick in the mind like velcro; while pleasant ones slip off easily like
teflon. That’s why, it’s a good practice to keep a diary to note down
all the pleasant things in life and recall them repeatedly. As you do
this regularly, you’ll discover that life may not be that cruel to you;
good things do happen in life and to you.
You may use this as a guide to help you recall the pleasant things in
life (my own examples are in italics):
• Be grateful that somebody has complimented you.
My students say that I’m a good teacher.
• Be grateful that someone has expressed appreciation to you.
One of my patients gave me a “my best doctor award.”
• Be grateful for a mistake that you have made and now know
how to avoid.
I have learned not to work too hard. When I rest more, I do
things more effectively and with more joy.
• Be grateful for something new that you have learned today.
I have learned how to design the cover of a book with Adobe
Photoshop and Illustrator computer software.
• Be grateful that there is someone who cares for you.
My mother and sister care for me. My patients also care for
me; they sometimes prepare me a home-cooked lunch when
they know that I may not have enough time to eat.
• Be grateful that you are able to do something that you have
I have the experience and time to write this meaningful book
that will bring happiness to many people.
• Be grateful that you have the basic needs of life, e.g. food,
I have a comfortable library at home for me to enjoy my
reading and writing.
• Be grateful for something that you have worked hard for and
achieved success in.
I manage to get plenty of donations to reprint this book for
free distribution in the community.
• Be grateful that you managed to help somebody.
I’ve helped several young doctors who were depressed.
• Be grateful that you have a certain skill or talent.
I’m a good and kind listener.
According to research by Professor Dr. Robert A. Emmons (editor in
chief of the Journal of Positive Psychology), grateful thinking can
increase happiness level by as much as 25% - have a grateful day.
6. SELF-COMPASSION ACTIVITIES:
Depression may be a signal that you have neglected
someone very important in life – YOU. Yes, you need to care for
yourself more. As part of depression treatment, I often ask my
patients to plan and do things that can make them happy.
This is not selfish; it’s kindness towards the self – part of
professional ‘prescription’ for depression. Many patients are so
used to sacrificing for the happiness of others. They may have
forgotten how to be kind to themselves, or even feel guilty for doing
These are examples of how I try to be kind to myself when I’m
• Go for a walk in the park
• Watch trees, birds and the sky
• Relax and meditate
• Read an inspirational book
• Have a cup of hot chocolate
• Listen to some soothing music
• Review the happy moments in life
• Let others help and support me
• Allow myself to be less productive at work
• Pray for my own well-being
I notice that when I care for myself well, I can care for others more
– I’m more kind, understanding and wise in dealing with others.
Depression is associated with lack of interest in activities; it’s part
of the illness. You may not feel like doing anything at all – this is
absolutely understandable. But try to recall what you used to like
doing before falling into depression, and trust Nike’s advice – Just
When you start doing them little by little, the mood will slowly
return. It may not feel as good as previously, but it’s often good
enough to motivate more activities and offer a feel of ‘getting back
to normal.’ Tiredness and moodiness in depression is not overcome
by more rest; it becomes worse – you’ll feel more tired, abnormal
Trust me, gradually engaging in more activities, especially those
that you once liked, is the right strategy – soon you’ll rediscover the
sparks of life.
7. DO VOLUNTARY SERVICE:
Life laughs at you when you are unhappy
Life smiles at you when you are happy
Life salutes you when you make others happy
- Anonymous -
Reaching out to help others through voluntary service has
‘pro-happinessant’ (promote happiness) effects:
• You’ll discover that you are not alone; many people have
similar problems like you. You may even realize that your
condition is not that bad after all.
• You’ll feel that you are useful; you are capable of doing
something meaningful to help others and make a difference
to the world.
• You’ll become less preoccupied with your own problems.
To stop negative thoughts is difficult. I know many people
have advised you to ‘think positive,’ but it’s never easy. It’s
easier to do it by distracting yourself with useful activities.
8. RADIATE KIND THOUGHTS TO OTHERS:
• Take a few slow deep breaths to relax
your mind and body.
• Think of the people in your life
especially your loved ones.
• Mentally, send good wishes to them,
like sending a mental SMS, e.g. “May
you be happy,” “May you get a
promotion,” “May you be healthy.”
• Smile to them and visualize them being happy. Imagine that
they smile back and thank you for the good wishes.
• Repeat this for a different person or group of people.
• You may also expand your kindness to animals and nature.
This is helpful for depression in several ways:
• 1. It trains the mind to focus on a positive emotion,
i.e. kindness, instead of a negative emotion like fear.
• 2. It stimulates the production of a neuro-hormone,
(i.e. oxytocin) which gives a sense of warmth and security
(the same chemical is produced during breast-feeding).
• 3. The kind thought and feelings can facilitate positive
behavior, (e.g. smiling and being friendly to others) that
improves interpersonal relationships.
9. TRANSFORM DEPRESSION INTO WISDOM:
He who has a WHY to live can bear almost any HOW
- Friedrich Nietzsche -
Though depression is painful, it’s not uncommon that patients
report that they have learned something useful from their illness.
Everything in life happens with some good purpose. Here are some
of the possible lessons from depression:
• “I’m more empathetic…I understand more about people with
• “Depression helps me to reprioritize my life”
• “I now understand that I can’t control everything in life”
• “I appreciate life more…I’m grateful that I’m alive”
• “I know who are the ones who really care for me”
• “Depression is like a compass; It reminds me about self-care
and focusing on what’s important in life”
• “I have learned to be less serious and laugh at myself”
• “I’m more kind to others”
We don’t ask for depression to come. But since it’s already here,
let’s learn to befriend depression and grow from the relationship.
Hi ‘Cikgu (Teacher) Depression,’ thank you for coming into my life…
10. BE KIND TO YOUR MEDICINES:
It’s extremely important to have a positive mental attitude
towards your medicines. Suppose each time you take medicines and
think, “Oh shit, I got to take these medicines again…it’s destroying
my kidneys and liver. When can I stop taking
medicines? I hate seeing the sickening doctor,”
it may interfere with your recovery from
depression as the mind is very powerful in
Case report: Once, there was a patient with
depression who attempted suicide by
overdosing on her antidepressant medicines that she believed
would kill her. She was admitted to the intensive care unit (ICU).
Unfortunately, she remained unwell despite all ICU monitoring
showed that she was normal. She only ‘recovered’ when her
psychiatrist told her that she was actually on placebo
antidepressant drugs (a sugar pill with no active medicines).
Kindly remember - If you believe that a medicine or treatment is
effective, the outcome will be better, and vice versa. No doubt,
antidepressants work. But they work even better when:
• The patient believes that it works.
• The patient’s doctor believes that it works.
• There’s a good relationship between the patient and doctor.
Therefore, the next time you take your medicines, say kindly in
““I’m so grateful that I get to take this medicine.
It’s so kind of my doctor to give this to me.
May my body be able to adjust to this medicine
and make good use of it for my recovery…
May God bless me and my medicine…
Yes, I’ll be well soon…Yeahhhh!”
12 ways to be kind to people
Various kindness-based strategies have been suggested in
the previous chapter for patients to cope with depression
(internal). It will be even better if we can extend kindness to those
who are suffering from depression (external). With a full dose of
kindness (internal and external), recovery from depression will be
much easier. How can we be kind to those who are depressed?
• 1. Don’t stigmatize them – they are not crazy, mad, psycho,
violent or bad. They are human beings like you and me (but with a
psychological illness), who are capable of being good, happy and
successful in life.
• 2. Try to understand depression as much as possible. Recall the
occasional periods of sadness and lack of motivation in your life.
Amplify that 10 times – that’s probably how it feels to have
depression as an illness. When we understand, we’ll be able to care
• 3. Gently remind them to take medications and do whatever
necessary to get well, e.g. engage in more activities, read about
depression, eat healthy food, and go for clinic follow-ups.
• 4. Spend time with and accompany them for their activities, e.g.
exercise, a walk in the park, buying things from the market. Don’t
just tell them to do it; invite them to do it with you and give plenty
of encouragement with every slight progress.
• 5. Offer practical support, e.g. cooking, cleaning the house, giving
a lift to the clinic, settling the bills, taking care of children, collecting
• 6. Don’t compulsively give advice, “Try this/that…don’t do
this/that…must do this/that…” Though with good intentions, you’ll
probably make him/her feel more confused and helpless. Be a good
listener - explore their concerns and empathise, before offering
• 7. Don’t be over-protective. They need to be trusted that they are
capable of doing things on their own with support. Sometimes we
also need to be firm with them for their own good, e.g. insisting that
they should stop abusing drugs (e.g. cannabis), compliance with
medications, clinic follow-ups and daily exercise.
• 8. Give them equal opportunity for employment when they are
well. Allow them to take leave just like any other illness when they
need to take time off for clinic follow-ups.
• 9. Forgive them if they are sometimes impatient, unreasonable
or even hostile. They are sick and in pain; may sometimes behave
like an injured scorpion that stings those who help them. The fact
that they reveal their unpleasant side to you may mean that they
actually trust you enough. Be grateful that you are the ‘chosen one’
–willing to endure with compassion.
• 10. When they are not ready to be helped, empathetically leave
them alone for the time being. I know that it’s helplessly painful
‘doing nothing.’ Bear in mind, most likely, they are aware that you
care, but they are not ready to seek help yet. They need more time
to accept the reality of depression; acceptance is a process, not an
on-off switch. Be kind to them by being patient and not rejecting
• 11. Repeatedly assure them in words that you love, care and
respect them unconditionally. It’s not they don’t trust you; they
actually don’t trust and probably hate themselves – depression has
damaged their self-confidence and self-worth.
There was never a night or a problem
that could defeat sunrise or hope
- Bern Williams -
• 12. Be kind and supportive through non-verbal expressions:
a friendly smile, a hug, offer tissue papers for crying, a pat on the
shoulder as encouragement.
Be mindful of false kindness
Sometimes kindness can be
misunderstood, applied wrongly and thus not
helpful in dealing with depression. Kindness
in coping with depression doesn’t mean:
1. Allowing ourselves to abuse alcohol or illicit drugs
(e.g. cannabis, heroin, amphetamine) to drown the depressive pain.
Even though it’s understandable, this is not self-kindness – it’s selfdestruction.
A better way would be getting professional help for
2. Self pity – repeatedly ruminating over how terrible life is
(‘poor me syndrome’). It’s done mainly to seek attention without
any willingness to do anything to make life better. A better way is to
take charge of our lives and make practical changes for
3. Blaming everyone and demanding the world to change. This
is not self-love – it’s self-centeredness. This kind of expectation will
only cause more disappointment and interpersonal conflicts. A
better way would be to gradually adjust our attitude and behavior
to build a better world.
4. False acceptance of illness. Some people totally ‘surrender’ to
depression; they don’t get help or do anything to get well. They may
also think, “Since depression is an illness, I’ll let my doctor make all
decisions and do the treatment. I don’t have to do anything.” This
isn’t true acceptance – it’s wrong understanding, denial and
avoidance. Kindly refer to page 26 on how to encourage someone
with depression to seek help.
5. Making all decisions for someone who is depressed. This may
be appropriate during the initial period when he or she is very sick;
it’s not helpful in the long-term. It’s better to slowly guide the
person in problem solving and decision making using ‘I.D.E.A.L.’
6. Doing everything for someone who is depressed. This is also
not helpful in the long-term; the person can’t resume independence.
It’s better to support them by dividing their task (e.g. cleaning
room) into smaller and more manageable parts, and let them do it.
- Monday: throw away rubbish & useless things
- Tuesday: sweep the floor
- Wednesday: mop the floor
- Thursday: clean the windows
- Friday: tidy up things
- Saturday: decorate the room
- Sunday: holiday
This helps to build confidence and promote independence.
7. Keep nagging and pestering the depressed to change. This is
often done in the name of kindness, “It’s for your own good!” We
need to be mindful that at times, this could be a reflection of our
impatience and non-acceptance. The expected improvement is also
sometimes more for our needs rather than theirs (e.g. we feel
shameful that we have a family member with depression). A better
way is to stay calm, be honest and kind with our feelings, listen to
their needs, and be generous with encouragement.
The next part will be on the frequently asked questions (FAQ’s) that
I received from my patients during their depression treatment. Feel
free to ask your mental health professional on anything related to
your depression. Be kind to yourself, you deserve good service –
your satisfaction is our inspiration. Of course, it’s impossible for me
to answer all questions related to your depression treatment.
Therefore, If there’s anything that isn’t answered through the 20
FAQ’s, kindly refer to your mental health professional or more
information available in “Further reading on depression
20 FAQ’s during depression treatment
1. Why am I like this/that? (referring to the various signs and
symptoms of depression). You are like this/that because you have a
psychological illness known as depression
which affects the way you ‘think-feelbehave’
and your body functions. For a
review of the signs and symptoms of
depression, you may refer to page 4. If there’s
anything which isn’t mentioned, please refer to
your mental health professional.
Some patients say, “I have this and that symptoms… but I don’t have
ALL the symptoms. So, I don’t think I have depression.” This may
NOT be true. You don’t need to have ALL the symptoms for a
diagnosis of depression. Kindly refer to page 4 for the minimal
number of symptoms and criteria required.
2. Why do I get depression?
The factors contributing to depression are often multiple
and different in different individuals (page 35). After an
assessment, your mental health professional should be able to tell
you the factors that contribute to your depression. Pay attention to
those modifiable factors, (e.g. alcohol abuse) as removing the factor
will be part of your depression treatment plan.
Some patients say, “I don’t have depression, I only have financial
problems.” Bear in mind that from a medical/psychological
perspective, a diagnosis of ‘depression’ is generally made
irrespective of the stressors (as long as the signs/symptoms and
criteria on page 4 are fulfilled and significantly interfering with a
3. Can I not take medicine?
Antidepressants are only one of the treatment methods for
depression. Whether you’ll need antidepressant treatment depends
on several factors:
• The severity of the depression
• Attitude towards medicines
• Are you sensitive to medicine side effects?
• Are you willing to come regularly for talk therapies?
• Are you willing to modify your lifestyle?
Generally speaking, it’s possible to treat mild depression (ONLY
mild) without the use of antidepressant – in fact, it’s a better option.
But one has to be willing to work hard on the non-medication
methods (page 122). To some, it may be easier to take medicines
than focusing on other methods that require more effort – it’s their
choice and we should respect the choice. I usually use both
methods; antidepressants for short term and the rest
(counseling/psychotherapy and non-medication methods) for long
term and relapse prevention.
Often in a Malaysian setting, by the time people are willing to seek
help from a psychiatrist; the depression is usually rather severe –
Antidepressants and other medicines are needed for stabilization
while working on other methods. So, if
you wish to recover fast from
depression without the use of
medicines - seek help early.
4. I don’t want to be addicted to medicine. I want to do be able
to do something besides taking medicine.
Antidepressants are NOT sleeping pills or tranquilizers
(which excessive usage can easily cause addiction). Antidepressants
are extremely unlikely to be addictive. Besides taking
antidepressants, there are many other things that you need to do
for recovery (page 122). So, you are not relying only on
antidepressants. In fact,
antidepressants take a minimum of 2-3 weeks to work. So, even if
you are on antidepressants, there are many things that you need to
do now, while waiting for the antidepressant to work.
5. Will I get side effects?
If you take antidepressants according to
your doctor’s recommendations with proper
monitoring, you’ll be SAFE. You will NOT get brain
damage, kidney failure, liver failure, heart attack. If you still worry
(understandable), we can do regular medical check-ups and blood
tests to ensure your physical fitness. With this arrangement, you’re
very likely to be healthier than those in the general population
(who may not be so health conscious).
Some may get mild side-effects like nausea, gastric problems,
headaches, sweating and giddiness, etc. It’s usually transient, not
dangerous and easily resolved - there’s no need to be overly
worried. If you have concerns over any particular side effect (which
is perfectly understandable, e.g. weight gain, dry mouth, sedation),
feel free to discuss with your psychiatrist for options: dose
reduction, change the type of antidepressant, reduce the number of
medicines, or even a trial of non-medication treatment plan.
If your psychiatrist is not helpful or you somehow don’t click well
with your psychiatrist, I suggest that you consult another
psychiatrist (page 23). It’s OK – be kind to yourself, you deserve
It’s not helpful to read on the internet of possible side-effects and,
scare yourself unnecessarily, and stop the medicines without any
discussion with your psychiatrist. Sometimes, the reported ‘sideeffects’
(e.g. tiredness, poor concentration/memory, low libido)
could actually be part of the depression, instead of true side-effects
of antidepressants. A better way is again to discuss with your
It’s important to understand the side effects
of antidepressants in proper perspective;
together with their benefits. Sometimes the
benefits of antidepressants (e.g. able to work and prevent a severe
relapse with suicidal tendencies) outweigh the side-effects (e.g.
weight gain). In this situation, it’s better to continue with the
antidepressant and overcome the weight gain by dietary and
In summary, taken and adjusted correctly, antidepressants can give
a lot of BENEFITS – not side-effects.
6. How long do I need to take the medicine?
Antidepressants should be taken for at least
6 months. To be more specific, it should be continued
for at least 6 months from the time that you are well
(NOT from the time you first started taking it).
When stopping, it should be done gradually
especially if you are on a high dose of antidepressants. If you are
thinking of taking antidepressants for only a few days or weeks, you
might as well forget about it – it won’t work. Antidepressants
shouldn’t be taken like panadol (only when it’s necessary). In fact, it
takes about 2-3 weeks before they work.
Besides antidepressants, your psychiatrist may sometimes
prescribe you another medicine of the benzodiazepine group, e.g.
alprazolam (xanax), midazolam (dormicum), diazepam (valium),
clonazepam (rivotril). They work immediately for sleep and
relaxation; hence also known as sleeping pills or tranquilizers.
Their advantage is immediate effect (while waiting for
antidepressants to work); the disadvantage is risk of dependence or
addiction when taken for long periods. So, it should not be
continued for more than 2-3 weeks. If you are taking it for a longer
period, ensure that your psychiatrist is aware of it and monitoring
Before you stop your antidepressant, it’s important that you
strengthen your non-medication methods (e.g. changing pessimistic
attitude and passive lifestyle) to cope with depression. Or else, you
may easily get a relapse upon stopping the antidepressant. It’s also
not helpful trying to stop medicine during stressful periods, e.g.
working in a new company – it’s more likely to be unsuccessful.
Some may need to take antidepressants for a longer time, e.g. 3, 5
years or even life long, depending on situations, e.g. a person with
repeated suicidal attempts, several hospitalization, unresolved
stressors, and poor family support. The good news is
antidepressants are generally safe even if taken for a long period of
time, if taken correctly with monitoring.
7. What else can I do besides taking medicine?
There are many things that you can do as part of self-care
and self-kindness in coping with depression:
• 1. Try to read and understand more about depression.
• 2. Exercise, e.g. brisk walking for at least 30 minutes
• 3. Exposure to sunlight – morning is a good time.
• 4. Engage in more activities especially
relaxing, fun and meaningful activities.
• 5. Balanced and healthy diet (page 123)
• 6. Avoid smoking, alcohol and illicit
drugs, e.g. cannabis, amphetamine.
• 7. Yoga, meditation, qigong, and
relaxation exercises (page 130)
• 8. Keep a diary to review the happy or pleasant things in life.
• 9. Talk to someone trusted to share your feelings or join a
depression support group.
• 10. Prayer for strength and hope.
8. Are there any food restriction?
In dealing with depression, we need healthy thoughts for the
mind, and healthy food for the body. Nutrients are important for
optimal brain and body functions. Don’t forget, depression also
affects the brain and body – hence the role of proper nutrition.
• Food rich in omega-3 fatty acids, e.g. fish, soybean, canola oil
• Food rich in tryptophan, e.g. milk, sunflower & sesame seed,
• Salty food
• Fatty food
• Processed food
Coffee is unhelpful if you have sleep difficulties, anxiety symptoms
or medical problems, e.g. gastric problem. However, moderate
consumption during daytime may be helpful to boost mood and
energy level for activities, e.g. exercise, social functions, and
voluntary service – that will further improve mood and energy.
Multivitamin supplementation (especially folic acids and vitamin
B’s) may also be helpful, particularly for those who are not eating
well and has various medical problems.
9. How am I going to tell my family members?
It can be tiring and frustrating trying to answer all the
confusion related to depression. To make it easier, you may request
your psychiatrist to break the news for you (it’s a kind thing to do
for yourself). Your psychiatrist may also give them a booklet or
pamphlet on depression to read. These can clarify any doubts that
they have on depression, e.g. on how to support you – the do’s and
don’ts. Of course, you can also pass this book to them. It will be
helpful if friends and family can be around during consultation.
They can help to clarify doubts and remember the doctor’s advice -
depression often affects memory and concentration – be nice to
10. Can I recover?
I have enough patients who recover – enough
to motivate me to remain in this meaningful
profession as a psychiatrist. More than 80% of my
patients with depression are well enough to move on with their
lives. Only some don’t really get well and need to be on long-term
medication. This is usually due to various unfavorable factors: long
duration of untreated illness, poor compliance with medicines and
therapy, abusing substance (e.g. cannabis, alcohol), poor social
support, unconsciously wanting to remain sick for attention, having
more than one psychiatric illness. So, if you wish to recover quickly,
seek help early and follow the treatment plan – you’re already
halfway to recovery.
Your chances of full recovery also depend on whether you follow
the treatment plan, which generally consists of four parts (just like
a car that needs four wheels to move):
2. Family support
3. Counseling therapy
4. Healthy lifestyle
For those with severe depression, the two most essential
components in the early treatment phase are medicines (page 40 &
116) and family support (page 107 & 147). The reason is that the
person is often too sick for counseling and lifestyle changes. Let the
medicines and your family support you first. When you’re stronger,
then it’s time for you to be more proactive in your treatment –
counseling (page 32) and a healthy lifestyle (page 122, 123, 128,
11. When will I recover?
This depends on various factors, e.g. the severity of your
depression. There’re also individual differences in how fast a
person responds to treatment. Generally speaking, it will take
several weeks to see significant improvement in mood and
behavior – definitely not in a few days – be patient. I suggest that
you should be mentally prepared to spend at least 3-6 months for a
complete treatment plan. Take this positively, like signing up for a
certificate course on depression – enjoy your
learning. You’ll be a better person after this.
12. How do I prevent a relapse?
If you are on antidepressants, please don’t stop too early
(it should be continued for at least 6 months after you are well). Try
to maintain whatever you practiced that brought you out of
depression and kept you well (e.g. all the non-medication
recommendations in this book). Just like physical health, mental
health doesn’t come free – we need to put in effort to maintain
Relapse often occurs with a unique set of symptoms specific to an
individual. Some people call this, ‘signature symptoms’ (e.g. poor
sleep, constipation, bad-tempered). Knowing them enables early
effort (e.g. relaxing more, go for counseling, resume medications) to
prevent a full-blown relapse.
13. Can I work? Can I have a family, etc?
When you are well, you can do whatever you want in life (as
long as you don’t harm yourself or others). Many very successful
people in life (e.g. politicians, scientists, musicians, doctors,
lecturers, etc) have gone through depression (page 27). Some
people also reported that their lives became even better after going
14. Will my medical records be confidential?
Yes, it’s private and confidential, except during emergencies,
e.g. when you are actively suicidal (we may need to get help from
your trusted family or friend to support you). We will not reveal
your clinical information to your employer, friends, relatives, etc.
without your consent. Don’t worry, we are here to help you – not
give you more problems.
15. How can I sleep better without sleeping pills?
The following ‘sleep hygiene’
practices can help you to have better sleep:
• 1. Avoid caffeine (coffee, tea, Chinese tea,
dark chocolate, Coca-Cola) in the evening.
Keep away from cigarettes and alcohol.
• 2. Consume hot milk or milk-based
products before sleep, e.g. cheese. Avoid heavy dinner or supper.
• 3. Conducive environment for sleep, e.g. quiet, dark, appropriate
• 4. Do physical exercise during day time (avoid within four hours
before sleep), and relaxation exercises (page 130) before sleep.
• 5. Try to sleep and wake up around the same time every day.
Avoid nap during daytime; if you’re really tired, close the eyes and
rest for awhile on a chair – don’t fall into deep sleep.
• 6. If you can’t sleep, don’t lie in bed or stare at the clock. Get up
and do something boring outside the bedroom. When you feel tired,
try to sleep again.
• 7. Bed should only be used for 2 things; sleep and sex – no other
activities, e.g. playing computer games.
• 8. Have sleep rituals to wind down, e.g. brush your teeth, say
‘good night,’ change into pajamas, read inspirational quotes. Try to
avoid exciting activities, e.g. e-chat on Facebook.
• 9. If you have a lot of worries, write down your ‘to-do-list’ or
‘worry-list’ before you sleep – to be continued tomorrow when you
• 10. Review all the pleasant things that have happened
throughout the day – smile and have sweet dreams.
Each night, when I go to sleep, I die.
And the next morning, when I wake up, I am reborn.
- Mahatma Gandhi -
16. I’m very restless. What can I do?
Sometimes the cure for
restlessness is just rest
- Colleen Wainwright -
Restlessness and feeling nervous or anxious often come
together with depression. You’ll feel better as your treatment
progresses. The following are some ways for you to practice
relaxation and cope with restlessness:
• 1. Learn to elicit ‘Relaxation Response (RR).’ This is a term
coined by Professor Dr. Herbert Benson (Harvard physician),
referring to a relaxed state of mind and body. All of us are
capable of eliciting RR – here’s the 4-step method:
n Find a quiet environment.
n Sit or lie in a comfortable position.
n Place your attention on any ‘mental device.’ This can be
sound (e.g. wind chime), word (e.g. “Relax”), phrase (e.g. “All
is well…”), prayer (e.g. chanting), fixed gaze (e.g. candle
flame), mental image (e.g. fresh flower), breathing or even
movement (e.g. walking). This helps to restrain the mind
from wandering restlessly.
n Adopt a passive attitude, i.e. don’t worry about the outcome
and repeatedly return your attention to the ‘mental device.’
You may practice this for 10-15 minutes at least twice a day. It’s
very helpful for relaxation – antidote for restlessness.
• 2. Practice ‘Four Pleasant States Imagery’ and other audio guided
relaxation exercises from the Mindful-Gym CD.
• 3. Practice ‘Mindful Body Stretching.’
This is very good for relaxing the muscles and relieving body
aches. A body massage is also a good option.
• 4. Physical exercise, (e.g. brisk walking, badminton), can help to
lessen nervous energy. It also helps the brain to produce
endorphins which helps to calm the mind and body.
• 5. Express your worries and concerns that can generate restless
feeling (either to someone or in your diary). Emotional
ventilation will make you feel calmer. You can also pray or
communicate with God or other divine beings for hope and
strength to move on with life.
“God, please grant me the Serenity
to accept the things that I cannot change,
Courage to change the things that I can change,
and the Wisdom to know the difference”
- Serenity Prayer by Reinhold Niebuhr -
• 6. If it’s severe, a low dose of benzodiazepine, e.g. xanax
(alprazolam) for short-term can be very helpful. Discuss with
your psychiatrist. This should always be combined with the
above methods as excessive use of benzodiazepine can lead to
17. I’m very confused and indecisive – should I…?
Don’t make hasty decisions (especially serious
decisions, e.g. divorce) when you are not well.
Depression can distort your perception of reality
and lead to regretful decisions. It’s wiser and
kinder to postpone your decision (e.g. whether to
quit studying in a university) until the mind is clearer. Your
psychiatrist can help you to write a letter to your university (or
other authorities), indicating your illness and your need to defer
When your mind is stronger and clearer, you may use the ‘I.D.E.A.L.’
guide to help you in decision-making or problem-solving:
I – Identify the issue, problem or challenge, e.g. should I resume
work immediately or rest first (assuming that you have got a job
D – Describe or review the possible options:
• Start work immediately.
• Rest for another 2 weeks and then start work.
• Rest for another 2 weeks and decide later.
E – Evaluate the pros and cons for each option.
• E.g. Start work immediately
- Pros: Good, my savings are running out.
- Cons: I need more time to figure out my career direction.
You can get help from others for this evaluation process – be kind
to yourself – ask for help.
A – Action plan for the selected option based on pros/ and cons.
• E.g. Rest for another two weeks and start work.
- I need to call up the company to see whether they are ok if I
start work after 2 weeks.
L – Learn from whatever decision you have made – the good and
the bad, e.g. I’m glad that I didn’t accept the job offer hastily. I
sought advice from my friends and discovered that there are other
better job offers.
A problem is something with a solution.
If there is no solution, then there is no problem
- Harold Macmilan -
18. How can I change my negative thoughts?
Cartoon by Robin Hall
Congratulations for asking this important question. When
you’re aware of and wish to change your negative thoughts, it’s
already a milestone in your recovery process. Changing negative
thoughts is important as thoughts have the power to generate
feelings and influence behavior; feelings and behavior will in turn
affect thoughts. So, how can we skillfully change our thoughts?
First of all, be aware that negative thoughts have certain
recognizable patterns (cognitive errors/distortions). According to
cognitive psychologists, these are the 10 patterns:
Fortune Telling or
Expecting a bad or the worst outcome
e.g. I will definitely fail my exam; he will
definitely reject me; there is no more
future; I won’t be able to do it; what if
this/that terrible thing happens?!;
“sure die one,” “ but it won’t work…”
Making generalized conclusion about
e.g. Men never listen; women always
talk a lot; local products are bad;
government doctors are useless; I’m
useless/a failure; he’s a drug addict; I’m
schizophrenic; she’s a coward…
Black & White
Thinking which is either all or none.
e.g. If I’m not successful, I must be a
failure; If he doesn’t call me again, he’s a
bad friend; If I don’t win, I’m a loser…
or Tunnel Vision
Focusing and amplifying the terrible
things in life.
e.g. I had an accident again; horrible
things always happen to me; the internet
is not working; the maid has run away;
my boss is terrible; the phone bill is not
Ignoring the good things in life.
e.g. I’m not a good mother, those are just
my basic responsibilities; I passed my
driving test because the examiner was
Excessively finding fault with ourselves
e.g. It’s all my fault, if not because of me,
he wouldn’t have died; I told you, I’ll ruin
it; he’s the one who made me suffer; it’s all
her fault…he/she should…!!!
7 Unfair comparison
Comparing with others in a way that is
unfair and undermines ourselves.
e.g. My consultant is really good…I’m
stupid, why can’t I get it right?; I used to
be very good at it before I was sick…
Making decisions and actions based on
our unpleasant feelings.
e.g. I felt scared during the presentation,
I must have done badly; If I’m angry,
someone is to be blamed; I’m tired, I
should rest more; I‘m scared, I should
Making assumptions about others’
thoughts and feelings.
e.g. She doesn’t like me; he thinks that
I’m fat; he’s cheating on me; they are
laughing at me; he’s not saying it but I
Rigid in thinking & expecting everything
to be ideal.
e.g. Everyone must like me; I must
always make people happy; everything
should be under control; you should
listen to me; I must know the cause…why
like this/that…why, why, why?!
Adapted from the work of Aaron Beck, Albert Ellis & David Clarke.
Once you’re pretty good at ‘catching’ the negative thought patterns
(like having good computer anti-viral software), you can now learn
to change them. Before that, it’s important to relate to the thoughts
with a right attitude - kindness. Try to imagine dealing with them,
as though you’re pacifying a crying baby – be gentle. Or else, you’ll
end up hating yourself more, “Oh Shit! I have these stupid thoughts
again…I’m really horrible,” This perpetuates depression as thoughts
often become more ‘sticky’ (emotionally charged and increased in
number), when we relate to them with frustration.
I SEE, IT’S OK….
I STILL LOVE YOU….
WE CAN ALWAYS
Be kind and gentle with negative thoughts.
Remember, even people who aren’t depressed have these negative
thoughts; only less in amount, frequency and credibility. Let’s look
at the ways to transform negative thoughts. I’m introducing the
word ‘transform,’ replacing ‘change’ to highlight a kinder and
gentler attitude in relating to thoughts.
Five ways to transform thoughts:
1. What is the evidence for and against what I’m thinking? Is there
any alternative or more likely explanation?
2. What thinking errors/distortion may I be having? How can I
think in a more helpful way? How would I advice a friend or child
who is in a similar situation?
3. When you find yourself worrying too
much, assure yourself, “What can the worst
be? Is it that terrible? What can I do about it
4. When the reality is painful and cannot be
changed, try to reflect, “Am I alone? Could it be
worse? What have I learned from it?”
5. Thoughts may not be facts. Allow them to come and go, like
clouds or birds passing through the sky. Practice relaxation
(page 130) to calm the mind first; re-examine the thoughts later
before believing or acting on them.
These 5 ways of self-questioning and self-reflection (which is based
on cognitive behavior therapy - CBT) will help us to effectively
transform our thoughts, feelings and behavior – become more
positive and helpful.
Last but not least, again, be kind to yourself – you can always get
help from your friends in this kind of mind-transforming exercise.
Watch your thoughts, for they become words…
Watch your words, for they become actions…
Watch your actions, for they become habits…
Watch your habits, for they become character…
Watch your character, for it becomes your destiny
- Frank Outlaw -
19. Are there different types of depression?
Yes, there are different types of depression.
Understanding them is useful as the treatment plan
(especially medication) is different. Here are some
of the common types of depression:
• Major Depression: This is the most common type of
depression seen in clinical practice, which has been described in
Part 1 of this book. ‘Major’ here doesn’t mean a severe type of
‘major depression.’ It means depression as an illness (more than the
occasional sadness). Major depression is further divided into mild,
moderate and severe, depending on the number of symptoms and
degree of impairment of function.
• Major Depression with psychosis: This is a severe form of
major depression. Besides the usual depressive symptoms, it also
has psychotic features - hallucinations (e.g. hearing voices, “You
should kill yourself”), delusions (e.g. false belief that the organs in
the body have rotted). Besides antidepressants, treatment will
include antipsychotic, e.g. risperidone.
• Depression of Bipolar Disorder: In this type of depression,
mood swings extremely between depression and mania (excessive
happiness or irritability, very talkative, over friendly, reduced need
for sleep, increased libido, spending spree, a lot of plans and
activities). Treatment will include antipsychotic (e.g. risperidone)
and mood stabilizer (e.g. lithium or epilim).
• Post-partum Depression: This is a form of major
depression that occurs in 10-20% of mothers a few days or months
after childbirth. This should be taken seriously as there’s risk of
harming the baby. It’s different from postpartum blues, i.e. a
passing state of sadness which occurs in about half of mothers after
• Dysthymia: This term is used to refer to low mood which is
long-standing (more than 2 years), but low grade (depressive
symptoms are not as many and severe as in major depression).
Stressful events (e.g. unemployment) may trigger a major
depression in those with underlying dysthymia – this is also known
as ‘double depression.’ Treatment for dysthymia is more of
counseling and psychotherapy; antidepressants have only a minor
• Adjustment Disorder with Depressed Mood: In this kind
of depression, you feel hopeless and sadder than would be expected
after a stressful event. Many types of events can cause stress, such
as changing schools or jobs, divorce, the birth of a child, death of a
loved one, a severe illness). You usually feel depressed starting
within three months after the event and get better in six months or
less. The depression is less severe compared to Major Depression
and shorter in duration compared to Dysthymia.
• Substance/Medication-Induced Depressive Disorder:
This is a kind of depression that is caused by using alcohol, drugs
(e.g. opioid, amphetamine, cannabis, cocaine) or medications (e.g.
steroid, chemotherapy drugs).
20. How do I find meaning and purpose in life?
I don’t mind to suffer
as long as it’s for a good purpose
– Dr. Victor E. Frankl –
Having meaning and purpose in life energizes
us, and it’s important for preventing depression relapse. Life is like
riding a bicycle; we got to keep on cycling, to move forward. Or else,
the bicycle will stop and fall to the side. Similarly, we got to move
on meaningfully in life. Otherwise, we can easily fall - back into
Here are some ways to help us to find meaning and purpose in life:
1. Think of or read about someone who inspires you, e.g. Mother
Teresa. Maybe you should try doing something like that.
2. Recall your childhood dreams, e.g. becoming an artist. Maybe it’s
time to revisit your dream.
3. Try to do something new and meet new people in life, e.g. new
hobbies, new hairstyle, join a book sharing club, go for a holiday
in Tibet. You may discover new experiences and purpose in life.
4. Try to do something routine in different ways – be creative, e.g.
different food for breakfast, taking a different road to work,
teaching using new methods. “The real voyage of discovery
consists not in seeking new lands but seeing with new eyes.” -
5. Read about religion, spirituality and philosophy. It broadens the
way we think about life.
6. Consider following your heart; not what society says you should
or shouldn’t do, e.g. a man becoming a home maker, a medical
graduate becoming a chef.
7. Know your signature strengths, (e.g. good listening skill, like to
help others, reflective), and use them more to spice up your life,
e.g. be a counselor, professionally and in voluntary service.
Of course, when the bicycle stops, we can always
stretch our legs to the ground to prevent the
bicycle from falling. This is like pausing for awhile
in life to find new meanings and purpose. It’s OK, but don’t pause
too long - we got to move on. Often, it’s in the process of moving on
that we discover new directions.
Enjoy your new journey in life
What should I say to support a person
Effective treatment of depression includes good social
support. Despite with good intention, we sometimes say things that
are unhelpful or may worsen a person's depression. Below are 10
things not helpful to say to them and what you can try to say
(1) Don’t be lazy; you’re wasting your time!
WHY NOT? Feeling tired all the time and loss of interest in activities
are common symptoms of depression. "Lazy" implies that the
person is having an attitude problem or is making it up.
Say: It must be very frustrating feeling tired and moody
all the time. You won’t be able to do things for yourself
and others. That must be a terrible feeling.
(2) Nothing is impossible; think positive and be strong.
WHY NOT? Having depression is not a sign of weakness. Depression
is an illness, not a weakness. Many great people in the world had
depression, e.g. Winston Churchill (British Prime Minister), J.K.
Rowling (author of Harry Potter), and Jim Carrey (actor and
Say: I'm sure it's tough going through all the difficulties.
Maybe you’re too strong for too long, and it's time for
(3) Be grateful; many people have a worse experience.
WHY NOT? This response may be invalidating or disrespecting the
emotional pain of a depressed person. They may also think, "Yes,
I'm so ungrateful and useless. People can cope and move on, but I
can't. I’m a burden to others."
Say: It’s unfortunate that so many bad things had
happened to you. Thank you for sharing your
experience. We’ll see what we can do to help you cope
with the challenges.
(4) It’s a result of your bad karma or sin; do more good and let
WHY NOT? We may induce or worsen guilt and shame feeling
which are common in depression. It may also trigger thoughts of
worthlessness, "I'm not good enough.”
Say: Bad things sometimes do happen in life and nobody
knows why. It happened to me/ my relatives/ my
friends too (share your experience). It's painful. Let’s
try to move on together.
(5) How long more do you want to be depressed?
WHY NOT? Being depressed is not a deliberate choice. People with
depression are often victims of abuse (e.g. bullied in school) and
discrimination (deprived of a job opportunity).
Say: Wow, you’ve been struggling for so long. It must be
challenging to go through this alone. Well done for not
giving up. Let me know if there’s anything that I can
support. We care for you.
(6) You think you’re the only one with problems?
WHY NOT? Yes, all of us have problems. But we have different
strength and weakness in coping with problems. It’s not helpful to
judge people’s ability to cope.
Say: I also have issues (share your experience). We have
different strength and weakness. We can help each
other to solve issues. Let me know if you wish to share
yours. Maybe we can discover a solution together.
(7) Stop pretending to be depressed!
WHY NOT? Nobody chooses or pretends to have cancer. The same
applies to depression, a medical condition with neurobiological
changes in the brain and body. A small number of people with
depression might have personality issues (e.g. using the illness to
avoid responsibilities or seek attention). Bear in mind that they're
the minorities. Most of them want to recover from depression but
are helpless in battling the disease.
Say: Perhaps you don’t have to try so hard pretending to
be happy. Sometimes, it’s OK not to be fine. I know
you've tried your best. It’s a horrible illness.
(8) You must be too free and thinking too much. Why don’t you
do something useful, e.g. exercise?
WHY NOT? Depression is not necessarily caused by having too
much of time, doing nothing, or thinking negatively. A person with
depressive mood has biochemical abnormalities in the brain and
body that cause them to have no strength to work on things. Just as
a person with knee injury can’t walk, a person with ‘mood injury’
(depression) can’t work.
Say: Feeling restless and like you’re wasting time is an
awful experience. Let’s start with doing the easy tasks.
(9) Never have suicidal thought. Your family will be hurt if you
die of suicide.
WHY NOT? Nobody wants to end their lives prematurely. People
with depression want to end their pain; not their lives. Having
suicidal thought is not a choice. It’s the consequence of the pain of
depression. Don’t add more pain by making them feel sorry for
having suicidal thoughts.
Say: Depression is painful, and it’s understandable that
you wish to end the pain. Depression is treatable! Let’s
seek advice from mental health professionals for
proper treatment of the pain. I know this good doctor personally/ I
heard of this excellent doctor. Would you like me to help you to get
(10) Your depressive mood will become a form of negative
energy to others.
WHY NOT? A depressed person knows very well that moodiness
and negative thoughts are unhealthy (just like a person with
chickenpox infection knows that it’s contagious). When we say the
above, they may feel guilty for emotionally disturbing the people
Say: It’s natural for a person suffering from depression to
feel moody. I know you don’t wish to be like that. No
worries and don’t feel bad as people wouldn’t blame
you if they have a proper understanding of depression. Let’s move
on. You have my support.
Speak only if it improves upon the Silence
- Mahatma Gandhi -
Forum for understanding depression
In order to highlight the value of kindness in coping with
depression, we organized a forum entitled, “Understanding
Depression with Kindness,” under Kuala Lumpur Buddhist Mental
Health Association. It was held at Utama Bodhi Vihara (Bandar
Utama) and well-attended by more than a hundred participants.
Moderated by Ms. Low Mi Yen (clinical psychologist), Venerable
Kumara (Buddhist monk and meditation teacher) spoke on
depression and kindness from a Buddhist perspective. The forum
was very inspiring and we had 3 special guests (Jasmine, Yin Hun
and Chwee Fang) who courageously shared their experiences in
coping with depression. Below is a brief report on the forum by Sis.
Forum for understanding depression with kindness
6 th July, 2012 - I attended a special forum organized by KL
Buddhist Mental Health Association (BMHA) with the theme,
"Understanding Depression with Kindness." It was a very
informative and inspiring forum. Dr. Phang Cheng Kar (psychiatrist
& president of BMHA) explained that depression is more than just
occasional low moods - it is a serious psychological illness! Among
the main common symptoms of depression are persistent feelings
of sadness with crying spells, tiredness, and loss of interest in doing
things. More serious symptoms include suicidal thoughts or
Dr. Phang stressed that just like physical illness,
patients who have depression can use
antidepressant medication to treat their depression
effectively. Antidepressants are non-addictive and
safe. However, effective treatment of depression should be
individualized and include non-medication strategies. Thirty
minutes of daily exposure to sunlight can brighten up mood.
Regular exercise, (e.g. brisk walking at least three times a week, 30
minutes each time) stimulates the production of feel-good
chemicals in the brain. Healthy eating habits with balanced
nutrition are important. Moderate coffee consumption (not more
than two to three cups a day) may be helpful to boost energy
(provided that you do not have anxiety symptoms, are able to
tolerate coffee, and do not take it at night). Food rich in omega fatty
acids, e.g. fish, soy milk, canola oil are nourishing for the depressive
brain. Counseling and more specialized psychotherapy, (e.g.
cognitive behavior therapy - CBT) are also helpful. Last but not
least, friends and family support is extremely important.
Dr. Phang ended his sharing by giving a meaningful quote, "If you
have depression, it doesn’t mean that you are weak - it probably
means that you’ve been strong for too long."
It is crucial for patients with depression to 'ACCEPT' their illness
with kindness and seek professional help. This message was echoed
by all the three special guests, who had experienced the dark
moments of depression, and shared their experience in the forum.
Venerable Kumara (Buddhist monk and
meditation teacher from Sasanarakkha
Buddhist Sanctuary) explained that, from
a Buddhist perspective, the root cause of
depression is mental defilements like
craving and aversion. In this state, the wholesome qualities of the
mind, such as confidence, energy and wisdom, are weak. Hence, it is
very important to increase the wholesome qualities. In line with
this, BMHA has developed "3G-Gratitude," which is a card game for
cultivating these beautiful qualities.
The moderator, Ms. Low Mi Yen (clinical psychologist) then invited
three specials guests, all sisters who had gone through depression
to share on how they discovered their illness, coped with it, with
support from their friends and family.
The first Sister (Jasmine) shared that she started off with mood
swings, crying most of the time and having suicidal thoughts. She
was referred by her general practitioner to a psychiatrist for
further assessment. She was given questionnaires to answer and
went through a thorough interview. Both 'tests' showed that she
The second Sister (Yin Hun) had a negative personality since young.
She had a few times subjected herself to self-injury. But due to a
lack of awareness, her family members didn’t send her for
treatment. However in 2004, when she had a very strong urge to
end her life, she was finally admitted to a psychiatric ward for
treatment. Even though she realized that she had had repeated low
moods since she was 15 years old, she never sought professional
help. She tried to cope by reading motivational and religious books.
However all was in vain. "Please get professional help early!"
emphasized the Sister Yin Hun who is on treatment for Bipolar
Even now and then, she has unpleasant thoughts and feelings. She
is aware of them and reminds herself, "I must keep myself busy
with work, e.g. jogging and charity work. The bad feeling will come
and go eventually." Another Sister said that after learning
techniques in MINDFULGym (a local mindfulness-based stress
reduction and wellness program), she is more mindful of her
thoughts, is able to think positively, and response wisely to
problems in life. MINDFULGym is a mindfulness-based stress
reduction and wellness program organized by BMHA.
As for the last Sister, it began with poor concentration in doing
things, loss of interest in activities that she used to like, excessive
fear without reasons, reluctance to talk, sad and moody feelings.
Ms. Mi Yen explained that a lot of people cannot
accept the fact that they have depression. This is
worsened by social stigma and wrong views
about depression. Kindness from friends and
family members is therapeutic and it facilitates acceptance. We also
need to understand that acceptance is not an on-off switch - it is a
gradual process. People may need to go through stages of shock or
disbelieve, anger, and blame before final acceptance. Venerable
Kumara added a witty remark to that, "If you cannot accept, at least
accept that you cannot accept."
When asked how they wish they can be supported by their friends
and family, they said, "a listening ear and smiling face." A physical
touch with care, e.g. holding hands, hugging, a pat on the shoulder
also mean a lot to them.
In short, kindness, friendship, listening ears are all very meaningful
to people suffering with depression; be kind to them and slowly
guide them out from the darkness of depression.
"People surrounding them must be kind and understanding to
them. They don’t choose to be like that, e.g. lack of energy, slow in
thinking, not motivated, not productive. The worst thing to tell a
person with depression is, 'Why are you so lazy!?" Why do you have
to do that to me?! (ignoring the fact that 'laziness' is part and parcel
of the illness)," reminded Dr. Phang, championing the voice of his
A member of the audience shared her own experience, "Loving
ourselves doesn’t mean that we are selfish. We must love ourselves
first; then we are able to love others better. Ms. Mi Yen affirmed her
view by adding a comment by Ajahn Brahmavamso (Buddhist
meditation monk), "When we have worked too hard and are tired of
holding a bottle for so long, we should put it down, even for a few
minutes; it is always easier when we take it up again - be kind to
Another asked if a patient with depression is suited to practice
meditation. Dr. Phang said meditation is only suitable for those with
mild depression. For those with severe depression (e.g. suicidal,
hearing voices, extremely restless), meditation is not suitable;
stabilization with medications and family support are more
important at this phase of the illness. Venerable Kumara shared
that for people with mental illness, such as depression, it is better
to meditate while walking, as it is easier to practice awareness that
way. They can also do that in daily activities, e.g. sweeping the floor,
exercising, washing. It is important that we do not use meditation
as an avoidance strategy to run away from life’s problems, stressed
Yet another asked if depression is genetically inherited. Dr Phang
said, "Yes," but it is not an unavoidable condition. That is why some
people with a family history of depression do not get it. There are
many things that we can do to influence gene expression and
prevent depression. Related to that, someone asked Venerable
Kumara whether depression is due to past kamma? "If you are
referring to something bad you did in the past life, I honestly don’t
know. What we experience now is a result of past conditions. We
can't change that. What's important though is how we relate to
what is happening now. That's the new kamma that would make all
the difference. For example, if we regard depression with kindness,
then that's good kamma; that is a condition for the healing of
depression," commented Venerable Kumara.
It is so inspiring to see several members of the audience openly
sharing their journey through depression - they are so courageous!
By the end of the forum, the shadows of depression were
transformed into a melody of kindness, hope and wisdom - it is
truly wonderful. I am so grateful for the opportunity to attend this
forum. Thank you.
Reported by Sis. Chew Poh.
Inspirational sayings by the forum speakers:
Things may not get better,
but I can always learn to cope better.
- Yin Hun –
Acceptance isn’t pleasant; it’s acknowledging
what’s happening – that’s kindness.
- Venerable Kumara –
We’re not alone in coping with depression.
There’s a light at the end of the tunnel - don’t give up.
- Jasmine –
Acceptance isn’t an on-off switch – it’s a gradual process.
- Low Mi Yen –
I’m grateful to depression – it makes a better me.
- Chwee Fang -
Having depression doesn’t mean that you are weak;
it probably means that you have been strong for too long.
- Dr. Phang Cheng Kar –
When depression is recurrent –
Mindfulness-based Cognitive Therapy
Depression can be recurrent (happening repeatedly). Each
episode of depression increases a person’s chances of another
episode by about 15%. Therefore, the more episodes of depression
you have, the more likely you’ll get another relapse. Mental health
professionals are working hard to find
to deal with recurrent depression.
One of the promising ways is through Mindfulness-based Cognitive
Therapy (MBCT), which was developed by Professor Dr. Mark
Williams and his team at the Oxford University. MBCT is based on
ancient wisdom of mindfulness (originated from contemplative
traditions especially Buddhism) and state-of-the-art research in
cognitive behavior therapy (CBT). MBCT has been shown to reduce
the risk of relapse by half in those who have had 3 or more episodes
of depression. This is an outline of some principles and exercises
used in MBCT.
1. Paying attention to the here-and-now: It means trying to give
full attention to whatever that we are doing. This is important as
when the mind is not anchored in the present-moment experience,
it tends automatically to ruminate about the past (guilt content) or
future (worrying content) – which is vulnerable to depression
relapse. Strategies to cultivate here-and-now awareness include:
a) Labeling – mentally naming and giving full attention to our
activities, e.g. ‘typing,’ ‘eating,’ ‘walking,’ ‘thinking,’ ‘talking,’
‘sweeping,’ ‘checking e-mails.’
b) Sensing – giving full attention to our sensory experience, e.g.
seeing, hearing, smelling, tasting, touching.
c) Beginner’s mind – experiencing life with an attitude of a beginner,
as if seeing things through fresh lenses and thinking of it as once-ina-lifetime
experience, e.g. eating chocolate slowly, with full
attention and as though tasting it for the first time.
2. Mindful walking: It involves paying full attention to the process
of walking: 1. Labeling the movements of the legs,
“Left…right…left…right,’ and 2. Noting the sensations around the
feet and other parts of the body (e.g. wind brushing against the
skin). Besides benefiting physical fitness, this is very helpful for
overcoming bodily restlessness and to slowly calm the mind.
3. Breath as emotional anchor: Mindfulness of breathing involves
repeatedly bringing gentle awareness to our breathing, “Breathing
in, I’m aware than I’m breathing in. Breathing out, I’m aware that
I’m breathing out.” This trains the mind to be less scattered and
more present or calm, which is very useful during emotional storms
Breathing is a useful mindfulness ‘tool’ as it’s with us wherever we
go (we can’t go anywhere without it).
4. Body scan and awareness: It involves repeatedly bringing
gentle awareness to the physical sensations (e.g. heat, tightness,
tiredness, pain) in different parts of the body (e.g. chest, neck, head,
hands, legs, stomach, back), and noting them with kindness,
acceptance, and a sense of curiosity (beginner’s mind). This is
useful in several ways: 1. It helps to disentangle ourselves from our
thoughts; won’t be so easily sucked into the drama of negative
thoughts. 2. It breaks the conditioned link between body sensations
and thinking (e.g. feeling physically tired which triggers negative
memories). 3. It helps us to be more aware of our ‘thinking-feeling’
as body sensations are mirror to our thoughts and emotions – sort
of a natural bio-feedback device.
5. Mindful awareness of thoughts: In recurrent depression, the
problem is usually not so much of the sadness which is brief and
‘normal’ (part and parcel of life). It’s more of how our mind reacts
to the sadness with aversion, “Oh my God, It’s back again!” “What’s
wrong with me?!” “Why can’t I just get over this?!” “Come on, move
on lah!” “I shouldn’t be like this!” “Shit, I should have tried harder!”
Such kind of self-critical thoughts can easily
suck us back into the depression ‘black hole.’
Mindfulness of thoughts involve mentally
stepping back and looking at the thoughts from a distance with
kindness – like watching birds and clouds passing through the sky.
In the process, one realizes that thoughts are just creations of the
mind which can be distorted. With that realization, we can respond
to situations wisely, instead of reacting impulsively, and end up
with full blown depression relapse.
This is the Chinese character for ‘Mindfulness,’
with sub-characters of ‘now,’ ‘heart/compassion’
and ‘home’ – all representing important values
for healing of depression.
For further information on MBCT, you may refer to the book,
“The Mindful Way through Depression: Freeing Yourself From
Chronic Unhappiness,” by Mark Williams, John Teasdale, Zindel
Segal & Jon Kabat-Zinn. In Malaysia, similar mindfulness-based
therapy is available at Sunway Medical Centre
FREE online MINDFULGym courses by Dr. Phang Cheng Kar for
stress reduction, health & healing:
KINDFULNESS REST-Shop (Mindfulness +
Kindness) on YouTube (7 episodes, 2 hours).
5-Week MINDFULGym Foundation Course.
12 MINDFULGym Tools.
The present moment is filled with joy and happiness.
If you are attentive, you will see it.
- Thich Nhat Hanh -
Follow me OUT…
1. A Journey Of Recovery
2. OMG – It’s Never Easy
3. More Than Just Depression
4. It’s Scary – Panic Attacks!
5. Ouch! – Invisible Pain
6. Don't Delay - Seek Proper Treatment
7. Is It Just Emotional Flu?
8. Trust Me - Medicine Is Very Important!
9. Have I Recovered?
10. Small Is Beautiful - Set Small Goals
11. A Mindful Attitude
12. Live In The Present Moment
13. It’s OK Not To Be Okay
14. It’s Time For ‘Me-Time’
15. Gyming The Mind & Body
16. Accept, Adjust & Move On (AAM)
17. Mental Immunity - 5 Mindful Vitamins
18. A Gratitude Visit
19. Be Grateful To Be Happy
20. Voluntary Service - I'm Not Alone
21. Don’t Give Up, Be Hopey!
A Journey Of Recovery
I first shared about my depression (Journey of Depression)
in the book “I’m Still Human – Understanding Depression with
Kindness,” co-authored with Dr. Phang in 2012. Now, in 2020, it’s
my 10th anniversary of living with depression. I’m grateful that
Dr. Phang invited me to share my experience further in recovering
from depression (Journey of Recovery). I dedicate this book to all
who are struggling with their mental health. By the power of my
sharing, may they be free from mental suffering and live happily.
OMG – It’s Never Easy
The journey of recovering from depression is challenging. In
the process of healing, I underwent many episodes of depression
relapse. I was tired and frustrated as I battled with the illness. At
times, I doubt whether I’m on the right path to improving my
mental health. However, I’m glad I learned wiser ways in handling
mood swings with each relapse. The American professor and
creator of the Mindfulness-based Stress Reduction (MBSR), Dr. Jon
Kabat-Zinn, said, “You can't stop the waves, but you can learn to
surf.” Our mission in recovery is learning to surf the waves of
emotional storms and stay afloat to live meaningfully. If we manage
our triggers, thoughts, and feelings properly, we can ride the waves
with ease and be happy.
More Than Just Depression
Besides episodes of low mood, I often had excessive worries,
panic attacks, mood swings, and sometimes visual hallucinations of
a little girl saying negative things (critical and suicidal). Oh no! It’s
terrible enough to have depression. You can imagine the hell I went
through with the additional anxiety and psychotic symptoms. I
started to have many worries, especially about whether I will ever
recover from my mental difficulties. “No worries, things will get
better, slowly, but surely,” I repeatedly consoled myself.
It’s Scary – Panic Attacks!
Due to excessive fears and worries, I had several panic
attacks. I still remember clearly the first time I had a panic attack. It
occurred on a quiet night when I was ready to go to bed. I suddenly
had difficulty breathing, chest tightness, numbness in hands and
fingers, and a fast heartbeat. It was like having a heart attack, and I
felt like I was going to die. My family sent me to a hospital accident
and emergency (A&E) department for a check-up. The medical
officer said it was not a heart attack; there was nothing wrong with
me, and I could go home and rest. The next day, I contacted my
psychiatrist. I described what had happened, and from there, I
finally understand what a panic attack is. Even though I
encountered various disturbing symptoms related to depression, I
want you to know - depression is treatable. So, please don’t give up.
There’re many effective treatments for depression nowadays.
Please seek professional help earlier for a better outcome.
Ouch! – Invisible Pain
We often hear from people who suffer from depression that
you won't understand how painful depression is. Yes, depression is
PAINFUL! You can't fully understand it unless you also suffer from
the same illness. The pain is invisible; it appears in the forms of
disturbing thoughts and feelings instead of physical injuries like
broken bones. When you're feeling depressed or anxious, you'll
typically believe, "I'm useless," "I'm a failure," "I'm hopeless," "I'm a
burden," and so on. The mind is bleeding, and it's very damaging to
self-esteem and mental health. People don't readily understand
depression compared to physical diseases like cancer. You're not
alone. I know it's intense suffering. But please remember; it's not
that you're terrible, it's the illness that makes you feel horrible.
You're not bad; the condition makes you feel bad.
Don't Delay - Seek Proper Treatment
Even though depression is common, people often delay
seeking professional and medical help. The main reasons are the
lack of understanding of depression and treatment options, social
stigma on mental illness, and a person's denial of the disease for
various reasons. Over the years, I've seen many people who
procrastinate treatment, resulting in immense suffering. The longer
the illness is left untreated, the more it damages our physical health,
self-esteem, relationship, and productivity. That also means it's
harder to recover when one is ready for help. Even if it’s late, never
mind, it's okay. It’s better to be late than never. Get help now, follow
the recommended treatment plan, and life will be brighter.
Is It Just Emotional Flu?
Some people call depression "emotional flu." Unfortunately,
the treatment for depression is not as simple as just taking flu or
fever medicine, and you recover within a week. There're many
causes and conditions for a person to develop depression.
Therefore, it's essential to have a proper understanding of our
illness. I’ve come a long way to explore and understand the factors
that contribute to my depression, e.g. low self-esteem, high
expectation, family issues, lack of self-compassion, and nonassertiveness.
I’ve realized, besides taking antidepressant
medications, you'll need a holistic treatment plan that includes
talking therapy, relaxation and mindfulness training, a healthy
lifestyle, and the right family and friend support. The
comprehensive treatment takes time. There's no short cut for deep
healing. Without this understanding, it's tough to have a real
improvement in therapy.
Trust Me –
Medicine Is Very Important!
Medicines for the brain and nerves play a vital role in my
recovery. It's an integral part of my treatment plan besides
psychotherapy and family support. The antidepressant medications
help stabilize my mood before we can proceed with other therapy
methods that focus on addressing the underlying emotional issues.
People with depression often have the dilemma of taking medicine,
including myself. It’s natural to be concerned about any
medication's side effects, such as weight gain, dependence, and
drowsiness. Never believe what you read on the internet blindly. If
not, you'll be very confused and worried, like what happens to
many people. Instead, find a caring and patient doctor, discuss your
concerns, and find medicines that suit you the most.
If you’re already taking an antidepressant, never stop consuming it
or reduce the dose without discussing it with your doctor. This
practice prevents withdrawal symptoms, recurrence, or worsening
of the ailment.
Have I Recovered?
On many occasions, out of concern, my close friends asked,
"Have you recovered from your depression?" My answer to them is
always, "YES, but I'm still on medication." They don't seem to agree
that I've recovered from depression. To most people, recovery
means a person is entirely well and no longer needs any treatment.
This belief is logical, but it doesn't apply to chronic and severe types
of depression, like the one I'm having.
I have a different and more realistic definition of recovery.
Recovery means I can move on with my life, perform my daily
routines with medicine's support. I can learn new things to upgrade
myself and share my experience to benefit others. It's good enough.
After all, numerous
people with chronic physical conditions like high blood pressure,
high cholesterol, diabetes also take medicine for the long term, even
some for a lifetime. I don't have to be free from medications to be
free from depression. That's how I befriend my illness. I like the
word "befriend" instead of "fight" depression, which reminds me of
the value of gentleness and kindness
in relating to depression.
Small Is Beautiful - Set Small Goals
When we're in the zone of depression, it's typically hard to
do anything, even a simple task. When I was severely depressed, to
bathe every day was pretty challenging for me. There were times
when I didn't shower for the entire week. So, don't expect too much
from yourself with heavy responsibilities, e.g. disciplining the
children, managing the household, making a crucial decision like
changing job or divorce. Else, you'll be disappointed and hate
yourself more and more. Try to kick-start the day by doing simple
activities, e.g. brush your teeth, water the plants, feed the cat, make
the bed. The satisfaction from accomplishing the smalls goals will
charge up energy for more actions on the to-do list. In this way,
gradually, you'll be more in charge of your life and feel good about
A Mindful Attitude
Practicing mindfulness, which I've learned from the
MINDFULGym program, becomes my daily mind-body workout. It's
nice to cultivate the ability to relate to our experience with an
attitude of kindness, a beginner's mind, and wisdom. Being mindful,
I'm aware when a depression relapse is coming. I can recognize my
negative thought patterns. Once identified, I'll usually do the
mindful body stretching and breathing exercises to help me relax.
Then I'll relate to the negativity with a mindful attitude:
Kindness: I gently acknowledge, accept, and embrace all the
unpleasant emotions with compassion. "The most important thing
to do is self-care," I continuously remind myself. I've learned not to
fight with the feelings but befriend them with a beginner's mind
Beginner's mind: I try to see my difficulties with empathy instead
of harsh judgment. Like the clouds passing through the sky, I let the
mental chatter come and go when they're ready. I remind myself
that thoughts are not necessarily facts, and they're impermanent.
That's how I apply "social distancing" to my 'infected mind' to keep
Wisdom: Nobody likes to have painful experiences. But they teach
us valuables lessons. I've learned that everything happens for a
good reason. The reasons might not be apparent now. But with time,
we'll discover and cherish them. The problems in life are like
fertilizers for our growth. When there's no mud, there's no lotus, as
Zen master Thich Nhat Hanh says.
Live In The Present Moment
Since my secondary school days, I often hear people say,
"don't overthink, live in the present moment." It's true, but I didn't
fully understand its practical use until the recovery phase of my
depression. To 'live in the present moment' means purposefully
paying attention and be grateful for any positive experience, no
matter how trivial it might be. This effort helps to build positive
emotions. It also means to relate to ourselves with kindness; in
thought, speech, and action, when we encounter any negative
experience. Living in the present moment makes me happier and
more resilient. It's a lovely way of life.
It’s OK Not To Be Okay
Low self-esteem and lack of self-compassion are among the
main contributory factors for my depression. In the past, I like to
criticize and blame myself. I felt so much hatred for myself, as I
thought I was a failure in life. Thinking in this way is unhelpful for
my recovery. I started to learn ways to love, trust, and appreciate
myself. I realize that being kind to myself is more than treating
myself with love and compassion. It's also learning to make peace
with my past mistakes and forgive myself. I got up from where I fell
and transform imperfection into meaningful lessons that I can share
with and benefit others. “Real beauty does not lie in perfection, but
in embracing and accepting imperfection,” says meditation teacher
Ajahn Brahmavamso. So, It's OK not to be okay. Just be kind to
yourself and stay hopeful.
It’s Time For ‘Me-Time’
The concept of 'me-time' was so alien to me. It took me a
long time to comprehend that me-time is self-care time instead of
moments of selfishness. I hope you can likewise resolve this
misconception that leads to a lot of inner conflicts. This reminder is
vital when you're a responsible and conscientious person, like me.
Nowadays, it's easier for me to take me-time without feeling guilty.
I ensure I give myself sufficient time being alone to refresh, reboot,
and recharge. The freedom to be alone gives me time to do things
that I like, which generates joy. It also gives me the space to
contemplate the true meaning and purpose of life. Me-time, I love
Gyming The Mind & Body
I try to maintain an exercise routine to keep my mind and
body healthy. My regular mind-body fitness plans consist of
mindfulness practice (body stretching and breathing), chanting,
loving-kindness, and gratitude meditations. Occasionally, I will run
on a track mill while enjoying inspirational movies or listening to
uplifting music. Regular exercise helps to increase dopamine,
serotonin, and endorphin levels in the brain and body. These
natural feel-good brain chemicals are useful for enhancing feelings
of well-being. It's also helpful to do something meaningful or
passionate to us, such as gardening, keeping pets, playing music,
making handicrafts, and doing voluntary service. Sometimes, it can
be tough to find things to do and hold the energy to accomplish an
activity. My experience tells me that we need to push ourselves and
experience some tension if we want to recover from depression.
Try to 'just do it' even if we don't like it, for a better future.
Accept, Adjust & Move On
No matter how strong we are, we have our vulnerable
moments in life. It's easy to feel helpless and hopeless if we don't
have the skills to cope with obstacles. The 'AAM' (Accept, Adjust &
Move On) is an indispensable tool for me to befriend depression
and strengthen resilience in my recovery journey.
Accept: I recognize and acknowledge challenges connected to my
depression with kindness (e.g. soothe myself with mindful body
stretching and breathing). I try not to beat myself up when
Adjust: I adjust the way I perceive things for a clearer
understanding of a problem. Seeing things from different
perspectives often helps in finding creative solutions.
Move On: I learn to let go/let it be if I can't solve an issue. Not
everything has a solution, and worrying is pointless. It's good
enough when we don't make things worse. We can then channel our
energy for other things that are within our control.
When I'm emotionally stuck, I try not to push myself too hard to
'AAM.' I give myself permission to stay with the unpleasant
thoughts, memories, and feelings for a while. In the process of
‘resting’ (non-struggling), I often see things with greater clarity and
learn new lessons.
It’s better to light a candle than to curse the darkness
- Chinese Proverb -
Mental Immunity -
5 Mindful Vitamins
When our body immunity is low, we take Vitamin C or other
supplements. As for me, when my emotional immunity is down,
I take the '5 Mindful Vitamin.' The mental vitamins are positive
mental attitudes that help me handle adverse situations.
I'm not alone: Instead of feeling shameful or isolated, I remind
myself that they're other people with a similar experience whom I
can seek advice.
It could have been worse: Instead of feeling overwhelmed,
I remind myself that whatever hardship that happened is not that
bad or could have been worse in many ways.
What I can I do now? Instead of wasting time worrying or
regretting something, I remind myself to focus on what I can do to
make things better.
What have I learned? Instead of resenting people or events that
caused afflictions, I remind myself to learn something useful from
This will also pass: Instead of holding on and magnifying problems,
I remind myself that all unpleasant feelings and situations are
A Gratitude Visit
Every year, I pay a visit to Dr. Ong, the family doctor who
first diagnosed me with depression and referred me to Dr. Phang
for further treatment. This year, 2020, is no different. Since the last
time I visited his clinic was a year ago, I was concerned I couldn't
recognize the roads to the place well. Nevertheless, I decided to
travel without GPS support. I wish to revisit the memories
intertwined with the journey when I first sought help for
As I drove along, I became familiar with the roads, sceneries, and
painful recollections. Yet, I felt peacefully detached as many things
had changed for the better over the years. It reminded me about the
Buddha's teaching of impermanence. I'm glad that the distressing
event's memories are still there but diluted and colored with new
The moment I stepped into the clinic, Dr. Ong welcomed me with a
smiling face. He's a kind and compassionate doctor who shares the
Dharma with me for deep healing. This year I visited him with
wholly grateful and joyful hearts. It's unlike the past years, whereby
I still had unfinished sadness. In this encounter, I related an
incident to Dr. Ong regarding my visit, a year ago, to the place that I
attempted suicide. Out of expectation, I broke down and cried
profusely. I never thought I had such an intense memory about the
Here's what Dr. Ong explained to me inspirationally:
"Some people will purposely revisit places associated with sadness.
It's a kind of therapy that enables a person to courageously
confront feelings of sadness, guilt, fear, and so on. It's okay that you
have unpleasant feelings or thoughts while going through the
process. Your emotions along the journey to visit me have
transformed over the years. The experience is part of our growing
pain, and it helps with gradual letting go of the past. Emotional
anguish lessens as time passes. This year, you have finally
conquered your trauma. That's very good. Time is the best healer."
Even though our meeting was short, it was therapeutic for me. It's
like a vaccine to raise my mental immunity. I left Dr. Ong's clinic
with immense gratitude. Thank you for everything you have done
for me, Dr. Ong. I also never forget to thank myself for not giving up
on my life and continuing to be a better person.
Be Grateful To Be Happy
Life with depression is tough, but I'm grateful for everyone
and everything I have. I make an effort to count my blessings every
day. I keep a gratitude diary to pen down three good things that
happen in a day. Initially, it was quite challenging to think about
good things. We tend to remember adverse events more easily;
happy memories require more effort to recall. I like the exercise
called 'Google-WWW-Yahoo,' which I learned from the
MINDFULGym program. It's an exercise to train your mind to pay
attention to the positive things in life and cultivate gratitude. How
to practice this exercise? Firstly, try to 'Google' (mentally search or
recall) '3W's' (what went well) every day and 'Yahoo' (rejoice or
celebrate) the good things in life. Once you get in the habit of doing
this daily, you'll notice it's easier to find happy things to be grateful
for. This is because your mind automatically begins to think with
Voluntary Service - I'm Not Alone
I sincerely appreciate the opportunity to do voluntary
service at the KL Buddhist Mental Health Association. Along with
the voluntary service, I’ve gained a lot of knowledge about mental
health through talks and training programs. I learned techniques
for relaxing the body, relieving mental stress, cultivating
mindfulness, and nurturing a positive mindset. In sharing those
methods, I met many people and realized that depression is a
common human experience. I discover that it benefits my mental
health by assisting others, as I feel I'm useful and needed. Life
becomes meaningful when I get to honour my suffering by sharing
the lessons to aid others.
Don’t Give Up, Be Hopey!
The tips, coping strategies, and exercises are beneficial for
my recovery from depression. I hope my sharing can help you to
manage your depression better. It's OK if you find the approach not
suitable for you. That's very normal as there's no one-size-fits-all
way for depression recovery. Don't give up. There’s light at the end
of the tunnel. My sharing is just a guide to lighten your depression.
It would be best if you always discussed with your therapist or
doctor to decide what suits your conditions. Thank you for
spending your precious time to read about my journey of recovery.
May you be well and happy.
Further reading on
• Depressed Little Prince
• Beyond Blue
• Blue Pages
• Black Dog Institute
• Depression – National Institute of Mental Health
• WedMD - Depression Slideshow
• The Mood-Gym – Online CBT for Depression
After rain there’s a rainbow,
After a storm there’s calm,
After the night there’s a morning,
After an ending there’s a new beginning
- Anonymous -
I would like to thank the following online services for providing the
use of photos and graphics in this book:
• Wikimedia Commons
• Open Clip Art Library
• Illustrations by Francois Lange
Cover image (cat & duck)
• licensed by https://www.123rf.com/
Sis. Lilian Thong for suggesting the name of the book,
Sis. Looi Sow Fei for language editing service,
reviewers for valuable feedback for improvement.
The publication of this book for free distribution is made possible through the
kindness and generosity of the following donors. By the power of this goodness,
may all beings be well and happy.
Anonymous • Ang Yoke Seng • Andrine Chan Mei Yoong • Anudeep • Brickfields Maha
Vihara • Ban Yok Fong • Barbara Yen & Bro. Wuan • Bro. Yeoh & Family • Caren Yong •
Chin Kong Meng • Chow Mun Wai • Chandra Malar • Cheong Lin Hi • Chai Lee lee • Chua
Chong Hock & Family • Chew Poh & Family • CY Kow • Chuan Boon Teik • Chua Ah Hua •
Chong Yi Leng • Chong Siew Ling • Chai TY • Chan Kah Yein • Chan Yoke Keng • Cheak
Sook Kun • Doris (Sentul Clinic) • Dato’ Jeff Yap & Datin Nicole Ting-Yap • Eddy Loh Wai
Mun • Emelia Kam • Florence Ng & Sisters IMO Mr. & Mrs. Ng Soon Swee • Foo Fatt Mee &
Family • Foon Kien Poo • Goh Sho Ring • Gan Poh Yan • Grace Lim Yew Min • Gaik Siew •
Hon Lee Keow • Hooi Hooi & Family • Hamidah • Hoh Li Jiun & Hoh Li Yun IMO • Lau
Foong Choo • IMO Phang Ah Keong & Family • IMO Chooi Ah Wah • IMO Sit Su Ling • IMO
Kee Liang Chor • IMO Lim Swee Hin • IMO Phoon Choy & Aw Ah Feng • IMO Chin Kim soon
& Hiew Wei Yuen IMO of Chin Kim Soon & IMO hiew Wei Yuen • IMO Mr. Au Yeong Thoong
Kong • IMO Low Geok Fei • IMO Lau Geok Lian • IMO Bobby Yap • Irene Ang & Family •
Juliana Oo • Joie Lee • Jessica Lee • Jasmine Choong • Jasmine & Family • Jaspal • Jenny
Ong • Kemmy Chew & Vince Ng • Kathyrn Geh • Katherine Loo Kian Mei Ming & Family •
Lee Teeng Teeng • Loh Hock Sun & Family • Liang Wei Fung • Lim Eng Bee • Lau Ah Tee •
Lee Suan Seng • Leong Lai Kah • Lau Hong Mui • Lau Hui Ling • Lau Phaik Lin • Lau Ron
Hsein & Lau Yi Ling • Lawrence Lim • Lee Oi Choo • Lilian Thong • Han Sheng • Han King •
Han Huang • Lee Yoot Khuan & Kids • Lin Jik Khoong • Lim Li Lian • Lim Chin Chin • Low
Khoon Hwa & Family • Loh Hooi Khin • Lum Peck Woon • Mittas from Singapore • Mimi
Wong & Family • Mah Li Chen • Mrs. Tay Kim Soon • Mita, Nitha, Thana & Vicnes • Mr. &
Mrs. Tan & Family • Mudita Yin Fan & Family • Nalanda Buddhist Society • Ng Peng Seng &
Family • NLWong • Pearly Toh & Family • Pun Chee Kent • Quah Siew Chin • Quah Poh
Lean • Rob & Ling Moult • Rose Cho • Sentul Buddhist Temple • Soo Yuet Yeng • Siew Fay
& Family • Soh Lai Sim • Stuart Chua Yu Tang • Satpal Kaur • Soo Lay Khim • Tuen Foo Fat
• Tan Joo Sin & Family • Tan Chee Eng • Tham & Family • Teoh Guan Huat • Turning Point
• Tee Ee Chien & Family • Wong Bee Mi • Wong Yan Kuiw • Wong Mei Ying • Yeoh Lee
Quan • Yeoh Ah Tu • Yeok Kim Yeok •
If the names are erroneously spelt or omitted from the donor list, I sincerely
apologize for the oversight. I will ensure it is rectified in the next reprinting,
should the errors be made known to me (email@example.com). All
excess funds received for this book shall be used for reprinting.
If you wish to support future reprints of this book, you may bank in the donation
to KUALA LUMPUR BUDDHIST MENTAL HEALTH ASSOCIATION (Maybank,
account number: 5144 7702 2950) with an email and attached bank slip to me
A brief introduction of BMHA:
Kuala Lumpur Buddhist Mental Health Association (BMHA) was
established on 1/3/2010 to promote mental health in the Buddhist
community through Buddhist psychology and Buddhism-influenced
Objectives of BMHA:
• To provide guidelines on principles,
standards and ethics for the application of Buddhist
wisdom for mental health.
• To promote positive mental health in the general
community with emphasis on psycho-spiritual wellbeing.
• To support its members in self-care and continuous
professional development in counseling and
• To collaborate with other organizations in
providing mental health education and service.
• To facilitate research related to mindfulness and
other psycho-spiritual principles of well-being.
About the author
Dr. Phang Cheng Kar (M.D.) is a consultant psychiatrist and
mindfulness-based therapist at Sunway Medical Centre.
Previously, he was practicing as a psychiatrist at the
Kuala Lumpur and Kajang General Hospitals; and lecturing
at the Universiti Putra Malaysia (UPM) Medical School.
He’s the developer of MINDFULGym
(http://mindfulgymalaysia.com), which is a Malaysian
mindfulness-based stress reduction and wellness program.
He's also the president of the Kuala Lumpur Buddhist Mental
Health Association (BMHA) and Malaysia Association for
Mindfulness Practice & Research (MMPR).
Books, CD’s & online resources
by the same author
1. No Worry-Lah, Be Happy: A Medical Student’s Motivational &
Inspirational Guide. http://issuu.com/pckar/docs/dwbh FREE
2. Don’t Worry, Be Healthy – A Buddhist Guide for Health & Healing –
Volume I & II. http://tinyurl.com/dwbhealthy FREE
3. Progressive Muscle Relaxation Made Clear & Simple.
• Video https://youtu.be/o93rxliG-bY FREE
• Book http://issuu.com/pckar/docs/pmr FREE
4. JOM-Lah FIKIR: A Guide On Transforming Your Thoughts For
Happiness http://tinyurl.com/jomlah-fikir FREE
5. NOW - Who Wants To Learn MINDFULGym? 12 Mindful Tools For
Stress Reduction & Wellness https://payhip.com/b/YHGq
6. Contentment as an Antidote for Depression – Audio CD
7. Mental Illness, Spirits or Charm? – Audio CD (FREE)
8. Garden of Mindfulness: Audio-Guided Mindfulness Practice for
Relaxation & Wellness - FREE
9. iMINDFULGym DVD: 8 Mindfulness-based Lessons for Stress Reduction
& Wellness - FREE
10. 3G GRATITUDE: Card Game for Cultivating Happiness