I'm Still Human: Understanding Depression With Kindness (Expanded Edition - 2021)

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.

2021

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 drphangsunmed@gmail.com

ISBN: 978-967-11016-1-2

Reminder

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:

https://www.mindfulgymalaysia.com/post/i-m-still-human

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

Clinical Psychologist,

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

understanding.

Professor Dr. Sherina Mohd Sidik

Family Physician,

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

Panel Counselor,

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,

HELP University.

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

myself.

Dr. Hazli Zakaria

Senior Medical Lecturer & Psychiatrist,

Universiti Kebangsaan Malaysia Medical Centre.

Content

Foreword

Dedication

Preface

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

– 88

• 12 ways to be kind to people

with depression – 107

• Be mindful of false kindness

– 111

• 20 FAQ’s during depression treatment – 114

• What should I say to support a person with depression?

– 147

• 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

– 167

• 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

Foreword I

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

Australia (PPAA).

20 th August, 2012.

Foreword II

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

“metamindfulness” 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.

With Metta,

Tian Po Oei

(Ph.D., FAPS.)

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.

Dedication

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.

Preface

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’…

PART 1

Understanding depression…

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

because:

• There are recognizable signs and symptoms (page 4).

• There are known causes, e.g. genetic, hormonal, excessive

stress.

1

• 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 Inventory.

• Depression can be treated with medicines, e.g.

antidepressants.

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)

2

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.

3

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

checklist).

For more than 2 WEEKS have you? Tick √ in

if ‘Yes’

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?

4

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

home).

5

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.

6

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.

7

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 treatment.

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

Population

Special features of depression

• Tend to perceive it as a sign of weakness.

Men

• Less likely than women to acknowledge and

express the feelings of sadness or

hopelessness.

• They tend to complain about fatigue,

irritability, sleep problems, and loss of

interest in work and hobbies.

8

• 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.

Women

• 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

children.

Children &

Adolescents

Elderly

• Irritability is the predominant symptom.

Unexplained body aches and pain are also

common.

• ‘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

independence.

• Tend to complain more about the physical

rather than the emotional symptoms of

depression. Irritability is also common.

9

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

outcome.

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

with life.

10

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

hopelessness.

• Visiting and contacting people to say goodbye.

11

• 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

possessions.

• Tendency towards unnecessary risky behavior that could

lead to death, e.g. driving at high speed and without seat

belts.

• 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.

12

What should I do if I or somebody

has depression?

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

13

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,

14

“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

rumination.

• 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

the depressed.

15

Who should I consult for

professional help?

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

suicide.

16

• 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

inappropriately.

• 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

like psychiatrists.

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

17

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

depression).

18

• 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*:

https://mmha.org.my/resources/directory-of-psychiatricservices/

https://mmha.org.my/resources/directory-of-counsellingservices/

Source: Malaysian Mental Health Association (MMHA).

19

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.

20

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

available.

21

Table 2: Private versus government psychiatric services.

PRIVATE *

psychiatric services

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

are available.

8. More expensive medications

are limited.

22

* Private psychiatric services in Malaysia:

http://www.psychiatry-malaysia.org/listcat.php?cid=28&all=Y

**Government hospitals with psychiatric services in Malaysia:

http://www.psychiatry-malaysia.org/listcat.php?cid=29&all=Y

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

following information:

• 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

appointments, etc.)

23

• Qualification of the therapist (counselor, clinical

psychologist, specialization, e.g. family therapist, play

therapist, etc)

• 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?

24

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.

25

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

fear.

• 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

an illness.”

26

• 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

http://www.youtube.com/watch?v=ci-2GDoGWHU

- Idols who suffered depression & anxiety

https://youtu.be/8VsPMZmnXHk

• 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.

27

• 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

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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

more effectively.

29

What is expected in the psychiatrist’s

consultation room?

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

background.

• 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).

30

• 5. Help you to identify the factors that contribute to your

depression.

• 6. Do physical examinations and blood investigations* if

necessary, e.g. a thyroid hormone disorder may contribute

to depression.

• 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

be fine.

31

What to expect from a counselor or

clinical psychologist?

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

therapy.

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

32

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.

33

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.

34

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

noradrenalin.

• 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.

35

• 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

personality.

36

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

37

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

them.

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.

38

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,

forgiveness.

• 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.

39

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

neurotransmitters.

40

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

proper monitoring.

• 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

41

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,

42

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…

43

PART 2

Jasmine’s Journey of

Depression…

When your fear touches someone’s pain,

it becomes pity; when your love touches

someone’s pain, it becomes compassion

- Stephen Lavine -

44

Come on,

Follow me IN…

45

CONTENT

1. Introduction

2. Hopeless

3. Useless

4. Guilt

5. Burden

6. Weak

7. Gloomy Evenings

8. Suicidal Thoughts

9. Self-Harm

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

46

~ 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

diagnosis.

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.

47

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

depressive ‘shell.’

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.

48

~ 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

49

many obstacles in my life. I’m tired of fighting; I’m getting weaker

and 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…

50

~ 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

51

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…

52

~ 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

behavior.

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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…

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~ 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

tolerate myself.

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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?

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~ 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.

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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’?

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~ 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

becomes darker.

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

past.

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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

painful emotions…

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~ 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

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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…

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~ 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.

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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….

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~ 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.

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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,

spirituality, etc.

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

me…

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~ 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).

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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

sleep.

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…

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~ 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.

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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!

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~ 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...

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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

life…

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

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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 -

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~ 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

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• 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

life.

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.

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~ 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 –

gardening.

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

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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

and grow.

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

psychiatrist.

“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.

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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.

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~ Let’s Be Friends ~

Dear Depression,

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!

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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.

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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.

With gratitude,

Jasmine.

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~ 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.

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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!

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~ 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.

Jasmine,

Email: jasminechiam1@gmail.com

(Feel free to contact me to share your experience in coping with

depression)

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Come on,

let’s follow me OUT…

stronger, Stronger

& STRONGER

Note: Permission has been acquired from Jasmine

to share her journey through depression in this book.

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PART 3

Kindness amidst depression…

Kindness is the language which the

deaf can hear and the blind can see

- Mark Twain -

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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

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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

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relieved, when they discover that there are others with similar

experiences.

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…”

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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

depressive disorder.

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?

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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

depressed.”

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

Be GENTLE

Be KIND

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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.

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• Remember that God is loving and forgiving when you

sincerely repent.

A – Aspiration

• Make an aspiration that you will not repeat the mistakes.

• Ask someone respectable, e.g. priest to be a witness to your

aspiration.

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

in perspective.

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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

kindness.

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

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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

peace).

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.

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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.

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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.”

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• 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

planned.

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,

shelter, clothes.

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.

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• 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.

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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

that.

These are examples of how I try to be kind to myself when I’m

emotionally down:

• 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.

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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

do it!

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

and useless.

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.

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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.

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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).

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• 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”

• “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”

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• “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

affecting healing.

Case report: Once, there was a patient with

depression who attempted suicide by

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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

your heart,

““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!”

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12 ways to be kind to people

with depression

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.

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• 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

more effectively.

• 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

medicines, etc.

• 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

suggestions.

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• 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

them.

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• 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.

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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

depression.

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

improvement.

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.

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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.’

(page 133).

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.

For example,

- 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

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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

(page 198).”

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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

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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

person’s life).

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

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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,

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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.

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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

better service.

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

psychiatrist.

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

lifestyle changes.

In summary, taken and adjusted correctly, antidepressants can give

a lot of BENEFITS – not side-effects.

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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

its use.

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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.

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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

every day.

• 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.

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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.

Take more:

• Fruits

• Vegetables

• Water

• Food rich in omega-3 fatty acids, e.g. fish, soybean, canola oil

• Food rich in tryptophan, e.g. milk, sunflower & sesame seed,

spirulina, cheese

Take less:

• Salty food

• Fatty food

• Processed food

• Alcohol

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.

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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

yourself.

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

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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):

1. Medicines

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,

130).

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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

wellness.

Relapse often occurs with a unique set of symptoms specific to an

individual. Some people call this, ‘signature symptoms’ (e.g. poor

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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

through depression.

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.

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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

temperature.

• 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.

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• 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

are refreshed.

• 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 -

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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.

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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.

http://tinyurl.com/4Pleasant

• 3. Practice ‘Mindful Body Stretching.’

https://youtu.be/o93rxliG-bY

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

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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

addiction.

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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

decisions.

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

offer)?

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.

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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 -

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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:

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1

Fortune Telling or

Catastrophic Thinking

Expecting a bad or the worst outcome

of something.

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

reality.

2

Labeling or

Over-Generalization

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…

3

Black & White

Thinking

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…

4

Mental Filter

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

settled yet…

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5

Discounting

Positive

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

lenient …

6

Blaming or

Personalization

Excessively finding fault with ourselves

or others.

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…

8

Emotional

Reasoning

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

avoid it…

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9

Telepathy or

Mind Reading

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

know…

Rigid in thinking & expecting everything

to be ideal.

10

Perfectionism or

Must-Should Thinking

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.

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I’M

USELES

S

I SEE, IT’S OK….

I STILL LOVE YOU….

WE CAN ALWAYS

TRANSFORM

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?

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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

now?

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.

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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 -

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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

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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

childbirth.

• 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

role.

• 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

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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

depression.

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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.” -

Marcel Proust.

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.

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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

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What should I say to support a person

with depression?

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

instead:

(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.

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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

comedian).

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

more self-compassion.

(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."

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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

go-lah!

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.

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(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.

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(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

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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

an appointment?

(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

around them.

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 -

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Forum for understanding depression

with Kindness

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.

Chew Poh.

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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

attempted suicides.

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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."

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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

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further assessment. She was given questionnaires to answer and

went through a thorough interview. Both 'tests' showed that she

had depression.

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

Depression.

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

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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.

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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

patients.

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

ourselves."

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,

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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

Ven. Kumara.

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.

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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 –

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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

ways

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,

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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.

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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

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‘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

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Segal & Jon Kabat-Zinn. In Malaysia, similar mindfulness-based

therapy is available at Sunway Medical Centre

http://sunwaymedical.com/doctor/dr-phang-cheng-kar/

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.

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PART 4

Jasmine’s Journey

of Recovery…

The present moment is filled with joy and happiness.

If you are attentive, you will see it.

- Thich Nhat Hanh -

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Come on,

Follow me OUT…

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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!

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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

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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.

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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

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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.

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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

yourself.

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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

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fight with the feelings but befriend them with a beginner's mind

and wisdom.

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

myself safe.

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.

sketchesinstillness.com

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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.

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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.

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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

you.

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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.

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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

triggered.

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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 -

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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.

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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

the experience.

This will also pass: Instead of holding on and magnifying problems,

I remind myself that all unpleasant feelings and situations are

impermanent.


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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

depression.

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

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event's memories are still there but diluted and colored with new

happy ones.

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

occurrence.

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."

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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.


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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

gratitude.

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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.

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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.

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Further reading on

depression

• Depressed Little Prince

http://www.depression.edu.hk/en/home.html

• Beyond Blue

https://www.beyondblue.org.au/

• Blue Pages

https://bluepages.anu.edu.au/

• Black Dog Institute

https://www.blackdoginstitute.org.au/resourcessupport/depression/

• Depression – National Institute of Mental Health

http://www.nimh.nih.gov/health/topics/depression/index.shtml

• WedMD - Depression Slideshow

http://www.webmd.com/depression/slideshow-depressionoverview

• The Mood-Gym – Online CBT for Depression

https://moodgym.anu.edu.au/welcome

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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 -

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Acknowledgement

I would like to thank the following online services for providing the

use of photos and graphics in this book:

• Pixabay

http://pixabay.com/

• MorgueFile

http://www.morguefile.com/

• Wikimedia Commons

http://commons.wikimedia.org/wiki/Main_Page

• Open Clip Art Library

http://openclipart.org/

• FreeFoto.com

http://www.freefoto.com/index.jsp

• Illustrations by Francois Lange

https://www.sketchesinstillness.com/

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.

200

DONATION

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 (drphangsunmed@gmail.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

(drphangsunmed@gmail.com).

201

A brief introduction of BMHA:

http://www.klbmha.com

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

psychotherapies.

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

psychotherapy.

• 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.

202

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).

203

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

http://tinyurl.com/contentment-depress FREE

7. Mental Illness, Spirits or Charm? – Audio CD (FREE)

https://soundcloud.com/zhen_phang/sets/mental-illness-spirits-or

8. Garden of Mindfulness: Audio-Guided Mindfulness Practice for

Relaxation & Wellness - FREE

https://soundcloud.com/phang-cheng-kar/sets/mindful-gym

9. iMINDFULGym DVD: 8 Mindfulness-based Lessons for Stress Reduction

& Wellness - FREE

http://mindful-gym.blogspot.my/2014/06/i-mindfulgym-course.html

10. 3G GRATITUDE: Card Game for Cultivating Happiness

https://www.mindfulgymalaysia.com/mindfulgym-gratitude-workout2

204

I'm Still Human: Understanding Depression With Kindness (Expanded Edition - 2021)

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