Elucidating one’s understanding of mental health

By Hiba Nizami and Sunny Singh

Mental health refers to cognitive, behavioural, and emotional well-being. This blog will not only further discuss what mental health is in relation to what the perceived (mis)understanding is, but also how people can learn to accept the idea of mental health, and the psychology and the science behind it. Mental disorders are conditions that affect your thinking, feeling, mood, and behaviour. They may be occasional or long-lasting (chronic). Mental illnesses are health conditions involving changes in emotion, thinking or behaviour (or a combination of these), they are associated with distress and/or problems functioning in social, work or family activities. Mental health conditions generally come paired with stigmas, and these stigmas are birthed due to lack of proper understanding as well as the ideas of previous generations being carried forward. These stigmas and lack of proper understanding, further cause common people to not know how to react or act around people who may have mental disorders, leading to more confusion. Understanding the relevant vocabulary in its medical context instead of the layman’s terms is vital in understanding why these mental health conditions are so severe and concerning (to begin with). Of course, there is a colloquialized definition that we cannot change. But at the very least, understand what is really being implied when someone says they had a “breakdown” or a “panic attack”. The more you understand about what it means to have these symptoms, the distinction between the colloquial and medical use becomes much more apparent, especially when someone is trying to convey their situation to you. Below are two tables, which show the medical definitions and perceived definitions of both Mental Health Conditions as well as terms associated to Mental Health, respectively:

Note: This is not to say that everyday emotions are not important – they are valid and management of them and stress are very important as well. What we are trying to point out is that people conflate symptoms of mental health conditions with regular emotional waves, which prevents them from seeking help or understand the gravity of the situation.

Also, the final column is supposed to refer to how people generally (misunderstand) the definitions of medical disorders / illnesses / conditions. We are not endorsing it – rather, we are pointing out that this way of thinking is wrong.

Understanding the vocabulary and the real nature of mental health is useful beyond the context of conversations between friends. In terms of public policies, evaluating research and news articles, and even seeking treatment, the vocabulary and concepts we hope to convey will help you make better judgement in these areas.

Ways to better understand mental health

There has been a lot of misrepresentation and misinformation about psychology and mental health without there really being a way to find out whether the information is correct. One does not need to be completely invested in every new piece of research that is published - at the very least people should know how to interpret whether a someone who is talking to them about their emotions is describing a normal phenomenon or is in need of a professional aid. Just as a fever can indicate either a cold or a COVID-19, depending on the severity and other symptoms, psychological and behavioural people can indicate a bad day, significant stress, grief, or a mental illness. It depends on how well acquainted we are with the understanding of the different intensities and the roots of certain behaviours.

We have listed down a few ways one can better understand mental health and unlearn false narratives and stigma that continue to be perpetuated.

• Being critical

In Singapore’s context, there is a suggested bias in the portrayal of mental illnesses as well. In a follow-up study, ‘Migration psychosis and homicide in Singapore: An 8‐year update’, the research indicated that there was an interconnection between immigration, development of psychosis and violent crimes, made by both the media and social commentators. Through their data analysis, one of their results was this: “The links made by the media among homicide, mental illness, and migration appear unsupported in Singapore.”[8] This may stem from the bias against migrant workers, but it seems to reflect how easily we are willing to use mental health as a basis for excluding migrant workers. The assumption is that mental illness leads to violence[9].

In addition, a Mothership.sg article had this title for an article written on the 1st of August 2020: “Foreign worker apprehended after standing on ledge outside window at Kaki Bukit dormitory”[10]. There was significant backlash on social media, as seen by the comment section below the Instagram update [seen by the attached images][11].

Insensitive articles like these stigmatize the migrant worker community using mental health as a basis of “irrationality”, and as one user nicely puts it “make[s] it sound like he did for fun”, hence insinuating that symptoms of mental health issues are ‘choices’ being made. In addition, Singapore had already decriminalized suicide (i.e. a person can no longer be put on trial for attempting suicide) – hence, the incorrect use of the word “apprehended” perpetuates a false narrative that is no longer true[12]. Furthermore, the seemingly ‘objectivity’ of the article completely isolate the incident to the specific moment, rather than trying to convey the entire story behind what led this man to stand on the edge. Such presentations can limit the degree of empathy we can give the person, who has been clearly taken in through the “Mental Health Act” [indicating that mental health issues were initially believed to be the fundamental issue]. We simply do not know enough about his story to understand his actions. This could re-enforce pre-existing biases that those with mental health conditions are “irrational” and “crazy”, as it would be the only “explanation” that people can make sense of [regardless of whether it is accurate or not].

There are efforts in Singapore and overseas in trying to tackle media narratives and stereotypes about the mental health community: Singapore has both public and government initiatives that try to bring about newer perspectives, like on Youth.sg and the Beyond the Label Campaign. Other newspapers are also publishing articles that attempt to be more sympathetic towards the cause, like this CNA article. As mentioned, “According to the experts and observers interviewed, Singaporeans’ attitudes towards mental illness and their knowledge of it have vastly improved compared with a decade ago.”[13]

While there has been progress, we still have a long journey to push through before we reach a more accepting society.

Hence, both the news media and the entertainment media are not reliable sources of learning about mental health issues, as there are often biases and artificial rhetoric that misrepresent the story. But if you can’t use these conventional [and rather convenient] sources of information to learn, where can you go to learn more? One example is research papers (among others, but that is for another post).

• Look into research papers [guide to how to read research papers]

- The topic of Mental Illnesses and Disorders is well-researched. There are studies that cover a variety of sub-topics from the models of diagnosis and treatments, social attributes and relationship with those with the diagnosis, among other things. If you are interested, reading research papers help put facts and understanding to the mental health conditions. IMH has catalogues of research, specific to Singapore. Also, we wanted to include tips on how the average person can read and understand these research papers:

1) Read the Introduction and Discussion (skim through Results)

There is a lot of jargon that doesn’t really make sense unless one has some background knowledge in psychology. But, more often than not, we can understand the basic argument being made. The introduction and discussion sections tend to contain the bulk of information that we are interested in (i.e. the science facts). It may take a while to really grasps the particular syntax and phrasings, but it is doable. You can read the methodology and results section as a way to critique the study, but again,that requires knowledge about how different methodologies work.

2) Write down a vocabulary list and find the origins of the word

When you look at a new fancy biological or psychological term, it’s best to write it down somewhere should you come across it again and again in a particular topic. It’s more likely to be repeated and hence it would be a good reference. Also, if you can track down the basis of the words, i.e. it’s Greek or Latin origins, it can help you understand the reasoning behind why a phenomenon was named a certain way.

3) CTRL+F any word you are looking for

This may lead to a problem of selective bias, i.e. you only choose studies that suite your views, so be very careful. Otherwise, it is an extremely useful tool, especially when you know what you’re looking for. When you CTRL+F and enter the keywords you are after, you can find the section in the paper that pertains to your interest or even simply that the paper you have is relevant to your personal research.

Here are some other links if you are interested in more tips: [HuffPost] How to Read and Understand a Scientific Paper: A Step-by-Step Guide for Non-Scientists, [thebmj] How to read a paper, [sciencemag] How to (seriously) read a scientific paper.

• Educate yourself by watching videos about those with Mental Illnesses / Disorders / Conditions

- If you want to understand how it is really like to live with a mental health condition, then seek out videos on YouTube, documentaries, or interviews about mental health. They can help you develop a more accurate idea of the life of someone who has a condition, which helps with generating more sympathy and critiquing articles and other representations in the media.

- [Sunny] One of my personal recommendation would be Special Books by Special Kids (SBSK). It is a YouTube channel that does “Interviews with people in the disability/neurodiversity community.”[14] Their interviews are super informative and personal. Their videos and community help strengthen my belief that this world can be built on love and respect – I highly recommend the channel! They have a full playlist on Mental Health Disorders (if you are interested, they have videos about folks with physical disabilities too).

--> My favourite parts about the interviews is when the interviewer asks questions about how the interviewee(s) would want the world to perceive them, and I think that’s one of the most important things to learn how to empathize with people – you may have good intentions, but making sure you empathize properly and in a way that benefits everyone is also important.

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CITATIONS:

[1] (Mental Health America, 2000)

[2] (Elk, 2017)

[3] (Haider, 2018)

[4] (NT Contributor, 2004)

[5] (Frankham, 2017)

[6] (Levin, 2011)

[7] (Bregman, 2020)

[8] (Yeo, Poremski, & Koh, 2020)

[9] (Neo, 2016)

[10] (Yeo J. , 2020)

[11] (mothershipsg, 2020)

[12] (Singapore Legal Advice, 2020)

[13] (Lim, 2019) [14] We are not sponsored by them at all and we have received permission to promote them in this blog: https://www.youtube.com/c/SpecialBooksbySpecialKids/about BIBLIOGRAPHY:

Section 1:

Mental health: Definition, common disorders, early signs, and more. (n.d.). Retrieved August 03, 2020, from https://www.medicalnewstoday.com/articles/154543

Mental Disorders. (2020, May 30). Retrieved August 03, 2020, from https://medlineplus.gov/mentaldisorders.html

Holland, K. (2018, September 19). Mental Health Basics: Types of Mental Illness, Diagnosis, Treatment. Retrieved August 03, 2020, from https://www.healthline.com/health/mental-health

Administration, S. (n.d.). Eating Disorders. Retrieved August 03, 2020, from https://www.aware.org.sg/information/eating-disorders/

Anxiety Disorders. (n.d.). Retrieved August 03, 2020, from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders

Behavioral Disorders. (n.d.). Retrieved August 03, 2020, from https://www.mentalhealth.gov/what-to-look-for/behavioral-disorders

Melissa Conrad Stöppler, M. (2019, July 15). Asperger's Syndrome Symptoms, Definition, Facts & Testing. Retrieved August 03, 2020, from https://www.medicinenet.com/asperger_syndrome/article.htm

Attention-deficit/hyperactivity disorder (ADHD) in children. (2019, June 25). Retrieved August 03, 2020, from https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889

Bhandari, S. (2019, October 22). Autism: Definition, Symptoms, Causes, & Types. Retrieved August 03, 2020, from https://www.webmd.com/brain/autism/understanding-autism-basics

Causes. (n.d.). Retrieved August 03, 2020, from https://www.autism-society.org/what-is/causes/

William C. Shiel Jr., M. (2018, December 21). Definition of Trigger. Retrieved August 03, 2020, from https://www.medicinenet.com/script/main/art.asp?articlekey=30700

Breakdown. (n.d.). Retrieved August 03, 2020, from https://medical-dictionary.thefreedictionary.com/breakdown

Psychopathy. (n.d.). Retrieved August 03, 2020, from https://www.sciencedirect.com/topics/neuroscience/psychopathy

Sociopathy. (n.d.). Retrieved August 03, 2020, from https://www.psychologytoday.com/intl/basics/sociopathy

Flashback. (n.d.). Retrieved August 03, 2020, from https://medical-dictionary.thefreedictionary.com/flashback

The Art of Masking: Women with Autism. (n.d.). Retrieved August 03, 2020, from https://www.tiimoapp.com/blog/art-of-masking-women-with-autism/

What Are the Signs and Symptoms of High-Functioning Depression? (n.d.). Retrieved August 03, 2020, from https://www.bridgestorecovery.com/high-functioning-depression/signs-symptoms-high-functioning-depression/

Section 2

Bregman, R. (2020). Humankind: A Hopeful History. Bloomsbury.

Elk, A. (2017, January 26). 'Split' review. Retrieved from Time to Change: https://www.time-to-change.org.uk/blog/split-review

Frankham, E. (2017, October 23). Stigmatizing Media Portrayals: What Can We Do? Retrieved from nami: National Alliance on Mental Illness: https://nami.org/Blogs/NAMI-Blog/October-2017/Stigmatizing-Media-Portrayals-What-Can-We-Do

Haider, A. (2018, August 28). How cinema stigmatises mental illness. Retrieved from BBC Culture: https://www.bbc.com/culture/article/20180828-how-cinema-stigmatises-mental-illness

Levin, A. (2011, December 16). Media Cling to Stigmatizing Portrayals of Mental Illness. Psychiatric News. doi:https://doi.org/10.1176/pn.46.24.psychnews_46_24_16-a

Lim, J. (2019, October 14). The Big Read: With youths more open about mental health, it’s time others learn to listen. Retrieved from Channel News Asia: https://www.channelnewsasia.com/news/singapore/mental-health-youths-suicide-depression-listen-11994612

Mental Health America. (2000, May 15). The Media's Impact on Public Perception of Mental Illness. Retrieved from News Wise: https://www.newswise.com/articles/the-medias-impact-on-public-perception-of-mental-illness

mothershipsg. (2020, August 02). Foreign worker apprehended after standing on ledge outside window at Kaki Bukit dormitory. Singapore.

Neo, G. (2016, June 22). A straining gap between Singaporeans and foreign workers. Retrieved from Youth.sg: https://www.youth.sg/Our-Voice/Opinions/2016/6/A-straining-gap-between-Singaporeans-and-foreign-workers

Ng, K. (2018, March 11). ‘Crazy, weird, scary’: Survey unveils negative labels youths associate with mental illness. Retrieved from TODAY Singapore: https://www.todayonline.com/singapore/crazy-weird-scary-survey-unveils-negative-labels-youths-associate-mental-illness

NT Contributor. (2004, August 24). Media representation of people with mental health problems. Retrieved from Nursing Times: https://www.nursingtimes.net/roles/mental-health-nurses/media-representation-of-people-with-mental-health-problems-24-08-2004/

Saleh, N. (2020, June 02). How the Stigma of Mental Health Is Spread by Mass Media. Retrieved from verywellmind: https://www.verywellmind.com/mental-health-stigmas-in-mass-media-4153888

Singapore Legal Advice. (2020, May 28). Is Suicide Illegal in Singapore? Will I Be Punished for Trying? Retrieved from Singapore Legal Advice.com: https://singaporelegaladvice.com/law-articles/is-it-illegal-to-commit-suicide-in-singapore-will-i-be-punished-if-my-attempt-at-suicide-fails/

Yeo, D., Poremski, D., & Koh, K. (2020). Migration psychosis and homicide in Singapore: An 8-year update. Psychiatry Clin Neurosci, 74(1), 84-85. doi:10.1111/pcn.12948

Yeo, J. (2020, August 01). Foreign worker apprehended after standing on ledge outside window at Kaki Bukit dormitory. mothership, pp. https://mothership.sg/2020/08/foreign-worker-kaki-bukit-arrested/.