A Personality Disorder is an enduring pattern of internal experiences and behaviours related to one’s perception of the external world that deviates drastically from societal expectations. 

It was an evening appointment, I recalled, when I first met Mavis (not her real name): A polite young lady dressed in her school uniform. “Mavis, hello! This way, please!” as I ushered her into the therapy office. Mavis was frustrated, confused and deeply hurt about chronic interpersonal issues (e.g., family, friends), on top of impending national exams. Mavis was tormented by daily suicidal thoughts and her body was constantly in distress and physical pain, which partially explained her thin frame.

Mavis described her pervasive struggles with interpersonal relationships (e.g., “I don’t know how to be around people”), existential dilemmas (e.g., “Who am I? I am not human.”), and the constant experience of hopelessness and helplessness. She often appeared furious when discussing her family and friends; however, I never failed to observe the hint of desperation and fear for the real or imagined loss of these relationships. Mavis’s inability to fully experience and express her emotions often led to self-isolation and feelings of emptiness. Frequent memory lapses, difficulty in focusing attention and retaining learned information were other challenges faced by Mavis. On her “up” days, Mavis can pull off consecutive all-nighters or lose herself in multiple competing projects with little to no sleep.

Imagine being Mavis for a minute: A brilliant mind fraught with chronic turmoil and emotional distress.

A Personality Disorder is an enduring pattern of internal experiences and behaviours related to one’s perception of the external world that deviates drastically from societal expectations. It develops during adolescence or early adulthood in response to chronic stressors in the environment, leaving significant gaps between one’s true potential and current daily functioning.

Commitment to psychotherapy and psychiatric support is crucial during the recovery process. It may be challenging and scary at first to see the world differently; however, the success of one’s hard work materializes when the improved communication skills and ability to regulate emotions leads to better expression of one’s needs and having them fulfilled successfully.

Are you ready to work for this life that you can have?

These were Mike’s (not his real name) greeting words to me as he wiggled his amputated left little finger.

“Six months ago, I cut off this finger as a reminder and promise that I will never gamble again, ” he continued. “I had just lost $300,000 in one week.”
“But I failed to keep my promise….. I simply could not control myself ….. I started gambling again the next day.”

“By then, I had lost almost everything in my life….. my savings, my job, the roof over my head.” Then, with tears welling in his eyes, he mumbled, “And my wife and kids too. They all left me.”

“Even when everything was disappearing in front of my eyes, I could not control myself from betting on those silly soccer matches!” he lamented.

“I could not focus at work. All I had in my head was how to find money and what matches to bet on,” he recalled. “My job performance went downhill. I often went MIA. I even misappropriated company money. Finally, after several warnings, I was sacked.”
“I didn’t wake up despite the sacking. I hid this from my wife by pretending to go to work everyday. Instead, I was placing bets at the illegal dens,” he recounted.

“It was thrilling at first. I loved the adrenaline rush when matches were won and money flowed in. I felt powerful!” he beamed excitedly. He then paused and stared into space, before continuing, “But shortly later, I kept losing and kept chasing my losses.”
“Things began to spiral downhill. My losses were piling. I had to borrow from banks, friends and loan sharks in order to cover my losses, and to have just enough money for my family’s survival.”

“I even sold off my car and apartment. We moved to a rental flat. But I gambled away the proceeds because I was hoping to win back all that I had lost.”

“I knew I had to stop gambling, and I tried so many times to stop. But each time, I felt so restless and edgy that I just had to bet again. The urge was too overwhelming”
“One day, my wife discovered how serious my gambling was ….. the day when the loan sharks splashed paint on the door,” his voice quivering. “I had no choice but to tell her everything. She took the kids and left. I was devastated. In a fit of anger, I cut off my finger as a promise to stop gambling.”

He stared at his amputated pinkie as he continued, “But I did not stop gambling. My mood crashed as my losses mounted. I was so depressed that I kept having thoughts of ending it all so that all these troubles could end. I was filled with guilt, full of shame. But I could not bring myself to do it because I still carried this hope ….. the hope of reconciling with my family.” Tears now rolled down his cheeks.

All this while, I listened attentively as Mike unreservedly poured out his story. Mike suffered from Gambling Disorder, an addictive brain disorder that is very similar to how an alcohol addict gets hooked to the drink or a substance addict gets hooked to a drug. A disordered gambler loses control over his gambling behaviour, and experiences multiple gambling-related problems. Like Mike, most disordered gamblers often hit rock bottom after having lost almost everything in their lives. Many suffer from clinical depression, being laden with tremendous shame and guilt. About 15-20% of disordered gamblers would attempt suicide. Family and significant others invariably suffer too.

The good news is — Gambling Disorder is a treatable condition. I have patients returning to their normal lives, getting back their jobs and reconciling with their loved ones. The disordered gambling behaviour can be ceased with professional help. Through a combination of medications and counselling, recovery is possible.

Mike managed to stop gambling with the help of treatment. Although it took some time and lots of perseverance, he eventually reconciled with his family, found a new job and repaid his debts. As for his shortened pinkie, it will forever serve as a reminder to him to never return to those dark gambling days.

Jack (not his real name) first saw me at my clinic because he was concerned about the way he was consuming alcohol.

What started off as leisure drinking with friends during weekends gradually became an integral part of his daily routine. He simply couldn’t stop drinking!

He needed to have his daily dose of beer from the moment he woke up in the morning, throughout the day, to the time he hit the bed at night. Without alcohol, he would become restless and edgy, and would not be able to function at work. He needed the drink constantly to calm his nerves and appear ‘normal’ in front of others. Without the drink, sleep was an impossibility. Alcohol had become a constant companion in his life that he could not live without. He felt trapped. He wanted to break out of this pattern of daily drinking. He wanted to be normal again, in the true sense of the word, without the drink. He tried so many times on his own to fight off the alcohol, but he could not succeed. Finally, he decided to seek professional help.

What Jack suffered from was a condition known as Alcohol Use Disorder. He had become physically and psychologically addicted to the drink. Like Jack, countless others with alcohol dependence have tried to stop drinking on their own, but most either failed to succeed or were not able to sustain a considerable period of sobriety. Professional treatment using a combination of medications and counselling offers the best chance for recovery.

After working with me over several treatment sessions, Jack finally shook off the alcohol. He didn’t need the drink anymore. He was ecstatic! However, I cautioned him that his recovery had only just begun, for recovery is always going to be a long journey. The road ahead is paved with temptations and triggers for relapses. But by applying skills that are acquired through counselling, and with the help of medications, long-term sobriety is possible. Jack did exactly this and continued to maintain his sobriety as he soldiered on the path of recovery.

Consultant Psychiatrist, Dr Thomas Lee

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“1, 2, 3, 4, 5. Once I caught a fish alive.

6, 7, 8, 9, 10. Then I let it go again.

Why did you let it go? Because it bit my finger so.

Which finger did it bite? This little finger on the right.”

This is not a simple nursery rhyme.

At least not to Danny (not his real name). It was a curse to him.

A song that returned to bite him again and again, since he was a teenager.

For whenever Danny needed to perform a particular ‘critical’ activity, he had to sing this nursery rhyme PERFECTLY without any errors before he could feel at complete ease to carry out that activity. For example, before he opened his car door or turned on the stove, he had to hum this nursery rhyme. If something went awry during the song — a word sung wrongly or pronounced unsatisfactorily, the tune went off slightly, the tempo was too fast or slow, or a stray thought popped into his mind — he had to repeat the song again until he got it PERFECTLY right. Most importantly, the volume of the numbers (1-2-3-4-5, 6-7-8-9-10) must be LOUDER than that of the words. So he must be sure to emphasize the numbers. And finally the finale — he had to wriggle his right little finger exactly 10 times at the end of the song.

Danny rarely got it right just once. Almost always, he had to repeat it several times before he was satisfied. This would usually take anywhere between 1 and 5 minutes before he could open his car door or turn on the stove.

Danny hated doing this. He knew it was absurd and nonsensical. But he felt totally helpless. He simply could not resist or fight it because he had this dreadful fear that some kind of disaster would befall him or his family if he did not sing it perfectly before each ‘critical’ activity. Such fears include serious vehicular accidents, explosion of stove, or some mishaps that could result in serious injuries or even death to him or his loved ones.

Imagine Danny’s life. Opening a car door and turning on the stove were only two examples of many ‘critical’ activities in his everyday life. His work was persistently hampered by this compulsion to hum the song before performing activities like switching on his desktop computer and opening his office door. It got worse over time. His life, work and relationships were mercilessly disrupted.

For Danny, life was a constant battle day and night as he struggled to fight the irrational thoughts in his head each day. Time seemed like an eternity as he wearily fought each skirmish alone and silently.

To the observer, Danny was an ineffective person who took longer than necessary to do anything. He was often observed to be distracted or staring blankly. Friends and colleagues avoided him. His superiors chastised him. Only his family stood by him ….. helplessly.

Danny suffered from a mental disorder known as Obsessive-Compulsive Disorder (OCD). A person with OCD has recurrent unwanted thoughts (obsessions) that generate intense fear, anxiety and worry. In order to eliminate such distressing thoughts, the person has to carry out specific actions in a rigid and ritualistic manner (compulsions). For Danny, the very fear of calamity befalling him and his loved ones (obsession) overpowered him to sing a perfect nursery rhyme (compulsion) resignedly so as to neutralize any possibility of a disaster. As a result, a person with OCD invariably suffers significant disruptions and impairments in most aspects of his or her life.

Obsessive-Compulsive Disorder is a treatable condition. A combination of medications and psychotherapy is the most effective way to alleviate the symptoms of OCD and to bring about recovery. Quality of life can improve. Life functions can be restored. For Danny, treatment gave him back his independence and freedom to live as normally as anyone else.

“My sky is black,” Jane (not her real name) sobbed. “Filled with dark clouds, not a light through.” Jane’s tears kept flowing during the entire interview session as she poured out her problems.

She had been feeling down for the past six months. She described how she had to struggle through each day with her mood down in the basement. “I hate to wake up every morning. The very thought of having to battle through the rest of the day just makes me feel worse. I cannot muster enough energy or motivation to do whatever I need to do,” she said.

“I can’t focus. My mind wanders off so easily. It’s like I’m in dreamland all the time. I can’t remember things well now … very forgetful. I may be in a meeting or staring at the TV screen, but I don’t remember what was discussed or what the story was about. I have to read and re-read even a simple sentence many times before it registers in my head.”
“I feel extremely irritable and jumpy. I can’t control my emotions. I become an angry person. I yell at people, at my friends and even my bosses! Very often, I had to excuse myself from an important meeting — abruptly — just so that I could run to the nearest restroom to cry. I cry at home, on the bus to work, when I meet my people ….. I just don’t understand why I cry so easily.”

“I have lost all interest in meeting people and friends. There is no longer any joy in stuff that I used to love to do. I don’t even feel like bathing.”

Insomnia was a nightly problem that she had to struggle with. She had trouble falling asleep every night. Also, she was easily startled in her sleep and woke up several times a night. The exhaustion from the lack of adequate sleep prevented her from functioning properly at work.

Appetite became negligible. “I don’t eat much now. Just nibble a bit each day just to survive. I’ve lost 10 pounds in two months.”

“I feel so lousy about what’s happening around me. I don’t know why … but I just blame myself for everything that goes wrong.” Then, she paused for a long while and stared into space before continuing, “Sometimes, I just don’t feel like living through this torture anymore. I want to disappear forever.”

It was a good long session. Jane hadn’t been able to share her pains and sorrows until now. It wasn’t because she had no one to talk to. She felt embarrassed to talk to somebody about what she was going through. She was fearful of being labelled ‘mad’ or ‘crazy’. So she chose to suffer in silence.

Jane suffered from a severe depressive disorder called Major Depression. It is a medical condition that is serious enough to incapacitate a person and disrupt his or her ability to cope with day-to-day living. Usual simple tasks at home, work or school can become laborious and wearying. A depressed person often sees the world as dark or even black. Nothing seems positive.

Early recognition of depression is important so that treatment can be rendered as early as possible. Medication is the primary and most effective treatment in Major Depression. Psychological therapy and counselling are also useful and effective.

Treatment wasn’t easy at the start as Jane struggled to overcome the barrier of accepting that she had depression and that she needed treatment. She had feared that this would further reinforce the label of her being ‘mad’. However, with the support of family and close friends, Jane eventually recovered with treatment. She regained her health and her ability to work and play, renewed relationships with her family, friends and colleagues, and most importantly, restored her confidence and self-esteem. “The world is brighter now, as it has always been,” she said during one of her follow-up sessions with me.

“The sky is blue.”