A Conversation with Self – Maneuver your life with self-care for mental health

Introduction
In response to devastating effect on the emotional and psychological well-being of community due to COVID-19 pandemic, Sunway Philanthropy Office successfully organized a webinar on ‘A Conversation with Self: Manoeuvre Your Life with Self-Care for Mental Health’ to raise awareness on mental health literacy on 25 August 2021. Professor Elizabeth Lee, CEO of Sunway Education Group (SEG) who delivered the welcome remarks, highlighted the importance of self-care in maintaining a good mental well-being especially during pandemic. In the webinar moderated by Ethan Ganes, our own Psychology Department Alumni from School of Medical and Life Sciences, Dr Hariyati Shahrima Abdul Majid, Consultant Psychologist of MERCY Malaysia shared her nuggets on self-care practices for better mental health. The attendees included students and staff of SEG as well as interested members of the public. Datin Raja Riza, Director of Sunway Philanthropy Office closed the webinar with words of encouragement on maintaining a good mental health literacy.

Content

M: Let me start with a question that I think a lot of us can resonate with. Recently we are all on social media all the time and we have social media telling us the right way to self-care, most of the time only examples such as take a nap, eat some marshmallows are given and it is a little hard to pin down exactly what is self-care and where we should start. Could you tell us a little bit more what exactly is self-care?

S: All right, before I jump into what is self-care, I hope that you see this event as a safe space for you to feel that you are being cared for, this is part of your self-care. The fact that you are deciding tonight to spend an hour, an hour and a half with all of us alright to learn something new about yourself to learn something to get insights and your perspective on things.

The common definition of self-care is that deliberate, intentional activity that you planned for yourself so that you are psychologically better, physically healthier, and be more at peace with yourself. I usually see it as a gift to yourself. A lot of people when they think about giving someone a present something they consider the things that are valuable. Question is what do you gift yourself? In the 24 hours that you have in a day or in seven days a week that you have how much time do you gift yourself so that you are able to do something that will enhance your physical health, improve your mental health and carry out the tasks that you have as a student, lecturer or even an administrator.

When the MCO was announced a year and a half ago there are hotlines all over the social because I believe it is important to educate Malaysians on the importance of self-care. A lot of people usually do not put themselves first and people often say that self-care is a form of indulgence. Self-care is about prioritizing yourself so that you are not left empty and be able to be a better version of yourself and contribute to the people around you. Self-care is a personalized preference. For example, some people enjoy eating “cempedak goreng” (jackfruit fritters) for tonight and so this is something that he/she enjoys and can make them feel better. As for me, I make sure that I have my quality sleep and it is something that I do not compromise. I enjoy my sleep; I love my sleep and I am aware that I cannot get too much sleep because I am also a caregiver to my dad who has Alzheimer's. I take care of him during the midnight, but yes, I make sure that I practice sleep hygiene by getting quality sleep. This is something deliberate, something that you contemplate on and something that you think about that you know it will help you to carry out your responsibilities.

G: Thank you Dr. Hari, I think that beautifully segues into the next idea. Once somebody asked me, "How do I see my sleep as important? I keep seeing it as the thing that I give up.” I thought this question was relevant, especially to us students. Maybe you can point out some red flags that tells us it is time to really push the brakes and do something about it.

S: I think the most important thing for you to remember is to be mindful and be aware of the changes that are happening to you. Sometimes it's difficult for us to detect thought patterns where we experience more stress, more anxiety, more negative emotions, but in the meantime, we can observe, or other people also can observe behavioral changes in us. So, one way of identifying what are the early warning signs would be behavioral indicators. For instance, you enjoy your meal, and you like what you are having for dinner today, but if suddenly you find yourself not having the appetite to eat. Sometimes you do not recognize that, but your friends and your family members do. They may come up to you and point out that you have not been eating well the past few days and this is very important feedback for you to reflect on. Do not deny and say, “You know I've been eating”, but you know yourself that it is otherwise. Another common scenario would be someone says you look awfully tired, and you are in denial and said, “I’m fine”, truth is when they observed the changes in you alright how tired you look, how sluggish you look or how uninterested you are you need to take a step back and tell yourself that these are actually indicators that I'm not taking care of myself. People often think that “sleep is only for the weak” don’t you remember how us humans get our energy back? Sleeping is a natural way for us to reenergize the resources that we have depleted during the day and that is the time where we gain back our resources to be able to meet the demands that we are going to be facing the next day. All in all, it is good if you yourself realize the behavioral changes and remind yourself to acknowledge the changes and do something about it. This is part of self-care.  

G: I think this is what many people are facing today, that there are a number of people in our audience who has starting to realize something does not feel quite right, and I think we have got two groups, one group is asking for advice on what they should do as they are feeling isolated by themselves without their loved ones around, while on the other hand, another group has too much to deal with family in the house: work, children, studies, or some have to juggle both. In this case, what are some things they can do for themselves?

S:  We are all weathering with the COVID-19 pandemic, and I believe a lot of people are currently working from home (WFH) and I usually avoid using that term because I don't believe in that. In fact, I trust that everyone is now working at home instead and at the same time trying their best to balance all the variables that are around them and I know it is not easy. For instance, a lecturer used to go to university and fully focus on preparing for next class or meeting students for consultation, but currently a lecturer had to stay at home, cook a meal and clean up afterwards. The important thing here that you need to be able to prioritize the list of things or responsibilities, to identify the must dos, should dos could dos and something nice that you can do but not relevant for now. It's very important for you to create that boundary; being able to have the space not just a physical space but a psychological space to carry out responsibilities as a student, lecturer or staff. For example, I start my work at 4:00 o'clock in the morning and therefore, I sleep early; I make sure I sleep at 10pm and no one disturbs me after 10 o'clock. I can focus and work happily, and this is my self-care. I think it is important that on a daily or weekly basis, list out the must dos, should dos and could dos.

For those in isolation, I think it's very important that you create, or find innovative ways to ensure that you are still connected to the friends or family members around you, schedule online meetings so that your parents know that they are still your priority, or schedule a Zoom meeting with your colleagues or close friends to have a short catch-up session and reconnect with them again, sometimes you might even find something new or interesting about them. I think there are many ways for you to ensure that you do not feel isolated and I am sure that you can call helplines so that you do not feel that you are on your own.

M: I think basically as you were sharing for those of us who have too many things to do, maybe it is about deciding what are the must dos and then another tier of should dos and could dos. And of course, at the lowest tier, the nice to have. I think that's a that's a very good emphasis. I was just thinking self-care is at the bottom and then the rest only comes after.

S: As mentioned earlier, self-care is a gift to yourself, and it can even be 3.5 minutes for yourself. Just so you know, when I find myself very overwhelmed, I just step out and play catch with my cats, they are happy, and I am happy too. We have got adrenaline and endorphins, merely playing with cats is just something that I know that can help myself and I call this as my “Emergency self-care plan”, where I execute this when I am in a critical situation. Also, know who you can rely upon and avoid those that may trigger or worsen your current mental state such as avoiding reading toxic messages on Whatsapp. I think the “Emergency self-care plan” is superbly applicable in somewhere we can all stand up.

M: Sometimes I do feel it like there is a very big sense of hype over what is the ultimate self-care, but I guess self-care is something that works for you and something that you can do for yourself. The next question was quite interesting because it talks about what one should do when motivation is running lower while struggling with studies and not prioritizing self-care at all.

S: Let’s talk about something that many of us can relate to. This is a psychological syndrome where we feel what we have been exposed to stress source that we have not been able to cope for a prolonged period, and so many students may feel burnt out, emotionally exhausted to think about studying. Well, is it fatigued or tired? There is a difference between being exhausted and tired; being tired is when you feel refreshed after you sleep for a while, whereas exhausted means the depletion of your energy such that you cannot continue to think about what you need to do. It is also worrying when you have thoughts such as “Why should I do this? No matter how hard I work it will still be the same”. You have become cynical and disillusioned; you know you promised things but not delivered, you feel that you are not being efficient, and you do not see any improvement, yet you are still facing the walls. I think is time for you then to take that step back or seek help and get someone to have a conversation with and find that intrinsic motivation. While looking for intrinsic motivation, you may want to go back and look at the things that you have been able to do successfully before and look upon your past achievements. This is important because people tend to forget, and they do not give themselves credit enough when they have done something. For you to get back your motivation, identify both these strings: motivation and the process of reigniting the passion, get support from the people you trust to help you bounce back or prepare for crisis that may happen in future, and speak to someone who may be able to appreciate what you are going through, then you may communicate with them and see things in different perspectives.

M: I do not think that is ever easy and for reminding us, you know, when times get a little bit low, and so is our motivation, we can draw on the initial spark as well as just redid. Revisit some past success to remind us that we can do this and that we are a generation who is getting a resilient certification. Let’s tackle a challenging question: some people are having difficulties getting their sleep back on track and some people are starting to get worried about reaching levels of anxiety or depressed lines. What is something those people who are reaching that point should do?

S: Disclaimer I am not a clinical psychologist so this will be recommendation by going back to the question that you've asked just now. We often talk about sleep hygiene, and as mentioned previously, it is extremely important to gift ourselves and it is not the easiest thing to do, because we do not see sleep as important. Therefore, it is not easy for you to practice sleep hygiene. A shortcut way to tackle this is to remind yourself that your bedroom is a place for you to sleep and rest, not a place where your brain is reminded of stress. Understanding that not everyone has their own room and not everyone has an office for themselves at home, but it is your decision that you must make on what to put aside so that your bedroom is only for relaxation and people often forget about. Besides, for us to be able to sleep, we need to take several measures; similar concept with warming up before exercise and cooling down after exercise; do not go to sleep with your mind still processing whatever that is happening or what needs to be done, the crucial element is the cooldown period. For instance, making sure that half an hour before you plan to fall asleep, you are already engaged in things that can relax your mind, rather than watching a thriller or checking messages on Whatsapp which might stimulate your brain when you found out there are more tasks that need to be done tomorrow. Allow yourself to separate your worries come from your rest time.

However, if you are beginning to show signs of depression and anxiety, it is important for you to mobilize social support at different levels: tangible support, informational support and emotional support, and of course, the highest tier would be people like clinical psychologist or counsellors for you to reach out and request for a session. Sessions are very important so that you know that there are many people out there who want to provide that support and you know the number of helplines now in Malaysia is an indicator that people want you to know that there is support. In the meantime, though, before you get an appointment or you cannot get through, make sure you have tools that you can use to manage your emotional distress, such as breathing techniques or relaxation techniques, practice them and make it a natural part of your daily functioning and remind yourself to do it so you do not experience the distress that may act as barriers for you to function. Well, it is not the solution to everything, but at least a starting point and when you are practicing these techniques, there is a need for you to be appreciative of the effects it has on yourself.

M: A listening ear to information and tangible stuff, as well as knowing that there are lines out there that can give you mental health support for your depressive nerves or anxiousness and in the meantime taking those steps to hold space for yourself. Another question is, how do you deal with the guilt of cutting out people you love, but they know that you know that they are not good for you. How do you deal with that guilt?

S:  Definitely not an easy question to answer as I do not know the circumstances behind it, but you should know the reasons why you cut them off in the first place right up and you may want to reflect upon the reason why you do that. For you to be able to reach a place where you are at peace with that decision, you need to be able to restructure how you think. So, ask yourself, what makes you feel guilty in the first place? Is it because they used to do something good for you but not anymore? Did they hurt you lately? How you feel about it? In my opinion, I believe at the end of the day, perhaps there will be a time where you reach that level of peace, you are going to be able to go back and make peace with those people. I am not going to be able to answer that question in a direct manner because I do not know the circumstances but to me, guilt, is usually a result of any inconsistency in the way you think in and the way you feel about things. But I truly believe if you really understand the reason why you had cut them off in the first place, the guilty feeling will slowly fade, and you will be able to accept the reasons why.

M: I think that's a good point, understating the time to understand and reflect on the main reason that you felt the need to exclude these people. Let’s move on. There are a few questions, but one of them is asking a little bit more about the state of mental health in Malaysia. Briefly speaking, how well are we doing?

S: This is a very important question. Based on my observations from my working field before the pandemic, one in three Malaysians was already reporting mental health issues as reported and we were already spending quite a bit of money on treatment of mental illnesses, although not as much as we should be because people still think of mental illness as a taboo. When the pandemic happened, we knew this was going to be an issue. From my perspective, younger people are a lot more literate when it comes to mental health issues or illnesses. There are still a lot of things that need to be done at the different levels of society and parents need to be willing to speak about mental health. I think people are now more aware of the need to understand more about mental health and it has become a priority at least the third tier of the resources allocated for it, like how common friends now have their own helplines or counsellors and psychologists to work and, and I hope that this not just a trend but a form of culture.