Have a good cry

Tears can soothe in this unusual season when people are experiencing anxiety, loss and collective grief

One minute, he was his boisterous self, belting out one Mandopop song after another at home. The next moment, he was crying like a baby.

Missing You Every Day - a poignant tune by the late Taiwanese singer-songwriter Chang Yu-sheng - was playing.

Surprised by his sudden tears, freelance photographer Tay Kay Chin, 54, mentioned the episode to a friend who bonds with him over JJ Lin songs and K-dramas.

"She assured me that it is okay to let down our guard once in a while, especially in this difficult period," he posted on Facebook.

"We agreed that music just has this strange power to move people, especially now."

He has also cried while watching the space docu-drama Apollo 13 (1995), during the uplifting scenes of the astronauts finally making their way back to Earth, he tells The Sunday Times.

There is "no shame" in weeping, he believes. "I feel absolutely 'shiok' after crying and, occasionally, I will burst out laughing at my silliness."

STOLEN MOMENTS

Crying is normal, especially during the coronavirus pandemic, experts say.

Tears can soothe, among several benefits, in this unusual season when people are experiencing anxiety and loss.

Conversely, not being able to express emotion may be more worrying, they caution, even if tears are deemed very private in Singapore and many societies.

  • HELPLINES

  • • National Care Hotline: 1800-202-6868

    • Fei Yue Community Services: Register for online counselling at www.ec2.sg

    • Touch Community Services TouchLine: Call 1800-377-2252 or e-mail counselling@touch.org.sg

    • Care Corner Counselling Centre: 1800-353-5800

    • Silver Ribbon: 6385-3714, 6386-1928 or 6509-0271

    • Institute of Mental Health's Mental Health Helpline: 6389-2222

    • Samaritans of Singapore: 1800-221-4444

Placing Covid-19 cathartic crying in perspective, clinical supervisor Jasmine Yeo from Safe Space, a digital platform that facilitates online counselling, says: "One unspoken devastation of the coronavirus pandemic is the stolen moments across the globe."

There are no baby showers and no large send-offs for funerals. Weddings are postponed and hugs are deferred.

"The disruption to our routine and normality of life contributes to this universal uneasiness and sadness we all are feeling," she notes.

Ms Mandy Tay, a visual storyteller who produces commercials, sobbed for lost time with her Swedish beau.

Last December, the two travel lovers met for the first time in Lebanon. Since then, she had visited him twice in Sweden and he was planning to fly here in early April.

That did not happen, of course, and it was hard, especially without him around at her milestone 40th birthday this month.

"But I think I was suppressing all of it, keeping myself busy. I was doing okay - good, in fact. But when the circuit breaker was extended to June 1, I burst out crying for the first time," she says.

"I think I was frustrated and wrung out of my unrealistic hopes that we would see each other again very soon."

MENTALLY WELL

Crying more easily now, or feeling depressed, does not mean one is mentally unwell.

Dr Morrison Loh, head of the medical directorate at Raffles Health Insurance, says crying is "a release of emotion" for some people - to relieve stress from Covid-19 uncertainty, for instance, or to share the joy of someone dear who recovers from the virus.

In non-coronavirus situations, people may get emotional over a job loss, examination results or a child's birth.

"However, this does not mean we are suffering from any mental condition," he says.

"Patients with true mental illness undergo long periods of such emotions and are unable to come out of it, leading to the presence of physical symptoms and loss of daily functioning," he explains.

The reality is that crying is one coping mechanism among many. "Some feel relief through crying, others through eating, drinking alcohol, exercising or talking to someone else."

Culturally, crying is often deemed a sign of weakness, says Ms Sarah Poh, a mental-health counsellor and founder of The Therapy Platform, a therapy booking platform.

"It is normal to cry when we feel hurt or when we feel someone's hurt. However, there is a negative association of crying with 'not being strong enough' or being 'like a child'. These negative associations result in shame."

Root out the shame, she counsels. "I think for people to feel comfortable in expressing emotion, we first have to deal with the emotion of shame, which is largely a culturally evoked emotion."

Mental-health professionals are more concerned about those who cannot cry, as they may be repressing their feelings and suffering psychologically.

"When crying no longer makes sense to the person, it is a clear sign to seek professional help," she says.

In the same vein, psychiatrist Kua Ee Heok says: "People with difficulties in expressing their emotion often see a doctor for physical health symptoms like headache, chest discomfort and insomnia, which are somatic symptoms of underlying anxiety or depression."

DOCTORS UNDER STRESS

So it seems like a healthy sign that Prof Kua has met Covid-19 front-line doctors and nurses whose eyes welled up in tears when they reflected on their heavy burden of care and their fears.

In a recent Zoom meeting, he spoke on anxiety to 370 doctors.

"Crying is therapeutic, for it unbottles your pent-up emotions of sadness, frustration and fear," says Prof Kua, a senior consultant psychiatrist at the National University of Singapore's department of psychological medicine.

One doctor he encountered felt "crushed" and had "knotted" feelings, he recounts. She was also sad, disappointed and even angry when a friend avoided her for fear of contamination.

"She is better now after a session of counselling and is back at work with good family support," he says.

"Doctors feel they have to remain stoic in the most demanding and distressing situations."

Some psychiatrists, including Prof Kua, who is the Tan Geok Yin Professor in Psychiatry and Neuroscience at the university, offer pro bono counselling to doctors under stress.

BREAKDOWN BENEFITS

Recently, a New York Times column carried the click-bait headline, Crying In Your Car Counts As Self-Care. The story normalises crying, among an array of actions to find headroom and even joy in dispiriting times.

Dr Loh from Raffles Health Insurance, a member of the Raffles Medical Group, describes two overarching sets of benefits.

• The "self-soothing" effects of crying on individuals. This reduces stress and enhances mood.

•The effects of a person's crying on other people. This promotes empathy and social bonding.

Notably, when athletes cry in triumph or defeat, or when prominent people get misty-eyed, they may form connections with the public.

He cites the examples of former British Prime Minister Theresa May, who cried during her resignation speech last year, and National Development Minister Lawrence Wong, who was moved to tears in Parliament on March 25 when he spoke about the fight against Covid-19.

In this light, Dr Loh says: "I think we should be more open to public displays of emotions. Singaporeans are still, in my opinion, considered a culturally reserved population."

FEELING WORSE

He acknowledges that some laboratory studies show that subjects feel worse after crying. This may be because the physical act of crying results in the "over-stimulation" of the crier's flight-or-fight response.

"Hence, the physical act of crying actually can have a negative physiological impact, but the individual might feel better after crying," he says.

Whether crying is cathartic depends heavily on the person who is crying, he notes, and also the reason for the tears.

In a study published in The Journal of Social and Clinical Psychology, researchers found that 70 per cent of people who looked back on recent crying episodes reported that their tears brought solace. But about 16 per cent experienced negative reactions from others, which made them feel worse.

Context plays a role. Being comforted by someone and reaching a new understanding of the event that caused the weeping are cathartic, according to the study. But experiencing shame is less likely to be so.

In context, Dr Goh Kah Hong, head and senior consultant of psychological medicine at Khoo Teck Puat Hospital, says: "Like laughter, crying in itself is not good or bad. Though most of us would agree, sometimes being able to cry does indeed feel good."

He adds: "Of course, crying may not feel so good when it is out of sync with our emotions or when we feel like it is out of control and prolonged."

PANDEMIC OF FEAR

Anecdotally, people with no underlying mental-health issues have remarked that they feel overwhelmed during the pandemic and wonder why they are teary or heavy-hearted.

Prof Kua, whose books include Speaking Up For Mental Illness, says he had numerous e-mail discussions with professors of psychiatry from China, Japan, the United Kingdom and the United States.

"We think there's also a pandemic of fear," he says. "When the pandemic is prolonged, it saps our mental resilience. There's a sense of helplessness and people become burnt out, sad and tearful."

The sadness may also be other-centred. Ms Poh from The Therapy Platform says: "Sometimes, we can feel the emotions of others without knowing it. We can feel the grief of others without seeing them."

This can explain why people can now feel "collective grief" that is not triggered by their personal circumstances, she adds.

Ms Louise Daley, deputy chief executive (Asia-Pacific) of global hospitality company Accor, recounts the first time she cried during the pandemic.

Recently, an Australian colleague asked Singapore-based Ms Daley if their scheduled 8pm call could be postponed to 9pm. He wanted to see his mother, who had dementia, before her nursing home was locked down that evening.

"I cried at the dislocation of people. During the lockdown, we are separated from loved ones, particularly some loved ones who don't understand why that's the case," she said during a webinar organised by Web in Travel, a content and community platform specialising in online travel.

"That was really the first tough moment. But it kind of galvanised me for many, many tough moments to come."

Perhaps some of the stigma of crying will dissolve during the pandemic. In Ms Daley's case, her empathetic tears also steeled her for an unimaginable crisis in the travel industry.

As Safe Space's Ms Yeo recommends: "Cry it out, release the stress hormones, come back stronger."


Facts about crying

1

People shed three types of tears. Tiny drops of basal tears flow continuously to lubricate and clean the cornea. Reflex tears protect the eye from irritants such as pollen or pepper spray. Emotional tears are triggered by stress, joy and other intense feelings.

2

Some personality types tend to cry more easily, including those who are empathetic, extroverted or anxious.

3

Women cry more than men. One estimate by neuroscientist William Frey is that women cry 5.3 times a month compared with 1.4 times for men. This gender difference appears to be both cultural and biological.

4

Japan has crying clubs. Men and women weep together to lighten their emotional baggage at rui-katsu (tear-seeking) sessions, where they may watch a tear-jerker film.

5

A newborn can wail for up to two hours - possibly longer - for various reasons. For instance, a hungry cry can be short and low-pitched, while a cry of pain is often a sudden high-pitched shriek.

6

Sleep-crying is real. People sometimes wake up with wet cheeks because of a sad dream, stress or chronic pain.

7

Too embarrassed to cry in front of someone? Try to postpone the tears. Alternatively, you can excuse yourself and look for an appropriate spot to get emotional.

• Sources: Mayo Clinic, The Japan Times, HuffPost, WebMD, Healthline

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A version of this article appeared in the print edition of The Sunday Times on May 24, 2020, with the headline Have a good cry. Subscribe