Illuminating the darkness, one step at a time

The first time I allowed myself to even contemplate that I could be struggling with my mental health, I came apart at the seams.

It had been a rough few months.

My mother was diagnosed with two primary cancers in early 2019, and as her eldest daughter, I was plunged into an unforgiving schedule of appointments for procedures, scans and chemotherapy amid my own hectic work commitments.

Devastated by her diagnosis, my mother was also constantly being haunted by thoughts of her mortality. After one particularly exhausting morning at the doctor’s, she asked, quietly: “Do you think I’m going to die?”

The weight of her question hung in the air. I fought back tears and wordlessly gripped her hand.

So, a few hours later, when a work acquaintance gently probed into how I was coping, my facade crumbled, and I collapsed into tears.

Everything I’d been holding in came tumbling out – the fears that kept my heart racing in bed at night, the burnout from juggling multiple responsibilities, and the bleakness of life that threatened to overwhelm me.

I thought I was finally letting off steam. But after comforting me, she encouraged me to consider mental health support.

Her concern gave me the validation that all the struggles I’d been grappling with were not just in my head, but real.

But still, were they bad enough that I needed professional help? I couldn’t shake the nagging feeling that I might be making a mountain out of a molehill.

Seek help early

What I didn’t know then was that pain does not need a clinical label to be worthy of a therapist’s time.

Mr Andy Lam, president of the Singapore Association for Counselling (SAC), pointed out that while mental health literacy has improved, understanding still tends to remain around

mental disorders that are diagnosed by doctors which may require

But not everyone who needs mental health support has a clinical disorder.

“When social understanding of mental health and seeking support are primarily within these parameters, it is understandable that many may experience tremendous apprehension. The barriers to action can be extremely daunting,” said Mr Lam.

“If you notice incremental moments of lower mood, where you’re not as happy as before or as interested in life, this is when you can start thinking about speaking to someone instead of ruminating over it.”

Looking back, sitting down with a counsellor when I was initially battling waves of stress and burnout would have given me helpful coping strategies. You don’t need to be drowning to appreciate a float.

I finally sought help in late 2021. A few months after my mother went into cancer remission, the Covid-19 pandemic hit. Its frequent changes and social isolation exacerbated my feelings of anxiety and burnout. At the same time, my decade-long relationship with my fiance came to an end, and we called off our wedding six months before we were due to tie the knot.

Depression is often thought of as crushing sadness, but it can also manifest as debilitating existential ennui. Like the emotional equivalent of losing the ability to taste, things that I used to savour – a good meal, laughter with friends, the fresh air during an early morning hike – all felt like sawdust.

As the alternating waves of sadness and banality sapped the colour and purpose out of life, daily errands started feeling like arduous chores. Cleaning my room, having regular meals, making my bed, it all seemed like too much work for too little reward.

Logically, I knew that these were small, everyday tasks. But helpless in the grip of depression, I simply could not bring myself to do them.

Making sense of the landscape

After a weekend where I slept for 20 hours a day to escape my dark thoughts, I knew I had hit rock bottom and needed help.

While help was not in short supply, the choices were not clearly signposted for a first-timer trying to make sense of the system.

There are various helplines and chatbots, family doctors and polyclinics which can provide referrals to public hospitals, community counselling services, and options in the private sector, but I was not sure where to start and what to choose.

Adding to my confusion was the different types of mental health professionals in the space, like psychiatrists, psychologists and counsellors.

Explaining the key differences, Mr Lam said psychiatrists are medical doctors who oversee interventions such as medication, hospitalisation and medical treatments.

Psychologists can provide diagnoses based on psychological assessment and evaluation tools.

Counsellors are trained to provide mental health support for clients with problems and struggles that are specific and current to their present realities, like stress or grief.

Another consideration for me was waiting time. I heard people could wait months for an appointment.

According to figures from the Ministry of Health, the average median waiting times for new subsidised appointments across public hospitals to see mental health professionals have risen from 2018 to 2023. The average median waiting time to see a psychiatrist jumped from 27 days in 2018 to 47 in 2023, and that to see a psychologist rose from 28 days to 36.

As my thoughts turned gloomier, I could not bear to wait so long. I decided to look in the private sector, but that came with its own set of challenges.

“Clients will need to do their own background check on the therapists of their choice, since counsellors and psychologists do not need a licence to practise,” said Ms Voon Yen Sing, deputy director of clinical services at the Singapore Association for Mental Health.

One way is to explore the list of registered professionals from the SAC or the Singapore Psychological Society (SPS), said SPS president Adrian Toh.

“Registered mental health professionals, who adhere to their respective associations’ codes of ethics, are required to practise within their areas of competence. They are also responsible for referring patients to the appropriate professional if the issue presented is beyond their expertise,” he said.

In my state of mind then, navigating these challenges felt like moving through a dim maze where the signs might as well be written in another language.

Thankfully, my friends, whom I am eternally grateful for, stepped in to help me shortlist a list of professionals, set up appointments, and even accompany me to the clinics.

As it turned out, I had no need to fret as the system is designed to refer you to the right type of help.

“Start from who you are most comfortable with and trust – be it your family GP, your school counsellor, a friend or family member who had used the system, a peer supporter in your school or workplace. Then give yourself permission to be open with the paths of care and treatment that open up ahead for you from there,” said Ms Anthea Ong, founder and co-lead of community initiative SG Mental Health Matters.

Being open about your needs

One counsellor, two psychologists and two psychiatrists later, I was diagnosed with moderate depression, and put on a regimen of regular talk therapy sessions along with antidepressants. To afford my treatments, which cost about $500 a month, I had to cut back on expenses like dining out.

Finding the right mental health professionals took trial and error. While everyone I saw was well qualified, rapport and interpersonal chemistry also mattered, as these people were the ones I had to reveal my ugliest thoughts to. One professional spent an entire session going through the various therapeutic approaches that could be used, while another had too big of an age gap with me to understand my millennial experiences.

When I finally found a psychologist who understood me and knew when to give me space and when to probe deeper, it felt like I had struck gold.

Mr Toh emphasised the importance of clear communication between clients and psychologists. “It’s crucial for clients to express their preferences early on.”

He added: “Some may prefer a psychologist of a certain gender, faith or background. By sharing these preferences upfront, clients can avoid unnecessary frustration and ensure a better fit from the beginning, rather than feeling the need to search for the right match later on.”

When I was considering whether to get on antidepressants, I had burning questions around the long-term impact of medication, the costs, and whether I had to take them for life.

Finding someone who could answer all my questions, reassure me and be realistic about the journey ahead was important to me.

While many patients know that psychiatric medications are not miracle pills, it is important that doctors help patients understand the journey involved, said Dr Jared Ng, director and psychiatrist at Connections MindHealth.

“The thing about psychiatric medications, such as antidepressants, is that it often takes two to four weeks to feel any improvement, and up to six weeks to see the full benefit. However, side effects like dizziness or nausea tend to appear sooner, which can be discouraging. That’s why it’s important to closely monitor patients, adjust medications as needed, and provide reassurance that this is a gradual process, not a one-size-fits-all solution,” said Dr Ng.

There is hope

My favourite piece of advice when I was struggling with depression was to not let the big, insurmountable questions crowd my mind. Will I be happy again? Will this pain pass?

While valid, these questions can be paralysing.

But if I focused on questions like, what is one small thing I can do to feel accomplished today, suddenly, the depression doesn’t feel so overwhelming.

A similar wisdom can be applied to those seeking help for the first time.

If you find yourself in a dark place, know that there is no perfect way to reach out. If you’re lost and confused, rest if you must, call for help if you need. The best way out of this maze is through it, and I’ve found kindness and guidance at every turn.

Even if the light in the maze you’re currently in illuminates only the next step – that’s all you need to begin moving forward.