23 February 2021 Appointment Dr Rohayah

History

We had a luxury of time today since I was the first patient and I came early. So, Dr Rohayah walked me through my very first appointment in psychiatry department on 1 August 2017. As she said she should set our pace back to my original issues. We have been distracted by the 'neighbours' problem since these past few months, so we should go back to the root of the problem. 

She read all the descriptions that she wrote for me 4 years ago. 

'Insomniac'

'Rigid thinking'

'Worrying thoughts'

'Persistent depression'

Rigid thinking? Hmmm. 'What makes me wrote that?' she laughed, perhaps trying to recall how was I on our very first met. 

I just smiled, cause I can recall the reasons. I remember her saying, 'Me and type A personality, not OCD but more to perfectionist.' 

I started my medication with 2 tablets of Escitalopram because my depression and anxiety score was soaring, and Lorazepam because I could not sleep. 

I have been switching medications regularly for some reasons. I have tried Fluvoxamine, Sentraline, but Escitalopram is the best for me. Haha

Over the years up at this moment, my depression condition is improving. It is no longer significant. Nonetheless, my anxiety score is still significant even it is much reduced than before. 

So, there were a series of Q and A from the doc to me. 

Have you ever experienced any unreasonable worries?

Do you feel the need to follow whatever you think of at the moment?

Because I am trying to rule out the possibility of you having Generalized Anxiety Disorder and Obsessive Compulsive Disorder. GAD's hallmark is having unreasonable worries. Meanwhile, OCD occurs when we have to follow some rules just to have a peace of mind. 

'I have anxiety for many reasons but I am not sure is it reasonable or not, Im anxious seeing my sisters playing phone around the clock, anxious of my parents having conversations, but why me? Why my brother and sister are not like me. They are not rigid like me.'

'Your siblings and you might carry the same rigid thinking genes, but the acceptance from each person differs, your brother and sister might experience some supports from friends etc that can naturalize the rigidity. But you can see how they carry themselves, you still can see the trait in them right?'

My mind went through all of my life, the previous incident, the latest one, the recent ones. Do I have experience unreasonable worries? Do I have the possibility to be diagnosed with new illness? or illnesses?!

Issues

Dr Rohayah highlighted my two main issues. 

1. Insomniac

2. Anxiety 

For the latter, I experience nightmares frequently, threatening and anxious dreams. So she presented to me this Theory of Mind from Sigmund Freud. 

Preconscious mind is the layer between conscious and unconscious mind. Conscious mind is the part what we reveal to the people. Meanwhile unconscious mind is where we keep our painful memories, things we do not want to remember. However, when we sleep, the memories can slip in through the conscious layer and appear as dreams and nightmares. 

I am no a psychologist, but you get the idea don't you? Haha. This is how our mind works, you know to avoid ourselves from getting hurt. 

Sometimes, psychologist conduct a hypnosis to bring the patient to subconscious or unconscious state. Because at the state, the patient are open to anything, bringing out the memories and putting in the good thoughts etc. Hence, at this stage, the psychiatrist would insert something to the patient, idk how to explain this. Something to cure them. To ease them. Perhaps rational thoughts. And the patient would receive it better than when he or she in conscious state. 

You know, when we are in conscious state, sometimes we filter things from the psychiatrist. We might disagree to some points that we reluctant to 'take it'. Hence that is why, subconscious state is the most effective state to treat patients with ... idk, painful childhood experiences and etc. 

Dr Rohayah told me, which I found exciting, Freud is very concerned towards childhood experiences of his patient. For him, that is the most essential period to shape someone in the future. When we were a kid, we are powerless, our physical is small, we see our parents or the adults as something we have to follow. So what they did, or how they treated us can give a very huge impact to us. okay, lets stop there. Haha. 

Dr Rohayah tried to dig on my history. My childhood experiences. Well, honestly I had excellent childhood. I think. It was just, we are trained to live by rules since before. Well, when we were kids, my father had a tough time, being a MA student and a depression fighter. Along the lines, we were told clearly the dos and donts. Among of the donts are, cannot watch Mr Bean, reality tv show programme, any entertainment show, no fun2 shows. We can't just simply skip schools, even when we were sick. No noises at all. Cannot scream, yell, fights, even we have to open the door knob carefully. 

"So, do you hate your father for that? Tell me, sincerely and honestly, from the bottom of your heart." she asked.

"I don't. I understand that what he has to do as a father." I answered her sincerely and honestly. 

"Good, because the hatred can be an obstacle to treat you," she nodded her head. 

"You, right now I dont know which factor I am pulling, because one thing we know, psychological condition occurs by multi factors. Perhaps, a patient dont tell me the other things, she selects what to tell me. and right now, I don't know what information you keep or not keeping from me." she smiled, and I did too. Cause she's right and deep down in my heart, I have no idea if I have the strength to go back to where I do not want to. 

Functions of Sleeping 

Dr Rohayah enlightened me the purpose of sleeping, biologically and psychologically.

Biology aspect

- Resting the mind and the body

- Boost our immunity system

Psychology aspect

- To process our painful emotions, memories, trauma. 

After the process, the conflict will resolve. That explains why when we have this overwhelming feelings, and we sleep, and then the next morning when we wake up, the feelings is not as terrible as before. (Even the problem is still there). 

I was at awe, knowing this for my first time. I mean, is that why I often feel restless? Because I do not have a good, quality sleep, thus all of my painful memories, traumatic experiences can not be processed. 

Be Present

My homework is practicing mindfulness activity. The concept of mindfulness is similar to concentrate and khusyuk in our solah. 

Our minds love to wander, to the past, to the future, but mindfulness would always bring us to the correct spot, present. Be present, at this moment.

The two activities that I can assign myself to are bathing and solah.

When I take my bath, I have to focus on how it feels, when the water falls, on our skin, the smell of the shampoo for instance.

Similar to solah, concentrate to solah, understand the meaning of the verses. Feel them.

Mindfulness train our mind to not be judgemental and, often bring our wander mind right back on track. It is absolutely normal for our minds to wander, from thinking about our remaining works, to why I can't live my life to the fullest?

At the end of the session

I was prescribed with Escitalopram and then I asked for Zolpidem Tartrate. The doc looked at me, 'how many have you taken?' since it is a recorded medicine, I should not abuse the drugs, meaning I should  not take daily for more than 3 days. Oh yes, it is sleeping pill, it can take only few seconds to force me to sleep. 

'Once a week,' I answered.

'Okay, good. You can take one tablet for per day for three days, and you have to follow all the sleeping hygiene that we have discussed before, your sleeping pattern should be normalized.' 

'and also, is it okay for you to meet me frequently? Perhaps once in 2 weeks. I need to monitor your progress.'

I nodded.