University Counselling Services (UCS),
NUS Health & Wellbeing
In this Special Feature, Benjamin and our Associate Director Dr LEE Li Neng discuss aspects of maintaining one’s mental wellbeing, including the need to reframe our understanding of struggle and how it relates to practical ways in which we can manage our mental wellbeing.
Tan, B. R. P. (2023, April 26). Special Feature on Mental Wellbeing: A Conversation with Benjamin TAN, NUS Health & Wellbeing. Teaching Connections. https://blog.nus.edu.sg/teachingconnections/2023/04/26/special-feature-on-mental-wellbeing-a-conversation-with-benjamin-tan-nus-health-and-wellbeing/
Tell us about yourself and your role at UCS
I would describe myself as a “wounded healer”, which is a term from old-school Jungian psychology that describes someone who tries to draw from their own past painful experiences to help others who are themselves in pain. To have lived a human existence is also to have been exposed to hurt, and I try to make meaning of my life and my own healing journey by trying to be of service to others. Vocationally, I trained as a Masters-degree level counselling psychologist in the US and, before that, taught English Language, History and Social Studies in our Singapore school system.
In my role as one of the clinical staff at the University Counselling Services (UCS), I try to combine the evidence-based clinical science of psychology with a person-centric sensibility to support students, staff and colleagues alike in our respective journeys to make NUS and Singapore a gentler place to live. About two-thirds of my time is spent delivering direct clinical services to students with the balance divided between administrative/portfolio roles and supporting fellow colleagues in a consultative capacity.
What is your understanding of struggle?
How do you think it relates to mental wellbeing?
I feel that struggle may be suitably defined as the unpleasant feeling of when the demands of our situations exceed our available resources. Milder levels of struggle are the basis for almost all learning and growth, as Vygotsky’s Theory of Potential Development observes. When struggle exceeds what someone can accomplish, be it without or even with assistance, that is where it becomes frustration. When the pains of struggle and frustration become chronic, they can lead to helplessness, which progressively turns inward into self-blame, guilt, shame, depression and other negative emotional spirals. The positive inverse is also true; repeated positive growth experiences do lead to higher self-esteem and self-confidence.
A healthy emotional life, in my view, should contain enough affirming experiences to foster a positive sense of self but also be tempered by enough instances of struggle such that a person can also develop empathy and avoid ego-centrism- the pleasant but ultimately inaccurate belief that the world can, does and should revolve around them.
You have mentioned that struggle is a skills gap.
Could you explain this further?
In my conversation with Dr Lee, I described struggle as being a lack of one or more of four elements. 1) Information or insight; 2) Skills; 3) Experience; and 4) Guidance. These would be the ‘resources’ that I mentioned earlier, that were not sufficiently available for a person to not struggle.
I strongly prefer addressing struggle through the lens of a skills gap rather than the other, perhaps more commonly, used lens in our Asian culture: The lens of personal failing or character flaw. I strongly believe that the skills gap approach gives people a more concrete and helpful way to struggle less, rather than blaming them for their own pain.
Spoiler alert: Blaming someone for their own pain is a quick shortcut to massive depression and self-loathing. To give a brief example, if someone struggles with procrastination, one could interpret that as being a skills gap related to time-management, generating and sustaining motivation, study or task management skills, or even a struggle with self-soothing their own anxiety (because procrastination is usually an anxious-avoidant response). Any and all of those ‘skills’ could be targeted for exploration and support interventions, which would gradually lead to a higher level of personal resourcing, which would support the person’s goal to procrastinate less. Contrast that with calling a person “lazy”, or “lacking willpower” or “not hungry enough” or, my personal favourite, “a disgrace to the family”. None of those labels are particularly helpful in guiding someone concretely to procrastinate less. It only makes them feel worse about their pain. This is a bit of what I mean by preferring to see struggle as a skills gap. I credit Dr Ross Greene’s framework of “Collaborative and Proactive Solutions” for these concepts, though I have developed my own way of explaining it in my clinical work (Greene, 2014).
Could you share some examples of situations where students face struggles in their academic and personal lives?
Following on from using the definition of struggle as a situation where demands exceed available resources, there are plenty of situations where university students experience skills gaps in their academic and personal lives. Academically, many students are coming from a more structured, scaffolded, even spoon-fed learning environments- because these approaches are efficient for high performing pre-university institutions to mass-deliver exam-relevant curriculum content. Every single university student, whatever their school background, will have to make the adjustments to the less structured, more individually driven, and often lonely learning environment that is university. Not everyone adjusts at the same pace, and many will never be fully comfortable in it even by the time they graduate. Some key skills to bridge include developing and keeping to a routine that works for them, learning for synthesis and not just retention, tolerance for uncertainty, and the balanced confidence to trust in their own judgements; not just those validated by peers, parents, mentors or instructors. Top of this list, though, is to learn how to fail; seeing failure (even the biggest ones) as an iterative process to move forward. To even seek out chances to ‘fail forward’, because that’s often where the biggest long term learning opportunities can be found. In their personal lives, university students are continuing the journey that began in their teens into a state of increased differentiation from their families, cultures, and communities of origin. It is no longer enough to privately have a different opinion, but there is a valid and developmentally appropriate drive to want to actualise some of those wishes in the name of healthy self-esteem. Some of the skills to be acquired and honed in service of these needs are empathic listening, negotiation, respectful debate and self-validation.
TLDR; University students are becoming more psychologically independent individuals in their academic and personal lives. The struggles and skills associated with this time of growth are very much about self-awareness, self-acceptance and navigating compromise between what they want and what they can be responsible for at this time.
What advice would you give to students who are struggling with mental health issues?
What are some practical steps that they can take to overcome their struggles?
I would say that the first step is to find vocabulary to help name the struggle in a way that makes sense for you. You can use the language of skills gap mentioned earlier (Lacking information, skills, experience, resources etc), or you can use any framework that seems to make sense for how you feel. It is important not to leave it there, though. The next step is to get connected with someone whom you feel can understand you on your own terms. It might be a family member, or a mentor, or even a mental health professional (and not all mental health professionals will always ‘get it’, so find one who does ‘get it’ enough for you). Once you have named the struggle and gotten connected with resources for it, the third step would be to make small steps in the direction you want to go. A good therapist can walk parts of that road with you, as can a caring friend or other person who has both willingness and ability to meet you where you are at. It is definitely possible to do it alone, but the struggle of mental health can be solitary and painful enough without having to make the healing journey solo as well. Also, every credible efficacy study I’ve encountered asserts that being connected with support makes the journey easier, faster and more likely to have gains be maintained over time.
Apart from seeking counselling, what other ways can students manage their wellbeing?
What are some self-care practices that you would recommend?
It doesn’t sound fancy, but a really accessible model for self-care is something that author and psychologist Emily Nagoski calls “completing the stress cycle” (Nagoski & Nagoski, 2019). In short, all our stressors in life signal in a very primal way to our bodies that we are in danger. Looming homework deadline? DANGER of displeasing someone who has influence over us. Quarrel with someone important to us? DANGER of being cut off from social safety and belonging. Big (or small!) class presentation coming up? DANGER that a poor performance will affect our social standing and the perception of how competent we will look to others. Even when the stressor has passed, we benefit from intentionally signalling to the body that this is the case. This is what she called ‘completing the cycle’ and it helps us bring our emotional activation down from a state of “I’m in danger” down to a state of “I’m safe now”. How does she suggest we do this? (Boring spoiler warning): Physical activity is the #1 best stress reliever. It lets us run, jump, punch, scream, cry and do anything kinesthetic to express that we have the freedom to act (and not just react). That messaging calms the body and mind. Close behind are socially-based approaches to assure us that we are safe from danger; spending quality time with friends and loved ones, physically affectionate contact with humans and/or companion animals, creative expressions such as writing, singing, dancing, painting and other forms of creation.
Ultimately, we may not always be able to resolve the stressor permanently (eg. if it is something inherent to one's job or a person who cannot be indefinitely avoided in one's life), but intentionally taking time away to disconnect from stressors is also helpful if it provides relief enough to regroup, recharge and then rejoin the fight.
Perhaps it explains why some people from Singapore love overseas vacations! I highly recommend that people go read Emily Nagoski’s book if they would like more detail. Despite its pitch being more toward female readers, I find it can have therapeutic relevance for anyone who has ever felt over-taxed and under appreciated. Guys: I challenge you to not be put off, information is information so read at least Chapters 1-3 before you decide it “doesn’t apply to me”.
What resources are available to NUS students who are struggling with mental health issues?
How can students access these resources?
I’d like to borrow from the care framework used by the NUS Health & Well Being team to describe categories of resources and how to access them.
- Self-initiated Resources. Consuming credible videos, books, and articles about mental health in general, or specific to one’s experience. Find the vocabulary, terms and stories that seem to resonate with you, and follow those leads to connect with strategies and techniques that might give you a ‘skill up’. Don’t be afraid to struggle as you try new approaches. Shamelessly borrow (HEALTHY) techniques from others and customise them in a way that works for you. Where to find: Libraries, “the internet”, or get a trusted social service professional to recommend you some initial reading / watching.
- Peer-centric Resources. Whether it is a caring friend, a CCA leader, someone in your age group or someone in your student tier, tapping on people who may have a similar situation or experiences as you can be a way to feel less alone and get some different ideas of how to do things differently. Yes, you might be seen as someone who is struggling if you share it with others, but perhaps it is better to be seen as someone who ‘struggled and got better’ than to be seen as someone who ‘is still struggling’ months later. Where to find: Pick someone whom you know who you feel will be willing to listen in a non-judgmental way. Everything else after that you can work it out together.
- Pastoral Care-type Resources. These resources are often provided by ‘adults’ in some position of organisational responsibility. They could be a lecturer or residential staff member you have good rapport with, an internship senior and, very often, can be wise family or community members whom you feel you could trust. They are typically not mental health or medical professionals so don’t expect them to have that training, even if they can be well intentioned in their feedback and suggestions. Where to find: Every faculty has a Student Support Manager to advise on academic and faculty-related matters. All NUS residential units have a residential staff system; pick someone you feel you could share a bit with and let them use the training they have to listen to you, and strategise from there. Outside NUS, coaches, spiritual leaders, volunteer group leaders and even some workplace supervisors can be sources of pastoral-care support; but as none of them are necessarily trained mental health professionals, expect that if you need to go beyond empathy, good intentions and well meaning suggestions, you might prefer to access the next tier which is…
- The Professional Tier. This is where counsellors, psychologists, social workers and other social service professionals are. They have varied approaches and backgrounds but, these days, are all fairly consistent in being able to support a person who is struggling with understanding what the struggle is from a trained scientific lens, and then guiding them along the path to desired change using a variety of therapeutic tools. NUS has a counselling centre with FREE services to all full time students. Part time students can also connect with the NUS counselling centre for consultation and information on what kind of community based resources would be suitable for their particular struggle.
- The Specialist/Medical Tier. This tier notably includes medical doctors and psychiatrists who support their patients with psycho-pharmacological treatments that control or mitigate symptoms of distress. (Caveat: Medications can reduce symptoms but don’t teach skills or grant insight). This tier also includes counsellors and psychologists who have further specialised training in supporting very intrusive and debilitating symptoms, such as persistent depression, acute anxiety, complex/chronic trauma, PTSD and some very long term global mental health struggles (eg. Severe OCD). The NUS University Health Centre has psychiatrists on staff who can provide subsidised consultations to all NUS students. Much more affordable than almost anywhere outside. Yes, wait times can be long (as is the case for nearly every publicly funded healthcare service in the world) but if one cannot wait, there is…
- The Emergency Tier. This is the ‘big red button’ that you press when you are just overwhelmed, don’t know what to do and are starting to feel like the world is closing in. Your resources are so stretched that your brain tells you it needs to escape by any means necessary. Including thoughts of ‘disappearing’, fantastically escaping, dying and thoughts of actively killing yourself because it is all getting too much to handle. Your heart can feel so crushed and torn that you don’t know if it could ever get better, and your gut feels like there is a huge empty pit that is at the same time so empty, yet so painfully full. The key word is ‘overwhelmed’. If you are here, or know you are getting there soon, you need emergency support and it’s not a weakness or at all shameful to seek it out. If we are having a heart attack, we call the ambulance. Everything else can be discussed once your health and life are back feeling more stable. During office hours, the NUS counselling centre has staff on duty who can meet briefly with you to strategise and triage what kinds of support are needed in the immediate, short, medium and longer terms. There is also the nearest hospital emergency room which can also provide the same type of basic support, though with a longer waiting time and they do levy fees. Short of the in-person avenues above, there is the NUS LifeLine (6516 7777) which is a 24/hour crisis line for all members of the NUS community, the IMH 24-hour hotline (6389 2222) for general psychological crisis consultation, and the Samaritans of Singapore (1767) which is an all-hours hotline specifically and specially for help with suicidal thoughts.
Greene, R. W. (2014). The explosive child [Fifth Edition]: A new approach for understanding and parenting easily frustrated, chronically inflexible children. Harper Paperbacks.
Nagoski, E., & Nagoski, A. (2019). Burnout: The secret to unlocking the stress cycle. Ballantine Books.
|Benjamin TAN is a Senior Counselling Psychologist with University Counselling Services (UCS), part of the NUS Health & Wellbeing Team. Together with his colleagues at UCS, he seeks to combine the evidence-based clinical science of psychology with a person-centric sensibility to support students, staff and colleagues alike in their respective journeys to make NUS and Singapore a gentler place to live.|