How many of us assume that if we were to develop a mental health condition, the signs would be obvious?
A dramatic breakdown, losing touch with reality, or a crisis that simply couldn’t be ignored.
In reality, that is rarely how mental health problems begin.
Picture a young professional who continues going to work daily, fulfilling his responsibilities, but for several months has gradually lost his ability to enjoy life.
He feels tired most of the time and tells himself, “This is just how life is; everyone feels sad when they are stressed.”
However, after making an unusual mistake at work, he begins to realise something inside him has changed.
His symptoms have started to worsen.
His story is not uncommon.
One of the most common things I hear during a first consultation is, “I thought it was normal to feel this way”.
Many people fail to recognise their symptoms because they often develop gradually.
Over time, they become part of everyday life.
Constant worrying, poor sleep, exhaustion, difficulty concentrating, or losing interest in things once enjoyed are often dismissed as simply part of adulthood.
Sometimes, it is only after treatment begins that people realise how much these symptoms had been affecting their quality of life.
In Malaysia, the growing use of mental health services and helplines such as Talian HEAL 15555 reflects increasing awareness that support is available.
However, despite the availability of mental health services, many people continue to struggle in silence.
Some are unsure whether their symptoms are serious enough to seek help.
Others worry about stigma, fear being judged, or receive little support from family members.
As a result, many only seek professional help when their work, relationships or daily functioning have already been significantly affected.
The good news is mental health problems, like many other illnesses, are often easier to treat when recognised early.
So, before things reach a crisis point, what warning signs should we be paying attention to?
Changes that cluster together
No single symptom is enough to diagnose a mental health condition.
It can be normal to have a bad day, a rough patch at work, or a night of poor sleep.
What mental health professionals look for instead is a cluster of symptoms that occur together, persist over time and begin interfering with daily life.
When these symptoms last for weeks and start affecting someone’s ability to study, work or maintain relationships, it is time to seek an assessment from a doctor or mental health professional.
The American Psychiatric Association and the National Alliance on Mental Illness (NAMI) describe several common warning signs, which broadly fall into four categories.
> Mood and emotions
Persistent sadness or low mood, excessive worry or fear, rapid mood swings, emotional numbness or unusual irritability and anger that seem disproportionate to the situation.
> Behaviour and daily habits
Withdrawing from family, friends or activities once enjoyed, declining performance at school or work, changes in sleep or appetite, increased use of alcohol or other drugs or neglecting personal hygiene and self-care.
In some conditions, particularly bipolar disorder, warning signs may instead include unusually increased energy, reduced need for sleep, impulsive behaviours, or acting in ways that are out of character.
> Thinking and perception
Difficulty concentrating, racing or disorganised thoughts, unusual beliefs about one’s abilities or influence over events, hearing or seeing things others do not, or feeling disconnected from oneself or reality.
> Physical symptoms
Persistent headaches, stomach discomfort, fatigue or other physical symptoms without a clear medical explanation can sometimes be signs of psychological distress.
Some people also experience chest tightness, palpitations or breathlessness.
These symptoms are often linked to anxiety, particularly once medical causes have been ruled out.Emotional distress, anxiety and high stress levels can trigger sudden bedwetting in children. — TNS
Children exhibit different symptoms
Warning signs in children and teenagers can look different from those seen in adults.
Young children may lack the emotional awareness to identify and describe what they are feeling.
Instead, distress is more likely to appear through behavioural changes such as a sudden decline in school performance, frequent nightmares, bedwetting, in- creased clinginess,
separation anxiety, unexplained irritability or aggression, or emotional outbursts that seem out of proportion for their age.
Among teenagers, warning signs may include withdrawing from family and friends, self-harm, misusing alcohol or drugs, or a noticeable change in their usual behaviour.
All these symptoms deserve attention.
When it is urgent
Some warning signs should never be dismissed as something that might simply pass.
These include talking about feeling hopeless, expressing a wish to die, giving away valued possessions, or talking about a specific plan to end one’s life.
Other warning signs that require immediate attention include losing touch with reality, being unable to care for oneself, or expressing thoughts of harming someone else.
If you or someone you know is experiencing any of these, seek help immediately.
> Talian HEAL (Health Ministry): 15555
> Befrienders KL (24-hour emotional support): 03-7627 2929, or find your nearest state centre at befrienders.org.my
> Talian Kasih (Women, Family and Community Development Ministry): 15999, or WhatsApp 019-261 5999
> Miasa Crisis Helpline: 1800 180 066, or WhatsApp 03-9765 6088
> Emergency services: 999
You do not need to be in severe psychological distress to contact these services.
They are there for anyone experiencing emotional distress or who simply needs someone to talk to.
An act of care, not alarm
It’s easy to dismiss early warning signs.
We may tell ourselves that this is “just stress” or that things will improve on their own.
Sometimes they do.
But sometimes they do not.
Getting an early assessment can provide reassurance, clarify what is happening and help identify practical ways to manage the problem before it becomes more severe.
If a mental health condition is present, recognising it early allows treatment to begin sooner, promotes better recovery and less disruption on work, relationships and overall quality of life.
Just as we would not ignore persistent chest pain or uncontrolled high blood pressure, we should not ignore persistent changes in our emotional well-being.
Although mental illnesses are not always visible, their impact can be as disabling as many physical illnesses, particularly when left untreated.
In the next article in this series, we will explore a few common questions.
Who should you see, and what are some of the differences between a counsellor, psychologist and psychiatrist?
Dr Lim Poh Khuen is a consultant psychiatrist. This is the first in a five-part weekly series on mental health treatment and practical guidance in Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
