Psychology, Psychiatry and Counselling

Stories, signs to notice and what to do

Who Should We See First?

Anita, twenty-six, had been having panic attacks on her commute to Bengaluru for three months. Her heart pounded, her hands tingled and she was sure she would faint. Her family argued about what to do. Her uncle said she needed a psychiatrist, which frightened her. Her aunt said a counsellor would be enough. A cousin said only a clinical psychologist was proper. Anita felt more anxious about choosing than about the attacks.

Her friend Zoya suggested starting with the family doctor. Dr Rao checked her heart, blood pressure and thyroid, and found nothing physical. He explained the different helpers in plain words. A psychiatrist is a medical doctor who can diagnose and, if needed, prescribe medicines. A clinical psychologist is trained in assessment and talking therapies. A counsellor helps people work through stress, relationships and life changes. 'These are not rivals,' he said. 'Often they work as a team.'

He referred Anita to a clinical psychologist who asked about her qualifications openly, explained how sessions worked and how fees and cancellations were handled. Anita liked that she was asked questions as well as given answers. After the first few sessions, the psychologist said that if the symptoms did not ease, a visit to a psychiatrist would be considered, and that she would send a note to Dr Rao with Anita's permission.

Anita learned to recognise the first signs of a panic wave and slow her breathing. The family stopped arguing and began asking how the sessions were going instead.

How to recognise it

• Repeated episodes of intense fear with racing heart, breathlessness or dizziness.
• Avoiding places or situations out of fear of another attack.
• Confusion in the family about which professional is the right one.
• Symptoms lasting weeks or months and interfering with work or travel.
• Physical causes not yet checked.

What this story explains

This story shows the differences between psychiatrists, clinical psychologists and counsellors and how the family doctor can act as a gateway. It also shows that a team approach is common.

Probable root causes

• Ongoing stress and fear of fainting in public that feeds the cycle of panic.
• Body's alarm system reacting strongly to normal sensations.
• Possible physical contributors such as thyroid problems, caffeine or poor sleep.
• Biological sensitivity to anxiety, sometimes running in families.
• Family confusion and stigma that delays the start of care.

What to do

1. Start with a family doctor to rule out physical causes.
2. Ask the doctor to explain which type of professional fits your problem.
3. Ask about training, registration, experience, fees and cancellations before starting.
4. Book a first session and treat it as a trial; you may change helpers if the fit is poor.
5. Share relevant information between professionals, with your permission.
6. Practise what you learn between sessions.

Whom to consult

• Family doctor first for a physical check and a referral.
• Clinical psychologist for assessment and talking therapy for anxiety and panic.
• Psychiatrist if symptoms are severe, long-lasting, or medical treatment may be needed.
• Counsellor if the main issue is stress, relationships or life transitions.

Do and don’t

How to behave and communicate

• Ask openly and politely: 'Could you explain how you work and what we can expect?'
• Describe symptoms in plain words: when they start, how long, what helps.
• Listen to the person's choice; this is their care.
• Avoid pressure with phrases such as 'you must see this person'.
• Show support: 'Would you like me to come with you to the first visit?'

A Door Closes, a Room Opens

Daniel was fifty-two, a regional manager in Nairobi, when his company closed its office and he was let go after twenty-three years. For weeks he told everyone he was fine. At home he was short-tempered with his wife Grace, scrolled job sites at midnight, and wondered who he was without his title.

Grace suggested he talk to a counsellor. Daniel bristled. 'I am not ill,' he said. Grace replied, 'I did not say you are ill. I said you are going through a big change.' He agreed to one session at a community centre.

The counsellor did not give him orders. She asked what had mattered most about his work, what he feared and what he wanted next. She listened as he said, for the first time aloud, that he felt ashamed. Over six sessions they looked at his strengths, talked about options such as consulting, training younger staff or learning a new skill, and broke the large problem into small steps for each week. She also told him that if his low mood deepened, if he lost interest in everything or found it hard to sleep for weeks, she would help him see a doctor.

Daniel did not become cheerful overnight. But he started a Tuesday mentoring group for young job seekers and began sleeping better. He later said that counselling felt less like being treated and more like having a thoughtful person help him sort a messy cupboard.

How to recognise it

• A major life transition such as job loss, retirement, migration or marriage that shakes identity.
• Irritability, avoidance of talking, sleep trouble and constant checking of options.
• Statements like 'I am fine' that sit alongside obvious strain.
• Shame or fear of the future rather than a clear illness.
• Mood that stays low or loses all interest for weeks, which may need medical care.

What this story explains

This story shows what counselling is and what it helps with: life transitions, career decisions, stress management and family conflict. It illustrates that talking with a trained person is practical and respectful, not only for 'serious' illness.

Probable root causes

• Sudden loss of income, role and routine.
• Self-worth tied closely to a job title.
• Worry about family finances and judgement from others.
• Little practice at talking about feelings, especially among men.
• Stress that accumulates when decisions feel too large to face.

What to do

1. Acknowledge the change as a real loss, even if it is not an illness.
2. Look for a trained counsellor and check their qualifications and approach.
3. Break big decisions into small weekly steps.
4. Keep daily routine, movement and contact with friends.
5. Agree with the counsellor how to review progress and when to involve a doctor.
6. Include the family in some conversations when appropriate.

Whom to consult

• Counsellor or counselling psychologist for career, stress and transition support.
• Family doctor if sleep, appetite or mood are changing for several weeks.
• Clinical psychologist or psychiatrist if low mood becomes constant or daily functioning drops.
• Employer assistance programme or community centre if one is available.

Do and don’t

How to behave and communicate

• Use a calm, respectful tone and avoid pushing solutions.
• Try 'This must be hard after so many years. I am with you.'
• Let the person talk without interrupting.
• Avoid 'at least' statements and comparisons with others.
• Ask, 'What would be a helpful small step this week?'

The Man with the Guaranteed Cure

Sunita's twenty-year-old son Vikas had been hearing whispers and becoming suspicious of the neighbours. He stopped studying and stayed awake at night. Frightened, Sunita asked everyone for advice. A relative told her about a 'specialist' in a nearby town who ran a three-month residential programme.

The man spoke confidently. He did not share his qualifications, but said he had cured hundreds. He promised 'complete cure in ninety days, guaranteed' and asked for the full fee, a large sum, in advance. He told Sunita not to bother with hospitals and that she should not tell anyone else about the programme. Something about the pressure made Sunita uneasy.

That evening she told her neighbour, Mrs Dsouza, a retired nurse, who listened and then said, 'A good professional answers questions openly and never promises a miracle.' She helped Sunita write a list: What are your qualifications? Are you registered? What problems do you work with? What do you charge and what if we stop? She also told her that Vikas's symptoms needed a proper medical assessment soon.

Sunita took Vikas to the government hospital, where a psychiatrist assessed him, explained the condition and the treatment plan, and linked them to a clinical psychologist and a social worker. Sunita asked about her rights and was told that she could ask for a second opinion at any time. Vikas's recovery was gradual, but it was guided by people who were open about what they could and could not do.

How to recognise it

• Sudden changes in behaviour such as hearing things others do not, strong suspicion, sleeplessness and withdrawal.
• Helpers who promise guaranteed or instant cure.
• Demands for large payments up front or pressure to keep things secret.
• Refusal to share qualifications or registration.
• Family fear and confusion pushing quick decisions.

What this story explains

This story shows the warning signs of an unsuitable helper and what to ask when choosing a professional. It also reflects the patient's right to dignity, information and a second opinion.

Probable root causes

• Fear and shame in the family that make false promises attractive.
• Limited awareness about where genuine care is available.
• Cost worries that push families to look for fast, cheap-looking solutions.
• Stigma that discourages hospital visits.
• Pressure from relatives and neighbours offering well-meant but unreliable advice.

What to do

1. Pause before paying anything and ask for qualifications and registration.
2. Ask what the helper has experience with and what the plan and costs are.
3. Have the person assessed by a medical doctor when behaviour has changed suddenly.
4. Check public or government services that provide care at low cost.
5. Ask for a clear explanation of diagnosis, treatment and expected time.
6. Get a second opinion if you are unsure.

Whom to consult

• Psychiatrist (medical doctor) as early as possible for sudden changes in thinking or perception.
• Family doctor or government hospital to help you navigate services.
• Clinical psychologist and social worker for therapy and family support once assessed.
• Trusted nurse, doctor or elder in the family to review any programme before paying.

Do and don’t

How to behave and communicate

• Speak calmly with the family member and avoid arguing about delusional beliefs.
• Say 'I believe that what you are feeling is real for you. Let us find a doctor who can help.'
• Listen to fears without ridiculing them.
• Avoid forcing, threatening or tricking the person into treatment unless safety demands emergency help.
• With professionals, ask politely: 'Could you tell us what you recommend and why?'

Second Opinions and Small Pills of Fear

Kwame, thirty, lived in Accra and had been through a long stretch of low mood, poor sleep and no appetite. His family doctor sent him to a psychiatrist, who spent forty minutes asking questions, explained that Kwame had depression and recommended a treatment plan that included talking therapy and a medicine.

Kwame left worried. His brother had heard that psychiatric medicines change your personality. A friend said they were addictive. At home he lay awake with these fears and nearly cancelled the follow-up visit. Finally he wrote his questions in a notebook.

At the next appointment he asked them one by one: What is this medicine for? What side effects might I notice? How long before I know if it is helping? What if I want to stop? The psychiatrist answered clearly, said the decisions would be made together, and added that Kwame could take as much time as he needed and even seek a second opinion. 'You have the right to be treated with dignity and to understand your treatment,' she said. She also reminded him never to change or stop medicine on his own without speaking to her, because changing suddenly can cause problems.

Kwame also began sessions with a clinical psychologist. Both professionals shared notes with his permission. A few months on, his sleep had improved and he felt more like himself. He later told his brother that asking questions had turned fear into understanding.

How to recognise it

• Low mood, poor sleep, loss of appetite and energy lasting weeks.
• Fear about medicines, based on myths from friends and relatives.
• Hesitation to return for follow-up because of worry.
• A plan that includes both talking therapy and medical care.
• A person who is not sure whether they are allowed to ask questions or get a second opinion.

What this story explains

This story shows how psychiatrists diagnose and treat and how a team of professionals can work together. It also highlights the patient's rights to dignity, information, confidentiality and a second opinion.

Probable root causes

• Depression involving a mix of biology, life stress and thinking patterns.
• Poor sleep and appetite that deepen low mood.
• Myths about psychiatric treatment spread by family or social media.
• Limited explanation in rushed medical encounters.
• Stigma that makes people hide treatment or hesitate to ask questions.

What to do

1. Write your questions down before appointments.
2. Ask for plain-language explanations of diagnosis, options, benefits and side effects.
3. Take the treatment plan as agreed and attend follow-ups.
4. Tell the doctor about any side effects or worries rather than stopping on your own.
5. Ask for a second opinion if you remain unsure.
6. Allow different professionals to share information when helpful.

Whom to consult

• Psychiatrist for diagnosis, medical treatment and review of medicines.
• Clinical psychologist or therapist for talking therapy alongside medical care.
• Family doctor for general health and to coordinate care.
• Pharmacist or nurse for practical questions about taking medicines as prescribed.

Do and don’t

How to behave and communicate

• Use a calm, curious tone when asking professionals: 'Can you explain this in simple words?'
• If supporting someone, ask 'What worries you about the treatment?' and listen fully.
• Avoid scaring phrases such as 'you will become dependent'.
• Encourage them to speak to the doctor instead of guessing.
• Offer to go with them or to wait outside, according to their wish.

This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.