Advanced Psychological Issues

Stories, signs to notice and what to do

The Glass Wall

Daniel Okafor, twenty-two, a student in Manchester, was walking back from the library after weeks of exam stress and little sleep when something odd happened. The street looked flat, like a film set. His own hands seemed to belong to someone else. He felt as if he was watching himself from a short distance. He knew who he was and where he was, but nothing felt real.

It passed after an hour, but returned over the next weeks, usually when he was anxious or exhausted. He told no one, afraid he was going mad. He kept pinching his arm to check he was real, which only made him more frightened.

Finally he told his tutor, who suggested the university counselling service. The counsellor listened and explained that this is a known experience called depersonalisation (feeling detached from yourself) and derealisation (the world seeming unreal). It often appears with stress, panic or past difficult experiences, and is the mind's way of stepping back from overload. She taught him grounding skills: naming five things he could see, pressing his feet on the floor, holding something cold. She also asked about sleep, alcohol and what had been weighing on him, and suggested a medical check.

The episodes grew shorter, and Daniel stopped fearing them. 'It is like a glass wall,' he said, 'but I know now it is not a madness. It is an alarm that has been going off too loudly.'

How to recognise it

• Feeling detached from your own body, thoughts or emotions, as if watching yourself.
• The world seeming foggy, dreamlike, flat or unreal, while you still know it is not.
• Episodes triggered by stress, panic, tiredness, drugs or alcohol, or reminders of difficult events.
• Gaps in memory for important personal events, which are more serious signs that need assessment.
• Fear of going mad, or distress and difficulty in daily life that lasts.

What this story explains

The chapter's dissociation section describes depersonalisation and derealisation as the mind detaching under overload, and mentions other dissociative problems such as amnesia and identity disorders. It is understandable and treatable.

Probable root causes

• Intense or long-term stress, panic or severe anxiety.
• Past trauma or difficult childhood experiences.
• Lack of sleep, heavy alcohol or drug use.
• Some medical causes, such as seizures or migraine, which need to be checked.

What to do

1. Stay calm and remind yourself: 'This is a stress response and it will pass.'
2. Use grounding: name things you see, hear and touch, or hold something cold.
3. Keep regular sleep, meals and exercise, and avoid alcohol and drugs.
4. Tell a trusted person what you are experiencing.
5. Seek assessment if episodes keep returning or you have gaps in memory.

Whom to consult

• Family doctor to rule out physical causes and to look at sleep, medicines and substance use.
• Clinical psychologist or counsellor for grounding skills and therapy, especially if trauma is involved.
• Psychiatrist if anxiety, depression or memory gaps are significant.
• Neurologist if the episodes come with blackouts, jerking or other physical signs.

Do and don’t

How to behave and communicate

• Stay calm: 'I am here with you. You are safe. Let's feel our feet on the floor.'
• Avoid 'snap out of it' or 'you are imagining it'.
• Ask what helps and listen to the answer.
• Speak slowly with short sentences when the person feels unreal.
• Say 'Thank you for telling me.'

Checking the Gas Again

Rukmini Iyer, thirty-four, an accountant in Chennai, used to be easy-going. In the past year she began checking the gas stove before leaving home. At first once, then five times, then until her hands ached. If she lost count, she started again. She was often late for work. A thought would pop in: 'what if the house burns and it is my fault?' She knew it was unlikely, but the dread was unbearable until she checked.

She hid it. Relatives joked she was 'a bit particular'. Inside, she was exhausted and ashamed. She also washed her hands until they cracked, and avoided touching door handles. Her husband Anand noticed that she woke early just to do her rituals.

One morning, after being forty minutes late to an important meeting, she cried in the office stairwell. Her colleague suggested a doctor. The psychiatrist explained that this was obsessive-compulsive disorder (OCD): unwanted, frightening thoughts called obsessions, and rituals called compulsions that give brief relief but keep the cycle going. It is not a weakness or a lack of willpower.

Treatment involved a form of talking therapy where she gradually faced the fear without performing the ritual, with a trained therapist guiding each small step, and, as the psychiatrist judged appropriate, medicine. Progress was slow but real. 'Now I check once, and I let the thought pass,' she said. 'I still have the thought, but it no longer gives the orders.'

How to recognise it

• Repeated unwanted thoughts, images or urges that cause strong fear, doubt or disgust.
• Rituals such as checking, washing, counting, arranging or repeating prayers or phrases to relieve the distress.
• Spending an hour or more a day on these thoughts and rituals, or running late because of them.
• Knowing the fear is exaggerated, yet feeling unable to stop.
• Avoiding places or things, and hiding the behaviour from others out of shame.

What this story explains

The chapter's OCD section describes obsessions, compulsions and common themes like contamination, checking and doubt. It shows that effective treatment exists, including exposure-based therapy and medicine.

Probable root causes

• Brain circuits that raise false alarms, with possible family tendency.
• Anxious or perfectionist temperament and high sense of responsibility.
• Stressful life events, such as new job, marriage or illness, which can trigger or worsen symptoms.
• Repeating rituals, which relieves fear briefly and strengthens the habit.

What to do

1. Recognise that this is a condition, not a character flaw.
2. Tell a trusted person and seek a professional assessment.
3. Resist the urge to seek repeated reassurance or to ritualise, with a therapist guiding step by step.
4. Keep a simple diary of triggers and rituals to share with the clinician.
5. Keep sleep, exercise and stress reduction in your routine.

Whom to consult

• Psychiatrist for assessment and, if appropriate, medicine.
• Clinical psychologist trained in exposure and response prevention for therapy.
• Family doctor as a first step if you are unsure whom to see.
• Emergency services or nearest hospital if distress leads to thoughts of self-harm.

Do and don’t

How to behave and communicate

• Be warm: 'I can see how frightening those thoughts are. I am with you.'
• Avoid 'just stop it' or 'think of something else'.
• Instead of repeating reassurance: 'I know you are scared, and I know your therapist has a plan for this.'
• Listen without judgement and ask what support helps.
• Celebrate effort, not just results.

The Empty Plate

Ananya Menon, fifteen, from Kochi, had always been a high achiever. After a classmate teased her about her weight, she started 'eating healthy'. Soon she cut out sweets, then dinner, then whole meals. She exercised in her room at night and wore loose clothes. Her mother noticed that she moved food around the plate, said she had eaten earlier, and became furious if anyone commented. She was often cold and tired, and her periods had stopped.

Her parents argued about whether to force her to eat. Her younger brother stopped inviting friends home. Ananya insisted she was fine and that she looked 'too big'. In the mirror she saw something others did not.

Her school counsellor spoke gently to the parents about the possibility of an eating disorder, a serious illness and not a phase of vanity. They took Ananya to a paediatrician, who checked her heart, blood tests and growth, and referred her to a team including a psychiatrist, a dietitian and a family therapist. The team explained that anorexia nervosa involves intense fear of weight gain and a distorted body image, and that the family is part of the treatment, not the cause.

Recovery was slow, with setbacks. But with supervised meals at home, therapy and medical monitoring, Ananya slowly regained strength. 'I thought I was in control,' she said. 'The illness was in control of me.'

How to recognise it

• Rapid weight loss, skipping meals, avoiding eating with others, or ritual eating.
• Intense fear of gaining weight and harsh self-criticism about body shape despite being thin.
• Excessive exercise, wearing baggy clothes, or hiding food.
• Physical signs such as tiredness, feeling cold, dizziness, hair loss or missed periods.
• Irritability, secrecy and withdrawal; the pattern may also show as binge eating, vomiting after meals or restricted eating without weight fear.

What this story explains

The chapter describes the eating disorders, including anorexia, bulimia, binge-eating disorder, ARFID and OSFED. The story shows that they are serious illnesses that need early medical and psychological help, with family involvement.

Probable root causes

• Pressure about body shape from peers, media or family comments.
• Perfectionism, anxiety or low self-worth.
• Dieting, which can trigger an illness in people who are vulnerable.
• Genetic and biological factors, along with life stress or teasing.

What to do

1. Take it seriously and arrange a medical check early.
2. Talk privately and calmly, focusing on your concern and not on weight or food.
3. Seek a team of specialists: doctor, mental health professional and dietitian.
4. Keep family meals calm and supportive, following the team's advice.
5. Look after yourself as a parent or carer as well.

Whom to consult

• Family doctor or paediatrician urgently for a physical check of heart, blood and growth.
• Psychiatrist or clinical psychologist experienced in eating disorders.
• Dietitian to plan safe, supervised refeeding.
• School counsellor to help with school support; emergency services or the nearest hospital if there is fainting, chest pain or thoughts of self-harm.

Do and don’t

How to behave and communicate

• Use 'I' statements: 'I am worried because you seem tired and sad, and I love you.'
• Avoid talking about looks, calories or weight.
• Listen to feelings behind the behaviour, such as fear or shame.
• Stay steady if the person gets angry; try again later.
• Say 'We will get through this together.'

Mira and the Storm of Feelings

Mira D'Souza, twenty-six, from Goa, felt things more intensely than anyone she knew. When her boyfriend Rohan was late replying, she felt a flood of panic that he was leaving. She would send many messages, then accuse him, then beg him to forgive her. Her friends were often 'the best people in the world' one week and 'traitors' the next. Afterwards she felt hollow and ashamed.

Rohan loved her, but he was exhausted. When he said he needed a break, Mira felt the floor drop. She hurt herself that night out of unbearable pain, and then told him. Frightened, he stayed with her, called her sister, and the next day they went together to a doctor.

The psychiatrist listened for a long time and then explained that some people have long-standing patterns of very strong emotions, fear of abandonment and unstable relationships, sometimes described as a personality disorder, one of several types in the chapter. It is not a moral failing. It often grows out of early pain, and it improves with the right therapy. Mira began a structured talking therapy that teaches skills to ride out emotional waves, communicate needs, and tolerate distress without harm. Her family learned how to respond calmly.

It took more than a year, with setbacks. But Mira built a toolkit: slow breathing, a call to her sister before sending that angry message, and a safety plan agreed with her therapist. 'The storm still comes,' she said. 'But now I have a boat.'

How to recognise it

• Intense, fast-changing emotions with strong fear of being left or rejected.
• Relationships that swing between idealising and angry blaming.
• Impulsive behaviour such as risky actions, spending, substance use or self-harm in times of distress.
• A long-standing pattern since the teens or early adult life, across many situations, not just one stress.
• Feeling empty, unsure of identity, and ashamed after outbursts.

What this story explains

The chapter describes personality disorders as long-standing patterns of thinking, feeling and relating, including the 'dramatic, emotional' cluster B. The story shows that skills-based therapy and a supportive family can bring real improvement.

Probable root causes

• Early experiences of neglect, loss, abuse or unstable care.
• Naturally sensitive emotional temperament.
• Genetic and biological factors affecting emotion control.
• Stress and unsafe relationships that reinforce fear of abandonment.

What to do

1. Stay calm and keep the person safe if they are in distress.
2. Encourage assessment by a mental health professional rather than debate labels.
3. Support structured therapy that teaches emotion and relationship skills.
4. Agree on a safety plan with the therapist, including who to call and what to do in a crisis.
5. Keep your own boundaries and care for yourself.

Whom to consult

• Psychiatrist for assessment, and to treat linked problems like depression or anxiety.
• Clinical psychologist trained in skills-based therapy for emotion regulation.
• Family doctor as a first contact if unsure where to start.
• Emergency services or nearest hospital at once if the person has harmed themselves or is in immediate danger.

Do and don’t

How to behave and communicate

• Validate first: 'I can see how much pain you are in right now.'
• Set boundaries kindly: 'I care about you, and I cannot talk at 3 a.m. Let's speak tomorrow.'
• Keep your voice low and steady during outbursts.
• Listen without interrupting, then ask 'What would help right now?'
• Praise use of coping skills.

One Drink to Sleep

Vikram Chauhan, fifty-one, was a successful transport contractor in Jaipur. After a business loss, he began to have 'one drink' at night to switch off. Within a year it was three or four. He told himself he only drank after work, so he was not an addict. But he started drinking earlier on weekends, felt shaky and anxious in the morning, and hid bottles. His sleep was poor and his temper shorter.

His wife Meenakshi found a bottle in the garage and confronted him; he shouted that she was exaggerating. His son, nineteen, began avoiding him. After he missed an important meeting because of a hangover, Vikram was ashamed. When he tried to stop for a week, he felt sweaty, trembling and could not sleep, and he poured a drink to feel better.

Meenakshi consulted the family doctor on her own first. The doctor advised that Vikram should not stop suddenly without medical supervision, as sudden stopping after heavy drinking can be dangerous. She invited him to come in for a 'general check-up'. Vikram came. The doctor spoke respectfully, explained how dependence develops, and arranged supervised treatment, then counselling and a support group.

Recovery had slips, but Vikram learned his triggers: stress and evenings alone. His family learned to support rather than police. A year later he said, 'The hardest thing was admitting it. The second hardest was to keep asking for help.'

How to recognise it

• Using alcohol or drugs to cope with stress, sleep or emotions, and needing more over time.
• Unsuccessful attempts to cut down, and drinking or using earlier or more than planned.
• Withdrawal signs such as shaking, sweating, anxiety or trouble sleeping when stopping.
• Neglecting work, family and responsibilities, hiding use, or lying about it.
• Continued use despite harm to health, money or relationships.

What this story explains

The chapter's section on substance use disorders explains how use can slide into dependence and affect health, mood and family life. The story shows that recovery is possible with medical supervision, therapy and family support.

Probable root causes

• Using alcohol or drugs to cope with stress, loss, anxiety or poor sleep.
• Biological vulnerability and family history of addiction.
• Easy availability and social habits that normalise heavy use.
• Untreated depression, anxiety or trauma underneath the use.

What to do

1. Admit the pattern honestly to yourself or a trusted person.
2. See a doctor before stopping heavy use, because sudden stopping can be dangerous.
3. Join a supervised treatment plan with counselling and relapse prevention.
4. Identify triggers, such as stress or boredom, and plan healthy alternatives.
5. Family members can seek their own support and learn how to help without enabling.

Whom to consult

• Family doctor first, to assess health and arrange safe withdrawal if needed.
• Psychiatrist or de-addiction specialist for treatment and any underlying depression or anxiety.
• Counsellor or clinical psychologist for therapy and relapse prevention.
• Emergency services or nearest hospital if there are seizures, severe confusion, shaking, or thoughts of self-harm.

Do and don’t

How to behave and communicate

• Choose a calm time, not when they are drunk: 'I am worried about you, and I love you.'
• Use specific, non-blaming statements: 'I saw how shaky you were this morning.'
• Listen to their shame and stress without arguing.
• Avoid labels like 'drunkard' or 'addict'.
• Offer: 'I will come with you to the doctor.'

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.