A 65-year-old lady, Mak Cik, comes to see me. She is perplexed, not sure how to start. I ask her about her family. Her husband, Pak Cik, is retired, in his 70s, still actively doing a property broker job.
Mak Cik is a housewife but not so active now. She keeps herself occupied doing house chores. For most of her time, she learns religion at madrassah and spends most of her time praying and fasting.
She is annoyed with the Pak Cik for not behaving like an elderly man. To her imagination, an elderly man should spend most of his time preparing for his afterlife. To her, the property broker has its own risk of bankruptcy and is seen as a risky business.
She is offended toward her eldest daughter who is marrying a Swiss and not obeying strict religious obligations and fails to educate her Muslim’s reverted husband on the proper conduct of a Muslim.
She is also preoccupied with another son who is a transgender and suffered from Bipolar Mood disorder.
Managing different perspectives in life is a difficult task. It seems that Pak Cik and Mak Cik do not share the same values and assumptions. For Mak Cik elderly period is a time to ponder, reflect and prepare for the afterlife (akhirat). To Mak Cik, work has its own limit but to Pak Cik works has no time limit.
Mak Cik is depressed and that makes her mind wander timelessly. Multiple family stressors added up to precipitate her depressive illness. The differential life perspective contributes relatively to a poor understanding of the illness. This eventually resulted in poor social support from the spouse that tend to perpetuate the depression. In the end, she may develop isolation and loneliness.
Life has to continue despite adversities. When time is perceived as limited, the social network provides a meaningful interaction and assistance.
To manage the problem, this couple has to adopt three successful separate processes, namely:
Selection: which refers to the patient focusing attention on fewer, more important goals e.g. rescaling/reconstructing goals. In fact, the couple has to focus their attention on narrowing the gap in life perspective.
Optimization. This involves engaging in goal-directed actions and means; such as investing time and energy into the acquisition, refinement, and application of goal-relevant means, seizing the right moment, persistence, acquisition of new skills/resources, and practice of skills. The couples have to invest their time in doing common tasks and hobbies.
Compensation. The last process maintains a given level of functioning in the face of loss and decline in goal-relevant means by the patient investing in compensatory means. In some cases, when the couple arrives at some mutual understanding, life continues, business as usual.
Born in Kedah. Studied at Alam Shah, Universiti Kebangsaan Malaysia and King's College, University of London. Previously, acted as Head, Dept of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia. Currently, works as Professor of Psychiatry at Sultan Abdul Halim Mu'adzam Shah International Islamic University, Kedah. Married and blessed with 4 grown-up children.
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Idea-logy 