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Work Addiction & Executive Burnout: Why High Achievers Can't Switch Off | Obi Unaka

• Abdullah Boulad

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Work addiction, burnout, anxiety, and the inability to switch off are challenges many high-performing professionals quietly struggle with. But what if the problem is not simply working too much, but using work as a way to avoid what is happening beneath the surface?

In this episode of Living A Life In Balance, Obi Unaka, Addiction Therapist and Relapse Prevention Specialist, joins Abdullah Boulad, Founder and CEO of THE BALANCE Rehab Clinic, for an insightful conversation about work addiction, executive burnout, emotional regulation, recovery, and the hidden costs of high achievement.

Drawing from his own personal experience, Obi shares how a successful career in finance eventually led him to recognize that work had become more than a profession; it had become an addiction. After losing important relationships, experiencing severe stress-related symptoms, and struggling to disconnect from work, he began a journey of recovery that ultimately led him into the field of psychotherapy and addiction treatment.

Together, they discuss:

• How work can become a behavioural addiction similar to gambling or substance use
• The warning signs of executive stress, burnout, and emotional exhaustion
• Why many high performers struggle to switch off and find balance outside of work
• The connection between purpose, identity, achievement, and self-worth
• Cultural perspectives on mental health, addiction, and emotional well-being across different societies
• The importance of family, community, and support systems in long-term recovery

This is a thoughtful and honest conversation about success, resilience, mental health, and the often-overlooked challenges faced by ambitious individuals. It explores what happens when achievement comes at the expense of wellbeing, and why finding balance requires more than simply working less.

About Obi Unaka:
Obi is an Addiction Therapist, Psychotherapist, and Relapse Prevention Specialist with decades of experience working in the field of mental health and addiction treatment. After leaving a successful career in finance due to his own struggles with work addiction, he retrained as a therapist and has since dedicated his career to helping individuals overcome addiction, burnout, and behavioural health challenges. 

00:00:00 - From Work Addiction to Addiction Therapist: Obi Wan's Journey from Finance Burnout to Recovery
00:03:29 - What Is Work Addiction? Signs, Symptoms, and When Hard Work Becomes Unhealthy
00:05:32 - The Psychology of Work Addiction: Why High Achievers Struggle to Switch Off
00:06:58 - Burnout Warning Signs: How Therapy Helped Identify a Destructive Work Pattern
00:08:59 - Finding Purpose After Burnout: Transitioning from Finance to Mental Health
00:10:38 - High-Pressure Careers, Executive Stress, and the Risk of Work Addiction
00:12:02 - Executive Burnout, Substance Use, and Unhealthy Coping Mechanisms in High Performers
00:14:22 - What Causes Burnout? Perfectionism, Internal Pressure, and Emotional Exhaustion
00:16:21 - The Biopsychosocial Model: Balancing Mental Health, Relationships, Purpose, and Wellbeing
00:18:47 - Burnout Red Flags: Overworking, Digital Addiction, Control, and Inability to Delegate
00:22:04 - Technology Addiction, Constant Connectivity, and the Loss of Human Connection
00:23:43 - Mental Health Across Cultures: Comparing Nigeria, the UK, and India
00:26:01 - Mental Health Stigma in India: Family Expectations, Psychiatry, and Cultural Beliefs
00:34:55 - Family Support, Addiction Recovery, and Preventing Relapse Through Community
00:37:52 - What the Western World Can Learn About Community, Connection, and Mental Wellbeing
00:44:01 - Cultural Differences in Therapy: Why Mental Health Treatment Is Not One-Size-Fits-All
00:47:17 - How Therapists Avoid Burnout: Self-Care, Boundaries, Delegation, and Work-Life Balance

Follow Abdullah Boulad: 
https://www.linkedin.com/in/abdullahboulad/    
https://www.instagram.com/abdullahboulad/   

Follow Obi:
https://www.linkedin.com/in/obi-unaka-4715141b/ 

You can order Abdullah’s books here: https://www.amazon.com/stores/author/B0BC9S5TCF?ccs_id=c64f2588-7eb1-4592-b4d1-647a0f379b51 

Follow THE BALANCE Rehab Clinic: 
https://www.linkedin.com/company/thebalancerehabclinic/    
https://www.instagram.com/thebalancerehabclinic/    

#LivingALifeInBalance #WorkAddiction #Burnout #Stress #Sleep  #Support #Wellbeing #IntegrativeMedicine #MentalHealth #Podcast

From Work Addiction to Addiction Therapist: Obi Wan's Journey from Finance Burnout to Recovery

SPEAKER_01

I trained in banking and finance and I was working in the city of London. And in a very short space of time, I realized that work became a big issue for me. It cost me my relationship with family, with my partner, with my kids. Subsequently, I started seeing a therapist. There was an opportunity for me to volunteer in a treatment facility, trained to be a psychotherapist and then specialise in addictions. And I started finding fulfillment just from helping other people. Just trying to understand the mechanics of work addiction.

SPEAKER_00

I couldn't sit with myself. I couldn't just be. Is it expectation? Is it perfectionism? Is it frustration? All of the above.

SPEAKER_01

The model of treatment that I work with is what we call the bipsychosocial model. So we look at your physical health, your psychological well-being, your interpersonal relationships, and purpose.

SPEAKER_00

You have certainly a multicultural view to the world and to mental health. Where do you see the differences in the world?

SPEAKER_01

Whatever way we look at it, people are people all around the world. But cultures are different. You know, and it's about being able to meet people and speak the language that they will respond better to.

SPEAKER_00

Welcome to the Living a Life and Balance podcast. My guest today is Obi Unaka, an addiction therapist and relapse prevention specialist with decades of experience in mental health treatment. I hope you will enjoy. Obi, what motivated you to do what you do today?

SPEAKER_01

Um it was never my life dream to be a therapist. There was no part of me that wanted to work in this field. Um, I trained in banking and finance and I was working in the city of London. Um and in a very short space of time, I realized that work became a big issue for me. Now, when I when I tell people about this, they're kind of like, what do you mean work with an issue? Well, even when I talk about addictions today, I look at it from the perspective of the problematic nature of whatever people are doing. Because there are some people, as you probably well know, that can go out over a weekend, have a drink, and it doesn't cost them anything. Or some people smoke a joint and they're fine. Well, there are also people that go to work, regular work, nine to five, and come back home and spend the weekend with their kids and their family. That wasn't the case with me. Um, some days I never went home. I stayed at work, I was working right through till night. Um, and it cost me a whole shed of relationships, my relationship with family, with my partner, with my kids. And subsequently, I started seeing a therapist. Um and very quickly came to the realization that I wasn't gonna go back to working in the city anymore. And my therapist just asked me one day, so what are you gonna do with yourself? Now, at that point, money wasn't the motivator because I'd made quite a bit of money at the time. And I said, I don't know. And she just asked me the question, Have you ever thought about becoming a therapist? And I was kind of looking, thinking, why on earth would I want to do that? You know, why would I want to be some emotional dustbin for someone else? Um, and I said, Well, why did you ask me? And she says, You have quite a bit of insight, but I think your way of delivering your delivery, you need to go and fine-tune it a bit. So, long story short, I decided to go for an evening course in introduction to counseling. You know, it was one evening a week, three hours, uh, over 10 weeks, and I caught the bug from there, you know. Um, and subsequently find myself where I am

What Is Work Addiction? Signs, Symptoms, and When Hard Work Becomes Unhealthy

SPEAKER_01

now.

SPEAKER_00

One led to the other. Yes. Work addiction. I mean what does it make it to be an addiction going to work?

SPEAKER_01

Okay, so as I said, there's one thing I always look at that even now, I I shy away from calling anybody an addict or an alcoholic. You know, I always so I was explaining earlier, if somebody came to me and says, Oh, I've got a problem with alcohol, my stance or my starting point always is in what ways you're drinking problematic? You know, so some people might turn around and say, When I start, I can't stop. Um, when I drink, I blackout, I beat my wife, um, I get caught drink driving, I've got criminal justice involvement, all that kind of stuff. Now, when I started in this field, I started from a harmonization perspective. So client comes to me with that perspective, I would ask them, okay, at what point do you lose control of yourself? Or maybe you might say after three bottles of alcohol. From the harmonization model of treatment, if I help you reduce to two, that is deemed to success. So looking at the problematic nature, when people come to me now, I just said to them, what is problematic about your substance use? So if people didn't see you with a joint in your hand or a glass in your hand, what behaviors might you be demonstrating that would lead people to think there's a problem here? And that would be the standpoint of where I work from. So then we're working on the stopping of the substance is the easy part. It's all the other associated behaviors, addictive patterns of behavior that the focus of the work is on generally. So in my case, it was not spending time with family, not going home regularly, working all hours a day and night, feeling anxious if I didn't meet certain targets, having the unrealistic expectations of everyone else around me. So imposing what I believed was the right thing for everybody else. And there was also a physical manifestation. I was having a lot of cluster headaches. You know, so very quickly I realized that this wasn't healthy, especially when I started seeing a therapist.

The Psychology of Work Addiction: Why High Achievers Struggle to Switch Off

SPEAKER_00

I'm just trying to understand the the mechanics and the emotional side of work addiction. Is it is it that you were addicted to the success you want to achieve, or is it just the process of work couldn't stop working? Or what is it exactly?

SPEAKER_01

Okay, I guess I'll say it's pretty similar to anybody with any other behavioral addiction or process addiction. I couldn't sit with myself. You know, I couldn't just be, you know, sometimes I would look at it and say I wasn't able to find pleasure from pleasurable activities. So the things that other people might do, like taking time out and spending time with family or going out to watch a game or watch a match or something of that sort. I always had in the back of my mind that I could be spending time working now. And there was some kind of withdrawal experience that I'll be having when if I'm not working, I'm constantly thinking about it. If I wake up in the morning, the first thing I want to do is check my emails, you know. But going back to that time, it was leadables. So we had leadables. You want to see, okay, who's the person who's gonna get the biggest bonus this month? And so there was an element of the financial compensation I'll get out of it, but also the fulfillment I got for it, it gave me purpose, it gave me meaning. Nothing else seemed to matter. The costs outweighed the benefits of what I was doing, and that's when it became a big

Burnout Warning Signs: How Therapy Helped Identify a Destructive Work Pattern

SPEAKER_01

problem for me.

SPEAKER_00

So the consequences from you being away from your family, from your friends, from how did this manifest exactly? Did someone tell you you you're working too much? How did you realize that? How how was your surroundings?

SPEAKER_01

Yeah, okay. So I I had a friend who was senior therapist, and every time I spoke about relationship difficulties I was having with people, not just my partner with people, not being present as a dad, uh having sleepless nights, not going home, all of the associated behaviors. He said to me that I think you need to speak to someone. You know, initially I thought, okay, maybe it was because of the physical manifestation, the cluster headaches, the anxiety, the sweats. And it's when I started seeing a therapist that actually started reeling off some of the patterns of behavior that I was demonstrating and introduced me to the concept of what a process addiction might be or a behavioral addiction might be. And, you know, comparing it with somebody with a gambling addiction and what the withdrawals might seem like. The traits seemed quite similar. It's just that mine was work that pushed that, you know, onto me. And then very quickly I realized, okay, I'm doing this, but I'm still working. And I didn't feel like anything was changing. So I took a sabbatical. And it was while I took that sabbatical that all of this side effect started manifesting myself, and that was the focus of the work. And that's when I realized I can't be back in that environment. A bit different from somebody with, I don't know, disordered eating. You know, you're not going to tell them don't eat. But for this, I had to remove myself from the work environment for a while, knowing that it would have to be a hard minimization perspective because I can't say I'm not going to work at all. Yeah. But I'd have to remove myself from the environment first and then start practicing some of what I was learning, implementing it, and being able to manage some of the presentations I was having.

Finding Purpose After Burnout: Transitioning from Finance to Mental Health

SPEAKER_00

How long did you withdraw from working?

SPEAKER_01

Well, I well, I stopped working in finance. Um and she introduced me, she said to me, What are you going to do? And, you know, there was an opportunity for me to volunteer in her treatment facility. You know, so I started volunteering there uh three evenings a week for four hours, you know, and it was I wasn't getting paid. I was just, you know, I was just working there. And I started finding fulfillment just from helping other people, you know. Um, and then a paid opportunity came up and she said to me, Um, would you like to get on a payroll? And I said, Well, yeah, if it means I've got a job, so I'm gonna be doing this. But at the same time, I was monitoring, or she was also monitoring how much work I was gonna be doing. Um, and in a very short space of time, it this treatment facility is in the southwest of the UK in Bournemouth, but it was a statutory service, so it wasn't for privately paying clients, it was government uh referrals. And what used to happen in those days, every so often, certain times of the year, you'd have less clients coming in. And when the numbers went down, she said, Unfortunately, I'm gonna have to let you go, you know, because I can't afford to keep paying you. So I said, All right, not a problem. I'll go back to volunteering, you know. And when the numbers came back up, she said, Yeah, I'd like to invite you to come back in, but this time I'd like you to come as a trainee therapist. So at the same time, I was doing my evening studies whilst working uh in the facility and subsequently finished counseling studies, went to university, trained to be a psychotherapist, and then specialized in addictions. An incredible way of doing it.

SPEAKER_00

Yeah, yeah, it's been a bit of a journey. It's been a bit of a

High-Pressure Careers, Executive Stress, and the Risk of Work Addiction

SPEAKER_00

journey. Do you think working in finance has a higher risk of work addiction or or um like with all the stress uh on uh on the individual and the amount of hours worked?

SPEAKER_01

I think anybody that works in any high-pressured environment where there are deliverables, outcomes, you know, um, or where you work anywhere where there's a lot of competition in the workplace, you know, um, whether it be for financial gain, whether it just be for recognition, anything of that sort can manifest itself in um a work addiction. But when I look back now, even today, most of the people I see, um, it will start from people using stimulants, you know, so things like cocaine, things like amphetamine, um, and and it will be co-occur alongside the work addiction. So very rarely does it just happen in isolation, you know, from the way the world we are in today. Um, there'd probably also be a smartphone addiction alongside it, you know, technology addiction, you know, digital addiction. So there's there's a whole mishmash of different uh manifestations. But as I said, I'm using the word addiction just so people understand. I just look at the problematic nature of what people do. Um so in the financial services industry, yes, certainly. Um people where their targets that have to be met, um, and the world we live in today, yes, I do believe so.

Executive Burnout, Substance Use, and Unhealthy Coping Mechanisms in High Performers

SPEAKER_00

I mean, in your case, it manifests certain form of working, overworking, and then the addiction uh patterns, behavioral patterns. But executive CEOs, people in leading roles, they struggle also with all the pressure. I mean, it all comes down, but the coping mechanisms they use to cope with that stress and anxiety and and and uh everything else coming at them uh can be different. You mentioned like cocaine, you mentioned uh other drugs. What addictions do you see with high performing individuals?

SPEAKER_01

For most high performing individuals, they are well, it normally starts from a manifestation of executive stress and burnout. You you notice people unable to focus, um, very short with their stuff, uh, having unrealistic expectations that are not being met, um physical manifestations of different ailments, depression, anxiety. Um and you you find they're not as productive as they would like to be, or the people around them start being affected by the behavior. You know, they put this on realistic pressure on everybody else. As human beings, we don't live in a world of one. You know, we live in communities, we live with people.

SPEAKER_02

Yes.

SPEAKER_01

And when I talk about the problematic nature, if this individual wants to do what he's doing and it's not impacting anybody else, you know, knock yourself out if you're okay with it. But when it starts impacting your relationships, when it starts impacting your ability to function, when it starts impacting your purpose and your meaning and your output as an individual, um you can tell when somebody is in that process and you can start seeing it being a matter of stress, and it might just be a case of they start drinking a bit more than they. Thought they were going to quite a lot of high-net worth people I know maybe use cocaine periodically for whatever it is, but all of a sudden it becomes a pattern, you know, it becomes habit forming. You notice them doing more, it might manifest itself in them seeing sex workers, you know, it just presents itself in so many different ways. Um, so yeah, that would be my experience of when I when I see high functioning or high net worth individuals.

SPEAKER_00

Often it leads to burnout, you said. Yes.

What Causes Burnout? Perfectionism, Internal Pressure, and Emotional Exhaustion

SPEAKER_00

What's the underlying cause of uh for that for this individual to get into a burnout? Inability to manage the high stressful situations, high stressful situations, is emotional regulations, is it expectation? Is it perfectionism? Is it frustration? All of the above. All of the above.

SPEAKER_01

And and the expectations, a lot of the time is not necessarily from other people, it's from within, you know, especially if your sense of self is derived from what you do as uh an employer or or or a somebody who's working in whatever the industry might be. Yes, you know, inability to cope with you know situations that they find themselves in, um, inability to regulate themselves properly, um, not taking meaningful breaks or time off from the work environment, you know, just constantly being in high stress situations, um, having no off switch is a way of a better way of putting it.

SPEAKER_00

Yes, I think that's a very important point. Um it it's also I feel like an entrepreneur with high expectations is because of that, they achieved a lot or they achieve a lot most of the time if they put the effort, the energy, and have the right ideas, yes, and the teams are supporting them. But it's the same, the same pattern, the same threat uh uh expectation um which can lead them to this problematic um behavior. So the question is when is the right time to find the right balance to accept or let go? What is it an entrepreneur should learn, let's say, from a therapeutic perspective, to to manage their expectations and emotional states, to avoid burnout?

SPEAKER_01

I don't

The Biopsychosocial Model: Balancing Mental Health, Relationships, Purpose, and Wellbeing

SPEAKER_01

I don't necessarily think it's something that's just unique to an entrepreneur, you know, because okay, say for example, um I don't know, I earn a million pounds a year and I'm struggling financially, you know, the feeling of my inability to be able to meet my financial obligations would be no different from if I was a cab driver that couldn't pay my rent. You know, so it depends on the meaning that I give it and how it impacts me. So for somebody in that kind of situation, it's also about the people around you, you know, being able to listen to feedback, being able to say, okay, work is work and being able to separate the two. Because, as you so rightly said, for most people who are entrepreneurs, that drive, that excess uh uh being in the workplace or the excess amount of time that's given to that is probably what got them successful. But there has to be a point where, as I said, when it starts being problematic, when it starts costing you something, when it starts impacting your physical health, your psychological well-being, your interpersonal relationships, your purpose, when you start seeing that it starts superseding the balance that we look for in life. You know, I mean, for example, the the model of treatment that I work with is what we call the bi-psychosocial model. So we look at your physical health, your psychological well-being, your interpersonal relationships and purpose. Now, nobody's ever going to have it perfect in all of that quadrant, you know. But the idea is that you try and have some balance in all of those areas. Well, if one area is leaning more towards one and there's deficits in the others, that's a good time to start looking and thinking, what am I doing too much of? And what else could I be doing to even out my my sense of self and my well-being? So for an entrepreneur, they might not be the first one who notices it. It will probably be the people around them that will first of all see that.

SPEAKER_00

It's it's tough. Uh, it's tough to do that break between work and and um and private life as well. I mean, I experienced that myself. It's uh because because owning a business, running a business, you you you you aware that uh responsibility um to everyone. And um, but still, how do you how do you do that? Uh or how should someone do it? You know, just walk in your door at home and then everything is gone? Can you do that? What

Burnout Red Flags: Overworking, Digital Addiction, Control, and Inability to Delegate

SPEAKER_00

do you do?

SPEAKER_01

No, I I guess it differs from person to person. I mean, look, nobody's ever gonna get this right. You know, um, it's it's the same like if you were having any other ailment that was gonna come up, you know. At some point, it might just be you realize that you you need a break or somebody just highlights it for you. I mean, case in point, I had a I had a client who, very successful, um, very regimented life. I mean, in his case, his life was so well structured that he knows he wakes up at this time in the morning, he does uh exercise, he does his yoga, he has his cup of coffee, he spends X amount of time with his kids, he goes to the office, he spends that much time. The difference with someone like him was if anything ever got in the way of that routine, his world always fell apart. You know, it could just be a case of a boss broke down on the on the outside lane and he couldn't get, you know, and he was timing himself to when he needed to get to work. That evening, it was a sign that that evening he was going to pick up alcohol again, which was his substance of choice in the beginning. Okay, you know. Now, the idea is that we start looking at, okay, what are these patterns that we notice? You know, what are these patterns? What are the, not necessarily the triggers, but what are the stresses that this individual faces that he's unable to cope with and what can be implemented? What support does he need to be able to manage when these things happen? Because the triggers, the stresses, those things are always going to be there, they're never gonna go away. It depends on the individual's ability to be able to cope or manage it, you know. And different people have different ways of self-regulating or needing external support. You know, if you find some kind of balance, like some people will be they know when to cut off, they go for a run or go for a cycle or go to the gym or whatever it might be. Or having something that takes you away from that high-pressured environment, not necessarily saying that you don't get to do it at all anymore, but developing some kind of resilience to be able to cope, but also knowing when to cut off, when to stay back, you know, when to take time out. Um, in my case, I couldn't remember in the whole time when I was working, when I ever went on holiday, I didn't. Because if I was on holiday, I'd need to be where there's a phone because I need to be able to find out what's going on. I need to be able to speak to people. And I was always thinking, oh, something's gonna be happening. Didn't delegate to no one. Always felt, oh, they're gonna get it wrong. I had to be the one that did it, you know? And that in and of itself would be an indicator if somebody's kind of getting to that point where they feel they're the ones that need to do everything, not wanting to pass it off or pass it on to somebody else. But every minute, wanting to check, wanting to constantly check emails, won't switch the phone off, got the phone beside you all the time, um, constantly scrolling, sat in a restaurant with family or friends, and they're on a, as you do when you walk past any restaurant and you see people doing that. Those are kind of red flags, those are signs that somebody could be coming quite close to their threshold.

SPEAKER_00

Is this happening because of we think we are that important, or we can influence everything much more better than others running a business, being an entrepreneur? Or what what's the underlying cause of wanting always being connected? And and and have influence on what's happening.

SPEAKER_01

Well,

Technology Addiction, Constant Connectivity, and the Loss of Human Connection

SPEAKER_01

I I I say our greatest strength is our greatest weakness. You know, um I remember when I was a kid, you know, I'll be on I'll be outside with my friends playing, and my mom would be shouting about seven o'clock in the evening, get inside, it's getting dark, you know. Um you've been out there all day. My kids, I remember telling them, get off that computer, go and play with your friends. You know, so it's flipped. You know, all of a sudden, the one thing that technology gives us is also the thing that's taking us away from interpersonal relationships, you know, connecting with people. And the idea, as I said, is about this balance that whatever way you look at it, the way these digital appliances have been designed is no different from you giving someone crack cocaine. Look at a one of the biggest mistakes I think we're making as human beings is you've got somebody who's got a year-old or 18-month-old kid, and when the kid starts crying, they either give the phone or they get them this little laptop. You wouldn't give your kid alcohol because you try taking that off the kid and look at what happens. Yeah, they start screaming their heads off. I didn't have that when I was growing up. So all of a sudden, the ability for people to self-regulate, the idea of somebody's going to self-soothe, we're giving them some external aid to do this, so much so that we're disconnected from ourselves and the ability to be able to talk to somebody and just share what I'm experiencing, as opposed to me just filling it with something else, filling it with something else. Because what happens when that thing is not there? Then it leaves this vacuum that you feel you need to fill

Mental Health Across Cultures: Comparing Nigeria, the UK, and India

SPEAKER_01

with something else.

SPEAKER_00

I I'm just thinking right now, are there cultural differences also when it comes to emotional regulation or how how people manage themselves? Because you you have you have Nigerian background, you grew up in the UK, you you're working currently in in India. Yes. So this you have certainly a multicultural view to the world and to mental health. Where do you see the differences and in the world of mental health and uh and emotional regulation?

SPEAKER_01

Okay, so I was born in London. I was born not far from here in Paddington. Um, my parents are Nigerians, so I went to Nigeria when I was six and did my primary and secondary education out there and came back to the UK when I was 20. Now, I remember when I was in Nigeria where somebody might say, I'm feeling depressed. And people would look at you and say, Whatever you've got to be depressed about, you know? You've got food, you've got a roof over your head, there's no such thing. Or there was a time when I was also of the belief that there's no such thing as an eating disorder. Because if you go to somebody in Nigeria that only has one meal a day, he's not eating he or she's not eating that food and throwing it back up. They don't know what they're gonna eat again, right? So when you look at the environment in which people come from, there is a collectivist system of people going along with the way the culture determines how you're going to be. There might be the odd one person who's experienced another culture that has a different experience. But generally, the collective, it's a bit like that uh when we had COVID and they said if you give a few people the vaccine, very soon everybody else is gonna, you know, is gonna take it. It's a bit like that.

SPEAKER_02

Yes.

SPEAKER_01

Okay. Then going to India, the one thing I knew very quickly was it would have been too naive of me to think I'm going to take a Western model or modality of therapy and take it into a very strong culture that has its own beliefs and value system. Right? Even up till today, I still learn from every single client that I meet.

Mental Health Stigma in India: Family Expectations, Psychiatry, and Cultural Beliefs

SPEAKER_01

So there is still a stigma around mental health there. You know, people, some people will look at it and think it's a moral failing, or you're not religious enough, or you're not weak or resilient. You know, they've they've come up with a number of reasons, or maybe your family's not religious, or you haven't prayed enough, or you haven't got the right guru, whatever it might be. And this is something that would have come down from generations of their culture over the years that, you know, for me to go in there and try and tell somebody no, that's that's not the reality of it, would be wrong. It's just about people getting people to come along, walk beside me as opposed to drag them in there. Now, there's a patriarchy, there's a hierarchy. And I'll give you an example. Where we are, we have quite a lot of Indian standards, you know, people who are very well-traveled, non-resident Indians who live abroad, who've experienced the Western world, live everywhere else. They come to India, they understand because they've been in, probably seen a uh primary care physician in the States or general practitioner over here. So they're used to the way things work. Over there, when people need treatment, the first place they go to is a psychiatrist. When I was over here, people go online, or some referrer just tells them about you know they're seeing a therapist and the therapist says, Oh, you need treatment.

SPEAKER_02

Yes.

SPEAKER_01

In India, is a psychiatrist. Okay. You know. Rightly or wrongly so, that's where people go to first. Now, what do we know about psychiatrists? The first thing a psychiatrist does is just bring out a prescription pad. Medication. And yes, everything seems to be medicalized. Part of this process is starting to get people to see that what we end up doing is giving you something else that you're going to probably get dependent on. Because there are people who have been on benzodiazepines that it started from, oh, the doctor gave it to me because I was feeling a bit anxious, and all of a sudden they've been on it for six years. Yeah, you know, and it's become problematic now.

SPEAKER_00

Just because the doctor gave it to you, it's legit.

SPEAKER_01

And if the psychiatrist says it, who am I to complain? He knows more than everybody else. Yes. You know? Now, it's different with the facility that I run now, by the way. I I felt the need to say that because part of what we're doing is trying to educate them on other models of treatment, how do things could be different? But also, you cannot do anything without the families buying. Because a lot of Indians live in joint families. So you'd have like three or four generations under the same roof. So much so that when somebody says we're going to come and visit, you know, okay, I always invite everybody, say, look, I'm not a salesman. I've told you what we do, how we can help, but come and have a visit, you know, come and see the facility, meet some of the other clients, speak to the staff, that way you can make an informed choice. I remember this one day, four car loads turned up. The whole community turned up to do it to have a look. I had to say to people, sorry, it's not a zoo, you know, I can't let everybody in and have a few people come in. But my point is, there's still this idea that we have to be intricately involved in everything that's going to happen, that's so much so that somebody might turn around and call and say, So, what has he been talking to you about in therapy? And I'm like, unfortunately, I can't really disclose he's my well, I'm the one paying. You know, so there's still that going on.

SPEAKER_02

Yeah.

SPEAKER_01

But there's also the stigma that nobody wants to talk about it. I mean, I was telling um one of your colleagues that India has the highest rate of male suicides anywhere in the world. You know, and it's just because of that, don't talk about it. You know, people don't have the ability to be able to share what's really going on with them. People see it as a weakness or a failing, as I said, you know, irrespective of the fact that India does have a lot of psychologists. They're top-heavy with clinicians, clinical psychologists, not so much talking therapists. So they're good with psychometric testing, they're very good with diagnosing.

SPEAKER_02

Yes.

SPEAKER_01

Um, I mean, it's changing, you know. I I I hate to blanket over it all, but times are changing, and I would suppose that they are probably where we were over here 25, 30 years ago.

SPEAKER_00

The numbers are huge. The the question to me is it's such an old um culture. Yes. And and historically, I mean, you you said it beautifully in Nigeria. You know, what's the problem? You have food, you have you have a roof of the is like some sort of mental health that's a bit provocative, uh, more a modern society problem. Yes. The the more comfortable we get in life that that we we develop this. The less resilient we are. Yeah. The less resilient we are, the more uh vulnerable we get. Yes. Um, but particularly now with these numbers, suicidal rates in India, has these numbers always been that high? Because historically it must have been also thousands of years ago the same. Um, or has this been increasing over time? And what was the kind of the turning point? What happened? So these numbers started to increase.

SPEAKER_01

Well, I I I can't I can't be specific about whether it's it's been like that over time, but I would like to think that the data has already been collected very recently in order for us to be able to say this is prevalent, you know. Um and it's also like one of those things I said there's this unspoken thing, nobody talks about it. And it's that whole thing of we don't talk about it doesn't exist. You know, that but now where there are a lot of mental health professionals beginning to look at this, there are people who are looking at male suicide rates and looking at all different other pathologies, borderline personality disorder, bipolar, ADHD, you know, it's becoming more prevalent that people are beginning to talk a bit more about mental health disorders and substance use. Whereas in the past, there was that belief that if we don't talk about it, it doesn't exist, or people would rather mask it as it being something else, as opposed to what we know it to be today. So, I mean, I've been in India three and a half, going on four years now, and in that time, every day I learn something new. You know, every day I see something that I'm looking at and thinking, yes, I remember there was a time when in the Western world, that's why we looked at it, but it's different now. It just means being able to bring people along, to be able to view this a totally different way, you know, especially if you've got, okay, they still have what they call these ashrams, you know, this uh I don't know, temples kind of thing where people go and they just feel that there's a guru there that's you know is gonna pray and everything is gonna be fine. It'd be very difficult for me, a Westerner, to go over there and tell people actually no, there's something else, something that over generations they've been using that they believe has worked in the past. You know, it might take one member of the family who's well traveled, who's been abroad, that kind of say, actually, let's listen to what this person says because we've been throwing money at this, we've been using this ancient form of treatment and it's not worse. Let's try something different. But you have to try and bring people along. Um for example, in all the time that I've been in India, um this current cohort of clients that we've got now is the most females I've seen in treatment. You know, we've got seven females at the moment. That's the most. You know, we've got 20 clients, seven of them are females. That never happened. Before I'd have 18 males, two females, and one female.

SPEAKER_00

Why is that so?

SPEAKER_01

It's a patriarchy, you know. Um wanna talk about it. Family not gonna let her go. She can't be open and honest about it. I mean, I'll probably say one out of five or one out of the six women that come in would also probably have an underlying eating disorder. But they don't talk about it. It's only when they come into treatment that that presents itself. Yeah. You know, that they don't want to talk about it. You know, they've there's shame attached to it, you know, there's blame attached to it, there's the patriarchy, um people expect you to be the wife and look after the kids.

SPEAKER_00

Yes, you know.

SPEAKER_01

So there are a number of different societal reasons as to why that's still happening.

SPEAKER_00

But yeah, and it's like with trauma, uh, if you if you don't escape it, I mean, escape it maybe would be the the the wrong uh definition, but if you are if you're still in the environment which has caused the trauma, you cannot heal from it. Yes, you're still dying. If you go to treatment and go back into this family dynamic or environment where uh another thought is not accepted, then it's also how how do you manage these cultural differences?

Family Support, Addiction Recovery, and Preventing Relapse Through Community

SPEAKER_01

Okay, one of the things that we we started doing is every client that comes in, we we involve the family as much as possible. You know, so the the the least amount of time people spend with us is five weeks, you know. So the first week is sort of like an assessment week. We do a psychiatric evaluation, we do a psychological evaluation, we send out questionnaires to significant members of the family, we ask them to fill it in independent of each other. So it gives us a 360-degree rounded uh perception, our observation of the client in that first week, and there is self-reports from the client. All of that is put into the mix, and then the collaborative treatment plan is done with the client. We always suggest to the client that it'd be really helpful if significant members of your family are involved in this process. Now, one of the things that we do, we've got the model of relapse prevention we use is the Gorski synapse model, you know, which posits that relapse is a process, not a single event. And what that then means is if somebody subscribes to that model of relapse prevention, it means that nobody from a period of abstinence just wakes up one morning and decides, I'm gonna start drinking again today. There's a process that precedes it. And that process, there are warning signs. You can see when the behavior changes start happening, when the attitude starts changing, that you can predict that if this behavior carries on, this person's going to be drinking soon. Yeah. We get the clients to explain it to the family members what signs they demonstrate. Because they're unique to each person. No two clients' uh warning signs are the same. But that's not just the end of it. You explain to them what signs you probably demonstrate before you start using, but also say how would you like them to intervene? What would you like them to do? Because people would normally do what they want to do until they find out what they're meant to do. You know, if you don't tell me, why can't you just stop? What's wrong with you? Um India would, by the way, they still have involuntary admissions, you know. So four guys just turn up and you know, you know. So, and when I ask the client, I'd like you to tell them what you'd like them to do. The client might say, I want you to stop following. Well, I didn't say what you want them to stop doing. What would you like them to do? Just, you know. And the idea is for the family to recognize what role they can also play. Because sometimes, being my experience, when I've invited the family to come in, sometimes they don't want to come because, as far as they're concerned, what you're trying to say is their fault why this is happening. They feel that you're going to blame them. So we take some educating. You know, we run um family support groups, you know, which we encourage all family members to attend. Yeah, yeah. They're free of charge. We do them free of charge, just to educate the family so they know how to respond when certain things are happening. Because as we're social animals, I'm yet to see anybody with problematic substance use that just impacts them. It impacts the whole system. And the idea is to try and help the system as much as possible to be able to cope and manage with the presentation, as and when it happens.

What the Western World Can Learn About Community, Connection, and Mental Wellbeing

SPEAKER_00

Yeah, that's beautiful to work with the families because uh they will be then the support group when they finish. So I'm I'm not that naive thinking the Western models will are the solution to the world's problems and mental health. What can we learn from, let's say, African background, Nigerian mental health background, or let's say Indian uh traditional cultures and treatment approaches? Yes.

SPEAKER_01

I'll tell you what, the most significant thing that I noticed. I used to live around here before I moved to India, and I lived here for quite some time. In a six-year period, I don't think I even knew my neighbors were. It was one of those where we just see each other over the back garden fence and we wave. Right? India, Africa, Nigeria, big sense of community. Everybody knows everybody. I remember growing up as a kid that I go out on the street and I'd be naughty. Somebody two streets away knows me, sees me, gives me a clip around the ear. I couldn't come home and come and tell my mom and dad that that person hit me because they're gonna give me another, you know, another flick around the ear. Over here, we still do things in isolation. That's the one thing I noticed straight away. So that connection, that community, you know, that whole thing about a child is brought up by a community, not by an individual, by the village, that's what we don't have over here. Yes, it's it's an untapped resource, as I always tell my clients over there. That you have this in spades that we don't have over here. The whole idea of them, we we might question it. People live intergenerationally under one roof, that there's a lot of supports. You people say, Um, oh, there's my cousin brother. That's how they say it, you know. So it's like maybe their auntie, third time removed her son, but they still looked at that as family. People are always willing to want to help each other. There's one adaptation we had to make because we we we do group therapy five days a week.

SPEAKER_00

Yeah.

SPEAKER_01

Over here, when we do group therapy, there is such a thing called confrontation in the group. The Indian culture doesn't lend itself to that. Indian culture doesn't lend itself to people holding the mirror up and challenging the behavior. So if you even just even the way I said it to you now, we change the word from confrontation to challenging, just to soften the interpretation of how people perceive it. And because sometimes when you're giving people feedback or you're telling people to give feedback, oh, I don't want to hurt him if I say the wrong thing. You know, there's this whole thing about people tiptoeing around the problem, not wanting to name it for what it is. And part of this process is to get people to practice being assertive, you know, because most people will be passive or they'll see something and say, that's not my problem. Getting them to realize that treatment is delivered in a community for a reason. You put 20 people together under one roof, there's going to be some discrepancies. There's going to be people that fall out with each other. Well, that's what happens in our communities. People fall out with each other. You can't be responsible for what somebody else does, but you can only be responsible for your response to it. And that's the whole approach that we use, you know. I think we could be using a bit more here.

SPEAKER_00

I love, I love that. I love the community aspect of um growing up and and and growing old, particularly as well. It gets more important in uh in later in life, but it brings also limitations to the individual, like uh in in some cultures, uh it has like expectations also, uh, and and how the individual can express themselves uh within that cultural community setting. So I think if they can find the right balance with that, with education, mixing, let's say, the western um knowledge and approaches with this community, this is this is a very powerful thing, um, and an advantage to living in big cities and uh and so on. I experienced that I come originally from from Lebanon, and culturally it's also you are more connected uh in communities, you know each other, even in big cities, you have you have you're you're close to your neighbors and and and friends. And um the approach to mental health historically was also like more um yeah, you don't there are no specific names. You you you probably used to say, Ah, I'm I'm mentally uh tired. Yeah, you know, so and then but you would express yourself, you're mentally tired in in a way, but you you got also that community support, uh being in that state. So people will help you, will will will be for you um in in that setting. And another aspect which comes to mind is as a difference to big cities and uh tall buildings. I just came back from Dubai. Yes. And um what I realize the they focus a lot on building new houses all over the place. But there isn't if if I look out into the world, how cities are developing, they are recognizing the community and where they create spaces where where people can connect, like in Singapore, um, some other movements, so people can walk uh the distance. Whereas now, in Dubai experience, you cannot do anything without having a car. Yeah, yeah. You have no possibility to go out and connect with people, it just goes in. Yeah. So there are so many aspects into it, from city planning to to uh local shops to to other aspects uh for the Western world. That you can learn

Cultural Differences in Therapy: Why Mental Health Treatment Is Not One-Size-Fits-All

SPEAKER_00

from. I mean, India, 1.6 billion people.

SPEAKER_01

Yeah. Right. Very well populated. If we start looking at pockets of a place like Mumbai, very highly populated. It wasn't planned properly because it's kind of colonial times. A lot of it was built in colonial times the way it is. So now there's a lot of regeneration going on. They're building modern amenities. They can't do the underground metro. So they're doing it the over overhead ones, you know. But there's not very brilliant town planning. So they're doing so much work at the same time, so much that is constant congestion. But if you see the people, they're just happy just to go with the flow. You know, whereas over here, everything's at fast pace, everybody's moving. You go and look at Liverpool Street Station or any station, there's people marching. Everything is slow there. You know, people pull out in front of you. Over here, we get high blood pressure, you get road rage. Never seen it. People walk in the road, and you're thinking, if that was over here, you get run over. No, they walk in the front of the cars were slowed down. You know, there's a different way of looking at it. But then I flip it. Just something you said earlier on and the penny drop for me. Taking a Western modality of therapy where the goal is to empower the client to make choices for himself, sometimes it's not necessarily going to work in the first instance for somebody who's lived in a community whereby he's always been told what to do. If in your formative years, what clothes you wear, what haircut you're going to have, what school you go to, what food you eat, everything has been decided by that. This is what you do. What you're going to do when you finish school, what university you're going to go to, what you're going to study, you're going to be a doctor, you know. Those decisions, if those were made for you, then all of a sudden you come into treatment, and then I'm giving you a menu saying, oh, what would you like to do?

SPEAKER_02

Yeah.

SPEAKER_01

Very difficult. And I'll tell you what, I had this experience over here. I had a Bangladeshi client many years ago over here, and his therapist sent him to me. He had to come into treatment, residential treatment in Bournemouth at the time. And I tried to work with this guy the way I would with any other client. And every time I tried to offer him, he just used to stare at me blankly. Like didn't understand the concept of me saying autonomy choice. So what I then had to start doing in the beginning was telling him what I wanted him to do. And he starts responding. And then I moved to the next stage of, would you like me to tell you what some other clients have done? And then I'll tell him and say, which of them do you want to try? Then I'm all I'm telling him is what I'm thinking, you know. Then I'm getting him to the place of what would you like to do? You know, it's very gradual, it's very slow, as opposed to us over here where a six-year-old mom said, What do you want to eat? You know, this guy's coming from a place where he didn't have choice. You had this one thing on the menu, and that was it. Yes, you know, so it's just about adapting to the culture, the nuances of the culture wherever we are.

SPEAKER_02

Yes.

SPEAKER_01

Whatever way we look at it, people are people all around the world. But cultures are different, you know, and it's about being able to meet people and speak the language that they will respond better to. That would be the approach I would

How Therapists Avoid Burnout: Self-Care, Boundaries, Delegation, and Work-Life Balance

SPEAKER_01

say.

SPEAKER_00

Beautiful. I think um what we can learn from it is just to be curious and open-minded, and um, and there is no one size fits all, certainly. Um, Obi, what do you do personally? Uh being a therapist, running businesses and everything, um, do to stay in balance?

SPEAKER_01

One of the things that I learned very early on, and and over the course of my career, I have trained so many therapists. I've had people who were clients who became therapists themselves. Um, I've interned, I'm a clinical supervisor, so I see a lot of people. One of the things I always say to them is it's very important, especially when you start training first, that you also have a therapist. I'm not saying that for the rest of your career you need to see a therapist every week. That's not what I'm saying. But you need to know where to go if and when you're struggling. Second thing, there has to be something that you also do to be able to switch off from the work. Whether it be seeing your therapist, whether it be going on holiday, whether it be using the gym for exercise, meditation, yoga, I listen to music, I go watch football, I meet friends, you know. So, okay, I've been in London. I came in London last Monday, I'm going back tomorrow. My phone's going, but my phone goes just for people to keep me updated about things I need to know. I don't make the decisions for the team because I always say, if the business can't run without me being there, then I'm not doing a good job. Yeah. The idea is they should be able to figure this out. Now, I would always say to the therapist, there's a senior therapist. If a decision has to be made, I would like the team as a whole to have a conversation, but the senior therapist will make the decision. I'll tell you what's most important. If and when I come back, I disagree with the decision, I won't say that to you. As long as I know that there was a clear process as to how you came to that conclusion that that's what you're going to do. And it might be a case I just turn around and say, it might help next time if you just consider this, if you consider that, if you consider that. But however, as long as we're not harming the clients, let's go along with what you decided. If it doesn't work, we change it. So I try not to make it be that I have to make all these decisions. Everything has to be run past me. I need to know about every single thing that's happening. No, I don't. If not, I'm not doing a good job. Beautiful.

SPEAKER_00

Thank you so much for uh being here with us today. I know you're busy and you're you're planning also your trip back. Yes. Um, I enjoyed our conversation. And um maybe if I if I come over to uh to to Mumbai, uh I'd love to host you.

SPEAKER_01

Yeah.

SPEAKER_00

I'd love to host you.

SPEAKER_01

Thank you for being here. Abdullah, thank you for the time. Cheers. Take care.