Sarah, a 20 year-old Chinese female, sought help from Agency X (a community mental health center) because of her concern for her 3-year-old child, Sammy. According to Sarah, there is “something wrong” with Sammy, but she does not know what it was.

Sammy is the oldest of two in the family. Unlike his younger brother (Tommy, 8 months old) who was said to be “normal”, Sammy was unresponsive to the people around him. Currently, he is still not talking and not toilet-trained. On the other hand, Sammy’s dad did not think there is any problem with Sammy, because he himself was not talking or toilet-trained until he was 5 years old. Sarah also noted that the only time Sammy would seek her out is when he wants something from her. However, his way of gesturing is by pulling and grabbing her hands to reach for the thing that he wants. He doesn’t make sounds and avoid eye contact. When he couldn’t get his way, he would scream and “go crazy,” until Sarah gives in to him.

Currently, Sarah is living with Chandran, a 30-year-old Indian man, who is the father of both Sammy and Tommy. Although not legally married, they have lived together for the last two years, since Sarah’s grandmother passed away. Sarah said that she loves her grandmother as her own mother. In fact, she claimed to still see her deceased grandmother coming back to visit her whenever she feels down and lonely. Sarah has vague memory of her biological parents, who had apparently left her with her grandmother when she was 4. The only thing that Sarah remembered was that her dad used to drink a lot and beat up her mother.

Sarah and Chandran, with their two kids, currently live in a rented low-cost apartment. She said that they could only afford one bed and the whole family sleeps together. Although periodically the local gang members would extort money from Sarah, she generally feels happy where she is living because her neighbors often help her take care of her children. Although Sarah adores her children, she gets very stressed out whenever her children cry, because she doesn’t know what to do with them. She also needs frequent reminders to feed and change their diapers. When the caseworker visited her home, it was found that there were dirty diapers and garbage everywhere. Sarah said that she just did not have the time to clean them.

Sarah stopped schooling around the age of 12. She said that she tried her best in school, but often failed most of her subjects. Currently unemployed, she reported some past experiences of working as a salesgirl, but was never able to keep a job for more than a few months. In all her jobs, Sarah often got teased as being “slow.” Sarah said that she hopes to become a policewoman one day, but has no idea how to do so. In terms of her health, Sarah has a history of epileptic seizures since childhood, which recurs whenever she is under stress. Relating to that, Sarah admitted not being regular with her medications.

It was apparent that there were some bruises on Sarah’s body. Sarah confessed that her boyfriend, Chandran, sometimes beat her up when he became drunk. This happened almost every other night. According to Sarah, Chandran has been drinking more and more lately and she is becoming more fearful of him. Nevertheless, Sarah insists that Chandran loves her dearly and believes that he will get better somehow. Currently, Chandran has not been able to find a job because of his drinking problem, although he blames it on his prison record for gang fighting several years ago.

Sarah said that she is a Christian, because she believes in God. She used to follow her grandmother to a nearby church because “the people there are very nice to me.” Now, she follows her boyfriend to the Hindu temple, because she knows this pleases him. Furthermore, she gets to learn some Tamil words and Indian custom, which helps her blend in with her neighbors who are primarily Tamil-speaking Indians. In her day-to-day communication, she tends to use a mixture of colloquial English and Malay languages. Although she is generally a chatty person, Sarah finds it hard to express herself clearly sometimes.

Following her neighbors’ suggestion that perhaps Sammy has been disturbed by some “dirty spirits,” Sarah has brought Sammy to various local mediums and bomoh (traditional healers), but to no avail. Instead, he is beginning to display more tantrums and even self-harming behaviors (e.g, banging his head repeatedly on the wall), whenever he could not get his way. Because Chandran is out of the house most of the time, Sarah feels very helpless with Sammy’s behaviors.