Friday, February 27, 2015

A Dreary Life-All Facts no Fiction.

Why are some people forced to lead wretched lives?Is it destiny?Or is it because of some wrong choices made by them?Is it because of a skewed up upbringing or is it because of defective genes?When we see a grown up man frittering away his youth we tend to put the onus on him but life is not so clear cut.Many factors join together to make a person what he is.

The life of Narayan,a young man of 41 years planted these thoughts in my mind.He was the eldest of three sons.His grandfather had been an SP.His father's elder brother had shot his own brother.His maternal uncle was a schizophrenic,as was Narayan's younger brother.The latter had been very sick and violent for 10 years after which he was given Electroconvulsive therapy.He improved after this and had been well since the last three years.

His father,a government employee,was an alcoholic.He mostly lived at his postings-away from the family and giving subsistence money to the family was for him,the end of his familial obligations.He dominated everybody,had no social life,and was fond of hunting.Once when Narayan was not even ten years old,his father handed him a gun and asked him to shoot.The gun exploded and the father was hurt.

These are some of the facts which Narayan disclosed to me on his very first sitting.I guess he wanted to ease the burden on his heart.To cut a long story short,this was the environment in which Narayan grew up.

At the age of eighteen years he went to join Indian Navy but he could not adjust to the tough regime and returned home.Moreover he aspired for a better occupation than that.He tried many options after this.First he did a two year degree course in MSW but could not get a job.Then he joined a private firm.He was happy there but that firm closed down.After this he worked for a relative but left this job because it demoralized him.Next,he opened a shop in his ancestral home.This too proved to be a flop.

It is no wonder that his main complaint upon coming to me was his sense of failure.He was depressed.He had a wife and son but could not support his family.There was no motivation.He always hankered for something which was out of his grasp.His biggest regret was that he left Indian Navy.

The one silver lining in this somber life-scape was his wife.She earned a meager income as a teacher but her unwavering support saw him through all his tribulations.

I gave him the necessary advice and asked him to come after fifteen days.He did not come.

After four months i followed up.His wife took the call.She told me that he was well now.He did not take any medicine.His wife's encouragement and his talk with me had helped him stabilize.

Now that you have all the facts,i leave it up to you to judge which factors were responsible for screwing up his life so terribly.Do post your answers.

Tuesday, February 17, 2015

#Generalized Anxiety Disorder

It is natural to be anxious when you have a tough task staring you in the face,when a huge life change is imminent,when the work-load on your shoulders is heavy, or when you or a dear one is diagnosed with a chronic disease.Yes all such and many other situations generate anxiety, but these difficulties do not confront us everyday.Yet there are some persons who are anxious every day,most of the time.Nervy and worried,they are fearful that something bad will happen to disrupt the tenor of their life.The extent and degree of their anxiety is not at all in consonance with external factors.They imagine the worst possible scenarios at the slightest pretext.Or they feel something is wrong but cannot pinpoint what.This is known as generalized anxiety disorder (GAD ) or free floating anxiety.

Let me share Rohit's case with you.He was eighteen years old and studying in a college.Good in studies, but very unhappy.He had a girl friend Rupa, but he was always afraid that a smarter boy would whisk her away.He also had issues about his looks-that his hair was thinning and who would give him a second glance if he went bald.He was not happy with his height or complexion either.I delved into his past and came to know that since his parents lived in a village,he had been sent to his uncle's home in a city to be educated.His uncle derided and reprimanded him no matter what he did.He was compared unfavorably with his cousins.As a result a feeling of inferiority lodged itself in his mind.It obstructed him from appreciating and enjoying the good things in his life.He was neither happy with his present,nor hopeful of his future.
Or take the case of Rita.She was starved of love,care and attention as a child.She strove to do well,be a model child;but it was never enough to extract a loving word or appreciation from her parents.However her diligence opened up excellent career opportunities for her and she married a loving boy.You would think that she was happy now, but this was not the case.She had a niggling feeling that her husband would break off with her and she would be left all alone.She could not believe her good luck would last.Result?
GAD or free floating anxiety .
  1. GAD can also have a number of physical symptoms, including:
    • dizziness.
    • tiredness.
    • a noticeably strong, fast or irregular heartbeat (palpitations)
    • muscle aches and tension.
    • trembling or shaking.
    • dry mouth.
    • excessive sweating.
    • shortness of breath.
  2. Generalised anxiety disorder in adults - Symptoms - NHS ...
Causes of GAD
Neurotransmitters--An imbalance in neurotransmitters can cause anxiety;but anxiety itself can also cause this imbalance.
Life experiences like childhood emotional abuse,rape,divorce,early loss of dear persons or some other trauma.
Family history--Whether a repetition of anxiety disorder in families is because of genes or a mere emulation of the behavior pattern of a close relative is not clear;but it has been seen that anxiety disorders can run in families.
Substance abuse and the effect of certain medicines can also cause free floating anxiety.
Long term stress can also result in excessive anxiety.
Certain diseases  like hypothyroidism, heart disease or a chronic illness too can cause anxiety.

Anxiety arising from specific triggers is easier to control because the cause can be identified and addressed.A perennial state of despondence is harder to jettison because very often the patient does not even realize that she has this condition and it should be rectified.She may accept it as just being her nature and not an ailment.

Sometimes if anxiety is manifested in the form of only one physical symptom,and not many as shown above;it may be viewed only as a physical illness --thereby delaying treatment.

As far as treatment is concerned cognitive behavior therapy is the first choice of experts.The therapist assists the patient to identify the negative thoughts and beliefs which distort her behavior.For example if Rita (in the example above ),had introspected and realized that her forebodings were only a replay of her childhood insecurities and frustrations,she would have learned to be more confident and eased her anxiety step by step.

Exercise is extremely effective for eliminating anxiety.It burns off surplus nervous energy and stimulates the release of neurotransmitters,which makes you calmer.

Yoga and meditation also help to erase anxiety.

Medicines can regulate the neurotransmitters but this can also be achieved through exercise;and without any side effects too.

Elimination of GAD requires sustained efforts because by the time it is found out, it has already taken firm roots in the patient's psyche.However the rewards are well worth the labor.Enhanced peace of mind is the first fruit followed by restful sleep,better health and a confident state of mind.Once you have taken care of free floating anxiety,you are better equipped to face the problems which crop up from time to time :-).   

Image from google search.

Tuesday, February 10, 2015

Mental Disease is a Disease--Nothing More,Nothing Less.

Me,a mental patient?How preposterous!

This is how we all react at the first hint of a mental disorder.Why?Because the whole vista of mental disease is nebulous,unfamiliar,scary and stigmatized.It is unfamiliar because very few sufferers talk about it;scary because we have seen only the extreme and perhaps untreated patients losing control over their thoughts,emotions and behavior.Those who suffer from a mental disorder,yet continue to function normally,generally don't talk about their condition.We conclude that all mental disorders possibly end like the extreme cases mentioned above.We stigmatize mental disease because the behavior of those we come across and recognize as mental patients, deviates considerably from the accepted norms.We interpret the outward manifestations of this disorder as a sign of weakness or a flaw in the patient's character,and therefore discredit that person as being unstable,dangerous,and not worthy of our time, friendship,or sympathy.

Before proceeding further let us consider what exactly is a mental illness or disorder.Here is one definition which,I think,covers it all :--

Mental illness is any disease or condition that influences the way a person thinks, feels, behaves, and/or relates to others and to his or her surroundings. Although the symptoms of mental illness can range from mild to severe and are different depending on the type of mental illness, a person with an untreated mental illness often is unable to cope with life's daily routines and demands.

And the cause of a mental disease could either be --

Genetic--A blood relation who is a mental patient.
Biological--Anomalies in brain chemistry.
Environmental--Brain injury,infections,substance abuse,poor nutrition,exposure to toxins,prenatal exposure to virus alcohol or toxins,child abuse and cruelty.
Psychological--A traumatic experience like death,disease,divorce,treachery,rape,loss etc.

If these be the causes of mental disorders,why and how does stigma creep in?The reason is quite simple.If I have a cardiac problem whatever is happening in my body is not visible outside;but in case of a mental disorder my moods,emotions and behavior are all open to public scrutiny.Any aberrations will be attributed to my incompetence,eccentricity,moodiness,selfishness,stupidity, immorality or an attention-gaining mechanism.

Inappropriate behavior sets a mental patient apart from others.He is unable to function in consonance with societal norms--whether in family,school or work place.

Since he is unable to tend to his own upkeep properly,his disheveled appearance adds to the bias against him.People around him fail to understand what he is going through and therefore label him uncharitably.

All this adds to the stigma, but the description above applies only to those who have not been treated.

There might be many mental patients around you who are being treated,who are productive members of society and whom you do not recognize as mental patients;because they have never talked about their illness.In this way they too,add to the stigma.

Not only others,even the patient often stigmatizes himself,thinks he is incapable of taking an active part in society,shuns company and plods on without seeking help .

Then there is the family--which wraps a curtain of secrecy around the patient,sometimes even confines him to a room and deprives him of social as well as familial interaction.

All this results in social,economical and professional discrimination.He gets fewer chances to study,evolve,work,make friends,get married and find suitable accommodation.

If it is not isolation and discrimination,it is bullying and humiliation.Is it any wonder then,that a person thus persecuted retrieves in his shell and becomes a social misfit?It is the society which puts him there.

Patients refrain from seeking treatment because of this stigma,but their worsening condition reinforces it.

According to National Mental Health Program,MoHFW,GOI--
"Treatment gap in severe Mental Disorders is 50%.In case of common Mental Disorders it is over 90%."

How To End This Stigma?
It is incumbent on all of us to realize that a mental disorder is a disease,not a self inflicted condition or something to be ashamed of.

Those who suffer from it can help by talking about it as Deepika Padukone did.When a person like Deepika admits to having been treated for depression,many others will gather the courage to do so.Those who seek treatment at the right time can continue to have a normal life-their symptoms controlled.Here is a list of fifty famous personalities who suffered from mental illness,yet they made a name for themselves.

If you come across a mental patient treat him no different than you would a person with a fractured arm.Do not avoid him,thinking that he is abnormal.When you connect with him you will realize that he too,is human like you, and hungry for companionship.He needs your empathy but not your pity.

I have interacted with many schizophrenics-who were undergoing treatment--none of them was unstable or dangerous.In fact they were intelligent and logical,the difference being that their perception of reality,their adapting skills were distorted.

If you see someone combating emotional problems show your willingness to help.Inform him about the various Mental Health Professionals available in your city and help him choose one.For example psychiatrists prescribe medicines but do very little counseling,others like a psychologist,clinical psychologist,or a psychiatric counselor diagnose the ailment,give extensive counseling and refer to a psychiatrist if medication is needed.It all depends upon the severity of the disease.There are also specialized professionals like child psychologists and marriage counselors.

Instead of ousting mental patients from schools,work places and houses,attempts should be made to rehabilitate them.

According to this site many people either recover fully through early diagnosis and proper treatment,or at least their symptoms can be managed successfully.Some of those who suffer from a severe disorder may be disabled.Eight out of ten can return to their normal activities.

The ball is in our court.

Related posts:--

Obsessive-Compulsive Disorder---The Enemy Within

# Fears and Phobias

Treating #Depression

#Suicidal Thoughts
Image from google search.

Tuesday, February 3, 2015

Forgiving--Whom,When and Why

Forgiving is often extolled as a balm for wounds inflicted by others' inconsiderate or aggressive behavior.It puts an end to a painful chapter so that we can focus on the here and now,without ghosts from the past distracting us.It initiates a healing process by virtue of which we regain our peace of mind,physical health and sleep.Our relationships and our life,slide back to normal.Yes,forgiveness can accomplish all that.
But there is no single size which fits all,because the offending behavior could range from crime,abuse,victimization,treachery and swindling to ridicule,humiliation,favoritism or plain neglect.The magnitude of offence certainly has a bearing upon whether it should be forgiven or punished.Holding grudges or mulling over offending behavior can cause anxiety and depression,but forgiving serious personal violations is also not conducive for one's peace of mind.So what is a person to do?Tough question--it is a catch 22 situation.
The decision to forgive or not, anchors upon many factors.Have a look:--
How severe is the offence ?
It goes without saying that crimes have to be reported to the concerned authorities,but what about abuse,which very often goes unreported?Especially physical,sexual and marital abuse?If a victim forgives the perpetrator in these cases then she exposes herself to further transgressions.  
How long back was it committed ?
If a wrong was committed a long time back and has not been repeated thence,then it certainly needs to be forgiven;because holding grudges for long periods only causes misery.It serves no purpose.Adult survivors of abuse often carry the scars for years,even decades;but by doing this they miss out on living life to the fullest.
Is the perpetrator out of your orbit?
If someone who hurt you terribly is no longer in your vicinity and is not likely to cross your path again,then that person should be forgotten and forgiven at the soonest.But if the culprit moves around in your circle then it would be a folly to forgive him--you have to make your displeasure known in no uncertain terms.
How is the perpetrator related to you ?
Some relationships cannot be terminated--however unkind or     insensitive that person might have been.Holding on to rancor against that person makes it difficult to function within that setup.There will always be an invisible wall between you two.This could be a parent,sibling,offspring,spouse,boss or a colleague.
Was the offence a one time occurrence or is it the norm ?
You can overlook a slight here, or an irritation there;but if someone is in the habit of belittling or domineering you at every possible opportunity then you have to stand up and say'this is enough,I shall have no more of it.'
Are you sure the affront was intentional and targeted at you ?
It is possible to misinterpret or take personally,a remark or gesture which was not meant that way at all--specially if you are in a vulnerable frame of mind.It is best to make sure before taking umbrage.

How To Forgive
Forgiving anyone is not easy.Even after you have decided to forgive,your heart may not support your decision and you will have to reinforce,convince yourself that this is the right thing to do.The following tips can help you along:---

  • Let time elapse.It will bring down your emotions from a boiling point to a low simmer.
  • Run through your mind a larger picture of the culprit's behavior and character, filtering out the act which stung you.Is he a nice person otherwise?Will you be safe after you forgive him?
  • Make an allowance for human frailties--none of us is perfect.You or I too,might have hurt many,did they harbor animosity towards us?Let me share my own experience with you.This happened only last month.Quite a few years back I broke off with a friend because she said something malicious and false about a friend of hers with whom I was not even acquainted.Lodging myself on a high moral ground,I cut her off completely.Then last month I thought she was considerably older than me,I too had reached seventy;how much time did we both have?So I just walked over to her home.Her enthusiastic welcome and unalloyed smile gave me a lesson for life.It was as if I had never shut her out of my life,she had forgiven me totally.
  • Go back to the episode which is smarting you and replay the whole sequence.Did you in any way instigate or annoy that person?Forgiving becomes easy if we too had a part to play in it.
  • A lot of time and energy go into consolidating a relationship but it takes only a moment to destroy it.If you value this relationship then nurturing resentment is not going to keep it that way.It is true that this person has hurt you, but recollect the good times you had with him and the moments when he was there for you.Won't you be sorry when the warmth dwindles to zero degree temperature?
  • Take a look at your mood these days-are you always pent-up,preoccupied and miserable?This will continue as long as you harbor resentment against the offender.Would you not like to go back to your old cheery self?This will happen only if you forgive that person.You should not suffer for someone else's misbehavior.
The decision to forgive or not is a very subjective one.Some people are very quick to take offence while some others forgive very easily.Definitely the latter are the happier lot.At the same time overlooking major violations against us, endangers our security and ruins our self worth.

For some people forgiving is not an option at all--they want revenge at any cost.This choice is full of land-mines.It puts all else on hold while the protagonist goes all out to take his revenge.Is it not possible to let the offender stew in his own juice and meet his own destiny?There is something like celestial justice after all!

As Gautam Buddha said"Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else;you are the one who gets burned."