Saturday, 6 October 2018

Q n A: Teen Daze: T2 (The telegraph) Article published on 7th Oct'2018

Q. Of late my daughter, who is in Class VIII, has become a compulsive liar. She lies even about basic things, like what she had for lunch. Is this a psychological condition or a passing phase?

When a child learns to lie it means they are learning to use their imagination to influence their reality. However, for a girl in Class VIII this is not normal. 
Communication is the key to solving problems, so sit her down and talk to her. Ask her about what’s going on in her life and why she is lying. There may be some stressors that she may have been facing, which is leading her to behave in this manner. Also, is she just lying to you or to everyone? If she is lying to you then you may need to change some aspects of your interaction with her. Explain clearly what is non-negotiable for you. Be firm. Angry outbursts often have a counter-productive effect on children with behavioural problems.
You may need to reiterate that lying is not acceptable. However, when you tell her that lying is not right, you have to be flexible to be able to deal with honesty. You need to be able to acknowledge and reward her each time she chooses to be honest instead of lying. If you think that the problem is getting out of hand, you can also take help of a counsellor. The counsellor should not only be able to help your daughter but will also be able to tell you what’s happening to her and help you interact better with her.

Q.I have a 17-year-old son who dropped out of college. He is now doing his graduation through distance learning. The problem is, he refuses to go out of the house and do anything. There are days when he doesn’t even get up from bed all day. He doesn’t like interacting with anyone. We have not been able to persuade him to see a counsellor. Please suggest what to do. 

This indeed is a tricky situation. The whole interaction depends on your shared dynamics. First, what led him to drop out of college? Maybe that is still the reason he is behaving the way he is. Be open and ask him if there is something that is going on and he’d like to share. Explain to him that you are very concerned. 
Encourage him to talk to you without nagging or prodding him. If he trusts you enough, perhaps, he will open up to you eventually. When he does, do not try to tell him what he should do or should not do or offer solutions and advice immediately. Just listen to him and ask him what he would like to do, so that he does not go on feeling the way he is. 
Reaffirm that you want him to enjoy life, go out and socialise and if he doesn’t, it may not be healthy. If he denies there is anything wrong, then encourage him to join in activities with you. Go for walks or to the gym together. If his mood and behaviour stay the same, then take him to a psychiatrist or a psychotherapist saying that as one goes for a medical check-up this is also to be sure that everything is all right with him.  Be firm but don’t lose your cool. You need to be tender yet persuasive to get through his resistance. 

Q.My son is an extrovert, quite a popular child in school. He is 15. Recently I have observed that he is stammering, especially at social gatherings. He is becoming very conscious of it.

Stammering can be due to psychological stress or sometimes due to a physical issue. However, since it has just started, it is more likely to have a psychological cause. Talk to him without making him feel judged or weird about himself. Try to find out if there is something that’s bothering him. Has he been anxious of late or has there been some incidence that is bothering him? You can take him to a counsellor if he is not opening up to you. 
At times, even after one deals with the psychological components, one needs to retrain their speech to overcome the impediment. Take him to a speech therapist, who, in this case, is the most qualified to help your son. Be sensitive to what is happening to him and do not keep correcting him when he is speaking.
Q.I’ve come across a stash of ganja in my 16-year-old son’s drawer. I can’t decide if I should confront him or let it be this time and keep an eye out in future? 

Ignoring a problem may save you an uncomfortable confrontation but is not helpful in the long run. Letting it be doesn’t address the problem. If it is okay with you, we recommend that you tell him what you’ve found in the drawer and ask him why it was with him. Hear him out patiently. Once you hear what he has to say, let him know that this is not all right with you. However, when you communicate this, do not be overemotional or angry. Communicate with him in a calm but firm manner. 
Children, as part of growing up, will push the boundaries that you have set. They test our threshold and push our limits but as parents, it is our duty to keep defining this boundary. It’s not necessary that they agree with us or see eye to eye with us on every issue but it is important that they learn to respect the limits set by us.
Tell him that if it is the first time and an experiment, you understand but you wouldn’t want this to be repeated. If he tries to argue with logic about how good it is, don’t encourage the discussion. Tell him that it’s not acceptable and as long as he is under your care, this cannot continue. You may also say that you have enough reasons to believe that weed is not good for his physical or mental health and that this is not up for discussion. 
If he says that he’ll not do it again then trust him and give him a chance to follow through on what he is promising. Be aware that in the future he might repeat the same thing and you may have to repeat the same exercise in a firmer way. Setting a boundary is often a long repetitive process, till it becomes apparent and obvious. It is important that you keep an eye on your son.

Q. My 13-year-old daughter still wets her bed at times. She has already started menstruating. How can we help her?

Bed-wetting can happen because of various physical and psychological issues. Some children bed-wet occasionally till they are around 12 or until they start menstruating. She is not very far off the normal bell curve as yet. Around the time of menarche, it is also not uncommon to have an uncomfortable feeling around the urinary tract, which can lead to bed-wetting. Sometimes an infection in the urinary tract can cause this type of episodes.
Take her to a paediatrician first and ensure that there is no physical cause for this. If physically she is fine, first, have a friendly chat with her. There can be a lot of anxiety and awkwardness regarding the menstrual cycle, and other pubertal changes. Make her feel normal and comfortable regarding these topics. 
Explore your relationship with her. Could this be a reflection of the anxiety and restlessness she’s feeling? Is she able to express herself and her feelings to either parent without fearing judgement and trivialisation? 
A few other practical things you can try out are as follows: Restrict her fluid intake after 7pm and, throughout the day, ensure she finishes 1.5 to 2 litres of water. Make sure she goes to the washroom just before retiring to bed. It might help to restrict exciting, adrenaline rush-causing films, like horror, suspense and thriller in the evenings. If you have a fairly good idea about which part of the night she is prone to bed-wet, you can wake her up prior to that and get her to go to the toilet, for a couple of months. It might also help her to have her own bed and eventually her own room if possible. A certain degree of autonomy helps them get better autonomy over their body.

Saturday, 22 September 2018

Emotional Eating: T2 (The Telegraph) Article dated 23rd Sep'2018

The festive season is around the corner. Get-togethers and parties with friends and family are in order, and one key ingredient that we cannot ignore in that celebration is food — lots of it. While many of us are looking forward to a good feast over the five days of Durga Puja, some perhaps are already dreading the aftermath of such indulgence. 

The connection between mental health and sleep is obvious; what is not so known is that our relationship with food is linked to our mental health too. When our body is starved or undernourished, it is normal to feel irritated, angry or even depressed. At times overeating can make us feel low about ourselves and take away our usual drive. In the context of mental health, food habit is very important: A balanced diet and healthy fluid intake can help one feel better and grounded.
There is another side to the story. Many times we neglect food as we neglect ourselves. This could be out of simple carelessness or a deep-seated self-loathing. We may starve ourselves as punishment and may not even be aware that we are doing so. 
On the other hand, when one is feeling emotionally distressed or feeling stressed, it is also not uncommon to binge-eat. We end up using the normal act of eating food as a way to feel good. In that case, we use food as something known and comforting, something that fills up our psychological void, although for a very short period. 
Eating or staying away from food — both give us a sense of control. Our dynamics with food is far from being simple and linear.

For thousands of years, in fact, for the longest period of human evolution, our most significant survival drive has been to secure our food supply by procuring enough. When we could gather food, we were valued by our community. 
Eating, for evolutionary purposes, has an intrinsic pleasure component attached to it in our mind. We feel good when we eat well. It’s not difficult to understand why food has always been a jubilant way to celebrate and enjoy. However, our expectations and conditioned ideal of ourselves have changed over the years. Being overweight, now, has an added component of shame and injury to self-esteem. So, it is not uncommon to see some of us being in a vicious cycle of craving food in order to feel good but ending up feeling worse after binge-eating. 

Bulimia and anorexia

In the extremes of this complex and layered dynamics with food, there are pathological eating disorders which are under the purview of mental health and psychiatry. 
There is ‘Bulimia nervosa’, which is characterised by repeated episodes of binge-eating with compensatory behaviours. Here one is morbidly afraid of becoming fat, yet at the same time they cannot help but eat more than they ought to. In a typical case, a person is persistently preoccupied with eating or thoughts of eating. They have irresistible cravings followed by binges or episodes of overeating. Often immediately after that, they try to counter the fattening effect of their binges by starving themselves, intentionally inducing vomiting, or misusing over-the-counter purgatives or other drugs to reduce the fattening effect by trying to purge or by increasing body metabolism or by dulling appetite.
Another common disorder is ‘Anorexia nervosa’, most commonly seen in young women in which there is a marked distortion of one’s body image in the mind. Even when they are thin, they see themselves as fat and there is a pathological desire for thinness. They try various methods to keep on reducing weight, which severely damages their physical health. Because of their continuous effort to lose weight, they suffer from severe malnourishment, low body weight, anaemia and various hormonal problems. Death due to anorexia nervosa is not uncommon. Often patients resist any attempt of treatment as they lack insight into their physical health condition. 

Regularise your food habit

Both the eating disorders have severe self-image and self-esteem issues associated with them. Like any relationship, our relationship with food vastly depends on how we feel about ourselves. Feeling good about ourselves doesn’t mean that we have to feel we are perfect or that we are infallible or that we can make no mistake. Paradoxically, feeling good about ourselves means we see ourselves as we are, with our flaws and vulnerabilities with honesty but without judgement, and without any need of pretence to hide them. 
Feeling good about ourselves means that we let go of our insecurities, we are ready to improve, open to learn and are not defensive or rigid about ourselves. There is no need to stick to a particular “how I should be” image, but if need be we are ready to work towards a goal. 

We accept ourselves as always learning, growing and changing. If we don’t know how to feel comfortable with ourselves, we will always depend on something external to make us feel good about ourselves. 
Unfortunately, nothing external — whether it is parental approval, peer acceptance, love of life, success, money, fame, respect or, in this case, food — can make us feel good about ourselves. It’s us who need to see ourselves gently, softly and with a little compassion. It is up to us to let go of any conditions or yardstick for accepting and valuing ourselves, and then as a society, we need to learn to let go of this need to constantly measure people by some standards and ideals and impose these ideas. 
So try to regularise your food habit. Watch out for stress eating. Acknowledge your cravings and examine them closely. You may get never-before insights about yourself. Be mindful of the craving for food just as a strategy to feel good about yourself. Put your “I can feel good ONLY IF…” ideas under the scanner and examine those rigid conditions. 
If you want to exercise and lose weight, that is fine. But do it because you want to be healthy, rather than out of pity and shame of being your current self. Remind yourself that it is an informed choice you are making as you want to take care of yourself, nothing more, nothing less. 

Explore your relationship with yourself as you explore your relationship with food. Like every journey of self-exploration, you need to be patient and gentle with yourself.

-Dr Sangbarta Chattopadhyay and Dr Namita Bhuta 
are medical practitioners and practising psychotherapists. 
They conduct individual and group therapy sessions.

Sunday, 26 August 2018

Self Harm : T2 (The Telegraph) article dated 26th Aug'2018

Self-injury, a common behaviour among teens, needs to be handled with care and courage

“It hurts so much… the pain is insufferable. The more I try to control it, the angrier and the more tormented I feel... and the only thing that gives me a little peace is when I cut myself. The sight of blood oozing out of my hand, the smell of it, the physical pain distracts me from the pain I feel inside…”

Accounts of self-harm can be unsettling even for seasoned mental health professionals, teachers and clinicians. And one can only imagine how distressing it is for parents of a child who’s bent on committing self-harm.
A study done in Australia estimated that one out of every 12 adolescents today subject themselves to self-harm, and these figures are only based on reported cases. The figures are likely to be higher in the UK and the US, and we have no reason to believe that India is far behind. 
Most of the time we confuse self-harm with suicide or attempted suicide, and the shame attached to it prevents the sufferer, or the caregiver, from seeking help. Due to this reason, it is difficult to gauge the gravity of the problem in our society. 
Self-harm is not the same as a suicide attempt, although in some cases suicidal thoughts may accompany self-harm behaviour. The intention in self-harm is more to inflict pain and suffering on one’s self, rather than killing oneself. Usually, teenagers from age 14 onwards show these self-harming behaviours, but it is possible to see its onset even earlier on. The commonly seen self-harm behaviour includes:
  • Cutting oneself.
  • Burning with a cigarette butt or incense stick or something similar.
  • Repeatedly banging the head or throwing oneself against something hard.
  • Punching oneself.
  • Overdosing on a medicine.
  • Poking things into the body.
  • Swallowing objects.

It might appear that these acts are done calmly and deliberately. They may seem like manipulative and attention-seeking tricks. But a person who is suffering often does not have full awareness and control of their actions as they are dealing with intense emotions and inner turmoil. While some people do it impulsively, others plan it and contemplate for a considerable time before they actually do something. Some people do it only once or twice in their life, whereas others do it repeatedly over many years even into their adulthood.

Psychology of self-harm

We tend to take our self-preservation and self-interest for granted and self-harm can seem confusing, baffling and an alien idea. But all of us, most probably, have a small degree of self-punishing, self-sabotaging and self-depriving traits in us.
Some of us harm ourselves in less obvious but more serious ways. These can range from indulging in sweets when we have diabetes, falling in love with the “wrong” person, destroying a settled relationship with a fling or an affair, staying in a volatile and/or violent relationship, driving recklessly, and indulging in substance abuse (alcohol and drugs).
If we look at ourselves closely, we will find that at some point we all have knowingly done something that was clearly against our greater good. Many psychologists have explored this “death wish”, “passive-aggressive” or “nihilistic” trait that is hidden. We are all often vulnerable and victims of our own mind’s manipulative tricks to choose pain and suffering. But physical harm is more violent and visually disturbing, and so it stands out.
One of the common features in the psychology of self-harm is intense self-loathing and self-hatred. In most cases, the pain one feels is triggered by or originates from harsh self-judgement because of their perceived failure to be accepted by or belong to a larger group. This larger group can be family, friends, society or even the tribe of the so-called “normal people”. 
Unfortunately, often our concerned and well-intended communication with people displaying self-harming behaviour actually adds to the problem rather than solving it. Imagine a terrified parent watching their child slashing themselves. After the initial panic and shock response the communication with the child will go something like this:
“What is wrong with you?”
“How can you do this?”
“We love you and do so much for you and this is how you reciprocate?” 
“Your mother is worried sick, see what have you done to her!”
“Do you not even care for us?”
“We are giving you everything, what else do you want?”
“You are emotionally torturing us and putting us through a very difficult time. We are depressed and we want to kill ourselves now.”
Each of these sentences is more shame-causing than the other. As a society, we believe that to “teach” a child, we must highlight how wrong they are, how they are failing us, how they let us down, how they are unacceptable and unwanted.
As authority figures, we spontaneously guide and teach by punishing, reprimanding, shaming and isolating a person. Even when we may no longer be using the stick, we end up punishing more severely through our words and our disapproval.
The other extreme of the communication is a panicky saviour who says, “You poor baby, don’t do this. I’ll give you whatever you want, whatever distracts you from this.” This doesn’t help either. It will probably make the person feel more miserable about themselves and you are now rewarding and giving an incentive to self-destructive behaviour.

Listen without judging

It is important to listen to a person demonstrating self-harm. Listening is not a passive phase where you are waiting impatiently for the person to finish and you jump to what you want to say. Listening is a dynamic process. It needs that we first let go of our need to label things as right and wrong, good and bad. We need to pause and be open to seeing the other person without any judgement, being available to them neutrally (not as an indulgent care-giver or as an interventionist).
Neutrally listening to a person is sometimes enough to remove feelings of isolation and disconnection and restore a sense of connectedness in them. It takes a tremendous amount of courage to be able to be calm and centred after witnessing a self-harming episode of a loved one. But it is of utmost importance, as any desperation or pushing can worsen the situation. 

If you are a sufferer

When you want to harm yourself, try to remind yourself that the feeling of self-harm is a passing phase. If you can cope with your distress without harming yourself for a time, it’ll get easier over the next few hours. 

  • Talk to someone. If you are on your own, perhaps you can call up a friend.
  • If the person you are with is making you feel worse, go out or go to another room.
  • Distract yourself by going out, listening to music, or by doing something harmless that interests you or that you enjoy. Exercise, brisk walking and running help.
  • Relax and focus your mind on something pleasant.
  • Find another way to express your feelings, such as squeezing ice cubes (which you can make with red juice to mimic blood if the sight of blood is important), or just drawing red lines on your skin.
  • If you need to, give yourself some “harmless pain” — eat a hot chilli, or have a cold shower.
  • Be kind to yourself — whatever you are feeling is going to be okay.
  • Write a diary or a letter, to explain what is happening to you. No one else needs to see it.
  • Later, think of taking professional help. Talk to an adult you trust.

Do and Don'TIf you are a caregiver 

  • Educate yourself and help the affected person learn about self-harm. There are numerous articles online. Make them feel okay about themselves and normal.
  • Take professional help. Often there’s an underlying mental health issue like Borderline Personality Disorder.
  • Help the sufferer think that self-harm is a problem to solve, not a shameful secret.
  • Don’t try to be their therapist. Therapy is complicated and you already have enough to deal with as their parent, friend, partner or relative.
  • Don’t expect quick fixes, or expect them to change their behaviour quickly. It’s difficult and takes time and effort.
  • Don’t react strongly by being angry, hurt or upset. It’s likely to make them feel worse. Talk about how it affects you, but do it calmly and only in a way that shows how much you care for them and how they are loved and valued.
  • Don’t struggle with them when they are about to commit self-harm. It’s better to walk away and suggest they come and talk about it than do something drastic.
  • Don’t make them promise not to do it again. Don’t emotionally blackmail them. For instance, don’t say you won’t see them unless they stop harming themselves.
  • Don’t feel responsible for their self-harm or become the person who would stop them. You must get on with your own life. Make sure you talk to someone close to you, so you get some support.

Sunday, 12 August 2018

Anxiety: T2 (The Telegraph) article dated 12th Aug '2018

Anxiety is universal and commonplace. We have all experienced anxiety at some point of time in our lives, and most of us don’t even think it is something to be taken seriously. Perhaps we assume that it’s natural to be worrying, anxious and high-strung in today’s world and so, we don’t see how anxiety wreaks havoc on our lives. 
Sometimes we confuse an anxious mind with an active mind or as being concerned, which gives us the justification and incentive to remain anxious. A mother who’s constantly thinking about her child’s future may find not worrying as a sign of being a bad mother. If a student is not crumbling under pressure before an exam, we might be quick to judge them as ‘not serious’ about studies. A person who usually takes things in their stride calmly may not be perceived as driven or productive enough. It will not be an exaggeration to say that through many of our apparently normal thoughts, ideas and lifestyle choices, we are constantly priming ourselves to be anxious in many ways. And many of us are paying a price for it. 
Anxiety falls under the umbrella term ‘neurosis’, which is defined as maladaptive psychological symptoms usually precipitated by stress. Basically, we are said to have neurosis when our mind cannot cope with the perceived or real challenges, threats or stressful situations, and we start worrying excessively, feeling apprehensive about the small things. This causes a lot of distress and dysfunctionality. 
Anxiety can manifest as a sudden episode of acute panic attack (Panic Disorder), worry of being embarrassed in public (Social Phobia), worry of being contaminated and developing a repetitive compulsive behaviour (Obsessive Compulsive Disorder), of being away from close ones (Separation Anxiety Disorder), fear of having a serious illness (Hypochondriasis) and being overweight (Anorexia Nervosa) to a more defused but constant lurking of fear and tension (Generalised Anxiety Disorder).

Generalised Anxiety Disorder (GAD)

It’s when there is more or less constant worrying even when things look okay. One feels an uncontrollable, persistent, free-floating anxiety most of the time of the day, and one is also always apprehensive about everyday events or problems. 
It gets accompanied by other symptoms like restlessness, tiredness, difficulty in concentration, irritability, muscle tightness and sleep disturbance. According to the DSM V (Diagnostic and Statistical Manual for mental disorder) criteria for diagnosis, if one has at least three of the above symptoms along with pervasive and persistent worry for most days for at least six months, one can be diagnosed of having GAD. 
According to ICD-10 (International Statistical Classification of Diseases and Related Health Problems), GAD is recognised by:
1. ‘Autonomic arousal’ including palpitation, increased heart rate, increased respiratory rate, trembling or shaking and dry mouth.

2.Physical symptoms like breathing difficulty, choking sensation, chest pain or discomfort, nausea, abdominal discomfort or pain.

3. Psychological symptoms like feeling unsteady, dizzy, light-headedness, ‘derealisation’ (which is an acute sense or suspicion of being in an unreal, unfamiliar world or/and a sense of detachment from one’s own thoughts and feelings or sense of self), fear of losing control, fear of going crazy or dying or passing out, difficulty in concentration or ‘mind going blank’ from stress, persistent irritability, sleep disturbance.

4.General symptoms like hot flushes, cold chills, numbness, tingling.

5. Symptoms of tension including muscle tension/aches and pains, restlessness or inability to relax, feeling on the edge or tense, feeling a lump in the throat or having difficulty in swallowing.

 Panic attack

A more dramatic and acute presentation of anxiety is a panic attack — a short period of intense fear accompanied by some of the symptoms mentioned above, including a few others. Sometimes the fear or anxiety can be so distressing and painful that suicidal thoughts can arise. In panic attack, symptoms develop rapidly, peaking in about 10 minutes and usually don’t last for more than 30 minutes. It may happen out of the blue or when there’s a specific recognisable trigger. Having to perform in front of others, meeting unknown people, facing a crowd, being in public places or in emotionally charged moments can be some of them.
Ironically, the fear of having a panic attack itself can trigger one; and so can the fear of getting sick or lost. Sometimes attacks may happen in sleep and in rare cases, physiological symptoms of anxiety may occur without the recognisable psychological component, which is known as non-fearful panic attack.
A chronic and recurring panic disorder may present itself with only physical symptoms like chest pain, Irritable Bowel Syndrome and certain types of headaches, that is, without an actual panic attack. Another common form of anxiety is ‘Specific Phobia’ where there is an irrational fear of a particular trigger, like phobia of closed spaces, public speaking or injections.

Five psychological potholes to avoid: 

‘Should be’ fixation: 

When one is too fixated on how things should be rather than being aligned with how things are, it creates a psychological environment of anxiety. It is great to try to better things but we also need to understand that not everything can be how we think it should be. We are imperfect creatures who live in an imperfect world and ‘should be’ can be aspirations and preferences but not compulsions and demands.  

‘Comfort zone’ adherence: 

If we only stick to things and environments that we are comfortable in, our tolerance threshold for things that we don’t know how to deal with is bound to be low. This does not help one to grow. The more we are exposed and forced to negotiate things that are outside our comfort zone, the more skilful we become to handle ourselves during stressful times. Slowly trying to get out of our comfort zone might make us less anxious.
Need to be in control: 

If one constantly nurtures a need to be in control and micro-manage one’s surrounding, then there will be anxiousness. There are things that we can be in control of — these are related to us, our behaviour, and our ideas. There will always be things that will be out of our control. Unless we are okay with that, we will always be stressed.

Resistance to ‘unpredictables’: 

Life surprises us. If we have a strong need to have a predictable outcome, we will often find ourselves distressed. Be ready and willing to negotiate surprises, both positive and negative, and you’ll find it easy to deal with ups and downs. 
Fixer syndrome: It is good to be a problem solver, but if you think you need to fix everyone ’s problems around you, you are in for trouble. There is a difference between the problems you can solve, problems which you want to solve any problems which need to be solved, so choose and prioritise carefully; you cannot fight every battle without getting torn apart within.

Learning to disengage

Whatever be the symptoms, there are psychological patterns behind most cases of anxiety. We love and value a person who is constantly anticipating, recognising, getting engaged with a problem and thinking of ways to handle them or at least trying to prevent them in advance. We also love a perfectionist who is in charge and delivers perfectly every time. These same traits can also give rise to dysfunctional anxiety or panic attacks because they programme us to constantly think of the worst-case scenarios and create an urgency to micro-manage our environment according to our ideals.
Learning to disengage from anxiety-creating thoughts, beliefs and ideas is an important skill to develop. We need to be self-vigilant so that we can recognise these troublemakers and challenge them when they are causing more distress than benefit. It requires long-term commitment to change and to keep disputing the beliefs and thoughts that may be triggers. 

Daily practice of breath control and meditation techniques like the ones taught in the Vipassana meditation courses, mindfulness-based stress reduction programmes, Zazen or Zen meditation are quite useful in dealing with anxiety. 
 Nowadays excellent medications are available for anxiety. Don’t shy away from consulting a psychiatrist and getting a proper evaluation and prescription. It is important to remember that many medical conditions like hyperthyroidism can mimic symptoms of anxiety or panic attack, so please get a doctor’s opinion. A therapist might also be able to help recognise early symptoms and teach effective tools.

In an acute condition, one needs to affirm to oneself that, “it’s a passing phase, it will go away in half-an-hour”. Practise focusing on your breath, and try breathing slowly and deeply during an acute attack. You can listen to calming music or nature sounds, or do a quick guided anxiety-relieving meditation on one of the various apps available. Carry your medicines if you are prone to panic attacks. Educate yourself and know what works for you.

Dr Sangbarta Chattopadhyay and Dr Namita Bhuta are medical practitioners and practising psychotherapists. They conduct individual and group therapy sessions

Sunday, 22 July 2018

QnA Parenting: T2 article Dated 22nd July, 2018

Q. My 10-year-old cannot go to sleep unless he is in physical contact with someone. Even if it’s for just 10 minutes before sleeping. How do I change this? He will be going to boarding school next year and I need to get him out of this habit.

A: The best way to deal with it is to have a talk with him; explain the situation and tell him why you need to help him get over this habit. 
There are a few things you should be aware of. Has he always been this way, or is it a recent habit? If it has always been like this, then probably you or one of the family members has created this habit. In that case, you need to talk to him first and deal with the situation based on his reaction. You may need to gradually wean him off this habit. Offer to sit in the room initially as he tries to sleep. After a few days, let him try and sleep alone. 
If this is a recent development, you need to determine its cause. Many times, a child may be fearful of something or they may feel they are not getting the attention they need. Chat with them without criticising them and then act accordingly. Children at age 10 are capable of sleeping alone, so knowing the root of the problem will help you solve it easily. Ensure that the solution is something that he is comfortable with. 

Q. Is fidgeting a psychological disorder? Do I need to be worried if my child is constantly fidgeting?

A: Fidgeting by itself is not a psychological disorder. It can be a symptom of behavioural issues, depending on the age of the child, the frequency and duration of fidgeting and whether it is disrupting normal activities and studies. 
Children under five years are generally fidgety and curious about their environment. They are restless and want to move about. This pattern decreases as they grow older. Try to engage your child in physical activity and encourage them to play games which require focus and concentration. If the fidgeting is affecting their studies or activities, consult a child counsellor. 

Q. My 18-year-old son has made friends with a gang of boys who are into doping. How do I keep a check on him without antagonising him?

A: This depends on your dynamics with your son. If you have a friendly relationship and he trusts you, then having a few heart-to-heart conversations and explaining your reservations should be enough. Make sure that you have authentic information before you have these conversations. Do not discard the importance of his friendship; rather talk about what your concerns are. 
If he has been staying away from doping despite his friends being into it, please make sure to compliment him. And let him know that you trust him. If you are open and can be non-judgemental, children are quite eager to share their stories; for that, though, you have to first gain their trust. If you already have a difficult relationship, then take the help of a professional counsellor to improve your relationship. 

Q. My 10-year-old daughter is quite sharp, but her attention span is very poor. She is hyperactive too. How do I help her?

A: Kids are more active than adults and often appear to be hyperactive. They also have shorter attention spans. At 10 years, they cannot sit for long periods to study. 
There are different styles of studying. Some kids, especially those with ADHD (attention deficit hyperactivity disorder), study better while moving around, others memorise better if they hear things and while some others are visual learners. Support your daughter by allowing her to learn in the style that suits her best. Try and make studies interesting for her. The sharper your child is, the more curious she will be and is more likely than others to be bored of things.
When studying, it is all right to give her a break after 30-40 minutes and resume. Encourage daily outdoor activities as children generally have lots of energy which needs to be spent. 
Various research shows that cutting out artificial sugars from a child’s diet helps those who are hyperactive. 
Reduce the time a child spends in front of the screen to a minimum, ideally not more than half an hour a day. If she still finds it difficult to concentrate, you can seek professional help. 

Q. How do I teach my nine-year-old son to handle rejection? From not being selected for the school football team to losing in a cricket tournament… of course, there are small rejections at every step.

A: There is no particular way to teach a child how to handle rejection. Children learn from their parents’ actions and responses — how you react to situations and respond to them. It is normal for your child to feel disheartened, let down, rejected when things don’t go their way. When you talk to your child, do not ignore these feelings. If they are very sad, tell them: “I know you are feeling sad, and it is okay. You can try next time.” 
Avoid trying to bribe your child with gifts or food to compensate for the rejection. Spend time with them, have a fun chat and play games when they feel disappointed and low. You can also assess your parenting strategies. Do you always say yes to your child or give in to their demands at some point? Then you need to start saying a firm no to their unreasonable demands. The skill to deal with rejection also comes from the ability to accept a no. 

Q. Bullying and physical violence is a major problem in boys’ schools. How do we advise our children to tackle that? Advising them to hit back always means encouraging them to be violent, while suffering quietly is seen as a mark of weakness.

A: Teaching your child about how to handle a bully is important irrespective of their gender. If there is physical violence involved where your son can be harmed, encourage him to report to an authority person immediately after the incident. Urge him to take precautions by making friends and staying with his group of friends. Teach him to shout out for help if he is alone and being harassed. Encourage your son when he helps his friends out in similar situations. Tell him: “Harassing someone is not acceptable behaviour, but that doesn’t mean that we retaliate by being the same way or taking law in our hands.”
Bullying is not just physical, there is verbal bullying, emotional bullying and cyber bullying. The key to tackling bullying is to have good communication with your child so that they can tell you without worrying about what is happening to them. The idea is to teach them to stand up for themselves, help them retain their self-esteem without encouraging to be violent or aggressive.

Q. To what extent do I allow my 10-year-old daughter to be on social media? Giving free access is proving to be addictive, while barring it is keeping her out of the loop while her peers are indulging in it. 

A: This is a very difficult and highly debated topic and it’s hardly possible to give a one-fits-all solution. The problem is not the fact that there is social media, it is how one uses it and for what one uses it. However, peer pressure should not be one of the reasons why you allow your child to use social media. Applications of social media is vast today; it includes various apps such as Facebook, YouTube, WhatsApp, Snapchat, Instagram and Tinder.
Homework assignment via WhatsApp is not harmful, but sharing private pictures or whereabouts to strangers on Facebook or Snapchat can be. 
Study and project material can be found online, so a blanket ban on social media is not a solution for the children of this generation. But as access to electronics increases, the electronic addiction also increases. You as parents have to be informed and discern which is the app that you will allow access to and which you won’t. Then fix a duration for which the child is allowed access to social media. Limit the duration of the overall screen usage as well. Do not allow online gaming every day. 
We believe, and these rules are arbitrary, that in the current Indian context, children should not have personal accounts on any social media before they are 15. For a 10-year-old, it is advisable to have limited and supervised access to an online medium.

Dr Sangbarta Chattopadhyay and Dr Namita Bhuta are medical practitioners and practising psychotherapists. They conduct individual and group therapy sessions in Kolkata.

Sunday, 8 July 2018

Work Stress/ "Load Shedding" : T2 article dated 8th July 2018

In a recent study of the American workforce, 77 per cent of the working individuals surveyed reported being unhappy because of work-related stress. Many of us could say the same about ourselves — the enormous stress that we feel because of our jobs. When we get stressed at work, it spills on to other aspects of our lives. Understanding how we behave, perform, respond and cope in our workplace is the key to dealing with stress in the long run. 

What is stress?

Stress is our physiological and psychological preparation for a real or presumed challenging situation. 
When we sense there’s a crisis coming up, we mentally switch to a crisis management state, we become alert, our blood pressure rises, the heart pounds, breathing becomes heavy, muscle tightens. Our body gets ready to fight or take flight. This priming response, which we recognise as the stress response of our body, is very important for our survival. When the crisis is over, our body is geared to go back to its normal state.
These physiological changes are not harmful to the body as long as the body returns to it’s resting or baseline equilibrium reasonably quickly, and what is causing the stress is there only for a limited time period. 
We also experience these biological changes when we get excited, say, when watching the World Cup match between Argentina and France, or doing physical training, or even when we have a fanboy/fangirl moment with a celebrity. Many might actually enjoy the adrenaline rush and crave it, as it lets us experience a sense of excitement, thrill and aliveness. It is only when our body’s functions do not return to their baseline — either due to long-standing exposure to the stressor, or because we don’t know how to disengage from the crisis situation and give ourselves a break — that stress actually gets to us and becomes harmful. 

Stress at the workplace

We may not realise it, but an insecure work environment, even when it works in our favour, actually can build up constant anticipatory stress and hurt our productivity. A workplace that is friendly and cooperative will naturally make one secure, relaxed and at ease. So nurturing a supportive work environment goes a long way toward reducing stress. Here are a few things we can do reduce work stress for ourselves and for our colleagues. 

Support your team

Listen to everyone in your team and respect them for their uniqueness. Avoid being a bully; instead, be there for the other person. Motivate, mentor and groom your juniors and help out your colleagues. They are likely to help you when you need their support! Avoid powerplay and favouritism. Sometimes in the guise of being playful or pulling someone’s leg for fun, we end up ridiculing, isolating, hurting or breaking our co-worker’s morale. Watch out against that. 

Avoid setting unrealistic targets and deadlines

Perhaps nothing stresses us out more than a feeling of helplessness when we deal with a situation that’s beyond our capacity. There is rarely anything more uncomfortable than the constant reminder of our inability to do something which can alter the outcome. What can one do in such a situation? 

1) Do not overcommit:

 If you are in a position to make decisions, try not to commit more than you can realistically deliver. Have a discussion with other team members to estimate the time needed to finish the work. Many a time, in our zeal, to push ourselves or please others or because of our inability to say ‘no’, we bite off more than we can chew. It may sound dynamic, but in the long run, it only takes away from the productivity of the team.

2) Communicate:

 If you don’t have a say in setting the deadline and it is imposed on you, try and communicate your concern and reservation to the team leader and the members objectively and gently. Make sure that you put your best foot forward but also prepare yourself that you may not have any control over the outcome. Support other team members and work towards the goal, keeping in mind that your estimation might be wrong and you may actually be able to meet the deadline. 

3) Plan and strategise:

 Break up your larger goal into bite-sized goals and spread them over a week, so that you have smaller daily targets. Prioritise the bigger picture, which is important, and focus and work towards it. A planned approach will put you at ease; it is the direct antidote to fight feelings of helplessness.

Fear of underperforming

It is important for us to be noticed, acknowledged and appreciated for our contribution. It is important for us to do well and live up to our own expectations. And in a situation where we are lagging behind, we may find ourselves unhappy and stressed. To deal with it, the following steps can be helpful.

1) Avoid comparisons with colleagues: 

Comparisons polarise us. Either we feel flawless and hence superior, or we feel deeply inadequate and hence inferior. Disengage when your colleagues play one-upmanship driven by their insecurities. To be on top of your game, you need to choose your battles carefully. 

2) Set goals for self-improvement and learning:

 Rather than trying to be better than your colleagues, try bettering your performance! Assess your skillset and aim at improving it. A self-focused growth plan can greatly help in reducing the fear of underperforming. 

3) Take unfair appraisal in your stride: 

Don’t be too harsh on yourself or hold onto grudges when you are given a poor appraisal. Sometimes you may not be given a justified appraisal even with your genuine effort and contributions, at other times, office politics or unconscious biases may affect you negatively. Try to not be bogged down and focus on what you can change. Communicate with your HR or manager. Discuss calmly why you have been scored so and what you can do to improve your performance. 


Work can be hectic and because we spend more time at work (including travel time) than ever before, it is vital that we are in fine form, physically and mentally. These small steps go a long way in preventing burnout.

1) Devise a switch-off switch-on office ritual: 

Try to switch off from work worries when you step out of the office. You can create a visual ritual to remind you of this. Imagine putting all the worries and issues in a backpack, zipping it and placing it under your office desk before leaving work. 

2) Participate in activities: 

Spend time outside your work; pursue a hobby or some extra-curricular activity. This will help to disengage from the stress and allow your mind to unwind. You can use meditation apps daily or try some residential meditational courses once in a while. Prioritise family and social connection time when you are out of your office. 

3) Get enough sleep: 

Having a good sleep cycle is important to rejuvenate your body and mind. To have sound sleep, avoid caffeine, watching television and using social media before going to bed.

4) Eat right: 

Are you going hungry for long hours and then end up binge eating? Eating right is not just about what you eat and how much you eat. It also matters when you eat. Eat at regular intervals and keep healthy snacks or fruits handy. 

5) Exercise: 

If you can’t manage 30 minutes of exercise during the day, break it down into 10-minute chunks thrice a day. At work, take regular breaks to stretch, especially if you have to sit for long hours.

6) Vacationing: 

It is needless to highlight the importance of a little time off once in a while. Plan and prioritise your vacations carefully. The idea is to give your body and mind an opportunity to recuperate and rest from the perceived crisis.