Coronavirus……COVID-19……Flu-like symptoms….Breathing difficulties….Isolation….Fever….Quarantine…..ICU….China…Europe…USA…India…Lockdown…Janta Curfew….and more…and more………

World News…Media…TV….FB…WhatsApp….gossips in homes…in offices… in phone calls….everywhere this is going on….

What are the signs of infection….what are the symptoms of infection….how can we check….how can we prevent infection……how can we treat infection….critical care for breathing….for circulation……guidelines….circulars…more and more…

WAIT! LET’S PAUSE! LET’S THINK….

Yes, it is very critical phase for all of us….but in the middle of all this panic… all this emergency care….What about our MIND…our mental health…our emotional well-being? Yes, all this is affecting our body….but is it not affecting our mind…..our emotions…?

Let’s think carefully. There are various ways and factors in which the Coronavirus Pandemic is interplaying with Mental Health. Let’s think about these factors or groups-

• • The group of people who are not infected with Covid-19 virus, but do have an episode of fever, cough, flu-like symptoms- this group will be genuinely worried and stressed, dreading that they may have been infected.
  • The group of people who unfortunately get infected with Covid-19 virus- they will be stressed and worried……no words can describe their stress. We are hearing news of some patients running away from hospitals, some patients attempting suicide, etc. The experience, the trauma, the grief, the bereavement, the time to recovery, the stigma……. Our full support to this group.
  • Then, there will be the group of people who suffer from Anxiety disorders, Somatisation disorders, Hypochondriacal disorders- this group of people may experience increase in their symptoms and deterioration of their mental health.
  • The families and carers of all the above groups will experience stress and this will have impact on their mental and emotional health.
  • Let’s also keep in mind the general public around the above groups of people. We are already hearing about mob getting angry, mob reacting towards infected people or towards those suspected with infection. Submerged in this anger is anxiety and fear, unhelpful beliefs, etc and this may lead to low mood or more anxiety.
  • The other aspect to think about is- the impact of the epidemic and pandemic on the economy…….the slow down…the fall in Stocks and Equities….the monetary and financial impact. This will cause stress and hence impact mental and emotional health.
  • Related to above- what about the group who survives on daily wages? The closures, slowdown, etc will impact on their ability to manage life. Hence, the impact on their mental health, and on their dependant’s, too.
  • Let’s think of another group- the healthcare staff (doctors, nurses, ambulance staff, paramedics, lab technicians, support staff, etc). On one hand will be the anxiety of getting infected. On the other hand, there will be the impact of fatigue, over-work, exhaustion, low staffing, increased demand. Also, the lack of vaccine, curative medicine, etc will have an impact on their morale and confidence. Needless to say, the healthcare worker’s families will also be impacted by the mental and emotional health of the worker.
  • Let’s consider another aspect- social distancing, self-quarantine, lockdowns, schools closed, offices closed, malls, cinemas, restaurants closed, work from home, domestic helps not able to come, can’t leave home……..….all this means everyone at home 24X7, no breaks from each other…no distractions available….tempers may fly, patience may be lost, tantrums may flare.

• Also, lack of above activities may mean that people are more glued to social media, FB, WhatsApp, etc……more rumours…more news…some true, some false…… hence, more anxiety, more stress.
• Let’s also think that as healthcare services are impacted, hence appointments, reviews, surgeries, treatments, etc for other conditions are also impacted. People with other chronic Physical conditions may experience a period of decreased support and care. People with existing Mental Health conditions may also experience decreased support and care. This will trigger further stress for these group of people. And, for their families and carers, too.

This list can go on…and on.

We are not realising the impact on our Mental and Emotional Health. This is probably because our hands are already full of worrying about the physical health impact of the Covid-19 pandemic. The soft signs of mental and emotional health easily submerge within the physical health worries or we try to brush them aside and ignore them or we minimise them. Whether we chose to recognise them or we chose to ignore them, they do exist.

The idea behind above is not that we start thinking that mental health crisis is inevitable, and we all need medicines or specialist treatments. The idea is to stimulate us to think, to be mindful, to be aware, to self-monitor. By being mindful and aware, most of the work is already done in looking after our mental and emotional health. Problems arise when one ignores this. By being aware and mindful, we will be able to look for early signs, act early before it becomes a bigger problem, and prevent further deterioration. We can also do the same for our near and dear ones around us, be aware of their emotional health and support them.

If we remain aware and self-monitor, then several early interventions can be done, and these will prevent further worsening. Such interventions are specific to the individual. A person will himself or herself know what will work and what will not work. There can’t be a universal remedy. Each person, each mind is individual; and hence every person, every mind has its own way to keep well. The things to consider can be-

• Self-help activities- our hobbies, our interests which refreshes us, which distracts us, which rejuvenates us. It could be reading, writing, drawing, singing, dancing…….and so on. Due to the current situation, there will be limitation in doing most of the group activities or outdoor activities. Examples like swimming, playing cricket, traveling, etc will not be feasible and other possible alternatives should be developed.
• Self-therapy activities- Mindfulness based activities, meditations, etc can also help. Individuals will have ways of helping based on their belief systems, faiths, religions, spirituality, culture, social systems, etc.
• People who already are on a treatment regime for mental health, should adhere to it and refrain from becoming non-compliant. They may have to cope with delays in review appointments, or with shorter quick review appointments. Adhering to the recovery plan and getting support from others like families and friends, to tide over this period may prove helpful.
• Managing social media, using it only as necessary, refraining from using it overwhelmingly, etc may also help. We need to realise that whatever we read or see, impacts our mind. So, best is to use selected things to impact our mind. Maybe, just use very few selected forums which we feel assured that they provide real facts.
• Most of us will not need anything more than the above. However, some of us may need to seek specialist help. They should consider getting assessed by a suitably qualified Psychiatrist. A Psychiatrist is a medically qualified professional who specialises in Mental and Emotional Health Disorder. Psychiatrist assesses, diagnoses, formulates and creates a treatment plan. This treatment plan may involve specialist therapies or medications or both. One should not think that seeing a Psychiatrist means invariably ending up with being prescribed medications. In most of the cases, the treatment plan may not include taking medications. One needs to be aware of this and should monitor self. And seek appropriate specialist help without delay.

I would like to end by just saying this-

Stress reduces our immunity. We all know this. So, let’s manage our stress. Let’s look after our and others’ Mental and Emotional Health and Well-Being.

In these difficult times, I wish WELL for ALL.

“Problem Child”; is that true?

The label of being a “problem child” is nowadays being used and heard very commonly.

“This child is too much”….. “He is very naughty”……“She is a nightmare”……“He is a problem child”……“She is trouble”.

We hear the above words from parents, family members, teachers, nursery nurses, coaches, and sometimes from healthcare professionals, too. The phrase “problem child” or “naughty child” invariably creates two impressions- one, that the “problem” is within the child; and other, that the child has knowingly created this “problem”, the child is choosing to behave so. Hence, it is the child’s fault, something needs to be done to the child to change this.

But, is that so?? We need to pause and think. Let’s think this with two examples.

                                               

John is a 7 year old boy who is very restless and disruptive. So, teachers feel John is “naughty”. And Parents feel John has “ADHD”. Has anyone paused to think WHY is John so restless in school? Does he struggle to understand lessons due to some Learning Difficulties, Dyslexia or Dyspraxia? Hence, he finds it boring and embarrassing in school, so becomes restless and disruptive…. Does he have any vision or hearing difficulties, hence he struggles in lessons, and hence …….Is the family atmosphere very unstable and eruptive, which makes him very restless….Is someone close to John very critically ill, which makes John so worried, that he struggles to concentrate…..The list can go on…. But before considering these, we, the teachers and parents label John as “naughty”, “the problem”.

                                               

Mary is a 15 year old young woman, who is very angry, impulsive and “shouts at anything and everything”. So, parents say Mary is “wild, we keep away from her”; teachers say Mary is “aggressive, no one likes her”. Again, has anyone paused to think WHY Mary is so angry? Is Mary unhappy about something in her life, unhappy about something in herself, which is making her so angry….Is Mary victim of some form of abuse, which makes her so angry… Has Mary witnessed severe parental discord and violence from a young age, is her mother withdrawn and depressed due to same, Mary can’t express her protest to her father, and as she is herself becoming a young woman, so all this is frustrating her too much and hence she is angry… Is Mary finding her onset of periods and other growth changes difficult, which is making her angry. Is Mary in a relationship which is going rough, which is making her angry….. Again, the list can go on…. But before even considering these, we, the parents and teachers label Mary as “angry”, “aggressive”, “the problem”.

It is not just inappropriate, but it is injustice to label a child, instead of understanding the reasons behind the behaviour. 

“One in ten children and young people has some form of clinically diagnosable mental health disorder”

“The majority of adult mental health problems begin in childhood”

“50 percent of adult mental health problems (excluding dementia) start before the age of 15”

“And 75% of mental health problems in adult life (excluding dementia) start by the age of 18”

The above alarming findings are from robust research done in United Kingdom over the past two decades. When I read this, the first thought that comes to my mind is that “the above data is from Western World and does not apply to India; we are different from the West”. We need to ask ourselves that in the current times, are we really that different from the West?

If the above is true that mental health issues in young people is a West phenomenon; then let’s look at the following-

“India Has the Highest Suicide Rate Among Youth.”
As per The Minds Foundation, unfortunately, India has the highest suicide rate in the world among the youth standing at 35.5 per 100,000 people for 2012, the last year for which numbers are available.

“It is estimated that the incidence of nonfatal deliberate self-harm (DSH) is 250 per 100,000 persons per year.”
This is as per Paramjit et al (Indian Journal of Psychiatry).

The urbanisation, the globalisation, the emergence of working families, the exposure to social media, the pace of life, the interests/hobbies/pursuits we have nowadays, the education system, the cut-throat competition, the social/personal/ethical/cultural values which we are fast adapting- are we really that different from the West?

In fact, the reality is that we are wanting to walk in the same shoes as West in most aspects of our life (education, corporate, professional, personal lifestyle); but the infrastructure, moral/ethical/social values, timekeeping, civic sense around us does not keep pace with that. Hence, due to this mismatch, gap and conflict, we are probably even more exposed to frustrations, apathy, hopelessness, withdrawal than the West. Plus stigma, reservations and lack of specialist services adds to these, resulting in more difficulties in accepting, recognising and accessing specialist mental health and wellbeing services geared specifically for children, adolescents, young adults and families.

Things are gradually changing. Courageous and bold young people like Zaira Wasim (“Dangal” and “Secret Superstar”) are raising awareness about mental health issues in this age group. Recently, Zaira spoke about how she suffered with Depression and Anxiety from age 13. Three cheers to Zaira for openly talking about this; this helps combating the stigma. The idea is not that everyone should talk openly about this; the idea being that people get the courage to access the right help and talk confidentially.

World Health Organisation has recently said that rates of depression in India in children vary between 0.3 to 1.2%. If the above figures are for depression alone, what about other mental health disorders like Anxiety Disorder, Panic, Phobias, Psychosis, Mania, Obsessive Compulsive Disorders, Somatisation Disorders, ADHD, etc.

We also need to bear in mind that for every young person who has a diagnosable mental health disorder, there are many more that do not have a diagnosable condition. They may only have behavioural symptoms. Low self-esteem, selective mutism, some degree of anxiety, nervousness, fear, anger and aggression, withdrawal, social skills deficits, self-destructive behaviours, avoidance behaviours, passive and active resistance behaviours; to just name a few. We need to understand each behaviour in an individual and functional manner. All these behaviours have the potential of causing long term mental health and wellbeing issues; they can affect our personalities, our relationships and our whole life.

We also need to keep in mind psychosomatic illnesses where both physical/somatic features and mental health features go hand in hand and exacerbate each other. Some common examples would be Asthma, Irritable Bowel Disease, Crohn’s Disease, Epilepsy, Psoriasis, etc. Then there are Somatisation Disorders and Conversion Disorders where people tend to come with a physical or neurological symptom which does not have an organic cause, but has an emotional or mental health cause. Common examples would be that a person experiences pain or weakness in a part of the body, or experiences specific symptoms like a fit, or nausea, etc. Also, Medically Unexplained Symptoms is another term used in a similar context. In all the above cases, to summarise, there is an underlying emotional or mental health reason, which is either clearly visible co-existing with physical symptoms or is submerged and is hard to come to the surface.

There is not just a strong health case to justify mental health and wellbeing of children, adolescents, young adults and families; but there is a moral and ethical case (we owe this to our future generation); there is a social case (we owe this for a healthier and open society); and above all, there is a very strong economic case for this. Our mental health and wellbeing has a huge impact on our potential, our scholastic performance, our goals, our future career, and our achievements.

Let’ ask ourselves, again-

Are we sitting on a minefield?

Are we seeing just the tip of an iceberg?

“MIND THE GAP”

With the above gap in mind, we are developing the Child, Adolescent and Family Mental Health & Well-Being Clinic. Our motto is “NO HEALTH WITHOUT MENTAL HEALTH”. We aim to provide a CONFIDENTIAL service, which will LISTEN TO YOU, and which will be SPECIFIC TO YOUR NEEDS AND PREFERENCES. We will provide full range of assessment and treatment for mental health and behavioural disorders affecting children, adolescents, young people and families.

Dr. Jinesh Shah
Consultant Child, Adolescent & Family Psychiatrist

MBBS,
MRCPsych (UK),
Dip Clinical Psychiatry (UK),
CCT in Child and Adolescent Psychiatry (UK),
CCT in General Adult Psychiatry (UK),
Cert. Hypnotherapy (UK).

Phone: +91-70434 04574
Email: drjinesh@gmail.com

When does adolescence end and adulthood begin???

Does this happen when-

• He is allowed to vote??
• Or, does it happen when he becomes 5’6” tall??
• Or, does it happen when his voice becomes deep and husky??
• Or, does it happen, when his moustache and beard becomes grown??
• Or, does it happen, when the hormones start a rampage inside his body??
• Or, does it happen, when the girls start noticing him??
• Or, does it happen, when people expect him to start choosing a career- Science or Commerce or Arts?

Wow!! This feels so confusing!! If thinking about this is so confusing, than imagine how confusing it is for the boy (or the man, if we may call him so)!!

Okay. Let’s think of the man and his manhood!!

• Is it okay for him to feel sad?
• If so, is it okay for him to say that he feels tearful??
• Can he cry, without feeling little on doing so??
• Is it okay for him to feel scared and anxious??
• Let’s take it a step further, is it okay for him to say that he is feeling so, that is scared and anxious??
• Is it okay for him to be sensitive??
• Is it okay for him to say have a “break” by “going for rest to his parent’s home (Piyar jaao chu!!)

Again, so much confusion. For some reason, the mind and emotions of a man have taken a backseat.  Why is this the case? Let’s ask ourselves. Do men not have a mind? Do men not have emotions? Is emotional health of men not important? The emotional health of men (and of course, women, too) is becoming even more relevant today, given the pace of life. The image is being created nowadays of a Metrosexual Man, the urban, well-groomed, fit, savvy, self sufficient, independent man. And all this comes with a price! To stay on top of things, to be able to compete, to be able to survive, to be able to thrive- all this has a big impact on emotional health and well-being.

Let’s first understand the current context and climate. Today, the metrosexual man is not only competing with a few people physically around him; but he is competing with many more in the virtual world. Globalization, internet, electronic media means that a professional sitting in Ahmedabad will now have competitors who may be sitting in Dubai or London. The choices available around him- what to wear, what to eat, what to drink, where to go, who to see, who to talk to, who to befriend, what to become, how to do something, what to believe in, what to practice, what to drive, etc is mindboggling. This is going to create so much dilemmas and distress in the poor young man. The expectations of people around him, the self-expectations, the demands, etc are endless. There is no doubt that his emotions are churning in full speed.

While on one hand, we are positively moving towards gender equality, on the other hand, unfortunately both the genders are still subjected to challenges of their own. Undoubtedly, women have to face challenges due to cultural reasons; but we also need to acknowledge that due to the same cultural issues, men also have their own set of challenges to face from an early age. I see so many men who talk to me about how they were expected to start earning and be productive and protective of others, from a very early age. So many report how they plunged themselves into the mad rat race of becoming a doctor or engineer without a second thought, as this was what was expected of them. So many report how they just ignored their emotions and distress from an early age, as they would otherwise be seen as weak. The list can go on……

Let’s also think carefully how sometimes emotional and mental health can portray differently in males than in females. There is no doubt that most of emotional and mental health problems will be similar in both the genders; being one gender does not mean that you may not feel an emotion like the other gender. However, sometimes expressions vary, and sometimes prevalence also varies. There are various factors for this- genetics, cultural, social, environmental, etc. However, instead of going into too much scientific details and debates, let’s have a general think about this.

If we consider early childhood and development, some neurodevelopmental conditions like Autism and ADHD (Attention Deficit Hyperactivity Disorder) is found to be more common in boys than in girls. These conditions come with significant behavioural and emotional component. Being different from others around him, being unable to make others understand self, being unable to understand others; all this is bound to make one feel more distressed.

If we move towards adolescence, in boys, emotional upset gets expressed more in the form of aggression, frustration, irritation. Hence, Conduct Disorders, Oppositional Defiant Disorders are more commonly seen in boys. Due to same reasons, Depression in boys and young men, manifests more as irritabilty, frustration and anger. On the other hand, in some boys, depression manifests as sudden or gradual change into becoming quiet, withdrawn and flat (emotionless) unlike girls who may present with low mood, tearfulness and distress. Again, all above factors, plus peer pressures (especially as one becomes more vulnerable in this emotional state) means substance misuse (including smoking) and addiction is also more common in boys and young men. Also, the psychosexual growth in this age group, causes a lot of anxiety in boys and young men, which then leads to low mood and withdrawn behaviours. I commonly see boys who present with low mood, and on detailed assessment, they talk about how they perceive themselves as failures in psychosexual aspects. A lot of them have not actually had a clear rejection in love, but they are so sensitive at this age, that small comments or gestures gets magnified and stuck in their mind as an act of rejection and failure.

Moving into adulthood, men are as susceptible to emotional health issues as are woman. However, the stigma and taboo makes it more difficult for men to accept this themselves and to let others accept it for them. While on one hand, the financial and family pressures play a role in causing emotional upsets; on the other hand, the same prevents them from addressing the emotional upsets. It then becomes a vicious cycle, which they find themselves trapped into.

For same reasons as mentioned before, depression and low mood in men may manifest as frustration, irritability, aggression, substance misuse, smoking, addiction. Research says that being male who is suffering with severe depression, this by itself is a marker for risk. Unfortunately, although the incidence of suicide attempts is higher in females; but the rates of completed suicides is higher in males. This finding is worldwide, including India. Schizophrenia is more commonly diagnosed in men than in women, and also at a younger age than in women.

The above is just to help us all think of how emotional and mental health is important for men and some examples of how this may manifest differently in men.

This November when we are celebrating manhood by growing moustache; let’s also celebrate the sensitivity and emotions in a man, in a boy, in an adolescent.