COPING WITH TRAUMA IN THE SCHOOL SET UP



In 2001 when the 9/11 attacks took place in USA, most of us were glued to the television sets, not realizing that our children who prima face seemed involved in their play were a witness to the trauma and were being affected by it. It mattered little that the incident took place in a different continent, miles away; the trauma was experienced by everyone around the world, including children. I have treated many children and adults alike after the earthquake of Latur in 1993 or more recent still 26/11 in Mumbai and the German bakery attack in Pune who were emotionally suffering after the traumatic terrorist attacks. But one of the most striking of them was this because we often think that a toddler who seems to be engrossed with his play is unaware and thereby immune to such events in our lives.

However, it is a well researched fact that stress is transferred from parents / care givers to children. They may viscerally transmit their own feelings of anxiety, rage and helplessness, and in doing so, colour the child’s internal model of self and the world. When caregivers are threatened or frightening, the intentional human to human quality of the trauma causes more severe negative consequences for the child than trauma from accidental causes (for example, a flood, fire or injury). In truth, however, all trauma may engender feelings of victimization, loss of control, despair and hopelessness and beliefs that the world is unsafe and life unfair. Young trauma victims often come to believe there is something inherently wrong with them, that they are at fault, unlovable, hateful, helpless and unworthy of protection and love. Such feelings lead to poor self image, self abandonment, and self destructiveness. Ultimately, these feelings may create a victim state of body mind spirit that leaves the child/adult vulnerable to subsequent trauma and re victimization.
In my next group Play Therapy session I saw to the trauma unfold itself. Rohan, 2 years old was a toddler having difficulty adjusting to the play school and was referred to me by the play school. He had been coming to me for the past 2 months and was gradually transferred to group play therapy sessions as he was now seemingly adjusting to the school. That day I was shocked at the emerging theme in the play session. As usual the 5 children assembled on the mattress and removed individual toys to play with. Shilpa started playing with blocks. Suddenly Rohan who was playing with an aeroplane and was keeping an eye on that Shilpa was making a tower; ran towards her with his hands outstretched and banged his plane on the tower that she had made and breaking instantaneously into hysterical laugh once the tower fell. Tears filled Shilpa’s eyes and she started crying softly while the others looked on. I was surprised by Rohan’s behavior as he had never in the past shown any signs of aggression, usually keeping to himself and playing with his cars / aeroplanes. I encouraged him to verbalize what he was playing and he referred to the bombings of the twin towers.

Play is a very powerful and natural medium through which children communicate. What happened in the group play session was an enactment of what the Rohan was observing around him. Enactment such as this helps children to understand the complex world around them. It also helps them to grasp and cope with difficult emotions of elders as well as their own reactions. In play children feel safe enough to demonstrate all this as it is an indirect manner of communication. Play session also helps them to work out their emotions and replace some with more constructive manner of communication. Instead of reprimanding the child (as usually the caregivers do), the play therapist attempts to understand the play and communicate the same to the child. This helps him to develop a thinking awareness about himself giving him the possibility to choose his actions. The failure of caregivers to sufficiently protect a child may be experienced as betrayal and further contribute to the adversity of the experience and effects of trauma. Traumatic stress may be transmitted by parents to their children.

School Principal and teachers play the role of care givers in school. Their function therefore goes much beyond the traditional belief of imparting knowledge or looking after their physical safety. Incident such as the recent attack by the MNS workers on the principal of DAV school can be quite traumatic for the children. This is especially true when the conflict is against the authorities (caregivers/ teachers / Parents) who are supposed to look after them. Children’s sense of safety both physical and emotional is thereby severely disturbed. If this is an ongoing conflict, the disturbance is more; effects of which mimic those of children of divorce. Those who are not addressed directly by the caregivers and kept in the dark face greater stress. Their curious minds seek information available through grape vines and media, leaving them more confused, misinformed and feeling disoriented. When the caregivers, in this case the principal and teachers directly impart information about the incident and address their anxieties, it reinstills faith in the protector’s ability to safeguard the child. Schools need to think along these lines too along with the safety drill. Just doing the terror drill without providing the emotional support needed by the topmost schools leaves a huge gap in the holistic development of the child.

Posttraumatic symptoms may encompass one or more of a broad range of behaviors, including the following:
§ Difficulty sleeping, eating, digesting, eliminating, breathing or focusing
§ A heightened startle response and hyper alertness
§ Agitation and overarousal, or underarousal, withdrawal or dissociation
§ Avoidance of eye contact and/or physical contact
§ Terrified responses to sights, sounds or other sensory input that remind the child of the traumatic experience(s),
§ Preoccupation with or re-enactment of the traumatic experience
Reestablishing safety or creating it for the first time involves setting up an external structure that provides a predictable, consistent routine for a child/youth and making sure their basic physical, emotional and social needs are met. Thus having their normal school routine is crucial. This also means to pay emotional attention to the individual child’s needs and allowing them to express their emotions in an appropriate manner. This could be done by the counsellor or a professional play therapist in group therapy sessions which could be short term weekend session or divided into 4 sessions spanned over the next one month.
Play therapy plays an important role in healing trauma victims, children use play powerfully to better emote their feelings rather than talk about them. It also provides an emotional distance to the children necessary to express threatening and negative emotions and thoughts. Thus through the use of play, we can reach out to both the younger children and the teenagers alike. Unfortunately this is a language that we as parents and teachers, have long forgotten and need to relearn it in order to understand what our child is feeling to help them.
This play way is used by a therapist trained in Play therapy to help children and parents understand and deal with their thoughts, feelings and behaviours. It aims to increase resilience and self esteem within each child enabling him / her to use this as a springboard to deal with difficulties in real world more confidently and to bridge the communication and emotional gap created by the trauma.

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UNDERSTANDING THE RELATIONSHIP BETWEEN FOOD AND EMOTIONS



We subconsciously associate food with nurturing. Tasty food brings about a sense of deep gratification and we associate it with filling a hungry gap, rewarding ourselves for effort spent or simply a good social time.

Due to our strong mind-body connection we literally program our living cells moment to moment via our thoughts and especially our feelings. If you find yourself running for something to eat every time you feel emotionally upset, disappointed or hurt, you might be a comfort eater and use food to lift your mood. If you are really keen on changing negative food habits, the place to begin is to understand what food represents emotionally to you. Without this, any diet change will only be temporary and but fail to induce life style change and the weight will eventually come back.

Comfort foods, like chocolate and biscuits or starchy foods, increase the body’s natural feel-good neurotransmitter, seretonin. Unfortunately like all quick fixes and addictions, the instant gratification is soon followed by a strong sense of guilt and feeling like a failure, which brings on depression. Thus for a person suffering from depression related obesity, you need to take care of the depression first or simultaneously with the diet regime inorder to ensure successful weight reduction and maintainence.

Just as, common cold cannot be cured by treating only the symptoms of cold such as sneezing or irritation in the nostril but requires the infection to be taken care of first and the symptoms will cease on its own. Similarly diets without understanding the reason for the obesity are sure to fail. The saying goes that inside every fat person is a thin person dying to come out. Psychologists call this inner person your “inner child” which probably needed a lot of cover up at some point in time in order to deal with difficult life circumstances. If we connect with this inner child and become aware of what causes him/her to run for the fridge in the first place, we can start to reprogram ourselves by tending to our real hurts and needs instead.

Take “LILA” for example, who was sexually abused as a child. She grew up to be an attractive and voluptuous woman. Yet every time a man leered at her she felt shame and repulsion. Lila started eating, subconsciously motivated to put on weight as a barrier between her and the outside world and also to hide her curvaceous figure in order to avoid lecherous stares. Yet at the same time she has grown accustomed to using her sexuality to control and manipulate men.
Lila’s primal need is for respect, love and healthy affection from an intimate relationship, yet she is programmed to associate intimacy with sexuality and thereby she keeps compromising herself sexually in order to get her basic needs for love “fulfilled”. This discrepancy between her need for respect and love versus her tendency to self-sacrifice in sexual behavior increases her sense of shame and the need for her inner child to resort to various defense mechanisms as well as her compulsive eating disorder.
Lila needs to honor and respect herself by focusing on what really makes her happy. She needs to practice hobbies and develop talents where she could meet men who share the same interests and value her for other qualities than just her (physical) body. Lila also needs to change her attitude towards men as sexual predators in order to break free from meeting the “wrong” type of men who perpetuate her one-sided perception and overemphasis on sexuality. Thus the cycle keeps on repeating itself and keeps her entrapped in her negative habits.

For many people, like Lila, food has become a means to self-destructive behavior or self-punishment. Research indicates that sexual abuse victims often feel responsible, shame and guilt for the abuse. In order to cope with these emotions our mind unconsciously replays them in various circumstances in hope to resolve this trauma. Thus, in Lila’s case self punishment is an unconscious motive attained and re experienced via obesity.

There is another unconscious motive. Obesity also makes her appear not so attractive and therefore less likely to be sexually abused. Thus we derive some benefit from our seemingly troubling behavior. That is, “symptoms” or “issues” can be construed as both “maladaptive” and “adaptive”. At first glance, symptoms look maladaptive, but closer scrutiny reveals that in some way, the individual “benefits” from them. That is, in some way the individual is protected by her “symptoms”. In effect, the “symptoms” represent a solution to a problem, albeit a far-from-ideal solution. The maladaptive aspects of “unwanted” behaviors are easy to recognize.

We need to ask ourselves what it is that we dislike so much in ourselves that we need to punish ourselves. Why are we so hard on ourselves that the simple bit of self-discipline required to stop eating when we are full, becomes such a difficult task that we would rather abandon all reason and give over to our rebellious inner child? By becoming aware of how and when we felt trapped under excessive discipline and criticism in our past, we can break the pattern of such an unnecessary authority that we’ve subconsciously internalized. Pay attention to your real needs. Are they really excessive or out of line? Wouldn’t a different approach of gentle encouragement and the focus on our good qualities have better results in our behavior?

Another reason why we put on weight is when our nurturing needs as an infant, baby or child were not met. Our mother may, unintentionally and very well meaning, either fed us too often and too much or too seldom and little or simply the wrong kinds of food in order to entice us to do something or to reward us. This lack of being in sync with the child’s natural needs, may lead the child to experience anxiety and the inability to perceive the natural call of hunger and sense of satiety.

Often this goes hand in hand with an overprotective or controlling mother towards whom we always feel indebted or striving to please in our behavior. Our inner child feels neglected and not understood, so we grow up trying to please through our “doing” instead of realizing how lovable we are in just “being” ourselves.
Are you able to say “No” when you don’t feel up to a request? We might struggle to communicate our feelings and needs and have problems with our personal boundaries allowing people to take advantage of us and then becoming resentful afterwards. And guess what, the quickest relief again becomes the fridge or some stacked chocolate bar.
There are many more reasons why people become obese. What I am suggesting is that before we look for the quickest and easiest diet available to lose weight, we must first make sure we are happy wholesome human beings, and love the body that we’re in despite it’s extra few bulges and curves.

Next time you run for the fridge, ask yourself:
 How do I feel right now?
 What is my reason for wanting to eat something?
 Is the food that I am about to consume really beneficial and nourishing to my body or am I trying to substitute food for feeling hurt, frustrated, angry, disappointed, bored etc?

Have a notepad ready in the kitchen and write down your feelings and motivation for eating.
This simple exercise will break the habit of compulsive eating and will buy you those few extra minutes which enables your conscious mind to intervene.

The exercise above provides you with a framework for thinking about the meaning of a puzzling symptom. At first blush, these questions seem ludicrous to many people. However, over time, they begin to make sense. Answering these steps can be a wonderful beginning to changing an unwanted behavior or situation. Talk your fears over with a trusted friend. Develop a plan for overcoming your “symptom”. Give yourself a timeframe for overcoming your “symptom” or achieving your goal. If after your most assiduous efforts, you are unable to take any of these steps, consider seeking psychotherapy from an experienced clinician. We know enough about psychodynamics and unconscious motivations that most symptoms can be understood and effectively addressed.

HOW TO IMPROVE YOUR MEMORY



Ramesh (37 years old) had been coming for therapy for depression for a week now. One evening he came for the session really frustrated. He asked tentatively whether loss of memory could be due to his depression or the related antidepressants that he was given by his psychiatrist. He then went on to explain that he had excellent memory as far as numbers were concerned, so much so that as a child he could remember almost all 49 children’s marks in the class as the teacher called them out aloud before handing over the papers. Yet the previous evening when he had to give his new office number to his very important client he could not just get it right. It almost cost him his contract as the client got offended.

When I asked him when he started noticing this forgetfulness in him, he mentioned that a little before his divorce 3 years ago he had been noticing his forgetfulness but had been too emotionally wrapped up to pay further attention to it. He now realizes that the forgetfulness has been increasing over the years. Initially he thought that he was preoccupied and later brushed it off as a sign of early ageing and even hereditary. But yesterday’s incident was disturbing him.

First and foremost any physical disorder needs to be eradicated. Secondly causal factors as well as the mechanism of forgetting need to be understood. Usually mental decline begins by the age of 40 or 50. However people who are undergoing high emotional stress for an extended period of time also experience these symptoms as early as in their 30’s. Some of the stressors one cannot do away with given the stressful and competitive environment we live in, however we can counter them with certain changes in lifestyle. Health conscious people interested in living quality life introduce yoga/ physical exercises to their routine along with dietary changes. Similarly for mental health one needs to introduce what is called Neurobics in their life, a mental gym. Also contrary to popular belief, the mental decline most people experience is not due to the steady death of nerve cells. Instead, it usually results from the thinning out of the number and complexity of dendrites, the branches on nerve cells that directly receive and process information from other nerve cells that forms the basis of memory. Dendrites receive information across connections called synapses. If connections aren’t regularly switched on, the dendrites can atrophy.

The function of memory is primarily carried out by the cortex and the hypothalamus in the brain. Hypothalamus is the emotional seat of the brain. Anything which is emotionally laden is usually easier to recall, however if there is a flood of emotions it leads to confusion however if this flood continues for extended period of time, it can even cause atrophy in dendrites. This reduces the brains ability to put new information into memory as well as to retrieve old information. The good news is that aging brain, however, continues to have a remarkable ability to grow, adapt, and change patterns of connections. Therefore establishing associations and new pathways for connection have a healing effect on the brain.

The exercise program calls for presenting the brain with nonroutine or unexpected experiences using various combinations of your physical senses—vision, smell, touch, taste, and hearing—as well as your emotional “sense.” It stimulates patterns of neural activity that create more connections between different brain areas and causes nerve cells to produce natural brain nutrients, called neurotrophins, that can dramatically increase the size and complexity of nerve cell dendrites. Neurotrophins make surrounding cells stronger and more resistant to the effects of aging. Also, using multisensory approach, retrieving from the memory becomes easier with a web of associations supporting the matter. More often than not, adults don’t exploit the brain’s rich potential for multisensory associations. Think of a baby encountering a rattle. She’ll look at it closely, pick it up, and run her fingers around it, shake it, listen to whether it makes a sound, and then most likely stick it in her mouth to taste and feel it with her tongue and lips. The child’s rapidly growing brain uses all of her senses to develop the network of associations that will become her memory of a rattle. Adults miss out on this multisensory experience of new associations and sensory involvement because we tend to rely heavily on only one or two senses. As we grow older, we find that life is easier and less stressful when it’s predictable. So we tend to avoid new experiences and develop routines around what we already know and feel comfortable with. By doing this, we reduce opportunities for making new associations to a level that is less than idea. Simultaneous sensory input creates a neural “safety net” that traps information for future access.

Social interactions are also non routine and therefore socializing has similar effect. However we find more often than not that people who are undergoing emotional stress / depression want to be left alone and withdraw from social contacts. Is it any wonder why Psychiatrists suggest going for a walk rather that doing a fitness workout alone in your gym? Going for a walk allows one to experience all 5 senses and also provides the brain with social nutrients necessary to heal the brain.

Here are some of the ways in which you can use mental gym to improve on your memory:

1. Involve one or more of your senses in a novel context.
By blunting the sense you normally use, force yourself to rely on other senses to do an ordinary task. For instance: Get dressed for work with your eyes closed. Eat a meal with your family in silence.
Or combine two or more senses in unexpected ways: Listen to a specific piece of music while smelling a particular aroma.

2. Engage your attention. To stand out from the background of everyday events and make your brain go into alert mode, an activity has to be unusual, fun, surprising, engage your emotions, or have meaning for you. Turn the pictures on your desktop upside down. Take your child, spouse, or parent to your office for the day.

3. Break a routine activity in an unexpected, nontrivial way.
(Novelty just for its own sake is not highly Neurobic.)
Take a completely new route to work. Shop at a road side market instead of a supermarket. Normally, placing a key in a lock uses vision and “motor memory”—an unconscious “map” in the parts of our brain that control movement—which provides an ongoing feedback that allows us to sense where parts of our body are in space. (This is called the proprioceptive sense.)

Neurobics is recommended as a lifestyle choice, not a crash course or a quick fix. Simply by making small changes in your daily habits, you can turn everyday routines into “mind-building” exercises. It’s like improving your physical state by using the stairs instead of the elevator or walking to the store instead of driving.

Ramesh worked on these mental gym exercises for about 6 months and started regaining confidence in himself and also noticed his stress reducing, life feeling more meaningful, increase in interest and involvement in routine as well as novel things and social interactions and in general an elevated mood.

CONVERTING PARENTING CRISIS INTO INCREASED COUPLE INTIMACY



Leena and Akash had been married for about 4 years when Soham, their first child was born. They had been looking forward to having a baby and believed that the birth of the child will further strengthen their marriage. However, during pregnancy, Leena became irritable and depressed. She was aware of hormonal changes and mood swings during pregnancy and discussed it with her gynecologist as well as with Akash. Akash initially was very supportive but after the first trimester he started working longer hours and avoiding spending time at home. He found Leena’s constant complains and irritable nature difficult to bear. To add to this, he, without realizing, in his want to provide the baby with financially secure environment started feeling justified of his absences and expected Leena to understand. Especially now, that the financial burden was completely on him for a period of 3 years when Leena would be focusing on being a full time mother and would soon quit her work. Akash’s absences however made Leena feel more uncertain and insecure about their marriage, as now she was not only dealing with the physiological discomfort of the pregnancy but also the loss of work life. She desperately tried to regain their marital bliss and in her attempts to communicate this loss, fluctuated between getting angry / demanding with Akash to crying and feeling hopeless and hurt. Both started feeling justified and thought that their spouse was insensitive and uncaring. In the last trimester when the doctor advised that they should refrain from sexual intercourse, her anxiety heightened. Post natal depressive symptoms and the hectic schedule of keeping up with the baby’s demands did not help either. The emotional distance and anger intensified and eventually blew into a full fledged argument on the day Akash attended the child naming ceremony held in Leenas maternal house and forgot to get the return gifts. Leena was to return to her matrimonial house after the customary maternity break at her mother’s house right after the ceremony. Akash’s lack of involvement in the child raising because of the distance and also because of his own anxieties fueled Leenas own anxieties of managing the infant without her mothers help and dealing with their marital discord. Leena very reluctantly returned to her matrimonial house. After her return, she felt all the more lonely and abandoned. Akash’s focus was Soham after he returned from work partially because he missed the first three months of his son’s development and partially because he didn’t know what to communicate with Leena. He felt rejected by Leena whenever he initiated sexual intimacy between the two of them, often as Leena would be tired after a long day and would struggle to catch up with her own sleep while Soham rested. Leena, on the other hand, seemed to have nothing much to share with Akash apart from Soham’s daily activities. She felt worth less, unloved and unappreciated. Motherhood seemed to be her only identity now. She had also stopped taking care of her physical appearance. Without realizing they had made Soham the center of their relationship in their individual attempts to reconnect with each other and deal with their marital crisis. But this only lead to further spiraling down of their relationship as they both felt ignored by their spouses and jealous of whom soham preferred. Their concerns for a helpless infants needs to take priority seemed justified.
When they finally approached the psychotherapist they had a long list of hurts and anger against each other and both wanted to be acknowledged that they were justified in their feelings.

How could couples like Akshay & Leena regain their love and intimacy for each other?
1. “Parenthood As Crisis” typically includes a decrease in positive marital interchange, an increase in marital conflict, and a decline in marital satisfaction. This is because parenthood brings new identities and responsibilities for mothers and fathers.
2.
3. There are often changes in a couple’s sex life and experience a slow down in their sex life. Women often feel differently about their bodies after childbirth, and they become insecure and less comfortable being intimate. Often, women gain a substantial amount of weight during pregnancy, and they have a hard time dropping the excess pounds after they give birth because they are so overwhelmed with the responsibilities of being a new mommy. This occurs because of the strains, stresses, and sources of conflict as parents adjust to their new care giving roles, responsibilities, and routines—and the gender differentiation therein—amidst depleted resources of time and energy.
4. Many women are known to undergo post natal depression and require more help in the form of attention and care.
5. At times child birth is used as a ruse to get back to your spouse / avoid troubling topics between the two. Often these problems have existed for a long time in their relationship, child birth just give a valid reason to exit mentally and physically from a less satisfying relationship. It is emotionally less straining for a couple to accept that they are unable to spend time with each other because of the child than to say that they have lost interest in each other.
6. Couples have to consciously choose to bring these up with each other and deal with the hurts and anger rather than pushing it under the carpet.
7. Sometimes men feel rejected and unloved by their wives because of the amount of time she is devoting to caring for their baby or children.
8. Some women feel resentment towards their husbands because they don’t feel like their husband is involved enough in taking care of the children and household.
9. Husbands and wives need to understand that they have to work together as a parent team and they also cannot forget to foster and nourish their relationship as a couple.
10. Husbands need to compliment the wife and help her out in the house management as this is a crisis phase.
11. Wives on the other hand need to nurture and care for their husbands as well as their baby.
12. Both need to remove time to make things special between them. Romanticizing each other again by initiating loving acts for each other.
13. Arrange for time off work. Ideally, get at least a week off following the baby’s birth. Your wife will need your help and this will be a wonderful time to bond as a family. Plan nothing else during your time off but helping your wife and child.
14. Ask relatives / friends to look after the baby for a while, while the two of you can catch a candle light dinner or cuddle up with popcorn to watch a movie.
15. Remember the heart of happy family lies a happy couple relationship.