Varsha Bhosle’s Suicide….A psychological perspective


Warning bells for depressed clients:

Person turns recluse
Shows little or no interest in the on-going activities / personal care
Has a history of previous suicide attempts or talks about wanting to end life
Has recently met with disappointment or failure
Has lost a loved one or moved away from a loved one
Changes in food and / or sleep habits
Increased physical complains
All the above mentioned signs were present in Varsha Bhosle. With a series of disappointments and failures in her life, losing a close friend and associate might have been the last straw which led her to end her life. However how does a caretaker determine in such a long standing case history of a depressed individual and repeated suicide attempts, when is she most likely to commit suicide? Often it so happens that the people around them take their depression as a routine and do not find anything unusually wrong in their behaviour that particular day.

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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.

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.

CHILDREN OF DIVORCED / SINGLE PARENTS



Vineeta lost her mother when she was a young adult; she pined for years, unable to overcome her grief over the loss of her parent. But when she underwent divorce, she was unable to understand her own 8 year old son, who was grieving the loss of his father. She struggled to understand why suddenly he was getting into trouble at home and at school, why were his grades falling although he was an intelligent child, why was he back answering and blaming her. Nothing made sense, but a sense that everything falling apart for them both was experienced. Maybe that is what a child feels when parents divorce/ separate. His entire world seems to come crashing down.

The movie Bal Ganesha which got everyone in the theatre to tears of joy when Ganesha showed his superior intelligence and circled his parents three times instead of taking three rounds around the world, winning the race against his younger brother. Little do we realize that this mythology is not about superior intelligence, rather it portrays the child’s perception of his parents, his world. For him, parents are at the center of his existence and therefore separation from one or both is experienced like death and a threat to his own survival.

Like any one who is fighting for their survival, children try out various options to survive this trauma, and attempt to reunite their parents. Like the Vineeta, who grieved for years over the loss of her mother, children do not give up hope of reuniting their parents for years after the separation. Parents who are anyways struggling to deal with their own emotions find it extremely difficult to deal with the emotions of the children. Children ask questions which seem impeccably correct putting the parents in a spot. “But why does he not like you? Maybe if you work hard and become smarter and thin, the way he wants you to, we can be together,” says a 7 year old boy to his mother. Or a 10 year old girl to her father “Why can’t you forgive her, maybe she did not mean the things she said to you. You forgive me every time I have lied, can’t you forgive her? For my sake please?”

In most cases the children tend to feel responsible for the divorce and try to change the behaviour and actions to please the other parent, like this 6 year old boy pleads to his mother, “lets go back home, I promise I will not make him angry and bother him for toys ever again or change the TV channels.” At times, in their attempt to get back the parents together, they may even get into negative behaviours such as lying, running away from home, cooking up stories, poor academic performance, and bedwetting, being irresponsible and stubborn etc. This problem is exaggerated if the child is very young and unable to communicate; or if he is entering his teens and feels confused and threatened about the volatile emotions characteristic of this age. Unable to deal with this confusion and inability to express their distress, children learn to bottle up emotions and thoughts, making communication all the more difficult. There seems to be a glass wall around them where you cannot hear what they are saying nor can they seem to understand what you are trying to communicate. Nothing seems to penetrate and touch them through this wall.

But there is a non threatening way to communicate to them, through the language of play. Play is a natural mode of communication of children. They can better emote their feelings unconsciously through play and therefore play becomes a powerful cathartic medium. It also provides an emotional distance to the children necessary to express threatening and negative emotions and thoughts. They cannot say that I don’t hate you mom for getting divorce but they can definitely express the same using a doll set or by beating at clay incessantly. Thus through the use of play, we can reach out to both the younger children and the teenagers alike.
This play way is used by a specially trained therapist to help children and parents better understand and deal with each others thoughts, feelings and behaviours. Unfortunately this is a language that we as parents, have long forgotten and need to relearn it in order to understand what our child is feeling to help them. Sometimes the Play Therapist also involves the parent to some of the structured play techniques which can help them bond better. This is what we did with Vineeta and her son. Through play materials we helped the child emote his anger and frustration. Once he had a name for the feelings, he was able to express it verbally. Vineeta on the other hand, when she was involved in the Play Therapy sessions, learned to better understand his emotions and respond appropriately to his needs.
The drawing in the picture was drawn by the child demonstrating his pain at the divorce as is seen by the heavy clouds, scratched sun and the two rivers which run parallel to each other like tears from the eyes. A Play therapist uses numerous play materials such as this to make such interpretations and convey it to the child, equipping the child with the ability to choose his reactions appropriately. It aims to increase resilience and self esteem within each child. Making him confident to face the future and challenges in life.

MANAGE YOUR CHILD’S HYPERACTIVITY USING PLAY THERAPY


It’s normal for children to occasionally forget their homework, daydream during class, act without thinking, or get fidgety at the dinner table. But inattention, impulsivity, and hyperactivity are also signs of attention deficit disorder ADD. ADD/ADHD makes it difficult for people to inhibit their spontaneous responses—responses that can involve everything from movement to speech and attentiveness. Having ADD/ADHD (for the child) can be just as frustrating as dealing with someone who has it. Kids with ADD/ADHD want to sit quietly; they want to make their rooms tidy and organized; they want to do everything Mom says to do, but they don’t know how to make it happen. They do not intentionally want to annoy you. If you keep this in mind, it will be a lot easier to respond to you child in positive, supportive ways. Like all kids, children with attention deficit disorder (ADD ADHD) sometimes make bad choices regarding their own behaviour.
Rima was getting ready to go for a swim with Akshay, her 10 year old son. Saturday morning is a planned outing with him and some of his school friends and their mothers and a special time for Akshay, something that he looks forward to the entire week. Rima asked Akshay to finish his breakfast, take a bath and pack his swimming bag while she went on hurriedly going about doing her household chores. Expecting Akshay to have finished at least with his breakfast and bath in the past half an hour, Rima went to check whether he needed anything. She found him sitting on the dinning table with the breakfast untouched and watching his favourite cartoon show. What is his problem? Yes, he has ADHD, but how hard is it to do three simple things? He loves to go to for the swim with his friends. Why is it such a struggle to get him to listen? As Rima hurries Akshay around, she is thinking of what her husband would say if he were around. ‘You are spoiling him by not being stricter with him and doing his work for him. He pays attention when he is playing with his video game, but not when we ask him to do his chores.’ Rima thinks that Akshay’s failure to comply is due to a lack of motivation – if he wanted to do it, he could. But Rima isn’t so sure. She’s been consistent with discipline. Rima also knows that Akshay feels bad about himself when he doesn’t succeed at school or when she constantly fusses at him at home. She knows that he has begun to compare himself to his peers. He seems frustrated with his inability to accomplish simple things that seem effortless for his friends. She has heard him refer to himself as “dumb.” She can’t understand why Akshay doesn’t comply with the instructions he receives from adults, but she doesn’t think it’s a lack of motivation. She knows in her heart that he would comply if he could. Rima has recently attended a talk by the school counselor on Executive Functions of ADHD. Equipped with this information she tries to understand what actually must be Akshay’s mental process.
Executive functions are mental processes that give organization and order to our behavior, allowing us to direct our actions through time toward a goal. Let us take Rima’s working of a single evening as an example of executive function. The previous evening, Rima left office for the weekend. She was tired and would have loved to go straight home especially with the heavy down pour since late afternoon. But she recalls that she needs to fill in some grocery first for dinner (working memory) and heads for the super market. She decides to pick up the lap top adaptor on the way to the grocery store (strategic thinking) so that she can work over the weekend and does not have to make another round this side of the town for the adaptor. She thinks of how comfortable her Sunday morning will be if she could in between the cooking do her work and then relax the entire day (internalized language). She begins to feel more energized as she weaves herself through the evening traffic (regulating motivation). As she reaches the grocery shop after picking up the adaptor, she makes a list of things that she would require to buy for the dinner (initialization action). Just as she gets her pen out, her cell phone rings, she checks the display and sees it is a friend who was returning her call. She makes a mental note of calling her later after dinner (strategic thinking) and chooses not to respond to the call right now (interference control). While entering the grocery store she sees that there are some attractive schemes on the 15 litre oil cans but decides to check on it the next week (interference control) as she is running late (a sense of time). As she heads for the vegetable section, she takes a quick look at her wrist watch. She has time to stock in the fruits and makes a bee line for section (self-monitoring). She decides to check on Akshay as she waits in the billing queue (shifting between tasks) so that his work is done by the time she reaches home. In the night before retiring in front of the television, Rima remembers to make the call to her friend (working memory) and calls her.
Rima’s executive functions work smoothly and efficiently. Because this functioning occurs without her conscious awareness, she takes it for granted. But the development of these functions took place over time. Imagine Rima at the age of 10, would she be able to do all this planning simultaneously? She would probably be able to only concentrate on her chore of buying chocolate at the super market. It was a gradual process for her actions and sense of time to become internally directed. Researchers believe that this capacity for self-direction is neurologically based and concentrated in the pre-frontal region of the brain. Rima learns that current research regarding ADHD is moving away from an emphasis on impulsivity and inattentiveness and toward an emphasis on executive functions. Many experts in the field recommend that individuals with ADHD compensate by using tools that “externalize” the executive functions. is a natural form of integrating these skills and Play therapists are specially trained counselors who use play appropriately to help children regulate their behaviour. The school counselor suggested Play therapy for Akshay. In many children’s games –Froggie May I, Statues, Simon Says, Freeze, mountain and river, saakli–while fun, also provide an engaging external framework for children to practice behaviors that are central to executive functioning. The therapist lets both Akshay and Rima know that a large part of each session will be devoted to play, and that she will even give some home assignments that involve play. Rima relates the history of Akshay’s diagnosis and treatment over the past three years her own attempts to firm up discipline and provide extra structure and support in Akshay’s day to day life. Both Rima and Akshay are tearful as they describe their frustrations and guilt and an overwhelming sense that they are not good enough. The therapist comments that they might want to add to their treatment plan is for Akshay to become a working member of the “treatment team.” The following weekend Akshay has an assignment from his therapist. Chores are a sore point in their household. Rima has always been frustrated that she has to remind Akshay each and every step of the way. Akshay’s assignment is to use the time honored habit of making a list to supplement his working memory and free him from dependence on his mother’s reminders. To engage Akshay’s interest and sense of fun, the therapist has given this tool a playful spin. An hour later, chores done, Rima and Akshay are on their way to the swim. “That was fun,” Akshay says to his mother. “And I got all my chores done by myself! Let’s do that again next week.” Rima reflects that it doesn’t matter whether Akshay relies on his working memory or uses a list. The results are what she cares about. She is pleased that the chores got done but is even more pleased to see that Akshay himself is so pleased. She was right; Akshay is motivated to succeed. But she had been expecting him to succeed in ways that were not in line with his development. She has now seen that, with the right external support, Akshay can experience the success that he so much wants for himself.

Smoothen transition into new academic year at school


As the new academic year sets in, it waits to be explored by your child. There are new goals to be achieved, new knowledge to be gained and new challenges to be faced.
One thing is certain. All children look for everything new… new books, new bags, new stationary etc. But does your child look forward to the new class which will bring a change in the classroom scenery? He/She will probably have new classmates, new teachers, new subjects etc.
Preparing your child for the new academic year is much more than equipping him/her with material requirements. If a child is not academically, socially and emotionally prepared, the disconcerting feeling may just last the whole year through.
Children often visualise about the year ahead based on the senior student’s experiences, which may be misleading and make your child anxious.
Some things to bear in mind when helping your child prepare for the fresh year…
• A higher class brings new challenges. Perhaps your child will be expected to do more homework or assignments. With fears of not measuring up academically, the best defence is a good offence. Getting organised and establishing reassuring routines can go a long way to making a child feel competent.
• Rumours of a particularly hard teacher may fuel fearing or disliking a new teacher. Do help your child keep in mind that one person’s dreaded teacher can also be another kid’s favourite. While it’s okay for your child to express his/her dislike of a teacher, he/she should be expected to remain respectful. You can encourage your child to be open-minded and approach this as an opportunity to help him/her learn how to deal with a person he/she finds difficult. Listen to his/her issues and plan to attend parent-teacher meetings to get your own take on the situation.
• A new class schedule can mean adjusting without friends, who have provided a social base in previous years. Try to present this as an opportunity for your child to widen his group of friends, rather than a tragic loss of familiar faces.
• If possible, get the class list and set up a play date before school starts, so that your child will have a new friend to look for on the first day. Establish time for him/her to catch up with old friends too.
• A new school or classroom may spark concerns about finding friends at all. An outside class or hobby such as dance or a sport can provide a conversation starter and the opportunity to meet kids outside your child’s usual circles. Talking to him/her about other challenging situations that he/she successfully navigated also boosts self-esteem.