Depression Treatment Options


However the client should be aware of the treatment options so that he /she can discuss with the consultant. Broadly speaking, the treatment of depression rests on two factors Medication, and Psychotherapy or Counselling.

  • Medication is required for moderate and severe depressive disorder cases.
  • Counseling and psychotherapy serves as an edge in treating depression and need to be started simultaneously along with medicines.
  • You should continue the full course of psychotherapy even if you are feeling better to prevent a relapse.
  • Suddenly stopping antidepressants can precipitate a relapse. Medication needs be tapered gradually under your doctor’s supervision.

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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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Why is Sachin still far from 100 not out? Is the psychological self sabotage at play here



While Sachin has dismissed the hundredth 100 as just another century, the Indian diaspora is keenly awaiting this one. And with the over zealous aspirations of 1.2 billion riding high on the bat of this young master, pressure is bound to build on him? Suddenly Sachin is out of form and the runs off the bat have abruptly dried up. In our opinion, we do not believe that the lack of form is at work here but certain certain self sabotaging behaviors are preventing him from achieving the much awaited milestone. In this article we explore the psychological impact of self sabotaging behaviour and how it emanates in daily walks of life.

Consider the following self-sabotaging behaviours which are commonly observed: Why do we wait till the last minute to leave for a place? Why are some people perpetually late for something important that they have really desired? Why do we remain employed in a company although we know we deserve and can get a better job? Why do we repeatedly get into an abusive relationship? We’ve all seen this in our friends and even, regrettably, in ourselves.

However bizarre as it may seem, we must derive some benefit from these problematic behaviours of ours. These problems may appear maladaptive on surface but if we give it a closer look, we will realize that in some way, we benefit from them. In other words, in some way we are protected by our problems. One can’t usually explain the “real” reasons for ones behavior because the reasons are outside of their conscious awareness. So although we may consciously strive for something, it is possible that our unconscious mind works in direct opposition to it, self-sabotaging our resolves leaving us frustrated and helpless.

This is precisely the reason why an obese person is unable to stick to the food diet regime. Maybe unconsciously becoming fitter would draw more attention from the opposite sex or make the person more successful than his loved one and thereby lose love of her spouse. Or getting into an abusive relationship is ones way to remain in agreement with the unconscious belief that one is not worthy of love. Or becoming more successful than ones parent will in some way unleash the wrath of the parent who may abandon them. These fears of abandonment or of a loved one getting angry are deeply rooted in one’s childhood experiences and are extremely anxiety provoking. They continue to strongly influence our current behavior unless we bring this conflict into consciousness to be worked on in therapy.

I was approached by a manager at a very senior level for marital counseling. The couple was batting infidelity in their marriage. While his outward behavior seemed very protective and caring towards his wife, his unwarranted affair had a devastating effect on his marriage. During sessions when I enquired about how the affair started and what the other woman meant to him, I was not surprised to hear that she meant nothing to him and that he himself couldn’t justify the need to get into this one night stand and risking his marriage. Worse still he made no effort to hide it from his wife and in fact seemed relieved when she got to know about it. This seemed to fit the bill of the maladaptive behavior perfectly and we looked for further clues on the possible benefits. As we explored the childhood and some of his current behaviours things crystalized further. He was a neglected child and grew up with a feeling of not worthy of love. This feeling remained entrenched in his unconscious although he gained good marks and then went on to become the most successful of all his siblings, taking care to help them settle in life and therefore much adored too. When he got married he started facing difficulties in developing intimacy with his. His wife found him very appropriate however lacking in demonstration of love and affection. She however was deeply in love with him and found his aloofness disturbing. This became an issue when she discovered that he had had a one night stand with a woman. What was disturbing her further was that he could not furbish any justifiable excuse nor did he even attempt to hide the truth from her. It was almost as if he wanted her to find out and thereby punish him by withdrawing her love. This was in line with his unconscious belief that he was not loveable and now he had proven to himself once again that he is not worthy of love.

Sachin Tendulkar too seems to be having this mal adaptive behavior which appears repetitive wherein he gets out just as he is touching his century or when there is tremendous pressure on him to perform. It’s almost as if, if he does meet with the expectations of the country then something terrible will befall on him. If he is successful then maybe he will be abandoned / not loved? Or worse still he will become somehow bigger and stronger than the father whose oedipal complex may still haunt him. It isn’t uncommon to be unable to perform at peak capacity or self-sabotage once life and career to tag the line of one’s unconscious oedipal fears of the opposite sex parent or the belief system of not being good enough/ not loveable/ not worthy of. Our actions are mainly governed by this unconscious dictum and efforts are made to keep it unconscious and seeking more and more proof through experiences that match these beliefs. It is kept unconscious precisely for this reason that it produces anxiety while conscious life experiences seem to fall in line magically with these beliefs.

Most people find the notion that all behavior, no matter how self-destructive, has an adaptive function difficult to grasp. So, how do you go about learning more about the advantages to maintaining your current (purportedly unwanted) situation? A first step is to examine the advantages to maintaining the status quo. To do this, ask yourself the following questions.
Describe a longstanding difficulty with which you have struggled. Describe the ways in which it is maladaptive. How does this difficulty hurt you or hold you back or make you unhappy? What is its impact on your relationships at work, at home, and socially? Ask yourself the following question:

1. Have you attempted to change this difficulty? If not, why not? If so, describe the nature of your efforts?
2. In what ways have your efforts been successful? If they have been unsuccessful, why?
3. In what ways have your efforts been thwarted? How were they sabotaged?

Most people never come to the stage of seeking out professional assistance because they are not aware that they are sabotaging themselves. Those that do seek help often wait until well into adulthood. In life, we all aspire to both conscious and unconscious goals, but often there are psychological barriers that we may cling to and be haunted by, which block our aspirations. Projected envy and terrors of the actual envy of others can block motivations to succeed, when dissociated and/or repressed primal rage intensify the intimidating power of projected hostility and envy, and of perceptions of others as rivalries in areas of competition. Desire can be blocked by oedipal level fears of rivalry and hostile completion, but more primitive and primal fears of abandonment can also be at play, when developmental arrests have taken place in the preoedipal years of separation-individuation and self-integration. How we address these psychological blocks in a clinical situation is critical to helping patients to overcome all their inhibitions and intimidations, as they attempt to motivate themselves to succeed in life.

Dealing with rejection



What makes Priyanka Chopra rejected by the wives of her co actors? Is there really a flaw in her character or is she a victim of the wives’ insecurities. Decide yourself in the article dealing with rejection.
Rejection is experienced as a deep blow to self esteem as it involves blaming you as a person. It is difficult to deal with it because it conveys the message of non-acceptance and that there is something wrong with you and you are not good enough or worse still there is something wrong with you, that you will never change and that you do not belong to this group and you’ve done something wrong or unacceptable. This leaves you with a deep sense of helplessness. There is nothing that you can do to change another person’s biases and perceptions and you are left to deal with all these emotions yourself. More often than not, these perceptions are often backed by societal or religious norms justifying the persons rejection.
Often people who are a victim of rejection keep going in circles feeling victimized and angry and are unable to get over it easily. Psychotherapy helps such individuals to differentiate between what is intrinsic to themselves and that which is not. This goes a long way in handling difficult emotions of rejection. By understanding ones ownself and how one uses psychological defense of projection and introjection one realizes that the emotions thrown into him by the person rejecting actually form the dark and unknown side of the rejecting individual’s personality which is unfortunately being flashed onto your character screen. Although not aware, the person has sense that he can succumb to these very biases and therefore fights it externally whenever he sees it. Unfortunately in the process does not cure himself and accumulates greater fear of the same biases. Therefore no logical argument is able to convince the person to give them up. The reason being, if they give up these biases, maybe there is a fear that he will have to face it within himself. After all isn’t it much easier to fight the devil on an external screen than to have him within yourself.
Equipped with this understanding by experiencing it within ones ownself, the individual is able to detach oneself from the influences of these negative emotions projected on him by the world and is able to restore his self esteem. Of course talking about these emotions forms the initial part of the cathartic therapy but psychotherapy does not stop at that alone. In fact if the therapist is unable to take the client beyond catharsis, the client keeps experiencing the wound in his mind but is unable to come out of it.
Understanding the mechanisms of rejection and knowing that it is never, and I repeat, never warranted or earned are the most fundamental keys to safeguarding your self esteem and sense of self worth. This is a choice. You have to make a choice about how you are going to understand the messages of rejection you receive everyday, and how you are going to, or not going to, integrate these messages into your psyche.
Remember that facing your fears, expressing and sharing your experience, no matter how shameful, is vital in overcoming the aloneness that rejection creates and which sustains its impact.
Make a choice today to focus on the dynamic you and your untapped potential and you will be unscathed by any experiences of rejection.

TO WATCH OR TO BE



With the recent incident of the Ministers, watching pornographic film has brought about much ethical debate in the media; however the psychological impact has not been discussed. Sexuality is an issue which profoundly impacts not only an individual but also the family at large. In my experience, with only several exceptions, pornography has been a major or minor contributor or facilitator in the acquisition of their deviation or sexual addiction apart from complete psychological isolation from family. Treatment (psychotherapy) of the same is necessary as it tends to recur as all other means of control used by individual and society fail without an insight into the urge.
I found four factors common to nearly all of my clients, with almost no exceptions, especially in their early involvement with pornography.
1. Addiction
A porn movie becomes an addiction as the material provides a very powerful sexual stimulant or aphrodisiac effect with powerful imagery as a base of further fantasies, followed by sexual release, most often through masturbation. Once addicted, they could not throw off their dependence on the material by themselves, despite many negative consequences such as divorce, loss of family, and problems with the law (as with sexual assault, harassment or abuse of fellow employees). Interestingly my clinical experience, education is positively correlated with sex addiction; that is to say higher the education and intelligence greater is the person’s vulnerability to sex addiction. Reason being, their finer ability to use their intelligence to fantasize.
2. Escalation
Like drug addicts, sex addicts with the passage of time require rougher, more “kinky” kinds of sexual material to get sexually aroused. If their spouses or girlfriends were involved with them, they eventually pushed their partners into doing increasingly bizarre and deviant sexual activities. They often preferred this sexual imagery, accompanied by masturbation, to sexual intercourse itself. This nearly always diminished their capacity to love and express affection to their partner in their intimate relations. In many cases, this resulted in a fall out in the relationship when the woman refused to go further-often leading to much conflict, separation or even divorce.
3. Desensitization
Material (in books, magazines or film/videos) which was originally perceived as shocking, taboo-breaking, illegal, repulsive or immoral, though still sexually arousing, in time came to be seen as acceptable and commonplace. There was increasingly a sense that “everybody does it” and this gave them permission to also do it, even though the activity was possibly illegal and contrary to their previous moral beliefs and personal standards.

4. Acting Out Sexually
There is alarmingly increased tendency to act out sexually the behaviors viewed in the pornography including compulsive promiscuity, exhibitionism, group sex, voyeurism, frequenting massage parlors, having sex with minor children, rape, and inflicting pain on themselves or a partner during sex. This behavior frequently grew into a sexual addiction which they found themselves locked into and unable to change or reverse–no matter what the negative consequences were in their life.

PORNOGRAPHY AND ITS IMPACT ON THE FAMILY
However, in my clinical experience, the major consequence of being addicted to pornography is not the probability or possibility of committing a serious sex crime (though this can and does occur), but rather it’s disturbance of the fragile bonds of intimate family and marital relationships. This is where the most grievous pain, damage and sorrow occurs. There is repeatedly an interference with or even destruction of healthy love and sexual relationships with long term bonded partners. The most important negative consequence is that it isolates one from one’s own self. The ‘real’ world no longer appears appealing and the individual prefers to be in his own world ultimately severing emotional ties that gives meaning to his own existence. No amount of ‘knowing that its bad’ helps to reverse this habit. It’s like a latent cancer, it almost never disappears on its own or reverses its course unless there is some psychotherapeutic intervention.
PARENTING ISSUES AND PORNOGRAPHY
With the explosion of internet usage parents need to keep in control on the internet usage of their young ones. Their curious mind and age is bound to take them in this direction if left unattended on the net. Pornography films are often dismissed off as ‘educative’ or seen as rebelliousness by care givers. However parents need to be aware that there is tremendous peer pressure on the young adults and they often resort to pornography to be a part of the ‘in’ group or for the purpose of self education. When parents provide scientifically correct and age appropriate sex education to the child from a young age, they squash this curiosity and the chances of their child being misinformed via porn films. In fact sex education classes are conducted in many schools for the same purpose. It is a myth that imparting sex education will increase sexual activity in young adults. Rather as parents and caregivers it is your duty to ensure that the child is well informed about the sexual boundaries and the consequences. In fact in many of the abuse cases that I have handled in my practice, children were unable to protect themselves from further abuse because they felt responsible and guilty of the abuse and were unable to convey their feelings their parents whom they thought they could not talk as it’s a taboo topic or worse still would blame them. Because the topic was never raised by their parents they have nowhere else to talk about but their peers or left on their own for further experimentation.
Watching porn movies has a far outreaching psychological impact, especially on a young adults mind. Most of the porn films are made by men and are often extremely sexist in nature often debasing or humiliating a woman. Therefore children at a very young and impressionable age learn to disrespect women in general and treat them as object of sexual pleasure, have distorted perceptions about sexuality, destroys confidence, commitment and responsibility of an intimate relationship and institution of marriage in particular and making polygamous relationship an acceptable idea. In addition, pornography portrays “unhealthy” or even antisocial kinds of sexual activity such as sadomasochism, abuse and humiliation of the female, involvement of minors, incest, group sex, voyeurism, exhibitionism, etc.
Watching pornographic films over an extended period of time raises a fundamental question of who you become as a person watching it.

SURVING CANCER



Being diagnosed with cancer affects a patient not just physiologically but also psychologically, and has a deep impact on the emotional status of the patient and his family for an extended period of time. And while there are treatments for the physiological symptoms of the patient, dealing with the psychological trauma associated with cancer is another story altogether. Cancer is an experience of repeated traumas and for undetermined length, unlike an accident. The patient may experience posttraumatic stress disorder (PTSD) symptoms anytime from diagnosis through completion of treatment and cancer recurrence.

As is seen in the case of our Indian skipper Yuvraj Singh how the misdiagnosis and then the reconfirmation of the cancer must have been a series of highs and lows. Especially for a sportsperson who works under tremendous pressure to be fit and putting out an outstanding performance, trauma such as this can be doubly difficult psychologically rather than physically. Any ones guess would be whether he will be able to return to the stadium fit enough to play his best innings. Here is a glimpse of what he might be undergoing…

Although, the end of treatment is often marked with a sense of relief, accomplishment, and even joy in having gotten through a difficult experience. Yet for many cancer survivors, it is also a stressful time filled with new routines to learn, as well as mixed feelings about what they’ve just gone through. Many people find themselves unsure of how to move forward, wondering, “Now what?” Therefore, effects of PTSD are long-lasting and serious. It does not end with the end of the treatment. It may affect the patient’s ability to have a normal lifestyle and may interfere with personal relationships, education, and employment even after the patient is ‘cured’. Because avoiding places and persons associated with cancer is part of PTSD, the syndrome may prevent the patient from seeking medical treatment or psychotherapy. It is therefore important that cancer survivors and their family receive information about the possible psychological effects of their cancer experience and early treatment of symptoms of PTSD.

Also, as a patient, they may have been so busy learning about their diagnosis, working with the medical team, and going through treatment that they didn’t fully feel the emotional impact of the diagnosis until after end of the treatment. It’s common for many cancer survivors to have a variety of complex and often conflicting feelings about their diagnosis, treatment, and recovery. It is normal to feel relieved that treatment is over, yet angry or sad about having gone through such a serious illness. Or, they may feel guilty about surviving a diagnosis that other people do not. The patient may also feel anxious and fearful about the cancer coming back, or worried that the treatment didn’t work. It is normal, too, to feel confused about what they’ve been through and to be concerned about the future. Family and friends can provide much comfort and support during this time. However, survivors often feel a bit isolated from loved ones and the world around them. Loved ones usually mean well, but they might not be fully aware of all the emotional challenges that can arise for you after overwhelming, interfering with your day-to-day activities and even your health.
Another concern faced by many cancer survivors is the realization that life after their diagnosis and treatment never really goes back to what it was before cancer. Many survivors find they are not able to return to their old “normal” life but must adapt to a “new normal.” Understanding what your new normal is can take time. This process may involve: Reflecting on what you’ve been through. Identifying changes you might want to make in your life. Recognizing what you’ve learned and what’s changed about yourself. Re-evaluating personal relationships or professional goals.
Discovering new ways of finding meaning and fulfillment.
In India, we find that patients usually resort to prayer, fasting, performing ceremonies in order to deal with their illness as against proactively seeking information from the doctor, reading up on the net and medical journals, exercising, eating healthy, meditating or seeking professional help to deal with their emotions. (Stress and Coping amongst infertile women Research conducted by Dimple Shah for Mumbai University, 1994.). Although these actions mimic active coping mechanisms, in essence it is passive coping mechanisms resigning pessimistically and blaming fate for their misfortune and instilling deep fear and helplessness, therefore unable to relieve the person of stress. Patients and their family needs to be informed of these inactive and potentially stress inducing coping mechanisms and be guided to utilize proactive coping mechanisms mentioned above from the beginning.

Therapies used to treat PTSD are those used for other trauma victims. Treatment may involve more than one type of therapy. Feelings of sorrow, grief, hopelessness; coupled with mood swings, fear of losing life, leaving behind loved ones and anxiety and depression are very common amongst patients fighting against cancer. Serious psychosocial distress was seen 40% more among cancer survivors of 5 years or more than in those who have never had cancer. About 10% develop major depressive disorder; others experience an adjustment disorder. In young adult cancer survivors, one small study found that 20% of participants met the full clinical diagnosis of post-traumatic stress disorder (PTSD), and 45% to 95% displayed at least one symptom of PTSD. Survivors of adult cancer are at an increased risk of suicidal ideology (having thoughts about suicide), while as many as 13% of childhood cancer survivors experience suicidal ideology.

The prognosis of cancer it is proven scientifically that an emotionally stable person reacts better to the medication and treatment modalities of cancer. This is where a person’s inner strength becomes paramount. Yet it is expected that the person who has been diagnosed with cancer will initially at least crumble under the stress of the trauma. Here the key is, the support system that has a tremendous impact to help the patient bounce back to fighting cancer is the family and friends. Psychotherapy from the time of diagnosis to surgery and post treatment is crucial in providing this supporting network. When one member of a family has cancer, the whole family is affected and, in fact, psychotherapists consider these family members to be “secondary patients.” Cancer affects an entire family, not only because there are genetic links to cancer and cancer risk, but because when one member of a family has cancer the whole family must deal with the illness.

The therapist focuses on solving problems, teaching coping skills, and providing a supportive setting for the patient. Some patients are helped by methods that teach them to change their behaviors by changing their thinking patterns. Some of these methods include helping the patient understand symptoms, teaching coping and stress management skills (such as relaxation training), teaching the patient to reward upsetting thoughts, and helping the patient become less sensitive to upsetting triggers. Therapist may also use group work and introspective art therapy help the patient express their emotions. Sometimes having someone paying attention to the painful emotions itself is healing and patients show tremendous resilience once they are able to confide in someone who can demonstrate strength to listen to their pain, which family members are unable to do so at that point of time.

Most importantly cancer trauma, like other life threatening traumas bring back the past and often unconscious hurts and losses and therefore the psychological effect appears long lasting and compounded. Often people close to the patient find the person overreacting and are unable to understand where they are coming from. They feel hurt, angry and confused. But if you make an effort to understand that these emotions of hurt, anger and confusion that you are experiencing are not really incident related or even yours; that they belong to the person who is suffering from cancer you will be better able to deal with both the patient and the emotions thrown into you. Doing this is not as easy as it sounds and this is also where the psychotherapists step in. Psychotherapists help the family to experience and deal with these emotions that are thrown into them and also help them make better response choices. Therefore the psychological treatment on which the prognosis of cancer depends is strengthened using multifaceted psychotherapy approaches. It is beneficial to start with these sessions from the time of diagnosis and continue till post treatment; as although we expect psychological reactions to emerge within the first three months of diagnosis, there is no fixed rule and if not brought into the forefront of therapy may remain suppressed and resurface later on after many years, often with unconceivable strength.
Follow up article on Yuvraj singhs recovery from cancer
https://revivallife.wordpress.com/2012/04/14/surviving-cancer-2/

ACID ATTACK AND ITS IMPACT



In a male chauvinistic world, woman is considered to be the property of man. Be it a spurned lover, a suspecting husband or a man who is shooed away when he wants a relationship, each feels humiliated and wants to take revenge against the woman. The easiest way to hurt the woman in such instances is throwing acid on her. It makes the man feel immensely and rather sadistically satisfied if the woman is disfigured. Experts believe that the foremost reasons behind this barbaric act are easy availability of acids and illiteracy among the masses. The overwhelming majority of the victims are women, and many of them are below 18 years of age. These attacks are often the result of family and land dispute, dowry demands or a desire for revenge. There are umpteen instances in history of how women were treated in times of war or conflict. With the advent of industrialization and inventions, acid has come handy to these egotists in their bid to disfigure women. Acid throwing could well be described as the attempt to control or subjugate women.

Victims of attacks not only undergo severe physical trauma but also traumatic changes in the way they feel and think. Psychological trauma is caused by both what the terror victims suffer during the attack, as they feel their skin burning away, and what they suffer after the attack with respect to the disfigurement or disabilities they have to live with for the rest of their lives. Victims suffer psychological symptoms such as depression, insomnia, nightmares, paranoia, and/or fear of facing the outside world, headaches, weakness and tiredness, difficulty in concentrating and remembering things, etc. They feel perpetually depressed, ashamed, worried and lonely. Usually, acid burn victims suffer severe psychological symptoms for years, if not forever, because they are constantly reminded of the violent act by their physical scars. The feeling of lack of hope and worth may never leave them.

Social and Economic Consequences
Acid burn victims face a lifetime of discrimination from society and they often become lonely. They are embarrassed as they think people may stare or laugh at them, and may hesitate to leave their homes fearing adverse reactions from the outside world. Victims who are not married are not likely to get married and those who have suffered serious disabilities because of an attack, like blindness, will not find jobs and earn a living. Discrimination from other people, or disabilities such as blindness, makes it very difficult for victims to fend for themselves and they become dependent on others for food and money.
It has, therefore, been argued that acid attacks need to be classified as a separate offence and harsher punishment needs to be prescribed. It has been further stated that the new law must include guidelines for handling/supporting victims economically, socially and psychologically, and provide compensation. In fact since acid is so readily available across the counter in medical and other stores, acid attacks are a relatively cheap and effective way of committing acts of violence against women. Buying hydrochloric acid is as easy and cheap as buying a bar of soap; a litre of acid costs anywhere between Rs. 16 and Rs. 25.
There is, however, no law to regulate acid sales except for the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989 (amended in 2000), and this only applies to industrial situations. Furthermore, there are no regular inspections and stock checking for acid sales as there are for explosives. It has been argued by some that controlling or regulating acid sales is an impossible task, as acid is used for many things including car batteries, etc. Thus, the deterrence should come in the form of stringent laws that punish the perpetrators. However, Bangladesh, a country with the highest incident rate of acid attacks, has passed a law in 2002 to control acid sales. Thus, acid violence can be tackled on both fronts simultaneously with harsher punishment on the perpetrator and control over the sale of acid to stop it from getting into the hands of criminals. International commerce of sulphuric acid is controlled under the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988, which lists sulphuric acid under Table II of the convention, as a chemical frequently used in the illicit manufacture of narcotic drugs or psychotropic substances.
Nitric or sulphuric acid has a catastrophic effect on human flesh. It causes the skin tissue to melt, often exposing the bones below the flesh, sometimes even dissolving the bone. When acid attacks the eyes, it damages them permanently. Many acid attacks survivors have lost the use of one or both eyes. But the scars left by acid are not just skin deep. In addition to the inevitable psychological trauma, some survivors also face social isolation and ostracism that further damage their self-esteem and seriously undermine their professional and personal futures. Women who have survived acid attacks have great difficulty in finding work and, if unmarried (as many victims tend to be), have very little chance of ever getting married. In a country like India this has serious social and economic consequences. The New York Times (Dec, 26, 2001) reports that kerosene as well as acid has fast become the weapons of choice for attacks on wives in India. The major victim of attacked is Women(47%) and Men(26%). Children(27%) could not escape from the attack. Sometimes domestic animals or birds are also victimized. The sad fact is that women who have been victimised by these attacks are mostly at the hands of someone known and close to them.
Landmark Judgement
Referring to the compensation to acid victims, the Law Commission, headed by Justice A.R. Lakshmanan, quoted the landmark judgement of the Honourable High Court of Kerala in the State of Karnataka in the Jalahalli Police Station vs. Joseph Rodrigues case (decided on 22 August 2006) wherein the accused was convicted under Section 307 of the IPC and sentenced to imprisonment for life. A compensation of Rs. 2,00,000, in addition to the trial court fine of Rs. 3,00,000, was to be paid by the accused to the victim’s parents. The acid attack deeply scarred the victim’s physical appearance, changed the colour and appearance of her face and left her blind. However, in many cases throughout India, punishment often did not take into account the deliberate and gruesome nature of the attack but only rested on technicalities of injuries. It is apt to recall here that the Law Commission also proposed a law known as ‘Criminal Injuries Compensation Act’ to be enacted as a separate law by the government. This law intends to provide both interim and final monetary compensation to victims of certain acts of violence like rape, sexual assault, acid attacks, etc., and should provide for their medical and other expenses relating to rehabilitation, loss of earnings, etc. Any compensation already received by the victim can be taken into account while computing compensation under this Act.

Pune ST bus driver runs amok killing 8 people, injuring over 30 people and smashing 37 vehicles before he was forcibly brought to a halt by two youths. The man appeared dazed and glassy eyed and was later discovered that he was suffering from schizophrenia, a mental illness. 25 million people suffer from schizophrenia in our country and an attempt is made to rehabilitate them and make them economically…Edit


Pune ST bus driver runs amok killing 8 people, injuring over 30 people and smashing 37 vehicles before he was forcibly brought to a halt by two youths. The man appeared dazed and glassy eyed and was later discovered that he was suffering from schizophrenia, a mental illness. 25 million people suffer from schizophrenia in our country and an attempt is made to rehabilitate them and make them economically…Edit

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.

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.