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.

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.