Millions of parents and their adult children live in different homes, cities or even continents. Challenges present themselves in many forms—distance, decline, disease, crisis, and emptiness—coupled with our own turmoil and realisation about life and death. Stress, burn-out, and grief become part and parcel of life when you take up the role of caregiver for your parents. Taking a closer look and ensuring that you understand the meaning of this journey can prepare you for the ride.

Acceptance

It is difficult to accept that a parent or a loved one is ‘fading out’ with age. There is always the uneasy gut feeling and that natural recoil thinking about your parents’ dependencies and the advancing impairments with age/disease. Denial is the biggest setback and prevents you from recognising your own emotions. Allow the knowledge to sink in that your parents need your hand. Let the shock subside, and accept the challenge of handling an ailing parent—be it any physical illness or somewhat more debilitating threats such as dementia.

Reaching out

Browse the internet and find out resources about care delivery—the who, what, how and where of it all. Seek a confidante/professional to tackle your difficult emotions of denial, anger, sadness, despair or just plain burnout. It is normal for you to crumble at times and seek help from any quarters to deal with that. If you have siblings in the same boat as yours, connect with them and bond over the practical aspects of sharing care as well as the mutual catharsis.

Assessment

An important aspect for you to consider is the degree of involvement required. Do your parents need to move in with you? Or would it serve best to let them to remain in their familiar environment, with a little care and presence of someone who would be available with their support? What is the nature of medical aid required and what would be the projected costs? What is their psychological status and how much do your parents need you around? How much can you afford in terms of your resources—finances as well as time and presence. Discuss with your spouse and family members and plan realistically. It is vital to understand that not every ageing parent will fit the same formula—what works for your spouse’s parents may not work for yours.

Environment

Make your parents’ home safer and more comfortable for them by bringing about changes in the structure of the house and its organisation.

1. Ensure adequate security as well as ease of movement, and have things organised for easy reference. Install security systems in the house if your parents are living all by themselves.
2. If required [in case any parent has memory loss or associated impairments] tag objects and places.
3. Install gadgets which are easy-to-use and low maintenance—for example, an AC with self-cleaning function, heaters with thermostat or a phone/ computer your parent is most comfortable handling. Parents may not be comfortable using the latest gadgets, so you may want to look for single-function devices for their ease of understanding, rather than multi-function tech-savvy gadgets.
4. Keep the home clutter-free and remove potential sources of danger, such as steps where your mother may be prone to accidental falls, or any plugs/ sockets that need repair.
5. A very pertinent but oft-ignored area is the restroom—you may have to think of structural changes to make it elderly-friendly. If your parents are living with you, think about how you could rope in your family members’ help to ensure that each one can participate in their own little way to pitch in and attend to their needs.

Resources

Source and write out all possible resources that could come in handy—from hospitals, doctors, nurses to friends, relatives, NGOs and grocery stores that do home delivery.    Spend time teaching your parents how to use a mobile or a computer or whatever new gadget you have installed. If you lack the patience, call a neighbour’s child who will enthusiastically play teacher with your parent and get the job done! Count on your neighbours, friends and relatives—reach out and let them know all possible resources you have listed out and prepare them with a plan for any sort of emergencies. Give them all your contact details and cultivate your relationship with these Samaritans—they will pitch in when you can’t.

If you are hiring a care nurse, make sure you have trained the professional regarding your parents’ likes and dislikes and set up a rapport with them—imagine how you’d have felt had your parents left you with a nanny without initially working on building your rapport.

Connect with elderly groups in your city—Senior Citizen forums operated by the government or municipalities also serve as very useful resources for distance-caring of elderly parents.

Sometimes an unexpected clique develops between your parents and your kids—grandparents can be entrusted with the care of your kids while you are out managing work and home. And vice versa.

Institutionalisation (Senior Living Facilities)

There are mixed views about institutionalising an ageing parent. Contrary to popular belief, it may sometimes be the right thing to do, given the practical constraints of adult children today. Institutionalisation may not always signify cruelty and negligence towards ageing parents. What defines the nobility is the intention and purpose. Consider senior living facilities only if you are sure that your parent will be better off living with like-minded individuals in a secured, warm home for ageing than either living with you or alone. Visit them or connect with them as frequently as possible, just as you would with a child who’s staying in a boarding school.

Encourage socialisation

Hold gatherings and encourage your parents to stay in touch with friends and relatives. Not only does this deal with their emptiness and loneliness; but also assures that all your acquaintances are on the same page as you regarding the health status of your parents.

Keep it light

Humour is perhaps the best way to diffuse tensions. Try to fuse humour to vent out irritability and frustration as well as make light of such situations where your parents may be feeling guilty about being a burden. As Martha Beck says, “If you can’t train your elder to go toward the light, you can make light of the situation”.

Face the eventuality

Ageing parents force you to face the reality of life—ageing, helplessness, dependence and eventually death—something that we keep denying most of our lives. When you watch your parents slowly moving into the dusky zone, brace yourself up to accept the eventuality of life.

This was first published in the September 2013 issue of Complete Wellbeing.

The post Challenges in taking care of ageing parents appeared first on Complete Wellbeing.

Any prolonged illness, whether terminal or not, has a deep impact on the family, especially on the spouse. The spotlight often falls on the care receiver for being the heroic warrior battling it out, while the spouse’s supporting act goes unappreciated. To deal with this sudden role reversal in your relationship, it helps to:

Accept the illness

After the roller coaster of emotions ranging from shock, denial, anger, frustration, sadness and even guilt, it is possible to emerge with feelings of acceptance and calmness. As difficult as it may seem, you must work towards reaching that state. Share what’s on your mind with someone—a friend or a professional—who will not judge you or the situation. Let the tears flow and wash away the burden of any guilt. Your spouse is also likely to have similar feelings. Talk to each other, discuss and share the pain. Resolving feelings of guilt is one way to be able to look at the illness as another challenge you both face as a couple.

Define your role

Any kind of prolonged illness results in a significant change in the roles of both partners. From being a part provider for your home, you may now have to be the sole provider. Discuss the new allocation of duties, considering the needs of your spouse who may now have physical limitations and lifestyle restrictions. Chalk out the new roles based on what both of you can contribute, and come to a clear understanding and acceptance of the change in roles.

Reach a new balance

Research shows that family dynamics take a drastic turn at the onset of a prolonged illness. The equilibrium you had reached as a couple gets disturbed. As much as you may want to keep things ‘normal’ or ‘as before’, it may not work. You may need to spend time and effort to find out what will work now. Allow yourselves time to settle down into your current roles and be prepared for initial hiccups.

Encourage independency

While it is natural to feel protective about your ill spouse and it may satisfy his/her need for emotional support as well, it is crucial to be watchful for signs of over-involvement. Do you oversee everything your spouse does? Do you feel irritated if something is done without your consent? Does your spouse feel that even though out of concern, you unnecessarily restrict his/her daily chores and responsibilities? Revise how much you want to be involved in his/her daily care. Your spouse also needs space and time to adapt to the illness just as much as you need some time to yourself.

Communicate

When times are stressful, communicating your feelings to your spouse becomes even more crucial. But keep yourself open to communication as well, as your spouse may be experiencing a whole range of emotions and, depending on the nature of the illness, may be feeling a loss of meaning in life. Let him/her convey their emotional journey in words, either by speaking or by writing. When expressing yourself, ensure that you don’t come across as accusatory.

Take care of the children

Research shows that children become emotionally vulnerable in times like these and need more care and attention. While the major responsibility of bringing up the children may shift on to you, allow your spouse to share in the process as much as s/he can. Review your strategies for assuring and disciplining your child. Now more than ever, your child needs to feel secure about the future. You may experience feelings of inadequacy as a parent. Seek help in resolving them, as they undermine your child’s emotional growth.

Embrace spirituality

Many have suggested that the belief in a supreme power may be an innate need in all of us. Your spiritual growth during the challenging times will help you come to terms with the grief. Connect with others who offer this wisdom to guide you through this journey.

Keep the family connected

You don’t have to organise a family get-together. Simply follow routine rituals, like praying or having meals together. Explain to your children how doing so helps keep the family connected through tough times.

Express negative emotions

For prolonged mental illnesses, like bi-polar disorder or schizophrenia, it is extremely important to watch out for emotions such as hostility, over-criticism, over-involvement and lack of warmth. Discuss with a professional if you feel overburdened and find yourself displaying any of the above. Negative emotions can lead to a relapse of the illness, and need to be dealt with by the caregivers themselves.

Spend some me-time

You need not feel guilty about spending some time with yourself. Nurture yourself, eat well, and unwind by indulging in your hobbies. Neglecting yourself will burn you out, besides making you unfit to take care of your family.

While you can’t stop the sun from setting, you can learn to look at the brighter side of your relationship till the light shines.

This was first published in the September 2012 issue of Complete Wellbeing.

The post Sail through the storm appeared first on Complete Wellbeing.

‘Commitmentphobia’, a term coined by Steven Carter and Julia Sokol in the popular book Men Who Can’t Love, refers to a fear of committing to long-term relationships or marriage. Not only men, but also women may be affected by this condition. Commitment phobics have a history of short-lived relationships, often with unlikely partners and are unable to let go of their fear of getting hurt, infidelity and the loss of freedom. They are unable to envision a healthy, committed long-term relationship.

Are you dating a commitment phobe?

The reasons underlying commitment phobia may be numerous but can usually be traced back to unhappy/unfulfilling close relationships, either directly or vicariously. Commitment phobes usually would have been subjected to traumatic experiences of having parents who had been unfaithful partners, or may have been witness to multiple rejection experiences of others. All such trauma leads to the belief that long-term relationships don’t work or that ‘If I commit, I will be hurt some day’. Consciously or otherwise, they recoil at the very thought of commitment. Behaviourally, they may avoid it by postponing decisions and discussions or they may choose partners who can be easily blamed for the separation or incompatibility. Unable to resolve their conflicting thoughts, they seek fulfilment in short-term affairs, especially in ones that may not require them to be in for the long haul. Severe commitment phobes may have difficulty not just in relationships but their tendency to avoid any kind of commitment may also result in other severe personality disorders.

The reasons underlying commitment phobia can usually be traced back to unhappy/unfulfilling close relationships

If your partner shudders at the thought of spending life with only one person, if he or she feels trapped by the thought of marriage, or feels an intense fear of rejection or getting hurt by you, once he or she gives in, perhaps it’s time to ask yourself—is your partner doing this out of a fear of not being able to trust the opposite sex or from the past experiences? Or are you noticing a pattern of a runaway bride/groom? Do watch out for overdiagnosing this condition—get a reality check on the relationship with the help of a professional.

What if, as you read this article, it slowly dawns on you that your partner may have been showing similar signs? Is there a step-by-step approach to solve this puzzle? Possibly yes!

Ask your partner how s/he feels about commitment and especially if that has resulted in postponing discussions on marriage or other long-term commitments. Be understanding to make it easy for him/her to discuss their fears. Sometimes, commitment phobics need a ‘safe’ relationship to be able to let go of their fears. So if you are able to provide that, your partner may come clean. However, do not think that this is the solution. Most commitment phobics would not feel safe to discuss this with their partners and consequently may never admit to their fear of commitment. If you feel your partner is not coming forth to discuss his/her fears in spite of you broaching the topic several times, just give them [and yourself] an ultimatum. Set a date by which s/he needs to respond to your repeated requests for more clarity in the relationship. Be firm and don’t fall for their emotional antics. Explain to them that commitment is an inherent part of love and without it no relationship can be stable or happy.

I’d like to mention here that you will have to, as best as you can, prepare yourself for any unfavourable outcome. Look at the cons of the relationship instead of just clinging on to the pros. Try to visualise the disaster that you could turn your life into, if you went ahead with this relationship. Also, try to envision the life you really want to live—this will help you see the difference between what you want and what you are getting/or will get. When nothing works in this relationship and your partner turns out to be another Raj, just move on. Love and a healthy relationship is not about being your partner’s shrink for the rest of his life.

Sometimes, commitment phobics need a ‘safe’ relationship to be able to let go of their fears

Are you a commitment phobe?

For all the commitment phobics—you are missing out on the warmth and joys of a committed relationship. Here are a few thoughts on how you can helf yourself:

Face it

Try to zero-in upon the thoughts and feelings which come to your mind when you hear the word ‘commitment’—what thoughts get evoked? You may also get disturbing images in your mind—relax your mind and at the same time, bring up the images and thoughts. Note them down. You don’t hold yourself back, but your thoughts do!

Think back

Try and track back to the time in your life from where these thoughts/assumptions came? Perhaps you have vague memories of married adults fighting with their partner? Or violent scenes from the past get raked up in your mind? Perhaps your own hurtful experience of getting rejected by a loved one? It may take you one evening to revisit these painful memories, but it will result in cleaning up your life. It’s really worth all the tears and pain of revisiting.

Talk

If possible, talk to the people involved in those memories/experiences you just revisited—it may help clear some misconceptions. Relationships are not always happy, but the bad/unhappy ones eventually die out and should be forgotten. Why should you let those bad relationships prevent you from being in happier ones?

Forgive

Calm your mind and ask—“Can I forgive myself for not being able to protect myself from this pain?” Your feelings towards the doer is of anger, but help yourself realise that you may be projecting the anger at yourself and consequently punishing yourself by shunning closeness and commitment in all future relationships. Your anger at the person who hurt you is justified, but had you been able to express it to him/her? If yes, then you have expressed yourself. If not, then you can’t keep burning yourself repeatedly. Instead, let go of the anger—write it down in a piece of paper and set it on fire.

Choose and reframe

Now that the slate is clean, reframe your thoughts. Choose what you want to believe about relationships. Do you want to continue believing that long-term relationships are not for you or that marriages don’t work? Or do you want to look around and see thousands of couples living happily ever after? The choice is yours—you can choose what you want in your life—to live happily with a committed partner whom you adore and respect, or indulge in faithless unions where you don’t feel happy or fulfilled.

Love and intimate relationships form a beautiful world of togetherness and help you lead a fulfilling life. You will be rewarded if you choose love; but if you choose past hurt and pain, you are choosing to punish yourself forever by holding back.

The post Are you or your partner commitment phobic? appeared first on Complete Wellbeing.

Sometimes we are placed in situations which act as triggers. Yet, triggers alone cannot lead to a fit of rage. For example, toys strewn around the house cannot be the only factor for you throwing a tantrum at your kids and your maid. There are times when you are able to take the same situation mildly and get it rectified without getting angry. But at a time, when you are returning from a long day at office and the least you are expecting is a relaxing shower and a good sleep. When you enter your house and see this mayhem, you immediately start feeling that perhaps your family members do not care about you or your long day at office. That is what sets off the anger bug–the thought, which intervenes between the situation and your behaviour. How we process information influences how we behave in every sphere of our lives.

On the road, if you strongly hold the belief that other people SHOULD not cut in front of you from the wrong side, when somebody does that, you think it’s unfair, WRONG and ought to be resisted and punished. This thought irks you and gradually sets off that emotional alarm and might lead you to abuse the individual.

Thus, anger management is not about setting the world right, it is in fact about adjusting your beliefs, so that you are able to live more peacefully.

People deal with anger in seemingly three different ways:

1. Acting out, which involves hostile aggressive behaviour, like abusing, fighting, screaming and throwing tantrums.
2. Suppressing anger, or avoiding conflicts, by being distant, passive aggressive, cynical and even taking it on oneself [this often leads to depression].
3. Calming down and responding assertively.

The third method is one that doesn’t come naturally to us, and needs to be learned and practised to perfection. The aim of this whole anger affair seems to have our own way. By calming down the ‘hot emotions’ we are able to prevent the brain hijack as well as act according to reason. We can thus behave assertively, negotiate with the other party and get our work done, without getting angry. Of course, it’s not as simple as it sounds, and it entails training and practice.

Anger as an advantage

Although anger is not appropriate most of the time, a study in 2007 suggests that anger-induced action is sometimes the result of quite clear-headed and deliberate processing. Which means, anger, when channelled for positive behaviour, leads to moving forward or even success. We do think of successful individuals as ones being a tad more aggressive than usual. Well, these are people who have been able to successfully channel their anger into their ingredient for success.

Anger management, therefore is NOT about NEVER getting angry again, but is about learning how to regulate and express the natural feelings in a way that makes us more effective—a trade-off between letting the steam escape a bit and at the same time firing the engine to work at a desired speed.

The Harvard Mental Health Letter suggests a blend of three therapeutic methods for managing anger:

1. Changing the way you process information, known as cognitive restructuring
2. Learning newer ways to cope with obstacles and frustrations in daily life, known as coping skills training
3. Using self-induced relaxation to simmer down that boiling pot of emotions.

We are blessed with a free will to make our lives more beautiful. We may choose to be angry or be calm and behave better.

The Buddha said, “Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the only one who gets burned.” The choice is ours, to live and let live or to fret and fight.

This was first published in the August 2011 issue of Complete Wellbeing.

The post Keep the lid on: Tips on anger management appeared first on Complete Wellbeing.

Like Ashish, many people’s behaviour is coloured by past experiences. Such experiences are the root cause of poor self-esteem or inferiority complex. In order for us to reach our potential, we need to leave our past behind and develop our self-esteem.

Identifying the signs and symptoms of poor self-esteem

It may be difficult to identify poor self-esteem, and you may require professional help to identify it in yourself. However, there are some telltale signs that can help spot the poor self-esteem:

1. Poor self-image

Those with a poor self-image highlight their deficits or negative qualities. They are often dissatisfied with some aspect of themselves. “I’m not as good”, “I’m a complete misfit”, “how much ever I try, I don’t meet the standards” and “I’m defective” are typical beliefs that point towards this tendency.

2. Unresolved past

Some people constantly live in the past, brood over their mistakes and failures and do not forgive themselves. In elderly individuals, this may manifest as an existential crisis characterised by a sense of feeling unfulfilled, incompleteness and waste of life.

3. Rejection sensitivity

Individuals with low self-esteem crave acceptance by others. Yet, when others show interest in liking in them, they are unable to deal with it. Due to this extreme sensitivity to rejection, they are sometimes unable to develop intimate relationships or deliver public performances like presentations or speeches.

4. Inability to take compliments

Compliments cause anxiety in those with low self-esteem and set them thinking whether others really mean it. Such people are notorious about not taking compliments gracefully; they might brush it off, seem off-guard, or even reply sarcastically. In fact, they are more prone to remember negative remarks and be influenced by them rather than praises and compliments.

5. Inability to explore the unknown

Due to their lack of self-confidence, these individuals tend to harbour a loss-oriented mindset. This makes them unable to take risks and, in turn, stick to their ‘negativity hypothesis’.

6. Lack of assertiveness

For people with low self-esteem, saying “No” becomes a matter of risk, because they fear that if they turn someone down, they might offend the person or get rejected in return. Their craving for acceptance and approval by others makes them unassertive and they end up complaining that everybody uses them or takes advantage of them.

You need to introspect

Identifying poor self-esteem is a matter of introspection and requires a great deal of self-awareness. Such individuals may be defensive about accepting that they might be suffering from poor self-esteem, although they constantly harbour self-doubts.

The symptoms of poor self-esteem can be evident or latent, depending on the person. It may not always manifest as low self-confidence and poor self-image. Sometimes, individuals having a deep-rooted issue with their self-esteem may manifest an inflated sense of self: they might imagine themselves to be the best, the greatest, too good for others and so on. Such individuals have the tendency to talk too much, and like to flaunt their achievements, subtly and overtly trying to prove their “superiority” to self and others.

8 steps healthy self-esteem

To introspect effectively, you need to be brutally honest with yourself. If you do so, and discover signs and symptoms of poor self-esteem in yourself, you can make conscious changes to your mindset by tuning your beliefs and choosing your associations with care. Here are a few steps that can help you get started.

1. Identify positive traits and talents in yourself

Those with healthy self-esteem know what they are good at. List your talents and strengths and capitalise on them.

2. Avoid bottling up your feelings

Discuss your feelings with close friends rather than bottling them up. As far as possible, surround yourself with positive people who encourage you; avoid those who discourage you or are overly critical of your thoughts and endeavours.

3. Avoid comparison

Avoid comparing yourself with others, unless you are doing it positively—to derive inspiration rather than to beat yourself up. Remember, you are unique — neither more nor less than others.

4. List your positive traits

Listing your strengths will increase your self-confidence. Positive self-talk is conducive to self-development. Make it a point to pat yourself on the back for every small or big achievement. And when you don’t do well, remember that all humans are fallible and “failure” is par for the course.

5. Do mirror exercises

Stand in front of a mirror and simulate social situations. Practise saying “thank you” upon receiving a compliment and social skills like eye-contact, smiling, greeting. Also practise assertiveness-skills like refusing politely or saying “No”.

6. Work on your goal-setting

Set and revise goals to make them realistic and achievable. [Read You are limited only by your imagination for guided imagery technique to help you with goal setting]

7. Train yourself to deal with difficult situations

Identify situations which induce anxiety and rehearse ways of handling them. [Read Coping with anxiety: 10 things you can do to help yourself right now]

8. Read books on personal growth

Reading books that help you grown in self-awareness can help you become more confident of yourself.

9. Learn from others

Befriend people who have overcome poor self-esteem. This will foster self-acceptance and forgiveness that will help resolve your past.

“Remember, you have been criticizing yourself for years, and it hasn’t worked. Try approving of yourself and see what happens.”
— Louise L. Hay

Updated on 17^th March 2021

The post Signs of Poor Self-Esteem + 9 Steps Towards Healthy Self-Esteem appeared first on Complete Wellbeing.

Brain behind it all

Erich Harth [in Windows of the Mind, 1982] put it like this: “The brain presents two seemingly irreconcilable aspects: It is a material body, exhibiting all the physical properties of matter, and it possesses a set of faculties and attributes, collectively called mind, that are not found in any other physical system.”

Our brain sends signals when there is a problem in either area. Most mental illnesses, be it depression, anxiety, psychosis, have been researched and found to have a brain basis, that is, certain neurochemical regulators, which become imbalanced in certain conditions. Early identification of these can stop the disease from aggravating or may be, even from precipitating.

Don’t miss these messages

Many a times, we pick up the signals our brain sends, while at other times, either due to ignorance or negligence, we miss them.

The following are some of common mental illnesses and their signs you should be aware of:

Depression

Amongst the different mental disorders, the most common is depression, which is said to be the ‘common cold’ in mental disorders. Depression is caused due to an imbalance of a neurotransmitter called serotonin.

This leads to dampening of certain brain circuits that are responsible for positive thinking, problem-solving and happiness. This leads to negative thinking, sadness, pessimistic and/or suicidal thoughts and dysfunctional thinking, which are the common symptoms of depression.

Signs: People in depression have a prominent ‘negativity bias’, which makes them look at all negativities in life and the world. They develop negative ideas about the self, world and future, consequently leading them to wish they were dead. There may be physical symptoms of depression too. These physical symptoms may include, but are not limited to, fatigue, loss of appetite or hyperphagia, decreased sexual interest, and sleep disturbances.

Depression can range from very mild to severe. But if you have been experiencing sadness, crying spells, negative automatic thinking, suicidal ideas, sudden loss/increase in appetite, for more than two weeks at a stretch, you must seek professional help. You may experience mild depression in the form of chronic fatigue, body aches and pains, inability to concentrate, loss of appetite, sleep and sexual interest. Depression can be effectively treated with medicines and psychotherapy.

Anxiety disorders

The spectrum of anxiety disorders is quite broad with the underlying symptom of feeling anxious, out-of-control, jittery, confused, indecisive and uncertain. Anxiety has very obvious physical manifestations, as we all experience it at least once daily. Anxiety is a state of autonomic arousal, that is, the autonomic nervous system springs into action.

Signs: Nervousness, excessive sweating, drying of throat, palpitation, choking, feeling dizzy, nausea, and gastrointestinal difficulties are some common symptoms. Physical symptoms include [but are not limited to] multiple aches and pains, gastro-intestinal difficulties, decreased immunity, cough and cold.

Anxiety may also manifests as other somatic signs, such as skin problems, hair fall, menstrual difficulties, or problems in sexual functioning. Certain behaviours such as twitching of muscles, mannerisms, fidgeting and shaking of limbs are also indicative of anxiety. Anxiety disorders are treatable with adequate medication and psychotherapy.

Mood disorders

Mood disorders include depression and mania. While depression has already been discussed, mania involves a state of hyper-excitability, irritability, over-energetic, elated mood, which can last for weeks to months. Mania may be followed by or occur after an episode of depression. So one may experience these opposite phases, in which the physical and psychological symptoms are contrasting and severe enough to warrant medical attention.

Signs: People suffering from mania undergo periods of feeling over-energetic; so they may do much more work than usual, be more religious, spend more, sleep less, eat more, involve in extra grooming, and display disinterest in sexual behaviour. Physical symptoms include sweating, pacing, weight lost and exhaustion. Mania is treatable with mood stabilisers and psychotherapy.

Moral of the story

All mental illnesses are a combination of biological and psychological factors in the individual’s constitution. There is no one-to-one correlation to support any one group of factors; like any other disease, mental disorders also manifest in physical and psychological signs and symptoms.

In fact, almost all chronic physical diseases, from cancer to AIDS have psychological repercussions. There is no reason to rely only on physical symptoms of any illness as the indicator of your wellbeing. Psychological intervention is as important in disorders of the body as in those of the mind.

The post The body speaks when the mind freaks appeared first on Complete Wellbeing.

The sleep cycle

During a night’s sleep, two types of sleep alternate in a cyclical fashion. These two types of sleep have been referred to as the Rapid Eye Movement [REM] Sleep and the Slow Wave Sleep or Non REM sleep [NREM]. REM sleep is interspersed with the NREM sleep, recurring every 90 minutes. Researchers have identified five different stages of sleep, with the first four being NREM which progresses towards REM sleep:

1. Light sleep; transition between wakefulness and sleep, muscles begin to relax, person can be easily awakened, 5 – 10 per cent of total sleep time.
2. Brain waves [electrical activity recorded via electrodes placed on the skull] slow down with occasional bursts of rapid waves [sleep spindles]. No eye movements. 40 – 50 per cent of total sleep time.
3. Characterised by very large and slow brain waves or delta waves interspersed with smaller faster waves.
4. More delta activity recorded [stages 4 and 5 constitute 20 per cent of total sleep time]
5. REM sleep: 20 – 25 per cent of total sleep time and occurs 4 – 5 times during an 8 – 9 hours sleep period. Duration of REM sleep period varies from 5 – 30 minutes. Decreased muscle tone, irregular heart rate, increase in brain metabolism by 20 per cent are characteristics and the person is cannot be woken up easily by sensory stimuli. Dreams in this stage are vividly recalled even after waking up.

The dream factor

Dreams are mind’s natural stress-busters. Psychoanalytically, dreams allow unconscious unfulfilled wishes and fantasies to be acted out in a safe context, which leads to release of anxiety and provides psychological balance. Dreams have also been widely interpreted to understand the unconscious mechanisms of the mind, thus revealing more about one’s mental health.

While the average adult requires one third of the day i.e. eight hours, children usually need 9-10 hours of a night’s sleep to feel fresh. However, modern lifestyle forces people to make do with 5-6 hours of sleep. The level of fatigue does not determine the hours of sleeping, instead it determines the length of REM sleep. Hence, the more fatigued you are, the less of REM sleep and the more of deep sleep you tend to get.

Research shows that metabolic activity of the brain decreases significantly after 24 hours of sustained wakefulness. Sleep deprivation [which researchers claim can be more dangerous than food deprivation], other medical complications, environmental conditions like light and disturbed levels of the hormone melatonin can lead to sleep disorders. It can also lead to an eventual decrease in immune system functioning as measured by white blood cell count, and decrease in the release of growth hormones.

The biological clock

An internal biological clock regulates the timing for sleep in humans. The activity of this clock makes us sleepy at night and awake during the day. Our clock cycles with an approximately 24-hour period and is called a circadian clock. The most important function of a biological clock is to regulate overt biological rhythms like the sleep/wake cycle. The cue that synchronises internal biological clock to the environmental cycle is light.

Upset circadian rhythm

• Effect on travellers: Jet lag results from the inability of our circadian clock to make an immediate adjustment to the changes in light cues that an individual experiences when rapidly crossing time zones. It produces a number of unwanted effects including excessive sleepiness, poor sleep, loss of concentration, poor motor control, slowed reflexes, nausea, and irritability.
• Monday morning blues: By staying up and sleeping in an hour or more than usual on the weekends, we provide our biological clock different cues that push it toward a later night time phase.
• Shift work: Modern society requires that services and businesses be available 24 hours a day. So, some individuals must work the night shift. These individuals no longer have synchrony between their internal clocks and external daylight and darkness signals.
• Lack of sunlight: Very little light reaching the biological clock in the SCN [a group of cells in the hypothalamus] appears to bring on this recognised form of depression in susceptible individuals.

Sleep deprivation

Voluntary behaviour: People who engage in voluntary, but unintentional, chronic sleep deprivation are classified as having a sleep disorder called behaviourally induced insufficient sleep syndrome. This is a type of hypersomnia. It involves a pattern of restricted sleep that is present almost daily for at least three months.

Personal obligations: Sleep deprivation can occur when personal obligations restrict sleep time. For example, a person may lose sleep while providing home care for a relative with a chronic illness.

Work hours: The work hours required by some occupations can produce sleep deprivation.

Medical problems: Sleep deprivation may be a symptom of an ongoing sleep disorder or other medical condition that disturbs sleep.

The effects

• The primary effect of sleep deprivation is excessive daytime sleepiness. This degree of severe sleepiness can be a safety hazard, causing accidents while driving and workplace injuries.
• Mood becomes irritable, anxious, depressed and shows lack of motivation.
• Performance will also be hampered due to lack of energy, coordination and concentration.
• Sleep deprivation has been associated with an increased risk of high blood pressure, heart attack, obesity and diabetes.

The solution

The remedy lies in use of sleep hygiene techniques and consulting professionals if the problem becomes severe. Sleep hygiene begins with arranging basic necessities for a good night’s sleep:

• A comfortable bed reserved only for sleeping at night
• Absence of lights and loud noises
• Fixed time to sleep and wake up everyday
• Day time sleeping is discouraged to ensure accumulation of fatigue at the end of the day
• Intake of caffeine, alcohol or watching bright screens like TVs and computers should be avoided at least since two hours before bedtime
• Dinner should be light and balanced in carbohydrates and proteins
• A glass of warm milk just before going to bed, also helps in inducing sleep, since warm milk contains tryptophan which stimulates secretion of sleep-inducing hormone, melatonin.

Sleep is essential for a person’s overall wellbeing. It is therefore advisable to work one’s routine in a manner that one gets the desired amount of sleep. This helps fight stress with the body’s natural restoring mechanism, thus maintaining an integrated physical, mental and spiritual wellbeing.

The post World Sleep Day special: Why we sleep appeared first on Complete Wellbeing.

Two days later, he cancelled the appointment fearing stigmatisation. A month later, he came to visit with his wife and son. The son was in severe depression, and had attempted suicide several times. In the interim, they had sought help from a person who claimed to make their son ‘normal’ through some ‘secret rituals’. When that failed, they realised they had to seek medical help. But they preferred not to put their son on medications, again fearing social stigma and side-effects of ‘mental blunting’ and drowsiness. Hence, they avoided seeing a psychiatrist and came for ‘counselling’. They requested me to do everything I could in one session, as they did not want to come again. It was a mammoth task to convince them to bring their son for regular psychotherapy sessions and follow-ups. Fortunately, they agreed, and we successfully resolved his difficulties over a few months.

Crazy beliefs

Later, I pondered over the matter a lot. I thought there must be many such individuals, who feel thoroughly confused about which professional to approach. They fear social stigma about visiting a mental health professional. They end up faultily diagnose themselves, based on their misconceptions and trips to quacks.

I realised that at the root of it all is the highly stigmatised concept of ‘abnormality’ and ‘abnormal behaviour’. People generally think of abnormality and normality as two distinct classifications. “Crazy”, “going-mad”, “mental”, “pagal”, “abnormal”, “mentally retarded” are oft-used terms, which convey a disastrous and irreversible picture of the mental health of a person. Quite contrary to the truth, the general notion is that these so-called ‘abnormal’ people are sick and cannot be treated. Often, their families desert them and they are left on the streets to live a sub-human life.

Silent sufferers

It is not only this severely ill population, but quite a sizable population of ‘sub-clinical’ individuals who need professional help. These individuals are found aplenty everywhere—from MNCs to schools to government agencies to the poverty-stricken slums. These individuals or those around them either find it difficult to identify and understand their problems, or may not have the means or the courage to seek help from a mental health professional. With the rise in stress levels in our lifestyles, there are a huge number of people being affected by lifestyle disorders, whose behaviours lie virtually on the thin line separating normal from abnormal. We all go through critical phases in our lives, when in some way or the other we feel we are not our ‘normal’ selves. This really brings us to a burning question: Who then is abnormal?

Abnormal behaviour defined

To define the ‘abnormal’, we need to first understand the concept of ‘normal’ and ‘normality’. Normality is based on our socio-cultural norms. Hence, behaviour that is in-keeping to an individual’s socio-cultural standards is considered ‘normal’, whereas, any deviation from such standards is considered ‘abnormal’.

However, abnormal behaviour can be said to be characterised by the four Ds:

• Deviant: from societal [or individual] norms
• Dysfunctional: the individual is affected such that s/he can not carry out his/her normal life
• Distress: such conditions result in distress for the individual
• Dangerous: becomes harmful to self and/or others around him/her.

Abnormal behaviour then is any behaviour, which is deviant from our normal behaviours and which leads to some or total disruption of our normal lifestyles, and causes distress to us, such that it may lead to dangerous consequences for ourselves and/or others.

Now let’s understand the role psychology plays in dealing with abnormality.

The truth about mental disorders

All mental diseases are not madness

Mental disorders are just like physical disorders. They have a root cause, which leads to the development of the symptoms. Most mental disorders have a known brain basis. Hence, just like diabetes is caused by a deficit of insulin in the body, mental disorders like schizophrenia or OCD or depression all have a known deficit in different brain-chemicals, called neurotransmitters.

Just like one must manage diabetes with regular medications, mental disorders, like those mentioned above can be managed with regular medications. Besides medications, however, research has proved that psychotherapy is also essential and leads to faster recovery than with treatment only with medications. After all, when dealing with something as unique and complex as the human mind, medications are not enough to tackle the problems, unlike that in physical disorders.

Hence, the common misconception that mental illnesses can not be cured or that abnormal people are “gone cases” is false and have no base in reality. Science has proven that with adequate treatment by trained professionals, mentally ill individuals can be return to society to contribute fruitfully and evolve in their individual lives. Hence, this is the role of a clinical psychologist in the treatment of the mentally ill. But it does not stop there. As mentioned before, clinical and non-clinical alike, we all go through phases in our lives when we seek help. So, going to the right professional to seek help is not that bad, is it?

Who to see when you feel troubled and want to stay well

The work of a clinical psychologist covers a wide spectrum. Although most specialise in a specific area, due to the scarcity of professionals in our country, we have to cater to diverse demands. Generally, a clinical psychologist works in:

• Assessment, using psychological tests, and making psychological profiles of children and adults to aid in understanding their problems. This may involve making personality profiles, career aptitude profiles, neuropsychological profiles [for brain stroke, head-injury and neurological problems], learning disability profile or assessment of intelligence.
• Psychotherapy and counselling to help individuals grow out of their problems towards their goals in life. Often, this roughly corresponds to a multitude of objectives: helping someone find his/her meaning in life, helping an individual in career guidance or changing the way one looks at the world, or helping couples repair their relationships or empowering a child to understand his emotions better or correcting certain dysfunctional beliefs which leads to a faulty perspective.
• Behaviour training for children and adults, to help manage behaviour problems; in training children with developmental disorders to help them learn vocational and life-skills.
• Stress management, lifestyle management and self-development programmes [popularly termed as personality development in self-help books].
• Rehabilitation of individuals with long-standing severe illnesses and brain damage, to empower them to lead better and more productive lives in society.

A little help

We all go through periods in life when we feel stagnated, and feel a tremendous need to grow. We also experience emotions in the ups and downs of life, which we feel no one might have experienced before. We all complain about not being able to cope with stress and feel the burden of life every now and then. Some of us have had terrible experiences in the past, which leads to our present day problems. But, the complexity of the human mind makes it impossible for us to understand how we develop such problems from seemingly minor issues or devastating experiences. At the same time, there is this tremendous human need to stay well, to complete one’s circle of life. This pushes us to a state of disequilibrium, when we want to do something, but we are unable to do it.

This is when all of us wish we had somebody who could understand us the way we are and why we are the way we are, and how we could help ourselves grow. Often, we settle for a family member, a spouse, a friend to talk about such things, but deep inside, we know, often it does not answer our questions. This is when a clinical psychologist is who you need to see. With the acumen of a scientist and the empathy of an artist, a clinical psychologist helps you understand yourself better and helps you in solving or managing your problems.

A clinical psychologist’s chamber is open to anybody who feels the need to change something about his/her perspective in life.

The post Am I mad if I visit a shrink? appeared first on Complete Wellbeing.

Suicide on the surface

Technically, suicide means intentional killing of oneself or performing an act destructive to one’s own interests. Suicides are classified as attempted and completed suicides. They are attempted in a premeditated planned manner or in an impulsive manner.

Often, premeditated suicides are attempted by individuals who are in a state of depression or despair. For such suicide attempters and victims, it is not so much the thought of death that drives them towards the decision, but an unbearable state of agony, helplessness and hopelessness, where they feel death is the only choice left.

When the suicide is attempted on an impulse, the attempters try to end their lives with a low intentionality for dying. Such persons often have underlying personality disorders, which push them towards taking such a drastic step. Suicide, in such cases, although looks like an act of despair, may have hidden motives of gaining attention or desired object.

The deep end

The power of the mind to infuse the will to live even in the most agonising of circumstances is extinguished when it is in the grasp of a devil, called depression. Depression, the common cold in psychiatry, is one of the leading causes of suicides. It can be severe and persistent enough to drive a person to end her own life.

In psychiatric literature, we have three terms to describe the mental state of a depressed person thinking about death and suicide—death wishes, suicidal ideation and suicidal attempts.

Death wishes refer to wishing to be dead in some way, not necessarily by planning to kill self. Such thoughts may be in the form of “I wish I would be dead” or “I wish I would get killed in an accident”. Death wishes can be experienced by people when they are moderately frustrated or mildly depressed, but when such thoughts become frequent or chronic, they lead to suicidal thoughts.

Suicidal thoughts are thoughts about killing self. For instance, “I feel like killing myself” or “I’d rather kill myself than live this miserable life”. Suicidal thoughts, when frequent, precipitate actual suicidal ideation, or the serious intention to attempt suicide. The intentionality to die may vary from one attempter to another. Some may plan to attempt in such a way that there might be chances of getting rescued.

The intention to die is low in such cases, and suicide is looked upon as a way of getting help/attention from others in some way. On the other hand are attempters, who may be severely depressed and their intentionality of death may be high. In such cases, suicide seems to be the only solution.

The terrible triangle

In psychotherapeutic literature, the trio of hopelessness, helplessness and worthlessness is what defines the depressive triangle, with the deadliest of emotions being hopelessness. The trio corresponds to negative thoughts and feelings about the self [worthlessness], world [helplessness] and future [hopelessness] and these three are considered to be the cognitive markers of severe depression.

Risk factors

Research has identified several risk factors of suicide. Studies suggest [based on All-India surveys] that suicide is more common among employed individuals than among unemployed individuals.

The following categories were found to be at a high risk of attempting suicide:

• Individuals with a mental health problem like depression, mood disorder, psychosis
• Individuals with substance-dependence [alcohol/drugs]
• Men below 25 years of age who are in depression
• Medical professionals
• Housewives
• Professionals in service in private sectors
• Individuals with nil, primary or matriculate education
• Married and unmarried individuals with relationship problems
• Divorced/separated individuals
• Individuals experiencing illnesses or family problems
• Early career professionals/ medical students.

Telltale signs

Family members/ colleagues/ friends can often sense that something is wrong, as depressed individuals usually display some classic warning signs.

These include:

• Talking about death
• Severe depressive symptoms: persistent sadness, crying spells, loss of pleasure in activities
• Refusing to eat
• Not taking care of self
• Not interacting with others
• Feeling helpless about one’s problems; feeling despair and agony about one’s life
• Feeling hopeless; being extremely pessimistic; saying “Nothing will work” or “Things will never improve” or “The future looks bleak and dark without any ray of hope”.

Suicide not only takes a loved one away, it leaves its survivors and/or their families in a deep state of shock and stigma. And although suicidal individuals may be identified in advance, such individuals need to undergo long-term counselling and psychotherapy to help them deal with the problem that is at the root of their depression or impulsivity in their personality.

Suicide prevention is a complex process, which cannot be done by a professional alone; family, friends and significant others too play an important role in helping those who see themselves between the devil and the deep blue sea.

The post The psychology of suicides appeared first on Complete Wellbeing.

How we make decisions

Making decisions is one of the hallmarks of human behaviour. Our decision-making abilities distinguish us from the primates and help us to make choices towards making our lives and civilisation better. It is a complex human behaviour, and the lack of it is one of the most debilitating causes of unhappiness in life.

Decisions are required in all aspects of life, however simple it may be, like deciding what to wear for office or deciding to invest in stocks or even extreme situations governing life and death. Decisions are about options and choosing from among the options wisely, so as to optimise the results. It is a complex cognitive process [thinking process], which requires synchronisation of other cognitive functions such as memory, assessment of risk, knowledge of outcomes, motivation and reasoning.

The decision-making process

The process of decision making involves:

1. Understanding the problem
2. Listing the alternatives
3. Evaluating the gains and risks with each alternative
4. Evaluating the probabilities associated with outcomes
5. Choosing the alternative
6. Learning from outcome.

Research has shown that parts of the brain known as the dorsal and ventral streams guide decision making. Injury to these parts, through physical injury, as in head injury or due to neuro-chemical imbalance as seen in psychiatric disorders, can bring about deficits in decision making.

In general, it can be said that synchronisation between emotional and cognitive processes ensure effective decision making. When emotional or cognitive processing is disturbed, such as seen in psychiatric conditions like depression, anxiety disorders, psychosis or personality disorders, the ability of decision making is severely impaired.

Understanding indecisiveness

Indecision or indecisiveness is a generic term for the inability to make decisions, not specifically due to any neurological or psychiatric conditions. It is a common condition experienced in different phases of life, when we are faced with challenges. These may involve difficult situations in which an important decision needs to be made. For example, choice of career, business decisions, financial investments, choice of friends, choice of a partner and so on. It is said that the most difficult decisions in life are not about choosing right v/s wrong, but about right v/s right.

Decision makers can be classified in two extreme groups: one who decide on impulse, and therefore may later repent or suffer because of their decisions. The second who due to their chronic indecisiveness are paralysed in making decisions. They suffer from extreme anxiety and frequently avoid making decisions by themselves. They may depend on others to make decisions for them or may avoid such situations altogether.

Indecisiveness is not a psychiatric condition

Indecisiveness is a condition that comes under the purview of personality disorders. It is to be noted that personality disorders do not signify any kind of neuro-chemical imbalance or any psychiatric condition, but it is a term used to signify relatively permanent patterns of behaviours of some individuals.

In some people, these patterns reveal a chronic inability to make decisions, since they can not judge the significance of their decisions or understand the risks involved. They frequently gamble with choices that involve heavy risks or minimum gains. Hence, such decisions often result in undesirable outcomes, unpleasantness, and repentance. Such outcomes often underline the decision maker’s incapacities. This makes the decision maker less confident about himself or herself, and fosters self-doubt and leads to more difficulties in making decisions. This comprises the vicious cycle of indecisiveness.

The rationale behind indecisiveness

Indecisiveness may also stem from a tendency towards perfectionism, which makes some people go after making the ‘perfect decision’. No decision can be perfect, since every decision is a weighted average of the pros and cons, but such perfectionist people are unable to sit quiet with such incongruence. Hence, for them, decision making is a scrupulous process, in which, they must follow each step minutely and accurately. This often prolongs the decision making process and leads to burn out of resources. Ultimately, they suffer from chronic indecisiveness.

It is said that the essence of human life lies with the capacity to ‘choose’. This freedom to choose to do what we want, gives our life a meaning and it further helps us to define our purpose of living. This purpose gives clarity to our thoughts and feelings, and further refines our ability to make decisions in line with our designated purpose of life.

Aimlessness often fosters indecisiveness

Individuals, who are unable to figure out their meaning or purpose in life, often suffer from a kind of aimlessness, which fosters indecisiveness. For example, students who are not sure about their knack or ambition, often feel confused about which career path to choose beyond schooling. Students who lack this focus, or aim in life, are unable to remain happy with any career decision, because, in the very first place, they were not sure about their meaning of life.

Similarly, many such decisions in life demand an effective resolution to the question about one’s meaning of life. Often indecisiveness stems from a battle between choices which demand choosing between our core values and what may be convenient for us. For example, when we choose to follow the wrong means for getting our work done, we choose to go against our value system, which may emphasise honesty and sincerity. In such situations, it is our meaning in life, which guides us in making a decision between these two choices, both of which appear apparently right!

You can overcome indecisiveness

At the outset, let us first understand that all problems do not have solutions. Similarly, all situations may not necessitate decision making. Even choosing not to make a decision is a decision! Hence, it is important to understand the background of our decisions, so that we can justify the circumstances with the decision we make.

This is an important point, because the significance of a decision changes with time. What may seem like a perfect decision today, may be a flawed one tomorrow. Hence, it must be remembered that decision making is not about making the one perfect solution, but is about making the best of a deal—every decision has its pros and cons. It is important to do a cost-benefit analysis when making a decision, since this highlights the gains and risks involved.

For chronic indecisiveness, the problem may not have such a simple solution. It may involve several steps in helping oneself.

4 steps to help you overcome indecisiveness

1. Identify your pattern

If you think you fiddle way too much with making decisions, and even after making decisions, you are not sure and repent having made a particular decision. You must first identify your pattern. Make a habit of writing a diary, where you can list down your difficulties and discomfort while making the decision and aftermath. This will provide insight into your pattern and help you understand where you may be going wrong.

2. Identify chronic areas

Once you have identified your pattern, try and understand the chronic area of failure. Is it with understanding the problem or with gauging the different options? Is it with evaluation of risks or with evaluating feasibility of alternatives? Is it with choosing the best option or with perfectionism hampering your peace after you have made the decision? It may be one, many or a mixture of all.

3. Build on what you may be lacking

If you have successfully identified the lacunae, you can help yourself. Take the help of your friends or close ones, or even a professional counsellor or clinical psychologist, who might help you build on your weak areas.

4. Correct some basic beliefs

Some people are perfectionists by nature. For them, perfectionism in whatever they do is a prerequisite. This stems from a basic belief system which emphasises that they ‘must’ do things perfectly. Such beliefs, as already discussed, hamper the decision making process, because such people are never satisfied with their decisions, and thereby suffer from chronic indecisiveness. The remedy is to correct such beliefs to understand that too much perfectionism is not ideal at all. Perfectionism itself has its pros and cons, and when applied to the decision making process, can lead to severe impairments.

Refine the decision making process: Evaluate the alternatives well, and get a fair idea of the costs and benefits of a choice. Once you decide upon the option, remember not to brood over it. While you may learn from your mistakes, brooding will only demotivate you.

Conclusion

In conclusion, it may be said, that indecisiveness is a common problem. However, there are no perfect decisions and no perfect decision makers. It is an individual’s psychological reality that decides for him/her, which alternative s/he chooses. After all, the freedom to choose is a basic human right. Perhaps, the only guiding principle which may be adopted is that: make the best of the deal and then look forward to making more decisions.

Last updated on 26^th November 2020

The post Understanding indecisiveness + 4 steps to overcome it appeared first on Complete Wellbeing.