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Summer 2016
Amplifying the voice of mental health
MOODS AND EMOTIONS 20
An Unquiet Mind:
a memoir of moods and madness
8 How Can We Use
Music To Handle Our Emotions?
29 HEALTHY USE
OF TECHNOLOGY AMONG YOUTH
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Emotions on the Go‌
Handling Difficult Emotions
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...Plus Our Regular Features 1 LOUDSPEAKER THE
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NIMHANS Centre for Well Being A Centre for Mental Health Promotion
#1/B, 9th main, 1st Phase, 1st Stage, BTM Layout, Bangalore– 76. Phone: 080-26685948 / 9480829670 email: nimhans.wellbeing@gmail.com www.facebook.com/nimhanscentreforwellbeing
Mental health for persons with medical illnesses Marital enrichment services Stress management Trauma recovery Brief psychotherapies & counseling services Enhancing positive mental health Family counselling Parents support group
Services Offered
Support in intimate partner violence Prevention & early treatment for addiction Enhancing parenting skills & child mental health Services for healthy use of technology Workshops & training programmes in mental health Elderly helpline & mental health helpline Youth well being
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Editor Dr. Prabha S. Chandra Professor of Psychiatry Coordinator NIMHANS Centre for Well Being
Editorial Team : (Left to Right) Meena K.S, Prasanthi Nattala, Manoj Chandran, Prabhu Dev, Padmavathy, Prabha S Chandra, & Taranum Taj
D
Editor’s Note
riving to work every morning on one of the busiest roads in Bangalore, I spend my time during the inordinate wait at signals, watching people’s emotions.
The annoyance in the driver behind me who honks even when one is at a red light, the smile on an auto driver’s face when he is having an interesting conversation with a customer, the surprisingly friendly banter between a transgender woman with bright red lipstick when she asks for money from a young man on a motorbike, the desperation of an elderly woman who sells jasmine flowers on the road and of course the occasional person who flies off the handle on the road, swearing at someone who overtook him. Emotions are all around us and often control the way we behave and respond to situations. Emotions and moods influence the atmosphere of our families and our work place in several different ways and are hence worthy of our attention. Emotions are also contagious and a smile can cascade into positive feelings of people around you while a frown can cause just the opposite. Most emotions are fleeting, like clouds, and pass on without lingering. However, sometimes emotions can remain as the predominant mood or they can get intense, causing distress to the person and the people around. It is these emotions that are worrying and need professional help. Many of us may not be aware of the nature of our feelings and find it hard to articulate them or even label them. In this issue, my efficient editorial team at Loudspeaker and the expert authors attempt to bring together various aspects of emotions . We address several aspects of moods, ranging from road rage to encouraging expression of feelings in children. We also discuss Bipolar Disorder, the extreme and sustained form of emotions becoming pathological and the role of music on our emotions. As the singer Manna Dey croons in the song from the film Anand Zindagi, Kaisi hai paheli haaye Kabhi to hansaaye Kabhi ye rulaaye (What a riddle this life is. Sometimes it makes us laugh and sometimes it makes us cry)
Sub Editors Dr. Prasanthi Nattala Associate Professor of Nursing NIMHANS
Dr. Meena K.S. Assistant Professor of Mental Health Education NIMHANS
Smt D. Padmavathy In-charge Staff Nurse NIMHANS Centre for Well Being
Editorial Board Mr. Manoj Chandran Mr. Prabhu Dev Ms. Tarannum Taj
Conceptualised and produced by NIMHANS Centre for Well Being Cover photos: Sunita Chakraborty Photo Credits:
So as we continue this journey that is life, we hope this issue of Loudspeaker will help you understand this riddle better, if not the solution to the riddle!
Printing of the Magazine funded by: Dr. Ramachandra N Moorthy Foundation for Mental Health and Neurological Sciences
National Institute of Mental THE Health & Neuro Sciences
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Contents
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Emotions On The Go… Fr. Rajeev Joseph Dr. Seema Mehrotra How to put a brake to negative emotions and enhance safety while on the road.
How Can We Use Music To Handle Our Emotions? Dr. Shantala Hegde
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“Without music, life would be a mistake” said the famous philosopher and composer, Friedrich Nietzsche.
What Is Bipolar Mood Disorder? Dr. Muralidharan. K Certain insights into Bipolar Mood Disorder, a serious, but treatable mental illness.
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14 Ageing And Elder Care: Making An Elderly Family Member Feel More Secure Dr. Santosh Loganathan How to make an elderly family member feel emotionally secure, particularly in these days when nuclear families are on the rise. How Can You Help Children To Express Their Emotions Better? Dr. Kavita Jangam Ms.Chaitra Holla Helping children to express their emotions, particularly as they are at a phase where they are very sensitive to the changes in their environment, and have an innate need to discuss what they observe around them.
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An Unquiet Mind: A Memoir Of Moods And Madness Mr. James Joseph Dr. Krishna Prasad M It indeed takes a great deal of courage to write about one’s own illness, and Kay Redfield Jamison, Professor of Psychiatry at Johns Hopkins School of Medicine does not have any less in measure.
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26 I Feel Like An Outsider - How Persons With Schizophrenia Can Understand Other People And Communicate Better Dr. Urvakhsh M. Mehta How to improve social interactions individuals with schizophrenia.
among
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22 Managing Emotions In The Workplace Dr. Paulomi M Sudhir Ms. Janhavi Devdutt Recognizing the importance of emotions and their role in workplace interactions.
Healthy Use Of Technology Among Youth Dr. Manoj Kumar Sharma Promoting healthy use of technology among the youth, especially during this era when the internet has revolutionised how we communicate, and has opened up entirely new forms of social interaction.
Emotions And Eating: Feeding Your Feelings! Dr. Preethi Sinha
Handling Difficult Emotions
How to ensure that negative emotions do not promote unhealthy eating.
Gretchen Rubin, chronicled her one-year search for the secrets of happiness in her bestselling book
Dr. Poornima Bhola
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Emotions on the Go‌ Roads tell us the stories of the joys of travel as well as our frustrations. Many of us spend about an hour or more of our wakeful time on the road on a regular day. There are so many different emotions that we frequently experience while on road, as a driver, a cotraveler, a passenger in a cab, or a pedestrian. These emotions come from what may be happening off the roads in our life as well as what happens on the roads. Have you noticed that there are times when we may take out our vehicle in order to experience an emotion or a mental state (e.g. excitement, a sense of control/freedom) or to get relief from an unwanted emotional state (e.g. boredom, anger, helplessness)? Some also report speeding up in order to get relief from negative moods. Such experiences remind us about our vulnerabilities on the roads and caution us about the need to apply the brake on emotions and the associated risky behaviours at the right time. They remind us about the thin line between narrow escape and fatal error. There are multiple triggers on the roads that are potentially bothersome. It is true that there are
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a number of external reasons for the negative emotions we experience: the unrelenting traffic, the bad road, the vehicles spitting thick black smoke and the blinding dust, the erring drivers and the incessant honking. Some of these can be altered by judicious and committed actions of the government and the citizens, but there are those little things that we can do as individuals too, which can make a difference. For instance, when we are feeling sad or fatigued, slower reflexes may hinder quick responding. It may be useful to use our own uplifters/energizers such as talking to a supportive buddy, or a taking a power nap, before starting on a drive. At other times, we may be in the amber zone of emotions (e.g. feeling a little too excited or anxious) that makes it difficult for us to focus. Reminding ourselves to slow down and focus on the task at hand may be useful. The red zone of emotions (e.g. feeling angry) is clearly a signal to take a brief pause to cool down. Taking a few deep breaths, listening to soothing music/ humming and calming self-talk like “Let me put it on hold� might help. Our ability to manage our
own emotions wisely is sometimes really tested due to challenging road situations. Our response to such frustrations may at least partly reflect how we respond to challenges in life, in general. The other way of looking at our road experiences and behaviours would be to see the emotional triggers on the road as opportunities for us to learn, practice and strengthen certain skills. Oh no, no… we do not mean stunts, weaving/zigzagging skills or getting into racing competitions (for these, it is wiser to join a rider’s club)! We mean practising the art of staying patient, staying as calm as possible and responding intelligently rather than reacting impulsively to provocations. It means learning to tell ourselves that ‘I am not going to let others or the road situations provoke me into driving irresponsibly’. So, it is about ensuring that it is we who are driving our vehicle, and not our emotions taking us for a ride. Roads also give us enough opportunity to notice and appreciate the goodness of others, even if you think that we have to look really hard and long for that! Have you heard some of these uplifting stories: the
truck driver who stopped (despite all the honking and the protest behind him) and gave time to an old man to cross the road in the midst of torrential rains on a narrow lane… or a pillion rider who got down from the bike while waiting for red light to turn green and lifted a huge piece of stone and kept it away to avert a road accident… or the good Samaritan who turned into a traffic-manager for thirty minutes in the scorching sun to clear the maddening traffic-jam on a super-busy junction with no traffic police? Can we offer such small acts of kindness and courtesy forward and create a ripple effect? Be Kool and Ride Kool!..
Dr. Seema Mehrotra Professor Department of Clinical Psychology NIMHANS, Bengaluru
Fr. Rajeev Joseph Clinical Psychologist St. Joseph’s Hospital Registrar, Jothirbhavan Institute of Theology & Spirituality Kochi, Kerala
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How Can We Use Music To Handle Our Emotions? A narration by Mrs. Sangeetha “Without music, life would be a mistake� said the famous philosopher and composer, Friedrich Nietzsche. This is completely true in my case, having completed more than five and a half decades of my life. As a widow and mother of two children, my life was completely busy until my children decided to move away from home in search of better career opportunities. The sudden emptiness and sorrow that followed was immense, and it was my interest in music that helped me come to terms with this change. I started listening to my old music collection of film songs and classical music. I started listening to music regularly, and I would keep the music player on while I was carrying out all the household chores. This way, I could focus my mind on the melody of music, and also keep myself away from the boring saga of mega serials on the television which only enhanced negative emotions. I even dusted my old musical instrument, the veena, and started playing some basic lessons I had learnt in my childhood.
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This brought back my old childhood memories, and I felt like a young student. There was a new goal and meaning in my life. Music not only evaded the feelings of emptiness but made a lot of positive changes in my life. Myriad benefits of music An entertainment... Music, at its very fundamental level, provides entertainment. Self preferred music can be one’s best companion whilst doing routine household chores, such as cleaning, washing and cooking, and while travelling. This will also keep our mind engaged. We often learn new songs and lyrics while humming along. This engages our ability to memorize new things. An even rhythm in music entrains us as well as entrains our inherent biological rhythm. When we walk or talk there is an inherent rhythm in it. Rhythm, which is a key component of music, can impact our heart rate and thereby our arousability.
A method to revitalise... Music has the power to revitalise our mood. Listening to self chosen music in the morning hours and relaxing music that has calming effect in evening can help us energise and calm down during dawn and dusk, respectively. Listening to a slow to medium paced rhythmic music can be a good companion during morning or evening walk. Slow paced instrumental music can facilitate good sleep as soothing music has an impact on our brain electrical and chemical activity. A stress buster... Music can be a good method to distract from unwanted thoughts and even physical sensations such as nagging pain which responds poorly to medication. Actively and passively engaging in music is known to release natural pain killers known as endorphins. Listening to music also lowers the levels of stress hormones known as cortisol. Facilitates emotional catharsis... Music chosen to match our present emotional state can help us to vent out the emotion (emotional catharsis). Thoughts and feelings that we find difficult to express through words can be expressed or experienced via music. Music can also enhance our capacity to empathise with the emotions of others. Juggles up past memories... Music can juggle up past memories or shared emotions with family, friends and loved ones. Dwelling in the past and remembering the past is one of the methods of introspection. Music therefore not only engages mental processes but also
engages emotional components attached with the past memories. Often this brings solace. A brain gym... Actively engaging in music, such as singing or playing an instrument, gives a strong sensation of thrill or feelings of accomplishment. It activates strong emotions. Apart from providing deep sensations, actively engaging in music involves a host of cognitive, emotional and motor processes which are important in maintaining our overall mental fitness.
The beauty of using music is that it can help us achieve more than one of the above mentioned domains at any given point in time. Self preferred music can entertain, revitalise, distract from unwanted thoughts, relax and activate a range of mental processes at one go. Indulging in music will surely have greater impact when compared to passive listening. Age is not a barrier and becoming a professional musician need not be everybody’s
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goal. But learning some form of music can be part of everybody’s routine. Music is considered as the best exercise to keep our brain, our mental and emotional processes, fit. A few take home messages.. • Music engages many mental processes. • Familiar music is good, but music that is unfamiliar may also have positive impact. Various features of music such as volume, density of notes, rhythm, timbre, minor or major notes etc. have strong effect on our musical experience. • Actively engaging in music is always superior to passively engaging in music. • There is no age limit to learning anything new, including music.
Dr. Shantala Hegde Assistant Professor Department of Clinical Psychology NIMHANS, Bengaluru
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What is bipolar mood disorder? Bipolar Disorder or mood disorder is a serious but treatable mental illness that influences the mood states of a person in an unusual way. Bipolar Disorder (BD) is characterized by two phases, namely: the “Up” Phase or manic episode and the “Down” Phase or depressive episode. Persons with BD could experience these episodes or phases in an alternating manner and often have normal mood in between them. The up feeling or the mania, lasts for more than a week. The down feeling or the depression usually lasts for more than two weeks. How is bipolar disorder (BD) different from the normal everyday ups and downs that we experience? BD is different from the normal mood swings: the
ups and downs that people go through, often in relation to the environment. Bipolar symptoms are more powerful than that. They can negatively affect relationships and make it hard to attend school or work. They can also be dangerous as people with BD may try to hurt themselves/attempt suicide. It is extremely important to be aware of these symptoms in order to seek help for oneself or others immediately. What are the symptoms of bipolar disorder? Symptoms of a manic episode are: • A long period of feeling “high” or extremely happy, or feeling extremely irritable and angry, lasting more than a week •
Feeling more energetic or powerful, often involving oneself in many activities and not completing most of them
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Being easily distracted
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Having racing thoughts
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Sleeping less than usual but still feeling refreshed
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Having unrealistic belief in one’s own abilities or identity
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Behaving impulsively and taking part in pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and gambling which is unusual for the person
Symptoms of a depressive episode are: • A long period of feeling sad or “low” most of the time, often crying without any apparent reason, lasting for more than two weeks •
Feeling tired or slowed down, less energetic than usual
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Loss of interest in activities which were enjoyable before, including sex
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Having problems concentrating
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Loss of self-confidence
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Negative thoughts like one’s future looking bleak and that one has become a burden to others
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Thoughts about death and bereavement
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Suicidal thoughts/attempts
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Decreased sleep and appetite, sometimes with weight loss
Who develops bipolar disorder? What causes bipolar disorder? Anyone can develop bipolar disorder. It is equally common in males and females. It usually starts in the early twenties, but can also affect children and elderly. In some women, it can occur during pregnancy or after delivery. Once diagnosed, it is a lifelong illness, although it can be controlled effectively with treatment. The exact cause is not known but research into the
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causes of bipolar disorder is ongoing. Sometimes bipolar disorder runs in families (genetic cause), though it may not affect all family members. Abnormal brain structure has also been associated with bipolar disorder. How is bipolar disorder diagnosed? The diagnosis of bipolar disorder should be made by a psychiatrist or a mental health professional. The diagnosis is made after a careful psychiatric and medical evaluation. Some investigations are advised to rule out common medical problems, like thyroid disorders, anaemia, diabetes and brain disorders. There is no laboratory test to diagnose bipolar disorder. It is often not easy to diagnose bipolar disorder as it co-exists with other conditions like attention-deficit hyperactivity disorder, alcohol or drug abuse and some neurological/endocrine disorders, to name a few. Consultation with a doctor is a must to diagnose this condition. Self-diagnosis is best avoided. It is important to consult an expert immediately if you or someone known to you has symptoms of bipolar disorder.
What is the treatment for bipolar disorder? There is no cure for bipolar disorder. However, it can be treated effectively and kept under control like other medical disorders like diabetes and hypertension. For severely ill patients, admission to the hospital may be necessary. All patients will require treatment with medications and/or psychotherapy. Antipsychotics and mood stabilizers are the commonly prescribed medications. Some patients may in addition require medications for sleep. Patients should take medications regularly and attend follow-up, as prescribed by the treating doctor, to keep the disorder under control. The doctor will monitor patients for common side effects of the prescribed medications. Some patients, particularly in the acute phase, may require treatment with Electro Convulsive Therapy, commonly referred to as ‘shock therapy’ in lay terms. Psychotherapy/counselling is prescribed in addition to medications. This is usually for patients who are having depression or who have difficulties in social/ occupational functioning. Any co-existing medical conditions, like thyroid disorders, would require appropriate treatment. It is important to seek treatment early for the disorder to be controlled more effectively.
Where can one get treatment for bipolar disorder? Treatment for bipolar disorder is provided by all hospitals with a specialist psychiatrist. NIMHANS provides treatment for at least 2000 new patients with bipolar disorder each year. Consultation at the earliest is best for any patient with bipolar disorder.
Dr. Muralidharan K Additional Professor of Psychiatry Department of Psychiatry NIMHANS, Bengaluru
Of Loss, Coping and Surviving Life is filled with so many emotions - Happiness, sadness, love, hate, tears, laughter and many more. Emotions are the innate feelings of an individual and words can never fully express how much someone means to us. Language and verbal expression may however provide comfort, solace, hope and even inspiration following the death of a loved one. All of us have emotional vulnerabilities that can drive our behaviour for better or worse. Each of us as individuals have our unique experiences and each of us may react differently according to the circumstances we face. Few years ago, I had a precious loss “My Mother”. This was also a time when I was at the critical juncture in my career. Losing the person I loved and admired the most had me totally shattered. There was a block in my thought and I didn’t know how and what to express. My surroundings were loud but I couldn’t hear anything. Despite the huge loss, I always felt her presence. Indirectly her thoughts would strengthen my will power. She taught me many beautiful lessons but nothing that could help me handle this most challenging time and accept new changes without her. However, one realizes that life doesn’t stop, whatever happens. I still carry within my heart a dull and lasting ache where once I felt love and security. I also realize that it is important to continue my search for the happiness the way my mother always desired. Ms. Taranum Taj, Assistant Coordinator, NIMHANS Centre for Well Being.
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Aging and Elder Care: Making an elderly family member feel more secure In this rapidly changing society, the traditional joint family system is paving the way for nuclear families. As a result, the support base for the elderly is gradually eroding. Aging family members can often become lonely and socially isolated. Loneliness can be compounded by medical problems, death of dear ones, family disputes, etc. However, there are families where the elderly continue to live with their children and grandchildren. Caring for an older person at home can be challenging, but can also be a very rewarding experience. Here are a few tips that you can follow to help your aged family member feel secure: • Listen: With age, the hearing and seeing ability of the elderly decline. They cannot often hear what is being said, so one may have to repeat what he or she has to say. Be patient, allow them time to express their thoughts, move close to them and speak clearly. Spend some time to understand what they are saying and feel genuinely involved. One needs to be patient as their responses and reactions may have slowed with age.
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Observe if they are able to see things clearly while they move about. Help them see a doctor for their vision or hearing issues. • Daily routine and activities: Make sure they have a routine for themselves despite all the others in the family being busy. This could involve some activities which they love doing. If one insists that they want to continue an activity every day, for example visiting a friend, try and arrange it, as it may be something that your loved one really enjoys. Discuss with them what other activities they may want to do – it could depend on their interests such as reading, gardening, watching their favourite television show, having a cup of coffee with friends, a walk in the park, spending time with grandchildren and so on. Sometimes they may want to get back to their interests they had years ago such as writing or poetry etc., but could not find the time to do it then. Facilitate these interests to the maximum extent possible, as it may really improve your loved one’s well being.
• Social support and socialisation: Talk to the older adults and keep them informed about your life as well. Try to have joint family activities now and then; it could be a visit to a relative’s place, or attending a family wedding, going out for lunch or dinner, going to a place of worship, or maybe taking them to their favourite movie or play. See if you can arrange for meetings with some of his / her old friends to cheer them up or have your relatives come over for lunch/ dinner and to spend time with them. Accompany your loved one to his/her doctor and discuss his / her health. Caring for an ageing person requires financial support as well. Offer support- it may include offering to pay bills, clearing loans, providing with medical costs and support for daily expenses. Elderly family members may resist taking your help. Speak to them, reassure them and explain why you want to help them. • Travel: Take time off from your own busy schedule to relax and unwind. Once in a way take your elderly family member to his / her favorite tourist destination. Make it a family affair or involve his/ her close friends. Be sure to ask them if they plan a religious pilgrimage
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grandchildren; this may often create a generation gap and loss of communication. Let that not stop your children from bonding with them. Create a common activity where both children and grandparents spend time and enjoy- it could be watching a TV show, playing a family game, a visit to the park, etc. Children can learn a lot from the wisdom of their grandparents. • Techno savvy elder: Have a computer or a phone with internet at home which your loved one can use during leisure. Help them have an e-mail account and link up with relatives and friends. Include him/ her in your family’s Facebook or WhatsApp account. Some of your old parents may have never used the internet. Teach them to use the internet and browse. If you have relatives or friends in other cities or countries, help them have video conversations with them.
or they would want a more relaxing holiday. Travelling can brighten their spirits and make them feel more connected with the family. • Bridging generation gap: Ageing family members usually love spending time with grandchildren. However, they may not be agile in supervising and caring for
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Remember that elderly are like children. When they receive support and encouragement for their efforts it helps them feel more positive about themselves.
Surprise them on their birthdays and anniversaries. Make them feel loved and cared. Help them to age beautifully!
Dr. Santosh Loganathan Associate professor Department of Psychiatry, NIMHANS
How can you help children to express their emotions better?
5 year old Anu discussing with her mother… Anu: Mummy, you know today two times I cried in class. Mom: Why dear.. Anu: I don’t like Ishant. He is very bad and I am very angry with him. Mom: What made you to get angry at him? Anu: He did not play with me today. Children are very sensitive to the changes occurring in their environment and they have innate need for discussing and informing whatever they observe. Moreover, children can be overwhelmed by their emotions related to these environmental changes. Children have similar emotions as adults. As the children find it difficult to verbalize more about the
incidents, they tend to express it with the help of their emotions. On the whole, children can be quite expressive and are often able to express their emotions honestly in various situations. “I am angry with my classmate” “I feel uncomfortable with someone” “I am scared that you will leave me” “I am upset you are ignoring me” “I am very happy for the doll that you got for me” This giant wheel is Soooo big giant . I am surprised” “I am confused about what happened to that old grandpa” Children have a natural tendency for expressing their emotions and adults can help them to express themselves in a much better way.
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“I think you are ANGRY with your friend for not playing with you” “Are you SURPRISED about it?” “Are you SCARED of going to that place?” “I know it can be DISAPPOINTING, if you don’t win the competition” These kinds of reflections by adults will help their children to understand what exactly they are feeling and how to name the emotions. Reading books to children also helps them understand and recognize their emotions better. At the same time, asking children to reflect on their daily experiences would help them in expressing their feelings. Regular discussions: Spend quality time with your child and discuss what happened in his/her school. When you ask the child, how was your day at the school, they get encouraged to express about the events and how they felt about it. Adults can just listen to them and observe their emotions without judging them. Parents can also help the children to clarify the reasons as to what made them experience a particular emotion, and so on. These regular discussions not only help the children to express their emotions and opinions but also helps in introspecting about their own behaviours. Use of media:
Recognizing and acknowledging emotions: Help children recognize and name their emotions. For this, adults must acknowledge their child’s emotions. Whenever a child is finding it difficult to verbalize how they are feeling, adults can name their expressions and emotions.
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Drawing by a child who experienced abuse Sometimes children find it difficult to discuss their concerns with adults. There are many reasons why
children are unable to do so. It can be their fears, hesitation, anger, or lack of language abilities. Under such circumstances, medium such as storytelling, play, facial expressions, drawing and colouring, and writing journals can be used to help children express their emotions. Use of such media helps children to open up much faster and express their emotions without fear of being judged. These medium are very useful in certain conditions where the child has been traumatized, confused and fearful due to any incident such as abuse, mishap, or loss. Helping children to manage their emotions: Sometimes, children express their emotions in ways that are problematic, e.g. throwing things when demands are not met or crying when frustrated. Children learn to manage their emotions by observing adults. Thus, adults can be good role models for children in terms of demonstrating how negative emotions such as anger, disappointment, frustration and fear can be handled. Discuss and demonstrate healthy alternatives for managing emotions in difficult situations. Father: Today I had a very bad day.
Adults can use various strategies to help children express their emotions in an appropriate manner. Spending quality time with children, providing attention to the child’s feelings and emotions, and listening to them non-judgmentally, encourages them to express and handle emotions better.
Child: What happened Papa? Father: I lost my wallet while walking on the street. I was so angry. Child: So what did you do? Father: I was angry, but then I calmed myself down, took a deep breath and felt relaxed. Then I called my friend who helped me to get back home.
Ms. Chaitra Holla Psychiatric Social Worker Dept. of Psychiatric Social Work NIMHANS.
Dr. Kavita Jangam Assistant Professor Dept. of Psychiatric Social Work NIMHANS.
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An Unquiet Mind: a memoir of moods and madness Kay Redfield Jamison Vintage Books, A division of Random house Inc, New York With a new preface, 2011 (first Vintage Books edition 1996) ISBN: 9780679763307 Pages: 224 Price: U.S. $15.95 It indeed takes a great deal of courage to write about one’s own illness, and Kay Redfield Jamison, Professor of Psychiatry at Johns Hopkins School of Medicine does not have any less in measure. She describes in this memoir her journey of recovery in her personal battle with manic depressive illness. Therefore, what is striking about this unique description of recovery is that this is by a mental health professional. The book raises several pertinent questions including whether people with mental illness should write at all about their illness; she though “writes from her heart” as “she ratchets up the stakes by a notch or two”. The reaction
to her work was in her own words in both predictable and not so predictable ways. The book is divided into four parts; The Wild Blue Yonder begins with the story of how an air-force pilot sacrifices his own life to save the lives of children that includes the young Kay in a playground. From then on she never saw the sky for its vastness or beauty but rather as a stark reminder of the imminence of death. The daughter of a meteorologist father from whom she inherits the genes for manic depressive illness wants to take up a career in medicine as she volunteers for a candy striper or nurse’s aide. The travails of the illness in adolescence alter the trajectory as she goes on to pursue a career in Psychology. Even as she has become a
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faculty she has little insight into her own condition and “within three months of becoming a professor she is ravingly psychotic.” A Not So Fine Madness is all about her flights of the mind into mania and plunges into depression as she misses the “rings of Saturn”. In mania, the ideas and feelings are fast and frequent like shooting stars, shyness goes, the right words and gestures are suddenly there, sensuality is pervasive as she gradually becomes irritable, angry frightened and finally there are only other’s recollections of her behaviour with a bitter aftermath to deal including bounced checks, lost friendships and ruined marriages. Then there is the phase when “she is just like the rest of us”. This part also details her long and lacerating black suicidal depression. The reluctance to graciously accept Lithium reaps her bitter harvest. Surprisingly, being a Psychologist by training she appears to be a strong proponent of biological psychiatry emphasising the unique place of Lithium in managing manic depressive illness. Lithium prevents her disastrous highs, diminishes depression, clears out the wool..., slows her down, gentles her out and makes psychotherapy possible but ineffably psychotherapy heals. This part concludes with her tenuring into Associate Professordom. The third part – This Medicine, Love begins with her engaging relationship to an Army Psychiatrist, David Laurie. His tragic death in Kathmandu brings a closure to this relationship. The chapter describes her grief, the people who helped her in the grieving process. This is the period in her life wherein after the initial reluctance to accept treatment she had begun to realise the benefits of taking lithium; as her lithium levels are optimised, she becomes more productive contributing many chapters in an authoritative textbook on manic depressive illness, of which she is the Co-Editor with Frederick Goodwin. In The Unquiet Mind she argues that the term “Manic Depressive illness” best captures the disorder it represents, rather than the increasingly popular bipolar disorder as she goes on to state her illness in DSM-IV diagnostic terms. Her mantra for doing away with stigma is not just to deal with semantics such as madness or crazy, but rather more tellingly with successful treatment, advocacy and legislation. Her interesting and easy encounters with Nobel Laureate Dr. Watson of the double helix DNA fame, and the famous Danish Psychiatrist Mogens Schou (whom we learn has a family history of manic depressive
illness) provide insights into the biological and genetic research for this highly heritable disorder. This last part also raises another important question of whether people with mental illness can treat other people with mental illness. There are no easy answers though. She succinctly puts it across “the privilege to practice is exactly that, a privilege it is, not a right”. The author also touches upon the sensitive issues of gender inequality and the status of non medical professionals in the realm of clinical psychiatry as she leads the affective disorders clinic and stands up to these. The “Oysters” and “Mouse-hearts” of the world are disappointing but they are a harsh reality. What is also real is the presence of insensitive physicians like the one who tells her “You shouldn’t have children. You have manic depressive illness”. In contrast, it is also reassuring and real that she found warmth in her family, support from her friends, colleagues and acceptance from lovers. The book is an easy read not only for professionals but lay-readers too. For the student of literature there is vivid prose and sheer poetry, for the sophomore of phenomenology there is excellent clinical description of mania, depression, cauldronous mixed states and also grief, for those interested in psychopharmacology there is all about lithium including the rare side effects such as on accommodation of the eye, but the memoir has strikingly little about what she underwent as psychotherapy. Finally and most importantly, in this deeply human endeavour there is a lot to learn about personal elements of recovery. Reviewed by: James Joseph, Krishna Prasad M. Psychiatric Rehabilitation Services NIMHANS, Bengaluru
Mr. James Joseph Psychiatric Rehabilitation Services NIMHANS, Bengaluru
Dr. Krishna Prasad M Associate Professor Psychiatric Rehabilitation Services NIMHANS, Bengaluru
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Managing Emotions in the Workplace Emotions, simply stated, is your ‘energy in motion’. It is a mental state accompanied by a range of bodily changes, expressions and actions. As emotions are an integral part of human nature and lives , it important to manage them effectively. Emotion regulation is a process that involves recognising and modifying emotions, and the experience and expression associated with them. Effective application of emotion regulation skills contributes to effective interpersonal interactions and better mental health. People spend a large part of their time at work. Thus, researchers have come to recognise the importance of emotions and their role in workplace interactions. Workplace behaviours and overall health of the organisation are influenced by the emotions experienced by employees. Effective emotion regulation helps alleviate stress, contributes to workplace competence, enhances employee motivation, reduces conflicts and improves health and productivity of the organisation. In addition to day-to-day events at work, some jobs place greater
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demand on an individual’s emotion regulation skills – both in terms of stressful workplace conditions (e.g. policemen) as well as part of the job profile (e.g. service industries like hotels, hospitals.). Emotions in workplace include: • emotional labour (efforts to portray emotion expressions that are not authentic, but guided by the display rules of the organisation during interaction with customers), • emotional work (genuine emotion in interaction with customers), • emotion - with - work (emotion stemming from interactions with coworkers),
• emotion - at - work (emotion from non-work sources experienced in the workplace), • emotions toward work itself (where work is the target of the feeling). Frequent experience of negative emotions (anger, frustration, uncertainty, humiliation and anxiety) without appropriate expression has been linked to multiple indices of physical health and poorer psychological well being. The experience of emotion is often due to the interpretation of the situation and its meaning. The same situation may give rise to different emotions in different people. The difference lies in the appraisal of the situation. Modifying the way we think about a particular situation can help modify the experience of the resulting emotions. Or one may change the outward expression of an emotion after it has been experienced (smiling at a rude customer, even when we feel angry with him/her). With greater emphasis on team work, interpersonal aspects of emotion regulation cannot be ignored. Other ways of managing emotions include situation selection i.e. increasing or decreasing our chances of being in a situation that will give rise to the emotions we would not like to have or want to avoid (e.g. postpone meeting a volatile boss if he/she is already in a bad mood); situation modification i.e. modifying the situation directly so as to alter its emotional impact (e.g. using humour to diffuse a potentially tense situation) and distraction i.e. focusing attention away from emotional aspects of the situation. We could also learn ways that could potentially reduce the intensity of our emotional responses- for example using relaxation to bring down anxiety. Positive Emotions and the Workplace Positive emotions help people consider more creative, expansive ideas, actions, and solutions. When employees experience positive events at work, they are also likely to have better social
relationships, thereby reducing stress, with greater work engagement and psychological well being. Factors Increasing Risk of Negative Emotions Experience of stressful life events or challenges, work-life conflicts, harassment presenteeism (being at work despite a sickness that justifies absence, consequently, work performance is under suboptimal conditions) are some factors that increase risk of experiencing difficult emotions at the workplace. Role of organisations Attending to employee emotions, considering emotional costs and benefits of their decisions, helping them resolve their issues will go a long way in having a happier and more productive workforce. Identifying triggers for negative emotions, training managers in positive management behaviour, communication skills and conflict management is important to develop a healthy emotional climate at the workplace. Emotions are intricately woven into the fabric of workplace experiences and determine the quality of our relationships. Thus, effective management of emotions at the workplace is an important step towards better mental health.
Dr. Paulomi M Sudhir Additional Professor Department of Clinical Psychology NIMHANS, Bengaluru
Ms. Janhavi Devdutt PhD Scholar Department of Clinical Psychology NIMHANS, Bengaluru
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Emotions and eating: feeding your feelings! How many of you turn to “food” when you are stressed, lonely, upset, angry, or happy? Does food act as your acts as your emotional support, during hard times and participate in your joys and sorrows? In other words, is food your ‘best friend?’ If the answer is ‘yes’ for yourself or someone you know, then you should continue reading. Although hunger is a life instinct, there is a deep relationship between eating and emotions. What we eat and how much we eat are influenced by our mood. The problem arises when the eating is only or majorly influenced by our emotions and feelings. You are not then feeding yourself but feeding your feelings and emotions! This can be quite detrimental as you just stuff yourself superfluously and with unhealthy food. The longer it continues, more is the unnecessary weight gain and physical problems. It also brings shame and guilt, which further add to the stress. Do you need to wait till this juncture to understand that feeding your feelings is not good and food in this way can’t be your friend? Let us talk about how to identify that eating and emotions are going on the same track. 1. Do you eat whenever your mood is not in the usual mode; may be when you’re upset, lonely, angry, or happy? 2. Was it difficult to handle these situations when you couldn’t eat for any reason? 3. Do you feel powerless in front of food?
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4. Do you often eat up to the brim even if that was not your intention? And does it trigger a feeling of guilt? 5. Do you suddenly feel hungry often and crave for a particular food item, at times, even when you have had a recent meal?
If it is “yes”” to any of these questions or if the doctor has advised you to change your food-habits but you aren’t able to do so, it means you need to deeply analyse your eating behaviour. Maintain a food and mood diary and see how many times you answer “YES” to these questions. Once you have recognised that your eating and emotions are entangled together, then please don’t get upset. You have already made the first step as you know what the problem is. There are broadly four steps to be followed to handle this: 1.
When you proceed to food i. Ask yourself whether you are really hungry or is it a craving for specific type of food. ii. Check your feelings and what precipitated them.
2.
Deal with the feelings-emotions through activities other than eating: i. Take 4-5 deep breaths/ practice Yoga. ii. Go for a walk/ play sport/ exercise. iii. Read something of your interest/ listen to music (these materials should be readily available to you). iv. Write a journal on your feelings. v. Talk to your friend or relative/ spend time with your pets.
3.
Stay away from food in these situations: i. Say to yourself • A big “No” and “ Stop” • Your goal and what to do if it is not achieved ii. Prefer- “I CHOOSE TO EAT HEALTHY FOOD” rather than “I have to eat healthy food”
4.
Change the behaviour and attitude towards eating: i. Perform a small ritual before eating, such as expressing the meaning of food to the life and gratitude to all who bring this healthy food to you ii. Sit while eating. Don’t engage in other activities while eating. iii. Restrict eating to Eat 3-5 small meals a day
However, remember that it’s quite okay to break the rules once in 5-7 days! The problem could be in any of the above steps, which you find difficult to resolve on your own. However, the consequences would be the sameweight gain and feelings of shame and guilt. If this happens, YOU SHOULD MEET A HEALTH PROFESSIONAL WHO CAN HELP YOU AT THE EARLIEST. YOU CAN CLIMB TO THE TOP, YOU JUST NEED A LADDER.
vi. Take a hot bath or shower. Dr. Preethi Sinha Assistant Professor Department of Psychiatry NIMHANS, Bengaluru
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I feel like an outsider - How persons with schizophrenia can understand other people and communicate better Suresh’s family was excited for him as he began his engineering degree – his long cherished dream. Soon his parents noticed that he spoke less and seemed worried. They thought he was taking time to adjust to the new environment. Within a week they got a call from his friends that Suresh was disturbed, and had grown extremely suspicious about his teachers. After consultation with a psychiatrist they learnt that Suresh had been hearing voices of strangers conspiring against him, and this was when they also learnt about his diagnosis – schizophrenia. After learning more about the illness, his parents recalled how Suresh, now 20 years old, was behaving differently in the last 1-2 years. He had nearly stopped meeting his friends, got into frequent arguments with his parents, had struggled to cope
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with his studies, often blaming and suspecting his friends and teachers for his problems. Suresh later confided that over the last year or so he had been hearing voices of strangers that had increased over the last couple of weeks. Individuals with schizophrenia have difficulties in understanding how other people think (perspective taking), recognising emotions correctly, and communicating adequately and appropriately with them. These ‘social cognition’ deficits may co-occur with problems in general cognition like concentration, memory, reasoning and planning. More often than not, they precede the more dramatic symptoms of hallucinations and delusions, and persist even after. These are often unrecognized and may
contribute to formation of delusions. For example, one may misinterpret actions or emotions in others and conclude wrongly that he or she is in danger. The inability to see alternative perspectives and correct these misinterpretations could then lead to a delusion. Understandably, the worlds of these individuals grow smaller as time passes, making them feel like outsiders even at home.
like badminton, football or basketball, can also be an easy and fun-filled substitute for such exercises. Just like physical exercises build our muscles, brain exercises can sharpen our cognition. These may range from reading for a course and writing an exam, to more specific tasks like solving puzzles, crosswords, Sudoku, mathematical problems or playing games like scrabble. It’s not without a reason that the ageold saying goes “use it or lose it�! Once we have our general cognition honed, social understanding and communication can be enriched using the SMART strategy. Of course, a doctor will be able to tell us where can one get more help in this regard. Prerequisites to apply this strategy include an opportunity to socialize and have fulfilling family relationships, as well as the drive or motivation to engage in these situations.
Schizophrenia is a brain disorder that occurs due to subtle changes in brain functions of thinking and feeling. It often begins during adolescence and has genetic underpinnings. While medications are an important component of treatment, especially for the delusions and hallucinations, there are certain other exercises and strategies that can be used to overcome the more difficult social and general cognitive deficits in schizophrenia. These strategies work on the premise that the human brain is malleable and changeable, being able to unlearn and relearn specific behaviours over a period of time.
The first step in SMART is Seeing Emotions. Identifying our own emotional state requires us to reflect upon our mood in a given situation and be aware of physical signs of different emotions (e.g., pounding heart and sweating can happen when we are very worried or very excited, while sadness manifests as low tone of speech and slow actions). Recognising our own emotions helps us identify emotions in others. Paying attention to facial (eyes, mouth and eyebrows) and vocal (tone of speech) cues is particularly helpful.
A social interaction is an inter-personal exchange that occurs between two or more individuals. It includes an exchange of emotions, thoughts, words and actions. Understanding social situations is a first step in ensuring proper communication, and this requires both general and social cognition. Researchers have found that aerobic exercises like cycling, swimming and running, not only increase the size of important brain structures like the hippocampus (responsible for memory), but also improve memory and concentration. Playing a sport
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Next, we need to have Mind Awareness. As with emotions, this begins with being aware of our own mind (i.e., our thoughts, intentions and judgements, examining the pros and cons of our decisions). This strategy will also help us understand thoughts and intentions in others. A useful way of doing this is by asking yourself, “What would I do/think in this situation if I were in his/her place?” This approach would go a long way in taking perspectives of the other person in order to understand him/her better and avoid misunderstanding. Not jumping to any conclusions and having a flexible mindset is another useful tactic.
appropriate responses and again obtaining feedback from others.
The next step is that of an Appropriate Response. Understanding emotions and thoughts guides our response in words or actions. A planned, reflective response is likely to be more useful in conveying what you want, than a spontaneous, reflexive response. It is a good practice to be aware of our strengths (e.g., fluent speech, expressive body language and good eye contact) and weaknesses, while communicating during social interactions. Often these are obtained from feedback that others give us (see below). Weaknesses can be rectified or learnt by observing someone whom you admire, imitating and practicing
Finally, visiting the doctor regularly, voicing your concerns – psychological or physical, illness related or medication related, personal or family related, and taking the prescribed medications, goes a long way in preventing the more disturbing delusions and hallucinations, which if recur, can worsen the cognitive deficits.
Lastly, being Thoughtful or meta-cognitive about the entire interactive process and its outcome gives us an opportunity to alter our responses according to the situation. Meta-cognition, in simple terms refers to the process of thinking about thinking. In this context, it applies to being thoughtful about our own as well as others’ emotions, thoughts, words and actions. This skill provides us the feedback to modulate our responses on a time-to-time basis, depending on changing social scenarios.
Dr. Urvakhsh M. Mehta Assistant Professor Department of Psychiatry, NIMHANS, Bengaluru
ALCOHOL IS NOT THE ANSWER TO LIFE’S PROBLEMS One notion that seems to prevail in the society – to some extent propagated by the media – is that using alcohol helps to relax or deal with stress. Several individuals who use alcohol blame family issues or other problems for their drinking. But fact is that problems exist for alcohol users and non-users alike. The difference lies in the way the problems are handled. For instance, a non-alcohol user would deal with stress or problems by seeking advice from family members/ well-wishers, or just waiting for time to resolve things, if nothing is working. But among alcohol users, the tendency may be to reach for a drink. However, alcohol does not solve problems, it compounds them, besides adversely affecting one’s health. It is not life circumstances that cause a person to use alcohol; rather, the circumstances may just maintain alcohol use in certain individuals, who get used to using it as a way of coping, over a period of time. The principle here is to break the link between everyday stresses and alcohol use, and gradually learn to deal with problems/stress the way a non-alcohol user would. -- Dr. Prasanthi Nattala, Associate Professor, Dept. of Nursing, NIMHANS
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Healthy Use of Technology among Youth With the advancement of technologies, the Internet has revolutionised how we communicate and its flow has enabled and opened up entirely new forms of social interaction, activities, and organization, with its widespread usability and access. The emergence of social networking websites such as Facebook®, Twitter® and Orkut®, have not only made it possible to find existing acquaintances via net and renew communication but also have created newer patterns of socialisation and interaction in the virtual world. Thus the metaphor “global village” is often used to describe how the Internet has shortened distances between people and facilitated the flow of information. According to the Pew Internet Study 2013, 92% of Internet users say the Internet is a good place for getting everyday information, 85% say the Internet is a good way to communicate or interact with others. 75% say the Internet is a good place to conduct everyday transactions, 69% say the Internet is a good way to entertain themselves in everyday life. Life has become easier with 3 characteristics of technology: 1) Accessibility (easily available), 2)
Convenience (one can do anything as per availability of time) and 3) Euphoria (feeling of goodness after completion of task). The sense of well being associated with technology use, leads to excessive use of the same. It also leads to unhealthy habits such as avoidance of offline interaction, outdoor activities, development of irregular food habits or sleep disturbance etc. You can screen the unhealthy use of technology by answering the following four ‘C’ questions in yes or no options: 1) Craving (continuous desire to be on the technology); 2) Control (losing technology);
control
whenever
on
3) Compulsion (it has become “a have to activity for you”) & 4) Consequences: A) Physical (experience health eye strain, pain, fatigue) B) Social (stopped going out, decrease social
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interaction with, preferred to spend time on technology) C) Psychological (using it as a way of coping). If the answer is ‘yes’ to 3 or more of the above, then the individual is engaging in excessive use of technology. You can promote healthy use by: Acknowledging the problem- Accept that it is interfering with other daily activities; ASK- Overcome your hesitation to seek help; discuss with your family members or counsellor and seek active help to promote healthy use of technology. Develop alternative pleasurable activities. For instance, you may be using the internet to manage negative mood states (i.e. sadness, loneliness, boredom, etc). Instead, try developing other activities to manage the mood states – e.g. start an outdoor hobby, interact with neighbours, meet up with friends, etc. Talk About It Talk with your children about the Internet, and encourage them to see it as a shared, open environment in which they have social responsibilities just as they would in any physical environment. With open discussion, you can set expectations about the behaviour you expect from them, curb negativity and discourage behaviours such as secrecy, late evening browsing or thrill-seeking. You can guide guide them regarding online safety issues as well as educate them about cyber laws. Keep in mind: Enjoy the technology along with your children, and discuss the variety of ways in which it brings new information into one’s lives as well as encourage them to share their opinion. Experience from research conducted in Indian context indicated that children develop psychological distress due to their online experience as well as inability to discuss with others Make yourself available to your child ‘s questions and encourage them to share their Internet experiences with you without fear of punishment about what they read, see or experience. Discuss the advantages of safe online interaction with others, why children should stay away from certain types of content and individuals.
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As the child get older, keep family communications about the Internet as open and positive as you can. Do not criticize his or her technology use. Talk with your kids about their online friends and activities just as you would talk about other friends and activities. Set Rules for Internet Use: Lay out rules for Internet use, setting clear expectations for your child online habits. A good set of rules should include things like the amount of time children are allowed to be online, what types of content are appropriate as well as proper online conduct . Keep in mind: The most successful rules are those that are created collaboratively. Discuss the rules frequently. Remind them that the rules are in place to protect your family, and that strictly maintaining privacy online can lower the risk of being targeted by online predators. Tell your children that following the rules and keeping communications open will allow them to gain freedom as they get older. Balance Time Online: Maintaining a balance between entertainment and other activities in children’s lives can be a serious challenge. The Internet has made it even more difficult, as the lines between entertainment
and education are often blurred. Modelling a healthy balance between your online and offline activities is a great way to encourage children to do the same. Keep in mind: Enforce rules about the amount of time your child may spend online and the hours they are allowed to go online. Help your child develop self-control, discipline and accountability regarding Internet use. Encourage and support their participation in other activities — particularly physical pastimes with other children. If your child is reluctant, look for offline activities that tap into the same interests your kids pursue online. Watch for signs of Internet dependency. (If Internet use seems excessive or begins to affect your child’s school performance, health or relationships). In that case, seek professional help at the earliest. Get factual information There’s a lot of content on the Internet that isn’t helpful or reliable. While more online fact checking happens today than previously, the ability of nearly anyone to offer opinions or build websites can make the Internet a confusing place for young people. In that case, seek professional help at the earliest. Train them to use a variety of online resources and to always check, question and verify what they see online. Keep in mind: Start young. Even preschool students use the Internet to look up information. Teach them early to distinguish fact from opinion, and discuss ways to recognise bias, propaganda and stereotyping. Challenge your children to evaluate what they see online by asking: What is the purpose of this site? To entertain? To sell? Is the “About Us” section authentic? Does a company or an individual person sponsor it? Is it a public conversation? Finally, challenge them to consider whether the Internet is the best place to find the information they need.
Keep Personal Facts Private Online privacy is vital to your family’s safety. Ensuring that your kids communicate online only with people known to them and your family can help limit their contact with unsavory elements. Still, as children grow older, they are bound to make new friends online, and it is important to teach them about keeping personal facts private. Keep in mind: Ensure that children keep facts such as their real name, age, gender and location private. Discuss how details in photographs can reveal more information to would-be predators than your child intends. Many children routinely visit social networks and blogs where they may post pictures, make comments and write personal entries. Insist that your children keep personal information private and that they think twice before joining locationbased peer groups that may give away information on their whereabouts. Ensure that your children understand the risks involved in making private or personal information public online. Keep an open dialogue about the people they come into contact with online. Discuss and evaluate online relationships as you would any other relationships in your child’s life. Barrier to develop healthy use: The main barriers manifest in the form of inability to see the problematic usage of available technology, absence of alternative activities to manage the situations associated with usage and hesitation to seek help for developing controlled healthy use of technology. There is a need for developing other leisure activities for oneself as well as for the children. So all of can experience the feeling of goodness after the use of technology. Source: Intenet and daily life accessed on www.pewinternet. org/2004/08/11/the-internet-and-daily-life Dr. Manoj Kumar Sharma Additional Profressor Services for Healthy Use of Technology(SHUT) Clinic, Dept. of Clinical Psychology, NIMHANS, Bengaluru
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Handling Difficult Emotions Gretchen Rubin chronicled her one-year search for the secrets of happiness in her bestselling book The Happiness Project. Interestingly, she speaks about the role that negative emotions can play in the pursuit of happiness; as signals that something isn’t right and that changes are needed. All of us have experienced being overwhelmed by intense and difficult emotions like sadness, guilt, frustration, anger, shame, anxiety or fear. So, how can we handle these emotions without being overwhelmed or paralysed? “Stop crying!”; “I’m fine” (even when you are not), are statements that demonstrate how we tend to deny or push them away our negative emotions. The first step in learning to handle difficult emotions is becoming aware and naming the emotion/s. Expand
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your ‘emotion vocabulary’ and ask yourself: Are you frustrated, worked up, irritated, furious, hostile, enraged or are you unhappy, sad, pessimistic, dejected, despairing, hurting, grieving? Sometimes you could start with labelling your emotion as anger and then realise that it is actually more a feeling of sadness and loneliness; or perhaps a mixture of many emotions. This can help you in your efforts to understand your emotions and experiment with a range of strategies to deal with them effectively. Different strategies would be useful according to the context and you need to judge which ones work best for you. While some strategies focus on reducing the intensity of the difficult emotion in the moment, other approaches look at developing more adaptive methods over time as well as trying to understand the thoughts, contexts, patterns and origins of the emotion.
Some of these strategies can be: Time out: It is sometimes uncomfortable, difficult, or inappropriate to express intense negative emotions in certain situations. A brief stepping away from the situation to take the time to compose yourself can be helpful. Distraction and Soothing Methods: A flood of emotions can be difficult to deal with. Try engaging in activities to distract yourself for temporary relief. This could be listening to music, concentrating on some other task, engaging in physical exercise or any other physical activity. Exercise can also work as a mood elevator through the release of ‘feel good’ chemicals in the brain. Soothing strategies, e.g. taking a walk and looking at the flowers in the park, enjoying a special meal, taking a warm shower, can help you cope with overwhelming emotions. • Imagery: Temporary reduction in the intensity of your difficult feelings can be achieved through visualisation exercises. For example, you can imagine putting your pain and sadness in a box on a cupboard shelf and you will get back to opening the box and sorting things out once you feel calmer. Visualising a scene, place or event that you remember as peaceful, beautiful or happy can be a powerful method. You should try and use all your senses and ‘see’, ‘hear’, ‘smell’ and ‘feel’ the scene in your imagination. • Breathing and Relaxation methods: Learning slow and deep breathing exercises, muscle relaxation
exercises are very important parts of your emotion toolkit. Mindfulness methods use a different approach; they encourage the mindful acceptance of the difficult emotion while recognising the impermanence of all emotions. • Expressing your emotions: Once you have been able to understand your emotions, regulate their intensity and what you want to convey. expressing your emotions in the appropriate context can be useful. A good way to make a start is to say “I feel….” “I felt…” or “I have been feeling….” . This is usually more effective than saying, “You made me feel….” . It is important to be specific about what you feel. Next you could go on to express the source/s of this feeling as well as anything you might want the other person to do. Remember that we express our emotions not only though our words but also the tone or volume of our voice, our facial expressions and our actions. • Using your Support Network: Sharing feelings and getting support from friends or family can help you feel less alone and perhaps learn from their suggestions and ways of looking at your situation. • Understanding your emotions: A number of methods can help you tease out the often complex reasons for the upsurge of certain emotions. Writing your feelings in the private diary, linking feelings to specific situations, events, personal beliefs or values or trying to list out the thoughts associated with these feelings (e.g. Its wrong to
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feel this way; If I feel this way, I will lose control) can give you a better understanding. This in turn provides guidance for the steps to deal with distressing thoughts or feelings. • Understanding the other’s emotion: When difficult emotions arise in the context of an interaction with another person, efforts at understanding your own emotions may not be enough. Trying to step into the other person’s shoes and tuning in into his or her emotions can sometimes lend a different perspective. • Help yourself in a safe space: Counselling or therapy can provide a safe, confidential and non-judgemental space for you to explore, understand and manage recurrent patterns of painful feelings.
As human beings in the world of relationships, emotional intelligence plays an importance role in our lives, influencing learning, relationships, creativity, decision-making and our overall wellbeing.
* The Yale Centre for Emotional Intelligence (www. ei.yale.edu) has a range of innovative ways to harness the power of emotions and teaches people of all ages how to develop their emotional intelligence.
Dr. Poornima Bhola Associate Professor Department of Clinical Psychology NIMHANS, Bengaluru
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Gatekeeper Training for Suicide Prevention Would you like to be a Gatekeeper? • In our Gatekeeper Training Program, A Gatekeeper is someone is someone who believes that suicide can be prevented in the community and is willing to give time and energy for this cause. • Gatekeepers could be anyone- teachers, parents, neighbours, hostel wardens, police or lay counselors.
training program which includes : • Lecture cum demonstrations • Role plays • Video shows • Case examples This training is conducted by a team comprising of Psychiatrist, Psychiatric Nurse & Psychiatric Social Worker.
• A Gatekeeper should sound the alarm when he/she identifies someone who is very distressed, provide initial emotional support and then refer them to a mental health professional. What do we do to help you be a Gatekeeper? • For 20 people at a time, we conduct a We now have a network of more than 500 trained gatekeepers To enroll, contact: NCWB @ 080-26685948 / 9480829670 Printing of the Magazine funded by: Dr. Ramachandra N Moorthy Foundation for Mental Health and Neurological Sciences
TRAUMA RECOVERY CLINIC Psychological Trauma: The Invisible Scars The clinic provides brief psychological interventions to adolescents and adult survivors of trauma through one-to-one and/ or group counselling and psychotherapy. The interventions are tailored to suit the unique needs of each client. Indications for consultation include: Interpersonal trauma such as domestic violence, betrayal trauma, trauma due to elder abuse, child sexual abuse, physical and sexual assault and traumatic bereavement. Indications also include trauma due to self-harm behaviours, trauma due to acqured disability, secondary trauma and specify in 2-3 words what is complex trauma.
Consultation days: Every Wednesday 9:30 am to 12:30 pm. To book your appointment, kindly contact:
NIMHANS CENTRE FOR WELLBEING 1/B, 9th Main, 1st Phase, 1st Stage, BTM Layout, Bengaluru 560 076 Phone: 080 26685948 or 9480829670 E mail: nimhans.wellbeing@gmail.com
AWAKE Clinic @ NIMHANS Centre for Well Being Benificiaries: Women with Intimate Partner Violence Services Offered: • Tailor-made mental health interventions and counselling for women with intimate partner violence. • Trauma care for the victims of violence. • Supportive and individual therapies to build self-esteem, self-confidence, coping skills, problem-solving skills and communication skills of women. • Telephone counselling. • Referral and information services regarding available resources, legal rights, shelter care. • Support group for women survivors of intimate partner violence. • Community based awareness and training programmes to prevent gender based violence. Timings: Every 2nd and 4th Wednesday between 2.00 pm to 4.30 pm Printing of the Magazine funded by: Dr. Ramachandra N Moorthy Foundation for Mental Health and Neurological Sciences
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