Do Doctors have fear?

The short answer is 'Yes, loads of it'.

Doctors are worried about the impact of the COVID epidemic on their family, health and finances. The call of duty seems such a burden now. It is fear that is making people avoid covid duty- the complaints of poor pay, poor facilities, unfair demands- these are all mere excuses.

Fear is definitely warranted too. The administration and society at large has been jealous of the imaginary privileges that doctors have- actually doctors have no privileges. They pay the same rates and taxes, and have to encounter the same struggles as in the average person's life. The deep resentment of the community towards doctors manifests as repeated persecutions in subtle and forceful ways. Thus doctors, too have lost trust.

Doctors want to know if they will get ppe, medical treatment and in event of demise - something of a support for their family. Many doctors are the only breadwinners of their families. So its very reasonable for them to be fearful. A simple answer to convince doctors to work is to offer them these facilities in writing- a proper letter of appointment mentioning all the things is needed. Anything less indicates an administration that is commitment- phobic and not trustworthy. How can you expect someone to put their life and the security of their family at risk for some flimsy verbal assurances?

The administration, particularly senior doctors in positions of authority need to understand the psychology of fear and address it because it is legitimate. Going for COVID duty without any sort of documentation based on which doctors can hope for even the basic care and compensation- I dont think other corona warriors are being expected to do so. I exhort the senior doctors to stop speaking threatening words of punitive action and instead initiate a dialogue to dispel fears of doctors. It should be done for every person in this situation- why not for doctors then?

We are confused and not at all serious about COVID

so I stepped out to get some essentials from the medical shop and I was relieved to find just one customer before me. Only one customer allowed in at a time and I could see what was happening from my place outside. Grandma had a 4 year old with her. And they were trying to choose a bag of chips. So each bag of chips was shown to the youngster who held it for a while and then returned it so she could see what was the next choice. The girl had a large, ill fitting mask hanging under her chin and Grandma also wearing something resembling a mask. After a good 20mins wait, I had to request them to hurry up and then after another 10mins of haggling over the price they were leaving. So I asked Grandma why she was outside with a small child and she showed me that the child had a rash that hadnt gone for about a week now despite the Doctor's advice. She was here to show the rash to the chemist. The Dr's note said 'Chickenpox' and sure enough the kid had a rash all over body that was typical of chicken pox. Grandma not convinced, pharmacist refused to treat the child and so Grandma proceeded to the next shop for advice.

Coming out I notice most folks roaming quite casually without masks. At a bread shop, the owner asks the customer 'where is your mask?'. Asks him to stand back to maintain social distancing. And as if the shopkeeper has abused him the man shouts a tirade at him about being insensitive to an old man who has merely been forgetful! Next I go to the lab for my blood test. Every new person has to be instructed by the staff to wear their mask properly and maintain social distancing. Most people wear their masks to cover only the lower lip. Its too hot when the mask covers the nose. And if it covers both lips, we cant talk. Some wear it like a scarf bunched around the neck and then pinch one end of it around the nose sometimes- how they decide when the nose and mouth are to be covered I could not find out.

Covid epidemic is real. And its spreading fast in Mumbai. Studies have shown that it can be controlled if everybody uses a mask- a fabric mask is sufficient. But the mask has to be worn by everyone, at all times when outside the house and the mask has to be closely fitting to cover the mouth and nose. How can this detail be conveyed to the public?

COVID- 19 and my experience

COVID-19 has affected people's mental health in different ways. Its not all bad. For example children are thrilled to bits that their parents are around. Except for people in troubled families, generally everybody is appreciating this time they are getting with each other. The need for diversion and entertainment has actually gone down with people really discovering that they love to just do things around the house or be with their family members.

However, I was much surprised that I saw a spurt in referrals for acute psychosis. It appears that people here have vulnerability to psychosis, as a population. Its also possible that the other folks reached Psychologists, while Acute Psychosis cant do without a Psychiatrist's medical intervention so I had to see them. Anyway- people developed delusions about having COVID- that then progressed into delusions of persecution that someone was trying to give them COVID purposely and so on.

Our Police and Chief Minister have constantly been worried about poor compliance to the lockdown orders. In my mind, this is a problem that needs to be researched and understood from a psychology perspective. The non cooperation is a feature of 'normal' individuals and needs to be understood from the perspective of culture and personality. Expert in fields of sociology, anthropology and social psychology need to be consulted on getting a plan to avoid overcrowding. It something urgently needed, because the triad of social distance, hygiene and personal protection will need to be followed for a long time to come.

I expect that this year schools will need to be online. I am not going to present the practical issues like lack of devices, etc as that is not the worry of a Psychiatrist per se. My problem is: As we are not allowed to prescribe stimulants after tele-consulting, learning challenges of children with ADHD may be magnified.  We Psychiatrists will really need to come out with coping strategies for families with children. A lot of their learning will have to be supervised by parents and parents need to be seriously empowered by modules on teaching along the lines of home- schooling. But home schooling isnt as rigid as a regular school curriculum is- and therefore parents are going to be struggling to cope with the speed. So schools also need to see if they can have a time table where longer parts in one subject are covered in a day and only 1-3 subjects done daily.

As we brace for a new lifestyle a lot of learning and unlearning will be needed and what do you think can help families and children?

WHY PERSONS WITH ADDICTIONS NEED MEDICAL HELP?

WHICH TYPE OF ADDICT NEEDS ACTIVE MEDICAL INTERVENTION

The definition of addictions has now been broadened to include a wide range of habits. This is in addition to habitual use of mind- altering substances. Some people are able to quit these addictions without absolutely any medical help. It is good if the withdrawals and recovery are uneventful. However, some persons will do better to seek medical help.

There are many reasons for getting medical help for addictions. One reason is that addictions are medical disorders diagnosed under ‘mental illness’ because the problem is mainly of behaviour. The problematic aspect is that the person begins to value the addictive habit more than anything else in his/ her life. Second reason is that the habit causes harmful bodily changes- for example liver disorders caused by alcohol. This will need to be checked by a doctor. Thirdly, some medicines are used to manage withdrawal symptoms and to reduce the temptation to use again.

As addiction is a behavioural disorder, Psychiatrists deal with it. Ideally all persons should go for a medical evaluation. Out of them some persons need hospitalisation. People using large amounts, continuously and suffering from many complications are admitted. Persons who have physical or mental illness or injuries, along with addiction also need hospitalisation. Some persons have tried to quit many times and have been unsuccessful- such persons need to be in rehabilitation centre for few months. Persons using multiple substances also require admission in a deaddiction facility. Rare and unusual addictions will require greater medical supervision, not necessarily hospitalisation. Persons with reasonable health, moderate levels of consumption and good motivation can be treated with minimal or no medication outside the hospital. 

TUITIONS FOR CHILDREN

When we were in school, it was a matter of shame to go to ‘tuition’. It meant that there was some weakness or intention to take a dis-honorable ‘short-cut’ in study. Nowadays, tuition/ class/ coaching has become part of almost every child’s routine. OK- Parents have become busier, more ambitious and have the money to buy help for their children. But often the child gains nothing from the tuition class. Why is it so?

It is found that child is admitted in tuition class for all the wrong reasons. 4 and 5 year olds are sent to tuition class because parents are unable to get them to sit in one place and study.  But in reality, it is not expected of children so young to be able to sit and ‘study’. Some children are sent to tutors because they trouble parents at home- so it is more like a child-minding exercise. In extreme cases child is rotated through multiple classes because there is no one available or willing to take care of the child at home. In these cases, often children are sent to self appointed teachers who are seldom qualified to teach. Some parents send children because others parents send; even children sometimes insist on going to tuition because their friends are going.

Poor academic performance is the only valid reason to send a child to tuitions. But this should be done only after thorough investigation for the cause of poor performance. One common cause of poor performance is poor teaching method- if restricted to few subjects, a qualified tutor may be employed. But if extends to several subjects, parents need to consider change of school. It will be overwhelming for the child to spend time relearning all subjects in tuition. Intellectual limitations, learning disorders, attention deficits and emotional problems also interfere with learning. Parents should seek counselling if any of these problems are found. This helps them to have realistic expectations from the child and to follow a plan which can help child to cope with studies properly by addressing the problem.

As it is, children are already burdened with school work. Parents should negotiate with the tutor not to give any homework. Some children only require assistance in completing their classwork and revision. Some children require teaching of concepts. Some children need practice. Yet others need only tips in presentation. A tutoring program cannot be ‘one size fits all’. Smart parents understand this and negotiate with the tutor to deliver tailor-made help.

Children attempting specific competitive exams or exams in subjects not available at school will also need tuitions. Because both the content and pattern of study are different and someone is needed to teach that.

It is the duty of parent to understand the process of teaching, decide whether it is suitable based on the child’s problem and monitor whether learning is happening. The child needs to be supervised to ensure attendance and attention. The tuition situation also needs to be safe- no child should be left alone with a tutor of any gender, age or even if you know the person well. Tutors should not be allowed to intimidate or abuse the child in any way. I have seen children who were threatened, pinched or beaten by tutors due to which they became emotionally disturbed and turned off from studies forever.

Most of all, the child should never be forced into tuitions. Child’s opinion and cooperation should be expressly sought. Tuitions should be few and meant only to help the child achieve specific learning goals.

EMOTIONAL FIRST AID- An essential skill for everyone

EMOTIONAL FIRST AID

Even a little child knows that one must take ‘first-aid’ when injured. It is common knowledge that first aid consists of examining the injury, preventing it from getting worse and determining if further treatment is warranted. For several decades, people have been trained in first aid workshops. This training is provided even to ‘lay persons’. The idea is that help is made available to every person, at all times.

As against this level of care, training and know-how about physical injuries- very little is available for addressing emotional injuries. In fact majority of doctors also do not have any idea about EFA. The end result is that our world is becoming more and more vulnerable to festering and worsening of emotional hurts. Emotional first aid concept was developed in Australia. WHO has promoted emotional first aid training and implementation as one of the important methods for mental health interventions. Emotional first aid is the intervention given to a person who has suffered emotional trauma. It is given immediately after the emotional hurt and before professional help becomes available. Many times, due to effective emotional first aid, professional help becomes unnecessary.

Emotional first aid can be learnt by any intelligent, helping- natured person through a training program. The training consists of learning about working of the mind, nature of emotional trauma and effects of emotional trauma. It will teach the persons to recognise the symptoms of trauma and to determine whether emotional first aid can be administered. Then come the actual skills of emotional first aid. Participants are encouraged to practise their skills as often as possible so that they become experts.

Emotional first aid is actually designed to help persons who have suffered mental trauma. Recipients have reported feeling better upon receiving timely EFA. Not only this, the persons who underwent EFA training also benefitted. They became more conscious about mental health, mental hygiene and were able to take better care of themselves. Hence, even training in EFA helps to improve overall mental health. It is indeed a simple, effective training that all must avail off.

https://www.ted.com/talks/guy_winch_the_case_for_emotional_hygiene?language=en

http://www.amazon.com/Emotional-First-Aid-Rejection-Everyday/dp/0142181072

TASKS OF PARENTING

Children are a promise of the future and a blessing for today

----- John Denver

They feel secure when you

1.     Strive to provide them with proper food, shelter, clothing, shelter and education

2.    Spend as much time as possible with them on a regular basis

3.    Always are gentle and considerate

4.    Address the child’s fears and equip him/ her to deal with them

They feel loved when you                      

1.     Make them a priority in your life

2.    Learn to find out their interests and likes

3.    Allow them to express themselves

4.    Always keep your promises to them

They feel respected when you

1.     Address them respectfully and politely

2.    Never hit, humiliate or abuse them

3.    Try to understand their point of view, even if you disagree with it

4.    Develop an understanding of their intelligence, temperament, talents and interests before forming expectations

They become moral and well behaved when you

1.     Give clear instructions about behaviour expected

2.    Show how to behave by behaving in the desired way yourself

3.    Encourage and appreciate them when they behave as desired

4.    Give proportionate and reasonable punishments for transgressions

5.    Discuss with them why something is important to you

They become emotionally strong when you

1.     Share your emotions and teach them to manage their own emotions

2.    Allow them to deal with adversity and frustration

3.    Encourage them to find solutions to problems and implement them

4.    Teach them to lead a healthy and balanced lifestyle

       Parenting is an opportunity, a gift, a task, a responsibility and most of all.......a great adventure........