Sunday, October 23, 2011

Tattoos - true love will never fade

sarus crane symbol of true love
What is the motivation or psychology behind obtaining a tattoo? Tattooing as a form of decorative body art has moved out of the realm of cults and organisations into mainstream society. It is increasingly common to see patients sporting a new tattoo. "Just like that, doctor. My friends were getting one". The Pune magazines reflect this new found art form through full page articles every other week. Driving through the some parts of Pune takes you past at least three studios specialising in the art of tattooing.

Here we are concerned with the psychological aspects of tattooing. As compared to body-piercing, a tattoo is relatively permanent and more deliberate operation. For the moment set aside doubts over hygiene, HIV, and hepatitis.

10 reasons people get a tattoo

  1. Beauty, art, and fashion. Tattoos are a means of decorating the body with a permanent fashion accessory. Many tattooed individuals refer to their tattoos as a piece of art. 
  2. Individuality. A tattoo fulfils the desire to create a distinct self-identity. The symbols or words embellishing the skin creates a special message that distinguishes the person from others. The individual gains a sense of control over their appearance and identity. We see this especially in teenagers brought in by their parents.
  3. Personal narrative. Women recovering from abuse create a new understanding of the injured part of the body. They reclaim possession through the deliberate and painful procedure of body modification. Tattoos have a self-healing effect in this reclamation of the body. 
  4. Physical endurance. For some tattoos are a statement about testing their threshold for pain endurance.  
  5. Group affiliations and commitment. Body ornaments are a permanent sign of love and commitment. The wish to belong to a certain community or to show affiliation to a particular group is a common reason for getting a tattoo. 
  6. Resistance. Tattoos are a provocative protest against parents and society, especially in college students. Body modification has long been associated with subcultural movements and criminal tendencies. Until recently most studies on tattooing were done on prison populations.
  7. Spirituality and cultural tradition. Body modifications emphasise personal affiliation to cultures and their spirituality. Esoteric symbols that convey special meaning are tattooed as a permanent reminder.
  8. Addiction. Tattoos and piercings possess an addictive character through the release of endorphins. These substances are released in brain areas in association with painful penetration of the body.
  9. Sexual motivation. Tattooing is a form of expressing sexual affectations and of emphasising ones own sexuality. 
  10. No specific reason. A tattoo may be obtained impulsively on the spur of the moment. Some individuals may be under the influence of alcohol or drugs while acquiring their piece of body art.

Reasons people have a tattoo removed

People are mostly satisfied with the actual design of their tattoo.

Most want their tattoo removed for personal reasons. This occurs when the quest for uniqueness turns into stigma, negative comments, and clothes problems. Poor decision making and subsequent personal regret seem to be frequent motivations for tattoo removal.

An improved sense of self and maturity is another factor. Especially for those who obtained their tattoos for internal expectations of self-identity at an early age. Many are still trying to dissociate from the past and improve self-identity. More than 40% of persons who choose a tattoo to feel unique are disillusioned when their unique product loses its luster and excitement.

Professional/social reasons account for another third of those motivated for tattoo removal. A new job or career is a major motivation. Negative workplace attitudes toward tattoos and perceived interference for a tattooed individual’s achievement is common. There is a perception of lowered credibility, competence, and sociability that diminishes the image of tattoo wearer in the workplace.

The possession risks are more for women than for men. More than two thirds of those seeking tattoo removal are women. Society support for women with tattoos is not as strong as for men. Strong tattoo support from significant others and friends is counterbalanced by negative remarks about the tattoos from fathers, physicians, and the public. Negative responses are also documented among career-oriented women with tattoos. Women still need to deliberately think about controlling the body placement of their tattoos to avoid the possession risks and to increase their own psychological comfort.

References
  1. Armstrong ML, Roberts AE, Koch JR, Saunders JC, Owen DC, Anderson RR. Motivation for contemporary tattoo removal: a shift in identity. Arch Dermatol. 2008 Jul;144(7):879-84.
  2. Silke Wohlrab, Jutta Stahl, Peter M. Kappeler. Modifying the body: Motivations for getting tattooed and pierced. Body Image 4 (2007) 87–95.

Tuesday, October 11, 2011

Learning Disability - academic underachievement

learning disorder
Impaired spelling and arithmetic in Standard 3 boy with Learning Disorder

Learning Disorder (LD) is characterised by impaired acquisition of academic skills. This impairment in scholastic skills is not due to intellectual disability, physical disorders, emotional disturbances, or environmental, cultural, or economic disadvantage.

There is a gap between ability and application. The child may know what is asked, is able to explain it verbally, but is unable to put it down in writing. Learning Disorder could affect any of the three scholastic Rs – Reading, wRiting or aRithmetic.

Types of Learning Disability

  1. Dyslexia – is the commonest learning disability (80%). It is marked by impairment of the ability to recognize and understand written words.
  2. Dyscalculia – problems with doing math, understanding time, using money.
  3. Dysgraphia – problems with handwriting, spelling.
  4. Dyspraxia – problems with hand-eye coordination and balance, difficulties with fine motor skills.

Signs and Symptoms

Most children with a Learning Disability are not diagnosed until they are in Standard 2-3 or 7-8 years of age. Remarks like ‘can do better’ or ‘handwriting needs to improve’ are often the first warning signs to appear in the report card. Many of these children would have been the stars of their nursery or kindergarten class. The transition to assessment of written output in primary school is what unmasks the disorder. The aware teacher is able to help the parents understand and put the parents on the path to remedial teaching.

Parents should watch out for

  • Reading may be slow or there is repeated rereading or skipping of an entire section. In the lower classes the child learns to memorise and reproduce entire chapters. Later the child is unable to hold the increasing amounts of material in memory, grades plummet, and confused parents are left searching for answers.
  • Problems in copying from the blackboard or a book. This is a frequent complaint of the teacher. Classwork is left incomplete. The child tries to copy from their partner and is punished for distracting the class.
  • Poor handwriting or drawing – their exercise books are messy, with frequent scratching out and erasing. This is especially so when the child writes on blank paper. It is also a reason why the child performs poorly in exams – they just cannot write quickly enough. They run out of time before they reach the last few questions.
  • Other signs in more severe conditions
    • Reversing numbers and letters while reading or writing - For example, confusing ‘b’ and ‘d’
    • Mixing the order of letters or numbers. Writing ‘twon’ instead of ‘town’.
    • Skipping letters in spelling. The child says ‘grass’ but writes ‘gas’.
    • Forgetting words they know well.
    • Weakness in mathematics.

Conquering Learning Disorder

  • Approach a centre undertaking diagnosis of learning disabilities.
  • A complete history of the child’s birth, milestones, health and academic record
  • Physical exam to exclude problems related to vision and hearing
  • Psychometry - to demonstrate specific academic problems that are not associated intellectual disability
  • Psychiatric assessment - to address associated anxiety, phobias and depression that arise out of repeated academic failures.
  • Psychiatric assessment - to exclude or address Attention Deficit Hyperactivity Disorder (ADHD) a common comorbidity. 15-40% of children with ADHD also have dyslexia.
  • Remedial teaching is essential to overcome learning problems 

Drug treatment for dyslexia?

There is a growing body of research to show that at least in children who have both ADHD and dyslexia there are significant improvements in reading ability with ADHD medication. These improvements in reading ability are not related merely to improvements in attention. The brain systems responsible for therapeutic improvement in children with ADHD + dyslexia are probably different from those in children with ADHD alone. The finding that selective areas of working memory can be enhanced by these medications is important, as poor working memory function appears to be a mental constraint on academic learning.

References
  1. Schulte-K├Ârne G. The Prevention, Diagnosis, and Treatment of Dyslexia. Dtsch Arztebl Int. 2010 Oct;107(41):718-26; quiz 27. Epub 2010 Oct 15
  2. Sumner CR, Gathercole S, Greenbaum M, Rubin R, Williams D, Hollandbeck M, Wietecha L. Atomoxetine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children with ADHD and dyslexia. Child Adolesc Psychiatry Ment Health. 2009 Dec 15;3:40..