Thursday, January 24, 2013

Irresponsible Drinking & Regulation

irresponsible drinking
Irresponsible drinking requires regulation to modulate its potential for harm. There are specific neurotoxic effects of alcohol drinking. The responsible individual needs to learn personal skills to refuse alcohol drinking when required to do so. The potential harm to society with irresponsible drinking and driving necessitates regulation at a societal level.

Regulating irresponsible drinking

Alcohol drinking and driving in Pune over New  Year's eve was markedly reduced as compared to last year. This year 145 drunk driving arrests were made as against 252 last year. This reduction was despite an increase in the total number of  arrests made in Pune for irresponsible drinking and driving in 2012 as compared to the previous year. The heightened deployment of police personnel manning 30 prominent points of the Pune roads on New Year's eve was apparently deterrent enough.

Alcohol drinking and liquor sales were down by 20-30% in September 2012 following a police raid on an unlicensed rural Pune nightspot. The uproar by its patrons and subsequent police action on liquor retailers and other restaurants resulted in the Pune District Wine Traders Association lamenting the impact of plunging alcohol sales at premium outlets and lounge bars.

Is regulation effective?

The effects of regulating alcohol drinking have been specifically studied.
  • In Kentucky — the birthplace of bourbon whiskey and the home of many distilleries — dry districts had less alcohol-related auto accidents and drunk driving arrests. This should cheer the citizens of Chandrapur which will be the third district in Maharashtra state to go dry in a bid to curb irresponsible drinking.
  • In Alaska, isolated villages that prohibited alcohol had lower rates of serious injury resulting from assault, and motor vehicle collisions. A local police presence in these dry villages further reduced the incidence of assault
Regulation of alcohol drinking is effective and necessary. It provides a deterrence to irresponsible drinking and illegal distribution of alcohol. Alcoholism treatment financially benefits the family. Regulating alcohol drinking works to benefit society.

  1. Darryl S. Wood, Paul J. Gruenewal. Local alcohol prohibition, police presence and serious injury in isolated Alaska Native villages. Article first published online: 27 FEB 2006 DOI: 10.1111/j.1360-0443.2006.01347.x
  2. Wilson RW, Niva G, Nicholson T. Prohibition revisited: county alcohol control consequences. J Ky Med Assoc. 1993 Jan;91(1):9-12.

Wednesday, December 19, 2012

Rejection sensitivity - rejecting an unwanted lover safely

rejecting an unwanted lover

Rejecting an unwanted lover unceremoniously can be dangerous. Rejection sensitivity and aggression by the scorned male can have disastrous consequences. Last week a college girl was attacked with a sickle for doing so. The demographic profile of students at our clinic is probably a representation of the Pune student population. Many students feel socially and culturally alienated while having to cope on their own with minimal family support. Some have no one to express their feelings or thoughts to. A smile or other facial expressions from a classmate or a single phrase while watching a game are viewed as tokens of intimacy. Subsequent fantasising invests these facial expressions and interactions with an excessive significance. That the girl does not initiate or acknowledge further interaction is rationalised as shyness and considered a virtue, further embedding the myth of intimacy.

The concept of gender equality may be alien in the culture of the student. It comes as a great shock to the lover, when he gathers up his courage to proclaim his love only to find it discarded unceremoniously. His reaction will depend on his attachment style - the behavioural response to separation developed in childhood. Mostly he will withdraw further into his shell, but in some cases, especially when he is high on the personality characteristic of rejection sensitivity and has a fearful attachment style, he will harbour and act out thoughts of revenge.These vengeful thoughts smoulder unrecognised until they burst forth in as dramatic and unexpected action as the initial profession of love.

Rejecting an unwanted lover

Rejection sensitivity is always a concern when rejecting an unwanted lover. The independent modern woman needs to learn how to handle this situation without involving family or other third parties. Rejecting an unwanted lover can be considered as a form of breaking bad news. For this there is no better technique than the SPIKES 6-step protocol which is used to break bad news in medicine.
Make sure there is privacy. No matter how startled you are by his profession of love, do not blurt out a summary dismissal in front of everyone. Stay in a public place, but take him to one side.
Ask him to clarify what he has just said, and what lead him to say that. This  will help you to place him, if you haven't already done so.
Ask whether you can tell him your point of view on the subject
giving Knowledge
Warning before giving the bad news helps the person process the information imparted without  getting angry or feeling isolated. Start by saying "I am sorry to say that I don't feel that way". Don't be rude or excessively blunt  Responses such as "who do you think you are?",  "why should I have feelings for you?" or laughing contemptuously are bound to turn love into the other end of the stick - hate, especially if he is high on rejection sensitivity. Check his reactions and modify  what you are saying so he can understand.
Identify his emotion - sadness, anger, hurt. Closely monitor his facial expressions. Acknowledge it. "I can see that you are feeling hurt. Anyone in your position might feel like that".
Discussing what comes next. Start from his Perception of the relationship to help vent his emotions. Deal with these Empathically, again the facial expressions are important. The goal should be to politely but firmly communicate "I don't feel that way" so "we cant take this any further, don't take this personally".
The aim is to stay polite while rejecting an unwanted lover without humiliating him. It should not take more than 5-10 minutes of time spent reading facial expressions and showing concern while firmly putting forward your own lack of 'spark' in the relationship.

  1. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302-11.

Wednesday, November 21, 2012

Job Satisfaction & Work Stress in the IT Industry

job satisfaction and work stress in IT
Work stress and low job satisfaction are the primary drivers for help-seeking in IT professionals. PR a 34-yr old software engineer employed in an IT company came to us for guidance while considering a career change. He felt stressed, and experienced his work as meaningless. He felt alienated from his colleagues and his job dissatisfaction was high.

PR’s is not a one-off case. A PPC Worldwide study reported that 62% of all employees experience work stress. Responses to a poll specifically studying IT related work stress are as depicted in the chart above.

Work stress contributes to job dissatisfaction and increased attrition in the workforce. Most burnout prevention methods focus on personal responsibility for wellness. They require sacrifice of personal time with the perverse goal of being more effective at work. We have already seen what the individual needs to do to manage stress with a health promoting lifestyle,  Even 15 minutes of exercise is effective. We now need to look at the organisational factors resulting in committed employees.

Job satisfaction involves certain obligations that exist in an employment relationship. Pay is largely considered to be the single-most contributor to job satisfaction, and perceptions of fairness in compensation have a direct influence on commitment to the organisation. However, intrinsic motivators contribute greatly to resistance to work stress. These include
Nature of work
Nature of work is an intrinsic motivator measured by an individual’s feeling that their job is meaningful. They feel engagement, and a sense of pride in the job. Humiliation at work does not foster this sense of engagement. For many of our clients humiliation is a prime driver to distress and burnout.
RK came to us when he was thinking of quitting his job. He had been 'de-promoted' into his own team when they were unable to meet a target. His self-esteem was low and he was depressed. He recovered with treatment and counselling. He could then decide his next career move from a position of strength.
Relationship with co-workers
Work plays an important part in fulfilling an individual’s social needs. Co-worker acceptance and a sense of belonging to a group and culture affect job satisfaction. Unfortunately the culture in many IT organisations continues to reflect the ‘in’ and ‘out’ groupings of the college hostels through which their managers have emerged. This only adds to the job dissatisfaction of IT professionals who may be contributing at their jobs but do not feel a part of the organisation.
The motivated and stress tolerant employee shows commitment to the organisation in two ways
  1. Emotional
  2.  Job dissatisfaction is inversely associated with emotional commitment. IT professionals who are satisfied feel more emotionally attached to and involved with their organisations.
  3. Obligational
  4. Job satisfaction is associated with feeling more obliged to remain with the organisation.
  5. Continuance
  6. Continuance commitment (cost associated with leaving the company) is not related to job satisfaction; pay does not matter disproportionately to the IT professional.
Work stress and work pressure are correlated with job dissatisfaction and poor employee engagement. The IT professional’s decision to stay with the company due to feelings of attachment and obligation results from job satisfaction rather than the costs associated with leaving the company. A working atmosphere that validates the individual and their differences will enhance that attachment and commitment to the organisation.

  1. E.J. Lumley, M. Coetzee, R. Tladinyane, N. Ferreira. Exploring the job satisfaction and organisational commitment of employees in the information technology environment. Southern African Business Review Volume 15 Number 1 2011.
  2. Kaluzniacky, Eugene. Stress Management. In: Managing psychological factors in information systems work : an orientation to emotional intelligence. Idea Group. London, 2004. Pg238-245.
  3. Psychol Rep. 2009 Dec;105(3 Pt 1):759-70. Employee engagement and job satisfaction in the information technology industry. Kamalanabhan TJ, Sai LP, Mayuri D.
  4. Saradha.H. Employee engagement in relation to organizational citizenship behaviour in information technology organizations. Submitted in partial fulfillment of the requirements for the degree of Master of Philosophy. Institute of Management, Christ University, Bangalore. 2010.

Wednesday, October 3, 2012

Conduct Disorder and Behaviour Problems in Children

conduct disorder

Conduct disorder and behaviour problems in children make the news when a 5-year old or a grandmother is killed while extorting money. Aggression in children  is just one of the offenses associated with conduct disorders . The seemingly lesser offenses of stealing in thousands from the home, or smoking 'weed' with their friends, pale in contrast. At the lowest end of the spectrum are those children who repeatedly confront authority in school or at home. Dubbed as 'monster kids' these children are viewed indulgently as being mischievous, naughty, 'bad', or 'delinquent'. Very seldom are they seen as having a mental health problem - a conduct disorder.

What is Conduct Disorder?

Behaviour problems that are persistent, violate the rights of others, go against societal norms, and disrupt family life, indicate a conduct disorder and merit psychiatric assessment. Conduct disorder is amongst the commonest childhood disorders seen in our clinic. Every one of us knows or has heard of a child with conduct disorders . Conduct disorder is characterised by the following behaviour problems .
This child (maybe a 2 year old preschool cherub) picks fights, bullies, or physically hurts younger siblings at home. He is frequently taken to the principal's office for fighting in school. When this child enters the park the other children get ready to leave. He has often used a weapon (stick, cricket bat, stone or brick) to deliberately assault a person or hurt an animal.
Destruction of property
These children are wilfully destructive. They are the ones who scratch the paint off your new car, slash the seats of parked 2 wheelers, deface the lift, cut up a mothers dress, and tear the library book. More seriously they set fire to clothes and in extreme cases to vehicles.
Lying and deceit
These are children who steal from parents, grandparents, and classmates. They forge their parent's signature on school reports, cheques, and credit cards.They lie,  cheat and pilfer from shops.
Violation of rules
They stay out until late at night against home rules and curfews. They 'bunk' school to hang out with other antisocial friends, and run away from home overnight.

What happens to children with conduct disorder behaviours ?

Most parents feel a child will outgrow behaviour problems and conduct disorders .  However studies show this is not so. If not addressed and treated, children with conduct disorders are suspended from school, and have brushes with the law. Half of these children also have ADHD (Attention Deficit Hyperactivity Disorder) which further impacts their schooling. Broken relationships and marriages, and substance abuse including alcohol and cannabis abuse are common. As adults children with behaviour problems develop antisocial personalities and lead a criminal lifestyle. In the extreme a child with conduct disorder will murder his grandmother or a hapless neighbour's toddler.

Thursday, September 27, 2012

Alzheimer's caregiver techniques

world alzheimers day 2012

Caregivers living with persons having Alzheimer's Disease face specific problem behaviours. These behavioural problems result from memory loss that is the hallmark symptom of Alzheimer's. We have previously discussed resources giving hope for dementia caregivers. Caregiver do's and dont's for mental illnesses in general have also been highlighted. Living with Alzheimer's Disease is the theme for World Alzheimer's Day 2012. In this post we specify methods to help caregivers living with persons having Alzheimer's handle problems related to memory loss and reduce the burden of  care at home.

Caregiver techniques for Alzheimer's

  1. Regular routine enables basic activities of daily living for a longer period of time. Make a visual time-table and regularly remind the person with Alzheimers to consult it so it becomes a habit.
  2. Keep large clocks in each room and remind them of the time at every opportunity.
  3. A personalised calendar with large figures helps plan and anticipate potentially confusing events such as a festival or travel.
  4. A room with a window is great for orientation. Natural daylight and dark phases maintain the sleep-wake cycle.
  5. Greet at every new meeting with date and time. The date is particularly difficult for a person with Alzheimer's to learn - it changes every day -  hence the disorientation. Repetition will keep the person with Alzheimers disease current with the month and year for longer.
  6. Keep familiar objects like photos, phone, books, and decorative pieces in the same place. People with Alzheimer's often have to move from one set of caregivers to another. Placing these objects in the same general positions helps them to avoid confusion and  anxiety.
  7. Photographs are important visual memory pegs. Two or three frames with photographs of the caregiver families and old friends reassures the person with Alzheimer's disease and facilitates their smooth transition between caregivers.
  8. An identity card is essential for every person with  Alzheimer's. It must contain an address and an emergency contact number. It should be worn at all times, even inside the  house. Your loved one can wander out of an open door and not  be able to find her way back. Reinforce and rehearse showing or consulting the identity card on being asked for address or phone number.
  9. Encourage and let them do the  things they can. Don't take over every activity or your caregiver burden will increase. Prompt them when they hesitate or take time. Help them in those activities they are unable to do.
Anti-dementia drugs delay nursing home admissions for upto a year. To make home this stay meaningful and to reduce the burden of care these methods need to be used by caregivers living with Alzheimer's Disease patients.