The Importance of Routine

Imagine if you have the freedom to wake up to a completely unstructured day, free from all constraints of time. To do whatever you want whenever you want all day long. This may sound like a dream; but try it for a few days and you will soon feel listless, dissatisfied and directionless. The feeling that life is passing you by and you have no control over it will overwhelm you, and you will long for the comfort of routine. 

Such is the power of routine and structure in our lives! It anchors us to our lives, gives it meaning and purpose. It is, undeniably, one of the most important aspects of our physical and mental well-being. As exciting as an unplanned day may appear, it can be very harmful for mental health and can exacerbate feelings of anxiety and distress.

Our lives involve constant interactions with our social and physical environment – at home, at work, in the neighbourhood and in the wider world around us. We have little or no control over most of these aspects of our lives and we know not when the unexpected may happen; therefore, it gives us a great sense of stability to have some things under our control. 

In a changing world, it is reassuring to realise that some things will be constant - the alarm that wakes us at a particular time, the morning cup of coffee, our daily walk, meals at particular times, getting dressed and reporting for work. This morning routine calms and prepares us for the day ahead and helps us cope during a crisis. 

The sense of normalcy that routine brings reduces stress and anxiety, which benefits us both physically and mentally, regulates the biological clock and enables better sleep; setting in a cycle of wellness and regularity.

Without structure, there is little motivation. Having a definite structure to the day also improves productivity and our sense of self-efficacy. By completing the routine tasks and chores which must be done, we get a sense of achievement, free ourselves of the nagging worry that incomplete tasks and procrastination inevitably bring and lets us focus on the more challenging tasks of the day.

How to start a routine

• Keep it simple. 
• Start with a sleep schedule. Go to bed and get up at the same time every day. The very act of getting up and changing into fresh clothes can set us to feel refreshed and motivated. 
• Build in the essentials – the things that must be done. This includes daily activities – such as meals, exercise, bath; and weekly chores such as buying groceries, laundry, house cleaning etc. 
• Do daily activities at the same time every day. Choose a time that works for you. If you are rushed in the mornings, schedule your exercise and bath for the evening.
• Always include some activities you enjoy – gardening, reading before bedtime, talking to friends or watching your favourite serial. 
• Remember not to keep your schedule too rigid. Allow for flexibility when the situation demands.
• Don’t be disheartened if you falter. According to one study, it took a minimum of 66 days to form a single new habit! 
• Reward yourself when you stick to a schedule.

References

1. https://adhdwellnesscenter.com/the-importance-of-structure-and-routine-for-your-mental-health/
2. The Importance of Keeping a Routine During Stressful Times (verywellmind.com)

 

Nostalgia

Remember that sepia-tinted class photo someone posted in your social media group? The flurry of comments, the almost-audible laughter, the warm fuzzy feeling, and the wistfulness that followed? You were indulging in a spot of nostalgia – that bittersweet feeling of pleasure mixed with sadness as you think of happy times in the past.

Nostalgia, literally meaning ‘ache for home’, was described in the 17th century and was considered an illness - a form of melancholy. While it’s true that we tend to indulge in nostalgia when we are unhappy, lonely or anxious; and during times of change and uncertainty; we also know that this yearning for the past is a universal human experience. Across cultures, we experience and indulge in nostalgia, and researchers now understand that it can serve many useful purposes.

• It helps us overcome negative emotions. 
• The positive emotions evoked by our nostalgic memories help us overcome feelings of sadness or anxiety we may be experiencing currently. 
• It helps us connect to our past and unifies our sense of identity. 
• We see our own journey through life - as we were, as we changed and adapted to circumstances, right through to who we are today. 
• It connects us to others and strengthens social bonds. Even when we are alone, our memories include and involve others, making us feel connected to them. This helps to dispel loneliness, especially in these difficult pandemic times. 
• Nostalgia is a good coping mechanism. The knowledge that we have overcome difficult situations in the past helps us cope with current situations; and gives us the perspective that the present, like the past, is temporary. 
• Nostalgia encourages feelings of empathy with others, even when they may not concern our own personal memories. It may serve to build bonds across generations and connect us our roots. 

However, there is a flip side too. Our forays into nostalgia may cause us to dwell on negative aspects of our past - the times when we were lonely, cold, hungry or rejected. Nostalgia may worsen feelings of sadness if we are depressed or going through a difficult phase in life. 

Nostalgia can alienate, rather than connect. Idealizing a particular time can cause resentment among those whose experiences were sharply divergent. Not everyone has had a happy childhood, and no period in history has been free of pain, anguish or injustice. 

It is also sobering to realise that nostalgia is often fuelled by dissatisfaction with the present, be it in our personal lives or in the wider socio-political climate. We tend to revert to memories of a simple, uncomplicated childhood, or to an imagined golden era in history to escape the demands of the present and anxieties relating to the future. 

‘Monetizing’ nostalgia 

Nostalgia can be deliberately triggered; and an entire industry cashes in on this very human frailty. While most of it is harmless and enjoyable, we must guard against the tendency to idealize and romanticise the past excessively. Nor should we allow ourselves to be manipulated by canny politicians who promise us ‘the good ol’ days’, in a bid to detract attention from current realities. 

You can’t have a better tomorrow if you are thinking about yesterday all the time

(Charles Kettering)

References

1. Krystine Batcho. Speaking of Psychology: Does nostalgia have a psychological purpose? (apa.org) 
2. Lottie Miles. The Psychology of Nostalgia: Why Do We Feel a Longing for the Past? - Learning Mind (learning-mind.com)

Humanity and Psychiatry | Prehistory to Pinel

Prehistoric human skull with trepanations (Monte Albán, Mexico)

Six to seven millenia ago in the Neolithic age it was understood that abnormal behaviours originated in the brain. However, the cause was ascribed to 'confined demons' and holes were drilled in the skull (trepanation) to let them out (Faria 2015). Later, the ancient Greeks and Egyptians developed an illness model of abnormal moods and behaviours, though they believed it was the heart and not the brain that controlled them. Texts that survive indicate formal psychiatric history taking and evaluation, prescription physical therapies like sleep, fever, and music alongside what would fit in with present day supportive and lifestyle and stress management therapies (Lambrini K, 2018). This care was confined to religious temple complexes some of which specialised in treatment of mental health disorders.

The 1st Millennium

Organised medical care in hospitals originated in the near and middle eastern regions. They were the first purely medical centres that developed outside of religious influence. Mental illness was also treated at these centers. The peak of this phase was in the academic medical centre (bimaristan) at Jundi-Shapur, Iran in the 6th century (Miller, 2006). Evidence based medicine may owe its first tentative roots to this centre. The crusaders, most notably the knights of St John brought back this model of aid to the ill and wounded on their return to Europe. Their legacy persists in the St John's Ambulance Brigade. 'Asylums for the Fearful' were maintained by Jain ascetic scholars during the medieval Chola period (848-1279) in Tamil Nadu, India as evidenced by stone inscriptions from that time.

In the 'Dark Ages' 

The 'dark' ages are considered as symbolizing everything malign about mental health treatments. However, medieval authors were mostly aware that diet, alcohol, overwork, and grief contributed to mental illness. The association with sin and punishment was probably propaganda that was used in a minority of cases (Kroll J, Bachrach B 1984). In 1487 Heinrich Kramer published the Malleus Malleficarum that became a paradigm for the treatment of  'witchcraft' and by extension of social and mental deviations from the norm of the time. The invention of the printing press and religious turmoil that occurred at the same time may have served to preserve what may otherwise have been an obscure book. Treatment of the 'insane' then became confined to asylums typified by the descent of Bethlehem Hospital into Bedlam by the early 15th century. In June 1816 Thomas Monro, Principal Physician, resigned as a result of scandal when he was accused of 'wanting in humanity' towards his patients.

Pinel in the age of reason

Philippe Pinel (1745–1826) initiated humanitarian reforms in the treatment of the mentally ill at the Pitié-Salpêtrière Hospital for women in Paris. He observed a strict nonviolent management of mental patients that came to be called moral treatment. He was dramatised in portraits as liberating the insane from their chains. His psychological approach was well thought out, behavioural, and tailored to the individual rather than the diagnosis. He assembled detailed case histories and a natural history of the progress of his cases. Pinel is seen as the physician who established the field that would come to be called psychiatry.

The empirical age

We are now in the age of evidence based medicine. Fortunately there is a mountain of evidence to support a humane, individualised approach to treatment of mental health disorders (Knoll 2013). The benefits of a pollution-free environment, nurturing homes, and safe schools and workplaces has a positive impact on mental health. Individual factors like regular exercise, moderation in diet, adequate rest, and recreation are still shown to improve mental health outcomes. Physical treatments and humanity still go hand in hand for the management of mental illness.

References:

1. Faria MA. Violence, mental illness, and the brain - A brief history of psychosurgery: Part 1 - From trephination to lobotomy. Surg Neurol Int. 2013 Apr 5;4:49. doi: 10.4103/2152-7806.110146. Print 2013. Accessed 03-Aug-2019
2. Lambrini K et al. Care for Patients with Mental Illness inAncient Greece. Top 10 Contributions on Nursing & Health Care: 2nd Edition. Chapter 1. 2018. Accessed 03-Aug-2019
3. Miller A. Jundi-Shapur, bimaristans, and the rise of academic medical centres. 2006. Accessed 20-Aug-2019
4. Kroll JBachrach Bhttps://www.ncbi.nlm.nih.gov/pubmed/6387755 1984. Accessed 13-Sep-2019
5. Wikipedia. https://en.wikipedia.org/wiki/Bethlem_Royal_Hospital . Accessed 02-Oct-2019
6. Wikipedia. https://en.wikipedia.org/wiki/Philippe_Pinel . Accessed 08-Oct-2019
7. Knoll JL. The Humanities and Psychiatry: The Rebirth of Mind. 2013-03-05. Accessed 2019-10-19
8. Somasundaram O, Raghavan V. Asylum for the fearful: A Jain innovation of the early Tamil land. Indian J Psychiatry [serial online] 2020 [cited 2020 Feb 3];62:107-8.