Psychiatry and Society

Caregivers of persons with chronic mental illness are usually family members, 'individuals whose own happiness is entwined with the well-being of people who are dear to them'. The burden of care is associated with significant stress. For one family the stress was unbearable. They abandoned their mentally ill daughter in a hospital . This story is repeated often enough in urban areas like Pune. How can a caregiver help a relative with mental illness? DOs Follow the treatment See to it that the person takes the prescribed dosage of medication regularly. Failure to keep to the dosage may lead to a relapse of the illness. Watch for a relapse A person in your care may suffer a relapse for no obvious reason. Watch out for early signs such as sleeplessness, restlessness, and irritability. Take the person immediately to a psychiatrist, so that medication may be adjusted. Take interest and appreciate Talk to the person. Show an interest in what he or she is doing. Apprec...

A Pune school joined the ranks of those in which a punished and humiliated teenager committed suicide. A teenage life snuffed out by the psychological pain of humiliation. It was apparently over his talking with a girl student. He was thrashed by the school principal, two teachers and the girl's uncle. This was not punishment - it was physical abuse. The boy did not return home after school. His father, a labourer, went to the school to look for him. The next morning the teenager’s body was found on the railway tracks. Labourers moving to their work-site Behaviours perceived as undesirable by teachers The chain of events in this suicide apparently begins with the teenager talking to a girl student - normal adolescent behaviour. It is in the stage of adolescence that opposite-sex social interaction begins. A co-ed school would be the ideal place for this adolescent interaction. Yet this behaviour was perceived as seriously undesirable by the school authorities. Let’s loo...

Last week I gave a talk on Personality and Sexuality. One question that cropped up was - "How do I know if my partner is cheating on me?" By chance the next morning there was a newspaper article attributing uncommitted sex, one-night stands, and acts of infidelity to genetics. Individuals who have frequent sex with multiple partners are psychologically different from those who have frequent sex with single partner (Simpson & Gangestad, 1991). This sociosexual difference places individuals in two groups Unrestricted sociosexual types , have a higher number of sexual partners, and one night stands. They have a permissive attitude to casual and uncommitted sex. Restricted sociosexual types , require greater closeness and commitment before sex with their romantic partner.   Genetics plays an important role in sociosexuality Genes evolve to enhance survival of the species. From an evolutionary viewpoint females reproduce with a mate who will invest in ...

Autism, in its broadest interpretation, has a prevalence of about 1:110 population. There is a severe shortage of early intervention facilities for persons with autism in India. World Disability Day is commemorated on 3rd December. Autism is not specifically included as a disability in the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995. This may be contributing to the lack of funding for early intervention facilities. Protodeclarative pointing - joint attention   Disability in autism manifests during infancy in three domains Social - Infants with autism show delays in smiling, gazing at their mothers and responding to their names and gesturing (e.g., pointing, waving bye-bye). This pattern continues, with the most impaired children growing to be avoidant or aloof from all social interaction. Communication - Infants and toddlers with autism have delays in babbling, using single words, and forming sentences. Effective...

Codeine is methyl-morphine Corex Cough Syrup contains codeine  – an addiction causing opioid. One 100ml bottle of codeine containing Corex cough syrup has the same effect as a 30mg tablet of morphine. The drug belongs to the same class of substances as heroin. Medicines are routinely purchased   over-the-counter   at most pharmacies in Pune and cough syrups very frequently so. Always read the fine print. Codeine suppresses the cough reflex through a direct effect on the cough centre in the brain stem. However, there is little evidence in the medical literature to support its use as a cough suppressant. Several studies show that codeine does not reduce cough frequency, intensity, or duration (Herbert & Brewster, 2000). Patients who are prescribed Corex cough syrup or those who buy it over-the-counter are not warned of its addiction potential. They subsequently continue using it as they 'feel restless and anxious' without it. These feelings are part of t...

Last Sunday, 14th November was Children's Day. The papers and supplements were full of articles about children and how to parent them. The need to let the child do whatever he or she wanted to do was stressed. Some articles went so far as to highlight families where the child's every whim was indulged. Until a worried parent of a five-year-old asked our counsellor Is discipline harming my child? The message from these articles being If you love them set them free - from your control Does it actually matter as to how you parent your child? Well, there are some associations between parenting styles and outcomes for the child. 4 Parenting Styles based on Responsiveness and Demands The concept of parenting style  has evolved through three major influences The differentiation of parenting style into four types based on " parental responsiveness " and " parental demandingness " by Maccoby and Martin (1983). The neglectful style where the pa...

Woman booked for attempting suicide A 21-yr woman attempted suicide by jumping from the fourth floor of the gynaecology ward she was admitted in. She could not stand the pain of complications after a Caesarean Section. Section 309 of the Indian Penal Code was slapped against her by the police. 612 people committed suicide in Pune in 2008. This gives a documented suicide rate in Pune of 16.3 persons per 100,000 population . The national suicide rate is 10.8/100,000. This data is based on police records. A verbal autopsy study (1994-99) estimated an actual suicide rate of 95.2/100 000 population —nine times the national average. This tragic incident and its background needs further analysis How common is attempted suicide in a 21 year old woman during and after pregnancy? The suicide rate for 15–24 year females is 109/100000 . This exceeds the male rate of 78/100 000. Suicide is responsible for 49% of all deaths in women at these ages. During pregnancy attempted suicide is ...

Some excerpts (reproduced with permission) from responses to my last post. " My Dad was a closet alcoholic " " ...asking for help on alcohol consumption for my friend's son who will soon turn 19 years...parents now try to monitor his timings, where he is but he is slippery and generally seems to be ahead of them. " People may know that a loved one requires help with an alcohol habit or other behavioural or emotional problem. The reluctance to seek help is mainly due to the stigma attached and the individuals lack of insight (blindness to the presence of the illness). How does the family or society (a neighbour) get the person to a psychiatrist or other mental health professional? Individual choice and potential for harm are in the balance I've listed out some methods  - by no means exhaustive - used successfully by other caregivers. They are in descending order of individual choice and autonomy. Use your discretion. How to get a ...

The legal age for obtaining an alcohol permit (yes, that's a prerequisite for alcohol consumption in Maharashtra) is 25 years. However, a recent survey of teenagers in major Indian cities including Pune would have us believe that 45% of Class XII students consume alcohol five to six times a month. Adolescence is characterised by experimentation The maturing adolescent brain with its new tool of abstract reasoning seeks to explore the environment and reach its own conclusions regarding the world. Experimenting with socially acceptable intoxicants is just another facet of this behaviour. So, whether legal or otherwise, some of Pune's teens will continue to consume alcohol. When does alcohol drinking become problem drinking? Is it to do with the frequency? If 5-6 times a month is excessive would 2-3 times be alright? Is it OK to drink alcohol in groups but not OK to drink when alone? When would it be time to seek help? How would a teenager know the experiment has gone out of con...

A family tragedy was played out through a small article in the Pune news . In a fit of rage a mentally ill woman set her daughter alight while she was asleep. The narrative was short and the item tucked into one of the inner pages under a largish headline.  This was the reason - the why - mental illness     A glib explanation for a horrific event lays the entire burden of its causation at the doors of a mental health disorder. The World Health Organisation  (WHO) has estimated that one in four persons  will have a mental health disorder at some stage of life . Violence is rarely a manifestation of mental illness In this rare cause of burning (mental illness), the burning of her daughter is an indicator of the severity of the mother's mental illness. Yet society, of which this news item is a barometer, has unquestioningly accepted mental illness as a sufficient cause. In a nation with about 0.48 mental health workers of any kind  for every 100...