Happiness

What is happiness? 

Happiness is a state of subjective well-being which includes: 

1. An affective component - A feeling of joy or pleasure
2. A cognitive component - A sense of contentment and satisfaction of living a meaningful life

The Ancient Greeks knew them by the terms hedonia and eudaimonia respectively, and though distinct, the two strongly correlate in people who report being happy. Happiness is, therefore, not about jumping from one joy to another, but also a deeper sense of fulfilment. 

Each one of us is unique and is made happy by a different experience, yet some people tend to be happier than others even through hard times. Do happy people share some common traits? It does appear so. Those who report feeling happy are generally 

1. Open to learning new things 
2. Find joys in the small things in life. 
3. Have healthy relationships. 
4. Have fewer expectations and do not register small annoyances. 
5. Tend to go with the flow. 
6. Practice compassion, gratitude and patience. 
7. Exercise self-care. 

Temperament, personality traits and even genetics may determine our ability to be happy, and external circumstances do play a part, but much is under our personal control. Being aware of small pleasures, maintaining strong and healthy relationships, immersing oneself in challenging activities and finding purpose in life beyond oneself are ways in which we can find and nurture happiness. 

According to Seligman, happiness results from people becoming aware of their own personal strengths, taking ownership of them and living as per these ‘signature strengths’. 

Why happiness is good for us

Happiness is the single-most desired outcome across cultures and a priority for people across the world. 

• It makes for a higher quality of life
• A positive affect tends to improve our problem-solving abilities
• Improves physical health – better cardiovascular health and immune response
• Increases longevity

Association of happiness and wealth 

Most of us tend to associate happiness with wealth, belongings, success and status. However, beyond a point that enables us to fulfil our basic needs (food, shelter, safety and security), money has little correlation with happiness. 

An increase in income is almost always associated with increasing needs and desires, leading to a situation known as the hedonic treadmill, with no resultant increase in happiness. Indeed, there is a theory that each of us have a ‘set point’ of happiness, and quickly adapt to good or bad circumstances, returning to our baseline levels of happiness! 

In conclusion is Immanuel Kant’s wonderful yet simple Rules for Happiness.

 something to do, someone to love, something to hope for

References

• The Psychology, Theory, and Science of Happiness (+ 16 Best Articles) (positivepsychology.com)
• Psychology of Happiness - Psychologist World
• Happiness | Psychology Today 

Popularity

Popularity is neither fame nor greatness - William Hazlitt

Popularity is the quality of being well-liked, admired or supported by a number of people. But as we all know many popular people are not well-liked, and many well-liked people are not popular.

Psychologists therefore define two types of popularity which are related but distinct.

Sociometric popularity:

is how well-liked an individual is. This is strongly determined by who a person is – their personality and pro-social behaviours – empathy, kindness and helpful attitude towards others.

Perceived popularity:

is closer to the commonly understood concept of popularity and is dependent on what a person is – their looks, wealth, possessions. It is related to status within the social group.

Popularity also depends on the existing environment or social group one is currently a part of- a person can be popular among friends but not at work; at work among superiors but not among peers or subordinates.

Why do we crave popularity?

Social beings that we humans are, we need to belong. The desire to be part of a group, to be liked and to have status within it is innate. As children, these needs are mainly fulfilled by the family. In adolescence, we desire to be independent and free of parental control, so we seek belongingness in peer groups. Not all group members are equal, nor perceived equally. There is a hierarchy of interpersonal attraction, determined partly by personality traits (who we are) and a great deal by what we are (good-looking, highly visible, outspoken, having the latest gadgets, good in sports) which in turn determines popularity. Ironically, traits like aggression and dominance often increases status and perceived popularity within a peer group.

Adult outcomes 

Sociometric popularity or ‘likability’ often translates to better outcomes in adult life. Their ability to make a person feel valued and included makes for better relationships and makes them good team leaders at work. Those rated high on perceived popularity or ‘status’ are often not liked even as adults and may have a history of poor relationships, anxiety, addictions and aggression. 

To be part of a group and to be popular within the group is advantageous. There is acceptance, companionship, security and approval, which in turn increases our own sense of self-worth. However, there is a price to be paid for popularity. 

• Popularity brings with it the pressure to conform: to always like, behave and believe in the same things as others in the group. 
• Popularity requires pleasing others: when you fail to please you risk becoming unpopular.
• Popularity breeds insincerity: you may have to pretend to be what you are not.
• Popularity is precarious: there is always a chance that you may offend someone.
• Popularity is competitive and is likely to invite jealousy, envy and ill-will.

In today’s world, pursuing status has become a normal activity determined by the number of likes, retweets and followers on social media platforms. This encourages people to voice opinions which gets them more likes or retweets, not what they believe in. Status or popularity becomes more important than friendships, and even more important than integrity and honesty.  

It is better to be true to yourself, to feel confident and secure enough to be able to express your own individuality and have your own opinions rather than aim to be popular. 

It is also good to remember that popularity is not about friendship. Popularity is more about rank and social status. Friendships are about caring, respecting and valuing others. It is better to be content with a few close friends,  companions you can have fun with and to develop the capacity to enjoy your own company.

References

1. Speaking of Psychology: Why popularity matters (apa.org)
2. Adolescence and the pursuit of popularity. | Psychology Today
3. The Dark Side Of Adolescent Popularity -- ScienceDaily

Caring for Children during Covid-19 | Parent and Caregiver Guide

Covid-19 has changed the way children play, learn, and live. Children may become clingy, withdrawn, angry, or start bedwetting. What can parents do to help them cope?

Respond to them supportively and listen to their concerns. Give them plenty of love and attention. Make extra time with them and remember to listen. Speak kindly and reassure them.  Make opportunities to relax and play. 

Keep children in touch with their teachers, friends, and extended family. If hospitalization occurs ensure contact by phone or video. Reassure them. 

Regular routines and schedules are required. Create new routines for learning, playing, relaxing and sleeping. Parents of younger children can implement a reward system to help kids stick with their new routine. Praise them whenever possible when they are doing the right thing. 

Provide facts about what has happened and explain what is going on. Give clear information about what to do to stay safe in words they can understand.

Provide information about what could happen in a reassuring way. Let them know they or a family member may start not feeling well. They may have to go to the hospital for some time so doctors can help them feel better. 

Parents must take care of themselves. It is OK to seek support from friends and adult family members away from their children so they can speak freely. Children will react to parental cues about how to respond, both emotionally and behaviourally. 

The red flags are the same. Suicidal ideation, self-harm behaviours, violent acting out, or a big change in normal functioning need urgent assessment. 

Stay safe, and reach out

References:

1. https://www.who.int/docs/default-source/coronaviruse/helping-children-cope-with-stress-print.pdf
2. https://www.medscape.com/viewarticle/928331

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Schizophrenia—Evolution of Humanness

Is schizophrenia bound to human evolution? Schizophrenia is a neuro-developmental disorder characterised by delusions, hallucinations, and bizarre behaviours. No other animal displays these symptoms. Depression, addiction, anxiety are all found in other animal species, but not schizophrenia. Schizophrenia is not even found in chimpanzees our most recent evolutionary ancestors. It is inheritable, and highly disadvantageous to survival of the affected person. Given this, schizophrenia should be almost non-existent. Yet it continues to affect a massive 1% of the global population. Something is pushing for the persistence of this disorder and its spontaneous manifestation in humans.

Human evolution separated from the chimpanzees 5.5 million years ago when we walked upright and then acquired language abilities. Language ability developed after 'lateralisation', the separation of brain functions into the left (sequential) and right (parallel processing) hemispheres. The peculiar delusions and hallucinations of schizophrenia can be understood as failure of the complex brain mechanism that enables the speaker to distinguish his thoughts from his speech or that of others. This brain mechanism evolved with lateralisation of brain functions. Loss of brain laterality in schizophrenia has been demonstrated.

Comparison of the gene sequences of early humans and their close evolutionary relatives, the Neanderthals have shown that regions of the human genome that underwent positive selection are enriched by association with schizophrenia. This suggests that schizophrenia susceptibility factors may be a "side effect" of human achievements like language and creative thinking. 

Recent evolutionary modifications in brain wiring and connections may have played a role in the development of schizophrenia in humans. Compared to our closest living relative the chimpanzee, brain connections present only in humans show a higher involvement in schizophrenia. Evolutionary changes in the human brain related to supporting more complex brain functions are paralleled with a higher risk for brain dysfunctions that can manifest as schizophrenia.

However, this genetic susceptibility is actually reducing. A study comparing modern-human-specific gene sites with archaic ones has shown that schizophrenia-risk related genes in modern humans are much less than those in Neanderthals and Denisovans (archaic humans). So negative selection of schizophrenia risk-related genes are probably being gradually removed from the modern human genome.

References

1. https://en.wikipedia.org/wiki/Human_evolution
2. Crow TJ. Is schizophrenia the price that Homo sapiens pays for language? Schizophr Res. 1997;28(2-3):127–141. doi:10.1016/s0920-9964(97)00110-2
3. Crow TJ. Schizophrenia as the price that homo sapiens pays for language: a resolution of the central paradox in the origin of the species. Brain Res Brain Res Rev. 2000;31(2-3):118–129. doi:10.1016/s0165-0173(99)00029-6
4. Srinivasan S, Bettella F, Mattingsdal M, et al. Genetic Markers of Human Evolution Are Enriched in Schizophrenia. Biol Psychiatry. 2016;80(4):284–292. doi:10.1016/j.biopsych.2015.10.009
5. van den Heuvel MP, Scholtens LH, de Lange SC, et al. Evolutionary modifications in human brain connectivity associated with schizophrenia. Brain. 2019;142(12):3991–4002. doi:10.1093/brain/awz330
6. Liu C, Everall I, Pantelis C, Bousman C. Interrogating the Evolutionary Paradox of Schizophrenia: A Novel Framework and Evidence Supporting Recent Negative Selection of Schizophrenia Risk Alleles. Front Genet. 2019;10:389. Published 2019 Apr 30. doi:10.3389/fgene.2019.00389

Creativity

How do we define creativity?

Creativity is the ability of individuals to develop novel and useful products. Novelty, originality, innovation, ingenuity are some of the words often used to define creativity. But originality is just one component of creativity. There is another essential aspect of creativity – the idea should be effective, useful or productive. 

Creativity exists in many domains and is not just limited to the arts, as most people seem to think. Creativity is at work behind most scientific inventions, innovative gadgets, health technologies and economic theories which have changed the world.

Individuals differ in their propensity and capacity to be creative. Many of us are creative in small ways - in ways we find solutions to problems of everyday life. Only a few are highly creative and leave their mark on the world.

What does it take to be creative?

Creative individuals tend to possess some qualities or traits that may contribute to or are associated with their original thinking:

• Excellence: creative people are usually masters in their particular domains.
• Interests: they tend to be interested and curious about many things outside their main subject. This probably enables them to combine ideas or techniques from other disciplines in unusual ways to come up with novel, workable solutions to problems.
• Exploratory: They tend to be open to new experiences, ideas and ways of doing things.
• Motivation: most creative individuals are passionate about their interests and internally motivated.

Creativity is not about sitting and waiting for a sudden flash of insight or inspiration. This insight usually comes after much time spent in gaining knowledge and working hard at the task on hand. Discipline and perseverance are an essential part of the creative process.

As Edison famously said

Genius is 1% inspiration and 99% perspiration

High intelligence does not equate with creativity, however, creative people tend to have an above average IQ.

Can creativity be taught?

The generally accepted view is that creativity is not a set of skills which can be taught or learnt. However, certain habits, tools or strategies can be taught, and an environment that encourages and fosters creativity can be provided in our homes, schools and workplaces.

• Building basic skills and domain-specific knowledge
• Stimulating and rewarding curiosity and exploration
• Encouraging internal motivation, mastery and self-competition
• Providing opportunities and resources
• Promoting a willingness to take risks

Creativity and mental health

Those in creative, artistic professions tend to have a higher than average correlation with mental illnesses including schizophrenia, bipolar illness, substance abuse and suicide risk. 

Conversely, creative activities such as music, dance, art, journaling and poetry writing have been known to promote psychological well-being.

Does treatment of mental illness reduce creativity?

Treatment of mental illness could both help or hurt creativity. When treatment reduces fearfulness and avoidance it helps creativity. When it reduces motivation and flexibility it can hurt creativity. In practice there is usually a delicate balance that needs to be monitored. Some treatments are more effective at preserving creativity than others. Treatment that preserves goal-driven motivation helps all people, not only those in the arts field. As with most other aspect of health, physical exercise and adequate sleep help creativity.

Creativity is not all good nor all beneficial to society. A quick survey of the daily newspaper is enough to demonstrate how people resort to extremely creative ways to cheat, defraud or harm others.

References

1. Flaherty AW. Brain illness and creativity: mechanisms and treatment risks. Can J Psychiatry. 2011;56(3):132–143. doi:10.1177/070674371105600303
2. MacCabe JH, Sariaslan A, Almqvist C, Lichtenstein P, Larsson H, Kyaga S. Artistic creativity and risk for schizophrenia, bipolar disorder and unipolar depression: a Swedish population-based case-control study and sib-pair analysis. Br J Psychiatry. 2018;212(6):370–376. doi:10.1192/bjp.2018.23

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.

Parenting After Divorce

Almost half of all couples divorcing have a child under the age of 16 years. Parental separation results in a major upheaval in the life of a child. Apart from the loss created by the absence of one parent, there are usually major changes in living conditions, home, neighbourhood and school. Added to this are the psychological hazards of insecurity, loss of trust, anxiety, guilt and fear.

Psychological impact of divorce on the child

The psychological impact of divorce on the child is a complex issue. Several factors such as the manner in which the parents separated; the age and maturity of the child, socio-economic factors and support of family members determine the effect of the separation on the child.

Emotional and behavioural problems in children have been found to occur more often when the separation has been hostile and accompanied by much unpleasantness. A little sensitivity, a great deal of love and understanding and reassurance goes a long way in preventing emotional and behavioural disorders in the child.

Child’s Emotional Experience

Irrespective of their age, the child may feel

• A sense of loss.
• Sudden unwelcome changes in his life – change of school, neighbourhood and friends.
• Fearful (Who will look after me? What will happen if my mom leaves me?)
• Angry – at one or both parents for failing to look after him.
• Guilt and confusion – (Has this happened because of me? Am I responsible in some way?)
• Insecure and rejected – their world has fallen apart.
• Torn between feelings for both parents

Developmental Stage Reactions

A young child (less than 8-9 years) is more dependent on the parents for love, protection and security, and is likely to respond with more fearfulness and anxiety. There is also a greater tendency towards wishful thinking and hoping that the parents get back together. He/she may become more ‘clingy’ and dependent; and may have nightmares, stomach-aches, or may regress to bed-wetting. Attention-seeking behaviours may be aimed at getting the parents back may result in childish behaviours and tantrums. It is important to reassure the child, and establish a predictable routine to give him a sense of security and stability.

An older child or adolescent tends to respond with greater anger and may become oppositional or withdrawn. He may feel that his parents have failed to look after him, and start relying more on himself; and may retaliate by being more self-centred, independent and deliberately hurtful.

‘They don’t care about me, why should I care about them’

It may help to talk things over with an adolescent, and channelize his need for independence by giving him some responsibilities.

Strategies to Help Your Child

DOs

• Be open. The child has the right to know what is going on and what to expect. It should be explained in simple terms why the parents are separating and who he he/she is going to stay with (without giving specific unpleasant details) and he/she should be given age appropriate answers to any questions they may have.
• Reassure the child that he/she will always be loved and looked after by both parents.
• Protect the child from the unpleasantness, conflicts and arguments which may arise between you and your spouse.
• Take responsibility for the situation, and be careful not to blame the child.
• Make as few changes as possible to the child’s daily routine and caregiving, though some changes are inevitable.
• Get help from family members, friends and teachers. Social support gives a sense of security and belonging to your child and is equally important for you.

DON’Ts

• Don’t pull your child into the conflict – do not use him as a weapon, messenger or spy. It only serves to build up resentment in the child.
• Don’t ask your child to take sides.
• Don’t criticise, abuse or argue with your ex in front of your child.
• Don’t share your anger and frustration about your spouse with your child. If you need to vent your feelings, do it with a friend, family member or counsellor.
• Don’t discuss mutual pending matters (e.g financial or legal issues) with your child.

Remember, your child has the right to be loved, cared for and protected. He has the right to know about changes which affect him. Above all, your child has the right to grow up like other children his age. Create an atmosphere of trust, where he/she can talk about his/her feelings, ask questions and expect truthful answers. A supportive and caring parent-child relationship has been found to greatly reduce the negative impact of divorce.

Ref:

1. https://www.justice.gc.ca/eng/rp-pr/fl-lf/divorce/wd98_2-dt98_2/wd98_2.pdf
2. https://link.springer.com/chapter/10.1007/978-1-4613-9811-0_7
3. https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/information-for-parents-and-carers/divorce-or-separation-of-parents---the-impact-on-children-and-adolescents-for-parents-and-carers

Multiple Illnesses and Multiple Prescriptions—Clarify safety with prescribing doctor

People with a serious psychiatric ailment fall ill, just like anyone else does. They develop colds and coughs, fevers and stomach ailments. They may sprain their ankles, have headaches, develop indigestion after having too good a meal, rashes after trying a new cosmetic and food poisoning after eating some unhygienic street food. Like anyone else, they do one of two things: they buy an OTC medicine; or they consult a general physician.

Precautions with other prescriptions

Be careful with OTC preparations. Not all OTC medications are benign or free from side effects. Avoid drug combinations. Cough syrups (even ‘safe’ herbal ones) usually have a combination of many ingredients, including substances which are highly addictive.

It is usually better and safer to go for option two – visit your GP. It is a good idea to establish a trusted professional relationship with one particular GP who knows your medical history thoroughly. However, this may not always be possible.

Very often, the distress of the current ailment takes precedence in the mind of both the patient and the doctor; because of immediate discomfort, pain or distress involved.  It is all too common for a busy GP, to misguidedly tell you to stop your psychiatric medication, attribute your symptoms to your medication or to simply waive the responsibility - ‘tell your psychiatrist to change your medication.’ Also, don't stop any long term medication on the advice of a person who is not a qualified medical practitioner.

Many psychiatric illnesses are serious, long-term, and may be life-threatening; just like chronic medical illnesses like hypertension, diabetes, epilepsy or heart disease are. No doctor will ever ask you to stop the medications for these illnesses abruptly while he treats your fever or loose motions. He will prescribe a medicine which will not react adversely with those you are already taking. Insist that your illness be treated similarly.

Medications for psychiatric illnesses are relatively few, as compared to the number of antibiotics, pain relievers or cough medicines available in the market. They also have to be started at low doses and built up gradually until you have the most benefits with the least side-effects. It is a slow process, for which you have had to follow-up regularly with your psychiatrist usually over months. It is important that this process should not be derailed without due consideration.

Stopping your psychiatric medication abruptly

1. May cause the distressing symptoms to return i.e you may relapse.
2. More seriously, you may find that the original medication, on which you were stable and symptom-free has now become ineffective, and you may require stronger medicines and/or multiple drugs to treat your illness.
3. Even more seriously, you may wrongly attempt to restart your psychiatry medication at its full strength when you recover from your viral fever after a week. Do not do so. Serious side-effects may follow.

What to do when consulting another doctor

• Always take your previous prescription with you when you need to consult another doctor. The prescription from our clinic has the dose and generic name of the medicine you are taking (as best practices worldwide demand and as mandated by the govt).
• Check with your doctor that he has prescribed a medicine which does not react with what you are already taking. Numerous apps are available to check drug interactions, which most doctors are conversant with. It takes only a couple of minutes to do so and prescribe a suitable drug. It can take months to find a new psychiatric medication that suits you and is as effective as the one you are on presently.
• In case, there is still a doubt, ask him to speak to your psychiatrist. Professional courtesy demands so.
• If you have stopped your medication, do not resume it without guidance. Seek an early appointment with your psychiatrist.

World Mental Health Day 2018

World Mental Health Day

World Mental Health Day is observed every year on the 10th of October to take awareness of mental health issues into the community. The theme for 2018 was Young People and Mental Health in a Changing World^[1].

Pathfinder Clinic WMHD2018 Event

On World Mental Health Day 2018 Pathfinder Clinic psychologists manned a desk for the day in the atrium at Magarpatta City, Pune. They used a short mental health quiz to pique the interest of anyone entering the shopping complex and rewarded all participants with an origami patronus! They were also administered a test of their current resilience. Our psychologists engaged in over-the-counter discussions on what constituted mental health issues. People brought out their own family and interpersonal problems, and to many it was an eye-opener that mental health issues could be contributory.

Why focus on young people?

Young people don't vote. They often don't have a voice and depend upon others to champion their right to health justice. The growing prevalence of youth mental health problems is a tsunami, and parents, the community and governments float in a small boat, named “denial”, on the quiet sea^[2]. Most mood and anxiety disorders, and schizophrenia have their onset in this age group[3]. Investing in early intervention programs is not only beneficial for patients, but also cost-effective[4].

What is changing in the young persons world?

The increasing use of online technologies and growing connectivity to virtual networks through the day and night add to pressures faced by adolescents. It is unclear whether some of these changes affect normal aspects of human behavior and cause psychiatric disorders. At the other end of the spectrum are young people caught in humanitarian crises due to conflict and environmental disasters that can overwhelm the coping ability of the individual.

Building resilience in young people

Resilience in young people is determined by their personal and social resources. Engaging young persons in therapy builds resilience through processes of bouncing back and personal growth[5]. Resilience is also built through the process of enhancing immunity to stress by 'innoculation', especially if the prior stress occurs early in life, is mild in its magnitude, and is controllable by the individual[6].

References

1. WHO. World Mental Health Day 2018. Accessed 2018-11-03
   
2. Helen Christensen, 1 Charles F. Reynolds, 3rd, 2 and Pim Cuijpers. Protecting youth mental health, protecting our future. World Psychiatry. 2017 Oct; 16(3): 327–328. Published online 2017 Sep 21. doi: [10.1002/wps.20437]. Accessed 2018-11-03
   
3. Cornelius LR, van der Klink JJ, de Boer MR, Brouwer S, Groothoff JW. High prevalence of early onset mental disorders among long-term disability claimants. Disabil Rehabil. 2016;38(6):520-7. doi: 10.3109/09638288.2015.1046566. Epub 2015 May 14. Accessed 2018-11-05
4. Celso Arango. First-Episode Psychosis Research: Time to Move Forward (by Looking Backwards). Schizophr Bull. 2015 Nov; 41(6): 1205–1206. Published online 2015 Sep 20. doi: [10.1093/schbul/sbv126]. Accessed 2018-11-05
5. Ayed N, Toner S, Priebe S. Psychol Psychother. Conceptualizing resilience in adult mental health literature: A systematic reviewand narrative synthesis. 2018 Jun 11. doi: 10.1111/papt.12185. [Epub ahead of print]. Accessed 2018-11-16.
6. Ashokan A, Sivasubramanian M, Mitra R. Seeding Stress Resilience through Inoculation. Neural Plast. 2016;2016:4928081. doi: 10.1155/2016/4928081. Epub 2016 Jan 5. Accessed 2018-11-16.

Parenting an Adolescent

Adolescence is a time of transition. Most parents find themselves bewildered by the changes in their previously affectionate and obedient children. Mood changes, withdrawal, monosyllabic answers and arguments find most parents asking, “What have we done wrong?”

Adolescence is marked by profound changes brought about by the hormonal surge at puberty. The physical changes are accompanied by emotional, behavioural and intellectual changes to which the child has to adapt rapidly.

“As their bodies, brains and worlds rearrange themselves, you (parents) will need to do your own reshuffling.”

Changing role of parenting adolescents

The need for autonomy, independence and a search for one’s own unique identity is an essential part of adolescence. Often, this is achieved by questioning and testing existing rules and norms. Make space for this quest. Handle an occasional error of judgement with explanations rather than with accusations and confrontation.

The essentials of parenting at this age are

1. Trust
2. Empathy
3. Respect
4. Support

Trust is important in all relationships. Trust your teen to do what is right. As far as possible, avoid correcting them and pointing out mistakes. Allow them to learn on their own.

Empathise. Your adolescent child is often plagued by self-doubts and insecurities. Remember you were an adolescent once, and do not trivialise their problems.

Respect their need to be away from you, alone or with friends. Listen to their opinions and try not to be dismissive of their views and values.

Support. Assure them of your love and support without being intrusive; this will encourage them to come to you in need.

Parenting styles

An authoritative parenting style provides the adolescent with opportunities to become self-reliant within a set of rules, limits and guidelines appropriate for his/her developmental age. The personality and temperament of the child may also influence your parenting style (a co-operative and responsible teen requiring much less supervision). The environment (e.g an unsafe neighbourhood) can also dictate your parenting style. Privileges and limits may be set with the active participation of the child. It helps to state your expectations without ambiguity (what is acceptable behaviour and what is not), set clear limits and enforce consequences (loss of privileges) when limits are not adhered to.

When parents differ in their parenting styles.

One parent (often a father who is away a great deal) may tend to be permissive in his parenting. Adolescents (and children!) are quick to take advantage of differences between parents. It is important for the parents to arrive at a consensus privately and present a united front when dealing with limits and consequences.

Autonomy vs Monitoring

There are no hard and fast rules. Monitoring does not mean constant surveillance. Safety concerns entail knowing about the whereabouts of the adolescent outside school hours, friends they are with and contact information. A schedule to return home should be worked out. Similar limits should be set for time spent on social media. Be honest in communicating your concerns and avoid doing things behind their backs. It only leads to lack of trust and a tendency to conceal things from you.

Do not seek to control. Often, clashes between parents and adolescent children are about who has control. Adolescents struggle for control over what they feel is their own life, while parents struggle to hold onto the control they had earlier.

Peers

Sometimes, you may be uncomfortable with the company your adolescent keeps. Do not rush into judgements and accusations. Observe for yourself if there is a genuine cause for concern. Teach your adolescents to say ‘no’ to what they feel uncomfortable about. Explain the harmful effects of risky behaviour (alcohol, drugs, sexual activity) at a young age.

When to seek help

Repetitive problem behaviours and high-risk behaviours require professional help and guidance. Aggressive and violent behaviour, progressive academic deterioration, school refusal or truancy, lying or cheating demand immediate attention. Increasing moodiness, lack of communication, inattention to personal hygiene are other warning signs of psychological distress.

Making the Cut—Self-cutting in Adolescents

Self-cutting in adolescents is the strongest predictor for subsequent suicide attempts. It is a clear signal of severe psychological pain being released physically by the act of self-cutting. However, relief is only temporary, and if ignored self-cutting can progress to suicide.

Self-cutting and Suicide

Repeated self-cutting in adolescents is the strongest predictor of attempted suicide. 70% of those who self-cut will attempt suicide at least once. The number of suicide attempts increases with the number of years engaged in self-cutting (Nock 2006). The risk of attempted suicide is higher than with any other psychiatric disorder including depression and borderline personality disorder. Self-cutting may be a uniquely important risk factor for suicide because its presence is associated with both increased desire and capability for suicide (Klonsky 2013).

Ms LM, 15 years old, was brought by her parents for counselling after a suicide attempt. She subsequently revealed repeated self-cutting over the upper, inner thighs after sexual abuse two years previously.

Self-cutting and Psychological Pain

The majority of people who self-cut do so to relieve intense psychological pain. It occurs independently of a diagnosis of borderline personality disorder, or history of sexual abuse in childhood (Klonsky 2014). Self-cutting has a calming effect. (Klonsky 2006). This is much the same way as applying a balm, the superficial irritation suppresses the underlying deep pain. Individuals who self-cut continue to do so because it decreases feelings of anxiety (Haines 1995). Some people self-cut to punish themselves. A small minority self-cut for attention seeking or to escape from responsibilities.

Ms RX, 24 years old: 'When I cut myself  I feel calm, I don't feel the pain'.

Self-cutting Scars

The scars of self-cutting can trigger distressing memories of a time of psychological pain. Seeing self-cutting scars on friends or hearing of self-cutting incidents can induce the urge to self-cut.

Ms KJ, 19 years old, had a history of self-cutting since middle school and was now coping well in a professional course while staying in hostel. She accidently saw self-cutting scars on her room mate. Since then she is anxious and fighting urges to self-cut.

An increasing number of self-cutting scars is associated with presence of suicide ideation and a history of suicide attempts (Taylor 2016). Visible scars on exposed parts of the body can restrict career and social choices. Skin grafting may be required in some cases (Todd 2012)

Mr JS, 21 years old, underwent training and qualified for an initial pilots license. During medical evaluation for a commercial pilots license self-cutting scars were noted on his chest. He was medically disqualified as a hazard to flight safety.

Why do some people self-cut and not others?

Biology may have an answer. A particular gene for serotonin regulation (5-HTTLPR) may be defective. Youths who face severe chronic interpersonal stress and have the defectives gene self-cut more than those with the fully functioning gene (Hankin 2014). Those who self-cut have reduced autonomic and stress responses to anticipation of pain making them less likely to avoid it. They also have increased responses after pain which reduces feelings of numbness and distress, and increases body awareness. This combination serves to reinforce self-cutting behaviour (Koenig 2017).

Self-cutting is a unique physical marker of severe psychiatric problems. Approach a mental-health professional for treatment.

References

1. Rebecca C. Brown and Paul L. Plener. Non-suicidal Self-Injury in Adolescence. Curr Psychiatry Rep. 2017; 19(3): 20. Published online 2017 Mar 17. doi: 10.1007/s11920-017-0767-9. Accessed 2018-09-14.
2. Haines J, Williams CL, Brain KL, Wilson GV. The psychophysiology of self-mutilation. J Abnorm Psychol. 1995 Aug;104(3):471-89.
3. Benjamin L. Hankin, Andrea L. Barrocas, Jami F. Young, Brett Haberstick, and Andrew Smolen. 5-HTTLPR x interpersonal stress interaction and nonsuicidal self-injury in general community sample of youth. Psychiatry Res. 2015 Feb 28; 225(3): 609–612. Published online 2014 Dec 3. doi: 10.1016/j.psychres.2014.11.037. Accessed 2018-09-13
4. Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev. 2007 Mar;27(2):226-39. Epub 2006 Oct 2. Accessed 2018-09-12.
   
5. Klonsky ED, May AM, Glenn CR. The relationship between nonsuicidal self-injury and attempted suicide: converging evidence from four samples. J Abnorm Psychol. 2013 Feb;122(1):231-237. doi: 10.1037/a0030278. Epub 2012 Oct 15. Accessed 2018-09-11
6. E David Klonsky, Sarah E Victor, and Boaz Y Saffer. Nonsuicidal Self-Injury: What We Know, and What We Need to Know. Can J Psychiatry. 2014 Nov; 59(11): 565–568. doi: 10.1177/070674371405901101. Accessed 2018-09-13
7. Julian Koenig, Lena Rinnewitz, Marco Warth,Thomas K. Hillecke, Romuald Brunner, Franz Resch, and Michael Kaess. Psychobiological response to pain in female adolescents with nonsuicidal self-injury. J Psychiatry Neurosci. 2017 May; 42(3): 189–199. Published online 2016 Nov 29. doi: 10.1503/jpn.160074. Accessed 2018-09-13
8. Nock MK, Joiner TE, Gordon KH, et al. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts.  Psychiatry Res. 2006;144(1):65–72. Accessed 2018-09-08
9. Taylor A. Burke, Jessica L. Hamilton, Jonah N. Cohen, Jonathan P. Stange, and Lauren B. Alloy. Identifying a Physical Indicator of Suicide Risk: Non-Suicidal Self-Injury Scars Predict Suicidal Ideation and Suicide Attempts. Compr Psychiatry. 2016 Feb; 65: 79–87. Accessed 2018-09-11
10. Jodi Todd, Sara Ud-Din, and Ardeshir Bayat. Extensive Self-Harm Scarring: Successful Treatment With Simultaneous Use of a Single Layer Skin Substitute and Split-Thickness Skin Graft. Eplasty. 2012; 12: e23. Accessed 2018-09-11

Anger—effect on your child

Effect of Anger on your Child

Anger has a silent but permanent effect on your child. Anger can affect your professional life, harm relationships, and has significant health implications. But quite apart from how it affects you personally, it affects your children. Children of angry adults have been seen to be more aggressive, oppositional and non-compliant. They are also less empathetic; and display poor overall social adjustment. Delinquency and anti-social behaviour are also more common in such children.

Is anger hereditary or learned?

• A child experiences emotions from birth, but how he/she handles emotions is largely determined by learning. While a child may have an irritable temperament, no child is born with temper tantrums. A child learns that throwing a temper tantrum is rewarding (gets attention or gets him what he wants).
• From infancy onward, children learn by imitation. As parents, we are the first role models. Our children watch us; and then model their behaviour on ours. A child will for example; notice that we talk to our elders respectfully, but that we talk brusquely, even rudely to our maids. They will soon behave the same way.So it is with anger. Children observe how we react in difficult situations, how we react to provocation; how we deal with differences. Do we negotiate and listen to the other person’s point of view? Or do we react immediately and aggressively? Do we talk amicably and or do we get what we want by threats and abuses? How we behave and act today is what our children will emulate tomorrow.

What is the effect on a child when adults behave angrily in front of them? It depends a great deal on the age, developmental stage, personality and emotional maturity of the child.

• Young children, particularly, are scared and confused when they see adults who are ‘out of control’. When it happens often, they learn to think of this behaviour as ‘normal’; and they assume that verbal or physical aggression is the ‘normal’ way to deal with differences, to control others, or get what one wants.
• Very often, children are at the receiving end of parental anger. This may be due to unfair and unrealistic expectations that parents have from their children; or misplaced anger that has its basis somewhere else. Fear, insecurity, and poor self-esteem occur almost universally. Withdrawal, anxiety, depression are some of the negative consequences of such anger. This affects optimal performance in school and peer relationships. 
• Alternatively, the child may learn to defend itself by increasingly oppositional behaviour, bullying younger siblings or other children, or engage in other disruptive behaviours –truancy, aggression and violence.
• Parental anger deprives children of the basic need for security and comfort in their own homes. It also perpetuates the legacy of anger and aggression; conflict and fear.

Anger management strategies for interacting with children

• Stay calm when interacting with children. If you are fuming because you were held up in a traffic jam, cool off with a shower before interacting with your child.
• Physical abuse is a strict no.
• Try and understand the underlying issues behind your anger. Is your frustration resulting from an unsatisfactory day at work? Is your disappointment with your child’s academic performance related to your own expectations?
• Learn about your child—his needs, his temperament, learning styles, even the normal development process. This will go a long way in modifying your unreal expectations.

It is possible to break the destructive chain of anger and to create an environment of safety and security in your home for your children. Start today.

Biology of Anger

We all get angry at times. But some of us get angry often and what is worse, we do not seem to be able to control it. We lash out verbally and sometimes physically at objects and people around us. Can we do something about our anger or is it something over which we have no control?

Let us seek to understand the evolutionary basis of anger and what happens inside our brains when we are angry. Anger is usually provoked by a threat; either real or perceived. Our ancestors had to react (and react immediately) to survive; or to protect themselves or their resources. To take time to think would be to lose valuable time. So the brain evolved a mechanism for immediate action.

An almond-shaped area of grey matter deep within our brains - the amygdala perceives threat and generates the emotions of anger and fear. It raises an alarm, and kick-starts the body responses which we collectively know as “arousal”. Our heart beats faster to pump blood to our muscles, the muscles tense for action, breathing becomes faster and shallower, voice becomes shriller. Our face assumes the expression of anger (clenched jaw, lowered brows) as a warning to the adversary; much in the same way that a dog growls and bares its teeth when threatened. All this happens in a matter of seconds.

The frontal cortex, (the part of our brains responsible for conscious decisions) is by now aware of these bodily reactions and the threat perception. It evaluates the situation and the social context. Based on past memory, learning and our individual experience, it decides to respond in a particular way.

So what we have here is an immediate emotional response, and a later conscious response. An example will make things clearer.

• Imagine yourself at a crowded mall. Someone pushes you and moves on un-heeding. You will naturally be annoyed, your face will mirror your displeasure. You are aroused and vigilant - your muscles tense, you breathe faster. This is the immediate response. You realise though after a minute or so that it was probably accidental and think no more about it.
• On the other hand, you may remember that a friend had his wallet stolen in the same way, you may remember reading media reports about pick-pocketing, and you may be having a substantial amount of money in your wallet. Your reactions will be stronger. You may yell at the person, or may even push him in turn. Your conscious mind from past learning and in the present situation causes you to respond differently.

Our emotions; (anger, fear etc) are innate; but our response styles are mostly learnt. We may have seen the same kind of behaviour in our parents (our first role models) in childhood. Or aggression may be our reaction to abuse or bullying. Or we may have observed that anger is the best way to get what we want. Genes, gender (males are known to be more physically aggressive when angry), and our own personality traits also contribute.

Since emotional arousal occurs involuntarily, you may well ask “How can I have any control over my anger?” You can control the behavioural manifestations of anger.

1. Firstly, recognise the signs of anger and arousal. 
2. Then learn to consciously control these processes. Breathe slowly, lower your voice, relax your muscles, stop frowning. 

Does it help? Yes! When we consciously speak slowly and lower our voices, when we relax our tense muscles, when we wipe the frown on our faces and replace it with a smile, we influence activity of the emotional regions of the brain. fMRI scans show less activation in the amygdala. The arousal process is reversed. This is the science behind and the biological basis of anger management. Cognitive Behaviour Therapy further seeks to modify your perceptions – may be what made you angry in the first place, what you perceived to be a threat; was not so at all?

Impulse Control Disorders – Skin Picking, Hair Pulling & More

Skin Picking, Hair Pulling & other Impulse Control Disorders

Impulse control disorders are a treatable group of disorders which share a common feature. This is the failure to resist an impulse or temptation to do something harmful, either to oneself or to others. The person usually senses increasing tension or arousal prior to the act; and pleasure, gratification or relief following the act.

Common Impulse Control Disorders

1. Trichotillomania or Compulsive Hair Pulling
2. Dermatillomania or Skin Picking Disorder
3. Kleptomania
4. Compulsive Buying Disorder
5. Pathological Gambling
6. Internet Addiction

Trichotillomania in simple terms is compulsive hair pulling. There is a recurrent or persistent urge to pull out hair leading to noticeable hair loss – usually from the scalp but sometimes from the eyelashes and eyebrows. It occurs more often in females and starts in adolescence. Sometimes the person may do it consciously, but mostly she is unaware of it, doing it when she is alone; - watching TV, talking on the phone or reading. It may be triggered by stress but may occur even when a person is calm and relaxed. The loss of hair is distressing to the person and she tries to hide the hair loss by using a cap or a scarf. In extreme cases, she may avoid going out and all social situations.

Dermatillomania or skin picking disorder is a similar disorder. A person may constantly pick at real blemishes (acne, scars, moles) causing bleeding, bruises, infections or permanent damage to the skin. Sometimes a person will pick at imagined defects which no-one else can see. The face is the commonest area. It may be a conscious response to anxiety or depression, but is frequently done as an unconscious habit.

Both trichotillomania and dermatillomania can be effectively treated by various forms of CBT such as Habit Reversal Training, Stimulus Control Techniques or Cognitive Restructuring. Compulsive hair pulling may occur in schizophrenia, therefore a psychiatry consultation is advisable. Medications may be required in severe cases.

Kleptomania is probably the best known of the impulse control disorders and has been described from the early 19th century. There is an irresistible urge to steal objects but these are not acquired for personal use or monetary gain. The objects may be discarded, given away or hoarded. There is a sense of tension prior to the act of stealing and a sense of gratification during and following the act.

Compulsive buying disorder, first described in the early years of the 20th century, is a preoccupation with shopping and spending. 80-90% of those affected are women, and it is more common in developed countries where there is a wide availability of items, higher incomes and leisure time. These people tend to share certain characteristics - they frequently shop alone, usually on credit (having many credit cards), buy items they do not need and are often in debt. Buying urges are episodic and can be frequent (daily) or infrequent (less than a month). Four distinct phases have been identified, including

1. Anticipation - in which there are thoughts and urges of shopping or having a specific item
2. Preparation – the stage at which the person plans and decides when and where to shop.
3. Shopping – which is usually described as “intensely exciting”
4. Spending – which is accompanied by a sense of relief but often feelings of disappointment with oneself.

Many of these women have low self-esteem; and the shopping temporarily allows them to feel better about themselves. It also explains why items purchased are mainly clothes, shoes, cosmetics and jewelry.

Pathological gambling: More common in young men, a person suffering from this disorder has an intense urge to gamble despite severe and often devastating personal, family or work-related consequences. He is unable to stop even with an effort of will. He is preoccupied by thoughts and images of gambling. He needs to gamble with increasing amounts of money to achieve the same level of excitement and is restless and irritable when attempting to stop or cut back. These features of tolerance and withdrawal are similar to those seen with alcohol and drug abuse.

Internet addiction or compulsive/problematic internet use: though much highlighted in the media, this requires further study. What is known is that compulsive internet use can interfere with daily life, work and relationships. When a person feels more comfortable with his online friends than his real ones, when he cannot stop himself from playing games, gambling, internet shopping, or compulsively checking his laptop or phone; it is probably time to acknowledge a problem and seek professional help.

Diagnosis

Impulse control disorders share features with obsessive compulsive disorders and with substance abuse. It is important to see a psychiatrist to rule out co-existing or underlying disorders. Impulse control disorders also need to be distinguished from other medical conditions. Milder cases can be treated as outpatients with medication and psychotherapy. Severe cases such as those with pathological gambling often require admission in a rehabilitation centre.

References

1. Black DW. A review of compulsive buying disorder. World Psychiatry. 2007;6(1):14-18. Accessed 09-May-2017
2. Grant JE, Schreiber LR, Odlaug BL.Phenomenology and treatment of Behavioural Addictions. Can J Psychiatry. 2013 May;58(5):252-9. Accessed 10-May-2017
   
3. Trichotillomania – Symptoms and Treatment Accessed 09-May-17
4. Skin Picking Disorder (Dermatillomania) – Symptoms and Treatment Accessed 09-May-2017

Diet & Depression

Diet and Depression

Depression diets were first described in the 2nd millennium BCE. Special diets (including donkey’s milk!) were prescribed in ancient Greece and Rome; and nutritionists have since been looking for possible links between diet and depression. With 350 million sufferers globally; the search for effective treatment and prevention of depression is still on. 

Link between diet and depression

Many people with moderate and severe depression are known to consume food of poor nutritional quality. This is often due to the symptoms of depression itself; such as the loss of appetite; lack of interest in day to day activities; and lack of motivation for self-care. Age, living alone, irregular and hectic work schedules, socio-economic status, cultural and religious taboos may further affect the quality of the diet.

The food we eat is broken down to its simplest forms in the intestines. The nutrients are then used to provide energy for the body and brain; and to synthesize essential compounds. Among them are the hormones and neurotransmitters which act as messengers in the brain. A lack of supply in the diet will therefore certainly affect production of these chemicals.

Bacteria present in our gut help in the breakdown, absorption and even in the synthesis of some of these essential compounds. The type of food we eat, in turn, affects the type of microbes in the gut Thus, there seems to be an important link between what we eat; the microbes in our gut, and all aspects of our health, including mental health.

What are the essential elements of the depression diet?

A diet including whole grains, leafy and colourful vegetables, fruits, nuts and legumes, high quality protein in the form of seafood, chicken and lean meats has been found to be positively correlated to mental health.

• Whole grains contain complex carbohydrates, which are linked to the mood boosting neurotransmitter serotonin. Complex carbohydrates break down slowly in the body, lead to steady levels of glucose in the blood and thus avoid mood fluctuations.
• Proteins of high quality as in egg whites, chicken, fish, milk products, soy products, beans and legumes are the source of the amino acid tryptophan, which is the precursor of serotonin. Trace minerals - selenium, chromium, and zinc, present in beans, legumes, lean meats, dairy products and whole grains are also linked to the brain and mental health.
• Anti-oxidants combat the free radicals which cause cell damage in the brain. Rich sources of anti-oxidants are coloured vegetables such as pumpkin, carrots, spinach(containing beta carotene), citrus fruits, tomato, potato, guava (containing Vit C); nuts, seeds and vegetable oils (having Vit E)
• Omega 3 fatty acids play an important role in mental health and may be used as a supplement in depression. Mammals do not synthesize omega 3 fatty acids and depend on dietary sources which include fatty fish, flaxseeds, and nuts (especially walnuts).

Vitamin D and Depression

Low Vitamin D levels are often seen in depression, but no definite causal association has yet been found. Depression itself may cause low Vitamin D levels, as people with depression are less likely to go outdoors. It would be sensible to correct Vitamin D levels and include fish oils, fish and dairy products in the diet, but use supplements with caution.

In conclusion

Depression cannot be prevented or cured by a special diet. However, a sensible diet including whole grains, proteins, fresh fruits and vegetables will keep you looking and feeling good. Limiting refined starches (the so-called “beige diet” pasta, pizza, bread, baked goods), caffeine, and alcohol also has a beneficial effect on mood. Do not go for any extreme or ‘fad’ diet. It will only add further to your stress and anxiety. A recent study of depression patients shows that diet does not prevent, cure or relieve depression, but diet may have a significant role in recovery and prevention of depression

Diet and dietary supplements are never a substitute for a therapist.

References:

1. Democritus Junior (Robert Burton). Anatomy of Melancholy (1652). Project Gutenberg release date January 13, 2004. Accessed 08-May-2017
   
2. Rashmi Nemade, Natalie Staats Reiss, Mark Dombeck. Historical Understandings Of Depression. Sep 19, 2007. Accessed 08-May-17
3. Rao TSS, Asha MR, Ramesh BN, Rao KSJ. Understanding nutrition, depression and mental illnesses. Indian Journal of Psychiatry. 2008;50(2):77-82. doi:10.4103/0019-5545.42391. Accessed 08-May-2017
4. Drew Ramsey. Prescribing a Diet to Treat Depression. February 03, 2017. Accessed 08-May-2017

Did you know? Many celebrities and historical figures have suffered from depression. Writer JK Rowling, musicians and singers Lady Gaga, Bruce Springstein, Sheryl Crow, actors Robin Williams, Jim Carey, Gwyneth Paltrow, astronaut Edwin ‘Buzz’ Aldrin suffered from depression. Abraham Lincoln, also a sufferer, once said “If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth.”