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Articles by Dr. Dubey on mental health.

Parent in midlife with teenage son

Parenting in midlife: Preventing teenage suicide

“I guess this is our last goodbye
And you don’t care, so I won’t cry
But you’ll be sorry when I’m dead
And all this guilt will be on your head
I guess you’d call it suicide
But I’m too full to swallow my pride
I can’t, I can’t, I can’t stand losing
I can’t, I can’t…

(https://www.sting.com/discography/lyrics/lyric/song/108)

Many parents currently in their midlife may be familiar with these lyrics from a 1978 Police song. Similar threats have been made by teenagers in real life. But, to parents and other adults, they seem like immature, empty threats to be ignored. On the other hand, suicide is frequently linked with clinical depression. Major depression is a mental illness that sometimes burdens one with such intensely negative thoughts that suicide seems like the only escape.

Most of the time teenagers who hurt themselves do not want to end their lives. They just want to put an end to the painful emotions they are experiencing. And, it is only chance that separates an attempted suicide from a fatal suicide. Hence, midlife parents who have teenaged children have to view all suicidal behaviours and threats as calls for help.

All teenagers do not think of harming themselves. And, the good news is that we now have a better understanding of why that is so. We have also been able to identify factors that make some teenagers more vulnerable to suicidal thoughts. This gives us many opportunities, as parents in midlife and adults, to intervene. To make changes that help reduce the pressure young people go through. To be more involved in kids lives, to listen, understand and support them through their struggles.

Risk factors for suicide amongst teenagers

Researchers have identified the following suicide risk factors that midlife parents can watch out for. Many teenagers who meet the following criteria may never hurt themselves. But the following factors do increase the chances of some young people attempting suicide.

ALERT Factors:

The following are common factors that increase the chances of a teenager attempting or completing suicide at some point in time.

– Having made one or more suicide attempts in the past
– Having been diagnosed with depression or bipolar disorder, eating disorders or tendency to behave in an aggressive-impulsive way
– Engaging in alcohol, drug or substance abuse of any kind
– Being 16 years old or older ( kids this age are more independent and not constantly monitored )
– Being a boy – While both boys and girls attempt suicide, boys tend to use more lethal means
– Having experienced abuse of any kind, including sexual or physical abuse
– Being gay or transgender
– Not having supportive relationships, that is, friends and adults they feel comfortable reaching out to for help.
– Relationship issues that includes family discord or fighting, bullying or being ostracised at school.
– Financial problems
– Suicide contagion – young people tend to get influenced by media coverage of suicides, especially those involving famous people or celebrities. They are also influenced by suicides committed by family members, people in their neighbourhood, school or others who seem to have a similar background or issues as them.

RED ALERT Factors:

The following factors show that a young person is currently in great distress and may attempt suicide. Parents need to keep a particularly close watch on a young person who shows any of the following. Getting help for their child as well as for themselves becomes crucial at such a time.

– Showing a drastic change in personality. For example, from being a social, outgoing, confident young person, becoming very reclusive, irritable, angry or withdrawn.
– Having recently undergone some kind of a socially stressful situation. For example, public humiliation, bullying, break-up, or something viewed as a big failure/loss
– Expressing thoughts around death and dying in conversations or through writing.
– Loss of ability to think clearly and logically.
– Extreme feeling of hopelessness.
– Overwhelming emotional pain or distress.

Factors that protect teenagers from suicide

Research has shown that there are two specific family related factors that protect children from suicide. These include:

Family connectedness:

Warm and caring behaviours are the hallmark of well connected families. Such families are able to role model better coping behaviour. Family members are able to openly express their feelings. They also tend to resolve differences in more constructive ways. Family members talk and share what is going on in their individual lives. They know each other’s internal and external worlds. And, they are able to offer support to each other through difficult times. In addition, stable family relationships provide a sense of stability and security to a child that helps in his/her emotional growth.

Most parents instinctively do what is right for their child. But parenting teenagers is undoubtedly a very demanding and complex task. So, if you feel concerned about your child or overwhelmed with the issues he/she is facing, reach out for trained, professional help. Also, try to create a support system of caring grown ups for yourself and your child.

If your relationship as a couple in midlife is rocky, it is likely to have an impact on your child. Therefore, it is crucial that you get help in order to sort out your own relationship issues. It is never too late to start creating a sense of family connectedness. Even if you do so in midlife.

Emotional wellbeing:

As parents, suicide prevention really begins with knowing one’s child. Who is he, how does she cope with emotional ups and downs, who are his friends, what is her everyday life like, is he getting bullied, is she having trouble with making friends, is he anxious about his studies, has her behaviour or academic performance undergone a change? The chin-up and deal with it strategy that schools and parents offer to young people, as that is the easiest, often fails.

Emotional wellbeing is the immunity that needs to be strengthened so that the young person can take on the ups and downs of life. Young people need caring grown ups to learn from. Young people need role models they can talk and interact with. Role models who demonstrate constructive coping behaviour. Young people need parents who can listen and try and understand their world. Young people need real people and time. None of this can be replaced by technology or child minders or technology as child minder.

One needs to listen to, try to understand, and help children problem solve from an early age. Warm, caring relationships foster emotional wellbeing. And, parents play the most crucial role in creating this warm, caring environment for their children. In order to do so, however, parents need to take care of their own emotional wellbeing first.

If you as a parent in midlife are finding it difficult emotionally to cope with challenges at work or home, get help. If you often feel overwhelmed by midlife issues or are resorting to food, alcohol, drugs, gambling, the internet or any other addictive behaviours to cope, then also seek help. If you feel angry and irritable often and take it out on your spouse or children, it is important to seek help.

It is important to address your personal issues not just for your own wellbeing but also for your child’s emotional wellbeing. If you are not feeling emotionally healthy you will not be able to help your child build his/her emotional immunity. In addition, you are the most important role model in your child’s life and he/she will learn how to cope with situations from you.

Systemic or Societal level changes:

– At a societal level, adults need to be mindful of the language we use and the coping strategies we adopt when faced with difficult situations.

– The media needs to be responsible in the way it covers news of suicide. Media guidelines have been developed internationally that describe how media should report on suicides. For example, the Austrians realised that there was in increase in suicides after the media reported on some subway suicides in Vienna in a sensationalized manner. They then developed and implemented media guidelines for reporting in suicides. After these guidelines were implemented, the numbers of suicides fell. Studies looking at the number of suicides four years after these guidelines were implemented found that the number of subway suicides had reduced by 75 %. The total number of suicides had also reduced by 25%.

– Health professionals who come in contact with teenagers need to be trained to identify signs of depression and potential for suicide. Appropriate help needs to be made available. Currently in India, very few psychiatrists and clinical psychologists are adequately trained to work with teenagers. If a teenager has to be given psychiatric medications, it should only be administered by a child and adolescent psychiatrist. These medications can affect young people in ways that are very different from the way they affect adults. Sometimes the effects can even be harmful.

– In rural India, agricultural pesticides are often bought and stored in large quantities. These become the most popular means of impulsive self harm when a person is upset. Selling pesticides and medications in packaging that is not easy to open may help, especially when the suicide attempt is an impulsive act. Parents need to store pesticides and medications in such a way that young people do not have easy access. Similarly restricting access to other means of suicide wherever possible may also help. For example, placing safety barriers around places, such as, train stations, bridges, etc., where suicide attempts are known to occur.

– Schools can also be places that can foster better coping behaviour amongst children. In India, the biggest challenge in rural and urban schools is curbing the culture of violence. Teachers need to become more sensitive towards their students. Bullying needs to stop. Tolerance for differences and cooperation engendered.

Aside from being diagnosed with a mental illness like depression, there are many other factors involved in teenage suicide. The good news about that is that it gives us many opportunities, as parents and adults, to intervene. To make changes that help reduce the pressure young people go through. To be more involved in kids lives, to listen, understand and support them through their struggles. To model better behaviour and encourage better ways of coping. To stop glorifying suicide or sensationalizing it on and off screen. This is why it also becomes crucial for parents to know their child’s temperament and the child’s world – the child’s friends, the status of their relationships, their activities, their interests, their worries, their ambitions, and through it all be a supportive presence. Be a stabilising presence.

Resources:

If you or someone you know is currently in great emotional distress or have suicidal thoughts, please seek help.

Some suicide prevention helplines in India are:

www.snehaindia.org
24 hours suicide prevention helpline. Call 91-44-24640050
Email: help@snehaindia.org

Vandravela All India 24 hour Mental Health Helpline: 1860-266-2345 / 1800-233-3330
Email: help@vandrevalafoundation.com

TISS iCALL Psychosocial Helpline
Telephone based counseling: 022-25521111 (Monday to Saturday, 8 AM to 10 PM)
Email based counsellling: icall@tiss.edu
Chat based counseling: nULTA App ( Monday to Friday, 10:30 AM to 5:30 PM)

If you live in any other country, you can get a list of country based suicide helpline numbers at:

www.suicide.org

If you are looking for ways to have a helpful conversation with someone who may be suicidal, you can take a free suicide prevention training at:

https://www.zerosuicidealliance.com/

If you are a media person and are looking for media reporting guidelines, you can visit:

http://www.who.int/mental_health/prevention/suicide/resource_media.pdf

Parenting in midlife: Understanding Teenage Suicide

Parenting in midlife: Understanding teenage suicide.

“I will kill myself and blame it on you,” said one upset teenager to another. The other responded, “You wait and see, I will kill myself before that and blame it on you.” She then actually carried out the threat. This conversation is not from a soap opera on television. A parent’s worst nightmare – this is a true incident that happened between two school friends in rural India. And the girls were not on Blue Whale or any such app.

Luckily, medical professionals were able to save the girl’s life. But the school authorities asked her to stop coming to school. They did not want to deal with liability issues. The same school had lost a male student to suicide in the previous year. The rumour was that the boy had consumed pesticide because he was infatuated with a girl and there were some problems because of that. The same boy had lost his young male cousin to suicide a few years earlier. The reason for that suicide was apparently the same – love life issues. Infatuations and love affairs are highly disapproved of in rural Indian society. None of these kids showed any signs of clinical depression.

But this is not a scary scenario that only rural parents deal with. Over the past year, coincidentally, I worked with two 16 year old girls – both of whom had attempted suicide. One has a history of cutting, while the other has attempted suicide before. For both, the recent episode was triggered by a fight with other kids in school. The girls belong to families that are on opposite ends of the socio-economic spectrum. One studies at a well known, high end, private boarding school. The other studies at a rural, government school. Both seem to have concerned, caring parents. And both seem to have a decent relationship with their parents.

For parents of teenagers, this brings up many questions. Why do some teenagers play these life and death games? How does the thought of killing themselves as a way of proving a point, making a statement, or scoring one on the other, enter their minds? Teenagers have their entire lives ahead of them, why then do some feel that they have nothing to live for? Or, why do they believe that their current situation will never change and their problems will never be solved?

Parents often wish to think of childhood and youth as a care-free time. By the time their children are in their teenage years, most parents have hit midlife. In midlife, it is often difficult for parents to remember what their own teenage years were like. In addition, midlife typically brings its own specific stresses and strains. In the midst of dealing with their own midlife issues, most middle aged parents tend to look back at their own teenage years with nostalgia. But the fact is that teenage years are not an easy time for most young people. They go through as much anxiety and stress as adults do, albeit of a different kind. And they often deal with these stresses without the needed coping skills and support systems. Some facts to consider are:

Intense emotions

Parents often complain about their teenaged children blowing hot and cold, emotionally. The reason for their confusing behaviour is that teenagers experience their emotions more strongly than adults do. Hormonal fluctuations and a still developing brain are most often blamed for this phenomenon. Whatever be the exact reasons, most teenagers feel happiness with as great an intensity as sadness, disappointment, anger, and so on. As a parent it is important to understand that young people often get so deeply immersed in their feelings that it is difficult for them to take perspective. At such times, it is difficult for them to believe that there can be an end to their anger or sorrow.

Impulse control issues
Everyone – parents, schools, and teenagers, themselves – expects teenagers to behave very maturely. But the fact is that while they may have achieved their full height, their brain still has catching up to do. One of the biggest challenges for teenagers is learning to control their impulses. This challenge often infuriates and frustrates parents. Research has shown that young people usually know what is good for them and what is not. However, when faced with tempting but harmful choices, such as, drug/alcohol use or premature sexual behaviour, they are unable to make the right decision. So, knowledge and information often falls short in keeping them safe.

Inadequate coping ability

We, as parents, spend years figuring our what is the best way to cope with situations and build relationships that we can lean on in times of trouble. Despite that, we get into trouble – often relying on excess food and/or alcohol to help us feel better, even in midlife. Adolescents are just starting out on this journey of figuring out how to cope with the myriad situations that life can throw one’s way. They obviously have a long way to go. A lot of young people do not have role models or parents/other adults who can model healthy behaviours. More importantly, many young people do not have the kind of relationship with one or more adults that they need to be able to seek out or accept the adult’s help. This leaves them to their own devices, especially when they are confused about how to handle situations, stressed or in trouble. If they are able to find their path, they are lucky. If not, they are lost.

Negative peer influences

Like young birds learning to fly, teenagers have to make their tentative leaps at independent decision making. During this time they often rely on others of their age for guidance and support. One’s friends can, therefore, be a very big source of influence and determine whether one choses to act in ways that are harmful or beneficial for oneself. The good thing is that nature has made us all developmentally unequal – we learn to walk, talk and become capable of mature decisions at different ages. While we all catch up and eventually learn to walk – this inequality means that an immature 16 year old may become friends with a more emotionally mature 16 year old and learn from them. However, the reverse also happens or a bunch of equally immature kids become friends, leading themselves and each other into trouble.

Thinking in extremes and catastrophizing

While the teenage years are romanticized, they are often the most anxiety driven years of a person’s life. The rat race starts young. Teenagers experience pressure from parents, school, friends and themselves. They experience performance pressures, social pressures and the overwhelming belief that it has to all work out now, or never. Thinking is in black and white and all mistakes, shortcomings, flaws, failures, including failed romances, are catastrophized. Doom and gloom is predicted whether one loses a percentage point or gets a pimple on one’s face. Many young people believe that if they do not get a specific percentage in the board exams or do not get admitted to a specific college, they are doomed. If they are not clear about their career goals right now and have not charted an educational path right now, they will be career-less.

Instead of helping them moderate this tendency to think in extremes, most parents and teachers reinforce it. For example, parents often hold the mistaken belief that scaring teenagers with dire consequences will motivate them to study harder. In addition, teenagers go through peer pressure to conform. To be considered “popular” or worthy of being admitted to a group ruled by “popular” kids, makes many a teenager’s life miserable. No wonder then that this pressure cooker like atmosphere makes it difficult for some to live.

Societal contribution

The idea of suicide often comes from external sources. For most kids, unfortunately, the sources are many. These include apps/games like the blue whale app, reading or hearing about suicides through the media, and having a family member, classmate or known person commit suicide. Children who grow up in rural areas in India are often surrounded by stories of suicides committed by grown-ups known to them. The reasons reported may include shame, financial difficulties, loss of any kind, failed love relationship, etc. A young girl recently told me that whenever her parents get into an argument with each other, one or the other threatens to kill himself/herself. If we, as adults, portray suicide as a way of dealing with various situations, it is no surprise then that young people also resort to thinking about, threatening, or attempting suicide as a way of dealing with their problems.

Not just depression

These days, most people, including the media, seem to think that all people who commit suicide are depressed. It is a fact that people diagnosed with psychiatric disorders, such as, moderate to severe clinical depression, bipolar disorder or schizophrenia are vulnerable to suicide. However, all people who commit suicide do not meet the criteria for a mental illness. Often, teenagers carry out suicidal acts on an impulse when under severe emotional stress. Such kids feel extreme emotional pain and just want to stop feeling the way they do at the moment. If they survive the suicide attempt they often state that they did not actually want to kill themselves. They only wanted to put an end to their emotional distress.

Physical, sexual or emotional abuse can place a young person under great emotional stress. But even if a teenager was saved from traumatic experiences, the reasons given above may place some teenagers in an emotionally vulnerable state. A state or point in time when suicide seems to be the only option available. Because it is nearly impossible to guess or predict someone else’s state of mind, even if it is your own child, parents need to think of prevention.

Watch out for the next blog post on teenage suicide prevention.

Binge Drinking in Midlife

“He didn’t show up for any of the meetings yesterday or today. I saw him at the beginning of the party day before and he seemed fine. He has not called in sick or returned any of our calls.” This is not the beginning of a murder mystery. This is a conversation about a middle aged binge drinker.

Social drinking has caught on in India. Friday night is synonymous with ‘getting drunk’ for many young, urban Indians. As the years go by, some people who binge drank in their youth may change their ways. Others, unfortunately, continue binge drinking into midlife. A 2009 multi-country study (GENACIS) reported as much. The study confirmed what we all know: Men in India drink much more and drink often compared to women. But the study also found that middle aged binge drinkers in India include both men and women. And both genders’ tendency towards heavy drinking only worsens with advancing age.

The binge drinkers I am talking about here may have once been the up all night partying types. But most people who binge drink into midlife stop being social drinkers. They don’t drink in the company of others. They mostly drink alone. Or, they may have a drink or two at a social gathering. And, they don’t stop at that. They come back home to continue solitary drinking for the next 24-48 hours, skipping work and other obligations.

The consequences of binge drinking

Most people know about the physical health consequences of drinking too much, too often. It can destroy the liver, create memory problems, cause alcohol poisoning and death. But there are equally devastating social and economic consequences to binge drinking, as well.

Binge drinking creates inconsistency at work. There are some very intelligent individuals in the corporate world who have a binge drinking problem. These folks may get to positions of seniority and authority in midlife. However, they find it difficult to stay in a job for long because of this problem. The organisation may be able to overlook their unpredictable, complete disappearances for some time. Eventually, despite their brilliance, the employer’s patience runs out. The resulting job loss and career disruptions have an economic impact on the family.

Binge drinking also creates uncertainty and chaos in the lives of the family members. The family members never know when and in what condition the binge drinker will turn up. Or, not turn up. Binge drinkers are unpredictable around their drinking. Hence, family outings, occasions, formal events or informal events are all frought with anxiety for the family.

Kids often suffer the most. Society looks down upon those who get drunk frequently. Kids pick up this attitude and feel ashamed because of their parent. They avoid bringing friends home because they do not know what condition their binge drinking parent will be in.They also end up covering up for their parents or tend to ‘over-achieve’ to compensate. Kids also worry about their parent’s wellbeing. More long term, kids who have grown up with parents who are alcohol dependent have a greater likelihood of becoming alcohol dependent themselves.

And, we have not even considered the impact of living with the typical alcoholic that movies portray. The binge drinker who may be a wife beating, child beating, raging alcoholic. Or, the one who, inebriated, gambled away her life savings and is on the streets. Or, the one who got into a serious fight or a fatal car accident, drunk. Or, some other such drastic situation. All because alcohol messed up their ability to control impulses or think rationally.

But why do people get addicted?

Binge drinking in midlife can usually be traced to binge drinking in youth. When young people drink, it is mostly a group activity. Youth drink because they are curious, they enjoy the disinhibition it brings, it makes them a part of their peer group, or they drink under pressure from their peer group. Increasingly in midlife, though, binge drinking serves to fill some kind of a vacuum or helps avoid painful emotions. Boredom and stress are two justifications.

The question this brings up is: Do other people not go through painful emotions or stress? Everyone does not resort to binge drinking. There is judgment in that statement. Somewhere we believe the binge drinker lacks will power. The implication is that he/she is a weak person. Or, a lazy person. A defective human being.

It is true that most people who are addicted to alcohol hide their addiction. They fear the judgment we talked about. Drinking may be their only coping mechanism. Or, they have tried giving up but failed. They feel guilty about that. They may also feel that they have no control over it. It all makes them feel bad. Hence, they do not like talking about it. Most of the times, there is outright denial of the addiction. This makes it doubly difficult for well-wishers to point out the obvious.

Research so far tells us that it is a combination in various parts of genetics, learned behaviour, and mental health disorders that are to blame. If you have a family history of alcohol addiction and/or you are suffering from an anxiety disorder, clinical depression or bipolar disorder, you may more easily get addicted to alcohol. And then there is the physiology and psychology of addiction that keeps a person hooked. Physiological addiction basically means that a person needs to consume more and more alcohol to get the desired effect. However, the increasing levels of alcohol are toxic for the various organs of the body. Psychological addiction means that a person relies on alcohol rather than anything or anyone else to make them feel better or avoid painful emotions.

Giving up alcohol

Because alcohol provides some kind of immediate relief, it is difficult to stop alcohol use. There needs to be a strong reason to want to give up alcohol. Sometimes, that motivation gets created when one is confronted with a serious negative consequence.

For many women, their responsibilities as a parent or realising that their drinking is affecting their child spurs them to take corrective action. For men though, it is often the women in their life who nudge them or push them to seek help. The problem is that most of the time the binge drinker is not convinced that there is a problem.

Even when realisation finally strikes that alcohol is doing more harm than good, leaving it is difficult. Once the body gets used to a certain amount of alcohol, reducing the amount or stopping altogether is problematic. It is that horrible hangover amplified that makes many turn back to the bottle.

Support is, therefore, one of the biggest factors that usually helps those who want to leave alcohol. Support to keep one motivated. And, it is a daily battle to be fought. Family can play a big role in supporting the binge drinker leave alcohol. But it is a long journey. And sometimes family members are unable to show understanding and support on a consistent basis. At the first slip or second slip the family is ready to give up. And, one then gives up faith in one’s ability to get back on the sobriety track. This is where organisations or support groups like the AA (Alcoholics Anonymous) come in. AA membership is free and they hold meetings in most cities and towns in India. You are not judged, you are encouraged, and each milestone of sobriety is celebrated.

In addition to seeking help from a support group, you may also need to see a psychiatrist and/or psychologist/therapist. They would be especially helpful if your alcohol dependence is a result of a mental health condition, such as depression. Residential treatment programs are not a requirement. But if you are experiencing serious withdrawal symptoms, you should consider getting admitted to one. This is because your body can no longer function as normal without alcohol. Hence, you would need to detoxify under a medical professional’s care and supervision.

Binge drinking is a reality across all sections of society. And it takes a terrible toll. If you are a binge drinker, seek help. Achieving sobriety may take effort and time, but it is possible. If you are a family member or friend, talk to the binge drinker. Not with judgment, but with concern. And be there to support them on the long road to sobriety.

9 Reasons marriages end up in divorce in midlife

“Did you not know? They got divorced a couple of months ago. The kids are now in boarding school.” This piece of news may have come as a shock because you did not realize your friends were headed in separate directions.

Your friends are not an exception. Divorce is on the rise in India. Not just the big metros, even smaller towns in India are witnessing marital discord leading to separation. Often the affected couples are in their midlife. Many of them have kids. Separation at any stage of life is traumatic for one or both partners. However, when couples with children decide to separate, it affects many more lives.

As a spouse in midlife, this information can be quite unsettling. You may worry for your marriage. But, we can try to make sense of this phenomenon. Let’s begin by talking about expectations. No marriage is perfect. The only time couples walk into the sunset holding hands is in the movies. Most couples in real life go through ups and downs. Almost all have to work towards creating and sustaining a strong bond.

Couples also face different issues at different stages of life. Most marriages go through teething troubles in the early years. Some marriages do not survive the initial challenges. Others that do sometimes run into trouble during midlife.

Midlife is a time when one goes through many changes. The body changes, aspirations change, interests change, responsibilities change. The stresses that midlife brings affects relationships in big and small ways. And, a midlife marriage has to be strong enough to survive these changes.

From my clinical practice, I have noticed the following common reasons for a midlife breakup:

Boredom, feeling disconnected or alienated

Marriages are about choice. Even most arranged marriages have an element of choice. You chose to get married to your spouse because you found them special or different from the others in some way. Or, you felt special with them.

Now, age can erode that sense of ‘specialness’ as you become more familiar with your spouse’s failings (No one is perfect, remember?). Some spouses, in fact, become experts at criticising. They systematically disregard or negate all positive aspects of their spouse’s personality or behaviour. It is the “Yes, but…” on an unending loop. When either spouse is so critical, the “special” feeling gets killed. You don’t feel special and you don’t see your spouse as special, either.

The result is emotional withdrawal and distance. Over time a feeling of alienation, disconnect or boredom dominates the relationship.

Over-involvement in work/career pursuits

Often midlife brings career satisfaction. People may find themselves in positions of authority at this age. With authority and seniority comes a sense of achievement or accomplishment. But with that creeps in greater responsibility.

Most senior professionals find themselves still putting in long hours at work. Work related travel adds to time away from spouse and family. This can make couples feel disconnected. Or, one spouse feels that the burden of house-hold/family responsibilities is disproportionately falling on their shoulders. For couples who are already facing relationship issues, this can add to the list of resentments.

For some couples, over-involvement in work is also a way to avoid confronting relationship issues. It is the elephant in the room that grows bigger with time and eventually stomps all over.

Spouse’s involvement in other pursuits

Midlife is a time when many adults decide to take a break from what they have been doing so far. Or, they may decide to re-prioritise life.

After years of focusing on work and family they may decide to pursue or explore activities that they enjoy. Indian cities now offer a range of recreational activities from ultra-marathons to bird watching. These activities provide the opportunity to meet like-minded people and socialize.

In some cases, the time devoted to such activities is at the expense of the time and attention one can devote to family. When one spouse becomes deeply involved in any such individual interest, the other spouse can become deeply resentful.

Spouse’s worsened addiction

Addiction or dependence on alcohol, drugs of any kind, gambling or sex can become worse in midlife. If a person had got into these addictions earlier in life, they tend to persist unless treated. Some individuals can also fall into addictions as a way to deal with midlife stress. Many a times the addiction is a symptom of an underlying mental health condition, such as depression or bipolar disorder. In such cases, appropriate treatment of the mental health condition is required.

Most of the time addictions affect relationships. Living with a spouse who has an addiction causes great emotional and/or financial stress. At some point, the non-addicted spouse may decide that he/she can no longer endure such stress. Marriages that have survived into midlife can then fall apart.

Unresolved issues around intimacy

Sex in India is shrouded with much mystery and misconceptions. And most Indians do not seek appropriate help for problems with intimacy.

Many couples struggle with sex from the time they get married. Most such couples do not have any physiological or biological problems. The issues arise either from a lack of information and exploration or from psychological issues. By the time couples reach midlife, they have often given up trying to solve the sex mystery. But a feeling of dissatisfaction lingers. If intimacy is an issue and the feeling of ‘specialness’ is also missing, then the marriage is likely to run into trouble.

Infidelity

Not getting into morals and values, the fact is that individuals tend to vary in their commitment to a relationship. Many Indians get into marriage stating reasons other than wanting to spend their entire lives with that one person. In addition, some individuals thrive in the attention they get from the opposite sex. Looks and appearance may matter greatly. Hence, they are open to entering into sexual encounters outside of marriage.

One or both partners may also get into affair if there are long term, unresolved relationship issues. No marriage is perfect and all couples need to work through various differences. However, when one or both partners have created an emotional distance from the other or there is constant fighting and animosity, “specialness” disappears and space for an affair is created.

Empty nest

Children leaving home for college or work causes a big change in the lives of family members.

For couples whose lives have revolved around their children, adjusting to this change is challenging. But it is most difficult for couples who have been avoiding facing relationship issues. Some couples are unable to resolve issues, have long standing resentments and fail to create a mutually supportive relationship. Spouses in such a marriage begin to then rely on their children for emotional support. They connect more with their kids than with each other. The kids may even become the go between the parents. The only reason such couples cite for being together is the kids. When the kids leave, there is no glue to hold the marriage together.

Financial issues

When two people get married they often hold different views on money. Growing up experiences, personalities and family values around money determine how much importance individuals give to wealth and possessions. When two people have similar perspectives on money, it is easier. However, problems can arise if these thoughts diverge greatly. Most couples over time figure out a common policy on money. Any initial differences over whether separate accounts should be maintained or joint ones are usually resolved by midlife.

Midlife tends to bring up different concerns around money. Savings, investments, planning for retirement become more important issues. Financial responsibilities can also be significant if kids’ college education and health issues of family members are added to the mix. Job loss and career breaks can cause significant stress. One or both partners may feel unhappy with their financial situation and resent past or present decisions. Some are nagged by the thought that one’s earning years are limited. Resentments around financial issues can cause big rifts.

Social contagion – hanging out with friends who are divorced

Friends are a great source of support. They also play a big role in defining what is socially acceptable behaviour. This is not only true during one’s teenage years but throughout life.

Divorce is gaining social acceptability in India, and more so in the big cities. Knowing people who have gone through a divorce helps one view divorce as a feasible option. It also helps create social support if one decides to separate. Instead of struggling through issues with one’s spouse, it seems easier to call it quits.

 

Whatever be the reasons for marital dissatisfaction, divorce is rarely an easy decision. Life after divorce can also be difficult for one or both spouses and the kids. But, it is possible to save and build back marriages, even in midlife. Hopefully, knowing what leads midlife marriages to the divorce courts may help you course correct before it is too late.

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The above article is based on Dr. Dubey’s work with Indian couples.

Four ways to protect your marriage from midlife stress

Hectic 40’s is when we often find ourselves coasting in only one area – our marriage.

 

In our busy, hectic lives, work, kids, ageing parents and in-laws demand much of our time and attention. These are the years when most marriages in India begin to get relegated to the bottom of any list. Yes, couples vacation together. But, most no longer hold hands and gaze into each other’s eyes over candle-lit dinners. To many, it may seem silly to even think of doing that. After all, as a couple you have gone through many more significant experiences together, the candle-light dinner seems juvenile.

So, we assume the marriage does not need much attention and care. It is that old, comfy couch that will not go anywhere. But then one day you realize that the old, comfy couch groans and creaks, and eventually breaks. This is what happens to some marriages, too. Affairs, separation and divorce. Friends and family are shocked. Nobody, including most spouses, see it coming.

Most relationships can be prevented from breaking down. Most relationships can be repaired and made stronger.

Here is how not to let midlife stresses affect your decades old relationship.

– Stop avoiding difficult issues.

Often couples find specific topics difficult to talk about. These include intimacy, parenting, finance and caring for elderly in-laws or parents. Whatever be the topic, if you feel stressed by it and avoid talking to your spouse about it, then it may take a toll on the relationship. Resentment over these topics often builds over time and comes out as anger. When one spouse attacks the other in anger, the response is of a similar kind. The outcome is frequent fights or long, withdrawn silences. Both over time undermine the marriage. If you are unable to resolve your differences then it may be time to seek help.

– An hour a day of meaningful conversation.

An hour a day can actually keep the therapist away. There is usually enough and more going on in our lives to keep us super-busy. And, most couples communicate. However, what they talk about is transactional – who’s coming for dinner, who’s picking the kids up from drama class, when is the maid on leave, and so on. Couples do need to work as a team around these aspects of daily life. The problem is that often communication does not go beyond these aspects. Over time spouses become oblivious to each other’s emotional landscape. Or, everything is attributed to personality quirks – “Oh, he always complains about the traffic,” or “She just needs to go shopping to feel better.” No extra attention is then given when either spouse needs support. An exclusive hour everyday talking about what one is thinking and feeling, what one’s dreams and worries are, is the key. These conversations must be uninterrupted by phone, internet or anything/anyone else. This one hour can go a long way in re-establishing an emotional connection.

– Finding fun things to do together.

Having fun together helps create happy memories. The more happy memories one has with a person or activity the more positive one feels about that person or activity. Most couples do enjoyable things together in the early years of the relationship. Over time, though, more mundane, daily living activities seem to take over. The focus may also shift to kid centric activities. Or, either spouse may discover or begin to nurture an individual interest, such as golf or running that takes care of their fun and social needs. The downside is that as the couple does less and less together, there is less and less to bond over, to laugh over, to enjoy together. Exploring and trying out different activities may help you find something that you enjoy doing together. This can bring the fun back in the relationship.

– Resetting boundaries around the relationship.

Midlife is when responsibilities peak. One’s kids are not yet financially or emotionally independent, parents have become dependent, work place responsibilities and stresses are higher. Add to that the feeling that one is neither invincible nor is life unlimited. Most people, therefore, feel the need to nurture themselves, re-discover passions or re-prioritise life. The external demands and one’s internal needs often take away time and attention from one’s relationship. It is important at this time to protect the relationship by openly talking to each other about what one is thinking and feeling. It also means supporting each other through various decisions and handling family challenges as a team. There is also a need for balancing one’s own unique interests/involvements with the needs of the relationship. Hence, it becomes important to balance the time and effort we spend on individual pursuits with the time and attention we give to our spouse.

None of this is rocket science. However, if you have neglected your marriage for a long time, you may find it difficult to implement these suggestions. If you find yourself stuck, do seek the help of a trained marriage or couple’s therapist/counsellor.

Depression – the cancer of the soul.

“So, you’re feling depressed? Why don’t you change your diet? You’ll feel better.” Says another well meaning friend. “Oh! Just go for a movie. Just go out, meet your friends – that will do it.” “You know, you just need to start thinking more positively.” “Actually, I know about this Babaji – my friend started visiting him and felt better.” Another friend, writes in “My sister felt depressed after her baby was born and she went to this great psychiatrist. He just gave her some pills and she started feeling better.” “No, no!” another fried counters this advice – “don’t try allopathy. Homeopathy is a lot better.”

Leaves you feeling confused? Maybe you have tried some of these things but they did not work for you. They did not work for Amy Bluel, the Founder of Project Semi-colon, a suicide awareness and prevention project. Amy struggled with depression and suicidal thoughts for several years and finally succumbed to suicide. On the other hand, a young person recently talked about finding help on Facebook and was cured of his depression.

Depression is the cancer of the soul. Not everyone experiences depression in the same way and not everyone feels better with the same interventions. While western medicine offers certain treatment protocols as it does for various kinds of illnesses, diagnosis and treatment varies with each individual. A simple viral infection may not need you to visit the doctor but if you feel very sick or the illness lasts a longer time than expected, you have to visit the doctor. Similarly, we go through different moods and the blues may pass. But, if you continue to feel sad, anxious, helpless, overwhelmed or your everyday life, studies, work or relationships are beginning to suffer, then you do need to seek help. In addition, if you find yourself self medicating with alcohol, drugs, or sleep medication, then you need to know that those will only leave you feeling worse.

Seeking help is not a sign of weakness – it is an important step towards taking charge of your life. You deserve to feel better and you owe it to yourself to do what you need to do to feel better. Clinical psychologists and psychiatrists are trained professionals who can help you feel better. Research has shown that sometimes talk therapy, which is how clinical psychologists and psychotherapists help, is all one needs. In other cases, a combination of medicines that psychiatrists are trained to prescribe and talk therapy is more effective. Be patient, and be persistent. It is a journey – it can take anywhere between a few months to longer to feel better.

Seven steps to help your child with exam stress.

Board and school/college final exams are around the corner. This is the time to prepare, to think and plan, to build your own and your child’s immunity to educational pressure and exam stress. We all want our children to be successful and happy, and it is high time we figured out how. Formulas often don’t work because each child is unique. Therefore, it is important to figure out what you and your child need to do to manage anxiety.

Watch out for anxiety-prone thinking:
Students who are keen on academics and want to excel in a given exam may sometimes go through intense anxiety. In fact, as exams approach, most students will feel anxious. Some anxiety is normal. Anxiety is what pushes us to work hard, focus on our goals and not become lazy or distracted. However, anxiety beyond a level is detrimental and affects performance negatively. Now, each person has a different threshold for anxiety. And this level is determined by each person’s unique biology or temperament and socialisation or learning from childhood. While we cannot change biology, it is the learning part that we can work on.

Anxiety is often triggered by the unknown, feeling that things are out of control, or focusing on outcomes that one fears. While most students who are well prepared usually feel confident and less anxious, some of these students may undergo intense anxiety. This happens if they indulge in unrealistic or erroneous thinking. Such children/teenagers may hold catastrophic beliefs around their results (e.g., coming second in an exam is the same as failure), have unrealistic/perfectionistic expectations, and their entire self worth is tied to their performance (e.g., have to top each exam, else I am not good enough). In order to prevent children and teenagers from becoming overly anxious, parents play a very important role by being realistic, and not reinforcing unfortunate beliefs. You can help a child who is highly anxious by discussing the worst case scenario so that there is a plan B in place and the unknown is not so scary.

Separate academic success from child’s worth
Another harmful tendency is to use academic performance as the only criteria for assessing a child’s worth. This is not only extremely damaging to the child but also to the society at large. There can only be a few “toppers” in a specific area, but there can be several “toppers” in many different areas, such as art, photography, music, dramatics, entrepreneurship, sports, etc. When we widen the possibilities of not only where success may lie but also what success means, success becomes more possible.

There are two problems that need to be addressed: wanting each child to be a “topper” as per set external standards (i.e., exam results); and, pushing each child to be that topper, whether the child is even remotely interested in it or not, and has the ability to do so or not. Parents can help children and teenagers build a stronger sense of self worth that is not tied so deeply to academic performance.There are many successful and happy people who have carved out a niche for themselves in an area after having been average students academically and doing different things until they found that one area which really excited them. We do not have to make the next generation go through the same long process and instead help them find their passion earlier in their lives.

Moderate self and child’s academic expectations:
Teenagers, especially in India, go through immense pressure and stress related to their educational pursuits. The pressure to excel is placed on them not only by parents but also by schools. In addition, while some children are quite self-driven and competitive by nature, their anxiety also stems from the desire to excel by the standards set by their peers.

Each child has his or her own personality, temperament, unique strengths, talents and abilities. While each child may be bright and capable in his or her own way, every child may not be interested in or suited to engaging in purely academic pursuits or becoming an engineer or doctor. It is important to assess where our child stands academically and whether his/her expectations as well as our expectations from his/her performance are realistic.

Do not impose own dreams/career choices on child
It is important to self reflect and make sure that as parents we are not imposing our own dreams and/or ambitions regarding academic/career choices on our children. Otherwise, we will be trying to put a square peg in a round hole – it will never fit. There are, unfortunately, scores of adults and young people who have been badgered into making educational and career choices they were not keen on and are not happy with. Quite a few of these teenagers and adults go through life struggling with low self esteem, anxiety and depression as they do not find what they do satisfying and are unable to put in their best efforts. In addition, everything they try to do is to somebody else’s standard, and that standard seems impossible to meet.

Help child discover areas of interests:
Exposure is the key to helping a teenager find his/her areas of interest. Once interested the teenager may develop enough discipline and motivation on his/her own to pursue their goals without parents needing to nag! Openly discussing the pros and cons of different career options and ideally having them speak to someone engaged in a career they are interested in, or visiting that person’s workplace, provides a more realistic picture. The idea, therefore, is not to leave teenagers to their own devices. It is important to be actively engaged in helping children discover for themselves their own interests and then making it clear that you expect them to put in their best efforts towards realizing their dreams. There is no substitute for hard work, no matter what field – arts, entertainment, business, medicine, etc.

Provide study tools and improve study habits:
Sometimes children perform at average or below average levels academically either due to a learning disability or due to being ill prepared because they do not have the study skills required. Often, the appropriate educational resources, including good teachers, are just not available. While universal good education should be a protected right, the reality is far from ideal.

Helping children and teenagers learn how to organise their time, to plan and make a study schedule, and to break big projects into small parts and tackle one part at a time is sometimes all that is required to alleviate their anxiety. In other situations, involving special educators, arranging for extra help, such as tutors, or sitting down with the child and helping them in areas where they need help can reduce the child’s anxiety and improve their academic performance.

Inculcate healthy lifestyle practices:
Parents often need to teach themselves and their children ways to calm themselves. For example, deep breathing, meditation techniques and positive thinking are very helpful, especially when one begins to feel anxious. In addition, a healthy diet, sufficient sleep and regular exercise are essential for helping the brain function at an optimal level. Engaging in leisure activities or hobbies is also a great antidote to stress. In very practical terms, for both you and your child, this might mean shutting off the wifi in the house at a set time each night, limiting screen time, connecting with each other and sharing a few laughs, and stepping out of the house to take a break, get some fresh air, and exercise.

It is important to pay attention and help your child now. Poor self esteem combined with unhelpful, unfortunate beliefs, high levels of anxiety, and pressure from parents or school to perform, is a deadly combination, which can lead to depression and/or extreme frustration and suicide. A life is too high a price to pay for someone else’s definition of success.

How to take care of your emotional health.

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While we all do stress about and take care of our physical health, how many of us truly think about and try to ensure our emotional well being?  Stress impacts how good we feel and how well we work. It even impacts our physical health in more ways than we realize – blood pressure, headaches, ulcers, etc., are all very often physical outcomes of psychological problems.  And all too often the cure we attempt fixes the symptoms rather than the cause.

The blues can hit anyone, anytime – summer or winter. You have a big event coming up, like your wedding or your child’s wedding, a big promotion that gives you more responsibility, more visibility – all good things…. but then there is the anxiety that creeps up. Of course, if things don’t go your way – did not get the much anticipated promotion or a relationship ended – there is a bigger and more complex box of emotions to deal with.

All of us go through such events in life.  Sometimes we are able to maintain our emotional balance and sometimes things seem overwhelming. This isn’t about being emotionally strong or weak; it is often about how much stress we are under. So, how do we watch out for when the usual anxious pangs begin to turn into panic or even panic attacks? Or, the blues just don’t go away. Given below are some  general guidelines that work for children as much as they work for adults:

– Diet and sleep. Take care of your diet and your sleep. Tired and hungry children are known to be cranky, and so are adults! Stick to a regular bedtime and bedtime routine, get enough sleep, and eat healthy.

– Exercise. Exercise is a well researched component of the treatment strategy for mild depression and anxiety. Exercise helps the body secrete endorphins, the feel good neurotransmitters. It also tires the body and helps in cases where sleep is disrupted due to stress.

– Interests and hobbies. Find some interests or hobbies that you enjoy pursuing. It could even be part of work that you do. Joy and wellbeing is experienced in what psychologist, Csikszentmihalyi, describes as “flow”.  It has been described as moments of “effortless concentration and enjoyment”.”Flow” is not passively watching TV or sitting in the sun (which can also make you feel happy), it is engaging in any activity which completely holds your attention, like reading a good book or connecting with a close friend. It involves actively pursuing some goals you set up for yourself – it could be at a game of chess or a business deal you are negotiating.

– Calm at bedtime. Bedtime or in general night time is usually not the best time to try and resolve conflicts or reflect on your worries. You will often only lose sleep and magnify you difficulties. In the light of day rationality prevails better and problem solving is definitely better after a good night’s rest!!

– Mind-body connection. The mind and body are definitely connected. And Indians or Asians, in general, are known for somaticizing or expressing emotional pain in the form of physical ailments. Consciously or otherwise, we tend to allow ourselves our physical aches and pains and even seek help for them, but not so for our emotional pains. Watch out for the elderly relative who just lost her spouse and seems to be coping fairly well. Most likely her blood pressure and diabetes have worsened!! Severe panic attacks look very much like heart attacks. When there are no physical reasons for a medical condition, look at the emotional. Addressing emotional stress in such cases is of prime importance.

– Meditation. Learn meditation or find ways by which you can get into a meditative state. An intense game of tennis or a long run can be meditation in action as it helps remove all thoughts and worries from the mind and compels one to focus on the immediate moment.

– Voluntary work. Volunteer when you can. Nothing works better to put our problems in perspective than closely interacting with or witnessing how difficult life is for a section of our society, be it the terminally ill, street children or people less privileged than us. This is a strategy that also works wonders with teenagers. It also helps give life a greater sense of purpose and meaning.

– Unclutter and prioritize. Unclutter your life. It is not important to be a super mom, super worker or super anything. Delete things from your to do list that you have a hard time juggling and are not essential to do.

– Love thyself. Finally, learn to love yourself!! Nobody else can be as critical of you as you can. Beating yourself up for small or big mistakes will only make you feel miserable. Also, perfection is an unachievable goal!! Develop some positive self talk and try to be your best advocate.

– Professional help. Most importantly, seek professional help i.e., counseling or psychotherapy. If you are losing sleep, losing weight, or gaining weight, get help. If you are self medicating by using sleeping pills too often or using alcohol to uplift your mood or help relieve stress, get help. Depression preceded by the death of a loved one, separation, or divorce most often leads to suicides. If you are going through any of these experiences, consider help. Also consider help if you are feeling depressed after loss of employment or any such dearly held and significant goal. If you observe anyone engaging in uncharacteristic behavior or behavior that concerns you, get a consultation. Professional help benefits not only those who are suffering from a severe psychiatric disorder but also those facing interpersonal issues. In addition, it is not just for fixing problems: if you want to be proactive, and untangle some of the tangles before they become problems, seek a consultation. And, when you do seek professional help ask the provider about his or her level of training and experience.

(Originally written for enricheducation)

Psychologist – Psychiatrist: What’s the difference?

What does a clinical psychologist do, and what does a psychiatrist do?Psychologist- Psychiatrist: what’s the difference?

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As someone I know put it simply: clinical psychologists are like software professionals, and psychiatrists are like hardware professionals. Clinical psychologists work with people with a wide range of mental health difficulties and sometimes with people who have no major problems at all but are keen to further grow and explore their human potential. The problems that clinical psychologists help individuals deal with include relatively less severe problems, such as, dealing with stress/dissatisfaction at work, or adjustment difficulties due to a recent relocation, as well as more severe problems, such as, severe depression, or panic attacks that look like heart attacks. Clinical psychologists help individuals, couples, and families solve their problems through talk therapy rather than pharmaceutical interventions.
Psychiatrists, on the other hand, step in only when mental health problems become more severe, which includes severe anxiety, depression, schizophrenia, etc. They focus on treating the chemical imbalances in the brain that accompany specific mental health conditions. Treatment is symptom based. So, the psychiatrists are the ones who will determine if medication is required, the kind of medication, and the dosage, whereas clinical psychologists will try to bring about change via changes in thought processes, behaviours, and emotions. Needless to say, psychologists need to work more regularly with their clients and often for longer durations than psychiatrists do. It is important to remember, however, that medicines alone cannot treat mental health conditions, at least not as effectively, or on a long term basis. Psychotherapy or Counselling is required in order to help individuals make long term and sustainable changes in their way of thinking so that they are better able to deal with various stressors in their lives, and lead more happy and fulfilling lives.
What are the qualifications of a psychiatrist?
A psychiatrist is a medical doctor. In India, to become a psychiatrist, a person has to earn an MBBS degree, followed by an MD in psychiatry or a DPM or DNB credential. Child psychiatrists specialize in the treatment of children and teenagers who suffer from a mental disorder and need medication, such as ADHD, depression, OCD, schizophrenia, etc. Psychiatrists typically see their patients once or twice a month for follow up. General practitioners also sometimes prescribe psychiatric medication but they are not trained in this field and may not have the knowledge or experience to distinguish between the various mental health conditions to be able to make the correct diagnosis. Also, psychiatric medication needs regular follow up in order to ensure that the dosage is accurate. For example, weight gain or weight loss would require modifications to be made to the dosage as the dose prescribed earlier will not work in an optimal manner. Also, side effects need to be monitored.
What are the qualifications of a clinical psychologist?
In the US, clinical psychologist is a title that persons who have completed their doctoral degree in clinical psychology (PhD or PsyD) can use after they have cleared the licensing exams. Psychotherapist or therapist is a title that can be used by people who have completed their MA in Clinical Psychology, MA in Social Work, etc. It is a more widely and generally used title and does not require a person to have cleared any licensing exam.
Counselling degree is usually a separate degree in the US. People can do their Masters or Doctorate in counselling.

 

The difference between a counselling degree and a clinical psychology degree is that counselling is more short term and focused on solving immediate problems, whereas clinical psychologists do more in depth and long term work with individuals. Also, clinical psychologists are the only ones trained to conduct comprehensive psychological assessments, including administering various IQ and personality assessment measures. For example, only a clinical psychologist would be able to conduct a comprehensive psychological assessment to determine whether speech delays in a child were due to learning disability or autism.

 

Marriage and Family Therapy is taught at a few places separately as a Masters or Doctoral level program. However, marriage counselling or couples and family therapy is also taught as part of clinical psychology programs.

 

In India, however, clinical psychology training is in its nascent stages. There is no professional regulation in this field; hence, anyone can use any title with little or no training. “Clinical psychologist”, “counsellor”, “therapist”, “marriage counsellor”, “child psychologist”, etc., are all terms that are used interchangeably and often have little to do with a person’s formal training. The most important aspect of clinical psychology or psychotherapy training is the practical aspect, and that is often missing in most programs of study in India. The diploma in counselling programs often either do not have a supervised practical training component or it is just not rigorous enough. Even the MA and PhD in Psychology programs are largely academic and do not focus on supervised practical training. Most of these programs also do not have a very strong specialization component wherein students could be exposed to the latest theory and practice methods in how to work with children and teenagers or with couples. Hence, it is very important that you ask your child’s therapist or marriage counsellor about their training, qualifications, and experience before you decide to work with them.

(Originally Posted January 22, 2012 in enricheducation)

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