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Articles by Dr. Dubey on mental health.

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.”20160123_175639

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 worry about and take care of our physical health, how many of us truly think about and try to ensure our emotional well being?  Our emotional well-being 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)

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 …

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 …

How to take care of your emotional health.

While we all do worry about and take care of our physical health, how many of us truly think about and try to ensure our …