THE Summer 2016

LOUDSPEAKERAmplifying the voice of mental health MOODS AND EMOTIONS 20 An Unquiet Mind: a memoir of moods and 8 madness How Can We Use Music To Handle Our Emotions? 29 HEALTHY USE OF TECHNOLOGY AMONG YOUTH Emotions on Handling Difficult 6 the Go… Emotions 32

THE ...Plus Our Regular Features1 LOUDSPEAKERAmplifying the voice of mental health NIMHANS Centre for Well Being A Centre for Mental Health Promotion

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THE 2 LOUDSPEAKERAmplifying the voice of mental health THE

LOUDSPEAKERAmplifying the voice of mental health

Editor

Dr. Prabha S. Chandra Professor of Psychiatry Coordinator NIMHANS Centre for Well Being

Editorial Team : (Left to Right) Meena K.S, Prasanthi Nattala, Manoj Chandran, Sub Editors Prabhu Dev, Padmavathy, Prabha S Chandra, & Taranum Taj Dr. Prasanthi Nattala Associate Professor of Nursing Editor’s Note NIMHANS riving to work every morning on one of the busiest roads in Bangalore, I spend my time during the inordinate wait at signals, watching Dpeople’s emotions. Dr. Meena K.S. Assistant Professor of The annoyance in the driver behind me who honks even when one is at a Mental Health Education red light, the smile on an auto driver’s face when he is having an interesting NIMHANS conversation with a customer, the surprisingly friendly banter between a transgender woman with bright red lipstick when she asks for money from a young man on a motorbike, the desperation of an elderly woman who sells Smt D. Padmavathy jasmine flowers on the road and of course the occasional person who flies off In-charge Staff Nurse the handle on the road, swearing at someone who overtook him. NIMHANS Centre for Well Being Emotions are all around us and often control the way we behave and respond to situations. Emotions and moods influence the atmosphere of our families and our work place in several different ways and are hence worthy of our Editorial Board attention. Emotions are also contagious and a smile can cascade into positive feelings of people around you while a frown can cause just the opposite. Mr. Manoj Chandran Most emotions are fleeting, like clouds, and pass on without lingering. Mr. Prabhu Dev However, sometimes emotions can remain as the predominant mood or they can get intense, causing distress to the person and the people around. It is Ms. Tarannum Taj these emotions that are worrying and need professional help. Many of us may not be aware of the nature of our feelings and find it hard to articulate them or even label them.

In this issue, my efficient editorial team at Loudspeaker and the expert authors attempt to bring together various aspects of emotions . We address several Conceptualised and produced by aspects of moods, ranging from road rage to encouraging expression of feelings in children. We also discuss , the extreme and sustained form NIMHANS Centre for Well Being of emotions becoming pathological and the role of music on our emotions.

As the singer Manna Dey croons in the song from the film Anand - Cover photos: Zindagi, Kaisi hai paheli haaye Sunita Chakraborty Kabhi to hansaaye Kabhi ye rulaaye Photo Credits: (What a riddle this life is. Sometimes it makes us laugh and sometimes it makes us cry)

So as we continue this journey that is life, we hope this issue of Loudspeaker will help you understand this riddle better, if not the solution to the riddle!

National Institute of Mental Printing of the Magazine funded by: Dr. Ramachandra N THE Health & Neuro Sciences Moorthy Foundation for Mental Health and Neurological Sciences 3 LOUDSPEAKERAmplifying the voice of mental health THE

LOUDSPEAKERAmplifying the voice of mental health Contents

Emotions On The 6 Go… Fr. Rajeev Joseph Dr. Seema Mehrotra

How to put a brake to negative emotions and enhance safety while on the road. 14 How Can We Use Music To Handle Our Emotions? Dr. Shantala Hegde Ageing And Elder Care: Making An Elderly Family “Without music, life would Member Feel More Secure 8 be a mistake” said the famous Dr. Santosh Loganathan philosopher and composer, How to make an elderly family member feel Friedrich Nietzsche. emotionally secure, particularly in these days when nuclear families are on the rise.

What Is Bipolar ? How Can You Help Children To Express Their Dr. Muralidharan. K Emotions Better? Dr. Kavita Jangam Certain insights into Bipolar Mood Disorder, a serious, Ms.Chaitra Holla but treatable mental illness. Helping children to express their emotions, particularly as they are at a phase where they are very sensitive to the changes in their environment, and have an innate need to discuss what they 11 observe around them.

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THE 4 LOUDSPEAKERAmplifying the voice of mental health An Unquiet Mind: A Memoir Of Moods And Madness Mr. James Joseph Dr. Krishna Prasad M 26 It indeed takes a great deal of courage to write about one’s own illness, and , I Feel Like An Outsider - How Persons With Professor of Psychiatry at Johns Hopkins School of Schizophrenia Can Understand Other People And Medicine does not have any less in measure. Communicate Better 20 Dr. Urvakhsh M. Mehta How to improve social interactions among individuals with schizophrenia.

29 22 Healthy Use Of Technology Among Youth Managing Emotions In The Workplace Dr. Manoj Kumar Sharma Dr. Paulomi M Sudhir Ms. Janhavi Devdutt Promoting healthy use of technology among the youth, especially during this era when the internet Recognizing the importance of emotions and their has revolutionised how we communicate, and has role in workplace interactions. opened up entirely new forms of social interaction.

Emotions And Eating: Feeding Your Feelings! Handling Difficult Emotions Dr. Preethi Sinha Dr. Poornima Bhola

How to ensure that negative emotions do not Gretchen Rubin, chronicled her one-year search for promote unhealthy eating. the secrets of happiness in her bestselling book 24

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THE 5 LOUDSPEAKERAmplifying the voice of mental health Emotions on the Go…

Roads tell us the stories of the joys of travel as well a number of external reasons for the negative as our frustrations. Many of us spend about an hour emotions we experience: the unrelenting traffic, or more of our wakeful time on the road on a regular the bad road, the vehicles spitting thick black day. There are so many different emotions that we smoke and the blinding dust, the erring drivers frequently experience while on road, as a driver, a co- and the incessant honking. Some of these can be traveler, a passenger in a cab, or a pedestrian. These altered by judicious and committed actions of the emotions come from what may be happening off government and the citizens, but there are those the roads in our life as well as what happens on the little things that we can do as individuals too, roads. Have you noticed that there are times when which can make a difference. For instance, when we may take out our vehicle in order to experience an we are feeling sad or fatigued, slower reflexes may emotion or a mental state (e.g. excitement, a sense of hinder quick responding. It may be useful to use control/freedom) or to get relief from an unwanted our own uplifters/energizers such as talking to a emotional state (e.g. boredom, anger, helplessness)? supportive buddy, or a taking a power nap, before Some also report speeding up in order to get relief starting on a drive. At other times, we may be in from negative moods. Such experiences remind us the amber zone of emotions (e.g. feeling a little too about our vulnerabilities on the roads and caution excited or anxious) that makes it difficult for us us about the need to apply the brake on emotions to focus. Reminding ourselves to slow down and and the associated risky behaviours at the right time. focus on the task at hand may be useful. The red They remind us about the thin line between narrow zone of emotions (e.g. feeling angry) is clearly a escape and fatal error. signal to take a brief pause to cool down. Taking a few deep breaths, listening to soothing music/ There are multiple triggers on the roads that are humming and calming self-talk like “Let me put potentially bothersome. It is true that there are it on hold” might help. Our ability to manage our

THE 6 LOUDSPEAKERAmplifying the voice of mental health own emotions wisely is sometimes really tested due to challenging road situations. Our response to such frustrations may at least partly reflect how we respond to challenges in life, in general.

The other way of looking at our road experiences and behaviours would be to see the emotional triggers on the road as opportunities for us to learn, practice and strengthen certain skills. Oh no, no… we do not mean stunts, weaving/zigzagging skills or getting into racing competitions (for these, it is wiser to join a rider’s club)! We mean practising the art of staying patient, staying as calm as possible and responding truck driver who stopped (despite all the honking intelligently rather than reacting impulsively to and the protest behind him) and gave time to an old provocations. It means learning to tell ourselves that man to cross the road in the midst of torrential rains ‘I am not going to let others or the road situations on a narrow lane… or a pillion rider who got down provoke me into driving irresponsibly’. So, it is from the bike while waiting for red light to turn green about ensuring that it is we who are driving our and lifted a huge piece of stone and kept it away to vehicle, and not our emotions taking us for a ride. avert a road accident… or the good Samaritan who turned into a traffic-manager for thirty minutes in the Roads also give us enough opportunity to notice and scorching sun to clear the maddening traffic-jam on appreciate the goodness of others, even if you think a super-busy junction with no traffic police? Can we that we have to look really hard and long for that! offer such small acts of kindness and courtesy forward Have you heard some of these uplifting stories: the and create a ripple effect? Be Kool and Ride Kool!..

Fr. Rajeev Joseph Clinical Psychologist Dr. Seema Mehrotra St. Joseph’s Hospital Professor Registrar, Jothirbhavan Department of Institute of Theology & Spirituality NIMHANS, Bengaluru Kochi, Kerala

THE 7 LOUDSPEAKERAmplifying the voice of mental health How Can We Use Music To Handle Our Emotions?

A narration by Mrs. Sangeetha This brought back my old childhood memories, and I felt like a young student. There was a new “Without music, life would be a mistake” said goal and meaning in my life. Music not only evaded the famous philosopher and composer, Friedrich the feelings of emptiness but made a lot of positive Nietzsche. This is completely true in my case, having changes in my life. completed more than five and a half decades of my life. As a widow and mother of two children, my Myriad benefits of music life was completely busy until my children decided to move away from home in search of better career An entertainment... opportunities. The sudden emptiness and sorrow Music, at its very fundamental level, that followed was immense, and it was my interest provides entertainment. Self preferred music can in music that helped me come to terms with this be one’s best companion whilst doing routine change. I started listening to my old music collection household chores, such as cleaning, washing and of film songs and classical music. I started listening to cooking, and while travelling. This will also keep music regularly, and I would keep the music player our mind engaged. We often learn new songs and on while I was carrying out all the household chores. lyrics while humming along. This engages our This way, I could focus my mind on the melody of ability to memorize new things. An even rhythm in music, and also keep myself away from the boring music entrains us as well as entrains our inherent saga of mega serials on the television which only biological rhythm. When we walk or talk there is enhanced negative emotions. I even dusted my old an inherent rhythm in it. Rhythm, which is a key musical instrument, the veena, and started playing component of music, can impact our heart rate and some basic lessons I had learnt in my childhood. thereby our arousability.

THE 8 LOUDSPEAKERAmplifying the voice of mental health A method to revitalise... Music has the power to revitalise our mood. Listening to self chosen music in the morning hours and relaxing music that has calming effect in evening can help us energise and calm down during dawn and dusk, respectively. Listening to a slow to medium paced rhythmic music can be a good companion during morning or evening walk. Slow paced instrumental music can facilitate good sleep as soothing music has an impact on our brain electrical and chemical activity.

A stress buster... Music can be a good method to distract from unwanted thoughts and even physical sensations such as nagging pain which responds poorly to medication. Actively and passively engaging in music is known to release natural pain killers known as endorphins. Listening to music also lowers the levels of stress hormones known as cortisol.

Facilitates emotional catharsis... Music chosen to match our present emotional state can help us to vent out the emotion (emotional catharsis). Thoughts and feelings that we find difficult to express through words can be expressed or experienced via music. Music can also enhance our capacity to empathise with the emotions of others.

engages emotional components attached with the Juggles up past memories... past memories. Often this brings solace. Music can juggle up past memories or shared emotions with family, friends and loved A brain gym... ones. Dwelling in the past and remembering the Actively engaging in music, such as singing past is one of the methods of introspection. Music or playing an instrument, gives a strong sensation therefore not only engages mental processes but also of thrill or feelings of accomplishment. It activates strong emotions. Apart from providing deep sensations, actively engaging in music involves a host of cognitive, emotional and motor processes which are important in maintaining our overall mental fitness.

The beauty of using music is that it can help us achieve more than one of the above mentioned domains at any given point in time. Self preferred music can entertain, revitalise, distract from unwanted thoughts, relax and activate a range of mental processes at one go. Indulging in music will surely have greater impact when compared to passive listening. Age is not a barrier and becoming a professional musician need not be everybody’s

THE 9 LOUDSPEAKERAmplifying the voice of mental health goal. But learning some form of music can be part of everybody’s routine. Music is considered as the best exercise to keep our brain, our mental and emotional processes, fit.

A few take home messages..

• Music engages many mental processes.

• Familiar music is good, but music that is unfamiliar may also have positive impact. Various features of music such as volume, density of notes, rhythm, timbre, minor or major notes etc. have strong effect on our musical experience.

• Actively engaging in music is always superior to passively engaging in music.

• There is no age limit to learning anything new, including music.

Dr. Shantala Hegde Assistant Professor Department of Clinical Psychology NIMHANS, Bengaluru

THE 10 LOUDSPEAKERAmplifying the voice of mental health What is bipolar mood disorder?

Bipolar Disorder or mood disorder is a serious but ups and downs that people go through, often in treatable mental illness that influences the mood states relation to the environment. Bipolar symptoms are of a person in an unusual way. Bipolar Disorder (BD) more powerful than that. They can negatively affect is characterized by two phases, namely: the “Up” Phase relationships and make it hard to attend school or or manic episode and the “Down” Phase or depressive work. They can also be dangerous as people with episode. Persons with BD could experience these BD may try to hurt themselves/attempt suicide. It is episodes or phases in an alternating manner and often extremely important to be aware of these symptoms have normal mood in between them. The up feeling in order to seek help for oneself or others immediately. or the , lasts for more than a week. The down feeling or the usually lasts for more than What are the symptoms of bipolar disorder? two weeks. Symptoms of a manic episode are: • A long period of feeling “high” or extremely How is bipolar disorder (BD) different from the happy, or feeling extremely irritable and angry, normal everyday ups and downs that we experience? lasting more than a week BD is different from the normal mood swings: the • Feeling more energetic or powerful, often involving oneself in many activities and not completing most of them • Being easily distracted • Having • Sleeping less than usual but still feeling refreshed • Having unrealistic belief in one’s own abilities or identity

THE 11 LOUDSPEAKERAmplifying the voice of mental health • Behaving impulsively and taking part in pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and gambling which is unusual for the person

Symptoms of a depressive episode are: • A long period of feeling sad or “low” most of the time, often crying without any apparent reason, lasting for more than two weeks • Feeling tired or slowed down, less energetic causes of bipolar disorder is ongoing. Sometimes than usual bipolar disorder runs in families (genetic cause), • Loss of interest in activities which were though it may not affect all family members. enjoyable before, including sex Abnormal brain structure has also been associated with bipolar disorder. • Having problems concentrating • Loss of self-confidence How is bipolar disorder diagnosed? • Negative thoughts like one’s future looking The diagnosis of bipolar disorder should be made by bleak and that one has become a burden to a psychiatrist or a mental health professional. others • Thoughts about death and bereavement The diagnosis is made after a careful psychiatric and medical evaluation. Some investigations are advised • Suicidal thoughts/attempts to rule out common medical problems, like thyroid • Decreased sleep and appetite, sometimes with disorders, anaemia, diabetes and brain disorders. weight loss There is no laboratory test to diagnose bipolar disorder. Who develops bipolar disorder? What causes bipolar disorder? It is often not easy to diagnose bipolar disorder as it Anyone can develop bipolar disorder. It is equally co-exists with other conditions like attention-deficit common in males and females. It usually starts hyperactivity disorder, alcohol or drug abuse and in the early twenties, but can also affect children some neurological/endocrine disorders, to name a and elderly. In some women, it can occur during few. Consultation with a doctor is a must to diagnose pregnancy or after delivery. Once diagnosed, it this condition. is a lifelong illness, although it can be controlled effectively with treatment. Self-diagnosis is best avoided. It is important to consult an expert immediately if you or someone The exact cause is not known but research into the known to you has symptoms of bipolar disorder.

THE 12 LOUDSPEAKERAmplifying the voice of mental health What is the treatment for bipolar disorder? There is no cure for bipolar disorder. However, it can be treated effectively and kept under control like other medical disorders like diabetes and hypertension. For severely ill patients, admission to the hospital may be necessary.

All patients will require treatment with medications and/or psychotherapy. and mood stabilizers are the commonly prescribed medications. Some patients may in addition require medications for sleep. Patients should take medications regularly and attend follow-up, as prescribed by the treating doctor, to keep the disorder under control. The doctor will monitor patients for common side effects of the prescribed medications. Some patients, particularly Where can one get treatment for bipolar disorder? in the acute phase, may require treatment with Treatment for bipolar disorder is provided Electro Convulsive Therapy, commonly referred to by all hospitals with a specialist psychiatrist. as ‘shock therapy’ in lay terms. NIMHANS provides treatment for at least 2000 new patients with bipolar disorder each year. Psychotherapy/counselling is prescribed in addition Consultation at the earliest is best for any patient to medications. This is usually for patients who are with bipolar disorder. having depression or who have difficulties in social/ occupational functioning.

Any co-existing medical conditions, like thyroid Dr. Muralidharan K disorders, would require appropriate treatment. Additional Professor of Psychiatry It is important to seek treatment early for the disorder Department of Psychiatry to be controlled more effectively. NIMHANS, Bengaluru

Of Loss, Coping and Surviving

Life is filled with so many emotions - Happiness, sadness, love, hate, tears, laughter and many more. Emotions are the innate feelings of an individual and words can never fully express how much someone means to us. Language and verbal expression may however provide comfort, solace, hope and even inspiration following the death of a loved one. All of us have emotional vulnerabilities that can drive our behaviour for better or worse. Each of us as individuals have our unique experiences and each of us may react differently according to the circumstances we face. Few years ago, I had a precious loss “My Mother”. This was also a time when I was at the critical juncture in my career. Losing the person I loved and admired the most had me totally shattered. There was a block in my thought and I didn’t know how and what to express. My surroundings were loud but I couldn’t hear anything.

Despite the huge loss, I always felt her presence. Indirectly her thoughts would strengthen my will power. She taught me many beautiful lessons but nothing that could help me handle this most challenging time and accept new changes without her. However, one realizes that life doesn’t stop, whatever happens. I still carry within my heart a dull and lasting ache where once I felt love and security. I also realize that it is important to continue my search for the happiness the way my mother always desired.

Ms. Taranum Taj, Assistant Coordinator, NIMHANS Centre for Well Being.

THE 13 LOUDSPEAKERAmplifying the voice of mental health Aging and Elder Care: Making an elderly family member feel more secure

In this rapidly changing society, the traditional Observe if they are able to see things clearly joint family system is paving the way for nuclear while they move about. Help them see a families. As a result, the support base for the elderly doctor for their vision or hearing issues. is gradually eroding. Aging family members can often become lonely and socially isolated. Loneliness • Daily routine and activities: Make sure can be compounded by medical problems, death they have a routine for themselves despite of dear ones, family disputes, etc. However, there all the others in the family being busy. This are families where the elderly continue to live with could involve some activities which they love their children and grandchildren. Caring for an doing. If one insists that they want to continue older person at home can be challenging, but can an activity every day, for example visiting also be a very rewarding experience. Here are a few a friend, try and arrange it, as it may be tips that you can follow to help your aged family something that your loved one really enjoys. member feel secure: Discuss with them what other activities they may want to do – it could depend on their • Listen: With age, the hearing and seeing interests such as reading, gardening, watching ability of the elderly decline. They cannot their favourite television show, having a cup often hear what is being said, so one may of coffee with friends, a walk in the park, have to repeat what he or she has to say. spending time with grandchildren and so on. Be patient, allow them time to express their Sometimes they may want to get back to their thoughts, move close to them and speak interests they had years ago such as writing or clearly. Spend some time to understand what poetry etc., but could not find the time to do it they are saying and feel genuinely involved. then. Facilitate these interests to the maximum One needs to be patient as their responses extent possible, as it may really improve your and reactions may have slowed with age. loved one’s well being.

THE 14 LOUDSPEAKERAmplifying the voice of mental health • Social support and socialisation: Talk to the older adults and keep them informed about your life as well. Try to have joint family activities now and then; it could be a visit to a relative’s place, or attending a family wedding, going out for lunch or dinner, going to a place of worship, or maybe taking them to their favourite movie or play. See if you can arrange for meetings with some of his / her old friends to cheer them up or have your relatives come over for lunch/ dinner and to spend time with them. Accompany your loved one to his/her doctor and discuss his / her health. Caring for an ageing person requires financial support as well. Offer support- it may include offering to pay bills, clearing loans, providing with medical costs and support for daily expenses. Elderly family members may resist taking your help. Speak to them, reassure them and explain why you want to help them.

• Travel: Take time off from your own busy schedule to relax and unwind. Once in a way take your elderly family member to his / her favorite tourist destination. Make it a family affair or involve his/ her close friends. Be sure to ask them if they plan a religious pilgrimage

THE 15 LOUDSPEAKERAmplifying the voice of mental health grandchildren; this may often create a generation gap and loss of communication. Let that not stop your children from bonding with them. Create a common activity where both children and grandparents spend time and enjoy- it could be watching a TV show, playing a family game, a visit to the park, etc. Children can learn a lot from the wisdom of their grandparents.

• Techno savvy elder: Have a computer or a phone with internet at home which your loved one can use during leisure. Help them have an e-mail account and link up with relatives and friends. Include him/ her in your family’s Facebook or WhatsApp account. Some of your old parents may have never used the internet. Teach them to use the internet and browse. If you have relatives or friends in other cities or countries, help them have video conversations with them.

Remember that elderly are like children. When they receive support and encouragement for their efforts it helps them feel more positive about themselves.

Surprise them on their birthdays and anniversaries. Make them feel loved and or they would want a more relaxing holiday. cared. Help them to age beautifully! Travelling can brighten their spirits and make them feel more connected with the family.

• Bridging generation gap: Ageing family Dr. Santosh Loganathan members usually love spending time Associate professor with grandchildren. However, they may Department of Psychiatry, not be agile in supervising and caring for NIMHANS

THE 16 LOUDSPEAKERAmplifying the voice of mental health How can you help children to express their emotions better?

incidents, they tend to express it with the help of their emotions. 5 year old Anu discussing with her mother…

Anu: Mummy, you know today two times I On the whole, children can be quite expressive and are often able to express their emotions honestly in cried in class. various situations. Mom: Why dear.. “I am angry with my classmate” Anu: I don’t like Ishant. He is very bad and I “I feel uncomfortable with someone” am very angry with him. “I am scared that you will leave me” Mom: What made you to get angry at him? “I am upset you are ignoring me” Anu: He did not play with me today. “I am very happy for the doll that you got for me” This giant wheel is Soooo big giant . I am surprised” Children are very sensitive to the changes occurring in their environment and they have innate need for “I am confused about what happened to that old discussing and informing whatever they observe. grandpa” Moreover, children can be overwhelmed by their emotions related to these environmental changes. Children have a natural tendency for expressing Children have similar emotions as adults. As the their emotions and adults can help them to express children find it difficult to verbalize more about the themselves in a much better way.

THE 17 LOUDSPEAKERAmplifying the voice of mental health “I think you are ANGRY with your friend for not playing with you”

“Are you SURPRISED about it?”

“Are you SCARED of going to that place?”

“I know it can be DISAPPOINTING, if you don’t win the competition”

These kinds of reflections by adults will help their children to understand what exactly they are feeling and how to name the emotions. Reading books to children also helps them understand and recognize their emotions better. At the same time, asking children to reflect on their daily experiences would help them in expressing their feelings.

Regular discussions:

Spend quality time with your child and discuss what happened in his/her school. When you ask the child, how was your day at the school, they get encouraged to express about the events and how they felt about it. Adults can just listen to them and observe their emotions without judging them. Parents can also help the children to clarify the reasons as to what made them experience a particular emotion, and so on. These regular discussions not only help the children to express their emotions and opinions but also helps in introspecting about their own behaviours.

Use of media:

Recognizing and acknowledging emotions:

Help children recognize and name their emotions. For this, adults must acknowledge their child’s Drawing by a child who experienced abuse emotions. Whenever a child is finding it difficult to verbalize how they are feeling, adults can name their Sometimes children find it difficult to discuss their expressions and emotions. concerns with adults. There are many reasons why

THE 18 LOUDSPEAKERAmplifying the voice of mental health children are unable to do so. It can be their fears, hesitation, anger, or lack of language abilities. Under such circumstances, medium such as storytelling, play, facial expressions, drawing and colouring, and writing journals can be used to help children express their emotions. Use of such media helps children to open up much faster and express their emotions without fear of being judged. These medium are very useful in certain conditions where the child has been traumatized, confused and fearful due to any incident such as abuse, mishap, or loss.

Helping children to manage their emotions:

Sometimes, children express their emotions in ways that are problematic, e.g. throwing things when demands are not met or crying when frustrated. Children learn to manage their emotions by observing adults. Thus, adults can be good role models for children in terms of demonstrating how negative emotions such as anger, disappointment, Adults can use various strategies to help children frustration and fear can be handled. Discuss and express their emotions in an appropriate manner. demonstrate healthy alternatives for managing Spending quality time with children, providing emotions in difficult situations. attention to the child’s feelings and emotions, and listening to them non-judgmentally, encourages Father: Today I had a very bad day. them to express and handle emotions better.

Child: What happened Papa?

Father: I lost my wallet while walking on the street. I was so angry.

Child: So what did you do?

Father: I was angry, but then I calmed myself down, took a deep breath and felt relaxed. Then I called my friend who helped me to get back home.

Ms. Chaitra Holla Dr. Kavita Jangam Psychiatric Social Worker Assistant Professor Dept. of Psychiatric Social Work Dept. of Psychiatric Social Work NIMHANS. NIMHANS.

THE 19 LOUDSPEAKERAmplifying the voice of mental health An Unquiet Mind: a memoir of moods and madness

Kay Redfield Jamison Vintage Books, A division of Random house Inc, New York With a new preface, 2011 (first Vintage Books edition 1996) ISBN: 9780679763307 Pages: 224 Price: U.S. $15.95

It indeed takes a to her work was in her great deal of courage own words in both to write about predictable and not so one’s own illness, predictable ways. and Kay Redfield The book is divided Jamison, Professor into four parts; The of Psychiatry at Wild Blue Yonder Johns Hopkins begins with the story School of Medicine of how an air-force does not have any pilot sacrifices his own less in measure. life to save the lives of She describes in children that includes this memoir her the young Kay in a journey of recovery playground. From in her personal then on she never saw battle with manic the sky for its vastness depressive illness. or beauty but rather Therefore, what is as a stark reminder striking about this of the imminence of unique description death. The daughter of recovery is that of a meteorologist this is by a mental father from whom health professional. she inherits the genes The book raises for manic depressive several pertinent illness wants to take questions including up a career in medicine whether people as she volunteers with mental illness for a candy striper should write at all or nurse’s aide. The about their illness; travails of the illness in she though “writes adolescence alter the from her heart” as trajectory as she goes “she ratchets up the on to pursue a career stakes by a notch or in Psychology. Even two”. The reaction as she has become a

THE 20 LOUDSPEAKERAmplifying the voice of mental health faculty she has little insight into her own condition illness) provide insights into the biological and and “within three months of becoming a professor genetic research for this highly heritable disorder. she is ravingly psychotic.” This last part also raises another important question of whether people with mental illness can treat A Not So Fine Madness is all about her flights of the other people with mental illness. There are no easy mind into mania and plunges into depression as answers though. She succinctly puts it across “the she misses the “rings of Saturn”. In mania, the ideas privilege to practice is exactly that, a privilege it is, and feelings are fast and frequent like shooting stars, not a right”. shyness goes, the right words and gestures are suddenly there, sensuality is pervasive as she gradually becomes The author also touches upon the sensitive issues irritable, angry frightened and finally there are only of gender inequality and the status of non medical other’s recollections of her behaviour with a bitter professionals in the realm of clinical psychiatry as aftermath to deal including bounced checks, lost she leads the affective disorders clinic and stands friendships and ruined marriages. Then there is the up to these. The “Oysters” and “Mouse-hearts” of phase when “she is just like the rest of us”. This part the world are disappointing but they are a harsh also details her long and lacerating black suicidal reality. What is also real is the presence of insensitive depression. The reluctance to graciously accept physicians like the one who tells her “You shouldn’t reaps her bitter harvest. Surprisingly, being have children. You have manic depressive illness”. a Psychologist by training she appears to be a strong In contrast, it is also reassuring and real that she proponent of biological psychiatry emphasising found warmth in her family, support from her the unique place of Lithium in managing manic friends, colleagues and acceptance from lovers. depressive illness. Lithium prevents her disastrous highs, diminishes depression, clears out the wool..., slows The book is an easy read not only for professionals her down, gentles her out and makes psychotherapy possible but lay-readers too. For the student of literature there but ineffably psychotherapy heals. This part concludes is vivid prose and sheer poetry, for the sophomore of with her tenuring into Associate Professordom. phenomenology there is excellent clinical description of mania, depression, cauldronous mixed states and The third part – This Medicine, Love begins with also grief, for those interested in psychopharmacology her engaging relationship to an Army Psychiatrist, there is all about lithium including the rare side David Laurie. His tragic death in Kathmandu brings effects such as on accommodation of the eye, but a closure to this relationship. The chapter describes the memoir has strikingly little about what she her grief, the people who helped her in the grieving underwent as psychotherapy. Finally and most process. This is the period in her life wherein after the importantly, in this deeply human endeavour there initial reluctance to accept treatment she had begun is a lot to learn about personal elements of recovery. to realise the benefits of taking lithium; as her lithium levels are optimised, she becomes more productive Reviewed by: James Joseph, Krishna Prasad M. contributing many chapters in an authoritative Psychiatric Rehabilitation Services NIMHANS, textbook on manic depressive illness, of which she is Bengaluru the Co-Editor with Frederick Goodwin.

In The Unquiet Mind she argues that the term “Manic Depressive illness” best captures the disorder it represents, rather than the increasingly popular Mr. James Joseph bipolar disorder as she goes on to state her illness in Psychiatric Rehabilitation Services DSM-IV diagnostic terms. Her mantra for doing away NIMHANS, Bengaluru with stigma is not just to deal with semantics such as madness or crazy, but rather more tellingly with successful treatment, advocacy and legislation. Her Dr. Krishna Prasad M interesting and easy encounters with Nobel Laureate Associate Professor Dr. Watson of the double helix DNA fame, and the Psychiatric Rehabilitation Services famous Danish Psychiatrist Mogens Schou (whom NIMHANS, Bengaluru we learn has a family history of manic depressive

THE 21 LOUDSPEAKERAmplifying the voice of mental health Managing Emotions in the Workplace

Emotions, simply stated, is your ‘energy in motion’. demand on an individual’s emotion regulation skills It is a mental state accompanied by a range of bodily – both in terms of stressful workplace conditions changes, expressions and actions. (e.g. policemen) as well as part of the job profile (e.g. service industries like hotels, hospitals.). As emotions are an integral part of human nature and lives , it important to manage them effectively. Emotion Emotions in workplace include: regulation is a process that involves recognising • emotional labour (efforts to portray emotion and modifying emotions, and the experience and expressions that are not authentic, but guided expression associated with them. Effective application by the display rules of the organisation during of emotion regulation skills contributes to effective interaction with customers), interpersonal interactions and better mental health. • emotional work (genuine emotion in interaction with customers), People spend a large part of their time at work. Thus, researchers have come to recognise the importance • emotion - with - work (emotion stemming from of emotions and their role in workplace interactions. interactions with coworkers),

Workplace behaviours and overall health of the organisation are influenced by the emotions experienced by employees. Effective emotion regulation helps alleviate stress, contributes to workplace competence, enhances employee motivation, reduces conflicts and improves health and productivity of the organisation. In addition to day-to-day events at work, some jobs place greater

THE 22 LOUDSPEAKERAmplifying the voice of mental health • emotion - at - work (emotion from non-work sources experienced in the workplace), • emotions toward work itself (where work is the target of the feeling).

Frequent experience of negative emotions (anger, frustration, uncertainty, humiliation and anxiety) without appropriate expression has been linked to multiple indices of physical health and poorer psychological well being.

The experience of emotion is often due to the interpretation of the situation and its meaning. The relationships, thereby reducing stress, with greater same situation may give rise to different emotions in work engagement and psychological well being. different people. The difference lies in the appraisal of the situation. Modifying the way we think about Factors Increasing Risk of Negative Emotions a particular situation can help modify the experience Experience of stressful life events or challenges, of the resulting emotions. Or one may change the work-life conflicts, harassment presenteeism (being outward expression of an emotion after it has been at work despite a sickness that justifies absence, experienced (smiling at a rude customer, even when consequently, work performance is under sub- we feel angry with him/her). With greater emphasis optimal conditions) are some factors that increase on team work, interpersonal aspects of emotion risk of experiencing difficult emotions at the regulation cannot be ignored. workplace.

Other ways of managing emotions include situation Role of organisations selection i.e. increasing or decreasing our chances of Attending to employee emotions, considering being in a situation that will give rise to the emotions emotional costs and benefits of their decisions, we would not like to have or want to avoid (e.g. helping them resolve their issues will go a long way postpone meeting a volatile boss if he/she is already in having a happier and more productive workforce. in a bad mood); situation modification i.e. modifying Identifying triggers for negative emotions, training the situation directly so as to alter its emotional managers in positive management behaviour, impact (e.g. using humour to diffuse a potentially communication skills and conflict management is tense situation) and distraction i.e. focusing attention important to develop a healthy emotional climate at away from emotional aspects of the situation. We the workplace. could also learn ways that could potentially reduce the intensity of our emotional responses- for example Emotions are intricately woven into the fabric of using relaxation to bring down anxiety. workplace experiences and determine the quality of our relationships. Thus, effective management Positive Emotions and the Workplace of emotions at the workplace is an important step Positive emotions help people consider more towards better mental health. creative, expansive ideas, actions, and solutions. When employees experience positive events at work, they are also likely to have better social Dr. Paulomi M Sudhir Additional Professor Department of Clinical Psychology NIMHANS, Bengaluru

Ms. Janhavi Devdutt PhD Scholar Department of Clinical Psychology NIMHANS, Bengaluru

THE 23 LOUDSPEAKERAmplifying the voice of mental health Emotions and eating: feeding your feelings!

How many of you turn to “food” when you are 4. Do you often eat up to the brim even if that was stressed, lonely, upset, angry, or happy? Does food not your intention? And does it trigger a feeling act as your acts as your emotional support, during of guilt? hard times and participate in your joys and sorrows? In other words, is food your ‘best friend?’ If the 5. Do you suddenly feel hungry often and crave answer is ‘yes’ for yourself or someone you know, for a particular food item, at times, even when then you should continue reading. Although hunger you have had a recent meal? is a life instinct, there is a deep relationship between eating and emotions. What we eat and how much we eat are influenced by our mood. The problem arises when the eating is only or majorly influenced by our emotions and feelings. You are not then feeding yourself but feeding your feelings and emotions!

This can be quite detrimental as you just stuff yourself superfluously and with unhealthy food. The longer it continues, more is the unnecessary weight gain and physical problems. It also brings shame and guilt, which further add to the stress. Do you need to wait till this juncture to understand that feeding your feelings is not good and food in this way can’t be your friend?

Let us talk about how to identify that eating and emotions are going on the same track. 1. Do you eat whenever your mood is not in the usual mode; may be when you’re upset, lonely, angry, or happy? 2. Was it difficult to handle these situations when you couldn’t eat for any reason? 3. Do you feel powerless in front of food?

THE 24 LOUDSPEAKERAmplifying the voice of mental health If it is “yes”” to any of these questions or if the doctor 3. Stay away from food in these situations: has advised you to change your food-habits but you i. Say to yourself aren’t able to do so, it means you need to deeply • A big “No” and “ Stop” analyse your eating behaviour. Maintain a food and mood diary and see how many times you answer • Your goal and what to do if it is not “YES” to these questions. achieved ii. Prefer- “I CHOOSE TO EAT HEALTHY Once you have recognised that your eating and FOOD” rather than “I have to eat healthy food” emotions are entangled together, then please don’t get upset. You have already made the first step as 4. Change the behaviour and attitude towards you know what the problem is. There are broadly eating: four steps to be followed to handle this: i. Perform a small ritual before eating, such as expressing the meaning of food to the life 1. When you proceed to food and gratitude to all who bring this healthy i. Ask yourself whether you are really hungry or food to you is it a craving for specific type of food. ii. Sit while eating. Don’t engage in other ii. Check your feelings and what precipitated activities while eating. them. iii. Restrict eating to Eat 3-5 small meals a day 2. Deal with the feelings-emotions through However, remember that it’s quite okay to break the activities other than eating: rules once in 5-7 days! i. Take 4-5 deep breaths/ practice Yoga. The problem could be in any of the above steps, ii. Go for a walk/ play sport/ exercise. which you find difficult to resolve on your own. iii. Read something of your interest/ listen to However, the consequences would be the same- music (these materials should be readily weight gain and feelings of shame and guilt. If available to you). this happens, YOU SHOULD MEET A HEALTH PROFESSIONAL WHO CAN HELP YOU AT THE iv. Write a journal on your feelings. EARLIEST. YOU CAN CLIMB TO THE TOP, v. Talk to your friend or relative/ spend time YOU JUST NEED A LADDER. with your pets. vi. Take a hot bath or shower. Dr. Preethi Sinha Assistant Professor Department of Psychiatry NIMHANS, Bengaluru

THE 25 LOUDSPEAKERAmplifying the voice of mental health I feel like an outsider - How persons with schizophrenia can understand other people and communicate better

Suresh’s family was excited for him as he began his with his studies, often blaming and suspecting his engineering degree – his long cherished dream. Soon friends and teachers for his problems. Suresh later his parents noticed that he spoke less and seemed confided that over the last year or so he had been worried. They thought he was taking time to adjust hearing voices of strangers that had increased over to the new environment. Within a week they got a the last couple of weeks. call from his friends that Suresh was disturbed, and had grown extremely suspicious about his teachers. Individuals with schizophrenia have difficulties in After consultation with a psychiatrist they learnt understanding how other people think (perspective that Suresh had been hearing voices of strangers taking), recognising emotions correctly, and conspiring against him, and this was when they communicating adequately and appropriately with also learnt about his diagnosis – schizophrenia. them. These ‘social cognition’ deficits may co-occur After learning more about the illness, his parents with problems in general cognition like concentration, recalled how Suresh, now 20 years old, was memory, reasoning and planning. More often than behaving differently in the last 1-2 years. He had not, they precede the more dramatic symptoms nearly stopped meeting his friends, got into frequent of and , and persist even arguments with his parents, had struggled to cope after. These are often unrecognized and may

THE 26 LOUDSPEAKERAmplifying the voice of mental health contribute to formation of delusions. For example, like badminton, football or basketball, can also be one may misinterpret actions or emotions in others an easy and fun-filled substitute for such exercises. and conclude wrongly that he or she is in danger. Just like physical exercises build our muscles, brain The inability to see alternative perspectives and exercises can sharpen our cognition. These may range correct these misinterpretations could then lead from reading for a course and writing an exam, to to a . Understandably, the worlds of these more specific tasks like solving puzzles, crosswords, individuals grow smaller as time passes, making Sudoku, mathematical problems or playing games them feel like outsiders even at home. like scrabble. It’s not without a reason that the age- old saying goes “use it or lose it”!

Once we have our general cognition honed, social understanding and communication can be enriched using the SMART strategy. Of course, a doctor will be able to tell us where can one get more help in this regard. Prerequisites to apply this strategy include an opportunity to socialize and have fulfilling family relationships, as well as the drive or motivation to engage in these situations.

The first step in SMART is Seeing Emotions. Identifying our own emotional state requires us to reflect upon our mood in a given situation andbe aware of physical signs of different emotions (e.g., pounding heart and sweating can happen when we are very worried or very excited, while sadness manifests as low tone of speech and slow actions). Recognising our own emotions helps us identify emotions in others. Paying attention to facial (eyes, mouth and eyebrows) and vocal (tone of speech) cues is particularly helpful. Schizophrenia is a brain disorder that occurs due to subtle changes in brain functions of thinking and feeling. It often begins during adolescence and has genetic underpinnings. While medications are an important component of treatment, especially for the delusions and hallucinations, there are certain other exercises and strategies that can be used to overcome the more difficult social and general cognitive deficits in schizophrenia. These strategies work on the premise that the human brain is malleable and changeable, being able to unlearn and relearn specific behaviours over a period of time.

A social interaction is an inter-personal exchange that occurs between two or more individuals. It includes an exchange of emotions, thoughts, words and actions. Understanding social situations is a first step in ensuring proper communication, and this requires both general and social cognition. Researchers have found that aerobic exercises like cycling, swimming and running, not only increase the size of important brain structures like the hippocampus (responsible for memory), but also improve memory and concentration. Playing a sport

THE 27 LOUDSPEAKERAmplifying the voice of mental health Next, we need to have Mind Awareness. As with appropriate responses and again obtaining feedback emotions, this begins with being aware of our own from others. mind (i.e., our thoughts, intentions and judgements, examining the pros and cons of our decisions). This Lastly, being Thoughtful or meta-cognitive about strategy will also help us understand thoughts and the entire interactive process and its outcome gives intentions in others. A useful way of doing this is us an opportunity to alter our responses according by asking yourself, “What would I do/think in this to the situation. Meta-cognition, in simple terms situation if I were in his/her place?” This approach refers to the process of thinking about thinking. In would go a long way in taking perspectives of the this context, it applies to being thoughtful about our other person in order to understand him/her better own as well as others’ emotions, thoughts, words and avoid misunderstanding. Not jumping to any and actions. This skill provides us the feedback to conclusions and having a flexible mindset is another modulate our responses on a time-to-time basis, useful tactic. depending on changing social scenarios.

The next step is that of an Appropriate Response. Finally, visiting the doctor regularly, voicing your Understanding emotions and thoughts guides our concerns – psychological or physical, illness related response in words or actions. A planned, reflective or medication related, personal or family related, response is likely to be more useful in conveying what and taking the prescribed medications, goes a long you want, than a spontaneous, reflexive response. It way in preventing the more disturbing delusions is a good practice to be aware of our strengths (e.g., and hallucinations, which if recur, can worsen the fluent speech, expressive body language and good cognitive deficits. eye contact) and weaknesses, while communicating during social interactions. Often these are obtained Dr. Urvakhsh M. Mehta from feedback that others give us (see below). Assistant Professor Weaknesses can be rectified or learnt by observing Department of Psychiatry, someone whom you admire, imitating and practicing NIMHANS, Bengaluru

ALCOHOL IS NOT THE ANSWER TO LIFE’S PROBLEMS

One notion that seems to prevail in the society – to some extent propagated by the media – is that using alcohol helps to relax or deal with stress. Several individuals who use alcohol blame family issues or other problems for their drinking. But fact is that problems exist for alcohol users and non-users alike. The difference lies in the way the problems are handled. For instance, a non-alcohol user would deal with stress or problems by seeking advice from family members/ well-wishers, or just waiting for time to resolve things, if nothing is working. But among alcohol users, the tendency may be to reach for a drink. However, alcohol does not solve problems, it compounds them, besides adversely affecting one’s health. It is not life circumstances that cause a person to use alcohol; rather, the circumstances may just maintain alcohol use in certain individuals, who get used to using it as a way of coping, over a period of time. The principle here is to break the link between everyday stresses and alcohol use, and gradually learn to deal with problems/stress the way a non-alcohol user would.

-- Dr. Prasanthi Nattala, Associate Professor, Dept. of Nursing, NIMHANS

THE 28 LOUDSPEAKERAmplifying the voice of mental health Healthy Use of Technology among Youth

With the advancement of technologies, the Internet Convenience (one can do anything as per availability has revolutionised how we communicate and its flow of time) and 3) Euphoria (feeling of goodness after has enabled and opened up entirely new forms of completion of task). The sense of well being associated social interaction, activities, and organization, with with technology use, leads to excessive use of the same. its widespread usability and access. The emergence It also leads to unhealthy habits such as avoidance of of social networking websites such as Facebook®, offline interaction, outdoor activities, development of Twitter® and Orkut®, have not only made it possible irregular food habits or sleep disturbance etc. to find existing acquaintances via net and renew communication but also have created newer patterns You can screen the unhealthy use of technology by of socialisation and interaction in the virtual world. answering the following four ‘C’ questions in yes or Thus the metaphor “global village” is often used to no options: describe how the Internet has shortened distances between people and facilitated the flow of information. 1) Craving (continuous desire to be on the technology); According to the Pew Internet Study 2013, 92% of 2) Control (losing control whenever on Internet users say the Internet is a good place for technology); getting everyday information, 85% say the Internet is 3) Compulsion (it has become “a have to activity a good way to communicate or interact with others. for you”) & 75% say the Internet is a good place to conduct everyday transactions, 69% say the Internet is a good 4) Consequences: way to entertain themselves in everyday life. A) Physical (experience health eye strain, pain, fatigue) Life has become easier with 3 characteristics of B) Social (stopped going out, decrease social technology: 1) Accessibility (easily available), 2)

THE 29 LOUDSPEAKERAmplifying the voice of mental health interaction with, preferred to spend time on technology) C) Psychological (using it as a way of coping).

If the answer is ‘yes’ to 3 or more of the above, then the individual is engaging in excessive use of technology.

You can promote healthy use by:  Acknowledging the problem- Accept that it is interfering with other daily activities;  ASK- Overcome your hesitation to seek help; discuss with your family members or counsellor and seek active help to promote healthy use of technology. As the child get older, keep family communications about the Internet as open and positive as you can.  Develop alternative pleasurable activities. Do not criticize his or her technology use. Talk with For instance, you may be using the internet your kids about their online friends and activities just to manage negative mood states (i.e. sadness, as you would talk about other friends and activities. loneliness, boredom, etc). Instead, try developing other activities to manage the mood Set Rules for Internet Use: Lay out rules for Internet states – e.g. start an outdoor hobby, interact use, setting clear expectations for your child online with neighbours, meet up with friends, etc. habits. A good set of rules should include things like the amount of time children are allowed to be Talk About It online, what types of content are appropriate as well Talk with your children about the Internet, and as proper online conduct . encourage them to see it as a shared, open environment in which they have social responsibilities just as they Keep in mind: would in any physical environment. The most successful rules are those that are created collaboratively. With open discussion, you can set expectations about the behaviour you expect from them, curb negativity Discuss the rules frequently. Remind them that and discourage behaviours such as secrecy, late evening the rules are in place to protect your family, and browsing or thrill-seeking. You can guide guide them that strictly maintaining privacy online can lower regarding online safety issues as well as educate them the risk of being targeted by online predators. about cyber laws. Tell your children that following the rules and Keep in mind: keeping communications open will allow them to Enjoy the technology along with your children, gain freedom as they get older. and discuss the variety of ways in which it brings new information into one’s lives as well as Balance Time Online: Maintaining a balance between encourage them to share their opinion. entertainment and other activities in children’s lives can be a serious challenge. The Internet has made it Experience from research conducted in Indian context even more difficult, as the lines between entertainment indicated that children develop psychological distress due to their online experience as well as inability to discuss with others Make yourself available to your child ‘s questions and encourage them to share their Internet experiences with you without fear of punishment about what they read, see or experience.

Discuss the advantages of safe online interaction with others, why children should stay away from certain types of content and individuals.

THE 30 LOUDSPEAKERAmplifying the voice of mental health and education are often blurred. Modelling a healthy Keep Personal Facts Private balance between your online and offline activities is Online privacy is vital to your family’s safety. a great way to encourage children to do the same. Ensuring that your kids communicate online only with people known to them and your family can Keep in mind: help limit their contact with unsavory elements. Enforce rules about the amount of time your child Still, as children grow older, they are bound to make may spend online and the hours they are allowed new friends online, and it is important to teach them to go online. Help your child develop self-control, about keeping personal facts private. discipline and accountability regarding Internet use. Keep in mind: Encourage and support their participation in Ensure that children keep facts such as their real other activities — particularly physical pastimes name, age, gender and location private. Discuss with other children. If your child is reluctant, look how details in photographs can reveal more for offline activities that tap into the same interests information to would-be predators than your your kids pursue online. child intends.

Watch for signs of Internet dependency. (If Internet Many children routinely visit social networks use seems excessive or begins to affect your child’s and blogs where they may post pictures, make school performance, health or relationships). In comments and write personal entries. Insist that that case, seek professional help at the earliest. your children keep personal information private and that they think twice before joining location- Get factual information based peer groups that may give away information There’s a lot of content on the Internet that isn’t on their whereabouts. helpful or reliable. While more online fact checking happens today than previously, the ability of nearly Ensure that your children understand the anyone to offer opinions or build websites can make risks involved in making private or personal the Internet a confusing place for young people. In information public online. Keep an open dialogue that case, seek professional help at the earliest. about the people they come into contact with online. Discuss and evaluate online relationships Train them to use a variety of online resources and to as you would any other relationships in your always check, question and verify what they see online. child’s life. Keep in mind: Barrier to develop healthy use: The main barriers Start young. Even preschool students use the manifest in the form of inability to see the problematic Internet to look up information. Teach them early usage of available technology, absence of alternative to distinguish fact from opinion, and discuss ways activities to manage the situations associated with to recognise bias, propaganda and stereotyping. usage and hesitation to seek help for developing controlled healthy use of technology. Challenge your children to evaluate what they see online by asking: What is the purpose of this site? There is a need for developing other leisure activities To entertain? To sell? Is the “About Us” section for oneself as well as for the children. So all of can authentic? Does a company or an individual person experience the feeling of goodness after the use of sponsor it? Is it a public conversation? Finally, technology. challenge them to consider whether the Internet is the best place to find the information they need. Source: Intenet and daily life accessed on www.pewinternet. org/2004/08/11/the-internet-and-daily-life

Dr. Manoj Kumar Sharma Additional Profressor Services for Healthy Use of Technology(SHUT) Clinic, Dept. of Clinical Psychology, NIMHANS, Bengaluru

THE 31 LOUDSPEAKERAmplifying the voice of mental health Handling Difficult Emotions

Gretchen Rubin chronicled her one-year search for your ‘emotion vocabulary’ and ask yourself: Are you the secrets of happiness in her bestselling book The frustrated, worked up, irritated, furious, hostile, Happiness Project. Interestingly, she speaks about the enraged or are you unhappy, sad, pessimistic, role that negative emotions can play in the pursuit of dejected, despairing, hurting, grieving? Sometimes happiness; as signals that something isn’t right and you could start with labelling your emotion as anger that changes are needed. and then realise that it is actually more a feeling of sadness and loneliness; or perhaps a mixture of All of us have experienced being overwhelmed many emotions. This can help you in your efforts by intense and difficult emotions like sadness, to understand your emotions and experiment with guilt, frustration, anger, shame, anxiety or fear. So, a range of strategies to deal with them effectively. how can we handle these emotions without being Different strategies would be useful according to the overwhelmed or paralysed? context and you need to judge which ones work best for you. While some strategies focus on reducing “Stop crying!”; “I’m fine” (even when you are not), the intensity of the difficult emotion in the moment, are statements that demonstrate how we tend to other approaches look at developing more adaptive deny or push them away our negative emotions. methods over time as well as trying to understand The first step in learning to handle difficult emotions the thoughts, contexts, patterns and origins of the is becoming aware and naming the emotion/s. Expand emotion.

THE 32 LOUDSPEAKERAmplifying the voice of mental health Some of these strategies can be: exercises are very important parts of your  Time out: It is sometimes uncomfortable, difficult, emotion toolkit. Mindfulness methods use a or inappropriate to express intense negative different approach; they encourage the mindful emotions in certain situations. A brief stepping acceptance of the difficult emotion while away from the situation to take the time to recognising the impermanence of all emotions. compose yourself can be helpful. • Expressing your emotions: Once you have been  Distraction and Soothing Methods: A flood of able to understand your emotions, regulate emotions can be difficult to deal with. Try their intensity and what you want to convey. engaging in activities to distract yourself for expressing your emotions in the appropriate temporary relief. This could be listening to music, context can be useful. A good way to make a concentrating on some other task, engaging in start is to say “I feel….” “I felt…” or “I have been physical exercise or any other physical activity. feeling….” . This is usually more effective than Exercise can also work as a mood elevator saying, “You made me feel….” . It is important to through the release of ‘feel good’ chemicals in be specific about what you feel. Next you could the brain. Soothing strategies, e.g. taking a walk go on to express the source/s of this feeling as and looking at the flowers in the park, enjoying well as anything you might want the other person a special meal, taking a warm shower, can help to do. Remember that we express our emotions you cope with overwhelming emotions. not only though our words but also the tone or volume of our voice, our facial expressions and • Imagery: Temporary reduction in the intensity of our actions. your difficult feelings can be achieved through visualisation exercises. For example, you can • Using your Support Network: Sharing feelings and imagine putting your pain and sadness in a box getting support from friends or family can help on a cupboard shelf and you will get back to you feel less alone and perhaps learn from their opening the box and sorting things out once you suggestions and ways of looking at your situation. feel calmer. Visualising a scene, place or event that you remember as peaceful, beautiful or • Understanding your emotions: A number of happy can be a powerful method. You should try methods can help you tease out the often complex and use all your senses and ‘see’, ‘hear’, ‘smell’ reasons for the upsurge of certain emotions. and ‘feel’ the scene in your imagination. Writing your feelings in the private diary, linking feelings to specific situations, events, personal • Breathing and Relaxation methods: Learning slow beliefs or values or trying to list out the thoughts and deep breathing exercises, muscle relaxation associated with these feelings (e.g. Its wrong to

THE 33 LOUDSPEAKERAmplifying the voice of mental health feel this way; If I feel this way, I will lose control) can give you a better understanding. This in turn provides guidance for the steps to deal with distressing thoughts or feelings.

• Understanding the other’s emotion: When difficult emotions arise in the context of an interaction with another person, efforts at understanding your own emotions may not be enough. Trying to step into the other person’s shoes and tuning in into his or her emotions can sometimes lend a different perspective.

• Help yourself in a safe space: Counselling or therapy can provide a safe, confidential and non-judgemental space for you to explore, understand and manage recurrent patterns of painful feelings.

As human beings in the world of relationships, * The Yale Centre for Emotional Intelligence (www. emotional intelligence plays an importance role in our ei.yale.edu) has a range of innovative ways to lives, influencing learning, relationships, creativity, harness the power of emotions and teaches people of decision-making and our overall wellbeing. all ages how to develop their emotional intelligence.

Dr. Poornima Bhola Associate Professor Department of Clinical Psychology NIMHANS, Bengaluru

THE 34 LOUDSPEAKERAmplifying the voice of mental health Gatekeeper Training for Suicide Prevention

Would you like to be a Gatekeeper? training program which includes : • In our Gatekeeper Training Program, A • Lecture cum demonstrations Gatekeeper is someone is someone who • Role plays believes that suicide can be prevented • Video shows in the community and is willing to give • Case examples time and energy for this cause. This training is conducted by a team • Gatekeepers could be anyone- teachers, comprising of Psychiatrist, Psychiatric parents, neighbours, hostel wardens, Nurse & Psychiatric Social Worker. police or lay counselors.

• A Gatekeeper should sound the alarm when he/she identifies someone who is very distressed, provide initial emotional support and then refer them to a mental health professional.

What do we do to help you be a Gatekeeper? • For 20 people at a time, we conduct a

We now have a network of more than 500 trained gatekeepers To enroll, contact: NCWB @ 080-26685948 / 9480829670

Printing of the Magazine funded by: Dr. Ramachandra N Moorthy Foundation for Mental Health and Neurological Sciences TRAUMA RECOVERY CLINIC Psychological Trauma: The Invisible Scars

The clinic provides brief psychological interventions to adolescents and adult survivors of trauma through one-to-one and/ or group counselling and psychotherapy. The interventions are tailored to suit the unique needs of each client.

Indications for consultation include: Interpersonal trauma such as domestic violence, betrayal trauma, trauma due to elder abuse, child sexual abuse, physical and sexual assault and traumatic bereavement. Indications also include trauma due to self-harm behaviours, trauma due to acqured disability, secondary trauma and specify in 2-3 words what is complex trauma.

Consultation days: Every Wednesday 9:30 am to 12:30 pm.

To book your appointment, kindly contact: NIMHANS CENTRE FOR WELLBEING 1/B, 9th Main, 1st Phase, 1st Stage, BTM Layout, Bengaluru 560 076 Phone: 080 26685948 or 9480829670 E mail: [email protected]

AWAKE Clinic @ NIMHANS Centre for Well Being

Benificiaries: Women with Intimate Partner Violence Services Offered:

• Tailor-made mental health interventions and counselling for women with intimate partner violence. • Trauma care for the victims of violence. • Supportive and individual therapies to build self-esteem, self-confidence, coping skills, problem-solving skills and communication skills of women. • Telephone counselling. • Referral and information services regarding available resources, legal rights, shelter care. • Support group for women survivors of intimate partner violence. • Community based awareness and training programmes to prevent gender based vio­lence.

Timings: Every 2nd and 4th Wednesday between 2.00 pm to 4.30 pm

Printing of the Magazine funded by: Dr. Ramachandra N Moorthy Foundation for Mental Health and Neurological Sciences THE 36 LOUDSPEAKERAmplifying the voice of mental health