Psyche & Soul 32: THE BURDEN OF MENTAL ILLNESS

 Podcast link:

2.32 Psyche & Soul # 71
https://anchor.fm/boscom/episodes/2-32-Psyche--Soul--71-epvtoa

 

The last few podcasts have been on mental health and wellbeing. This weekend I shall focus on the burden of mental illness, that is prevalence of mental illness globally and especially in India.

THE BURDEN OF MENTAL ILLNESS

Mental illness is a reality in the lives of many people and is on the increase.  There has been a 13% rise in mental health conditions and substance use disorders between 1997 and 2017. Latest pre-Covid data available (The Global Burden of Disease Study 1990–2017, a massive  collaborative work of World  Health Organization, World Bank and Harvard University) showed that globally 970 million people (10.7 percent, that is a little more than 1 in 10 people)  worldwide had a mental health or substance abuse disorder in 2017. Of the population affected by mental illness Anxiety is the most common mental disorder, affecting 284 million people worldwide. Next is depression affects 264 million people. Schizophrenia affects 20 million people.

Around 20% of the world’s children and adolescents have a mental health condition. Globally, mental illness affects more females (11.9%) than males (9.3%). The mortality rate of those with mental disorders is significantly higher than that of the general population. It is estimated mental disorders are attributable to 14.3% of deaths worldwide, or approximately 8 million deaths each year. One emerging reality that is of some concern is that more and more young people are reporting mental illness.

 

The Indian Situation

According to the GBD Study cited above, a little more than one in seven Indians (7.5 per or about 197.3 million) suffer from some mental disorder, ranging from mild to severe.  The study had predicted that by end of 2020 roughly 20 per cent of Indians will suffer from mental illnesses.

 As at the global level, depressive and anxiety disorders are the more common form of mental illness in India.  According to data collected, 47.7 million Indians suffer from depression and 44.9 million Indians suffer from anxiety disorders. The prevalence of depressive and disorders was significantly higher in females than in males. This could be related to gender discrimination, violence, sexual abuse, antenatal and postnatal stress, and adverse socio-cultural norms.

 

Suicide

There was also a significant, but modest correlation between the prevalence of depressive disorders and suicide. India accounts for 36.6 per cent of suicides globally. Indian women have double the global rate for death by suicide of women. Latest (2020) data released by the National Crime Record Bureau had shown that India reported an average 381 deaths by suicide daily in 2019. As many as 1,39,123  people died by suicide in India in 2019, marking a 3.4 per cent increase compared to 2018. Notably, over 90,000 of the people who died by suicide in 2019 were aged between 18 and 45.

 

Shortage of Mental Health Workers

A WHO Report (2018) had stated that the mental health workforce in India is not up to the mark and there is a huge shortage of psychiatrists and psychologists in the country as compared to the number of people suffering from mental health issues. WHO states that in India, per 100,000 population, there are only 0.20 psychiatrists, 0.07 psychologists, and 0.36 other mental health workers available. This means many needing psychological and psychiatric help would be deprived of it.

Increase through Corona Pandemic

The situation has been exasperated by Covid-19. An American Psychological Association  survey, conducted between Aug. 28 and Oct. 5, 2020,  found that nearly 3 in 10 psychologists (29%) said they are seeing more patients overall since the start of the pandemic. Of psychologists who provide treatment for anxiety disorders, nearly three-quarters (74%) reported an increase in demand for such treatment, and 60% of those providing treatment for depressive disorders saw an increase. The enforced home isolation has led to increased stress and anxiety in families. In some studies up to one third of families have reported feeling very or extremely anxious. A growing body of research is raising concerns about the impact of loneliness during the pandemic.

This is also true of India. A survey by the Indian Psychiatric Society showed a 20 percent increase in mental illness due to Covid-19. More recently Dr. Rajesh Sagar, professor of psychiatry at the All India Institute of Mental Sciences (AIIMS), New Delhi, India’s premier psychiatrist institute, said there is a 50% increase in cases of psychological distress, as also the number of people reporting symptoms of anxiety than before (Times of India, Dec 31, 2020)

Increasing demands of meeting patient needs are affecting mental health providers too. In the American Psychological Association survey mentioned above, more than four in 10 psychologists (41%) said that they felt burned out, and 30% said that they have not been able to meet the demand for treatment from their patients.

Unlike physical disorders which can be verified by objective criteria and test, as is the case with Covid-19, most mental health disorders cannot be tracked with a test or tangible sign. Hence there would be a large group of silent sufferers, whose illness would go unnoticed.

Genetic (inborn) vulnerabilities to psychiatric disorders, which have been kept in abeyance through a nurturing environment, can be activated when experiencing prolonged and high levels of stress. This is especially true of schizophrenia and major depression.

Mental health experts warn that the impact of Covid-19 on mental health would be felt for years after the virus has been brought under control. Dr. Adrian James, president of the Royal College of Psychiatrists, for example, warns that Covid-19 “is going to have a profound effect on mental health. It is probably the biggest hit to mental health since the second world war. It doesn’t stop when the virus is under control and there are few people in hospital… [there are] long-term consequences.”

Introspection and Prayer

What is your reaction and response to the data on mental illness presented on this podcast? What does it evoke in in you?

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Jesus of Nazareth was concerned about eliminating suffering from human lives. During his life ion Palestine he encountered many who were suffering from all sorts of mental illness. He showed great compassion for them of their afflictions.

May be we can recall one of his healing encounters with the ill and rest for while in his company in that scene. We could then bring before him all those who suffer from mental illness, especially those we know, praying for their healing, or begin a fantasy journey of healing with him.

Have pleasant weekend. Be safe. Be blessed.

Thank you for listening/reading.

Pictures: courtesy Google Images

Jose Parappully SDB, PHD

sumedhacentre@gmail.com 

Psyche & Soul 26: MOVING INTO THE NEW YEAR WITH HOPE!

 Podcast link:

https://anchor.fm/boscom/episodes/2-26-Psyche--Soul--59-eo70mr

As 2020 comes to a close, we look forward to 2021 with Hope.

2020 changed our world. 2020 has been very distressing and disruptive and in some sense a disastrous year. A year which has affected the global society in so many negative and painful ways. Covid-19 blighted our hopes and dreams, disrupted our lives in drastic ways. It undermined our sense of security and predictability. Uncontrollable spread of the deadly virus led to over a million being infected and to the death of hundreds of thousands, leaving families in grief, sometimes in despair. The lockdown caused immense suffering, especially to the vulnerable. Travel was curtailed, social contact was restricted, and we were forced to be homebound. Economy collapsed, leading to loss of hundreds of thousands of jobs. Haunting pictures of deprivation and death on the road have seared into our collective memory. There is a sense of helplessness and hopelessness, increase in mental illness and suicide.

In this context, hope is our greatest ally. Every New Year brings a fresh outlook; we look forward to better times. We dream.

And we really hope that 2021 will usher in that freshness and newness in a very special way. We need this newness very badly in every sphere of our lives. A newness that will help us wipe away the bad memories, the nightmares, of 2020. Hope that the New Year will dissipate the virus, restore health and wellbeing to all of us, usher in a safer, more peaceful, and a more equitable and compassionate society.

WHAT IS HOPE?

Hope is the conviction of having a meaningful future despite obstacles and difficulties, and also choosing the pathways and means to make that future real.

Persons high on hope have visions of who they want to be and what they want to accomplish in life and are able to motivate themselves, and feel resourceful to accomplish their objectives.

 Hope includes practical pathways to realize the bright future we envisage. We work hard at realizing that dreamed of future. We persist in seeking goals despite setbacks and obstacles. We are also flexible enough to find different ways to get to our goals or to switch goals, if needed.

Hope and optimism go together. Optimism provides us with a faith that the future is going to be bright, that we can accomplish our goals, whatever they may be. When in a tight spot, we reassure ourselves that things will get better. Hope thus involves faith, belief in one’s capacity to achieve desired results.

 

HOPE THEORY

This is the understanding of hope provided by C. R. Snyder, the leading psychologist exploring hope. Snyder and his colleagues have come up with what they call the “Hope Theory.” The theory holds that hope involves two types of thinking: agency thinking and pathway thinking.

 Agency thinking refers to our determination to achieve our goals despite possible obstacles,

When we are high on hope, we embrace such self-talk phrases as “I can do this” and “I am not going to be stopped.”

Pathways thinking refers to the ways in which we strive to achieve these personal goals.

It involves generating an effective route to a desired goal. When that route does not bear the desired fruit, we create alternate routes and persist until desired outcomes are realized.

 

HOPE IS NOT WISHFUL THINKING

Hope, thus, is not mere wishful thinking, an illusion. It is real. It involves having goals and working towards realization of those goals, despite obstacles. Hope calls for determination, commitment and persistence. Hope is aptly expressed in Barack Obama’s famous election slogan. “Yes, We Can!” It was not just a slogan, a belief. He set in motion a powerful election machine, and organized an army of committed volunteers working hard to make the dream come true.

BENEFITS OF HOPE

A large body of research shows that hope promotes health and happiness. Hope buffers individuals against a number of physical and mental problems and helps them heal faster and easier. Individuals who maintain high levels of hope when battling illness significantly enhance their chances of recovery. They remain appropriately energized and focused on what they need to do in order to recuperate.

 Hope is negatively correlated with depression, anxiety, and anger and positively correlated with life satisfaction, positive physical and mental health, self-esteem, ability to adapt and cope in various situations and longer life.

Because of these benefits, hope would be our best companion to journey through 2021. We need to believe that 2021 will be a better year, and strive with confidence and persistence to make it a better year for us and our world.

 

Introspection

·         How do we really feel as we come to the end of 2020 and move toward 2021?

·         What is it that we hope for us and our world as we move into 2021?

·         What is the newness that we would like to experience in the New Year? What is it we need to do to bring about that newness?

Prayer

Sacred scripture provides frequent assurance from God that he will bring about better times. Prophets Isaiah and Jeremiah especially speak of the better times that God will usher in particularly after times of suffering and deprivation. For example, Isaiah says, something which is very relevant in the context of the suffering and hopelessness brought by Covid-19.: “And (God) will destroy…the covering that is cast over all peoples, the veil that is spread over all nations. He will swallow up death forever, and the Lord God will wipe away tears from all faces…” (25, 6-8)

In the Book of Revelation, we hear the One sitting on the throne in heaven saying: “See, I make all things new!” (21, 5)

Christmas, the Incarnation of God, that we just celebrated, is not only about the embodiment of God, divinization of nature, as we heard in last week’s podcast, but also about God’s comforting presence with us. Through the prophet Isaiah God assures us: “When you pass through the waters, I will be with you; and through the rivers, they shall not overwhelm you; when you walk through fire you shall not be burned, and the flame shall not consume you…. Fear not, for I am with you” (43, 2-5). And Jesus’ final words in the gospel of Mathew is: “I am with you always, to the close of the age.” (28, 20)

This protective and caring God, our Emmanuel, is very much with us here and now, in whatever circumstances we find ourselves at year end. We could consciously attune ourselves to God’s presence to us and spend some time talking to God about our travails of 2020, about our hopes for 2021, the newness that we would like to experience. And listen to what God has to tell us, to discern what God’s New Year gift/message is to us.

I wish you a very happy, safe, healthy and blessed New Year.

Thank you for listening.

Pictures: Courtesy Google Images

Jose Parappully SDB, PhD

sumedhacentre@gmail.com

GUIDELINES FOR PSYCHOLOGICAL CARE DURING QUARANTINE

GUIDELINES FOR PSYCHOLOGICAL CARE DURING QUARANTINE

Provided by

Clinical Unit of Psychology (UNINPSI) of the Universidad Pontificia Comillas, Madrid, Spain

APPENDIX 1: PSYCHOLOGICAL TIPS FOR SELF-CARE

Throughout the quarantine it is normal to go through different moments and emotional states: stress, anxiety, loneliness, frustration, boredom, anger, feelings of fear and hopelessness, etc. These effects may last or appear even after confinement. 

Taking care of your actions, thoughts and feelings will be of great importance in responding appropriately to periods when your mood may fail and the feeling of uncertainty or uneasiness grows, if at all. 

We offer you a series of recommendations, from a psychological point of view, in case you find yourself in any of the following three scenarios: (A) you are in isolation but not affected by the disease; (B) you belong to the population at risk; (C) you suffer from the disease by infection of COVID-19. Some of these scenarios have already been discussed in previous sections of this guide, but they are summarized here. 

(A) IF YOU ARE IN ISOLATION, UNAFFECTED BY THE DISEASE, BUT ARE NEVERTHELESS FEELING ANY OF THE FOLLOWING EMOTIONS - OR OTHERS WE HAVE NOTED ABOVE - PERSISTENTLY OR WITH HIGH INTENSITY: 

- Nervousness, agitation or tension, with feelings of imminent danger, and/or panic. - You can't stop thinking about anything other than the illness or worrying about getting sick. - You need to be constantly seeing or hearing information on this subject and have difficulty in taking an interest in other issues. - You find it too difficult to concentrate, to carry out your daily tasks, to do your work properly or you are paralysed by fear. - You are in a state of alert, continuously analysing your body sensations and interpreting them -not being pathological signs- as symptoms of illness. - You find it difficult to control your concern and you persistently ask people around you about your health, warning them of the serious dangers they are in given the situation. - You avoid contact with other people too much for fear of contagion. - You notice an increase in heart rate, rapid breathing, sweating or trembling without good reason. - You have difficulty in maintaining a restful sleep. - Your emotional problems get worse or return after they have been overcome. 

THEN WE RECOMMEND THE FOLLOWING: 

1. Identify the thoughts that make you uneasy. Constantly thinking about the disease can cause symptoms to appear or become more pronounced, which can increase your discomfort. Try to talk about what you like or are excited about. 2. Recognize your emotions and accept them. If necessary, express and share your situation with the people closest to you - those who give you confidence - to find the help and support you need. People who appreciate you will probably feel better knowing how you feel.

3. Question what you are experiencing and look for evidence of reality. Know the facts, and trust the information provided by the official scientific media. Be aware that, from some forums, alarmist images can be transmitted, and over-information given from a negative perspective, magnifying the phenomenon and making you perceive greater threat. 4. Avoid information saturation. Living permanently connected will not make you better informed and, on the contrary, will increase your sense of risk and nervousness unnecessarily. 5. Go to official sources and look for proven information from experts: Ministry of Health, Official College of Physicians, World Health Organization, other official organizations, etc. 6. Check the information you share, especially if you use social networks. 7. Don't contribute to the dissemination of false news and hoaxes. Do not feed your fear or that of others. 8. Carry out the appropriate hygiene habits recommended by the Health Department, but remember that this is not the only thing you have to do throughout the day. 9. Avoid talking about the subject all the time and look for other areas of conversation. 10. Support the members of your community, fellow priests, family members, collaborators of the apostolic work to which you belong, etc. 11. Help those around you to remain calm and to develop adaptive thinking in each situation. 12. Try to make life as normal as possible and continue with your usual routines, within the situation in which we find ourselves. In areas where you cannot keep up, reorganize your schedule. 13. Beware of behaviours such as rejection, stigma and discrimination. Fear can cause us to behave impulsively, rejecting or discriminating against certain people. If you have felt this way in recent days, also try to understand that some people are even more nervous, and that most likely it was not a direct attack on you, but the result of their discomfort.  

(B) IF YOU BELONG TO THE POPULATION AT RISK: 

1. Follow the recommendations and prevention measures as determined by the health authorities. Trust them.  2. Get informed in a realistic way and follow the guidelines suggested in previous sections. 3. Do not trivialize your risk to try to avoid the feeling of fear or apprehension of the disease. Pretending that nothing is wrong is a natural way for human beings to protect themselves from what is causing them distress or great concern. But it is healthier to talk about what you are worried about or afraid of so that you can deal with it without having to hide it. 4. Don't magnify your actual risk. Be cautious and prudent without being alarmed, knowing that sometimes we can also exaggerate to relieve and protect ourselves from what frightens us. 5. Don't take actions that compromise you, pretending to feel unrealistic invulnerability. Avoid behaviours that encourage addictive behaviours.

6. Be objective and adopt a global perspective. Think that many scientists throughout the world are working on the issue and are providing us with advice to solve this situation in the best possible way. 

(C) IF YOU ARE SUFFERING FROM THE ILLNESS: 

Follow the recommendations above and, in addition: 

1. The more unknown a disease is, the more restlessness it can generate. However, try to manage your intrusive thoughts: don’t put yourself in the worst position in advance. 2. Don’t be unnecessarily alarmed. Be realistic: most people seem to be getting well. 3. When you feel afraid, rely on the experience you have from similar situations. You may not associate it now because you have a more serious perception, but it brings to mind how many difficult illnesses or circumstances you have successfully overcome in your life. 

 

APPENDIX 2: RELAXATION EXERCISES

Below we propose three types of exercises that can be useful if you think you need a space for relaxation. There are several variants and different modalities. Some people find them helpful to help with their emotional integration. That is why we suggest them. However, each individual finds benefit in different techniques. If you feel that these do not help or satisfy you, feel free to find what works best for you.

 

BREATHING CONTROL 

It is not difficult for you to experience some feelings of anxiety throughout the quarantine. One of your symptoms is shallow breathing. We offer you a simple technique that you can practice anywhere: breath control. 1. Breathe in through your nose instead of your mouth. 2. Breathe gently and deeply several times. 3. Notice how your abdomen widens on inhalation and narrows on exhalation. 4. Take a couple of deep breaths in through your nose followed by slow, gentle breaths out through your mouth. 

DIAPHRAGMATIC BREATHING 

This technique needs a little more training and a quiet place where you can concentrate on it. 1. Get into a comfortable position and try to relax your muscles. 2. Place one hand on your chest and the other on your abdomen. 3. Breathe in slowly through your nose, extending it to your hand on your abdomen. The hand on your chest should remain still. 4. When you get the air there, hold it for a couple of seconds. 5. Release the air slowly through your mouth, so that you feel it go dropping the abdomen, and the hand on the chest remains motionless. 6. Repeat this exercise several times. 

VISUALISATION 

This exercise combines relaxation techniques with meditation. 1. Find a comfortable and uninterrupted place. 2. Light up the space in a soft and pleasant way for you. 3. Play music at a low volume, enough to be heard but not to disturb or distract you. 4. Close your eyes and concentrate on your breathing. Feel the air coming in through your nose and going out through your mouth. 5. Think of a blue sky. Feel the energy the sun gives you and focus your attention on the feeling these days give you. 6. Enjoy the view of the sky for a few minutes. 7. Add the sea to your vision. Listen to the sound of the waves. 8. Flood your brain with the vision and focus on the feelings it brings up. 9. You will be more and more relaxed. When you do, visualize yourself, in that landscape, lying on the grass or on the sand of the beach, with no one around you.

10. Enjoy the feeling of relaxation and peace that floods you for a few minutes. 11. Visualize yourself getting up in the landscape and start stretching your muscles of the body, little by little and without opening the eyes. 12. As you stretch, also become aware again of the music that surrounds you. And, when you are ready, open your eyes slowly, without hurrying, in peace.