Psyche & Soul 37: ANXIETY DISORDERS

 Podcast link:

 https://anchor.fm/boscom/episodes/2-37-Psyche--Soul--81-esduqh

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul.

 

In this weekend’s edition, I shall present anxiety disorders from which very many people suffer.

Anxiety is the body’s response to worry and fear. Anxiety operates on many different levels and to different degrees. There is a wide range in how deeply anxiety affects us and to what extent it interferes with our quality of life. Accordingly there are different anxiety disorders.

Causes of Anxiety Disorders

Genetic (inherited) factors contribute in some degree to anxiety, just as they do in other mental illness. Brain chemicals called neurotransmitters, as well as a pair of structures inside the brain called the amygdalae, seem to play a big role. Personality, experiences and environmental situations also contribute.

 

There are a number of medical disorders and the medications used to treat them that can cause anxiety. Some of these include: hyperthyroidism, heart disease, diabetes, respiratory disorders, emphysema, and asthma

At the root of anxiety is fear that works mostly at an unconscious level. According to MacKinnon & Michels, authors of the classic text The Psychiatric Interview in Clinical Practice,  anxiety “is the psychological response to danger, and is often seen when the individual feels that there is an ongoing threat to his [or her] welfare” The source of this threat may often lie at the unconscious level.

Generalized Anxiety Disorder

It is quite natural for us to worry during stressful times. But some of us feel tense and anxious day after day, even with little to worry about, and without any perceived trigger to provoke it. When this lasts for 6 months or longer, it would be diagnosed as Generalized Anxiety Disorder (GAD), which is the most common of anxiety disorders. What sets generalized anxiety disorder apart from ordinary worrying is the feeling that we can't stop worrying. Worry becomes chronic, almost second nature to us. This will begin to affect our social, work, and family life.

Persons of any age, even children, can develop generalized anxiety disorder. It tends to appear gradually, with the first symptoms most likely to happen between childhood and middle age. An estimated 31% of all adults will experience an anxiety disorder at some point in their life. Anxiety disorders are more prevalent in women (23%) than in men (14%) worldwide.

The main symptom GAD is a constant and exaggerated sense of tension and anxiety. We may not be able to pinpoint a reason why we feel tense. Or we may worry excessively and frequently about ordinary things, such as bills to be paid, our relationships, the safety of our children, or our health. This can lead to sleep problems and distortions in thinking. Poor sleep, in turn, can lead to irritability and strain relationships. It can also lead to restlessness, fatigue, feeling on edge, and difficulty in concentrating. Severe cases can hamper work and daily activities.

When we suffer from GAD, we are vulnerable to developing depression, alcoholism, or drug addiction. Anxiety disorders can also cause physical problems. These include: muscle tension or pain, headaches, nausea, stomach upsets and trembling. we can also develop other disorders that involve anxiety such as panic disorder, phobias, obsessive-compulsive disorder, and posttraumatic stress disorder

Panic Disorder

Panic disorder involves sudden attacks of terror triggered by an object or situation that can reach their peak within minutes. Persons who experience panic attacks may try to avoid situations or constantly worry about when the next panic attack might happen.

Symptoms can include a pounding heart, sweating, dizziness, nausea, trembling, shortness of breath, chest pain and a feeling of being out of control. We may think we are having a heart attack, or facing imminent danger or destruction, or even dying.

Phobias

A phobia is an intense fear or apprehensiveness about specific objects or situations that in reality are not likely to cause any harm. Even when some of these objects or situations may have reason to cause fear, the fear felt by the individual is disproportionate to the actual danger posed.

Common phobias include fear of heights, closed-in spaces like elevators, flying, water or creatures like ants and spiders. One woman I know is so afraid of flying that she never takes a plane, and so does not do any international travel, though she would love to visit many places.

During the height of the Covid pandemic, many people would not leave the home even for essential work, for intense fear of catching the contagion.

Social Anxiety Disorder

Social Anxiety Disorder is a common specific form of phobia. Those afflicted with this disorder feel panicky and self-conscious even in ordinary social situations. They are intensely anxious about being judged or rejected in social situations. Even when they realize their worry is unreasonable, they cannot avoid being anxious. Symptoms include a sense of dread before social events, with sweating, blushing, nausea, or trouble speaking during the events.

 

There are two other common disorders that have anxiety as one of the key symptoms but are no longer classified as anxiety disorders in the DSM-5 (The Statistical Manual of Mental Disorder, volume 5). These re Obsessive Compulsive Disorder or OCD, and Post Traumatic Disorder or PTSD.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder or OCD is a disorder where individuals have recurring, unwanted thoughts, ideas, or sensations (obsessions); or the urge to do something repetitively (compulsions).  Some people have both obsessions and compulsions.

When we suffer from obsessive-compulsive disorder (OCD), we will have troubling thoughts that we feel we cannot control. We may repeat a name, phrase, or behavior because we fear something bad will happen if don’t do that. We feel the need to repeat actions again and again, such as washing hands or checking that the door is locked. We may be obsessed about dressing in a certain order or count objects for no good reason. They may for example lay out items clothing in a particular order, pick them up in the exact order in which they were laid out, believing if the order is changed some mishap will happen to them. They may also feel they have to touch a particular object before they open the door, in order to ward of any danger.

Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) arises in the aftermath of some terrifying event, such as physical attacks in which we fear we may killed, severe sexual abuse, involvement in terrifying accident, or terrorist attack such as the one on the World Trade Centre..

Symptoms may happen months or longer after the event. These may include recurrent vivid flashbacks and nightmares about the event, Avoidance of things related to the event: people, places, or situations and a loss of interest in activities that were once enjoyable.

Treatment

The treatment for anxiety disorders follow the same model as described in dealing with depression and schizophrenia.

Antidepressant drugs, especially the newer variety, work well to lower anxiety. However, some of these drugs carry a risk of dependence.

Psychotherapy, especially cognitive behavioral therapy is very effective in treating anxiety. The focus here is on identifying negative thoughts and changing them. Since feelings and behaviour are primarily triggered by our thoughts, when we change our negative thoughts to more positive ones, our mood changes.  Clients are also taught calming techniques, such as meditation, that help them to calm themselves.

A few simple changes in our daily living can help. Caffeine, sugar, and even some medicines, can boost anxiety symptoms. Getting enough rest and eating healthy foods have a positive effect on anxiety. Use of relaxation techniques, such as meditation also help. Exercise can refresh the body and calm the mind.

Anxiety vs. Depression

It is important to note that there is a difference between anxiety and depression. In a very basic sense, anxiety is an excessive feeling of worry and apprehension, while depression is excessive feelings of hopelessness and worthlessness. It is possible for a person to have both anxiety and depression at the same time.

Introspection and Prayer

Have we experienced any type of anxiety disorders described here? If so, what was the experience like?

We often find Jesus in the Gospels exhorting his disciples not to be anxious. A classic case is that of the disciples caught in the storm at sea (Mark 4, 35-49). Jesus asks them “Why are you anxious?”  Elsewhere he asks them not to worry about their life, for their heavenly father provides them with everything (Mathew 6, 25-34).

We could read or contemplate any of these passages, stay with whatever these evoke in us, and spend time in the company of Jesus who is with us here and now, assuring us there is no need to be anxious and bring to him all our worries and anxieties and ask him to calm our fears.

 

Have pleasant weekend. Be safe. Be healthy. Be blessed.

Thank you for listening/reading.

Picture: Courtesy Google Images

Jose Parappully SDB, PHD

sumedhacentre@gmail.com 

 

Psyche & Soul 35: SCHIZOPHRENIA - 2 - HALLUCINATIONS

 Podcast link:

https://anchor.fm/boscom/episodes/2-35-Psyche--Soul--77-er52ns

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul.

 

Last week I presented one major symptom of schizophrenia, namely, delusions. In this edition I shall explore hallucination and other symptoms.

Hallucinations

In hallucination the person experiences an auditory (hearing voices), visual (seeing imaginary sights), tactile (feeling sensations on the body), or olfactory (related to smells) sensation that has no basis in reality, that is, happening without an external stimulus. Auditory hallucinations are the most common.

The nature and content of both delusions and hallucinations are influenced by a person’s values and personal experiences. Thus, religious people often have delusions and hallucinations with a religious content. An illustrative example is that of Sr. Florence.

 

Sr. Florence’s community members noticed that she had been behaving oddly for some days. She spent most of the time in her room, not coming for community prayers and even meals. When she did spend time with community, she would talk about Jesus appearing to her and giving her messages for the Pope. She insisted that she had to go to Rome and give the message personally to the Pope. She was spending more time in her room because it is there that Jesus was appearing to her. The superior, who had some psychology background, suspected some mental derangement and wanted to take her to a doctor. But Florence insisted there was nothing wrong with her, but that she was a chosen person. Fortunately the superior remembered that Florence had complained of severe headaches sometime earlier. On pretext of taking her to see a doctor for her headaches, she tried again to get Florence to see a psychiatrist. One morning the superior went to Florence’s room to convince her to go to a doctor. She was surprised to see Florence kneeling in front of an empty chair in the corner, her face animated. “Sister, please kneel down. Jesus is sitting in that chair. Don’t you see him?” she said. … Florence was suffering from full-blown schizophrenia with visual and auditory hallucinations and having the grandiose delusion of being a specially chosen person by Jesus.

Catatonia

Those suffering from schizophrenia may also engage in bizarre posturing and inappropriate behaviour. In what is known as catatonic schizophrenia, a person, for example, may remain in a freeze position, with no movement at all, with a fixed stare, arms raised in an awkward position, and so on, for a very long time, resisting any attempt by others to stop them. There can be a complete lack of verbal or movement responses. On the other hand, the person may keep repeating the same gesture or movement for a long time meaninglessly. Classic portrayals of these are found in the movies “One Flew Over the Cuckoos’ Nest” and “Patch Adams.”

Disorganized Schizophrenia

In disorganized schizophrenia, a person may burst into laughter, grimaces, or giggles without an appropriate stimulus. Another example is of a person on the street talking to himself or herself, gesticulating to no one in particular, or directing the traffic even when a police person is doing it, sometimes imitating the police. Or, we may find the person looking up to the sky, gesticulating and castigating God. Persons affected by this form of schizophrenia may look markedly disheveled, dress in unusual manner, or display clearly inappropriate sexual behaviour in public. Their behaviours can also be unpredictable, suddenly becoming agitated, for example, swearing and screaming loudly.

Primary Dynamic: Distorted Cognition

The cognitive processes (perception, interpretation, judgment and so on) of persons suffering from schizophrenia are seriously impaired.  They may have trouble organizing their thoughts or making logical connections. Their mind tends to jump from one unrelated thought to another in a confusing and bewildering sequence. They may assign special meaning to seemingly everyday words, which only they understand. Those listening to them will have great difficulty in making sense of what they are trying to say. Delusions, hallucinations and behavioral difficulties, as also affective and emotional turbulence, have their roots in impaired cognitive processes. This cognitive impairment is the primary dynamic in schizophrenia.

 

Negative Symptoms

There are also what are known as “negative symptoms.” These are so called because they are an absence as much as a presence. These include inexpressive faces, blank looks, monotone and monosyllabic speech, seeming lack of interest in the world and other people, inability to feel pleasure or act spontaneously. Schizophrenia can exist only with these “negative” symptoms without the more florid “positive” symptoms described above. In this case, the term “simple schizophrenia” is sometimes used. These symptoms, though not as incapacitating as the positive symptoms, can affect occupational life and relationships. These negative symptoms are the main reason those who suffer from them find difficult to live independently, and manage everyday life.

Introspection and Prayer

The description of hallucinations and other symptoms of schizophrenia above will show us how these can be cause of much suffering and relational difficulties. May be we have come across people afflicted by the disorder. We may be living with family members or others who suffer from it, or taking care of them.

A number of persons presented ion the gospels as being possessed by demons and whom jeus healed, were probably suffering from schizophrenia or other mental illnesses. The Gerasene demoniac (Luke 8, 26-39) as possible example. We could recall one of these stories and focus on Jesus’ compassion for those suffering from these illnesses and his eagerness to heal them.

 

We could then stay for a while with whatever the information provided in this podcast and Jesus’ healing stories evoke in us and share these with that same Jesus who is with us in the here and now extending to each of us the same compassion, or in the presence of  our compassionate God – seeking healing for ourselves and others.

Have pleasant weekend. Be safe. Be healthy. Be blessed.

Thank you for listening/reading.

Pcitures: Courtesy Google Images

Jose Parappully SDB, PHD

sumedhacentre@gmail.com 

 

 

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?

-----

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 with our heart and mind. 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 29: ENHANCING MENTAL HEALTH AND WELLBEING THROUGH MEANINGFUL LIVING

 podcast link:

www.anchor.fm/boscom

https://anchor.fm/boscom/episodes/2-29-Psyche--Soul--65-ep1kp6

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul. 

In this weekend’s podcast I shall continue exploration of mental health and wellbeing by looking at the role of meaningful living

 

An important resource for our mental wellbeing is finding life meaningful and purposeful, even in the midst of tragedy.

Recent research on health and happiness show that a sense of meaning in life is one of the major contributors to emotional and physical wellbeing. Psychologists call finding meaningfulness in life creating “Coherence.” Coherence, is founded in the deeply human desire to make sense of the world. Trauma, such as caused by Covid-19, fragments our basic assumptions about life, especially of safety, security, predictability and a benevolent universe. When this happens, meaningfulness of life can get diluted or even disappear altogether. We can gradually sink into clinical depression and sometimes think of ending our life and even attempt to do so.

Meaningfulness is essential to sustain our wellbeing. We need to recreate meaning in the midst fragmentation, disappointments and frustrations that are part of our live, especially these days.

When we find some meaning in the midst of personal tragedy it improves our mental health. Based on his extensive research on expressive writing, Psychologist James Pennebaker observes that when people write about traumatic experiences and reorganize these experiences into coherent and meaningful narratives, their psychological health and well-being increases.

Something Meaningful to Do

When we have something meaningful to do, something we enjoy doing, life becomes meaningful, satisfying, fulfilling. When we do not have it, we feel frustrated, unhappy, become sour with life.  Loss of meaning and purpose is at the root of depression and suicidality. Finding life meaningful is antidote to depressive and suicidal ideation.

Something to Look Forward

While having something to do in the present, having something to which we can look forward with hope and some certainty, such as getting a new job, or getting a promotion, finding a spouse and looking forward to a happy married life, or getting ordained a priest adds to the meaningfulness of life.

Having something to which we can look forward gives us a feeling of control over our lives and boosts our self-esteem, enhances our wellbeing. It makes it much easier for us to triumph over present difficulties and problems and maintaining our sanity and serenity.

Reaching Out to Others

Reaching out to others, making others’ lives significant, is one of the major ways that we can bring meaningfulness into our own lives. Personality psychologist Dan McAdams observes that goals that enhance the future of humanity as a whole contributes in special way to health and happiness. There is much research that says that when we engage in acts of kindness and compassion it can create positive emotions in us which in turn boost of our mental wellbeing.

Questions to Ask

Psychologists Craig Polizzi and colleagues suggest some questions that can help us create meaning and purpose: What is important to me? What makes me feel good, even when confronted with a situation I can’t fully control? What do I want other people to say about me and how I respond to painful situations? What do I want to be known for? What is it to which I look forward with eagerness? The answers to these questions often reveal to us our deeper motivations and what really matters to us. This enables us to pursue meaningful goals and activities under the darkest of circumstances and achieve a resilient outcome and maintain long-term psychological wellbeing (Clinical Neuropsychiatry, 2020 17, 2, p. 61)

Daily experiences of positive meaning come in several forms. Psychologist Barbara Frederickson cites some of these based on her many years of research. The most frequently reported forms include: feeling connected to others and cared about (22%), having an opportunity to be distracted from every day cares (21%), feeling a sense of achievement, pride, or self-esteem (17%), feeling hope or optimism (13%), and receiving affirmation or validation from others (11%).

The Religious Worldview

Many persons find meaning in the midst of suffering through their religious worldview. Belief in an afterlife sustains many to remain undisturbed in the face of impending death. Gordon Allport, the founder-father of personality psychology had observed a long time ago: “The religious sentiment…is the portion of the personality that arises at the core…and for this reason is capable of conferring marked integration upon personality.”

Contemporary personality psychologist Robert Emmons, echoes Allport: “Religion and spirituality can provide a unifying philosophy of life and serve as an integrating and stabilizing force in the face of constant environmental and cultural pressures that push for fragmentation, particularly in post-modern cultures.”

We have to find our own ways to find meaningfulness in life. Without it mental wellbeing would be a challenge.

Nandita (name changed), who is therapy for some years, has frequently struggled with meaningfulness of her life. She recently expressed the following that shows how not finding meaning in life affects one’s wellbeing. She wrote:

"One existential query about meaning of life/universe that I have been struggling with and for which I can’t see a possibility of an answer within my reach, still has me in its grip. It has set in a kind of inertia. On the surface life is going on in the way possible under current circumstances but deep down there is a sense of existence being non-sensical. I came across the following during my readings, which exactly describes what I am presently experiencing: ‘For humans to be able to live they must either not see the infinite, or have such an explanation of the meaning of life as will connect the finite with the infinite.’

The desire is to get an automatic tailor-made answer that brings with it an instant clarity of purpose, passion in its act and potential for a sense of fulfillment – so that life can move on meaningfully. ...

I need to overcome my inner inertia emerging from lack of trust in being able to ever find a meaning in life through this ocean of unknowing."

 

Introspection and Prayer

We could now take a few moments to ask ourselves: What gives meaning and purpose to my life? ….. If I am experiencing meaninglessness at this time, what is it I can do to create meaning and purpose?

We could offer to our ever present and compassionate God who has our welfare and wellbeing at heart, whatever is causing meaninglessness in our lives and listen to what God might tell us as to how we can enhance meaningfulness in our lives and thereby improve our mental health and wellbeing…..

Have a meaningful weekend.

Be well. Be safe. Be blessed.

 

Thank you for listening/reading.

Pictures: Courtesy google Images

JOSE PARAPPULLY SDB, PHD

sumedhacentre@gmail.com