India, spanning across 29 states and 8 union territories, offers unique ethnic, religious and linguistic diversity. While taking a stroll in the streets of India, one can see people doing their daily stuff, whatever that is. Or they are just standing and sitting around talking in a large group of people. Whatever they are engaged in, one thing is universal. They seem to be relaxed in whatever they do and be at peace with themselves and the environment. It is as if they don’t need the word ‘happy’ in their vocabulary to feel good and relaxed: they are fine with how it is. In India, happiness is not an abstract term. that people all intend to have as their life’s goal.

Maybe the Indian version of happiness has something to do with the present activities. Maybe being happy is just equivalent to being yourself. It’s more about not wishing for anything else and not to have big desires for which we would be willing to give something dear but to find these desires and happiness in the things we already have and as a result be grateful and at peace. Maybe it is acceptance of what is instead of hoping for what may be. 

Happiness, Well-being and Human Development

It is quite understandable that the ultimate objective of social and economic development is to provide improvements in the lives of men and women who generate employment now and the younger generation who we hope will generate in the future. This makes the idea of well-being universal: achieving a state of well-being has to be inclusive everywhere, whether in developed or developing countries (OECD, 2015).

Well-being is a focal concept: human well-being provides a means of understanding the growing relationships between apparently diverse ideas and issues that abound as and often appear to compete, in the international agendas. The proper study of human well-being provides a possible way to map out the relationship between poverty and sustainability as it helps us to explore the relationship between various economic dimensions and development such as productivity and efficiency, social cohesion and governance which are vital for the successful overall development (OECD, 2015).

Following the need to study the relevance of happiness, well-being and human development, various methodologies were developed in the international conferences and meetings of the United Nations (UN), United Nations Development Programme (UNDP) and Organization for Economic Cooperation and Development (OECD). These methodologies presented frameworks that incorporated the socio-economic indicators which can be used to assess the improvements in human well-being. One of the innovations suggested by the well-being approach saw human well-being as a holistic phenomenon. The framework which was put forward by OECD was known as ‘How is Life’ framework. This provides a good example of this multidimensional approach to measuring human well-being that can be used to discuss its relevance for developing countries.

The above figure depicts the process of the OECDs ‘How is Life’ framework which involves three categories of variables. These three categories are listed below: 

• Material Conditions
• Quality of Life
• Sustainability 

Within each of these three categories, there are a certain set of variables upon which data is assembled. Under ‘Material Conditions’ following three variables are listed:

• Income and wealth
• Jobs and earnings
• Housing 

The variables included in the category ‘Quality of Life’ are listed below:

• Health status
• Work and life balance
• Education and skills
• Social connections
• Civic engagement and governance
• Environmental quality
• Personal security
• Subjective well-being

In the last ‘Sustainability’ category there are four types of capitals which are identified as being significant for the process that produces both material well-being and quality of life outcomes. These are listed below:

• Natural capital
• Economic capital
• Human capital
• Social capita

Thus the major innovation will lie in the integrated adoption of a multidimensional approach to understanding progress which integrally considers people’s subjective evaluation of their quality of life. 

Subjective Well-being as an Alternate Tool for Policy Evaluation

In recent times, subjective wellbeing measures have established themselves as reliable alternatives to standard economic indicators of welfare. Intertest in subjective metrics have been largely driven by the growing dissatisfaction with the conventional use of objective indicators like GDP to evaluate the impact of economic activities on public and private sector decision making. This has led international organisations such as the UN and OECD to advise against using the GDP as a measure of economic progress as it does not capture the outcomes that matter to the well-being of the people. 

Today, the governments in places like New Zealand, Wales, Iceland and Scotland have advocated and justified the use of subjective well-being matrices in evaluating public policy. As a result of which these countries have recently established the Wellbeing Economy Governments Alliance (WEGO) that aims to promote and share their expertise and transferable policy practices in regard to subjective well-being (Wiking, 2020).

The core benefit of using subjective well-being is that it measures individual experience by directly asking people to report how they feel about their lives. This is in contrast to the conventional economic metrics like inflation rate, unemployment rate and GDP per capita that focus instead on people’s market behaviour. The measures of subjective well-being have proven to be reliable across varying contexts. They remain stable over time, correlate with the third party, associate with physiological makers, respond to life changes and even help in predicting future socio-economic behaviour of individuals including suicide. 

It is observed that the United Nations for the last eight years has published national rankings of subjective wellbeing in their World Happiness Report. These well-being measures have proven to be aligned with economic objective country conditions, including GDP per capita, life expectancy and levels of corruption. Subjective wellbeing metrics are therefore poised to reveal important underlying dynamics that can help us to understand how people have felt and behaved during the COVID-19 pandemic (Wiking, 2020). 

The Lessons Learnt From Nordic Countries

From 2013 till today, every time the World Happiness Report (WHR) has published its annual ranking of countries, the five Nordic countries- Finland, Denmark, Norway, Sweden and Iceland have all been placed in the top ten with Nordic countries occupying the top three spots in 2017, 2018 and 2019. It is of no doubt that whether we look at the state of democracy, structure of political institutions, lack of corruption, social cohesion, trust between the citizens, gender equality or Human Development Index, one can easily find the Nordic countries in the global top spots (Martela & Greve, 2020). 

There has been a lot of research done on finding the reasons that make Nordic citizens so exceptionally satisfied with their lives. Through reviewing the existing literature the prominent factors responsible for the happiness of Nordic citizens include quality of institutions, low corruption and proper well-functioning of democracy and political institutions. In addition, Nordic citizens experience a high sense of freedom as well as high levels of social trust among each other that play a significant role in determining life satisfaction (Martela & Greve, 2020). 

Denmark is one of the top five happiest nations in the world. It has consistently remained in the top three global spots in the World Happiness Report. Comparing the Indian and Danish GDP, the GDP growth rate of Denmark averaged 0.40% from 1991 to 2018 while the annual growth rate of India’s GDP averaged at 6.61% from 1951 to 2018 (Trading Economics, 2019). Indian economy is much larger as compared to Danish economy. However, there are other factors than financial prosperity and GDP that makes the Danish people among the top happiest in the world. 

If India has to go the Nordic way, it can adopt some features of the happy country as mentioned in Figure 2. It clearly depicts that Denmark does simple things elegantly and makes it the motto of their life. They seek happiness in the small happening of their life and build a hyggelig environment around themselves (Sarkar, 2018). 

Weaving the Path for India to Follow the Nordic Happiness Way: A Long Way Ahead

The happiness of the citizens in India needs to follow a six-pronged strategy to go the Nordic way of living and can be counted as a happy nation in near future. This strategy is depicted in the figure below:

Indian policymakers should carefully observe how education, transport, health and social policies will affect the happiness of citizens. Furthermore, policies that aim to promote public cooperation and equality are equally likely helpful in increasing the subjective indicators of well-being like longevity. India has been a place for poverty research for a very long period of time. With the appropriate policies in place, maybe it could become a laboratory to study happiness one day. 

Bibliography

Martela, F., & Greve, B. (2020, March 20). The Nordic Exceptionalism: What Explains Why the Nordic Countries Are Constantly Among the Happiest in the World. World Happiness Report. https://worldhappiness.report/ed/2020/the-nordic-exceptionalism-what-explains-why-the-nordic-countries-are-constantly-among-the-happiest-in-the-world/

OECD. (2015, April 5). MEASURING WELL-BEING FOR DEVELOPMENT. OECD Development Centre. https://www.oecd.org/site/oecdgfd/Session%203.1%20-%20GFD%20Background%20Paper.pdf

Sarkar, D. D. (2018, April 13). India and the happiness quotient. Mint. https://www.livemint.com/Opinion/n5HPI9id2l3jBrjZLut3SL/India-and-the-happiness-quotient.html

Trading Economics. (2019, August 4). Denmark and India-Economic Indicators. Trading Economics. https://tradingeconomics.com/denmark/indicators

Wiking, M. (2020, June 20). Wellbeing in the age of COVID-19. Happiness Research Institute. https://6e3636b7-ad2f-4292-b910-faa23b9c20aa.filesusr.com/ugd/928487_f35139968bca4668b456726d010e8d45.pdf

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Autism is related to some genetic and environmental factors. Certain factors during pregnancy such as alcoholism, cocaine, etc lead to autism in newborns. Recent researches confirm multiple genetic abnormalities that can lead to autism. In addition to this, many metabolic or biochemical factors that can cause autism in children There are many environmental factors as well, which may not be much. Children with autism need constant care and protection from their family members and other caregivers.

Understanding Autism

While autism can only be treated by doctors, there are many common symptoms that parents and caregivers can look out for:

• Pragmatic Language – Most individuals with autism have difficulty communicating with other people. This particular symptom shows up during early childhood. Any delays in speech development and nonverbal communication should encourage parents to see a specialist.
• Eye Contact and Nonverbal Communication – Children with autism often have difficulty making eye-contact. Other non-verbal communication difficulties may include recognizing and using facial expressions, physical gestures, and overall body language.
• The Tone of Voice – Some people with autism may have difficulty modulating their tone of voice. As a result, they may speak too loudly, too quietly, and/or with a monotone voice.
• Repetitive Behaviors – Many people with autism may perform the same behaviours repetitively. This is also common for schizophrenic patients. This may include rocking, spinning, or flapping of the hands and arms.
• Ritualistic Behaviors – This may include eating the same food at every meal or watching the same videos repetitively. They also get upset easily.
• Self-Injury – Some children with autism tend to hurt themselves. These signs can also arise early, so a parent can notice and ask for immediate help.

Challenges Faced by Autistic Children

Children with autism go through many challenges in their lives, as do their parents and guardians. As they have many motor and communicative difficulties, they have trouble in school. A school rarely provides a good environment for an autistic child. Other kids’ success and the various challenges in a school environment often makes it difficult for the autistic child to cope. In such cases, it might make autism worse.

Autistic kids are often sensitive to loud noises and bright lights. Schools are often breeding grounds for such noises and lights which might cause discomfort among the children. This might further agitate them and make them hurt themselves. An autistic child often has problems with reading and writing. Children with autism are almost certain to be at a disadvantage, as learning how to read and write can be a major challenge. There are many other challenges that an autistic child might face in a school which would be very unpleasant and in some cases dangerous for them. 21st-century schools are in no way a fit for such children. Schools today are only designed for a specific group of students.

Researches on Autism in India

As a developing country, India has had more research articles on Autism than any others. There have been many published and unpublished articles that have helped in the advances made.

In a country as vast as India, there are no direct channels to organizations dealing with such disorders such as the National Institute for the Mentally Handicapped, in Secunderabad, and Action for Autism, New Delhi. Parents must rely on references from their paediatricians, and psychologists, on word of mouth, and newspaper articles or television broadcasts to find out about such places. By the time families of autistic children become aware that there is a national organization that specifically deals with these needs, things get worse. In the case of autism, a correct diagnosis is crucial because research has demonstrated the effectiveness of the early intervention, a specific intervention that occurs between the age of birth, and four years.

Treatments of this Mental Condition

Indians have a reputation for considering Autism as being a mental disorder. So, the vast majority of children do not get the appropriate kind of treatment. Historically, most autistic children were not even recognized until it was too late. Most people in India thought that children with autism were “slow” and best left to themselves.

Currently, many schools provide education to children with autism in the correct way. There are now autism-specific schools in India. However, considering the number of children suffering from autism, the number is not a lot. Most of these schools do not have a sufficient number of trainers.

TEACCH (Treatment and Education of Autistic and Communication Handicapped Children) is a behaviour-based treatment, for children with autism. In India, TEACCH strategies were first introduced at Open Door in Delhi in 1995, followed shortly by ASHA in Bangalore. Over the next few years, TEACCH strategies began to spread across India through various training workshops.

Family Coping

Children with autism cannot take care of themselves. They have to be under constant care by their parents. Parents of autistic children have to be specifically attentive to the children, noting the little changes taking place. Parents need to constantly educate themselves. They are advised to keep up to date on all research to help their children. Most parents have to quit their jobs to focus their attention on their children.

Conclusion

Over the last decade, there has been a dramatic increase in the number of diagnosed cases of autism in the U.S. and around the world. Experts do not know if this is because the disorder is actually on the rise, or if doctors are simply diagnosing it more effectively. We should learn more answers to questions like these over the next few years. That’s because many researchers are currently looking into autism’s origins, prevalence, and treatment.

Autism is a sad disorder that swipes the face of Earth. Unfortunately, it usually gets unnoticed by people. Most people do not know about the issues faced by such patients and the toll it takes over the family members. In order to treat Autism in a correct way, people have to come to terms with the presence of disorders such as this and other disorders which affect the cognitive and emotional health. Only then can it be acknowledged and hence treated in its fullest sense. Many children miss out on their lives owing to Autism and many parents suffer seeing their children go through this journey. As citizens, we must all learn to deal with autistic individuals and make their surroundings loving and easy.

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Women’s ability to access safe and legal abortion is prohibited in many countries. Countries that do allow it have poor facilities that hinder women’s health. Apart from this, abortion is not accepted by society and it makes a woman wary of making that choice. Feminists believe that women should be allowed the right to abort because in many cases the pregnancy is a result of rape. They argue that women have the right to decide independently in such matters. They consider the right to abort a human right. It is saddening that 13% of maternal deaths worldwide are due to unsafe abortion. Many women are oftentimes forced to carry a child which further leads to health issues in the mother. In many nations, the act of abortion is has been criminalized by the nation runners and thereby, denied.

State of Right to Abortion in India

The nation of India has always seen the concept of abortion as a shameful act, culturally speaking. Despite the societal notions, India seems to have a largely progressive regime for abortion, on paper. There have been many instances where abortion has been denied to people. Women in India have had to resort to unsafe abortions which ultimately ruin their health and lead to infertility or death in many cases. Most women in India are hardly aware of the concept of abortion and where it is offered. Around 2-4% of women are forced to get abortions in India due to the preference of sons over daughters. In a country like India, the awareness and the act of it has been more like a privilege. Abortion centres are not well-maintained and it reflects the ideals people have about abortion.

The National Advocates for Pregnant Women (NAPW),  which is a small nonprofit group leading the research and defence of such cases, tabulates that some eight hundred “arrests and equivalent deprivations of liberty” of pregnant women have been made since 2005, for crimes including murder, manslaughter, and foeticide.

State of Right to Abortion in Poland

Recently, the Constitution in Poland has ruled that an existing law allowing abortion of malformed foetuses unconstitutional. This has provoked an outcry from women and pro-choice activists. The tribunal’s president Julia Przylebska said that permitting abortions in the case of fetal deformities legalized “eugenic practices concerning an unborn child, thus denying it the respect and protection of human dignity.” Since the Polish constitution assures a right to life, Przylebska argued that an abortion based on a fetal malfunction was “a directly forbidden form of discrimination.”

Before the ruling, Poland had permitted abortion in three scenarios: for fetal abnormalities, in the case of a threat to a woman’s health, and the case of incest or rape. But, the latest court rulings argued that abortion due to abnormal fetal abnormalities is unconstitutional, which stirred up unrest among the people. Since the ruling, protesters have gathered around demanding a reversal of the ruling.

State of Right to Abortion in the USA

In the first months of this year, nearly 30 states in the United States introduced an abortion ban. Fifteen of these states have been working to pass bills that will ban abortion after six weeks of pregnancy. Earlier in May, Alabama lawmakers passed a bill to ban abortion entirely and Missouri’s sole abortion clinic remains engrossed in a legal battle to keep its operating license from the state health department. If they lose, Missouri will become the only US state without an abortion clinic.

The US movement against abortion has been raging since the 1800s.  It has largely been led by Catholics and conservative religious groups. Ever since the abortion ban was introduced, many people, especially women have protested against this decision. Celebrities have been seen taking to social media to express their anger. Many celebrities have decided to stop working in the states which have completely banned abortion. Disney has decided to quit Georgia over abortion law and “Netflix” has decided to rethink its operations in Georgia.

The Fight for the Right to Abortion Continues

Most believe that the right to abort is a human right and the decision to abort should be solely given to women who are the child-bearers. Throughout this fight, we have seen the various governments picking out specific parts of the concept of abortion and creating opinions but what they fail to understand is that, at the end of the day, women are the ones bearing the child and they are on the receiving end of the consequences stemming out from unwanted pregnancies. Banning abortion entirely or allowing it only for specific reasons which may be acceptable to only a group of law-makers is only another way to oppress women.

The fight for abortion has been an age-old fight. Many generations of women have led movements against any government banning abortion. Even in the 21^st century, when women are being told what to do, how to use their body and whether or not to carry children in their wombs, it largely feels like women are losing the long-fought battle against the ban of abortion. The importance of the right to abortion and the need for proper clinics that follow all medical protocols are not yet known to the people. The way people look at it gives us a peek at the devastating condition of women in the world and makes the fight difficult every day.

Featured Image: Reuters (Jakub Wlodek/Agencja Gazeta)

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No Mobile Phone Phobia or ‘Nomophobia’ is the irrational fear of being without your mobile phone or being unable to use your mobile phone for a certain reason. The condition is characterized by feelings of anxiety when people lose their phones, run out of battery life, or have no cellular coverage.

In today’s era when physical interactions have come to a halt and an air of uncertainty fills the surroundings, it’s our gadgets which keep us huddled together as a community. These days when our mobile phones serve as the sole source of connection with the world outside, the over-reliance on gadgets leads to the development of behavioural addiction.

Therefore, when a person is out of reach of her/his mobile phone, she/he often experiences anxiety, fear or even feelings of fear and panic. Experts believe that if left unsupervised, such a condition can be detrimental for physical and mental health in the long-run.

Unearthing the Statistics

In the 21st century, when technology has eclipsed all areas of human endeavour, a huge chunk of the population is vulnerable to develop symptoms of nomophobia. On average, a person checks her/his phone about 110 times a day without any concrete reason.

A study in Britain on mobile phone users suggests that 53% people tend to feel anxious when they lose their mobile phone, run out of battery or balance, or have no network coverage’. Nearly 72% of respondents admitted that there is a bleak chance that they will ever stay more than 5 feet away from their mobile phone.

In the United States, 66% people suffer from nomophobia. One in five people admit that they would rather go without shoes for a week than take a break from their phone.

A study conducted in India indicates that 43% of people use their phones more than 5 hours a day. Over 30% tend to check their phones more than 50 times a day while 31% check as frequently as every 10 minutes. It is reported that there is lesser number of calls or emails received and sent, than text messages.

These statistics suggest that mobile phones are primarily being used for accessing social media than for traditional ‘calling’ purposes. Around 85% use these palm-sized gadgets for simply ‘killing time’.

Who is Most Vulnerable?

Research investigations reveal that people falling between the age group of 18-24 are most prone to develop symptoms of nomophobia. It’s clearly evident that college students seem to fall under high levels of nomophobia than the working populace. This is primarily due to comparative higher availability of leisure time, a lesser number of responsibilities, curiosity to explore new technology at hand and extensive usage for educational and research purposes.

A research sample conducted with over 1500 students on prevalence of nomophobia in India point out to gender disparity in numbers. While women often fall under the category of ‘moderate’, ‘men’ usually show ‘mild’ symptoms. Though both have the tendency to develop ‘severe’ levels of the phobia.

Of the many reasons identified which increase vulnerability, one of the important causes is the easy and affordable access to internet. But even this luxury comes laced with potential risks as people spend hours lying on their couch, sending across text messages to their near and dear-ones with the help of free messaging applications, available just a finger-tap away.

Moreover, with the advent of social media, the entire planet has been woven into a tiny virtual space in our palms. It has got translated into our sole source of connection with the outside world. Therefore people are getting easily dependent on their phones to maintain affinity with their closed ones. Increased number of people are also using it as a tool to do away with their feelings of loneliness.

Symptoms of Nomophobia

A person symptomatic of nomophobia shows a number of physical, emotional and cognitive symptoms such as:

• Breathing at a faster rate, increased heart rate, sweating, shaking and trembling. People may also begin to feel weak or dizzy.
• The inability to turn off one’s phone
• Constantly checking the phone for missed messages, emails, or calls
• Charging the battery even when one’s phone is almost fully charged
• Fear of being without WiFi or being able to connect to a cellular data network

As the number of hours of mobile phone usage accelerates, the tendency to succumb to nomophobia increases. In the absence of their gadgets, some people may even start experiencing withdrawal symptoms.

Frequent or compulsive mobile phone use is also connected to increased stress, anxiety, and depression. Excessive phone use has been linked to a number of negative effects that include decreased grades, lower life satisfaction, and a lower sense of overall well-being.

Dealing with Nomophobia

Nomophobia if left unattended, can metamorphosise into a grave problem for mental and physical health. Therefore, taking timely action and repairing the faucet before it bursts can avert the impending danger. Some of the ways to keep a tab on mobile addiction are:

• One can design a sturdy schedule and adhere to it religiously. The time for using the phone can be determined in advance and alarms can also be set as reminders.
• A person must try to have more in-person interactions with people who are in physical proximity. Having a short conversation with a co-worker, chat with a classmate or neighbour can lower one’s feelings of loneliness and reduce the tendency of excessive usage of the phone.
• In India, we have a tradition of keeping fast on certain days. Likewise, one can set aside at least one day in a week as a ‘tech-free day’ and use the time to focus on oneself, one’s hobbies and even relax and do meditation.
• If possible, one can to try to leave the phone at home for short periods of time, such as while going for a walk, purchasing groceries etc. Just being mindful of one’s activities around can have a relaxing effect on the mind.

Lastly, in case one faces severe symptoms of nomophobia, then taking psychiatric aid is also an option available. Trained mental health experts can help a person with medications and therapies. Cognitive Behaviour Therapy (CBT) and Exposure Therapies have come a long way to help in reducing symptoms of nomophobia.

Conclusion

Nomophobia is just one example of the many health hazards posed by the over-dependence on technology. With unrestrained use of gadgets, the human populace seems to pave the trajectory towards its own doom. Being cautious of one’s mobile phone usage, taking timely action in case of adversity and maintaining good and healthy social relations can perhaps prevent the impending tragedy in the coming years.

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KIM NOBLE : AN ARTIST DIVIDED

“A lot of people are very frightened of us until they meet us”

~ Kim Noble

Kim Noble is a 59-year-old mother who lives in south London with her teenage daughter Aimee, two dogs and more than 20 separate personalities. 

Dawn is stuck in 1997, searching for her daughter Sky, who she believes was taken away.

Bonny had the strength to fight for her child through the courts.

Ken is a depressed gay man of 21.

Abi has loneliness in her life. 

Ria Pratt is 12 or 13, and is thought to have been abused.

Judy is a 15-year-old anorexic and bulimic, and is often a bit cheeky, but is very good at painting.

Patricia, in her 50’s, is strict and sensible and is the narrator of an intriguing new book called “All of Me.” She is the most consistent personality of Kim.

While all these personalities appear independent, each is a part of Kim Noble, whose main personality is split into several parts, each having an amnesic barrier between them. Her other alter egos include Salome the devout Catholic, a little boy who speaks only Latin, an elective mute, a sensible Hayley, and a handful of children “frozen” in time. While many of the alters are unaware of it, some of the alters know that Kim has Dissociative Identity Disorder or D.I.D—the preferred term for Split Personality Disorder or what used to be called Multiple Personality Disorder.

From the age of 14, Kim spent twenty years in and out of psychiatric hospitals because of being diagnosed with everything from schizophrenia to depression, hysterical amnesia, anorexia and bulimia. Finally, she met Dr Valerie Sinason and Dr Rob Hale at the Tavistock and Portman Clinics and in 1995 she began therapy and was diagnosed with Dissociative Identity Disorder. 

D.I.D is a rare reaction to severe trauma in which the brain splits into multiple personalities as a defence mechanism to cope with chronic trauma.  Kim is believed to have suffered severe trauma from sexual abuse as a young child that caused her mind to split into these multiple personalities and develop D.I.D as a “creative way to cope with unbearable pain”. 

In 2004, after spending a short time with an art therapist, Kim and 12 of her alter personalities developed an interest in painting despite having no formal art training. These 12 artists have their own distinctive artistic styles, colours and themes-

Bonny’s pictures often feature robotic dancing figures or “frieze people”, Suzy repeatedly paints a kneeling mother, Anon paints at night and uses texture in paintings, Abi’s paintings are usually people from a behind view, Patricia paints the desert landscapes which according to her are a “bit boring” and Judy’s canvasses are large, conceptual pieces which are usually portraits – some with their eyes open, others shut. Ria on the other hand paints very differently. Using bold bright colours, her childlike but disturbing pieces often reveal deeply traumatic events involving child abuse.

Art has definitely had a therapeutic effect on Kim and instead of coming out as words, the expression comes out in art. These personalities, combined, have had over 60 exhibitions, nationally and internationally.

Generally, Patricia’s personality switches around four or five times a day – a switch that can last five minutes, a few hours or several days. Stress or lack of sleep can increase the number of switches, as can painting – a sign, Patricia believes, that a personality just wants to come out and paint to express themselves.

Despite the fact that she has to live with several alter personalities –– Kim Noble is fortunate enough to be living a relatively normal life. To communicate with “Patricia,” “Judy”, “Salome”, “Ken” and the others, Kim’s therapist sends emails to each of them. All of the personalities have separate email addresses and passwords, and Patricia leaves notes for them. “Patricia” says her situation isn’t such where a single personality represents a specific mood (such as “anger” or “fear”). Instead, each of her 20 personalities has a full range of emotions and living with Dissociative Identity Disorder means “sharing a household—there are different clothes, closets and toothbrushes for each personality.”

In the past few years, Kim Noble was featured in national newspapers such as The Telegraph, The Guardian, The Independent and several others. She even appeared at the Oprah Show, This Morning Show, Anderson Cooper Show and BBC Radio1 with Victoria Derbyshire.

DISSOCIATIVE IDENTITY DISORDER

Dissociative disorders involve problems with memory, emotion, identity, perception, behaviour and sense of self. 

Dissociative Identity Disorder is caused by “overwhelming experiences, traumatic events, and/or abuse occurring in childhood.” 

The DSM-5 gives the following diagnostic criteria for Dissociative Identity Disorder: 

1. “Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual. 
2. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. 
3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 
4. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. 
5. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behaviour during alcohol intoxication) or another medical condition (e.g., complex partial seizures).” 

Treatment

Treatment typically involves psychotherapy through which people gain control over the symptoms and the dissociative process. Therapy aims at helping individuals integrate the different elements of identity. 

Therapy for this trauma based disorder may be difficult and intense as it requires remembering and coping with traumatic experiences of the past. Cognitive behavioural therapy and dialectical behavioural therapy are two commonly used types of therapy. Like in the case of Kim Noble, art can have a therapeutic effect on individuals with Dissociative Identity Disorder. Hypnosis has also been found to be helpful in some cases. There are no medications which specifically threat the symptoms of D.I.D, but doctors may prescribe medicines such as anti-psychotic drugs or anti-depressants which may be helpful in the treatment of those specific symptoms. 

Thus, with appropriate treatment, most of the people suffering from Dissociative Identity Disorder are successful in coping with the major symptoms of this rare mental illness and improving their ability to function and live a productive and fulfilling life. 

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As Coronavirus outbreak took place in India, the India council of medical research (ICMR) allowed doctors to take recourse to telemedicine. It is a modern healthcare practice around the globe. Telemedicine is provided by the doctors since 2000 in India but as the COVID-19 outburst took place it has received the necessary statutory support. The state medical councils revoked the ban on telemedicine which led to it being fully legal and beneficial for the patients and the doctors. The step became necessary despite the fact of whether the healthcare teams and patients were ready or not. 

On 7th July 2020 Niti Aayog made a statement on twitter- A study shows that 50 million Indians have accessed online healthcare and in-person doctor visits are down by 67 per cent. What a feat!

BENEFITS OF TELEMEDICINE

Telemedicine gives the patients to make decisions and teaches them self-care. For example, in the case of diabetes patients visit doctors once in 2-3 months to get advice on change in the dosage of medicines. Such visits can be skipped. The patients can get in touch with a specialist of their choice located in another city through video calls or other mobile applications. We have various communication platforms like WhatsApp, mail etc., the time has come to adopt all these technologies. Some of the benefits are-

• Reduces healthcare Costs- It helps to reduce healthcare costs by avoiding transfer of patients from one location to another, reduction in hospital costs etc. 
• Improves quality health-care delivery- It can help improve the quality of delivery with both mental and physical conditions. 
• Enhances traditional face-to-face medicine- The practice of telemedicine should support the traditional practice rather than replacing it. The medical practitioners shall pay a visit to patients from time-to-time while still providing convenience and flexibility of seeing patients remotely.
• Provides engagement and satisfaction- The practice makes it easy for patients to maintain their health while engaging in the practice of taking care of themselves. 
• Provides access to care- The time gap that travels brings between care providers and patients can create a hurdle in access to care. It can be beneficial for people in rural areas and locations with undermined facilities.

DISADVANTAGES OF TELEMEDICINE

• Lack of Personal relationship– If a patient prefers a face-to-face relationship with their doctor or a more intimate treatment, then telemedicine might not the option for them. The patient may never meet the doctor in person.
• Availability and Cost- For health care providers, it can be difficult to set up and maintain the process. It can be very costly for small healthcare clinics.
• Insurance- Not all countries allow insurance coverage for telemedicine. Currently, only 26 states require insurers to cover or reimburse the costs.
• Protection of data- Hackers can access the medical information of a person, especially when the patient uses a public network.
• Delay in Care- In case of requirement of emergency care, accessing telemedicine first may cause a delay in treatment because a doctor cannot provide life-saving tests or laboratories digitally. 

AVAILABILITY OF APPS FOR TELEMEDICINE CONSULTATION

These applications are need of the hour now, we must be careful while using them as we cannot avoid them completely. Nowadays most of the urban patients keep blood pressure machine, thermometers etc. with them, but when these apps are connected to the apps the information goes to the doctor directly which can help him advise the best treatment. Some apps have diagnostic centres attached to them, the information goes to the doctor and the patient is provided with the timely and best advice. Smart-phone parameters help to maintain a record of patients which helps in tracking the changing health parameters, it is an elaborate and trendy way to provide help to the patients. 

HOW DIFFICULT CAN IT BE TO ACCEPT THIS CHANGE?

In the last few decades, people have adapted themselves to many technological changes. It is time that we learn to live with the novel coronavirus. The doctors have made themselves ready for it, now the patients need to get accustomed to this practice too; so that crowd, long queues at doctor’s clinic can be avoided. Hospitals will always be available for emergencies but consultation from home is the best option in current times. Primarily developed for providing assistance in rural areas, it has found a fresh lease of life during this pandemic. 

The fear is running high which is making it easy for people to get people on board with telemedicine. Based on a study of 5 crore people who accessed online healthcare between March and May by Health tech platform Practo shows how virtual appointments increased by 500% out of which 80% were first-timers, signalling a possible shift in healthcare delivery. The older people might find it difficult to accept these changes given the fact that they are not familiar with smartphones and the digital world.

CONCLUSION

Despite being in existence for decades now, the telemedicine was not an active practice given the ambiguities around it. The uncertainty of rules and legislation that came along with it, made it a risky practice and patients, as well as the doctors, choose to stick to the forever-old practice of in-person treatments. However, pandemic changed the situation. From the past few months, given the amount of risk around the world people became ready to divert to remote healthcare practices. While it has its own pros and cons, the practice is the need of the hour.

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The first case of novel-coronavirus was reported in the state of Kerala on January 30, 2020 and as of June 31, 2020 the total number of positive cases stands at 5,86,056 including 2,20,728 active cases, 3,47,851 discharged/recovered and 17,411 deaths have been confirmed across India (Source). To effectively prevent the spread of COVID-19, well-organized testing programs, and extensive efforts to isolate infected people, contact tracing and quarantining people they have come in contact with is the need of the hour. Indian Council of Medical Research (ICMR) on June 31 informed that till then 88,26,585 samples have been tested of which 2,17,931 samples were tested in the last 24 hours.

Right from the outbreak of the COVID-19 several preventive strategies are adopted by the central government in consultation with states. After the lockdown is lifted there lies a huge burden on the states to work on containment of the virus. Recently through social media, COVID-19 comparison ratios are becoming widely popular where certain states and their administration are being widely criticized for their testing rates and inefficiency.

Flatten the Curve – State’s Difficulties.

It is relatively easy to design for the perfect cases, when everything goes right, or when all the information required is available in a proper format

 Donald Norman

Adequate testing and proper information are the only means through which public health intervention by the state can be done both diagnostically and therapeutically to flatten the curve. But the figures released cannot be perceived in isolation, they should be tallied with the population (test per million) of the state or test positivity rate in the state which captures the size of epidemic and scale of testing in number. 

Delhi has one of the highest testing rates per million but in terms of test positivity rate, it is relatively performing low. Also, the test positivity rates show wide variations in Delhi at 23 per cent positivity rate and Telangana at 18 per cent whereas West Bengal is at 3.5 per cent. Test positivity rates show the prevalence of infection and approach adopted where the epidemic is growing and tests are lagging. 

This presents a huge problem with respect to expanding the amount of testing base in the country because even though the testing rates are increasing in the country as a whole, positivity rates are constant at 7.4 to 8.1 per cent. So this presents a picture that there is no proper circulation of data which can show the exact incidence of the disease through which we can estimate whether we are testing enough. Overburdening of Government hospitals and reduced testing needs to be encountered as part of expanding the testing base in the country.

Testing Deregulation as a Way: Private players

With the rise in the risks of community spread of the virus, the Telangana government is often being criticized for its approach of not engaging private labs in testing even after demands pertaining to that was made by ICMR and Telangana High Court. 

Engaging private players in the fight can always be treated as a viable option because of efficiency. Also, these players are controlled by an incentive-based environment where performance is always rated. Germany’s success in testing for the virus proves the mechanism engaging the present approach. Germany has been testing more than one hundred thousand people per week since late February. By April 20, it had tested more than twenty-five persons per thousand. Compare this to India, where the testing rate is less than one person per thousand. One reason for Germany’s success is a relatively freer market for medical testing compared to India. Private companies in Germany were able to mass-produce the test kits early on, as they were less burdened by a central regulatory body like the Indian Council of Medical Research. 

In the name of quality maintenance, there is a heavy licensing mechanism for private labs inserted by Indian Council of Medical Research but it has forgone the key idea that then government organizations private players predict the probabilities of demand in the community concerning testing as they need to make living out of it. It is just the way they predict stock prices.

Conclusion

The primary question that arises most often in the community is “How many tests are enough tests?” and “When will we reach normalcy?”. The only answer for that would be that all states should ideally keep a watch at the indicators such as positivity rate and condition of spread in an epidemic that needs immediate attention. Thus till vaccine comes into the picture we can flatten the curve only by considering the epidemiological indicators and rampant testing through the inclusion of private players.

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