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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Symptoms

National Institute of Mental Health (NIMH) lists down a few symptoms of GAD on their official website. These include excessive worrying, nervousness, difficulty in concentration, troubled sleep schedules, etc. People with anxiety tend to overthink situations more than the average person and worry about future scenarios that may seem implausible to other people. They may sometimes experience anxiety attacks which aren’t the same as panic attacks, although the terms are used interchangeably. Anxiety attacks are usually caused by a particular event and have a cause and origin. During anxiety attacks, people with anxiety may be extra sensitive to stimuli such as repetitive sounds, actions, etc. Trouble going to sleep or staying asleep is another symptom of anxiety if the person is being kept awake by their thoughts. They find it tough to relax or fully immerse themselves in any activity. But anxiety isn’t simply a feeling, anxiety triggers the body’s fight or flight response which results in the manifestation of physical symptoms such as shortness of breath, muscle pain or tightening of muscles, teeth grinding, sweating, nauseousness, etc. This causes people to sometimes confuse it for a physical ailment and not consider a mental aspect to it.

Social Anxiety

Social Anxiety Disorder is a medically diagnosable condition that is one step further than introversion and shyness. It is extremely common and causes people to have trouble going on dates, talking to new people, public speaking, attending parties, etc. These issues originate from a fear of being publicly humiliated or snubbed or being judged for any of their actions. Social anxiety can be dealt with by self-soothing methods but it causes a person to be crippled when it comes to socialising. Thus naturally, people with social anxiety tend to avoid large gatherings or even any places where they might meet new people. They choose to stay home and decline invitations as soon as they come in. This behaviour may sound familiar as is stereotypically assumed for introverts. So it is not a surprise that introversion and social anxiety are used interchangeably, but that isn’t correct.

Introverts are basically people who are more concerned with their inner world than the outside world. Unlike extroverts, who get energized and feel connected to people while socialising, it is only a tedious task to introverts, who would if given the choice, choose to stay at home alone. But contrary to popular belief, being an introvert does not equate shyness or a lack of social skills. Introverts could be master people pleasers and could charm their way around a room whole wishing they were at home watching a movie instead. So while some introverts may have social anxiety and some people with social anxiety may be introverted, these two qualities do not necessarily go hand in hand.

Extroverts and Social Anxiety

On a completely opposite note, extroverts are seen as loud, funny and dynamic personalities who cannot possibly know how to stay quiet. So the idea of an extrovert having social anxiety seems entirely impossible. And even if it does seem possible, it is assumed that it would be very easy to observe.  But as definitely as they exist, it is also extra tough for them to handle both extraversion and social anxiety at the same time. While some of them may simply choose to stay home and avoid putting themselves in positions where they would have to socialize, others try to force themselves to get out there and end up making themselves miserable. The ones who stay at home, end up convincing themselves and people around them that they’re an introvert when in reality they have much more fun going outside and hanging out with people. The ones who do force themselves to go outside, live in constant fear where they question every single step they take or every sentence they speak. They might replay conversations and try to figure out if they did something wrong and overthink themselves into a frenzy of worry and nervousness over future interactions.

Thus, extroverts with social anxiety find themselves in a unique conundrum. While they need social interactions to thrive, those very interactions also cause them immense amounts of worry.

Tips to Work Through Social Anxiety

Be mindful. Anxiety makes you worry about the future or the past so it is important to keep reminding yourself that the present is all that matters.

Give yourself time. Allow yourself space to get comfortable with the idea of a situation before putting yourself in it. For example, do not immediately force yourself to go for tryouts in a huge club without some time to wrap your mind around the idea.

Start small. Take small steps towards what you want to achieve while constantly showing your inner critic that you’re doing well. For example, instead of going to a huge party full of strangers, go to a small lunch with friends and maybe 1 or 2 mutual friends that you have never talked to.

Remember that you’re not alone and chances are there may be a lot more people around you who are dealing with social anxiety that isn’t obvious to you.

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Separation Anxiety Disorder is experienced by children when they have intense anxiety concerning separation from their home or caregivers. It is natural for a young child to feel anxious when they are separated from their parents. It usually starts from a child’s first birthday and can last up to their fourth birthday. Parents can ease their child’s anxiety by being patient and by setting some limits. However, some kid’s anxiety does not go away and it becomes a sign of a larger problem that is separation anxiety disorder. It is not a normal stage of development. Children with this disorder avoid situations in which they will be parted from their caregivers. Even the thought of separation causes extreme anxiety. Situations like when their caregivers are going to work or before going to sleep at night they become anxious. They ask one of their parents to stay with them and leave them after they sleep because they get nightmares regarding separation. Adults avoid going out and staying with others for example going to a friend’s house for a night out.

When they are separated from their caregivers they develop intense fear. They think something terrible will happen to their caregivers or themselves. The fear gets intense that they feel they will get kidnapped.  To avoid this situation they complain about physical symptoms such as stomach ache, fever etc. They become panicky, miserable, homesick, socially withdrawn and sad. They also demand constant attention and sometimes become so clingy that they will not allow one of their caregiver to go out of sight. People with separation anxiety disorder are also at greater risk of subsequently developing other anxiety disorder such as panic disorder.

SYMPTOMS

The symptoms of separation anxiety disorder include:

1. Fear and worry that something will happen to their caregivers
2. Children refuse to go to school
3. Insomnia
4. Complains about headache and stomachache
5. Clinging to the caregiver
6. Nightmares about separation
7. Fear of being alone
8. Bedwetting
9. Temper tantrums

Children and adolescents should show at least three symptoms from the above mentioned symptoms. The symptoms should last for at least four weeks and cause significant distress.

CAUSES

It occurs because of the fear a child has in some ways. If we can know the actual cause we will be one step closer to help the child through their struggles. A strong genetic component was used as evidenced by analyses based on twin data. Important environmental factors such as low-income environment, new house or school can trigger symptoms. They can also develop it because of natural or manmade disasters such as losing a loved one in an attack or tsunami etc. An overprotective parent or insecure attachment can also be a problem because they manifest their own anxiety about separation on the kid. 

DIAGNOSIS

Separation Anxiety Disorder is diagnosed on the basis of the signs and symptoms shown by the person. It varies from age to age. Children in the range of 5 to 8 show more symptoms than the 9 to 12 age group. Young children report more nightmares. Adolescents are more likely to report physical symptoms. Parents and child symptoms differ from each other. Clinicians are more likely to diagnose children with the disorder when parents report their symptoms. There are no laboratory tests for this disorder but the clinicians can ask for a blood test. If no physical illness is found, the child is sent to a psychologist to diagnose and treat them.

TREATMENT

The majority of children diagnosed with the disorder are completely free of symptoms within 18 months. However, people those who need help get the proper treatment from the clinicians. Behavioural techniques such as Systematic Desensitization, Exposure Therapy and Modeling is used for treating fear and anxieties. Contingency management and self management are also useful in teaching child to react positively to their fear-provoking situations. The therapies can be given individually or in combination. Cognitive Behavioral Therapy seems to be the most promising. It helps to reshape the child’s thinking and behaviour. Other therapies include Talk Therapy and Family Counseling to help the child to fight from their fears of separation.  There are no specific medications but in severe cases, antidepressant or anti-anxiety pills can be given to the person. Parents can also help their children at home by making proper plans for them and replacing their anxiety provoking thoughts into positive thoughts and also by setting some limits. They should also allow the child to stay or go to some place alone and should give up on their insecurities regarding their children.

CONCLUSION

Most children with the disorder get better and healthy with time. They need family support and love and when this thing combines with the treatment the chances of recovery improves. There is no way of preventing it but acting and recognizing it at the right time is important. They should live at a better place and should adapt with the changes and should give away their fears and accept the challenges with a positive attitude.

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Inside the cramped bank vault, a strange, positive, compassionate bond developed between the captors and the captives. On one occasion, when hostage Kristin Enmark began to shiver, Olsson draped a wool jacket over her shoulders and even soothed her when she had a bad dream. He also gave her a bullet as a keepsake. When 21-year old bank cashier, Elisabeth Oldgren, complained of feeling claustrophobic inside the confined bank vault, he tied her to a leash and according to the captive herself, he “was very kind enough” to allow her to walk outside the vault. When hostage Birgitta Lundblad couldn’t contact her family members over the phone, Olsson consoled her by telling her, “try again; don’t give up.” These acts of kindness inculcated feelings of sympathy in the hostages and in the words of Sven Safstrom, the lone male hostage, the captives saw him “as an emergency God.”

A more infamous incident than this “Bank Drama,” a term coined by a 1794 New York Times article, is that of Patty Hearst or Patricia Hearst, a famous media heiress who was seen helping her captors rob a bank after a few months of being kidnapped by revolutionary militants in 1974. 

As an explanation, ‘Stockholm Syndrome,’ a phrase coined by criminologist and psychiatrist Nils Bejerot, was born. 

CAUSES OF STOCKHOLM SYNDROME

Intrigued by this rare phenomenon, Psychiatrist Dr Frank Ochberg, went on to study and define the syndrome for Federal Bureau of Investigation (FBI) and Scotland Yard in the 1970s. According to him, the criteria for Stockholm Syndrome included the following – 

1. A sudden experience of something terrifying and feeling certain that they are going to die.
2. Experiencing a type of ‘infantilisation’ – where they are unable to speak or eat or go to the washroom without permission. 

When the hostages receive small acts of kindness from their captors, they experience a “primitive gratitude for the gift of life,” and that inculcates a “powerful, primitive, positive feeling” towards the captor. 

In hostage negotiation, this syndrome is defined as “the psychological tendency of a hostage to bond with, identify with, or sympathise with his or her captor.” 

A forensic psychologist in Rochester, Minnesota, Steven Norton, explained that while Stockholm Syndrome is a psychological concept seen as a survival strategy or a coping mechanism, it is not a formal diagnosis. It is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Statistical Classification of Diseases and Related Health Problems (ICD-10). According to Norton, the increased fear and trauma may induce sympathetic feelings and that can make the hostages emotionally dependent on the captors, but these symptoms of Stockholm Syndrome could overlap with the symptoms of PTSD (post-traumatic stress disorder) and learned helplessness. 

However, a 1999 FBI law enforcement bulletin states that victims with Stockholm syndrome will exhibit two key characteristics:

1. Positive feelings toward their captors and
2. Negative feelings of distrust and anger towards law enforcement officials. 

This might lead them into feeling that police actions might threaten their safety. 

In tune with these explanations, Dr. Dee L. R. Graham, a psychologist and professor at the University of Cincinnati, and her colleagues, described that this rare syndrome is more likely to occur in these following conditions – 

1. “Victims perceiving a threat to their survival at the hands of their captors.
2. Victims perceiving small acts of kindnesses coming from their captors, such as not getting hurt or receiving water and food.
3. Isolation of victims from perspectives other than those of their captors.
4. Inability of the victims to escape from their situation.”

The display of positive feelings can also be from the captors’ end. A classic evidence of this is Olsson’s remarks – “It was the hostages’ fault. They did everything I told them to do. Why didn’t any of them attack me? They made it hard to kill. They made us go on living together day after day, like goats, in that filth. There was nothing to do but get to know each other.” This even rarer phenomenon is known as “Lima Syndrome.” 

This notion that development of positive feelings is bidirectional in cases of captor- captive situation has encouraged hostage and crisis negotiators to develop similar supportive behavioural skills. 

Although Stockholm Syndrome is a rare phenomenon when it comes to hostage and captor incidents, the underlying principles of how it develops and works is witnessed in different, yet more common circumstances and situations. 

HELD HOSTAGE BY THE ONE YOU LOVE

Battered individuals failing to press charges against their violent abusers, victims denying the presence of violence in their relationships, or men, women or children willingly wanting to stay back with their abusers because of the love, strong emotional connect and deep sympathy, are all examples of symptoms associated with Stockholm Syndrome. Another example is corporate Stockholm Syndrome which takes place in organisations where a supervisor or boss has immense control over the employees and these employees believe that they will eventually benefit if they are compliant. 

This terror-bonding or trauma bonding typically happens in women and children. According to psychologist Jennifer Wild, a consultant clinical psychologist at the Oxford University, women who develop a sense of dependency on their partners, might feel less of anger and more of empathy towards their abusive partners, and they might choose to continue staying with their partners despite being victims of Intimate Partner Violence or Domestic Violence. 

Similarly, child abuse is another example. When care givers or parents physically and/or emotionally abuse their children, children may deny it or lie about it or choose not to speak up about it because of the protective feelings and the love they have towards their parents or caregivers. 

Whether Stockholm syndrome is a myth or it actually exists in reality is still an ongoing debate. However, for the individuals who experience symptoms similar to that of Stockholm Syndrome, it is very hard for them to accept the reality and come out of the abusive relationship. Offering full support and providing a safe space where they feel accepted and loved is something which friends and family members can do to help them. 

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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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“Believe me, every heart has its secret sorrows, which the world knows not, and oftentimes we call a man cold, when he is only sad.”

— Henry Wadsworth Longfellow, Hyperion

Although emotions have a biological base, the meanings of emotions and the appropriateness of emotional expression are products of socialisation. One critically important moderator of what children learn about emotions and the appropriateness of emotional displays is gender (Parkins R, 2012). Gender differences in experiencing and expressing emotions is largely a result of the gender-stereotypic socialisation which is usually instilled in the members of culture from early childhood (Fischer A, et.al. 2004). Thus, emotions which are fundamentally neutral and are experienced by all, come to be perceived as gender-specific stereotypes.  Consequently, these stereotypes provide a basis for society to determine what is and is not socially acceptable for males and females in displaying emotions.

IDENTIFYING THE STEREOTYPES

Phrases like “boys don’t cry”, “emotional women”, “man up” and the like are all examples of stereotypes associated with gender-based appropriateness of emotional expression. We are all wired into believing that women are more emotional than men, or at least are more emotionally expressive. This occurrence of women being more emotionally expressive than men is majorly a result of the early shaping of our views on emotional expressivity. 

According to Denham et al. (2007), children learn about emotions through three primary modes of direct and indirect socialization: 

1. Witnessing others’ feelings and emotions, 
2. Having their emotional displays responded to and 
3. The ways they are taught about their feelings and emotions. 

Indirect socialisation happens when children observe other family members display specific emotions. Accordingly, they gather information and internalise the level of appropriateness for specific emotions. Direct socialisation takes place through discussions on emotions parents have with their children or via parental reactions to emotions. Emotional expressions which are reinforced with warm, sensitive responses from parents and caregivers are instilled and repeated whereas emotional expressions which are accompanied by non-supportive responses are suppressed or avoided.

As a result, several studies have found that men learn to express powerful, externalizing emotions that display one’s assertiveness and power, such as anger, contempt and pride and suppress the “non-masculine” expression of sadness (Siegel & Alloy, 1990) whereas women express the powerless, internalising emotions such as happiness, embarrassment, surprise, sadness, fear, shame, and guilt which serve to imply vulnerability and maintain harmony in social relations with a minimum of overt hostility.

Even the highly applauded Pixar movie “Inside Out” which beautifully taught us the importance of balancing the complex emotions, portrayed certain stereotypes. Anger was shown as a man with a deep, gravelly voice, Disgust was guised as a “spoiled bratty girl”, sending strong messages about emotions in female adolescence and Sadness and Joy were personified as two distinct types of women, capturing the idea that sensitive empathy and unswerving optimism are synonymous with the female emotional condition. 

These gender stereotypes associated with expression of emotions is not only restricted to face to face communication, but also social media interactions. In a study by Róisín Parkins (2012), posts, tweets and comments were analysed to examine the emotional expressivity of men and women in the realm of social networking sites such as Facebook and Twitter. It was interesting to observe that despite the relative anonymity that comes with online communication, the gender stereotypes associated with expression of emotions is still prevalent and women are the more emotionally expressive gender.

However, a study by Fabes and Martin (1991) has shown that women are perceived to express emotions more than men but that there is little difference in the perception of men and women’s emotional experience. This means that one has to consciously understand the difference between “expressing emotions” and “experiencing emotions.” This distinction is meaningful because it endorses the notion that gender stereotypes shape emotional expression. 

UNDERSTANDING THE NEGATIVE CONSEQUENCES

Times and situations have changed and we now live in a world where gender roles have become overlapping and the very concept of “gender” has become more fluid. In these times inability to foster emotional diversity in children may have long-term problematic consequences. 

Both men and women are subjected to norms of appropriate expression of emotions in the workplace, but women experience greater scrutiny compared to men when it comes to emotional expressions at work. While men who get angry at work are perceived as decisive and strong, women who loses their cool and act in anger are regarded unprofessional and incompetent. At the same time, when women express the stereotypical “feminine” emotions, they are judged as lacking emotional control, which again undermines their competence. Such perceptions leave women in a bind – being passive prevents them from being heard and expressing anger raises questions on their professional legitimacy. This leads to women diverting or suppressing their anger. While the former may hamper their relationships with friends, family and loved ones, the latter can make them more resentful and cause anxiety or depression. 

Men, however, suffer beneath the gravity of conventional masculinity and experience greater depressive symptoms than women. Boys grow up in a world inhabited by a narrower range of emotions and the cultural pressures to act masculine may further prevent them from expressing their emotions in healthy ways. Men are taught to refrain from expressing any emotional vulnerability and are expected to show only a limited range of emotions. This process of limiting the range of men’s allowable emotional expression helps set the path towards anger and aggression. Denying emotional vulnerability makes them prone to engaging in health risk behaviours and substance abuse. While women may experience depression more than men, many men may restrict emotions and avoid the feelings associated with depression by embracing anger and resorting to physical violence. Inability to express emotions extends to the home as well where men find it difficult to share their own vulnerable emotions with partners and are less open to these experiences in their partners. Thus, emotion suppression can have detrimental effects on their physical, psychological and relational health and men may be at greater risk for stress-related cardiovascular problems in the long run.

CONCLUSION

Letting the guards down and expressing emotional vulnerability is easier said than done, but bottling up or avoiding emotions has never had a positive outcome. Thus, acknowledging and embracing the emotions, expressing them in appropriate ways and creating a safe space for others to open too are necessary for the psychological health of the individual and for the society at large.  

“Life without emotions would be as calm as death, like a world without weather. Accept feelings as they are; pleasant or painful, they are natural and don’t need fixing. Let them rise and pass without allowing changeable emotions to run your life.”

— Dan Millman

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Symptoms

Conditions such as anxiety, depression, panic attacks, lucid dreams, phobia, insomnia affect our mental health. Overthinking plays a very huge part when we talk about mental health. Many people tend to think too much about the situations which will probably never happen. People don’t have control over how much they overthink. There are many solutions to overthinking if you search it up on the internet but, in reality, it’s not very elementary. You can experience these conditions at any point of your life, no matter the age, sex or ethnicity. Some people can be more prone to depression than others because of well, life situations, peer pressure, sexual identity and whatnot.

According to a study by WHO, half of all mental health conditions start by 14 years of age. Adolescents are at greater risk of mental health conditions due to their stigma, discrimination or exclusion, or lack of support from their parents/friends. As per the same study by WHO, suicide is the third leading cause of death in older adolescents because of mental illness and lack of access to help/therapy. There is a growing consensus that healthy development during childhood contributes to good mental health.

Lancet’s Study

Lancet has found the efficacy of “brief lay counsellor delivered, problem-solving intervention’’ for mental health problems in adolescents from government schools in Delhi. This is for adolescents who can’t afford to pay for therapy sessions. The premium for Adolescents (PRIDE) is a six-year research programme dedicated to making psychosocial interventions for improving the mental health of adolescents in India. “The study established that with limited resources and counselling intervention, we can give practical tools to adolescents to manage and deal with their mental health issues. This also makes mental health treatment accessible to those from underprivileged sections of society,” says Dr Kanika Malik, a clinical psychologist. The programme is going really well and is pretty successful. More than 250 adolescents were enrolled for the programme between August and December in 2018. For the treatment, they made a problem-solving booklet in a comic format to keep up with the interest of the adolescents. The book has many chapters which teach the kids to deal with domestic problems. This is very important because domestic life can be a major source of stress for the students and they don’t have the resources to tackle these situations but the comic book gives them tools to work through them. Not only did they distribute the booklets but also hired and trained the members of the community to counsel students.

According to a study by the lancet, more than 99% of adolescents and children with mental health problems remain undiagnosed in India. If these students receive proper treatment right now, they are less likely to suffer from serious mental health conditions in the later stage of their life. The initiative that lancet took for these adolescents is exceptional. 

Vulnerable Teens 

Another problem that students face while growing up is whether or not they should tell their parents about what they are going through. Adolescence is a very crucial period in our lives. Your decision-making power is not the best at this age. Parents are also requested to listen to their kids, to understand them, to tell them that it’s normal to feel this way. Many kids have abusive parents which makes it even more difficult for them to go through the illness. 

Look out for yourself and other people

 Mental illness is a very serious condition and it should not be neglected. Your brain is just as important as your heart and other body parts. It can only handle so much. Also, we should not forget the fact that we are in the middle of a pandemic right now and this COVID situation is not helping. This is for all the parents, if your kid is struggling, love him/her. This is for all the people who have friends with mental illness, support your friends.

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In India, as reported by the National Mental Health Survey (NMHS) 2015-16, nearly 15% of Indian adults require interceding for mental health issues and at least one in twenty Indians suffer from depression. According to the recent WHO report India is the 6^th most depressed country with 258,000 reported suicides in the year 2012. The report also mentions that around 80% of Indians don’t seek treatment after getting diagnosed with depression, mostly because of the stigmatization of mental health in Indian society.

Reasons for Depression:

• Hormonal changes in the brain of a human being.
• A person who always thinks negatively or perceives the conditions with a pessimist approach more likely faces stress loneliness and anxiety.
• Some people who constantly experience violence, hatred, abuse, poverty, and relationship disputes easily tend to fall in depression.
• Sometimes genetics plays a major role in making a person vulnerable to depression as it runs from the parents to their children and affects them without external causes.

Symptoms of Depression:

• Fluctuating body weight
• Energy loss or fatigue
• Feeling irritated or agitated
• Finding oneself guilty and worthless
• The feeling of being left out
• Reduced concentration power
• Lowering interest and pleasure in activities and works.
• Suicidal thoughts or constant thoughts about self-harm

Present Scenario

Normally, people in the midst of lockdown have confined themselves in their houses which might be necessary for the amelioration of the nation but when it comes to the mental health of an individual, without any medical treatments or personal measures being taken many people are going through major repercussions like depression, anxiety, frustration, fear, etc. and these sort of feelings within a person has resulted in the upsurge of activities like domestic violence and suicide attempts. Usually, people tend to find solutions for such problems through an intense consumption of alcohol and drugs but improper awareness, the looming threat of a pandemic, fear of joblessness, and lack of medical facilities available in hospitals have caused amplification of this issue.

Confirming to the Ministry of Health and Family Welfare, India requires around 13,000 psychiatrists. An ideal ratio to be attained is 1 psychiatrist for 8000 patients but at present, we have 3500 psychiatrists which are about 1 for 2 lakh or 200,000 people. Regarding clinical psychologists, we need 20,000 but we have only 1000 working clinical psychologists. Though we are doing much well in the manufacturing, supply, and export of PPE kits yet it’s a need of the hour to fill this gap between the patients and the doctors required for mental health treatments by the government.

Social media has become an alternative way of living a life for us where due to loneliness people have presumed social networking sites as a second world. We have already witnessed cases of suicides due to a lesser number of likes and public views on social media handles of a person. Current so-called modern communication tools have resulted in remoteness from personal/physical engagements and gatherings.

Due to lockdown, we have started utilizing video calling tools that are leading towards a virtual life rather than a real one. Though it must be helping us in the continuation of our regular schedules it has now led to such disorders and has started affecting humans both mentally as well as physically. A human is called a social being but soon this sentence will reverberate as a fantasy and unfortunately, in the end, these social beings will find themselves as introverts.

Medical Treatments and Therapies for Depression

Though it is one of the most lethal disorders, it can be treated which must be done as soon as the illness gets diagnosed. The general method for getting it treated is with medications and psychotherapy or with the combination of both. When these solutions don’t work electroconvulsive therapy and brain stimulation therapies are the options that are mostly explored.

Considering the medications, anti-depressants are the most recommended medicines to treat depression which may improve the brain’s way of using certain chemicals that manages the mood and stress of an individual. They may usually take 2 to 4 weeks to deliver some positive results. Such kinds of prescriptions should never be taken without the counsel of a trusted doctor because an over-dosage or mistakes in the courses of intake of an antidepressant can cause serious side effects.

Psychotherapy is another option which is also termed as ‘talk therapy’ or ‘counselling’. It can help to reduce the symptoms of depression. Methods such as interpersonal therapy (IPT), cognitive-behavioural therapy (CBT), and problem-solving therapy are the approaches for the treatment of depression.

If the above mentioned medical treatments don’t give expected results then electroconvulsive therapy (ECT) plays a major role in the treatment of depression. The treatment includes continuous sessions which may be thrice a week for almost two to four weeks but may cause few side effects like confusion or memory loss. However, now due to the advancement in the method of ECT, it has become safer and more effective for the patients. The procedure though is not painful and a patient is put under anaesthesia. There are many more methods to treat this mental disorder which are being studied by the researchers and the doctors and soon may be utilized for the better and more accurate treatment of the illness.

Yoga to Overcome Depression

Yoga alone should never be considered as a treatment for depression but should complement with proper medication and other options after proper consultation with the doctors. Regular yoga will definitely help a person to overcome stress and will give strength to think optimistically and makes a person optimistic. Yoga includes asanas, pranayamas, and also yoga philosophies.

Yoga Asanas:

• Dhanurasana (Bow Pose)
• Janu Shirsasana (One-Legged Forward Bend)
• Setu Bhadasana (Bridge Pose)
• Matsyasana (Fish Pose)
• Pashchimottanasana (Two Legged Forward Bend)
• Hastapadasana (Standing Forward Bend)
• Marjariasana (Cat Scratch)
• Adho Mukha Svanasana (Downward Facing Dog)
• Sirsasana (Headstand)
• Shavasana (Corpse Pose)

These asanas help in releasing the tension and negativity from the systems of the body.

Pranayamas to relieve anxiety:

• Kapal Bhati Pranayama
• Nadi Shodha Pranayama
• Bhastrika Pranayama
• Bhramari Pranayama

These pranayamas are done by focusing or putting attention on the breath to relax and free the mind and erase thoughts that procreates anxiety or depression.

Meditation is the method that should be followed daily because when a person gets too anxious regarding a threat or for varied reasons the muscles of a body get tense and the body starts sweating and scientific research has proven that meditation can significantly reduce the level of stress hormones.

The ancient yoga philosophies mention about two important principles of yoga, ‘yamas’ and ‘niyamas’. According to this principle, niyama teaches about the value of containment whereas the Aprigraha principle guides us in overcoming greediness which has always remained a reason for anxiety. Another principle called the Shahucha principle glorifies the cleanliness of the body and mind. These principles also mention healthy eating habits and a proper lifestyle for a perfect livelihood.

Lastly, praying to the god and keeping positive group of company around ourselves can keep our faces smiling and can breed peace and joy in our lives.

Conclusion

The recent committing of suicide by a well-known actor Sushant Singh Rajput has left us astonished and where depression is said to be the reason for the unfortunate step he took. These problems can simply get solved by sharing our feelings with the near and the dear ones and consulting trained professionals in due time. Unfortunately, the lockdown has kept few people away from their close relatives and friends even then suicide should never be a choice because “suicide does not end the probabilities of life getting worse but it eliminates the possibilities of it ever getting any better.”

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This article is about ‘Bella Clifton’ and her fight with BPD.

Bella Clifton was a 9-year-old girl when she saw her parents fighting every day and night. Little as she was, in that environment of hostile and distressful, her child-like mind started believing that people leave when we need them the most. Although her parents reconciled after years of arguments and fights but her subconscious mind was still lost in those years of her childhood. 

During her teenager days, she lost some of her closest friends and became more & more depressed. She had a feeling of insecurity & fear of rejection. So, she never made very close relationships. She was emotionally imbalanced, full of sadness and the cloud of self-worthlessness thoughts started following her. She even started questioning her existence. Those events made her lonelier. She was feeling empty inside her own. 

Borderline personality disorder or BPD is a serious Psychological Disorder, often confused with bipolar disorder. According to the most recent DSM-4-TR lists nine categorical criteria for BPD, five of which must be present for diagnosis. 

The nine Psychological criteria are as follows:-

1. Frantic efforts to avoid real or imagined abandonment.
2. Unstable and intense interpersonal relationships.
3. Lack of a clear sense of identity.
4. Impulsiveness in potentially self-damaging behaviours, such as substance abuse, sex, shoplifting, reckless driving, binge eating, etc.
5. Recurrent suicidal threats or gestures, or self-mutilating behaviours.
6. Severe mood shifts and extreme reactivity to situational stress.
7. Chronic feelings of emptiness.
8. Frequent and inappropriate displays of anger.
9. Transient, stress-related feelings of unreality or paranoia.

Discussion

Borderline personality disorder (BPD) is one of the group B-type of personality disorder. It is common in a psychiatric environment with a recorded prevalence of 20%. In BPD comorbid depression, anxiety spectrum disorders & bipolar illness occur more frequently & the lifetime risk of having at least one comorbid mental disorder approaches 100%. It is more common in women, higher in the urban population. It was originally used in psychodramatic circles to describe people with a marked instability. (source)

People suffering from borderline personality usually have a traumatic childhood experience such as separation of parents, sexual assault, or physical violence. The world of a borderline, like that of a child, is split into black and white. At any particular moment, one is either “good” or “evil”; there is no grey area. Splitting is an escaping mechanism from anxiety. A person suffering from BPD desperately seeks out new relationships; for solitude, even temporary aloneness is intolerable than mistreatment. 

BPD is often accompanied by- anxiety, anger, depression, panic attacks, sleep disturbance, episodes of frequent mood swings.

In Bella’s case, it was her traumatic childhood which made her a patient of BPD. At first, she wasn’t ready to go to a psychiatrist but after lots of convincing and arguments with her childhood best friend, she gave in. Bella was prescribed with some mood stabilizer, anti-depressant and sleep-improver. Her psychiatrist recommended her a clinical psychologist and the journey of her DBT session (therapy for BPD) begins.

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