pill shaming

My first fifty milligrams…

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50 mgs of a drug,

A drug that i have been prescribing without a second thought or hesitation to so many of my patients since almost 6 years now…

50 mgs of a ssri ,a drug which i remember my father taking when i was a baby and getting back to his normal chirpy self,20 mgs of its brother drug which my mother has been taking since long.

50 mgs of an ssri aand here i am questioning my ability as a mental health professional,or is it a part of my illness?

i ponder i procrastinate,i suffer even after knowing that this might help

i delay,i think ,i judge myself,

50 mgs of an ssri for the first time and i feel low about it,it is a sinking feeling,most probably a symptom of my illness

june 2020 i take my first 50 mgs of ssri,and i feel ,empathise and understand all those peoples plight,who hesitate taking psychotropics ,who refrain from opening up about it ,and suffer for longer they could,this pill shaming runs deep,it is embedded deeply,difficult to overcome and uproot …

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pill shaming can be defined as the negative reaction and responses that one receives when they are taking medications

it is usually seen with mental health issues or menstrual issues,i would restrict this blog to psychotropics…

so why is it there and why do we justify it?

  1. IGNORANCE: many of us including myself minimize our distress,invalidate our feelings of despair and say to ourselves ‘ah this happens to everybody”it will get better on its own’ ‘it is not severe enough ,that i need to take meds’ ‘my distress is not that bad that i warrant taking medicines’ well i know how it feels,especially when your judgement is clouded ,i fortunately had my mother and reliable seniors who helped me get over my procrastination and reservations related to being on medicines.
  2. within the mental health community,mental health professionals at times themselves engage into pill shaming, majorly psychologists and alternative therapists(not at all generalizing,i have my share of very good and aware psychologists) and they believe ,that since the medicines did not work very well for them,or some other modality worked better,it is not the right path for anyone else,on the other hand due to the stigma associated with mental illnesses ,people who have genuinely benefited with pharmacotherapy do not open up about it.
  3. Within the medical fraternity as well,people consider psychiatry to a non scientific or vague subject,even though recent advances and studies prove that apart from environmental and psychological factors,biological causes of mental illnesses are equally or even more important,

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  • for example like there is insulin resistance in diabetes,similarly in depression the neurotransmitter serotonin has deficient levels in the brain,and just like giving insulin injections,diabetes can be put under control ,giving antidepressants can help in treating the biological etiology of depression, like stress can aggravate diabetes ,it can affect the mental health as well,like exercising and dietary changes  help with mild insulin resistance,similarly they might help with mild depression and anxiety symptoms as well,when we are diagnosed with diabetes,we get conscious about everything and take our medicines regularly,because we are well informed about the ill effects of not taking the meds and the effects are clearly visible and evident,but for mental illnesses we take a different approach,just because it is not visible and we are not well informed about the adverse effects it can have on our quality of life
  • on our work and functional efficiency
  • Our physical health and immunity 
  • our relationships and social standing
  • it can led to life threatening events like suicide

effects of pill shaming:

  • the lag between the onset of distress and treatment is increased massively ,we delay seeking help,the solution to it is reaching out to people you trust,seeking professional help and letting the experts decide along with your agreement on what will be the correct line of treatment,ask questions whenever in doubt.we as mental health professional are already trying and will keep trying to reduce the stigma and burden of mental illnesses from our side.
  • once starting,we hurry to taper or adherence to medicines is poor,which can lead to frequent relapses,solution to this is again asking your doctor,till what time you will have to take the medicines and reminding them to taper it when they and you feel it is right.
  • people often have to struggle with negative beliefs about themselves,thinking they are ‘less than’ if they have a mental illness or if they need medications,these feelings feed shame,it makes people feel alone and isolated.
  • talking about side effects ,they can be a powerful deterrent if someone is already ambivalent about taking medicines,often side effects subside once our bodies acclimatize to the medication,some might even persist.Like any other treatment the pros need to outweigh the cons,that i why we advocate holistic approach towards treatment,where both the patient and the doctor have a role in deciding the treatment plan,no doctor will ever force you to take medicines(unless there is a lack of insight and your life is at stake”
  • DEP_info_meds

These believes are pervasive  and deep rooted in our culture as a whole, but is even found in some self-help books or mutual-help support groups .It is never helpful to shame individuals struggling with mental health issues and to discourage them from getting help in the same way that they would for any other medical condition.

take home message

Treatment for mental health conditions can help end symptoms, restore quality of life, and allow you to feel healthy once again.Having suffered myself and getting much better on treatment i can vouch for this even more confidently now.Talk to your doctor ,discuss about your concerns and clear your doubts.It requires efforts ,patience and adherence from both sides.

Mental illness is not a moral failing or a lack of motivation and it doesn’t only affect people who don’t try hard enough or who are weak,Instead, mental illness is a chemical imbalance in our brains, and in order for us to not experience symptoms or active illness, we need to seek out and receive ongoing treatment.

It is okay if you have been reluctant about your mental health,it is okay if you have been resistant and biased again taking medicines,it is okay if you have procrastinated and questioned your doctor about the decision,be sure about it,clear your doubts,information(from the right sources) is the greatest tool to reduce anxiety,and please reach out, you are never alone,it is not worth this much suffering…

https://youtu.be/joquQNgtuzk

Ps:SSRI: Selective serotonin reuptake inhibitor


cleansing…

Blurr…

we had an aquarium ,when i was a kid

we let the fish poop,eat and die in it

would let the dirt settle,making the water unclear…

would make the fish less visible…then once in a month when it would get very dirty…

we would get our hands dirty and put the fish in a smaller vessel,when we moved them,they would gasp for their air i.e. water for a while,some would struggle and fall on the ground…

most of them would get back to normal,once put back in the jar…

some would get sick and recover while some would succumb…

would that stop us from cleaning the aquarium?

would not cleaning it regularly prevent the deaths?

would the dirty aquarium not become like a gas chamber?

would it not lead to sickness ?

well im on the journey of cleansing my minds aquarium,i have opened my long standing wound for dressing

it pains, it hurts, i shriek i cry…i go quiet…

i know it hurts my vicinity as well,but can the flow ,can the journey be stopped?

i am trying hard,really hard to see clearly but in vain,the water is dirty,stagnant,the settled dirt has surfaced…

but i can do nothing but wait…holding on to faith ,giving up on hope…

i am waiting patiently,patiently to see clearly…

Photo by Engin Akyurt on Pexels.com

Contd. On the second page…

Do what you truly desire…


oh dear sleep…

hello readers,

well it has been long since I wrote something related to mental health, I like anyone else am not immune to procrastination, anyway, finally, I could motivate myself enough to write,

without beating around the bush much, let me get to the point here

she was 14 years old,childhood sexual abuse ,positive family history of neurosis,trying to win the rat race took a toll on her mental health,manifesting in the form of long long nights which seemed never ending,the frustration of watching other people sleep peacefully was something noone else could ever decipher,

12th standard board exams ,dreadful most physics paper,pcos,and an ambition to become a doctor ,became too much for her to take,11 pm she went to bed,her mother brother and dog sleeping in the same room,she shut her eyes tight,physics questions moving in her head,motion momentum etc etc,her heart racing faster,she needs to sleep she thought to herself,oh what if she doesnt sleep the whole night,her performance will get hampered ,she will not score marks,she will not do well,she needs to sleep anyhow she thought to herself,she could hear her doggie snore,it was 12 am now,she had to wake up at 7 am to revise one last time,7 hrs of sleep ,good enough she thought,her mother woke up ,and exclaimed “u are still up,sleep now”and this increased her apprehension,oh i really need to sleep she thought to herself,her heart pounding ,she couldn’t lie down now,got up paced around in the other room,took her book out and started reading,she could not focus ,but did not give in,kept reading,1:30 am ,2:00 am and she was wide awake,went back to her room,chanted some mantras,but no her sleep had a mind of her own tonight,was playing hide and seek ,never to be found,she shut her eyes again,just like this she struggled till it was 5 and when she has lost all hope she fell asleep to wake up at 7 with a headache,took the exam…

One of the most significant human behavior,universally demonstrated in all animal species is sleep,it is something that is required by the brain to function.also, one the vegetative functions,very commonly affected in almost every mental illness,sleep is something we dont pay much importance to,whether the sleep disturbance is singularly present or associated with other symptoms,sleep hygiene is something that has been found to be helpful in maintaining regular sleep pattern.

hygiene is something that we have heard very frequently during this pandemic

hygiene can be defined as conditions or practices conducive to maintaining health and preventing disease, so sleep hygiene practices help maintain healthy sleep patterns.ill be mentioning a few points for sleep hygiene:

dos and donts for good sleep hygiene:
DO :

  1. maintaining regular hours of bedtime and rising:sticking to a consistent sleep schedule is very important when it comes to sleep hygiene and cannot be emphasised enough. okay so talking in terms of the current pandemic situation keeping any kind of schedule is hard undoubtedly,still if you figure a way to maintain a regular timing for sleep ,it can pay major dividends for your health,the principle behind this theory being the circardian rhythm.it’s best to go to bed and wake up at the same time each day. This allows your brain to predict behavior and cue your body to wind-down or wake-up.

2. maintain a night time routine
creating a winding up routine before sleeping helps the body get habituated to and signals the brain that it is about to go into the sleep mode soon.winding up routine can ideally be started atleast an hour before the desired time of sleep,atleast 1 hour before sleeping one should try to shut out all other work.

3.Create a sleep sanctuary

  • Your bedroom should be a sleep sanctuary! Soft lighting, quiet, and cozy. When the bedroom is devoid of visual and audio stimulants it allows our bodies to restore and refresh for the next day.Basically conducive to sleep,neither very hot nor too cold,comfortable bed and free from disturbing/stimulating sound,light or smell

4.use your bed exclusively for sleep and sex only:

  • again about giving clues to the brain and making it used to the same,if one carries work or entertainment or anything else other than sleeping on the bed,our brain doesnt get the clue that going in your bedroom or bed is equal to sleep,why confuse our brains right.

5. tire your body:

  • being physically active,and exercise helps you sleep better,but scheduling exercise earlier in the day atleast 3 hours prior to the sleep time,tires the body and helps in sleeping better.

6 .go to bed only when very tired and sleepy:

  • to avoid tossing and turning in bed and avoiding the frustration of not being able to sleep.If after 20 or so minutes of laying in bed you do not fall asleep, you should get up do something calm or even boring. You don’t want to lay in bed awake for extended periods of time since this sets up an association of feeling angry, frustrated and depressed while laying in bed. You do not want negative feelings, associations or thoughts while in bed. Try sitting quietly in another room wit the lights off (bright light incorrectly tell your brain that it is time to be awake), or read something boring like the phone book (school books always work well for me). You want to avoid doing anything that is too stimulating or interesting, since this will wake you up even more. When you feel sleepy again, go back to bed and try again.


7. sleep journal :

  • Documenting behaviors and habits by use of a sleep diary or sleep log can be useful to visualize what’s happening and how it influences you. As a sleep physician, I often use a sleep diary to track patients progress and adherence to sleep hygiene rules. Patients are often shocked when comparing their initial patterns to weeks to months later and seeing the dramatic difference and improvement.

DONTS
1.use phones and tablets in bedroom:

  • light from the phones interfere with the release of melatonin,which a sleep inducing hormone.It’s tempting to check emails or social media before we go to bed but this is a horrible habit to get into. This often gets our brain into task mode and the blue light from electronic screens can affect our ability to fall asleep.

2.take caffiene after the sunset:

  • Caffeine can have a disruptive effect on your sleep. The most obvious effect of the stimulant is that it can make it hard for you to fall asleep. One study also found that caffeine can delay the timing of your body clock. These effects will reduce your total sleep time. caffeine is present in tea,coffee,cola,red bull etc.

3.Take alcohol and tobacco :

  • Anyone who drinks alcohol from time to time knows that beer, wine, or spirits can sometimes leave you feeling drowsy. But while alcohol, a depressant, can help you fall asleep faster, it also contributes to poor quality sleep later,so paradoxically alcohol is harmful for sleep structure.
  • Nicotine disrupts sleep – and smoking can also raise the risk of developing sleep conditions, such as sleep apnea. if you are consuming both of these avoid taking them late in the day atleast.

4.taking afternoon naps :

Naps can be an effective tool in giving us a boost for that second half of the day, but they shouldn’t be used too close to bedtime or last longer than 20-30 minutes.

5. eat heavy meals:

  • Avoid heavy and spicy foods at dinner. Gas-forming foods and hurried eating also cause abdominal discomfort, which in turn interferes with sound sleep. Limit your intake of gas-forming foods to the morning hours, and thoroughly chew food to avoid gulping air.

6.watching the clock:

  • This also sets up a negative feeling of “oh no I only have X hours of sleep left” or “I can’t believe it’s 2 am and I’m still awake”. These obsessive and negative thoughts only contribute to your insomnia. Have an alarm set for the desired rise time and unless you hear the alarm go off, it doesn’t matter what time it is; it’s sleep time!

Apart from all this yoga,meditation and other relaxation techniques like the jacobsons progressive muscle relaxation helps in inducing and maintaining good quality sleep…

I am attaching two videos one a musical piece i love and has helped me sleep many times,another the technique i.e. jacobsons progressive muscle relaxation

Please note:Having mentioned sleep hygiene,I would like to emphasize that sleep disturbance can be a symptom of primarily other psychiatric illnesses also,so self diagnosis and medication may lead to implications in the quality of life,for which, seeking professional help is the only thing recommended.

i hope this helps ,feedback is most welcome.

Until next time Goodbye and take care readers,you can get in touch with me through my Instagram page

Wounded_shrink.


Joy and Sorrow

Pass it on and do return 

@vickykaushal09 se prerit
@sirphira_ghumakkad ke dwara vilambit

People turn to God, and spirituality, when they experience suffering,I did too,turned to Bhagwad Geeta 
Vishada means sadness or sorrow, and yoga means the state.(my interpretation)
The first chapter of Geeta is about Arjuna’ sorrow,and doubt,he was taken upon by grief ,grief of what lay in front of him,doubt about what is right and what is not.
Why was Arjuna filled with sorrow in the battlefield? Arjuna the mightiest warrior of all times,the learned disciple of Lord Krishna was sad?Did that make him any less courageous?

It was primarily because he was emotionally attached to his relations and family members . Attachment is a human value.People experience fear and anxiety at the prospect of losing something,in the prospect of seperation

Being human, Arjuna felt the same. His state of mind also revealed that he had preferences and biases in life. We all have likes and dislikes and Arjuna was not different. He had attraction for life and aversion to death. He identified himself with his mind and body, which made him feel vulnerable. Even if you have trained well under a spiritual master for long, in moments of crisis you may act like a normal human being and experience stress. It happened to Arjuna, although he too was well-versed in the knowledge of the scriptures and possessed the knowledge of the Self.

Sorrow is a modification of the mind,  books in Psychiatry have also mentioned mania of extreme happiness to be a defence mechanism against sorrow.

Being sad and anxious to little extent in crisis situations like these are normal.You are not alone.

I am not alone.

Being Sad at times is normal, giving up at times is normal,we are not sages ,we are humans.We feel therefore we are human.
If you study life carefully, you will realize that sorrow opens our eyes to the truths of our existence. It makes us reflective and introspective.it gives depth, compassion and empathy.
Stop judging yourself for giving up. Be kind to yourself.

Learning important lessons from the difficulties and sorrows in your life makes you wiser.
Karma does the same. It chisels our thinking and behavior.Trust the almighty,times are tough ,but we are not alone,We are all connected in a collective consciousness,We are all a part of Him ,he is a part of all of us,Rekindle what you have always had, rekindle your spiritual being,sit with yourself meditate,help others,serve others .
Spread love and positivity.
we are in this together ♥️.


ROOM NO.501 (contd.)

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10th of September 2017 ,marks the 15th time the world health organisation is endorsing the idea of SUICIDE prevention.

suicide in Latin means “self murder”.

It ranges from thinking that life is not worth living to actually completing the act.

It is one of the very few Psychiatric emergencies we come across.

like time,suicide has a past ,a present and a future.

past implies to the previous mental illnesses (studies suggest suicide is almost always the result of a mental illness).

present implies to the act of committing it .

and with future i imply ,the devastating legacy it leaves for those who have lost a loved one to it.We refer to them as the SURVIVORS of suicide.

room no. 501 has left its paint on my mind,

it reminds me of allot ,

it reminds of both good and extremely bad times.

the beginning was the toughest ,it was a ‘house full’ of lonely nights , hopeless evenings and mundane Sunday mornings.

then with help it became easier, and coming out of the phase changed me immensely.

i came out as a more confident , less anxious , more forgiving ,less judging and a more positive being.

after the phase i understood my patients’ agony better ,may be it was purposed to happen ,so that i would come out stronger.

I now connect better with my patients,I listen more intently, observe more keenly and take more interest.

Just about last year i received a call from my mother ,in between my exams that one our known expired ,on inquiring she said it was a completed suicide.

this was the first time I came across someone who ,not related to my work background ,

had done so.It was perturbing.when other people in our circle discussed about it,

I understood suicide’ position in our society.

  1. most commonly people said “what was so bad in the persons life that she has to resort to such a huge step.”

to that i would usually say that it is very rare that suicide occurs as a result of a single factor,usually there are many.and it is very difficult to explain.

2.others would try to ignore suicide and just concentrate on the death part.it is a big taboo to talk about it.

to that i would usually surrender (my bad).

understanding the risk factors can help us all to curb the rising rates .

  1. age :over 45 yrs.
  2. divorced/widowed.
  3. unemployed.
  4. conflictual interpersonal relationships
  5. chaotic family backgrounds
  6. chronic illnesses.
  7. substance abuses
  8. hopelessness
  9. previous suicide attempt(the most important determinant).
  10. social isolation.

there are many others and it should be noted that anybody ,anytime of their lives can become suicidal ,and anyone ,anytime of their lives should be taken seriously if they report so.

action to be taken is i would say report to a doctor immediately ,preferably a person who is trained in the field of mental illness.

following is the link to my previous article on the similar topic.

ROOM NO.501

reach out.take help.your life is precious.all problems have a solution.your suffering can be lessened .it is an illness like any other physical illness that demands attention and treatment.