International Overdose Awareness Day – Time to Remember. Time to Act.

In 2019 alone, the World Drug Report estimated a total of 494,000 deaths attributed to drug use, out of which, 128,000 were mainly due to overdose (United Nations Office on Drugs and Crime [UNODC], 2021). Compared to 2017, there has been nearly a 5 percent increase in drug-use-related deaths. 

What is an Overdose? 

Overdose, having more of a drug (or combination of drugs) than one’s body can cope with (International Overdose Awareness Day, n.d.). These drugs are not limited to hard drugs. All drugs, including prescribed medication from doctors, can cause an overdose. However, the most recurring drug noted in overdose deaths is opioids, though in most cases, such deaths are avoidable. Other notable drugs include depressants, alcohol, stimulants, psychoactive substances, and crystal methamphetamine. 

How did International Overdose Awareness Day come about? 

In 2001, Sally J Finn in Melbourne, Australia initiated what would be the world’s largest annual campaign to end overdose, International Overdose Awareness Day (International Overdose Awareness Day, n.d.). Since 2012, the day has been coordinated by Penington Insitute, an Australian not-for-profit public health organization. The day aims to: 

  1. Raise awareness of overdose; 
  2. Prompt discussion and action about overdose prevention and drug policies that are evidence-based;   
  3. Acknowledge the grief felt by friends and families whose loved ones have died or suffered permanent injury from a drug overdose; and 
  4. Spread the message about the tragedy of drug overdose death and that drug overdose is preventable.

What SHOULD you do if you see someone who overdosed? 

Firstly, it is important to note that different drugs have different response requirements from the witness. However, there are some measures that are common to most, if not all: 

  1. Call an ambulance, tell the operator your location, and stay on the line.
  2. If they are awake, try to keep them in a sitting position and awake. 
  3. If you can’t get a response or the person is unconscious, put them in the recovery position. 

Figure 1: Recovery Position (Source: International Overdose Awareness Day, n.d.)

To know the more specific responses for the different types of drugs, please visit here and carefully read through the “A4 Fact Sheets.”

What should you NOT do if you see someone who overdosed?

Similar to the previous section, different drugs have different response requirements from the witness. However, the common measures are: 

  1. Do NOT leave the person alone. 
  2. Do NOT give the person anything to eat or drink, or try to induce vomiting.

To know the more specific responses for the different types of drugs, please visit here and carefully read through the “A4 Fact Sheets.”

If you have witnessed somebody overdose, what can you do for your mental health?

Witnessing such a traumatic event, especially if the individual was a loved one, can be extremely difficult to process and get through. In such a situation, the two main approaches professionals recommend taking care of your mental health are therapy-based treatment and medication-based treatment. 

  1. Therapy-Based Treatment 

The goal of therapy-based treatment approaches is to help an individual work through emotions and memories related to their trauma, while also aiding in developing healthy coping mechanisms and managing daily triggers and/or stressors (Sunshine Behavioral Health, n.d.). The three most common approaches are Cognitive-Behavioral Therapy, Exposure-Based Therapy, and Coping Skills Therapy. 

Cognitive-Behavioral Therapy focuses on helping patients identify the faulty belief systems and thinking that developed as a result of harsh life events. Thereafter, patients learn to replace these destructive thinking patterns with healthy ways of seeing the world around them. 

Exposure-Based Therapy refers to overcoming trauma-related fears. In this approach, patients are gradually exposed to things that trigger trauma-related fears. The emotional response caused by the trauma becomes extinguished over the course of 12 or more sessions. 

Coping Skills Therapy refers to using a wide array of techniques to help patients better manage feelings of anxiety and destructive patterns of thinking in their daily lives. Other techniques that are commonly used along with this approach include: biofeedback, relaxation training, role-playing, muscle relaxation, and learning about Post-Traumatic-Stress Disorder (PTSD) and how it plays out in their daily behaviors and thoughts. 

  1. Medication-Based Treatment 

If the PTSD symptoms are severe, it is possible that therapy alone will bring little to no progress because of the feeling of overwhelmingness. In such cases, medication-based treatments can be added as a supplement to provide the patients relief from distressing symptoms, while also allowing patients to better engage with the therapy process. 

How can YOU make an impact? 

There are different actions that you can take to help raise awareness and prevent overdose: 

  1. Host, or attend, your own International Overdose Awareness Day event or activity;
  2. Share campaign materials within your community (click here);
  3. Post your tribute to a loved one who has passed away from an overdose (click here to post on the official International Overdose Awareness Day website); 
  4. Donate and help to raise awareness of overdose and spread the message that overdose is preventable (click here to donate).

Let’s take this day to remember, without stigma, those who have died and acknowledge the grief of the friends and family left behind. Time to Remember. Time to Act. 

-By Arushi Mittal

(Trainee at EMOTICONS India)

References

International Overdose Awareness Day. (n.d.). Overdose Basics. https://www.overdoseday.com/overdose-basics/ 

International Overdose Awareness Day. (n.d.). About The Campaign. https://www.overdoseday.com/about-the-campaign/ 

United Nations Office on Drugs and Crime. (2021). Booklet 2 – Global overview of drug demand and drug supply. https://www.unodc.org/unodc/en/data-and-analysis/wdr-2021_booklet-2.html 

Sunshine Behavioral Health. (n.d.). PTSD Resource for Those Who Have Seen a Loved One Overdose.https://www.sunshinebehavioralhealth.com/resources/ptsd-resource-after-witnessing-overdose/

Self care – A Necessity

“Self care is something that refuels us rather than takes from us” – Agnes Wainman, Psychologist

When was the last time you deliberately took some time off for yourself and engaged in activities that relax you, rejuvenate you, that brighten up your mood and give you a more positive outlook on your day to day life?

Let’s think of ourselves as a car engine. The car functions well when its fuel levels are good. Over time, these resources reduce and we need to stop and replenish it. The car doesn’t function at its best when it doesn’t have any fuel in it. This is what self care is. Self-care is our fuel. It is a necessity.

Self care promotes mental, emotional and physical wellbeing. 

All of us are running through our day checking off things from our “have to” lists. Self care is something that is to be in our “need to” list. Our hectic schedules at times might  leave us exhausted, hopeless and even put a strain on our personal relationships. Self care adds a lot of advantages to our plates. It helps us in building up our resilience, which comes into action when we face extremely stressful life events. Practising self care is linked to better self esteem and confidence levels, higher motivation and better functioning on a physical level, too!

Self care need not be considered as a selfish act.  It is a tool that helps us have a better relationship with ourselves as well as with others. It is our “me time”; something that is sacred to every individual.True self care does not  cost anything, but its value is paramount. Checking in with yourself, acknowledging your current state and your emotions is self care. Doing so, we can take care of ourselves and be able to effectively look after the people around us.

Every person, whatever their age may be, can practise and avail the many benefits of self care. Learning the skills of self care at a young age can reduce the risk of developing mental illnesses like anxiety and depression.

 As someone who is transitioning from teenage to adulthood, and facing a whole new level of changes and challenges, I, too, have realised the true value of self care. With regular self care activities, I have observed a significant betterment in my physical health and also found a new sense of love for myself.

A long spa day or mini vacation every now and then sure seems very nice. In practicality, however, it’s something that is not possible for everyone. So how can we include self care in our life?

 I remember, a few days ago, it was a particularly stressful day for everyone in my family. We decided to play a game of carrom later that night. Before we even realised, we were on our 5th round! Faces full of joy and energy, conversations brimming with excitement, reminiscing the good old days and childhood memories. Just like that, we as a family, found our new self care routine.

Self care looks different for everyone. It does not have the one-size-fits-all characteristic. For someone it can be cleaning the clutter in their room, for another it could be putting on fresh bed sheets! 

The key to self care is to start small. The smallest of activities can have the biggest of effects. It can be as simple as taking a walk, listening to your favourite music or perhaps having a nice hot shower. Even meditation, having a proper sleep schedule , exercising or engaging in some creative activity can be helpful.

In light of the ongoing pandemic, almost all of us have experienced some big changes in our lives; be it schooling or our work environment. Adapting to change can be hard, making self all the more important.

Being stuck at home can be tough. Everything can feel overwhelming. This is where self care kicks in. Sitting in one place, hours together in front of a screen is a tiresome job. Aren’t power naps in the digital age golden? Taking regular breaks, stretching yourself a bit or talking to your loved ones can do wonders.

Self care also includes having regular health check-ups, following up on doctors’ appointments or even adopting a healthier diet.

Seeking therapy can be a form of self care, too. By doing so, we are taking a step to help us grow, to understand ourselves better and make better choices.

 Self care, however, can be difficult to implement. It is an intentional practice. Like any activity, it takes time for us to get into the flow. What we need to keep in mind is that these little steps we would be taking will not only boost us today, but also keep us fueled for the long run ahead!

By Esha Sonarikar

Trainee at EMOTICONS India

UNDERSTANDING SCHIZOPHRENIA

“Imagine if you suddenly learned that the people, places, the moments most important to you were not gone, not dead, but worse, had never been. What kind of hell would that be?’

It’s difficult to even imagine what is written in the above statement. Unfortunately, this is a reality for many people out there. 1 in every 100 is affected by schizophrenia, a disorder which affects an individual’s cognition, emotions, perceptions and behavioural patterns. Although the literal meaning of the word Schizophrenia (Skhizein + phren) might mean split mind, the actual condition is quite different. Often confused with Dissociative Identity Disorder (a condition wherein multiple identities coexist in one body), Schizophrenia can be described as a condition where the individual cannot differentiate between what is real and what is unreal. It manifests in a different way in each person and hence everyone’s story is quite different. 

The term ‘Schizophrenia’ was first coined by Eugene Bleuler and Emil Kraeplin was one of the first mental health researchers who gave a comprehensive description of Schizophrenia. At the same time, there were many other researchers who contributed in defining the condition. However one of the earliest references  can be traced back to John Haslam’s book, in which he described  a condition which was similar to what we now know as Schizophrenia. 

Typically, Schizophrenia is characterized by hallucinations and delusions. Often these terms are used interchangeably or highly misunderstood. Simply put, hallucinations can be defined as unreal or false sensory experiences, whereas delusions can be defined as misrepresentation of reality. However, these are not the only two symptoms of schizophrenia. 

An individual affected by Schizophrenia also exhibits lack of pleasure, inability to persist or initiate activities, loss of words, inability to express emotions (please note that they have a difficulty in expressing the emotion and not feeling the emotion) and disorganized speech. According to DSM 5, experiencing just one of the symptoms doesn’t lead to the diagnosis of Schizophrenia. To make a diagnosis the disturbance must have persisted for at least 6 months and while doing so the individual’s cultural and social context is taken into consideration (In some cultures hearing voices or ability to see things is considered normal).

As important as it is to know and understand the symptoms of the disorder, it is also extremely important to address the misinformation about Schizophrenia among masses. While addressing these misconceptions, it should be noted that karmic activities or paranormal activities do not lead to the development of Schizophrenia. Although the exact cause is not known, research indicates that one’s genetics, imbalances in neurochemical activities, possible abnormalities in brain functioning and environmental factors  influence the risk of developing Schizophrenia. 

Below is an excerpt of an 8 minute ‘TED talks’ video. This TED talk was given by an individual who herself has been diagnosed with Schizophrenia. In a few words, the speaker has removed many misconceptions one might  hold.

“After my diagnosis, I was shocked to learn that I had a mental illness. I had a normal and happy childhood. I was an ordinary person , how could I have schizophrenia? Before the diagnosis, I was completing my graduation but during my fourth year I dropped out, a side effect of developing the symptoms. However, after 3 months of treatment and medications, my symptoms had virtually disappeared. Couple of years later, I was able to go back to my education and complete my graduation. It has been 11 years of full remission and no relapse. Yes, I do have some limitations, I can’t drive or I can’t work full time.  It is a life condition but I DON’T see it as a life sentence.” – Bethany Yeiser 

As rightly stated by the speaker, although Schizophrenia is a life condition, proper medication and therapy help in managing the symptoms of Schizophrenia. With the right help, the individual can go back to his/her normal routine albeit with a few limitations. This debunks the myth about Schizophrenia which leads people to believe that affected individuals cannot be fully functional and are dangerous and violent. Unfortunately, in a few cases they themselves might be a victim of violence.

Due to these misconceptions about Schizophrenia, there is a lot of stigma attached to disorder as well as the individuals diagnosed with it. Research shows that stigma is negatively correlated to the quality of life of individuals who are affected by Schizophrenia and also leads to alienation of the individuals. In these cases support from clinicians and family members plays a great role in helping the individual to accept the situation.

On the path of destigmatizing Schizophrenia, creating awareness is an important step. Lack of awareness is one of the major causes that individuals with Schizophrenia are unable to identify what is happening to them. It is also a reason why individuals refuse to and/or are unable to seek help. Hence to create more awareness, 24th May has been declared as Schizophrenia Awareness Day.

 As members of the society we can also play a huge part in creating awareness. Here are some of the things which can help in creating awareness about the same:

  •  EDUCATE : Educate yourself about what the disorder is, the symptoms, the history, the treatment. It is important to increase our understanding about the condition which has such a high prevalence. Educate people around you as well!
  • UNDERSTAND : Understand what the person and his family members are going through. A little empathy and help go a long way!
  • BE INCLUSIVE: Alienating individuals with Schizophrenia can affect the individual negatively. They are neither dangerous or violent. Be inclusive!
  • BE NON-JUDGEMENTAL: Coloring your opinions and thoughts with false information will hamper your behavior towards them. Remember having a mental disorder does not make them any less human!

Please remember that there is no shame in asking for help to achieve better quality of life. And we at EMOTICONS India are ready to do the same. For more details please visit our website www.emoticonsindia.com or you can also look up our Instagram handle @emoticonsindia.

By Shweta Rajopadhye

Trainee at EMOTICONS India

A Phoenix Rising from the Ashes: Healing with Post-Traumatic Growth

“Something very beautiful happens to people when their world has fallen apart: a humility, a nobility, a higher intelligence emerges at just the point when our knees hit the floor.”

– Marianne Williamson

Trauma – an event leading to distress, and physical or emotional disturbance.

Growth – a physical, mental, and spiritual development or positive change.

Post-Traumatic Growth – each person’s unique experience with positive change resulting from a past or ongoing trauma. 

Post-Traumatic Growth (PTG) has its roots in a period of intense life struggles and crises, with its precursor being PTSD (Post Traumatic Stress Disorder). Often, even the most obstinate and resistant individuals experience change after they come out of a traumatic event or period of struggle. When this ‘change’ is for the better, when it takes us in a positive direction towards our goals, it is known as growth. Recovery and growth go hand-in-hand; we cannot do one without the other. While we tend to associate negative events in our lives with negative results, research on post-traumatic growth suggests that in many cases, traumas can give rise to constructive and positive changes.

Let’s not get our wires crossed – there are many differences between PTG and what we understand as resilience. A faster recovery from trauma and being able to ‘bounce back’ from its effects is sometimes known as resilience, and studies show that individuals who show resilience towards an adverse situation or trauma don’t show much positive growth. PTG is positive growth following or during a traumatic event.

It is human tendency to search for a positive outcome or perspective to any personal tragedy, period of suffering, or loss. When we struggle and finally begin to see brighter days once more, most of us would want to believe that it was all for something. What that thing is, we can decide.

Our journey through Post-Traumatic Growth can begin with a few behaviour and thought-changes:

  • Embrace the ‘dark side’! Our negative emotions usually tell us more about how we perceive a situation, both while we go through it and after. Trauma usually leads to feelings of loss of control in our lives. In order to reclaim that healthy amount of control, we must look at our negative emotions as equally important to our positive ones. It is when we can accept all parts of ourselves when we can give our all to the things we do.
  • Our present is a gift to us from our past! This is not to say ‘leave the past in the past’ because the goal here is not to forget or suppress the trauma that we have been through. What it does mean is – we must stay grounded in our present life. Having been through a great ordeal is far from easy to look at in a positive light, but what is in our control is our ability to…
  • Rewrite the story! There is no one who can evaluate our strengths and weaknesses better than ourselves. We don’t have to depend on someone else’s definition of what makes a person ‘strong’ or ‘weak.’ When we take the pen in our hands and write our stories, we can choose the experiences and events that shaped us into who we are today.
  • Keep a consistent routine! Many times, we associate ‘routines’ with packed schedules and achieving large-scale tasks each day or week. However, this has the opposite effect to what we need to achieve through post-traumatic growth. Routines don’t need to keep us busy; even getting up at a fixed time or making your bed each morning is a great start to a positive emotional change. Print out a weekly planner and note down even the smallest of things that you do in a day. This works as a jumpstart for us to embrace a ‘new normal’ way of living.
  •  Emotional and physical support is a prerogative! Living through a trauma can leave us emotionally drained and sometimes even apathetic. Seeking help – from friends, a mental health professional, or even an emotional-support dog – can relieve us of so much of the burden from our past that we carry with us. Talking to someone who listens and understands your situation even in the slightest helps our pain feel validated and helps us see that even in life’s most turbulent periods, we have the support of others.
  • Treat the mind and body with kindness! Numerous studies show the benefits of mindfulness training for individuals recovering from PTSD. According to one study, short-term meditation training shows positive changes in cancer patients and other medical trauma patients. In another study, a 12-week meditative course known as ‘Loving-kindness meditation’ was used with War Veterans suffering from PTSD in order to instil more compassion and kindness towards the self. As a result, there was an observed reduction in PTSD symptoms and Depressive symptoms, which led to an increase in letting in and embracing positive emotions. Self-care involves paying attention to our emotional and psychical needs. We can heal from trauma when we respect ourselves and show ourselves compassion in times of change.
  • The positive effects of creativity! A fresh start after an unsettling and painful experience is like a much-needed drink of water after a long walk in the desert. The newness of creating something of our own is always something to look forward to. It doesn’t have to be a masterpiece or have a deadline to be completed by. It is ours and we can give ourselves the freedom to bring something new into our lives. While something completely new and original is creatively refreshing, so is reviving an old hobby. Think back to an activity or passion that brought positivity in the past, and use it as a reminder of the potential of growth that is within each one of us!
  • Optimism is the healthiest mindset for PTG! Not only does being optimistic lay out the foundation for future contentment, but also provides a different perspective on our past. This is not to invalidate the pain caused by past trauma; it is so that we can come to open ourselves to the more positive aspects of our lives – past and present. Research using Cognitive Behavioural Therapy interventions followed the process of first confronting the worst of the trauma and then reconstructing one’s beliefs to take back control. This intervention led to a significant increase in optimism and openness during Post-Traumatic Growth. Positivity is all around us – we just need to break down the walls to see it!
  • Patience is a virtue of the strong-minded! Trauma is not an experience that leaves us at once. There could be recurring memories, triggers, and painful thoughts relating to the past. There are always people to reach out to, ways to indulge in self-care, and the present to cultivate. Being kind to ourselves means being patient with the stronger waves of pain and believing that there are better things in store for us!

‘Emotional growth’ encompasses many meanings of the word. If we were to take each person’s perspective on what growth means to them, we would get a myriad of answers. This is why Post-Traumatic Growth is best observed by its effect on five major domains of life. The concept of Post-Traumatic Growth was first developed by psychologists Richard Tedeschi and Lawrence Calhoun in the mid-1990’s. According to the PTG Inventory they established, there are five areas in an individual’s life where they can experience growth.

To understand growth after experiencing trauma, these are five areas of our lives that hold a potential for positive growth during PTG:

  • Life Appreciation: Appreciating our life as a whole may sound a little vague and intimidating, but all it means is observing and appreciating even the smallest and most natural moments in life. These moments can come in the form of a good laugh with a friend, a tranquil walk through a park, or even a morning cup of tea or coffee overlooking a beautiful sunrise. When reflecting back on previous the day or week, we can bring theses memories to the forefront and admire ourselves for experiencing and living them. At times, these moments might seem almost insignificant and unmemorable in the face of all the trauma we have faced, but trauma also tends to remind us that we are mortal and that the small moments are important too.
  • Interpersonal Relationships: How we relate to those around us is a huge part of our daily lives. For people who have experienced or are currently experiencing a trauma, the support of those around them can really help with positive growth. Facing trauma can also push us to confide in a friend or be open to seeking professional help. Trauma can also increase levels of empathy and make us more compassionate towards others who are in similar situations. When we reach out in this way, it really broadens our perspective on the amount of positivity that surrounds us and gives us a new hope. Even being able to identify and connecting with one individual in our life who we feel supports and listens to us can heal our worst wounds.
  • Recognising Personal Strengths: When having experienced trauma, many people resort to behaviours and thought-processes that end up causing more harm to us. Some of these behaviours include finding distractions to avoid confronting the pain, using substances, and overburdening ourselves with work. If we are to instead recognise our strengths and give ourselves due credit there, we can experience many positive changes. Recognising our strengths and virtues either means:
    • Spending some alone-time to reflect inwards. Reflection can involve journaling, writing down positive affirmations. One technique to foster positive thinking is to write down even the smallest thing we have achieved by the end of the day. This is quite an effective end-of-day activity and it’s much better than creating to-do lists that only stress us out more.
    • Doing an activity or hobby that interests us and giving our time to that. An activity could include playing a sport, working on our creative skills, and anything else that helps us connect to ourselves.
  • New Possibilities: Embracing a different path from the ones we were set on before experiencing trauma really can change our perspective for the better. Some things that were of great value and importance to us before a traumatic experience may not be on the top of our priority list afterward. This shift in perspective is usually a welcome change. When we realise that what once mattered to us doesn’t anymore, we can see clearly the changes that come along with letting it go. 
  • Spiritual Growth: Since many experiences of trauma are life-threatening or involve death, many people seek spiritual growth and meaning and begin to look at their life through that lens. As a way of coping with the trauma and a fear of the uncertainty surrounding the event, it is natural for us to search for answers that lie beyond our understanding up until that point. Spirituality has many avenues and practices within it, and as per a person’s needs and their specific situation, they take a path that most intrigues them. Spiritual growth has a way of teaching us how to gently guide ourselves through our pain.

A movie that portrays some of these pillars of Post-Traumatic Growth is ‘Collateral Beauty.’ In it, the protagonist faces a trauma, and when he feels lost, Love, Time, and Death come to him in human form and help him see a path of personal growth from his pain. A quote from the film –

“Death is so much more vital than Time. Death gives Time all of its value.”

-By Taira Deshpande 

(Trainee at EMOTICONS India)

Pride Month: Mental Health Concerns of the LGBTQIA+ community

“People should just be allowed to look in the mirror and see all kinds of possibilities.” – M-E Girard

Pride can mean a wide range of things for individuals identifying as LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and other evolving and varying identities, including but not limited to Pansexual, Genderqueer, etc.). Pride is also associated with the assertion of one’s identity and confidence with their gender and sexuality. It also holds importance on account of the oppression faced by the community throughout history, which furthers the need of LGBTQIA+ Pride.

History of Pride Month

The month of June is celebrated as Pride Month to create awareness about the LGBTQIA+ community all over the world. Although there have been a fair number of movements to support the LGBTQIA+ community since the early 20th century, a certain event in the United States catalyzed the entire movement. It also led to the declaration of June as the Pride Month. In June 1969, police raided Stonewall Inn, a gay club in Greenwich village, New York. The crowd rioted against the police to protest against the discrimination of LGBTQIA+ community. The riots lasted for nearly five days and provided a groundbreaking start to the movement. One year later, on 28th June 1970, a march was organized to commemorate the Stonewall protests.

Pride and India

As for India, the first Pride Parade was witnessed in July 1999 in Kolkata which was called ‘Kolkata Rainbow Pride Walk’. Post that a few parades did take place but a major turning point was in 2008, when other cities like Mumbai, Delhi and Bengaluru joined in. In 2014, Guwahati organized its first pride parade, the first one in North East India. The long history of protests led to the remarkable move by the Supreme Court to decriminalize part of Section 377 of IPC and provide legal approval and recognition to homesexuality. This movement was spearheaded by two Supreme Court lawyers, Menaka Guruswamy and Arundhati Katju, who came out as a couple, providing hope and strength to the otherwise ‘invisible’ queers in the country. However, there is still a long way to go in terms of the wide array of challenges faced by the community, with mental health being a foremost concern.

In India, many individuals prefer local identities over western labels to describe themselves. Kothi, Panthi, Hijra are the terms used which describe the individual’s sexual behaviours, practices and gender presentation. Labels are considered necessary to communicate their identity in their social network and as a political statement.

Mental Health Concerns

Research shows that the members of LGBTQIA+ community experience poor mental health in comparison to heterosexual individuals. They are subjected to immense discrimination and prejudice on account of their sexual preference and gender identity. Often this discrimination and prejudice arises from peoples’s false understanding of homosexuality as a disease, something which can be “altered” or “cured.” Discrimination, prejudice and homophobia have alarming effects on the mental health of the LGBTQIA+ youth. At the social level, lack of support from others and stigma around LGBTQIA+ community also affects their mental health negatively.

A recent review by Wandrekar and Nigudkar, published in April 2020, reveals that LGBTQIA+ individuals show higher rates of mental health concerns in India. In spite of the high prevalence of mental health issues among LGBTQIA+ individuals, most of them avoid seeking help due to the stigma attached to mental illness, fear of negative medical interventions or previous unfavorable experiences.

Research indicates that LGBTQIA+ individuals experience actual, felt and internalized stigma. They experience lack of acceptance, family exacted violence, violence from peers and partners, discrimination in employment, housing, health care services and discrimination at workplace or school. All of this has a negative effect leading them to feel the need to hide their identity.  The stigma and discrimination at times makes them uncomfortable with their sexuality. Meyer (1997) in his minority stress theory states that sexual minorities experience internalized homophobia, felt stigma and actual stigma which contributes to higher stress that increases the vulnerability to mental health conditions. This further contributes to low self esteem, depression, suicidal ideation, substance abuse and higher vulnerability to HIV. Research also shows that  LGBTQIA+ individuals show more negative emotional regulation compared to heterosexual individuals

One of the most atrocious forms of prejudice, discrimination and homophobia, and a matter of concern for the mental healthcare providers is that of conversion therapy. Such practices are alarming in light of the American Psychological Association’s declaration that homosexuality is no longer a psychiatric disorder, it is not something to be cured or treated. The horrific consequences of this atrocity were brought to the forefront with the recent suicide case of a queer student from Kerala who had been forced to undergo conversion therapy. This practice is unethical as well as illegal and must be discouraged on all fronts.

In addition to the existing mental health concerns on account of their identity, lack of acceptance and the associated stigma, LGBTQIA+ individuals have been subjected to additional challenges due to the quarantine. Some of these individuals who have shared their mental health challenges in response to a survey sent by us are mentioned here:

“Being stuck at home with my parents while being closeted is truly difficult. To top it, they constantly pass homophobic comments very casually. It makes it really difficult to stop myself from spiralling into a hole of self-hate.”

– Pooja, 21, Female, Bisexual

“Parents aren’t very accepting of my sexual orientation, so that’s a problem given that I’m living with them 24*7”

-Anonymous, 21, Female, Bisexual

“None of my family members know about my sexual orientation, so I cannot fully be myself when I’m around them. I’ve gotten used to the idea of hiding certain aspects of my life when I’m around them. My family members are quite homophobic, so their offensive jabs at the community negatively affect me. But I am not able to defend our community, in the risk of being outed, or at least raising suspicions.”

-Subhrasish, 19, Male, Homosexual

Resolving the Mental Health Concerns of the LGBTQIA+ Community

The members of this community with mental health concerns not only have to fight the stigma around mental health but also their gender and sexuality. The very first step in this movement for addressing mental health concerns of the LGBTQIA+ individuals is awareness, as well as acceptance. Secondly, the mental healthcare providers must be equipped with the skills for addressing their issues, instead of resorting to unethical practices such as conversion therapy. However, as a society we need to be more sensitive and informed to be better allies for the queer community. There are several measures that can be adopted at an individual, as well as the community level, some of which are mentioned below:

  • Educating and informing ourselves as well as others about queer identities and the LGBTQIA+ community as well as the mental health concerns faced by them.
  • Adopting sensitivity while addressing or interacting with members of the community.
  • Providing the members of the community with a safe space and listening to them while trying to understand their challenges.
  • Discouraging those around us from discriminating against or harming the members of the LGBTQIA+ community in any manner, including practices such as conversion therapy or others.
  • Challenging the heteronormativity, or the view of heterosexuality as being the default, in our own ways such as encouraging dialogue on queer identities.
  • Supporting your family members, friends or others around you who identifies as LGBTQIA+ by encouraging them to seek professional help, preferably from queer affirmative practitioners (some of have been listed below).
  • Helping members of the community who are dealing with internalized homophobia due to the lack of acceptance around them and negative feelings towards one’s own identity.

Finally, here are some messages from LGBTQIA+ individuals themselves about navigating the challenges and what they want to share with others this Pride Months:

“It’s hard not being able to show your true self to your close ones, but coming out is a process and a choice. It’s better to realise if you are in a safe environment before coming out. If you are not accepted by your friends and family that you come out to, always remember that there is an entire community here that accepts you no matter what.”

-Khushi, 20, Female, Bisexual (Queer)

“Things will be dark. There might be more lows than highs. It might feel like you are harbouring a dirty secret; on some days more than others, it’s lonely weight will crush your shoulders, but the night is the darkest before dawn. It has taken me quite a while to get here but love is the most important aspect of living and do not let anyone tell you otherwise. You will get there. The sun will rise once again, hold on.” 

-Anonymous, 19, Female, Lesbian

“ I want people to know that they are not alone. You might be in the closet, and it might be difficult coping with viewpoints that might offend your world; but this is temporary. Use it as an opportunity to learn what bigotry might look like. Learn about it, and learn to cope from it. Use it to understand what queer phobia is. It’s only when one has seen it, that one can cope with it.”

-Anonymous, 21, Cis-gender Asexual, Aromantic

“Reach out to others for help, just emotional support if nothing else. It goes a long way.”

-Tanmay, 22, Non Binary, Pansexual

Although the times are difficult and the lockdown may be having a negative effect on your mental health, you do not have to go through this alone. Here is a list of some queer affirmative therapists to whom you can reach out to:

Ahmedabad- Dr Mamta Shah : +918141333136 /  mamtashah75@yahoo.com

Bangalore- Sidhanta Borkataky: 9810669666 / sidhanta.b@gmail.com

Delhi- Rajinder Singh: rajinderpsy@gmail.com

Goa- Priya Babu: 9953239966 /  babu.priya@yahoo.com

Hyderabad- Arathi Selavan: 9490707847 / arathiselavan@gmail.com

Kolkata- Dr Nupur Guha Ray: 9331297260

Manipur- Sadam Hanjabam: +91 – 6009032883

Mumbai- Pawan Soni: 9967656878 / paawan.soni@gmail.com

Pune-  Dr Sachin: 9738804882

For a more comprehensive list visit, https://www.instagram.com/p/B_kQ4Icp_Lc/?igshid=1m98gak58veaj

The names shared here are with the prior permission of the individuals, and we thank them for opening up about their experiences and allowing us to share the same with the readers.

We are also here to assist all those in need. You can reach out to us on www.emoticonsindia.com or on Instagram @emoticonsindia.

-By Anjali Alloria and Shweta Rajopadhye

(Trainees at EMOTICONS India)

Converse, Don’t Condemn: Men’s Mental Health Awareness Month

“I am no less a man because I fear. I am no less a man because I am mentally ill. I am no less a man because only I get to decide what it means to be a man.”

Shawn Henfling

What makes us human is that we can emote, and we can empathise. Empathy, by definition, is the capacity to share in and understand another’s emotions. As mental health garners more attention from people today, we must keep in mind that with each person breaking a boundary, there is someone out there reinforcing it. This is not to be pessimistic, but to gain a clearer understanding of the reality of the stigma that runs deep and still surrounds mental illness. As June, which is Men’s Mental Health Awareness Month, comes to a close, we must recognise and continue the conversation about men’s mental health well into the future. 

Perception of Mental Health and Mental Illness

Mental Health Awareness and Literacy programs aim to provide a more positive perception and image of mental illness. To reach this goal, the first and most crucial step is to decrease the stigma surrounding mental health issues, followed by maintaining this positive perception by having more platforms and professionals from whom to seek help. In India itself, studies show that descriptions of mental illness are either associated with negative or violent connotations or ignorant and pitiful attitudes towards patients of mental illness. Even more shocking are the emotions attached towards people with mental health issues – sympathy, apathy, fear, and disgust as some of them. 

Global statistics issued by the World Health Organisation (WHO) show the prevalence of mental illness affecting one in every four people, making it the leading health concern worldwide! Out of a global population of 7.7 billion people, approximately one-fourth of us live with mental health issues. If that is not a collective cry for help, what is? 

Know What to Say

Here are a few steps we can take at an individual level to reach the goal of positive mental health perception:

  • Let’s educate ourselves! As the familiar saying goes – “You must be the change you want to see in the world.” There can be no excuses for being a hypocrite; advocating mental health awareness involves at least a fundamental and healthy understanding of what mental health issues entail at a medical as well as emotional level. 
  • Let your family, partner, colleagues, and friends know what you know. At the end of the day, we cannot enforce our beliefs on others – sometimes, even if they are closest to us. Spreading awareness isn’t a passive act, but it doesn’t have to be approached aggressively either. People listen best when they are presented with factual information from reliable sources in a non-confrontational manner. If even after your efforts, they do not wish to change their beliefs, there is still a whole audience out there who will hear you out, with social media being the leading platform for public discourse on such matters.
  • Speak up to a public audience! There can be no excuses for being a hypocrite; educating ourselves is the first step, but there is little change that can occur if we do not spread the message. In the past, countless atrocities and injustices have been brought to light through mass movements and the general public’s recognition of accountability. Start your own Twitter thread, Instagram page, or Facebook group; create videos, share experiences, and, most importantly, be open-minded! Gaining first-hand experience with mental health campaigns for spreading awareness can also give us many insights into the reality of mental health issues. Our participation in them can only help us and those who are struggling. Seeing all the support they get can encourage them to be more open. 
  • Seek help yourself! Many a time, we invest so much of our time and energy into advocating for mental health awareness that we overlook or repress our own needs and struggles. Psychologist Marsha Linehan says from experience that some psychologists themselves do not give as much attention to their mental health as they need to because they are concerned with damaging their professional integrity. However, we must remember that it is normal to face problems that lie out of the ordinary. We all have different reactions and predispositions to similar circumstances. We do not need to change ourselves, but the definition itself of what constitutes as ‘abnormal.’ 
Quotes From Men on Mental Health Stigmas

Celebrities Advocating Men’s Mental Health:

Shawn Mendes addressing his struggle with severe anxiety as a musician and performer- “I knew people who had found it kind of hard to understand, but then when it hits you, you’re like, ‘Oh my God, what is this?’”

Michael Phelps, an Olympic Swimmer expressing his views on mental health struggles as a man – “We’re supposed to be this big, macho, physically strong human beings, but this is not a weakness. We are seeking and reaching for help.”

Virat Kohli speaking for stress among sportsmen - “I think these things should be of great importance because if you think that a player is important enough, for the team and for Indian cricket to go forward, I think they should be looked after.”

Chris Evans narrates his experience with struggling with anxiety and seeking help from a professional – “I do struggle. I get anxiety about certain things like press conferences. I asked every human being in my life what they thought and they said I should do the movie (Avengers), and then I went for therapy. I thought, I’ll talk to my therapist and see what they have to say.”

Abhinav Bindra, Olympic Shooter and gold-medalist, opens up about the pressures he imposed on himself as a professional and the toll it took on his mental health - “I abused my passion. I did not maintain a balance. By abuse, I mean the single-minded focus on one thing.”

Singer Zayn Malik opened up to the public about his struggles with an eating disorder as well as anxiety. Upon going public in an interview with Us Weekly, Malik said, “I’m definitely glad I got that off my chest, as anybody is when you feel like you’re keeping something from someone. You have to speak about it and clear up the air.”

Milind Deora, a senior leader of Congress, speaks on suicidal ideation and coping mechanisms - “I encountered suicidal thoughts around the age of 16-17…The second wave hit me when I was an MP.”
Break the Stigma!

Stop Saying ‘Man Up’ and Start ‘Opening Up’

Stigma symbolises the walls holding up conventional beliefs and stereotypes of a society that should have left us decades ago. We can only begin a new tradition of openly discussing mental illness among men when we provide a space that feels safe and without harsh judgement or consequences. 

The social stigma is such that it sinks its claws deep into social roles and images that many men feel almost compelled to adhere to. Stepping away from these traditional roles usually holds many consequences, such as harsh words and judgement, social exclusion. Phrases like ‘man up,’ ‘boys/men don’t cry,’ and ‘you can’t take care of your family if you are weak’ all need to be consciously removed from our vocabulary if we are to see any positive change.  

Here are some more social pressures boys/men face daily that we need to stop reinforcing:

  • Toxic Masculinity — Many men get thrown into the fruitless cycle of toxic masculinity from the day they are born. Studies show that it is one of the leading causes of depression in men. Having our emotions belittled and neglected often leads to suppression of emotion. When men are always told to be ‘strong’ and not express their sadness or emotional vulnerability towards an upsetting situation, this pent up sadness eventually comes out in a dysfunctional form of depression. 
  • Male Gender Stereotypes and Social Roles — Many mental health concerns for men can also be linked to stereotyped behaviour reinforced by patriarchal systems, especially in collectivistic societies and joint family settings. ‘Man of the family,’ ‘head of the family,’ ‘following in your father’ s/grandfather’s footsteps’ are all commonly experienced compulsions for men, and are usually reinforced from a very young age. This gives rise to many burdensome responsibilities and complexes where failure is out of the question. 

Gender Disparities in Disorders and Therapy

A lack of knowledge surrounding men’s mental health can be accounted for by the higher rates of diagnosis and treatment among women than men. Men are more hesitant to seek help from or approach a professional under fear of people knowing and resorting to ridicule and judgment. Even the way certain disorders are perceived has been directly correlated to the stigma surrounding men’s mental health issues. ‘Masculine’ stereotypes are associated with disorders such as Antisocial Personality Disorder and Addictions. ‘Feminine’ stereotypes are more commonly associated with Eating Disorders, Body Dysmorphic Disorder, and Histrionic Personality Disorder.’ The very symptoms of the disorders mentioned above fall in line with gender stereotypes. 

For example, while it is true that eating disorders and body dysmorphic disorders are more prevalent in women, it is important to keep two points in mind – 

  1. There is data supporting the fact that of all those diagnosed with Anorexia or Bulimia, 10-15% are male!  
  2. It all still comes around to gender roles and norms related to men and women’s body-types as perceived ‘ideal’ by social standards. 

More than one-third of men struggling with mental illness only spoke up about it to friends or family after two years! This is in comparison to 25% of women. 

Failure and hardships are all part of life’s erratic journey if one thinks about it philosophically. We all experience them at one point or another. How we perceive them and how others perceive them is vital to recovery. Men are not weak or failures for experiencing mental health issues and seeking help. Spread messages of positivity and the benefits of bringing the conversation around mental illness to the forefront. 

In this journey of your ups and downs, we at EMOTICONS India are there to support you and lend a helping hand to one and all! You are not alone! 

Contact us on www.emoticonsindia.com 

or on Instagram @emoticonsindia 

-Taira Deshpande

Trainee

EMOTICONS India

June: PTSD Awareness Month and COVID-19 Impacts

Posttraumatic Stress Disorder or PTSD is a mental disorder characterized by anxiety due to experiencing or witnessing a life-threatening traumatic event. This disorder came to the limelight due to the traumatic experiences of the war veterans, especially after the Vietnam War disaster in the mid-20th century. Similar mental conditions emerging from war experiences were earlier termed as “soldier’s heart”, “shell shock” and “war neurosis”. However, it is now well understood that psychological trauma is not limited to war experiences, and can result from a wide range of traumatic experiences. PTSD was formally introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980.

PTSD Awareness Month

In order to spread awareness about the millions of people who suffer from PTSD each year, June 27th was declared as the PTSD Awareness Day in 2010, and further the month of June was declared as the PTSD Awareness Month by the National Center for PTSD. The public can support PTSD Awareness in several ways, including wearing the teal PTSD ribbon, or educating oneself and the others around us about the experiences of this disorder.

What kind of trauma can result in PTSD?

Even though war and combat exposure were earlier seen as the leading causes of PTSD, several other kinds of traumatic events have been identified to cause psychological trauma. These include childhood physical abuse, sexual violence, physical assault, being threatened with a weapon, accident or natural disaster, terrorist attacks or other similar life-threatening events.

What are the symptoms of PTSD?

The DSM-V highlights several symptoms of PTSD which include the following recurrent features related to the traumatic event:

  • intrusive distressing memories
  • distressing dreams and flashbacks or dissociative reactions
  • intense or prolonged psychological distress
  • physiological reactions to external or internal cues
  • avoidance of stimuli related to the traumatic event
  • negative changes in memory, beliefs, cognition, emotional state, interests, etc.
  • irritable, reckless or hyper-vigilant behavior
  • sleep disturbances

It is also important to highlight that PTSD experiences are not limited to adults. Children can also develop this disorder upon experiencing or witnessing a traumatic event. They may exhibit the symptoms differently than adults and can be observed as:

  • repetitive play with themes of the traumatic event, trauma-specific re-enactment in play
  • frightening dreams without recognizable content
  • worrying about dying at a young age, being more aggressive and violent than before
  • problems in school, trouble focusing

COVID-19 and PTSD

The prevalent situation worldwide as a result of the COVID-19 pandemic can function as a source of trauma for various people. Whether it is the healthcare providers including doctors and nurses, essential workers or the affected patients and their families, who have been subjected to unprecedented levels of stress and anxiety. The is evident through the significant spike in mental health issues in India itself, which is estimated to be around 22 per cent since the pandemic struck the country.

With so many people battling at the forefront to fight the pandemic, there is a rising crisis of mental health which will result from these months of intense trauma and stress, with PTSD being a looming concern. For the patients, the hospitalization amidst the burdened medical sector can serve as a traumatic experience. With the added uncertainty associated with the pandemic, the future risk of developing PTSD is even higher. This prediction is based on the research conducted on the hospitalized patients during similar coronavirus outbreaks of the SARS (Severe acute respiratory syndrome) in 2002–2004, and the MERS (Middle East respiratory syndrome) in 2012, where 1 in 3 hospitalized patients developed PTSD.

In addition to the patients of the coronavirus, the healthcare workers are also at risk for developing PTSD due to the prolonged stress experienced by them while putting their own health on the line to save others. Many of them have also witnessed severe cases, even loss of hundreds and thousands of lives. The burden this puts on their mental health can result in several issues, especially if there is lack of support and mental health initiatives to alleviate their stress.

The pandemic has also had adverse effects on children due to a breakdown of their earlier routine such as going to school, outside playtime, time spent with friends and other activities conducted outdoors. Due to being unable to grasp the reality and understanding the impact of the virus, children may experience strain on their mental and emotional health. Additionally, the stress experienced by the adult family members can also serve as stressors for children who observe them.

Even the rest of the population navigating life while being quarantined are at risk of developing issues such as PTSD due to the prolonged isolation and distancing from society. Research has also revealed that quarantine can lead to psychological effects such as post-traumatic stress symptoms, confusion and anger. These arise mainly due to longer periods of isolation, fear of contracting the disease, frustration, boredom, financial loss, among others.

Reducing the Risk of PTSD in a Post-COVID-19 World

Several mental health professionals and experts have been proactive in coming up with measures to reduce the mental health burden and ensuring a steady transition to the post-COVID-19 world. Jennifer Taitz, an assistant clinical professor in psychiatry at the University of California, Los Angeles, is one such expert who has highlighted some key measures to reduce the risk of PTSD. These include:

  • Appreciating your inner resilience as the first response to trauma
  • Purposefully increasing your well-being by including positive activities in the routine and distracting oneself
  • Connecting and sharing with people to strengthen social support
  • Noticing your negative thoughts and questioning whether they are helpful
  • Utilizing self-compassion
  • Reflecting instead of overthinking and ruminating
  • Choosing courage over avoidance by being mindful of the negative emotions instead of suppressing them

In addition to these above measures, research has also highlighted several means to reduce the risk of PTSD for the quarantined individuals:

  • Keeping the quarantine period as short as possible by the authorities
  • Providing people with as much information and supplies as possible
  • Dealing with the boredom and isolation through effective communication
  • Understanding that quarantine is not a forced compulsion rather than an act of altruism to keep the vulnerable individuals (very young or old people and those with existing medical conditions) safe

For reducing the risk of children developing mental health issues the following measures can be taken:

  • Reassure and comfort children
  • Structure and plan their day
  • Explain the pandemic situation to them without causing additional stress
  • Reducing their exposure to harmful social media content on the pandemic
  • Teaching them measures to prevent infection without instilling fear

However, it is essential to highlight that even though one can take these precautionary measures to reduce the risk of mental health issues such PTSD, often availing professional help in addition to these measures is extremely crucial for a mentally healthy way of transitioning to the post-COVID-19 world.

Additionally, the mental health industry must also be equipped to effectively deal with the looming mental health crisis which will arise due to the pandemic. The mental health professionals, social workers, psychologists, psychiatrists, counselors and others in this industry must be equipped to provide support to the survivors, their families, along with the healthcare workers to efficiently deal with the stress and trauma of the pandemic.

Several such measures have already been taken worldwide, for instance, the psychiatry department at the University of Washington in Seattle, offered PTSD counselling to the medical workers to cope with battling COVID-19. However, as highlighted by Dr. Trish Kritek, people are reluctant to avail such services due to the stigma associated with mental health. Therefore, another simultaneous challenge before us is the eradication of stigma surrounding mental health, so that the affected individuals as well as the others around them can be better equipped to handle the mental health crisis that awaits us.

The first step in this direction would be awareness and acceptance. There is a dire need of educating oneself, whether it is about issues such as PTSD through the PTSD Awareness Month, or in general, initiating a dialogue and providing a safe space for discussions on mental health issues. This would ensure that humanity not only addresses the health challenges of the coronavirus, but also the mental health challenges.

Know it’s a sign of strength to reach out when in need. We are here to assist all those in need. You can reach out us on www.emoticonsindia.com or on Instagram @emoticonsindia

By Anjali Alloria

Trainee at EMOTICONS India

Understanding and Resolving the Suicide Crisis

To all who walk the dark path, and to those who walk in the sunshine but hold out a hand in the darkness to travel beside us: Brighter days are coming. Clearer sight will arrive. And you will arrive too. No, it might not be forever. The bright moments might be for a few days at a time, but hold on for those days. Those days are worth the dark.” — Jenny Lawson

The above quote might resonate with some of you walking down or walking beside someone on that dark path, or had the misfortune of losing someone to this darkness. This darkness inevitably takes away people from us, who never get to live the bright moments awaiting ahead in their journey, a journey which was cut short due to the horrifying reality of suicides.

The topic of suicide has a lot of stigma attached to it and hence is rarely discussed openly. However, it is of utmost importance to shed some light on it, to raise awareness and to discuss it more openly so we can save another individual from taking such a drastic step. It is extremely important to know what drives an individual to take their own life but alongside one must also know how to help someone who might be thinking of taking the same step.

Suicide is a whispered word, inappropriate for polite company. Family and friends often pretend they do not hear the word’s dread sound even when it is uttered. For suicide is a taboo subject that stigmatizes not only the victim but the survivors as well.” — Earl A Grollman

The importance of ending the stigma around suicide has been aptly summed in the above quote. Suicide is a serious mental health crisis faced globally, with over 800,000 deaths recorded annually, or one death every second, as reported by the WHO. Suicidal thoughts refer to thinking about suicide or taking one’s own life. The concepts associated with suicide vary in intensity and range from ideation, intent, planning and attempt. These concepts can be explained as follows:

  • Ideation refers to the thought patterns surrounding suicide; this may not necessarily result in actual attempts to take one’s life.
  • Intent refers to the purpose or goal behind the behavior of self-killing, without overtly engaging in that behavior.
  • Planning refers to devising ways or concretely thinking about the method of self-killing.
  • Attempt refers to the actual act with the intent of self-killing, which might be fatal or lead to death.

It is important to understand the distinction between these terminologies to better support and help those experiencing suicidal thoughts, and encouraging them to seek help, as well providing efficient intervention for prevention at the stage of ideation itself.

There also exists opposition towards the usage of the terminology “committing suicide”, due to the associated connotations of a crime or immoral act being committed, adding stigma to the victims of suicidal thoughts and behaviors. “Death by suicide” is considered more appropriate as it is sensitive and less stigmatizing.

Causes of Suicide

Suicide is a complex problem, and suicidal thoughts and behaviors might result from a wide range of causes, which differ in intensity. Some of these causes include:

  • Psychological disorders such as depression, anxiety, eating disorders such as anorexia, or substance abuse, or other disorders
  • Family history of mental illness
  • Situations such as financial problems, death of a loved one
  • Distress due to lack of acceptance of one’s gender identity or sexual orientation
  • Complex interaction of biological, psychological, genetic, social, cultural and environmental factors

It is also important to note that material wealth, success, popularity, etc. are not indicators of one’s mental health; even individuals possessing these might succumb to suicidal thoughts. Moreover, suicide is never a sign of weakness!

Symptoms and Red Flags to Look For

Although suicide can be an unpredictable event and suicidal thoughts might not be externally observable, there are certain symptoms or red flags that one can look out for to identify someone undergoing psychological distress including suicidal ideation. Some of these include:

  • Expressing feeling of helplessness towards life
  • Indulging in self-harm/ self-destruction
  • Buying things such as guns, which could possibly result in self-harm
  • Changes in eating habits and sleeping patterns
  • Increased indulgence of substances like alcohol and drugs
  • Disengagement from social circles, reduced interest in social interactions
  • Extreme mood swings: rage, intention to seek revenge
  • Giving away personal belongings
  • Talking, writing or thinking about death
  • Threats or comments about killing oneself

Healing is not about moving on or ‘getting over it,’ it’s about learning to make peace with our pain and finding purpose in our lives again.”― Shirley Kamisky

Suicide Prevention

At present, India records more than 200,000 deaths by suicide annually. The actual numbers might even be higher due to the lack of reporting of suicide cases because of the stigma associated. Criminalization of suicide was earlier deemed as an appropriate measure for suicide prevention; however, it was proven to be inefficient, since a majority of suicide attempts result from psychological distress. As a result, the Health Ministry of India passed the Mental Healthcare Act 2017 which decriminalized suicide attempts. This Act denounced Section 309 of the Indian Penal Code which highlighted imprisonment for individuals attempting suicide.

This was a crucial decision since it recognized that attempts at suicide result from psychological distress, thus, should not be considered a crime, rather effective interventions must be provided to resolve the distress. In lieu of this Act, the government should provide care, treatment and rehabilitation to anyone who attempts suicide so as to prevent the risk of recurrence.

“Understand that suicidal tendency is not a permanent reality for the majority of the people. You can overcome it with support. Confide in someone you love or trust. It will help you feel better.” — Pulkit Sharma

The first step towards suicide prevention is spreading awareness on mental health as well breaking the stigma associated with mental health issues. It is of equal importance that individuals with suicidal thoughts seek help from a professional. However, seeking therapy is not the only solution. Caregivers and family members can contribute a lot in helping the individual come out of the dark place by following the tips highlighted by National Institute of Mental Health (NIMH) for responding to someone undergoing a crisis and at risk for suicide:

1 Asking them if they are thinking about suicide can be an efficient preventive measure. It is very important for the family members and friends to talk to them and keep all the topics open for discussion. It is also advised to openly discuss about suicide, as research has shown that talking about suicide openly lead to prevention rather than increasing the risk of suicide.

Some questions that might help include, “Are you having thoughts of suicide?” or “Are you thinking about killing yourself?” This will allow them to talk about their problems, as well as reassure them that someone cares about them. Do not ask leading or judgmental questions such as “You’re not thinking of doing anything stupid, are you?”

2 Keeping them safe by staying around them or supervising them and removing anything that could be used for self-killing. Individuals with suicidal thoughts tend to store knives or guns for self-harm. Additionally, medication or drugs, which could have harmful impacts on the individual must be kept away from them.

3 Listening to them and being there for them can help them express and vent their distress. This listening must take place in a non-judgmental environment, without discouraging them with statements such as, “Think about how much this will hurt your family.” This will only lower their trust and not allow them to communicate effectively.

Instead, listen actively without judging, advising or preaching them against suicide. Try to understand their pain and let them know they are heard. Often individuals with suicidal thoughts feel unheard and alone, listening to them might help unburdening some of these problems and provide them with a safe space.

4 Encouraging them to contact a helpline (some of them have been listed below) or reach out to someone for support such as friends or family. Encouraging them to join a self-help group or support group where they can share their problems with people who understand or help people going through similar issues can also help them.

It is also important to note, that as friends or family members without the skills and expertise of a counselor, you might unintentionally cause more harm than good. Therefore, it is extremely crucial that after talking and listening to them, professional help is advised with trained psychologists and psychotherapists.

5 Following up with them after the crisis to prevent any chances of recurrence is also extremely crucial. Once the individual has received professional help and begun to deal with the challenges faced by them, it is important to follow up to reduce the chances of relapse. Due to the unpredictable nature of suicides, a person who seemingly looks ‘fine’ might still be undergoing psychological distress, therefore staying in touch and being there for them will be an important step towards prevention.

Suicide Prevention Helplines in India

The following is a list of organizations which can be contacted for suicide helplines:

AASRA : +91 98204 66726

Fortis Stress Helpline :+9183768 04102

Parivarthan : +91 76766 02602

Cooj Mental Health Foundation : +832 2252525

Sneha Foundation : 044–24640050

iCall : +91 22 2552111 | +91 91529 87821

Vandrevala Foundation : +91 730 459 9836 | +91 730 459 9837 | 1860 2662 345

Hang on! Sometimes, the brightest light comes from the darkest places.

We are also here to assist all those in need. You can reach out to us on www.emoticonsindia.com or on Instagram @emoticonsindia

By Anjali Alloria and Shweta Rajopadhye

Trainees at EMOTICONS India

Life on the Borderline

“Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering” -Marsha Linehan

Marsha Linehan, an American psychologist and author, is the expert and pioneer of research on Borderline Personality Disorder (BPD) — one of the most intense and commonly misunderstood psychiatric disorders. She also created the Dialectical Behavior Therapy (DBT), which is the most commonly practiced type of psychotherapy for the treatment of BPD. This therapy incorporates the practice of mindfulness and acceptance. Linehan’s personal journey was a difficult one since she suffered from the symptoms of BPD before the disorder was completely understood.

When was Borderline Personality Disorder formally recognized?

Due to the complicated nature of the symptoms BPD was not formally introduced as a diagnosis, until its inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM)- III in 1980. This was a result of intense research on the suffering of patients who exhibited the painful symptoms of BPD, and were misdiagnosed with either Schizophrenia or Bipolar Disorder. However, BPD is far more common than both these disorders combined, and presents a suicide rate far exceeding that of the general population. Even the nomenclature of this disorder was based on the symptoms which lay on the border of psychosis and neurosis.

Why is May the BPD Awareness Month?

The month of May was declared as the BPD Awareness month in 2008 by the US House of Representatives. This decision was a result of the misconceptions around the disorder and the stigma associated with individuals with BPD. Despite the amount of research surrounding BPD, there seems to be a prevalent misunderstanding among the general population about this disorder. This apprehension is even exhibited by mental health professionals, who either fall victims to misdiagnosing individuals with BPD or are reluctant to offer care because of the stigma surrounding BPD as being an untreatable disorder. This is also worsened due to the comorbidities that exist with BPD, such as depression, anxiety, PTSD, etc. along with the misdiagnosis as bipolar disorder.

What are the common misconceptions about BPD?

Even individuals with minimum understanding of abnormal psychology or psychological disorders, fall victim to the misconceptions surrounding BPD due to its portrayal in popular media. Some of these portrayals which might be familiar to us include movies such Fatal Attraction (1987), Girl, Interrupted (1999), Monster (2003), amongst others. These depictions, along with other stereotypes such as BPD being untreatable, people with BPD being unable to have stable and loving relationships, labels such as ‘crazy’, ‘abusive’ or ‘attention-seeking’, not only spread misconceptions but also make the lives of such individuals more painful than it already is.

The month of May in 2020 is one of the most unprecedented ones during most of our lifetimesdue to the prevalent lockdown and quarantine as a result of COVID-19. So, I would like to use this opportunity to dispel some of the misconceptions surrounding BPD and also share personal experiences of some individuals who are living with this disorder, along with my own experiences since the formal diagnosis received by me in February 2020.

What exactly is BPD? What are the symptoms?

Before moving on to the individual experiences of the disorder, it is important to understand the main symptoms of BPD. According to the DSM-V, this disorder is characterized by a pattern of instability observed in the individual’s personal relationships, emotions and identity. It is also marked by impulsivity and begins in early adulthood. There is a fear of abandonment and efforts to avoid any real or imagined abandonment. These symptoms are present in varying degrees in an individual with BPD.

From a neurobiological perspective, this disorder is marked by the increased activity of the amygdala, or the emotional center of the brain, resulting in intense emotional experiences, often at extremes. This extreme experience is also experienced as ‘black and white thinking’ or ‘splitting’. There is also reduced activity of the prefrontal cortex which makes rational thinking a difficult task for such individuals.

As Cedar R. Koons mentions in his book, The Mindfulness Solution for Intense Emotions: Take Control of BPD with DBT, “people with BPD look very different from one another.” This unique manifestation of BPD symptoms in individuals makes it one of the most intense and painful disorders.

What do people living with BPD have to say?

I was provided with the rewarding opportunity to interact with over ten individuals who share their BPD and mental health journeys through the social media platform of Instagram. This allowed me to understand their experiences of navigating life through the intense and often confusing symptoms of the disorder, the coping strategies used by them, as well as the impact of the current quarantine on their mental health. It also allowed me to gather first-hand experiences which would help the readers to understand the myths and misconceptions of the disorder.

What do the BPD survivors have to say about the common misconceptions?

When I asked the individuals with BPD about the misconceptions that they commonly face, many of them reported saying that there is a stigma of people with BPD being ‘manipulative’ and ‘violent’, which is not accurate. Another individual (@borderline.world), claims that people with BPD are not as represented in media. Another BPD survivor (@mylifewithbpd_jazriella), says that what might come across as ‘overacting’ to a neurotypical individual, is the heightened severity of emotion experienced by people with BPD.

Wendy Scaletta, also highlights that the excessive emotional reactions which might seem ‘dramatic’ or ‘out of proportion’ to neurotypicals, are in fact experienced by people with BPD at that heightened level of intensity and severity. However, in reality, it is an excruciatingly painful experience over which they do not posses any control. As Daisy Hannan-Young said, for her BPD seems like “you’re on a wild rollercoaster of emotions every day.”Another apt description of the personal experience of dealing with BPD has been provided (@bpdcantbreakme), “BPD is a bully inside our head and we are doing all we can to ignore him.”

Natasha (@overthetopwoman) also dispels the stereotypes surrounding people with BPD by claiming, “we aren’t monsters.” She is one of the individuals who recently received her BPD diagnosis, a week before her country went under lockdown. In order to share awareness, she also hosts a podcast, and she wishes to inform the readers, “Be kind! You never know what’s going on with someone. For people with BPD, I can say that every day is a challenge. But we are warriors. All of us.”

What are the methods of coping used by BPD survivors?

The BPD survivors also shared the coping strategies used by them. For some of them it’s music, writing, art and self-talk. Some of them use the DBT and mindfulness skills such as rational thinking and acceptance. Whereas some write songs as a cathartic activity. One of them also wishes to write a book about her BPD experiences. There have been other skills such as playing the violin which is calming or taking kickboxing lessons to channel out the anger in beneficial ways. Other coping activities include journaling and spending time in the nature. Most of them also share their experiences on mental health pages on Instagram and contribute to making the BPD community on Instagram a supporting and safe space for the survivors, as well as spreading awareness about the same.

How has the quarantine impacted the mental health of most BPD survivors?

The ongoing quarantine has impacted individuals with BPD in varying ways. For some of them, their families do not acknowledge and accept the disorder, making it difficult for them to stay at home in such environments. Whereas, some have experienced loss of family members to the pandemic which has worsened their symptomsand made coping more difficult. On the other hand, the change in routine has also worsened the symptoms for some. For instance, a BPD survivor and a mother, claims that with the disruption in her routine as well as her daughter’s, she has experienced change in her sleep schedule and insomnia, along with increased lethargy and irritability.

Another major impact of the lockdown has been the disruption in therapy, while some of them have been availing online sessions, for others it has been difficult. Some of them also received their diagnosis not long before the pandemic sent the world into a lockdown, giving them less time to understand and deal with the disorder. Additionally, with less contact with their friends and other loved ones, the fear of abandonment has heightened, making it difficult for many of them to cope.

However, for some of them, this lockdown has proven to be beneficial. This time off has allowed some of them to work on themselves, spend more time with their families and feel loved. Whereas for some, it has allowed them to indulge more in their hobbies and interests. Despite all these challenges, all these individuals are trying their best to put a brave front and fight through the disorder.

Messages from the BPD survivors to the readers

The BPD community wishes to communicate to the readers that living with this disorder is one of the most painful experiences. What you can do to help someone who might be going through BPD, is to empathize with us without invalidating the seriousness of the disorder. Additionally, as one of them (@mylifewithbpd_jazriella) puts it across, BPD survivors often have to ‘suffer in silence’, therefore others must understand that it is a real disorder and the emotions and experiences that follow this disorder are valid. She also expresses that validation and acceptance are the most important things to provide to someone who has BPD because the one thing they always feel is invalidated.

Moreover, often the sufferers themselves do not understand the disorder due to lack of awareness and misunderstandings surrounding it, the judgment that follows only makes their experience more painful. Another message that a BPD survivor (@bpdrelates) wishes to send across is, “Borderline personality disorder isn’t to be taken lightly, it’s probably one of the most painful disorders because not only do we have to adjust our entire minds to the ‘realities’ perceived by other people in order to feel normal, we have such a hard time finding a sense of stability not in the outer surroundings only, but especially and ALWAYS within ourselves.”

Finally, another message that Wendy Scaletta wishes to send to the readers is that even though sufferers of BPD must be held accountable for their actions which hurt others, and should not be excused just because of their disorder, but there still needs to be understanding and acceptance so that the guilt already experienced can be reduced. What best sums up the message that we as BPD survivors want to send across, as put forth by Wendy Scaletta, is “we are not ticking time bombs who are bound to destroy and hurt everyone around us.”

The names shared here are with the prior permission of the individuals and we thank them for opening up about their experiences and allowing us to share the same with the readers.

Know it’s a sign of strength to reach out when in need. We are here to assist all those in need. You can reach out us on www.emoticonsindia.com or on Instagram @emoticonsindia

Take care ’cause you matter!


By Anjali Alloria

Trainee

EMOTICONS India

Healthy Habits for Coping With Uncertainty During a Pandemic

“The chains of habit are too weak to be felt, until they are too heavy to be broken!” 

The first thought that entered my mind about being quarantined at home was that I would not be able to meet my friends. Who would have thought that when summer began, we would be taking out face-masks instead of sun hats? While our accessories may have changed, we certainly have not. Our needs remain the same as before – to meet our friends and relatives, to travel, or even a walk to the nearby park. In these uncertain times where we are confined to our homes and seek any source of company or entertainment, most of us turn towards technology, food, and work. The equivalent to staying healthy – mentally and physically – during this time, is to moderate all activities. 

As time passes and we become increasingly hopeful of the lockdown lifting and life resuming its daily routine, many of us are unable to manage our productivity or keeping ourselves busy. Sure, some of our initial thoughts and motivations would have been more focused on our hobbies, interests, and skills that we previously had insufficient time to build. However, to maintain this sense of enthusiasm, or at least remain preoccupied doing activities we are fond of, a constant change-up in the order and way we spend our day is necessary. 

So often, we are attached to the comfort of routine, being busy, working, distractions, that we forget to create new routines. Instead of letting ourselves fall into a rut because we are afraid to leave behind our lives before lockdown began, let’s look at some ways in which we can look forward – or at least inward – to what inspiring insights our home-lives hold for us. 

Take part in an online event or activity

Many creators, influencers, bloggers, and educators have not let home confinement come in the way of their enterprises. While social media platforms are proving to be many people’s primary mode of communication during this lockdown, how we engage with each other as part of a global community is becoming clearer as well. Here is a list of the types of live events on social media that fit a variety of interests – 

  • Taking up an online course to brush up on your skills, building your knowledge in your area of expertise, and even resurrecting an old hobby.
  • Live Workouts by various prominent fitness bloggers on social media platforms. 
  • Connect with friends and relatives! Video-chats and Online Meets have made staying distanced from our loved ones bearable to a certain degree.

Maintain an activity and sleep log. 

Many of us have become nocturnal creatures during this pandemic. We sleep when it is time to wake up and work when it is time to sleep. Studies show that imbalances in our circadian rhythms can be a major determinant as causes of depression. Activity and sleep logs not only make you more mindful and aware of the number of things you do in a day, but revisiting it at the end of the day can also give you a sense of short-term motivation and help you spend your day doing things you value. 

A log could be a challenge that you completed in your exercise routine, a meal that you prepared by yourself, quality time that you spent with your family, or even decluttering your room. The cumulative small things we do in a day should not go unnoticed by us. 

Create new routines for yourself each week. 

Productivity is essential to many of us when it comes to reaching career or life milestones and even our short-term goals. However, focusing on only the threat of productivity won’t create a stable web. What prevents us from forming routines in times such as these is the lack of outdoor activities and significant reduction of things such as running errands, traveling to and from work or school, and visiting relatives or friends. There is no change in the physical environment in which we are present. 

Keeping the same routine for several days or weeks puts us in a rut and displaces any sense of enthusiasm with monotony. While there are certain minor habits and acts that we take part in each day such as working, bathing, cleaning, things can always be kept interesting by shifting some of these activities around. Print out a template for a timetable, with a different schedule or sequence of events for each day or week, and see the graph of your productivity changing.

While these activities are all beneficial for brightening up the days to come, the one frame of mind that we must maintain for ourselves is to give ourselves breaks. Even at times when we are keeping ourselves preoccupied with mindful and healthy activities, we must also learn the value of time spent alone and doing things that do not involve too much physical or mental exertion. This could involve being more considerate of our abilities, looking forward to those one or two off-days after many days of hard work, or doing a meditative exercise instead of a high-intensity one. 

In these uncertain times, we seek a sense of security within the confines of our home, and one way to challenge this apprehension is to assess the likelihood of good and bad outcomes resulting from the lifestyle we are currently leading from an objective point of view. 
Home isolation has put us in a position where we are removed from those whom we usually surround ourselves with and it is a great opportunity to discover those parts of you that are not influenced by others. It is time to discover thyself! You never know, all the wonders you are seeking could be hiding within you.

-Taira Deshpande

Trainee

EMOTICONS India