ഇന്ത്യ
6 days ago
Thursday, August 28, 2008
Wednesday, August 27, 2008
Behavior change, awareness and attitudes
Another aspect important for behavior change is one's attitude to the problem. Here we look at the person's attitude to the problem and his awareness of its negative impact on his life. Based on the work of two psychologists who worked in this area -Prochaska and Declemente - we can classify people on a continuum from lack of awareness to full awareness. This can be understood as stages in 'the wheel of change'. The stages are as follows. It has to be realized that one can remain in any of these stages for a long time in the absence of effort to change.
1) Pre-contemplation: A person who has not even realized that his behavior (or addiction) has become a significant problem. Often we hear alcohol users trying to convince us that 'Drinks are not a problem for me. i can easily quit anytime '. But everybody else around knows that this is false.
2) Contemplation: Here the person knows that there is a problem but is ambivalent about changing it or thinks he is helpless.
3) Determination: In this stage the person knows that he has to change, has decided to do something about it, but keeps postponing things. 'I will surely meet a doctor and take treatment after this deal is over'. This is repeated over and over again.
4) Action: Only in this stage does the person starts to take the necessary steps to effect the change.
5) Maintenance: In this stage the person maintains the beneficial effects of the successful action taken.
6) Relapse: This is another stage in the 'wheel of change'. So it should not come as a shock or surprise. Things may not always be rosy. Cracks start showing and relapse occurs during times of stress.
From this stage the person enters back into stage 4. He has to taken appropriate actions to end the relapse and go back to the stage of maintenance. In drug / alcohol addictions a person has to go through this cycle 6 or 7 times before exiting for good. For other problems like risky driving, gambling, overeating etc also this is true. It is even true about our refusal to wear helmets and seats belts while biking or driving. For these behaviors punishment acts as deterrent.
1) Pre-contemplation: A person who has not even realized that his behavior (or addiction) has become a significant problem. Often we hear alcohol users trying to convince us that 'Drinks are not a problem for me. i can easily quit anytime '. But everybody else around knows that this is false.
2) Contemplation: Here the person knows that there is a problem but is ambivalent about changing it or thinks he is helpless.
3) Determination: In this stage the person knows that he has to change, has decided to do something about it, but keeps postponing things. 'I will surely meet a doctor and take treatment after this deal is over'. This is repeated over and over again.
4) Action: Only in this stage does the person starts to take the necessary steps to effect the change.
5) Maintenance: In this stage the person maintains the beneficial effects of the successful action taken.
6) Relapse: This is another stage in the 'wheel of change'. So it should not come as a shock or surprise. Things may not always be rosy. Cracks start showing and relapse occurs during times of stress.
From this stage the person enters back into stage 4. He has to taken appropriate actions to end the relapse and go back to the stage of maintenance. In drug / alcohol addictions a person has to go through this cycle 6 or 7 times before exiting for good. For other problems like risky driving, gambling, overeating etc also this is true. It is even true about our refusal to wear helmets and seats belts while biking or driving. For these behaviors punishment acts as deterrent.
Behavior change and Locus of Control
Locus of control in this context can be external or internal. People with internal locus of control (loc) tend to change their behavior based on their own decisions. Those with external loc need external motivating factors for changing behaviors. The external motives can be words of praise and appreciation or tangible gifts. Another form of external control which acts as a deterrent on negative behaviors is punishment.
Majority of the population will fall in between. Extremes may be uncommon. But still it is useful to understand where one falls in this continuum from fully internal loc to fully external. Based on this one can devise strategies to change one's undesirable behaviors. A person with mostly internal loc can strengthen his resolve to change by adding some external rewards. "If I can avoid smoking for one day I will buy myself my favorite music CD".
Majority of the population will fall in between. Extremes may be uncommon. But still it is useful to understand where one falls in this continuum from fully internal loc to fully external. Based on this one can devise strategies to change one's undesirable behaviors. A person with mostly internal loc can strengthen his resolve to change by adding some external rewards. "If I can avoid smoking for one day I will buy myself my favorite music CD".
Addiction and Behavior change
Addiction is a state of mind in which a person is unable to resist certain actions. It can have cognitive (pertaining to thoughts), emotional, behavioral components. In the case of chemical substances it can have physiological component as well.
People generally equate addiction with the use of such drugs. Fame, sex, money, power and even pain can be addictive (Imagine the situation of a person with a tendency to inflict pain on himself and enjoy this - a state called masochism).
Why do we get addicted ? In neurobiological terms pleasure is thought to be a sensation derived from the release of a chemical called dopamine in certain areas of the brain. This area is called Nucleus Accumbens and is a part of limbic system - the area that processes emotions.
The most powerful releaser of dopamine at this site now available are the opiate drugs. That is why this class of drugs are highly addictive. A person used to this kind of intense pleasure (!) is unable to derive pleasure from lesser amounts of dopamine release, which is caused by the usual little day to day pleasures.
But imagine an addict shutting out himself from the rest of the world, injecting himself in some dark and shabby alley, and experiencing this so called 'pleasure'!. Is it real pleasure ?. Even if it is pleasure, I think it is of the most selfish kind - a pure chemical phenomenon.
A great amount of effort is needed to get rid of any form of addictions. After the emergence of HIV infections, the importance of behavior change has come into prominence. Behavior change techniques can be helpful in this situation. These techniques understand the maladaptive behavior as the result of several variables. The person's subjective attitude, the response he gets for his efforts to change himself etc are all important.
People generally equate addiction with the use of such drugs. Fame, sex, money, power and even pain can be addictive (Imagine the situation of a person with a tendency to inflict pain on himself and enjoy this - a state called masochism).
Why do we get addicted ? In neurobiological terms pleasure is thought to be a sensation derived from the release of a chemical called dopamine in certain areas of the brain. This area is called Nucleus Accumbens and is a part of limbic system - the area that processes emotions.
The most powerful releaser of dopamine at this site now available are the opiate drugs. That is why this class of drugs are highly addictive. A person used to this kind of intense pleasure (!) is unable to derive pleasure from lesser amounts of dopamine release, which is caused by the usual little day to day pleasures.
But imagine an addict shutting out himself from the rest of the world, injecting himself in some dark and shabby alley, and experiencing this so called 'pleasure'!. Is it real pleasure ?. Even if it is pleasure, I think it is of the most selfish kind - a pure chemical phenomenon.
A great amount of effort is needed to get rid of any form of addictions. After the emergence of HIV infections, the importance of behavior change has come into prominence. Behavior change techniques can be helpful in this situation. These techniques understand the maladaptive behavior as the result of several variables. The person's subjective attitude, the response he gets for his efforts to change himself etc are all important.
Awareness program on Mental Health at Calicut Press Club August 21st 2008.
View of the dias.
Welcome speech by Dr. Roshan Bijlee
Monday, August 25, 2008
Details fo the Awareness program on Mental Health for the Mediapersons
Date 21st August 2008.
Venue: Press Club hall, Calicut Press Club.
The program was jointly organized by Institute of Mental Health and Neurosciences (IMHANS) Calicut, District mental Program Kannur and the Calicut Press Club. It was inaugurated by Shri Prashanth IAS, Assistant Collector Calicut in the absence of the District Collector. Mr. T P Ramakrishnan, President of Calicut Press Club presided over the function. Dr. P V Narayanan, Principal Medical College Calicut and Dr. A. Baburaj, District Medical Officer felicitated. Mr. Kamal Varadoor, secretary press club proposed vote of thanks.
Topics and speakers.
1) Mind and Brain: Dr. Harish M T, Asst Professor Medical college, Cakicut.
2) Role of media and media persons in the area of mental health: Dr. C J John, Chief Psychiatrist, Medical Trust Hospital, Kochi.
3) Mental health and mental illnesses: Dr. Krishnakumar Director IMHANS Calicut.
4) Mental health and illnesses from the perspective of a psychologist: Mr. K T Paulachen, Clinical Psychologist, IMHANS Calicut.
5) Mental health of Malayalis: Prof. Sasidharan, Head of Psychology, University of Calicut.
6) Panel discussion and clarification of doubts : Moderatored by Dr. Roshan Bijlee, Research officer, IMHANS, Calicut.
Venue: Press Club hall, Calicut Press Club.
The program was jointly organized by Institute of Mental Health and Neurosciences (IMHANS) Calicut, District mental Program Kannur and the Calicut Press Club. It was inaugurated by Shri Prashanth IAS, Assistant Collector Calicut in the absence of the District Collector. Mr. T P Ramakrishnan, President of Calicut Press Club presided over the function. Dr. P V Narayanan, Principal Medical College Calicut and Dr. A. Baburaj, District Medical Officer felicitated. Mr. Kamal Varadoor, secretary press club proposed vote of thanks.
Topics and speakers.
1) Mind and Brain: Dr. Harish M T, Asst Professor Medical college, Cakicut.
2) Role of media and media persons in the area of mental health: Dr. C J John, Chief Psychiatrist, Medical Trust Hospital, Kochi.
3) Mental health and mental illnesses: Dr. Krishnakumar Director IMHANS Calicut.
4) Mental health and illnesses from the perspective of a psychologist: Mr. K T Paulachen, Clinical Psychologist, IMHANS Calicut.
5) Mental health of Malayalis: Prof. Sasidharan, Head of Psychology, University of Calicut.
6) Panel discussion and clarification of doubts : Moderatored by Dr. Roshan Bijlee, Research officer, IMHANS, Calicut.
Abuse of prescription drugs
Many drugs prescribed by doctors for various ailments can alter the mental state. Such drugs with psychotropic (mind altering) properties are being abused by a section of the society. Abuse of codeine containing cough syrups like Phensedyl is common in the north eastern states of India. Anxiety reducing drugs like diazepam, alprazolam and pain relieving drugs containing synthetic analogues of opium are the other commonly abused group of drugs. Some chemists and retail drug shops make money by diverting drugs to this route. These agents even go to the extent of printing prescriptions of doctors and hospitals and smuggling from other states. V. Shabna, reporter of Indiavision TV highlights about this problem in Kerala in the previous post.
Abuse of prescription drugs in Kerala - Report by V. Shabna, Indiavision.
Shown in this video are 1) Advocate Titto, Director, Center for Social Research and Development, Calicut, Kerala and 2) Dr. Harish. M.Tharayil, Department of Psychiatry, Medical College Calicut, Kerala, India.
In this post abuse of presription drug like dextropropoxyphene, diazepam, nitrazepam,codeine containing cough syrups etc in Kerala is discussed.
Sunday, August 24, 2008
Stigma ! Stigma !! Stigma !!!
Most people believe that you get infected if you come into contact with bacteria. Detergent makers make money by such ads. But reality is different. It is true that bacteria are present in our environment. But whether a person succumbs or not depends on many factors. People who study about distribution of diseases in the population(epidemiologists) discuss these factors under three headings.
1) Agent related: This includes factors like the number of organisms gaining entry to your body, their ability to multiply and produce toxins (virulence) etc.
2) Host factors: Your general state of health, nutrition. Whether there has been previous exposure to the same bacteria, whether you already have other infections, your body's immunity, emotional state etc.
Relationship between outcome after cancer, heart attack or major surgery and the person's mental state has been established. The patient's emotional state is one of the variables that determine the outcome.
3) Environmental factors: Living in overcrowded, areas with poor sanitation increases the risk of infection.
In the case of mental illnesses, there are no known pathogens. Except for addictions no external agents exist.
Host factors include your genetic vulnerability, intelligence, your life experiences in the past, your mental make up etc. For most mental disorders the risk increases if you have an affected close relative. In the case of schizophrenia the risk in the general population is 1%, but if one of your parent has the illness the risk increases to 10%. It has to be emphasized that you are not inheriting the illness, but only an increased vulnerability to develop it.
Environmental factors assume much more significance in the case of mental illnesses. The circumstances of your life, family and social support etc are important.
What I want to highlight is the fact that even for infections, it is not true to say that disease is acquired as soon as you are exposed to the bacteria. Biological, psychological and social factors are important. All illnesses, whether physical or mental, have these three factors operating. The difference is only in the degree of importance.
This being the state of affairs, why do people stigmatize the mentally ill alone ? Nobody stigmatises you for getting typhoid or pneumonia etc !
1) Agent related: This includes factors like the number of organisms gaining entry to your body, their ability to multiply and produce toxins (virulence) etc.
2) Host factors: Your general state of health, nutrition. Whether there has been previous exposure to the same bacteria, whether you already have other infections, your body's immunity, emotional state etc.
Relationship between outcome after cancer, heart attack or major surgery and the person's mental state has been established. The patient's emotional state is one of the variables that determine the outcome.
3) Environmental factors: Living in overcrowded, areas with poor sanitation increases the risk of infection.
In the case of mental illnesses, there are no known pathogens. Except for addictions no external agents exist.
Host factors include your genetic vulnerability, intelligence, your life experiences in the past, your mental make up etc. For most mental disorders the risk increases if you have an affected close relative. In the case of schizophrenia the risk in the general population is 1%, but if one of your parent has the illness the risk increases to 10%. It has to be emphasized that you are not inheriting the illness, but only an increased vulnerability to develop it.
Environmental factors assume much more significance in the case of mental illnesses. The circumstances of your life, family and social support etc are important.
What I want to highlight is the fact that even for infections, it is not true to say that disease is acquired as soon as you are exposed to the bacteria. Biological, psychological and social factors are important. All illnesses, whether physical or mental, have these three factors operating. The difference is only in the degree of importance.
This being the state of affairs, why do people stigmatize the mentally ill alone ? Nobody stigmatises you for getting typhoid or pneumonia etc !
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