What motivates the suicide squads?

Hi readers,

Manu has asked "What motivates a terrorist ?" in response to one of my earlier posts. In fact most of us would be having the same thought in our minds, post the recent events in Mumbai. Why do they do this?

Recently there has been reports of youth from even the southern most state of India - Kerala, where nobody speaks Hindi, leave alone Urdu - being recruited for terrorist activities in Kashmir. Most of these were either unemployed youth desperate to get a job or people with past criminal record who came into contact with the recruiting agents. Money would be a very powerful factor to lure such people. Obviously, there is huge money involved in this business. It is not fully convincing to think that Pakistan alone is behind all this. Can the government of a poor nation like Pakistan alone fund such large scale activities? May be, Pakistan is only a transit point in the whole affair. Funding may be being done outside that country by some agency with real money power. Revealing the whole truth needs concerted efforts of all nations. Such issues are not my subject in any case.

Mental health professionals will be more interested in uncovering the factors motivating one to join the ranks of such outifts involved in inhuman activities. It is very difficult to think that a pious person -of any faith - will involve in such activities.

I am quoting from an email send to the e-group of psychiatrists by Dr Abhay Matkar practising psychiatrist at Hubli, Karnataka. He describes findings from his study by interviewing some militants captured by army from Kashmir.

Dr. Matkar writes...."I am reminded of the study which was conducted by me & few others to know the psychodynamics of militancy.I pen down a few thoughts picked during the study on over 500 militants captured by the Indian army: Economic deprivation & deep sense of hurt(alienation) was the major cause of militancy in Kashmir.Coercion was the next major cause to take up to arms.Contrary to the popular belief,religion was not the primary motivational factor for Kashmir militants. What was striking was the strong motivation to sacrifice oneself for Jihad--the holy war.The indoctrination of ethnic & religious identity,political insecurity &deep sense of personal deprivation entrapped the virgin mind into taking to the 'gun culture'.The weak ego,a low self esteem & low frustration made matters worse. Militants seen by me showed no warmth in their relationship with family members nor a keen desire to be reunited with their dear ones.Three-fourths of these are between 15 to 30 years of age;most of them school dropouts.A significant youngsters had painfully tattooed the organisation they belonged to. Militants showed no personal involvement; killing was dehumanised- the victim was faceless,unknown to him.Often the militant was ordered or nominated to carry out the killing-killing was institutionalised. Suicide for a cause was rational & was called martyrdom. A group seen by me reacted with pride when chosen for a 'mission'.Those not selected reacted with bitter & sometimes hysterical resentment.The chosen ones were given a 'dining out' by the Commander.The farewell speech super-charged them mentally. These militants could not be categorised as "fanatics" or "mad men","psychopaths" or "mentally abnormal".They are normal people with a different psycho-logic of their own. It pains to see that time has not removed the veil of cruelty.Political answers are far from soothing. A real introspection & EARLY INTERVENTION are the only way we can have a safe tomorrow. LETS RISE.Regards. Abhay Matkar Hubli"

I am posting this for wider circulation among mental health professionals, other experts, social / political leaders and the public. Comments are welcome.

Bye

Dr Harish M Tharayil

Sleep and your mood.

As said earlier mood disorders are closely associated with sleep disturbances.
What is the relationship between sleep and mood?
Studies have shown that transient sleep deprivation can lead to an elevation of mood. A depressed person feels much better after overnight sleep deprivation.
Sleep deprivation can increase the risk of precipitating an attack of mania in a person predisposed to Bipolar disorder. Many persons develop their first manic episodes during festival seasons. They go to the temple yards to watch the late night celebration and fireworks. This is repeated frequently as most of the festivals are clustered in the same period. The resultant sleep deprivation triggers a manic episode.

Another condition that can be worsened by sleep deprivation is epilepsy. Sleep deprivation can precipitate an attack of seizure in a person predispose to it or in whom the disease is under control using drugs.

Management of sleep problems.

Non pharmacological treatment of insomnia

1) Maintain regular hours for going to bed and waking up. Try to wake up at a fixed time every day, even if you find it difficult to fall asleep at a fixed time. Even though you feel sleepy, do not sleep again. Within a few days the time of sleep onset advances to an earlier time.
2) Avoid heavy meals closer to bed time. Early dinner is better, especially if it is heavy.
3) Avoid day time naps.
4) Engage in some physical exercises. Avoid doing it or any other vigorous physical activity during late evenings.
5) Avoid tea, coffee and tobacco at least 6 hours prior to bed time.
6) Avoid bright light before sleep time. It is better for the bedroom to be dimly lit and slightly cool to promote sleep.
7) Clean up your mind before going to sleep. Avoid pondering over issues while lying on the bed. If you suddenly remember something urgent or important, jot it on a piece of paper to look into it next morning.
8) Avoid gazing at the clock repeatedly if you are lying in the bed awake. It is better to sit up and do something that is dull, boring and non stimulating.
9) If you find it difficult to get sleep even after 15 to 20 minutes in bed, get up and sit down. Get something that is not very stimulating or interesting to read. Read it sitting on a chair beside the bed using a reading lamp or in dim light. If you feel sleepy after sometime again try to sleep. Repeat this till you sleep.
10) If you feel tensed up while in bed, engage in deep, slow, abdominal (diaphragmatic) breathing. Take slow deep breaths ensuring that your abdomen lifts up with each breath. Avoid laboring with your chest. When the breath is fully in and your abdomen is protuberant, start slow exhalation by slowing tucking in the abdomen. Repeating this for a few minutes will make you feel relaxed. Thinking some positive thoughts or soothing imagery during this deep breathing may be helpful to some.
11) Use the bed exclusively for sex and sleeping. Avoid reading on the bed even during daytime.
12) Keep away from the tendency to use alcohol as a hypnotic.
These measures can be tried by any one who has difficulty to get sleep. There is no risk involved with any of this.
Insomnia can be transient or continuous.
Transient insomnia is due to mental tension or some minor problems. Continuous insomnia may be due to medical or psychiatric disorders.
Depression, anxiety, psychosis, substance abuse etc are the psychiatric illnesses leading to insomnia.

Using drugs for the treatment of insomnia is not always advocated. First of all the medical and psychiatric disorders have to be ruled out. Next an agent with minimum chances of abuse has to be selected which does not cause daytime sleepiness. Unfortunately, not many drugs are available which satisfies the above criteria. Hence it is better to consult a doctor for choosing a drug and for appropriate instructions.

Some sleep problems....

Delayed sleep phase syndrome is a mismatch between a person’s sleep-wake cycle to that of the general population. Most of us sleep between 10 pm to 12 midnight and wake up between 5 am to 7am.
But a person with this condition is not able to sleep till 2 am or 3 am. He is awake and mentally active till this time, showing no signs of exhaustion or sleepiness. He is able get up without feeling sleepy only bi 11 am or 12 noon.
There are many explanations for the development of this condition. One is that the sufferer’s brain is unable to respond to the most important regulator of our sleep – wake cycle i.e. light. The brain areas controlling the sleep – wakefulness cycle do not respond to the diminishing daylight to induce sleepiness. In majority of us this is why we feel sleepy when the lights are dimmed.
Need for sleep varies between individuals, and within the individual at different points in life. People with need for longer sleep may be dissatisfied even after sleeping for 9 to 10 hours. People with mood disorders – both unipolar depression and bipolar disorder – show abnormalities of sleep. Many of the bipolar patients in depressed phase, and those with a subtype of unipolar depression called atypical depression sleep for long hours.

Sleep duration, quality, dreaming......

Misconceptions about many aspects of sleep, including its duration are highly prevalent in the community. Sleeping for lesser duration is equated with evidence of hard work. There is no fact in this. An adolescent aged 14 or 15 years has to sleep at least 9 hours a day according to most experts. But will any child who is to appear for CBSE / SSLC be permitted to sleep this much ?
In reality, there is wide variation in the sleep requirement of individuals. Some can function without any problem even by sleeping for 4 or 5 hours. But generalizing this to the whole population will only lead to unnecessary conflicts. Advancing age reduces the need for sleep as well as results in fragmented and poor quality sleep.
Among the stages of sleep about 25% of time is spent in REM sleep and 75% in Non REM sleep. About 25 to 30% of the Non REM sleep is spent in superficial stages I and II. Usually this portion of sleep can be dispensed off without much adverse consequences. This is what is done by most short sleepers. They enter in to the deeper stages of Non REM III and IV within few minutes of sleep onset. The minimum time of sleep needed may vary from 4.5 to 5.5 hours. This is roughly the time spent in Non REM Stages III, IV and REM together. Reducing the time spent in these stages can lead to sleepiness, poor concentration, impaired work performance, accident proneness etc. If such a deprivation is prolonged mental or physical disorders can occur.
Dreams mostly occur during REM sleep. Dreams may occur in SWS also, but these are less likely to be remembered. It is usual for the sleep to be disturbed by dreams after being deprived of proper sleep the previous night. This is due to rebound of REM sleep. The body tries to compensate for the lost REM sleep by more frequent bursts in the succeeding night.

Dreams were thought to have symbolic meaning. This idea attained maximum scientific attention after Sigmund Freud's book 'The interpretation of dreams'. But now, neuroscientists and psychologists do not give much importance to the content of dreams in understanding the mental life of a person.

Sleep......

Sleep is a behavior seen in almost all animals. We spend around one third of our life time asleep. Prolonged sleep deprivation can lead to severe mental and physical problems and result in death. Lack of proper sleep can lead to reduced immunity, impairment in memory, reduced alertness and clarity if thinking. Disturbances of sleep are commonly found in majority of psychiatric disorders.
Generally people think of sleep as a uniform state. But studies using electrophysiological equipments have shown that sleep can be divided into distinct stages which occur in a predictable sequence. This pattern is referred to as sleep architecture.
Sleep can be defined as a state of rest with reduced awareness about the environment that is easily reversible. Thus it is different from other superficially similar states like coma.
Human sleep is subdivided into 2 types based on certain electrophysiological parameters and other phenomena. These are the REM (rapid eye movement) and Non REM sleep. REM sleep gets this name as there are rapid movements of the eye balls during this phase. This phase is associated with vivid dreams.
As one falls asleep the first stage occurring is called Stage I of NREM sleep. Then we successively pass through stages II, III and IV. Each stage has characteristic features on the Electro encephalogram (EEG). Slowing of EEG activity is noted from stages I through IV. Stages III and IV are together called Slow wave sleep (SWS) because the EEG record show considerable slowing during these stages. The EEG of REM sleep shows fast activity resembling the waking record.
REM sleep appears in bursts. At the end of approximately 90 to 110 minutes the first burst occurs. By this time the subject would have progressed to the SWS stages.
Subsequently, the subject moves back to SWS in around 20 minutes. Thereafter the sleep alternates between SWS and REM bouts every 60 to 90 minutes. The person enters the stages I and II of NREM only if wakes up again. Otherwise the rest of night is spent in SWS and REM sleep only.
Sleep is essential for growth and repair of the body, consolidation of memory and many other unknown functions. The secretion of growth hormone is maximal during sleep in babies, showing the important role of sleep in their growth.

Is addiction a moral weakness?

The only reason to make the distinction [between habit and addiction] is to persecute somebody’ (Szasz, 1973).
The terms addiction, abuse, dependence etc have been used in an imprecise manner by many and this has created some confusion. Lay people still use the term 'addict, addiction' as these are easily understood. But professionals, especially mental health professionals, prefer to avoid these terms for various reasons. One reason is from the angle of political correctness - these terms have pejorative connotations. The other reason is the lack of precise definition, even though these terms have been in use for quite long time. Yet another issue is the trivialized usage. This is when we refer to 'cross word puzzle addicts or exercise addict'. Using the term this way creates a wrong impression that substance use is a problem of similar nature.
Both DSM - TR and ICD - 10 (these are the classification systems used by psychiatrists for diagnosing and classifying mental disorders) use the terms 'substance use disorders' and substance induced disorders'. Substance use disorders include 'substance abuse' and 'substance dependence'. Substance induced disorders include intoxication, withdrawal and other more serious psychiatric conditions.
There are two aspects to dependence - physiological and behavioral. Physiological dependence has two aspects. One is the development of tolerance to the drug necessitating the use of increased quantity over time. The other is the development of a specific withdrawal syndrome on cessation of use.
Behavioral aspects include 1) strong desire or craving for the substance, 2) inability to control the onset, duration, termination or quantity of use, 3) spending lot of time to procure, use or get over from the effects and neglecting other avenues of pleasure due to excessive preoccupation with the substance
and 4) continued despite having adverse consequence (e.g: drinking despite having liver impairment)
It has been argued that it is better to use the term 'neuro adaptation' to the physiological phenomena of tolerance and withdrawal. Therefore, the term dependence is better reserved for the psychological and behavioral consequences.
But this is not strictly adhered to by most authorities. Thus the term 'dependence' continues to include both the physiological phenomena and the behavioral aspects.
The quote given at the beginning is not acceptable to mental health professionals. Dependence is a maladaptive state. It is a significant problem affecting millions all over the world - both the users, their families, employers and the society as a whole. A problem of such magnitude should not be trivialized by comparing with use of common things like food, music, clothes, water or oxygen.
Dependence to substances need not always be thought of from the moralistic angle. A person who is dependent on a psychoactive substance is in a pathological state. It is not like excessive time being spent on music or cross word puzzles. There are no serious physical, mental or social consequences for them. But the serious consequences of substance dependence can be proved with ample evidence. There is no need to be value neutral when one is dealing with a disease condition.
There is definite vulnerability underlying development of dependence. When such a vulnerable person is exposed to the substance, he is at risk for dependence. Social, cultural and psychological factors are also important in shaping the final picture. There may be several others who can have controlled usage. Dependence on substance is not a sign of moral weakness. It is a pathological condition which develops in persons with biological, psychological or social vulnerability, needing proper evaluation and treatment. If untreated, it will lead to serious individual and social consequences. Substance abuse in most cases, is just a prelude to development of dependence. It is always better to intervene at this stage without waiting for development of a full blown dependence syndrome or serious health consequences.