Punishment for children – Is it judicious or ridiculous?

Many parents come for help reporting that…‘Mine is a problem child’, ‘can’t manage the tantrums’, ‘disobedient’, ‘too demanding’, ‘disrespectful’ ‘can’t control him/her’, and a lot of other problems.

So what is the role of punishment in bringing up a child?

Punishment should be used sparingly, and as a last resort on children. It should not become a way of taking revenge, insulting or humiliating the child. It should be administered with the aim of helping the child develop an internal control over self for the bad habits.

Technically it can be defined as presenting an aversive stimulus contingent on the target behaviour for the purpose of decreasing the target behaviour.

The first strategy should always involve “positive strategies” such as

• Rewarding for good behaviour (just praising verbally is usually more than sufficient, more elaborate schemes may include gifts, picnic/party or whatever suits your scene).

• Not meeting the demands of the 'bad behaviour' in the initiation only (so as to avoid setting up of an unhealthy pattern; an unrewarding act is likely to get extinguished on its own).

• Withdrawing some privileges (e.g. I will not play with you today) as you did this bad behaviour.

Explain to the child what wrong he/she has done, and that it is undesirable, and that you are reacting to it, and that you would not do it if the ‘bad behaviour’ was not there. You should be sure of what you are doing, and be consistent with it.

Excessive use of punishment only decreases its efficacy, and in the long run causes strained relations between parent and child, and if you are very unlucky, the child learns to deceive you by lying and hiding mistakes for the fear of punishment. Beating up the child is usually undesirable; it is mostly the result of parent anger rather than purpose of helping the child… and the child can also learn from Your aggressive behaviour. Punishment may be called the lowest form of education.

Spend time with your child, it will help avoid development of problem behaviours, and you will know what causes bad behaviour when it is there.

The Paa Problem... PROGERIA

Auro is suffering from 'Progeria'.

The word Progeria is derived from the Greek progeros meaning 'prematurely old'. The Greek word pro means 'before', while the word geras means 'old age'. It is an extremely rare, fatal genetic condition.Progeria affects children and gives them an appearance of accelerated aging.

Progeria Factfile

• About 100 cases (only!) have been formally recorded in medical history till date.
• There is a 1 in 8 million chance of having it!
• Children with Progeria are born looking healthy.
• Features of aging that should start in 60s, start to appear as the child ages past infancy.
• Growth failure, Loss of body fat, Loss of hair, and a distinctive facial appearance (small face and jaw, pinched nose) are all characteristic of progeria.
• They will have small, fragile bodies, like those of elderly people.
• Later, the condition causes wrinkled skin, atherosclerosis, and cardiovascular problems.
• Progeria patients generally die in early teens.
• Most die from cardiovascular complications.
• Patients with Progeria have a mutation on the gene that encodes a protein “Lamin A” whose fuction is to hold the nucleus of the cell together.
• The defective Lamin A protein makes the nucleus unstable, which leads to the process of premature aging.
• This is a rare gene change which happens purely by chance, and not inherited.
• For treatment few anti cancer drugs (eg Lonafarnib- a type of Farnesyltransferase inhibitor) are being tried but with minimal success.
• Mainstay of management is symptomatic and supportive medical care for complications; supportive psychotherapy for patient as well as care givers.
• Any research into finding a cure for Progeria would probably have results which would benefit adults with diseases linked to aging.

Reference

Scaffidi P, Gordon L, Misteli T (2005) The Cell Nucleus and Aging: Tantalizing Clues and Hopeful Promises. PLoS Biol 3(11): e395. doi:10.1371/journal.pbio.0030395

Why SHOUT?

A saint asked his disciples, 'Why do we shout in anger? Why do people shout at each other when they are upset?'

Disciples thought for a while, one of them said, 'Because we lose our calm, we shout for that.''
But, why to shout when the other person is just next to you?' asked the saint. 'Isn't it possible to speak to him or her with a soft voice? Why do you shout at a person when you're angry?'

Disciples gave some other answers but none satisfied the saint.
Finally he explained, 'When two people are angry at each other, their hearts distance a lot. To cover that distance they must shout to be able to hear each other. The angrier they are, the stronger they will have to shout to hear each other through that great distance.'

Then the saint asked, 'What happens when two people fall in love? They don't shout at each other but talk softly, why? Because their hearts are very close. The distance between them is very small...'

The saint continued, 'When they love each other even more, what happens? They do not speak, only whisper and they get even closer to each other in their love. Finally they even need not whisper, they only look at each other and that's all.
That is how close two people are when they love each other.'

Happy ............ day!

Birthdays make us feel special, and anniversaries bring back the joy (or the sorrows) of our past. Parties are good fun to have, socialize and diversify.
But for this, why the need of some specific excuse which really serves as no better than a nomenclature of sorts. What of the rest of 364 days?
I have always been wondering, what is the importance of so called “special” days in our life? In fact I find myself in minority when I say all days are equal for me, I don’t want birthdays or anniversaries to be celebrated. Consider exchanging gifts on one day (anniversary) and brickbats most of the year. Celebrating a theme for a day and then forgetting it (or putting on reminder for next year) seems a show off, plastic and banal (retarded at times!). Each theme is for every day to enjoy, rather than to compartmentalise it to “those” days.
So enjoy every moment. And HappyEveryday!

Schizophrenia... Disorganised Thoughts

Given below is the actual account given by one of my patients. Please read till end to understand what gross problems he had in his thinking processes.

He was asked wether he knew Mahatma Gandhi, to which he told yes and described Him as follows....

The above speech sample demonstrates a type disorganisation of thought that is technically called by psychiatrists as 'loosening of associations'.

It is a pattern of spontaneous speech in which the ideas slip off the track onto another one which is clearly but obliquely related, or onto one which is completely unrelated. This pattern of speech is often characterized as sounding "disjointed.’ There is a slow, steady slippage, with no single derailment being particularly severe, so that the speaker gets farther and farther off the track with each derailment, without showing any awareness that his reply no longer has any connection with the question which was asked. This abnormality is often characterized by lack of cohesion between clauses and sentences and by unclear pronoun referents.
Termed simply... there is lack of cohesion leading to disintegration of core of self, and relationship to reality.

It is one of the impotant symptoms of illness called Schizophrenia, which has many other aspects like hallucinations and delusions, along with socio-occupational dysfunction.

The above person was diagnosed as suffering from Schizophrenia and showed good improvent with medications and occupational therapy. He is now back with his family and has started working at his brothers shop.

(Patients Identity witheld on ethical grounds)

Understanding Emotions

'तेरा इमोशनल अत्याचार'.... taking cues from this popular song,lets give a few thoughts about emotions.

Emotion is a mental state involving a distinctive feeling tone. It is defined as “a moved or stirred-up state of an organism caused by physiological changes occurring as a response to some event and which tends to maintain or abolish the causative event.”

Emotion includes a wide range of observable behaviors, expressed feelings, and changes in the body state. This diversity in intended meanings of the word emotion makes it hard to understand and study. For many of us emotions are very personal states, difficult to define or to identify except in the most obvious instances. Moreover, many aspects of emotion seem unconscious to us. Even simple emotional states appear to be much more complicated than states as hunger and thirst. The expression of emotion is also an effective means of communication.
There are four basic components of emotions:


1. The physiological aspect, which involves active changes in the body physically, e.g., tachycardia (rapid heart rate), tachypnoea (fast breathing), dilated pupils etc. For example, try to recall the pounding heart and dry mouth, just before looking at the notice board for the annual exam results.


2. The cognitive component, which emphasizes the importance of thoughts, beliefs, and expectations in determining the type and intensity of emotional response. For example, if we look back and think about our friends/relatives, we do recall that ‘sensitivity’ was inbuilt in some.


3. The behavioural component, which involves the various forms of expressions that emotions may take , e.g., facial expressions, bodily postures, gestures, and tone of voice which changes with anger, joy, fear, sorrow, etc. Some ‘express’ more, others less. As in, in our culture girls have a much free hand at crying, if they cry it’s ok, and when boys do that, they are ‘sissy’.


4. The subjective experience, which includes elements of pleasure, or displeasure, intensity of feeling, etc. what one individual experiences as intensely as pleasurable may be boring for another. So, remember the best and worst moment of your life for five minutes each, and try to recognise what is the difference while you were reliving those states.
(References available on request)

Normal Thinking: A Psychiatrist's Perspective

“We are what we think. All that we are arises with our thoughts. With our thoughts, we make the world” Gautam Buddha.

It is hard not to think. During most of our waking hours and even when we are asleep and dreaming we are thinking. Thinking consists of cognitive rearrangement or manipulation of both information from the environment and the symbols stored in long term memory. It is the form of information processing that goes on during the period between a stimulus event and response to it.
Normal ThinkingThinking refers to the ideational components of mental activity, processes used to imagine, appraise, evaluate, forecast, plan, create, and will. Most thought involves complex rules that are probably best currently approximated (albeit inexactly) by fuzzy-logic decision-making algorithms that use neural net technology, increasingly applied by scientists and engineers in vague situations in which all-or-none, black-or-white thinking does not apply but in which multifaceted, contradictory, and competing possibilities and biases are the rule. Most of what is known about thinking derives from the study of language as the product (and reflection) of thought, yet a great deal of thinking takes place preverbally and nonverbally. Thinking occurs in images, music, and kinesthetic sensations and in symbols other than linguistic ones.

Ideas are the contents of the stream of thought. They may arise on the basis of a percept, may follow a memory, may arise out of a mood state or atmosphere, or may occur de novo. Those that are consistent with one's sense of self, compatible with the individual's self-image, are called ego-syntonic. Other thoughts that conflict with one's central values are called ego-alien or ego-dystonic.

Normal beliefs and valuesPhilosophers have for many years distinguished beliefs and values and debated the relationship between the two. A belief (or an inference) is something thought to be true because of observation or evidence. It can often be subjected to empirical testing or logic to derive facts, which tend to be objective and universally agreed. By contrast, a value is something thought to be good or important to an individual. Hence strongly held values are the principles on which one will not yield and are not subject to empirical testing. Normal values may be divided between those that are terminal (e.g. the importance of happiness) and those that are instrumental (e.g. the importance of being honest). Values (like beliefs) are on a continuum in terms of the degree of importance attached. Some values might be viewed as extreme (e.g. those values held by a racist organisation or an orthodox religious group) but they are not classified as a mental disorder. Evaluations (or attitudes) are associated with values. They are a rating of an event or person on a scale of good and bad. In comparison to beliefs, values or evaluations are not subject to empirical testing. They are more difficult to measure or challenge because they are subjective and personal. Sometimes beliefs are influenced by a value. For example, beliefs about the risk of HIV and sexual behaviours are influenced by values regarding excitement and stimulation. The reverse may also occur, in which values are influenced by beliefs. For example, a belief that there has been an increase in the incidence or severity of HIV infection may increase values about the importance of caution, restraint or self-discipline. The division between beliefs and values is often blurred. They are like two sides of a coin.

Belief systems are the scaffolding of thought, chains of impressions, and expectations around which plans and behaviours are organized. Belief systems may be attitudinal, setting general expectations and biases about the world that inform how incoming information is processed; examples are optimism, pessimism, and paranoia. Some beliefs are effervescent and fleeting, whereas others are pervasive, tenacious, enduring, and influential. The enduring belief systems are associated with behaviours consistent with the belief, at times dominating interpersonal relationships and lifestyles. Some beliefs are unique and private, whereas many are shared by others.

Abstract thinking is the ability to assume a mental set, to keep simultaneously in mind all of the aspects of a complex situation, to move from feature to feature as indicated by the situation, and to abstract common properties. Complex thinking also concerns the ability to simultaneously consider many different, vague, and subtle aspects of situations; to appreciate differing and contradictory points of view; and to integrate these multiple dimensions to form opinions that are marked by differentiatedness and nuance.

Concrete thinking is a disturbance in the ability to form abstract concepts, generally illustrated by literal mindedness and the inability to abstract the commonality of members of a group, for example, the fact that a flea and a tree are similar in that they are both living things. Concrete thinkers seem unable to free themselves from the literal or superficial meanings of words. Concrete thinkers may be more prone to prejudice and stereotypical thinking and more likely to manifest unidimensional or “all-or-none” reactions to complex situations. Concrete thinking can be seen in individuals with lower intelligence, organic mental disorders, and schizophrenia.

Freud considered division of thought into primary and secondary process-
Primary process thinking, the more primitive type, includes thinking that is dereistic, illogical, magical; normally found in dreams, abnormally in psychosis. This type of thinking disregards logic, permits contradictions to exist simultaneously, disregards the linear notion of time, and is dominated by wish and fantasy. It uses symbol, metaphor, imagery, condensation, displacement, and concretism in its organization, creating the jumbled and incoherent style of thinking characteristic of dreams and has been associated with visual images and creative thought.
Secondary process thinking is characterized by logic. In contrast to primary process thinking, the secondary process uses linear notions of time, clearly delineated abstract categories, and deductive rules of logic. The abilities to think abstractly and to think in detail about future plans are characteristic of secondary process thinking. Normal secondary process thinking is also characterized by predictability, coherence, and redundancy. Words, vocal inflections, and gestures provide important contextual cues and create a sense of overall coherence to the communication. Ideas follow one another in a sequence that is understandable to the listener.

Later Conceptualisations of Types of thinking
The process resulting in a thought can vary with regard to the degree to which external reality and goal-directness are taken into account. In this perspective three types of thinking can be distinguished which represent a continuum without sharp boundaries and are intertwined in everyday life: fantasy thinking, imaginative thinking, and rational thinking. Since each of these types can become dominant under some conditions, this distinction is useful to aid understanding of certain abnormal phenomena. The characteristics of the three types can best be illustrated by considering the differences between fantasy thinking and rational thinking.
Fantasy thinking (also called dereistic or autistic thinking) produces ideas which have no external reality. This process can be completely non-goal-directed, even if the subject is to some extent aware of the mood, affect, or drive which motivates it. In other cases fantasy thinking serves to exclude reality because it requires actions that the subject does not want to accomplish. This second kind of fantasy thinking is not undirected. Its goal is not to solve a problem but to avoid it via neglect, denial, or distortion of reality. Normal subjects use fantasy thinking deliberately and sporadically. However, if its content becomes subjectively accepted as a real fact, it becomes abnormal. This pathological exclusion of reality can remain limited in extent (e.g. in hysterical conversion and dissociation, pseudologia phantastica, and some delusions) or it may be manifested as complete autistic withdrawal from the real world. Bleuler believed that excessive ‘autistic’ thinking in schizophrenia was partly the result of formal thought disorder.
Rational (conceptual) thinking attempts to resolve a problem through the use of logic, excluding fantasy. The accuracy of this endeavour depends on the person's intelligence, which can be affected by various disturbances of the different components involved in understanding and reasoning.
Imaginative thinking can be located between the fantasy thinking and rational thinking. It is a process of forming a representation of an object or a situation using fantasy but without going beyond the rational and possible. This thinking is goal directed but frequently leads to more general plans than the solution of immediate problems. The essential difference between imaginative and rational thinking is that the former neglects the notion that each theoretical assumption should be accompanied by an attempt to falsify or refute it. Imaginative thinking becomes pathological if the person attaches more weight to his representation of events than to other objectively equally possible interpretations. In overvalued ideas, the imagined interpretation surpasses other interpretations in strength; in delusions, all other possibilities are excluded.

(References available on request)