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The Effects of Digitalism on Children

Around the world, digital technologies have rapidly become an active part of everyday life. There has been a seismic shift in the way people interact with their environments, from work to leisure, from healthcare to food & grocery management. Whether it is through social media, payment wallets or apps for a plethora of needs, we have digital technologies to aid us in most aspects of our lives. This is true for children as well. Due to the restrictions imposed upon large sections of the world population during the Covid-19 pandemic, numerous schools had to move towards online education – further digitalizing children’s life world over. 

Children today have been a part of the digital world for their whole lives, unlike people born before the 2000s. They are active digital consumers, even at a relatively young age, interacting with a number of new and interactive digital technologies. They are almost always ‘connected’ to the digital world – depending on digital services for everything from school to social interactions. This level of digital interaction comes with a number of positives and negatives. Children could use these technologies to further express themselves, to learn more (at a faster speed), to connect socially with others their own age, and to learn a more globalized approach to life. However, there are several drawbacks to letting children interact with these emerging digital technologies – they are often targeted by online predators, cyber bullies and harmful content, that they may not be able to find their way past. 

Advantages of digitalization on children’s mental health 

  1. Increased IQ and EQ levels

Children around the world are showing higher levels of IQ & EQ than their predecessors. Many experts around the world attribute this to the rise of digital technologies and the access that children have to it. The increase in the number of technological devices and applications used by children can serve to increase their stimuli to a range of complex problems. 

  1. Educational & mental skill development

Digital technologies can have a positive impact on a child’s development right from adolescence, if they are exposed to the appropriate technologies. Educational and instructional tools can help children develop cognitive skills early on, by allowing them to interact with technologies that can have multiple benefits. Games designed to help children with memory, attention, language, math, science and more, can help children improve in areas where they may be lacking. 

  1. Enhanced learning opportunities & advanced problem solving

Children today have access to content on the Internet that would otherwise be extremely hard to access. Instead of having to depend on schools, libraries or after school tutorials, children can download any extra modules, work sheets, video tutorials and more, from the comfort of their living rooms. They can interact with other children, teachers, parents or experts online, through various apps and websites that will provide them with the opportunity to learn whenever and wherever they way. Visual design, technical drawing, coding, Web 3.0 and statistical programs help children develop both creative and cognitive skills. 

  1. Emergency management

One of the most positive effects of digitalization on children is that it helps parents keep track of their children, even in case of an emergency.  Mobile phones, smart watches, tablets, and more come equipped with tracking software, so you can locate your child if they appear lost or confused. By using alarm features on these devices, parents can make sure their children are trained to take medication on time, or to stay in touch in case of a medical emergency. 

  1. Critical thinking development

With the advent of interactive games, mental exercises and language tutorials, children can develop critical thinking skills much earlier than ever before. By exposing children to different technologies that can boost strategic thinking, parents can help their children think for themselves, while solving complex problems right from a young age. 

  1. Engaged through entertainment

Parents can find a wide range of technologies that can provide their children with informational content that is most interesting to them, and thus they can learn while they have fun! Parents can use digital technologies to help their children with a variety of problems, ranging from common boredom to attention deficit disorders. Children can enjoy their leisure time, by working on activities that can help them build better mental health, instead of focusing on negative things. 

  1. Staying socially connected

With the advent of social media, children can now stay in touch with the world around them easier than ever. They can keep in touch with their family and friends, at the click of a button, thus expanding their social connectivity and reach. If monitored properly, digital technologies can help children connect with others within their own age-group, who share their same interests, much easier than ever before. 

Disadvantages of digitalization on children’s mental health 

  1. Lower attention spans

The extreme use of digital technologies such as tablets, laptops and tablets can lead to difficulty in concentration and can cause distractions to children. The misuse of apps and technologies aimed at educating children can actually result in a lack of focus, short attention span and other learning disabilities in children, especially if experts have not certified the apps or technologies.

  1. Minimized ‘real world’ interactions

A number of digital technologies available to children tend to ‘gameify’ learning, by rewarding children with levels, stars, and more. Children who do not like socializing are more likely to distract themselves in these virtual worlds where they may feel more comfortable. However, this will just serve as a temporary problem to a problem that will only grow as they become older. Children must be encouraged to maintain a balance between their online and real world interactions, so that they learn to get along with people in various settings. 

  1. Increased aggression levels

Children tend to have colorful imaginations that can easily be manipulated by online interactions. Games in general could increase aggression levels in children, since they could lead to frustration in children who are not equipped to handle failure yet. Violence and frightening images depicted in games or social media, could lead to unhealthy emotions building up in children. 

  1. Health problems lead to mental health problems

Overexposing children to digital technologies can lead to a number of physical health problems that can have a negative impact on their mental health. Some of the most common problems include: neck pains, skeletal distortion/bad body posture, numbness in the arm, hand or fingers, vision problems, sleep issues and obesity. If children use technology to offset physical activities in real life, it can have an extremely adverse effect on their physical and mental health wellbeing. 

  1. Cyber bullying, abuse and other security risks

While social media can help children stay entertained, it can also lead to cyber bullying, which is a common problem in the digital age. The anonymity of the Internet gives rise to a number of harmful comments and posts from all corners of the world. Children could be bullied over their appearance, number of social contacts, interests, mental health and more. It is important to monitor children’s social media in order to make sure predators aren’t targeting them.

  1. Risk of depression, social anxiety and fear of missing out

It is easy for children to compare themselves and their lives to those of other people online. This can cause a high level of social anxiety and even depression in children, who may turn to social media in order to feel better, thus continuing the cycle. Instead of them falling deeper into the social media hole, it is important to bring them out of it and base them in reality. In extreme cases, it is important to seek out the help of an expert who can help your child cope with their difficulties. 

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How can you help children identify and tackle mental health issues?

Taking care of your child’s overall health involves making sure their physical, mental, emotional, environmental, and social needs are met. Usually parents hope to find the best school they can afford, the best tuition and after-school activities, nurturing friends or social groups, and positive influences in their children’s lives. However, in our society, we often neglect taking care of our children’s mental health needs. Good mental health can be the difference between a child succeeding and being happy, while learning and acclimatizing faster than those with poor mental health. 

How do mental health problems affect children?

Mental health problems can affect the way a child thinks, how they cope with difficult situations, their moods and emotions, and their ability to form or want social connections. Mental health problems in childhood can delay &and disrupt a child’s normal life, causing behavioral problems, a lack of social skills, emotional stunting, cycles of negative feelings, anxiety about their place in the world, and much more. These problems can distress, antagonize, and isolate children; these children have a much harder time coping with reality than children with good mental health. 

Much like physical health, your child’s mental health will change over a period of time, which makes it important to keep a track of. It is important to be able to sit down with your child and help them build habits that will contribute towards a healthy mental health balance. Some habits, such as a regulated sleep cycle, brushing teeth twice a day, eating nutritious and healthy food, exercising regularly, and socializing with other people regularly, can help children learn lifelong lessons in how to maintain a healthy mental health balance. 

However, something to note is that mental health problems can be quite common during childhood. By learning how to spot the problem early on, you can ensure that your child gets help sooner rather than later, because the faster you address these problems, the faster you can work together to find solutions. 

How do you identify problems in children?

It can be tricky to distinguish between regular hormonal changes, growing pains and emotional fluctuations from a full-blown mental health problem. This is why it’s important to seek the help of a professional when you cannot pinpoint the exact problem. However, here are a few things you can do with your child to help them identify if they have a mental health problem.

  • Sit down with your child and talk to them about their problems. Ask them questions about their feelings, their thoughts, their worries & anxieties, and so on. Pay close attention to what they say, take notes and watch out for any warning signals they may be giving off verbally and non-verbally. 
  • Listen, listen, listen! Make sure you listen to your child, instead of talking over them. Sometimes, we have the tendency to come up with preconceived ideas about how our child feels.  It is important to put these notions aside and instead just process what they say to you. Even though you might have ideas and input, see what your child feels comfortable with – you might find all they want is a shoulder to cry or, or someone to commiserate with them. 
  • Take regular notes about your child’s feelings and emotions. Has your child been feeling extra moody or withdrawn for more than 2 weeks? Have you notices severe mood swings or big changes in behavior? This may mean your child is experiencing a mental health problem. Look into other aspects of their life like: 
  • Do they regularly have problems making friends or creating relationships with other people?
  • Do sudden feelings of worry, fear, or anxiety overwhelm them in situations that shouldn’t?
  • Are they unusually irritable or explosively angry?
  • Do you notice sleep issues or food related issues?
  • Are they experiencing weight fluctuations or sudden illnesses (stomach aches/headaches/nausea) without cause?
  • Are they isolating from other people, forming bonds with unhealthy elements or avoiding school/activities?
  • Are they using drugs or alcohol?
  • Do they talk or joke about death or talk about hurting themselves/wanting to die?
  • Have they stopped doing things they once enjoyed?
  • Are they spending an unhealthy amount of time on social media or digital devices?

Answering these questions could give you a more thorough insight into your child’s life, and can help you make notes that you can share with a professional therapist. 

What can you (and your family) do to encourage healthy mental health habits?

  • Encourage, validate and accept.  Encourage your child to share their feelings & learn more about their emotions. Validate their feelings & emotions, by agreeing with them instead of arguing – tell them that you hear them, and you understand them. Accept their emotions, thoughts, feelings and ideas, and reward them for being honest with you.
  • Come up with coping solutions together. Make your child an important part of the solution process. Make sure that they know this – by feeling like their voice is being heard, they may open up to new ideas that you may bring up to them as well. Every child is different, and children may have to find different ways to cope that works for them. 
  • Enforce healthy habits in your household. Children learn from the adults around them, if you have unhealthy habits they are sure to pick up on them, so try to set healthy habits for your entire family to follow.  This can be something as simple as planning healthy meals for everyone at home, and can be as complex as developing healthy ways to deal with frustration. If someone at home uses curse words or violence to deal with unfavorable situations, you can be sure your child will learn to do this as well. 
  • Build strong and positive relationships between your children and other members of your family. Make sure that your children learn from other role models around the family. Monitor these interactions and make sure you keep your children away from traumatic interactions.
  • Establish regular/weekly family time activities. You can set aside a particular amount of time per week to allow for activities like game nights, educational trips, beach days, and more. Ask your child what they would like to do, and make them a part of the decision process so that they feel validated. 
  • Reduce stress, conflict and negative emotions around the house. Teach your family healthy coping mechanisms to use at home around children. Instead of shouting, hurling abuses, or resorting to violence, you can all sit down and talk together. Your child should feel safe and at ease within their environment, and this is a good way to express it to the rest of your family. 
  • Limit time with screens, and spend quality time out in nature. Social media and digital media can have an adverse affect on your child’s development. Restrict their use of digital devices, monitor how they spend their time online, and provide them with fun & healthy alternatives. You can take the whole family or just your child on outdoor adventures once a week; maybe even encourage them to learn how to enjoy being in nature. 

The most important thing to remember is that it’s okay to ask for professional help, whether your child needs it or someone else in your family does. Don’t shame or blame anyone for seeking help, be there for him or her instead, and offer whatever help you can! If you need to consult a psychologist or psychiatrist, please don’t wait; get the process started at the earliest!

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How can you promote healthy mental health development in adolescents?

Childhood and adolescence are extremely important to the development of a person’s long-term mental health & well-being. During adolescence, a child’s brain goes through rapid, accelerated growth & development that helps them develop the cognitive, social & emotional skills they need in order to shape their interaction with society at large.  

Assess your environment

First and foremost, the environmental quality of where adolescents grow up plays a large part in shaping their cognitive, emotional & mental health balances. Any early exposure to bad or negative experiences at home(s), school(s), or digital spaces/social media platforms can increase their risk of mental health problems. Early exposures to violence, mental illness of someone in close proximity, bullying, poverty, failure, sexual abuse, prolonged illness & more, can have severe long-term ramifications on an adolescent’s mental health.

Address mental health issues at the earliest 

Some mental health problems like childhood epilepsy, anxiety, depression, developmental & learning disabilities, and behavioral disorders, are large contributing causes of mental illness and disability amongst adolescents. Worldwide, 1 out of 10 adolescents will experience a mental health disorder in some form, but most of these cases will go unreported and undiagnosed, with little chance of the adolescent in question getting help. By not addressing mental health problems at the earliest, adolescents run the risk of growing into adulthood with untreated illnesses that could hamper their development in various ways. This could limit the way they are able to interact mentally, physically, socially, and psychologically with the world around them. They also run the risk of having suicidal tendencies from early in life, and suicide among teens is the 4th highest known killer for people in that age range. 

By adopting practices that promote positive mental health and well-being, adolescents are led through various methods by which they can function fluently in society, foster important early social connections, gain & maintain positive self-esteem and cope with the ups and downs of life in a healthy way. Some of these practices include the adoption of healthy sleep patterns, the establishment of a regular exercise schedule, the development of coping mechanisms, problem-solving techniques & interpersonal communication skills, and emotional management. 

Identifying common mental health warning signs in adolescents

Mental health problems in adolescents cannot be judged by the presence or absence of any particular symptoms, and that is why it can be hard to identify and diagnose these problems in this age group.  However, there are some signs that you can look out for in your adolescent, which could help you intervene and provide them with much-needed support. Some of these signs include:

  • Losing interest in activities they once enjoyed
  • Having low energy or attention spans
  • Having difficulty falling asleep
  • Spending more time in isolation, while avoiding social activities
  • Eating difficulties – which could be eating less or eating more than normal
  • Self-harm methods like cutting, burning, hair pulling, and more
  • Using alcohol, tobacco, or drugs (that aren’t prescribed)
  • Engaging in violent or risky behavior
  • Suicidal thoughts or tendencies
  • Unrealistic feelings about the world – seeing/hearing things that don’t exist, feeling that other people want to harm them
  • Experiencing a high range of mood swings
  • Shutting down or retreating into a shell – this can be evidence of physical/sexual/mental/emotional abuse

How can you promote healthy practices in your child? 

The promotion of mental health in adolescents and children seeks to encourage mental health development while increasing healthy behaviors and protective factors. This can help in preventing or delaying the onset of a diagnosable mental disorder while mitigating several risk factors that can invariably lead to the formation of a mental health problem.2 

By creating supportive environments and positive living conditions, one can help their adolescent maintain a healthy lifestyle.  It is important for an adolescent to feel respected in their environment, without worrying about their most basic rights being infringed upon. 

Some of the most basic ways to promote mental health well-being in adolescents are:

  • Negotiating early interventions – this can be as early as when your significant other is pregnant and making sure their needs are well met, and that they stay away from harmful substances/practices. You can also encourage psychosocial engagement for your adolescent by enrolling them in a reputed preschool, and by fostering early adolescent friendships. 
  • Building support networks for adolescents – Enroll your adolescent in a skill-building program, or a youth development program. You can take your child to several different activities/workshops/sporting events, and see which one suits them best.
  • Psychosocial interventions post-crisis – It is healthy to teach children how to contend with tough situations, by turning crises into teaching moments. Instead of showing an adolescent the worst of a bad situation, you can help them see things in a different light, which in turn will help them learn how to deal with diverse and difficult situations.
  • Violence prevention programs
  • Creating safe digital spaces
  • Encouraging independent behaviors

Teach your child valuable life skills

A number of skills can be learned at any stage in life, however, adolescents have the ability to integrate these skills much faster than adults. These life skills can help in promoting psychosocial engagement within children, which can then turn into learned behaviors that can stay with your child for life. 

Communication and interpersonal skills

  • Learning verbal/non-verbal communication & social cues
  • Active listening, memory retention
  • Expressing feelings in a positive manner, giving & receiving feedback positively


Decision-making and critical-thinking skills

  • Thinking through the consequences of actions 
  • Finding appropriate or creative solutions to problems
  • Analyzing the influence of values and attitudes about self and others on various topics
  • Learning to analyze the influence of society, media, friends & family
  • Analyzing how various values, attitudes, beliefs, social norms, and hierarchies affect their lives

Coping and self-management skills

  • Nurturing & building self-esteem and confidence
  • Inculcating self-awareness skills towards human rights, influences, values, goals, problems, attitudes, strengths & weaknesses
  • Goal setting and rewarding completed goals
  • Self-assessment -> self-monitoring -> self-evaluation

Negotiation/refusal skills:

  • Open negotiation, conflict management & resolution
  • Assertiveness – refusals and priority-based negotiating processes
  • Building empathy, sympathy, trust, and leadership qualities
  • Learning to listen & understand others’ needs, environments, circumstances & situations, while expressing this understanding clearly

Advocacy, cooperation & teamwork skills:

  • Influencing skills -> Persuasive speech -> Public Speaking -> Networking
  • Valuing and respecting others’ contributions, different styles, and various methodologies
  • Evaluating their own unique abilities, contributing to the group in whatever way necessary, and working cohesively with others

Skills for managing feelings & stress:

  • Dealing with negative feelings like anger, grief, jealousy, and anxiety
  • Learning how to create coping mechanisms to deal with losses, trauma, and abuse
  • Time management -> organizational methods -> avoiding procrastination 
  • Forming positive relaxation techniques 
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A fine balance

Once again, in October, I had the privilege of attending Chennai’s international festival of short films on mental health, “Frame of Mind” organised by SCARF (the Schizophrenia Research Foundation India). My task was to interact with the audience after the Richard Gere film, “Mr. Jones” about an extraordinarily charming man with bipolar affective disorder (manic depressive illness).

The film begins with the protagonist wanting to fly off the high roof of a building he is working on. His childhood desire to fly — matched by his firm belief while in a manic state, about his ability to do so — makes a potent and heady combination. As he watches a plane fly overhead and prepares to launch himself off the roof in pursuit, he is saved by his colleague’s presence of mind, thus landing in a psychiatric treatment facility.

Being a Hollywood film it needs a heroine; in this case a female psychiatrist of Swedish origin, whose first encounter with Mr. Jones at the facility she works in, leads to his choice of her as his doctor. Even from the beginning the relationship develops along rather unusual lines. She recognises his problem as being bipolar disorder and that he needs continued treatment rather than discharge. Her attempt to convince the court that he must be held against his will, and treated, fails. She leaves the courtroom disappointed and frustrated, only to have him request a ride home, as he has no money.

Blurring lines

The lines become blurred as professional and client proceed to not only have lunch en route, they also end up having a most enjoyable afternoon together. sharing a romantic walk on the seashore, with profound insights on music, gourmet preferences and each other’s lives, her appointments at work, clearly being forgotten. While the film thus portrays the human being within the patient and the professional, it also serves to disappoint the professional viewer, as the very foundations of therapeutic relationships and of appropriate behaviours within their context come crashing down.

The film follows Mr. Jones through a manic phase of illness during which he is seen withdrawing his entire bank balance in one go, proceeding to invite the rather pretty and flirtatious bank clerk for an afternoon of fun. The roller-coaster of his mania takes over both their lives for a few hours, as street food, shopping for a piano for him and clothes for her, intimate moments in a swanky hotel room, and a visit to the opera follow one another in rapid succession. His attempt to conduct the opera, notwithstanding his later justifications about how Bach should really be played, result in his return to psychiatric care. Poignant moments in the film ensue: when asked about his mania he says, rather emphatically, “of course I am happy; I am ecstatic!” revealing his distinct preference for that euphoric state of mind. Another moment of truth is when he ticks off his psychiatrist for asking intrusive and personal questions, pointing out that it is rude to do so. That psychiatric illness is dehumanising and strips the sufferer of his dignity, even through these seemingly mature and civil interactions, is well brought out here.

Mr. Jones slips, (as he inevitably must) from the high of mania, into the depth of depression. His distress, despair and pathos are well brought out, moments of anguish being portrayed sensitively. Once again, however, the rather unusual client-therapist relationship comes to the fore.

In general, physical closeness between client and therapist is discouraged; a firm professional handshake being, perhaps, the only physical contact endorsed; children and the elderly being possible exceptions. Here, client and therapist share hugs rather freely and with complete abandon. His long stay in the treatment centre where his therapist works, allows us brief insights into the lives of other patients and therapists, their trials and tribulations. An act of violence against our heroine by another deluded inmate, and Mr. Jones’ extraordinary presence of mind in saving her, result inevitably in increased closeness.

Dealing with rejection

It is only in cinema that a professional psychiatrist and a client admitted under her care go for a drive together, get drenched in the rain and end up making love. Nevertheless, these actions seem to bring about awareness in our heroine, about having crossed a professional line, and she seeks to remedy matters by discussing the situation with a professional colleague, taking herself off the Mr. Jones’ case.

Her rejection of Mr. Jones also brings to the fore earlier rejections by those he is intimate with, but who cannot deal with his bipolar tendency; the changes of mood and impulsive actions that accompany this disorder. She finds out that “Ellen”, his former girlfriend whom he often refers to as “dead”, is indeed alive. Mr. Jones merely deals with her rejection of him as “death”; death for him perhaps of an ideal, a persona; of hope and long cherished dreams. The tribulations of those who live with bipolar disorder sufferers come to the fore here.

Rather poignantly, the bank clerk who spent a roller coaster day with our protagonist visits his psychiatrist to enquire about his well being. Her inability to understand how such a remarkably funny, engaging and talented person like Mr. Jones could possibly be ill is common experience. The hypo-manic state where euphoria is predominant and actions expansive; the full blown state of mania where the person loses the ability to reason and is out of touch with reality; alternating with states of depression or low mood, poor appetite, low energy levels and insomnia characterise this disorder. While all of us experience some mood swings, they are usually in consonance with our circumstances and proportionate to them, which is not the case in bipolar disorder.

The film also brings out the common biological explanation for this condition, that it is due to a chemical imbalance in the brain, and that there is need for compliance with drug treatment, so necessary here. In one rather fetching moment, our heroine drops Mr. Jones at his doorstep, and as he crosses the road to his house, tosses across his medication, “your chemicals”; as she drives away Mr. Jones is seen tossing the pills into the litter bin, and walking nonchalantly home. This failure of patients to be compliant with treatment, one of the greatest challenges in managing psychiatric illness, is well portrayed.

Issues to the fore

During the audience discussion, the ability of Mr. Jones to choose whether he needs admission or not; the long conversations and therapeutic sessions he has with his psychiatrist; the need for a court order for his treatment are issues that come to the fore. Many wonder whether such interactions are at all possible in the Indian context and indeed whether they exist.

Professionals in the audience hasten to point out that Hollywood has undoubtedly taken liberties, and that there are cultural differences between the American setting and ours; that civil liberties for the person with mental illness are common around the world, although lack of awareness and education lead to their being transgressed in low and middle income countries. The ongoing redevelopment of India’s Mental Health Act is also discussed.

The client-therapist relationship comes in for much discussion; professionals in the audience ruing the unfortunate tendency among filmmakers to portray such romantic relationships. A call to filmmakers for more accurate portrayals of mental illness and therapeutic relationships is made. However, the group also acknowledged that film, like other art forms, is a caricature and thrives on dramatisation and exaggeration. View it with a pinch of salt is the common refrain.

The film ends where it begins. Mr. Jones is on the roof again, although his dejection and despair make us wonder whether it is to fly with childlike abandonment, or to die in abject surrender. True to cinematic endeavour, the heroine arrives in the nick of time to save his life and the couple unite in romance, her professional vows seemingly a distant memory. Will Mr. Jones’ ever get better? Will his heroine ever get to practice psychiatry again; lose, as she will, her medical license for consorting with a client? Will they live happily ever after?

The viewer is left with these and other questions as this rollercoaster of a film ends. It does underline for us, clearly, the travails of bipolar disorder, the importance of mental equilibrium, and of maintaining in our lives, a fine balance.

Quick facts

Psychiatric illness is dehumanising and strips the sufferer of his dignity, even when interactions are mature and civil

The failure of patients to be compliant with treatment, is one of the greatest challenges in managing psychiatric illness

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A sustained, integrative effort towards getting better is important for the elderly

Buddhi Clinic observes World Alzheimer’s Month

A 3M approach to elder care that involves memory, mobility and mental health was advocated at a programme held to mark World Alzheimer’s Month at the Buddhi Clinic on Saturday.

Speaking about the theme for World Alzheimer’s Day this year, which focussed on diagnosis, Ennapadam S. Krishnamoorthy, founder, Buddhi Clinic, said this made the 3M approach even more relevant.

He further shed light on how integrative medicine can make a difference for the elderly. “The emphasis for older people is often on getting one big procedure done to knock a condition out of the park, when it should actually be on a gentle and slow process towards getting better. A sustained, integrative effort towards getting better is what is important.” 

Dr. Krishnamoorthy spoke about the ‘Buddhi’ philosophy and stressed on the need for harmony between modern science and ancient medicine. “All disciplines have something to offer, and we need to identify and take the best of this. We should not work in competition but rather in collaboration,” he said.

The results of a study on taking an integrative approach to address cognitive disorders, which was carried out by Buddhi Clinic among 25 persons over the age of 55 with mild cognitive impairment showed that 75% of the patients showed an improvement at eight-week intervals, said Dr. Krishnamoorthy, sharing the findings.

A series of talks on managing pain and mobility, ayurveda for brain health, yoga and nutrition for brain health and sharing the experiences of a patient were made by doctors and other professionals from the Buddhi Clinic. Urging persons above 45 years to get a memory screening done, Dr. Krishnamoorthy said Buddhi Clinic was offering free memory assessment screenings to mark World Alzheimer’s Day.

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Canine Neuropsychiatry Featured

A Rottweiler’s multiverse

Before you judge the breed, think again

My name is Kaiser, and I am a Rottweiler who lives in Chennai. The person writing this on my behalf is dad, the leader of our pack. I am of German and Serbian stock, and my origins go back to Rottweil in Germany, a town founded by Romans in a cattle-herding region. I owe my large head and snout to the mastiffs I was bred from, and my intent watchfulness to my role as a guardian. Indeed, butchers would hang their purses around our necks to keep them safe.

To my family, I am an affectionate goofball, prone to sit on their feet unmindful of my size. I calm down to the meaningful Malayalam song Manushyan Madhangalai Shrishtichu by K.J. Yesudas, written by Vayalar Rama Varma for the movie Achanum Bappayum. That together with my penchant for tearing newspapers and disliking men in uniform has led dad to conclude that I must have been a left-leaning, chai-sipping newshound in my last birth (notice the oxymoron).

My greatest joy is my morning walk with dad, our “me time”. Because I am hyperactive (dad says ADHD), I am sensitive to my environment — joggers, people who look me in the eye, whirring cycles and mopeds, people sporting helmets, umbrellas, head-covers, my list is long. My usual response is to charge in the general direction of the offender, and after a few surprises (torn sleeves, falling men and himself included), dad muzzles and harnesses me for these excursions.

Here are a few classes of humans I meet every day.

The dogo-philic: they love us and want to play, little realising that I, Kaiser (that’s German for Emperor), do not care for trifles.

The dogo-phobic: I can spot them a mile away, but they cross the road to avoid us; no fun but no trouble either.

The dog-agnostic: folks who don’t seem to recognise “the dog walking”. Here I am, 45 kg, deep-chested, big-headed, putting on my best swagger, and they walk right into us, preoccupied with their phones, companions, or thoughts. Being agnostic of me is not really wise, methinks!

The dog-walkers: Unlike us, many of these folks are not purposeful walkers; they amble, stop to socialise, hang around street corners. I believe it was George Bernard Shaw who said “Golf is a good walk spoilt!”. Now let’s paraphrase that, shall we? And of their dogs, the wise ignore me, the foolish bark, and the insane wail!

The talkers: “It’s good to talk,” says a popular telephony brand, but some take that slogan too seriously. When folks want to chat or socialise, I can be quite upfront about my disapproval. Those who don’t give up are greeted with a leap in their direction, which never fails to get them scurrying along.

The term multiverse was coined by American philosopher William James in 1895 to refer to the confusing moral meaning of natural phenomena. As a much misunderstood breed, I have described my multiverse to you. Despite my many redeeming qualities, the world views me with trepidation, not understanding that my responses are wired into me, through nature and nurture, by my evolved status as a guardian breed, created for humankind, by humankind, of humankind. Before you judge me and my fellow-Rotties, think again!

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Canine Neuropsychiatry Featured

Lessons from a bullmastiff

The writer is all praise for the pet he brought home as a puppy and who is now a loyal companion.

About a year ago, I became the fortunate owner of a Bullmastiff. An eternal dog-lover, I acquired my first dog, a Beagle, when I was 11 years old. Over time, in my journey to middle age, I have experienced life with three other (all long-lived) dogs — a Labrador, German Shepherd and Basset Hound. En route, thanks too in part to my professional predilections, I have developed an interest in dog behaviour and temperament. My focus on the mastiffs as a generic breed, followed my search for a guard dog, one that could innately discriminate friend from foe, and innocuous experience from potential danger. My search ended when my sister found a home-bred Bullmastiff litter on Facebook, culminating in a frantic drive to Bengaluru with my 9-year-old son, to choose our puppy. Thus began our tryst with a mastiff.

Widely described as “reliable, devoted, reserved, protective, alert, docile, loyal, calm, powerful, courageous and loving,” the Bullmastiff shares the characteristics of the Molosser dogs used by gamekeepers to guard the old English estates. Indeed, its progenitor, the English Mastiff, while alert and formidable, was thought to be too slow and plodding to take on the poacher and his dog, the lurcher. By crossing the English Mastiff with the Old English Bulldog (now extinct) in the late 19th Century, the compact, muscular and agile Bullmastiff came into being.

Legend has it that it was introduced at a fair, when a man challenged those present to try and outrun his dog; the man who tried, failed gloriously in his attempt, being brought down thrice by the Bullmastiff. Only one of about 13 mastiff breeds, the tallest being the Great Dane and the largest the English Mastiff (Argentina, Brazil, North America, parts of Europe and Eurasia, Tibet, all being represented in the mastiff family), the Bullmastiff is a large domestic dog with a solid build and a short muzzle.

I was inclined to choose a male puppy, having never brought up a female dog. Surprisingly, the advice I received from the breeder was to choose a female, as I would not, as a first time Mastiff owner (albeit experienced dog lover), cope with a male. I was also advised to build a dominant relationship with my dog, an egalitarian relationship being unsustainable with this breed.

“This is not a Labrador that you are taking home” said the gentleman repeatedly, with genuine concern. As it happens, Layla the Enchantress (as we named her), chose us and we were soon on our way home. In the car, all of two months old, she was composed in a way that was hard to believe. We would stop ever so often to give her a drink of water and/or a loo break, on the six-hour drive to Chennai, and she cooperated as if she had done it many times before, not soiling the car once, nary a whimper. Arriving home, we soon settled into a routine of feeds, exercise, toilet training and play.

Over a few days, Layla settled into our home having explored every nook and corner. In weeks, we could see why she was the “Gamekeepers’ Guard Dog”. Every sound was attended too, every person considered an intruder until introduced, every shadow a reason for suspicion. Indeed, late one night when she was asleep inside a bedroom, our son quietly brought in his friend for a natter. Any illusion of having cheated young Layla was destroyed in minutes, as she emerged from her apparent slumber, growling, the hair over her spine erect (distinctly coloured too), and proceeded to search the house until she had identified the intruder’s location and barked at him, until introduced properly. Indeed, the mastiff will not attack an intruder; instead it will rush towards him barking (a formidable sight), corner him and continue to bark until reassured.

Our morning walks are a daily highlight and eagerly anticipated. Within minutes of setting off, Layla “will do her jobs”, ensuring the remainder of the walk is a holy communion between man and beast. Indeed, by the time she was four months old, I had her walking “off leash” on the footpaths alongside the arterial roads near our home. Not once has she lost her composure, even when we come across another excited dog. Not once has she attempted to leave my side, except when I have meandered from my usual path into unfamiliar territory. Not once has she attempted to lead me; instead in classic pack animal behaviour, she waits at doorways, gates, even pathway dividers, for me to lead the way, acknowledging my pack leadership. Not once have I had to strike her, raising my voice, even an angry glance being enough for her to alter her behaviour suitably.

It is not that she has not tried to push the envelope, that being the predilection of this breed. Everyone is tested for their ability to “stand up”. For those who fail the test, Layla is the pack leader, and they must therefore follow her. The few who succeed are rewarded with loyalty and obedience that is par compare. Only one person, though, is given the privilege of being the “master”, and accorded unquestioning obedience and unbridled affection. From knowing which piece of furniture to occupy and which ones to avoid; begging for a scrap of food with immense dignity, yet never grabbing it from the table, even unattended; sitting still in a public place with amazing grace, surrounded by a hundred curious strangers, the Mastiff demonstrates a poise that is both awe-inspiring and endearing.

Many dog breeds have superior intelligence and can be trained to perform a range of often astonishing tasks. What intrigues me about the mastiff is its “sixth sense”, the instinct to modulate its behaviour in accordance with the human species; to have a place for everyone in its heart, and for everyone to have a place in its social pecking order. The innate power to discriminate between different human beings, their relevance to context and intentions.

Of course, the Mastiff is not alone in being able to do this. Among snakes, the King Cobra is thought to share this unique sixth sense. Indeed, herpetologist Romulus Whitaker describes rather eloquently, an incident during the making of his documentary, when he got too close to a King Cobra, who proceeded to warn him by rushing in his direction without biting and when the offence was repeated, proceeded to bite his behind. Whitaker credited being alive to his thick jeans. Other examples of the “superior intellect” this 12-18 feet long king of snakes possesses, are permitting its trainer to kiss the top of its head (as it stands erect, hood spread out) and indeed permitting lady trainers to dance for an audience with its head inside their mouth, both these being part of public performances in South East Asia. Once again, the innate ability to distinguish friend from foe and build a relationship with a “master” appear to be unique to this sub-species. Of course, stories abound among those interested in the animal kingdom about unique human-animal bonding: many dog breeds, elephants, the big cats, dolphins and killer whales, all being included.

So what is it about these sub-species that confers upon them such uniqueness? From my Bullmastiff, I have learnt the importance of mutual respect; of routines and predictability in interaction; of being assertive without being aggressive or offensive; of integrity and faithfulness; and of demonstrating love unabashedly when it is due. When Layla joins me on my favourite couch, sits on my head, all 50 kg of her, demanding to be petted at the end of a long working day, I am reminded that the best form of love is “tough love”. Indeed!

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Canine Neuropsychiatry Featured

Temperamental, Indeed

How the contrasting behaviour of two dogs can give one an insight into brain dominance and enhance understanding of human nature.

Life with my pet canines is not just joyful and entertaining; it reveals to me each day, profound neuro-scientific insights. Carlo, my German Shepherd, is a classic example of his breed; in looks and temperament. A “Master’s” dog, his life revolves around my routines. A glance in his direction, slight change in tone, low whistle, all will ensure his immediate compliance with “his Master’s” desires. Obedient and devoted to a fault, Carlo is also extremely high strung and anxious, alert to every change in his environment, and protective of it; so much so that I rarely catch him in fitful slumber. Blessed with an uncanny sixth sense for “his Master”, a trait that his breed is famous for, Carlo actually heads for the gate, minutes before my arrival at home from work. Not one to break rules, he will not enter a room or defile a piece of furniture, once forbidden. Natty and fastidious about his appearance, he remains shiny coated through the week, not an ounce of dirt on him, nor a doggy odour.

Unpredictable and wilful

Contrast this with my later acquisition Coco, a Basset Hound. A handsome specimen with the classic sad and droopy face, jowls et al, Coco suffers from both occasional seizures and frequent mood swings. An approach in his direction, with best intentions, can evoke dramatically different responses: from a friendly, excited, tail-wagging welcome, to total loss of control; sometimes a resentful, even angry growl, bark or snap in the general direction of approach. Unpredictable mood swings from hypomania and hyperactivity to depression and profound apathy characterise his eventful existence. Disobedient, wilful and obstinate, he can be depended on to do exactly the opposite of what is intended, oblivious to “his Master’s” pleas, commands and threats. Indeed so agnostic is Coco of his surroundings that he can collapse like a sac, his numerous folds spread around him, in fitful slumber, no matter what the circumstances are. House rules mean little to this brat! Stride he will into any room at will, climb on any piece of furniture that strikes his fancy; and somehow manage at least once in each week to manifest for our benefit the pinnacle of filth; no part of the garden, however muddy, having been spared during his meanderings.

Not surprisingly, he emits a profound doggy odour so striking that dog lovers claim it should be bottled and sold (Chanel by Coco is our private joke). Guests without a fondness for canines, beat a hasty retreat from our abode when he decides to bless our company with his presence.

The contrasts in doggy behaviour become most apparent in our morning walk together. Carlo, the German Shepherd, needs no leash, walking three to four kilometres on the footpath that runs alongside arterial roads near our home. Rarely straying more than 10 feet from “his Master”, purposeful in his stride, nary a glance asunder, whatever the provocation, Carlo is the epitome of walking propriety, even his ablutions being timed for completion at a certain discreet spot.

Coco, the Basset Hound, on the other hand, treats the walk as a grand exploration of sorts; an opportunity to experience for himself this beautiful world that the good God has created. Constantly tugging at his leash in an angle perpendicular to the general direction of travel; sparing no human, animal or plant form en route from his nasal excursions, Coco is anything but purposeful about his morning constitutional, his ablutions being intermittent and erratic, intruding into the well directed journey of his fellow canine and Master, much to their combined annoyance. No order is heard, let alone obeyed; no single purpose complied with, other than that, which his doggie mind is set on.

My clinical experience in brain and mind matters has led me to conclude that Carlo, my German Shepherd, is left-brained and Coco, my Basset Hound, right-brained. The concept of hemispheric dominance, i.e. which side of the brain has a more dominant effect in the concerned individual, is one example of how brain function may influence behaviour and temperament.

Left brain dominant individuals tend to be more ideological and philosophical in their approach; more motivated by social and pragmatic, rather than emotional concerns; more diligent, purposeful, capable of greater tenacity and driven more often by a sense of duty.

On the other hand, right brain dominant people have a better appreciation of the world around them, greater creative ability; a proclivity for the finer aspects of life; and tend to be more mood and emotion driven in making their choices; both day to day ones and those that are life-defining. Put simply, left brained individuals think with their heads, the right brained with their hearts; and can be quite a study in contrasts, experiencing great difficulty understanding one another. Little wonder then that many professional and personal relationships run into rough weather; the two parties failing to understand each other’s contrasting preferences and predilections.

Unique temperamental attributes

Carlo and Coco have taught me that brain dominance is not an exclusive prerogative of the human race. And love them as I do, equally, I have learnt through them to celebrate rather than despair in these unique temperamental attributes conferred on us by our brain, that marvellous wonder of creation. To understand my family and friends better by observing their brain dominance. To choose correctly my activity companions: left brained for the purposeful and right brained, the hedonistic; and to tailor my expectations of them, appropriately. Carlo and Coco have enhanced my understanding of human nature; and thanks in part to them, I find myself at peace with my fellow men; well most of the time. It is a dog’s life, indeed!

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Featured

THE INDIAN SCENARIO OF MENTAL HEALTH

Dr. E.S. Krishnamoorthy , Behavioural Neurologist & Neuropsychiatrist, Founder of Buddhi Clinic in conversation with Dr. Sameer Parikh and Ms. Gayathri Prabhu.

Dr. E.S. Krishnamoorthy, Behavioural Neurologist & Neuropsychiatrist, Founder of Buddhi Clinic in conversation with Dr. Sameer Parikh who trains doctors, psychologists, and other mental health specialists, and Ms. Gayathri Prabhu who teaches literary studies at Manipal University and is an author of a memoir, “If I Had To Tell It Again” and has written few other novels like Maya and The Untitled. Dr. Sameer is the author of two books, one for children and one for adults.

Mental health. A word that is highly neglected by Indian society. In India, experiencing mental health issues is seen with suspicion, and individuals suffering from mental illnesses face stigma. Mental problems are frequently thought to be the result of a lack of discipline and determination. Mental health stigma, as well as an absence of availability, affordability, and knowledge, contribute to major disparities in treatment. ‘There is a deficit of experts and I don’t think it will compensate for a long time because the deficit is too high’ said Dr. Sameer Parikh.  He also added how important it is to address mental health issues in the early stage and find preventive measures for them. While finding the solution to an issue, we should also make the effort to learn more about mental health and the doctors should take the initiative to impart the knowledge to the rest of the world. Another insightful thing mentioned by Dr. Sameer was that teachers and counsellors who work with adolescence will know what mental health issues they go through and how they can tackle them. ‘True change of mental health advances can only happen with the help of teachers and not purely by experts because we don’t have as many’ he added.

When Dr. Krishnamoorthy asked Ms. Gayathri Prabhu about how depression or any mental health issue of a person can affect their family member or the caretaker, she read a small part of her book where she wrote about her father’s illness. It reads, ‘Why? It is always the first question depression sparks. Where did this come from? Not asked from a diagnostic mood but in avoidance or curiosity or habit. If it is here, if it is in our mind, we need to ask what is to be done.

If mental health issues remain a stigma, then help-seeking behaviour will be prevented. If people don’t seek help, then there won’t be any change in the issues in society. ‘Help-seeking is not going to a doctor. Help-seeking is starting a conversation. Recognizing you have a problem and you need to find a solution’ informed Dr. Sameer. Ms. Gayathri said that stigma is her fear. It is an individual’s fear. When a person wants to seek help, they keep anticipating the reaction of society and this stops them from asking for help.

It is critical to remember that determining mental disease can only be done by establishing screening benchmarks. There is also an urgent need to dispel the myth that mental health is just the prevalence of mental health issues. Long-delayed debates and efforts to address the issue of access to mental health care are now making their intentions clear. Careful mapping and investigation are required to provide quality data, which is required to grasp the scope of the problem.

Dr. Krishnamoorthy has covered everything from adolescence depression to substance abuse in The Hindu Lit For Life (LFL) 2019.

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Featured

Covid-19 And It’s Spread Over The Mind.

Dr. E.S. Krishnamoorthy , Behavioural Neurologist & Neuropsychiatrist, Founder of Buddhi Clinic in conversation with Dr. Pratima Murthy, Dr. Shekhar Seshadri, and Dr. Soumitra Pathare.

The world has experienced a surge in the concern over mental health during the Covid-19 times, the concern has been to the extent that words like pandemic, covid, lockdown, quarantine and many more have come to be associated with ‘mental health.’ Dr. E.S Krishnamoorthy, Behavioural Neurologist & Neuropsychiatrist, Founder of Buddhi Clinic, virtually sat down with Dr. Shekhar Seshadri, child psychiatrist, a senior professor in the department of child and adolescent psychiatrist and dean of the behavioural sciences division; Dr. Soumitra Pathare, a consultant psychiatrist and director of the center for mental health, law and policy: Indian law society, Pune;  Dr. Pratima Murthy, Professor and Head of the Department of Psychiatry, NIMHANS.

Dr. E.S Krishnamoorthy began the panel discussion by pointing out the irony of a world which changed due to a virus instead of wars and governments. He also noticed that the thing that changed the most is the impact that the pandemic has had on the mental health of people and awareness about the importance of mental health. 

“There is no health without mental health,” Dr. Pratima Murthy observed. She explained that the initial stage of the lockdown was met with a positive response but it was soon overpowered by anxiety over sickness, family and hospitalization. She proceeded to exemplify the following with a personal experience while simultaneously pointing out that the most difficult part of the whole experience was the loneliness of the mental trauma, sickness and death due to the pandemic. Dr. Seshadri added onto the topic raised by Dr. Pratima and discussed the patterns of coping and stress of children during Covid-19 and their lack of understanding regarding the pandemic, angst about hospitalization and grief over loss of their parents, social interactions and predictability. He also mentions “intolerance of unpredictability.” Dr. Soumitra Pathare took over and talked about the emergence of awareness of mental health in Middle class India and the hoarding of the meager human resources for mental health by the privileged class of people. 

Dr. E.S Krishnamoorthy questioned Dr. Pratima Murthy on the impact of the pandemic on women and she explained that there is a treatment gap and the services are not gender sensitive along with economic disparities, multiple roles expected of them and the stigma around seeking help. She also talked about the increase in domestic violence and the burden over working women to take care of their children, compared to working men.

When questioned by Dr. E.S Krishnamoorthy about the impact of the pandemic over the special needs children, Dr. Seshadri responded that pandemic and covid have a disproportionate response on the more vulnerable people. He carried on by explaining the difference between equality and equity and related it to the issues faced by the special needs children. Contrasted to him, Dr. Pathare discussed the discrimination faced by adults with mental illnesses and the ignorance of the authorities, even during covid, to include them in the ‘at-risk’ population until ordered to do so by the SCI. Contrary to that, the hospital of Dr. Pratima made sure to protect the individuals with mental illnesses and recognise them as “at-risk” individuals.


The discussion moved onto the vulnerable groups of India, Dr. Pratima talked about addicts and their problems; girl child and children with lack of technology; chemical and behavioral addictions. Dr. Seshadri stated that developmental psychology hasn’t considered the evolutionary impact of the Pandemic on the young children.  

The panel moved onto the subject of suicide, domestic violence and alcohol consumption as well as the connection between the three. Dr. Pathare talked about the dependency on alcohol and the lack of alcohol without access to treatment during the lockdown. 

The discussion concluded with highlighting the positive aspects of technology and the interconnectedness it provided to people during the times of stress and anxiety. The panel proved that the existence of Covid-19 had a toll on not only the physical well being of the citizens but also the mental health.