Dr. Avinash Dsousa – Mental Well-Being of Children – Trinayani

What is the difference between psychiatry and psychology?

Psychiatry is referred to as the treatment of mental health (manochikitsa), and psychology is the scientific study of the mind and behavior (manovigyan).
Those who practice psychology usually have an M.A. degree and study in the arts stream.
In some colleges, they study in the science stream and pursue an M.Sc. in Psychology.
A psychiatrist, on the other hand, is a doctor.
They first complete the basic MBBS course, followed by a three-year specialization in MD Psychiatry.
Psychiatrists not only provide therapy, but also prescribe medication and offer counseling, while psychologists assess the mental condition of patients using various tests to determine the extent of their mental distress, they also provide counseling and therapy.
If someone has a mental health condition or disorder, should they consult a psychiatrist or a psychologist?
Generally when a mental health condition arises, people tend to visit a general practitioner or their family doctor.
The family doctor generally refers the patient to a counselor because it is less intimidating and they feel that the counselor won’t prescribe medicines but would simply talk or have a discussion to find a solution.
So, usually people visit a psychologist first.
When a psychologist believes that the issue is too severe to be addressed by counseling alone and medicines are needed to be prescribed, they may refer the patient to a psychiatrist.
Sometimes people go directly to psychiatrists, but it’s not always necessary that they will be prescribed medication.
Psychiatrists may also suggest that medication isn’t required and that the issue can be resolved with counseling alone.

What are your thoughts on the increasing prevalence of mental health conditions among school-going children?

In today’s digital age, especially after the COVID-19 pandemic, many children who had no prior exposure to digital gadgets suddenly were attracted and had access to them, at a very young age.
Children who were meant to receive a mobile phone in grades 8, 9, or 10 are now getting one as early as grade 5. Similarly, those who were expected to be introduced to gadgets a few years later are now fully exposed to them much earlier.
This has led to an increase in gadget addiction among school going children, and we often see that children have difficulty concentrating in classrooms.
Their tolerance level has decreased leading to depression, anxiety, worrying and aggression.
Previously, there was a limit to the challenges children encountered. However, with the rise of the digital age, globalization, and other factors, they now cross these boundaries more easily. While there was once a level of understanding and tolerance for such issues, the prevalence of mental health concerns among children has significantly increased.
Nowadays, even primary school children are experiencing depression
They struggle with anger issues, find it difficult to sit still in class, they don’t listen to the teacher, speak back, and exhibit signs of anger and frustration.
A lot of this is due to the kind of content they are exposed to online, which negatively impacts their mental health.
At times, YouTube features videos that encourage viewers to prioritize finding a job over studying, which can create a misleading impression in a child’s mind.
Some children, influenced by content that encourages them to take whatever they desire, may even resort to stealing. The psychological impact of online content on young minds remains unpredictable.
As a result, mental health conditions can be observed in children from a young age through secondary school.

Could you share your insights on how a child’s disability impacts both the child and their parents?

First of all, children with disabilities have a greater number of mental health problems because they feel that their disability makes them different.
They believe their ability to work, study, or understand is lower than that of non-disabled children. Feeling physically different, their confidence is diminished from the very start.
The parents of a children with disability might have shame, anger or worries about the child’s future.
When raising children with disabilities, parents often experience stress due to the challenges involved. They may show signs of depression, struggle with acceptance, or feel a sense of shame.

What strategies do you employ when supporting parents and children with disabilities?

When parents of children with disabilities come for a consultation, we not only work with the child but also ensure that the entire family understands disability, its challenges, and the potential of a child with a disability. This awareness is crucial for their growth and support.
It’s crucial for parents to accept their child and understand their disability.
Until families fully accept this perspective and shift their mindset and viewpoints— understanding that even if a child has limited abilities, we should support them in reaching their highest potential — they will no longer feel ashamed of their child’s disability. Instilling this mindset in parents is key to fostering acceptance and growth.
Overcoming this initial shame is very critical.

How do children with physical disabilities navigate body image as they grow older and interact with their peers?

This is an important matter, because when we look at students in grades 8, 9, and 10 – who are in the adolescent phase – both physical and mental development occur.
Children with disabilities, especially those with physical disabilities, often experience developmental delays in certain areas of their bodies, leading to difficulties in walking, sitting or getting up.
People stare at them and perceive them differently in public spaces such as cafes, hotels and other social settings.
Although acceptance of disability has improved, people are still not entirely disability-friendly.
When these children reach grades 11 and 12 or enter college, they begin to notice how others around them live their lives.
They see an attractive boy going on a date with his girlfriend or a beautiful girl with her boyfriend, and they start to wonder, “Do I look different?”, “Why don’t I have a boyfriend or girlfriend?”, “Is there something missing in me?”, “Why is my face like this?” or “Why is my hand like this?”, “Why is my leg like this?”
These thoughts can lead to feelings of shame toward their own bodies and, in some cases, even self-hatred.

Do you help parents of children with disabilities talk about sexuality as their kids reach adolescence or adulthood?

When parents come to us with children who are going through this stage of life, we notice that sexuality is a topic that no parent brings up.
They assume that since their child has a disability, they would not have any sexual desires or thoughts, which is a completely incorrect assumption.
The children have a body, and within their bodies exist various chemicals, hormones and emotions.
Their minds function just like anyone else’s, and it is natural for them to have sexual feelings.
However, they often struggle with expressing these emotions, and there is a deep sense of hesitation when it comes to discussing such topics because of their disability.
Parents never talk to their children about sexuality, and if the child ever initiates the conversation, parents often react with, “You are already struggling with so much, and now you want to talk about these shameful things?”
This reaction scares the child, making them hesitant to ever bring it up again.
This is why open conversations are extremely important.
The children have their own bodies, their own rights, and one of their fundamental human rights is the ability to express their sexuality.
And sexuality is still a taboo topic in certain sections of society, but it is essential that we start discussing it openly.

Do share your thoughts on suicidal tendencies among children with disabilities.

When we observe children and adolescents with disabilities, we often notice that they struggle with feelings of hopelessness, sadness, anxiety, and worry.
When these emotions become overwhelming, thoughts like, “What is the point of my life?” or “Why should I even be alive?” can arise in their minds.
At that time, they may even start having suicidal thoughts.
We see this especially among the children who lack family support, or who are condemned by their own families, or who are mocked.
If they are bullied at college, if their photos are taken and turned into memes or inappropriate images circulated online, it affects their mental state deeply.
These situations can push them toward suicidal thoughts.
Just as we hesitate to discuss sexuality in the context of disability, we also avoid talking about these serious mental health issues.
Parents often believe, “My child already has so many challenges, why would they think of suicide?”
They assume that because their child is physically weaker, they wouldn’t have the strength to take such drastic steps, however, it is crucial to ask children and adolescents the right questions.
If anyone we see is feeling hopeless, sad or anxious, we must ask, “Do you feel like your life has no meaning?”, “Do you ever have thoughts of ending your life?”, because if we do not ask, they will not tell us.
But if we do ask, and they open up about their struggles, we might be able to save a life through timely intervention.

What advice would you give parents to help their child with disabilities feel comfortable opening up and communicating?

I always tell parents: If your child has a disability, make it a habit to sit and talk with them every single day.
Dedicate at least one or two hours to them, the mother an hour, the father an hour, and they should have conversations about various aspects of the child’s life.
Ask them how their daily routine is going, how their friends are, whether they face any difficulties in school or college, in the classrooms, if they are having trouble studying.
Parents should assure their children that whatever may happen, they’ll always support them – “Whatever may happen, we will fight and win this battle, we are with you, even if the whole world turns against you.”
If the child has this assurance and support, the child can strive to achieve whatever they want in life, finding ways to work around their disability.

What are your thoughts on the stigma associated with seeking help from psychiatrists?

Often, when we suggest that a parent or child consult a psychiatrist, they associate it with shame.
This stems from the belief that seeing a psychiatrist is a sign of mental instability, and that psychiatrists are only for treating “crazy” people. Many people also fear that a psychiatrist might admit them to a hospital and administer electroshock therapy, due to misconceptions and stigma around mental health care.
So, this creates a fear among the people.
But a psychiatrist is like any other person – he is a father, a brother, he has children, he earns a living – he has studied psychiatry to treat you and is a doctor.
He is not a person sitting inside a hospital with a stick to electrocute you and torture you.
So, this definition (idea) of a psychiatrist needs to change.
The second idea is that when a psychiatrist will prescribe medicines, a person will get addicted to it.
So, I always tell people: “If you had a problem with your kidney or heart, you would take medicines, but with a mental health issue, you are not ready to take medication”.
And now in 2024, we have plenty of medicines with no side-effects.
The medicines are effective and provide proper treatment, and the medication is discontinued once the patient has recovered.
If we get over these myths and consult a psychiatrist, many people will receive support in their mental health journey.
Many times, people hesitate to seek help for mental health issues because of stigma, shame and fear.
There is a taboo surrounding it and people think that having a mental health issue is equal to being crazy, but the two are different.
Anyone may have depression – according to WHO, one in three people have depression.
Therefore, in a room with three people, one may have depression.
So, it’s not that everyone will be crazy – and there’s a cure as well – but this stigma of “What will people say?”, “people might think I am crazy, or my child is crazy”, this fear among the people in India and in many other countries, this deeply ingrained fear prevents them from seeking the help they need.
Breaking this stigma is essential, and it is the responsibility of today’s generation to ensure that we break the stigma.