Dr. Zirak Marker Talks About Mental Health With RTN. Dr. Prakriti Poddar
I was talking with a young adult about going to gym. I asked him if he went to exercise because he was unwell, for fitness perspective or overall health. He said he did so for his health. That made me question why we never go to see a psychiatrist or a therapist to check in whether our emotional and psychological well-being is intact.
When you have a mental health illness or a disorder, it is termed an illness because it is one. We can do a blood test to see if we have diabetes or Vitamin D3 deficiency or high cholesterol level. Still, there is no way to simply diagnose mental health through a test or medical intervention. That is why the clinical symptoms are so important to flesh out, to know what you are diagnosing and how you are taking that treatment forward.
Researchers have indicated that just as we have hormones in our body, there are certain neurochemicals in our brain. The most widely researched one is dopamine which helps us with our thought processes and impulses. Serotonin is responsible for your moods. You may or may not have a contributing factor but when neuro-chemicals like dopamine and serotonin are imbalanced, you can have mental health illnesses or disorders. This could be clinical depression, anxiety, panic attacks, bipolar disorder, or all the other labels we have.
Each of us here today has had psychological and emotional setbacks, and that is how I look at mental health in that spectrum from wellness to illness. It is important to reiterate that it is a clinical aspect and a neurochemical imbalance. There is therapy and medication that helps, just like tablets for cholesterol levels or insulin for diabetes. You have smart and intelligent treatment profiles for psychiatric condition analysis as well. It is the overall sense of well-being in that spectrum, that is how I look at mental health.
Now, more than ever, WHO is talking about how mental health is the next crisis after the pandemic if it is not already a crisis.
What do you see as the key challenges before this generation and the elderly?
I put them into four categories. One is the children. I call them lockdown babies because they might have been born in the lockdown period or immediately before. They don’t know normal school life. Some of them haven’t been exposed to any of the experiences of children up to the ages of seven in normal situations: playschool, nursery school, play dates, kindergarten, birthday parties, loud sounds and noises, swimming and running in open spaces. They have been deprived of it all. All these experiences have been taken away from them, so many of them are suffering from social deprivation.
There is not only social deprivation but also sensory deprivation… kids having little playdates at present don’t know how to socialise. Their anxiety or fearful responses are becoming challenges because, otherwise, there is sound, noise, auditory and visual stimulation when you go to a playschool. A lack of that is sensory deprivation. We guide many parents and mothers on how to stimulate these children and integrate their five senses because we see huge chunks of learning lags in these core areas.
Between 8 and 12, we have seen kids overly dependent and almost addicted to their gadgets. They are going through online burnout. You speak to most parents and find kids’ irritability, frustration, headaches, posture problems and backaches. The children are finishing online schooling and going back to their gadgets and games. I know kids spending ridiculously long hours, like between 12 to15 hours on games like Minecraft, fortnight and so on. Some of these games are incredibly aggressive… kids are very comfortable online with the virtual world and completely uncomfortable when interacting with their social world. We have seen kids in the pre-diabetic state because of unhealthy eating habits, unhealthy diets, not sleeping right etc.
Every one in three kids has been diagnosed with either B12 or Vitamin D3 deficiency because they have not been exposed to outdoor activities or natural sunlight. Then you have the 13 onwards section, which is a difficult age group; the virtual world and excess social media comes with its own risk. We are witnessing a high surge of inappropriate social media, pornography, risk-taking behaviour, interaction, and dating, perhaps with strangers. The biggest fear right now is the dark web. It is not just pornography anymore. We are talking about paedophiles, who are propagating businesses, grooming young teenagers and young adults, sometimes, in that direction. We are looking at a lot of inappropriate content that comes up even when the kids are browsing, and the worst part is that we see a high rise in these virtual groups. You are constantly frustrated and bored, emotionally disturbed and stressed, and you will be interacting with a whole gang of other teenagers who are as depressed or anxious around the world; you are forming groups and giving inappropriate strategies of coping with stress or distress.
The most common are these crazy groups that tell you how to self-harm. For example, self-cutters propagate that when you are emotionally disturbed, cut yourself, and that will numb the pain, or that is the best way to cope with pain. There is immense propagation of negativity. As adults or stakeholders and/or parents, we need to be aware of this considerable rise. Surprisingly, despite lockdown and lack of basic amenities, there is a high rise of substance abuse, especially marijuana. The sad part is that so many parents are misinformed and feel that marijuana is not a drug and not unsafe for kids. Sometimes parents tell me that they think it is safer than drinking and smoking, which is not true. Marijuana and weed are addictive, and harmful for kids. Marijuana induces psychosis, marijuana-induced panic attacks with depression, cognitive decline, memory focus and concentration problems, further worsening ADHD symptoms and a whole spectrum of other allied issues.
Then, you have other actual mental health concerns. We see a huge rise in anxiety, panic attacks, kids, or young adults with obsessive-compulsive disorder. You can imagine how the pandemic must have heightened those symptoms and made them far worse. Most heart-wrenching is dealing with children between the ages of 9 and 12 or any group that has lost both parents to death because of COVID-19. We see a lot of anxiety and actual post-traumatic stress disorder symptoms because when parents are either in the hospital or have passed away, there is no closure for these children. They are not allowed to visit their parents at the hospital or even go to the cremation grounds. So, that is another spectrum of acute stress. It is not just the loss of parents or loved ones that we are living through but also the loss of a social structure. Loss of jobs, contacts, so many people stuck in different parts of the world, students stuck in Bombay unable to go and fulfil their dreams. I know of parents who have saved all their earnings to send their children abroad to the university, and these children don’t have any campus or college life. They have done all their education online. So, yes, these are the challenges that the kids and the youth are going through. When we were younger, our summer break felt like a year. I mean, I recall coming back to the classrooms and not even remembering some of the classrooms. Can you imagine how a one-and-a-half-year-old will feel? I have a 10-year-old and an 8-year-old. They have forgotten what school life is. They are so anxious. As much as I would like to shield them and make this whole bubble a fun zone, they are anxious; they break down every second or third week. There are questions about death; they see the news, we are talking about it, all going through some form of anxiety or other. We need to be aware that this is going to be getting worse if we are not prepared. Mental health is already a crisis in existence.
You mentioned that there are WhatsApp groups encouraging self-harm. After hearing that, I went to my son’s phone, and he was like, why? That is an invasion of privacy. I told him that he is 13 years old. Anyways, he doesn’t show me his phone, and then he starts laughing about something, and he shows it to my other son. I asked him what it is. He said it is a mime and funny. All I could see of that mime was two people hitting each other badly, accompanied by music in the background. I couldn’t understand what he found humorous in this. It is not a joke; it is violent. When did violence become humorous? I feel mass desensitisation is going on, and I wonder if you have any thoughts about it? It is really scary.
It is not just about the videos and games; those are just videos and games that we know. The most unhealthy is that new voyeuristic and unrealistic videos pop up no matter how much parents block them. We discussed with the cybercrime cell that when you are looking at a dog beaten to death, what is the impact that will have on a child, or you have tied firecrackers to a dog’s tail, it leaves a lot of psychological scars traumatic experiences. Trauma can come in all sorts of forms, and then you have cyberbullying. You have no idea how big that has also become because there is so much exposure to screen time that kids have become more deviant. I don’t know if it is due to boredom or pathologies already existing in their persona. There is a lack of supervision; they are putting up more photographs of their friends, there is a lot of sexual harassment or sexual trolling that happens among 12-year-olds. They are creating hate WhatsApp and Instagram profiles with a lot of comments against some students.
You can’t be afraid of having real-life conversations with your kids. I know many adults ask what is the right age to talk about abuse and sex education? My answer to that is the minute they start understanding the English language. If you read the research and statistics, 80-90% of children who have been sexually abused are under the ages of 7 and 9. When you start having age-appropriate conversations, you are normalising these concepts and normalising mental health. You are providing the right vocabulary to them to make them understand things they are exposed to. Don’t forget, when we were 15-16-years old, we were babies. Now, at 15-16, they are going on 21 because of their exposure and the parenting style that we have tried to achieve in being westernised or open and communicative with them. But that is the realistic approach: that we need to not run away from. We can’t run away from technology. I have seen parents who have gone to extreme ways. They proudly say that their child is seven and does not watch television, or the child is six and has not seen an iPad. And I point out that if nothing, the pandemic has told us that the world is going to take huge technology jumps. There are so many benefits as well. There are many advantages, but if you are more mindful of your conversation, you realise that we bring risk factors into conversations with children. Give them reasons why you are being strict or firm or setting boundaries. I don’t know why the parents are so afraid of disciplining their kids. I believe that in some hard-core disciplinary action of love, sometimes a No is a No. And, yes, they don’t want to hear a no just because I am saying no but give them an age-appropriate rational explanation of why safety comes first, what are risks, why are things age-appropriate; you can’t shy away from these problems.
I tell this at all the schools. We need to have social-emotional learning and a mental health curriculum in schools. You have to talk to your children about death; death is part of life. Use a scientific approach to speak to them. I had to sit my child down and talk about death as well. I spoke to my seven-year-old when we were travelling overseas and saw two men kissing each other on the lips; we have to normalise diversity. We told them we didn’t laugh or put that down because that worsens the marginalisation. Inclusion is important because our next generation will be global citizens; you can’t hush all this. I told my kids that it is normal for a man and woman to fall in love and get married, but it is also normal for a man and man or a woman and a woman to fall in love, get married and have kids. And they both looked at me shocked, but that is the reality of today and why not? If we don’t teach our kids today to be more compassionate, and have more empathy and inclusion, normalise these things, don’t put down someone who has dyslexia or a disability, don’t laugh at someone of a different religion, that is bad. Kids today can be so nasty. I have kids who bully other kids based on skin colour, the cars they come to school in, the designer or not designer t-shirts they wear, the list is endless, and I don’t see it as the children’s fault. I point my finger at the parents. The way we bring up our kids has to be with tough love and more emphasis on emotional intelligence. I come down very hard on my kids if they are not friendly to others. You can’t turn your face away and use expressions like boys will be boys or let them deal with their battles. We have to have our kids’ backs; we have to navigate for them and teach them what is right and wrong; we have to teach them empathy. Only then can we talk about safeguarding the next generation’s mental health.
What is the risk factor for fear and anxiety among the elderly because it has also been magnified during this period?
I see my own parents’ struggle. First of all, there is the absence of normal socialisation. Walking and other things that are good for health and mental health are taken away from them. There is a deep sense of isolation and loneliness and a lot of anxiety. Simple things that we take for granted. I, as a 47-year-old have never done an NEFT transaction on my phone, but the lockdown has taught me that. However, my parents struggle with even sending text messages because they do not belong to the generation that is comfortable with technology. We connect through social media, but when you have eyesight problems, are not tech-savvy, and are generally dependent, it becomes challenging. Especially in that age group when you are proud of your autonomy and responsibility and independence, it is suddenly taken away from you.
You feel trapped, isolated and incapacitated, and that is what most of my clients think. Because they cannot do things that come naturally to the younger generation. All our parents fear to go to the hospital. This is a new stressful factor that is more frightening to envision happening to our loved ones. Those are the main stressors: you age faster; your immunity drops because you are not exposed to the normal external environment. Right now, we are telling every individual to keep moving even if it is just walk up and down in the house, go to the window and breath in fresh air and sunlight, take supplements like vitamins and calcium, zinc, eat healthily, keeping your mind occupied by reading etc. I think it is up to us to be constantly in touch with them. Reaching out compassionately to people around us, to neighbours who are alone, to grandparents who are alone, and to keep them going.
We had so many people call in for their parents suggesting that their parents may be going through catatonic behaviour, and that was really scary. There were a lot of people who went into an internal lockdown.
What you are talking about is the new concept of lockdown fatigue. There are a lot of children and adults going through several lockdown related issues. One is even if you are at home, there is a lot of mental fatigue and physical fatigue, mood fluctuations and excessive lethargy, over sleeping and imbalanced circadian rhythms. Teenagers are up all night and sleeping all day. I know a lot of elders who are sleeping all through the day and at night and sleeping up to 17-18 hours daily. Lot of what we describe as mental fog, difficulty with memory, registration or recall or feeling of helplessness, low moods, irritability in moods, feeling overwhelmed and almost like a Stockholm Syndrome. Even now, when the things are slightly normal, there are so many people across who are afraid to go back to normal life. The Stockholm Syndrome in psychiatry is quite interesting in which they say you identify with your kidnapper, it is literally like you have identified with the virus and this new lifestyle change and it is difficult to come back to what we call normal life.
We are teaching parents to prepare kids to go back to school and have normal school and normal socialising. As adults, we have to get over so many fears. Many adults are now mandated to come to work three or four times a week and they are refusing because their anxiety has suddenly leaped. People going to back to work have started experiencing headaches and more fatigue because suddenly, there is traffic and weather change and everything that is out of the norm. But the risk factors here are pandemic related or in other cases, if there is family history, because mental disorders are also genetic. So, if there is a family member who has had a history of psychosis, schizophrenia, depression or bi-polar there is a high predisposition of loved ones to get mental health concerns. Second big risk factors are life changing events, so shifting homes, financial losses, huge job changes or job-based stresses, death, chronic illness in family or loved ones, all those pose as big life changing events. Even things like marital discord, divorces, individuals going through it, abuse – physical, psychological, sexual, trauma, accidents, these are all risk factors and definitely there are some health conditions which are clear contributing factors. So, some symptoms could be depression and anxiety but lack of Vitamin D3 manifests with mental health symptoms, severe thyroid – hyperthyroid or hypothyroid can mimic symptoms of panic attacks or anxiety, sweating, mood swings, irritability or depression. Then you have diabetes, also. So, there are a lot of endocrinological or hormonal imbalances and medical problems. That is why when we also see clients and families, we don’t immediately label someone with mental health concern. I do a robust set of investigations, check ups and rule out another medical contributor and then work out a treatment plan if it is a psychological condition. A lot of kids go through bullying and a bad time in school or suffer from learning disability which sometimes goes undiagnosed. A lot of kids are dealing with their own sexuality and these are all contributing factors for mental health concerns in the future.
A lot of us lead organisations and it becomes important to be sensitive towards mental health issues and how we support them. People are losing very good talent because the talent is going through a challenging time at this time. So, do we support them, how do we identify what is going on?
It is through platforms like these that you bring more awareness and increase knowledge. There are signs you can pick up even as lay people. There is an intuitive gut feeling that you or your loved one is not okay, you should reach out for help. For example, cancer, the earlier you intervene, the better the chance of recovery and this is more so with mental health issues. WHO has recently told us that India has the highest number of people suffering from depression in the world. The second alarming statistic is that suicide is the third leading cause of death among our youth today, more so in India. As we speak, there is one attempt of suicide every three seconds and one death by suicide, every 45 seconds. By the time there is the on-set of mental health concerns and by the time individuals and family members get treated, can you guess what the time lag is? It is 8 to 10 years! That is because of the stigmas. What has to be cognisant about these risk factors? We all go through psychological and emotional problems but sometimes when there are no external factors, no deaths, no family problems, no conflicts, everything seems great on the surface. I still feel from within that I am not okay and that feeling doesn’t go. Now imagine that the feeling escalates and suddenly I am losing interest in everything.
There is a sense of helplessness, hopelessness, worthlessness. I am constantly feeling that I am in a brain fog, I cannot make simple decisions, I cannot remember things, I cannot make certain choices, I am struggling to enjoy all the pleasurable activities that I used to enjoy, I don’t go out, I am losing interest in speaking to people, loved ones, I don’t feel like going to outings and dinners, I am suddenly feeling that I cannot function.
Even the smallest of impediments or issues that I could deal with, I suddenly don’t want to deal with them. I am losing interest and I feel like everything is over, I suddenly feel that I am reduced to tears, I am getting panicky, there is sudden tightness in my chest, I am getting headaches or back aches, a lot of stress induced feelings are coming up, feeling hyper sensitive about the smallest of things, thinking why did I suddenly yell or feel upset or sometimes getting thoughts of not living, getting suicidal ideations, I am thinking of ways to end my life, the constant feeling of ending life, low self-esteem, low self-worth and the main thing that will tell you that either you or your loved one is going through that is clinical is when all these symptoms start actually affecting the day-to-day functioning. I have clients who have not got out of bed in four or five days, clients who have not had a bath or shaved for days, clients who planned for suicide and ending, they had written their notes, they have packed away things, they closed bank accounts, you can see changes in body language, sleep pattern change, appetite pattern change, and there is clearly something off. When these feelings don’t shake off easily, you try counselling, talking to your best friend, nothing works out. This means you need to seek medical and professional help. We are not scary, we are not going to catch you and label you with something and we are not going to give you 20 drugs.
We all feel that this is a passing phase, it will go away. We hear the typical advice that loved ones give. They say go have a drink and you will be fine, go meet your friends, focus on your work, get married, some will be as silly as smoke a joint and go chill, party with friends. Many people who suffer from the above-named symptoms, even educated ones, question whether they are mentally weak. Parents feel ashamed that the child has depression and question whether they are bad parents. They ask all sorts of questions of themselves. What will people say? What if I bump into someone I know at the psychiatry clinic? What will I tell them? If I go to the psychiatrist, I’ll have to take medicines to be taken for life, I will get fat and get dependent on them. You will never be given medications that you have to take for life. Every medication is properly, thoroughly FDA approved, scientifically researched and amazing safe drugs that even a nine or 10-year-old can take. You have to undergo a proper treatment plan. You have to understand that all the treatments for psychiatry have a course period. It is not a quick fix and the medications take time because, as I explained, we have neuro-chemicals in our brain, the drug has to get absorbed in the blood brain barrier, then it starts to regulate the dopamine and serotonin level and then you will see respite in the symptoms after two to three weeks. The second mistake they make is to stop after feeling well in a month or two – they wonder why the need to take the medications at all. And this is the biggest mistake of what we call as treatment fall outs or relapses. You have to complete the course for six to nine months, for teenagers, kids, and adults.
Research has clearly indicated that if you stop the treatment before six months, there is a 50 per cent chance of a relapse. Of course, you don’t do doctor shopping, don’t go on Google. People go on the internet and read about the side effects. Think about it, every drug, the most abused and dangerous drug is the one we all keep using and that is paracetamol. What I am getting at is these are all myths in our minds. Yes, unfortunately, psychiatrists today over-prescribe and over-medicate. But you have to find the right therapists and specialised individuals in mental health and, of course, have a holistic approach. You can’t treat mental health with just one pill. It is medication, therapy, counselling, lifestyle changes, physical exercise, and gut health. Please understand gut health, physical health and mental health is all interconnected. You can’t treat one without treating the other.
How important is it to recognise the need for seeking help and how much of the battle is won at that stage?
It is fully won. Today, I discussed all the symptoms with you. If you are going through them as an individual and not sure whether it is psychological, psychiatric or if you need counselling or a blood test what is the harm in seeking help? Think about it like this: I have a tooth ache that is lingering and is not going better and I am worried it will get worse. Now on third or fourth day, my jaws have swollen up, will I go and see a general physician? Or will I go and see my dentist? That is the answer for you. You have to understand that now, with everything, there are super specialists and there is no harm or no shame. In fact, 80-90 per cent of my clients are on that wellness spectrum, I don’t treat them with medication, I do a lot of counselling and therapy which is more of a thought management and life coach so to say and that also helps a lot. With a lifestyle change, diet plan and all the other stuff that we spoke about. So, early intervention is huge in recovery when you pick up the warning signs.
As parents, what are the pointers that we should watch out for because fatigue is setting in with the whole day Zoom sessions?
Online schooling is important, but it is not appropriate as there are too many things that the kids are deprived of, one has to stimulate that in the child. Yes, school time is important, many schools are doing a great job but it is so important to focus on their mental health, talk to them every day, verbalise their anxieties and talk about going back to normalcy. You can do loads at home, you don’t need a big space or small space, add humour and fun every single day and every single thing that you do, keep vigilant for warning signs, there will be moodiness and there will be irritability. There will be times when older kids want time out and space and independence, provide them that respect to have time-outs, teach them empathy, gratitude exercising. Teach them that there are so many small things that we should be grateful for. Make the so-called small things, big. Celebrate. Breaks, balance, structure, routine, ensuring sleep time, routine time, TV time, screen time, you have to be a bit firm on all those aspects. That is the best I can say on this platform.
We live in such politically polarised and nationalistic times, what is the effect of all this kind of atmosphere in the country, what do you think is the reaction of the teens to these times?
Teens and all the kids are role-modelling us. When I brought up empathy and compassion and inclusion and exclusion, it comes from us. Kids speak to each other but when they talk about how their peers are talking and speak in a way, it eventually comes from us. What I try and do and propagate is that we all have our views about politics and religion, community, and marriage, allow our kids to have a voice and opinions. Take a simple example. We say when you grow up you must marry a tall, dark and handsome or a very pretty and fair woman, someone who is from a good family. What defines a good family? Why should you marry into a wealthy family? And things like that which are so ingrained and conditioned from grandparents to kids, I call that bias. It is bias that our kids are going through, we have to recondition their brains to not propagate what we think is right or wrong. It is very important to give them a neutral view. Giving pros and cons, teaching them to see the positives and the negatives and this is one line I live by is a silver lining concept. And if we can teach our kids that, I think we can become more resilient. In the end what do we want our kids to be? Sound in mind and body and resilient. It means the inner strength to bounce back stronger with healthier coping mechanisms. So, being neutral and compassionate, being effective role-model for our kids is what this next generation really needs.
In this pandemic, many senior citizens are not going out of the house or have lost their loved ones or spouse leading them to a major depression, but they are not willing to except the fact that they have gone into depression, or, they are not willing to seek any medical health. How do you manage to get them to a doctor or get medical help?
Sometimes, it is natural with so many external factors that they are going to slide in to emotional setbacks for a period of time. When these emotions don’t get better and scale up even after 3 to 4 weeks and affect their functionality of sleep, appetite, fatigue and yet they are not accepting to seek professional help, then we need to step in. Get a thorough clinical history taken and start them on safe medication and perhaps unfortunately, unknowingly. You have to tell them that it is to keep their pressure or stress in balance. And, to be honest, some of these medicines are also prescribed by the cardiologists because they keep the heart rate a bit low. It is like a mild anti-depressant. They can be prescribed like that and I have seen huge recovery. I have had such clients with a lot of deterioration after three to four months. Physical and mental health go hand in hand so one is bound to deteriorate in time without intervention.
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