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Postpartum Depression

Mothers Feeling Blue

As edited and published by the Womens Feature Service

So strong are stereotypes about the bliss of motherhood that the popular imagination allows little space for the lived reality of many women. Many women find themselves besieged by feelings of negativity – and the consequent guilt – after childbirth.

Postpartum depression (PPD) is the cause, says Dr Prathap Tharyan, Head of the Psychiatry Department in the prestigious Vellore-based Christian Medical College. In a British Journal of Psychiatry study that Tharyan and his colleagues carried out in rural Tamil Nadu and published in 2002, they found that 11 per cent of the pregnant women monitored had PPD.

Although there are no figures available for India, Planned Parenthood, USA believes that one in 10 women in the US suffer from PPD.

Unfortunately, says Tharyan, there is not enough awareness about this disease, possibly because psychiatry is not addressed adequately in medical colleges across India. While awareness levels among the general public are abysmal, even those in the medical profession are not well acquainted with PPD, he says.

PPD is a biochemical illness caused by changes in the brain chemistry. It might cause a woman to become deeply despondent and weepy; she might develop insomnia, anxiety or an aversion to touching her baby. She might feel ‘out of control’ and, more horrifying for her, develop a fear that she might harm her baby. A past history of psychiatric illnesses is a good indicator for PPD, but is not a prerequisite. And being from a ‘good Indian family’ is certainly no protection either!

In addition, Tharyan says, various factors – like bearing a female child when there was pressure to bear a male child, problems with in-laws, poverty, or a lack of help in the postpartum period – could result in PPD.

‘Baby blues’ is a milder, more common variant. (Planned Parenthood estimates that about 80 per cent women suffer from it.) The blues may cause a new mother to have mood swings – from an emotional ‘high’ of euphoria, to an emotional ‘low’ of being overwhelmed. She might also suffer from loneliness, sadness, loss of identity, irritability and decreased sexuality. The blues often resolve themselves without medical intervention. PPD however requires counseling and often medication.

According to Niloufer Ebrahim, a psychologist in Pune’s Jehangir Hospital, soon after childbirth, hormone levels in a woman’s body abruptly drop back to pre-pregnancy levels. Coupled with changes the body undergoes in order to prepare for milk production and the lack of sleep, a new mother is under immense stress. This could manifest as PPD. While the hospital’s gynecologists do refer such women for pyscho-therapy, only about one in 20 of them actually seek help, says Ebrahim. “This is unfortunate because sometimes all it takes is for a qualified person to listen to the woman, take her seriously and validate her feelings.”

Considering the high incidence of this illness, which makes it a public health problem, why are women not routinely educated about PPD in India? Dr Jyothi Unni, a gynecologist at Jehangir says that time constraint is a big factor. There are many issues, like nutrition, that she needs to cover in her brief sessions with each patient.

Tharyan believes the Indian doctor’s mindset of ‘preventing harm’ to the patients is also a factor. “We interpret that to mean a situation of ‘compassionate deceit’. For instance, we often don’t inform our patients about the potential side-effects of the medicines. There are a lot of problems in communication between doctors and patients.” So, PPD is left unaddressed.

Ebrahim says, “The word ‘depression’ is always associated with ‘mental’, and people don’t realize that the mind is also a part of your body. No one’s ashamed of going to a doctor for an upset stomach. People don’t realize that being depressed is as much a physical medical condition as that, and as treatable.”

Then there is the social and guilt factor. The new mother, Ebrahim explains, is asked questions like, “You’ve had a wonderful baby, why are you doing this to your child, to your husband?” It makes the woman doubt herself, because nobody is ready to believe in her.

Tharyan agrees. “The problem is the issue of depression is not very well recognised among clinicians, who say, ‘this woman has a difficult pregnancy, so give her some time’. There is a tendency to naturalize a process that is going to be chemically disabling.”

Ebrahim says mothers need to ignore well-meaning, conflicting advice and seek help from experts, be it for breastfeeding or getting the baby to sleep longer. What they also need is a good support system that validates their feelings. The new mother needs reassurance that it is natural to be confused and stressed with a newborn. “You should be getting positive inputs from your gynecologist, from your pediatrician – Oh! You’re breastfeeding, wonderful!”

And to husbands, she has this to say: “If your wife seems to be happy one moment, crying one moment, she doesn’t need to be told millions of women have been through this. Give her a hug, get her some juice; do whatever it takes to make her feel better.”

A severe, though much rarer, manifestation of PPD is postpartum psychosis (PPP). Tharyan says that PPP might cause a woman to feel agitated, deluded or hostile. “There is no specific category of PPP per se, because people with PPP usually have a mood disorder, are bi-polar, or more likely, it could be an exacerbation of previous psychiatric illnesses.” Without treatment, women with PPP may try to hurt themselves or those around them. Andrea Yates of the United States is an especially telling example – her church allegedly told her to ignore her psychiatrist’s recommendations; lacking proper treatment and medication, she went on to drown all five of her children on June 20, 2001.

A Pune-based pediatrician had suggested that it is unnecessary to expose new mothers to “such things” that may “give her ideas”. Ebrahim retorts sharply to this. “Nonsense! Just because you know a knife can kill someone, doesn’t mean that you go run out and do it.” In fact, knowing that her anguish has medical basis, and that many other women suffer from this, would serve the new mother better; along with psychotherapy and medication, of course.

December 3, 2006
Women’s Feature Service

Printed Nationally by Indian Express on Tuesday, Dec 26, 2006

Assam Sentinel

http://www.boloji.com/wfs5/wfs743.htm
http://www.deccanherald.com/deccanherald/dec82006/living1752282006128.asp
http://www.dailyexcelsior.com/magazine/07jan07/inner.htm
http://www.dementia.com/news/detail.jhtml;jsessionid=PUPAOHHZH5VSCCUCERDRXCQ?itemname=a1210842.6ie0&parentSite=www.psychiatry24x7.com

Sexed Up Education

Sini recoils in horror at the idea of sex education for kindergarteners. “They’re too young!” she exclaims. Mother of a 4 1/2 year old boy, she is fuming at the recent decision by the Central Board of Secondary Education to introduce sex education for children as young as 3 years.

Psychotherapist Niloufer Ebrahim says, “The problem is, the moment people hear the word “sex”, they think of two people doing something. They do not realize that this is more about self-awareness.” About Sini’s response, Ebrahim says, “She is frightened, because she thinks her 4 1/2 year old is going to be taught how to do it! He is not.”

According to Ebrahim, ideally sex education would be imparted to kids in very small increments, in an age-appropriate manner, taking into account the levels of understanding of the children.

Ebrahim says, “Done right, it would start with making children sensitive to the differences between men and women, an awareness of hygiene. Gradually, as the children got older, they would be more aware of their bodies, and bodily changes, which should be normal and not something to be ashamed of.” She says, “There would have to be awareness of so many things before we even touch what we call “sex”.”

Sex education would help children recognize sexual abuse, by teaching them to distinguish between “good” touch or “bad”. Ebrahim says, “Kids need to be taught that if anybody touches them in areas that are covered by clothes, it is not acceptable. That if such a thing were to happen, they should tell.” Unfortunately though, there is a common perception that such things do not happen in “good” families.

About the general disbelief that boys can be molested too, Ebrahim says, “Yes,boys do get molested, by other males, by females. Mostly, the molester is known to the family; it is person who you probably care for very much, or consider part of your family.”

Ebrahim says emphatically, “One thing we must remember, just because you teach a person what sex is, doesn’t mean they will run out and have sex. You know that if you take a knife and stab somebody; you can kill that person, does not mean you go get a knife and stab somebody.”

India Today recently did a survey about children today being sexually active from a very early age. With AIDS and other sexually transmitted diseases becoming a hard reality, to not make these kids aware of responsible sexual behaviour, and the use of condoms, is an epidemic waiting to happen. Ebrahim says grimly. “They are likely to get diseases, they are likely to get pregnant. People are using plastic bags, can you imagine? Milk bags instead of condoms?”

Published in The Times of India, Pune Edition
Friday, Nov 10, 2006

Will I post more?

A few people have asked about this. Not anytime soon, I’m afraid, because I’m seriously working on a book. I need to get that done soon. If I do (or when I do) it’ll have to be about the attitude of government servants in India (don’t get me started – I don’t have the time! 😉

Women in the Army

By Rasana Atreya

Published nationally in The Hindu

LAST MONTH a woman army officer, Sushmita Chakraborty, ostensibly disillusioned with Army life, took her life. Everyone rushed to pass judgment on her suicide, which could well have been due to extremely personal, non-disclosed reasons. In a bid to distance itself from the situation, the Army rushed to release private psychiatric records of the officer.

As if this were not bad enough, the Vice-Chief of the Army, Lieutenant General S. Pattabhiraman, jumped into the fray claiming “the force could do without women.” This of course promptly politicised the whole sordid mess by drawing in Sushma Swaraj of the BJP and also the National Commission for Women, and ticking off a whole bunch of women in the process. There are a few different issues involved here which are worth a look.

Image takes a beating

First, the public image of the Army has taken a beating after this incident, not necessarily as a result of the suicide, but as a result of the utterances of its Vice-Chief. Possibly to divert attention from the General’s statement, the Army released the mental health records of Chakraborty.

By doing this, not only did the Army fail this officer by neglecting to take her concerns seriously (she had already attempted suicide once before), but in the process also breached the tenet of medical ethics that requires that medical records be kept completely confidential. An unintended consequence of this blatant disregard for medical confidentiality could be that it might discourage other similarly disturbed armed forces personnel from seeking medical or psychiatric help.

Secondly, the issue here should have been suicide by any officer, and not just that of a woman officer. In this, the General did his fellow officers a grave disservice. In a less sensationalised account of male officer suicides (tucked away in the back pages, as opposed to the front page article on Chakraborty), The Times of India reported that a staggering 430 personnel, both officers and other ranks, have committed suicide in the armed forces since 2002. Neither the armed forces nor the Army Vice-Chief seem to have felt the need to explain away those other suicides.

The third issue here is the presence of women in the armed forces. Very obviously there is a problem with the integration of women in the Forces if the top brass is not able to reconcile itself to the fact. Since women have been inducted only into the “non-combatant” divisions of the armed forces, there is an inference right off the bat that the women officers are simply not good enough, even though the General himself admits that there is little doubt about the abilities or merit of the women officers.

The problem therefore lies not with the women themselves, but with the attitude of the male officers. One of the reasons the forces were forced to take on women (no pun intended) was because, by the General’s own admission, not enough qualified men were coming forward. Because of his statements the General might now have discouraged women from joining up.

As for sceptics of women’s place in the Army, it was not too long ago that women were not deemed fit enough for the work force, or to drive or even have a vote. What is needed is a sincere effort to resolve issues involved with men and women working together, as in any other field. Because discipline is a major issue in the forces, male personnel need to be given gender sensitisation training to pre-empt insubordination.

From all accounts, Sushmita Chakraborty was unhappy with her work in the Army. Yet no attempt seems to have been made to resolve this by giving her an alternative assignment. Discipline in the Army is one thing, rigidity of thought quite another. The Army brass needs to realise that what cannot bend often breaks, as happened in the case of Chakraborty.

The Forces have taken the first welcome step toward gender equalisation by accepting women officers. It now needs to move forward by not putting them under the microscope, but treating them as just other army officers. The forces could even take this a step further by opening up to not just officers, but even to other ranks.

If the armed forces were not quite as insulated from the real world, it might be able to help its personnel come to terms with the new reality (i.e. women now are part of the armed forces) faster. And lastly, the first beneficiary of the gender sensitisation programme could be the General himself.

Published in The Hindu, all editions
Sunday July 9, 2006

http://www.hindu.com/op/2006/07/09/stories/2006070901371400.htm

By Rasana Atreya
Published in The Times of India, Pune Edition

Geography lessons from textbooks? That is so passé! Articles from in-flight magazines, a piece from a travel book – those are what might go into a “subject file” for the students of Sanskriti School.

Principal of Sanskriti, Devyani Mungale used to be part of the conventional school system; in fact she taught at the Delhi Public School, NOIDA for 10 years. But something was missing. Mrs. Mungale says, “I got an opportunity to attend many wonderful workshops. You came back recharged, but once you came back to your classroom, it was so difficult to implement them with large numbers; you were always racing against time because you needed to finish things just because the other section had done that.” Disillusioned, Mrs. Mungale decided to start her own school, and Sanskriti School was born.

Mrs. Mungale realized that in conventional schools, only the brightest or the most mischievous students got noticed in class. Often times, the kids that really needed help the most fell through the cracks. This is what she has set out to remedy in her school. The soft-spoken principal insists, “There is nothing wrong with the children as such.” Nothing that some loving, individualized attention won’t remedy. Towards that end, she has 8 teachers for the 32 students in her school, a ratio of teacher to student which would be unimaginable in a conventional school.

Sanskriti differentiates between kids by assigning them to different “learning groups”. For example, a child could be in class 5, but if her Maths skills are not up to par, she would work on lower-level Maths until she was able to catch up.

In Sanskriti if a child is distracted, he might be sent off to tend to the 2-3 plants he is assigned; he could work on a puzzle, or play a board game. To learn a poem, the child might choose to sit on a bench in the front yard. And vocabulary building isn’t by memorization, he’d play Scrabble instead.

Presently located in a bungalow in Baner, the school hopes to move to a 7 acre plot near Chandi Chowk by June. Mrs. Mungale says, “I intend to have farming patches for them where they can actually see the rabi and kharif crops rather than reading in the books about them.”

For examinations, the school follows the National Open School system which is based on CBSE (Central Board of Secondary Education). Mrs. Mungale says except for English, all other subjects in NOS are on par with CBSE. But, says Mrs. Mungale, this should not matter, because the English her kids are exposed to exceeds even CBSE’s specifications.

As to what the kids can expect to get out of this school, Mrs. Mungale just hopes to inculcate a love of learning in a stress-free environment.

sanskritischoolpune.com
dmungali@rediffmail.com

By Rasana Atreya
Published in The Times of India, Pune Edition

That Pune is one of the most polluted cities in India is beyond dispute. But what is especially worrisome is that one of the more significant causes of pollution, a brick kiln, which emits harmful gases, is located right next to a prominent school where hundreds of children are being exposed to its toxicity on a daily basis.

The school, Delhi Public School in Mohammadwadi, has been actively trying to have the brick kiln moved to an alternate location. According to the school headmistress Mrs. Chakrabarty, “This school is for children, so we want this out”. Says Col. Sinha, the school’s Chief Operating Officer, “The school has a written notice from Mr. Prabhakar Deshmukh, the Pune District Collector, that the kiln will be moved out by July”.

Pune’s Municipal Commissioner Dr. Nitin Kareer, has this to say, “The PMC has asked the government for alternate land for brick kilns, and it is also trying to incentivise the conversion of land from use of brick kilns to residential”. He adds that the relocations of all kilns close to populated areas will on hinge on how soon the government can allocate land, though he isn’t able to comment on a specific kiln.

Meanwhile, according to Dr. Ajay Ojha, Program Manager of Pune’s Air Quality Management Cell, work is being done to move all kilns out of the city. He adds, “I hope that this will be done in the next 6 months. The plan is complicated because we need to make sure that standards are complied with.”

Brick kilns are known to be a significant source of pollution. Some of the toxic emissions from the kilns are Carbon Monoxide and Sulphur Dioxide and also PM10, a major air pollutant consisting of tiny particles that can settle in the lungs. All these pollutants together are known to cause asthma attacks, chronic bronchitis, chronic coughs, impaired vision, reduced brain function, and even death.

With all the conflicting statements on the relocation of the kiln, it is unclear what the real timeline is. Meanwhile the children of DPS continue to breathe in the toxic air.

The Times of India, Pune Edition

July 9, 2006

By Rasana Atreya
Published in The Times of India, Pune Edition

Though consumerism has arrived in India in a big way, consumer awareness is still in its infancy. So who is a consumer? One who pays to avail of services or products, says Consumer Activist Aroona Nafday.

Convener of the Consumer Empowerment Centre (phone number 2543-8559), Nafday says their mission is to educate consumers about their rights. Herself a lawyer, Nafde sees the court only as a last resort because of the time and money involved.

Nafday says, “The Centre is like a helpline. We also take up larger policy issues, where you need to regulate.” In addition, they offer mediation. Nafday says though, for mediation to work, both parties have to be willing. As a matter of principle, her organization will not accept any funding from the government or from any corporate bodies; they prefer not to run into any “conflict of interest” situations.

Nafday is very emphatic that consumers first need to be aware of their duties before they can demand their rights. She says, “We ask, don’t actively take decisions that are bad for consumers. They may be good for me at that moment in time, but in the long run, they are likely to be bad for other consumers. If I am going to purchase something on the black market, then how good a consumer am I? How many of us even ask for a bill for the purchases we make?”

But what really gets Nafday going is the consumer apathy she’s witnessed over the years. “The Indian consumers are a completely apathetic lot. They do not want to fight for their rights. They only want to get free aid, and free help, and free counseling.” She is rues the fact that even after cases are satisfactorily resolved, people will seldom pay the fees to become members of the Centre.

As an example of the apathy, she talks about a case of overloading of auto-rickshaws with school-going children. After a couple of accidents, they decided to get the school management and the PMT involved. They chalked out bus routes so children could travel in safety. And yet, not many parents
bothered to sign up for the buses.

Nafday says unless consumers come together to do things collectively, it is difficult to bring about change of any kind. To illustrate the power of collective action to get results, she gives the example of a shoe store that has sold a defective pair of sandals that they refuse to repair or replace. She says, “You can just get together a group of people in front of the shop standing quietly and telling other shoppers about the issue.” Once other shoppers become aware of the problem, the management is going to want to resolve the issue pretty quickly.

Nafday says collective action is especially necessary because initially businesses were a little afraid because of the Consumer Protection Act. Now that they’ve realized that cases may take as long as 2-3 years to get resolved, they’ve reverted back to being unresponsive. She says, “Even though my organization lobbied for this Act, and we welcomed it, we must also do something. Sending every case to court is not going to help. There are too many cases and not enough judges to try these cases.”

Nafday talks about the time the Centre took the Consumer Awareness campaign to go to schools. She says, “There were very few schools who would respond. It was more the vernacular schools that were interested. It is an issue where you’d think a particular class would be more responsive. But that class is the couch potato class. Though they are huge consumers of products and services, they don’t have the will to do anything.”

Nafday says, “People need to realize, if you can have Nobel Laureates in America leading a march on a civic issue, why can’t people in Pune do the same?” She adds on a note of finality, “I’ve studied this psychology for a long time, and I’ve come to the conclusion that we are very selfish and individualistic people.

Published in The Times of India, Pune Edition