Home   |  Issues  |  The Daily Star Home | Volume 3, Issue 65, Tuesday November 14, 2006



Interpreter of maladies

Dr. Nighat Ara, Psychiatrist, Counsellor and Therapist

Q: My sister and I have always been different characteristically, especially when it comes to fear. I am still scared of the dark and unable to sleep by myself and yet she has slept in her own room ever since she was a child. As children, even though I was always petrified by horror movies, horror stories or anything that was half scary, she remarkably managed to stay unperturbed. Recently however, she seems to have undergone a drastic change. We live on the top floor, with a huge terrace and one night out of the blue, she woke me up and told me that she saw an old woman sitting outside. I blew it off, thinking it was just a mistake, but this has happened to her on several occasions in a very short span of time. It has gone to the extent that she once felt someone touch her, speak to her and even give her a slight push from the back when she was out on the roof. There is no way I can bring myself to believe any of these things really happened but it upsets me to see the state she is in. She seems to panic at the drop of a hat now and refuses to stay alone or go to the roof at all. What could have suddenly brought this on and how can we do away with it?

Dear reader,
Yes, it is very hard to watch ones sister going through this kind of bizarre behavioural changes. I understand your sister is now very fearful which contradicts her usual self. You have also indicated that this change has happened very quickly within a short span of time. I'm curious to know if you have noticed any other behavioural changes (e.g. partially withdrawn or isolated, self-muttering, less interactive attitude etc) prior to the appearance of these present symptoms. It is also important to know if any kind of psycho-social factor (e.g. domestic violence, harassment, stalking, threats etc.) could have contributed in precipitating or maintaining these symptoms. Her level of functioning in other areas of life (e.g. school, in other social setting etc.) will give important clues to determine the extent of her illness. The link between these fears to specific people (e.g. family members), places (e.g. roof of the house) or situations (e.g. being alone, at night etc) needs further exploration to help us understand its role in disease manifestation. In fact, your sister seriously requires a complete psychiatric assessment in order to determine the nature and extent of her illness.

Signs and symptoms suggesting a quick (slow insidious onset is a more typical presentation in certain forms of Schizophrenia) personality change at adolescent or young adult stage of life accompanied by hallucination and delusion is often suggestive of major psychiatric illnesses including Schizophrenia. Major Clinical Depression, Acute Psychotic Episode, Dissociative Identity Disorder etc. are some other psychiatric conditions that need to be ruled out too. Hallucination is a disturbance of perception where people can see things known as “visual hallucinations” (e.g. an old woman sitting outside), hear voices known as “auditory hallucinations” (e.g. someone speaking to her) or get bodily sensation known as “somatic hallucinations” (e.g. slight push from the back or touch) without any real stimulus in the environment.

Delusion is usually (but not necessarily) a false belief that a person tends to hold very firmly without adequate evidence to support it or even in the face of evidences against it (e.g. believes someone is trying to harm her etc.). In a paranoid state of mind people are overtly suspicious, nerves are so tensed that startled responses (e.g. panic at the drop of a hat) are very common.

In the early phases of Schizophrenia, signs of disturbance in the thought process and perception may manifest in an attenuated form (e.g. odd beliefs, unusual perceptions etc.). However, a detailed history taken by an expert clinician in this field will be immensely helpful to distinguish between symptoms presented in a similar fashion in some other psychiatric illnesses too. There are standard diagnostic tools commonly used by clinicians to come up with a preliminary diagnosis essential to make a treatment plan. The initial diagnosis may however change over time with the appearance of a new set of symptoms or depending on the course of the disease etc. Most psychiatric illnesses are multi-factorial such as biological, psychological and social in origin. Sometimes all these factors co-incidentally work together to trigger the disease process in a genetically susceptible person in whom the disease could have otherwise remained dormant for the rest of his/her life.

The earlier she gets treatment, better the outcome. Once the disease becomes chronic or old, it usually doesn't respond so well to conventional treatment. However, with the advanced knowledge in neuro-psychiatry and latest breakthroughs in medication, the future of this group of patients looks much brighter than before. A qualified psychiatrist should be consulted and if the patient is a minor, a legal guardian should take the initiative to set up an appointment. Direct close observation by hospitalization may be necessary in some cases. Hospitalization is not only a diagnostic aid but also ensures some security, stability and structure in the life of a sufferer besides ensuring compliance to medication as a part of the whole treatment process.

I believe, her psychiatrist would be the right person to answer your questions in a customized way. Patience and support from family members is crucial for quick recovery.

Beauty Dissected

Dr.firdous Quader Minu M.B.B.S, D.L.O ENT, Head-Neck & Cosmetic Surgeon Consultant, Cosmetic Surgery Centre

Dear Dr. Minu,
I am an 18 year-old female and I am suffering from hair loss. I have been losing hair for the last 12 months and have been trying to stop it by adopting a lot of medication, shampoos (herbal and non-herbal), but nothing seems to work. Now I am afraid of being hairless within a short time if the present trend continues.
Please help.

Dear Nayeema,
First of all please rest assured that you are not going to be hairless. You didn't mention what medicines you have been using. First of all I'll ask you to stop taking these. Then if you have dandruff start using any good anti- dandruff shampoo. Do hot oil massage with coconut oil once a week. Do not use any medicated shampoos that may contain conditioners. Eat a well balanced diet and if there is anything stressful happening, try to overcome it. Do this and then if the hair fall doesn't reduce, contact Cosmetic Surgery Centre to enrol in a Hair Restoration programme.

Dear Dr. Minu,
I am 36yrs.old and have three children. After my third child my breasts have become very saggy and I don't like that. Can it be corrected?

Dear Reader,
Yes, this can be done by an operation where the breasts are uplifted to make them look better. Any well- trained plastic\cosmetic surgeon will be able to help you.

By the way

If you've lost the back of your earring or other small object in your carpet, run a coat hanger over carpet. Most small objects will be tossed in the air.

Under A Different Sky

By Iffat Nawaz

Dissecting her, me and the one next to us

She wasn't pretty, neither was I, neither was the one next to us. Because there was more than beauty playing in our surfaces than the asset we describe to be pretty. And we were beautiful. She was and so were the rest, even the men…through their imperfections and perfections, there were smiles more amazing than the ones we pass out everyday, to strangers and non. We were smiling for ourselves, not for you, not for her, not even for the one next to her.

There was a house, there was a party and it was just anther Saturday night and we needed an excuse to stay up late. So we went, to the house and to the party, I have gone to many others like this one but there was one difference-the people there were all Bangladeshis in their 20s and 30s but they were neither out of it nor into it, not trying to be Bengali or to be American. No force of insecurity told them to act a certain way and they were just themselves.

There were married ones, attached ones and some non-attached vibrant ones. Everyone was confident because it wasn't about your marital status or the position you hold at your work, your degree or the car you drive. There was individualism and there wasn't a rule but there was an aura of not asking silly questions that usually make up normal conversations in any other party. Here we knew those questions were irrelevant and each of our independence defined us- not as Bengali Americans, but as us, just people. Even if we didn't know each other prior to this party, we knew all that was relevant was that we were ourselves and we cherished…celebrated…celebrated nothing and everything…

So I sang, danced, screamed and also sat in the corner staring at everyone else, getting to know them not through words but the way their mouths moved, the way their hair flowed, the way the men looked at each other and the women smiled sharing open secrets. It wasn't magical, because magic doesn't exist, it was realistic and it was comfortable and all we needed was an open blissful mind.

Maybe tomorrow when I see them it won't be the same. Maybe it was just that one night when a bunch of post 71 generation kids all grown up with finally discarded superficialities molded together into something bigger than what we grew up seeing, knowing to be right. The right way to come together, the gossips and the back biting and the judgments, the competitions and the cliques, and the table full of food which often makes those other conventional parties most memorable. Those weren't the point here, at least that night, maybe later there was, there will be, but we won't worry about later.

So tomorrow when I see one of them on the street or at another common gathering and the same warmth is missing I wont be disappointed. I believe in chances and the right times, the thousand personas we carry and pull out of our sleeves, the restrains, and constrains of being complex beings, and tomorrow if I am not who I seemed to be at a carefree night of being purely me, don't judge me. I am under pressure, just like you, to fit in, not for you, not for me, but for the sake of old grinded habits.

I am no different now. I just know there is a chance, a chance for you and for the one next to you to be us, so we wait for another auspicious night and another auspicious gathering where we show our faces for what it's worth, nothing more nothing less, not being Bengalis and not being Americans… just being human…trapped, discovered and freed.


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