Interpreter of Maladies

Dr. Nighat Ara, Psychiatrist

Q. My mother has a very critical problem. She thinks that she has another person talking inside her mind, which is very evil. We have taken her to many doctors but it has been like 15 years, no change has occurred. It all started after her marriage. My parents had a great marital problem. They could not understand each-others demands. My mother felt deprived all the time. My father was out to his work daily and my mother had to do all the house-holds along with her job. After the birth of my younger sister the pressure was extreme on her. She also became so rude to me and my elder brother. Then suddenly the problem I stated above started. A whole new chaotic situation grew. Recently she has been transferred to a college outside Dhaka. Although we all have grown up but the memory shock us. She has grown weak and in disappointment sometimes she stops eating and taking her medicine there. She also refuses to go to the doctor saying it's useless. Physically she has grown more feeble. I really am very worried. Is it called MPD(Multiple personality Disorder) and does the mental shock causes people to forget the past? In fact she cannot remember anything. Plz tell me what to do. -Tormented.

Ans. You have described quite an alarming situation that needs immediate & appropriate attention. Your mother is suffering from a chronic psychiatric condition and had been to so many doctors without much help. However, you didn't mention anything about the diagnosis or medications she has received so far which could have been a valuable clue to understand her present situation. You have also hinted at the communication gap between your parents as well as serious marital problems that had precipitated this mental condition of your mom. In fact, a stressful environment can interact with the genetic vulnerability of an individual to a particular mental illness, and accelerates the process of bringing the dormant condition to a full-blown disease. Your mother thinks she has another person talking inside her mind. This is a very important symptom that needs to be explored further in detail to understand its origin and nature. MPD (multiple personality Disorder) and few other major psychiatric illnesses like Schizophrenia, Schizoaffective Disorder etc. are associated with this symptom too. Sometimes Depressive Disorder can also present with very similar picture. However, Clinical expertise, adequate observation, complete history and trial with medicines are often helpful ways to clear this confusion. Duration of symptoms (15years- pretty long time!), severity of symptoms (self-negligence to the level of not eating well or taking even important medications) and the consequences in other aspects of life (can she do her job well? Has she alienating herself from everyone else and is now socially isolated? ), all these are important assessment tools in mental illnesses. As a working mother without any support from her spouse, it seems that she was probably stretching herself beyond her capacity. Her childhood history is also quite relevant here. People have different tolerance levels and when the stress or trauma crosses the individual threshold level, the brain can shut down and psychological defences come into play to protect the traumatised person. Multiple personality disorder (MPD) is now known as Dissociative Identity Disorder (DID) according to DSMIV. It is very difficult to come up with a diagnosis from this little information you have provided here, though personally, I believe other major psychiatric illnesses need to be ruled out first. Undoubtedly she needs proper attention and care. It is very difficult to come up with a diagnosis (it is not fair to try even!) from the little information you have provided here though, I personally believe other major psychiatric illnesses need to be considered too. "She cannot remember anything"- this generalized loss of memory is again pointing to more serious mental conditions (some organic brain diseases also produce this symptom). In DID (or in Dissociative amnesia) people can suffer from loss of memory (usually around more selective issues though), and mental shock definitely can cause a person to forget the past, which again depends on the person's individual vulnerability and personality trait. DID is often associated with anxiety or depression which also requires treatment on their own right.

Dental wise

DR. Mahfujul Haq Khan BDS, DDS, FSDCE (USA), PhD (Japan), Post Doc. (Japan) Specialised: Crown and Bridge work, and Periodontal plastic surgery (USA) Senior Medical Officer, Department of Dentistry, BIRDEM Hospital.

Hello Dr. Khan,
I am 46 years and doing business in Chittagong. I always enjoy your article as I have lot of dental problems. I have dental cavity but no pain at all. Should I visit a Dentist?
Would you mind if I ask you: "Dental practice is not service oriented, but rather, a business". When we go to a Dentist with a certain problem, some dentists try to find out other problems simply to make some extra money. Am I right? However, I do not mean you as I know you are different.
Zulhash, Chittagong

Dear Zulhash,
Thank you for reading and enjoying my article and this will encourage me to go forward.
You have mentioned that you have a lot of cavity without pain. Yes you must visit a Dentist right away. Dental Caries (Cavity) very often appears as a white chalky area on the enamel, which becomes brownish and then black. As long as the caries remains within the enamel, no pain should be experienced. It later softens, after which the tooth structure breaks down. If not treated in the initial stages, it progresses towards the pulp and will then require extensive treatment to save the tooth. Tooth decay usually does not pose a serious health risk if treated early; however, if the decay is allowed to progress, the tooth will likely die, and the spreading infection may result in general blood poisoning, fever, swelling in the face and neck, and a general feeling of being unwell. So, please visit your dentist right now and save your money and avoid further health hazard.
I will not mind any kinds of questions that might arise from my respected readers. Your next comment is "Dental practice is not service oriented rather business". Yes you are 100% right; we are doing business, but it is a SERVICE ORIENTED BUSINESS. It is our moral professional duty to inform the patient about any silent disease. At the initial stage, most of the dental diseases are symptom free and if those can be treated initially, then it will be helpful for the patient both financially and physically.

Dear Dr. Khan,
Hello, How are you doing? A few months back, I read an article mentioning some tips "How to quit smoking". I have lost that article. Would you please tell me the tips again? By the way, are you a smoker?
Javed, AUIB

Four Keys for Quitting Smoking!
Studies have shown that these five steps will help you quit and quit for good. You have the best chances of quitting if you use them together.
1. Get ready.
2. Get support.
3. Learn new skills and behaviors.
4. Be prepared for relapse or difficult situations.
1. Get Ready
Set a quit date.
Change your environment.
1.Get rid of ALL cigarettes and ashtrays in your home, car, and place of work.
2.Don't let people smoke in your home.
Review your past attempts to quit. Think about what worked and what did not.
Once you quit, don't smokeNOT EVEN A PUFF!
2. Get Support and Encouragement
Studies have shown that you have a better chance of being successful if you have help. You can get support in many ways:
Tell your family, friends, and co-workers that you are going to quit and want their support. Ask them not to smoke around you or leave cigarettes out.
Talk to your health care provider (for example, doctor, dentist, nurse, pharmacist, psychologist, or smoking counselor).
Get individual, group, or telephone counseling. The more counseling you have, the better your chances are of quitting. Programs are given at local hospitals and health centres. Call your local health department for information about programs in your area.
3. Learn New Skills and Behaviours
Try to distract yourself from urges to smoke. Talk to someone, go for a walk, or get busy with a task.
When you first try to quit, change your routine. Use a different route to work. Drink tea instead of coffee. Eat breakfast in a different place.
Do something to reduce your stress. Take a hot bath, exercise, or read a book.
Plan something enjoyable to do every day.
Drink a lot of water and other fluids.
4. Be Prepared for Relapse or Difficult Situations
Most relapses occur within the first 3 months after quitting. Don't be discouraged if you start smoking again. Remember, most people try several times before they finally quit. Here are some difficult situations to watch for:
Alcohol. Avoid drinking alcohol. Drinking lowers your chances of success.
Other Smokers. Being around those who smoke can make you want to smoke.
Weight Gain. Many smokers will gain weight when they quit, usually less than 10 pounds. Eat a healthy diet and stay active. Don't let weight gain distract you from your main goal quitting smoking. Some quit-smoking medications may help delay weight gain.
Bad Mood or Depression. There are a lot of ways to improve your mood other than smoking.
If you are having problems with any of these situations, talk to your doctor other health care provider.
Quitting smoking is one of the most important things you will ever do.
You will live longer and live better.
Quitting will lower your chance of having a heart attack, stroke, or cancer.
If you are pregnant, quitting smoking will improve your chances of having a healthy baby.
The people you live with, especially your children, will be healthier.
You will have extra money to spend on things other than cigarettes.
Yes I was smoker!
Visit Dr. Khan’s website “www.aikodental.com” for more information on oral and dental health.

Punishment for child trafficking

Child trafficking is one of the major crimes against children. In Bangladesh the phenomenon is severe. Every month, around two hundred children are trafficked to India, Pakistan and the Middle East. There are serious punishments for trafficking but the problem still continues to exist along with all forms of other abuse against children. For your information according to the section 6 of 'naari o shishu nirjaton domon aain 2000', punishment for child trafficking is death or life sentence, sometimes with a fine depending on the degree of the crime.

 

UNDER A DIFFERENT SKY

Falling

The time was between corduroy and linen, end of summer with a touch of fall. The weather was indefinitely indecisive and I felt the direct ambiguity in every vein of my body. Every Fall, my eyes struggle a bit more to shine, smile the usual smiles as my ears hear the drop of every leaf.
The soon to be naked trees burning with orange and red leaves celebrate with me the last few days of warmth without the mechanical help of heaters. I miss the summer that I never fully take advantage of, I miss the heat which I never gladly welcome without squinting a bit.
Outside, people in their winter clothes, back to full sleeves and turtle necks, walk by up-to-date with fall fashion. The sweater that I bought at an off-season sale with an unbeatable price finally gets to hug my body, I walk out to be one of them, trying to overcome the depression of the coming winter with stylish winter clothes, the clothes which we feel so enthusiastic to wear during the first few semi-cooler days.
As the winter gets graver, the corner of our eyes frequently touch the bright summer clothes and open-toed sandals peaking out from the back of the closet to give us some hope; optimism from sunflower prints and magenta hues.
Some people suffer from symptoms of depression during the winter months, with symptoms subsiding during the spring and summer months. Of course the smart psychologists have identified this as a sign of Seasonal Affective Disorder (SAD). SAD is a mood disorder associated with depression episodes and related to seasonal variations of light.
I wonder sometimes if I have SAD, and how sad it would be if I was diagnosed with this particular disorder. Sure, it would provide me with an excuse to remain cranky and grumpy during the winter months, but the attachment of a disorder while defining my personality really would hurt my Bengali mind. Because like most Bengalis I find words like disorder, counseling, psychologists terribly offensive, and I would rather be diagnosed with a major case of denial than a definite mental disorder.
But the matter is not so light; winter in North America for me poses all kinds of definite threats. Not just me, think of all those September babies who were born, nine months from the cold December, how many of them were conceived out of the joy of Christmas and new year's eve and how many of them were conceived from mere frosty boredom and loneliness…
I guess those are the kinds of data that will never be collected and documented, it will only circle around my twisted world of random thoughts. But just to set the records straight I have nothing against September babies, I get along great with Libras and Virgos amuse me…
But seriously have you thought about it? Why are all the major holidays during the winter months in America, Thanksgiving, Hanukkah, Christmas and New Years? Why is it that the colder world has to act extra hard during the winter months to make a show of joviality?
We have to be showered with Christmas presents and consume lethargic food like huge turkeys to keep us sedated. We are even given bonuses at work during winter months, the only time employers give away free money (how unnatural is that?), Christmas bonus, Christmas parties, even an after-Christmas 70% markdown in stores…why do we deserve so much during the winter months, to keep us from which sudden SADness?
I remember as a child I would draw a very frequent picture out of imagination and glimpses from animation shown on television, the sketch was of a snow man and two little kids proudly standing next to him. There were unnaturally huge balls of snow falling from the sky…every time I finished drawing the picture I sighed regretting living in snowless Bangladesh.
I guess it's the affect of my age, or SAD or my terrible snowman drawings which never got appreciated much, that have lead me to dread the winters in America. And now, living in between summer and winter, this Fall I am falling again in the arms of short days and long nights and a bitter Bengali mood.

By Iffat Nawaz