INTERPRETER OF MALADIES

Dr. Nighat Ara, Psychiatrist

Dear doctor
I'm a girl in my early twenties, and have a teenaged younger sister. Our parents have brought us up on an equal basis, liberally bestowing love, affection, and attention on us both without any partiality whatsoever.

Now, I have always been of a more academic frame of mind, preferring a good book to a party. I've also been relatively docile (more out of laziness than an innate sense of obedience!) and rarely disobeyed my parents. My choice of friends have been in keeping with my parents' approval.

My sister, on the other hand, has been, since childhood, a more rebellious child, more interested in outdoor activities, be it sports or cultural activities, than in studies. You know how parents are always concerned about their children's academic performances, so there has been many an occasion when my sister got berated for not being serious enough. As is human nature, comparisons have been drawn between her and myself.

The problem that has arisen is that my sister now feels that my parents are displaying favouritism towards me, and she feels neglected and unloved. She feels that she will never be good enough for their affection, and this inferiority complex has led her to further engage in activities that invite castigation. She also associates with the kind of people who are un-ambitious and have no goals. Because of this perceived lack of affection from her parents, my sister also resents me sometimes, feeling herself to be under my shadow, so to speak.

You can well imagine the situation at home…my parents are at the end of their tether with her; she is depressed and insecure most of the time, and I'm the unfortunate one caught in the crossfire. How do we deal with this?--Sandwich

Ans: You have described a very clear scenario where we see how each member in a family gets affected by one another. Typically, we tend to point our finger to one member as the index patient though; the whole family in fact is the background patient. Your sister is apparently the index patient here and is probably acting out to get attention and also using her power to control the dynamics that has failed to fulfill her needs. It appears to me that your parents had the challenging job to raise two temperamentally opposite children. You were docile, studious, introvert kind of person whereas your sister is a high-energy, emotionally sensitive, extrovert kind of person. Your parents have had you first and had a smooth sail. However, parenting high-energy children is definitely a tough job (parenting can easily become a guilt trip!). You were always compliant to your parents and did all the right things, no wonder your poor sister feels so lost and has a distorted self-image, which could be the outcome of direct and indirect messages she received from significant others in life. You have stated that your parents were impartial in providing love, affection and attention. However, this is your view and she might have perceived it differently and someone has to believe her story too (it is important to validate her feelings instead of dismissing it right away). Teen-age children go through the most difficult developmental task, "identity vs. role confusion", at this age many children rebel against their parents (more common in extrovert children who do not want to live by the family rules) and test the limit of their parents by trying newer values/attitudes. Good news is, children do grow out of this phase eventually. An extrovert child needs to be encouraged to spend their energy in outdoor activities (sports, cultural activities etc) and help them to find who they are. Children who are not academically high achievers and are belittled for their under achievement ignoring their natural talents in other areas, start to suffer from low self-esteem and frustration. Rigid rules and critical comments made by parents have the potential to get internalized deeply (forming super ego component of metaphorical mind) by the child to the extent that it would continue to judge her as "no good" for the rest of the life even in the absence of that message from the parents in later life. If the child starts believing that "nothing is ever going to be good enough"- s/he would end up feeling hopeless and worthless. This perceived lack of any reward tends to inhibit them from trying harder in the future and they eventually give up. Instilling hope, lowering/changing expectation of parents, accepting the child for who she is instead of trying to transform her into someone else (and losing her real self in the race!)--are some important tools to recover from this situation. If "love" is always conditioned with "performance" (e.g. "if you get high grades then you are a good girl "-- the hidden message is you are lovable only if you are a good student), this deprives the child from "unconditional love" that is so important for nurturing the soul. Discipline that promotes self-reliance, co-operation and respect, democratic parenting (neither aggressive nor passive), effective communication (specially active listening), application of consequences which are logical (giving her a chance to know the natural consequences of an action as well) and above all letting her know that she is loved as a person (even though her behaviour is unapprovable)--can be some psychological methods to deal with this situation.

ADHD (attention deficit hyperactivity disorder) and learning disability are certain psychiatric conditions where children cannot reach an optimum level of achievement. Effective treatment of ADHD can magically change the life. Learning disability children need special care to adjust their special needs. These "high maintenance" children can eventually make significant progress in life. Personality disorder, mood disorder etc. at the onset can also create this kind of confusion.

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.

Dr. Khan
I had several black colour metal fillings (amalgam which containing mercury), but one tooth is a lower molar which I did more than four times. Actually it has no supporting wall to hold the filling in place. Doctors suggested that I go for root canal treatment followed by cap. My question is, if I don't have any pain or any sensation why I should go for root canal treatment? Is there any other alternative treatment? Are dental amalgams safe?
Thanking you
Towhid Hussain

I think you should go for inlay (laboratory based cast filling),though it's not familiar in Bangladesh. We very few dentists are doing inlay in Bangladesh. I think if you don't have pain sensation then Root canal treatment will not be appropriate unless X-ray reveals any infection. Dental amalgam has been used in tooth restorations worldwide for more than 100 years. Studies have failed to find any constructive link between amalgam restorations and any medical disorder, but it is somehow still controversial as it contains mercury. Inlay is a wonderful alternative of amalgam filling. I got very satisfactory responses from my patients having inlay. For making inlay you don't need to sacrificed your original surrounding tooth structure as we do for making cap.

Dear Dr. Khan,
I have missing teeth and it is difficult to chew properly, especially hard food. I am thinking of making a bridge but before that I want to know whether there is another way I can have a tooth replaced other than a bridge?
Uttam Shaha

Dental implants can provide artificial teeth that look natural and feel secure. Dental implants can also be used to attach full or partial dentures. Implants, however are not an option for everyone. Because implants require surgery, patients must be in good health, have healthy gums, have adequate bone to support the implant and be committed to meticulous oral hygiene and regular dental visits. If you are considering implants, a thorough evaluation by your dentist will help determine if you would be a good candidate. Otherwise proper fitted bridge can solve your problem.

Remedy for fizzy hair

Fly-away, frizzy bits of hair can get on anyone's nerves. Tame those unruly strands by adding a single drop of moisturizer on your hands, and then running your fingers lightly through the frizz.

 

UNDER A DIFFERENT SKY

The Green in Red, White and Blue

It was a Friday night and I was too lazy to make it in, so I stayed out. Out enough to be close to my home near the border of Washington DC, where pretense suburb meets the spurious city. After a long week of "nothing much," sleeping-in always seems like the most wretched option to me. So to upkeep the posing social life of mine I often end up making elaborate plans on Friday nights. Meeting with old friends and ending up at the same lounges, trying to scream out conversations over louder shouts of vocalists which will be easily forgotten with a semi-good night of sleep (both shouts, mine and the vocalist's), and drinks that will not result in a hang-over but will bite my inside about the extra intake of calories. The life of a good few 20, 30, 40some Bengalis living in USA.

The night didn't promise much and I wasn't in the mood to not act my age, the company I was with also didn't want to play any games of charade. So we didn't drive to Adam's Morgan's cluttered openness or metro to DuPont Circle's uncovered-make-believe-porches serving fruity delights. After dinner we barely skipped over to a local restaurant that demises itself to a DC lounge in its authentic Caribbean style with not so authentic Missy Elliot and one hit wonders… classics that are so not classy…yet so convenient.

With the prefect city snobbery that we have practiced to the T, we made our nonchalant entrances, scoping out the place as others around decide if we are worth a scoop. Surrounded by mock coconut trees and real hammocks we found a real couch to sit on. We debated if we should get dessert or an appetizer, and decided we should watch out for that threat of love handles, so we sat pretty with our non-fruity drinks in the middle of turquoise and yellow cocktails…

In the corner a group of mostly African American brothers got friendly with their "sistas" and amongst them a token white boy and his pastier girlfriend tried hard to belong with their "hollas" and slang throwing. He showed more interest in all the girls with more tainted colors than his pale girlfriend with tight jeans who constantly tried to drag him to the dance floor… but I guess the alcohol in his head constantly forced him to belong, belong, belong. He screamed out "Once you have gone black, there is no coming back," while the rest of us looked at him with our "you are so ignorant" look and he tried to come back with his best Eminem "like I give a @#$%" look…

Two girls giggled their way into the couches on our right. They sat down fixing their hair and their lip-gloss and a foursome of 30something followed them. They sat on each other's laps, giggling and saying sweet nothings, and then…surprised me when I heard them talk about the Iraq war, the rising gas prices in America, about Bush's lies.

One of the girls and one from the 4 some (a tall Caucasian male with an army buzz cut hair) broke out into an argument. She insisted on Bush's treachery about the ongoing unneeded war in Iraq, about how all Muslims (or in her words "Moslems") are not bad. He argued about patriotism, having faith, about how "you only show mercy to those who gives it back"….and they melted into a long fiery conversation. And I listened.

This is something the Adam's Morgan lounges can never offer me, the emotions of a raw American, which is so not "in" to express in the middle of trend city DC. At the hip places in DC we talk about the independent films, the hot spots to eat at, and yes politics, but only to a vague limit. There it's cool to act liberal even for the republicans. One would have to hit what I have tonight a "Mango Mike" at the border of suburbs to really hear the sides that decide…the side of an American army, who had been to war or maybe never have, yet believes strongly in the decisions that the president have made.

Towards the end of his argument he said, 'I am sorry if I offended you, but I am not sorry about how I feel…this is who I am, and I am not alone." And I the nosy neighbour wanted to tell him that it's okay, he is good the way he is, to believe is not a bad thing, it's what you do with your belief is what matters…but I kept my mouth shut and moved my eyes to the left couch.

At our not so exciting sofa we looked at each other, we got comfortable and decided to order a plate of breaded, fried and buttered chicken wings with jumbo fries. There was no way we would leave at that moment. The entertainment called life was too live and thumping for us to ignore and we let ourselves drift away from one reality to the next…and I said to myself…finally…. Welcome to America.

By Iffat Nawaz