Social Psychiatry

Substance abuse in the elderly: A hidden behemoth Subhash Das, Siddharth Sarkar Indian Journal of Social Psychiatry 2020 36(4):267-269

Of mice and men.....The unforgettable narrative of how social factors shape substance use, addiction, and recovery Debasish Basu Indian Journal of Social Psychiatry 2020 36(4):270-276 The currently predominant model to explain addiction is the brain disease model of addiction, which emphasizes drug-induced brain changes at the individual level, producing an uncontrollable, chronic relapsing disease. It tacitly de-emphasizes the complex sociocultural, contextual, and other environmental determinants of substance use and addiction. In this oration, I challenge these assumptions with a hop-and-stop tour of five countries: Canada, the USA, India, Vietnam, and Iceland. The journey covers five narratives: isolation, pain, frustration, and then the positive narrative of recovery, and finally the narrative of hope. The socially enriched rats in the “Rat Park” in a laboratory in Canada consumed much less morphine than the isolated, caged rats. People dying of opioid overdose in the worst-ever opioid epidemic in the USA might be using opioids as an escape from broadly defined “pain,” where pain is an emblem of deeper societal isolation and suffering. In Punjab, India, frustrated youths due to complex socio-political-economic reasons are falling easy prey to the profiteering drug mafia. On the positive side of the narratives, most of the Vietnam war veterans who had been using heroin heavily while in Vietnam quit after returning to the comfort of their home, family, and friends, thus providing the narrative of recovery. Finally, the Icelandic Model, a series of pro-social policy measures at the government level targeting the children, the parents, the school, and the environment in Iceland, where teenage substance abuse had been peaking alarmingly in the mid-1990s, demonstrated the preventive prowess of these measures. All in all, this journey teaches us vital lessons not to forget the social psychiatry of addiction. It also teaches us that it would be a wise investment to improve the social determinants of health, including mental health and addiction.

The role of "Attributions" in social psychology and their relevance in psychosocial health: A narrative review Debanjan Banerjee, Chehak Gidwani, TS Sathyanarayana Rao Indian Journal of Social Psychiatry 2020 36(4):277-283 Assigning motives or reasons to situations and actions have been the basic premise of human existence. Attributing cause to an action makes it logical and easier to comprehend. In social psychology, attribution is the process through which individuals explain the causes of behavior and events. Various theories and models have been proposed to explain this concept, starting from the early works of Fritz Heider in the early 20th century and further advances by Harold Kelley and Bernard Weiner. Attributional concepts can be used in a wide arena of behavioral science ranging from mental health stigma-related interventions to consumerism, corporate and jury psychology, and finally, attributional bias in psychosis and learned helplessness in depression. Attribution theories are viewed as the relevant concepts in the exploration and explanation of a wide repertoire of psychopathologies, especially for culture bound syndromes. Research into the translational use of attributional theories has declined in the recent years, the models being criticized for being mechanistic and reductionistic in approach. Nevertheless, the role of “attributions” in social psychology remains equally important today to explore the various facets of human behavior and reactions. The article explores the relevance of attributions in the fields of psychosocial health. It discusses various theoretical perspectives and frameworks premised on attributional models and narrates the understanding as well as the applications of the relevant theories in the realms of stigma research and consumerism. The criticism and implications in mental health are highlighted thereafter.

Care of transgender individuals in India: A clinical perspective Shiva Prakash Srinivasan, Sruti Chandrasekaran Indian Journal of Social Psychiatry 2020 36(4):284-288 India is making rapid strides in recent times in recognizing and providing legal supports to the transgender community. An increasing number of individuals are seeking medical assistance for gender-affirming medical interventions. Many medical and surgical practitioners working with transgender clients in the Indian subcontinent face clinical and social challenges. In this article, we highlight some of the common challenges experienced by healthcare professionals and the solutions adopted in providing care for transgender clients.

Social media disorder among Indian undergraduate medical students and its association with depression: An institution-based mixed-method study Rajib Saha, Manisha Sarkar Indian Journal of Social Psychiatry 2020 36(4):289-295 Background: Social media disorder (SMD) is the current entity in this decade that leads to different screen-related health problems. Despite of tremendous academic pressure, how social media affects the future doctors, is yet unknown. Aims: The aim is to determine the prevalence of SMD among the undergraduate medical students of a tertiary care hospital in West Bengal and to determine its predictors. Settings and Design: A cross sectional analytical mixed-method study was conducted at a tertiary care center of Bankura. Methodology: During April–June 2019, 216 undergraduate medical students were selected through two-stage sampling method. Data were collected using semi-structured questionnaire, 9-item SMD scale, and Beck's Depression Inventory Scale. Statistical Analysis Used: Data were analyzed using SPSS (version 16) initially through bivariate analysis using Chi-square test and later logistic regression was used to determine the actual predictor(s). Results: The prevalence of SMD was found to be 11.6%. All of the students were found to be social media users and among them the prevalence of screen-related sleep disturbance, headache, eye problem, musculoskeletal problems, and overweight or obesity was 35.6%, 36.1%, 28.7%, 31.5%, and 50.9%, respectively. However, no significant relationship was obtained between SMD and above health problems. Through logistic regression model, it was found that the students with depression were 6.7 times more prone to develop SMD. Conclusions: Depression being a risk-factor for SMD needs to be addressed as priority by providing appropriate counseling and/or professional consultation.

Taking therapy beyond clinics – An evaluation of family therapy training program with lay counselors Janardhana Navaneetham, Tania Roy Indian Journal of Social Psychiatry 2020 36(4):296-302 Background: Families have been accommodating the changes to suit the present situation. Indian families even though structurally moving toward nuclear families, still carry on the values of the joint families of connectedness, interfamily influences, extended family influences on decision-making, etc., Subjects and Methods: The study aims at understanding the effectiveness of family training with lay counselors. An interview schedule was prepared to collect sociodemographic profile, knowledge about family therapy (FT), and confidence of practicing FT. The participants were enrolled for training based on ‘first come first serve’; those who completed postgraduation and PG diploma were included for the training program, and most of them were involved in the helping profession either as part of the training or service. This study was of a quasi-experimental design with assessments at two timelines – pre-post training sessions. Results: Most of them expressed that they had previously worked with families with child abuse, academic difficulties in children, marital issues, domestic violence, etc. A test of Wilcoxon's signed-rank test showed the change in the knowledge and confidence level of the trainees. Nearly 48.1% and 46.3% of the participants felt they have high and moderate skills in identifying cases that require family interventions, respectively, 70.4% said that the sessions were high in clarity, while 25.9% reported moderate clarity. Almost 68.5% expressed no difficulty in understanding sessions. This article attempts to share their experience of conducting the dissemination of systemic family intervention for the people in the service sector. It was found that the participants appreciated the training programs and were able to see the benefit of including systemic approach in their family intervention. Conclusion: This article attempts to share the experience of conducting the dissemination of systemic family intervention for the people in the service sector. It was found that the participants appreciated the training programs and were able to see the benefit of including systemic approach in their family intervention.

Impact of social-emotional learning intervention on emotional intelligence of adolescents Shruthi Kothari, Mareena Susan Wesley Indian Journal of Social Psychiatry 2020 36(4):303-309 Adolescents face a variety of challenges, some of which include social, emotional, cognitive, and interpersonal. In order to help them with their emotions, adolescents should be taught a variety of skills to regulate and handle emotions better. With this intent in mind, a social-emotional learning (SEL) intervention module was developed by the researchers. This module covered aspects related to self-awareness, social awareness, responsibility, empathy and decision-making. These components also form the basis for emotional intelligence (EI) which is defined as the ability to perceive, understand, and regulate emotions of oneself and others. The present study aimed to understand if there arises any difference in scores of EI post the SEL intervention. Second, the gender differences with respect to EI were also be analyzed. The EI Scale (2014) was administered to 80 students between the age group of 13–14 years, from a CBSE school in Chennai. These adolescents were selected through the convenience sampling, and the four subscales were also analyzed. The findings from the study revealed a significant difference in scores from pretest to posttest (t = −4.66, P < 0.05). With respect to gender, no significant difference was found. On the subscales, two of four subscales showed significant difference in understanding emotions (Z = −4.63, P < 0.05) and handling emotions (Z = −4.023, P < 0.05).

The influence of social environment on children of a commercial sex worker V Deepa, MY Manjula Indian Journal of Social Psychiatry 2020 36(4):310-316 The case study aims to understand the influence of social environment on the course of life of children of a commercial sex worker. The participants of the study were two sons of a commercial sex worker who grew up in different environments. The older sibling who is 19 years of age (case 1) lives with his mother, whereas the younger sibling who is 17 years of age (case 2) lives in a hostel distant from everyday influence of a brothel. The study adopts multiple case study design and in-depth interviews were conducted to gather data. The obtained data were subjected to thematic analysis. Each case was analyzed individually, and then cross comparison of the themes derived was carried out. The themes derived on analyzing case 1 were social categorization, mercenary activity, substance aficionado, complacency in life, and compliance with life while the themes derived on analyzing case 2 were disgust toward commercial sex work, feeling of precariousness, antipathy toward home environment, irrational thoughts and anticipation of a better future. The only overlapping issue that emerged in both cases was being protective about their mother. It was concluded that environmental variance contributes to the difference in experience and perception of the situation and society.

Medical students and marijuana, attitudes and beliefs: A comparative study Gurappa Puttanna Gururaj, Ruth Sneha Chandrakumar Indian Journal of Social Psychiatry 2020 36(4):317-320 Background and Objectives: Various studies indicating that cannabis is associated with various psychiatric disorders despite which is a controversy existing regarding the legalisation of cannabis by all the promoters and consumers of the substance. Our objective was to find out the knowledge and awareness among the 1st year and final year medical students toward the effects and experiences with the consumption of cannabis. Methodology: It was a cross-sectional study done on first and final year medical students between July 2019 and August 2019 in Sri Devaraj Urs higher education and research center, who are assessed using a structured and validated instrument, Marijuana Effect Expectancy Questionnaire-Brief (MEEQ-B) questionnaire. Results: Both the first-year and final-year medical students in our study had poor awareness and inadequate knowledge about the various adverse effects of cannabis, especially on all the six parameters of the MEEQ questionnaire. Conclusion: Extensive and elaborative teaching regarding substance use, especially of cannabis and its implication must be updated in the curriculum of both UG teaching and PG teaching in other specialities as well.

Psychological aspects of infertility: A comparative study Nigesh Kalorath, Tilottama Mukherjee Indian Journal of Social Psychiatry 2020 36(4):321-326 Introduction: Psychosocial aspects of infertility in couples are of much relevance. This paper attempts to compare psychological factors that may play a role in couples with and without infertility. The main objectives are to examine the differences concerning marital quality, attachment styles, and defense styles of infertile and fertile couples. Methods: A total of 60 individuals (30 infertile couples and 30 matched fertile couples) were assessed through administering the personal information schedule, Marital Quality Scale, Attachment Style Questionnaire, and Defense Style Questionnaire-40. General Health Questionnaire-28 was administered in the fertile couples to rule out psychiatric morbidity. Results: Statistical analyses revealed that infertile couples differed from fertile couples on marital quality dimensions of understanding, satisfaction, trust, role functioning, despair, and rejection. On the attachment style, component of preoccupation with relationships and the use of immature defenses such as acting out and displacement. Conclusions: This research identified several psychological dimensions related to fertility. Understanding these factors may be helpful for the couples, their family members, and practitioners, with regard to the psychological and social needs related to infertility.

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