<figure><img width="1400" height="932" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902db9c7e80680e037c8bjpeg.jpg" alt=""/><figcaption>Source: The Lancet</figcaption></figure>The debilitating effects of mental health diseases and the <a href="http://archive.nepalitimes.com/news.php?id=14138#.W2MFj9Uza70" target="_blank" rel="noopener">social stigma associated with them</a> are not limited to patients: the lives of family members also change irrevocably. Family support can also be an important source of strength and even help in the healing process, say psychiatrists, patients and their relatives.Reshma Magar from Sindhuli, brought her 35-year-old son to a mental health clinic in Kathmandu after he displayed symptoms like severe headaches, mouth fizzing, and haphazard running around. As a mother, she was constantly worried he might hurt himself.“We have the Sun Kosi River nearby and I would think: what if he jumped?” says Magar, who has to tie him up in the hospital bed to contain his violent behavior. “I would be crying and the nurses here would console me.”Read also: <a href="https://www.nepalitimes.com/?p=10647&amp;preview=true" target="_blank" rel="noopener">Raising children can be therapy</a>, Ketan DulalNabina and Samira Pradhan shared similar hardships. Their brother, 40, started showing erratic behaviour after his wife left him, taking their daughter with her. He throws things around, does not eat, and their 71—year-old mother has to look after him.“It is very hard,” Nabina says, “mother herself has health issues and because of our brother’s state, violence in the home remains a constant danger.”Sufferers of psychotic mental illnesses are generally unaware they have a problem. In <a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener">schizophrenia</a>, a severe psychotic disease, patients have a distorted sense of reality − hallucinations, extreme paranoia, hearing voices − that their mind infers as truth. They resist help, and family members have a difficult job coaxing them to seek and continue medical treatment.Beyond this, the emotional trauma of having a suffering relative is a constant feature of life for the Magar and Pradhan families, which makes each day frightening and unpredictable.Read also: <a href="https://www.nepalitimes.com/?p=10641&amp;preview=true" target="_blank" rel="noopener">Addicted to the joystick</a> , Suprasanna AryalResearch has shown that patients suffering from psychosis have various structural and functional abnormalities in the brain. Schizophrenia patients have dysfunctions in their neurotransmitter systems, metabolic pathways and certain structures in the brain regulating motor activity.Traditionally Nepali society, which did not have coping mechanisms, regarded mental disorder as a curse, and there is strong social stigma and ostracisation of both the patients and their families. Derogatory labels for <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/overcoming-depression,2164" target="_blank" rel="noopener">‘crazy’ people like ‘dimag khuskeko’ or ‘pagal’</a> are still widely used.However, now that science has shown that the causes are mostly chemical imbalances, there is treatment says Basudev Karki of Lagankhel Mental Hospital: “Medicine now has treatment for mental diseases, just like for physical ailments. Problems of the mind also need medical care and treatment and there is nothing wrong in that. Instilling this understanding will help address stigma for patients.”Read also: <a href="https://www.nepalitimes.com/?p=10601&amp;preview=true" target="_blank" rel="noopener">Ashna comes out of black</a>, Sewa Bhattarai <img width="670" height="585" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902de9c7e80680e037c8cjpeg.jpg" alt="">However, Karki cautions that medical interventions alone sometimes do not suffice because the triggers may be a combination of biological, psychological and social factors. For example, there was a <a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener">surge in mental disorders in Nepali society</a> during <a href="http://archive.nepalitimes.com/article/nation/psychological-scars-of-maoist-conflict-on-young-survivors-take-longer-to-heal,1519" target="_blank" rel="noopener">the conflict</a> and after <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">the earthquake</a> and Blockade. Out-migration and family separation pushes people into another class of mental illness, like neuroses, such as <a href="http://archive.nepalitimes.com/regular-columns/all-in-mind/the-silent-scream-depression-is-common-but-only-few-get-treatment,588" target="_blank" rel="noopener">depression</a> and anxieties in which, unlike psychosis, the patients preserve a sense of reality.Following hospital treatment it is up to family to provide psychological support for patients, to think positively and maintain a healthy lifestyle. They must protect patients from extreme stress due to social factors, such as unemployment or financial trouble.Muna Tamang shows extraordinary determination this week as she sits beside the hospital bed of her 24-year-old daughter who is suffering from psychosis. “As long as she can live and heal, I have decided that we will do anything for her treatment, even if we have to take loans,” Tamang told us.Read also: <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">It's all in the mind</a>, Sonia AwaleNepal’s mental health facilities are mostly based in cities, but even here there aren’t enough trained specialists to deal with what is a national mental health epidemic. Up to one-third of Nepal’s population suffers from some form of mental illness, according to one study. (See chart)One group, The Transcultural Psychosocial Organistaiton (TPO) is working to remedy the urban-rural mental health gap, by training doctors and health workers at the local level with Female Community Health Workers.“We do not just want to make these services available, but to also ensure people reach out to them, and refer patients to seek help in facilities,” says Kamal Gautam at the TPO.Such efforts have helped remove stigma, and empowered patients and families to receive treatment and care. But Nepal still has a long way to go. With greater state investment, access to mental health services and proper therapy, family members can be even more involved in helping patients and reducing their stigma.Some names have been changed.

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All in the family

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110714114/636902e69c7e80680e037c8fjpeg.jpg" alt="" width="1400" height="1050"/><figcaption>Kunda Dixit</figcaption></figure>When my daughter was born I was not present during the delivery. I could not hold her like most parents after their newborn is brought into this world.Here I was in Canada, and she was born in Nepal. At five months, she arrived at Charlottetown airport. I did not hug her first, because her mother who had warned me on Skype: ‘Don’t suddenly hug your daughter, she gets spooked easily.’She is a beautiful baby and I can see myself spending a lot of time with her as she grows up, as I dream about what kind of person I want her to be.Why become a parent? The evolutionary reason for it is that you want to leave your genes after you pass on. But that idea is wrong. Parenthood, as Andrew Solomon says in his book Far <a href="https://www.amazon.com/Far-Tree-Parents-Children-Identity-ebook/dp/B007EDOLJ2" target="_blank" rel="noopener">From the Tree</a> , is an act of production rather than reproduction. Seeing ourselves in our progeny is a profound mistake.Parenting is anything but normal. What you are doing in becoming a parent is sacrificing your life to a being, while not knowing how they will turn out. It is a fulltime job for which there are no wages.In <a href="https://www.amazon.com/Gardener-Carpenter-Development-Relationship-Children/dp/1536617830" target="_blank" rel="noopener">The Gardener and Carpenter</a>, psychologist Allison Gopnik has problems with the current model of parenting. Parents, instead of thinking themselves as guardians of their children and trying to mould them into what they want them to be, should instead let them flourish as they are, she says.To build such a relationship with children is the key to becoming a parent. It is especially important for parents with <a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener">mental illness, like me</a>. The stereotypical view is that parents with mental illness are not good at their job. Admittedly that has been supported by some studies, which show that parenting can indeed lead to more stress for fathers and mothers with mental illness.Read also: <a href="https://www.nepalitimes.com/?p=10636&amp;preview=true" target="_blank" rel="noopener">All in the family</a>, PRAKRITI KANDELHowever, there have also been several studies to show that raising children can actually bring about short and long-term change in the hormones in the parents' brains. The attachment between mother and child, for instance, is stimulated by the production of the hormone oxytocin in the brain. Oxytocin levels in fathers also seems to increase following the birth of a child and during interactions with infants.Similarly, testosterone in the brain of a father decreases after a child is born and following interaction with children, although it may help in protective response, for example, when the child is threatened by a predator.Parenting can also be a therapeutic tool for patients with mental diseases like <a href="https://en.wikipedia.org/wiki/" target="_blank" rel="noopener">schizophrenia</a>, who are under antipsychotic medications that block the receptors of dopamine. However, although antipsychotics can treat symptoms of schizophrenia (like hallucinations and delusions) it is ineffective in treating other symptoms like lack of motivation.Oxytocin, on the other hand, is involved in the process of attachment. The hormone can be used as a therapeutic agent to reduce some symptoms of schizophrenia. And since it is produced also in fathers and mothers when they interact with their children, parenting could be an antidote to the disorder.The most important thing for parents with mental disease like schizophrenia is not to be too anxious about how their children are going to turn out as they grow up, but look to develop lasting relationships with them.Parenting can be stressful, but is a blessing. Developing good parenting skills to build good relationships with our children (without trying to mould them) can be an effective tool for handling <a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener">mental disease</a>.I have schizophrenia, and one of the things that I do to reduce relapse is interact with my daughter as much as possible and also build a positive approach to my parenting job.Ketan Dulal is a PhD candidate at the University of Prince Edward Island in Canada.Read also: <a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener">Stigma and silence</a>, Ketan Dulal<a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener">It's all in the mind</a>, Sonia Awale<a href="http://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener">The republic of insomnia</a>, Editorial

Raising children can be therapy

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Raising children can be therapy