WOW | People

MIND MATTERS

As the COVID-19 relentlessly sweeps the world with many countries under lockdown, life has changed dramatically. Our day structure, our interactions, isolation, the news we consume about the pandemic, the uncertainty has created anxiety fear… life is different. In this edition, WOW explores how we can protect and maintain emotional and mental health in general. We talk to five different experts in the field of mental health about managing mental wellbeing.

Complied by: Pabita Dahal

Dr. Krista Rajkarnikar
Counseling Psychologist

Dr. Krista Rajkarnikar moved back to Nepal six years ago after receiving her doctorate and working in the UK for ten years. She is a charted counseling psychologist and has worked in private and public sectors and specialised centers. Currently she runs her practice and is a consultant psychologist at CIWEC Hospital and other organisations.

What are the main causes of mental, emotional and behavioural disorders?

Causes of mental health disorders are mostly a combination of factors. People can primarily be affected by one significant trigger, but it depends on their internal values and beliefs as well as their external and possibly genetic factors.

What do you do to help people?

As a chartered counseling psychologist, I hold a pluralistic perspective where I believe different interventions work for different people based on their presentations and what kind of outcomes they seek. For example, I offer cognitive-behavioural therapy if people want to identify thoughts, emotions and behaviours and challenge these, thereby reducing symptoms. If people want to process difficult experiences or understand core beliefs to negate dysfunctional ones, I offer more humanistic approaches such as person-centered therapy. Assimilative integrative therapies can also work based on client needs.

People can also seek help to gain clarity and increase self-esteem and sense of self so they feel better about themselves and hence improve levels of happiness and mental health, and wellbeing in general. Apart from interventions with individuals, psychologists can also administer psychometric testing and work in research, training.

What are some habits to improve mental wellbeing?

There are a lot of things people can engage in to improve mental health wellbeing. Generalised strategies focus largely on taking care of your physiological health and positive behaviours that increase positive relatedness, competency, and autonomy. I suggest people personalise the generalised suggestions and make sure they work for them on an individual basis. For example, if physical activity is suggested, if you like walking as opposed to swimming, remember to choose your choice of exercise that will be beneficial for you.

One tip you recommend everyone adopt towards improving their mental and emotional wellbeing?

There are so many ways to improve mental health wellbeing. My main tip however would be to ask yourself if you are okay. If not, seek help and support from friends, family, peers or practitioners. Identify thoughts, emotions and behaviours that will make you happier without harming yourself or others.

What advice would you have for people to take care of their mental wellbeing during COVID 19 pandemic?

A global pandemic like this can be worrying on many levels to all of us at some stage. While it is important to stay informed, there are many other ways we can take care of our mental wellbeing. Check reliable sources for news and updates, but also limit how many times you watch the news daily. Repetitive and difficult news can add more stress. So, try to stay connected with loved ones. Engage in healthy and meaningful behaviours and habits. Try to keep up positive thinking and normalise and rationalise worry. Keep a daily structure and have some aims and goals to accomplish during the lockdown. Make sure you keep active and engage in exercise, yoga or meditation once a day at least for 20 minutes. Help somebody without putting yourself at risk. This can increase sense of purpose during times when people feel helpless. Accept that we are all in a time of uncertainty and remain hopeful. If you were dealing with difficulty before the pandemic, continue processing this with a trusted confidant or with professional help. Limit judgment, discrimination and increase compassion and empathy. Do not be afraid to ask for help.

Dr. Kapil Dev Upadhyaya
Senior Consultant Psychiatrist & Advisor at the Centre for Mental Health and Counselling Nepal

Dr. Kapil Dev Upadhyaya completed his MBBS in 1971 from Patiala Medical College, India. He has also done DPM from the National Institute of Mental Health and Neuroscience, Bangalore and Diploma in Neurology from Tel Aviv University, Israel. He served with the Government of Nepal for almost 34 years and retired as a Chief Mental Health Specialist and Director of Mental Hospital. After retiring from government service, he has worked as UN Stress Counselor at UN office Nepal for three years. Currently, he is Advisor at CMC- Nepal. He has also published various articles on mental health.

What are the main causes of mental, emotional and behavioural disorders?

Various biological, psychological, social, and environmental causes lead to mental, emotional, and behavioural disorders. Right from hereditary and genetic causes, psychological problems in growing up children and adolescents, social factors, the environment at home, at school and the community level can also lead to such disorders. Physical, emotional, and sexual abuse during childhood and adolescence can cause certain mental health problems in adults. Likewise, socio-economic inequalities, homelessness, and unemployment are risk factors for mental health. Many physical illnesses like thyroid problems, diabetes, cardiovascular illnesses, arthritis, and vitamin deficiency also invite mental illness. Alcohol dependence syndrome or alcohol addiction and drug addiction too are considered mental health problems.

What do you do to help people?

At first, we try to find out the most likely causes of mental disorder. After diagnosis, we apply therapies, counseling, and medication as per the need of the patient. We help small children by play therapy whereas art and drawing are useful for little grown-ups. But before applying any other methods we try by counseling to parents initially. Similarly, some adolescents need social and environmental modifications along with psychotherapy or behaviour therapy. Others may need medications. Adults often require different therapies and medications depending upon their diagnosis. People who have more severe mental disorders like psychosis, bipolar disorders, etc need medications and at times hospitalisation and management.

What are some habits to improve mental wellbeing?

Healthy lifestyle like having good nutrition, regular physical exercise, proper rest, and sleep are good for physical and mental health. Social interactions, going out in nature, managing anger, frustration, and stress are needed for good mental health. Avoiding smoking and drinking also relieves mental health problems and seeking help from the specialist helps early recognition of problems and management of it.
Some other pieces of advice about your proper mental health are: do not compare yourself with others and do not be too ambitious to achieve unattainable goals. Be an optimist, and have self-confidence. Do not try to change others, instead try to change yourself which is possible. Learn some yoga or meditation and practice regularly which improves your concentration, relaxes you and helps to calm you.

One tip you recommend everyone adopt towards improving their mental and emotional wellbeing?

Accept yourself the way you are, do not worry what others think of you and enjoy every moment of life as a great gift.

What advice would you have for people to take care of their mental wellbeing during COVID 19 pandemic?

Coronavirus has created fear among people from all over the world and it is natural too. But fear will not make it go away. Instead it’s better to avoid infection and stay healthy. Also save yourselves from false news to reduce anxiety and stress. Fear is nothing more than imagination. We should accept our emotions and naturally process them instead of being overpowered by fear, anxiety and stress.

I would also advise adopting healthy hygiene habits such as washing hands with soap, using sanitizer, not touching face frequently with hands, using masks while going out from the home, maintaining social distance and staying positive.

Lockdown is declared in the country and passing the time has become a problem for many people. But small things can help like listening to classical music for half an hour can assuage stress. Watch movies, read books, talk joyfully with family, and spend time talking on Skype and Viber. If you believe in praying, worship and listening to holy talks from your favourite guru, it can also create peace of mind. Adequate sleep, nutritious food, and regular exercise can increase our immune power. Meditation and yoga also are helpful.

Lisa A Gautschi
Holistic Therapist

Lisa A Gautschi (Sannyasi Yogatara Saraswati) is a holistic therapist, yoga practitioner and certified somatic experiencing practitioner. Her background lies in the hard science of biochemistry, but over 20 years ago she transitioned into the life sciences of yoga and spiritual psychology. Director of the Isha Institute Nepal and Isha LLC, USA, she serves individuals and groups who seek true wellbeing through her role as counselor, consultant and educator. Born in the US, raised in France, she has lived in Nepal for over 20 years.

What are the main causes of mental, emotional and behavioural disorders?

Although this seems like a simple question, this is quite complex. There are many different points of view on this matter.
As a holistic therapist, with a background in yogic sciences and spiritual psychology, I understand that the mind (thought processes, perception), the emotional body (feelings) and the physical body (the medium through which we act and behave) are interrelated and interacting at all times. As such, disturbed thinking patterns will create emotional struggle (negative emotions or an inability to manage them), which then influences how we interact with others and behave.

There are several things that can cause disturbances in the way we think, understand, express ourselves and behave. Some are related to our own personality and nature, including influence from the genetic material we have inherited. Another important factor is the environment in which we grow up and in which we live. Our understanding of the world (how we see it, how we feel it and how we feel ourselves in it) takes root in our childhood, from the time of conception. The sense of safety we feel—physical, emotional, intellectual— or lack thereof, our own sense of self (or lack thereof) greatly influence how we see things, our ability to access and manage emotions, and how we interact.

As someone specialised in trauma resolution, I see that trauma—in childhood or in later life— is a significant contributor to mental, emotional and behavioural disturbances. Trauma can be big or small. It includes things such as neglect, abuse, unhealthy dynamics, manipulation, as well as accidents, natural disasters, and injury. But it is a beauty of trauma that it can be resolved or renegotiated, under the right care and with the proper support.

What do you do to help people?

I strive to provide a safe space in which people can come and begin to express and explore what is off-kilter in their lives—both internally and externally. These are people who may be in a transition point, or might be dealing with anxiety, acute/chronic physical distress, or simply feel confused or stuck. I help them all. I support those who have experienced a traumatic event to renegotiate this.

I use the tools of listening, creative expression, body movement, mindfulness, and Somatic Experiencing-a body-oriented approach to the healing of trauma and other stress disorders. My goal is to give people tools they can use to help themselves, so that they are not dependent on the therapist, but rather become one of their own best allies.

What are some habits to improve mental wellbeing?

There are many, but three of my favourites are the following:

• The basis of all wellbeing is to develop and cultivate awareness.

• This means having the courage and willingness to get to know one’s self truly and honestly. To do so we need to develop skillful presence, to become still and observe ourselves. Once we are aware, our next task is to accept what is there and ourselves as we are at that moment. The change is only possible when we know and accept our real condition.

• Nourishing our minds and hearts Just as we are careful about what food we put in our bodies, it is equally important that we feed our mind and heart with uplifting, supportive and positive inputs. Some things we can do are read inspiring stories, listen to uplifting people/music, and surround ourselves with people who bring out the best in us.

• Move, move, move! Our bodies, minds, and emotions are inter-related. One of the best medicines for our mind is to move our body in healthy ways, and regularly. Dance, walk, run, practice yoga. We shift our psychology when we shift our physiology.

One tip you recommend everyone adopt towards improving their mental and emotional wellbeing?

I would suggest two tips. First, find ways to learn to know yourself and to express yourself in healthy ways. That could be through a practice of mindfulness, meditation or even therapy. You can express yourself through your words, dance, drawing, doodling, or finding a trusted someone you can speak with.

Secondly, reach out for help and support when you’re struggling. Whether the problem feels big or small, know that you are not alone and you do not have to figure everything out alone.

What advice would you have for people to take care of their mental wellbeing during COVID 19 pandemic?

This pandemic situation is causing disturbance and change in our day to day life within us and society. Although stress is a natural occurrence of every day, such special situations create more. However, we can care about our mental health wellbeing by adopting the following strategies:

• Acknowledge and accept how/what you are feeling.

• Slow down and re-establish a new daily routine (pace yourself).

• Reclaim your power-recognise what you can do in order to adapt to the sudden change, even if it is the smallest of things.

• Stay engaged in constructive activities.

• Connect with others: more than texting or writing, call others or use video chat.

• Do practices like yoga, tai chi, meditation, breathing practices. All of this help deepen our presence and connection with ourselves in here and now. They also swing the nervous system into its “rest” phase.

• Seek professional help. Don’t be shy to ask for help, even if it seems like a “small thing”. There are several agencies/professionals in Nepal.

Uden Maharjan
Sound Therapist & Public Health Researcher

Uden Maharjan is a Public Health Researcher who has completed the Master of Public Health specialising in Health System Research and Program from Thammasat University, Thailand. He has been working in the field of public health for the past 11 years with various organisations and independent researchers mainly contributing to social and health research and project management. He is also a sound therapist who heals emotional and mental disturbances by using singing bowls and guided meditation for two years.

What are the main causes of mental, emotional and behavioural disorders?

Social determinants of health are the conditions in which people are born, grow, work, and live, and the main causes of mental disorders. Such determinants like family background, relationship with family, friends, and society, suppressed desires, unfulfilled wills, expectations and pressure of family and society, traumatic experience in early life, smoking, alcoholism, etc mainly determine our behavioural choices, mental state, and emotional state.

What do you do to help people?

Being somebody to listen to a person’s feelings is the finest way of mental healing since a lot of emotional and mental issues occur because of unexpressed feelings and suppressed desires. Lots of issues are solved when they share things honestly. At first, I give people enough space to talk, to express the truthful state of mind so that they feel free. I also help them to relax by focusing on breathing. Lastly, I use singing bowls as a tool for therapy.

What are some habits to improve mental wellbeing?

Having a positive attitude towards ourselves and life is crucial for mental wellbeing. Listening to motivational speakers and leadership experts may help to a certain level. It is also necessary to talk and express our feelings. If you have no one to talk to, then you can take the help of a professional psychologist. In the same way, we must have or develop a positive, healthy, and open relationship with our family members and friends where proper communication is possible. Compassion, kindness, generosity, and forgiveness are essential for a good state of mind. I find people very happy and having respectable feelings about themselves who are kind and helpful to others. We need to do things that make our life worthy. For instance, helping needy people, animals, etc.

One tip you recommend everyone adopt towards improving their mental and emotional wellbeing?

Having a healthy relationship with family members is the basis of good mental health. So, we have to make an effort to build an open and healthy relationship in the family.

What advice would you have for people to take care of their mental wellbeing during COVID 19 pandemic?

Everyone is panicking in this global pandemic situation and the main reason is lack of appropriate knowledge about Coronavirus and its effect. Moreover we are getting over information through social media and various news channels, and we tend to update ourselves on what is happening in the world every minute, and that increases stress the most. Get information only from reliable resources like the Ministry of Health and Population and World Health Organisation once or twice in a day and use the rest of the time in a creative and positive way.

It is also essential to ensure that we are following all the safety measures and lockdown properly. These measures can reduce the fear of getting infected and mental stress automatically goes down.

It is very difficult to spend time at home for all of us during the lockdown. But it can become easy if we make it productive. Spending more time with family is the best way. We can do small and wonderful things with family like cleaning the house, gardening, planting flowers, watching old movies, cherishing old photographs, etc. Such mind diverting activities bring positivity along with assuaging the stress. The finest utilisation of this free time also could be doing pending household works like, managing goods, cleaning rooms, etc. I am doing the same.

Likewise exercise is very important since we are just sitting at home and eating a lot. We can keep ourselves physically active by doing yoga and other physical activities. Overall, try and follow a normal daily routine. Over-thinking does not help us, rather actively engaging in work does.

Mausham Ratna Shakya
Mindfulness Coach

Mausham Ratna Shakya introduces himself as a continuous learner and mindfulness coach. Having an interest in meditation from a young age he has done his Master’s Degree in Buddhist Studies and is pursuing Ph.D. in the same subject from Lumbini Buddhist University. He conducts trainings, seminars and personal coaching on mindfulness giving special focus on self-care. He is serving in the professional domain of mindfulness for the past seven years.

What are the main causes of mental, emotional and behavioural disorders?

Mental disorder is the state when any kind of problem occurs in the brain and it manifests through our thoughts, emotions and behaviours. The causes of these problems are imprints of our own bad experiences and the imbalanced lifestyle we adopt without understanding the nature of one self. We can even link it to our early childhood and during the state of pregnancy. However, the development of the brain is a continuous process. It develops and functions along with the environment we live in. So, if we provide a positive environment and educate about the nature and functions of the brain even the evil experience of our life can turn into a better condition of our own self. So here we need to understand that all kinds of disorders can be cured.

What do you do to help people?

The person having mental disorder must believe that it is only a phase from which s/he can recover. I help them to build that trust first which really helps in quick healing. As a mindfulness coach, I teach people to manage emotions, and negative thoughts as well as to release imprints of bad experiences of the past through different mind-training exercises. People having mental disorders often cannot enjoy the flow of present moments. They live with their own fears, anxious assumptions, and imagination. I help them to live in a moment through the experiential process to better understand the nature of the brain and its functions, especially connected to thoughts, emotions and behaviours.

What are some habits to improve mental wellbeing?

The simple way of improving mental wellbeing is using all our six senses-body, brain, eyes, ears, nose and tongue in a balanced way. Living in the real world rather than the virtual world can help create balance. For instance, smelling natural odours, practicing mindful eating where you completely immerse in the taste, texture and aroma of the food exercising regularly, etc. We have to check if we are utilising all our senses or not. If not we have to search the ways to do it. Another way of improving mental wellbeing is by creating a positive environment around ourselves, like in the family, office and society.

One tip you recommend everyone adopt towards improving their mental and emotional wellbeing?

Trust your mind and capacity of the brain, keep doing things you are good with and learn new skills.

What advice would you have for people to take care of their mental wellbeing during COVID 19 pandemic?

Even though we have proper information about the problem, habitually our brain reacts to uncertain situations with stress, anxiety and panic. The thought of possible negative outcomes and negative assumptions are enough to ruin the mental state.

But none of us have completely lost our ability to process stress, anxiety and panic. This is the time to realise strongly that we must make conscious decisions to understand one self and follow simple discipline. Whenever our old habits start dominating, let’s be aware. Take a deep breath, hold as long as possible, then release, relax and reflect. Neuroscience has proved this simple process is the key to healing.

This is also a time to understand our interconnectedness of relationships, time for true team building, and time to learn the true meaning of our lives. We can watch movies together, work together, clean together. We can sing, dance, play together and be childlike again and enjoy time with the family.

Engage mindfully in small daily activities like simple exercise, stretching, yoga, meditation, contemplation. Write a diary to educate future generations. Be creative!