CHASING HAPPINESS

Long ago when I was in the village, I was a contended young boy.  Happiness was easy to find. We did not require wealth to buy happiness! Small things in life use to give us enough happiness, and our parents didn't have to struggle to make any one of us happy.

Rice with some vegetable curry would be the most delicious food. We would look forward to special occasions such as Diwali and Dashera to have a meal with meat. Having had the opportunity to have such specials food during those occasions would make us really euphoric! Three good meals that kept our stomachs full were enough to make us satisfied. We didn't even know that the foods that our children eat today ever existed! We simply knew that foods were grown in the fields and needed a lot of hard work to produce. We didn't have any clue about foods being sold in restaurants until much later.  On the way to Tashigang, where I went to study after graduating from my village school, we saw people eating in hotels and restaurants but we didn’t have much privilege to dine in those.  We generally carried rice with us to be cooked where ever we put up overnight. 

We were made to believe that wearing clothes was primarily to protect us from weather and to protect our modesty! We didn't have the slightest knowledge about any fad or fashion, nor did we have the choice for any colour or design. We would get a new pair of clothes during the festive season and that too came after a long wait of one year. A new pair of clothes used to bring lots of joy for us.  We would go visiting relatives during those days showing off our new dresses.

Everyone walked bare feet, including the domestic animals, so question didn't arise of not wearing any foot wears. Walking barefoot was, therefore the norm of the society. I learnt to wear flip-flops only after I joined the school at Tashigang. I bought my first pair of block-heeled shoes sometime in 1977 after I earned enough money for it working as a labourer during school winter break. I felt myself at the top of the world at the feeling of walking about 3 inches above ground!

Entertainments that amused us and gave us extra dose of happiness were simple things, such as school concert, rice paddy harvesting season, going around playing "Dewshi" during Diwali nights, watching a pair of rooster or bull fighting, watching football matches in the rain etc. We were fortunate to have a small Sony radio which used to sing a variety of Nepali songs for us every day and that was one thing that really amused my. For elders, happiness perhaps was more evident when they grew more crops, when the cattle population grew or when there was birth of new family member! Religious congregations during weekends, where people chanted of religious songs, seemed to make them elated for long.

Things have become different now and I have to be constantly chasing HAPPINESS in this modern era of materialism! I do not seem to be able to catch it though. The salary I earn has to be shared among many of us in the family, not only my own but also my relatives' because I am the first generation of salary earner. I have many more new things to acquire but I always run short of budget. There are number of desires which are unfulfilled and make me NOT HAPPY! For example, I don't have a house to call it mine, keep aside having a building in Thimphu; I simply have a tiny little Alto car when my friends move around in SUVs like Tucson and Prado; I wear mostly Bangladesh made garments and have not been able to afford designer dresses; my meals are as simple as they used to be when I was a village boy except that I may be taking more meat items now; I cannot afford the balanced diet of enough protein, minerals and vitamins, consisting of plenty of vegetables, meat, eggs and fruits, as learnt in Medical school. 

There are many reasons for me NOT to be HAPPY! My children are not securing first position in their classes and that makes me unhappy. My neighbour has a better sofa sets, bigger and latest television set, iPad, iPhone and whatnots which I have not been able to buy and that makes me unhappy.  The desires are limitless; list of things I want is unlimited.

I am not the only lone citizen of the GNH (Gross National Happiness) country who aspires to be happy.  There are many, may be the entire population, who would try to be happy with the DESIRE for innumerable things that have become part of our lives particularly in an urban setting. We have a large number of so called educated youth who are roaming the streets of Thimphu and Phuentsholing after graduating from Middle secondary schools, thanks to the free basic education in our country! Having got the taste of urban life no one likes to go back to the villages where life is tough.  The job market is highly competitive and almost saturated. These tenth grade drop-outs have  desires like anyone else.  But how would they then fulfil those desires without resorting to theft, burglary, mugging, and fraudulence? 

We have yet another category of youth that has become difficult now. They are the ones who are onto alcohol and drug abuse. They probably are the ones who come from broken families, or families which are busy trying to earn a living and do not have much time to monitor their children.  There are others who are so affluent that they simply keep their children pleased with money but have no TIME for them.  These are the ones who frequent the bars and discotheques, creating nuisance at times.  In spite of such obvious privileges they enjoy, they seem to be always ANGRY and far from HAPPY!

Buddhism teaches us that "desire is the main cause of suffering" and not desiring will make us HAPPY but who listens to this and who practises it? When everyone else is competing in the rat-race, nobody would sit back and watch others gathering wealth?  Given the opportunity everyone would like to be the wealthiest person in the world! But will that wealth bring HAPPINESS to these people, or is HAPPINESS still out of reach even to them? May be, I guess their desires would still be unmet and they may continue to be UNHAPPY!

On retrospect, I would rather prefer to go back in time when I was a village boy contented with the small things that came my way bringing little packages of HAPPINESS now and then!

Alcohol and its ill effects

Brief History:

Although the exact date when alcohol was produced remains elusive, from archeological  discovery of late ‘Stone Age Beer Jugs’ points to the fact that  intentionally fermented beverages existed as early as the Neolithic period.

Alcoholic drinks were an intricate part of most civilization ranging from China and India and Western Asia to Europe. In India alcoholic beverages appeared during the Indus Valley Civilization, In Hindu Ayurvedic texts both the beneficial and detrimental effects of alcohol have been outlined. Distilled spirits originated in India and China around 800 B.C. the distillation process emerged in Europe around the eleventh century.

We have no records when alcoholic beverages appeared in Bhutan but from our rituals, cultural practices and customs we can safely make a guess that drinking of alcohol must have been there since long. People from all the ethnic groups in Bhutan know the process of brewing alcoholic beverages.  Prior to 1976, until the establishment of Army Welfare Project which started manufacturing modern liquor, most people used to drink home-brewed alcoholic beverages such as Bangchang, sinchang, and ara. 

Since most of the people worked in the fields and used limited quantity of the alcoholic beverages during their work hours, there was perhaps not much severe physical harm to them then.  May be most of the alcohol they consumed would have got ‘burnt out’ faster due to hard physical labour.  However, our old habits carried to our modern lifestyle have been showing a different picture now.  Due to abundance of several brands and makes of alcoholic drinks in modern day Bhutan, there are many people addicted to alcohol.  The most common cause of death in Jigme Dorji Wangchuck National Referral Hospital is Alcoholic liver disease.

Physical effects of alcohol:

Alcohol is a central nervous system depressant because of this it impairs judgment, speech and muscular coordination. It slows down the reaction time and causes the person to make some risky decisions that would normally be avoided; it thus impairs the ability to drive.

Alcohol use over time can cause serious physical ailments. Alcohol causes inflammation of the liver leading to increase in size called alcoholic hepatitis. There will be deposition of fat in some areas of the liver leading to fatty liver. Fatty liver decreases the amount of liver tissue.  Overtime the swelling will be replaced by scar tissue developing into cirrhosis.  The liver ultimately loses healthy tissue until it can no longer function. The signs of severe liver disease are abdominal swelling and pain, nausea, vomiting, jaundice and mental confusion. Some people might bleed easily especially inside the digestive tracts that can go unnoticed resulting into death.

 

Alcohol is an irritant to the gastrointestinal tract and can inflame the lining of the oesophagus and the stomach.  This inflammation causes chronic gastritis and at times even ulceration. Chronic inflammation of the stomach also prevents absorption of vitamins such as folic acid and thiamine which are necessary for good health. Alcohol can also damage the pancreas, which is an organ that manufactures certain enzymes for digesting proteins, carbohydrates and fats. The body’s metabolism is also affected when the pancreas is damaged by heavy drinking. 


Alcohol is bad for people who suffer from diabetes as alcohol will keep glucose that exists in the liver from being released into the bloodstream. This in turn will increase the chances of developing low blood sugar, also called hypoglycemia.

 

High blood pressure and damage to heart muscle can be precipitated by alcoholism. People are thus put at risk of suffering a stroke or having a heart attack. Kidney disease has also been known to develop in people who consume excess amounts of alcohol.

Erectile dysfunction (failure to achieve erection of penis) in males and interruptions in women's menstrual cycle have also been associated with the effects of alcohol. Pregnant women who are addicted to alcohol have high risk for miscarriage. Even if they attend full term pregnancy, the chances of children being born with foetal alcohol syndrome is very high. Alcohol affects bone mass, causing thinning of bones so that fractures are much more likely to occur. Numbness in the feet and hands, dementia, and an increased prospect of developing cancers such as cancer of the liver, throat, and colon are other possible physical effects of alcohol addiction.

Psychological Effects of Alcoholism

Alcohol is a highly addictive substance that can carry with it numerous short- and long-term effects. While it can be physically damaging to our health, it can also be mentally damaging to our psyche

Short Term Effects

Short-term effects of alcohol, say from one night of drinking with friends, can range from slurred speech, difficulty balancing, impaired decision making, lowered inhibitions and memory loss, depending on the amount of drink. Blackouts are also a short term result of drinking and occur when a person drinks alcohol quickly and the blood alcohol level rises swiftly. Black out means loss of memory of events that take place while drinking, that is, the person will not be able to remember anything that ensues during the bout of drinking.

 

Long Term Effects
In people who drink heavily and regularly, alcohol causes depression, anxiety and many other dysfunctions of the brain.

 

1.      Depression

Many people believe that alcohol can treat depression and make someone happier, but on the contrary, alcohol can lead to depression, or greatly increase the symptoms of depression in a person diagnosed with depression. Taking alcohol to treat depression can lead to severity of symptoms at times leading to suicidal attempts and suicides.

2.      Anxiety

Much like depression, alcohol can also lead to serious anxiety issues, especially in a person diagnosed with an anxiety disorder. Alcohol can cause or increase anxiety by depressing the nervous system and leading to irritation and fatigue. Often the hangover effect caused by drinking alcohol can increase feelings of anxiety. Excessive alcohol consumption can also increase heart rate and blood pressure, a physical aspect that can lead to greater anxiety and panic attacks.

3.      Brain dysfunction

Overtime, with heavy drinking, alcohol has been found to lower the cognitive functions of the brain such as ability to learn new information and remember things. This happens because alcohol kills the brain cells and brain cells once destroyed do not regenerate.

 

4.      Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff syndrome is a severe brain disorder resulting from thiamine (Vitamin B1) deficiency, which is often a result of long-term heavy drinking. WKS causes poor coordination, muscle movement, confusion, an inability to learn and remember things and disorientation. While early stages can be treated with administration of thiamine, if left untreated it can lead to a permanent condition that can cause coma or death.

 

Signs and Symptoms of alcoholism:

Drinking is woven into the fabric of many societies. Sharing a bottle of wine over a meal, going out for drinks with friends, celebrating special occasions with champagne etc. are commonly accepted norms in many societies.  Since alcohol is such a common element in many celebrations and activities, it will be hard to realize when one progresses from social user to a problem drinker.  However, if someone consumes alcohol simply to feel good, or to avoid feeling bad, this could become problematic.

Drinking problems are due to many interconnected factors, including genetics, upbringing, and the social environment and one’s emotional health. People who have a family history of alcoholism or who associate closely with heavy drinkers are more likely to develop drinking problems. People who suffer from a mental health problem such as anxiety, depression, or bipolar disorder are also particularly at risk, because alcohol may be used for self-medication.

Since drinking is so common in many cultures and the effects vary so widely from person to person, it’s not always easy to figure out where the line is between social drinking and problem drinking. The bottom line is how alcohol affects the individual. Therefore, if your drinking is causing problems in your life, you have a drinking problem.

 You may have a drinking problem if you...

• Feel guilty or ashamed about your drinking.
• Lie to others or hide your drinking habits.
• Have friends or family members who are worried about your drinking.
• Need to drink in order to relax or feel better.
• “Black out” or forget what you did while you were drinking.
• Regularly drink more than you intended to.

Substance abuse experts make a distinction between alcohol abuse and alcoholism (also called alcohol dependence). Unlike alcoholics, alcohol abusers have some ability to set limits on their drinking. However, their alcohol use is still self-destructive and dangerous to themselves or others.

Common signs and symptoms of alcohol abuse include:

• Repeatedly neglecting your responsibilities at home, work, or school because of your drinking. For example, performing poorly at work, failing in the examinations, neglecting your kids, or skipping out on commitments because you’re hung over.

• Using alcohol in situations where it’s physically dangerous, such as drinking and driving, operating machinery while intoxicated, or mixing alcohol with prescription medication against doctor’s orders.

• Experiencing repeated legal problems on account of your drinking. For example, getting arrested for driving under the influence or for drunk and disorderly conduct.

• Continuing to drink even though your alcohol use is causing problems in your relationships. Getting drunk with your friends, for example, even though you know your wife will be very upset, or fighting with your family because they dislike how you act when you drink.

• Drinking as a way to relax or de-stress. Many drinking problems start when people use alcohol to self-medicate for relief of stress. Getting drunk after every stressful day, for example, or reaching for a bottle every time you have an argument with your spouse or boss.

The path from alcohol abuse to alcoholism

Not all alcohol abusers become full-blown alcoholics, but it is a big risk factor. Sometimes alcoholism develops suddenly in response to a stressful change, such as a breakup, retirement, or some other loss. Other times, it gradually creeps up on you as your tolerance to alcohol increases. If you’re a binge drinker or you drink every day, the risks of developing alcoholism are even greater.

Signs and symptoms of alcoholism (alcohol dependence)

Alcoholism is the most severe form of problem drinking. Alcoholism involves all the symptoms of alcohol abuse, but it also involves another element: physical dependence on alcohol. If you rely on alcohol to function or feel physically compelled to drink, you’re an alcoholic.

Tolerance: The 1st major warning sign of alcoholism

Do you have to drink a lot more than you used to in order to get drunk or to feel relaxed? Can you drink more than other people without getting drunk? These are signs of tolerance, which can be an early warning sign of alcoholism. Tolerance means that, over time, you need more and more alcohol to feel the same effects.

Withdrawal: The 2nd major warning sign of alcoholism

Do you need a drink to steady the shakes in the morning? Drinking to relieve or avoid withdrawal symptoms is a sign of alcoholism and a huge red flag. When you drink heavily, your body gets used to the alcohol and experiences withdrawal symptoms if it is taken away. These include:

·         Anxiety or jumpiness

·         Shakiness or trembling

·         Sweating

·         Nausea and vomiting

·         Insomnia

·         Depression

·         Irritability

·         Fatigue

·         Loss of appetite

·         Headache

In severe cases, withdrawal from alcohol can also involve hallucinations, confusion, seizures (fits), fever, and agitation. These symptoms can be dangerous, therefore, it is advisable to take help from a doctor or health worker if you are a heavy drinker and want to quit.

Other signs and symptoms of alcoholism (alcohol dependence)

• You’ve lost control over your drinking. You often drink more alcohol than you wanted to, for longer than you intended, or despite telling yourself you wouldn’t.

• You want to quit drinking, but you can’t. You have a persistent desire to cut down or stop your alcohol use, but your efforts to quit have been unsuccessful.

• You have given up other activities because of alcohol. You’re spending less time on activities that used to be important to you (hanging out with family and friends, going to the gym, pursuing your hobbies) because of your alcohol use.

• Alcohol takes up a great deal of your energy and focus. You spend a lot of time drinking, thinking about it, or recovering from its effects. You have few, if any, interests or social involvements that don’t revolve around drinking.

• You drink even though you know it’s causing problems. For example, you recognize that your alcohol use is damaging your marriage, making your depression worse, or causing health problems, but you continue to drink anyway.

Drinking problems and denial

Denial is one of the biggest obstacles to getting help for alcohol abuse and alcoholism. The desire to drink is so strong that the mind finds many ways to rationalize drinking, even when the consequences are obvious. By keeping you from looking honestly at your behaviour and its negative effects, denial also exacerbates alcohol-related problems with work, finances, and relationships. For example, you may blame an ‘unfair boss’ for trouble at work or a ‘nagging wife’ for your marital issues, rather than look at how your drinking is contributing to the problem. While work, relationship, and financial stresses happen to everyone, an overall pattern of deterioration and blaming others may be a sign of trouble.

If you find yourself rationalizing your drinking habits, lying about them, or refusing to discuss the subject, take a moment to consider why you’re so defensive. If you truly believe you don’t have a problem, why do you feel the need to cover up your drinking or make excuses? Is it possible that your drinking means more to you than you’re ready to admit?

If you have a drinking problem, you may deny it by:

• Drastically underestimating how much you drink
• Downplaying the negative consequences of your drinking
• Complaining that family and friends are exaggerating the problem
• Blaming your drinking or drinking-related problems on other

  

Treatment:

Alcoholism is considered a disease and treatment helps in quitting alcohol and remaining sober.  Since alcoholism is a lifelong problem, the main objective of treatment is to achieve sobriety for lifelong.

Treatment consists of different phases; even though benefit of going through all the phases is much more than one single phase, it is not mandatory for everyone to go through all the phases.

Detoxification (detox for short) literally means the physiological or medicinal removal of toxic substances from a living organism. In treatment of alcoholism, the person abstains from drinking alcohol and medicines which prevent development of withdrawal symptoms are prescribed for a period of ten to twelve days. Detoxification can be done on domiciliary basis or in a hospital setting depending on the severity of alcoholism.

Counselling:  Through counselling the person is educated about the harmful effects of alcohol, methods of coping with urges and trigger, time management etc. Counselling in Bhutan is provided in the Drop-in-centres, hospital and the rehabilitation centres. 

Rehabilitation: Through cognitive behaviour therapy and other psychological exercises the person is prepared to live an alcohol free life.  People who have lost jobs due to alcoholism are taught some skills which they can use later in life.  A typical Rehabilitation Program last from three to six months. The Nazheon Pelri Treatment and Rehabilitation Centre for Drug and Alcohol Dependence at Serbithang is one such centre in Bhutan and the program is for 3 months.

Support groups: Support groups, such as “Chithuen Phendey”, alcoholic anonymous and Al-anon try to help the recovering alcoholics and their family members cop up with problems that could result due to alcoholism, teach skills to handle cravings,  and provide continued support prevention of relapses.

Reference:

1. http://www.ehow.com/about_5557931_psychological-effects-alcohol.html#ixzz1JJk63iFx
2. http://www.awp.com.bt/brief_history_awp.php
3. http://www.ehow.com/about_4827654_physical-effects-alcohol-addiction.html
4. http://pubs.niaaa.nih.gov/publications/aa63/aa63.htm
5. http://helpguide.org/mental/alcohol_abuse_alcoholism_signs_effects_treatment.htm

Happiness in depression

Bhutan, the land of Gross National Happiness, has been seeing an increasing number of patients with depression, especially from the rural areas. Mental illness, particularly depression, is viewed as a paradoxical mental status for a country which is trying very hard to make the concept of GNH a reality. Being one of the two psychiatrists in Bhutan, I find it really hard to answer questions many visitors ask me about the reason behind increasing number of people suffering from depression. I really do not have any evidence to give an answer right away, however, when I reflect, I cannot help but highlight some factors which might have significant effects on the psyche of our older generation making them stressed and depressed.

We have seen rapid modernization and development over the last four decades. People got exposed to modern ideas, lots of information on health and education was given to them, and many other modern concepts became evident which were unknown until then. Schools were built everywhere. Children of school going ages were encouraged to get enrolled in schools with promise for better future for them. People learnt to take advantage of the family planning services that were extended to every household to cut the family size to a manageable level. “Small family, happy family” was a dream everyone aspired to have! Young parents in the eighties and nineties wanted all their children to go to school. They wanted them to study hard and get government jobs. For those who went to school, there was smooth sailing all the way. While few managed to do graduation, most got educated up to high school level and got into smaller jobs. The more brilliant ones pursued higher education to become professionals, and yet others achieved bigger positions in the civil service. All in all, none of them returned to the villages to live with their parents.

The young parents of those days have become aged now and they are staying back at the villages. Having educated all their children, there is now no one to help the parents in the farming work. The government encourages the villagers to cultivate their land and the “Gup” (village headman) makes sure it is done, at times forcefully. There is no excuse for keeping the land fallow, not even the frail health of the owner. In absence of ready labour force in the form of children and relatives, there is no option for the parents but to toil and toil until they get fully exhausted. To be a farmer in Bhutan, especially where mechanization is unknown, is perhaps the most difficult job than anything else. The day to day work in the field is manual and tiresome.

The global warning is a reality and the impact is obvious. This year alone there were several flash floods and landslides damaging substantial amount of arable lands and crops. Unpredictable weather conditions such as untimely rainfalls, storms, hail storms and drought are other factors that keep a famer always worried. The food grains, product of their hard toil, are never safe until harvested!

To make the matter worse, we have been seeing a number of wild animals increasing over the last few decades; we may call this the adverse affect of conservation of forest and preservation of the environment! People not only have to work hard to grow the crops but have to stay awake in the nights to protect them from wild animals, at times paying with their own lives!

In such a scenario, there is definitely a constant flow of stress hormones, and it is but understandable for a farmer to feel severely stressed. This stress causes a lot of harm to the mind and the physique of a villager. No wonder then, are we, getting more and more depressed people now, even though we would like them to be happy.

There is another factor now in the recent days and that is the rural urban migration, and the educated generation sticking to the urban centres. Life becoming difficult at the villages with all those odds most prefer to earn a living in the cities, even if it is just hand to mouth. They stick to the urban centres, establish a family and then get entangled in the webs of modernization. The salary they earn is limited, and the so called necessities in the towns and cities are many. Every day there is a new thing to be acquired, and the desire for materialist achievements is a never ending! Even if somebody wants to help their parents they become helpless. Few afford to send money to their parents, and most cannot afford to do that too. The attachment with the parents slowly gets distant and the dreams of the parents of a ‘small and happy family” becomes a remote and fading illusion.

Some children who are really concerned about their parents would like them to stay with them in the cities. But for the parents who have always lived in the village, it becomes a great plight to stay in apartments inside big buildings where 12 to 15 families live but never interact! The children seem always busy either trying to make a living, or glued to the television! No one seems to interact much with each other, and the conversations are always brief and precise. The way of life they find in the urban areas is beyond the imagination of a person who has always lived in the village minding his agricultural land and farm. Back home they are used to interact with their neighbours freely, share the common interests among them and help each other in almost every occasion. The building, even though, has as many households and people as in a small village, there is no sense of belongingness. They soon start feeling homesick and prefer to go back to their “home” and live with their dear neighbours where they find more warmth emotionally and feel closer to them than their offspring!

It is, therefore, too much of an expectation for these physically and emotionally fatigued lots to be happy. Philosophy alone will not bring about happiness, and to expect happiness in depression is ridiculous! We need to find out the multiple factors associated with depression and address them effectively if we want to take these rural folks out of the blues!

Women and depression:

Over the recent times a lot has been happening to boost the status of women in the society. Women now shoulder greater responsibilities and are capable of doing almost anything that men can do. In spite of these social advancements women still remain vulnerable to number of mental illnesses and depression is the most common one. Women mostly present with unexplained physical symptoms, such as tiredness, aches and pains, dizziness, palpitations and sleep problems.

The common symptoms of depression are Persistent sad or low mood, Loss of interest or pleasure in usual activities, including sex, Restlessness, irritability, or excessive crying, Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism, Sleeping too much or too little, early morning awakening, Appetite and/or weight loss or overeating and weight gain, Decreased energy, fatigue, feeling "slowed down", Thoughts of death or suicide, or suicide attempts, Difficulty concentrating, remembering, or making decisions, However, not everyone with depression experiences all of these symptoms, and the severity of the symptoms may vary from person to person. In order to consider depression as a disorder, the symptoms must persist for more than two weeks and should interfere with one’s work or family life.


Major depression and dysthymia (chronic depressed mood) affect twice as many women as men. This two-to-one ratio exists regardless of racial and ethnic background or economic status. Many factors unique to women are suspected to play a role in developing depression. These can be reproductive, hormonal, genetic or other biological factors. Abuse and oppression due to gender biases and certain psychological and personality characteristics are also some other factors. However, it has not been possible to pinpoint any the specific cause for depression as many women exposed to these stress factors do not develop depression.

Scientific studies done in many other countries show that higher incidence of depression in females begins in adolescence. This is due to the fact that roles and expectations change dramatically during adolescence. Other stresses of adolescence include forming an identity, confronting sexuality, separating from parents, and making decisions for the first time, along with other physical, intellectual, and hormonal changes. These stresses are generally different for boys and girls, and may be associated more often with depression in females. It is also suggested that men and women differ in their expression of emotional problems. While men choose to self medicate by taking alcohol or drugs, women tend to express these through emotion, thus becoming depressed.

Adulthood has its own share of stresses for women. These are major responsibilities at home and work, single parenthood, and caring for children and aging parents. Even in a married relationship women carry a greater share of child care and household responsibilities. Role conflict sometimes becomes an issue too. Women at times need to choose between family and work responsibilities, often having difficulty in deciding about which choice is the "proper" one!

Unlike men, women go through many reproductive events. Menstrual cycle, pregnancy, the post pregnancy period, infertility, menopause, and sometimes, the decision not to have children are various reproductive events they go through. All of these events can bring fluctuations in mood which can include depression in some women. Although the specific biological mechanism explaining hormonal involvement in depression is not known many researchers have confirmed that hormones have as effect on the brain chemistry leading to changes in emotions and mood. Because of this many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes called premenstrual syndrome. During the post delivery period women are more likely to suffer from depression. Postpartum depressions can range from transient "blues" following childbirth to severe, incapacitating, psychotic depressions.

Pregnancy, if desired, does not lead to depression and having an abortion does not appear to lead to a higher incidence of depression either. However, women with infertility problems may be subject to extreme anxiety or sadness, most of the time aggravated by cultural beliefs where infertility is considered ominous. Teenage pregnancy or young motherhood is also a risk for depression due to the increased stress. Housewives who depend on their husbands for financial needs can become uncertain especially when they have abusive husbands. Frequent domestic violence and apathetic attitude of parents and siblings towards married daughters or siblings can lead to helplessness and hopelessness.

Untreated depression can lead to suicide but even severe depression can be highly responsive to treatment. Of course, believing one's condition as "incurable" is often part of the hopelessness that accompanies serious depression. Indeed, treatment is not to eliminate life’s inevitable stresses and ups and downs but to enhance the ability to manage such challenges and lead to greater enjoyment in life.

Silence behind domestic violence

Domestic violence is also known as domestic abuse, spousal abuse, child abuse or intimate partner violence. It can be broadly defined as a pattern of abusive behaviours by one or both partners in an intimate relationship such as marriage, dating, family, friends or cohabitation.

The commonest form of domestic violence seen in Bhutan is spousal abuse, particularly, violence against the wife by her husband. In the recent times we have been seeing an increasing number of such cases. Many women visit the forensic unit and the psychiatric OPD of JDW NR Hospital for various problems which include physical injuries and mental trauma.

The Royal Government of Bhutan has been doing a lot lately to elevate the status of women in the society and alleviate their sufferings. There are now a number of agencies taking care of the needs of the women. The National Commission for Women and Children, RENEW (Respect, Educate, Nurture and Empower Women), and the Child and Women protection unit of the Royal Bhutan Police are such organizations.

In absence of a scientific study, it becomes difficult to pinpoint one single cause for spousal abuse in Bhutan; however, it is not so difficult to guess some of the possible causes. Alcohol seems to be the most important cause followed closely by gambling. The other causes would be personality mismatch, jealousy, financial dependence of a woman on her husband, emotional factors, helpless situation etc.

Alcohol is not only the main culprit by itself, it is also an indirect cause for other mental illnesses leading to more abuse and violence. Most common form of mental disorder in alcoholics is morbid jealousy, also known as pathological jealousy or “Othello syndrome”. Persons suffering from this condition can have unshakable belief that their partners are unfaithful; it can be so severe that the sufferer may even kill the spouse for this.

Even though we have so many organizations to protect these victims of abuse and violence, why are not all coming out to seek help? Although it is appropriate to find the cause for domestic violence, it is also equally important to find out the reasons for their helplessness. What could be the reasons for them to be so secretive? Why do they prefer to hide and weep behind closed doors?

While I may be wrong, I feel these are some of the reasons for the silence behind the domestic violence:

1. Financial dependence:
Due to disparity in education in the past more males are employed in Bhutan than women, thus women are more dependent financially on their husbands. Financial dependency makes women vulnerable to feel obliged to their husbands. Men take advantage of this situation and victimize their wives to comply with their wishes, be it unreasonable and unjustified.

2. Social customs:
In some ethnicity, especially in a patriarchal society, the girls once married belong to the in-laws. They will have nothing to do with their own parents and siblings except for some emotional attachment. In Hindu society, for example, the daughter becomes the “property” of the in-laws. The girl will relinquish her “clan name” to adopt the one from her husband. Such customs can make the women highly susceptible for abuse and violence. Even when the relatives know that their daughter or sister is abused they hardly offer help to mitigate the problem. She is not even welcomed to her parental home when she is thrown out by her husband thus making her helpless and hopeless.

3. Emotional factors:
Women tend to be more emotionally attached to their children because of which they would not mind to continue the relationship for the sake of their children even though there is constant oppression from the husbands. Many women take the role of protector for their children from the abusive husbands, in the process suffering more and more.

In contrary to the general notion that Bhutanese women have equal status and rights as their male counterparts, they are more dependent on their husbands for almost everything. That is why most women suffer silently without even mentioning about the abuse and violence to anyone, not even to their treating doctor. Some women even go to the extent of concealing the real cause of their physical injuries with which they come for treatment. Even though they may be going through severe mental depression, they will rather complain about physical symptoms, such as aches and pains, chronic headaches and insomnia.

Unless we take care of the factors leading to the “silence” women will continue to suffer quietly within the four walls of their houses. They will continue to be the victims of violence and abuse. If we don’t protect our daughters, sisters and our women relatives from their abusive partners, we will never be able to empower them!

Experiment with tobacco

Experiment with tobacco

It was in 1970, I was 9 years old and was studying in class II, my father wanted me to attend a private school some 2 hours’ walk from our village at Diklai. We usually got about two months summer holidays and my father wanted me to take extra lessons to be able to top the class. To reach Diklai we had to cross a river which had a huge log of timber laid across it for a bridge. The children from this village had difficulty in attending the only village school which was situated at Dalim, about 3 hours walk. Probably that was the reason for setting up of that private school. The school was a mere shabby shed of thatch roof with bamboo mats as walls, large enough to accommodate around 30 children. There were no rooms for different classes so everyone attended the same class, a multi-grade style. There was just one teacher who may not have had any qualification beyond the sixth standard. Whatever it was, I had to attend that school along with a cousin brother Chakra Bahadur Thapa.

During one of the classes at Diklai, I saw a student of my age taking khaini (chewing tobacco). I knew for sure it was tobacco but I could not imagine a boy of nine taking it regularly. I had seen my father taking khaini but he was an adult and probably it was right for him to indulge in that habit; but a boy doing that was unimaginable!

I had seen how my father used to procure his quota of khaini. He used to buy long leaves of dry tobacco from Assam and it was processed manually into palatable ‘khaini’. I had almost mastered the art of processing it, for I had assisted my father on many occasions. The leaves were chopped finely, some lime (calcium carbonate) was added and it was rubbed vigorously between the palms, occasionally sprinkling water onto it. When done, it used to be packed in an air tight long cylindrical container with a sallower compartment on the other end for some extra lime. On numerous occasions I had helped him process the ‘khaini’ but it never occurred to me that I should try. To me, tobacco chewing was the privilege only the adults were entitled to.

However, when this classmate of mine took it so casually I got interested too. I asked him why he was taking it and he said that it gave him some sort of pleasurable sensation. He also asked me if I wanted to try. At first I hesitated but later I thought, why not? We were sitting right at the back of the class and the teacher was quite unaware of what was going at the back. That boy took out a small polythene pouch from his shorts’ pocket gave me a pinch of tobacco from it on my palm. I had seen my father holding the tobacco between the forefinger and the thumb, and almost imitating him in my imagination, I did the same thing. I took the entire amount between my forefinger and thumb of the right hand, with the left hand I parted my lower lip from the gums and made a receptacle to hold the tobacco and carefully placed it there. As directed, I was to keep the tobacco there until all the ‘juices’ got extracted. Slowly I could feel the bitter and strong taste of tobacco flooding the floor of my mouth. I had the urge to spit but I had to experience the pleasure and I was not supposed to spit out. I swallowed about ten millilitre of oral secretion dressed with tobacco juice with utmost difficulty. The next swig was not so bad but within no time I started experiencing some strange feelings. My head started reeling, I was feeling tremulous and my limbs became listless. I was nauseated and would vomit any moment. I wanted to get up but my feet were too weak by then. I took the help of my hands and with great effort stood up, swaying back and forth. I gathered courage to request the teacher to go out. I said I was feeling unwell. I barely managed to reach a spot just out of earshot for other to hear me retching, and brought out everything! The khaini came first followed by the rice and buttermilk I had for breakfast and then the gastric juices; when nothing was left inside, the bitter bile came out! I was totally exhausted but slowly I started feeling better in the sense that my head was stable, the tremulousness had gone by then and I regained the strength in my limbs. That was almost near death experience to me!

TEENAGE PREGNANCY

We hear of considerable number of school girls getting pregnant and leaving their studies. Number of abandoned infants were found in Thimphu, some alive and others dead. These all point to one thing, unwarranted teenage pregnancy, a consequence of human sexuality. This article is, thus, intended to highlight issues of teenage pregnancy so that the psychology of adolescent sexuality and its consequences are understood in a better perspective.
Teenage is defined as the period from thirteen to nineteen years of age. Teenager or teen is a person whose age in this age group. The word is of recent origin, only having appeared in the mid 20th century. Equivalent words in other languages may apply to a larger age bracket, including (at least some) preteens; e.g. tiener in Dutch officially from 12, colloquially from 10. Teenager can be divided into two groups: Early Teens- Age 13-15 and Late Teens- Age 16-19. Teenage pregnancy is, therefore, the pregnancy that occurs in girls under the age of 20.
The problem of teenage pregnancy is considerably worse in the United States than in almost any other developed country. Among developed countries, the United States has one of the highest birth rates for women under 20. A detailed study comparing Canada, England and Wales, France, The Netherlands, Sweden, and the United States suggested that the problem of teen pregnancy in the United States may be related to less sex education in schools and lower availability of birth control services and supplies to adolescents. We have no such survey to substantiate the claim that teenage pregnancy is a problem in our country. Nevertheless, from whatever interaction I had with School Health in-charges during workshops, the problem exists and is likely to increase over the period of time.

In the recent times two important trends concerning adolescent sexuality have been observed. First, that the sexual intercourse among teenagers in increasing quite rapidly, particularly since 1970s. Second, the increase is more pronounced for girls than boys. Why is this happening? The most obvious answer is a gradual reversal of the sexual double standard. Historically, boys were freer to engage in sexual intercourse. Over the past thirty years teenage girls have become much more sexually active. Many teenagers do not plan to have intercourse. Often they feel that sex is something that happened to them, not something they chose to do. Probably this is the reason shy a sizable percentage of teenagers have negative feelings about sexual experiences, particularly the first one. It is reported that only 25% of the girls ever report feeling excited about their first act of intercourse, whereas nearly 50% of the boys report being excited; sixty three percent of the girls were actually afraid in contrast to only 17% of the boys reporting the same feeling.

For most teenagers one of the unintended consequences of sexual intercourse is the risk of pregnancy. Teenagers become pregnant following sexual intercourse with other teenagers or with adults. Thousands of adolescent girls face the difficult choice of terminating their pregnancies or giving birth with little in the way of emotional or financial support. For teens who give birth, there is a rough road ahead. Teenage mothers are more likely to leave school early and to experience difficulty finding adequate employment than women of similar backgrounds who delay childbirth. Often facing parenthood before they are emotionally ready and without the support of a spouse, these young mothers are also likely to encounter problems in early parent-child relationships. Moreover, many have to face prejudice and stigma from the hostile communities, and sometimes even from their unreasonable parents, which can hurt their morale severely. However, researchers have found that certain degree of resilience develops among teenage mothers and this is a plus point for later in life many show the capacity to recover both emotionally and economically.

At first glance, the frequency of teenage pregnancy is perplexing when contraceptives are so readily available these days. Why do, then, the adolescent boys and girls, fail to use them? The reason is, teenagers are sometimes remarkably unaware of how conception occurs. Many simply do not understand that pregnancy is related to sexual intercourse and a woman’s menstrual cycle. Research has shown that in societies that provide adequate information and access to contraceptive devices, the abortion rates are much lower.

When adolescent lack information, they tend to engage in sexual practices that can lead directly to pregnancy. They may practice birth control infrequently or not at all, or seek counsel of peers, who often provide incorrect information. Parents can offer much more reliable information about pregnancy, but unfortunately most parents in our society do not consider this necessary. We are a shy society and therefore treat talking sex as a taboo. Even the enlightened stratum of our society most parents do not share this information adequately. Therefore, most adolescents do not learn about sex from their parents but turn to peers, who are equally ignorant.

Unprotected sex has always involved the risk of pregnancy, but we now know that it can also lead to diseases like AIDS and hepatitis B and C, all of them do not have a cure. In spite of so much information is available in the internet and from various health sources, adolescents have shown few signs of practicing “safe sex” on a large scale. Unfortunately, we sadly foresee that these deadly diseases will become ever greater threat as today’s adolescent become young adults. Sound education about adolescent sexuality may be the best hope for effective solution.