Sunday, June 28, 2009


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.


Adolescence is the period of psychological and social transition between childhood and adulthood. The World Health Organization (WHO) defines adolescence as the period of life between 10 and 19 years of age. In contrast, in the United States, adolescence generally begins at age 13, and ends at 20. "Adolescence" is a cultural and social phenomenon and therefore its endpoints are not easily tied to physical milestones. The word derives from the Latin verb adolescere meaning "to grow up." The ages of adolescence vary by culture. As a transitional stage of human development it represents the period of time during which a juvenile matures into adulthood.

Adolescence is not a universal state. Rather, it is as invention of modern societies that emphasize a transition between the carefree childhood years and the more complex responsibilities of adulthood. Most cultures regard people as becoming adults at various ages of the teenage years. For example, Jewish tradition considers males to be adult members of the community at age 13 and females at age 12, and this transition is celebrated in the Bat Mitzvah for girls and the Bar Mitzvah for boys. Young Catholics have the sacrament of confirmation and then are full members of the community. Usually, there is a formal age of majority when adolescents formally become adults. For example, Japan's celebration of this is called seijin shiki ("Adult ceremony"). However, in a traditional society like ours, adolescence is hardly a distinct period in person’s life. As soon as a child grows up to be able to do certain chores that most adults do, he is considered an adult. Some youngsters start taking all the responsibilities of a grownup as soon as they step into the teenage. Issue of adolescence is thus more applicable to the educated and the modern society.

Adolescence is characterized by profound biological, psychological and social developmental changes. The biological onset of adolescence is signalled by rapid speeding up of skeletal growth and the beginnings of physical sexual development. The psychological onset is characterized by acceleration of cognitive development and consolidation of personality formation. Socially adolescence is a period of intensified preparation for the coming role of young adulthood. It is a time of adjusting to the bodily changes, of new relationship with members of the opposite sex, and of emerging intellectual powers.

By virtue of schooling and disposition, adolescents often find themselves pondering and debating major social and political issues. Many find that adolescent years as a time of confusion and despair. They can have conflicts with parents, anxiety about scholastic performance, and pressure for peer recognition. However, not all encounter serious problems in personal adjustment, nor do they hold sharply negative attitudes towards their parents.

The conflicting opinions may result from the different ways that adolescents respond to the teenage years. Some react by challenging and testing authority, whereas others adjust relatively easily. Should there be a legal drinking age? Is premarital sex wrong? Adolescents debate these issues with great passion and a probing intellect. Risk-taking behaviour is very common at this age. It can involve alcohol, tobacco, and other substance use. Promiscuous sexual activity, which is especially dangerous in view of the risk of acquired immune deficiency syndrome (AIDS), and accident-prone fast driving are common.

What would prompt the adolescents to behave this way? One reason is that risk taking seems to be natural component of the teenage years. Adolescents often maintain an unrealistic sense of their own vulnerability. They believe that little enduring harm will come their way. Death and disability are things for the older people to worry about. Even more curious, however, is the tendency of the adolescents to assess incorrectly the likelihood that misfortune will befall on them. For example, they at times erroneously conclude that risks such as pregnancy following unprotected intercourse, or addiction from drug abuse are less likely to occur. Adolescents do not lack the logical abilities, but despite that, they often act irrationally, even to the point of endangering their own lives. Personal needs sometimes cloud the judgement of adolescents and lead them to engage in extremely risky actions.

At the beginning of adolescence, thinking usually becomes abstract, conceptual, and future oriented. Many adolescents show remarkable creativity, which they express in writing, music, art, and poetry. Creativity is also expressed in sports and in adolescents’ interests in the world of ideas, humanitarian issues, morals, ethics and religion. A major task of adolescence is to achieve a secure sense of self. Identity diffusion is a failure to develop a cohesive self or self awareness. Adolescent identity crisis is partly resolved by the move from dependency to independence.

Understanding adolescents is a difficult task. “No, I can do it myself. Don’t tell me how long my hair should be. Don’t tell me what to wear”. This negativism is a renewed attempt to tell parents and the world that young persons have minds of their own. Negativism becomes an active, verbal way of expressing anger; adolescents may seize almost any issue to express their independence. However, most teenage can negotiate the demands of school and family life with little disruption. Therefore, serious mood and behaviour disturbances during adolescence should be considered potential symptoms of mental illness and be investigated.

The school experience accelerates and intensifies separation from the family. More and more adolescents live in a world unfamiliar to their parents. Home becomes just a base; the real world is the school and the most important relationships, besides the adolescents’ family, are with persons of similar ages and interests. Adolescents attempt to establish a personal identity separate from their parents but close enough to the family structure to be included. Although adolescents tend to depend on peers for day-to-day support, the social support provided by the parents has a stress-buffering effect in emergency situations. Adolescents often view themselves through the eyes of their peers, and any deviation in appearance, dress code, or behaviour can result in diminished self-esteem. Parents must be aware of the sudden, frequent changes in friendships, personal appearance, and interests but must not show the authority to change that.

Parents of adolescents have their own problems. In addition to having to deal with the turmoil that accompanies the adolescent development, parents of adolescents are usually middle aged and must also make adjustment to work, to marriage, and to their own parents. Many difficulties surround adolescents’ need to assume increased independence from home, a move that can be threatening to parents who cannot let go and who want to maintain control of their children. Some parents may be unable to set limits of behaviour; others act out their hidden or unconscious fantasies through the lives of their children.

In spite of these possibilities, parents of adolescents report few major altercations and get along with their children. For most part, adolescents are receptive to parental approval and disapproval, and most adolescents and their parents can bridge the generation gap successfully. When they do not, the failure may arise from mental disorders in children, parents or both. Mental disorders are often associated with delinquent behaviour, rebelliousness, and academic failure – all of which may contribute to family disharmony.

Thursday, June 4, 2009

Doctor-patient relationship:

Can you hear the tension in this encounter? Why are doctors and patients so often at odds? Why are both expressing more frustration and less satisfaction? This is what research has to say about doctor-patient relationship:

If you’re wondering why so many hospital visits turn into a tug of war, it’s partly because doctors and patients are on different ends of the rope.

• To the doctor, illness is a disease process that can be measured and understood through laboratory tests and clinical observations. To the patient, illness is a disrupted life.

• The doctor’s focus is more on keeping up with the rapid advances in medical science than on trying to understand the patient’s feelings and concerns. Yet patient satisfaction comes primarily from a sense of being heard and understood.

• Many doctors do not see the role of physician as listener, but instead view their function more as a human car mechanic: Find it and fix it. Yet patients often feel devalued when their illness is reduced to mechanical process.

• Doctors feel frustrated, even betrayed, when patients withhold pertinent information. Yet patients who use alternative medicine, for example, may not tell their doctors for fear of ridicule or being labeled as flaky or gullible.

Patients aren’t perfect either.

Some patients described as “frustrating” by doctors:
• Do not trust or agree with the doctor.
• Present too many problems for one visit.
• Do not follow instructions.
• Are demanding or controlling.

It has been observed that:

• Patients who use the doctor as a scapegoat for their anger at the illness are less likely to get good care

• A patient who is consistently rude and irritable will almost certainly not receive the same medical care as a patient who conveys more positive attitudes.

What must the doctor do to improve the relationship?

• Doctors must cultivate a patient-centered partnership. The patient desires to be known as a human being, not merely to be recognized as the outer wrappings for a disease.

• To improve patient compliance, work on mutual trust.

• Research confirms that the health of the doctor-patient relationship is the best predictor of whether the patient will follow the doctor’s instructions and advice.

• Respect patients as experts in the experience of illness.

What must the patients do?

• Be willing to demonstrate the attitudes that you want from your doctor. For example, if you would like more give and take in the relationship, demonstrate your own flexibility by offering to negotiate and make concessions. Patients can be a powerful agent for change of a physician’s behavior.

• While medical science has limits, hope does not. If a patient is ready to be helped, even a little, and grateful for the marginal, it enhances the doctor’s commitment to fostering a relationship between equals. Only such a relationship, bonded by understanding and respect, can deepen into a true healing partnership.

• Accept realistic treatment goals. Many chronic diseases can be managed, but not cured. In this age of hype, patients have come to expect the impossible; Doctors frequently grope in the dark, not because they are delinquent in learning, but because the science is not there. But even when a cure is impossible, healing may be possible

In spite of all these problems, there is reason for hope. Yes, doctors and patients will always be on opposite ends of the healthcare system, but that doesn’t mean they can’t pull in the same direction