Friendship is something you never outgrow. No matter how old you are or what you’re going through, healthy and close friendships encourage positive mental health and well-being. They celebrate with you through the good times in life and are there for you through the bad. In times such as now, it has become more important for us to be there for each other and check up on our loved ones.
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Valerie- Welcome to LonePack Conversations! I’m Valerie.
Today we have with us Dr. Vinod Kumar, Psychiatrist and Head of Mpower – The Centre. He has trained extensively in the UK and has qualifications and skills in various psycho-therapeutic modalities. He has also acquired qualifications in psycho-dynamic psycho-therapy, interpersonal psycho-therapy and cognitive behavioral psycho-therapy. He has endeavored to develop a truly holistic approach to mental health issues and works with a particular emphasis on psycho-dynamic psychiatry, wherein apart from the biological issues, emphasis is laid on the individual personality and the way that interacts with the illness.
Welcome, Dr. Vinod!
Dr. Vinod– Welcome. Thank you for such a wonderful and warm welcome introduction.
Valerie- Thank you for being here with us today.
Dr. Vinod- You’re welcome.
Valerie- So, in the recent past, the importance of mental health awareness and the need to be sensitive to people around us has become an integral topic of discussion. How do we create an environment to make sure that people feel comfortable opening up to us?
Dr. Vinod- So, there are quite a few general factors and also some specific tips I can give with regards to this. If you think about it, amongst your own network, say- you have a group of friends in your class or in your school, or certain family members- some of us are endowed with that sort of warm and empathetic personality so people kind of gravitate towards us in the sense that some of us are natural agony aunts in the way we are built and structured in our personality. Having said that, we can all endeavour to become better agony aunts.
We use some specific techniques. Say, if we are talking about our family and friends only, and we’re talking about people we have to live and interact with on a daily basis, we know their nature- how non-judgemental they are, how secretive or sensitive they are to personal information, how not to share it and so on. We already have a pre-conception so we will automatically choose whom we open upto or not. If we keep that in the background, that individual people have different abilities to be good listeners and agony aunts, if you think about specifics, we do this program called ‘The Youth Mental Health First-Aid’. I don’t know if you’ve come across that but that’s an Australian training program which we use primarily to equip people who work with younger people to be good mental health first-aiders. So, as a part of that program, there is this mnemonic that we use which is called ALGEE. That is used very commonly in all spheres. So, ‘A’ stands for ‘Assess for the risk of suicide or harm’, ‘L’ stands for the ability to develop ‘Listening non-judgementally’- we all have a tendency to be judgemental at times and being aware of the fact that any judgements from our side or being judgy in any way is going to put off the other person from opening up to us fully-, then ‘G’ stands for to ‘Give reassurance and information that is appropriate and adequate’ and I’ll expand on that in a second, ‘E’ stands for ‘Encourage appropriate professional help’ and the second ‘E’ stands for ‘Encourage self-help and other support strategies’.
So, this kind of gives you a framework of what works. So, some basic practical tips- you sense that somebody in your family or in your network of friends is struggling emotionally. How are you going to approach them? It’s very important to choose the timing of your opening gambit to them, the situation- you don’t do it on a dinner table, you know what I mean? If you’ve got five or six people, typically in a family, sitting over dinner, and then you sense that your younger sister or brother is struggling emotionally, you don’t bring it up then like “What’s going on with you? I’ve been noticing that you’ve been awfully quiet”. Automatically, the situation will generate a response which would make them close in again “No no, I’m fine. Why do you ask?”. Also, without knowing, non-verbally, we have tendencies to talk down to people, right? So very simple things- like when you approach somebody, you make sure you are at the same eye level as they are. If they are sitting, you don’t go and stand tall on them and say “I have been noticing you’re not yourself”. That is threatening. So, you take a very non-threatening, very humble stance, right? So say, if you’re dealing with a younger person, you make sure that if they are sitting, you go sit down next to them, where your eye levels are horizontal rather than you looking at them from top. You become aware of any non-verbal gestures which will be threatening.
You pick a time and a space which is appropriate for somebody to open up about their inner issues. It sounds like common sense but most of us don’t do it appropriately enough because what happens is that it usually comes out in a context where some argument is ensued and then you want to explore what is wrong with this young person or this other person, right? So, be aware of that. For that, you need to be sensitive, you have to be aware of your own body language which you portray. Generally, think about the timing of the intervention and the situation of the intervention. Have ‘AGLEE’ as a mnemonic at the back of your mind. So then you would basically take a stance where you are in the exploratory mode, which is very hard for most of us. We tend to take on the Captain Detective mode- “What is wrong with you? I’ve been noticing…” If the enquiry is very loaded with judgements, then it’s not likely to lead to any opening.
So, the questions should always be from an open-ended structure to close-ended. I’ll give you an example, suppose I’m talking to you and you are like my family member and I say “Hey, are you depressed?”, that’s obviously a very close-ended question. Instead, if the question was framed bearing in mind that you are sitting at the same eye-level and in a non-threatening posture and so on, and you say “How have you been feeling in yourself in the last few weeks?”, do you see the difference? The answer to the question should not end up becoming “Yes, I am depressed” or “No, I’m not depressed”, you understand? So, it’s an open-ended question where you say “Yeah, I’ve been feeling alright but you know what? I don’t feel that great”. So, you’re giving that space to the person. Your questioning should be what we call ‘conical shaped, which is you go from an open-ended question and if they don’t take the bait, then you can ask more closed questions- “But you know what? I’ve been noticing you’re not as participatory in the family events…” or whatever, right? So, you can bring in some data and then try and open them up. So, don’t act like a lawyer “Have you done it or not?”. That’s a basic thing.
Always be courteous and be okay with the person not wanting to open up at that point in time. That’s basic common sense again but see, you planned it carefully that you’re going to go and do this exploration or intervention and offer supportive nature and if the other person is not ready for it, then you give them that opening that okay, you understand that they don’t feel like talking right now but whenever they feel upto it, they can approach you. Leave the doors open that way, yeah? Nothing you do should come across with any kind of force or anything which is threatening like “You better talk to me”. You know what I mean? That should not be the attitude. So, it’s that very gentle open invitation at an appropriate time and an appropriate situation, I would say.
Valerie- I like that you said we need to respect their space and we need to seem sensitive to them so that it gives them a kind of comfort when it comes to the fact that they can open upto us whenever they feel like it, and also the importance of non-verbal gestures.
So now, supposing we do all of this and somebody does open up to us, or in the recent past, we’ve had a lot of people put up on their social handles messages saying “My messages are always open to you so reach out to me whenever you feel like it” but we need to educate ourselves on how we react when people actually do reach out to us. So, what are a few things we should keep in mind when people reach out?
Dr. Vinod- So, I think the first thing is to be very very acutely aware of not being judgy. That’s very off-putting. Just put yourself in the other person’s shoes- they’re trying to share something difficult and before you’ve exhausted what you want to say, somebody has already made up their mind on what’s wrong with you and they’ve got a piece of advice, whatever that might be. That’s very off-putting. That’s very much against the ethos of good listening, you know what I mean? So, you need to give them that space again and whatever it might be, you listen first, and you listen with intent and you listen with that sort of one-pointed focus, as much as possible. Let them come to a natural closure to what they want to share before you make comments. I think in between, you could give cues like “Mhmm”, “No, I understand”, “Tell me more”, that sort of a thing, just to get the process going or keep it going but nothing you do should come across as judgy, at least in the initial phases of the conversation. That’s one.
Secondly, depending on the situation, you should also give a very clear message that whatever the other person is now going to share with you is going to stay here. One of the barriers for people sharing difficult things with other people is that there’s a sense of not feeling secure, that the other person will share it with the other and so on. So, if you make a statement that to that fact, in simple words, that “I understand that this is difficult for you but let me reassure you that whatever we talk about now stays here” and that you’re not going to judge and you’re just here to give that space and time to that person so that they can open up about their mental anguish. So, it’s those things, whether they’re done very concretely and verbally, or through your non-verbal attitude and gesture, it’s a combination that leads to success, isn’t it?
Valerie- Yeah. Okay, now you’ve also spoken about how one needs to be in the right mindset to offer mental health support because a lot of us might think that the true definition of friendship is being there for someone no matter what. While it’s something that we can admire, it also comes at the cost of our own mental health at times. We might be going through something, we might not be in the place to offer support to somebody else. So, how do we be a good friend to someone going through a difficult time while not neglecting our own needs?
Dr. Vinod- I think that goes without saying, isn’t it? That you can be of positive help when you have the ability and the resources and the space within yourself. If you are struggling yourself, it’s better to deal with that first, right? It’s a bit like what they say, it’s a very cliched thing which people use but when you’re given instructions in a flight before the flight takes off that “The oxygen mask will fall and we want you to take care of yourself before you can help others.” So, that’s a given because without that, you’re not just going to make matters worse for yourself, but also for the other person.
Valerie- Right but so often you feel like you’re not doing enough for somebody, especially when you tell them you’re “always there” and then when they do come to you but you’re not in the right space of mind, you just can’t offer help. It doesn’t really seem right to you as well, feeling like you’re not doing justice to them coming and talking to you.
Dr. Vinod- You know when one says that “I’m always there for you when you need me”, that always has a condition that I’m there for you when I’m okay to be there for you, correct? It goes without saying, I think. There’s no substitute for honesty. Suppose somebody does choose or decide to open up to you, and like we said, the situation and the time is very important and that goes both ways, doesn’t it? When they are ready to connect with you and if you are not, there is no substitute for just being very honest and say “Right now, I’m not in the right space of mind. I will come back to you on it”. There might be a little to and fro but there is no substitute for honesty.
Valerie- Right, okay. So, while peer support is critical, it can’t replace professional help, right? But a lot of people are reluctant or outright unwilling to seek professional help. You don’t want to admit that something is wrong with you and you don’t want to go to a professional about it. Why do you think this is the case and how can we encourage people to seek professional help?
Dr. Vinod- There are so many barriers. The first one obviously being the sense of stigma around seeking any kind of mental health help, which has come about culturally, historically, due to various ways in which mental health issues and mental health professionals have been portrayed in the media and in the wider culture as well. There are a lot of negative connotations attached like “Main pagal thodi hu” (“I’m not crazy”), that kind of attitude. So, it’s very very difficult to break that and I think, in all cultures, I’ll tell you it’s not just India. In all cultures, there is a stigma attached to it but obviously, it varies with how evolved a culture is in this aspect. anyway. So what are the ways around it? Clearly, education, education ,education. The more people know about what it entails, what kinds of issues can be helped, right?
For instance, what we’re trying to do today, it’s part of that isn’t it? So, when more and more people become more and more aware that it’s okay to share with somebody who is trained and is professional with this. It’s kind of like people can cut their own hair at home but if you go to a professional hairstylist, obviously the outcome is better. Maybe it’s not a very good example but it just came to my mind. So, there is a difference in that.So, the biggest barrier is myths and misconceptions that people hold about professionals that when you kind of lose it is the only time you go and seek help or when there’s no other option. It doesn’t have to be that way. That’s point one.
So, there’s a very interesting position people take on this. Their whole sense of identity and pride is linked to being mentally sound and stable and safe. Owning that you’re not, is a big jolt to your ego and your identity and it’s all very unfounded. I think it’s completely nonsense, you know? I mean I have had so many clients over the years who come to me like “Doctor, tell me, I’m not insane, am I?” You know what I mean? It’s that sort of black and white thinking about this issue which has come. It’s very immature. I don’t know how it’s come and why it’s come.
Due to multiple factors, I suppose but you wouldn’t worry so much about seeking help from a gastroenterologist if you’ve got stomach issues. There is something fundamentally wrong with us thinking our entire identity is linked to our mind and our thinking. It’s like saying that “I am my sweat and my skin”. It’s just not true. It’s a part of you. Your brain and your thoughts and your feelings are a part of you but that’s not entirely you. So who are you? They’re a part of you but in my opinion, you are your awareness and your consciousness.
Now, if that becomes aware that there is burning when you’re passing urine, you would go see a urologist or a general surgeon to get the right help for it. When that awareness becomes aware that the brain, the thoughts and the feelings are not as healthy as they can be or they should be, then why not seek appropriate help for that? What’s the problem? But it’s amazing, it’s something which is a problem we’re all trying to unravel and break through and I think things are changing and what happens is popular role models and popular culture helps break these barriers as well.
For instance, when Ms. Deepika Padukone or a filmstar comes out and says “I have suffered with depression and I have sought professional help and it’s really sorted me out” and so on, that helps. I think that helps break some of the barriers because these celebrities do have a lot of influence on our thinking and I think, very importantly, what is portrayed in movies and in popular media, that shapes and defines our thinking and our attitude towards such things. For years, filmmakers have tried to use mental health issues as a substrate for humour, and that does not help matters. In fact, the Royal College of Psychiatrists has got an entire team looking at how mental health issues are portrayed in films and popular media and they do some very proactive work on trying to change that. Those are the things we all need to be wary of and challenge.
Valerie- I also feel like the culture we’ve been brought up in, we’ve been taught that you shouldn’t be crying. That it’s not a good thing for you to even show emotion and eventually when you keep hearing that, again and again, you become numb to even showing emotion to anybody. So, even if you don’t feel okay, you’re putting up a brave face, right? You need to really trust somebody to be able to actually talk about your issues and it becomes even more difficult, even though you know that you will be talking to a professional, you’re still talking to a stranger that you don’t trust and that you don’t know, so if somebody opens up to us as a friend that they really trust, how do we then tell them that “This isn’t a problem I can solve and it’s not something that will just go away so it’s better for you to seek professional help”. How do you say that without making it sound dismissive?
Dr. Vinod- Yeah. So, I think using a similar strategy as I just did. Using analogies of a stomach ache or other physical ailments. You have a set of experiences which are unrelenting, continuous. You feel sad, you’re not sleeping well, you’re not concentrating well, or you feel very panicky and stressed out all day and all that. Now, this has been going on for days and weeks. When the same thing is happening in your stomach and you’re having continuous diarrhoea, for instance, would you not see a professional to sort it out? So why is this different? So, it’s that kind of an approach, I would say.
But also, I see your point that without sounding judgemental… So don’t jump the gun about asking people to seek professional help. I think, exhaust the obvious ones. A lot of healing and therapeutic effects happen in good listening, right? Then encouraging problem solving in that person “Okay so now what are you going to do about it?” or “How are you going to handle it from here on? Let’s think about that together”. So maintain good sleep hygiene, get some exercise everyday, focus on the here and now, break down problems into solvable chunks and build it up, don’t look at the whole thing and get overwhelmed. Whatever your abilities are, when you exhaust all that and the problem persists and you’ve had more than one or two sessions, that’s when you probably bring in the possibility of them seeking professional help. So, it’s again timing and that judgement should come depending on the person’s openness and so on.
What is very very different is, say your best friend, she can share everything with you about her issues with her boyfriend or her mother and so on but when it comes to really deep dark secrets, right? People will hold off opening up about those things to the most loved ones as well because there is a fundamental problem here in your relationship which is that you are there as a part of their life. They have to interact with you, deal with you on a regular basis. So this is where the professional counselling bit comes in because here, clearly any counsellor or therapist of any worth should have very clear boundaries between professional work and their personal lives. So, I will not try and socialize with my clients as far as possible so I’m not a part of their life in that sense so they can open up about everything. Again, I come with years of training, a non-judgemental attitude, experience of dealing and working with difficult emotional issues so that also gives the professionals a bit of an advantage, you know?
It’s very different talking to a friend or a family member compared to talking to a good, well-trained professional therapist of any kind because it’s a safe space to begin with. A hundred percent safe. That much guarantee a therapist has to give, that “Whatever happens between these four walls stays here and if you don’t want me to share anything with anybody then that’s that. I’m not going to judge you. There’s nothing I haven’t heard before”. And so on. I think the classic example would be that you can do first-aid but when the person needs a bit more than first-aid, you’d obviously take them to a professional doctor, won’t you?
Valerie- I like that you talked about the importance of active listening and then gradually bringing up the conversation of seeking help so that we are there for them but then they also know that it’s important to seek professional help and get the help that you need because you can only provide so much.
Dr. Vinod- Yeah.
Valerie- So, the pandemic that we’re all going through and the lockdown has definitely taken a toll on all of us, be it mentally, emotionally or physically. We are no longer as aware of how people in our circles are doing as we once were. So, how do we take care of ourselves while also checking in on our friends? This would also maybe extend to when the lockdown ends but a lot of us still have long distance friends where we don’t see them on a regular basis, we don’t know what they’re going through. How do we check up on them?
Dr. Vinod- So, it’s very difficult. If you are used to somebody every other day and so on, that is obviously going to get diluted now but in my experience, I believe that the kind of perceived sense of support is way more important than actual support. Do you see what I mean? So, if you have a group of friends, say you’ve got like twenty friends, and they will be pretty demonstrative and they’re always there, supporting you. That’s very nice. But if you have fewer friends and you know that they are solid and that they’re going to be there if you need them, that perception, that sense in one’s mind is very helpful. So, it doesn’t have to be physically demonstrated and physical presence, you know?
It’s the quality rather than quantity, if you ask me, of that support you can offer to a loved one or a friend or a family member and that’s very important. So never forget that quality is way more important than quantity and that different circumstances in our lifetimes will warrant different levels of quantifiable contact and support, correct? The current situation is like that and we do what we can and obviously, with the access to technology and the amount of virtual meetings that’s happening, we do what’s possible. But I think it’s always the quality that matters. Somebody can be in your face all day long but they are of no use to you emotionally, you know what I mean? But then one person you may connect with once a year but the quality of that relationship is so beautiful that you value that a lot more if you were asked to list out people who you would depend on if your life depended on it, you know? You would name them. So, there’s no substitute for that.
Valerie- Well, Dr. Vinod, thank you so much for talking to us. There was so much that I got to learn from you, especially when it came to how to make somebody feel comfortable even when you’re not speaking to them or how to be sensitive and respect somebody’s space. Active listening was an important thing that I learnt from you today, to make sure that you’re there for somebody and they know that they’re heard.
Dr. Vinod- And remember there’s no substitute for genuine empathy. Genuine empathy. I didn’t emphasize enough.
Valerie- That’s right, yeah.
Dr. Vinod- Anyway, it was great. I mean, there’s a lot to say so we’ve tried to cover a lot today but if I can be of any further help any time, please feel free to connect.
Valerie- Thank you so much.