Families not only play a crucial role in the development of the overall personality, but actively influence the psychological adjustment of adolescence, problem-solving strategies, strengthening of self-confidence and the ability to set clear goals. The healthy functioning of these interaction patterns increases the psychological well-being of an individual.
Experts around the world have found that a vulnerable family environment (poor family function, poor social support, and mental stress on caregivers) is an important predictor of children’s mental health. It also predicts that these needs will not be met.
In a study published in the Journal of Adolescence, researchers concluded that a poorer family environment was associated with less emotion-focused support seeking and cognitive restructuring, and more emotional and behavioral problems. It added that a positive family environment helps adolescents adapt and ensure the ability to deal effectively with stress. They also claimed that children growing up in poor family settings can suffer from depression and anxiety.
On the occasion of Mental Health Week, News 18 reached out to Reena Nath, a New Delhi-based psychotherapist and systemic family therapist. Nath has worked in several countries and organizations – the Marlborough Family Services Center, the Anna Freud Center and the London Marriage Guidance Council, UK. She also offered group therapy in crisis situations in Punjab, Kashmir and Afghanistan, the latter under the United Nations. She was the secretary of the Indian Association of Family Therapy, a board member of the International Family Therapy Association, and currently serves on the board of the Journal of Family Therapy.
Edited excerpts from the interview:
Based on your long experience in family therapy, do you believe that an abusive family environment affects a child’s growth – both mentally and physically?
Yes sir. Yes, of course you can. An abusive family environment also affects children emotionally and academically. An abusive environment would encompass everything from physical violence towards the child or violence among adults to verbal abuse. And I would also like to add that harmful parenting practices can also be negligence. For example, when a child is injured and denied medical treatment, it is part of a poor upbringing. Not all bad parenting is inherently abusive, sometimes they may not be an active abuse, but there would be negligence and they affect the children in different ways. Some children become violent actors or perpetrators or victims, and sometimes they have both. In this way, these childhood experiences are carried on and carried on in the families. In some cases, these children become anxious adults or have other mental health issues that prevent them from leading full lives. After all, it also affects their relationship with friends and partners.
Children are resilient, however, not every child exposed to any form of negligence or abusive family practices will develop negatively. Some of them stay healthy and become more aware of things and advocate that they should become better parents and partners. But, especially at a very young age, abusive environments have a major impact on children. However, despite good parenting practices, people sometimes have misguided ideas. We know that we can grow up as neurotics, if not more severely psychotic. But these things are within normal functioning with some dysfunction that we all have, but help is available for that and it can be overcome.
Not only would abuse from the family affect a child, abuse from the family environment can also lead to consequences, especially if you are an immigrant or live in a very caste-bound area, then the entire family is abuse.
Amid a massive spike in domestic violence and prolonged isolation, how has the pandemic changed the family structure?
The pandemic has definitely affected family dynamics, sometimes negatively. And especially in families where there are people in need of care or families with physically or mentally handicapped people. Due to prolonged isolation and lockdown, they were unable to leave the house, resulting in tension, stress, anxiety and fatigue from months and months of relentless care which I believe negatively affected people. And I think within that feeling of pressure there could have been violence and abusive practices. And for fear of contracting the disease, there was no one to help, no one to intervene. People felt broken down, helpless and hopeless. In several cases, people did not seek help thinking what someone would do in this situation.
But on the flip side, some families I spoke to found that during the pandemic they got closer and felt more connected as the outside pressure was on them, they didn’t have to deal with any part of the world. Some relationships have healed themselves due to the lack of stress and hectic working hours. The rise in domestic violence may have occurred in families where a caregiver and a patient required 24-hour surveillance.
Q. Would you share your social work experience while working in rural Haryana? And how was that different from working with Sanjeevani?
One of the biggest differences was the rural and urban decor. Sanjeevani was one of the first accessible crisis intervention centers and that could only happen in New Delhi in those years. So we were faced with a stark difference between an awakened and more conscious population compared to the rural segment. In Sanjeevani the people were “self-centered”, they heard about the center and decided to go inside, while in the rural areas of Haryana, Kashmir and Punjab the people of the rural areas of Haryana, Kashmir and Punjab had never heard of mental health problems, they had to do with it but never knew what it is actually true. It was a big challenge telling people that it was ‘ok to talk’. In Haryana we did not have direct access to patients, but we reached them through medical staff who were remarkably good at their jobs. They were fully aware of the patients’ cases, which helped us tremendously with treatment. They were aware of the patient’s family situation, they were empathetic towards them and all of this was a great welcome surprise for us. Meanwhile, we were still fighting the mental health stigma in urban areas. It was a big deal for people to go to a therapy center and deal with their deteriorating mental health. Unlike in rural areas, people in urban areas are much more isolated and there is no sense of sharing or community.
In the context of India, has the mental health awareness scenario changed in the past two decades? Do you see more parents bringing their children to therapy sessions?
Absolutely, it has changed. Now there is a lot more acceptance of getting help and there is a visible difference in saying that I have depression or anxiety or that I need professional help to improve my mental health. Now at the latest we know that if we are going through something, we have to see a psychiatrist and not a general practitioner, which was not the case two decades ago. However, the stigma is still prevalent, people suffering from manic-depressive or mood disorders are still reluctant to seek help. Families caring for a mentally ill girl or boy do not want them to step out of their home, all of which is due to the stigma surrounding mental illness.
Given your years of experience in the field of psychotherapy, how do you think India’s mental health infrastructure can be improved? And what role can the public play?
First and foremost, we need to address the shortage of mental health professionals who care for a huge population. It is a serious problem, the government needs to increase the number of doctor positions in psychiatry and set up more colleges to encourage students to study clinical psychology, social work, and family therapy. Therapeutic intervention is another need of the hour that should be available in every department of a hospital, rather than just a team of mental health experts for the entire hospital.
Institutional support is lacking – insurance companies don’t cover mental health costs so people don’t even apply, and all westerners are covered by their mental health insurance policies.
At the organizational level, people are reluctant to contact their HR department to request leave for psychological reasons. Several people I have met believe that this vacation could be an obstacle to their professional development. In order to strive for an overall infrastructural development, structural changes are required on the ground floor.
However, there have been some positive changes at the educational level, with several schools now having advisors on board to help children address problems, combat stigma and find solutions. Recently a family was referred to me from their school after they beat up their child, this was an interesting development and a concrete example of a shift in the mental health scenario.
We also need more walk-in centers like Sanjeevani and government intervention to create these centers with the help of social groups and NGOs. This can make treatments for mental illness more affordable and accessible.
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