Bhooshan Shukla Profile picture
Sep 29, 2020 21 tweets 4 min read Read on X
#Thread
#grief
#COVID19

Over last few months many mental health practitioners like me have received requests about grief counseling due to death in family (due to Covid 19)

A short thread on helping kids deal with early days of grief.
First of all - all bereaved persons do not require grief counselling.
Culture and traditions help us deal with loss of loved ones in most situations and then there are time and life , the great healers.

So please don't rush in with psychological help on day one.
When death is untimely i.e. a person who dies earlier than old age, it can get complicated.

Many factors add to trauma of grief in pandemic -

1. Trauma of finding treatment for Covid19
2. possibility of immediate family being sick or in isolation complicates things.
3. Denial of usual rituals associated with dead.
4. Lack of extended family and friends' physical presence to soothe the grieving persons
5. Loss of more than one member of family

List just adds up.
My focus in this thread is in helping children in the family to deal with first few weeks of grief.
Key issue is "primary attachment figure for the child"
The person who is emotionally closest from child's point of view, who is approached by child to share all good and bad experiences, the person who is child's support in all aspects is primary attachment figure (simplified)
Usually this person is mother. But grandmother, father, elder sibling can also be in this or a similar role.

If primary attachment figure is intact, child are well buttressed to handle grief.
What happens when this key person in child's life disappears suddenly ?

Some simple steps can help the child cope better -
1. Let the child know about hospitalization. Don't keep it secret.
2. Let the child know about deteriorating condition (if applicable) and passing away of the person.
3. Let another member of family take the role of mother (usually it is grandmother or father in urban families)
4. Let the child realise that they are supported and looked after by actions NOT by repetitive sermons.
5. Whatever belief about "after death" existence is accepted by the family should be offered to the child.
6. Let the child express their grief freely in a manner they find okay. Don't try to suppress their crying and grief expression because it is too much for you to bear.
7. Offer help at bedtime. Many kids can't sleep by themselves at such times.
8. Let the child settle down with family before exposing to visitors.
9. Don't stop the child meeting friends and playing if child desires so.
10. Routine is healing. Let the child carry on with school, play, study activity as soon as possible. I have met kids who attended school next morning. This is perfectly okay.
11. Do not go overboard in caring for the child. Infantalizing them is not a good idea.
12. Let siblings help each other.
13. Children feel safe when they see confident adults around them. Sense of continuation is important for them.
14. Some young children ask "who is going to feed me? Who will take me to toilet? Who will tell me bedtime story?" These are legitimate needs of a young kid. They are not being selfish. They are scared. Give reasonable answers. Let them know that they are supported.
It is never easy to talk to or look after a bereaved child. Have faith in nature and our in born ability to overcome loss.

Please do not shut the child away from last visit to the dead. Give the child a choice if they want to see the dead body and pay their respects.
This is important for the child. Children as young as 3 or 4 years have participated in last rituals of their mother sitting in lap of father. This can help the child if they desire so.
Let the child move away if they are uncomfortable in the rituals.
Choice should be child's.
I hope none of us face this situation. But life and pandemics don't follow our wishes.

When should you look for formal psychological help?
Few pointers -
1. Inconsolable state of child even when close family members are available.
2. Serious sleep and appetite disturbances lasting beyond few days
3. Regression - child going to psychological state of much younger age e.g. bed wetting in a grown child
4. Searching for the dead intensively or denial of death lasting beyond few weeks
5. Most importantly - inability to connect with another adult.

Don't take the child with you for first professional consultation if possible.
Many times it is possible to help the child via family members.

I hope you and friends don't have to face this situation and all this information is completely wasted.

May the force be with us all.

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More from @docbhooshan

Apr 30
A thread on one of the most popular misconceptions about mental health in India.

1. Most people can identify psychological distress and pain quite quickly. This is the good and easy part.
As humans we are born with the ability to sense emotions in others and sometimes ourselves as well.
2. What the identity as "source" or "cause" of that distress is where all the fun lies.
There entire thinking process and behaviour is dictated by their attributed cause. Entirely dictated by their own perception and conditioning (biases).
3. It is almost universal belief that there is ONE single cause of that distress/illness. People look for agency that will "neutralise" that perceived SINGLE cause.
Read 14 tweets
Apr 27
A thread on medicalisation of grief.

1. In last six months. Five of my friends lost a parent. It can get overwhelming. Being a local to their parent's city i was involved in the process medically / supportingly / logistically.
Here are some observations about wrong use of antidepressant medications for the grieving.
2. Many left behind a spouse. Completely heartbroken and distraught due to the loss.

Unfortunately, their well wishing family physicians advised antidepressant prescription.

I have a serious disagreement with this. Hence the thread.
3. After such a profound loss. Death of a spouse of 40 years or more. A huge void is left in life. Sadness and grief is intense and in indian culture it is expressed by copious crying, re telling of last illness / last moments with every visitor.
Read 17 tweets
Apr 9
#ChildMentalHealth #India

A 13 yr old with severe Obsessive Compulsive Disorder. He has to wash hands to reduce anxiety even temporarily.
It is so bad that his hands are white with painful linear breaks in skin (ulcers).

Referred to a child psychiatrist. Started on single medication (fluoxetine). Cognitive therapy not possible as child lives 250km away.
Excellent response to meds in 2 months.
This should be happy ending isn't it ?

But it is not....
A 🧵-
After those 2 months parents buy the tablet locally and continue for 3 more months and stop using it. All by themselves.

Symptoms come back within a month and they restart meds in half dose on their own for another 6 months. Majority of symptoms go away and some remain.
They decide to stop meds again and same story goes again.

After it all becomes intolerable, they come to me and ask for help.

My first duty after confirming the diagnosis is - to know whey keep stopping the medicine.
1. They can afford it easily
2. There are NO adverse effects of the medicine.
3. Their doctor was available on phone to guide so no issue of costs involved in repeated psychiatrist visits.
Read 10 tweets
Dec 10, 2023
One more suicide.
A young doctor studying at THE most prestigious institution loses life to suicide.
I realised that he was following me on this platform. That realisation makes this even more sad at personal level. Was there any way i could have helped him and prevented the tragedy?

I dont know perfect answers to all these questions.
Attempting to write a few that can be helpful for all young adult students (18-25 age group) -
1. Irrespective of what your seniors tell you, mental health IS important.
It is based on combination of your brain chemistry, your formative experiences and your circumstances. There is no SINGLE cause or simple single remedy.
Getting help from professionals remains single most effective life saver as of now.
2. "Feeling hopeless" is a robust indicator of high suicidality. Anger with or without agitation and consuming intoxicants like alcohol are high risk factors. A combination of these three (hopelessness, agitation and alcohol) is lethal.

Watchout for that in yourself and your near ones.
Read 11 tweets
Nov 24, 2023
A day well spent at Chitale Dairy at Bhilawadi. Thanks to @nikhilchitale and Chitale family.

Their milk and milk products factory is state of the art. Sharing few photographs-
Command centre powered by AI that detects break in pattern and activates action. Image
Packing machines.
A keen eye will notice "Nicrome" a pune based company that pioneered manufacturing of these machines in India @aparanjape rt from
Image
Image
Read 9 tweets
Aug 31, 2023
#Psychotherapy #Reality

One thing that makes therapy relationship different in a beneficial way is privacy.
It is not about "confidentiality " (your information is not shared with others by treating team) only.
Therapy also helps people process their own difficulties in the solitude of their own mind and come up with their own conclusions, processes, emotions. They OWN the solution.

I see this process destroyed quite frequently by well meaning (and sometimes self serving) others in patient's life.

How? Pl read on -
Many adults have friends and family who help them in difficult times. Patients have already discussed their difficulties with these people before meeting a therapist.

For children, parents play a serious supervisory role out of concern and parental authority as well.
When such adults and children enter therapy, their near one's / parents often sit with them after every therapy session, eager to hear what happened in the session and "what did the therapist tell you?"

This is usually done by people who have not experienced GOOD therapy themselves. They are not aware of the importance of privacy to make therapy happen.
Read 12 tweets

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