Thread by @psychidiaries

#CasesInPsychiatry
#ChildandAdolescentMentalHealth
#MedTwitter
A 15 year old boy was brought by his maternal uncle (Mama)to OPD today.
The boy had been having issues of nocturnal enuresis- which means passing urine while sleeping.
A 🧵
1/n

The first question we asked was of course why his parents were not here. Got to know from his Mama that parents and the kid stay in interior rural Maharashtra near Guj-Maha border. The boy had come to his Mama's place in Surat for his summer vacations a week back.
2/n

Mama and Mami noticed that he was passing urine every night in bed. Initially they were angry on the boy but then Mami was discussing this with other neighboring ladies about it & one of the ladies told her that her daughter too had such issues & they had taken her to Civil
3/n

Now please understand that Mama & Mami also come from a very poor socioeconomic background but after being told about it by neighbor they too decided to bring the kid to Civil Hospital. 4/n

Upon history taking from the kid, what we discovered was-
He had been having nightmares,
Persistent sadness of mood,
Irritability, decreased appetite and refusal to go to school.
5/n

When the kid was interviewed in privacy, he slowly started warming up and showed me his right ear. He had cryptotia which is basically an 👂 deformity of the cartilage of the ear. It looks like something like this-
6/n

Now because of this he used to be teased and bullied a lot by his school mates especially his seniors in school who would call him names. With time he started to feel really bad about himself which led to low self esteem to an extent he started hating his existence!
7/n

He started having nightmares and would have bed wetting. This further led to his parents becoming angry on him. One of the reasons why he was urinating in bed more frequently was also due to increased water intake at night as he would have panic attacks.
8/n

He reported that sometimes he had to drink an entire bottle of water to calm himself down. Unfortunately, parents due to their poor educational background, could not understand the problems the child was facing. They would keep shouting at him to stop urinating in bed but.. 9/n

..that is not how treatment happens. The kind of unawareness that we have regarding mental health in our country even amongst the educated class is a pity. So to expect the parents here to be aware of things is a really tall ask. 10/n

But what I admire about this story is the fact that a neighbor had the guts to disclose about her daughter having similar issues and guiding Mama and Mami to the right place. That can only happen if we start normalizing talks about mental health. This gives me hope. 11/n

Also, another thing this story highlights is how bullying amd teasing at school can affect the mental health of so many people. Let's be honest here to say that we have also at times being complicit in teasing few people in our early school days. We thought it was fun then. 12/n

Teasing people/ Body shaming/ Bulllying is not cool and not fun. The kids do learn from the elder generation which is why we need to be at least aware of and responsible in our behavior. At the same time let's not shy away from sharing our stories of vulnerability. 13/n

When we share our stories, it becomes a guiding path for someone else who is struggling too.
I don't think anybody can put it better than H.W. Longfellow-
14/n

Regarding the kid, he is now being treated for all the issues he is having. Mama and Mami have promised to call the kid's parents who we need to psychoeducate. It's a long way to go, but the journey to recovery has started. 🤞🙂
15/n

One of my best friends, Dr. Shail Shah who is now a surgeon, and @ProfSomashekhar
had published this paper long time back. I think it's worth revisiting. 16/16 ncbi.nlm.nih.gov/pmc/articles/P…

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