"Breathe In, Breathe Out..." Acknowledging and Facing Anxiety

Fabiha Atiq
Sophomore
School of Life Sciences
Independent University, Bangladesh

October 13th, 2017

A dear friend once described the following incident to me:

It was a Saturday night, which turned into a Sunday morning as she studied for a quiz. Her alarm went off, and she realized she hadn’t slept at all. “It’s okay. It’s fine. I’ll just go to class with a mug of coffee,” she said to herself. But then all of a sudden, without warning, this intense and hitherto unfamiliar feeling came crashing down on her. She felt weak, and even thought that she might die (her words not mine). Her head had started hurting, and she felt as if an earthquake was taking place inside her skull. She tried to get up from her bed but fell back, collapsing into what felt like an abyss.

Over the next few weeks, she skipped classes, quizzes, meals, and going out, paralyzed by the fear of another attack. All the blood tests in the next two weeks couldn’t help her or her family figure out what was wrong with her. Everything showed normal in the test results. Until, that is, one doctor recommended a psychologist.

The psychologist, after a lot of assessment and tests, diagnosed her with an anxiety disorder. What she had experienced was a panic attack. Note that panic disorder (which results in panic attacks) is a type of anxiety disorder, and anxiety attacks (characterized by a momentary fear and shortness of breath) tend to be milder and more short-lived than panic attacks.

Art by Gemma Correll

Now, in our culture, a psychologist is usually referred to as a “pagol-er-daktar” (translated – a doctor for crazy people). But in actuality, a psychologist is a mental health professional who analyzes behavior and mental processes, and recommends strategies for overcoming behavioral impediments to proper functioning. Psychiatrists are similar to psychologists, with one of the main distinctions being that psychiatrists can prescribe drugs.

Let us refresh our memory a little by recalling what mental health is, maybe? Mental health refers to one’s emotional, psychological and social well-being, and affects how one thinks, feels and hence, acts. Mental health disorders may or may not have clear biochemical bases.

The dictionary defines anxiety as a feeling of worry, nervousness or unease, typically about an imminent event. Science adds that it may not necessarily be about an imminent event or an identifiable trigger. Regardless of how it occurs, anxiety can rob a person of their appetite, their social skills, and their ability to function properly or study. There are different levels of anxiety, like any other illness out there; from mild cases to very severe ones.

A person with anxiety overthinks often and to an extent that they feel nauseous and faint. Breathing becomes difficult, and the person loses strength in their limbs, feels terribly weak, which can lead to to them thinking that they will collapse any second, which some actually do.

Several factors may contribute to triggering anxiety. Environmental factors, medical factors, genetics, brain chemistry, substance abuse, or a combination of these. Biologically speaking, anxiety appears to be tied to our fight-or-flight response, which involves the secretion of adrenaline and the priming of the body to respond to danger. But the problem is never the fight-or-flight system itself. The problem is the fight-or-flight response getting activated from a falsely heightened perception of danger, or when there is no danger at all.

Having said that, social factors also have a huge role to play here. Society tends to stress people out. Society often expects something from a person which they feel obliged to do even when they don’t want to (for instance, choose a subject they don’t want to study), which then stresses them out when they don’t like doing it, and thus cannot perform to live up to expectations. This can lead to anxiety. But there are can be a variety of reasons.

It is very easy to confuse anxiety with other similar mental illnesses, for example, depression. One might actually have questions as to how one differentiates between depression and anxiety. Depression is characterized by frustration, sadness and irritability amongst others whereas anxiety is associated with trembling, increased breathing rate and incredible sweating. They do, however, have some traits in common: restlessness, having trouble thinking/concentrating, having trouble with making decisions, excessive worrying, agitation and more.  Many people with depression do suffer from anxiety. Truth be told, there is no differentiating between them on your own, and it is best to leave it to one’s psychiatrist or psychologist, who will prescribe the appropriate drug, therapy, or course of action.

I have close friends, and immediate family who suffer from anxiety. I myself suffer from anxiety. Anxiety which is so bad I shamelessly admit that I have to take medication (prescribed of course) to function properly on a regular basis.

To most people, anxiety is basically nothing. They will tell you to not worry about it. But it can quickly turn into a severe illness. It is better to pay attention, and address the symptoms early on, before it becomes severe and leads to loss of functioning, self-harm etc.

In our culture, people may be afraid to seek help because of social stigma.
“Are they going to call me crazy?”
“What will society say?”
“Will people look at me differently?” and on and on it goes.

It doesn’t matter. Seek help, for it can get bad. Talk to your friends, talk to your family, and if you don’t feel comfortable enough, then don’t. For there is a place called the internet. There are so many people out there, going through what you are going through, and they will come through and help you, if you only reach out and ask.

Take a long, slow breath in through your nose, first filling your lower lungs, then your upper lungs. Hold your breath to the count of "three." Then release.

It isn’t a myth. It works.

Go online, make a blog, drink, eat, breathe, live.
Take one step at a time. But live.

Fabiha is in her second year at IUB. She is a bookworm, a shutterbug, and loves to write.

Shedding in Pounds, Gaining in Control: Exploring the Determinants of Anorexia Nervosa Through a Personal Perspective

Nuzhat Faizah

Sophomore

School of Life Sciences

Independent University, Bangladesh

September 15th, 2017

Apshara stood up from her bed and stretched in the direction of the sun just shining its warm golden light on the balcony. Her eyes barely open, she could see the sharp shadows cast by the neon street lamps gradually disappearing with the onset of daylight. As she went towards the balcony, the dew-laden Jasmine tree embraced her with its fragrance even as she felt the tightening grip of the immense expectations she was carrying within herself. The vibrant summer rays kissed the outline of her curves, and tinted her brownish hair orange while she was standing in front of her mirror and pounding on her abdomen with her wrists. She was standing at the edge of her teenage years and was disgusted to see her belly. Eventually she thought to make it disappear.

Apshara's elder sister had eloped with her boyfriend and gotten married five years ago, and since then her relatives have been taunting her and her parents about upbringing and moral values. On top of that, her parents regularly taunted her, predicting that she was going to follow her sister's footsteps and tarnish the remaining reputation her family has in society. Her relationship of seven years with her boyfriend had ended with betrayal and heartbreak which shattered all her hopes of having a perfect family with the man she loved in the future. Moreover, disturbing fights and daily quarrels between her parents had her convinced that she could never have a harmonious environment at home. Ultimately, all these experiences had a negative impact on her professional life. Her friends and colleagues, while fully aware of her circumstances, had still taken advantage of her emotional disturbances and eventually boycotted her instead of standing beside her and supporting her through these ups and downs. Apshara realized that she was losing everything, and little did she know that she was going to get addicted to losing soon.

She could not believe in God anymore, not even in her own worth. As days passed by, she began to be under the impression that she was cursed, flawed, and worthless. She was fed up while coping with the taunts, expectations and decisions her parents had imposed on her, losing her job and friends, heartbreak, and betrayal. She was surrounded by the daily hustle and bustle, clustering of known and unknown people but at the end of the day, she was completely alone, concealed by the shadows of her agony and depression.

In response, she began to take control of her body and mind, and began losing calories. She did not care much about her health, as she did not want to live anymore. Her body amazed her when she woke up every day and went to coaching centers to teach children after she lost her job. She did feel uncomfortable and exhausted as she had very little body fat and almost no energy. The skinnier she became, the harder it was to keep the people around her from noticing, though she did everything to hide her body. She stopped caring about what everyone thought and focused on living up to her own standards of starvation.

What remained of her social life took a toll. Visiting Burger Lab, Pizza Inn or any other fast-food shops became a nightmare. "You are fat! You have to lose calories again! You are a failure! A disappointment to your family! You should die!" -an inner voice recited to her, conflating her feelings of loss and alienation with self-esteem issues regarding her physical appearance.

By April of this year, her physical conditions had worsened so much that she could not cover it up with clothes. Her hands and feet were completely emaciated and she tended to lose her balance whenever she tried to walk. One day at the coaching center, she collapsed. Once taken to the hospital, the doctor told her that her right leg was paralyzed and gradually the most important organs of her body would give up if she kept going this way. Apshara was scared but she was unsure if she wanted to go back to the days before she had started starving herself. Sitting emotionally numb at the doctor's chamber, she got to know that she was a serious patient of Anorexia Nervosa and if she had the will to get better and live a normal life, she would definitely attain success one day.

What could cause a normal person like Apshara to intentionally starve herself to this extent? What external factors and influences contributed to trigger this behavior? Could she recover?

There are two sub-types of anorexia: the restricting type, which typically involves severe reduction of food intake but no purging (self-induced vomiting or misuse of laxatives and diuretics);  and the binge-eating/purging type, which involves relatively frequent episodes of excessive eating followed by compensatory purging. The latter is distinct from bulimia nervosa, which also involves binge-eating and purging, but affected individuals are usually of normal or above average body weight.

Eating disorders like anorexia are products of many risk factors which might be cultural, biological or psychological, and these can add to the probability of developing anorexia, especially during late adolescence or early adulthood.

Anorexia’s general physical symptoms include rapid weight loss, irregular menstrual cycles in women, decreased libido in men, dizziness, bowel problems, swelling of face, hands and feet, anaemia, osteoporosis (thinning of the bones), dental problems, feeling cold most of the time even in warm weather, and feeling bloated and constipated. Furthermore, anorexia can result in lethargy, low energy and insomnia. But anorexia nervosa, at its root, is a mental health disorder. Anorexic individuals exhibit obsessive behavior such as excessive fasting and counting of calories. They often isolate themselves, and can become suicida.

Anorexia Nervosa, according to American Psychiatric Association Practice Guidelines can be treated by nutritional rehabilitation, psychosocial therapy, and medication such as anti-depressants and antipsychotics.

Nutritional rehabilitation simply refers to attempts to reverse the starvation-associated symptoms of anorexia through feeding of energy-rich foods. It is important to note, however, that overly rapid intake of nutrients in malnourished patients can result in refeeding syndrome, which is characterized by metabolic disruption and electrolytic imbalance. Patients are often resistant to change, so nutritional rehabilitation is often coupled with psychosocial therapies, which can include education, individual and family psychotherapy, and counseling. Interestingly, studies have shown that family therapy works best for adolescents while adults respond best to individual therapy. The Maudsley approach, developed for the treatment of anorexic patients, is a family-based therapy where parents play an active role to help their children start eating again and gain weight according to their age and weight. At such a vulnerable stage in their development, it appears that adolescents need encouragement and positive reinforcement to properly recover. It can take up to years to fully recover, and relapses can occur. But those are no reasons to give up trying.

It is undeniable that women are more susceptible to anorexia than men (the ratio is roughly 10:1). As girls grow up, they are complimented more on their physical appearances than on any other qualities they have. A majority of them follow diets and become conscious of their bodies from a young age. It is hardly surprising, then, that girls respond to feelings of inadequacy through enforcing harsh control over their bodies. Low self-worth combines with society’s ideals of beauty. While short-term measures must involve accurate assessment of each individual patient’s experiences and mental health, society’s attitudes toward women must change to truly break the cycle.

Name of character has been changed to maintain anonymity.

Nuzhat is a Biochemistry second-year with a neverending passion for photography and birds. She likes to study about mental disorders.

“Depression does not exist. You’re fine!”

Fabiha Atiq
Freshman
School of Life Sciences
Independent University

June 16th, 2017

A widely circulated quote on the internet states, “Sometimes when I say ‘I am okay’, I wish someone would look me in the eyes, hug me tight and say, ‘I know you’re not okay, but it IS okay to feel like that.’ ”. Put in the context of mental health, I tend to agree. It is okay.

So what does mental health actually mean?

Mental health refers to one’s emotional, psychological and social well-being, and affects how one thinks, feels and hence acts.

Depression is not just about feeling down. It is a serious, and one of the most common mental illnesses worldwide, and also in our country. Studies suggest that the prevalence of mental health illness among adults in Bangladesh can vary from 6.5% to as high as 31% in many regions, while WHO has reported that more than 4% of the population are seen to be suffering from depression. Frighteningly, it is rising. According to a fellow loved one, here is a short explanation on what depression feels like:

Do you ever feel like staying in bed all day long even though you are not someone who would sleep all the time? Do you ever feel like your smile is forceful or that you want to cry out loud but all you’re doing is smiling? Or maybe that you’re drowning even though everyone around you seems fine? That’s what basic depression feels like. Depression affects one’s mood, thoughts, behavior, feelings. One usually feels anxious, empty, useless, and lonely. Ultimately, then, depression affects one’s functionality.

Depression can be triggered by a range of social factors, on their own or in combination: childhood trauma, mental/physical/sexual abuse, stress, grief, dysfunctional family, difficult life circumstances, and the list probably won’t come to an end! Research shows that even these factors don’t necessarily need to trigger one’s depression. It could be anything and nothing at all; people who come from wealth, well-adjusted families can be depressed too.

Alongside social factors, biology plays a huge role here. Genetic inheritance, hormones and chemicals in the brain can be involved in various capacities. Certain genes, when inherited, may increase the risk of depression in response to social and environmental risk factors. Depression and other mental health disorders have been associated with changes in the levels of various hormones and neurotransmitters in the brain, but it is difficult to establish whether this causes depression, or vice versa.

Deep in the brain there is a structure called the amygdala. It is concerned with emotions like anger, sorrow, pleasure and fear among other emotions. A study has shown that the amygdala is overly active in people with depression when a sad stimulus is presented to them, but is underactive when a positive stimulus, like smiling faces, is presented.

Having said all of this, when people think that depression is just caused by the biomedical changes in the brain, it robs them of the realization that society and the environment can have a huge impact on mental health. It is important to understand the biochemical bases of disease, but it is just as important to identify the social, political, and economic structures and practices that are likely leading to the rise in incidence of depression we are observing. People generally do not understand how dangerous depression can be. Both chronic and acute depression can result in self-harm, substance abuse, or worse, suicide. It leads to much more severe mental illnesses like psychosis if not treated.

Famous actor Robin Williams, a person who made people laugh for decades, died by committing suicide. He had been suffering from depression for a very long time till at the age of 63 he finally hanged himself in his home and took his own life. Even success and humor were not adequate defenses.

In this generation, may they be children, teens or adults, people suffer from depression and usually don’t show it due to social stigma.
“What if people judge me?”
“What if no one marries me?”
“What if I am declared crazy?” and so on.

I have friends and family who suffer from depression. And it isn’t something to be taken lightly. If you are reading this, and you’re suffering from depression, seek help. There is no shame in taking medication either. If you have a supportive family and a supportive friend circle, talk to them. OR NOT; If you do not feel like talking about it with your friends and family, then you don’t have to. The best thing about this generation is the internet; go online, make a blog, talk to people who feel the same way you feel.

Watch movies, eat, drink, breathe, live. Seek help if you need.
Take one step at a time. Get through one day at a time.
And always remember, you’re not alone.

“Mental illness is nothing to be ashamed of. Neither is talking about it. It’s #TimeToTalk” – time-to-change.org.uk

Fabiha is in her first year at IUB, and aspires to be a forensic scientist. She is a bookwork, a shutterbug, and loves to write.

What Causes Schizophrenia?

Kingson Wilson
Junior
School of Life Sciences (transferring out next term)
Independent University, Bangladesh

April 6th, 2017

Schizophrenia is a chronic mental disorder we often hear about, and while many of its associated symptoms such as hallucinations and paranoia are well-known, few of us have given much thought to what causes the disorder. Over 50 million people worldwide live with schizophrenia, with chances of developing the disorder being highest in the early or mid-20s for men, and in the late 20s for women. Understanding this disorder (and mental health issues in general) is the first step toward being more sensitive toward affected individuals around us. The symptoms of schizophrenia vary in wide range, and commonly include:

• Disoriented thinking, emotions and behavior, resulting in mood swings, detachment etc.
• Loss of contact with reality
• Hallucinations, most commonly auditory hallucinations
• Difficulties in communication
• Paranoia

What do scientists know so far about the biochemical basis of the disease? There is evidence to suggest that schizophrenia is linked to changes in the activity of chemicals in the brain called neurotransmitters. Scientists think overly responsive dopamine systems may affect the brain in such a way that causes hallucinations and other symptoms. Dopamine is a neurotransmitter that influences movement, learning, attention and emotions. Patients with schizophrenia are often diagnosed with extra receptors for dopamine in their nervous systems. Neurotransmitters work by binding to receptors on specific cells, and an increase in the number of receptors makes the cells more sensitive to the effects of the neurotransmitter. Due to these associations, dopamine blocking drugs are used as anti-psychotic medications in treatment. Alongside dopamine, the activity of other neurotransmitters such as serotonin, Gamma-aminobutyric acid (GABA), glutamate/N-methyl-D-aspartate (NMDA), acetylcholine, and norepinephrine have also been linked to schizophrenia in various studies.

What, then, are the physiological manifestations of the biochemical imbalance? Research shows that schizophrenics are often diagnosed with high activity in the thalamus of the brain, which alters sensory signals and can cause hallucinations. The thalamus is located between the cerebral cortex and the midbrain. It regulates voluntary motions, like consciousness and the sleep/wake cycle. It is also responsible for other senses like sound, taste, touch and sensing a person sitting beside you. Most of the signals from the thalamus go to the eyes, ears, mouth and skin.

Another region of the brain that is thought to be involved is the amygdala. The two amygdalae are on opposite sides of the brain’s medial temporal lobe. They are associated with emotions, fight-or-flight instincts, and pleasure. Aberrant activity results in unbalanced production of neurotransmitters. Patients with schizophrenia have abnormally high levels of activity in the amygdalae, which is strongly associated with paranoia.

Evidence for genetic basis of schizophrenia.

Schizophrenia is a disorder which is influenced by genetics. The probability of developing the disorder are one in a hundred, but if a sibling or a parent has it, the odds jump to one in ten. Current evidence suggests that a combination of genetic makeup and environmental stress contribute to the onset of schizophrenia. This means that people with genetic vulnerability will not necessarily develop schizophrenia, but they are more likely to develop it than the average person, especially when exposed to external stressors in the environment. Schizophrenia can also occur regardless of family history, with environmental stressors being thought of as the primary cause in those cases.

Several studies have tried to identify the genes that predispose individuals to schizophrenia. A recent study published in Nature by the Schizophrenia Working Group of the Psychiatrics Genomics Consortium compared more than 35,000 people living with schizophrenia with more than 110,000 people without the disorder from 35 different countries, and discovered more than 100 genes that are associated with, and potentially responsible for, the development of the disorder. Though most of these genes code for dopamine regulation, others code for immune system functioning. Scientists are working on how the genes coding for immune system can be responsible for schizophrenia.

Today, people suffering from schizophrenia can achieve proper care and live with the disorder to lead a mostly normal life. They can be supported by professionals that help them cope with the condition. Understanding the disease is a work in progress and new hypotheses are constantly being explored, which will hopefully lead us to positive outcomes regarding this disorder. However, despite all of this progress, according to WHO, one out of two people suffering from schizophrenia still does not receive proper treatment. Getting rid of the stigma associated with schizophrenia and mental health disease in general could change this, and promote better delivery of care to affected individuals.

Kingson's goal is to invent vaccines against viruses he releases. He says it is to make money for charity, and not to buy a waffle maker. He has good intentions.

Kingson has decided to transfer out of SLS to pursue a career in a different field. We wish him good luck!