Sunday, March 18, 2018

The Power of Now

Eckhart Tolle’ s spiritually awaking book The Power of Now highlights the  importance of living in the present moment.  Ironically people avoid the present moment most of the time and dwelling in the depressive thoughts of the past or anxiety related thoughts connected with the future. A person who does not live in the present moment becomes a victim of time. Many psychological ailments are associated with missing the present moment.    
In this famous book Eckhart states: “Time isn’t precious at all, because it is an illusion. What you perceive as precious is not time but the one point that is out of time: the Now. That is precious indeed. The more you are focused on time—past and future—the more you miss the Now, the most precious thing there is.” 
Mindfulness can be considered as a universal human ability embodied to foster clear thinking and open-heartedness (Trousselard et al., 2014).The art of mindfulness is based on living in the present moment. The practice of mindfulness involves moment to moment awareness of in the present moment. It is paying attention in a particular way: on purpose, in the present moment in a nonjudgmental and nonreactive way. Some 2600 years ago the Buddha said to his decuples; “ Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment and live wisely and earnestly.
The awareness of present moment experience is vital. It is ongoing monitoring of present-moment experience with an orientation of acceptance. This process helps to reduce mind wandering and facilitate emotion regulation. Mind wandering and mindfulness are often described as divergent mental states with opposing effects on cognitive performance and mental health and spontaneous mind wandering is typically associated with self-reflective states that contribute to negative processing of the past, worrying/fantasizing about the future, and disruption of primary task performance.  (Vago & Zeidan,  2016).  Mind-wandering correlates with unhappiness and with activation in a network of brain areas associated with self-referential processing. Mindfulness is an antidote for mind wandering. In mindfulness people monitor their present-moment experience with a lens of acceptance (Brewer et al., 2011).
The research has found that long-term mindfulness meditation practice promotes executive functioning and the ability to sustain attention. Mindful awareness is frequently described as a focus on present sensory input without cognitive elaboration or emotional reactivity, and is associated with improved task performance and decreased stress-related symptomology( Vago & Zeidan,  2016). According to Zeidan  et al (2010 ) mindfulness training significantly improved visuo-spatial processing, working memory, and executive functioning. In addition mindfulness reduces multiple negative dimensions of psychological stress (Goyal et al.,2014). Long-term practice of mindfulness leads to emotional stability by promoting acceptance of emotional states and enhanced present-moment awareness (Taylor et al.,2011).
Dr Ruwan M Jayatunge 

Thursday, March 15, 2018

Sanity vs Insanity


Dr. Ruwan M Jayatunge    

Insanity is the only sane reaction to an insane society  –Thomas Szas

Although sanity refers to the soundness, rationality and healthiness of the human mind there is no clear demarcation between sanity and insanity. Some view the difference between sanity and insanity as a few nanometers and measured by success. The causes for insanity are multifactorial. Genetics, life stressors, infections, injuries to the central nervous system, drug abuse and even society and culture can contribute to the progression of different mental disorders.

 Chemical Imbalance of the Brain
Deficits or defects in the structural or functional integrity of the nervous system could lead to insanity. For instanceNeurotransmitter imbalances can cause mental disorders. Neurotransmitters are endogenous chemicals that allow the transmission of signals from one neuron to the next across synapses. Acetylcholine, dopamine, GABA, serotonin, epinephrine, norepinephrine and endorphins are the most significant or crucial neurotransmitters found in the human brain and neurotransmitter imbalances within the brain   are the main causes of psychiatric conditions.

 Human Society and Mental Illnesses
Throughout the human history mental illnesses were considered as demonic possession or the presence of evil spirit. In the Medieval Europe psychiatric patients were burned at the stake accusing them as the agents of Satan. In 1247 London’s Bethlem asylum was found and the term “bedlam” became associated with chaos, confusion, and poor treatment, which reflected the general attitude toward mental illness. The mentally ill received harsh treatments. The 17th century English physician Thomas Willis declared that: “discipline, threats, fetters, and blows are needed as much as medical treatment for the mentally ill.

 Humane Way of Treating the Mentally Ill
Dr. Philippe Pinel – one of the founders of modern psychiatry introduced humane way of treating the mentally ill patients in Europe. In 1793 he was appointed the director of the BicƒÆ’†’ªtre Insane Asylum and took numerous revolutionary decisions. He unchained the mental patients and stopped ill treatments.   Dr.  Pinel treated the patient as well as his surrounding environment. His innovations in treating mentally ill patients are still used by the modern psychiatry.

 King Buddhadasa’s Approach to the Mentally Ill
Many centuries before Dr. Philippe Pinel the King Buddhadasa of Sri Lanka (398 AD) treated psychiatric patients with compassion. He was a prominent physician, surgeon as well as a psychotherapist. According to the history once an insane individual insulted the King  Buddhadasa in front of royal gathering  Instead of punishing him the King treated his mental illness successfully. The King Buddhadasa used herbals, empathetic words and healthy community atmosphere to treat the mentally ill.    

 Institutionalization of Psychiatric Patients
Institutions for the mentally ill were established beginning in the 14th century. Institutionalization is a deliberate process whereby a person entering the institution is reprogrammed to accept and conform to strict controls that enables the institution to manage a large number of people with a minimum of necessary staff. Until the end of 1960 s Institutionalization was considered as the viable option to treat psychiatric patients. In these institutions psychiatric patients were often subjected to humiliations and maltreatment. Prolonged years of Institutionalization diminished thesocial and life skills of the patients. This condition was identified as Institutionalization Syndrome which had the features of loss of independence, loss of self-confidence, erosion of desire and skills for social interaction, excessive reliance on institutions and fear of authority.

 The movie Girl Interrupted recounts the true personal story of the   writer Susanna Kaysen’s account of her 18-month stay at a mental hospital in the 1960s.  Diagnosed with Borderline personality disorder Susanna was institutionalized against her will. She questions the doctors the validity of her diagnosis and to what degree it could be applied universally to anyone showing nonconformist behavior. Deinstitualization or the removal of mentally ill occurred in late 1960 s and treating the mantel patients within the community began after the deinstitutionalization process. 

 Community Psychiatry and the Neelammahara Model
Under the Community mental health services mentally ill are treated in a domiciliary setting, instead of psychiatric hospitals or institutions.  This mode has been adopted and successfully maintained in Australia, UK , Belgium and many other Western countries.  This model of community mental health services were available in Sri Lanka some 300 years ago in a village named Neelammahara.  Neelammahara was prominent for Ayurvedic psychiatry and this model allowed psychiatric patients to live in the community and obtain treatment.

 Michel Foucalt and Anti-psychiatry Movement
The Anti-psychiatry Movement which was formed in 1960 questioned the fundamental assumptions and practices of psychiatry. Foucalt pointed out that the specific definitions of, or criteria for, hundreds of current psychiatric diagnoses or disorders are vague and arbitrary, leaving too much room for opinions and interpretations to meet basic scientific standards. In addition inappropriate and overuse of medical concepts and tools to understand the mind and society, including the miscategorization of normal reactions to extreme situations as psychiatric disorders. Hence Foucalt emphasized that prevailing psychiatric treatments are ultimately far more damaging than helpful to patients.  

 The Ambiguity of Psychiatric Diagnoses
The popular move One Flew over the Cuckoo’s Nest made a colossal impact on the ambiguity of psychiatric diagnoses. According to the movie Randle McMurphy charged with statutory rape, decides to avoid the prison by willfully presenting the psychiatric symptoms.  In the mental institution he was given ECT (Electroconvulsive therapy)and eventually forced to undergo    Lobotomy (a surgical procedure consists of cutting the connections to and from the prefrontal cortex   the anterior part of the frontal lobes of the brain).

  On Being Sane in Insane Places
Psychologist David Rosenhan conducted a study to check the validity of psychiatric diagnosis in 1973. Rosenhan’s study consisted of two parts. The first involved the use of healthy associates or ‘pseudo patients’, who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in 5 different states in various locations in the United States. The second involved asking staff at a psychiatric hospital to detect non-existent ‘fake’ patients. In the first case hospital staff failed to detect a single pseudo patient, in the second the staff falsely detected large numbers of genuine patients as impostors. The study is considered an important and influential criticism of psychiatric diagnosis.

  The Case of P.P. Jamis
The Case of P.P. Jamis gives some impression on being sane in insanity places. Mr. P.P. Jamis committed a minor offence in 1958 and he was sent to Mental Hospital Angoda , Sri Lanka for an evaluation.  His life changed unexpectedly. Jamis had to spend 50 years in the Mental Hospital and spent his entire youth inside a cubicle. After the interventions by the activists he was released on bail in 2008.

The Sane Society and the Mentally Ill
The Psychologist Eric Fromm proposed that, not just individuals, but entire societies “may be lacking in sanity”. Eric Fromm further says that “yet many psychiatrists and psychologists refuse to entertain the idea that society as a whole may be lacking in sanity. They hold that the problem of mental health in a society is only that of the number of  ”unadjusted’ individuals, and not of a possible unadjustment of the culture itself.

Wednesday, March 14, 2018

බිලි බෝයිස්ලා බඳවා ගැනිමට උපදෙස්

ඔබට අන්තවාදී /ආගම්වාදී /වර්ගවාදී/ රැඩිකල් මාක්ස්වාදී /යන ඕනෑම ආකාරයේ පක්‍ෂයක් අරඹා ප්‍රචණ්ඩ ක්‍රියා මගින් ඔබගේ දෙශපාලන අභිලාශයන් සාක්‍ෂාත් කර ගැනීමට අවශ්‍ය නම් මුලින්ම ඔබ විචාර බුද්ධිය අඩු වැඩි ආවේගශිලී බවක් තිබෙන තරුණ කොටස් තම අනුගාමිකයන් ( බිලි බෝයිස්ලා) ලෙස බඳවා ගත යුතුය​. 

වයස 16 - 23 අතර වයස් කාණ්ඩ වල මොලයේ බිය / වගකීම / සහානුභූතිය සඳහා වග කිව යුතු ප්‍රදේශ තවමත් නිසි පරිදි වැඩී නැත​. මේ නිසා ඕනෑම මතවාදයක් හරහා මේ වයස් වල පුද්ගලයෝ සමාජ විරෝධී ක්‍රියා වල යොදවා ගත හැකි බලල් අත් වෙයි.එම නිසා එකී වයස් කාණ්ඩ වෙත අවධානය යොමු කරන්න 

මෙම අනුගාමිකයන් ලවා මිනී මැරවීමට​, අන්‍යන්ට වධ බන්ධනය පැමිනුවීමට​, ගිනි තැබීම් සිදු කිරීමට , පහර දීම්වල යෙදවීමට, කඩාකප්පල්කාරී  ක්‍රියා වල යෙදවීමට , ත්‍රස්ත ක්‍රියා වල යෙදවීමට  ඔබට හැකියාවක් තිබිය යුතුය​. මේ සඳහා මෙම ක්‍රියාවලීන්ට යොමු කල හැකි පිරිස සොයා ගැනීමට ඔබ තීක්‍ෂණය විය යුතුය​. 

දෙමාපියන් ගේ ආදරය අවධානය එතරම් නොලැබූ කොටස් වෙත ව්‍යාජ ලෙස දයාව කරුණාව පෙන්වීමෙන් මේ පිරිස් වලට බිග් බ්‍රදර් කෙනෙක් වීමෙන් ඔබට ඔවුන් දිනා ගත හැකිය​. 

එසේම සමාජයේ අවධානයට ලක්වීමක් නොමැති අධ්‍යාපනය අඩු විරැකියාවෙන් පෙලෙන නන්නත්තාර වූ කොටස් ද ඔබට ඉල්ලමකි. සමාජයේ අවධානයට පත් වීමට මේ නොබොඩීස්ලා අතිශයින් කැමතිය​. එය ඔබගේ වාසියට හරවා ගන්න​. 

තවද  පන්සල් වල පල්ලිවල  ලිංගික අපයෝජනයන්ට ලක්ව මානසික ප්‍රතිකාර නොලැබූ කොටස්ද ඔබගේ සැලසුම් වලට යොදා ගත හැකිය​. ඔවුන් තුල පවත්නා පැසවන ගින්න ඔබගේ වාසියට යොදා ගන්න 

එසේම ග්‍රාමීය පසුගාමීත්වයෙන් පෙලෙන සමාජ ආර්ථික කුල පීඩනයන්ට ලක්වූ සරසවි සිසුන් ද හොඳ බිලි බෝයිස්ලා පිරිසකි. කොලඹට කිරි උඹලාට කැකිරි න්‍යායෙන් සහ පන්ති වෛරය පැතිරවීම මගින් මේ පිරිස් ඔබට හොඳින් මුවහත් කර ගත හැකි වෙයි. ඉන් පසු ඔවුන් ප්‍රහාරයකදී ඉදිරි පෙල සොල්දාදුවන් ලෙස යොදා ගත හැකි වීම විශේෂත්වයකි. 

මෙලෙස මේ කොටස් තුල ජාතිවාදී කතා මගින් , ආගම්වාදී කතා මගින් පන්ති වෛරය උද්දීපනය කිරීමෙන් ඔවුන් ඔබගේ සොල්දාදුවන් බවට පත් කර ගත හැකිය​. ඉන් පසු ප්‍රහාර සඳහා මොවුන් යොදා ගැනීමට අවශ්‍ය වාතාවරණය එන තෙක් සිටින්න​. මොවුන් ප්‍රහාර සඳහා යොදවන විට ඔබත් ඔබගේ දරු පවුලත් සුරක්‍ෂිතව සිටීම අත්‍යාවශ්‍ය කරුණක් වෙයි. දරුවන් බටහිර රටවලට යවා බිලි බෝයිස්ලා ප්‍රහාර සඳහා යෙදවීම ඔබගේ තීක්‍ෂණ බව පෙන්වයි. ඔබ විසින් බිලි බා ගන්නා ලද මේ කොටස් උපකරණ ලෙස යොදාගන්න. අවශ්‍ය ඕනෑම විටකදී මොවුන්ව බිල්ලට දෙන්න​. 

Tuesday, March 13, 2018

“Essays on Psychology”,

The book “Essays on Psychology”, by Ruwan M Jayatunge M.D., is written for psychology undergrads and also people who are interested in psychology. As the title states this is a compilation of “essays” on a very heterogeneous spectrum of topics. There are short texts on selected mental disorders like OCD, PTSD, pain, substance abuse, or schizophrenia. There are others on treatments like EMDR, DBT, meditation, or cannabis. There are several texts on psychodynamic therapy. You can find also pathographias of Gogol, Hemingway and others. Finally there are also essays on cultural or philosophical questions.There are many topics one would not find in other psychology books, from nymphomania to matricide. More important is that the essays regularly refer to Asian concepts of mental illness and treatment, which are often unfamiliar to western readers. The book is no textbook but a stimulating book which covers new topics or gives new perspectives on well known topics. It is stimulating and can therefore be recommended if you want to widen your own horizon and if you are happy to read thoughts different from what you may read otherwise.

Prof. Dr. Michael Linden
Charité University Medicine Berlin
Berlin, Germany

Monday, March 12, 2018

ජීවන මාර්ගය


අපිත් හදමු නව පෙරමුණක්
රට ජාතිය ආගම බේරගන්න 
මුලින්ම හදමු බැංකු ගිණුමක්
මැදපෙරදිග කොරියාවේ යුරෝපයේ
ලෝකයේ හතර කොනේ ඉන්න 
අපේ මෝඩ වාහෙලාගෙන් 
ගරා ගන්න අත මිට මුදල් හදල් 

හේත්තු වෙමු අපි හොර ඇමතියෙක්ට
උගෙන් ගමු වාහන අමාත්‍යාංශයේ නමට
බොරුවට බුරමු පෙන්නා අපේ වැඩ කිඩ
මාසෙකට දෙකකට වරක් කොහේ හෝ තැනක  
උද්ගෝෂණය කරමු රට ජාතිය ආගම විනාසයි කියා

හොයාගමු මොකෙක් හෝ හතුරෙක්ව කොහෙන් හරි 
පෙන්වමු ඌ තමයි අපිව විනාශ කරන්න ඉන්නේ කියා
එක්‍ රැස් කරමු අපේ සේනාව ඉල්ලමු තව තවත් ආධාර 
සල්ලි ගිණුමට එනකොට යමු රට සවාරි 
විස්කි බ්‍රැන්ඩි හොරෙන් ගහමු නොපෙනෙන්නට 
නාරි මාංශයත් හොරෙන් විඳිමු පෙන්වමින් නික්ලේශී බව 
මේක කර ගමු අපේ ජීවන මාර්ගය  
එකම ආදායම් මාර්ගය ගොඩ යාමට හැකි 

Sunday, March 11, 2018

දරුඑල ලැබීම


1998 වසරේදී නාරි හා ප්‍රසව ජේෂ්ඨ වෛද්‍ය නිලධාරී ලෙස සේවය කල සමයේදී මම නාරි හා ප්‍රසව විශේෂඥ වෛද්‍යවරයාගේ අනුමැතියෙන් සහ අධීක්‍ෂණයෙන් දරුඑල නොමැති කාන්තාවන් සඳහා සඑලතාවය ලබා ගැනීම සඳහාප්‍රතිකාරාත්මක ක්‍රමවේදයන් ගෙන් සහාය වූයෙමි. 

වර්තමානයේ ඉතා දියුණු ප්‍රතිකාර ක්‍රමයන් තිබුනද ඒ කාලයේ අප බොහෝ විට යොදා ගත්තේ පැලෝපීය නාල අවහිරවතිබුනේ නම් එය මඟ හරවා ගැනීම සඳහා ඝර්භාෂයට දියර විදීමේ ක්‍රමයයි. මෙමගින් අවහිරව තිබෙන පැලෝපීය නාල යලියථා තත්වයට පත් වෙයි. මෙය සරල ක්‍රමයක් වූවද මේ සඳහා කාන්තාව සම්පූර්ණ වශයෙන් නිර්වින්දනය කොට ඇයගේගැබ් ගෙල විවෘත කිරීම අවශ්‍ය කෙරේ. ඉන්පසු විශේෂ උපකරණයක් මගින් සේලයින් ජලය හෝ හයිඩ්‍රෝකෝර්ටිසෝන්ද්‍රාවණය ගැබ් ගෙල හරහා  පැලෝපීය නාල වලට විදිනු ලැබේ. මෙම ක්‍රමය මගින් කාන්තාවන් යම් ප්‍රමාණයකට දරුවන්පිලිසිඳ ගැනීම සඳහා අප උපකාර කලෙමු. 

මේ ක්‍රමය අනුව දරුවෙකු බිහි කල එක් කාන්තාවක් මට මතක් වෙයි. ඇය මීගමුව ප්‍රදේශයේ පදිංචි කාන්තාවකි. වයසඅවුරුදු 35 පමණ වූ ඇය විවහා වී වසර අටක් ගතවූවද දරුවන් ලැබී තිබුනේ නැත​. අප සායනයේදී මේ කාන්තාව සහ ඇයගේසැමියාව පරික්‍ෂාවට ලක් කලෙමු.    

සැමියාගේ ධාතු පරීක්‍ෂාව අනුව ඔහුගේ ශූක්‍රාණු සංඛ්‍යාව මෙන්ම එහි තත්ත්වය සාමාන්‍ය මට්ටමේ තිබුණි. ඔහුසම්බන්ධයෙන් කිසිදු ව්‍යාධි තත්වයක් වාර්තා නොවීය​. කාන්තාවගේ ස්කෑන් පරීක්‍ෂාව අනුව ඇයගේ ඝර්භාශයේ යම්අස්වාභාවික පිහිටීමක් වාර්තා විය​. මේ නිසා  පැලෝපීය නාල වල යම් අක්‍රමවත් බවක් තිබිය හැකි බව නාරි හා ප්‍රසවවිශේෂඥ වෛද්‍ය අජිත් සේමගේ මහතා අනුමාන කරන ලදි. මේ අනුව ඇයගේ ගැබ් ගෙල හරහා පැලෝපීය නාල වලටහයිඩ්‍රෝකෝර්ටිසෝන් ද්‍රාවණය එන්නත් කරන ලෙසට නාරි හා ප්‍රසව විශේෂඥ වෛද්‍යවරයා මට දැන්වීය​. 

මේ අනුව මමඑම කාන්තාවට හයිඩ්‍රෝකෝර්ටිසෝන් ද්‍රාවණය එන්නත් කලෙමි. මෙම මූලික ප්‍රතිකාරයෙන් පසු ඇයව අප මසකට වරක් සායනයේදී නිරීක්‍ෂණය කලෙමු. එම මූලික ප්‍රතිකාරයෙන් මාසතුනක් යාමට ප්‍රථම ඇය ගැබ් ගත්තාය​. මේ අනුව නාරි හා ප්‍රසව විශේෂඥ වෛද්‍ය අජිත් සේමගේ මහතා විසින් අනුමානකල ලෙසින් පැලෝපීය නාල අවහිරය තහවුරු විය​. ගැබ් ගෙල හරහා පැලෝපීය නාල වලට හයිඩ්‍රෝකෝර්ටිසෝන් ද්‍රාවණයඑන්නත් කිරීම මගින් පැලෝපීය නාල අවහිරය යථා තත්වයට පත්වූ බැවින් ඇයට සාමාන්‍ය අන් දමට දරු ගැබක් පිහිටන ලදි.ඉන් පසු නියමිත කාලයේදී මෙම කාන්තාවට මම සීසර් ශල්‍යකර්මයක් කලෙමි. ඇයට නීරෝගී පිරිමි දරුවෙකු ලැබුණාය​. 

වෛද්‍ය රුවන් එම් ජයතුංග 

Saturday, March 10, 2018

නවක වධය සාධාරණීකරනය සහ ස්ටොක්හෝම් සින්ඩ්‍රෝමය

පෑන් ගැසීම නම් නවක වධය නිසා උඩු මහලින් බිමට පැන ආබාධිතව පසුව කළකිරීම නිසා සිය දිවි නසාගත් රූපා රත්නසීලී

තිලිනි ෂැල්වින්  නම් කාන්තාවක් නවක වදය ගැන මෙසේ ලියා තිබුණි.  {රැග් නොතිබුණිනම්, අපේ තිස්සමහාරාමේ සරක්කුවාගේ අයියාගේ මළගමට උදේ 6 වන විට බස් දෙකකින් කොලු කෙල්ලන් බහින්නේ නැත, මළගෙදර උයන පිහන අස් කරන තේ බිස්කට් අල්ලන වැඩ උන් අතින් කෙරෙන්නේ නැත, ලස්සනට වල කපා තොරන් බැඳ කවි ගී ලියවෙන්නේ නැත. (ඔය එකක් පමණි. එවන් අත්දැකීම් නම් අනන්තය)}  

නවක වධය ගැන සොඳුරු කතා මවන තිලිනි ෂැල්වින්  නම් කාන්තාව ගුරුවරියක් බව කියවෙයි. පසු ගිය කාලයේ දේශපාලන පන්දම් මතද ලොකු ලොක්කන් ඉදිරියේ හාන්සිවීම් මතද ගුරු රැකියා ලැබුනු බව නොරහසකි. තිලිනි ෂැල්වින්  මේ කුමන ආකාරයට තමාගේ රැකියාව ලබා ගත්තද අපට අවුලක් නැත​.  නමුත් මානසික රෝගීවූ අසහනකාරයන් විසින් සිදු කරන නවක වදය නම් හිංසනයක් සාධාරණීකරනය  කිරීම මගින් ඇය සමස්ථ ගුරු වෘත්තියේම ගරුත්වය පහත දමා තිබේ.  නවක වධය සාධාරණීකරනය කරන මේ තැනැත්තිය වැනි පුද්ගලයෝ ස්ටොක්හෝම් සින්ඩ්‍රෝමයට ලක් වූවන් වෙති. ස්ටොක්හෝම් සින්ඩ්‍රෝමය යනු කුමක්ද ?  

සමහර විට නවක වදයට ලක්වූ වින්දිතයන්  නවක වදය කෙරෙහි මෙන් ම තමන්ව වධයට පත් කල වධකයන් කෙරෙහි ආශක්තවීම මෙන්ම නවක වදය සොඳුරු අත්දැකීමක් ලෙසට අර්ථ කතනය කිරීමත් දක්නට ලැබේ. මෙම සංසිද්ධිය ස්ටොක්හෝම් සින්ඩ්‍රෝමය  ලෙස හැඳින් වේ.  (Stockholm syndrome (also known as "terror bonding" and "traumatic bonding") is a psychological tendency of a hostage to bond with, identify with, or sympathize with his or her captor. This syndrome can be seen as a form of traumatic bonding).   සංක්‍ෂිප්තව දැක්වීමේදී  ස්ටොක්හෝම් සින්ඩ්‍රෝමය  යනු පීඩිතයා විසින් පීඩකයා කෙරෙහි ඇති කර ගන්නා අසාමාන්‍ය බැඳීමයි. ස්වයං වධ බන්ධන ලැදියාව මෙන්ම තම වධකයන් කෙරෙහි ඇතිවන  අවිඥානික  ලිංගිකව ඇල්මද මේ සඳහා හේතු කාරක වේ.  

නවක වදය නීරෝගී චරියාවක් නොවේ. නවක වදය කායික මානසික රෝග ඇති කරවයි. නවක වදය නිසා විශාදය (Depression)  , භීතිකාවන් (phobias)  , පශ්චාත් ක්ලමථ  ව්‍යසන අක්‍රමතාව (PTSD) , සමායෝගී ආබාධ (Adjustment Disorder) වැනි මානසික ආබාධ ඇති විය හැකිය​. එසේම අතුරු ආබාධ බොහෝ කාලයක් පවතියි. මේ හැර භංගුර (vulnerable) පුද්ගලයන් අතර මනෝ ව්‍යාධික (psychotic)  තත්ව එනම් භින්නෝන්මාදය (Schizophrenia) , අධි තීව්‍ර මනෝ ව්‍යාධි (Acute Transient Psychotic Disorders)  වැනි මානසික රෝග වලට ලක්වීමේ ප්‍රවනතාවන් ද නිරීක්‍ෂණය කොට තිබේ.    

අවසානයට කිව යුත්තේ ගුරු වෘත්තියට පිවිසී නවක වධය සාධාරණීකරනය කිරීම මෙන්ම අනාගත පරපුරේ ඔළු ගෙඩි මොට කරන මෙවැනි මෝඩ කාන්තාවන් ගුරුවරියන් ලෙසට  නොව පාසල්වල වැසිකිළි පවිත්‍ර කරන්නියන් ලෙසට  වත්   අධ්‍යාපන අමාත්‍යාංශයට බඳවා ගැනීම නුසුදුසුය. 

I am not a number

The following is a poem inspired by the text  I Am Not A Number by First Nations member Jenny Kay Dupuis and Kathy Kacer as well as research on the horrors of life in residential schools in the rarely discussed bleak years of Canadian history.

This is my story
But I am not a number 
I am a human 
Although  they thought I was a commodity 

They removed me from my family 
Took me to a residential school 
They called it assimilation 
Civilizing the savage 

I faced dreaded events 
Also witnessed the horror 
I saw clergy  who worshiped  Christ 
Sexually molesting my brothers and sisters 

It was cultural genocide
They took away our identity 
If we spoke our native language 
We faced severe punishment 

We underwent humiliation 
Beatings and  piercing of tongues
Isolation and  shaving of heads
That took our dignity away 

So this is my story 
This is what they  did to us 
It may not be in the history books  
But this is what truly happened

I am old now 
I am destitute and wasted 
I am a survivor  
But I am not a number 

Dr Ruwan M Jayatunge 

Friday, March 9, 2018

Post-Traumatic Stress Disorder: A Review of Therapeutic Role of Meditation Interventions

Ruwan M. Jayatunge and Mieczyslaw Pokorski
Abstract  This review is an attempt to provide a comprehensive view of post-traumatic-stress disorder (PTSD) and its therapy, focusing on the use of meditation interventions. PTSD is a multimodal psycho-physiological-behavioral disorder, which calls for the potential usefulness of spiritual therapy. Recent times witness a substantial scientific interest in an alternative mind-to-body psychobehavioral therapy; the exemplary of which is meditation. Meditation is a form of mental exercise that has an extensive, albeit still mostly empiric, therapeutic value. Meditation steadily gains an increasing popularity as a psychobehavioral adjunct to therapy in many areas of medicine and psychology. While the review does not provide a final or conclusive answer on the use of meditation in PTSD treatment we believe the available empirical evidence demonstrates that meditation is associated with overall reduction in PTSD symptoms, and it improves mental and somatic quality of life of PTSD patients. Therefore, studies give a clear cue for a trial of meditation-associated techniques as an adjunct to pharmacotherapy or standalone treatment in otherwise resistant cases of the disease.

Keywords:Breathing - Meditation - Mindfulness of breathing - Posttraumatic stress disorder - Psychobehavioral therapy

Cite this article  as:

Jayatunge R.M., Pokorski M. (2018) Post-traumatic Stress Disorder: A Review of Therapeutic Role of Meditation Interventions. In: . Advances in Experimental Medicine and Biology. Springer, New York, NY

1  Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a clinical syndrome that may develop following extreme traumatic stress. It is an important, albeit relatively uncommon, consequence of exposure to traumatic events, presumably the result of life threats and conditioned fear (Greenberg et al. 2015; Ramage et al. 2015). PTSD is recently defined by four categories of socio-psychological symptoms(DSM-V 2013): 1/ intrusion that encompassesre-experiencing the traumatic event through intrusive memories, flashbacks, nightmares, and physiological responses similar to those when the traumatic event occurred; 2) avoidance that encompassesmind-numbing occurrences, such as avoiding situations and people reminding of past trauma, amnesia for trauma-related information, loss of interest in activities, social and emotional detachment, emotional numbing especially for feelings associated with intimacy, and nihilistic feelings of the future; 3/changes in arousal manifested by angry outbursts, sleep problems,startle responses, and hypervigilance; and 4/mood and cognition disorders consisting of difficulty to cope by feeling down and hopeless, dysphoric mood, problems with judgment, reasoning, and emotion perception, as well as with focusing attention on a task completion.

PTSD is a global health issue (Jindani ‎2015; Ramchand et al. 2015). The disorder develops in approximately 20% of people exposed to a traumatic event (Freedman et al. 2015). It is more prevalent in females than males: typically about twice the rate (Jaycox et al. 2004;Kessler et al. 1995). It affects about 8% of the general US population at some point during their lifetime (Gates et al. 2012).Risk factors for PTSD in adults vary across studies. The three factors identified as having relatively uniform effects are the following: 1/ preexisting psychiatric disorders; 2/ family history of suchdisorders; and 3/ childhood trauma (Breslau 2002). The lifetime prevalence in the US female population is more than 10% (Kessler et al. 1995). The prevalence rate of lifetime PTSD in Canada is estimated at 9.2%, with a rate of current (one-month) PTSD of 2.4% (Van Ameringen et al. 2008). According to the 2013 Canadian Forces Mental Health Survey, 5.3% of soldiers report experiencing PTSD at some point of service (Zamorski et al. 2016). PTSD is alleged to be associated with high rates of concurrent psychiatric disorders, particularly including but not limited to substance and alcohol/nicotine use disorders and all kinds of depressive disorders (Williamson et al. 2017;Bollinger et al. 2000; Keane andWolfe 1990). Further, traumatic events triple the risk of developing subsequent psychotic experiences later in life; the effect persist after adjustment for the possible presence of a mental disorder preceding the psychotic post-traumatic episode, which points to a direct and strong association between PTSD and psychosis (McGrath et al. 2017).

Aside from the socio-psychological or psychiatric consequences, PTSDmay also encompass, debilitating somatic disorders. In this context, comorbid metabolic and hormonal sequelae are notably underscored (Morris et al. 2012). PTSD increases two-fold the risk to develop insulin-resistant diabetes type 2, and also is conducive to the development of obesity, and other atherosclerosis-related pathological conditions (Roberts et al. 2015). Although molecular phenomena linking such comorbid conditions to PTSD remain mostly conjectural, interestingly the common denominator seems to be proinflammatory propensity endowed by PTSD (von Känel et al. 2007). Since somatic complications of PTSD may come to light in a variably and unpredictably delayed time scale, patients with the pathologies above outlined ought to be assiduously scrutinized in the process of anamnesis taking for the past history of a traumatic imbroglio toidentify biopsychosocial disease links.

PTSD has complex and multiple symptoms and is a highly impairing condition that imposes a significant economic and social burden(Hawkins et al. 2015; Kessler 2000). When coping with serious illness, choosing the right therapy is of key importance. However, treating patients suffering from PTSD poses a significant challenge and therapy still remains within the arcana of medical art. The existing guidelines for pharmacotherapy concern so broad and divergent groups of drugs, for instance, selective serotonin reuptake inhibitor (SSRI) like fluoxetine and related compounds, monoamine oxidase inhibitors like phenelzine,tetracyclic antidepressants like mitrazepin, antipsychotics like risperidone, and the list goes on (Cipriani et al. 2017). Pharmacotherapy should be individually tailored, taking into account the background history and current disease manifestations, with the placebo effect being sometimes the best therapeutic solution.

2  Meditation Interventions in Post-Traumatic Stress Disorder

Since the available evidence is not robust enough to suggest any pharmacotherapy of PTSD of finite efficacy, psychotherapeutic interventions have come to the fore as a prioritized option (Bisson and Andrew 2007; Schäfer and Najavits 2007). A variety of psychotherapy treatments have been developed for PTSD, such as trauma-focused cognitive behavioral therapy, stress management, or eye movement desensitization and reprocessing; the therapies that also include cognitive group treatment. Among the psychological interventions, meditation has been recognized as one of the notably effective modes. Meditation is an empirically-validated treatment for PTSD. A growing body of evidence suggests that meditation-based interventions have the potential to reduce symptoms and improve mood and general well-being (Mitchell et al. 2014; Seppälä et al. 2014). Further, meditation enhances openness to experience, one of the personality traits, which is associates with improvement in coping with stress by decreasing avoidance-oriented attitude to stressful situationsand with better control of one’s emotions(Pokorski and Suchorzynska 2017).

Meditation is a mind-body practice. It is an essential element in all of the world’s major contemplative spiritual and philosophical traditions (Walsh 1999;Shapiro 2008). According to Manocha (2000) meditation is a discrete and well-defined experience of a state of ‘thoughtless awareness’ or mental silence, in which the activity of the mind is minimized without reducing the level of alertness.Walsh and Shapiro (2006) described meditation as self-regulation practices that aim to bring mental processes under voluntary control through focusing attention and awareness. The effects of meditation on health are based on the principle of mind-body connection and there is a growing body of literature showing the efficacy of meditation on various health related problems (Hussain and Bhushan, 2010).Mind-body practices are increasingly used in the treatment ofPTSDand are associated with a positive influence onstress-induced illnesses such as depression andPTSDin most existing studies (Kim et al. 2013). As described by Cloitre et al. (2011) meditation has been identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances in PTSD. Lang et al. (2012) further suggest the meditationas a therapeutic intervention for PTSD.

Anapanasati meditation, which is a concentrative meditation that focuses on one’s respiration and suppresses other thoughts, is a tool for exploring subtle awareness of mind and life. Mindfulness of breathing helps oxygenate the body, reduces stress and anxiety, and induces peace of mind(Deo et al. 2015).The meditator is able to focus attention and see the impermanenceof his experiences, which nullifies the feeling of being destroyed by them. Breathing interventions boost emotion regulatory processes in healthy populations (Arch and Craske2006). Sack et al. (2004) have indicated that breathing-based meditation practices may be beneficial for PTSD. Seppälä et al. (2014) have reported that breathing-based meditation decrease posttraumatic stress disorder symptoms in US military veterans.

Mindfulness meditation, which is a sensitive non-concentrative type of meditation that notices things and picks up the object of attention as it pleases, helps reduce the level of stress in PTSD patients by cultivating awareness and acceptance of dysfunctional mental behaviors and helping change emotional experiences (Steinbergand Eisner 2015). The term ‘mindfulness’ has been used to refer to a psychological state of awareness, a practice that promotes this awareness, a mode of processing information, and a characterological trait. Germer et al. (2005) defines mindfulness as moment-by-moment awareness. The evidence concur that mindfulness helps develop effective emotion regulation in the brain (Davis and Hayes 2011; Siegel 2007). Mindfulness is associated with low levels of neuroticism, anxiety, and depressive symptoms, as well as high levels of self-esteem and satisfaction with life (Tanner et al. 2009; Brown and Ryan 2003).Mindfulness meditation is indicated in PTSD as it leads to positive outcomes in trauma survivors (Christelle et al 2014; Follett et al. 2006).

Likewise, vedananupassana meditation or awareness of sensations and feelings is a form of mindfulness meditation which is useful in the treatment of PTSD. Chronic pain and PTSD commonly co-occur in the aftermath of a traumatic event (Palyo and Beck 2005). In addition, both are mutually maintaining conditions, and pain sensations can trigger PTSD symptoms(Sharp and Harvey 2001). People with chronic pain and co-morbid PTSD report poorer quality of life (Morasco et al. 2013). Vedananupassana meditation is beneficial in alleviating paininthe individuals with PTSD.

Loving-kindness meditation is a practice designed to enhance feelings of kindness and compassion for self and others. Self-compassion is considered a promising change mode of behavioral approach in thetreatmentof PTSD (Hoffart et al. 2015).Kearney et al. (2014) have conducted a loving-kindness meditation study in 42 military veterans with active PTSD and found the effect of increased positive emotions. According to Kearney et al. (2013), this kind of meditation appears safe and acceptable, and is associated with reduced symptoms of PTSD and depression.Hinton et al. (2013) have demonstrated that loving-kindness meditation has a potential to increase emotional flexibility and to decrease rumination. Itmay regulate emotional stability and form a new adaptive processing mode centered on psychological flexibility.

Research has shown that transcendental meditation can also be an effective technique to treat PTSD. Transcendental meditation is derived from the ancient yoga teaching (Lansky and St. Louis 2006). It is apurely mental technique that falls within the category of ‘automatic self-transcending’ because the practice allows the mind to effortlessly settle inward, beyond thought, to experience the source of thought, pure awareness (Rees 2011; Travis and Shear 2010). Chhatre et al. (2013) have describedtranscendental meditation as a behavioral stress reduction program that incorporates mind-body approach, and demonstrated its effectiveness in improving outcomes through stress reduction.Rees et al. (2013) have shown a reduction in posttraumatic stress symptoms in Congolese refugees practicing transcendental meditation. Rosenthal et al. (2011) have highlighted the successful use of transcendental meditation on the veterans of Operation Enduring Freedom and Operation Iraqi Freedom suffering from PTSD. Further,Orme-Johnson and Barnes (2014) have explored a reduction in anxiety in response to transcendental meditation.

Meditation may have added value concerning PTSD, which is a hypnotic-like effect. Zazen, ‘seated meditation’ in which the body and mind are calmed, has an apparent hypnotic influence as evidenced by blocking the cortical alpha wave EGG response to repeat click stimuli (Kasamatsu and Tomio 1966). Hypnogenic engagement of attention with imaginary resources prevents the perception of the sense of reality and hinders the passage of external painful remembrances (Tellegen and Atkinson 1974), with understandably beneficial effects in PTSD. Hypnotherapy alone has a beneficial effect on PTSD symptoms. The largest to-date meta-analysis on the subject, performed on the selected 6 studies covering 391 subjects, has demonstrated positive effects of hypnotherapeutic techniques specifically related to avoidance and intrusion, and in generally to overall PTSD symptomatology (O’Toole et al. 2016). Meditation-associated hypnosis, although seldom by far considered for PTSD treatment, appears to be of distinct efficacy (Lesmana et al. 2009).

3  Conclusions

PTSD is a psycho-physiological-behavioral disorder, which calls for psychobehavioral ways of treatment.Meditation is an important part of health and spiritual practice. It is a form of mental exercise that has an extensive therapeutic value. There are three major types of meditative practices: mindfulness of breathing, non-concentrative mindfulness, and transcendental meditation. Due to a multitude of meditative techniques and approaches, it is hard to average meditations together to define the underlying mechanisms and clinical benefits. The difficulty consists in the paucity of verifiable research, small sample sizes of patients, variable methods of meditation, setting different outcome measures, and other issues. Despite these shortcomings, empirical evidence accumulates to demonstrate that meditation is associated with overall reduction in PTSD symptoms, and it improvesmental and somatic quality of life of PTSD patients. Meditation interventions seem justifiable as an adjunct to ill-defined polypharmacy arsenal in PTSD treatment or a standalone trial in otherwise failed treatment efforts of this multimodal disease.

Acknowledgements: Our thanks go toRev.Harispaththuwe Ariyawansalankara Thero from Vipassana Meditation Center in Colombo, Sri Lanka; Dr. David R. Leffler, Executive Director of the Center for Advanced Military Science (CAMS) Institute of Science, Technology and Public Policy, Iowa; and  Dr. Fred Travis, a post-doc fellowin basic sleep research at the University of California, Davis, CA.

Conflicts of interest: The authors declare no conflicts of interest in relation to this article.

About Mieczyslaw Pokorski, M.D., Ph.D., D.Sc.  

Professor at the Polish Academy of Sciences Medical Research Center - Head of the Department of Respiratory Research.  Affiliated with Medical Research Center, Polish Academy of Sciences in Warsaw, Poland; Department of Neuroscience and Imaging, “G. d’Annunzio” University of Chieti-Pescara, Italy; and the University of Opole, Poland.  


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