Everything is Blurry

Sitting in the Psychiatry ward of a government hospital in Lahore is an experience which is very important for every practicing psychologist. People walk in all scared as psychiatric issue, and visiting a psychologist is a taboo and they fought a battle with themselves before taking this decision to visit. What I see every week is women, children and men all moving very slowly. They have to look, wait and rethink without uttering a single word. It seems as if life has paused for them. I look closer at their hand movements and their walk, they have lost the pace of life and are clueless how to get it back or to fix it. I look at those eyes asking me so many questions that they themselves don’t have the energy to ask. Every human to me is a piece of art and what I feel while looking at them is that this piece has lost its colors. The picture is still there, but it has lost charm and beauty, and it makes me wonder where do we all go wrong to face this or at first place why we face this.

I see couples holding hands, women crying in a room full of people where everyone is staring at them but they cannot help it. I see strong (outwardly) men saying “It’s just that I am not myself anymore”. I see old women holding hands of their young daughters fixing their dupattas because the daughter is not right there at that moment. What I see the most is that Psychological sufferings make us the most helpless because I hear this very often, “He/ she was perfecting fine and then he/she stopped talking”, they don’t understand that it doesn’t happen overnight it was just that we only realize the presence of psychological issues in our loved ones when they are no more themselves and it hits us strongly.

I find those eyes asking me again and again why me. In a society like Pakistan, where we have learned to fix everything with a pill, talking to a psychologist is still a far fetched idea, but how badly we all need it can be seen when you visit any Psychiatry OPD. I see young couples, the husband complaining about her fits of unconsciousness that started right after they got married. He is unable to comprehend what went wrong because apparently they are very happy together. I walk through several wards and OPD’s to reach the Psychiatry OPD and what I see is a different picture from rest of the hospital. The eyes are lost, wandering and clueless, the body language is almost missing, I see smiles that have lost life and spark, I have to repeat my questions to get the right answers, what I see is the life in slow motion.

What I see is someone who has been trying his/ her best to be so called “NORMAL” but has finally collapsed and thinks himself as a failure because ending up in a Psychiatry OPD is considered a weakness. I come across parents who feel extremely embarrassed while sharing the symptoms of their young son or daughter who has been delusional, sexually overactive, abusive, paranoid, lethargic, addicted or just irresponsive. I can feel the resistance to share in their tone and ambiguity in their answers followed by the very commonly used phrase “he/she was not like this before it just happened and we don’t know why”. Let’s just accept our vulnerabilities and stop being ashamed of them. The pressure to stay normal is driving us insane.

By Naeema Sarfraz (Clinical Psychologist)

Intimate Partner Violence experienced by Female Sex Workers

“I cannot say “No” to any kind of brutality, be it sexual or verbal. Men come to us not for pleasure but to let out their anger and anxieties” said one of the sex worker. Intimate partner violence is still a term not known by the women in our society. The right to say “No” to your partner for acts that question your self- esteem and safety. Our women in general have been raised in a way that this has been engraved in their mind that once they get married their husband owns their body and if she is not obeying him she will be punished by God. Intimate Partner violence and its different forms are not reported because majority of women consider it as a part of their married life and their duty.. Discussing such issues in families can raise several questions including their character.

Intimate Partner violence is definite or threatened physical, sexual, psychological violence by current or former partners against the same or opposite sex.  Partner violence is reflected by means of both its frequency and adverse consequences. Women are more likely to become the victim by of partner violence including  rape, physical assault, being degraded , humiliated and stalked  by the intimate partner. Violence against female sex workers is no different from violence against women in general but due to the humiliation connected to being a female sex worker they  are unwilling to talk about it.  The cultural context as marginalised females further effects their experiences of violence. Cultural context asserts that violent behavior is normal for these marginalized groups so this factor makes it  difficult for these women to escape or seek help.

“We face violence not only from our customers but also from our husbands too, they just treat us as money making machines and an object for physical pleasure. We get to hear from our partner that if you can offer everything to your customers then why not us. Safe sex is not a choice that we have”.

Female Sex workers are being subjected to exploitation by police, pimps, clients and community leaders because of their illegal status. Therefore this group is a target of violence, HIV and several mental health issues such as anxiety, depression, PTSD, drug addiction and poor body image leading to  low body esteem. Sex workers as a marginalized group, experience worse health issues than comparable age groups of the general population. Sex workers do not fit into the public health framework of occupational health because of the illegal and stigmatizing nature of sex work. These females experience various expressions of violence in their daily lives from insults to murder. Sexual and physical violence like abuse and rape are predominant among female sex workers. Drug addiction such as alcohol consumption is another most significant indicator of violence towards female sex workers.

S.A, a 21 year old female sex worker who recently moved to Lahore and settled in a hostel. She moved to Lahore to support her family and ended up becoming a sex worker. While narrating her experience she said “I was picked from a hostel by a boy and I had no clue where I was going. All I knew was that a handsome amount will be paid to the dealer and she will get a share from that amount. When she reached there she was gang raped which was not part of the deal and she was not allowed to report this at any level because she was paid..!!

Experience of increased violence creates numerous problems such as psychosocial distress and depression and risk taking behaviours in female sex workers. Psychological distress and overall violence is associated with three specific types of violence toward female sex workers i.e. emotional violence such as emotional abuse or verbal assaults, physical violence such as physical assaults and sexual violence such as rape, sexual coercion. In Pakistan there is limited research in  this area, however one research conducted in GC University Lahore by Iftikhar and Sarfraz (refrence) has looked into the phenomenon of Intimate partner violence faced by Female sex workers. Their results show that intimate partner violence is a strong indicator of psychological distress. Their study included 60 female sex workers from different areas of Lahore with an age range between 18-40 years. Out of these  56 had clinically significant psychological distress (93%) and they reported higher levels of Intimate partner violence. One of them reported that they are considered as a punching bag by their customers, majority of them come drunk or frustrated and then they use their bodies to get rid of that anger and frustration.

Female sex workers are that part of our society that are deprived of basic rights, they are exploited by their own families and then by their customers. We do talk about women rights but why do we forget this marginalized group which is suffering psychologically and we have no rehabilitation places for their mental health concerns or laws that protect them from violence from their partners.

 By Naeema Sarfraz (Clinical Psychologist)

Autism in Today's World

 By Naeema Sarfraz (Clinical Psychologist)We are all surrounded by fear of unknown and uncertainty during the current crisis with the Covid-19. As a Special needs psychologist, I am very concerned as to how children with autism must be adjusting to this  new world order. Children with autism are very routine oriented, this world was already full of chaos and uncertainty for them. The current scenario of COVID-19 has restricted us all in our homes, we can make sense of and comprehend the current situation however, it’s very difficult for these children to understand this new change the world is going through.

These children have set routines and schedules, they like keeping to their routines as it helps   with their stress/anxiety associated with any uncertainty or change. This uncertainty and chaos can make them display behaviors that are challenging for people who support them such as  their family members. These Challenging behaviors may include screaming, hitting, spitting, rocking etc.  To  help them cope with this anxiety related to uncertainty, parents should prepare daily schedules, of a number of activities such as breakfast time, play time, Tv time, snack time, music time, lunch time, exercise time , nap time, computer games time, art time, dinner time, and bed time. To help with the schedule’s communication cards can be used, which are easily available online.

 It can be a very interactive activity for the family, as under the current circumstances taking prints can be difficult, so you can instead draw them on white cards that children can cut, then you can all draw and color. Include your child with autism in this activity as they usually like art activities and it can be a good family time too. As we know these children face difficulty in socialization, this time can be utilized to engage them in some indoor activities that keep them busy too. Due to their difficult behaviors, it will be unfair to keep them segregated and less involved as it can increase their frustration and anger.

Children with autism do have certain sensory issues, if your child has any tactile or texture sensitivity don’t force them to wear masks or gloves  as it will only make them more upset and anxious. Instead you can make sure that their hands are washed properly and regularly. To help with this, you can create a social story with their favorite character, so they know the importance of hand washing and cleanliness in these challenging times.

It is easy to get angry and frustrated as a parent or a caretaker of a child with Autism, but you need to keep in mind how their inner world works, before punishing them for their challenging/difficult  behaviors. You can use this time to help their siblings or the other family members to understand and learn about the needs of your child.  You can also try switching roles as parents, as it  can be a daunting task for one parent to manage the child all the time. Majority children on the spectrum have communication issues so it will be useful to keep their communication cards or communication book in reach at all times, as most problem behaviors take place when the children are not understood, or they are unable to communicate. We can use the current crisis situation of the pandemic to make them part of our family system and own them rather than making them feel as a if they are unwanted or a burden for the family.