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| Vol.
4. No.3 |
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November
2004 |
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Editorial |
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| The
UN Convention for the Rights of Persons with Disabilities
is eliciting a lot of interest in the mental health
sector. Carers’ interest versus users’ interest
tops the list of cutting-edge controversies with
respect to this Convention. Other issues being widely
debated, raising controversies, relate to (1) full
legal capacity for persons with a psycho-social
disability and (2) demands against forced treatment.
This issue of aaina carries an information update
on the UN Convention.
A carer’s viewpoint on advocacy
issues in mental health is being presented here.
As a willing participant in a difficult conversation,
aaina also brings the user perspective on full legal
capacity. Aaina wishes to present more
of this discussion in the forthcoming issues, so
do write.
The spread of carers’ groups in
India and their push on the mental health sector
was evident in a psychiatric meeting organized in
Chennai, as the 6th Biennial Conference, by the
World Federation for Schizophrenia and Allied Disorders,
between 2-4th November, 2004. The event was hosted
by Aasha, a carer’s group from Chennai.
Over 150 people participated, both from India as
well as elsewhere. Equally evident in this event
was the influence of bio-medicine and the pharmaceuticals.
The event was funded by Eli Lilly, (makers
of popular brands of anti-depressants), Novartis
and Pfizer, all of them being MNCs in psycho-pharma.
The event was opened by the President of the Indian
Psychiatric Society. A useful directory of the carers’
organizations gathered there was brought out, along
with a comprehensive book of abstracts.
Another meeting concerning the
rights of homeless persons with a psycho-social
disability was organized by The Banyan
in Chennai. You will find a brief report of their
manifesto in this issue of aaina. |
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Contents |
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| Aaina
is a mental health advocacy newsletter. Advocacy demands
critical, creative and transformative engagement with
the state, policy makers, professionals, law, family and
society at large.
Aaina is an opinion-making
and opinion-leading newsletter, with a consistent message
of user empowerment, good practice, policy, legal and
social reform in the mental health care sector in India.
Aaina covers issues
in community mental health, the role of NGOs in mental
health, self-help and healing, the use of non-medical
alternatives in mental health, human rights issues in
mental health, institutional reform, ethical dilemmas,
policy discussions, and the mental health needs of special
groups (young people, women, the poor, sexual minorities,
persons with a disability, etc.). |
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Editorial
Team
Bhargavi Davar
Sadhana Natu |
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Administrative
Support
Rupesh Kharat
Ramya Anand
Atul Sutar |
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Design
and Layout
Communication
Support |
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Contact
Address
Center
for Advocacy in Mental Health,
B1/11, B1/12, Konark Pooram, Kondhwa Khurd,
Pune- 411048.
Phone: 26837644/47.
Email: wamhc@vsnl.net |
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Aaina
covers themes related to disability caused by psychiatric
drug use, and long term institutionalization. It
has a great interest in how much money pharma companies
are making by pushing hazardous drugs onto poorly
informed communities.
Aaina provides
a forum for users to express their problems and
dialogues with the mental health service system,
and their demands for change. It also addresses
issues of social living for persons with a psychiatric
disability, stigma, discrimination and deprivation
of the right to life, especially of the poor and
the homeless.
Aaina is circulated
free to people concerned about these topics. It
reaches out to over 300 people and organizations,
and also to various policy makers and human rights
watchdog agencies.
If you are interested in writing
for aaina, or in receiving print copies, write to
us at: aaina@camhindia.org You may also contact
the editors at: baputrust@rediffmail.com or satish.sadhana@vsnl.com
If you wish to make a donation to aaina, please
make a DD or a cheque in favour of “Bapu Trust for
Research on Mind & Discourse, Pune” and post
it to our mailing address. |
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The
UN Convention on Rights of Persons with Disabilities:
An Information Update |
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| Prof.
Amita Dhanda, Faculty of Law, NALSAR, Hyderabad. |
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Binding Obligations in International Law
A Convention or treaty is a binding legal obligation
in International Law. The treaty or Convention has special
binding quality because the obligations specified in
it are those which States Parties have voluntarily entered
into after a process of negotiation. The volition of
the States enters into every stage of the process from
negotiating to signing to ratifying. Even as State sovereignty
is constantly asserted in the formulation of a Convention
it would be important to appreciate that this freedom
is relative. States are at different junctures subject
to pulls and pressures from both the international community
and their own citizenry. It is important to note that
these pressures sometimes pull in the same direction
and sometimes in opposite directions. It becomes thus
a matter of speculation as to which pressure will win
state assent and approval on the day. Along with Conventions
there are softer instruments of international law such
as General Assembly Declarations and Resolutions which
are not binding on the States but which specify the
direction that States are expected to adopt in relation
to the issue on which the Declaration has been promulgated.
Factual Background
It is in background of this very basic understanding
of international law that we need to appreciate the
present international negotiations around the UN Convention
on Disability Rights. Even though international law
history makes mention of some unsuccessful efforts at
attempting to frame a United Nations Convention on Disability,
the UN law on disability has primarily been contained
in some soft law instruments. Some of which are the
UN Declaration on the Rights of the Disabled; the UN
Declaration on the Rights of Persons with Mental Retardation
and the United Nations Rules on the Equalization of
Opportunities for Persons with Disabilities. In the
present phase, a resolution for a Disability Convention
was first introduced by Mexico in the World Conference
Against Racism and when it received support,
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Mexico pushed the resolution setting up the Ad Hoc
Committee through the General Assembly. Consequent to
this effort the UN General Assembly set up an Ad hoc
Committee under the chairpersonship of the Ambassador
of Ecuador to draft a Convention on the Rights of Persons
with Disabilities. Mexico had also prepared a draft,
which was presented publicly in connection with an inter-regional
experts meeting in April 2002. It was also made available
online for comment. A revised version was published
before the first AHC meeting in July-August 2002. Besides
the Mexico expert meeting, there were regional meetings
held in Quito (Americas region), Bangkok (Asia Pacific)
& Johannesburg (Africa). The Bangkok meetings held
under the sponsorship of ESCAP were the most well developed
and took place over a longer period of time, resulting
in an actual text in October 2003. The Bangkok draft
became the main source for the Chair’s draft submitted
to the Working Group. This draft provided the framework
for discussion in the Working Group although the Group
was free to depart from it in substance. The Group consisted
of State parties, non governmental organizations and
one National Human Rights Inistitution. The Working
Group met for a two-week period in January 2004 and
finalized its draft in that time . It is this working
group Draft which is providing the foundational basis
for negotiations between States parties.
The Working Group Draft , the suggestions by various
States Parties as well as Disabled Persons Organizations
can be electronically accessed on the United Nations
website:
http://www.un.org/esa/socdev/enable/rights/adhoccom.htm
It is also important to note that there has been in
the first instance various disability organizations,
country and regional representatives of persons with
disabilities started to participate as disparate groups.
However increasingly through a process of continuous
dialogue this disparate group of organizations has come
to establish itself as a Disability Caucus on the Convention
and is working hard
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at speaking in one voice to the States. Details on
the membership of the Caucus and some of its position
papers can also be obtained from the above-mentioned
UN website.
After having provided some general information on
international law making and the working out of this
in the realm of Disability I would in the rest of this
note wish to focus attention on, one, some key conceptual
controversies surrounding the Convention and two, specially
zero in on those parts of the Convention which are of
special interest to persons with psycho social disabilities.
Crucial Controversies
What should find inclusion in the Convention?
One issue which keeps resurfacing at the deliberations
on the Convention in one form or the other revolves
around what should find inclusion in the Convention?
These questions arise because the Convention includes
within its conspectus civil political rights such as
: the right to life, liberty, freedom of expression
or social economic rights like the right to work, health
or rehabilitation or even special interests rights such
as the rights of women or children. A number of States
are at pains to point out that Conventions encompassing
such like rights already exist and as these rights would
also extend to persons with disabilities their reenactment
in the Disability Convention was unnecessary. Whilst
questions around the rights extending to special groups
are still pending discussion the reiteration of the
civil political rights has been conceded to on the reasoning
that if these rights were in fact accessible to persons
with disability there would be no need to deliberate
on this Convention. Further these primary rights require
inclusion in the Convention because they need to be
tailored to the specific concerns of persons with disabilities.
It should be noted that even as this reasoning is being
conceded States are at pains to point out that the Convention
is arising on the plank of non discrimination which
means what is available to all other persons should
also be available to persons with disabilities but not
that rights which have not been conceded to the non
disabled should be provided to persons with disabilities.
Here the controversy very often is whether a reasonable
accommodation provision is granting the same or more
to persons with disabilities?
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The Progressive
Realization of Social- Economic Rights
It has been an accepted tenet of international
law that whilst civil-political rights were immediately
realizable social-economic rights had to be progressively
realized. The fact that social -economic rights are resource
driven is provided as the reason for the delayed implementation
of these rights. One of the questions which is being vociferously
argued in the present negotiations relates to the inclusion
of an explicit provision which states that those social
economic rights which do not require resources shall be
immediately implemented. The States opposing such a provision
are providing a multiplicity of reasons. Some of these
reasons are that the idea of progressive realization implicitly
acknowledges that those rights which do not require resources
should be immediately enforced. An explicit mention is
not needed. On being asked as to why which is implicit
cannot be made explicit the reply is that if that were
done persons with disabilities would be provided rights
not available to others in the population.
What is meant by reasonable
accommodation?
Evidently if discrimination of persons
with disabilities is to be actively addressed it is necessary
that their particular needs should be accommodated. And
to ensure that this accommodation is not disproportionate
and unlimited it is provided that such accommodation should
not be unreasonable. Here in contrast to the reasoning
which was put forth in the provision relating to progressive
realization of social -economic rights a number of states
are contending that the article itself should state that
such accommodation should be made unless it results in
disproportionate burden. The anxiety being expressed here
is that such a qualifier would provide states with an
escape route and negate one of the core concepts of disability
rights.
How should the Convention mention
families?
One of the key obligations of the States
in the Convention relate to recognizing the participation
and representational rights of persons with disabilities.
A number of States underscoring the fact that several
persons with intellectual or multiple disabilities may
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desire that this provision should not only make reference
to persons with disabilities but to persons with disabilities
and where appropriate their families. The Disability
Caucus is contending that the participation should be
of persons with disabilities and their representative
organizations. Such a formulation it is contended allows
for families and family organizations to be consulted
where they are the representative organization and yet
accords primacy to the aspirations of self advocacy.
It allows for a merger of aspirational norms and pragmatic
implementation.
Concerns of persons with psychosocial disabilities
Whilst the Convention is being negotiated on a global
version of disability, it is still evident that some
rights are of greater concern to people with some disabilities
over others. In this section I recount the deliberations
around the issue of legal capacity and forced interventions
which have assumed special importance for persons with
psychosocial disabilities because they more than any
other persons with disability have been on the receiving
end of incapacity labeling and compulsory civil commitment.
The working group has recommended that in article
9 (which deals with legal capacity) states parties should
recognize persons with disabilities as individuals with
rights before law equal to all other persons. They should
also accept that persons with disabilities have full
legal capacity on an equal basis with others. Where
assistance is necessary to exercise legal capacity it
should be proportional to the needs of a person. Such
supported decision-making it is contended shall keep
the wishes and aspirations of persons with disability
in the forefront and in no case can the person providing
support supplant the person with disability. The working
group recommendation to the Committee took the stance
that all persons could take decisions with support and
substituted decision- making or guardianship was not
required. In the reading of this recommendation in the
May meeting of the Ad hoc Committee there was a proposal
by Canada which was accorded support by other countries
whereby a new paragraph was to be added to the article
which allows for the appointment of substitute decision-makers
or guardians for those persons with
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disabilities who are unable to take decisions even
with support. These guardians are to be appointed after
the observance of fair procedure safeguards which is
usually understood to mean a court, hearing , representation
by a lawyer etc.
The ground of controversy here is once the provision
is included its applicability shall be tested against
all persons with psychosocial disability. The very stereotype
of incapacity which the Convention is intended to challenge
shall be reinforced by the Convention. Hence the Disability
Caucus and some states are contending that an effort
should be made to see whether the functions of guardianship
can be fulfilled through supported decision making and
legal devices such as advance directives and powers
of attorney. In mooting supported decision-making the
disability caucus is making a distinction between the
need to provide support to those who need it and allowing
people the dignity of risk.
Guardianship is problematic as it in the name of providing
the first also takes away the second.
The other issue of concern is how should the Convention
deal with forced interventions? The Disability Caucus
takes the view that a Disability Rights Convention should
necessarily endorse the position of persons with disability
that compulsory treatment was a contradiction in terms.
And if it was not possible to unequivocally take this
position then it was better that the Convention did
not deal with the issue. It is further being asked is
not the compulsory commitment of persons with disability
because they are a danger to self or others discrimination?
No other risk behaviour it is pointed out invites such
like treatment. The Disability Caucus is therefore contending
that behaviour dangerous to others should be dealt with
under the criminal law and dangerous to self conduct
should be prevented only if the State is planning to
intervene in relation all risky behaviour.
Conclusion
The above note is aimed to provide an information
update on the deliberations around the Convention and
the discussions which transpired in the recently concluded
meeting of the Ad hoc Committee from 23rd August to
3rd September 2004. As we ponder on the pros and cons
of various proposals
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it would be appropriate
to remember that an international Convention in contrast
to a domestic law and policy is aimed to be futuristic
in its purport. It is made for not just for the near but
also the distant future. Hence it should be providing
direction setting principles. And the principles which
we accept should be those which whilst acknowledging the
limitations of the present do not stranglehold the future.
Prof. Amita Dhanda, a steadfast
advocate for the rights of persons with psycho-social
disabilities, has been a part of the UN Ad Hoc Committee
meetings, as a part of the World Network of Users and
Survivors of Psychiatry. For more details, and a continuing
dialogue on the Convention, please contact:
Prof. Amita Dhanda
21/1 Janakpuri, Gunrock Enclave,
Secunderabad 500 009, A.P. India.
(Tel): 0091-40-27816033
(m): 09849064951
Email: amitadhanda@rediffmail.com

Institution
By Cynthia L. Damiano
Inside
Nothing grows deprived of
Sunny skies
In time
Unheard, with no opportunity
To bloom with grace
Instead the buds wither
On stems of
Neglect
(Source: Madness Network, Fall 1984,
Vol 7, No 4) |
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Gender and Mental
Health: A 2 week Residential Program,
March 14th–27th, 2005,
Pune.
This course has been developed
as a response to a huge need felt by women’s collectives,
non-governmental organizations, government agencies,
research, teaching institutions and diverse kinds
of professional agencies to develop perspective
and understanding in a core area of women’s health.
Participants may be health or mental health professionals,
health care providers, policy developers, program
managers, researchers, community organizers or
human rights professionals. Topics covered are:
Concepts in Gender / Mental Health; Reproductive
Health, Sexuality and Mental Health; Education,
Policy and Advocacy in Mental Health; and Ethics,
Law and Mental Health. Teaching methods
used are interactive groups, lectures, seminars,
and work assignments. The language of instruction
is English. For more information, contact us:
Course co-ordinators, “Gender
and Mental Health”
Center for Advocacy in Mental Health,
B 1/11, B 1/12, VI Floor,
Konark Pooram, Kondhwa Khurd,
Pune- 411 048 Maharashtra.
Tel: 020-26837644/47
Email:
wamhc@vsnl.net; info@camhindia.org
Or visit our website: www.camhindia.org |
VISIT OUR NEWLY UPDATED WEBSITE:
www.camhindia.org
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The
psychology of adolescence with sketches of
guidance format |
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Prof. (Dr.) Nilanjana Sanyal |
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Miss Nilanjana Banerjee |
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ADOLESCENCE………
The key word brings as a hallmark to our general mental
canvas of the profile of an “adult” in the making, with
a health full of vitality, vigour, energetic, enthusiastic,
colourful dynamic youth vibrating with spasms of life
in possible positive directions. It is the time when
individual talent begins to manifest itself in academic
as well as in cultural dimensions. Negative profiles
in the context is no rarity. Yet they should be considered
as deviations.
Definition
Adolescence can be defined as a multi-dimensional
developmental period, having distinctive behavioural
ornaments here and there.
The existing scenario
A transitional life stage between childhood
and adulthood is now evident in most of the societies
of the world with their associated culture, specific
patterns and practices. The new form of adolescence
now taking hold across societies, however, are distinguished
by a common set of historically recent elements associated
with globalization that create a longer, more distinct
transitional period [Schlegel and Barry(1991)]. These
include longer schooling, earlier puberty, later marriage
and for many youth, urbanization particularly, and greater
separation from the world of adults. The pathways to
adulthood-- these adolescences -- take different forms
in different social, cultural and economic settings
(Caldwell, Caldwell, Caldwell and Pieris, 1998; Larson,2002).
In many societies, for example, this period does not
involve the task of psychic separation from parents
or carry the connotations of emotional turmoil with
adolescents in the West (Dasen, 2000).
Adolescence in all parts of the world has been in
in-flux of energy despite the changing socio-cultural
fabric of current day societies due to globalization,
urbanization, nuclear family and telecommunication revolution.
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The basic process of adolescent development involves
changing relations between the individual and the multiple
levels of the context within which the young person
is embedded. Variations in the substance and timing
of these relations promote diversity in adolescence
and represents sources of risk or protective factors
across this life period.
Role of parents and peers during adolescence
For adolescents, this period is a dramatic challenge,
one requiring adjustment to changes in the self, in
the family and in the peer group. For both adolescents
and their parents, adolescence is a time of excitement
and of anxiety, of happiness and of troubles, of discovery
and of bewilderment and of breaks with the past and
of links with the future. If parents are aware of the
path their child’s development is supposed to take,
they can be major supports during this period. They
can also spot potential problems that need to be brought
to the attention of correction and modification.
In this crucial phase of multi dimensional changes,
peer relations play a significant role. (Bukowski, Hoza
and Boivin, 1994). As children move into early adolescence,
involvement with one’s peers and attraction of peer
identification increases. As pre-adolescents experience
rapid physical, emotional and social changes, they begin
to question adult standards and the need for parental
guidance. They find it reassuring to turn to advice
to friends who understand and sympathize--friends who
are in the same position themselves (Laursen, 2001).
Yet the word “peer pressure” comes with all the negative
connotations of luring the adolescents into learning
dangerous and destructive behaviour by discarding the
parental values. But, on the other hand, peer pressure
has enormous positivity in supplying emotional and moral
support in the lives of the adolescents. It keeps youth
participating in sports, religious activities and community
welfare programmes even when they are not always the
leaders.
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The peer group is a source of affection, sympathy
and understanding, a place for experimentation, and
a supportive ambience for achieving two primary developmental
tasks of adolescence: identity and autonomy.
DEVELOPMENT DURING ADOLESCENCE
Adolescents grow and develop in more “ways” and more
“quickly” than people in any other age group. This “rapid”
rate of change combined with changes occurring in all
systems at once can produce problems and at best can
be a difficult experience for the adolescent. Adolescents
change in three ways—physically, cognitively and psycho-socially
and no single influence acts either alone or as the
prime mover of change.
Developmental path seems to be simpler if changes
in all these three systems occurred simultaneously.
The asynchrony among these can result in problems and
developmental pathologies. In the context of “psychic
development” of adolescents, the cognitive as well as
the psychosocial growth needs further clarifications
and probing.
Cognitive development:
During adolescence, with the development of body in
size, strength and reproductive abilities, the mind
becomes capable of more abstract thinking, future orientation
and ethical convictions.
The key features of this kind of formal thought is
the ability to:
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Generate abstractions
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Generate hypothesis
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Consider contrary-to-fact situations
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Generate all possibilities from
a specific situation
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Approach a problem in a systematic
fashion
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Use “combinatory logic”(the ability
to combine ideas to derive a conclusion)
These developments in thinking needs nurturing in
order to grow further, since developing a realistic
self-image is dependent on effective cognitive development.
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Psychosocial development
This refers to the teenager’s growing ability to relate
realistically to other people, to learn to become a
mature partner in an intimate relationship and to see
oneself realistically. This type of development may
never actually end, but a good deal of it should be
accomplished before a person can be considered an adult.
There are four tasks involved in becoming psycho-socially
developed. They are:
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The ability to separate effectively
from the parents both emotionally and intellectually
while still retaining the bonds of the family
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The ability to choose a realistically
vocational goal
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Developing a mature sexuality
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Developing a realistic and positive
self-image
For this type of development, adolescence is divided
into three stages
> Early adolescence: from about 10-13 years old
> Middle adolescence: from 14-17 years old
> Late adolescence: from 18-21 or 22 years age
These age changes are not absolute, but they work as
a good general guide to pinpoint the different patterns
of psychosocial changes at different adolescent stages,
like early adolescents desire to become independent
in a totally non-rational manner whereas late adolescents
acknowledge that parents may not be infalliable, but
can be their best friends.
The major psychosocial features of adolescence
tend to be:
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Intimacy-forming close socio-emotional
relationships with others
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Autonomy-establishing a healthy
sense of independence
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Identity- becoming a successful
and competent member of society
In the task of such attainments, parental control
tend to fall away rapidly and for today’s adolescents,
it is true that they search out sources of information
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other than parents that give them an independent status
as opposed to earlier dependent one. Here the mass media
and internet provide attractive alternatives. Adolescents
are found to resonate with media content depending on
the developmental task at hand. In Indian context specifically,
adolescents’ independence is not as much in terms of
monetary aspects as it is in the decisions regarding
personal appearance, habits and manners, vocational,
social, recreational and educational choices of adolescents.
In an overall stance, across cultures and classes,
the select ‘psychic’ features of adolescents tend to
be:
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Time of seeking status as individual
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To be within the emotional embraces
of peer group relations, attaining status and recognition
by the age mates
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Attainment of physical maturity
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Time of intellectual expansion
and of academic experience
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A time of development and of evaluation
of values. It is a time of conflict between youthful
idealism and reality
Sexuality also is a strong component
of psychosocial development during adolescence (Browning
et al.1999). It involves a person’s sense of self as
a man or woman. It is the ability to enter into and
maintain an intimate relationship with the significant
other, and the ability to relate to other people in
general (Kinsman, Romer, Furstenberg and Schwartz, 1998).
It is composed of the following factors:
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Biological: ones genetic make-up
and the way it is expressed (one’s appearance)
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Familial: the role modeling provided
by and the behaviours demonstrated by the closest
adults to the adolescents, usually the parents
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Cultural: the roles assigned to
men and women by the adolescent’s culture and the
ways in which men and women are supposed to interact
- Societal: the mix of cultural norms that make up the
society
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Adolescent sexuality is expressed differently
at each stage of development during adolescence:
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The early adolescent is basically
working on hormones and the models provided by parents
and other adults close to the adolescent. These factors,
combined with a new self awareness that produces intense
embarrassment, makes up sexuality at this phase. Adolescents
will have romantic fantasies about ideal partners,
but they will usually remain fantasies.
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Middle adolescents have become
surer of themselves. Their bodies are settling down,
and they are more comfortable with mixed-sex peer
groups. They still have fantasies of ideal partners,
but they can try out some behaviours (for e.g. in
parties) that cause parental anxiety.
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Late adolescents will have reached
the point at which they can begin to enter into relationships
giving to their partner as much as they receive, the
hallmark of an adult relationship. Conflicts about
sexual preference are being worked out, and thoughts
about more permanent relationships occur.
Risk behaviour during adolescence
Because adolescence, more than any other
stage in the life span, is likely to involve experimentation
and exploration, it is not surprising that we observe
the emergence of risk behaviours (Steinberg, 2002). Two
trends characterize the nature of risk behaviours in adolescence.
First, some risk behaviour is normative. For e.g., a majority
of adolescents will at least experiment with smoking.
Second, risk behaviours increase in adolescence, although
the developmental course that a particular behaviour follows
(when it reaches its height) is unique to the specific
behaviour (Achenbach, 1991). Delinquency, for instance,
rises and falls in adolescence, but alchohol use and sexual
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Across the diverse sets of individual and contextual
factors that are associated with the actualization of
risk behaviours in adolescence—that is teenage pregnancy
and abortion, transmission of STDs due to unsafe sex,
decline in school attention, performance and educational
aspirations and substance abuse and delinquent behaviour-
or with the prevention of these risk behaviours, respectively,
there are six common characteristics that are involved
in the occurrence of one or more of these risk behaviours
(Cicchetti and Dawson, 2002). They are as follows:
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Age: the earlier
the initiation of any of the risk behaviors of adolescence,
the more likely it is that the youth will engage in
the behaviour to a great extent and that he or she
will suffer negative consequences.
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Expectations for education
and school grades: Youth who do not expect
to do well in school, and who do not actually do well,
are at risk for the problem behaviours reviewed.
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General behaviour:
Inappropriate behaviours and inadequate conduct (e.g.
acting out, truancy and conduct disorders) are related
to the appearance of risk behaviours.
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Peer influences:
An individual’s likelihood of engaging in problem
behaviours is not just due to individual factors (such
as early pubertal maturation) but due to contextual
factors as well, for instance, having peers who engage
in risk behaviours.
-
Parental influences:
Particular styles of parenting – that is authoritarian
or permissive styles, as compared with an authoritative
one, place a youth at risk for problem behaviours.
In addition, if adolescents are not positively affectively
tied to their parents, risk behaviours are also likely
to occur.
-
Neighborhood influences:
The community context also plays a role in the development
of risk behaviours. A neighbourhood characterized
by poverty, or by urban, high-density living, is more
involved in risk actualization.
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Hence ‘psychic’ growth and development during adolescence
flashes itself as multi-faceted process, involving every
aspect of a young person’s being. It is rapid and can
be confusing and distressing.
Dealing with the Adolescents: Some Tips for
Parents and Professionals
Each generation of young people and their families
face new, and perhaps more challenging, circumstances.
Parents are understandably troubled by the confrontational
nature of some adolescent behaviour. They also worry
about other actions that may threaten the safety of
their child. Early intervention with young people who
are troubled is crucial to reducing problems, or the
resulting acting out behaviour might cause (Collins
and Russell, 1991). The parents need to be alert and
notice the following warning signs that their child
shows when in trouble, indicating that they need help:
-
Large amounts of time spent alone
and isolation from family and friends
-
Sudden changes in school performance
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Drastic mood swings or changes
in behaviour
-
Changes in the child’s peer group
or separation from long-time friends
-
Lack of interest in hobbies or
social and recreational activities
While there are no easy answers in parenting, the following
strategies may help the parents to support their child
during adolescence while reducing the risk of serious
harm either to the child or another person (Baumrind,
1991):
-
Educate yourself about adolescent
development. Learn about the behaviours to expect,
the effects of physical changes and ways to help your
child deal with change and respect their need for
privacy.
-
Remember your own adolescence--your
changing feelings, anger at authority, and fears and
hopes and look at your adolescents behaviour in that
context. Understand the adolescent’s developmental
urge to challenge the authority.
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Listen more than talk. Young people
have spent at least a decade as listeners in most
situations. During adolescence, they want and need
the chance to share their feelings and ideas and to
begin recasting family beliefs and traditions in the
light of their changing identity.
-
Teach your adolescent about the
joys and troubles of life and ways to revel in the
good times and cope with the bad. Teach practically
how to deal with stress.
-
Use positive reinforcement for
positive behaviour whenever possible; it is far more
effective than criticism or punishment for negative
behaviour. Words that belittle can hurt your adolescent’s
self esteem. The most useful tools in raising young
people are love, compassion, sensitivity, affection,
praise, understanding and communication. Be flexible
while making and reinforcing rules.
-
Teach your adolescent that rights
and responsibilities go hand in hand, and give your
child increasing responsibility for his/her personal
well being and that of the family.
-
Help your adolescent move toward
independence. Becoming attuned to your adolescent’s
attempt to operate independently will help you to
support those efforts and provide proper guidance
whenever they take any decision. Encourage your adolescent
to set reasonable but challenging goals.
-
Show interest in their school
activities and encourage getting involved ingroup
activities. Talk about choosing friends in school
and having good relationships. Explore ways to help
deal with peer pressure in school.
-
Offer your child chances to become
involved in the community. Their involvement in developing
solutions to community problems can shift their focus
from themselves and help them to develop skills and
feel involved and empowered.
-
Spend quality and quantity time
with your adolescent and do things that are enjoyable.
-
Accept that you have feelings
too. You may feel fustrated, angry, discouraged or
sad during difficult times with your adolescent. Model
the ability to apologize when you feel that you let
your emotions get the best of you. Your example will
help your adolescent understand human frailty and
ways of mending relationships strained by stress or
disagreement.
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In spite of the above
efforts, the parents might fail to deal effectively with
their adolescent and might have to seek professional help.
The important points that a professional needs to keep
in mind while dealing with an adolescent are:
-
Find ways to help adolescents cope
with anger and resolve conflicts without violence.
-
Observe signs that he/she is feeling
nervous, lonely or ‘that’ things are just not going
right.
At the end, we must not forget that adolescents
strive for independence and identity and to help them
fulfill their dreams and desires we need to:
- We must locate the inner resources in their individuality.
- We must respect their specificities and differences
from us.
- We must love them unconditionally.
- We must not personalise their odd behaviour to us.
- We must offer them opportunities of growth and needed
corrections.
- We must try to portray us as level-best role models
to them.
Given adequate support, guidance, firm
limits and unconditional love, adolescents can make it
through this turbulent time with minimal damage and with
a vision of a positive future as a contributing adult.
To understand their ‘psyche’,
we need to look back into our ‘youth days’ and keep
a smile on our face thinking, ‘they would also be the
level-best role models for the next generation’.
References:
- Achenbach,T. M. (1991). Integrative
guide for the 1991 CBCL/4-18,YSR, and TRF Profiles. Burlington:
University of Vermont.
- Baumrind, D. (1991). Effective parenting
during the early adolescent transition. In P.A.Cowan and
M.Hetherington(Eds.), Family transitions (pp.111-163).
Hillsdale, NJ;Erlbaum.
- Browning, J. R., Kessler, D., Hatfield,
E., & Choo, P. (1999). Power, gender, and sexual behaviour.
Journal of Sex Research, 36, 342-347. |
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- Bukowski,W.M., Hoza, B., & Boivin,
M. (1994). Measuring friendship quality during pre and
early adolescence: The development and psychometric
properties of the friendship qualities scale. Journal
of Social and Personal Relationship, 11, 471- 484.
- Caldwell, J. C; Caldwell, P.B.K
and Pieris, I. (1998). The Construction of Adolescence
In a changing World: Implications for Sexuality, Reproduction
and Marriage. ‘Studies in Family Planning’, 29, 137-153
- Cicchetti, D., & Dawson, G.
(2002). Editorial:Multiple levels of analysis. Development
and Psychopathology, 14, 417- 420.
- Collins, W. A., & Russell, G.
(1991). Mother-child and father child relationships
in moddle childhood and adolescence: A developmental
analysis. Developmental Review, 11, 99-136.
- Dasen, P.R. (2000). Rapid Social
Change and the Turmoil of Adolescence: A Cross-Cultural
Perspective. ‘International Journal of Group Tensions’,
29, 17-49.
- Kinsman, S. B., Romer, D., Furstenberg,
F. F., & Schwartz, D. F. (1998). Early sexual initiation:
The role of peer norms. Pediatrics, 102, 1185-1192.
- Laursen, B. (2001). A developmental
meta-analysis of peer conflict resolution. Developmental
Review, 21, 423-449.
- Schlegel, A. & Barry, H (1991).
Adolescence: An Anthropological Inquiry. New York: Free
Press.
- Steinberg, L. (2002). Clinical adolescent
psychology: What it is, and what it needs to be. Journal
of Consulting and Clinical psychology, 70, 124-128.

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National Workshop on
Mental Illness and Homelessness
25th-27th August, 2004
A brief report
Homeless people are considered the most vulnerable
members of any society. The lack of secure housing,
regular sources of income and therefore low levels
of nutrition, no access to health care and education
are highly prevalent amongst the homeless. Limited
access to government facilities and entitlements as
well as constant threats of eviction further aggravate
already precarious living conditions. Mental illness,
alcohol abuse and substance abuse are found to be
3 to 5 times as high among the homeless as compared
to the general population. Medical care for homeless
people with a mental illness is not available at the
government sponsored primary health care level. The
Mental Health Act (1987) has made provisions for the
care and treatment, and rehabilitation, of the homeless
mentally ill men and women. Despite these provisions,
concerned authorities have consistently turned a blind
eye towards these people. Care for the homeless mentally
ill has become the sole responsibility of the NGOs.
Against this context, The Banyan, Chennai, had organized
a 3 day National level workshop on “Mental illness
and homelessness”, supported by Sir Ratan Tata Trust.
The objectives of the workshop were to bring together
NGOs and government agencies to discuss the situation
of the mentally ill homeless in various parts of the
country, to share experiences, and to identify areas
for action. 4 thematic issues were discussed by forming
discussion groups:
-
1. Putting Mental Health on
the Agenda of Government and NGOs
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Promoting early identification
of mental illness and community based access to
care
-
Enhancing quality in care for
the homeless mentally ill
-
Ensuring legal and economic
support for the mentally ill
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The full report of the working group recommendations
can be downloaded from the Banyan website: http://www.thebanyan.org
Workshop Manifesto:
The workshop participants jointly identified the following
24 key areas for action and resolved that these will
be the focus of their work:
1. |
Right to mental health as
a basic right |
2. |
Facilitate the access to
mental health care to prevent homelessness due
to mental illness, and remove all administrative
bottlenecks |
3. |
Mainstream the services for
the homeless mentally ill persons in all the relevant
programs in the local
context |
4. |
Promote partnership of Government,
NGOs, professionals to address the needs and rights
of the homeless mentally ill |
5. |
Promote transparency and
de-custodialisation in mental health institutions
and all other care institutions |
6. |
Reinvestigate the current
status of the police as the first point of contact
and explore alternatives |
7. |
Social mobilization through
inter-sectoral co- ordination including the media
to de-stigmatise mental illness and promote awareness
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8. |
Models (and services for
making them accessible) should be ethically sound
and legally permissible |
9. |
Formulate a policy for involuntary
admission and discharge with necessary checks
and balances |
10. |
Establish wholistic models
of mental health care |
11. |
Make available and publicise
a databank of professionals and services |
12. |
Create a multi-representative
nodal agency at the state level to document and
address issues pertaining to the mentally ill
homeless |
13. |
Recommend amending and updating
the Mental Health Act’s provisions of admissions,
discharge, licensing, rehabilitation and the needs
of the homeless mentally ill |
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14. |
Promote common minimum standards
and accountability in care and intervention of
the mentally ill |
15. |
Delineate the common minimum
components of rehabilitation to be followed |
16. |
Augment, formulate and monitor
funding for the homeless mentally ill |
17. |
Include the issues of the
mentally ill homeless in the National Mental Health
Program and the DMHP |
18. |
Institute a central helpline
number to reach out to the needs of the mentally
ill homeless |
19. |
Provide legal services for
the homeless mentally ill |
20. |
Facilitate access to social
security measures provided for disabled people
including all schemes under the departments of
Social Justice and
Empowerment, Human Resource Development and Health
|
21. |
Recognize that the condition
of homelessness contributes to mental illness
|
22. |
Conduct training to build
on existing human resources in the field of mental
health |
23. |
Provide shelters for the
homeless |
24. |
Involve users and carers
in policy and programme formulations regarding
the homeless mentally ill |

All back issues of aaina can
be freely downloaded from our website:
www.camhindia.org
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“Advocacy
Note on Legal Capacity” |
advocacy
news |
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WNUSP,
the World Network of Users and Survivors of Psychiatry,
has recently adopted the following note on “legal
capacity”. This Note, prepared for the WNUSP, by
Dr. Amita Dhanda, spells out the position of this
world coalition of psychiatric users and survivors,
on the right to full legal capacity for persons
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Capacity in law constructed by
society:
The first thing to appreciate in relation
to legal capacity is that it is socially constructed and
is thus reflective of choices societies have made at different
points of time. Historically capacity has been an attribute
or a presumption that the law has conferred or denied
from populations. A useful illustration of this process
is provided by the legal management of the capacity of
women. The negotiable content of the concept is again
demonstrated by the Convention on the Rights of the Child
acknowledging the evolving capacities of the child and
explicitly incorporating the right to participation (Article
12). Therefore when we are asking for the legal disqualifications
applicable against us (persons with psychosocial disability)
to be lifted we are in a manner of speaking treading paths
traversed by other excluded groups. We are saying that
the allegation of incapacity that society makes in relation
to some or all of us is false and we have a right to live
like any other on our own terms.
Cognitive Capabilities Privileged
in Legal Construction of Capacity
Whilst accepting the constructed nature
of legal capacity (it is necessary to understand) that
it is primarily constructed from a normative standard
of cognitive capabilities. This privileging of cognitive
capabilities is questionable as not all of us use cognitive
capabilities to make our decisions. Should those of us
who use an emotive or intuitive basis for reaching decisions
be considered incapable? The law by according primacy
to a certain way of being in the world seems to be manufacturing
incapacity labels. If the presumption comes into being
because of the way in which the law treats different kinds
of intelligences then evidently a Disability Rights Convention
needs to change this presumption and recognize these differences.
This process would stand initiated if the Convention should
unequivocally state that all persons with disabilities
have legal capacity.
Legal Capacity not to do with
Wisdom of Choices
One of the arguments put forth for substituted
decision-making is that a number of persons do not have
the wisdom to exercise legal capacity. But legal capacity
is about the freedom to make choices and not the wisdom
of those choices. There is an inherent freedom for all
human beings to make the same or new mistakes and to learn
or not learn from them. This liberty to learn from mistakes
is at other than legal sites referred to as experimentation
or even learning from trial and error. Humanity has progressed
by allowing people the freedom to make mistakes. This
may be because it has often been found that the blunder
of today becomes the discovery of tomorrow. Whenever any
people are not accorded the freedom to make their own
errors they are in effect not being allowed to develop
in accordance with their own genius and it is this discrimination
and deprivation that needs to be addressed in relation
to persons with psychosocial disability. Dignity of risk
and the right not to be protected are inherent rights
of all adults. A Convention which is being negotiated
to return to persons with disability their full personhood
has necessarily to interrogate all stereotypes because
if it were to get entrapped by stereotypes it would not
just reinforce a mistaken impression it would legitimize
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Need to Distinguish between a Norm and its
Implementation
It is next contended by the proponents of guardianship
that supported decision-making cannot substitute for
guardianship and even if it could such support is not
available. These arguments it is submitted conflate
the concerns of implementation into the adoption of
norms. Should these constraints of implementation provide
the basis for adoption of norms under the Convention
especially when the norms adopted under the Convention
will be the basis of all future discourse on rights
of person with disabilities? A pragmatic approach for
the implementation of norms is acceptable but a similar
perspective towards the adoption of norms is questionable
because this is letting the limitations of today confine
the developments of tomorrow.
Substituted Decision Making will apply to
all persons with psychosocial disability
A further argument by proponents of some form of substituted
decision-making is that as a rule all persons with disability
have legal capacity but there are a very small percentage
of persons with severe disability for whom supported
decision-making will not be sufficient and for whom
guardianship will need to be provided. Proponents argue
that these guardianship arrangements should be put in
place subsequent to determination by a judicial body
after due observance of fair procedure safeguards. They
contend that this substituted decision-making will be
the exception not the rule and would apply to a small
percentage of cases.
The first consequence of accepting this argument will
be that the rule of substituted decision-making will
need to be incorporated in the Convention. Now the rule
according to its proponents has been incorporated only
for a very small percentage of persons with psychosocial
disability. It therefore becomes necessary to ask by
what procedure this small percentage of persons will
be identified. Evidently this will be done from case
to case. This process of identification will render
the capacity of all persons with psychosocial disability
open to question.
This would give rise to a situation where for questionable
advantages to a small group of persons all persons with
psychosocial disability shall be disadvantaged. The
contention of questionable advantage is being made because
studies evaluating the functioning of guardianship have
found abuse isn’t in fact prevented with guardianship,
it is facilitated. Further these arrangements once made
cause the guardian to take all decisions on behalf of
and without consultation with the ward. This ouster
makes for the civil death of the persons subjected to
guardianship.
Supported Decision Making the Sole Model
In the circumstances it may be worthwhile to ask if
the paradigm of supported decision-making would be a
preferable option for all persons with disability as
it would keep us at the centre of all decisions affecting
us. It would interrogate the cognitive privileging existing
in present laws and yet allow persons with disabilities
along with others needing help to seek assistance in
those tasks which require higher reliance on cognitive
capabilities.

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| Resources in Mental
Health |
Bijli: Treatment
of mental disorders-
A new publication from Bapu Trust
No. of pages: 32
Price: Rs. 20/-
Written by: Bhargavi Davar and Deepra
Dandekar |
Contact: wamhc@vsnl.net |
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| in
the spotlight |
Carers’
Advocacy in Mental Health- AMEND / ACMI
-
Nirmala Srinivasan and Laila Ollapally |
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There
has been a continuing discussion among the “consumers”
of mental health services (including both carers
as well as the end users of psychiatric services),
about human rights issues. The carers groups are
forming politically informed groups all over India.
AMEND has been one of the earliest initiatives of
carers’ mobilization. AMEND here clarifies the concept
of “advocacy” in the mental health area. How the
carers’ political platform is different from the
medical professionals’ on the one hand, and from
the end users, on the other hand, is evident from
this article. Particularly worthy of critical discussion
is the suggestion that availability of more psychiatrists,
and more psychiatric drugs, is a “human rights”
issue in mental health policy making. |
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