Invest in family.

The family is an integral part of one's life. It is very essential that every individual employed or unemployed invests time therein. The family is a source of support and growth for an individual, and the lack of family support or loneliness may be a causative factor in the genesis of psychiatric disorders, especially depression. In India, family plays a paramount role when it comes to mental health of the individual. Tips on how one should invest time in one's family along with the role of a family in one's personal and social structure are discussed.

Introduction

This is the first time that I (NS*) am elected (taking over) as the President of a prestigious Association like ‘the Bombay Psychiatric Society and therefore I would like to say a few words before I deliver the Presidential Address. The two questions asked to me in the last few days are:

Why did I decide to take over as a President and

How do I feel about it?

There are a number of senior, wise, respected and renowned individuals who have been Presidents of the BPS in the past. Similarly, there are many other senior, wise, respected and renowned individuals who have refrained from this position.

Then why did I decide to take over as President of BPS and not refrain? I so decided due to the new concept of positive mental health promoted by World Health Organization, which says that mere absence of physical or mental disorder does not mean that you are healthy (World Health Organization, 2002[8]). Not only that, but there are scales like Global Assessment of Functioning (GAF), which rate you on your level of functioning (American Psychiatric Association, 2000[1]). For example-if you are taking care of yourself, your family members and going to your job regularly your level of functioning is around 70. If you wish to increase it to around 80 or 90, you have to excel in some extracurricular activities or be an active member, office bearer or president of some society.

I tried some extracurricular activities like watching TV and collecting stamps. Unfortunately watching TV is hardly considered an extracurricular activity and stamp collection has become very difficult after the availability of courier services and E-mail facility. Hence, in order to increase my level of functioning on the GAF scale, I had no other option but to become a President of some prestigious organisation like the BPS. So, then, here I am.*

Now, to answer the second question – how do I feel about it? (Being a president). I feel very happy and honoured. At this moment, I can empathize with and understand the feelings of all those people who get prestigious awards like – Oscar, Grammy, Film-fare, Mr. India or Ms. World, etc.

As we know, Chanakya trained king Chandragupta, Arjun was educated by Guru Dronacharya and was lead to victory by Lord Krishna. So was I trained by a number of individuals, many of whom are present here today. On this occasion, I would like to acknowledge their contribution to my career and express my heartfelt gratitude towards them. I am very grateful to my parents for providing me a strong basic foundation of life on which I could build my career. I am highly obliged to all my relatives - Prof. L. P. Shah and Mrs. Hema Shah for their guidance and encouragement from time to time. I am also very grateful to my wife and children for tolerating me, for putting up with my whims and fancies and for being with me in my good times as well difficult ones. I am really indebted to all my teachers, my colleagues and my friends for being patient with me, and for helping me to keep my head on my shoulders and my feet firmly on the ground. I would also like to thank all my students for bringing out the best of my teaching abilities and for organising frequent parties and picnics. I think I would be failing in my duties if I did not express my heartfelt thanks to all the members of the BPS for giving me this honour and an opportunity to serve as a President of the BPS. I hope that in this academic year, as a President, I would be able to contribute substantially to meet the objectives of our Society.

I think the first and the most difficult task one is expected to perform as a President is to deliver a Presidential Address. Most of the time, when invited to speak, one is also given the topic of the lecture. Not only this, but some good organisers, concerned and worried as they rightly are about our presentational abilities, also tell one what and how to speak on that topic. So one does not have to really worry about choosing a topic. For the BPS Presidential Address, however, one is expected to choose a topic by oneself. Also, one may not feel very comfortable asking for help. But luckily I could overcome that discomfort and took help from some of my colleagues and well-wishers. This is what they told me, and I quote:

Nilesh, you don’t have to be very anxious and feel so responsible for this Address. When you speak — not many people are likely to take you very seriously (Though this statement was a little annoying, it was reassuring as well).

Try to say something very simple, which is known to everyone. Statements like what many political leaders tell us, ‘We should not panic and maintain peace and harmony’.

Avoid a heavy academic topic and technical jargon. Avoid talking on second messenger system or the role of N-methyl D-aspartate receptors in schizophrenia. For such topics you may have to work very hard and though you may be able to impress the audience, they may not be able to take home any message.

Give some slogan, like ‘Aaram Haram Hai’, ‘Garibi Hatao’, etc. Someone from the newspapers may publish it.

So, taking their sage advice, I would like to start my address with a message in the form of a slogan, ‘Invest in family’, which is also the topic of my presentation.

Invest in Family

Recently, I heard the conversation of two psychiatrists during the lunch-time of a meeting.

1st psychiatrist: “Congratulations!”

2nd psychiatrist: “Thanks! But what for?”

1st: “Your daughter won the personality contest in the school.”

2nd: “Is it? I didn’t know. I had gone out and I just returned day before yesterday and then I was very busy with this meeting and conference and patients …,” and so on and so forth.

Though it may sound a bit exaggerated, in a lighter vein, one of my psychiatrist friends once told me about a syndrome called “The Sunday Uncle Syndrome.” It seems that in many families children get to meet their father only on Sundays. On all other days as children are very busy with their school, tuitions and other activities and father is busy with his own business and other commitments, they get to meet each other only on Sundays. So these children know their father as “Sunday Uncle,” the person who is seen around only on Sundays.

Few years back a colleague of mine who practices psychiatry in Canada told me that there is an acute scarcity of psychiatrists there. It is very difficult to get their appointments as most of them stop practice by 6.00 p.m. Previously, they used to work very hard and see patients till late evening. As a result they were able to spend very little time with family members and so there was a very high divorce rate noted amongst medical professionals and psychiatrists. To prevent this, now many psychiatrists prefer to spend their evenings with the family. Similarly a friend of mine, who is an interventional cardiologist, has stopped his evening consultation so that he can spend more time with family.

I feel that in general, in last few years, our involvement in our family has decreased. The number of hours we spend and the so-called “quality time” we give family members has reduced considerably. We have migrated from small villages and village culture to the culture of mega-cities and metropolis. We have moved away from interdependence to independence, that is, from “We” to “I.” It may not be a good sign for us as well as our families. Therefore, it is very important for all of us to realise this and increase involvement in the family. We should invest our time, energy and resources in the family. I think this investment will give us a number of benefits and yield us very high returns in both the short and the long term.

Benefits of Investing in Family

Identity

Investment in family gives us an identity, so very important for all of us. Along with helping our children, spending time with the family also helps us grow personally. We often relive our childhood while helping them with school-work, projects and while teaching them, just like our parents did for us. We also identify characteristic behaviours and patterns they demonstrate that are similar to what we showed when young and in school. Psychologically we all need some kind of identity or recognition. I can share with you my experience as a resident doctor in Cooper and KEM Hospital. As opposed to KEM hospital, Cooper hospital is a smaller peripheral hospital with less number of departments and fewer doctors. The atmosphere in Cooper hospital is more like what you have in one family. People know each other by their names. They meet everyday on the breakfast table, at lunch and dinner. They also spend time together in the evening in the TV-room or while playing table-tennis. Most of us used to like that atmosphere as it was less stressful, more personal and congenial. Each of us had our own identity and recognition, which gave a great boost to our self-esteem. As opposed to this when we shifted to KEM hospital we experienced a kind of “loss of identity,” which occurs frequently in a bigger organisation. Everyone was busy with their own work, running around with the least concern for others.

Belongingness

Investment in family gives us belongingness. Along with identity, we also want to belong to someone or some group. We want to feel we are part of a group; therefore there are a number of groups. We frequently hear proud statements like, ‘I am a Lion,’ or, ‘I am a Rotarian,’ etc. All these are like extended families.

Security

This identity and belongingness give us security. When we are not well, when we are worried, when we are scared, where do we go? We run home. After the World Trade Center (9/11) incidence, majority of the people who survived and who did not require hospitalisation went back to their families. They travelled long distances by whatever transport available but tried to go back to their families (DiGrande et al., 2011[3]).

Maturity

Investment in family is responsible for our maturity and growth. We not only think about ourselves and our needs, but also learn to think about others and their needs. Occasionally we may also give priority to their needs over our own.

Buffer

Family acts as a buffer, as a cushion in our difficult times. The risk of suicide is much less in an individual who is married or who is with his family than for an individual staying all alone by himself without much attachment with family members (Ernst and Cacioppo, 1999[5]) (Though, in a lighter vein, one may say that marriage itself is a “suicide,” its benefits far outweighing the price one has to pay for it!). Family not only reduces the chance of developing physical and mental disorders but also provides adequate support if one develops them (Avasthi, 2010[2]). Number of people end up spending the majority of their precious time in permit-rooms, night clubs, and kitty-parties due to lack of family ties (Sethi, 1989[7]).

Boon for children and elderly

Family is a boon for children and the elderly. Home with at least one parent, or grandparents, is much better and safer for children than a crèche (Dolbin-Macnab and Keiley, 2009[4]). Luckily we are born with the natural instinct to care for young ones, and we should follow that natural instinct. Unfortunately, we are not born with the instinct to care for the elderly, and that needs to be cultivated to avoid problems like the “empty nest syndrome.”

How to Invest

Finally, I would like to say what I also believe in: “Vasudhaiva Kutumbhkam”: the whole universe is our family.

Wake-up early in the morning before children go to school.

Try to spend evenings, Sundays and holidays with the family.

Take interest in the activities of family members: children, spouse, parents etc.

Have regular gathering of all family members. We have number of occasions and festivals to do so.

Even when one has to separate due to physical constraints and it may not be possible for all members to stay under one roof, maintain emotional ties.

Try to create a congenial and cordial family-like atmosphere even in the neighbourhood, at work place and in the other groups and associations. Family does not mean chaos and unrestricted liberty. One can, and should, have some rules and regulations in the family.

Current Understanding

Family as we understand it today has been defined in the Oxford Dictionary as:

The word family is derived from the Latin word “familia,” which denotes a household establishment. Families are a source of interdependence and strength for individual members within their domain. We are in an era of globalisation and modernisation where unfortunately families are separated more than being united. Large joint families in India are a thing of the past and the emergence of nuclear families is in vogue. Mental health professionals need to promote family unity and well-being at every stage of human development. There is a need for family education with regard to the maintenance of unity and integrity of the social milieu called “the family.” Families in the modern era need to encourage communication between members and there is a need for open minded expression of thoughts and sharing rather than holding onto personal grudges and prejudices. Schools need to cultivate family values in children from an early age and a genuine effort is needed across cultures and nation in this direction.

The body of persons who live in one house or under one head, including parents, children, servants;

The group consisting of parents and their children, whether living together or not; in wider sense, all those who are nearly connected by blood or affinity;

A person's children reared collectively;

Those descended, or claiming descent from a common ancestor (Oxford English Dictionary, 2014[6]).

Concluding Remarks

The family is important for one's mental health and personal growth. One must invest time in the family in order to benefit from their support. In the modern era, families are drifting apart and we must make an effort to preserve and cherish the family as a unit [Figure 1: Flowchart of paper].

Figure 1

Flowchart of paper

Take Home Message

Family is a tool of strength and support and every individual must invest time in his family.

Questions That This Paper Raises

What is the role of family in an individual's life?

What is the advantage of time invested in one's family?

What is the need to invest time and energy in one's family?

Is family as a social institution an important component of one's life?

About the Author

Nilesh Shah MD is Professor and Head of the Department of Psychiatry at Lokmanya Tilak Municipal Medical College, Mumbai, India. He is an avid researcher, astute clinician and a sought after speaker in various conferences all over the country. He has over 100 publications in National and International journals and is known for his wit and humour in his presentations. His areas of research interest include electroconvulsive therapy, emerging areas in psychopharmacology and schizophrenia.

Avinash De Sousa MD is a consultant psychiatrist and psychotherapist with a private practice in Mumbai, India. He has over 280 publications in National and International journals. His main areas of interest are alcohol dependence, child and adolescent psychiatry, mental retardation, autism and developmental disabilities and electroconvulsive therapy. He teaches psychiatry, child psychology and psychotherapy at over 18 institutions as a visiting faculty. He is one of the few psychiatrists who, in addition to a psychiatry degree, has an MBA in Human Resource Development, a Masters in Psychotherapy and Counseling, an MPhil in Psychology and a doctorate in Clinical Psychology.