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“Don’t ever question the value of volunteers. Noah’s Ark was built by volunteers, the Titanic was built by professionals.”-Dave GlynnMr. Ram was 17 years old and far away from home in boarding school when he lost his father to a chronic illness. He was aware that his father was unwell but was not informed by his family about the rapidly declining condition. Ram was not informed about his father’s death for almost two months because the family knew he had important examinations to take in the upcoming months. When he was eventually told about his father’s passing, he was in shock, was angry at the family for keeping him in the dark, and felt they made decisions on his behalf, leaving him feeling lonely and abandoned in his grief. His mother and elders in the family told him, “Don’t cry like this; you are the man in this house, and you have to be strong.” Six years later, he is seen changing multiple jobs and facing rejection, which leaves him struggling to cope and confused about how he should be feeling as a man.Cancer burden continues to grow day by day worldwide, with an increased number of newly diagnosed cases and deaths each year. “Don’t ever question the value of volunteers. Noah’s Ark was built by volunteers, the Titanic was built by professionals.”-Dave GlynnMr. Ram was 17 years old and far away from home in boarding school when he lost his father to a chronic illness. He was aware that his father was unwell but was not informed by his family about the rapidly declining condition. Ram was not informed about his father’s death for almost two months because the family knew he had important examinations to take in the upcoming months. When he was eventually told about his father’s passing, he was in shock, was angry at the family for keeping him in the dark, and felt they made decisions on his behalf, leaving him feeling lonely and abandoned in his grief. His mother and elders in the family told him, “Don’t cry like this; you are the man in this house, and you have to be strong.” Six years later, he is seen changing multiple jobs and facing rejection, which leaves him struggling to cope and confused about how he should be feeling as a man. Mr. Ram was 17 years old and far away from home in boarding school when he lost his father to a chronic illness. He was aware that his father was unwell but was not informed by his family about the rapidly declining condition. Ram was not informed about his father’s death for almost two months because the family knew he had important examinations to take in the upcoming months. When he was eventually told about his father’s passing, he was in shock, was angry at the family for keeping him in the dark, and felt they made decisions on his behalf, leaving him feeling lonely and abandoned in his grief. His mother and elders in the family told him, “Don’t cry like this; you are the man in this house, and you have to be strong.” Six years later, he is seen changing multiple jobs and facing rejection, which leaves him struggling to cope and confused about how he should be feeling as a man.Cancer burden continues to grow day by day worldwide, with an increased number of newly diagnosed cases and deaths each year.

In a world overflowing with challenges, societal injustice, outbreak of sudden disease, mental and physical health issues, it is evident that we all carry our own baggage. While some may succumb to these difficult times, others discover their strength and view these moments as inspiration to take action. Volunteering is one such way to discover ourselves and focus our attention on more productive avenues.This story about Ram is about his difficult life experiences and how these experiences have shaped him over the years. Today, Ram is 36 years old and married with two children. When he came in for a session, he narrated how he has coped by reminding himself that life goes on and that it was his responsibility to hold himself accountable for all that took place, which involved his family and career. He feels he should possess strong masculine traits to lead a good life, but he also mentioned that it is just what people around him and society expect. The myriad of unresolved questions and emotions of grief from back then has culminated in him asking, “Is it forever that I have to prove to be masculine enough and mask my feelings and losses as a person just to prove to others I am strong?” A significant proportion of such individuals at any stage of the disease trajectory suffer social, emotional, and psychological distress due to stigma related to cancer, diagnosis and treatment side-effects, survivorship issues etc. Therefore, psychological distress needs to be assessed on a regular basis to understand the reason and severity of the problem in order to help the individuals. In a world overflowing with challenges, societal injustice, outbreak of sudden disease, mental and physical health issues, it is evident that we all carry our own baggage. While some may succumb to these difficult times, others discover their strength and view these moments as inspiration to take action. Volunteering is one such way to discover ourselves and focus our attention on more productive avenues.This story about Ram is about his difficult life experiences and how these experiences have shaped him over the years. Today, Ram is 36 years old and married with two children. When he came in for a session, he narrated how he has coped by reminding himself that life goes on and that it was his responsibility to hold himself accountable for all that took place, which involved his family and career. He feels he should possess strong masculine traits to lead a good life, but he also mentioned that it is just what people around him and society expect. The myriad of unresolved questions and emotions of grief from back then has culminated in him asking, “Is it forever that I have to prove to be masculine enough and mask my feelings and losses as a person just to prove to others I am strong?” This story about Ram is about his difficult life experiences and how these experiences have shaped him over the years. Today, Ram is 36 years old and married with two children. When he came in for a session, he narrated how he has coped by reminding himself that life goes on and that it was his responsibility to hold himself accountable for all that took place, which involved his family and career. He feels he should possess strong masculine traits to lead a good life, but he also mentioned that it is just what people around him and society expect. The myriad of unresolved questions and emotions of grief from back then has culminated in him asking, “Is it forever that I have to prove to be masculine enough and mask my feelings and losses as a person just to prove to others I am strong?” A significant proportion of such individuals at any stage of the disease trajectory suffer social, emotional, and psychological distress due to stigma related to cancer, diagnosis and treatment side-effects, survivorship issues etc. Therefore, psychological distress needs to be assessed on a regular basis to understand the reason and severity of the problem in order to help the individuals.

I have been volunteering in many different ways from childhood and it has added valuable dimension to my personality. My experiences with volunteering know no boundaries – it transcends borders, cultures, and languages. It has also aided me in building trust and confidence between societies.In the grandeur of life, the cry “Gone but not forgotten” is a voice that speaks to every heart. But for men, facing the complexities of bereavement is a challenge of its own. In a culture that thrives on stoicism, navigating grief is a path less traveled. It is a walk of unspoken struggles and a journey fraught with societal expectations. This blog explores the complexities of men’s mental health in relation to bereavement and explores why it is so important to break the silence and create a healing culture.Distress is an unpleasant experience of a physical, mental, social, or spiritual nature. It can make it difficult for someone to cope with having cancer, its symptoms, treatment, both curative as well as side effects. This  affects their survivorship and hence it impacts the entire family.  Distress affect one across the range of experience. It varies from mild to severe, which includes sadness, fear, and helplessness with intensity. I have been volunteering in many different ways from childhood and it has added valuable dimension to my personality. My experiences with volunteering know no boundaries – it transcends borders, cultures, and languages. It has also aided me in building trust and confidence between societies.In the grandeur of life, the cry “Gone but not forgotten” is a voice that speaks to every heart. But for men, facing the complexities of bereavement is a challenge of its own. In a culture that thrives on stoicism, navigating grief is a path less traveled. It is a walk of unspoken struggles and a journey fraught with societal expectations. This blog explores the complexities of men’s mental health in relation to bereavement and explores why it is so important to break the silence and create a healing culture. In the grandeur of life, the cry “Gone but not forgotten” is a voice that speaks to every heart. But for men, facing the complexities of bereavement is a challenge of its own. In a culture that thrives on stoicism, navigating grief is a path less traveled. It is a walk of unspoken struggles and a journey fraught with societal expectations. This blog explores the complexities of men’s mental health in relation to bereavement and explores why it is so important to break the silence and create a healing culture.Distress is an unpleasant experience of a physical, mental, social, or spiritual nature. It can make it difficult for someone to cope with having cancer, its symptoms, treatment, both curative as well as side effects. This  affects their survivorship and hence it impacts the entire family.  Distress affect one across the range of experience. It varies from mild to severe, which includes sadness, fear, and helplessness with intensity.

While I initially believed, I was giving back to the society, I soon realized that i was the one benefiting from volunteering. It liberated my soul, I became more willing to take responsibility, did engaging work, gained new skills, made new friends, felt more confident than ever, improved my mental health, reduced stress and more importantly, it gave meaning to my life. Simultaneously, Sadhguru’s words echoed into my ears, “To volunteer is to become willing. To be willing beyond personal choices is the way to liberation”. It cemented my understanding of benefits of volunteering when I recently stumbled on the fact that approximately 77% of the volunteers have acknowledged to have  improved mental health from the time they began doing so.  Discrimination based on mental health has a detrimental effect on access to mental health care, help-seeking behavior, and the first treatment for people with mental struggles or illnesses, resulting in higher rates of disease and deathEveryone with cancer has some level of distress at some point of time. Not only the patient but their caregivers too experience some level of distress during and after the course of illness, Moreover, distress extends along the continuum, ranging from common normal feelings of vulnerability, sadness, and fear to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual issues. While I initially believed, I was giving back to the society, I soon realized that i was the one benefiting from volunteering. It liberated my soul, I became more willing to take responsibility, did engaging work, gained new skills, made new friends, felt more confident than ever, improved my mental health, reduced stress and more importantly, it gave meaning to my life. Simultaneously, Sadhguru’s words echoed into my ears, “To volunteer is to become willing. To be willing beyond personal choices is the way to liberation”. It cemented my understanding of benefits of volunteering when I recently stumbled on the fact that approximately 77% of the volunteers have acknowledged to have  improved mental health from the time they began doing so.  Discrimination based on mental health has a detrimental effect on access to mental health care, help-seeking behavior, and the first treatment for people with mental struggles or illnesses, resulting in higher rates of disease and death Discrimination based on mental health has a detrimental effect on access to mental health care, help-seeking behavior, and the first treatment for people with mental struggles or illnesses, resulting in higher rates of disease and deathEveryone with cancer has some level of distress at some point of time. Not only the patient but their caregivers too experience some level of distress during and after the course of illness, Moreover, distress extends along the continuum, ranging from common normal feelings of vulnerability, sadness, and fear to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual issues.

As per United Nations Volunteers program, around 60% of the volunteers in India, are below the age of 30. Approximately 40% of Indians engage in some form of volunteering. As the world confronts increasing challenges, younger volunteers are often the first to step forward, positioning youth volunteers at the forefront during crises and emergencies. This allows them to bring their unique skill sets to the organisation.  NGO’s have always benefitted from the experiences brought by the senior volunteers, no matter how big or small. In today’s world, time is the most precious thing to gift or donate. Corporate and the working individuals set an example by donating their time and resources, no matter how busy they may be. To quote the quote by Martin Luther King Jr. “Volunteers do not necessarily have time, they just have the heart.”   Grief is a complex emotion, and it can be difficult for many people to express it in a way that is appropriate for them. For many men, grief can be difficult to express because they have been taught to suppress their emotions. This can lead to delayed or unresolved grief. Society including mental health professionals must recognize and respect different ways in which grief can be expressed through providing a safe space to share and process these unique difficult feelings.Vital signs like body temperature, pulse or heart rate, blood pressure, and respiratory rate are four physical vital signs that are routinely measured to best described as a patient’s physical status. Pain is designated as the 5^th vital sign as being very common symptom in cancer, and distress being highly prevalent in cancer, is designated as the 6th vital sign. As per United Nations Volunteers program, around 60% of the volunteers in India, are below the age of 30. Approximately 40% of Indians engage in some form of volunteering. As the world confronts increasing challenges, younger volunteers are often the first to step forward, positioning youth volunteers at the forefront during crises and emergencies. This allows them to bring their unique skill sets to the organisation.  NGO’s have always benefitted from the experiences brought by the senior volunteers, no matter how big or small. In today’s world, time is the most precious thing to gift or donate. Corporate and the working individuals set an example by donating their time and resources, no matter how busy they may be. To quote the quote by Martin Luther King Jr. “Volunteers do not necessarily have time, they just have the heart.” Grief is a complex emotion, and it can be difficult for many people to express it in a way that is appropriate for them. For many men, grief can be difficult to express because they have been taught to suppress their emotions. This can lead to delayed or unresolved grief. Society including mental health professionals must recognize and respect different ways in which grief can be expressed through providing a safe space to share and process these unique difficult feelings. Grief is a complex emotion, and it can be difficult for many people to express it in a way that is appropriate for them. For many men, grief can be difficult to express because they have been taught to suppress their emotions. This can lead to delayed or unresolved grief. Society including mental health professionals must recognize and respect different ways in which grief can be expressed through providing a safe space to share and process these unique difficult feelings.Vital signs like body temperature, pulse or heart rate, blood pressure, and respiratory rate are four physical vital signs that are routinely measured to best described as a patient’s physical status. Pain is designated as the 5^th vital sign as being very common symptom in cancer, and distress being highly prevalent in cancer, is designated as the 6th vital sign.

Every year on 5th December, International Volunteers Day, serves as a reminder that volunteering is not just one-day celebration but a lifelong commitment to making the world a better place. This year’s theme, “the collective action: if everyone did”, encourages us to recognise the impact of individual contributions when combined with the efforts of others.  Grief is a complex emotion, and it can be difficult for many people to express it in a way that is appropriate for them. For many men, grief can be difficult to express because they have been taught to suppress their emotions. This can lead to delayed or unresolved grief. Society including mental health professionals must recognize and respect different ways in which grief can be expressed through providing a safe space to share and process these unique difficult feelings.Vital signs like body temperature, pulse or heart rate, blood pressure, and respiratory rate are four physical vital signs that are routinely measured to best described as a patient’s physical status. Pain is designated as the 5^th vital sign as being very common symptom in cancer, and distress being highly prevalent in cancer, is designated as the 6th vital sign. As per United Nations Volunteers program, around 60% of the volunteers in India, are below the age of 30. Approximately 40% of Indians engage in some form of volunteering. As the world confronts increasing challenges, younger volunteers are often the first to step forward, positioning youth volunteers at the forefront during crises and emergencies. This allows them to bring their unique skill sets to the organisation.  NGO’s have always benefitted from the experiences brought by the senior volunteers, no matter how big or small. In today’s world, time is the most precious thing to gift or donate. Corporate and the working individuals set an example by donating their time and resources, no matter how busy they may be. To quote the quote by Martin Luther King Jr. “Volunteers do not necessarily have time, they just have the heart.” Grief is a complex emotion, and it can be difficult for many people to express it in a way that is appropriate for them. For many men, grief can be difficult to express because they have been taught to suppress their emotions. This can lead to delayed or unresolved grief. Society including mental health professionals must recognize and respect different ways in which grief can be expressed through providing a safe space to share and process these unique difficult feelings. Grief is a complex emotion, and it can be difficult for many people to express it in a way that is appropriate for them. For many men, grief can be difficult to express because they have been taught to suppress their emotions. This can lead to delayed or unresolved grief. Society including mental health professionals must recognize and respect different ways in which grief can be expressed through providing a safe space to share and process these unique difficult feelings.Vital signs like body temperature, pulse or heart rate, blood pressure, and respiratory rate are four physical vital signs that are routinely measured to best described as a patient’s physical status. Pain is designated as the 5^th vital sign as being very common symptom in cancer, and distress being highly prevalent in cancer, is designated as the 6th vital sign.

On this special day, Karunashraya takes the opportunity to recognize and applaud the millions of volunteers who selflessly dedicate their time, skills, energy, and resources to make the world a better place to live. Let’s stand with volunteers- Everywhere! Together, we can build a more compassionate, inclusive, and sustainable world.  Masculine standards are the social norms and behaviors that men and manhood must adhere to within a cultural context. Failing to adhere to these strict masculine standards can exacerbate depression and anxiety, substance abuse, increased health risks, dating and interpersonal intimacy problems, interpersonal violence issues, stigma around seeking help, and an increase in general psychological distress.Forty percent of patients diagnosed with cancer experience significant level of distress.  However fewer than 10% of patients are identified and referred for appropriate psychosocial support. Screening for distress is important for every patient at the appropriate time, and this needs to be managed by health professionals with the required expertise.

Author: Shilpi Agrawal

Volunteer at Bangalore Hospice Trust – Karunashraya Volunteer at Bangalore Hospice Trust – Karunashraya Psycho oncologist & Lead counselling services
Bagchi Karunashraya Palliative Care Center
Bhubaneswar, Odisha,  India

Preface

Mr. Ram was 17 years old and far away from home in boarding school when he lost his father to a chronic illness. He was aware that his father was unwell but was not informed by his family about the rapidly declining condition. Ram was not informed about his father’s death for almost two months because the family knew he had important examinations to take in the upcoming months. When he was eventually told about his father’s passing, he was in shock, was angry at the family for keeping him in the dark, and felt they made decisions on his behalf, leaving him feeling lonely and abandoned in his grief. His mother and elders in the family told him, “Don’t cry like this; you are the man in this house, and you have to be strong.” Six years later, he is seen changing multiple jobs and facing rejection, which leaves him struggling to cope and confused about how he should be feeling as a man. Mr. Ram was 17 years old and far away from home in boarding school when he lost his father to a chronic illness. He was aware that his father was unwell but was not informed by his family about the rapidly declining condition. Ram was not informed about his father’s death for almost two months because the family knew he had important examinations to take in the upcoming months. When he was eventually told about his father’s passing, he was in shock, was angry at the family for keeping him in the dark, and felt they made decisions on his behalf, leaving him feeling lonely and abandoned in his grief. His mother and elders in the family told him, “Don’t cry like this; you are the man in this house, and you have to be strong.” Six years later, he is seen changing multiple jobs and facing rejection, which leaves him struggling to cope and confused about how he should be feeling as a man.Cancer burden continues to grow day by day worldwide, with an increased number of newly diagnosed cases and deaths each year.

This story about Ram is about his difficult life experiences and how these experiences have shaped him over the years. Today, Ram is 36 years old and married with two children. When he came in for a session, he narrated how he has coped by reminding himself that life goes on and that it was his responsibility to hold himself accountable for all that took place, which involved his family and career. He feels he should possess strong masculine traits to lead a good life, but he also mentioned that it is just what people around him and society expect. The myriad of unresolved questions and emotions of grief from back then has culminated in him asking, “Is it forever that I have to prove to be masculine enough and mask my feelings and losses as a person just to prove to others I am strong?” This story about Ram is about his difficult life experiences and how these experiences have shaped him over the years. Today, Ram is 36 years old and married with two children. When he came in for a session, he narrated how he has coped by reminding himself that life goes on and that it was his responsibility to hold himself accountable for all that took place, which involved his family and career. He feels he should possess strong masculine traits to lead a good life, but he also mentioned that it is just what people around him and society expect. The myriad of unresolved questions and emotions of grief from back then has culminated in him asking, “Is it forever that I have to prove to be masculine enough and mask my feelings and losses as a person just to prove to others I am strong?” A significant proportion of such individuals at any stage of the disease trajectory suffer social, emotional, and psychological distress due to stigma related to cancer, diagnosis and treatment side-effects, survivorship issues etc. Therefore, psychological distress needs to be assessed on a regular basis to understand the reason and severity of the problem in order to help the individuals.

In the grandeur of life, the cry “Gone but not forgotten” is a voice that speaks to every heart. But for men, facing the complexities of bereavement is a challenge of its own. In a culture that thrives on stoicism, navigating grief is a path less traveled. It is a walk of unspoken struggles and a journey fraught with societal expectations. This blog explores the complexities of men’s mental health in relation to bereavement and explores why it is so important to break the silence and create a healing culture. In the grandeur of life, the cry “Gone but not forgotten” is a voice that speaks to every heart. But for men, facing the complexities of bereavement is a challenge of its own. In a culture that thrives on stoicism, navigating grief is a path less traveled. It is a walk of unspoken struggles and a journey fraught with societal expectations. This blog explores the complexities of men’s mental health in relation to bereavement and explores why it is so important to break the silence and create a healing culture.Distress is an unpleasant experience of a physical, mental, social, or spiritual nature. It can make it difficult for someone to cope with having cancer, its symptoms, treatment, both curative as well as side effects. This  affects their survivorship and hence it impacts the entire family.  Distress affect one across the range of experience. It varies from mild to severe, which includes sadness, fear, and helplessness with intensity.

Our Current Scenario Our current scenarioThe 6^th vital sign

Discrimination based on mental health has a detrimental effect on access to mental health care, help-seeking behavior, and the first treatment for people with mental struggles or illnesses, resulting in higher rates of disease and death Discrimination based on mental health has a detrimental effect on access to mental health care, help-seeking behavior, and the first treatment for people with mental struggles or illnesses, resulting in higher rates of disease and deathEveryone with cancer has some level of distress at some point of time. Not only the patient but their caregivers too experience some level of distress during and after the course of illness, Moreover, distress extends along the continuum, ranging from common normal feelings of vulnerability, sadness, and fear to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual issues.

Grief is a complex emotion, and it can be difficult for many people to express it in a way that is appropriate for them. For many men, grief can be difficult to express because they have been taught to suppress their emotions. This can lead to delayed or unresolved grief. Society including mental health professionals must recognize and respect different ways in which grief can be expressed through providing a safe space to share and process these unique difficult feelings. Grief is a complex emotion, and it can be difficult for many people to express it in a way that is appropriate for them. For many men, grief can be difficult to express because they have been taught to suppress their emotions. This can lead to delayed or unresolved grief. Society including mental health professionals must recognize and respect different ways in which grief can be expressed through providing a safe space to share and process these unique difficult feelings.Vital signs like body temperature, pulse or heart rate, blood pressure, and respiratory rate are four physical vital signs that are routinely measured to best described as a patient’s physical status. Pain is designated as the 5^th vital sign as being very common symptom in cancer, and distress being highly prevalent in cancer, is designated as the 6th vital sign.

Masculine Norms Masculine norms Vulnerability to distress

Masculine standards are the social norms and behaviors that men and manhood must adhere to within a cultural context. Failing to adhere to these strict masculine standards can exacerbate depression and anxiety, substance abuse, increased health risks, dating and interpersonal intimacy problems, interpersonal violence issues, stigma around seeking help, and an increase in general psychological distress. Masculine standards are the social norms and behaviors that men and manhood must adhere to within a cultural context. Failing to adhere to these strict masculine standards can exacerbate depression and anxiety, substance abuse, increased health risks, dating and interpersonal intimacy problems, interpersonal violence issues, stigma around seeking help, and an increase in general psychological distress.Forty percent of patients diagnosed with cancer experience significant level of distress.  However fewer than 10% of patients are identified and referred for appropriate psychosocial support. Screening for distress is important for every patient at the appropriate time, and this needs to be managed by health professionals with the required expertise.

While masculine norms seem to be important to society at one end, it is also important to consider that grieving is a natural experience for all man-kind. Men are no exceptions, and hence, they too can equally feel vulnerable to grief through the journey. As suggested by the well-known psychiatrist Elizabeth Kubler Ross, sailing through grief can be a continuous and fluid journey with waves through different phases like denial, anger, bargaining, depression, and acceptance. Being in denial can help one take the shock of the sudden loss initially, but prolonged denial can impact one’s well-being. Anger is a large wave of many emotions, but one barely swims deep to see the other emotions resulting. Bargaining might not change the situation, but the wishful thinking behind it provides coping. Society holds a taboo against depression, but no one steps forward to understand the multiple complex layers and help one resolve issues and pass through it. Acceptance (with unique meanings to each one) comes with time, and patience is what is not understood by all. An important bottleneck is the silence taken by the individual in the shade of masculine norms. While masculine norms seem to be important to society at one end, it is also important to consider that grieving is a natural experience for all man-kind. Men are no exceptions, and hence, they too can equally feel vulnerable to grief through the journey. As suggested by the well-known psychiatrist Elizabeth Kubler Ross, sailing through grief can be a continuous and fluid journey with waves through different phases like denial, anger, bargaining, depression, and acceptance. Being in denial can help one take the shock of the sudden loss initially, but prolonged denial can impact one’s well-being. Anger is a large wave of many emotions, but one barely swims deep to see the other emotions resulting. Bargaining might not change the situation, but the wishful thinking behind it provides coping. Society holds a taboo against depression, but no one steps forward to understand the multiple complex layers and help one resolve issues and pass through it. Acceptance (with unique meanings to each one) comes with time, and patience is what is not understood by all. An important bottleneck is the silence taken by the individual in the shade of masculine norms.This becomes clinically significant when it interferes with the patients’ general functioning with their cancer treatment or with their progress in cancer care. It can be influenced by many factors such as type of cancer, stage of cancer, type of treatment, individual characteristics such as patients’ personality, available social support, financial conditions etc. Psychological distress is common as patient with cancer move beyond their diagnosis and into the intensive treatment. Distress is very common among cancer patients across diagnosis and across the disease trajectory. Psychological distress is common in cancer patients; however, it is often unrecognized and untreated.

Grieving is a universal human experience, but men are often held back by society’s expectation that they should be “strong pillars.” It’s time to break the taboo around men’s mental health when it comes to bereavement. There’s a time and a place for everyone to feel vulnerable, but it’s important to remember that speaking up is the only way to heal. Grieving is a universal human experience, but men are often held back by society’s expectation that they should be “strong pillars.” It’s time to break the taboo around men’s mental health when it comes to bereavement. There’s a time and a place for everyone to feel vulnerable, but it’s important to remember that speaking up is the only way to heal.Patients are vulnerable to distress at various stages of the disease trajectory, since they face the risk of substantial and permanent physical impairment, disability, and inability to perform routine activities. Investigation periods/ process and finding out diagnosis, getting treatment and facing its side effects are the stages when patient’ vulnerability is high. Stressor of the survivorship, as the constant fear of recurrence or relapse is always there.  Getting back to the normalcy also becomes a challenge for many people surviving cancer.

Expressing GriefExpressing GriefVulnerability to distress

The case study mentioned at the beginning is an example of how men, too, experience the intricacies of grief but cannot express their feelings. The first step in the healing process for an individual is to allow them to express their grief openly. Whether through conversation, writing, or creative expression, providing men with ways to express their grief empowers them to navigate the emotional rollercoaster of grief. Expression freedom enables men to express their emotions in a way that allows them to feel more in control as they move through the grieving process. The case study mentioned at the beginning is an example of how men, too, experience the intricacies of grief but cannot express their feelings. The first step in the healing process for an individual is to allow them to express their grief openly. Whether through conversation, writing, or creative expression, providing men with ways to express their grief empowers them to navigate the emotional rollercoaster of grief. Expression freedom enables men to express their emotions in a way that allows them to feel more in control as they move through the grieving process.Patients are vulnerable to distress at various stages of the disease trajectory, since they face the risk of substantial and permanent physical impairment, disability, and inability to perform routine activities. Investigation periods/ process and finding out diagnosis, getting treatment and facing its side effects are the stages when patient’ vulnerability is high. Stressor of the survivorship, as the constant fear of recurrence or relapse is always there.  Getting back to the normalcy also becomes a challenge for many people surviving cancer.

Seeking Support Expressing GriefVulnerability to distressSeeking support Expressing GriefExpressing GriefVulnerability to distress

Grief can be an isolating experience for any individual. Especially for men, who have always been taught to hold themselves strong, maintain their distance and high self-esteem, and deal with grief in silence. This can make it more difficult for men to find someone to lean on.Grief can be an isolating experience for any individual. Especially for men, who have always been taught to hold themselves strong, maintain their distance and high self-esteem, and deal with grief in silence. This can make it more difficult for men to find someone to lean on.Distressed patients tend to make extra visits to the physician and hospitals. Often, they seem to have trouble making decisions about treatment and adhering to the treatment. Patients also become dissatisfied with their physicians and medical care when in distress.

Establishing relationships with friends and family or mental health professionals can be a lifesaver during these challenging times. Support groups, therapy sessions, or even simple conversations can give bereaved men a sense of belonging, reminding them that they don’t have to go through this alone.Grief can be an isolating experience for any individual. Especially for men, who have always been taught to hold themselves strong, maintain their distance and high self-esteem, and deal with grief in silence. This can make it more difficult for men to find someone to lean on.Distressed patients tend to make extra visits to the physician and hospitals. Often, they seem to have trouble making decisions about treatment and adhering to the treatment. Patients also become dissatisfied with their physicians and medical care when in distress.

Coping Strategies

Managing the mental health challenges of bereavement can be made easier by providing men with coping strategies. Mindfulness, self-reflection/ introspection, exercise, and joy-filled activities can help to improve emotional health. Creating a personalized toolkit can help cope with grief with resilience and compassion.  Managing the mental health challenges of bereavement can be made easier by providing men with coping strategies. Mindfulness, self-reflection/ introspection, exercise, and joy-filled activities can help to improve emotional health. Creating a personalized toolkit can help cope with grief with resilience and compassion.Early diagnosis and Psycho-oncology services help the patients in theenhancement of treatment satisfaction and helps them cope with the accompanying emotions. It also helps in improving patients – physician communication, respect, and trust. Additionally Psycho oncology services are also helpful in improving patients’ adherence to the treatment regimen and survivorship issues. 

Understanding when professional support is needed is important for mental health care during the grief journey. Psychologists can help navigate the grieving process, provide coping strategies, and provide a safe space for them to express their emotions. It’s important not to stigmatize seeking professional help but to emphasize that it’s a brave step towards healing. The effort to seek professional help might seem like a big step, but the consistent therapeutic process can be nurturing and fulfilling. It is built on stepping stones, but one can not only understand their loss and feelings better but also differentiate between healthy and unhealthy coping. Thus enhancing one’s well-functioning life as an individual.  Managing the mental health challenges of bereavement can be made easier by providing men with coping strategies. Mindfulness, self-reflection/ introspection, exercise, and joy-filled activities can help to improve emotional health. Creating a personalized toolkit can help cope with grief with resilience and compassion.Early diagnosis and Psycho-oncology services help the patients in theenhancement of treatment satisfaction and helps them cope with the accompanying emotions. It also helps in improving patients – physician communication, respect, and trust. Additionally Psycho oncology services are also helpful in improving patients’ adherence to the treatment regimen and survivorship issues.  Understanding when professional support is needed is important for mental health care during the grief journey. Psychologists can help navigate the grieving process, provide coping strategies, and provide a safe space for them to express their emotions. It’s important not to stigmatize seeking professional help but to emphasize that it’s a brave step towards healing. The effort to seek professional help might seem like a big step, but the consistent therapeutic process can be nurturing and fulfilling. It is built on stepping stones, but one can not only understand their loss and feelings better but also differentiate between healthy and unhealthy coping. Thus enhancing one’s well-functioning life as an individual.Managing the mental health challenges of bereavement can be made easier by providing men with coping strategies. Mindfulness, self-reflection/ introspection, exercise, and joy-filled activities can help to improve emotional health. Creating a personalized toolkit can help cope with grief with resilience and compassion.  Managing the mental health challenges of bereavement can be made easier by providing men with coping strategies. Mindfulness, self-reflection/ introspection, exercise, and joy-filled activities can help to improve emotional health. Creating a personalized toolkit can help cope with grief with resilience and compassion.Early diagnosis and Psycho-oncology services help the patients in theenhancement of treatment satisfaction and helps them cope with the accompanying emotions. It also helps in improving patients – physician communication, respect, and trust. Additionally Psycho oncology services are also helpful in improving patients’ adherence to the treatment regimen and survivorship issues. 

To summarize, recognizing the unique issues men face in the complex dance of grief is an essential part of building a healing culture. By challenging societal norms, allowing people to express themselves freely, connecting with others, and providing culturally responsive care, we can create a mental health landscape that empowers men to navigate the grief process with strength, resilience, and authenticity. Let’s work together to create a symphony of support where vulnerability is a strength and healing is a shared journey.To summarize, recognizing the unique issues men face in the complex dance of grief is an essential part of building a healing culture. By challenging societal norms, allowing people to express themselves freely, connecting with others, and providing culturally responsive care, we can create a mental health landscape that empowers men to navigate the grief process with strength, resilience, and authenticity. Let’s work together to create a symphony of support where vulnerability is a strength and healing is a shared journey.Psycho oncology is a specialty which is concerned with the understanding and treating the social, psychological, emotional, spiritual, quality of life and other functional aspects of cancer from prevention to palliation and survivorship. Hence it focuses on improving the mental health of individuals who are diagnosed with cancer and their caregivers.   Cancer affects not only to an individual, but it affects the entire family. Hence it becomes imperative to care for the caregivers as well. Patients admitted in the hospital for cancer directed treatment are regularly seen by psycho-oncologist. Therefore, regular screening of distress helps understanding the severity and specific area due to which psychological issues and concerns arise and helps to plan the better intervention for the same.

This blog commemorates Men’s Day, celebrated on 19th November 2023. To summarize, recognizing the unique issues men face in the complex dance of grief is an essential part of building a healing culture. By challenging societal norms, allowing people to express themselves freely, connecting with others, and providing culturally responsive care, we can create a mental health landscape that empowers men to navigate the grief process with strength, resilience, and authenticity. Let’s work together to create a symphony of support where vulnerability is a strength and healing is a shared journey.Psycho oncology is a specialty which is concerned with the understanding and treating the social, psychological, emotional, spiritual, quality of life and other functional aspects of cancer from prevention to palliation and survivorship. Hence it focuses on improving the mental health of individuals who are diagnosed with cancer and their caregivers.   Cancer affects not only to an individual, but it affects the entire family. Hence it becomes imperative to care for the caregivers as well. Patients admitted in the hospital for cancer directed treatment are regularly seen by psycho-oncologist. Therefore, regular screening of distress helps understanding the severity and specific area due to which psychological issues and concerns arise and helps to plan the better intervention for the same.

Author: Keshav Sharma

Psycho oncologist & Lead counselling services
Bagchi Karunashraya Palliative Care Center
Bhubaneswar, Odisha,  India

As I sit down to write this blog, I cannot help but think of my parents and the myriad number of uncles and aunts that I am privileged to have in my life. Their countless stories, compelling experiences, and collective wisdom have shaped me and influenced my worldview. As a child, I have watched them chase their dreams, conquer challenges, and embrace new experiences with an insatiable thirst for life. Their homes bustling with activity, the tantalizing aroma of delectable dishes wafting through the air, our holidays were a delightful experience that left cherished memories etched in our hearts. Now in their 70s and 80s, their boundless energy dissipated, I see them struggle with the complexities of ageing. Their homes empty, the children having flown the coop, I see them struggle with loneliness seeking solace in memories and in each other, awaiting the phone call from the ever-busy progeny. They have considerably slowed down physically and mentally, and falls have become the norm. Regular doctor visits, multiple medications, and aches and pains are the new normal. I see their struggle as they attempt to assimilate themselves into a rapidly changing world, struggling to use WhatsApp, G-Pay, and manage Teleconsults. I also see the impatience in many of the younger generation tech-geeks. With the passing of their contemporaries and near and dear ones, our elders grapple with grief and their own mortality, often reflecting on the fragility of life and the inevitability of their own journey’s end. I returned from my parent’s home a few weeks ago, and my father’s words still echo in my ears. He said, “You should learn to detach yourself from us now. Learn to let go of us.” It’s the 21st of September 1994, in Edinburgh, when Alzheimer’s International-an organisation dedicated for research and spreading of awareness for Alzheimer’s disease, celebrated the 1st “World Alzheimer’s’ Day”. The day and the entire month of September is utilised to enhance our knowledge, in one of the most common causes of dementia in elderly-Alzheimer’s’ disease. It dates back to the year 1906, when Dr Alzheimer Aloi named the disease, which he discovered in a lady, he had first encountered in 1901.In a day and age like ours, good lifestyle practises are comprised. We have breakfast that is instant, processed and easy to eat, on the go, work long hours while sometimes skipping meals, stay up late and grab just a few winks and most importantly, do not find time to exercise or meditate. We are caught up in a race for time, money, power and in general, life itself. When on the one hand technological advancements have made life easier, they have also successfully tipped the scale onto the other side with the plethora of side effects their existence brings with them. As I sit down to write this blog, I cannot help but think of my parents and the myriad number of uncles and aunts that I am privileged to have in my life. Their countless stories, compelling experiences, and collective wisdom have shaped me and influenced my worldview. As a child, I have watched them chase their dreams, conquer challenges, and embrace new experiences with an insatiable thirst for life. Their homes bustling with activity, the tantalizing aroma of delectable dishes wafting through the air, our holidays were a delightful experience that left cherished memories etched in our hearts. Now in their 70s and 80s, their boundless energy dissipated, I see them struggle with the complexities of ageing. Their homes empty, the children having flown the coop, I see them struggle with loneliness seeking solace in memories and in each other, awaiting the phone call from the ever-busy progeny. They have considerably slowed down physically and mentally, and falls have become the norm. Regular doctor visits, multiple medications, and aches and pains are the new normal. I see their struggle as they attempt to assimilate themselves into a rapidly changing world, struggling to use WhatsApp, G-Pay, and manage Teleconsults. I also see the impatience in many of the younger generation tech-geeks. With the passing of their contemporaries and near and dear ones, our elders grapple with grief and their own mortality, often reflecting on the fragility of life and the inevitability of their own journey’s end. I returned from my parent’s home a few weeks ago, and my father’s words still echo in my ears. He said, “You should learn to detach yourself from us now. Learn to let go of us.” It’s the 21st of September 1994, in Edinburgh, when Alzheimer’s International-an organisation dedicated for research and spreading of awareness for Alzheimer’s disease, celebrated the 1st “World Alzheimer’s’ Day”. The day and the entire month of September is utilised to enhance our knowledge, in one of the most common causes of dementia in elderly-Alzheimer’s’ disease. It dates back to the year 1906, when Dr Alzheimer Aloi named the disease, which he discovered in a lady, he had first encountered in 1901.It’s the 21st of September 1994, in Edinburgh, when Alzheimer’s International-an organisation dedicated for research and spreading of awareness for Alzheimer’s disease, celebrated the 1st “World Alzheimer’s’ Day”. The day and the entire month of September is utilised to enhance our knowledge, in one of the most common causes of dementia in elderly-Alzheimer’s’ disease. It dates back to the year 1906, when Dr Alzheimer Aloi named the disease, which he discovered in a lady, he had first encountered in 1901.In a day and age like ours, good lifestyle practises are comprised. We have breakfast that is instant, processed and easy to eat, on the go, work long hours while sometimes skipping meals, stay up late and grab just a few winks and most importantly, do not find time to exercise or meditate. We are caught up in a race for time, money, power and in general, life itself. When on the one hand technological advancements have made life easier, they have also successfully tipped the scale onto the other side with the plethora of side effects their existence brings with them.

It also pushes me to reflect on as a society and as individuals how cognizant are we of their needs and wants. Around 15 million elderly Indians live all alone, with three-fourths of them being women (Census 2011). Of the 250 million households, 31% have at least one elderly person. Globally, one in every six elderly faces abuse, while the prevalence ranges between 9.6-62% in India, with the abusers being either family members or caregivers. The absence of geriatric clinics, the logistics of accessing hospitals, long waiting lines to meet doctors, and the exorbitant healthcare costs deter elders from seeking help for their medical problems. Financial dependency, malnutrition, social isolation, lack of autonomy, and social security impact the wellbeing of the elderly. The International Day of the Older Persons, observed on October 1, every year, was established by the United Nations to recognize and celebrate the contributions and achievements of older people worldwide. It also serves as a reminder of the challenges they face and the need for society to support and empower them. The theme of this year, “Fulfilling the Promises of the Universal Declaration of Human Rights for Older Persons: Across Generations”, aims to highlight the specific issues of older persons around the world, to empower them to enjoy their rights and address their violations, and strengthen the intergeneration bonds.We all forget things in our everyday lives. Be it the misplaced car key or the displaced phone, we all is used to such incidents. But it becomes pathological when one refuses to recognise one’s spouse, forgets the name of his mother or when a person of spectacular IQ once, finds it difficult to add 2 with 2. It’s worse than its sounds, people with Alzheimer’s’ and their caregivers have seen catastrophic consequences of the same. Often the patients are not treated well in their surroundings owing to the lack of awareness about the disease. We have 6.7 million people living with Alzheimer’s today, and each one of them is living in agony.It’s not of surprise that unhealthy lifestyles have paved paths for the onset of different types of diseases, cancer being most prevalent among them. We’ve all heard our friends or family members say that the incidence has exponentially increased over the last decade or two. Of course, there are other causes for cancer such as pollution, food adulteration, lack of hygiene, tobacco and alcohol abuse, and the list goes on. It also pushes me to reflect on as a society and as individuals how cognizant are we of their needs and wants. Around 15 million elderly Indians live all alone, with three-fourths of them being women (Census 2011). Of the 250 million households, 31% have at least one elderly person. Globally, one in every six elderly faces abuse, while the prevalence ranges between 9.6-62% in India, with the abusers being either family members or caregivers. The absence of geriatric clinics, the logistics of accessing hospitals, long waiting lines to meet doctors, and the exorbitant healthcare costs deter elders from seeking help for their medical problems. Financial dependency, malnutrition, social isolation, lack of autonomy, and social security impact the wellbeing of the elderly. The International Day of the Older Persons, observed on October 1, every year, was established by the United Nations to recognize and celebrate the contributions and achievements of older people worldwide. It also serves as a reminder of the challenges they face and the need for society to support and empower them. The theme of this year, “Fulfilling the Promises of the Universal Declaration of Human Rights for Older Persons: Across Generations”, aims to highlight the specific issues of older persons around the world, to empower them to enjoy their rights and address their violations, and strengthen the intergeneration bonds.We all forget things in our everyday lives. Be it the misplaced car key or the displaced phone, we all is used to such incidents. But it becomes pathological when one refuses to recognise one’s spouse, forgets the name of his mother or when a person of spectacular IQ once, finds it difficult to add 2 with 2. It’s worse than its sounds, people with Alzheimer’s’ and their caregivers have seen catastrophic consequences of the same. Often the patients are not treated well in their surroundings owing to the lack of awareness about the disease. We have 6.7 million people living with Alzheimer’s today, and each one of them is living in agony.We all forget things in our everyday lives. Be it the misplaced car key or the displaced phone, we all is used to such incidents. But it becomes pathological when one refuses to recognise one’s spouse, forgets the name of his mother or when a person of spectacular IQ once, finds it difficult to add 2 with 2. It’s worse than its sounds, people with Alzheimer’s’ and their caregivers have seen catastrophic consequences of the same. Often the patients are not treated well in their surroundings owing to the lack of awareness about the disease. We have 6.7 million people living with Alzheimer’s today, and each one of them is living in agony.It’s not of surprise that unhealthy lifestyles have paved paths for the onset of different types of diseases, cancer being most prevalent among them. We’ve all heard our friends or family members say that the incidence has exponentially increased over the last decade or two. Of course, there are other causes for cancer such as pollution, food adulteration, lack of hygiene, tobacco and alcohol abuse, and the list goes on.

In India, where traditions and family values run deep, the significance of this day cannot be overstated. We have a rich cultural heritage that has been nurtured and preserved over centuries. Our elders are the living repositories of our heritage. One of the strong landmarks of our society is the emphasis on family bonds. Traditional Indian values have emphasized the value of respecting our elders, along with caring for them as our collective responsibility. As India modernizes and moves towards a more individualistic society, we seem to be losing the plot, with one in six of our elderly being abandoned and abused. The Maintenance and Welfare of Parents and Senior Citizens Act, 2007, empowers elders to seek redressal if they are abused or neglected, but what about the social isolation, love, and care they need? How can we as a society generate intergenerational solidarity?Undoubtedly it is a disease of the elderly, but about 5% people develop the disease in middle age as well. Life comes to a standstill, with Alzheimer’s and things turn haywire. The theme for this year is – “It’s never too early, It’s never too late” (hence the title!). It refers to the early identification of risk factors as well as proficient risk reduction for prevention of the disease, as Alzheimer’s begins 20 years before the development of noticeable symptoms. Unfortunately, it is an incurable, progressive, neurogenerative disorder leading to decrease in cognition, loss of memory and impairment of mental functions. The disease leads to the death of nerve cells, with consequent inflammation and shrinkage of the brain. The early symptoms are difficulty in recalling names, events, lack of enthusiasm, followed by depressive episodes, poor judgement and behavioural changes. In the late stages of the disease, it might be difficult to walk and speak for patients. Some patients leave home and are lost forever. Cancer related mortality is a hot subject of research conducted in various universities the world over and many a time, in collaboration with the WHO. A study on the Indian cancer statistics conducted by The Lancet in year 2012, reported a staggering 5,55,000 cancer deaths in India, in 2010 alone. Also, research led by Dr. Prabhat Jha, the Director for Centre for Global Health Research, St. Michael’s Hospital, Toronto, in year 2012 resulted in a model that is now being used as a reference to compute cancer deaths in India. They employed a unique method of arriving at statistics by extrapolating information derived from studying cancer patterns and mortalities in our country between years 2000 and 2003, using a sample of households. Another notable agency is the International Agency for Research on Cancer (IARC) whose GLOBOCAN database forms the basis for recording cancer incidences in India. Similarly Dr. Jha’s model is used to study cancer mortalities in India. India Today iterated that cancer deaths worldwide were approximately 8.2 million in year 2012. Indian Council for Medical Research (ICMR) has projected that by year 2020, the total number of cancer mortalities in the country will be nearly 17.3 lakh. In year 2016, the highest number of cancer cases was estimated to be of breast cancer followed by lung cancer. With such daunting statistics in hand proven and projected through research, it is of great relief to come to the realization that advanced medical procedures are now available that have been found to increase the human life span by almost 30 to 40 years. Organizations that specialize in palliative care for terminally ill patients are the new go-to centres for families with patients suffering from chronic illnesses. In India, where traditions and family values run deep, the significance of this day cannot be overstated. We have a rich cultural heritage that has been nurtured and preserved over centuries. Our elders are the living repositories of our heritage. One of the strong landmarks of our society is the emphasis on family bonds. Traditional Indian values have emphasized the value of respecting our elders, along with caring for them as our collective responsibility. As India modernizes and moves towards a more individualistic society, we seem to be losing the plot, with one in six of our elderly being abandoned and abused. The Maintenance and Welfare of Parents and Senior Citizens Act, 2007, empowers elders to seek redressal if they are abused or neglected, but what about the social isolation, love, and care they need? How can we as a society generate intergenerational solidarity?The disease leaves the option of only palliation of symptoms. The challenge is that, with passage of time, the symptoms become resistant to the medications and the increase in dose leads to intolerable side effects. Talking about achievements, Aducanumab and lecanemab are 2 FDA approved drugs for modifying the underlying pathology of the disease. Well, they are again not cure for Alzheimer’s, but they do decline the rate of progression of the disease and can be useful if used in early phase of the disease. Undoubtedly it is a disease of the elderly, but about 5% people develop the disease in middle age as well. Life comes to a standstill, with Alzheimer’s and things turn haywire. The theme for this year is – “It’s never too early, It’s never too late” (hence the title!). It refers to the early identification of risk factors as well as proficient risk reduction for prevention of the disease, as Alzheimer’s begins 20 years before the development of noticeable symptoms. Unfortunately, it is an incurable, progressive, neurogenerative disorder leading to decrease in cognition, loss of memory and impairment of mental functions. The disease leads to the death of nerve cells, with consequent inflammation and shrinkage of the brain. The early symptoms are difficulty in recalling names, events, lack of enthusiasm, followed by depressive episodes, poor judgement and behavioural changes. In the late stages of the disease, it might be difficult to walk and speak for patients. Some patients leave home and are lost forever. Cancer related mortality is a hot subject of research conducted in various universities the world over and many a time, in collaboration with the WHO. A study on the Indian cancer statistics conducted by The Lancet in year 2012, reported a staggering 5,55,000 cancer deaths in India, in 2010 alone. Also, research led by Dr. Prabhat Jha, the Director for Centre for Global Health Research, St. Michael’s Hospital, Toronto, in year 2012 resulted in a model that is now being used as a reference to compute cancer deaths in India. They employed a unique method of arriving at statistics by extrapolating information derived from studying cancer patterns and mortalities in our country between years 2000 and 2003, using a sample of households. Another notable agency is the International Agency for Research on Cancer (IARC) whose GLOBOCAN database forms the basis for recording cancer incidences in India. Similarly Dr. Jha’s model is used to study cancer mortalities in India. India Today iterated that cancer deaths worldwide were approximately 8.2 million in year 2012. Indian Council for Medical Research (ICMR) has projected that by year 2020, the total number of cancer mortalities in the country will be nearly 17.3 lakh. In year 2016, the highest number of cancer cases was estimated to be of breast cancer followed by lung cancer. With such daunting statistics in hand proven and projected through research, it is of great relief to come to the realization that advanced medical procedures are now available that have been found to increase the human life span by almost 30 to 40 years. Organizations that specialize in palliative care for terminally ill patients are the new go-to centres for families with patients suffering from chronic illnesses.

Let us on this day pledge to keep our elders close to our hearts, individually and as a society. Respecting and integrating our elders into our lives and society is not just the mark of a culture society, but also a pathway for personal growth and wisdom. Their life stories and the lessons learned from their own trials and tribulations are invaluable. When we take time to listen, acknowledge, and learn from their life stories, we are able to foster the generational gap, fostering a sense of continuity and unity. I still remember my unique bond with my maternal grandmother (the only one I had the fortune to know), the comfort I felt in her embrace and the insight I absorbed from her life story. Elders provide us with invaluable life lessons and wisdom, while the we can provide them with companionship and technological assistance. With each generation learning from the other, this synergy ensures a harmonious existence and a culture that upholds human dignity.Let us on this day pledge to keep our elders close to our hearts, individually and as a society. Respecting and integrating our elders into our lives and society is not just the mark of a culture society, but also a pathway for personal growth and wisdom. Their life stories and the lessons learned from their own trials and tribulations are invaluable. When we take time to listen, acknowledge, and learn from their life stories, we are able to foster the generational gap, fostering a sense of continuity and unity. I still remember my unique bond with my maternal grandmother (the only one I had the fortune to know), the comfort I felt in her embrace and the insight I absorbed from her life story. Elders provide us with invaluable life lessons and wisdom, while the we can provide them with companionship and technological assistance. With each generation learning from the other, this synergy ensures a harmonious existence and a culture that upholds human dignity.At last, but not the least, the need of the hour, is to spread information regarding the disease, so that the patients and caregivers are treated with compassion and not hatred. They need empathy and not sympathy. It’s not always the medicine that heals, love and gestures of kindness often do wonders. So, it’s certainly not late. Let’s join hands together to make the world a better place for the ones who are suffering, for we never know, we might be one of them in a few years of time, after all we are all ageing!

Integrating elders into our lives and society means more than just paying lip service to their wisdom. It involves creating opportunities for meaningful interactions, seeking advice, and actively involving them in community and volunteering activities while being cognizant of their special needs. In doing so, we not only honour their contributions but also give them a sense of purpose and ensure that their legacy continues. In a fast-paced world that constantly seeks the newest and the latest, this day is a reminder that as we innovate and progress, we must not lose sight of the timeless values and traditions that has shaped us.

To conclude, intergenerational solidarity remains a vital component of Indian society, and the time has come to prevent further erosion of our traditional values. It is the responsibility of every Indian to unite the wisdom of the past, with the energy of the future. Intergenerational solidarity is not just a concept, but a commitment to nurturing a society, where the elderly are cherished, valued and facilitated to live a life of dignity and purpose.

Author: Seema R RaoSeema R Rao Author: Dr Pratyasa Padhi

Associate Director (Education and Research)
Karunashraya Institute for Palliative Care Education and Research (KIPCER)
Bengaluru, India
Honorary Tutor, School of Medicine, Cardiff University, UK

It’s the 21st of September 1994, in Edinburgh, when Alzheimer’s International-an organisation dedicated for research and spreading of awareness for Alzheimer’s disease, celebrated the 1st “World Alzheimer’s’ Day”. The day and the entire month of September is utilised to enhance our knowledge, in one of the most common causes of dementia in elderly-Alzheimer’s’ disease. It dates back to the year 1906, when Dr Alzheimer Aloi named the disease, which he discovered in a lady, he had first encountered in 1901.It’s the 21st of September 1994, in Edinburgh, when Alzheimer’s International-an organisation dedicated for research and spreading of awareness for Alzheimer’s disease, celebrated the 1st “World Alzheimer’s’ Day”. The day and the entire month of September is utilised to enhance our knowledge, in one of the most common causes of dementia in elderly-Alzheimer’s’ disease. It dates back to the year 1906, when Dr Alzheimer Aloi named the disease, which he discovered in a lady, he had first encountered in 1901.In a day and age like ours, good lifestyle practises are comprised. We have breakfast that is instant, processed and easy to eat, on the go, work long hours while sometimes skipping meals, stay up late and grab just a few winks and most importantly, do not find time to exercise or meditate. We are caught up in a race for time, money, power and in general, life itself. When on the one hand technological advancements have made life easier, they have also successfully tipped the scale onto the other side with the plethora of side effects their existence brings with them.

We all forget things in our everyday lives. Be it the misplaced car key or the displaced phone, we all is used to such incidents. But it becomes pathological when one refuses to recognise one’s spouse, forgets the name of his mother or when a person of spectacular IQ once, finds it difficult to add 2 with 2. It’s worse than its sounds, people with Alzheimer’s’ and their caregivers have seen catastrophic consequences of the same. Often the patients are not treated well in their surroundings owing to the lack of awareness about the disease. We have 6.7 million people living with Alzheimer’s today, and each one of them is living in agony.We all forget things in our everyday lives. Be it the misplaced car key or the displaced phone, we all is used to such incidents. But it becomes pathological when one refuses to recognise one’s spouse, forgets the name of his mother or when a person of spectacular IQ once, finds it difficult to add 2 with 2. It’s worse than its sounds, people with Alzheimer’s’ and their caregivers have seen catastrophic consequences of the same. Often the patients are not treated well in their surroundings owing to the lack of awareness about the disease. We have 6.7 million people living with Alzheimer’s today, and each one of them is living in agony.It’s not of surprise that unhealthy lifestyles have paved paths for the onset of different types of diseases, cancer being most prevalent among them. We’ve all heard our friends or family members say that the incidence has exponentially increased over the last decade or two. Of course, there are other causes for cancer such as pollution, food adulteration, lack of hygiene, tobacco and alcohol abuse, and the list goes on.

The disease leaves the option of only palliation of symptoms. The challenge is that, with passage of time, the symptoms become resistant to the medications and the increase in dose leads to intolerable side effects. Talking about achievements, Aducanumab and lecanemab are 2 FDA approved drugs for modifying the underlying pathology of the disease. Well, they are again not cure for Alzheimer’s, but they do decline the rate of progression of the disease and can be useful if used in early phase of the disease. Undoubtedly it is a disease of the elderly, but about 5% people develop the disease in middle age as well. Life comes to a standstill, with Alzheimer’s and things turn haywire. The theme for this year is – “It’s never too early, It’s never too late” (hence the title!). It refers to the early identification of risk factors as well as proficient risk reduction for prevention of the disease, as Alzheimer’s begins 20 years before the development of noticeable symptoms. Unfortunately, it is an incurable, progressive, neurogenerative disorder leading to decrease in cognition, loss of memory and impairment of mental functions. The disease leads to the death of nerve cells, with consequent inflammation and shrinkage of the brain. The early symptoms are difficulty in recalling names, events, lack of enthusiasm, followed by depressive episodes, poor judgement and behavioural changes. In the late stages of the disease, it might be difficult to walk and speak for patients. Some patients leave home and are lost forever. Cancer related mortality is a hot subject of research conducted in various universities the world over and many a time, in collaboration with the WHO. A study on the Indian cancer statistics conducted by The Lancet in year 2012, reported a staggering 5,55,000 cancer deaths in India, in 2010 alone. Also, research led by Dr. Prabhat Jha, the Director for Centre for Global Health Research, St. Michael’s Hospital, Toronto, in year 2012 resulted in a model that is now being used as a reference to compute cancer deaths in India. They employed a unique method of arriving at statistics by extrapolating information derived from studying cancer patterns and mortalities in our country between years 2000 and 2003, using a sample of households. Another notable agency is the International Agency for Research on Cancer (IARC) whose GLOBOCAN database forms the basis for recording cancer incidences in India. Similarly Dr. Jha’s model is used to study cancer mortalities in India. India Today iterated that cancer deaths worldwide were approximately 8.2 million in year 2012. Indian Council for Medical Research (ICMR) has projected that by year 2020, the total number of cancer mortalities in the country will be nearly 17.3 lakh. In year 2016, the highest number of cancer cases was estimated to be of breast cancer followed by lung cancer. With such daunting statistics in hand proven and projected through research, it is of great relief to come to the realization that advanced medical procedures are now available that have been found to increase the human life span by almost 30 to 40 years. Organizations that specialize in palliative care for terminally ill patients are the new go-to centres for families with patients suffering from chronic illnesses.

At last, but not the least, the need of the hour, is to spread information regarding the disease, so that the patients and caregivers are treated with compassion and not hatred. They need empathy and not sympathy. It’s not always the medicine that heals, love and gestures of kindness often do wonders. So, it’s certainly not late. Let’s join hands together to make the world a better place for the ones who are suffering, for we never know, we might be one of them in a few years of time, after all we are all ageing!

Author: Dr Pratyasa Padhi

MBBS, MD Palliative Medicine,
Junior Consultant
Bagchi Karunashraya Palliative Care Center
Bhubaneswar, Odisha, India

Preface

Cancer burden continues to grow day by day worldwide, with an increased number of newly diagnosed cases and deaths each year.

A significant proportion of such individuals at any stage of the disease trajectory suffer social, emotional, and psychological distress due to stigma related to cancer, diagnosis and treatment side-effects, survivorship issues etc. Therefore, psychological distress needs to be assessed on a regular basis to understand the reason and severity of the problem in order to help the individuals.

Distress is an unpleasant experience of a physical, mental, social, or spiritual nature. It can make it difficult for someone to cope with having cancer, its symptoms, treatment, both curative as well as side effects. This  affects their survivorship and hence it impacts the entire family.  Distress affect one across the range of experience. It varies from mild to severe, which includes sadness, fear, and helplessness with intensity.

Everyone with cancer has some level of distress at some point of time. Not only the patient but their caregivers too experience some level of distress during and after the course of illness, Moreover, distress extends along the continuum, ranging from common normal feelings of vulnerability, sadness, and fear to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual issues.

The 6^th vital sign

Vital signs like body temperature, pulse or heart rate, blood pressure, and respiratory rate are four physical vital signs that are routinely measured to best described as a patient’s physical status. Pain is designated as the 5^th vital sign as being very common symptom in cancer, and distress being highly prevalent in cancer, is designated as the 6th vital sign.

Forty percent of patients diagnosed with cancer experience significant level of distress.  However fewer than 10% of patients are identified and referred for appropriate psychosocial support. Screening for distress is important for every patient at the appropriate time, and this needs to be managed by health professionals with the required expertise.

This becomes clinically significant when it interferes with the patients’ general functioning with their cancer treatment or with their progress in cancer care. It can be influenced by many factors such as type of cancer, stage of cancer, type of treatment, individual characteristics such as patients’ personality, available social support, financial conditions etc. Psychological distress is common as patient with cancer move beyond their diagnosis and into the intensive treatment. Distress is very common among cancer patients across diagnosis and across the disease trajectory. Psychological distress is common in cancer patients; however, it is often unrecognized and untreated.

Vulnerability to distress

Patients are vulnerable to distress at various stages of the disease trajectory, since they face the risk of substantial and permanent physical impairment, disability, and inability to perform routine activities. Investigation periods/ process and finding out diagnosis, getting treatment and facing its side effects are the stages when patient’ vulnerability is high. Stressor of the survivorship, as the constant fear of recurrence or relapse is always there.  Getting back to the normalcy also becomes a challenge for many people surviving cancer.

Distressed patients tend to make extra visits to the physician and hospitals. Often, they seem to have trouble making decisions about treatment and adhering to the treatment. Patients also become dissatisfied with their physicians and medical care when in distress.

Role of the psycho-oncologist

Early diagnosis and Psycho-oncology services help the patients in theenhancement of treatment satisfaction and helps them cope with the accompanying emotions. It also helps in improving patients – physician communication, respect, and trust. Additionally Psycho oncology services are also helpful in improving patients’ adherence to the treatment regimen and survivorship issues. 

Summary

Psycho oncology is a specialty which is concerned with the understanding and treating the social, psychological, emotional, spiritual, quality of life and other functional aspects of cancer from prevention to palliation and survivorship. Hence it focuses on improving the mental health of individuals who are diagnosed with cancer and their caregivers.   Cancer affects not only to an individual, but it affects the entire family. Hence it becomes imperative to care for the caregivers as well. Patients admitted in the hospital for cancer directed treatment are regularly seen by psycho-oncologist. Therefore, regular screening of distress helps understanding the severity and specific area due to which psychological issues and concerns arise and helps to plan the better intervention for the same.

Author: Keshav Sharma

Psycho oncologist & Lead counselling services
Bagchi Karunashraya Palliative Care Center
Bhubaneswar, Odisha,  India

In a day and age like ours, good lifestyle practises are comprised. We have breakfast that is instant, processed and easy to eat, on the go, work long hours while sometimes skipping meals, stay up late and grab just a few winks and most importantly, do not find time to exercise or meditate. We are caught up in a race for time, money, power and in general, life itself. When on the one hand technological advancements have made life easier, they have also successfully tipped the scale onto the other side with the plethora of side effects their existence brings with them.

It’s not of surprise that unhealthy lifestyles have paved paths for the onset of different types of diseases, cancer being most prevalent among them. We’ve all heard our friends or family members say that the incidence has exponentially increased over the last decade or two. Of course, there are other causes for cancer such as pollution, food adulteration, lack of hygiene, tobacco and alcohol abuse, and the list goes on.

Cancer Research

Cancer related mortality is a hot subject of research conducted in various universities the world over and many a time, in collaboration with the WHO. A study on the Indian cancer statistics conducted by The Lancet in year 2012, reported a staggering 5,55,000 cancer deaths in India, in 2010 alone. Also, research led by Dr. Prabhat Jha, the Director for Centre for Global Health Research, St. Michael’s Hospital, Toronto, in year 2012 resulted in a model that is now being used as a reference to compute cancer deaths in India. They employed a unique method of arriving at statistics by extrapolating information derived from studying cancer patterns and mortalities in our country between years 2000 and 2003, using a sample of households. Another notable agency is the International Agency for Research on Cancer (IARC) whose GLOBOCAN database forms the basis for recording cancer incidences in India. Similarly Dr. Jha’s model is used to study cancer mortalities in India. India Today iterated that cancer deaths worldwide were approximately 8.2 million in year 2012. Indian Council for Medical Research (ICMR) has projected that by year 2020, the total number of cancer mortalities in the country will be nearly 17.3 lakh. In year 2016, the highest number of cancer cases was estimated to be of breast cancer followed by lung cancer. With such daunting statistics in hand proven and projected through research, it is of great relief to come to the realization that advanced medical procedures are now available that have been found to increase the human life span by almost 30 to 40 years. Organizations that specialize in palliative care for terminally ill patients are the new go-to centres for families with patients suffering from chronic illnesses.

Palliative Care in India

In India, the utility of palliative care in improving the quality of life of terminally ill patients took long to be fully recognized by the law. Some key reasons were uncertainty and fear of use of morphine and other opium-based drugs for alleviation of painful symptoms, policies that were existent in the 1980s and 1990s when it began to gain momentum, that strictly prohibited this practice, and a general lack of awareness and interest in the subject. The establishment of the Narcotic Drugs and Psychotropic Substances Act (NDPA) in 1985 further made it difficult to convince the government about the advantages of palliative medicine. Eventually, the central government initiated measures to implement it but its instructions to the state governments to soften their narcotic regulations fell on deaf ears. The NDPA has been considerably modified over the years but needs to be implemented effectively by some state governments. Access to opiates remained a problem with some states where they had to gain its access from neighbouring states for their centre’s functioning.

This approach slowly gained popularity in mid 1980s with the advent of “hospice and palliative care movement”. Such care centres were first established in Gujarat in the 1980s following which Indian Association of Palliative Care (IAPC) was formed and till date is considered one of the milestones in the history of palliative and hospice care. This type of treatment is not only directed towards alleviating physiological symptoms but also aims to address psychological symptoms of both patients and their family members.

With a 1.2 billion population, less than 1% of our country’s inhabitants have access to palliative care. Today, Kerala is one of the states in the country to house maximum number of such centres with Tamil Nadu and Karnataka following closely behind. Continued advocacy by the palliative care community bore fruit in 2010 when the Medical Council of India accepted palliative medicine as a medical specialty and announced a post graduate course in the subject. This step was crucial to influencing the expansion of this practise in the country.

Karunashraya

Karunashraya is a non-profit organization in Bangalore, that recognized the need for a care centre for terminally ill cancer patients and made offering free palliative care to them, its mission. It adapts palliative care measures which constitute medical treatment procedures that reduce pain and other agonizing symptoms and improve the quality of life of such patients. The first hospice of its kind in India, their team aims to help patients who seek their support, get a life free of pain and one filled with dignity and peace. Having been operational since year 1995, they offer both inpatient care and homecare with the flexible option of the patient shuttling between the hospice and his/her home. Their work has been acknowledged by 15 awards.

The Team

It is run by a Board of Trustees who leave no stone unturned in dedicating time to this cause and ensuring efficient functioning of the centre’s activities. The organizational structure is orderly and favourable to the mission of providing free palliative care in a manner that gives respect and dignity to the patients. The homecare and inpatient teams comprise well trained and dedicated doctors, multi-disciplinary nurses, physiotherapists, health assistants and social workers who give free palliative care including counseling and non-curative treatment. This endeavour is ardently supported by patron organizations and corporations who extend funds to Karunashraya.

Statistics

They have more than 150 staff members who diligently work day in and day out to tend to their patients in the best manner possible. They have extended inpatient care to as many as 14000 cancer patients and homecare to 3500 patients. Whether inpatient or homecare, their services are free of cost. A good number of volunteers get on board every year to lend their services to this cause.

Education & Research

As is primary to any organization that aims to deliver top quality services, even Karunashraya gives priority to education and research. Since the concept of palliative care is fairly new and was introduced in India only in the 1980s, they pursued and currently have tie-ups with reputed centres and universities such as NIMHANS, Severn Hospice and Cardiff University to leverage and foster education, research and training in the fields of hospice and palliative care.

Located on Old Airport-Varthur Main Road, its calm and clean atmosphere and dedicated workmanship have been testified by the loved ones of many patients who were under their care.

www.karunashraya.org

Old Airport – Varthur Main Road,
Kundalahalli Gate, Marathahalli,
Bangalore – 56 0037, INDIA
Phone: +91 80 4268 5666, 2847 6133, 2847 6509
E-mail: info@karunashraya.org

Have you ever had an ailing family member in your vicinity day in and day out? What would be the first thing you’d do when they’d need help? Surely you’d rush to them and do the needful, possibly help feed them, clean them or just simply have a chat with them.

Care givers and what they do:

The same kind of tasks are done with as much care and love, by caregivers who are trained in the intricacies of care giving for patients suffering from chronic or terminal illnesses.  They literally become the beacons of service-mindedness in their endeavour to deliver their “job”. Their lives revolve around administering medication, booking consultations with doctors and other specialists like dieticians, psychologists, etc. and in some cases, even feeding, bathing and cleaning their patients. They shift focus from themselves to their patient, with a smile. So lost are they in their mission of catering to the needs of the patient they are entrusted with that they often end up not taking care of themselves. Wouldn’t you think such a person who is a personification of patience & care giving should also take care of herself/himself? In fact, caregivers should first take good care of themselves as one cannot take care of another individual unless (s)he is healthy.

Personal Care is Important:

We are always told to eat on time and sleep on time, take our medicines, if need be, on time, regularly exercise, meditate to keep our minds calm and fill our minds with positive thoughts. The simple reason behind this is good health. Imagine the problems that care givers will have to face in case they do not regularly take care of themselves. They might feel exhausted during their work hours, feel weak or fall sick. This is why it is reiterated that they pay as much attention to themselves while they are in charge of another person’s well being.

Effects of Care Giving on the Health & Well-being of the Caregiver:

Unfortunately, many a time the caregivers tend to get adversely affected by their nature of work.  Caregivers handle different types of patients with illnesses of different magnitudes and sometimes for many years. It is bound to have some effect on their well being if they are not constantly aware of their emotions and behaviour. Some repercussions are:

• Sleep deprivation
• Extreme emotions
• Failure to eat or sleep well
• Postponing their own health care
• Stress & anxiety

When we start to wonder about why this happens, we begin to realize that these things sometimes happen without their knowledge. What might be the support available to them?

Support Available to Care Givers:

Many Palliative Care centres extend succour to such caregivers so as to help them cope with their issues.

1. Psychological support – Consultations with psychiatrists and psychologists are made available to them to address their personal problems.
2. Peer Support Groups – Such groups tend to work in relieving stress and strengthening not only the bond between all these people from the same background but, even in personal strengthening. You might know that when you offer advice to another person, you feel you are in a better position than him/her.
3. Caregiver Helpline – Many palliative care centres have a helpline for the caregivers in case of emergencies. This way they can reach out for help when they do not know where else to go.
4. General Training in Palliative Care – Such vocational courses equip students (prospective caregivers) with the skills and knowledge of what they will be dealing with on a day-to-day basis. They are coached on how they should take care of themselves both physically and mentally. Handholding them through this process by giving them an insight into what they can anticipate, generally makes these trainings holistic and helpful in the long run.

When does one find the need to let go or suggest to another person that they must let go of something or someone? It is usually when a circumstance or situation is bound to cause pain, disappointment, sadness or any other emotion that might have a negative impact on us.

It is often challenging to just let go and this is because we tend to relate instances in our lives to some sort of an emotion. The emotions we feel are driven by the nature of the people involved or some past experiences with them, etc.  The same applies even to inanimate possessions. Emotions are not only felt but are perceived from others as well and this is the core of human existence and evolution.

Dealing with the loss of somebody we know can affect us to different extents depending on who they are. This is related to memories or experiences with them. If it is somebody very close to us such as a family member or a good friend, the grief over loss is much deeper than when we lose an acquaintance or a co-worker, when it might come as a jolt and cause brief sadness. Letting go of memories and emotions that remind us of the latter is fairly easier than in the case of the former. Different people have different ways of dealing with grief. Our lives might seem to have come to a standstill but the reality is that it must go on, nevertheless. Thus, it’s imperative that we come to terms with such situations.

General ways by which such suffering can be reduced:

1. Acknowledgment of the emotions that one is feeling at the loss of somebody they know could be a good release mechanism. The emotions could range from anger to lowered confidence to extreme sadness and disappointment. In some other cases, when the death of a loved one follows immense suffering on the part of the departed, many people feel a sense of relief and peace. Some people like to be alone and connect with themselves in order to come to terms with the occurrence. Sometimes, talking about it with another person helps vocalize thoughts and contributes to the process of moving on. Actions like crying actually reaffirm this acknowledgment effort.
2. Channelizing our energy spent on crying and being bitter, towards something more meaningful helps lighten the burden. Some people choose to immerse themselves in social service to spread awareness on their experiences whereas some others find socializing more, meeting new people and engaging themselves in regular routine activities helps them get past this phase.
3. Only when faced head on with such a situation do we realize the worth of the one who has passed and also of those who are still alive, and start pondering on the purpose of life and death. With the right kind of support, this propels us to discover and pursue whatever we discern to be our purpose for this life. Thus, it becomes important to surround ourselves with loved ones during this time of grief.
   In the recent years, scientific advancements and research have gifted us with the concept of palliative care that is extended to terminally ill patients as well as their families. It is a multidisciplinary approach to providing treatment to such patients and facilitates inclusion of positivity and dignity in their last days. Thus, suffering patients and their loved ones receive support from these centres that specialize in medical procedures that alleviate the

When you find out that a member of your family is suffering from a terminal illness, it turns out to be a devastating situation. Many of us don’t know how to react, what to say to each other or the patient or, what to do next. We wish we could just pretend like nothing has changed from yesterday, and behave normally.

 In some other cases, the disease might’ve progressed from bad to worse over a period of time in which case the family will be well aware of the changes that they might have to prepare for. Consultations with doctors generally engage family members of the patient so that:

• they are aware of the characteristics of the disease & its impact on the patient
• they have their consent for suggested medical procedures

There is no way that we can imagine getting through a situation where a family member is terminally ill, without awareness on the disease and its manifestations, a heads up on how soon to expect death, or how we can take care of ourselves and them in the best way possible. It is but evident that the idea of caring for a loved one who might pass on soon is disconcerting and scary. Many of us would’ve rarely encountered that kind of a situation before. All our skills and prowess developed over the years might suddenly seem like they count for nothing.

All of the above might be true. However, there is no need to feel like all hope is lost. There are very many families that handle such predicaments fairly well. Their love for the ailing person invokes a desire to become strong and keep the patient happy in his/her last days. This is an act of bravery and often requires a lot of work & some form of motivation or support from external sources. The good news is that there is support available for such family members, which helps them with realizing and adopting favourable coping mechanisms.

Coping Mechanisms that family members of ailing patients adopt:

When even the slightest of setbacks or problems at work or with friends cause emotional outbursts, it is but common to expect that repercussions of such events take the form of psychological manifestations. Following are some means by which these family members are advised on coping with their situations to help segregate the negatives from positives and focus on the positives.

1. We side with the fact that communication is the key to resolving problems. This saying holds good in this scenario as well. Many family members talk to each other and confide in each other to feel lighter. Knowing that there is somebody who’s shoulder they can cry on is a comforting feeling. Communication may be verbal or written, as long as there is some sort of dialogue between a person and his/her immediate family members. This is categorized as emotion-focused coping strategy. Psychiatrists and psychologists generally offer this form of support.
2. Another approach is cognitive distraction that is also an emotion-focused strategy where certain activities carried out by family members of ailing patients help distract themselves from the painful situation in hand. This primarily limits the attention and concentration of these people and as a consequence, from instinctively reacting to everything that takes place. Again, psychiatrists and psychologists provide support in this direction.
3. Many seek out support groups to meet people from various backgrounds and walks of life, all ultimately dealing with a similar situation of caring for an ailing, beloved family member. This makes for a platform where people can freely share their experiences, emotions and hardships and also cry as it is central to coping strategies to get the weight off one’s chest. All the people in such groups understand each other’s situations and circumstances well.
4. Many of us have faith in god or some form of divine intelligence. There are spiritual groups that bring together people from the same faith and take them through prayers and spiritual discussions that aim at health appraisal. It helps to keep ourselves connected to that faith through worship at a holy place or just spending a few minutes everyday, on prayers. You might want to take some alone time to do some reflection on the day’s happenings and introspect on your behaviour and reactions to situations. Spiritual growth and connection with oneself makes for good grounding and maintenance of favourable mental health. You cannot give until you have!

These mechanisms work differently on different individuals considering the backgrounds we might be from, the strength of the relationship shared with the ailing family member, our upbringing and environment exposed to over the years growing up. Although above mentioned strategies are generally adopted, often psychiatrists and psychologists customize their application by these family members, for best outcomes.