Mental(ity) Testing

Following the murder of a senior police officer at Mumbai’s Vakola Police Station by a colleague (who went on to commit suicide), Mumbai Police Commissioner Rakesh Maria set in motion mental health evaluations for the Mumbai Police force. This implied assembling trained mental health professionals to conduct comprehensive psychological tests on thousands of police personnel in Mumbai. Initial screening would determine which individuals would require further assistance, through awareness lectures and individual treatment. In fact, a senior psychiatrist also wrote an open letter suggesting several ways to curb suicides and promote mental health in the force.

However, how do you screen for mental illness? Typically through a questionnaire or a psychological test. The salient features of such tests are high reliability (consistency in measurement) and validity (they measure what they are supposed to measure). For instance, if you are asked a series of questions about your appetite, sleep patterns, changes in mood, or increasing disinterest in things you usually liked, you’re probably being screened for a mood disorder (depression). Such screening instruments have been developed keeping in mind the science of psychometrics (psycho meaning related to the mind, and metric meaning related to measurement). In essence, these are tools developed for psychological measurement, and have to be administered, scored, and interpreted by trained mental health professionals.

Returning to the mental health check-ups for the police, the tests included questions on physical and mental health, personal and emotional problems, and alcohol use. Tobacco use, which is on the rise among police personnel, was not mentioned as an area of assessment. Such test content is riddled with problems. For instance, it was unclear whether these tests had been translated into Marathi from standardized assessment tools, or were a set of compiled questions. The reason I raise such questions is because the psychometric sensitivity and specificity of such tools is paramount to the efficiency and success of any mental health screening. This basically means that the tests should be able to adequately discriminate between individuals who experience symptoms and those who do not. In the absence of standardized tools, we cannot claim with certainty which personnel require further assistance with mental health interventions; this is because we will not know above which cutoff score the individual’s score must lie, to require further assessment. Similarly, non-standardized psychometric tools runt the risk of being arbitrary when it comes to setting cutoff levels.

Let me explain this with an example. Imagine you’re playing a video game, where you have to collect a certain number of points to advance to the next level. This number is determined by averaging several other players’ scores on the same game. So if you’re above the average score, you’ll move to the next level. Now, unless you have data on other players’ scores (through research), you will not be able to determine the average, which is like the cutoff. If your score on a psychological test (the cumulative number of symptoms you experience) is above average (more than the cutoff), you need to go to the next level (individual treatment and therapy. This may be a crude analogy, but the necessity of having uniform tests for mental health screening, with cutoffs, had to be emphasized.

Using standardized psychometric tests is the first step. The second is to ensure that trained professionals interpret the test results; the dearth of such professionals can be addressed in another post. If the Local Arms Deputy Commissioner wants to allow only mentally fit personnel to be allocated firearms, then the criteria of mental fitness must be clearly defined, in a consistent and valid manner. A recent instance of a lack of face validity (the test does not “look” like it is measuring what it is supposed to measure) occurred with when Air India aspirants claimed that the 10-minute oral test with a psychologist asked irrelevant questions of them. Apparently, questions like “what does your father do?” were asked, which are regular fixtures in job interviews, but definitely not in psychometric assessments.

On the bright side, the DGCA is contemplating regular psychometric tests for pilots, in light of the Germanwings suicide-homicide. Although such evaluations are conducted upon induction into airlines (policy demands it), subsequent testing is absent. Physical health, on the other hand, is assessed every six months, which is characteristic of the lopsided emphasis on the body in lieu of the mind. However, as the DGCA is still designing the protocol for mental health screening and testing, it is important that they focus on the psychometric features of the tools. These include reliability, validity, test length, and areas (subscales) assessed by the test. For instance, whether the tool assesses anxiety and mood symptoms, which may be relevant areas for screening. Using available tools, like the General Health Questionnaire (GHQ) or the Self-Reporting Questionnaire found to have better discriminability, compared to other similar questionnaires (Patel et al., 2008) can be employed after appropriate translations are completed.

Similarly, private organizations may choose to provide support to their employees via Employee Assistance Programs (EAPs). Such initiatives include using psychometric assessments, such as the GHQ or resilience measures, to screen individuals and provide targeted help for dealing with personal and professional concerns. EAPs managed by external counseling agencies are being incorporated into corporate offices, and the initiative taken by Maria could be reframed as an EAP for government officials. However, for EAPs to be efficient, the psychometric tools used are, needless to say, standardized, reliable, and valid.

Addressing mental health in strictly hierarchical professions having long and erratic working hours is crucial. Another similarity between pilots and police personnel is that they’re meant to be responsible for the security and safety of others. Screening for mental illness is a significant step to combat myths and misconceptions associated with the same. However, such assessment needs to be conducted by psychologists and psychiatrists, using reliable and valid tools. Else, individuals with mental health concerns may go under the scanner, and screening may not be sufficient to prevent another fatal incident.

Hansika Kapoor

Broken Crayons Still Colour

My journey with visual art therapy began three years ago during a workshop when I first met Susan Bolluogh Khare, a strong advocate of person-centred art therapy. Her exhibition in Pune on The Therapeutic Value of Art showcases the role of creative art in the therapeutic process.

One’s expression through art is used to address both psychological and emotional needs of the person in visual art therapy. According to Khare, it is the artistic process that is more important than the final product. Visual art therapy uses art as a medium for expressing oneself through a creative process on the path toward self-awareness. According to Cathy A. Malchiodi in her book Expressive Therapies (2005), art therapy uses traditional psychotherapy and its techniques in union with the creative process to improve one’s psychological health and wellbeing.

During her workshops, Khare urges participants to explore the art medium slowly in the beginning, by letting them to express their feelings through lines and colours. Subsequently through active imagination or the introduction of themes, art therapists like Khare help clients explore emotions like fear, anger, and sadness to get in touch with their senses. Extending emotions to cognition, Lusebrink (2004) explored the relationship between art expression and functions of the brain. The sensory processes involved while making art activates different brain regions, and the expression of art stimulates the kinaesthetic and visual senses in the brain before processing the information through cognition. By letting clients evince themselves through art, they may come to terms with difficult thoughts or feelings that may be at the root of their problems and explore ways to cope with them.

As an art therapist, one is skilled to identify the nonverbal representations and analogies that are communicated through the art form, which might not be as easily expressed in words. Riley (2001) has also shown that many adolescents are more comfortable expressing themselves with visual art than talking about their feelings. Khare emphasizes on the interpretation of the art by the person, who gives it meaning, as opposed to the therapist explaining the piece as followed in traditional projective techniques.

Art as therapy can be employed as a clinical intervention and is effective in treating a variety of symptoms in diverse populations. Creating art as a process in the therapeutic environment offers opportunities for counsellors to build relationships with the client and explore areas that arise from the client’s artwork. The integration of art therapy and solution-focused treatment has proved effective for substance abuse as it blends cognitive and perceptual strategies (Matto, Corcoran & Fassler, 2003). Research by Northwestern Memorial Hospital (2006), found that art therapy allows cancer patients to focus on something positive and gives them something they can control. Thus the process involved in making art is not only therapeutic but helps improve their quality of life and boosts their abilities to cope with stress.

Chapman et al. (2001) found that children receiving art therapy treatment experienced a reduction in acute stress symptoms and Gussak (2009) showed that art therapy greatly improved the mood of inmates by helping them shift to an internal locus of control. Creating art together brings a different synergy to a group and provides the therapist with insight into group dynamics. As prolific as art therapy is in groups, it can also be effectively used in a one-on-one format for personal development, self-exploration, and an in-depth understanding of one’s persona.

Pablo Picasso once said that “Art washes away from the soul the dust of everyday life.” According to Khare, only when we are comfortable working with art as a medium and have explored our personal issues through art, will we be able to effectively work with others. Art therapy is truly an opportunity to explore oneself and develop skills of acceptance and empathy for the people with whom we interact in our daily lives.  

Nikita D'Souza

No Beef For You!

"What is food to one man may be fierce poison to others."

                                                                                             -Lucretius

Food habits are bound to differ in a country as multicultural as India. In light of the recent Beef ban in Maharashtra, the discourse on food rights becomes a very sensitive topic. There exists a food hierarchy in India that gives vegetarians superiority over their meat eating counterparts. This is largely because there exists a taboo on eating meat; particularly of the cow, an animal revered by the majority Hindu demographic as a sacred symbol. However one needs to keep in mind that food rights are part of a larger conflict that impacts the basic ethos of humanity.

The conflict of animal rights over human rights is real and the humane treatment of animals is at the core of animal rights. However proponents of the beef ban having vested political interests, are concerned about the animal rights of only one animal- the cow. This gentle bovine creature is thus being used as a political vehicle to manipulate the food habits and intimidate the minority. The discourse on beef eating consequently becomes very complex in the Indian context.  And therefore makes it all the more important to accept an ethnocentric view while discussing bovine consumption. The dominant caste Hindu majority regard the killing of cattle with abhorrence and their meat eating brethren with repugnance. Further, these views are often imposed by the dominant castes who belong to a higher socio-economic status and sadly have more power to decide laws that govern cultures. This is reflected in the draconian bills enacted by them that hide behind the façade of animal rights but which only seek to protect animals which this majority considers ‘sacred’. However, the failure to include other animals that are normally consumed to this bill further propagates the notion that the bill seeks to harass and subjugate the minorities to the will of the ruling majority.  

Conversely, Hindus that are a part of India’s largely agrarian economy are much more accepting of selling their cattle to slaughter houses. They represent a remarkably modern outlook. They view the cow as sacred in that it is part of their economic sustainability and viability. Yet they are more attuned to the reality that the lifespan of these animals (that often become akin to family members in the course of their servitude to the farmer) often exceeds their usefulness. Rather than cruelly starve them or leave them as accident risks at the side of busy highways they sell them off to butchers, using the sale money to purchase new cows. It is unfortunate that the butcher community largely consists of the Muslim minority. This serves as fodder to the Hindu majority who believe that minority religions convey unequivocally that God created animals, plants, flowers for the pleasures of man. In doing so, it inevitably flames the fires of communal discord. The economic ramifications of not accepting an ethnocentric view are proving to be very costly. Accounts from many different sources maintain that the largely useless cattle that exist in India today have become more of a liability that an asset in view of our land resources. The beef ban thus puts pressure on an economy that is already struggling to feed its millions who are dying from malnutrition. Beef then manages to serve two purposes, in that it provides a much needed cheap source of protein while simultaneously taking care of our very expensive cattle upkeep. The ban thus appears to be unsympathetic to the plight of the agrarian community and insensitive to the multicultural practices of various communities. The lack of provisions to make up for the loss of livelihood for the communities that are entirely dependent on beef (slaughter, tanning, etc) and the fact that the animal chosen to be the beneficiary of human ‘kindness’ happens to be the symbol of sacredness for the majority culture makes the ban appear politically motivated.

Food is an important part of India’s cultural plurality. It is therefore necessary to remember that meat eating can be considered rational or irrational like any other practice or belief but must be viewed in the context of a culture’s adaptability. The failure to do so might result in the extinction of that culture. Moreover, in an era of advanced capitalism and universalization of democracy, a homogenization of people’s cultural practices would have disastrous consequences and would set up a foundation for communal intolerance. Thus policy makers by adopting ethnocentric views would be able to protect and preserve the animals they so claim to care for while preserving the multicultural heritage that is part of one of the greatest civilizations to exist!

Kimberly Rodrigues