Tag: psychological analysis

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Current Affairs Psychology in Pakistan

Tax Kum Karo: Analyzing the Relationship Between Income, Taxes and Mental Health in Pakistan

Written by Abdullah Qureshi

“If money is the bond binding me to human life, binding society to me, connecting me with nature and man, is not money the bond of all bonds? Can it not dissolve and bind all ties? Is it not, therefore, also the universal agent of separation?”

Karl Marx

Pakistan has entered its 5th unofficial year of economic turmoil. While the steep decline seems to have become lesser so, the decline still continues.

An Introduction to Pakistan’s Economic Woes

The National Accounts Committee (NAC) said that the average income per person went up a little from $1,551 in fiscal year 2023 to $1,680 in 2024. For reference, it was $1,766 in 2022 and $1,677 in fiscal year 2021.

On top of that, the Pakistani government is planning to raise direct taxes by 48% and secondary taxes by 35%.

This indicates an overall level of decline in the per capita income and a stark increase in taxes. To top it off, this decline is also in the midst of economic and political turmoil.

As a response to the proposed budget, many salaried people have resorted to protests. Banners are held high of #taxkumkaro (lower the taxes). These protests are still not as rage-filled as the table talk in Pakistani households.

What brews at the domestic and psychological level is far more debilitating than one can imagine.

These are the bare figures of the problem.

In this essay, I will attempt to assess how income and taxes impact mental health. I will also discuss what this means in the context of Pakistan.

Income and Mental Health

‘Tax Kum Karo’ is not just about taxes.

It is also about the shockingly low income of the salaried class that has to now pay additional taxes.

Low-income populations usually live under stressful situations. These chronic stressors ratchet up the risk of worsening mental health problems. Economic turmoil has long been linked to dissatisfaction with life. Poverty is associated with greater risk of common mental disorders (Adler et al., 2016).

According to the World Bank, 40% of Pakistanis are already living below the poverty line, with another 10 million hovering just above it.

This is a colossal figure. I argue here that it is far more pernicious than just a matter of sustenance.

It is a matter of psychological and philosophical devastation of an entire nation.

First, let us do a bit of groundwork and understand how the economy interacts with psychology.

How does Income Affect Mental Health?

Shields-Zeeman (2021) conducted a study on the linkage between income and mental health. They found that income is associated with reduced psychological distress and improved health.

So, combing this research with the fact that poverty exacerbates psychological issues, this presents us with an ugly cocktail.

How does Mental Health Affect Income?

A decline in mental health has a significant cost in the productivity of a country.

A decline in physical health also has a substantial cost on the economy.

In fact, Poverty is thought to lower people’s ‘cognitive bandwidth,’ which can change how they make decisions and lead to dangerous health behaviors (Schilbach et al., 2016). Knapp and Wong (2020) wrote an entire essay detailing where economics and mental health meet. They cited productivity costs and the cost of illness (COI) as coming through both direct and indirect means.

Moreover, Marcotte & Wilcox-Gök (2001) conclude that 5–6 million workers in the US between the ages of 16 and 54 lose their jobs, don’t look for work, or can’t find work every year because of mental illness. Researchers think that people with mental illness make between $3,500 and $6,000 less a year compared to those who don’t have mental illness.

However, this relationship is even more complex when both directions are considered.

The Complexity

A review by Shields-Zeeman and Smit (2022) found that increases in income were associated with a small improvement in mental health. However, a drop in income had a larger negative influence on psychological well-being.

These findings suggest that the effect of income loss is more detrimental to mental health than an increase in income is for improving mental health.

This has important implications for those living just above or below the poverty line.

Why?

Because a very short drop in income can present these people a substantial risk to income security and mental health.

In Pakistan’s context, these findings have serious implications. This is because a significant amount of people were pushed to a lower socioeconomic class in the last 5 years (Ali, 2022). In fact, many of these crises featured political turmoil and polarization.

Link to Suicide

Another crucial bit of information is that domestic and financial problems are the two most significant reasons for suicide (Naveed et al., 2023). This, in some ways, solidifies a link between financial problems and severe psychological issues.

In fact, it is even more illuminating as the political polarization effects family leadership (Rashid & Rashid, 2024). This in turn could cause many domestic issues. Thus, the economic crisis and the political polarization have both a direct and indirect effect on mental health in Pakistan.

Taxation and Mental Health

Rawls’ (1971/1999) theory of justice says that countries with more progressive taxation had higher ratings of well-being. Meanwhile, countries with less progressive taxation had more negative daily experiences.

This was corroborated by a study conducted by Oishi et al. (2012).

However, in Pakistan, the current taxation is not progressive. This is because, according to the proposed budget, the people who fall inside the ‘middle class’ are also slapped with very similar tax bracket of the more affluent class.

Moreover, many of the taxes actually target the classes which are underprivileged.

The Pakistani Finance Bill was recently changed to raise taxes on business dairy farms and fuel. Builders and investors’ earnings are also taxed at a rate of 10% to 12%. Besides that, there is now a 10% sales tax on office supplies such as notebooks, pencils, pens, ink, staplers, and more.

MNAs’ trip allowances, on the other hand, has gone up from Rs10/km to Rs25/km.

There are also some seemingly ‘soft’ attempts to recover money from those who d o not pay their taxes.

These policies can be seen as pernicious for the people who they do not benefit.

The problem is that the people who do not benefit from this are also the people who no longer possess financial stability.

Another very important finding indicated by Oishi et al. (2012) was that in low income countries, even progressive taxation does not improve well-being.

Trust

It is no secret, however, that these tax demands are not the government’s own policy.

Most of the tax demands arise from the International Monetary Fund’s camp.

The IMF’s key demands include an increase in the tax revenue target, withdrawal of subsidies, taxes on the agriculture sector, increase in levy and taxes on power, gas and oil sectors, privatisation of sick government organisations and units and improving administration, a ministry official was quoted as saying.

The problem here is that this reduces the utility of government action. Once the utility is lowered, so is the level of trust in the population.

Nations are built on philosophical principles. A nation-state that cannot protect its citizens fails to justify its utility.

This can have an even more grievous impact on the national perception of the government. Rothstein and Uslaner (2005) argue that the social trust of a government is in itself a different dimension.

If social trust is lower, many people in the population reject even the better policies. Thus, if the current party in power has any interest in continuing its service in this fragile democracy, their way of handling the economic crisis is failing.

Conclusion

It appears as if the government of Pakistan has yet to understand basic principles of building trust. This trust is not built by documentation on social media about the work trips of chief ministers. Rather, trust is built based on policies which positively affect the people. One could argue that higher taxation is the way to go.

However, when allowances of government officials are increased at the same time, one can question:

Who is the state protecting?

So far, the tentative budget favors the people who are privileged. It allows room for tax evaders. But unfortunately, it strangles those who are already living below reasonable means.

 But the protests of ‘tax kum karo’ rage on. One can only hope that at some point, the middle class could find a way into the power corridors of Pakistan. Perhaps, the people who are suffering the most deserve a chance at ruling.

References

  • Adler, N. E., Glymour, M. M., & Fielding, J. (2016). Addressing social determinants of health and health inequalities. Jama, 316(16), 1641-1642.
  • Knapp, M., & Wong, G. (2020). Economics and mental health: the current scenario. World Psychiatry, 19(1), 3-14.
  • Marcotte, D. E., & Wilcox-Gök, V. (2001). Estimating the employment and earnings costs of mental illness: recent developments in the United States. Social Science & Medicine, 53(1), 21-27.
  • Naveed, S., Tahir, S. M., Imran, N., Rafiq, B., Ayub, M., Haider, I. I., & Khan, M. M. (2023). Sociodemographic characteristics and patterns of suicide in Pakistan: an analysis of current trends. Community mental health journal, 59(6), 1064-1070
  • Oishi, Shigehiro & Schimmack, Ulrich & Diener, Ed. (2011). Progressive Taxation and the Subjective Well-Being of Nations. Psychological science. 23. 86-92. 10.1177/0956797611420882.
  • Rashid, Z., & Rashid, S. (2024). Political Instability Causes & Affects. Pakistan Journal of Humanities and Social Sciences, 12(1), 294-303.
  • Rawls, J. (1999). A theory of justice (Rev. ed.). Cambridge, MA: Harvard University Press. (Original work published 1971)
  • Rothstein, B., & Uslaner, E. M. (2005). All for All: Equality, Corruption, and Social Trust. World Politics, 58(1), 41–72. doi:10.1353/wp.2006.0022
  • Schilbach, F., Schofield, H., & Mullainathan, S. (2016). The psychological lives of the poor. American Economic Review, 106(5), 435-440.
  • Shields-Zeeman, L., Collin, D. F., Batra, A., & Hamad, R. (2021). How does income affect mental health and health behaviours? A quasi-experimental study of the earned income tax credit. Journal of epidemiology and community health, 75(10), 929–935. https://doi.org/10.1136/jech-2020-214841
  • Shields-Zeeman, L., & Smit, F. (2022). The impact of income on mental health. The Lancet Public Health, 7(6), e486-e487.
Categories
Film Entertainment

Is Riley’s Anxiety Justified? – Analysis of the Movie “Inside Out 2”

Riley Anderson. All copyrights of images used in the film belong to Disney and Pixar.

Written by Najwa Bashir

Recently an animated movie named “Inside Out 2” came out and it is all over the internet. From Instagram posts and reels to google YouTube and Google, people are talking about it everywhere. The kids laughed at the intense scenes of the movie

But the adults are seen to be crying at the same scenes!

This is the case especially in the scene where Anxiety seems to have lost control over the situation and Riley gets a panic attack.

Many adults have shared how they could relate to Riley in different situations. However, many scenes in the movie makes us ponder if Riley’s anxiety was justifiable? This article therefore attempts to explain this question by analyzing the movie from the perspective of anxiety.

However, before that, let’s understand what anxiety is.

Anxiety

According to the American Psychological Association (APA), anxiety is a feeling that is marked by stress, worrying thoughts, and changes in the body like higher blood pressure.

Fear and anxiety are not the same thing, but people often use both terms interchangeably. People think of anxiety as a long-lasting, future-focused response to a vague threat, while fear is seen as a useful, present-focused, short-lived reaction to a clear and specific danger (American Psychological Association, 2024).

Feelings of danger, whether they are real or imagined, can cause anxiety. It can cause changes in how you think, feel, and act. When we are in or think we are in danger, our brains release adrenaline, a hormone and chemical messenger that sets off these fear reactions.

This is called the fight-or-flight response. This reaction might happen to some people in tough social situations or when they are thinking about big decisions or events (Felman & Browne,2018).

How Riley’s Anxiety Attempted to Protect Her

First off, anxiety makes Riley make a new friend as soon as she drops off at the college for hockey camp.

This was done in order to prevent the situation where Riley would be left lonely as her friends were going to a different high school. When Joy asked Anxiety why he did that, Anxiety explained; “the next three days could determine the next four years of our lives”. This is not just it, Anxiety also showed the possible worst case scenarios where Riley is sitting alone, eating alone and nobody knows her name except for her teachers, she does not fit in the group of other classmates and so on. This shows how Anxiety was trying to prevent uncomfortable circumstances by preparing for the future in advance.

Extent to Which Riley’s Anxiety Affected Her     

In order to prevent future adversities, Riley’s Anxiety made her leave her best friends on their own and go to make new friends in the high school.

Riley is seen hanging out with them, joining her new friends’ team and even getting her hair dyed like her new friends to fit in. Moreover, she broke her promise of staying together with her best friends, one of her core beliefs. This shows the extent to which anxiety can affect the individual.

Once Anxiety was done ensuring Riley makes new friends for her high school, he begins to analyze the situation of game. Anxiety wanted to make sure Riley is on the team and the coach has positive opinion about her.

However, he could not know about her coach’s opinion without accessing the diary in which the coach wrote everything.

This increased Riley’s anxiety and she started to experience intense symptoms. She felt restless, excessively worried, irritable, and could not sleep, all of which are the symptoms of anxiety (Felman& Browne, 2018).

Anxiety made Riley sneak into her coach’s office and steal her diary. She read what her coach wrote about her and Riley got quite uncomfortable after reading that which made her practice even more.

During the match, she could not concentrate and played so harshly that she hit one of her best friends. The lack of concentration is another symptoms of anxiety (Felman& Browne, 2018). Riley was so disturbed and started doubting her worth. She could remember all negative things about her. This is where Anxiety loses control and Riley gets a panic attack.

The Diagnostic and Statistical Manual of Mental Health Disorders (DSM) explains panic attack as a sudden, strong feeling of fear or discomfort that is over in minutes.

A panic attack is marked by four or more of a certain set of physical signs. Among these symptoms are palpitations (a racing or pounding heart), sweating, trembling, or shaking, shortness of breath or suffocating feelings, choking feelings, chest pain or discomfort, nausea or stomach problems, feeling dizzy, unsteady, lightheaded, or faint, chills or heat sensations, derealization (a feeling of not being in reality) or depersonalization (a feeling of being separate from oneself), fear of losing control or “going crazy,” and fear of dying (Cackovic et al., 2023).

Riley is seen to experience majority of these symptoms. While everything blurs in front of Riley, Anxiety is seem to go crazy and out of control in the headquarters of her mind. He loses control and fails to find any way to get out of the unpleasant situation.

Finally Joy is successful in bringing Anxiety out of the situation and seeing Riley’s condition, which still did not get better, he apologizes.

Anxiety says, “I’m sorry I was just trying to protect her but you are right, we don’t get to choose who Riley is.” This makes her realize, it is not Anxiety’s fault alone, they were all trying to control Riley in one way or the other which way making Riley what she was not. Nevertheless, Riley only got better when all her emotions hugged her and she was allowed to feel each one of them equally.

Is Anxiety’s Behavior Justifiable?

As far as Anxiety’s behavior is concerned, he was just trying to protect her. However, in doing so, he disregarded the need of other emotions in Riley’s life and took the whole situation in his control which just made the situation worse and things began to get off his hands to the extent that Riley got a panic attack.

Anxiety makes Riley modify her feelings to elicit favorable responses from people and adheres to social norms, which exacerbates her anxiety. This is acceptable to a certain extent as Anxiety was trying to protect her from unpleasant future circumstances.

However, keeping Riley’s old emotions away from her was a wrong move. Anxiety must have not done that. Regardless of this, as he said, he was just trying to protect Riley. Despite everything, the other emotions including Joy understood Anxiety and made him understand that certain things are not in Riley’s control and she must not worry about them, rather she should worry and prepare about things that are in her control. This is one way anxiety can be dealt in a positive way. Joy was empathetic enough to understand Anxiety’s perspective and help him do his work but in a better way.

This empathetic behavior is not only exhibited by Joy and other emotions but also Riley’s best friends who forgave her after all she did with them once Riley told them the main reason for her to do that all (her friends were going to a different high school and she did not feel good about it), and Val, her new friend. When people genuinely feel and comprehend what another person is going through, they are more inclined to provide consolation, support, or help. Maintaining and fostering connections in both the personal and professional spheres requires this kind reaction. Riley experiences ups and downs, but everyone around her, including those she tries to impress, shows empathy for her. One such person is Val, who at the same time gives her comfort and causes concern.Val treats Riley gently, consoles her, praises her, and shows her affection despite her uncomfortable and eccentric conduct. All she wants is for Riley to be herself and not live up to the hidden and explicit expectations.

So, Anxiety’s behavior is justifiable although he took some extreme steps (like keeping Riley’s old emotions away from her and taking full control over everything) which he should not have, however, understanding Anxiety’s perspective is also important as he was just doing it to protect Riley.

Conclusion    

Similar to feelings of anger or embarrassment, anxiety is a natural emotional spectrum. Anxiety rarely lasts and usually goes away on its own in teens. However, for other youngsters, it either doesn’t go away or is so severe that it prevents them from going about their daily lives. It’s also critical to keep in mind that anxiety among teens isn’t inherently harmful. Teens who experience anxiety are more likely to think critically about their circumstances, which helps keep them safe. It may also inspire people to strive for excellence. Additionally, it can assist students in preparing for difficult circumstances like public speaking or athletic contests. Anxiety is not always bad, but one needs to be able to control it and prevent it from superseding everything before it is too late and things go out of hands.

Inside Out serves as a poignant and imaginative depiction of Riley’s inner thoughts, showing us that, despite the difficulties we face, a sense of safety and belonging can be fostered by acknowledging and accepting our feelings and placing a high value on wholesome connections.

References

  • American Psychological Association (2024). Anxiety. Available at: https://www.apa.org/topics/anxiety/
  • Cackovic, C., Nazir, S., Marwaha, R. (2023). Panic Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430973/
  • Felman, A., & Browne, D. (2018). What to know about anxiety. Medical News Today. Available at: https://www.medicalnewstoday.com/articles/323454#what-is-anxiety
Categories
Commentary

Analysis: “95 percent of Women in Pakistan are ignorant”

Written by Abdullah Qureshi

In the last days of June, 2024, an episode of Mukalma with Khalil-ur-Rehman Qamar aired on Samaa TV. This show caused ripples of conversation all over the Pakistani internet. Mukalma with Khalil-ur-Rehman is a show which features discussions on various topics. These conversations are usually between the titular writer, Khalil-ur-Rehman, and one or more guests. In this particular episode, the guest was Sahil Adeem.

Sahil Adeem is known as a religious scholar and a psychologist. Over the years, he has publicly appeared in multiple forums. His debate tactics are quite provocative. They often employ derogatory commentary on branches of religious scholarship. However, much of his commentary seems to resonate with many people. I would not deny that he has bits and pieces of information about many different subjects – even if they are misleading.

Sahil Adeem is also a very creative person. He tries to connect scientific discoveries with the Ayat in the Quran. This is not the first time that public figures in Pakistan have tried to do so. Adeem’s own research appears to be limited to anecdotal evidence and pop science.

So, to say that Adeem’s grip, even over pop science or pop psychology, is substantial could be incorrect.

The episode of Mukalma with Khalil-ur-Rehman in question is an example of this.

In this article, I would go over three pieces of evidence highlighting cognitive biases.

Evidence 1: The Validity of the Claim ‘95 Percent of (Muslim) Women in Pakistan are ignorant’

In the most highlighted part of the episode, Sahil Adeem claims that 95% of women in Pakistan are ignorant about Taghut. Taghut in Islam is the concept of focusing on some other being as opposed to Allah (Ahmad, 2009). All in all, Ahmad (2009), drawing on Maududi’s teachings, explains that this concept encompasses the entirety of the state. If any person in the state holds anything ‘above’ Allah in his priorities, he is falling under the ambit of Taghut.

Sahil Adeem claims that most Pakistanis (around 40% of men and 95% of women) do not understand this concept. However, one thing that Adeem fails to mention is that he has no evidence to back this claim.

He has cited no polls. He has cited no studies.

Hence, this claim is a perspective. Perhaps a better way of stating this claim is that it is his hypothesis.

However, even the hypothesis is poorly constructed.

The Issue with Invalid Claims

The entire episode of Mukaalma with Khalil-ur-Rehman has multiple invalidated claims. For example, at a certain point, Khalil-ur-Rehman indicates that 99% of the top brass of media executives are feminists.

This is the demonstration of overgeneralization. Overgeneralization is a cognitive error which is based on incorrectly counting the number of instances. Then, the individual inductively reasons that this is the case for a large population of instances (Franceschi, 2009).

The issues with overgeneralization are multifold.

When you do not operationally define ‘feminists’ or ‘taghut’, you are not clear in what you are measuring. Hence, Sahil Adeem is unlikely to calculate the number of people who understands various levels of this concept.

Secondly, the claims are misleading. They are not proven to be representative of the population. Thus, there is a high risk that your claims are incorrect.

This is particularly harmful if the claim is uttered by people of influence. The opinion-setters of a culture could thus be misleading their audience. Especially in matters of emotional value.

Evidence 2: Intellectual Dishonesty

Not knowing the word ‘taghut’ does not mean one is ignorant about the concept.

While Maududi opposed this, many religious scholars do limit taghut to obeying and/or worshipping of tyrannical authorities or idols. Indeed, in classical Islam, taghut is used in the context of those who consider themselves above the commands of Allah.

“See how they fabricate lies against Allah—this alone is a blatant sin.

Have you ˹O Prophet˺ not seen those who were given a portion of the Scriptures yet believe in idols and false gods and reassure the disbelievers1 that they are better guided than the believers?” (4:50-4:51)

So, are Muslim women and men ignorant about the consequences of holding equals or superiors to Allah?

By claiming that 95% of women are ignorant of this concept, Sahil Adeem is displaying an inability to understand the other person’s arguments.

Issues with Intellectual Dishonesty

Intellectual dishonesty could be defined as willfully tempering with logical arguments. The problem with this is that it indicates biases. When bias is introduced into an intellectual debate, there is a high probability of misrepresenting the core arguments. For example, Adeem’s claim of ‘jahiliyat’ or ignorance in women is substantiated by the argument that his understanding of ‘taghut’ is not already understood by others.

As I have explained earlier, not knowing the word ‘taghut’ is not indicative of ignorance of the concept.

In Sahil Adeem’s case, the most likely bias to cause this is the illusion of explanatory depth. The Illusion of explanatory depth is a cognitive bias in which Adeem could believe that his explanation of ‘taghut’ has more depth than another individual’s concept (Rozenblit & Keil, 2002). This makes him disregard the fact that many muslims already have the idea or even a more substantiated idea of taghut.

This is why I would want to properly represent the opposition’s arguments.

I would have to understand the other perspective. If one does not understand the other perspective, he/she cannot argue with logic. This makes the debate less productive and insightful.

Evidence 3: Focus on Provocation  

Focus on provocation compromises scientific and intellectual validity in a debate. Provocative statements, however, can be reinforced more heavily.

To claim that 95% of (muslim) women in Pakistan do not understand a major sin in Islam can be reinforcing.

It is reinforcing because people respond more to these claims. Whether people rebut or agree, it seldom matters as long as it gets an emotional reaction.

Unfortunately, there are seldom any checks put on shows in the Pakistani context. Political commentary is fact-checked in a somewhat bipartisan manner. However, the religious commentary is not. Social commentary is also not fact-checked as rigorously as it should be.

This allows commentators to give out provocative statements regularly.

The female host of the show provided some pushback. But these rebuttals were not about the validity of the information that both Khalil-ur-Rehman and Sahil Adeem handed out. Moreover, the panelists seemed to agree on the point that Aurat March featured placards that were ‘obscene.’

At one point, Khalil-ur-Rehman eluded that these cards were made for prostitutes. While my perspective on sex work remains largely amoral, I understand that remarks like these could be considered derogatory. 

But the writer faced no pushback on this claim.

Issues with Provocative Statements

While Khalil-ur-Rehman does not consider himself to be a scientist, Sahil Adeem does. Adeem has claimed at multiple points that he is a psychologist. Psychology is a behavioral science and thus to pose as an authority in that could give credence to certain claims.

The issue with scientists using certain provocative statements is that this compromises their neutrality. A provocative statement can often misconstrue certain facts. In fact, a focus on provocation could even ‘create’ false facts.

Conclusion

The interview reflected the state of television, its regulation, standards of content and reliance on sensationalism. One particular point that really stuck with me was the ease by which this show allowed misinformation by the guests and the hosts. At the end of the day, the ratings and views stacked up. One question remained:

What did we really learn about women’s rights?

Perhaps at a certain point of the future, this issue would be addressed. However, looking at the current specimen, I am not optimistic. Sensationalism is a powerful tool of journalism. But I believe that sensationalism in scholarship, as demonstrated by Sahil Adeem, is indicative of poor standards.

One can still hope that new standards could be set. I, for one, have hope even if it is in futility.  

References

  • Ahmad, I. (2009). Genealogy of the Islamic state: reflections on Maududi’s political thought and Islamism. Journal of the Royal Anthropological Institute, 15, S145-S162.
  • Franceschi, P. (2009). Theory of Cognitive Distortions: Over-Generalization and Mislabeling.
  • Rozenblit, L., & Keil, F. (2002). The misunderstood limits of folk science: An illusion of explanatory depth. Cognitive science, 26(5), 521-562.

Written by Abdullah Qureshi

Categories
Psychiatric Disorders

Diagnostic Features of Social (Pragmatic) Communication Disorder

Written by Najwa Bashir

In the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a new condition called Social (Pragmatic) Communication condition (SPCD) was added. Individuals with this disorder have problems with their pragmatic communication skills (Amoretti et al., 2021). Individuals with this condition, which is a type of Communication Disorder (CD), have a major issue with their functional skills in a broad sense. Sometimes people with SPCD have trouble communicating with others, can’t change what they say depending on the situation, and have trouble following the rules of speech (American Psychiatric Association, 2013, p. 47).

Children who don’t meet the standards for an autism spectrum disorder may have social problems when they talk to others. This is referred to as social (pragmatic) communication disorder (Flax et al., 2019). In the past, before DSM-5, three types of behavior were needed to diagnose ASD: interacting with others, communicating, and restricted, repetitive, or stereotypical behaviors. Communication and social interaction have been combined into a single criterion called “Social Communication,” with structure language used as an additional descriptor. The RRB criteria have stayed mostly the same, with the addition of sensory problems and behaviors that were not in DSM-IV. The term “Social Pragmatic Communication Disorder” (SPCD) was created to include kids who didn’t meet the new criteria for ASD but might have met criteria for DSM-IV, and PDD-NOS in the past, such as having limited hobbies and doing the same things over and over again (Swineford et al., 2014). ASD 299.00 (F84.0) or Language Disorder 315.39 (F80.9) are not the only problems that kids with SPCD have when it comes to communicating with others. As Flax et al. (2019) say, SPCD is a developmental condition that causes problems with social, vocal, and nonverbal communication.

Prevalence

Not much is known about how common SPCD is in the general population using DSM-5 criteria right now. Also, there isn’t much known about what functional effects come from weaknesses in certain types of social-pragmatic communication (Adams et al., 2015). South Korean kids ages 7 to 12 who were evaluated for autism had SPCD in 0.5% of the cases (Kim et al., 2014). A clinical group of kids with autism was screened, and only 8% met the standards for SPCD. Most of these kids had major behavior problems (Mandy et al., 2017). The structure language skills, on the other hand, were not reviewed independently (Saul et al., 2023).

Functional Impairment

Many kids who have problems with social and pragmatics also have issues with their behavior and emotions (Mandy et al., 2017). Gemillion and Martel (2014) also say that kids who have behavior problems often have issues with speaking, social skills, and everyday life skills. Some people have said that social-pragmatic skills help connect structured language to behavior, especially in poor areas (Law et al., 2014). It has also been said that social and functional communication skills are important for getting ready for school (Pace et al., 2019). These skills play a big role in how well kids do in reading and math at a young age and in their ability to control their emotions (Ramshook et al., 2020). As expected, kids with SPCD have trouble with schoolwork, especially reading (Freed et al., 2015), because they need to use their social cognitive and inferencing skills to understand what they read. So far, research has shown that social-pragmatic deficits are linked to other developmental issues that raise the risk of bad outcomes. This shows how much SPCD might cost the public health system and how important it is to plan good health and education services for kids who have these problems (Saul et al., 2023).

Diagnostic Criteria for Social (Pragmatic) Communication Disorder

According to DSM 5 TR (APA, 2022), the following are the diagnostic criteria for social (pragmatic) communication disorder:    

A. People who have persistent problems with social verbal and unconscious interactions show it in the following ways:

  1. Problems making friends and communicating in a way that fits the social situation, like saying hello and sharing information.
  2. Being unable to change the way you talk depending on the setting or the person you are talking to includes not using too much serious language, talking differently in a classroom than on the field, and talking differently to a child than to an adult.
  3. Problems following the rules for talking and sharing stories, such as being patient, asking questions when something isn’t clear, and knowing how to use spoken and silent hints to manage interactions.
  4. Difficulty understanding subtext (like making conclusions) and unclear language (like puns, jokes, metaphors, and words that can mean more than one thing depending on the context).

B. The problems make it hard to communicate, meet new people, form relationships, do well in school, or do well at work, either on their own or together with other problems.
C. The signs start in the early stages of development, but the problems might not show up fully until they have to deal with social situations that are too hard for them to handle.
D. The symptoms aren’t caused by another neurological or medical condition or by not being good at grammar and word structure. They also don’t fit better with autism spectrum disorder, intellectual developmental disorder (ID), global developmental delay, or another mental disorder.

Diagnostic Features of Social (Pragmatic) Communication Disorder

Drawing on DSM 5 TR (APA, 2022), here are the signs  that someone has  childhood fluency disorder:

  • Finding it hard to understand pragmatics, which is the social use of words and conversation. This shows up as problems understanding and following the rules of both spoken and unspoken communication in real-life situations, as well as changing their language to fit the listener’s needs or the situation, and following the rules for conversations and telling stories.
  • Due to problems with social communication, people can’t communicate effectively, participate in social activities, make friends, do well in school, or do their jobs successfully. There is no better way to understand the problems than by having low skills in structural language, cognitive ability, or autism spectrum disease.

Associated Features

Below-mentioned are some associated features of social (pragmatic) communication disorder:

  • Language impairment, which means falling behind in language stages and having structured language problems in the past or present, is the most common social (pragmatic) communication disorder trait.
  • People who have trouble communicating with others may avoid social situations.
  • People who are affected are also more likely to have attention-deficit/hyperactivity disorder (ADHD), mental and behavioral problems, and certain learning issues.

Looking at the prevalence scores of this disorder, it appears that the condition is not diagnosed much and there have not been enough studies on it. However, the aforementioned diagnostic criteria and features can help spot individuals with SPCD so professional treatment can be sought in time.

References

  • Adams, C., Gaile, J., Lockton, E., & Freed, J. (2015). Integrating language, pragmatics, and social intervention in a single-subject case study of a child with a developmental social communication disorder. Language, Speech, and Hearing Services in Schools, 46(4), 294-311. https://doi.org/10.1044/2015_LSHSS-14-0084
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • Amoretti, M. C., Lalumera, E., & Serpico, D. (2021). The DSM-5 introduction of the Social (Pragmatic) Communication Disorder as a new mental disorder: a philosophical review. History and Philosophy of the Life Sciences, 43(4), 108. https://doi.org/10.1007/s40656-021-00460-0
  • Flax, J., Gwin, C., Wilson, S., Fradkin, Y., Buyske, S., & Brzustowicz, L. (2019). Social (pragmatic) communication disorder: Another name for the broad autism phenotype? Autism, 23(8), 1982-1992. https://doi.org/10.1177/1362361318822503
  • Freed, J., Adams, C., & Lockton, E. (2015). Predictors of reading comprehension ability in primary school-aged children who have pragmatic language impairment. Research in developmental disabilities, 41, 13-21. https://doi.org/10.1016/j.ridd.2015.03.003
  • Gremillion, M. L., & Martel, M. M. (2014). Merely misunderstood? Receptive, expressive, and pragmatic language in young children with disruptive behavior disorders. Journal of Clinical Child & Adolescent Psychology, 43(5), 765-776. https://doi.org/10.1080/15374416.2013.822306
  • Kim, Y. S., Fombonne, E., Koh, Y. J., Kim, S. J., Cheon, K. A., & Leventhal, B. L. (2014). A comparison of DSM-IV pervasive developmental disorder and DSM-5 autism spectrum disorder prevalence in an epidemiologic sample. Journal of the American Academy of Child & Adolescent Psychiatry, 53(5), 500-508. https://doi.org/10.1016/j.jaac.2013.12.021
  • Law, J., Rush, R., & McBean, K. (2014). The relative roles played by structural and pragmatic language skills in relation to behaviour in a population of primary school children from socially disadvantaged backgrounds. Emotional and Behavioural Difficulties, 19(1), 28-40. https://doi.org/10.1080/13632752.2013.854960
  • Mandy, W., Wang, A., Lee, I., & Skuse, D. (2017). Evaluating social (pragmatic) communication disorder. Journal of Child Psychology and Psychiatry, 58(10), 1166-1175. https://doi.org/10.1111/jcpp.12785
  • Pace, A., Alper, R., Burchinal, M. R., Golinkoff, R. M., & Hirsh-Pasek, K. (2019). Measuring success: Within and cross-domain predictors of academic and social trajectories in elementary school. Early Childhood Research Quarterly, 46, 112-125. https://doi.org/10.1016/j.ecresq.2018.04.001
  • Ramsook, K. A., Welsh, J. A., & Bierman, K. L. (2020). What you say, and how you say it: Preschoolers’ growth in vocabulary and communication skills differentially predict kindergarten academic achievement and self‐regulation. Social Development, 29(3), 783-800. https://doi.org/10.1111/sode.12425
  • Saul, J., Griffiths, S., & Norbury, C. F. (2023). Prevalence and functional impact of social (pragmatic) communication disorders. Journal of Child Psychology and Psychiatry, 64(3), 376-387. https://doi.org/10.1111/jcpp.13705
  • Swineford, L. B., Thurm, A., Baird, G., Wetherby, A. M., & Swedo, S. (2014). Social (pragmatic) communication disorder: A research review of this new DSM-5 diagnostic category. Journal of neurodevelopmental disorders, 6, 1-8. https://doi.org/10.1186/1866-1955-6-41
Categories
Psychiatric Disorders

Diagnostic Features of Childhood-Onset Fluency Disorder (Stuttering)

Written by Najwa Bashir

Stuttering

Sometimes called stammering and more generally disfluent speech, stuttering is a speech condition marked by repeating sounds, syllables, or words; sound delay; and speech breaks called blocks (NIDCD, 2017). The childhood-onset fluency disorder is a chronic change in the normal flow and timing of speech that is not proper for the person’s age (American Psychiatric Association, 2013 as cited in SheikhBahaei et al., 2022).

Individuals who stutter know exactly what they want to say but struggle to organize it smoothly. People with trouble speaking may also show signs of stress, like blinking their eyes quickly or trembling their lips. People who stutter may find it hard to talk to others, which can impact their quality of life and ties with others. Stuttering can also make it harder to get a job which can negatively impact your chances of getting hired, and treatment can cost a lot of money. People who stutter can have very different symptoms at different times of the day. Most of the time, stuttering gets worse when someone speaks in front of a group or on the phone. On the other hand, singing, reading, or speaking in unison can briefly make stuttering better (NIDCD, 2017).

Differences in the structure, function, and control of dopamine in the brain have been linked to stuttering. These differences are thought to be genetic. It is important to make sure that the right evaluation or recommendation is made for children because more and more people agree that starting speech therapy early for kids who stutter is very important. For adults, stuttering can be linked to a lot of mental and social problems, like social nervousness and a low quality of life. Recently, pharmacologic treatment has gotten a lot of attention, but there isn’t a lot of clinical evidence to back it up. Speech therapy is still the most common way to help kids and adults (Perez & Stoeckle, 2016). The number of people who have DS depends on their age and the exact meaning of stuttering that is used. The most common number given is a lifetime frequency (chance that a person will ever stutter) of 5%. However, new information suggests that the total frequency is more like 10% (Yairi & Ambrose, 2013), with kids being most affected. Up to 90% of kids who stutter (CWS) will get better on their own as kids. Persistent DS is when an adult did not heal from DS as a kid. This happens to less than 1% of the population (Yairi & Ambrose, 2013). Stuttering that is thought to be caused by mental stress or brain damage is less common, but no one knows how common it is (Theys et al., 2011). According to Yari and Ambrose (2013), men are four times more likely than women to have DS, and men are also more likely to have it last longer than women. Other things that can help you tell if someone will continue with stuttering are a late start age, longer length of stuttering, a family history of persistence, and lower language and nonverbal skills (Yairi et al., 1996). It is very important to diagnose children right away because early treatment has the best results (Weir & Bianchet, 2004).

Diagnostic Criteria for Childhood-Onset Fluency Disorder

According to DSM 5 TR (APA, 2022), the following is the diagnostic criteria for childhood-onset fluency disorder:

A. Disturbances in the regular flow and timing of speech that aren’t acceptable for the person’s age or language skills, last a long time, and are marked by one or more of the following happening often and clearly:

  1. Repetition of sounds and syllables.
  2. Sound expansions of vowels and consonants.
  3. Broken words (e.g., stops within a word).
  4. Audible or silence blocking (filled or unfilled breaks in words).
  5. Circumlocutions are word changes that get rid of troublesome words.
  6. Words that are spoken with too much physical stress.
  7. Whole words that repeat on one syllable, like “I-I-I-I see him”

B. The problem makes people nervous about saying out loud or makes it harder for them to communicate, interact with others, or do well in school or at work, either on its own or in combination with other problems.
C. Symptoms start in the early stages of growth. Note: cases that start later are called F98.5 adult-onset speech disorder.
D. It’s not caused by a problem with speech, movement, or senses; it’s not slurred speech from a brain injury (like a stroke, tumor, or trauma); it’s not caused by another medical condition; and it’s not better explained by another mental disease.

Diagnostic Features of Childhood-Onset Fluency Disorder

In the light of DSM 5 TR, the following are the diagnostic features of childhood-fluency disorder:

  • A main feature of childhood-onset fluency disorder (stuttering) is a change in the usual flow and timing of speech that isn’t proper for the person’s age.
  • This disorder is marked by repeated or prolonged sounds or syllables and different kinds of speech problems, such as broken words (like pauses within a word), audible or silent blocking (like filled or unfilled pauses in speech), circumlocutions (like changing words to avoid problematic ones), words made with too much physical tension, and repeated monosyllabic whole-words (like “I-I-I-I see him”).
  • The problem with speech could make it harder to do well in school or at work and to talk to other people.
  • Situationally, the level of disturbance changes, and it’s usually worse when there’s extra pressure to talk (like when you have to give a report at school or talk about a job).
  • Most of the time, dysfluency doesn’t show up when reading out loud, singing, or talking to pets or inanimate objects.

Associated Features

The associated features are as follows (APA, 2022):

  • Individuals may start to fear the problem before it happens.
  • Disfluencies can be avoided by changing the rate of speech or ignoring certain words or sounds. The speaker may also try to avoid certain speech situations, like talking on the phone or in public.
  • Not only do worry and anxiety make dysfluency worse, they are also symptoms of the disease.
  • Motor movements may happen along with a childhood-onset fluency disorder. These can include eye blinks, tics, twitches of the lips or face, jerks of the head, breathing movements, and tightening of the hand.
  • There are different levels of speaking skills in kids with speech disorders, and it’s not clear what the link is between the two. Studies have shown that kids who stutter have differences in both the structure and function of their brains. Estimates vary based on age and the possible cause of stuttering, but men are more likely than women to stumble.
  • Stuttering has many causes, some of which are genetic and some of which are neurological.

Conclusion

The childhood-onset fluency disorder is a serious concern as it can cause trouble in communication, academics, and overall functioning of the children, either directly or indirectly. Therefore, it is important to take the signs and symptoms of stuttering seriously and seek treatment immediately.

References

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
  • NIDCD (2017). Stuttering. Available from: https://www.nidcd.nih.gov/health/stuttering#:~:text= Stuttering%20is%20a%20speech%20disorder,a%20normal %20flow%20of%20speech.
  • Perez, H. R., & Stoeckle, J. H. (2016). Stuttering: clinical and research update. Canadian family physician, 62(6), 479-484. Available from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907555/
  • SheikhBahaei, S., Millwater, M., & Maguire, G. A. (2023). Stuttering as a spectrum disorder: A hypothesis. Current Research in Neurobiology, 5, 100116. https://doi.org/10.1016/j.crneur.2023.100116
  • Theys, C., Van Wieringen, A., Sunaert, S., Thijs, V., & De Nil, L. F. (2011). A one year prospective study of neurogenic stuttering following stroke: incidence and co-occurring disorders. Journal of communication disorders, 44(6), 678-687. https://doi.org/10.1016/j.jcomdis.2011.06.001
  • Weir, E., & Bianchet, S. (2004). Developmental dysfluency: early intervention is key. Cmaj, 170(12), 1790-1791. https://doi.org/10.1503/cmaj.1040733
  • Yairi, E., & Ambrose, N. (2013). Epidemiology of stuttering: 21st century advances. Journal of fluency disorders, 38(2), 66-87. https://doi.org/10.1016/j.jfludis.2012.11.002
  • Yairi, E., Ambrose, N. G., Paden, E. P., & Throneburg, R. N. (1996). Predictive factors of persistence and recovery: Pathways of childhood stuttering. Journal of communication disorders, 29(1), 51-77. https://doi.org/10.1016/0021-9924(95)00051-8
Categories
Current Affairs

The Establishment: A Pakistani Archetype

Written by Abdullah Qureshi

“The power of a popular delusion lies in its ability to tap into the deepest fears, desires, and insecurities of a society, offering a false sense of security or hope in the face of uncertainty.”

Charles Mackay (1832)

Over the course of Pakistan’s history, many institutions have been critiqued. Zulfiqar Ali Bhutto laid much of the blame on bureaucratic corruption. As soon as Bhutto took power, he fired 1,300 civil servants without a hearing. This is testament to his disdain for the CSP cadre (Ansari & Bajwa, 2019).

Then, the Shareef brothers have at multiple times put the blame on impartial judicial processes. More recently, Imran Khan (and much of the military presidents) blamed politicians for Pakistan’s dire economic straits.

Many of these critiques are fair.

However, there is one institution, universally lambasted since the beginning of this country.

The establishment.

The Evergreen Villain

The establishment is considered to be the ultimate boogieman. It is an organization which topples powerful governments, controls politics from the barracks and eats up all the resources. Politicians seem to fear the establishment. Those who seem to go against their plans are ousted from office on bogus charges. Worse, they are often exiled and some are killed.

Here are some questions for people who prop up this image of ‘the establishment’:

Do the cases against politicians hold merit?

If the person you oppose was charged with a similar crime, would it still be as unbelievable?

Do you believe the establishment should be neutral?

Has your ‘political favorite’ committed acts that undermine the security of your country?

Is the government machinery free of corruption, in general?

If you genuinely take the time to answer these questions you will realize one very important thing.

Human beings are biased. According to Lawrence Kohlberg (1963), a renowned developmental psychologist, humans start adhering to a moral view of the world, fairly early in their lives. By the early adolescence, they start developing the conventional morality. They subscribe to societal norms because they allow them to function. This social teaching predisposes us to have certain biases.

It is very easy to stay at the conventional stage. It is very easy to label things as ‘good’ or ‘bad’. In fact, doing so would allow you to stall cognitive dissonance for a long time.

Until, you are forced to encounter reality.

The reason why the ‘establishment’ is the villain, is because it is easy to consider them so.

If we accept that the establishment is to blame for everything, we allow ourselves freedom to not think.

Why would anyone want to think about their own sins? Sins that they can be held accountable for.

The Establishment vs the Innocents

Often in Pakistan, when someone talks about the establishment, they refer to the military. They think back to the 3 decades of military regimes in Pakistan’s history. There is no question that such breaks in democracy do make governance difficult.

However, is it not true that political actors have played a fair share in impulsive decision-making? Is it not true that counterproductive policies, like the creation of the Federal Security Force in the 1970s, did more harm than good?

A sitting prime minister decided to head to the streets because a new army chief was being instated. If this is the regular behavior of a prime minister, many political idiocies can be justified.

One also has to wonder whether prime ministers are afforded license to kill. If not, then how can anyone justify a Prime Minister’s orders to stop a plane in mid air, carrying the chief of the army?

While the prime minister is the top official, he is not allowed to have someone killed. Just letting you know, in case we have forgotten basic values at this point.

Philosophical Suicide of the Intellectuals

More educated and aware journalists and academics also talk about the role of the judiciary and/or the bureaucracy. However, in some ways, they commit philosophical suicide when they still use the word ‘the establishment’.

The Sapir-Whorf hypothesis argues that the language we speak determines our experience (Sapir, 1836). There is also the psychological concept of self-fulfilling prophecies. If you keep repeating to yourself that something will happen, that something eventually does happen.

‘The establishment’, has unfortunately become a part of our language. We have accepted the complete dominance of one institution. The establishment has been the boogieman for too long a time.

Reality Check

To find a solution to the political instability in Pakistan, it is important to break the archetype of the establishment. Are we sure that civilian governments have delivered what was required of them? Are we sure that the red tape in the bureaucracy is justified? Are we sure that the judiciary is impartial?

Statistics point towards one single answer: no.

In 2023, Transparency International Pakistan (TIP) conducted a National Corruption Perception Survey (NCPS). The results are very telling.

According to the National Corruption Perception Survey 2023, the police are still the most corrupt department (30%). Tendering and Contracting came in at number two (16%), and the judiciary came in at number three (13%).

None of these sectors consider themselves part of the establishment. 

Yet, they are infringing upon the boundaries of their professions which are specifically meant for justice.

Has the establishment pointed a gun to their heads and made them glutton down resources?

It Wasn’t Me, It Was Them!

The establishment is the altar where we wash our sins as a nation. It does not exist.

Political power does. The prime minister does, and so do the other two heads of the three arms of the state. Military influence on governance is undeniable. As undeniable as the forfeiture of responsibility demonstrated by officials involved in corruption.

By assigning the establishment the responsibility of corruption, poor governance, we allow many people to be free of accountability. For they too blame the establishment on one hand, and slacken their own responsibilities with the other. Sadly, the very beneficiaries of the status quo lambast those who they consider more powerful than them.

The Way Forward

Politicians and officials cannot remain within conventional morality. They might blame others for the debacles we are in, but they did choose to be in this position. Hence, we cannot blame the establishment.

We can only blame ourselves.

However, I am not optimistic about the people of Pakistan relinquishing their archetype of the establishment. As a practicing clinical psychologist, I believe we as people can improve. Warped beliefs are difficult to treat.

References

  • Ansari, S. H., & Bajwa, F. (2019). HIGHER BUREAUCRACY IN PAKISTAN: AN HISTORICAL ANALYSIS OF PRAISE AND BLAME. ISSRA Papers, 11(I), 73-96
  • Kohlberg, L. (1963). Moral development and identification.
  • Mackay, C. (1932). Extraordinary popular delusions and the madness of crowds. Noonday Press. 
  • Sapir, E. (1836). Sapir–Whorf Hypothesis.