Yousuf Raza – Mental Health & Adolescence
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Assalamu alaikum everyone.
We are back with Psych Baitak.
This is Yusuf Raza and Azam Khalid.
And today we have a very special guest.
As most of you already know, Dr. Ali
Hashmi.
Before I ask him to join us, I'll
just bring Azam in.
And here's Azam.
Assalamu alaikum, Azam.
Walaikum assalam.
How are you?
I am fine.
How are you?
I hope that everyone is fine.
So, Yusuf and I thought that instead of
talking about ourselves, why don't we bring in
a guest who has been an inspiration to
us.
And also, those whose kicks, slaps, and scoldings
have helped us a lot to keep ourselves
straight.
Because there is so much in the market.
There is so much in the market about
psychiatry that it's easy that you get lost.
So, one of our inspirations, I would say,
are our mentors.
So, I think, instead of wasting more people's
time, let's bring in Dr. Ali Hashmi.
Sir, assalamu alaikum.
Assalamu alaikum.
Walaikum assalam.
Sir, how are you?
I am absolutely fine.
I would just like to go on record.
People are sensitive these days.
I have never slapped anyone.
I have never kicked anyone.
And I have never slapped anyone.
Except metaphorically speaking.
So, just to get that on the record.
Sir, metaphorical slaps were very important.
We had literally lost hope in psychiatry in
Pakistan.
And thankfully, we were able to see a
lot of light.
I think your audience should also know that,
unlike me, I am just a currently a
psychiatrist.
Both of you have already surpassed me by
far.
As in, you are doing a PhD in
psychology from the US.
And Yusuf, you are planning to do, I
think, a PhD in psychology.
And I think both of you have done
some advanced degrees in philosophy also.
So, your knowledge base and your skills are
no less than mine.
And in many ways, far advanced than mine.
And there is nothing that makes a teacher
happier, obviously, than to see their students achieve
more than I could ever dream of.
So, I am very happy to be here
and very proud to be here.
So, thank you so much, sir.
Your inspiration is what allows for us to
do whatever it is that we are doing.
There are very few psychiatrists who would appreciate
the importance of psychology, philosophy and other things
for psychiatry and mental health in general.
Which is why you are our first guest
on this show.
So, thank you so much for agreeing to
be here and taking out your time.
So, we go on with the topic for
the day.
Azam?
Yes.
For the audience, what
is the importance of mental health in adolescence?
Because generally, it is understood that children do
not need mental health help.
And it is only needed by the elderly
or those who are unemployed or those who
have problems.
And children are usually not considered.
What is your experience about that, sir?
Okay.
So, Azam, as you know, I am not
a…
Of course, in psychiatry, we have specializations.
I am not a child and adolescent psychiatrist,
which is a separate specialty.
But from the perspective of a general psychiatrist
and a father, really, which is a more
useful experience than being a psychiatrist when you
see those things in your own home.
So, I mean, I think to say that
there is no need to pay attention to
mental health in adolescents, teenagers or children is
very silly.
Because when you are young and then when
you are in your teens, this is the
time when your personality is actually forming.
Right?
All your worldviews, education, your personality is forming,
it is molding.
Your perspectives are forming, which will largely continue
to be determined by what happens in your
childhood and your adolescence and your early adulthood.
This is one thing.
Second, of course, we already know from the
knowledge base that we have.
We have a genetic code that we take
with us from our mother's womb.
But we know that the environment we grow
up in, the education we receive, the culture
we grow up in, all of those things
have a huge impact on our mental functioning,
how we look at the world, how our
personalities develop.
And also our tendency towards mental health and
the positive, the mental excellence or mental health
or tendency towards mental illness.
So, the environment that determines this, the earliest
formative experiences are from our childhood, from our
home, from our school, from our college and
university.
So, of course, you know, actually, child mental
health and adolescent mental health is in fact,
in some ways, even more important than adult
mental health.
In some way, not necessarily.
So, you know, for instance, you know, you
can have an onset of mental health problems
as an adult, as an older person also,
which are not connected to your childhood or
your teenage.
But if you have had some experiences in
your childhood or teenage, which have left, you
know, some marks or which have molded your
personality in certain ways or left some tendency
towards problems, then obviously, it can be aggravated.
So, you know, it's extremely important.
I think I'm very happy that you have
chosen adolescence and are focusing on mental health.
Adolescent mental health, in many ways, is as
important or even more important than paying attention
to mental health beyond adolescence.
Thank you, sir.
Sir, when we talk about this domain, about
adolescent mental health, we usually think that it
occurs because of the bullying which happens in
school.
Sir, can bullying
also occur in the families?
And those are also close relationships.
The siblings in the family, the parents, can
bullying or trauma originate from there?
Because we usually think that the parents are
very sincere and the siblings are also sincere.
Even despite of sincerity, can trauma unintentionally occur?
I think it can happen.
I'm smiling because my perspective on this has
of course changed from the time when I
was a teenager and a student to the
time I was a young person to the
time I became a professional.
And then I got married and then I
had my own children.
And now I'm the father of teenagers.
So it's interesting to see how a person's
perspective changes.
So I think one perspective is that in
our culture, parenting is a much more directed
and much more, in some ways, a much
more rigid exercise.
So when you are studying in America, you
must have observed that the parenting style is
different there.
Now that's a long debate, why is it
like that, what is that culture, etc.
But briefly, in America and Western countries, children
are given much more latitude to explore their
environment, their education, all of these things in
a much freer way.
They are given this free hand to do
whatever they want to do.
Of course, there are pros and cons to
that.
In our country, in Pakistan, parents are more
hands-on, one can say, that do this,
don't do that, this is right, this is
not right.
There are pros and cons to that as
well.
When children move from, let's say, middle school
or middle school to high school, when they
enter adolescence, when they are 12, 13, 14
years old, under the influence of various bodily
hormones and all that, there are mental changes,
as you know, and children are supposed to
actually become more autonomous, they develop the ability
to question authority, to make their own decisions,
or they want to at least.
They want guidance, but they don't want a
rigid way of saying, do this, don't do
that.
So, there is a conflict in our society
because our parents, for various reasons, including economic
reasons, they direct their children to do this,
don't do that, this is right, this is
wrong.
Which, you know, I mean, from the perspective
of a father, you know, like I said,
I said earlier that my perspective was that
I was a teenager, and now that I
am a father, it has changed a little.
So, it has changed in such a way
that my teenage children, they might want to
do things that they think are good for
them now, but that might hurt them later
on.
But I, as a father, need to find
a balance to where I allow them to
explore their own interests and give them some
latitude to explore those interests and then, according
to that, make a certain framework and tell
them accordingly.
So, I'll give you an example.
In our country, in Pakistan, generally, and I
teach at McKinney-King Airport, you have worked
with us there, you have lived there.
So, mostly, we have, just an example, we
have a lot of students, mostly students come,
students come to medical college.
They have a default way of selecting medical
college, as you know.
That is, the students who are good in
studies from the beginning, who are first-star
students, they are told to become a doctor,
become a doctor, become a doctor, come to
medical college, become a doctor.
And after many years of starting medical college,
they think that, I don't know if I
should have done this or not.
Because they have never thought about it, they
have never been encouraged to think about what
they want to do.
So, after that, there can be a little
conflict that, for instance, nowadays, I am treating
a young man who is a graduate of
our college.
One of his central issues is that he
has never been very happy, he was never
very happy being a medical student.
He is a bright boy, and he is
a doctor now, but he is not really
very happy with that.
He doesn't really want to do that, he
has other interests, web designing, etc.
So, he is struggling with the idea of,
should I do this, should I not do
this?
But now he has become a doctor.
So, there, what you talked about, family, what
is family to children?
I mean, yes, you could call it trauma.
I mean, one thing is that, you know,
frank abuse, beating children, all of that.
So, physical abuse is one, which is clearly,
you know, clearly, and it is still very
common in our country.
So, that's clearly not appropriate.
You know, the whole idea of, so, verbal
abuse is another, which is also not appropriate.
Emotional abuse, I am a little bit, as
you know, I am a little bit hesitant
about classifying that.
Because there is a standard of emotional abuse
in the West, and here it is a
little bit different.
You know, we have a different way of
doing it.
Then, there is a difference between genders also.
There is a little bit of treatment for
girls and boys.
So, but yes, in families, what happens in
families, in families, it happens that children are
traumatized by it.
And this is keeping aside, that if there
is frank trauma, physical trauma, sexual abuse, that
can never be justified on family conditions.
But I think what you are asking is
that, if a child is not given his
own interest, his own ideas, his own freedom
of thought, and he is being forced into
a particular paradigm, that he should read this,
he should not read this, he should believe
this, he should not believe this, then is
that also traumatic?
Of course, it can be.
But keep in mind that the children, the
family members are one ecosystem, right?
So, that family is existing in a larger
ecosystem than the society.
So, again, as my perspective, as a point
of a father is, I need to give
my children my point of view, because they
are getting other points of view from larger
society, from media, from other people around them,
from their peers.
Let's not forget that in adolescence, the importance
of adults for teenagers is reduced.
The importance of their peers is very high
for them.
So, their most important influence is their peer
group.
That's where they are getting most of their
information, their advice, all of that.
So, they are getting information from there.
So, you know, I need to get my
point of view across.
You know, my father, as you know, he
is a psychologist and, you know, a much
wiser man than I am.
He put it in such a way that,
if I am not giving my children my
point of view, I am withholding all of
those years of my experience and not giving
them the benefit of my experience, that they
will say bad things about me.
Now, my children are teenagers.
Teenagers have an attitude that whoever you talk
to, their foreheads get cold.
They say, oh, Baba, why are you so
old, man?
You know, they have this sort of faux,
you know, sort of, a love-filled contempt,
you know, loving contempt, or contemptuous love, whatever.
So, that doesn't mean that I should get
upset with them.
Stop talking to them or stop giving them
my…
But I think you are not talking about
someone like me who is doing it in
a nuanced way.
You are forcing your children to read this,
read that, meet this, meet that, do this,
do that.
So, if I may, just a couple of
months back, there was a patient that I
was treating.
He was a teenager, 16, 17.
And his symptoms started when his father became
really religious.
Or when his father became really, really religious,
this guy started engaging in self-cutting behavior.
And when he was given antidepressants, whoever he
went to did not bother talking to him.
To no avail, his suicidality, his insomnia was
worsening.
So, when I finally talked to him, he
was like, I have some particular practices, I
have some gender interactions in the university, which
my father does not approve of.
And my father is right.
This should not happen at all.
But I cannot control it.
So, I am bad.
And if I am bad, then I deserve
these cuts that I am putting on myself.
I mean, this is what it is.
And that's something that we regularly have to
confront.
So, I am curious, Yusuf.
We have had discussions on religion and religiosity
before.
So, let me pose you a question.
So, we are talking about the normal emergence
of adolescent sexual feelings.
This is part of puberty.
It happens as you enter puberty and as
you go along.
Recently, I re-shared an article.
I wrote something about Valentine's Day.
Every year, every February, tourists start coming to
Pakistan.
When February comes, they say, Valentine's Day is
coming.
Stop it.
Stop it.
Stop it.
Stop it.
You know, all of this.
So, I wrote an article from the perspective
of, I think it's something called love in
all its forms or something.
So, you raise a very important point here,
which is, a teenager, especially a teenage boy,
who is growing up in a very religious
family, in which all sexual feelings and sexual
behavior has been equated with sin.
Right?
And with guilt.
Even thoughts.
Behavior is for later.
Even thoughts.
Okay.
Thoughts.
Right.
Okay.
Okay.
So,
religious guilt.
So, how would you, I mean, you know,
how would, I'm asking you, how would you,
because you know more about, you know, how
would you advise a person like this?
Yeah.
If he wants to go now, you know,
clearly, okay.
Yeah.
Yeah.
Now, we don't want it to become where
it is like in America or the West,
you know, teenage pregnancies and all this kind
of stuff.
Yeah.
Okay.
Okay.
And all this, and we don't, we don't
want that happening.
So, as soon as a boy or a
girl reached puberty, which, you know, usually at
the age of 13, 12, 13, 14, they
can, they can indulge those desires within the
bonds of marriage or whatever.
The earning potential of, of young men is
delayed into their twenties or whatever.
And so they can't get married at 13
or 14 or 15.
It's not possible.
They can't support the family.
Number one.
Biologically speaking, a girl is not physically ready
to become a mother at the age of
13 or 14.
She can develop various medical issues.
And all this, if she had, you know,
they get very sick and all this kind
of stuff.
So, so we, you know, so that, that
natural urge, the sexual urge has to be
suppressed in the interest of other things, social
interests until such a time that, that, that
the, that the young man or the woman
both are economically ready to support the responsibility
of the family and physically, especially the girl
because the girl is one who has to
carry the pregnancy.
She's physically able to carry the pregnancy without
it having a harmful effect on the health.
So I'm curious, how would you, how, what
did you do?
So with that particular person, the way it
started was to identify with him.
And he was equating, okay, my father's interpretation.
It's completely wrong.
It's a sin, right?
So I started off by saying, okay, your
father's interpretation is that religion?
Is that the only interpretation?
And his immediate response was yes.
In the space that this is one interpretation
that your father is giving, there is a
great chance of fallibility there.
May not be the way to go about
it.
And there's other possibilities.
There are other ways of looking at it.
Like your particular situation has to be dealt
with.
So the first session was entirely dedicated to
that.
And then when that was achieved where he
was towards the end, towards the end, he
was convinced.
And it was pretty dramatic.
He came back the next session.
And he was like self-cutting.
He's actually, you know, he's not as guilty
as he was before.
But unfortunately, he discussed everything he discussed with
me, with his father, and then he never
came again.
So he wasn't allowed to have the third
session.
You did your duty.
That's all right.
That actually raises another very important point, which
is, you know, the way the core function,
mental health, which
is one of the central features of what
we try to help people do, right?
You know, a person with mental illness or
mental illness itself doesn't exist in a vacuum.
You know, a person is exhibiting some symptoms
of mental illness within a family, which is
within a community, which is within a society.
And sometimes, as you know, families can then,
you know, one person sort of gets designated
as the container of the family dysfunction.
And then when you try to fix that,
then people say, we didn't say you should
fix it.
We didn't say you should take the whole
family.
We said you should fix it.
Why are you fixing it?
What are you telling us?
And then if you go beyond that, then
outside the family, the larger society has its
own problems, which are not under our control.
We can play an indirect role in the
larger society of psychiatry and mental health, but
directly through one person, whom we are trying
to treat.
So it becomes an interesting dilemma.
In my experience, I've sort of tried to
look at it two ways.
One is, you know, you want to relieve
a person's distress.
But we don't want to pretend that it
doesn't exist, but we don't want to pretend
that it can't be worked on.
So it can be worked on one person,
but to some extent.
And if they want to do that much,
then it's their own choice.
If they want more than this, like you
said yourself, that he got a little better,
then he told his father, which is very
common, by the way.
In our society, we don't want to pretend
that it doesn't exist.
You know, there are very few secrets, at
least in Lahore.
I mean, you know, in Pakistan, we have
a culture where we...
I often joke when we work in Mayo
Hospital.
Medical decision-making is rarely ever...
If a patient has to do this or
that, I often say, as I'm stopping now,
that a person can never make a decision.
The decision is made by the panchayat.
The decision is made by the panchayat.
One person can't do it.
Before that, they'll ask their mother, father, the
whole family.
Because that's our culture, right?
We are a society which is based on...
If there's a long debate, we won't go
there.
But we do collective decision-making, we do
collective, you know, all kinds of things.
So the concept of one individual doing something
alone, which is sacred, by the way.
In America, it's a very individualistic culture, right?
One person will do it all by himself.
Here, it's the opposite.
So in that, I'm not surprised that the
boy told his father right away.
And then whatever reaction your father had, whatever...
Anyway, you achieved your goal, which is that
his immediate distress level decreased, his health improved
a little.
Now, you know, the dilemma is still there.
Your father must have told him, what does
Maulvi Yusuf Sahib know, etc.
Whatever it is, he might come again.
But that's a family issue, then it's a
larger social issue, where problems are going on.
You know, I think you did what you
had to do, and you did a good
job of it.
If that problem doesn't come, then okay, next
time it will come, you'll work on it
again.
Absolutely.
At least the seed has been sown.
It has opened up a dimension, maybe at
some later point, that will bear fruit.
But carrying from your conversation, what you said,
when we're dealing with people in our practice,
we're not just dealing with individuals, we're dealing
with whole families.
There are some social pathologies, some are our
educational institutions, some are our religious institutions, some
are even our medical fraternity.
We're reinforcing some psychological problems of the youth
of adolescence.
Some of our conceptions are like, the way
the father came to get a label, or
we told him to fix this.
A lot of practitioners will comply.
They will do that.
They will give the label, and they will
give the medications, and they will ignore the
psychological or the family side of the problem
altogether.
So, there's just so much to deal with.
So, at least here, we can talk a
little socially, maybe we can point to those
social pathologies.
No, no, we can't point to them.
We can openly tell them that it's a
social pathology, but keeping the realistic perspective, that
a person, even if he's a so-called
patient, we all dislike that word.
I mean, I'm a patient, you're a patient.
We shouldn't use that word.
It's a stigmatizing word.
So, the person who comes to you for
help, and you want to help him, you
should definitely have a one-on-one interaction
with him.
And you can certainly point out that there
are issues in your family, there are issues
in the people around you.
Let's talk about educational institutions.
So, this is not something hidden.
I've written about it.
Take our education system.
Let's talk about universities, colleges, where I teach
myself and you're all educated.
So, most of our so-called teaching, so
-called, in universities is done in that very
old top-down system where knowledge is sort
of transferred, or supposed to be transferred passively
from the teacher, quote-unquote, who's supposed to
know everything,
and
the student who's supposed to be the empty
vessel.
You know, somehow, in our colleges and universities,
somehow, the students, because of whom the university
is made, are the least important component of
the university.
They're almost an afterthought.
Nobody wants to know what they want to
study, how they want to study, who they
want to study from, etc., etc., etc.
So, you know, our educational system doesn't encourage
critical thought or self-thinking, but rather discourages
it.
So, our students, when they leave the education
system, they don't learn anything.
I didn't learn anything either.
I finished my formal college education in Pakistan
and started learning again.
Then I realized that, actually, studying and gaining
knowledge can be fun instead of being a
torture.
Right?
But now, we've made a system in which
we force our students to do what I'm
telling them to do.
And if you're interested, we're not interested in
that.
You study this way, we're not interested in
that.
Do what we're telling you to do.
And do it the way we're telling you
to do.
And don't do anything else.
So, it's obvious that, from where you came
from, our largest society has a reflection of
an authoritarian, sort of, top-down system.
Do what we're telling you to do.
Although, you know, for instance, we just talked
about this, before we started this session, I
asked you, what application are you using?
You told me.
I didn't know anything.
This is the first time I'm doing this.
So, you know, my students, many of whom
might be listening right now, are far, far
ahead of me in terms of these technological
things, Insta Live and Facebook Live.
I don't know what this is.
But you're my students, you're young people, you're
updated, you're energetic, you're interested, you teach me.
So, if I'm a teacher, the appropriate attitude
of a teacher needs to be, you know,
I would love to learn this along with
you.
That would be great.
Let's learn something together.
That's the right attitude of a teacher.
And somebody who doesn't have that attitude shouldn't
be a teacher.
Meaning, if a teacher is an attitude of
a teacher, who knows everything, then he shouldn't
be a teacher at all.
Because the whole purpose of teaching is to
learn.
So, okay, I know a little bit about
my life experience.
I know what you don't know because you
don't have that much life experience because you're
young.
Apart from that, let's pretend that 25 years
ago, in 1994, I did a residency in
America.
I finished it in 1998.
In 1999, I did my American course.
So, the knowledge I had 20 years ago,
its application today is ludicrous.
Knowledge is one year old, six months old.
What I learned at that time, it had
no application.
It was something like what Freud said.
It was something like an established principle that
is still valid somehow.
So, I should admit that my students, my
mentees, like you, my students, they know a
lot of things that I can benefit from.
I know things that they can benefit from.
So, teaching is always a collaborative process and
it should be a collaborative fun process.
It should be something that teachers and students
should do together rather than teachers saying, I'll
tell you what happens.
You don't know.
You don't know.
Sir, the flip side of this, what we
see, for example, in the Western University, that
new knowledge is being promoted so much that
what Freud has to say is now history.
It's archival.
It's like, the elders of the field whose
shoulders we have reached here, who are capable
of saying something, now in university courses, in
psychology courses, they have the least importance.
Psychiatrists can go through their training programs and
become psychiatrists and not be able to name
even the top three people of the field
in the past 100 years.
Their flip side is also like you said,
the collaboration to grow, oh yes, like novelties
are coming, to assimilate them, but to remain
attached to our tradition.
You're absolutely right.
The key here is to develop a love
of learning.
This is the key here.
If you enjoy it, if you like it,
if you are passionate about it, then you
will learn effectively.
Then you will learn well.
Then you will learn more.
The only way to do that is to
figure out, as a teacher, I mean I'm
also a learner, but I'm at the age
where I'm also a teacher.
My task is to help figure out or
help my students, for me to figure out
what they want to learn, how they want
to learn, and teach them in that way.
It's obvious that there is a prescribed curriculum,
there are prescribed syllabus, which we have to
follow.
You can take any discipline, whether it's medical,
psychology, if you want to learn for the
sake of learning, which is a great thing,
but if you want to achieve a certain
level of competence in an established body of
knowledge, and then you want to get a
degree, you want to get a certificate for
whatever purpose, you want to do something else,
you want to work, you want to do
something else, then you need a framework that
you have to learn this, in all these
years, you have to learn this much.
So we have to follow that.
University teacher, college teacher, whatever you are doing,
you have to master that.
But while staying within that, there are many
ways in which to make learning interesting, to
make it collaborative, to make it fun for
everyone concerned.
Right?
So I'll give you an example.
Recently, due to COVID, we are sort of
off the title of adolescence in mental health,
but I guess we can come back to
that.
Due to COVID, the universities and colleges have
been shut down.
There was a lockdown in March.
It's the fourth month now.
Our own university is also locked down.
So all of the universities and colleges, even
schools, had to move quickly on to sort
of online learning.
Zoom classes and all this kind of stuff,
they have to do that.
Now, in that, we also, the psychiatry teachers,
we were told that you were on a
lecture, record the online lecture and send it.
Okay?
So I didn't even know what to record,
how to record.
I had no idea.
I thought they should tell me.
Then they said, make a slide show.
I said, let's make it.
They said, record the slides.
Then I asked my 19-year-old son,
I said, tell me how to record.
He came and said, Baba, you have to
do this, you have to do that.
He scolded me a couple of times.
You didn't understand, Baba, this is how you
do it.
I said, please tell me.
He told me.
Okay, when I recorded it for the first
time, I felt a little odd.
It's a new thing.
I mean, I'm talking to a screen which
has a slide on it.
Usually, I'm used to talking to people, getting
some, you know, all that.
but we won't go into the details of
the shortcomings of online teaching or whatever.
I didn't mean to sound mean, but I
was just trying to make it interesting, but
they liked it, they liked the fact that
I was
trying to make it interesting, but I didn't
mean to sound mean, but I was trying
to make it interesting, but they liked it,
they liked the fact that I was trying
to make it interesting, but they liked the
fact that I was trying to make it
interesting, but they liked the fact that I
was trying to make it interesting, but they
liked the fact that I was trying to
make it interesting, but they liked the fact
that I was trying to make it interesting,
but I didn't know that anyone wanted to
make the material.
People didn't want to make the material, so
I made the material myself.
I don't know if it's it.
I think let me talk first to the
I think let me talk first to the
I think let me talk first to the
parents of three teenagers.
parents of three teenagers.
I don't smoke or use any drugs, never
have, and I'm quite open about my distaste
of smoking and drugs.
Not because I don't want my kids to
use them, of course I want them to,
but because I believe that smoking is a
bad thing, drinking alcohol is a bad thing,
doing drugs is a bad thing, because it
causes a lot of health problems, mental health
problems, physical health problems.
So I'm not shy about expressing that opinion
to my children.
There's a sort of cliché that they can
see that there's no difference between a father's
call and a son's fail.
The father is the one who's telling the
child what to do.
That's one thing.
The other thing is that it's very important
to have open lines of communication with your
children as much as possible, which is difficult
to do, more difficult to do for the
father than for the mother in a traditional
single-income household.
So it means that I work outside the
house, my wife is a homemaker, so she
sees more of the kids, I see very...
because I'm busy, I don't get to meet
them that much, but I try, I actively
try to spend as much time as possible
with them, and then I encourage them to
talk about their lives in general.
I mean, I'm interested in what they're doing.
Partly, I'm interested because I want to know
who they're meeting, where they're going, what they're
doing, all of that.
So there's a vigilant oversight.
I try not to make them feel that
we're being forced, that we're being surveilled, but
I make it very clear that I want
to know who their friends are, where they're
going, when they'll go, where they'll meet their
friends, when they'll come back, who will be
there, all of that.
So this is quite clear about that, and
I've been doing this from the start.
There's no doubt about it, and they've never
given me a chance to doubt it, I've
never felt angry about it.
So there's no harm in checking up on
that.
In fact, that should be done, because as
you know, while teenagers may struggle against limits
based on their behavior, they actually need those
limits in order to structure their behavior.
This is part of their personality development, right?
So they'll be troubled, that why are you
telling us to come home early, where are
you going?
But the limits I've put in place, they're
measuring their behavior against those limits, and they're
making their own internal code, that we have
to do this, we don't have to do
that.
So those limits are necessary.
They'll be troubled themselves, sometimes they trouble us
as well.
What's the problem?
Why are you following me?
But it's necessary for them.
So that's one thing.
Secondly, it's important to remember that you can't
stop the exposure of drugs, alcohol, and cigarettes
to teenagers.
Even in a place like Pakistan, where supposedly
there's a religious environment, but you can find
drugs and cigarettes everywhere, outside schools, here and
there.
So now there's no need to go anywhere,
you know, this beautiful thing that you have
with you, which is called a cell phone,
everyone comes home.
So there's no way to...
It's not possible that you can stop the
exposure of kids.
So they're seeing all those things, they're getting
exposure to all those things.
Now they can experiment as well, under air
pressure.
But if they experiment there, or if they
think about it, or if they're offered, then
that open line of communication will be useful.
If you've told them this thing, or if
you've demonstrated it with your behavior, that you
have to do this, you have to do
that, you have to do this, you have
to do that, then they'll come and tell
you.
They'll tell their mother, they'll tell me, and
then there can be an open discussion about
what to do and what not to do.
So, you know, as long as you've formed
a model, that this is how it should
be, it shouldn't be like this at home,
you should do this, you shouldn't do that,
You know, we need to
give them You know, we need to give
them the freedom to express their opinions to
talk about whatever issues they have without being
judgmental about it and without them feeling that
we are we are you know judging them,
we are telling other people or whatever you
know they need to be able to have
that trust in us in order to confide
if something is bothering them.
At the same time we need to give
them the the uh uh
which is very important for teenagers by the
way it is very important for teenagers as
they get older from there to move from
you know 11 12 and onward into teenage
that they that they have um some privacy
some confidentiality about the way they do things
so i have no interest in prying into
their life into their uh into their you
know they can have their privacy they i
don't need to know everything it's
all right i mean i trust you i
trust that i have given you some some
some guidance in order for you to make
your own decisions safely right and if you
want my guidance then you can ask for
it that's okay i mean you know it's
it's a sort of a fine line provide
them a healthy environment at home like
an open accepting environment i think i think
most of those things go a long way
towards in our aspect you know other we've
often talked about the fact that it's important
for instance uh for example a cardiologist so
a cardiologist who's overweight and who smokes and
who's out of breath is not a good
role model right so a psychiatrist who does
not have good mental health is
not a good role model right so so
possible the family conflicts need to be resolved
especially parental conflict that has a huge negative
impact on children's mental health they are very
resilient they i mean you know most of
us survived our childhood and our teenage we
all survived our parents right and i'm sure
our children will survive us one last question
sir how should parents speak with their young
children about sexuality keeping in mind our cultural
norms uh
actually no i i i cannot remember the
last time i had a discussion my children
who are my i have a son who's
19 a son who's 17 and a daughter
is almost 14 and uh anytime that this
issue has been brought i will bring it
up as a joke really and they will
all say stop don't don't talk about it
you know so they kind of just make
a face and they say we don't talk
so you know i um um i i
i'm recalling when i was growing up this
is before internet before all this which
which was a basic sort of uh book
about um * education uh geared towards i
think younger kids or maybe pre-teenagers not
uh you
know so
you know i i don't have a good
answer to what is asking i think it
would be very helpful i believe
at some point * education you
know how it is over here foreign education
about sexuality even though we're becoming doctors uh
so you know resources i'm i'm not aware
of any they should be i would think
but even um anatomy even
doctors even medical students uh depression
then afterwards i sent her an article on
on uh treatment because i know and
you know and i know problem
again around that issue issues it's
something that everybody sort of experiences i mean
it's part of life isn't it huge
mess the
neurotic
problems that which will manifest as depression and
anxiety sexual repression is the is the cause
was a problem and he would see a
lot of those conversion cases and
that's perhaps because now we have that level
of sexual repression in our society and it
may be a good idea for us to
have a dedicated um dedicated program of psych
by just on that i think it would
be great service it would be yes there
is a time time
and nobody has * well i wonder how
we got to 20 because we're not talking
about uh uh thank
you sir thank you very much thank you
very much thank
you very much boys thank you very much
thank you thank you so much sir thank
you