Growing Cyber Harassment in Pakistan

Growing Cyber Harassment in Pakistan

Adil Ali   04 August

It is estimated that there are over 37.5 million 3G, 4G/LTE subscribers in Pakistan at the moment. This dramatic rise in the use of internet technology has virtually reduced the world to  a Global Village. Though there are some challenges in this new virtual space and one such challenge is the striking rise in cyber crimes across Pakistan.

Cyber Harassment is one such form of cyber crimes which is getting more common in our society.  In this regard, psychologists of Global Medical Services Rawalpindi (Mr. Adil Ali & Ms. Ruhma Shahid) took the initiative and did an awareness program on PTV World on August 1st, 2017.



CYBER HARASSMENT

Cyber Harassment is the use of Information and Communications Technology to harass, control, manipulate or habitually disparage a child, adult, business or group without a direct or implied threat of physical harm.  It is commonly understood as behavior that disturbs or upsets, and it is characteristically repetitive.

There are many different types of harassment over the internet, some of which are given below:

Cyber Bullying:
This  include mean text messages or emails, rumors sent by email or posted on social networking sites, and embarrassing pictures, videos, websites, or fake profiles. Messages and images can be posted anonymously and distributed quickly to a very wide audience and can be difficult and sometimes impossible to trace the source or deleting inappropriate or harassing messages, texts, and pictures.

Cyber Stalking:
This includes the use of the Internet or other electronic means to stalk or harass an individual. It may include false accusations or attempts to defame the victim. It may also include monitoring, identity theft, threats, vandalism, solicitation for sex, or gathering information that may be used to threaten, embarrass or harass.

Spreading False Information about an Individual:
This includes sharing or posting false information about someone on social media that damages their reputation.

Hate speech:

This includes using abusive language, inappropriate comments based on religion, ethnicity or any other classification.

Leaking or publishing an individual’s personally identifiable information:
This includes publishing someone's identifiable information such name, date of birth, pictures or personal information such as medical conditions online.

Accessing and dissemination of private data without consent
This includes accessing someone's private information and sharing it online without their permission.

Hacking Electronic Devices / Accounts:
This includes hacking someone's electronic devices, email or social media accounts with intent to monitor their activities or to post something on their behalf without their knowledge.

PAKISTAN'S CYBER CRIME LAW
On 11/08/2016, National Assembly of Pakistan passed Cyber Crime Bill in Pakistan.  According to this new law, there are punishments for all kinds of cyber harassment:

Crimes	Punishments
Spreading False Information about an Individual	Up to 3 years in Prison or up to Rs. 1 Million in Fine or both
Making /  Spreading Explicit Images or Videos of an Individual	Up to 5 Years in Prison or up to Rs. 5 Million in Fine or both
Making / Spreading Explicit Images or Videos of Minor	Up to 7 Years in Prison or up to Rs. 5 Million in Fine or both
Cyber stalking	Up to 3 Years in Jail or Up to Rs. 1 Million in Fine or both
Cyber Stalking with a Minor	Up to 5 Years in Jail and up to Rs. 10 Million in Fine
Hacking Email / phone for Stalking	Up to 3 Years in Jail or Up to Rs. 1 Million in Fine or both
Making Videos/Pics and Distributing without Consent	Up to 3 Years in Jail or Up to Rs. 1 Million in Fine or both
Hate speech	Up to 7 Years in Prison or fine or both

Two days ago, on 02/08/2017, a man who blackmailed and harassed a girl through social networking website “Facebook” has been jailed for 14 months in prison along with a fine of fine of Rs 200,000.

WHAT MOTIVATES CYBER HARASSERS?
While discussing in a program World This Morning on PTV World (aired 1st Aug, 2017), Clinical Psychologist Mr. Adil Ali said that the freedom of privacy and personal anonymity that internet offers encourages many individuals to do things and say words that are generally not acceptable socially.  If there were no social norms, no rules, no regulations, no control, many of us would behave in the same way we do on the internet when we have the freedom of privacy.  Ms. Ruhma Shahid added that it is the persona that we wear that makes us civilized human beings.

HOW MAJORITY OF WOMEN REACT?
According to a study, 70% of Pakistani women afraid of posting their pictures online due to lack of safety. Cases of stolen Facebook profile pictures are routine and in some cases have forced women to completely stop using social media sites and they in fact get blamed from their families for doing it.

Not quite surprisingly, there is so much stigma around it that majority of women choose to stay quiet for the honor of their families and would refrain from seeking any kind of professional support.

CONSEQUENCES OF NOT GETTING HELP:
Not seeking help can effect the psychological well-being of victims.  According to Mr. Adil Ali, victims could develop different mental health issues including depression, anxiety and PTSD to name a few.

WHAT CAN VICTIMS DO:

Realize that its NOT your fault:
There should be no threat to family's honor if someone bullies you or harasses you online. You have the right to go online, create your profiles use all the social media websites.  Don't ever blame yourself.

Block the Harasser:
There are blocking options available to users on almost all websites and social media platforms.

Report to the platform:
Don't forget to share your bad experience with the platform you had it on.  For instance if you are on Facebook, report it to the Facebook authorities.

Seek Help from Local Authorities:
Report the incident to National Response Center for Cyber Crime by dialing the Cyber Rescue Help line at 9911.  Or call the recently launched Pakistan's first Cyber Harassment Hotline at 0800-39393.

Seek Psychological Help:
Its never easy to deal with such issues all alone.  Your family and social support network is going to be a huge help for you but its always good to see a psychologist, or counselor for help.  Psychologists or Counselors can help the victims in getting a psychologically safe environment to discuss their harassment and to take necessary steps for their safety.

CONTACT FOR SUPPORT:
If your are a victim of cyber harassment and need psychological support, feel free to contact Global Medical Services in Rawalpindi at (051) 4848934-36 or see any other psychologists in your area.

Psychosocial Impact of Multiple Sclerosis: Challenges and Solutions

Psychosocial Impact of Multiple Sclerosis: Challenges and Solutions

Adil Ali   16 May

Multiple sclerosis (MS) is a disease of the central nervous system characterized by an immune-mediated attack on the myelin and oligodendrocytes, resulting in inflammatory lesions, astrocytic scarring, and axonal loss. It is estimated that more than 300,000 people in the United States have MS, and there is some epidemiologic evidence that the incidence is increasing in women. Symptoms of MS are wide ranging in nature and severity and may or may not include disturbances in gait, balance, vision, bladder and/or bowel function, sensation, sexual function, psychiatric status, and cognition. The course of MS is highly variable, although the expected life span is decreased only by a few years.

Psychosocial Challenges

MS is an unpredictable, potentially disabling disease. Although outcomes can be estimated in large epidemiologic studies and follow-up studies from large clinical trials, it is very difficult to predict long-term outcomes for a given individual. This uncertainty represents a challenge to the coping capacity of persons with MS. There are a number of specific psychosocial challenges, including clinical depression, anxiety, sexual dysfunction, cognitive changes, and demoralization and grief associated with MS-related losses.

Clinical Depression and Grief

Depression is the most common psychiatric disorder in MS. Major depression is a serious psychiatric disorder that is distinguished from minor depression, discouragement, and grief by the persistence, severity, and number of symptoms.

According to the Diagnostic and Statistical Manual for Mental Disorders, 4th edition, text revision, a diagnosis of major depression requires an individual to have a sad or irritable mood most of the day and nearly every day for at least 2 weeks. In addition, there must be 4 other symptoms present during this time, which may include:

• anhedonia (loss of interest in the things one is usually interested in and capable of doing);
• feelings of worthlessness or excessive/inappropriate guilt;
• significant increase or decrease in appetite with weight gain or loss;
• change in sleep patterns (waking up 2-3 hours earlier than usual, or increase in number of hours of sleeps each day, by several hours or more);
• recurrent thoughts of death or suicidal feelings and thoughts;
• fatigue;
• attentional impairment; and
• sexual dysfunction.

Some of the symptoms associated with major depression are also associated with MS. Consequently, it's important to differentiate between social withdrawal associated with depression (due to loss of interest in usual social activities) and the inability to socialize in one's usual manner due to MS symptoms or impairments. If the persistent and severe mood changes that characterize major depression are not present, such symptoms are most likely due to MS.

Major depression among those with MS is consistently related to a loss in the perceived quality of life and is associated with decreases in self-care, including adhering to disease-modifying medications in MS, the failure of which may lead to long-term disease morbidity. In contrast to clinical depression, normal grief tends to occur after a loss (eg, recent exacerbation that produced permanent neurologic impairments). Grief is not associated with significant sustained impairments in function and is not typically associated with anhedonia.

In MS there is increased suicidal risk. One study that evaluated death records in MS found that suicide rates in MS patients were up to 7.5 times greater than in the general population. These findings are supported by other studies that show that suicidal ideation and lifetime suicidal intent among individuals with MS were approximately 18% and 28% respectively.

Evidence from several studies suggests that many MS patients who experience major depression are not treated or are significantly undertreated for their depressive symptoms. The latter studies highlight the need for increased systematic screening in MS for depression. Decreases in depression in MS patients receiving treatment for depression have also been associated with decreases in in-vitro antigen-specific and non-antigen-specific TH1-mediated interferon-gamma production, which may reflect an underlying inflammatory component associated with major depression in MS.

Because numerous studies estimate that between 36% and 60% of MS patients will experience an episode of major depression at some point during their lifetime, it is imperative to screen for depression during visits. Recommendations for screening have included the use of self-report scales, such as the Beck Depression Inventory II, Patient Health Questionnaire, and Chicago Multiscale Depression Inventory. One study found that simply asking the following questions was able to detect the presence of a major depressive episode with high sensitivity and specificity:

During the past 2 weeks, have you often been bothered by feeling down, depressed, or hopeless?
During the past 2 weeks, have you often been bothered by little interest or pleasure in doing things?
Several randomized trials in MS have indicated that depression can be treated successfully with a variety of antidepressant medications, cognitive-behavioral therapy, or both. The relative effect sizes of antidepressant therapy and cognitive-behavioral therapy on depression in MS have been found to be similar, so individuals can be offered a choice. However, in patients with severe depression, mental health professionals consider antidepressant therapy the first line of treatment, with psychotherapy serving as an important adjunctive therapy. There is some evidence that offering both antidepressant treatment and psychotherapy will confer improved long-term outcomes over either treatment alone.

Anxiety

The prevalence rates of clinically significant symptoms of anxiety in MS vary from 12% to 90% with most studies indicating 30% to 50%. Risk factors for anxiety disorders in MS patients have included female sex, time since diagnosis, comorbid diagnosis of depression, limited social support, and disability status. MS patients report significantly more anxiety than do healthy controls, with anxiety symptoms associated with fatigue, sleep disturbance, problem-solving deficits, pain, and disability status. It is possible that screening assessments or targeted interventions can be put into place based on the findings about prevalence rates or predictors of anxiety.

The point-prevalence of clinically significant anxiety was found to be 25% in one study, which was 3 times the rate of clinically significant depression in the sample. Females were significantly more anxious than males, and anxiety comorbid with depression was associated with increased thoughts of self-harm, more somatic complaints, and greater social dysfunction.

Social anxiety has also been found to be common. In one study, 30.6% of serial clinic patients met criteria for social phobia (fear and avoidance of social situations) on the Social Phobia Inventory, which was not associated with severity of disability. The presence of social phobia was associated with reduced health-related quality of life. To date, no treatments for social phobia in MS have been reported in the literature.

Injection phobia is also fairly common in MS. This is a problematic symptom, as most disease-modifying therapies are delivered by injection and require a schedule of either subcutaneous or intramuscular injections ranging in frequency from daily to weekly. Patients with injection phobia often select a family member/friend/other to conduct the injection, which is strongly linked to poor long-term adherence.

Cognitive-behavioral therapy for the treatment of injection phobia in MS patients was successful in one small sample pilot study published to date. In this study, 8 patients who could not self-inject due to phobia were able to do so within 7 treatment sessions, and 7 of 8 patients continued to self-inject at 3-month follow up. Given poor long-term adherence associated with non-self-injection, it is advisable to treat injection phobia early.

The MS literature cites the treatment of generalized anxiety with psychopharmacologic agents, including benzodiazepines and SSRI's. To date, one randomized clinical trial of short-term (6 weeks) cognitive-behavioral therapy reported clinically significant reductions in anxiety (and comorbid depression) with treatment (cognitive-behavioral therapy combined with progressive deep-muscle relaxation training adapted for patients with MS) relative to non-treatment (MS clinic services only). This study also reported that treated patients showed increases in coping behaviors that were associated with better emotional management and problem-solving behaviors. More recently, a 1-year, open-label trial of escitalopram in women with relapsing-remitting MS reported reduced risk for relapses associated with stressful life events; results will need to be replicated in larger samples with better controlled studies.

Cognitive Dysfunction in MS

Prevalence studies report that 43% to 65% of persons diagnosed with MS have objective cognitive impairments on neuropsychological tests. The prevalence rates range widely, in part due to sampling and other study design issues. Studies that focused on community samples of MS patients and excluded clinic patients report lower rates, while studies that sampled clinic patients report higher rates.

The types of cognitive impairments identified in MS are wide ranging and have included slowed processing speed, impairments in verbal and visual memory, various aspects of attention, visual-spatial judgment, verbal fluency, and executive function. Cognitive impairments can occur very early in MS, and several studies have identified impairments in patients with clinically isolated syndrome before meeting the criteria for clinically definite MS. The severity of cognitive impairment in MS also ranges widely, mirroring the variability of other clinical symptoms. Most patients have multifocal impairments with relatively good preservation of premorbid language abilities and some aspects of reasoning skills. Occasionally the severity is extreme, with the obvious presence of a dementia. Natural history studies are few but have indicated that patients identified with a focal cognitive impairment are likely to have progression of that impairment longitudinally and to develop additional impairments.

Cognitive impairments have been found to be highly associated with employment problems, social problems, difficulties in activities of daily living, and quality of life. The presence of a cognitive impairment cannot be predicted from the overall severity of disability, as numerous studies report the relationship between them to be quite modest. Cognitive impairments correlate better with a variety of MRI metrics, including T2 lesion load, T1 "black hole" lesions, cerebral atrophy, diffusion tensor imaging, and diffusion-weighted imaging studies. Third-ventricle width has been highly associated with the presence of cognitive impairments, probably due to the relationship between proximal thalamic and other structures that are highly related to cognitive function. Overall, studies have indicated that measures of atrophy account for more variance in cognition than does lesion burden.

The literature on the treatment of cognitive impairments is relatively sparse. Symptomatic treatment studies are inconclusive or largely negative. There are few large-scale, well-controlled, or well-designed studies on cognitive rehabilitation to date, although preliminary studies have found that verbal learning and memory can be improved objectively. Evidence from substudies of clinical trials of disease-modifying therapies indicates that cognitive impairments can be prevented or delayed. Studies of beta-interferon 1a and 1b found fewer cognitive deficits at the end of trials in patients randomly assigned to active treatment arms, although substudy data from a clinical trial of glatiramer acetate did not find differences between groups. Differences in results between disease-modifying therapies must not be overinterpreted, however, because these trials were not designed or powered to evaluate cognitive outcomes as either primary or secondary endpoints. Future studies that are designed and powered for that purpose will shed better light on the impact of disease-modifying therapy on cognition.

This article was originally published in Medscape by authors: Frederick W. Foley, PhD, faculty and disclosures

Child Labour and its Dismal Psychological Implications

Child Labour and its Dismal Psychological Implications

Adil Ali   30 April

The psychological effects of child labour in third-world countries are considerably intense as compared to the rest of the world due to poverty, low literacy rates and improper conduct with children.

Psychological effects of child labour are as severe as its physical ones but unfortunately, they received attention only at the end of the twentieth century.

Depression, hopelessness, shame, guilt, loss of confidence and anxiety are some of the horrible emotional effects of child labour, leading to a high risk of mental illness and antisocial behavior. To mitigate the psychological effects of child labour, proper awareness and education in societies are the utmost requirement.

Child labour is a very commonplace problem which has moved from a matter of regional and national anxiety to international discussion and possibly needs global influence and policy imposition. In order to overcome this enormous problem of our times, one must fully understand the factors which result in child labor, its consequences, and how to prevent it without harming affected children.

The problem of child labour significantly depends on culture and geographical location e.g. the younger generations of third-world countries are the main victims. According to UNICEF statistics, about one-third of the child population in developing countries do not even complete four years of education, culminating in circumstances of child labor (UNICEF, 2008).

An international labour organization (ILO) approximation shows that approximately 180 million children in developing countries are completely embroiled in child labour, and in Pakistan specifically, 12.5 million children were laboring.

One basic reason that pushes children to work is the low socio-economic condition of their family. Many times, their work ends up unpaid and compensated for only by their boarding and lodging. Child labour creates many physical hazards to child health but the most devastating effect is in fact psychological.

Children who become involved in different labor-related works have no opportunity to develop their natural psycho-social health; about 40% of child labourers are affected by abnormal psychological growth (Jordan, 2012).

Both the parents and children are often not aware of the scale of hazards to which these children are exposed. In some cases, the parents do know but can nnot find another alternative to create a source of income. To mitigate child labour, efforts must be made to create an environment which makes it easier for every child to go to school and prevents their parents from pulling out them before they can finish their basic education.

During the 19th century, the term “child labour” was introduced in Britain with the implication that the children should not be dragged to work (International Labour Organization). The International Labour Organization (ILO) defines child labour as an activity other than study or play carried out by a person, paid or unpaid, under the age of fifteen.

In 1989, the United Nation (UN) set the full range of children’s rights at the Convention on the Rights of the Child as well as the two ILO conventions, the Minimum Age Convention (No. 138, 1973) and the Worst Forms of Child Labour Convention (No.182, 1999). These rights were to protect children from exploitation and from any sort of work which would be harmful to their health (physical, mental, moral, spiritual or social).

The criteria set by ILO as ‘hazardous work’ was, ‘work that exposes children to physical harm, sexual exploitation, and psychological effects.’

As previously stated, the main reason that pushes children to work is the poor economic condition of their families. In most cases, a child’s family cannot even afford basic food and housing, let alone basic education for children. There are numerous reasons behind those families’ poverty, including national, traditional, historical and cultural.

Other reasons which may lead children to work include family breakdown (e.g. divorce) or a stigmatized attitude towards girls e.g. girls are discouraged from studying at school and propelled into adulthood at a much younger age than boys, either by work or an early wedding.

The employers are interested in hiring children because they are cheap and obedient. Inadequate laws and lack of education provide further opportunities to society to drag children into work.

In general, studies show that children working in factories and mines operate machinery, use chemicals, and are exposed to high or very cold temperatures, which ultimately endangers their lives. Also, children are used to direct life-threatening situational works such as sex work, as soldiers in wars, drugs and smuggling.

One particular example from the United State of America is that the victims of occupational accidents are aged 15-17 twice as often as they are adults (UNICEF, 2011). The lack of personal experience and emotional and physical maturity puts their lives in dangers.

Until 1998, most national and international studies focused their attention on the physical effects of child labour. However, children are more prone to psychological and social risks as compared to physical (reported by Leng and Mayers in 1998). Due to a lack of physical and mental maturity children are always appointed to the lowest grades and levels of their work.

Another study comparing psychological and behavioral problems between the working and non-working children shows that children’s development in the working case is almost seized. The study, conducted by Matalqa in 2004 in the streets of Jordan, showed that working children have lower levels of adaptive skill, lesser physical health and demonstrate unwanted social behaviors.

Child labourers using obscene words, exhibiting high emotions with low creativity and relying on excess use of cigarettes and alcohol was also one of the conclusions reported by Dmour in 2006. Child trafficking, which comes under the worst forms of child labour, has lasting psychological effects on the victims.

Children separated from their families, homes and communities continuously encounter sexual abuse and emotional trauma. Depression, hopelessness, shame, guilt, nightmares, loss of confidence, low self-esteem and anxiety are the appalling consequences faced by these trafficking children.

These pessimistic indications influence their senses and put them in a cycle of self-blame. Psychological abuse tremendously affects self-concept, personal goals, and relationships with others and seriously damages emotional well-being. Sexually-abused children are more likely to experience offensive emotional outcomes such as symptoms of post-traumatic stress disorder (PTSD) and suicide.

Children exposed to these numerous experiences of victimization are at high risk of mental illness. Adults who experience such forms of child labour are likely to resort to violence and display antisocial behavior (Gordon Betcherman, Jean Fares,Amy Luinstra, and Robert Prouty, July, 2004).

To mitigate child labour, a coordinated set of multiple actions with well-meaning intentions is of the utmost importance. For example, to address the root causes of child labour, we must prevent children from dropping out of school and discourage parents from putting their children in the labor market.

It is necessary to construct appropriate and concise laws and policies which not only ensure child protection but are also understood by the parents in such a way so as to compel them to obey those laws.

In conclusion, child labour is a social and moral problem which damages society constantly. To understand and mitigate this problem, one should first fully understand the reasons which push children into the labor market, then the outcome of child labour and its impact on societies, and the need to explore appropriate approaches to bringing back children from labour work to schools.

Around the world, different reasons for child labour have been pointed out but the main reason stands as poverty. Child labour has numerous consequences but the psychological impact is the most long-term problem and needs attention on an emergency basis, especially in third-world countries where people lack awareness of it.

Existing studies about the psychological effect of child labour report that victims of child labour face depression, lack of trust, hopelessness, low levels of confidence, shame and guilt, low self-esteem and anxiety, and may grow up to be adults who also pose certain risks to society. For a better future and protective society, several coordinated actions must be taken to mitigate child labour.

Governments as well as responsible organizations around the world must provide an environment which makes it easier for poor people to keep their children in school (at least until primary education) and create awareness in societies about child labour and its outcomes.

Courtesy: JPMS Medical Blog / Dawn News

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