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I’m a 35-year-old man and I’m struggling to balance my duties as a son and a husband. My wife doesn’t get along with my mother and my mother isn’t particularly fond of my wife either. They get into arguments very often and both of them expect me to take their side every time. I try to stay out of their issues but I feel like it’s my responsibility to sort things out between them. I feel helpless when I can’t. What can I do?

Answered by Rishav Koirala, psychiatrist and researcher

Balancing the relationship between your mother and your wife can be a formidable challenge. To address this conflict effectively, initiating open and honest conversations with both your wife and your mother is a crucial first step. This allows you to seek their perspectives and express your concerns openly. 

It’s essential to establish clear boundaries that encourage both parties to interact civilly and respectfully, even if they don’t become the best of friends. If conflicts persist and mediating becomes difficult, consider seeking professional help, such as couples counseling or family therapy, which can provide a neutral space for everyone to express their feelings and work towards resolutions.

Moreover, it’s important to encourage your wife and mother to develop their relationship with each other. While they may not become close friends, fostering some understanding and mutual respect can significantly improve the overall family dynamic.

In moments of conflict, strive to be a fair mediator, remaining calm and unbiased. Avoid taking sides and focus on finding common ground and practical solutions. Prioritize your marriage, and your relationship with your mother as well investing time and effort to maintain a strong and healthy relationship with your wife and your mother. This can contribute to an improved family atmosphere.

Most importantly, don’t forget to take care of your well-being, as dealing with family conflicts can be emotionally draining. Seek support from friends, support groups, or a therapist to help you cope with the emotional stress. Keep in mind that resolving family conflicts takes time, so approach the situation with patience and empathy. By focusing on communication, setting boundaries, and being open to positive relationship evolution over time, you can create a more harmonious environment for everyone involved.

My grandmother is a 65-year-old retired teacher. Lately, she has been experiencing memory problems, such as forgetting appointments, misplacing keys, and struggling to recall the names of familiar people. What could it be and is there anything that could be done

Answered by Rishav Koirala, psychiatrist and researcher

Age-related cognitive changes are common, and some degree of forgetfulness is considered a normal part of aging. Chronic stress can lead to cognitive difficulties, and addressing stress management techniques may help improve memory. Sleep disturbances, such as sleep apnea or insomnia, can also impair cognitive function, and optimizing sleep quality can have a positive impact. 

If your grandmother is on some medication regimen, there are some drugs that may be affecting her memory. So a review of her medication is essential. Additionally, addressing any underlying medical conditions and ensuring proper nutrition can play a crucial role in memory improvement.

With the aging population in Nepal, the prevalence of cognitive disorders, including dementia, has been on the rise. In the context of dementia, individuals may experience a distorted sense of temporal orientation, emphasizing past memories while struggling to remember or anticipate the future. This temporal disorientation can lead to a sense of ‘wandering’ through time, where past experiences become more accessible, while future events and plans become increasingly elusive. 

As a result of this temporal disorientation, individuals experiencing memory problems may also find it challenging to remember tasks or work that was in progress, which can be disruptive and disorienting. This issue can further compound the difficulties associated with dementia, as individuals may ‘lose track’ of their ongoing tasks, adding to their sense of temporal disorientation and causing frustration and confusion. Understanding and addressing these challenges are essential in providing appropriate care and support to individuals with dementia.

Moreover, it’s crucial to recognize that the person looking after the patient, such as family members or caregivers, may experience significant emotional and psychological challenges. The constant adjustments and uncertainties brought about by dementia can lead to caregiver anxiety, stress, and burnout. Caregivers often grapple with the demanding responsibilities of ensuring the patient’s safety, providing emotional support, and managing the daily care routine, all while witnessing the progressive decline of their loved one's cognitive function. Recognizing and addressing the caregiver’s well-being is a vital aspect of holistic care for individuals with dementia, as it helps ensure the patient receives the best possible support while also maintaining the caregiver’s own mental and emotional health.

To determine the exact cause and appropriate interventions, it is crucial for your grandmother to seek a comprehensive evaluation from a healthcare professional, be it a psychiatrist, neurologist, or geriatrician, who can provide a tailored assessment and guidance for her specific situation. Early intervention and support can significantly affect the management of memory issues, irrespective of their underlying cause, and may involve addressing temporal disorientation and providing a supportive environment for individuals with dementia.

I’m a 27-year-old woman and I have an issue with self-esteem. I say that because I am always worried about what people will think of me and go to extreme lengths to seem kind and polite in group settings. I hardly ever say no, and I’m always compromising even when I feel really bad about it. People tend to take me for granted and I allow it to happen. How do I change myself and become more confident about who I am? 

Answered by Rishav Koirala, psychiatrist and researcher

As a 27-year-old woman grappling with self-esteem issues, your tendency to excessively concern yourself with others' opinions and consistently prioritize their needs at your own could be indicative of underlying self-esteem challenges. These behaviors, including an inability to say no and a propensity to over compromise, may stem from a fear of rejection or a desire for approval. Recognizing these patterns is an important first step towards personal growth and self-confidence. Exploring potential root causes, such as past experiences or influences, including past relationships that may have impacted your sense of self-worth, can help you gain insight into your behavior. Embracing the concept of abundance, where you believe in your inherent worth and the availability of positive opportunities and relationships, can also be transformative in your journey towards building confidence. It’s important to remember that seeking to change and build confidence is a gradual process, and it can be valuable to seek professional support, such as therapy or counseling.

Individuals with personality disorders, like Borderline Personality Disorder (BPD) or Avoidant Personality Disorder (AvPD), often grapple with low self-esteem and difficulties in assertiveness. Building self-esteem and learning to say no assertively are critical skills for them. Assertive responses can take various forms, such as direct refusal, empathetic declines, or offering alternatives. It’s vital to respect one's needs and feelings while considering the feelings of others. Seeking professional guidance and practicing assertive communication can help individuals with personality disorders enhance their self-esteem and navigate social interactions more effectively, ultimately fostering healthier relationships.

Consulting a therapist or counselor is a valuable step to consider, as they can provide you with professional guidance, support, and tailored strategies to navigate these challenges and foster a more assertive and self-assured self. It’s important to note that sometimes these symptoms of low self-esteem, excessive worrying about what others think, and people-pleasing may occur alongside other symptoms of anxiety, potentially indicative of Generalized Anxiety Disorder (GAD).

I’m a 45-year-old woman who has a teenage daughter. She is 14. I’m finding it difficult to relate to and understand her. I have told her to share her problems with me and she seems to trust me enough to confide her secrets. But I find myself getting angry. I realize that’s not the right response but her ‘boy troubles’ and peer pressure issues make me want to punish her. How do I discipline my child and make sure she doesn’t become rebellious and pick up bad habits?  

Answered by Kapil Sharma, counseling psychologist, Nepal Institute of Mental Health 

Every mother wants nothing but the best for her child. It’s natural to feel frustrated with children for their recklessness at times, but punishing them might not be the most effective approach, as you seem to be aware. Yet the way you are feeling now might be due to anger issues with your daughter’s transition, disciplinary concerns, expectations you have for your daughter or your own personal struggle.

When things don’t go as planned, parents-adolescent conflict is fairly common, creating emotional irritation, rage, and concern. Also, because your daughter is just 14, she is in the process of transitioning from childhood to adolescence. You can start by educating yourself on adolescent issues so that you can help your child deal with them.

You’ve stated that you want your daughter to confide in you, and it’s wonderful that she does. It’s great that you want an open relationship for a safe and secure environment for her. But the main issue is that you lose your temper easily. Rather than interrupting, consider active listening. You can try to wait until she finishes her narrative before speaking. If you feel dissatisfied after hearing what she has to say, try asking open-ended questions to convince her to reflect on her thoughts and actions. She might have her own conclusion or way out about the issue. Also you can reflect on what you would expect from your mother if you were in your daughter’s place. This may change your perspective as well.

Try empathetic communication as that might help you deal with her rebellion. Instead of  restricting your daughter from doing things, try to make her feel at ease by validating her feelings. Also, learn to resolve your own anger issues first. To begin with, reflect on your personal life including your expectations and stress.  Try fixing them  through conflict resolution and problem solving skills. But even after this, if you still feel confused, I recommend you attend a therapy session.