Dr. Rohit Raman Pandey on Sex Education, Addiction, and Psychiatry in India (Part-2)

Dr. Rohit Raman Pandey: Sexual medicine can be a valuable resource because it's widely available, even in remote areas. Whether you're pressed for time or have the freedom to seek help, there are options for obtaining sexual health medications. Visiting a sexual health clinic can be an eye-opening experience, with various people sharing their treatment journeys that make you feel like you're living in 2023.

Many individuals may be advised to consider medications or injections due to issues like low sperm count or other concerns related to their sexual health. These recommendations may challenge long-held beliefs and societal norms, which have been ingrained in us for years. Even our families may have had similar beliefs. In the past, access to sexual health information was limited, especially during times when the internet and television were not readily available.

Our lifestyles have evolved, with factors like diabetes, addiction, and the portrayal of substance use in movies affecting our perceptions. Unfortunately, some individuals, often less educated, follow influencers who promote unhealthy habits, such as substance use, as a form of rebellion. Peer pressure has become a significant factor in modern society.

The lack of sexual education within families has led to a reliance on friends for information and guidance, even on subjects as personal as sexual health. This can leave individuals vulnerable to misinformation and manipulation.

In an ideal scenario, parents would provide comprehensive and accurate sexual education, establishing a strong support system within the family. This would reduce the dependence on peers or older siblings, who may not always provide reliable guidance. Therefore, fostering open and informed discussions about sexual health is crucial.

In conclusion, my passion for these issues stems from the realization that many people are seeking treatment for concerns that aren't necessarily medical conditions. If parents had played a more active role in providing sexual education and support, the reliance on external sources of information and peer pressure might have been significantly reduced.

Dr. Rohit Raman Pandey: In our society, there is a concerning trend of misusing certain terms, especially when it comes to therapy. Nowadays, casual conversations with friends are often labeled as therapy. We have a structured system for counselors in our country. If someone is part of this system, they are recognized as a counselor.

However, if you read the latest articles or news, you'll notice that many social influencers are branding themselves as counselors, therapists, or mental health professionals.

This creates confusion and undermines the credibility of the profession. It's crucial to standardize and clarify these roles. For instance, physical medicine and rehabilitation (PMR) specialists have distinct titles, and physiotherapists often have different designations. Psychotherapists, on the other hand, tend to earn a good income, reflecting their specialized training and expertise.

The key point here is that anyone can claim to be a social influencer, but it's essential to look at their qualifications and certifications. Only then can you be certain that someone is a certified counselor or holds a relevant degree. This distinction is vital for providing proper guidance and support.

Similar issues exist in various professions. For example, even in the field of music, you might find unqualified individuals performing in villages. This problem extends beyond therapy and counseling.

I hope that the National Medical Commission (NMC) or relevant authorities can address this issue. It's a significant problem that has real consequences, including cases of negligence. Many unqualified individuals are operating in these roles, and it's essential to find a way to put an end to this practice, even though it may be a challenging task.

Dr. Rohit Raman Pandey: One critical aspect that needs attention is mental health. When we compare our country to places like the US and the UK, it's evident that we haven't made sufficient efforts in this area. There's a lack of social health workers, and it's unclear how many visits and what level of care are available for mental health patients. It's apparent that we are not on par with these countries in terms of mental health support within the healthcare system.

Dr. Rohit Raman Pandey: If someone is struggling with addiction or is a patient, it's essential not to assume that they are intentionally engaging in harmful behavior. Often, our societal mindset leads us to believe that individuals choose addiction willingly. However, addiction—whether to substances like cannabis, opioids, or even alcohol—is not a matter of choice. These substances alter the brain and behavior, and we have diagnostic criteria for mental and behavioral disorders.

The critical point to understand is that addiction cannot be cured through punishment. Practical steps are necessary. It's crucial to consult with relevant medical professionals who can guide you on the best course of action, including motivation, treatment, duration, and outcomes.

It's important to recognize signs of dependence as early as possible. Some individuals might justify their behavior by saying they only drink or use substances a few days a week. However, if withdrawal symptoms occur within a few days of abstinence, it's a clear sign of addiction.

In my area of expertise, which involves opioids and alcohol, we are focusing on raising awareness of the harmful effects. Many people are unaware of the consequences of opioid use and mistakenly believe they are simply enjoying the experience. These substances create powerful memories, making it challenging to quit once started. Withdrawal from certain drugs can be so severe that it can harm individuals and their relationships.

Raising awareness is crucial because many people underestimate the dangers of tobacco and its link to cancer. Addressing this issue and reducing tobacco use can significantly impact cancer rates.

Furthermore, some individuals believe that certain behaviors, like excessive eating or serving others, are part of their way of life, not realizing the harm they may cause.

To address these misconceptions, it's essential to invest time and effort into educating individuals about the risks and consequences of their actions.

Regarding the issue of influencers and actors endorsing harmful products like tobacco, it's a complex matter. While I can't comment on whether laws should be enacted, I believe it's a moral responsibility for individuals, especially those in influential positions, to refrain from promoting such products. Contracts and endorsements carry financial incentives, but it's important to prioritize ethical values and consider the impact on society.

Ultimately, if your moral compass is intact, you should strive to act responsibly and set a positive example for others.

Dr. Rohit Raman Pandey: We've discussed this extensively, and in my personal opinion, there's a lack of awareness about psychiatry as a sub-specialty, especially in India. Even after completing an MD in psychiatry, many haven't considered further sub-specialization. Sub-specialization in psychiatry hasn't gained significant prominence in our country yet, but it may change in the future, perhaps in the next 5–10 years.

One primary reason for this is the shortage of psychiatrists in India. There's much work to be done in terms of training and development. If you examine the field of mental health, you'll find gaps in various areas that need addressing from top to bottom. This transformation will take time.

Moreover, there's a common misconception among the public that psychiatrists primarily deal with addiction. People often seek help from primary care physicians, neurologists, or general medical practitioners for issues like addiction or depression, assuming these problems don't require psychiatric intervention.

Regarding my research and publications, I value their importance. However, the credibility of publications in India remains a concern due to the proliferation of numerous journals with varying degrees of quality and reliability. I won't comment on this aspect, but I plan to publish my work in reputable journals to uphold its credibility.

Dr. Rohit Raman Pandey: Managing such situations can be challenging. Patients may become confrontational, accusing the doctor of not prescribing enough or the right medication. This is a common issue, especially in regions where Alprazolam has a reputation for its effectiveness.

I'd like to pose a question: How many Alprazolam tablets should a person take, say, at 0.5 mg each? The correct answer is 0.5 mg, but some individuals end up taking five or even seven tablets, totaling 2.5 or 3.5 mg.

In such cases, it's crucial to educate patients about the potential risks associated with excessive Alprazolam use, including cognitive impairment and dependence. If necessary, we may transition them to a longer-acting benzodiazepine to make it easier to taper the dosage. However, it can be challenging to convince patients to accept these changes.

Another common problem is patients self-administering more medication than prescribed, leading to issues with refills. It's essential to provide patients with clear explanations and guidance to help them understand the importance of responsible medication use.