Q I seem to have a problem in getting even small tiffs out of my mind. I keep thinking about them, even at night, so much so that I am not able to sleep well. What to do?

Yours is an interesting problem but many questions come to my mind, the first being why do you think these are “small” tiffs? These may be quite emotionally disturbing to you, otherwise you would not have kept on thinking about it. What is small to you may be quite big to me. 

Is there a pattern to these tiffs? Is it with the few important people in your life? Are you a person who cannot live with emotional dissonance? Do you want everything to happen as per your wish and get upset if they do not? Are these disagreements so important that you will have to lose sleep over it? Do the outcome of these disagreements affect your life over the next one week, one month or one year or your entire life? Have you told the people with whom you are having these tiffs how badly it affects you? 

Essentially, it is about how you handle disappointments. Answering my questions will shed some light on how your mind works. This knowledge will enable you to find solutions. That will also save you a trip to a counsellor!

Q Even when I am among people, I tend to zone out and my mind keeps wandering. Is it an indication of something?

What you are describing is surprisingly quite common and happens to all of us. So by itself it is not an indication of anything grave. It can indicate tiredness, boredom or unstimulating conversation and whatever you are doing at that point in time, does not interest you. Maybe you need better company to keep your mind engaged! 

I would be worried only if it affects your job or relationships. Also, I suspect many of us are losing the virtue of focusing deeply on whatever we are doing at any given point in time. We are constantly interrupted by phone calls, messages and notifications on social media; our mind no longer focuses on one particular chain of thought or event. 
Practising meditation and borrowing from the principles of mindfulness practice, you can certainly enforce more control on your wandering mind.

Q Lack of confidence is hampering my work and causing me to be nervous and stressed all the time. I believe that nothing I do seems to be up to the mark, while a lot of people, who are doing inferior work than me, are very sure of themselves. How do I build up my confidence?

You may need to enrol yourself in a crash course, like “How to boost your way to success”, or an easier way would be to follow the methods shown by Donald Trump! 

On a serious note, you need to take a trusted colleague into confidence for an objective assessment of your work. Management gurus call it SWOT analysis. What comes across in your post is your negative appraisal of your own work, your nervousness and your resentment about people’s success. 

I have to caution you about not getting too convinced about your own judgements and tormenting yourself about it. Is it because you are a nervous person by nature, and are underconfident and uncomfortable about accepting that you do a decent job? Is it because you are a perfectionist who is never satisfied with the end product? Essentially, you need a mentor who can guide you and rectify any deficits that can be overcome.

Q My husband is 49 and had an angioplasty two years ago. He was completely fine for a year but has recently started experiencing chest pain and sweating again and feels he might faint. He has become extremely worried about this and feels his heart condition is worsening. However, his cardiologist and other doctors have reassured him that there is nothing wrong with his heart and it is occurring due to anxiety. Is this possible? How can anxiety cause chest pain?

Symptoms as experienced by your husband are extremely common. Symptoms of anxiety are very commonly expressed through physical manifestations. For example, all of us have experienced palpitations in our chest, sweating, and discomfort in our stomach before difficult examinations or when we are in difficult situations. This is caused by our brain releasing a substance known as noradrenaline. In patients with anxiety disorder, this brain chemical is liberated in amounts more than what is desirable. This is exactly what is happening to your husband. His symptoms are suggestive of an underlying anxiety disorder. 

One of the difficulties in such a situation is that patients often find it difficult to accept that the root cause of their problem lies not in the body but in the mind. Many people find it hard to accept that they are suffering from a mental disorder. 

Anxiety disorder is an extremely common condition and in your husband’s situation, it is natural that he is anxious (having angioplasty at 47 years of age is worrying). So they needlessly seek different medical opinions and subject themselves to more and more investigations to be absolutely sure that nothing is being missed. This causes unnecessary delay in seeking the correct medical treatment.

I advise that you trust what your doctors are saying and seek an opinion from a psychiatrist to solve his problems.

Q My mother is 57 years old. For the past few months, she does not want to go to sleep. It is not that she is not getting sleep or is unable to fall asleep but soon after falling asleep, she wakes up screaming. She feels as if she is falling from a height and wakes up feeling very scared and anxious. Recently, she has forced my father to put a grill on our balcony on the first floor, as she is afraid she might fall. She refuses to climb stairs. This behaviour is very unusual as she has never been afraid of heights. 

From your description, there are two possibilities that can explain her symptoms. First, she is suffering from a sleep disorder, which is known as nightmares. Nightmares are vivid dreams that can cause feelings of fear, terror, and/or anxiety. Usually, the person having a nightmare is abruptly awakened from sleep and is able to describe detailed dream content. The person having a nightmare has difficulty returning to sleep. Nightmares can be caused by many factors, including physical illness, anxiety, the loss of a loved one, or adverse reactions to a medicine. It is possible that your mother is having recurrent nightmares and the experience is so terrifying that she does not want to go to sleep.

Second, she could be suffering from an anxiety disorder, which is manifesting through her sleep problems. The fact that she has put a grill on the balcony and is refusing to climb stairs could be a reflection of her anxious state of mind where she fears something bad, like an accident, might occur. This is a typical symptom of anxiety. I would advise you to gently talk to your mother to find out whether she is upset or anxious about something and is finding it difficult to express. It could be that her anxiety is finding an expression through bad dreams. 

The second step would be to reassure your mother that good treatment is available for her sleep problems and either counselling or low doses of anti-anxiety drugs can help. I would advise you to take your mother to a psychiatrist for evaluation. 

Dr Jai Ranjan Ram is a senior consultant psychiatrist and co-founder of Mental Health Foundation (www.mhfkolkata.coam). Find him on Facebook @Jai R Ram