Dr K K Aggarwal speaks on Quantum Physics and Mental Health at the 21st World Congress on Mental Health

Dr K K Aggarwal speaks on Quantum Physics and Mental Health at the 21^st World Congress on Mental Health

Understanding how particle duality works and balancing this can help in treating depression and other such mental disorders

New Delhi, 6^th November 2017: As per a recent report, about 7.5% Indians suffer from major or minor mental disorders requiring expert intervention. About 56 million Indians have depression and another 38 million Indians suffer from anxiety disorders. At a recent event, organized by the World Federation of Mental Health, called the 21^st World Congress on Mental Health, Dr K K Aggarwal, National President, IMA delivered an insightful address on Quantum Physics and Mental Health. IMA was a supporter to the event. 

Dr Aggarwal’s session focused on how quantum physics explains that the mechanism of depression and anxiety can be an imbalance between understanding the way particle duality functions. Balancing this can further help in treating depression and other such mental disorders.The parasympathetic nervous system plays a vital role in maintaining both mental and physical health by helping the body to calm down from stress reactions that elevate blood pressure, dilate the pupils, and divert energy from other body processes to fighting or fleeing.

Speaking at the event, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI),said, “Photon is the smallest unit of light,quantum is the smallest unit of energy,electron is the smallest unit of electricity,graviton is the smallest unit of gravity. Similarly, the smallest unit of thought is qualia, or tanmatra, as mentioned in Vedic sciences. We remember photon in medical science with the word MRI. Photon is both a wave and a particle at the same time. In mythology, we call this as Shiva Shakti, the particle duality of a human being. Thus, the human body is also a particle and a wave at the same time; a co-existence of male and female energy, shiva and shakti, purusha and prakriti. This duality, in science, is a balance between sympathetic and parasympathetic response. In an extreme degree of a parasympathetic state of mind, you understand that you are both a particle and a wave. Balancing the wave is what parasympathetic treatment procedures are all about, some of which include mind-body relaxation, progressive muscular relaxation, slower and deeper breathing, conscious breathing, and present moment awareness. These are indirectly also called as pranayama meditation procedures.”

Research shows that a person’s reaction to the people and environment around them has a major impact on the balance between the sympathetic and parasympathetic nervous system. In those people where the sympathetic nervous system is dominant, there is a feeling of nervousness, jitteriness or tension. When a person is depressed, there is a disconnect between his physical and mental health.

Adding further, Dr Aggarwal, said, “We know that depression is treated using serotonin, which is a drug available as SSRI. Through conventional means of therapy and by not even giving serotonin, it is possible to produce serotonin in the body by changing our understanding of how particle duality works. It is possible to treat mental disorders through counseling and the yogic way. Treating mental disorders involves re-understanding quantum physics to shift the body from sympathetic to parasympathetic mode as also learning the art of a parasympathetic lifestyle. All treatment procedures that help in balancing this duality can be used to treat mental disorders.”

Dr RN Tandon – Honorary Secretary General IMA, added, “This event was a platform apt for deliberating on mental health and the associated topics. The IMA always strives to support such events that address health issues at a larger level.”

The following tips can be followed to practice the art of a parasympathetic lifestyle.

• Include foods that support your system Consume a diet based on whole foods. This includes green leafy vegetables, quality protein, healthy fats, and complex carbohydrates.

• Hydrate the body adequately Staying hydrated will help the lymphatic system flush out toxins and remove the metabolic waste out of the body. This is essential to detoxify, nourish, and regenerate tissue.

• Include some physical activity Exercise is positive physiological stress for the body. Yoga, for example, is known to accrue great benefits to both the mind and body.

• Practice mindfulness This includes a combination of practices, habits, thoughts, and behaviours to help you get through your daily life. Mindfulness means intentionally and actively seeking to lower the body’s response to stress.

IMA highlights deficiencies in the new Mental Health Bill 2016 passed by the Parliament

IMA highlights deficiencies in the new Mental Health Bill 2016 passed by the Parliament The Lower House of the Parliament passed the new Mental Healthcare Bill 2016 on Monday. The Upper House had already passed the Bill in August last year. · It clearly spells out clearly government’s responsibility. · It decriminalizes attempt to suicide. · It has made the mentally ill eligible for insurance cover etc The Bill has some very good provisions (as above) and it has been enacted by the Parliament, it suffers from some fundamental inconsistencies and poor drafting. Submissions have been made in detail to the Hon’ble Health Minister by the Indian Psychiatric Society. Some of the fundamental problems with the Bill are as mentioned below 1. Definition of mental illness: Mental illness is defined as “substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behavior, capacity to recognize reality and ability to meet ordinary demands of life” · This definition is at variance with that of National Mental Health Policy. · As per the definition, even serious mental illnesses like Depression and Delusional Disorder cannot be considered as mental illnesses. Common mental illnesses like Panic Disorder, Obsessive compulsive disorder also cannot be considered as mental illnesses, whereas these illnesses can be very disabling. Hence, the provisions of the act can benefit only a small portion of people with mental illnesses (PMI). · The act states that all PMI should be admitted as “Independent” as per Section 65(2). How can this be possible? A person who suffers from grossly impaired judgement and not able to meet ordinary demands of life will be in no position to seek voluntary admission. 2. Mental Health Establishment Section 2(1) (P): As per the definition, even a general hospital psychiatric unit (GHPU) will be deemed to be a Mental Health Establishment and therefore needs to be registered as such. · Singling out mentally ill in this fashion goes against the vision of National Mental Health Policy, which envisages full integration of psychiatric services in mainstream medicine. · As per the definition, practically all hospitals will be deemed to be Mental Health Establishments because mental illnesses and physical illnesses frequently coexist. For example, a person who gets into a hospital for Diabetes may have Depression and will need psychiatric treatment. · It will not be possible for the State mental health authority to regularly monitor all hospitals and other establishments 3. Mental Health Nurse Section 2(1)(q): As per the definition even a nurse with diploma in general nursing is mental Health Nurse and can be registered as a mental health professional (Section 55). A mental Health professional can admit patients and send them on leave. A Psychiatrist who had undergone rigorous training for 10 years is sought to be equated with person with 3 years training in nursing! Giving responsibilities to people who have no adequate knowledge and skill will create havoc in mental health care service. 4. Advance Directive (Section 5): It is almost impossible for a common man (Future Psychiatric Patient) to determine what treatment he should have or should not. Psychiatric knowledge is limited even in medical graduates. 5. Nominated Representative (Section 14): In our country, family members take the major responsibility of caring for mentally ill. Bringing a third party into the decision making process is against the culture of our country. Even the WHO Mental Health Act and Convention on the Rights of Persons with Disabilities (CRPD) advocate culturally consistent laws for member states. 6. Section 18(1) (3) Not Consistent with section 2(1)(s). 18(1)(3) section states that every person should have access to mental health care, whereas section 2(1)(s) even excludes people suffering from common mental illnesses and even some serious mental illnesses. 7. State Mental Health Authority: In our country, we have one psychiatrist for more than 3 lakh people. This small number of psychiatrists is shouldering enormous responsibilities. Psychiatrists who are experts in the field are not adequately represented in the State Mental Health Boards. At least 4 psychiatrists including 2 private psychiatrists should be included as members. 8. Central Mental Health Authority: At least 4 psychiatrists as above should be included as members. 9. Electro Convulsive Therapy (Section 94(3)): This is a treatment NOT a punishment as depicted in films. It is lifesaving in certain psychiatric conditions. High voltage current is directly applied to the chest without anesthesia in cardiac emergencies. Surgeons routinely apply electric current to burn tissues during operation to stop bleeding. Why special restrictions are placed on psychiatrists? It would be in the best interests of patients if treatment decisions are left to specialists. 10. Community Care: The bill deals with institutional care. Provisions for Community care are not there in it at all. DRAFTING ERRORS The Bill is studded with errors. For example: · In the index at the beginning of the Bill “Mental Health Commission” is mentioned. There is NO Mental Health Commission in the Bill. · Section 103 quoted as emergency treatment whereas it is section 94, which actually deals with emergency treatment. · There are many more such errors Conclusion This bill is a Legal cum Professional document. Enormous difficulties will arise in implementing the present bill. People particularly in the vast rural areas of country will be at a disadvantage in getting access to mental health care. The Indian Psychiatric Society, the premier body of Psychiatrists in our country, is prepared to sit with concerned officials to sort out the lacunae in the bill. Summary The Mental Health Care (MHC) Bill may end up ruining the mental health sector in the country. The MHC Bill proposes to bring the General Hospital Psychiatry Units (GHPUs) under its purview. The general hospitals mostly treat people with depression, anxiety, phobias, sexual dysfunctions, adjustment and stress disorders, etc, before any disability sets in. “If we are trying to put these everyday life events into legal framework, people will not seek treatment and some of them may even commit suicide, ultimately leaving the Bill a disaster.” GHPU attached to teaching hospitals, general hospitals, and to some major private hospitals was the biggest revolution in psychiatry in the last 50 years. It has de-stigmatized psychiatric treatment by bringing mental health care from the confines of the mental hospitals to the doorsteps of the common man. Moreover, the MHC Bill is modelled on certain Western Bills. Various clauses in the Bill like ‘nominated representatives’ and ‘advance directives’ are completely alien to the Indian family ethos. Dr KK Aggarwal National President IMA & HCFI With contributions from: Dr (Prof) Roy Abraham Kallivayalil, National Vice-President, IMA and Dr RN Tandon Hony Secy Gen IMA With detailed inputs from: Dr Prof Brig MSVK Raju, President, Indian Psychiatric Society

Deepika Padukone Launches Nationwide Mental Health Program

Deepika Padukone Launches Nationwide Mental Health Program The setting-Kamal Mahal, Maurya Hotel Delhi, an epitome of luxury. The occasion- the launch of the first Mental Health Campaign in India by Deepika Padukone's NGO The Live Love Laugh Foundation. There is an air of subdued excitement as invited guests and members of the press walk in and mingle over a cup of tea. The buzz and hush is very palpable as all eyes keep looking at the door just waiting for the founder of Live Love Laugh foundation, Deepika Padukone to walk in. One might ask- what relation does depression have with this beautiful, ethereal, stunning, talented and famous goddess of the Bollywood industry? She has everything- beauty, money, fame - what more does she want? This is just a fad of the rich and famous most would say. And that's where they are wrong in their perception of depression. It is thought of as being all in the mind, a by-product of our emotions and stress and possibly a weakness and not as something that is a disease like an authentic diabetes or a heart attack. The numbers are staggering and the resources scarce. And hence the need for an initiative like the Live Love Laugh Foundation founded by Deepika . To educate, empower and prevent , to remove the stigma associated with the word depression and to bring mental health to the fore as a disease entity which can strike anyone, anytime and needs to be treated like any other chronic non communicable disease. While explaining how important it is to take the step of talking to the one suffering from depression, Deepika launched a social campaign through her Live Love Laugh foundation, #DOBARAPOOCHO. “In the times we are living today, we have become so competitive, which is a good thing, but we have become extremely insensitive too. Through this campaign, I dedicate this to people who have survived depression, people suffering through it even now and urge the society to become more sensitive.” According to Indian Medical Association President-Elect Dr K K Aggarwal, "The government estimates that 6-7 per cent of the country's population lives with major to minor mental health concerns. But we have only 6,500 trained psychiatrists and even fewer psychologists. What is worse is that the stigma and discrimination faced by these people and their families prevent them from seeking guidance." Rajya Sabha has already passed the Mental Health Care Bill 2013 which once cleared by the Lok Sabha would replace the Mental Health Act, 1987. The first ever National Mental Health Policy was launched on October 10, 2014 which seeks to provide universal psychiatric care to the population, 20 per cent of which is likely to suffer some form of mental illness by 2020. The campaign has been jointly launched by the IMA, the Indian Psychiatric Society and Bollywood actress Deepika Padukone's Bengaluru-based Live Love Laugh Foundation (TLLLF). IMA, IPS & TLLLF will be conducting CME Programs across the country to train General Practitioners on Mental Health. Dr Veena Aggarwal Executive Editor eMedinews and IJCP Group

“Dobara Poocho” says TLLLF, urging Indians to reach out to those with mental health challenges

“Dobara Poocho” says TLLLF, urging Indians to reach out to those with mental health challenges - India’s First Nationwide Public Awareness Campaign on Mental Health Launched on World Mental Health Day New Delhi, October 10, 2016: The Live Love Laugh Foundation (TLLLF) today unveiled the country’s first nationwide public awareness campaign on mental health aiming to bring conversations around mental health into the mainstream, and inspire people to reach out to those who could be suffering from mental disorders. The campaign has been designed by McCann Worldgroup and uses the tag-line Dobara Poocho (Ask Again). It was launched as part of World Mental Health Day celebrations in the nation’s capital, in the presence of Smt. Anupriya Patel, Minister of State for Health and Family Welfare, Government of India. Dobara Poocho will run across television, print, digital and radio and comes even as India prepares to cope with the severe economic and societal burden brought on by the epidemic of mental illness in the country. WHO (World Health Organization) estimates that 10% of India’s population suffers from mental health disorders; 80% of those affected are depressed and / or suffering from anxiety, while the remaining 20% battle with severe mental health issues such psychosis, bipolar disorder, schizophrenia etc. In 2013, India lost 31 million years of healthy life due to mental illness of its citizens according to Lancet. By 2025, it is estimated that 38.1 million years of healthy life in India will be lost (23% increase in 12 years). Lancet data also shows that India accounts for a massive 15% of the global mental, neurological and substance-use disorder burden with depressive disorders and anxiety disorders being the most common. According to a 2014 report by the World Economic Forum and Harvard School of Public Health, mental health was expected to cause a loss of US$1.03 trillion in economic output in the country between 2012 and 2030. “Those facing mental health challenges need love and support. TLLLF’s sincere hope is that Dobara Poocho will inspire all of us to become a little more sensitive to the people around us, look out for those who might have mental health issues and guide them to take the right action on the road to good mental health. We believe the campaign will be an important marker in the long and challenging journey to build more awareness and address the social stigma around mental health,” said Deepika Padukone, Founder, TLLLF. “Not only is it imperative to be aware of depression and other mental disorders, it is also important to spread awareness and sensitise society that all individuals who have some form of mental illness have the right and should be provided the resources to deal with these challenges. Caring and supporting such a person through the journey is the need of the hour; we need to build a nation that promotes social inclusion across every dimension” noted Anna Chandy, Chair of TLLLF’s Board of Trustees. Elaborating on the campaign concept, Prasoon Joshi, Chairman Asia Pacific, CEO & Chief Creative Officer India, McCann Worldgroup, said “Questions like “How are you”?, “How was your day?”, “What’s up?,” are asked as a form of greeting. Very often they are empty tokens of communication – asked and then immediately forgotten. Wedo not wait for an open, heartfelt response and we’d be taken aback if the person actually responded honestly on her or his state of mind at that moment! The truth is that behind that mask, one out of every ten Indians are afflicted with depression and anxiety. Dobara Poocho was born out of this very need to look at someone again, to observe that someone closely again, to be aware of his or her nuances again, to hold the person close again, to ask again.” The campaign film for Dobara Poocho has been shot by Nirvana and features simple stories of regular people courageously facing and fighting depression. It is a testament to the strength and courage of the human spirit. The print campaign showcases real people who have gone through or are going through depression, and fought the illness to become stronger and whole. The Dobara Poocho launch in New Delhi was preceded by a panel discussion featuring an eclectic mix of speakers including Dr. Sadhana Bhagwat - National Professional Officer, Non-Communicable Diseases, WHO-India; Dr. KK Agarwal – National President Elect, Indian Medical Association; Dr. G Prasad Rao - President, Indian Psychiatric Society and Dr. Vikram Patel - Founder and Member of the Management Committee, Sangath. The discussion was moderated by Dr. Shyam Bhat, Trustee of TLLLF. Jio is the Campaign Partner for Dobara Poocho. Other partners include DNA Networks (Event Partner), ITC (Hospitality Partner), Tissot (Initiative Partner) and Vistara (Airline Partner). Background: Mental Health in India has assumed crisis propositions and is being viewed as India’s next biggest health and societal crisis. It is estimated that ~ 15% of the country’s population lives with major to minor mental health concerns. That’s more than 100 million Indians, with the number increasing every year. Despite the large number of people who require mental health attention, India has only ~ 6,500 trained psychiatrists and ~ 22,000- 25,000 mental health workers including social workers, psychologists and counsellors. What’s worse is that stigma and discrimination faced by those suffering and their family members prevent them from seeking guidance. Only about one in 10 people with mental health disorders are thought to receive evidence-based treatment. The Live Love Laugh Foundation (TLLLF) was set up in 2015 as a Charitable Trust to champion the cause of mental health in India and focus on depression in particular. The main aim of TLLLF is to reduce social stigma and create awareness around mental health. TLLLF has spread awareness on mental health via its English / Hindi website (www.thelivelovelaughfoundation.org / www.thelivelovelaughfoundation.org/hi), through extensive engagement on social media, outreach to various print, TV, radio and digital media outlets, and by undertaking several on-ground activities such as mental health awareness programs for school students and teachers which has been already conducted in 27 schools, reaching 4804 students and 1332 teachers around the country. TLLLF has also commenced a sensitization program on mental health for doctors in collaboration with the Indian Medical Association (IMA) as well as the Indian Psychiatric Society (IPS) reaching more than 2,000 doctors so far, with a target of an additional 5,000 doctors during 20016-17. The launch of Doobara Poocho is an important complement to TLLLF’s activities.

Denial of justice: Mediclaim does not cover treatment for any mental illness or psychosomatic disorder

Denial of justice: Mediclaim does not cover treatment for any mental illness or psychosomatic  disorder

Dr KK Aggarwal

National President Elect and Honorary Secretary General IMA

On 10^th October we are observing World Mental Health day.  We have been propagating that there is a paradigm shift the way we need to tackle mental illnesses. That depression is no more a stigma or a social issue, that depression is treatable, that depression is a manageable disease and that depression needs to be diagnosed early.

If it is a disease then why still it is not covered under mediclaim?  Why would people disclose ‘depression’ when getting admitted when their whole claim can get cancelled?

We say suicidal ideation is a medical emergency and such patients needs admission. If it is not covered in mediclaim nobody will disclose or one will get admitted under the disguise of some other illness.

On one hand we want special act for mental health and on the other hand we deny their right to get treated.

Some facts

1.      “I have carefully looked into this. As of now there are no specific government guidelines or legislative provisions about insurance coverage of psychiatric disorders. Hence the insurance providers are not providing coverage for Depression. This is denial of justice and we must fight against it. Prof Roy Abraham Kallivayalil. Secretary General, World Psychiatric Association”

2.       Travel Medical Insurance Policy Exclusions: No claim will be paid arising from suicide, attempted suicide or wilfully self-inflicted injury or illness, mental disorder, anxiety, stress of depression, alcoholism, drunkenness or the abuse of drugs.

3.      The World Health Organisation has recently estimated that 1 in 4 persons will be affected by some form of mental illness once in their lifetime.

4.      In 2005, it was estimated that 6-7% of the population suffered from mental disorders, and about 1-2% suffered from severe mental disorders such as schizophrenia and bipolar disorder.

5.      Nearly 5% of the population suffer from common mental disorders such as depression and anxiety. This number is much higher as mental illness often goes underreported due to the associated stigma and non-coverage in mediclaim like policies.

Good News

As passed by Rajya Sabha on 8th August 2016, the new mental care health bill clause (4) every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness. Also under the new bill suicide has been treated as a form of severe stress which will not be punishable under 309 of IPC. But as on day the act is not applicable and depression patients are not under the coverage of mediclaim or other reimbursements.

Indian Medical Association (IMA), The Live Love Laugh Foundation (TLLLF) and Indian Psychiatric Society (IPS) to educate the medical community on depression

Indian Medical Association (IMA), The Live Love Laugh Foundation (TLLLF) and Indian Psychiatric Society (IPS) to educate the medical community on depression To organize a Continuing Medical Education seminar in Delhi on Sunday to mark the upcoming World Mental Health Awareness Day on October 10 New Delhi, October 8, 2016: Addressing the need to reduce the increasing burden of mental health disorders such as depression on the Indian healthcare system, IMA, IPS and TLLLF will organize a one-of-its-kind Continuing Medical Education seminar for doctors on Sunday, (Oct 9, 2016) in Delhi. This CME is a part of the ‘Together Against Depression’ program launched by The Live Love Laugh Foundation (TLLLF), a not-for-profit organization started by actress Deepika Padukone with an aim to raise awareness about mental health in India. The purpose of the seminar is to sensitize and assist doctors in working more effectively with their patients who may be going through depression or anxiety. The Indian government estimates that 6-7% of the country’s population lives with major to minor mental health concerns. This amounts to approximately 70 million Indians, with the number increasing every year. Despite the large number of people who require mental health attention, India has only 3,500 trained psychiatrists and even fewer psychologists. What’s worse is that the stigma and discrimination faced by these people and their families prevent them from seeking guidance. "A General Practitioner (GP) is the first point of contact for a patient and must be sensitized on ways in which they can diagnose signs of depression amongst patients and help them seek appropriate care. This program is in line with the MCI’s (Medical Council of India) new guidelines that state that 10% of all medical education programs should focus on mental health. We hope that through this initiative, we can help raise mass awareness about important health issues impacting the overall population and the criticality of prevention, timely diagnosis and treatment”, said Padma Shri Awardee Dr KK Aggarwal – President Elect IMA & President HCFI. “There is a need to increase resources — human and financial — for mental health in our country. Owing to the associated stigma as well as the shortage of trained medical practitioners in our country, a majority of patients continue to suffer in silence. Since its inception last year, The Live Love Laugh Foundation has been committed to developing outreach programs to highlight the urgent and massive mental health challenges that India faces. We are happy to be hosting this seminar with the support of the Indian Medical Association and the Indian Psychiatric Society. We believe that sensitizing medical practitioners constitutes a major part of the multi-pronged battle that’s needed to fight depression," said Dr. Shyam Bhat, Member of the Board of Trustees, TLLLF. “In our country, depression is underdiagnosed and not recognized even by our doctors. However, it should be known that depression is a treatable disease and more and more people must be encouraged to seek help in time. Given the shortage of psychiatrists and counselors in our country, GP sensitization is essential. We are hopeful that through these CMEs being organized in partnership with IMA & TLLLF, we will be able to better equip practicing doctors with the awareness and resources needed to be able to help their patients. The IPS is focused on positive mental health and in stigma reduction not only for depression but also across the spectrum for all psychiatric disorders” said Dr. G Prasad Rao, President, Indian Psychiatric Society. Our country is home to one of the smallest per capita base of mental health professionals globally. This becomes apparent through the following WHO statistics: For every 100,000 people in India, the base of resources for mental health is abysmally small – just 0.3 psychiatrists, 0.07 psychologists, 0.07 social workers, 0.12 nurses. Moreover, there are only 2.1 hospital beds for every 1,00,000 population. This adds up to a huge burden of mental disorders — 2,443 disability-adjusted life years per 1,00,000 population[i]. These statistics are shocking and reflect the fact that India is grappling with one of the highest burden for mental health disease in the world. The need of the hour is to arm doctors with the resources required to help patients receive appropriate medical attention and treatment and the CME in Delhi is a step in this direction. Ends- [i] http://www.firstpost.com/india/india-needs-to-develop-a-strategy-for-training-human-resources-for-mental-healthcare-3001840.html

Obsessively yours: Signs That You May Have OCD New Delhi, July 26, 2016: Obsessive–compulsive disorder (OCD) is a disabling and potentially chronic anxiety disorder and is characterized by anxiety–provoking intrusive thoughts and repetitive behaviors, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Obsessions may consist of aggressive thoughts and impulses, fears of contamination by germs or dirt, or fears of harm befalling someone. Compulsions such as washing, checking, or counting are rituals whose purpose is to neutralize or reverse the fears. OCD occurs in 2 to 3 percent of the population. People with OCD have uncontrolled thoughts that compel them to develop habits or rituals to ease their anxiousness. The Anxiety Disorders Association of America offers this list of potential warning signs of OCD: • Persistent irrational fears or concerns, commonly about being dirty or getting sick. • Obsessing about things being in order or arranged a certain way. • Being afraid that your thoughts or actions will cause harm to you or someone else. • Hoarding objects with no value. • Irrational doubts or fears that you will harm someone else. • Impulsively and repeatedly cleaning your body or your home. • Repeatedly checking something, such as if the doors are locked, appliances are unplugged or the stove is turned off. • Habits such as repeatedly saying a word or a name, or walking in the same place or in the same way. • Constantly re–living conversations, repeating words or counting.