Caregiver’s stress or psychiatric emergency

On Saturday, the past week, a woman in her early forties, came with her mother and child to see me. The person who needed a counseling intervention was her mother, who came in with a deeply disturbed state of mind. I felt her inner fabric had been suddenly jolted due to a shock and catapulted her into a state from which she could not recover, with her own means.

According to the description of the daughter initially, and later corroborated by the mother herself, possibly two significant events in her life had lead to that. In the distant past, she had lost her spouse, in 2009, which possibly triggered off a grief which could not be duly addressed, or if it was it was not assimilated properly. However, the lady lived a fairly active life despite that, with one of her other daughters, in Bombay. In the recent past, the daughter who accompanied her to meet me, moved from Bombay to Goa, with her family, in response to her husband’s need for better work prospects. That set off another degree of anxiety in her heart, which remained unarticulated.

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All of a sudden the daughter became unwell (she had a bipolar diagnosis) due to adjustment stress in a new situation, whilst otherwise she had been quite stable for long years and off medication of any sort. The news of her daughter falling sick made the mother panic, and her anxiety took a turn for the worse- pushing her off the brink and rattling her fragile balance significantly.

When she came to meet me, for her daughter thought the next intervention required would be counseling/therapy, her discomfort and constant talk made me immediately decide that this was not someone who needed counseling support but immediate relief from her ‘symptoms’. The talk was ceaseless, she was frantic, tearful, anxious, repetitive, and kept saying that she would not take any medicine. The daughter was trying her level best to seek out any intervention that would work for her. I decided within five- seven minutes of listening to her that she would not have any effect of counseling, and requested her to take homeopathy, which she had been taking earlier as well.  But it had not been effective of late. I even referred my own doctor to them, lest their doctor have a limited repertoire, which is mostly the case with homeopathy. Before coming to meet me they had tried other ‘treatment’ options of reflexology, possibly reiki and other things.

I called up my doctor and also made her talk to him, and requested him to intervene, give a prescription which would be followed here in Goa. This is not something that we do frequently- because every doctor needs to meet their patients face-to-face. Doctor sa’ab was kind enough to relent, seeing the lady hysterical, and reporting lack of interest in anything in life, suicidal ideas, and several other indicators.

However , the catch in the whole picture was that she kept saying, that, if my daughter (indicating to the woman with her) comes back to Bombay I will be fine. This was a peculiar situation, because her deepest attachment seems to be with her daughter who is already married with a child of her own. The mother is so deeply attached to her, that it is almost like a parasitic attachment.

They stayed with me for over an hour, but since I had decided earlier, I did not put a bill on the exercise. What is the point of taking money when the recipient is not ready for what you have to offer- I cannot be a mercenary like a ‘professional’ if I remain untouched by human suffering, and focus just on the money that my practice can bring me. The more I thought about it, the more ethical I thought my decision was. Of course I could have told them to leave quickly, but considering they had come a long way, I just let them stay and talk about how to go about it and of course explaining to the daughter the medicines the doctor  had prescribed, since it was me who had spoken to him not her.

The Next Action

Today is Monday, and according to me today the whole routine would have fallen in place. However the daughter called me up today before noon and said her mother was refusing to take the medicines and had gone back to her earlier prescription of homeopathy. She reported a further hardening in the head and was unstoppable. I felt anguished to hear that. I had seen the mother to be a headstrong lady and I could see she was making it difficult for everyone around her to deal with the situation and only making it worse, in every possible way.

That brought to mind the last resort of psychiatry. I thought there was no option but to sedate her to calm her down. It is a very sad thing when I myself have to recommend psychiatric medication to anyone, because I try the best that nobody should be pushed into it. But if there is no alternative left and the person is adamant, what else can the family do? Her behavior must be causing a great deal of stress to her daughter also, poor girl, who was bravely facing it, both in front of her husband and in front of her mother- keeping a calm exterior.

I thought for the time being the best option was to anyhow medicate the lady and help her calm down. Over time when things stabilize and she has had some sleep due to sedation, possibly she would look for other ways to deal with her stresses and the triggers. For now her franticness would only make others spiral into the same. Her daughter said she was herself thinking of the same, as nothing else seemed to be working for now. In other words, the difficulty a family faces, pushes a person into forcible psychiatric intervention. The only trick is that at a suitable time the person has to be weaned away from psychiatric medication, because psychiatrists themselves will never prescribe it!

On that note we parted over the phone- me with a resignation that only when people are willing to get well and be compliant to recommendation of any sort, does an intervention work. Some people make difficult patients- they resist everything, for they know the better of it. I cannot but feel sorry when people have to be administered psychiatric medication, but I always hope that it would be a short term measure. Of course if the patient is complying, like me myself, homeopathy can work very well.

I do not see any recourse except for a devious manner of giving the medication or per force- which actually amounts to a human rights abuse. So that brings in the ethical dimension, as well as the dilemma- what could have been done alternatively? What can be done now? I am not sure today and I leave this post with this query.

Everyone will have a different response to this situation, but how does one decide. I do not know if they will come back to me, because they need not. But I will be around to support them in future, if they choose to. The mother certainly needs counseling to help her deal with the sense of loss that she is suffering from, and to help her focus on what is present in her life, rather than clinging on to adult children, who need to fly away from the nest, towards greener pastures.

I also hope that the daughter would not be unduly troubled by her mother’s suffering, as it creates a scope for her own suffering to surface once again.

On the last note, I am also wondering whether the mother’s suffering is not another face of the caregiver’s burden of looking after a child with bipolar and being tuned to her needs in an obsessive, fussing manner. But there is no way to find out about that, because I had no time to talk to them about their life together. Only this much could be ascertained within the scope that we had, once I felt it would not be proper to dig further into her psychic matrix. Whether this is an ’empty nest’ syndrome, a psychiatric emergency or another form of caregiver’s hyper-reaction to her daughter’s situation, piercing through her own frame, it is difficult to ascertain at this stage.

The power play in university departments

I ought to have written this blog post longer ago, but spinal pain did not permit me to sit at the computer, to last as long as a blog post (naturally the priority is always the emails first of all)

I want to share my dismay at the sheer play of power that I got wind of from a recent dialogue with a graduate student pursuing a masters’ course in psychology in a prominent university in India. As part of the course they are also being offered a six-monthly exposure to counseling (I pray to god, they don’t become counselors after that- it would be a great disaster). As part of that course, they are also invited to undergo their own analysis for the briefest possible span of time. I asked the student how much the time was and who was doing the ‘analysis’.

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I was told that one of their professors, (who is known to me as an academic and not a therapist) listens to their dreams and interprets them. So what follows is the memory of my dialogue with the young scholar, that left me troubled and anguished for many days afterwards, but I will share the reasons of that after the dialogue that I quote. I represent me as M and the student as S.

M: So your teacher went through a dream analysis session with you? And what was the outcome of that?

S: The outcome was nothing specific, he gave me an explanation based on symbols, which he said were universal symbols, and which were part of his repertoire.

M: By talking to him, did some clarity emerge in the picture or put is differently, did you benefit from his dream analysis?

S: Yes mam, I gained some clarity in some respects about the dream?

M: What does that mean? Did it leave some unexplained things as well?

S: Actually it opened up some unexpected parts, which were left unattended to.

M: Really?! But there was no further dialogue with the teacher on them?

I was angered, because an academic who is not an analyst is not supposed to interpret dreams out of context for a student. Just because they have the power to demand from students a certain accountability does not mean they can pry open the lives of their students.

Unfortunately, Indian students are very vulnerable and docile by temperament, more so women. They would never think of raising their voice against this sort of an intrusion, which has no accountability. How can a university professor demand that his students tell him their dreams in a sporadic manner and then leave the dreams with whatever interpretation he knows best? There is nothing universal in dreams, except for the imagery. A dream has to make sense and have relevance for the person who sees the dream.

I remember in years of my own analysis with my therapist, we barely discussed dreams on more than two three occasions. It was never the centrality of our dialogues- if I had a dream that I wanted to talk about we did. There was never a nudge from her to share dreams. But whenever I did, the explanations that emerged were very deep and meaningful. I always felt it had been worthwhile to talk it out with her.

But look at this blatant misuse of a teacher’s power in the classroom. Of course he did not publicly hear the student out, but nevertheless when he was not an analyst, did not know what all it takes to unearth the symbolism inherent in a dream, by simply interpreting it in some universal way, he just showed for once again the patriarchal nature of our education system…where the souls of students can be cut open without due regard to their humanity and suffering, without a qualm or a guilt as to what pandora’s box you are opening up for them. SHAME ON HIGHER EDUCATION in India. Will we ever become sensitive towards our fellow human beings?

Why family support is NOT WORKING in mental health

This article can be downloaded from here, and is one of the resources offered by Antardhwanee. In this location, this article is titled, Families and Recovery.

In societies where social resources in health are limited, families play a crucial role in the illness and recovery of people. In mental health the case is even more so. For long periods, it is the family alone that bears the brunt of people’s illness and disabilities. Sometimes this may amount of a lifetime, and then the parents/siblings, who are the primary caregivers end up with the massive concern of who will look after their loved one[1], after their own demise.

Here is a brief list of findings, that research leads me to conclude, in the context of roles that families are playing, which ensure that people remain mentally ill, rather than recover and reintegrate back into society. This list is not exhaustive and as study is an ongoing process more thoughts will get added to this. Here are the beginning ideas.

Learning to be helpless together

Sometimes when one person is given a mental illness diagnosis, the whole family is paralyzed by a fear that mental illness has crept into their gene pool. They feel  extreme pressure due to the diagnosis and the social stigma associated with it. They all feel helpless about it and the infirmity or sense of loss that accompanies mental illness diagnosis of one person, in fact impacts everyone deeply. Secretly, they all start analyzing their own behaviours to see whether some traits of it are also lying within them!

In such a case if another member of the family faces anything of a similar nature, they are very quick to take action and take them for a ‘check up’ as well.

Protecting the loved one interminably

I have seen personally families being so defensive about their loved ones, that they keep protecting them from the world around. At times it amounts to the extreme case of hiding them from view, or not letting their loved one engage in any social milieu by themselves or without supervision. It aids in chocking both the people or set of people very severely, as no new ideas can come into the ecosystem, which does not interact with the outside world in any significant ways.

I have even seen another extreme, which surfaces in scenarios of marriage. I am not sure if this happens in India, but I have seen it here only. I have seen multiple families ‘hiding’ the mental illness diagnosis from the partners of their loved ones. As a result people are not able to remain truthful in relationships, and the trust that could be there between married partners never develops fully, because one partner knows they are not honest. This protectionism of the parents does not allow the partners to be one another’s greatest support systems, which marriage was traditionally meant to be.

Hero worshipping

Paradoxical as it may sound, I have found in many families that parents or siblings talk about their loved one, with a great fondness and regard, often attributing their mental illness to a ‘high IQ’, superior intelligence, artistic abilities or anything else like that. Though there are studies that have proved that mental illness is more positively linked to artistic creativity, the reverse is not true. Artistic creativity does not appear out of the blue, just because you are mentally ill and therefore your intelligence is also more than the average person.

By making their loved believe they are ‘smarter than the average’, families bestow them with a sense of entitlement, which means, just because they are more intelligent, they have a right to have moodiness, depressions, or any other attribute. This even inflates their ego and self belief that whatever they do or not do is well deserved, because now they are ‘mentally ill’.

I have seen in many cases that these loved ones, even when they come into counseling are so cocksure of themselves that they do not believe they will gain anything from counseling. They don’t. Their own intelligence is such a barrier, which their parents have created around them, that they are unable to use that intelligence for their own betterment by seeking help from anyone outside the circle.

Families ensure compliance to Medication

Since families have a great amount of faith in modern medicine they do not believe that psychiatry does not have a cure for mental illness. In fact, I would go to the extreme of saying that in families where parents or siblings are doctors or scientists, the possibility of anyone recovering from any serious mental illness is quite remote. Due to their unquestioning faith in modern medicine they keep medicating their loved ones, without ever probing into whether medicines are really bringing any tangible outcome.

Families may become human rights violators

Nobody ought to be coerced or forced into psychiatric treatment, especially electroconvulsive therapy (ECT). Families often believe doctors so blindly and rather innocently, that whatever the medical professional recommends is to be taken as a rule. ECT  is a very controversial procedure which has long term repercussions for a person. There is no need to administer ECT to anyone, but doctors do not educate families enough, who are anyways only too willing to follow what psychiatrists say.

Often people are given psychiatric medication against their will and in spite of having no need for it, even on the sly (by mixing in food for instance). Those with mental illnesses are not allowed to choose their treatments, because their families believe they cannot decide for themselves. As a result they keep medicating them and pushing them towards the edge, for the rest of their lives, till they reach their end! Sadly, the human rights violations in mental health are the most in any category of health, and the most part of it comes from families.

Fractured Communications

In  a whole lot of families people do not talk to one another- either properly or at all. As a result whatever support could come to all of them due to interpersonal communication, does not come about. Everyone lives in an emotionally marooned state, spiritually shrunk, cold, deeply fatigued, restless and wounded.

Even if one of them finds a solution to a problem, since their inherent communications are flawed, they are not able to convey that to others. In my own work I have seen many a family member, including people with a diagnosis, have been enthused to either meet me, encounter my work or hear about the sort of work we do. However, they have not been able to convince other members in their families due to a long term loss of trust, in one another and in the fact that any other ways could appear, leading them out of mental illnesses.

Not only in my case, but often due to lack of communications, people do not seek any other social mechanism to deal with mental illness, apart from free resources that the internet offers them.

[1] Throughout this writing I have used the phrase ‘loved one’ to refer to those who have been given a mental illness diagnosis, rather than calling them someone with a mental illness.

Therapy is not common sense- trust me

If everything could be achieved by common sense communication, then people would easily learn a few skills and resolve all their problems. But that rarely happens.  A vast array of problems start from communications, but to solve those problems we cannot often fall back on our own communication skills or abilities only.

People, particularly in India, often have a mistaken notion that someone who is therapist/counselor is talking from common sense and giving advice based on their intelligence. Yes, I agree, it seems like that, but reality is that is never the case. Let me start by saying that whoever has whatever level of intelligence, they have reached there in a complex distillation of ideas, study, immersion and of course years of work in the field.

I am giving this prelude to a recent encounter with a family that I want to talk about. It was the brother who approached me through a social network, upon seeing my work in mental health in some way. He asked me a few things and over time that set the ball rolling. His concern was for his older sister, a woman in her early thirties, who had been given a diagnosis of schizophrenia. In due course when I traveled to Delhi, they came nearly 300 kms to meet me, all the way from UP.

The woman, let us call her Sarita, came energetically and seemed charged with ideas, and full of enthusiasm and verve. I could see she was excited, and ‘high’ in some way. I would not want to see this ‘high’ as a psychotic high but there was a case of being sure of one’s self, and a bit of grandiosity- what would be seen as the classical ‘symptoms’ of a disturbance in the psychological wellbeing of a person. However, I never want to look at people through the lens of pathology or illness and therefore despite seeing the ‘symptoms’, which were truly subtle, I noticed her emotional fragility, anger and inner disturbance. After all I am not a peer for nothing, if I cannot discern how subtle the emotional fabric is.

At the end of the dialogue, which lasted a good two hours, I figured that the young lady had come to take a clean chit from me, that she did not have a mental illness and therefore did not require medication. Of course, I do not believe that anyone requires medication. But to move away from that stage where you do not have to take medication, you have to be cognizant  enough to move into the behavioural domain. I mean to say, that certain behaviours of those who are classified ‘mentally ill’ is ‘not normal’ by the standards of those around them. That is why they are taken to a professional- psychiatrist, therapist or counselor, or any other doctor.

Each one of these professionals acts in accordance with their  training. A psychiatrist believes that the ‘symptoms’ are due to a chemical imbalance and if the proper chemical is given, the person will become ‘normal’ or ‘fine’. Psychologists come with various kinds of training but they are mostly informed by the same set of principles as psychiatrists, especially those who go through clinical psychology courses.

I have a diploma in counseling. But more significantly also a lived- illness/recovery experience, to fall back on.  I fall back on my lived experience based knowledge pretty regularly to understand the suffering of others. People, like me, often work in the domain of social psychology and self experience puts my knowledge at an altogether different level. I am not arrogant about it, but trying to capture the difference. Just imagine a dentist who has never known a toothache. How can they understand the pain of a patient? Contrast that with a dentist who has had dental caries, been through root canal treatment, got a tooth extracted in teenage and has two cavities. How much more the latter would know about the suffering of their patient?

The Story I was referring to…

Coming back to Sarita’s story. After one set of dialogues the duo went back. There was a lot of friction with the father and that seemed to be a dominant motif that emerged. The younger brother played the balancing role in the family. Sarita was happy that I was willing to look at her beyond the psychiatric label of schizophrenia. After that assurance, she was sure that she did not need any medication, which in any case, she had been flushing down the commode.

A few days later, she befriended me on the social network, and I noticed a sudden spike in her activity. In a way Facebook serves me very well, especially for watching what is going on in the lives of those I counsel or generally engage with, because it warns me if something is going wrong. (I recently also caught another friend getting into the spiral of PTSD, and warned her, told her to go to sleep calmly for a few days. It seems she tided over that. She her admitted to all the ‘symptoms’ that I had seen, which made me raise the question with her in the first place). I found her trailing me on every forum and posting her own posts there, by joining a whole lot of fora where I was involved. I found this a very unusual behaviour and I asked her brother, if everything was ok.

He informed me that things were not good and Sarita was too excited about a certain new thing in her life. She was going on talking about it to everyone, in a manner which raised suspicion about her. I told him, to tell her to talk to me, if she would like to. She did, through a facebook or WhatsApp message! In what way can a professional help a client via a message?

Few days later, on the occasion of the World Mental Health Day, I sent a message to her brother again, hoping all was well. It wasn’t. Sarita was clearly ‘high’ by now and aggressive, offensive and charging her family, particularly father, with all sorts of things. All my exchange happened with the younger brother alone, via messages only. When it seemed she would not be interested in counseling, I told him to seek recourse to psychiatry, which I inevitably know, would forcefully drug her, sedate her and possibly give her ECT. I shudder to think of that!

The brother understood what the way out was, since the sister was unwilling to talk to me, or seek any insights into her life, or have any other way, but her own. She left a job that I had encouraged her brother to help her hold on to, because she wanted to float her own entrepreneurial venture. I told him how to win her over take up the government job, as she was adamant, that it was beneath her dignity to do so.

Upon my recommendation, the brother took her to the psychiatrist and sure enough, the forcible drugging, the sedation and the ECTs followed suit. Families will never know how they become the chief arm of psychiatric coercion and the biggest reason why people become permanently disable due to mental health conditions, that they can easily recover from. What could I have done in this case, even if the brother trusted me completely to guide them? If the person who needs to talk to me, and understand the situation does not understand it herself, what recourse can the family take?

My advice to any family would come from two options. One is the biomedical way, which is often forcible and therapy/counseling. The latter is difficult, and requires patience. No matter what medication they take, if you do not want to incapacitate your loved one for the rest of their life, they will have to seek therapeutic guidance and support, to deal with their situation/s. If you forcibly medicate them or give them ECT (which should be made illegal immediately), you are actually infringing on their human rights. Yes, you got it right- it is a human rights violation, which you are committing within your own home, with your own loved one. Sorry to say that, if it hurts your sense of justice, but I cannot fool you or me about this.

How could therapeutic work have proceeded after the first meeting with Sarita?

Ideally the first meeting is where anyone assesses a situation. You hear the two points of view or sometimes even one person, if they have come alone. First meeting or even a few meetings should be the ground that people have to understand one another. Entering into therapy is entering into a relationship and both people need to know another. Would you not like to know who your therapist is after all?

In family counseling it is always better to listen to everyone and talk to everyone concerned, because ultimately everyone in the family is impacted by one person’s condition, whatever it is. Narrative therapy goes even a step further to include even the next level of people, and open dialogues mean involving even the kinsmen!

In the subsequent meetings, one sets an agenda for action and a modus operandi. No therapy work cannot get over in one, two or three meetings. Often it takes many a meeting with clients, for someone to truly understand where the roots of suffering lie in their life.

In Sarita’s case, this could have happened-

  1. Sarita could stay in touch with me and talk to me, not more than once in two-three weeks. That would really help us understand what is going on in her life, which causes her frustrations and anguish, and which periodically boils up as temper tantrums and then accusations against her parents.
  2. The way to deal with any behavioural issue is to address the behaviour directly. I increasingly prefer to bring families into dialogues early, so that whatever we are talking with one person, could be known to others who would help in accomplishing the goals of that one person. Often family communications are deeply fractious due to forcible handling of psychiatric crises. Families need help with talking to one another gently, without causing further rifts.
  3. Ultimately, it is Sarita’s journey towards her individuation and she needs to understand that whatever expressions she has to express her anger, frustration and moods is not working with others around. She would have to develop a more reasonable and non-threatening communication which does not make her family and herself a social nuisance and laughing stock. Part of the anguish of her brother stems from this responsibility towards his parents and neighbours.
  4. Any journey towards finding one’s balance takes time. Most will not even attempt it in their lifetime. Only the ones who are deeply fractured seem the most appropriate ones to require a therapeutic dialogue. In reality everyone needs help, support and guidance.
  5. Equally as much as Sarita, her family needs the support, help and collaboration. That is why family therapy is the need of the hour, not individual therapy.
  6. Assuming that a client like Sarita would speak with me once a month, it will easily take her between two -three years to understand her issues in a more clear way. Though it may seem a lot, but what is two/three years compared to a life of psychiatric medication and who knows how much disability due to them? I must add here, that every meeting between a therapist and their client, has long term effects. So though once a month may seem very small a time, in reality it has a long lasting effect, almost like a butterfly effect, which touches many chords in their lives.
  7. In family therapy literature, it is said that within 20 sessions, most outcomes of a long term nature, would emerge. I agree with this. (In due course if we can create reflecting teams, that would be even more empowering and faster). 20 sessions can happen over a couple of years…is that not truly remarkable? I am not sure India is ready for it yet! Sad, but this is what I am seeing from multiple families.

What follows are some general ideas about therapy-

  1. Till those who are given mental illness diagnosis do not feel the need to seek help to change their outcomes, no change can happen with a dialogue between any member of their family and a counselor, like me. I have seen many a person in a family wanting to bring their loved ones for counseling, but find that they do not have enough trust between one another, to accomplish that!  It is truly sad for them.
  2. Therapy is not a day long affair. It is a reflection on our lives and how we have come a long way, with our behaviours. Therapy does not mean I am a therapist and you are a patient. Therapy is your attempt to heal yourself through dialogue and understanding that emerges from it, by learning to look at your life in a more balanced, philosophical and calmer way.
  3. Therapy means someone is helping you change your behaviour and assisting you become what you always wanted to- by holding your hand, while you gain that wisdom. It is not about guiding you at all. It is about letting you become the expert in your own life. But until you want to change your behaviour, nothing about your life can ever change.

antardhwanee- one at a time, towards better mental health

It is a great challenge to work towards mental health of others and deal with the challenges of your daily life, which do not diminish just because you have recovered from mental illness. Life does not give you a respite- it gives you more and more…suffering, challenges and obstacles, with courage if you can muster it,  just because you have dealt with something serious in the past. I think most of the time I derive courage in my situations remembering how bad it was when I was totally depressed. Today when I encounter others in that state, I know from so much experience that they can also recover. The hope of recovery is what my counseling is all about, as of course the knowledge gained from decades of study and research.

It all began with research, because while researching in mental health, I realized a whole lot of things,which were not of a psychological nature at all, but of a social one, impacting mental health. By understanding my recovery more and more, I started gaining insights into how more become ill and can become well. That is the USP I have in counseling.

 Life begins on wasteland

Anyhow, this blog post is to share the work that I had started long back, but is now in the domain of the public, to offer my services in counseling. I am relieved and hopeful that more will recover, also with some of the insights that would emerge in the counseling process.

Here is the website– and I am happy that I have at last gained the clarity to bring all my mental health ideas, concerns, and research into one pool. Onward from here. This is the page we maintain on facebook about the same.

The Incongruity of ‘Yoga Day’

Yasmin gyaate sarvamidam gyatam bhavati nishchitam[1]

Tasmin parishramah kaaryah kimnyat shastrabhashitam II 18 II

‘When by knowing this (Yoga-sastra) all others are clearly known, of what profit can it be to labour and find out what the other sastras say?- 18’

From younger days I have been exposed to yoga at an emotional and spiritual level, as a practice that integrates and unifies the human organism. I never believed it to be anything but an allowance for developing an inner discipline. That is the most significant thing about it- inner discipline; not an outer enforced discipline which comes due to the authority of another and not from self motivation.

Even though I was exposed to yogasana early in life, I never took to it easily, because of plain laziness. But I always remained interested in the other sides of yoga apart from asana, in particular to understand pranayama, and other aspects that signified withdrawal of senses and becoming more still. It was a difficult road considering the extremely difficult mental states I traversed. However, it never took me away from the theoretical interest.

In 2010-11, while staying in Faridabad, I came in contact with Subbarao-ji, who had been a great yoga adept and taught generations of students at the NSD, in Delhi- both yogasana and voice culture. He took me under his wing and decided to teach me. For the first time, I formally learnt yoga under the direct one-on-one supervision of a learned person. Soon thereafter he moved to Hyderabad, and my contact with him terminated. By then I had consolidated all the knowledge of yogasana I had from younger years and he added a whole array of breathing exercises as well as other exercises for voice culture etc.

Over decades of my life, by assimilating ideas from many convergent direction, if there is one thing that I have learnt about yoga, it is humility that must accompany it. In fact the very word yoga is such a big idea that it carries with it deep philosophical connotations, which are lost on most who keep using the words yogasana and yoga interchangeably. They are not interchangeable. They can never be. Yogasana is the mere start of the journey of yoga, especially if we see the eight-fold path. Asana or physical exercise is done for  one’s own wellbeing and  the purpose of one’s  body is not conquest of others. It is about cultivating a disciplined, principled stance towards life, society and the world at large. If we do not care about our body, how will we take care of anything else?

But equally significantly, yoga is not about showing-off or about marking days in the calendar year, to signify the presence of yoga as a form of knowledge, which is Indian or belongs to a particular part of the globe. All knowledge is universal and belongs to the human race- and any part of the human race can be the place of its origin. A place of birth does not hold proprietary claims, but in fact becomes responsible to take the knowledge wider- to the whole world, as an offering to the human race.

I feel amused at the efforts at the noise and the self-congratulatory back-patting in the recent media reports about the acceptance of 21st June as the World Yoga Day by the United Nations. Crores of rupees are spent in meaningless exercises by official government machinery in planning and creating events to mark it. School children and government employees are being roped in huge numbers, across the country to come, participate in yoga day exercises and displays. Why, why, why?

I cannot but see the futility of it. Instead of creating a school system in which health is a natural concern of the child, giving them ample room to play and discipline the body through various forms of exercise while at school, the government decides to institute a day to mark its commitment to public health. Why not increase the area allotted to schools and let them build spaces within them where indoor auditoriums can be built, or more public parks be created in which there would be spaces for exercising, running, playing, doing any form of physical exercises? Will one day take care of their need for the rest of the year, or be enough to inculcate a habit on a long term basis?

Does anyone remember how people live in inner city spaces in any city in India? Do you know that children have never entered a public park on ten consecutive days in their lives? Millions live in jhuggis and slums where it is not possible for ten people to stand side-by-side and exercise in any manner, where children go to open spaces and garbage heaps to defecate and they are chased by dogs, pigs and vultures? There is no question of women exercising anywhere- millions of women. I am not referring to the ones who can go to gyms, jogger’s parks, and privileged spaces demarcated from the rest of the population. I am talking of humble, hardworking, toiling girls and women, who walk out of Muslim ghettoes, of Hindu slums, of Catholic vaddos, and who only know the joy of their body when they come to dress it up for festivities and weddings. Would they ever find the space to do yoga, where their lives are so saddled with disproportionate work and responsibility?

Some might say, oh, why get cynical, this is only a start- more will be embraced by this wave. More people will start exercising and doing yogasana- in future surely.

Right, I get it, World Yoga Day is only meant for those who can  afford to take the time off or be forced into it by authority figures in their vicinity to partake of a government program. Yoga is not meant for the man on the street, because being the man of the street he still has to live off the street. So he cannot give up his occupation and join the yoga crowd, because who will tend to his teashop, bookshop, kiosk, fast food shop, or any shop on the street? Who will tend to your home if the domestic help decided to do yogasana? Okay one day is fine, but what if she gets serious and starts it everyday?

I  get it: we do not need more public spaces where people can do yoga, because as long as they know the significance of yoga, they will do it anywhere, including in their jhuggis which have garbage accumulated close by, or open drains, crisscrossing their paths, making pranayama difficult no doubt, but possible nevertheless. As long as the government can spend crores of rupees on advertizing about it and then feeling proud that a day has been marked in honor of the yoga day, we all have reasons to be proud of something which, in any case, is a part of our lives, even without this governmental effort. How we embrace it and whether it changes anything that now there is a World Yoga Day is something I am not even going to ponder about. It does not. 

It does not change anything. Oh yes, the taxpayer had been made a little proud that his/her hard earned money, is being expended in ventures where they did not have a say, without any public goods being created by way of parks, spaces, jogging tracks, conversion of lands from wastelands to green parks or anything, or even spending the money to pay yoga instructors, who would go into community centers and such public spaces and teach people yogasana for free. At least it would have created more employment!

The institution of the yoga day is actually a repudiating of the very spirit of yoga, which is not about yogasana alone, nor about dominance of yogasana over other any other path of living. The word yoga, signifies union- meant to be a union of the opposites within a person, the evolution of an integrated self, by overcoming through diligent hard work the duality, we are all torn by and emergence of a unified being. It is not meant to be a dominance of any religious belief system over another, in a bid to make them look lesser, or insignificant.

Yoga is about overcoming one’s own lower nature by letting the divine aspect within express by conquering the lower mind, instincts and tendencies. This is the attitude with which I have followed the path of yoga in its different forms, and tried to comprehend the diverse streams of bhakti and karma yoga. To feel the need for a World Yoga Day is the sign of mind having an egoistic attachment to fame and need for adulation, in which we want to drive home the point of our knowledge to other countries, instead of trying to offer it to our own people in ways that they can access it easily, safely and joyfully.

If only more people remembered that Hindi song from the film Guddi-

Hum ko mann ki shakti dena, mann vijay karein; doosron ki jay se pehle khud ko jay karein.

‘Grant me the courage, that before seeking to conquer another, I conquer my own (divided) self’            -the real essence of yoga will come alive for a whole civilization.

It is reasonably doubtful whether 21st June will accomplish the same. India does not need to ‘sell’ yoga further, but become a land of real knowledge seekers, who live the spirit, not mere salesmen, alienated from the soul of what they stand in the market as their wares. It is a world market, let us sell something else now. Any ideas?

(It seems India repeatedly needs to  project its ‘soft-appeal’. Now from a land of snake charmers, holy men and elephants, we are the official salesmen of yoga. Thank you baba Ramdev- but you only came in the line of scores of gurus, before you, nothing special. I remember in my childhood watching Dhirendra Bramhachari. You have sold yoga well, starting from the Astha Channel. But what was your contribution to it, which others did not make? You only came in a time of the media boom, that is all!)

[1] Ghosh, Shyam (1980). The Original Yoga. Munshiram Manoharlal Publishers Pvt. Ltd. New Delhi. p.6

The First Thing about RECOVERY from mental illness- a readiness to accept it is possible

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A few years ago when ‘Orkut’ was still going around, a young woman sent me a query, seeing me respond to something about bipolar disorder. She sent me a list of ‘symptoms’ and asked me if it amounted to bipolar- was she bipolar by any chance? I was perplexed to receive the query in the first place- it seemed as though she wanted to be classified as bipolar. It was as though it were a club for the privileged and she wanted to part of it! Nothing is farther from truth, for those who have been there, know the suffering of everyone, once gets a mental illness diagnosis. Nobody who is really ‘bipolar in disorder’ wants to be there, rest assured- it is NOT the club I would have chosen for myself. In fact this post is about recovery and why we want to recover from the suffering, rather than remain its captive for the rest of our lives- a captive of moods that imperil your very life, existence and fabric. Schizophrenia equally or more so.

This is also one of the attitudes that I encountered in the course of my own long association with bipolar. To be honest, once the association starts, there is no going back- there is no stepping out of the field of experience any more. I cannot go  back to my pre-psychosis days, for instance. Of course it has brought much by way of experience, (and I have been tough enough to put myself through the rigour of seeking knowledge out of the enterprise)

What was recovery then?

One of the most difficult things, for even me to accept was the possibility of recovery. No matter what anyone would say, I would not believe that recovery would mean going off psychiatric medication. To me recovery was the fact that I was ‘stable’ (not having psychotic breakdowns any more) and relatively functional in most domains of life- from writing, singing, teaching, performing to other social sides of me. But to be off psychiatric medication only the fools would attempt it! Little did I know that someday when I would think of recovery from serious mental illness, it would really begin with the end of psychiatric medication.

Co-morbid conditions notwithstanding (I suffered from thyroid malfunction for 13 years due to lithium, and then due to valproate, there was liver malfunction, which I have not been able to recover from. Apart from this there was PCOD and other issues) I would not believe that someone could go off psychiatric medication and never have a relapse of any sort. To the extent, that I remember that there was a senior psychiatrist in the All India Institute of Medical Sciences, one of the premier institutes in India, who suggested to me that possibly I need not remain dependent on medication for the rest of my life. I was still in my twenties. I was so shocked at his suggestion, that I though possibly he did not understand bipolar very well! I did not go back to him- the fool that I was. Possibly if I had, I would have got off psychiatric drugs long back. But nay, I had to go round the mulberry bush for another decade easily, before I would be able to come to that clarity.

Families and Medication

This brings me to the idea that mental illness has a way out, and medicine is not the only way it works. A few years ago, I had referred someone to my own homeopath, who also had a bipolar diagnosis. He was a younger man, in his early 30’s then. He went and took the homeopathic medicines and started getting better. Unfortunately his life and situations were such that they drove him towards alcohol in the past. Due to his psychiatrist’s advice he stopped drinking while on medication. So once he started getting better with homeopathy, he started drinking again.

His parents started arguing with me that due to homeopathy he was back into drinking again! Nobody starts drinking because of medication – but due to stresses in their daily life, which they are trying to deal with in ways that they understand best. He was unwilling to come into therapeutic dialogue, because that was not something that could have any outcomes as far as they were concerned- it was only for fire-fighting (dealing with emergencies, such as his panic when his wife was pregnant). He would really not come into any clearing- just live his life, do his stuff and then in the evening go out to drink with his friends.

Anyways, the summary of that story is that the boy was brought back into psychiatric medication, because (sadly enough) he could not deal with his parents’s opposition to homeopathy on the one hand, on the other  deal with the reasons that caused him the suffering- which were all embedded in his family dynamics and the family communications, as I could make out quickly.

His father had been dominant all his life (though not in an unkind manner), even as he grew up. It undermined his selfhood and when he grew up, he could not get over the criticism that would come to him from the paternal side, which made him remain ‘small’- as though ‘incompetent’ or ‘incapable’, in spite of being a young man, married and with a child too. Parents can undermine children and, without knowing, mothers become a another pillar of support to the patriarchy which torments young boys – they never understand that their suffering comes from what goes on in their families- not any biochemical imbalances. So how can medicines rectify something which is simply not there– but is there in how people are talking and construing one another?

Most people think that those who recover do so because they are lucky or they have done something special, which they themselves cannot do. The reality is that they have worked on those sides of them, which others are ignoring repeatedly. And getting past parental domination should be on everyone’s agenda- including the parents, to be certain. And this is not meant as an offence. That autonomy which needs to develop in teenage, never develops due to parental over-concern. So parents, if you are reading, please understand your child’s distress is a function of your engagement too- please do not be offended by this statement, because that is not my sentiment. I want to bring this to your knowledge, to help you think of newer ways to go over the same paths.

Otherwise, families will continue to suffer for decades and decades and nobody will know the way out. Please be kind to yourself and your loved ones- but not over-kind.

Caregivers can change outcomes in mental illnesses

Having seen the outcomes of many recovery stories and even non-recovery ones, the one thing that becomes clear is that if assisted positively and non-intrusively, many people can recover even from serious mental illnesses.

So why does it not happen more often? The one likely thing that comes to mind is that mental illness triggers off due to some contribution from the family environments- like it or not. Perhaps this is the most difficult idea to digest.  But if we can stomach it, and be willing to reflect upon what they could have done or wrongly so, then many things can change.

With this in mind, I work in therapy with people- I mean families, and with the same idea, I decided I ought to reach out to a wider number of people. But instead of choosing to keep the knowledge offered as part of the course, only a function of my own knowledge, why not spread the net wider and bring in many others, who have been working in mental health with a similar or same commitment as me, and trying to diminish the burden of human suffering, wherever possible.

With this idea as a background I decided to do two things- first of all create a framework of ideas and then a resource base of ‘experts’. Honestly speaking, perhaps neither of these ‘experts’ would claim themselves to be as such, and this is not to judge their knowledge and represent it in the same way as the positivist tradition does- for measuring expertise by degrees and professions. My only basis for classifying them as ‘experts’ is the number of years they have been working in the field and the orientation they carry- recovery and rehabilitation from mental illnesses.

As yet this orientation has not gained salience in India, unlike some Western countries- and therefore these people have not been seen as such either. But I hope with this course now in the public domain, more people will recognize the reality that mental illnesses can be a thing of the past, if more people take heart, families change their attitudes and supportive behaviours. This is one of the key advantages of being in relatively poorer countries- that our family systems are quite intact. So why not assist them in augmenting what is already present, rather than aping Western models and walk towards our own annihilation via their pharma enterprises.

Here is the first Caregivers’ Online Course, that I have been referring to as part of this blog post. And I feel relieved at last to have come to this clearing- there is so much water under the bridge, from making the website, to getting the experts to collaborate, structure, and now the next challenge- to ensure its viability and efficacy.

You are NOT your label

For many months I have been wanting to write about Suneetha (name changed) who has been talking to me over the phone, ever since she read my article about recovery from mental illness in the Hindu newspaper. Suneetha told me that she had a schizophrenia diagnosis for over two decades of her life and she had been on a number of medications for that and then the comorbidities that appeared later.

One of the key things for her nowadays is SLE (lupus in some form) and then irritable bowel syndrome, which keeps her movements outside her home restricted. When I heard her story long back, I figured she had no reasons for a schizophrenia diagnosis at all. She was given some simple tablet, which could very well  have been a placebo for all the doctor cared, but he certainly gave her a label. She was in her school going years then. Many things happened, including marriage, divorce, brother’s suicide, mother’s death and so forth. Her medications increased over time but none of them had anything to do with her schizophrenia diagnosis, but sometimes memory, sometimes stomach, sometimes concentration. She feels the need to go and seek medical help for these conditions, which I feel basically happen because she is alone, alone and alone! I sometimes admire her courage to live alone and manage to spend a day by herself. It takes a lot for a single woman to survive, without much social support, a job or any significant relationships. It is very courageous indeed.

On this blog sometimes I want to note the interactions I have with this woman, who is now in her early forties, is fearful of going out of her home because she has fear that she may have to go to evacuate her bowels suddenly, as the bowel movement is not predictable, and that has made her life very limited in many ways. Many a times I just talk to her for a short while, 35-30 minutes and offer her courage and alternative ways of looking at her life, which she does not mind considering for the time we talk and even later.

I think the only thing people need is a voice to offer them courage, hope and remind them that there is a reason to be alive. She just now told me that she was very suicidal for the last two weeks, just like her brother (she said). And then she felt better by staying closely connected to her sister’s daughter. Even earlier she has expressed to me that she is happy to be with younger children. So I wondered then why not she go and work in a school, of young children, instead of wanting to work in an engineering job, just because she trained to be an engineer? Is it so difficult to choose happiness, I wondered? Perhaps she  understood and at my recommendation she has been looking around for a school job for the last few months and no longer focusing on getting a job in a company or corporate.

On a parting note she said that she just wanted to hear my voice, instead of writing an email to me, because she feels a lot calmer, once she hears me. And I thought, how much she would benefit if she could be in regular interaction with different sorts of people, who do not constantly remind her of her diagnosis but see what good she offers to them. This is the general tone of my dialogues also with her- building hope and courage. I hope to see new changes in her life, for I can see she is trying to create a new story, and go beyond her diagnosis. I feel just a little more time and things will start looking up. I have to remind her and myself that jobs are not so easy to come by these days, as there is a recession in the market, all over the world, whether we are aware of it or not.

I have hope because the channels of communication are open and many things can flow on those pathways. Recovery included.

Comprehending complexities

Nothing in the world is a simple thing, including ideas of any hue or shade. Health, wellness, illness and becoming healthy are not simple ideas by any stretch of imagination. However to reach a certain stage of complexity one has to pass through many intermediate stages of events that are interwoven, which may be simple or complex in their constructions.

Complexity theory is a well honed framework in research, particularly in systems theory which looks at the functioning of individual units while looking at the functioning of a system as a whole. I am working with complexity theory and systems approach in family counseling, and how the various actors interact with one another is of immense significance to me, at all times. From my past observations what I find is that in a family system when one person is adversely impacted by family dynamics, in reality every person is being impacted adversely- to one or another degree.

These days I am reading some very fascinating yet complex ideas from a totally different domain- and trying to understand the meaning and difference between decolonial perspectives and postcolonial perspectives. On the whole applying this to the domain of mental health is another long journey of complexity, or looking at the same picture from a different lens.

Language has increasingly become the focus of my work and yet seeing the conception of language, or knowledge from the point of view of decolonial perspectives is challenging all the previously held notions of mine, even in mental  health. I think this will take me to a new inquiry, of an even more serious nature than I had ever thought of or thought that I would be capable of. Currently I am toying with many ideas coming out of South America, and superimposing them on ideas of emancipation, to see what new synthesis emerges.

Mostly new ideas will emerge in the domain  of research only, but inevitably research percolates down into day-to-day encounters in therapy. As a result, and thanks to the research orientation I bring into therapeutic dialogic collaborations, the conceptualization of distress itself is so vastly different in my mind, from the day-to-day mental illness labels that they are as far apart as the two poles, which would never meet!

I must be working on the intersection of complexity theory in family therapy, and that is how when I talk to one person facing a mental illness label it is my attempt that their family become a part of the therapeutic collaboration, to enable faster outcomes and better bonds, due to more open dialogues that happen in therapy sessions.