Recovery Oriented Blog for Mental Illness

I have recently started a new blog, because I felt that I needed to strictly focus on recovery in serious mental illness, as a theme by itself and calling it any other name would not do justice to my commitment, engagement and research. I have, in the past, tried writing on this blog about mental illness related encounters I have had. However the purpose of the new blog is slightly different.

The new blog is committed to one single theme. All my mental ‘illness’ oriented work would go on that blog as it is also my desire to share with the lay intelligent reader whatever knowledge I interact with, in the course of my phd research. Since a researcher by definition tends to be looking into a vaster expanse of information, data, analysis and study than someone who is not a researcher, for reasons of social good and making research accessible, people could routinely offer small chunks of that knowledge to the wider audience. This is my attempt in that direction.cropped-website-hope-image

However research is not an easy journey to make, for it is largely solitary and a tough act of balancing one’s financial needs, professional goals, study commitments, family responsibilities, domestic routines and you name it. I cannot say I am in any enviable position except that to reduce the monotony of my work, I have started teaching classical music to a few youngsters- it is a breath of air for me. Of course I continue learning with my own guru also- another breather!

This blog post is basically to re-direct anyone who is connected to me for the above reason, to redirect their gaze in a more appropriate corner. You can well imagine that I am likely to post little on this blog, while my focus lies in recovery. However peace is close to my heart and at the heart of all my efforts. If one can help even a single person come into their own center, attain a little peace- they will gradually create their own peace and spread it further as well. I call the new blog- recovering self, because only in re-covering ground that people lose due to setbacks which are called mental illness, do we become our WHOLE SELF again- the self that we were intended by Mother Nature to be. The recovery blog is only meant to be a little offering in wholeness, a testimony to the work I am doing as well as a knowledge sharing blog- diminishing stereotypes about mental illness, challenging convention and offering alternatives.

Hope it accomplishes the intention of its birth.

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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.

You are responsible for your recovery (from mental illness)

You will probably think I am unkind to even suggest this. But the truth is that nobody can bring change to your life, if you won’t. Just like no outsider can bring development in another country, nobody can bring progress to another group,  neither can anyone bring change in your life- even if they be your parents or anyone else close to you. You have to free yourself from the ghoul of mental illness. Be assured that others have trod the path, you are not alone.

The human mind is an interesting,  powerful device, and there is nothing that it cannot learn or unlearn. Even if there are behaviours that you have come to be  attached to, which you identify as inherent to your personality and sense of who you are, if they are not doing you good, you need to change them. Not because I am saying so- because getting rid of something that is not working for you, is only going to make you happier.

If you look all around the world, people who have overcome their severe disabling conditions are not weak people, who were attached to their disabled selves. They have taken their disabling conditions to be a part of their lives and lived lives accordingly, without being overwhelmed by disability forever. I am sure you would agree with me if I mention the names of Hellen Keller and Stephen Hawking. Perhaps on would think their disabilities have been big enough to incapacitate the average person’s mind into inaction. But that did not stop them. These are the role models one needs to look upto.

Trust me, I have always worked by looking up at role models- people whose stories I could see reflected in my own, and in whose struggles I felt I could find a resonance. I have found immense courage and will to survive by looking at others, especially those who suffer. Take heart and look at others. You will see more faces like mine, of those who have recovered.

Only when you believe that you too want to recover, will you take the next step – to plan how the recovery will happen. Recovery is always a slow process. You cannot be impatient about it, as you will have to muster many sorts of inner and outer resources, filter them over time to see what is working and what is not and remain consistently involved with them. I do not think anything can stop you from recovering. That is a promise from someone who has been there, done that.

However, before I conclude this little writing I must share with you, that nobody can recover without the support of outsiders of the circle. We cannot see where we are going wrong, or even if we can, we often do not know how to change it, because we are so accustomed to behaving in ways that we have always known. For that we need suitable others.

Since the mind is capable of learning and adapting, it can adapt to new behaviours. But what those behaviours could be, is not what we may know. That is where, counselors and therapists come in: to help you steer your path. If I did not have a therapist may be I would never have recovered myself. Whether or not I could be in regular counseling with her, whatever she advised me, I followed meticulously, because I valued her presence in my life immensely. Without outsiders we will make progress, but at a rate which may take decades to recover.

Choose sensibly therefore.

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.

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

(In case you would like to comment, please leave them on the main blog post and not on social networks of facebook, google or linkedin- for that retains the comments for future. Please consider sharing this post, if it appeals to you)

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.

What is important about Nash’s story, for families around the world

Yesterday I got a message from a young man, a part of which was- My whole life is put at stake. My parents are planning for divorce, all due to this paranoia and papa’s stubbornness. I was thinking to get some legal help but I think that will also be like going too hard for him.

Symptoms of distress that manifest as paranoia, hallucinations, delusions, or anything else are extremely taxing for families to deal with, and this message was written by a young man in his early twenties to me, as he desperately tries to hold the family together, in the hope that somehow they would jointly tide over the struggles of one person, and support him. however, the ‘papa’ is adamant both about treatment of any sort- medical, dialogic or anything else. He has a confirmed diagnosis- yet there is no way anyone can have a reasonable situation with him.

John Nash

This brings me to the context of Nash’s story, dramatized for the world by the award winning film, A beautiful mind. What needs to be remembered about him is that notwithstanding his schizophrenia diagnosis, for which he was medicated for 25 years, he actually stopped his medication in 1970– and that is never brought out easily. His wife divorced him once, but married him again, at a later date. She played an important role and as someone said in a recent article that I read, she appealed to his emotional side, rather than his logical/mathematical brain.

I quote from the same article, as follows, while the whole article can be read from the link above, in blue-green.

Family and schizophrenia

Frieda Fromm-Reichmann was a psychoanalyst of German descent, who was forced into exile by Nazism and worked in the USA from 1935. At the end of the 1940s she presented a theory that schizophrenia was the result of growing up with a cold and distant mother. Her theory was never proved through empirical studies, which would not have been easy to do.

Later on this theory was criticised from different perspectives. People said that there could be a number of reasons for an unsuccessful interaction between a mother and her mentally ill child. In addition, by portraying a parent as the reason for their child’s schizophrenia is a way of attributing blame and can prevent a parent from giving the help and support that is required.

The view of schizophrenia as a result of unsuccessful family relationships had many advocates particularly in the USA in the 1940s and 1950s. However, this theory was later abandoned, partly because of subsequent empirical research.

When neuroleptics started to be administered in depot form, it was discovered that treatment could prevent relapses. In the 1970s a group of British researchers showed that the risk of relapse was also affected by the emotional climate in the home environment. A high level of expressed emotions (EE) could increase the risk of relapse, particularly if they were negative, critical expressions of emotions or excessive devotion.

As a result of these studies, a new kind of family therapy was developed that focussed on helping relatives find a supportive way of communicating. This kind of family work has shown to produce good results, unlike family therapy that focuses on conflict.

Returning back to the Indian context, in India we are at a stage of infancy in the advocacy about mental health, and bringing all sides of it to a level playing field. Those who work in mental health from past experiences themselves are only a handful in number and they are extremely marginalized- the dominant voices, understandably belong to psychiatry, which is always on a high tide, thanks to the media, which loves mental health, yet only knows psychiatry as its representative.

The reason for me writing this blog post is to highlight two facts about John Nash’s life which are pertinent from the point of view of caregivers- one that through a supportive environment and by focusing on the functional aspects of a person, rather than their dysfunctional side (and who does not have a dysfunctional side in their personality) one can overcome most symptoms of schizophrenia. Love is an important device to utilize intelligently- yet not in an overly controlled manner the way most people do.

The second fact of Nash’s story is that he was NOT ON MEDICATION since 1970. In other words- thanks to the fact that he could continue in his line of work (mathematician, academic), be socially acknowledged for it (what could be bigger than a Nobel), be supported by his family (wife divorced and remarried him later!). How many families are willing to let their loved ones go off medication? That is the trick question, which everyone needs to consider. So in addition to going off psychiatric medication he was also in an employment. Rehabilitation via finding work, appropriate to one’s skill-set are among the surest pathways for recovery. Everyone needs to work – please mark this.

On the other hand, on a parting note, I will say that even in families where I have been involved, the only real outcomes emerge when families as a whole come into therapeutic conversations, and not individuals come for therapy. In India we have yet to reach that stage in mental health, though it may have been reached in allied domains of children, domestic violence or feminist counseling. Unless families enter the process, of empowering everyone concerned within the family-fold their problems and ‘mistakes’ will continue haunting the most weak people- who will show mental illnesses of this or that classification. Family therapy is not even a concern in India, and that is my concern. And whatever two penny bit counseling is offered to families it is largely done by psychiatry, as psycho-education, whose very purpose is to ensure compliance to drug therapy, as a first line of treatment, rather than address the underlying distress, and its sources.