Understanding our vulnerabilities toward achieving stability

I have a question for you if that’s ok. When you mean you recovered, do you mean you understood the root of your depressions and manic states, your bipolar disorder? Was there meaning, trauma in your life that led to that? And do you not suffer from that anymore? I hope these are ok questions to ask you. (E.L.)

My present blogpost is a response to this query from someone. I think it is befitting that I should answer to an earnest question in an honest manner. I am writing this post specifically so that I can share it with others and not have to make the effort again.

In response to the first question, whether I understood the roots of my depressions/mania- Yes indeed. As well as the triggers.

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This dog knows it can get attacked by its fellow dogs, and so it chooses to sit on someone’s wall and jump inside the house, if other dogs came after him. He knew he was vulnerable and kept the distance from the rest of the mongrels. Why not learn from animals?

What our triggers are – are our vulnerabilities. If one can isolate that it is a great victory and the best way to identify that would be a therapeutic dialogue with a therapist who is kind, wise and non-leading. It is not so easy to find such a person and that is the greatest challenge really.

Dear E. suffering is a part of our human destiny- but it does not have to annihilate us completely- we can live with it peacefully, we can make sense of it on a day-to- day basis and we can find better ways to make sense of things, alternative worldviews and conceptualizations.

Let me explain with an example. I currently suffer from a lot of spinal issues- which is quite painful. But I try to not let it affect me all the time in the day. yes some part of the day it certainly pins me down and when I lie down it just comes over me like a flood. I cannot even sit on the computer for any reasonable length of time that a doctoral reseracher would be expected to. And since spine is affected- so are my arms, legs and feet! I could be a ball of pain- but then I decided I cannot let it have the better of me. I cannot NOT do anything. 

SO, I am not going to compete with another phd candidate who can possibly study eight hours a day- but I will certainly try to do my two today and possibly a little more tomorrow, if tomorrow is not the same as today. This is how we build up our mental muscle- you don’t do it in a day. You do not become another person, you just learn to live with yourself a little more peacefully, more centered, greater equipoise. 

I hope you get the picture- if not please feel free to ask further.

(For those who read my blog with any regularity, pardon me I am not able to write however much I may want to thanks to the cold and my bone issues. But hopefully with summer coming soon, the months ahead would be better. Thank you for staying connected)

 

A good 24 years later

It was in November 1992 that I got a diagnosis of bipolar in disorder, and the calamity that followed had to be lived to know. I cannot imagine why depression should debilitate people, but I mostly think it is the diagnosis that does so. It freezes you to the point of stoniness- you cannot think there is life beyond the diagnosis. You just cave in, hopelessly, stoic and resigned, as though nothing at all in the world can change any longer and this is the final judgement on your intelligence, capability and achievements. When the whole world around seems to be joyfully straddling along, notwithstanding how much joy anyone is really experiencing, a depression diagnosis simply hollows you out from within. It does not stop, it keeps on doing it- hollowing you out. You waste away, and life passes by around in a haze as though you are watching it in a dream state.

However many times I would try to get well something or the other got me down and kept me so. Life passed by, friends passed by, careers never took off, people stopped believing in you, and the loss of face one experienced kept one automatically away from the world. With what face can you go and tell the world that you do not do anything of any consequence because you suffer from depressions.

At least today I know that even if depression are a part of life, they need not incapacitate someone permanently- people have a lot of strength in them, if they can develop the capacity for changing what is not working, to what could work. When relationships do not work, either we leave the relationship or recreate it. Remaining in an unhappy relationship with anyone- even with a job, or a partner, friend, birth family, neighbour or colleague makes a person anxious, troubled, irritable, withdrawn and perform far below one’s capacity.

Anyhow, long years did not bring changes- only more of the same. It was time for a change. I changed practically every aspect of my life, and it happened a great deal due to the entry of my dogs. Thereafter, a move to staying alone made me realize that a lot of my conflicts were due to family life- understanding oneself from the solitude of one’s existence offers the scope to question many assumptions we carry about ourselves. It was a great though tough experience to live alone from the time I was 35 years old, with four dogs, yet this leap was the pivot of change.

I turned on that axis of change to such a wide degree that I turned my life upside down or inside out, whichever sounds more realistic. In 2016 it would be 24 years that I had a first brush with bipolar. But today my life is not what it was then, or what it was at any time in the interim. Every step I took in these 24 years, with 18 years of drug dependence for bipolar, fortified my tenacity and willpower to deal with suffering- whether real or imaginary.

On 14th April 2016, I am starting PhD research in mental health and law, at Nalsar- it is a long journey at every step, even making it through the phd was not foreseen until a few months ago, due to certain issues of marks that I had during my MA years.

The reason for writing this post is nothing if not sharing with anyone who reads it that change is the nature of life and the universe. If you want to change anything about your life which is not working for you, you just got to be sure about it- life will give you chances from unexpected quarters. My experience of getting admission into the phd program is testimony that anything can happen to those who are standing in the queue. If you are sitting at home or sleeping away feeling disabled then you are the biggest impediment in your struggle.

If I, who had no hope whatsoever to do anything in life, can get into a phd program, I believe anyone who has a mental health issue can recover and reclaim their life. IT is my firm belief and conviction. And the sort of work that I do in counseling is ensuring that this is happening. Life is a big mystery and we all need to continuously reinvent ourselves, in response to the environment, our bodies, our minds and our resources. Change is ever ready to welcome us- and so should we be. Finally like the woodpecker in this picture, I pecked at it until it changed- whatever it was- fate, destiny, my life or my options.

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The greatest lessons usually come to me from nature, birds and animals

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?

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.

Arts, Media and Mental Health- WCPRR special issue

http://www.wcprr.org/volumes/volume-10-number-34/

This blog post is only to share this link, via which I hope to save here the special issue of the World Cultural Psychiatry Research Review, in which my article has appeared finally, nearly two years from the start of the process. What a painful journey. This journal is a publication of the World Association of Cultural Psychiatry. 

I am not sure if there are more recovery stories in there, apart from my own, but I hope to look into that also later. However, this special issue is about how the arts interact with mental health and whether change occurs in the lives of people due to it. I am going to write my reflections on the issue and in general about psychiatry and how it appropriates human suffering, by calling it madness so effectively- and a whole array of resources get going to confirm that position.

Narratives as method in Law School

INTRODUCTION TO THE COURSE

Introductory Narrative Methods is the course that Prateeksha Sharma, a classical musician who works in mental health and communications, taught a group of 24 students within a span of 11 days at our law school. This elective subject was offered to the students from the second year till the final year, fifth year, students. According to us, the elective was unique in that it was a one of a kind elective that had never been taught at a law school. With lessons that related law with narratives and also made the students interpret a few events in a holistic view the elective was offered as a one credit course to the students. We think ,the idea behind the elective was to enable storytelling – recounting experiences and using your own experiences to understand and relate to other people’s experiences. Also we felt that, the course aimed to develop the skills of expression and listening that are pertinent to the practicing of the legal profession.

 Our  survey will focus on the Introductory Narrative Methods classes itself and opinions from various group of students as well as the course instructor and will conclude with whether the course helped the students arrive at a synthesis to their thesis and anti-thesis and whether the elective was really something that should be advised for law students or not.

THE METHOD

 The primary method of collecting our data was through surveys. There are three different types of groups that were interviewed by us : the people who were given the opportunity, the people who were not given the opportunity and the course instructor. Within the people who were given the opportunity there were two different groups- the students who opted for the course and the students who did not opt for the course. Our  group of three allocated specific roles for ourselves and we worked towards reaching those goals and in the end everything was collectively edited and made. One of us interviewed the people who were not given the opportunity, the people who are in the second year including the second year students who attended the elective and the course instructor herself. One among us interviewed the people who are in the third year and the fourth year including the people who took the elective from those years; and the one of our member  interviewed the people who are in the fifth year and also the fifth year students who opted for the elective.

For this blog post a total of 40 students were interviewed by us and this blog post will cover all the different views and opinions shared by them.

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THE ACTUAL NARRATIVE:

People who were given the opportunity:

  • People who took the opportunity;
  • People who did not take the opportunity

People who were not given the opportunity: The first year students were not given the opportunity to elect this course. As the first years are not given the opportunity to take part in any electives they are the group that comprise of people who were not given the opportunity.

While interviewing the first year students, our member gave them a basic outline of what the elective is about and also showed them the brief description of the course, which was provided to the other students before the start of the elective. They were then asked whether they would be interested in taking part in such an elective or not and asked for their honest opinions about it.

We see that ,Nathan was not too excited when he heard about the elective. His goal is to work at a corporate firm and so he thought that the course would be of no help to him especially since it doesn’t even deal with any legal aspect.

“I don’t see any point in doing such a course which is not even related to law. I mean what more can this course teach me than the saying that there is always more than one side of a story?”

Willa replied to us that she did seem interested in the topic but the only drawback that she thought the course had was that the course instructor was a music teacher and had no legal background. She also mentioned “without a legal background I don’t think the course would be of any help to me because she wouldn’t know the laws that go behind let’s say arbitration which has been pointed out in the brief description given by the teacher.”

We got some other responses like , Kate did not want to be a part of any elective as she was already busy with all of her other credits and she did not think that she would be able to give enough time for the elective.

Shyaak told us that he did not want to take any elective, as he wanted to just enjoy life and live in the moment. He was satisfied with everything he has as a compulsory subject and he did not want to sit in a classroom for another 2 hours every day just to earn one more credit.

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We have also interviewed the second years to delve deeper into the reasoning behind the students’ interest in the Introductory Narrative Methods course. We have divided the second years  into three categories to gauge their opinions. The groups were:

  • Students who applied for the course but later dropped down.
  • Students who applied for the course and continued it.
  • Students who did not apply for the course.

Neil told us that he opted for this course as it was took relatively lesser time and efforts when compared to other law school subjects.He even felt that he developed a new perspective on law school and legal writing.

After speaking to Emma we felt that she was exposed to newer forms and techniques in writing. She wanted  to take this learning further. She also said that the course instructor introduced her into a new world.

Armaan said that taking this course was an enriching experience for him. He put down his unexpressed thoughts onto paper with the self-narrative writing task. He also felt glad that he interacted with a varied set of people.

Sara applied for this course. Later, she opted out of it due to some health issues. But told us that she was really interested in doing the course and would have done it if she had been feeling well.

Zayan attended the first class and later decided not to do the course because he was expecting the course to be more law oriented. The course did not appeal to him because it was mostly arts oriented. We understood from his words that he felt wanted to do a course which would be  more in consonance with what he was studying at law school.

We had some unique response too.Sasha’s was one such. She expressed that the course description was too abstract for her liking. She felt she might not give her best to the course as she was packed up with a lot of other work. The writing task mentioned in the description also did not interest her.

And Juliet  replied to our questionnaire saying that she heard about the course before it started and found it interesting. But she chose not to do it as she had booked her tickets to go home. And she wanted to spend time with her family during the festive time.

We found a contrasting opinion in Jennifer’s response , she said that the course description was not appealing. She also disliked writing tasks and so did not choose the course.

The third year, fourth year and fifth year students mostly overlapped in their criticism and appreciation of the course. This is what we could comprehend from their responses. As far as the assignments are concerned, a few people were a little uncomfortable at the personal nature of the self-narrative. Even people who are open about their thoughts and feelings draw the line at people they are close to and comfortable with. They even shared that, the foundation of the course being connecting with people and finding your comfort space, people were not willing to extend their personal space to people they otherwise don’t interact too much with were reluctant in taking up the course. With the self-narrative, there were concerns as to how they could be completely honest about their experience in narrating it to a stranger. Secondly, an experience has no objective standard of grading. How then will the self-narrative be graded as an assignment? How can a third person evaluate your story? And if the point was just to enable one to write his/her story/experience, it comes down to it being a personal choice of values.

Some students replied to us that, if the course was to be conducted earlier in the semester, they would have enrolled for it as October being the month of submissions, exams etc. tends to get quite hectic.

There were others who didn’t sign up because they didn’t find the course relevant to legal studies or to their choice of field.  A few others feltthat this sort of learning need not come through a course. Some people were just not open to the idea that this course might bring in something new in terms of learning and did not consider it important to their goals in law school. Some people were busy with other things and could not take out time for this course even though they desired to do so. The timing was an issue for quite a few people because after full day class, an extra class can be quite exhausting. Logistical issues were quite prominent among the issues people raised. We observe that apart from the first years, the students from other batches had expressed similar concerns.

This was the aggregate of the opinion collected by us from who attended the course.Among people who took the course, apart from those who raised concerns about their personal space and thus not being able to realize the purpose of the course, it was described by a few as a fresh course that was fun and extremely relaxed. The new activities and ideas that the course introduced them to was a welcome distraction. Prateeksha Ma’am especially was appreciated for her kindness towards the students and her own openness. Some people feel that even if they are not sure what the learning from the course is at this very moment, they can keep drawing from it in the future. The course wasn’t one with a definite end, but is about ongoing experiences.

THE COURSE INSTRUCTOR:

Prateeksha Sharma was invited to University of Law to teach the students. With a specialization in mental health she wanted the students understand that every word such as “criminal” and “victim” have more than one way people can view it. Since she works with stories and since stories have a lot of possibilities. Moreover, law is also full of stories include law Introductory Narrative Methods was the course to teach. To see your own story as an outsider was an objective that the students were to understand during the elective. The first year students should have been given this opportunity as it would help them make the connection. It will make the students more sensitized. While we felt that she was expecting a little more stories and interaction from the students, Prateeksha found the class a little dampening and thought that the students were looking at the elective through the lens of academics and grades and no fun. However, she was happy to see a few people’s earnest effort to write. She also found the 4:20 to 6:20 timing a littleodd, as the students were burnt out by the time class started.

Prateeksha had to take a 3day leave from her daily life to come to our college and teach us. The repetition of such an elective occurring next year is not plausible as it takes a lot of her time and she would prefer that students come to her and learn, which could be done during the semester breaks or during a 3 or 4 day break within the semester.

After an interaction with her , we could get  more useful insights about the course from her. She said that it was  a ‘challenge’ for her to mould her research experience into teaching of narrative methods. Her experience in teaching prior to this course was mainly in the field of music. But she has been constantly working in the realm of narratives in mental health. Her efforts were to bring narrative tradition into law school. We understand that her main concern after beginning teaching was that this course should be introduced as early as the first of law school. She even believed that a teacher’s learning undergoes fine tuning with teaching. We comprehend that she meant that she was learning with us too. She even had to try hard to link the subject to real life narratives , as this would make every student engaged in the lecture. We felt that this was an appreciative way to evoke responses from the students. On being asked about where she found motivation to teach. She replied to us that she felt it as a responsibility to carry forward the energy and efforts put in by the students. That’s what kept her moving.

Reaction to the course

Me: So why did you think narrative methods would help us law students?

Prateeksha: See basically I work in mental health and I’m always looking into stories of people. If I look at people from the same framework as society is labeling them, is that enough- like when I say  like “criminal”. Is that all or is there more to it? Do I want to listen to the label as a finality, or should I look at their subjective experiences? I am interested in looking into the stories of other people and since I do I thought whether it could be related to law. I had a choice of choosing whatever I could do here. She (the academic convenor) said I could do something which would make students understand life with a new perspective, which made me look up ways to take my knowledge into a law school; and I read a paper of how law is all about stories. So I thought of teaching this course.

The Course Material

Me: So about the course material. Did you teach everything that you have expected to teach us?

Prateeksha: I came with the idea that I should give an introduction into what narratives are. When I thought about the course, I structured it mentally as an exercise which produces a reflective attitude within learners. When we work in stories and mental health anybody who becomes a therapist should learn to look at their own story in an objective way first, otherwise one never develops a distance from one’s own subjective reality. Should lawyers not be open to this and see justice and injustice first within their own lives? Learn to see their stories as outsiders or should they see everything without delving into their subjective truths, which are always changing? One of the key objectives for me was to help students develop a self distance from their narratives and believe that they are experiences that belong to a human domain, not just their personal truths.

  • Shaemus thought that the course material hitting the objective of what was supposed to be taught in a narrative methods class.

“The course material was, see it was good. Good as in substantial as in it was relating to narrative methods. It was hitting the target.”

  • John was happy when we asked him about the course material because it had actually helped him in writing a better narrative.

“The course material helped me in understanding how to write a narrative but since I was absent I can’t comment over its application in law.”

CONTROVERSIES:

Our interaction with anumber of students has reiterated the fact that there were no controversies related to the elective course “Introductory Narrative Methods.”

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CONCLUSION:

The conclusion is an amalgam of our convictions and our learning . introductory narrative methods course was a unique elective course offered in a law school. After doing this course we have learnt a new of way of viewing every legal issue. For instance, in every single legal case there are various perspectives, and each perspective is a narrative. As law students we would be benefitted by the knowledge of narratives to understand various existing narratives.Though the course seemed to be off track, the element of law was not absent. The essence of law is language. The impact that words can have through writing was highlighted to us.This could be taught to the law students in their initial years at law school. They would be hugely benefitted by it because they will develop a holistic perspective in viewing everything. Most of the students were impressed by the course description. But some of them could not opt as they had time management issues and other workload. Most of the students who have taken the elective course found it to be a rewarding experience. They even expected to have contours drawn and a framework to be set to the course as the intended results would be delivered better then. They even opined that the given course time could have been used more a effectively and productively to imbibe more valuable information from the course instructor. We felt that the  sessions were highly interactive and the course instructor was flexible with the students too. We even learnt that every issue in law has a social , penal and legal perspective to it. This made sure that elective course was not cumbersome. So all together, it was a joyful learning experience for us. We would also like to express that there was a legal angle to this course which was not noticed by many. It might have been underplayed. But trying to understand the legal aspect of this course was the main objective.

Note from examiner: The responses that have been included here from me, prateeksha, are changed from the original submission, without affecting the grades of those being marked for them. I thought it was best to write my own language here, because young students may not be able to represent what I am saying to the extent I can do so. But that need not impact on how anyone has to respond to this narrative. 

Sorry, due to my inability to do so, I am unable to upload video clip.