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)

 

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.

antardhwanee- one at a time, towards better mental health

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

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

 Life begins on wasteland

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

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

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.

Self talk, and embracing the enlarged Self

The purpose about communication about one’s own self can only be towards enlarging the scope of possibilities of human endeavour, hope and courage. So though I usually do not like to speak about myself, unless the reason be very compelling, I did accept an invitation to talk about myself for once, in a detailed manner in the Department of Psychology, at the Delhi University, on 4th Sep, 2015, at the behest of a professor, who has been a collaborator on many issues of mutual interest in the past as well.

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Dr. Suneet Varma, is to the extreme left in the picture here

Dr. Suneet Varma carries out the tough act of introducing the new paradigm of Indian Psychology to his graduate students and as part of that exposes many a scholar, practitioner and academic to students to drive home the point of the various threads that contribute towards the ethos of India’s myriad cultural, artistic, spiritual, aesthetic and philosophical traditions. In that context, he has exposed his students to many aspects of Indian music as well, particularly those strands that interest him deeply. My interest with him coincides on the page of Kabir. My article about Kumar Gandharva is also something that he has shared with his students in the past.

When I shared with Suneet, about my article – Making Song, Making Sanity, being purely in the context of Kabir, he was interested in having me come and talk to his students. I took up the option, even though it meant talking about myself, which I find extremely difficult, because of my shy nature. No, do not get me wrong– I am not shy the way one would think the ‘shy’ word- I am shy to talk about myself (a great irony in the times we live in). That is it! The paradox is that my own life has many a hint for many to think about in the context of illness and recovery, or in fact human capability. On the other extreme, in research I have frequently written about myself, which is a very difficult thing to do. But I cannot explain the complex thought behind that is this blog post- it would take a full research article, about my motives.IMG_2435

Illness of the spirit is not an ordinary somatic illness, because everyone’s spirit can be troubled, just like Arjun was in the midst of the Mahabharata. The troubled Arjun can remain troubled until a discerning Self in the form of Krishna does not appear. Krishna is actually the ‘Viveka’ in the human, that awakens by complex ways. I cannot go into details here. The journey of what is classified as mental illness is something that I see as the search for an authentic self- the self that cannot connect with the falsities and facades of modern living. Various people reject the world around for various ways in the which they do not sync with the possibilities inherent in the experience of daily living. To come to the point of a ‘breakdown’ is a real amplification of those incongruous situations and the rupture of the psychic fabric.

Of course it is another thing to experience, what students in Psychology would understand as PEAK EXPERIENCES, and another thing to be able to harness the waking power of the sleeping serpent- that is where madness emanates. Naturally life is too short to explain all that I have understood in journal articles and I have no use for any further academic writing. But yes, there is a need to write about the consciousness and how it originates and how it diversifies and whether it really achieves the dimension of the transpersonal or whether it is only a theoretical possibility.

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So I gave a talk in the department, which was received with an unprecedented appreciation, for me. I have spoken about myself in guarded ways, in the past as well- particular in conferences. The prime reason for my shyness does not stem so much from the stigma of mental illness, as much as it does from the self-centred, attention seeking attitude with which those who share  illness narratives, often end up representing themselves with.

For me, there is no self that remains to be represented, if not the past self of an immature mind, that goes through a process of maturation, by its dive into the IMG_2416underworld of its unconscious and by integrating knowledge both from the personal to the collective human history, which lies in each of us as the collective unconscious, emerges from the experience a tired, centered being- no longer dazzled  by anything at all in the world, not interested in any trappings of scholarship, spirituality or a desire to attract attention. It is just like coming home to oneself- there is no one there, but silence- and all noise is outside now. And yet we have to constantly guard against the outside noise, which is only too close and will catch one unsuspecting.

But I am happy and surprised to note, that though my narration of my past was to a group of young women and men, who were perhaps on an identical inquiry in their own ways, with the tools that they have at their age, the response I got from this lot of young people is by far quite unusual, for it brings to mind another interaction of another nature, whose context was directly mental health. That was in the Ambedkar University, and a panel discussion on the subject of mental illness- in which a number of people were invited to be part of the panel, including me. The year was 2013. However, the response I got from the students there, who would perhaps be directly dealing with the subject of mental health, was markedly lukewarm as compared to this experience of Suneet’s students.

Even in the past many students have filled their seminar room, including having more senior professors too hearing me talk, but this time the students lingered on IMG_2464much longer, after the talk got over. Not just a couple of them, but many actually. This is surprising, and made me self reflect what was the reason? Is it because they are hearing a self narrative of recovery? Is it because it gives them hope and courage to deal with whatever they are dealing with at present? Do they see a possibility out of mental illnesses for others as well? There are questions galore in my mind too, as to why the story of one person interests another.

However, the reason for this post is partially to note the experience and partially to invite the young women and men to comment about what was it really that they felt connected to, which they can openly articulate for everyone to read. So this blog post will go to all the students, with a request for their footprints here, and their thoughts, reflections and insights. That may give me the scope to look for further possibilities to connect with them, via another talk/lecture/workshop or collaborative research- the way I had initially mooted about the ‘musical self’ but which the time constraint did not permit an articulation of.

The young man who has taken these pictures, was astute enough to note that if someone can overcome something as difficult as a mental illness, then possibly overcoming the struggle of doing a master’s degree would not be so bad! Well, they do not even occur on the same page Rishi. And on the last note, knowledge which is gained from universities is just an introduction, which is no substitute for lived experience based knowledge. Perhaps you would agree as also several of your friends understand.

IMG_2355Thank you my dears, for helping me deal with the hesitation of self narration, so that though I have attained a certain level of triumph over my past self that suffered so much, I still have to move myself towards a larger self, in which I am not hindered by what others conceive of me, upon hearing about a past of mental illness. Your feedback, appreciation and generous ideas certainly give me hope and courage that the youth are not impervious, indifferent people but sensitive and looking for authentic encounters- to express their own authentic selves.

I invite your comments and the same ideas or new ones, on this blog post, to save it for all our future references. Thanks to Rishi for the efforts, as of course we all must thank your department, and Suneet in particular. Eric there is a lot of Jung in me, so perhaps the next collaboration could be with you ?!! 🙂

Ah yes, I muIMG_2366st mention how difficult it is to talk and sing at the same time, to illustrate some of the ideas that I am discussing, but I try not to fight shy of the challenge. The voice from talking, becomes tired and is then made to flip over to the singing side. I hope to master this challenge, if someone can! IN any case, I seem to be doing this quite a bit, in talking on the subject of music all over the scope of my work.

I could add here that the title of this post is a trifle misleading, because ‘self talk’ is what happens inside a person’s mind and not in the public domain. But when the inner self talk, which arises due to a disturbed state of mind is more or less over, then the talk about the ‘self’ which is not an individual but universal self is what the post title could be seen to imply. Self is not the focus, but the SELF, which is common to the whole of humanity and its awareness- that is the intent.

This post has an unusually large number of photographs because the photographer was generous enough to not only shoot many, but also send them to me. Thank you for that.

Emphasis on Recovery- whose focus should it be

The overriding concern of psychiatric services till date has been management of mental illnesses– by any number of drugs and services. Whatever counseling or therapy has accompanied these services, the dominant role has still been played by the model offered by psychiatry (in other words, the DSM)

I am not writing a critique of psychiatry here, because it is unnecessary. It may have had something good to offer, to a lot of people, facing crises, but it does not offer recovery as an option- that is a certainty. If you are willing to submit to its ideas and experiments, newer and newer drugs will keep appearing and they will keep promising newer outcomes; NOT RECOVERY among them.

When recovery is not even an agenda for psychiatric services, to expect that people will get well and fully recovered, just by taking psychiatric drugs and nothing else, is nothing but ignorance. I for one, know from myself and scores of others that, no psychiatrist ever tells a patient that they can go off medication or they can be on their own without drugs (unless they are working in government hospitals, where they are not always working for profits). The bigger issue is that patients and their families keep looking up at doctors to give them the cue that they can be off drugs! They never have the courage to take their own decisions- for everyone who has known psychosis or extreme mood states knows the perils of them. Of course, even if family caregivers tell psychiatrists that their loved ones do not require medication, because the initial symptoms have subsided, they do not pay heed. From self experience, I documented this as part of this research article in 2011.

So whose focus should recovery be, if patients have to recover? I just asked my mother this question awhile back. In fact, in the blog post I wrote before this, about the dilemma of caregivers, I had mentioned about my mother being a very active and militant sort of a person, which she is- not to take any nonsense, to give speeches wherever need be, and in general to stand up for causes that she finds justification in (quite radical actually). Even her mother was a radical in her own time, who the then PM of India, Lal Bahadur Shastri (or was it Jawahar Lal Nehru?) had invited to be part of the parliament. She had declined because one of her children was quadriplegic and there was no one to look after him. In other words, their children have been one of the key priorities of women in my family.

No matter what her personal position in other domains of life,  it was she who was more recovery- focused than me! I was in no condition to even consider recovery as an option, for with great perseverance I had come to a point where I had achieved a certain measure of ‘stability’ (an absence of diametrically opposite mood states), and I knew that with the given dosage (valproate mostly) I could go on and on for years. I would not worry about any more fluctuations. It was another matter that for years the fog in my brain would not lift, the heart was always heavy, the body always tired and moods relatively low- but I accepted that as a part of being ‘bipolar’, and disorder was there to stay.

Mummy would not accept that. From ayurveda to homeopathy, to any other system of medicine that could yield results, including naturopathy, yoga or what have we, any new- found person, anything, even an astrologer would work- as long as her child could get some succor. I do not really see that tenacity in a lot of people, who are willing to let medical science decide the course of action for them. No doubt, the haze in mental health is so huge, most parents will never get to researching of the kind my mother could read or comprehend, or what most other researchers access and read, especially in the context of critical psychiatry and psychology. I even work in language to see how language impacts mental health- and what are the complexities of the phenomenon.

Recovery is Coming into Light 

In some advanced countries of the world, as I noted earlier in this article, recovery has become an important focus for caregivers. But these are welfare oriented countries, not where health care spending is routinely cut to add to defense budgets or give bailouts to big industrial houses.

Recovery is only going to be a focus in cases where people are not worried about making profits out of healthcare. Yesterday a senior and retired professor of Psychiatry sent me some of his writings, in which he is talking of the utility of home based care in which a caregiver who is a trained professional would go to people’s homes and offer guidance and support not only to the main ‘patient’ but also their family caregivers. This is also the sort of model which has been followed in Finland, where they have accomplished recovery to such an extent that they have practically emptied out psychiatric wards in hospitals. Their model of social psychiatric, services embedded within the community, is taken as an exceptional model by all standards.

However, to make that model a reality one would have to create the sort of social, cultural, political, and financial infrastructure that Finland created for it to succeed. As of course the willpower that we wanted our people to recover. Do we really? Who has the jobs to offer if more people join the workforce, if they want to be married and want housing, if they want everything the way everyone else does? Who wants that psychiatric medicines should be consumed and psychiatric wards should remain active and abuzz with human footfalls? Surely not parents or caregivers.

So whose focus should it be that their children and loved ones should become well? Those whose interests are tied to the perpetuation of psychiatry? Will parents wake up and see reality?

Will they understand that they do not need to fight for more psychiatric services, but better education systems, and health care (not mental healthcare)?

Will people ever understand which wolf is wearing the sheep’s clothing?

On a parting note, in case any parents are reading this, please work with those psychiatrists who are employed in government hospitals, not private clinics, because they would be glad to assist your children/loved ones be on the lowest possible dosage of drugs, and not prescribe unnecessary tests, unless absolutely required. They are the most likely people who would have a recovery focus. Meeting some psychiatrists I too have gained that impression. All of them are not feeding the pharma-industrial complex alone- some genuinely care for patients.

The suffering of family caregivers- WHO AFTER ME…

‘Who after me’- is a question which every parent whose child faces a disabling condition, which requires their care-giving, support and engagement, has to deal with. There are many ways to look at this question- to look at the individual side of the question, or look at the social side of the question. Since one cannot but act only at a small level in the short run, I will begin by answering this question at an individual level.

Personal history

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In fact, let me begin my question with myself. When I was extremely ill, my parents handled my full-fledged responsibility; I lived in their home, and they went to teach in their respective institutions (in Delhi University, both of them), while my grandmother and one dog was the remaining family. I was completely incapacitated, would not get up till 10:30 or even 11:00 in the morning on certain days. The depressions were so huge that life was completely unlivable. But whenever the skies would clear up, I would pick up my pieces and start mending the frame somewhere- I mean the frame of my existence.

One thing was clear- my siblings were both in the US, and had lives of their own, and I, the oldest, was with my parents, who both went to work. In other words, at the prime of my life, in my 20’s and 30’s I was sitting at home doing nothing, but some study, some reading, writing and singing. I could not imagine that my parents would keep on working and I would just spend the rest of my life that way. I was troubled, useless to myself and the world around and there was nothing I could do, would do or go meet anyone. (whatever exceptions were there in music or writing happened on days which were not so bad). There were no friends from any dimension- school, college or neighbourhood, no relatives who knew anything or if they did, they pretended to act ignorant, and there was nothing but a great spiritual stagnation.

At a very critical age of my life- at 35, I decided I could not live the life of my parents, I had to figure out my own. What would happen when they would not be around any more? I would have no skills to deal with anything. I would have no income of my own, no friends, no relatives to fall back on, nothing at all…where would I go and what would I do? So that brings me to the question of this post- the question that all parents face, whose children are incapacitated from doing the day-to-day actions of living and participating in life in ways what gives them hope , courage and happiness.

When I got well, whose story is written elsewhere in research, the one thing that progressively became important for me was to see whether this recovery was a chance or random act, or was it happening among others too and what pathways they were adopting to get there. This has been the general direction of my research as well- towards recovery solutions. So if I just come back to the first question, one has to see whether someone like me can act at an individual level or a social level.

At the individual level, one can engage with one person, nay one family at a time, help them comprehend distress, help them rehabilitate and recover the manner I have done myself or now hold many other hands- towards recovery solutions. I do not think people cannot recover- no matter what span of time they have been ‘ill’. But it is just like saying that someone who has been used to walking with crutches will now learn to run. So how to bring the turnaround and who will bell the cat- the suffering? Before they drop their crutches, they have to gain courage that they can indeed walk, that their limbs have strength and they will not tumble, just because they will let go of the crutch, which they have been depending upon for so long. (the crutch metaphor is only a metaphor, no intention to allude to another ‘disability’)

What can one person do?

I am very clear in my mind , that I cannot bring social change- that is for the government to accomplish for they alone have that many resources that they can empower, employ, and rehabilitate hundreds of people. However, that does not mean I cannot do anything at all. I, or anyone like me, can only deal with one person at at time. There are many people who create organizations in the hope that they can mediate with the government and bring in more interventions at a macro level which can transform society. Often a lot of times, these people have no model by which they want the change to come about. I do, because I AM THE CHANGE MYSELF, not just the change-maker, or someone fighting for change, without a concrete plan of action.

I believe that people can recover. Needless to say, I have seen them recover, both from bipolar and schizophrenia; I need not delve into other things of a less distressing nature, not that they do not make life difficult in any way. The only thing we can do is then from this prototype of recovery, to create more recovery outcomes. If recovery could be accomplished by the government then perhaps the whole country would have healed by now, and there would have been no problems.

Maybe some people have hope in the government and its systems, I do not. I think it is only up to me to do what I can and bring all resources I can, to reach out to the widest number of people- both families and individuals to let them know, first of all, that recovery happens all the time, many recover, and it happens all around the world- not just in resource rich countries.

The concern of parents that comes from the WHO AFTER ME question is a reflection of the unending suffering of both parents and their children who have become permanently dependent, thanks to a system of continued infirmity. I know one thing for sure, that if one remains dependent upon psychiatric medication, nobody can recover. Yes, you will most certainly become functional in many domains of life, but independent living, and handling life stresses- that can never happen. Each one of us (including John Nash) who recovers, anywhere, has gone off psychiatric medication at some or another stage of their life, by creating alternative resources, no matter what. So who after me, is a confirmation that the path of rehabilitation that they have followed has actually disabled their child, and made him/her permanently dependent, rather than making them recover any aspect of their lives.

A few months back, I was talking to Dr. K.S. Jacob of the CMC, Vellore on the subject of continued medication, and he brought a startling insight to my notice- that only one- third patients require long term medication. I was so shocked to hear that, because in my 18 years of psychiatric dependence, my psychiatrist NEVER EVER told me that I could go off psychiatric medication, no matter how many times I would implore him to help me reduce the drugs. Certainly he brought them down to a minimum, but no way he would say I could go off them. I would have to continue them for the rest of my life, what did it matter?

What did it matter to him that I had co-morbid conditions and I had gained so much weight that it contributed to a lack of self esteem and self worth? The mental fog that would waft through my brain at all times, never would lift for me to face any day of the year, any festival, any change of season with any ray of hope in my heart? I was just a patient who was a regular nuisance, because she would come and request a reduction in medication all the time.

Today when I look at my own recovery I am grateful to my parents that they let me make some important decisions of my life, including the choice to live alone, including the choice to come back home when one marriage did not work or more. I am grateful to my mother who never told me to take psychiatric medications, because she was quite open to other alternatives. In fact it was she who would regularly encourage me to try out new things and even eat them herself to offer me solidarity- one of them being the bitter leaf of ashwagandha that grew wild in my then home in Faridabad. Ashwagandha is known to be a mood stabilizer, and she would try getting me many sorts of ayurvedic pills and potions, or stand with me in queues of this or that vaidya.

I think one of the key people in my recovery are my parents, and they have always supported me in my choices, no matter how difficult they be. When I see other parents on the one hand I understand their suffering, on the other hand I see how they become the chief mechanism through which their children get medication for years and years on psychiatric drugs- for they never have the courage to look for alternatives. But like I said about mine, though they are the KEY PEOPLE, they are not the reasons for my recovery ALONE, in fact not in any significant way- if I did not have the scope to express myself through other means.

That is the sort of alternatives I am trying to bring together towards the recovery programs we are designing at Hamsadhwani- mostly for people suffering, but in one exceptional case- for parents too- The Caregivers’ Online Program, as part of which parents will not only get to meet many people who have recovered from serious mental illnesses but live lives just like anyone they know. Needless to say, psychiatrists who have a recovery orientation are part of the contributing experts as well as professors who have worked in clinical psychology and health psychology, activists who routinely meet and deal with people having mental illnesses.

Naturally enough all of us who work in mental health, regularly meet people- I also meet families due to my orientation towards family therapy, are more exposed to mental illness stories of people than parents who only know their one or two children or a few friends’ children with identical stories. It is only by exposure to new ideas can new solutions be found- for by now everyone knows that psychiatric medication can only go so far. We cannot solve the problems that we have created by the same thinking that created them (Albert Einstein). As Anil Vartak, the vice president of the Schizophrenia Awareness Association says, that solutions for mental illnesses can only come if those who have recovered actively set out to help more recover. That is also my effort via this program and that is why I have also roped him in.

Parents will have to continue worrying about their children permanently if their caregiving is so dependence-creating that they cannot enable their children to become functional, and self preserving. Instead of working on the deficit side of their children, if they can help them deal with their mental distress in ways that their existing strengths and abilities are only further consolidated, their worry about WHO AFTER ME, will never be a worry again, because after them, their children will be well enough to manage their own lives.

For that outcome to emerge they have to put their children in front, as agents of change in their own lives, and allow them to make mistakes and grow, rather than determine the direction of their growth all the time, proactively run around here and there looking for solutions and meeting all sorts of experts, all over the world.

ON a last note, I just remembered that my mother was a very active and valiant parent when we were growing up as children. She would actively fight against issues in the parent- teachers’ association in school and at another level in the politics of the teachers of Delhi University, among other things, such as women’s issues. However, I thank god that she never took up these roles in mental health, choosing instead to focus on me as the sole concern. In getting her priorities different from parents who created organizations to fight for the whole society, she created the scope for me to recover and possibly bring that knowledge to others, rather than keep debating with the government for more measures to deal with mental health. She did not have any hope from the government too, I reckon. No surprises, I am indeed her daughter.

Of course this is not to say that those who took these paths do not deserve recognition for it. I am certain in their own ways they may have contributed to some social outcomes, but has it also brought about a recovery in their own children’s lives? That is the key issue. If they have succeeded in that, then they may have a path to show to the rest of the parents, or else, it is we who have recovered, who have dedicated our lives and our youth, our homes and our families to the suffering of humanity need to take care of this responsibility.

And this is where I stand too.