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.

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.

Ordinary Life Therapy

I encountered the work of Carina Hakanson a few months ago via her very beautiful and simple book, simply titled- ordinary life therapy. Upon encountering this video I thought there is no way I cannot share it with those who would not have access to her book.

As the end comes once again…

… new beginnings begin to show.

The road does not end, it merely turns around a corner…

I have not been writing this blog for long (in terms of years)- I mean this is one of my recent blogs. I used to blog a lot once upon a time- it was even therapeutic during a certain phase. There was a time when I was very afraid of the wordpress platform for it baffled me so!

As the year comes to an end, I have just now written a little piece about art advocacy to be used by people who suffer from various mental illnesses, to offer some ideas and recommendations they can use in their lives, via the arts- the performing and visual arts. I am writing another bit for a conference in mental health in which I would be speaking on the subject of whether the labels of mental illness are a useful device and if they really help anyone.

But the most important venture that I hope to  start in the new year, on the subject of mental health is a twosome- one is the counseling, for which my website is almost ready, and the second is the counseling training course that i will offer to people who have themselves lived through mental illnesses. The purpose is to empower them by helping them understand the roots of their own suffering as well as be trained to support others via a proper method of counseling- taken from a merger of post modern collaborative approaches and systems theory. Of course all my work is rooted in social psychology- in which I view human suffering as an outcome of people’s social settings and environments.

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On the (terrible) idea of putting people in Rehab centers

DSC00895In response to my article in the Hindu, I got this mail-

Respected maam..i have read your todays article on mental illness in the hindu. I have mailed as you are working the field of mental health..
Problem is that My elder brother is suffering from schizophrenia since 16 years.. currently 32 yrs age and unmarried..whole his teenage and adulthood have been destroyed due to this disease..we had consulted many doctors from aiims to peripheral institutes.. symptoms only get for few days or weeks..then again relapse. Doctors advised to indulge him in some work..but its impossible to get him into as he his very resistive..
So just mailed you maam that if you could tell me regarding some rehablitation center for schizophrenia patients in india..where work with medicines will both go together..thanks ..

(i have not changed this in the least)

This is one among many. People think that by sending their ‘mentally ill’ family members to any rehabilitation center they can really rehabilitate them. What is the meaning of rehabilitationRehabilitation is the act of restoring something to its original state, says this link. In what manner do people think that a rehabilitation center can restore anyone to their ‘original state’ I cannot imagine. Mostly people who recover do so because they DO NOT GO TO ANY REHAB CENTER. The ones who go are the ones who are condemned for life to go there or condemned to remaining mentally ill! I have NOT seen anyone who recovered in any significant manner by going to a rehabilitation center. They just went there, spent their time and got home tired so as not to be a burden for their own family. That was that. No progress- just a dead repetition day after day, month after month, year after year!

Okay let me share with you what happens in a rehab center-

From morning to evening, they keep people of a similar kind, engrossed in one activity after another. How about basket weaving, walk in garden, eating your food, lying down for sometime, meet a counselor for some time…everyday? Day after day! A fatigue factor will set in.

The rehab center is NOT interested in your patient, if you are not. They are only interested in being paid for performing some service on a day-to-day basis, because that keeps them going and keeps the general cycle in motion. Rehab centers have no new ideas or any ideas at all about how people can recover. IF they did, rehab centers would become empty! ( the ways psychiatric facilities are becoming empty in Finland)

As far as I am concerned I have only seen people deteriorate progressively by going to any rehab program, unless that rehab program be worked out within their home environments with supportive others, who gently coax and help the person when they go through their periodic spells of anxiety or other emotional turbulence. To write about what I have seen in rehab or of those who have been to rehabilitation centers, I would require more time and space- or it would go into something different from a blog post. But this is just to warn those who are considering the option of rehab centers, that if you really want your loved one to get better- rehab is one option you best leave alone. But of course you are the best judge of your situation. This is only my experience based on my work for the last 20 odd years.

A Collaborative Dialogue Directed at Someone Suffering

Hesitant as I am to buy or sell the idea of anyone being ‘mentally ill’, for the sake of those who believe that they are, I will go with that classification for the present blogpost. This post talks about the stories of two young men who worked in the medical profession and who got the labels themselves.

My mother just told me this story- and the boy was also once upon a time known to my sister. The boy was among the toppers at the stage of entrance into medical college and he went to one such which would rank among the top five institutions in India. When he became a doctor, he was immediately (perhaps, or this is our guess) assigned to some section where he had a lot of encounters with the ‘dead’ (bodies? post mortems? Forensic? or something else like that? we do not know)

It seems the boy just could not handle it and the next thing heard about him was that the family would keep him confined and possibly tied up! But the sad thing is he was finally dead by the time he reached his 30’s! We do not know the story for how it progressed, we just knew of the boy entering medical college when he had – for he was the talk of the town then. Could not imagine he would come to such an end.

That brings me to a mail, I just received from another friend, (about another medico) saying -‘Hi! There’s this guy, who had arguments with his parents about his exams and career few years back. His parents took him to a psychiatrist who labeled him with schizophrenia. The psychiatrist was telling him that he has OCD too as he was not willing to accept his diagnosis. He doesn’t get any hallucination or delusions…He says now he is being covertly drugged. I asked how and what he is feeling now and asked for the side effects and when he’s getting them. And I think he IS being drugged. Further he says his parents are demoralizing, humiliating and inciting him by showing his case paper to all the relatives. He has completed his graduation and wants to do PG now. Though his parents are ready to help him financially he feels scared to take any help. He doesn’t know what to do about the situation. Both his parents are doctors.’

Here is what I am seeing in the story (the marks in red above indicate the flaws, which are the red herrings in the picture to me), if I just deconstruct the power axis here:

The parents are in a position of power over their son and these are the ways in which they are exercising control-

  1. In response to arguments (which are a sign of any child rebelling or asserting his/her rights-autonomy or selfhood) take youth/child to psychiatrist.
  2. Youth/child is not allowed to choose career as they do not permit the choice for they know ‘better’, have seen more of life, know what is best for the child, can take better informed decisions for him.
  3. Psychiatrist hands over schizophrenia diagnosis because boy is clearly showing anger, rebellion, and even rejecting the further labelling of OCD. this is even more problematic in their collective eyes, because people want that those who are being given the label should accept them (called diagnosis) meekly and silently.
  4. Parents decide to avenge this ‘misbehaviour’– and now attempt to socially isolate him, by public display of his ‘pathology’.
  5. They further want to help him financially, for continuing his education.

The mental state of the person in question here, may be like this:

  1. Initially anger
  2. Wronged- because he has been unfairly given a ‘diagnosis’
  3. Cheated by being covertly drugged; unfortunately by parents, against whom the defense mechanism is weakest.
  4. When parents let you down, who can you further trust?
  5. Where can he turn now, and more so, what options exist for him?
  6. If parents are trying to bail him out financially, how much more control will they exercise over him? For what can he trust them?
  7. If this is the way life will go further, what is the nature of happiness in his life, or will there be any? Will he be able to determine the course of his life or will it be the parents all the time making decisions for him?

(All the above ideas are in the nature of conjectures, because I have not directly spoken to the person. I am just writing this out so that more people who may chance upon this writing may read and take some inspiration, if they can)

The real question of mental illness here is a question of developing a voice or autonomy. Autonomy is supposed to develop during teenage, as per psychological parameters. At that stage because it is also accompanied by hormonal maturation, it becomes a cluster of experiences- some of them showing assertiveness which is construed as rebellion by families. In a culture where submissiveness or unquestioning obedience is valued, any sign of rejection, questioning or self-expression becomes a threat to the ‘system’ around every individual. People who are showing these expressions are taken as rebels and they are then given appropriate ‘correction’ mechanisms to make them fall in line. Unfortunately, this is what happens in a vast majority of cases.

Somewhere along the way, such people also part ways with their friends and peers because they are too anguished to share what is happening in their personal lives, with their ‘friends’ for they think whatever is happening, is happening to them ALONE- they become prisoners of their mind, their souls and their imagination. Reality is that we are all on a continuum of human experience and suffering and a lot of people are suffering due to overt or covert family violence of this sort, where children are unequally pitted against their parents for they are weaker in position in multiple ways- financially, socially, initially physically, and more. Often parents also operate as ONE unit/voice- no difference between the parent as mother and father.

My further recommendations, in a very remote manner would be somewhat on these lines.keep the glow intact

  1. You need to develop your own inner and outer resources– which starts from financially to social mechanisms of support.
  2. Remember, the more you rebel in this scenario, the more you will be penalized and you are already outnumbered, out-powered and out-witted for the’system’ can overpower you very easily- DO NOT try to challenge the system. The ‘system’ refers to family, psychiatry, relatives, neighbours etc in this case. It may also be your educational institution tomorrow, which is another kind of system. Each of these is a system in its own sense, for it has its own principles, guidelines and methods, and together this process is a complex systems thinking.
  3. When parents are not your support systems it often becomes difficult to trust outsiders. But there are many resources out there in the world and support mechanisms– though those who have mental illnesses themselves cannot be your support systems right now, for how much can you support another one , if need be? Be wise and be safe. Do not become part of peer support groups, because that would be only more aggravating and you will see your own story played out in different variations across the spectrum and it will fluster you further.
  4. If you can make slow progress one day at a time, by even continuing your education, by slowly gaining control over one aspect of your life at a time, it will slowly fortify you and give you the ego-strength to overcome the system. Instead if you try to challenge the system by taking it head-on, it will punish you seriously. Do not do that.
  5. Come to a clearing, where you can totally wrest free of your parents and your diagnosis, by reclaiming your life as your own. This cannot happen till you are dependent on them in any way. For that you need to develop your mind, and your body adequately and you will be able to get up and walk away from everything that holds you back today.
  6. Remember a day a time and not a life in a day.
  7. Be slow, be steady and be regular– even if you make an inch of progress in a day. Even if you wake up late, even if you have no one to talk to- you will have someone soon.
  8. Believe in yourself and your strength and build it a drop at a time, a little at a time.

I believe everyone can overcome their pathology and diagnosis if they have others who believe in them and if they also believe in themselves and hold on to their dreams. So hold on to your’s, no matter if they are the most ridiculous ones also and try to see them as clearly as possible. You have to gain the power that others hold over you, into your own hands- be the HERO of your own story.

Already, even at this stage, though this person is not directly in touch with me, there is a collaboration at work FOR HIM- for there is a friend of his, who has written to me. I have sat down and invested this effort in deconstruction/writing/counseling…we are the smallest links in the chain and a proof that there is hope and scope for everyone, because when you cry for help, someone hears it- even if distantly. SO PLEASE …ask for help, for it will come to you.