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.

Therapy is not common sense- trust me

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

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

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

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

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

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

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

The Story I was referring to…

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

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

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

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

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

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

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

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

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

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

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

In Sarita’s case, this could have happened-

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

What follows are some general ideas about therapy-

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

The 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.

You are NOT your label

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

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

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

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

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

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

Why people do not benefit from counseling easily

Recently I had two experiences which made me view again this question. Does counseling really work and where or why does it, when it does and why not when it does not.

My experience stems from both personal experience of receiving and offering counseling to others. What I find is that when a person who offers counseling to another, it usually momentarily props up the person and possibly puts them on a new path of gaining self confidence or clarity about their current situation. But in that momentary clarity they often think that they have gained all the clarity they require to navigate through all that they are going through, just because the person who is counseling them is also offering them verbal advice ‘only’ which in any case they are smart enough to suggest to themselves as well.

Is that really the case?

A person who takes on the role and responsibility of being a therapist, counselor, psychologist or collaborator is someone who is ‘outside’ of the situation faced by who they help. But that is not the only reason for their insights, also years of preparation to don the role they are now taking on.

Equally true they work with many people at a time and their knowledge may be constantly augmented due to those exposures, or some (like me) who are also studying/working in research. That gives people more perspectives, not to mention the lived experience of mental suffering.

Why people do not seek help easily

Experience tells me that most people who go to counselors and therapists believe that ‘professionals’ are talking from common sense wisdom, which they (who seek help) also have in abundance. So why should they go and pay for common sense wisdom? This reminds me of an experience with a friend long ago, who needed help and I referred to my own psychologist at that time. When she came back from the counseling session with her, she responded, “Why should I go and talk with her, what she had to say is pretty much what you have to say!”. But that is the whole point- when you pay someone you value their wisdom. But then she was a psychologist who my friend had gone to meet and I was training to me one- so it was not a bad thing that I had ideas identical to her. But naturally those ideas were not something which everyone in society is holding. When we see an outsider of our situation to seek their guidance it is an act of reaching out to a pool of wisdom which is universal and a source of insight, outside of our knowledge.

Of course I have to say this, that in my family we were always taught and made to believe that when one has a problem, one needs to go and seek its solutions in the world outside, because the cumulative wisdom of the world or even two other people is going to be more than our own singular knowledge or wisdom. In seeking help we become humble, and invite others to share their ideas with us, even guide us to a certain extent and that is a good sign. Nobody is so unique that their suffering is above or beyond the grasp of suffering of another- yet we closet ourselves in little spaces and freeze emotionally. Time to see that we are humans and we are connected to other humans and if we can establish our connections with others around us, it will stop being a calamity for us and connect us with the flow of life, which has momentarily ceased, due to our withdrawal.

There are two things about common sense I must share in this context. According to Bernard Shaw, ‘common sense is most uncommon‘, and apart from that, common sense wisdom about one’s own situation is not an easily gained sense– so if someone else were to be struck in your situation what you can recommend to them is not what you will recommend to yourself. In our own problems we are also coloured by our subjectivities, whereas an outsider in not. Whatever they can offer is something which is coming from a faraway perspective, not daily living with you.

As a result what a therapist says becomes meaningful, because you do not go and walk through all your problems with them. I always believe that unless people develop help seeking attitudes they can never get out of their immediate situation, because the aggregate knowledge of a system, even if it be a collaboration between two individuals only, is always more than the knowledge and experience of one person.

Of course the path of taking medicines is always available, and that gives a false sense of security that you have addressed the problem in the correct way, as best as you could. People forget that even after taking medicine you still have to act and take responsibility for your life and actions. And for that you still need to go and meet a person who is outside of your situation, to assist you. If your parents, caregivers or friends could do it, you would never land yourself in such a spot, in the first place.

We all need to learn and gain from each other’s knowledge and wisdom. So do not hesitate to seek help and identify who can be of real help, and who not. The faith people have in modern medicines makes them turn towards psychiatry, without realizing that psychiatry cannot solve anyone’s issues of life and survival, often without seeing where the suffering stems from.

Faith in modern medicine

Like I wrote in the recent article, if our faith in psychiatry stems from our faith in the ethics of science and we assume that science is always ethical and scientific progress is always intended for the best outcomes in society, then we would never have seen the destruction of Hiroshima and Nagasaki, due to the atom bomb. Neither would we see so much war, hunger and disease all over the world. We already have enough resources for the whole planet earth- but do they really get where they ought to be reaching? In reality however, notwithstanding our belief in the ethics of science, it has become a slave of the market. Wherever there is profit to be made science becomes a method using which people do diverse acts to suppress knowledge and help others. People do not need so much medicine for mental suffering- they just need dialogue and communication, which was fractured in their lives long back- there is a need to re-establish the relationships we have with the world and with ourselves, honor our needs and those of others around and in general live a life of relative peace.

Even if you consume medicine, does it address the underlying causes of your suffering, and tell you that now the suffering will be taken care of? People who do not want to go the counseling way, need to ask themselves this seriously or else face a life long dependence on psychiatry, with not much progress.

Losing sight of your Self

A few days ago a friend left a message saying he wanted to talk, over the chat box of fb. After a little effort of a few days we got together to talk. He suffered and I could see that, but having known him for a couple of years I could not connect the dots- though I never under-estimate anyone’s ability for suffering.

I sensed there was a dejection of the spirit and a pressure which probably had built over a long time, especially seeing one’s peers well established by a certain age and him struggling with holding on to a job. I think there are many people who need to find the groove they fit into before they can be in the groove for long enough- and for some that may be a difficult road to try out several grooves before you land up in the right one.

I have been seeing him for a long time and this is the sense I always got from him- that he was in search of the right groove, which would fit into his soul and unlock potential lying within, making him happy and feel fulfilled. The reality of life is a very funny thing. It seldom offers such linear solutions- so we have to constantly find our balance and adjust with whatever we have in our hands- that is what is called ‘compromise’! ALAS!

Anyhow, while counseling I look at everyone as someone who has momentarily lost sight of who they are, or is unaware of who they are in general. But with those who are in depressions, I particularly see that they have reduced themselves to self-hurting talk, that goes on inside ceaselessly. Instead of he telling me how he was feeling, I offered this  perspective –

I think you are feeling very overwhelmed by what you are faced with in a new job and also seeing yourself viz.a. viz, your peers and classmates and thinking they are all doing so well, while you are still searching for the right job. And possibly all the past hurt is also accumulated and giving you an overall sense of failure, that seems too large to handle. Plus in the new job that you are, you feel pressured to rise upto the levels of expectations others have of you and you fear you cannot deliver.

He agreed this was indeed the case. Of course about the new job I am only quoting his insights, for he felt that the goals were too high for him to acheive and he was closeted inside himself, instead of being able to interact with others around, for that made him feel insecure, as though they would be able to judge his lack of ability- while he of course has the ability. He just forgot this for the inner talk that went on inside him, made him feel like a loser.

And this is what I shared with him then, and my words to any who has momentarily lost sight of who they are-

what you are today is a culmination of all your past. Your past is not just made up of your failures, because even failures are new knowledge. You have a lot of strength, based on which you have been hired in the first place. Do not push yourself but be gentle and remember that what is your current goal, and which unnerves you, is already within your reach- that is why this goal has been set for you by those who hired you. They know you can do it.

Life is not a summary, it is an unfolding, in which we move from the past to the present, integrate the learning from our failures and successes, act in the present and lay foundations for the future. Do not see any of these as though they are complete within themselves.

Of course what I told him, was also in particular said to him, which was that

Even if you are not the way others are, of your age and among your peers, I feel you are on the path of finding an authentic expression of your soul, that is why this confusion, this search for gurus and teachers and new jobs and new colleagues, a certain restlessness. For most people a job that pays and takes care of their bills is all that they want. For ones who want a little more the price is bit unusual- so do not compare yourself with those whose yardsticks of living and measuring success are not determined my your scale.

I asked him how he felt after that. He said, he felt a lot lighter, and his spirits had lifted already!

This is what I work like– to just bring light into the darkness, in which a suffering spirit has encased itself. This entire dialogue happened within 20 minutes, and I knew my dal, that was cooking on the stove, would then burn, so I just pushed him away- but not before I was certain that the psychiatric diagnosis had been laid to rest. There was no depression that needed a cure- just a reminder about the divine that hides within and asks for recognition– a play that I always love.

I also put this under the head of relational leading, for had it not been the trust he had in me, to call me up to seek this insight, i could not have shed this light on the situations around him. His instinct lead him to me, but my instinct about him and his suffering lead him into a ‘clearing’ – the goal of the therapeutic dialogue accomplished for the moment.

Me- the collaborator 🙂

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Anxious about anxiety!

A few days ago I had a first encounter with a lady who suffers from deep seated anxiety, It had to be a brief encounter for we were just trying to ascertain if the skype connection, through which we were connecting, really worked or not. She is in Europe, a recent (two years) immigrant from South Asia, educated person, in her late forties. I also wanted to establish a face-to-face link before we could sit peacefully to communicate, at a later date.

In the course of those approx.11 minutes of my communication with her (which I never understood why they became so long, just to fix an appointment) she was so restless it was difficult to focus on anything she said. This was how the talk went typically-

First of all, instead of facing me or looking up at the camera of her hand held device, she kept on holding it at such an angle that I could only see her eyes and part of the nose and covered head, as though it was a veiled impression she wanted to convey to me. So you can imagine I was talking to someone who was seemingly talking to someone else, not me! I have conversations with people via the skype from all parts of the world and we always get a sense of looking at the other person directly, even though they may not be lookign at the lens of the camera but the computer screen. She kept on holding me, as though, ‘below her chin’. People do not understand how much their body chemistry conveys to another!

Secondly, instead of realizing whether this was a real call to communicate her distress, she simply started off, without a prelude or a warning. Even if one goes into the consulting room or home of a person, you may have to wait awhile before you are invited to communicate. In your own anxiety to say whatever you want to, you cannot be unmindful that the other may not be yet ready to hear you out. They also want to be ‘present’ for you, not just physically be there. I was unwell. I told her so. But she did not seem to care- her own distress was paramount. It is all consuming, so much so that it made her ‘berserk’ and possibly a bit selfish too!

Healing is such a complex, multivariate phenomenon and not accomplished by just rattling your story out to someone who is lending their ears. I told her that I work in a three pronged manner- whatever it was I told her. She seemed to not be listening! Can anyone really help such a person? She was in therapy with another young person and had a few (seven-eight!) CBT sessions with her. Am not sure how CBT can work with anyone apart from social anxiety or minor ideas like that. Anxiety or a generalized anxiety disorder or possibly chronic anxiety. Can people understand that the times we live in produce an anxiety in everyone in general? And to deal with it, we have to create meaning in our lives, make connections with the world around and slowly intergrate in the milieu we are in.

Moving from one part of the world to a completely different world is definitely very alarming for anyone, especially in their middle age years. So to work out through that maze one has to be able to put the finger on the right and convergent causes, and not look at the continuity of life experiences on a continuum and catastrophize every experience, because we will have to continuously adjust to life, at every stage, no matter what. Building reserves, resources is very essential.

And equally important it is to go, look for support, identify your support mechanisms and stick to them for awhile. She thought she had a good rapport with the young woman who gave her CBT. When i asked in what manner she benefited, she said it was yet to ‘get over’. Does anyone really benefit from anything if the signs of it do not start showing in the first couple of meetings itself!

Time to move beyond Western models …particularly in Mental health

When western models do not work in the West, to expect that they would work in the non-west is  great ignorance and of course a colonial hangover. The Westerners left, but not before they ensured that the Easterners were so enamored by their culture and civilization that they would forever keep looking at the West for answers to their problems, no matter in what domain. So whatever originates from the West is seen as authentic, more worthwhile and true. That is called colonial hangover and the move to counteract that is post- colonialism, which brings the focus back to one’s own self, via one’s own worldview and not that proffered by the west.

I believe that the poorer nations, who are also in some ways, responsible for the riches of the richer nations, have to craft their own stories, pathways and salvation. Instead we keep looking at the rich nations to resolve problems that were created in the west and then handed out to the rest. Psychiatry is of course, one such dilemma. It was a product of the West, particularly the US and now it dominates the whole scene of mental health in the world. Nobody questions it easily, for the idea does not even occur to most.

However, this western hegemony not only continues in the field of mental health, but also in the field of the non-profits who work in mental health and constantly look at models and support systems from the West to the way to go and on another plane they constantly keep on preaching the same models, another new version of the colonial hangover! The West is a different society, with its own social reality, its affluence and its own structure of society and family. Can we ever learn to go past what the White wo/man is doing, for god sake? Can we ever learn to reclaim our reality and believe that we can offer them solution sometimes and not they all the time?

Time for our own emancipation, our way, our stories, our narratives and our interpretation. Time for the launch of the collaborative therapy. But just before I do that I would like to share with the readers of this blog, a recent paper that I have written in the context of mental health, in which I question the ability of some people to label others as mentally ill. Of course most of my work for now is in the domain of social constructionism, and so is this paper. So here is an excerpt from the paper, which is fully downloadable here-

Power to Label: The Social Construction of Madness

The label of mental illness is a demonizing indictment which gives power to one group [of professionals] over another [patients and caregivers], by way of its ability to pathologize human behavior. What is the basis of this nomenclature and how accurately can it map human distress? Does this categorization serve any purpose besides creating categories that then become ‘treatable’ via pharmaceutical interventions? Does it really end up treating people and help them reclaim their lives in any manner? From a social constructionist perspective this paper offers a critique of the current DSM based knowledge, and questions the hegemony of professionals in dealing with situations beyond their control.

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Empowering everyone- mantra for 2015…onward

I should have written this post longer back, right at the start of the new year. However today is an auspicious day in India and a start can be made right here. This post is about the one significant thing that i have been thinking/planninh for many months in the realm of mental health- the start of a new training program for those having mental illness experiences in their past.

Collaborative Therapy

Of course collaborative therapy is a well honed paradigm of postmodern approaches in family counseling and so forth. I am extending this genre to bring peer support into a more organized format. The basis of this is that experience, research and scores of discussions across the board taught me that counseling, therapy or any form of mediation was really not working with people who were in the profession as ‘professionals’, with degrees the sole arbitrator for the claim. On the other hand I did find that those who had lived perspectives not only made sense to those currently suffering, they could not go beyond offering a little support, which was not tangible, often at considerable personal costs.

So this mode of therapy, that i have been working on myself for the last few years, needs to be shared with others so they can work with further and further people toward helping them deal better with their mental distresses of various sorts. The hope is to train a group between 10-20 in the first batch of learners. It will be across India and anyone is welcome to join from anywhere in the world- there is a course, a method (entailing direct collaborative work to understand how it works), a great amount of writing work, research, study and then reflecting teams- as part of which several people will become part of a learning cohort and after the first year of independent work, everyone will work jointly with one or more others.

Currently I am putting the framework together and I hope to wind that off in a week or so- then comes the time to prepare a syllabus of study- for a two year stretch of time. This blog post is a precursor to the main work that is about to come.

Writing should be meaning making

I have decided to stop all research writing, unless it is really meaning making for many- as a result I am only writing this year what can represent ideas in a serious way- for research has no innate value for me. I have just finished writing a piece about using the arts for mental health and now need to cut it short, to send it to a publication. Plus I have written about the construction of mental illness via the biomedical route and how it is a dominant attribute of medical science that considers itself capable of classifying human suffering as mental illness.

I intend doing a good part of my work in teacher training this year- because my whole focus is preventive mental health for now, and schools are the main site of this intervention. Hope to share more outcomes of that in due course, right on this blog as well, among other things. This is the core mantra for life- and putting this out in the open now onward.