The Piano Teacher

Earlier this week, I called up Hem, who identifies himself as a creative film maker/ recordist (!!) After discussing my recording requirements, which are mostly classical music based stuff, I was generally talking to him about a few other things.

Hem is a south Indian, and lives near my parents’ home in Delhi, a place called Kalkaji. He is trying to set up a studio of his own, which I think finally he has found a place for. When I was here in December from Goa, he and another person, who we will call as R, came to meet me. R has been known to me for the last nearly two decades or possibly a little less than that. I have known him to be a musician of a small order, who has not learnt music thoroughly from anyone, yet by learning to play by himself and by dabbling with his keyboards.

He has often come to me for learning music, but more with the intention of ‘getting things out’ rather than really learning classical music. Surprisingly enough we have never clicked as a teacher-student. He always came, once in a couple of years, bowed at my feet (whcih I always resisted and told me not to) and talked about musical ideas and compositions. He never had it in him to learn music with anyone- he was always in a hurry to ‘encash’ things- quickly learn a raga and show if off to others. Even when I invited him to play with me, as I sang, I did not find him competent enough to, because he would be too restless to hear and start playing as I would start singing.

There are many I know like him- who keep playing tunes on the keyboards and then they figure out full melodies and they become musicians. Nothing wrong with that. They are doing things which they wanted to, by dint of sheer persistence.

best-mobile-piano-ringtones-free-download

So willy nilly, moving in our conversation, Hem informed me that R is ‘out of the market’. I heard him and did not pay heed. He repeated it for me again. I thought ‘what a strange thing to say’. So I asked him what he meant. He repeated himself and said that R was in jail, for the next ten years at that. Oh! I thought, now what was that about.

And then it struck me that I had read about it in the Hindu paper, that  a piano teacher being caught abusing his student in Kalkaji. I asked Hem if he was talking of that incident. At that moment when I read about it, I thought of R- what a coincidence. I of course was not thinking of him as an abuser, but I just thought that he was the only piano teacher that I knew of in Kalkaji. But then I consoled myself thinking that hopefully there would be others, and it is not him. Now what Hem was telling me confirmed that indeed it was R!

It is sad. The world of Hindustani music is rife with teacher-student abuse, which has stifled many a career and many a relationship. ( There have been instances when teachers have married their students, but that is not an instance of abuse) But a man in his forties abusing or exploiting a child. I do not know how quickly the prosecution worked but they gave him ten years in jail. I thought for a moment, what would happen to him after those ten years and what about his family?

And then what about the child who suffered? What would be the consequences of this on her? And what if there would be more children, who could not raise their voices against him? Would there be someone to support her traumatic experience? I am sure it would have taken a lot for her to express her suffering.

The sad thing is that when people known to you do anything, your faith in humanity is shaken for a moemnt and then the whole anger which each of us has against the systemic abuse- finds a target. I feel no sympathy for R. In fact, I feel more for his wife and family. What a suffering they would have to go through socially. Like we always say, letting go of every abuser only emboldens them further- it is about time some were punished. Even if those some be people of our own associations and families. It is about time.

Here is a related post about the same incident, on another blog.

 

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

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

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

John Nash

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

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

Family and schizophrenia

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

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

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

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

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

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

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

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

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

Caregivers can change outcomes in mental illnesses

Having seen the outcomes of many recovery stories and even non-recovery ones, the one thing that becomes clear is that if assisted positively and non-intrusively, many people can recover even from serious mental illnesses.

So why does it not happen more often? The one likely thing that comes to mind is that mental illness triggers off due to some contribution from the family environments- like it or not. Perhaps this is the most difficult idea to digest.  But if we can stomach it, and be willing to reflect upon what they could have done or wrongly so, then many things can change.

With this in mind, I work in therapy with people- I mean families, and with the same idea, I decided I ought to reach out to a wider number of people. But instead of choosing to keep the knowledge offered as part of the course, only a function of my own knowledge, why not spread the net wider and bring in many others, who have been working in mental health with a similar or same commitment as me, and trying to diminish the burden of human suffering, wherever possible.

With this idea as a background I decided to do two things- first of all create a framework of ideas and then a resource base of ‘experts’. Honestly speaking, perhaps neither of these ‘experts’ would claim themselves to be as such, and this is not to judge their knowledge and represent it in the same way as the positivist tradition does- for measuring expertise by degrees and professions. My only basis for classifying them as ‘experts’ is the number of years they have been working in the field and the orientation they carry- recovery and rehabilitation from mental illnesses.

As yet this orientation has not gained salience in India, unlike some Western countries- and therefore these people have not been seen as such either. But I hope with this course now in the public domain, more people will recognize the reality that mental illnesses can be a thing of the past, if more people take heart, families change their attitudes and supportive behaviours. This is one of the key advantages of being in relatively poorer countries- that our family systems are quite intact. So why not assist them in augmenting what is already present, rather than aping Western models and walk towards our own annihilation via their pharma enterprises.

Here is the first Caregivers’ Online Course, that I have been referring to as part of this blog post. And I feel relieved at last to have come to this clearing- there is so much water under the bridge, from making the website, to getting the experts to collaborate, structure, and now the next challenge- to ensure its viability and efficacy.

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.

Help Seeking Behaviour

Just look at the picture that is part of this post- there is a prayer on in someone’s compound, in front of their home. Many people are there- family, friends, neighbours and so forth. These things happen commonly all around the world- people come together for shared occasions, and help one another, organize a whole lot of activities in their homes. Nobody does anything alone. It is a circle of help and everyone helps everyone else- even a small help like informing everyone in the neighbourhood is help for the family that is organizing a prayer meeting of this nature.2014 002

Help Seeking Behaviour

I am trying to illustrate something about help seeking behaviour here- which I intend illustrating with examples from my personal experiences. Help seeking behaviour is considered an important attribute in psychology because it is a form of behaviour which is part of the social nature of a human. Man is not an island so whatever we do, we require other humans around us. Illness is a particularly difficult case because during illness the ability of a person is reduced by a significant amount to do what they would have been able to, had they not been ill. In that case help seeking is even more important.

But often I have noticed people do not seek help- out of shyness, out of a sense of dejection, rejection, hopelessness, helplessness, depression, immaturity or inflated ego. This is the greatest ignorance in my estimation. Or even if they ask for help, they do not want to follow what the other person is saying- they ask for help half-heartedly and even if someone offers suggestions, based on prior experience or knowledge, they are doubtful and suspicious about it.  I also find that people who have a mental illness diagnosis are the most reluctant to take or ask for help. I am going to illustrate this with a few examples.

I received the following letter from a (worried) parent-

Dear  mam,
I came to about u frm …Really hats up for the cause u r helping.Really many are ignorant about the remedies of mental illness.
My daughter, who  is B.tech. and serving in an IT co[mpan]y in …In Sept.`13 it started.Her frnds informed us as we are frm …Immediately i rushed and took her in spite of her unwillingness.She was diagnised as  suffering frm Shizophernia.Then i took her to Mumbai and now she has been under the treatment of …She is taking
one …and one …She is our only child .She was on leave for 6 months.After that i left my job and since her joining i`m staying with her.She is 26 yrs old.So we are searching for her marriage after consultation with Dr. Dr.is telling to stop above medicines after her marriage.But i`m apprehensive if after stopping medicine will she be able to be ok?If not it may affect her mrrg.
Can u guide stopping medicine after mrrg is acceptable?Is there any herbal treatment which i can start before mrrg discontinuing above med.She has become very slow.She is working out and doing yoga.
Can u help a helpless father .Is there any NGO in …on the similar line of activity ,who can guide us .I also want to consult Dr in … without going to Mumbai cause it`s too costly.But effectiveness can`t be comprosied.
I know u must be  very busy. Plz reply to help.

I wrote back the following-

Dear Mr. S
 
I am really happy that your daughter is very young- so she can be totally well and recovered and likely she does not need any medication. So if the doctor is saying so, believe it- often they give medicine as a precaution and then they see it is not required in the least…but do not want to admit that they made a mistake.
 
If you like to talk to me, please feel free to call me. The most important thing is to offer her counseling and strength to deal with day-to-day life issues, as a result she will be just fine. And in any case the single most important thing is there in your case, your commitment to your daughter’s welfare. Let me talk to both you and your daughter and if need be, I do not mind counseling her as well. Once i talk to her, i will know the truth very quickly- about what the root of the ‘illness’ is or was.
Sometimes young people, in particular, women suffer due to setbacks in matters of the heart, or an experience of being raped, molested, incest or a boss who is misbehaving but they do not have the ego strength to deal with it. I find that due to mobility and education though a lot of young women are there as part of the labour force they are quite emotionally, physically, sexually, and spiritually weak and vulnerable. Their milieu does not permit them any scope for mental growth, though they acquire degrees to fit professional roles.
As a result without a mind which is developed and matured commensurate with age, they just move from one stage to another and when any real challenge of life appears at any stage, they are simply not ready to handle it. This happens due to both marriage, as well as mobility into jobs and for jobs, to new places which may make them move away from the protective yolk of family support. This produces distress of various sorts, and they run to ‘professionals’ of various hues and shades. Now what can so-called professionals do? They have been through [seemingly organized and] long courses of understanding human suffering and putting medical labels on them. They identify a little cluster of symptoms and classify it as a mental illness, without telling anyone how they arrive at that classification.
Parents and families are so baffled by the medical terminology, facades and authoritativeness that they believe doctors are messiahs and they know everything. If only doctors knew the way out of mental illness, many millions of people would have recovered and got well- the way they do in Finland, where they emptied out psychiatric wards because of the sort of communications they had with the people and families.

Again the gentleman of the above communication, wrote the following-

Thanks for your quick response to my mail.I`m happy that you have agreed to counsel her as well as me.
Will u plz tell your suitable time(Indian time) for talk. Latest development , which has made the matter more
serious that yesterday my daughter`s manager  called her and told that she is under tremendous pressure
from the H.R.Deptt. to terminate her.Her manager has been kind enough to tell HR to give 3 months time 
for improvement.She has become very slow.
I had a feeling that her pathology was coming from her work environment somewhere and sure enough the evidence is there already. It may not be that this person calls up because sometimes, in India I find that people feel more comfortable talking face-to-face rather than long distance, without realizing that the best fit for you or the person who can really understand your case, is not always going to be the one next door. the whole reason that I encourage everyone to use modern technology, particularly the phone and internet to bridge distance of time and geography is to find the best matches spiritually and emotionally among professionals who can deal with your story, without affirming what another (psychiatrist) is saying.
This brings to mind the case of another young woman who called me  and said that she suffered from schizophrenia for the last 25 years! I asked her what medicines she took for it, and what the rest of the story was. In the first communication itself I told her we could draw a plan for her recovery and rehabilitation. She is an engineer, single woman, lives alone has several co-morbid conditions and whatnot. The only kin is a sister who lives faraway. She asked me if she could get well.
I always believe that people who seek solutions find one, so I see no reason she would not recover, because she wants to recover.- However, to seek solutions just within yourself is the greatest foolishness. We are social beings, we have to rely on our communications and our potentials for learning that come from our social milieu. Of course one can always run into those fair-minded professionals who do not view you from the lens of your pathology, but want to know what happened in your life, in your past, in your office, in your home, your childhood and whatnot. How people underestimate the power of communication- the only road that really relieves you of all the soul burden you carry. That is why as I put my enterprise on track, I have created a communications based one- Here is the website getting ready.
And I know that those who land up talking to me have really been the full course [of being treated by doctors and counseled by psychologists in many cases too] before they knock at my doors and they soon know the difference. I never coerce or even ask anyone to [even] pay, for often I understand that people cannot. Let them pay out of their own conscience if they feel they have benefited. The above woman (25 years case story) asked me how much I needed to be paid. I just told her, since she is not earning anything yet, we can always defer this. For me it is more important that she reclaims her life. Money that is mine will always come to me, in its own time. But let people live fully in the present- this is my offering to them.
This makes me want to share a little from a letter from another person who I collaborate with via our dialogues from England. He said, Suffice to say i though today’s session was a success. One of the parts that stuck in my mind was that I may be able to streamline my life and focus my interests on some productive areas. After I got off Skype I removed the huge piles of books that have been building around my flat and shelved them. Its not to say that I won’t look at them, I’m still fascinated by foriegn languages but I think I need to get things in their proper place. Later this evening I went out to the supermarket and instead of feeling stressed and anxious I felt calm and clear. I feel I need to discuss with you how and what I am able to pay you. Its hard to say at this stage (early days) but I think this may be just what I need. 
We all get what we want…provided we are looking for it- even the right therapist or collaborator. So why not learn to ask for the right person in the first place?
And then develop the mind to recognize them, for who knows in what form they could materialize? Na jaane kis roop mein narayan mil jaayein. (who knows in what form I may find god/what I am looking for)

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.