a recent interview

 

Money is something that one can Make or Ignore!

From Jansons School of Business (Autonomous)

Domain (The Journal of Management Research)                   Vol: 11 ~ Issue:1    Jan-Dec 2018

An interview with Dr. R.K. Rudhran

Consultant Psychiatrist with more than thirty years of experience.His forte is clinical psychiatry with emphasis on precise diagnosis and eclectic intervention strategies. He is the pioneer in using Drama Therapy in India. He is an artist, sculptor, poet, bilingual orator, writer & director of 12 stage plays which include adaptations of Kafka, Tamil versions of Sophocles and Shakespeare. He is the author of 14 books on Psychiatry, Philosophy and Theatre

 

 

“The moon has aged too, and became no more the romantic muse of adolescent attempts at poetry. My hair turns whiter every day, while my mind delves into days and dreams that I lived in my younger and younger days.”     -Rudhran

 

 

A Glimpse of My Younger Days:

From a childhood peppered with Perry Mason books, and the afterschool bus stand in front of the High Court in Chennai, came the initial wish to become a lawyer. Though my mother wanted me to become a doctor, the family background was simply a dampener to her dreams, and it was just good marks that put me in the great grounds of the Madras Medical College. After a tumultuous MBBS in which my rebellious nature and an inflated self-esteem based on self-belief, posed conflicts and problems with examiners, I finally started a modest general medical practice.

As luck would have it, I was quickly blessed with a fairly good number of patients and soon was busy throughout my clinic timings. I had managed even to save a decent amount in my first two years and it was then that I decided I would produce my stage play. I chose Apitha by LaSaRa, a novelette written almost in a stream of consciousness style. Scripted it for stage and even convinced the eminent musician M.B. Srinivasan to score and give me recorded music for the play. The play bombed. I did not have money to start another venture. The play also reduced my practice as I had taken off on many days to oversee rehearsals. I began to feel the economic pinch again in my life.

In my teens, in the early years of my MBBS, my family plunged so much into a financial pit that there were times when I would surreptiously peep into the kitchen and if the stove and the vessels were barren, would declare I am going out, and going out I looked and found many odd jobs – painting wall advertisements, working in a printing press and at times painting and selling my paintings in a store.

Psychiatry & Drama:

Through my teens, art and literature were my most trusted companions in moments of poverty’s pain, boredom and lonely contemplations. Psychology was naturally an allied interest and then I read Irving Stone’s ‘Passions of the Mind’. Psychiatry became my choice of specialization not just inspired by Freud, but also because it was a challenge- not the intrinsic clinical challenge of the specialty, but the huge challenge it faced with the still-present stigma and the abounding myths and misconceptions regarding the field amidst the public.

Theatre sparked my smothered embers and though there was no money to produce plays, I kept reading and creating characters and their dialogues in my mind. This led to trying to fathom their psyche, and like all I imagined that psychological medicine would be the best avenue for me to travel in the future.

Reading & Writing:

Post-graduation in Psychiatry had all the text books that mattered in psychology to be read, but the focus was on the clinical and medical part of psychology. I still remember the day when I almost thought a deluded paranoid person was speaking the truth and wanted the family to be reported! Within a few months of clinical psychiatry exposure, I fell in love with the subject. I did not need a stethoscope or an ophthalmoscope, I did not even need to do an X-ray investigation; all I needed was my mouth to ask and my brain to interpret. I felt relieved that I would not need much of an investment when I start my psychiatric practice!

I keep reading. When my reading becomes stalled and I find it laborious to go through words that are really worth reading, I resort to reading crime thrillers- finding clues before the author discloses them is as intriguing as listening to a patient tell his complaints and his story and seeing through the layers of defense that always dominate a psychiatric narration.

I keep painting and drawing though not for money anymore. With advent of digital art, it has become a daily ritual for me to sit in front of the monitor and let the mouse wander with colours. I keep writing, and the number of unfinished books may someday create a record!

Family Support:

My family was extremely supportive of whatever I did, because they were never given a chance to be otherwise! But, they were supportive in the sense that whatever I do they would try to engage themselves in a discussion with me, and those conversations were never to dissuade me though would always be cautioning me.

What motivates me?

My ‘self’. I love painting, I like writing and I live every moment I sit in my clinic. Only when there are no patients for me to see or when I am incapacitated physically to see any more patients will life cease to mean anything for me.

Why this passion? Though it started with an inquisitive thrill-seeking clamour, it has made me feel fulfilled. The smile I see when someone is told the treatment is over, the wet eyes that thank me for their recovery, the small presents (like home-grown vegetables) that those who are treated free come and give me, the moment when the day’s work is over in my clinic and I leave the room with a glad heart, are the ‘lub’ and ‘dub’ of my heart, to keep me alive and eager for the next working day.

My take on Failures:

Oh yes! I have faced failures -failures that follies always beckon. Ambitiously just four years after my psychiatric qualification, I started a nursing home, with a heavy bank loan. I had enough patients to fill all the beds, but the patients did not have money to pay me! Loan strangled me and at the same time newer medicines came into practice greatly reducing the need for admissions. I closed the nursing home with a tremendous loss. Had I been compromising on the ethics of my profession I may have escaped the loss but would have lost my face in front of my morning mirror.

Even in MBBS I faced failures in exams, never for not studying, but for not behaving properly, and the same continued in post-graduation too! Every time I fail, I think back and see if I would have done anything differently and till date the answer has always been ‘NO’.

My failures did not dent me; they cautioned me and made my vision deeper and sharper. I may still start something totally unnecessary in this stage of life, and I may mostly fail as I may not have the vigour and vitality needed, but I will not take that failure to the grave, rather, I would evaluate it and perhaps smile- as I can economically take some failures now.

My failures have always been economical rather than emotional and money is something that one can make or ignore.

My definition of Success:

Success to me is the smile I have when I look into the mirror and reflect on yesterday. That smile makes the beginning of every today a spark that would ignite a potent success. Success to me, is the feeling of contentment that comes with a job well done without compromise.

The One Big Lesson that Life has taught me:

Heraclitus has time and again proven to me that change is the only constant in life and life has proven again and again to me that I cannot step into the same river again. Time flows on and on giving a fleeting illusion that things are the same, and if this illusion were to determine your thought and action, you would step into the river of life and find it is not the same, and if diligent you might understand it can never be the same.

Every time I had a fall, I have risen, bouncing back like a rubber ball that is hit hard on the ground. There are times when I have risen to greater heights and times when I had to roll over as inept.

Life has taught me to not think back.

Many days and hours have been spent on unproductive ruminations of the past. Recalling glorious victories is as useless as sulking about disastrous failures.

Life has taught me to make the most of every moment.

Life has taught me to ‘see’ people – sometimes I see through them, sometimes I see beyond them and sometimes I see myself in them. Seeing is all that matters to live. Seeing is understanding and applying that understanding in the thought process.

Life has taught me to become more stoic when being epicurean was my desire.

Over the years I have learnt that like happiness, sadness is also fleeting. While the cup of joy never remains full so too is the cup of sorrow.

Life has taught me to live.

My Philosophy of Work

•  My work is my meditation.        When I sit in my clinic, when I write and when I paint, none of the worries that normally fleet and cloud my empty hours would interfere. I would be focused and relaxed. That meditative state makes me comeback for more and more.
•   If your work becomes your meditation, your success would become your enlightenment.

maladies of the mind..

“The lover, lunatic and the poet are all of imagination compact”, remarked the Bard, perhaps signalling that all of them have intense emotional experiences, which we all do have. The term lunatic, inappropriate in all times is invalid now, and mental illness is the description that has replaced it. Mental illness is not just about emotions and their intensity or lack of it, it is an umbrella under which many maladies are contained. Even for this googling generation, almost all mental illnesses are conveniently or comfortably labelled as depression. Depression is just one of the many mental illnesses that affect humans.

Depression though a very commonly used, and rather misused term ( as many use it to call from degenerative brain pathology, technically called Dementia to simple difficulties in social functioning, as in personality disorders), is not just one type. We have all experienced losses and failures and felt low, sad and even at times despondent because of those events. This is called secondary depression. It is a reaction to an unpleasant event in life. Generally this would pass off in time and we would get back to our social and functional adequacy.  And then, there is another one called Major or Primary Depression.

Major Depression is not event related. It can strike anyone anytime, as it is a disorder of neurochemical transmission. Though there are some factors like hypothyroidism, diabetes, certain medications, and some genetic factors that can predispose one to a Major Depressive Disorder, it is essentially a biochemical disturbance that can only be treated with medication. In the currently raging fad that makes people shrug at the very mention of a prescription, MDD is a ripe field for quacks and fakes to swindle people and waste their time in getting early and proper treatment. On this, we shall see later.

What happens when MDD strikes? The person loses sleep to begin with, and gradually loses interest in all that he was involved passionately earlier. It mars his concentration, reduces his functional competency, makes him see the world dark, pushes him into a self- withdrawal, refuses him to take care of himself, and this ‘darkness visible’, can at times push him into a suicidal rumination and attempt. Depression can be considered as a serious emergency because of its potential life-taking possibility.

MDD apart, mood dysregulation can also manifest as a BI-POLAR disorder in which a person alternatively exhibits severe depressive sadness and switches imperceptibly into a ‘manic’ phase that is marked by incongruent elation and disturbing exuberance. This shifting mood makes not just the person unpredictable but also his relationships vulnerable. This again is a major mental illness and can be treated only with medication.

Mood apart, thought is what makes a man function- personally and socially. A severe form of thought disorder in which even perceptions get disarrayed is called SCHIZOPHRENIA. This is a very severe mental illness and it affects all social classes, both sexes, beyond religious and national boundaries in the age group 15 to 45. Unless detected and treated early, schizophrenia can devastate an individual’s life. This again is a neurochemical dysfunction coupled perhaps with a genetic transmission. This is one mental illness that is most researched and even now is the focus of scientific psychiatric investigation. Medication alone can handle this malady.

Schizophrenia is characterised by again loss of sleep and withdrawal in the beginning. But as time passes the individual loses focus in almost everything and is seen going further into himself. Though the affected alone can hear voices talking to him, threatening him and commenting on him, the outsider can still identify this symptom of ‘voices’. The patient would start muttering to self, not like what we all do when stressed or rehearsing for a stressful event, but muttering and alternatively appearing to listen as though he is in a conversation with a non-existent being. Besides hearing voices and responding to them orally or at time by acting out the ‘received ‘commands, schizophrenia is also characterised by delusions. These false beliefs are not induced as in the religious charlatans ‘money making mockery of the public. These delusions are baseless convictions in which even an innocent child can appear as a sinister evil conspiring and planning to harm the patient. These paranoid delusions are very common in schizophrenia. Again, it has to be reiterated that only medication can help these suffering individuals, because of the increasing popularity of  the stylish fad  wondering whether counselling alone would not suffice as therapy. You cannot counsel a schizophrenic patient, because he does not have insight- the reasoning of reality that makes him accept that he is sick. His hallucinatory voices and delusional convictions are unshaken in any conversation that tries logical reasoning. Unless the neurochemical balance is corrected, he will not listen, and therefore not understand.

Another important and common psychiatric illness is Obsessive Compulsive Disorder. Unlike in schizophrenia here the affected person is aware of his problems but absolutely incapable of doing anything to come out of it. OCD is again not a rare illness. It can be seen even in literary descriptions, like the Lady Macbeth lamenting on the inadequacy of all the perfumes of Arabia to wash her stain. OCD is characterised by repetitive actions done consciously but without voluntary control. Unless a specific number of times an act is done the individual becomes stressed and distressed very much. There are tow types of OCD symptoms one is repetitive cleaning and the other repetitive checking. A variant of these two would be repetitive acts that may be guffawed away as quirks or habits. We check because we are scared, we clean because something is dirty. Fear and shame are the underlying emotional disturbances in OCD. Regarding OCD, certainly medication is the first line of treatment. But since the individual can listen to sense and comply with therapeutic instructions, some behavioural modification techniques when taught alongside the prescription would help in recovery.

Now to come to minor mental illnesses, one can see the entire human emotional and social spectrum. From simple anxiety which we all experience and conveniently describe as non-existent butterflies in the stomach, to severe panic in which we cannot get into a lift or even close the toilet door when we have to use the restroom, there are a wide range of problems. Most of them are self-remitting, that is short lived and event related. Some like Phobia persist and do not go away even with total insight and high level intellectual capability.

Dependency on drugs or people can also be a psychiatric problem to be addressed. Addiction is another area of mental illness. Besides these, mental retardation, dementia, personality disorders, relationship  problems, learning difficulties and many more come under the group called psychiatric illnesses. Even the problem encountered by many doctors who are frustrated explaining to their patient that there is no physical problems, but find them coming again and again- the problem of what was once called hypochondriasis is a psychiatric illness. A once popular word, another misnomer that is still in usage- ‘hysteria ‘is also a mental illness.

Hysteria was named thus as the Greeks believed that the uterus of the woman was moving all over her inside and making her do bizarre things. This is now described under two types. One is conversion’- where one converts a psychological problem into a physical one. A common example would be having a headache when one is angry and unwilling to go to bed with partner. The other is ‘dissociation’- where the individual dis- associates from reality to escape stress or seek attention. This is commonly manifested in our country as ‘possession’- by a God or an Evil spirit, according to their cultural milieu. Here the individual though initially behaves involuntarily, at some time enjoys the attention he or she gets and goes on to exhibit the behaviour as and when time permits and need arises.

This is a very, very brief outline of mental illnesses. This may not help you to understand them all. But to identify any mental illness look out for- 1) sleep disturbance, 2)lack of focus in work, conversation and self-care 3) unusual and inappropriate speech or behaviour even if it is only for a brief period, 4) emotional imbalance of inappropriately extreme sadness or elation, 5) a gradual decline in occupational, social and interpersonal spheres of life. If you notice these take the individual to a doctor. Don’t Google and conclude, don’t get swayed by the promises of quacks, don’t ask the opinion of every non-medical person ranging from your auto-rickshaw driver to your jobless neighbour. Mental illness is treatable and in many cases curable. Help them to get their life back.

This was written for ‘THE WEEK’ mental health special issue October 10, 2015 (http://specials.manoramaonline.com/THEWEEK/2015/Mental-Health/experts/various-mind-disorders-symptoms-therapies/index.html)