Archive for the ‘written for a magazine’ category

maladies of the mind..

October 9, 2015

“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 (


happiness and emotional equations

June 8, 2009

***while browsing through my own blogs, a vanity that is yet to vanish from me, i came across this blog which i had accidentally termed private in september 2008, and since there is no time related topicality for this subject i am posting or rather republishing this.***

Relationships and reactions formulate the emotional equations that determine the success of life. Life’s success is not necessarily a sum total of successes one has enjoyed in one’s lifetime. Success, as a synonym for happiness, is the pursuit of life. Persistence and diligence alone make this pursuit worthwhile, and only worthy pursuits win worthy prizes. Life’s success is always determined by its diligence in pursuing happiness.

Encountering moments that appear to pose intense difficulty or danger are not uncommon in life. These moments of crises need not necessarily be catastrophical. They can be simple everyday occurrences that challenge the mind. One need not keep reading Sun Tzu’s Art of War to understand how to manage resources and win challenges. The mind has its own repertoire of management tools, keeps learning and updating its self-management skills and handles moments without even bringing the process to the notice of consciousness. When a crisis happens or a challenge appears, the mind is always ready with all its options- to run, to charge or to surrender. The mind always knows what it is going to do, yet the consciousness called intellect, questions the questions and makes the process sometimes difficult and sometimes painful. These painful difficulties are translated as emotions and cause discomfort, and on many occasions are the reason why the sweetest success would taste bland.

To enjoy life one has to just listen to one’s own mind, for the mind is programmed to produce and savour happiness all the time. Pain teaches caution, and caution shrouds the instinct. In the vicious cycle that follows, instinct appears again and again on the terrain of mindscape only to be driven away by fears, doubts and hopes. Hesitations and confusions prevail. Anxiety becomes the undercurrent of all actions. Problems appear magnified to the mind and solutions disappear into the distance of time. Difficulties become crises.

Life can be happy only if the question, `what is happiness?’ is answered. Questions form the mind’s most beautiful self-regulatory mechanism. If some questions are perceived by the mind as obstacles in attaining happiness, the mind keeps those questions hidden in its remote corner. If some questions are going to enhance its own functioning, then the mind permits them to surface on the conscious intellect and seek answers. It is only when the mind is ready that answers become meaningful. Emotional equations are formed by proper questions that bring forth the right answers. The right and wrong of this internal question is not a socially sanctioned description but the instinctual vision in darkness. The right answer enhances an evolution in thought and maturity of thought translates itself into dignified action. Emotions do not cloud the internal vision anymore. It is into this state of equanimity that the mind’s seed awaits to blossom.

Life’s equation of satisfaction depends on understanding the Question of happiness, the Economics of happiness, the Management of happiness and Evaluation of emotions in happiness.

Happiness is one of the most loosely applied words in description. Often the user means that he is glad while some times the user may use it to complement a social etiquette. Real happiness is one in which the mind feels full, the memories retain the flavour for future and the moment seems to expand into eternity. The religious and metaphysically inclined may use it in derogatory or exultatory tone depending on their avowed principles.

Happiness however is, to most of us, a moment’s fulfilment of desire and the happy ending to a sequel of hardships. When we achieve a trophy, a victory or even the acknowledging glance from the person we desire, we do feel happy. Happiness and joy are often used synonymously. Joy is generally within the context of a limited period. (That is, we enjoy a nice drink. But the joy does not permeate into the remaining part of the day). Happiness however, being the result of the toil of the past and holding the promise of finer things to continue, is considered to be longer lasting. If you believe that you are happy it simply means that your every moment( in whatever context that declaration was made) brings joy. If however you say, out of a social obligation or a personal convenience, that you are happy, it implies that you refuse to face reality.

What does constitute happiness? The beauty of happiness is that it moves on and with time, to give us different views of its perspectives. The happiness of a kiss from the mother and the happiness of a kiss from the beloved are different frames in the same film of life. Age, social milieu, emotional state- all contribute towards defining and experiencing happiness. Unless one has reached the final stages of psychosocial development described by Maslow, happiness keeps changing its hues and tones. When one has reached the point of self-actualization, the concept as well as the pursuit of happiness become singularly focused and clearly defined. But then, those blessed or fortunate or deserving ones are far too few. We, engaged in the possibly semantic ritual of exploring and explaining happiness have to find lesser idioms to move on.

Though the wise would unanimously declare that happiness is not based on economic considerations, our present life does need to know the economics of happiness. To be economical need not necessarily mean to be frugal, but affordability should never be an avenue for indulgence. That is, if I can afford a thousand rupees book and the same is available in another low priced ( not low quality) edition, vanity should not lead me into purchasing the costlier edition. This is not a moral sense but a practical sense. Accumulation of buying power is not a guarantee for happiness, it is the sensible way of utilizing resources that would bring happiness. It is invariably the tendency of the human mind to mistake attractiveness for value. Attraction is external, value is internal. Poetry always lies in the inherent t meanings than in the rhapsody of rhetoric. Sensible spending of time and effort (in thought and action) would ensure an easier path in the journey towards happiness wherein extravagance  would at the least be redundant and at the worst agonizing.

Once the resources are assessed and the target defined, management is a process that would ensure success. Management is not just achieving the target but maintaining the position while constantly cushioning for expansion. Regarding happiness, management is in regulating emotions while becoming aware of social and personal situations. To remain happy is also an effort. It involves recruiting (evolved thoughts) and dismissing (useless emotions).

“Pain is pleasure, pleasure vain -when you pursue what is vain” remarked the poet.

Emotions are the fingers of the present that play tunes of future on the keyboard of past. To remain surrounded by the sound of music, the muse of happiness and peace, one has to become aware of emotions. Awareness will help to regulate (not control) emotions. Though being happy is described as an  individual or primary emotional state in Natyasastra and Tholkappiam, (the two great indian treatises that described emotions much before the texts that proliferate the present bookshelves), it is strangely interdependent on other emotional states like anger and sadness. There are indeed some times when we may feel happy as an after-thought that we were angry or sad about a particular person or situation. To achieve, retain and enrich happiness, we have to have a control over emotions.

Wondrous moments have been spoiled for millions every day just because their emotions clouded their perceptive faculty. Instinct is always pleasure oriented  (even the avoidance of pain is a pursuit of pleasure). But, instinct is often clouded by the intellect. The intellect is a sum total of experiences recorded by emotions. Happiness depends on our emotional equations. When we negate and when we acquiesce the lessons taught by emotions, the intellect becomes capable of managing life better. Intellect and instinct when operating in synchronicity, foretell only happiness – the poise of equanimity that remains only to grow.

this again was written in 2006 for a magazine in chennai, and reading it again i wonder if i can add more to happiness!

incapacity in melancholy

October 13, 2008

If sadness were to always follow stress and strain, and invariably precede by failure, what is the emotional capacity of the mind, that is, how much can it take? If an athlete can train her/his body to perform more and sustain more than fellow humans, can there be a way to make the mind more capable of dealing with emotional drain? Why are there so many questions when there are always so few answers? To protect oneself one has to be aware of what can hurt. Unless the arrow is identified the amour cannot be designed.

What does hurt the mind? It is always a failure or sometimes even the fear of a failure! Failure is perceived or anticipated incapacity to meet the needs of one’s economy or emotions. This logically dissolves into the rhetoric whether emotional equilibrium is suffice to satiate needs that always have a definitive monetary price tag, and would economic freedom to indulge in exuberance would gratify the demands and desires of emotions!

What would a better state of living be? To begin with let us explore the economic well being which many feel can easily be assessed, defined and successfully accomplished. In the words of Gibbons, the definitive authority on the rise and fall of a culturally rich extravaganza, the answer is interesting, and can perhaps be applied at all times, in and for all times. He said,”According to the scales of Switzerland, I am a rich man; and I am indeed rich, since my income is superior to my expense, and my expense is equal to my wishes.” How wondrous would it be even to dream of this state; but then to be rich, or even assume to satisfy one that the self is rich, is not a guarantee for a life free of stress.

The rich and the poor have an equal amount of tears stored in their eyes; the mind just opens these reservoirs when emotional stress threatens to break the dam of security. So, is emotional stress more difficult to cope with than economic stress? Perhaps yes, depending on one’s capacity to cope with either hunger or humiliation. If the hunger of pride can be suppressed, if the humiliation of hunger can be ignored, if the tenacity of temptation be shelved and if one can just be oneself, well, life can be without stress. Let us therefore define stress to understand, interpret and devise strategies to counter its influence on well-being.

STRESS is and can actually be either EUSTRESS or DISTRESS. (In a lighter but still angrier vein, I do recollect an ill-meaning person saying that the third form of stress was mistress!!). Over the years, just as how good words have become bad, and bad become good, unfortunately unknown to the moralists of modern Tamilnadu, (and here I mean both the protagonists and the antagonists of the shameful farce enacted in the tragic-comedy with a three letter title), the word stress has become associated with its sub-division distress, and eustress is ignored.

Even if we were to follow the last sheep in the line and accept stress as meaning distress, it would help to know the different types of distress. To begin with, let us enlist the types of stress (henceforth synonymous in this article with distress).

There are different types of stress!

  • Disabling stress
  • Disintegrating stress
  • Desired stress
  • Deliberate stress
  • Dazed stress, and,
  • Divine/irrational/incomprehensible fatality masquerading as stress.

It may perhaps help to facilitate the faculties of the mind of the distant yet endangered reader, to comprehend each of these, however concisely compressed this composition be.

Disabling stress:

In these cases, one becomes incapacitated in the present so much that the future goes bleaker and blank. The situations vary with age. In adolescence, a rejected poetic attempt can trigger an inability to do erstwhile capable tasks, and, with physiology partially inclined towards male exhibitionism, beards grow and cigarettes flout in public! At times, if the ladies who perchance read worry, these beards are substituted by neglect of self-care. If one cannot groom self, one cannot speak as usual, smile/frown/be even silent as usual, it may be deterioration. In the adolescent age ( unlike those ages- in terms of years -that it had been synonymous with the teen age of yester-years, it has been declared by the WHO as the age between 12 and 19 (?!!) , love is the incapacitating factor, often misinterpreted as the yearning of the biological leaning towards gratification from the opposite. As one grows older (not necessarily wiser) disability is directly proportional to the decline and disappointments of a Maslowian definition. Maslow was, (for the uninitiated, the ‘guru’ who said man (or human!) needs to satisfy needs primarily to move on in life; his needs in order were, physical, emotional, functional, and social and finally – in a way, spiritual)…joseph campbell diagress with this, and I agree with him

Disintegration was once called `hysteria’. The term became obsolete when people discovered that hysterus referred to the uterus, and it was not responsible for mental afflictions. Possession et al came in this category.

And then, we come to the interesting categories. Can stress ever be desired? Can it be a by-product of bedazzlement? Can on the contrary, it ever be a deliberation? All these questions are answered yes because of the next question. Can there be a stress because of

divine/irrational/incomprehensible fatality masquerading as stress? The answer is simple!

The mask, however minutely designed to masquerade, can never be the real face; so too with stress. Imaginations abound in stress because many think they formulate a refuge. On the contrary ( please think again, can any escape be an acquittal?), all attempts to fool future fall back and one is left to fume about the past while the present falls lower and lower with the clock’s second ( or is it third!?) hand.


Let us face reality. Money buys comforts. Comforts are bought by dreams. Dreams are designed by learning. Learning, if ever faulty, will give the wrong answer. Wrong answers fail. Failure saddens. Sadness is therefore avoidable!

Understand emotions, apply judicial introspection, arrive at conclusion, test it out and finally arrive – to draw a blue-print and build a future!

A hand is needed not just to lift the fallen from a pit, but often to support the trudge uphill. It can be your own hand if you have the courage and desire to climb out of a pit.

written in 2005


September 25, 2008

“I wish I were jealous- of myself,” remarked a poet, apparently aghast at his felt incompetence. He may have been depressed at the time, feeling that his vocabulary bank was drying up or he may have been simply suffering from an inferiority complex comparing and thereafter feeling incompetent to rub shoulders with Homer or Goethe. He could just have begun his trip on jealousy.

Jealousy is not the exclusive domain of poets and artists. All of us have experienced jealousy. Though it is not principally categorized as an emotion, jealousy is a feeling that evokes strong emotions. Every human being has been jealous. Winged birds and their flights beyond visual boundaries evoked jealousy, and the zealous human invented the air-plane. The jealous do sometimes channelize their energy into creativity; but, more often than not, the jealous get crushed under the weight of their own desires.

Jealousy snarls at the mind only when there is a comparison; a comparison that is clouded by a wish; a wish that reminds one of one’s own inadequacy or another’s supremacy. There have been innumerable words written on the difference between jealousy and envy. Though being envious is considered a destructive mind set, jealousy has its word origin in a positive feeling – zeal and the desire to emulate. In the Shakespearean tragedy was Othello jealous and was Iago envious? Who was destructive? Is destruction only external? If envy is the fire that is lit to burn down another’s palace, jealousy is a flame that can gut down one’s own hut.

Though, from time immemorial, moralistic ethical teachings have advised humans to avoid jealousy, it has survived and even thrived. In modern times, jealousy is actually promoted. Every advertisement sells an idea that makes you zealous to ‘earn’ that commodity. Earnings- whether economical, social or emotional, always stir feelings of jealousy. You generally want something because you `know’ that someone else can afford that. The zealous are just the masked jealous. To emulate is a yearning, not for self-fulfillment, but for a social sanction. Jealousy is usually not about having, but about not having. To have or not to have is, not a need based decision. It is the product of desire. To kill desires and live in peace is the simplistic teaching of every messiah known and unknown  in this world. If happiness is the basic pursuit of humanity, then the peaceful smile and the graceful simplicity of the portrayed Buddha and Jesus should have evoked tremendous jealousy. Jealousy always spurs one to imitate the object of jealousy and achieve whatever is considered as the other’s achievement. Yet no one has jealously or zealously tried to emulate  Buddha or Jesus, except perhaps for some self-proclaimed God-men or Godly-men who of course have a different agenda to follow.

It is obvious that we all are jealous only of those whom we can easily emulate. A CEO of a MNC can only become jealous of the CEO of another MNC. He normally would not be jealous of the President of India or the USA. Jealousy is therefore based on assessment of opportunities. A columnist would become jealous of a Nobel laureate in literature only if he believes that he has the same potential to create similar works. An author generally is never jealous about an artist. A dancer does not feel jealous about a musician.  There are however, some people who just cannot take it when others win – deservingly or otherwise. These people cannot bear when some one else is in the centre of the spotlight. This is a different game altogether. This is envy- most frequently misused as a synonym for jealousy. Envy is actually an irrelevant, inappropriate and non-productive feeling. In envy I would even hate the plume of a peacock.

Just as how envy is about hatred, jealousy is actually about love! It is love of and for oneself. In a psychosocial perspective, our self is a broad enough term to include our primary family. It is in this societal context that this form of jealousy makes a loving parent become jealous of another’s child and other parents who have won more. When the coveted object is not a social applause but a personal psychosexual gratification, one feels jealousy when the object of love is actually in love with someone else. The primary concept of the mind in these cases is that one deserves much more than one gets, and one deserves so much because of the intense and immaculate self-love. This self-love is not narcissism which by its self consummated nature creates a monument of pride in one’s own mindscape. Narcissism and pride are inseparable while jealousy is essentially about one’s inability to achieve. Narcissism is about having in abundance while jealousy is always about insufficiency. Narcissistic self-love would look down on others while the jealous self-love would keep looking up at others.

Yearning and itching to reach the pedestal that another has reached creates various forms of unrest in the mind. There is sadness that one has not reached the line, and then comes a paranoia that there is a cosmic conspiracy preventing one’s deserved success. The blame game begins. Gods and stars are blamed for not formulating the right design called luck, society and family are blamed for not giving the right breaks. The whole world is blamed for not being capable of understanding and accepting true greatness. The mind sulks. The sulking mind falters. Everything is perceived with disbelief. There is lack of faith in others leading to doubts about self-worth. There is anger. There is bitterness. Simpler things become harder to do. Failures begin. Infinite circles of pain, paranoia, anger and sadness begin. Then and thus, jealousy becomes envy.

Emotions are the mind’s reactions to external events. Emotions though intense are not permanent. We all become angry or sad at times, but the same intensity of the feeling does not last for days and months. In the case of envy and jealousy it is different. Though envy and jealousy are also emotive responses to external events, they cast a deeper impression in the mind. They cloud the mind and colour the perspectives. Everything is viewed through the green-eyed glass of jealousy. Nothing is the same anymore. The affectionate competitor becomes the nasty winner and relationships become superficial societal obligatory chores. Once jealousy sets in, the mind begins to doubt. Even the sneer hides a fear. Contempt becomes a camouflage for failure’s self-inflicted wound. This state of mind can alter the route of life and lead to a downhill blind alley. It is in the best interest of oneself that one needs to encounter and handle feelings of jealousy and envy.

A  psycho-philosophical understanding of emotions declares that there are just three types of feelings – the pleasant, the unpleasant and the neutral ones. Jealousy of course is unpleasant- not only during its acute experience but also in its tragic aftermath. There is only one way to deal with these unpleasant emotions. One has to identify, understand and accept the pangs, causes and confusions of jealousy. The technique is simple. Just start watching the advertisements on the media. It is actually the moral right of every advertiser to entice more than educate, therefore just watch non-judgementally. Products are offered. Advantages are described. Even social reputations are challenged. But just watch. A product is offered for sale. To buy or not should be based on whether one needs it or not. Now examine the need to buy or have. Is it to enhance one’s own pleasurable moments of life or just to display in a corner without even noticing the dust gathered on it? But there are times when we can fall in love with an artifact and empty our purse to possess it. Even this will not create future unpleasantness, except perhaps when the credit card statement does not tally with your bank balance. Uneasiness and unpleasantness begin only when you want to buy or have something simply (and only) because someone else has it. It becomes more unpleasant when you realize that you cannot afford it. So the best way to overcome jealousy would be to become capable enough to afford whatever you want. Capability enhancement is the key. When you are immersed in a full-time activity like enhancing your skills, economy or relationships, there will be not be any time to be jealous.

Just learn to begin to be jealous of yourself.

written 2006

depression , some more

September 22, 2008

There are some who say that Buddha, and for that matter Jesus too was depressed. Perhaps they did display sadness in words and deeds, but that sadness was an emanation of empathy, which made posterity confer them with divinity, and not the yearning for sympathy that is characteristic of a depressive disorder.

Melancholia, one of the early descriptive terms for depression, dates to ancient Greece. All cultures, all over the world have recorded from early times, in epics and poetry, descriptions that would, in modern scientific and medical thinking, be called clinical depression. For centuries many have postulated on the cause of depressive illness, and based on their background and the scientific data available in that period, attributed it to body humors, bile, and in some cultural contexts a curse.

Symptoms are the manifestations of a dysfunction in any mechanism, and when the mind becomes dysfunctional with a depressive disorder the following symptoms are commonly seen- low mood or sadness nearly every day almost the whole day, loss of energy, lack of faith in one’s self- worth, sleep and appetite disturbances, neglect of self- care, inability to enjoy or indulge in previously pleasurable activities. If these symptoms persist and cause deterioration in social / occupational functioning, then the illness requires immediate intervention. In severe depression, suicidal ruminations are common and critical.

Depression, though often considered a reaction to unpleasant events, as an illness is quite common, and rather complex. Various factors contribute to a depressive illness. Genetic, neurobiological and environmental factors are the ones most commonly considered as causes of depressive illness. If you are depressed it does not mean your child is going to get depressed, similarly the chromosomes of your parents are not making you depressed. Genetic possibilities have been debated in psychiatric research but not conclusively proven. However if depression runs in the family, then one can be expected to breakdown more quickly and easily than other people in the face of stress. Unpleasant environment or events can trigger a sad mood which may be a forerunner of the illness spectrum.

Diabetes, hypothyroidism and many endocrine disorders can instigate depression in people. HIV, tuberculosis and some more systemic infections can cause depression. Some drugs used to treat other illnesses can cause depression.

Women in particular have a tendency to get major depressive disorders. Hormonal imbalance and endocrine dysregulation can cause depression.  Preceding or following menstruation some women experience and exhibit mood changes. This is not to be confused with major depressive disorder, in which the mood worsens as days pass. Immediately after child-birth, some women experience a depressive-psychotic breakdown, and this is called post-partum disorder.

When we talk of a major depressive disorder, we should keep in mind that this is an illness, caused not by anyone or anything outside. Neurotransmitters, chemical substances necessary to process functioning in the nervous system are considered as the most important cause of this illness. Therefore medical management is essential.

Medical management of depression involves prescribed medication, and in some rare cases even electric shock therapy is considered appropriate. When the thought process is numbed by the depressive illness, the affected individual cannot be counseled. The neurochemical balance must be restored. This is where the popular `Prozac’ comes into play. There have been anti-depressant drugs much before fluoxetine (the real name for prozac) came into vogue. There are many more newer antidepressants that have been discovered and available in the market.

Antidepressant medicine is intended to regulate neuro-chemicals like serotonin and norepinephrine and the actions of dopamine. There are many types of antidepressants and the choice of the drug for the individual is always based on the clinical assessment of the consulting psychiatrist.

Of course, as with all medicines (including the commonly consumed paracetomol) there are side- effects for each of these anti-depressants. The most common side-effects of antidepressants are constipation, blurring of vision, dryness of mouth, nausea, and in a few cases drowsiness. Depending on the severity of the illness and the side- effect the drug needs to be continued or changed.

It is a myth that medications used in psychiatry are for sleep, and they will be addictive. Many are also under the wrong notion that an individual has to take medicines life-long. These false ideas propel people to take recourse to alternative therapies. Reiki, Pranic healing, Aroma therapy and the whole range of non-pharmacological treatments are widely advertised and therefore acclaimed. They may to a small extent contribute to recovery in secondary depression (which would have subsided anyway over a period of time). In the case of major depressive disorder, only medication will help. Maybe after the initial phase, when the symptoms are controllable and tolerable, these techniques will help the individual to believe in recovery. It needs to be emphasized again and again that major depression being a medical illness needs medical treatment.

Besides the commonly encountered frustrated sadness after a failure, depression comes in many forms. Major depressive disorder is the severe form that needs immediate treatment as it contains a volatile suicidal risk. Sometimes mood swings from the sad end to the excited, both extremes stretching all norms of behavioral expectations. This condition is called manic depressive psychosis. In some cases there is a condition called atypical depression, where the individual would be more agitated and touchy, trying to do things he actually cannot, becoming irritable and losing concentration easily. This condition requires a correct clinical diagnosis for proper treatment.

There are people who always look low, down, unable to laugh and enjoy life, but who are capable of functioning in their occupational role well. They are called depressive personalities, and no treatment is going to bring a ready smile on their face. This is something the individual has learnt from early days. His motto and theory of life would be “I can only lose, so why should I smile, after all being happy does not last long”.counseling does not help these people since their ideas and notions are deep rooted in their psyche.

When someone is down with depression in your intimate circle, keep a watch without making it appear intrusive. Depression invites suicidal thoughts. Give them company, but do not patronize. You cannot make them see sense till the acute phase is over, so do not try to talk them out of it. All you can do in the beginning is to wait for the medication to start working and in a couple of weeks the individual will be ready to listen and understand reality and logic.and then, talk, talk more and talk sincerely.

Some other conditions mimic depression. There are many who apparently seek philosophical and mystic meanings in life, not doing anything constructive or productive. For some this is a mask for their laziness or incompetence. Some like to play the sick role as it generates sympathy and accrues attention. A close and careful observation of the life-style, work pattern and past record will help in distinguishing these pseudo-depressives.

Depression, gloom, fatalistic thinking, pessimism, disregard for personal grooming or comfort, and long periods of inaction are all seen in some artists. Depression does not create an artist. Only the artist, like any other individual can get depressed. It is also a myth that depression spurs creativity since many poets write wonderfully about the state of sadness. Creativity can always find an apt expression whether the mood is sad, happy or angry. It just so happens that happiness is a song while sadness is a poem. Literature abounds with descriptions of depression. William Styrron’s ‘Darkness Visible’ is a beautifully written account of a major depressive disorder. Any artist can create a wonderful work on depression, but not in depression. One has to be out of depression to become functional and creative. The good news is that though depression is debilitating, it is definitely treatable quickly and effectively with the newer drug formulations.

written 2005, part two of the previous post

depression, some thoughts

September 18, 2008

The smile is the only affirmation of one’s comfortable co-existence in this world, and when that twists, and the eyes glisten to see the world dull and gloomy, when the vision of the mind too turns out of focus, and when time seems to extend itself, the description, the definition and the diagnosis is depression.

In everyone’s life there will be many moments that may be described as blue. This is not the radiant vibrant happily freckled bright sky blue, but a murky dull and suffocating gloom. This is commonly and in psychiatric parlance known as depression.

If one were to consider sadness as an emotion and a reaction to external stimuli, depression can be construed as a state of mind, but in actuality it is an illness. It can affect anyone, anytime. It not only hurts and numbs, it makes perspectives bitter too.

It strikes silently and silences. Depressive illness manifests in two ways, a major depressive illness or a minor depressive episode.

In the minor variant, Bitterness is an acquired distaste, something we have learnt to dislike, but sadness is an engulfing disability over which we do not have control. Over the years one may learn to identify troublesome situations and prevent getting hurt, but this is possible only with external situations involving conscious likes and dislikes. In the major form of the illness, depression strikes from inside. There are no obvious contributing causes outside. The neurochemistry of the individual gets disturbed and the illness manifests with signs and symptoms, needing therapeutic intervention.
Whether a person is suffering from major or minor depression the main presentation appears similar. There is a sad mood inside and a forlorn look outside. In minor depression a concerned, rational and objective friend would suffice to tide over the mood, but in major depression medication and therefore professional help is absolutely essential.

Minor depression is also known as reactive or secondary. It is a reaction to (or secondary to) an event that disrupts the emotional equilibrium of the individual. This generally follows sequentially an expectation, a disappointment, a shocked disbelief, shame of failure, fear of incompetence, uncertainty of future and inability to function in order to cope with the distress.

Expectations are imposed and inculcated as an everyday routine right from childhood. You have to be good to get a chocolate, and if you are wrong you miss something. Deep inside is ingrained a notion that if you are good you win and lose only if you are bad. Therefore when we have done everything well, behaved well, and done what is generally known as right and been good by our own definitions, we have to win. If circumstances decide that we have lost, we are shocked, hurt and bewildered. A cheating husband does not get that disturbed when his wife has an extramarital relationship, though he may show his resentment. A student who has not studied never gets depressed when he fails in an examination. It is only when we feel that we have been right and the world is being `unfair’ that depression sets in. Of course, there are many times when we feel we have put in our best, while in actuality it is inadequate to accomplish. Only in those situations when we feel we should have passed and when we have failed, we get depressed. Minor or secondary depression is always our reaction to our perceived failure or betrayal. In inexplicable situations, the betrayer becomes GOD, since there are no other humans to blame. If we cannot blame God and attribute the misery to the mysterious hand of fate, but have to only blame ourselves, we sulk more and sadness is more profound. It does not mean that an atheist would get more depressed in a tight situation; in fact, a rational mind recovers faster as it sees reality more quickly.

The main problem that one encounters when one gets depressed is that one’s ability is reduced and therefore coping and recovering take a longer time. Depression is sadness. Sadness is an emotional reaction to a situation. When the situation and the reaction are disproportionate, it becomes a disorder. Maria Sharapova may miss a simple volley and this situation can irritate, frustrate, sadden or shock her. But she would recover in the next game. We too have met many losses and many failures which we could have prevented had we been at our best performing level. If we shrug or even bang our fist and move on it will not end up as depression. if losing one volley is going to incapacitate talent in such magnitude as to lose a match, it is depression. If it is for a few hours or even a couple of days, sadness need not be called depression. The problem should persist and make present moments painful and future expectancies bleak for it to be termed as a depressive disorder.

Grief following bereavement is not depression since it is an emotionally appropriate and proportional reaction to the permanent loss of a person in one’s life. Prolonged grief however is pathological. Loss of loved one, not necessarily owing to death, is as severe as bereavement, if the love was intense, passionate and honest. Even is such instances, one is expected to be sad, dull, dejected and even angry for some time, not for long. How long one feels low after the loss of a significant individual in one’s life depends not only on the significance of the relationship but also on one’s dependence on the relationship. Dependence is the ultimate expectation and every expectation is pregnant with a disappointment.

It is not often easy for everyone to identify someone who is depressed. Though it may start following a traumatizing event suddenly, the incapacity of melancholy sets in gradually. Though the intensity of depression can be assessed only by a trained professional, it has to be identified by close family members or friends in order to provide timely help for quicker recovery. Time, as the old adage truly remarks, does heal but we do not have to let time ‘take its own time’ to heal with the advent of modern mental health science. Early identification of the disorder is therefore essential for prompt and proper help.

Depressed persons generally exhibit the following symptoms and signs. Sleep is affected. Some may have difficulty in falling asleep while some may awake earlier or intermittently, in rare cases there may even be excessive sleep. Sleep is significant since it shows what the mind wants to do- be alert for further dangers or shut down to escape from reality. Appetite may be altered; some do not want to eat while a few may eat more. Concentration falters, and as a consequence performance levels drop. There may be disregard for personal grooming, loss of interest in previously interested activities. Amotivation to do anything purposeful and fight the mood will be also present. The mood will be described as sad, gloomy, and dull and the emotional responses become lackadaisical. The smile becomes a rarity and the eyes reflect the inner quake. Tears may not be public but they will be ready to flow at the slightest opportunity. Ruminations about suicide too occur in some individuals. Though most of the persons who get depressed may become dull and withdrawn a few may show agitation and restlessness too. In all cases, the content of speech rather than the form of behavior will indicate the depressive disorder.

The mind however is well equipped to handle any trauma. It has its own defense mechanisms. It is for the professional to suggest which areas need to be strengthened in order to overcome the difficulty faster. In this matter however many people come forth with impractical suggestions. If an athlete fails in a meet, you cannot ask him to learn music to overcome the sadness, instead a new workout in a new gym might help. Suggestions to overcome depression are often the result of media hype on meditaion and alternate methods of `treatment’. Yoga will help as much as aerobics. Meditation will help and so will listening to good music. If you care to help an individual who is depressed, be supportive, don’t argue even if he talks nonsense, but never allow him to talk out of tune with reality. If you cannot make him stop talking irrationally, change the topic or silence him by your silence.

Initially medication may be required even in minor depression to help to sleep. But this again has to be under professional guidance and supervision.

Depression can be endured effectively with the right support. Not all can turn their sadness into a Tajmahal; making the rest of life comfortable and successful is by itself a monument to the wound that has caused the depression.
********this is just the first part and we will continue in the next on other forms of depression, defense mechanisms and treatment options*********

written in 2005


September 8, 2008

Am I a cannibal? I do eat up fellow humans. I suck their emotions, beat them to a psychological death, take delight in devouring their haplessness, and have no qualms but a sense of satisfaction at being able to devour, digest and defecate other potential threatening species of my own kind. Perhaps I do not relish the taste of their sweaty stinking flesh, but I certainly have developed the desire to eat off my opponents. And, I am not reprimanded but respected by my own species. I command fear and demand respect. I am not classified as a cannibal.

What is being a cannibal? Commonly humans who eat (literally) fellow humans have been declared and described as cannibals. Technically cannibalism is known as anthropophagy. The confused Columbus called the `Indians’ cannibals. The name however was derived from the native word whose root means `strong man’. Cannibals have to be strong! To survive or live by feasting on the living is indeed strength!

Cannibalism has been classified as survival cannibalism, ritual cannibalism and dietary cannibalism. To survive under extreme duress and to turn to your species for the basic necessity of food has been a plot for some good novels and a couple of films. In these cases the gory act is masked by the grave situation. Ritualistic cannibalism perhaps present more probably than the survival one, has been documented in all myths. It passes off with less distaste (pun unintended) because of its magical nature and mystical quixotism. It is only when cannibalism becomes a culinary exercise with a chef’s professionalism that it evokes anger and disgust. There have been some reports that human placenta is dished out as a delicacy under the pretext of medicinal value. Some villains do eat their victims to make the plot thick and sticky!

There are three types of cannibalism- Auto cannibalism in which one eats oneself, or parts of oneself; Exocannibalism where one eats outsiders- those who do not belong to their own social an cultural milieu;. Endocannibalism in which one eats even one’s own kin.

We who live on iddlis or pizzas may not prefer a finger or a tongue (of a human) even if marinated with the best spices but there are real people who possible speak in languages not totally alien to us, who do eat other people cooked or raw in full or in parts! Psychology being the eager subject that wants to give more answers than there are questions, naturally has lapped up cannibalism too. And you can bet that Freud would not let such a delicious item be untouched! He tried to explain this as a fixation in the oral stage of human mind’s development. Some psychologists have postulated that improper weaning; leaving the infant still groping for the delicacy of mother’s breast can be an underlying desire to eat flesh. Aggression coupled with frustration is one of the common themes of psychologists who try to explain cannibalism. Of course none of these theories are sufficiently and scientifically (with statistically significant research findings) recorded. Such studies are of course continuing to be difficult since a researcher may find himself more inside the stomach than inside the mind of the cannibal.

In psychiatry, an illness has been documented as a consequence of cannibalism. The Fore people of New Guinea were affected by an illness called kuru. It was a movement disorder. Research discovered that these Fore people practiced cannibalisms. In their ritual practice, the women prepared the bodies. They served the prime parts (muscles) to the men while they ate the lesser (!) stuff like the brain. It so happened that the virus was carried in the parts that women ate and more women ended up with the disease. These cases were reported in the 1940s and since 1950s these cannibalistic funeral rituals have ceased and illness is no more found!

Rites and rituals have been a part of human history. It is the stuff of which myths are made. Almost all myths have a cannibalistic story to tell. More than eating one of their own kind, which may cause a discomforting distaste in the mind, the `greater’ stories are of the kind in which one cooks one’s own species to appease the Gods! This was considered a great sacrifice. The dearer and nearer the one who is cooked happens to be, the greater the sacrifice!

In Greek myths Artemis demands that Agamemnon sacrifices his daughter Iphigenia in order to win a war. He decides to do so with dramatic tears and throes of affection. However the kind Goddess intervenes in the last second and takes the nice girl away to make her a great priestess. In Indian mythology, the great Shiva demands that one of his devotees offer him “pillai curry” (child fry?), and when the weeping parents kill, cook and serve the kid, the God being mightily pleased blesses them all and assures a berth in heaven. In both these cases the Gods demand a cannibalistic feast that is bound to be a test of the sacrificial will of the devotee. The king need not win the war and the devotee need not go to heaven by killing their own children. Yet they offer to do so. Perhaps the love of God was greater than the love of their offspring. Perhaps the fear of God was stronger than the bonds of affection. Whatever the cause, the action speaks louder and tells that humans do not stop at killing and cooking to serve their own species. Is it survival? Is it greed? Is it fatalistic compliance? Is it getting defeated happily? Why should a human kill his own kind, not just another unknown face, but his dear child and offer as food for God? These myths imply much more than what these stories apparently dramatize.

These stories might explain the concept of auto cannibalism. It is not just a survival mechanism. It is the state of mind wherein greed for some greater satisfaction sacrifices one’s own code of ethics. To eat is not necessarily to enjoy. Eating can become a necessary function to protract life. To kill one’s own kin for a futuristic pleasure is just a way of making life better at any cost. Killing need not be the termination of heartbeat and breath. The worst murder is one in which another’s emotions are ravaged. In its worst extension it is suicide. Suicide though generally an escape is sometimes a sick mind’s search for a solution. If suicide were to be considered auto cannibalism, then incest can be a form of endo- cannibalism.

But it is the form of exo-cannibalism that is prevalent in our present society. We are in various manners, eating or preparing to eat our fellow men. We do not care for their feelings and needs and trample on their sensitivities to achieve our goals. It is not perhaps intentional self indulgence. It may have become a social style of functioning. But in the metaphorical sense of cannibalism our current acts of self preservation are indeed manifesting without our conscious sanctioning.

So? Do we continue our latent cannibalistic instincts? Can we afford to desist eating one another and not end up like how the good old dinos did long long ago and finally vanish? YES!! Cannibalism was perhaps substituted by cultivation of agriculture. We can try the same game. Instead of feeding and feasting on one another, we can try to find pleasures in other things. Lively things. Like art!!

written in 2005 for ritz