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)

happiness and emotional equations

***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!