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)

Facebook foible

To discover or invent the psychology of the pathology of the facebook I need words, but I wonder if I do really have them. I am getting close to saying I am at a loss for words.

If I were not in facebook, I would have savoured and used many words again. I don’t mean just words. Words are just a part of a grand design whose line drawing is a sentence.

I may have gone on writing in the paper on the same page the next day or the next year, but the page with my words would have just been there, hanging around like a loyal dog waiting for an uncaring master. I may have even let the poor dog die unfed and uncared, but I would not have caught it and flung onto the street, where its whimpers would have drowned in the chaotic traffic out there. Facebook  has made me merciless and cruel, more cruel than a child battering mother. I give birth to these words in their formative design, and without waiting for them to grow and grab other words and weave another branch or related words, I thrust them out into the harsh light of social media which scorches more than the sun in its peak of heat.

I am not lamenting at the premature death of so many poetic probabilities that were prematurely delivered and left to die, untreated and uncared at the reduced number of ‘likes’. Thank God they did not create a  clickable ‘dislike’ till this moment. I feel like the shameless and selfish mother who disowns her child because it does not beget her appreciation. I have let so many lovely angels decay before they grew their wings and turned rosy. My words are unfortunate to have been born in this facebook era. Had they been born in the days of paper and pen, they would have still been alive and around, and if perchance I see them in a new light, may have got resuscitated. Not these days; words flee from typing fingers onto the launch pad of a click button, and in seconds after their appearance, appear in front of all. Not the ‘ALL’, but the ‘all’ who I have considered my temporary all. And, not all look at these words. Some are not even aware that they have arrived, some do not care to give them a second look, a few ignore, and a few more refuse to acknowledge. The fresh sculpture soon finds a dustbin, and with the million tons of debris and rubbish that keep piling everyday it may never find an archaeologist, anytime in the farthest future.

Having wasted so many words I still keep collecting them. I still keep weaving them into a tapestry that I always imagine would surpass the shroud of Turin. But those golden threads have gone out of the window, and I have gilded copies which would soon fade and dim in the eyes and minds of whoever cares to even take them on for a look.

I pause, ponder and in defense pontificate, that words are just the outpouring of a perennial stream and there it would always be, the source of the stream, supplying for eternity.  I lie to myself and write- ‘Wordless in the wilderness of mind..’

It is not that words have flown away from my memory; it is just that they are looking back at my mind which flung them out. They look down and mock at times, at my foolish delusion that they would one day soar up above the world so high that they would twinkle and light a new path. They do look up at me with ineffable sorrow, to make me guilty that I have thrown a seed out before looking at the ground and its fertility. They pray to me, an incompetent creator, hoping that I would resurrect them or give another birth and a chance to do something worthwhile. They pretend to believe in me, and pretend to believe in the world outside of me.  I have thrown out many words. Every word I threw out was not a casual toss into oblivion; they were all pellets aimed at a goliath that I had not even sighted. I have thrown away many words, original words that glittered and glimmered in the illusory sentences that my mind elaborately designed in deceit. All those words are gone. My mind and its brain still have surplus stock of words, but many are just replicas of those original words which went flying out into a fathomless obscurity. Having had the delight and ecstasy of using the original word in its pristine form to make a virgin design, replicas make me sigh.

Lies again. Not the cunning, scheming, malicious and brutal lies that are generally evident; these are lies that smoothly sail out like a leaking perfume, and hover long enough to get noticed and vanish. They would by the time have made their impact. An impact that would not choke or scorch, but an impact that would slowly cloud the vision, temporarily but long enough to distract and alter the perspective. Depths would no more be deep enough….

NO..I cannot write lies to myself. I cannot take writing down to the level of a ‘selfie’. I have to save my words, whatever is left of them, for a hope in the dark future when I may have an opportunity to unhurriedly set a necklace uncaring whose neck it would adorn the next day.

Until then, I have to write lies, not for myself but for others.