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YOU GOTTA GET OFF THAT ROCK, CHUCK

Rohini Lall

Teddy Daniels: So, what’s our next move?

Chuck Aule: You tell me.

Teddy Daniels: I gotta get off this rock, Chuck. Get back to the mainland. Whatever the hell’s going on here, it’s bad. [pause]

Teddy Daniels: [sotto voce] Don’t worry, partner, they’re not gonna catch us.

Chuck Aule: That’s right, we’re too smart for ’em.

Teddy Daniels: Yeah, we are, aren’t we? [pause]

Teddy Daniels: You know, this place makes me wonder.

Chuck Aule: Yeah, what’s that, boss?

Teddy Daniels: Which would be worse – to live as a monster? Or to die as a good man?

I grew up in a town without Marlboros and psychiatrists. It was the year 2012. Contrary to the Mayan promise, the world had not yet ended, and I needed both with an immediate, inexplicable

urgency. It was still the year of Eminem’s Recovery for me, and I was desperate to seek mine. The breakout album had come out not too long ago, and I was unwilling to stay at home. I needed to peer back into me and I needed assistance and, as it turns out, medication.

It wasn’t the first-world petulance that drove me out of there but true, dire need for help. I left in the dark, through hidden alleys, dressed in my brother’s friend’s oversized clothes to board the train that would take me to my halfway house. I couldn’t be on a reserved seat. I could be tracked and brought home, to be told that whatever I had could be washed away and I didn’t really need to see anyone. After all, what good would that even bring?

The wooden berths were harder than surfaces I had previously slept on, but the women around me let me have one because they loved my large eyes, my wide smile, and my soft, shiny hair. One of them explicitly said, ‘We are used to sleeping on the floor. Let me touch your hair once, and you can have the top berth.’ I let her touch my hair to her heart’s content.

It was a women-only compartment filled with the smell of food, sweat, cheap talcum powder, and hair oil. The sound that wafted through was of wailing babies. I was fussed over while their own snotty-nosed children wandered about. I was fed, and I was fed well. Succulent pieces of meat and hard boiled rice – that is what I ate. Their water, probably out of a hand pump, was unsanitary and tasted of the earth. If I looked closely, I could see silt at the bottom, but I was thirsty.

A few texts were exchanged between my cousin and I, and I then destroyed my SIM card.

I sat by the window and pulled out a cigarette. The women said nothing. There were no sniggers, no prohibition, just silent acceptance. It was temporary, but that is what I had longed for and set out to find. The wind was cold and soothing and the woman, all covered in a burka, asked if she could have one of my cigarettes. I wasn’t going to decline after such effusive  hospitality and brilliant food. She almost snatched it, brought her face close to the window, and lifted her veil entirely. I could see her hair now – rough, streaked with henna, and tied into a large, stern knot. She tilted her head backwards and exhaled, smoke pouring out of both her nostrils.

‘Sleep,’ she commanded. ‘I’ll wake you up in the morning when Howrah is near,’ she assured. I climbed up, knowing that I wasn’t getting my cigarette back.

The City of Joy

I was nudged softly. Prodded a bit and then, in a soft voice, told it was 10 minutes away. I had been covered after I had slept, and I was woken up by the woman who didn’t owe it to me. Sunlight was pouring in and it was lush green outside, bathed in golden light. I wasn’t ready to give up on the world. Not when it looked like that. My shackles could be dealt with later. At that moment I had to look at the light. My mouth still tasted of spices and hard water, but I wasn’t sure I wanted to brush it off just yet.

The station came up quicker than I expected, and I got down after a warm embrace from the veiled woman. I offered her my cigarette box and she pulled out three. We said our goodbyes and left.

I pity the fact that I was a fugitive in Calcutta, not a tourist.I would have loved to go to the places I was asked to visit. Stand and stare. Frolic, maybe. I had a flight to find and a flight to catch. I had nothing planned out. I didn’t know the way to the airport but I was told that the taxis are fair and not as expensive as Delhi taxis.

What was curious though, was that I was fed everywhere whether I wanted or not. Don’t misunderstand me, I was thrilled. I was, however, light-headed and still carried the hurt within. I

had images flitting through my head as I chomped on my third sondesh from the cabbie’s box. On and off, I’d tear up and the great citizens of my country would stuff me with food.

‘Look, the airport,’ the cabbie said.

I paid my fare and walked in to look for the next flight out. I had to wait for two hours and still did not have a plan or a doctor. I, however, did have a plan for a doctor. I was supposed to reach Delhi and meet up with my old English teacher and draw up a list. We’ll come back to that later.

For now, I had two hours to kill and enough books to read. But, as a rule, one must visit the airport bookstore to pick up a souvenir of your travel.

I picked up The Hungry Tide. It was divided into two parts. The Ebb, or bhata, and The Tide, or jowar.

I finished The Ebb on the flight. And then, I slept. I don’t often dream. But I did that day. Despite what I dreamt of, I wouldn’t call it a nightmare. It no longer gave me cold sweats, it did not jolt me awake, so nightmare it wasn’t.

His teeth sunk into my flesh again, I lost my hymen and my dignity again. The thrusts very excruciatingly painful, and I remembered everything, like a series of curated photographs. There were pauses and dark blank spaces. There were crisp images and blackouts. No blurs.

The scalding hot water stung my skin but not as much as I expected it to. It gently tried to remind me of my cuts and sores a little less. The red, pink sores turning into shades of blue and purple. Colours I would avoid wearing for years. Now, however, I seek dark blues with a passion. Interesting – how time works.

‘The world is so full of sluts that it’s a pain finding a virgin,’ he slurred over and over in his drunkenness. That is where I remember biting his forearm so hard that I felt his blood gush

into my mouth. I have no sympathies for drunken lechers, and I would have drunk my fill faster than an impoverished vampire if I did not have his body on top of me.

I dreamt it in my narrow seat, huddled like I was in its aftermath.

I dream vividly when I do.

I see things as adequately exposed photographs. I hear sounds. That afternoon, I saw my blood cover the marble floor and slowly dissolve in the water that was getting tepid as the time passed.

I did that for a week. Bleeding everyday. Sitting in the shower till the scalding water grew tepid and blood changed colour from raw red to a paler version of itself. The pain lessened

but never disappeared and showering with scalding water till it goes tepid became an obsession. I still bathe the same way. The difference, there’s no longer blood in the water.

I did not have nightmares. I slept. But, I drank myself to sleep. At the age of 21, I drank myself to sleep. Or, when I was kinder to myself, I ran myself to sleep. They were ad hoc solutions, patchworks, band aids. I desperately needed a full-blown cure.

Delhi is Not Far

If I were to recount instances where I’d be incredibly, irredeemably grateful to someone, it would have to be my cousin Kumar Ritwik, my brother Vageesh Lall, and my then English teacher

Rowena Gideon.

The day I reached Delhi, I met up with Rowena Gideon and drew up a list of 10 names.  Between sleep, wakefulness and anxiety, I burnt through nine names faster than an oil-soaked fuse.

‘Be careful with the last one,’ I was advised.           

I was wary too.

The people were chipping away at me. The commute was weighing me down, and I had no idea as to what was left of my sanity. Or, for that matter, if I had ever possessed any.

‘Do you know him?’ I had asked before I visited the last name on my list.

‘Not really,’ I was told. ‘All I know is that he is patient, unusually so, and a man in his mid-30s.’

‘Ringing endorsement,’ I laughed. Perhaps after a fortnight. But I did. And at his expense. That is another nugget of gratitude I owe him.

Before I left, she left me a note with a quote from the movie Under the Tuscan Sun.

‘They built a train track over these Alps to connect Vienna and Venice. They built these tracks even before there was a train in existence that could make the trip. They built it because they knew some day, the train would come.’

With the paper neatly folded, I went home… Rohini Lall is the author of The Sour Faced Moon (Frog Books, 2013).

GHOSTS FROM MY PAST

Lisa C

If you follow my journey to and from the summer of hell, you will get an idea about who I really am. When I look back and think of the passage through the dark tunnel and out, I see an image of myself from that time serving as a reminder of the crisis that almost crushed me. Almost.  Before I delve into the depths of my past, let me introduce myself.

First things first. My name is Lisa C., though that has not always been my name, for I am a transgender woman. I am 22, a psychology student and interested in many creative initiatives.

I am one of the many people whose paths intersect yours, whose stories hide dark moments they have silently suffered, and who have coped with various forms of gnawing mental illnesses. I have

always suffered from severe anxiety disorder. All my problems – acute anxiety, obsessive negativity, and hypersensitivity – combined to push me down a chasm at that point in my life – the summer of 2011 – when I wished to take my own life because I believed I was a waste of space, and life was no longer worth living. Before I recall that dark hour, however, I want to first share with you how I ended up feeling so much self-hatred and explain the accumulation of disgust for being alive.

It all really started during my high-school days. I literally went downhill to school. I was about 11 or 12, if I recall correctly. Middle school had been just a walk in the park. Though I had begun to deal with being left out by ‘friends’ at times, I still felt some connection to the world around me. Even to feel that I belonged was enough to want to keep existing. I loved Winx Club, The Powerpuff Girls, Pokémon, Digimon, and Totally Spies!, and unbelievably, I even had friends who enjoyed such shows. But when I continued to cling to them in high school, somehow, I became someone to be shunned and laughed at. ‘Pokémon is for kids.’ I heard such derisive remarks echo around the playground for years. ‘Winx Club is for girls,’ was another familiar refrain. Mind you, I was still a boy at the time, so my interests were picked apart for being both unusual and unconventional, to say the least (though we all know now there is absolutely nothing wrong with a boy liking Winx Club). In that crowd, I was not just a loner but an oddity too. I was not a stereotypical schoolboy, running around, shouting, a little rough and tough. For the rogues, I was an effeminate sissy. The more self-aware – and increasingly ashamed of the things that

gave me joy – I became, the more the bullies targeted me. I had a handful of friends at school and in our neighbourhood as well. I liked to think I had a decent relationship with all of them; I’d always considered myself a nice and genuine person who could get along with everyone. However, it soon became evident that what they meant to me did not necessarily correspond to what I meant to them. While I considered them my friends and loved hanging out with them whenever I could, they slowly revealed their lack of interest in my friendship. Eventually, I became someone they sought out when no one else was available – a backup plan; I was the desolate rock or a solitary pebble that lies unobtrusively in a corner, a substitute football sent flying by someone passing by on a whim.

During this time, I had a friend who liked to switch up his personality depending on who was around us. If it was just the two of us, we could talk and hang and have fun for hours without any issues whatsoever. But the minute the cool guys joined the circle, he was quick to jump on the bandwagon, his words, actions, and his entire demeanour going through noticeable changes. And I endured it all, because, why wouldn’t I? They were still spending time with me, and that was an infinitely better prospect than being a complete loner forever. This terrifying thought, of being left alone, the perfect fodder for my anxiety, fed my growing depression as well. The only person with whom I could sit and eat lunch suffered from chronic bowel disease, so he was often absent from school for one or two months at a time. With him gone for long periods of time, I found myself spending lunchtime alone. With or without physical company around me, in my mind, I was always alone. Being a slow eater didn’t help either; when the other kids tore through their lunches and rushed out to play, I sat there all alone, feeling the razor-sharp pierce of everyone’s eyes on me. I took to eating my lunch in a bathroom stall, with music blaring through my earphones. With music, I could relax; I could stop focusing on the dreadful isolation, disassociate myself from the world. I never faced the dramatic bullying that many people

are familiar with. I didn’t have people throwing pens, pencil cases, or chairs at me. I wasn’t locked inside closets. Nobody ever physically harassed me, none of them laid a finger on me. However, my entire existence was slowly being ignored, obliterated, and somehow, on some plane, that made sense to me, because I felt it could have been worse. When people could truly look through me without really seeing me, the voices in my head began to taunt me: ‘You don’t matter’, or my personal favourite, ‘No one’s going to miss you when you’re gone.’

To this date, I haven’t been able to truly wipe out these traumatizing notions from my anxious mind. I’m fully aware that there is no reason for me to still believe those negative voices my mind

is riddled with, but it is now almost second nature. I had believed them for too long – a whole stretch of 17 years of my existence – to be able to stop now.

That famous saying that everybody just loves to throw about: ‘sticks and stones may break my bones, but…’ Though the but is usually followed by whatever random conclusion the person can conjure up, the original words completing it keep coming back: ‘…words will never harm me’. This has been so far removed from my reality… words were precisely what broke me down from the inside – and they still do, to this day. Ironically, it was not just the words that I was susceptible to. It was also the loud silences that I had to deal with, while my mind proceeded to tear itself apart. The sheer loneliness, the fact that I had no one to help me fight my wars against the negativity, aggravated my depression. I was all alone tackling my mind, and if there is one thing that I have learned over the years, it is that my mind is the most dangerous thing I could confront. Or as RuPaul, the famous American drag queen puts it, ‘the inner saboteur’. Sometimes, there were rare kindnesses: a classmate would tell me not to be alone when

my friend was absent, or when someone would notice that I was being excluded from a group conversation. And yet, a circle of people always shrank right at my spot, in a way that I got pushed out of it; even if someone noticed that I wasn’t included, the circle would always close back in a matter of seconds. And I went on to feel that if I wasn’t even worth being on the playground at school, I wasn’t worth a spot on the planet. Many of my highschool exclusions went beyond the realms of getting picked last at gym, or not getting invited to a cool classmate’s birthday party. Unless something was needed that I could provide – homework, a pen, or a textbook – I was dutifully ignored. And the 15-year-old me was always quick to share, because maybe, just maybe, they would start to notice me, respect me, or surprise, want to become my friend. When my class decided to order pizza during one pizza break, they skipped right over me as if I were nothing but an empty seat. There is an abundance of stories like these, and these were the deep-seated wounds that led up to that summer.

Now, as bad as this all sounds, during high school, I was at least thrown into contact with other human beings, whether they acknowledged me or not. I still had to leave the house; I still had to be busy with homework and studying (though I was relatively lax at that); and I still had to talk to people I somewhat knew. But during the summer of 2011, which was the summer in between my penultimate and my ultimate year of high school (fifth and sixth year for me, being part of the educational system of Belgium), my life reached an all-time low. Firm social groups had been created, and I was inevitably and irrevocably ruled out from their plans. This pushed me down a dark passage of loneliness, and I felt desolate, discarded, and scared. I remained in this state of isolation for two months, feeling depressed and drained out. There was something haunting about my unmitigated loneliness. I was like a bird, storm-swept and unflocked. It was around this time that my depression became acute. The prospect of another day was terrifying. During that summer, I had nothing to distract me from myself. Stuck with only my mauled and lacerated mind for 60 days, my loneliness was assailing me. My spirits were low, and I had no courage to go on. I no longer bothered with anything. I did not care one bit about my life; it was not much to begin with, anyway. I didn’t care for hygiene and appearances. What am I going to wear today? The question never entered my mind, because I wouldn’t be leaving the house, and therefore, it would be a ‘pyjama day’ every day. Whatever tormented me at the moment, I decided, was for me, me alone, to face and figure out. It’s my life anyway. The causes of the turmoil inside me began to unfold themselves with more clarity – a fleeting gender-identity

crisis, concerns about my sexuality, and thoughts about ending my life. I never mentioned my self-hate and other related problems to my parents, mainly because I didn’t want to worry them.

So they had absolutely no idea about the storm ripping my life apart.

However, I did one thing right. Even as I sidestepped thoughts of ending my short life every single day of that summer, I chose to take refuge in many fantastic outlets (fantastic, as in

fictional and surreal rather than amazing, though that works too): anime, Korean pop, online games, vlogs of K-pop groups, and more. The resulting vicarious sense of belonging worked wonders. I took to a nocturnal lifestyle, sleeping most of the day away, because hey, if I was going to be alone anyway, it was definitely better to be alone at night, when everyone else was asleep and gone. I have never wanted to die as much as I did in those two months, and I have never felt as depressed and lonely as I did back then. Telling myself that I was unworthy of living and that no one would miss me even for a second if I decided to end it, I was filled to the brim with a sense of morbidity and being utterly useless. I do not recall too many incidents that happened during that period; I did absolutely nothing, after all, preferring to confine myself

to my room with my familiar and comforting pursuits. Every day was like another day, unvaryingly gloomy and monotonous. Luckily for me, when I had escaped into the fantastic realm of the Internet, I was presented with an online version of a social life. What had all started with simple messages after online fights on Tekken 6 quickly turned into all-out, abiding friendships. On the Internet, I was to no extent inhibited by my anxiety, simply because the fears of physical exclusion did not apply. Moreover, the friends that I had met across cyberspace all shared the same interests as me so there was always something to talk about. I realized very quickly that the friends I had made appreciated me for who I was and actively acknowledged me, even going as far as actually seeking me out or missing me when I was not online. This had been my very first encounter with people who seemed to thoroughly enjoy my presence and my personality. But whenever that power button was switched off, I returned to reality and felt as worthless as I had done before. Summer of 2011 thus became a little more manageable for me because nobody forced me to switch off the power, enabling me to always access my online social circle. Nevertheless, I could still feel the limits of online friends every single day. I am convinced that those people played an important role in saving my life. So, even though things went awry between one of them and I, and I have now lost track of most of the others, they still hold a special place in my heart for rescuing me.

So far, I have mainly focused on the warmth and intimacy of friendship, or its absence. But what about my family? Honestly, I don’t even remember leaving the house for family visits that

summer, though I most likely did and ended up feeling isolated anyway. Brace yourselves, this may come as a surprise, but I never truly had a sense of belonging to my family as a whole, and have never been attached to the extended family, either on the maternal or the paternal side. For some reason, I was always left out, though I truly wasn’t, but I did not realize it then. It was just my wicked mind telling me all these nasty lies; the irrational fear of being ignored and excluded had driven me crazy at school and in our neighbourhood too. No doubt, the same fear was back, haunting me, I tried to comfort myself. Surely the spooks in my mind were driving a wedge between my family and me? The fear, I suspected, was alienating me from those who were there for me unconditionally. I somehow believed that I was, or would be, ignored if I asked for something. Gradually, I stopped asking for anything. I was too afraid to even ask for the ketchup or some extra fries when the whole family was dining together, because I felt my requests would only be ignored. So, I didn’t bother until someone asked me if I needed anything else, and then I would hesitantly request a second helping. Feeling awkward, they always told me to just ask next time I needed something, but I never could. It got to a point where I started to panic and sweat at the mere thought of asking something out loud. These traits even now remain as residual side-effects of my physiological metamorphosis. Today, however, I have an amazing relationship with my entire family. Incidentally, all it took to open up to them was my increasing realization and acceptance of who I was as a person. And it was my coming-out as Lisa that truly made me realize how much they all have cared for me and still do. On my father’s side, everyone is fairly loud, uninhibited, and unable to experience anything but positivity, much like him. I have always admired them, and I wish I could be free like them someday. And even though I have travelled quite a distance towards that goal, I still have a long way to go. Somehow, after I survived that one near-catastrophic summer, even as I spent another bad year at high school, I was able to get and remain in touch with the people around me. My life slowly got back on track, and I made an adventurous new friend who influenced me to travel to a lot of places and meet a lot of people, who, magically, all seemed to like me…Lisa C. a student of literature, linguistics and psychology, she lives in Genk, Belgium. She is a transgender woman currently in the process of her transition.

MY JOURNEY WITH DEPRESSION

Sanjay Chugh

My journey with depression and other mental illnesses began some 30 years ago. When I was studying medicine, I never imagined that one day I would be working as a psychiatrist. In medical college, we read about mental disorders purely as diseases. And yet, we found ourselves diagnosing various ailments in us. Back then, this wasn’t a very comfortable idea. ‘Me having traits of depression or anxiety?’ Such thoughts bothered me. Little did I know that my experience of depression at that time was nowhere close to the real thing! When I look back now, I see it purely as my imagination.

I remember vividly the mechanical ease with which I worked for the first six months of my internship – with people suffering from a whole range of psychiatric conditions like depression, obsessive-compulsive disorder (OCD), substance abuse, eating disorders, schizophrenia, phobia and so on. I was good at diagnosing, even better at differential diagnosis, and the line of treatment came to me easily. After a point, it became so simple that I found no challenge in it. I almost started to feel a bit bored. I began to wonder if I had made the right choice. As I was going through this existential crisis of sorts, I encountered depression for the first time, in the real sense.

Anil (name changed) walked into my chamber, and I started my routine by taking his history. One look at him and I knew that he was suffering from depression. He looked like a mess. He was in his pyjamas, which I’m sure he hadn’t changed for several days; he was unshaven, with dishevelled hair and a lost look in his eyes. Every step was an effort for him as he slowly walked up to my desk. He let his weight fall on the chair as he sat and made no effort to make any eye contact with me. His very presence was so resigned that it seemed to yell out, ‘Well, what’s the point anyway?’ I somehow gathered motivation in the face of this despair and started asking the routine questions. He spoke in a low, burdened voice as he struggled to answer them. I did my assessment, promptly wrote a prescription, and asked him to see me after ten days. I spent the rest of the day in the usual way, seeing many other patients. But for some reason, Anil continued to be on my mind. I kept thinking about him and could sense a strange, unfamiliar heaviness in my chest. I dismissed it thinking that it must be the result of a stressful day at work. Later in the week, I was sitting with a colleague who pointed out that I appeared to be a bit preoccupied. That set me thinking, and I connected with the fact that I had never really stopped thinking (even if subconsciously) about Anil. For some reason, his condition had affected me like nothing else. I asked myself why it was bothering me so much when I had actually seen people who were in much worse conditions. Then it struck me – the point at which I sort of froze in my mind was when Anil took out a picture of his from a month ago, when he was doing fine. I could not believe that this was the same man. The dapper man in the picture had little resemblance to the tired and bedraggled patient sitting in front of me.

Anil was a successful professional doing very well for himself till depression struck. He was someone who had worked his way to success through sheer grit and hard work. He had studied at the best schools in the country and seemed to be a master of his trade. He said, ‘My work comes so naturally to me that it no longer excites me. I do it mechanically.’ As he narrated his story to me, I could really relate to him. He sounded like another version of me. The way he thought, the way he worked, his ideas, and even the traces of that sense of humour were all things that could have easily been me. Two near-identical lives had run parallel till we reached this point where we sat across each other – me as the doctor and him as the patient. This is when it started to dawn upon me why Anil’s story had impacted me the way it did. There was just one thought in my head: it could have been me in his place.

In retrospect, this was the point when I really started to understand depression. I could relate to Anil on so many levels and so deeply that I could almost feel the depression that he was

going through. I had always known that depression was a terrible illness to go through. But this time, I could deeply sense the abyss that this disease could lead you into. I could feel the impact

of crash-landing from a successful, happy life to the unending gloom of depression. This ailment gives more meaning to the phrase ‘pulling the rug from under one’s feet’! One day you are the cat’s whiskers and just overnight a pathetic thing with no grip over your own life.

My self-assured hubris rattled; Anil had brought me down to face my vulnerability. I realized that till now I had never felt depression so closely because I never allowed myself to connect with anyone. I would look at them from a safe distance so that I saw only the symptoms of a disease and the person behind them would just be a haze. After all, I thought to myself, we were taught in medical college that we are supposed to maintain a professional relationship with patients and not get involved or attached to them. I thought to myself that these people were perhaps not smart enough to understand that they needed to fix the way they were thinking. Or perhaps, they were not efficient enough to be able to do what was needed to get them out of depression. Little did I know that the real way of understanding depression was not through a textbook, or the words of a patient, but through one’s own vulnerability. This was the first time that I allowed myself to feel vulnerable – to my own fear that this could happen to me, and to the realization that I really did not know what depression was and so I may not have all the answers to the unknown and unfamiliar feelings that had suddenly welled up inside me.

Over the years, as I have continued to walk hand-in-hand with depression, it has never failed in keeping my work challenging and putting me on maximum alert. It keeps revealing to me yet another layer of the riddle called the human mind each time I get close enough to it. It amazes me each time I realize what a huge, inexplicable difference there is between something that I have understood theoretically and that which I have learnt intuitively and experientially.

Somewhere down the line, I decided to do psychotherapeutic work with my patients. This helped me connect with depression even better. I have had the good fortune of working with some of the most genuine human beings, who were extremely generous in opening up their inner selves before me – pure, unedited, uncensored versions of their bruised, depressed selves.

My patients helped me see how the sadness that they experience in depression is not the same as the sadness or low moods that we experience on a day-to-day basis. My experience of working with them made me extremely particular and careful about the usage of the word ‘depression’. I too, like most of the people around me, used to casually remark, ‘Oh! I’m feeling so depressed!’

On a regular day when things were not going my way this would be my response. I no longer use  it as a synonym for feeling low or upset. We can perhaps empathize with depressive sadness if we tune in to our own experience of low moods and crank up the intensity and duration…Dr Sanjay Chugh is a Senior Neuropsychiatrist. He has written extensively on the subject.

WHERE HAVE THE BOYS GONE? -

Shafaq Shah

He is talking about college, courses, and places. ‘Once I leave for college, I am never coming back  to this place.’ I am not looking at him. I do not need to. I know his face as good as I know mine.  I have known him for 20 years now, or maybe more, I don’t know. Birthdays aren’t a priority  here. Randomly chosen dates become birthdays.

On my first day at school, the teacher glanced at me, while I shifted uncomfortably in my new shoes, and gave me my new birthday – so casual, so quick that it still makes me wonder what made him choose that particular date for me. How do I look like someone born on 7 February and not 30 August?

We are sitting at our tiny mohalla shop, where recharge cards, biscuits, pins are sold.  Packets of brightly coloured, neatly arranged Uncle Chips dangle in front of us. This has been our meeting point for years now.

Curfew was lifted today. That means bright school uniforms, blaring of horns, and the bustle dispersing the chill – all this now part of the morning scene. Normalcy has returned, at least for the time being, and the biggest proof of that is my neighbourhood uncle, Deputy Saheb as he is called, taking his ancient monument, older than God, a dilapidated Maruti 800, for repairs for the hundredth time. I immediately turn my face away, lest he ask me to accompany him. I do not want to waste the first day of our newfound and clearly short-lived independence listening to the Sheikh Abdullah tales from the days of Uncle’s youth.

He is still talking about college and going away. He, it seems, just cannot stop talking.

‘I couldn’t sleep last night, couldn’t stop thinking about him. I’m okay, there’s nothing really wrong with me, but I’m just so angry.’

This makes me sigh, like an old man waiting in line for his pension. I want to shout at him. Or grab him by his shoulders and shake him. Or just walk away and never return. Our childhood friend is dead. He’s dead. We were all supposed to go to college together. Remember we shopped for our schoolbags together, smoked our first fags together, bought our first smartphones together? And the other day you stared at his body while others were reciting al-Fātihah at his funeral. You are not supposed to be all right!

It then hits me like a chill running through me, colder than the harshest winter in the Valley. A sudden realization that the sun is setting and we can’t remain outdoors after dark. What if he goes too and joins them? What if he, like so many other angry boys, takes up the gun? I am troubled. Do they feel the same when they see the lifeless bodies of their friends, brothers, their fathers, and recall how wide their smiles used to be and how kind their hands? Were they battling the same demons? All this blood and death and boots and this gloom… Did they feel it too, the ones before us? So much anger on those angst-ridden faces and an overwhelming sense of loss… There was a ruckus in the state Assembly over reports that some 200 boys had taken up guns after Burhan Wani. What if he becomes another number in this mindless spectrum of violence? Another hothead sneaking into forbidden territory to train and come back to unleash chaos?

Should I talk to him about it? What do I say? Quote Gandhi’s words about ahimsa? Talk to him about PTSD? He would probably laugh in my face, ignore the worried look in my eyes, and ask me to stop reading all those crazy books. ‘All this crap is corroding your mind. How do you even read these boring theories? What good are they? Attend next Friday’s khutbah, and God might save you,’ his voice rang in my head. This was the last month when the world was still okay and our friend wasn’t in the grave.

Perhaps I should have attended the khutbah.

Why hadn’t he talked to us? Why hadn’t he talked to someone? Why didn’t anyone talk to all those boys? Why won’t anyone talk to us? Where are we supposed to keep all this anger and rage and helplessness? Kashmir, Kashmir, Kashmir – so much noise and confusion over Kashmir, but why there is nobody here right now to tell us what to do with ourselves. How to get out of all this? So many boys would still be here, gossiping in the mohalla square. So many boys. Those who never returned home, those who arrived in coffins, those who had stones in their hands and masksover their faces, those fighting their battles on Facebook, and the lucky ones just glad to have left this beautiful Paradise, our home. So many boys. Shouting during cricket matches, their pherans dangling along their lank bodies, wheezing off on their motorcycles along the tree-lined paths, walking along the bunds, loitering at the kandurwanns. The old-fashioned bread shops have always been the meeting points for the village folks. All those boys with their merry eyes and red cheeks.

Bashir dada’s voice rang in my ears.

            ‘Dai Kher Karus Pot Alau Dis, Ya Ash Dadrai Che Traw Mateo. Yus Sham Dalith Aze Nanworeu, Gare Trewith Koh Kut Darv Mateu.’

He asked me to pray for the boys or to call them back. The old man wanted me to weep for the barefoot boy who had gone away at dusk leaving behind his home, hearth – everything.

Many conflict studies over the years have made it pretty evident that death as a result of wars is only the tip of the iceberg. Armed conflicts have been the ugly constant in history since mankind started calling itself civilized. They have had the most devastating impact on the mental health of civilians exposed to such conflicts. The people in rural areas, women and the young in particular, are usually the worst affected. And a large number of those living in active conflict zones experience regularly traumatic events that result in very severe mental conditions − major depression, anxiety disorder, schizophrenia and PTSD.

            According to a research study on mental health, social functioning and disability in post-war Afghanistan, the disabled and women are perpetually haunted by the ghosts of fighting,

suffering and torture, and have been rendered mere shadows of their original selves, their will shattered by the trauma, their mental health in shambles.

Conflict, violence and physical suffering have brought in their wake a still unheard-of  phenomenon, mental illness, something Kashmir had not been previously familiar with. Recently, a mental-health survey of Kashmir has been doing the rounds of social media. My Facebook friends share it nonstop. The number is growing by the day.

According to this survey, conducted by the medical humanitarian organization Médecins Sans Frontieres (doctors without borders) – better known by its acronym MSF – about 1.8 million, 45 per cent of adults in the Kashmir Valley, have significant symptoms of mental distress; 1.6 million adults, constituting 41 per cent of their population, are living with significant symptoms of depression, 26 per cent having significant symptoms of anxiety related disorder.

And it goes on.

‘Living with’ – interesting words, huh? But in a place where countless people are dead before their time, their shadows loom so large that the living pale in comparison. Their misery, their struggle is barely noticed. So many morgues but not enough places of congregation for the ones who still walk, no one to talk to, no one to listen to, no places for celebrating the fact that they haven’t joined their kin six feet under, except maybe after jummah, to pick up stones and use this asymmetric weapon against a colossal adversary, unfazed or unaware that they may not come back alive or come back only after losing their eyes, limbs, or minds.

Perhaps there is more than I exactly know. Quite a few crossed over to the other side, trained in special camps and returned to wage war. At times, they overstep the line into the unforgiving territory of terror that the whole world is struggling to come to terms with.

I am now ‘living with’ Delhi. There are no chinars here, no blue mountains, no snow-crested peaks, but no guns either. People are different here, the heaviness seems to be lifting a little. But

Kashmir doesn’t leave me – its memories, its pain, the rustle of  the chinar trees…

Your home never leaves you, even if it kills you. A thud anywhere and I freeze instantly. A blast? Firing? A suicide attack on an army camp? Another crackdown? A village circled in for a combing operation? Voices in my head raise an alarm; they make noises. Still my first thoughts, after all these years…

Actually, the only sound here in Delhi is the watchman’s whistle. I remember this day, long ago, back in our village, when crackers were burst by some neighbourhood boys during a wedding, and before this reckless gaiety of the young could transform into an adult, mature disdain for silly things, we saw throngs of people running, shovels in hand, wrinkled foreheads, worried eyes, panicked, women with their pherans across their shoulders, frayed locks, hissing. Blast? Firing? Crackdown? There are no boys in a war.

One of those friends grew up to be a successful engineer in the Middle East, with severe anger issues. I do not know what happened to the rest; hopefully the sound of crackers doesn’t

unnerve them anymore. Yet, it was not the sound of gunshots, tear-gas shells being lobbed, slogans of azaadi or the azaan echoing across the orchards, which comes back to me when I look

back on my childhood. It’s that eerie silence of the nights in my village that still haunts me. No movement, no sounds, no outing after dark. The windows so tightly shut that everyone inside felt stifled. These nights have snatched away so many of our people, ruined our peace and challenged our sanity…Shafaq Shah is a lawyer in Srinagar and a columnist for the Greater

Kashmir newspaper.

PHOENIX NOT JUST A PLACE IN ARIZONA

Sumeet Panigrahi

One

18 March 2017

After almost eight arduous hours, three bottles of packaged water, three glasses of natural water, nearly six to seven glasses of lemon juice, several gulps of aerated drinks, one and a half packets

of Monaco biscuits, three tamarind candies, recurring phases of overwhelming fatigue, several moments of despondent weakness, and a flurry of expletives from my friend-turned-coach Srijit Basu, a cinematographer in Mumbai, I finally complete the ascent and descent of Mount Girnar in the afternoon.

A chilled glass of sugarcane juice, an overjoyed Srijit, and appreciative smiles from Vishwas and Mandvi welcome me at the base. Having gone up to the Dattatreya temple at around six in the morning, we come back after taking short breaks and one breakfast stopover that lasts around half an hour during our descent. That is 20,000 steps: steep inclines and sudden declines.

They say less than one per cent of the people who enter the gates of the Girnar temple go up to the Dattatreya temple. Out of those, most of the people take almost the entire day to finish the

trip, avoiding the harsh midday sun when heat and fatigue sap you alternately.

            But I am not boasting about my feat as an explorer here; this is not even my story. I am just a side character in this odyssey. In truth, it’s the story of Mandvi Garg, a gutsy girl from Haryana. I will trace my own roadshow, started long ago, a while later. Here, it’s Mandvi, the intrepid girl on an incredible journey.

            Mandvi grew up in Hisar. Even before she was 20, she lost her vision due to retinitis pigmentosa. This is a host of eye problems affecting the retina. Now completely blind, the young woman decided to grab life by the horns and live it fully, with meaning and purpose. In the next 10 years, she became an avid mountaineer and went on many treks and expeditions all over India. In March 2017, she decided to do the impossible.

            Here is what she did. With strong support from two sports enthusiasts, Vishwas Bhamburkar and Vishal Chavda, Mandvi cycled from Ahmedabad to Junagadh along National

Highway 47, covering a distance of 346 kilometres in three days sharp, rested for the evening, and climbed Mount Girnar the very next morning.

            Now that you have read about it, do your own math. Mandvi knew Vishwas from before, and she met Vishal after she arrived in Ahmedabad. And then, on 15 March, the three of them

started to cycle on one of the most chaotic national highways in India. Mandvi managed the spectacular rally without any prior training or cycling practice, unlike Vishwas and Vishal; both of them are long-distance cyclists and athletes. Close your eyes and try to walk from one room to another in your house; that will give you some idea about Mandvi’s heroic journey.

Just try it.

Thanks to a few common friends, I got to travel with them to document this event and interpret her determined ride for a larger meaning. I sat behind the camera capturing the blind girl’s triumph.

            On 18 March, I set out with them to conquer Mount Girnar. I realized the toughness of the challenge – 10,000 steps – a little later, and by then, it was a little too late. Here is some

more context: I weigh 88 kg, and that means I am easily 25 kg overweight. I have never worked out in a gym or participated in sports of any kind at any level. I have – here is the most ludicrous

part – never run more than 10 metres in my life. I have trouble breathing after climbing four floors. ‘Unfit’ is definitely an ideal word, but I managed to do this unbelieving feat with all three of them. As one can imagine, I touched the base a good 20 minutes or so later.

Vishwas had run a hundred miles in a single go in Brazil and still remains the only Indian to have done so. Vishal is a born athlete and cycles city-to-city regularly. Mandvi is a trained mountaineer, who carries up to 20 kg of weight on her back and climbs up and down the stairway 200 times at home almost regularly. Srijit has been a swimmer for 28 years now. I, on the other hand, have done none of this and have in fact abused my body, living as a shut-in and a couch potato for years, binging on junk food to keep myself occupied. The maximum number of steps I had climbed was at the Panchalingeshwar temple in Baleshwar as a child. At 30, I possibly might have high blood pressure, which I plan to get checked soon. Acid reflux, unreliable digestion, long phases of ennui, and disenchantment are some of the other aspects of my existence.

So, at a personal level, this was my biggest physical feat. Srijit and Vishwas both asked me how it felt to do what less than one per cent of visitors dared. To be honest, it did not feel like

much, and that I attribute to my anhedonia and general sense of despair combined with my discontent. But that’s not important.

            Here is the important part: it’s never too late to reclaim your life and live it 2.0. All you need to do is just do it. It’s that simple.

Two

Sometime in February 2017

Scene I

I wake up one morning and start to sob. I rush to the washroom, lock it from the inside, bite my hand to stop whimpering, and sob uncontrollably. The sobs come in oscillating waves, hitting me in the depth of my being where the hurt is immense. It lasts for about 30 minutes, and by the end of it, I can barely stand. I finally regain my composure and come out of the dark pit.

Scene II

I am bored. No, it’s more than that. I am disenfranchised in life. Even sitting and breathing seems like a Herculean task.

I see on YouTube the latest trailer of Logan, the last Hugh Jackman outing as Wolverine, flashing on top. I start watching it, and midway, tears start to stream down my face. The trailer ends, and I cry. I cry some more and then – again. I get up, wash my face, and make myself some coffee – black with no sugar.

Scene III

I wake up in the morning after a dream and find myself crying. It’s around 7, and I feel tired. I manage to stop after five minutes. In my dream, I won an award. That was the trigger. The notion of winning an award, probably as a filmmaker or a screenwriter, in my dream made me feel gloomy enough to cry.

Scene IV

It’s YouTube again. In the recommended section, there is a video of Corey Taylor, the frontman of the heavy metal band Slipknot. I watch the video and cry, feeling suddenly overwhelmed. I immediately listen to ‘Iowa’, one of their earlier tracks, and fall asleep. (Yes. That song is sort of a lullaby for me.)

Scene V

It’s two in the morning. I toss and turn and finally wake up. I have been homeless for several months now, having run away from my marriage and my home in October 2016, and will continue to stay in this shelter for another couple of weeks. I have been an insomniac for

decades and moving about the house like a ghost has now become a ritual for me.

I switch on my cell phone and check the table – a packet of cigarettes, some magazines, and the computer. I don’t smoke now, switching the Mac might wake people up, and I have not read a book or a magazine in years. So I take my phone to the washroom and try to masturbate. I have been celibate for more than four months. In this moment, I just want to feel something, anything: intimacy, a surge of passion, a little joy, joie de vivre, an urge to live. Or an

orgasm. Or the worst – an ejaculation, which will result in a small explosion of dopamine. That will be something.

I want to hold another human being and be held. There are three people in the flat, and they are all grown men, deep in their sleep. But I am afraid of being judged. I am afraid of being seen this naked and this vulnerable. So my effort increases and my fingers grip my shaft tighter. I try for ten minutes or so.

By the end of it, I feel the hurt: physical, emotional and spiritual. I am one with the universe, in my profound loneliness. I am one with Sartre, Kafka, Kierkegaard, Nietzsche, Schopenhauer,

Camus, Beckett, Tom Waits, Leonard Cohen, and I am overwhelmed by my own misery. I don’t want to live, and I don’t want to die. I don’t want ‘want’ and I don’t want ‘thought’ or consciousness or existence or nonexistence. I want nothing, and I don’t want ‘wanting nothing’. I am a black hole in the toilet, gaining mass, and I have an urgent, sincere wish to be sucked inside

the commode and flushed out like filth. Or maybe methane. I am the sombre Sisyphean nightmare. I am Mahler’s quartet. I am both my funeral and my corpse. I hate oxygen. I hate humanity. I hate life. I hate hormones. I hate women. I hate eyes and the ache and the mountain that is stuck in my throat. I hate my engorged manhood; I hate its curvature and the fire of lust that rages within, albeit superficially. I hate my small hands. I hate my body. I hate my parents and their small frames. I hate my wife for drifting apart as I sink beneath in the darkness of life. I hate the lack of love. I hate ‘hate’. I hate thought. I hate the word ‘I’.

I get up and sit in the shower. It feels better. I undress and embrace myself, coiling my arms around me. For the first time in 30 years, I want to love myself. Maybe a little. And the

tears rush. They scald my face despite the cold water raining on me. Five minutes elapse and it’s an eternity. I get up, unlock the door and scan the flat: they are all asleep. I take out my clothes

and walk naked to my backpack in tiptoes. I change into a pair of shorts and a tee, drink a glass of water. Next I switch on the Mac and continue to cough for 30 seconds as if it will drown out the boot music. My eyes sting, my testicles hurt, and I want to burn the world for tormenting me. Instead, I open up a document and type nonstop for 10 minutes. I change the alignment to ‘centre’, convert it to a PDF document, and open my Facebook account. I rename it “The Letter”… Sumeet Panigrahi is a Bollywood scriptwriter. He works as a cinematographer as well.

THE OTHER SIDE OF MIDNIGHT

Reshma Hingorani

I graduated in 1981, a medical doctor at last. A few years later, when it was time to specialize, I wanted to get into psychiatry.

‘Psychiatry? Are you already out of your mind?’

‘Psychiatrists are crazy people; or they eventually become loony; okay, even if they don’t go mad, they always look, well, not exactly normal!’

Char bimariyan, char davaiyan, thik kisi ne hona nahin. Kya faida, beta, aisi line pakad ke? Gyne kar lo. Ladki ho, hamesha kaam ayegi! (Four illnesses, four medications, no one gets well

anyway. What’s the point of getting into such a field? Become a gynaecologist. You are a woman, it will always work out.)’

The last one, from my family of course.

And so it was that I got pushed into a politically correct discipline, my wishes be damned.

Years later, after I had switched over from a women’s specialist to a ‘mind’ doctor, what’s the question I’ve had to answer the most? You got it! I finally perfected the answer to that why: ‘to make both ends meet!’

But the truth is, I had an N.D.E. (a near-death experience), and at that precise moment of truth, when I thought I wasn’t going to live, I regretted the fact that I hadn’t done what I wanted to do.

So I promised myself that if I made it, I would listen to my heart. As you can see, I survived! And I learnt my big lesson: if you don’t love what you do, you’ll end up doing what you don’t love, and you’ll be stressed out.

The ‘char bimariyan…’ myth was shattered when the international diagnostic systems began listing hundreds of mental disorders, pharmaceuticals released innumerable medications for the mentally ill, and recovery rates improved sufficiently to ease psychiatry out of the closet, although it still has a long way to go to full freedom. Celebrities have contributed in a big way by

openly talking about winning their battles, and the ones that lost equally brought into focus the hitherto stigmatized area of mental illness.

Why this near-phobia of anything psychiatric? This reluctance to accept mental illness and seek treatment? I found a strange misconception: most people seem to believe that the slightest emotional disturbance is the beginning of the end, that it will slowly but inexorably slide on to the other end of the spectrum, that ‘madness’ is now inevitable (an idea that,  unfortunately, comes from its stereotypical depiction, mostly in movies). The result – denial. It’s like believing that diabetes or hypertension will all end in the dreaded cancer. The most common disorders – anxiety and depression – are just as manageable as any other medical illness; in fact, except for infections and surgery, ‘control’ still remains the norm rather than ‘cure’ in most medical sciences.

And how does one keep the flame of hope alive, while being surrounded by tormented souls? Remain optimistic even in the midst of morbid noises? At times, it overwhelms my coping

abilities, and my inner cobweb zone goes into overheat mode, but the whole process of lifting someone out of their blues is a therapeutic triumph as well.

Let me relive some of those special moments here…

Vignette 1

Zindagi tarq pe nahin chalti doctor-saab, bhavnaaon pe chalti hai… (Life doesn’t run on logic, doctor, it runs on emotions…)’

            With that one sentence, he rubbished my entire lecture. That sentence has often returned to haunt me. And hit me with its truth.

He was admitted in our psychiatry ward for attempted suicide. It’s the same old story. Unrequited love. But he was willing to talk about it. In the presence of medical students. This was unusual since most such patients are embarrassed or ashamed. So I presented him to a group of about 20, all of whom sat in rapt attention, some possibly identifying with him to various degrees, as he regaled them with the story of his passionate love affair, ending as usual with her marriage being fixed elsewhere and him overdosing. There was crying involved, more than a few wet eyes.

He answered all their questions honestly.

And then I went about putting all my counselling and psychotherapeutic skills to good use. As I proudly wrapped up, a half hour later, the audience suitably impressed with my efforts

and convinced that he had been cured of his ailment, I ended with the usual question, ‘Do you feel better?’

            ‘Mere jeen eka koi maksad nahin bacha… Ab ki baar koshish fail nahin hone doonga… zindagi tarq pe nahin chalti doctor-saab, bhavnaon pe chalti hai… (I have no reason to live anymore… This time, it won’t be a failed attempt… life doesn’t run on logic,

doctor, it runs on emotions.)’

            Shocked faces and confused eyes demanded an explanation of what was going on. After getting him escorted safely to his bed, we began deciphering what was going on.

            It was clear that the situation was more of a bereavement reaction than clinical depression. Mourning isn’t always over the dead. It can be over a loss, perceived to be as serious as death – of money, a relationship, one’s job…

His life had centred around her and what they had shared… Not only was he losing her, he was losing her to someone else. His self-esteem was bruised. As soon as he heard the

news, he consumed a mixture of whatever pills he could lay his hands on from their first-aid kit at home. Then, he called her. She, of course, lost no time in informing his family, who rushed him to the emergency, from where he was referred to our psychiatry department.

            There was no pre-meditation – accumulating a lethal dose or adopting a fool-proof method. This was more of a para-suicide, a suicidal gesture, a cry for help that gets labelled as ‘emotional blackmail’. While the intention may not be to die, it is serious enough to merit a thorough evaluation and proper management to prevent repeated attempts, because the risk of another attempt, a successful one, remains throughout life.

            Moreover, he was what gets referred to often as the ‘heart-driven personality’. He was impulsive by temperament, driven to excesses in behaviour, emotionally unstable, and all

these might have contributed to rocky and fragile relationships, not only with his partner but even with family and friends. This would then lead to brief depressive episodes and lability of mood, resulting in some socio-occupational decline, and the vicious cycle would continue, till some form of continued therapy was undertaken.

Take-home message:

Suicidality is an emergency, and in fact, the only 100 per cent preventable death; hence, always an indication for hospitalization. Although very often, it is not always an indicator of severe depression. Suicide attempts could be impulsive acts, resulting from deviant personality traits. Many end in repeated attempts or even successful suicides. All the prescribed precautions must therefore be taken unfailingly, and patients must be followed up with, to see if the mental state settles down or escalates into a clinical depression, which would then invariably require antidepressant medications in addition to psychotherapy and sometimes, even ECT (electroconvulsive therapy).

Vignette 2

            ‘Ma’am, she did it…I wish I’d listened to you…’

            The phone all but dropped from my hand. I was on my way to the conference hall for a lecture…

            ‘Is she…?’ I found it difficult to complete my question.

            She was my colleague’s mother, 69, brought by her to my OPD one winter morning. She was not eating or sleeping well, seemed sad all the time, felt useless and helpless, couldn’t find

pleasure in anything, had no energy or enthusiasm. In short, she displayed all the classical symptoms of depression. It was quite unlike her; for over a month, the elderly woman had not been her usual self.

            During assessment, I asked her about any death wish or suicidal impulses. Two things happened. The daughter gave me a hard, accusing glare, as if I were planting the idea of self-destruction into her mother’s head. And the mother began sobbing quietly.

            Both are very common reactions to an essential line of questioning in all cases of depression. Any explanation of the actual truth, that such ideas emerge from an inner feeling of utter hopelessness and despair when life doesn’t seem worth living, never convinces the caregivers, as also the fact that if not enquired into, one will not be able to prevent their progression into dangerous, life-threatening attempts. On the other hand, the patients

invariably feel relieved that they can talk about it. That someone empathizes. After all, a death wish is a silent cry for help. They feel understood. Like she did.

            Then it all came pouring out. ‘Din mein kayi baar vichaar aata hai ki aisi zindagi se to jaan le lun. (Several times a day, I feel it is better to take my life than be so miserable.)’

            Next, the professor from our medical college broke down, hugging her mother. ‘Mom, why didn’t you ever tell us? Oh my God!’

            Incidentally, her brother, also a medical doctor, lived in the same house. But such is the ignorance about mental-health issues that there is an overwhelming tendency to rationalize any abnormal emotions or behaviour and attribute them to some event, a belief that our locus of control is outside us, and so of course ‘sab thik ho jayega (time will heal everything)’ – that much avoidable suffering continues.

            I advised hospitalization, as would be the norm in all such cases, and met more resistance of the usual type: ‘Psychiatry general ward? Can’t we keep her in the private nursing home?’

            ‘No, she needs constant attention, for which the wards are more suitably designed, plus there will be lots of staff around.’

            My voice was firm. The mere mention of ECT sealed the issue. It was a perfectly safe and ideal procedure, especially for her age and severity of illness, with definite rapid results. Many

phone consultations later, the family’s collective decision was that they would do all that was necessary at home, her dad and brother would manage, and she would visit frequently to be monitored.

            No amount of convincing helped, and I wrote out the standard protocol, the antidepressant medications, no sharp or rope-like objects around her, 24x7 observation, supervised medication delivered by family and so on.

            And then, the phone call came.

            All seemed to be going fine; the old lady was improving. Then one early winter morning, as the husband dozed off briefly (how much energy does one expect from a 75-year-old?), she quietly slipped out, and leaped off their second-floor balcony.

            ‘Is she...?’

            Yes, I had found it difficult to complete my question.

            Through broken ribs and many other broken bones, through many surgeries and a prolonged ICU stay, that die-hard spirit miraculously defied death and tempted me to believe in

fate. And finally, she made it back to my OPD many months later. All smiles, a little bashful, extremely grateful, but all in one piece. And peaceful!

            Meanwhile, I had helped her doctor children cook up a story about a seizure leading to her accidental fall, which she was told since she did not have a complete recall of the whole event.

            Everyone’s face was saved.

            The stigma did not stick.

            But I have questioned myself several times since: could I have pushed harder? Where does one draw the line between respect for a doctor colleague and asserting firmly as a professional?

But retrospective wisdom should not lead to guilt. It only serves to guide future decisions in similar situations.

Take-home message:

While sadness is a normal and universally experienced emotion, one must get assessed if it becomes persistent for at least two weeks, and pervasive over different situations in life, like home, work or society. This is required to decide if it has developed into a disorder called ‘depression’. Clinical depression can be self-limiting, but it is so easily treatable with medications, with very few side-effects and very good recovery rates that it is imperative that one cuts short the agony and nips it in the bud, preventing its progression into a more serious illness. Unabated, it is fraught with risks of self-harm, requiring a much more rigorous treatment and for a longer duration.

Vignette 3

Doctor saab, hamare inka ilaaj to bas aapko hi karna hai. Hamare padosi bhi aapke under bharti hokar gaye thhe – pehle se bhi jyaada achhe ho gaye!’ (Doctor, you have to treat my husband too. Our neighbour had been under your care – he became even better than before!)

During morning rounds, this woman walked up to me. Turned out, she’d been specifically asking for me in the OPD and got directed to the ward, since our unit OPD was the next day. Many accompanying staff members nodded in appreciation!

Doctor madam bahut acchhi hain. Wait kar lo – round ke baad dekhengi. (Our doctor madam is very good. Please wait – she will attend to you after the rounds.)’ The nurse took charge of the situation.

Was I flattered? I couldn’t be, having immediately realized what had happened. The gentleman in question, her neighbour, had been admitted with severe depression, had recovered, and apparently had become very cheerful, talking and laughing a lot, and seemed full of energy. She said it was almost as if ‘his motor had been changed!’ He wasn’t like this before his illness. She thought I had even changed his personality for the better! I wish I could!

Well, his motor had surely been changed, in a manner of speaking. He had probably switched into a manic state. I asked her to make sure he came back for evaluation to my OPD along with her and her husband. It was important for me to find out why it had happened: was it an oversight of our team? In any case, we needed to clarify the diagnosis and modify the management plan immediately.

One of the risks with every patient of depression is of the condition actually being bipolar disorder, where depressive episodes alternate with manic episodes, where ‘the motor reverses’ –

there is hyperactivity, excessive talking, laughing, increased energy levels, grandiosity, reduced need for sleep and appetite – almost the exact opposite of the depressive picture…Dr Reshma Hingorani, a former Chief Medical Officer at GB Pant Hospital, Delhi, now practices in

Maryland, USA.

I FOUND MORE ROPE

Ateendriya

You’re nine years old, wedged between your parents on the modestly large double bed. In the morning, you complained that you’d like a room of your own, like your brother has. Come next morning, you’ll complain again. But all through the night, you’ll grab onto a bit of your mother’s dress as she sleeps with her back to you. All you can think about is your parents dying.

You don’t want them to die.

You can’t voice this absurd, untimely fear as you cry yourself to sleep, the tears rolling sideways down one cheek. It feels uncomfortable, all that salt water pooling on the pillow under your left

cheek, but you don’t have the heart to let go of mother’s dress. So you close your eyes and go to sleep; the nightmares follow you. In the morning, you have the memory of that hollow fear you felt in the dark, but you cannot, for the life of you, access that feeling. You know it’ll come again, come night. You dread it; but you can’t tell anyone.

They’ll think you’re insane. They might just laugh at you.

You’re 13 years old, on a school bus. You’re relegated to a corner, because the kids don’t really like you. You don’t care. You clamp your teeth shut, take out a bit of your frustration with the world on your jaw, and look out the window. You think about the classes. You think about homework. You think about the 3rd period test. You try not to think about recess.

You’ll have to find a corner that people won’t stumble into. It’s a daily dance. Your strategies need modification every day. If recess is outdoors, as usual, you will linger in the classrooms and

hallways. Until a janitor or a cleaner or a teacher finds you and commands you out to where everyone else is. Then you’ll find a way to give them the slip and look for a different spot, away from the kids. If it rains and recess is indoors, you’ll find an empty stall in the washroom.

Come recess, you botch up the execution of plan A and plan B, even the contingency plan. You take a look at your lunch box, throw out the food, and make your way to the library. You can sit

there as long as you don’t eat.

You didn’t like what your mother had packed anyway.

You’re 15, standing on the edge of the terrace, looking down, wondering how many limbs you’ll break if you take the plunge. You don’t want to end up mangled yet breathing. It’s just three

floors; there’s a good chance this will not kill you. You wish you lived in a taller building. You think of other strategies. Something full-proof. At this point, the only thing worse than dying would be trying and not dying. You don’t want to set yourself up for that lifetime of mockery.

You think about leaving a note. So that people don’t assume that you died for something silly, like exam results (which is why you’re doing this before the results are out) or a boy or a girl.

What would you write?

I decided to die when I was writing my board exams.

I had already begun studying for them, so I thought

I might as well see it through. But I see no point in

continuing. Life is tiring, and I’m exhausted all the

time. I don’t really enjoy it much and the cons outweigh

the pros.

You read it and you’re pleased. This is exactly what you feel (which is mostly nothing), and it has come out sounding right. Sounding mature.

You end up not jumping, in the end. You decide that it is too much of an active decision. You decide to let life play itself out. [Maybe you were scared. You don’t want to admit to that cowardice.]

You’re 17 and you’re reading a chapter on torque. You’re texting the closest thing to a best friend you have about how badly your physics teacher had explained stuff because, honestly, you’re reading the Resnick and Halliday chapter and this is so lucid. You absent-mindedly run your fingers over the scabs on your left arm. They’re almost… beautiful.

Your mother walks in with snacks and you pull down your sleeve in a rush. You accidently knock something over. As your mother picks it up, she says in the passing: Isn’t it too hot for full-sleeves?

You just shrug.

You started cutting yourself a few months ago. You hide the scars as best as you can. Not because you’re ashamed. You’re not. You’re rather proud, in fact. People misconstrue cutting. You don’t do it because you want to die. You do it because you don’t. It takes the edge off; it makes you feel in control. It gives you an alternate pain to focus on. Sometimes, it is the only thing that can tell you that you’re still alive.

Once, someone who noticed the scars asked if you were suicidal. You laughed and said, ‘Dude. I’m not stupid. Do you see how far from the veins these cuts are? What do you think, I keep missing the wrist accidently?’

They laughed. You laughed. You both thought it was pretty funny.

You’re 19 years old. You can’t breathe. The walls feel as if they are closing in on you; your claustrophobia is not helping. You stare at the ceiling, imagining it shrinking by the second. You’re hemmed in, bricked up – all alone in a dark cell. Cabined, cribbed, confined – the haunting line from Macbeth unfolds its full meaning for you.You want to shout, but you don’t want to wake up the entire house. You thought you had things under control, but you clearly

don’t.

That night, you try to break down the walls of your room with your hand. You. Just. Want. To. Breathe. So you ram your fists against the wall until your fists are bruised and bleeding. Without

realizing it, at some point, you start crying, then howling, screaming for someone to let you out.

You just wanted to breathe.

Your mother hears you from the other room and comes running. She is mortified. She holds you back as you struggle against her, against the wall, against your lungs that are threatening to collapse. Your mother worries that it has something to do with your arrhythmia, but you eventually fall asleep – drained.

No one speaks about it the next day. You cross your mother in the hallway and look her in the eye, and you’re thankful that she doesn’t bring it up. If she did, you’d want to die.

You’re 21 and alone in your apartment. You love living alone. The silence that comes with it is exhilarating, because honestly, living with people can be so trying. You love being away from voices all the time. Until you realize that you’re not… away from voices.

The first time you start living alone, you realize two things – that it is the life for you; and that you cannot have it. Not because you are scared, or lonely, or incapable of handling it. But because as the day settles and you shelf your work for tomorrow, the voices in your head come crawling out of the woodwork. A stray whisper here, a din there, a hiss outside the door – you go so close, so perilously close to losing your mind. You’ve seen the edge. And it’s scary as hell, because through all your years of senseless emotional shipwrecks, you had at least been sure that you were just sad, cut off, not raving mad. Now, you’re not so sure anymore.

Reality starts to slip – a rip here, a crack there.

You open your laptop and put on an episode. You don’t even notice what show it is; you just want those voices to drown. You drift off to sleep with dialogues blaring in the background.

You’re 22 and back at home. You’re running through your contact list to see if there’s anyone you could call up. You realize you don’t. You have friends who are unaware of this side of you. You have friends who think your afflictions are fabricated. Imagined, not real. You have friends who tell you that you are wrong about your own illness. Even worse: you have friends who don’t react well to words like depression and bipolar. They think these are cool tags that you’re using to one-up them. They get pissed off when you tell them they’re wrong.

You just don’t understand. Who would think this covetable? You think: You want it? Take it. I’ve been trying to get rid of it all my life. Finally, you call up the one person you think might care. You tell them: I’ve hit a wall. You tell them: I need help. You realize this is the first in your life you have used these words.

You hear nothing from the other end. You wonder whether this was a mistake. ‘I don’t know what to say to you,’ the voice at the other end murmurs. You realize this was a mistake. You were told if you wanted help, you should ask. You took up this advice for the first time in 22 years and your cynic was proven right.

You hang up. What else can you do?... Ateendriya, who read English Literature and Linguistics at Delhi University, works in publishing. Her short story, “The Final Cadenza”, won the first prize in a Juggernaut short story contest in 2016.

ALONG THE SHADOW LINE

Pallav Bonerjee

A young woman, a trainee in a big corporate house, said something during the course of her treatment that gave me an insight into the general perception of mental health and illness and the issues it encompasses. During a counselling session, she told me that the company she worked for had an inhouse mental-health professional available to the employees for consultations. Hearing this, I was a little surprised. ‘Then why do you come to me?’ I asked her. ‘You could very well consult the doctor in your office.’

Noticing my puzzlement, the corporate trainee smiled and went on to narrate something that had elements of Franz Kafka’s The Trial in it. A senior executive of her company had often

consulted the psychologist in the office. He was seen walking into the doctor’s clinic quite regularly. His performance appraisal by the HR for that year was damning, and he was fired on the basis of that. The management apparently thought that since the executive was so stressed out on his personal front, he would not be able to meet the targets set for him.

Hearing this, I was both shocked and amused. Some amount of stress or anxiety surely would not have stood in the way of the executive’s satisfactory performance? It became equally clear to me why this young woman was consulting me instead of the doctor at her workplace. My client could perhaps guess the question bothering me. Since that incident, she said, people in her

organization had chosen not to consult the in-house psychologist anymore. They looked elsewhere for help. The well-publicized initiative by the corporates and the MNCs to promote mental health of their employees, I now knew, was nothing more than tokenism.

The stigma attached to mental illnesses has perhaps something to do with our social psyche. There is a certain amount of morbidity associated with mental health in our culture. This inhibits a person needing medical support from approaching a doctor or talking about his problem. The old idea of a lunatic asylum as a refuge for the insane still evokes powerful negative emotions and images, conveying a sense of dread and loss. The notion that it is a dungeon from where no inmate returns still seems valid. Despite the sweeping changes and technological breakthroughs, somehow, the image has stuck with us. Most people find it difficult to

look at it from any other perspective, even though we no longer use terms like ‘asylum’, ‘insane’, and ‘inmate’, at least within progressive medical communities. That this horrid image persists is

perhaps not without some basis.

An important fact I came across during my post-graduate training has stayed with me. Mostly, the psychiatry departments in general hospitals are situated in very inconspicuous and

obscure corners of the building complex, like the basement or the rear. The reason? To keep this malady and the abnormal air around it as far away as possible from public attention. It seems

the hospital itself is ashamed of having such a department, an embarrassment that needs to be pushed behind, as if the psychiatric ward were an indecency the authorities are trying their best to hide. In fact, some are located right beside the forbidding morgue with the seemingly bizarre logic that the screaming mental-health patients will not be able to vitiate the hospital atmosphere from the back of the beyond.

The concept of treatment for people suffering from mental illnesses has undergone a sea change, thanks to the advent of modern drugs and research on effective psychotherapies and other

non-pharmacological therapies, which are accessible and affordable in most healthcare setups in the cities today. Unfortunately, people are very quick to judge an individual as mentally unstable

if they happen to mention that they are seeking treatment or help for their emotional issues. What baffles me is the lack of understanding among a rather large number of educated people that not everyone seeking such help actually suffers from a severe mental illness or needs immediate hospitalization. Everybody seeking psychiatric treatment, we need to understand, may not be a threat to themselves or others. Such incorrect perceptions promote fear and ignorance and only add to the barriers of seeking help for people who genuinely need it.

Interestingly, the greatest and the most profound learning for me, as a clinical psychologist with some years of training and practice, was not the mere knowledge of the different forms of potentially debilitating mental illnesses and their treatment approaches but the simple fact that all of us are vulnerable to it. This realization itself was liberating for me. It made that bold line dividing the normal us and abnormal them disappear for good. It helped me see that I was not immune to it, nor was anyone else around me. It suddenly put everyone on an even keel, and the matter ultimately boiled down to who was sitting on which side of the table on a given day. Unfortunately, many of us may not be able to appreciate this fact entirely, at least not yet.

A tradition that has always hero-worshipped the brave warrior riding a white horse may not offer enough space to those suffering from mental illnesses. Persisting prejudices lead to discrimination

and isolation of such people, adding to our fears and acting as a major barrier to seeking help. For many people, it is unacceptable to seek treatment for anxiety, depression, and a host

of other common mental illnesses – first for the refusal to accept that these are ailments worth treating and then the fear of being exposed, isolated from their families and communities. The

lurking apprehension of being cast aside and ostracized by those around stands in their way of reaching out to the doctor.

In the absence of adequate information about these conditions, dark beliefs and superstitions sneak in. Our culture leaves spaces for prejudices to grow. There is a notion that mental illnesses

are a consequence of bad deeds in the previous life, that they are an expression of demonic possessions and, therefore, need a ghostbuster to exorcise the evil inside the mind. The hugely

popular movie The Exorcist brings the trauma and tribulations of the possessed to a superb effect. Many mentally ill people go to faith healers and herbal doctors for help, without understanding

that their ailment is a simple case of depression and treatable with some medication and therapy. In the popular perception, the mental hospital is the kind of blind alley from where coming

back is not possible. Families, therefore, take the mentally ill to a fakir, pir, shaman, or Baba, claiming that the affected person has come under some evil shadow. In a conventional society, the fear of being stigmatized as mentally ill is real. For such people, the mental hospital is the last option…Pallav Bonerjee is a Consultant Clinical Psychologist at Vimhans Hospital, New Delhi. He has a Master’s degree in Applied Psychology from Calcutta University and an MPhil in  Clinical Psychology from the Institute of Human Behaviour & Allied Sciences, Delhi.

PHOTO ESSAY

It is almost impossible to capture the images of mental illness on camera. It is something not really visible. A severe breakdown may perhaps leave a trace, but not depression, a sadness that no one recognizes as a malady. And there are an endless number of such invisible maladies.

Our first thought was to drop this regular section where we carry pictures in keeping with the theme of the number. No doctor can help you, one of them explained, for confidentiality is the basis on which their relationship with a patient grows. The hospitals would not even hear of such an idea. And at the same time, the visuals or

the sketches we carry to give more layers to the chosen theme are something the reader has become familiar with, grown fond of. So, we found a way out.

We brought together a few who, at various stages in their lives, have been treated for depression, bipolarity, psychosis and so on. They did not actually pose for the camera; they let the photographers do their work. They were conscious that their private moments were being clicked away.

In some cases, it is the lensman’s perception; they caught someone unaware; perhaps they saw a glimpse of the illness in a moment. You need to see the images from their prism, for there is no way of confirming, vouching for the images. Look at them closely – those anguished faces, faraway looks, their puzzlement with the

world around. Let them be etched on your memory. They live among us. Soon, you will see more of them at bus stands, at the workplace, or on the balcony right across yours, looking into a distance we cannot measure…Sangeeta Purkayastha

BEHIND THE MASK OF NORMALITY

Ira Pundeer

A preschool child, ready in my neatly ironed uniform, I could not leave home in the morning without howling for my mother. That is one of my earliest memories. I remember exactly the thing about school that scared me – the din of the children playing among themselves; all of them played but not me. I would block my ears to keep the noise out; the screeching of the school bell drove me nuts. I used to flinch at the thought of physical touch with other children and adults. I remember sobbing inconsolably at being forced to hold hands with a classmate.

To my utter horror, my teacher retaliated by openly deriding me for being a ‘snob’ and benevolently whacking some ‘sense’ into my big head. Naturally, I became a target for bullies. I was tormented for weeks by a girl who would quietly pinch me from under the desk for a little pleasure. By then, however, I had grown remarkably well in suppressing my outrage and saving the sobs for later. I was not going to be the one to complain.

School was no longer the place to learn and express myself. The few hours I had to spend in school were torture, enough to set me off in a flurry of anxiety for the rest of the day. The struggle to make it through drained me out and left me irritated. I was one stressed-out kid. I started dreading school, begging my mom to let me stay at home. Everyone thought I was lazy. But whatever said and done, I desperately wanted to blend in, not stand out, just so they would leave me alone. To avoid the risk of being misunderstood and punished, my five-year-old self was forced to bottle it up and learn to ‘behave’. And I soon became wonderfully adept at doing just that.

At the end of the year, I managed to pass with decent marks. My teacher signed off my progress report with a few remarks on how I was painfully shy and constantly nervous, but nevertheless very ‘well-behaved’. My parents sighed in relief. They could probably have paraded me as a triumph of disciplining in Indian schools.

These days, I joke about it by saying that it was a traumatic start to my lengthy acting career.

On a summer night in Delhi in 2009, I sat on the floor of my bathroom, exhausted and burned out. I could feel a constant stabbing at the back of my head, which made me writhe in silent agony. I lashed out with my fists, attempting to dent the cool off-white tiles. The self-stimulated physical anguish was distracting, to say the least. Screaming would have been less painful, the familiar flapping of the hands would have been the most comforting, but I would not have allowed myself to regress. Moreover, I did not wish to wake up my roommate who was sleeping in the room outside. What would I say to her? How would I explain that I was not trying to hurt myself, just looking for an outlet? I did not have the words to explain what I was going through. Did I even understand what was happening? Once you show the propensity to self-injury, nothing you can say will let them trust you with your own body. Were they going to put me in a hospital? Would I end up institutionalized like my brother? It was a Monday and I had the whole of the week ahead of me, with no idea how I was going to make it through.

I managed to recover in a few days and continued with my classes as usual. But it turned out to be the year of doom as the spectre of relentless exhaustion and anxiety followed me wherever I went, leaving me tongue-tied, aloof, and constantly paranoid. That summer, I spent far too many nights on the cool, pale tiles of my bathroom.

‘Don’t be too harsh on yourself.’

When everything else had failed, I found my 17-year-old self in the large and airy room of the private clinic of a renowned psychiatrist in my hometown.

Ever since my brother’s diagnosis of autism more than a decade ago, this man had been godsend to our family, the interpreter of its maladies. That was the reason my mother had dragged me to

his clinic when the chips were really down. In a nutshell, here’s what had happened: Being home for the autumn break from my first year of graduation in Delhi, I had told my parents about my

decision to not go back. I told them that I had made a mistake in choosing my subject. I felt like a misfit. I did not tell them about the cool bathroom tiles and the muffled sobbing at night. I

did not have the courage to suggest that I perhaps need help. My mother, who had always been particularly sensitive to my pain, detected some kind of a warning signal in my desperate words

and managed to convince me to see the psychiatrist. This, she thought, would help me start a conversation to unburden myself.

Even though I should have been comfortable talking about my emotional breakdown to a professional who was there to help, I could not keep away the nagging suspicion that I would sound like a complete wimp. I loathed the idea of someone coming to know about my vulnerabilities. Big girls, after all, don’t cry.

Going through the session with the psychiatrist, I wondered if the good doctor was being sarcastic, a little dismissive hearing my tale of woes. By any chance, did he get it? He wore an impenetrable smile all over his face, like a face mask. Do all doctors wear masks? I toyed with the question inside my mind. I had a feeling that he was perhaps being condescending to me.

As if he got a hint of what was going on in my mind, the doc smiled genially. ‘Stop worrying, you’re doing just fine.’

In the summer of 2009, I moved into a paying-guest accommodation on North Campus, Delhi University, to pursue a graduate degree for the next three years. It was a change I had really wanted, but for which perhaps I had not prepared myself well enough. Being in the constant company of people who did not know me well was debilitating in that I could not be myself in front of them. I had always known that flapping hands was considered to be a sign of stress and tension, and a regressive habit too. This habit from childhood, I had learnt, one must give up. No one had ever told me that this was my way of stimming, which is a coping mechanism that people on the autism spectrum use in order to counter stress. It was meant to be pleasurable and not something to be detested and repressed. Being ignorant about my own needs, I tried to suppress the one thing that allowed me to put up with the rigours of everyday life.

The year I was born, my brother was diagnosed with autism. My parents were naturally shocked and worried about raising a child with this life-long condition that they had no clue about. These

were the early 1990s, mind you, and research on mental-health issues was not a just click away on the Internet.

For a very long time, my parents dismissed my habit of stimming and repeating words – echolalia – as something I did mimicking my brother. After all, young children do pick up habits from their elder siblings. They thought it was just a phase that would pass eventually. And pass it did, at least in the public eye. As I grew older, I learnt to camouflage my stimming into more inconspicuous and loud expressions. Growing up in a household that was so used to my brother’s stimming, my minor deviant behaviour never stood out as being particularly odd. What was there to worry about? I was not loud and aggressive like my brother. I was just the typical child, though a little shy, awkward, and anxious…A freelance editor and researcher, Ira Pundeer writes on invisible disabilities. She lives in Delhi.

LIVING WITH SCARS

Nikita Sailesh

We’re all survivors, with scars from different battles. Maybe yours run deeper, or perhaps they don’t. It doesn’t really matter. Scars aren’t medals. They’re just reminders. Reminders of your battles, my battles. They’re not a yardstick to draw comparisons of strength, nor do they speak of

your valour. They’re just a part of you, like any other.

But don’t be mistaken. I don’t mean to trivialize them – your scars or mine. For all their ugliness, they are beautiful. They are there because you went through something. It’s just that ‘something’ that interests me more than the scars themselves. I don’t want to admire your scars from a distance; I want to know how you got them in the first place.

I hope one day you will share this with me. Like I am sharing with you how I got mine. Maybe we could sit together, sipping cups of tea, tipping off ash from our cigarettes, and laugh

about them – our battles.

I suppose the signs were there from an early age. I was an unusual child, who would keep to herself mostly. I didn’t have that many friends at school. I was an atypically imaginative child, who would make up stories to amuse herself. I guess everyone thought I was an introvert. The anomalous spells and the bouts of sadness hadn’t revealed their presence up until I was older.

I was 18 when I had my first brush with the debilitating ‘disease’ called depression. I had just written my board exams and was soon to join college. To be honest, I didn’t have anything to

be sad or depressed about. But this is the funny part about depression. It doesn’t knock on your door, and ask you for permission to step inside. It doesn’t give you any reasons for its sudden visitation. Like an unwelcome guest who will force his way through the gates of your mind, it will come down on you suddenly, forcefully and will never give you a departure date.

I remember how my life had turned upside down for me. How I was scared all the time, too scared to enter a classroom full of students, too scared to talk to anyone, too shaky to even

make eye contact. I was anxious all the time, about nothing and everything. I had lost interest in eating, and sleep was hard to come by. I’d lie awake all night, engulfed by fear, too nervous to

face the next day. When the next day did come, I was too afraid to step out of my house. Never before had I felt the utter helplessness that I was feeling then. I was consumed with despair and a

certain despondency that is hard to comprehend, and even harder to convey. I didn’t know what to do. Luckily, my parents noticed that something wasn’t right and sought help right away from a trusted doctor.

Dr K agreed to see me. I went with my parents, and as soon as I sat on the chair in front of him, my eyes welled up and the tears didn’t stop. He smiled and politely waited till I was done. Then he simply said, ‘You’re depressed. And guess what? Depression is like a flu. It’s common. And you have to take medication for it, just like you do for the flu.’

Dr. K had so simply broken down the big fat monster that depression was for me, into something as common, as trivial as a flu. Fortunately, I bought his explanation and views. Unfortunately, the world does not hold the same view.

You see, the world was never the same for me once I was diagnosed with depression. Living with depression is like living with a cruel stepmother who is out to destroy you, to break you. I struggled for years, with bouts of anxiety and immense sadness that would go on for months

with no sign of clearing out. There were periods of normalcy, when I regained my confidence,

but for the most part, I was constantly afraid of the next time the unwelcome visitor would come by. Those months of being depressed were the worst, not only because they would take away all the happiness and joy I had, but because they turned me into someone completely different – a total nervous wreck who could not get anything done, talk to people, or even function normally.

I still remember the time when my apparent breakdown had just begun. I was new to a job that I’d dreamt of for a long time. It was exhilarating to be in that position, to be in that office.

It felt like I had finally achieved something after a great struggle. But slowly, I began to feel uneasy. The pressure to perform was provoking the anxiety that I had tried so hard to keep at bay. I began to mistrust my surroundings. I began to mistrust my peers, my seniors. I began to doubt myself. I soon found myself in a situation where I felt incapable of doing anything. Fear had set in, surreptitiously but surely. I went into a spiral, with every disturbing thought leading to another set of destructive thoughts. I couldn’t do anything to stop it. Finally, I decided to quit my job. I lost my sense of independence and with it, my sense of being.

This has been the story for almost three years, with me not being able to find my footing, being unsettled, and switching from one job to another. The funny thing is, depression can often

make you feel like you’re at fault. Like you’ve done something wrong. Like you are letting down yourself and others by being ‘sad’ or ‘unstable’. You often blame yourself for not being more

‘together’. In extreme situations, you feel so low and lost that you start hating yourself. Self-loathing and self-destruction go hand in hand. When things are bleak, your natural response is to give up on yourself. It’s easier to do that…Nikita Sailesh is an advertising professional

in Delhi. She is also a Western contemporary vocalist.

PSYCHOTHERAPY IN THE TIME OF THE VEDAS

KK Aggarwal

Long before Freud, and millennia before talk-therapy was even coined as a term, a man, full of insights into human situations, counselled a reluctant prince – a brilliant warrior – to take up arms and get back into the battle. After this counselling session, the young man got over his melancholia and overcame his dilemma about fighting and vanquishing members of his own clan. He had been convinced by his therapist that the battle at hand was not an ordinary one, but was meant to defend dharma, to reinforce the moral order.

Krishna, in the true sense, was the first and perhaps the most celebrated counsellor, whose sessions with his patient, Arjuna, not only led to his spectacular recovery but also constituted

one of the most revered ancient texts, the 700-verse Bhagavad Gita.

The history of psychiatry in India begins with Sri Krishna’s successful counselling of Arjuna before the 18-day battle of the Mahabharata. This raises a valid question: how did the ancient

Indians deal with mental conditions, personality traits that were not ‘normal’? At a time when there were no psych drugs or mental- health professionals accessible on Justdial or LinkedIn, what was society’s response to depression, bipolarity or an extreme form of anxiety visible in someone?

The Sanskrit epics seem to have offered a few answers. The Mahabharata itself is full of pointers to such issues of psychiatric dimensions. Did Shakuni come under the shadow of evil, someone

unable to bridle his wickedness? The Kaurava crown prince Duryodhana clearly displayed the Freudian id – strong instincts ungoverned by a superego. He knew he was nowhere near Arjuna and Bhima in terms of valour and heroism. The inferiority complex that drove him to do evil deeds has a clear psychological explanation. Torn between fighting against his relatives and his

‘sacred duty’, or dharma, to fight the battle of the Mahabharata, Arjuna went to Sri Krishna for counselling. His symptoms were clearly those of melancholia.

Of course, the Vedic Indian did not know about antidepressants. But it was a time when the bucolic environment – woods running along the riverbanks, deer prancing around, peacocks

strutting close to the courtyard – had its own way of healing the bruised mind. The Bhagavad Gita is largely read for spiritual guidance, and it has drawn the attention of many modern-day

philosophers as well, but it is also possible to look for psychological insights in this sacred text. With twitchy, sweaty palms, frozen limbs, goose bumps, and a whirling mind – signs that point

towards depression with acute panic reaction in medical terms – Arjuna sat through 18 sessions with Krishna.

Today, the Diagnostic and Statistical Manual lists over 400 mental, neurological and behavioural problems. Feeling anxious, fearful, sad, confused or forgetful is quite natural, but when a person’s

emotions begin to govern every waking second of their life and disrupt their day-to-day activities, it is quite possible that the person is suffering from a mental illness. The greatest challenge

psychiatrists face is to determine which of the many illnesses the patient is suffering from.

Today, there is an assortment of drugs available that nourish the mental health of an individual. The prescription differs from person to person, of course. However, the case wasn’t really

so a few decades ago.

In the Vedas, the mind has been conceived to be the instrumental aspect of the soul. There is ample emphasis on the prevention of mental pain or depression in these ancient scripts. In the Yajurveda, the mind has been theorized as the inner flame of knowledge, the very basis of consciousness. Thoughts spur from consciousness and are analysed by the intellect. The ego transforms the thoughts into actions, which lead to memory and in turn, to desire. This

cycle becomes your habit and by extension, your personality. As you think, so you become. Disconcerted thoughts, however, often lead to pent-up frustrations that lead to aggression. Either

you gulp it down and become passive-aggressive, or you spit it out. While the stored anger manifests itself in sudden outbursts and physiological ailments such as acidity and heart diseases, the exposition of rage results in crimes, high blood pressure and heart attacks.

The Vedic approach to mental health focuses on controlling your mind, intellect, and ego. Lord Shiva presents a very Vedic way of anger management. Whenever you are filled with resentment, store the negative thoughts in your throat (neelkanth). After some time, think about the issue at hand with a cool mind (the moon and the Ganga flowing from Lord Shiva’s matted hair). What the Vedas really depict is a holistic way of managing emotions. Had Duryodhana controlled his jealousy or Shakuni sought counselling for the malevolence that his mind bred, the Mahabharata would have been a very different epic, heroic but ot so tragic…An eminent cardiologist, Dr KK Aggarwal is the current president of the Indian Medical Association.

OF THE MIND AND ITS MALADIES

Rajesh Sagar and Ananya Mahapatra

‘…because wherever I sat – on the deck of a ship or at a street café in Paris or Bangkok – I would be sitting under the same glass bell jar, stewing in my own sour air.’

– Sylvia Plath, The Bell Jar

Sylvia Plath, the celebrated poet and writer, was formally diagnosed with depression at the age of 20, and barely a decade later, she took her own life. Her works, including her semi- autobiographical novel, The Bell Jar, poignantly describes her mental anguish as a shroud of darkness gradually consuming her mind and colouring her perceptions in dismal shades, finally stemming the flow of her young and promising life.

The afflictions of the human mind have been a subject of deep inquiry over the ages, fascinating scientists, spiritualists and philosophers alike. They have been intrigued by the inner suffering

of humans, which may be at variance with a person’s material situation. The whole idea of mental illness has evolved over a long period of time, and it is an interesting story in itself. The definition of this malady has changed with the changing definitions of what is considered normal and abnormal with the passage of time. Throughout history, there have been paradigm shifts in how the mentally ill are treated and cared for, in concert with the changing societal views and knowledge of mental illness.

In ancient times, mental illnesses were explained in terms of various supernatural phenomena ranging from punishment for the evil deeds done in previous lives to demonic possession. As a consequence, the mentally ill individuals were subjected to various punitive practices. Around 400 BC, Hippocrates made an attempt to tease out the supernatural and socio-religious views from medicine by proposing that a deficiency in or an excess of one of the four essential bodily fluids known as ‘humours’ was responsible for physical and mental illness. He proposed that there were four fluids in the body: phlegm, blood, yellow bile and black bile, and that the variations in the levels of these fluids were connected to changes in people’s moods. It was the first attempt to bring mental afflictions into the realm of medicine – the idea that they were illnesses that happened to people, not conditions caused by one’s own doing. Thereafter, through the Middles Ages, mental illness was believed to result from an imbalance of these humours.

Since then, medical science has tried in various ways to unravel the aetiology of mental disorders. Scientists have tried to look for an answer as to what causes the machinery of the mind to break down under stress. A whole lot of explanations are offered, starting from ‘wandering wombs’ resulting in hysterectomies being performed for women suffering from ‘hysteria’ – an ancient

catch-all phrase for emotional or mental-health issues pertaining to women – to various infective causes, weakness of the nerves and so on. In contemporary times, mental disorders are attributed

to a web of factors – genetic predisposition, early childhood experiences, and psychosocial stresses among them. It is only now that scientists have learned to appreciate the complexities underlying the functioning of the mind and the futility of trying to simplistically explain its dysfunction.

While the brain is concrete, made of flesh and nerves and cells visible to the human eye, the mind is an amorphous concept, invisible as well as invincible to the traditional methods of  studying the human body. However, the functioning of the mind is vital to the functioning of the human body. Even Ayurveda takes due cognizance of the individuality of manas (psyche) and sharira (body) and their intertwined dynamics in the functioning of the human body. However, the limited knowledge of the ‘mind’ handed down by traditions poses a Herculean challenge to the scientists who have attempted to systematically study mental disorders and subsequently find means for treating them. As one of the earliest treatises of human afflictions, Ayurveda probably made the first attempt to classify mental disorders based on dosha types.

The formal classification of mental disorders in contemporary medicine began in the late 18th century, with the European diagnostic systems beginning to describe different temperaments

and patterns of behaviour in psychiatric terms. Most physicians during this time were focused on observing and describing the behavioural phenomena of the mentally ill. Meticulous observation

and cataloguing of symptoms as well as following their course diligently over the years have yielded the present classification systems − ICD (International Classification of Disease) and DSM (Diagnostic and Statistical Manual) – of mental disorders, which are used to diagnose mental disorders and as a standard reference for physicians. With improved understanding and rigour of scientific studies, these classificatory systems have evolved over time and become more comprehensive…Dr Rajesh Sagar is Professor of Psychiatry at the All India Institute of Medical Sciences (AIIMS), New Delhi. Dr Ananya Mahapatra is a Senior Resident at the same institute.

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