Musings of an Indian Psychiatrist

A new study suggests the phrase ‘like father, like son’ also applies to drinking habits. US researchers took more than 4,700 teenagers and their parents, and asked them about their relationship with alcohol. Generally, the researchers found parents’ drinking levels were linked to those of their teenagers. But there was more to it than a simple case of copying, with many seeing their parents’ drinking as a sign of lax parenting.

This was a report from Newsbeat of BBC dated: 13 Feb 2008. I have already written about the monumental waste that alcohol is.  I was yet again struck by another half baked attempt from the UK government to curb drinking among youngsters. Plans were revealed yesterday about how “Parents are to be given guidelines on how much alcohol their children can safely consume, in a bid to encourage teenagers to drink more responsibly.”

How can we expect youngsters to drink more responsibly? They don’t really begin to value health, work, family relationships, and the impact of drinking on all aspects of their lives at that tender age. Its only a good few years down the line that they learn the life’s lessons, sometimes the hard way, coping with all the exigencies and travails that life throws at them. They see drinking alcohol as a new found love, a new route of escape and a way of asserting their independence. When the older people cannot be expected to drink responsibly, how then can we expect the youngsters to do so? While the thought behind the policy is praiseworthy, the policy itself is not.

It is important to send out the message that drinking responsibly is not a viable option; staying away from the drink, especially when you are young, is the preferred route. Fill the youngsters’ life with enough love, attention and care at home, so that they do not need to seek it out elsewhere. Make their lives worthwhile, and make them feel wanted and respected.

Love your family, love yourself and stay away from alcohol.

Cheers (you don’t have to be drinking to say cheers!)

Zen

“They don’t want mental problems in the family to be exposed. They want to hide it, to preserve the family image and status.”

Isn’t this what we hear commonly and regularly from sympathisers of a typical Indian family sharing the burden of a mentally ill member amongst themselves, and suffering silently? And we presume the above quote must also have been said about a family in an Indian town. Surprise, surprise, this is not about India we are talking! This is a quote from a BBC report about Asian families in UK. One would have expected that in a so called “enlightened, educated, developed country” a comment like this had no place. But unfortunately this is what is happening in England too. For fear of shame, ridicule and/or rejection, families of Asian origin with mental health problems are missing out on the treatment that is generally and freely available. This, in turn, is contributing to the high suicide rate among Asian women.

“The effect of stigma is deadly. It can lead to people harming themselves, possibly committing suicide or in some cases harming others. Statistics show that twice as many Asian women kill themselves as the rest of the population.“

Every time I read a disconcerting psychiatric news, I immediately start to wonder about the situation in India. Whilst there are some parallels that can be drawn between here in the UK and India, there are numerous others factors that cannot be compared at all. In the UK, there is a GP led service; every resident is registered with the local GPs (general practitioners), who provide free health care assessments. These GPs are trained to pick up mental health problems, and even start immediate treatment. They then refer such patients to specialist care. Despite this effective network, the news about so many people slipping through the net is indeed shocking.

Now consider the situation in India. There is no effective primary care network. The GPs only manage minor ailments. There is a culture of direct specialist self-referral. And if the family decides not to take their mentally unwell member to the doctor, the doctor does not come to their house! The patient either becomes violent towards others, or harms himself or herself by committing suicide. Not only the patient loses out, the family also ends up paying the price. If there is unfortunately a case of a completed suicide in the family, the family not only has to deal with their own grief and bereavement, they also have to bear the endless enquiries and police harassment. If the suicide attempt does not succeed, then the person is charged by the police- damned if you do it, damned if you do not!!!

Is it all worth it for the sake of that inflated ego about “khaandaan ki izzat” or family pride, or the fear of embarassment at the hands of people who do not matter at all? Even if you do something wrong, or make a mistake in life, people who matter to you will not mind, and people who do mind, do not matter to you at all.

And mental illness is “not your mistake”, it is not the result of bad blood, or bad dharma or bad karma (or even burey karmaon ka badla). It is a biological illness, a physical disorder, just like diabetes, or hypertension or cancer.

Treat mental illness, do not hide it, do not run away from it, do not be ashamed of it, and PLEASE DO NOT STIGMATISE PEOPLE WHO HAVE MENTAL ILLNESS.

Say no to Stigma against Mental illness.

Take care,

Zen

There has been no entry on the blog for some time. I was listening to the BBC news as I drove home from work yesterday. One of the news items caught my attention. There was a report about the big increase in admission numbers in hospitals due to illnesses directly related to alcohol. It said that alcohol was the main or secondary cause of 207,800 NHS admissions in 2006/7, compared to 93,500 in 1995/96, all across hospitals in England. In the report, 30% of 15 year olds said it was fine to get drunk at least once a week. Among adults in 2006, 72% of men and 57% of women reported drinking an alcoholic drink on at least one day in the previous week. And 12% of men and 7% of women reported drinking on every day in the previous week.

Whereas before most hospital consultants would have seen patients in their fifties or sixties in the past, they now describe seeing patients in their early twenties with alcohol-related hepatitis, and women whose livers are permanently damaged with the scarring known as cirrhosis by the time they are 30.

Now lets compare a few things. The population of England is around 50 million. The population of India is around 1.13 billion. This makes India almost 200 times bigger than England or even UK ( UK’s population is still only about 60 million!). If we extrapolate the above hospital admission numbers to India,  a very scary picture starts to emerge - about 40 million (or 4 crore) hospital admissions due to alcohol related problems. I do not know the total number of hospital beds all over India (and I wonder if anybody knows at all, what with so much of our healthcare being provided via the private sector). But just imagine - 4 crores of people being admitted to hospitals in India only due to a habit, a momentary pleasure,  getting out of hand. Imagine the man days lost, imagine the resources and money spent, imagine the number of broken homes, and domestic violence leading upto them, imagine the number of marriage break downs, imagine the number of orphaned children. Do you imagine the nightmare that alcohol is? And I am not even mentioning the huge numbers of road traffic accidents, the unreported illnesses and miseries and reported and unreported deaths due to alcohol.

Is it worth the trouble? My simple message is: Stay away from the bottle, you never know when its gonna hit you, and hit you it certainly will!

Happy reading,

Zen

Former deputy prime minister John Prescott has confessed to suffering from the eating disorder bulimia.

He told BBC News 24 that he suffered in misery and in silence for 10 years because of the shame of being a high-profile man with the illness.

He writes in the Sunday Times that he would gorge on food and then vomit.

The 69-year-old told the BBC: “I never admitted to this out of the shame and embarrassment.

“I found it difficult as a man like me to admit that I suffered from bulimia - the doctors told me that it was probably due to stress”.

Well, coming from such a high profile politician, it definitely does not look like it is an all female problem.

Click here to  know more about bulimia.

Zen

I write regularly on psychiatric issues aimed towards a common readership in the leading Urdu newspapers of Hyderabad, India. There is no dearth of information in today’s world, and in fact we have all been inundated left, right and centre with an information deluge, thanks to the Internet. However, there is a distinct lack of quality information in simple language, aimed at the common man. Most of the information originates in the west, and has little resonance with problems in an Indian context. What I have been trying in Urdu is to write articles using live examples from my clinical practice and explain the finer aspects of various mental disorders in an “easy to digest and remember” manner. Some of my colleagues have asked me to do the same in Plain English.

As this is my first column for this blog, I thought it may be prudent to give the readers a bit of my background. I shall not be too pretentious and call it remarkable in the real sense, but indeed for my own self, what I have achieved is due to a combination of good luck, hard work and a desire to succeed along with an unflinching support from my family.

Growing up in the old city of Hyderabad had its own advantages. When you dress up smartly in your starched school uniform, neck tie and all, and walk towards the railway station early morning to catch a train to school in Secunderabad, people begin to take notice of you. I was the only one, not only from that station, but a few stations earlier and a few later, to have had the good fortune of attending St Patrick’s High School, an excellent school managed by Catholic priests, called the Society of Jesuits. My neighbours started enquiring as to what I would like to do when I grew up. I always used to blurt out, “I want to be a doctor”. Even if some people may have laughed at the idea, they had the decency (thanks to my family’s reputation and the respect we received in the area) never to do it in front of me. Some people actually started believing in my dreams by calling me “Doctor saab” when I was only 12 or 13! During my first visit home after becoming a doctor, one of those people came up to me and said that he had been waiting for this moment to recount his ills and thus became one of my first patients! He always had a great confidence in me and refused to see a specialist until I left the country for higher education (read greener pastures).

The disadvantage of course was the look some people in my school used to give me when I gave them my address. More than three quarters of them did not even know where Yakutpura was! The few people who knew it would say, as if almost accusingly, “What, you mean you actually live there?” As if I was talking about the planet Mars! Sometimes I used to joke that I owned the whole area and that my father was the local Nawab there. My brother once suggested that in future I should proclaim living in “Yakut Hills”, to rhyme with posh residential areas of Hyderabad – Banjara Hills and Jubilee Hills! Despite these difficulties, I did well in school and was always encouraged by the then Principal Father Devasia and the Vice-Principal Father Phillips. They used to lend me books from their personal library, thus inculcating in me a lifetime love of reading and writing. I was made the Vice-Captain of the school, which sowed the seeds of leadership skills.

When I was in the second year of medical school at Gulbarga (Mahadevappa Rampure Medical College) I started studying psychiatry as a subject. Although I had seen psychiatric patients (not only on the streets) but also at the private hospital run by my maternal uncle Dr M A Majeed Khan, the leading Psychiatrist, this was my first brush with the subject. My uncle was a kind of a role model for me and I always had this desire to be “like him”. But within a few days of starting to study it, I made up my mind to become a psychiatrist. Of course the path from the squeaky chairs around that comments-etched, old and greasy table in the smoke filled college canteen in Gulbarga to 17 Belgrave Square, London (the National Headquarters of Royal College of Psychiatrists) was not a smooth one. In fact it was so difficult that to describe the journey in its full narrative might take up a couple of articles, and I seriously want to spare you the pain of reading it.

Suffice it to say, when I held my membership certificate (declaring I was a fully qualified Psychiatrist) in my hand for the first time, I got lost in the wee lanes of Yakutpura and Secunderabad, and I thought of that bright day in the smoky canteen of my college when I had first dreamt I would become a Psychiatrist.

Well, that was the beginning. I am now working as a General Adult and Rehabilitation Psychiatrist in Royal Edinburgh Hospital/St John’s Hospital, located in the beautiful part of the world called Scotland, in UK. I have my family here with me, my wife who is a Community Paediatrician and three lovely daughters. Modern technology, advanced gadgetry and Information and Communication technology are my latest chums (much to my wife’s chagrin). I have always taken a keen interest in educating patients about their illnesses. Combining these two interests have resulted in a very basic and amateurish website on common Psychiatric conditions called www.indianpsychiatry.com . I also chair the Mental Health Informatics Special Interest Group at the Royal College of Psychiatrists, London, UK.

In the future, I will endeavour to comment on various topics of psychiatric, social, cultural and family interests, with less of the usual psycho-babble and definitely not in a sombre mood. This section of my blog will also host articles of a personal nature, my travelogues, my interests etc.

Happy Reading,

Zen

A senior family court judge has hit out at the government over what he says is an “epidemic” of family failure that will have “catastrophic” effects.

In a speech, Mr Justice Coleridge, a Family Division judge for England and Wales, warned the results could be as destructive as global warming.

The judge said those who witnessed the goings-on inside family courts would be aware of it being a “never ending carnival of human misery - a ceaseless river of human distress”.”What is certain is that almost all of society’s social ills can be traced directly to the collapse of the family life,” he said. “I am not saying every broken family produces dysfunctional children but I am saying that almost every dysfunctional child is the product of a broken family.

This is indeed a very bold and controversial speech, which is bound to stir up a hornet’s nest. A country which used to pride itself on its family and societal values is in the midst of a serious meltdown. The erosion of these very values has been gradual. Recognition of the fact that people could cohabit together, without any pressure form any quarter to enter into lawful marriages, is possibly one reason. Adoption of legislation that legalises single sex marriages is one another. Globalisation on an unprecedented level leads to people moving away from their family bases and strongholds. Moving away from familial, religious and established moral codes could be yet another reason.

But what impact does a broken home has on a young mind? One only has to be part of the caring profession called psychiatry to realise the mayhem caused within families. The family psychiatry units have gory stories to tell, if only one is prepared to listen. There is so much psychiatric morbidity among children that one gets the feeling - is anything working? Childhood depression, increasing suicidal or self harm trends, abuse of illicit substances (read drugs), juvenile delinquencies and increasing violence amongst these innocent and tender people is mind boggling.

One of the strengths of Indian society is its integrity of family system and moral values. Unfortunately globalisation is now a fashionable term in India, and is here pretty much to stay. Beware of its pitfalls, before a family court judge in India delivers a similar stern warning. Let the families come together and live cohesively, as we used to, not in the far distant past.

http://news.bbc.co.uk/1/hi/uk/7331882.stm

It is becoming increasingly evident that far more people with schizophrenia develop serious physical illnesses (like heart problems, obesity, diabetes, abnormal cholesterol levels etc) than those without schizophrenia. Various scientific studies have been carried out, and many are on going, into this heady mixture of mental and physical illnesses. Some studies have been quite alarming, suggesting that people with schizophrenia die a lot earlier than their counterparts who do not have schizophrenia. Psychiatrists and their patients with schizophrenia may not be communicating about overall health care to the extent that they should, according to the results of a new survey released by Mental Health America, but both express a desire to discuss issues such as smoking, obesity, diabetes, and metabolic syndrome—issues that are critical to patients’ recovery. Indeed there is greater need for more communication among psychiatrists and their patients with serious mental illness.

In India there is still a culture of subservience and extreme obedience to the doctors from the patients and their carers. Out of respect/fear, they do not ask doctors probing questions. I think we should encourage a culture whereby patients and their carers develop a trusting relationship with their doctors and make sure they ask them about all important issues of care. From the psychiatrist’s side, we should be more forthcoming and help the patients develop an empathic, trusting,  long term, working relationship. And indeed, we should invariably ask them about their physical health on every occasion. I even ask them about their pet’s health and well being!!

Ref: http://pn.psychiatryonline.org/cgi/content/full/43/6/14?etoc

Cheers and have a great Easter.

Zen

Last week I attended an excellent lecture at my hospital in Scotland. One of my colleagues was presenting her experiences from her work in New York, USA, from where she recently returned, having spent a year on sabbatical leave. She worked there with Psychiatrists and their teams who were engaged in providing psychiatric services to the homeless population.

The statistics she presented were shocking! In a country which is now considered the only super power in the world (despite the sub-prime mortgage crisis and the economic downturn!) about 7,00,000 people remained homeless every night across the country! And about 25% of them had psychiatric problems. The psychiatrists she worked with used to go around the various facilities set up by local authorities to provide shelter to these people on a temporary basis, and screen them for any psychiatric illnesses. Depending on the severity of the diagnosed problem, the psychiatric patients, who would have hitherto remained undiagnosed and untreated, would be suitably treated.

Here in Scotland, we have a National Health Service (NHS) which provides free treatment to one and all. It runs a special general practice, called “Homeless Practice”. One does not need to be registered and can just walk in to any of these practices to receive treatment. The Psychiatrists covering that area provide services for the people attending the Homeless GP practice.

I sat there listening to the lecture raptly. However, my mind started to wander about. I found myself in the streets of India, visualising driving through the quiet streets in the dead of the night, spotting the umpteen human silhouettes spread across in various angles, across the uneven footpaths. I wondered how many of these people sleeping rough in India would have an undiagnosed psychiatric illness. I wondered if it would be possible one day, for the government to estimate how many people in India were homeless on any given night. I wondered if it could be estimated how many of them had psychiatric illnesses and I wondered whether one day we would be able to provide psychiatric services to these homeless people!!!

Zen

Many doctors across the world have started maintaining their own blogs these days. Blogs are a series of short articles posted regularly (somewhat similar to a personal diary), in which people write about several topics close to their hearts. Some chronicle their work experiences, interesting work encounters and new developments in their respective fields, while others use this medium to write about their interests and their life generally. Sometimes they are in the form of a light hearted banter, and other times they are tongue in cheek criticisms of everything under the sun.

Indianpsychiatry.com is a website devoted to providing good quality psychiatric information (about mental health, mental illnesses and disorders) to patients and carers in India, in simple and jargon free English. It is also aimed at fellow psychiatrists in India, to provide them with a medium to post their articles, information about their hospitals and clinics, and to learn and to tell others about new developments in their fields. Currently it is developing slowly, as it is a singular effort. I have a full time job in the UK to attend to, and a family to look after.

Why this blog then?

Indeed some people may question as to why a new blog requiring additional work, when I am unable to update my site regularly. The answer is simple (or at least I think). I want to establish contact with the viewership, in a didactic way, or as a two way traffic. Yes, I have been inundated with emails and queries about various things. But I want it to be live! I want other people to be able to leave comments about my website, suggestions for improvement, and also for other people to be able to read them. And I want to be able to relate to you all. The best way I thought was to utilise the latest technology. I am grateful to the team at Wordpress.org, who have kindly permitted to utilise their software WORDPRESS for maintaining my blog and installing the same in my website.

I intend to keep the write ups short, simple and hopefully regular. They will have links to anything interesting I read about, and which I think may interest you as well. They will be a mixture of serious information, comments on general topics of my interest and some light hearted comments on things I observe around me. I will be happy to receive comments from the readers, including suggestions that you think others should know about. Please send me the links and I will consider their suitability for posting on this blog.

Happy reading!!!

Zen (this is how I intend to style myself before you all, to maintain some degree of anonymity and to add a bit of “masala” as they say in Bollywood!!!)

This is a new blog created for the website www.indianpsychiatry.com