Wednesday, June 29, 2022

All psychiatrists are slightly mad, so are we.




I was in third year of my medical school in New Delhi and was eagerly looking forward to my two weeks posting in psychiatry. G B Pant Hospital associated with Maulana Azad Medical College had a renowned department of psychiatry. I had a very keen interest in functioning of human mind & psychiatry. Overwhelmed with enthusiasm I had bought two books of psychiatry while most of my fellow students didn’t care to have even one. Not only had I bought the books but also I had started reading them well in advance so that I could make most of my anticipated fortnight in the psychiatry wards. 

The day arrived and we, a group of about ten students, wandered to the psychiatry ward on the ground floor of the hospital. The place had a eerie feel to it. We would not know who’s a patient there or who wasn’t. Timidly we enquired about where & to whom did we need to report. We were directed to a consultant’s room where were made to stand in a line facing the consultant. He was slouching on his armchair. Parched white face, thin lips, hair long, oiled and thrown back; and an expression suitable perhaps for the outer space or another world. Suddenly he emerged from his interstellar thoughts & asked:

“Third year students?”
“Yes sir”, we replied in unison & with optimism.
“Hmm”, he was barely audible & then returned to his thoughts. It was a long time, he may have travelled around some imaginary planet before he returned and uttered:
“Third year. Ok. Go to Dr Gupta (not real name) he will take your class.” 

This premonitory introduction should have revealed to our naïve minds the nature of days to come. Each day was eventful and, in retrospect, very fascinating. There were encounters with patients, with patients posing as well meaning relatives of other patients and with most other consultants. 

The outcome of the posting was that all probability of my considering a career in psychiatry was shattered into pieces. I concluded that the life & work environment of psychiatry practice was too overwhelming for people to stay sane. However, I didn't consider that the individuals opting for a career in mental health were already predisposed to be affected by it. And I did challenge myself by thinking that I was generalizing too much and that 2 weeks of spending time in a place was too short to make any judgement (leave alone diagnose) on people who are running the show. So I kept my mind & eyes open in the years that followed. I came across may a psychiatrists & psychologists - as friends or as colleagues - during my life as a doctor; barring a few exceptions my opinion was only reiterated that there was something peculiar or odd about their personalities.

Being fascinated by the subject of mind I started reading about & the works of some iconic figures in the fields - Carl G Jung, Sigmund Freud, etc - not only to learn from their knowledge but also to get a glimpse into their minds. To my surprise both these great leaders in the fields also demonstrated quirks in their personality & thought process. While Jung used to have visions, some vivid dreams, hypnogogic phenomenon and a clear acknowledgement of two personalities, Freud was too obsessed with sexuality and would explain every psychological disturbance in a person on the basis of some childhood sexual complex or event; he also showed some traits of neurosis in his behaviour. 

I have seen psychiatrists & psychologists showing signs of depression, anxiety, narcissism, substance abuse, etc. Even the ones who appear perfectly normal & stable from far reveal some weak areas on close exploration. It is probable that because of their own demons & instabilities they get drawn to the profession of mental health - with a desire to help others & to help themselves.

"Am I being biased & judgmental ?" I thought to myself. And this self-doubt made me explore this subject further. I started looking at everyone - all those who were not psychiatrists - other doctors, other professional, general public - basically everyone around. My observations startled me. Everyone, yes everyone is prone to depression, to anxiety, to delusional thoughts, to illogical behavior, to hypochondria, to a degree of mania, to some narcissism, etc. Basically everyone is slightly mad - at some time or even all the time. So not just psychiatrists but philosophers like Neitsche, composers like Mussorgsky, leaders like Hitler, painters like Van Gogh, etc., they all exhibited some traits of madness.

The emotions or feelings of depression, anxiety, phobia, obsession, delusions, etc are to an extent normal & experienced by everyone sometime or the other. They become abnormal when they become severe in intensity & prolonged enough to cause distress to the individual & interfere with person's normal functionality & pursuit of life. So the abnormality does not exist in the quality of the feelings but the quantity & duration of the feelings. We are all given to imagine things but when the imagination becomes so strong that the person starts perceiving things - hearing sounds, seeing imagery, etc. then it becomes hallucination. It may be safe to say that a psychiatric illness may be just an extreme state of normal mind but of a nature whose magnitude & duration is beyond the voluntary control of the person.

How does it help to know this ? 

Knowing the functioning of human mind not only helps understand others but also ourselves. Everyone goes through phases of emotional distress & sometimes awkward behavior or introversion. An awareness of plethora of disturbing emotions & feelings will make us more empathetic towards others & will provide us a clarity of thought to deal with our own situation.

Some madness is good for growth - it provides creativity & drive to do thing different & better. Look at all the successful institutions, businesses, corporates, etc., and it’s very likely that you may find a slightly mad man as the top leader. 

So if you find a mad streak in yourself, don’t shun or shy away from it, embrace it & channelise it to make your life better, to achieve something great.

Lastly, if you do feel overwhelmed by your emotions, thoughts or situation, don't hesitate to reach out to a friend, a counselor or even a psychiatrist. You are very likely to get an empathetic response from them because they themselves may be familiar with what you are going through.

Saturday, June 11, 2022

Beat the Blues: 10 Practical tips to help you pull yourself out of deep dark depression.





Everyone, yes everyone experiences depression & low dark moods at different times through the life, all of the life. 

Depression, to some extent, is a normal feeling. It’s useful & required because one can’t continuously feel happy & elated. The low feelings provide a much needed contrast & motivate us to keep working towards happiness. 

The problem arises when depression becomes severe, incapacitating & an obstruction to pursuit & enjoyment of normal life. That’s when expert help is required. For milder degrees of depression friends & some simple self-help measures work very well. But for severe depression it’s best to seek professional help from a psychiatrist AND a psychologist. 

Self-help Tips to beat the blues (read mild depression): 

1. Sleep: A regular timed & adequate sleep of about 8 hours goes a long way. Neither less NOR more. 

2. Meals: Regular timed meals with healthy balanced diet & good hydration will keep your body functioning well & provide good milieu for your mind. 

3. Exercise: The most effective anti-depressant for any severity of depression. One can completely cure mild to moderate depression with regular moderate to intense exercise routine and can reduce the required medication in severe forms. However, in severe forms it’s difficult for the person to find motivation to start exercising. 
And the most important requirement for exercise is “motivation” - it’s not important what form of exercise you do & what equipment you use. A good gym, a good group or a good friend can help in being a source of motivation. 
For the exercise to be effective it should be at least moderately intense, regular & sustained for at least a month to “feel” the benefit. Thereafter, there’s no looking back. 
Many a fitness freaks you see around you are addicted to exercising because knowingly or unknowingly they are beating their blues. 

4. Sun Exposure: Sunlight is extremely important for a healthy mental state. Although we get good sun in India but our indoor life style & our phobia of dark complexion prevents us from benefiting from the sun. Do incorporate 30-60 mins of direct sun exposure in your daily routine. You will be surprised to feel the benefits in 2-4 weeks. Start with times when sun is soft & for a duration that’s tolerable. Slowly increase. Your skin may get darkened but your mood & mind will become bright. 

5. Fun / Hobby / Passion: Pursue some passion or hobby on a regular basis. Something that you really enjoy & something that’s different from your profession. It can be anything - music, singing, painting, reading, photography - the options are endless. Don’t get serious about it. Just have fun & enjoy. You may keep switching to different things if you get bored. 

6. Don’t work too hard ! Yes, we humans are not designed to work hard long hours. We should not be working longer than 4-8 hours daily for 4-6 days a week. The lesser you can afford to work the better. And never sit in a chair for too long. Adopt standing work station or keep moving often. 

7. Friends ! It’s important to interact with people - friends or family or strangers. Connect & interact with as many people as you want to. 
And have at least a few close friends who you can confide in - just in case your depression overwhelms you, your friends should be able to (get you) help - some call them 4 am friends, I would say 24x7. 

8. Read (Learn) - Books are the best teachers, guides & friends. Reading really helps in clearing one’s mind & uplifting the spirit. Be it self help books, fiction, non-fiction or any genre or subject that you enjoy reading, every book enriches your mind. If reading books is difficult then evening listening to the audio books helps deal with your blues. Alternatively you may just learn something new by attending courses or following video lessons. Try it. 

9. Hiking / Travel - Travelling or hiking in beautiful nature can have a transformative effect on the state of our mind. A moderately difficult trek on the mountains & camping can leave you happy & at peace with yourself. Of all the tips mentioned here if you were to do just one thing, then this is it ! 

10. CBT (Cognitive Behaviour Therapy) - Although it’s best to take help of an experienced psychologist yet it is possible learn it to help yourself. There are books & online courses available to help (check out The Great Courses online). 

In addition to above it may also help to reduce noise in our daily life - noise can be in the form of sound, light, electrical & electronic appliances all around is, digital noise in the form of computers, phones, internet, etc; the screens we view, the mechanical vibrations of motor vehicles & machinery, and the information & data noise. Once you experience the quiet & peace of nature for long enough time would you realise how much of a din we are exposed to & how much it helps to eliminate that. 

You may notice that most of these tips (except perhaps reading & CBT) are nothing but a natural way of living our life - the way nature designed us to live - the way animals live in the wild. Yes you can learn a lot from animals. Be as close to nature & live as natural a life as possible. 

Life will become better ! 

The results may not appear instantly and you may have to tell yourself to patiently go through the process of recovery & self-healing. Typical the process may take 1-3 months. At the end when you come out of it you will also have a celebratory satisfaction of doing it all by yourself !

I will be happy to clarify any points or doubts & answer any questions. Above is a conclusion from life observations, vast reading of various subjects & my medical background. 

Regards

Dr Sanjay Dhawan