When I tell people that I am studying to be a psychiatrist, they always say "Oh!" with a raised eyebrow and a sort of high tone towards the end of that exclamation, whereas if I were to say that I am a surgical resident,their response would be more "Oh!" with a punch and enthusiasm at the end of that remark.

Another thing I tend to notice in the response of my esteemed colleagues in a general hospital set up is that "Could you counsel this patient? He's just been admitted for consumption of Organophosphorous Compound poisoning." While I realize and appreciate the role I will play in helping counsel people, I must emphatically point out that Psychiatry is not about only counseling, or listening to people's problems. It's about sifting and sorting out details that others would readily write off as too trivial, and using those details to come to a conclusion about the person's diagnosis, and hence come up with a rational treatment option for them.

Many people tend to scoff at such a task, and I myself have found it a tad tedious and "What's the use of finding all this out?", but it is only after seeing the way the faculty here at NIMHANS use those very same details to reach a tentative diagnosis that I find out the value of it.

Psychiatry has been given a fairly bad press by everybody. People tend to think of it as too trivial a specialty for it to be taken seriously. But I believe that this specialty helps me improve the quality of people's lives more than any other medical branch.

I am saying this not to boast my choice or sound holier-than-thou, but I would like this to be a way of telling people that there is nothing wrong in psychiatry or in seeing a psychiatrist, because there is nothing wrong with mental illness. It's not about going "mental" and being admitted in a "mental hospital". It's about an illness, just like Diabetes or Asthma, that has only recently gained recognition in Medicine.

Most of the problem arose from the lack of a proper pharmacological arsenal to counter Schizophrenia and Psychosis. Traditionally, people with psychosis were treated with cold water baths,or were put in an insulin induced coma!

Compare that with anti psychotics that are now available, and for the most part, efficient. They are, however, not fool proof ,and there have been times when they have failed. Now, instead of saying that "That's mental illness for you!" I would like to put it like this : That there is much about the biological basis of mental illness that is yet to be discovered, and this only opens more avenues for research and growth.

It should be worth pointing out that many times treatment is life-long, for the psychoses and the Schizophrenics. But which medical disease, save from infectious disease(excluding AIDS and Hepatitis B and C) promises a brief treatment followed by absolute cure? Nil.

By administering psychiatric treatment, we can give families a chance to be normal again ,we can give a man or woman the chance to go back to work and make a living for him or herself. What's wrong about that?

Depression is a chronic disorder that does not, as is commonly thought, always arise from traumatic life events or a troubled childhood. It is caused due to a deficiency of Serotonin in the body. Serotonin is a key neurochemical in the brain that helps modulate mood. A lack of it causes people to be depressed. So, it need not only be that a guy with some family issues and stress at work ends up "Depressed". It can also mean that a person who is working normally, with a loving family and a strong friends circle ends up depressed.

Features of this disorder include fatigue, waking up in the morning 2 hours before the normal wake up time (for eg: waking up at 3 or 4 am instead of 6 am), feelings of sadness that are continuous, persistent, and which does not abate with activities that are usually pleasurable, such as watching a good movie, or going out for a walk. Feelings of worthlessness, feeling hopeless, that one is better off dead than alive,and suicidal thoughts and plans.

The major risk of Depression is suicide, and if you see the families of people who have taken their lives, you will know how traumatic an event that is for them. Very often, they feel that it was their fault ,that they could have done something to help. The fact of it is that the depressive will be so wound up in his world that there is precious little that one can do in terms of an intervention. But it is always helpful to keep track of your loved ones for any of the symptoms listed above.

Again, this is not to sound haughty and this is not meant to be a scientific lecture. This is meant to spread the word around that mental illness is prevalent, and that it is treatable, and that it is still stigmatized to this day. It is my hope that this stigma reduces in the days to come.

The world is, officially as of now,the most dangerous place to live in.

The attack in Mumbai has shown us many things-that life tends to be a bit senseless once in a while, that good people die for no reason, that governments will NOT do what they say they would do, that our police force and security have much to work on, and that even terrorists will stoop to such depths so as to hold a hospital hostage, where people are treated and their health improved regardless of what religion they belong to.

It showed us that some families in neighbouring countries are so hard up that anyone willing to raise and take responsibility for one of their kids are welcomed with open arms, and that even though their kids are raised well and taught to speak english and dress in jeans and a t-shirt, the fact that they are in that situation is because their families do not have the money to provide for them, hence foster care is most welcome.

Whether the provider is one who plans to train the young ward to kill people and hold up guns is immaterial. I suppose that, as an afterthought, the young one might actually realize, while he is in the thick of all that gunfire, that he might not get out of this particular chore alive.

It's a vicious cycle. Poverty-Terrorism-Death/Incarceration/Escape. Only Education will help at this point. People who can think for themselves and not being scared to do so, people thinking for themselves, confident in the knowledge that the wrong answer will not see their cerebrospinal fluid bathing the walls. People who can be detached from a particular situation and see the merits and demerits as they are and not as how others say they are.

Why is it that we can’t stop living in the past? Why are we drawn to it like moths to a flame? I mean, the present moment to us, is challenging, and difficult, and for the life of us we wish we weren’t in the situation to begin with. But as we look back at those times, we feel a sense of peace, of regret, of lessons learned that we didn’t in the past, when we were cursing it and wishing to God these times would end, and soon at that.

The sense of kinsman ship, if I could call it that, might perhaps be a defense mechanism, to keep us from making any real effort towards solving the present predicament that we are in at this time. I don’t know, really. To the psychoanalyst the past is always a goldmine to dig deep in, and it does have its rewards, as long as we learn from it, and not let it control us to the extent that we cannot work efficiently in the present, and as long as it doesn’t give us our own personal balloon to float in before reality succeeds in bursting it.

Those who have done it, have succeeded in a way few others have. And it is difficult. But the point is that it can be done. At least I hope so, with all my heart. Because we all tend to have these mental cushions of the past that we turn to when we are troubled by the present. But it is only to learn from, and not live from. Because we are not our past. And we can change thinking like that but it’ll take a helluva lot of effort for us to live in the here and now. Hell, if I were living in the here and now I wouldn’t have to type this cathartic entry!! But that’s the way it is.

There may be aspects of us that we lost in the past that we need now. For example, being more patient, more giving, and more compassionate, the intensity of which tends to erode with time, leaving us self absorbed and drained. And there are definitely parts of us that we are glad that we changed. One of which I’m sure many would relate to : being a pushover. A doormat.

How may countries tend to live in the past, following the same policies that have been perpetrated for centuries, but which they continue to execute, just because it’s what has been done before?

Change is often difficult, and almost always a life long struggle. Why do it, if it takes so long? Because there is nothing else, and because there is no other way!!

Couple of other things I would like to say:

1) You know you’re a doctor when people tell you that you’re responsible for working 6.5 days a week, with almost no respite in between.

2) You know you’re a doctor when your most vivid fantasies involve a pager and a cricket bat, with violent contact between the aforementioned objects.

3) You know you’re a doctor when you have this sudden panic attack ‘cos you fear that you may have a personality disorder, a prolapsed intervertebral disc, and amoebiasis in the time frame of 4 hours, with or without chronic bronchitis.

4) You know you’re a doctor when people ask you everytime they meet you what exactly it is that you’re doing.

5) You know you’re a doctor when people ask you out of a sense of bewilderment and more commonly sadism how many more years it is that you’re going to be studying. An apt response in most of the recipient’s mind in such situations is : “Just wait till the day it burns while you pee, mutherfucker, and we’ll see if my diagnosing a Chlamydia infection then is reason enough why I trained so fucking hard!”

6) You know you’re a doctor when your old schoolmates talk about the stock market and you’re trying to recall the latest research findings of your thesis.

7) You know you’re a doctor when you can say “And I thought it was lung cancer after seeing the x ray but it turned out to be an artifact!!” and laugh till you get tears in your eyes and the non medicos are wondering how pathetic you have actually become.

8) Also, with special regard to my particular field of expertise, you know you’re a psychiatrist when people ask you, in all innocence, whether it is actually as demanding as how you make it out to be.

The Dark Knight

Hi, and how are you doing? I suppose I can always blame work for not being able to blog more often, but as always, the real truth is somewhere between the long hours and my personal lack of initiative to sit down and put thought on to the internet.

I have seen The Dark Knight, and I feel that the movie was amazing, awesome, hu-aah, and all other superlatives that I can't think of at the moment. It looks, in theory to be a one man show, with the late Mr.Ledger blowing us all away with a performance that should earn him a posthumous Oscar award, not nomination, for playing an iconic villain in a way that nobody ever thought he could, or would do. But it was a team effort. From the Nolan brothers to Wally Pfeister's cinematography to Hans Zimmer and James Newton-Howard's epic score to just as intense performances by Christian Bale, Aaron Eckhart, and Gary Oldman.The latter two deserve special mention for playing their roles to absolute perfection. I was a bit touch and go when I heard that Eckhart was slated to play Harvey Dent, and I am damn glad that he has proven me wrong one hundred percent. Oldman is also amazing as Jim Gordon, and he is pivotal in making the last scene of the movie so unbelievably intense, at the culmination of which you sayto yourself :"Whoa,Phew,I can't think of anything to say!!"

I have seen it thrice and am planning to go again a fourth time. Because although the script has it's flaws, this is one movie that somehow manages to blend in 2 genres to near perfection. And for that itself, Nolan should pat himself on the back. I must say that it would have taken guts to cast an actor most noted for playing a repressed homosexual cowboy as one of the most meanest mutherfuckers ever to appear in the history if comic book novels, and yet he did, and the result is for all of us to see,and worship, and mourn.

Will there be a third installment in the series? It depends on Nolan. Although the movie's ending most likely promises a sequel, if Nolan does not feel it's right, then it's fine, 'cos he believes in quality over quantity, but if he does plan to come out with part 3 ,then it's interesting to see whom he would cast as a villain who suits the Gotham that he has so expertly created. I honestly doubt that the Catwoman, Riddler, or the Penguin will be cast. Let's see how it goes...I'm sure many of us will be waiting with baited breath for what will transpire in the days to come.

In other news, India has done well in the Olympics, coming off with 3 medals with one of them being a first time Gold. Hopefully, this should give the entire sporting community in India a much needed facelift, as everybody cares about only cricket here. This might give other people the courage to follow the sport of their choice, and yet have the conviction that it might reap them rewards, just as it did for Abhinav Bindra.

In other news, there isn't any!! That is if you can exclude ward work, the casualty duties, more ward work, and then more admissions, and more case conferences, and more......well...you know how it ends!(It doesn't really, not in NIMHANS!)

More later.

Good night, and Good luck.

What is the answer?

The world has become a much darker place to live in. Although it was obvious from the start that terrorism is out there,and is rampant, it's always with a knowledge that we weren't there when it happened;we hear it in the news,listen to it, and then carry on with our lives.

What happened here in Bangalore was a wake-up call. In fact,it happened very close to the place where I am working,and the news got out that there have been 7 low intensity blasts scattered across the city,in key traffic areas too. And it was then that I realised that it can harm me too,something that had never occured to me before.

The next day,I had gone to the Forum to book tickets for a movie,and as I was calling my friends and asking them whether I should book tickets for them as well,they told me to stay away from the Forum as there was a bomb that had been disabled there this morning. While I later learnt that it was not,in fact, in the Forum that the bomb was disabled but within a short distance from there,at the time I heard it I was wondering just how crazy things have become.

How do we deal with this? The next day there were blasts in Ahmedabad that killed around 40 people. There is no answer. Carry on with our lives?Is that what we can tell the families of those people who were killed? It's all to easy to say that we should fight back,that we should retaliate. What are the consequences? It'll give the people who plotted the attack exactly what they want: an all out war,where thousands more will die. Just don't give a damn?

If you know the answer,let me know.

I have just returned from a late night show,and all the while I was at the mall and a few times I was watching the movie I was thinking to myself :What will happen if the bomb goes out now? How will it be if I see the bomb exploding right in front of me? I hope that the day will come when our children,more likely our grandchildren will live in a world where the only thing worrying people is how much they are making a difference to the lives of others,and not about caring for their safety as they are being threatened by the plague that is continuing to hound us presently.

Please do not misunderstand this entry to be an ultra right wing call to arms or an anti-religious attack. It's merely my thoughts as they had occured the past 2 days,thats's all.

Take care.

.....and the meaning of life.

What are we here for,ultimately? Earning shitloads of money?To further the family name? To finally prove to somebody that we are more than what they thought we were? What is the primary aim of our existence here on earth?

There have been volumes printed on this subject..and I do not purport to be an authority on this subject. But here I would like to present my viewpoint. Feel free to roll your eyes and doze off as you please.

I feel the ultimate purpose is to feel free inside. Not in a way that destroys our bodies and our souls like how most drugs do, but in the kind of manner that makes us liberated when we know that we have come to terms with who we are and have accepted it, instead of forever fighting with these issues with no end to the battle in sight.

I do not mean this in a way that we accept all the negative energies we have within us and say "Well,this is who I am,and that's that," but to change,with genuine intent,what we see within us as not productive to the bigger picture as to how we see ourselves,and not how others see us.

This is easier said than done, and the number of people who achieve it in their lifetimes is miniscule. In fact, it is the hardest thing that we will have to face in our journey here.

If you know how to do it,do let me know.

The choice for freedom,regardless of circumstance is there everywhere. Those who are interested in this subject can read "Man's search for meaning" by Viktor Frankl,a Jewish Psychiatrist who was imprisoned by the Nazis during World War 2. How he came to terms with his situation-he had lost his wife, and his brother and other immediate members of his family-and used it to his advantage-is masterfully depicted. He says that,ultimately, not matter whatever the shit it is that is going on around you, there is the core of you that can choose how you respond to it.

I can only hope that we do not need such dramatic and stressful life events to make us aware of it. We can realise it right now,as I type this and as you read it,that it is ultimately within us. We can always make excuses for not being able to do it, but in the end it will catch up with us.

Heavy Duty!!

Hi,

It has been 2 months since the last entry and the reason for said delay is the fact that I have started my residency in NIMHANS,Bangalore, and it's a Baptism by Fire kind of situation. From spending the past 2 years in virtual hibernation in front of a book to 12 hour days in a tertiary referral centre was a bit jarring. Although welcoming work,it didn't take immediately....the hectic hours, the endless number of patients in the OPD, to weekly duties and so on.

One thing I have realised is that the mental aspect of suffering is way way overlooked. It is all too easy to concentrate on the physical,organic aspects of health,but in truth the daily issues we wrestle with occur in our minds. I am,of course, not referring to the overtly psychotic schizpohrenia kind of picture, but we do encounter mental strain more often than we do the physical kind.

The number of psychotic cases,defined by the ICD(International Classification of Diseases) as that having delusional or hallucinatory behaviour with disturbances in Psychomotor Activity,is truly astounding. The Neuroses and the Anxiety cases are a minority,something which I did not anticipate,thinking that they far outweigh the Psychotic/Schizophrenia spectrum. But in truth it is the other way around.

The agony a patient with mental illness goes through can only be imagined. My professor told me that the film "A Beautiful Mind" starring Russell Crowe is a kind of marker to understand what a patient goes through..in the movie,the protagonist does not know what is real and what isn't! Imagine being in a situation like that,where you believe things to be true but it is in fact the other way around.

Ok,ok enough of the hi funda gyaan.

I do not know why people have praised Iron Man so much. I did not find anything so spetacular with it to begin with, although it is better than The Fantastic Four series, but not better than the X Men,well at least not yet.It will depend on the further sequels to decide. But Robert Downey nailed the part of Tony Stark,who later on becomes Iron Man. Nobody could be better suited for the role,man.

Only a little more than a month left for The Dark Knight!! It is gonna rock. Seriously can not wait.

I haven't had much time to discuss the circumstances that lead to my getting an MD,when the 5 of you who have read my previous entries will recall that I was chosen for the Diploma in Psychiatry but not the MD. That,I hope will be covered in the next one.

Take Care.