It is enthusing that the Government of India recently decided to launch 24X7 toll-free mental rehabilitation helpline KIRAN in thirteen languages. Such and similar efforts will certainly add a new dimension to emergent New India, for the mental health of a nation is determined and manifested in various ways: in its courage, purposes, scientific and cultural achievements, moral responsibility, self-reliance and quality of life
Indeed it is often the case that my patients are only pieces of a total situation which I have to explore. The single patient who is by himself is rather the exception.
The psychiatrist in TS Eliot’s The Cocktail Party
Gifted with ability to observe keenly and sensitively human behaviour, literary figures, those who penned poems, novels and plays, brought to human knowledge many scintillating and moving descriptions of characters displaying abnormal behaviour. This happened much before abnormal behaviour became an area of scientific enquiry. Even psychologists believe that literary classics while describing human abnormality in all its infinite elegance often achieve explicitly representational accounts that science cannot archive. Othello introduced readers to deep insight into facets of obsessive jealousy. Euripides in his play Medea described emotions of jealousy and revenge by a mother who killed her children. Sophocles in Orestes vividly explained delusional and hallucinatory symptoms stemming from severe feelings of remorse and guilt. The intense guilt reaction of Lady Macbeth after her having participated in killing of King Duncan got expressed in her symbolic hand washing and turning a somnambulist. The noteworthy descriptions of “world within”, one can come across in two books: one by Thomas De Quincey in his eighteenth century unforgettable autobiography Confessions of An English Opium-Eater and Salman Rushdie’s book East, West. De Quincey, inter alia, described the content of his dreams induced by consumption of opium:
“I brought together all creatures, birds, beasts, reptiles, all trees and plants, usages and appearances that are found in all tropical regions, and assembled them together in China or Indostan. From kindred feelings, I soon brought Egypt and all her gods under the same law. I was stared at, hooted at, grinned at, chattered at, ran into pagodas: and was fixed for centuries at the summit, or in secret rooms: I was the idol; I was the priest; I was worshiped; I was sacrificed. I fled from the wrath of Brama through all the forests of Asia; Vishnu hated me; Seeva laid wait for me. I came suddenly upon Isis and Osiris…I was kissed, with cancerous kisses, by crocodiles; and laid, confounded with all unutterable slimy things, amongst reeds and Nilotic mud.”
Moving to as recent past as 1994, in a story titled “The Harmony of the Spheres” included in: EAST, WEST, Salman Rushdie portrayed a character named Eliot Crane, a thirty-two year man, who was suffering from what he called “brainstorms” of paranoid schizophrenia. As part of these “brainstorms”, Eliot used to narrate tales of local Sabbats. He sold his haunted house and shifted to a new one but it had not worked. Rushdie wrote, “...the demon had traced the number of his (Eliot’s) car licence plates, that it could call him any time on his unlisted telephone; that it had rediscovered his home address.” Analysing Eliot’s condition, Rushdie reconnoitered, Lucy, wife of Eliot, “…would phone with bulletins: the drugs were working, the drugs were not working because he refused to take them regularly, he seemed better as long as he did not try to write, he seemed worse because not writing plunged him into such deep depressions, he was passive and inert, he was raging and violent, he was filled with guilt and despair.”
One day, Eliot along with his wife had lunch together. He appeared joyful, told his wife he needed rest and would go to bed early. He kept his words but an hour later, though Lucy was awake with “a premonition of disaster”, she slept soundly until morning. In the meanwhile, Eliot used his shotgun and pulled the trigger. He repeated the history bequeathed to him by his father. The only note Eliot left after committing what Rushdie called, “this final act of macabre symmetry” was how to clean and take care of the gun.
It’s interesting to glimpse through some of the Eliot’s typed and hurriedly written papers containing “inchoate rants against the universe in general”. These included alternative personal futures “of extra-ordinary distinction and renown” for himself or a self-pitying of himself as a genius lost in obscurity ultimately ending in agonising illness or assassination by jealous rivals, etc.
While De Quincey had delved deep into his own mental and physical experiences and thought processes, Rushdie recorded virtually the same in case of his character Eliot. Both explanations deal with concerned individual’s intense emotional turmoil, and a nightmarish sense of utter confusion. These also highlighted underlying symptoms of various types of behavioral deviations, indicative particularly of disorders like schizophrenia, bipolar disorders and drug addiction, etc. De Quincey’s book and Rushdie’s story provide the world an account of irrational motivations and images that come to fore under the influence of delirium, the influence of drugs or severe mental disorders when inner restraints become feeble leading to distortions of perceptions and an inward orientation away from reality. These two storytellers, through their literary creations, exactly do the job of a well-trained psychiatrist.
The term “abnormal” connotes “away from the normal”. In case of physical deviations or illness the norm is functional and structural integrity of the body and any disequilibrium in such integrity can be easily measured by medical science through various tests. But is there any such norm for gauging abnormal deviation? Psychologists suggest normal behaviour conforms to social expectations whereas abnormal does not. Another view is when a person’s behaviour is maladaptive i.e when he/she is unable to cope with life situations as he/she sees these, he/she is abnormal.
The word “deviance” or “deviant behaviour” in the past has been equated with bizarre and dangerous behaviour. Of late with discovery of better and very effective medicines available for treatment and psychosocial and family help available to patients, the notion of mental disorders and patients suffering from these has undergone complete change. That is also possible because of realisation that these disorders cover a wide range of behavioural patterns. While some may be pathological by nature, others need not have pathological causes, but they have displayed an inability to cope with various problems of day to day life. Excessive worries and apprehensions about failure in examination by brilliant students, failure of rejection by young and beautiful girls for modelling, fear of losing jobs, fear of divorce, etc, may be such examples. People nurture “free-floating” sources of anxieties where the eliciting stimuli causing deviations in behaviour are nebulous and pervasive. These people admit they have no real cause to be fearful of an object or situation but they cannot help worrying. These are definitely cases of cause for concern but well within the bounds of ordinary, understandable human experience. More severe cases include examples such as a man believing irrationally that his enemies have plotted a device for pouring sludge into his mind and controlling his thoughts or a man who sees dreams while he is awake and believes these to be true (hallucinations) or who has auditory voices commanding him.
Broadly speaking, mental disorders have been classified under two categories: neurosis and psychosis. Neurotic symptom patterns include ailments like anxiety involving light to severe anxiety the source of which is not specific, phobia involving various irrational fears from which the patient cannot obtain freedom, obsessive-compulsive neurosis involving irrational actions and thoughts which keep persisting, hysterical neurosis involving amnesia and multiple personality, hypochromic neurosis involving preoccupation with one’s health and most importantly depressive neurosis commonly called depression involving abnormally prolonged dejection, internal conflict and interpersonal loss. However, depression is considered the most common and most talked of mental health issues. It is said to be a form of “existential neurosis” indicative of a maladaptive pattern marked by chronic feelings of alienation and purposelessness. Joseph Cowen rightly captures a depressed individual’s state of health in following lines: “In the slave market of my melancholy mind I mount the auction block to sell myself to the highest bidder of misery.” Depression is believed to be a “byproduct of our contemporary society”.
When we move from the realm of neurosis to that of psychosis, we enter a far more serious field of abnormal psychology where patients suffer from distortions of reality, disorganisation and fragmentation of perceptions, thoughts and emotions and withdrawal from social interaction. The principal symptoms are delusions (irrational beliefs that patient treats as truths like others are talking about him or enemies are harming him or he is a great scientist and writer or leader) Hallucinations of different types (seeing demons or angels, hearing voices ordering him what to do, sensing irrational taste: sensing poison in his food, etc)
Last century and of course current one has witnessed use of psychotropic or psychoactive drugs that have therapeutic value for medicinal purposes for treating mental disorders like depression, schizophrenia and bipolar diseases. However the danger lies in concurrent misuse of such drugs for drug dependence or addiction. Alcoholism being an important example. There are drugs that affect mental processes and the drugs most commonly associated with dependence would appear to be narcotics, sedatives, stimulants, tranquilisers and hallucinogens. Man has used opium and its derivatives for more than 5000 years. Literary figures of eminence had bragged about opium’s so-called benevolent effects. Let us visit a few.
Coleridge was unquestionably a poet of extraordinary abilities and imagination. He suffered rheumatism. Seeking remedy from excruciating pain he came across what he called “infallible” remedy: opium. It worked like magic for him; his pains disappeared. He became alive again. Once he slept under the influence of the drug to be invaded by glorious dreams and ecstasies. Immediately on waking up, he penned down a poem known as Kubla Khan where he described the gardens and fountains, ancient forests and incense bearing trees. The very words he wrote occurred to him as he saw them in his dreams. In the meanwhile, a visitor came to meet him and after he left, there were no remains of his rendezvous with his dreams. He kept keenly exploring the haunts of forbidden experience. All futile.
Similarly De Quincey called the opium selling druggist “unconscious minister of celestial pleasures” and further summarised his experiences an hour later after taking opium: ‘O heavens! What a revulsion! What a resurrection, from its lowest depths of the inner spirit! What an apocalypse of the world within me.’
Citing these is only for literary/academic interest and not meant in any way to justify the misuse of these legally banned drugs.
Recently, there are very effective medicines available for treatment not only of milder versions of abnormal behaviour but also serious illnesses like schizophrenia and bipolar disorders the prognosis for which until quite recent times was generally unfavorable. Psychiatrists and behavioural therapists very effectively handle serious cases by focusing on removing the reinforcing conditions that appear to contribute to development and maintenance of symptoms. Patients with proper treatment and family care can lead a normal, healthy life discharging family and social responsibilities.
Towards the end, one may like to pause and visit the totality of circumstances that is being spoken about in The Cocktail Party as cited in the beginning. World over increasing public awareness of the magnitude of contemporary mental health problems may make it possible to do a concerted attack on these disorders with a view to obtain better and more holistic understanding, more effective treatment and long-range prevention. We have to realise the interdependence among us. If any individual loses his ability to achieve his full potential because of mental health issues, it is a loss to us both individually and collectively. Society loses. One cannot forget the genius mathematician from Bihar late Vashishtha Narayan Singh, who was affected by schizophrenia and the consequential loss to society which was deprived of his immense contribution. What an irreparable loss to the world!
It is enthusing that the Central Government recently decided to launch 24X7 toll-free mental rehabilitation helpline KIRAN in thirteen languages that will definitely go a long way in providing much needed succour to needy people. The helpline is dedicated to resolve issues concerning mental health and provide counselling relating to various disorders like anxiety, depression, suicide, substance abuse, etc. Such and similar efforts by the Government of India will certainly add a new dimension to emergent New India, for the mental health of a nation is determined and manifested in various ways: in its courage, purposes, scientific and cultural achievements, moral responsibility, self-reliance and quality of life. The New India has got to be fit: physically, spiritually and mentally.
(The writer, is a poet, writer and columnist. Author of three volumes of poetry. His poems have been translated into Hindi (Andhere Se Nikli Kavitayen-VANI PRAKASHAN (2017) and his book “Shadows of the Real” into Russian by veteran Russian poet Adolf Shvedchikov. His fourth book “Soliloquy of a Small-Town Uncivil Servant”: a literary non-fiction published in March 2019 by Rupa Publications, New Delhi, has been receiving international acclaim in literary field. He was Additional Deputy Comptroller and Auditor General in the office of Comptroller & Auditor General of India when he superannuated recently.Views expressed here are his personal views)