Mind Matters: A Psychiatrist’s Narrations

By Amresh Shrivastava MD

This book is narration by a psychiatrist. The purpose of this book is to provide education, information and knowledge about mental health and prevention of psychological illnesses. For this reason, Dr Shrivastava, a long time psychiatrist, has compiled stories of problems faced by patients and treatments they received with frank discussion and academic facts. One out of five people in our society suffer from a mental disorder. The experience of psychological illness disconnects them from their own selves. Though it is a treatable condition, patients seldom receive treatment. One of the main barriers is the stigma which is a clinical risk factor. We are unable to deal with stigma because people do not speak up about their experiences. We are unable to project examples of successful treatment. This limitation increases stigma.

• Language: English
• Publisher: Lulu Publishing Services
• Release date: Jul 16, 2018
• ISBN: 9781483484853

Book preview

MIND

MATTERS

A PSYCHIATRIST’S NARRATIONS

Dr. Amresh Shrivastava, MD

Copyright © 2018 Dr. Amresh Shrivastava, MD.

Art credits: Ajay Chavan and Shriansh Shrivastava

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of the author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

This book is a work of non-fiction. Unless otherwise noted, the author and the publisher make no explicit guarantees as to the accuracy of the information contained in this book and in some cases, names of people and places have been altered to protect their privacy

ISBN: 978-1-4834-8486-0 (sc)

ISBN: 978-1-4834-8485-3 (e)

Library of Congress Control Number: 2018905091

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Lulu Publishing Services rev. date: 5/31/2018

DISCLAIMER

The content of this book is not a medical or legal document for any kind of evidence in any real life-situation. In this books every person’s name and all kinds of information for any possible identification of any person or situation has been changed. The stories are blinded for protection of privacy and confidentiality. This book is not intended as a suggestion, evidence or substitute for the medical advice of physicians. The reader should regularly consult a physician for matters relating to his or her health, and particularly with respect to any symptom that may require immediate attention, investigation, diagnosis and treatment. Contents of the book are neither any evidence nor support any legal positions that may arise in any situation pertaining to mental illnesses of an individual. The book is written for awareness, information and education in the field of mental health. It is not intended to form any opinion or pass any judgement or be pre-judgmental, be discriminatory, bring prejudice or cause any emotional or psychological trauma or damage about any patient or their families or caregivers. Any resemblance to demographic, history, social situations, illness, diagnosis, treatment and consequences of illnesses or treatment discussed in the book is merely coincidental.

Education empowers people and enlightens professionals- Amresh Shrivastava

Dedicated to those

who taught me the art and science of medicine: my Patients.

ACKNOWLEDGEMENTS

I am much obliged to my family for their encouragement, contribution and support: Ujwala, Swati, Shriansh and Siddhansh

Special acknowledgement to Justina,

for her help in the editing process.

Education enlightens professionals and empowers patients and relatives

Psychiatric treatment restores dignity and human right of individuals with mental disorders

FOREWORD

I never would’ve thought that I needed to reach out to someone for help, until I learnt what was ailing me. Like most, I too felt that asking for help was a faux pas in this fast-paced world that we live in. These are rather strange but unique times we live in, we are too obsessed with money, we drink too much coffee to keep on going, to work harder and harder, to satisfy needs that we didn’t have before, only to have television and magazines convinced that we aren’t enough. But more importantly, we are in a progressive age where information travels at the speed of light, and we have become more global in our devices than ever before. This, therefore, is the right climate to pilot awareness about mental health. It is high time that we expand our understanding on issues regarding mental health and square our shoulders to it. Just as we are involved in charity because we understand the cause behind it, we must also feel obligated to learn what is mental health. Once we do that, we can identify its implications in the world or perhaps in our own microcosm.

This book covers all these areas in a neat package. Author Dr. Shrivastava speaks from his years of clinical experience as a psychiatrist and has laid out plainly the distilled facts that one must know about mental health. Having practiced in the UK, Canada and India, his repertoire of clinical experience is multicultural. Mind Matters is organized into anecdotes followed by a lesson about its psychiatric significance in a simplified language. It is a folly to state that there is a serious lack of mental health awareness. That isn’t the case. For instance, consider the evolution of awareness of depression. It is a success-child of numerous awareness endeavors that has brought society at the doorstep of empathy and understanding of mental illness. No longer does a sufferer of depression feel oppressed, he/she can talk about it with the surety that the topic is not alien to all. People display warmth and compassion toward such a person, which I feel is a wonderful element of society, and that it is possible to incorporate change within us and those around us. Then why not all the other mental health issues?

This is the aim of Mind Matters, to shine light upon the mental illnesses and spread awareness, and is structured around that idea in a way that just about anyone can read this book without prerequisite.

Dr. Shrivastava, a very research-oriented and true believer in academia, has unintentionally reflected himself through this book. An astute clinician and diagnostician, his detail in his work and straightforwardness is portrayed with subtle stylistic control through his words, which ameliorates the applicability of this book.

I congratulate the author on this book and I encourage the reader to engage themselves with the accounts of this book, for they are based on true stories, whose value would anything but rise if the lesson is pocketed away.

A service user

PREFACE

I am thankful to those who experienced challenges in their lives and chose to trust my skills and my abilities to help them. Over the course of my professional life, I have developed very close and personal connection with the field of mental health, which has grown to become not only my profession but also my passion. When I started realizing the significance of the psychological aspects of the patients coming to the hospital, as a medical student, mental health was not yet a favorite subject. There were not many professors interested in teaching it, and information and resources were scarce and not readily available. As a postgraduate student in psychiatry, I became convinced that mental health was, in fact, a science of the brain and with this realization, I grasped its great significance. Since then I have had the privilege of working with a vast number of patients in many settings in different countries, being a first-hand witness of the influence, the cultural and social dynamics can have on the mental health of people. Although this influence is of utmost importance, it was not a topic of textbooks in my time, and it is rarely addressed in psychiatry books now. I have had plenty of opportunities to connect with patients who found it difficult to share their problems; I have felt the pleasure of being successful in their treatment, as well as the disappointment of failure. I have realized how education, access to information and fostering a better understanding of mental health can indeed change lives. Mental health is an integral part of our life. We cannot live or function without sound psychological health. Unfortunately, there are many changes taking place in our surroundings that are increasing stressors in our daily lives. While we try to keep pace with the requirements of time, society is going through a severe transition. Socio-economic conditions, value systems, conflicts, natural disasters, wars, terrorism, cultural changes, and the loss of traditions are affecting our minds and body. Mental health is not limited to presence of mental disorders alone. It is the need of prevention against all diseases and behavioral challenges, be it heart disease, diabetes, smoking, alcoholism, poor nutrition or suicide. People have a mistaken understanding of mental illnesses. They think that people suffering from mental disorders do not recover and remain a liability for family and society. However, the fact is that many individuals recover from mental illnesses, but ironically, they never speak about it because of the widespread stigma. Since only a very small percentage of patients receive treatment, most of the relatives and friends of patients have never witnessed examples of success. Consequently, most cases of mental disorders go untreated, mainly because of the prevailing stigma and discrimination. While it is true that some mental health problems can be managed by appealing to self-help techniques, lifestyle changes, prayer, positive thinking, spirituality and religious practices, it is also true that in some cases this is not enough. When the problem remains untreated by mental health professionals, the symptoms become more severe and therefore more intensive treatments are required. This book aims to promote psychosocial well-being, convey optimism, renew hope, and its primary goal is to bring peace and happiness to the lives of patients and relatives. Mental health is an integral part of our life that determines the way we feel and behave. A healthy mindset is not only part of a healthy life, but it also makes it easy to choose a healthy way of living. This book highlights problems of mental illnesses and the practice of psychiatric medicine. It portrays the strengths, weaknesses, merits, and challenges of the psychiatric profession. Revolutionary changes are taking place in the field of psychiatric research. There are newer treatments, newer understanding of mental disorders. However, the most critical challenge is to translate these research findings into ordinary people’s language and to innovate methods aimed to make these achievements easily accessible to everyone. This book also provides some of the much-needed education, information, and knowledge about mental health. To do this, I have compiled several stories on the problems faced by patients and their relatives during their treatment, along with an explicit discussion of each case, and the relevant academic facts. I have chosen the format of stories to discuss various situations of mental health so that readers can relate to the problem that is addressed in each of them. Mental illnesses are common, and a large section of population is suffering. Fortunately, they are both treatable and preventable, like any physical disorder. They impose a high economic burden on patients, relatives, and governments, which leads to a severe loss of productivity. Researchers suggest that psychiatric disorders affect one in four or five people.¹ About six to eight percent of children and adolescents are under severe psychological stress and at risk of developing mental disorders. In India, more than twenty million people suffer from severe mental disorders such as schizophrenia and bipolar disorder and globally, around 450 million people are currently affected by mental illness.² As a postgraduate student, and later as a faculty member, I had the privilege of studying and practicing in rural regions, urban and metropolis regions of India, in the United Kingdom and in Canada on several positions. I hope that this book becomes a dialogue or conversation among people who care and people who need care, a bridge to facilitate early identification and access to care. The book highlights weal and woes of patients and relatives, challenges for doctors, resources for mental health, and possibilities amongst impossibilities. I have tried to synthesize what I have seen, experienced, inferred, together with what I have understood and questioned. I am neither passing any judgment nor advising any treatment. I am only stating the facts as I have seen them, and the issues I had felt concerned about. I hope this book can encourage people to get up and go to their near, dear and loved ones, open their hearts to solve their problems and decide together if they need to see a professional. I begin with prayers to Lord Dhanvantari, who in our culture, is the God of Medicine, and to Mother Saraswati, who provides us with the power and wisdom of knowledge.

Happiness can be found in the darkest of times if only one remembers to turn the lights on.

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II

MENTAL

HEALTH

1. EXPERIENCES

Depression is a cough and cold of mental illness. But imagine if you were continually suffering from the flu. Recall the last time you had the flu; even in the worst-case scenario, evidently it didn’t last longer than two, maybe three weeks. If you were sick for more than a month, you would go to the doctor’s office and make it a priority. But depression is usually chronic; treatment involves keeping your mental health under control, recognizing the signs when it gets worse, and acting appropriately. Good mental health is not the absence of a disorder, but mental well-being and the satisfaction of life goals relative to each age. ‘Life goals’ are those milestones that you achieve in life, which, when missed, leave people feeling as if something was missing in their lives. For example, people in their late teens and early adulthood are at a stage where they might want to get an education. A lack of it will leave them feeling that they are going to miss out on worldly opportunities that others are enjoying. On the outset, they might feel as though their real life hasn’t quite started and they are already on the wrong foot. This is how depression can cast a dark shadow in one’s life, compared to others who may or may not be facing similar hardships. Moreover, multiple issues can pile up upon each other in the life of a depressed person, making their condition more unique, and thereby make it harder to confide in another person. Approaching a friend who cannot understand your problem can make it worse. One might go through emotions of confusion, doubting your abilities to be happy, or feeling you are mentally weak or unstable. It might sound cliché to say that everyone’s depression is a little different, and it is, but only because it is true. Some people don’t need much time to adapt to their depression. They know what to do when they are feeling low, and how to stay up as much as possible. Some people are not, and they require support to learn better ways of managing themselves. Often, they fall into crises time and time again because a prolonged depressive episode will throw their life completely off-balance. The most important thing to know about depression is that it is not just sadness. Therefore, no happiness can be directly prescribed. However, it is true that depression begins with ‘lack of enjoyment.’ Usually, depression emerges from an adverse life event. An occurrence of something mentally taxing that is not resolved in due time can turn a depressed episode into a depressed state that lasts for many months. Usually, someone suffering in this way seeks help, and with the right treatment is back on his feet, without the need to look back. This is what people usually mean when they say, it was a dark period in my life, but luckily I got through it. Unfortunately, many times depression rebounds like a boomerang. It may relapse over and over, and a cycle of recurrence is formed which slowly turns into chronic depression. The reasons for relapse are multiple; some are at the mercy of their genetics and neurobiological composition, as depression grips them tighter. Some are ignorant of their treatment, which is not something to be condemned, as accepting the fact that you have depression is not easy. A very reductive analogy could be to pain: imagine having a backache. One takes medication for immediate relief but cannot stop going to work nor take a break from physical activity altogether. One may not follow the treatment carefully, may receive pain medication on and off, may falsely believe that the pain resolved on its own, only for it to recur. What is happening here is that the body is under constant stress and strain, the problem is being temporarily fixed, but slowly that back pain is turning into chronic back pain. The person develops a back condition, and now movements are restricted. This person may enjoy hobbies such as swimming, but can’t do it anymore, or maybe the stronger pain medications prescribed may make the person drowsy, and this is how daily life becomes complicated. The best way to deal with depression, which many people can benefit from, is accepting that vulnerability is a natural part of life. This advice applies to any kind of health issue. Usually, people get angry over the fact that their body cannot cope. If a healthy woman in her mid-twenties on her way to a good job and husband, is suddenly met with the news of cancer, say leukemia, she will start resisting the reality she is about to face. She might feel as though she is healthy, beautiful, and has hopes and dreams; but her body has failed on her. She may get angry at the fact that her body cannot possibly deceive her and ruin her life this way. But psychologically tuning oneself to the approaching disease is the right thing to do. It may sound drab, but it is a bitter pill that someone with depression must swallow. If we think of it as a vital life lesson, you are only helping yourself. Furthermore, treatment consists in achieving a balancing act between psychology and physiology. They are the two plates of a weighing scale that must be leveled for the treatment to work. Medications act on the physiology of the person, and they control behaviors that we cannot help just by words and actions. A depressed patient can have constant negative thoughts that attack their self-confidence and mind. One may get mentally exhausted by being bogged down by feelings one does not want to think; one might be scared that there is no self-control, there might be thoughts that are hard to express, which can drive one into loneliness. Medication can help slow down these thoughts, and only after the relief is felt by the patients, they come to understand that their mind has been spinning like a top and it was wearing them out. We should understand and acknowledge that medications are not just sedatives, contrary to popular belief. Psychologically, depressed individuals need to address the problems that are bothering them. For any mental illness, being grounded is the right attitude to have; putting stock into an old wives’ tale does not help. Understanding this is winning half the battle. People find ease in understanding what is happening to them, why they are feeling troubled, why depression is making them feel like everything is going wrong, why they are feeling out of it today, or what they can do not bring themselves up to do what they feel. Having an answer to these questions helps them get past their emotions better and see the problem from a different angle. A prevalent treatment is known as Cognitive Behavior Therapy (CBT), which teaches how to cope with situations. Developing an assertive behavior towards one’s depression will ultimately bring stability to life, which is second to the best possible outcome. The telltale signs that someone is developing a depression is straightforward; they are appetite and sleep. A follow-up with a psychiatrist always begins with the patient being asked if she or he is eating and sleeping well. Weight loss resulting from low appetite directly hints at a person’s lack of interest in caring for himself/herself or at neurochemical changes suppressing appetite. One may also exhibit other signs: not enjoying any other daily activities as one used to. Sleep is another important symptom. An excess of sleep could accompany prolonged periods of grief and act as a mental way of escaping life. The opposite could be true; a person could lose sleep while suffering from a constant state of stress or anxiety. An important facet of depression is the mind’s acclimatization to being depressed. Over time, the mind is conditioned to feel helpless about its condition. The result is something called ‘learned helplessness,’ where past experiences have taught that no matter how much effort is put in, a crisis cannot be solved. Therefore, it is futile to try to fight back. This behavior is as notorious as weeds that grow in a lawn. They need to be uprooted from deep within, or they will spring back. A constant back and forth in a cycle of learned helplessness and failure will leave the patient feeling more mentally disabled than one already is. In severe cases, a patient may achieve a break-through with psychological support, only to return to the same state all over again. A favorite phrase is I have re-discovered myself repeatedly, I feel like time plays no role in my situation and there is nothing I can do. These are some of the signs of a patient suffering at the hands of depression to a point where he or she cannot progress in life at all and needs help. Often, these times are troubling; patients spiral into self-loathe and pity. They develop habits that sabotage themselves and directly threaten their life. This behavior resembles the behavioral pattern of individuals with alcoholism and their relapses, falling into it repeatedly. After years of self-abuse, one might feel as though much has been done all ready to come back to the usual self and may feel more hopeless. However, patients need to learn that the disorder can be reverted, they must have faith and know that those around them have faith. ‘Faith’ refers to: having faith in ourselves that their suffering is for the time-being and it can be reversed, or its pain can be minimized; faith also refers to having faith in the treatment they are receiving as well among those who are providing this treatment. There is no doubt that people having strong faith in the treatment recover much faster, much better and they can bear the pain and suffering much more easily Severe chronic depression presents as a vicious cycle, and it can be a slippery slope towards hitting rock bottom. Social support is very beneficial in depression. Having a true friend, an understanding and considerate spouse or guardian can be the leverage needed to keep fit. Human beings are innately social creatures, and connectivity with society generates a strong positivity that can genuinely vibe with the patient’s road to recovery. We often overlook this fact; we don’t think much of volunteer or service or social activities; however, acts of altruism can drive away negativity. Some may chalk up a smaller social circle due to introversion or a shy personality, but a keen eye on an individual’s emotional and social quotient can also unlock alternative approaches to therapy. So far, we have been discussing the broad aspects of depressions. Depression in daily life crops up as small obstacles that one must deal with no matter what: experience does not stand still for depression. Mood instability is the most discernible visage of depression. A low mood comes in cycles; it might affect a person every two month, for example, even when he or she is stable on medications. When the mind is more troubled, or the person is in a stressful environment, these mood changes become more frequent. There are the physical manifestations of depression, such as muscle aches or excessive sleeping. Some people might experience intense dysphoria, or if they have anxiety related depression, they might experience feelings of impending doom at odd times, with no direct triggering factors whatsoever. For example, someone might experience palpitations when they wake up in the morning. A common sign of depressed state is the unwillingness to get out of bed in the mornings. The person might take more naps, which might perplex others, but for the depressed, sleeping is taking a break from life so that they don’t crumble under pressure. What is worse is that the sleep may never feel restful: being in a constant state of worry of taking on the day. The sleep might be split into mere hours, only to wake up with fear of the outside world. This ‘hiding under the blanket’ attitude is a hallmark of depression. Sometimes, the psychiatrist may ask a patient if he ever feels as if a good cry might make you feel better. This is a means of finding out if the patient is bottling up his emotions. A healthy channel to vent out feelings is not a wrong way of stopping depression from getting the best of people. Mentally, depression can clog your creativity. Especially if a patient is young, it might affect industriousness in work. People may have problems with focus and memory, which they need to keep going throughout the day. If things get too bad, people might have to resign themselves to a low stress, easy-going life. Similarly, a person might have the desire to be a runner, but with an injured ankle, it wouldn’t be wise to keep pushing towards that dream. Some might turn to alcohol, it might be a release to have a drink at the end of a hard day, but the cycle might increase the consumption. Even if the patient has a family and does not go overboard with substances, they still must withstand a painful hangover the morning after and a blurry state of mind. This might cause problems in relationships with spouse or relatives. Thus, the cracks of depression widen and spread.

A small note about depression with other psychiatric disorders: Depression accompanies disabilities of the physical and mental kind. It is not uncommon to find two or three things clustered together, such as the development of a panic disorder, anxiety or phobia of some sort. A patient could be suffering from a dissociative disorder or an unexpected change in personality. Insomnia, hallucinations or spells of manic phases followed by distressfully low moods are all red flags that should point towards at the need to see a psychiatrist as urgently as possible. We do not like to speak of it, and it may sound far-fetched, but depression can lead to suicide. There are several kinds of suicidal behaviors. Some might be just thoughts, which the person has no intention of acting upon. Some might be sporadic. Some might be planned: I have a gun in my dresser, if something happens today I will blow my brains out. Either way, the psychiatrist must ask if the patient has any ideas of suicidality whatsoever. The ability to identify suicidal ideas depends on awareness about the problem of suicide. Awareness campaigns such as ‘Depression: Let’s Talk’ by the World Health Organization (WHO-2018) ³ spread the message of the importance of asking your friend, neighbors or coworkers how they are doing. A simple conversation can uncover a silent sufferer and stop a potential suicide. Finally, I would like to bring you back to the opening comment about depression: it is a cough and cold of psychiatry. It can be treated, it can be maintained, and encouraging the stigma around it is not the smart thing to do. Happiness can be found in the darkest of times if only one remembers to turn the lights on.

‘11 of the 23 family members suffered a mental disorder’

2. MENTAL ILLNESS RUNS IN THE FAMILY

Ramesh is a doctor by profession, a naturopath, and a successful man. He and his parents lived in a small town of about 100,000 inhabitants. He always lived in this town and had only been away for five years, when he went to the university. There he met Rashmi, who was his class fellow. They got married and came back, ready to set-up their own practice in his hometown. His