Doctor Diaries. Patient prescribed treatments.

Thanks to a doctor’s strike in response to a very obnoxious law that the State Government is intent on passing, I finally get the oppurtunity to sit down in front of a computer without the chaos that I’m usually immersed in. Kids packed off to school, no patients waiting and my ward rounds done, I sit in my OPD and wonder how to start off. Its been so long off the blogosphere, that just the thought of writing something is giving me the heebi jeebies of a newcomer climbing on to the stage for the first time.

And then, there is a discrete knock on the door. My hired help comes in to enquire about medication for her daughter’s cold. I give her the name of a tablet and look back to my laptop screen. She hovers around and finally asks ” Ondu tonic kodbahuda? (Can I give her a tonic too?”.

And gives me my fodder for today’s blog.

Practising in a smaller city gives me an oppurtunity to deal with a potpourri of patients. Some of them young, google friendly and fit bit savvy and the others who still believe that spending a few lakhs of rupees on a puja is much better than spending a few hundred on a qualified person’s consultation. The rest oscillate between the two.

Every place and its population has its own etiquette and culture which make it unique. Apart from the cultural and religious norms that we follow, there are certain illness behaviours specific to people and their mindsets. Most of these dictims are age old and seem to have no logic attached to it, but are still followed diligently. These are a few things that seem to constitute a set of behaviours that I call “patient culture”.

Sample a few of them:

  1. Post partum mummifying:

Just as a pregnant woman can be identified by her baby bulge, so can a post partum one (in any part of India), by her near mummified state. This special garb includes a head scarf which conceals cotton stuffed ears, a heavy sweater over a nightie which is covered by an even thicker shawl, socks, (occasionally gloves) and hawai chappals.

Never mind that it may be the middle of summer with average temperatures hovering between 30 to 40 degrees. Just looking at the woman makes me feel like taking the ice bucket challenge (which was an internet sensation) willingly!

On my ward rounds, innumerable number of times, I have admonished the relatives,  made sure that the additional layers are removed and switched on the fan- only to find that the moment I leave, they sneakily get back into the same attire, tch tching about my state of ignorance about correct post partum fashion!

The lady in question accepts this with equanimity though she is sweating buckets!

2. The obsession with tonics and tonic injections (mind you, both are different and decided on by the patient, based on severity of his symptoms).

In my part of the world, patients believe that any consultation with a doctor which ends with only a prescription and some well meaning advice is a complete waste of hard earned money. Throw in a colorful looking injection and a bottle of vile smelling B complex syrup, you rise up in their eyes, as a doctor of worth.

So strong is this obsession, that occasionally, when they are strapped for cash to buy medicines, they buy the tonic and give up their antiepileptics!

I recently visited a renowned stroke center in the middle of a village in Uttara Kannada district. The center is famous for an injection which is supposed to cure stroke. Pushing through a patient line of close to 200, we met the administrator to find out what the miracle injection was. Turns out that it is Methylcobalamine (which is vitamin B12). The administrator rues the fact that patients cannot be convinced into taking physiotherapy and medication. The center does not even have a neurologist! A huge board which claims “We do not give injection for stroke” hangs desolately next to the serpentine line, with no takers for its claims!

3. The glucose panacea.

In furtherance to the obsession with injections, is the enormous level of faith that our masses have on “glucose” – which means any IV drip. Feel tired, feel woozy, not feeling like work, heart burn, heavy bleeding during your period, seizures, heart attack…. go to the nearest doctor for a glucose to solve all your problems. If the patient so much as skips one meal, the relative discretely asks me why I have’nt yet thought of the “Glucose”.

4. The concept of cold and hot foods.

Deriving directly from the concept of ayurveda is the concept that certain foods cause “heat” and “cold” in our body. When a patient innocently asks me how to cure his constipation, he gives me no clue that he knows the ins and outs of his body’s reactions to a million items on the food list. Consider this- bananas cause phelgm, milk and ragi cause cold, nothing from the fridge beacuse it causes his throat to itch, ginger and garlic give him piles and mouth ulcers, sesame and papaya are known to his give his wife increased mentrual bleeding, oily food causes cough, sour foods and peanuts give him gastritis, porridge cause flatulence,  and so on. I am left grappling with a tiny list of acceptable edibles to prescibe. So much for balanced diet!

Once you accept these stoically without batting and eyelid and nodding understandingly, your are accepted as an experienced doc!

Have you had any experiences to add?



A book of light to end the brain fog!


I have discovered something about writing. It has whims and fancies of its own. When you are in the practice of writing most days, the words flow easily, your thinking does not falter and sentences form fast,fluent and effortless. But when you have stopped for a while, for reasons beyond your control, it acts like a spoilt tantrum throwing brat. You have to really scratch your brain about that particular flash of inspiration which occurred yesterday, right in the middle of a busy opd, which evaporated miraculously like the whiff of an agarbatti smoke. It is as if your writing has gone into a huff, for not giving it enough time!

This is the state I found myself in last month. A month of busy, busy work days, the responsibilities that go with being an exam mother (by which I mean revising with your kid, subjects which you tried hard to avoid studying into adulthood), trying to teach my younger one to read by herself and the general business of keeping house – all of which allowed absolutely no vigour or brain space to open my laptop.

At the end of the day, the only energy I had was enough to flip the pages on my kindle, and so, that’s what I did. I read some amazing books- those that made me happy, sad, upset and in awe of things they spoke about.

The oneswhichhad adirect impact were Em and the Big Hoom by Jerry Pinto and the Book of Light.

On a day to day basis, I see a range of emotions (from anger to over protectiveness) shown by the relatives of my patients. Some are shocked to realize that their relatives are mentally ill, some refuse to acknowledge it and some firmly believe that their son or daughter is showing symptoms to cop out of some responsibility. When I am talking to the family about the actual nature of the illness which their closest of kin are suffering from, I usually discuss it with the adults, and the children are generally playing around in my consulting room. I surprisingly realized that I have never ever discussed the illness from the child’s point of view. A vibrant impressionable mind, which is in confusion about why their favorite adult is behaving somewhat differently and unpredictably from the rest.

Which is why I found Em and the Big Hoom a very interesting read. How would a child feel, when a parent is mentally ill? When the caretaking becomes a child’s responsibility instead of the other way round. When it is difficult to expect your parent to attend your school functions or pta meetings for the fear that he/she may do something embarrassing.

The story revolves around the author’s family whose the mother suffers from bipolar disorder.  The book is written from a child’s point of view, and tries to address the concerns which are unique to such families. Have they inherited the illness? Will they become mentally ill like their parent? Or will it skip a generation and affect their children? Or are they, at the other end of the spectrum,  accepting the adults as they are and ignoring the quirks?

Going through the book, gave me insight about a huge chunk of responsibility I was ignoring! As for many other mental health professionals, though time is tight, I promised myself that I would spend some time for these children henceforth.

Going on, I read another book, written on the same lines. The Book of Light, which is a collection of stories written by the relatives of the mentally ill about their experiences in life. There are very few books written about mental illness in the Indian context, and hence this book gives an idea as to how the people from different sections of society deal with the illness and the adjustments that go along with it.

If anything, I felt the need to do more, work harder. Not only to help those who are overtly ill, but also those who are silently suffering on the side.Or confused. Or slowly slipping into an illness themselves.

Only if there were more than twenty four hours in a day! (and no math exams!)



How bad is it, doc?

doctors There are many cliches associated with being doctors. The near dictum that doctors are next to Gods. That practicing medicine is a noble, respectable, ideal profession. In the nineties, most children in India, I would safely say, grew up with an idea that their life would be made if they became doctors, or engineers. It was the rare parent that would allow his child to choose a profession apart from these two.

According to a recent study by the WHO, despite medical schools mushrooming all over India, we still are short of doctors.  The state of a patient in rural India, who needs some form of emergency medicine is still abysmally bad. So,yes,we do need doctors.

But suddenly, it almost feels like doctors are everyone’s favorite punching bag. It is as if we are a group of individuals with dubious reputations, unscrupulous, unethical and those trying to make a buck out of the poor patient’s pocket.

It is therefore probably the right time to remind ourselves that medicine is, basically, just another profession. Yes, compassion is important, as well as a sense of responsibility. But then, those with an aptitude for both should not have difficulty in finding their way into this field, just as someone with good computing skills takes up computer engineering. To deglamorise, doctors study five and a half years for a degree which tells them how tackle certain ills in a scientific manner. We do not claim to be Gods, nor are we the devil reincarnate.

I do agree that there is a lot going wrong with the practice of medicine in India. But these wrongs mainly stem from a flawed, aged, system rather than the individual doctor.

Children as young as seventeen, I believe, rarely have the maturity to realize the seriousness of a profession like medicine. In the west, medical school would be an option to only those with an undergraduate degree under their belt. I personally know of kids who take up medicine because of the glamour associated with it or because of parental pressure. When you choose a profession for the wrong reasons, the outcome seems near obviously bad.

The presence of corruption in a system which deals with life itself. In conversation with one of vice chancellors of a medical school, I get to understand that the seat matrix in any medical school across India is decided by how many palms are greased rather than, how good the patient student ratio in the teaching hospital is. We see around us a number of med schools where professors exist only on office papers, and the teaching hospital needs to be filled with fake patients who are hired during MCI inspections. We PRACTICE MEDICINE. And where the practice of teaching is poor, the confidence of a doctor to handle a patient is obviously poor.

The weird attitude that once we choose to become doctors, we, as individuals, need to give up on material gains. The salaries of doctors in rural service is pathetically low for the amount of risk that they take. To quote Atul Gawande in his book, “Better” ,doctors in rural India are the most innovative and efficient. They need to work with patchy electricity, minus specialist help, have to work against unhealthy  but traditional practices to the convince the family to get the patient treated. Hence, they learn to work with enormous amount of common sense. But, the rewards materialistically or otherwise are poor. They have poor roads, horrible infrastructure, no legal aid, their children have no good schools, due to which they would have to be sent away for their education. All the while, when media glaringly shows them, that their counterparts, with half the years of education, are earning fat sums, driving the newest eye candy, spending time in malls, living in penthouses, working in centrally air conditioned offices and sending their children to international schools. Who in their right mind would choose rural service?

As doctors we ultimately deal with lives. And people. And people with a million different personalities. And these personalities, when they are under stress of illness. But nowhere in medical schools are we taught the importance of good communication, on dealing with grief, on being calm during periods of stress or emergency. It is as if we are expected to magically source this information from some place in the universe and imbibe it. The art of counseling, is not hereditary. It needs to be taught. And as my dean in med school, Prof. Dr.B.M.Hegde would quote, doctors, needed to be trained to “cure rarely, care often and comfort always”. Poor counseling skills, automatically translates to poor patient care.

Law concerning self protection, medical insurance and negligence are alien subjects when we study medicine. We only get to hear these terms when we land, slap bang in the middle of a controversy. We do make mistakes. We are human. But, mostly the health of our egos and our bank balance depend on the good health of our patients. The pleasure we get when we see a critically ill patient walk back home with a smile on his face, is probably what keeps most of my fellow doctors in the profession, despite the grueling hours and non existant social life. Hence, if we were to be taught what to do when we err, we would definitely tread with more caution, rather be caught on tv appearing like a petty criminal.

If we are a society concerned with health, then we have to understand that we have an individual responsibility towards our health. Poor lifestyle habits, not following the doctor’s advice and skipping doses, and then blaming the doctor for poor health despite taking expensive medicines is simply playing the blame game. Not acceptable.

To summarize, we need a multi pronged approach to start a change in most of these areas. Able law makers,thinkers, senior doctors and the public at large who should first understand the flawed but totteringly functional system completely. And then attempt change. Only then, we can hope for the health of the country as well as its doctors.  Till then, still happy to be a doctor and enjoying it despite the hurdles!

Are women their own worst enemies??

I am in a sour mood today. This usually happens when my day starts badly, or my daughter is in a god awful fussy mood or when one of my patients is not doing well. Today, the reason happens to be none of the above. Instead, it is because one of my patients told me very nonchalantly that she was pulling her daughter out of school. The girl in question was an 80 percenter, was so popular that her teachers apparently came home to beg her parents to let her continue on. But the parents were unmoved. The teachers went a step ahead and dangled a scholarship carrot which would reduce the financial burden. No difference. They explained that the college which would accept this girl was not co ed, wondering whether that was one of the parent’s concerns. No avail. Coolly, the mother tells me that she decided against it, because, hold your breath…. paying the city bus fare was not worth it!

This probably happens to many thousands of girls across India. But what pricked me most was the amount of carelessness that the mother displayed when she spoke about her daughter’s plight. She tells me that the girl cried for a while, stopped eating well and finally accepted her fate and is now working as a maid. The more I got flustered, the more calmer the mother seemed. My arguing on her behalf did not make one bit of difference. I asked her whether she did not want her daughter to be in a better financial, social position than she herself was in now?  She parrots that the matter is closed and she is happy now. I ask her how she would have felt in that place. She says she was never interested in studies. I wonder whether she did not feel some amount of pity when the girl cried. She coolly denies it. And THIS makes me so mad!

I have been party to many heated debates with my friends and relatives on the matter of whether women were in fact women’s worst enemies.  The topic itself used to drive me crazy. Outwardly calm, I would be fuming inside at anybody who would condescendingly support that statement. I would argue against it and sulk for the next few hours at least.

I am, I feel, slowly having to eat my own words. The amount of discrimination I see in my everyday practice is to put it mildly, is enormous. Over a period of time, I feel I have become over sensitive to it.

It creeps in so mildly, that its over before you think up a sarcastic retort that you hope will teach them a thing or two.

The wilt in the voice when they say, “ Oh, I have ONLY three daughters”, (no matter that they are all double graduates), or when they say” Please keep me healthy till I PUT my daughter into a good home” ( as if it a piece of furniture you want to sell). Or when a patient as old as my granny pats me on my head and says “ Hope you have a son who can follow your path”. Or when they proudly claim” He is my ONLY son” (after three daughters who were sired hoping for them to be sons). When relatives of mine think a hundred times before letting their daughters go to some hobby class far away from home, because “these times are soo bad”. One of my friends once told me that a patient of hers who was grateful for the care given, pulled her aside and thrust a hundred rupee note into her hand as a contribution towards her daughter’s future wedding. The implication being that it was a burden!

I am sure most of us have been through circumstances similar to these on a regular basis. And thinking back to most of these instances, the person who would have sighed the discomfort happen to be women.

Like the word BITCHING. Well accepted, commonly used and quite often by women, but so discriminatory. Somehow, it makes me feel small. Makes me feel ashamed to be a woman.

Like when I see photographs of female genital mutilation, and the people who restrain the victim are always women!

When I read reports in newspapers of mothers in law being held for dowry harassment. When I hear about two heroines having a “cat fight”. When women talk ill about other women and judge them as being characterless. Elderly women in the household who in the behest of upholding traditions of the yore, harass the younger ones. When working women are not cut any slack at home the way their spouses are. When younger women make specific demands of not wanting to live with or care for their in laws even before meeting and gauging them.

And somewhere subconsciously, it does seem as though women are the ones holding the others behind. In their defense, maybe, just maybe a few of the factors influenced their way of thinking:

  1. Women who are less educated, end up believing myths and misconceptions easily. And because they have no solid knowledge of why what is being done, they assert themselves, mainly in front of other younger women, for all the wrong reasons. That is probably the only way they can wield authority, which defines them.
  2. Women who marry so young that they have no idea what they are missing in their youth. The frustration shows through in their middle age, when they are angry with others who seem to have enjoyed more than they have. They end up judgmental- a classical case of sour grapes.
  3. Some others who have been brought up in the above two scenarios who think that it is the normal way of life and repeat the cycle.
  4. And though I seem to be repeating myself way too much, I have a serious grouse against the typecasting ways of the television soaps, which mouth dialogues like “ a girl’s place is always next to her husband” , “ Once married, only my dead body will go back to my maternal home” or “how will you ever live alone in this big bad world( and hence you need marriage asap!) and the like… I’m sure you get the thread. In most homes, people from all age groups between three to a hundred sit glued to watch these. Probably subconsciously start believing that this is the way the world thinks.

I agree these may be oversimplifications, but at least they may help us to start the rehab work.

The theory of women being women’s worst enemies may not actually be true. We hear stories of women having done great service to their fellow beings and the world in general. Women who brave the odds and manage to reach the top.Women who have helped out their children and displayed grit and determination in helping them reach great heights. I feel strongly that these are the stories that need to be venerated, celebrated and followed in media, kept as mandatory reading since primary school, as dinner table discussions in most homes, and as heroines of prime time tv. The social media network and the internet, still only reaches very few.

And then hopefully, this adage will die a fitful death!

Let us start a change.

This morning, our hired help got an emergency call from her daughter’s home. Apparently, there was a tiff between her daughter and son in law, no doubt precipitated by her mother in law,that led to a big war of words. The reason for the fight was that the daughter had returned home a day later than was permitted by the monster in law. My maid was ordered by her son in law to take her daughter back home forever, just like that. And worse, my maid obeyed meekly and begged for forgiveness! My maid’s daughter is all of eighteen, married off 6 months before her birthday, despite all our protests and a very timid, quiet girl. Before her marriage, she would handle all the household responsibilities before going to work herself. She used to work without taking without a day’s off, even on her birthday. And finally agreed to marry a man 10 years her senior, without as much as speaking to him, because her mother told her to. And now this!

In the past few days after “India’s Daughter” was released, I have seen every social media platform, every single TV station, every whatsapp group and every newspaper give enormous publicity to what happened. There have been pro ban messages, anti ban messages, protests held and discussions dissecting every single aspect of the documentary and the attitudes that prevail. I did watch the documentary myself and felt my skin crawl and tears fall freely when the creep ( in the garb of a lawyer) and the accused speak of Jyothi/Nirbhaya almost mechanically. I felt a helpless outrage. And then it remained that way. Because:

  1. I feel that no amount of media coverage may change the harsh ground realities of thousands of millions of faceless, nameless Nirbahyas across our country or the world. The huge mass of humanity which watches these shows and newsreels are those who already seem to have a slightly different, egalitarian and non traditional mental attitude. These are not much the group who needs to change. Change needs to happen in the rural most parts of India, where women’s dignity and independence are still decided by the men of the family. Where women are not individuals, but burdens. Where the society (as Mukesh Kumar’s lawyer aptly put it) has no place for women. No point in just showing them the middle finger. We need to actively change them. But how?? We have “Beti bachao, Beti padhao”in place, but no “Beti ko respect dena bêteko sikhao”anywhere in sight.
  2. The evil mother in law does exist. Those who have different rules for their daughters and different ones for their daughters in law. Those who think and believe that the ‘sun’ rises and sets with their ‘son’, or rather because of him. They shower so much love on their sons that it becomes a sort of emotional debt to repay back that love, by taking sides when there is fight between the mother and the wife! The daughter in law that they themselves sought after the many ‘girl seeing’ sessions, becomes an object of hatred because she tries to tweak the rules of the house a little. A reverse Oedipus complex I would say! It is difficult to be non judgmental about such women and rationalize their bad behavior with many excuses. When we try family counselling in such situations, it feels as though you are smashing your head against a brick wall! And the men of the family at best, look mutely, smile condescending smiles and say “Oh, you know women, what can we do? “, and act as though the whole thing had nothing to do with them!
  3. And the so called myth that ‘Women are women’s worst enemies” seems true to a certain extent. Pick a random case of dowry death, the MIL is almost always the master mind. Pick a case of child marriage, the mother is the one who has ‘counselled’ the daughter that this is what is best for her(as in the case of our maid). Pick any post marital conflict, the mother is the one advising the daughter to go back, so as to avoid the shame society would hoist upon them, lest a daughter comes back to the maternal home in disgrace. Pick any child who has dropped out of school, it is because there was no one to share the mother’s burden of work (it does not occur that the boy can share this burden too!). These are the bitter realities, which we as the middle class have forgotten and brushed under the carpet. We are truly a lucky group of people whose parents changed their attitudes. But for a lot of other women, these painful realities are a part of daily existence, and they come to us as patients of depression, or victims of assault, if they try swimming against the stream.
  4. Finally,us. Most of us did download the controversial video and watched it in horror, a lot of us walked candle light marches, many hosted seminars on the evils occurring to women and many spoke/ wrote about it( including me, by the way), but it did not cause change where it mattered most. When my maid got her daughter married, it was on the tip of my tongue to advice the girl to rebel, and go back to her studies. But I did not. I protested feebly, and then left for her to decide. I feel like telling my abused patients to get the hell out of their abusive marriages and make a life for themselves, but refrain because of my so called professional ethics. When I hear my neighbor beating or scolding his wife in a drunken brawl, I choose to curb my anger, rather than go back there and help bash the living daylights out of him! I am sure most of us are in the same state of helplessness and hence the quantum of people abusing/ disrespecting/ troubling/ and killing women will not subside.

There are too few of us who do and too many of us who keep quiet. Far too many who accept a ‘pedha’ as a sign of happiness when a male baby is born and sweetened puffed rice (almost apologetically) when a girl is born. Too many of us who still believe that with marriage and children only, is a woman’s life complete. Too many of us who do not protest when widows are not given adequate respect at family functions… and so on the list grows.

Changing rules and government policies may work in the long run, but till then we may continue to lose many of our kind. So let us start the change in our everyday lives. Let us not wait for some incident to happen for us to awaken from our stupor. Let us start small, and consistent. Let each one of us make sure that our maids have an education. Let us not watch/allow watching of regressive serials where women are typecast. Let us not hum item songs, because they do objectify women, how much ever they are supposed to be an integral part of the script!

Instead let us show small children inspiring videos of women who have done great work despite their odds, as a part of school curriculum. Let us teach them how to use legislation in case they are harmed. Let them know that they need not swallow abuse just because their marital prospects and family honor may be damaged. Such small things may go a long way in building positive attitudes at a young age. Let us show them that…

women rights quotes

A confused Indian, hindu, mother, human, me?…

Let me confess at the outset, that I do not even know whether I am qualified or deep enough to write this piece. My defense is that there may be an equally large number of people out there who feel like me, and are also not completely well read in all matters history, religion or politics. And I also confess that being a mother,  I tend to dwell a lot on the premise of what kind of a world is it that I am letting my children wander into?A world where you have to be scared of belonging to a faith? Or one where you wear it like a badge!I feel it needs to be neither.

This year has been all about a feeling of unease about religion. I have never big on either politics or religion, but this year has pushed me into thinking a lot about it for various reasons. A few to be mentioned are- the recent spate of killings by the ISIS, a few videos that I watched on whatsapp of a close up of beheading done in cold blood in some Arab country, “Aavarana”, a book by S.L. Bhyrappa that I read with mixed feelings, a few statements made by our seers which claimed that Hindu women needed to procreate with greater speed and intensity to save our religion and finally culminating with an experience that I had this afternoon- a ‘Pathasanchalana’- a march of thousands of RSS swayam sevaks held in my hometown.

Growing up, I was brought up in a family which held our country’s values of democracy and secularism in high stead. My home town, though rich in history was not too communal. And the street I lived in had people belonging to almost all religions and caste. Hence, the idea that something really deep could divide us only struck me during the Babri Masjid riots. I remember huddling in my school waiting for someone from home to come and pick me up. I also remember the fear on my Muslim friend’s face during the wait. It was a little more complicated for her. She was waiting to be taken home safely by someone hopefully arriving to pick her safely! After this, there was again a sense of peace which prevailed for the next so many years. Slowly, I pushed these disturbing memories to the remotest corner of my mind.

I have always felt that religion should be something very personal. Something which gives you a sense of peace, a feeling of security and belief that if something goes wrong,the Almighty(with a capital A) was there to protect you. And some place you send your prayers to. But why is it not so simple? Why do people then try to publicize it? Or propagate it? Probably because then you get the power of numbers? And then politics enter into it? And jumble it up further? And make you smile at people and want to stab them in the back at the same time? But still want to stick to the book and pretend to be a pious human being who does no wrong? And so many more questions that I have, which will fetch me more confused answers!

So I decided to read up (at least a little) about what drives these religions. And I came upon Aavarana, a book which sort of describes the history of Islam and the Mughal rule in detail. Lets say that it was not all complimentary to Islam, but the book does claim to have its research done from books written by Mughal rulers themselves. Which is the reason why, we can understand having a right wing which claims to set right these wrongs and protect the Hindus. And we have, in between all this, the British who tried to stay back and rule by dividing the already divided, further! And our politicians, who have tried to cash in on this divide, for votes. Now, how do we ever disentangle this mess?

Reading further and deeper into this topic is guaranteed to make you more and more depressed. There are so many avenues, nuances, dead ends and a general insensitivity which make the situation worse. Where do we start smoothing the creases? And revert back to the basic concept of getting comfort from your choice of faith? Because, now it scares!

Standing on the road today, watching the procession, I was eves dropping on the conversations going on around me. And generally observing everything going on around.Two women discussing the number of ‘holiges’( a sweet preparation) which were cooked for the swayam sevaks’ feast. A fully sozzled guy, trying to clearly voice out ‘vande mataram’. Two girls obviously tickled about his inebriated state and giggling away constantly every time he managed to get it right. A lady trying her best to edge into the front row, using her husband’s paralytic limb as an excuse.  A policeman, trying his best to control an undisciplined crowd.  Swayam sevaks in the march capturing images on their mobile phones. Two boys sitting on roof top, emptying Nandini milk packets on to a huge hoarding of Shivaji! Our grocery store, uncharacteristically being closed owing to the fact that it belonged to a muslim and there was a RSS march going on. Basically, life was going on as usual a midst all the hype about faith. This reassured me, that deep down, all that we want is food, a roof, some security and an opportunity to have some harmless fun.

Abraham Maslow, a psychologist, famously gave his pyramid of hierarchy of needs. The pyramid claims, that unless basic needs of food and security are met, you cannot move on to the next level , and later push yourself on to achieving  self actualization- ‘nirvana’ in the end.


In this respect, we in India, at least vast majority of the population, are still grappling with stage one and two! Then why should we confuse issues, instead of providing for the first two levels?

Why should we inculcate religion like a discipline, rather than teach our children to grow into a faith of their own creation? Based on what is needed for the day, rather than what had happened many hundreds of thousands of years ago? Some place where the need of this day is discussed, rather than vengeance? Where we can discuss religion freely, rather than impose it upon others or worse, behead them?

History tells us about how different faiths have tried to come up each, by putting down the other. Why not make it better now rather than ruffle feathers?We have always been taught that all religions are good. lets now learn to accept the fact that there is some bad too. And move on.

I know that this post contains more questions than answers. It is because these questions have been there for a long while without finding answers that pacify me. And leaving me confused as to what I should be first- a mother who teaches secularism, a hindu (just because I happen to be born one), who upholds ideals dealt out by our seers, an Indian or just simply, plain old me????


An apology to Monali Mahala.

suicide-noteMonali is the name of the fifteen year old girl who committed suicide in Bengaluru yesterday.She chose to take such a drastic step  because she was suspended from school for inappropriate behavior. The behavior that was so labelled, included apparent PDA with a boy in school whom she was warned against earlier.

Almost every single day in my practice, I see Monalis of varying age groups and backgrounds, but brought for counseling with similar problems. That they were on varying levels of intimacy with boys of questionable reputations, and excessive usage of mobile phones. The parents are angry, defensive and would have tried everything in the book from scolding to physical abuse to emotional blackmail till nothing works and they decide to try counseling as the last resort. Schools take to vigorous punishments, strict rules, dress codes, lectures and seminars proclaiming the importance of our RICH Indian tradition which does not accept such interactions (but by the way, somehow chanced upon the kamasutra!) and many more such ‘disciplinary’ measures.

Whenever I read newspaper reports of such incidents or watch the Breaking News on prime time, I always wonder why we do not try to understand how such drastic rules came to be a part of schools in this age and time? After all, teenage crushes did not originate in this generation, and have been persisting from the time I remember going to school and probably earlier too. And handling such situations should have got better by practice and with time. Just like how we learn to deal with an irritating co worker or a pestering relative. You worry, you try but finally accept and get used to them and hopefully handle them with just the right amount of maturity. Why hasn’t that happened with such situations?

The most common answer that I get for such a question is that children now, are very precocious.That they would not think twice before taking the relationship further(by which I mean, to the physical intimacy level) and lose track of studies. True, but this again is something you have to accept,get used to and change slow and steady. With the right amount of concern and finesse. By trial and error. By guiding rather than pushing. By asking rather than assuming (the worst).Just the way we got used to any new change like the television, internet, cell phones and globalization, which we have no qualms about embracing, but needed trial and error to tell how much of it was just right. Not by bull dozing our concerns as didactic rules.

Whenever I have interacted with  teachers of children with behavioral problems, the primary emotion the most teachers express is one of fear rather than care.Fear that if something goes wrong, the responsibility will land squarely on their shoulders! The reason for this is the change in quite a few parents’ behavior whenever something is not happening as per their expectations. From issues such as not doing well in academics, to having bad friends to falling in love and elopement -all of which become the school’s responsibility. When parents do find fault, then often do it vociferously and drag the media along, who add a generous dose of sensationalism to the whole deal. And they are often looking to put the blame squarely on any one person’s shoulder. The person whom the complaint is against-which most often is the teacher or the school. I am sure, if the teacher in the above incident was asked why she/ he dealt out such an illogical or unwarranted punishment, this is probably the reason they would give you. It is NOT that I support what the school has done, but rather than just blaming the school, I think we should find out solutions so that this this does not happen again.Because after a while, Monali’s memory may fade, but the illogical rules will remain.

We live in confused times. We teach our kids to feel free to make friendships, but worry if they do make friends with the opposite sex; we teach them that they can share everything with us but become judgmental if they do share something which does not belong to our school of thought; we show them movies(and also often watch enthusiastically alongside) of how a couple goes against the world, falls in love and gets married to live happily ever after, but do not allow them the same yardstick to choose their spouse. We still do not discuss sexuality or growing up freely in our households. Instead, we spy on our children and give veiled warnings of what they would face in case of a bad grade or a bad boyfriend or both! Sex education gets a negative connotation, and hence, schools are wary of practicing it. We do not have clear cut reasoning to define why we are enforcing certain rules or the validity of it. Like why girls and boys are made to sit separately in high school or how banning girls from entering college libraries (as in Aligarh Muslim University) will prevent inappropriate behavior and increase grades!

There are hardly any school counselors whom the child can open up to, and most are worried whether discussing their love life with a counselor would actually be wise. Just this morning, an article in ‘The Hindu’, discussed the constraints students face when talking to school counselors. A girl who went to the counselor for sadness due to a fight with her boyfriend was advised by the counselor to concentrate on her studies instead. The irony of this was that, the girl had in the first place consulted the counselor because she was not able to study due to her depression!

In such a scenario, it is but natural that the schools (as in Monali’s case), parents(as in Aarushi Talwar’s case) and children themselves(scores of Monalis who grow up in confusion) over react to situations which are a part of a natural growing phase.

Until and unless  we think of a comprehensive system where we as parents, learn to communicate without inhibitions with our children; teachers and schools first respect and care for their children before becoming judgmental about them; the system and the government realize that any amount of drilling about Indian tradition would not curb hormonal development, movies stop showing unrealistic romanticized versions of teenage life and the media becomes responsible rather than sensational, we may end up losing many more Monalis for no fault of theirs.

Sorry Monali, we owe you bad! Sorry that we as a society, were so confused, that we could not save you! RIP.

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Caught between the old and the new.

working woman

I had been to my in laws recently. They stay in a small town near my place. Just a shift of 70 kms or so changes my life quite a lot for the short while that I am there. Back in the city, I am a working mother, living a busy life with children, work and a lot of other assignments. I can make or break my own rules, with not much affecting my life style. I can go out buy a magazine late at night all alone, feed my kids cereal when I feel lazy to cook, talk about individuality and feminism as if they grew in my backyard and be as boisterous as I like. Yes, my work commitments and the pace of life do tire me out, and I often want a break from it. Sometimes, the meandering life, the slow passing of time and the quiet life of a small town attract and tempt me to give it all up and run. But, there is a catch. There, I see around me women who follow traditional gender roles optimally, and I definitely fall short. So, I am confused how I need to be happy.

I have grown up in a generation where education, occupation, freedom and individuality for women(to a certain extent at least) were just becoming commonplace and penetrating into the small towns of India like slow seeping of lava after a volcanic eruption. It made the landscape look different, but only some embraced it while others lived uncomfortably with it. Most, though still kept adjusting. A way of thinking where women/girls were given ‘freedom’ to study according to their will and wish, allowed to make choices regarding their careers, the first few batches of girls for whom higher education was a given rather than a doubt or choice, the first few to be given a chance at a semblance of a courtship after our marriages were already decided upon and arranged (and a lucky few whose choices of spouse were first made by them and later accepted well by the elders) and definitely the first few for whom choice of deciding when to conceive and after how long was decided by work and educational commitments rather than number of years post the marriage and irritating queries from relatives regarding the ‘good news’!

When I was growing up, I took most of these liberties for granted. I thoroughly enjoyed my childhood and college days, read about progress which was much huger than this and felt that this was the way of the world and felt lucky to be born at a time where I could do what I wanted, when I wanted to and that everyone would be accepting and appreciating of this fact.

Off late, I have started being thankful for the privileges that I have got, and definitely do not take them for granted. This is because, I see a lot of my friends, acquaintances and sometimes me leading a life which is not quite there nor here. We seem like the sandwich generation, who are caught between what the old world expects out of us, and the urge to break free of all those shackles without hurting anyone in the process. And, believe me it is exhausting.

Since times immemorial, women had to bear the brunt of everything bad that constitutes traditional. If the husband died, the wife had to be the sati and jump into the fire while the same rule did not apply to men if their spouse died. A boy child’s birth was always auspicious because some traditional text in the past claimed that being cremated by your son apparently led you to heaven (though I would say in recent times, the clamor for the boy child had a lot to do with how much dowry they would fetch!). Households were replete with stories of how mothers sacrificed their share of food or clothing or some such thing which was needed for the children. Women were depicted as being great only if were super sacrificing, always keeping others above their needs and had super human qualities of taking care of and feeding a large horde of relatives when they landed for festivals or functions. All in all, they were supposed to be always gracious and super tired if at all they had to be appreciated! Its okay if you have a personality to match, but I seriously doubt anyone’s ability to be on their best behavior at all times. I have no idea when these women did something to keep themselves happy, in between all this hoo haa.

Though we have changed with times, we still seem cling on to those role models to define ourselves. We want to live a life where we are appreciated for ourselves; both our good as well as not so great qualities which make us as human as the rest of the world. But the society we live in, our ingrained cultural values and well defined role identities make this difficult for us. In the bargain, we have ended up as a generation where we are professionals, but struggle and juggle our work and personal lives, try our best to be  loving wives, obedient daughters in law, daughters who try their best to fulfill their parents aspirations not only educationally but also by proving to them that even with double degrees and salaries to match, we still retained those obsolete qualities of maintaining our traditional roles and keeping everyone in the extended family happy! It is a tall order to meet. Even Indira Nooyi, the CEO of Pepsico could not escape these ideologies! In comparison, the men are seemingly oblivious to the turmoil we go through or choose to ignore it completely!

Hence, in my practice and around me, I see a lot of women, who are irritable, frustrated, tired and unhappy! And those, who depressingly believe that this is life and not much can change. We end up taking out our frustrations on our children and friends, coz those are the only ones who we can take for granted!

Sometimes, I feel an Indian woman’s addiction to soaps which show the wily and wicked usurping the limelight is a picturization of what we want to do in our minds, as opposed to what we are actually doing. A defense mechanism by proxy!

Indian soap operas, ruled by mothers-in-law.

I strongly believe that women have an innate strength which can work wonders if put to good use. But this can happen only if we treat ourselves as individuals first, and not ‘girls’. We need to understand that it is not a crime to occasionally take the first bite of ice cream or polish off a whole bar of chocolate before your kid does. We need to make clear rules about handling responsibilities post marriage rather than plan elaborate weddings. We need to learn to pamper ourselves, so we can be happy-and believe me, a happy wife and mother is definitely a better one than a grumpy, spiteful but self sacrificing one. We need to learn to be self sufficient bur accepting of our inadequacies. We should learn to be tradition bound, but only when the tradition seems to make sense to us.

And we need to instill these ideas in our children, so that they do not succumb to the same pressure that we did.

Can we get some respect, please?

Philippe Pinel removing physical restraints from a mentally ill woman in La Salpêtrière,France
Philippe Pinel removing physical restraints from a mentally ill woman in La Salpêtrière,France

There are a few illnesses in the world which resemble Voldemort! They exist but cannot be named or accepted. And mental illnesses top this list.Both the patient, as well as relatives, seem to be in a state of denial. In my practice,I have seen a range of behaviors which constitute this stigma. People sitting in front of me, suddenly getting a call on their cell phones, hurriedly pick it up and coolly proceed to tell the caller that they are in a cinema hall or market while making pleading faces at me; patients requesting to be seen urgently because they spotted a fellow villager entering the neurology section of the hospital (which makes him a patient with a respectable illness); or a mother who gets the child to the clinic without informing the father or grandparents!

The word  stigma, apparently originated in Greece. In Greek society, stizein was a mark placed on slaves to identify their position in the social structure and to indicate that they were of less value. The modern derivative, stigma, is therefore a distinguishing mark of social disgrace attached to patients in order to  identify and to devalue them. Stigma occurs in two different ways. One, wherein the general public, family and friends of the particular patient happen to discriminate the patient, and two, where due to this discrimination the patient himself begins to demotivate and hate himself.

There are box full of myths all over the place about the cause, nature as well as cure of mental illnesses. Hence, patients are feared for their potential violent nature, lack of will power and apparent genetic heritability of the illness. Stigma in any form is obviously painful and causes a lot of stress and loss of confidence in the person, but the amount of stigma faced by women having mental illnesses is really demoralizing.

I had a 25 year old girl, recently married who had had a relapse of psychotic illness(in which she behaved abnormally, got angry, aggressive and tried to assault the mother in law). This girl was our patient for the past two years and was completely stable with medication. Some time ago,the mother cautiously broached the topic of whether they could get her married. As is the custom, I took time to explain to her that it would be better that the prospective groom come for a counseling session; that he be in the knowhow of her illness and how it was quite harmless; that I would try and dispel myths which he may be having. If he did not agree, then it would ok.  She could get married to someone understands her illness and still accepts her!

When this was discussed within the family, it was met with strong opposition. The family felt that telling anyone would spell doom, not only for the girl, but for her younger sisters who were also of marriageable age. Hence, the mother carefully un wrapped the medicines from the wrapper, made different boxes and hid it in the girl’s clothing so that she could consume it as stealthily as possible. Unfortunately, post marriage, the girl discovered that the wardrobe given to her was in a landing where anyone could walk in any time, and hence started missing doses to avoid being discovered. This led to a relapse, the groom’s side discovering the tablets and blaming the girls’s side for cheating them.

Now they were sitting in front of me, the sulky husband, the fire brand mother in law to one side, the teary girl in the middle and the defensive mother of the bride to the other! And to take the matter to its logical conclusion, there were about 10 panchayat members who had tagged along!

The boy was unwilling to take her back, the Mom in law said, “If they lied about this, there may be other things too”. The mother who had spent heavily on the wedding, alongside a fat dowry, was livid.“Well, she was fine in our house. It is your fault she is this way. And if you want us to take the girl back, you may as well pay us back all the dowry and expenses of the marriage”. The panchayat members were cajoling, “Think about the girl. Who else will marry her? You have to give her a life. Take her back. She will listen to whatever you say and live like your servant!”(Well, this was supposed to be in support of the girl!)

In between all this, the girl was sitting eyes downcast and teary. It made me feel so low and depressed to imagine how she was facing this. She was unwanted by her own family, a burden which was now someone else’s responsibility. Otherwise, she would have to be kept at home and taken care of unto death. The husband, understandably felt cheated, but looked willing, if not for the mother in law who was already making plans for his second marriage and a second dowry! The panchayat felt that the deed had been done and it was now the girl’s fate to suffer at the hands of a spineless husband, and a tyrant mom in law!

This does not happen to be an individual instance. Whenever men develop a mental illness, we find the parents almost magically find brides for them who are willing to “adjust” to being with a husband suffering from an illness or disability. We have seen instances of husbands convincing wives (who are mentally ill) to agree to their second marriages, wives taking domestic abuse of aggressive, alcoholic  husbands with resignation and accept their husband’s infidelity with a pinch of salt. All the while feeling that either their children, or parents or the husband may feel bad if they desert them!

Parents of young girls are devasted when they hear of their child or relative having a mental illness. They take great pains to hide it from near and dear with the fear that they may spread word and spoil her future marriage prospects. All thoughts of education, job etc etc just fly out the window, and the only question that looms large is whether their daughter will get a good husband. Immediately, she becomes a second class citizen.

But reverse the picture, men seem to think that it is impossible to adjust with anything other than perfect. The minute their wives are diagnosed with a mental illness, there are barbed comments, outright disgust and a permission to insult their spouses any which way they please. Everything becomes their fault.I may be over generalizing here, but the ratio of men and families being nice and supportive to women suffering from mental illness is impossibly skewed in the wrong direction.

And the women themselves, in between suffering from an illness that shakes their very core, have to deal with a hostile world. No wonder, many of them relapse repeatedly.

Spreading awareness about mental illnesses, bringing up our girls to develop a sense of self worth, teaching them to fight back and not take crap( I mean, if the husband does accept the girl back, how could she live with him knowing that he did not even stand up to her??) may be over simplified solutions to a very complex problem. We have a long way to go. And a lot of awareness to spread. And a lot of confidence to build. Till then, there are thousands of those who suffer indignity in silence.

Indian woman mourns death of her relative killed in tsunami in Cuddalore