A little bit of empathy- Doctor diaries.

 

Monotony brings in boredom. I believe that this happens to the best of us, in whichever profession we happen to be involved in, and so medicine is no exception. Though we start of as idealistic, bright eyed, young doctors, over the years, we get jaded due to tiredness and the sheer numbers that we treat. There is hardly any time to think. Rather, we work more by force of habit, than the passion that we started of with.

Prof. B.M. Hegde, the former Vice Chancellor of MAHE University was often known to quote, that as doctors, we need to cure rarely, care often and comfort always.  But in the mad juggle of life, responsibilities and work, we sometimes lose out on the sensitivity which we need to show the patient, rather than just treating him.

As a mental health professional, the number of times that I have had to diagnose a life threatening illness is less as compared to many other branches of medicine. Rather, most of the illnesses in my bag, fall in the category of life altering. Nothing remains the same after the diagnosis is made. Both for the patient and the family. A lot of times, this causes morbidity in ways which are unseen, but cause a lot of suffering. Decisions that fall outside realm of medicine, like long term medications to be given to patients who are not so willing to swallow them, the crashing of dreams which the parents would have built for their children, the change in roles and responsibilities when the bread winner of the family falls sick, the insecurity of a relapse, the frustrations of the family which work adversely on patient outcome and the societal shaming – all of which are invisible to us, but very much a part and parcel of the illness. And as it is invisible, it often becomes easy to brush off conveniently under the carpet.

It was on one of such days when I diagnosed schizophrenia in a seventeen year old boy. The mother  broke down and started crying copiously. After customarily consoling her, I happened to remark that there were others who had worse forms of the disease, and so should consider herself lucky. To which she replied that maybe it was so, but she was crying not only for her son, but also for breakdown of her life which was painstakingly constructed for the past so many years. She told me that she had to cry so that she could grieve the loss, the burden and her son, and only then she could accept it. She asked for permission to cry, because she could not do it in front of her son or family. Once done, she walked away quietly, only to return for the next visit with a set of questions regarding how her son and family could cope better.

This small incident made me rethink my qualities as an effective counselor. As a doctor, I had thought it important to treat the disease, but forgot about the patient and his family. I could have consoled myself saying that the lack of time was the cause of this heartlessness, but it somehow seemed unforgivable. There are many instances that I have seen, where there are doctors with no super specialty degrees or  swanky clinics, but where the Que for visiting the doctor is serpentine. What they call “Kai guna” in kannada, must be the magic of sharp observation, unhurried questioning and a profound sense of empathy used together as treatment. This combination must be more potent than all the medications and hi fi equipment put together.

From then on, I resolved to spend a little more time with my patients than just enough to spot the diagnosis. And the results have been nothing short of remarkable. Now I have extended families in my patients. The caretakers know that they have a shoulder to cry on and are hence more comfortable. Each milestone they have achieved becomes partly mine. And when the seventeen year old passed his class twelve with a first class, I got home a huge box of yummy mysurpak. There seems to be no monotony anymore.

Baby steps towards a bigger cause.

I still remember the day when my Professor of Psychiatry  told me, that it took him quite a while to find a bride who was willing to accept a “mental” doctor for a husband!

It has been almost thirty years since, but despite enormous strides taken by science and society alike, the ground reality for patients suffering from mental illnesses, especially in India, is still one shrouded by secrecy or shame.

On a day to day basis, we encounter a wide range of patients who need help, but deny themselves, for fear of being branded as mental patients. On the other extreme, we see relatives or well wishers of patients who try their own form of counseling not realizing that they are doing more harm than good! Every patient in the inpatient department of our hospital, coming from various socio- economic- cultural- religious backgrounds, is bound by the common factor of the presence of a talisman of some kind,either round their wrist or their neck, waiting to cure the illness if the doctor cannot!

In a population which fast succumbing to the high levels of stress in today’s world, the statistics regarding mental ill health are truly scary. Every one in four individuals anywhere in the world would have suffered from  mental ill health at some point in their lives. Depression ranks third among illnesses which kills the patient. And India, estimates say, has about  50 million people who need mental health care. Unfortunately, the supply of mental health professionals to handle such a huge load of patients is dismally low! We have currently in India,  about 3800 psychiatrists,398 clinical psychologists and 850   psychiatric social workers. There are no registries for counselors at all!

Even with the intent of helping the patients as best as we can, we, as mental health professionals face the problem of having too little time and too many who need it.

Hence, I feel it is the duty of every human being to finally start recognising that we need to chip in our little bit in order to elevate the status of mental health. Government agencies, NGO’s and media can only do so much if the public at large behaves like an ostrich with its head buried in the sand.

A few things which I believe we can inculcate are:

  1. Start by regarding the mind as a tangible organ of our body. One of the reasons that we refuse to consider a diseased mind is because, we cannot accurately locate the whereabouts of it. It is vague, complex and therefore out of bounds to any physical testing, apart from analysing our behavior. But this does not make it non existent. We need to start teaching the habit of recognizing emotions and their healthy expression in children, so that they learn to understand their minds early. Then on, recognizing the stress and negative emotional states may become easy and non stigmatic.
  2. Do not regard mental health professional as enemies in disguise. It is frustrating to see well educated, intelligent people take their kith and kin to quacks or magico religious healers and subject them to different kinds of torture. Eg. Thrashing, burning, keeping them hungry for days, making them eat leftovers etc. The common excuse given is that they were worried that the doctor would addict them to medicines!!! As if the torture meted to them was better than suffering from an addiction! We are commonly asked whether medication can ruin kidneys or whether we can cure a disease without medicating(when they have no qualms about swallowing diclofenac indiscriminately for their arthritis!). The need of the hour is to learn to trust that the doctor knows his job as he has been trained for a minimum of two to three years in psychiatry. At least, he is better than the neighbor who makes tall claims about the state of the patient’s kidneys(which we apparently spoil by medicating) without having studied biology for the past so many years of his life. We would love to help if you would just let us.
  3. Realize that, just as there are different treatment procedures for the body, the same follows for the mind. Discuss treatment options clearly, and realize, please, that we will not be standing with an electrical prong waiting to give an ECT to anyone who happens to walk inside the door!ECT is a valid, useful form of therapy and not used as punishment as depicted in many movies.
  4. Many mental health professionals are reaching out to the general public by way of television, media, articles and public programs to raise awareness about mental ill health. Listen, read and believe only what is coming from a genuine source, and not what gathers most trp’s, as in the case of television channels airing programs of regression therapy and past life therapy. They are false. Period.
  5. When you meet a person who confesses to feeling depressed or upset or has some trouble with his emotions, kindly refrain from offering suggestions like”You need to use your will power to come out of this” or “Look at someone worse than you, you will feel better”. Mental illnesses have nothing to do with will power. The strongest, most wealthy and physically healthy among us can succumb to mental illness. It would be better to find the best counselor in town and gently direct the person to speak with them. The counselor in turn can gauge the problem and decide whether he/she needs a psychiatrist.
  6. Do not judge the patient, after treatment, based on his illness. Mental illness makes us behave uncharacteristically. Do not hold grudges against the patient for their bad behavior during the illness nor judge him/her for the rest of their lives based on this. It is harmful for their self confidence. Eg. If a person tried to attempt suicide, do not reject his application in a job place or his proposal for marriage. Instead, ask whether the person has taken his full course of treatment. Discuss with the doctor in detail, how well the person is and how much responsibility he can handle. This solves much of the problem rather than enhancing it.
  7. Do not hide the fact that someone has suffered from mental illness, especially when the person is getting married. We see marriages breaking down in our consultation rooms, for this very reason, that the spouse discovered the illness after the wedding. Every person has a right to decide on the kind of spouse that they want. Deceit wont help. Give your child the confidence of owning up to facing a difficult illness and still believe in their self worth.Then look for a spouse. In an arranged marriage scenario, there may be a lot who shy away from proposals, but believe me, your daughter or son would be happier with a person who genuinely accepts them and respects them rather than live in shame and neglect.
  8. Practice acceptance. We never shy away from accepting any of our physical ailments. In fact, sometimes, we exaggerate them. But mental stress and strain are denied consistently. Unless we ourselves are unaccepting of our problems, there is no way the society will accept it. It was an exhilarating moment for us when a postgraduate student of surgery came up on stage at a public function to own up that she had suffered from schizophrenia and achieved what she wanted despite of it. We need more celebrities, survivors of traumatic stress disorders and people around us to start accepting their problems without shame. Only then, can the dignity step in.

Most of what I have written about is something that we all can practice at an individual level. If we can inculcate it and spread the word, we can probably inch closer to the WHO theme of this year’s mental health day”Dignity in mental health”.