Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They can ease symptoms of moderate to severe depression, are relatively safe and typically cause fewer side effects than other types of antidepressants do.

How SSRIs work

SSRIs ease depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain cells. SSRIs block the reabsorption (reuptake) of serotonin in the brain, making more serotonin available. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters.

SSRIs also may be used to treat conditions other than depression, such as anxiety disorders….(more here)

SSRIs and brain damage

Supporting loved ones- two encounters

Today a young duo came to meet me. The young girl had heard me in a college talk somewhere in a college in Delhi and the young man she brought along was her friend, going through a ‘tough’ spot. Just yesterday she had got in touch with me, by taking my number from her teacher who had facilitated my talk in their college. By chance I had time today, as I am also trying to take it a bit easy these last days of June- waiting to resolve my own back pain issues and in general having a low tempo on research in general.

She was insistent that the boy should meet me, rather than a psychologist or psychiatrist, because she knew that psychiatry cannot resolve the problems of growing up or coming of age or anything for that matter. She argued and debated with  64a7c29daa675f24921866182bd7b920

the boy’s family and pushed them into meeting me.  She was insistent that he ought not to go the psychiatric way. In the end however, she only came to meet me with him.

We spoke and I understood at least the initial roots of the suffering. I could see that he faced a certain mental blankness these days, which were not a part of his extroverted personality. They both insisted on that. And yet, the young woman was also insistent that instead of going to a psychiatrist they ought to come and meet me- for I may see something more into the scenario than a psychiatrist’s diagnosing sensibility. Which of course is not far from the truth- with patience I sit and listen to people, probing deeply sometimes and sometimes in a superficial manner, depending upon them.

Seeing her passion and commitment, I suddenly had tears in my eyes. Not because there was something extraordinary at work here only…but because I realized that how few such people would be whose loved ones, be it anyone- in the family or friends, would support them so passionately in a crisis – however big or small it be. Ordinarily the family would have taken him to a psychiatrist- as they had already been given a diagnosis of ‘clinical depression’ by a neurologist! (of all people). But this young lady’s insistence that no we will not go to a psychologist or psychiatrist- may make all the difference in her friend’s life.

Such few people would know that the ways out of depression are not medication but talking and building your lost sense of self and hope slowly. At critical moments having a supportive milieu can make all the difference- between disabling mental health conditions and recovering your self-hood.

That also brings me to the conversation I had yesterday with a young man who is going to be part of my research, hopefully. In talking about his family he said, that his parents let him go through his (psychotic) crisis, without pushing him into psychiatry’s arms entirely and he owes it to them that he could find his own bearings in the world. If only more parents and friends could understand that.

In a nutshell…

In distress there are many ways to deal with a situation. If we start looking at a psychiatric option, it usually overrides every other option and then people get into a net of medications,without any change in their situation significantly and a progressive deterioration.

The choice is with people how they want to see their loved ones- enabled or disabled and that is where the crux of the solution lies.The dominance of psychiatric discourse, which permeates society is another issue, and few can overcome that- while finding their path in a knowledge oriented way. It is difficult, arduous but worth the trouble.

 

Valuing research informants

I was recently reading an article by Neely Myers titled, A Fragile Recovery in the United States, in the book, Our Most Troubling Madness. The book chapter is a storied account of how the researcher (who is an anthropologist working on her doctoral thesis) engages with the central character of the chapter, a woman she refers to as Meg, as Meg struggles to balance her life shunting between ‘shelters’ for the homeless and other such institutions, as well as comes to construct her mental illness identity as a ‘schizoaffective’. It is a queer, sad sort of a chapter in the beginning, because in receiving the diagnosis the woman is actually happy and relieved- because that makes her eligible for disability benefits. It is sad, touching and a stark reminder of the cruel world we live in , where our infirmities are the reason that society looks at us as worthy of support/charity, and not just because we are human.

It is also painful for me on another count- to read a researcher’s perspective. May be researchers are trained to be aloof from the subjects they study. But is it really possible? (In fact, if I recall now, she says that her brother also suffers from something identical). I am bothered a bit, because I don’t find myself so detached yet- I am actually attached to my research subjects- quite a bit. I don’t mean that I would go ga-ga over them, but i am concerned in their welfare, in wanting to tell them more- from things i study and read about, in case they want to know about recovery. I want to help them, wherever I can. May be I am stupid, or may be this is what survivor-research is all about- about holding others while you have crossed the stream yourself and not forgetting them completely, because in your crossing there is not a personal victory, but a social possibility that resides.

Like I read somewhere, the choice of what we study or research about itself is a bias- there is no objectivity here. We are humans and we choose as researchers what we want to study and how. That inherently has a bias in it, because we want to study what we want to study, not what is imposed on us by an educational institution- we are not following a syllabus, but constructing a pathway to study a phenomenon. Nobody tells us how to study it, nobody lays the path out. You create the path, you lay it down brick by brick and be sure about it, because someday at a later date you have to justify why you took the path, how you took it, what the bricks and mortar of the path are and how it leads you to your research question, or how it contributes to it.

And that brings me to the start of my research on a new platform-

Gathering Data

My research has two parts to it, one of which is to meet people who have been given a diagnosis of psychosis at some time in their lives, and interview them. This is the ‘data’ that I have to gather.

In these past few weeks I met two of my research participants (called informants)- both happened to be women, and by chance, both agreed to come to my home and talk to me. That was a quaint coincidence, which I don’t expect from anyone in future hereafter! And both these interviews happened in the same week- the last week of May. It was quite a thing- one came on a tuesday and the other on the Friday. Oh my goodness! there was so much to listen and write down. Naturally enough they had a lot to share as well- but on the whole it was a great time I had with both. Or let’s say we all had with one another.

The other connector was that both of these ladies were ‘recovered’ – if I may use a silly term. One has recently quit a university teaching assignment and the second is about to start a year long apprenticeship in a place faraway from home, after completing a master’s degree in something. They are both well on their ways in their own professional and personal lives. The latter is still on medication and the former left it years ago. Of course, both had a bipolar diagnosis- one got it in the US, while pursuing her doctoral research there. In other words, both are highly educated as well!

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With families…

The other part of the data is meeting the families of the research informants. And I am trying to work that out, by taking appointments with these ladies’ families. The older, who is recovered is not a problem in this matter, because her parents are elderly now, and I can pretty much meet them soon anytime. But the younger one has some issues, having a working mother. When I hear a parent talk, I hear my own parents voice in them sometimes. I hear their fears and their concerns about their children. I so much want to tell them that, ‘look your child can also recover. Recovery is not such a difficult thing that it is reserved for a few.‘ But it takes time to get to that point, where you meet a family in person and let them talk out their fears, their suffering and their concerns. And yet, that happens all the time- not only in research, but even otherwise.

This part of the research design is turning out to be nightmarish. There are so many families that just do not want to talk about mental illness! Right while having people with mental illness diagnosis among them- what is going on in India is strange to say the least. Of course people who are diagnosed ‘ill’ have their own suffering, but what about the fact nobody wants to talk about it in each other’s presence? What is going on here? This is very strange, confusing and flummoxing. If there is a suffering, and it is a collective suffering of the family as a unit, why are people not willing to talk about it?

So, even while I ponder over the phenomenon (yes, it is beginning to look like one) there is an article looming in front of my eyes on the subject and am thinking of putting pen to paper.

But coming back to data collection, I realize also from Myers’ article, how as researchers we start valuing and engaging with our research informants. We want them to be happy, to succeed in their chosen vocations, to do well, to tide over their suffering. At least emancipatory researchers like me want that because our destinies are tied to the fate of society (does it sound too dramatic?!). We want that others would succeed in breaking the shackles that we have broken from the hegemonic clutches of biomedical ideas of human suffering- sold off as psychiatric diagnostic categories.

And in understanding the silence that is part of our cultural landscape, it becomes all the more a reason for me to value and cherish the presence of my research participants, because in their opening their stories to me, they are not only opening their hearts out, but also overcoming a great societal barrier- which they may not even know at present. But they are letting an ‘outsider’ in- someone who does not know their story, now does. And yet, they also understand that this ‘outsider’ is really an ‘insider’- someone who has known the road of suffering only too well herself.

Thank you dear informants. This is a knowledge making project and in you making your contribution we all learn something from our association- not me alone. Be assured of it.

As time rolls by, I will keep adding more blog posts about the data collection part of my work, depending upon time and inclination. Earlier i had planned to write one blog post per person that I met, but somehow it has not materialized till now. Let’s see if I can manage that ahead.

The struggle to find research informants is another story, and I really hope to write it down someday.

Social Defeat and the roots of Psychosis

For the last few days, whenever I can before closing my eyes for the day, I pick up this book called Our Most Troubling Madness, a fascinating collection of ethnographies from different parts of the world. It is a research in medical anthropology- with different researchers writing from different countries, including from India. My brother sent the book from the US, only earlier this month. The strange thing is that the theory that I am about to write about was taken from animal studies- in fact rats, and how they behave in newer scenarios and how bullying of newcomers can lead to a what is then called …

Social Defeat

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A few years back I lived as a tenant in the house of a man in a village in South Goa, who was completely isolated from the society around him. In the one year that I saw him, I observed the effect of his social isolation and rejection by the world around him to be so powerful that it broke his spirit to the core. He died soon after. Social rejection is one of the cruelest things people can inflict on one another- no matter what the grounds be.

Yesterday I encountered the idea of social defeat- and how when people perceive it, as a loss of face among those they live with, it affects their sense of selfhood and self esteem. Then those among them who are vulnerable, become more prone to psychotic breakdowns. The theory of social defeat proposes that the experience of defeat in a  social context is felt, in the body that is vulnerable to psychosis, so profoundly that it can make the body ill with serious psychotic disorder…Social defeat is not the same phenomenon as symbolic violence or structural violence. Violence is a means. Defeat is an outcome.(p.198)

The writers were quoting about the rise of schizophrenia in Ireland during the 1970’s and how it was directly correlated to migration of successful people and that so many men who were left behind single, faced criticism and rejection from society, including their families, women and so forth. Ireland had the greatest number of men then, with a diagnosis of schizophrenia.

The idea of families isolating individuals and mounting criticism on them, being harsh, dominating and controlling of them, is very well known as a factor leading to schizophrenia. So now coupled with the new-found idea of social defeat, I think I have come across an interesting and compelling argument about how breakdowns happen or why.

This is just a small scribble to jot down a point that I want to refer back to. I cannot do this with every new idea, but I think I had to with this one. I am also concurrently reading the phd research of another researcher from Norway in the context of recovery and the manner in which she is framing her research is very nice indeed.

I am beginning my qualitative research- data collection this week. It is exciting and makes me nervous, because this is the real test for me- how I would arrive at the analysis later on. keeping fingers crossed.

Oh, and on a last note- I just spoke with a senior advocate of the High Court, someone who has been involved with disability and mental health laws in the courts. Interestingly enough she turned out to be living in the same part of the city as me, and invited me to come to her home to discuss whatever I wanted to, about mental health laws etc. I told her simply that as a social sciences based person I do not know how to read and interpret laws. She simply said, ‘don’t worry, now you will learn that.’ Meaning, I will help you! I was so grateful, and I said so. Just like the post I wrote earlier- when I need help I always ask for it and go all the way. What other way can we grow?