Why ‘recovery’ seems so difficult in India

I have been working in the area of recovery for at least a few years now and what I find is there are at least a few impediments to ‘recovery’, especially in India.

The first seems to be the internal communication within families- which is often severely fractured.

The second seems an over-riding belief in psychiatric medication year after year and looking up to psychiatrists to decide the future course of their own or their loved ones’ lives.

The belief that there is a mental ‘illness’ and it can be ‘cured’ via medication, the way fever can be! In other words, complete surrender to the biomedical perspective, regardless of seeing evidence to its contrary.

The next thing is that I will be talking about some of these issues in a Symposium in Greece later this summer. The irony of the situation is that I am going there to learn how to work with the OPEN DIALOGUE APPROACH from the people who have created the method in Finland, but the scenario on the ground in India is utterly dismal. Families just do not come into dialogue together. Of course we cannot have a situation that is prevailing in Western Lapland here- but the intra-family dynamics, that can be the sole fulcrum of change, are actually poised against ‘recovery’ at present.

But of course there are scores of cases of recovery also and in each of them, the role of family is visible and significant. However, that reminds me of a lady I had met in Goa, who thought that as a parent she was so important and at the center of the whole situation that her daughter (given a schizophrenia label) was a minor actor and she needed to be at the center of our conversations. It was a great failure, as far as I am concerned. She never let the daughter establish a direct and meaningful relationship with me, which if it had developed, may have produced different outcomes.

I have been interested in Open Dialogue for a long time- several years at least, and an opportunity to meet with Prof. Seikkula and several others from around the world will be a great experience of learning and sharing my own experiences of working here. Certainly there is no harm in wanting to do better, regardless of how people behave with each other, because I know from my own practice also that people can completely recover, needn’t take medication for even a single day just by talking it out in a patient, trusting environment, and of course never look back at therapy/counseling again. I find that the best thing, when a person is so well that they never need to come back into counseling, but not after a fractured communication, which is more likely to happen in India, because we people have more faith in a prescription and not in a conversation- which seems only words.

At present I am fiddling with what topic I would be talking about at the seminar. I have to nail it down and send it to the organizers. How I wish I had something to say about the Open Dialogue approach here, but I think i will stick with peer counseling and how lived experience is a rich firmament to start this work from and take it further. Or may be I can talk about the fact that in India most people are not ready with the post-modern collaborative stance, and they look at the therapist at the ‘expert’ a position I try hard to move away from, even if I have a certain set of knowledge. That knowledge does not produce complacency, but calmness in the face of storms. Of course when individuals who are in stormy situations or families are there, that knowledge does not let me lose my ground and perspective and take opposing positions, and that is what really works finally. SO straddling these gap between conflicting parties is always useful and that is where my knowledge comes in handy.

Oh and since the symposium is in Greece, we have to read Plato’s symposium and go!

Last bit, water finds it’s own level. I was keen to do a Phd in counseling and all my efforts were in that direction and then came along the current option, for want of better options, but then the heart always takes one in the direction of their dreams> So here I am -learning about Open Dialogues, instead of Law!

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We never meet such people in India!

Family Support- Not working

(this post was written on another blog, on 30th October 2015. I am only copying and pasting it here, not re-writing)

In societies where social resources in health are limited, families play a crucial role in the illness and recovery of people. In mental health the case is even more so. For long periods, it is the family alone that bears the brunt of people’s illness and disabilities. Sometimes this may amount of a lifetime, and then the parents/siblings, who are the primary caregivers end up with the massive concern of who will look after their loved one[1], after their own demise.

Here is a brief list of findings, that research leads me to conclude, in the context of roles that families play, which ensure that people remain mentally ill, rather than recover and reintegrate back into society. This list is not exhaustive and as study is an ongoing process more thoughts will get added to this. Here are the beginning ideas.

Learning to be helpless together

Sometimes when one person is given a mental illness diagnosis, the whole family is paralyzed by a fear that mental illness has crept into their gene pool. They feel  extreme pressure due to the diagnosis and the social stigma associated with it. They all feel helpless about it and the infirmity or sense of loss that accompanies mental illness diagnosis of one person, in fact impacts everyone deeply. Secretly, they all start analyzing their own behaviours to see whether some traits of it are also lying within them!

In such a case if another member of the family faces anything of a similar nature, they are very quick to take action and take them for a ‘check up’ as well.

Protecting the loved one interminably

I have seen personally families being so defensive about their loved ones, that they keep protecting them from the world around. At times it amounts to the extreme case of hiding them from view, or not letting their loved one engage in any social milieu by themselves or without supervision. It aids in chocking both the people or set of people very severely, as no new ideas can come into the ecosystem, which does not interact with the outside world in any significant ways.

I have even seen another extreme, which surfaces in scenarios of marriage. I am not sure if this happens in India, but I have seen it here only. I have seen multiple families ‘hiding’ the mental illness diagnosis from the partners of their loved ones. As a result people are not able to remain truthful in relationships, and the trust that could be there between married partners never develops fully, because one partner knows they are not honest. This protectionism of the parents does not allow the partners to be one another’s greatest support systems, which marriage was traditionally meant to be.

Hero worshipping

Paradoxical as it may sound, I have found in many families that parents or siblings talk about their loved one, with a great fondness and regard, often attributing their mental illness to a ‘high IQ’, superior intelligence, artistic abilities or anything else like that. Though there are studies that have proved that mental illness is more positively linked to artistic creativity, the reverse is not true. Artistic creativity does not appear out of the blue, just because you are mentally ill and therefore your intelligence is also more than the average person.

By making their loved believe they are ‘smarter than the average’, families bestow them with a sense of entitlement, which means, just because they are more intelligent, they have a right to have moodiness, depressions, or any other attribute. This even inflates their ego and self belief that whatever they do or not do is well deserved, because now they are ‘mentally ill’.

I have seen in many cases that these loved ones, even when they come into counseling are so cocksure of themselves that they do not believe they will gain anything from counseling. They don’t. Their own intelligence is such a barrier, which their parents have created around them, that they are unable to use that intelligence for their own betterment by seeking help from anyone outside the circle.

Families ensure compliance to Medication

Since families have a great amount of faith in modern medicine they do not believe that psychiatry does not have a cure for mental illness. In fact, I would go to the extreme of saying that in families where parents or siblings are doctors or scientists, the possibility of anyone recovering from any serious mental illness is quite remote. Due to their unquestioning faith in modern medicine they keep medicating their loved ones, without ever probing into whether medicines are really bringing any tangible outcome.

Families may become human rights violators

Nobody ought to be coerced or forced into psychiatric treatment, especially electroconvulsive therapy (ECT). Families often believe doctors so blindly and rather innocently, that whatever the medical professional recommends is to be taken as a rule. ECT  is a very controversial procedure which has long term repercussions for a person. There is no need to administer ECT to anyone, but doctors do not educate families enough, who are anyways only too willing to follow what psychiatrists say.

Often people are given psychiatric medication against their will and in spite of having no need for it, even on the sly (by mixing in food for instance). Those with mental illnesses are not allowed to choose their treatments, because their families believe they cannot decide for themselves. As a result they keep medicating them and pushing them towards the edge, for the rest of their lives, till they reach their end! Sadly, the human rights violations in mental health are the most in any category of health, and the most part of it comes from families.

Fractured Communications

In  a whole lot of families people do not talk to one another- either properly or at all. As a result whatever support could come to all of them due to interpersonal communication, does not come about. Everyone lives in an emotionally marooned state, spiritually shrunk, cold, deeply fatigued, restless and wounded.

Even if one of them finds a solution to a problem, since their inherent communications are flawed, they are not able to convey that to others. In my own work I have seen many a family member, including people with a diagnosis, have been enthused to either meet me, encounter my work or hear about the sort of work we do. However, they have not been able to convince other members in their families due to a long term loss of trust, in one another and in the fact that any other ways could appear, leading them out of mental illnesses.

Not only in my case, but often due to lack of communications, people do not seek any other social mechanism to deal with mental illness, apart from free resources that the internet offers them.

[1] Throughout this writing I have used the phrase ‘loved one’ to refer to those who have been given a mental illness diagnosis, rather than calling them someone with a mental illness.

Accepting recovery as reality

By and large people do not accept that ‘recovery’ is possible.  This post, from 2015, further elaborates on this idea. Please click the link to access it.

You are responsible for your recovery

Before this blog, I used to write in another location and upon a sudden nudge from someone, I looked up that blog today. What I found is that there are several articles and posts there which are relevant to this blog, about ‘recovery’. So I am going to link the two together so that those ideas would also remain in circulation.

I wrote this post, You are responsible for your recovery. Please click the link in blue to read it on that blog. Will be posting other relevant posts as well.

Joanna Moncrieff

I am quite fond of Joanna Moncrieff’s writing and having found a video of her I thought it may be a good idea to share it further.

Campaign against the Schizophrenia Label

I just encountered the Campaign against Schizophrenia Label (CASL) while reading China Mills’ book, Decolonizing Global Mental Health . This is an important book for many reasons, chief among them being the other resources, research, ideas and people whose work I am getting to encounter as a result of this work. Anyhow this blog post is only about CASL, that too to note down what work they do or did and to link it to my work later.

So here is what the search for CASL brought for me. In brief it is here-

The idea that schizophrenia can viewed as a specific, genetically determined, biologically driven, brain disease has been based on bad science and social control since its inception. If the scientific argument against `schizophrenia’ is judged to be won, it remains to take the evidence to the people, to explain and develop the alternatives in the full light of day. This is why the campaign is led by Asylum, the magazine for democratic psychiatry, psychology, education and community development. We believe the time is fully ripe for a paradigm shift across the field of mental distress and that the alternative knowledges and resources are now in place to mobilise for change. No more will we view the scandal where intelligent persons are expected to accept discredited diagnoses for fear of being labelled as `lacking in insight’ and having treatment forced on them.