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


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?


Pave the way or ask for directions?

alI am amused and surprised about the number of people who meet me and DO NOT ASK for directions. Of course nobody is an idiot to offer help without being asked for it! Certainly not me at 45 years!

Yes, meeting someone who is recovered is an encouragement to most and they see, in person, someone who has accomplished something difficult. Possibly it offers hope- but I am surprised about the ignorance of a large majority that does not ask me how I managed it or how indeed can they? Perhaps a large number of them want to pave the way for themselves, because repeatedly (in research literature) one reads that recovery is a very individualistic effort. NOTHING, indeed nothing, can be farther from the truth. Perhaps this notion is spread so that people do not talk to one another.

If diagnosis is made on the basis of certain shared attributes then recovery also would have certain aspects which would be visible in all individuals who accomplish a goal of recovery. Yes of course, everyone’s recovery is going to look different from another’s -but they all would look recovered.

That reminds me of a story from my life long ago. It was the cassette (those were cassette days, CDs not having arrived on the scene) release programme of my first musical album- Kahe Kabir, which in its final avatar became a four CD album, with 24 original songs by me. The cassettes were released by a senior musician, who was one of the brothers of a duo of classical musicians. In India there is a tradition, especially in the traditional art forms of touching the feet of the guru, or any senior person as a mark of respect to them and the tradition they represent. In the context of the tradition, Surinder Singh-ji, the musician who inaugurated my cassettes said that, ” As we grow older people automatically touch one’s feet to seek blessings. It does not mean that we have become all knowing. It simply means that we have walked the path ahead of you and as you join the path now, we have already made the journey, you would be making now. Therefore everyone consults their seniors as someone who are familiar with the road.”

So how does that fit in on a blog about recovery from mental illness? The same truth holds here- as the current writer being the person who has made the journey and is familiar with the road (of recovery from mental illness). No I am not asking anyone to touch my feet (in fact as a classical musician I forbid my students from it completely). It just needs a bit of recognition to see what I am saying here.

Let me illustrate with an example. Recently someone who is suffering (I think) approached me with a request to write a blog post for a blog they have started and could I please write my story on that? I thought about it for a moment.

In the early years of this decade, the first time I decided to write about myself, it was in a journal article- the length was approximately 5000 words. Then I wrote another piece/article, it was upwards of 7000, and another which was another 8000+ article, and then there was another smaller thing -possibly 1000-1500 words. A journal article easily takes a year to write because it is a very thorough piece of writing- going back and forth between the writer, editor, reviewers, proof readers etc many times. According to a senior academic known to me, a journal article is easily a three year thing. From the beginning to the end of the process, when you see the article in print- it takes that much time. I have myself seen articles going for two years, like a bone struck in your throat! Having done that much of writing about myself- I am quite tired to visiting my past so much, so many times and that too to analyze and sift out what part of it should be now talked about, which has not been talked about in the past. (all those articles may be downloaded from my research link on academia dot edu)

Irrespective of the outcome of the connection with this young person, whose intentions are honorable and praiseworthy where they are- I am NOT surprised they did not want to make the effort to take the long road I had suggested. I suggested why not read the articles I have already written and make a summary of them? Instead of asking me to write about myself, why not ask me about recovery? DO YOU NOT want to recover? Does being a mentally suffering person make you happy about yourself and your life? Would you not want a way out of it? (I did not ask the things in the purple font, but i had these in my mind)

So many university students read my articles and even write about them in their exams- for there is that much to be learned from them! They are not people who are necessarily suffering from any mood afflictions. A couple of years ago one student told me, ‘ma’am we have attempted one and a half question about you in our exams this time.’ I was so amused to hear that and I wondered what the framing of those questions could be like. These were masters’ students of Delhi University.


That is me talking to the MA class in psychology there

I have even heard a presentation about my own article in one college in Delhi University last year- it was funny and strange- because here was young student trying to represent me and my past, while I sat right in front. But the sharing that followed was so emotional after that, that in a class of nearly 20 students, at least 15 broke down for this or that reason. Obviously it was not an emotional moment in my life that moved them so, but their own lives which they were willing to examine in the light of mine. We were talking about disability and identity there.

An attitude of learning…

The point I am trying to make here is that people who are given diagnosis would rather NOT LEARN. Sadly enough the ones who are learning from such a one who has walked the road are university students. Of course everyone who is currently mentally ill and wants to recover (IF THEY WANT TO) can create their own recovery, in their own time- it may take two years or twenty, nobody can predict.

But would it not make sense to ask someone who has walked the road ahead of you? Had I known such a person when I was ill, I would have certainly asked them the path, because the path is not so simple, visible and clear that one can take it at one’s free will. And if you were to ever ask a psychiatrist they would deny that such a possibility even exists!

But then… I have an attitude of a learner, a seeker and I am willing to humble myself in front of someone who is learned. That is why I learned and continue learning, constantly seeking guidance from senior academics (who are often not my formal supervisors). And of  course one of the key reasons for my recovery was I trusted- I trusted many a person whose guidance I sought and followed their direction blindly, with faith and in surrender. My therapist said about me, that Prateeksha you were the only person who did everything I ever told you to, and read most of the books I gave. I didn’t actually, because I was so ill that I could not always read them But I made sure to make photocopies for days when the mind would be clearer enough to comprehend and that happened sooner than later.

That brings me to the concluding thought about a recent WhatsApp chat I had with someone who has a diagnosis as simple as OCD. According to people like me, OCD does not even qualify to be a mental illness. it is the sheer cruelty of pharma companies to morph that into a mental illness category and sell drugs in its name. Naturally enough nobody can recover- what can you recover FROM? There is no ‘illness’ anywhere in your body or mind. They told me that they have been taking medicines for the last 26 years. So my response was that if in this much time you are not healed and recovered, obviously something is NOT right about the path you have taken. You need to change course.

Even this person has known me from nearly 2012-13. But never once made an attempt to come and meet me, talk to me, trying to understand whether there could be a recovery angle to it. People keep doing more of the same, popping pills, writing about themselves and gathering more people around them in the name of their afflictions in the hope that it would help them pass their time and possibly meet more like themselves! (misery likes company?) I never ever joined any such group when I was on a road to recovery, for I cannot imagine even till date how it would help. I have always maintained that how would a diabetic benefit from another? So why would a schizophrenia patient benefit from meeting another? You are not your illness category after all. You are a person.

Ask, to save time

So my advice to anyone who is currently suffering is that if you meet someone who has taken a path that you would also like to take, don’t hesitate to ask them. It will only cut short your travel time. Otherwise of course if you would rather spend a lifetime searching the correct path, and where the slippery alleys are by no means can anyone stop you. It is your life, your time- you choose how you want to invest it.

Finally I think it is the attitude of a person which decides about who will recover. Learning, humility and openness are the keys that will open the gates of knowledge and challenge the darkness of ignorance.

‘Treatment’ for Bipolar

my 19 years old older brother is suffering from bipolar disorder….we have already started his medication with psychiatrist…. …..mam can u suggest me some good treatment of this illness….

Since I have been repeatedly receiving queries of this sort, from someone with a loved one with a bipolar diagnosis, I am writing this post as a response.

Please understand that according to psychiatry a person with a diagnosis of either schizophrenia or bipolar disorder requires lifelong medication. You will most likely never hear the word- cure, or recovery in India, from a psychiatrist.

I personally would not use the word cure either, because what can be ‘cured’ today can also recur tomorrow. Distress of the mind is like that. But isn’t the whole body identical. Just because you have overcome a toothache today, does not mean you will never have it again in another or the same tooth again. Life continues and we have to keep responding to whatever the changing situations bring. The important thing is that whatever we face, we need to increase our understanding and our knowledge about the subject. If you face a new subject, say like trigonometry or statistics, will you not make an effort at it? Similarly if you are suffering in your health and your spirits, you need to reach to the bottom of the issue- not just accept what a psychiatrist has to say about it.

In the advanced Western countries however this is not the case. The movement by those who have suffered at the hands of psychiatry has been very strong and robust, from the 1970s and a number of people are well organized into groups that support one another as well as work towards recovery alternatives. (This is also beginning to percolate towards low income countries like India, as the flow of knowledge is usually from the richer to the poorer countries). In its earliest phases the idea of recovery came from former patients who chose to get out of psychiatric systems and remained patients no longer. They began to be called as ex-patients or even psychiatric- survivors. But one must understand that in the advanced Western countries because of their advancement the level of psychiatrization of the population is quite high and people are often forcibly medicated, without their consent (naturally). That also happens in India I am now seeing.

Psychiatric Recovery

As survivors became more organized the mainstream psychiatry also adopted the idea of recovery from them. So now they also have their own version of ‘recovery’- which essentially means becoming functional in day-to-day life while living a life like any other person- return to the ordinary life. A large number of people keep taking psychiatric medication and yet have professions that pay their bills, enter into relationships and do everything else. They keep visiting their psychiatrists once in a while and yet function ‘normally’ – to the extent that even their spouses cannot make out that they are taking medication (if they have hidden it from their spouses in the first place!!).

Is there another version of Recovery

The other version of recovery actually resides in rejection of the psychiatric model and seeking out alternatives. Many people take the non-psychiatric path, find alternative medical systems, practitioners or practices (like yoga, pranayama, Zen, or anything according to their disposition). But a vast number of such people take the psychiatric route in the first instance ( I myself was on psychiatric medication for 18 uninterrupted years from November 1992-Nov 2010).

At a suitable point, with the consolidation of many resources people go off psychiatric medication. That usually does NOT happen with the assistance of a psychiatrist, because largely no psychiatrist is going to advise a patient to stop taking medicines- they derive their bread and butter from it after all. The greatest risk lies in going off psychiatric medication because these are chemicals that have been affecting your nervous system for so long that the body is now used to it.. Going off medication can happen slowly and by proper mediation of those who can assist a patient to go off medication- it would require support from many others including family.

What can be done when someone is newly diagnosed

I know and I can well imagine that getting a sudden diagnosis can be a very unsettling experience for anyone and the family concerned. Ordinarily one would not even know that such a thing or ‘illness’ exists and you would start poring over all resources to understand what the hell it is all about. The first resource you would naturally tap is the internet.

Now the internet is FULLLL of resources to befuddle the mind- confuse you and scare the life out of you. If you read article after article and millions of testimonies around, you will become more and more convinced that you are condemned to remain a patient for the rest of your life. I suggest keep reading but do not give up on ideas of recovery and the determination that someday you have to be well and get off medication as well. Unless you decide it for yourself, you can never ever recover. I have learnt this over time. I have seen countless families wanting their loved ones to recover (especially when they meet me it kindles a ray of hope that someone has recovered, and so can their loved one too). But the loved ones are so comfortable or resigned to the idea that they are ‘ill’ that they do not believe that recovery is possible and therefore are unwilling to make any effort in that direction!

Here is a potential roadmap-

  • Take a deep breath and understand the implications of the diagnosis
  • Take an alternative view- second opinion does not hurt. Do not tell the second person the first person’s diagnosis
  • Life may be jeopardized for a short while, but don’t let it off the rails for long. Continue doing what you were doing. May be your efficiency would get affected and you will not perform as well as you could earlier, because medicines given to you would have side-effects. But don’t despair- continuity is more important at this moment. Giving up will be very damaging and have long term consequences.
  • If you know alternative practitioners such as homeopaths, ayurvedacharyas or other medical systems, approach them and seek their guidance and interventions. The authentic people in these systems have very thorough knowledge about many things, and they do not adopt psychiatric diagnostic categories.
  • Try to stabilize as much as possible, while you continue living your life- whether as a student, a working person or anything else. Take an off if necessary, but do not freeze- take heart. You will get a grip on it sooner than later.
  • Once you achieve a certain level of stability- with your medicines and professional roles/goals, you have managed the first level of recovery- from the point of view of psychiatry.
  • Now start looking for alternatives that can take you off the neuroleptics (psychiatric drugs).
  • Seek counseling- this is the trickiest bit because finding a counselor/therapist who supports your decision to go off medication is going to be extremely DIFFFFFIIICULT. But the good news it that NOTHING IS IMPOSSIBLE. Keep your courage and keep moving slowly.
  • Hopefully you will meet many others like me as well, who can support your process of recovery to the last bit. Or some counselor or a rare psychiatrist who will assist you gently (more likely in the West than in India though)

I hope you get some clarity from this. Stay connected with this blog and I will keep sharing further ideas about side-effects of medicines, further strategies for recovery and so forth. You can always consult me professionally or help/support Hansadhwani Foundation that supports me – so that I may offer my services for free. For right now, they are chargeable. We are a non-funded, non-profit and whatever we do, it is for the sheer love of sharing knowledge, & for people and a desire to assist them in their suffering.

SSRIs, Akathisia and Suicide Risk

If you suffer from either of the following-  depression, obsessive-compulsive disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). you may be prescribed a drug called Paxil, an SSRI. All explanations follow.

Paxil is one of a class of antidepressant drugs known as selective serotonin reuptake inhibitors or SSRI’s.  These have become some of the most commonly prescribed drugs in America and worldwide, offered to treat a wide range of emotional ills from grief to social anxiety.   But while many people find them helpful, they have long been known to make some patients irritable and anxious. (Healy’s blog)

{PAXIL (paroxetine hydrochloride) is an orally administered psychotropic drug. It is the hydrochloride salt of a phenylpiperidine compound identified chemically as (-)-trans-4R-(4’fluorophenyl)-3S-[(3′,4′-methylenedioxyphenoxy) methyl] piperidine hydrochloride hemihydrate and has the empirical formula of C19H20FNO3•HCl•½H2O. The molecular weight is 374.8 (329.4 as free base). The structural formula of paroxetine hydrochloride is:

Paroxetine hydrochloride is an odorless, off-white powder, having a melting point range of 120° to 138°C and a solubility of 5.4 mg/mL in water.

This information is taken from- this link (please click it for more information)}

Common side effects

You can read effects of this medicine by clicking here.

However, the common ones are- asthenia, constipation, diarrhea, dizziness, drowsiness, ejaculatory disorder, erectile dysfunction, insomnia, male genital disease, nausea, headache, decreased libido, delayed ejaculation, diaphoresis, and xerostomia.

Other side effects include: infection, blurred vision, female genital tract disease, impotence, lack of concentration, orgasm disturbance, tremor, vasodilatation, visual disturbance, anxiety, paresthesia, abnormal dreams, decreased appetite, and yawning.

In India Paxil sells under the brand names- Cinpar, Oxitine PR, Leparox, Deprox,Onbixin, Panex, Paradise-XR, Pari, Panex. For more names, please click here.


In extreme cases, this can advance to a state known as akathisia – an intense emotional turmoil and physical restlessness that can be so unbearable as to trigger suicide in those who suffer from it.

Here is a link to an organization that is working in the area of medicine induced suicide risk, created by the family of the person who actually committed the suicide and in whose memory the lawsuit was fought and won by the family.

Okay, this blog post is not going to be longer than this. Time ensures brevity. However recently Glaxo SmithKline lost a lawsuit in the US, for the death of a man who took this medicine for a very short span of time. David Healy has written an elaborate post on the subject and he is also an expert on SSRIs. You are welcome to read his pPlaceholder Imageost here (or the top link where I posted it).

Towards the end of his post he recommends that the FDA should put a suicide warning on the Paxil drug. My post is just joining the dots together and in case you are on Paxil or any of its derivatives, please understand in case you feel more restless and agitated after taking the drug…it is probably a side effect of it, and if the doctor does not change the medicine- PLEASE CONSIDER CHANGING THE DOCTOR!

Support in bipolar

There are may ways to support people with bipolar. One of the key things is to understand the relationship you are in with them. As well as your proximity.

There can be two different outcomes from bipolar support- one which produces a recovery, and one which creates a life long dependence and disability. You have to decide what sort of an outcome you want to create. Nobody who supports another can decide on any outcome actually; it is all dependent upon the person who is suffering. Are they going to accept it for the rest of their life that they are going to be ‘mentally ill’ and therefore dysfunctional or are they going to believe that ‘ok, this is how I am and not let me get on with the rest of the business.‘?


Can you please leave me alone?

There will be days when your loved one will be extremely functional and capable of doing everything, but there may be spells when the mood swings to another extreme and debilitates them. This is the time to support them and encourage them to do whatever little they can, trying to remain useful, even if not optimally so. Pushing them hard is never a solution, neither are your inspiring words. People who keep doing even a little everyday will eventually turn things around in their favour. Those who are protected by families in the belief that they are ill will become more and more ill and debilitated over time.

Your support does not mean that you have to try leading the person towards any outcome- they will produce their own outcomes. Just try not to guide them too much, except during phases when they lose self confidence, hope and courage, when anxiety overcomes them and makes the head go into a spin and fog engulfs the soul. Only on those days you need to offer courage and gentle support. Rest they will manage and accomplish everything they want in life-including professional competencies, relationships and you name it.

Never think anyone who has a mental illness label is a stupid person and they need your guidance or direction at any time, most of the time. Yes they may need it once in awhile- the courage that they have lost momentarily must come from the words of another. So kindly do not offer it, but sense the need for it and only then support them.

Understand the roots of your suffering

Several of the posts on this blog are going to be blog entries from my other blogs, which I have written in the past. Since this blog is meant to be a collective of all threads I have on the subject of mental illness, I intend re-posting them from wherever they are scattered in cyberspace, for the sake of order and access.

Someone asked me a question, in response to which I wrote the blog post that I am about to share. If the query interests you as well, please read the rest of the post by clicking the external link, provided ahead.

I have a question for you if that’s ok. When you mean you recovered, do you mean you understood the root of your depressions and manic states, your bipolar disorder? Was there meaning, trauma in your life that led to that? And do you not suffer from that anymore? I hope these are ok questions to ask you. (E.L.)

What our triggers are – are our vulnerabilities. If one can isolate that it is a great victory and the best way to identify that would be a therapeutic dialogue with a therapist who is kind, wise and non-leading. It is not so easy to find such a person and that is the greatest challenge really.

Dear E. suffering is a part of our human destiny- but it does not have to annihilate us completely- we can live with it peacefully, we can make sense of it on a day-to- day basis and we can find better ways to make sense of things, alternative worldviews and conceptualizations.

Please read it all here.