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Fractured Realities – Part -3


My mother is in the hospital with a condition of chest congestion. She is eighty one and her lungs have become quite weak. The monsoon rains which washes over my jaded spirits, fatigued by the blistering heat of the North Indian summer, are not too kind to her aging respiratory tissues. She has developed a tendency towards chest problems almost as soon as the temperatures come down and the moisture content in the atmosphere increases.

This is a fairly big hospital in this part of the town. Passing by the Reception area on the way to the canteen for an early morning cup of tea, I just glanced up at the board indicating all the services provided there. Various departments show up ,cardiology, neurology, paediatrics, diabetic clinics, physiotherapy, gynaecology, homeo and ayurveda clinics and lots more. Curiously, there is no psychiatry department.

Kerala is known to be a State where the level of morbidity is quite high. The corridors and the lobbies that literally teem with patients in that hospital or any other ,on any given day is a sure indication of that and yet for all the awareness and readiness to get treatment for physical problems seems to be inversely proportional to the alacricity with which medical help is sought in mental disorders.

Here in Kerala, there are indeed quite a few social welfare schemes in place. Every time I come down here, I am surprised and pleasantly at that, to learn about the rather effective implementation of most of them at ground level. These days , for example, there is a lot of focus on the environment . There is the Government sponsored programme, aptly named,”Bhoomikku oru kuda” (an umbrella for the earth) and the “Seed” project sponsored by “Mathrubhumi”, a well established Newspaper group which has been around for many, many decades. Under both these programmes, saplings are being freely distributed. Schools are encouraged to have their own kitchen gardens and to plant trees in their compounds. Groups are formed with committed leadership from the teachers and the students. Prizes are given away regularly for the best efforts in this direction. My sister, who is a Village Officer, says that the collection of taxes for landed property also increases when the Agriculture Department comes up with schemes for distribution of saplings because those who desire to procure the benefit of free good quality saplings , are required to produce documentary proof that they are up to date in their dues to the Government. It’s not much really, just Rupees twenty or so per acre of land. But there are still defaulters, which number comes down when the plants go around. Killing two birds with one stone, so to speak or may be that is a negative kind of proverb to quote here. Whatever, quite a smart move on the Government’s part, I thought.

The good thing about Kerala politics is that the change in Governments are not allowed to disrupt such welfare schemes, thanks to a very aware public who does not shy away from applying pressures on the authorities, which is why the very obvious neglect in the area of Mental Health is kind of disappointing. It seemed that it has now fallen on the NGOs and missionary institutions to fill in the lacunas and try and do their best. It clearly isn’t enough. I guess the apathy has a lot to do with the attitude of the ordinary citizen towards what we ordinarily brand as “Madness”.

In the West, people seek psychiatric help much as unabashedly as we would approach a physician for a migraine or a severe attack of cold and cough. The slightest of tendencies towards depression or anxiety have them seeking appointments for counselling or medication as need be. But here there is so much of stigma attached to aberrations in mental health that we tend to ignore the symptoms or hide them from others till the condition degenerates to such extent that it reaches a critical stage and by that time it only makes matters more complicated for everyone.

There were so many cases one came across during the two days that I accompanied Dr. Chitra on her rounds to various places, about whom , all of us , the neighbourhood, community or Government had not bothered to be concerned in any remarkable way. And yet community support and timely professional help could’ve gone a long way in alleviating the discomfort caused by the illness, both for the affected individuals and the family concerned.

 
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Posted by on June 15, 2011 in Community, Reflections

 

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Fractured realities-Part-II


It really wouldn’t be an easy matter to have someone in the house who is not “quite there”. It creates friction and anger, anxiety and tension in the household. To have to constantly take care of someone whose reality no longer aligns itself with that of others, can be extremely trying,to say the least., particularly when the demons in their minds make them act with aggression which showed in abusive language , constant suspicions and physical violence. Not all the patience that one summons may be enough to be able to cope with the constant delirium of a parent, sibling, spouse or child.

Our society is a strange one. We have the utmost sympathies for those suffering from a debilitating or terminal physical illness. We visit our ailing relatives in hospitals, we enquire after them, we are sensitive to their pain and appreciative of those who look after them . But with a mentally ill patient , it is generally a different story altogether. It is not just they who become subjects for ridicule, their kith and kin also begin to be shunned or at least kept at a comfortable distance.

While sitting there with Chitra , as she observed them one by one, my mind travelled back in time to meet some of the “crazy” ones who for us , I am now ashamed to admit, were sources of amusement. There was this woman, who went by the name “Anai’. To this day , I do not know her real name. I remember that she did have some small means of employment somewhere in the town. She would walk past our house in the evening after getting down from the bus. Someone in the row of shops near the bus stop would shout “Anai!!”, which in Malayalam means elephant and she would retrace her steps shouting at the top of her voice and flinging the choicest abuses at all around. This would go on for several minutes till either she or her tormentors got tired of it.

There was Sundariamma who lived just across the road with her son and daughter . She was just a bit quirky , sometimes muttering under her breath or sitting in a corner somewhere for hours, lost in her own world. But she was quite capable of looking after herself. After the son got married and stopped looking after her she had even got herself employed as a maid. She would come to us quite often for getting letters written to her daughter who had moved to Mumbai after her marriage. Her dictation was sane enough and would mostly end with requests for financial help. It rarely came.

Through the years,her condition had worsened.The family had never sought psychiatric help. May be they weren’t even aware that medication could’ve improved her condition. Her attacks of depression only made her son and daughter in law more apathetic to her. With age inflicting its added physical woes, Sundariamma had become a shrivelled, bent, bony old woman, curled up on a mat in a corner of a dark corner of a hut, where her children had confined her, the room reeking of urine that she had involuntarily passed. That is how I last saw her and that was her condition till she slowly, piteously breathed her last.

Pathumma had worked as a maid in a cousin’s house. Every time the cousin visited us or we visited her, stories would be narrated to the accompaniment of peals of laughter from all of us , about the fantasies of Pathumma which to her were very real In that imaginary world, she had a husband who was working in another town, He would visit here from time to time with gifts of scented soaps and hair oils . He would lovingly tease her and she even was with child. We loved the meanderings of her mind and found her anecdotes hugely entertaining. Pathumma had died of a physical ailment, I later learnt. When she died, she was still trapped in her world of fantasies.

But Pathumma was all alone and if her make-believe circumstances made her happy there was no one else who would’ve been disturbed by her distorted sense of reality that was the source of that happiness. The mother who accompanied her daughter to the clinic at “Samhati”, an NGO which had sought Dr. Chitra’s services, was however a concerned woman. The young girl had shown no tell-tale signs of abnormality when she was a child. The father had abandoned them and it was her mother who had brought her up, rearing cows and selling milk. When she was fifteen or sixteen, she had been engaged as a household help in a convent. It was after she returned from there that she started having delusional spells.She would speak of a young man , who , according to the mother was a distant acquaintance, who lived miles away. He was married and had kids .But the girl kept insisting that he was in love with her. In her perceived sense of reality, he would often come to visit her, staying in the house next door and coming out of the house when he had rested after his long journey. He could even read her mind, such was their connection , the way she saw it. Everything else about her was normal. No one yet knew or suspected that she was having problems. She was neatly dressed and had such a shy warm smile. But she lived in a world of her own and would not participate in any of the household chores or help her mother while she struggled to eke out a livelihood.

There was no guarantee that she would ever be able to discard her dream world. But with medication, said Chitra , she would definitely be able to be more constructive and focuses in her day to day life. It could be that by and by, with the period of normal activity extending over longer periods as time went on, counseling would help her come to terms with the fact that the reality that she had been living in was in fact a figment of her imagination. Would some understanding, sensitive young man ever be willing to take this affectionate , gentle maiden into his care? Could such a man eventually merge with the image of the lover who now roamed freely in her mind? How I wished that could be!1

To be continued…

 
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Posted by on June 14, 2011 in Community, Reflections

 

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Fractured Realities-Part -1


She kept pacing tirelessly across the room where the inmates had gathered for an activity session. It was as if the regular rhythm of her moving feet helped lull the agitations of her mind. Mother Carolina told us that she would keep spitting all over the place and if rebuked, would promptly clear her throat and go on to repeat the spitting act with obvious defiance. But when she came and sat on the chair in front of Dr. Chitra, she appeared docile and co-operative. She wanted to go home , she kept repeating. Afterwards , she continued with her walking in the verandah and in the activity room, sitting for just a few moments and resuming again. She had complained to Chitra about aching legs without being able to make any cognizance of the association between her constant walking and the pain.

The rest , all twenty three of them, sat on chairs in a wide circle, some drowsy and nodding , some listless with blank stares, others with bent heads, drooping lips and sagging shoulders, as if grief and hopelessness were weighing them down. A few were of course abnormally perky, just waiting to be asked something for them to break into into a ceaseless disjointed narrative .

Mariamma(name changed) had been asked to take on the role of the class teacher during this activity session. With a piece of chalk , she was diligently writing down the names of all those seated there , on a slate. She then instructed them in a very authoritative tone, to say “present “, when she’d call out their names. All of them complied without a word, not once but several times, till the volunteer present there had to kindly but firmly coax her to get on with the class. When he tried suggesting what they should do, she was adamant that he shouldn’t interfere ,as the first hour was her period and she would be taking maths.

Mariamma had been a primary school teacher. Her body language and manner of speaking gave the impression that she must’ve been quite efficient in her job, may be a tard too much of a disciplinarian. For the past twenty years, she hasn’t been what we call “normal”. She has a younger sister who was apparently quite well off. Maraimma wasn’t exactly in indigent circumstances either. But she was not welcome in her sister’s house. So she has been spending her time in one institution or the other.

Here in Snehabhavan in Alapuzha, (Kerala), Mother Carolina, an elderly nun of the Visitation Order and two other much younger Sisters, take care of Mariamma and others like her with all the love and compassion that the most loving parent would extend to their vulnerable little children. It there is improvement in their condition, they are sent back to their relatives, so that others who are more in need of their care can be accommodated in this Home. Most of them are chronic cases of mental illnesses, some who have been under treatment , while some have been just left to themselves with gradual and complete deterioration of their faculties.

I had reached “Snehabhavan” with my friend Dr. Chitra Venkateswaran. Chitra is a psychiatrist who has spent quite some time in the Palliative Care Wing of the Calicut Medical College, tending to terminally ill patients both within the hospital premises and also visiting them at their residences as a part of the Home care programme. Now she is on the faculty of the Amrita Hospital at Ernakulam where she works for three days in a week on a salary . She spends the next two days providing free clinics at several places, counselling and prescribing appropriate medication for mentally ill patients, under the aegis of “Mehac” , a charitable Trust of which she is a Founder Member.

http://www.mehacfoundation.org/

 

The sisters at Snehabhavan brought the patients to her one by one . She talked to them , assessing their behavioural patterns and changing the medication or modifying the dosage. Some of them had been brought to Snehbhavan after many , ,many years of illness.The families had given them up as lost cases , sometimes in sheer helplessness, their indingent circumstances making it impossible for them to seek medical help on a continued basis or buy medicines for the patient , week after week and year after year. Sometimes, where financial well being was not so much of an issue, the family had neglected them out of just plain disgust.

The abnormalities came in all shades of a wide spectrum.According to Dr. Chitra, medication may not be able to completely reverse the conditions of psychosis or scizophrenia or other cases of extreme mental disorders. But they did help to contain the disturbances and keep them calm enough to be able to help them lead a less chaotic day to day life, both for themselves and for the other members of the family , who were responsible for them.

To be continued…

 

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