Tag Archives: Mental illness

Fractured Realities-Part-4

Jnanpith award winner, M.T.Vasudevan Nair is one of the most eminent figures of Malayalam literature today. Those who have read him get entrenched in his world of nostalgia. He transports you to the times and places he grew up in and his characters seep into your psyche as very identifiable bits of your own self…at least for us old timers. I have no idea how today’s youngsters relate to his wistfulness for another kind of world where human relations are based on loyalty and commitment and more importantly, dollops of love and affection. The angst of his characters as they are caught up in the sweep of the changing times , is something many of us who have grown up in slower and down to earth times , authentically know and vicariously live through them.. Many would brand his writing as sentimental…but what is human existence all about , other than a myriad blend of emotions and sentiments?

One of his most touching characters is from his story “Iruttinte aathmaavu” (Soul of Darkness), that of “ Branthan Velayudan “,. The story was made into a film , as have many of M.T’s other stories and novels , quite a number of which have won awards at the State and National levels. In the film, Velayudhan’s role was played by Prem Nazir, the then reigning king of Malayalam cinema and was perhaps one of his best performances amongst the more than 400 different roles he must have played in his lifetime.

This is the plot of the story as it appears in the Wikipedia:
“Velayudan’s existence poses a problem to all the members of the joint family. Velayudhan is a twenty – year old man, but he has the intelligence of a child. The head of the joint family thinks Velayudan symbolizes the curse which hangs heavy over the house. To his mother he is source of constant sorrow. His uncle’s daughter is his would be bride. He is attached to her. She is very kind to him and refuses to treat him as a mad man. Velayudan triggers problems one after the other and every new lapse help only to put fresh chains. He refuses to feel he is mad. In the end Ammukutty is given away in marriage to an old widower. Velayudhan surrenders himself and yells “Chain me I am mad!”

Will not the “maddest “ of them all respond to care and compassion and medical intervention? M.T.Vasudevan Nair certainly seems to think so. He is one of the Trustees of the Mehac Foundation , a recently formed NGO:

I was in Ernakulam , last week to be with my friend Dr. Chitra and two of my friends from school, Suchitra and Suchitralekha. They are always happy times, for the bonds we share are full of the positive vibes of unconditional friendship , that go back a long way. I was therefore immensely happy to be able to witness first hand, the work Mehac was involved with. Dr.Chitra , as I mentioned in an earlier part of this write-up is its Clinical Director .

What Mehac is doing is to form partnerships with existing bodies at grass roots level and build up a mental health care programme , in which trained volunteers interact with the patients and help them slowly regain their balance and productivity , duly supported by clinical assessment and medication. Unique to any such scheme perhaps is the involvement of the Muhamma Panchayat , who have started a Palliative Centre with available local funds .Together with Mehac , they are slowly building up a team of volunteers, who are responsible for each patient they identify . These volunteers personally observe the improvements or downslide of each of these patients and report them to Chitra on her next weekly visit to the clinic. The volunteer team are also responsible for organising activities that could help them become self sufficient. Coir rope making is one such activity they have started. There is a similar tie-up with Tata Charitable Trust Hospital at Chottanikkara as also with Snehbhavan Visitation Convent at Kalavoor , which I mentioned earlier.

I accompanied Chitra on her home visits in and around Mararikulam. The volunteers this time, were a spirited team from “Sanhati”, an NGO engaged in promoting selfhelp groups and also providing palliative care. This is a coastal belt , where most of the families earn a livelihood through fishing or coir rope making. Poverty is not so grinding in Kerala as in many other states of the country. This section of the society, however, do find it difficult to make ends meet. When the monsoons set in, for example and trolleying boats are prohibited from going into the sea, because of the breeding season, they are left with no daily income and their saving in the previous months , if they do manage to keep by something, is hardly enough to sustain them during these lean months. The Government does provide free ration , but that is about it.

To have a terminally ill family member or one suffering from mental disorders is like having a pus- filled boil on a hunchback, as the saying goes in malayalam. The families that we visited were heart-wrenching examples of this sorry state of affairs.

We also came across these two sisters, both old, the deranged one above eighty perhaps. She was sitting all bunched up on an old mat, in that small dwelling, frail and helpless , not quite understanding what was being asked . It was left to the younger one who had been looking after her for more than forty years to fill in the details. “ She hasn’t taken a bath for many, many days and I have not enough strength left in my hands to lift her up and take her outside , after twisting ropes all day long . And if didn’t do that, all three of us would go hungry. She just sits there all day long. It is such a task even getting to feed her” The third one was the husband , who didn’t do any work. Such debilitating collusion of poverty and illness and yet the woman had a calm demeanor, narrating her story very matter of factly without any dramatic frills of self-pity or complaints.

Another pair of siblings we visited, were in worse circumstances. They too lived in a small dwelling with just one room, a portion of it demarcated as the kitchen. It was filthy and cluttered with a pile of very soiled clothes lying in a corner , bottles and dented aluminium vessels vying for space on the cemented floor, which was almost half covered with a thick layer of sand…”to keep out the cold from the moist floor”,explained the younger sister , who must’ve been in her late fifties. “She finds it difficult to sit with her feet on the cold floor”, she said, pointing out to her older sibling who sat on a rickety cot covered with a moth-eaten blanket .Both the sisters looked sloppy and unkempt, their short ,curly hair liberally streaked with white, hanging in scraggly strands .

The house was in the corner of a huge compound with another, much bigger house at one end of it. “We were all staying together in that house, two brothers and four sisters. Then our father died and this one here lost her senses. And then one brother committed suicide. The other one got married as did the other two sisters”. The sisters were apparently well off . The surviving brother and is wife had got tired of the presence of a cranky sister and had built this room for them . Ill luck seemed to stalk the family at every turn, for the elder brother too died in an accident and his wife remarried and moved on. Chitra mentioned that there may have been a genetic proclivity in the family for depression. The sister who was normal also talked in a way that gave the impression that she too was slightly quirky.

The property therefore now belonged to the four sisters. But the house remained locked up as they were scared to move in there. They had no means of livelihood in spite of having the not so inconsiderable land holding at their disposal. The little money that came their way for food and medication depended on the occasional magnanimity of the tow well off sisters during their rare visits .The volunteers of Sanhati had become their immediate saviours . They brought small portions of rice and lentils for the sisters and ointments and pills for their aches and pains and now Chitra’s visits would ensure continued medication and counselling. She sought the co-operation of the volunteers to clean up the place on one of the following days. The sisters of course were delighted. The elder one even got up and shuffled to the door on her swollen feet to see us off.

Back at the house , which had offered their premises for running a temporary clinic on the days of Chitra’s weekly visits, we had hot tea and roasted seeds of a particular mini-version of the jackfruit called “aanjily chakka”. The wood of this tree was used for making boats, I was told. The small pods inside the fruit had a slightly sour-sweetish taste.

There were a few patients waiting there as well. . One of them, a young female had come from quite a distance with her son. Annie, the spunky volunteer from Sanhati told us that she herself was a victim of acute depression, but it was left to her to look after her brother in-law , who had to be necessarily kept chained till her husband returned from work.

I was exhausted by the end of the two days with the stories of so many lives so full of distress and it’s still hanging like a cloud in my mind. I marvelled at Chitra and her team who would be continuing to make these rounds , week after week.

It was an agonising experience and yet somehow it was filled with a strange kind of energy and hope. Thank you Chitra.


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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.


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…


Posted by on June 14, 2011 in Community, Reflections


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