Excerpts from a forthcoming book by Lavanya Seshasayee

How so vain? O the bane of the vain,
O what a shame!!!

So thought Aditi with her cheek rested rather pensively on her palm. It was to be a journey through Schizophrenia that she was to commence – just about to commence – a journey to the depths of hell and back. This wasn’t just explainable – in fact it was by far over-simplistic to say- ‘the mind in itself can make a hell of heaven and heaven of hell’. It was 2 years after the period when street urchins danced their swaying hips and sang to the tunes of ROJA, a Tamil movie – AT THE NATIONAL COLLEGE. Before the second EPISODE. That was only see-able [sadly not knowable to the uninitiated others!!!!]. She hadn’t read enough Thoreau to be aware of this:

If a man does not keep pace with his companions, perhaps it is because he hears a different drummer. Let him step to the music which he hears, however measured or far away.

And so she willingly broke all social codes and norms pertaining to appropriate behaviour. Aditi did not like force or authority. Aditi was being gobbled up in her own world- time was coming to an end – her universe was ending- her brain was exploding for it could take no more!!!

The difficulty was locked away in some deep furrow or fissure of the brain. It wasn’t caused by or in the brain – it was only mediated by the brain. It needed to be coaxed out with sweet words that nobody was willing to articulate. That nobody had the time or the inclination to articulate. And had anybody actually articulated the problem the others would simply be oblivious to it. It was to split the brain of the Indian woman into two pieces – figuratively so to say – so great was its intensity. And yet you couldn’t put your finger on it. Where exactly the difficulty lay was something that evaded and eluded the understanding of the most brilliant scientists.

It was something that was to be handled by the Indian woman all alone. Unfortunately. The lay advisors thought you could get it out of the mental system by playing a game of rummy or socializing with friends or playing with children or going shopping or meditating when the symptoms were about to surface. However it wasn’t quite as simple as that. It was mental discontent with what the specialists seemed to be doing to people. They, the sufferers, did not have a right to voice it. And yet anybody and everybody who had ever been mentally ill or on the brink of a mental breakdown was sure to have experienced it. Wrestled with it. All alone. With no help and sometimes if you were lucky, then with help.

Help? What the hell!!! Help was help!!! The women flocked at the community resource centres in India hoping to find a miracle cure but were sadly disillusioned when they realised that these centres never developed into anything other than drug dispensaries. They – the women – the patients were made to stand in long queues even as psychiatric medication was doled out to them. The women received glistening glossy packets of drugs coupled with leaflets to check for the Pfizer side effects.

For instance Daxid setraline [Zoloft], an antidepressant. And what was the distilled wisdom of the ages – soon to be capitalized upon by the pharmaceutical companies – that produced these leaflets? Written on these leaflets were the words ‘Setraline, power that speaks softly’ and ‘Pfizer, working together for a healthier world’.

The whole mental-health show was manned by several people. They worked intensively from their offices that could be likened to bee hives. Incessantly. Continuously. With just a half hour break in the afternoon. Many of them had after all been through a mental illness themselves. And yet they did not choose to favour those with an experiential perspective- at least they did not choose to favour the patients fighting against doctors. While their efforts may have been motivated by the noblest of intentions there clearly was to be something way beyond mere psychiatric medication or forced medical remedies that would truly help.

And so way back then Aditi was forced by circumstances to take her medication, and in a half dazed state perform the domestic chores [O she desperately needed to work to keep her brain still], shop for bangles and bindis, buy curtains that were colour-coordinated with the walls in various rooms of her house, cook the muttar Paneer, the chole poori, the South Indian dishes and Indian chat if her mood so permitted, pay a visit to some friend of hers or the other to overcome the gnawing sense of insecurity she felt at being confined to the home and not being allowed to go to college… Just because a psychiatrist had instructed her parents to keep her home. In vain did she tell herself that ikebana flower arrangement or some such activity would help. This was just before the psychological Tsunami.

She dreaded the lady psychiatrist whose only questions to her parents when she was taken to the IIMH hospital in Bangalore had been: a} does she eat properly? And b} sleep properly? c} does she take her regular dosages of medication three times a day? D} does she get violent or agitated? Does she throw things at people for instance? – Without a thought being spared on why exactly she became violent or what made her violent. What made Aditi throw things? Social pathology was never corrected. The onus to change and recover always lay on the individual and never with the caregivers who made her who she was and what she was and who were never assigned any responsibility or standard to change their behaviour to induce recovery or at least help induce recovery in Aditi.

She hated clocks. For they reminded her that time was passing.

For hundreds of years nothing was spoken regarding this dissension in the minds of millions of Indian women – ever since western psychiatry entered India – for until then there had been the Darghas and the traditional temples that were healing sites. Western psychiatry that entered India spread itself most rapidly via the establishment of Indian’s premier mental health institution in Bangalore- the Indian Institute of Mental Health. On account of India’s colonial legacy western psychiatry was now being repainted and glamorized as India’s only hope of recovery for it’s mentally ill women.

At the familial realm [or at least in Aditi’s family], being a wife and a mother or being trained to be a wife and a good mother were the only roles being conceptualized for women back then and women who became hysterical or schizophrenic supposedly did so because they refused to accept these god-given, god-ordained roles.

O it was so glorious to be wife to a successful man. A materially well-to-do-man. An excellent catch. A man who’d reach for the bait. The woman’s bait. An intelligent woman’s bait. A smart woman’s bait. Bangalore was quite medieval in this respect. Especially the Kannada speaking Brahmin families … The feminine women were destined to ‘reach for the stars’ in the marital market. This obsession with being a trophy wife – a rich man’s trophy never seemed to wane. If you were not yet married you needed to be an excellent potential-trophy-wife. If you were a software engineer cum potentially submissive trophy-wife you would be an ideal catch for the man.

This had been the reality for women way back then, when Aditi had been a teenager. When she’d been very intelligent at solving highly complicated mathematical problems even at the age of 14. When she had been forced to unlearn what she had learned with such great interest. The tsunami was to happen a little later than this but had shown all possible signs of happening!!!! In vain did she cry out for help. Also and alas!!! The consequence of forced adherence to sex stereotypes had never been considered and questioned while formulating a psychiatric diagnosis. 

Aditi hadn’t submitted, of course, didn’t want to- didn’t allow herself to and that was where the problem lay…

You needed to be highly modernized in your dressing and language but old fashioned and Victorian in your thinking. If you didn’t you’d land up in a mental hospital. The much advocated movement for Global Mental Health that came a decade later was to hardly even consider all these social realities.

There were prominent NGOs in India that offered low income families free medication for life. The other NGOs served as distribution networks for doing this.

In a similar vein, the Movement for Global Mental Health [MGMH] was to crop up a decade later. Had it happened in 1997 it would hardly have caused any significant change in the conditions of clients like Aditi. The over-medicalization and over-psychiatrization endemic was beginning to extend its tentacles to suck the blood off anybody who would be a suitable target. … It targeted several of the NGOs with whom it established curious networks to achieve its purpose. The MGMH was to ‘scale –up’ services for ‘mental disorders’ in low income countries.

There was no talk of targeting the Indian [as also other] caregivers with their dysfunctional habits of interaction and who were often an incorrigible lot. The movement argued that just the way HIV AIDS activism brought results global mental health advocacy could be modelled after it. The movement constructed mental illness as an illness that was ‘like any other illness.’ While this sounded very good it was far from doing any real good to the common person. Ridiculous parallels were being increasingly drawn between improving access to psychiatric medication just like that done for epilepsy and anti-retrovirals for AIDS. The movement sounded very sympathetic and condescending indeed when the proponents declared it was ‘unethical to deny effective, acceptable, and affordable treatment to millions of people suffering from treatable disorders.’

There was however a flip side to the whole argument. Especially when research showed that evidence for the organic basis of mental health problems – such as schizophrenia- was not as considerable as some suggested. HIV research was in no way comparable with mental health research. For the drug-placebo differences were statistically significant in HIV research but not in research for depression. Moreover, the World Mental Health Survey suggested that low and middle income countries did have better long term outcomes for Schizophrenia. In fact scholars and experts constantly wondered as to what it was about low and middle income countries that led to a much lower prevalence of schizophrenia despite the fact that very few people in low and middle income countries received treatment for psychiatric disorders. They were trying to universalize bio-psychiatry when other community mental health methods could be substantially used to promote mental health among clients. The movement sought to replace traditional and alternative meanings of distress that had so far been sites of resistance to domination by bio-psychiatry. But access to psychiatric medication could never be synonymous with social justice – could it? Weren’t other kinds of support needed as much as medication was? What about the social, cultural, political and economic determinants of recovery? Medication all by itself did not help.

Aditi was at that point in time, which was a decade before the movement for global mental health started, when she had her episode, experienced shaking and shivering of her hands due to psychiatric medication. Medication acted like a double-edged sword. When you took medication and engaged yourself in dynamic activity to shift attention outside yourself – when you became part of a dynamic social circle outside the home – you functioned very well but if you took medication and just stayed home or in an institution you only went from bad to worse and reached a point of no return. Your fingers became stiff and you would be unable to engage in any meaningful activity- the medication – the very medication that was supposed to help, then made you dysfunctional. Totally. A wreck.

Aditi’s question No.1 was: Alas!!! And who is it who decides the standards for maladaptive behaviour? You are going by normative societal standards in deciding what’s normal and what’s abnormal- aren’t you? Running away from your master who enslaved you was termed abnormal hundreds of years ago. This was termed ‘Drapetomania’ by Psychiatry. Did that mean it was actually wrong to run away from a man who enslaved you? But that was what normality constituted hundreds of years ago!!!! …
Aditi’s question No.2 was: Who was the silly therapist to decide what was realistic and what was unrealistic when she didn’t even possess the expertise to gauge Aditi’s true potential ? Many of the psychiatric survivors or even users for that matter had been declared ‘medical failures’ by this same system but made a remarkable return to recovery. …
Aditi’s question No.3 was: Some influence???? Saying the problem was in the client and not in her dysfunctional environment totally absolved the caregivers and most importantly, even the professionals of any responsibility …
Aditi’s question No.4: Many of the achievers actually succeeded on account of this sort of thinking which was nothing short of determination- are we then saying people with mental illness should have no determination at all? That they don’t have a right to their dreams just because YOU see them as defective?
Aditi’s question No.5: Some people do have an external locus of responsibility and control because of their strong experiences with their environment and a need for acclamation and achievement that might be antithetical to any self-control approaches and so what was wrong if you did things to achieve social recognition?
Aditi’s question No.6: ‘Why can’t the same therapist make the client put in hard work to help her in achieving her ambitions? Why try making the client not aim to achieve something she desperately wanted to?
The individual is the primary focus in all these theories and must adapt to these environmental forces. Aditi had her own contentions with such a theory. And with the therapies based on such theories which for her were quite meaningless. Her reality was reality as she saw it and not what somebody else said it was. It was precisely because she had not been allowed to go to college and prove her potential that she had become what she had become. Had it been wrong for her to even want to go to college and study which was what all the other teenagers did? Was it wrong for her to have her own ambitions and desires and to try fulfilling them via hard work?
The entire process should have been client-led because it was she-Aditi who was the subjective experiencer. The therapist did not know more about what had happened to Aditi than Aditi knew about what had happened to herself. To be sure.
Aditi should have been asked to do what she wanted to do and helped in achieving her goals step by step. Instead the professionals and her caregivers did what they wanted to do to her. Because they assumed she was incompetent to make decisions on account of her label – the ‘mental patient’ label.
The user-survivor literature is rich and vast. The users should have been encouraged to come up with subjective and creative methods to manage their illness. Psychiatrists should have drawn upon user-knowledge and user-based mechanisms in addressing distress and helping solve the user’s problems.
And The Movement for Global Mental Health could never have helped somebody like Aditi.
The MGMH created a division amongst the users. While many users in low and middle income countries were counted upon to be advocates of the movement for Global Mental Health, many of the users in high income countries criticized psychiatric practices in terms of calling them dehumanizing and violent. But why so? Both the violence of forced medication and ECT [shock treatment] and being labelled irrational and incompetent were truly degrading to the human spirit.
There was no talk on the politicization of distress. ‘Mental illness’ was not really an illness but just a way of coping with and resisting unequal social realities and trauma.
Permitted No rhyme, No reason. O surely this was treason!!!!

(DRAFT ONLY, not for citing or quoting)

Lavanya Seshasayee, Bangalore, 05-03-2015

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