Shrink's Views

ramblings of an unknown psychiatrist

psychotherapy beyond boundaries

Posted by Dheeraj Kattula on April 28, 2009

He was allotted to me as I could speak Bengali. He was slow in his movements and in speech. He used words which I did not understand and spoke with a accent difficult for me to comprehend. I had many cases to see that day and I had reasons to feel irritated. I listened to him. He was depressed. He had seen psychiatrists in Europe, Bangladesh and in India. He had received many drugs from many people. He had lost hope in everything.

He should be admitted as an in-patient with the level of hopelessness and suicidal ideation. One cannot be admitted into the Mental Health Center, Vellore without a accompanying relative. So, If I wanted to help him I would have to treat him on an OP basis. I had many OP psychotherapy appointments and I had my hands full with full quota of IP patients too. I gave him a time slot for an afternoon session with him. That day I saw him sitting in front of my room right in the morning. He greeted me humbly, understanding my busyness, not expecting to be seen immediately.

I liked this guy’s commitment to therapy. I decided to give my my best. His visa was for 30 days and few days are already gone. I had to hurry. I squeezed in some time even during my duty days to see him on a regular basis. I remember I had a session with him between 9.00 and 10.00 pm! I struggled to communicate with him. He understood that I was struggling. He tried to be helpful ! I started him on a rapid modified Cognitive Behavioral Therapy (CBT). I failed miserably to even communicate what an automatic negative thought was. So I focused on behavioral issues.

His diagnosis was Dysthymia with Depression. We had also started him on an antidepressant called Imipramine. As he and I struggled together, I remember on one occasion I shouted so much at him that it was audible outside my consultation room. This was because he was nodding in that session as if he was understanding so as to not displease me! But to me the time was FULLY wasted, a reason to feel displeasure.

My therapy was primarily supportive, as my glorious plan of CBT failed. There were many issues he discussed with me. His anger over his brother, who had cheated him of all his savings for 5 years, his sexual problem after being married thinking marriage would lift him out of depression, his poor supports in Europe, treatment failures everywhere and many other things.

I was listening patiently. In a sense, buying time for the time tested Imipramine to work. He was on a pretty good dose of 175 mg.The time for his going was nearing. I took an opportunity to ask if it was possible for him to forgive his brother unilaterally. He said it was impossible. I prayed with him once. I gave him a exercise for my last session. He had to make a ‘mixture’ using puffed rice, onions, tomatoes, some sweets and boondi.

I will never forget the last meeting. He came in unexpected on a day I had to leave to another campus to see patients. Every minute with him would crunch my lunch time. The expression on his face made me skip lunch. I ate the ‘mixture’ he had bought. Told him that it was very good. I took him to my supervisor and told of his improvements. I wrote letters to the psychiatrists, who might have to follow him up. I gave my personal email ID and mobile number. This is usually not done in our set up. I did it as I felt he might not be able to send a email himself but if he ever required help I could offer it over telephone.

A year later I received a phone call from him. I was having my final PG exams. I could not give him much time. I told him ‘DO NOT STOP medicines. Show my letters to psychiatrists there and follow their advice.’ I had written long term treatment plans in the letter.

I received another call 6 months later. I was in Baripada. My Tamilnadu mobile is roaming. I use it for sms only. I picked it as it was an international call thinking it was my aunt calling. He told me that 6 months ago when he had cal led had  I told  him to follow up locally. They had changed the   medicine. The changed Imipramine to a newer drug. He slowly slipped into depression again. He had stopped work. He wanted to come, wherever I was for getting treated! I gave him my address.

Lo Behold ! In a month’s time he was in Baripada. He shocked our staff and our town people, who heard this. He got admitted. I restarted him on Imipramine. He improved in 2 weeks and went back. Last month he called from Europe. He told me that he is doing well and has also got a promotion. I congratulated him. I was happy for him and for myself too !

I was wondering what is it that has brought him from thousands of miles to get treated from a young psychiatrist like me? It would have lessons for me to learn and be consistent about. It was :-

1. Willingness to take up extra work despite a lot of busyness, if that is the only way another person can be helped.

2.Willingness to invest time and energy, without looking for rewards.

3.Looking at a person as a whole not as a label.

4.Being really committed to well being of a person, even if minor departure from protocol.

5.Using time tested medicines.

6.Being available.

It was not that the doctors, who saw him were incompetent. They could not give him hope at a personal level. To them he was a case, who was treatment resistant. To me he was MY patient who has problems. I do not deny that failures on his part would not have affected me, with this sort of an attachment, but at times it is that attachment only that holds a person who is sinking.

There was two things that he told me in this Baripada admission that I would never forget.

‘Sir, I have forgiven my brother fully. I hugged him and cried. My relationship with him has been restored, but this depression has not left me.’ He need not tell this as I had never pushed him to it. I had just suggested it. Traditionally psychiatry is neutral regarding forgiveness etc, but I sense some of those things matter a lot to people.

‘Sir, If you had not given me an appointment soon after you saw me to explain me the treatment plan and the time required to improve, I would have gone and slept  on a railway track in Vellore itself.’

I realize there are many opportunities which come our way to make a difference in people’s lives, if we are patient enough to respond.

May God give us such patience at all times.

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3 Responses to “psychotherapy beyond boundaries”

  1. Steve said

    Bro this was really a touching example…..I really learnt key points which would also help me to make a difference in the lives of people..Learnt that stepping into full time work for his kingdom is not just preach but make time and being patient and humble…..pray that you would be consistent even after ages making difference in the lives of people…Keep the good work going and poud to be your bro and thanks for always being a INSPIRATION and ROLE MODEL….God bless……….

  2. Jotham said

    I think this is classic of the ‘butterfly effect’… imp for us to realize its implications on us.. every thing that we say or dont say, do or dont do to someone… whether we like it or not does effect them. And even though we might not mean it, may really hurt them and bring out Big changes, similarly the right thing at the right time, could infact be a life saver… anna.. may God bless your commitment and may you only grow to be more patient and dedicated as time goes by

  3. antony said

    great and inspiring anna 🙂

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