Shrink's Views

ramblings of an unknown psychiatrist

Archive for the ‘philosophy’ Category

Two Ships: a painting

Posted by Dheeraj Kattula on December 4, 2011

Two Ships

Title:Two ships
Watercolour on Handmade paper
3.12.2011
Original Size:29 x 39 cm

This painting reminds me of something I had pondered over few years ago.
The main issues that a captain of the ship is concerned with are
1. How to keep my ship from sinking?
2. How to avoid bumping into other ships?

In life the answer to first question leads us to ‘personal ethics’. The answer to the second question leads us to ‘social ethics’.

Is not the problem of mankind beyond the pragmatic – why is the ship in the sea? 🙂

I had not removed the painting from the easel when it was done. As I kept looking at it, it looked a bit dull.So I added lemon yellow into horizon area, darkened the foreground waters,added some detail into the ship with ball point pen, added some background interest with birds and finally remembered to sign 🙂 Friends later pointed out that the version 1.0 had better reflections of the ships in water. I then added some plain water to the ships bottom parts and let the water drip to get the reflection look on to the painting. This is the final version of two ships.

Two Ships

Posted in art, ethics, philosophy | Leave a Comment »

Hell’s View on Mind, Mentally Ill and Mental Illness: Satan writes to Screwtape

Posted by Dheeraj Kattula on August 31, 2010

Prologue:

The Screwtape Letters is a Christian apologetics novel written in epistolary style by C. S. Lewis, first published in book form in February 1942. The story takes the form of a series of letters from a senior demon, Screwtape, to his nephew, a junior tempter named Wormwood, so as to advise him on methods of securing the damnation of a British man, known only as “the Patient”.

One must know this background to understand the following post. The following is a letter written to Screwtape by the father below Satan himself. It addresses issues of the mental illness and mind.

Letter:

Depths of Hell

21st Century. Year of the Enemy

Dear Screwtape,

I bring greetings from the depths of our eternal home. I have heard of your progress from your junior aid Wormwood. He gave me the news that you have been active in trying to understand and use the interface of spiritual and mental realms for our purpose.

I must warn you of the dire consequences of making yourself too obvious. Our success lies in our subtlety. You know it clearly that the ones who are obsessed with us and the ones who do not even believe in our existence are not our threat. In fact they are safe in our hands. I use the word safe only for sarcasm. You know the truth that they are actually unsafe in our hands 🙂

Many of our Enemy’s children are slowly coming into our camp. They are quite obsessed with us. Many of them do not even realize it. They know us. They can drive us out of our subjects with the authority of the Enemy. What is good for us is that they see us in everything. What our Enemy intended for them is to know Him more deeply. We can keep them preoccupied with us and distract them from Him. We can make them hate us more, thus filling their heart with more hatred. This distracts them from showing love for their brothers through their actions.

I see you have done a good job in the area of mental ill-health. Of course, I cannot credit you with making people mentally ill. I know some of this is beyond our capacity. We can only hurt those subjects as much as we are allowed by the enemy. You have quite nicely convinced many that mental illness is caused by us. It is a great lie. I love it. It is useful in quite a number of ways.

One, it keeps people in search of a magical-spiritual cure, which we can use for drawing them closer to us by involving them in rituals that are not pleasing to Him. Secondly, this preoccupation helps them keep away from medical attention. This makes the subject live in a psychotic state, away from reality. This makes him lose contact with the world that the enemy has created and makes them live in a world of lies. Remember our job is to steal, kill and destroy. We steal, kill and destroy the time of our subjects through this.

When we encounter any illness, we can use it for our purpose. We can use mental illness, even more. Our weapon of lies is very powerful. You are using it well. People fear mentally ill. They think that mentally ill subjects are violent and dangerous. Those of them who fear us also think we are causing these patients to do their behaviors. What a joke! We can laugh at this even in hell! The subjects who seem to be walking around normally and living their life successfully could probably be much more in our control. In fact they could be much more dangerous than subjects with mental illness.

We must realize that every bad thing that happens to His children is a good thing-gone wrong. For example when a man works hard in his business, he is doing what our enemy intended him to do i.e. to provide for his family and share with others. This good can be made to be bad when he works hard to make more and more money to the point of neglecting his family. It can be made to be bad in another way, when he earns for his family only and does not give out to anybody else. I am sure you have been using these distraction tactics to deviate our Enemy’s children.

Basically evil is qualitatively only slightly different from what is good. It is at times quantitatively only a changed proportion. Now why do I say this, we cannot take credit for the evil in the world too. We have not created it from anything. Evil is only the deviation from what our enemy meant in this world. We love it though.

If a person takes cocaine, he will get a high. Cocaine works in his brain and alters the chemicals in different areas. If a person takes Diazepam, he will get sleep, as Diazepam acts on certain areas in the brain which induce sleep. Did you or I create these substances? No! Can you or I control that effect? No! It is bound to happen in a world created by our enemy. In fact all of the day to day functions are regulated by chemicals in the body.

Our enemy has created certain chemicals, when present in right quantities make subjects happy. If these are not present in right quantities or if their proportions deviate then the subject loses his happiness and become depressed. If this is severe he may become suicidal and may even end his life. We love imbalance. We want his subjects to die if they are depressed. We can rejoice in death of a human subject, but we do not earn points. What extra have we done? It may be more like a person with cardiac failure dying with a cardiac arrest. Would I give you any points for it? Absolutely not!

These guys with mental illness lose capacity. Even the earthly Courts of Law give them some immunity by considering them not criminally responsible if they were to do a murder under specific circumstances. Our Enemy loves them much more. How much more he would be gracious towards these mentally ill on the day of judgment!  These people might get away with much of what they do due to their illness. Remember to not take credit for what bad happens to them and do not feel happy when they do something bad.

Mind is a good playground for us to demonstrate our skills. You and I cannot know exactly what our subjects are thinking in their mind, but we can input thoughts in their mind. I am not speaking of the thought insertion seen in what the humans call Schizophrenia or the intrusive thoughts seen in what they call Obsessive Compulsive Disorder. These phenomena as I said earlier are not out doing. If I hear of you take any credit for this kind of phenomena seen in your assigned subjects, you would be demoted in the hierarchy of Hell.

What you would be given credit for is, when you can instill a normal human with automatic negative thoughts. By this you trigger a volley of negative thoughts. These affect the subject’s mood making him anxious, angry, bitter or depressed. I agree that this is more pronounced when he is mentally ill. You would get no points for that. You would score if you use this on normal people, happy people, loving people, and obedient people and successfully make them lose contact with what our enemy intended them to keep in touch with, by painting a darker picture of reality even if it lasts for a short while. I would be happy if you could do this long enough to make thought patterns freeze. They should ultimately submit and react to thoughts that arise in the minds without questioning it rationally. This would ensure the subject’s drift away from the Enemy.

By the way I liked your letters to Wormwood. I have asked new recruits and slow learners to read the letters to improve their performance. Wishing you all the very best in accomplishing our task.

Hail Me!

Your Father below,

Satan

Posted in christian, depression, fiction, humour, OCD, philosophy, psychiatry, religion, schizophrenia, science, spiritual, stigma | Tagged: , , , , , , , , | 15 Comments »

“He will get bed sores and die in about three months. Take care of him. Feed him with what he likes.”: Medical Model VS Family Practice Model

Posted by Dheeraj Kattula on June 29, 2010

He was discussing about his experiences after he came down from the mountains. He was doctor doing medical work in the communities based in nearby hills. He was posted there by our hospital for a couple of months. Of the many things he told that day, I remember this story clearly.

He had seen a 74 year old man with a fracture in his femur in a hilly village. He asked me what he would have done. It was a simple answer for me. I said, “You would have told them to bring him down to the hospital. We could give some charity, even if they cannot pay fully. The bones can be fixed.” There were five competent orthopaedic surgeons in our hospital at that time. He smiled sarcastically. He wanted to make a point, but what he said shocked me.

He had said, “I told them, that he might not live very long. He cannot move here and there because of his broken hip. He will get bed sores and die in about three months. Take care of him. Feed him with what he likes. Let him enjoy the time he has.”

I was filled with malaise. What?!!! How can a doctor say this kind of stuff? I couldn’t control myself. I asked him, “Wasn’t it inhuman? Fractures are treatable. Isn’t it? Then why not offer it. How can we give a death sentence for a treatable condition?”

He laughed at me as if I was talking rubbish. I heard his argument keenly. Probably, it was to rubbish his argument to boost my egoistic ethical pride. He said, “Listen, this old man has a son who is the only bread winner. His daughter-in-law is a house wife. His grandson is now in standard 10. His grand-daughter is in standard 8. It costs about Rs 5000/- to bring him down from the hills in a vehicle. The cost of treatment in the hospital would at least be Rs 30,000/-. They do not have that much of money. If I do send them down, they will have to bring him back after a discussion with a orthopaedic surgeon. In the bargain they would have spent off large amount of money. Just in case they go ahead and treat him, they will have to sell off their house. If they sell it off, then they will have to live in the street.”

I was listening. He went on, “If they spend all that they have, the grandson may not pursue education beyond high school. The grand-daughter would have to discontinue school to add to family income. All this might add one or two more years to a 74 year old man. Is adding a couple of years to such a man worth losing the future of a whole generation?”

It was a tough call. I was a new graduate then. I was trained in the medical model. I was supposed to tell the best medical treatment available to the patients and let them decide what they wanted. I realized this model absolves me of any feeling of guilt. The truth is I do have in my mind what is better, but still I would have done what is ‘right’. My friend’s argument did not convince me.

After about 6 years of that incident I am wondering if that ‘right’ that I would have done is really right?  What would I do if I were in that old man’s position? I am absolutely sure I would rather wish a better future for my grandchild than live a few extra years. I have heard grandparents in India bless their grand children, “Let my years be added to you.” Of course that does not mean that one can assume this sentiment in every case?

The point is that my friend is a family physician. His expertise is not only in managing health problems at a primary level but also in understanding clinical problems and treatment options in the light of socio-economic conditions and the values of the family. His model makes people happier and fulfilled more than the medical model which has the appearance of being more scientific. May be it is time the specialists learn to use the broader model. This can be done when; in addition to eliciting clinical histories clinicians spend some more time with patients in understanding their and their family context and expectations.

PS: This event happened about 6 years ago. Today, thanks to Chief Minister’s insurance scheme and 108 ambulance services, patients like the one described can get free treatment in our hospital.

Posted in challenge, children, Diagnosis, distress, economics, education, ethics, indian society, medicine, philosophy, social | Tagged: , , , , , , , , | 3 Comments »

A tale of two teachers: A story

Posted by Dheeraj Kattula on June 5, 2010

They were not just teachers they were cousins. They were lucky to get employed in the same Government run school. They spent considerable amount of time in our school, which is located in deeply rural area of Bihar, India. I knew both of them from the day of their joining. They were good at their work and were assets to our school. They worked overtime teaching village kids and encouraging their mothers. I liked them both. They were like my daughters.

Sita was the older one. She did her Bachelor’s degree before she did the certificate course in teaching secondary school students. She was able and energetic, when she joined. Her blemish less skin got scarred with pimples and got tanned in the tropical heat. By the time she struck thirty, she gained weight and lost her looks. I have seen her beauty fade right in front of my eyes. I was concerned for her marriage. How would she get married at this age in this society where all she has lost is considered important and all that she has accomplished is considered nothing?

Gita on the other hand was relatively young. She hailed from a large town. She had greater exposure. She was clear about being a school teacher. So she did her training appropriately without any ‘wastage’ of time, like doing a graduation. She was beautiful and carried herself well. She had a big family to back her. I wondered who that lucky one would be, the one who would marry her.

*********************************************************************************

Let us take a break. Do you think Sita and Gita ever got married? Take a guess and then read further.

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Yes. They did. Sita got married to a man who worked in a NGO in a tribal area. It is very far from here. It is even farther from residence of her parents and also her in-laws. He earned lesser than how much she earned here. I was concerned as she had to resign her Government job to go there.

On the other hand Gita got married in the town that she grew up in. Her in-laws and husband worked for the Government. They were rich. They could live a decent life from the money derived from their assets, even if they did not hold jobs. Her in-laws liked her so much that they did not take any dowry. (Sadly, it is a rare gesture in India.) Gita too resigned from the Government services. I was glad she could rest and enjoy life.

*********************************************************************************

Let us take a break again. How do you think these ladies fared in their marriages? Do take a moment off and think which would have been more difficult, which would have been happier, which would have brought happiness to their families?

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I would not guess if you have got it right or wrong. Let me tell you what happened. Sita left her Government job and gave up her stable salary, but she continued to do what she does best- teach. She started a small school in the tribal area where she was based. It is such a backward area, that even the Government did not have a school in a radius of 20 km around it. I am still shocked after I heard that tribal people are sending their children to study instead of using them for hunting, gathering and at their best- farming! Her husband’s development work took a quantum leap as she made in-roads into that community with education. Her parents and in-laws are proud of her as much as her husband. They may be short of material wealth but they are rich in their being. She is doing what principals like me can only dream of, even though we have a team and Government resources.

Gita resigned and rested at her new home. We teachers are as born as we are made. She taught children of her husband’s siblings and cousins, who lived in the locality. They were rich spoilt brats. Her methods were not appreciated by her relatives. She got fed up. In our school, even if a teacher beat a student, the parents always trusted our judgement. They aligned themselves to our terms of discipline in the best interest of the child. Gita lost that privilege. After all, there is a difference between teaching a rich kid and a poor kid.

Her husband loved her too much. He was very possessive of her. I am troubled to call it any other, so I fool myself calling this love. She could not visit her parents’ home without his permission, though it was just a couple of streets away. Going there alone would be such brazen behaviour that it would never be tolerated. After all, restrictions were for her safety. Her beauty conspired against her.

She had to restrict herself to household chores. She was never good at that. Her mother had pampered her by not letting her do them. While working in our school Gita escaped household chores. Her cousin Sita did the household work, while Gita attended to her personal grooming more diligently. What Gita treasured became the enemy of her life and what she avoided became her partner to escape a meaningless existence.

*********************************************************************************

I do not know what you had guessed. Let me tell you that my guess was wrong. My calculation was terribly wrong. I thought Gita was living a happy life and Sita was suffering. It is true that Sita has difficulties and Gita has comforts but that is far from reality. I wonder how I could be so wrong.

The patterns which make us anticipate outcomes may be right but these may fool us utterly at times. I also wonder if the patterns that we use are useful, if we could be wrong in both directions in both qualitative and quantitative terms. Hmmm… I would not doubt the usefulness of a pattern. Sita and Gita’s life indicates that there are more important issues than beauty and bank balance in determining soundness of a marriage and happiness in general.

Posted in education, fiction, indian society, love, philosophy, women's issues | Tagged: , , , , , , , | 14 Comments »

Processes, Outcomes and God

Posted by Dheeraj Kattula on March 15, 2010

I heard a person share about how importance of persistence in prayer. He shared a testimony with great enthusiasm. He spoke of a Christian family. Their marriage was arranged. They were from a different religious background. Before they got married, they had been praying to get married to a person with their new faith. They could not tell this to their families for some reason, but they were persistent in their prayer. After marriage, when it was time to consummate, one of them wanted some time for prayer. The other got excited on hearing that. Lo behold! They realized that they both had Christian faith and that God had miraculously united them. Wow! That was a great story. I smiled but something was sticking out like a sore thumb in my mind. It required deeper thought.

Firstly, can we thank God in a situation like this? Of course one could. It makes sense to thank God for any positive outcome for which no wrongful means was used. (Obviously one cannot thank God for the driving licence if a bribe was paid in the transport office.) It requires greater faith to thank God for bad outcomes like being diagnosed of a bad disease, death of a loved one etc. Putting the thanking God aspect aside, let us examine the case described. We have educated persons who profess to have strong convictions. They do not tell that publicly. They are afraid of the consequences. So, they prayed regularly for a miracle! They go through a wedding with all its rituals in a manner that may not be acceptable to them personally, but privately want to pray just before consummating a marriage!

 So, what is the big deal? What is wrong with that? Why can’t it be God’s way of doing things? Is it not amazing to see such a coincidence? Let us consider a girl of similar profile, similar faith, who prayed similar prayers, who obeyed parents similarly but had a different marital experience with a violent, debauched alcoholic husband. What would people say? They would say that this happened because she did not ‘take a stand’. They would say that God is punishing her for her sin of disobeying God in being unequally yoked.

Let us take the case of another girl, who told her family exactly what her convictions were about whom to marry. Her parents do not get a proper match as they do not have many contacts in a faith community from their own. Assume this lady remained single and has a tough life in her fifties. What would people say? They would say that God plans singleness for few and would give them His grace for handling loneliness. The worse among the lot would say, ‘She was too choosy. God does not help choosy people.’

What does this leave us with? It looks like we reason things about life from the outcomes and not through the processes. In the first case, it was absolutely irrational for educated people to engage in marriage without discussing faith issues especially if faith was an important issue to them. But we would praise God as somehow it worked out well. In the second case the process adopted was similar to first case, but the outcome was bad. We are quick to pick the mistake of one responsible- namely the suffering individual. In our objectivity we highlight reasons and forget to give needed support. In the third case, the process probably was right but outcome was not desirable. We conveniently put the responsibility on God himself!

Lessons:

(From the perspective of sufferers) Do whatever you want. If it works out, say ‘Praise God’. People will resonate with you. If it does not work out, repent if you were wrong. God will forgive you, don’t worry. If you were right, it is indeed painful. Cry out to God. God comforts us too. Just one thing-don’t bother about what people say. They either don’t know stuff or they don’t care. This is not a view I personally would endorse but I see it in practice, quite successfully.

(From perspective of ‘others’) Don’t judge people with what happens to them. It is hardly any evidence for what they are and what they deserve. Don’t judge God based on what his people say. We thank him and blame him indiscriminately.

Posted in christian, indian society, marriage, philosophy, prayer, religion, spiritual | 5 Comments »

Religion,Depression and Suicide:an Observation

Posted by Dheeraj Kattula on July 26, 2009

Kandhamal district of Orissa is stunningly beautiful. In the peak of winter there is a place here where it snows. It is surrounded by mountains and is covered with thick forests. The air is pleasantly cold. The canvas of it’s beauty was marred by violence that struck its heart in August 2008.You may read about what happened here.

It is sad that I have not seen Kandhamal in its best of times. I have been there on two occasions.Once it was as a Medical Officer from Red Cross to look into health issues in Nuagam Relief Camp in November 2008. Recently I went with a team of other doctors and conducted camps in four different sites in the district.

A carpenter looks for nails everywhere. I, a novice carpenter of the mind looked for stress related mental disorders. I expected to see PTSD, Severe Depression, Anxiety disorders, Insomnias, complicated grief and suicidal ideation. What else do we expect in a group of people who have lost all their assets and have no clue what the future had in store for them?

I was wrong.I did not find even one PTSD case in about 1000 consultations that I had in the Relief Camp. Of course people were concerned about their future and were sad about the persecution they faced,but they had enormous faith in their God,who they felt allows suffering but is in control. I found that they had tent prayers everyday.

Situations have changed. The situation now is not at all as bloody as it had been. There may be tensions. There may be animosity, but the situation is now in control.The Governments are trying their best. In this state of peace, I recently went to Kandhamal again.

In this visit I  saw about 250-300 patients. I did find people with depression. I found a couple of them quite severely depressed. When we mental health workers probe about very personal thoughts and behaviors, we usually ask open ended broad questions and slowly zero-into specific areas.

In case of depression,we usually enquire if the patient feels himself to be useless & worthless, then ask if he feels lonely and helpless, then ask if he thinks that things are going to improve in future. If he says yes to these then we tell him,”when life feels so difficult many people feel it is better to die,have you ever felt like that?” If patient says yes, then we ask regarding suicidal intent,which will have a bearing on how we would manage the patient by asking ” Have you ever felt like killing yourself?”

I have seen a many people in Tamil Nadu, easily consider the thought of killing themselves when overwhelmed with stress. In a study in Vellore,the average annual suicide rate was 95 per 100 000 for the years 1994-99. The rates in adolescent males and females and those over 55 years were 148, 58 and 189 per 100 000 respectively.(The British Journal of Psychiatry (2006) 188: 86.)

In Kandhamal I had a shock.I did not find even one person consider suicide despite overwhelming adverse life events and financial distress.Individual cases were depressed clinically, but they were not feeling ‘hopeless’.Many reflected their view to be like,”Yes I feel bad.I have nothing left.I do not know what I will happen tomorrow.I wish to go back to my village to start a new life.I hope they allow me to start again.I feel sad,but I know God is there.He has helped us till now.If it were not him,I would not be here today.He will continue to take care of me and my family.Why would I kill myself and hurt God?Things will improve.We are praying.”

The pattern forced me to think if indeed religion and faith protected people from suicide and mental illness in general. Why is it that I did not find a single case of PTSD in a relief camp after a spate of bloody violence?What makes them stronger than American war veterans from Vietnam!!?

Harold G Koenig’s review in Candian Journal of Psychiatry 2009;54(5): 283–291  concludes stating that “In general, studies of subjects in different settings (such as medical, psychiatric, and the general population), from different ethnic backgrounds (such as Caucasian, African American, Hispanic, and Native American), in different age groups (young, middle-aged, and elderly), and in different locations (such as the United States and Canada, Europe, and countries in the East) find that religious involvement is related to better coping with stress and less depression, suicide, anxiety, and substance abuse.”

Considering suicidality in specific, an article in Journal of Affective Disorders reports that its results suggest that religious attendance is associated with decreased suicide attempts in the general population and in those with a mental illness independent of the effects of social supports.

Indeed, research validates my observation that religion does help in coping stress and prevent mental illness and decrease suicidality.

References:

1.In the name of God.

(http://www.tehelka.comstory_main40.asp?filename=Ne130908CoverStory.asp)

2. Manoranjitham et al.Suicide in India.

(http://bjp.rcpsych.org/cgi/content/full/188/1/86)

3.Harold G.Koenig.Research on Religion, Spirituality, and Mental Health:
A Review

(http://publications.cpa-apc.org/media.php?mid=793&xwm=true)

4.Daniel T.Rasic et al.Spirituality,religion and suicidal behaviour in a nationally representative sample.

(http://www.jad-journal.com/article/S0165-0327(08)00344-3/abstract)

Posted in anxiety, depression, distress, grief, mood disorders, philosophy, psychiatry, religion, spiritual, substance abuse, suicide, Uncategorized | 3 Comments »

Success Associated with Self is CAUSED: Failure Associated with Self is ONLY an Association

Posted by Dheeraj Kattula on June 6, 2009

He walked into the hospital with his sister and a friend, the other day. He had headache and fever for the past two weeks. His fever came and went at regular intervals. Everyone knew it could be malaria. Yes, it was. The blood tests showed he was positive for the malaria germ Plasmodium falciparum. His severe headache indicated this being the ominous cerebral (brain) malaria.

We gave him Injection Artesenuate, the nuke of anti-malarial arsenal. We also attacked the germs with other missiles Chloroquine, Sulphadiazine, Pyrimethamine. He should have improved in a day. He worsened. His fever disappeared but he was drowsy and had decreased activity.

We wanted to see if he had other germs affecting his brain. To test that we usually put a needle into a patient’s back ( lumbar puncture) and drain some fluid which bathes the brain. Before we do that we had to rule out increased pressure in his skull (Intra-Cranial Tension). If one does this procedure in a person with increased pressure in the skull, one could precipitate immediate death.

We had to dilate his pupils and look deep into his eyes. I found something different. The picture in both eyes was little different. It reminded me of a rare syndrome called Foster Kennedy Syndrome, which I had read about in 2001 and remembered only because of my penchant for rare syndromes. A wise medical goes like this- If you diagnose a rare disease you would be rarely correct. I still like to study what is rare because, if we do not study what is rare, it becomes rarer still.

We sought opinion of a good ophthalmologist. What we had written “ Left eye- ? Papilledema . Right eye – ? optic atrophy”, her findings were “ Left eye-?? Papilledema. Right eye -?? optic atrophy”. At least we were in right track. A CT scan of Brain needed to be done to confirm findings and ruling out a tumour in the brain. Fosner Kennedy Syndrome occurs in tumours of front part of the brain (frontal lobe).

We explained the relatives that the patient probably has a serious brain disease in addition to having malaria. The treatment for malaria was already on. The required CT scan of Brain could be done in the morning of next day. Till then we could not do anything. He was not well enough to be moved 250 km away where radiological, neurosurgical and expert medical services were available. They could not afford these either.

We gave the option of going to a Government Hospital at the District Head-Quarters (DHQH) where the CT could be done the next day. The relatives wanted to go the next day for investigation but wanted to continue treatment in our place. As the day progressed, his level of consciousness came down. At night the relatives asked us if we could guarantee that he would survive the night. We said that we could not guarantee that. Then they told us that they wanted to go to DHQH. We had to discharge him, knowing very well that nothing could be done there at such a time. The doctors there are over-worked and nursing department is understaffed to even deliver normal care.

Next day, in the evening my colleague and I decided visit him at DHQH. I wanted to check if our diagnosis was correct (a competence issue ) and he wanted to know if the patient is doing fine ( compassion issue ). After a search in various medical wards, we found a nurse and asked about him.

She said “Oh, that man, who was admitted in the Mission Hospital. He died today morning. We could not do anything. They referred him so late. What can we do? Many private hospitals refer patients who would die anyway, but they do not keep any patient till the last hour.”

She thought we were relatives, so she was thinking aloud. It was a blow to us. She felt we ‘did not know’ (competence)  and ‘we did not care’( compassion). We did not give any defense. She is not going to understand the medical issues. She had also made up her mind on our attitude. A single conversation is not going to change her views. So an apologia is a waste of time. We walked out slowly.

Saddened- for different reasons. My friend was sad as the patient who had walked in to the hospital died in two days, having worsened during treatment. I was sad that, after having picked a probable right rare diagnosis and having explained things to relatives they had reflected wrong views to others. Where had we gone wrong?

My friend said, “Patient was fine when he came in. He was started on treatment. The natural course of illness may have overtaken the treatments. They do not know that. His admission followed by his treatment is associated with his worsening condition. They would definitely attribute his death to treatment and not a hidden disease.”

We always enjoy the joy of patients’ improvement, attributing the cause to our treatments but we find it so difficult to digest when someone wrongly attributes bad outcomes to our treatment.

Isn’t it?

Posted in challenge, distress, Neurology, philosophy | 4 Comments »

Being caught on one side of the ‘cut-off’

Posted by Dheeraj Kattula on May 26, 2009

Have you wondered how marks of an exam are distributed? Normal Curve? Skewed to right? or left? Ok. All answers are accepted. But wait…

Who are the ones who fail? The ones below a “cut off” point.

If the examiner feels only 50 % of the people should pass, the median would be the ‘cut off’ point. At different cut off points the percentage of people who pass and fail differs.

In Life, aren’t cut off points arbitrary? How is the person just above the cut-off better than the one just below it? Let us leave this for the moment and consider a cut-off point such that 40 students of a class of 100 students failed an exam as they got less than 30 marks.

Good news is that the school has ‘supplementary exams’. The exam can be taken again in 2 weeks time and people are given a chance to move on or they would have to repeat the course.

Hey!!! A naughty fellow is taking them for a 10 day trek into the woods. What do you think would happen, if this bunch of 40 students NEVER touched the book in 2 weeks and re-appear for the exam? Would all of them fail again? Remember, they were ‘failures’ in the first place and they wasted the time they got by enjoying themselves. They all ought to fail. Right?

Nope!!! Many of them passed. 35 of them! Only 5 failed again. How is that????

Let us confess that our performance is not stable at all times. We have our peaks and dips. In any exam the bright ones, whose dip would always be higher than the cut-off would always clear. Many average ones, when caught in the peak manage to clear the cut-off and when caught in the dip fail to do so.

Few of the ones who fail to do so, if given another chance through a supplementary exam would clear the cut-off. This happens by pure chance. It need not be due to preparation. If all 100 had re-written the exam may be a different set of 40 would have failed. The ones, who fail repeatedly, show that their preparation was inadequate that even in their peak moments they are not clearing the cut off.

Now if you have failed in your life. Don’t worry. Chance had caught you on the wrong side. There are many on the other side, who aren’t significantly different from you. They are there by chance alone. You will get to that side in a short-time with more trials. Don’t worry. Be patient.

If you have failed repeatedly, friend…you have to work harder. Your peak should go higher.

If you have passed this time and you think you are lucky, thank God. He is the one who made uncertainty a certainty. He favored you blindly as you played dice this time.

If you always pass, thank God again. You are too favored, my friend. You are on the extreme of normal curve of capability. You are here not by chance; you were designed to be here. Also be careful. Life is like a tennis match with many sets and many games. As you play more games, you will encounter dips…you might get caught below the cut off at one point. There is never a case when you need not be thankful and never a case when you need to give up.

Posted in challenge, philosophy, spiritual, statistics | 7 Comments »

“Lies, Damned Lies and Statistics”

Posted by Dheeraj Kattula on May 22, 2009

Warning:

If you cannot stand a bit of statistics/maths or dry humor please stop here. If you do not mind that then, please read the disclaimer.

Disclaimer:

The following research is purely fiction. The quotes are original. The author of the post believes there is some ‘truth’ in these quotes.

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Benjamin Disraeli, the British politician said There are three kinds of lies: DisraeliLies, Damned Lies and Statistics.

It is interesting to know how one comes to such a conclusion. First collect data. Without data you cannot conclude any thing. Here you collect all statements which are ‘lies’. Lies- being defined as that which does not correspond to truth. Truth- being defined as that which corresponds to reality. ‘Lies’ are categories. Also define a continuous variable called ‘distance from truth’. So each lie is distant from truth by some degree.

A huge sample of ‘lies’ is collected. And the distance from truth is noted for each lie. The frequency distribution at each distance is seen.

Hey! You do not get a normal curve (with a single peak at the mean) in this as you get for most distributions. This is a trimodal curve. There are three peaks!!!

On analysis it was found that the ones with low distance from truth were uttered mostly by common people in the sample. These are Disraeli’s ‘lies’. The ones whose distance from truth was farther were mainly politicians. Their utterances were the ‘Damned Lies’.

The ones who were farthest from the truth were researchers, scientists and officials whose lies were officially ‘statistics’.

This is not to say that the scientific community has always got it wrong. It is just to remind ourselves that we have to be humble in science. We could be the ones farthest from truth if we ‘seek’ to find our pet conclusions. Let us remember the Nobel Laureate Ronald Coase’s adage “ If we torture data long enough, it will confess.

Posted in philosophy, science, statistics | 2 Comments »