Shrink's Views

ramblings of an unknown psychiatrist

Archive for the ‘psychiatry’ Category

The Spy Who Knew Himself : a story

Posted by Dheeraj Kattula on May 18, 2012

They were those times when terror occupied the consciousness of common men. Even though the fringe elements were successful in creating mayhem, fear psychosis lasted only a short while. Life just goes on for a common man, till death comes knocking at his door. It is a privileged few who fight for causes higher than themselves. I believed that I was one such person. So I sharpened my awareness of what was going on around me. I was still a student of Electronic Engineering.

I received a message, if I would like to cooperate with the CIA as an agent. I took time and then agreed. I had to leave my home without informing my parents or my brothers. It was a secret assignment. I went to Mumbai and kept track of the movement of Taxi’s in Mumbai Central station. I learnt to communicate in a specific code. I dropped the messages in the waste paper bin near the railway reservation counter. Other agents would pick them up from there. I did my job well. They could verify the information that I was sending was true. However they can never know what is in my heart. I was serving my own national interest.

I never got paid for my services from the CIA. Occasionally they sent agents to give me messages through food packet covers. They would give me these as leftover food. The food was a bonus in those cases. I was pretty busy with my tasks at hand. I sometimes didn’t shave for weeks and understandably many mistook me for a beggar. The cops never asked me for a platform ticket. They probably knew I was a double agent. They just let me do my job. I occasionally napped in the platform itself.

Few years into the job, I realized Indian scientists perfected the BINTAAR technology, a wireless technology with which they could read my thoughts. They could know the messages I was sending the other agency. It was then that I started feeding misinformation to my primary recruiters. After all they were not doing the job they were to. There was enough knowledge in open space to know the origin of terror in the region, but they were not acting. I thought it is better to let the company waste resources by chasing some of my misinformation. I had to do this in right mix. Everyone knows that a complete liar is easily found.

I realized that even the Indian intelligence agency was not right in its intent. Some of the agents who were supposed to pass me cigarette butts would grimace looking at me. I noticed them chat about me and even make fun of me. There wasn’t a need for that. I was doing field work and was not under cover like them. They ought to have treated me with respect. I know I should not personalize issues and jeopardize national interest. I informed my handlers through BINTAAR that I was not interested in Mumbai anymore and would rather work somewhere where stress would be lighter. I wanted a break from work. I was working 24 x 7 x 12 for 10 long years. I did not want to be disturbed by any agents.

I took a train to southern part of India. I just hopped and changed trains so as to not leave a track. I posed as a beggar in town in Tamil Nadu. I lived on a street and people helped me with food. I was at times irritated with few agents moving around. I sometimes lost my cool and shouted at them. I was once approached by a nice looking guy. He offered me food. He called me to his office which he said was nearby. He walked with me at my pace. He had a genuine smile. I wondered if Intelligence agencies were recruiting psychology majors for their debriefing work. If they were doing so, it was a good thing. I was quite stressed. He made a ‘free chart’ and offered me to stay in a home in a nearby town. I agreed. Few men came in an hour’s time and took me to a home for homeless people. I qualified for it as I did not have a proper home. In a larger sense India is my home and I was free to be anywhere. They gave me medicines to help me. They also did some blood tests and found them to be normal. The detailed procedures they went through, I thought they were trying to size up a double agent. You could never trust a betrayer, no matter if he has betrayed others for you. I was in no mood to protest or even think deeply for my conscience was clear.

In a couple of days the guy who saw me came along with his seniors to our home. They were all very excited to see me. It was after a long time that I saw someone happy seeing me. They asked me about a variety of things and then finally asked me about if I had a family. I always knew about my family but it was sort of in the background. This break from work, living with a community of homeless people reminded me of the joy of family. There is nothing like the own family.

I had made our telephone number into a musical mnemonic. I rattled the number out. They made a phone call. Apparently my family left the village, but had given their new contact details. In couple of phone calls my family was traced. They came in a week’s time to the homeless home. My mother was bent with age but she mustered enough energy to come all the way. I was surprised to see how much my brothers had grown up. They told me that my father had died two years ago. It was his last wish that my brothers never give up looking for me. I bid good bye to my new friends. Before we left for our home, I visited the office of guy who debriefed me. He was in fact a psychiatrist. He wrote a letter to a local psychiatrist to follow up my care.

I have been following up locally in my town for five years now. I take an injection once in two weeks and a couple of pills. I have no interference from any intelligence agents these days. They have disconnected me from BINTAAR. I live with my brothers. I help my eldest brother in his mobile shop. I have done a course to deal with mobile repairs. I am now in mid thirties. My family wants me to get married. I feel shy but I too long to have a family of my own. I would reveal the fact that I need to take these medications for a long time before I marry anyone. One who would accept me as I am, deserves my love and commitment for life. Now I too live the life of a common man, enjoying life till death comes knocking at the door.

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This is a fictitious story of a homeless mentally ill person. References to people and agencies were coincidental.However the story is inspired by the work of CMC Vellore’s Department of Psychiatry Unit III ‘s work along with an NGO Uthavum Ullangal in caring for the homeless mentally ill.

This patient is a case of Paranoid Schizophrenia. He was a homeless mentally ill person living around the Mumbai Central Railway station. He had no links with any spy agency. It was a grandiose belief that he held. He later developed persecutory and referential delusions. He had ‘thought broadcasting’ phenomena. He also used neologism called BINTAAR meaning ‘without wire’ to explain his experience. He developed partial insight especially regarding the need for treatment. He recovered well with medical management and family support.

Mental illness is treatable. Homeless people can be reunited with their families with some effort.

Posted in challenge, fiction, love, psychiatry, schizophrenia, stigma | Tagged: , , , , , , | 6 Comments »

Marital Conflict: an abstract painting

Posted by Dheeraj Kattula on December 2, 2011

Marital Conflict

Title: Marital conflict

Watercolor on handmade paper

24 x 32 cm

2.12.2011

Realistic art is technically challenging and abstract art is ‘technically challenged’, so I thought and refrained from abstract art till now. Art need not be technically complex and simplicity may not be meaningless.This painting has taken a lot of thought and very less time.I call it ‘Marital Conflict’.

Any marriage is attacked by strong emotions and deep passions as represented by the red. It can be shielded by patience, serenity and wisdom as represented by the cool blue. In that love lives on, represented by the form of heart. There is peace, represented by white.In that context partners experience growth, as represented by green. Due to stressors, personality factors and rarely mental disorder this buffer is lost. Peace is found in separation as seen in the inverted funnel.Partners may grow but not to the level they together could as shown by the sizes of green blots.The blue drops above offer hope that outside forces can increase the buffer to protect love, peace and growth through social support,therapy and God’s enabling.

 

Posted in art, love, marriage, personality, psychiatry, psychotherapy | 2 Comments »

Psychiatrist as a Prostitute

Posted by Dheeraj Kattula on August 1, 2011

A very admirable teacher of mine said, “Psychiatrists are emotional prostitutes. They make the client have a ‘good feeling’ and get paid for giving that experience.” It might sound very crass, but there is some truth to it.

A good psychiatrist maintains boundaries in his therapeutic relationship, so as to prevent hurt and damage to the client and the therapist herself. Is it not like a wise prostitute would want a barrier to prevent transmission of diseases?

A psychiatrist would do everything to avoid being physically involved with the patient. It goes against her professional interest. Would not a prostitute be afraid of being emotionally involved with her clients? Emotional involvement for a sex worker could mean free sex with the one involved, which is bad business!

Both need contacts to earn referrals. They manage the bulk of clients with social skills more than technical skills. However to retain top class clients technical expertise is a prerequisite.

Many end up in prostitution without their choice. It may be a good finding if psychiatrists chose their profession. Interestingly there is something that makes a psychiatrist worse than a prostitute. A prostitute sells her body to serve her client but many psychiatrists sell their soul to pharmaceutical companies without the knowledge of their clients.

Sadly both prostitutes and psychiatrists get stigmatized in society. Society wrongly thinks they are preoccupied with sex when they are actually preoccupied with their business!

Intentionally the gender of the psychiatrist used here is female so as to not let men appear intellectual as psychiatrists and women appear weak as prostitutes.

Posted in gender, psychiatry, social, stigma | 22 Comments »

Important Content: a story

Posted by Dheeraj Kattula on June 12, 2011

“Don’t irritate me, even a bit more mama”, Shravan Iyer said rushing into his room. He closed the door behind his back and muttered to himself “I am sick of these females”. He lay in his bed, pillows covering his ears. The soft Carnatic music that his mother was playing in the dining room could not be heard in his room.

About a hundred kilometres away was the Azad family, a high class business family which was English speaking but had retained its traditions. They had been having trouble controlling Salma, since her teen years. Her behavioural problems never ceased even after visits to many dargas. Many holy men tried to get the ‘Jinn effect’ out of her, but all was in vain.

Sandeep went to Shravan’s room to get his ipod as he prepared to go for his evening jog. When he went in he smiled at his brother, who was in no mood for any humour. Shravan was pacing in his room, running his hand through his hair, turning to and fro, clenching his teeth and kept muttering to himself. Sandeep asked if he needed something. Shravan denied wanting anything. Just as Sandeep left the room, there was a loud noise. There was a shout “Stop it, you bitch”. Shravan had broken the desktop computer in his room with his Cricket bat.

After a lot of shopping for a magical remedy Azad’s wanted to try out medical help, after a cousin told them that Salma could be mentally ill. “I AM NOT MAD.YOU ALL ARE….”,Salma shrieked. Her neighbourhood knew her shriek. It was because the Azads had done a lot of philanthropy in the neighbourhood for two generations that people put up with the drama of their home. Otherwise it was a pain to be woken up by Salma’s shouts.

Sandeep and his mother came running into Shravan’s room. It was not acceptable to destroy a computer. It was OK if he punched or threw pillows at the wall to let his frustration. They had been thinking that he probably had a ‘love failure’. They had been very tolerant of him to get over it, but things had only been getting worse. He stopped going to work for the past two months and had been increasingly preoccupied. They had been encouraging him all the while fearing that he might harm himself, but that day’s aggression was clearly beyond the limits.

Salma was taken to a psychiatric facility. The doctors could not conclude about her illness. They wanted to clarify her diagnosis by observing her in the ward. After all her only behavioural problems were a bit of adamancy and problematic shouting to get her way through.

Shravan was evaluated in the same hospital. It was found that he had been having auditory hallucinations. The psychiatrist just asked him if the voices spoke to him or spoke among themselves regarding him or gave a running commentary on his actions. He replied that the voice abused him. The psychiatrist moved on to assess other areas in his mental status. He recorded second person auditory hallucinations in the medical records. He was admitted into the facility due to risk for property.

Salma was admitted in the same facility in room no 3. Her family had requested for room no 10, which was the last room in the corridor. It would give them some more privacy and that Salma would not be a disturbance either. The doctor insisted that treatment in all rooms would be the same and did not change her room. He wanted to avoid few extra steps he might have to make during rounds.

Salma shrieked that night in the corridor. Shravan realized that the one who had been tormenting him was near. He had been hearing a similar voice shouting at him and abusing him all this while. Salma looked at him and was shocked. His thin built, fair complexion and brown eyes reminded her of the school teacher, who abused her when she was 12 years old. She shouted even more.

Shravan could hold himself no longer. He charged towards her and caught her neck with his hands. She fell backwards and opened her room door and fell on the table. In her agitation she got a knife which was on the fruit tray. She picked it and drove it into her assaulter’s abdomen. He bent on himself. There was a gush of blood. Salma fainted.

Shravan was operated upon and he survived. The knife had nicked the spleen. It had to be removed to save his life. Iyer family did not want to pursue the legal case. Azads paid a good amount to the police and saw that FIR was not filed.

The psychiatrist was clueless about what had happened. Was he wrong in where he placed them as inpatients? He was convinced that he was following the diagnostic manuals. He had picked the phenomenology right. He was right in the diagnosis. He was following treatment guidelines and he was right in the drug treatment.

What he did not realize is that diagnosis depends on the ‘form’ of psychopathology but risks are due to the ‘content’ of the psychopathology. In his management, he should consider content as seriously as form.

Shravan and Salma continued their treatment in the facility and did well.

Dargas- A Sufi shrine built over a grave of religious figure usually frequented by Muslims.

Jinn effect- Effect of Demons

Posted in Diagnosis, fiction, medicine, psychiatry, schizophrenia | 4 Comments »

Bollywood, Brothel and Being Born Again: a story

Posted by Dheeraj Kattula on September 25, 2010

This is a sequel to the story ‘A Dirty Job’ that I had written a couple of weeks ago. You can read it by clicking this.

It was the story of a girl who had very traumatic childhood. She landed in a brothel at an early age. She was rescued from there. She was given therapy to overcome her problems. She was also trained to live a decent life. She chased a dream to dance on film sets after she gained majority. She ended up having an affair and mothered a girl child. Hunger and desperation pushed her to the streets to solicit men.

The story was harshly realistic, reflecting lives of scores of women who land in brothels having chased a Bollywood dream. Is life over for them or is there any other way? Please read on…This story reflects a hope that I believe in.

Bollywood, Brothel and Being Born Again

Bollywood dream is over. I was not getting chances as expected. I made a new choice- to do the dirty job. I had detested it. I always had maintained that I would never do it. I was warned of this by few people. I wonder how they saw this possibility. I do not even want to think about where I went wrong. I always had prided in living in the present. No one knows what the future holds and no one can change the past. So why bother about these things which are not in one’s control. This is how I always thought. The doctor I had met used to advise me of being mindful, but my mind was full of ‘never mind’ philosophy. I think when one crosses boundaries and chooses to go far away from the previously set boundaries; it becomes easier as one moves along.

Having slept with a man once again to satisfy my hunger pangs, I was willing to continue this to sustain myself and my child decently. I went to Kamathipura and joined a brothel. I was given a small room. There were four others with me sharing the room. There were times when two of us were servicing our clients with only a cloth separating us. In the beginning I was a bit disturbed when I used to hear my daughter cry when I was engaged at work. I could see her through the diaphanous cloth which was to shield my shame. I have since gotten used to it. It is all right for a child to cry once in a while, especially if the tummy is getting filled thrice in a day.

I do not know why, but many of my clients come back to me for more. I had a record for this in our brothel. Mohammad Altaf was a local goonda who used to come for me frequently. He looked terrifying. He always carried his revolver with him. Another such regular client was Inspector Chogle. Chogle used to even bring biscuits and milk for my kid. Chogle had apparently recommended one of his bosses an IPS officer Mr Tripathi. He too came regularly. My status in brothel increased. I was given some freedom of movement. Moreover, I was voluntary here. Other girls who were trafficked from Nepal and Andhra had no contact with outside world except the clients.

One day Chogle came and told me to dress well for an outside engagement. He took me in a taxi to Bombay Orchid Hotel. He told me that it was one of the best hotels in India. The hotel looked astounding. He took me to a room more luxurious than the hotel. It did not require me to be an intelligence officer to know that I might have to service a big-shot.

I was shocked to see him. He was a minister. Everyone in the country knew him. Xavier Francis was his name. I had seen him debate on TV on issues of women like rights, dignity and self- reliance. He always wears Khadhi and speaks desi stuff. This is his real face- sleeping with young women in star hotels. After the job was done, he threw two bundles of Rs 100/- notes. I had earned Rs 20,000/- in one hour! I was thrilled. Suddenly he asked me to return the money. As I was giving him back, he tore few pages from a book that was placed near the table lamp. He wrapped the money in those papers. He then secured them with my rubber hair bands that I had left on the table and gave back the money to me with a smile. I liked his gesture.

When I went back to my brothel, I unwrapped the covers to take the money out. I was about to throw the papers, I thought I could as well read them. It was long since I read something in English. I might forget it fully if I did not read on and off. One sheet was the first page of a book. It had a seal stating ‘placed by Gideons International’. The other sheet had a story.

It went like this,

“But Jesus went to the Mount of Olives. At dawn he appeared again in the temple courts, where all the people gathered around him, and he sat down to teach them. The teachers of the law and the Pharisees brought in a woman caught in adultery. They made her stand before the group and said to Jesus, “Teacher, this woman was caught in the act of adultery. In the Law Moses commanded us to stone such women. Now what do you say?” They were using this question as a trap, in order to have a basis for accusing him.

But Jesus bent down and started to write on the ground with his finger. When they kept on questioning him, he straightened up and said to them, “If any one of you is without sin, let him be the first to throw a stone at her.” Again he stooped down and wrote on the ground.

At this, those who heard began to go away one at a time, the older ones first, until only Jesus was left, with the woman still standing there. Jesus straightened up and asked her, “Woman, where are they? Has no one condemned you?”

“No one, sir,” she said. “Then neither do I condemn you,” Jesus declared. “Go now and leave your life of sin.””

I got shocked. There were many things that I did not understand in the story like what are olives, who was Moses, what is this trap thing for this man Jesus etc but I did understand one thing. I am like that woman. I could be caught by police and tried according to the law. This would not happen as people like Chogle sleep with me. This man Jesus was different. He could have condemned that woman but he did not do that. He did not use this position in any other way too. He just told her to go and leave the life of sin. “Go now and leave your life of sin”- that statement rang in my ears for few minutes. I was so lost in these thoughts that I did not even notice that brothel keeper and my co-workers came and took away my money.

When I came to senses, I did not even feel the loss of money. I was awakened. Something was new in me. May be like a sapling. It was alive and growing. I was beginning to see things a bit differently. I do not know how to explain this. I could no longer enjoy the services I rendered. I was lost in some other world. My regulars also noticed a difference. Many of them asked me if I was not well. In fact I was feeling more than well. I realized that there is a thirst in me that needed to be quenched.

A few days later I was on my way to a beauty parlour. I was on an over-bridge near railway tracks. A drunkard walking with a cup of tea on the bridge spilt some tea on my shoe. I looked around for some waste paper. I saw an old man stand in a corner of the over-bridge giving away some booklets. I took one and tore a sheet from it to wipe my shoes and threw the rest of the booklet away.  Just as I was about to throw the sheet off, I realized I could read some English like I did on and off.

The passage went like this:

“Now he had to go through Samaria. So he came to a town in Samaria called Sychar, near the plot of ground Jacob had given to his son Joseph. Jacob’s well was there, and Jesus, tired as he was from the journey, sat down by the well. It was about the sixth hour.

When a Samaritan woman came to draw water, Jesus said to her, “Will you give me a drink?” (His disciples had gone into the town to buy food.)

The Samaritan woman said to him, “You are a Jew and I am a Samaritan woman. How can you ask me for a drink?” (For Jews do not associate with Samaritans.)

Jesus answered her, “If you knew the gift of God and who it is that asks you for a drink, you would have asked him and he would have given you living water.”

“Sir,” the woman said, “you have nothing to draw with and the well is deep. Where can you get this living water? Are you greater than our father Jacob, who gave us the well and drank from it himself, as did also his sons and his flocks and herds?”

Jesus answered, “Everyone who drinks this water will be thirsty again, but whoever drinks the water I give him will never thirst. Indeed, the water I give him will become in him a spring of water welling up to eternal life.”

The woman said to him, “Sir, give me this water so that I won’t get thirsty and have to keep coming here to draw water.”

He told her, “Go, call your husband and come back.”

“I have no husband,” she replied.

Jesus said to her, “You are right when you say you have no husband. The fact is, you have had five husbands, and the man you now have is not your husband. What you have just said is quite true.”

“Sir,” the woman said, “I can see that you are a prophet. Our fathers worshiped on this mountain, but you Jews claim that the place where we must worship is in Jerusalem.”

Jesus declared, “Believe me, woman, a time is coming when you will worship the Father neither on this mountain nor in Jerusalem. You Samaritans worship what you do not know; we worship what we do know, for salvation is from the Jews. Yet a time is coming and has now come when the true worshipers will worship the Father in spirit and truth, for they are the kind of worshipers the Father seeks. God is spirit, and his worshipers must worship in spirit and in truth.”

The woman said, “I know that Messiah” (called Christ) “is coming. When he comes, he will explain everything to us.”

Then Jesus declared, “I who speak to you am he.”

I got excited as I read this. This is the same man Jesus. I had difficulties in understanding everything. Of course I was reading a passage out of a story book and I cannot get an understanding reading a small portion. I asked the man distributing for another copy. He gave piercing looks and looked at the booklet I had thrown away. It had landed open and face down on the railway tracks. I knew what I had to do. I ran as fast as I could and got there before a train came and destroyed it. I sat in the platform and read through this booklet. It was called ‘Gospel of John’. It was about Jesus. It says a lot of things about love.

It said that “God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life. For God did not send his Son into the world to condemn the world, but to save the world through him.”  It also said, “Light has come into the world, but men loved darkness instead of light because their deeds were evil. Everyone who does evil hates the light, and will not come into the light for fear that his deeds will be exposed. But whoever lives by the truth comes into the light, so that it may be seen plainly that what he has done has been done through God.”

What I had read earlier was also in this booklet. I realized that I was living in dark. In reality brothels are dark places. Many of our clients want their visits to Kamathipura to be kept in dark. I was living in dark and I was doing evil. Do I have a choice? Can I make a living for my child and me in a way that is not evil? Even if it were to be possible, was I willing to come into the light?

I realized that if I could do it, it would mean plainly that I have done this through God. I prayed to God to help me know the right thing and do the right thing. I went back to my brothel. Life was never the same. I could not enjoy my work at all. It was seen by my clients and soon my brothel keeper would know it. I could fake being happy, but I could not bring myself to do it. There was a discomfort welling within me about being untruthful. I could not even fake it for my survival. I was happy acting in line with my feelings.

I decided I must leave this brothel and this life style. I can work as a maid servant and life a truthful life. I should not let my daughter enter this dirty world if I really love her. Usually the brothel keeper never lets me out with my daughter alone. I had to find the right reason to take her out. That very week Chogle gave two passes for an amusement park nearby. One was for an adult and one was for a child. I had the right reason to go with my daughter and no one else would be with us.

Where would I go with my kid in Mumbai? Whom could I trust? I just wondered. I remembered that things are possible with God. I phoned Mohammad Altaf from a phone booth. I knew Altaf was a goonda and was a ‘bad guy’. Anyway, I decided to trust him, as he was on the wrong side of the law and was faithful to people on the wrong side. Chogle, Tripathi, Xavier etc appear to be on the right side of the law and are unfaithful to the ones on their own side.

Altaf came in about 15 minutes. I told him, “Altaf, I want to leave this trade. I need money to leave this place. I know that you are a tough guy, but I also know you are a good guy. So I have trusted you. Please help me. I want to do the right thing.”

“Laila. Come let us go to ATM…How much do you want?” he asked. “How much ever you can offer”, I answered. He gave me Rs 10,000/- and said, “Leave Mumbai. It is not safe here. They will be able to get to you. Wait for a minute… I will buy you a burqa from the shop near the mosque. You can cover your face.”

He came within five minutes and gave me a burqua. He told me to go behind the pan shop to wear it. In the meantime he took my daughter behind a barber’s shop and cut off the hair of my daughter and dressed her up like a boy. I was so happy for his resourcefulness. We had a chance to escape in nice disguise. As we were about to leave, he got emotional, “Laila, I wish I was a good guy. I would have given you a new life. My life has no future and so I can never commit. I would always love you.”

I always had this intuition that Altaf was a good guy at core but had life had built this tough shell around him. What else can you expect? His mother was also a worker like me, who died of HIV few years ago. He never knew who his father was. I was glad at least he realized there is something called love. I prayed that he too understands God’s love and power to change our lives.

I took a train to the place where I was treated as a teen-ager. I still remember the doctor who cared so much for me and gave me so much of advice. I hoped that he was still there. The hospital had not changed much. Extensions had been made in existing buildings. I went to the room where he used to meet me. I peeped in. He was there. His hairs have greyed a bit and he has put in few kilos of weight. His assistant wanted me to show the appointment card, which I did not have. All of a sudden the doctor came out, probably to grab a cup of tea in between few sessions. I called out for him. He took a couple of seconds, but he recognized me by my name. I was so happy. I was Laila, Lovely or Darling to many men according to their choice, but to the doctor I was, who I really was. He told me to wait till he finished his appointments. He asked me if I had eaten before he went in and resumed his work. I knew I reached a place which had some concern for me.

The wait felt very short. I told my whole story to him. He was not amused. He took it in as if he knew it all. He made some phone calls and then told his assistant to take me to the destitute home. He told me this was a short term arrangement till we could work out a long term plan. The home had 20 destitute women who were old and infirm. They had been deserted by their families. I enjoyed work in the home. Those ladies took good care of my daughter as well. I began to learn their language. There was a nurse who visited us twice in a week. She used to sing songs of Jesus at the beginning and at the end of her work. I shared with her my story. She got excited. She started praying with me for future of me and my child. I began to realize that this place was not my long term home. I wanted to move back to the brothels and help rescue many little girls and young women who are forced in to this trade.

I discussed this with the doctor. He bore the same expression he had when I had shared about wanting to be a dancer in Bollywood. He was true in believing that sparks should be kept far away from fuels. He thought it was intrinsically risky with the promise of earning powerful enemies. There was also the risk of me falling back into the trade. He encouraged me to stay at destitute home to help in the daily chores. He also encouraged me to complete my schooling.

I found a new love for books. They told me about how the world operated, a world created by God. This love made me learn with enthusiasm unlike the way I studied earlier. In a couple of years, I finished my XII standard. I even appeared for the Nursing School Admission test in the hospital where I had got treated. I got selected. My doctor and his friends supported me by paying my fees. They were also supporting my daughter’s school education.

In five years I completed my Nursing course and accumulated two years of experience. My daughter finished her VIII standard. It was an easy choice for me to wait for four more years till my daughter finished her XII standard and secured a seat in Nursing School. I continued to feel the pull to go and rescue girls who were caught in the dirt of flesh trade. I discussed with my doctor. He felt I was a mature woman now. He had developed links with NGOs who are trying to rescue girls and women who were trafficked. He said he would put me in touch with one of those NGOs. I put my daughter in hostel attached to our destitute home. My daughter knew the importance of my work. She was glad to release me. There was a mobile in the home. I could contact her anytime in the evenings.

In the first one month of my job, we were off on a raid. My job was to provide support to the rescued girls. We had social workers, volunteers and police in the raid team. The vehicle’s windows were covered. When the door opened and we alighted, it was like a déjà vu for me. The scent was familiar, the landscape, the building…everything. In fact it was not a déjà vu-It was all real. We had come to the place where it whole thing had begun for me about 20 years ago.

We rescued 15 girls that day. On our way back, I had tears in my eyes. I too had been rescued once, but I had fallen back. I needed a saviour. I knew these girls need a lot of love and a lot of grace to make this rescue meaningful. In our journey back, I prayed for each of these girls as they slept around me in the van. Maybe I lacked someone’s prayers and therefore I got back into the mess. I would not let that happen to these children. I have received love and it is time I share it.

Epilogue:

I became 50 years old few weeks ago. My daughter has become a nurse. She is a nursing tutor in the hospital that took care of us. Her husband is a Physiotherapist. They have a beautiful daughter Raksha.

I chose not to marry again though I had few proposals. I dedicated my life to a mission to rescue girls and I did not want any other engagement in my mind.

I have had my own share of problems too. I have been assaulted numerous times during the raids. I have had fractures a couple of times. Once I had a gunshot wound in my thigh and I lost a lot of blood. I was reminded of my saviours shed blood for me. Without sacrifice of some body, no good would come to this world.

I have been part of numerous rescue operations. Hundreds of girls have got rescued under my eyes. I do not know what has happened to each. I am sure there may be quite a few who have gotten back to the trade. I also know of numerous examples of those who get a new life after a rescue. I have seen them marry and establish homes and families. It is such stories which keep me moving forward. God has been faithful. He always gave me the needed strength. I would carry this on till my death. That is what I am called for.

******

Goonda- Ruffian/ Hooligan

Khadi- Indian fabric usually made employing rural populace

Desi-Refers to people, cultures and products of Indian subcontinent

Burqa- is an enveloping outer garment worn by women in some Islamic traditions to cover their bodies in public places which includes woman’s loose body-covering, head-covering and the face-veil.

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Love – Feeling, Reason and Choice: a story

Posted by Dheeraj Kattula on September 19, 2010

Background:

This is continuation of the story “Rights and Love”. If you have not read it, you could find it by clicking this. It was a story about a lawyer called James. His wife Agnes suffered with Schizophrenia. Under the influence of some delusions she attempted to murder him. He recovered and then took care of her. Despite all care she had not improved much. He continued to care for her despite the risk of harm that he could suffer. He surprised everyone with his love.

Love: feeling, reason and choice

It was nearly six months since Tab Clozapine was started. James reported that Agnes was doing well. She was not suspicious as before. She had started working again two weeks ago. She had put on some weight, but she got back the smile that she always had. As Agnes waited in the queue to get her medicines from the Pharmacy, James was called back by Dr Manas to the consultation room.

Dr Manas said “Mr James, I was glad to hear that Agnes is doing well. I wanted to tell you something. Do you have few minutes?” James was so happy that Agnes has improved so much. His eyes filled with tears as he said, “Of course doctor, you are always there for us. Please go ahead.”

“I have resigned my job here and I am moving to Kolkata. So I have transferred the care of Mrs Agnes to Dr Gurupreet Kaur. You have seen her during the in-patient stay. She is a fine doctor”, Dr Manas said as he looked away from James and stared into the empty sky through the window. He did not notice the crushed look on James’s face, as he nodded his head. James liked Dr Manas. He was a good doctor.

Suffering is not new to Dr Manas. He saw it every day. He was used to it. Despite his heroic efforts, his patients continue to succeed in suicidal attempts; they go off medications and relapse into full blown illness episodes. This was part of his life, but there was some suffering different about the case of Agnes and James that touched him.

“Mr James, I have seen many families with mental illness. They all care. If they did not care, the patients would not have been brought here or the family member would not have come here. I have seen people get beaten in episodes of rage. I have seen domestic violence exist in chronic form, but I have never seen one who had a brush with death because of an attempted homicide by a wife, care for his assaulter with so much of dedication and persistence. I admire you, Mr James. How do you do it? Is your marriage a love marriage?” Dr Manas inquired.

James smiled and replied, “I do not know if you could call it a love marriage. I guess you could. Agnes and I went to the same Church in Bangalore. Her parents had passed away in a road accident in her childhood. Her grandfather brought her up. He was a retired railway employee. They lived on his pension. He had multiple strokes and developed dementia. Agnes took good care of him. She used to bring him for the mass regularly. She was also active in the Sunday school.

I liked the way she behaved with children and elderly people. She was simple and had a simple lifestyle. I was interested in providing legal aid to poor people in Mumbai. I wanted to marry a girl who could fit in. I reasoned Agnes could be the right girl. I discussed this with the Church father. He was very happy. Agnes agreed to marry me. We got married after she finished her graduation. In the meantime her grandfather passed away. Then we moved to Mumbai.”

“Oh I see. Looks like you took a logical decision. Isn’t it?” Dr Manas asked.

James replied, “Yes sir. It was a 100% rational decision. I never had any flutter in my heart seeing Agnes nor did I miss sleep. In fact I have not had the feelings for Agnes that I once had for a girl…(smiles)

I had this feeling of being in love when I was in my 3rd year in the Law College. Permit me to leave her unnamed. She was the only daughter of a top criminal lawyer in Bangalore. She was obviously going to take over her father’s practice. Her father defends crimes done by politicians and their goons. She would have to do the same.

I desired a just society. If I married her, I would be aligning myself with enemies of truth and justice. I knew she was not the right girl for me.

Trust me; this knowledge did not help me lose feelings for her. I would get energized as if I had two cups of chai, if she were to just say a hello. I just cannot explain it. This ‘love’ seemed real, as I could feel it strongly. It lasted a year till she started going around with a minister’s son.” He smiled and added, “Thank God for that match! My emotions left. ”

“You said that you never had strong feelings for Agnes, but you seem to demonstrate love that I have not seen before. How is that?” Dr Manas asked inquisitively.

“Dr Manas, I have decided to love my wife Agnes. However she is, whatever she does, I will love her. I mean I would act in her interest. I might not have feelings like I had in college. I might not be as rational as when I had decided to marry Agnes. Love here is a choice I make.

In College years my feelings of love were not even in line with reason. They felt most real, but they were most deceptive. These feelings just evaporated. Imagine trusting those feelings and taking life decisions. My reason was stronger than my feeling when I decided to marry Agnes. If the situations did not change, reason would have been sufficient cause for a lasting marriage.

But things changed. You know it. I could have started a new life without her. Getting her out of prison and living with her in the same house with no one else, when she was still suspicious of me goes against sound reason. It was a choice I made to love Agnes that mattered. I thought in her interest. I had risk. I had fear. I faced it. It was ultimately a choice I made.”

“Mr James, I like the choice you made. I respect it. I appreciate it. In fact, you have inspired me to make such a choice. I normally don’t discuss my personal life with patients or their families, but I think you are different and I thought I could share this with you.

Let me first tell you that I hate Kolkata. I am a Bengali .I believe anyone who wants to work hard and grow cannot do so in Bengal. So, I always wanted to move out of Bengal.

I was involved in research which was being done in collaboration with the Indian Statistical Institute in Kolkata. I fell in love with a mathematician there. She was beautiful, brilliant and a Bengali. I had all reasons and all the feelings to get married. We married and were happy for few months. I then noticed that she was drawing closer and closer to her equations and was distancing herself from me. I do not suspect her for having an affair or any thing, but I felt she was not contributing to our relationship. I felt she was not valuing our relationship. Her equation was not an equality.

I got an opening here in Mumbai. I came here thinking that the distance would make her realize my absence and seek me. It did not work out. A couple of months ago I sent a divorce notice to her. Then I saw you. I saw what you were giving after having tasted what you had received. I knew this transcended reason and feelings. I thought I too should choose to love my wife.

Last month I called her and asked her forgiveness. I told her that though I hate Kolkata, I am willing to join her in Kolkata because I choose to love her. To my surprise, she wept. She felt sorry. She felt ashamed to call me and was desperately waiting for me to call. She too asked for my forgiveness as she had not been concerned for me.

She has requested a transfer to Indian Statistical Institute in Bangalore, with the idea that I can join NIMHANS. It is a matter of time that this would come through. I am glad I made the right choice. If I chose freedom as a right, we both would have lost. As I chose love, we both have gained.”

“I am so glad for you, sir. May God bless your marriage.” James blessed as a matter of fact.

Dr Manas held the hands of James and thanked him. Agnes came to the door after buying her medicines. They bid good bye to the doctor. Wiping his tears, the psychiatrist wondered when love as a choice is so beautiful and worthy, why we humans are so reluctant to choose it.

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Rights and Love: a story

Posted by Dheeraj Kattula on September 7, 2010

He was a tall man. Dark and young, his name was James. He came for a full cup Chai* five years ago. He never stopped coming. To him, Chai was like petrol. It kept his engine running. He made friends easily. He became friends with Rafique on the very first day. Rafique was here to buy his bundle of beedis. The minute James realized that Rafique has just discontinued studies; he spent an hour with him to get him back to school. He failed. Of course! Who can convince a thug in the making. I have been hearing Rafique’s mother Salma begging him to study properly for the past 10 years now. It was of no avail. Rafique played the fool throughout his school life. He was no different from most of the guys in Dharavi. Honestly, at his age I was like that too. I left my home in Allepy when I was younger than Rafique. My original name is Abdullah. People now call me Nair. When I came to Mumbai, I wanted to be a hero, a star.  Fate had its way. I became a chaiwala*. I work hard and earn my roti*. That is a decent life. Isn’t it? At least I did not do crime.

Even though Rafique did not take advice, he realized that James was his well wisher. He became his friend and partner in his work. James was like a student who was interested in finding out our problems. He wanted to know about our lives. He wanted to find how we decided what was right and what was wrong. He wanted to know what we did when we perceived injustice. Rafique helped him meet up people in the slum. James came twice a week and did his job. He never missed his full cup special chai in my shop.

In about a year, James started educating us about our rights. He told us about how the real system ought to work. We knew how it worked. The constable on beat was the symbol of all authority to us. Give him a free cup of chai, he would not bother you for the day. The other symbol of power we know is the neta*. His ilk come here before the elections and would never show up again. The bigger guys here keep in touch with the netas. James taught us that these fellows are there to serve us and not get served by us. He also told us about the court system. In fact, that year Police picked Zuber and locked him up. They had suspected him in some bomb-blast case. We knew Zuber as a hard working tailor. He was cool and liberal. He could have no such links. James came to our rescue. It was then that we came to know that he was a lawyer. It seems he had studied in one of the best law colleges in India. I heard it is in Banglore. To us he was like God. Zuber was back. We learnt we could fight.

He fought few other court cases for our slum people. One was a divorce of Janaki and Kadam. Kadam’s drinking was routine. He beat his Janaki black and blue. One night she fell on a doorpost and bled from her scalp. It required 4 stitches to control that bleeding. Next weekday was the day James usually came to our slum. He spoke to Janaki and other neighbors and reported to the police. Police laughed at the issue. They said domestic fights between husband and wife are normal and they should be sorted at home and not police station. With James around they anyway had to register the case. James tried counseling Kadam. I would not have even tried. Some people won’t change. Atrocities on Janaki increased. Janaki decided to leave Kadam. Where would she go in Mumbai? How would she feed herself and her little five year old son Babul? She was concerned as Babul too was getting beaten regularly. She was also afraid that he could become like his father.

James fought for her and got her a divorce and also the custody of the child. Guys like Rafique too were not very happy with the divorce thing happening. Why? Aren’t other women adjusting with alcoholic men? Aren’t other women tolerating few beatings received from their husbands? James reasoned that we all have basic rights common to all mankind. One such thing is a right to life, liberty and security. He said our liberty should end one foot away from his neighbor. Here we had Kadam always violating his wife’s right to security and exercising his pseudo-liberty. He also felt Janaki could leave her husband exercising her right to liberty. I can very well understand that. Marriage should be based on mutual continual nurturing relationship. I was sort of convinced that she had a right to break the marriage. James also found Janaki a house maid’s job in Rajiv Gandhi Nagar, which is not too far from Dharavi. Kadam has died two years ago in a train traffic accident. Obviously, he should. He was totally drunk and was crossing the railway tracks. I wonder how he had survived 40 years on those tracks.

During last year’s elections most of our area’s people had gone to election campaign programs for money. There was very little business. I could have some personal time with James. I asked him about how he spent rest of the time. He said that he visited slums in Thane and Pune on a regular basis. He was doing the same thing that he has been doing to us, providing legal aid. I asked him how he managed to live. He smiled and said that few friends support him. Many of them were from a  network of Lawyers. There were others who also contributed. A dozen of them gave about Rs 1000/- each per month. That probably washed their conscience of the guilt of not doing anything for the poor. Many of those lawyers had monthly income running into Lakhs*. His wife Agnes was a teacher in a school and she earned another Rs 5000/-. They managed their livelihood in Mumbai with that money. It was difficult to imagine the kind of place that he was staying. He probably was not too better off than us.

Last year, he started coming less frequently. I was busy with pregnancy of my wife. I did not notice that I did not see him for six months. He came two weeks ago. He looked tired and worn out. His head was low as he walked past my shop.  I shouted for him, “ Saab. Chai?”  He pulled himself to the bench in my shop and sat down. I gave him his usual -special full cup Chai. He looked at me as he sipped and smiled. He looked older and mature. His dynamic force was gone. He was sober but looked to be in control. He finished his cup and went to meet others in the slum. I got busy with my work.

That evening I met Rafique. I told him that James had come that morning. I also shared my observations and expressed my wonder at the change. Rafique smiled and said, “You will never believe what he has gone through. He appears different, but this is what he really was- all the time that we saw him.” “Why? What happened? Tell me what you know”, I asked knowing very well that Rafique being close to James would know more.

Rafique narrated this story, “ Agnes, the wife of  James Sir had been suspecting him of having an affair with someone. She put strictures on where he could go, when he would be back, whom he would talk to and so on. She also felt that he was trying to kill her. Six months ago she stabbed James in his stomach with a knife. James was lucky; the knife pierced his bowels but spared his blood vessels. His neighbors heard the shriek and rescued him. They took him to Lokmanya Tilak Municipal General, Hopital in Sion. They did an operation and saved him. In the meantime his wife Agnes was arrested for attempted murder.”

“Oh! My God. It should be tough on James to go through all this”, I asked “What happened next?” Rafique said, “I am still shocked at what James has done. After his discharge, he fought for release of Agnes and won the case. He then got her treated in a psychiatric facility. They gave her shock treatment and medicines.” Rafique added, “She had not responded well to treatment. She is now on the best medicine in the world for her problem. James Sir takes her for blood tests every week. She still has not improved. She is suspicious of him even now. James Sir still lives with her, though he had to change the locality. The locals requested him to vacate. Our great lawyer chose not to fight.” I felt numbed. I could not say anything. Rafique had his cup of chai and left.

I could not sleep well that night. How can James live with his wife after what she did to him? How can he continue to be with her when she still poses a threat on his life? How can he share home with such a dangerous woman? Why can’t he divorce her and start a new life? He has helped so many people start afresh.

When he came today, I asked him, “Saab, Can I ask you something personal?” He agreed with his usual smile. “Saab, I heard what has been happening in your life from Rafique. I feel very bad about it. I want to know why you want to continue living with a person who is suspicious of you and has tried to even murder you? Can’t you choose a life of liberty that you want us to have? Why…?”

James then said, “Nair, we all have rights. Don’t you realize, if we all had our rights then nothing will be left. We all give up our rights for those we love. Don’t we? You have every right to eat from what you earn. Would you spend it eating Chicken Biryani alone or would you spend money to eat normal food with others in family? I have a right to liberty. I can divorce her as she would not allow me to be close with her, but I also have a duty to care for her. I have made a promise to be together in health and in disease, in happiness and in suffering. I will keep my promise even if it means to give up some of my freedom.

“But…You fight for our freedom”, I asked. He said, “Yes, I do fight for freedom and so many other rights. Many of our friends are unaware of their rights. If they are aware they would like to claim them. I help in raising awareness and helping fight to claim it. If someone does not want to claim a right for a different purpose, it is absolutely acceptable. It would be nice if that purpose is rational. Do you remember, last year Shinde joined BSc in Maths though he got a quota seat in Engineering. It is rare for someone to get to college level from Dharavi. Everyone scolded him. I knew he had a higher agenda. He wants to prove himself. A person who can run does not need crutches. Shinde will come up in life. He will live with self respect. Watch him. Anyway coming back to the point, rights give people a chance to make their life beautiful. Giving up your rights too can make life beautiful. In the case of me and Agnes, it is not yet beautiful. I agree I do not know what can happen to me, but that is alright. In a grand plan of people caring for their family, it is already beautiful.”

As I saw him walk away, I wondered James did give up much to be with us and has made life more beautiful for us. I found a new definition of love: That which makes the subject give up his/her rights to make life more beautiful for the object of his love.

————————————————-

*Chaiwala- One who deals with Tea.

*Roti- Pancake made from wheat. Contextual translation- bread.

*Neta– Leader, usually political.

*Lakh- 100,000.

*Saab– Sir

PS:( added on 25th September 2010) A sequel to this story “Love: Feeling, Reason and Choice” can be found here.

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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

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“Can you please give me some poison?” – Part III

Posted by Dheeraj Kattula on July 10, 2010

It was usual Wednesday morning. Patients on Clozapine lined up to get the investigation request signed. It is a quick process for the doctors to sign a small bunch of slips. The OPD assistant filled in those slips and gets the job done. I looked up for a moment to see the patients. I saw Murugan’s aunt. I had come to know her well by then. You can read the posts “Can you please give me some poison?” and “Can you please give me some poison?- Part II” to get the context.

The first post was about this lady who was the sole care giver for her nephew who had Schizophrenia. She was struggling for long to get him well. It required an admission into hospital to make him better. She had no supports to facilitate that. In that post I promised that old lady that I would visit her village to help her bring her nephew to the hospital.

The second post was about my visit to their village and my encounter with the patient. Though I could not bring the patient that day, the patient came to the hospital for an admission as a voluntary patient. He was started on Tab Clozapine, the most efficacious anti-psychotic drug in the world after a fully informed consent. He improved much and got discharged. The senior psychiatrist of the hospital made a rare exception to Murugan by making hospital purchase Clozapine from an outside pharmacy to be given to Murugan for free. Murugan was lucky.

He was supposed to come every week for a routine blood test. This is because the drug Clozapine is associated with a rare but dangerous side effect in which the blood cells required for fighting the germs decrease badly. In rare instances, it can cause death too. Therefore we are very careful in monitoring the counts of those blood cells every week.

Murugan’s aunt asked me how she could get his test done as he has not turned up. What?!!! A Clozapine patient has not come for the routine blood test. He could die of agranulocytsis, where his blood cells which fight infections get reduced in the blood. The fact of this risk had been explained to both of them many times. They consented to come regularly for blood tests with their thumb impressions. Our explanation should be quite fresh in his memory. How can he not come? How dare this dear lady come and ask for ‘repeat medicines’ like it had been the practice before? I had every reason to be irritated.

I asked her, “OK. Why has he not come? Did we not tell that he MUST come for blood tests? What is he doing at home?” She said softly, “He has gone to the mill.”

“Mill? Did he go for work?” I asked with surprise.

“Yes. He started working last Friday. He gets Rs 120/- per day.”

Oh my God! This guy had not worked productively in any place for the past 20 years. He never earned a rupee. From my experience in their village, I knew that he had potential to work. When I was waiting at the bus stop, I heard a man call him out. Murugan had come with me to send me off. This man told Murugan to be ready by 6.00 am the next day. Apparently, that man wanted help in keeping an eye on a four wheeler for an hour the next day in a nearby village. All that Murugan would have received for that job is a bunch of beedis (rolled tobacco leaves about ¼ the size of a cigar).

I was amazed. Murugan has got a job in a spinning mill. I remembered my co-passenger had asked me if I was looking for such a job in a mill. Murugan has successfully found such a job. I credit Clozapine for such magic. If Clozapine was to continue, then it is mandatory that he came for the test.

I pulled a small sheet of paper and wrote a note to him. “Dear Murugan, I am very happy that you have found a job. Congratulations. Your blood test is very important. Do come and get it done.” I expected them to come the next day, but Murugan came back to get the test done before we closed work that evening. I also had an opportunity to write a letter to the manager of spinning mill to kindly give him leave on Wednesdays, so that he can come for certain blood tests which are necessary for his problems.

Next week I found Murugan had not gone back for work. His aunt prevented him from delivering the letter. She thought I had probably written to the manager mentioning details of his mental illness. She reasoned that such a letter could go against him because of the stigma attached to mental illness. She felt I was uninformed about the status of the real world as I was limited to ‘high society’!

I reassured her and explained to her what I had written. Murugan then informed me that it was not only this fear but the prophet-parrot had predicted that Murugan was in a ‘bad time period’. In India soothsayers/ fortune tellers use parrots to pick cards which are supposed to bear the secrets of the future of the client. His aunt had wanted to shield him away from authorities, just in case they stopped him from work. He was as irritated about her behaviour as me. I gave her a strong dose of scolding. Poor people take even a scolding in good sense, when they think that you are a concerned person. You cannot assume this for the rich patients. The rich though can be deceived by sweet talk even if you are not really concerned.

Next week Murugan was back. He had delivered the letter to his manager. His manager was okay with a weekly ‘off’ on Wednesdays. Murugan would regularly come from now on. His aunt wanted a letter to get a weekly ‘off’ from her company too. We gave one for her too. She too would get a weekly ‘off’ on Wednesdays. From now on she can happily accompany him. I am amazed at how much difference a typed letter sent to an employer by the doctor could make to the patient. I would use this method more and check if this makes any more difference than just encouraging patients to go for work.

Murugan’s story is a miracle. It is a miracle because of Clozapine, health care workers, hospital and the spinning mill which employs him. It is thrilling not only to see a homicide and suicide prevented, but also see lives transformed when modern medicine works along with social services and occupational rehabilitation.

Does this old lady want poison, now? May be…to kill rats and cockroaches! 🙂

Posted in challenge, drug therapy, emotion, indian society, love, psychiatry, schizophrenia, stigma | Tagged: , , , , , , , , , | 4 Comments »

“Can you please give me some poison?” – Part II

Posted by Dheeraj Kattula on June 20, 2010

This is the continuation of the life story “Can you please give me some poison?” Please read it if you can, to get the background. It was about a lady who was the sole care giver for a nephew who had Schizophrenia. She was struggling for long to get him well. It required an admission into hospital to make him better. She had no supports to facilitate that. In that post I promised that old lady that I would visit her village to help her bring her nephew to the hospital.

I did not keep the promise. Life is quite busy in Oddanchatram. Four weeks passed and the lady came back as proxy for review. I can never forget the look on her face. It showed how much of expectation she had of me and how I had let her down. I had missed four weekends to do a job I promised. If I had a conscience, I had to do something that week.

On the third day, I wound up my work by 5.00 pm and rushed to the Oddanchatram bus-stand. I bought a large coconut bun as a gift. The bun is usually cut into eight pieces before being sold. It was not very costly. In fact it was the item with maximum volume for a given price in that bakery. I believe volume matters to the poor and price matters to the rich in judging the quality of the gifts. I had filled my mp3 player with psychology lectures, to listen during the travel. I never switched the player on, as I was sooooo excited.

I would fulfil my promise. My challenge was to bring an unwilling disturbed patient, who had never seen me before, to the hospital for an admission. I didn’t have a team to assist me. I couldn’t apply restraints. I was not carrying rapidly acting injectable antipsychotics. I heard from a Public Health practitioner that practicing psychiatry in community is like trying to control a lion in the jungle. Controlling a violent patient in hospital is more like controlling the lion in a circus, he said. I was prepared for the worst. I kept my ID card, so that I can get help from people and police…Just in case…However my plan was to talk the person into a voluntary admission.

 I reached the nearest town in an hour. I had to wait to catch a bus to her village. It was getting dark and cloudy. It could rain at any time. I had second thoughts. Is it possible for me to bring an involuntary patient through this complicated travel back to Oddanchatram in a rainy dark night? Though I could abort my mission at that time, I did not. Could I face that lady again, without keeping my promise? Only God knows if one gets another chance. In about 20 minutes, I got the right bus. I asked the co-passengers, to tell me when the right village came. A teenager told me to follow him as he was to alight in the same village. He enquired if I too was going there to find job of a daily wage labourer in the spinning mills located in that area! This is when I was wearing formal clothes and leather shoes. I consoled myself, thinking I was able to relate with him so much that he identified me as a co-worker. 🙂

Once I got down from the bus, I found a street running perpendicular to the main road. I enquired from people if it was the right place. I asked for Murugan’s *house. “Which Murugan?, they asked. Reluctantly, I said,“Mentally deranged Murugan.” I was not comfortable using such a label to identify him. His aunt had wanted me to enquire like that. She had said, “If you ask for the ‘Mentally deranged Murugan’, even the village dogs will show you the way to our house.” I was told to go near the temple, located deeper the village. It started to drizzle. I walked faster. I found a group of people in a circle, chit chatting and having fun in verandah of the village school. When I asked, they pointed to a man who was engaged in a chat with another group nearby.

 He looked like an average poor man. Thinly built and unshaven, he wore a shirt and a lungi. His lungi was pulled up so much so that it exposed his thighs. As I looked at him and his mannerisms, I understood, he could easily be an object of mockery. It was difficult for me to imagine that he could be stoned to death in the village as his aunt portrayed. He smiled innocently as I introduced myself as a doctor from the hospital where he gets his medicines from.

He was happy to receive a guest. He left his group, as he understood that he had to take me to his house. On the way he said that his aunt had brought the Injection but he could not yet get the shot, as the village nurse was not coming regularly. By then it began to pour. We ran to his house, which was not very far from that school. He was surely not as bad as I thought.

 His house had tiled roof and brick walls. It had three compartments. One was the corridor, right in front of the door. On the left was an elevated area, which was used as a kitchen on distal end and store area on the proximal end. On the right side there was another wall which had a door in the middle. The door led to a bedroom. That room had a cupboard, a chair and a trunk. Few clothes were scattered on the floor. His aunt was cooking rice at that time. She was excited when she saw me. She hurriedly cleared the scattered clothes and ordered Murugan to get me a ‘colour’. I figured out that she meant a cool drink. I told her not to bother as it was cold and raining. I had the magical thinking that rain would stop soon. Aren’t some of us are extreme optimists, especially if we take some action?

They spoke in a language called Kannada. I asked about their roots and how they came to Tamil Nadu etc. I then moved to the business of getting Murugan back to the Hospital. I knew the journey was long and difficult. I did not mind the cost of throwing the half cooked rice away to get back to Oddanchatram as fast as possible. I gave the coconut bun. Murugan was happy to take it. He asked me if it was cake!

I gave Murugan the Flufenazine shot that was due to be given. I explained the reason for my visit to Murugan. I asked his aunt about what she wanted to do. Murugan listened to everything. At last he asked me if I would be there in the hospital, if he came. It was as if he said, “If you are there, then I will come.” I got excited. At least some rapport has got established.

In my heart I was keen on taking him personally. I cannot believe judgement of a psychotic person. It could change anytime. His aunt told me if Murugan said something, he would do it. She said, “Now that Murugan knows you and likes you, I will not have any difficulty in bringing him to the Hospital.” I thought I would leave the issue at that point. This was more so because of logistic problems.

The rain showed no inclination to stop. It was already dark and getting late. If I delayed any further, could miss the last bus passing through the village. I packed and secured my mobile and mp3 player in a plastic cover. I walked to the bus stop in the heavy rain after bidding good bye. Murugan also walked right beside me. He wanted to give me a ‘send off’! I enjoyed getting drenched. The tiredness of the day got washed away, as I walked with the hope that Murugan would come to the Hospital after many years.

Three weeks later, Lo behold! Murugan and his aunt came to the hospital for an admission. We had already decided that Murugan’s aunt need not pay any money to the hospital for the in-patient care. There was an arrangement made to procure free food for him too. We explained the possible side effects of Clozapine and the need to come to Hospital weekly for a blood test, before we started him on Clozapine. He and his aunt agreed to the contract. On Clozapine, his behaviour started improving. Before we reached the full dose, I had to go to another part of the country for some work. So I did not see him at discharge. I heard that he improved much by the time of discharge.

What a joy it is to be involved in people’s lives to change it for the better. In the trip to his village I learnt much. The label of being ‘mentally deranged’ transcended even love. Even his dear aunt used it. It was not as bad as I thought. The stigma of mental illness is less palpable in villages, as people did relate with the patient. They chatted, played and smoked with him. After all, he was their friend who got ‘mentally deranged’. The picture was different from what his aunt described. Anyway, what I saw was a snap shot. I might understand these issues more in the future. Murugan comes regularly for follow up, now.

What happened after Murugan got discharged? That would be covered in a future post.

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* Name changed

 ‘Murugan’ is a very common name in Tamil Nadu

Posted in challenge, distress, drug therapy, indian society, psychiatry, schizophrenia, stigma | Tagged: , , , , , , , , , , , , | 15 Comments »