Shrink's Views

ramblings of an unknown psychiatrist

Posts Tagged ‘law’

Pehle Hum Hindustani Hain: a poem

Posted by Dheeraj Kattula on September 29, 2010

Background:

India awaits the judgment on Ayodhya’s controversial site on 30th September. Apparently the Moghul Emperor Babar demolished a temple and built a mosque. Fundamentalist Hindus demolished the mosque in 1992 wanting to erect a Ram temple in the site. Both parties Hindus and Muslims stake claim to the historical site wanting the structure of their choice to be erected there.

Do ordinary Hindus or Muslims have any stake in this decision and what comes after it? This poem is written from the perspective of Ali, a muslim Riskshaw puller. It also echoes sentiments of his childhood Hindu friend Shyam. Having lost close relatives in communal violence, both realize that more than religious identity what binds people together is basic needs or rather the lack of it. The poem ends with a patriotic note that Indian identity comes prior to all other identities of religion, caste, language and class.

Pehle hum Hindustani Hain

main hoon Ali, mera dost hai Shyam,

main Musalman, uska devta hai Ram,

Ayodhya mein hamara janam hua,

vahin par ham donon bade hue.

 

hamari yaari itni pakki thi,

log iski kasam khate the.

kisi ko agar kuch cahiye hota,

turant madat pahunch jata tha.

 

Hindu log jab Babri mazjid tode,

charon oor dange fasaad shuru hue.

Shyam ke saale ne mere bhai ko mara,

jis bhai ko maine bachpan se pala.

 

mere bête ne aatank machane ki tani,

bahana chaha khoon jaise ki pani.

Bomb banana kisi ne use sikhaya,

haivaniyat ka kharab rasta dikhaya.

 

Bomb ki durgatna mein bête ka haat kat gaya,

dange fasaad mein he Shyam ka saala mit gaya.

sab kuch lutakar, main aaj bhi hoon ek riskshawala,

mera yaar shyam bhi hai, ek sadharan paan wala.

 

kal mandir bane ya masjid bane,

kisi ko kya fark padta hai.

mere aur Shyam ki kaun sune,

dangon ke baad, zindgi sadta hai.

 

ho sakta hai ki kaum hamara chahta ho,

vahan Mandir ke badle masjid ho.

usi prakar shyam ka jo sangh hai,

manta hai ki Ram mandir he tik hai.

 

mandir se ya masjid se,

kya kisi ki pet bharta hai?

jise tand se kampan hota hai,

kya ent patharon ko od pata hai?

jiske ghar par chat nahin,

aaradhna ka jagah, vo chahe kahin?

 

hindu ho ya musalman, sabko yahi chahiye,

Ram ya Raheem ke pehle, Roti hame chahiye,

Mandir ya Masjid ke pehle, Makan hame chahiye,

Kafan our Kabr ke pehle, Kapde hame chahiye.

 

Jaanta hoon main aaj bhi ki,

Shyam ke vichar mujhse bhinn nahin.

Dharam, jaat, bhasha, varg halanki alag ho,

Pehle hum hindustani hain, Yahi baat hai sahi.

*****

Advertisements

Posted in distress, fiction, HINDI, indian society, poetry, religion, social | Tagged: , , , , , , , , , , | 7 Comments »

“There is a limit to suffering one can take. I have to poison her before she brings disgrace.”

Posted by Dheeraj Kattula on April 5, 2010

She had an innocent smile of a child on her face. It was the first time I was seeing her. She was of dusky complexion, cute looks and shy behaviour. She had been on low dose anti-psychotics for few weeks. Her mother complained of her missed periods. Every day, we reassure a lot of people regarding menstrual abnormalities secondary to anti-psychotic use. As I reassured them, I could see that her mother was not satisfied. She complained of swelling in her lower abdomen. I smiled sarcastically at her ignorance. I felt she was worried thinking of menstrual blood getting accumulated down there.

Ignorance is fought with education. A couple of minutes of psycho-education could let them cool down, I thought. As I reassured them again, I noticed a smile of the patient. It was not the usual smile. It had a touch of mental retardation. I became serious. I knew she is a likely victim of sexual abuse. She was single, female, poor, beautiful and mentally disabled. I looked at her parents again. They obviously knew better than me of the possibilities. That was why they looked so distressed. They were afraid of the worst possibility- PREGNANCY.

The elderly couple also have a son. He has chronic Schizophrenia. He is dependent on them. The patient in front of me was dependent too. The grown up children cannot do any meaningful labour in the marketplace. Their mother is the bread winner. Their father is unable to work anymore because of old age. He minds the kids at home. The old lady was already in tears. I told her that she was not alone and such suffering is not uncommon. I realize these words are empty. Suffering hurts most when it hurts you.

She wiped her tears with the free end of her saree. She said “There is a limit to suffering one can take”, as she blew her nose she added, “I will have to poison her sometime, before she brings any disgrace to us.” I could understand her pain. I was shocked to see her daughter smile innocently as she heard this. I knew why this ghastly filicide had not happened till now. It is not tough to kill someone who would submit to you with a smile. It is impossible. Her mother loved her much. She just did not know how to handle her situation,  if at all there is a right way to handle it.

I wanted to send the patient for a pregnancy test. I also wanted to treat her with dignity as an individual with some ‘capacity’. So I asked her if ‘any man had come close’ to her. She agreed with a shy smile. My heart sank. Her mother nearly fainted. She reached out to the nearest bench that was available. I told them not to worry. We could find out if she is truly pregnant in the first place. Her missed periods could be due to medicine itself.

 Her parents did not want the test!!! Why?? I was shocked. They should be asking for it not me! They told me that a test would take time and if they do not go back in time, their schizophrenic son might wander away. Our OP assistant gave them an idea. Her father could return home and mother could take the patient back after the tests are over.

After a couple of hours, I saw them again. The pregnancy test was NEGATIVE. I sighed with relief. I am pro-life. I cannot think of recommending an abortion. We don’t do it in our hospital either. In fact if she was positive, I really do not know what I would/ should have done. Thank God! The old couple would not get another dependent into their family. They also did not have to kill a weak and helpless unborn child.

I told the mother to teach her to keep a distance from unknown men. Of course I know the ones who abuse are usually the known men. But here it was the case of an unknown man. Her mother told me that she had beaten her number of times to teach her that lesson. I wondered why she had to beat her daughter before an act was done! She knows her daughter and their situations better. I better not theorize how to handle these at this stage.  Anyway, now that the patient has experienced a ‘reward’ for the act, I predict she would continue to seek it. This is not my guess .It is the law of effect in maintaining behaviours called ‘operant conditioning’. I suspect that the mother understands this risk. She can never be in peace.

They left, temporarily relieved. I know God does not test us beyond what we can stand. I hope and pray they do not fail the test. We can imagine but we would never know tough it is. How could one help the patient live in safety? What should this mother do now, to prevent such happenings? What are her options given that are such daughters have right to liberty granted to them by International law like Convention on Rights of People with Disability? Where do local laws/ policies stand in situations like this?

Do comment and help me write the responses to the questions stated above in my future posts.

Posted in behavioral therapy, challenge, children, distress, ethics, law, love, mental retardation, schizophrenia, stigma, women's issues | Tagged: , , , , , , , , | 11 Comments »

‘Agreement’ among Psychiatrists and Legal proffessionals:Towards better Mental Healthcare and Justice

Posted by Dheeraj Kattula on October 12, 2009

Consider a psychiatrist who diagnoses ‘severe depressive disorder with psychotic features’ in a patient. He makes diagnoses like this everyday. How can we be sure that he is making a right diagnosis? How do we judge? Usually this would be based on his qualifications and training. Isn’t it? What is training? How does training help?

A psychiatrist learns a set of criteria based on which he makes the diagnosis. He learns this process by observing senior psychiatrists till he begins to identify signs and symptoms just like them. This happens to every student of psychiatry. So at the end of a long period of training every student would probably make same diagnosis on seeing the same patient. Practically this does not happen in all cases. It would be in ‘typical’ cases but not all cases. When two doctors see a patient separately and diagnose a patient to have an illness or clear him as not having an illness, we can say they are in ‘agreement’. When one diagnoses a illness and another clears the same patient as not having an illness, we can say they are in ‘disagreement’.

The criteria for diagnosis are formulated in such a way that agreement of responses is made possible to the maximum extent. For example, we can study two psychiatrists by making them assess 100 patients among whom there are few patients with depressed mood. Each psychiatrist is asked to evaluate for depressive symptoms. At the end of the study usually psychiatrist A and psychiatrist B would have agreed on certain people to have depressive symptoms and certain to not have depressive symptoms. There would be certain people whom A would have said to have depressive symptoms which B would have cleared them off as not having depressive symptoms. There would be another set of people whom B would have said to have depressive symptoms which A would have cleared them off as not having depressive symptoms.

If B was a 10 year old boy who would toss a coin and call all ‘heads’ as ‘depressive symptoms’ and all ‘tails’ as ‘no depressive symptoms’, there would still be some agreement between A and B. This is because of chance. Isn’t it? We can adjust for chance ‘agreement’ and find ‘true agreement’ by calculating a statistic called Kappa. If Kappa is high, it means that level of agreement is high.

Lately, I have found many lawyer friends. I discuss legal issues with them. I have been learning much from them. I also bore them with theoretical questions like this one- what is the level of agreement among judges while sentencing convicts?

For example there are 100 convicts. How would Judges A and B sentence them? There would be few to who both might give strict punishment. There would be few for who both would give liberal punishment (not so strict). There would be few, for whom one would give a strict punishment and another would give a liberal one.

Judge A

Punishment strict

Punishment liberal

Judge B

Punishment strict

🙂

😦

Punishment liberal

😦

🙂

Intuitively the level of agreement ought to be high, if one were to have faith in the legal system. The smiley in the table indicates that there is no problem when there is agreement.The sad face reflects feelings when a person could possibly be getting the wrong sentence.

To my surprise, many of my lawyer friends felt that agreement would probably be less. I was also shocked to see that they were comfortable with this lack of ‘clarity’. I sensed how other doctors perceived the low agreement levels in few of the psychiatric diagnosis. But ‘psychiatric diagnosis’ is of less significance than a ‘sentence’ in court. A disagreement in psychiatry might mean a patient might take a medicine for few extra months. Whereas a disagreement in a court of law might mean a death sentence for someone!!! How can lawyers be comfortable with this sort of system?

There is another principle which operates in the legal system. That principle allows a party to ‘appeal’ to a higher court. Just in case a party feels justice was not delivered in a court of law, then the party could appeal to a higher court. The higher court would look at evidence again and pass a fresh judgement. Courts are organized in such a way that there are 3-4 levels till which a case can be taken up. How on earth does this help? Let us see it- statistically!

Let us assume an average Judge has 90% accuracy in making his judgements. If he were to sentence 1000 people, he would have 900 correct decisions and 100 errors. If these 100 go to a higher court, 90 sentences would be corrected and only 10 errors would remain. If these 10 go to an even higher court 9 would be corrected and only 1 would end up getting a wrong sentence. This model assumes that every judge has 10 % error in judgements. The truth is that as we move to the higher courts there would be judges with less error rates. This is because higher courts have judges with more experience and better track records. This ensures that justice does get served.

Hmmm… Now I know realize why they were comfortable. It reminds me of what I do when I have a diagnostic dilemma in an atypical case. I would ask my peers to see the patient. If we ‘agree’ I assume that we are right. Something like this happens when courts use a ‘jury’. What do I do when my peer and I ‘disagree’? We ask a senior’s opinion. It would be usually someone with more experience and knowledge. Hey…That is like an ‘appeal’ to a higher court in the legal system. What can be done if the agreement among judges at higher courts is low? Make the law more comprehensive and clear! This is similar to what psychiatric researchers do, while revising the diagnostic criteria.

Wow! Is it not amazing to see commonalities in approach of lawyers and psychiatrists? We also share a common desire for our clients. That is the client’s well being. But, it is funny that we don’t seem to understand each other in our arguements. We would…soon 🙂

Posted in law, psychiatry, statistics | Tagged: , , | Leave a Comment »