Mum’s the problem.

Recently I have met a Professor of Psychotherapy, a Consultant Psychiatrist and a GP – all parents of children lost to mental illnesses. Here’s what one mum says:

“Whenever I have seen a therapist, they have gone straight to my childhood, my up-bringing, my parents and their parents. All my behaviours and feelings seem to be explained and understood based on their behaviours, however ‘normal’, for their times. I am encouraged to think of all the ways in which they could have directly or indirectly damaged me.

By that principle, all of my child’s behaviours and feelings should be explained and understood based on the behaviours of his parents. Half of them is me. I agree. I must be part of the problem. My profession is perceived as a bigger problem. ‘High achieving Asian’ parents are assumed to put a lot of pressure on their children. So much so, the medics looking after him didn’t even need to meet me or know the quality of our relationship to be certain that my job makes me a bigger problem than most other mums. They could squarely put the blame on me and actively keep me out of the picture. I asked too many questions. I was the biggest problem. They wrote it in their notes.

However, that does not mean that I cannot be part of the solution. NICE guidelines lay out my role beautifully but do the people on ground read any of these guidelines? In my experience, not. If half of all that is written in Policies and guidelines was implemented, families could engage meaningfully in helping their kids recover.”

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Ref: https://www.nice.org.uk/guidance/cg185/chapter/1-Recommendations#recognising-diagnosing-and-managing-bipolar-disorder-in-children-and-young-people-2

A song and a prayer.

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Once upon a time I used to sing. My friends had to beg me to stop. In 1987, a whole bunch of us, medical students traveled from Ludhiana to Delhi to participate in the Annual music festival at All India Institute of Medical Sciences, called ‘Pulse’. It was just the perfect time for us to be and sing together. We belted out song after song for the entire duration of the train ride. Some onlookers were entertained and others annoyed but we were oblivious to them all. By the end of the journey, we were hoarse. I had no regrets that on the day of the competition, I sounded nothing like myself. I had had a great time.

I grew up in a house filled with music. The radio used to be on before we woke up in the morning and we followed the charts closely every friday on ‘Binaca Geet Mala’. My parents loved Hindi film music which by default is the most popular music in India. My mother has an uncanny ability to remember lyrics that I seem to have inherited. The popularity of the music of a film determines its box-office success. Our playback singers are worshiped like Gods.

Saagar found Hindi film music b-o-r-i-n-g!!! He thought it lacked imagination and the lyrics were always about romantic love. True. Yet, he accompanied me in my singing whenever I asked him. Despite the fact he didn’t know the songs, he played the drums or Djembe along to perfection. The boy had a solid sense of rhythm. After losing Saagar, I lost my songs. Some, I just couldn’t bear to listen to. Others, I could sometimes play for myself and occasionally enjoy. But singing was undoable. My tears would come tumbling in waves if I attempted it. For more than 4 years, I mostly stuck with words, Radio 4 and the random weekly music of someone else’s choice on Desert Island Discs. For the last 2 years, Si and I would dance to some of our favourites on Saturday evenings, while pottering around in the kitchen.

A few months ago, some songs came to me. They were devotional and Sufi. Initially, they came with tears of love, sorrow and gratitude. With practice, the tears learnt to hide. My friends accompanied me – Katie on viola and Rajesh on the tabla and finally, last week I gathered the confidence to sing in public after 5 years. It was an exercise in equanimity. It didn’t matter how melodious or off-key the song was, it was an offering from the heart. It was a way of loving and honouring myself, Saagar,  friends and families present and all the lovely people they had lost to suicide. It was a new beginning.

English translation of O Paalan hare

Oh, nurturing Lord, beyond description and beyond all,
Except you, we have no one
Ease our difficulties, oh God

Except you, we have no one
You are our only supporter
You are our only protector
Except you, we have no one.

It is you who has filled the moon with moonlight
The sun’s brightness is from you
The sky is content, you have given it stars
God, if you don’t adorn this life
Then who will adorn it?

Oh, nurturing Lord, beyond description and beyond all,
Except you, we have no one.

If you listen, Lord, I shall make a plea
Give patience to the sorrowful
So that they never give in to their sorrow
Provide the powerless with protection
So that the powerless can live happily.

Provide our devotion with strength.
Provide our devotion with strength.

As you are the master of the world, please hear this plea
There is darkness in our path
Shine your divine light for us.

Oh, nurturing Lord, beyond description and beyond all,
Except you, we have no one
Ease our difficulties, oh God
Except you, we have no one.

Lyricist: Javed Akhtar
Composer: A R Rahman
Film: Lagaan

Youtube: https://www.youtube.com/watch?v=arF8gWNFyZo

Recording: http://we.tl/t-npGeikz9QP?src=dnl

Venue: St Martin in the Fields. 9th March 2019.

Big thanks to Mary Kennedy for recording the song and to David Mosse for organising the Time to Talk service.

Gold flecks

Every day since Saagar’s death, I looked for him in my face when I looked in the mirror. I searched hard. I desperately wanted to see him. Just a hint of him. But, no. Nothing showed up. Absolutely nothing.

Last night, I hunted again and I am definite I found a hue of him in the black and golden flecks on the irises of my eyes. Just a shimmer, only visible when light fell at a particular angle. Fleeting but present. The golden flecks weren’t as bright as his. They were somewhat faded but they were certainly there. And they were his.

I smiled. Yes. He was right here.  In my eyes.

Every week day morning and every week day evening, I walk to and from the same railway station where it happened. As I walk to the station, I walk his last walk. As I walk home, I walk the path he didn’t. I send him my love and blessings at every step. He is in my mornings and evenings and in everything in between.

A new Blackbird Bakery kiosk has recently opened on Platform 1 at West Norwood station. The staff are friendly and coffee fabulous. I wish it had been there then. It makes it a happier place. I am glad it’s there now.

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Molly. Oh Molly!

When I look back I can clearly see we were headed this way. But once again, it has taken the shocking death of 14 years old Molly Russell, to call the big bad media companies to account. They claim to be helpful and in some ways they are but their algorithms aren’t.

A few weeks back I was researching base-ball caps for a piece of writing and now I can’t log on to the internet without someone trying to sell me one such cap. I feel like I am being hounded, sitting alone in my study. It’s all about unabashed, indiscriminate, aggressive marketing. “We’ll give you want we think you want and more”, they scream.

In the last week of January, Ian Russell shook the media world by naming and blaming Instagram directly for making a major contribution to the death of his lovely Molly, by her own hands, in November 2017. Even after she had passed, she was being sent inappropriate images and material in response to her previous search for ‘Depression’ and ‘suicide’. The heart-break was written all over him. The very next week, Instagram was hauled up by the Parliament and its CEO agreed to take responsibility for removing and monitoring harmful content. Google and Facebook are yet to follow suit.

As indicated by this data from the ONS, there has been a worrying rise in female suicides, at either end of the age spectrum. The rise has been consistent in young women, 10 to 29 years of age, since 2013.

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Last week, at the National Suicide Prevention Alliance Annual Conference, there was much discussion on the same subject. The minister for Suicide Prevention, Jackie Doyle-Price spoke briefly, trying to convince us that she would do everything she can to tackle the issue and we are watching. Like hawks.

 

Help? Me?

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“Call for help” is the first step in Basic Life Support. At the hospital, I encourage Junior doctors to recognise early when a patient is too complex or too sick and ask for help at an early, rather than late stage.

It took six sessions of counselling to wake me up with a jolt to the fact that I needed to ask for help. Yes. I was a strong and independent woman. Yes. Very self-sufficient. Omnipotent, in my view. I offered help generously but hesitated to ask. Saagar was ill. I was looking after him the best I could while working full time. All our family was in India.  Saagar’s dad stepped in as much as he could. He worked full time too. We had no back-up. No support net-work. No community. We were muddling along till it dawned on me after 6 weekly Talking Therapy sessions of one hour each, that I could and should ask my family for help even though they were thousands of miles away.

I didn’t know it then, but it would seem I didn’t like asking for help. It made me feel weak, vulnerable and inadequate. Exposed. I don’t know why but it seemed like an admission of failure to manage my affairs. But now, Saagar was ill and we needed help.

On the night of the last session of therapy, I wrote an e-mail to all the adults on my side of the family, explaining our situation and finally, asking them for help.

One of my brothers responded. He applied for his UK Visa at once. A few days later he was told there weren’t enough blank pages in his Passport for the Visa to be stamped. He took the document back to the Passport office to get more blank pages added on. That took a few days. He then re-applied for his UK visa and finally got it a further few days later. By now 2 more weeks had passed.

In the mean time I arranged with one of my young friends, Jan to come to stay with us. Jan and his mum attended meditation lessons with me. Jan was a compassionate and enthusiastic young man who had recently lost his job and was looking for something meaningful to do. I offered him our guest room and invited him to stay with us, explaining the situation. He was excited about it. I asked Saagar how he felt about this temporary arrangement.

“It’s okay Mamma. I’ll wait for Uncle to come.”

I listened. I understood. I was tempted to push it. But I wanted to respect Saagar’s wishes. I didn’t want to take away the little control over his life that he had left.

A few days later, the visa arrived. Just in time for Saagar’s uncle to attend his funeral.

Moral of the story: Ask for help openly and EARLY.
Reminder: It takes a village …

Song: Lean on me:

https: //www.youtube.com/watch?v=qTVEIOOBD6Q

Andy’s dilemma. Errm … decision.

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On Friday, the first thing I heard on radio was Andy in tears. It was also the last thing on TV before going to bed. A proud Scotsman, 31 years of age, Andy announces his retirement after a scintillating career in tennis and a long fight with an injury to his right hip. Tall and athletic, in a deep blue t-shirt, seated in front of a dark grey screen covered in contrasting logos, he faced the press. Eyes lowered. Head bent. His left hand trying to cover his face in the guise of adjusting the brim of his baseball cap.
“Ermm. Not great.” (Nods, looks sideways, down and to his right. Nods twice to himself. Big sigh.)
“Ermm…”(Comes close to breaking down and leaves his seat. Walks off with head steeply bent forward.)
Comes back. Sits down. Starts again.
“Sorry.” (Small cough)
“Ermm. Yeah. So, not … not feeling good.
Obviously been struggling, been struggling for a long time.
I can still play to a level. Not a level I’m happy playing at. But also, it’s not just that the pain is … too much really. I don’t want to keep playing that way. You know, I spoke to my team and I told them that, you know, I can’t … I can’t keep doing this and I needed to have an endpoint. I told my team that I needed to get through this till Wimbledon. That’s where … where I’d like to stop.
Ermm … stop playing. (Visibly steels himself as he says this).
Ermm … but also not certain I’m able to do that. (Shakes his head and bends it further forward)
Ya. Ya. I think there’s a chance of that for sure. (Rubs his right eye. Purses his lips.)
Ermm. Ya. There’s … sure, because like I said I am not sure … not sure I’m able to … to play through the pain you know. For another 4-5 months. Ermm. I have an option to, you know, have another operation which you know is … you know a little bit more … more kind of severe than what I’ve had before and having my hip resurfaced will allow me to have a better quality of life and be out of pain and that’s something I’m seriously considering right now. There’s obviously no guarantees. The reason for having an operation like that is not to return to professional sport. It’s just for a better quality of life. Yeah. For myself mainly. (Pulls the brim of his hat forward). There’s lots of little things. I mean, you guys see me running around the tennis court and walking around in between points and it obviously doesn’t look good and doesn’t look comfortable but you know there’s little things like day to day, that are also a struggle, and ya, it’d be nice to be able to do them without any pain. Putting your shoes on, socks on – things like that. Having the limitations and the pain is not allowing me to enjoy competing or training or any of the stuff that (shrugs) I love about tennis.
Nothing helps. You’re in lots and lots of pain. You can’t do what you want to do, what you love doing. I can do it but it’s not fun. I’m not enjoying doing it. So … I mean. That’s what I’ve done. Tried to deal with it, talk about it. Ermm. But none of that makes my hip feel better unfortunately. I wish it did, cause if it did, I’d be feeling brilliant just now but it doesn’t. So…” (Gets up and leaves.)

His deep sense of loss, confusion, pain and vulnerability came across clearly. It’s probably one of the hardest decisions of his life. I visualise a society, our society, creating space for such expression, not just for physical but also emotional pain. It’s going to be a tricky transition. I am sure he has the required support network in place. Good luck Andy!

Ref: https://www.theguardian.com/sport/2019/jan/13/andy-murray-tennis-retirement

 

The Cats

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(Merry Christmas from Milkshake)

The Intensive Care Unit (ICU) at the City Hospital was a circus. A different clown (read Consultant) was in-charge everyday. What was right on a Monday was completely wrong on a Tuesday. The same action would be pronounced as ‘perfect’ by one clown and ‘abhorrent’ by another. To make things better, they didn’t talk to each other. The flunkies (read junior doctors) were the in-betweeners that got lammed from both sides as their shifts crossed over time-territories. They were the pawns on the frontline that took over the running of the unit from one clown at the beginning of a shift and handed over to the other at the end. They were the ones dodging the arrows of conflict over phones, in hospital corridors and at handovers. They were the ones that stayed up all night working hard, only to be abused and criticised the next morning. They were the buckets into which bile was poured, the bile of bitterness that the clowns didn’t have the guts to express to each other.

In 2004, I was one of those flunkies. After about 8 months of this non-sense, I was done. I was loosing my sense of self, my confidence in making decisions and most importantly,  pride in my job. It was time to stop and take stock. After a nasty night shift, I was handing over the patients to the day team. I am sure at one point I heard the Consultant taking over suggest to me ‘you need your head examined’.  That did it for me. Bleary-eyed and broken, I couldn’t bear to go home only to come back to this toxic work environment yet again that night. I planted myself in Psychiatry Outpatient Department and demanded to be seen by someone. Dr Ingram was a handsome, young psychiatrist with kind eyes and a small beer belly, well couched in his grey suit. He understood. I was given 6 weeks of work-related-stress leave and started on Fluoxetine. I was also seen by an occupational therapist once every fortnight. She suggested getting a cat.

At the local Animal rescue home, we found an enchanting black and white, one year old feline. It was her eyes that got me – talking and smiling eyes. We were told it was a girl. We decided to call her Bella. We were advised to keep her strictly indoors for at least 6 weeks, till she got used to the smells in the house. She found her way to the strangest of places –  on top of kitchen cabinets and radiator covers, squeezed behind and underneath beds, chairs and sofas, inside shoes and boxes. The only place she didn’t like was her soft furry blanketed bed.

On our first trip to the vet for a basic check-up and vaccinations, we found out that the she-cat was in fact a he-cat. After much consultation, he was christened ‘Mr Bronx’, the old faithful. He soon became a source of great joy, comfort and hilarity for the family. We had him go crazy playing with balls of wool, soft toys with tiny in-built bells and laser beams. He was pure entertainment from a distance at the beginning but slowly he allowed us to stroke and cuddle him. Within a month we were having full-fledged conversations with him.

The Fluoxetine made me feel frozen. Hollow. No joy. No pain. No love. It was dehumanising and unbearable at times. It was proof that pills alone cannot make you happy. After 6 weeks, it was time to go back to work. I did. A cunning plan was put into place so that I didn’t spend too much time at the ICU. It worked.

9 years later, Saagar was home from University and I got a phone call from him at work. He said he’d found a cat on ‘Gumtree’ and he would love to get it. That evening we went over to a tiny flat in Sydenham occupied by a family of 4 – mum and 3 kids. On a window sill lounged another family of 4, a grey mother-cat with her three grey kittens, 6 weeks old. One of the malnourished kids was about 3. He handled the kittens like rags. He didn’t care if he lifted them by their ears or tails or bellies. He let them go from various heights above the floor, cornered and held them with a lot of force. He told us all about what the cats ate. We picked the cutest little kitten who resembled a mini-punk, got it properly accessorised and brought “Milkshake” home. He was Saagar’s baby that summer.

Not once did it occur to me that there might be a connection between the circumstances under which we got the first cat and the second.

Ref: https://www.cats.org.uk/news/purring-the-blues-away