Day 967

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One of the actors at the above workshop, who is also a mentally ill patient in recovery spoke about his insights, “I realised that as long as I depend on the State to look after me, I will be met with the lowest common denominator. This brought me to the conclusion that I may not have control but I have agency.”

After I got home, I looked up the meaning of ‘agency’ to figure out exactly what he meant. Agency is an ‘action or intervention producing a particular effect’. For example, many infectious diseases are caused by the agency of insects. Synonyms to this effect are: influence, power, effect, force, means, channels, routes, mechanisms and techniques.

In effect, he was referring to ‘self-help’. He was saying, “I have the power to change my situation.” It was inspiring for me to hear him say that. That statement reinforced the message of the workshop – there is a very thin line between the well and the ill. Role reversals are common. Sometimes visible. Often not.

I came away from there with a mixed bag of feelings. On the one hand, I could clearly see the daily struggles of mentally ill patients and on the other, their brilliance shone through. I wonder how Saagar would have been, had he got through that big dip.

May the force be with you. And me.

Day 966

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It seems like that was another lifetime. Some moments however last forever. My mind has been dancing in overlapping elliptical, circular, zig-zag and squiggly shapes between the remotest past and the far future and deep inside this bottomless present moment. I find gems scattered all around. Today the moment when I first saw his face shone the brightest. I picked it up. I held it in both my hands, looked at it for a while, felt it, kissed it and held it close to my heart. This is where he lives. In my heart, in the past, the future and the Now.  That moment from another lifetime is mine again.

Experiences can only be experienced. Not explained. Ones who has experienced it know it, ones who haven’t can have a guess. Some songs say it all. This one does. It speaks to me. It’s a song of love. Roberta Flack sings to my heart. She knows how I felt the first time ever I saw his face.

“The first time ever I saw your face
I thought the sun rose in your eyes
And the moon and the stars were the gifts you gave
To the dark and the endless skies my love
To the dark and the endless skies

The first time ever I kissed your mouth
I felt the earth move in my hand
Like the trembling heart of a captive bird
That was there at my command my love
That was there at my command my love

And the first time ever I lay with you
I felt your heart so close to mine
And I knew our joy would fill the earth
And last ’till the end of time my love
And it would last ’till the end of time

The first time ever I saw your face
Your face, your face.”

Day 963

Wysa

A young couple, committed to making a difference used their love and  intellect to create Touchkin, Artificial Intelligence for proactive care, integrating behavioural health into medical practice.

Tom Insel, a psychiatrist from National Institute of Mental Health (NIMH), the world’s largest mental-health research institution, spoke frankly about how MH services and research were failing to help the mentally ill. He openly dismissed the DSM (Diagnostic and Statistical Manual of Mental Disorders). At any given moment, roughly one in seven of the world’s 7.5 billion people is struggling with mental illness. “We’re not going to reach all those people by hiring more psychiatrists,” says Insel. But we might reach them with smartphones.

In one of his talks, Insel was sharing the intricacies of the delicate workings of the brain.   Someone interrupted him and said, “You don’t get it. The house is on fire, and you are discussing the chemistry of the paint”

Jo Aggarwal, one of the developers of Touchkin says:

“This line from the article resonated deeply with me. It’s a familiar sentiment – one many of us in development have had in conferences on employment, education, conflict. They are all at some level connected to the base fire that engulfs our world today – that of mental health. Until this fire is brought under control, we don’t have a hope for any of the rest of it.

His dramatic move lends credibility behind the idea that phones may be the answer. Identifying issues using smartphone behavior is powerful, though it can feel creepy. But detection is not enough. In our trials at Touchkin, phone sensors were able to predict depression in people with diabetes to a 90% accuracy, and went a long way in getting the physicians convinced to integrate mental health into their regimen. But only 1 in 30 people diagnosed went on to take treatment for the depression.

It said to us – “The house is on fire, the fire brigade is missing, and here we are saying how accurate our fire alarms are”

Wysa the emotionally intelligent penguin willed itself into existence somewhere along the way. It was a side feature created between ‘formal’ projects to improve accuracy. Taken by how people reacted to the prototype, we all kept working on making it better… in three months it crossed a threshold. It started changing lives. Last month, 3 people wrote in to say it saved their life, it is what is keeping them from suicide. Over 50,000 people talked to it anonymously, and thousands of them wrote in to us to say how much it meant to them.

Unlike the Stanford psychologists creating Woebot- we have no hypotheses around Wysa. It is evolving entirely based on what works for its users. It has evidence-based techniques, but everytime we add more tools or advice or tips we get users telling us to just let them talk to Wysa, and not to underestimate how much of a difference that makes.

“The fire in the house, is in our brains. The fuel is the language of the conversations we have inside our head. “

We started out, like Insel, trying to detect the fires… Wysa is leading us to try and put a fire extinguisher in everyone’s pocket. Any pretence of our own hypothesis went out of the window when the first person wrote in to say it saved their life. Now we are following it to see where it goes.

Like us, like Tim, there are many unwitting recruits to this fight.

Rick Little started fighting it as soon as he graduated college. So many of my friends… Sangeeta Mahajan who lost her son to suicide and has dedicated her life to preventing it for others. Anjana Ajay who is changing others lives after healing her own Stage 4 cancer by focusing on healing her mind. Bhavana Issar who is doing amazing work at Caregiver Saathi.Pooja Goyal who is creating resilience in pre-school children and their parents, bravely facing all the storms that come her way. Archana Aggarwal Sarda has made emotional support a way to get intl level diabetes outcomes in rural children, long before she realised that she was doing it.

None of them are psychologists. They each have options of more comfortable, lucrative ways to spend their time. They are all powerless to not do this. “The house is on fire. Once you see it, and you realise that you can stop it spreading, it is hard to do anything else.”

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Day 957

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At 26, she finally sought help. She is bright, has received fabulous education, is brought up in a stable, happy household and has travelled extensively. After graduation she got a great job in the city of London but came to realise it was not right for her.

After a tempestuous patch, she has landed on her feet. Great wisdom has come to her in abundance. She has discovered that her family is her strength. She can trust them. Her mother walks right beside her, growing with her, every step of the way. She now appreciates her dog more than ever before. A drive to the coast and a stroll by the sea with a loved one is not something she takes for granted anymore. Yoga is now a part of her daily routine. Gardening brings her peace. She spends her time colouring picture books and drawing sketches.

Her creativity is finding expression. Zaynah lives with Borderline Personality Disorder and writes a blog – Not a simple mind. Her life is not easy but it is a hundred percent authentic. She shares it generously. She is determined to help others. While Facebook constantly incites her to compare her life with that of others, she knows better. She can tell real from fake. She understands she is in recovery. It’s a zig-zag road but it’s good. Yes. All this learning at 26!

“Recovery isn’t about getting back to how you were before, it’s about building something new.” – Anonymous.

In the recording below, Zaynah talks to me about her diagnosis, her recovery and the changes in her life:

 

Day 952

A surgeon’s wife writes

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The Dark side of Doctoring is an insightful blog written by a surgeon.
The common themes that push doctors into dark despair are:

1.Loss of control.
2. Loss of support. 6am. Repeat.
3. Loss of meaning.

One would think that those who look after other people would know how to look after themselves and their colleagues. Not so at all.

Thank you Dr Eric Levi.

 

Day 951

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Who? The young. 

1 in 6 people is an adolescent. More than 3000 adolescents die every day from largely preventable causes, according to a new report from WHO and partners. That amounts to 1.2 million deaths per year.  Many key risk factors for future adult disease start or are consolidated in adolescence. Adolescent mental health and well-being are often overlooked.

In 2015, more than two-thirds of these deaths occurred in low- and middle-income countries in Africa and South-East Asia. Road traffic injuries, lower respiratory infections, and suicide are the biggest causes of death among adolescents.

Most of these deaths can be prevented with good health services, education and social support. But in many cases, adolescents who suffer from mental health disorders, substance use, or poor nutrition cannot obtain critical prevention and care services – either because the services do not exist, or because they do not know about them.

“Adolescents have been entirely absent from national health plans for decades,” says Dr Flavia Bustreo, Assistant Director-General, WHO. “Relatively small investments focused on adolescents now will not only result in healthy and empowered adults who thrive and contribute positively to their communities, but it will also result in healthier future generations, yielding enormous returns.”

Suicide and accidental death from self-harm were the third cause of adolescent mortality in 2015, resulting in an estimated 67 000 deaths. Self-harm largely occurs among older adolescents, and globally it is the second leading cause of death for older adolescent girls. It is the leading or second cause of adolescent death in Europe and South-East Asia.

“Improving the way health systems serve adolescents is just one part of improving their health,” says Dr Anthony Costello, Director, Child and Adolescent Health, WHO. “Parents, families, and communities are extremely important, as they have the greatest potential to positively influence adolescent behaviour and health.”

At long last, the world is waking up and so is the World Health Organisation.

Podcast:
In conversation with Meera S and Dr George at Business FM, Malaysia:

Doctor in the house: Adolescent Health

Day 948

Why Pinky?

My deepest thoughts are in Hindi. Only when I am in a hurry do I think in English. It’s my second language. A legacy of the Raj. Even though I have been using it for most of my personal and professional life, I need to constantly work at it. Being bilingual means one has 3 languages to have fun with – Hindi, English and Hinglish.

The English in the UK is different from the one I learnt as a child. That English was more a medium of education. As a teenager I started to enjoy it, especially through Tintins – billions of bilious blue blistering barnacles.

The usage of a language in its native country is very different from anywhere else. I had no idea what ‘Pinky’ was. For me it’s a person’s name, mostly a girl but could also be a boy. Little finger? Really? It would never have crossed my mind.

This notice in the loo on the train showed me the endearing way in which vernacular can be used : ‘Please don’t flush nappies, sanitary towels, gum, old phones, unpaid bills, junk mail, your ex’s sweater, hopes, dreams or goldfish down this toilet.’

‘Numpty’ is not quite the same as idiot. It has a particularly affectionate tone to it. Cute! Again, a new one for me. ‘Skulking’ is not as simple as loitering. It is, moving about shadily, with something to hide. It has a naughty/sinister connotation to it. ‘Four Weddings and a Funeral’ introduced it to me.

This evening I asked 2 English men their favourite word and both of them perfectly pronounced the same one:  Floccinaucinihilipilification.

Recently I was flattered to be asked to write an article for the charity Mind, about a simple coping mechanism that has helped me and can help anyone. I wrote about writing. This is how I grieve: Woes and Prose.