Day 944

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The Great Master

All I manage to read these days are short stories. Partly due to my abbreviated attention span and partly because the time has come when I ‘should’ start wearing reading glasses but I don’t. I get by, by increasing the font size and by reading for short periods of time. Also by squinting a lot.

‘The First Forty nine stories’ is a collection by the Nobel prize winner, Earnest Hemingway. In the preface he says, “In going where you have to go and doing what you have to do and seeing what you have to see, you dull and blunt the instrument you write with. But I would rather have it bent and dull and know I had put it on the grindstone again and hammer it into shape and out a whetstone to it, and know that I had something to write about, than to have it bright and shining and nothing to say, or smooth and well-oiled in the closet, but unused.”

After devouring the collection, I read up about him and was saddened to find that he suffered with depression and died of suicide. Here’s an example of the sensitivity and vulnerability of his characters and the simplicity of his story telling style. It’s called ‘Cat in the rain’.

https://soundcloud.com/user-474898075/new-recording-2

 

Day 936

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Born to run

“Patti will observe a freight train bearing down, loaded with nitroglycerin and running quickly out of track… she gets me to the doctors and says, ‘This man needs a pill’.”

 His new memoirs speak a lot about his long battle with depression. Bruce Springsteen had a strong family history of mental illness. He didn’t do drugs as a rock star which is unusual. He was afraid  they would unmask his genetic potential for insanity but he was already suffering  with serious melancholia.

On the therapeutic value of touring he says, “You are free of yourself for those hours; all the voices in your head are gone. Just gone. There’s no room for them. There’s one voice, the voice you’re speaking in.”

His wife of 25 years, Patti understands his illness. She helps him manage it. “A lot of his work comes from him trying to overcome that part of himself”, she says.

The media often reinforces negative stereotypes of people with mental illness, depicting them as inadequate, unlikable, dangerous, confused, aggressive and unpredictable. The Boss’s devotion to many progressive causes sharply contrasts that image.

Public stigma leads to self-stigma. It stops us from talking about mental illness and worse, ask for help when we are struggling. Patti was initially apprehensive about the book in which Bruce speaks openly about how years of depression left him crushed. It would be read by millions. But then, she saw the value in that.

I watched Bruce Springsteen in 1985 at a Live Aid Concert in Delhi. I was terribly envious of the young lady he invited on to the stage from the audience to dance with him.

Long live The Boss!

“In the day we sweat it out on the streets of a runaway American dream
At night we ride through the mansions of glory in suicide machines
Sprung from cages out on highway nine,
Chrome wheeled, fuel injected, and steppin’ out over the line”
H-Oh, Baby this town rips the bones from your back
It’s a death trap, it’s a suicide rap
We gotta get out while we’re young
`Cause tramps like us, baby we were born to run.”

 

Day 928

Metamorphosis

When something like this happens, it changes who you are and how you live your life. Your alignment with the universe shifts and you transform into an avatar of your former self. There are some similarities but huge differences.

I can’t remember what I used to be like.

Large swathes of my mental canvas have been rendered blank. Maybe it’s a defence mechanism. Maybe it’s the accelerated ageing process. Maybe shock and grief have gobbled up millions of my grey cells. Maybe part of my brain has mulched into pulp.

Whole new plantations have made an appearance in this barren space. I feel like I am going mad about MAD – making a difference. Writing was a miniscule and secretive part of my life but now it claims a lot of territory. I used to spend a lot of time and energy on my job. Now it takes up only a small part of my time. My job used to be satisfying and pleasurable. Now it sits in the back-ground. I find fulfilment in writing, connecting with people and volunteering my time to raise awareness of mental health issues.

Keeping Saagar alive through sharing his story seems like the most meaningful thing to do. Repeating his story as many times as it takes, to change things that need to change is of paramount importance.

Living in gratitude is the only way to live.

Last week I wrote this article sitting at the dining table in my parent’s house with the intention to mark the Mental Health Awareness week. Thankfully Huffington post published it today.

Thirty months on:

http://www.huffingtonpost.co.uk/sangeeta-mahajan/thirty-months-on_b_16412078.html

 

Day 926

AYA-5

Finally something wholistic. Is it?

Ayahuasca is a foul tasting, nauseating brown Amazonian psychoactive brew.

The name comes from the Quechua language where aya means soul, ancestors or dead persons and wasca (huasca) means vine or rope. One interpretation of the name is “vine of the soul” and another is “rope of death”. Of late more arguments are being made in favour of the former than the latter.

This Shamanic concoction has been the core of many religious, magical, curative, initiation, and other tribal rituals for millennia in the indigenous and mestizo populations of South America. They respect the brew as a sacrament and value it as a powerful medicine for physical and mental problems, social issues and spiritual crises. It is traditional medicine and cultural psychiatry.

During the last two decades Ayahuasca has become increasingly known to both scientists and laymen. Its popularity is spreading all over the Western world. People seeking improved insight, personal growth; emotional healing and contact with a sacred nature, deities, spirits and natural energies have given rise to the phenomenon of ‘drug tourism’.

In the correct therapeutic/ritualistic setting, with proper preparation of the user and subsequent integration of the experience, Ayahuasca has proven effective in the treatment of substance dependence and depression. The therapeutic effects of Ayahuasca are best understood from a bio-psycho-socio-spiritual model.

The first Randomised Clinical trial, led by Draulio Barros de Araujo at the Federal University of Rio Grande do Norte in Natal, Brazil has been published.  2 similar groups of 14 and 15 patients with resistant depression were randomised to receiving either placebo or the active drug. They filled out standard questionnaires the day before receiving their dose and 2 and 7 days later.
64% of patients who took Ayahuasca felt the severity of their depression fall to half. This was true for only a quarter of those who took placebo. The inference drawn is that Ayahuasca is better than placebo at least for the short term. More studies are required to see if the effects are sustained over longer periods.

Roughly 350 million people experience depression globally. Between one-third and half of  them do not respond well to medications. In addition to psychedelics such as Ketamine and Psilocybin, Ayahuasca is being investigated further as potential treatment for resistant major depression.

Ref:
Articles:
1. Therapeutic Potentials of Ayahuasca https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773875/
2. Rapid Antidepressant effects of Ayahuasca: http://biorxiv.org/content/early/2017/01/27/103531

Presentation by Draulio Barros de Araujo: https://vimeo.com/143399447

Day 878

Gary’s story.
The Last Word.
Work Under Pressure.

These 3 powerful videos appear on the website of Mates in Mind (MiM). Suicide kills far more construction workers than work place accidents.  MiM is a charitable programme to improve and promote positive mental health in construction. It has been co-founded by Health in Construction and British Safety Council.

At present, one in 6 workers in the UK is experiencing depression, anxiety or stress. 6% of the UK work force is made up of construction workers, that is 2.1 million people. Hence at any given time at least 350,000 people in the industry will be dealing with mental ill health and possibly feeling alone. Raising awareness and generating champions through modular training in that community means there will always be someone close by who can help or are dealing with similar feelings.

A recent article in the BMJ states 5 facts about the conditions in anaesthetic training –

Workload – Nearly all had stayed beyond their shift. Nearly two thirds (62%) said that in the previous month they had gone through a shift without a meal, and 75% had done a shift without drinking enough water.

Health – Sixty four per cent of the anaesthetics trainees thought that their job had negatively affected their physical health, and 61% thought it had negatively affected their mental health.

Morale – Poor work-life balance, the burden of assessment, career uncertainty, frequent rotations, and terms and conditions of service sapped their morale.

Patient safety – This had worsened due to lack of available hospital beds, staff morale, and staff shortages.

Burnout risk – 85% of these young doctors were at risk of burnout.

I think Mr Hunt can take credit for some of these issues.

Mate in Mind is a fantastic example for other industries to make a concerted effort to address the well being of their employees in these difficult and uncertain times.

Ref:
https://www.matesinmind.org/employers.html

http://careers.bmj.com/careers/advice/Five_facts_about_conditions_in_anaesthetics_training

Day 875

Why is the length of my mental to-do list directly proportional to my inability to get through it?
Because it encroaches on the functional capacity of my brain.
Our cognitive bandwidth is limited, like our current account. Constantly dipping into it reduces its ability to deal with the jobs at hand.

In Psychology, Zeigarnik effect states that people remember uncompleted or interrupted tasks better than completed tasks. This is a human phenomenon that is becoming more apparent in the present times of perpetual clock chasing.

In a recent article in the British Medical Journal, Tom Nolan, a GP says,
“As I run later and later, rather than completing the task straight away, I add it to my list —my brain’s equivalent of opening up a new tab. The later I run, the more frazzled I get, and the more opening up a new tab becomes the answer to people’s problems. Mrs Jones’s headache becomes a neurology referral instead of finding out what’s really going on in her life. Mr Jones’s headache also becomes a neurology referral. With a few more questions and a bit more headspace, I might have realised that the Jones’s have left their gas on.

The more tabs I open, the greater my sense of impending administrative doom. My system runs slower and slower… The longer they’re open, the less important they seem. That’s when it becomes a real problem and the errors and complaints start piling up.”

He feels that if each of his appointments were 15 minutes long, he could do justice to his patients and the paper work, thus reducing errors and complaints.

Ref:

Freeing up some cognitive bandwidth in General Practice: http://blogs.bmj.com/bmj/2017/02/17/tom-nolan-freeing-up-some-cognitive-bandwidth-in-general-practice/

Mental Bandwidth:
http://blog.handy.com/whats-all-this-about-mental-bandwidth/

15 minute appointments:
https://www.theguardian.com/society/2016/aug/28/doctor-appointments-15-minutes-bma-overweight-population

Day 864

This is a well-known story within medical circles. A few years ago, a patient was in the operating theatre to have his diseased kidney taken out. Everyone believed it to be the left kidney, except a medical student who said in a hesitant, soft and muffled voice that he thought it was the right kidney. No one paid him any attention and went right ahead to take the left kidney out. It turned out, that was the wrong kidney. The only person who was correct was the medical student. The person who suffered the damage was the patient.

Large organisations are hierarchical by nature. Decisions taken by those on top are rarely questioned by juniors. But true leadership means, the ability to challenge the status quo. The culture of an organization is shaped by the worst behavior the leader is willing to tolerate.

During their selection process, Google particularly look out for ‘courage’ in candidates. They prefer to hire people who ask the right questions and are not afraid to be open if they disagree with what is being said, irrespective of who says it.

The only way to improve is to be open. That is how we learn.

When was the last time I kept quiet when in fact I had something to say? When was the last time I didn’t have the patience to listen? What are the dynamics at my work place? Who pays the price for my silence or my inability to listen? Will I have the courage to speak-up the next time? Will I have the courage to listen?

“It is not because things are difficult that we do not dare, it is because we do not dare that they are difficult.” – Seneca

Ref: Just a Routine Operation (A short film about the importance of Human factors , one of them being assertiveness) : https://www.youtube.com/watch?v=JzlvgtPIof4