World Mental Health Day observed at Calicut

Every year the 10th of October is observed as the World Mental Health Day as called for by the World Federation of Mental Health and the World health Organization. This years theme is "Making mental health a global priority; Scaling up services through citizen advocacy and action " The World Mental Health Day was observed at Calicut on 10tth October 2008 in a grand function organized at I M A Hall Calicut jointly by Institute of Mental Health and Neuroscience (IMHANS) Calicut, Kerala State branch of the Indian Psychiatric Society ()IPS) and Arogyakeralam (National Rural Health Mission). The function was inaugurated by Worshipful Mayor of Calicut Shri M Bhaskaran in a function presided over by Mr A Pradeep Kumar, MLA. Shri Radhakrishnan Master, Chairman of the Health Standing Committee, Kozhikode District Panchayat, Dr A Baburaj District Medical Officer and District Program Manager of NRHM, and Dr Mathew Nambeli, Coordinator of Pain and Palliative Care Society Malappuram felicitated on the occasion. Dr. Harish M T Assistant Professor of Psychiaatry and Editor of Kerlaa Journal of Psychiatry of IPS welcomed the gathering. Dr Roshan Bijlee, Research Officer at IMHANS proposed vote of thanks. Dr K S Shaji President of Indian Psychiatric Society, Kerala state branch delivered the keynote address focusing on reducing the burden of care givers by using community volunteers of the Pain and Palliative Care Initiative. He stated that IPS Kerala is willing to associate with this project and also in the long term community care of geriatric persons. Different models of community care were presented in the seminar that followed. Shri Johny from Jyoti Nivas at Vazhavatta, Wayanad presented his efforts in organizing long stay and rehab facilities by individual effort alone with little charity contribution later. The Malappuram and Balussery models were presented next. Here community care and rehab are being organized by collective efforts of Local Self Governance bodies with technical support of the Pain and Palliative Care Society. The District Mental Health Program model of Wayanad and Kannur was presented by Dr Krishnakumar next. Both of these are top down models implemented with financial assistance of Central Government by tertiary care institutions. Department of Psychiatry, Medical College Calicut is implementing the program at Kannur (Dr Harish M T is the nodal officer) and IMHANS is implemnenting it in Wayanad. Dr Krishnakumar, Director of IMHANS is the nodal officer. Mr. Baby from IMHANS presented the story of how the note book manufacturing unit was started as part of the rehab initiative by IMHANS from 1989 onwards.

Buddha, Gandhiji and Spillberg

A famous Professor of Psychiatry in Bombay used to narrate the story of Siddhartha Gautama to his fresh post graduates in Psychiatry (of course without revealing the name) and ask them "What will be your advice if such a parson is brought to you by his parents ?" Obviously it is difficult to give an accurate answer.
The concept of normality is based on statistical norms or conventions etc. A person whose thoughts and behaviors run contrary to these standards is at risk of being labelled abnormal.
I had read in 'Readers' Digest' long ago that the famous Hollywood director Steven Spillberg showed unusual behaviors as a child. He had a huge parakeet living in his room. Nobody except his grandma used to enter his room for cleaning or collecting dirty clothes. All of them were afraid that the bird will fly away. The room was untidy most of the time.
This and many other peculiarities might have given him several unusual experiences in childhood. All these might have contributed to his later creative work. (Later he was diagnosed as having Asperger's syndrome).

His grandma also remembers that the family was advised to consult a psychiatrist by many relatives and friends. She never allowed the parents to do this. She thinks this way she helped to protect his creativity. Is she right ? I have no answer. Is this why Americans use the term Headshrinker (shrinks !) for psychiatrists ?

Creativity and mood disorders.

The present understanding is that Type II bipolar disorder is the underlying disorder in creative persons. When depressed people tend to look back at life and the world with a philosophical outlook. Mind goes into an introspective attitude, analyzing everything with detachment. Such mental state may give rise to profound insight about everything. Later when they become hypomanic, there is increased energy and activity, thoughts race through the mind with extreme clarity and pace. Such state helps the writer to complete the creative work. It has to be emphasized that the severe form of mania is not compatible with this ability to control one's mind and produce works of art. This is why Type II Bipolar disorder is found to be more prevalent. Alcoholism could also be related to this. When depressed they may self medicate with this to improve mood state. During the hypomania it may be used to curb the excess energy and obtain sleep. Other than this, excess use of alcohol may occur as a hazard of being a celebrity. Many of these creative persons are as vulnerable to vices as any of us, if not more. Some think they have a licence to get away with any sort of behaviors, like some of our professional politicians.

Mood disorders

This is the second most serious mental illness after schizophrenia. There are two prototypes of mood syndromes. Mania is characterized by extreme and unreasonable cheerfulness. The person's mood is described as euphoric or elated. He has fat racing thoughts, fast and pressured speech. His activity level increases. In some cases the patient develops grandiose ideas, which reaches delusional conviction in some cases. The person may believe that he is of superior birth, has higher purpose and is chosen by God, or he may believe that he is wealthy and spend recklessly. This cheerfulness may suddenly shift to irritability, anger and assaulting tendency at times. Usually this occurs when relatives try to control the behavior by advice or other means. A milder version of the same condition is called hypomania.
Depression is the opposite extreme. I have already discussed about depression in an earlier post (The black cloud of depression - 09/03/08). Bipolar disorder is a condition which a person shows symptoms of mania (or hypomania) and depression at different times.
Depression can occur as a single episode or as Recurrent depression with multiple episodes. If such a patient develops mania or hypomania later, the diagnosis of recurrent depression changes to bipolar disorder. This condition is subdivided in to several subtypes. If the person get s episodes of both Mania and depression it is called Bipolar Disorder Type I. If he gets depression and hypomanic episodes only it is called Type II. There are many other subtypes but we need not go in to these at present.

Creativity and mental illnesses....

Rather than engaging in side wise discussion (by posting replies), I thought I will write another post. I thank Ajeesh for bringing up the most appropriate reference on the topic. There has been a paradigm shift in understanding the relationship between mental illness and creativity. Earlier most psychiatrists were of the opinion that schizophrenia and related conditions would be the underlying condition in creative people. The perceptual distortions and oddities made them think this way. Van Gogh is one such case in point. It was thought that he suffered from schizophrenia. This could also be due to the lack of proper diagnostic criteria and definitions for the major mental illnesses. The psychological theories dominant at that time may also contributed to this. I am speaking about the 19th century and first half of the 20th century.
Now all this have changed. Mental disorders are now diagnosed by fairly objective criteria and the age of impressionism in diagnosis is over. Most of the psychological theories have now receded to the realm of pseudo science (Thanks to Karl Popper et al and the behaviorists). Now there is fairly good consensus among psychiatrists that mood disorders, especially bipolar disorder is the most common condition found in creative writers and mass leaders. Alcoholism is another common diagnosis. Earnest Hemingway suffered from both. Tolstoy, Abraham Lincoln, Issac Newton etc suffered from depression. Winston Churchill, Beethoven etc suffered from Bipolar disorder. Our own Vaikom Muhamed Basheer also suffered from severe manic episodes with paranoid delusion.

Thinking. mentall illness...and creativity...

The most important events in our waking time are - maintaining alertness and choosing what to pay attention to, processing these inputs and associated feelings etc, thinking and planning, and finally responding by appropriate verbal or behavioral means. We are continuously preoccupied with one thought or another throughout our waking hours. But what is thinking ?
According to one definition It is a flow of ideas, symbols (words are symbols for objects or concepts) or associations (refers to connection between one idea and the next). Thought is usually initiated by a problem or a task, proceeds in a logical manner and results in a reality oriented conclusion. This type of thinking is called rational thinking which is the most usual mode of thinking employed by us. Such thought can also use the medium of combinations of sounds or colors as when a musician or painter makes his creations. But usually most of our thought uses the medium of language.
But we are also capable of many other types of thought. In fantasy there is no clear use of logic. Contact with reality may also be abandoned to some extent when one is in the mode of fantasy thinking. Creative writers use this mode for creating their tales or poems. But if fantasy thinking becomes excessive, or uncontrolled, or if it becomes the predominant mode, the person may have crossed over to the other side of the Line of control. Psychotics are unable to distinguish between these modes of thinking. A person with schizophrenia may be believing the irrational or subjective reality created by his mind and taking this as objective fact. (It has to be conceded that his genetic and environmental vulnerabilty also contributes to this state).
This may be one reason why madness and creativity were thought of as 2 sides of the same coin. In psychosis, the person is unable to perform reality checks to put his subjective world in order. A creative writer is able to utilise this gift of imagination in a controlled manner.In addition he also has good linguistic skills, vocabulary, the insight and empathy to understand the emotional world of others. Many of them have an open attitude and are bold to experiment with life and entertain unconventional ideas. I think it is this combination of many facets that makes a creative writer. It has to highlighted that emotional skills are as much important as cognitive skill for an artist.

Am I 'mentally normal' ?

Well, it is one of the most difficult questions to answer. Psychiatrists have to face this question frequently. We happen to see grossly abnormal, psychotic person asserting that he is normal; on the other hand many apparently normal persons approach us with the above question. The truth is that there is no absolute yardstick to measure whether one is normal or not. But this is so even in the most branches of biology.
We can define an average Indian male citizen as a person with X cms of height, Y kg of weight, Z color of skin, M color of eyes etc. But such a person may never exist in real world !. This normality is based on statistical calculations.
We may also define normality by other methods. All are presumed to be healthy unless found to have an abnormality or a symptom. This is a presumptive criterion used in community health.
Normality can also be thought of as an ideal or utopia. It can also be viewed as a dynamic state or as a process.
I am stressing this difficulty as I think it is important that we are aware of the limitations in judging others. With this background only we can start the discussion on mental health, illness, creativity and psychopathology.
We have to accpet that even the most normal of us can have certain queer or abnormal behaviors in some situations.

On lagging behind....

In continuation of the post on "We" lagging behind our brains, I am quoiting Dr. Vilayanur S Ramachandran's words on this subject. Please read on ....

"Now let's go back to normals and do a PET scan when you're voluntarily moving your finger using your free will. A second to three-fourths of a second prior to moving your finger, I get the EEG potential and it's called the Readiness Potential. It's as though the brain events are kicking in a second prior to your actual finger movement, even though your conscious intention of moving the finger coincides almost exactly with the wiggle of the finger. Why? Why is the mental sensation of willing the finger delayed by a second, coming a second after the brain events kick in as monitored by the EEG? What might the evolutionary rationale be?
The answer is, I think, that there is an inevitable neural delay before the signal arising in the brain cascades through the brain and the message arrives to wiggle you finger. There's going to be a delay because of neural processing - just like the satellite interviews on TV which you've all been watching. So natural selection has ensured that the subjective sensation of wiling is delayed deliberately to coincide not with the onset of the brain commands but with the actual execution of the command by your finger, so that you feel you're moving it.
And this in turn is telling you something important. It's telling you that the subjective sensations that accompany brain events must have an evolutionary purpose, for if it had no purpose and merely accompanied brain events - like so many philosophers believe (this is called epiphenomenalism) - in other words the subjective sensation of willing is like a shadow that moves with you as you walk but is not causal in making you move, if that's correct then why would evolution bother delaying the signal so that it coincides with your finger movement?
So you see the amazing paradox is that on the one hand the experiment shows that free will is illusory, right? It can't be causing the brain events because the events kick in a second earlier. But on the other hand it has to have some function because if it didn't have a function, why would evolution bother delaying it? But if it does have a function, what could it be other than moving the finger? So may be our very notion of causation requires a radical revision here as happened in quantum physics. OK, enough of free will. It's all philosophy!"
Splendid !.
But I salute the great Lord Buddha, who declared 2500 years ago. that the notion of our 'self' is an illusion (though he could not tell us the process behind this). In fact there is only moment to moment existence.

The Self

To start a discussion on self I am quoting from Dr V S Ramachandran, from his BBC Lectures. He says the sense of slf has 4 elements -

Emodiment or ownership - we experience our self as embodied in our body.
Continuity We experience ourselves as having continuity is time - past present and future.
Unity - Though undegoing diverse sensory and other experiences and doing many things, we experience a sense of unity. The 'me' doing all this is experienced as the same.
Agency - We experience ourselves as masters of our own actions, experiences and our destiny.

Please read on ......
V S Ramachandran.....
"But what about the self? The last remaining great mystery in science,it's something that everybody's interested in - and especially ifyou're from India, like me. Now obviously self and qualia are twosides of the same coin. You can't have free-floating sensations or qualia with no-one to experience it and you can't have a self completely devoid of sensory experiences, memories or emotions.
What exactly do people mean when they speak of the self? Its defining characteristics are fourfold. First of all, continuity. You've a sense of time, a sense of past, a sense of future. There seems to be a thread running through your personality, through your mind. Second,closely related is the idea of unity or coherence of self. In spite ofthe diversity of sensory experiences, memories, beliefs and thoughts,you experience yourself as one person, as a unity.
So there's continuity, there's unity. And then there's the sense of embodiment or ownership - yourself as anchored to your body. And fourth is a sense of agency, what we call free will, your sense of being in charge of your own destiny. I moved my finger. Now as we've seen in my lectures so far, these different aspects of self can be differentially disturbed in brain disease, which leads me to believe that the self really isn't one thing, but many. Just like love or happiness, we have one word but it's actually lumping together many different phenomena. For example, if I stimulate your right parietal cortex with an electrode (you're conscious and awake) you will momentarily feel that you are floating near the ceiling watchingyour own body down below. You have an out-of-the-body experience. The embodiment of self is abandoned. One of the axiomatic foundations ofyour Self is temporarily abandoned. And this is true of each of those aspects of self I was talking about. They can be selectively affected in brain disease".