Dx: Depression. Maybe not?

Thoughts never stop. You think at least 6000 thoughts during your waking hours. Constant processing of data from both your inner world and the outer world – even minute details that you might not consciously register – generates thoughts.

Unless you’re concentrating on something, thoughts switch 6-7 times over 1 minute, and each thought creates a corresponding fleeting micro-mood. If you’ve had an unproductive, lousy morning it could be because the average of these micro-moods has kept your mood below the baseline-neutral one that you usually bring to work.

Your thoughts stay focused if you’re in problem-solving mode, or totally immersed in something, or meditating, and your mood remains stable. Otherwise, they come and go like puffs of wind and you go through finely nuanced mood changes that give a particular colour to the ‘I’ of the moment, like flag colours of different countries that are shone on monuments like the Eiffel Tower to mark an occasion.

Or, moods are like visible shifting sands on the beach, thoughts like invisible gusts of wind that cause the waves that shift the sands.

Sadness is a mood. It is a biologically designed response, like pain. It tells you that something hurts inside you. You can’t always trace the feeling back to a particular thought because the link between the thought-clip and the mood-clip often disappears instantly.

You might self-diagnose depression because you see no obvious reason for you to be sad. Actually, feeling blue, being in a funk, being down in the dumps, being in the doldrums, feeling low – describe these passing bouts of sadness better. They happen to everyone.

Sadness is the tube of black paint nestled in the midst of greens, browns, blues, reds, yellows and whites in the box. Mixed with any other colour in a small amount, it adds depth. Too much of it smothers the other colour out of existence. Nevertheless, it belongs on your emotional palette and underlines the importance of someone or something in your life. It is also the basis of necessary emotions like empathy and compassion.

Sadness is physiological, i.e. feeling sad is a normal response to a sad situation, unlike depression, which is pathological. We shouldn’t brand a patient with a label that signifies a ‘disorder’ when he has cause to be sad. Every low mood is not depression. But since ‘depression’ is used interchangeably with ‘sadness’ in common parlance, it is compromised as a diagnostic term, though it’s still in use.

Depression, unlike sadness, doesn’t tell you something is wrong, but falsely makes you feel something is terribly wrong, because it takes away your insight. It’s like too much black paint. The visceral howl that escapes when a patient chokes out, “Why can’t I be like everyone else? Why can’t I just be happy? It’s so-o-o-o hard . . . ” comes from the depths of her being. Her misery is agonizing as she fights to understand how and when the dark abyss yawned open in her inner world.

This is depression, not sadness. It is closest to the grief of bereavement, a deep sorrow mixed with a sense of irrevocable loss. Here, it’s the loss of the Self that used to be a happy, normal girl before the bouts of black moods set in.

According to DSM-5 criteria, Major Depressive Disorder is diagnosed if sadness has been present for more than two weeks, there has been a loss of interest or pleasure in most activities, physical exhaustion, inability to think clearly, marked changes in appetite, weight and sleep pattern, feelings of worthlessness and guilt, recurrent thoughts of death and suicide. At least five of these, along with the sad mood, have to be present.

So, intense sadness lasting over two weeks and adversely affecting a patient’s ability to deal with day-to-day activities, eat, sleep, work and engage with the world as expected, qualifies for a diagnosis of Major Depressive Disorder and is to be treated accordingly.

In practice, the DSM has to be used along with clinical judgment and common sense, and the context in which depression has occurred must be taken into account to plan sensible treatment.

Sadness and depression are not synonyms. Sadness lies within the normal range of human emotions and doesn’t need medicines, except perhaps a dose of a mild sedative if there’s accompanying anxiety, insomnia or crying spells. Whereas, depression often benefits from antidepressants – they take the edge off melancholy, reduce anxiety, bring a little clarity to thought, and improve sleep. They are given for only a few months unless depression persists over time.

Depressed people need to return to normal and we have to use all available resources to help them along. Medicines may not be effective all the time, but we need to get what use we can out of them.

That’s not all. The probable trigger, the circumstances in which the episode originated, the course it took, coping strategies used, have to be examined for treatment to be complete, and to find ways to recognize and limit the effects of future episodes. Resilience is built into the human mental make-up, and most people process the experience and find ways to make sense of it, and therapy might help tap into that natural resilience.

The DSM-5 criteria for the diagnosis of Major Depressive Disorder are not set in stone. They get revised every few years based on current research in the domains of genetics, epigenetics, stress (hypothyroid-pituitary-adrenal stress response), neurological biomarkers, neuromodulators, individual variables, and psychic and social processes.

Here are a few representative references from research articles on depression, but please note, they are only by people working in the field of mental illness. People in other fields like Philosophy, Sociology, Evolutionary psychology, Psychological anthropology and Religion have their own take on why people get depressed. And I think every individual has his own theory too!

There are 227 possible ways to meet the symptom criteria for major depressive disorder.

Zimmerman, 2015

The current criteria for major depression have been criticized for the heterogeneity of the clinical syndrome they define. The genetics and neurobiology underlying the depressive disorder still remain largely unknown.

Østergaard, 2011

Diagnoses, like many psychological terms, are concepts that refer not to fixed behavioural or mental states but to complex apprehensions of the relationship of a variety of behavioural phenomena with the world.

Rosenman and Nasti, 2012

Neuroticism, morning cortisol, frontal asymmetry of cortical electrical activity, reward learning and biases of attention and memory have been proposed as endophenotypes for depression.

Goldstein and Klein, 2014

Neuroimaging studies have identified that anhedonia, a core feature of major depressive disorder, is associated with dysfunction in reward and cognitive control networks.

Liang Gong, 2018

Links between specific depressive symptoms and areas of the brain have been identified, for example, crying with fusiform gyrus, irritability and loss of interest with hippocampus, worthlessness with cingulate gyrus.

Hilland et al, 2020

Data-driven studies have identified biological subtypes of major depressive disorder based on clinical features, biological variables, disturbed neurotransmitter levels, medication response, inflammation, and weight gain.

Beijers, 2019

But here’s the thing. One group’s research often contributes only one little fact to the existing body of literature on a subject. It might not have an immediate application, or none at all, ever. It’s like how water has been discovered on the moon and on Mars – so what are we going to do about it? For the moment, nothing. Maybe future generations will.

Depression needs a tighter definition to be useful as a diagnostic term. It is the outer manifestation of many different processes. Two examples:

  • Many people respond with a low mood to reduced ambient light, a condition called Seasonal Affective Disorder caused by a process that leads to decreased serotonin levels in the brain. This sort of depression, then, comes from somewhere else, not directly from thoughts.
  • Then, there’s depression associated with low motivation, a lack of interest in chasing goals, apparently because of low dopamine levels. This is controlled by the limbic system in the brain, so emotions influence the endocrine system and the autonomic nervous system first, then the person uses thought to figure out why he does not particularly want what he is supposed to, and gets depressed.

As the current diagnostic criteria are based on symptoms and not the yet-unknown cause of depression we use the diagnosis of Major Depressive Disorder to address symptoms. This way, the patient can get his life back on track to an extent.

So ‘depression’ has been reduced to the status of ‘cough’ or ‘fever’. Without knowing the cause of a cough or a fever, the only treatment given is a dose of cough syrup or an antipyretic rather than an appropriate antibiotic.

For depression, it is a course of an antidepressant, which is like giving a course of a broad-spectrum antibiotic because there’s no lab available to run a culture and sensitivity test – not the best, but a fair chance that it will help. This is not the ideal way to treat a life-wrecking condition.

We are constantly looking for ways to define and diagnose depression, but we aren’t anywhere close to giving an irrefutable statement of what it is. Medicines and therapy are the best we’ve got at present, imperfect though they both are. Tracing the history of depression from Melancholia to Depressive Disorder through the centuries shows that it has been a fraught journey, and still is.

and this is my robe, slightly singed

Narcissus, gazing at his image in the pool, wept.
A friend passing by saw him and asked, “Narcissus, why do you weep?”
“Because my face has changed”, Narcissus said.
“Do you cry because you grow older?”
“No. I see that I am no longer innocent. I have been gazing at myself long and long, and so doing have worn out my innocence”.

I don’t know where this passage is originally from. It was quoted in a novel I read in my twenties soon after graduating from NIMHANS as a psychiatrist.

Here, Narcissus mourns his loss of innocence from gazing too long at himself. I could relate to this feeling. As a post-graduate student of Psychiatry I often felt disconcerted by gazing too long into other people’s minds, then gazing into my own to fathom the meaning of what was going on in those other minds. Lectures, seminars and case conferences were also about much the same thing, as they had to be.

Studying the human psyche too closely can recalibrate the filters of one’s mind. I realised this when I stepped out of University into the regular world, because looking for layers of meaning had become second nature.

Like Narcissus, I keenly felt the loss of innocence.

*****

A couple of months ago I bought a book of poems by the Polish poet Wisława Szymborska from a tiny bookstore in New York, the sort where poetry books sit cheek by jowl with books on philosophy, history, geology and other things, crammed together without strict categorisation, exactly the way I like bookstore shelves to be. It leaves room for serendipitous finds like this one! I had never heard of Szymborska but the first few pages got me hooked.

I am halfway through the book now, reading one every two-three days, savouring each poem slowly. This is one I read last week.

Soliloquy for Cassandra

Here I am, Cassandra.
And this is my city under ashes.
And these are my prophet’s staff and ribbons.
And this is my head full of doubts.

It’s true, I am triumphant.
My prophetic words burn like fire in the sky.
Only unacknowledged prophets
are privy to such prospects.
Only those who got off on the wrong foot,
whose predictions turned to fact so quickly—
it’s as if they’d never lived.

I remember it so clearly—
how people, seeing me, would break off in midword. Laughter died.
Lovers’ hands unclasped.
Children ran to their mothers.
I didn’t even know their short-lived names.
And that song about a little green leaf—
no one ever finished it near me.

I loved them.
But I loved them haughtily.
From heights beyond life.
From the future. Where it’s always empty
and nothing is easier than seeing death.
I’m sorry that my voice was hard.
Look down on yourselves from the stars, I cried,
look down on yourselves from the stars.
They heard me and lowered their eyes.

They lived within life.
Pierced by that great wind.
Condemned.
Trapped from birth in departing bodies.
But in them they bore a moist hope,
a flame fuelled by its own flickering.
They really knew what a moment means,
oh any moment, any one at all
before—

It turns out I was right.
But nothing has come of it.
And this is my robe, slightly singed.
And this is my prophet’s junk.
And this is my twisted face.
A face that didn’t know it could be beautiful.

Having never formally studied poetry I don’t know how to critique a poem. If it speaks to me, that’s it, I read it over and over again and enjoy it for a long time.

One of the reasons I read poems is because the glimpses I catch from not being able to fully understand them make them tantalising, like an unsolved mystery, or an entrancing world spied through a lace curtain. I love the fuzziness of impressionist paintings for the same reason.

I hadn’t heard this story before, the story of Cassandra who was given the gift of prophecy but was fated to never be believed. Her triumph was only in knowing the future, because the predictions turned to fact so quickly. How frustrating that must’ve been!

Cassandra raving
Met Museum collection, impression from an 1852 reissue of the 1795 original

*****

It’s how I feel about mental illnesses like schizophrenia that can only be managed, not cured. So triumph is only in diagnosis, while the poor prognosis of the illness, sadly, turns to fact quickly. That goes for a host of physical diseases as well, not only psychoses.

Patients diagnosed schizophrenic often relapse because of missed doses despite the time and effort I put into explaining possible outcomes to the caregiver, with diagrams, with special emphasis on the need for regular meds. But there, that’s how it goes. I know how hard it is to care for someone 24/7, so I simply slip into damage-control mode, like the GPS in my car that merely suggests a different route when I miss a turn.

It turns out I was right.
But nothing has come of it.

Yet –

They lived within life.
Pierced by that great wind.
Condemned.
Trapped from birth in departing bodies.
But in them they bore a moist hope,
a flame fuelled by its own flickering.
They really knew what a moment means,
oh any moment, any one at all
before—

They lived within life. I admire their moist hope (which I take to mean either ‘alive’ or ‘tear-soaked’) that tomorrow will be better, their son’s new medicine will work better, they will soon see him going out to work like other youngsters, getting married, being ordinary. A flame fuelled by its own flickering. This, to me, is hope, not denial.

When they smilingly report an incremental improvement it seems they really knew what a moment means, any one at all before . . . Maybe not. Maybe I read the hope in their eyes that way, or they reflect the hope I convey, because I never give up until there are no options left and the disease inexorably settles into chronicity.

After all, schizophrenia is caused by a gene connected with the immune system, one that was meant to control the handling of invading organisms and cell debris, but has unfortunately been repurposed – wrongly – for pruning synapses of brain cells. The logical treatment for schizophrenia is still in the future, reducing current treatment to controlling symptoms and normalising the patient’s life to the extent possible.

Individual lines in the poem leap out at me like coded messages, exhorting me to look back at the years I spent working with patients, to ask myself if my voice was hard, and my caring ever seemed haughty because I had to school my expression most of the time.

Did I inadvertently make patients lower their eyes, make them feel judged by the impatience that crept into my voice when they fiddled with their doses? When I urged them to see the big picture, to look down on yourselves from the stars, did it come across as patronising?

And this is my head full of doubts.

This poem gave words to some of the feelings that swirled within me for the longest time, especially helplessness in the face of illnesses that could only be managed and not cured.

That’s the thing about Art and Poetry; they gently tap and feel and nudge around what lies dormant in your heart and, in so doing, shake loose a repressed feeling that has been sitting there like a stone in a shoe. They make you feel lighter – at least for a few moments – that you are not alone in your turmoil, that somebody, somewhere on earth, possibly living in a different time, has felt what you feel.

And this is my robe, slightly singed.
And this is my prophet’s junk.

My robe – my old lab coat – now lies folded in a corner of my wardrobe, unlikely to be used again since I stopped working some time ago. Books, notes, photocopies of journal articles, and more than twenty years worth of patients’ case files – my prophet’s junk – lie in a cupboard in my study, to be eventually shredded and sent for pulping.

The last two lines of this poem are harsh and bitter. I don’t know what to make of them. They bring up a completely different set of images in my mind.

And this is my twisted face.
A face that didn’t know it could be beautiful.

Cassandra’s inability to use her gift was due to Apollo’s curse, and the backstory has parallels in today’s world – of broken promises, misunderstandings, anger and retaliation. A significant number of women – and a smaller number of men – in bad relationships consider their life a curse and seek help for depression, anxiety, anger, insomnia, suicidal thoughts, breakdowns and other mental health problems.

Could any of us have come up with a solution for Cassandra’s predicament? I don’t think so, just as we can’t for some illnesses that can’t be cured, no matter how much we know about them.

*****

in passing

When we went to New York in spring we flew Ethiopian Airlines for the first time. There was a layover at Addis Ababa and the onward flight picked up passengers going to Lomé in Togo.

The man sitting beside me was Togolese. I confess I know nothing about Togo except that it is a tiny country sandwiched between Ghana and Nigeria, along with another small country. Ivory Coast? Benin? I asked him when we got into conversation later. Benin, he said.

When I asked what language they spoke in Togo I was surprised to hear it was French. I said, “ You all don’t speak anything else? I mean, what is your original native language?” He said, “They took away everything . . . the Europeans . . .” and shook his head sadly. I said, “Hmmm . . . They did that to my country too, but the English language they left behind has fortunately proved useful in some ways.”

I found out later – from the net – that they speak about forty different native tongues, but French is the official language. From 1884-1914 it was German; from 1916-1957 it was English and French as they were colonies of the British and the French. Togo was the heart of the slave trade in Africa. Now the UNGA has listed it as the saddest country in the world in its World Happiness Report. The meaning of his terse “They took away everything . . . the Europeans . . .” became perfectly clear in the light of what I learned.

As we approached Lomé he looked out the porthole in the fond way one looks at one’s child. Lomé did look pretty from the air – low buildings, many with blue roofs, lots of greenery, and no tall buildings at all. One wide asphalted highway ran down the middle of the city. Untarred roads of warm reddish-brown compacted mud crisscrossed the city. Maybe they were meant to let rainwater percolate down and recharge the water table.

When I got up from my aisle seat to make way for him to exit I said, “Your city looks so pretty – and I love the colour of the soil – is it iron-rich?” He said “No. Phosphorus – we have lots of it.” He smiled and gave a quick wave as he walked down the aisle towards the exit.

*****

We flew back home a month ago, again by Ethiopian Airlines. Same route in reverse: NY – Lomé – Addis Ababa – Bangalore. We landed at Addis Ababa in the middle of the night. It was cold, and we thankfully got into the coach for the 5-minute ride to the terminal.

I found a seat beside a young Togolese woman with a bright-eyed, smiling baby excitedly bouncing on her lap. The baby reached out and touched my arm with his tiny hand. I asked his mum how old he was. He had just turned eight months. She told me his name and he recognised it when I called him. I stretched my hands towards him and he crawled into my lap smiling his cherubic smile. It was nice that ‘stranger anxiety’ hadn’t set in yet, though it was due, I thought. Wrong! He immediately struggled to go back to his mum! I handed him back and wished her “Happy Mother’s Day” as that day was Mother’s Day.

I casually said kids grow up and leave home before you realise it, and she was lucky to have so many years ahead with this baby.

To my surprise, tears welled up in her eyes and she told me that she was visiting Bangalore for the baby’s medical treatment. He had a hole in his heart. I asked, “At Narayana? Dr. Devi Shetty?” She nodded. By then we reached the terminal and the coach stopped. As we left our seats and walked towards the exit I couldn’t think of anything adequate to say except express my hope that the surgery would go well and the little one would be fine.

She looked scared and doubtful, on the verge of tears. In a bid to comfort her I told her that Dr. Shetty was my senior in medical college and he was a good surgeon even then, and yes, I had watched him operate, so maybe she should trust he’d do his best, and try not to worry too much.

Now I hope Narayana Hrudayalaya lives up to my endorsement. I have no personal experience of the place to draw on, and the reputation of an institution or individual found online is not reliable. If you look me up, www.medindia.net will tell you I am an orthopaedic doctor, while another site gets my specialty right but says I have zero years of experience!

ruled by mercury

One morning, when I was walking around the lake near my house and thinking of nothing in particular, two unrelated streams of random thought intersected.

Why does the world seem to be constantly in turmoil? Could it have something to do with the zodiac signs of the men and women that run the world? Ha! That’s funny!! But, wait . . . aren’t there too many born under Gemini* in this lot? Just an impression – but I thought it would be fun to find out anyway.

Now, I don’t know much about Astrology except what I picked up from Linda Goodman’s Sun Signs and Linda Goodman’s Love Signs during college days. There were a couple of copies of each around and they were in much demand as everyone in the hostel used them as ready reckoners to figure out roommates, friends and boyfriends.

So I looked up the zodiac signs of people who routinely take the lead in world affairs.

There are three types of Signs:

  1. Cardinal – leaders
  2. Fixed – organisers
  3. Mutable – communicators

The world now seems to be run largely by people born under Mutable signs, i.e. Gemini, Virgo, Sagittarius and Pisces!

Among the G-20 nations, 9 are Mutable!

  • India, Modi – Virgo
  • China, Xi – Gemini
  • Turkey, Erdogan – Pisces
  • Saudi, MBS – Virgo
  • France, Macron – Sagittarius
  • Germany, Scholz – Gemini (Merkel is a Cancer, leader)
  • Italy, Draghi – Virgo
  • UK, Boris Johnson – Gemini
  • EU, Charles Michel – Sagittarius (represents EU at G20 summits along with Ursula von der Leyen as far as I know)

There are only 5 Cardinal signs in the G20:

  • Russia, Putin – Libra
  • Indonesia, Widodo – Cancer
  • Brazil, Bolsonaro – Aries
  • Canada, Trudeau – Capricorn, and
  • Argentina, Fernandez – Aries

Of these, two (Brazil, Indonesia) are born on the cusp, the 21st, and might not even be Cardinal.

The remaining 6 are Fixed signs:

  • Japan, Kishida – Leo
  • Oz, Scott Morrison – Taurus
  • S Africa, Ramaphosa – Scorpio
  • US, Biden – Scorpio (cusp, 20th Nov)
  • Mexico, AMLO – Scorpio, and
  • S Korea, Moon Jae-in – Aquarius

These people are supposed to keep things steady and may not lead change. Biden might’ve been more relaxed if he didn’t have the world scrutinizing his every move intently. He might’ve been more like pre-COVID Scott Morrison, or Moon Jae-in without the Kim factor!

It’s not surprising the G20 doesn’t come across as a cohesive, focused, pro-active group. There aren’t enough leaders in it, especially after Angela Merkel retired.

Now, look at Europe.

These 7 are ruled by Mutable Gemini:

  • Poland
  • Germany
  • Greece
  • Romania
  • Bulgaria
  • Hungary
  • Estonia

Gemini is also Trump’s sign, Pence’s too, also the late Gaddafi’s, and Xi’s and Boris Johnson’s, and IMAFT head Raheel Sharif’s.

The following are ruled by the other three Mutable signs, viz. Virgo, Sag, Pisces:

  • Spain – Pisces
  • Turkey – Pisces
  • Austria – Virgo
  • Switzerland – Sag
  • Portugal – Sag
  • Serbia – Pisces
  • Norway – Pisces
  • Latvia – Sag

That’s a lot of communicative leaders in Europe who may mesmerize people with their silver tongues but not necessarily lead their country anywhere, nor hold on to gains and keep things stable. You can expect some amount of drama and chaos with Mutable signs.

Tedros, the WHO chief who has been handling the corona pandemic, is also Pisces. So is Jens Stoltenberg, the present secretary general of NATO.

By the way, Teresa May and David Cameron are Libra, and so was Margaret Thatcher. Ursula von der Leyen, President of the European Commission, is Libra too.

Wang Yi, the tough-talking Chinese foreign minister, is Libra, so is the Kremlin spokesperson Dmitry Peskov.

Central and South America:

Only Chile and Guatemala have Mutable heads of state at present. Venezuela too, if you consider Nicolás Maduro President. Other than Costa Rica, all have presidents born under Fixed signs, and six of them are Scorpio – Haiti, Nicaragua, Mexico, Honduras, Paraguay and Ecuador. Scorpios are good at staying on track and getting people to toe their line.

I don’t know enough about these countries to say how they are faring under these leaders, but my Mexican friend says AMLO has been good for Mexico and is very popular.

The Middle-East:

8 countries are ruled by Mutable signs:

  • Iran – Sag
  • Iraq – Virgo
  • Saudi – Virgo
  • Turkey – Pisces
  • Kuwait – Gemini
  • Syria – Virgo
  • Qatar – Gemini
  • UAE – Virgo

Only 2 by Cardinal signs:

  • Israel – Aries (his predecessor Netanyahu is Scorpio; Benny Gantz is Gemini)
  • Cyprus – Libra

6 by Fixed signs:

  • Egypt – Scorpio
  • Oman – Scorpio
  • Bahrain – Scorpio
  • Lebanon – Scorpio
  • Palestine – Scorpio
  • Jordan – Aquarius

Again, a lot of Scorpios.

We in India have had our share of them during the Nehru and Indira Gandhi years, both Scorpio. Morarji Desai and I K Gujral were the only Mutable signed Prime Ministers we’ve had. Four of our PMs were born under Cancer, two Libra, two Capricorn, one Taurus and one Leo.

A preponderance of Cardinal signs. Our country loves monarch-types rather than those that cycle to work like Mark Rutte (Aquarius, not a conventional guy) of the Netherlands!

Right now, we have China, Nepal and Sri Lanka in our immediate neighbourhood ruled by Gemini. Aung San Suu Kyi is Gemini too. Imran Khan of Pakistan is Libra and General Bajwa is Scorpio. Interesting!

I haven’t looked at Africa, the SE Asian countries or all the countries formed when Yugoslavia and Czechoslovakia were fragmented; I’ve also left out places that don’t loom large in the daily news, like Kosovo, Moldova, etc. I don’t want to labour the point . . . This is, after all, not a serious in-depth study but a bunch of observations born out of idle curiosity.

I glanced through the zodiac signs of people who dominated the political scene in the seventies, i.e. the places we heard about frequently in connection with India. Here’s a sampling:

  • India – Indira Gandhi, Scorpio
  • Sri Lanka – Sirimavo Bandaranaike, Aries
  • China – Mao, Capricorn; Hua Guofeng, Aquarius
  • Pakistan – Z A Bhutto, Capricorn; Zia, Leo
  • Russia – Brezhnev, Sagittarius
  • Israel – Golda Meir, Taurus
  • Iran – Reza Shah Pahlavi, Scorpio
  • France – Georges Pompidou, Cancer
  • UK – Harold Wilson, Pisces
  • US – Nixon – Capricorn, Ford – Cancer, and Carter – Libra
  • Germany – Helmut Schmidt – Capricorn, Helmut Kohl – Aries, but Willy Brandt was Sagittarius

In other words, most of them were steadfast/rigid types, and not prone to being all over the place like the Mutable signs that now rule the roost!

Make of it what you will. I’m just a dabbler. I know the sun sign is far from the complete picture. For example, an astrologer would make something of the fact that Brezhnev had Aries rising, Obama has a Gemini moon, and Modi has a Scorpio ascendant.

And that’s why this is merely a light blog post and not a research article 🙂     

*Mercury, the ruler of Gemini, is the god of shopkeepers and merchants, travelers and transporters of goods, and thieves and tricksters in Roman religion. In Greek religion he is Hermes, the fleet-footed messenger of the gods. Mercury is also known as quicksilver, i.e. given to changing rapidly or unpredictably.

to be happy

I came across an interview from 2018, where the late David Graeber talks about his earlier book Bullshit Jobs: A Theory, that I hadn’t heard of until today, because that’s not my area of obsession, unlike his new title The Dawn of Everything: A New History of Humanity. This was recently released by his co-author David Wengrow, and I was looking for a review of it.

The interview is full of great insights, but this line especially jumped out at me:

David Graeber: “I think most people really do want to believe that they’re contributing to the world in some way, and if you deny that to them, they go crazy or become quietly miserable.”

Link:

https://www.vox.com/2018/5/8/17308744/bullshit-jobs-book-david-graeber-occupy-wall-street-karl-marx

What he says is a thought that has kept many of us awake nights at some point in our youth. To be happy we need to contribute to the world, we need to have a purpose so we don’t “go crazy or become quietly miserable”, as he says.

We are often told, “If you want to be happy, try to make someone else happy.” Ethical altruism.

For the longest time I accepted this. I believed it was the answer to the age-old question of the purpose of life. This truism dovetailed beautifully with my work as a doctor, so there was no dissonance. Over time though, I stopped being so certain that ethical altruism towards people – or animals as the case may be – was the only way for anyone to find meaning.

My faith in us as a civilisation has been shaken in recent years. Ignorance used to be bliss before Internet. Information was simply not available. Not anymore. It’s frustrating to have an abundance of information about something, say COVID, and still be ignorant because of the contradictions.

Though I know that worse things have happened over centuries past, I have lived most of my life in a period of peace and predictability in the world. The Cold War, and then a couple of wars involving India but restricted to border areas, hardly impacted me. Most importantly, news came only once a day, in the morning newspaper.

I visited many countries in Europe, North and South America, Africa and Asia in the eighties and nineties. Boarding an international flight was as simple as boarding a city bus, and it was all fun. The world was a friendly, trusting place overall.

Ever since oil- and terrorism-related events erupted in the world, the sense of safety that I used to have is gone. Now the world doesn’t even make sense at times. For example, I find things like prison-industrial complex and military-industrial complex pathological. Just thinking of their ramifications makes my head hurt.

With so much stacked in our favour as an advanced species, this is not who we are supposed to be. We can be so much better. Or I wish it were so – for the sake of my children’s generation.

Governments are squandering away human achievements of the last few hundred years by indulging in all sorts of brinkmanship. This needs to be fixed, but can’t be. The beacon has gone out in the UN lighthouse and the G20’s declarations sound like pipedreams. Sure, on an individual level a lot of people, including me, are happy with their lot.

******

I wrote this but didn’t hit ‘Publish’ because I was still mulling over what I had jotted down.

******

It’s Saturday. There is a weekend curfew on because of Omicron.

We decided to watch a movie. We picked one without reading reviews. Meryl Streep, Leonardo DiCaprio, Cate Blanchett, Jennifer Lawrence, and young Timothée Chalamet in a small role as well. It had to be a good movie, right?

Well, it was. Don’t Look Up is its name. But it left me with more of the same feeling, that we are wrecking the earth through greed and short-sightedness.

No more mulling. Hitting ‘Publish’ now.

lathe biosas

Another year begins. Another blip on the fourth dimension, the temporal dimension on which we can only move our three-dimensional selves forwards. There is no going back. Which means we live with awareness, so there’s no regret, no longing to go back to correct something.

Ever since I began delving into the geological history of Earth my world has become immeasurably larger and more ancient, more awe-inspiring, more precious. The sense of continuity the fourth dimension brings is indescribable. It’s a whole new perspective.

I see myself as a short-lived life form, just one of the trillions of creatures that routinely float across the earth’s surface like soap bubbles and disappear. Our lifespan of a few decades is nothing compared to the earth’s age of 4.5 billion years.

From the time COVID started, this awareness of deep time has become more intense. It’s become the wallpaper of my life. It informs every thought, emotion and judgment. But it’s also a sort of relief, like laying down a heavy load. So much is not in my hands. Not indifference, not nihilism, just que será, será.

Psychic numbing caused by the big COVID numbers of the last two years has added to the befuddlement created by elastic time, time that is marked by random corona outbreaks rather than by clock and calendar. I feel like a child looking hard at the sky to see where it ends.

So much has ceased to matter. Taking the narrower view of life, the health, safety and happiness of my family, friends and myself do matter, and I have been worried when one of them came down with COVID and I couldn’t travel to be there. Thankfully, a good friend, an infectious diseases specialist who lives in the same city, held the fort.

I have had minimal contact with other people for a long time now. Over these two locked-down/social-distanced years I have unconsciously withdrawn emotional investment in human beings and formed some sort of happy connections with elements of the landscape of Karnataka over many road trips and hikes during the last 15 months, like a series of mini peak experiences! If something goes out of your life, I guess something else takes its place, and life goes on.

Lofty boulder-strewn green hills, forests, smooth winding roads, wayside coffee shops, small towns, trekking trails, wild flowers, bird calls, hilltops, village temples, backwaters, clouds, hill shrines, flocks of farm animals, tiny rills and waterfalls in the ghats, the occasional squall, are like a screensaver in my head now.

I feel I belong with them more than I belong to Bangalore city. I’m very, very surprised by this realization. Life right now is like living in a child’s picture book! It’s like what people say about being invested in characters in TV shows that run into many seasons, and vicariously living those lives.

Day-to-day life is the same, though. Lathe biōsas* works for me. It’s quiet. It’s meaningful.

At my stage of life the present is the future that I had envisaged in the past. I’m here, in the future. This is it. I’m not interested in leaving a legacy of any kind when I depart because, for what? The kids are perfectly capable of making interesting and happy lives for themselves. As for the world at large, it has enough people leaving legacies; I have no such duty or wish!

Lots of people have helped make my life easier. For example, I don’t have to keep a cow in my building basement and milk it everyday as someone somewhere keeps cows, and the milkman gets me half a litre of milk every morning!

The dairy folk and the milkman are glial cells to my neuron, just as I am glial cell to someone else’s neuron. Neurons need support, protection and nourishment from glial cells for complex thought processes . . . We are all connected and need each other, like neurons and glial cells . . .

It’s unthinkable that glial cells were dismissed as packing material for neurons when I was a medical student . . . The universe is a network. Nobody exists merely as someone’s packing material or exclusive support; each one has an identity and is the nucleus of some other subsystem.

Yet, in my current state of psychic numbness, these nice people are only their roles, mere cardboard cutouts. I feel grateful for them, but wearing a mask means unseen smile and muffled speech, so it feels like a video call with a bad connection every time. I miss the warmth, wholeness and rapport of engaging with unmasked faces.

I hope 2022 will be different.

A happier new year to all!

*One meaning of lathe biōsas is to ‘live in obscurity, get through life without drawing attention to yourself, live without pursuing glory or wealth or power, but anonymously, enjoying little things like food, the company of friends, etc.

what if . . .

It so happens that the book I finished today, Chicago by Alaa Al Aswany, and the movie Dev Bhoomi that I had started watching two days ago and finished just now, set off thoughts that converged and kept me occupied all evening.

In both the book and the movie the main characters are in their sunset years, looking back at decisions taken decades ago to leave their countries for better lives. They yearn to go back to the point where the road forked and look at the one not travelled, to paraphrase Robert Frost.

In Dev Bhoomi, Rahul Negi returns to his Himalayan village after forty years and is met variously with wariness, hostility, relief and joy by the different people who used to be in his life before he left for the UK.

He appears so ill at ease, so displaced, aching, regretful, occasionally hopeful . . . A range of nuanced emotions flit across his face, consummate actor that Victor Banerjee is. A step taken at one point in his youth, and he is left thinking of the road not taken for the next forty years. What torture!

In Chicago there is severe confusion and regret regarding the path taken, the one that actually led to the dreamed-of success! The characters – of whom there are quite a few transplanted and homesick ones – go through identity diffusion, loneliness, and a sense of not belonging to either home country or adopted one.

Despite the stilted dialogue and the translated feel that never leaves you through the entire book, you appreciate the conflict between their intense nostalgia for the established societal rules that decide things for them back in Egypt, and the freedom that makes them frighteningly responsible for every decision while living in the US.

You face a fork in the road several times in a lifetime. You choose one. All the paths you couldn’t take are alternative lives you might have led. No matter which one you choose there’s only so much you can do in one lifetime, even if you max out your talents and abilities and make every second count, use every minute being productive. No route is guaranteed to be the right one; even in hindsight you can’t tell if any of the others might have been the right ones. And right does not mean perfect because some things will still go wrong anyway.

When I have the crazy urge to look back and “What if . . . ” about my choices, I ask myself what is it exactly that I hope to gain from the exercise. It’s pointless to dwell on what I could have done differently, because things have turned out well enough.

“What if . . .” is fine if I go into a pleasant reverie in an idle moment, in which case I drift lazily through my parallel universe, enjoy the change of scene, and come back recharged when I finally stop dreaming. Even when I hit the brakes, they work like Tesla’s regenerative braking, using that energy to charge my batteries!

negative effects of therapy

More people are in therapy now than a generation ago. Some benefit from it, some don’t. Not everybody is comfortable opening up to a stranger, something I totally understand, because I would find it hard to bare my soul to someone in the transactional way in which therapy occurs in practice. That is why I empathize readily and try to put patients at their ease. It is also why I feel for those who are mortified at the thought of opening up, and weep hot tears of shame after they do.

It was in 2009 or so that I began to notice that therapy had limitations. Sometimes therapy didn’t help a patient at all. Sometimes it created a new set of problems for the patient, usually interpersonal, which made me question what I was doing wrong.

At that time I could not find much useful research on why therapy might be ineffective or harmful. I went over the notes of my sessions and summarized their outcomes as honestly and objectively as I could, trying to figure out how therapy worked, or didn’t work, for different patients.

A combination of psychiatric medicines and psychotherapy using an eclectic approach benefitted at least 80% of patients. Some patients said their medicines were very effective and they didn’t need to know what was wrong with them, and that it was enough that I knew what was wrong with them!

But when patients did benefit from therapy, I was never convinced that it wasn’t only because I had seen many more summers than a lot of my patients had, plus I had looked closely at the inner lives of hundreds of people over the years. Then, was it more of experience and less of method that mattered? It’s hard to tell, because for a professional in any field, domain knowledge becomes second nature, something taken for granted.

Many types of therapy exist, with rigorous rules laid down for their practice. But I still see therapy as quite subjective because, no matter what a method is in theory, it finally passes through the medium of the therapist’s psyche and is influenced/modified by the person she is and the antecedents that made her who she is. It is not as simple as cooking from a recipe, though, in that too, the nature of ingredients can differ due to local factors and the final product can turn out different than what is expected.

***

As a psychiatrist I am expected to be neutral when a patient tells his story. But I have to separate the chaff from the grain in his jumbled outpourings, for which I have to judge what is chaff and what is grain. A certain amount of subjectivity creeps in right away. And every prompt and um-hum might seem a micro-judgment to him, regardless of my neutral tone and expression.

The deepest currents of meaning and knowledge take place within the individual through one’s senses, perceptions, beliefs and judgments . . .

This requires a disciplined commitment to remain with a question intensely and continuously until it is illuminated or answered . . .

– Clark Moustakas

Psychotherapy as a treatment modality is necessarily, inherently, a heuristic process for a psychiatrist attempting to tune into a patient’s frequency. She first has to put herself in his shoes to see where he is coming from.

I am well aware that I can fall prey to cognitive biases in this heuristic process: availability bias, confirmation bias, egocentric bias, framing, representativeness – and all sorts of unconscious ones besides. And, sometimes, I do. Just as judges do, despite having strict laws to base their judgments on, because judges are also human, and deal with the unpredictable doings of other humans. An investigative interview conducted by police to gather information can also falter if a suspect is hard to read, or ready to confess to anything he’s accused of, out of sheer anxiety.

There are  hundreds of variables in the complex therapeutic relationship between psychiatrist and patient that influence what is said and what meaning is taken. The patient is not a passive recipient of psychotherapy; he is a thinking person who is weighing what and how much he can tell his doctor.

Intuition, thin-slicing, tacit knowing and non-verbal communication are as important as what is being said. Sometimes I pick up on a tell and pursue it with surprising results, but cannot explain how that happened, not even to myself. If I were contributing data to an evidence-based study I would feel restricted because staying with a script would mean not following up important leads that I catch in the spaces between utterances, the non-verbal parts.

I have often been guilty of positivity bias and shown more optimism than a patient’s situation merited. I have had to check my inner Pollyanna several times when empathy and wishful thinking briefly eclipsed facts.

So, basically, I have to watch out for my own biases all the time.

***

I recently revisited the problem of negative effects of therapy after a 20-year-old girl told me that she had confronted the adults in her joint family about the sexual abuse she had been subjected to by a family member as a little girl. She had not wanted to, but an older cousin who had been similarly abused by the same person had convinced her she should. She felt exposed, angry and confused, because the adults ‘trivialized’ it – played it down – exactly the way she knew they would.

In the earliest years of my clinical practice I might have naïvely suggested exactly what the cousin had, with the expectation that her mother at least would support her. And I might have counted the unhappiness and anger she felt when that didn’t happen as some sort of ‘negative effects of therapy’.

Now, this young girl wanted to transcend that experience, build a successful career, so that the memory – and the perpetrator – became insignificant in her life. She didn’t want to talk about it. In fact, she said, “I will not be a victim and give him so much importance”. To deal with it in her own way was her prerogative; sometimes therapy means leaving well alone. True, time might never heal a wound completely, but neither might therapy.

***

There’s more literature published on the negative effects of psychotherapy now than what was available to me in 2009.

These are some of the negative effects of therapy listed by various researchers. Most psychiatrists encounter them and find ways to reduce their impact.

  • Worsening of symptoms: Symptoms can worsen temporarily in the first 2-3 sessions because old scabs may be peeled off, leaving old wounds exposed.
  • Treatment failure: The worst cases I have seen are those where someone unfamiliar with mental illness has failed to diagnose a psychotic break and has tried to reduce the patient’s agitation with ‘counselling’.
  • Emergence of new symptoms: Patients who present early in the course of a mental illness can develop new symptoms unrelated to therapy, e.g. obsessions being addressed in therapy could turn out to be prodromal symptoms of schizophrenia. Acting out, common during therapy, might be reported as an alarming new symptom, or worsening caused by therapy.
  • Heightened concern regarding existing symptoms: The line of questioning leading to a diagnosis can be unsettling for a patient. Explaining the biological or psychological basis of symptoms helps, also outlining what can be done, treatment-wise.
  • Suicidality: a patient treated for depression sometimes snaps out of inertia and finds the energy to plan and execute a suicide. So all involved – doctor, patient and the people the patient lives with – must be alert to signs. In some cases, depression might be the only visible part of a deeper disturbance, and the provisional diagnosis might not point to the possibility of self-harm.
  • Occupational problems: People sometimes function best on high alert, juggling multiple balls and deftly keeping them all up in the air, albeit at a steep cost to their mental health. If a patient is distracted from this hyperfocused state too fast with the intention of reducing anxiety, he might lose focus and drop all the balls, and this can cause serious problems at work. Therapy takes time.
  • Stigmatization: This can happen when a patient shares the fact of his treatment with people he believes are his wellwishers, but they use it to control him instead. He might be disillusioned  and need support to hold on to the gains he has made.
  • Changes in the social network: Self-awareness and insight are products of therapy. A patient might distance himself from toxic people and develop healthier social ties. This could have negative effects on his support system, yet be positive for his growth.
  • Strains in relationships: If a patient gains new perspectives and seeks a more equitable relationship, a close family member whose self esteem is tied up with his sick role might react angrily and put a strain on the relationship.
  • Therapy dependence: A clarification at the beginning that therapy will only be for a short time – the way a plaster cast is retained only until broken bones are healed – can pre-empt dependence.
  • Undermining of self‐efficacy: Some people fall in their own estimation if they see themselves as needing to be propped up by another person. A psychiatrist must watch for this and prevent damage to a patient’s self-image.

Recent studies have concluded that adverse effects occur in 5-20% of patients, and 50% of patients show no clinically significant change with therapy. Most of the published research is based on patients being treated by therapy alone. Since psychiatric treatment is a combination of phamaco- and psychotherapy, our patients ought to be doing better than what these numbers show . . .

***

Psychotherapy is not like fundamental Physics. It’s a human interaction, with all its imperfections. If anything, mental illness is closer to String Theory in its simplest form! Most psychiatric symptoms are an exaggeration of normal thoughts and feelings, like the vibrations of strings that make them look like particles. They can be toned down with medicines and psychotherapy.

Calling therapy an art would make the treated patient a product. Calling it a science would mean that a patient’s recovery is backed by strong measurable evidence and the results can be replicated in another patient by repeating the process. How is that possible, when each patient, his circumstances, as well as a therapist’s own inner life are all in flux all the time? The approach has to fit the need of the moment and a lot depends on the rapport between doctor and patient.

It is difficult to observe the effects of psychotherapy on patients – the way one might study the effect of heat on copper sulphate crystals – because the therapist factor greatly affects the process, as does the patient’s capacity for introspection and abstraction. For that matter, even pharmaceuticals do not have the same effect on every patient and, therefore, a list of  possible idiosyncratic side effects comes with every medicine.

Therapy is only possible because the experience of being human is common to all of us. We have all been there, or been somewhere like it.

‘It came upon her now, as it always had done: a happy flood of feeling, a wild unrest. This moment counts. This moment, and no other. That old man with a crutch, that woman crying, the boy with a spinning top, those lovers smiling: they were part of something known and shared and remembered, an oft-recurring richly coloured pattern. The child who fell in the gutter was herself and so was the the girl who waved from an upper window, “This was what I was once, I’ve been them all” – that aching heart, that burst of sudden laughter, those angry tears, that bubble of desire.’

– From Mary Anne, by Daphne du Maurier

So, the ability to synthesise the disparate facts of an anxious or depressed patient’s life into a cogent whole that he confidently recognises as a better and manageable version of himself is perhaps neither an art nor science. It is a perspective, or a skill, like the ability to do mental math like a whizz, or the ability to visualise a prospective movie frame by frame while reading a novel.

A psychiatrist ultimately uses her personhood as an instrument to empathise with the patient; she syncs her mind with the patient’s, then disengages herself to analyse the information objectively. It takes time, effort and a lot of introspection to get closer to the unachievable target, perfection, on the lines of ‘aim at a star and you’ll shoot high’. Even so, some unexpected developments – side effects – can occur in the process of therapy and must be dealt with as par for the course, the way we do with medications.

trekking around bangalore

We’ve been driving out to some of those pleasant places situated roughly between 60 and 100 km from Bangalore on some Saturdays ever since the lockdown ended last year. Driving down the smooth highways is as much of a pleasure as reaching the destination, something unthinkable ten years ago.

We start out around 6:00 a.m. and stop for breakfast on the highway at a place that has outdoor seating, and the waiters are masked. We keep our masks on, except when we are actually eating. Most often, no other table is occupied, so we are social distanced anyway.

A plate of piping hot idli-sambar, or a masala dosa, with a tumbler of coffee, and we are on our way to a memorable visit to some nice dreamscape. The Deccan plateau is dotted with hills strewn with massive boulders, that make for a climb that is neither easy nor hard, but just right to give us a great workout and a sense of achievement. The view from the top is enough to make one send up a prayer of thanks for being a Bangalorean! And the cool breeze up there? Heavenly!

There are no crowds at any of them, especially as we arrive before 8:00 in the morning. And we are back home by late afternoon, before Bangalore’s awful traffic starts jamming up the roads, after a scrumptious lunch at a restaurant on the highway. We normally make a game of spotting a good eatery and predicting the quality of the fare on offer before pulling over. We have never been disappointed!

Here are some snapshots.

Thottikallu falls: Bangalore Urban district, 35 km south of Bangalore

This was our first outing. We made the mistake of starting out late in the morning, and the place was crowded. Entry to the falls was restricted so we walked along the river and peeked at the falls from a distance. Actually, just being out in the open after months of lockdown was itself exhilarating enough for nothing else to matter!

*******

Shivanasamudra falls: Mandya district, 133 km southwest of Bangalore

Again, beautiful but crowded place, but large enough to keep a safe distance from others who, like us, were reveling in their new freedom. Shivanasamudra is like Nandi Hills – all of us Bangaloreans treat it like our backyard and drive up whenever we feel like running away from Bangalore’s noise and air pollution.

*******

Antargange: Kolar district, 64 km east of Bangalore

We climbed up many flights of steps that led to a small temple complex. Behind the temples was a trekking trail to reach the caves that Antargange is famous for. The climb involved feeling for hand- and footholds to clamber up and around rocks. It was between easy and moderate, very satisfying.

We didn’t go into the caves to avoid getting into unventilated spaces. Local people selling water, bananas and cucumbers along the way told us there were no corona cases there, but we kept our masks on and kept our distance.

*******

Kailasagiri: Chikkaballapura district, 77 km northeast of Bangalore

We reached Kailasagiri at 8:30 a.m. We were the only people there! We thought it might be closed, as it was a public holiday for Sankranthi. We looked it up online and found it would open at half past ten.

As we sat on a low wall not sure what to do, we saw motorbikes coming out of a lane every few minutes. So we went to check out what was up the lane and ended up walking uphill for 3.5 km.

The trail opened on to a flat wide space where there was a small Anjaneya temple that housed a stone slab with a 1000-year-old carving of Anjaneya. The temple archak told us it had been dug out from under a huge anthill and consecrated. A larger temple was under construction.

From this point one could climb up the rocky hill to a fort at the top but we decided to do that another time, as the trek under an overcast sky had been fulfilling enough for one day.

*******

Haddinakallu: Tumkur district, 104 km west of Bangalore

We parked at the base of the hill and learned from locals that we had to leave our shoes in the car and go up the hill barefoot as they regarded the entire hill as holy. There was a tiny shrine right there near where we parked, and one more a little way up, apart from the temple right at the top.

Feeling the ancient rough granite underfoot was nice, actually, despite the occasional pointy little stones I sometimes stepped on. There were no trees, no shade at all, so it was a tiring climb to the top. The view was as spectacular as expected. We could see our parked car so far below that it seemed like we would never be able to get back to it again!

Coming down, the granite underfoot was scorching hot and we tippy-toed to the car as fast as we could. It was a very hot day. Even the cold water we had carried in thermoses didn’t slake our thirst. We stopped at a sugarcane juice gaadi a few km down the road and I felt this was perhaps what amrit, the nectar of the gods, tasted like!

*******

Lepakshi: Anantpur district, Andhra Pradesh, 124 km north of Bangalore

Lepakshi is just across the Karnataka-AP border. There’s a temple complex built by the Vijayanagar kings in the 15th century. It is like Hampi on a much smaller scale and has the same super-peaceful Hampi vibe.

Lepakshi is where the bird Jatayu fell when Ravana attacked him in the Ramayana. Lord Rama tried to revive him saying “Get up, bird”, which is “Lepakshi” in Telugu. There’s a huge sculpture of Jatayu and a nicely maintained park around it.

On this trip there was no trekking or rock-climbing. Just walking through the ancient temple complex, then around the Jatayu Park and the nearby Nandi Park was nice. We came across unexpected little pockets of beauty: a small lotus pond, bougainvillea in every colour along the path, clever work by ancient stone masons where they had moulded the slabs to follow the contours of the hill on which the temple was built – interesting little things like that.

And there was a Hangyo ice cream kiosk selling the creamiest kulfi, most welcome on a hot Andhra day!

Achalubetta: Bangalore Rural district, 73 km southwest of Bangalore

Acchalu is a tiny hamlet, a cluster of 15-20 little houses. We asked a couple of women how to get to the top of the hill behind their village and they said, “follow the electricity lines”. Perfect directions!

We climbed up nearly to the top without meeting a single soul. It was unseasonably warm, so we decided to turn back a kilometer or so shy of the hilltop.

When we passed a flat-ish part of the trail I picked up a long straight stick and tried a ‘javelin throw’, wholly inspired by Neeraj’s Olympic gold medal! As someone who used to be a javelin thrower in high school I was thrilled to watch it trace a beautiful arc and land with its point hitting the ground. And when my kid shouted, “Ma, you threw so well!” I felt a surge of podium-level joy!

When we came down to the village the women we had met earlier asked if we had enjoyed the climb. They smiled broadly when I gave them a thumbs-up and said I’d love to buy a house in Acchalu and live there.

*******

Makalidurga: Bangalore Rural district, 58 km north of Bangalore

We asked the young couple next door if they would like to join us with their toddler. They were thrilled at the prospect of an outing where the little one could expend some of her boundless energy.

Luckily, the first part of the trek was a walking path, minimally inclined, not strenuous at all. It was fun watching the kid exclaim over everything she had been denied in her corona-controlled young life. She kept picking up mud and letting it slip out between her fingers, enjoying its texture. She ran up and down the trekking trail, then settled down on a large rock and began to seriously build cairns!

We turned back when we reached the part where we would have to negotiate rocky paths to climb uphill.

A railway track passed through Makalidurga and a pretty red train, a long one, went by, much to the little girl’s surprise and delight.

*******

Avani: Kolar district, 94 km east of Bangalore

The high point of the drive to Avani was the flame-of-the-forest trees in bloom in the near distance. We got down to take a closer look at one particularly beautiful one.

The legend of the Sita temple in Avani goes back to the days of the Ramayana. It is said to be the birthplace of Lord Rama’s sons Lava and Kusha. The many temples in the complex, as I understand it, were built in the 10th century by a Kannadiga dynasty called Nolamba that I had not heard of before.

As we were there for trekking I didn’t really take in enough of the history and architecture, something that I intend to do another time. The climb was worth it, though – good exercise, good view from the hilltop.

*******

Madhugiri: Tumkur district, 105 km northwest of Bangalore

The fort at the top of the hill was closed because of COVID. We strolled around parts of Madhugiri town near the fort and absorbed the town vibe, watching people go about their business. The feel of a town and city are so different, so it was a nice change from Bangalore.

When we came upon this crossroad a flurry of rapidly changing images rushed through my mind, of places I had been to as a child, villages I had passed through in more recent years, places I had seen in movies, scrambled with places I had imagined in History classes at school. There was a strange but pleasant sense of déjà vu.

*******

SRS Hills and Kootgal: Ramnagara district, 63 km southwest of Bangalore

We set out at 6 o’clock in the morning and stopped for a breakfast of thatte idli that’s famous around Bidadi. At Ramanagara we got off the highway and drove down a State road flanked by massive ancient trees. I took the wheel on this beautiful smooth winding road that took us through many, many little villages with names that seem to encapsulate a story.

Gollachennayyana doddi. Maybe this land was once owned by a cowherd/shepherd (golla) called Chennayya?

Petekurubanahalli. Was there someone from the Kuruba community who moved to the big city (pete) and prospered and was thereafter referred to as Pete-Kuruba, and then others started referring to his village by the name of its successful son?

We reached SRS hills at about quarter past eight. Like Haddinakallu, we had to climb barefoot but it was an easy climb up roughly hewn steps to the Siddeshwara temple at the top of the hill. And the trail was completely in the shade of a metal awning that extended all the way from the bottom to the top. The view was typical Ramnagara, comfortingly familiar.

As this had been an easy climb we drove another 20 km to Kootgal. In the eighties, a trekker friend and I had gone as guides with my younger sister and her friends to Thimmappanabetta near Kootgal on a night trek. We had had to put off the trek because local people told us there were bears about at night. So we had slept in the bus stand at Kootgal and walked to Thimmappanabetta in the morning.

Kootgal – 1980s

It looked exactly the way it did then! I was glad to see the immutable Kootgal rocks standing stolidly in a world where everything changes too rapidly for my comfort. From one side we got an aerial view of the neat little village of Kootgal.

Kootgal – 1980s

*******

Mandaragiri: Tumkur district, 62 km northwest of Bangalore

The Jain temple was closed due to COVID. We climbed to the top of a monolithic granite hill, an easy climb. We walked through the foliage and reached a lake where there were already a lot of people.

I saw a dog chase and catch a baby bird by its wing. The mother bird followed the dog, twittering anxiously. Without thinking, I chased the dog. The dog dropped the baby bird and dived into the undergrowth, and the baby bird flew away with its mother. Then the dog came out and hunted around for its prey and slunk away in disappointment . . . I was left with the unhappy feeling that I had intervened in something that wasn’t my business. Then I noticed that he had a collar . . .

*******

Avalabetta: Chikkaballapur district, 91 km north of Bangalore

We left home at 6:00 a.m. as usual and had breakfast on the way. Bright patches of flaming orange and yellow marigold fields flew past our windows every now and then, and we couldn’t resist pulling over once to admire them and take snaps.

At Avalabetta we parked the car in the area that has been recently cleared for parking cars and bikes because of it’s sudden popularity with trekkers. Then, on an impulse, we decided to stroll a little way down the narrow mud road leading to the next village. The surface was terrible but there was a rusty board saying the government planned to pave it . . . It really should get down to it asap. Villagers on motorbikes passed us every few minutes on our 2 km walk and it was obvious they were struggling to keep their balance, especially on the parts that were very much like scree, dangerously slippery.

There were little patches of wild flowers all along the edge, and tufts of lemon grass that had a definite citrus smell when I crushed a blade between my fingers.

After walking for 2 km we turned back and went to the beginning of the trail to climb the hill. It wasn’t very challenging as it was just a nicely paved road leading to the temples at the top. There was a Sunday crowd (that’s why we normally trek on Saturdays) so we kept our masks on and didn’t stay long.

At one point I stopped to ask a young couple coming down how much longer it would take to reach the top. It was a very short conversation (‘Where are you from?’ ‘Bangalore. And you?’ ‘Also Bangalore’) but the boy self-consciously inserted “we’re married.” I was astonished, but caught on fast enough to say, “Oh my, I’m not the moral police here!” They laughed loudly in relief but looked sheepish at the same time.

morning walks in bangalore

Citizens of Bangalore have been asking the government where the 20,000 crore rupees allocated for road improvement have gone.

Most have concluded that the money is being spent only on roads in the CBD, repairing and beautifying the same stretches over and over.

True.

Every morning, I walk down one of the beautiful sidewalks that stretch out in every direction from my lane, feeling selfishly grateful for the Smart City Project.

Coupled with our famed weather, mornings are wonderful, and walking 5-6 km is a cinch!

As the newspaper article only quotes disgruntled people I feel obliged to add my voice. As a satisfied citizen. I have waited for sidewalks for decades! Walking in other cities, from Los Angeles to Paris to Kuwait City to Ulsan, I have envied residents their pavements. Finally, now, it’s my turn to enjoy them!

These photos are going to be a record of this time, a time when beauty briefly returned to my part of the city, the short honeymoon phase before the BBMP, BWSSB and BESCOM will dig up these roads and sidewalks and leave their usual debris of jumbled cables, unused pipes, broken tiles and heaps of sand, cement and jelly stones interspersed with discarded paper cups and plastic water bottles left by workers.

The second picture, the one in the centre below, is of Primrose Road. This narrow lane was part of my route to work, but I always drove – even though it was less than 2 km – as there was no place to walk.

A lot of work still needs to be done. But each day brings some improvement, so I’m hopeful things will only get better.