hoping for miracles

Work has always been about food and safety since the beginning of human time. It still is for most people. But some of us have moved away from that basic premise and work to fulfill either our higher needs or unmet psychological needs. We tend to treat food and a safe home like collateral benefits.

At one extreme, Elon Musk says, “Why do you want to live? What is the point? What do you love about the future? If the future does not include being out there among the stars and being a multi-planet species, I find that incredibly depressing.”

I don’t deny that the launch of his manned rocket is a huge feat. It’s just unsettling to have news of his rockets and driverless cars juxtaposed with images of hunger and homelessness of millions caused by corona, then Amphan, Nisarga, Christobal and earthquakes and forest fires.

But then, everything else can’t stop just like that, right? So other things happening – like the launch of Falcon 9 with two brave people inside – alongside the march of the corona virus, worldwide protests against racial discrimination, and extreme weather events is just how life works.

Far removed from Elon Musk’s reality there is a lot of anxiety in the world of ordinary people right now. Anxiety, unfortunately, is not something that happens in a small corner of the mind. It involves the whole person. It can eventually cause high blood pressure, a heart attack or a stroke if it becomes chronic.

I think everybody knows most of this, but I’ll do a quick recap:

  • It starts with the eyes and ears observing and transmitting data to the back of the brain.
  • In a flash the information reaches the forebrain, which interprets it and sends it to the midbrain, the emotional part we have in common with lower animals, and we feel fear.
  • This sets off a cascade of stress-related hormones that course through the blood stream and whip the heart, lungs, guts and kidneys into action, preparing us for fight, flight or freeze.
  • So the heart beats furiously, blood pressure goes up, lungs pant out heaving breaths, sweat glands pour out sweat, the stomach churns, and there might be an urge to run to the bathroom, as all systems are in overdrive.
  • Within the brain itself, the hippocampus opens the folder of memories related to the current fear and reminds us how terrible it was the last time around.
  • And the amygdala computes the emotional value of the information and decides how awful we should feel.

Different neurotransmitters are released in the brain at each stage of information transfer. There are more brain chemicals swirling around in an anxious brain than the number of mind-altering ingredients in a glass of LIIT!

Anti-anxiety medicines stop this hectic activity and reduce restlessness, depression and confusion. I prescribe them if anxiety is severe, and only for a short time, because they cause dependence in the long term. So they are not a solution.

The mind of a super-anxious person is like a blast furnace. Somebody has to collect the slag, turn it into skid-resistant asphalt aggregate and use it to pave the rutted road of his life, and that’s what I do. I use the period of relative calm when a patient is on meds to sort out things through therapy – to some extent. So this is only a partial solution and that too, only for some patients.

I realize that one might learn all the mental gymnastics therapy can teach, but when there’s hunger and fear and creditors knocking on the door, autosuggestions to be positive might seem delusional. There is a limit to cognitive restructuring and trying to neutralize negative thoughts in the face of reality. And reality is so harsh for millions that therapy doesn’t even enter the picture; it would be like Marie Antoinette allegedly said, “let them eat cake”.

There isn’t always a simple solution, hence the number of corona-related suicides in the news. We need more than psychiatrists and mental health workers to reduce the suicide rate because people don’t kill themselves for the simple 2+2=4 reasons that relatives and friends usually give the police. Despair – a complete loss of hope of getting support – pushes people over the edge when a trigger like corona comes along and wrecks their fragile financial systems.

I hear from those who received regular rations from the Public Distribution System in the last four months that they were okay because they didn’t have to go hungry during the lockdown. That, and physical shelter, is what we didn’t give the migrant labourers who wound up walking across the country for thousands of miles to reach home.

As I said in my last post, we can’t control everything in life. The idea of God is a natural outcome of people having to deal with a difficult present and an unseen future, like now. Hoping for miracles is not that different from a therapist telling you to be positive in a hopeless situation.

I sometimes think that what people are going through is more like grief at the death of someone dearly loved than any other emotion. The new normal is an unalterable reality and we are never going to get back the life we knew and liked. There’s a profound sense of loss.

Those who depended on the gig economy in some way, including the migrant laborers who trekked across the country in thousands, are devastated. Even those who stayed afloat financially feel grief for the loss of a familiar way of life, mixed with relief and gratitude as in ‘there, but for the grace of God, go I.’

People who had slowly crawled out of poverty are mourning for the lives they had painstakingly constructed, rupee by rupee.

  • I talked with Kiran, a 23-year-old who works for a small event-management company putting up decorations at venues. No events, no gigs, no income.
  • Ashwini, a young assistant at a dentist’s office, has been on half-pay since her employer sees only occasional emergency cases due to corona risk.
  • Sunil, the barber near the market, shut shop just before lockdown and rushed back to his hometown. The owner of the general store next to the barbershop says he isn’t coming back now fearing institutional quarantine.

I don’t know how these people will rebuild their lives when this sad chapter is over. Maybe they are more resilient and stronger in spirit than I think. Mothers forget the intense labour pains of their first delivery and go on to have more children – my friend Mario’s mother had fourteen!

Viktor Frankl, the famous neurologist and psychiatrist, did a lot of meaningful work after surviving the Holocaust. He lived to be 92. Maybe the ability to forget pain – despite having every single memory stored somewhere in the brain – is a gift. It’s probably what keeps us going, because none of us go through life unscathed.

getting there

 

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My daughter got her first job a couple of months ago. Sigh . . . That part of parenting, raising a child from infancy to adulthood until she gets a degree and a job that she’s happy with, is over. The moral dilemmas around parenting are thankfully behind me.

Parents get a lot of flak for pushing their children to compete. When mine were in school I tried to dial down the pushing to ‘just do your best, it’s going to be fine’. There was no way I could raise my children in India and tell them not to worry about doing well in school if they were to eventually get into good colleges. The main thing was to keep it constructive and never stress them out with neurotic goals.

Competing is one way of channelizing aggression in a positive way. A little aggression is part of human nature, though the word is used in common parlance to mean uncontrolled anger and violence. Aggression is an inbuilt survival skill for warding off threats to our being, for protecting ourselves. As long as competition is coupled with good sportsmanship – in any sphere – it’s fine. Parent-induced angelic goodness doesn’t work in the tough world of children. It just makes the child timid, a target for bullies, instead of making her confident.

As a parent I was torn between raising my children to be ‘good’, and teaching them to be canny in a not-so-safe world. Somehow, sullying their innocent little minds felt like a crime. There was always a conflict between toughening them up, and leaving them vulnerable by keeping them blinkered against the unfair side of life. Over the years, learning from both, my own children and the kids and parents I met in clinical practice, I concluded that it was important to keep things real and be practical, sacrificing lofty ideals where they might do more harm than good. It was about finding a balance.

Frankly, I don’t think there’s ever been a time in human history, since the establishment of civilisations, when there was no competition. Competition has to be measured, though, and shouldn’t turn a child into the kind of insensitive go-getter that kicks and shoves everyone else aside to get ahead. So it is important to encourage cooperation as well: share, be nice, listen, wait your turn, say thank you. The world needs team players. Competition and cooperation, along with jugaad ­(resourcefulness) and duniyadaari (the art of dealing with people) are what we try to pass on to our children, along with formal education and soft skills. I might add – jugaad is much more than problem-solving skills, and duniyadaari is much more than interpersonal skills!

Despite our best efforts to give children a good education, 80% of Indian engineering graduates have been declared unemployable by the National Employability Report 2019. Eighty percent! This is a statistic that has bothered me ever since I saw it. I find myself thinking ‘there must be some mistake – this is unbelievable’. How hopeless it must make those young people feel, after struggling for years to get into college and graduate with a decent GPA. The thinking among educationists has recently shifted from STEM to STEAM, including Arts in Science colleges, something that will hopefully help our youngsters gain the necessary soft skills. More importantly, we need to raise the standard of college education so new graduates are work-ready.

As a psychiatrist I have seen the despair of unemployed people at close quarters. The only way I can think of preventing despair and self-harm, frequent concomitants of being unable to support one’s self and dependents, is to raise children to be resilient. This is what parents could do during children’s school years if they weren’t themselves putting undue pressure on children to get impossible grades and build incredible résumés. Resilience training has been tried in a few Indian schools and published articles are available.

It’s also important to teach kids to deal with failure. This is not as hard as it sounds. Every child fails at something in his twelve years at school. I used those experiences as opportunities to let my children know it’s normal and acceptable to fail sometimes. Through 2015-2016 there was considerable interest in studying the benefits of failure and there is plenty of information available online. The main thing is that parents and teachers must respond to a child’s ‘failure’ with constructive comments and not shame or guilt the child.

Education is a vexed topic in India. I have read through portions of the draft of the New Education Policy. It seems good, at least on paper. The part about vocational courses especially caught my attention. If vocational courses are taught in a truly practical way, like Germany’s dual VET (Vocational Education and Training) system, they might be the answer to some of our unemployment worries. Obviously, vocational training must guarantee employability, and the jobs youngsters get after vocational training must be remunerative enough.

Last month I had a conversation with a friendly young waiter at a restaurant. He was from a small town in north Karnataka. He said that boys with engineering degrees in his hometown were not able to get jobs, so he decided there was no point wasting time and money on college. I asked him what he might be doing, like maybe five-ten years from now. He said he and his brother – who was also working at a restaurant – were planning to start an eatery of their own. I don’t think that’s a bad idea at all if the alternative is a college education that confers a degree but can’t get you a job.

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Life Skills are apparently being taught in schools to help kids navigate life better, like avoiding taking up careers they have no aptitude for. These are the ten Life Skills listed by the WHO:

  1. Decision making
  2. Problem solving
  3. Creative thinking
  4. Critical thinking
  5. Effective communication
  6. Interpersonal relationship skills
  7. Self-awareness
  8. Empathy
  9. Coping with emotions
  10. Coping with stress

To this list I would add basic cooking, sewing (at least hemming and back-stitch for mending and minor alterations, and how to sew on buttons), doing laundry, riding a bike, and managing money, if I didn’t think many young people would scoff at their redundancy! I guess people have to individually decide what ‘Life Skills’ mean to them, but these are what I tried to equip my kids with before they left for college.

 

 

 

 

 

 

 

 

 

 

 

 

 

Despair

I first heard the word anomie when I was a postgraduate student. A little French word that described a profound feeling of disconnect that people experience when life goes so out of control that it starts to feel meaningless.

I remembered the ‘meaning of Life’ discussions with friends at undergrad college. None of us had read the philosophers; nobody did anything but study science in the years leading up to medical college those days. Some of us had heard of nihilism, but we didn’t subscribe to that. We had been brought up to believe that God watched over us, and there was a reason for everything that happened. For that reason we didn’t despair; we soldiered on with a ‘que sera, sera’ attitude.

Newspapers now frequently carry stories of teenagers taking their lives out of ‘despair’. And readers anxiously wonder why this is happening to our kids.

In the nineteenth century a French sociologist, Emile Durkheim, used the word anomie to describe the feeling of alienation, the disconnectedness that one feels when there is a mismatch between a personal goal and a social one. There is a breakdown of social bonds between the individual and his community.

This, I suppose, is what those youngsters feel: expectations from parents and society are either different or higher than their own, filling them with despair and a sense of failure, with no inner strength to deal with it.

If a kid who wants to be a pilot is forced to take up a course in Medicine, what happens to his personal goal? Won’t he feel isolated from his classmates who are obviously passionate about Medicine? Won’t he feel a disconnect with himself, his own identity, and ask “Who am I, really?” How does the future look to him?

If a kid growing up in poverty wants to get rich but can’t get admission into a college to fulfill his dream, won’t he feel a lack of meaning and direction? Won’t he feel lonely, desperate and angry? One can quite imagine why some youngsters get talked into get-rich-quick schemes and have run-ins with the police. Strain Theory, based on anomie, explains it as a discrepancy between common social goals and legitimate means to attain those goals.

In recent years norms have changed. There was a time when it was usual for a child to pray before leaving for school. No one does that anymore. Most city children don’t anyway. A child never gets a chance to learn how to connect with his innermost self every day, for that’s what prayer is partly about: connecting with and learning to believe in ourselves, deriving strength from a benevolent God who we imagine is watching out for us. Over the years a source of strength is lost, leaving . . . what? When a teenager encounters a setback in school or college and ends his life because he can’t deal with it, we are shocked. How did he become so fragile? Shouldn’t he have been more resilient? Shouldn’t he have been stronger?

The German philosopher Frieidrich Nietzsche said that belief in God acts as an antidote against nihilism, against despair, against meaninglessness. Why is Moral Science no longer taught in schools? In our country we have never had difficulty dealing with dichotomies; though we give science its due, we believe in a force beyond science too. We start scientific seminars with five dignitaries lighting a lamp, and having someone sing an invocation to God to ensure the seminar’s success!

Emile Durkheim also said that traditional religions provide the basis for the shared values that an anomic person lacks. These values give him a sense of rootedness, a connection with his community, and a faith in God, so he has both people and God to reach out to in a crisis. He doesn’t sink into the terrifying emptiness that is anomie.

Over the years I have received phone calls, mostly in the middle of the night, from young patients on the verge of giving up on life. Each time I’ve sensed that they are in a place beyond depression, an empty place where nothing seems to matter. They cry in such anguish that I know it must be very, very frightening. I imagine anomie feels like being all alone in a rudderless boat on a rough sea, in complete darkness, the oars already yanked out of your hands by the wind long ago.

The American philosopher, George Santayana described faith as that ‘splendid error, which conforms better to the impulses of the soul’. He apparently wrote this when he mourned his loss of faith. Faith may be unscientific, but so what? As long as it works when a kid needs it. . .

Encouraging a child to have faith in God may help him through the tender adolescent years when he needs support. As I’ve said elsewhere in my blog, religion can be seen as a scaffold to stand on while he’s building his value system brick by brick; he may discard it when the stronger structure of his adult personality is firmly in place, if he wants to.

Note: The paintings in this post were made by two young patients of mine to express their sense of isolation, despair and inability to control what they were going through.