Breathless: A silent short film on Anxiety

Anxiety is a common emotion; everyone experiences it.  It is natural to feel anxious when you are called upon to perform in public, meet new people, visit a hospital, meet a deadline, etc.  

So, when does it become a problem? 

As therapists, we look at the quantity and quality of anxiety.  In other words, anxiety becomes a problem when the duration of symptoms exceeds far beyond what is expected, or when the quality of life is affected.  For example, if anxiety persists even after the provocative task is completed, or even after the stressful issue has been resolved, then it can be a problem. 

Further, if the anxiety worsens so much that a person is paralyzed with stress/fear, and is unable to complete the task, or go about his/her daily routine, then too, anxiety can be unproductive.  It then progresses from common anxiety to an anxiety disorder. 

Anxiety disorder manifests in many ways: panic attacks, generalized anxiety, fear of objects/situations (phobias – commonly agoraphobia & social phobia), stress following a traumatic event (post-traumatic stress disorder - PTSD), repetitive thought & actions (obsessive-compulsive disorder - OCD), etc. 

In this short silent educative film, the following conditions have been depicted:

Credits
Featuring: Aadya Pawar
Writing/Direction/Editing: Deepak Pawar

[Currently only showing in Festival Circuits]

Panic attacks: Brief spells of intense dread with physical symptoms such as breathlessness, palpitations and tremors, and psychological symptoms such as feelings of losing control/dying and sensation of body/surroundings altering in shape/form/colour. It is annoyingly repetitive and can occur even without provocation.  That is, even when the person is not doing anything stressful, when he/she is at home, or in peaceful surroundings.  It may occur on its own or in combination with any of the other anxiety disorders. 

Agoraphobia: Fear of becoming stuck in an inescapable situation, such as in crowds, buses, lifts, etc.  The individual may become homebound in severe cases; that is, he/she may not leave the place of safety – usually their home – at all.

There can also be other specific phobias: social phobia – inability to meet people/perform in public; fear of spiders (arachnophobia), snakes (ophidiophobia), injections (needle phobia), etc.

PTSD: Feelings of intense reliving experiences after a traumatic event; even though this is a stress-related disorder, anxiety and depressive feelings occur quite commonly in this condition, and the person may become homebound as he/she avoids getting into a similar situation.

OCD: Unwanted, repetitive thoughts/images/urges that cause distress (e.g., hand contamination), which is relieved by doing a compensatory act (e.g., handwashing).  This can be a highly disabling condition and affects the quality of life of both the sufferer and the carer.   

In this film, I have intermittently added imagery pertaining to anxiety-provoking objects/occurrences (traffic, spiders, snakes, natural disasters, flight turbulence, injections, accidents) to illustrate the variety of stimuli that can cause anxiety.  The film ends with a series of noises that can be most annoying to the human ear, and can therefore precipitate or worsen anxiety.

The purpose of this film is not to scare you, but to accurately depict the above conditions, so as to facilitate understanding of the nature of anxiety and its many triggers and manifestations.  I hope this helps medical/psychiatric students, patients, carers, and interested lay viewers to better understand anxiety disorders and seek timely professional help, where necessary.

As ever, I invite your constructive feedback and comments.  Please rate/review Breathless on IMDb.

Please read these earlier articles to know more about OCD, and stress.

For a more professional lecture on stress and anxiety disorders, please see the video link in this post.

Film festival selections for Breathless: 

1. Lift-Off Global Network First-Time Filmmakers Sessions:

https://liftoff.network/ft-filmmaker-sessions-may-2022/

Resources/references:
'Worry' quote: psychcentral.com

Book conversations: In the Shadow of Death

Through this book, the retired Director General of Police (Karnataka CID), Mr D V Guruprasad, presents cases of convicts on the death-row, with the hope of discerning the mental state of such criminals.  As he writes in the Preface, he was inspired by his encounters with late-stage cancer patients who experience hope, denial and depression in varying measures.

Mr Guruprasad has taken the trouble of interviewing several death-row convicts, some of whom have committed the most heinous crimes possible.  Of the many convicts that he meets, fascinating stories of eight are presented in this book, along with their post-crime mental state.  If not for anything, the individual stories presented in this book are themselves worth your time.  Though reprehensible, it is an eye-opening experience to find out about the extent to which one individual could stoop to, to get what he/she wants. 

Before I go into the discussions of the contents of this book, permit me to digress a little to talk about the psychosocial aspects of the criminal mind, which have a bearing on the contents.

Many of the criminals, and a majority of the prison population, would qualify for a diagnosis of Antisocial Personality Disorder (ASPD).  Therefore, it would be prudent to remind ourselves about the diagnostic criteria for ASPD before we proceed further. 

[Note: These criteria are according to the Diagnostic and Statistical Manual Version 5 (DSM-5) devised by the American Psychiatric Association for arriving at the diagnoses of mental illnesses.  There is also the International Classification of Diseases Version 10 (ICD-10), devised by the World Health Organization, in which ASPD is termed Dissocial Personality Disorder, but the diagnostic criteria are  largely similar to those of DSM-5].

ASPD is characterized by a casual disregard for, and violation of others' rights in all social situations.  This is indicated by 3 or more of the following:

• Failure to follow social norms and law, indicated by repeated illegal acts leading to arrest.
• Deceitfulness, indicated by lying, use of aliases, or conning others for profit/pleasure.
• Impulsivity or failure to plan ahead.
• Irritability/aggressiveness, indicated by fights/assaults.
• Reckless disregard for safety of self/others.
• Consistent irresponsibility, indicated by failure to have gainful employment or to meet financial obligations.
• Lack of remorse, indicated by indifference or rationalization (explaining away) of problematic behaviour.

The above features should have started before 15 years of age, but the diagnosis of ASPD is made after 18 years of age.  This means that there could be precursors to troublesome behaviour even in the early developmental period, which often go unchecked, leading to the eventual ADHD in adulthood.  It is worth noting that a majority of the individuals with ASPD are men.  

One might also add loss of empathy (inability to understand others' feelings/suffering), and loss of insight (inability to fathom one's own problematic behaviour and accept help/treatment for the same).  Non-empathetic behaviour implies that individuals with ASPD see and treat other people like inanimate objects that they can abuse for their own personal gain.  

Further, loss of insight means that they fail to understand the gravity of crime committed by them and instead apportion the blame onto others (this is qualitatively different from the loss of insight one sees in psychotic conditions such as schizophrenia, in which the individual firmly adheres to the delusional belief in spite of evidence to the contrary).  Put simply, for individuals with ASPD, the whole world is at fault, except themselves.

However, crime does not always have to be due to underlying ASPD.  In many cases, crime occurs due to the complexities of the human mind; its hypocritical, sensitive and inconsistent nature that renders it vulnerable to exaggerated reactions to trivial provocations.  Since most of us interact with the world through our ego, or the lower self, our interactions are laced with deep disappointments and resentment due to unmet expectations from others around us.  

In the oft repeated nature versus nurture debate, it is important to remember that in the context of human personality, both are important.  Of course, there could be genetic and hereditary influences on deviant personality, but if the upbringing is good, and the early childhood environment is conducive to good psychosocial development, the adverse effects of genes could be mitigated to some extent.  I have documented this in an earlier work on a family whose many members had mental illnesses, with the sole exception of an elderly matriarch who displayed remarkable resilience and fortitude in handling the situation amicably.  

Spiritually, it is said that the karma we bring with us to our human existence compels us to behave in ways that can generate more karma, good or bad.  We can use our free will to act and behave in ways that can minimize the effects of bad karma and enhance the possibility of accruing good karma.  However, in reality, unless one is an advanced seer, this is easier said than done due to the effects of mind/ego.  

We easily forget that nothing and nobody is under our control; we forget we need to accept people for what they are, and that it is okay for others to behave contrary to how we would in a given situation.  The mind with its ego rules over us, compelling us to behave in often unproductive and even harmful ways.  ASPD and other personality disorders happen to be products of the vagaries of the human mind/ego, and indeed, bad karma.  

With this background, let us now delve into the individual cases presented in the book briefly (these are my personal views on these cases without any spoilers; for more specific details please read the book).

Rohan: He can qualify as the Ted Bundy of India, although the latter is said to have been even more creative in the violence he inflicted on his victims (please see films on Bundy, such as Extremely Wicked, Shockingly Evil and Vile, 2019).  Rohan befriended women and made away with their valuables after killing them.  

I was struck by the extent of gullibility of all his female victims who fell for this ploy.  Indeed, this is one of the enduring mysteries of our existence: like moths drawn to fire, seemingly smart women blindly trust conniving conmen to the point of self-negation.  Even if they survive, they continue to live in abusive relationships, something that can perhaps be explained by the psychological phenomenon of learned helplessness - giving up trying to escape an adverse situation even when escape is possible -  which I have observed in abused women that I have seen in my medical practice.

The Dandupalya gang: There appeared to be interesting group dynamics within the gang, alternately bickering and uniting with each other, opportunistically.  They were probably bound together by the common cause: crime, and escaping the consequences of such crime, which gave a cultish feel to their gang.  At least one member of the gang displayed the tendency of getting high on killing others; a fascination for the act of murder and bloodletting.  Given the multiplicity and the heinous nature of their crimes, it is appalling that the otherwise disparate group stuck together in the vehement denial of its wrongdoing, and one of the reasons for this appears to be the shared loss of insight described under the ASPD criteria above.  

Pushpa: This a rare case of female ASPD, with the additional problems of insatiable greed, and an inability to stay away from the act of murder, ostensibly to steal the valuables of victims, but really, I suspect, due to an addiction.  As in the gang above, any action that activates the reward mechanism in the brain (any action that triggers dopamine release in certain brain areas resulting in pleasurable emotions), can result in the individual becoming dependent or addicted to it.  

Be that as it may, her modus operandi was particularly problematic because she took advantage of her victims' vulnerability and conducted sham religious procedures to gain their confidence and kill them.  Fakery such as Pushpa's leads one to cast aspersions on even genuine practitioners of Sanatana Dharma.  Besides, her actions play right into the hands of the so-called rationalists who have a particular predilection for venting vitriol on Hindu rituals.   

Mahesh: Who said that big burly men do not cross-dress?  Yet another case of ASPD, Mahesh yo-yoed between sexually assaulting female victims and surreptitious transvestism.  It is particularly disconcerting to note that a law enforcer could turn into a law breaker and evader, which once again goes to highlight the tenacity of the criminal mind that compels one to become so. 

Suresh: For a change, this was a convict with no signs of ASPD, but he did seem to have the affliction of another kind, something which can affect any one of us.  As described above, a small word with a big problem: ego.  Hurt by the fact that one of his female relatives preferred marrying somebody else, he went on a killing spree of his family; possibly a suicide-pact that went horribly wrong.   

Sairam: Sometimes circumstances force a person to take matters into his own hands, and this man was unlucky to have had two deceptive wives.  He too, is unlikely to have had ASPD.  His case begs the question, how would we react if we were faced with a similar predicament?

Srikant: Once again, ego was hurt at the fact that a female relative that he had an incestuous feeling towards was seeing somebody else.  Like most of the cases included in this study, he too denied any wrongdoing on his part.  

Sanjay: Can alcohol blackouts be used as defence against a murder charge?  Medically, we know that alcohol increases risk of both suicide and homicide since it is a disinhibitant; that is, it takes away the usual restraint and grace that we exercise in our social relations.  The answer is probably no, because alcohol can be seen as a lifestyle choice that the perpetrator willingly indulged in, in the first place.  Sanjay probably also had dissociative episodes (loss of memory/control during stressful periods) while killing his family.  The cause for his breakdown appears to be typical marital strife that usually leads to intensely emotional upheavals and high stress and duress.

If unearthing the nature of 'death-row syndrome' is the primary purpose of this work, it is, as the author himself admits, not achieved.  There appear to be two main reasons for this.  Firstly, as Mr Guruprasad  suggests in the Afterword, the convicts appear to have been instructed by their lawyers and fellow inmates to maintain their innocence with everyone they meet, especially with a visiting policeman.  This is because they live in the hope of being released early, given the changing nature of our jurisprudence, differential application of law, and the whims of the deciding/appellate courts, judges and other authorities.  

They take heart from the fact that in several previous cases, convicts have benefitted by such largesse, and at least on one occasion, a retiring President of the country had commuted the sentence and paved the way for early release of many similar convicts.  The professional hangman that Mr Guruprasad interviews, also observes that almost none of the convicts he has hanged expressed regret for their actions, and some have resorted to the art of malingering - deliberately harming oneself or feigning symptoms of illness - to escape the noose.  

Secondly, I suspect that there could be a deeper reason for such blatant denial: the lack of insight described above under the ASPD criteria.  Many convicts actually believe in their innocence, and would do anything to rationalize their acts and shift the blame onto the victim, arresting police officers, judge, judicial system, etc.  In any case, the entire situation appears to be vastly different from what one encounters in the western countries, where there is an air of finality to the sentence, and convicts are likely to actually display the 'death-row syndrome.'  [Note: please seen excellent fictional film adaptations of real-life stories; e.g., Trial by Fire (2018) and Clemency (2019)].

I have worked in Forensic Psychiatry service while in the UK, wherein criminals who are mentally ill, or, conversely and more importantly, persons with mental disorders who commit a crime, are managed.  There is a lack of forensic psychiatric services across India, barring a few major centres.   Here, they tend to be managed in prisons by the resident doctor, who, at best, can provide only basic medical care.  

Hence, the problematic behaviour and/or psychiatric issue, notably ASPD, remains unaddressed  and mismanaged.  This in turn has a bearing on the recidivism rates, which remain high even in the presence of robust forensic psychiatric services.  This explains why convicts are liable to commit similar or other crimes upon early release from prison.  In between incarceration and being released, either through bail, furlough, or a commuted sentence, there is hardly any forensic psychiatric care available, putting both the perpetrators and their victims at risk.  

I am no legal expert, but like any law-abiding citizen, I do feel strongly about cases where gross injustice was done towards the victims.  Overall, there appears to be a lot of slips between the proverbial cup and the lip as far as serving justice is concerned.  As the saying goes, there is plenty of law in our courts, but not enough justice.  From diversion tactics, to subverting evidence, to changing statements, to feigning illnesses, to hoping for a commuted sentence, a convict and his/her representatives can take advantage of the many loopholes in the judicial system.  

The elusive nature of truth, and the almost impossible task of proving guilt 'beyond reasonable doubt' ensure that justice, sadly, for many of the victims described in this work and otherwise, remains a myth.  None of the convicts presented in this book have been hanged, and many are living in the hope of having their sentences commuted.  This is probably the reason why Mr Guruprasad has not found any significant mental illnesses, notably depression, among many of these convicts (unlike late-stage cancer patients who inspired this work).  

Which brings me, finally, to the touchy subject of capital punishment.  There have been raging debates about the veracity of this punishment method.  On the one hand, almost all victims (of other cases) and their families have expressed the wish that the convicts responsible for those cases be hanged.  On the other hand, the self-appointed guardians of human rights have cried foul and argued that capital punishment is barbaric, retributive, and has failed to act as a deterrent of further crime.  

This debate raises a few other germane questions.  Why can't punishment, including death penalty, be meted out proportionate to the crime committed in individual cases, regardless of whether such punishment acts as a deterrent of future crime or not?  What about the legal loopholes that a convict has recourse to, indeed, even that convict who has committed the 'rarest of rare' crimes?  What about the human rights of the victim who suffered at the hands of the convict?  And what guarantee can those against capital punishment provide to ensure that recidivism rates are addressed, and the released convict will never revert to his/her old behaviour?  If capital punishment is to be done away with, can the existing jurisprudence guarantee that a hardcore, incorrigible convict would be kept incarcerated till the end of his/her natural life, with no recourse to appeals, bail, furlough, or a commuted sentence?  

This, of course, is unlikely to happen because, only recently, the Supreme Court stated that the right to furlough of a convict cannot be foreclosed since it is 'an incentive towards good jail conduct.'  It is worth noting that the said convict in the case had had his death penalty commuted to life imprisonment by the President of the country with the condition that he would remain in prison 'for the whole of the remainder of his natural life without parole and there shall be no remission of the term of imprisonment.'

Both the parties in the capital punishment debate, I suggest, are missing the larger point.  Spiritually, it is said that nobody has the right to take the life of a fellow human being, no matter what he/she has done, whether it is the case of a criminal killing his victim, or a vigilante seeking retribution.  Our scriptures tell us that killing another person should be the last resort, an action that is undertaken under strict dharmic conditions when all other strategies have been exhausted.  Further, the karmic theory holds that each person should be given the chance to live out his/her karma to the fullest extent so as to facilitate their spiritual progress.  

Having said that, allowing a criminal to run riot and maim/kill others, and putting up with the inflicted injustice passively, are also adharma.  This is where the state, as the parens patriae of its people, has to step in to maintain the fine balancing act of ensuring the safety of its citizens on the one hand, and providing medicolegal and psychosocial care to convicts on the other.  This, as we have seen in multiple examples from this book and elsewhere, is easier said than done.   

If we can find the answers/solutions to these larger questions/issues, we can hope to come close to solving the conundrum of capital punishment, and indeed, meting out equitable and timely justice in all cases.

Mr Guruprasad candidly admits that this is a limited study: a single individual's effort in collecting anecdotal evidence from a limited number of perpetrators from a single centre.  Going forward, the subject of death-row syndrome requires a multi-centre, objective study of convicts' mental state using standardized tools of measurement.  

Having said that, this work is a thought-provoking attempt at understanding the criminal mind, which also serves as a grim reminder of the potential for evil that is lurking in the human mind.  Only by acknowledging and studying and managing this potential can we hope to create a safe society, and to this end, Mr Guruprasad's work is a worthy addition.

References/resources:
Image source: https://www.amazon.in/Shadow-Death-Stories-Convicts-Penalty-ebook/dp/B09MQRTDVL
Furlough news source: Apex court says no blanket denial of furlough to life convicts, Deccan Herald, 30 April 2022.

Yoga: 'Is it validated?'

In 2015, I somehow managed to contract a gut infection and was admitted in the hospital for about 10 days.  During the prolonged recuperation period post-discharge, I resolved that I should do something about my health/immunity.  I decided to take up yoga lessons and enrolled myself at a local yoga teacher's class.

Since then I have been doing yoga asanas, pranayama, meditative exercises, walking, and mild weight training, while taking adequate quantity and quality of mostly vegetarian diet.  Even though I am not practising vigorous yogic asanas, I make sure I do them regularly - more than the duration or intensity, I score high on consistency.  Yoga has become a way of life, something that I do as a daily routine.  

This has kept me going since then without any adverse health event, bar an occasional upper respiratory infection, and I continue to maintain my weight and fitness at a reasonable level.    

I have also advised patients that I see to take up yoga to maintain health, and/or to reduce the symptoms of disorders such as anxiety and stress.  I have tried to modify my own medical practice by incorporating holistic healing techniques, including Ayurveda and yoga, in collaboration with a qualified practitioner.

However, I have also realised that yoga is fraught with misconceptions and scepticism.  Generally, I divide the naysayers into two broad groups: sceptics and bigots.  The former are those who are genuinely sceptical about the health benefits of yoga; that is, they want to do it, but are uncertain about the overall effect of doing yoga.  They are more trusting of allopathic medical systems, and cast a distrusting eye over anything eastern/oriental.  

Then there are the bigots, by which I mean adherents of dogmatic religions who have been brainwashed into believing that anything outside their own religious practice is worthy of condemnation and derision.  These are the incorrigibles who will go to any extent to discredit, vilify, demonize and discourage anything that is remotely sanatanic, be it yoga, consecrated food, worshipping images/idols, or wearing bindis, for that matter.  

I quote a few examples.  A few years ago, a pastor in the US famously called yoga a 'demonic' practice.  When I was working in the UK, an Egyptian-Arabic doctor colleague spoke very condescendingly of yoga, and was dismissive of its healing power. 

Ironically, even in India, where yoga originated yugas ago, it has been reduced to a 'new age' fad, a necessity that we have taken to vicariously because the West has taken a fancy to it.  'Whatever they do, it must be good for us too,' seems to be the thought process behind the revival of yoga in our society, reflective of the underlying western bias thanks to the Macaulayian education system that we are all products of.  

In Bangalore, at a certain missionary hospital I was working in, a physician colleague of a certain denomination, inquired if yoga was 'validated' as a treatment when I said that I was advising my patients to do yoga.  He remained sceptical even after I explained that it was, and suggested that yoga was being promoted because of the wave of saffronization that was sweeping across the country!  

His religious bias against yoga became apparent when, during a later encounter, he was all for incorporating tai chi as a therapeutic practice in the treatment of neurological movement disorders, but evidently not yoga.  Perhaps, anything that was remotely sanatanic in its origin was a strict taboo for him due to his evangelical disposition.       

I find that sceptics, bigots and allopathy-chauvinists are quick to ask if yoga is 'validated' as a therapeutic intervention, fully ignoring the fact that the so-called evidence-based allopathic interventions hardly cure chronic illnesses, and worse, cause harmful adverse effects.   

More and more studies are confirming the physical and mental health benefits of yoga, such as those conducted at the premier neurosciences centre in the country, NIMHANS (in Bangalore), which has a dedicated yoga research centre.  These studies have been published in leading Indian journals, notably, the Indian Journal of Psychiatry, and at least on one occasion, in a special yoga supplement of the British Journal of Psychiatry.

But since we seem to value western opinion so much, I shall quote examples from western studies: in 2019, researchers in the USA found that yoga and breathing exercises improved the symptoms of Major Depressive Disorder after just one session, with cumulative effects in the long term [1].  A meta-analytic study published in the peer-reviewed journal in 2013, showed that yoga had beneficial effects on hypertension [2].  

If you look at the current the allopathic treatments for these very conditions, you will find that antidepressants can only increase serotonin and other neurotransmitter levels in the brain, but cannot address the root cause of depression.  Similarly, antihypertensives can symptomatically reduce the BP, but cannot cure hypertension.  Both these groups of medications are associated with their own unique side-effects. 

Researchers from Washington State and Ohio State Universities found that yoga can improve body image, which may be helpful in the treatment of eating disorders [3].  Again, there is no definitive treatment in the allopathic psychiatric system for any of the eating disorders, and mortality rate for anorexia nervosa, even with standard intervention, remains very high. 

For the sceptics among you, I would suggest that you ask yourself these questions: Is there any harm in doing yoga?  Clearly not, if done under proper guidance.  Is it beneficial for physical/mental health?  Several studies seem to indicate so.  Can it be the sole treatment for all conditions?  No, one has to judiciously use the right treatment technique for the right condition, or even combine allopathic, other complementary, or any of the yogic practices for a good therapeutic effect.  

Further, more than a therapeutic intervention, I see yoga as a preventive measure; a positive medical/psychiatric practice that can promote good health through balancing the body, mind and spirit.  Surely, with these conditions satisfied you should have no hesitation in accepting yoga as a holistic healing practice, unless religious bigotry prevents you from doing so.  

Which brings me to the bigots.  I have no solution for the bigots out there.  If bending your body a certain way in the pursuit of healthy body/mind is an affront to your religious belief, then it must be based on a very rigid and insecure premise [4], and frankly, it is your loss.  A case in point: similar sentiments were behind the decision to eliminate suryanamaskar from the very first International Yoga Day event in 2015 (but we did it anyway!).

Finally, the decision to do yoga has to come from within you.  Sanatana Dharma does not believe in enforcing any particular practice on anybody.  Watch videos and read books on the topic of yoga if you are unsure.  You can begin by reading the book Light on Life by the yoga master, B K S Iyengar, which clearly elucidates the spiritual nature of yoga.  Speak to those who are already doing it and ask if they have noticed any beneficial changes.  

And only if you are fully convinced, take up yoga classes from a trained practitioner.

Picture: How-To-Meditate-Making-The-Most-Of-Meditation.jpg (815×588) (meditationlifeskills.com)

References:

1. https://www.researchgate.net/publication/313806681_Treatment_of_Major_Depressive_Disorder_with_Iyengar_Yoga_and_Coherent_Breathing_A_Randomized_Controlled_Dosing_Study (reported in bu.edu/brink)
2. https://www.researchgate.net/publication/239948768_Effectiveness_of_Yoga_for_Hypertension_Systematic_Review_and_Meta-Analysis 
3. https://cpb-us-w2.wpmucdn.com/u.osu.edu/dist/1/10560/files/2020/12/Cox_Tylka_2020_Conceptual-Model.pdf (reported in PsychologyToday.com)
4. Quote attributed to Sadhguru Jaggi Vasudev

  

Should I get MARRIED?!

Bhaasyaa daivakritah sakhaa

'Wife is divinely caused friend'

Yudhishthira in The Mahabharata, Vana Parva, 313.72

~o~

Bhaasyaam manoramaam dehi manovrityanusaarineem

'Bless me with a pleasant wife who shares my mental inclinations'

Markandeya Purana

~o~

'Marriage entices the unwed and causes repentance in the wedded,' so goes a popular saying in Hindi.  Over the years I have encountered many people seeking marital counselling to save their failing relationships.  Some I have dealt with myself as best as I could, while many I have referred to the counsellors after discussing their cases with them.  In some cases, I have sat in with the therapist during the session.  

Based on these experiences that are predominantly from the Indian society, and some mine own, I have vlogged about this issue, and what follows here is an addendum to the contents of this video (in English, with Hindi & Kannada texts):

https://youtu.be/6pue3Uhf3cY

Just as one can fall in love, falling out of love is a distinct possibility.  More than falling in love, remaining in love is the harder part.  This is true of marriage too.  Love and marriage are hard work, says M. Scott Peck, the American psychiatrist.  I have seen many a couple, and indeed, their parents, seeking professional counselling to save their marriages, in the vain hope that all will be hunky dory at the end of the counselling sessions.  That somehow the counsellor will be able to wield a magic wand and all the issues accrued over years of living together, all the pent up emotions that have built up towards each other, all the heartache borne out of misunderstandings, miscommunications, affairs, and lovelessness will be waved away and they will be back to living happily ever after again.  

Alas, that is not how it works out.  

Especially in the Indian context, there are multiple factors at play in a marriage.  It begins with the notion that one can 'lie a thousand times to get a man and woman married,' as a popular saying goes in Kannada.  People hide disgraceful family secrets, mental and physical illnesses, sexual deviances, and just about everything that is considered embarrassing or a stigma, just to get the couple married.  

I have seen a wife who desperately brought her mentally retarded husband for treatment.  This, of course, was not possible, because there is no cure for mental retardation.  She was not told about this illness in her husband before the marriage.  When I confronted the husband's family as to why this was not revealed, their response was, 'if we had not hidden this information, how would we get him married?!'  For many, living unmarried is a social stigma, and so is getting divorced.

Marriage is not just between two individuals; in the Indian context, it is also between two families.  Since there are multiple individuals in large families, everyone has a say in what needs to be done, who one should marry, what kind of issues should be kept secret, etc.  By the time the couple get together, their minds are already so influenced by all these ideas and opinions that they often begin the relationship on the wrong foot.  Once the honeymoon period wanes - literally and metaphorically - lifestyle issues, adjustment problems, gender differences, and compatibility difficulties crop up, further complicating the picture.  

In India, marriage is seen as a one-stop solution for all problems under the sun.  Does your daughter have epilepsy?  Get her married, she'll recover in no time.  Is your son wayward and has fallen in wrong company?  Get him married, he'll 'settle down' in no time.  Does your son have schizophrenia?  Why, marriage will set him right, of course!  Is your son gay?  Then you should definitely get him married, that'll straighten him up like nothing else!  And so on and so forth go the specious marriage dictums.  

If only things were that simple.  Indeed, in many cases, marriage can be detrimental to a person's overall wellbeing.  I also firmly believe that certain people are not marriage material, or for that matter, parent material.  It is a commitment and a responsibility that not all are cut out to handle.  Therefore, the existing Indian preoccupation with a hundred percent marriage rate is spurious and inadvisable. I have highlighted some indicators for both getting married and not getting married in the video.

Who doesn't know about the problems originating from the fractious relationship between the mother-in-law and the daughter-in-law?  It is the stuff of legends and K-serials.  You see, for a mother, her son is her magnum opus, a creation that she has put her heart and soul into.  And then, along comes an upstart extra who lays claims to him wholly, leaving the mother feeling insecure about her reduced influence and hold on her son's affairs.  This then leads to machinations of the mind between the two women in the man's life and he is left with the prospect of having to walk a tightrope in managing both their egos.  This is not to say that the fathers-in-law are exonerated from their share in marital discords; it's just that their role remains largely inconspicuous.   

Everything is ultimately related to the ego, of course.  We are defective, inconsistent, hypocritical beings that interact with each other through our own mental conditionings.  These conditionings, and the preconceived opinions, expectations and disappointments that go along with them, are responsible for the fragile nature of our relations.  Often, it comes down to 'my ego versus your ego' in marital discords.  Even petty fights are blown out of proportion with intense, emotionally charged arguments, and end in deepening chasms.  Our ancients, who probably realised this issue, made entreaties to the lords above to grant amity in our intimate relations, as shown by the Markandeya Purana quote above.  

I often wonder why people marry if all they want to do is have extramarital affairs?  I am well aware of the complexities of the loving heart, but why go commit yourself to a binding relationship such as marriage if you are already seeing someone else, or you are unlikely to remain faithful to your partner?  Marriage can be too restricting for those who are free-spirited and value unbridled independence in the way they want to live their lives, or indeed, how many affairs they want to have.  Such people will truly suffer if they get married due to familial pressure, social expectations, or a misconceived notion of enhancing their 'status in society.'

The ultimate purpose of getting married and living together as partners is spiritual progress, say M Scott Peck in his book.  We are, as the saying goes, spiritual beings having a human experience.  We are here to play certain interactive roles with each other, and through them, to clear our karma and vasanas and sanskars so that we can spiritually progress higher towards our own ultimate emancipation. 

'Marriage is a trivial solution to the miseries of life, the real solution lies elsewhere,' warns Swami Virajeshwara, referring to the impediment caused by marriage to spiritual progress.  The expectations and emotional involvement that go with being married do not allow for any deviation whatsoever from a worldly lifestyle toward a detached, spiritual existence. 

Further, M. Scott Peck reminds us that we will never find love if our intention is only to be loved; the better way is to become a person worthy of love.  This being the case, we will do well to approach our marital relations, indeed any relation, with as egoless a state as possible, through love, understanding, communication, and by letting go of ill feelings arising out of others' shortcomings.  Yudhishthira, in his observation quoted above, is perhaps reminding us about these very issues.  

If, on the other hand, in spite of putting into practice all these virtues, the relationship is turning toxic, then it's best we let go of it amicably and move on, because self-harm through persisting in a unhelpful relationship is also bad, warns Dr Brian Weiss, American psychiatrist and regression therapist.   

Manu of the scriptural fame is credited as saying that during childhood a woman should be under the care of her father, during youth she should be entitled to the care of her husband, and during old age she should be under the care of her son.  Is marriage a sign of underlying patriarchy that compels a woman's family to seek a socially sanctioned union with a male before she 'goes astray' and brings dishonour to the family?  Is a girlchild perceived as a liability and a responsibility that needs to be handed over from one man to another?  

This would then explain why families of young women are so eager to see them married off, and why the bride's family is compelled to pay the dowry to the groom's family, and not the other way round.  One can almost hear the father of the bride saying to his prospective son-in-law 'hey, I've taken care of my daughter all these years; now I hand her over to you... and here's some cash and property to help you bear her responsibility!'  This makes marriage an elaborate ploy to sanction intimacy between two individuals, a ruse for the bride's family to 'solicit the presence of' huger numbers of relatives, friends and acquaintances so they can bear witness to this ritual of handing over of the bride to the groom.  

Not to mention the costs that the bride's family has to incur in staging and hosting the entire wedding event.  Excessive food that goes waste, gifts exchanges, designer clothes & jewellery, destination weddings, exotic honeymoons: all go to make the great Indian wedding that often is nothing more than an ostentatious display of 'status' in society.  Most guests are there just to return the invitation-gift-favour that families keep tabs on, and during the actual ceremony are quite content to catch up with each other, gossip, gluttonously down the culinary spread, and keep an eye out for the next prospective bride/groom.  

Even as the guests hobnob with each other, consider some of the rituals that take place during a conventional wedding ceremony: varapooje (bride's parents honouring the groom by worshipping his feet!), groom arriving on horseback to the wedding, much like the warriors and princes of yore who arrived to carry away their brides, kanyadaan (quite literally, 'virgin donation').  Are these are not indicative of the patriarchal basis of marriages?  

Further, why should the woman move to her husband's house after marriage?  Why should her surname be replaced by her husband's surname after marriage?  In short, why should her identity be subsumed by another individual and his family only because she got married to him?  Are these not expressions of the underlying patriarchy that is the driving force of the conventional present-day institute of marriage?

On the other hand, the dowry law is often misused to threaten the groom's side when relations sour.  In trying to curb the social menaces of dowry and bride harassment, the law seems to have tilted overwhelmingly in favour of the woman, at least as far as divorce laws are concerned.  Alimony and child rearing rights further compound the picture.  Some resort to exaggerated feminism to counter patriarchy, but this too is problematic as it undermines impartiality in man-woman, husband-wife dispute resolution.  This is not to exonerate either parties, but there needs to be a balance in the way marital/dowry laws are applied. 

Whatever the reasons for the coming together of man and woman, the institution of marriage has undergone a sea change since it first began.  And it continues to evolve even today.  I certainly hope that the patriarchal foundation that marriages are based on goes, and it takes on a more equitable tone in the future.  I predict that in the future, when cultural conditioning of young minds has been assuaged, marriages would become optional.  Living alone would not be looked down upon.  

Going forward, in stead of the bride moving to the groom's house, why not move to a neutral place post-marriage?  Both the bride and groom can refuse monetary payments of any kind, or at least make sure that gifts exchanges are done equally.  Perhaps, both can have 'double-barreled' surnames, hyphening both the bride's and groom's family names?  These are issues, I hope, that future generations will ponder on before saying yes to marriage, if at all.  Only when changes occur from within, will the cultural conditionings discussed above, abate.

Further, coexistence without the bond of marriage, or live-in relations, if you like, and unions of the non-heteronormative kind would become more common and acceptable.  Man-man, woman-woman, transgender, LGBTQI+, asexual, platonic, non-childbearing, long-distance and VR-metaverse kind of relationships will become commonplace.  It wouldn't be too farfetched to surmise a situation in which parents will begin by having an open conversation with their children about their gender identification and sexuality, before going on to seek and approve any of these relationships.  

Getting married should be a well thought out decision, and not something that you agree to impulsively, or just to please your family, or due to the ephemeral notion of 'love at first sight' based only on looks.  Beauty does matter to a certain extent, at least in the beginning, but in the long run, when the vagaries of time inflict their scars on the physical appearances of you and your partner, the deeper issues discussed in the video and this article will be the deciding factors in breaking or sustaining the marriage.  

So choose wisely.  Shubhmangal savdhan!

References & resources

Paternal provisioning results from ecological change, Alger et al, PNAS.org, 1st May 2020 (quoted in Kaleidoscope, British Journal of Psychiatry, Vol. 217/No. 1, July 2020)

Quotes: 

Marvels and Mysteries of the Mahabharata, Abhijit Basu, Leadstart Publishing, 2014

The Road Less Traveled, M. Scott Peck, Random House UK, 1990

Messages From The Masters, Dr Brian Weiss, Piatkus, 2000

Scientist's Search for Truth, Swami Virajeshwara, Hamsa Ashramam, 1997

Pictures: 

Krishna Videotech from Pexels

https://www.pngall.com/wp-content/uploads/2016/04/Fancy-Wedding-Border-PNG-Image.png

https://www.pngall.com/wp-content/uploads/2/Marriage-PNG-Free-Image.png

Background music: Vinyasa by Chris Haugen

Bleak: A silent short film on Depression

I have heard patients describing depression as a dark cloud that hangs over the head.  There are also periods of intense sadness and spontaneous bursts of crying for no reason.  Depression is a harrowing mental condition that saps one's energy, motivation and will to do anything useful.  

It is said that 'depression is an inability to construct a future'.  I would suggest that this is so because of the extreme preoccupation with the past events that occurs in depression, although it is not always necessary for depression to occur as a result of past adverse events.

Patients also experience negative automatic thoughts such as dichotomous or black-and-white thinking, that is, everybody/everything viewed as being either good or bad. 

Low self-esteem, feelings of guilt, worthlessness, hopelessness and the ominous threat of suicidal ideas further compound the problem. 

Bodily symptoms such as loss of appetite leading to weight loss, sleep disturbance often presenting as early morning awakening, and loss of libido/menstruation are often present.

Credits
Featuring: Aadya Pawar
Writing/Direction/Editing: Deepak Pawar

[Currently only showing in Festival Circuits]

In this silent short film on depression, I have attempted to depict these very signs and symptoms in a young person, although depression can occur at any age.  I hope medical/paramedical students will find this video useful in identifying the clinical features of depression.

I have experimented with colour tones, imagery, sound and pacing to symbolize the bleakness, misery and desolation that go with depression. 

The purpose of this video is not to scare you, but to motivate you to seek timely professional intervention.  Treatment in the form of antidepressant medication and psychotherapy/counselling ensures that depression can be treated and controlled.

Please don't forget to rate/review Bleak on IMDb.

Film festival selections for Bleak:

1. Lift-Off Global Network First-Time Filmmakers Sessions:

https://liftoff.network/ft-filmmaker-sessions-may-2022/

2. Black Cat Award International Film Festival:

3. Quarter-Finalist: Aakruti-My Creation International Film Festival:

Resources:

Background music: No.8 Requiem, Esther Abrami

Quotes: Attributed to William Styron, Side Effects, Netflix

Should I become a DOCTOR?

Medical career is such that it sucks you in and never lets you go.  Basically, once a doctor, you are always a doctor.  It is very rare for somebody to be both a doctor and a high achiever in any other field, be it another profession or even a hobby.  

The thing is, medical education demands so much of your time and attention that there is hardly any time left for you to upskill yourself in any other field.  If you do manage to achieve this, it is often through compromise; you might have to cut down on your medical practice significantly to attend to your other interests, or vice versa.  

Students are often misled into believing that the medical profession is glamorous (as shown in films or media) and/or one can get name, fame and authority just by becoming a doctor.  First of, it is anything but glamorous.  If anything, it involves getting your hands dirty and being ready to attend to a person in distress at any time of the day or night.  This means being groggy eyed, disheveled, harried, and running around like a headless chicken most of the times.  

Name and fame are to be gained; they will only come to you after you have been through the grist and worked your way up to a position of some authority, if at all.  I have had instances during my days as a junior doctor when patients have refused to see me because I was not a consultant. 

I also believe that many enter the medical field due to false notions of grandiosity; just to prove to their extended family and friends how special and intelligent they are.  These people typically hanker after multiple PG degrees to put after their names, and to spruce up their CV, and to exert authority over their hapless juniors and nurses.  It wouldn't be farfetched to suggest that their ego is directly proportional to the number of letters they put after their names!  

Students also make the mistake of assuming that they will go on to become neurologists, cardiologists, pediatricians, orthopedicians or radiologists, even before they enter the medical field.  Such preconceived notions are bound to lead to disappointments because only a small percentage of them get such coveted specialties; the rest have to 'compromise' and settle for other less lucrative specialties.  

I have seen parents becoming depressed because their son did not get the coveted seat even after several years of studying for PG entrance exams.  Finally the family had to sell off property to fund his higher educational desire. 

Actually, MBBS is the easy part.  Even though you might think that cracking the NEET/COMED exams is challenging and the subjects taught in the UG course are difficult, you are likely to breeze through the 5-6 years of MBBS course because you are so involved with friends, studies and extra-curricular activities.  It is what happens after MBBS that is most daunting; that's when the harsh realities of medical life sink in, and you will be caught between the opposing prospects of working in a medical setup on the one hand, and studying for PG entrance exams on the other.

Please also be open about the possibility of NOT getting to work in a clinical field.  That is, you may not get to work with patients in a clinic or a hospital.  Depending on your performance in the PG entrance exams, you may end up in a pre- or paraclinical field, such as Anatomy, Physiology, Pathology, Pharmacology, Community Medicine or Forensic Medicine.  In that case, you might have to take up faculty/teaching post in a medical college, or do lab/research work, depending on the field.  

Mind you, pre- and paraclinical careers are equally respectable and rewarding, but it's just that students never consider these when they think of entering the medical field.  I am reminded of a friend who had to give up his ambition of becoming a surgeon only because he was a Hep-B non-responder; that is, he was prone to contracting hepatitis from his patients.

I often recommend a trimurti, or a holy trinity, of entry criteria that aspiring medical students should consider before taking the plunge into the medical field: super rich, super intelligent, and from a family with a medical background.

It helps immensely if your family is already endowed with wealth to fund the seemingly never ending and financially draining medical education.  This wealth will come in handy particularly when 'management seats' are the only options left after your underwhelming performances in the entrance exams.

You can alleviate this financial burden somewhat if you happen to be super intelligent, or, as is required for medical exams, if you are smart enough to learn the study techniques necessary to ace the PG entrance exams, and can walk through the seat selection process with a plum specialty.  Easier said than done.

At the very least, it is helpful if you have an understanding father, mother, brother or a sister who is already an established doctor and is able to understand your predicament, and is willing to support you through the tough post-UG phase until you make it.  It is much easier to explain why you need to burn the midnight oil studying for PG entrance exams after finishing MBBS to a family member who is a doctor than to one who has no idea of how medical education/career works. 

If you feel that you are deficient in these criteria, please look for an alternative career.  Do not go through decades of struggle only to realize that this profession is not for you.  And don't ever listen to anybody, not even your family, when it comes to your course/career: your career, your life, your decision!  Nobody is going to come to your aid later on when you are disillusioned and despondent and stuck in a career that they wanted you to take up. 

I have raised these issues in this video in English with text in Hindi and Kannada:

https://youtu.be/DrfGigouuRs

Quite apart from the issues mentioned above, I have also written about a couple of other bugbears of this profession: assaults on doctors and draconian rules and regulations that govern the profession.  Read them too, just so you are aware what you are getting into.

Having said that, not for a moment am I suggesting that nobody should become a doctor.  If you are absolutely passionate about the medical field, if you genuinely care about the human condition, if you have the aptitude to deal with the issues discussed above, if you can put your ego behind and prioritize your work and career development for the sake of patient service, you can do wonders in this field (note the key words/phrases in red).  

If you are confused, seek professional help from a career counsellor.  Also consider taking an aptitude and/or personality test to see if you are cut out for this profession.

If, in spite of doing all that, you still have an iota of doubt about entering the medical profession, my sincere advice is: DO NOT!

Resources:
Background music: Wave in the Atmosphere, Dan Lebowitz
Pictures: 
https://pixnio.com/free-images/2017/04/03/2017-04-03-10-02-15.jpg
https://cdn.pixabay.com/photo/2016/09/29/19/55/doctor-1703644_1280.jpg 

Book conversations: India's Most Fearless

Two things become clear when you read this book on Indian armed forces' operations.  

One, Kashmir, or to be more specific, POK, continues to be the white elephant that has drained India's resources in terms of wealth and manpower over the years.  

Two, our security forces have been engaged in and successful at carrying out Zero Dark Thirty type of operations since ages.  

Aroor and Singh present several stories of bravery and sacrifice from the battle frontlines, encompassing all three divisions of the armed forces: army, navy and airforce.  These are stories that needed to be told, because, with the exception of Uri and Shershaah, not many make it to mainstream media, save a tiny newspaper report or a posthumous gallantry award.

From these stories one can get an idea as to the mindset of the soldiers who went into combat knowing fully well that the price to be paid was their lives.  One can glean this from some of the memorable quotes attributed to the soldiers themselves:

'...he was married to the adrenaline of combat.' (on why a certain soldier took risks in combat)

'Only soldiers who have bled together in combat will understand that.' (on what it is to be injured in combat)

'Lead your life.  Don't let life lead you.' (advice given to a soldier by his father while enlisting)

One hopes that the powers that be take timely affirmative steps to address the threat posed by hostile neighbours that we are surrounded by so as to mitigate the loss of lives of our brave soldiers.  In addition they also need to look at the threat that is already within the country, thanks to the lax border restrictions and indifferent deportation strategies.  

We also live in hope that attacks are prevented rather than fire fought, and if that calls for more surgical strikes, then so be it.  Especially so because the perpetrators of some of the major attacks are safely ensconced in havens across the border.

That this book has spawned a second volume of further stories of bravery and sacrifice is testimony to this ongoing threat, which in today's world is covert and subversive.

We wish our armed forces health and safety and all the success in countering the same.  

Picture source:

https://www.amazon.in/Indias-Most-Fearless-Stories-Military/dp/0143440446/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=