Psychiatry as Behavioral Health
Mood:  bright

The Holy Trinity in Modern Psychiatry

It is behaviour which should be our focus too, and health of course. But along with overt behaviour, we must not neglect both internal thought processes and emotive underpinnings, as also the fact that we have medications which can be powerful tools if used judiciously, for reducing mental distress and ameliorating mental disorders.

I think an eclectic approach which combines emphasis on overt behaviour, with analysis of deeper thought-emotive processes, and judicious drug regimen - this need be the holy trinity of modern psychiatry.


Ajai
11 Feb 2006

Drive Through Life
Mood:  cool
Topic: A short poem

Drive through life

It’s a great idea
To
Come fast
But
Drive
Slow.

For
Guys who
Go very fast
May
Reach very
Late.

One cuts on distance, not time.

And
In any case
The trick is
Not to
Ride roughshod
On rough roads

And skirt
The potholes
And speed breakers
That populate
The highways
And bye lanes
Of your city
And your life.

Not that it’s always possible
But why not
Give it an honest try?

Ajai
28-31 Aug 2005

More Smoke
Mood:  blue

In the hot sultry fiasco of damp
enthusiasms
and silver rays in gloomy
archives,
narcosis and the feeling
of melting ice on frozen palms.

Arborescent shadows of sorrow
in reminiscent silhouettes
the rain soaked evening
of pouring emotions
and grassy long walks on dripping
pavements
Seeking out each other.

Remember, my dear
the sweet faint lavender
in the cleft of your breasts
hidden from the present and
posterity
and the knowledge of transience.

Looking at the grey skies
I think of clear blue water
and simmering passions
although
I’ve heard
you’ve created a smoke screen
from tall chimneys.

Ajai

Published in BLOB, 6 March 1974

Sickness not Reducing in Number, only Changing in Type
Mood:  quizzical
Topic: Medicine
Innovation in medicine is keeping in step with aggressive marketing of health services. The patient consumer has at his disposal a vast array of therapeutic facilities, all attractively packaged, and convincingly portrayed.The physician too has to keep abreast of a sea of fresh information bombarding him from numerous quarters, some genuine, some not so genuine. And he often finds himself at a loss to discriminate between the two.

Health awareness has increased. So has the average life expectancy.Medical science boasts of a vast array of treatment modalities for an equally vast array of diseases. Distress has been ameliorated, disability curtailed,death postponed.

And yet, if the booming medical practice and pharma industry are any indication, the patient population has not reduced. In fact, it has multiplied. Not all of this is because of increased health awareness. While individual distress may have been reduced, individual disability curtailed and individual death postponed due to better treatment facilities, the number of distressed have not reduced. Neither have the number of disabled, nor that of the dead.

What does this signify?

It signifies, if nothing else, that while individual disease treatment is progressing, so also is human pathology. Newer and more ingenious ways of falling ill are seeing the light of day, and the body is finding newer ways of getting out of order.

Sicknesses are not reducing in number. They are changing in type. If infectious diseases and malnutrition took their toll in the earlier centuries(and in certain sections of the world even today), life style diseases, chronic conditions and neoplastic disorders are taking their toll in the present. It is almost like changing fashions in the world of disease.

If we ever do feel we are successful in reducing morbidity and mortality of these conditions, along will come new diseases introduced by use of modern gadgetry. This century will surely witness an upsurge in sicknesses from use of wireless technology, permissive morality and greater commercialization. It will be compounded with deaths not because of infectious epidemics, but mass destruction due to external calamities like earthquakes, floods, tsunamis and hurricanes. As also man-made ones like terrorist attacks using modern technology on inimical civilizations. As though aiming to convert modern technology itself into an inimical civilization.


Ajai

(From Mens Sana Monographs, III,4-5, Nov. 2005-Feb. 2006, p15-16. Reproduced with permission of coauthor and publisher.)

A Poem
Topic: An Indian Village Road

The dust

In dusty drawn windswept
bullock cart roads
and ripe yellow mustard pastures
clinging to slender pathways
tread bold exuberant
rustic giggles.

And I sweep them in an embrace
with every swish of their skirt
and every awkwardness of their run.

Ajai
Sometime in 1974

Psychology, Science, Evidence and Intuition
Mood:  bright
Topic: No master tool
I find much to commend in Psychology, even if it is a western concept. Its emphasis on the scientific outlook and evidence has much to speak for in its favour. However, the only problem is when we make science (or evidence) a master tool, a litmus test to judge all phenomena. There is no master tool, actually. In empirical matters, we need observational evidence. But in intuitive matters, we need contemplation and introspection. Why should one exclude the other? I think they complement each other in a holistic understanding of the world, and phenomena.
I believe just as science is no master tool, neither is intuition or contemplation. But an amalgam of the two, by truly committed and sincere workers, is the cure for a distressed modern society vacillating between the skepticism of science and the credulity of religion. Here statements like those of Einstein start making sense:
Science without religion is lame, religion, without science, is blind.
If an essentially lame Science (by lame, I mean a branch which cannot go very far on its own) can ride an essentially blind religion (by blind, I mean oblivious to empirical phenomena), probably both will complete the journey. And they will offer man a means of self-actualization.
Herein is both the fruition of the two branches, as the well being and glory of mankind itself.


Ajai
17 Feb 2006

Philosophy
Mood:  quizzical
Topic: Not sourfaced, no requiem
Philosophy can do with being less sombre and sour-faced. Or sounding like a requiem. Serious pursuits need not be carried out in a grave manner. One can avoid being considered frivolous or flippant by means other than solemnity or pomposity. And it is mere poppycock that needs the subterfuge of pedagogy or pontificality. By appearing intense, dedicated, obsessed or harrassed one can succeed in conveying honesty of purpose. But to more avail would be an intensity that is not an obsession, a dedication which is unharrassed, a genius that is not a snob, a honesty that is not doctrinaire, a purposefulness that is neither a crusade nor a diktat.
Of greater import is the joy de vivre of describing the bubling ecstasy of a baby's smile or the twinkle of mischief in a toddler's eyes than all the reams that can be written in aesthetics. Read Will Durant's autobiography, Transition. Especially his final chapter. Or note the way in which most seeking or creative souls come into their deliverence.
Ideology, power, money, fame, all become redundant.
Non-Issues become the supreme Issues.



Ajai
? Oct 1989


(Excerpted from On Non-Issues , New Quest, March-April 1991,p89-97, quote on p97. Co-author: Shakuntala. Reproduced with her permission.)

Food for Thought for Prospective Singers
Mood:  lyrical
Topic: Music
Classical training for light music
I find an interesting argument doing the rounds in music circles. When asked if you have undergone training in classical music, some people have a ready reply: ‘what about Kishore Kumar and O.P. Nayyar? They had no formal training in classical music. See the beauty with which they did their music. Who says classical training is necessary for light music?’

Well, let me tell you if you have the caliber and pratibha of a Kishore Kumar or an O.P.Nayyar, you don’t need to read me. Maybe I should come and take a lesson or two from you. For all the rest, it may make more sense to listen to what I have to say here.

There are grades of difficult songs, but we can roughly classify them into three categories:

1.Easy, 2. Difficult, and 3. Very Difficult.

This classification is from the point of singing, and has nothing to do with the worth or ability of the singer rendering it.

1. Easy:
Songs like ‘Mera joota hai japani’, ‘Kisiki muskurahaton pe ho nisar,’ can be classified in the Easy category. In fact a number of Mukesh numbers sung for Raj Kapoor were like that. They were meant to be, for the master film-maker wanted simple heart touching melodies for his films which would appeal to the common man’s emotions. Here, even if you have no classical training whatsoever, only a basic understanding of sur, tala and laya, you can enjoy a number of such melodies all through life without bothering about anything else.
So many light, foot tapping numbers of this type keep on getting produced from earlier times till today, and no classical base is necessary to enjoy singing them.

2. DifficultSongs like those sung by Rafi for Naushad like ‘Suhani raat dhal chuki,’ of Lata sung for Madan Mohan like ‘Yoon hasraton ke daagh’, or even the Melodies of Khayyam like, ‘Who subaha kabhi to ayegi’ will come in this category. Even Talat Mehmood’s most popular songs like ‘Jalte hain jiske liye,’ or ‘Tasveer banata hoon’, also fall here. In this case classical training is not obligatory, but facilitates the voice flexibility that the grinding undergone by a classical training brings about.
So it will help you for sure, but you may do without it if you carry out serious riyaz of light music.
3. Very DifficultIn this category come songs like ‘Ayega anewala’ of Lata, ‘Dekhi zamane ki yari’ of Rafi, most songs of Manna Dey with a classical base like ‘Bhay bhanjana’, non-filmi songs of Jagjit Singh like ‘Koi paas aya sawere sawere’, of Mehdi Hasan like ‘Konpalen phir phoot aayin’, and the difficult Ghulam Ali numbers like,‘Hungama hai kyun barpa’, and some songs of Talat like ‘Tasveer teri dil mera behla na sakegi’, or ‘Beraham aasman’.
These songs cannot be faithfully rendered without a classical base, howsoever hard you try.
If your dream is to sing such numbers, (or even songs rendered in films by classical maestros like ‘Ketaki gulab juhi champaka bana phoole’), go and take refuge under the feet of a guru who will chisel and fashion your voice to make it capable of such rendition. He may or may not teach you to sing such songs (most probably, he will not), but he will help you get such control over sur that is the essence of high quality singing

Any effort in this direction, properly guided, will reap rich rewards.

Any attempt to prove me wrong may just be so much effort gone down the drain.

I would hardly recommend you do that to your self, at least not in the field of music, and definitely not since you are in Swara Sampada*.


Ajai
16 June 2005


*Written as The President Speaks His Mind for Swara Sampada, a music organisation. See: http://swarasampada.tripod.com

Experiencing the Present
Mood:  cool
Topic: A short poem

Moments
If you allow
Moments to be
Experienced,
Experiences
Do not
Remain
Only a moment.

Ajai
29 Aug 2005

'Psychiatry' or 'Behavioral Health'
Mood:  sharp
Topic: Clean up your act, guys
I gather there is a move, especially in New York, to use the term 'Behavioral Health' instead of 'Psychiatry'. This move, as an acquaintance says tongue firmly in cheek, is not for any ideological reasons, or to describe the multiple disciplines involved in mental health services, but because of the generally poor reputation that psychiatry has with the general public and other medical services.
This news is chastening, true, but not disheartening. I take this problem as an opportunity. If psychiatrists brighten up their act and do something to salvage their reputation, so much the better for them, and the branch to which they owe so much.
Only let's hope the change is not mere window dressing.
Call it whatever, psychiatry or behavioural (or behavioral, if you will) health, or whatever. But go ahead and clean up your act, guys.

Ajai
19 Feb 2006

What do we do when she dies...
Mood:  blue
Topic: Grounded before takeoff
A young girl dies by hanging. A starlet who came to Bombay to make a career in showbiz.
A promising career is sniffed out before it takes off. Some people cry, most are numbed, many others are shocked.
'Never thought she would do it'. 'She was the strong type'. 'She was quiet but determined'. 'Just talked to her a few days back and she appeared ok'. 'I was looking forward to her career upswing'.
And then this happens.
People are at a loss for words. Parents are aghast. Peers are benumbed. Rivals are smirking. Wrinkles appear on the forehead like question marks. The end of the mouth twists into a question mark too. The customary apt sentences of condolence are uttered. Sobbing, wiping a tear welling up, a tug at the heart.
The cremation ceremony is attended with appropriate gloom writ large on the face.
Then slow, measured steps walk out of the cremation ground. The lines of a melancholic number spring to the mind. But the sound of traffic while crossing the road is stronger. The mind jerkes to attention. All senses are alert. A death is forgotten in a hurry to start living once again.
One more suicide becomes a statistic.

Ajai
16 Feb 2006

'R'
Mood:  incredulous
Topic: Childhood buddy hangs up
'R' really was special. Shouldered the responsibility of a business family at a tender age. Worked over inefficient estate management by elders, saw to it younger siblings were settled, sacrificed youth to bring up business and family. Enjoyed friends, drinks, driving.
We were childhood buddies from the same town.
I had met him a couple of months before the incident. It was after nearly a decade. At a chemist's shop. He was buying medicines. Antidepressants. I asked him what happened. He had tears in his eyes. There was no flicker of the customary light on his face I had known so well. The smile that usually sparkled in his eye as he met an old childhood buddy had vanished.
I could read the distress. I shook hands and told him to meet me in the clinic and we would sort it out. Depression is perfectly treatable, I said. Did you undergo psychotherapy. No, he said. Only drugs, but felt better. Some thoughts bothering you, I asked. Yes. Why not talk to your psychiatrist, I said. He thought for a moment, a long moment. I had never known 'R' to take that long to decide. Finally he said he would come and meet me in my clinic.
Suddenly 'R' was dead.
Died by hanging.
I wondered what went wrong. Would I have saved him if I had got over my profesional reserve and insisted he come for treatment? Was he really taking treatment with someone, or just self-medicating himself? I know he listened to me. If I had phoned him up, or his parents, and told them: nothing doing, I want to see 'R' well. Let him come to my clinic. Would that not have given him a chance to survive? Or even if he did commit the act, it would not be from want of trying.
Some days later. As I neared his house while I was going to a neighbour's, I looked up at the forlorn structure. A grim board outside said, "Trespassers will be prosecuted".
What about the late owner, who prosecuted me since I could not trespass a professional limitation: don't solicit patients.

Ajai
17 Feb 2006

Joy and Helplessness
Mood:  a-ok
Topic: Well, there we go
This blog will contain a series of incidents/thoughts which either stir up the present or refuse to evaporate with time. They express the inner thoughts, the helplessness, as also the joys of a psychiatrist who is one by choice; who also loves philosophy, enjoys music, reads and writes poetry, and is proud of being a medical man. And yet...

Ajai
18 Feb 2006