After 14 years of practicing psychiatry, things often seem repetitive and standard. Dealing with depression and anxiety most of the time, prescribing the same medicines, listening to almost similar complaints and giving the standard advice of non judgmental listening to family members becomes reflexive and doesn’t exercise my brain.
Thankfully, people do come with different emotional and behavioral problems, which ‘wakes’ me up and ‘jolts’ my brain to action.
A well to do family of Delhi called me urgently for a home visit, explaining that a decision had to be taken by the extended family and they needed my help for it. I was intrigued and agreed. At their family home, I was greeted by 8 people all visibly glum, tired and perplexed. The index/reason was the daughter in law of the family. Her parents and brother were present, along with the husband, parents in law and a family friend who had tried to help.
Over the next 4 hours, each person narrated their own perspective of the behavior of the 38 year old mother of two, and I was asked to define whether the lady had a treatable mental disorder or whether it was ‘just attitude’. Since this was the first time they were meeting a mental health professional, the narratives would begin from the time husband-wife had been boy friend-girl friend. Love, opposition, marriage, career growth, flight to US, temporary separation, emotional distancing, arguments, infidelity, coming back to India . . . all seemed important and I allowed them to talk, listening patiently. The outcome that they wanted from me wasn’t a small matter and I hoped that once I had ‘announced my decision’ they would all feel heard and listened to.
What was challenging in this scenario was that it wasn’t just their individual perspective that differed but the lady herself didn’t clearly know why things had turned out the way they had turned out to be. She had never spoken to anybody about herself and her feelings, always having had to defend and then respond to what her family wanted. She had no self esteem and her role was that of a home maker and a mother which was rarely acknowledged or appreciated. Her longing for a life beyond the extended family, where she would be free, not judged and dictated upon, where she could take decisions and be financially independent, where she could respond equally to her husband and not be submissive; had all remained a dream. Two years in the US had been life as she had wanted, but it changed suddenly and forcibly because of her infidelity. Now, the same had happened while in Delhi and the family’s query was whether the infidelity was a behavior or a problem.
Unfortunately, the consequence of the answer was that the former meant that the marriage would end while the latter meant that they would give it another try. Further, even if infidelity was a problem, the treatment was supposed to come from the lady herself and the family i.e. husband and in laws did not feel they had any role to play in either the emergence of the emotional and behavioral disorder or its treatment. The challenge for me was not merely a diagnosis or a formulation of the problem but also of providing a feasible solution which the family would feel part of and actively participate. Such psychosocial treatments have a poor success rate mostly because of a single person being made the focus of all interventions. The past often continues to play a big role in families’ responses and they need help to be able to look at the present (now and here) and make the future as positive as can be.
I defended the woman’s right to be ‘treated’ along with the husband, who was reminded of his marriage vows of being companions in happiness and grief. When I generated a ‘prescription’ of advice and behaviors for ‘Mrs and Mr . . .’ eyebrows were raised and a quizzing stare from the in-laws met me. “The marriage is the problem, isn’t it,” I explained!
Luckily, they haven’t given up on me. In contrast, a couple who had walked into my clinic a few weeks back, walked out arguing with each other because I had ‘prescribed’ for Mrs and Mr . . . . The husband in that incidence, felt really infuriated at the hint that he too was part of the problem!!