A fine balance

Once again, in October, I had the privilege of attending Chennai’s international festival of short films on mental health, “Frame of Mind” organised by SCARF (the Schizophrenia Research Foundation India). My task was to interact with the audience after the Richard Gere film, “Mr. Jones” about an extraordinarily charming man with bipolar affective disorder (manic depressive illness).

The film begins with the protagonist wanting to fly off the high roof of a building he is working on. His childhood desire to fly — matched by his firm belief while in a manic state, about his ability to do so — makes a potent and heady combination. As he watches a plane fly overhead and prepares to launch himself off the roof in pursuit, he is saved by his colleague’s presence of mind, thus landing in a psychiatric treatment facility.

Being a Hollywood film it needs a heroine; in this case a female psychiatrist of Swedish origin, whose first encounter with Mr. Jones at the facility she works in, leads to his choice of her as his doctor. Even from the beginning the relationship develops along rather unusual lines. She recognises his problem as being bipolar disorder and that he needs continued treatment rather than discharge. Her attempt to convince the court that he must be held against his will, and treated, fails. She leaves the courtroom disappointed and frustrated, only to have him request a ride home, as he has no money.

Blurring lines

The lines become blurred as professional and client proceed to not only have lunch en route, they also end up having a most enjoyable afternoon together. sharing a romantic walk on the seashore, with profound insights on music, gourmet preferences and each other’s lives, her appointments at work, clearly being forgotten. While the film thus portrays the human being within the patient and the professional, it also serves to disappoint the professional viewer, as the very foundations of therapeutic relationships and of appropriate behaviours within their context come crashing down.

The film follows Mr. Jones through a manic phase of illness during which he is seen withdrawing his entire bank balance in one go, proceeding to invite the rather pretty and flirtatious bank clerk for an afternoon of fun. The roller-coaster of his mania takes over both their lives for a few hours, as street food, shopping for a piano for him and clothes for her, intimate moments in a swanky hotel room, and a visit to the opera follow one another in rapid succession. His attempt to conduct the opera, notwithstanding his later justifications about how Bach should really be played, result in his return to psychiatric care. Poignant moments in the film ensue: when asked about his mania he says, rather emphatically, “of course I am happy; I am ecstatic!” revealing his distinct preference for that euphoric state of mind. Another moment of truth is when he ticks off his psychiatrist for asking intrusive and personal questions, pointing out that it is rude to do so. That psychiatric illness is dehumanising and strips the sufferer of his dignity, even through these seemingly mature and civil interactions, is well brought out here.

Mr. Jones slips, (as he inevitably must) from the high of mania, into the depth of depression. His distress, despair and pathos are well brought out, moments of anguish being portrayed sensitively. Once again, however, the rather unusual client-therapist relationship comes to the fore.

In general, physical closeness between client and therapist is discouraged; a firm professional handshake being, perhaps, the only physical contact endorsed; children and the elderly being possible exceptions. Here, client and therapist share hugs rather freely and with complete abandon. His long stay in the treatment centre where his therapist works, allows us brief insights into the lives of other patients and therapists, their trials and tribulations. An act of violence against our heroine by another deluded inmate, and Mr. Jones’ extraordinary presence of mind in saving her, result inevitably in increased closeness.

Dealing with rejection

It is only in cinema that a professional psychiatrist and a client admitted under her care go for a drive together, get drenched in the rain and end up making love. Nevertheless, these actions seem to bring about awareness in our heroine, about having crossed a professional line, and she seeks to remedy matters by discussing the situation with a professional colleague, taking herself off the Mr. Jones’ case.

Her rejection of Mr. Jones also brings to the fore earlier rejections by those he is intimate with, but who cannot deal with his bipolar tendency; the changes of mood and impulsive actions that accompany this disorder. She finds out that “Ellen”, his former girlfriend whom he often refers to as “dead”, is indeed alive. Mr. Jones merely deals with her rejection of him as “death”; death for him perhaps of an ideal, a persona; of hope and long cherished dreams. The tribulations of those who live with bipolar disorder sufferers come to the fore here.

Rather poignantly, the bank clerk who spent a roller coaster day with our protagonist visits his psychiatrist to enquire about his well being. Her inability to understand how such a remarkably funny, engaging and talented person like Mr. Jones could possibly be ill is common experience. The hypo-manic state where euphoria is predominant and actions expansive; the full blown state of mania where the person loses the ability to reason and is out of touch with reality; alternating with states of depression or low mood, poor appetite, low energy levels and insomnia characterise this disorder. While all of us experience some mood swings, they are usually in consonance with our circumstances and proportionate to them, which is not the case in bipolar disorder.

The film also brings out the common biological explanation for this condition, that it is due to a chemical imbalance in the brain, and that there is need for compliance with drug treatment, so necessary here. In one rather fetching moment, our heroine drops Mr. Jones at his doorstep, and as he crosses the road to his house, tosses across his medication, “your chemicals”; as she drives away Mr. Jones is seen tossing the pills into the litter bin, and walking nonchalantly home. This failure of patients to be compliant with treatment, one of the greatest challenges in managing psychiatric illness, is well portrayed.

Issues to the fore

During the audience discussion, the ability of Mr. Jones to choose whether he needs admission or not; the long conversations and therapeutic sessions he has with his psychiatrist; the need for a court order for his treatment are issues that come to the fore. Many wonder whether such interactions are at all possible in the Indian context and indeed whether they exist.

Professionals in the audience hasten to point out that Hollywood has undoubtedly taken liberties, and that there are cultural differences between the American setting and ours; that civil liberties for the person with mental illness are common around the world, although lack of awareness and education lead to their being transgressed in low and middle income countries. The ongoing redevelopment of India’s Mental Health Act is also discussed.

The client-therapist relationship comes in for much discussion; professionals in the audience ruing the unfortunate tendency among filmmakers to portray such romantic relationships. A call to filmmakers for more accurate portrayals of mental illness and therapeutic relationships is made. However, the group also acknowledged that film, like other art forms, is a caricature and thrives on dramatisation and exaggeration. View it with a pinch of salt is the common refrain.

The film ends where it begins. Mr. Jones is on the roof again, although his dejection and despair make us wonder whether it is to fly with childlike abandonment, or to die in abject surrender. True to cinematic endeavour, the heroine arrives in the nick of time to save his life and the couple unite in romance, her professional vows seemingly a distant memory. Will Mr. Jones’ ever get better? Will his heroine ever get to practice psychiatry again; lose, as she will, her medical license for consorting with a client? Will they live happily ever after?

The viewer is left with these and other questions as this rollercoaster of a film ends. It does underline for us, clearly, the travails of bipolar disorder, the importance of mental equilibrium, and of maintaining in our lives, a fine balance.

Quick facts

Psychiatric illness is dehumanising and strips the sufferer of his dignity, even when interactions are mature and civil

The failure of patients to be compliant with treatment, is one of the greatest challenges in managing psychiatric illness

Canine Neuropsychiatry Featured

A Rottweiler’s multiverse

Before you judge the breed, think again

My name is Kaiser, and I am a Rottweiler who lives in Chennai. The person writing this on my behalf is dad, the leader of our pack. I am of German and Serbian stock, and my origins go back to Rottweil in Germany, a town founded by Romans in a cattle-herding region. I owe my large head and snout to the mastiffs I was bred from, and my intent watchfulness to my role as a guardian. Indeed, butchers would hang their purses around our necks to keep them safe.

To my family, I am an affectionate goofball, prone to sit on their feet unmindful of my size. I calm down to the meaningful Malayalam song Manushyan Madhangalai Shrishtichu by K.J. Yesudas, written by Vayalar Rama Varma for the movie Achanum Bappayum. That together with my penchant for tearing newspapers and disliking men in uniform has led dad to conclude that I must have been a left-leaning, chai-sipping newshound in my last birth (notice the oxymoron).

My greatest joy is my morning walk with dad, our “me time”. Because I am hyperactive (dad says ADHD), I am sensitive to my environment — joggers, people who look me in the eye, whirring cycles and mopeds, people sporting helmets, umbrellas, head-covers, my list is long. My usual response is to charge in the general direction of the offender, and after a few surprises (torn sleeves, falling men and himself included), dad muzzles and harnesses me for these excursions.

Here are a few classes of humans I meet every day.

The dogo-philic: they love us and want to play, little realising that I, Kaiser (that’s German for Emperor), do not care for trifles.

The dogo-phobic: I can spot them a mile away, but they cross the road to avoid us; no fun but no trouble either.

The dog-agnostic: folks who don’t seem to recognise “the dog walking”. Here I am, 45 kg, deep-chested, big-headed, putting on my best swagger, and they walk right into us, preoccupied with their phones, companions, or thoughts. Being agnostic of me is not really wise, methinks!

The dog-walkers: Unlike us, many of these folks are not purposeful walkers; they amble, stop to socialise, hang around street corners. I believe it was George Bernard Shaw who said “Golf is a good walk spoilt!”. Now let’s paraphrase that, shall we? And of their dogs, the wise ignore me, the foolish bark, and the insane wail!

The talkers: “It’s good to talk,” says a popular telephony brand, but some take that slogan too seriously. When folks want to chat or socialise, I can be quite upfront about my disapproval. Those who don’t give up are greeted with a leap in their direction, which never fails to get them scurrying along.

The term multiverse was coined by American philosopher William James in 1895 to refer to the confusing moral meaning of natural phenomena. As a much misunderstood breed, I have described my multiverse to you. Despite my many redeeming qualities, the world views me with trepidation, not understanding that my responses are wired into me, through nature and nurture, by my evolved status as a guardian breed, created for humankind, by humankind, of humankind. Before you judge me and my fellow-Rotties, think again!

Elders Expert Blogs Featured

A sustained, integrative effort towards getting better is important for the elderly

Buddhi Clinic observes World Alzheimer’s Month

A 3M approach to elder care that involves memory, mobility and mental health was advocated at a programme held to mark World Alzheimer’s Month at the Buddhi Clinic on Saturday.

Speaking about the theme for World Alzheimer’s Day this year, which focussed on diagnosis, Ennapadam S. Krishnamoorthy, founder, Buddhi Clinic, said this made the 3M approach even more relevant.

He further shed light on how integrative medicine can make a difference for the elderly. “The emphasis for older people is often on getting one big procedure done to knock a condition out of the park, when it should actually be on a gentle and slow process towards getting better. A sustained, integrative effort towards getting better is what is important.” 

Dr. Krishnamoorthy spoke about the ‘Buddhi’ philosophy and stressed on the need for harmony between modern science and ancient medicine. “All disciplines have something to offer, and we need to identify and take the best of this. We should not work in competition but rather in collaboration,” he said.

The results of a study on taking an integrative approach to address cognitive disorders, which was carried out by Buddhi Clinic among 25 persons over the age of 55 with mild cognitive impairment showed that 75% of the patients showed an improvement at eight-week intervals, said Dr. Krishnamoorthy, sharing the findings.

A series of talks on managing pain and mobility, ayurveda for brain health, yoga and nutrition for brain health and sharing the experiences of a patient were made by doctors and other professionals from the Buddhi Clinic. Urging persons above 45 years to get a memory screening done, Dr. Krishnamoorthy said Buddhi Clinic was offering free memory assessment screenings to mark World Alzheimer’s Day.

Canine Neuropsychiatry Featured

Lessons from a bullmastiff

The writer is all praise for the pet he brought home as a puppy and who is now a loyal companion.

About a year ago, I became the fortunate owner of a Bullmastiff. An eternal dog-lover, I acquired my first dog, a Beagle, when I was 11 years old. Over time, in my journey to middle age, I have experienced life with three other (all long-lived) dogs — a Labrador, German Shepherd and Basset Hound. En route, thanks too in part to my professional predilections, I have developed an interest in dog behaviour and temperament. My focus on the mastiffs as a generic breed, followed my search for a guard dog, one that could innately discriminate friend from foe, and innocuous experience from potential danger. My search ended when my sister found a home-bred Bullmastiff litter on Facebook, culminating in a frantic drive to Bengaluru with my 9-year-old son, to choose our puppy. Thus began our tryst with a mastiff.

Widely described as “reliable, devoted, reserved, protective, alert, docile, loyal, calm, powerful, courageous and loving,” the Bullmastiff shares the characteristics of the Molosser dogs used by gamekeepers to guard the old English estates. Indeed, its progenitor, the English Mastiff, while alert and formidable, was thought to be too slow and plodding to take on the poacher and his dog, the lurcher. By crossing the English Mastiff with the Old English Bulldog (now extinct) in the late 19th Century, the compact, muscular and agile Bullmastiff came into being.

Legend has it that it was introduced at a fair, when a man challenged those present to try and outrun his dog; the man who tried, failed gloriously in his attempt, being brought down thrice by the Bullmastiff. Only one of about 13 mastiff breeds, the tallest being the Great Dane and the largest the English Mastiff (Argentina, Brazil, North America, parts of Europe and Eurasia, Tibet, all being represented in the mastiff family), the Bullmastiff is a large domestic dog with a solid build and a short muzzle.

I was inclined to choose a male puppy, having never brought up a female dog. Surprisingly, the advice I received from the breeder was to choose a female, as I would not, as a first time Mastiff owner (albeit experienced dog lover), cope with a male. I was also advised to build a dominant relationship with my dog, an egalitarian relationship being unsustainable with this breed.

“This is not a Labrador that you are taking home” said the gentleman repeatedly, with genuine concern. As it happens, Layla the Enchantress (as we named her), chose us and we were soon on our way home. In the car, all of two months old, she was composed in a way that was hard to believe. We would stop ever so often to give her a drink of water and/or a loo break, on the six-hour drive to Chennai, and she cooperated as if she had done it many times before, not soiling the car once, nary a whimper. Arriving home, we soon settled into a routine of feeds, exercise, toilet training and play.

Over a few days, Layla settled into our home having explored every nook and corner. In weeks, we could see why she was the “Gamekeepers’ Guard Dog”. Every sound was attended too, every person considered an intruder until introduced, every shadow a reason for suspicion. Indeed, late one night when she was asleep inside a bedroom, our son quietly brought in his friend for a natter. Any illusion of having cheated young Layla was destroyed in minutes, as she emerged from her apparent slumber, growling, the hair over her spine erect (distinctly coloured too), and proceeded to search the house until she had identified the intruder’s location and barked at him, until introduced properly. Indeed, the mastiff will not attack an intruder; instead it will rush towards him barking (a formidable sight), corner him and continue to bark until reassured.

Our morning walks are a daily highlight and eagerly anticipated. Within minutes of setting off, Layla “will do her jobs”, ensuring the remainder of the walk is a holy communion between man and beast. Indeed, by the time she was four months old, I had her walking “off leash” on the footpaths alongside the arterial roads near our home. Not once has she lost her composure, even when we come across another excited dog. Not once has she attempted to leave my side, except when I have meandered from my usual path into unfamiliar territory. Not once has she attempted to lead me; instead in classic pack animal behaviour, she waits at doorways, gates, even pathway dividers, for me to lead the way, acknowledging my pack leadership. Not once have I had to strike her, raising my voice, even an angry glance being enough for her to alter her behaviour suitably.

It is not that she has not tried to push the envelope, that being the predilection of this breed. Everyone is tested for their ability to “stand up”. For those who fail the test, Layla is the pack leader, and they must therefore follow her. The few who succeed are rewarded with loyalty and obedience that is par compare. Only one person, though, is given the privilege of being the “master”, and accorded unquestioning obedience and unbridled affection. From knowing which piece of furniture to occupy and which ones to avoid; begging for a scrap of food with immense dignity, yet never grabbing it from the table, even unattended; sitting still in a public place with amazing grace, surrounded by a hundred curious strangers, the Mastiff demonstrates a poise that is both awe-inspiring and endearing.

Many dog breeds have superior intelligence and can be trained to perform a range of often astonishing tasks. What intrigues me about the mastiff is its “sixth sense”, the instinct to modulate its behaviour in accordance with the human species; to have a place for everyone in its heart, and for everyone to have a place in its social pecking order. The innate power to discriminate between different human beings, their relevance to context and intentions.

Of course, the Mastiff is not alone in being able to do this. Among snakes, the King Cobra is thought to share this unique sixth sense. Indeed, herpetologist Romulus Whitaker describes rather eloquently, an incident during the making of his documentary, when he got too close to a King Cobra, who proceeded to warn him by rushing in his direction without biting and when the offence was repeated, proceeded to bite his behind. Whitaker credited being alive to his thick jeans. Other examples of the “superior intellect” this 12-18 feet long king of snakes possesses, are permitting its trainer to kiss the top of its head (as it stands erect, hood spread out) and indeed permitting lady trainers to dance for an audience with its head inside their mouth, both these being part of public performances in South East Asia. Once again, the innate ability to distinguish friend from foe and build a relationship with a “master” appear to be unique to this sub-species. Of course, stories abound among those interested in the animal kingdom about unique human-animal bonding: many dog breeds, elephants, the big cats, dolphins and killer whales, all being included.

So what is it about these sub-species that confers upon them such uniqueness? From my Bullmastiff, I have learnt the importance of mutual respect; of routines and predictability in interaction; of being assertive without being aggressive or offensive; of integrity and faithfulness; and of demonstrating love unabashedly when it is due. When Layla joins me on my favourite couch, sits on my head, all 50 kg of her, demanding to be petted at the end of a long working day, I am reminded that the best form of love is “tough love”. Indeed!


The Indian Scenario of Mental Health

Dr. E.S. Krishnamoorthy , Behavioural Neurologist & Neuropsychiatrist, Founder of Buddhi Clinic in conversation with Dr. Sameer Parikh and Ms. Gayathri Prabhu.

Dr. E.S. Krishnamoorthy, Behavioural Neurologist & Neuropsychiatrist, Founder of Buddhi Clinic in conversation with Dr. Sameer Parikh who trains doctors, psychologists, and other mental health specialists, and Ms. Gayathri Prabhu who teaches literary studies at Manipal University and is an author of a memoir, “If I Had To Tell It Again” and has written few other novels like Maya and The Untitled. Dr. Sameer is the author of two books, one for children and one for adults.

Mental health. A word that is highly neglected by Indian society. In India, experiencing mental health issues is seen with suspicion, and individuals suffering from mental illnesses face stigma. Mental problems are frequently thought to be the result of a lack of discipline and determination. Mental health stigma, as well as an absence of availability, affordability, and knowledge, contribute to major disparities in treatment. ‘There is a deficit of experts and I don’t think it will compensate for a long time because the deficit is too high’ said Dr. Sameer Parikh.  He also added how important it is to address mental health issues in the early stage and find preventive measures for them. While finding the solution to an issue, we should also make the effort to learn more about mental health and the doctors should take the initiative to impart the knowledge to the rest of the world. Another insightful thing mentioned by Dr. Sameer was that teachers and counsellors who work with adolescence will know what mental health issues they go through and how they can tackle them. ‘True change of mental health advances can only happen with the help of teachers and not purely by experts because we don’t have as many’ he added.

When Dr. Krishnamoorthy asked Ms. Gayathri Prabhu about how depression or any mental health issue of a person can affect their family member or the caretaker, she read a small part of her book where she wrote about her father’s illness. It reads, ‘Why? It is always the first question depression sparks. Where did this come from? Not asked from a diagnostic mood but in avoidance or curiosity or habit. If it is here, if it is in our mind, we need to ask what is to be done.

If mental health issues remain a stigma, then help-seeking behaviour will be prevented. If people don’t seek help, then there won’t be any change in the issues in society. ‘Help-seeking is not going to a doctor. Help-seeking is starting a conversation. Recognizing you have a problem and you need to find a solution’ informed Dr. Sameer. Ms. Gayathri said that stigma is her fear. It is an individual’s fear. When a person wants to seek help, they keep anticipating the reaction of society and this stops them from asking for help.

It is critical to remember that determining mental disease can only be done by establishing screening benchmarks. There is also an urgent need to dispel the myth that mental health is just the prevalence of mental health issues. Long-delayed debates and efforts to address the issue of access to mental health care are now making their intentions clear. Careful mapping and investigation are required to provide quality data, which is required to grasp the scope of the problem.

Dr. Krishnamoorthy has covered everything from adolescence depression to substance abuse in The Hindu Lit For Life (LFL) 2019.


Covid-19 And It’s Spread Over The Mind.

Dr. E.S. Krishnamoorthy , Behavioural Neurologist & Neuropsychiatrist, Founder of Buddhi Clinic in conversation with Dr. Pratima Murthy, Dr. Shekhar Seshadri, and Dr. Soumitra Pathare.

The world has experienced a surge in the concern over mental health during the Covid-19 times, the concern has been to the extent that words like pandemic, covid, lockdown, quarantine and many more have come to be associated with ‘mental health.’ Dr. E.S Krishnamoorthy, Behavioural Neurologist & Neuropsychiatrist, Founder of Buddhi Clinic, virtually sat down with Dr. Shekhar Seshadri, child psychiatrist, a senior professor in the department of child and adolescent psychiatrist and dean of the behavioural sciences division; Dr. Soumitra Pathare, a consultant psychiatrist and director of the center for mental health, law and policy: Indian law society, Pune;  Dr. Pratima Murthy, Professor and Head of the Department of Psychiatry, NIMHANS.

Dr. E.S Krishnamoorthy began the panel discussion by pointing out the irony of a world which changed due to a virus instead of wars and governments. He also noticed that the thing that changed the most is the impact that the pandemic has had on the mental health of people and awareness about the importance of mental health. 

“There is no health without mental health,” Dr. Pratima Murthy observed. She explained that the initial stage of the lockdown was met with a positive response but it was soon overpowered by anxiety over sickness, family and hospitalization. She proceeded to exemplify the following with a personal experience while simultaneously pointing out that the most difficult part of the whole experience was the loneliness of the mental trauma, sickness and death due to the pandemic. Dr. Seshadri added onto the topic raised by Dr. Pratima and discussed the patterns of coping and stress of children during Covid-19 and their lack of understanding regarding the pandemic, angst about hospitalization and grief over loss of their parents, social interactions and predictability. He also mentions “intolerance of unpredictability.” Dr. Soumitra Pathare took over and talked about the emergence of awareness of mental health in Middle class India and the hoarding of the meager human resources for mental health by the privileged class of people. 

Dr. E.S Krishnamoorthy questioned Dr. Pratima Murthy on the impact of the pandemic on women and she explained that there is a treatment gap and the services are not gender sensitive along with economic disparities, multiple roles expected of them and the stigma around seeking help. She also talked about the increase in domestic violence and the burden over working women to take care of their children, compared to working men.

When questioned by Dr. E.S Krishnamoorthy about the impact of the pandemic over the special needs children, Dr. Seshadri responded that pandemic and covid have a disproportionate response on the more vulnerable people. He carried on by explaining the difference between equality and equity and related it to the issues faced by the special needs children. Contrasted to him, Dr. Pathare discussed the discrimination faced by adults with mental illnesses and the ignorance of the authorities, even during covid, to include them in the ‘at-risk’ population until ordered to do so by the SCI. Contrary to that, the hospital of Dr. Pratima made sure to protect the individuals with mental illnesses and recognise them as “at-risk” individuals.

The discussion moved onto the vulnerable groups of India, Dr. Pratima talked about addicts and their problems; girl child and children with lack of technology; chemical and behavioral addictions. Dr. Seshadri stated that developmental psychology hasn’t considered the evolutionary impact of the Pandemic on the young children.  

The panel moved onto the subject of suicide, domestic violence and alcohol consumption as well as the connection between the three. Dr. Pathare talked about the dependency on alcohol and the lack of alcohol without access to treatment during the lockdown. 

The discussion concluded with highlighting the positive aspects of technology and the interconnectedness it provided to people during the times of stress and anxiety. The panel proved that the existence of Covid-19 had a toll on not only the physical well being of the citizens but also the mental health.

Canine Neuropsychiatry Featured

Temperamental, Indeed

How the contrasting behaviour of two dogs can give one an insight into brain dominance and enhance understanding of human nature.

Life with my pet canines is not just joyful and entertaining; it reveals to me each day, profound neuro-scientific insights. Carlo, my German Shepherd, is a classic example of his breed; in looks and temperament. A “Master’s” dog, his life revolves around my routines. A glance in his direction, slight change in tone, low whistle, all will ensure his immediate compliance with “his Master’s” desires. Obedient and devoted to a fault, Carlo is also extremely high strung and anxious, alert to every change in his environment, and protective of it; so much so that I rarely catch him in fitful slumber. Blessed with an uncanny sixth sense for “his Master”, a trait that his breed is famous for, Carlo actually heads for the gate, minutes before my arrival at home from work. Not one to break rules, he will not enter a room or defile a piece of furniture, once forbidden. Natty and fastidious about his appearance, he remains shiny coated through the week, not an ounce of dirt on him, nor a doggy odour.

Unpredictable and wilful

Contrast this with my later acquisition Coco, a Basset Hound. A handsome specimen with the classic sad and droopy face, jowls et al, Coco suffers from both occasional seizures and frequent mood swings. An approach in his direction, with best intentions, can evoke dramatically different responses: from a friendly, excited, tail-wagging welcome, to total loss of control; sometimes a resentful, even angry growl, bark or snap in the general direction of approach. Unpredictable mood swings from hypomania and hyperactivity to depression and profound apathy characterise his eventful existence. Disobedient, wilful and obstinate, he can be depended on to do exactly the opposite of what is intended, oblivious to “his Master’s” pleas, commands and threats. Indeed so agnostic is Coco of his surroundings that he can collapse like a sac, his numerous folds spread around him, in fitful slumber, no matter what the circumstances are. House rules mean little to this brat! Stride he will into any room at will, climb on any piece of furniture that strikes his fancy; and somehow manage at least once in each week to manifest for our benefit the pinnacle of filth; no part of the garden, however muddy, having been spared during his meanderings.

Not surprisingly, he emits a profound doggy odour so striking that dog lovers claim it should be bottled and sold (Chanel by Coco is our private joke). Guests without a fondness for canines, beat a hasty retreat from our abode when he decides to bless our company with his presence.

The contrasts in doggy behaviour become most apparent in our morning walk together. Carlo, the German Shepherd, needs no leash, walking three to four kilometres on the footpath that runs alongside arterial roads near our home. Rarely straying more than 10 feet from “his Master”, purposeful in his stride, nary a glance asunder, whatever the provocation, Carlo is the epitome of walking propriety, even his ablutions being timed for completion at a certain discreet spot.

Coco, the Basset Hound, on the other hand, treats the walk as a grand exploration of sorts; an opportunity to experience for himself this beautiful world that the good God has created. Constantly tugging at his leash in an angle perpendicular to the general direction of travel; sparing no human, animal or plant form en route from his nasal excursions, Coco is anything but purposeful about his morning constitutional, his ablutions being intermittent and erratic, intruding into the well directed journey of his fellow canine and Master, much to their combined annoyance. No order is heard, let alone obeyed; no single purpose complied with, other than that, which his doggie mind is set on.

My clinical experience in brain and mind matters has led me to conclude that Carlo, my German Shepherd, is left-brained and Coco, my Basset Hound, right-brained. The concept of hemispheric dominance, i.e. which side of the brain has a more dominant effect in the concerned individual, is one example of how brain function may influence behaviour and temperament.

Left brain dominant individuals tend to be more ideological and philosophical in their approach; more motivated by social and pragmatic, rather than emotional concerns; more diligent, purposeful, capable of greater tenacity and driven more often by a sense of duty.

On the other hand, right brain dominant people have a better appreciation of the world around them, greater creative ability; a proclivity for the finer aspects of life; and tend to be more mood and emotion driven in making their choices; both day to day ones and those that are life-defining. Put simply, left brained individuals think with their heads, the right brained with their hearts; and can be quite a study in contrasts, experiencing great difficulty understanding one another. Little wonder then that many professional and personal relationships run into rough weather; the two parties failing to understand each other’s contrasting preferences and predilections.

Unique temperamental attributes

Carlo and Coco have taught me that brain dominance is not an exclusive prerogative of the human race. And love them as I do, equally, I have learnt through them to celebrate rather than despair in these unique temperamental attributes conferred on us by our brain, that marvellous wonder of creation. To understand my family and friends better by observing their brain dominance. To choose correctly my activity companions: left brained for the purposeful and right brained, the hedonistic; and to tailor my expectations of them, appropriately. Carlo and Coco have enhanced my understanding of human nature; and thanks in part to them, I find myself at peace with my fellow men; well most of the time. It is a dog’s life, indeed!

Adolescents Adults Children Elders Expert Blogs Featured

Why do i find it difficult to finish what i started?

A lawyer who quit his profession because he could not pay attention to what his opponent was saying in court. A start-up founder, brilliant at strategizing, lost money because he could not send invoices on time. 

And then we take you back 500 years to the story of Leonardo Da Vinci, one of the greatest artists the world has ever known, but also, a scientist-painter who never got around to finishing what he started. He would procrastinate, skip from one task to another, and in his lifetime managed to complete only 20 works of art, leaving countless unfinished. 

Attention Deficit Disorder (ADD), say mental health experts,  brain disorder that affects adult’s ability to pay attention, control moods and complete tasks, explains the behaviour. 

Though not recognised as a mental disorder till the 1960s, studies have found that there are more than 350 million adults affected with ADD globally (says a study published in 2021 in the Journal of Global Health) and has been shown to be progressively increasing over the years. And the pandemic seems to have more adults seeking help for the condition, says neuropsychiatrist Dr. Ennapadam S Krishnamoorthy, founder of Buddhi Clinic in Chennai & Coimbatore. 

“The Frontal lobe of the brain is the executive brain, responsible for planning, organisational skills, focus, and time management. It is also the site of the social brain, which gives one the ability to regulate behaviour. Both these are affected in those with ADD,” he says. The shift to remote working and months spent in isolation during the pandemic resulted in social cues from the environment being r replaced b y cognitive cues, which a person with ADD tends to struggle with, explains Dr Krishnamoorthy. “For instance, a person with ADD may do certain tasks in the office only when they are reminded of it by a colleague. The social cues are not there when you are working from home, and those with ADD may lose track of their daily tasks.”

There is a misconception that Attention Deficit Hyperactive Disorder (ADHD) presents only in children, but that is not so, explains Dr. Krishnamoorthy. In adults “Hyperactivity” is replaced with impulsivity, which is why it is referred to as ADD. 

Sonal Singh, a certified ADHD/ADD coach, says the condition is exaggerated in times of transition, like when one goes from college to work, or is promoted from executive manager, moves cities, and so on. “Neurotypical people find it easier to adjust to change,” says Sonal, who adds that in the past couple of years, startup founders have begun to make up for a larger part of her clientele. “These are otherwise bright young adults with high IQs, but have difficulty focusing and paying attention.” 

Chennai based psychiatrist Dr. N. Rangarajan though believes people sometimes reach out for a clinical diagnosis to validate their difficulties in coping with change. “Several of my patients seek help for self-diagnosed conditions that readymade online tests tell them they have. ADD needs to be clinically diagnosed. For some it may just be merely about learning to accept change.” 

A Study published in the Indian Industrial Psychiatry Journal indicates that 17% to 22% of adults reporting to psychiatric services reporting for other mental conditions have been found to have ADD. In some cases says Dr. Krishnamoorthy ADD can masquerade as depression or anxiety, which also affect working (short-term) memory and the ability to pay attention. “In these cases, if the mental health issue is sorted out, the problems of attention deficit will disappear.”

One of the most visible signs of ADD is procrastination. “The person will be brilliant at ideating, but find it impossible to send an email or file an invoice” says Sonal. 

King’s College London researcher Professor Marco Catani, who presented his hypothesis on da Vinci in 2019, in the journal “Brain’, attributes his explanation of the painter’s ADD to historical records which showed he ‘spent excessive time planning projects but lacked the perseverance’. “Those with ADD may also make promises they don’t keep because they have forgotten almost as soon as they made them. This can play havoc with both work life and personal relationships,” says Sonal . “In the end, ADD is all about emotional regulation. “ And the first step is to pay attention to the signs. 

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The quintessential rational mind

An examination of the Buddha’s views on the mind. Two and half millennia after his time, shows them to be remarkably rational and contemporary.

Emphasis on empirical evidence: The Buddha laid the foundations of scientific spirit and enquiry 2500 years ago.

The day of Vaisakh Purnima (May 27 this year), is significant for three reasons. It was on this day that Gautama Buddha was born as Prince Siddhartha at Lumbini in Nepal in 560 B.C; the day when he attained enlightenment at Gaya in India; and the day he attained Nirvana (Unity with the Absolute) in 480 B.C. It is, therefore, observed as Buddha Purnima, worldwide. To mark this day in 2010, we examine the rational mind, as conceived by Buddha.

It has become fashionable and commonplace to associate Buddhism with the metaphysical. This is in stark contrast with Buddha’s emphasis on rational thought and insistence on empirical verification. He encouraged the development of theories that were verifiable and was strongly opposed to dogma, which he viewed as an impediment to the truth. To him the truth was supreme, and ideas that hinder the discovery of truth best avoided. He believed in full freedom in thought and action; “the gates of freedom will cease to be gates, if people start clinging to the gates.”

Buddha also had very interesting, remarkably contemporary views on the mind and some of these are enumerated below.

On thoughts and ideas

The very first verse of the Dhammapada translates as “you are nothing but your mind”, based on which, “Sarvam Buddhimayam Jagat” has been proposed. The word used by Buddha ‘ mana ‘ translates both as thoughts and as mind, and can be interpreted to mean the brain. Buddha’s emphasis is on the flow of thoughts and the continuous change in the thinking process. In his concept, ideas are not constant, they change all the time. Ideas have no independent origination; they have ideas preceding and following them. Consequently, all ideas are interrelated and there are no stand alone or absolute ideas. The thinker, the thought and the concepts therein cannot be separated. Interestingly, this concept has parallels in modern psychiatry. A primary delusion, a first rank symptom of Schizophrenia is said to arise when the person, following a “delusional mood” has a thought “out of the blue” and “without antecedents”. To have such a thought that has no thoughts preceding it, and possibly therefore no basis in fact, was abnormal to the Buddha, and remains so in modern concept.

On perception

Both the Surangama Sutra and the Lankavatra Sutra attribute perception, physical and emotional, to the mind. “Both delusion and enlightenment originate within the mind and every existence or phenomenon arise from the functions of the mind.” The Surangama Sutra poses an interesting question: “A man opens his hand and the mind perceives it; but what is it that moves? Is it the mind, or is it the hand? Or is it neither of them? If the hand moves then the mind moves accordingly, and vice versa; but the moving mind is only a superficial appearance of mind.” According to the Buddha, all perception had basis within oneself. This concept of the Buddha has neuro-scientific underpinnings. If one were to replace the “mind” as Buddha called it, with “brain” as he probably meant, and is contemporary concept; that all our perception and action has basis in the brain, is truism. Prof. V.S. Ramachandran has described in his book Phantoms in the Brain, novel representation areas for human body parts that have been amputated, developing in the brain.

This illustration leads to another important question, namely, what is ‘me’ and what is ‘mine’? Buddha, through fables, encourages us to think about this existential dilemma. The parable is about a man who takes shelter in an abandoned structure on a stormy night. Sitting in a corner of a dilapidated room he sees around midnight, a demon enter, with a corpse. The demon leaves the corpse on the floor; suddenly another demon appears and claims the corpse. Both demons turn to the man and ask him to decide on the ownership of the corpse. Being truthful, he indicates he saw the first demon bring in the corpse. On hearing this, the second demon is enraged, tears away and eats the hand of the unfortunate man, which the first demon, immediately replaces with the one taken from the corpse. After the demons leave, the man wonders and thinks aloud, “the replaced hand is ‘mine’ but is it ‘me’?

Again, the questions raised have neuro-scientific relevance. After damaging physical trauma, and transplants, it is well reported that people sometimes feel dissociated from their new organs. Indeed, having an organ replaced can be a life-changing experience. At another level, damage to the brain, the parietal lobe in particular, can result in the sufferer neglecting his body parts, as he does not recognise them as his own. The phenomenon of anosognosia, leading to neglect of one half of the body (hemi-neglect), is a well described phenomenon after a stroke. Here, the person sees the paralysed limb lying beside him on the bed, but is unable to recognise it as his own.

Buddha did, therefore, begin the mind-matter debate much before it became fashionable in contemporary philosophy. He placed human emotion firmly within the organ he referred to as the mind, which we now understand to be the brain. His statement – “If we learn that there is no world of delusion outside the mind, the bewildered mind becomes clear” – is remarkably accurate.

On perception and memory

Buddha made a distinction between the flow of thoughts and the stock of memory influencing our perception. In his view our perceptions are influenced by our memory. Thus we view the present through the coloured glass of past experience and do not see things as they exist or as they are constituted. When a person perceives an object, both the memory of the same or similar object and the feelings the person had on the earlier occasion are rekindled. Moreover, comparisons are made between imaginary constructions of the object and the object itself. However, this distinction between stock and flow is more analytical than exclusive. Indeed, stock and flow interact all the time.

This view mirrors our current understanding of how the limbic system in the brain works. It has been proposed that the hippocampus is the storehouse of memories. Adjacent and connected to it by a chemical rich neural network is the amygdala, an organ deeply concerned with human emotion.

Any external stimulus results in activation of both organs; thus when a person sees a snake, his memory (and learning) tell him that it could be dangerous, and he experiences fear as a consequence. Memory and emotion are therefore in continuous interplay, as conceived by Buddha.

The rational mind

Buddha’s understanding of the human mind (and brain) was unique; both rational and contemporary. He encouraged debate and discourse; raised questions more often than he provided answers; encouraging his followers to think like him, with freedom. He recognised the pitfalls of blind faith, unquestioning belief and intolerance of contradictory ideas. He laid emphasis on empirical verification and on understanding the world, as it is and as it is constituted. Indeed, through his radical empiricism, he laid the foundations of scientific spirit and enquiry 2500 years ago. His was the quintessential rational mind.

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New Horizons in Elder Care

New Horizons in Elder Care

This week, we at Buddhi Clinic inaugurate our new centrally located World Class Resource Hub,representing excellence in brain & mind care.With cutting edge diagnosis, comprehensive neurorehabilitation, mental health care and holistic wellness, expertly curated to suit each individual patient, Buddhi Clinic achieves a whole new milestone, another global first from Chennai.

We care about the elder, who cared for us when we were growing up. Elders are vulnerable to neuropsychiatric conditions — Parkinson’s disease, Alzheimer’s Dementia, Stroke and Depression.
Accordingly, tremors, slowness & stiffness, forgetfulness, falls & paralysis, mental depression are all problematic and often difficult to treat. At Buddhi Clinic we bring together cutting edge modern science, the wisdom of ancient healthcare traditions & comprehensive rehabilitation under one roof. Explore Buddhi Clinic & Experience World Class Care.

Our Buddhi Clinic mantra is to integrate the best of modern science & the wisdom of ancient healthcare traditions for people with a range of brain & mind conditions across the lifespan. With
15 different non-pharmacological therapies under one roof, we offer world class multidisciplinary, multicomponent & holistic care. View our diversity of experience on www.buddhiclinic.com or read
our expert blog on “falling men, failing neurons”to learn more.

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