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Temperamental, Indeed

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!

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The Stress Vortex

The word stress, used loosely today in society, has many connotations and can imply a range of circumstances from ordinary workplace or familial dissonance to serious mental disturbance. Crucially, what starts off as a minimal disturbance in one sphere of activity can have significant ramifications that affect many life spheres, if left unattended.

Life and society in the 21st century are profoundly stress generating. While a range of reasons may be held responsible, central to all manner of stress genesis is “the yawning gap between expectation and reality”. Modern lives have spiralled unthinkingly into a vortex, driven by predominantly Western economic models: of unremitting desire, relentless aspiration, pursuit of material gain, needless and thoughtless consumption, transient and elusive fulfilment, and unfettered hedonism. Stress is a natural accompaniment, a constant companion, as new desires replace the old, and the gap between expectation and reality remains constant, if not ever-widening.

Can we escape this vortex? Reduce, even remove, the negative factors that perpetuate stress in our lives? Transform ourselves into that epitome of self-management that others look up to?

Sources of stress

The Psychological Conflict Hypothesis: The concept of a psychological conflict comes from Freudian thought and is believed to underlie emotional stress. Freud proposed that we have both an unconscious and a conscious mind and that there were inherent conflicts between the primitive urges (Id), the unconscious (ego, current awareness) and the feedback from the moral agency (super-ego). While Freud emphasised sexual urges, psychological conflicts are generally believed to have their genesis in the dissonance that can arise between our inner urges and socially permissible actions; a dissonance that may defy resolution.

The Self Actualisation Hypothesis:

Proposed by Maslow, it assumes that each individual has to ascend different steps of the self-actualisation pyramid. At the very bottom of the pyramid are the person’s survival needs; after which appear, progressively, security needs, social needs and ego needs in that order (see box). When all these needs are addressed to a significant extent, the person achieves a state of self actualisation, of fulfilment and being content with one’s lot. Stress is a constant companion at various points on the self-actualisation pyramid and disappears when self actualisation is achieved. However, Maslow’s rather utopian view of the lasting self-actualised state of being may not hold true in the fast-paced modern world, where events often outpace individual development in most unexpected ways.

The Locus of Control Hypothesis:

An important psychological construct used to explain the development of depression, an important consequence of stress is the locus of control hypothesis. It has been observed that rats placed in connected cages soon learn to avoid the cage that habitually gives them an adverse stimulus such as an electric shock. However, when the rat receives shocks in an unpredictable manner, it becomes listless, withdrawn and inactive, a state of “learned helplessness”. This has led to the understanding that internal locus of control (where the person feels in control of his circumstances) is protective from emotional stress; while an external locus of control (being controlled by one’s circumstances), makes one vulnerable to it. In the years of post-war industrialisation this phenomenon was recognised in “assembly line workers” who had little control over the nature or pace of their work and were expected to perform a repetitive task for hours on end. Interestingly, our much vaunted IT revolution has ushered in a new generation of “assembly line workers” who operate on international time and in response to international demands, often with little control over their workspace destiny.

The Coping Hypothesis:

One point which eludes us when we are in a stressful situation is that there are, usually, only two ways out. Take for instance the example of a very short-tempered boss who reacts without provocation. One can either attempt to modify the situation (i.e. bring about a change in the boss so that he loses his temper less); or one can modify one’s own expectations (i.e. accept that boss with his short temper and learn to work around it). No prizes for guessing which is the easier pathway here. It is often said for this reason

“when you cannot modify the situation, modify your expectations”.

Coping strategies are of two kinds: i. Problem-focused coping where the attempt is to short-circuit negative emotions by modifying, avoiding or changing the threatening situation and; ii. Emotion-focused coping where the attempt to moderate or eliminate unpleasant emotions by rethinking in a positive way. Some strategies employed include relaxation, denial and wishful thinking.

In many circumstances, both approaches are combined in the effort to overcome stress.

Preventing Stress

The prevention of stress is achieved through good self management. The key to self management lies in being mindful: of oneself and the world around. Inexorably linked with this mindfulness is developing a better understanding of oneself and one’s fellowmen. Caught as one is in the vortex of modern existence, mindfulness can often be elusive, as the roller coaster of life takes us from one event to the next.

The famous Tibetan Buddhist teacher and philosopher Sogyal Rimpoche differentiates the active laziness of the West whereby unimportant tasks become responsibilities, part of a rigid schedule, and begin to dictate one’s existence (appointments, schedules, waiting times); from the passive laziness of the East, hanging out in front of the roadside stall with film music blaring, watching the world go by.

Neither, he contends, is ideal; instead, he highlights the importance of spirituality and contemplation and the need for us to devote some time in each day to examining the deeper meaning of life. In his view “Our task is to strike a balance, to find a middle way, to learn not to overstretch ourselves with extraneous activities and preoccupations, but to simplify our lives more and more. The key to finding a happy balance in modern lives is simplicity.”

It must be noted that stress clearly has its benefits. Imagine if you did not feel stressed out in advance of an interview or exam; your preparation and performance are both likely to be sub-optimal. Some stress is therefore necessary in order for human beings to “survive”. Too much stress, on the other hand, can be unproductive, even wasteful; resulting in much negative energy being expended. What we must try and achieve, therefore, is a fine balance between ambition and motivation on one hand and equanimity of mind on the other. And, while we strive to control our own destinies, by being in control of our lives and circumstances, our destiny may have other plans, that we cannot fathom; plans that we must learn to accept and live with. Perhaps, therein lies the key to effective stress management.

Heart Facts:

  • Stress impacts on the heart: it can cause myocardial infarction (heart attacks) and sudden death. It can affect the regulation of your heart beat by the central nervous system.
  • The INTERHEART study investigated the relationship between chronic stressors and Myocardial Infarction in about 25,000 people from 52 countries. After adjusting for other risk factors, those who reported “permanent stress” at work or at home had double the risk for developing a heart attack (MI).
  • The broken heart syndrome , sudden ballooning of the heart apex (left ventricle) follows acute stress. Often there is no evidence of obstructive blood vessel disease. Episodes of intense emotional or physiological stress are reported prior to presentation and maybe the triggering factor. Even when intense bouts of emotion don’t kill, they may cause long-lasting heart damage.
  • The Whitehall II study found over a two-fold increased risk for new coronary heart disease in men who experienced a mismatch between effort and reward at work. High-risk subjects were those who were competitive, hostile, and overcommitted at work, in the face of poor promotion prospects and blocked careers.
  • Cardiac syndrome X affects women more; there is angina-like chest pain and a positive response to the treadmill test with normal heart circulation. Cardiac syndrome X patients report more depression, anxiety and somatic (physical) concerns; they also have better prognosis.
  • Depression is a primary risk factor for Ischemic Heart Disease and an independent secondary risk factor for Heart Attacks. Depression also has a direct impact on cardiac risk factors such as diabetes, hypertension and obesity. Depression after myocardial infarction more than doubles the risk of death and of another heart attack. People who suffer chronic anxiety are more likely than others to suffer heart attack. Emotional trauma such as the death of a spouse, mental or physical abuse, or post-traumatic stress disorder (PTSD) increases risk of heart attack.
  • People with Type D personalities (characterised by pessimistic emotions and inability to share emotions with others) and Type A personalities (characterised by anxiety directed outward as aggressive, irritable, or hostile behaviours) are more likely than others to suffer heart attacks.
  • Freud said that happiness comes when one has pleasure in love and work. Research shows that marital stress in women and both marital and work stress in men greatly increase the risk of death due to a cardiac event. A famous doctor has observed “where can he go if he is unhappy at work and at home?” The implied, if somewhat flamboyant, answer was always “to an early grave.”
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The Entrepreneurial Mind

Many years ago, I remember watching a BBC program on the qualities of entrepreneurship. A diverse group of young individuals who did not know each other and had no knowledge of each other’s identity were being put through a series of tests, to identify secret entrepreneurs in their midst. One test stands out in my mind: the participants were asked to aim for and hit a target from a distance of their choice. Needless to say, the greater the distance from which one tried to accomplish the task, the more the rewards and indeed, the risks. Interestingly, the entrepreneurs in the group were the ones who chose to try from seemingly impossible distances. This appetite for risk is well recognized as being a quintessential entrepreneurial quality. But pray, what else characterizes the entrepreneurial mind? This is the subject of our exploration.

Five Minds!

Howard Gardner has described “the five minds” that are necessary for leadership. He begins with “the disciplined mind” acquired through years spent in scholarship, a craft or a profession, which he estimates takes the average person a decade to master. He prescribes that the disciplined mind emerges from consistent work done to develop skill sets and a knowledge base. This concept of “the disciplined mind” necessitates education and/or training, of course. But is education or training an essential pre-requisite for the entrepreneur? Many famous entrepreneurs have had very limited formal education, and in many instances have dropped out of the educational system, only to prosper. Famous examples of people who did not survive the educational system for a variety of reasons include Bill Gates, Richard Branson, Steve Jobs and our own Dhirubhai Ambani; all synonyms of successful entrepreneurship. So is education at all necessary for entrepreneurial excellence?

John Warrilow in a recent article identifies some reasons why an MBA may be bad for entrepreneurship.

1. Causal rather than Effectual Reasoning:

Entrepreneurs use effectual reasoning (they assess what resources they have and ask themselves what can be created) while conventional CEO’s use causal reasoning (they set goals and develop systematic plans to achieve those goals). MBA programs teach causal rather than effectual reasoning.

2. Adaptive rather than Innovative Thinking:

Adaptors are cautious and pragmatic. They take others ideas and try to innovate them, incrementally. On the other hand innovators overturn other ideas, challenge conventional concepts and are into big-bang thinking. MBA programs teach adaptive thinking rather than innovation, which is an entrepreneurial quality.

The advantages of the disciplined mind notwithstanding, one must address the question therefore, whether formal education is necessary for entrepreneurship, or whether indeed it is an impediment for success. John Warrilow points out that an MBA is bad for entrepreneurs also because “your classmates will not be entrepreneurs” and “you will waste 40% of your risk free years in a classroom”. It is a truism that the higher one climbs on the academic ladder, the more one usually has by way of formal employment opportunities, and the greater are the risks when one chooses to pursue an entrepreneurial venture in favor of well paid employment. Thus, too many years spent in education maybe a disincentive for risk, that important entrepreneurial quality. On the other hand it has to be acknowledged that formal education such as an MBA does bestow on one credibility, a critical element for entrepreneurial progress, at least in the early years. A doctor turned entrepreneur recently remarked to me, rather ruefully, that it took an ivy league MBA for people to be convinced about the seriousness of his entrepreneurial intent and ability.

Howard Gardner goes on to describe “the synthesizing mind” as learning to integrate disparate sources of information, identifying the links between them. Synthesis he says is identifying the jobs that need to be done and the people available to do those jobs. Synthesis is the identification of priorities and the way forward, balancing past visions with future aspirations. Synthesis enables one to examine new ideas in the light of one’s knowledge base. In this concept one needs the discipline of education combined with the ability to integrate disparate sources of information, an ability that usually comes with work experience.

Gardner then describes “the creating mind”, more a function of the leader than of the manager. Entrepreneurs are leaders and are generally bestowed with a strong sense of creativity, the ability to innovate and think out of the box. In general, the leadership of organizations require the development of compelling narrative, which then gets embodied in the leaders life. Good leaders (and entrepreneurs) are therefore expected to live by the principle “my life is my work; my work is my life” and to bring about changes to the lives of those

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The Stranger In The Mirror

Mad Tales looks at the way Hindi cinema has portrayed human emotions, madness in particular, down the decades and what these caricatures tell us about ourselves as a society.In a country like India, where people idolise film stars and are influenced greatly by cinema, it is very important that issues like human emotion and mental illness are portrayed accurately and responsibly.

Mad tales from Bollywood, Professor Dinesh Bhugra, Maudsley Monographs number Forty-eight, Psychology Press, U.K.Art is often viewed as a caricature of society — an exaggerated portrayal of the life and times it evolves in. In no art form perhaps is this a greater truism than the world of cinema. Human emotion takes the centre-stage in most cinematic endeavour: from romance to war, epics, social drama and magical realism. Indeed, even the most Kafkaesque (or for that matter, Tarantinoesque) contribution, is fashioned around bedrock of human emotion.

Mad Tales from Bollywood (2006: Psychological Press, Hove, U.K.) is a unique effort by a London based academic psychiatrist of Indian origin, Professor Dinesh Bhugra. In this work he analyses from a cultural viewpoint the portrayal of human emotions and mental illness in Indian Cinema.

The book begins on a technical note, defining and introducing some basic terms and concepts. One of these, “The Other”, an individual who stands for something quite opposite to what we stand for, is of interest from the perspective of how mental illness and villainy are portrayed. How this other gets defined, vilified, criticised, made fun of, or rejected outright is crucial, as mental illness may be then viewed as a visitation, mitigating one’s responsibility for it and engendering greater acceptance of the sufferer.

The author explores the socio-cultural underpinnings of Indian cinema, paying attention to the extended family in Indian society with its attendant religious undertones. The use of song and dance in Indian movies, to convey emotions of love, passion, anger and hatred, with the protagonists often being far apart from one another, is dealt with in some detail. The roles of gender, social and class factors, besides that of patriarchal hierarchy, dictate how songs are used in Indian society. The new boldness that has swept Indian cinema halls, particularly in how sexual emotions are dealt with, is discussed here.

While in the yesteryears the coming together of flowers or butterflies would convey erotica, or indeed, such portrayal will be relegated to the vamp or coquettish mistress, there is today a sexual brazenness sweeping Indian cinema, reflecting the changing sexual mores of Indian society. The fact that the character played by Amitabh Bachchan in “Hum” could sing, “Jumma, chumma de de (kiss me…)” and the heroine in “Khalnayak” asked, “What is under your blouse?” reflects the social shift towards a more open acknowledgement of sexual desire and erotic thoughts.

Changing Landscape: The author traces the history of Indian cinema against the background of the changing political, economic, cultural and social landscape of the country, the hero being the focus of this exploration. In the 1950s and 1960s, several Muslim socials (as films with Muslim stories and characters were often called) of the time represented the zenith of that culture in Indian cinema. After the initial shock of the Partition, these films were placed very much in the Islamic context, and they exploited the culture of a bygone and much-mourned era. There was also a post-independence idealism that marked this period, many films with patriotic fervour being released at that time. The 1960s, widely regarded as the golden era, was characterised by a certain romanticism, with family and social melodramas, excellent lyrics and good songs that had wholesome family appeal. The hero was our aspirational ideal: good looking, vibrant and romantic. In the 1970s, the euphoria of independence had disappeared. The protagonist is shown as a marginalised individual whom the audience can identify with. He is much wronged and exploited, and has suffered physically, emotionally and psychologically. He does what we would like to do, but are prevented from doing because of social mores and our own private morals. Interestingly, this change coincided with the imposition of the “Emergency” in India and the widespread social disaffection this provoked in Indian society. This theme continued well into the next decade, with the portrayal becoming more prominent, aggressive and violent.

The dominance of the angry young man continued in the 1990s. However, his anger was no longer directed against society. Instead, it became a symbol of love. The roles of Shah Rukh Khan as the love-obsessed stalker in films like “Deewana”, “Darr”, “Baazigar” and “Anjaam” heralded the arrival of a psychopath who feels no remorse or guilt. Another theme that emerged in this period, which has continued in this millennium, is a new idealism involving young people with high aspirations and dreams, either in urban India, or often living abroad, but culturally conscious of their “Indian-ness”. This evolution, which coincided with economic liberalisation and globalisation, appeals both to the younger audience of Indians and to the Indian Diaspora. Family dramas and romance have made their reappearance reflecting also an interesting coexistence of tradition and modernity. Interestingly, the psychopath who engages in mindless violence (“Abhay” in Hindi, “Alavandan” in Tamil); the person with an explosive impulsive personality (Shah Rukh Khan in many films); the multiple personality disorder sufferer (“Manichitratazhe” in Malayalam; “Chandramukhi” in Tamil); all continue to engage our cinematic cultural consciousness, as do themes of marital jealousy and infidelity (“Astitva”), unusual relationships that transgress social class and mores (“Chandni Bar”, “Ek Chalis ki Local”); differences in age (“Jogger’s Park”, “Nishabdh”, “Cheeni Kum”) and other conventional barriers. Indeed, it could be said that Indian cinema has demonstrated the maturity to explore many an unconventional emotive theme, while continuing to remain curiously infantile in Toto, largely reflecting a male dominated parochial society.

Appalling Portrayal: The portrayal of madness in Indian cinema is appalling. Those with mental illness are clowns, feeble and weak. Those treating them are caricatures, all in white coats and, absurdly enough, they get the hero to face the truth by setting up situations, as a detective might. Prof. Bhugra reviews several Indian (mainly Hindi) movies to make this point. As in “Khamoshi”, the senior psychiatrist chairs a meeting with at least 10 other psychiatrists to decide whether the protagonist is insane or not. They take turns in asking questions to assess his mental state; with one psychiatrist (unusually) instructing him to keep his answers short and to the point. The interview is more like an inquisition with rapid fire questioning.

Illogical and unrealistic portrayals of mental illness in Indian cinema are highlighted here. The heroine, usually a nurse or, more recently, doctor, makes it her life’s mission to “cure” the mentally ill protagonist, often going far beyond the call of her profession; more alarmingly, often breaching clinical ethics by falling in love; the submission of the heroine to many a risky assignation in order to diagnose or identify the cause of the protagonists madness; the explosive climax which puts all including the protagonist at risk of losing life, limb and sanity; the ward filled with several mentally ill people, most engaged in some ridiculous form of repetitive activity (running around, body rocking, asking the same comical question repeatedly, staring into space) all of which reduce mental illness to a caricature; the delivery of treatment in a most unethical, unacceptable and unrealistic manner etc. without discussion or consent, etc. The common thread that binds these cinematic situations together is that they are designed to shock the viewer and dissociate him from mental illness, making the mentally ill person the classic “other”. Indeed, Western films too share the tendency to portray mental illness and its treatment unrealistically, resulting in worldwide misconceptions about the role of the psychiatrist and psychiatric treatments. Electroconvulsive Therapy (ECT) or shock treatment as it is popularly referred to, has suffered and been demonised in particular due to its unrealistic portrayal in cinema. People are often given ECTs when fully conscious and sitting up, a most unusual practice, not in the armamentarium of any right thinking psychiatrist.

Curiously, however, there is also a humanism that is often conveyed through this bizarre portrayal. The nurse is often portrayed as having genuine empathy for her patients while remaining fiercely loyal towards the doctor, resulting in an emotional conflict (for her). The patients appear to form a closer network and, to their minds, “the other” is obviously the hierarchy and the establishment.The chronological approach adopted in this book enables the reader to study the evolution of Indian cinema over time, to comprehend the change in perception and portrayal of various subjects including mental illness over the decades and how the changes in politics, economics, culture and society affect changes in cinema, ensuring that he leaves no ambiguity in conveying his findings.

The films that Dr. Bhugra has made references to are popular, decade-specific contributions that attracted large audiences in their respective times, were influenced by the social climate of the country, and in turn influenced society as well. The cumulative effect of viewing film after film is the creation of a mental warehouse full of internal stereotypes stored in the preconscious and unconscious memory banks. He calls for more studies on the influence of external factors on the way films are conceived and made, so that a more accurate picture of mental illness can be projected by cinema, which is a rather powerful medium influencing public opinion.

Deceptive Title: The title of the book and of its many constituent chapters is deceptively light hearted and in some ways does not do justice to it. This book is a comprehensive and scholarly analysis of the gamut of philosophical, psychological, social and cultural issues associated with human emotion (including mental illness) in Indian cinema, dealt with in a serious, theoretical manner. The book does largely limit itself to Hindi cinema save a few references to regional contributions. The author draws on a vast theoretical and academic base to convey his point authentically. The wide array of references ensure that the book is a storehouse of information not only for cinema buffs and mental health professionals, but also students across the spectrum of humanities.In a country like India, where people idolise film stars and are influenced greatly by cinema, it is very important that issues like human emotion and mental illness are portrayed accurately and responsibly. With the great mass of Indian cinema audiences being highly vulnerable to the influences of this medium, accurate and responsible attempts at portraying human emotion and mental illness are necessary, as also avoiding portrayals that trivialise and dehumanise important disorders of the mind. However, as the author has pointed out rather eloquently, the trivialisation of madness in India cinema may in itself be a reflection of the liberal, forgiving and largely tolerant society that we are!

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Inspirational Genius

When we refer to our minds, we often touch our hearts, or our heads. Yet, the mind as a physical entity, one that can be localised in a scan for example, does not reside anywhere in the human body. Our feelings, thoughts and emotions do — they are represented in our brains. To try and unravel this conundrum, let us take a computer analogy. When we consider cognition and behaviour, our brain is the hardware, the equipment and processes that make computers work. On the other hand, the mind is an operating system that draws upon the hardware but does not have significant physical representation, much like the software in our computers. The mind, therefore, is a virtual entity, one that reflects the workings of the neural networks, chemical and hormonal systems in our brain.

Having accepted that the brain and the mind are a unitary organ with diverse functions, it becomes imperative that we consider the “soul”, traditionally an esoteric and controversial concept. A noun variously defined as “psyche, inspiration and energy”, the soul has many synonyms in the English language. Where the soul resides is, however, a matter of conjecture; a question that is both difficult to answer and difficult to objectively experiment on. However, if one were to consider “the soul” as the vital force that inspires, energises and stimulates us, then it may be possible to study its manifestations and effects in all human activity having those qualities.

The possibility that one could study the soul by associating inspirational human experience, religion, music, poetry and literature, with the brain, is tantalising to say the least. In his book The Soul in the Brain, Michael R. Trimble, Emeritus Professor of Behavioural Neurology at University College of London, expounds the neurological correlates of such inspirational human experiences that were once considered to be the exclusive purview of the heart. Trimble commences his book with the words, “If you fear that opening your mind will cause your brain to fall out, then this book is not for you. If you are unhappy discussing neuroscience in the context of poetry, music and, above all, religion, then again this text cannot be recommended.”

Basis of Emotions: Trimble begins by exploring the brain anatomy of human emotion, implicating the Limbic System as the seat of human emotion. Seated deep within the brain and consisting of a network of critical structures, the Limbic System is the oldest part of the mammalian brain. There is considerable data today from brain imaging studies to show that this part is closely associated with emotional disorders. For example, the Amygdala, a multinucleated structure intricately connected with many brain parts, has been shown to both vary in size and to have different levels of neurochemical activity in various emotional disorders. The Amygdala is today the focus of much of the brain research that is concerned with human emotion and emotional disorders. Expounding on the neurobiology of emotion beyond these structures, Trimble discusses their links with other critical brain areas. He quotes extensively from the work of 20th century experts who have contributed to our understanding of emotional brain function, exploring brain anatomy beyond limbic structures that has a role in human emotion.

Poetry and literature are areas that Trimble explores at some length in this book. He describes how the use of the language of poetry and metaphor produces heightened activity of the right hemisphere of the brain. Pointing out that certain neuropsychiatric conditions have strong associations with specific creative pursuits, he draws attention to the links between literary creativity and Bipolar Affective Disorder (Manic Depressive Illness), an association strangely not witnessed with another major mental illness, Schizophrenia. He quotes extensively from the works of several poets with Bipolar Affective Disorder such as William Cowper (1731-1800), Robert Lowell (1917- 1977) and Anne Sexton (1928-74). For example, Anne Sexton, who frequently took drug overdoses and finally committed suicide, wrote:

Anne Sexton

Sleepmonger,
deathmonger,
with capsules in my palms each night,
eight at a time from sweet pharmaceutical bottles
I make arrangements for a pint-sized journey.
I’m the queen of this condition.
I’m an expert on making the trip
and now they say I’m an addict.
Now they ask why.
WHY!
Don’t they know that I promised to die!

Yes
I try
to kill myself in small amounts,
an innocuous occupation.

One cannot help but draw a parallel with the famous Tamil poet of the Indian independence movement, Subramanya Bharathi, who was renowned for his extraordinary creativity, intermingled with profound emotionality supplemented by generous doses of nationalistic and religious fervour (see box). Indeed, the creative human brain has perhaps an excessive proclivity for emotionality; quite understandably, given that creativity is often inspired; and inspiration in all forms requires feeling!

Another Meeting Ground: Religion is another area that exemplifies this meeting of the “trinity”. Most dictionaries describe religion as “a way of life”; religious beliefs, practices and experiences have a strong cultural basis in their evolution. It seems inconceivable therefore that religious experience may have its basis in the brain. However, why are some people more intense in their practice of religion, while others are considerably less enthusiastic; or why do one’s religious attitudes, beliefs and practices change during one’s life span? Can this be explained by sociocultural factors alone, or are there more inherent biological determinants of these behaviours? For example, there are considerable differences in how siblings experience and practise religion even though their sociocultural ethos are similar, and we witness the entire spectrum from intense religiosity to strong agnostic tendency within a family.

Further, religiosity is an important component of many brain and mind disorders. The depressed, anxious or avoidant individual is almost desperate in his pleas for religious salvation, rather different from the intense ritualism of the person with Obsessive Compulsive Disorder.

The religious ecstasy of the person with mania is qualitatively different from the prophetic fervour of the person with paranoid schizophrenia or temporal lobe epilepsy. The hyper-religious individual with temporal lobe epilepsy has on occasion been described as a dramatic persona complete with religious symbols and a prophetic fervour, with an unshakeable belief that his existence had a special purpose for the world we live in. In his chapters on “Neurotheology”, Trimble also quotes patients with epilepsy, dementia and head injury who have religious experiences. The triad of hyper-graphia (the keeping of copious and detailed notes and diaries), hyper-religiosity ( an increased interest and practise of religious matters) and hypo-sexuality (a diminished interest in matters sexual) is well described in the syndrome of temporal lobe epilepsy; especially in long standing and poorly controlled patients with recurrent temporal lobe epileptic seizures. It is accompanied by an obsessional and viscous personality. Trimble points out that while the note taking and diary keeping is copious, it lacks, unlike the poetry of the person with bipolar disorder, creativity and appeal. This fundamental difference may reflect the different brain substrates that underlie these conditions.

“The content of the writing from hypergraphic patients with epilepsy often reflects religious or mystical themes.” (Roberts, Robertson, and Trimble, 1982.)In his chapter on “Music and the brain” Trimble brings out the emotional nature of musical language.

‘Plato considers that music played in different modes arouses different emotions… Major chords are cheerful, minor ones sad; the ups and downs of life…”

While music and the brain is a topic that has been covered widely elsewhere, the uniqueness of Trimble’s contribution is in developing the links between the brain, mind and music. Pointing out that music and poetry have the unique ability to bring one to tears, often as part of a state of ecstasy, he goes on to explore the brain processes that may mediate emotional crying, which he points out as being a uniquely human experience. Why are we, the human race, so moved by art, poetry and music that we are reduced to tears, not those of sorrow, but of elation and ecstasy? In Indian lore, musical saints and savants are often described to reach states of ecstasy in the development or indeed deliverance of their favourite compositions, usually in praise of their favourite lord. The great composer Thyagaraja attained this state in the worship of Lord Rama; Purandaradas in the worship of Vitobha; Bharathi in the worship of his favourite Parasakthi; the list is indeed long. What brain and mind processes lead to these states of intense devotion and creative focus, combined with religious fervour?

The Creative Half: Trimble in his book quotes many studies that implicate right hemisphere activity in musical perception. It is widely understood that the right hemisphere is the “creative half” of the human brain. Interestingly, the right hemisphere also happens to be the emotional hemisphere. That right hemisphere dominant individuals are both creative and emotional may explain why those engaged in artistic pursuits express both qualities in ample measure. There is an impression among clinicians that Bipolar Affective Disorder (Manic Depressive Illness) is for example over represented in the creative professions; the biological basis for this may well rest in the right brain. Trimble himself has pointed out that the relationship between the brain and aesthetic experiences, rather than being the rule, may indeed be exceptional: “… not all patients with bipolar disorder become poets, of course nor are all poets manic-depressive” (p. 106). Further, it may be erroneous to conclude that these experiences belong to the brain alone. The mind, while an abstract construct in this the 21st century, remains an important part of clinical and scientific lore. The contributions of the mind to poetry, music, art and religion cannot therefore be ignored. Trimble’s work is commendable as a rare attempt to relate the highly technical specialty of neuroscience with something as abstract as art and in doing so fills an important void in scientific and popular literature.“The neuroscientific community has generally shown little interest in exploring the finer aspects of human behaviour and thought, especially aesthetic experience and creativity.”

Tangible Markers: Intellectual debate about where the soul resides is likely to continue for eons. Through this important work we understand emotional experience and creative pursuits are vicarious markers of the human soul. We may then develop a persuasive argument that a critical mass of brain structures and their connections are associated closely with these vicarious markers of the soul. While this does not prove that these critical brain structures are where the soul does indeed reside; not even that the vicarious markers are a true soul representation; it is an important scientific link between profoundly moving human experience and the brain. One could still argue that the soul does not necessarily reside in the human brain and that we do not have adequate “proof of this concept”. Which does of course leave us asking, “Pray, just where doth the soul reside”?

Everyday Relevance: What is the relevance of “Trinity Talking” concept to our lives, you may well ask. All of us come across people in society who excel in their creativity. Obviously these individuals have inspirational periods when their mind, brain and soul are in sync! The more productive the individual and the more evocative her/his productions, the more frequently is their “Trinity Talking” may well be one explanation. Indeed, going beyond the creative pursuits to other professions and trades, every one of us will possibly have at least one moment in our life, profession or vocations when we experience this spark of “enlightenment”, however brief. In these periods there is sudden clarity that often follows a period of confusion and turmoil. In these periods we often make momentous decisions and take definitive actions that may have an impact on our whole life. In these periods we experience true “self actualisation”. One may contend that the more frequent and more sustained these experiences, and more willing the person to explore and follow up on them, the more successful and productive he is. Clearly these are precious moments when our thoughts, beliefs and emotions meet with.

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Adults Cerebral Musings Expert Blogs Featured

The Almighty Within

Most dictionaries describe religion as “a way of life”. Religious beliefs, practices and experiences of individuals in our society, appear to have a strong cultural basis in their evolution and have been described as part of every ancient civilisation discovered and studied by modern man. On the face of it, therefore, it seems inconceivable that religious experiences may have biological basis in our brains.Several questions remain unanswered in our quest to understand how religious experiences occur.

Why are some people intense in their religious beliefs and practices and others considerably less enthusiastic? Or indeed, why do one’s religious attitudes, beliefs and practices change during a life span, progressing sometimes: from atheism to agnosia to intense religiosity (or indeed in the converse direction)? Can socio-cultural factors alone have such influence on our lives, or are there more inherent biological determinants of these experiences and behaviours? Empirical observation suggests that a simple sociocultural explanation may be inadequate. There are for example considerable differences in religious attitudes and practices between siblings born of the same set of parents. The socio-cultural ethos in this situation is a virtual constant. Yet variations in the quality, frequency and intensity of religious experiences are observed and it’s not uncommon to witness the entire spectrum, from intense religiosity to a strong atheistic tendency within the same family. While psychological experiences and social factors unique to each individual may have a significant role in determining these variations, they are often conjectures that arise from social and clinical observation.

Insights from NeuropsychiatryNeurology, psychiatry and their interface discipline neuropsychiatry provide many interesting models for the study of religiosity. Religious phenomena vary tremendously across brain and mind disorders. The religious ecstasy of the person in a bipolar mania is qualitatively different from the prophetic fervour of the person with paranoid schizophrenia. The depressed, anxious or avoidant individual is almost desperate in his pleas for religious salvation, rather different from the intense ritualism of the person with OCD or indeed the magical beliefs of the schizotypal individual.

There are also variations in quality and intensity of religious experience across psychiatric disorders; for example, the acute hyper-religiosity of mania is rather different from the grumbling, slowly evolving, almost prophet-like religious fervour of the person with a schizophrenia-like illness. Are these variations in phenomenology, quality and intensity of religious experience governed by psychological and socio-cultural determinants alone? Or indeed do different brain mechanisms have a role to play in determining these variations?Neurology too has its share of religiosity models. The Geschwind syndrome is a personality syndrome that has been described in people with poorly controlled temporal lobe epilepsy. While a well defined cluster of behavioural symptoms characterise this personality type (see “The Inside Man”, The Hindu Magazinedated November 29, 2009), intense hyper-religiosity with intensified preoccupations related to moral, philosophical, religious, or ethical themes are a core feature of this syndrome (see also box on Kumagusu Minakata). Bear and Fedio (1977) provided a biological explanation for this syndrome (the sensory-limbic hyperconnection” hypothesis). They proposed that ongoing electrical activity in the temporal lobe (in the person with temporal lobe epilepsy or TLE) resulted in all sensory experience (seeing, hearing, feeling, smelling, tasting etc.) being suffused with a strong emotional coloration. This resulted in relatively ordinary experiences being viewed with a certain emotional intensity by the person with TLE. Hyper-connection of critical brain structures for emotion, specifically the limbic system comprising the amygdala, hippocampus and other critical structures, was therefore thought to be the biological underpinning that determined hyper-religiosity and other personality features in TLE.

A God Module in the Brain?Perhaps the most dramatic recent description of hyper-religiosity in epilepsy is that of V.S. Ramachandran in his book “Phantoms in the Brain”. In a chapter provocatively titled “God and the Limbic System”, Ramachandran draws on his clinical experience to give the reader an evocative description of a hyper-religious patient with temporal lobe epilepsy. He describes the dramatis persona complete with religious symbols and a prophetic fervour, accompanied by a firm belief (in that individual) that his life had special meaning and his existence a special purpose for the world we live in. While Ramachandran’s subject had symptoms that were decidedly exaggerated (a caricature rather than the norm), hyper-religiosity in people with TLE evolves over time (a trait phenomenon), not just appearing suddenly (as in a state phenomenon).

Ramachandran poses the interesting question “is religiosity a pre-determined biological trait”; paraphrased, this could read “is there a god module in the human brain?” Research using MRI volumetry and functional MRI (fMRI) techniques have demonstrated rather interestingly, links between structures in the limbic brain, especially the hippocampus and religiosity. Indeed, one paper that I co-authored (Wuerfel et al, 2004) demonstrated links between a small right hippocampus and hyper-religiosity in epilepsy.

Unanswered QuestionsWhile putative associations between religious experiences and the limbic system have been demonstrated, a number of questions remain unanswered. First, what exactly is normal religiosity and what is hyper-religiosity? One suspects that this in itself is subject to transcultural influences. Western studies report about a third of people surveyed as being “religious” or “very religious”. We surveyed over 500 people using a suburban railway booking counter in Chennai and found almost 70 per cent of all individuals qualified as being “religious” or “very religious”. In the Indian social context, where religious expressions and beliefs are common place, the phenomenon of hyper-religiosity can be difficult to define.

For example, in our Chennai survey, when we described hyper-religiosity as being two standard deviations from the median score in our questionnaire, we found only a small proportion of people qualified. Social norms of “normal religiosity” will therefore have a significant impact on what we perceive in each culture as hyper-religiosity.Second, are religious experiences a trait or state phenomenon? It seems clear that religiosity can be both a state and trait phenomenon when observed across the spectrum of neuropsychiatric disorders. Contrary to popular perception, trait behaviours do not stop developing with the onset of adulthood and continue to evolve subtly over many years. It is conceivable that religiosity as a trait behaviour in people with neuropsychiatric disorders may exist from early on, but become very much more apparent during the course of the lifespan, periods of acute emotional distress being particularly prone for religious expression. On the other hand, hyper-religiosity may also be a pure state phenomenon, as observed in mania or acute psychotic episodes, with the person reverting to baseline levels of religious expression, post-episode. In a person without neuropsychiatric illness the religiosity trait may evolve over a lifespan, and depending on life experience may enhance or become muted.

Our religiosity may also periodically achieve enhancement during times of adversity, sorrow and grief or indeed euphoria; times when we instinctively reach out to powers beyond.Third, is religiosity a natural consequence of adversity rather than a pathological process? It seems entirely plausible, when viewed from a psychological perspective, that individuals meet adversity in their lives with an increase in religious interest and or experience. Indeed, society encourages and endorses such reactive religiosity and acute emotional breakdown states are often described as spiritual experience or transformation. The flight into hyper-religiosity in the context of a neuropsychiatric disorder may well be a helpful, socially endorsed coping mechanism; spiritual excess being better accepted in society than emotional distress. Why hyper-religiosity disappears in many disorders with the resolution of neuropsychiatric symptoms, and persists in others even after their resolution, does of course beg answers.Fourth, is hyper-religiosity a pathological phenomenon? With the finding of a small right hippocampus being associated with hyper-religiosity and other descriptions of altered limbic physiology in this state, it seems conceivable that biological influences may in some way affect the development or maintenance of hyper-religiosity. Is hyper-religiosity as behaviour pathological? To decide this, one would typically have to refer to the individual’s previous background (personal and socio-cultural) in the religiosity context. Religious behaviours especially those with sudden onset and not in keeping with the person’s background may well be, from a behavioural perspective, pathological.Finally, are the changes in limbic system structure and activity identified in brain imaging of hyper-religious individuals, a cause or consequence of this behavioural predilection? Changes in limbic system structure and function are thought to accompany the longitudinal course of many neuropsychiatric disorders: epilepsy, schizophrenia and depression to name a few conditions. Clarity about what precedes (structural change or behaviour) remains elusive and the changes observed in the brain may thus be both cause and consequence, the brain being a remarkably plastic organ.

Final analysis: So is there a god module in our brain? The evidence available seems to indicate that our emotional brain, the limbic system, the hippocampus in particular, perhaps more on the right side, plays a significant role in determining the nature and quality of one’s religious experience and expression. It is very likely, the rich neuro-chemical networks that populate this region, including dopamine and serotonin, have considerable influence on our religiosity, notwithstanding the alteration of brain structure, right hippocampal atrophy. Religiosity may thus be viewed as a trait, which can undergo both physiological and pathological evolution during the course of a person’s lifetime. The nature of the underlying biological framework in an individual is likely to determine the form, quantum and nature of religious experience and expression that psychosocial adversity and emotional illness provoke.

The bio-psychosocial model of mental health and illness dictates that both the physiological and pathological manifestations of this trait marker are likely to be influenced strongly by the sociocultural ethos of the individual, as well as his psychological evolution during the course of a lifespan.We must acknowledge here, the very significant role that religion and spirituality play, in helping human beings maintain optimal emotional well being or indeed achieve restoration of emotional health after a breakdown. One must also acknowledge our collective ignorance, as a society, about the biological, neuropsychiatric and psychological effects and virtues of theism, atheism and their many-splendored, much-debated, interface. Whether our religious predilections have a role in protecting and preserving or indeed enhancing our emotional state, remains thus, a matter of conjecture. The influence of this god module in our brain, “The Almighty Within”, is however probably omnipresent, just as our ancients conceived the almighty himself to be. Strange then, indeed, are his ways!

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Adults Cerebral Musings Expert Blogs Featured

The Godfather Paradox

Over four decades ago, Mario Puzo gave us, through his The Godfather, an insight into the mind of the socially enabled psychopath. Born in Corleone, a small village in Sicily, that troubled, deprived and violent part of Italy we have learnt to associate closely with the “mafia”, Vito Corleone earned his stripes as a young boy, learning to use the Sicilian gun “the Lupara” with finesse and precision. His flight from Sicily, early years in New York as a humble immigrant, barely managing to make ends meet, and struggling to provide for his young family during the great depression, and his eventual entry into the grey belly of the New York “underworld” after his shrewd murder of a local don, were brought to life most brilliantly by Puzo. Incredibly, the “Godfather” who emerged from these violent beginnings metamorphosed over time into “a reasonable man”, a fact the author takes pain to reiterate several times during the course of the complex tale.

The Mind of the Psychopath: Vito Corleone, the Godfather who emerged from these humble beginnings in Puzo’s novel and went on to occupy a pre-eminent position in the underworld, makes a fascinating case study, one of the finest descriptions of psychopathic personality in popular fiction. The prototypical psychopath has deficits or deviances in some core areas: interpersonal relationships, emotion, and self-control. Psychopaths gain satisfaction through antisocial (or socially deviant) behaviour, and do not experience shame, guilt, or remorse for their actions. A classic trait among psychopaths is the lack of a sense of guilt or remorse for any harm they may have caused others. Instead, the psychopath rationalises his behaviour, blames it on others, or denies it outright. Psychopaths also lack empathy towards others in general, resulting in tactlessness, insensitivity, and contemptuousness. All of this belies their tendency to make a good, likable first impression. Psychopaths have a superficial charm about them, enabled by a willingness to say anything without concern for accuracy or truth. Shallow affect also describes the psychopath’s tendency for genuine emotion to be short lived and egocentric with an overall cold demeanour. Their behaviour is impulsive and irresponsible, often failing to keep a job or defaulting on debts. Psychopaths also have a markedly distorted sense of the potential consequences of their actions, not only for others, but also for themselves. They do not, for example, recognise the inherent risk of being caught, disbelieved or injured as a result of their behaviour.Emotionally, the fundamental traits underlying this personality are an inability to empathise with others, to feel their emotions, to share their love, joy, pain and sorrow in a deep way. Indeed, the emotions that this personality experiences are distinctly shallow and poorly sustained. It is not that the psychopath does not feel emotions; he feels them so fleetingly and his being carried away by them is so transient (albeit intense) that those feelings fail to have any impact on how he perceives and reacts to the emotions of others. In other words, his emotional experience probably has little impact on his emotional learning and development as a human being.

Research has shown that psychopaths have poor perception of the facial emotions others express, and experience difficulties in affect recognition (i.e. gauging the other person’s mood). They also seem to have difficulty in integrating contextual cues in their environment; their perception of an environmental cue is linked to how it relates to goal-relevant environmental information. Put simply, the psychopath fails to perceive environmental cues in the context they are and may thus react inappropriately.

As a consequence, psychopathic personalities may fail to perceive fear in the object of their aggression; fail to recognise his abject submission; and therefore perhaps, fail to tailor their aggression to that which will merely provoke a desired response. In the process, their aggressive reactions may be far in excess of that needed to achieve their ends.Psychopaths also often do not sense right and wrong in conventional ways accepted by society: in other words, they often choose to operate from their own reality framework and do not necessarily fit within the moral and legal framework that we accept as a society. From Al Pacino to Veerappan, Real life examples of “Godfathers”, like Veerappan, have been (with few exceptions) intensely proud men, who are not afraid to write their own rule books; judge right and wrong in their unique ways; seldom appearing to feel, certainly not expressing remorse for their actions, however impactful, including the ending of human life, both of perceived opponents and of their own kith and kin. For example, Puzo’s godfather, in mourning the violent death of his favourite older son, focuses more on his (son’s) inability to control his impulses rather than on his own contribution to the sadness that has visited his family. Curiously, the Godfather’s wife, a devout Christian, is described as fervently praying for his (the Godfather’s) soul and presumably its salvation.

A Reasonable Man: What is fascinating about Puzo’s Godfather is his quality of “reasonableness”, so important for a leader, yet so unusual for a psychopath. Indeed, Vito Corleone is almost statesmanlike in his responses. Highly moralistic in his personal values, he is portrayed as having very strong views about appropriate public behaviour, family honour and sexuality in particular, and is seen to frown on social inappropriateness of any kind. Indeed his second son’s fondness for company with the opposite sex becomes the major reason for the Godfather to summarily reject him, despite having lost his older son to the ravages of his profession. Particular about language and its usage, he reserves his strongest rebuke, “infamita”, to markedly inoffensive situations; even so, it conveys squarely to those around him his displeasure about a person, his statements or actions. That someone so moralistic does not see it amiss to eliminate a rival through murder in cold blood, or indeed coerce a recalcitrant and arrogant movie producer by decapitating his favourite, priceless race horse, leaving the (race horse’s) head in his bedroom for him to wake up beside, experiencing untold terror in the process, exemplifies for us the paradox the Godfather is. Strangely also, throughout the book, the Godfather stands out for his willingness to negotiate; “I will reason with them” is his favourite refrain when confronted with a difficult situation.

The Godfather ParadoxSo if Puzo’s Godfather is a psychopath, what manner of psychopathy does he represent? The primary quality of psychopathy that the Godfather possesses to a great extent appears to be the ability to be ruthless in achieving his own ends. A second psychopathic quality the Godfather exudes is a distorted reality of the impact of his actions; not quite consonant with traditional expectations or social beliefs, nor indeed particularly empathetic. A third, perhaps most striking psychopathic quality the Godfather possesses is his ability to manipulate people and situations rather skilfully. His dispensation of favours is usually with a caveat; that one day, at an appropriate time, the favours will have to be returned. Hesitation to accept or return the Godfather’s favour is viewed with open contempt, suspicion, even derision.

There are, however, several differences. Quite contrary to the typical psychopathic personality, the Godfather’s is a slow to warm, even phlegmatic, temperament, and he does not exude a superficial charm. Nor does he lose control over his emotions at any point in time, whatever the provocation; indeed, he regards the inability to control one’s emotions as being an “animal” quality, unbecoming of a sensible human being. His is also a remarkably sensitive personality; quick to take offence and very perceptive of the moods, emotions and reactions of those around him. His ability to perceive social and emotional cues is highly developed, quite unlike the conventional psychopath who appears oblivious to these. Finally, his almost statesman-like willingness to reason makes him stand out from the conventional image we have of the psychopath as a society. Puzo’s Godfather does, therefore, present us with a paradox; cruel psychopath to some, beloved friend and protector to others; a unique combination of sense and sensibility on the one hand, balanced against latent potential for ruthless violence. Does he then represent the socially enabled psychopath?

Are effective leaders socially enabled psychopaths?

While “goodness” and “greatness” within organisations is determined in large part by their in-built value systems, leaders often have potential to change value systems, goals, performance and outcomes both positively and negatively. In traditional professions and businesses, leadership is often either supervisory or strategic: the former focussing on getting the organisation (or a group within it) to perform effectively; the latter on managing change and uncertainty effectively, positioning the organisation for future growth. While many forms of leadership have been described, “inspirational leadership” has as its focus “the emotional connect” with people’s energies and goals, converting them into effective followers under all circumstances. This form is perhaps predominant in the leader who is a socially enabled psychopath.Effective leadership is often about helping people and organisations achieve the goals they have set for themselves. Engagement in such goal-oriented activity does call for a certain focus; where the goals set achieve primacy over other concerns, for example, those of the ethical or moral kind. In the competitive world of business, for example, the most effective leader is often perceived as the one who “delivers” whatever the means he employs. It is in this environment that the socially enabled psychopath with his unique perceptions of reality, willingness to shift societal norms and expectations to suit his agenda, and most importantly “willingness to reason with his fellow men” using a range of strategies from charming persuasion to latent threat, comes into his own. His “killer instinct”, lack of empathy and inability to experience and empathise excessively with the pathos of his fellow men consequent to his actions, serve him well here. His actions may hurt his fellow men, or be distasteful; but in the rough and tumble modern world we inhabit, the ability to achieve tangible and productive goals profitable to his organisation and to him, without twinges of conscience or feelings of regret, is often advantageous.

The modern-day CEO is, therefore, in many cases, a socially enabled psychopath, effective leaders in business, science, technology, medicine, politics, and religion all exemplifying this “Godfather Paradox”.To label all effective leaders as “socially enabled psychopaths” would clearly be uncharitable to society at large and too much of a generalisation. However, empirical observation does highlight the predominance of aforementioned qualities in various permutations and combinations, among leaders in society, which is curious, to say the least. One may even argue that a certain amount of “social psychopathy” is necessary in order for leaders to succeed, as excessive empathy towards different stakeholders, lack of a personal reality orientation, and inability to “reason” can in many situations be detrimental to the larger cause one represents. Perhaps modern society would eventually deem acceptable a breed of leaders with such “benevolent positive psychopathic traits” without an iota of physical or emotional violence in them. Perhaps, we will as a society, one day, celebrate rather than vilify, “the Godfather Paradox”. Perhaps!

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Autistic Spectrum Disorder (ASD) Expert Blogs Featured

Overcoming Autism with Growing Brain Lab

Disorders of brain and nervous system development are among the most disabling disorders that  affect young children and their families. These include several forms of mental   retardation and learning disability, cerebral palsy, dyslexia, autism, attention   deficit and hyperactivity disorder and a spectrum of motor, cognitive, behavioral and emotional   disorders including those due to family and school stress.

Autism is one of the most important disorders that affects young children. Autism is known as a ‘spectrum disorder,’ because the severity of symptoms ranges from a mild disabilities in learning, language development and social interactions to a severe impairment, with multiple problems and highly unusual behavior. The disorder may occur alone, or with accompanying problems such as mental retardation or seizures. Autism is not a rare disorder, being the third most common developmental disorder, more common than Down’s Syndrome. Typically, about 20 in a population of 10,000 people will be autistic or have autistic symptoms. 80% of those affected by autism are boys.

Children with Autism need the care and attention of a multi-disciplinary team, including the paediatrician, neurologist, psychiatrist, physical, occupational and speech therapists,   psychologists with special training and interest in education and development,   special educators, social workers, speech therapists and nurses.  At present, there is no pharmacological therapy which can cure autism. The only consistently effective treatment for autism is a structured training program; therefore, a combination of a good school and parent training is the best known treatment. Autistic children can make significant progress if the intervention is appropriate and consistent.

Growing Brain Lab (GBL) is an innovative project at Neurokrish-Trimed.  Over a decade GBL has evolved as multidisciplinary model of assessment that addresses Learning,   Aptitude and Behaviour across motor, cognitive, emotional, and psychosocial   domains. GBL has also perfected in this timeframe a model of after-school   therapy incorporating behavioral management and Neurodevelopmental therapy.   With the advent of TRIMED and it’s integrative approach, GBL now incorporates seamlessly a range of holistic interventions targeting symptoms of various developmental disorders including Autism. Play Yoga, Mud Therapy, Reflexology, Ayurvedic Therapies all blend seamlessly into a whole in the TRIMED-GBL program. Inspired by excellence and Success Stories, GBL is today making accessible to families, modern healthcare with ancient wisdom, which is the TRIMED mantra.

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Dementia Dementia & Memory Loss Elders Expert Blogs Featured

Dementia: A Looming Threat

Photo Credit: The Hindu: N Sridharan

A low level of awareness about dementia is most often why diagnosis is delayed and public health consciousness remains poor.

World Alzheimer’s Day (September 21) was marked this year, in India, by the release of a comprehensive Dementia India Report. Prepared by national experts, converging under the Alzheimer’s and Related Disorders Society of India (ARDSI) umbrella, it estimates that there are 3.7 million elderly currently living with dementia in India, each spending Rs. 43,000 per annum on medical care. Dementia mainly affects older people, although about two per cent of cases start before the age of 65 years. After this, the prevalence doubles every five years with over a third of all people aged 90+ years being affected. With the exponential increase in the population of the elderly (60+ years) in India, an estimated 100 million today, expected to rise 198 million in 2030 and 326 million in 2050, dementia poses a looming public health challenge, the enormity of which cannot be underscored. The report thus addresses a felt need among professionals, policy makers, dementia sufferers and their families.

What it is ?

Dementia is a neuropsychiatric disorder in which memory and other cognitive functions like thought, comprehension, language, arithmetic, judgment and insight deteriorate progressively.

While it increases in prevalence with advancing age, it is not a normal feature of ageing, a common misconception. Further, dementia is a clinical syndrome, one with many underlying causes, some potentially treatable. Of the many conditions that cause dementia, Alzheimer’s disease (AD) associated with neuro-chemical decline and waste product accumulation in the brain; vascular dementia (VaD) associated with strokes; dementia with Lewy bodies (DLB), a condition associated with Parkinson’s disease; and frontotemporal dementia (FTD), are most common.

The treatable conditions that cause dementia include infections such as syphilis, HIV and tuberculosis; hypothyroidism and other endocrinal problems; vitamin B12 and folic acid deficiency; toxic conditions of various kinds and so on. As they are potentially reversible they need to be addressed swiftly.

What the report highlights ?

The report highlights two areas of great import for dementia sufferers and their families: activities of daily living (ADL) an important measure of the human condition, and behavioural and psychological symptoms associated with dementia (BPSD), an important predictor of health related quality of life (HRQoL). Problem behaviours in dementia include agitation, aggression, calling out repeatedly, sleep disturbance, wandering and apathy.

Common psychological symptoms include anxiety, depression, delusions and hallucinations. BPSD occur most commonly in the middle stage of dementia and are an important cause of caregiver strain. They appear to be just as common in low and middle income countries as in developed ones.

The report outlines the current evidence based pharmacological treatments for dementia, especially AD and VaD: cholinesterase inhibitors (donepezil, rivastigmine, galantamine); NMDA agonists (memantine); drugs for BPSD (SSRI’s for depression and anxiety; new antipsychotics for psychotic symptoms like agitation, aggression, hallucinations; antiepileptic drugs that serve as mood stabilising agents); addressing also their cost-benefit in low-middle income countries. It also lays stress on the importance of structured caregiver interventions as part of standard treatment including psycho-educational interventions for dementia; psychological therapies such as cognitive behaviour therapy, cognitive retraining and family and caregiver counselling; as also caregiver support and respite care. Highlighting that caregiver interventions have been conclusively shown to delay institutionalisation of the person with dementia in the developed world; it observes that many new treatments in advanced stages of research hold promise for persons with dementia and their families.

The report differentiates risk factors into those that are non-modifiable (genetic factors for example) and those that are potentially modifiable. It highlights the extensive and evolving medical literature on the role of lifestyle diseases: diabetes and insulin resistance; high cholesterol levels; high blood pressure; increased fat intake and obesity; together the so-called metabolic syndrome as a modifiable risk factor for dementia. It is important that policy makers recognise these factors as targets for both primary (early) and secondary (after the onset) risk factor prevention. It points to the low level of awareness about dementia as an important reason why diagnosis is delayed and public health consciousness remains poor.

Worryingly, it observes that the lack of awareness extends to health professionals, formal training in dementia diagnosis and care not being a part of most medical, nursing and paramedical curricula; a matter of great concern needing immediate remediation. That stigmatisation of persons with dementia is rampant and that there is a need for raising awareness about the condition across segments of society is explicitly stated.

In India…

Assuming incremental life expectancy and a stable incidence of dementia, the report attempts to estimate the future burden of dementia both nationally and State-wise.

A twofold increase in dementia prevalence to 7.6 million by 2030 and a threefold increase to over 14 million by 2050 are thus estimated. Interestingly in the State-wise estimation, Delhi, Bihar and Jharkhand are all estimated to witness a 200 per cent or greater increment in dementia cases.

These figures have of course been calculated based on certain assumptions. When one factors in the significant disability that dementia confers on the affected person, estimated as being greater than any other health condition except severe developmental disability, the impact of this exponential rise in prevalence, even put mildly, is staggering. The report addresses the need for services to be developed: memory clinics, day care, residential care, support groups and helplines, pointing out the paucity that currently exists. Also highlighted is the severe paucity of human resources for dementia care.

A number of short-term and long-term focus goals, to improve resources; as well as scope, scale and quality of care are proposed.The report concludes with several key recommendations. The most important of these are:

  • Make dementia a national priority
  • Increase funding for dementia research
  • Increase awareness about dementia
  • Improve dementia identification and care skills
  • Develop community support mechanisms
  • Guarantee caregiver support packages
  • Develop comprehensive dementia care models
  • Develop new national policies and legislation for people with dementia

While these recommendations do address the need for dementia to be integrated into the National Policy for Older Persons (NPOP), they predominantly highlight the specific needs of dementia as a disabling and common condition among the elderly; one that can and will challenge Indian public health systems. However, the report acknowledges that dementia must be viewed in the context of other elder health problems, and within the framework of the NPOP.

Sets a gold-standard

Perhaps the greatest contribution of this Dementia India Report is in its setting a gold-standard for other disorders of ageing: quantifying the prevalence and burden of the condition; its impact on the sufferer, caregiver and society as a whole; the framework of services required in order to give succour and solace to sufferers and their families; the causes, risk factors, treatments and management models; and the State-wise national impact.

One fervently hopes that it will facilitate a powerful and futuristic policy response from the powers that be. In a country where the average age of the parliamentarian clearly falls in the “elder” category, one can only hope that it will be welcomed and adopted with the enthusiasm it richly deserves.Acknowledgements: Dr. K Jacob Roy, National Chairman of Alzheimer’s and Related Disorders Society of India (ARDSI) for permission to present this summary of the report and the use of figures.

Facts: 

  • There are 3.7 million elderly currently living with dementia in India, each spending Rs. 43,000 per annum on medical care
  • A twofold increase in dementia prevalence to 7.6 million by 2030 and a threefold increase to over 14 million by 2050 are thus estimated
  • Many new treatments in advanced stages of research hold promise for persons with dementia and their families

With the exponential increase in the population of the elderly in India, the disorder poses a challenge to public health systems.

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Food for Thought

A healthy diet and lifestyle can stave off memory loss.Dementia is a disorder of brain aging caused by a range of factors: degeneration of chemical systems in the brain; accumulation of waste products; diminishing blood perfusion leading to many small areas of damage (microvascular infarction); and several other causative factors.Prevention assumes great significance in this era of chronic and lifestyle diseases; with hypertension, obesity, lipid disorders (high cholesterol) and diabetes (HOLD) being rampant in society. Nutrition underpins both HOLD and dementia.It is well known that sub-clinical deficiency in essential nutrients can lead to dementia. Research has shown memory deficits in people with low plasma levels of vitamin B 12, folic acid, lycopene, a-carotene, b-carotene, total carotene, b-cryptoxanthin, a-tocopherol etc.

There is mounting evidence for the Mediterranean diet — high consumption of olive oil and fish, hence elevated intakes of monounsaturated fatty acids and v–3 polyunsaturated fatty acids — being protective against age-related cognitive decline. The antioxidant compounds in olive oil (tocopherols and polyphenols), and fatty acids may help maintain the structural integrity of nerve membranes. The naturopathy food pyramid is a good indicator of what we should eat in order to remain healthy and prevent dementia.There is no doubt that red wine consumed in moderation may be beneficial, reducing bad cholesterol, preventing blood clots and protecting the heart. The protection may come from the constituents of red wine made from tannin grapes, which include procyanidins, a class of flavonoids also found in plants, fruits and cocoa beans. Thus moderate red wine consumption maybe good, but only when accompanied by a “healthy” lifestyle.There is growing evidence that vitamin supplementation has a significant role to play in lowering the risk of dementia. Evidence for vit C, E, B12 and folic acid — as supplements in higher doses — is particularly strong. Indeed, the US FDA has recommended folic acid fortification of foods, for example flour and bread. High vitamin levels due to inappropriate supplementation can, however, be problematic and must be guarded against.It has long been known that certain plant formulations — Brahmi (Bacopa Monnieri), Tulsi (Basil), Ashwagandha (Withania Somnifera), Curcumin (in turmeric), extra virgin coconut oil — may enhance memory function and these are subjects of active research. Evidence to support over-the-counter plant formulations is, however, not available.A well-preserved memory is the cornerstone of a good life; good nutrition and a healthy lifestyle will help us achieve this milestone. To paraphrase the great bard, do we not desire to avoid or at least postpone our “sans everything” years?

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