Top hats & pink skirts.

Had the children's day celebrations at the ward today. yeah, late by almost a week; as the ward strength was a bit on the lower side. Admission spree for a week, and we were back in business with a reasonably large turn out for the programme. Topped it off with a discussion on Sex reassignemnt surgery, therapy and a fever. I guess, this day qualifies for being dysfunctional. Except probably the chicken biriyani at lunch. Maslow must have been gorging on some crumb fried chicken when he came up with his heirarchy model. There's something about food, or sometimes even the recollection of it, which can make up for some bile.

oh well, the discussion on gender identity and transgender issues was not so bad. Though such admissions can lose u some Portnoy's-complaint-type cool points.
Heck, there maybe such a thing as too much cribbing. Though some people would have a real problem with that concept. After all it was the staple defense throughout adolescence and still the easiest way to unload. Freud missed it because he didn't work with angst filled college students. I digress.. transgender. Right! All that got me wondering about the complex web of biological sex, gender role, gender identity, sexual behaviors and identities. Not to mention sexual roles. And the reductionistic ideas of being a hettie male or a lesbian. Most of the other things we're often able to come to terms with. But the roles, sexual and gender are not easy to crack. A perfectly well adjusted gay man, or a heterosexual women could well want a passive or active role. And strange and often unpredictable permutations and combinations of the determinants.

And to sign off in the predictable way, there are some neuro-behavioral correlates for dominant-passive behavior. It may not be just habit. :)

Osho

Monsters & the closet.

Back in child psychiatry posting for the next three months. Completely isolated in a huge ward/den, also referred to as the monsters inc, we're pitted against 6-10 adolescents and children per resident, with nothing more than a time out room to protect ourselves. I could also try and make u believe that we are tied to our therapy rooms and are let out only for food and sleep. Maybe with an evil senior resident with a deft wrist and a handy cat-o-nine tails thrown in. Oh well, that would have had some pizzaz at least. Sigh.. Anyway, the biggest crib for this
posting is that there is no tea shop near the wards, and the planes don't fly above.
Nothing to distract us, or allow us to send a quick message while the rounds pause for the planes to pass. Miss the spice jet B 737-82N with no winglets (castrated as
some people call it) coming in at 9 30 am. Well, at least it had won me a bet.

Also been thinking about behavior a bit. well, children-families-behavior. You see..
Been shaping an old idea about phenotypes among men (and women, if u insist). Straight, gay, bi, curious (dont ask me..), metrosexual <:)>, asexual and those who
do anything that walks. Of course, behaviors. But then there is an understanding that
some of these go beyond that, and go onto orientations and identities; often with some neuro-biological correlates. And thus, the nature-nurture Q. But we wouldn't want to go there. I'm begining to think it is easier to conceptualize them as
phenotypes with the 'genotype' being something else. for eg, u have the gay men with gay phenotypes (queeny) or straight (butch), and the same for straight men. I mean, 'metrosexual' could be a 'gay' phenotype for the straight man. Or an excuse for people who're lost searching for the light switch in the closet. But, the funny part
seems to be that the 'phenotype' which is often held close to hearts as their identity is often environmentally influenced, in essence partly learned. But then, the similarities are hard to ignore. I mean, it basically makes you wonder what is 'gay' or 'straight'?
Other than being person specific adjectives, thus being of limited use.

osho

p.s: genotype is the genetic defenition of a person encoded in genes, while the phenotype is the physical or the behavioral description.

of love and other thoughts..

I wouldn't be overstating it when i say that one of the biggest concerns a gay man learns to grow up with is one of instability of 'love' as a concept and relationships practically. Of course, not being just in the purview of gay mind space, this concept must'ave been belted out of sanity by any number of self help books, written by anyone who has gone through one relationship; and often not. Thus the disclaimer that I don't think i am attempting to be producing original thought. And since I have not been able to read those books, owing to some personal 
prejudices; i can only say that this is jus once chewed, at the best. Anyway, Was basically thinking about why 'love', and relationships often don't last, while we are perfectly capable of having sexual contact with the same partners 
or the same kind of people for long. Well, i think it is basically that the basic needs of sex, security & food (maslow or whatever..), are essentially driven by the older parts of the brain (limbic cortex), and are thus emotion driven. While the ideas of 'love'(which may just be a learned emotional response..like pavlov's dog's salivation. that i find incredibly funny, the frontal cortex salivating for love.) and relationships, may be the colours put together by thoughts which are the babies of our 'newer' frontal cortices of the brain.

Essentially that 'love'(pardon me, its just a convenient word) is a thought driven process, often associated with learned emotional reflexes. And this could explain why love is more specific than the urge to have sex, thanks to the frontal brain. And being the fragile little urn carrying the ashes of sanity, coccooned by thoughts, we are able to keep it under our wraps,either in letting go; or in holding on to it with our dear lives. Well, the point is just that I don't think we can have a spontaneous process of love (unlike the stupid usage 'falling in love'), but one which needs to be steered through all sort of muck and beautiful monsoons. And much as we might be able to discredit the power of thought as 'rationalization' one can't go through with 'love' without thoughts.. words.. communication. of course, in limits.

And of course there are people who go their entire lifetime without much thought
about why they are in a relationship; i jus don't know how they do it, but I suspect
it happens when there is shared & learned emotional reflexes. or nothing..

in an orgy of 'rationalization'.

aswin.

Spa(m)sms..

I had just got around to finishing work today morning when the spate of messages from Airtel started. I get a whole round everyday from astrology, to ring tones, cricket news, and new kannada songs(all of it useless, needless to say). And a regular evening call which i have blocked, thanks to the consistency of the numbers used by the nefarious beings at airtel, who by now, i'm convinced, take great pleasure in doing this. I assume they have inane lives and attempt to decrease the angst of being shouted, yelled at and kicked around by their 'superiors'; by taking it out on some other soul. By and large, i think that's one explanation which holds good for most rude people on the road. Of course, some are habitually and temperamentally rude, but if u think of it that way, one wouldn't be able to sympathise with them, and thus feel more angry and bugged with the whole world, resulting in worse days for yourself. Anyway, since sympathy is the worst i can offer to a human being, thus there is some satisfaction in it for me too.

But things could be a lot worse, if these are the machinations of an evil server on airtel which manages this, which i suspect it is. Well, the same reasoning holds good. One cannot sympathise with a chip, so u try and assume that it is a human brain behind all this. At least at the conceptual level. Anyway, suffice it to say that it is rather frustrating to think that there is no way(which i've found) to unsubscribe and since it is the service provider per se who's the culprit, there seems to be nobody to complain to. Was thinking about the general futility of beliefs that life's fair and that one can get our rights, unless u go to a court. Which in itself is a laughable idea, considering the long waiting lists and the fact that I might not even be having the connection when it comes up for hearing. (Wonder if this sort of thing can be tried at a consumer court). Anyway, even the less cynical children grow up thinking that Justice is a joke in india. That seems to be rather dysfunctional, since it is essentially the most important function of the government. Redistribution of resources anyway seems to be done shoddily. And my consultants wonder why we want to get out of the country. Not that we think it is a lot different else where, but few democracies should be worse than this.

deleting them.. (technically called 'learned helplessness')

Osho

MoKA for the jobless mind.

It all started with another lazy evening (my brain cells have gotten accustomed to 
not doing anything worthwhile after the evening work out; i seriously wonder if its true that one's neocortex is inversely proportional in size to your biceps. Some preliminary observations at the gym seem to suggest it. But then,it maybe that the sample is skewed thanks to a large majority of straight people at the gym). I digress.. ah lazy evening. Was nursing my triceps after work out, with my brain cells slipping into near comatose inactivity and musing on the general futility of natural selection for not having eliminated people who think it appropriate
for a thursday evening psychiatric movie club to have a movie on anterograde amnesia. Much as i like the production idea of Memento, it seems to be the product of a convoluted mind to have inapporpriate editing antics to add to the confusion of a movie with multiple sub-plots and a protagonist (albeit cute)with little short
term memory stores. Eternal sunshine was so much better that way. Anyway more
joblesness would get you to imdb movie search with psychiatric key words and voila, there u have 'the cabinet of dr caligari', 'Kira's reason' and a few hundred
others. Interestingly, there are more search results for 'hypnotic-regression'
(I have no idea what that could be) than 'facial expression'. Maybe a little search program is laughing away at the current movie standards. At some stage I couldn't be but impressed with Imdb for being so savvy as to have multiple categories of each mental disorder classified neatly and the movies sorted 
with it. Turns out that its all the power of MoKA (movie keyword analyzer). But it seems a tad bit too much to have games with it. But of course, like reality TV,
people who crib about it are those who have had time to waste watching it.

hail MoKA.. and the jobless minds

osho.

Medicine mania..?

To start off on an almost kiddishly defiant note about scientologists and depression; one wonders what they would advocate for mania, in which the symptoms are an exact opposite, the brain areas involved are just on the right instead of the left side in depression, but does not respond to any sort of 'talking therapies'.  Or maybe the psychotherapists believe that there's no such thing as mania, but only reaction formation to depression. :) but of course, in a branch like psychology, being opinionated is considered knowledgeable, and evidence is for poor scientists.

Well, mania and depression may be entirely separate disease entities, but there's
enough evidence to suggest that they occur together or in close succession. Anyway, the point is not to suggest that depression is an entirely biological illness like cancer, but it would also be ridiculous to think that medicines are excessive in  depression. 

The other correlate is that happiness and sadness can be environmentally determined. And for a lot of people, it is the only kind of mood shifts possible. And then, some are able to have their own highs and lows. There is no contention that happiness and sadness can be environmentally manipulated, but it is only when it crosses those broad lines into a persisitent state which we can't help; that we begin to see the need for treatment.

this is the last on the morbid topic. Had thought I'd touch upon it briefly and move on; but it brings up enough bile. Incidentally depression was thought to be due to increase in black bile, by the greeks. And being tangential about greeks, sounds interesting to think that hope was the greatest weapon Zeus used against Prometheus. Bugs me, the issue of hope. anyway, later..

osho

Watch out for the green chillies..

We're back on a mildly academic discussion partly fuelled by something i read recently on a blog and partly by the resistance offered by humanity to the idea of going under anti-depressants. Its not like the psychiatrists want to control the world. . The question is simple, and related to the one on mind control. About what addiction means. Got me wondering if my perpetual messaging is one, and if a certain surgeon having withdrawal sleep disturbance when he doesn't have a slow breeze from his fan is addiciton. SMS addction, sex addiction and other behavioral addictions seem to be well characterized(if we let addiction psychiatrists take over the world, we'll have a lot mroe to be pararoid about) now. And,if u need anti-depressants for a long time, is one addicted to it.. and if we are addicted to coffeee? green chillies..?

It seems that capsaicin, in green chillies has been found to have addictive potential. caffeine has been long known to have some of it. And apparenty all medicines, anti-depressants and laxatives included, produce some alterations in our body that makes the body want it more. Sometimes a bit more, sometimes a lot more. Probably the slow breeze from a fan.

It seems that the current definitions of what addiction has do with a state when u can't give up something, and it is causing you some distress. And the difference between our routine 'dependance' on some of our necessities, and alcohol-nicotine-street drugs seem to be the activation of a particular pathway in out brain. (Dopaminergic conenctions from VTA to the cortex, actually). Essentially that the 'dangerous' ones act of these pathways and modify your brain in a way that normal drives are altered. And hopefully our regular addictions don't. We don't know if they do, but till then, we can be paranoid. Or maybe feel good.

osho

The Shrinking Corner..

Difficult to resist the shrink pun. After all, it has helped me through quite a few dinner conversations in the first year of shrinking.. or shrink-ship.
Anyway, here is where I introduce, to my ever increasing readers(i'm trying the laugh-track psychology), the section on the blog devoted to snippets from the madhouse. Like one of my severe OCD patients who decided to get married to a man with failing kidneys and are blissful in their expectably difficult and possibly short nuptial life. Sometimes the cynic garb falls away, and I have to admit that life is really beautiful. And then again we have our paranoid senior resident who is ever-increasingly aware of the fact that his rounds notes get written before his rounds(thank you sir humphrey..), and now has taken to giving us short chits with his diagnoses. But we are grateful to nature for having provided him with a short attention span which amply protects us against his wrath on the next week rounds. And then there is the politically incorrect manic lady in the closed ward who has decided that my Hindu name is unbecoming and bestowed me with an appropriate christian one.

more later..

Back to some cribbing about workouts. Difficult to resist the topic, since my instructor has chanced upon some nice and rounded fat deposits which I was nurturing with tender loving care, and thrice weekly chocolate ice cream; and bang goes my dinner. Think i've come to realize that if I have to give up chocolate to look good, it'd be a serious distortion of priorities. And downright madness.. Boyfriends can raise their eyebrows, but the hedonistic lobes of my brain might just hemorrhage and die. Shrink up probably.

osho

Mind control

We're back on the subject of primacy of our mind, and it being the defining character of our identities (yeah, yeah, it is obvious...).

This friend of mine and I were having this chat on depression and I was slightly taken aback when I had stiff resistance to the suggestion that antidepressants may be useful. Mentally cursing Tom Cruise and his Scientology shit (I mean, look at the man, he could do with a low dose anti-psychotic.. okie, I'm joking there), I got around to attempting to convince him that anti-depressants are nonaddictive and not gonna make you a slave to them for the rest of our lives. Half way around I was beginning to realize that this is not about anti-depressants but the idea of using mind medicines, and the resistance to accepting the concept of a diseased mind. Before we get stuck in spirals of definitions of disease and normalcy, let me clarify that i mean a deviation from a state which would help us function with optimal efficiency and productivity, or something like what WHO defines it to be. I mean, people would find it so much more easier if one were to do functional MRIs and demonstrate hypo-frontality, or demonstrate decreased CSF serotonin metabolites. Well, it is true that it is not universal in depression and not consistent.

Anyway, coming back to the issue of antidepressants, what people would essentially be scared of is the fact that it would mean that we are admitting to giving up some degree of control over our own mind. Which brings us to the concepts of the idea of mind as an ephemeral concept independent of our body over which we are meant to have full control of. Won't that be rather unmindful of the role of the organ that our brain is, especially the pre-frontal cortex and the limbic parts? Parts which could get diseased and produce symptoms. What could we expect those symptoms to be...?

But of course, we could also conceptualize depression as an inability to deal with a life stressor, which could mean a personality (forebrain) predisposition to this, or that the stress was quite severe. In either case, we may not be able to equate it to the 'biological' depressions. And the role of antidepressants may be questionable.

The question really is this? Are we obliged to have complete control of our minds, or is that a societal sanction to prevent irrational and acceptable behavior. Of course, it is a nice ideal to have complete and unalienable control over our minds, but could it be possible in allow sigma biological system?
:)..

Holding on..

osho

Gymbivalence

Caught myself completely stuck and in a joey-type dysfunctional mode today morning. Story goes like this. I had promised the gym instructor last evening that i will go to the gym twice today, to have got off early to go for an academic programme in the evening. Got up today morning in a half-out-of-sheets-groggy way yearning for coffee in bed and cursing the whole programme where the sun pops up at 7 sharp, and sets things in motion. On those lines I am completely for a nuclear war, with perennial deep winters. Anyway, I digress.. So i was generally feeling woozy and had convinced myseslf that i was unfit to go to the gym, woke up another hour later to realize that was rounds was postponed by an hour. Guilt came up like a tide.../puke, and I ran to the gym to catch a quick work out. Got there to realize that my instructor is going on his morning break. Somehow, instead of staying back and catching up on my work out, i ran back with the excuse of having to read for rounds.

Am not very sure whether there are psychological reports on gym attitudes; but then these days psychologists abound and there is a study on everything. Its not that i don't like going to the gym , and the whole episode got me wondering about what it is that really gets me to the gym. There could be the insecurity-pride continuum, the regularity of a routine, external push from the instructor etc. What seems possible is that the balance between external and internal loci of control for the decision could be upset, and maybe the reason why we vacillate. More curious is the question on a larger scale; whether gym attendance is fostered by a sense of better-being,<:)> or a sense of insecurity. A friend with whom I've had this discussion believes that this is a dichotomous concept and even that it is the latter which prods more gay men to flock to the gym. I should think that we are on a continuum of ego-security(so to speak), and we slide along this at times and both the ends could push us to the gym, a tangible and easy mode to self improvement.

And some of us have the opportunity of being able to lech at the gym.. :)

osho

Wheezing geezers..

Some of the most interesting takes on life is offered by patients with hysteria. That if I am not able to deal with the anxiety that my 'unconscious' turns up, my 'unconscious' will act crazy or ill. Not kind of course, but one is definitely distressed by patients waking u up at 3 am on a night duty complaining of breathlessness, where nothing organic could be found; and you re-assure the patient and try to go back to sleep.

A slower reappraisal might suggest that this could be another instance of according relatively less sympathy to a symptom of mental causation, despite being critical of our medical colleagues for not being 'sensitive' to psychological distress. Being a learned response, one slips from this high ideal at times, often later into the night and with more sleep backlog. There may be multiple facets to this particular problem. The primary being that, in the absence of any real evidence organic brain disorders in hysteria, we're forced to rely on freudian concepts of dissociation which are, incidentally close to the idea of malingering, give or take a little gain. :) The more curious idea being that we are somehow programmed to give less credit to a 'software' defect of our mind than a brain disease and that even less than for a general medical illness. I am guessing it is related to the primal position with which the mind is treated, as it is root of identity of self, and thus the self of pride one has in oneself(refraining from 'go'). And that any problem 'in your mind' may thus reflect poor control over our own 'self'.

A toast to the control freaks of the world..and the hysterics. being some of both myself. :)

osho

The outside of the asylum

One often wonders if sanity is relative as insanity may only be a perceptual phenomenon coloured by the state of the person who lords over the decision of deeming one sane. This, is a relative attmept at sanity. As much as can be reasonably expected to be left behind after days of working in one of the oldest of the asylums in India.

As it often reminds the few students who pass by the now defunct main gate of the department of psychiatry(picture), the flowers and impressive porticos in stone only serve to mute the cries of some of its inhabitants. That's right, it is the junior residents under the payroll of the henious Vogons who lord over the throne of this century old insituition; the patients having gone on to much higher levels of existence as ensured by chlorpromazine and the NHRC.

This post hopes to echo the cries of all those who languish till late, bitch at the coffee shop and embarrass ourselves in therapy, thesis and academics through an MD degree and to chronicle the few pickled anecdotes from within the beautiful stone walls.

and thus,

with due respects to Douglas Adams, and Wonko the sane.

from the outside of the asylum,

osho