This piece was published in India West newspaper on May 16, 2018
Much has been written about the mind. It is mysterious. Sigmund Freud famously said “The mind is like an iceberg, it floats with one-seventh of its bulk above water.” Its state can be altered with drugs. We can lose our mind, suffer a mental breakdown.
Matters of the mind have always provoked my interest, curiosity, and compassion. All of us have friends and or relatives who have faced mental illness. My vivacious, lively, beautiful mother suffered from depression after menopause. I don't believe she or others in the family fully understood what she was going through. To my continuing regret, I once took her to a psychiatrist near where she lived, ignorant of the varying quality of mental health care in India (and perhaps everywhere). He prescribed medications that had horrendous side effects such as complete loss of muscular coordination. She ended up requiring hospitalization, and her immensely capable primary care physician worked to medically reverse those effects and bring her back to normalcy.
A few days ago, I noticed an event I had put on my calendar: a book discussion event for Sunday, April 15th. It was called “Coping, Caring, & Compassion: Addressing issues around mental illness and its effect on relationships.” The afternoon event, which I decided to attend, was a panel discussion hosted by the Indian Business and Professional Women (IBPW) organization at the India Community Center (ICC) in Milpitas.
The event was introduced by IBPW executive directors Deepka Lalwani and Shubhangi Vaidya. Ritu Sandhu moderated the panel discussion, and is described on an event announcement page as “life apprentice, big picture thinker and tea enthusiast.” She was eloquent, thoughtful and a capable moderator. The panelists were Dr. Alzak Amlani, Ph.D., Counseling Psychologist, Professor of Psychology at the California Institute of Integral Studies, and Rajni Madan, Founder and President of Jeena, a non-profit self-help group of parents of children with developmental disabilities.
About a dozen people were in attendance, some of whom were professionals in the mental health care arena. There was a child psychiatrist, and a couple of licensed clinical social workers (LCSW). Their comments made for a lively, interactive discussion.
The moderator spoke of Mark Lukach’s book, “My Lovely Wife in the Psych Ward”, an account of his family’s experience with his wife Giulia’s unexpected psychotic episodes a few years after they were married. The author is a teacher in Danville, CA. An eloquent summary of the book, quoted by Sandhu is that it is about “the fragility of the of the mind and the tenacity of the human spirit.”
I had not read the book and was able to find a sample online prior to the panel discussion. Through this, I learned of the storybook romance soon after the couple met, and the beginning of Giulia’s manifestations of mental illness.
Sandhu described the four pillars around which she wanted to structure the discussion: (I) the definition and types of mental illness. (II) understanding the system for getting care, (III) support and available systems and (IV) cultural perspectives for South Asians.
I. Definition and characterization of mental illness
Amlani spoke of mental health as a spectrum from normal to severe, ranging from paranoia to schizophrenia / psychosis to depression and catatonia. The conditions can be caused by different forms of trauma, such as abuse, famine, or living in a war zone. There are genetic predispositions to some conditions such as depression, bipolar disorder and schizophrenia. Amlani stressed the importance of lifestyle and support as making a huge importance in managing stress, as the chances of anxiety disorders go up when stress levels are high.
Madan spoke of developmental disabilities, which could be physical, cognitive, social, or related to speech and language. They are defined as impairments that manifest before age 18. She recommended the audio version of Mark Lukach’s book, narrated by Josh Bloomberg.
II. Understanding the System
The panelists outlined the structure within the medical system for getting mental health care. Overall, it follows the same structure as referrals to specialties from one’s primary care physician, one such specialty being mental health. We learned of emergency psychiatrist services (EPS), and Institute for Mental Diseases (IMD) facilities. Santa Clara County has mental health urgent care, and the treatment can vary according to the severity of the presentation. A person can be given medication and sent home, after which follow-up is performed on an outpatient basis. If they are not ready or well enough to go home, they may be admitted to the psychiatry ward until the crisis passes, with an outpatient full-service program for follow-up.
Family members are advised to persuade an affected individual to voluntarily seek help, as medical care cannot be forced upon someone in violation of their civil rights. There was a discussion of the required collaboration, partnership and balance between primary care physicians and specialists. Having the primary care physician prescribe medications can be tricky, as minor modifications in the person’s condition may require adjustments to medications. Those qualified to prescribe medications are psychiatrists, who have MDs, as well as some psychiatric LCSWs.
Amlani addressed the care that is available in a private setting. He recommended going to a therapist or counselor who has been recommended by someone based on personal experience, stressing the importance of the right match. A feeling of trust is foundational; the relationship between the caregiver and the person seeking help is the basis of that trust. An audience member Simi Markar a Marriage and Family Therapist (MFT) suggested trying a few providers to explore a good match.
Support groups were also suggested as being very helpful for managing stress, anxiety as well as unemployment. The National Alliance for Mental Health (NAMI) is a good resource.
III. Support
Rajni Madan founded Jeena, a self-help group of parents of children with developmental disabilities, after her daughter Gina Madan, born with significant medical needs and developmental delays, passed away at sixteen months of age. Madan spoke from her personal experience and professional knowledge that information from peers is priceless. She described support groups as the cornerstone of well-being. Some support groups she named were SAMHSA - Substance Abuse and Mental Health Services Administration, as well as various support groups available through Kaiser for mental health and substance abuse. Mental Health Advocacy Project (MHAP) empowers people with mental health and developmental disabilities through the enforcement of their legal rights.
Amlani added to this by stating the importance of nutrition, dietary supplements and nature as aids to coping.
IV. Cultural perspectives
There was general agreement that there is stigma around mental illness, and an added cultural layer with South Asians. Amlani spoke of a lot of misunderstanding around the psyche. Mental illness is not seen the same way as physical illness. There is reluctance to go outside the family for really personal things. Even if it is a single individual showing symptoms within the family, caregivers need to look at the entire family.
For example, there is a lot of stress that accompanies the Silicon Valley culture, and a high rate of teen suicide. There is a tendency to minimize the struggles children face in the US, e.g. by relating experiences of difficulty when the parents were children in India.
Being able to talk with another person is healing in itself. That connection and sharing contributes to well-being.
Amlani mentioned the strong community framework in the South Asian community. When someone dies, people bring food for days. Imagine doing that for mental illness!
During the Q&A session, an audience member asked about efforts to reduce the stigma associated with mental illness. The panelists responded that May is mental health awareness month, and NAMI has events around it. MySahana is an California-based organization dedicated to spreading awareness about mental health issues in the South Asian community. Some avenues to increase awareness were discussed, such as documentary films. The film “Hichki” about Tourette’s syndrome, starring Rani Mukherji, was mentioned as an example.
Another audience member asked for advice on getting assistance for her mentally ill father who did not appreciate that he had any issue, as well as her mother needed support in the situation. She was pointed to mental health geriatric services, available at medical institutions.
Amlani recommended a integrative, holistic approach with bodywork such as acupressure, acupuncture, Ayurveda, as well as music. An integral approach that includes mindfulness and meditation has great value. He spoke of the Integrative Psychiatry and Psychotherapy program at UCSF’s Center for Integrative Medicine.
All attendees shared the hope that the discussion which began that afternoon would continue and spread into the community, increasing awareness for mental health issues and the support that is available.