Thursday, September 18, 2014

Dr; Is there any blood test I can do? Me: No & Yes

I get to hear this question or it's variants every now and then.

Imagine the scenario in my consultation room when someone walks in quite agitated about something, speaks to me at length and then asks for my opinion. (The secret terminology for this process is called History and Mental Status Examination!)

I proceed to tell the noble soul that his condition fits a particular diagnosis. That is; if there is a diagnosis in the first place.

The diagnosis could be Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder, Obsessive Compulsive Disorder or one of the types of Schizophrenia. And then there are so many other categories too...

Then I begin to talk about the treatment options. Medication and Psychotherapy in various combinations...

Sure enough; I am asked...

Is there any blood test that can prove Bipolar or Schizophrenia?

Do you suggest any CT scan or MRI scan of the brain.

My answer is - No !

Mark my words. There is absolutely NO standard diagnostic blood test yet for most psychiatric disorders.

Also; there is generally NO physical abnormality that a typical CT or MRI scan can pick up.

You say... So; then; doctor how did you diagnose my condition?

My answer would be that we psychiatrists base our diagnosis on "cluster of symptoms". Not just one symptom but a cluster of symptoms.

And I get my knowledge of your symptoms through my conversation with you. Through the observation of your behavior... As well as the details supplied by a reliable near and dear one.

Above all; I don't believe in unnecessary investigations. But then sometimes investigations are important to a psychiatrist.

Monday, September 15, 2014

A Cute Appendix

This poem was sent to me by a surgeon friend. 

It is true that as a Psychiatrist; I don't deal with an appendix but I deal with humour :)

Therefore; it finds place on my website. Hope you enjoy it.

If not; forward it to any of your friends who are doctors. I am sure they will love it.

Here it goes...

Once there lived an appendix,
as cute as one can be.
Ileum and caecum right and left,
in the middle lay she.

Darling of the abdomen,
she was slim and pink.
With a very narrow lumen,
and lymphoid cells within.

Not one knew her functions,
some said she stayed for free.
Free-loader some called her,
but others let her be.

Along came an appendiculolith,
handsome they say was he.
Riding through the gut on stools,
and love it had to be!

Plump and red she grew with love,
yet more love showered he.
Their love irked some around,
but the peritoneum couldn't let them be!

They say that day was grim,
as no day shall ever be.
He covered his face with a mask,
and a gown in green wore he.

The taenia coli showed the way,
and at their junction the lovers found.
Crushed thrice and ligated,
only a stump will ever be found.

Now weeps the whole abdomen,
and says their love was deep.
Paralytic ileus has been agreed upon,
to honour the lovers in their sleep.

Friday, September 12, 2014

The Limits Of Client Confidentiality

In my previous post; I discussed how confidentiality is sacred "dharma" for clinical practice.

A Counselor or Psychiatrist can not be a tale-bearer.

But is confidentiality an absolute right? Something which has no limits.

Well... That does not seem to be the case.

Let us consider what the latest legislation in India called the The Mental Health Care Bill 2013 says.

Let me reproduce Clause 23 in full so that we have a 360 degree perspective.

Here it is...

(1) A person with mental illness shall have the right to confidentiality in respect of
his mental health, mental health care, treatment and physical health care.

(2) All health professionals providing care or treatment to a person with mental illness
shall have a duty to keep all such information confidential which has been obtained during
care or treatment with the following exceptions, namely:––

(a) release of information to the nominated representative to enable him to fulfill
his duties under this Act;

(b) release of information to other mental health professionals and other health
professionals to enable them to provide care and treatment to the person with mental

(c) release of information if it is necessary to protect any other person from harm
or violence;

(d) only such information that is necessary to protect against the harm identified
shall be released;

(e) release of information in the case of life threatening emergencies where such
information is urgently needed to save lives;

(f) release of information upon an order by concerned Board or the Commission
or High Court or Supreme Court or any other statutory authority competent to do so;

(g) release of information in the interests of public safety and security

Self explanatory. Isn't it?

Thursday, September 11, 2014

Four Reasons Why My Clients Insist On Confidentiality

Every now and then; someone will say the following to me when they first see me...

That is - "Doctor; please keep this strictly confidential."

And I understand that completely.

After all; these are things they can't share with family members and even close friends.


First... However; well intentioned your immediate circle; they have subtle, almost unconscious agendas which becomes a wall towards your full disclosure to them.

Second... Friends & family may not have what we call the "clarity of distance".

Third... You may not want your near and dear ones to feel guilty about what is happening to you.

Fourth... Some of us perceive tremendous hurt in our most intimate relationships. The last thing we want to do is flare up matters by talking more.

And hence the request for strict confidentiality and my assurance of the same..

Wednesday, July 21, 2010

My Signature Themes ( I got myself analyzed) !

The Gallup Organization has a personal analysis tool called the Strengthfinder. I just took it and here is the result.

Your Signature Themes

Many years of research conducted by The Gallup Organization suggest that the most effective people are those who understand their strengths and behaviors. These people are best able to develop strategies to meet and exceed the demands of their daily lives, their careers, and their families.

A review of the knowledge and skills you have acquired can provide a basic sense of your abilities, but an awareness and understanding of your natural talents will provide true insight into the core reasons behind your consistent successes.

Your Signature Themes report presents your five most dominant themes of talent, in the rank order revealed by your responses to StrengthsFinder. Of the 34 themes measured, these are your "top five."

Your Signature Themes are very important in maximizing the talents that lead to your successes. By focusing on your Signature Themes, separately and in combination, you can identify your talents, build them into strengths, and enjoy personal and career success through consistent, near-perfect performance.


Things happen for a reason. You are sure of it. You are sure of it because in your soul you know that we are all connected. Yes, we are individuals, responsible for our own judgments and in possession of our own free will, but nonetheless we are part of something larger. Some may call it the collective unconscious. Others may label it spirit or life force. But whatever your word of choice, you gain confidence from knowing that we are not isolated from one another or from the earth and the life on it. This feeling of Connectedness implies certain responsibilities. If we are all part of a larger picture, then we must not harm others because we will be harming ourselves. We must not exploit because we will be exploiting ourselves. Your awareness of these responsibilities creates your value system. You are considerate, caring, and accepting. Certain of the unity of humankind, you are a bridge builder for people of different cultures. Sensitive to the invisible hand, you can give others comfort that there is a purpose beyond our humdrum lives. The exact articles of your faith will depend on your upbringing and your culture, but your faith is strong. It sustains you and your close friends in the face of life’s mysteries.


You are inquisitive. You collect things. You might collect information—words, facts, books, and quotations—or you might collect tangible objects such as butterflies, baseball cards, porcelain dolls, or sepia photographs. Whatever you collect, you collect it because it interests you. And yours is the kind of mind that finds so many things interesting. The world is exciting precisely because of its infinite variety and complexity. If you read a great deal, it is not necessarily to refine your theories but, rather, to add more information to your archives. If you like to travel, it is because each new location offers novel artifacts and facts. These can be acquired and then stored away. Why are they worth storing? At the time of storing it is often hard to say exactly when or why you might need them, but who knows when they might become useful? With all those possible uses in mind, you really don’t feel comfortable throwing anything away. So you keep acquiring and compiling and filing stuff away. It’s interesting. It keeps your mind fresh. And perhaps one day some of it will prove valuable.


You like to think. You like mental activity. You like exercising the “muscles” of your brain, stretching them in multiple directions. This need for mental activity may be focused; for example, you may be trying to solve a problem or develop an idea or understand another person’s feelings. The exact focus will depend on your other strengths. On the other hand, this mental activity may very well lack focus. The theme of Intellection does not dictate what you are thinking about; it simply describes that you like to think. You are the kind of person who enjoys your time alone because it is your time for musing and reflection. You are introspective. In a sense you are your own best companion, as you pose yourself questions and try out answers on yourself to see how they sound. This introspection may lead you to a slight sense of discontent as you compare what you are actually doing with all the thoughts and ideas that your mind conceives. Or this introspection may tend toward more pragmatic matters such as the events of the day or a conversation that you plan to have later. Wherever it leads you, this mental hum is one of the constants of your life.


You love to learn. The subject matter that interests you most will be determined by your other themes and experiences, but whatever the subject, you will always be drawn to the process of learning. The process, more than the content or the result, is especially exciting for you. You are energized by the steady and deliberate journey from ignorance to competence. The thrill of the first few facts, the early efforts to recite or practice what you have learned, the growing confidence of a skill mastered—this is the process that entices you. Your excitement leads you to engage in adult learning experiences—yoga or piano lessons or graduate classes. It enables you to thrive in dynamic work environments where you are asked to take on short project assignments and are expected to learn a lot about the new subject matter in a short period of time and then move on to the next one. This Learner theme does not necessarily mean that you seek to become the subject matter expert, or that you are striving for the respect that accompanies a professional or academic credential. The outcome of the learning is less significant than the “getting there.”


You can sense the emotions of those around you. You can feel what they are feeling as though their feelings are your own. Intuitively, you are able to see the world through their eyes and share their perspective. You do not necessarily agree with each person’s perspective. You do not necessarily feel pity for each person’s predicament—this would be sympathy, not Empathy. You do not necessarily condone the choices each person makes, but you do understand. This instinctive ability to understand is powerful. You hear the unvoiced questions. You anticipate the need. Where others grapple for words, you seem to find the right words and the right tone. You help people find the right phrases to express their feelings—to themselves as well as to others. You help them give voice to their emotional life. For all these reasons other people are drawn to you.


Friday, June 18, 2010

Courtship & Your Wallet; How They Are Linked?

Experimental studies show that when men think about attractive women, they tend to spend more money on conspicuous goods (cars, watches, and expensive holidays) than on inconspicuous goods (washing machines, toasters, medicine).

Whereas when women think about attractive men they tend to spend more time on acts of conspicuous charity (volunteering to help the poor or the sick) than on acts of inconspicuous charity (picking up trash when no one is looking or conserving water while taking bath).

So during courtship, men are likely to display their wealth more while women are likely to display their kindness more.

Knowing this may help a lot of us! For starters; we may be able to pick out who is putting his money where his mouth is! And yes; it may help in being fiscally prudent and avoiding a lifestyle of liability creation.

Let me also say that like all studies in science/psychology, based as they are on Inductive Logic, that this study is not the final truth on anything. It’s just a good pointer of behavior.

(Idea expressed by Geoffrey Miller, Professor of Psychology at the University of New Mexico, US in his recent book “Spent-Sex, Evolution and Consumer Behavior)


Tuesday, June 8, 2010

The ONE Instrument Every Psychiatrist & Counsellor Must Have

While I was doing my post graduation; I was told to look into my patient’s eyes and understand his mental state. I soon realised that I need to look into one more set of eyes; that is the eyes of the patient’s father/mother/spouse/ sibling or child. They, as the primary caretakers, go through a lot too. Sometimes the stress of caring for their loved one makes them clinically depressed.

To be able to feel the pain of the man sitting across our consultation room must stir us up. To feel his handicap and discomfort must put fire in our bones. To know that your patient has not done anything to deserve what he is going through keeps you from passing judgements on him. To know that you could have been in his shoes keeps you humble.

A Cardiologist will be known by his expensive stethoscope, a Surgeon by his sharp scalpel but a Psychiatrist will have to be known by his genuine empathy. That is one instrument which he can’t afford to not have when he gets in to his consultations.

The imperfection of Psychiatric medication can only be mitigated by grace in our attitude as doctors.


Tehelka Does A Story On The State Of Psychiatric Treatment In India

“65 million Indians suffer from psychiatric disorders. But is it not just the number of people suffering from mental illness that is staggering. The corresponding figures for their care and rehabilitation tell an even more frightening story. The most startling figure is that there are only 3,500 accredited psychiatristsfor a population of one billion people in India.”


Thursday, May 27, 2010

We; The Informed And The Distracted

We are told that we live in the Information Age. With 234 million websites (two of mine own included!) and 126 million blogs it sure is. Add to that the fact that You Tube serves up 1 billion videos everyday and 247 billion emails are sent everyday (81% are spam). More than 60 million status updates are posted everyday on Facebook and 2.5 billion photos are uploaded to Facebook every month. The iTunes Store is renting over 50,000 movies daily, turning it into the most popular movie store, too, with a catalog of over 20,000 TV episodes, over 2,000 films, and 8 million audio tracks. Not to be left behind is the daily buzz of unwanted calls on your phone and the sheer multiplication of newspapers, magazines, and radio and TV channels.

We are literally swimming and drowning in a sea of information. Whatever happened to old-sounding wisdom? And deliberation? And focussed thought? The one area where the pain is acute is relationships. The time spent developing relationships is being taken up by virtual communication and we are the poorer for that.

My purpose in writing this article is not to be anti-technology. I love tech, gadgets and of course Facebook, You Tube, Twitter and iTunes. My purpose is just to point out, in my capacity as a Psychiatrist and a student of the mind that the brain functions best with focus. Multi-tasking is so neurologically passe! Just like we conserve our economic resources; we need to conserve our psychological resources. The brain has limitations and we would perform better if we learned our way around them instead of against them.

More about that in the next article but let me leave you with one tip for today. Optimise the time you sit before a screen and minimise unproductive time on social networking sites when you can hit the gym and meet people in person. Start with a day in a week (maybe Sunday) when you are away from all electronic messages.

The Industrial Age resulted in environmental pollution and my fear is that the Information Age may result in an Information Pollution wherein we will be continuously informed and permanently distracted.

Your comments are most welcome!


Sunday, December 6, 2009

Kutta, Sher Aur Bandar ( A Witty Little Story In Hindi)

Ek din ek kutta jungle main raasta kho gaya. Tabhi usane dekha ek sher uskii taraf aa raha hai. Kutte ki saans rookh gayi. "Aaj to kaam tamaam mera!" usne socha. Phir usne saamane kuchh sookhi haddiyan padi dekhi. Woh aate hue sher ki taraf peeth kar ke baith gaya aur ek sookhi hadii ko choosne laga aur zor zor se bolne laga, "wah! Sher ko khaane ka mazaa hi kuch aur hai. Ek aur mil jaaye to poori daawat ho jayegi!"

Aur usne zor se dakaar mara. Is bar sher soch mein pad gayaa. Usne socha "ye kutta to sher ka shikar karta hai! Jaan bacha kara bhago!"

Aur sher wahan se jaan bachaa ke bhaaga.

Ped par baitha ek Bandar yeh sab tamasha dekh raha tha. Usne socha yeh mauka achha hai sher ko saari kahani bata deta hoon - sher se dosti ho jayegi aur usse zindagi bhar ke liye jaan ka khatra dur ho jayega.. Woh phataphat sher ke pichhe bhaaga. Kutte ne Bandar ko jaate hue dekh liya aur samajh gayaki koi locha hai. Udhar Bandar ne sher ko sab bata diya ki kaise kutte ne use bewakoof banaya hai. Sher zor se dahada, "chal mere saath abhi uski leela khatam karta hoon" aur Bandar ko apani peeth par baitha kar sher kutte ki taraf lapka.

Can u imagine the quick thinking by the DOG...

Kutte ne sher ko aate dekha to ek baar phir uskii taraf peeth karke baith gaya aur zor zor se bolne laga, "Is Bandar ko bhej ke ek ghanta ho gaya, bewakoof ek sher phaans kar nahi la sakta!"

Moral of the story:
There are many such monkeys, dogs and lions around us, try to identify them..


Tuesday, October 27, 2009

I Like This Girl

Many years ago in a small Indian village a farmer had the misfortune of owing a large sum of money to a village moneylender. The moneylender, who was old and ugly, fancied the farmer's beautiful daughter.

So he proposed a bargain. He said he would forego the farmer's debt if he could marry his daughter. Both the farmer and his daughter were horrified by the proposal.

So the cunning moneylender suggested that they let Providence decide the matter. He told them that he would put a black pebble and a white pebble into an empty money bag. Then the girl would have to pick one pebble from the bag.

1) If she picked the black pebble, she would become his wife and her father's debt would be forgiven.

2) If she picked the white pebble she need not marry him and her father's debt would still be forgiven.

3) But if she refused to pick a pebble, her father would be thrown into Jail.

They were standing on a pebble strewn path in the farmer's field. As they talked, the moneylender bent over to pick up two pebbles. As he picked them up, the sharp-eyed girl noticed that he had picked up two black pebbles and put them into the bag. He then asked the girl to pick a pebble from the bag.

Now, imagine that you were standing in the field. What would you have done if you were the girl? If you had to advise her, what would you have told her?

Careful analysis would produce three possibilities:

1. The girl should refuse to take a pebble.

2. The girl should show that there were two black pebbles in the bag and expose the moneylender as a cheat.

3. The girl should pick a black pebble and sacrifice herself in order to save her father from his debt and imprisonment.

Take a moment to ponder over the story. The above story is used with the hope that it will make us appreciate the difference between lateral and deductive modes of thinking.

The girl's dilemma cannot be solved with deductive thinking. Think of the consequences if she chooses the above logical answers. What would you recommend to the girl to do?

Well here is what she did....

The girl put her hand into the moneybag and drew out a pebble. Without looking at it, she fumbled and let it fall onto the pebble strewn path where it immediately became lost among all the other pebbles."Oh, how clumsy of me," she said. "But never mind, if you look into the bag for the one that is left, you will be able to tell which pebble I picked."

Since the remaining pebble is black, it must be assumed that she had picked the white one. And since the money-lender dared not admit his dishonesty, the girl changed what seemed an impossible situation in to an extremely advantageous one.

Most complex problems do have a solution. It is only that we don't attempt to think. Thinking itself is a task and lateral thinking even more so because it involves reason and imagination unlike pure deduction which is primarily only reason.


Saturday, October 17, 2009

The Two Systems Of Thinking

We can roughly map our judgement and decision-making activities in to two formats. As a Psychiatrist; I am well aware of how puny our understanding of the brain and it's chemistry is. So I will not make any dogmatic claims on neurology. 

SYSTEM 1 - This is the intuition-based, emotional, almost automatic, effortless and above all a quick way to decisions. It's the short-cuts we take due to experience or innate impulses (like self-preservation). These short-cuts are studied in the branch called "Heuristics". Obviously a short-cut will sometimes cause mistakes and these mistakes are called "Biases". Biases may be positive or negative in quantity and can be measured so we can get the accurate picture. This "fast and frugal" experiential system is considered the "limbic brain". Humans share this kind of decision-making with birds and animals. Malcolm Gladwell describes this system in his book called "Blink". The process you run through is more opaque than System 2 processes.

SYSTEM 2- This system really sets "Man" at the head of the created order. You obviously do not know of your pet dog or cat or parrot thinking hard about the ultimate meaning of life. Nor do you see them ever able to handle problems of logic, mathematics and twists of language. This system is considered the "cortical brain" and it is the slow, logical, progressive kind of thinking which really drains you. Since you are aware of the progression of your thoughts you can retrace the mental events and see where you went wrong.

In my next post we will see where to use which system and the implications of messing up on this vital distinction.


What I Learnt From "Outliers"

(1) Today when I meet someone I consider successful; I am not too much over-awed by their success. I know that their success has to a large extent to do with the opportunities that came their way.

(2) I understand that some advantages may be purely because of arbitrary rules and regulations which are apparent only on closer examination.

(3) I realize that where I come from matters. I can not ignore my cultural legacy. Since I know what parts of my cultural legacy can stand in the way of my success; I will work to lose their grip on me and I would like to accentuate those parts which add to my chances of success.

(4) The 10,000 hour rule tells me that I can't be world class at ten things in one go. I need to prune back my activities to let the sap flow into the juiciest grapes.

(5) I am no more afraid of people who have much higher IQ than me but my focus is on looking up to those who have creative intelligence and social intelligence.

(6) When I have kids; I plan to bring them up in ways which develop their sense of autonomy and identity leading to a healthy self-image and the ability to handle social situations tactfully. I say this because my upbringing contributes to my introvert and inward looking tendency which I fight daily.

(7) I realize that if an organization works for the upfiftment of society then they have to take intelligent steps to achieve their goals faster.

(8) I plan to interview successful people regularly and make notes about not only what they did but also where they come from.


Key Thoughts In "Outliers"

(1) Random rules like minimum age for entering school can advantage some children at the expense of others. These children who are not very successful to start with come under the positive effect of "Self-Fulfilling Prophecies" which evoke the behavior of success. 

(2) Those who are already successful are more likely to get opportunities that lead to more success. This is "Accumulative Advantage" at work. 

(3) Ability, opportunity and arbitrary advantages combine to create success. If you want to master anything just spend 10,000 quality hours at it and you will be world class. This applies to whatever you want to do-Maths, Literature, Business, Sport, Music and even Robbery!

(4) Extra-ordinary talent is shaped by extra-ordinary opportunities. Be thankful to God and be humble if you are successful because you may have been given extra-ordinary opportunities which may have passed others due to some very random reasons. To make matters more complicated; the world at your time should be able to appreciate your 10,000 hours and reward you for it!

(5) IQ is not everything. Creative Intelligence (divergent logic) is much more important for success than Analytical Intelligence (convergent logic). Practical Intelligence means being able to handle ground situations well. Unlike Analytical Intelligence it is not a genetically determined trait. It is a result of "Concerted Cultivation" of the child's personality by the parents in which the child is taught independence and is exposed to decision-making almost as an adult would.

(6) Sometimes some people are unsuccessful just because of "Demographic Reasons". Nothing seems to work in spite of their intelligence and hard work because social and economic structures are unfavorable to different professions and different classes at times. So we must learn to read the signs of the times to escape this limitation.

(7) Hard work is a prison sentence if it does not have meaning. To have meaning in your work; you must have some "Autonomy" while working, a reasonable amount of "Complexity" to handle and there must be a clear connection between "Effort And Reward". Successful people endure rough conditions and low payback if their work is meaningful and this endurance leads to breakthroughs irrespective of humble origins.

(8) Cultural legacy is a strangely powerful force which can work for you or against you. You need to break out from your cultural legacy and re-train yourself if this stands in your way. Its obvious at times that your skills just don't matter if cultural legacy is standing in the way. Cultures that place a high emphasis on hard work are likely to produce more winners in almost any and every related or unrelated field.

(9) Finally success is not mysterious at all. It is a product of History, Community, Opportunity and Legacy besides Intelligent Hard Work. This thought keeps us from the pride of our achievements.


What Is An Outlier?

An outlier is a statistical observation that is markedly different in value from the others of the sample. Gladwell's latest book, Outliers, studies exceptionally successful people from an entirely unexplored perspective. I am just about done with it and in my next post I hope to summarize the main thoughts. Basically, Gladwell argues that we tend to focus too much on the personality based reasons of success and we ignore to observe and analyze the special conditions, extra opportunities and other such external factors in evaluating a person's success.