My Impressions of Psychiatry in India

My impressions of Psychiatry in India

( Guest post by Sarah Orr, Medical Student, Kings College, London)


I am a medical student from London; having spent four weeks shadowing psychiatrists in Pune I would like to share my thoughts on the experience.


I compared my visit to the Trimiti Clinic with my experience of the National Health Service (NHS) and psychiatry in the UK. The social and cultural observations I made are likewise based from a background of the familial and social structures present in the United Kingdom. This article will cover similarities and differences between these perspectives, without intending to criticise or judge either one.


On arrival to the clinic I saw that the furnishing had more character and warmth than UK clinics; I am more used to clinical shades of white and blue. The informality of the setting was also new to me; comfy sofa chairs with a coffee table instead of a desk and upright chairs. The former may help people to share more of their feelings and concerns as they feel more comfortable.


The way the clinic was run is also different. In India there appear to be few waiting lists; patients are seen when they wish to be seen. The doctors work much longer hours to accommodate this. These doctors see far more patients than their UK colleagues. They also have far less paperwork. This may reflect the lack of litigation; everything British doctors do is scrutinised by colleagues and I think that the patients might be more likely to sue their carers.


The patients themselves differ from what I would expect. On the first day I saw patients ranging from the ages of seven to early twenties. This meant that the child psychiatrist would see their patient from their early years up to adulthood and beyond if they wished – providing a great continuity of care. In the UK, psychiatric patients are moved to adult services at the age of about 18 regardless of what they would prefer. This may entail longer waiting lists with a difficult transition to an unfamiliar service. Many patients are likely to be lost in this system; this has cost some families dearly as their children struggle without treatment.


Children are seen with a variety of problems in India, not all of them psychiatric. This gave me the impression that the psychiatrist is seen as a well of knowledge and source of advice for all areas of life; more than just a doctor to prescribe treatments. In England patients are only seen by the psychiatrist after having seen a range of other professionals (social workers, GP, mental health nurses) – the doctor is made relatively inaccessible through a network of referrals.


The family in India is much more involved in treatment – I have rarely seen a psychiatric patient on their own. Most often they are accompanied by at least two relatives, sometimes three or four. These family members are enlisted to help aid the recovery of the patient through education about their condition and its management alongside more practical help (such as ensuring the patient completes tasks and takes medication).  This support network is much more extensive than in the UK where “nuclear” families with few children or single parents are becoming more common. It seems we may suffer from this; our psychiatric patients are often alone and struggling to manage their illnesses. Few are in employment. However, the family involvement seen in India may come at a cost; it seems to be difficult to maintain privacy in this setting. Parents are aware of relationships and information shared with the doctor – this may cause them to make their own decisions based on their beliefs of what is best for the child. For this reason the child’s own choice may be at risk. On the other hand this may mean that they are kept safe from the impulsive decisions young adults sometimes make.


Overall I had a lovely experience; all the staff were friendly and kind, the work was interesting and I have learnt a great deal. India is a fascinating country as are its people.

Play, Games and Sports….

Play, Games and Sports … want to know more?


English is a funny language. More so because a lot of words used daily are also used as “technical” (read – specific, narrow meaning) words by psychologists.

Play, Game and Sports are like that. In the sport of Cricket, a game is usually started by the umpire saying “Gentlemen, let’s play.” So all three words used in the same context!!

Unfortunately, psychology is a bit more convoluted. Let me explain –

Play – usually played alone, always unstructured, almost dream like, no rules at all, symbolic, experimentation all around, emotion laden, role oriented, very little equipment needed mostly one thing can be used in various roles, no spectators needed. E.g. – one or more kids playing “house”, “pretend play”. Only kids do this. When adults do it, it is “art”.

Game – usually more than one person involved, mutually agreed rules that are changeable mid-game by common consent, fun, very little role play, little sense of competition, no coaching needed, can be learned while playing directly for the first time, no adult involvement needed, very little equipment needed, spectators can be accommodated but not necessary. E.g. – card games, board games, ground games like hide and seek, fire on the mountain, etc. Kids do this occasionally adults play games as relaxation and fun.

Sports – modern substitute for war; internationally agreed, written down rules; coaching and adult participation mandatory; special clothes, equipments, facilities, time, safety gear mandatory; no equipment needed can be made by a child with his own hands at home using easily available material; very competitive; little or no fun at all (people who find organised sports funny have really missed out on fun-play as children) ; no value without spectators and winning. Only adults play this. Kids doing sports are really preparing for adult form.


I believe that you must have got the point by now. That point is – Play is necessary for normal psychological growth, creativity and relaxation. Games teach us how to have fun by agreeing to obey some rules and learn social skills in the process. Sports is for adult fitness, release of competitive neuroses and as a source of earning.


“Play” is what artists, scientists, creative people do. Play is where we learn problem solving. Now the choice is yours…

Plight of Indian Mom

(Declaration – This is not serious medical literature. Please do not read further if you lack sense of humour or if you are of sensitive disposition. You WILL be offended.)

In most middle class and upper middle class families, a strange thing happens as soon as a woman gets pregnant – Like baby turtles emerging from underground nest on a full moon night, grandparents are born with this news of pregnancy! Grandmother, who till now, was lost in her addiction of afternoon TV, suddenly springs into action, forgets everything about her creaking knees, heart trouble, migraine, etc. and prepares for a complete takeover of life of a young woman whose only real fault is that she let her family know about pregnancy.

Grand journey of helplessness for poor mother starts here. As her parents, parents-in-law and everyone who was ever pregnant in last hundred years, start to insinuate in her most precious, personal experience.

In the most cases the mother-to-be, is so shocked by this onslaught of concerned relatives that she loses will to control her body, mind, clothes, food, body-functions, baby and husband. As pregnancy advances, so does the takeover of mother’s life. She is brain washed into believing that pregnancy is a massive undertaking and without active management skills of all these people, she will do something seriously harmful to the baby and future of mankind.

Towards end of pregnancy, this takeover is complete. This chubby, rotund, waddling woman, who until recently was a capable, lovely, young person becomes a distant (and substantially more rounded) shadow of her former confident self. In Indian sub-continent, very few women, if at all, can go back to their pre-pregnancy state of being.

If any humiliation was remaining, it is completed with actual birth of the baby. (Let’s assume that it is a baby boy as chance of a girl being born is quite slim, thanks to prenatal sonography.) Senior members now start doling out their “expert advice” on everything related to baby. Their most powerful tools are mother’s natural concern for welfare of her baby and her fatigue that is also a natural consequence of labour, feeding, eating and sleepless nights.

In the name of “helping young and inexperienced mother”, baby is taken away from her for most of his waking hours. There is always someone available to take the baby away as soon as he is awake, playful, smiling, quiet or mildly irritated. As soon as the baby is really cranky, sleepy or asleep, he is handed back to mother. As mother’s quality bonding time with baby is completely destroyed, she gradually starts to believe that this baby is a big mistake and coping with demands of motherhood is beyond her healthy human capacity. She starts living in terror of this infant tyrant and is more than willing to give up the baby to grandparents and wants to return to her safe and familiar zone of office work (this
transition coupled with drying up of breast milk under stress, marks end of maternity leave in India).

Further complications are directly proportional to the “help” offered by family members to real parents. In last decade, with ease of telecommunication, mothers cannot escape this torment even if they are on a different continent.

In fact living in western countries worsens mother’s difficulties. Matter of fact approach to pregnancy, so main stream in west, really scares them. No weekly doctor’s visits, no fortnightly sonographies, no doctor at the end of phone line to explain every ache, pain and missed heartbeat, nothing like how it is “back home”. This is very scary for middle class Indian family (“no wonder these people have so few kids, nobody cares for mother and baby in this country!”) On top of that, grandparents extend their stay to maximum limit allowed by visa regulations. If they cannot stay on, then, skype calls many times a day to “their” grandchild! I don’t think that anybody expected this out of increased life expectancy, affluence and telecom revolution!

Back to India, net result of this mostly good intentioned but deadly hijack is that there are multiple parent figures with conflicting set of parenting ideas. As real parents look for solace at workplace, child is gradually left without any one being in charge for real. This vacuum in parent authority is filled up by child’s desire to control his life.

Real parents, specially mothers, continue to feel increasingly helpless in front of this all powerful and precious child. She oscillates between desire to take control (expressed as anger outbursts and emotional blackmail) and helplessness ( expressed as permissive, tired parenting and “children now-a-days are too much…”). This is fertile ground to breed all sorts of behavioural issues starting at home and
spilling over at school and social spheres. As child becomes more difficult to connect with, parents start feeling even more helpless and look for
professional help. Severe emotional and marital disturbance emerges and depression, etc. is not far behind. In a culture where your child’s position vis-a-vis his peers defines your identity, this is a real breaking point.

Helping families at this point is a real challenge. Main task is to help parents feel confident enough to re-develop parent-child relationship. Invitation to participate in Family therapy can be extended to grandparents also. Re-alignment of common and age appropriate family goals are possible if parents are willing treat this “infant terrible” as per his real age.  It takes at least six months to get this train back on the track.

Fortunately, if parents can see this problem as emotional struggle of their evolving family then corrective steps are possible. When parents show courage to do what is right, happy ending is almost always possible. What else do you expect for people brought up on Bollywood?

(P.S. – you may be surprised and ask, “where is father of the child when all this is happening to his beloved wife and child?” I share your surprise.

Reality of Learning by Rote

“Rote learning” has been bedrock of Indian teaching method since ancient times. A person blurting out passages from ancient texts was held in high esteem by the so called higher casts. In days before printing reached India, there was no way to access the knowledge other than storing it in your head, to be retrieved on demand.

I grew up in Nashik, a small town famous for its place in Ramayan. Every year, on the banks of river Godawari, there was a contest to recite various ancient shlokas and sutras. A panel of near senile, overweight and Dhoti clad men asked contestants to start reciting from any word that came to their mind and to contestant being able match his memory to their whims would be winner. I can imagine a few hundred generations doing exactly the same thing as pursuit of “knowledge”.

In contrast there are thousands of stories in ancient literature of such “knowledgeable” men falling prey to simplest tasks in life and often unable to save their own life. All these stories insist that “Wisdom” and “application of knowledge” is always more valued than being a mere “data bank”.

Lord Macaulay was looking for this dumbing down when he planned his infamous mass education system for India. And most of us are still victims of this “data bank” kind of education. A lot of schools still insist that students reproduce answers in exactly the same sequence of words as prescribed by textbooks.

Now there is this universal protest in more enlightened homes against forcing kids to learn by rote. I was asked this question by Dr. Venkat Panchgnula, an eminent scientist at National Chemical Laboratory, Pune. (Venkat does not agree with the “eminent” bit, so I will keep it for sake of controversy, after all what is a blog without controversy?)

Venkat’s daughter’s school has prescribed learning tables (up to 10, i think). He asked – “school teacher wants rote learning of tables. First occasion in my daughter’s schooling where rote learning is expected. I have encouraged concept learning so far, is it worth standing my ground or not? I am letting kid decide what she is comfortable with. Obviously, she is not comfortable with memorizing tables.”

Venkat is not alone this dilemma. Most sensitive and intelligent parents feel same.

My answer is –

Dear Venkat,

Rote learning is a tricky thing. There are certain data that need to be available to us “in a flash”. This saves on precious brain recourse of processing speed and time, e.g. – name, address, phone no. , passwords, etc. thousands of things. We memorize these things as we go along in life. We go on accumulating this “unconscious learning” thru our life. Even kinetic memory like walking, cycling, swimming, touch typing, etc is rote memory of muscles!

Tables are no different. In fact all kids should memorize 30 by 15 tables if possible. Our senior generation, they knew tables of 0.5, 0.75, 1.25! This facilitates higher learning in math. Without number tables, math can become a laborious, tiring exercise. It is one of the fundamental skills to learn math. You can compare it to learning atomic symbols and basic formulae.

So let your daughter learn tables by heart, it will give huge dividends very soon.

Best Wishes,


P.S. – I am completely against rote learning of concepts. Everything that can be understood must be understood and not learned by rote. You will agree that there is nothing to understand in tables. It is just data that should be conveniently available at the fingertips (like anniversaries and birthdays)

Within a day, my thoughts were challenged by my friends Amit Paranjape and (Dr.) Navin Kabra. Both insisted that though it helps a great deal to remember tables, there is no need to learn tables beyond 10! You can learn to use various multiplication tricks to come up with necessary answers. When Amit and Navin say these kind of things, I have to take notice as they both got into IIT, Mumbai ( it was IIT, Bombay then) and Navin did that without attending coaching classes ! (Amit also insists that learning tricks of multiplication is not to everyone’s liking in such cases tables should be learned by rote)

So my suggestion is that you must learn tables up to 10. And then try to learn multiplication tricks. If you realize that you cannot use these tricks with required speed, you have options

  • Learn tables by rote
  • Do not attempt IIT entrance exam
  • Learn to use calculator
  • Become an artist.

Navin suggested two books that propelled him towards math (by his own admission, he was “weak” in math till 8th STD!)

  • Figuring, the Joy of Numbers by Shakuntala Devi
  • Figures for Fun by Yakov Perelman.

Both are available for Rs. 100 or less, each, on Flipkart.

So like all good questions Venkat’s queston raised more issues than it solved. I like that. That is how we learn and grow and have fun with little bit of rote on the way.

Inside the Mind of a Creative Genius

Today was a very special day for
me. I got a chance to spend almost three hours with a great music composer,
Rahul Ranade (


Rahul is best known for his music but he has acted, directed and created in marathi and hindi. He is one of the founders of GRIPS theatre in India.

After composing music for
countless plays, films, serials and even political campaigns, Rahul continues
to enjoy music like a child in a sweet shop – amused, thrilled, fascinated and
intensely in love with music. I feel Rahul is at his best when he writes
melancholic music and also when he lets loose his natural flamboyance and writes
riotous, joyous music.

He talked about the kind of music
I like to listen to, helped me choose music and suggested what I should
experiment with. It was a fascinating experience. I felt like I was given the
key to Alibaba’s cave and could experience the wealth!

As it often happens, our
discussion turned towards his creative process and Rahul told me about how he
has changed as a composer since the first time he wrote music (he was 16
then!). He is composing for thirty years now and still enjoys it every bit.

When he started, it was all
analog music where, every music player, every piece of machinery and intimate
mechanical knowledge were vital for creating music. Now it is all digital and
with one machine, he can create whatever he wants to! It is fantastic to be
able to create all by yourself with the help of a machine.

I am impressed by Rahul’s ability
and willingness to keep learning this huge change in technology and use it
positively. I have heard stories about brilliant music artists unable to adjust
with this change and being sidelined and almost starving. Rahul knows quite a
few of them and agrees that if one cannot change with the flow, it is all over!

This brings home two important
points for me as a parent and human being-

1. Change is perpetual. I must
inculcate the capacity to flow and bend and grow with my environment. If my
education does not help me to learn this process of learning, it is useless

2. Human brain has great
plasticity at all ages and we can learn throughout life. This is opposite of
what is told to you by phony parenting coaches – human brain grows till age of
five so cram in everything till then. This is a marketing gimmick to fool you
into buying their brain stimulation products. Creative and happy people like Rahul
will tell you that when you follow your heart’s direction and your natural
talent, learning becomes a part of you and you continue to grow without realizing


Another thing that Rahul talked
about was his pattern of taking a day or two off every week and spending it
listening to music, watching movies or doing things that give him tranquility. This
means he gets away from excessive stimulation and gives his creativity a
chance. This is exactly what I have tried to convey in my previous blog on
creativity. This ability to spend unstructured time is the most valuable human
ability and it is mother of all human genius.


I came away feeling blessed and
happy. Music has a quality to make you feel emotional and because of Rahul and
his music this became a very intense experience helping me to explore more
corners of my mind that are inaccessible to words!