#mentalhealth #knowyourrights

A client recently told me that she had been taking a particular medicine for the past few weeks even though it was making her continually nauseous. I asked whether she had reported it to her treating physician. She said she hadn’t because physician apparently gets ‘angry’ with her for complaining too much.

It made me think of my privilege as an empowered woman as well as a medical professional. I take it for granted that I can question my service provider. But women raised to live life bowing to tradition and hierarchy, they cannot confidently question authority figures. So they bear discomfort, even illness and pain, just so that authority figures can feel smug about having ‘succesfully’ treated her illness.

The doctor–patient relationship has historically been described as based on trust rather than on the monetary considerations evident in the more typical business transaction. With increasing cost and complexity of treatments, hospitals began considering themselves business establishments and patients started viewing themselves as ‘consumers’.

Patient’s rights are inextricably linked to human rights. Access to healthcare is a human right.
In the paternalistic model of the doctor-patient relationship, the doctor utilises his skills to choose the necessary interventions and treatments most likely to restore the patient’s health or ameliorate his pain. Any information given to the patient is selected to encourage them to consent to the doctor’s decisions.

This description of the asymmetrical or imbalanced interaction between doctor and patient has been challenged during the last 20 years. Critics have proposed a more active, autonomous and thus patient-centred role for the patient who advocates greater patient control, reduced physician dominance, and more mutual participation. 

I am enumerating some of patient’s basic rights, that apply not just to Psychiatry but to all specialities.

1. Right to Appropriate Medical Care and Humane Treatment.

2. Right to Informed Consent.

3. Right to Privacy and Confidentiality. 

4. Right to  Information.

5. The Right to Choose  Health  Care Provider  and Facility.

6. Right to Self-Determination. 

7. Right to Religious  Belief.

8. Right to Medical Records.

9. Right to Leave.

10. Right to Refuse Participation In Medical Research.

11. RIght to Correspondence and to Receive Visitors.

12. Right  to  Express Grievances. 

13. RIght to be Informed of His Rights and Obligations as a Patient.

I hope the readers are encouraged to exert their rights that WHO espoused in the Universal Declaration of Human Rights in 1948 and the Alma Ata Declaration of 1978.
Ask your doctor for information about your illness, plan of management, alternative treatments, cost of treatment, short and long term side effects.
Be an informed patient in this information age, it is your right as well as your duty.

Reading Challenge 2019

This year has been by far, the best year ever since i touched my twenties, in terms of the amount of reading i got done.

1. I started the year with Herman Hesse’s Siddhartha. What it tweaked in my grey cells, I’m not sure, but i realised that I’ve been right about most things including Buddhism, all along.

2. I had no idea that Rahul Sanskrutyayan had published a book in 1943 that might be burnt in the streets today for suggesting an alternative history.
Volga to Ganga took me on a breathtaking journey of self-discovery. This book made me feel spiritually connected to humanity as never before, and believe me, I’m about as spiritual as a rotten turnip.

3. Slaughterhouse- Five by Kurt Vonnegut, i started reading it happily thinking it would be like Catch 22. Anushrees fault, this book was her suggestion. This little book was nothing like Catch 22 or anything I’ve ever read. It was gut wrenching, and i recommend it should only be read when one is NOT anywhere near a psychic collapse or civilizational collapse.

4. I started Meditations by Marcus Aurelius with grave reservations. Meditation makes me think of ungodly things. And so is this book, quite ungodly, just a fellow writing how tough it is to be king. To judge people correctly and fight the demons of past mistakes, this book left me with a feeling of peace.

5. Ants Among Elephants, by Sujatha Gidla, my friend Parul made me read. The nuances of class vs caste in the backdrop of a communist movement, it’s a never ending maze that leads to the Telengana Armed Revolt, the Naxalite movement of Bengal and all the Maoist movements in other parts of the country. How little I know of history!
A student of science in India in plus 2 can narrate all of indian history in about 5 words – Mughal, British, Gandhi, Nehru, Bjp. I am hoping to correct my knowledge in the coming year.

6. Americanah by Chimamanda Ngozi Adichie opened my eyes to the cultures of the indigenous peoples of Nigeria, and the experience of being coloured in a white supremacist world.
Sadly, the trans exclusivist comments being attributed to the author made me realise all the more the need for INTERSECTIONAL feminism.

7. One of my favourite discoveries was The Good Soldier Svejk by Jaroslav Hasek. It is a hilarious take on the territorial animal called man, and how civilizations fall to the folly of racial, ethnic and communal divides.

8. My affinity for irreverence in all walks of life led me to Good Omens by Terri Pratchett, Neil Gaiman. Though not in the same league as The Hitchhiker’s Guide of Douglas Adams, it is one of the most politically correct but hilarious books I’ve read.

9. Wendy Donigers book The Hindus almost got banned in India. That was the reason i picked it up. It was a revelation. I realised the vastness of the blind spot we have for ourselves and our own kind. It was difficult to read for me, because i had no idea about the tools of the Historian. I strongly recommend it even if, like me, you have to google something on every page, to cross check or to understand.

10. Amrita Shergill by Yashodhara Dalmia left me thirsting for more on women artists of the world. For every Pablo Picasso, there are innumerable Amrita Shergills who lost the gender lottery. This book also made me think of all the unsung artists who could have been, had they been born to the privilege of Shergill herself.

11. Because i couldn’t watch it, and i was feeling like a kid left out from the party, i read The Game of Thrones. In bits and parts, it’s interesting. But fantasy is not my genre. Towards the end of it, i felt like i have been cheated and would have demanded all those hours I’ve wasted on it, back, so I can read some real realism. I’m a freak of nature, i didn’t even like Harry Potter.

12. Rohinton Mistry’s Such a Long Journey, was my first Rohinton Mistry and is certainly not going to be the last. I’m going to read up everything else he’s written, hoping to find at least one strong and central female character.

13. In an Antique Land by Amitava Ghosh, takes one on an extremely well researched journey as is expected from Amitava Ghosh. One makes Harrison Fordesque swashbuckling discoveries while sitting in old and decaying libraries. The only regret one is left with at the end of any Amitava Ghosh book is that he lays the facts before you without making a statement. It’s on my frail shoulders to make a moral out of the story, whether we be reading about Marichjhapi or Morocco.

14. A History of God by Karen Armstrong I started reading as part of my self education project on world religions. In particular, i wanted to know about the religion that’s always in news – Islam. Religion has always been a tool of politics, history has proved several times over. And the opiate of the masses cannot be done away with either. So here we are, still warring over who’s imaginary friend is the best.

15. Seeing Like a Feminist, Nivedita Menon, a book that every woman should read. I can’t believe that I’ve lived so many years of my life not knowing my own home. Exactly why the personal is political was answered to me in the language i understand- the language of logic and justice.

16. Buffalo Nationalism by Kancha Ilaiah Shepherd. It’s not very healthy to discuss the creature, certainly not it’s fair cousin. This book is not an easy read for those who haven’t read Mr Shepherd before. It is a compilation of essays and definitely worth a read.

17. Daughters of the Sun, Ira Mukhoty, a feminist read of Mughal history. The more we ‘otherize’ via whatsapp, there will always be the ones who will humanise.

18. The Body Keeps the Score by Bessel Van der Kolk, the psychopathology of trauma, the most challenging and intriguing field in modern Psychiatry. I have so much to say about this book that I’ve lingered on over so many sentences and researches, it will end up being another 500 word post to review this one.

19. The easiest read of the year was Adam Kay’s This is Going to Hurt. It was roll on floor laughing funny and poignant. Strongly recommended read for doctors everywhere.So finally I come to the books i couldn’t finish.
The Intelligent Investor by Benjamin Graham and Dale Carnegie’s How to win friends….
Both books were making my grey cells commit mass suicide. But even the books i couldn’t read, told me so much about myself. I am no investor, perhaps I’m not even intelligent. I am certainly not out to make friends. These books were profound statements in what i would never want to be or do.

Hair Today

For the past several months, i have been planning a visit to the haircut people. I keep postponing because they are so preachy, so mean to me. First they start by complimenting my hair “You have such nice volume”.
The first time i heard this i thought they are talking about my expanding girth and i was pleased that they find it attractive.
Things go downhill from there. They discover that without me knowing it, i have been suffering from a dreaded disease called dandruff. Of course, it’s their duty to inform me, they try to be gentle breaking this news to me. “OMG you have DANDRUFF!”

I am so naive, i don’t even understand the implications of this serious news. I am transported back to my Dermatology posting during internship when we were told in the clinics that dandruff is dead skin. Apparently, we shed dead skin all the time, quite like snakes. Nothing to worry our heads about unless it’s infected with fungus, in which case you absolutely will KNOW about it.

For hair professionals, it seems dandruff is a far greater villain. They look at me with pity and promise that they won’t abandon me in my most difficult hour. I forget to be grateful, and ask if we can get on with the cutting hair part. They forgive me for a while, thinking I’m in denial.
But to their horror, they find out that i intend fully to remain in denial. They show me proof, i am losing hair by the kilos it seems. Again, I have to admit I’m adorable like cats, I shed. But history has proven time and again, that it grows right back.

Finally they give up helping me heal my hair but it has already taken a toll on our relationship. We go snipping away in a loud uncomfortable silence. I pay them and thank them but they look at me as if it’s been an ordeal dealing with me.
That’s why I’m so wary of inflicting myself on the haircare people now.

Draped this Ikat silk that i bring out every winter, super light weight and a little too cheery for my melancholic tastes

Thin is a state of mind.

In yesterday’s pic I was looking thin, many friends have commented thus. I believe an explanation is warranted. Yes, I have cut carbs like by only about 80 percent of what I was having before. So I think I lost around 2 kg weight over the last month.
No one noticed in the pic I put up on Monday. I couldn’t have lost significantly in the four days that followed, because it’s only on Friday that you all noticed.

Let me share the secret.
1. You have to wear a very loose blouse, one that keeps falling off your shoulders as well as doesn’t at all fit your arm circumference. It should look like you wore your heavier cousin’s hand me downs.

2. Set the timer selfie and suck in your tummy.

3. Lean forward slightly so your head looms large over the entire picture and body becomes disproportionately small. Think Megamind.

4. Buy your phone after carefully researching which company is giving you the best photo filters. They make you glow like you just conceived a very naughty idea.

Despite every body positivity song I sing, do not believe for a second that I am comfortable in my body. I would have exchanged it with a fitter body in a jiffy if my kiddos allowed it. They like my jiggly belly, my kissable cheeks and my well padded shoulders and arms. So long as they like it, I’m keeping it.

Your comments in the morning made me think I should be able to carry off a synthetic saree today. I mean you never know if I gain the 2 kg back by tomorrow, better not take a chance and drape the sexy thing right away. Also do notice how my leafy garden has proliferated by chain migration, from one pot to another, and now there’s a whole wall of it.
This bandhej in psychedelic colours is very appropriate for my Friday .

Lapis Blue

It was raining yesterday. I clicked some pictures of my garden. During rains my garden look like how my children look just before I see them off for school. All neat and combed and fresh. Within 30 seconds, my daughter manages to make her hair look like Mowgli of wolf upbringing fame. Likewise, the moment it stops raining, the garden starts pretending no other season is worth living for. I have to give them all my love, and patience so they may thrive.

Seasons have this peculiar tendency to overdo themselves. Just when you start enjoying the warmth, nature decides to bless you with more and mercury climbs to boiling point. If you love the rain, it will give you so much rain, that you stay awake at night thinking if it’s possible for oceans to overflow?

Not that there aren’t other horrors to worry about. Human ingenuity comes up with new abominations every day. Why, we can easily look forward to a world war sometime soon, if one is particularly well informed and reads multiple newspapers every day.
That’s why I also follow the Paleontology publications, they predict that dinosaurs will be revived and we will all by killed by marauding packs of big lizards. That’s a comforting thought if one knows about Auschwitz-Birkenau etc.

Draped this lapis lazuli blue (does the colour name exist or did I just invent it??) begumpuri yesterday

Lazy Rainy Days

This morning when the alarm rang at 5.30, it was raining cats and dogs. We had gone away for the weekend and both of us (spouse and myself) were feeling too lazy to start the week. Both of us were reluctant to say so.

Me: It’s raining so heavily.
Him: Yes, totally pouring.
Me: Umbrella won’t save anyone from getting wet.
Him: It’s not healthy to stay in wet clothes all day.
Me: Roads will get waterlogged.
Him: Too much rain this year, they should declare a holiday for children.
Me: Are you saying we shouldn’t send children to school today?
Him: No, but if you are saying so, I would agree.

Of course, we didn’t bother to get up. Consensus is easily reached in such matters in our home. At around 6.45, the rain, the treacherous wet evil thing, it stopped. We hoped that it would pick up momentum again after a short lull, but no, it was going to be a bright clear day after all.

Now I started getting violent pangs of guilt. This month school has been skipped multiple times already. I am not adulting enough, not mothering consistently and my kids will grow up as if they have been raised in the jungle by wolves. (No offence to wolf mothers of human babies, they do a fairly good job.)

Believe it or not, this story has a happy ending. At around 8 am, I noticed this message in WhatsApp

Dear parents.

Due to heavy rain school is closed for all.

Thank you.

The shenanigans we had been up to over the weekend, included me dressing up in this treasure Telia cotton that I find so pretty that I almost forgive myself for having splurged on it

Diversity is Life

A discussion between my friends Samruddhi Bhartiya and Fatima A. Athar that was worth saving for posterity.

1.) Do you think that sex is biological, while gender is a social construct?

Yes, sex is biological and gender is a social construct. The biology of sex and the social construction of gender are both more diverse and complicated than we are typically told to believe.

2.) On what basis do you think that we can identify SEX of people?

In medical and scientific practice a lot of different methods may be used to identify the sex. There is no “one true method”. Broadly speaking biological sex is a tapestry, a mosaic if you would, of lots of different things. This includes sex chromosomes, hormones, phenotypes, anatomy, and so on.

3.) And how many sexes do we have, if we go by the markers based on which you believe that sexes can be identified & distinguished?
If there are more sexes than just males & females, then can you also name a few of them?

It’s difficult to count how many sexes we have because of the presence of numerous “intersex” conditions, a word which is itself a bit of a misnomer since it makes it sound like all the sexes that aren’t chromosomally & phenotypically XX or XY are simply stops in between these two poles. A professional in the field might be able to better help you with the number. Suffice it to say there are at least 4-5 combinations that I know of, probably more.

a.) Man/Woman/Demigirl/Demiboy/etc type classification (something which we see discussed a lot these days)?
Or does it mean
b.) feminine/masculine/neutral type classification (TERFs use this classification, and by gender, they often mean way of self expression)?

4.a. When we say gender is a social construct, we mean that the social identities and norms we associate with these sexes vary between societies, subcultures, and times. Our understanding of the world around us happens in our minds, our conversations, our thoughts/explanations, and the thoughts or explanations others pass on to us. This is how some societies recognize only 2 genders, others 3, yet others 5 or more. Think about how there was a time when early researchers thought homosexuals must not be men or women, because they understood heterosexuality as one of the traits of those two genders. In some forms this idea still survives.

4.b. Masculine, feminine etc are adjectives which is why different from the nouns above. They are not who you are but how you are. The point of this grammar lesson is that understanding these as descriptors is important because one, it does not limit the person to being 1 type of person and two, they can be combined and layered as ways of describing different norms, behaviors, subcultures and even people of any gender. There can be masculine women, feminine men, and androgynous individuals; there can be toxic masculinity and the feminine mystique; there can be performative masculinity or femininity; and the many culturally distinct permutations of these. For example, skirts can be symbols of dainty femininity in one cultural but warriorlike ferocity in another culture. In some cultures, being noisy is a feminine thing and in others it’s a masculine thing.

4.c. You absolutely can reject gender and all trans individuals do inherently reject the imposition of one form of gender: cisgender, or the idea that your gender is what your body appeared as to other people at the time of birth. Radical transfeminism has a wealth of insight into understanding different forms of experiencing gender or no gender whatsoever–the struggle is not against the subjective experience of gender, if any, but the prescriptive one. That being said, a “social construct” as explained in 4(a) does not mean “something that does not actually exist” but simply “something that we built up with each other”. Other examples of social constructs include morality, justice systems, and money. Think about that–even money is a social construct, given that it relies on all of us agreeing that something (bits of paper, bits of metal, shiny rock, cowrie shells) has some value to us (though we decide what “value” means and how much of that value this has). Economics is a science entirely devoted to the study of these socially constructed systems. Yet no-one argues that because money is a social construct the reality of class oppression or wealth inequality does not exist. Money is in fact a social construct so powerful that it can directly or indirectly lead to death, and death is probably one of the most absolute material realities possible. So gender as a social construct can and does still have both profound tangible impact on the individual and on wider society.

5.) whether there are disagreements on what sex/gender means, or how they can be distinguished, and how many types there are, one place where i have seen TERFs agree with intersectional feminists is, that the way one dresses, or whaterver interest someone picks up, has got nothing to do with sex, like they dont think that wearing dress/make up, or having an interest in cooking/stitching/etc, has got anything to do with gender, THEN, on what basis do ppl think that they were born in wrong bodies, if their interests have got nothing to do with their sexes?

The idea that behavior may have nothing to do with gender which in turn may have nothing to do with sex does NOT in turn mean that behavior *must* have nothing to with gender which *must* have nothing to do with sex. This is the difference between expanding vs essentializing our understanding of human diversity. A woman with facial hair is not a less authentic woman — a woman without facial hair is also not a less authentic woman. Depending on the moment in history and the culture, one may be socially validated more than the other. But it doesn’t change that basic premise and to dictate to either one that she is only more real if she can resemble the other is what the problem is. Similarly there are at least two ways to arrive at a society in which gender as a concept holds no influence: force everyone to conform to an androgynous ideal (and what is “androgynous”? Why t-shirts and not dresses?) OR ensure everyone has the necessary personal freedom to define themselves however they want without it leading to any systemic incentives or punishments. To this end not all trans people feel they are in the “wrong” body. Some of them might, just as some gay people feel their experience of sexual abuse contributed to their orientation. But the whole point of self-definition is that you get to decide about yourself.

6.) do biological differences affect our abilities/skills?

What biological differences, which abilities, how do we decide something has been “affected” and is not just part of the spectrum of variation in the skill? These are important questions that should not be taken for granted before answering or asking this question. The science is still out on this but we do know two things: the first, that the brain is a highly adaptive organ that is molded by its experiences; and second, the body’s survival depends on adapting to the demands of its environments. This why for nearly every difference that has been studied so far, it has been impossible to assign causality. There are other differences — for example, it’s not possible to gestate a human baby inside your body if you lack a uterus, whether you’re a man or a woman. (And just to add, it’s not only trans women who may lack a uterus; cis women can be born without one too. So if in #2 you had said women/female is the sex that has a uterus, those cis women would suddenly fall outside your definition as would cis women who have had hysterectomies. Interestingly, a very patriarchal line of thought already does insist that a woman without a uterus/breasts/vagina/menses/fertility is no longer a “real” woman.)

7.) if so, should trans women and cis women be allowed to compete against each other in sports?

The entire field of sports is based on the idea that people’s bodies can be trained or can be naturally gifted or BOTH to be included in a competition of physical excellence for the entertainment or inspiration of others. That’s about it. No male athlete has ever been thrown out for having an unfair natural physical advantage over his peers — that is the point of the competition. Personally, I’m of the opinion that separate categories for men and women are an archaic hangover from the time women were not expected to participate in (or be biologically capable of) physically vigorous activities. Yet at these same times and in these same societies, there would be working class and slave women engaged in massive physical toil for the benefit of their male masters. Nobody seemed to notice (then or now) the biological unfitness of these women for that backbreaking labor, or offer them comfortable cushioned parlor sofas to rest their delicate womanly bodies on. Now that women want to be in sports, there’s hemming and hawing about their physical capacity for them? Some people, including some trans people, do disagree with this — they argue that cis women with naturally higher androgens may have an unfair advantage and that trans women (who often have *lower* than average cis androgen levels during and after transition) may be at an unfair disadvantage. The reasoning doesn’t hold up, as far as I’m concerned. Anyone able to qualify should be able to compete.

8.) i have always denied admitting biological differences having any link/correlation with our abilities, bcos historically, it has been used as an argument to either push a lot of responsibilities on us, or to restrict our access to certain fields, but if at all you agree with 6th question, then keeping that in mind, how do you plan to combat ppl who use our disadvantages against us to restrict us more? (this question kinda takes away from trans ppl and their struggles, and i am sorry about that)
And do we also have somethings which give us an advantage over men, as a result of biological differences?

My plan to combat people who use other people’s natural or systemic disadvantages to deny them rights and restrict them against their will is feminism. That’s about it. That is all of it.