Ship of Theseus

ship-of-theseus

If a ship is replaced part by part up to a point where not a single original part remains in it, is it still the same ship?

This is a central theme of the philosophical paradox and has been reflected in the 2012 movie of the same name (which I happened to watch yesterday….yes I know, I am late by a mere 5 years!). The film depicts the journey of three people who have had an organ transplantation, cornea, liver and kidney respectively. I wish the filmmaker would have delved a bit more on how the transplantation changed the recipients. Especially since the corneal transplant was done on a blind woman who was a talented photographer and would rely on sounds to capture pictures, before the surgery. After the surgery, I wonder if there was a difference on how she would perceive photography, now that she had both sight and sound to rely on.

But on a deeper level, we have all gone through periods of breaking down, learning and then moving on in life. At each of these ‘episodes’ we have given up a part of ourselves as in our beliefs, and gained some qualities to face life, become stronger. So even if we may not remain our ‘original’ factory setting self, the constant learning, re-learning has made us the person we are. Hence, by the Theseus paradox, we may not be how we started, but we are still our own unique self.

I believe that life’s constant motion of shaping our thoughts takes us on our path to spiritualism and our higher selves; however, we have made a mess of everything with soul, re birth, immortality etc. in this mix.  It would be simpler to just focus on the process of creating and re creating ourselves and getting through life, while being ethical with our surroundings.

However, ethics for me can be different from for instance, the monk in the film, who would walk miles and miles without footwear so that he doesn’t hurt insects on his path. A part of the monk did change though, as he was shown advocating against using animals in research at the beginning of his story and finally made peace and went through a liver transplant and medication regime, to survive liver cirrhosis. Both transplant technology and pharmaceutical industry use research on animals at some point in their development, and that was something the monk had to come to terms with.

It’s very difficult to go through the metamorphosis of having our principles crumble and regain our strengths, but that is exactly what makes life interesting as well. And perhaps we should not tag it with whether it was the right thing to do or wrong, since it was for that moment in our lives, we chose the best thing for ourselves.

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Of Mental Wellbeing

“Your job is not to judge.

Your job is not to figure out if someone deserves something.

Your job is to lift the fallen, to restore the broken,

And to heal the hurting.”

-Joel Osteen

I remember a college trip to Srisailam waterfalls. The monsoons had just passed and our group of jolly youngsters was greeted by the gorgeous, abundant gurgling falls. But perhaps what is etched in our memories even today, is a group of patients from a local mental health rehabilitation center, mostly elderly women, all squatting together, their legs chained and bound firmly, as though they would just spread their arms and fly, if freed. Their condition stopped us in our tracks. We could not appreciate the natural wealth posing a distorted, contrasting picture behind the queue of suffering, helpless people in need and most importantly, a humane understanding.

I hope that we have come a long way from those days; however, I am certain that there is a longer way to proceed before we even start to manage mental well-being in our households, in our community; and understand the differences in the wide spectrum that constitutes mental health.

A review of the national report on Accidental Deaths and Suicides in India 2014 http://www.ncrb.gov.in/ shows that 17% of suicides in the world occur in India. The biggest cause of suicide is illness and prolonged illness (aka health related issues). Probable reasons being, medical expenses, hospital expenses, lack of proper hospice care, societal/family alienation, compounded with physical inability at meeting basic day to day self care needs. How immensely sad it is for all of us that our own who are already suffering due to physical illnesses have to additionally undergo insurmountable mental stress.

A country of 1.25 billion people, of whom 83% are mentally and physically strong enough not to commit suicide, cannot take care of 17% of population who cross the bridge and push themselves to end their lives.

The World Mental Health Day will be celebrated on October 10. India has slowly begun to acknowledge that mental health as a key to wellbeing. We are slowly understanding the differences in mental health, mental health conditions, disorders and how these can be treated and overcome. We are also arriving at the knowing that a positive environment can build a positive life. Our schools and our offices are encouraging mental wellness programmes.  However, our homes, our communities are not doing enough. ‘Mental health begins with me’ is aptly the first mantra to mental wellness. Though unlike physical discomfort, which is easily sensed by an individual, mental discomfort is seldom acknowledged by our own self. Although with a strong family, community and social network, this can be easily identified and alleviated at very initial stages.

Families are the first line of social network and it is easy to identify sudden changes in behavior of family members. The key is to invest time in building an open communication channel with family members. In our race to meet deadlines, to showcase ourselves in the eyes of those we think are important, we turn our back on our most important allies, our silent supporters, our parents and our children. There is great power in observation, but we must give our own that much time and commitment.

Additionally the stigma attached to the word ‘mental’ deters even acknowledging that there may be issues amongst family members. Is our social status of being a ‘perfect family’ so important that it overrides our intelligence in disregarding obvious changes in behavior and attitude which can lead to a far greater problem for our loved ones leading to irreversible changes in our lives? Coping with suicide death of a family member is an even greater challenge.

Fortunately, there is help. Several not for profit organizations are diligently involved in community awareness programmes (listed at the end along with other resources). Representatives are trained in identifying symptoms and more importantly, to discuss with members of a locality on how to identify signs and symptoms of mental distress in their families and providing the first line of care. If you live in a society housing complex, you could ask the managing officials to call the NGO representatives to deliver lectures. If you live in an independent house, you could request lectures through your local clubs. It is also important to get everyone to these meetings, including those who support our households on all levels and belong to every economic background.

Equally important is to be vigilant and empathic to those we interact with on a daily basis who are outside of our family. Sometimes, it helps to be a patient listener with the local grocer, the domestic help or even the lucky neighbor whom you get to see only on weekends. Going by success stories from all other public health areas in both research and implementation, it will be actions taken at the community level, by the community that would be sustainable in the long run. No external resource, aid, or team can bring about a substantial prolonged difference, unless we at individual level are aware and accountable for our own and those around us.

The Mental Health Care Bill that was passed in the Rajya Sabha recently, demonstrates the initial shift in our mind set by acknowledging attempted suicide as caused by extreme stress and disassociating it from being a criminal offence. The government and not for profit sectors can help us capacity build a manpower trained to facilitate mental health awareness at a household level. Our capable and ever smiling front line health workers (ASHAs and ANMs) are often burdened with multiple responsibilities, compounded with a measly incentivization process. While we strengthen our communities, national and international resources could be channeled to create a stronger health system management process by training a large team of health workers who are motivated to put in their efforts. A large trained mentally happy workforce can care for a larger population needing good quality care and service.

That mental wellness is a key to overall good health is evident from the scriptures that helped us grow through ages. The past does hold solutions to our future. How else would have Arjuna won the battle against the Kauravas, without the constant mental support provided by his most experienced charioteer?

Reads:

http://www.apd-india.org/?q=what-we-do/healthcare/community-mental-health-program

http://www.scarfindia.org/community-mental-health/

http://manas.org.in/default.aspx

http://www.thebanyan.org/html/communitymental.html

http://www.sangath.com/index.php

http://www.anjalimentalhealth.org/about.php

http://mhfkolkata.com/index.php/our-services/psychiatric

http://www.aasra.info

http://www.suicide.org/hotlines/international/india-suicide-hotlines.html

http://thelivelovelaughfoundation.org/