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When the brain misfires: Understanding psychiatric illnesses

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Anshu Bahanda: Welcome to Wellness Curated. This is your host, Anshu Bahanda. And as you know, we try and help you lead healthier, happier, more hopeful lives by giving you tips, tools and techniques from all over the world. So this season is all about understanding the brain. And to that effect, today, we have columnist Aparna Piramal Raje, who has written this incredible book called Chemical Khichdi, which a few of you might have heard of already. It’s about her experience of living with bipolarity. We also have the eminent psychiatrist Dr. Kersi Chavda who’s associated with hospitals like the Sir H.N. Reliance hospital and the Hinduja hospital. Thank you, both of you, for taking the time to be here with us today. 

Aparna Piramal Raje: Thank you. Thank you for having us. 

AB: Thank you also for sharing your experience and your guidance with our audience and for helping us with a topic which is very sensitive. Dr Chavda, I wanted to ask you, globally, I think, about one in seven or one in eight people live with mental disorders. And the Public Health Foundation of India said that one in seven people in India are living with some sort of mental disorders, mainly anxiety and depression. So, firstly, is that right? Do you feel, from your experience, that those numbers are right? And secondly, what do you think is the cause of it? Is it mainly genetic? Is it external factors?

Dr Kersi Chavda : Okay, so let me state that I think that these numbers are extremely underreported. From what most of us are feeling, it’s probably one in four. So about 25% of the population would have some kind of psychiatric illness and hardly 20% of this group would actually be in a position to access proper mental health, which is a huge gap that we see, in terms of people who actually need help and those who get it. If you are looking at it in terms of the kind of illnesses nowadays, we don’t look at it in terms of just one particular thing. We look at it in terms of a continuum. And we are also looking at it in terms of the fact that it kind of affects the mitochondria of every organism. So that not only when you have problems relating to the mental illness, but then it’s not surprising that most of the people who would have a mental illness would also have problems relating to the physical aspects. So there would be a higher than normal incidence, possibly of cardiovascular incidents, or they’d be a higher than normal incidence of endocrine disorders, et cetera, et cetera. Because the mitochondria is nondiscriminatory, it not only hits your brain, it also hits the various parts of the body. If you’re looking at it in terms of this, once again, we don’t look at it only in terms of depression or anxiety or things like that. These are nice little things to hang our hats on, but it’s very unlikely that they’re all in these individualized little compartments. So a person who would be having so-called depression would also possibly be having a lot of anxiety, might be having something associated with panic attacks, might be having something associated with the fact that he keeps counting over and over again or that he’s a little obsessed with cleanliness. So there’s a part of obsessive stuff coming in. He might also be getting old— so there may be some neurodegenerative issues. He might have been on some medication for other reasons, because of which he lands up having movement disorders.  

AB: Right. So you’re telling me that some are genetic and some you pick up along the way in life?

Dr KC: No, I’m saying that they were always 99%… I mean, they are always genetic, but very often, in spite of them being genetic, there’s a kind of a stability that occurs. You manage because of your own support systems, you manage to cope, and then something happens, and then you trigger into something. 

AB: You trigger that gene. 

Dr KC: Yeah. And you might have some people who are facing that. You might have about 20 people facing the same stimulus, but unfortunately, there are only a few people who might react in a particular way, and there it’s basically the genetic component that plays an extremely important role. 

AB: So, Aparna, I wanted to ask you in your book, and also in several talks that you’ve done, you talk about how to manage mental health. So how and when did you recognize that you were living with bipolarity and also talk to us about some of the common misconceptions to do with bipolarity. 

APR: Yeah. So actually, my first manic episode, which is what characterizes a lot of bipolarity, happened when I was in my mid 20s, just before I was about to go to Harvard Business School, and I had all these delusions of grandeur. I thought I could change the world. I think, anyway, when you go to Harvard Business School, you think you can change the world. So I think that made it even more exaggerated. I was losing sleep, I had lots of ideas, and these were the typical sort of textbook symptoms of mania, as it’s known. But back then, which was over 20 years ago, we didn’t really have the vocabulary to look at it that way. We just thought that maybe this is a personality issue or that I’m responding to life circumstances, and it took me a while to actually get officially diagnosed over ten years. So I think that it’s quite a long journey. I think it happens to a lot of people that diagnosis can take time. So coming to the common myths, I think a lot of people think that people who are bipolar are always swinging between highs and lows, that there’s never equilibrium, there’s never peace time, as I call it. But actually, that’s a misconception, because I think these phases happen at certain points in time. There’s a lot of variation from what I’m given to understand between patients. So these mood swings can vary in length and duration and frequency from patient to patient. But I’ve had years of being in a good place. For example, I’ve just spent five years now in a pretty good place without any manic episodes. So that’s one misconception. And the second thing is that we cannot live fulfilling and meaningful lives, that we can’t have a steady job, we may not have a family life, we may not have a career. People are very… There is a lot of taboo around mental health in general, but these are some of the misconceptions that hold us back. 

AB: So Dr. Chavda, like we’ve heard in Aparna’s case, even for someone like her, it took ten years to put a name to it because she was saying, at that point, people didn’t know. There wasn’t enough awareness around it. I wanted to ask you something. So for the masses in general, popular culture makes them sort of come to their decisions on what an illness is. There was a film called Split, as an example, where they talked about dissociative identity disorder, and in that film the person becomes violent. That makes people have all these fears. So how often, if at all, do people turn violent when they’re living with a mental disorder?

Dr KC: They probably turn violent less often than people who don’t have a psychiatric illness. So when was the last time you turned… I mean taken that you don’t have a psychiatric illness, when was the last time you turned violent? You don’t remember? I hardly remember a time when any of my patients turned violent. Now, if you’re talking in terms of aggression, yes, they may get a little aggressive. They may, if they’re in a hospital, want to pull out a nose tube, or they might want to pull out an IV set. But that would happen even with people who don’t have a psychiatric illness. A lot of people get very, very uncomfortable, for example, after an operation, and they pull out their IV sets. That doesn’t mean that they are aggressive. So this myth of aggression being associated with mental illness, or the other way, mental illness being associated with aggression, is just not based on reality. 

AB: Thank you. That was something very important that you’ve addressed. 

Dr KC: And unfortunately, the films like you mentioned, I mean, I haven’t seen the particular movie that you mentioned. But it’s not surprising to me that they would categorize the very important aspects and make them into something that’s laughable. I mean, when we’ve seen shock treatment, for example, being given. it’s horrendous— what they show you on television. In real life, it’s nothing like that. We don’t realize that there’s this huge population of people who actually believe what they see on the screen, and that’s disgusting, because what you’re doing then is perpetuating a myth. 

AB: Yeah. So this is a real debate, isn’t it, that are the filmmakers… should they take responsibility or are they just trying to entertain people rather than educate them? But Aparna, I want to ask you about this. So there are certain things that are promoted, let’s say in films and in popular culture, and if we come to language, what are the right phrases to use and what phrases should be avoided?

APR: Well, I think it’s nice to say that someone lives with a mental health condition rather than having that condition, because it sort of implies that this is something that they need to manage and it’s less of an identity. Even though I have no problem saying I am bipolar, I think it’s easier to say that somebody— X, Y and Z lives with that. That’s one thing. I also prefer to use bipolarity rather than bipolar disorder because in my mind disorder, although it’s a technical term, suggests some sort of malfunction. And for me it’s not a malfunction, it’s something I live with. And it’s in a way a source of illumination as much as anything else. But even if you don’t look at it as a source of illumination, if you just look at it as a vulnerability, I just prefer bipolarity. And then there are things like suicide. I think we say commit suicide very casually, which I think there’s been a big move now, for media houses in particular, to say somebody, so and so died by suicide or took their own life, rather than saying that they committed suicide, which suggests that they committed a crime. So I think these are just very small ways to remove the stigma associated with mental health. And one of my big personal intents is to try and shape the dialogue, the narrative, discourse, and the conversation around mental health in India. Because I think when we speak about it and when we can talk about it, it really makes a difference. And I’ll just share, just coming down to language, I’ll share a little anecdote. We were on the subway in London last year and they had a chair reserved at the edge, which they often do for people who need assistance. But it said over there, not all disabilities are visible. So my 11 year old points to me and he says, that chair is for you, Mama, because of your mental health condition. And of course not everyone will respond nicely to that comment, but he said it with a lot of empathy. He didn’t intend to be funny with it. He said it with a lot of empathy. So I just think that if we can kind of normalize the language, it really goes a long way for people to be able to talk about it more openly. 

AB: I totally agree with you. I mean, like, if someone has diabetes or heart condition, they talk about it without thinking twice, right? So what is the difference? I 100% agree with you here, but Aparna, one other quick question. In your book, you talk about how you see movies in your head. Now, I know a lot of people who have very active imaginations. So can you tell me, what is the difference? When you’re seeing a movie in your head, can you switch your focus? Can you go into all that?

APR: So I think that’s a big difference, right? Like, if I’m seeing a movie in my head, when I’m psychotic, the remote control is really not in my hand. I mean, when you’re seeing a movie in your head, probably the remote control is in your hand. You can decide that I need to cook something now, I need to sit down and have a meal. Or if somebody’s talking to me, I need to pay attention and switch off the movie and come back to it. But really, if I’m in a manic state then it’s very difficult for me to actually do that. I’m just so absorbed in what I’m seeing that I just don’t want to be disturbed. And there’s a soundtrack, there’s a commentary that’s happening live in my head, and it’s just very absorbing. And it’s difficult to pay attention to anything that’s happening on the outside. Even to the point of not remembering whether you’ve had a shower or not had a shower, or which clothes have you been wearing lately, or just the mundane becomes very difficult to deal with because there’s something so action-packed and exciting that’s happening in the head. It could be traumatic also, but there’s a lot happening in the head. 

AB: Thank you. Dr. Chavda now, what I want to ask you since everyone’s experience is so different, right? And every situation is so different. How can we let caregivers and family, friends, educators, co-workers know there is a point which should be an alarm bell for them if they know that this person has mental health or is living with a mental health condition? Because very often they go undiagnosed and then, unfortunately, there’s a tragic incident and then that’s what makes people sit up. 

Dr KC: So I look at it like this. I think we all must have an index of suspicion, and that only comes with education. So if you’re not educated enough, then you’re not going to be aware of the fact that such a thing exists. And if you’re not aware of the fact that such a thing exists, then you’re not going to have that index of suspicion and look at it in terms of the fact that this is something that is an illness and this is something that can be treated. Let me again emphasize— it certainly can be treated. Point number two, you ask when does some abnormal behavior become an illness? When it starts affecting the person’s normal, occupational, social hygienic, academic, work life and when it’s consistent over a period of time. See, if I occasionally start crying because I’m overwhelmed with COVID and what it has done to people around me, it wouldn’t necessarily be considered to be a depressive episode or it might just be considered to be a depressive trait or a mildly anxious trait. But if I constantly cry and I refuse to get out of bed and then I’m scared that it’s going to come to get at me. So I don’t open the door and I don’t go down for a couple of months at all and I make people wash their hands 25 times a day and I pray six hours a day and this, that and the other, then obviously there is something that is wrong. And this whole thing of oh, he’s just passing through a bad stage or oh, he’ll outgrow. It is bunkum. Even if we are overemphasizing on this, I tell people if you have even the slightest suspicion that there may be something that is not okay with your family member or your friend, seek help. There are about 20% to 30% of people who come to me and I say there’s nothing wrong with you. So it’s not necessary that everybody who comes to me has a diagnosis. It’s not necessary that everybody who comes to me needs some treatment. But the amount of people who don’t seek help and the amount of caregivers who pass through this whole thing of – Oh, but he’s a sensitive person or somebody died in his office so he got affected or he has an alcohol problem and you know how it is, all boys get aggravated when they drink. You need to get over that. But like I keep telling people, we first have to accept that there may be a problem and then undergo the necessary clinical diagnosis towards the same. 

APR: Can I just add over there that it just took us a really long time to accept that there was an issue, in the sense, first of all, there was some confusion about whether I was a borderline case or whether I was actually bipolar. But we were very uncomfortable with the label. We were uncomfortable with taking meds and we just generally found it difficult to… that acceptance took a really long time and I think that’s, I guess, one of the reasons why I wanted to write the book— to make it easier for people to accept whatever diagnosis they had. 

AB: That’s wonderful. 

Dr KC: Sorry, I’m interrupting. Let me just say that you’re one of the 95% of the population who would have had a problem in acceptance. It’s not easy, you know. It’s like when we get into a marriage, nobody gets into a marriage expecting that there’s going to be a divorce. Nobody has a child thinking that there’s going to be a problem with a child. And none of us would actually believe that our mother, father, brother, aunty, uncle, or we ourselves would have a psychiatric illness. It doesn’t cross our minds. I mean, when we are sitting, even if you’re in a nice, educated, open family system over the breakfast table, we talk about marriage and we talk about studies, and we talk about whatever else. How many of us talk about mental health with our kids? How many of us talk about mental illness with our kids? I can’t think of anybody. It is not a topic of conversation, which is why it’s so very important to normalize, or so called normalize this, so that it no longer holds this, oh, it can’t be happening to me kind of thing.

AB: Absolutely but Aparna just on what you’ve said, it took you a while to come to terms with it. So tell me, how can we help people? So if, say, I suspect that one of my loved ones has some sort of mental health condition, is living with some sort of a mental health condition, firstly, how do I have that conversation with them? And then how do I impress upon them the need for help, because it’s not always accepted?

APR: Well, I think I can only share what really worked with us— and that was to have family friends, as well as other family members who had a medical background, intervene. And they would say, “Okay, she’s really kind of not in a good place. She needs to see a psychiatrist now. We need medication.” In fact, it had reached a kind of a crisis point, so that required it. But because it came from a doctor who was a family friend, then I think all of us were more willing to listen. So I think if there is somebody in the ecosystem that has some sort of sense of authority or competence in this area and they can kind of intervene, that’s probably more effective than all of us who are lay people suggesting that there’s something wrong. Because people would say that, oh, are you feeling better? And I would say, what’s wrong with me? I’d say I’m fine, there’s nothing wrong with me. 

AB: Thank you. Dr Chavda, I wanted to ask you, the same sort of question, that when someone is living with bipolarity and they’re going through a manic phase or someone who’s depressed and is not ready to accept that they need help, how would you suggest that one approaches them?

Dr KC: Okay. Now, many years ago, I was very diffident. So I remember there was this time when I was a junior consultant, and I had this senior person who I absolutely adored. He was one of the best doctors around. And I just kept feeling that there was something wrong with him. And I kept telling myself, I’m too junior to actually go up to him and ask him, is there something I can do? Can I ask, is there something wrong? You don’t have to answer me, but I want you to know that I’m there, blah, blah, blah, and I didn’t do it. And about three weeks after I felt there was something wrong, he died by suicide. And that left a horrible impression on my head. And I swore to myself, that come what may, whenever I felt that there was something wrong with either my friends or my relatives or my colleagues or whoever, and if I felt that they were behaving in a way which was not normal, which was different, not normal, but which was different— then I would actually go up to them and ask them if there was something that was wrong. And I did this. I must have done this to more than about 200 people since that time. And almost everybody told me that there was something wrong. Almost everybody did. I can hardly think of two or three people who took umbrage at what I said. Most people, even if they said, no, no, nothing’s wrong, then they would call me back after two days saying, “Hey, you know what you asked me that day? Can I come over and chat?” And I think it’s very essential for all of us. Now, I might be in a slightly unique position, in that I’m also a doctor and I’m a psychiatrist, and like Aparna was saying, that sometimes having an authoritative or so-called authoritative figure makes a lot of difference. But I do believe that even if you are not a doctor or you’re not in the mental health profession, just going up to the guy and saying that I think there’s something wrong, I’ve been noticing that there’s been a slight change in the way you’re behaving. You’re looking very sad. Is there anything I can do? If you do need my help, I’m there for support. We are more and more aware of mental health. I think our youngsters are so much more aware than what we were and what our parents, of course, were. And I think that’s a wonderful thing. We still have a huge way to go. But if we do start feeling that there is something wrong, we need to talk about it now. Now, talking a little more [about this], suppose, I believe that you have an illness and you refuse to take help and your condition is deteriorating. We have a mental health act which allows for people to be admitted and treated even against their will, because we cannot allow for some calamitous thing to happen. And there are safeguards put into it so that the rights of the patient are also looked after. 

AB: So Aparna, you said that sometimes people are trying to help, and people are trying their best. So a caregiver might sometimes use an approach which doesn’t work for the patient. So the caregiver might keep saying, take your medicines, take your medicine, or they might tell someone, you don’t have any reason to be upset. So can you talk to us about that? And then can you also talk about your seven therapies. 

APR: So, for the caregivers, what I have seen actually is that caregivers sometimes have a different role than their friends. Because I think caregivers want to fix a situation, right? They want a patient to stabilize. If the patient is manic, for example, or if the person is depressed, they want them to get back to their normal routine. And so there’s a huge element of trying to fix the sleep, trying to fix the food, trying to fix the routine, trying to fix the meds, all of that. And that sometimes makes it difficult for the person living with the condition, because then they really start feeling like they’re being a patient, they feel much more vulnerable. I think in those moments, I definitely felt a lot more, that everybody else is telling me what to do. And there’s a sense, not quite of being policed, but there is a sense of being policed. So I think it’s important for caregivers to strike that right balance and it’s a difficult one. So, whereas I found that friends often have that luxury of being a little bit distant and they can do a lot more listening, and they can just kind of just be there, have lots of cups of green tea in my case, and listen about what’s actually going on and have the patience to do that, because they’re not responsible for fixing the situation. As for the seven therapies, medication, medical therapies— which include talk therapy as well as drug therapy, that’s, for me, the starting point. But as I see it, it’s necessary, but it’s not sufficient. It needs to be complemented by lifestyle therapy and what I just described earlier, the caregivers or the love therapy. So these three for me are the triangles that are just the essential ones— the love therapy, the medical therapy and the lifestyle. But then there’s also the role of the workplace, the role of friends, the role of, let’s say spirituality, which has been a big part of my journey, and also the conversations that I’m having with myself, my self therapy, which I think has been a huge part of my healing and recovery. So I think that there are some therapies that just help us to survive and then there are some therapies that help us to go from surviving to thriving. 

AB: Surviving to thriving. I love that phase. Thank you, Aparna. Dr Chavda, what is your advice to caregivers? Sometimes caregivers and loved ones feel really helpless. 

Dr KC: Okay, so I’m going to just suggest a couple of things. I think what Mrs Apana said was fantastic and I would absolutely agree with what she said in terms of the therapies. How do we deal with caregivers? We deal with caregivers by requesting them not to become doctors.  Dr Google has been the worst thing ever that could have occurred in the history of medicine. And now we have all our chat boxes which are even worse. So I actually had patients, relatives, coming up to me and saying, oh, you’re suggesting this medicine. Let me check. Dr Google is not a doctor. He’s about 18 to 20 years old. A lot of us are older than he is. I mean, I tell people that if you look up Crocin, you’ll probably find that you’re either dying or you’ve got cancer because of Crocin. This is a whole bunch of crap. Having said that, the right caregiver is a fantastic person because he gives as much as necessary and he doesn’t police. And if he can manage to be objective rather than emotional, he’d be fantastic in terms of the support that the person gets. You talked about the myths of mental illness. We should have a 16 hour talk on the myths of medical tablets. So tablets are a big taboo, and a lot of us get into this thing of why should I take medication? Isn’t it going to cause harm? And I am strong enough. And I’ve often wondered, what is the strength thing? You’re not weak if you have diabetes and you’re not weak if you have blood pressure. So how do you suddenly become weak?If you have a depressive episode or you’re very anxious or you’ve got claustrophobia and can’t get into an enclosed space or you land up feeling very frightened because you feel that there are messages coming from the television or that people have put something in your brain which is causing you to behave in a particular way. How does that make you weak? How is it bad parenting? I mean, you’re not a product of bad parenting if you’ve got diabetes or blood pressure or you have a thyroid dysfunction. Why are you a product of bad parenting if you’re depressed or anxious? Today everybody is fighting for their rights, quite correctly, because just like we wouldn’t think of having a person, I’m using the same example, diabetes, hypertensive… Again, if you’re diabetic and hypertensive, no boss is going to ask you to leave your company just like that. If you have episodes of anxiety, or you have episodes of bipolar disorder, or you have an episode of even frank psychosis, it should not be that that’s an automatic cause for dismissal. By and large, the rights are looked at much, much more than what they used to be. Even in divorce cases at one time, it was just taken for granted that if you had a mental illness. The judge would grant you a divorce and that is no longer followed. Judges will grant you a divorce, if, because of your mental illness, you are not capable of being either a good husband or a good wife, then; or a good mother or a good father, then maybe the judge might think of it, and even then he would suggest treatment. So there’s a huge change in the way we deal with mental illnesses, quite correctly. Long way to go, but we are always optimistic. 

AB: So, Dr Chavda, what people say about medication is that if we start taking them, we can’t stop. And what will be the side effects of the medication? So can you go into those for us a little?

Dr KC: Yeah I’m going to go into that for you. Suppose, you had blood pressure and because of the blood pressure, you tried your yoga and you tried reducing the salt intake and you went for exercises to reduce weight, and your blood pressure fell to some extent, but it was still there. You go to a cardiologist, he’d do some tests, and he’d say, you need to be on an anti-hypertensive. You’re put on an anti-hypertensive, and after about three, four, five months, your blood pressure comes under control— would you then go to the doctor and say, my blood pressure is under control, can I stop the medication? No, you wouldn’t. If you’re diabetic and you end up having a bit of blood spikes of sugar, and the doctor says, get on to insulin initially, and then you manage to get it under some element of control, you might want to shift to tablets. And you do that. And in addition, you’re doing your exercise and you’re doing your diet control and you’re restricting the amount of carbs you’re taking, et cetera, et cetera, and your sugar comes under some element of control. And then would you ever go to your doctor and say, oh, can I just stop my anti-diabetics? I’m fine now. You wouldn’t, because if that happens, the sugar or the blood pressure would again go up in a similar fashion. Very often, when you’re okay mentally, when you’re no longer depressed, when you’re no longer crying, when you’re no longer having mood swings, when you’re no longer suicidal, when you’re no longer talking absolute gibberish which you believe is very authentic, and you are under control, then I don’t know what this thing is of ‘I want to stop the medication immediately’.  Okay. Now, for what it’s worth, it should continue for a period of at least a year of stability. After that, we can try to taper it off. About 50% will not manage. 50% will. If it doesn’t, then we let it continue. And this whole thing of ‘mind altering’, well, guess what— about 40 or 50% of the drugs that we use for blood pressure work through certain release factors in the brain. About 30% to 40% of those that control your blood sugar do a similar thing. A lot of our gut problems— irritable bowel syndrome, loosies [diarrhea], a whole bunch of other things work on medicines which work through the brain. So if you’re talking of, oh, how can I have brain altering substances— you’re doing it anyway? I’m certainly not saying that every person needs medication for the rest of his life, but I’m saying a large number might. So rather than getting into this, oh, how can I take medications for the rest of my life, it’s going to alter my brain. I’m going to say if you don’t take it, then your brain will get altered, your brain will go into inflammation, and then what might have come under control with one or two tablets, you might eat 20 of them [now]. And we have to realize that mental illness doesn’t only affect the person who has the illness, it affects the entire family. Now, let me also say something. By the time they come to us, we have a lot of people who will first be prayed upon. They want to go to a masjid or a mandir, or want to go to church and be prayed upon, that’s great. Then they get into the various modalities of treatment. Should they be homeopathy and Ayurveda and allopathy? At one time, they would have tried Reiki and they’ve tried wheat grass therapy and they’ve tried other stuff as well. You have to realize also that for us, we can suggest, we can advise, [but] we cannot police. Sometimes it breaks my heart when I see parents not paying enough attention to us, and because of their own myths related to medication, which they have heard 60 years ago when they’ve been in their fossilized state, to end up saying things which don’t make sense in today’s generation. It kills me to believe that this kid would do better with medication. Maybe if it was for attention deficit or even some behavioral issues, or the autism spectrum disorder, where we know that some medicines would help some of the behavioral issues, and they get into this, oh no, how can I give a little child medication? And they allow a child to suffer, and they allow a child who would have basically maybe an academic problem or related to his attention— he’s not given the proper treatment, and then he ends up having a social problem as well. Because he just cannot get along with other kids. And if, on the other hand, you give him the appropriate medication, he will become more adjusted and more people will like him. Now, I’m certainly not saying that medicines work for everybody, but I’m saying they work most of the time, if not all the time. So do not let your own biases come in the way of what could be a proper treatment for your child. 

AB: Thank you. And Aparna, I wanted your view on this because you’ve experienced this yourself. You said medicines helped you greatly. So give us your view on what people believe about— is it for life, mind altering drugs, side effects, all that?

APR: Yeah, so I was worried about the side effects. I think that particularly some of the drugs that you take when you are bipolar can have harmful effects on pregnancy, if you want to have a family. So that was one of the reasons that was holding us back from taking medication. But what I would say now is that I’ve been on meds for the last decade, and I probably will be on meds for the rest of my life. I’m not the doctor to take that decision. It’s a joint decision with my doctor and me. But really, I have a very full life. I have a lot going on. Apart from my family, I work and travel. I have a lot of things that keep me stimulated intellectually. A lot of what I do is very creative and very intellectual. And there’s just a really fine line between what I do to express myself fully, on a daily level, and then just tipping over into something that would be more unhealthy. So to risk all of that, by just not taking the meds, is just a very, for me personally, irresponsible thing to do. Not to take those meds would be irresponsible and would be risky because there’s a lot at stake in terms of my own health, but also, as Dr said, the family and the impact on the family and the place where I work. So all of these things are very important considerations. 

Dr KC: Over here I think what she said was fantastic, but just a little thing over here. The latest research has shown that supposing you’ve been on medication, then you get pregnant. Except in very few cases, we make the person go through pregnancy taking the same medication that continues even through lactation. And it’s now been proven, over and over and over again, that a person who’s happy and cheerful and stable and on medication is more likely to deliver a child who is absolutely normal and healthy rather than a person whose medication you stopped. And then she becomes cranky and cries and goes through all the emotional upheavals that have caused the problem in the first place. So, yes, there are some medicines which we cannot give in pregnancy, but very few of them, and there are even fewer of those during lactation. So even those who are pregnant and who are lactating, don’t stop medication. 

AB: Thank you, both of you. That’s been just so helpful, and I’m sure it’ll help a lot of people. So we’re going to do a quick rapid-fire round to summarize what we said. Dr. Chavda one common red flag?

Dr KC: Change in their behavior to a drastic effect. 

AB: Okay. Common roadblock to managing conditions and learning to live with it as well as possible.  

Dr KC: Dr Google. And now with all these chat boxes coming out, it becomes a little frightening and a little horrendous to think that you have this artificially intelligent nebulous form who tells you what you have and what you don’t have. There is unlikely to be empathy. There is unlikely to be the humanness that goes with actually seeing somebody crying in front of that somebody, allowing that somebody to touch you on occasion, allowing that somebody to wait for you to respond appropriately. 

APR: Yeah, I really believe you shouldn’t Google symptoms ever. As you said, Dr Google and ChatGPT— no way at all. I think it’s actually very scary to be an individual and to be looking up, googling your symptoms and also looking at artificial intelligence because there are huge issues of accuracy to begin with and so that’s very scary. And second is also the way the data is presented puts you off. So, again when I was young and I Googled— bipolar disorder and they said that the rates of suicide are so much higher for people with bipolar than it is for the normal population, which may be true, but the fact is when it’s presented like that, then your immediate response is like, okay, then I’m not bipolar because I don’t want to deal with this. So I think that the implications are very scary for people who are as it is struggling with lack of information. 

AB: One important piece of advice to caregivers or sufferers. 

Dr KC: It certainly doesn’t make you weak if you’re taking medication. It just shows that you’re using your ‘bhejas’ for things other than just keeping your ears apart. So utilize everything we have in terms of information and knowledge and take the medication or other treatment as and when necessary. 

AB: Aparna how easy or hard is it for someone living with a mental health disorder to find his or her place in the corporate world?

APR: Not easy, but very possible. 

AB: Biggest challenge that you continue to face in work or society or any other aspect of your life?

APR: Just finding balance on an everyday basis. I think we all struggle with balance, but I think balance is harder for me to arrive at than it is for other people, perhaps. 

AB: One important piece of advice to caregivers or sufferers. 

APR: Mental health is a team sport and your role in the team is very important. 

AB: Thank you so much for your time. Thank you Aparna for sharing your deeply personal experiences.  And Dr Chavda, thank you so much. We’re really grateful for your guidance and I think this has been an absolutely exceptional episode. Thank you for being here. To the listeners, we hope you learned something new. We hope we help clear some misconceptions about mental health disorders. And if you are living with a mental health disorder, we hope you realize that you’re not alone in this. If you enjoyed this show, please press like. Please tell your friends and family to subscribe to our channel. And most importantly, I would love to hear from you. Please write to me with any questions you have with topic suggestions. My email is I would love to hear from you. Thank you for listening and see you next week.