Author Archives: Trikalsun

I am spinning a pun on the famous pediatrician Winicott’s “ good enough mother” but not really!

What did he mean by that concept? Let’s explore because this has a very direct bearing on the subject matter

Winnicott thought that the “good enough mother” early on, tunes in completely with the infant because the later has no way of communicating except “crying”. She has to be like an “empath” who can read her infants mind and feel perhaps the same emotions what her child is experiencing.She is entirely devoted to the baby and tries to take care of its needs. As time goes by, however, the mother allows the infant to experience small amounts of frustration.

We can continue what else goes on in the mother – child duo but we are using this concept as a yardstick to measure “psychiatric care”.

Let’s refocus on the “patient- psychiatrist” first encounter- I need to qualify that I would be using the word “newborn/infant/toddler” to signify the “patienthood” and not the patient as a person and also psychiatrist as a “provider” and not as an individual.

Patienthood is born when a patient meets “the good enough” psychiatrist. Coming to see a psychiatrist is a “big step” in willingness to accept one’s helplessness in not being able to cope with the conflicting demands of life both within and without.

If the patient “feels” being held by the psychiatrist’s presence – it’s a good start. The way a “good enough “ psychiatrist is able to do that, is by giving an undivided attention to the patient. This kind of attention is not available outside a “loving relationship”. There is a “catch-22” here , because psychiatric illnesses attack the “ capacity to form loving intimate relationships “. This “capacity” is contingent upon the ability to accept one’s vulnerabilities to hurts and pain which is unavoidable in the struggle to develop intimacy. “A good enough” psychiatrist can at the very least provide with a “sample of this much needed relationship”to satisfy that need” to give some hope to the patient, that intimacy is possible.This simple explanation does run the risk of ridicule,by the likes of William Schofield, who writes in his critique of our profession “Psychotherapy- the purchase for friendship”, that, psychotherapist not trained as a specialist in therapeutic conversation, can fall unwittingly into the role of moral counselor or morale coach, and can be seduced into the chronic role of “best friend.

“How do I find my self?”

To answer this question-first we would have to define “self.”

Defining something has always been difficult for me, but that struggle has translated into developing a varied perspective.

Let’s start with a simple approach; is my “self” what I feel, what I think, what I experience or how I appear? Is it how others perceive me? Is it what others reveal to me or how I connect with others? There may be even more approaches to the “self.” Let’s think our way through each of these hypothetical approaches to the self.

If self is “what I feel”, then it is constantly changing, since we have a variety of feeling tones. So, we may have happy self, sad self, angry self and so on.

If it’s connected with what I think, then it could be: how my mind perceives, processes, and imagines ideas, putting them in language and symbols: The final product is what I say, do, or write.

If self is what I experience, then it could be pleasant, unpleasant, toxic, stifling, despondent, hopeful, hopeless, helpless or uplifting and so on.

If self is my body,then it could be tall, short, white, black, beautiful, ugly, young, old, sick or healthy.

Is self located within myself or outside myself? I think most of us believe it’s something internal—but what if it is external to us, when we encounter others? Could it be like a halo that envelops us , and where all things outside of us converge—people, things, trees, animals, earth, sky and beyond.

The question of defining “self” can be pretty destabilizing! Similar to what the fellow Christians might have felt, when Galileo Galilei denounced“the church’s unchangeable truth,that earth is at the center of the universe.” This is what the leading thinkers on this topic of “self” face!

We want to see ourselves as cohesive and stable at the “core” , much like the pit of a cherry- but maybe it’s more of a scattered concept. Some psychoanalysts have stressed the importance of living through this “multiplicity of selves” rather than trying to encapsulate one’s psychic world into cohesiveness. What they mean in simpler terms is tolerance for “situational” selves and not looking for the continuity of self.

If that is so, then perhaps Jim Carrey in “Me, Myself and Irene” portrayed a universal struggle rather than that of a schizophrenic.

The quest for knowing our self is worthwhile and heroic if we are willing to risk our convictions and the security of feeling solid!

If you would like more resources on “self”and locating one’s self, leave a comment below and I can direct you to some interesting resources.

It’s absurd” means “It’s impossible” but also “It’s contradictory.” If I see a man armed only with a sword attack a group of machine guns, I shall consider his act to be absurd.
There are absurd marriages, challenges, rancors, silences, wars, and even peace treaties.
Absurd is not in man (if such a metaphor could have a meaning) nor in the world, but in their presence together.— Myth of Sisyphus, Albert Camus.
No one has embraced “ the absurd” better than Franz Kafka – he makes it very apparent through his works- he introduces this in his short story“ metamorphosis”and develops further in the novellas “ the trial” and “ the castle”

Metamorphosis is a story about a traveling salesman who is going through the drudgery of his job because of assumed family responsibilities and to pay off family debt. One fine morning he wakes up and find himself turned into a “giant beetle” – what drives the absurdity home is his “ annoyance with this inconvenience because he is getting late for work”- in other words when his whole existence has changed he still is worried about “ catching a train in time”.
In a very concrete manner one could easily relate to this scenario when one is employed in a boring job so that one can “buy the latest gadget and be with jones and smiths” and is totally oblivious of the way it is “ transforming her life”.
This idea is developed further in his work “ the trial” wherein Mr K finds himself “arrested by three officials, “ as soon as he wakes up. He is clueless about the nature of his crime, and remains so, even after having navigated the “labyrinth of a convoluted legal system”.
Absurd is very succinctly examined by Albert Camus in the “myth of Sisyphus”
“What, then, is that incalculable feeling that deprives the mind of the sleep necessary to life? A world that can be explained even with bad reasons, is a familiar world. But, on the other hand, in a universe suddenly divested of illusions and lights, man feels an alien, a stranger. His exile is without remedy since he is deprived of the memory of a lost home or the hope of a promised land. This divorce between man and his life, the actor and his setting, is properly the feeling of absurdity”.
“ this feeling of absurdity causes extreme “nausea towards life” as taken up by Jean Paul Sartre in his work “ Nausea” – it causes despair and is excruciatingly painful.
The remedies, unfortunately, are not listed by these philosophers, but nonetheless, I would like to quote Camus again”We turn toward God only to obtain the impossible. As for the possible, men suffice.”

Psychiatric treatment



Can this

With that

Help?

Everyone reaches a point where they think: “we need help,” but if their healing processes are compromised, then they are unable to help themselves. Although our bodies and minds have the capacity to heal, sometimes the healthy part gets buried underneath the wounded self. For example, when a surgeon is treating a wound, he has to secure healthy margins of the wound, to put a suture to close the wound. Similarly, a psychiatrist assists with the mental wound; to secure those parts of the mind which are unaffected by the disease process. He appeals to those parts of your being, which are relatively healthy.  Simply by giving medications, this is not a cure-all solution. Medications are like a surgeon’s knife, can cure, as well as injure. To become a psychiatrist, one has to graduate from a medical school – just like any other doctor and go through specialized training focused on brain and psyche.Though not required, but it’s useful to study psychology and sociology as well. He also has to know how the society functions, because the individual he is treating does not live in a vacuum. Under optimal conditions, he is required to understand his own mind; which is an important tool to understand others. In addition, he needs to know his own biases and develop some clarity to know what the patient’s problems are, and not to confuse his own issues with the patients. On HBO Max, there is a relevant TV show “in treatment,” which describes the hard work of the psychiatrist; to correct these processes and to be able to assist the patients. 

The Latin root of ‘procrastination’ is ‘procrastinare’, which means “to put off or postpone until another day”.

In order to get an unbiased view of “this thief of time”, it is important, that we separate the construct of procrastination,from its presumed consequences.

So why do we procrastinate?

Simple answer “ to prevent mood dysregulation” meaning “keeping our good mood from taking a dip”.

After days of saying to yourself “I’ll do it tomorrow,” it is now the day before your report is due despite your intention to get it done a few weeks ago. However, instead of sitting down to finish it, you decide to get busy catching up answering email with the hope that you will soon feel more in the mood to work on the report. – does that sound familiar? I would like to be brutally honest and share that I have a deadline coming up reviewing some documents but currently, I am enjoying writing this “blog”! If I were to give up this activity and focus on the aversive task of reading the documents, I am going to be an “unhappy camper”. If I “procrastinate , I would be in a time crunch and perhaps end up being in worse mood but “tomorrow “.

Focusing on regulating mood and feeling states in the short term can lead to failure of self-control in other areas of our lives. When we are in a bad mood, we want to feel better, but many ways of feeling better involve indulging our appetites that we usually use self control to resist (e.g., eating sweet foods, shopping for items beyond our financial resources). In terms of procrastination, the argument is that aversive tasks lead to anxiety and worry, and that task avoidance is a strategy to avoid this negative mood.

There is a tremendous gain for “the you of today” but “what about the you of tomorrow“?

Yeah that’s the downside of procrastination- today’s gain is tomorrow’s loss.

Let’s admit we all procrastinate, and some researchers- such as Pannapacker, think moderate procrastination helps creative thinking, probably by problem restructuring, and the activation of new knowledge. Let me quote him”Anecdotally, Leonardo da Vinci is known to have been an inveterate procrastinator and there is evidence that Albert Einstein, Thomas Edison, and Frank Lloyd Wright engaged in procrastination.”

But, are there some of us who are chronic procrastinators? I guess there are. So, by using the previous logic of payoff why would they have such a need to regulate their mood by procrastinating. Applying common sense I could say “maybe they have chronic dysregulated mood” which in more technical nomenclature is called dysphoria

There has been some research done on that front,and some researchers connected chronic procrastination to generalized anxiety disorder. These folks can not afford to have more anxiety, lest they go into a complete panic mode. They are so precarious,mood wise and can not risk feeling worse, so they have increased need to postpone tasks.

Few words about the treatment part. Therapy of course- to help us see the downside of the mood advantage we get by procrastination and if it’s possible to develop better coping skills. Anti anxiety medications such as SSRI’s and benzodiazepines perhaps- even though none has been approved by FDA for the treatment of procrastination.

We can but live once and at a particular given moment can walk but one road. Even though regrets mostly pertain to misgivings about not having taken an alternate course of action, one could have regrets about future. Our thinking, takes us back and forth, and we almost live different life scenarios- like the heroine in the movie “sliding doors”- who found her new love, when she boards the train in scenario #1 and catches her boyfriend in bed with another woman when she reaches home; whereas in scenario #2 she misses the train, gets mugged and then meets her future love, but escapes the shock of catching them in the act. Both scenarios develop differently, though in a “parallel manner”in the movie. She gets pregnant, and has a miscarriage in both scenarios, however in scenario #1 she lives and #2 scenario she dies.

Psychologically, regrets are “counter factual” because cognitively we pursue “what didn’t happen “so it is “counter” to the “fact”.

Is it a futile activity which at best leads to pangs of emotional pain or is there a possibility of redemption and growth?

Let’s start with the assumption that it’s futile activity and collect evidence to prove it wrong just like researchers do using “null hypothesis “. Can we establish it as a constructive emotion? Wait a minute-is it just an emotion or is there a cognitive component. Many philosophers have a consensus on the hybrid nature of this “state of mind”

Opportunity breeds regret. In other words, those who are oppressed or live in a rigidly conventional society would rarely be regretful. They have little use for this activity.

There is some other set of people who are immune from regrets – deeply religious, because they have no other choice but, follow the dictates of “God”. On the other end of spectrum, there is some evidence, that psychopaths remain free of this tormenting emotion as are people with damaged frontal lobes of the brain.

But for the rest of us,it is inevitable- whether futile or constructive.”

It is a value laden activity- we can only regret not having acted in a certain way, if we value that course of action. At times, we are aware of this valency, as we are making decisions- we are really speculating how could we avoid “regrets in future”. Let me explain with an example. Nancy got pregnant- her first pregnancy- out of wedlock at a very inconvenient time in her life when she was still in college with no income and little possibility of support from the “one night stand” who she met in Hawaii and has no way to track him down for child support. Should she abort this unwanted pregnancy or go ahead and have the child? If she aborts her pregnancy-she is putting “value” on her career- thinking she can become pregnant again and if she goes ahead, it with it perhaps valuing “motherhood” – assuming career is secondary or something on the similar lines.

Whatever course of action she chooses, I think most of us would agree that she could have some regrets about the choice not made going forward, but then it also depends on what our values are.

So, we have established that futuristic regrets help us make a choice based on how we prioritize our values.

What’s the payoff for being regretful for some decision already taken? painful as it is.

To define the unique type of pain regret is, let me borrow from Ishiguro’s “remains of the day” and bring in the central character Steven – a butler, very devoted one to both his old master – an English Nobleman who was not that noble after all; and his new master – an American nouveau rich. His whole life was centered on doing a job well, with utmost professionalism, to the exclusion of any “romance at work”. After his new master, sends him out for a little vacation- Steven chances upon an opportunity to meet his old colleague Ms. Kenton and realizes that by keeping romance out of work he also threw an opportunity for a fulfilling life with Ms. Kenton who is rather unhappy but devoted wife, may have had feelings for Steven but were unrequited.

Unlike the heroine Helen in Sliding doors, Steven alas, cannot go back and fix it. When he comes back to the manor, he resolves to learn how to engage in “bantering” which he had been struggling to get a hang of .In some oblique way this resolve was a product of poignantly painful regret mentioned earlier.

Just like Steven, maybe we would factor the expression of regrets into our future decisions if come face to face with choosing one course of action over the other. It could help rearrange our value system.

I may have some “regrets” – pun very much intended, for not bringing more evidence but some of you might agree that the “null hypothesis” that regrets are futile, has been disproven.

Homo sapiens just like many other mammals live in social groups. The proliferation of social media filled the vacuum created by weakening of the communal living – maybe? The babble of social media is not unlike the lingo used by the brainwashed cult members. We look down upon communes and cults, even though they fulfill the same need- to foster a sense of belonging at much deeper level, than the transient groups on social media.
Whatever we think is toxic in cults, permeates the social media communes too. Cults have their rituals and cult members use a uniform lingo to communicate their solidarity. At least in cults or communes one relates to what is in the vicinity and unfolding as it is rather than a “staging of the events “as in the social media. We connect with other people “as if they are on the stage – performing” – if one goes by the “sheer number of smiling faces” there should be no sadness in this universe. “
Even though it may be counterintuitive for some, I find it interesting to explore those organizations which are far removed from the idea of cult because “there is no worshipping or religion involved”. “Amway and Market America “were the two business organizations which I saw some of my friends became involved with during my training in Brooklyn, New York in mid 90’s.

This friend of mine, a fellow resident in psychiatry with me – very bright young fella -his spouse was a physician in training as well and had recently immigrated from India to pursue more advanced training in the field of medicine. Somehow, he got involved with Amway. Just like a fresh convert, he would leave no opportunity to promote Amway, even though didn’t make a dime himself. He would go to all the business meetings and conventions sometimes in other cities. He started buying their products- ostensibly to sell, which never materialized . I also noticed a sudden transformation in his demeanor, he appeared at ease and confident and rooted in the new country as if he had found a sense of purpose and meaning in his life. He would talk about the millions his “top earing distributors”-obviously higher on the totem pole, had made, and how he could join the same league. “False hope” but it was hope, nonetheless. I wanted to become comfortable, confident and acculturate to the new country as well. My program director suggested “psychoanalysis”- I jumped right in, looking for confidence and meaningful uplifting, but the only hope it offered to me was, converting “my misery” to “ordinary unhappiness”- would it even qualify as hope?
I had some personal experience with these “sellers of hope”,

when I went to a convention hosted by “Market America”. The founder CEO came on the stage to deliver his inaugural talk – oh boy! he sure was a performer and sold the “dream of becoming a millionaire” so well that by the end of the day I felt rich enough to buy a “Montblanc” fountain pen, because I couldn’t settle for less, when I knew soon enough I would be endorsing those “fantasized checks” I would receive, selling Market America products and “becoming an emerald level distributor”. I would be brutally honest in admitting that by the end of the day I catapulted from “misery” to “happy”. Alas, it didn’t last long as my skepticism kicked in. All said and done, I still want to be fair to these organizations- they sell hope but keep the cost “well hidden”.
Organized religion, Cults, communes, conmen – they all sell “hope” in some form or the other – the price extraction differs in form and steepness.

This Lady I knew a while back – worked in healthcare business. She had,a rather troubled teenage years,because of her mother’s bipolar illness. She did get herself involved in drugs. She didn’t make it very clear to me whether she was still doing drugs when she moved in a “commune” in Carolinas. She completed her college and got herself a good job during her continued stay in this “community- run by her Spiritual Guru”. The cost of staying in the commune was – giving at least one weekend towards the upkeep of the community and buying groceries from the “shop they had onsite”. She was happy, got married and her husband stayed there as well. Somewhere down the lane, they developed some differences, which were obliquely related to the communal living and the husband wanted to move out. The “guru” according to my acquaintance, started to “drive a wedge” in their already rocky relationship and wanted her to let her husband go and herself stay on. I guess this was a wakeup call for her and she decided to leave the commune lock stock and barrel. Adios commune!
After she got out, she was very bitter towards the “guru”, lamenting that she was robbed thousands and thousands of dollars she gave them directly or indirectly. I couldn’t help but observe that she did find some “shelter for her troubled soul during those years” and yes paid them for their services dearly, perhaps.
Many of the hard-core cults attract both charismatic personalities and members who feel alienated from the society. Some of them, can provide an insulated world of “us against them” to shield its more vulnerable members from the harsh reality of the real world, not unlike the protective walls of the mental asylum. The cost besides money its member pays is “selling one’s mind and souls to the good of the cult.” The cult -Branch Davidians led by David Koresh could be a good example though eventually rather than protecting it exposed them to even harsher fate.

Social media with its “groups”” friends” and so on provides a forum wherein “one is never alone” – when troubled can ask for help – start a “go fund me” if in dire straits. Share and find solidarity with the like-minded people and “follow the gurus on twitter”- seek guidance and most of it is free. The cost is very well hidden. One really must be as patient as an archaeologist, to go through the layers and layers of “freebies”,to arrive at the hidden price one pays. At the very minimum, it is one’s time and attention,and worst-case scenario parting with personal information ,for free. The data collected on the “users” is traded like commodity. One could argue – so what – it’s just data and no one individual can “mine cryptocurrency” “from that data”.Well… it’s convoluted and complex- I would suggest watching this movie “the Great Hack” to understand the full scope of this “ chess game” in which we amount to less than mere pawns.
Without getting lost in my own argument, what I am proposing is that “social media communes” also extract a price for the “hope and support” and “fostering a sense of belonging” they offer.
I acknowledge, that it would be very hard, for me to sell the proposition, that even conmen offer hope, I would easily concede though that the price extracted is at times “obscene” and could be at least potentially, more damaging than the help being offered.
The last, but not the least is “ the chemicals” or drugs – give hope to masses but again may cost more than one bargained for.
In the end, I can’t help but state, somewhat dated observation by Carl Marx that “ religion is the opium for masses”.

“An empty mind is Devil’s workshop”- many of us perhaps grew up with this dictum. The emphasis hence to stay busy and “not be bored”. Being bored for many is “being slothful”.

Is that so? If so – let’s examine what is boredom and the causes of boredom?

Leo Tolstoy called it “a desire for desires”. Philosopher, Soren Kierkegaard, thought “boredom is the root of all evil-despairing refusal to be oneself”. He might have even said that Gods created human beings out of sheer boredom!

Let’s examine it at more mundane level.

What causes boredom?

Could we say it’s “lack of stimulation”? if we turn it around and examine what happens when there is lack of stimulation say depriving “the urbanite” of their smart phones and” TikTok/ Instagram/ Twitter/ Snapchat and you would know. If you want to be cruel then deprive him of TV, music, coffee, coke -you could see boredom in a “physical form”. Some others resort to drugs, gambling, and other kinds of stimulations to keep boredom at bay. All said and done, there is a limit to which the brain can be stimulated, after which it has to “descend into torpor”. That’s the nature of the beast, so to say. The “crash” cocaine bingers experience, wherein no amount of cocaine gives them pleasure is intriguing, and the answer lies in the neurochemistry. As it happens, the brain has exhausted all its stores of “pleasure elixir” technically known as “dopamine”.

Psychological cause of boredom, is perhaps, a mismatch between the subject’s expectation, and what is available for such stimulation. For example, if you go to a talk or show , for knowledge or entertainment ,and the host or performers don’t come up to your expectations – you would be bored in all probability.

The above examples pertain to “ordinary boredom”

Then there is “existential boredom” which afflicts “chosen few” like the protagonist in Sartre’s novel “nausea”. That kind of boredom is malignant and very hard to deal with. The Zen masters have prescribed a “twisted remedy” for such boredom- “if something bores you in two minutes- do it for four minutes and if that doesn’t work for eight – sixteen and so on and you shall find it ceases to be boring”.

Between these two poles -there are “51 shades of boredom”!

We all know what boredom does to us in causing discomfort- is there any payoff for being bored? Yes, there is but only “if it doesn’t kill you” which reminds me of a song by Kelly Clarkson “what doesn’t kill you, make you stronger”. Surviving boredom may open the gates of “creativity”. Who knows the prehistoric man who invented “the wheel” was simply” bored”?

I am guilty of being somewhat “non-self-disclosing” and have a strong urge to “confess” so as to emphasize that “scammers” are always “one up” on us, in spite of our caution.

Historically, I have been pretty skeptical of everything “which is too good to be true”. I have never bought a lottery ticket in my life because to hope against “all odds” pun intended, has not been my strong point. I have suffered because of my skepticism, “I have never won a jackpot”. At times, I do have regrets. Self-disclosure is painful, but I would admit, I have lost some money in the stock market though.

Few years back, visiting my parents in New Delhi India, I was “scammed”. The way it happened was that the domestic help which they couldn’t do without because of their advancing age took off – leaving them high and dry. I was pretty anxious to “put things in order” and earn parental respect of a “prodigal son”

Spoiled by my sojourn in the States, I thought I could “order domestic help online” having been heavily addicted to Amazon. Lo and behold I could find someone online, who was willing to send me a maid before the end of the day.

“It was too good to be true” and I jumped at the opportunity. They wanted me to wire advance payment of few thousand rupees- roughly $100. I promptly wired the money- was disappointed because the maid didn’t arrive by the evening and as a matter of fact never showed up. I tried calling my contact number for the maid service, someone would answer and assure me that they were having some difficulty but nothing to worry about and would happen soon. After few angry exchanges they very conveniently “disconnected the phone number”.

Looking back, I recall having been surprised that they could arrange for the maid that fast, but chose to brush any doubt aside as it was more convenient to trust them against my better judgment.