Recently had chaired a seminar on Transcultural aspects of psychotherapy. A few social work students were in attendance. They have been shadowing in my op.
We met a young graduate who revealed that he was using alcohol weekly and was smoking ganja occasionally. + He had problems with his parents and as a family they needed therapy.
He had history of mental illness and substance use was not good for him. However he was keen on continuing the use of the same.
I let it slide (rolled with resistance) and gave an appointment. +

Recently met someone who is from a Shia Muslim family who have a very syncretic faith. She prays to Hindu gods and goddesses and feels emotional peace! She studies in a Muslim college. She fears her beliefs and practices being known to her friends. So keeps a distance. In a short span of time I got some rapport. I told her, I don't care about her religious identity and beliefs and she can feel free to share without fearing judgement. I could see a sense of relief in her face.

The job I had in my UG college office got me to visit it. The new #MMC (#MadrasMedicalCollege) is at a different plane. The infrastructure is much better than what we had in the 90s.

https://twitter.com/askdheeraj/status/1841827444061253802

This was the adda, where we used to sit and have tea and chit chat about cases we saw or topics we read with classmates and people from other batches.

Attended Church today.
The sermon alluded to opening of #OpeningCeremony . The pastor didn't tell us that we Christians are offended.
He was concerned that in the west offensive things are being celebrated.
Christians are easy target for cultural bullying. They expect it.

https://twitter.com/TimesAlgebraIND/status/1817426292880691708

They are told to expect it and stay strong in their faith.
However when west tries to destroy the pillars on which it was built, it will fall.
France of all nations has witnessed onslaught other cultures. France thinks it is stong with naive oppositionality to Christianity.

There are times I feel I am a fool to spend too much time with patients. Knowing details of their back stories may not change management in clear cut cases. However I just can't stop being myself from trying to know the person. Here is a thread which makes me feel it is worth it This morning I was having a chai on a roadside when I got a call from an unknown number.
"Sir Mai Kaun hoon?"
"Pehchana nahin, boliye"
"Apne humare bete ke liye xyz gift diya"
"Oh, aap...boliye kaise yaad kiya?"
"Sir I am in a community clinic...+

Small thread about my wife:

Ours was an arranged marriage. We spoke to each other 4 times on phone and met once for 15 min before engagement and marriage.

She was a MD gen physician in a corporate hospital in Hyderabad and I was a DPM psychiatrist in a mission hospital. 1/10 She had just got a job as Assistant Professor of Medicine in a Govt Medical College in Andhra Pradesh and I was about to get an MD seat in Vellore. She dropped that job and followed me. She could have had an academic career here too. 2/10

After a long time I got tears while seeing a patient. As much as I tried to hide it I couldn't. I acknowledged it openly and told why I was moved.

Here is the story: #Psychiatry #PsychX #MedX #PsychTwitter #MedTwitter
1/14 Recently a couple brought their daughter to see me, as suggested by a neurologist friend on mine.
Parents were happy that the file came to me but the patient who had a mask sat there with eyes closed refusing to communicate with me.

2/14

The problem with anti-psychiatry is not that it critiques the worst of psychiatry. It uses the worst understanding of few psychiatrists to undermine best contribution of #psychiatry to the society.
#mentalhealth

https://twitter.com/justin_garson/status/1743606925600940426

If @ReadReadj had argued about medicalization of social distress and critiqued practice of psychiatrsts' unnecessary use of medication and not offering psychosocial interventions I would have fully supported him.

Had a talk on " #Dementia and caregivers of Dementia" in St Andrew's Kirk, Egmore Chennai. More than 60 attended. Given that there were many caregivers from homes, decided to do it in Tamil. Our discussions overshot into lunch time and no one bothered about it. ❤️the interaction When I was a medical student, I wanted to go and see the beautiful Church in Gothic Architecture. Watchman didn't allow me. In another attempt, I succeeded to enter and see the majestic building. Was very happy to get invited by the counseling department of the church.

More than a decade ago, I was a young psychiatrist who went to conferences with enthusiasm to learn and make friends. I met a medical representative from a certain company. He was an energetic gentleman. He told to about his kids, his family etc. On one side he was a cut throat businessman and on the other side he was very deeply spiritual. He was training his kids to be priests in a gurukul.
I met him in every conference. He would identify me from far and would come and update about himself.

I see a discussion on #MedTwitter about countering/ accepting unscientific practices of patients.
My take has changed over time.
When I was young, I was like an activist. I was driven with zeal to educate and smash wrong beliefs with evidence and arguments. As months rolled by I realized those with whom I had passionately argued to drive a point were not following up.
When I trained in psychiatry under a senior Prof KS Jacob, I was surprised that he being an atheist would encourage people to visit their temple or dargah.

Was site appraiser for FMGE for a TN site. Had some conversations with candidates. Sharing few which gives a peek into lives.
Me: hello, how was the exam?
FMG: a bit tough sir.
Me: OK. Where are you from?
FMG: Ukraine
Me: When did you return?
FMG: long time ago + ...I am married and have a child.
Me: That's great ma. Good that you are re-entering medicine. Did you take any coaching?
FMG: self study sir
Me: It isn't wrong to take coaching ma. Everyone is taking. It might help pass sooner.
All the best
FMG: (smiles) Thank you sir

Many years ago I met a young girl who was still in school who had attempted suicide.
I asked her what had happened. She didn't open her mouth. Tears rolled down her eyes.
Her family told me Chennai police had informed them that they found her in a public place. The girl had gone missing for one day and reunited with her family. However she attempted suicide.
She survived.
It took a long time for us to develop rapport with her to listen to her story.
She was in class XI and was aspiring to do MBBS. She had got more than 90% in X.

Our dept of Child and Adolescent psychiatry consultants call me to help out in few special cases of adolescent boys with externalizing disorders and adolescent girls with addiction issues.
Today I met a young girl who had multiple issues. + Cluster B personality + Opioid dependence.
She also had a different style of haircut. I asked about it and told her I liked it.
We then went on to discuss various aspects of her Rx. She even agreed to come as a day care patient to occupational therapy dept. +

I met an old lady who had #schizophrenia. She was on antipsychotics for more than 50 years. Never remitted. Had delusions of infidelity on her husband. He loved her and brought up his kids. The kids are grown up and married now. She was also a cancer survivor. Docs repeated the same medicines as there weren't too many problems even though she was not fully well too.
I took a bold decision to start her on #Clozapine, a drug with risks but also better efficacy. Discussed with her and family.

A year ago I got a call from a Prof of Developmental Pediatrics. He asked me if he could transfer a patient whom he has been seeing for the past 16 years. The patient was 19 years old. He had cerebral palsy and he could not speak, though could hear and understand instructions. Met the boy with his mom. The boy was suicidal. It was heart breaking to see him cry on the first visit. He felt rejected by his dad, who was a mechanic. His dad would say words like "less intelligent" and "dumb". I phoned his dad. Requested him to come and see me.

A resident told me that he didn't find psychotic features in a case that he had to present. I had seen the patient before and was convinced there were features. I went to clarify it in his presence. We spent nearly two hours and felt we had enough evidence. However we felt there were more that we need to uncover. We sent off the patient as he was sleepy.
We then analyzed why it takes so much time, why it is required and why it is fulfilling in doing so.

The head of a particular department called me last week to inform me about a staff in his department. He was surprised to note that I knew the person and had referred him for more detailed work. I then told him where I see staff in his campus (without regn) to decrease #stigma Today I saw three patients from his dept. He had sent them. He had enough trust. Would continue to work with all of them.
It is a great joy when people in your hospital start recognizing your work. Nothing pleases a clinician more than referrals from colleagues.