HOMESICKNESS AND TUBERCULOSIS: CROSSING LINES AND INVENTING THE PSYCHIATRIC CONNECTION

By Sudarshan R Kattoi

Edited by Shambhavi Singh, Senior Editor, The Indian Economist

In the winter months of October, 2012 my physical body (not my social body or the political body) started running out of order progressively. I would feel tired easily. I would end up having severe fever by the evening. I would shiver at night and sweat profusely. I was losing weight day by day. My appetite reduced. I had a bad cough. I suffered from severe chest pain and found it hard even to my college. It is sufficient to say that I was reduced to a skeleton fit to be housed in an Anatomy laboratory of a Medical College for live demonstrations. I am naturally very thin. When my near and dear ones used to exclaim regarding my extreme thinness, I never pondered over it. May be, coming from a family of ancient Ayurvedic court physicians of the King of Kerala and the modern day doctors, the physical body never attracted much attention for me. Though sadly, it was for the first time in my life that I spent anxious moments looking at my own corporal form in the mirror and try to make sense of my dissipating body structure.

Let me bring out the lost context for you. I was undergoing my two year professional M. Phil course in Clinical Psychology at a Central Institute in Assam. I was in the second year then, with only 6 months left to appear for the final exams. It is important to remind you here that this is a teaching hospital run by the Central Government which has medical departments of Pathology, Biochemistry, Radiology, Microbiology, Anaesthesiology and Psychiatry along with other non-medical departments of Psychiatric Social Work and Clinical Psychology.

I reported my ailing condition to the Head of the Department who was a Psychiatrist, an Assistant Professor. I was referred to a medicine specialist, an MD in General Medicine. The doctor suspected TB. He prescribed antibiotics for 2 weeks that cost me around 1200 rupees. (Later I came to know from the TB specialist that the doctor had flouted the guidelines by prescribing high dose antibiotics when TB was not yet ruled out due to which I became resistant to TB drugs later.) Leave was sanctioned and I was at rest at the hostel. Meanwhile when I met the doctor in the Biochemistry Department, she staunchly downplayed the Medicine specialist’s version saying that she was fully convinced that I had never suffered from TB after all.

After 10 days, I was asked to meet the Assistant Professor of Psychiatry with all my medical reports. Almost half of the blood in my body was given to the Institute laboratory in the firm hope that I will be diagnosed with something and get treated. After going through the reports she advised me to stop all the medications because there was nothing ‘abnormal’ in the reports. I asked her specifically whether I should go and meet the Medicine specialist for follow-up as advised. She said “no”. One of the students explained to the Assistant Professor that the reason for my ailing condition is homesickness (Adjustment Disorder in Psychiatric terminology). He substantiated it saying that I was not a happy-go lucky, jumpy, extroverted person. He advised me to be “cheerful” to get away from this “emotional illness.” The very act of the budding psychiatrist to point out difference in me and exhorting to behave like the majority others, speaks volumes about Psychiatry’s role as a means of social control; leading people to conform to the existing socio-cultural institutions. This explicates what Nicholas Rose from the Department of Sociology, London School of Economics in her research article “Disorders without borders: The expanding scope of Psychiatric practice” calls the “medicalisation of difference”. For being a reserved person, the psychiatric gaze expanded to observe my ailing physical condition- Tuberculosis. Psychiatry was born in mental asylums to treat the mentally ill, but now the scope of psychiatric treatment has expanded to include social deviance or problems with living that has no place in Psychiatry.

The different versions of different specialists illustrate the crossing of each biomedicine specialist’s designated territory of expertise, grabbing each other’s domain, creating unwanted anxieties in the patient, and because I am a non-medical person, the authority to disseminate information without coherent thinking is palpable. The voice of the doctor is rendered ‘powerful’ taking the patient’s ignorance for granted. Doctors just wanted to bring in the power equations into play taking an expert role of a doctor. Jumping to conclusions by setting aside the context in which illness occurs can be examined. The clinical examination has been secondary to the doctors and the over-reliance on the laboratory reports for diagnosis was the norm. Who knows better about the disease, the doctor or the patient? Why is the patient’s illness narrative silenced? Is there a need for hierarchical stance between a doctor and patient? And does that succeed in this modern information age?

If I had been a medical student, the way I would have been treated might have been very different. The kind of callousness meted out to me would have never occurred. The Biochemistry specialist would have never uttered non-sense that I would never suffer from TB by just glancing through a sputum test report. I would not have been seen through the psychiatric lens. This points out the fact that medicine is not value-free or politically neutral as it is generally believed. Health is a political issue involving power, and access to quality healthcare is based largely on one’s socio-economic status. My experience can be extrapolated to the global Ebola crisis currently in news where the African belt is struggling to cope with the situation. Africa is almost neglected and the West is engaged primarily in protecting itself. Ebola got worldwide attention only after two white men died, although it had taken the lives of almost 4000 African citizens by then.

I was dubbed to be suffering from a psychiatric disorder. The voice of psychiatry prevailed over the voice of my life world and my ‘self’ was reduced to a mere “file self” for the doctors as American Psychologist Rom Harre (1984) puts it. I was ordered to join back for duties immediately. I was almost half dead and I was sure that if I stay back I might retire from life itself soon. So I flew back home the next day where I was diagnosed as a case of Extra-pulmonary TB in a late stage.

If I had not gone back home I would have died in the midst of doctor-psychiatrists, and I would have been the first person to die due to homesickness because my Psychiatrist friends would have written voluminously on my “severe emotional sickness” and by now homesickness would have got global attention as a chronic debilitating psychiatric disorder. Pharmaceutical companies would have funded enormously for homesickness research involving random control trials for psychiatric medications to find the most effective medicine to treat homesickness. Global Mental Health movement would have described homesickness as a global burden and issued pamphlets in public interest stating that “Home sickness is a brain disorder, a global burden which can lead to death. Consult your psychiatrist.”

Let us be very vigilant regarding neocolonialism and the psychiatric imperialism which are tactically involved in deflecting our attention away from psychosocial problems by linking even poverty to mental illness. By linking poverty to mental illness, psychiatrists are now involved in treating the poor citizen’s brain by prescribing antidepressants and other psychotropic drugs. We don’t want to be happy by taking pills. We want to be happy by building a robust society. It is high time the Psychiatrists undertook ‘social prescribing’ rather than silencing powerful ‘voices of illness and suffering’ by categorizing them as ‘psychiatric disorders’ to be ‘treated’.

Sudarshan R. Kottai studied his M.Sc in Applied Psychology from Pondichery University and his M.Phil Clinical Psychology from LGBRIMH, Assam. He is a recent RCI registered Clinical Psychologist .He is currently pursuing his PhD in Psychology at Indian Institute of Technology, Hyderabad. He is passionately involved in bringing to the fore sensitive issues related to human mental life such as sexuality. He also follows issues related to Public Administration that has direct consequences to human life in general and human mentation in particular. Solitary activities like travelling, listening to music, reading literature and spending time with animals are sources of immense contemplations for him. Sudarshan R Kottai can be reached at la14resch11003@iith.ac.in.