Thursday, October 8, 2009


He sat some distance away from us. We were four. I was a fledging medical student and the two with me were elders from my home town and one of them was the father of the youngman who sat away from us. They had come to see me to get help to access a psychiatrist in one of the premier neuropsychiatric institutes of the country [true even after 50 years, the Institute I mean]. As a medical student I could get them to see the specialist without much hassle. But before that we had to have our lunch and we had gone to a nearby eating place. The patient in question chose to sit apart or the seniors made him sit apart I don’t know.

The problem was that the youngman was not like others of his age. He hardly talked, was not much interested in dress, took bath several times a day, extremely poor in scholastic performance [he was 20 but had not passed his metric [high school], very fond of animals but cruel to his brothers and sisters, disobeyed orders etc. They were advised to see a psychiatrist and this commodity of doctors were hardly there in those days and only ones present were in this institute. If they had taken all the trouble to come from such a far off place, there must be really something wrong with the man I surmised. Then who am I to decide, my job was to take them and make then see the nut cracker [psychiatrist].

We ordered meals for four. Those days, food was very cheap and came in unlimited quantities. For half a rupee [three cents] one could eat a stomachful. The tray had rice, lentils, pickles, three vegetables, a bowl of curd and four rotis [kind of flat whet bread]. You can order a refill of any of the items any number of times! We were all finishing our respective meals when the waiter came to our table and pointing to the youngman sitting at a distance asked us,’ is he the part of your party?’. We said yes. He said, ’please tell him we have run out of roti dough’.’ You are supposed to serve unlimited number, how can you run out of food’ I asked the waiter. ‘Yes, what you say is correct under normal working conditions, but he, again pointing an accusing finger at the distant figure, has already eaten 25 rotis and is demanding more’

25 rotis! Enough to fill stomachs of five normal persons and here is this thin built man who has eaten 25 rotis and is demanding some more!’ 'You tell him that that is all you can serve him and no more’ I told him. ‘I did that and he is showing the board [which declared unlimited food] and has also taken out his pocket knife and is making threatening gestures. He is part of you guys and you please handle him’ said the waiter.

We were now faced with a new problem. I asked the father about his violent nature and the prodigious appetite of his son. He said,’ sometimes he becomes violent for silly reason and after a while he calms down but I have not seen him eating this much before. I will go and tell him that the food is over and he has to stop eating’. The father went to his son and tried to explain. After some loud altercation the son seemed to simmer down and there was peace once again in that hotel. The father returned to our table and said,'this is another problem, you never can tell what this fellow will do next, I only hope the doctor will help him’

Bakasura is the name of a demon mentioned in the Indian epic Mahabharata, who terrorized villagers around and demanded and got a cartful of food daily. His appetite was so great that he not only ate the food but also the bullocks and the cart man! How the distressed villagers were saved by Bhim is part of the story of Mahabharath. Looking at this thin tall man I just couldn’t believe his stomach could accommodate so much of food. A true modern day Bakasura I thought.

Consultation was duly done that afternoon and he was prescribed some medication and the party went back to the village. Many years later I came to know that this youngman, though academically a failure, became a successful agriculturist, married and raised a family with no apparent problems!

This brings me to the problem I have often faced in my practice. Who is really psychiatrically ill? How many of the patients who are presently being treated as ill are victims of the oppressive or unacceptable environment and their reaction is interpreted as psychiatric illness? Are we doctors dumping patients who are normal and because we cannot find anything wrong, as mentally ill and treating them?

Today’s psychiatrically ill, may be tomorrow’s normal person?

1 comment:

Leslie said...

Excellent question. I work with foster kids who have behavioral issues. Many of them are on serious medications for mental illness. I often ask myself the same question you pose here.