Keeping sane -- Part I

So much has happened this year already and it is only the 1st of April. Nine long months more to go to start anew. As an epidemiologist only partly contributing to epidemiology (and mostly working in Outcomes Assessment), I am pulled into the ongoing news cycle of the COVID-19 pandemic even though I have work that keeps me away from it. But how can anyone, leave alone an epidemiologist, turn away from this living laboratory whose results we can only partly imagine and partly deduce from ever-changing, dynamic models? These models are dynamic because they are dependent on variable inputs like population demographics, policy, public health messaging, degree and nature of social distancing, compliance, severity of cases, healthcare facilities, to name just a few.  

Everyone who is under lock down now to prevent or minimize the spread of COVID-19 understands the importance of physical distancing while staying emotionally and socially connected. The internet has helped us much in this. But how did people do this historically during other times of crises such as wars, pogroms/genocides, previous pandemics, incarceration, or kidnappings? How did they stay sane given additional fear and stress factors such as being discovered hiding, breaking the law or being hunted? What experiences did they endure? What degrees of mental strength did they possess or cultivate? What routines of habit did they cultivate? In a series of blog posts I hope to put a collection together as a testament to human trials and tragedies, including triumphs over life's unexpected and sometimes grueling circumstances.  

I start with what history teaches us about life under pandemics -- about implementing quarantine and conveying need for social distancing. This National Geographic article has charts demonstrating lowered curves and second waves in cities where social distancing wasn't enforced long enough. 

In 2007, two studies published in the Proceedings of the National Academy of Sciences sought to understand how responses influenced the disease’s spread in different cities. By comparing fatality rates, timing, and public health interventions, they found death rates were around 50 percent lower in cities that implemented preventative measures early on, versus those that did so late or not at all. The most effective efforts had simultaneously closed schools, churches, and theaters, and banned public gatherings. This allowed time for vaccine development and lessened the strain on health care systems.

The studies reached another important conclusion: That relaxing intervention measures too early could cause an otherwise stabilized city to relapse. St. Louis, for example, was so emboldened by its low death rate that the city lifted restrictions on public gatherings less than two months after the outbreak began. A rash of new cases soon followed. Of the cities that kept interventions in place, none experienced a second wave of high death rates.

This NYT article is an introduction to social distancing during the plague.

Charles II issued a formal order in 1666 that ordered a halt to all public gatherings, including funerals. Already, theaters had been shut down in London, and licensing curtailed for new pubs. Oxford and Cambridge closed.

But here is what catches my eye in this article:

Isaac Newton was one of the students sent home, and his family was among the wealthy who fled the cities so they could shelter in place at their country homes. He spent the plague year at his family estate, teasing out the foundational ideas for calculus.

If only all of us can hunker down, discipline our minds and focus on one accomplishment. But the distractions in this modern world are too many, at least for me. 

In my next post, I will write about some people who weren't as fortunate as Newton was and describe how they passed their time, so our own lock downs seem like a vacation in comparison.

 


       

       

Parenting is just too hard

It is almost three years since my last post. Not only has life kept me distracted and undisciplined (except to meet my bare minimum day-to-day responsibilities), but major events have also overwhelmed me and kept me not only from blogging, writing and dreaming up a book, but also from sleeping. During these absent years I have experienced life that no other person in my immediate social circle has gone through -- the loss of a parent who was estranged for 11 years (until 18 months before death) and with whom I had unresolved emotional issues; the sudden realization that life will go on even without the resolution that I so intensely hoped for; the discovery that I am capable of forgiveness towards parents for the past yet struggle with newer ongoing incidents rising from the same old patterns of neglect; the awareness that there is only a fine line between falling into a mental health crisis situation and keeping it all together, at least during work hours (sometimes not even then, but hiding it well)... But none of these experiences compare with the torture of having to parent teenagers who suddenly see nothing redeeming in me, leave alone anything loving and respectable about me. Ah, I know I sound so, so...pathetic!  But it is the truth. Raising tantrum-ready toddlers and talkative eight year olds is nothing compared to teenagers who ignore me one moment and mock me the next and refuse to heed any advice just because it comes from me. Because in those other growing periods, they still hugged me, kissed me, needed me, and cuddled with me on the couch. The only thing they need me for is to pay for their clothes/shoes/never-ending school fundraising!

Actually, I hope the worst is over with my soon-to-be 17-year old child. We are at a point where things are somewhat easy again. Judging by the dynamics in my nuclear family, the pre-teen and early-teen years are likely the worst, when kids are testing their boundaries and the limits of what they can get away with. It still means another four to five years of frustration and tears for me. The timing is so disastrous -- I need some time and space for my own personal grievances and losses, but I have to handle parenting, as my first priority, even though I am aware that one thing influences the other. Nothing happens in silos (unlike work places), when it comes to our personal lives.    

 

      

My Son, My Very Own Canadian for Clinton

Son, for the millionth time: Why can't we donate to Hillary Clinton's campaign? Please?

Dad, for the 999,999th time: We can't! We are foreign nationals. We don't want to put Hillary in trouble, remember? Even a cent from three insignificant Canadians will spell trouble for her. Besides, you are just 10 years old!

Son, crestfallen: Ummm, why are they so unfair?

Mom: OK, buddy, I'll buy a 'Hillary for President' bumper sticker, OK?

Son: Oh, and can we also buy lawn signs?

Dad: OK, we'll do that.
[Silence, blessed silence, for a few, fleeting moments]

Then a light goes off in son's head: Can my sisters contribute to Hillary's campaign? They were born here.

Dad: Oh no, this guy has found a loophole now!

                           ******

"In search of memory this Memorial Day."

In search of memory this Memorial Day

Is a line I heard on NPR

While I struggle to experiment with appam batter

-- A culinary art I never had a chance to learn

Nor miss

While still a child at home,
Co-existing with the Lost Generation.

This Memorial Day
I don't need to search my memory
To remember my grandmother
Who neither fought in a man's war
Nor has passed away,
But merely, enormously
Hovers
Between life and blessed death.

But this battle

For breath,

Neither old nor new for her,

Is a struggle she'd consider

Much less tortuous

And more welcome

Than the fight for dignity

That she has been losing

For more than half of her life.

Malathi, 5/30/2016

The identity of a 11-year old

I am.

I am the wind

I have the power of one thousand

butterflies.

I am like a fire

Wild and untamed.

I am like air

Significant like everyone else.

I am a volcano,

Tall and mysterious.

I am like an eagle,

I soar to great heights.

I am like water

Calm and easy to see through.

I am lightening

I have the speed of a cheetah.

I am like a tiny cube of sugar

Sweet and pleasant.

I am a dog,

I will never let you down.

I am Divya Durai.

Say no to the idea of Rohith's depression -- until further evidence

A prominent columnist claimed that Rohith Vemula's suicide was not caused by oppression but by depression. After circuitous arguments, he arrived at the confident conclusion that Rohith was clinically depressed. Furthermore, if Rohith had been depressed, then how could the cultural cartel have oppressed him? Impossible!, he declared. According to him, the two conditions are mutually exclusive.

But it makes no sense, you say? Gentle reader, it didn't make much sense to me or a number of other friends, acquaintances, and well-wishers, either.

So to counter his 'either/or' verdict that came down heavily on the side of "clinical depression" driving Rohith to suicide, I wrote the following:

[Rohith's death] is a multi-factorial story with several predisposing factors (examples: his neuropsychology; class; caste; awareness of self; personal perception of limited possibilities for his dreams and abilities; social connectedness or lack thereof; perception of limits to his upward mobility or at least social mobility) and one or two precipitating factors (examples: the latest events such as his expulsion from university; his likely sleep deprivation given he was out on the streets; his perception that he may never recover from this setback; his debts). I am not claiming that I know his personal, unique story precisely, but I am aware, from population studies in different countries/professional groups/subcultures, that just a single variable change could have potentially given him an opportunity to rewrite his life-story (example: if he hadn't been alone that night or, in the Indian context, if he felt like he had something yet to live for, or if he knew he could fly to another country and start a new PhD program, or get a science writing job without a degree but just with 'English with a capital E' and connections, or an uncle in business who will have given him a managerial job). In other words, inequities in life follows you into your preparation for death.

I know no clinician who will isolate one factor from the other in an individual case, but you've managed to declare precisely that from just sitting at your desk and typing a few words. You didn't even consult with somebody who studies depression or suicides in mainstream populations and in socioeconomic subgroups.

But this was three days ago. I've had some time to think and I now wonder why, in my eagerness to emhasize the socioeconomic effect, I failed to completely dismiss the idea of his depression. Yes, American statistics dictate that about 90% of suicides can be attributed to depression and/or substance abuse. But this proportion can vary in different cultural groups. But even that high number leaves at least 10% of suicides unexplained by depression. Had there been a history for Rohith? Nobody who is following his story from a distance, after his death, knows. If we know nothing about his medical history, then why assume depression? Is it because he killed himself? (Does that mean, the four friends who were expelled along with him are not depressed, because they are with us still?) Is it because Rohith was Dalit? Studies have shown that marginalized communities and people with lower socioeconomic status are depressed at higher rates than their mainstream and better-off counterparts. Even P. Sainath, who is reminding people to look at the suicide note in the context of Rohith's suicide, noted that some castes and classes in India experience depression at higher rates than others'. 

Still, no amount of population-based numbers will help one understand definitively whether a particular individual with all the risk factors was depressed. Clinicians use risk factors to guide them in screening their patients, but definitive diagnosis can be made only by collecting and integrating the individual's information.  

So when I saw another prominent writer, one that I respect, acknowledge that social and political matters can lead to or aggravate depression which in turn can push a person to take his own life, I wrote the following:

I want to understand why we assume [Rohith] was "depressed." Why do we not assume that he was stifled, made to or chose to extinguish himself; the social and the political directly acting on him, without any comodifying (i.e., encouraging) effects from depression? Because as far as I know (from public reports of his lifestory) no healthcare professional has ever counseled him; he didn't seek medical help; nobody who knew him personally suggested mental health issues while he was alive. One journalist qualified to write well (but without the necessary health professional background) has made a suggestion of depression, nay, declared a verdict of depression, and none among us has dared to wonder why this may NOT be true in Vemula's case at all.

It is true that epidemiological studies suggest that socioeconomic deprivations play a role in depression manifestations and that societies should work on removing inequities to reduce the proportion of deaths due to *suicidal depression* tendencies occurring along with low SES. But this does not necessarily always translate into one individual's life in any of the many possible directions. For example, suicide is not always preceded by depression (there are a few times when the motivations leading to suicide are defined and varied, even culture-specific) and depression does not always lead to suicide (people even get over a depressive phase if they have the necessary resources and adequate help). And this emerging picture of Vemula suggests that he was a highly resilient individual tapping into as many inner and external resources as was possible for him, until his last few days.

"Depression" has become part of the common lexicon in a facile manner, while the label/diagnosis should actually be given only by a qualified professional. I think the reason we all accept the possibility of "depression" is because it is still seen as this mysterious personal responsibility, a personal crisis -- something an individual has to take care of in the privacy of his/her mind (and with a doctor, if one is lucky enough to have one). But socioeconomic and political conditions, all reasonable, compassionate people will agree, are society's collective responsibilities. By speculating "depression," we just hand society and ourselves yet another assurance that we can all turn our backs and walk away when a struggling youngster (with or without a history of depression) feels he has come to the end of his rope.

My point was that it is possible even for individuals from marginalized communities to never experience chronic depression or suicidal depression. Each one of us may know such exceptional people from our own personal lives. Then why is it not possible for Rohith to have been one such person? In the absence of evidence of a history of depression, why are we stripping Rohith of yet another layer of his truth when he is not here to explain for himself?  Already, his merit achievements have been questioned or ignored under the shaming attitudes towards "quota students"; his Dalit status was suspected and scrutinized after his death; his scholarship was assumed to have been awarded due to nothing more than his "Dalit" credentials? Now his resilience despite his rise from his difficult background, so well described by Sudipto Mondal here, is also questioned? The odds were stacked so steeply against him even before he was born. Yet, he persevered. And by sheer hard-work and temerity, he arrived at the one place, a place of higher learning and intellectualism, where he hoped he would come to belong. From all public accounts, he was exceptional, extraordinary -- he was the one who aimed for Carl Sagan's stars -- and he accomplished this journey mostly on his own. Does he sound like he was prone to depression to you? Whether you answer, 'Yes', 'No', or 'Don't know', let me tell you: none of us know the correct answer.  

So why do we as a society insist on seeing past visible acts of exclusionary politics, tangible discrimination, and systemic indifference meted out to students of marginalized communities, only to search for excuses and latch onto explanations about a little-understood, invisible-to-the-naked-eye, intangible mental health issue that may or may not have existed in one who was not examined for it?

Until, a healthcare professional who examined him in his worldly life comes forward with a diagnosis that was made previously, say no to any speculation of 'Rohith's depression'. Emphatically.

                                                                     *****

Here are two examples of people from different walks of life who appear to not be afflicted with depression. Their approach to life is very different from that of the average middle-class person.
Stephen Batchelor, a secular Buddhist, has said:  
Death is certain, its time is uncertain. So let me live this day as if it is the last day of my life.

The portrait of this young lady from New Delhi, India, on Humans of New York has received 249,779 'likes' as of this day. She says: 
I don't have any dreams. What's the point? I'm poor. I don't have any skills. I wash the utensils in the kitchen-- that's what I do. But I like the girls I work with. We make fun together. I tell jokes. They tell jokes. I'm happy-- it's in my nature.

Who is to say Rohith could not have been like them -- adopting a pragmatic, forgiving, and no-unnecessary-sweat approach to life? A Carl Sagan admirer, he must have cherished this saying, 'Aim for the moon, even if you miss, you will fall among the stars'. I join Pratap Bhanu Mehta in concluding that at the time of his death Rohith Vemula was 'yearning for a space beyond power and rancour.' And maybe even beyond depression.

                                                                        *****

Name a country in Europe

My son, Rahul, who was a toddler when I started this blog, is now 9 years old, loves live theatre and music, and cannot decide whether he wants to be a veterinarian (like his mother) or a musician (like his idol Paul McCartney) or both. [Word of advice from mom: Just focus on becoming Paul McCartney, kiddo!] 

But this fall he surprised himself and us all by writing comedy like his dad does. In fact, he went a step further than dad by actually enjoying being on stage. Here is the skit Rahul wrote and performed this week together with his theatre class, Act Two Comedy Troupe. His teacher, Tamara Kist, edited the skit big time and deserves credit for the final version, while dad, Melvin, gets some credit for helping with first draft.

Teacher: Class, today we're going to learn about Europe, where many of our ancestors came from.  Can anybody name a country in Europe?

[Noah raises his hand.] Yes, Noah?

Noah: Chicken. [Class giggles.]

Teacher: Chicken?! Oh, you mean Turkey?

Noah: Oh yes, Turkey. I knew it had something to do with lunch meat.

Teacher: Can anyone else name a country in Europe?

[Derek raises his hand.] Derek?

 

Derek: Ham?

Cole: That's a lunch meat, too! 

Teacher: Nice try, Derek. But there's no country called Ham.

Derek: But my grandfather says we came from some place that begins with the word Ham.

Teacher: Hamburg? That's a city in Germany.

Lamia: Is that where hamburgers come from?

Teacher: Actually, yes. Can anyone else name a country in Europe?

Cole: I know a country! I know one!

Teacher: Yes, Cole?

Cole: Australia!

Noah: That's a good one bro!

Cole: I know, right? That's a country, right Teach?

Teacher: Yes, it's a country. Unfortunately, it is not in Europe. 

Cole: Oh.

Rahul: Isn't that where they filmed the Sound of Music? All those rolling hills? Not that I've ever watched it or anything.

Teacher: You mean Austria. THAT is in Europe.

Lamia: Austria sounds a lot like a shortened version of Australia.

Teacher: I suppose so, Lamia.

Noah: Teacher?

Teacher: Yes, Noah?

Noah: Does Austria have short kangaroos?

Teacher: No Noah, it does not.

[Rahul raises his hand.] Yes, Rahul?

Rahul: Greece.

Teacher: Very good. Greece is a country in southeastern Europe.

Rahul: I knew that because they filmed Mama Mia there. Beaches, blue water, boats. Not that I have ever watched it.

Derek: Who would name a country grease? I hate grease with my food.

Cole: Hey, isn't that a movie with Olivia Newton-John and John Travolta?

Rahul: Yes. They sing the song Summer Nights in that. Not that I've ever seen it.

Lamia: I'm Hungry.

Teacher: Is your family from Hungary, Lamia?

Lamia: No. My stomach is growling. Is it lunch time yet?

Teacher [looks at her watch]: I guess it is. You can go eat now.

Rahul: Yeah, I feel like some turkey.

Cole: You are a turkey.

Derek: Just no grease, OK?

   ~***~