Slide-show

When I’m going through these phases, it feels like my mind is clicking through a slide-show featuring several catchy images of why I can’t possibly do well in life.

The oldest ones are from my childhood days (between 5 and 13 years of age), originating mostly from my mother and her extended family.

“How could you I possibly have a son like you?” 

“Why can’t you be more like your cousins?”

“You are a disgrace to our family!”

“Remember that you will suffer through this for the rest of your life if you don’t…”

Then, there was a phase when I was in medical school (between 17 and 20 years of age), featuring an unending stream of implicit commentary from the people I had to surround myself with:

“What a dork!”

“He’s so awkward!” 

“He couldn’t possibly be empathic!” 

“How could such a person take care of other people?”

Then, there was a phase after my post-graduation (between 28 to 30 years of age), where I received a few deeply wounding comments around a fleeting relationship.

“You aren’t good enough at most things you do, which is why you are scared to practice medicine and why you aren’t good at music.” 

“People are saying so many bad things about you. I just overheard them at a party. I am telling you this because I am protective of you.”

Then, in the last seven of years or so (between 33 to 40+ years), despite a relatively successful time in my life, I heard some more.

“The things that you call ‘relationships’ weren’t really ones. Those were just flings. A real ‘relationship’ involves conflict. Conflicts are natural. The fact that you can’t cope with a ‘real’ relationship means that there is something wrong with you.” 

“You have changed. You used to be nice. You used to care. You used to be kind. You aren’t any of that. You are a monster.” 

“I don’t know if you can think of a career change because most careers will need you to be socially active. You are unable to do that. It will be hard for you to build and maintain circles of people, professionally or socially.”

My slide-show moves along just like any other. But just like how advertisements are meant to attract the attention of people, slides like these hoard my consciousness.

Maybe I’m all of this. Or maybe I’m not. Maybe I’m all of this because I have been told I’m all of this. And maybe I’m not all of this because I have changed after people have told me that I’m some or all of this.

The story of Ugly and my response

*For some weird reason, My friend and fellow book club member forwarded me a story of a cat called Ugly (see attached image). Although the story is graphic (in a negative way about Ugly being treated badly), it ends with the author(s) being positively influenced by the valiant cat.

(*Edit: Since I published the post, my friend and I had a conversation. She thought that despite the sad story, this was a a good example of unconditional love by an animal, which I would related to because I'm a cat lover; of course, her intent was not to make me feel bad or to trigger traumatic memories. This conversation happened on the book club group chat, and one other member pointed out the perils of feel-good stories: "Always missing the point that not everybody reacts to the same to a scenario."  A very valid point, I think.)

I have had a storied life of being traumatized by experiences of cats in peril. Ugly's story thus forced me to respond in the following manner:

Sorry for the essay response, but I had to.

I don't know if you know this, but I have been at the wrong end of cats being mauled. In Kerala, I have always had cats/kittens with me. Some of my dearest cats have died grueling deaths thanks to packs of dogs mauling them. I would be woken up in the middle of a rainy night just to hear the last part of the fight, and I would be so bitter and upset with myself of not having been there to help them. The next day morning, I would have to find their bodies and bury them. Happened to me at least thrice, and I have always had a problem trying to get over this.

In fact last year, there were a couple of nights when I couldn't sleep because I thought Spock (image below; Spock with KiKi), who was a kitten then, was getting mauled by dogs (or other cats) and I have been out searching for him late in the night, after apparently hearing sounds of a cat in distress (which others didn't hear). I eventually found only his mom and his litter mates and would come home and be on the verge of a panic attack and would have had trouble falling asleep. None of the others would "get" my feelings/panic. J would realize that there was something that had triggered me like very few other things do, but was unable to exactly understand the gravity of the situation.

Both of these Spock nights had a happy ending (so to speak) because I would leap out of my bed at dawn and go out to search for him, and I would find him safe and happy somewhere. However, these did trigger a few of my older (PTSD-triggering memories) and have been the focus of a couple of my therapy sessions.

About cats dying in my arms -- yes, I have had a couple of such experiences as well. They were not directly due to mauling, but because of infections because of mauling or abuse. Those are such strong memories, and I think, just like how this story describes it, are life changing.

Unlike the author in the story, I have never really gotten over these in a positive way. What this has made me is to be fiercely protective of the people/animals that I love, which sort of manifests in me being extremely aggressive toward people to mistreat animals. At least people who were at the table at the last Annual Meeting party would remember how I was about to pick a fight with a waiter because he was trying to shoo away a cat that was rubbing up against us under our tables.

In conclusion, I don't know why you specifically tagged me, but it made me revisit a strong/painful series of memories. But it hasn't evoked a panic response yet. So I guess it's all right. :)

What I'm going through to get better

I'm sure that among my readers, there are at least a few who have battled depression. What it does to you is sometimes devastating. You simply forget how to live they way you used to live and forget how to love what you used to love. It's incapacitating. I still remember that only a few years before, I was interested in going out to a movie and eating out and simply having fun. Two years back, I was absolutely in love with traveling and look forwarded to go to new places and have exotic experiences. The list goes on and on.

After being on a relatively ineffective pharmacotherapy cocktail for approximately two years, I consulted my present shrink, who switched to the present the pharmacotherapy cocktail (below) and guided me to talk/behavioral therapy. During the course of psychological testing, I was diagnosed with major depressive disorder (MDD), anxiety disorder, stress disorder most probably as an effect of post-traumatic stress disorder (PTSD) due to childhood trauma. Yes, it sounds like a lot. Hence, along with the medications, I have started an efficacious, albeit debated, psychotherapy method called eye movement desensitization and reprocessing for PTSD.

As pharmacotherapy for depression, I'm on the following cocktail:

• low-dose amitryptiline (a classical tricyclic antidepressant)
• medium-dose bupropion (an atypical antidpressant mood stabilizer)
• low-dose clonazepam (an antianxiety agent)
• low-dose haloperidol (an antipsychotic agent)

Apart from that, I'm taking Vitamin B and Vitamin D supplementation.*
As part of pscyhotherapy, I have undergone/am undergoing the following:

• cognitive behavioral therapy (CBT)
• eye movement desensitization and reprocessing (EMDR)
• reading and learning about depression, PTSD, and cognition in general
• Social: Why Our Brain is Wired to Connect - by Matthew D. Lieberman
• Feeling Good: The New Mood Therapy - by David D. Burns
• Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy - by Francine Shapiro

Wondering the reason behind why I'm posting all these details? To be honest, I have come across several people suffering from depression who are simply unaware of what they can do to get themselves and their lives back on track. By being open about what I'm going through, I hope to bring more awareness regarding depression and PTSD so that more people can help themselves.

An important point to note is that the bullet about reading and learning about depression, PTSD, and cognition in general need not be limited to who are suffering from depression or PTSD. I would recommend this as a useful exercise to just get accustomed to the concepts and the phenomena underlying these conditions. Especially, those who are close to those who are the sufferers.

In the last few weeks, I have recommended these the first two books to several people and I have gotten very positive responses regarding the same. I hope that I can get my family (my sister and my mother at least) to read these books.
If you are reading this and if you know someone who shows signs of these conditions, please encourage the to seek help and/or read these books.

*I was diagnosed with Vitamin D deficiency a couple of years back.