Differences and Similarites

Even though I think mental institutions have a lot of similarities, the differences should also be taken into consideration. For example, all doors at VIMHANS are virtually unlocked and when I spoke to this doctor who told me that doors are not always unlocked in other countries made realize that this is a special attribute of this hospital. Locked doors are usually associated with mental institutions and a lot of times that holds truth but not at VIMHANS. All in-patients have attendants who have to be with them at all times while the patient has the freedom to go wherever they want whenever they want.

Another difference between hospitals in India and hospitals in other countries is the emphasis and focus on family. A lot of times a family member stays with the patient at the hospital. When walking through the wards, I often see a lot of family members. Every time we speak to patients, we also interview a family member and there is always one around. I am not sure how it is handled in other countries, but I doubt that family members are always allowed to stay with the patient 24/7. However, as I mentioned before I have never completed an internship at a hospital at any other country so I really shouldn't be the one making conclusions.  

Art Therapy Workshop

I was obviously very interested in that workshop. I have always been very interested in art therapy. Even though the workshop wasn't very theoretical but mostly practical I still enjoyed it a lot. All of us had to paint to one of three suggested guidelines. I picked the one that said to draw a person in the rain. When I started drawing I told myself not to draw according to any kind of rules or plans but intuitively feel where the painting will take me. Obviously the painting was somewhat disorganized, abstract and a little weird. After all of us had finished our paintings the art therapist interpreted all of them for us as it would be done in art therapy. First I was a little skeptical and I still am but the art therapist was able to convince me somewhat.

I still believe that interpreting paintings, even though there is some structure in doing that, is pretty much subjective. This is not a bad thing but a good thing. The structure/the system that art therapists follow to interpret paintings should be loose because meaning changes depending on who paints the picture. There are so many factors that influence the way a painting should be interpreted therefore I believe there should not be too much of a rigid system and rules in interpreting paintings. Anyway, fact is that when she came to my painting, she totally pinpointed it down. I really thought she could not make any sense out of it but with two sentences she was able to capture my entire inside. I was surprised, impressed and persuaded.   

Road Trip

Cows on the streets, different environment for consultation, very good lunch, some Indian history in the temple, what more did I expect out of this satisfying trip to Arpana Hospital. 

I knew I will get it

Today for the first time I got the chance to understand most of the patients. I have been sitting in the OPD (Out-Patient Department) for a while now but most of the time people have spoken Hindi only. Today I sat with a Doctor I have never sat with before and all her patients, literally all, spoke at least some English or even only English. It makes such a huge difference if you actually understand what they are saying. Time flies by and there is so much more that you learn. It's amazing how complex, interesting, sad, surprising and/or emotional all cases are. This day made it worth it to wait; it makes up for all the days that I have not understood anything.

Tomorrow I am going back to Carnal, Arpana Hospital. I am excited because I love the atmosphere of that hospital. 

Nature and Religious Values, Part of the Past

I came to the conclusion that the environment will not be of any help for patients suffering from an mental illness in Delhi, in particular not in the summer. The only people who do spend a lot of time outside  in the environment are people who don't have a choice. Other people who have a choice consider being inside in an air-conditioned room as a necessity. Priority becomes to be more and more similar to the western world rather than spending time in temples, meditating or doing yoga. Maybe a few years ago or in smaller cities, towns or villages people still acknowledge nature, spiritual healing, meditation and a healthy environment as important aspects of life. But in Delhi, those values seem to be lost. People want to move forward and not backward and those values are understood as past/old fashion. This claim is not based on research and also should not be given any validity. I have only come to this thinking by observing and listening to conversations that people have amongst each other at the hospital so what do I know...?  

Delhi, environmentally concsious?

Throughout my stay in Delhi
 I have become increasingly aware of little signs that have been put up to remind people of the environment. Although often times when I ask my friends from Delhi if people are environmentally conscious, people usually say, "not at all." But I can still see a lot of conscious effort to make people aware of the environment's importance. I took some pictures of two signs that were posted near CP (Connaught Place). Those two signs were very close to each other. This makes me think that there must be more concern about the environment than what people think.

And the last picture was taken at Arpana Hospital. When we really pay attention we can find environmental consciousness in a lot of places. 

Last day for my Buddy Interns

Now I got left all by myself. The other interns who I was always with, left. Their internship was only for a month and that month is over. Yesterday was their last day. I am glad that we had a really nice last day. We had a lecture by the director/owner of the hospital in which he told us how important the profession of psychologists is. Then we had an awesome lunch... I love Indian food. Right after all of this, the girls got their one month internship certificate and we left. Later that night, we went out to a coffee shop. We talked, reflected and remembered. It's funny how fast I share so many memories with them. I also stayed over with my friend Vartika at my friend Mukta's house. There again, we had awesome food. Her mom is just an awesome cook. Our conversation continued until late at night, at which time I finally past out.

Individuality vs Collectivity

The other day I was speaking to a friend of mine from India and she told me that she was initially very surprised about me. She told me, people in India have a specific perception of foreigners. People in India think that foreigners are rather individualistic than collectivistic. Meeting me, she says was a surprise for her because her thinking was proved wrong. She didn't get the impression at all that I am rather individualistic in my thinking. Because I am not like that, she says she thinks I have probably become "Indianized," which is why I act more collectivistic than individualistic. This conclusion was made in a very short amount of time since I have been here only for almost a month now. However, it has surprised me to hear that from her because in the 5 years  that I have been in the US, I have never been told that. However, thinking this way is pretty sterotypical and I am sure the more foreigners she will meet she will find that it is not as clear cut as that. Even about myself I would say I am individualistic in some sense as well as collectivistic in other areas.  

Fascinating

Today we went to see a Hindu priest (pandit) to find out more about my life. A lot of people in India believe in astrology. They ask the stars about the future, the past and the present. Many people value the things a pandit tells them. I am not sure yet if I truly believe in what the pandit told me but to some extent I believe in what I want he told me. Nevertheless, it was an incredible experience. The pandit and the people working in the temple were so welcoming and they took so much time for us. And the way the temple looked was simply amazing. I have never been to a temple like that before.

It's the same everywhere!

Before I left to India I went with my dad to work in Germany and one of the people he works with was very surprised that I am going to do an internship at a mental institution in India. But after a few seconds of thinking he told me, "you are going to be fine. Mental illness is the same everywhere." Even though he doesn't know anything about psychology, he was able to totally pinpoint it down. In a broad sense, even though some differences are present, mental illness seems to be the same. Obviously I have never done an internship at an American or German institution but according to the observations I am making, I can imagine that it is pretty similar. The patients that I interact with often show very typical behavior of what my understanding of an illness is. Although, it is much more complicated and not as clear cut as some books might make it seem, most of the patients that I have seen show characteristics that I would expect.

Thus far, all patients are pretty stable. They have been on medication for a while or don't really show their symptoms because they want to get discharged or they feel too embarrassed. But today, I met a patient who came to the hospital for consultation and she was out of control. She was admitted immediately. I have only seen her in the waiting area. She was very disturbed. Her clothes were dirty.  She was standing in the middle of the floor with her hair all over her face talking to herself and occasionally screaming. Is it possible or likely that people suffering from mental illness act this way in other parts of the world as well, I would think so.

The picture shows how a consultation room looks like.

I knew it...

Today I was on rounds with one doctor as I have for the last couple of days. As I have mentioned before, I don't always feel very comfortable being on those rounds. I think the patients feel as if I invade their personal space. Often they also appear to be put on display for us. Some doctors even refer to the patient's symptoms and behavior while the patient is still in the room. They talk about the patient as if the patient doesn't exist. I honestly doubt that having six or so interns on rounds makes the patients feel comfortable. If I would be a patient I and would have to speak about my fears, concerns and abnormal behavior, I could be ashamed, uncomfortable and angry about the fact that so many people are staring at me. On the rounds today, one patient pointed that out and I felt terrible about it because it is true and I am part of the people that are doing this. I feel like I am causing more harm then I can help or learn from those experiences. Most patients converse in Hindi so I don't really learn a lot anyway so why making it more uncomfortable for something that is not worth it, there is no benefit but mostly harm.  

I know I am too negative right now. I just need some time to cool off and then I will be able to see all this in a better light. To cool off we went for some coffee and on our way there we found some kids who loved to be photographed.

Why people want to fit in?

Every time I see tourists here in Delhi I notice that many of the female ones wear traditional Indian clothes. And since it is a big majority of them who wear those clothes I started to wonder why... One of the first explanations that popped up my mind was that they are being incredibly stared at. They are being stared at because they are different, they stand out. In order not to stand out, women start wearing traditional clothes so they can blend in better and the stares will hopefully decrease a little. But in fact there are many many many young Indian women who wear mostly western clothes. Anyway, there might obviously be many more reasons why tourists wear traditional clothing but that's one reason that I came up with. I have bought some Kurtas but not really many at all so I barely wear traditional clothes. Firstly, because I believe I can fit in in other ways and the other reason is because I don't really have a big budget. I prefer going out for food and sightseeing than buying clothes and my mother always says, "you can't have everything you have to choose" so I chose. However, I caught myself trying to look more like Indian women in different ways than buying Kurtas. I am not sure that this is in general a style that I like or is it really because I want to blend in better. I don't know but I will explore my psyche more and let you know what I found out.

Mentality of India

I am very surprised how well I fit into the lives of Indian people. It has always been hard for me to adapt to a new place fast. It usually took me a year at least  to feel comfortable at a place but it's different here. From the moment I came here it seemed as if I belong here without any contemplation. Obviously there will always be things that I like and don't like so much but overall I am very content about my stay here from the beginning. I have the conversations I admire, friends that I appreciate and meaning of my day to day activities that I value. Thank you India and thanks to all the new friends who have enabled me this type of experience. 

Building a Routine

I finally have managed to learn the names of most doctors and other interns. I know what time to come, where to go and who to approach for help, concerns and questions. This knowledge and solidifying routine helped me to build confidence. By having more confidence, I also can shift now from being an observer to being an active participant in all the activities going on around the hospital. For example, the doctors are on rounds every morning and the interns join them on them on those every day. Even though I don't understand most of it, it is nice to trot along with the doctors and see all the patients and observe them. After we have seen one patient the doctor discusses the patient's case with us. Before that, I did not really feel comfortable because I felt I am being to invasive of the personal space of the patients by coming into the room and evaluating their suffering. I am not able to help them anyway, why bother them then? But now, I think I learn and at some point I will be able to help. The doctors also actually encourage me to go with them.

Amazing

Today, we went on a little trip to a different hospital. The hospital was about  three hours north from VIMHANS. It was called Arpana Pushpanjali hospital. This hospital is as opposed VIMHANS a government run hospital and from what I have seen totally different. First, we went to this temple on the hospital's ground. The temple was incredible. There, we saw a million sculptures and pictures of different gods and goddesses. Among them there was Jesus Christ and Mohammad, the Moslem prophet. The philosophy of the hospital was that people of all religions should live as a family. Everybody who comes to the hospital is considered part of a big family and treated accordingly. We met the sister of the founder of the hospital and she kept emphasizing how important meditation is. All illnesses, psychological and physical, can be cured by relaxation and meditation. At the garden right outside of the temple, the sculptures of gods and goddesses continued and made the garden look even more beautiful. The hospital as a whole seemed much more meditation and yoga based than VIMHANS; it made me feel much more calm. The philosophy of the hospital seemed very spiritual and we were welcomed very warmly. The hospital is also far off from any bigger city. There are not too many cars, no honking and the air doesn't appear to be as polluted. Because of all this loving, spiritual and environmentally friendly surrounding, can patients be considered to be more likely to recover? Be cured? Maybe... I don't know!?

Struggles

Talking to patients has always been a problem because of the language and cultural barrier. This is why I liked it when I was able to speak to the French patient; I was able to relate to his experiences in India. And then yesterday, I spoke to a patient who is originally from India but has done his studies at NYU. So both of us have studied in New York and lived there for a while. It was much easier for me to build a rapport with him. I was also able to make him trust me, which made him and me more comfortable talking. I knew what questions to ask and what kind of conversations to have. Since he felt increasingly comfortable, he opened up not only about himself but also about his illness and symptoms. Unfortunately for me but luckily for them, the French patient and the New York patient were discharged only a few days later after I started talking to them. I feel like every time I am starting to build good relationship with patients, things get disrupted. But obviously I am glad that they were discharged and stated to feel better.

Yesterday I slept over at my friend's house. I obviously couldn't sleep because it was a new place and it usually takes me forever to get used to it. So I got up early and started taking pictures... I KNOW I AM WEIRD. Those are the pictures that came out. 

Traumhochzeit

Yesterday night I went to an Indian wedding for the first time. It was awesome. The venue and food were incredible. Before going to the wedding I visited Mukta at her house and borrowed some clothes. The way to Mukta's house was in itself an adventure because it is pretty far from the hospital. To get there, we took a bus. This was also my first time taking the bus. Trust me, it was so much better having Mukta with me. Obviously, people will stare anyway but in buses especially I feel like I am invading people's place as a foreigner. Having somebody from here who can guide me through gave me much more confidence and acceptance from the other passengers.

I also saw for the first time a bunch of cows on the street taking a walk in the middle of the road. Noida is pretty far from the center of Delhi and I think this is why there even are cows on the road. I did not see them anywhere else besides there.

Most Beaufitul Place Ever

I finally found the perfect place. I really like Haus Kas Village. It has a bunch of monuments, some cafes and galleries. You walk through very narrow streets and get lost in order to find new corners that you haven’t seen yet. But the best part of all of it is its beautiful lake and the huge park surrounding it. After it hit 6 pm, people got out and started walking around, playing cricket and sitting nearby on benches. This is the first place which seemed to have a relaxing effect on people. There were no cars, no honking and no massive amount of people. 

Obviously it is hard to get the same scenery at a hospital like VIMHANS. Even though they have put a lot of work into the gardens, it is not the same. The gardens are obviously much smaller and not as cozy. I think the main reason why most patients don’t go out is the heat and there is nothing we can do. Maybe I can suggest building another hospital in the middle of the Haus Khas Village Park. Then, patients would be able to get up early in the morning and do their yoga in nature before the day hits the heat.   

Not what I expected

People here are much more skeptical of spiritual healing, meditation therapy and yoga therapy. We are in a psychiatric hospital and psychiatrists are usually not thrilled about those things as far as I have seen. And then the psychologists are busy defending psychotherapy to even start thinking of anything that goes further. There was this girl I met in the hospital who wants to go to a western country to be trained in spiritual healing such as angel therapy where you use gods to which patients speaks to.

I constantly hear that India is a developing country that goes through a lot of change right now. They are trying to catch up with developed countries and in order to do so they have to do everything exactly like they did. And there is no space for any spirituality. There was my other friend who told me at the beginning of my stay that India is losing its values and western countries are picking up on those. She said that at this point, people in western countries know more about yoga and meditation and how it can be used for therapy. There are a bunch of places in which you can get trained in yoga therapy or mediation therapy in the UK but there is not too many places that offer those training programs here in Delhi.

I am also wondering if all this has something to do with the fact that I am in New Delhi. It might be that if I go away from the capital, things might have not changed as much. Delhi makes it also hard to include the environment as an important part of the healing process for mentally ill people because it is so polluted and it is hard to find enjoyable places where you can relax in the environment. I have not traveled as much in Delhi yet so I am not able to pinpoint places that could be used for meditation and where people can have a break from every day life and heal. There are a lot of parks but they are usually surrounded by cars and tons of people. There are also a lot of beautiful temples to which I haven't been yet. And in particular those are used by people to get a break and get spiritually energized. They are often surrounded by beautiful gardens but at the same time you can still hear the honking of the cars and the busy life that is going on right outside the door.   

The Benefits of Day Care

I had to write a reflection about one thing I have learned at Day Care. I have learned the benefits of Day Care. Even though Day Care doesn't provide an environmental comfortable atmosphere, there is a lot that the patients can benefit from.

In day care, every day is organized different but very structured. There is a schedule of all activities hanging in the hall so the day care members know exactly what to expect. I have realized how important it is to offer the day care members a well-organized schedule that they have to follow. Some not all of the patients might want to return back to work and they should know and be taught what it means to follow a routine. They learn what it means to be at a place on time, they learn to start and complete tasks and they learn how to socially interact with other people. Some patients might use those new acquired skills to prepare for a job and others might simply use those skills to prepare for a life outside of day care in the real world.

Besides teaching patients new skills, the day care also allows the patients to engage in meaningful tasks. After the day is over, patients can reflect back on it and can feel good about what they have accomplished. For example, people who are diagnosed with a mental illness might not find anything to do at home. At the end of the day, they might feel sad because they don’t have done anything for the entire day and there is nothing to reflect on. But through day care and their activities their day is given meaning. In addition, day care’ activities might give the patients a break from their illness. If they don’t do anything, they might be too preoccupied with their symptoms and so they might experience them as even worse. Day care activities pull patients away from their symptoms and give them an alternative to focus on. Another benefit of day care is the fact that it builds confidents in a lot of patients. They are given a task, they complete it, then it is checked and they are being praised for their good work. Given the patients a reason to be complimented on helps them to be proud of themselves which subsequently increases their self-confidence.

Admitting: I am a little Exhausted

I wish I could say more but I am a little exhausted. I have a Monday through Friday week, from early morning until 4.30pm. At the same time I am trying to explore Delhi as much as I can. On top of all that, we also have assignments that we have to submit. Not a big deal, but still some work. I feel a little low on energy right now.

Another reason for my exhaustion is a new patient. I have shifted to the IPD (Inpatient Department) a few days ago and we are assigned a bipolar patient and she is in a manic stage right now. Trust me, this is hard for us and really exhausting; we are not sure how to deal with it.

Anyway, today we had a little break because we went for our supervisory session to the University. Since I have become an honorary member of that school, I obviously can't miss those sessions. And from there we went out to explore Connaught Place. To get there, we took a ricksha, which is where the picture was taken. 

Walking is just not the same...

I really love walking. I prefer walking to everything else. It is relaxing and calming me down after work or school. And before leaving to work or school, it is waking me up. I think it is pretty stressful to take public transportation or to taking the car. I don't like waiting for the bus, wondering if it ever show up and then being smashed into a corner of a crowded bus. I also don't like driving in traffic and then looking for parking spots for hours while worrying to be late.

I know that when I leave the house at a certain time, I will need exactly 45 minutes to get to the hospital no matter what. The reason for walking is to see the people of Delhi on the streets, I want to see how they work, how they interact and how they live. Getting from place to the other by ricksha, car or bus makes me miss out on so many things.

Another reason for walking is to become more comfortable with my surrounding. When I am not in a tourist area, people stare tremendously. Especially, in lower economic background neighborhoods, people stare me down. And I have to admit that I get a little scared. But I don't want to be scared, I want to experience Indian culture and not only be comfortable in tourist areas. I also want to be able to feel fine by myself among Indians. By walking, I thought I would have all that. I would get a nice walk to work and get to know the Indian culture as well as become more comfortable being around that culture by myself.

But instead of all the positive attributes that I expected, I have had mostly negative experiences. I know it is really hot and I think I can take the heat pretty well but I don't think I can deal with all the smog and dust. I think my lungs have already turned black. I am coughing constantly and every time I blow my nose there is literally black stuff... I don't think I should have that. The other thing is that I being stared at. I expected that but whenever I reach the less "good" neighborhoods, there are a lot of homeless people on the streets walking and sometimes they walk really close to me and I have change sidewalks. There is really enough space so there is no need to walk so close behind me but people do anyway. I wish I would not feel this way but I do. There was another instance where one little boy came running to me, laughing really hard, touched my arm and run back to his friends. I know that it is not something that they see every day (a white girl) but I have to admit I am scared because I never know how people will react to me. The last thing that makes me not enjoy my walk are the tons of cars. Everybody, literally EVERYBODY, is honking. And they also drive dangerously close to you and I always think they will run me over. It is in particular difficult to cross streets and I have to do that constantly.

Walking today in the morning, I really started questioning if I really want to continue walking. Is it worth it? At this point, I am rather stressed walking instead of enjoying it...  

The Lack of Hindi becomes Increasingly a Problem...

In the hospital, everybody speaks English. And by everybody I don't really mean everybody but rather the doctors and most of the patients. For example, the attendants and the staff around the hospital don't speak English. However, even though most of the doctors speak English, they prefer speaking Hindi. This is the same for all the students and interns. They do speak English when they have to but obviously they prefer speaking their language, Hindi.

We have case presentations every Wednesday, Thursday and Saturday. Every doctor or senior intern is either presenting a patient and their symptoms, diagnosis etc or simply a topic assigned to them. They also usually have pretty good discussions after the presentations. But even though the presentations are in English, a lot of the doctors are asking questions in Hindi. And since I don't understand Hindi, I am totally kicked out of the discussion. I understand that it's the language that they feel more comfortable with and that there are things that cannot be said in English as well as they can in Hindi but what I would suggest is to keep the amount of Hindi to a reasonable amount. For example, today the whole entire discussion was in Hindi, nobody ever said anything in English and I was lost.

Today, I also had my first day at the IPD, which is the In Patient Ward. We were assigned patients and obviously my patient didn't speak English at all. I think that is unnecessary because there are a lot of patients who in fact speak English why not assign me those. We are divided into groups of two or three so I know that the other interns can translate but there is such so much that gets lost. And I would really like to get the whole gist of the patient and not only some translation. 

Later in the day we also had two lectures by two resident doctors and I have to admit that I barely understand them. In particular one of them had a pretty heavy accent and he also didn't put a lot of emphasis into what he said. As a whole, it was really hard to understand. So I think I got only about 25% out of the lectures. I tried to copy the notes from the other interns but it was too stressful to keep up with the paste.

I know that this sounds as if I am whining but I just have to express my frustration. At the end, it is not as bad. I still like being there and simply experiencing even though I don't understand everything.

I got too Attached!

The French guy is gone. He was discharged at noon and I did not get to say goodbye. I really liked him. I really liked talking to him. I felt like we were having a good conversation and I could reach him somehow but all of this is over. I probably should distance myself more from instances like this because if this is how it feels every time after a patient is gone then I will have a hard time. I think because I feel so out of place with the other patients, the French guy gave me hope again. I connected with him, he talked and I listened. With the other patients it is much more difficult. Either the language barrier is in the way or other cultural factors; with the French guy I didn't have that. Maybe, I have to get more open with the situation that I am in. I have to learn to become comfortable talking to the other patients as well and just make the best out of it. Use the disadvantage to your advantage.

After the internship I went to the Humayun's Tomb, one of Delhi's most famous monuments. Even there, there are tons of dogs roaming around but some people are not as scared of those dogs as you can see on the picture. 

Back to the Internship after only one Day off

I am sick so I felt awful today. My nose kept running the whole day, my head was about to explode and my ears were plugged. However, I was brave and stuck at the hospital until the end and beyond. We really wanted to speak again to the French guy so we waited until he woke up from his nap, which was after 4.30pm (which is when we usually get off). While waiting for the French guy, we made some goodbye cards for the previous interns. You can see us doing that in the picture. The patients will sign those cards and sing a song for the interns when they will give her the card. So the other interns were practicing the songs with the patients and we made the cards.

Then, I finally went to see the French guy. He was awaiting us. We promised him to bring him some paper, brushes and paint so he could start painting again. I also brought him a German magazine. He says that he has trouble reading English but German is fine. We got to his room we talked a little about his paintings. He also painted a picture for one of the interns and it was awesome. We obviously tried to find out what all the things meant that he painted but it sounds easier than it was. Because he says that he paints intuitively, he doesn't think about what he paints.

There were a couple of things that I found out about the paintings of patients suffering from schizophrenia. Those paintings can help patients to express things that have otherwise no words. Patients can communicate their experiences. Painting can also help patients to merge the things that are happening inside of them with the outside reality and by that coming closer to reality. Schizophrenic patients' experiences, thoughts and emotions can be taking out of their surreal world that exist inside of them and make them part of reality by making it a painting.           

There were a lot of mentally ill artists who became very famous for their work. A few of the most famous are Vincent Van Gogh, Eduard Munch and Gustav Klimt so why not this French Guy.

First Sleep Over

I haven’t left my house yet so there is not much to report on. I am excited for my first sleep over of my temporary home, New Delhi. I will be going to the Saket Market first with Mukta and then we will go over to her house. At night she said she would like to go swimming. I love swimming so I am happy. I think it’s nice because we can discuss together things about Samuel (the French patient) and about our conversation we had with him. This is what the doctor asked us to do; reflect on what we have talked about.

I also realized that my throat hurts really bad and I think this is because of the horrible air here in Delhi. I am totally sick of breathing in all that dust. It’s amazingly dusty here. Since I am walking to my internship every morning for like 45 minutes I am extremely exposed to the cars, their emissions and the dust. I hate it and my throat doesn't like it either.