Reflections

The CDC asked me to reflect with a picture on my internship and I did...

There is so much more than just the psychology specific knowledge that I had to acquire in order to interact with clients. The way I ask questions, the questions I ask and the way I understand them are dependent on the knowledge I have about the culture.

For example, if we have a new client join Day Care at VIMHANS (Vidyasagar Institute of Mental Health and Neuro-Sciences), the client first needs to be assessed. One of the ways the client is assessed is by conducting a Mental Status Examination. This is a standardized format in which the clinician records the psychiatric signs and symptoms present at the time of the interview. Let's say I want to test the client for his or her memory function and ask him or her what he or she ate last night but I get no answer, I have to be able to give suggestions about what he might have eaten. He obviously will not have eaten a burger and some fries so I have to know what they eat in an Indian household in order to give logical suggestions.

I am learning very day and I think I am getting more and more a hang of it even though I do mistakes all the time. Sometimes there is only the patient and the conductor of the assessment and the parent/caregiver/family member is interviewed separately or they are sitting together. But as of now my assessments are repeated again with a professional. At times, they let me do it for practice when everybody else is busy at the moment; otherwise I observe.   

How much will medication really help if they have gone through so much Trauma?

Today I went to this organization called Don Bosco who is sponsored by the UNHCR (United Nations High Commission for Refugees). The organization has many centers throughout New Delhi. The center that we went to, Don Bosco provides help for refugees with social, psychological and physical related issues. But their are also other centers of Don Bosco who do a whole lot more for them. For example, they teach them computer skills, how to sew and how to speak English and/or Hindi. They help refugees find jobs, places to stay and advice them in legal matters.

VIMHANS provides Don Bosco with a psychiatrist once per week to take care of refugees with psychological problems. All patients I have seen with the doctor today have undergone a lot of trauma and I was wondering the whole entire time who wouldn't come out of what they have experienced with psychological disturbances. A lot of them where depressed and/or had anxieties. The doctor herself questioned how much medication will really help if they have gone through so much. It takes so much more to heal wounds like that than just drugs. In particular, if a lot of the causes which have brought along those symptoms are still present. Just because refuguees escape from the countries, they a lot of times can't escape their problems. If a woman is being abused and falls sick because of it, how can medication help if she is still victim to that abuse.

In those cases there is so much more than a biological bases to the illness. People are suffering from depression etc. because of much more than simply a chemical imbalance in the brain. But having said that, who is going to provide them with the additional therapy, who is going to help them get out of their problems, who is going to help them improve their living situation and who is going to pay for all of this? Feeling of helplessness...

Battle Field, "Take two"

Today once more I was able to experience a psychologists verses psychiatrists battle. I talk a lot about the case presentations here so I want to explain them a bit more. We have presentations every Wednesday, Thursday and Friday. Presentations on Wednesdays and Fridays are usually conducted by Resident doctors while Thursdays the psychology interns take their shot. Most of the people sitting in the conference room are psychiatrists and only a few psychologists of which barely any speak up. And a lot of times when the psychology interns present they are criticized and questioned extensively on psychological theories, concepts and therapy approaches.

In particular, one of the doctors has a very strong belief against a lot of the psychology doctrines. But because she is the eldest among all, everybody has to respect her and her a lot of times strong articulated opinions. But today people have not been as patient with her as they usually are. Firstly because the intern who has presenting was pushed into tears by the comments of the doctors, specifically by the one just mentioned. The second reason why people have not been as patient with her today is becuase the presentation was overseen by a psychologist who took the comments pretty offensive as well. This scenario ended up in a battle field and left me wondering if this is how it is everywhere.

I am really surprised about this constant fight of psychologists against psychiatrists but I assume this is going to be the same everywhere you go. It might not be as openly presented as it is in this situation but I am sure that this clash between beliefs will be present in the US as well as in Germany or even all over the world. What do you think?

Art Therapy Continued

Today, I decided to share my painting with you. As I said last time, I painted a person in the rain. Even though the person is a male, he is symbolizing me and my "male" attributes. The male attributes would be my dominant personality, my anger issues and my assertiveness. I drew myself under the umbrella, creating a separate, isolated space for myself in which I can be me and do what I want. According to the picture I painted, I am very protective about my space and I only let selected people in that I want to have in. But when people come closer who I don't want to be closer with, I will not look down upon them; instead I will kindly let them know that they are not the person who I want to be close with.

I really tried to make the painting difficult accessible when I was making it. I wanted to challenge the therapist. However, the therapist tackled the conclusion down within a few seconds. First, I had to think a little over the analysis but when I am honest to myself then this is pretty much who I am.

After this experience, I came to the realization that art can really be used as a starting point for therapy. It gives the therapist a tool to get into the deeper level of the patient. I had no intention to open up myself in front of the therapist and tell her who I am but I did, unknowingly.

The therapist pointed out to us that we as therapists do nothing else but introduce the clients to themselves through the paintings. Sometimes people get too caught up with a million other things in their lives and fail to see who they are.   

"Only Americans and Schizophrenics talk about Sex"

"Only Americans and Schizophrenics talk about Sex," this statement was made by one of our Senior doctors today at our case presentation. She is the oldest among the doctors and she makes the case presentations interesting for me because she tends to make statements like the one above all the time. The case presentations happen early in the morning, presented by one of the resident doctors who usually are pretty hard to understand when they speak English and not to understand for me at all when they speak Hindi. As everybody can imagine, those presentations are not the most exciting thing I have ever experienced but mandatory to attend. So I always get hyped up when the Senior doctor contributes her thoughts to the discussion.

Today, the case presentation was on a dementia patient who has been a widow for the past five years. One of the doctors asked the presenter if he had inquired the sexual history of the patient and the presenter said that he hadn't since the woman has been a widow for the past five years... And then the whole scene started again. Even in this hospital we were taught that sexual history is part of history taking and should be inquired from the patient but the Senior doctor strongly opposed that need. According to her, we don't ask about sex, "only Americans and Schizophrenics talk about Sex."

Too funny... does she truly believe that?

Rain Season

It has started raining everywhere else in India but here in Delhi. Only two days ago it has finally started raining. I am actually glad to be able to breath again. It is incredible how people can function in 50 degree temperature. I have also been walking since I came here and even though it was not that bad, I can still truly appreciate the change in temperature now. I am not scared anymore to go home, chill, relax and take a nap because now I am actually comfortable being in my room. Before I was just sweating constantly and having to take a shower every hour to cool myself down. This is also the first time I am using a bed shed to cover myself at night. I have never appreciated some air so much as I do now. Thank you for the RAIN! 

Frustration

Today I realized for the first time that things are getting repetitive to an extent that I don't really benefit from them anymore. I liked doing everything twice at the hospital because I always felt that I didn't get everything I could out of it the first time. But now, that feeling has changed. I came to India to explore Vimhans' relationship to the environment but there is really no relationship and definitely nobody who I could talk to about this. And again I am on my on, trying to find things which I don't know that I am looking for. I have not found anybody who thinks that the environment can be used as a medium to heal people. I know that I might not be looking at the right places but I hoped for at least somebody who would want to explore that topic a little with me together. Concluding: there is nobody at MHC who could really guide me or work with me, neither is there anybody here who could help me and I am too lost to do it myself. I have come to the realization that the topic was created in my head and I have not gained enough background knowledge to put anything together or at least look at the right places. This is where a mentor comes in, somebody who helps you move in the right direction and look at the right places but if that's missing, it's almost impossible to make up for it. So my question is, should we then only pursue stable, solid and already existing research topics that can be supported by somebody. Maybe this is what I should have done instead of following my interest.

 I have to admit that I am also getting a little frustrated with my further planning. Where to go, what to look for, who to go with, how to manage to go to places I would like to see... As a female traveling by myself in a country that I don't know is really not easy!