The headaches that never go away
by Dr Nandini Chakraborty, Consultant Psychiatrist, Leicestershire Partnership NHS Trust
‘Headaches for six months. No physical cause identified. Refer to psychiatry’ – a quickly written line on a pink card smaller than a sheet of A4 paper, which formed the records for a patient in a busy state government hospital in Calcutta. The one-line referral from medical outpatients to their psychiatry counterparts formed the bread and butter of our clinical practice.
Emotional pain can come in many forms – headache like a tight band, unresolved back pain, unremitting tummy aches, mysterious joint pains, and unremitting cramps. Bursting pain, pins and needles, ‘like electric shocks’, twisting, wrenching, heavy… all adjectives that could describe their unhappy lives and the trapped conditions that a population in a developing country could live in when money is tight, a young family needs to be fed, elderly parents need to be looked after; a society where there is no government support for poverty, no benefit system – everyone to themselves.
There were other complaints – indigestion, lack of appetite, sleeplessness, constant tiredness, the lack of motivation to do anything. And always the frustration of something having been missed. “Depression? You mean I am imagining this? The pain that keeps me awake at night? The fact that my stomach cannot keep down anything that I force down my throat? How dare you? Someone has not read my reports right. Can’t I have another X-ray?”
When I later trained in psychiatry in a neighbouring state, in Central Institute, it was a standing joke about Bengalis. “Ask a Bengali patient what is wrong and he will take out a thick file,” one of my Marathi colleagues said over a sugary cup of tea in the cramped canteen where we exchanged patient stories. “My history starts from 1970 when I attended a marriage party and experienced my first bout of acidity. Since then things have never been right, says my patient, and then it is report after report, investigation after investigation – my heart sinks the moment I see that cardboard folder!” my colleague finishes with a sigh. Indignant though I feel for my community, I must admit that he is right. Depression in Calcutta was physical discomfort – as if raw emotions had vented themselves in raw pain.
Yet there is one woman who stands out in my memory. As I entered the outpatient department that day, she was crouching in a corner, sobbing her heart out on the edge of her faded thin cotton saree. The voices were telling her to kill herself but she had three children. How could she? “Shock me, madam,” she begged, tears running down her cheeks, her hands very close to clutching my ankles in desperation. “That is the only thing that works,” she cried, referring to electroconvulsive therapy. “Nothing else will take them away”… Somewhere at the root of mental illness the same chemicals run through our nerve endings, just as the same blood runs through our veins.
112 is the national emergency number for India.
Samaritans Mumbai: (samaritansmumbai.com) – +91 8422984528, +91 8422984529, +91 8422984530 – 3 pm to 9 pm, all days. samaritans.helpline@gmail.com. Helpline providing emotional support for those who are stressed, distressed, depressed, or suicidal.
AASRA (http://www.aasra.info/): 91-22-27546669 is a 24-hours a day, 7 days a week nationwide voluntary, professional and confidential services.
Sneha India (http://www.snehaindia.org) is available 24/7 on the phone by calling 91 44 24640050.