When children become our mirrors
[Music]
from my early childhood days i knew
intuitively that i was letting people
down i tried i really tried hard but
nothing seemed to work
therefore you can imagine everyone’s
surprised when not only did i get into a
top medical school
but somehow managed to complete it too
after graduating in medicine came the
dilemma
what do i specialize in after much
discussion and anguish
i chose psychiatry to most people’s
surprise and disdain
i remember my dhih my favorite
grandparent
exclaiming with deep disappointment
after all these years of hard work
is that all he could think of becoming a
pagola doctor
a doctor for the man
the stigma and shame around mental
illness was deep and continues to be
after all these years
yet i held on as there was something
about mental health that really
intrigued me
perhaps due to my own brush with it
while training in psychiatry i
gravitated naturally towards
child and adolescent mental health
working with children and their families
i discovered the joy of being
unpretentious and spontaneous again but
what struck me the most was the uncanny
knack
of holding a mirror to the adult world
where we could see our
own values and double standards our
dreams and disappointments
as well as as our challenges and
failings
it was in the so-called naughty kids
that i saw my reflection
particularly the ones that are bouncing
off the wall and getting into trouble at
home
school or the playground who ever so
often were written off by the world
i saw my troubled childhood in their
eyes my angst written adolescence in
their words
i’d grown up hearing my childhood
stories told and retold with a
combination of despair and amusement by
my family
as a toddler how my mother had to tie me
with a saree otherwise
i would run away or how i was ready to
take risky chances
from an early age i have experienced
being the invisible child in a
classroom due to my struggles with
academics
or being singled out as a failure
knowing these kids was like coming back
a full circle
it struck me that very much like some of
the kids i was treating
i too had adhd attention deficit
hyperactivity disorder
but just like i had resisted being
slaughtered into a single story of
being only a troublemaker i could not
allow these kids to slip into a
single story of adhd in my life i was
lucky to find people who could
see me in a more wholesome way and keep
faith in my abilities
and that is how i wanted to help the
kids i saw
not slot them into problem saturated
boxes but
create spaces for them to be seen heard
and to find richer stories for them
and for that to happen i had to see them
through different lenses
and not just through the traditional
lens of mental illness and treatment
and in this journey of being not just a
psychiatrist
but an advocate for children i picked up
different lenses on the way
which i want to share with you today and
reflect and why it may be important for
all of us
the first lens i discovered quite early
was that
do not write off people who develop a
so-called mental illness
they are much more than a cluster of
symptoms and label
indeed they carry many other stories
that can make their lives much richer
and meaningful if they find a space to
tell them
i remember 17 year old ajay who had come
from a
small town in central india he had been
labeled
as a psychotic patient and was taking
eight different
medicines in a day he had dropped out of
school
could barely step out of home had lost
all connection
with friends and cousins had put on
weight and had recently started losing
control
over his bowels he was virtually written
off by school his so-called friends
and extended family that’s when his
parents decided to bring him to the
child psychiatric department of an
institute in bangalore
where he was admitted for the next
couple of months
the first thing our treating team
decided to do was to take him
of all medication and observe and what
emerged was refreshing
as ajay started moving and talking more
freely expressing his desires and hopes
about school and college
with less fear catching us by surprise
with his sense of humor
getting excited about his session and
his passion and cricket
and wanting to reconnect with his
friends
and suddenly the human being and
teenager in ajay
came alive although ajay did eventually
get a diagnosis which needed treatment
he and his family went back home with
hope and possibilities of a future for
him
my second lens we cannot hold young
people responsible for their mental
health struggles
which so often shows up as difficult
behaviors instead
we all need to come together to take
collective responsibility
this lens came to me in the next phase
of my journey
in an attempt to train further in child
and adolescent mental health
and to experience the workings of the
world outside india
my wife shelagh and i took off to work
in the uk
in the mid 90s and stayed there for the
next eight years
working for the nhs the national
national health service
though the nhs has its own struggles and
challenges we learned
how social structures can be created for
the best interest of the child
i saw how care can be rooted in the
community
with schools social work child
protection services
even police and and responsible citizens
can come together
to look after their troubled young
people another thing that changed our
lives forever
while we were in england was having our
children first nishat and then anya
they filled our lives with excitement
and meaning but challenges too
as they added an additional lens a
mirror another mirror
yes it is not easy when you are
surrounded by children at
work and at home they have sensitive
radars for and hypocrisy
i believe that our children helped us
grow and realize even more
that we had to do something to make this
world a better place for our own
and other children to thrive with that
determination we returned to india with
a single-minded purpose
of developing child and adolescent
mental health services
cams in short to which i’ll refer to now
and then
friends and well-wishers advise us not
to pull up put all our eggs in one
basket you know as a society they said
was not ready for it yet some told us
that children in india
did not have mental health problems and
that child abuse
only happened in the west but we stuck
to our
child friendly guns doggedly and in 2004
under the ages of a welcoming
multi-speciality hospital
we started the first dedicated camps in
delhi
within two years we were struggling to
cope with the deluge of referrals
despite our growing multi-disciplinary
team
in another couple of years we were
bursting at the seams in the limited
space the hospital could
provide us and so in 2009 we took a
leap of faith to break away and form
children first
an organization looking after the mental
health needs of children and adolescents
placed within the community this time
i believe that children first was
waiting to happen
the gaping needs of young people in
today’s times was demanding it
it was not surprising therefore that in
the next 10 years
it became one of the biggest stand-alone
facilities for
camps in india and it also evolved in
ways that we couldn’t foresee which came
from our responses to the children and
families
we met and the interface with the larger
community
and it is in this context and
experiences within it
that i picked up another two lenses
take the case of 15 year old sahil a
bright and talented young man who had
started hating school
and studies since he was he came to
middle school
a voracious reader a deep thinker he
would question everything
especially the education system parents
and teachers had given up on him
as he was bunking classes failing in
exams arguing with teachers and
disrupting the class with his
so-called rude and defined behaviors and
more recently
worryingly he started experimenting with
substances of abuse
but sahil was not always like this do
you know as a younger child he was a
curious and imaginative playful and
affectionate
and wrote exceptional poetry although
quick learner
and clear with his concepts he was a
dreamer in class
and would often struggle to complete
academic work both in school and at home
things had clearly become much more
complicated by the time he came to see
us
sahil was diagnosed with adhd and it was
evident
with a lot of that a lot of his angst
and aggression
was in response to the judgment and
criticism that were thrown at him
from middle school onwards a time when
school becomes increasingly
uncompromising with studies and
academics he was on the verge of
slipping into depression
or serious substance misuse had it not
been for the timely intervention
one can imagine how his story could have
been so different had his parents and
teachers
recognize that he was wired differently
and responded to his talents and
abilities
rather than his failings or
consider the story of 12 year old
shannaz who was
brought by the police to a reputed ngo
that i work with closely
along with her 10 year old sister
shaina’s now had disclosed that her
stepfather
had been sexually abusing her repeatedly
after their mother’s death
from the time she was nine years old she
had kept quiet till she noticed that
this man’s roving eyes
were increasingly falling on his other
growing daughter
and shaynaz could no longer bear the
thought of the impending doom
that was awaiting her little sister
the man was promptly celtic sent to jail
under the stringent law of
pogso which is the prevention of child
sexual offenses
act in india and the extended family saw
shahnaz’s act of care towards a sister
as selfishness and blamed her for
breaking the family
and denounced both the children shania
and her sister
were accepted and nurtured in the ngo
and settled well in their new home
over the next few months till shannaz
was taken for a mandatory visit
to the state-run cwc or child welfare
committee which is meant to take care of
children’s welfare as their name would
suggest
but instead they questioned her motive
and admonished her for bringing
disrepute to the family
shannaz plunged into depression plagued
with guilt
she made a serious suicidal attempt and
started getting disturbing nightmares
and
flashbacks from the days of abuse by her
own father
it took her many months to recover from
the tormenting symptoms
and for healing to begin it was ironical
that shania’s attempts at saving a
little sister
from sexual abuse provoked such extreme
reaction from adults around her
the same adults who would be expected to
protect her damaged her further
working with children like sahil and
shanna’s gave me my third lens
i realized that children can be wired
and inspired differently
and some might have the propensity of
developing
mental health difficulties under stress
but it is the reaction of adults and the
world we have created around them
that makes it much more complicated and
damaging for them
i have so often seen that in our apathy
and the callous responses
of our institutions that drive our young
people to despair
and disruptive or even dangerous
behaviors
and then last year covert 19 happened
which demolished some of the foundations
of our society that were
cracking up already we were all impacted
by it but it was the youth that bore the
brunt of this brutal blow
suddenly mental health became a crisis
and we were overwhelmed with stories of
despair and death
at children first we responded by
starting a brief therapy service for
young adults
hundreds of isolated young people
started reaching out to us for help
cut off from families and friends with
little access to activities
and spaces that breathe life and meaning
into our existence
many lost their fledging jobs and others
could not go to college
as their planned what struck us what
that
so many of them were considered capable
well-adjusted
and successful young people before the
pandemic took away all freedom
and agency from their lives my fourth
lens
came from this realization that mental
health problems do not
in any way indicate that people are
damaged broken or weak
given the same context and circumstances
any of us
would respond in the same way
in summary i would like to emphasize it
is not
abnormal it is not abnormal to feel
despair in hopelessness
or to develop symptoms of anxiety or
depression when you’re completely
isolated from family and friends
and have no certainty about the future
as so many young people did in the
pandemic lockdown
it is not unusual to lash out with words
become rebellious and start taking
dangerous chances like style did when
you’re judged criticized
and marginalized for having difficulties
in learning
and isn’t it amazing that a 12 year old
gathered the courage to take a
definitive stand to protect her younger
sister from a sexual predator
and it is understandable when she
crumbles in the face of shaming and
ostracization
for those very acts of courage and
starts getting
terrifying nightmares of the sexual
abuse she suffered as a child
like shanna’s did it is indeed the norm
both functionally and statistically
to go through mental health struggles at
some time in our lives
just like we all go through physical
health or financial troubles
it is therefore vital that we begin to
accept it as an integral part of our
lives
become more aware and equipped to deal
with it
so bringing together my four lenses
number one do not write off people who
develop
a so-called mental illness they’re much
more than a cluster of symptoms and
labels
indeed they carry many more stories that
can make their lives much
richer and meaningful if they’re
provided a safe space to tell them
we cannot and that’s number two we
cannot hold young people
responsible for their mental health
struggles which so often shows up as
difficult behaviors
instead we all need to come together to
take collective responsibility
number three young people can be wired
and inspired differently
and some might have the propensity of
developing mental health difficulties
under stress
but it is the reaction of adults and the
world we have created around them
that makes it much more complicated and
damaging for them
number four mental health problems do
not in any way indicate that people are
damaged
broken or weak given the same context
and circumstances
any one of us could respond in the same
way
the pandemic has jolted humanity and
made us question the way we have
treated nature and our environment and
has raised doubts about the meaning of
success
the institutions that define it and our
mindless pursuit of the material
it has also given us an opportunity to
reconsider
our priorities in terms of mental health
and well-being
but the question is how much of our mind
space and resources are we willing to
devote to it
in the so-called new normal each one of
us can be a catalyst for this change
so i have one thing to say to you
whether you are a parent a teacher
mental health worker a young activist or
just a person who cares
together we can create a movement for
our children
and youth are you ready for it
you