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18 June 2008

What's Wrong With My Body?

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Surajit Dasgupta
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(Click on the headline for details of cognitive behaviour therapy for hypochondriasis by the Journal of the American Medical Association)
The reproduction of this article in this blog has been provoked by a frequent topic of discussion at this writer's workplace: health profiles of the respective speakers. It amuses me, hailing as I do from a small town where I grew up leading a carefree and yet disease-free life, as to why the people living in big cities are often unduly worried about their health


Asukh: This film by Rituparno Ghosh showed how the mere thought of a disease can wreck a family
(Published first in The Pioneer on 1 October 2007)
Ever since The Pioneer published the story, "Indian woman stripped of her job for wearing nose stud in UK" (September 19), I have been trying to eat with my nose and figure out how it could possibly affect my hygiene and that of the people whose company I keep.

Jokes apart, what raises hackles is that the firm Eurest, while trying to justify the sacking of Amrit Lalji, stated that "jewellery can harbour bacteria, create a hazard when working with machinery and find its way into food..." So was a nose-studded Lalji, if not eating, cooking or serving food with her nose, handling machinery with that organ of her body? Howsoever funny this may sound, it is a very valid scientific question.

And the question is a pointer to a psychological disorder called hypochondriasis, a preoccupying fear of having, or acquiring from others, serious diseases. It happens to two classes of people: One, who are not able to engage themselves enough in constructive work and, two, amateurs in medical science.

The first class of people while idling around indulge in various useless thoughts, one of which is a compulsive niggling notion that something must be wrong in their body. It is, therefore, a major problem in those regions of the world where unemployment is a widespread phenomenon: Erstwhile socialist countries in Europe, a major part of Latin America and the State of West Bengal in India.

But hypochondria does not spare the prosperous people either. There, the victims are casual students of medical science. While being initiated into physiology, these amateurs read about various diseases and tend to take the reverse route to analyse their health. That is, they first read the symptoms, then recall their environment and physiological history, tally the third with the second and the first, and infer, wrongly, that one of the diseases mentioned in the books must have afflicted them. It is this reason that turns many Americans, Britons and Germans hypochondriacs.

As consumer awareness is high in these countries, and medical service falls in the ambit of consumer rights, lay citizens are given an elementary idea of various common diseases, their causes, symptoms and treatments. While this makes some people health conscious, others turn hypersensitive to possibilities of ailments. Employer Eurest, which sacked Lalji, probably suffers from this category of the psychological disorder.

But out of the two kinds of hypochondriacs, Bengalis are the worst hit. For them, it is a vicious circle where the first reason (decades of recession in West Bengal) augments the second (health consciousness). It is a rare phenomenon to come across a Bengali from the State -- probashi or non-residents are a breed apart -- who does not complain of ambol (indigestion). If the listener is unlucky enough to be caught unawares by a Bengali hypochondriac, a larger health bulletin will follow, and a gamut of gastro-enterological ailments will be listed.

Regular visits to the local physician, right from his childhood, gives a Bengali a fair idea of names of a plethora of diseases and drugs. This, rather than keeping him alert of impending health crises, keeps him preoccupied with a phobia of diseases. He is obsessed with bodily functions and interprets normal sensations (heart beats, sweating, bowel movements, etc) or minor abnormalities (a runny nose, a small sore, slightly swollen lymph nodes, etc) as symptoms of serious medical conditions.

A similar social condition makes Americans and Britons suffer despite their much better economies. Unlike in India, in the US and the UK, physicians' prescriptions are like packaged products. The recommended doses are legibly typewritten and pasted on the lid of a box containing the medicines. The other labels on the cuboidal box include the patient's medical history and side effects, if any, of the prescribed drugs.

A regular study of such medical kits turns the patient into a quack who thinks he can now afford to treat himself as and when he falls ill in future. Last week, a survey by food diagnostic company YorkTest found that of 12 million Britons who claimed to be food intolerant, less than a quarter had been formally diagnosed; 39 per cent of those polled believe it is trendy to declare themselves food intolerant.

The report suggests that the Brits have deceived themselves into becoming a nation of hypochondriacs with at least three million having wrongly convinced themselves that they are sufferers.

Hypochondria can be treated, but it takes time. And the tendency to have exaggerated health anxiety may not vanish completely. The patient should be first made to acknowledge the fact that he has anxiety, and not a serious physical disease. Then is the need to reduce his anxiety.

Hypochondria is often triggered by a major life event. For example, parents who have a single child after the mother had had several miscarriages, or the first one or two babies died, may rush to the doctor to get the surviving child checked even if he has an innocuous common cold.

Cognitive-behavioural treatment combined with medication, if needed, is perhaps the best approach. First, the patient explains his symptoms and the doctor makes an evaluation whether he has been examined well enough. Of course, the healers should not discuss whether the patient has his symptoms (pain, nausea, numbness, etc) or not, which are always subjective, and hence 'accepted'.

However, interpretation of the symptoms should be accurate. A hypochondriac believes something serious must have happened to him. He cannot imagine that his 'symptoms' can be caused by, say, anxiety.

During the treatment, the patient registers what he thinks when he notices his 'symptoms'. Hypochondriacs choose the most serious, but often least probable, explanation: Headache is not migraine or stress but brain tumour; chest pain is not caused by tense muscles but is a serious heart attack! They may believe, "It is normal to feel okay; that does not mean I'm fine... doctors may mis-diagnose even cancer!" So, the healers must first win their trust. Behavioural (checking the body less) and cognitive work (registering situations, thoughts, feelings and behaviour) therapies follow.

Are you a hypochondriac? Test for yourself. Below is a list of questions about your health. For each one, circle the number indicating how much this is true for you: 1. not at all, 2. a little bit, 3. moderately, 4. quite a bit, 5. a great deal.

  • Do you worry a lot about your health?
  • Do you think there is something seriously wrong with your body?
  • Is it hard for you to forget about yourself and think about other things?
  • If you feel ill and someone tells you that you are fine, does it annoy you?
  • Are you often aware of various things happening in your body?
  • Are you bothered by aches and pains?
  • Are you afraid of illness?
  • Do you worry about your health more than most people?
  • Do you get the feeling that people are not taking your illnesses seriously enough?
  • Is it hard for you to believe the doctor when he/ she tells you there is nothing for you to worry about?
  • Do you often worry about the possibility that you have a serious illness?
  • If a disease is brought to your attention (through the radio, TV, newspapers, or someone you know), do you worry about getting it yourself?
  • Do you find that you are bothered by may different symptoms?
  • Do you often have the symptoms of a very serious disease?

You arrive at what is known as the "Whiteley Index score", found by summing the responses to each question. The higher the score the more hypochondriacal you are. There is no set cut-off score, but healthy people without health anxiety generally have a score of 21 ± 7 (14 to 28). Patients with hypochondria are found to have a score of 44 ± 11 (32 to 55). If your score is high, you must seek professional help. Notice that if you are depressed, you might get a high score, and your hypochondriacal ideas might be secondary to your depression. The same is true if you have a specific or general anxiety disorder. In both instances, you must talk to your doctor.

The writer is a mathematician and linguist, now a corporate communicator and has been a journalist, a teacher and marketing manager (in reverse chronological order) in his previous vocations

Reason Is The Illusion Of Reality

Things exist because they do
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Debarshi Dey
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Reason and reality: these are the two parameters we constantly invoke in our post modern lives to validate and justify all that we think and all that we do. Such is the absolute power of these two concepts on our minds that even our Gods and our innermost dreams have to pass the twin tests: Are they reasonable? Are they realistic? We might use other words in their place: “scientific”, “rational”, “practical”, “pragmatic”, but they all convey the same meaning. In all our experiences, and in all our conscious responses to them, we try to satisfy ourselves that they have the twin blessings of being reasonable and real.

When these ideas of reason and reality are of so paramount importance in the way we live our lives, or rather in the way we think and make sense of things that are happening around us, let us ask ourselves: what do these words actually mean?

Reality:

What is reality? What are the things we consider as real, and what do we brush aside as unreal? In common parlance the state of things that actually exists out there are considered as real. How do we know what is actually existing out there? By our experience, we quip. But then do the dreams that we all experience while sleeping qualify as being real? No! we gasp! Dreams are imaginations of our minds, we reason, an experience that holds true only for the one who is dreaming, that too while sleeping. It has no truth once he wakes up. So for something to be real, it should not be an individual experience, it should be a shared experience. It should not be born out of the mind, it should be grasped by the mind. In fact, what we really mean is that reality remains reality whether we are observant or oblivious of it. It is that state of things which is out there in spite of us, independent of us.

Let us try to understand and analyze some universally accepted “real” events that pass these tests of objectivity. The rising of the sun in the eastern horizon and its setting in the west, is something we all experience. But the reality we know is on the contrary. The sun does not rise, neither does it set. It is the earth, and we by virtue of being its inhabitants, that go around it and delude ourselves with the experience of the rising and the setting sun. Though now this is primary school knowledge, humanity actually got to know and accept this “reality” only after much resistance and hesitation just five centuries ago. So we see, that shared experience can be far removed from reality. It is not experience per se, but a deeper understanding of that experience that qualify as reality.

There can be other examples: the blue ocean in reality is a colorless mass of water, the blueness though is the shared experience is not the reality, but reflection of the blue sky. The flatness of the earth, moving trees we see while traveling in a train, passage of time when waiting for a loved person, are all far from what the reality is. So we see this criteria of shared or personal experience as defining something as real may be misleading at best, delusional at worst.

Let us consider another example. A piece of cloth. Whether one has observed it or not, whether one has touched it or not, it does not alter the state of its reality a bit. It remains a darn piece of cloth. Now what is this piece of cloth in reality? Well one might say it is a collection of threads interwoven to give us something we call cloth. So a piece of cloth in reality is just a bundle of interwoven threads. Now it does not end there. One really persistent reality seeker will prop in that what appears as threads in reality is nothing but cotton. So what we observed as a piece of cloth, we have now realized in reality is nothing but cotton. So reality here turns out to be different levels of observations. Can this be called different stages of reality, where the higher stage does not contradict the earlier stage, but subsumes it with itself? Whatever it is, we see that there can be multiple way of making sense of the same reality. Reality is not a frozen and rigid thing.

But this idea of going to the next basic level of reality of a substance can be extended even further. Cotton is made up of molecules, molecules are made up of atoms, atoms are made up of empty space and a sprinkling of electrons, protons and neutrons, which are in turn made up of deuterons and other smaller particles, and finally if we believe and follow today’s physicists we conclude they are nothing but wave forms of energy giving us an illusion of matter. Lo and behold! Searching for reality we end up with illusion. But alas! This is the true picture of reality we obtain when we try to zero in on a substance removed from the personal experience of it, dissecting it with an impassioned zeal of objectivity at the altar of impersonal physics and mathematics. We wanted reality, pure and non-corrupt, and we got it.

Now surely this is not what we meant when we started out on our quest for reality! Matter may be mainly empty space and swirling waves of energy, but it is evidently not the first thing that comes to our mind when we talk of something as real as matter. What is then real in our everyday life, can be alternatively explained by two conditions: they are the information and impulses we receive though our senses that has the property of repeatability and a rational/logical meaning to it. Dreams are not real because they fail the test of repeatability. Rising and setting sun is not real because they fail the test of rationality- the earth is orbiting the sun, hence though it appears that the sun is rising and setting, that is not supported by the rational understanding of the earth and the sun’s motion. Matter, and not waves are real, as far as our every day life experiences goes, because our senses are not refined enough to pick up the subtle nature of matter.

Now agreeing with this definition of reality, let us consider we have a nice smooth red ball in our hands. If I hand over this ball to my friends, they would all agree with me that it’s a nice little red ball. The ball remains nice and red now, tomorrow, next week, as long as I don’t break it or paint it blue. So with our agreed definition, this little red ball is a real thing. The realness of it consists of its color, its shape and the material it is made up of. Let’s first look into the reality of the color. What is the reality of its redness? Redness is nothing but an experience that is triggered by certain receptors in our retina when light rays or energy of certain frequency or wavelength falls on our optic nerves and is carried as electromagnetic waves to them. The wavelength was not red in color, or the receptors, or the optic nerves. The redness is purely a quality that arises in the mind. So what is the real color of the ball independent of our experience, repeated, shared, logical? Similarly the shape of the ball which is so real to us is also the way our mind interprets the impulses it receives from the real shape of the ball. Is there any way we can experience the reality out there independent of our mind, independent of our consciousness?

Then of course there is the question of the real world out there: the real world where, we are told, every one is up against every one in their struggle for existence, the real world where material possession and power are the prime motivators of most human endeavors, the real world, where each one pursues his “self-interest”, where one person’s self-interest is mostly at odd with another person’s. The real world where every one goes on living a life as if death is the most unreal, uncertain thing. In this rush for accumulating and achieving, the fragility and fleeting nature of life do not register as real. But what can be farther away from reality? We all “know” death is the only certainty, the only constant factor of life. But in our conception of reality, we choose to remain oblivious to it. The mermaids, the fairies, the angels, the demons that were so real co-inhabitants of our world when we were kids, we realize were fantastic ideas and products of fertile imagination of our tender mind, which have no reality with our advanced understanding of the nature of reality. Is this not the case also that in our being grounded in “reality” as we understand it, the things we consider as so real, that we don’t even doubt their validity and take their existence as an unquestioned fact, is also an elaborate imagination we have constructed for ourselves to remain secured in the state of delusion we find ourselves so comfortably situated?

Reason:

Reasoning is born out of the assumption that everything we see around us has a coherent and connected meaning to them, a meaning we have the cognitive ability to grasp and make sense. Barring a few self-evident events and phenomenona, like the fact that we exist and are self-aware, we try to understand everything within this logical framework of thinking we call reasoning.

But what is interesting to notice is reason is a product of our thinking, a “logical” way of explaining things we see around us. Let me illustrate with an example. The reason why planets orbit around the Sun, we were told by Newton, is the force of gravitation. But then almost three centuries down the line, Einstein came and explained, that the real reason the planets orbit around the sun is not because of gravitation, but it is because the space on which the planets rest is curved and hence it appears that it is orbiting round the sun, while it is only moving in a straight line on that curved space. So we see the reasons behind the things we observe and experience change with our increased understanding of them. So no more is the reason for an eclipse a huge snake swallowing the sun, but it is because the moon comes in between.

Every event we witness, every experience we have, we want to believe that there is a reason behind it. And more importantly that reason is comprehensible. Either we have already made it out, or with furtherance of knowledge, we are sure, we will make it out. This optimism about our power of reasoning is the motivation behind all scientific enquiry. In our ever broadening field of experience and reasoning, we come up with new reasons to explain the same phenomenon. What is today’s reason was yesterday’s fantasy and may be tomorrow’s naiveté. How can we be so certain about the rectitude of today’s reasoning then? All we can say is that this is how we understand it today. That’s all!

Now let us consider another situation. Let us suppose, in a room water is boiling in a kettle. Three persons come in and they are asked the reason for it. The first person, with all his scientific knowledge, says that it is boiling because the molecules are in an energized state. The second person walks in and reasons that it is the fire under the kettle which is making the water to boil. The third person, who actually put the kettle of water on the fire, has his own reason though. He says the water is boiling because he wants to have some tea. Now which reason is more acceptable? Or which reason do we put aside as unreasonable? Here we see an example of reason being subject to the observer. We find the reason for an event, that suits our subjectivity. If in the earlier example we saw one reason superseding another, here we see multiple reasons being perfectly reasonable at the same time.

But the most remarkable thing about reason is not that it is neither final nor is that it is not unique. It is this belief about reason that it has to accompany our every experience. What makes us so certain that every experience we have should have an underlying reason? And if there is one, how do we know we are so wired that we can make it out? Rightly that is?

The reason that we have synthesized with our reality, both stands on foundations that are far from solid. They are subject to subjectivity, interpretation and change. Both are intensely a product of human experience. Hence there is no way we can conclude there is a finality to them. The number of questions they answer are minuscule in comparison to the questions they have no answer for. This being the case, is it too presumptuous to say, “Reason is the illusion of reality”?

The writer is a PhD student of Statistics at the University of California, Riverside, USA

17 June 2008

Bottling The Truth Or Sugar-Coating It?

Shivraj Patil must come clean
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M Ratan
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Ambala, New Delhi, Latur, June 6: Union Home Minister Shivraj Patil’s record in office may not be much to write home about — a string of terrorist attacks across the country since he took charge and no sign of a breakthrough in any case. On one front, at least, the Minister has delivered — by providing the clout of his official address to help his son’s businesses, from a distillery in Haryana to a sugar mill in Maharashtra.
An investigation by The Indian Express in New Delhi, Ambala and Latur has found that the Home Minister’s son Shailesh Patil and daughter-in-law Archana Patil have cited the Home Minister’s official residence, 4, Janpath, as their address when they became part of a Rs 149-crore distillery project sprawled across 52 acres in Ambala.
Records obtained from the Registrar of Companies and pollution board authorities show Shailesh and Archana Patil joined as directors of N V Distilleries Ltd on May 9, 2005. The plant started bottling operations for major brands, including Seagram’s, three months ago.
Shailesh Patil, who works out of an office in his father’s residence, told The Indian Express that he has a 50% stake in the distillery. But its chairman Ashok Jain claims that the Home Minister’s son “has no financial stake.” Jain, however, admits: “Having Shailesh Patil on board added to the profile of my project.” He isn’t off the mark.
For, records show that the Union Environment Ministry violated its own guidelines to clear the distillery’s expansion (more of that later). And several officials in the Haryana Excise and Pollution Control departments admit to be under “strong pressure” due to what they call the “4, Janpath connection.”
When contacted, Shailesh Patil declined to discuss this project and said: “Given my family background, I like to keep a low profile. There is nothing about the distillery project we have to hide. I feel very satisfied that such an investment in a rural area provides employment opportunities for poor farmers.”
At the distillery site, villagers of Badoli — where most of the land acquisition was done — allege they have been “cheated” by the distillery owners since they were not provided employment as they had been promised. Village Sarpanches of adjoining Gola and Sherpur villages allege their land has been “usurped” as the distillery expands its operations.
Far away from the distillery, in his father’s former constituency Latur, Shailesh Patil is also the chief patron of a sugar cooperative mill in Nalegaon. That factory, which Shivraj Patil helped start, is steeped in losses and debt, is fighting scores of legal battles and is struggling to survive even as it is making expansion plans.
The annual report of the factory describes Shailesh Patil as a “young leader” who is the “margdarshak” or guide and whose picture is printed ahead of that of the chairman.
Chairman Manikrao Patil, a doctor who is related to the Home Minister’s family, says he has been running the factory for the last two years “with the help of Shailesh.” He admits that “Shailesh’s presence helps as he involves himself in getting the required permissions and also in interacting with the commissioner of co-operatives in Pune and at the CM’s office.”
Workers and the management headed by Manikrao blame the previous one for the factory’s plight and even accuse it of corruption. The previous management, which was headed by Basavjirao Patil, a local Congressman, in turn, blames it on “market conditions and the vagaries of cane farming.”
But everyone is unambiguous about one aspect: the involvement of Shailesh Patil. Says Basavjirao Patil: “During my tenure, too, Shailesh Patil took equal interest and would accompany me when I had to meet government officials. At the government level, he is the one who makes phone calls when we need any help. He also has helped us when we have had to answer banks.”

Report by Ritu Sarin & Smita Nair for The Indian Express


In a series of four investigative reports (June 7-10), a national daily with editions from 10 cities, The Indian Express, recently accused Union Home Minister Shivraj Patil of letting his son, Shailesh, and daughter-in-law, Archana, carry on their business of a distillery in Haryana and a sugar mill in Latur, a former constituency of the minister, from his official residence: 4 Janpath, New Delhi.

It is alleged that using his father's official standing in the UPA Government, the son is "pulling strings" to secure all necessary clearances -- environmental and bureaucratic -- without a hitch. It's interesting to note how promptly the minister's official Janpath address opens its doors in matters of convenience. The fact that the home minister's son and wife are living with him, the latter could not possibly be unaware of the former's business and industrial activities. No wonder, Shivraj Patil or any spokesperson representing him -- the Principal Information Officer(PIO) or the DPIO directly dealing with the Home Ministry in the Press Information Bureau(PIB) -- has not thought it fit to respond to the serious charges of the minister's alleged connivance in his son's dubious operations.

The Indian Express claims to have sent a fax followed by a reminder, seeking the minister's rejoinder. But he has clearly chosen to remain silent. Neither his party, the Congress, nor the PMO headed by a man reputed for high integrity and principles has chosen to come out with an explanation of the alleged misuse of the minister's official residence as a business address of a relation of his (son or whoever that might be). What an example of transparency and accountability!

With ministers like Shivraj Patil, does the ruling party need any more enemies?

The writer is known for his letters that are published at frequent intervals in various national newspapers

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Surajit Dasgupta treats no individual, organisation or institution as a holy cow.