Economic and Financial Implications of Mental Illness - An Open Letter to the Prime Minister

Economic and Financial Implications of Mental Illness

An Open Letter to the Prime Minister

Some Time in May, 2010-Abridged part of this Article was Published in the Economic Times on the OP-ED Page (Editorial) Page on 1st June,2010

Respected Dr. Singh,

In the Life of a Nation some dates are defining. For India, August 6, 2001 was one, when dozens of hapless chained mentally ill were roasted alive at Erwadi, Tamilnadu, when fire engulfed the Moideen Badusha Mental Home. Sadly, as we enter the decadal year of the monumental tragedy, Lessons of Erwadi largely remain unlearnt.

This letter solicits your attention to the existential, institutional and policy implications of the grave malady of Mental Illness inflicting the nation. It also appeals, on behalf of muted millions, to intellect, erudition and conscience of the Prime Minister. And, there is urgency -seldom do nations get second shot at deliverance after squandering the first - 7th May, 2010 was one such date, on which following two coincidently happened simultaneously:

First, an open letter reached Union Minister of Health, architect of the letter being Hon’ble Justice Ajit Prakash Shah, retired Chief Justice of Delhi High Court. Six page letter is a factual account of state of rightlessness and non-person status of mentally ill in India. One paragraph of the letter is reproduced verbatim here “discrimination against people on the basis of diagnosis of mental illness is common place in India and even in the laws in India. If the multiple laws which sanction the discrimination are not addressed simultaneously then the persons living with mental illness will continue to be incarcerated in institutions”.

Second, latest issue of Tehelka has come out with the headline: “Someone close to you is screaming for help-LISTEN” and the byline “unattended, ignored, millions of families are struggling with someone who is mentally ill. But India has virtually no mechanisms to deal with this”. Its cover story “Mind Snare” traces the tragic debris of destroyed lives in a well-researched and objective manner. You will find the story heart wrenching and as one which brings the Naked-Naked-Truth of the suffering of mentally ill and their equally hapless care-givers. But, I doubt the article will have any lasting impact on our conscience, so deep rooted and exasperatingly imbedded is the stigma against psychiatric illness in our national psyche.

Sir, through most of human existence, 99.99% people, leave the world, having embattled their life as a symbol of inertia and cultural statis, some how managing to keep their life and family together. Dr. Manmohan Singh, over two decades has proved to be one from among that 0.01% people, who disrupt equilibrium and to whom posterity accords the status of world changers. Today the subject of Psychiatric Illness begs your personal attention, if not for the reasons of rights and inclusion as brought out by Justice Shah or for the sheer state of desperation as brought out by Tehelka, then for the sound economic and financial reasons brought out here. I dare say Sir, psychiatric illnesses as a group have turned serious deflators of Indian Economy, and the impact is 2-3% of GDP per annum.

The task of making difference to life and times of sufferers of psychiatric illness is humongous and shall remain non-starter unless championed by you. I do understand your compulsions- governmental resources are finite, and the buck stops at your level to exercise the hard choice between alternative uses of same resource. But Sir, how can the dream of Indian century be actualized if we persistently refuse to or are unable to use Whole Mind of the Nation.

I trust this letter ignites the mind of humane development economist in you and my aim is definitely not to elicit sympathy or empathy quotient for the mentally ill. Assuming we ascribe zero value to human costs of psychiatric illness, the economic costs themselves-both direct and indirect are staggering. Given the famine of even homegrown etiological and epidemiological studies of mental illness in India, for analyzing complex issue of economic and financial implications, I have relied on the external wisdom. Nevertheless, they do provide insight and replicable lessons for informed public policy:

One, during your tenure as Finance Minister, the World Bank in its 1993 World Development Report, highlighted Mental Illness as major contributor to the Global Burden of Disease. Also in 1995, a study by the Massachusetts Institute of Technology found depression costing American industry $43.7 billion annually, including $23.8 billion in lost time due to absenteeism and reduced productivity, $7.5 billion in lost earnings due to depression related suicide and $12.4 billion in direct care costs

Two, Dr. Kathleen Merikangas of NAMI and Ronald Kessler of Harvard Medical School in a study published in Archives of General Psychiatry in 2007, concluded, annual loss of 1.3 billion working days in U.S. due to mental disorders, 50% to all chronic physical conditions combined. Subsequently, in, 2008 the American Journal of Psychiatry, extrapolating from another study by Kessler et. estimated total annual economic cost of serious mental illness in US having doubled from US $ 156 to 317 billion between 1992-2002 excluding costs of comorbidity, incarceration, homelessness, and mortality. By, 2010, this annual loss is, expected to be nearly half of annual GDP of India

Three, WHO in its 2005 Report “Economies of Mental Health’’ concluded that economic costs related to mental illness accounted for 3-4% of GNP in EU nations. Also, Sainsbury Centre for Mental Health in UK estimated this cost to English Economy as Pound Sterling seventy seven billion per annum. Both these numbers are dated today.

BY 2020, the pandemonium of Mental Illness will engulf one member of every family in the country and we need Indian Next Practices and the golden touch of Manmohanomics to combat the scourge. Present dysfunctional paradigm which perpetuates incarceration of sufferers needs speedy burial. The CHOICE program of WHO provides some hope- 300 to 500 million years of healthy life could be gained for every US$ 1 million invested on mental care. The pay back period is nano-low and rate of return exponentially high. You can make tomorrow come today.

Yours Truly,
Akhileshwar Sahay
Principal Instigator
Whole Mind India Foundation

When a Turbulent Mind found its CALLING of LIFE

When I landed at Chennai Airport in early hours of 1st July, 2010, I was unaware, the visit would again alter the course of my five decades of Roller Coaster Life lived with Turbulent Mind. I was greeted on arrival with warm and triumphant smile by the person carrying a placard “The Banyan” and was escorted to a vehicle which said “I Exist Therefore I am”. The normal calling of the vehicle was to ferry rescued wandering Mentally Ill women from Chennai Roads to transit care hospital run by the Banyan. It was befitting that in this extraordinary trip I would have fortune to board the vehicle-It was poetic justice to my Life and Times lived with debilitating Manic Depressive Insanity, secularly called Bipolar Disorder, diagnosed 13 years ago. Unlike my usual corporate journeys to Chennai when I would stay in luxurious star hotels and driven in swanky cars, this special journey for three days was a humbling experience. In my abode for three day stay, Asha Niwas, the room was devoid of luxuries of modern life, except a noisy air-conditioner. Still it was soothing and heartwarming and I had a room companion, the person representing Sir Ratan Tata Trust for the three day event: “National Seminar on Mental Health organized by The Banyan and BALM (The Banyan Academy of Leadership in Mental Health) supported by Navajbai Ratan Tata Trust.


I was listed as one of the speakers on the first day in the inaugural session under the category “User Survivor”. I was humbled and honored at this magnanimity of organizers as a late gate-crasher to the event. This was more so because, instead of being a domain expert on Mental Illness, I thus far was a hapless sufferer of one of the worst forms of insanity known to mankind, an illness where there is only temporary tenuous illusory remission and no permanent recovery and whose etiology and cure has belied the medical and scientific community for more than two millenniums since Hippocrates. The seminar schedule was packed, I was self invited with promise to organizers to finish my presentation within ten minutes. I was there primarily for immersion in the subject which I needed to understand for existential reasons and learn from luminaries, experts and activists working for decades against all odds.

What stuck me most at the Seminar, was presence of an old gentle man of ninety years, intently absorbing full three days of proceedings- he turned out to be one B. Aravind Vellody, India’s past ambassador to world at large, writer of the book “Around the World in Eighty Years” and past-chairperson of the Board of Trustees of the Banyan. Also among delegates was a warrior of rights for disabilities, in wheelchair due to his cerebral palsy, a mental illness cause champion, who sacrificed her marital bliss to be a care giver to a Schizophrenic brother and a petite girl, who had happily assumed arduous role of care giver to the mentally ill sister of her husband.

The seminar turned out to be defining three days for mental health movement with erudite speakers, their zeal, passion and proven track record in preventing, treating, managing, rehabilitating and improving the life and time of mentally ill. The roll-call of speakers was headed by a learned sitting judge of High Court, a doctor Minister from Tamilnadu, relevant government officials, President Elect of Indian Psychiatric Society, leading psychiatrists, other professionals, academia, front line NGOs, advocacy groups, media, caregivers and users. Most impressive were those working with passion at the bottom of the pyramid with destitute and home less mentally ill on the streets of Chennai, Kolkata, Delhi, with tribal’s in Nilgiri range and at beggars home of Mumbai and Delhi. My own contribution was limited setting bizarre process precedence by consuming 90 minutes of proceedings against allotted 10 minutes bringing chaos to Seminar schedule.

The Chennai visit proved chastening, learning, exhilarating, living and extraordinarily humbling journey for me. But what changed the facts of my life for ever, was listening to the wrenching story of the valiant warrior Thiruchelvi who, in last six and half years renewed herself with a miraculous turnaround in life - from the stage of a mental wreck in readiness to sell her two and half year old baby son for a bowl of rice, to the one who was deserted by her husband in her mentally ill state, the one who was rescued from Marina beach and rehabilitated back to normalcy by the Banyan and the one who today gives transformational lectures on bringing new meaning to Life Lived with Madness and Sadness and Mental Wellbeing. Thiruchelvi taught me “There is Life Beyond Madness and Sadness even in extremities of Penury and Hopelessness”. Thank u Thiruchelvi, my teacher, for imparting this one of the greatest learning of life.

I had gone to Chennai with the greed of sharing my own story “Of Madness and Sadness” and the rainbow coalition of my Life, which had given me the status of a relatively successful knowledge worker in the country, despite leading a disrupted undulating life alternating between the abyss of depression and high of Mania. What I came back with, was the indelible impression of gratitude and the lingering memory of a rainbow coalition provided for restoration and giving dignity to the Life to Thiruchelvsi. A sense of I can.

I found new meaning and new calling to my Life midway of the seminar and left Chennai with new found faith – “I would not let my Audacious Dreams for Whole Mind India Foundation (WMIF) die young or unsung, even if it takes my own life prematurely to the grave in the process. The dream of WMIF is to become ultimate rainbow coalition for aggregating all the non-governmental efforts to achieve illusory Total Mental Health Status and to dedicate balance years of my uncertain life to capacity building of all the stakeholders to fight the unequal war of removing stigma, darkness of veil and discrimination from which mentally ill suffer. Chennai enhanced my adrenal to Fight, to envision more than what I was capable of. It also gave me the strength; I found fellow travelers and many of them walking the thorny path for quite a while.

The task assumed by WMIF is daunting and path has blind alleys. Sadly, my own life is fragile, Consensus research, puts my expected life-span ten year lesser than a normal Indian, owing to the complexities of my bipolar disorder & co-morbidities, including substance abuse ( obsessive compulsive smoking) and/or side effects of life and mind saving psychotropic Medication (choice is between life long medication or insanity). This realization of fragility of my life, combined with the constitutional status of a person “with unsound mind” and a non-person status under various statues of the country due to my manic depressive insanity, I have taken a conscious call. And the call is: “I might have been the Principal Instigator of WMIF, but would not hold any position in the governance structure of the Foundation ever. Having been certified as one suffering from serious mental disorder by AIIMS, I, as a responsible citizen, would not take refuse under the legalistic position that I have not been declared of “Unsound Mind” by a court. I accept the reality of my life- my semblance of sanity, is handiwork of medication and other enabling conditions, and will be there is there only till the tenuous Remission lasts. Last, it remains daily battle with violent undulating moods of my SAD (seasonally affective disorder) Bipolar Disorder. My madness can strike back any time with undefined severity.

Chennai also concretized the idea of commemorating India entering tenth year of Erwadi by observing it as India’s First National Mental Health Awareness Day. The name Re: Mind India and its logo came from the creative mind of Vaishnavi Jaikumar to reminding a nation of the Sacrifice of Erwadi Martyrs and to take a pledge not to let Erwadi happen again. It is a year long inclusive festival to celebrate every step of inclusion and banish every trace of stigma and de-humanization attached to Mental Illness.

Re-mind India starts on 6th August the day we enter 10th year of monumental tragedy of Erwadi. It will ask seminal question “Why people land at Erwadis of India in the very first place and what has changed ten years since Erwadi”. And the only visible answer is, India is increasingly getting disrupted with more and more joining mentally ill bandwagon with psychiatric services for prevention, cure and rehabilitation falling woefully short of requirement. From families, society, government to all other stakeholders, all are lacking in even appreciation of the problem and remain oblivious or turn blind eye to graveness of the situation. While country pays collateral damage in terms of serious psychological, familial, societal, institutional, organizational and national disruptions, including humongous economic and financial costs, the sixty year old festival of denial continues. Leaving all human suffering aside, India is at a cusp where Mental Illness has turned serious deflator of GDP by minimum 2to 3% per annum.

On 6th August, We the People of India take a pledge- “Not to Let Erwadi Happen Again” and we will light CANDLES OF REMEMBRANCE AND HOPE. This 6th August, and every year there after would be observed as National Mental Health Awareness Day, with multi-partisan support of all stakeholders. Broad consensus of stakeholders has decided Re:Mind India will be observed on this 6th August across the country at almost the same time, with symbols of hope and remembrance being CANDLES AND SILENCE. There will be other activities local, regional and national during the year. Re:Mind India Initiative is owned by every Indian, just instigated and powered by Whole Mind India Foundation.

And, here comes the time for some random thoughts and musings of dwelling down the memory lane and why and how Whole Mind India Foundation came into being on 2nd, January, 2010. The cardinal question which often visits my Mind and which repeatedly is asked by friends, family members and well-wishers is, - “What prompted my muddling in the murky Business of Mental Illness, a condition which carries the level of stigma today, worse than that of leprosy in previous century. Further, why I am so fanatically passionate about making difference to the Life of Times of Mentally Ill , when my own life is disrupted beyond repair and needs a daily support system, not only to keep my mood and life even, but also to keep up with the regimen of conformity to mind saving psychotropic medication. And, lastly why and what motivated me to launch Whole Mind India Foundation (WMIF) in the very first place and dream with an unachievable BHAG (Big Hairy Audacious Goal)

These questions are intricate existential questions of my life, and my mis-wired brain does not have any simple answer. One possible explanation (given by my Friend and well wisher Subroto Bagchi, Co-Founder and Gardener of Mind-Tree) is –“probably God sculpted me manic depressive and sent to the Planet Earth with the Bipolar Gift to undertake this mission impossible. The second, probable, explanation is - during my manic high in year 2000, I got a vision to change the world (I then considered myself an incarnation which was a cross between Mahatma Gandhi and J. R. D. “Jeh” Tata, in the hallucination and delusions of manic breakdown) and I indeed set up an umbrella called “Parivartan Foundation” to take forward the vision then. The vision was still born and got lost to my bouts of insanity. Thirdly, it is possible that while asking the fundamental questions “Who I am? And What I want to do in second half of Life”, just before the start of new millennium, thousands of nautical miles away from India, in mentally disrupted state, I got my calling which came to me as “I did not want to be the richest man in cemetery or when I was consigned to flames” .

Of all the possible reasons I can adduce for setting Whole Mind India Foundation, the one which comes closest to Truth is- “When My World Came Crashing Down- I had help readily available at hand”. There came a protective and enabling “rainbow coalition” a canopy of family, friends, well wishers, colleagues, subordinates and passers by who navigated me through troubled water. With five years of past thirteen years spent with severe disability in a vegetative state, I say this with conviction, Whole Mind India Foundation, got instigated by me just because, I turned out to be one lucky Indian despite my devastating “madness and sadness”, in a country where millions of sufferers of Mental Illness either remain incarcerated at asylums, homes, prisons and homes or still worse die often young and unsung and that too due to self inflicted injuries (scientifically called completed suicide). It is the suffering of millions and the great societal debt I carry in perpetuity in Mind, which gave the calling of life, and a new purpose to the meaning of Second Half or balance ten years of life- this is the story of birth of Whole Mind India Foundation on 2nd January, 2010 in cyberspace. It was only on 2nd April, 2010 that A Lamp was Lit by Users and Caregivers with collateral support of stakeholders at India International Centre, New Delhi, which marked the arrival of WMIF in real space, without a home or registration under any valid statute of India. Whole Mind India Foundation could not have asked for a more auspicious place for its birth- India International- the dream project of Dr. Sarvapalli Radhakrishan, India’s second President, actualized with the visionary support of Pandit Jawaharlal Nehru.

I did not suddenly contract Bipolar Disorder through viral infection (it is substantially inherited with nurture playing the role in triggering the onset). Similarly, Whole Mind India Foundation was not born in a day. Since the idea first came in a flash in “Sunken Garden” in Manila, Philippines in my dazed state like sudden reawakening in year 1999, it has changed contours many a times and has been a still born baby more than once. Even today WMIF is a pre-maturely born child in incubator, running largely out of meager personal savings of a Manic Depressive, whose financial net worth is perpetually in negative. Mentally Ill Indians, those at the bottom of the pyramid, the destitute and homeless survive by wandering on street, even the one with money normally are not welcome as a neighbor. WMIF has existential similarities with home less mentally ill, as it primarily exists as loose confederation of conscientious Indians, joined together with the passion for the cause, with home-base of WMIF being the squatter in the cyberspace with temporary shelters here and there. The only capital WMIF possesses is that of goodwill and my hope is, it will survive and thrive beyond the troubled birth on voluntarism and hundreds of volunteers across India of Re:Mind India Movement and 1500 plus members of WMIF hyper-connected through super connectivity of social networks-Facebook and Twitter

Leading a difficult disrupted life full “of Madness and Sadness” undulating between mania and depression is not easy in any part of the world. It is excruciatingly difficult for me in our part of the world. It is extremely difficult to explain what goes into the mind of mentally ill even to the nearest and dearest. The Constitution of India brands a seriously mentally ill person (of course once declared by court) as one of “unsound mind”. Statutory frame work of Mental Health Act, 1987 remains one of fear of saving the society from lunatics, something deeply engrained in the preamble of statute itself. The societal construct is one of stigma, veil of darkness and discrimination. Life of a mentally ill is one of seclusion not of inclusion; it is one of fear not of love. Is one of incarceration not of accommodation? This has been my life too, except that I have been lucky, I have a rainbow coalition.

If above is the true state of Life and Times of Mentally Ill in India, and if my life has been saved by my rainbow coalition, if instead of stigmatized by all and sundry, I have received love and affection despite my madness and sadness, if marriages break at the first instance of mental illness in this country, still my wife has been a rock solid single source caregiver and therapist, in the process forgetting her own existence, if my children from childhood have directly landed to adulthood bypassing adolescence, if my employers have not abandoned in mental illness, if my clients wait for my blues to go away to serve them, all I can say. There is Life Beyond Madness and Sadness. There is hope amidst hopelessness. Even mentally ill deserve life of dignity; more over given right umbrella they can propel the annual gross domestic product of economy by minimum additional two percent. Even for mentally ill, if the stigma and discrimination vanishes, life can turn from living hell to heaven on planet earth and they can shine like stars in the sky. Just let them be.

Smoking One-self into the Grave-The Naked Naked Truth

Saturday, May 30, 2010


Smoking One-self into the Grave


"Smoking yourself into the Grave" is the sentence which welcomed me in a swanky private hospital of Delhi yesterday. That turned out to be the hospital's way of deathly reminder to me, of fragility of my own life, the one which has the penchant of digging its own grave. It made me pause. Wrong. It sent shivers deep down to my marrows. And the seminal question came to mind- When will I leave smoking?-. On way to grave or when I rested in grave.



The cardinal question remains unanswered. In few hours from now, the World observes Anti-Tobacco Day. Wrong. It has already started observing at least at the eastern end of the globe and the reminders of ill-effect of substance will reverberate for next forty eight hours in western hemisphere.

I can spend days lecture on harmful effects of smoking use of other forms of tobacco and substance abuse. Like every one else, I know Smoking Kills. And I also know that consumption of tobacco in its totality kills  one person @every eight second. My interest in the damage that smoking and tobacco consumption does, is more than routine. It is an existential dilemma for me and a question of life and death.

Cigarette has been my strange bed-fellow for last three decades. A constant companion taking my life away every nano-second with every puff. I also am a pollutor personified- for every three hundred cigrettes smoked by me, I destroy one tree. Quite a sullied record for a person who champions the cause of public transport for environment friendly sustainable urban mobility. I call it dichotomy of my life. My car seats have holes created by burning splinters and in past my bedsheets have caught fire more than once. The fact that I got saved every time, is n guarantee I will be lucky one more time..


My daily quota of consumption of cancer sticks is twenty Wills Filter Navy Cut. When my love affair with smoking began in 1981, it was the era of "Made for Each Other" the romanticised marketing of the deadly cancer stick by the Great Indian Tobacco Company (ITC). Today, nothing has changed ,except the writing on the pack-t just says plain Naked Naked Truth"Smoking Kills". It does not trouble me.  Vague pictorial warning on the pack of my cigarettes shows how powerful is the tobacco lobby. I just fails to scare me and that is the intent of death merchants. The deadly pictorial warnings in Europe and Singapore, scared me to death and often used to force me to tear off that portion of the cover, but they too never deterred me from being the walking steam engine, such an addicted smoker I am. I have been a valiiant carrier of my own death bomb for decades. Smoking Kills. I smoke. It does not hurt me.



I have been a loyal brand ambassdor for ITC. It has been three decades of Wills Filter Navy Cut. And I will do any thing for the love of it. I will lie at home about the number of cigarettes smoked during the day. I would pickpocket money from my wife's purse or children's wallets which they could decipher instantly. There was an occassion when my desperation made me snatch rupees five, from my previous day offering to God. My quota of Wills has made me break custom laws of the nations I have visited frequently and I have audacity to call  my self an Ethics Counselor in Professional Life. When ever I travelled abroad I would always carry sufficient numbers of packets in my foreign jaunts, which were many and the benevolent customs officials would always heed to my pleadings. Wills filter was central to my survival. Wrong, it was central to acceleration of my death sentence. Even Supreme Court's verdict to Gallows, has a mercy appeal to President of India. There is no such appeal for smokers. They go to grave, directly-Appeal summarily rejected by God. Caregivers suffer, Cancer-stick wins. It is an unequal war.

Only time, I changed my brand loyalty to Navy Cut, was in favour Charms, the filter version of Charminar, in an era when I found ten rupees for a Wills pack unaffordable. For a year in Manila, Phillipines I was a Marlboro Man. In one year, I consumed the quantum of cigarretes which I would have consumed in ten years.. Marlboro man might have died of cancer, but Marlboro pack of 20, came dirt cheap in Manila in 1999, one rupee for every cancer stick for taking away few seconds of my life, bit by bit. It was a story of blown to bits, blown to smoke.

I have defied the law of gravity so far- I am alive and kicking. The question remains-for how long?.  My smoking has ensured my admittance to the emergency ward of  Escorts Heart Hospital . Lucky again. Let off with a stern warning. I do await a heart attack. My cholestrol level is still manageable and I have Lal Pathological Laboratory's results of yesterday to back it up.. Multiple linear ulcers in my esophagus nearly took my life they were direct result of my being chimney. But at the time of last endoscopy two years back, they had not yet turned malignant. Who knows about tomorrow. Smoking kills. I smoke.


Smoking Kills and before that it makes life hell. Still I smoke and if I donot take a vow for life it will drive me from cell to grave. I did not start smoking because of its romanticised charm nor did I start thinking it would add to my smartness. I casually tasted it in  the State Bank Staff College, Hyderabad in 1981 and before I knew, I had turned an obscessive-compulsive smoker. My journey to grave continues at accelerated pace. On a normal day, I light twenty cancer sticks. I live in a false world of self fulfilling profecy and audacity of hope with a mistaken belief that I take only few puffs per cigarette and that per cancer-stick I consume much lesser nicotine or tar than my soulmates.

My younger son was with me in the hospital yesterday, when the message "Smoking Yourself into the Grave" was doing the break-dance of death, the tandav nritya, before my naked  eyes. His concerned question was- "Dad what Next"?. My usual aunconvicing nswer was "Betu I would think". I am thinking still. Though today I lighting half the number of cigarettes than yesterday-the number is down to 10 from 20. But for how long. I promised my wife and kids a week back-This Anti-Tobacco Day i wouldcall quits to my lady love-the ubiquitous Wills Filter-made for each other. Will tomorrow ever come. Will it come in this life, or after my  passage to grave. The question remains... and I am momentrarily petrified down to my bone-marrows.


Why do I smoke? It is a million dollar question and I keep asking repeatedly. I donot enjoy smoking. Still I long for a cigarrete at pre-determined intervals. I smoke in temples. I have smoked near funeral pyres. Smoking my self into the grave has been a merathon hurdle. My home is declared smoke free and so is my office. I have to come out of home and stand on thethe road to smoke combining the nicotine, tar and mixing it with Delhi's automobile pollution before inhaling it. I do so  in the wilderness of night, in the chilly windy winter, on a hot sun filled day or a day when it incessantly rains. I will get drenched in my car but my car windows shutter down for a puff of cigarrete. So much for my love of smoking. If every husband has the same love for his life, divorce rate in India will dwindle to zero. My marriage survives, I smoke. Smoking Kills, and I smoke. I tell to myself I will not smoke, but I smoke.


I live my roller coaster life dangerously at the edge. I dangle closely to death. I know smoking kills. I still smoke and beauty of my love affair with smoking is I donot want to die. I have unfinished dreams in life-for self, family and society. I am a pathological dreamer and obsessive compulsive smoker. I promise to quit and donot deliver on promise. My first line treatment of bipolar disorder controls me from above, it drives closer to depression and substantially reduces my intellectual prowess. I can not leave psychotropic medication as non-conformity to medication will drive me to madness, a life back to unbridled insanity. My smoking enervates me physically and works as a slow poison. The combination of two is deadly-one eats my mind like a termite. Another kills my body by the second. When will I stop smoking. Smoking Kills.


I have tried to stop smoking several times. I am a strong willed person. I had promised my father in law before marriage, I would come to mandap as a non-smoker. I have given and broken the promises, thousand times to my wife in last twenty three years.  I have tried nicotine patch and chewing-gums which only doubled my smoking.. I have taken professional help. I have gone to faquirs and tantrik s, temples and dargahs of sufi sants,  to pyschiatrists and clinical psychologists. Smoking kills, but I smoke. I know its pitfalls-digging my own grave.


Is there some explanation of my inability to stop my fast-farward march to grave. Probably yes. probably no. In United States of America 45 percent of cigarretes are consumed by those who are mentally ill. In India there is no such statistics avaliable. But co-morbidity of obsessive-compulsive smoking with mental illness is as established a scientific fact as the realization that smkoing kills. The latter is believed. The inability to quit smoking is deemed as character flaw, lack of will, a criminal conspiracy against life. The country works for the benefit of tobacco companies, it has no program of increasing exponentially the outlay for mental health program-and public health programs. Root cause analysis is needed and the causes have to nibbed in the bud.


I long to live. Still I love to kill myself bit by bit. All the scientific evidences point to my early departure to grave. There is a finer point we all miss in India. Smoking in case of most people is a fad, a fashion or a deadly addiction. Obsessive compulsive smoking in case of most suffering from  depression bipolar disorder, schizophrenia  or some other  serious mental disorders is a facts of life and death- thy name is co-morbidity of Substance Abuse. There are studies galore- be it Lancet and Nature the most respected medical journals or studies from the anals of feted Harvard Medical School and others. A case in point, is, the sad part of bipolar disorder - comorbidity with substance abuse is very high-smoking, drug abusing and alcoholisms can be as 60% in manic depressives Smoking kills but I smoke. To me, my more recent explanation is it is co-morbidity.

Honourble, Chief Justice of India, are you listening my Lord. I long to live, still I kill my self daily. Your judical pronouncement of banning smoking in  in public place  is laudable. But where I go.. Your judgements have made my life more miserable but it has not made me quit smokingmakes my life more miserable. It does not help me. It has made my work life a living hell. Do I have a right to live Sir freely. Your prouncements are noble, but they infringe on my fundamental rights under Article 21 and Artile 22 of constitution. And as a responsible citizen I try to follow your judgement to the core when others flaunt it by day. Your honour, I am yet to find a definition of public place.

 I suffer from debilitating manic depressive insanity. My smoking gets classified as  obsessive ompulsve comorbidity. Your laws give me the status of a non-person  with no-rights. That has made me be Pappu by choice. As aresponsible citizen who suffers the double whammy of rightlessness and non-person status, I still travel down fifteen floors of my swanky office to smoke one cigarrete. Your judicial pronouncements are profound your Honour, except that they are killing the messenger not the  culpprit-the government which plays in the hands of smoking lobby on one side and does not change the paradigm of managing mental illness. The omillion of such smokers in India who smoke due to their comorbidity of mental  mental illness are not on radar- they reresent a non-subject to Indian pysche, to policy makers and other stakeholders


But here is my resolve. And public made on this Anti-tobacco day. I will quit smoking . I will do it for the love of my wife and sons who have been pivots of sanity in my insane life. I will quit because I want to fight to finish- for making difference to life and time of mentally ill, with the vehicle of Whole Mind India Foundation (WMIF) still a baby in the incubator. My vow is, I will not smoke myself into grave.
 
I will stop my silent march to grave before it becomes a violent departure to pit. I believe can. I give life to me. I will quit smoking. Smoking kills. I still smoke. The silver-lining is- I have driven my debilitating Bipolar Disorder to slumber called remission. That was more difficult thing to do. I will quit smoking, sooner rather than later. I want to embrace life. Want to say yes to Life and no to Grave. God help me if u are there, and I know u are there. My rainbow coalition is intact. Hope I will soon get the steely resolve. Else, it will be too late in the day.
 
My fellow smokers call it quits. Do it now. Tomorrow never comes

Smoking One-self into the Grave

 "Smoking yourself into the Grave" is the sentence which welcomed me in a swanky private hospital of Delhi today. That turned out to be the hospital's way of deathly reminder  to me, of fragility of my own life, the one which has the penchant of digging its own grave. It made me pause. Wrong. It sent shivers deep down to my marrows. And the seminal question which came to mind- When will I leave smoking?-. On way to grave or when I rest in grave.

The cardinal question remains unanswered. In few hours from now, the World observes Anti-Tobacco Day. I can give a day lecture on harmful effects of smoking. Like every one else, I know Smoking Kills. And I also know that it kills  @ one person every eight second.  My interest in the damage that smoking does, is more than perfunctionarly. It has been my strange bed-fellow for last three decades. A constant companion taking my life away every nano-second with every puff.  I  also am a pollutor personified- for every three hundred cigrettes smoked by me, I destroy one tree. Quite a sullied record for a person who champions the cause of public transport for environment friendly sustainable urban mobility. I call it dichotomy of my life.

My daily quota of consumption of cancer sticks is 20 Wills Filter Navy Cut. When my love affair with smoking began in 1981, it was the era of "Made for Each Other" the romanticised marketing of the deadly cancer stick. Today nothing has changed ,except the writing on the pack. It just says "Smoking Kills". Its vague pictorial warning does not scare me. The deadly picotrial warnings in Europe and Singapore, used to force me to tear off that portion of the cover but they never deterred me from being the walking steam engine. I have been a valiiant carrier of my own death bomb.

I have been a loyal brand ambassdor for ITC. It has been three decades of Wills Filter Navy Cut. And I will do any thing for the love of it.. I will lie at home. Pickpocket money from my wife's purse or children's wallets
which they could decipher instantly. My quota of Wills has made me break custom laws of the nations I have visited-I call my self as Ethics Counselor in Professional Life. I would always carry sufficient numbers of packets  in my foreign jaunts, which were many. Only time, I changed the brand loyalty was in favour Charms, the filter version of  Charminar, in an era when I found ten rupees for a Wills pack costly. For a year in Manila I was a Marlboro Man. In one year, I consumed what I would have consumed in ten years.. Marlboro man might have died of cancer, but Marlboro pack of 20, came dirt cheap in Manila in 1999,  one rupee for every  cancer stick for taking few seconds of my life. It was a story of blown to bits, blown to smoke.

I have defied the law of gravity so far.. my smoking has ensured that I am admitted in the Escorts Heart Hospital in the emergency. I do await a heart attack. My cholestrol level is still manageable. Multiple linear ulcers in my esophagus nearly took my life. But at the time of last endoscopy two years back, they had not yet turned malignant. Who knows about tomorrow. Smoking kills. I smoke.

Smoking Kills and before that it makes life hell. Still i smoke. I did not start smoking because of its romanticised charm nor did I start thinking it would add to my smartness. I casually tasted it in State Bank Staff College, Hyderabad in 1981 and before I knew I became an obscessive-compulsive smoker. My journey to grave continues at accelerated pace. On a normal day, I light twenty cancer sticks. I live in a false world- my mistaken belief that I take only few puffs and that per cancer-stick I consume  much lesser nicotine or tar than my soulmates.

My younger son was with me in the hospital today, when the message "Smoking Yourself into the Grave" was doing the break-dance of death before my eyes. His concerned question was- Dad what Next?. My usual answer was "Betu I would think". I promised my wife and kids a week back. This Anti-Tobacco Day i will call quits to my lady love-the ubiquitous Wills Filter-made for each other. Will tomorrow ever come. Will it come in this life, or after my accelerated passage to grave. The question remains... and I am momentrarily petrified.

Why do I smoke? It is a million dollar question. Smoking my self into the grave has been a merathon hurdle. My home is smoke free. I have to visit the road to smoke- in the wilderness of night, in the chilly winder, on a hot sun filled day or a day when incessantly rains. I will get drenched in my car but my winter shutter will be down for a puff of cigarrete.

I live life dangerously. I dangle closely to death. I know smoking kills. I still smoke. I donot want to die. I have  unfinished dreams in life-for self, family and society. I am a pathological dreamer and obsessive compulsive smoker. I promise to quit and donot deliver on promise. My first line treatment of bipolar disorder controls me from above, it drives closer to depression and substantially reduces my intellectual prowess. I can not leave medication as non-conformity to medication will drive me to madness. My smoking enervates me physically. The combination of two is deadly-one eats my mind like a termite. Another kills my body by the second. When will I stop smoking. Smoking Kills.

I have tried to stop smoking several times. I am a strong willed person. I had promised my father in law before marriage, I would come to mandap as a non-smoker. I have given and broken the promises thousand times to my wife in last twenty three years. Have tried nicotine patch and chewing-gums which only doubled my smoking.. Have taken professional help. Has gone to faquir and tantrik and doctors.  Smoking kills but I smoke. I know its pitfalls-digging my own grave.

Is there some explanation of my inability to stop my fast-farward march to grave. Probably yes. probably no. In United States of America 45 percent of cigarretes are consumed by those who are mentally ill. In India there is no such statistics avaliable. But co-morbidity  of obsessive-compulsive smoking with mental illness is as established a scientific fact as the realization that smkoing kills. The latter is believed. The inability to quit smoking is deemed as character  flaw, lack of will, a criminal conspiracy against life.

I want to live. Still I kill myself bit by bit. All the scientific evidences point to my early departure to grave. There is a finer point we all miss in India. Smoking in case of most people is a fad, a fashion or a deadly addition. Obsessive compulsive smoking for a bipolar or some other suffering from serious mental disorders is a facts of life and eath. There are studies galore- be it Lancet and Nature the most respected medical journals or studies for Harvard Medical School or others. The sad part of bipolar disorder is that comorbidity with  substance abuse is very high-smoking, drug abusing and alcoholisms. It can be as high as 60%. Smoking kills but i smoke.  To me it is co-morbidity. Honourble, Chief Justice of India, Are you listening my Lord. i want to live, still I kill. Your statute of ban in public place makes my life more miserable. It does not help me. It has made my work life a living hell. I am not allowed to smoke even in the compund. Do I have a right to live sir. Your statute gets disobeyed. I am mentally ill, comorbidity is my obsessive ompulsve smoking. As aresponsible citizen who suffers the double whammy of rightlessness and non-person status, I still travel down fifteen floors to take one cigarrete. Your judicial pronouncements are profound your Honour, except that it is killing the messenger. Not the culprit-in case of million smokers in India their mental illness-a non-subject to Indian pysche, to policy makers and other stakeholders

But here is my resolve. A public one. I will not  smoke myself into grave. I will stop my silent march to grave before it becomes a violent departure to pit. I believe  can. I give life to me. I will quit smoking. Smoking kills. I still smoke. The  silver-lining is- I have driven my debilitating Bipolar Disorder to slumber called remission that was more difficult thing to do. I will quit smoking, sooner rather than later. I want to embrace life. Want to say yes to Life and No to Grave. God help me if u are there, and I know u are there. My rainbow coalition is intact. Hope I will soon get steely resolve. Else, it will be too late in the day



I

Travesty of Life: When Youth Died Young and Unsung

Good Bye Suresh,


Suresh is no more. He died in prime of his youth- both young and unsung. He remains in my heart. Suresh left for heavenly abode five days back but I came to knew only an hour back and yet to recover. In shock is the right expression. Death of Suresh was not worthy of front page, Page 3 or inner page of any local news paper, not even vernacular Marathi one, he was a native of Konkan village.
This obituary is to lessen my grief and guilt. I am not sure what killed Suresh. Doctors say it was brain tumor. Alas! He was here taking care of me and taking care of his family. I wonder did abject poverty killed him or lack of Medicare facility for the poor. He was to be here in Mumbai this week for treatment, which any case he or his family could not afford.

Suresh was unemployed for few months. And I feel guilt for that. He was not able to manage his family with his meager salary in any case and had not got customary wage increase last year. His health was deteriorating and stress level at work was increasing. He needed another helping hand in guest house, we were not able to provide, because we were on genuine serious cost optimization spree.

Due to double whammy of uncertainty of election last year and looming depression, all of us had gone for a salary freeze. Suresh too also was in the same boat except that his basic needs were more than his meager means. I carry the guilt- had promised to put forward his case for raise but in between he fell sick and went home. My last remembrance of him was crying with pain, in the guest house, he did not know his ailment then.

Suresh leaves behind in this world an ailing physically dependent mother who is very old, a young illiterate wife with no earning capacity and a four year old son. The bereaving family does not even know how to express its grief.

My bonding with Suresh was without bound- he was not the caretaker of our Mumbai guest house. For me he was my carer, it was his responsibility that I got my psychiatric medicines for Bipolar disorder in time, he knew my medicines and its exact dosage. When I would lie low (Mumbai had that effect on me) in frequent visits to Mumbai he would provide me relaxation by massaging. His countless cups of tea. His attuning his sleep to my erratic bipolar sleep deprivation, they r all missed. We will miss him as a family too, when we came for few days for a family wedding in 2008, Suresh became a part of family.
Before we started our guest house few years back Suresh was an office boy in our Mumbai office. The occasion I remember most  is when he worked by my side for 100 hours without break on a very important assignment that was the level of his devotion.
Suresh was loving and caring beyond his normal call of duty. He was a true service professional par excellence in a service company which prides on excellence> Suresh was a true Feedbacker. For me he was many things, am not finding words to express.

U will be missed Suresh for ever. But also will be in the heart. May God give Rest to the noble soul.


Love , peace and Amen

India's Defining Decade-Your Mind needed for an Idea whose Time has come

Good Bye 2009- Welcome New New Decade of Hope
First decade of the new mellinium has gone by. It's  farewell for me was significant, maddening, saddenning but beautiful like the following rememberances from a Verginia Woolf Quote:

"I can only note that the past is beautiful because one never realises an emotion at the time. It expands later, and thus we don't have complete emotions about the present, only about the past.
Virginia Woolf "

The new mellinium had started for me in a devastating and debilitating manner thousands of miles away from India. In  was in year 2000, when I was stuck by "Madness"  in full bloom outof no where. Thereafter, it has been an intense and often losing but dogged battle with "Madness and Sadness" with  diurnal abrupt variation of moods of my daily and seaonally affective disorder-Manic Depressive Insanity . In recent years, the winter has meant  horrifying Depression and summer often brought unknown pleasures, extraordinary abilities and unrealistic exuberance of Mania- it also gave eminently forgettable periods of complete psychotic breakdowns.

The decade tested my "rainbow coalition" of family, friends and wellwishers to extreme. It was resolute doggeedness of my wife annd kids which has seen me survive the daily and seasonal battles and few close calls of deadend- The Death from Self Inflicted Injury.


Circa 2009 began एंड ended in  contrast- at the beginning of the year, like global economy, my mind and life was in debilitating Depression - a carry forward from last three months of 2008. My extreme sorrow  went away very painfully and excruciatingly slowly with the help of my psychiatrist, care of my wife and kids and very strong support from my employers, colleagues, friends, subordinates and clients. Yet, final lifting of mood was like magic and it came while listening live to Anouska Shankar live in a South Delhi Mall open space. Music has always helped me fight the "Black Dog"

Decade and the year which just got over, instilled a new purpose to my life, profession and turned out to be defining one, as it provided me with the "New New Calling in Life".

I had many failures and missed targets during the year, none of them more important than non-completion of  the book "Of Madness and Sadness: Life and Times of an Ordinary Indian". The book is a clarion call of my life and it was scheduled to be published in 2009. It has been a conscious decision to go slow- to save me from burnout and to make it more meaningful. It is one of my ways of fighting the 100 Year War against Stigma and Lack of Awareness in India against mental and brain disorders of all types.

Given the fact that Valproate my first line medication, controls me from above, leaving me to perform at sub-normal and sub-optimal level (against my old  untreated exuberant self), with all humility I did have few satisfactions in both personal and professional life during the year. I definitely grew as a knowledge worker, as a knowledge sharing teacher, as a very hestitant member of the commentrariat and lastly I took baby steps in my foray of "Working as a Life Coach". I also took conviction and fight for resoration of values and ethics in a disrupted nation to the next level- learning to differentiate between right and more right.

On 5th November, 2009 my life was turned upside down when the trailler on my fights with Manic Depressive Disorder was croniclled by Mint (A Hindustant Times- Wall Street Journal Business Daily in India) as a front page story. Its effect has been electrifying- at personal level it has further strengthened my "rainbow coallition" and at a humane level, it has given me the New New Calling for balance period of my life. I have rededicated my life in the New New decade to making difference to those suffering from mental disorders in India.

A humble beginning has been made by reactivating my blogsite (akhileshwarsahay.blogpost.com), which I have primarily devoted to topical issues pertaining to mental illnesses in general and Manic Depressive Disorder (Bipolar Disorder) in particular But the more significant activities lined up for 2010 are two fold:

One,  completion of my Memoirs of Madness and Sadness during the first year of the decade. The sole purpose of the book is to desimminate the hope in a hopeless situation. I also believe that it will help other sufferers in coming out with  their own sufferings and coping strategies.Even a mentally ill can live a productive life and the cost of inaction is very heavy.

Two, In December some leading minds joined me when I conceived the idea of Whole Mind India Foundations (WMIF) as its Instigator. The year will see getting it formalised. The process of registration as a Society and development of its website (http://www.wholemindindia.org/) is a work in proress. The organization is being set up with a big hairy audacious goal (BHAG)- to become national aggregator of all the efforts of improvement in the lot of those suffering from mental disorders. In the first month it has a aim of having 50 members and 1000 Friends. It is going to work in the areas of education, destigmatisation, awareness generation, policy change advocacy, working with and recognising the effort of front line NGOS in the field.

The responsibilities assumed are onerous but the battle has begun. I might be one of the early bird fighters but I have this humbling realisation- I canot win the war. It needs all of you and millions more. Urge you to rise for the cause- some where some one whom you know  needs your support. After all, 120 million Indians suffer from one or other mental disorder today and at least one in four will be afflicted by the same at least once in their life time








  

Naked Naked Truth: Suicidal Facts of Imagining India Circa2010-You and Them

In few days from now, it will be curtains to 2009 and India will step into 2010 with new hope and vigour. After all, the country has been successful in beating the worst drought in recent memory and global recession. Despite a slow start, the year is likely to end with a growth rate next only to China in the world. It is thus time to celebrate and march forward irrespective of  unevenness of the growth. 


But last week when I was at Indian Institute of Management at Lucknow for a lecture series to civil services officers of Jammu and Kashmir, I was rankled by a page three report in the local edition of Hindustant Times. It was both tragic and dehumanising to read that Jyoti Rani (24) a budding aspiring doctor who was a final year MBBS student of  CSM Medical University had committed suicide. She was in serious depression on account of untimely death of a cousin in accident. I did not know Jyoti Rani but have lost too many of my friends and well wishers in my fivty years of uneven life journey to suicide. And, I know first hand how close a person suffering from clinical depression or manic depression is to the danger of suicide. This forced me to complete my half written latest post on Bipolar Stroke.


This post is dedicated to a group of Indians who had unique accomplishments in last one year or so and their accomplishments would be reckoned in the government records only two years from now. These are the men and women, boys and girls who have had high motivation levels, many of them capable of transforming India in 21st century. They all have been professionals in their own right, some accomplished  ones but most of them  budding; many experienced but many more as  future of imagining India. They are representative of all castes, religions, regions and age groups.  But as I write this blog, I have decided to talk  about them and their achievements in past tense for eminently valid reason. They all belong to the category who like Usha Rani are successful cases of completed suicide of last last one year or so.


The roll of honour is quite impressive to start with:

• "Manjit Singh Dhillon Air Vice Marshal (Retd) a Vir Chakra and Yavu Sena Medal Awardee; and Rajinder Vadra, father in law of Priyanka Gandhi; 
• Harminder Raj Singh, Jagdanand Panda and A.S. Chatwal senior I.A.S. Officers of Orissa, UP and Punjab cadre respectively; 
• Jagjit Kumar senior IPS, IG Police of Himachal and Mujeeb Usman Karjat Kar,jatkar I.P.S. Superintendent in Police in Maharashtra; Ramchandran Retd. Deputy Supdt. of Police from Chennai 
• Rohini Sonawane a doctor at KEM hospital Mumbai, Pradeep Sharma, a young psychiatrist at PGI Chandigarh; Magan Ramlingam, 25 year old surgeon in Tamilnadu; Patanjali Bhat, Assitant Professor at Kasturba Medical College, Manipal Karnataka; Dr Captain Bharati Zingade, a young doctor working in army; Sanjeev Kumar Saxena 44, a doctor at Lucknow; 
• Dalia Nayak, Associate Professor at Shaha Institute of Nuclear Physics; M P Singh, Deputy Director of Indian Council of Medical Research; Bhupinder Singh, Professor of Computer Science at Punjab Engineering College Chandigarh and K. Venkatiraman a senior official of Institute of Chartererd Accountants of India;
• S. Amravati, a boxer trainee at centre of excellence, Hyderabad; Amit Yadav and Sandeep Kashyap young lawyers from Bhilwara and Muzaffar Nagar; Sunil Khanna a journalist from Panchkula Chandigarh and Chaturvesh Sharma a 23 year student of journalism;
  
•  Yogendra Singh, a 400th rank holder of IIT Joint entrance exam and a student of IIT Kharagpur; Satyendra K. Singh a student of MCA at National Institute of Technology Jamshedpur;  G. Suman, asecond year post graduate student at IIT Kanpur; Balkrishna Gupta, a P.hD. student of IIT Mumbai; Toya Chattterji a fourth year student at IIT Kanpur
• Upendra Sharma a share broker at Rajkot; Manish Patel a business man from Ahmedabad; K L Lingesh a Bangalore based entrepreneur and founder of Lxlab; Dhanajay Brahmapurikar a senior business executive with a leading company; Namita Mehta a senior HR Executivre and Bikram Bhardwaj a senior executive of an export house both from Gurgaon
  
• Amit Budhiraj an Engineer in Infosys; Vishal Yadav, a Business Analyst at Wipro; Syed Ahmed Makdoom, a software professional at Wipro; Vikash Kumar Sharma, Senior Network Analyst at HCL; Vishwa Ganesh a software engineer at Styam Computers, Software engineer T. L. V. S. Rao from IBM and his wife;  Sandeep Selke software engineer at Persistent Systems Ltd Pune; Pradeep Kumar Gondkar 26 years software engineer at IBM and Abhijit Mukherji trainee engineer at Infosys; ; 
  
• Gaurav Gupta a first semester law student at BHU,Mercedes Kohndam, 21 year nursing student at Lady Hardinge Medical College;Priyagandha Singh who passed CBSE 12th exam with 86% marks;
• Achut Mandal an Associate Professor of Delhi University; Jqram Ahmed, retired professor of Jamia University;  
• Raj Aditya Thampu, telgu film director; Bhargavi upcoming Telgu Actress; and ex Model Monica Choudhari, 45 daughter of  noted Ghazal singers Chitra Singh and Jagjit Singh"...........  

All the above,  bright and shining stars made news in 2009, some  on front page while others in an inner page of the daily news papers. They will formally become part of government statistics two years from now when 2009 suicide data is compiled ironically by Ministry of Home. It is a different thing  altogether that these men and women, boys and girls are now part of the other galaxy and their counting should not be a difficult exercise.


These chart busters of the illustrious group which is known as "completed suicide" of  last one year chose many means to end their life. Many of them hanged themselves at home or in garden from a tree, some shot themselves, few jumped to death while others consumed or injected lethal poisons or burnt themselves alive. There were an odd case of an I.A.S. officer and a techie who also killed few family members along with them. Morever, as I complete this blog there is a news of a whole family of three Indians in gulf who took their life yesterday in a suicide pact-they literally hanged themselves to death.


All  of above have left behind them grieving families, friends and well wishers and a government which neither understands suicide nor is bothered about the implications. In a country like ours which has more problems than what we can solve in a century. why families, society and those at helms of the affairs in the country  should worry about few who were weak enough to commit suicide.


 And why I am geeting muddled  my mind for these inconsequential people. There are few reasons for the same:




One, though the above list is initself disturbing anough and the problem of professional suicides is only exacerbating by the day, the real picture is far more devastatinng. The real geastalt of completed suicide group is much larger . This includes  an ever increasing number of debt stricken farmers, poor from both  villages and towns (while the burnt of poverty and debt stricken suicide in villages is well documented now, poverty  led suicides is becoming an increasingly urban phenomena), stressed and distressed students, victims of domestic violence and  dowry victims are only few of these cases.


Two, at governmental level there is complete denial of the problem, at the societal level completed and attempted is stigma  where as at the level of family it is an unacceptable shame and  something to be swept below carpet. This realisation has not crept in that, completed and attempted suicides are symptoms and not the disease. We as a nation are not just interested in root cause analysis.


Three, suicide kills annually more individuals than terrorism, wars and homicides taken together in the world and is already one of the ten leading causes of death. Even with sketchy unrealiable governmental annual statistics of suicide (which we will confront soon) deaths from completed suicide in India per annum are higher than sum total of killings due to internal meance of naxalism and external or home grown terrorism.


Four, why do people commit suicide in the very first place? It is a complex question and suicides etiology is a  mixture of genetic, environmental, cultural and religious factors. But there is one common thread which runs across one million completed and five million failed suicides in the world every year- this is the mental disorders particularly untreated ones.


Five, researchers and scientists ( in dedeloped countries) have unanimity that there are two groups of people who commit suicide- first group of 50% of individuals who commit suicide belong to such category with a diagnosed or treated mental disorder. The second group belongs to individuals who commit suicides but have not been diagnosed suffering from psychiatric disorders. Even in this group, which accounts for balance fifty percent of suicides, psychiatric autopsies and retrospective studies have confirmed that a psychiatric disorder could be established in 90% of this later category. Famous psychiatrists Jamison and Goodwin in their book report that the above finding was the basis for The Surgeons Generals Call to Action to Prevent Suicide in USA in 1999.


Six, as a person who have suffered debilitating consequences of mental disorder for more than twelve years, a person who has  had suicidal ideation as a constant companion, had more than one case of failed or near complete suicide attempt and one who was  kept for nearly eight years on active suide watch by psychiatrists, I do understand to an extent, what goes inside the mind of a person who completes suicide or is a faillure even in the desperate bid to end his life. The life of living in ignominy of a failed suicide needs rehabilitation and not incarceration. If I am able to write this blog it is because 24*7 active suicide watch of my wife and children and becuse my greater propensity to live than die (except in horrendous state of mental disorder) has enabled me to some how live a saner life despite my debilitating manicdepressive insanity.


Seven, the menace of suicide and its familial, social and economic burden in India has reached monstrous proportions and has become one of the most dmaging public health epidemic, except that we as nation do not care. The consequence are there for all to see- unmitigated sufferings to the families of those who complete suicide, an incarcerated life for those who fail in their attempt and a great loss to national productivity as two third of those who commit suicide in India (even as per government statistics) are below the age of 44. Suicide exacts huge psychological and social costs, and the economic costs of suicide to society (lost productivity, health and social care costs) are estimated at many billions of dollars each year and more than 20 millions years of healthy life lost in the world.


In 2010, what India and we Indians need to do differently to ensure that we first recognise this social cancer, second arrest its unabated growth and then reverse the trend to a manageable level. There are many steps to be taken -all simultaneously and my pick of "Ten Key Commandments" is as under:

One, recognise the writing on the wall. The cancer of suicide if not arrested immediately is going to tear the familial and social fabric apart in near future. It is time to take stock, to get out of the denial mode and to face the world of Naked Naked Truth of Suicide boldly- take the bull by horns

Two, get the Indain suicide numbers right. If one goes by the statistics published by Ministry of Home, Government of India annual deaths from suicide are numbered at 1,22,667. This number is bad enough and represents 12% of global suicides ranking India high in the pecking order of suicidal nations. But there are two lacuane in this statistics- first it does not represent true and fair picture as it is dated.. These are 2007 numbers. More importantly, even government does not believe its numbers as in India less than 20% deaths are medically certified. There is a huge stigma and shame attached to the suicide and if we correct the Indian suicide rates for just three factors non-reporting rates due to incompletenenss, stigma and shame, Indian numbers will double up and India will be at the top of suicide league table of the world. There is urgent need to improve both reliability and validity of our data collection tools. Suicide reporting methodology of evn neighbouring China is more robust than India.

Three,  humanise and decrimininalise suicide. Section 309 0f Indian Penal Code has to be struck down the statue book as of yesterday.Section 309 says: “Whoever attempts to commit suicide and does any act towards the commission of such offence shall be punished with simple imprisonment for a term which may extend to one year or with fine, or with both.”

If any doubt persists on immediacy of removing Section 309 from Indian Penal Code, the 210th report of the Law Commission, headed by Justice A.R. Lakshmanan,  submitted to the government in 2008 dispells the myth and it says : “Section 309 provides double punishment for a person who has already got fed up with his life and desires to end it. Section 309 is also a stumbling block to prevention of suicides and improving the access of medical care to those who have attempted suicide.”

The Commission further said: “It is unreasonable to inflict punishment upon a person who, on account of family discord, destitution, loss of a dear relation or cause of a like nature, overcomes the instinct of self-preservation and decides to take his own life. In such a case, the unfortunate person deserves sympathy, counselling and appropriate treatment, and certainly not the prison. Section 309 needs to be effaced from the statute book because the provision is inhuman, irrespective of whether it is constitutional or unconstitutional.”


The commission also noted that only Pakistan, Bangladesh, Malaysia, Singapore and India have persisted with this undesirable law. “The panacea for those who attempt suicide certainly cannot be imprisonment. They need compassion, emotional support and sometimes even psychiatric help.” If attempted suicide were decriminalised it would make things more workable and “easier for all to extend their hand and support in reducing suicide in India.”

The commission has resolved to recommend to the government to initiate steps for repeal of the anachronistic law contained in section 309, IPC, which would relieve the distressed of his suffering. At present only a handful of countries in the world, like Pakistan, Bangladesh, Malaysia, Singapore and India have persisted with this undesirable law.

Four, the above recommendations of Law Commission have not yielded any result so far. After all Indian Penal Code was written by Britishers in 19th century. Let India take a leaf out of Section 1 and 2 of British Suicide Act, 1961  which has folowing message for the Indian Law makers:

"1. Suicide to cease to be a crime.The rule of law whereby it is a crime for a person to commit suicide is hereby abrogated.

2. Criminal liability for complicity in another’s suicide.— (1) A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.

Even the over all import of clause 2 of British Suicide Act, 1961 is such that it has been virtually eliminated the possibility of witchhunting using this clause

Five, accept the another Naked Naked truth- that 25% Indians will suffer from  one or other mental disorder at least once in their life time and at this given monent, 120 million Indians i.e. 10% of the entire population is in grip of mental disorders and half of them of serious nature. Let the realisation dawn that, they are serious target group for difficult but attainable suicide prevention measures. It is proven beyond doubt tthat he clinical and manic depression is a fundamental trigger of majority of completed or failed suicide cases.

Six, immediately set up standing highpowered National Commission of Mental Health. The detection, treatment and rehabiltation has to go hand in hand with destigmatisation, education and creating public aware ness.

Seven, have the paradigm shift at the governmental, societal and familial level- mental disorders can be managed and suicide prevention is possible. It requires total rethink of existing medical education. One will be surprised to note that in a five year medical education in the country, psychiatry is a didactic lecture content of fifteen hours and most of the students bunk the placid classes. With crhonic shortage of psychiatrists and clinical psychologists in the country there is urgent need of total integration of primary health care with targetted efforts.

Eight, there is urgent need for exponential increase in government budget allocation. As most suicides are in the productive age group there is very sound economic logic to it and financial rate of return is very very high. It will have substantial GDP inflator impact. Non-governmental efforts have to be mainstreamed  and upsacaled instead of present efforts at perriphery and government and non-government need to do a tango with individuals and target families.

Nine, it is time for the fourth estate- print and visual media to come forward in dissemination of information, education and creation of awareness. They have a collateral resonsbility and they also need to become more responsive and responsible- a new era of humanising, educating and deliberate desensationalisation needs to be ushered in.

Lastly, there is need for active intervention for improving the lot of other key target group- the deprived and poor. Both urban and rural poverty has serious implications and positive correlation with high incidence of suicide is palpable.

Last word, not all are as lucky as me.  My rainbow coalition of a deciated wife and children and accessibility to doctors has ensured that I am able to cheat death more often than is warranted. How many Indians or Asians are that lucky. Suicide is preventable. Let us take a vow to take the small first step as we welcome Circa 2010.

Deciphering Manic Depressive Disorder

In a recent response to me, one of my Indian friends (a senior bureaucrat) said "we both had a brush with abnormal psychology in 1980s as we had opted for psychology as one of the two optionals for Indian Civil Services Examination. On going through your case I tried to think of the possible reasons and implications but soon decided to accept the authors view".

Another friend wrote to me about his close relative, a senior executve of a large multinational who committed suicide due to his bipolar illness and but for the grit of his wife who single handedly brought up children after taking up teaching job his family would have been destroyed. A third friend wrote about his own brush with being detected with bipolar disorder in mid 1990s. Most damning was receiving the news of sad state of affairs of a close friend (and a senior Indian bureaucrat) who is not able to come out of the illness and he could not get the type of support with his marriage breaking down...... such are the traumas of this just one illness and there are many compounding and comorbid mental disorders which often come in bundles

It forces me say a few words of my own and some borrowed from one of the most trusted scientists in the field. Let us accept prima facie that doctors and researchers are still trying to figure out what exactly causes Manic Depressive Disorder and that in some way explains why there is no certain cure of the disorder ( but patients can be well managed) more than 110 years after Krapelin labelled it as Manic Depressive Insaniy by separating it from what he called other form of insanity- dementia paracox (since designated Schizoprhenia by Bleurer).

Manic Depressive Disorder itself in 1980s (DSM III onwards) was given a more exotic covering of Bipolar Disorder though the change of nomenclature has no way impacted on the lethal and pernicious nature of the disease where in the case of untreated cases, 15-20% of the sufferers complete suicide and at least double of that make one or more attempt to make suicide. In India among those who donot die due to self inflicted unjury a large majority remain incarerated in asylums, jails, homes or streets. Most go untreated and in case ofthose who manage to reach vanishing tribe of psychiatrists (last count 3000 left in India for 1.2 billion population)nearly three fourth are misdiagnosed either as cases of clinical depression or schizoprenia.

Sadly, in India those who fail in their suicide attempt have to face the ignominy of harrasement at the hands of state (instead of rehabilitation and help)- the country has a glorious tradition of having Assisted Suicide Clinics in the name of religion (like Mukti Dhams in Kashi and Swargashrams in Rishikesh) but mental health sucide cases instead of being regarded as serious public health problem are treated as right cases of harrassement by state in the garb of 19th century Criminal Procedure Code for managing 21st Century

India- which makes suicide punishable by imprisionment.

It would be instructive to note that in a country like India, those who suffer from mental illnesses (and one out four Indians will suffer at least once in their life time), have no where to go and are not supposed to have a even decent lunatic life even in an asylum or a jail. Street is more often the natural abode.

Sorry for digression.. but what else can I write about a country which till very recently was governed by Indian Lunacy Act, 1912 and what ever statute changes have happened recenly they still are some where rooted in the basic premise of the old Lunacy Act. Sadly the subject continues to be dehumanised as the Indian Constitution itself is yet to come out of the mould of Constituent Assembly Debate of 1948 and the phrase which desribe mentally ill in the constitution even today is "mentally unsound", a remnant of old latin phrase meaning insanity.

While causes and consequences of Manic Depressive Disorder will be dealt with, I am tempted to quote two paragraphs from hundred of thousand pages read by me on the subject. They are extracted from " Prologue" of "An Unquiet Mind: A memoir of moods and madness" by Kay Redfield Jamison, an eminent authority on the subject, a professor at John Hopkins School of Medicine and a sufferer of the Bipolar Disorder herself:

".....Manic-depression disorts mood and thoughts, incites dreadful behaviours, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet the one feels psychological in its experience of it an illness that is unique in conferring advanage and pleasure and yet one that brings in its wake almos unendurable sufferings, and not infrequently, suicide.

.....The major problem in treating manic-depressive illness is not that there are not effective medications-there are-but the patients so foten refuse to take them. Worse yet,because of lack of informaion, poor medical advice, stigma or fear of personal and professional reprisals they do not seek treatment at all"


Dr. Jamison wrote he above in her autobiography in 1995 and the same was written in the American context. Think and mull over how bad the case in India is amidst familial, societal and governmental apathy, rather antipathy towards the mentally ill.

When a roller coaster life is turned upside down

When I started blogging on 31st Augus, 2008, I impromptuo called it Bipolar Stroke. Partly because it reflected me, the real me, the way I was born. In my  first blog I decided to come in open (uncharacteristically so for an Indian) about my being one of those 1.5% of global population who suffer from this affliction which does not hve a cure. The first line treatments available for the disorder(Lithium and Valproate) barely manage it and high degree of prolonged socio-occupational maladjustment among many sufferers is the life long pattern of the disorder. If left untreated (and majority of patirents either do not seek or do not receive treatment) it only worsens with the age......

When I started blogging last year, little did I realise that one day I will recristen the very purpose of this blogging site to taking the stigma out of the pernicious last remanant of "Leprosy of 21st Century" and that in India at least it would fall on my shoulders the onerous responsibility of blowing the counch ( or say being the early bird fighter) for starting the "100 Year War against Stigma related to all forms of Mental Illnesses"

Though I had followed a policy of glasnost in case of my own condition ever since the madness and sadness stuck my life in 1997, it was only in recent years that I started on the uncharted path of trying to become better read layman on all aspects of mental disorders. As my years of knowledge seeking needed an outlet, I unconsciously started on taking the battle to the street- by talking about different aspects of "mental disorders and India" in multiple forums. It was in this context that in 2008 when 'I was invited by one of the National Insititutes of Disabilities to give key note address, I launched my public awareness compaign for treating mental disorders and physical illnesses on the same footing. In June, 2009 when I was invited by Public Union of Civil Liberties (PUCL) in Patna, I chose to dwell on "Mental Illness and BIMARU Bihar"- the state today accounts for 8-9% of India's population but alas has no mental health care facility.

But none of above had prepared me for the tsunami unleased in my roller coaster life, which has been totally turned upside down by the recent coverage of one part of my 12 years survival with Manic Depressive Disorder in Mint on 5th November, 2009 (http://www.livemint.com/2009/11/04235750/Akhileshwar-Sahay--Life-lesso.html).

I was not prepared by the unprecedented response which the article has generated. In public, the solidarity from friends, colleagues, family members and unknowns has been reassurig but at the same time it has also been scary, numbing and humbling. More importantly, it has put onerous responsibiliy on me, some of which I am neither educated to discharge, nor allowed to deal with.

People in private have been coming out with their stories, stories of the relatives and friends and children and spouses. I am also finding many co-collaborators who are ready to join the battle by coming out with  the cases in their personal life. There is another type of people asking for details pertaining to the illness- I am afraid the individual cases are person specific, and the first thing a suffer or a carer of mental disorders should do is to get to its family physician and with his/her help try to locate a psychatrist/ clinical psychologist in the nearest centre.

In coming days i would try to make this site a reservoir of resources for creating better awareness, understanding and education of issues related to mental disorders, with specific reference to India

I have thought through the implications of having having started on this uncharted path... it is to do my bit in the 100 year war. I may be an early bird warrior and not the most ideally suited for. This war requires million of soldiers wih various types of arms and ammunitions and steely determination of fight to finish....Are you man or woman enough to be part of the war monentarily, figuratively or purposely

Bipolar stroke: The Mind Game- Life and time of a Bipolar

Bipolar stroke: The Mind Game- Life and time of a Bipolar

The Mind Game- Life and time of a Bipolar

A Quiet-unquiet Mind

It my day one at blogging. And I rather start with my one self, by telling something, which individuals and families across the countries and cultures prefer to keep under the rug. I am a successful knowledge worker, having reasonable material comfort and societal status. But my mind acts quiet- unquiet in turn. And there is not much I can do about it, except managing the inner turbulence in the most optimal manner.

I am one of those other type whom medical science describes as "Bipolar" or "the one having mania-depressive disorder". To the uninitiated, it suffices to say, Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression. Normally first occurrence of bipolar condition, considered largely a genetic condition is in adolescence but there are many instances of late onset.

I am fortunate in having extremely caring family, a strong supportive friend network, having received the best medical care and an understanding organization and colleagues where I work in. But I am the lucky few. To understand what does an average bipolar undergoes, and how disruptive his/her life becomes in India with at least 20 million bipolars (2.7% of adult US population is bipolar) with barely 3,500 psychiatrists ,and even increasing familial, societal and work place taboo against mental illness, one should get hold of the bold movie by young Rehana Mirza-"Hiding Divya" (2006)starring legendry Madhur Jaffrey, Puja Kumar and Deep Kadkare
depicting the life, and fights oof an indian-american bipolar. It is time for the prejudices and the lack of understanding to be replaced by the understanding- bipolars may have a rollar-coastr mind but it is often a "beautiful mind"