Wednesday, April 20, 2011

Cultural Pathologies of India

Mental illnesses are universal i.e. found in all societies and cultures.

Mental illnesses existed in the past, exist now and will continue to exist later too.

The causes of mental illnesses such as environmental stresses and biological, psychological , genetic vulnerabilities are present everywhere.

However, the environmental stresses are unique to each culture and so the person’s manifestations of symptoms too will vary. A schizophrenic from Russia may suspect the KGB of following him, an Indian schizophrenic may believe his neighbour has put black magic on him….and so on. Though the underlying illness, e.g. Schizophrenia is the same in all countries, the manifestation of symptoms of schizophrenia varies as it is influenced by culture.

There is a fascinating chapter in the CTP (Comprehensive Textbook of Psychiatry by Kaplan & Sadock) about mental illnesses unique to different cultures. There are also new diagnosis of new mental illnesses being published in medical literature . Some of the new disorders which did not exist a few years ago include internet addiction, video game addictions, Hoarding,etc. This indicates that  new changes in lifestyles, for example the invention and wide-spread use of computers brought about these new disorders.

Here, I am writing about my observations of the oddities unique to Indian culture  I came across in the patients of a department of psychiatry  I worked in India

These patients of the outpatient department  had odd behaviours, personality traits, style of thinking, unique to Indian culture which

(a)are definitely MALADAPTIVE.

(b)Do not add up to a full diagnosis of a mental illness or a personality disorder or a neurosis

(c) have not been recognized as a mental disorder by the medical field as yet

(d) but are sufficient to warrant attention, sufficient to prevent the person from spending life as a happy, well adjusted, productive person.

Let me add here that I observed  these behaviours  not only in clients who came into the psychiatry dept seeking help but also  in Indian society.

These are not full blown mental illnesses but behaviours which I came across in my practice…these behaviours cannot be given any existing diagnostic label either from the ICD-10 or the DSM-IV R as they don’t fit the criteria. I strongly believe that most of these behaviours also exist as the Indian culture encourage or at least do not actively discourage these behaviours. Also the extremely schizophrenic nature of Indian society may be contributing for the development of unhealthy behaviours to cope with this society.

The “odd but not odd enough for a clinical diagnosis” behaviours and personality traits intrigue me and as I neither have the interest or energy to do more research, I have just blogged my thoughts below.

I just thought of something! These may not be unique to India, they may be in other societies too....but my experience is mostly in India. I also think that any culture with similar patterns in the  roles of parents, similar interaction patterns in the society, similar pwoer structure, similar hierrarchy, similar role of religion, etc may produce the same patterns of behaviour.

The lazy person: These are young men of say 20-30 years of age brought by their parents, usually village or small town folks, usually of agricultural background. They are of middle class or lower middle class. These young men are not working, they are either married or single, with at least  grade 10  level of education or a bit higher. The parents main concern when they land in the outpatients department of psychiatry is that their son work on the family owned agricultural land or get a job.

Interviews, mental status examinations, psychological testing yield no answers to the person’s lack of interest in finding work or working. They do not seem to have depression, anxiety or schizophrenia and there is no disturbance of biological functions. The biggest issue/?symptom is the lack of motivation and lack of interest to work. These youth do not mind idling away the days, either visiting the town, gambling with friends, going to movies, etc. If they happen to be married, they do not have a sense of responsibility about their wife or kids .
To some extent, the Indian society contributes to this behaviour. The youth are brought up dependent on their parents. When these youth enter their teens and refuse to participate in the house or field work, their parents are easy-going and dont push them to work; marriages are arranged for them when they are in their twenties…(there is no courtship as these marriages are arranted by parents) . The  girl  chosen to marry one of these youth, usually has little or no choice about marrying the youth.

Once married, the girl lives with her husband and parents-in-law. She does the housework while her parents in law and brothers-in-law continue to work in the fields. The lazy person’s wife continues to look after him such as cooking for him, doing his laundry, etc. As it is a joint family, there is no danger of economic problems and this lazy person continues his idle lifestyle. The lazy person is supported by the joint family system adequately and he even has children who are looked after by his wife, brothers, his parents while he takes little or no responsibility. When brought to the psychiatry department, some report a few somatic symptoms for their ‘inability’ to work. However most of these people, lead lives in the villages and rarely are considered as needing psychological or psychiatric help.

A few of them get some sense of satisfaction or the feeling of achievement by doing very light chores and also doing chores of their choice. If a chore involves visits to the city or another village or meeting someone interesting, they offer to do it, but decline to do any task which is hard or mundane !

I have seen a similar pattern of behaviour in the cities too in the  males of joint families who run family businesses. While one son or two sons are  hardworking and slog away at the family business , one or more may work in a very cursory manner and get away by whiling their time indulging themselves. The eldest or the most assertive may control the money and again there is a lot of unfairness regarding how much money each son or his family can  access. The assertive ones get more from the pot while the less assertive ones get little and this leads to a lot of frustration for  wife and kids of the unassertive son(the guy who works and takes little from the pot does not feel disturbed but his wife and kids surely do!) Several women from such joint families have approached the psychiatry department for counselling and expressed their bitterness and frustration. But the problems of the joint family system in India is another huge can of worms altogether.

Another similar set of  people are  the unemployed youth in India... at least the few I have seen in my village and taluk: They are either college or school drop outs, unemployed and  who tend to hang about ‘important’ people such as politicians or people in the political field and 'obey' these big shots.. Most of these youth are not really employed by these politicians but they seem to enjoy hanging around these men and whiling away their years. They seem to derive a sense of satisfaction and importance by being associated to these politicians who are mostly thugs. The politicians too make use of them and also manage to attract them by providing them, not consistently  but on & off, alcohol, food & money  and also  as I recently discovered, sex trade workers. Though there is no consistent salary or work,  these youth tend to hang around these people.
I bet there are a few people out there who may find me judgemental....that "to spend life, in a way one likes is okay and who am I to judge?" But I find this way of life parasitic, where the lazy person, seems to live off others, without guilt or any qualms. They are young, able-bodied and idle. There are millions of youth in India who are struggling to find a job and earn a living but unable to do so. However these youth are those who smply do not want to work. Not wanting to work, (a)when one is able,(b) when work is available, (c)when one is dependent on others (for food, etc) is a kind of pathological behaviour according to me.
The consistent failure of the monsoons in Tumkur has now increased the number of such youth...i.e. those who while away their time. But is this a  mental illness or a disease of society and circumstances...circumstances such as poor rains, failed crops, poor skills dervided from a lacklustrre education system, poor opportunities for jobs?
I am not sure whether I would call the young, able-bodied people begging on the roads or the saffron-clad people, who lead their life praying and wandering as having pathological behaviours. Many beggers identify begging as a profession and so I do not find begging pathological. Being Indian and a Hindu, I have empathy for monks, mendicants, sanyasis, sadhus, etc and do not find the behaviour of those who have given up family and work to search God,  pathological.
I must relate an interesting  case here. I had attended the case conference of a young man, who belonged to a rich business family in India. He had left his home and wanted to become a Monk. He was an only son, heir to heaps of property and businesses and his father was growing crazy trying to get his son to come back home! He had dragged his son to this psychiatric hospital and wanted the psychiatrists to cure him. Lots of mental status examinations, psychological testing, physical examinations later, the shrinks could not find anything wrong with him! Other than wanting to become a Sanyasi, this guy was perfectly normal! Swami Vivekananda is another example of a person who gave up home life to become a monk.
 I have heard of a few men who gave up family and  jobs and everything in their life and went in search of God or Nirvana or whatever at different points in their life. These men usually went to temples or Ashrams in the Himalayas and did not return. Let me explain here that none of these men were running away from difficulties in life, none were mentally ill, none were doing it on the sly. They had this inner urge to find God (or whatever) and left their safe, comfortable homes. They spent the reminder of their lives in these ashrams till they died.
Many of these men were deeply knowledgable about philosophy and were good debaters and teachers about their school of philosophy , their religion and rituals. Today, one finds such people in smaller numbers than in the past, but they do exist. These people  renounce the usual way of living....the usual way of living is  going through the life cycle of studies, marriage & children, work, retirement...or the 4 Ashramas i.e. Brahmacharya, Gruhasta, Vanaprastha and Sanyasa;
 These people jump into the Sanyasa ashram very early in their life, maybe without ever entering either the Gruhasta or Vanaprastha Ashramas. Having met a few of these men, I am full of admiration for their knowledge, calmness and their wisdom and though they have sought this life style, one can never accuse them of any sort of pathology. They derive meaning in life through their search for God, serving people by teaching philosophy, working in the Ashrams, doing social service. Many have left grieving wives and parents behind but this does not seem to affect them. (Hindu philosophy says that "you come into this world  alone  and you leave this world alone". These monks seem to follow this and have no sadness when they leave  their family members). This life style is seen all over the world...the Catholic  priests who dedicate their lives to God, the nuns, The Buddhist monks in different parts of the world and so on.
But in today's very materialistic world, these people stick out like sore thumbs at times. It would be wonderful if these people were looked after by the governments of their countries so that they could dedicate their lives to Philosophy, which would benefit all mankind. In India, these monks can survive due to the alms given by people, as people have faith in the monks. But I think it would be very difficult for these men to survive in countries where  everyone is expected to earn and not beg for a living. A begging monk would look definitly odd/pathological in some places.


Wild goose chasers: OR People with poor judgement OR unrealistic people OR  Delusional people.

If someone is persistent and succeeds their persistence is admired but if someone persists and fails they are labelled insane for persisting in something that was doomed to fail!

I know it is wrong to judge a person’s sanity by the results they achieve but I cant help it . This kind of doomed persistence and therefore insanity is seen in another set of people(cultural pathology-2) who try for roles in movies or television series in India. I have seen about 4 people in the dept of psychiatry and I am sure there are millions more in India who fit this type of madness. The symptoms they have include:

A strong, persistent, unshakable belief that they should be a movie actor

No training to reach their goal such as no efforts to enrol in an acting school, etc

Very average looks ( Believe me, in India, ‘looks, contacts & money’ are more important than acting skills, if you want to get a ‘break’ in movies or serials)

Refusing/not trying to develop skills to get alternate jobs if acting does not pan out.(there's no plan-B)

Hanging out near film shooting units, near directors and producers of movies at all times or as much as possible.

Doing odd chores for the movie people, working without payment in the hope that they will get a role, waiting for years without losing hope.

Neglecting all other areas of their lives such as family, education, job, hobbies, etc.

I have seen one who dropped out of college and was hanging around movie units till his 30s...he never completed his educaiton nor did he seek a job...his mother fed him daily and he spent his time hanging at movie shooting sites, hoping to get a role...for years and years!

There was another guy  who left his village to work in movies and never got a role but was hanging around the movie sets;
And one guy who wrote scripts without getting paid or even getting credit though his scripts werrre used.

No amount of counselling can make these people get out and seek a different goal in life.

In some ways they are like gamblers and people who buy the lottery…the firm, unshakable belief/delusion that one day, their day will come. But it never seems to come to many.

I do not even want to talk about the deluded young women who want to enter the film field in India.  In addition to all the  problems  the deluded film-crazy young men experience, these young women face sexual exploitation too.

My family have argued with me about including this wild goose chase as a family members, think that there is nothing wrong about being passionate about something, that most Indians always play it safe and are conservative and want to only seek education which gaurentes them jobs...that most Indians are averse to risk and dont even attempt to do something they love, without worrying about earning. But I disagree. I have seen many people in India who are passionate about what they do and they do it knowing fully well that they may not earn much but they are enjoying what they are doing and they are passionate about thier work. I dont see these people as mentally ill ...I see them as passionate, perhaps not practical and worldly but they do know the consequences of thier choices and still choose to do what they do. One example is a close friend of mine who is an artist...does minimalist works which are not really popular in India but she does it as it is her passion. She has exhibited abroad and has sold to museums but has little money to show for it. Though she is frustrated about the poor money she makes, she has accepted the low financial benefits and refuses to make art which is more commerically viable.


Another phenomenon I observed while working in the Indian hospital is the onset of psychosis in one set of students i.e. students  taking the PUC ( PUC is Pre-University Certificate…it is the 11th & 12th grade equivalent)exams especially the science stream:

I worked for about 7 years in the psychiatry dept and came across more than 25-30 cases of 'first episode' psychosis/schizophrenia in youth aged about 17-18. The fact that it is a first episode psychosis is not unique. The age of onset is also not unique. What was unique was that all of these youth, were studying in the science stream (i.e. Physics, Chemistry, Biology, Mathematics as their main subjects) and were in the second year when they had their first episode of psychosis. This indicates to me that :

It is mostly the science stream who were stressed out enough to have a break down and not the arts or commerce students of PUC or other youth of the same age group.

It is only in the second year of PUC that the stress gets to them.

This indicates to me that many students taking the science stream are extremely stressed out and should not be stressing themselves out like this. They opt for science so as to study engineering, medicine, dental, and other professional courses after PUC

I am not talking of a cause-effect relationship between taking science and getting psychosis, but these are kids who got poor scores in school, have limited capacity to study tough subjects, yet opt for these subjects and then break down.

A major insane behaviour seen in south India and now I realize it is a behaviour seen in many east Asian countries as well…… the insane need of parents to force kids to study science ; some parents  believe this is the only way to ensure future economic and job success/security for their kids. It is not just the parents who insist their kids to study science; many kids too opt for science even if they lack the interest or aptitude for science for insane reasons like, ‘All my friends are taking science and I have to take it too’; or ‘others will think I am dumb if I do not take science’.

Truth be told, I have seen parents who did not want their child to take science in college as they knew it would be too tough for their child to handle but their child insisted on taking science as "all his friends were taking science". I have also seen children who did not want to take science but were coerced by parents who assumed that their child's future would be bleak if he took arts or some other stream.

I suppose variations of this behaviour is seen in children and parents all over the world. For example, I have a Canadian colleague who says that ‘every Canadian parent seems to think that his kid is the next NHL player’ and that lots of parents put immense pressure on their kids to do well in sports, irrespective of the child’s skills or aptitude.

Putting pressure on one's children, controlling many aspects of their life is one common feature in many eastern cultures. This makes children feel powerless and resentful. They end up doing many things against their wishes and finally if they meet with failure, the blame-game starts and no one is willing to take responsibility. Children blame parents for not being allowed to make their own choices and parents blame children for failing in spite of the sacrifices they made for them.
Lots of adults do not have choices in eastern cultures and have to do their parents bidding. Parents dictate what the adult child wears, what he/she chooses to study. Even the career and spouse may be chosen by parents! With little autonomy over their lives, it is natural for a variety of pathological behavioiurs to develop.
Lack of logic: To me, this is the biggest mental symptom in the Indians ( I am an Indian and so I may have the same symptom……. who knows???) A lack of logic and magical thinking is highly prevalent in the Indian population and seems to be unaffected by factors like education, intelligence and exposure to facts! To me this lack of logic or magical thinking or Denial as the Freudians call it is a huge barrier to successful and happy adjustment .

Let me tell you some examples of the unrealistic expectations, I came across in my clients:

Teens and their parents: Many parents dragged their teenage kids to me for counselling to improve their academic performances. They would ask/demand for pills to improve memory, pills to improve intelligence, hypnosis to improve their performance in exams.

On assessment, most of these kids were average or low average and their parents expected spectacular academic performances from them. They believed that if the kid only worked harder, he could get 100% in mathematics or 99 in physics or whatever. No amount of explaining or counselling would dispel the expectations they had of their kids. I was distressed to see a person who had a son with developmental delay who was giving him pills (from Himalayan Drug company) to improve his IQ as was promised by the person who prescribed it.

An illogical belief in prayers, worship, rituals, mantras, etc to cure mental illness: Many clients to the department of psychiatry, especially those from rural areas, lower socio-economic status, lower literacy levels usually took the family member suffering from mental or physical illness to black magicians, priests to get them cured as they believed the cause of the problems was black magic done by some jealous person and removing the black magic will cure them. What left me irritated was that a lot of literate people too held these beliefs. By literate I mean those with at least college level education and some with science majors!

Going in unprepared, in the belief that things will 'somehow' workout: This is another illogical practice I have observed in me, many Indian children and adults. Many Indians (and maybe people of other nationalities too but I do not know of them) go to many important events totally or partially unprepared and hope that  'luck' will get them good outcomes! I have seen students who whiled away their time and went unprepared for exams and expected some good fortune to happen to them to give them a pass with good marks! I have seen adults go to interviews without preparation, hoping that they will be 'lucky' and get the job! I have seen people expecting good luck to take care of them and they never try to take to do the logical thing to get a favourable outcome i.e.  planning ,doing what is needed  and by working hard!


Apart from the examples mentioned above of people who show odd behaviours and do not fit into any diagnositc category, there are also people in India who fit into psychiatric diagnostic categories but who do not have any label attached to them and who are doing well. These are the Asperger's syndrome people, alcoholics,people with other forms of substance abuse, some people with borderline or mild developmental delay, people with a definite psychiatric diagnosis but who do not ask for asessment and treatment, etc.
 These people live in society and are never brought for treatment...this happens as they not only lack insight but as the people  around them are lacking the guts to suggest they get treatment or report them to the proper authorities.

A few of the several cultural and economic factors causing pathological behaviours in people of India:
Demanding Dowry: Not only do people take dowry, but they pretend they don't; It is the pretence which is more nauseating than the asking or taking dowry itself.
Bullying of new students by old students
leading to the victims attempting/completing suicide, giving up the educational course and returning home, suffering from depression and anxiety, etc.
Farmers suicides due to a range of interrelated factors
Murders of wives by alcoholic men: These men are so brain damaged by heavy drinking and suffer from alcoholic jealousy and paranoid illnesses. But the newspaper articles reporting of incidents of these men killing their wives never mention the  psychiatric problems such as alcoholic jealousy, paranoia and brain damage  these men suffer from; this gives the impression, to the vast majority of readers that the wives were adulterous. Since I see at least one such death every week in one city's newspapers, you can imagine how many more are happening!
Exposure to Gender and Caste discrimination in India right from childhood, leads women and lower caste people to have a certain unhealthy self-concept and low self-esteem. This pathology of low self-esteem is common in majority of Indian women, low caste people and by many others who are neither low caste or women such as thpose who suffer from handicaps, and those who are different in some visible way;
people in India develop low self-esteem, for various faulty child-rearing patterns, harsh teachers and  stupid value system, period.
The few who do not develop this pathology and have healthy self-esteems are brutally treated by some who cannot tolerate this and verbally or physically assault them until they are cowed down. This is seen more in rural areas than urban and among the  folks who are less evolved. A low caste person demanding his rights is considered to be 'arrogant'; or  a girl who demands equal rights is subjected to such harassment until she backs down and accepts that she was wrong. I can go on and on about several such issues. But I think I have made my point that
 several aspects of Indian culture is pathological;
that many pathologies are acceptable and normal and highly valued in India and
many  normal and decent values are unacceptable to majority of people; that this will continue as long as the people who are right do not fight and resist; that this will continue as long as the oppressors who benefit from this pathology, fight to maintain the current sick culture.



Cases of Nonconsummation of marriage was another unique phenomenon I came across in Indian society through the psychiatry department clients. On taking the case history and detailed interviews, I realized that

most of the marriages were arranged by the parents of the man and woman, there had been little or no courtship or interaction or even communication during the period they knew each other before the marriage.

Causes for non-consummation: Often the man or woman, were not interested in the marriage but were forced to marry by the parents.

In more than one case the man was gay and had not revealed to his parents or wife and the homosexuality was disclosed only when the medical team interviewed him at length.

In some cases, one of the spouses already had a lover, but had neither told the parents nor tried strongly enough to resist marriage to this person. After marriage, the other spouse was left wondering why, the partner refused to have sex.

There was one case of impotence, one case of schizophrenia (parents had not disclosed that he was mentally ill either to the bride or her parents) and one case of severe alcohol dependence for non-consummation of marriages.

It was very sad for me to see the lives of these young men and especially women, affected by this web of lies and deceit which could have been avoided, if the spouse/his family was upfront before the wedding and prevented teh wedding from ever taking place!

I do not know if any of the cases I saw went through divorce or  got counseling or got some sort of help. The person with schizophrenia did get help but the others did not return after a few sessions.

In India, with arranged marriages still prevalent, I do not know how many other types of problems are lurking.


Children’s expectations from their parents: One slightly bizarre behaviour I saw in a few cases was the demands made by children on their parents in some upper and middle-class families.
Two were women :one in her late 30s and one in her late 40s ; both were furious with their fathers for not getting them married. As you know it is mostly arranged marriages in India and Indian girls expect their parents to find suitable grooms for them. These 2 women during their 20s had rejected many ‘suitable’ proposals when their dad brought them giving various reasons such as he is not good looking, he is not in a good job, he is not earning enough, I don’t like his house, etc. Now in their 30s and 40s, they are accusing their aged parents, of ruining their lives. Both women are unemployed, have gradually withdrawn and refuse to visit other families and friends, do not participate in house work and are looked after by their aging parents. It is difficult to make any diagnosis as they do not fulfil any criteria except maybe psychosis nos or depression nos. At the beginning i.e. when this behaviour starts, they do not fit any diagnostic criteria but after several years of the same behaviour and increase in withdrawal, they seem to fit criteria for a illness at some point in time. The lapse into illness is 'seamless' and slow.

Unfortunately I have seen many similar cases amongst relatives, friends and neighbours. I really blame the Indian culture for these expectations  children have of their parents.

It is a combination of reasons such as
(a) the youth not allowed to find their own spouses i.e. lack of autonomy over one's life and parental interference,
(b) the youth not allowed to mix freely with the opposite sex(this has changed now, at least in the cities, thank God),
(c) lack of economic independence (mostly in women than men)when one does not work.
 I have also seen cases of severe marital conflict and where the married person continues to blame the parents (for  several decades after marriage),  for not finding a suitable partner. The parents bear it silently with a sense of guilt. This would not happen if one could have autonomy over selection of one's partner. Many of the people continue to be married to the person who was 'selected by parents' and neither divorce or try to get along or seek counselling. They spend lives in bitterness. 
One major reason for this seems to be that many Indians do not take responsibility but blame others or external forces for their miseries. To this day, a common tale of woe you hear in many Indian households is of a father or mother telling the kids   " I did not want to marry your father/mother. I was forced to by your grandfather and now my life is ruined". These accusations continue to be thrown for ages and never seem to stop!

Another type of unrealistic expectations I witnessed was kids demanding their parents to shell out huge sums of money (“take a loan if you do not have the money; Get me the money somehow”!) for their education. One case I quote here was a girl of 18 who got average marks (and hence the marks are not good enough to enter medical college easily) and got into a medical college after her parents took a huge loan(fees/donation are high if your marks are poor). She then refused to go to the college as ‘she did not like it’ and demanded her parents take another loan and put her in another medical college! It was then her parents brought her in for counseling. This girl was simply unable to see reason and refused to budge saying that her parents have to take a loan and get her into another college and that she will clear their loan at a later date. She dropped out after coming reluctantly just once and I am not sure what happened to her. This is another case which looks so delusional and yet her bizarre behaviour is partly the result of her parents being indulgent for a long period of time....and being unable to put their foot down when she made these ludicrous demands.

 I have seen many adults make similar unrealistic demands on  their hapless parents and throw tantrums (these are adults in their 30s and 40s…not little children). I have seen some guys asking their parent to get them a beautiful bride and their parents move heaven and earth, trying to find someone not only beautiful but also willing to marry their son! What puzzles me is the utter coolness with which these demands are made, the inability to see how wrong their demands are, and the parents inability to draw the line.

All these behaviours do not add up to a personality disorder in most cases. They definitley do not add up to be schizophrenia, depression, mania or any type of psychosis. These are behaviours which have reached this point due to a variety of cultural factors such as over-indulgence by parents , partiality to male children, parents jumping through hoops for thier kids instead of setting limits...believing that if they give everything to thier kids, they will make thier kids happy and successful or that their kids will love them or look after them in their old age.

The shocking anti-social  behaviours displayed by the sons of the very rich in India such as sons of politicians is another example of cultural pathology. These boys get away with murder!...Yes. They can literally kill one or more human beings and get away with it. Reading the Indian newspapers will give you many examples. These kids do not display such  pathological behaviour because of  mental illnesses ...they become like that due to cultural factors such as over-indulgent parents and sycophants surrounding their families; deviant parent role models, not being punished when they do wrong as children, etc. The fact that their parents use their power to twist the law to get their kids out of trouble only encourages them more.

There is also the unnatural expectations parents have from their adult children (such as complete obedience without exercising personal choice or independent thinking) but I am not going to dwell on it much. You would have seen it in the million Hindi movies released every year.

Blind love is another phenomenon but this is of course not unique to India! I have seen this both in  people with and without psychiatric diagnosis . I have seen it in friends and relatives. To me blind love is where a person is having so much love and affection for a person that  it blinds them to the loved one’s defects.

I have given one example of blind love here; one psychiatric patient killed a person and  reached his  home late that night. He confessed to his mother that he has just killed a person and do you know what his mother's response was? His mother told him,” what is done is done and cannot be undone. Eat your dinner. You are late and you must be very hungry”.  She was more worried about her son's hunger  than about the murder he had committed!

There are many such people, who love so blindly that they simply fail to see even the most severe faults in their loved ones. Mothers blind love and forgiving nature towards their ‘oldest child’, ‘youngest child’, ‘only son’, ‘only daughter’ , ‘grand-child’, is bizarre, moving and sickening all at the same time!

 I know an old lady, whose son borrowed money and failed to return and the mother accused the moneylender! The lender had actually lent the money out of compassion but this mother accused him of loaning money to her son for the selfish reason of charging interest! She did not acknowledge the fact that her son did not even bother to return the money or pay interest or even call the money lender to apologize.
The extent to which blind love, twists people’s logic is simply amazing. I know of another mother who was treated very harshly by her adult son.... Instead of feeling anger against her son, she  blamed the maid-servant  in the house for putting black magic on her son and turning him against her!  The human mind has an infinite capacity to be deluded!There are millions of cases such as this but again, they are not really mentally ill according to any criteria. But to the eyes of an objective outsider, the delusions appear highly pathological!
Twisted perception such as the ones mentioned above is another common pathology one sees in India. Indians (or is it the entire world?) interpret informaton in ways to suit their beliefs, they twist reality and make explainations to suit their perceptions. The reason I keep harping on India and Indians is that I have lived in Canada for 8 years and I do not see the extent of delusions, lack of logical thinking, and denial and twisted perception among the Canadians...whatever their level of education, age or background is. They seem to be more grounded and realistic than Indians are. This makes me wonder if we Indians are somehow more delusional and pathological than the rest of the world. One good reason I can think of for this could be that: The stress caused by living in India is much higher than living in Canada. Therefore we all become a bit mad, in order to survive living in India. If we were completley sane and not delusional, then living in India would become hell! (No defense mechanisms to survive the ugly truths we face in India means ouor ego will collapse in no time!)

As society evolves,  people evolve too and adapt to the change. It is possible that the pathologies are not new but have been influenced by the culture and transformed into new maladaptive behaviours. For example the addiction may have changed over time but  addicts have existed at all points in time. It may have been alcohol addiction in the last century and drug addiction today.

There is an ongoing Metamorphosis of culture, society& behaviour and therefore metamorphosis of  pathology too.  I wonder  if a day will come when society has evolved in a healthy direction and  to such an extent   that there will be very little need for pathological behaviours.
One example of society evolving and decrease in pathological behaviour I have observed is that in my family (about 100 including all uncles, aunts, grand parents, cousins, their spouses, siblings, their spouses, etc)there seems to be lesser of blaming parents as autonomy in choice of partner has increased in the recent generations. My grand parents generation had no choice in selection of their own spouse, parents generation had no choice too; but in my generation, those who married 30 years ago had no choice but those marrying now select their own spouses....the marital harmony, respect for women, economic equality between genders, 'about' equal levels of  education between the genders and also greater levels of education than pervious generations, etc seems greater in the newer marriages than the older ones.
Another example I can give about evolving leading to decreased pathology is  the lower prevalence of mental illness and greater mental health in healthier societies today such as the Scandinavian countries.
A few other pathologies I have observed which seem to be unique to India and these are pathologies which are sub-clinical and not enough to warrent a diagnosis are:

Attributing success and failure to totally unrelated events:
e.g.: I passed in the exam because I prayed to God;
e.g.: I failed in the exam because a black cat crossed my path , the day I went to write the exam.

I always believe that where there is no freedom and where people are repressed, threathened and bullied,  they show unnatural behaviours. The behaviours are not natural to the situation and often people do not even realize what is happening. In majority of the people's lives, there is fear and lack of freedom. So majority of people show unnatural behaviours in many situations.
The harsh punishment of teachers in schools scars many children for life and they show unnatural behaviours all through thier lives.
The punitive methods used by many parents especially in the lower strata of society makes many children behave unnaturally. Exposure to harsh realities of life from childhood itself such as hunger, physical,verbal and at times sexual abuse make many children react unnaturally.
The bullying nature of bosses, the hierarchy, the nepotism, gender inequality, discrimination based on caste, etc at work places make people cope by reacting unnaturally.
Why do I say "react unnaturally"? to all the above situations. It is becaue to react naturally in those situations is to expresss anger, dislike and to escape or to change the situation. However, as most children and people are neither able to escape or change the situations, they end up by coping with it in unnatural ways. This is the pathology. For example, The child fearing but continuing to respect and obey the punitive/bullying teacher is a kind of pathological behaviour but it helps the child cope and survive. This can go on for so long that the child, now an adult, does not even realize that it is wrong or pathological to respect and obey a bullying person. As an adult, the person does  not even recognize abuse as he is so used to it from childhood and thinks of abuse as "something good and necessary" and may himself become abusive .....and perceive it as "I may be harsh but it is for the child's good".

When one looks around in many eastern societies, so many pathological behaviours go unrecognized as pathological. Some of these pathologies are even glorified as Good or benevolent behaviours!
I have seen parents of kids with ADHD  who are initially, extremely proud of their kids as they equate the hyperactivity with intelligence ; another example is that many men with poor social skills or shyness,  or men who do not interact with women are regarded as 'very decent' and 'good' while someone who interacts easily may be suspect! Asperger's goes undiagnosed often in Indian culture; many cases of mild depression, anxiety, obsessive compulsive neurosis, several types of seizures, many personality disorders, borderline intelligence, are neither recognized or treated. The odd behaviours are accepted, tolerated, maybe even considered as more  'positive'  than 'normal' behaviours by Indians! This happens even amongst the educated folks.
I have seen one very pious and religious family who believed that their son who was very very hyperactive in childhood was an incarnation of Lord  Krishna. The positive view of his ADHD probably did good to his self-esteem but the family went through a tough time when his behaviours got worse as he entered adulthood and their belief that he is an incarnation of Krishna was severely tested.

Footnote: I was inspired to write this after reading online about  a pathology unique to Japan (and a few other east Asian countries)i.e. Hikikomori and after reading the chapter on cultural psychiatry in Kaplan and Sadock's Comprehensive Textbook of Psychiatry.
While working in India in a major mental hospital, I came across 'recognized' psychiatric disorders and psychiatric disorders unique to India such as Possesion, and disorders found more often in say for example the Indian population than the western such as psychogenic seizures. While there is some published research on disorders occuring in some cultures, there is not much being done to explore the link between the factors causing these problems and not much being done by the authorities(government, policy makers, etc) to counter these factors.


Abortion of female children is not unique to India. It is a practice prevalent in many countries in the east, in patriarchal societies, in societies where parents consider sons as blessings and assets and daughters as liabilities or a burden. The extent to which female fetus are aborted in India is so vast that the current male-female ratio is many parts of India is skewed. Instead of 50-50 or the 51 females to 50 males, typical of many developed countries, it is 933 females to 1000 males. I naively believed that education will lead to a healthier sex ratio and this is not so. People with education also abort female fetus; I naively believed that people of higher socio-economic status will not abort females as they don't have any 'financial problems' . But a study in Bombay, showed that the number of females born in 'affluent' areas of Bombay wee lesser than those born in less affluent areas of Bombay. Abortions are legal in India. However aborting a fetus because of it's gender i.e. because  it's a female is not legal. Yet, millions of fetus are aborted in India every year! What does this say about Indian society? About our morals and ethics and decency? You have these middle-class and upper class people, who visit the scanning centre and pay to know if the fetus is a female or male. Then they decide to abort it as it's a female. Become pregnant again and check again and abort again if it's another female. Continue this until a male is born! They don't experience guilt, significant enough to stop them from aborting. They overcome their guilt, if any, through many rationalizations to themselves. Of course, they keep this abortion a secret and don't discuss it openly. They don't want any criticism of their act! The people aborting are often  educated, know that it is both wrong and illegal, and are females themselves! I have seen a gynecologist abort her own female fetus until she had a son. I have seen lecturers who 'preach' to students about psychology, sociology, etc abort their fetus. The pathology  leading to abortion is multi-dimensional and too much to discuss at length here. I will mention a few here, without going into depth.
(a)double standards...preaching equality of genders but practicing abortion of female fetus.
(b) believing they are 'decent', morally upright', 'educated', people and don't even seem to realize they are murdering a helpless fetus, their own daughter or granddaughter or niece or whatever who is innocent, helpless. (many women abort because they are pressured into aborting by their husbands, in-laws, their own parents, etc)
(c). Their need to show off that they have a 'son' and their shame about 'not having a son'...they consider having a son as an achievement to be proud of! They don't seem to realize it is just 'chance' and 'nature' that it happens to be a boy. Their sense of shame, anger, and frustration when they have a daughter...though the girl who is born has done no crime!
(d)All of these unwashed ass-holes want a good-looking, hard-working, obedient, educated daughter-in-law for their son; but don't want a daughter !
(e)The people running the 'scanning centres' don't feel guilty and think they are 'doing a favour to society'; The doctors aborting countless female fetus don't have any compunction doing what they do. To hell with the Hippocratic oath! They are here to make money! There is so much money in abortions  in some parts of India, that doctors compete to do their masters in  courses related to this field. The police turn a blind eye or take bribes and let these things continue.
(f)What I hate the most is the need these people have to project an IDEAL FAMILY PICTURE to the world..."We are a happy family; My husband is an engineer and we have one son and one daughter. we have a house and car" . Or "we are a happy family; we have two sons". I HATE THE LIES OF THESE PEOPLE; They don't admit that their happy family is because they aborted 3 female fetus and kept trying for a son; they don't admit that the car the family has is the dowry given by the woman's dad; that he is an engineer because his dad paid donation as he did not get good enough marks to get an engineering seat. That he got the job of engineer as his dad and father-in-law bribed to buy his job"
It is the utter callousness of the abortions, and the hiding and lying about the abortions that bothers me the most about this Indian culture's pathology of female feticide.

I came across a few unusual  cases but as they are just one of a kind, I do not want to put them under cultural pathology. But they are definitely influenced/caused by the culture surrounding them.
Here are 2 which I recall.
One male, with 10th standard level of education was referred to psychiatry for assessment by surgeons of another hospital. He had approached that hospital asking for a sex change surgery and he had been referred to psychiatry to rule out psychiatric issues before they did surgery. I am not sure if the doctors would have gone ahead with the surgery if he had gone back to them. While interviewing this guy  about the reasons  for a sex change, he said he was the son of a farmer, he wanted employment in the polic force and if he was a female he had better chances of getting the job as he had the required 'height' and had passed 10th standard! He had two criteria to get the job; now al lhe needed to do was be a female(because some quota of jobs are reserved for females; the females quota of jobs remain unfilled at times due to few women applying)
I explained to him that the sex change operation was not simple or something he could be done with in a day or a week, that there was a lot of cost involved even if the surgery was free (hormone treatments), that there was no guarantee that he will get the police constable's job if he had the surgery, that he will have to explain to his parents, that he will have to face his village folk, etc.
 He had not thought this whole thing through and had just impulsively hopped on a bus and come to Bangalore, gone to a hospital and landed with us! He left us and did not come again. I hope he has reached his village safely and got a job or is working on his parents farm.
Why do I link this to culture or the society around him? I am not sure if I am right but I think  that: (1) if getting a job for a villager in India was not so difficult,(2) if he had a better quality education,(3) if he had sensible people around him with whom he could have discussed this idea of his, he would not have ended coming to Bangalore for a sex change operation.

The second case is of one where a rural boy had been dressed as a girl by his family since childhood and he also sat in the girls side of the class. Arond 7th standard, his family seemed to wake up and wanted him to start acting as a boy and dress like a boy but the boy refused. A similar case which again presented in the department of psychiatry was of a girl who had been dressed as a boy all her life and the parents wanted her to go back to being a girl when she was around 9th grade. What amazed me was that the kids got away in school. I alwyas wondered how they got away while using the toilets in teh school? I wondered about the relatives and neighbours who in the early days at least, would know the gender of the child and how could they ALL forget the gender of these kids over time?
In both cases, the parents had no satisfactory answers as to why they brought up the kids as the opposite gender.  I do know of many girls brought up as boys in Afganisthan so as to get education, go out in the city and work, go out to simply shop for vegetables. But these 2 kids were brought up as if they were the  opposite gender, studied alongside the opposite gender kids (a girl sitting with boys in class or a boy sitting with girls  is a very big deal in Indian villages) and were suddenly expected to change gender and behave and dress differently when the parents realized that 'the time had passed' and it was time for them to revert to their right gender. I do not know of what happned to these 2 cases too. Often, many villagers make one or two trips to the city hospitals and cannot afford to come for psychiatric treatment to the city regularly.

Another pathology, whether it is unique to India or prevalent in other countries I dont the Lack of depth in thinking and planning before taking major decisions. I will write about this some other time when I have composed my thoughts., Right now I have a dozen examples and I think if I write those examples, people from other countries will not believe these are true examples! That we could be so unthinking, ergo stupid in India!!!

Dressing as the opposite gender is something I have seen often in India. I think there are many reasons why we Indians do that but none of the reasons seem very strong. Parents want to see how their baby boy looks in a frock, they dress him in that. and take a few photoes for posterity! They  dress a boy as Krishna and that involves a lot of girlie things like silk clothes, eye-liner, rouge on cheeks, Lip stick, peacock feather in hair, gold jewels for arms, waist, etc. And some parents address a beloved daughter as if she is a son and this continues all through their life.
 But I have seen this often, with no serious psychological or other consequences.

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