Can I get some Prozac, doc?

Those clichéd couches; what purpose do they serve?
That’s from Freud. His method — psychoanalysis — is where you lie down on the couch, the analyst is behind you, you can’t see him. It’s called transference; he is supposed to become like a mother or father in your mind while standing behind you. Psychoanalysis has mostly died out except in places where they provide public money for it. Most psychiatrists now don’t do psychotherapy, they just give medication. You go to a psychologist for therapy.

Are Prozac and other depression medications used in India?
They are vastly over-prescribed, not just by psychiatrists, but by family doctors, even cardiologists, for stress and other things. Prozac should not be used for that. It can cause weight gain, loss of sexual desire. Medication should only be prescribed for moderate to severe depression. For minor depression, behavioural treatment, not medicine, is called for.

Does hypnosis really work?
Some don’t want it, others come just for that, sometimes because they’ve read about past lives — but we don’t do that usually. We use it a lot, for a wide variety of problems. It increases the effectiveness of psychotherapy. It’s a clinical judgment if patients should have it. It works very fast compared to other forms of therapy — in more than 50 percent of patients it makes a rapid change. But anything that can do good can do harm. With a psychotic disorder, hypnosis can sometimes trigger a relapse or an emotional condition.

Do psychiatrists need shrinks?
We analyse a little bit more. We are a little more careful about our own families. It depends on the kind of balance one has. The thing is, some psychiatrists are disturbed themselves. Doctors are less likely to take treatment and more likely to self-medicate. The same goes for psychiatrists.

How realistic are the scenes in One Flew Over the Cuckoo’s Nest?
Very realistic. My guess is similar things happen in India, in third world countries Often, the people who run the hospital are not highly educated, and there is a whole lot of coercion, control using food or cigarettes or electric shock treatment.

Isn’t shock therapy inhuman?
There is stigma because of misuse, because people don’t like the idea of no
anaesthesia — which doesn’t happen now — of electricity flowing through the brain. It’s banned in some states in the US, but widely used here. It can be life-saving for someone who is catatonic, not eating, or suicidal. But, rarely, it can cause partial memory loss, even death.

Can all mental illness be blamed on a disturbed childhood?
Not all, but it is an important factor. [Research has proved] that kids who are bullied are more likely to have psychological issues. But sometimes it’s not that. It’s a break-up of a relationship, or a genetic link. There is no simple cause.

What makes perfectly normal people turn into criminals and killers?
It could be genetic. Often it’s very complex. A person just gets depressed, or they have an angry personality, or something happens in a relationship. Sometimes it’s an impulse. It’s the kind of thing Shakespeare writes about. In India, psychiatric patients are slightly more likely to get upset or violent, but they are less likely to murder.

If a patient tells you they are going to do something illegal, what do you do?
If most countries, if a patient says they will kill someone, you have to inform the police. If it is child molestation or someone who poses a threat to the public, and they won’t follow through with treatment, you have to tell someone. But generally that rarely happens. In India people are less likely to commit offences, in the West it seems people are more likely to be violent.

Why do people choose to be psychiatrists?
One reason could be a desire to help people; it’s not a high paying profession, especially compared to other doctors. Or an interest in the human mind. Sometimes the person has family members that have problems. Or they themselves have problems, and don’t want to admit they have a problem.

How do you know if you have a disturbed psychiatrist or a good one?
From the worst psychotherapist to the best one the variance is nine: the best psychiatrist is nine times more effective than the worst. If, in the first six sessions, you are doing better than when you came in—not necessarily that you are perfectly okay, but you are feeling hopeful—then you have a good one. If you are getting worse, you need to see someone else or do something else.

Do psychiatrists ever commiserate with each other about their patients?
It happens between friends sometimes. Someone with a difficult situation with a patient would talk to senior person about how to deal with it. People are sometimes surprised that psychiatrists, who don’t practice psychotherapy, choose to undergo therapy themselves. They really believe in it, even if they don’t practice it and just prescribe medicine. A colleague of mine wasn’t doing well in practice; he went for therapy for two years, and saw a vast difference.

What are average billing rates like? And what’s the average length of time for treatment?
In India, we charge anywhere from 300 to 3000 rupees. The average time for therapy is six months. But for medication it is eight to nine months. Some people take medicine or therapy for longer. Patients often start more frequently at first and then it comes down. If, for example, you have a severe obsessive compulsive disorder that doesn’t respond to medicine, then you need to go for the rest of your life. At least 10 percent would be in that category. But psychiatry doesn’t have a cure for everything. And for many people, even if they don’t have treatment they get well.

Coordinated by Elizabeth Flock

Our next insider is a private investigator. If you have questions for the detective, email us (ask.forbesindia@network18online.com). We also welcome suggestions on future “insiders” you’d like to see.