The headaches that never go away<\/p>\n
\u00a0<\/em><\/p>\n by Dr Nandini Chakraborty, Consultant Psychiatrist, Leicestershire Partnership NHS Trust<\/em><\/p>\n <\/p>\n \u2018Headaches for six months. No physical cause identified. Refer to psychiatry’ \u2013 a quickly written line on a pink card smaller than a sheet of A4 paper, which formed the records for a patient in a busy state government hospital in Calcutta. The one-line referral from medical outpatients to their psychiatry counterparts formed the bread and butter of our clinical practice.<\/p>\n Emotional pain can come in many forms \u2013 headache like a tight band, unresolved back pain, unremitting tummy aches, mysterious joint pains, and unremitting cramps. Bursting pain, pins and needles, ‘like electric shocks’, twisting, wrenching, heavy… all adjectives that could describe their unhappy lives and the trapped conditions that a population in a developing country could live in when money is tight, a young family needs to be fed, elderly parents need to be looked after; a society where there is no government support for poverty, no benefit system \u2013 everyone to themselves.<\/p>\n There were other complaints \u2013 indigestion, lack of appetite, sleeplessness, constant tiredness, the lack of motivation to do anything. And always the frustration of something having been missed. \u201cDepression? You mean I am imagining this? The pain that keeps me awake at night? The fact that my stomach cannot keep down anything that I force down my throat? How dare you? Someone has not read my reports right. Can’t I have another X-ray?\u201d<\/p>\n When I later trained in psychiatry in a neighbouring state, in Central Institute, it was a standing joke about Bengalis. \u201cAsk a Bengali patient what is wrong and he will take out a thick file,\u201d one of my Marathi colleagues said over a sugary cup of tea in the cramped canteen where we exchanged patient stories. \u201cMy history starts from 1970 when I attended a marriage party and experienced my first bout of acidity. Since then things have never been right, says my patient, and then it is report after report, investigation after investigation \u2013 my heart sinks the moment I see that cardboard folder!\u201d my colleague finishes with a sigh. Indignant though I feel for my community, I must admit that he is right. Depression in Calcutta was physical discomfort \u2013 as if raw emotions had vented themselves in raw pain.<\/p>\n Yet there is one woman who stands out in my memory. As I entered the outpatient department that day, she was crouching in a corner, sobbing her heart out on the edge of her faded thin cotton saree. The voices were telling her to kill herself but she had three children. How could she? \u201cShock me, madam,\u201d she begged, tears running down her cheeks, her hands very close to clutching my ankles in desperation. \u201cThat is the only thing that works,\u201d she cried, referring to electroconvulsive therapy. \u201cNothing else will take them away\u201d\u2026 Somewhere at the root of mental illness the same chemicals run through our nerve endings, just as the same blood runs through our veins.<\/p>\n 112 is the national emergency number for India.<\/b><\/p>\n Samaritans Mumbai:<\/b> (samaritansmumbai.com<\/b>) – +91 8422984528, +91 8422984529, +91 8422984530<\/b> – 3 pm to 9 pm, all days. samaritans.helpline@gmail.com. Helpline providing emotional support for those who are stressed, distressed, depressed, or suicidal.<\/b><\/p>\n