MEDICINE
I’ve Gone to the Country Spa
My reflections on psychiatry and heredity
I never bathed in the Ganges like my granduncle. The yellow bulb in California skies a distant relative to the Vedic sun he bathed under. I have his hair. Our hair carries madness that wriggles through generations like worms after rain. My granduncle lost his mind, beating bulls near fields of poppy, reduced to a drunk. He did not rest gently among the flowers.
My dad and I walked along the village road, near fields of cotton shrubs waving in the wind. Our walking tempo was set to the rattle of various drupes. I saw fields of poppies, blood red, dripping as watercolor, blurring with setting suns, wrinkly petals sneering back. We took an offshoot from the road into the cracked inlets of the village. There was the square cement house springing from the ground where generations of my family had lived. It was early evening, the houses were lit by an oblique light, the air threatened rain. We walked as he recalled his former neighbors, telling stories of his childhood. I couldn’t tell if the drizzle I felt was God or the drippings from the billowing laundry on clotheslines tacked outside houses. For a cohort of men, including my father, the journey from East to West was a radical change, one of the defining choices in their lives. Each emigrated life diverged in a different direction, like homunculi, fates folded into each person, slowly unfolding with time. This was my father’s distinguishing conflict: leaving behind family and facing the culture shock of raising me in America.
Twenty years prior my granduncle had a reckoning of his own. Known as The Emergency, then Prime Minister of India, Indira Gandhi took dictator-like control of the country, citing “internal disturbances.” From 1975 to 1977 elections were canceled, civil liberties ignored, the press censored, and a mass campaign of vasectomies were enacted under the guise of population control. It was a controversial time in India filled with riots, deaths, forced sterilizations, and hundreds of thousands of people relocated, including my granduncle. Indira Gandhi became the Caesar of India — she was shot by her bodyguard in an “Et tu Brute?” imitation of art.
I turned to my dad and asked him what he thought of my granduncle.
“I didn’t know him well. He was 26, 27 before he died. I think it was bad karma.”
“Do you know if his illness is heritable?”
“I don’t know.”
I imagined my granduncle being dragged back to the house, doors slammed shut before the gossiping ladies of the village started to gather and peered through the window netting. He probably thrashed around like a wild bird in the throes of mania. Two years after the Emergency he was rolling among the flowers. His fate unfurled with the times and soon his mind.
Speeding past the recently greened hills of California made me almost miss the dehydrated brown they used to be. It was pouring, as it’s been of late, but I enjoyed the views towards Wine Country. The endless strings of grape-bearing vines curve with the hills and stretch to the horizon. The narrow rows resemble the lines of parallel brick houses in my village. Napa State Psychiatric Hospital was bordered by three different wineries, like an island or a sore pimple sticking out beside the placid resorts and golf courses. I was lucky to approach the banal beige building. A furtive attempt to camouflage among the ordinary. I pictured an asylum of unstable people screaming profanities as they stripped themselves naked. I was nervous. The only people admitted were through involuntary civil community programs, proven incompetent to stand trial, or proven not guilty by insanity. Picture One Flew over the Cuckoo’s Nest but without the charismatic Jack Nicholson hiding from the law. There was only Nurse Ratched without the mutineer.
I waited in the administration building, bags searched by security, and got an ID — music therapy student. I waited in the lounge for Dr. H who came lumbering, hair slicked to the side with his dark 5 o’clock shadow. He reminded me that I could only see a few people as psychiatry has stark confidentiality barriers.
I watched Dr. H take his notes, and order labs, and delegate orders. I followed him cautiously as he went around talking to some patients, spending a few minutes just to assess their status and willingness to talk. These were people whose minds had fully collapsed. Some struggled to keep eye contact or form complete sentences. Some seemed normal even if a bit apathetic. Their manic and depressive fluctuations suppressed through heavy medication; they spoke slowly. Dr. H studied the entire personal history of each patient, each defining incident in their lives, their family history, every abusive act, every risky decision.
The most striking patient I saw was an Indian man, haggard and shaggy even though nurses regularly tend to his needs. He was in his mid-forties but he had seemingly aged more. He was distracted as Dr. H spoke to him. He moved with the uncertainty of a child, his words fulsome and rapid, arriving in fitful bouts. He spoke with a surprising force like an infant spitting out bits of food their mother had spooned for the third time.
He was once an incoming law student, a charismatic assertive individual. He came home from college anxious over some interviews. To distract him his brother asked for help on his math homework. As the older sibling with the pridefulness of adolescence, he worked methodically through the night, pacing and scribbling. He stayed up all night which was unusual for him. He carefully wrote down the solution on a few pages and laid it on his brother’s desk in the morning. A week later another night of insomnia. Then another. Then came night terrors. His father prayed with fervor when he noticed his son’s instability. Their cousin had severe bipolar disorder and had taken his own life a few years prior during a depressive period. His son’s mania returned with ferocity. Within a few months, he dropped out of college. His father cycled through multiple therapists, psychiatrists, and medications with little improvement. In one paranoid fugue, the son left the house, terrifying his parents, only found when he was arrested for assaulting a young woman.
He sat across from me playing with the rudraksha beads on his necklace protruding from under his shirt. When he spoke to Dr. H he seemed absent. Dulled. The usual spark of someone’s eyes missing as if somebody painted his eyes grey. It was hard to imagine him during a manic episode, how aggressive or fearful he may get, how he saw an innocent woman as a specter of death, how her screams were like a Siren luring fisherman to drown.
Swiss psychiatrist Eugen Blueler first named and categorized schizophrenia, after “split-brain” in 1911. Today we know there are 108 genetic regions that schizophrenia emanates from. There are only a handful of genes that researchers are familiar with. One is C4, an immune system protein that can over-prune nerve cells and damage our sanity. The connection between the immune system and schizophrenia is still being uncovered.
I was emotional sitting across from this man. Did he lose his mind because of the all-nighter? Or was his mania already seeping in which caused him to stay up? Problematic laws from unruly presidents, a death in the family, or simply the stress of being a student could activate a harmful gene. I fear some probabilistic outcome, some prophetic nightmare where my mind falls under the weight of what I see, of what hurts me, of my dreams and anxieties.
“What do I fear? Myself? There’s none else by.”
- William Shakespeare, Richard III Act 5 Scene 3
My dad and I walked on a dirt path leading to the village water pump. A line of women in their nightgowns stood waiting to fill their brightly colored plastic buckets. Barefoot on pebbles and the vestiges of cement they gossiped, laughed, and occasionally yelled in annoyance. There is an ironic freshness in the evening breeze. A musical quality to the distant voices, truck horns, and clatter of temple bells that classically harmonizes.
I looked at my dad. We both have gears in our heads that make us tick, in our shared gait or humor. Gears that could one day lag in its pace, stutter, or stop. He is a diabetic. Hypertension, coronary artery disease, diabetes, infertility, and obesity are all heritable illnesses. Some of these illnesses are preventable, but the onset of mental illness given family history comes from an incomplete equation. I asked him, “Did you know depression, anxiety, and schizophrenia have a high prevalence in South India, specifically Tamil Nadu?” My family is from there. We were standing in a field at the Southern tip of the state. He shook his head nullifying the statistic with his gesture. He responded grimly, “It’s fate.”
What force or mechanism might explain the divergent fates of individuals? Hindus have long believed that a person’s fate was derived from some calculus of good and evil acts that they had done. The Hindu God is a moral tax accountant, tallying portions of good and bad fate based on past investments. He is a mercurial bookkeeper and an inscrutable arbiter of destiny. So are my predispositions the sins of earlier lives?
I don’t think Hindus are entirely wrong — life events write themselves into our very genome. My ancestors, farmers working under the cruel Indian sun, developed dark melanated skin and skinny ankles. Their physical and mental health developed over thousands of years, shaped by their environment and livelihood, and trickled down to us.
My father and I share many genes and studies say we converge towards similar behaviors. Separated-at-birth twins were shown to cry at the same Chopin nocturne. Surprisingly, even things like political leaning, economic choices, altruism, music, impulsiveness all have some genetic correlation. It is a part of growing up and biology that I appreciate my father, to share acts with him and to rebel a few for my own.
While we seal our own fates, the fluctuations of our lives permeate into our genomes. Illness, accident, trauma. A bad date, a missed train, a failed test can alter our very tissue and steal our sanity. Our predispositions are a ticking bomb. Most often it’s a dud. But the wrong trigger can set it off. In the mess of war, famine, culture, politics, past and future lives a fragile amalgamation of human nature.
My dad and I walked down the road where we found some guava trees that he planted years ago. We spent the remaining time plucking the few fruits not eaten by bugs or birds. He told me that he wants to return to India after he retires. I was caught off guard.
“If you return to India, I would be in the same position as you. You made the sacrifice to leave your family and come here. Why continue that generational pain?” There is a melancholy that we all carry, emotional and psychological wounds to lick — regrets, wishes, and fading memories. I saw my dad’s yearning for reconnection, but couldn’t justify it in the moment. I was angry, selfishly. When the Emergency happened, like a plant uprooted from its natural habitat, my granduncle wilted. With immigration, my father felt out of touch, though he kept his lucidity.
What could tip the scale in my head, in my child’s head, in my grandchild’s head?
“They fuck you up, your mum and dad.
They may not mean to, but they do.
They fill you with the faults they had
And add some extra, just for you.
Man hands on misery to man.
It deepens like a coastal shelf.”
- Philip Larkin, This Be the Verse
Prospero, raging against the deformed monster Caliban in The Tempest, describes him as “a devil, born devil, on whose nature, is that his intrinsic nature can never stick.” Isn’t it ironic that his biggest flaw is that his nature cannot be altered? It’s the fact that our programming can adapt that makes us human, that creates meaning and our idiosyncrasies.
Dr. H and I spoke for a while after shadowing. Each gene can have a myriad of functions. He explained how the same genes that cause bipolar disorder also cause “creative effervescence.” At times heightened creativity manifests during manic episodes. A mind oscillating between madness and brilliance is less of a pendulum and more of two states bordering each other, contiguous. It’s tempting to romanticize psychiatric disorders and the “crazy genius” that popular culture portrays. Let’s be clear, severe psychiatric disorders are devastating to patients and loved ones.
Edvard Munch once said, “My troubles are part of me and my art. They are indistinguishable from me, and treatment would destroy my art. I want to keep those sufferings.” Countless high-functioning individuals have struggled with their balance between normalcy and psychological impair. Van Gogh, Jack Kerouac, Bobby Fischer. Sylvia Plath wrote her most famous poem Lady Lazarus after struggling with another suicide attempt. “Once every ten [years],” she confesses.
If we diagnose these illnesses, find the genes that cause them, and medicate them, will we be painting countless eyes grey? Potentially limiting those with exceptional creative abilities? Innovation in psychiatry seems to challenge to what extent we are willing to revert to some arbitrary mean of human nature.
I watched Dr. H carefully comb through every little detail of the known history of his patients. We are the sum of our parts, which means with enough computational power illness will become more calculable. There will come a day when we know how our children will be, what they will succumb to; our predictive permutations will become so sensitive and reliable. This will only create more questions of what is natural? What is divisible from the self and what is not?
What are we happy to give to our kids: our eyes, your partner’s kindness? What do we dislike about ourselves enough to keep from them: our addictions or vices?
I began the initial chords of Bach’s Chaconne on the facility’s aging Steinway piano. Amongst the silence was a calmness like the evening breeze of India. The unease I felt throughout my day dissipated with the contrapuntal melody. At least for a moment, the patients seemed relieved. Maybe a Beatles song would have gotten a louder reaction. I thanked those listening and returned my badge to security. On the drive home the countryside looked muddy and somber. I thought of the Indian patient. I took a deep breath: I am, I am, I am. I remember my dad talking to me when we were on the rooftop balcony of my grandparents’ house. We could hear voices and cars like desolate birds. He was anxious after our discussion of heredity. My dad turned to me and asked as he sometimes does:
“Will you care for me when I’m old?”
“Yes.”
My dad had a health scare due to his diabetes a few months ago. It shook my family and brought heredity and health to the forefront. It’s acceptance of the unfathomable karmic calculus or the indifferent entropy that punishes flesh.
My dad burned his father on the pyre when he was twenty-eight. I pray I’m far older till I say goodbye. I pray I don’t outlive my children. Some things seem bound to repeat, some things can change, and some things must be lived. My dad and I sat on the roof listening to Tamil songs from his childhood, music that I’ve appreciated more with age, admiring diffused lights in the night fog where mayflies come for their final rest. Moments of good seep from one life to the next and after and after. One more moment in this opaque night.
Albany: How have you known the miseries of your father?
Edgar: By nursing them, my lord.
- William Shakespeare, King Lear, Act 5 Scene 3
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