 So, we are here in the world, there is a work around us, there are relationships, so all these are sources, these can, they are very very comforting things. These things make your life, but these things can also turn into problems. So, societal changes, what is India going through? What is India going through? All value system, what was being taught over 100 years, India has not changed that fast as it has changed in the last 20 years. The rate of change and let me quote something from Alvin Toffler, you have must have read a book called Future Shock. He was writing in 16 and 70s in US that the rate of change of the society is faster than what mind can absorb and that is what he called adaptational crisis. What was happening in US in 60s is happening in India now. In 4,500 years we were going at a very very slow pace, easy, last 20 years everything has changed. So, every day is a new day, you really do not know what is going to happen, what technology will come and it is also not over doing. See there is a context, there is a mind, Indian mindset is a very very laid back slow, where the father left the son would catch, he would pass it to the son, same pace. No hurry. This no hurry thing has suddenly been pushed into, you have to run, you have to run get up in the morning, do this, do that, achieve that, take loads and all that stuff. So, we actually went into 180 degree shift and that is the problem, that is the problem that is one of the causes of a sudden increase in what you call mental disorders. Frustrations, normal, all this is normal, failures, what is he thinking, you do not know which way, when I am saying fuzzy is not mathematical fuzzy, it is this fuzzy, literary fuzzy, you do not know why you cannot know which way, other clouds, everything is a cloud these days, right, Mr. Steve Jobs cloud or anybody's cloud or what a great poet says is L K s cloud, I also call it L K, you know L K, L K s cloud is Lord Krishna's cloud, you do not know which way, come, welcome. So, when does the behavior qualify for being a sign of mental illness, this is a crucial question, when, anybody of you can tell me, when would you call? Because you are making a particular action repeatedly, sometimes we also nag, you know, you tell something repeatedly and people get disturbed, I have some, if he nags I will tell you, so, but with this behavior is very consistent, then there must be something slightly of that. So, certain behavior which is out of context, repetitive and troublesome, so let us see, whether these are mental illnesses or they are problems of living, conflict, fear, depression, thought, individual versus society, age old voices, drinking, smoking, sex, what is the result, anxiety or depression? Keep these two words in mind, mental illness and problems of living, let us see. One big sign of mental illness which always was there, why certain people will call mad, the basic premise was their behavior was seen to be deviant from the statistics or they were found to be disruptive, somebody goes and start jumping from the, you will know that there is something wrong or harmful and the intention obviously. Mentally people are supposed not to have intentions, they just do it because they do not have mental illness, but if you do not have a mental illness, then you have an intention. Now, who decide, because if you have an intention, law deals with you for the same act, for the same act, law deals with you if you have an intention. If you do not have an intention and you are mentally ill, then you are at least, that is burden of intention is taken off. This is one of the biggest plea which people have used in the courts to save them from capital punishment, to prove that mentally. That is the only way, you prove yourself mentally, but the law is very smart. So, the law used to say, mentally you go to a hospital or asylum. So, you go to the asylum, you never come out. Every time they go to the court, they will ask you, can you promise doctor that he will not do it again, no doctor can promise he will not do it again. Take him, bring him when you can promise. So, he ends up giving, leaving more things in, he has in mental hospital. Then, see it is all tricky. Most people would never know the subtleties. But how did society respond to all this deviant? It was not that always they were called mad people or mentally ill people and they should give respect and put them into proper places. All that was not there. What happened initially, the first thing which started was a witch hunting. It still happens in some villages. Read in the newspaper. All that is witch hunting. Read European history, it is full of witch hunting. Witch hunting became a metaphor actually. Still, if you, every 2-3 months you will find out this thing in the paper when somebody will say, this is witch hunting is going on, that people are blaming somebody for something and they are victimizing him. Then, what came was prison. They all considered to be even disruptive, put them in jail. Then, lunatic asylum. Then, last century, 18th century, all this lunatic asylum started turning into mental hospital and in the last century, all mental hospitals are also closing down all over the world. That long term admission into a mental hospital are being closed except for few places in Europe and India. India still has 800 bedded hospital in Ranchi where people are just being dumped. Nobody comes back to look after them. But, more scientifically and progressive institutes like say, Imans and other places, they do not keep people for very long because the whole concept is changed. The concept is that somebody is mentally ill, treat him, put him back into the mainstream because that person also has a right to live like you and me. Rehabilitation has become very important. This is the thought, but still it is to percolate down to lot of people. Most people still live in that game. This is a common saying. A psychiatric patient, this guy come from because you have to, he will be carrying this thick of bundle of prescriptions. Most psychiatrists will tell them that if you take a medicine, they will take it for life. Nobody even stops things and that person, even if he is having a real pain here, even most doctors, suppose you go, this person goes and says I am having a pain here and I am taking this medicine and he sees a psychiatrist. Oh, forget it, may be having a real pain. So, one blame which mentally ill patients are given all the time that they are prone to violence. They are actually not prone to violence. They are prone to violence being done upon them because they really do not know. This is also violence. Nobody listens to them as if all their rights to exist as human beings to assert their emotion like somebody has a mood disorder and had episode of depression or say excitement called many and many times. Now, this person even if he is normally sad or normally happy, people around him will start jumping. Last night he was angry. So, what? So, what? It does not mean illness. Everybody has a chance to get angry. So, this is the type of stigma in which these mentally ill people live and there is some, this amount of condescending attitude. Bichara, what bichara? Nothing. They have all the rights. But this is even for a psychiatrist to challenge all these traditions is very difficult. And I can confess this. I have to tell people that you are not ill. All your illness is under control. Go and work. They do not accept it because they have not thought of accepting this. Family does not accept it. What are you saying? He is so ill. How can you? He is a normal man. Go and work. Take your medicine. Diabeticists take their medicine and work. Hypertensive take their medicine and work. Cancer people take their medicine and work. So, why does not a mentally ill person take medicine and work? This is because the stigma and this first word which I am using, deviant. It is so deep rooted in our heads that if you are mentally ill, you are off from the mainstream. You are on the fringe. And that is why people do not want to share their problems. They may be crying all night. They want to die. But they would not get up and come to a psychiatrist to discuss. Because they think if this is a sign of weakness, if I go and say what people will say, what will they think about me. But anyway, luckily what happened is the medicine came to rescue. So, now what we have is a medical model of mental illness. It is experiential and descriptive. That lies in the whole problem. All psychiatry diagnosis are based on description of your problem. The person comes and says, what is happening? Tell me. Unless you tell me, I will not diagnose. A physician will never ask you. You say abdominal pain, he will put his hand. Go and get this test done. So, why it is happening? Because all over classificatory systems, there is something called DSM, diagnostic and statistical manual from US. And international classification of disease for rest of the world. Americans have to be different. So, they cannot follow ICD. So, you make ICD, they will say I will make DSM. You say make ICD 10, 10th version of international classification, they will say we will make DSM 4. You tell them we will make 11, they will say we will make DSM 5. Because they have to be different. Anyway, it does not matter. One more reason why they have to be different is all the pharmaceutical companies come from there. And all the categories, if you go through these manuals sometime, all the categories are based on treatment. So, the broad division in mental illness is called organic. Organic means you have a cause for it. There is a cause anyway. There is a micro neurotransmitters which go into this balance and you have a illness. But sometimes you have a tumor, sometimes you have a tuberculosis, sometimes you have a blood flow problem, anything. That is organic. So, if you do not, only 5, 10 percent people have organic problems. You remove them. Rest is non-organic. Non-organic is again divided into, I will show you what happens there when it comes to that confusion. So, they are all treatment based categories. That is another, so do not go confused. There is a whole lot of confusion in what is happening. But now they are being considered doctors because one-third of the population is going to be slightly conked. Medicine works like this symptom, cause treatment. You say I have abdominal pain. The doctor will examine you, send you for an ultrasound. They will say that you have a gallbladder with stones. They do not have to look into what you are doing, what you are not doing. They will talk to you just to become friendly. But in fact, they do not need, they want your abdomen. If you have abdominal pain, they want to see your abdomen. They are just not bothered whether you are Christian or Muslim or give it to them. Psychiatrists cannot perform like this. They cause driven classification there because of infection, because of endocrinology, because of what trauma. If you have a broken leg, you have a broken leg. They have to find out whether it got because of the injury or lack of calcium or what. Psychiatry is reverse. They are symptoms. They are treatment. We do not know the cause. You tell us the symptom, we will treat it. Forget us. Anybody can treat you. Physicians write anti-psychiatry medication, neurologists write. Then everybody becomes alright. You ask them the cause. No idea. Neurology is a bit tight. They know the cause for everything. No treatment. This is how it is happening. So, description and treatment driven classification is our... So, unless somebody describes like after 20 years of psychiatry, I can see a face and tell what is your problem and then write. But still it is a very, very big guesswork. One has to tell. But still we have a savior. All this would have gone for a fluke. You would have all laughed at us. But you cannot laugh at us because who is saving us? Who is saving the psychiatrist? It is epidemiology. Cross-cultural studies all over the world. It is a worldwide prevalence of psychiatry illnesses. One third of population at any time in this world is mentally ill. Now, you can challenge the whole DSM and say this is not mental illness. That is a different thing. There was a man called Thomas Saz and there was a man called R.D. Lang. Thomas Saz is the chair of psychiatry in New York. In the day time, he writes psychiatry drugs. In the evening, he criticizes psychiatry. He says anti-psychiatry movement. He says this is all. There is no illness in psychiatry. This is all a creation of some psychiatrist and psychologist to run their business. There is nothing called schizophrenia. There is nothing called depression. These are all just temporary mental state when people should handle themselves. Because you cannot understand the language of a schizophrenic. That is why you say he is a schizophrenic. He is hearing voices. Who knows that somebody is not talking to him? Because you cannot see the other end. So, you are saying he is hallucinating. There are people like this. I do not know. You really do not know. Even Stephen Hawking says that there are signals coming from the cosmos. The problem is you do not have an instrument to read it. He said who knows what is happening in the cosmos. There may be signals. There are signals. We know this. We do not have the final instruments to read it. So, a schizophrenic language will be a true language. But then there are philosophical questions. We do not get into that with you all. But largely there are so many layers of reality. But on the operational level, because you sit as a psychiatrist, you have to treat it. What is the other saviour that no man is an island? As I told you, all of us are genetically related. Our grandest mother was same. And then we had four daughters who shifted to Asia. Europe is that. So, European gene pool is like us. Recently, when they were fighting about Sinhales and Tamil thing in Sri Lanka, suddenly somebody came up and said what nonsense? Bengalis are closely retro Sinhales. Their genes are very closely related to Bengalis in Sinhales. So, Chinese used to say that we are different. But now Chinese are also the same. So, one pool came to Asia, one to Europe. Asian-European pool is the same. And no man is an island. The same if that old lady had a genetic mutation of a schizophrenia, we also have it. And that is the fact. The risk, all of us have a risk. What I said in the beginning, are they different? They are not different. I have a one percent risk of having schizophrenia in my lifetime between 16 to 45 years of age. That is the time when most illnesses start. Leave apart the childhood disorders. If in my family somebody had a schizophrenia, my risk will go up to 10 percent. If two first degree relatives have a schizophrenia, it will go up to 20 percent. Monozygotic twins, the twins born out of the same embryo by dividing, have 60 percent concordant. Both of them will have it, 60 percent chances. Depression, we have a risk of 2 to 3 percent. Obsessive composite disorder, all have the risk of having the same mental illnesses both the mentally people are having. It is just a matter of your risk getting expressed. And that is the understanding now. We all have a tendency given a sufficient environmental stress, given a sufficient risk in your psychological thing. You can have relative risk varies and neurochemistry saves us. Neurochemistry is all these neurotransmitters. There are four major of them serotonin, norepinephrine, acetylcholine and dopamine. They are the major four chemicals which remain in different parts of the brain in different balances. In a certain part of the brain, one chemical goes into disbalance because of genes that there is a sudden, you are suddenly growing up and 16 year gene turns on. Then you have a episode. You have a episode, this chemical disturbance happens. We give medicines and we correct it. So, hence we prove that there was a chemical disturbance. We send external chemical which corrected that balance and you are all right. Now, that may not be the cause. Cause may be something else. We do not know the cause as I said. What we know? What disturbance happens? You can correct this disturbance and you can move on. Simple. This is a pragmatic thing. Cause may be, I do not know what. Like some people used to believe there is a booth, there is a ghost. They used to believe this. Now, some people started saying it is genetics, total genetics. Again, there is a reversal. People saying this cannot be total genetics because if it is a total genetics, then if we study 100 twins, suppose we take 100 monozycotic twins. Monozycotic means one embryo which splits. Dizygotic is two different. If you take 100 monozycotic twins, all of them should have schizophrenia. If suppose one has, then all 100 of them, but they do not have it. If you have 100 people with schizophrenia and take their monozycotic twins, they will not have. They will have only 60. What happens to the rest of the 40? That means not genetics. It again depends on that you have a tendency and the environment. So, that is the understanding. This I have shown. But this is, I think is the, let me go to this. There can be lot of etiology means causes. Nature, genetics, anti-natal influence. You are a healthy child in the womb and your mother suddenly goes crazy. She starts drinking alcohol. By the time you are born, your half brain is already gone into some genetic mutation. You will certainly land up in a problem. People who get into alcohol problem, if you study their kids from very early age, they are without knowing their heart rate and their body response to seeing alcohol is different. That will tell you whether this person is going to get excited by alcohol in future or not. Parenting. You may be the best genetic makeup. And you are given to parents who are unstable, gone, lost, over. The best genetic makeup cannot save you. This is the story of most people, traumatic childhoods. When people come to us at 40, we know that the way the story has been written in childhood. That is what fraud used to say without knowing science. But there is the truth. Leurological illness, biochemistry, psychological stress. This is the most common thing these days. Let me see if there is any other slide. This is a classification. Move disorders. People who have episodes of depression, not for half an hour, one day or half day, at least one or two weeks. Or in reverse, they have episodes of excitement. Many are talking too much. Obsessive compulsive disorder. 20 years back it was one or two percent. Now it is hugely increasing. We do not know whether it is the change of lifestyle which is causing this or some biology which is causing this. But youngsters are very, very, the prevalence and incidence in youngsters. OCD is obsessive compulsive disorder. You have a repeated thought, repeated doubt, repeated image which keeps coming to you. You know it is foolish. It should not be there, but you cannot stop it. And it is treatable. The good thing is that we can treat. We do not know the cause, but we can. So, we are sitting like boss. God does it. God also does it. He did not bother about the words. If you want to correct it, let us correct it. We will see it later. Now OCD could also be because of psychological change. In 20 years it has increased. I have a theory. I do not know whether it is right or wrong, but let me mention it. 20 years back when we used to travel, we had less things to bother about. These days when we travel, apart from our own personal things, we had at least two chargers and two electronic gadgets and two or three pendrives, these, that, whatever, credit cards. The more you carry, the more you have to bother about to keep things in perfection and categorized and in control. OCD is just the need for control. In last 20 years, our minds have become so cluttered that all the time we have to keep working that this should not go wrong, that should not go wrong. This should not happen. That should not happen. That keeps you in a, you are working, but in back of the mind something is, that is OCD. Any of this thought can grow out to be repetitive from your own mind out of context, out of time and travel you. Could be. You do not know. Organic states, I told you schizophrenia is again, this is a common word called split personality. Schizophrenia is not a split personality. Schizophrenia is actually a split between your thought and emotion and then you have psychotic symptoms like hearing voices, hallucinations or false fixed belief called delusions. Personality disorder is something which you are going to see in next 20 years, much more than west. West is very well known for it, borderline personality, but next 20 years is going to be a boom in personality disorders and there are 1000 reasons. None of them is biological. It is all social. Borderline personality disorder is a construct of social thing. People who are empty inside, they do not have a substantial sustained relationship with each other, mood showing this and that. I call it effluenza. You have heard of word called influenza? It is a word called effluenza. You know what effluenza is? Problems arising out of effluenza. When your tummy is full, your mind is empty, then you get into a lot of shoes unless you learn to direct your mind to more creative and productive thing which people are not being trained into. If you are trained to use your mind constructively, use it. Otherwise, you had no struggle in life. You do not have a struggle in life, you create problems by yourself. So, western cuttings are well fed. So, there are lot of youngsters who do not have any goal in life, generally having a bad time. They are the people who are prone to borderline. Plus trauma of childhood, disturbed families, child abuse, all that contributes. Anxiety is a very common thing all of you know. So, metoform is your body starts showing symptoms because of your mental stress and childhood disorders. So, people who think that what is the problem? What is the issue? It happens. You can call a child useless. You can call a child something. It may have been okay, but this was a belief 100 years back also. Parents used to say this, at least in this country, right? Westerners are worse than us. They used to abuse children. That is the result. All this is happening now. Imagine if 100 years back everything was so healthy, if 5000 years back things were so healthy, why suddenly there is an increase in mental disorders? We are a product of healthy people. Why are we becoming crazy? That means it is a flawed assumption, right? We can become conscious and make next 20, 30 years healthy. What was the flaw? The flaw was when you are bringing up kids. All this thing when you tell a kid that you are useless. You cannot do anything. It is a word which is gone. It already gets into the head and can work both ways. Some kid may actually get so angry that he or she might do something great just to prove you wrong, but that is a very small percentage. Most of the people believe it. Most of the people believe it. Westerners do a lot of physical sexual abuse to children. Indians do a lot of verbal and emotional abuse, right? How many people have you met in your life? Let me, you are youngsters. You should tell me honestly. First thing they will meet you and tell you, boss, good, good, go and do it. Most people will try to pull the rug. What are you doing here? Hello, what? But all this thing is going to head. They create huge amount of anxiety. And just let me give you how society creates anxiety. Society creates anxiety by ask females. They will tell you what is the problem. Five thousand years, this country still has not decided whether the girl's house belongs to father's house or to the husband's house. Whether whose house the girl belongs to? Father. Father, right. But if we go and check and do a survey, we will not find one crore people who will think like this. And have seen across liberals, professors. My daughter is first my daughter. But people like us, that is the issue. Here comes the problem. Your father's daughter. But her father wouldn't think the same way. That is what I am saying. That is what I am saying. You imagine the amount of anxiety which females live in this country. All their life, 24 years they are living in father's house. Back of the mind, everybody knows you have to go. What is this? And this girl has to suddenly leave this house. Go. Luckily all this is changing. Luckily because of the shifting in metros and all that, both the male and the female have to leave their houses. Good. All this will change. When all this will change, a lot of mental illnesses will go. Because this source of unhappiness percolates into the family. Into the family. Believe me. I mean we all know it. I am just giving an example how it works. If people say that this doesn't work, they are lying to themselves. And people have tremendous capacity to lie to themselves. This is not lying. They are unconsciously denying it. As long as you keep denying, you will not accept. You will not accept, you will not change. So mental psychiatry is not free from society. What we see is a product of society. So all psychiatrists who say we sit in our chambers and treat mental illnesses, they are telling a lie. Psychiatrists has to step out of them. And one big reason why it has to step is this. What is happening in the last 20 years? Think over. This is the question which I am throwing at you. DSM-5 is coming in May. Diagnostic and status can be the fifth version. What they have done now? There is a blame which is going on against DSM, which I think might be correct. I don't know. I should not make it a political thing but still. They have made categories and dimensions of illness, which people say are totally driven by pharmaceutical industries. And if DSM-5 is actually applied like a grid on a population, 90% of the people will have a level of mental illness. 90%. Even your small problems which go beyond a certain point. You can have a shoulder pain for 10 years. What is the big deal? Who don't get a cause for it? You are mentally ill. In last 20 years because of the rush or whatever reasons, the problems which say 60 years back like a relationship problem was being sorted out by family, by this, that there is a social suffering and problems of living are being medicalized. You take a problem? They say it's illness, medication. And people are using illness as a escape. It's a phenomena of west which is very, very popular. People get a diagnosis. They don't want to work. They want a duel. Indians are getting richer and the number of people who take a small problem and want to escape from there under the cover of illness is on an increase. And the last thing which I would say there is a disability. There is always a disability which is being associated with mental illness which is not true. Impairment is a loss of function. Disability is a psychological construct. I may not have this hand but I may not be disabled. I can work with this. So all these are real issues which all of us as a society will face. It's easy for doctors to say it's a mental illness but much better if the person tries to, because everything will be illness then. Everything will be illness. I can't study. It's illness. A lot of people will say, man nahi lagara. Man nahi lagara. What is man nahi lagara? Man nahi lagara has become illness. Really? I mean my whole energy goes the whole day into man nahi lagara. What man? What is man? This is a problem. Students will come say I have a competition. I can't study. No problem. Don't study. Only way to get through is study and answer your question. You don't want to do. You don't want to do. This they will not accept. They want a medical solution for this. This is the new problem this country is going to face. In next 20 years you will see it more and more anyway. We will do whatever we can. But that is the status of mental health illness. We have a classificatory system on which we put label. We treat. Most psychiatrist doctors will treat that. Society will keep getting more and more labels. Society has to decide whether they want more labels or they want to correct their own behaviors and train them into. This dilemma of mental health and illness is going to come out in a major. Because 40 percent Indians are not well. It is a major issue. 40 percent would have 18 percent or 30 percent as youth. That means how many people are sitting here? 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. That means 6 out of us are not well. Really? They are listening to all these. Many people will start. Anyway, so I will end at this end. Anything you want to ask is agree, agree, fear, views or anything? I have a question related to your OCD thing. You said that the more and more cumbersome the urban life becomes. Probably the clinical reports of OCD perhaps is increasing because of that. Based on your 20 years of experience. Is there any comparison between the urban and rural population of reported OCDs which confirms these hypotheses? What has happened is that one of the best thesis on OCD is Salman Akhtar. The process remains the same. By definition, repetitive, hot, doubt, images from your own mind which are not in your general scheme of things. They are ego-distanic. And any attempt to resist increases the anxiety. That is obsession. And the act, people do acts either to control it. That is controlling compulsions or they yield to that thought. Like if the mind keeps telling that, okay, I am guilty towards God. Suppose repeatedly. Then either they will try to control it by touching feet many times. For example. Or they will just yield to it or do something, some act like this. Like washing a person. Like you might keep telling, I have washed it, still it is not. Let me do it. So either they will yield to it and keep washing. Or to control it, they will go and start doing some other compulsion. There, the phenomenology, the content of obsessions are really expanded. All this old time when we in 90s, the washing, checking, symmetrical. That, you know, they are very, very simple obsessions now. You see this in rural population. Right? But what we see in clinical practice, it is something which has to be studied actually. I do not know whether somebody has really done it. But I am sure this is the thing because the type of thoughts which become obsessions are derived from life. Like one of the commonest obsessions these days which we see in our clinics is people having repeated thoughts about that somebody, like somebody has gone out, like kid has gone out of the house. Something should not happen to him. Or the spouse has gone out of the house, whether she will come back or not. Once or twice, everybody thinks this. But then it is a typical qualifying thing for obsessions. So, the obsessions of the city are all derived from, like, what if I lose money? What if I lose money? Okay, you think everybody thinks. But it actually reaches the obsession level. So, any of these normal thought, villages, they have this typical obsession which the textbook description. The simpler, what I see in my clinical practice is I do not know whether it can be verified. I am sure it would be because this is an idea for research. It is that people who are living a very, very baseline simple life, their obsessions still under the washing level, checking and need for symmetry at maximum blasphemous obsessions. Like you see a God's victory in the start getting sexual thought, sexual obsessions. But as people are more educated into this fast life, their obsessions derive from their lives. Commonest is this fear of something happening. The fear of losing. It could be fear of losing a person or fear of losing money or something going wrong. It attains the almost obsessional quality. What has also happened is that these may not be the pure OCDs, actually. These are not pure OCDs. It is like an obsessive spectrum starting from the social phobia, anxious avoidant personality. And these are like what we prefer to call obsesoid thoughts. So they are not pure OCDs. Pure OCDs still remain the same, but this phenomena almost borders on the dilemma whether to treat it or not. But the amount of problems it causes we have to treat it. One option is we don't treat. If people are able to get over it and do other behavioral techniques. But again, as I said, because medications are so freely available and everybody has information, access to it. So they are almost bordering on obsesoid, OCD. Pure OCD still remains as you say. This phenomena almost can turn to OCD. The dilemma is whether to treat or leave or not leave. But most people prefer to get treated. Because obviously when you give SSRI 4 to 6 weeks, they feel easy. And then you take medicine for 6 months and stop it. This is the problem actually. The medication once they started can be stopped. This is something which people have to learn and not get dependent on medicine unless I take this medicine. But it is very interesting because it is getting more complicated. At times it is very difficult. Let me tell you something. A lot of these obsessions appear as delusions almost. There is a small percentage of people. The resistance is one of the hallmarks of obsession. Your mind resists it. And any attempt to resist will create anxiety. Some people lose their resistance. Especially children when they are there. Youngsters are having a lot of OCD symptoms these days. And they don't have resistance. And some actually start, it goes to delusional level. So this obsession delusion is again a hypothesis which works. Whether it is the same phenomena at two extremes beyond normal to obsession to delusion. In the adolescent population, would there be a possibility that more and more uncertainty is built into the involvement. Absolutely. The more and more obsessive tendency. See one of us, you know it as psychological theory. For it is guilt and go to Freudian theory. He said regression to earlier stage of development. Anyway, even if that doesn't hold true these days. We know from just to get a very baseline when insecurity can trigger all these things. Security can trigger anxiety, insecurity can trigger. But luckily because most minds do not have a tendency to have OCD. That's why they pass on. One hour you can get worried what will happen if I fail. Another interesting question I want to ask. From your clinical experience, do you find that the adolescent community or young adults who are reaching you in last 20 years. Is it that most of them are from technical education or those who are pursuing technical education or those who are into so-called non-technical education? Non-technicals are less. It is people who are in the streams of this technical professional education. That includes engineering, medical, charade accountancy. They are a troubled lot. The stakes are high. Stakes are high and it starts very early. It starts from class 8. From 8 to 9 tenths you have to study. And then from 10th choosing the subject and coaching. One reason and then obviously once they get into it. Surprisingly medical students come less. They don't consult. I don't know for some reason. Engineering students all over. Not only institutes like IIT, all over. They are slightly on the edge always. They may go better. Medical students 5 years, 10 years they have to study. I really don't know. Maybe the public dealing is more. Another reason could be that engineering students are largely dependent on their instructors. Whereas in medical education you are more dependent on your seniors. One and two you keep interacting with those who are already suffering. That's true. One reason for medicine is that because human interaction is much more. And you are actually in a public sphere. Engineering students are slightly for four years. Not four years, six years. Two years of preparation also. They are almost isolated from life. They are put into a different jungle altogether. And then suddenly you come out in the world. So you really don't know what is happening. Medical students are in such a public sphere. At right after one and a half years you have to interact with patients. There are tendons and you see all the drama of life going on. So you say it's fine whatever it is. You get out of the right and wrong and you get too much. But all this is happening because and that's why I am saying next twenty years is very interesting. I mean it's a lot of anticipation. And if you believe me one thing which we as we said. All this will go increase if we do not train children to control their mind. Because the choice is also increased. See the first thing is for another psychologist you know it's. First thing you have to train the mind to choose correctly. And then the choice should come. That is the logical process of the world nature whatever. If you don't train the mind to choose correctly and then you give the choice. What will happen? Either wrong choices, too many choices, no choices or anxiety. What is happening in the last twenty years even before the education system could get to that point. Where students and kids are taught to think. Taught to think according to what? According to your need and your nature and your temperament and all that. There are lot of choices which were being analyzed. So really it's very difficult to decide whether we are doing what is needed for us. Or we are just in the grind. It's a big question. But anyway that is the world the way it was. But again now I think it's the genetic vulnerability of illnesses. See illnesses are again schizophrenia is 1%. Autism is 1 out of 150. Dyslexia is 1 out of 10. Depression and bipolar is 2 out of 100. So if you add all of them it would not be more than how much? 5-10%. So there are only 8-10% people are actually having illnesses. At any point of time if you take 100 people in a psychiatric clinic. There will be 5 max 10 who will be having biological illnesses like schizophrenia or OCD. I add up all of this. But what are those 90% people? Who are these 90% people? They are the people who are having problems of living. What you call social suffering. The medicalization of this social suffering is the risk. Because when there were no medicines I am just going back. When we were kids. How did we resolve our issues? Say 1950s relationship issue. How would you resolve it? How would you resolve a failure in exam? How would we? What would you do when you are feeling low in the evening? Suppose you do not get a sleep. What would you do? Go and chat with someone. Go chat with someone. Go to your elders. Go out in a group. Do some activity. Take a walk. Go to a temple. Go to do something. Do something. These days immediately instead of getting into your inner resource. People want an external thing. What are these external things? They will not go to the doctor first. Doctor is not the first external. The first external is substance. Alcohol, this, that, whatever. Anger outbursts have become very common in adolescence. Because they have a mode of expression now. Because they can express and get away. This is a societal change. 40 years back you could not express and get away. This is when you can get angry and get away. In your home. You will hit your mother and still you will be brought to a psychiatrist and not punished. And then somebody will call it illness. There are major issues. Who decides all this? What I am trying to say? This is for all of us to think actually. I am also, I do not have the answers. But I am just asking a question. When we were kids there was no way, now you can call us suppressed kids. You can call it. No, but I have a right to express my anger. So I am more free and liberal and progressive. What? Who says this? But number of kids who get angry these days is huge. They go to any school they will tell you. So there is pressure which is bottling up. Because of the political situation, social situation, whatever. That is this 90% of the people who want to escape. Once I tell somebody that you are depressed and all your behaviour. And I will tell your family do not worry. He is doing all this. He hit you because he is having impulse discontrol. You are free and you are a free man. You can happily take medicine for 3 months, keep hitting anybody for next 3 months. And after 3 months you will decide, if you hit somebody 10 times your anger is already out. And then you can become peaceful like Buddha and say good. This is the easy way. The tough way is I tell you boss you are not. Please take responsibility of your actions. Next time you do land up in jail. That is a very tough thing. Because you are already angry, you are already angry. You are only bottled up. Put your anger into a constructive way. Or go do a punching bag. That is difficult. That is the real answer. Medicines have the support systems. Leave those 10%. For them, medicine is life. For 90% medicine is support system. Rest of the systems people have to evolve. It is a huge result. We are walking right now. It is very easy to label these days. If I don't label as a psychiatrist, the physician will label it. Cardiologist will label and neurologist will label. They are all sitting there to label it. It is very easy to turn. The moment I tell you a label that you cannot maintain a sustained friendship all your life because you have a borderline personality disorder. All your problems are sorted out. You have no bloody responsibility for anything now. I am borderline. This is what happens in western. This is going to happen in 20 years in India with all this. This is going to happen. We have to watch out as a society, as teachers, as everybody. Other questions? You asked about people integrating our people in liberal arts and people in medicine or whatever going to the psychiatrist. What about the people in the sciences, the natural sciences? They are mathematics, for example. They are any way mad. There is a difference actually. People who are actually doing natural sciences, not for job and all that. They are one of the few sane people in this world because they are still lost in their own thing. But there are very few of them. They are also dwindling now. True mathematician or true physicist, I don't know. I haven't seen you as a mathematician. I have lost in my own world. See, that's what I am saying. In my 40 years, I see less and less of them. I don't see those crazy mathematicians. I know a lot of them oldies. Where is the typical physicist? Where is the typical physicist who looks beyond the sky? That brings me to that mathematics example you were giving. I mean, it may be totally out of the hat, but one sign why these people, because their end product became useful to the world, that's why you accept that they were the mad geniuses. Suppose there was a guy called Vashesh Narayan Singh. He was found in Patna and brought them to the man's. He had schizophrenia, right? And he had used, we still have those 64 pages, copies of his calculation and all that. Nobody can make any sense out of it. He had developed true schizophrenia and one of the politicians wanted us to treat him and bring back to mathematics. We said, boss, this is illness. One thing why this madness and genius thing is because obviously, let us, mind has to break that frame of normal thought to create something new and that the world doesn't accept. The world has to. The world accepted Newton when he gave this. Otherwise, suppose Newton would have not brought out anything. And Newton was not a very properly dressed man and used to keep dirty and all this stuff. And style was wiling over time, all the time. But thinking, they accepted his school dropout. Imagine, Tagore was a school dropout. Absolutely. Suppose Tagore would have not done what he did or Mathama Gandhi would not have done, then what would have been the perspective? That again brings me to the same old question. Is it the productivity of the person? Whether it takes it to this route or that route or what route? Why can't we accept people who just don't contribute and still aren't in their own world? Then, to them, we start labelling. But that is probably again, there is a huge difference between the real thought process and the operation. This is all operational stuff. When a person can get a leave, he is working for 30 years bringing up the family. For two months, if he doesn't want to work, we should accept that he doesn't want to work for two months. For those two months, why does he have to get depressed? That depression seems to be only severe. If he says, I don't want to work for two months, everybody will start jumping. Try it in families. When you first tell your parents, one year I am going to relax. See what happens. Just tell them, one year I am taking a break, no work, no study. It will be a major stuff. The first thing they will do is bring you to a doctor. Kids are burning out and if you tell kids, their kids don't want to study because you put them into a school when they are just out of the womb. Two years, two and a half years and then how many years they will study? I started studying at 6. Then we studied till 32, 33, whatever, all the time in the world to study. They burn out. So at 20, they don't want to study. By the time they are in second year of IT, and suddenly you have a CPI drop, you don't realize that this poor kid started studying at two and a half years. The whole system is gone. What do you want to do? Give a break. IT is good. They give you a semester drop at least. Most places don't give. Who will analyze all this? It's very difficult. So what happens is that we clearly demarcate. We say we are psychiatrists, passive psychiatrists who will walk to us, will treat you, treat your mental illness. Psychologists will make their theories for corporate industry, this, that, whatever. Who is talking about the normal human being? Normal human being is being left to all these charlatans, self-help gurus, and all the trauma which goes on in the name of spirituality. That is the risk. So anyway, we will keep doing whatever. Sir, what is the difference between OCD and addiction? Nobody knows. Let me tell you. We always put this question. Whether it's OCD or addiction. See, it is the whole irrationality of the thing. By obsession is a repetitive thought, image, impulse, this, that, whatever. Which is from your own mind. I am just defining it. Then you will find out. From your own mind, it's ego-dystonic. Ego-dystonic means it is not in your scheme of things. Right? And any attempt to resist it creates anxiety. Right? So it never was and it will never will be in your system of things. That is one. Addiction is not very ego-dystonic actually. And it is totally involuntary. Obsessions are, you don't want the obsessions to come in. All addictions have a will in it. There is no addiction in the world which is totally unwilling by all addiction even to start some act, isn't it? Even if you have an internet sex addiction, you have to log in and put in. There is a first step. You can stop yourself. You have to go and buy alcohol. You have to write. So addiction, what happens is that addiction has a different mind process also. Like you start doing something, they have brain centers which will get rewarded. Dopamine will go up. You do it again because that is giving you pleasure. Obsessions never give you pleasure. There is no pleasure, no will in obsession. Actually it's a whole battle. But at a later stage when it really becomes addiction, when people are not able to get out, it may appear as an obsession. But it's not obsession because you can always stop it. Now some people may say that you cannot stop it but let's see there is a hell lot of people who believe you can stop it. You have to probably have to go pay alcohol. It's a huge 10 minutes you have. Obsession will not give you this time. Obsession you are trying to read and there is a God's image and certainly all the sexual images will start coming in. There is no choice. Obsessions don't give you a choice. Any normal thought can become an obsession. But addiction will always have a will. See again addiction is a huge issue. Nobody knows it's a illness. It's a moral problem. It's a psychological problem. It's a sociological problem. Because you see the ads of anti-smoking all these days. In all cinema halls, all movies are huge. Very idiotically made ads. They have borrowed it from Australia and all that. My simple question is that if you want to stop smoking, you stop the production. Why are you selling and asking people not to smoke? Business will be taken. Then who is healthy and who is ill? Then there is a big question. What is the debate? Why somebody takes a gun and shoots? You call him mentally ill or healthy? They can't decide it. With their own DSM, they can't decide it. This boy who killed, major drama, whether he was ill, you are selling guns on the stores. You go buy a gun. What will a person do with a gun? He'll use it someday. I heard that you can read in Ankura also. What? Ankura will be the gunman. This is a new phenomenon which we'll face. It hasn't started in India now. Because there is so much violence otherwise. It hasn't started in school but madam, if you call it a mental illness then it can happen anytime. Actually there is an increase in school violence. School violence? You know what kids? They locked up the teachers in Kolkata school. Four hours. Madurai student stabbed the teacher. Chennai student slapped the teacher. All murky grounds. Very murky grounds. We are still safe. It's all murky grounds. So what I'm saying is that obsession, OCD will still, but don't think that there is no will in OCD. If there is no will in OCD for causing it, at least there is a will for treating it. Because what is the behaviour therapy after all? There is something called, I'll just give you an example. Exposure, response, prevention. Somebody sees a rat or a lizard, starts getting obsessions, panic. One of the steps is that you see, either you sit and imagine a lizard and don't run away. Or you see a real lizard don't run away. Once, twice, thrice, ten times, anxiety will go. But then it has to be a will that I will not run away. Okay? So let me end with one thing. Have you seen a film called Bruce Almaty? All of it? No? See it. This guy Bruce, Jim Carrey, is always screaming. So Morgan Freeman was the guy who calls him up one day to a building. And there is a huge rat like this. And the rat always files open. This is unending files, file after file. Every thought has become a file. And then you see it. Then this guy appears. And he is saying, how is this possible? But then there is a wall. And the rat is this big. Files are huge. So he says it must be an illusion. He tries to find out. But there is nothing. Obviously there is nothing. So he said, you are not God. Don't fool me. He said, okay, tell me how many fingers. So he says two, three. He is doing like this and God is telling. Why God says, don't tempt the Lord. And he says, ah, let me do it again. So he opens up seven fingers. God says seven. He just shows five. But by the time it does five, there are seven here. In this one hand seven fingers. He just gets freaked out. And runs out. So God again calls him. He says, why did you run away? I didn't tell you the rules. So he says, ah, I got freaked out. He said, don't worry. I did this to Gandhi. And he did not eat for three weeks. And then he said, you creep a lot. You become the God. There is only one rule. Two rules. Don't tell anybody. And you will not interfere with free will. So there is still something called a free will in human mind which can override barring schizophrenia and some amount of mania. It can still override a lot of illnesses. People who say that nothing is in your hand are not telling the truth. It is a matter of training your mind because even those who have bipolar illnesses, mania and depression, they can monitor their illness. They actually tell them to monitor you. You know the first sign that you are not going to be well? Take medicine. That requires will. Even the most disorganized schizophrenic. That poor person who is on the road, tattered clothes, picking up rugs and all that. There is nobody worse than him. Still twice in a day, he goes on a hunt for food with all his brain intact. He knows what is food and what is not food. So that means mind somewhere has something which holds the biology. The only poor people who cannot is our people with dementia actually. Their brain sense knows. They really don't know which. By that time brain has started degenerating. Those illnesses start from 16 years. Let me tell you this. 16 to 45. Because brain develops till 16, 18. And then from 18, don't think your brain is growing up. Your brain is already not declining. It starts declining after 20. It's just that we consolidated it by learning and all that. So it keeps intact. Anyway, so don't worry. Six out of us are crazy with six. I have one on that. Don't worry. Okay.