What Day Is It, Anyway?

Jet-lag is interesting. I can't quite remember the day or date, and around noon my cognition becomes impaired. It's getting a bit better each day, though today I was meeting with a colleague from Boston and discussing strategies for working collaboratively with multiple organizations, the culture of Mumbai, putative reasons why this current terrorist attack has led to a shift in the state of the system, and how to approach research design and trainings, and my mind wasn't working quite right. Yet, it was a very productive meeting and a pleasure to get moving. My greatest victory (one not achieved by any mean effort but a near-Herculean feat enabled only with the aide of my diligent driver) on Day 1 was getting a SIM card. It costs 400 times less to use a SIM card here, than my global mobile phone from the US.



In the morning, while waiting for various call-backs, I had an opportunity to troll around Lower Parel, where my lodging is (thanks to the Times of India for being very hospitable and generous). My keepers attempted to stop me from going out, though it seemed safe enough, and I enjoyed getting to know this one small corner of the city as a tourist. The people are quite friendly and seem to like being photographed. While the area for my troll-stroll was very "local", I somehow managed to miss the massive modern shopping mall immediately adjacent to my high-rise. When I discovered it, I felt like I was at home, and it was a further example of the many contrasts of this sprawling metropolis of 18+ million souls.



It was great to have a face-to-face meeting and get down to work, and even better to do it in a coffee shop and meet in addition to this colleague, two companions of his, in college, bright and passionate, who offered a contemporary youthful perspective on recent events. There is much anger right now around a sense of the administration having failed to prevent this attack, a familiar feeling.

I wondered with them if this was related to the current stage of evolution of events, even if the facts show that there was a failure to act when action could have been preventive. There is a great desire for proactive preparedness, but many parties and a long history of territorial competing interests. One note I love about Mumbai is that originally it was a collection of 7 islands (originally called "Heptanesia" by the Greeks), but with progressive expansion the spaces between the islands were filled in. I appreciate the symbolism of this in the geographico-psychodynamics of such a multiplicitous city.



Subsequently, I had several telephone conversations arranging meetings over the next couple of days. Tomorrow meeting with the driver of the Times disaster institute effort, as well as a private practitioner from an upscale hospital in South Mumbai (a popular destination for medical tourism to boot), which will include a focus-group with her and several other colleagues of hers in private practice, working with terror-affected individuals from different strata.

Wednesday I will meet with her, the de facto head of psychiatry at her hospital (though there is no offical department of psychiatry), and the CEO of the hospital (a late addition which makes me wonder what the meeting may yield). In addition, she has colleagues interested in 1) work with hotel employees, 2) work with first responders and 3) a young colleague interested in becoming involved with disaster mental health, just embarking on her post-graduate work. Finally, we (we being Dr. Siddharth Shah from Greenleaf Integrative Strategies and I) will dine with board members from the Bombay Psychiatric Society, for whom we are doing a training in several days.

Potentially overwhelming, but not quite, and worth remaining cognizant of the possibility of being overwhelmed and keeping the scope of a two week mission in mind. Dr. Shah will join me physically in a couple of days but we speak 2-3 times a day for planning and support, in keeping with the well-conceived DPO rule of always working with a partner. Also useful for a quick hand-off of cellphone to the driver when the taxi on the way back costs twice as much as the same ride on the way there.

...to give a partial picture of where things are. We also have two other solid trainings coming up and several other less formulated possibilities. I want to offer something useful to everyone, even if it is a brief primer workshop or a preliminary meeting, with the exploration of future work, if desired and appropriate.




My overall sense is that while the city seems to have recovered quickly (a trait of which Mumbaikers are proud), not far under the surface there is much more. I've only yet caught a glimpse of it directly and in stories I've heard. I attend to how my own experience may influence how I interpret the present.

Mindful of my own self-care (not a bad excuse), I took a few hours off for a 2 hour ayurvedic "Nirvana" treatment - during the shirodhara phase of the massage, when oil is dripped on the forehead to open the "third eye", in a hypnogogic state as the first warm scented drop hit my head in my mind's eye I saw an image of Krishna, blue and beatific, which strangely also resembled Mr. Spock from Star Trek. The treatment almost negated the additional stress from the taxi ride to the ayurvedic center.



My experience with shirodhara is an example of how culture affects attribution of psychic phenomena, and the more general question of the applicability of Western psychosocial and mental health frameworks in other cultures. A less humorous and more familiar example is that of Latah, a "culturally-bound syndrome" in DSM parlance which has many features similar to PTSD. Which naturally leads me to idly wonder if the DSM had emerged from Indonesia (what would it then be called?), would Latah be a code-able diagnosis, and PTSD a culturally-bound syndrome?