Tuesday, April 10, 2012

PERSONAL AUTONOMY AND INSTRUMENTAL ACCURACY





Professor Varma, Ladies and Gentlemen,
I am grateful to Dr. Malavika Kapur and the University Grants Commission for having given me this opportunity to participate in your deliberations on psychotherapy.

Two travellers were sitting by the wayside.  A camel was passing by.  One of them said "Ah that reminds me of food".  "Why" asked the other, "have you become an Arab that you like camel flesh".  "Oh, no" said the first, "nothing like that, everything reminds me of food".  Everything reminds me of personal autonomy.  So, when Dr. Malavika Kapur asked me if I would like to say something on psychotherapeutic processes, "yes", I said, "I shall certainly talk about personal autonomy!”  

To help you to be objective about my talk I must warn you that I am a fanatic partisan of personal autonomy, and entirely subjective.  I have thoroughly enjoyed myself preparing this talk and I wish you some share of this joy.

I present to you abstracts of some interactions in which I have been a participant observer, and a few reflections of interest to me, and which might interest you.

Here is a middle aged clerk. For a pain in the back of his left leg and thigh he received some injections in the gluteal region.  He had been going to different medical departments.  His pain persisted.  Already he had taken quite a few months of leave.  He was referred to me to support another month’s leave from work.

I said, "Sir, it is sad to see you in such suffering.  You have already taken two or three months leave.  I understand you are staying at home.  Is your pain improved by staying at home?"

"No, Sir, it is as bad as ever.  A bit worse, I should say," he replied.

"You are a brave man," I remarked.  "Could you tell me in detail how you spend your time at home."

"Oh sir, what can I do? I sit around", he said.

"You are a lucky man", I said, "but surely your wife must by now be fed up of your face.  By the way, you have a wife and two kids.  It cannot be too easy for them with your being on half pay and all that."

"Yes, sir, with this pain and all, but nobody understands me.  My wife grumbles.  I am getting fed up," he said somewhat tearfully.

"That's true.  But let us come back to my point.  You said you were sitting around.  Surely that cannot be true.  Just help me to fill in the details.  We must somehow solve the problem, is it not?  Details will help us," I coaxed.

With a little patient inquiry it emerged that in fact he was not sitting still at home doing absolutely nothing.  With his help I calculated for him that almost everyday he had to go a furlong to take a child to school; he had to be moving from one corner to the other while his wife pushed him around to enable her to do the household chores in a small accommodation.  She was grumbling.  Once a week he had been going to the bus stand, a small distance away and thence to the hospital to keep his appointments.  At the hospital he had to be sitting or walking around for a couple of hours at least before he was disposed off.

He has been praying to Lord Ganesh, but to no purpose.  He was now not having enough enthusiasm even to go to the temple.

I prescribed some tablets for sleep assuring him that the tablet is not likely to have much effect since already so many other tablets proved hopeless.  I told him that these medicines are hit and miss affairs, and that they work differently with different people.  The best thing is for him to see me as frequently as possible, initially, and tell me in detail what the tablet is doing to him so that I can be guided by his advice.  There were very brief visits of ten to fifteen minutes which enabled him to take some active interest in his own treatment and also give me and him some more detailed information about his life and work.

I gathered that now he was doing more work at home than he was doing at office.  Walking a few yards to the office; sitting in a chair under an electric fan; writing about 30 lines a day; walking ten yards, three times a day to the head clerk's table; listening to his grumbling.  It became apparent that his head clerk's grumbling was both quantitatively and qualitatively much less than the constant nagging he was experiencing at home.

Then we talked about Ganesh, the first of Gods.  I wanted to know why he went to Ganesh and what he thought of Ganesh.  He thought that Ganesh was omnipotent and omniscient, but he was now having doubts.  I remarked that I thought it a bit odd that he should believe Ganesh to be omnipotent and omniscient and yet question his decisions.  I told him I had not met Ganesh, but I certainly would be fed up, if someone told me that I was his Master, but grumbled every time I did not comply with the wishes of my self declared servant.  I asked him if he offered flowers and incense to Ganesh.  He said he did.  I asked him why he did not collect a plateful of thorns and mud.  I asked him if he offered only flowers and incense carefully, why he was going on offering to Ganesh all the time only his pain in the leg and his sufferings.

Did he not know that according to our ancients God is Sudarshana, the perfect mirror?  More powerful than laser.

If you show thorns to God he will reflect back a thousand thorns.  If you show him flowers you will get flowers.  If you only tell him your difficulties, for instance you tell him day after day only about your leg pain, you will soon find that your whole body pains, then your mind becomes painful and all this will spread to a dozen around you.

But you must be truthful and accurate.  It is true that your left leg pains.  But your right leg is alright.  Offer Him thanks.  The left leg is able to bear your weight, thank Him for that.  Your right hand, left hand, eyes, ears, nose, mouth etc. are alright, offer thanks in detail.  Your wife and children are in good health, even if your pay is less, offer him thanks for all that.  Just for a few seconds be truthful and accurate.  Just try this for about two minutes once or twice a day   in detail.  Item by item I want you to count your good points as carefully as you have been telling about that pain.

Then we agreed, that if the pain was the same, sitting at home or at the office, while other things considered the office was more comfortable, it was better to go to office and get the salary.  What compensation better than to see your family happy.  I told him that I was ready to sign for the leave, but seeing he is such a brave man doing so much work despite the pain, I thought we might put his capacity for work to good use.  First to join duty, and then keep seeing me.  I told him that paying attention to the healthy parts and functions of his body will tend to reduce the pain and cramp in his left leg also.  I gave him the use of small quantities of analgesics on his own guidance.  He agreed that if he had an estate, and one worker was sick, he would not give sick leave to all the other workers, or allow them to waste their whole time talking about the sick man.  The body with so many different workers was the same and that you, as the owner of the estate should see that the little sickness of one part did not spread to another by your mental sanctions.

The principles involved here are:
(1)  To replace negative scanning by positive scanning.  Scan for the least bit of positive good in the body, the person and environment.
(2)  To concretely realign these factors to the best advantage.
(3)  To convert useless activity into useful activity.
(4)  To avoid woolly generalisations and promote total bodily participation of the person in his own betterment.
(5)  To be deeply interested.
(6)  To smuggle in and awaken a sense of personal autonomy, responsibility and pride in the subject by every available stratagem and tactics.
(7)  To remember that you can personally verify the truth of these statements in group interactions like committee meetings and so on.
(8)  The strategy and tactics of this method require the personal apprenticeship of the therapist in establishing his own personal autonomy on his own personal apparatus called his body.
(9)  The efficacy of small concrete corrections.
(10)  The human nervous system is a collective entity with individuals as semi comatose ganglia.  Patient and therapist are one semi independent complex.  One of them trying to stabilise and improve his own perception and performance helps the other.  This should be experienced and experimented with.

Even in a chronic schizophrenic there are actions that can be realigned to a corrective use and growth as was done by Dr. Miller (Ref. the forgotten patient Lancet.)

He began taking more and more interest and he improved.

This man had lost his sense of personal responsibility for the management of his own body, lost all clarity.  The object of the exercise was to let him recover this and slowly to see for himself how this body of his, which no doctor made, was fitted with possibilities of rectifying itself to serve the master.  Here is a classic example of iatrogenic paralysis of will and wisdom that is rampant on an epidemic scale.  First, this man is made to believe in the delusion of a pain free life as the goal of life; then caught in the net of their logic, they refer him to physician, surgeon, neurologist, and to psychiatrist, anybody excepting to himself   sciatica, slipped disc, hysteria, and finally that insult to rationality, malingering.  Would the doctors tell me what exactly is the measure of another man's pain?  Malingering is the initial lie you have sown that catches up with you and you confront the monster of your make with the word 'Liar!’

I venture to suggest that the most deadly peril facing humanity today is Iatrogenic Abulia. 




Here is a short abstract showing how iatrogenic abulia affects the doctor himself.

This is a young doctor sitting in his chair in a village dispensary.  There is the village woman with her child who has high fever, a running nose and rattling noises in throat and chest.

There is no penicillin in the dispensary and no means to get white blood counts.  The doctor is waving his arms about and giving vent to his anger.  "What to do! No penicillin! No microscope! The stupid government sends me to this place.  Take the child to the big hospital.  You are asking me how to go.  Take a bus, take a bullock cart do something, I am not here to tell you all that.  What! You are asking me to give some medicine or other! Do you think I am quack to give you some coloured water or other! I am not a cheat.  Now don't holler," and so on.

This doctor has lost all sense of personal responsibility and dignity.  Simultaneously he has lost the use of his eyes, ears, head, heart and limbs.  His whole brain is paralysed and he can only talk of things that are not there and of the things he cannot do.  He talks of the penicillin which is not there, of the microscope which he himself has systematically ruined by neglect, and of the government about which he can do nothing.

If he had some respect for himself and his body and its capacities, he would have found time, interest and energy to note:  The child is having a high temperature, but in a child not necessarily dreadful.  A little sponging could be done on the spot.  The child is producing fearsome noises in the throat and chest, but is really quite alert.  Was she not pulling at his stethoscope and showing interest around the place? A little cleaning up of the nose and throat could at least make the child look less frightful.  About penicillin of whose absence he moans, does he not remember the nuisance of sensitivity tests and the fact that with all precautions some people do die of it and that it is not a panacea, and that before penicillin came and before he himself was born children were being taken care of in the circumstances available to them by the best of physicians? Could he not give a few drams of mixture with quinine ammoniata and syrup of cardamom, which would improve the morale of the mother, the quality of her attention to the baby, and so on?  If he was really so worried about the child and if he remained calm and alert scanning for the things he can do rather than moan about the things he cannot do, he would have noted that just then a visitor's car was going to town and he could have easily arranged for the woman to go to hospital.

How have we contrived, and with such dexterity, and with much malice aforethought, to produce such a doctor? We said we were producing doctors to spread the message of total health, and here is one of them spreading terror in the village.

The problem solving potentiality of a human being and his body has been systematically eroded.  There is no mystery here.

He has become what we have trained him to be.  His mouth has learnt to utter the words we have taught him   all about the unity of mind and body, integral health; and his body has learnt to behave exactly as we behave.  He is uttering the teacher's words and implementing the teacher's practice.  He sees no discrepancy in the principles he propounds and the actual things he does.  The teachers have not taken personal responsibility to implement and verify the principles of health they profess to the students and advices they offer the patients.  There in lies the major disaster.

More concretely I ask myself: For instance, for a number of years in the medical college I have been taught about the physiology of everybody's eyes, ears, and hands.  But there was little training of my own eyes and ears in their total interactional relationship with the world, not even simple perceptual exercises to improve their functioning.  The matter of developing the efficiency of these important sensory inputs has been left to pure chance or to the realm of so called individual personality differences.  It has been considered just not necessary.  An instrument was being ostentatiously trained to rectify other instruments but its own efficiency has not even found an hour of syllabus time in a week.

From my intimate contact with the health profession I have learnt some very valuable practical lessons for my day to day life.  Next time I buy a car I shall ask the dealer to first select ten cars with the best horns graded for pitch, frequency, musical qualities and other sophistications.  For instance, some cars have horns that shout out all the rules of the road, others admonish rash drivers and so on.  Then I shall have a small committee to choose the best car with the most sophisticated horn.  To hell with other matters, unimportant things like if the car has brakes, gears and even an engine.  Don't even think of a trial run.

This is exactly the method we employ to choose persons for post graduate courses and higher posts.  We arrange elaborate means of testing the vocal apparatus and the various aspects of the Broca's area.  All the qualities that go to make a good health worker   patience, capacity for anxiety absorbing behaviour, qualities of hand and heart that go to make a good problem solving person, all these qualities are in practice systematically pruned out.  

The person who can repeat four definitions of physical health and five definitions of physical health and five definitions of mental health, and the statistical tables in musical voice is chosen.  Meantime the quiet, hard working, somewhat tongue tied worker in the various hospitals is only fit to be seen and shown, patronised and patted on the back.

Health and politics were originally the part time job of priests.

Health education suffers from its heredity.  Chanting of formulas and ritualistic manipulation of apparatus and maintenance of the priestly hierarchy by procedures as ingenuous as the maintenance of the caste system, all become the procedures of choice.

I define priestly attitude as one which is characterised by:
(1)  Interpretative authority replacing personal verification by experiment as the basis for behaviour
(2)  Personal practice divorced from principles preached by the person.

This attitude has to a great extent been weeded out from the other disciplines   engineering, mountaineering and so on.  Of course the cant phrase is paraded   but the human body is not an engine or car.  If that were the whole truth we have no business to talk of scientific medicine or psychiatry.  If an automobile engineer sells you a car or prescribes repairs for it you would be reasonably certain that he has personally driven or done something to the car.  if I say I am specialising in repairing the human machine and some of its problems, I should be reasonably certain that I am continually engaged in some degree in understanding at least one total human machine as thoroughly as I can and that total human machine is first of all myself.  We are confronted with that deadly joke   Doctors don't follow their own advice.

I repeat again:  If I profess to tell others about total health, then I must have experience in the management of at least one total human being, and that of necessity is only myself, I and my body.  I need not be a paragon of virtues   all that is necessary is that I am engaged in active experimentation with and experience of myself as a total human being, trying to reach ever new heights of efficiency.  Otherwise I have no business to talk of total health to others:  I can teach the peddling of pills, organ transplants, anxiety reductions and so on, increasing the number of specialities to deal with the off spring of the dragon seeds we have sown.  

We can as well appoint as professor of mountaineering persons with the best capacity to talk about mountains, the biographies of mountaineers and so on, without the least necessity to show that he is engaged even in climbing his own roof, let alone a mountain.

Meantime it will be scientifically consistent to name our health institutions as Institutes of Broca.

The word autonomy I owe to Ivan Illych.  He has done great service in illustrating the social roots of the systematic erosion of autonomy in health that has taken place over the years with a wealth of detail.  He infers that health institutions have become the hand maidens of a society that has a heavy investment in disability, in impairing the personal autonomy of its citizens with regard to their health.  I am in deep sympathy with this view.  I am not very clear as to his view on the methods of re-establishing this autonomy, the personal responsibility for one's own health.  Perhaps he has been inclined to some sort of social action.  There has also been a suggestion that suffering and pain are to be accepted as concomitants of life to be met with stoic fortitude.  I do not fully share this view.  I hope and pray that he will meet with some success in at least arousing a challenging interest.

However, I have been drawn to this question of personal autonomy and an experimental inquiry into this question driven by the needs of my own total health.  In my fumblings I had been greatly helped out of experimental and other difficulties by the teachings of the great pioneers in the field of total human behaviour and its potentialities and possibilities.

Krishna lays the theme:  The only knowledge you need is the knowledge of the I and its field, the body.  The sages spoke of the body as verily the instrument of dharma or harmony, laying the scientific foundation for considering the body as an instrument and therefore worthy of study.  Krishna says that the aim and end of all Veda and Vedanta is to know 'I'.  This 'I', engaged in bringing the body under its control, into unity of purpose with itself and the achievement of this unity by skilful action is yoga. Yoga is skill in action is Krishna's classical definition for Yoga.  Krishna asks what is your home, and answers   it is your body.  The body of yours is your first home, vehicle and weapon, and if you haven't learnt to be happy in it, dexterous with its use, of what use the various instruments and adjuncts it makes?  Abhyasa is the key.

The Buddha, by meticulous personal experiment explored the minutest details of the human body and its functions and parts as experienced and understood by itself and showed how these details could be rearranged with skill to produce a more harmonious and suffering free life.  To beware of abstract principles, to systematically gain the control of your body by patient practice, so that in the end nothing is happening within you or without you without awareness and control, to do all this with skill, the processes of changing one's friction habits, the eradication of such negative habits by systematic cultivation of the opposite habits rather than by negative and infructuous moral resolutions, the art of converting useless and harmful activity into useful activity, a deep and dignified sense of personal responsibility.  Thus from the Buddha.

Christ emphasises man's choice   to choose between serving the Devil or the Divine.  The Bible shows the importance of the 'I' by making God call himself "I AM that I AM".

All this I have verbally learnt from their teachings.  I must underline the word, verbally learnt.  It might take ages for me to teach my body a fraction of all this.

I do not wish to bolster up my statements with quotes from scriptures but would rather leave their validity or otherwise to your own personal experiment and experience.

I have already drawn attention to the overvaluation of the speech system.  Let me also examine its value.  Nearly ninety per cent of our interpersonal interactions are based on the use of words.  Even our so called thinking is a journey in the jungle of words.  Pavlov and his successors, especially Professor Luria, have shown methodically, experimentally how human learning differs from animal learning qualitatively in that even as early as two years or less of age all human learning is mediated through the second signal system, speech.  Thousand of years or more back, Panini, the father of all grammar, elaborately explores the physiological basis of words in a work humbly called a text of Sanskrit grammar.  Forget all that and examine how profoundly words affect you from morning till next morning: some words ruin your appetite and sleep for days on end, some words increase your appetite.  The psychotherapist whose basic weapon is speech must thoroughly explore and experience for himself the profound psychosomatic roots of words and their interactional implications for health and ill health.

Let us see Krishna's directions on the austerity of speech:  speech that is free from anxiety provoking properties, realistic, helpful, self experienced   this is austerity of speech.  If any of these qualities are missing then to shut up.  It is not enforced silence that is preached here:  one can sit very silent radiating sulky or murderous anger.  What is required is austerity of speech, whether to a patient or a friend.  How can we afford to be extremely careless of our speech to our families, friends, and in committee rooms, spreading tensions and confusion and do nothing to rectify all this with the attitude of a skilled experimenter and then suddenly blossom out as psychotherapists in the clinic? All that is asked for is that we must progressively be actively engaged in this task, not necessarily reach the everests of behaviour.  You need not reach Everest to become a mountain guide, but you must be actively climbing mountains.

I shall now present you an example to show the difference between verbal learning and total body learning.  I have verbally learnt that ghosts do not exist and that really there is no experimental proof that they exist.  My friend, the professor of rational philosophy, has repeatedly convinced me of this.  One midnight he accompanies me on a walk through a grave yard.  There is a rustle in the bushes.  I scream and I try to run, but stumble on something heavy.  Later I discover that my professor of rational philosophy has fainted.  You see, here the whole trouble is that while my tongue has learnt to say that there are no ghosts, it is a pity that neither my heart nor lungs, nor the heart and lungs of my learned friend had learnt the alphabet.  If I had by my side that other friend of mine who thinks that perhaps ghosts are interesting and he could walk by my side whistling and telling jokes I should have been helped.  By the little experience I now have I have learnt the meaning of the Sufi saying that you really learn only in the company of a good man, a well balanced person, not from preachers of good things.  An hour in the company of a good man teaches you more about mental and physical health than hours spent in lecture halls.  In the field of health, especially mental health we should be very careful about the fallacy that relegates the profession to a narrow saccharin adherence to formal degrees and diplomas.  I have learnt the essential rudiments of psychiatric treatment from many sources, not necessarily within the precincts of psychiatric institutions and texts.

However, by way of a personal memory I recall Dr. James Valentine, my first formal teacher in psychiatry, 25 years ago, and that first incident is clear in mind.  Late in the evening a young woman was admitted in an excited, semi delirious state.  There was shortage of staff.  A nursing sister and I were in attendance for over a couple of hours.  We felt that the lady needed some intramuscular sedative or ECT, and we rang up for Dr. Valentine.  He came, a quiet gentleman of large heart and modest and economical speech.  He sat by the side of the patient as if he had all the time in the world (perhaps he left his supper table), listening to the lady's ravings, occasionally saying 'yes', 'indeed' and so on.  After a few minutes he looked at both of us, the nurse and myself, and inquired if we had time to have our evening meal, we having been with the patient.  He insisted on being with the patient while one or both of us had a little rest and food.  Some treatment was prescribed.  The patient was quiet and seemed to respond to his presence.  Here, I have learnt two lessons.  One is the effect of a basically quiet and compassionate man on the behaviour of another person.  The second is that this compassion was all inclusive.  He was open and alert, not only to the needs of the patient but to the needs of his mere assistants as well.  It was a total therapeutic action reducing anxiety levels, promoting group efficiency etc., and all with the utmost economy of words.

Needless to say it is within the experience of all of us how in the presence of a basically quiet, confident and compassionate person, whose awareness range becomes automatically large, a whole disturbed group can be beneficially affected, irrespective of that person's lack of great verbal and theorising talents.  Mauna Guru   the silent influence, this aspect,   and the possible processes underlying such silent interaction is a potent factor in day to day life, and I feel it is hardly appreciated and its study neglected in the field of psychiatry.  Could we look into it?

Now let me take an example of double talk I had been practising and I witnessed and still witness.  We have many behavioural laboratories all over the world where a class of persons called patients and rats are being treated for anxieties, phobias and poor frustration thresholds.  Is it to be supposed that the persons who are peddling these methods are themselves free from these mortal ills?  What is the number of psychiatric teachers or their students who are actually using these methods to get over their own deficits in behaviour?

If at least some degree of personal verification and involvement of a continuing nature is not there what exactly is the term to be applied for this sort of salesmanship.  Either we must take it for granted that we the teachers are free of these various defects we diagnose for the patients, or that we have some secret, personal methods of overcoming them, or that we feel that we are better mortals who can enjoy these defects without losing our jobs, or that we are plainly agents of the Devil.

Take another instance:  We have a large section in the syllabus for psychology to demonstrate errors of perception and the effects of parataxic thinking to the trainees.  We also teach how these are at the root of much maladjustment, individual and social.  Then we spend hours in the classroom and clinic to teach the trainees how to correct these errors in others and to treat others.  Now the point is, have the teachers and trainees themselves overcome these defects? If so where is the proof? Does the syllabus show even an hour spent on this most important question?  However, we peddle treatments merely bolstered up by statistics, that brain child of the gambling houses.  The disastrous results of this self deception can be seen in the paradox that the amount of physical and mental disability is snow balling into unmanageable proportions.  Even in institutions, like officer training schools of the army, space travel training programs, great concern, experiment and practice and effort is being devoted to the question of behavioural transformation with all participants personally engaged in the business.  What a tragedy that persons trained in our institutions should have to go from door to door to so called institutions   religious, yogic and so on to learn the business of healthy living involving self transformation.  I humbly suggest that it is in the institution of mental health etc., that the task of self transformation must be undertaken in the interests of scientific honesty.  The syllabus must reflect our concern in this matter.  Even an army officer gets better training in interpersonal behaviour than our trainees get in our health institutions.  Just as surely as an officer of a regiment is expected to remember and reflect the dignity of the rank he holds, a member of mental health or health team must at all times, in private or public bear some responsibility for the profession to which he belongs.  I cannot be giving lectures on group psychotherapy, preside over group psychotherapy sessions and yet in my behaviour to my own colleagues go hay wire and display the lowest common average behaviour of the street   impatience, greed or disruptive behaviour based on those very errors of perception we have been writing papers upon.  Again this is not a moral exhortation for which I have no qualifications.  It is simply that if you are teaching mountaineering you must be engaged in mountain climbing.  If you teach health, you must be engaged in improving your own health and satisfy at least yourself that you are doing so.

In order to emphasise the concept of 'I' and 'My body' as the primary unit of all behaviour, I shall present an example:

Take the example of a person going to Madras, driving his car, costing some 20,000 rupees, in order to attend an important committee meeting.  On the way he finds that his brakes are lose and there is ominous knocking in the engine.  What does he do? Press the accelerator, saying, 'I must go to Madras, I must reach Madras!'  Usually he is still normal, and therefore stops the car and tries to do something about it.  His primary concern is the car and its safety.  This for a car costing Rs. 20,000.  But let us see what he does to his priceless body, without which he is nothing, he, his cars, his committee and so on.  He goes to some meeting or other.  Everybody opposes him and he does not get what he wants.  His temper is rising; his pulses beat furiously, his speech is becoming harsh; brakes are lose; horn is stuck, and the accelerator is going hay wire; the horn is saying 'I must get what I want, want, want.'  Meantime his car called the body is coursing headlong to a collision with a few other cars similarly driven by savages from the caves who have not gone to a driving school.  And this person, so savagely ruining his car, the body, says that all that he is doing is for the security of his body.  What is the use of dozen promotions and mansions if your first base is totally gone.  Is it a wonder that the average age of this grossly maltreated vehicle is hardly three score and ten, and the last decade or so spent in the garage storehouse for derelicts, called geriatric wards?  As the road becomes difficult and crowded a good driver must pay more attention to the dash board and the immediate few yards ahead, and not keep yammering about fates and governments and general injustice in the world.

It is a good principle for efficient car driving to accelerate well within the power of its engine.  Imagine the noise rattle, wear and tear if you run a low h.p. car in top gear on an ascent.  If he is a villager he thinks that all this noise is a sign of great power.  Compare its performance with a good engine and a good driver in a Mercedes silently rushing by.  The villager thinks it is a poor car.  

Similar is the comparison between an angry man and a calm man.  Anger is a sign of weakness, a sign that one is accelerating on low pulling power, and the sensible person must learn to come to a low gear, to pipe down immediately.  He must learn to operate within his limits till he learns more about the sources of power.  A man must learn to live within his automatic limits till he understands things better.  If he rushes into battle without adequate control of his body he will be like a warrior in shining armour finding himself fighting his unruly horse more than anything else.  It is once again to stress that your personal autonomy lies in your capacity to master the controls of your own body.  It is the basis for total health.  It can be learnt.  It does not always fall as a gift from heaven.  Even in the constitutionally blessed man he has ever higher peaks of skill and efficiency to reach.

The achievements of man in the external world have done much to give us some good even if partial models of the behaviour of the human machine, the second of our assets, the first being the master control called 'I'.  The degree of civilization is the degree to which the I and its body coordinate, and the dialectic movement between the two is the organic force behind forward evolution.

The learning of the driving skills necessary for piloting one's body require the same methodical care, effort and zeal as the learning to drive any other vehicle.  Very often what you are doing to your car, your furniture and your friends and colleagues is a mirror image of what you are doing to your own body and that should help you.  Do not blame the vehicle.  The first lie we have learnt to utter is 'Oh, my spirit is willing but my flesh is weak.'  Your body obeys you in a flash, that is its greatest strength and at once its weakness.  If you say I am depressed it plays possum, if you say you are fatigued it plays the necessary drama.  If you say that you are undecided it plays the necessary part.  The poor body acts today as a car does when you are nominally in the driving seat, but you also have your wife in the back seat or a hijacker with a gun by your side, all of them effectively sharing the steering wheel.  Do not blame the body, the instrument, the maker of all other instruments on earth.

At this point I have to point to the increasing craze of all and sundry for Yoga, Spirituality and occultism and so on.  All these so called spiritual practices are instruments.  To ask if a particular meditation is good or bad is like asking if a spanner or screwdriver is good or bad.

These practices, like spanners, tranquilisers, transplant operations are no substitutes for methodical personal learning to drive one's own body.  They cannot teach you driving.  They may improve your head lights or tighten your brakes; or provide good springs while you are merrily careering along the road on a crash course.  That is why the leading pilots of the human machine, like Krishna, Buddha, Christ, Sri Aurobindo, Ramakrishna, Ramanamaharshi and others did not emphasise these special instruments.  In fact all these special practices have been included as esoteric knowledge to be imparted to those who have sincerely shown over the years that they were first of all interested in changing their day to day driving attitudes on the road of ordinary human relationships.  Unfortunately, this long apprenticeship necessary before one was permitted to do special concentration exercises etc., has been ignored because of the ease with which books can be printed and verbally expounded.  Referring to special yogic skills Ramakrishna says "The vulture soars very high, but its eyes are on carrion."  Yogic and spiritual practice that does not lead to changes in your external behaviour permitting a more compassionate and wider and harmonious interaction with the world and persons around you is anything else but spiritual.  If I am half blind with open eyes, and am hostile to the things that I see, what am I to see and do with the things I conjure up with my closed eyes?

For the purposes of the topic I have chosen, I shall define healthy behaviour as problem solving behaviour.  From this it follows that all problem evading or problem multiplying behaviour is unhealthy behaviour.  The 'I' and its body are the agents in this context.  Personal autonomy or freedom is the degree with which a person feels comfortable in his driving seat and in the driving.  Your degree of freedom with your car is the degree of your knowledge of its parts and controls and your capacity to use them.  All learning is total body learning.

The first fundamental property of the human body is its almost limitless capacity to learn, in fact, learning is its main if not its only function.  If you do not programme it to ever new learning it goes on learning more and more disorganized behaviour of which death is the final act of learnt disorganization.

Making the goal of one's life as the constant and progressively better mastery of the body by its own particular control 'I' is something that cannot be prescribed to everybody.  All may not desire this autonomy.

It is a profession and can be attempted.  The leaders in the field of health say that they are engaged to tell others as to how to manage their bodies and minds.  It is but reasonable that such persons should pay some attention to this question in personal practice.  Personal autonomy cannot be achieved except by creating models of such autonomy.  The minute attention to instrumental accuracy of one's own functioning is the preferred method.  For this particular speciality in health I like to use the word Experiential physiology as opposed to expounded physiology:  A man intimately experiencing his own physiological mechanisms and learning better control.  Perhaps this is the underlying principle behind the Buddha's path of awareness. I like to use the term auto monitoring in full awareness for the practical methodology implied in my talk.

The best way to teach oneself mental health is first to make an exact operational definition of what you mean; next step is to systematically try to change your own behaviour to express what you propounded using every interaction and opportunity to make your body express what you believe.  Change yourself; try it is the central teaching of the Mother of our Ashram.  The basic step in yoga is to ask yourself 'What is the type of person I do not wish to be and am:  what is the type of person I wish to become.'  If this question is not properly stated, answered and remembered the rest of Yoga flounders said Sri Aurobindo in effect.  Everybody believes; the hero behaves as if he believes, said Carlyle.  Trying to make your body express the beliefs you hold is the only reliable definition for sincerity of your professions.

To become responsible for your own beliefs is the central theme of the Gita.  This is not equivalent to the practicing of some moral virtues or avoiding some vices   virtues and vices codified according to the pet theories of somebody or other, but becoming responsible for your own values.  Mental health from the point of view of personal autonomy is not a moral rearmament crusade, though it may take it into account.  The extraordinary degree of cruelty sometimes practiced by the priestly propagandists of all love shows the fundamental poverty of that type of thinking.  Judging other persons according to some yard stick or other and trying to change them by hook or crook is the occupation of those who first of all take no personal responsibility to change their own personal behaviour.

Sri Aurobindo, sometimes, refers to virtues and vices as the double gates to hell.  The true freedom of man lies in first of all being free in his own body, to have a body that is in harmony with the personal will   To be Swarat, the ruler of one's own house, body, is the condition of true freedom.  Such a man is free in a concentration camp and another man may utterly be bound even in the fullest of a democracy.

I am a partisan in favour of personal autonomy, which is the true basis of freedom independent of race, creed, religion and political 'isms'.

I believe this concept has important implications for practical mental health.

I must make it clear that I am not against any other method, or approach.  I have simply emphasised an area of work that interests me and in which I am an active apprentice.

I conclude that psychotherapy is very important.

Thank you.

1 comment:

paulsb02 said...

Excellent article. Thought provoking and very helpful. With the assistance of good stories, the driving was very comfortable and the idea reached home safely on fast pace. Thanks for sharing it with us...