Daily Times

“It’s no use going back to yesterday, because I was a different person then”

—Alice in Wonderland

Words are the stock-in-trade of psychiatrists (and other mental health professionals). The work we do involves a lot of listening and some talking. As such, we know the importance of words; what they convey as well as what they hide.

Three instances recently reminded me of the importance of words. A young woman from a local college came to my clinic ostensibly for help in treating her depression. She had seen me months before (once) and never returned. This time she came in at the insistence of a friend to whom she had confided that she was having daily thoughts of committing suicide. Her story, which came out haltingly, was heartbreaking. She had lost her mother at a very young age. Her father had remarried but was an abusive, violent man and her step mother, with whom she eventually formed a strong bond, also finally left, tired of his abuse. She had a brother who had, like her, been the target of her father’s outbursts and was now just as estranged from the father (and her) as she was. She lived alone in Lahore with no social support system to speak of other than a few friends. Luckily, her college was one of the few institutions in Lahore that recognized the importance of the mental health of their students and one of the staff members (who had accompanied her to her appointment with me) had stepped in to help her. I talked to her at length, then met with the staff member, then met with both of them again. We talked about developing a safety plan for her as well as beginning appropriate treatment. Given her history, recovery is likely to be long and difficult but by the time we finished, she was able to smile and I could detect a glimmer of hope in her eyes.

The right choice of words, at the right time, can lift a person out of despair and, literally, save a person’s life while an ill-chosen word or worse, a purposely harsh one, can scar a person sometimes for life

The next day, I met a young man I had been seeing for several weeks. He was from a prominent family in the city. Both parents were well known professionals, highly regarded in their respective fields. The only son in the family, he had been tortured by what might generically be termed ‘existential doubts’ for as long as he could remember. I recalled that he had first come to see me years ago (once) at the request of his mother for what, at the time, seemed like mild depression. He was morose and downcast and continuously bothered by thoughts that life was meaningless, that there was no point in doing anything and that there was no God. I don’t remember what we talked about that day but it apparently helped enough to where he never came back to see me until recently. This time, he was in the throes of an acute depression brought on partially by his recent engagement. He was tormented by repeated negative thoughts about his fiancée (her looks, her family, her ‘morals’ etc) to the point that he could focus on little else throughout the day. It had progressed to the point where he was hardly eating or sleeping and was paralyzed by doubt. He had refused, up until that point, to see a mental health professional and had only come in very reluctantly to see me because he knew me through his mother. When I saw him that day we had been meeting for several weeks and although I had counseled restraint, he had, impulsively broken off his engagement and had been in agony at the thought that he had made a mistake. He sought reassurance and support from his family incessantly to the point that they, too, were desperate. Fortunately, partly as a result of the work we had done over the past several weeks, that day he seemed calmer and while we still spent a considerable amount of time going back and forth over his decision (which we had done countless times before), it appeared that he was finally moving forward with his life and making plans for the future.

That same day, my soon to be 18 year old son received his recent exam results which were considerably below what he had expected. Unusually for him (he is a rather stoic fellow, not given to obvious displays of emotion), there followed a rather dramatic temper tantrum and some tears and anger which lasted for most of the day. Late in the day, he finally allowed himself to be comforted by his mother and 12 year old sister and we had a talk about what had gone wrong, what should have been done before and what needed to be done in the future. Since any advice I offer is often interpreted as ‘a lecture’, I have gotten into the habit of offering my words sparingly. That day I was supportive, pointed out that this kind of extreme reaction was uncalled for given that no one had died or developed a terminal illness and that we did not think any less of him because of his grades. The next day we had another talk, this time a sterner one from me telling him that I was not satisfied with his efforts so far and that I was confident he could do better if he applied himself in a consistent way. By the next day, he was back to his old self, made a detailed study schedule and showed it to me and is, as of this moment, helping his 15 year old younger brother make a schedule for his studies as well.

All emotion, including our most cherished ones (love, empathy, devotion) are ultimately chemical reactions in the brain and can be manipulated, enhanced and extinguished. Electrodes planted in the right areas in the brain can make a person feel anger, fear, hunger or lust when stimulated. Chemicals ingested into the body can do the same. The entire field of psychopharmacology (chemical/medicinal manipulation of brain/emotional states) is based on this simple fact. And in fact, there is now plenty of evidence that words can induce the same chemical changes in the brain through slightly different mechanisms. Words can make us feel happy or sad, angry or relieved, hopeful or hopeless, despairing or ecstatic. The right choice of words, at the right time, can lift a person out of despair and, literally, save a person’s life while an ill-chosen word or worse, a purposely harsh one, can scar a person sometimes for life.

In a country like Pakistan, everyone understands the value of concrete interventions: stents in the heart, metallic knees, new corneas; but few people place the same value on words and fewer still understand their importance, both to harm and to heal.

The writer is a psychiatrist practicing in Lahore. He taught and practiced Psychiatry in the United States for 16 years

Published in Daily Times, February 1^st 2019.