Being smart doesn’t make psychiatrists, as a body at least, immune to irresponsibility and foolishness. One of author Tanveer Ahmed’s pet peeves is the way every mental affliction, from sadness upwards, is being medicalised, labelled a condition and therefore in need of treatment.
Fragile Nation
by Tanveer Ahmed
Connor Court, 2016, 212 pages, $24.95
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Tanveer Ahmed demonstrated his commonsense optimism in his memoir The Exotic Rissole (2011). That book ended with his success, on the third attempt, to convert his medical degree into qualifications to practise as a psychiatrist. Fragile Nation is his report on the mental state of the nation, based on his subsequent professional experience.
The first and most obvious thing about the book is that it is surprisingly cheerful and hopeful. Ahmed is fascinated by people and by the challenges his work presents. His predominant theme is that his patients are not helpless victims, no matter what the cause of their suffering, but people who have somehow lost the ability to live fully. He sees his task as guiding them to ways of rediscovering the ability to cope with life’s vicissitudes.
He finds that such guidance, offering a proper balance of sympathy and firmness, and reminding his patients of the rewards and penalties that are the consequences of their behaviour, leads in most cases to satisfactory improvement and allows his patients to get on top of their problems and resume normal life. He attributes their recovery to “their extraordinary courage and grace in the face of tremendous adversity” and their “wide variety of responses to crafting a meaningful life”.
He does not claim to cure his patients. He can only show them how to cure themselves; which is where the courage is required. This is one crucial way in which psychiatric medicine differs from medicine more generally. Physical ailments are cured largely by following medical advice and waiting. Recovering from psychiatric ailments takes courage.
The courage psychiatric patients need is not the passive courage they may have used to try to put up with their troubles, or the destructive courage they may have used to lash out wildly in desperation, but the positive courage that draws on their virtues and recovers their full humanity. It must be truly encouraging to people at the end of their tether to be shown how they can make their way forward again using their own inner resources.
Ahmed recounts a wide variety of his cases, across a range of social classes, ethnic groups and geographical areas. He approaches each patient as an individual with unique circumstances. He is not bound by theory. While he has studied and read widely and continues to do so—the fifty or so references in the book would supply a year or two of fascinating and instructive reading to most of us—he does not try to fit his patients to his theories, but rather uses his theories where they can help each patient.
He explains, for example, that while the usefulness of prescription drugs has its limits, drug therapy can work in many cases. Patients suffering from their own damaging behaviour brought on by anxiety can often be treated with anti-depressants. Where their anxiety has led to bad mental habits—severe neuroses, we might have said in the past, but Ahmed does not use that term—and the bad habits in turn have intensified the anxiety, a course of anti-depressants can take away the anxiety, and the bad habits, for a few months while Ahmed brings his patients to an understanding of where they have been going wrong and how they can avoid relapsing in future. A bad habit can be extremely difficult to break, but an encouraged person who has broken a bad habit and understands its dangers can avoid a relapse relatively easily.