Psychoses- what caregivers need to know

‘ Psycho’, ‘ Psychotic’, ‘ Lunatic’ etc are words that we are used to hearing and reading in movies, books, amongst our family and friends etc. However, how often do we stop to think about what these words really mean, and whether they should be used or not?. The often derogatory and disrespectful words above are commonly used to describe a health problem called psychoses or we also use the term ‘ Schizophrenia’ to refer to the same.

So, what is psychoses? 

Psychoses is a serious health problem that affects one’s thoughts, perception, emotions and behaviour. It is becoming increasingly common in Sri Lanka, and it is difficult to say what exactly causes it. There can be a multitude of biological, psychological, environmental and social factors that can cause psychoses, and it can happen to anyone from any social background. It does not affect only people from lower socio-economic backgrounds, it affects everyone.

How do I know if my loved one/friend is affected by psychoses ?

Ask yourself the questions below.

  • Have there been significant changes in my loved one’s behaviour?
  • Does he/she appear to neglect usual responsibilities related to school, work, home and social activities ?
  • Does he/she appear to be overly agitated, confused and aggressive?
  • Has his/her personal hygiene, grooming etc been neglected?
  • Has my loved one developed fixed false beliefs that are not shared by others in your family, community and culture?. Does he/she seem to be suspicious of others, and often act frightened?
  • Has my loved one talked about hearing voices that are not really there or seeing things that no one else seems to see?
  • Does he/she seem oblivious to the fact that they may be experiencing mental illness?

Key messages to caregivers 

  • If you have noticed one or more of the symptoms given above, seek medical help early. Early treatment often leads to positive outcomes for the individual. Psychiatrists can be consulted in most private and government hospitals.
  • Your loved one is not ‘ crazy’, ‘mad’, or should not be put in the ‘loony bin’. They have a health problem, which can be managed with appropriate treatment and care. The above words are derogatory and disrespectful, and contributes to existing stigma and discrimination. Everyone must be treated with dignity.
  • It is not your fault or your loved one’s fault that they are experiencing a health problem.
  • Do not attempt to convince your loved one that their beliefs or experiences are nonsensical and unreal. Be supportive, and do not collude with their perceptions and beliefs.
  • Do not laugh at or ridicule your loved one due to their illness. They need your love and support.
  • Ask about suicide- ask early and ask often. Asking can help save a life.
  • Provide a conducive environment, with minimal stress, and adequate social support. Do not criticize or be hostile towards your loved one.
  • Help them have a healthy lifestyle with adequate sleep, exercise, and good dietary habits.
  • Help your loved one avoid alcohol, and other substances including prescription drugs.
  • Comply with recommendations made by your loved one’s doctor about treatment, and it is important that medication is taken as advised by a health professional. Do not start new medication or stop medication without consulting your family member’s doctor.  

People living with psychoses can lead very productive and fruitful lives with proper treatment and management. They are capable of engaging in a job, studying, and contributing to society. They can engage in social activities and can be included in weddings, family outings, and other community events. People experiencing psychoses are not dangerous.  Isolation does not help. No one likes to feel left out.

Caring for someone with psychoses can be difficult and painful. It is of vital importance that you take care of yourself. Take breaks, engage in activities that you enjoy, and seek support by talking to those close to you. You are not alone.

Need to talk?

Sumithrayo – 0112692909 between 9am-8pm.

CCC Line- 1333 between 9am-9pm.

Shanthi Maargam- 0717639898 -24hrs.





Depression- what caregivers need to know.

Depression is a major public health concern around the world and it is known to affect 1 in 4 people in their lifetime. 322 million people live with depression globally, and we also know that by 2020 depression will be the leading cause of disability in the world.

Enough with the numbers, already.

We all have bouts of the ‘ blues’ and feel sad and miserable on occasion. This is not depression. As human beings we are allowed to feel sad, angry, irritated and just low, and this doesn’t mean that one is depressed.

So, then, what is depression?

Depression is a health problem that affects the body and the mind. It is an illness just like diabetes or hypertension. It is not just a ‘ passing phase’. It is difficult to say what truly causes depression, but it is often a combination of genetic, biological, psychological, environmental and social factors. It is a mixed bag really. There is no one reason as to why your loved one/s may experience depression.

Identifying depression in your love one/s

Ask yourself the questions given below.

  • Does he/she seem low most of the day for a period of two weeks or more?
  • Has he/she lost interest in things they enjoy doing?
  • Are there sleep difficulties? Is he/she sleeping well?
  • How is my loved one’s appetite?
  • Are there complaints about aches and pains, headaches, and constant fatigue without an apparent cause? Are these complaints increasingly frequent?
  • Does my loved one talk about feeling worthless, useless, a burden, a waste of space etc?
  • Does he/she have difficulty getting out of bed in the morning?
  • Is he/she talking about life being not worth it, or about wanting to die?

Key messages for caregivers

  • If you have noticed the signs above in your loved one/s, they may be experiencing depression. Seek help early for better outcomes.
  • Depression can be treated.
  • Not everyone who is depressed requires medication. Some people can recover through psychotherapy, positive family support, etc.
  • It is important that you loved one is assessed by a competent mental health professional before deciding on treatment.
  • Those who are depressed are not ‘ lazy’, ‘ attention seeking’ or ‘silly’. They have a health problem.
  • Your loved one needs to be involved in decisions made about treatment and care. They require your support.
  • Ask about suicide- ask early, ask often. Asking does not make people want to end their lives. Asking can save a life. ‘ Are you thinking about ending your life? ‘ Do you have thoughts about suicide’, can be questions you can ask.
  • It is important not to isolate your loved one. Involve them in social gatherings, family functions etc. People with depression can live very productive lives.
  • Take care of yourself. Take breaks. Seek support.
  •  Keep faith and be hopeful- because there is light at the end of the tunnel ( it’s true, no matter how cliched it sounds).

What your loved one does not want to hear

  • “Aney-  stop overthinking men”
  • ” Get a move on”.
  • ” Oh, just snap out of it”.
  • ” Don’t get worked up for nothing men”.
  • ” You’ll be fine- you are just sad”.

You get the gist, right?

There is a shortage of mental health professionals in Sri Lanka and this is a fact. So, the family becomes so very important in the recovery of those with mental health problems. You as a caregiver/friend have a vital role to play in your loved one’s journey towards wellness and recovery.

Need to talk?

Sumithrayo – 0112692909 between 9am-8pm.

CCC Line- 1333 between 9am-9pm.

Shanthi Maargam- 0717639898 -24hrs.




For those left behind

‘ She has committed suicide’. 

‘I never wanted to believe it. I told everyone including you that it was an accident. I was lying to my self too’. 

‘Coz she was never that type of a person. I was feeling guilty of myself. Being her best friend I couldn’t save her. I was three minutes away from her but I still failed. I was lying to myself right throughout that it wasn’t a suicide’.



I received this text message two hours ago from a dear friend who recently lost her best friend to suicide. It struck a chord in me and with the recent deaths by suicide that have taken place in Sri Lanka, it got me thinking about the impact suicide has on those who are left behind, on those who survive. What happens to them? What happens to us?

A death by suicide, when it occurs,most often shatters the existing status quo of a family, community and society.  It’s like being tossed around in a whirlpool, I suppose. All that we once believed in is shattered and those of us who are left behind often have to pick up the pieces, and piece together a fabric of something that possibly could help us find some solace, barely.

I remember how I cried when a classmate from my Bachelor’s course in India, took her life, when I was far away, in Norway. I couldn’t be there with the rest of my classmates. There weren’t any pieces to pick up. Nothing to hold on to other than Facebook messages sent by classmates, and a few photos that were online.

My friend found her.

The guilt of surviving, shame, feelings of regret, anger, abandonment, emptiness and a whole plethora of feelings come gushing through, maybe not immediately, maybe later, and maybe not at all- there is no one way of feeling about something so ambiguous like suicide. You might ask the question ‘ why’ or you might not. You might wonder what you did wrong, of how you could have saved your loved one’s life, of that one thing that could  have made a difference, but from a different point of view, it might seem pointless to think about it at all, I don’t know. But, what I do know is that it is okay to feel, whatever you feel- because they are your feelings and it is important that what you feel is acknowledged. However, silence sometimes becomes convenient for some and although deafening, a  way of coping for others. Feelings tend to go unacknowledged and unheard, leaving a survivor of suicide in a mass of isolation, heaviness and despair. There is a ‘wall of silence’ that erects itself around an individual or  family who has lost a loved one to suicide and in Sri Lanka, we often see the stigma and shame surrounding suicide only making the wall taller and thicker. It doesn’t have to be that way, and we as a community have the power to change that.

It is important not to isolate individuals and families who have experienced loss due to suicide, even though it might seem rather daunting and confusing to think about ‘ what to say’. I’ll get to that in a moment, but reaching out and not waiting for survivors to reach out is a great way to start. They may not want to talk, or even look at you, but it’s your presence that matters. It takes away the isolation and emptiness.  It is often not immediately after a loss that the most support is needed, but it is when a month or two has passed and people slowly begin to forget. People gradually begin to trickle away, and contact with the community decreases, and this is when you can help sift through the debris. You don’t always have to say much, but checking in regularly, and creating a permissive environment for feelings to be expressed can go a long way in someone feeling supported and cared for. I must also bring in the use of language when talking about suicide. ‘ Died by suicide’ rather than ‘ committed suicide’ is an useful way to talk about suicide. It makes it seem less like an offense or a crime. ‘ Took his/her own life’ can be used instead of ‘ completed suicide’. ‘ Ended his/her life’ can be used and not phrases like ‘ a successful suicide’. You get the gist right?

Are you a survivor of suicide loss?

What can you do to cope in the aftermath of a loved one taking his/her own life?

  • Try not to isolate yourself.
  • Speak about your deceased loved one with other members of your family and friends. Share positive memories you have of the person you lost. It is okay to acknowledge that the person both lived and died.
  • Use creative mediums like journalling, art based activities etc to work through your feelings. Psst, you can also speak to a mental health worker.
  • Keep your loved one’s memory alive- photos, letters, memento’s etc can be used to help you through the process of grieving. The person may have died but can still live on in your memory.
  • Allow yourself to cry, to express emotions, even difficult one’s like guilt, shame and regret. They also need to be acknowledged.
  • Take care of yourself- get adequate sleep and nutrition.
  • Seek support- there is no shame in doing so,


Where can you seek support?

Sumithrayo- No.60B Horton Place, Colombo ( 0112692909). 9am-8pm.

CCC Line- 1333.  9am-9pm

Shanthi Maargam- 0717639898. 24hrs









The Pain Behind the Pride : Student Suicides at Monash University,Malaysia

I was strolling around the Sunway Monash Campus in Malaysia, last week while on holiday. It was a beautiful campus, with everything a student can possibly ask for. There were tall buildings that boasted of fine intellect and academic rigor and you could almost smell the cortisol floating around while students were prancing around ‘ checking the boxes’. However, I also felt a certain eeriness while inside the campus because of another reality I was aware of. Unnoticed and hidden under the pride and acclaim of everything Monash claims to be, is a dark cloud of pain and anguish- student suicides.

I won’t go into the details here, out of respect for those who lost their lives and their families, but there have been quite a few  students who have taken their own lives while and after studying at Monash University, Malaysia. A number of them-international students. However, apart from ‘regretfully’ releasing statements, there appears to be little else done via the university to work towards suicide prevention.

While walking around campus, and while using public transport i.e. the BRT, I saw lonely eyes glued to mobile devices and computers and I couldn’t help but wonder about how their hearts were. What were they feeling?. Were they feeling at all?. Did they have someone to tell them that they are loved and cared for- or was their worth solely based on how academically sound they were. I was thinking about those lives lost to suicide. What were they like? What were their stories? Who did they leave behind?

What do we do with the residual traces of what’s left behind? The lingering vapor of hearts riddled with pain,guilt and loneliness, about low grades, failed exams, friends who have failed them and families who have shamed them.

We have two choices;

  1. To pretend that it never happened and move on with our lives.
  2. To create a more compassionate world collectively.

I obviously advocate for the second choice.

A few pointers for students studying at Monash,Malaysia and their parents

For parents:

  1. Expectations! Expectations! Expectations!- Manage them.
  2. Check on your son/daughter often. You are not being a pain in the behind, just a  caring parent.
  3. Ask after their mental health- not just whether they are eating well or not.
  4. Teach your child about coping with failure and learn some of that yourself.
  5. Provide options not dead-end’s.

For students:

  1. Check on your friends often. A simple ‘ how is your day going?’ would do.
  2. Take your eyes off your smart phone and look someone else in the eye and let them know that you care.
  3. As much as it looks ‘cool’ to make someone else feel like ****, it’s way cooler to help someone out. It doesn’t take much of your precious time.
  4. Quit laughing about suicide and poking fun at people who may talk about wanting to harm themselves. Help them seek support.
  5. Please stop the ‘hate’ on social media and on pages like this. It only adds to the pain.
  6. Take care of your mental health as much as you do your physical health.

For Monash, Malaysia and other universities around the world: 

  1. Check on the well-being of your students- not just their attendance and grades.
  2. Reach out to students who may be having trouble adjusting and actively support them. It really does not take up too many resources.
  3. Include life skills and coping skills education in your curriculum. A degree is not just a piece of paper it is also about life.
  4. Identify suicide hotspots on campus and take measures to prevent further suicides from taking place.
  5. Talk about suicide prevention in your campus and do not just slip difficult conversations under the carpet.


Here’s to a healthy, compassionate world.









Staying well O’er the season

December is a month of joy, colour, bonding and giving or at least that’s what we’ve learnt over time. However, this might not be true for everyone, and hey, it does not have to be the end of the year, for life to be extra joyous and merry. So, what I am really trying to get at is, that December, and everything that comes with it may not always bring happiness and contentment. It could for some, be a very stressful month, and for some, extra lonely.

There is the commercial buzz around this time of year, where people are racing for time, to finish their shopping, and to get some of that spring cleaning done. Santa’s prancing around the streets, gigantic Christmas trees popping up around the city and general bonhomie is what one would notice, at least on the periphery. We however tend to sometimes forget that there is also another side to Christmas and of course the dawning of a new year which is around the corner (Gulp!). I decided to pen down this article, to acknowledge the often-unacknowledged side to the season in Sri Lanka and to share some thoughts on how to cope with the niggles that come with it.

There is a hype of activity around this time of year, and a great deal of pressure for some to part take in the festive cheer. A whiff of consumerism is in the air, with shops beautifully decorated, whippy adverts on television and of course those provocative discounts and sales. Television shows portray love filled families, sitting around crackling fires and gobbling down turkey. Radio hosts (some of them) are extra cheery and bubbly. While I am totally for joy and happiness, I also know that parents may feel pressured to buy gifts for their children, people may feel obliged to host the ‘party of the year’, and for others, the season might bring with it the necessity to guzzle down spirits, in order to belong and to feel bonded. December can be a very lonely month for certain segments of society and this could also bring about bouts of depression, anxiety and cause high levels of stress.

It’s okay, to not feel as bright and cheerful as you are supposed to feel. You are not defective, just because you do not feel like donning your best, and celebrating. You, my dear friend, don’t have to snap out of the sadness you feel, just because it is Christmas. You can say ‘no’ to a party you are invited to, and for you beautiful parents out there, you are allowed to not buy your child the most expensive gift this year. You are also important, and your well-being is as important as everyone else’s. You can give yourself permission to take a break. It is not a catastrophe, to not put up a Christmas tree at home, or to not bake at your best this year. Balancing your reality versus expectations you, and others have of you can be a way of staying well, this season.

We are vulnerable sometimes to developing mental illnesses and some may be already diagnosed with a psychological disorder. A few simple strategies can prevent the onset of mental health issues or the exacerbation of already existing illness, especially in this time of year.

  • Create a balance of activity and rest into your day.
  •  Get enough sleep and try keeping your sleep cycle in place.
  • Watch the alcohol and other substances – you do not always have to drink or get high, to be merry.
  • Be aware of certain triggers that cause distress (i.e. a Christmas movie, portraying a warm family- while this can provide comfort and hope, it can also bring about difficult feelings).
  • Reach out and give some of your time to others who may want some company this December.
  • Keep a tab on your expenditure so that you can minimize the stress of over-spending. You can use a worksheet like this to keep track of your expenses.
  • You are allowed to talk about the difficult stuff, it doesn’t’ always have to be cheery.
  • There is support available in Sri Lanka, even during Christmas and new year’s.


So, folks, I wish you a mindful and peaceful Christmas and a hopeful new year.


Stay well, and keep each other well.








An Open Letter to the Commissioner General of Prisons, Sri Lanka

Sir, I write this as a citizen of Sri Lanka who values human dignity and I have a thing or two to say to you.

I acknowledge the fact that I maybe a tiny speck of dust when considering the larger scheme of things, but, I still want to raise my voice and to be heard. I think every citizen of any country deserves that basic right. I hope you will hear me out.

I am a mental health worker who has been visiting the Welikade male prison for the past one year. I visit the prison twice a month and spend a couple of hours counselling individuals who are referred to me via the welfare division of the prison. I also deliver short talks on mental health and well-being for the prison population from time to time. I enjoy my visits and find them to be meaningful and rewarding.

Now that we’ve gotten that squared away, the real reason I am writing is to share both what needs to be celebrated and also what tends to make me feel sad and angry about the corrections system in Sri Lanka.

First, kudos to you and all those who work with you and for you, for the progress made over the last few years. There are efforts to ensure rehabilitation and reintegration through avenues like vocational training, counselling, medical and psychiatric care, religious facilities and other steps taken by all stakeholders to create a better functioning system overall. I know it’s not easy with the limited funding and priority given by the government. So, hats off to you sir.

Having said that, as a mental health worker I believe in the need for advocacy  and social justice. Therefore, I feel I must yield the proverbial sword, my pen, to bring to light injustice and human rights violations that occur within the prisons system. Individuals enter the corrections system in Sri Lanka for various reasons. Some because they commit crimes that make them a liability to their families and society, others because they cannot afford bail or a fine and some others because they’ve been wrongfully detained and charged, just so that certain quota’s get filled. There are some who are return customers and others who become an institution within an institution. They come from varied backgrounds, and from all corners of the country. You might agree with me when I say that some live a cushy life inside prison whereas others are dealt a tough round of cards.

Sir, would you take a minute or two to just bear witness to a few moments of the life of an individual who has just entered prison to start with?. The uncertainty, fear, the desperation and the looming months and years that seem so far away. Memories of beautiful wives and children they’ve left behind, some of whom might not even know that their husbands and fathers have been imprisoned. Can we just sit with these feelings for a minute?

I have had individuals tell me about feeling utterly lost and powerless when they enter prison with no knowledge on how to survive. There is no survival manual but they say they learn to keep their heads low and their eyes averted when they receive slaps that sting and baton strikes to their faces and heads. Repeated beatings are administered to break them in and alas, the institutionalization has already begun. Those who are newly imprisoned just fall in line with the rest, like a herd of wild cattle and go through the initial days in a haze. The insipid and unhygienic food, the cramped spaces they are expected to sleep in and of course when an young ‘ hurubuhuti kolla’ is spotted, the accidental brushing against genitals and attempts to take them to secluded spaces are just a few examples of what they have to endure.

I apologize for putting you on the spot, but, how do we balance what our hearts want  and what the system has in store for those under our supervision and care?. How do we seek dignity for those in the corrections system when jailers themselves physically violate prisoners and senior prisoners violate the junior prisoners. How do we go about ensuring health and well-being for all when there is a rampant flow of skin diseases, Tuberculosis, Sexually transmitted diseases and other infectious diseases. Oh, and mental illness? don’t even get me started.

Sir, for you, they might be just visitors with only some taking up permanent residence at the various institutions under your supervision. They are rejects and failures in the eyes of general society, defective products of god or whoever else who created humanity. But, for me, they are human. Human like you and me. Vulnerable like you and me. If you really peeked into their souls, you might find festering wounds and deeply etched scars that never leave. If you took a glance at most of the genograms I draw in my counselling room, you will find missing links, dotted lines, and of course the dreaded crosses.

So, with all due respect, please take heed. There is always opportunity to change and to allow some of those soul wounds to actually heal, instead of band-aiding them for our convenience. Can we prioritize kindness over batons and acceptance over disgust?.

Can we?.

Commissioner General of Prisons, Sri Lanka- over to you.



Mortui Vivos Docent

You know, how some places leave a lasting impression etched somewhere in your person, and gives you a whole different perspective to life when you least expect it. A visit to the Judicial Medical Officer’s (JMO) office in Colombo recently gave rise to this intense need to want to place somewhere, the images that emerged, before they fade away into just vague memories. It is almost as if I want to have a tight grip on everything that I saw,heard,felt and smelt, because it was sacred, but at the same time to dissect everything in postmortem. It was for me,the ultimate truth about being human.

In case you are wondering, I was at the JMO’s office on official work, but I was also very curious to explore the mortuary located at the same premises. There was a feeling of despair in the air, as I walked into the morgue along with two colleagues only to be greeted by a weird mixture of humidity and eerie coolness. The strong stench of disinfectant mixed with rotting organs in waste-bins was an assault on the senses, as we walked in to the room where they conduct postmortem’s. There were cold,steel workstations with dried blood stains on the floor underneath them.Remnants and reminders of bodies unceremoniously emptied. Each stain would have a history behind it.

The postmortem room led to the area where the refrigerators were, and I was engulfed at once by the torrid stench of decadence, this time the handkerchief I had over my nose was not enough to ward any of it off. It was present, and it followed me around, lurking in the backdrop, creeping up on me like an elusive chilly breeze, on a hot day. The kind that gives you goose-flesh.  My colleague described it as being stuck in her throat. It would not go away.

One of the refrigerators was opened, casually, almost like you and I do when we want respite in a glass of iced water, after a hot, tiring day. There was a pair of feet visible, with all its toes intact, and trays containing intestines and other spare parts (pardon the pun) stacked on top. It felt like a store-room, but with just human filth in it. It is a very vivid image, that has rooted itself somewhere in the depths of my brain, and it had to come out like this. What kind of lives did these people lead? Who did that pair of feet belong to? What paths have those feet walked? Were they weary?. I was grappling with these questions, but it was also time for me to get out, as curiosity was replaced by queasiness.

On the way out, near the exit, there was a lone body, wrapped in a white sheet, on a gurney, waiting to be either preserved or taken apart. Waiting, just lying there, resonating with the deafening stillness pervading the morgue. This brought about a stark realization of how fragile and temporary human life is. I was confronted by my own mortality and that was a revelation. Human bodies that were once whole, become mere inhabitants of a wasteland store-room, with nowhere to belong to. You become a memory in the annals of history, and everything else is a facade. Nothingness.

The dead teach the living.