|MEDICAL HISTORY PAGE
|Year : 2019 | Volume
| Issue : 2 | Page : 89-91
Em and the Big Hoom- A Psychiatrist's Perspective
Smitha Lamiya Rasquinha
Department of Psychiatry, Father Muller Medical College, Mangalore, Karnataka, India
|Date of Web Publication||24-Jan-2020|
Dr. Smitha Lamiya Rasquinha
Department of Psychiatry, Father Muller Medical College, Mangalore - 575 002, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rasquinha SL. Em and the Big Hoom- A Psychiatrist's Perspective. Muller J Med Sci Res 2019;10:89-91
Very rarely does one come across contemporary Indian literature at the heart of which lies mental illness, especially where the protagonist (or a character of influence) suffers from what mental health professionals can glean out as psychopathology (as opposed to inaccurate and vague descriptions of “madness”). Jerry Pinto's “Em and the Big Hoom” is a welcome exception.
This is not just a book that is accurate in terms of symptoms of psychiatric disorders, it is so much more. It is a beautifully moving yet simple story, with equal measures of pain and unbridled wit. It is a book of resilience in the face of chaos and overwhelming odds, of children coming to terms with the reality of imperfect parents, of sacrifice and unfanciful, rock-solid love. It is also about a child dealing with his mother's mental illness, his reaction to her “micro weathers,” his wanting to believe everything his mother says (especially so, because “the outside world immediately discounted whatever she said”) and the hard acceptance of the ambivalence he feels towards her.
The plot revolves around a Goan Catholic family in Bombay – The Mendeses, Em (Imelda), her Big Hoom (Augustine, the Husband) and her two children, Susan, and the unnamed adolescent narrator, through whose eyes the story unfolds. Em suffers from Bipolar Affective Disorder (though the narrator tells us that diagnoses of a “nervous condition,” a “nervous breakdown,” and “schizophrenia” were thought of before finally settling on “manic-depressive”). The narrative isn't linear or sequential, it is disjointed and unorderly and inconsistent, quite similar to how their lives are. However, never a difficult read and peppered with Goan-Catholic idioms, the narrative flows through anecdotes, recollections, excerpts from letters and diaries, and the occasional charming play-like-script. It flows from “Ward 33 (Psychiatric) Sir J. J. Hospital” to their one BHK in Mahim, with flashbacks in offices, The American Embassy, Bookstores and Bombay Taxis.
It may dawn on you, during the reading of this book, that there is a telling choice of colors, the deep, dark purple of the edges around all the pages and on the cover, and the flash of bright red pages at the start and finish of the book. One may take it that these hues are meant to hint at Em's affliction, the former, one would like to think symbolizing her depressive episodes and the latter her manic ones.
This book is prolific with examples of signs and symptoms of the mind. They are, in fact, described as well as any example in a text-book of psychopathology. Better yet, the author accurately elucidates the nuances of mental illness to the layman, without romanticizing it as many authors do, or erroneously depicting it, as most books of fiction do.
Em describes the beginning of her life-long struggle with bipolar disorder-an episode of depression, beginning after the author's birth. The author skillfully delineates how clinical depression is different from sadness, felt as a normal human emotion.
“After you were born, someone turned on a tap. At first it was only a drip, a black drip, and I felt it as sadness. I had felt sad before…who hasn't? I knew what it was like. But I didn't know that it would come like that, for no reason. I lived with it for weeks.”
She talks about there being no “drain” for the sadness that dripped, and then goes on to describe the overwhelming intensity of this sadness, “molasses, slow at first.” Being so afraid she would “drown in it” and drown her children in it as well, she decided it was better that she jumps in front of a bus and goes out “quick, like a bang.”
Her manic episodes are scorching, larger-than-life affairs. Described vividly, usually starting off with endless cups of tea, chain smoking of “Ganesh Chhaap beedis” and eventually moving on to sleepless nights for her and the family. Em becomes a caustic, garrulous, cantankerous woman, ready with barbs spiked with verbal venom, especially directed to the ones she loves.
Delusions and hallucinations flourish during her mania. Em recounts a bone-chilling incident about the day she takes her second-born child and walks away from home and into the clutches of a particularly nasty man, because “the fan-or the people from the fan” ordered her to “take your son and leave the house.” Not all their orders were this ominous. Occasionally the voices dictated “a jam sandwich to be consumed at three o'clock in the morning.” On one occasion, the author finds a note from Em, left under his pillow explaining why she was so vicious with him the previous night. The note says that if “they” of the fan think that she hates him, he was safe and that is why she has to be mean to him.
A study on the disorder of thought could focus on a paragraph that runs like-“because the sky is so high and the crow that shat in your left eye. I could tell you a lie but I don't see why. The world is a game and the game is a tie. The tie is around your neck and they'll string you high.”
The family's life revolves around Em, which isn't much different from what we see every day with caretakers of the mentally ill. They are the “love-battered” Mendeses, who are not sure who they are going to find opening the door, when they come back home; Em in a “panic of sorrow” or “ raging against some unnamed enemies” or “in a laughing fit with a beedi fuming in her hands”? When she is hospitalized, they take turns to stay with her. When she is ill and at home, they have to be constantly vigilant. In one particular “time of plenty,” a nurse was hired and “Em was, for once, someone else's responsibility.” And so the children decide to do what others their age did, and go to the movies (Coolie-one that their father wouldn't have approved of and their mother would have mocked at, we are told). They come home to find the nurse asleep and their mother locked up in the bathroom with her wrist slashed.
The author also uses this book to showcase how it is to be in close proximity, and to love and care for someone suffering from a mental illness. Being with someone who suffers from depression, is likened to, the narrator standing by “frozen” while watching his mother step into a patch of “quicksand” and sink, all the while feeling helpless. He vividly describes the nadir of her depression – her being a “curled-up foetal ball, moaning in pain, breathing because her body forces her to.” During one of her manic episodes, when Em decides to go to the hospital herself, the narrator recounts how in an attempt to make sense of all of this his “overheated” mind decides that she is “faking it.” He could never think that during her depressive episodes, he tells us. Occasionally, we find the narrator poignantly attributing the development of his identity to Em and her illness. He even wonders if his “exhausting curiosity” is something he should blame his mother for?
Through most of the book, the narrator desperately tries to make sense of his mother's illness. The reader empathizes with him, often wondering how, why and when someone as intelligent, and articulate as Em, slipped down the Bipolar slope. Along with the narrator, one finds oneself scrutinizing every letter written, every dialogue had and every action made, to decipher if there was an inkling to the illness that lurked beneath. Does the “ease with which she writes” go hand in hand with her illness? Or was her eloquence destroyed by it? Were her moments of sadness and happiness, and her anxieties, just part of the human emotion spectrum or were they indicators to something more sinister? On occasion, the author wonders if the Big Hoom had an idea of what was going to plague his beloved Em? Could and should he have known?
No doubt, Em dominates the storyline and leaps at you from the pages. But it is the stoic, ever-dependable and pragmatic Big Hoom, who is the pillar from whom the family obtains their support. The Big Hoom, prior to Em's illness, was a different one from the mysterious man that his children know and love, a “man with a future who had given it all up to make sure the present was manageable.” The narrator is petrified at the thought of anything ever happening to his father; for how will they manage Em? Even in the most severe of her episodes, the Big Hoom is the one person to whom Em listens to. The book doesn't tell us much about how he felt about his wife's illness, but, that he is a devoted and caring husband and father, is never in doubt. When the narrator seeks comfort from his father, upset that the boys in the neighborhood are mocking him, he tells him that this is because “they do not understand” and compares the illness to having diabetes, an allegory that mental health professionals use quite often.
Many a psychiatrist has been faced with the difficult situation, of having family members of a patient wanting to know the chances of developing a similar mental illness. The narrator is plagued with the same doubt. Jerry Pinto handles this delicately and honestly. The distressed narrator visits one of Em's most favorite psychiatrists, and poses the question “will I go mad?” His fear is almost palpable.
It may be of interest to psychiatrists, that the author does describe Em's treatment. We know she has been admitted a number of times and is quite the favorite inpatient and “Nursie's little helper.” We know that the neuroleptics she was on aimed at keeping her symptoms at bay, “muting the paranoia, calming the rage, raising the endorphins,” but failed at keeping her in remission. We know that Em believed the pills made, what she loved doing the most-reading, difficult; though was it the illness or the drugs that took away her concentration and her ability to sympathize? And then came the summer of Lithium carbonate, the “miracle drug” that made things better-at least for a while. And the reader cheered for Em and her family, for they could finally “taste” their “happiness,” however short-lived.
This book is a favorite, a book that I have recommended to many. To the casual reader, it is a good story, which sensitizes one to and hopes to de-stigmatize mental illness. To have written something so nuanced and genuine, one is convinced that the author has to have had some first-hand experience with mental illness. Jerry Pinto, when asked, said that the book is “95% fact and 95% fiction.” Is it important? I'm not sure, but I am glad he tells it like it is. To those dealing with mental illness, it reminds us to look for the person beneath the diagnoses we make, to remember we are but at the fringes of the main act; it reminds us of our limitations and the paramount importance of empathizing with the family and addressing all their insecurities.
This book is an excellent way to understand the psychopathology of bipolar disorder and the workings of the mental health system (including a peek into the abysmal conditions of the mental asylums of that era). Until recently, attempted suicide was a crime under the Indian Penal Code, Section 309 and in a particularly ironical piece of prose, the narrator quips, that suicide was the only crime “where you could be punished for failing.”
But beyond all that, it is a brave attempt at delving into a topic that so few touch upon in the literary world. And luckily for us, it makes for an excellent read.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pinto J. Em and the Big Hoom. New Delhi. Aleph Book Company; 2012.