The Camels of Genghis Khan

While passing through Ulaanbataar (UB), I had seen a strange sculpture with a row of camels standing in a tiny park in the middle of the road. I wanted to look at them properly and photograph them. However, it was a busy crossing, always full of traffic and clicking a picture of those camels from a moving car was impossible. So one afternoon I decided to walk and search for those camels.

This post is about my walk through the city, searching for those camels in Ulaanbataar (UB), the capital of Mongolia.

Mongolian Hero Genghis Khan

Genghis Khan is the national hero of Mongolia. His statues adorn some of the famous landmarks of the country like the central square of UB in front of the national parliament. They can also be seen in some unlikely places like his giant face designed on the side of a hill overlooking the city. Genghis Khan had led his caravans to conquer the world.

Mongolia is the land of nomadic people with their animals including horses, sheep, goats and camels – in fact Mongolia has 10 times more animals/cattle compared to its human population. So those camels could have been a representation of a Mongolian nomad. Thus, those sculptures could be a representation of the great Khan or of a Mongolian nomad.

Old wall-paintings & The Motorbike Guy

This time, I am staying at Shangri-La hotel on Embassy road in UB. I came out of the hotel and started my walk by going towards left, to the Children’s Palace, while across the road I could see Bayangol hotel, which is one of the historical hotels of UB.

I have been to Mongolia many times for work related to a disability programme. During my first visit to Mongolia in early 1990s, I had stayed in the Bayangol hotel. At that time UB was a completely different city, as Mongolia was just coming out of decades of a communist regime under the Soviet influence. Hardly anyone spoke English, while many persons spoke Russian. There were only a few buildings in this part of UB at that time while the road was narrow and there was no traffic except for a rare car.

This whole area is now completely transformed, full of sky-scrappers. The much wider road is jam-packed with cars. In the nearby Sukhbataar square there is the new parliament building. It is a beautiful place today with wonderful ambience and colourful buildings.

As I started my walk on Embassy road, I saw some beautiful old wall-paintings along the road. Their colours had faded but I could still make out their designs, which seemed to be telling some Buddhist story regarding the killing of some demon. I hope that these can be rennovated.

My first stop was the metallic sculpture of the Motorbike Man, which looks straight out of the Mad Max films, with an alien guy driving an amazing alien looking motorbike. I loved this sculpture placed just outside the Children's Palace. It seems to be the work of an artist called Mr. Santo, born in Thailand, who uses chains, springs, rods, ball bearings, brake bands, gears, and lots of other recycled metal to create art.

Park Place City Marker

I turned left on Chinggis Road (another way of saying Genghis), which is a broad road with never-ending traffic. My next stop was to admire the metallic city-marker of Park Place, showing the distances from UB to major cities of the world, including London, Sydney, Moscow and Beijing.

I have seen similar distance markers in many cities but this was the first time to see a metallic sculpture made for this purpose.

Peace Bridge

Going further south along the Chinggis Road I reached the Peace Bridge which passes above Dund-Gol river and Narnii Road, the bypass road of UB made for avoiding the traffic of the city centre.

The Peace Bridge was built with Chinese help in 1963 and was renovated in 2012. Dund-Gol is a small river, which joins Tuul river to the south of UB. From the Peace Bridge, I could see little water in Dund Gol (literally ‘Middle River’). Fortunately, it seemed relatively free of the trash which such places usually seem to get due to neglect.

The Blue Horses and the Summer Fountain

After crossing the bridge I reached the area around the National Sports Stadium of UB, which is full of shopping areas, restaurants and other modern buildings. In front of the square facing the Nadaam Mall, there was an open space with two beautiful blue horses, made in plastic or some synthetic materials. After the Motorbike Man and Park Place City Distances indicator and these horses, I was really impressed by the quality of public art in UB. It was also good to see that local youth had not tried to deface these art works by writing on them, which is a common problem in most urban places.

The fountains next to the horses, erupted with water suddenly and in unpredictable ways. Children playing between those fountains, were having a lot of fun as it was a warm day and many of them were soaking wet. As usually happens in such situations, a couple of adolescent boys had picked another boy and forced-carried him above one of the erupting fountains, accompanied with a lot of shouting and merry-making. Families sitting around looked at them with tolerant bemusement.

Children's Park

Next to the Nadaam Mall is the only pedestrian crossing bridge over Chenggis road. With so much traffic on this road, it was a safe way for me to cross the road. On the other side, the bridge led to a children's park full of statues of zebras, deer, eagles and tigers, where families were children were visiting. It is almost like a zoo, the only difference was that instead of live animals, it has statues.

It also had a nice fountain with the Blue coloured sculpture of a woman wearing traditional Mongolian dress.

Behind the park, I saw an old building which had a mosaic of a Soviet style of wall-art from the pre-1990s period (in the image below). Most of such buildings are slowly being replaced by new constructions. I wish someone would photograph and keep a record of all such wall-arts as these represent the city history.

Genghis Khan Camel Caravan

Finally, I reached the Camel sculptures in the traffic island marking the point where the north-to-south going Chenggis road meets the east-to-west going Chenggis avenue, which goes towards the international airport. The metal sculptures are called the "Silk Road Complex monument" and are the works of an artist called Dalkh-Ochir.

In 2015 a competition was held to identify sculptures for UB and in that competition 15 sculptures were selected. These have been placed in different parts of UB, including the motorbike man mentioned above.

In the Silk Road sculptures, initially there was only one statue of a Bactrian camel. Now there are 9 Bactrian camels, one dog and a bearded man on a horse, who may represent Genghis Khan or perhaps a Mongolian nomad. According to the GoGo website, "Initially the camel monument complex was named Migration and the idea of camels facing towards the city center has a meaning of inflow of wealth."

I am glad that I had decided to make this walk to look for those camels. They looked absolutely amazing. The sculptures are huge and made with a metallic sheet, and thus can hopefully withstand the harsh Mongolian winter.

I spent some time walking around the sculptures and clicking pictures while the amused locals, waiting for the bus at the bus-stand across the road looked at me.

To Conclude

Just after the Silk Road monument complex crossing, there was the Palace and Museum of Bogd Khan, who was the first king of Mongolia after its independence from China in early twentieth century. However, I was too tired by this time and decided to leave visiting that to another day.

It was a very satisfying walk. It took me a couple of hours, but that was because I was stopping every where to look around and click pictures. If you are in a hurry, you can do it faster. The image below shows another Soviet-era wall-art from a building near the Silk Road complex crossing. I am fascinated by the history hidden in these wall-arts.

UB has some wonderful examples of good quality public art. Though I have been to UB many times, I am not much acquainted with the town except for the area around Gandam monastery. I am glad that this time I could explore a new part of the city.

*****

#mongoliaub #ubmongolia #ulaanbaatar #publicart #genghiskhan

Disturbances of Brain & Mind: The Psychiatry Story

Jeffrey A. Liberman, a professor of psychiatry at Columbia university (USA), has written, “Shrinks – the Untold Story of Psychiatry” (Little Brown and company, 2015). Psychiatry is the branch of medicine which deals with mental illness. It is a poorly understood area, not just for common public but also for some doctors like me. I found the book fascinating and read it in almost one sitting.

In this post, I am going to write about some of the key things I have learned about mental illness and psychiatry from this book.

Mental Illness

Mental illness is unlike any other illness – it is a medical illness (something to do with our body, especially with our brain and its functioning) and it is also an existential illness (something to do with our thoughts, feelings and emotions). Each kind of mental illness is composed of a cluster of symptoms, that may be present in a variable pattern and severity in individual persons.

The 3 most common kinds of mental illnesses are – (1) Psychosis such as schizophrenia (loss of touch with reality, confused thinking, hearing voices or seeing things, having strange beliefs);(2) Depression (feelings of apathy, sadness and uselessness); and, (3) Mania or bipolar disorder (characterised by extreme mood swings).

Personal Experiences

When I studied medicine in the 1970s in India, I found that psychiatry was a little confusing. It had a lot of Freud and his theories about our repressed sexual desires and it had a few medicines for conditions like depression. I could not make any sense out of it and I was sceptical about the explanations of Freud as the causes of mental illness.

During the early 1990s, I started dealing with community-based rehabilitation (CBR) programs and came across two terms - 'mental illness' (strange behaviour) and 'mental disabilities' (such as low IQ and learning ability). In the communities, people used words like 'crazy' and 'idiots' for these two conditions. However, the affected persons found these colloquial terms negative and extremely hurtful. They taught me to use more neutral words such as persons with mental illness or learning disability.

I have also known some persons who define themselves as 'Survivors of Psychiatry', who do not like psychiatry and do not believe in its usefulness. They feel that psychiatry is a kind of conspiracy theory to control people and they say things like – "psychiatric medicines are useless, they are used only to make rich the Big Pharma; they take perfectly normal behaviours and call them illnesses to give them medicines; their drugs and treatments destroy people’s brains."

Negative Reputation of Psychiatry

Lieberman owns up immediately that for this negative reputation, psychiatrists themselves are to be blamed, “There’s good reason that so many people will do everything they can to avoid seeing a psychiatrist. I believe that the only way psychiatrists can demonstrate just how far we have hoisted ourselves from the murk is to first own up to our long history of missteps and share the uncensored story of how we overcame our dubious past ... Psychiatry’s story consists mostly of false starts, extended periods of stagnation, and two steps forward and one step back.”

From the start of the nineteenth century until the start of the twenty-first, each new wave of psychiatric sleuths unearthed new clues—and mistakenly chased shiny red herrings—ending up with radically different conclusions about the basic nature of mental illness, drawing psychiatry into a ceaseless pendulum swing between two seemingly antithetical perspectives on mental illness: the belief that mental illness lies entirely within the mind, and the belief that it lies entirely within the brain. … Psychiatry, on the other hand, has struggled harder than any other medical specialty to provide tangible evidence that the maladies under its charge even exist. As a result, psychiatry has always been susceptible to ideas that are outlandish or downright bizarre; when people are desperate, they are willing to listen to any explanation and source of hope.
The term “psychiatry”—coined by the German physician Johann Christian Reil in 1808—literally means “medical treatment of the soul.” Psychiatry’s beginning is linked to a German named Franz Anton Mesmer in the 18th century, who rejected the common ideas of divine punishments and sins as cause of these disturbances and suggested that they were caused by the blockage of an invisible energy running through magnetic channels in our bodies. He called this energy 'animal magnetism'. Though his ideas about the invisible energy were wrong, but this was the beginning of looking for causes of mental illness inside ourselves.

Over the next 200 years, many other persons such as Benjamin Rush, Julius Wagner-Jauregg, Manfred Sakel, Neil Macleod, Walter Freeman, Melanie Klein and Wilhelm Reich, came up with similar theories about causes of mental illnesses, each of which resulted in its own treatment, which became famous for a period but was actually ineffective. Some of these treatments had mortal side-effects and none of them had any empirical basis.

Theories of Sigmund Freud

The most influential among these theories about causes of mental illnesses were those advanced by Freud (1856-1939) in early 20th century. His most celebrated book was, The Interpretation of Dreams, which explained the role of subconscious mind and its unresolved conflicts, leading to mental illness. Freud divided the mind into different levels of consciousness - 'id' (source of instincts and desires), 'superego' (voice of conscience) and 'ego' (everyday consciousness).

These ideas revolutionised psychiatry and became the dominant way to understand and treat mental illnesses. Like the other theories mentioned earlier, even Freud’s theories did not have any empirical evidence and psychoanalytical approaches helped few, if any, persons with serious mental illnesses.

Freudian treatment required the doctor to remain remote and impersonal. As recently as the 1990s, psychiatrists were still being trained to stay aloof, deflecting a patient’s questions with questions of their own. About Freud, Lieberman writes, “Freud did teach me the invaluable lesson that mental phenomena were not random events; they were determined by processes that could be studied, analysed, and, ultimately, illuminated. Much about Freud and his influence on psychiatry and our society is paradoxical—revealing insights into the human mind while leading psychiatrists down a garden path of unsubstantiated theory.”

New Psychiatry After Second World War

Till 1940s, there was no other way to treat mental illnesses except for Freud’s psychoanalytic approach. The first medicines for treating the three most common mental illnesses were all discovered after the second world war - Chlorpromazine for treating psychosis, Imipramine for treating depression and Lithium Carbonate for treating the bipolar disorder.

The impact of these medicines was dramatic. For example, Lieberman evokes the impact of using chlorpromazine with the following words.

“On January 19, 1952, chlorpromazine was administered to Jacques L., a highly agitated twenty-four-year-old psychotic prone to violence. Following the drug’s intravenous administration, Jacques rapidly settled down and became calm. After three steady weeks on chlorpromazine, Jacques carried out all his normal activities.” It is hard to overstate the epochal nature of Laborit’s discovery. Like a bolt from the blue, here was a medication that could relieve the madness that disabled tens of millions of men and women—souls who had so very often been relegated to permanent institutionalization. Now they could return home and, incredibly, begin to live stable and even purposeful lives.

During 1960s, another researcher-psychiatrist Eric Kandel, showed anatomical changes in brain linked with memory and opened the pathway to the understanding of biological causes of mental illnesses in the brain. During the 20th century, the only way to study brain was through autopsies and brain operations. After Kendel, a large number of biologists, geneticists, neurologists and other scientists, using other innovative technologies such as MRI, started studying brain and its functioning in live persons, providing new insights about mental illnesses.

The 3rd area of big change which initiated in the 1960s and has now become widespread, is to move away from psychoanalysis as suggested by Freud, and replace it with psychotherapies starting with Cognitive Behaviour Therapy (CBT) pioneered by Tim Beck. The unexpected success of CBT opened the door to other kinds of evidence-based psychotherapy such as interpersonal psychotherapy, dialectical behavioral therapy and motivational interviewing.

Future of Psychiatry

Lieberman proposes a pluralistic vision of psychiatry: “Mental illness is not only biological and is not only psychological – it involves both brain and mind in different ways. Treatments include psychotherapy and psycho-pharmaceuticals.” He also lists some of the promising areas of research which should improve the impact of psychiatry in the future - genetics (how certain patterns or networks of genes confer different levels of risk), new diagnostic tests for mental illness (including genetic tests, electrophysiology-tests, serological tests and brain imaging tests), and new developments in psychotherapy based on cognitive neuroscience.

Some researchers are combining psychotherapy with medicines to increase their impact. Drugs that enhance learning and neuroplasticity can increase the effectiveness of psychotherapy and reduce the number of sessions necessary to produce change. For example, cognitive-behavioural therapy (CBT) can be combined with D-cycloserine, which enhances learning by acting on glutamate receptors in the brain, and strengthens the effects of CBT.
Internet-based applications for mobile devices that assist patients with treatment adherence, provide auxiliary therapeutic support, and enable patients to remain in virtual contact with their mental health providers, are another area for the future development.

Conclusions

I loved Liberman’s book because it gave an overview and understanding about mental illnesses and what can be done about them.
Unfortunately, strange ideas about causes of mental illnesses, not based on any empirical evidence, continue to be common even today, attracting big group of followers. Lieberman has written about the current popularity of the ideas of one such person (Daniel Amen) and his propagation of another theory which is not based on any empirical proof. Charismatic persons have always had this power to make people believe in their extravagant ideas and only time shows that their fame was built on a false premise.

The book made me understand that boundaries between what I understood as “mental illness” and “mental disabilities” are porous and dynamic. Even my notions of separating “neurosis” (mental illnesses where persons do not lose touch with reality) and “psychosis” (mental illnesses where persons lose touch with reality) are not very useful categories. Similarly, it is no use looking for the right answer to mental illness in only medicines or only psychotherapy - a pluralistic vision where both medicines and psychotherapy may play a role can be better.

*****

Note: The two images used in this post are from a "dance therapy" session for persons with mental illness in Brazil

#mentalillness #psychiatry #bookreview #historyofpsychiatry