Fighting Superbugs

65 years ago when I was born, dying due to a simple infection such as diarrhoea or pneumonia was common. Our family history had numerous stories of persons dying young. At that time, average life expectancy in India was less than 38 years. While I was growing up, during 1960s and 70s, slowly we had become familiar with names of antibiotics like Tetracycline and Chloramphenicol. By the time I finished my medical college in late 1970s, average life expectancy had increased to 53 years, while the list of available antibiotics had become much longer with drugs like ampicillin, amoxicillin, erythromycin and gentamycin. Every year, new medicines were coming out. Occasionally we had infections which were resistant to some of these medicines, so we had started doing cultures to check which antibiotics could be more effective in a patient who was not responding to treatment.

In the last 50 years, the situation has changed drastically. Every now and then we hear of infections which do not respond to any medicine. Matt McCarthy's 2019 book "Superbugs: The Race to Stop an Epidemic" is about this subject.

Use of Antibiotics in Livestock

The first use of antibiotics in the livestock was approved by the Federal Drug Agency (FDA) of USA in 1951. They started to be used in small amounts in concentrated animal-feeds for growth promotion and prevention of diseases among the farm animals, especially in the poultry and cattle destined for meat production. They helped chickens, pigs and livestock to grow faster and put on weight. Since then, the use of antibiotics in the industrial production of meat has become routine.

Eating this meat introduces those antibiotics in our bodies and in the environment, promoting drug resistance in the bacteria. Already in 1969, a British committee of experts had concluded that the use of antibiotics in animals was contributing to antibiotic resistance in humans. Thus we are aware of this problem for a long time. However, its importance was under-estimated.

Apart from the use of antibiotics in the livestock, another problem has been indiscriminate use of antibiotics. Many doctors prescribe antibiotics for viral infections, even when they know that these are not useful. There is no control on the sale of antibiotics in many countries, so that people can buy them without prescription.

Antibiotic resistance and resistant bacteria both travel around the world, passing from one country to another. Thus, it is global problem affecting everyone and no one is safe from it.

Over the past decade, numerous cases of infections non responding to any medicine and leading to death of persons have brought this subject to the attention of general public. Extremely resistant cases of diseases like tuberculosis have appeared and are widely feared. The World Health Organisation has already issued some catastrophic warnings and asked for urgent search for solutions.

Matt McCarthy's Book

McCarthy's book on the subject of superbugs is written in an extremely engaging style. He works at the Presbyterian Hospital in New York, where they try to identify new antibiotics which can treat resistant infections. He explains the difficulties of treating superbugs through stories of individuals who turn up in the emergency department of his hospital. Reading the theories of antibiotic resistance is very different from reading about someone who has this infection.

For example, the story of a person, whose diagnosis of cancer has devastated his family. When it seems that chemotherapy might save him, a minor infection suddenly takes him close to death, unless the doctors can find some new treatment to treat it, but it is not responding to any medicine. McCarthy's book has a series of these real-life inspired stories, which start as a character sketch of the persons and their families and then reach a sudden turn of random events which turn their lives upside down, showing the fragility of our lives.

Once I started this book, I didn't stop reading it till 4 days later when I finished it. While I have known about superbugs and the problems of antibiotic resistance for a long time, the book explained the different challenges associated with it. Mixing of scientific information with human stories makes it very interesting. The book mainly moves around the human trials of a new antibiotic called "Dalbavancin" or Dalba. It also mentions some other new medicines and the persons involved in their research but most of its stories are of persons on whom Dalba is being tried.

Over the decades, doctors engaged in research for new medicines have not always behaved in an ethical manner. Recently, I was reading about an unethical research done by Armeur Hansen, who is known as the person who had discovered the leprosy bacillus in 1873. McCarthy shares the details of inhuman and unethical research done in the Nazi camps. Then he tells about another research carried out in Tuskegee, Alabama (USA), where hundreds of black men and women were recruited in a research, given false information and denied treatment which could have easily cured them, so that the doctors could study the natural evolution of the sexually transmitted infection syphilis. This had happened in 1950s-60s, years after the Nazi experiments.

The book also touches on the world of Big Pharma. For many years, I was part of a group fighting for people's right to health. In these groups, multinationals and especially the Big Pharma, is seen as villain, as they look only at their profit margins and are uncaring of the poor persons' need of medicines. McCarthy's book avoids painting the drug companies in black and white.

For example, McCarthy's explanation about insufficient research on new antibiotics and the role of the big Pharma is in the following terms:

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, is the man responsible for establishing federal funding priorities for research on antibiotic resistance, and he told me that developing new drugs is, in fact, one of his top priorities. But the situation is complicated. “You don’t want the federal government to be a pharmaceutical company,” he said, “because you’d have to build an entire industry, and that would divert away from what the government does well, which is scientific discovery and concept validation. We need a partner.”And that partner, for better or worse, is Big Pharma. “If the federal government tried to re-create Merck,” Fauci said, “it would cost billions of dollars. The expertise of production, filling, packaging, and lot consistency. People take that for granted, but that’s an art form that has been perfected by these companies, not the government.”The problem, ultimately, is that many antibiotics are not very profitable. When a new drug emerges from an idea, there’s a step-by-step process that costs upward of a billion dollars to bring it to market. If that leads to Viagra, the expense is justified because you’ve just made a multibillion-dollar drug. With an antibiotic, however, the profit margins are narrow because of three characteristics: they’re usually given in short courses, they’re prescribed only when someone is sick, and sooner or later even that terrific new antibiotic is going to develop drug resistance. The latter is not a matter of if but when. “The incentive to make major investments in antibiotics,” Fauci told me, “is not something that attracts the pharmaceutical industry, so how do you get around that?”

The book is also an ode to McCarthy's senior colleague and mentor, Tom Walsh , director of the Transplantation-Oncology Infectious Diseases Program, who seems to live only for his work and does it with great empathy. It is difficult not to share McCarthy's admiration of such a wonderful human being and professional, and wish that if one day we would find ourselves in a hospital, we shall have a doctor like him.

Apart from his skills as a clinician and researcher, McCarthy also has a way with the words. For example, he introduces Tom Walsh with the following words:Walsh is a wisp of a man, pale and thin like a potato chip, with deep-set eyes, a warm smile, and a surprisingly firm handshake. His modest features are a notable contrast with my own: I have a high forehead, broad shoulders, and a nose that’s slightly too large for my face. We make for an odd pair.

Conclusions

I love reading books about health and medicine. These give an overview of the issues in a way which is impossible in the medicine textbooks, which limit themselves to dry facts - symptoms, diagnosis and treatments. On the other hand, a good book on medicine aimed at general public, provides a glimpse into its history and how our understanding about the disease condition changed over a period of years or decades.

For example, I have been really impressed by a couple of books on psychiatry and autism, which I had read recently - they had opened the doors to a largely unknown world to me. "Superbugs" by Matt McCarthy didn't have the same impact, because I was already familiar with some the ideas and questions it discusses. However, I loved reading it and will recommend it to everyone for gaining a deeper understanding about an important subject, in an engaging way.

Note: In 2019, after writing this post I had contacts with Dr Abdul Gafoor who told me about the WHO initiative on antibiotics resistence and that spread of resistant strains through lack of sanitation was a much bigger contributing factor compared to the irrational use of antibiotics. He referred me to his article in The Hindu, from which the following excerpts are presented below:

"... back in 2010, people like me sincerely believed that AMR was caused primarily by the misuse of antibiotics by the medical community. We all wrote a few lines about infection control, but 90% of our articles, research papers was about irrational antibiotics usage. I did not write about environmental sanitation. I did not write about most of the things that I know today, because that the concept has changed over the last 10 years. At that time, we thought that antibiotic stewardship was the most important component in tackling AMR, along with infection control, and then made a mention of the importance of sanitation. Now if you ask me, what is the most important component of tackling AMR, I will say in a developing country such as India – it is sanitation. I will put sanitation right on top, then I will put in infection control, and then, antimicrobial stewardship, rational antibiotics usage - whether at the hospital or over the counter.

Why? Thanks to scientific evidence that has emerged, since, and changed our perspective. A commentary published in Antibiotics, an open access journal, recently showed that AMR rates were found ‘positively correlated with higher temperature climates, poorer administrative governance, and the ratio of private to public health expenditure.’ When a more complex analysis was done, then better infrastructure (e.g., improved sanitation and potable water) as well as better administrative governance (e.g., less corruption) were strongly and statistically significantly associated with lower AMR indices. And this is significant: the comment stated that ‘Surprising, and contrary to most current beliefs, antibiotic consumption was not strongly associated with AMR levels. This empirical evidence implies that contagion, rather than antibiotic usage volumes, is the major factor contributing to the variations in antibiotic resistant levels across countries.’"

*****

#bookreview #antibioticresistance #mattmccarthy

Documentary Film - Allah Loves Equality

I think that I had first met Wajahat Abbas Kazmi, then a young film-maker from Pakistan, about a decade ago, at the River to River film festival in Florence. I had even done an interview with him about his film "The Dusk" in 2011. Thus, when he invited me to see his new documentary film "Allah Loves Equality", I was curious.

Theme of Allah Loves Equality

The film looks at what it means to be a person of alternate sexuality or a LGBTQ person in Pakistan today. It starts with some examples of more accepting views towards alternate sexualities, especially towards cross-dressing, gay men and transgender women, in early Islamic society and in the Indian subcontinent, even during the Mughal period.

The film moves between 3 main strands - 

(1) The traditional communities of transgender women (Khawaja Sira or Hijra communities) and their accepted roles in the mainstream society;

(2) The struggles of gay persons (and a few lesbian persons) to live their sexual identities and their difficulties of coming out of clandestinity;

(3) The efforts of a few NGOs fighting for the rights of LGBTQ persons.

Moving between these 3 strands, the film explores their challenges, alliances and solidarities, as well as, what it means to live the porous and dynamic boundaries of different queer identities in contemporary Pakistan.

The violent reactions of a conservative patriarchal society are shown through a few social media and news clips. There is the vivid story of Alisha, a transgender woman, shot 6 times, forced to wait in the hospital because they could not decide if she should be treated as a man or as a woman and in the end, treated in the corridor of the male ward, in front of the lavatory, till her death.

The fear of violence is omnipresent in the film, expressed in the furtive gestures and anxious glances of film's testimonies. Bubbly, the guru/matriarch of a traditional Khawaja sira community, explains the importance of her traditional role in a soft and gentle voice - there is no other safe space, no space where you can find friendship and support outside their confines. She is reassuring and yet frightening because she underlines the perils of being an individual on your own in a society which does not accept you and can easily kill you.

Bubbly Malik has created a NGO called Wajood (Identity) for safeguarding the rights of transgender persons in Pakistan. She says "To live in a Daire Dari, the traditional home of Khwaja, you have to accept its rules. You get the love and support of a family but you must obey its rules."

Anaya Sheikh a young transgender stand-up comedian or Hannan Siddique, a well-known gay make-up artist, talk about the difficulties of living their sexual identities. Anaya can only be safe as a part of the Khwaja Sira and Hannan must wait for his companion, who is under family pressure to get married.

The crowd of young men dancing with joy in a private gay party or the transgender woman dancing at a home accompanied by a traditional musician are both facets of the same reality.

The lesbian women are a hidden world, briefly mentioned in the documentary for the violence they must face. "They can't even accept that lesbians exist here. To accept that would mean that women have a sexuality. So many women in rural areas are circumcised, they can't be allowed to have a sexuality."

In the film one person says, "It is better to have the traditional identity of Hijra or Khwaja Sira, it has a role in the society and it keeps us safe. Calling ourselves gay or transgender exposes us to violence." However, as Khwaja Sira, the opportunities for living are limited - you can beg or dance during marriages and births or sell your body for sex. There are no other options.

The NGOs, even if they are talking about HIV screening and prevention, need to be careful in what they say and how they are perceived. The film explains the efforts of Qasim Iqbal, who is considered the father of the movement for the LGBTQ rights in Pakistan.

If you wish to contact Wajahat Kazmi and to organise screening of this film, you can contact him through his website.

Conclusions

The parts of the film about Khwaja sira community reminded me of my (limited) interactions with the Hijra and Kinnar communities in India. Though many of the prejudices faced by persons with alternate sexualities are similar in India and Pakistan, I think that in India the LGBTQ world is much more ahead in raising their concerns and sharing their ideas.

The film does not talk of transgender men and other queer groups, showing that probably these groups are without voices in Pakistan and were not available to share insights about their lives in the film.

Some years ago, I had written about Parvez Sharma's film "Jihad for love" in which he had talked about the difficulty of reconciling the alternate sexualities with being a good Muslim. Wajahat's film briefly touches on this theme but does not go deeper. I guess that it is a difficult area to present in a sensitive way.

A few years ago, Wajahat did his coming out as a gay person and has been very active on social media in promoting the rights of young persons, especially Muslims, to live their sexuality without fear or repression. There was a period when I was worried that some radical Islamist group will kill him.

I can imagine that making "Allah loves equality" and shooting in Pakistan for this film could not have been easy. It is a hard-hitting film and shows aspects of alternate sexualities in Pakistan that are usually hidden from public gaze. Allah may love equality but some of his people do not love it. Wajahat has a long fight ahead of him, his film is a courageous step in that direction.

Film credits: 

Made by Il Grande Colibri, 2019, duration 55 min., produced by Elena de Piccoli, Michele Benini and Pier Cesare Notaro, directed by Wajahat Abbas Kazmi

*****

#lgbt #documentaryfilm #alternatesexualities #pakistan #lgbtpakistan

The Metaphorical Ganesh

Among all the Hindu deities, my favourite is Ganesh, with his pot-belly and the face of an elephant. In this post I want to talk about my fascination with Ganesh ji and how I understand his metaphorical meanings, as well as, about a book called “Ginger and Ganesh” which I read recently.

The above image of Ganesh is from Guwahati in the north-east of India, where I lived for a couple of years. I love the 3 baby monkeys playing on the statue of Ganesh ji. It expresses perfectly how I see Ganesh as a deity. However, let me start this post with the book.

The Book: Ginger and Ganesh

Nani Power’s quirky book “Ginger and Ganesh – An Adventure in Indian Cooking, Culture and Love” (2019, Counterpoint, Berkeley) is a personal memoir of her love story with an Indian student and an exploration of Indian homes in North Virginia (USA) in search of traditional Indian recipes.

The book is dedicated to the Ganesh, “O elephant-faced God, Ganesha, you are served by the attendants of Shiva and you eat forest apples and blackberries. You are Uma’s son, the destroyer of sorrows. I bow to the lotus feet of the remover of obstacles”.

In the book, she explains her fascination with the figure of Ganesh: “On this path I met Sri Ganesh. You may be familiar with him: he is the ever-popular elephant-headed deity, accompanied by a tiny mouse. He has a large jovial belly, and holds a conch shell. I’m not sure why he in particular ignited my passion for this culture and beyond, but perhaps it was the fact that his statue was present the first time I tasted the incendiary potions of India I came to love. Or maybe, the wisdom and calm that he emanates soothed my world-weary soul, and he seemed to be a constant reminder—at the doorway of most houses, or in their altars—that I was on a spiritual path as well as physical.”

In the book, stories of encounters with Indian families alternate with vegetarian recipes and brief reflections about Ganesh ji, after she had placed a simple advertisement in the Craiglist about wishing to learn traditional Indian recipes. The book chronicles her experiences over a period of one year, summarised in the following words:

Almost imperceptibly, the culture of this rich and varied country slithered into my life like a sinuous cobra, combining the modern ways of the United States with the Technicolor of India, while I ate some damn good food. I wanted to understand the Indian culture and people; and what seemed so enchanting was that I was constantly being surprised and challenged by how complex—and contradictory—it can be. While at one time thousands of years old, in another time it seems jauntily modern, yet where this occurs bewilders me. I have learned to keep an open mind. Now, after this year of cooking real Indian food, I realize that the only real way to learn to cook is through the senses and heart. It turns out that it is the only real way to live and to love, as well …This simple year long cooking lesson—innocently started as a little two-line ad on Craigslist because I was frustrated with my lame attempts at Palak Paneer—taught me a lot more than how to make a killer spinach and cheese curry. It smashed open my heart, in so many ways. The kindness of the women, the beauty of the culture, the explosion of flavors, and, curiously, the very physical act of cooking led me to examine what is beyond all this: the spiritual realm.

Ganesh, the People’s God

The word Ganesh is made of Gan (people) and Ish (God) and he is one of the most popular deities in Hinduism.

Hinduism has different and sometimes contradictory ways of defining and understanding God. There are Hindu hymns which talk of God as a formless, beginning-less, ending-less, eternal consciousness which pervades all atoms and molecules. God is also present in each of us, humans, animals and plants, as part of our consciousness, as part of our soul. Then there are Hindu hymns which identify God through human and animal avatars – the pantheon of 33 million major and minor Gods.

Each Hindu deity is known by different names in different parts of India and Ganesh ji is no exception. Some of his other names are – Ganapati (people’s leader), Adidev (ancient God), Gajanan (elephant face), Gaurinandan (son of Gauri), Lambodara (big belly), Prathameesh (first God) and Vidyadhar (one who holds knowledge).

Mythology About Ganesh

The Hindu Gods can be seen as statues of deities, some of them in strange shapes and forms linked with mythologies. They can also be seen as symbols of different aspects of the human reality with deeper meanings.

The mythological stories about Ganesh ji, present him as the creation of Parvati (the daughter of the Himalaya mountain), the consort of Shiva. While Shiva is away on a long journey, Parvati creates Ganesh out of her own body. When Shiva comes back, Ganesha is a child, who does not recognise him. Since his mother is taking a bath, he blocks Shiva’s path, refusing to let him enter their home. An angry Shiva cuts his head. When Parvati finds this out, she is grief-stricken so, Shiva sends his men to look for a substitute head, and those men bring the head of an elephant. Thus, Ganesh ends up with an elephant's head.

Metaphorical Understandings of Ganesh

I am sure that Freud would have a theory about meanings and significance of Ganesh linking him with sex or sexuality. However, I think that Ganesha is a metaphorical representation of human brain and the different functions of mind in Hinduism.

The story of the replacement of Ganesh’s head with that of an elephant can be seen as a metaphor for human evolution, the arrival of Homo sapiens, those with the memory and intelligence. Elephants are known for their memory and their intelligence, and thus Ganesh can be seen as a representation of the human brain and therefore, of the emotions and instincts, as well as of the rational mind.

Different names of Ganesh point towards the different functions of the brain. As Vighnakarta and Vinayak, he is the one who creates obstacles; and as Avighna, Siddhivinayak and Vighnaharan, he is also the one who overcomes obstacles. As Vidyadhar, he holds all the knowledge. As Yogadeep, he is the one who does yoga and meditation. As Uddanda, he is the wild one, the one difficult to control. As Sarvasiddhanta he controls different skills. As Harsha and Pramod, he signifies happiness. As Kaveesha, he inspires our poetry and creativity. As Ekadrishta, he controls our mind’s focus and attention.

Thus, for me Ganesh is the guide to the path of meditation and reflection for controlling the mind and the senses, for focusing our attention and building our strengths. He reminds us that we create our own obstacles and teaches us to empower ourselves for overcoming those obstacles.

Conclusions

I like the figure of Ganesh ji because I think that the combination of his human and animal forms, is an important reminder to humanity to respect the earth, the environment and the nature. His vehicle, the tiny mouse, is another reminder that every life on our planet, even that of the smallest creature, is important for our biodiversity and for the future of humanity.

Hinduism has different human-animal mixed figures including those of Hanuman and Narsimha. It also has some animal and bird forms as deities, such as those of Varaha and Garuda. All the different Gods and Goddesses of Hinduism are linked to an animal and to a plant. Thus, every life form and every component of nature is seen as sacred. As we move recklessly towards destruction of nature and of biodiversity, it reminds us to be responsible for the way we use technology and safeguard the nature for the future of humanity.

Finally I also like that our Gods can have deeper metaphorical meanings, like the significance of Ganesh as a representation of Brain and mind. This way of understanding religion is more complex and non-linear, it does not have the God as a saviour or as someone who punishes you for your sins or tells you what to do or not do, instead, it is guide to the reality and complexity of life.

*****

#ganeshji #hinduism #religion #philisophy #nanipower #bookreview #recipes #indiancooking

Lessons of Life from Adam Smith

Adam Smith is considered to be the father of liberal capitalism and free markets. His book "The Wealth of Nations" is considered as one of the most influential books on economics. Smith had written another book, "The Theory of Moral Sentiments", which is hardly remembered today, which was about human nature and how to live a fulfilling life. Russ Roberts' book "How Adam Smith can change your life" is a reflection and analysis of this lesser known book of Smith.

This post is about the book "How Adam Smith can change your life - An Unexpected Guide to Human Nature and Happiness". The book is full of interesting insights about human nature and why we behave the way we do. In this post I am going to focus on only 2 ideas of this book.

Self-Deception & Confirmation Bias

According to Smith, human beings are self-centred. For us our own life problems are much more important compared to big tragedies befalling humanity in some far away place.Human beings also have a big capacity for self-deception, sometimes unconsciously, so that we find an excuse to do things without listening to the voice of our self-conscience. Russ writes about this self-deception:

Rather than see ourselves as we truly are, we see ourselves as we would like to be. Self-deception can be more comforting than self-knowledge. We like to fool ourselves. 

When we behave in selfish and self-serving ways, sometimes we even justify it by saying that we did it for altruistic reasons, to help others. We describe our selfish actions in selfless language. According to Smith, we do this not only to convince others but also to convince ourselves, so that we can continue to hold a positive image of ourselves in our minds. According to Smith, our behaviour sometimes falls short of our ideals not because we’re bad people and not because our self-interest outweighs our benevolence, but because of what is called the "confirmation bias" - we don’t realize that we’re not living up to our ideals.

A modern name for Smith’s insights about self-deception is confirmation bias. Confirmation bias happens when we filter reality through our biases, ignoring evidence that challenges or refutes what we believe and eagerly accepting evidence that confirms what we believe. ... Another modern name for the challenge of understanding our complex world with any precision comes from Nassim Taleb—the narrative fallacy. We like narratives that follow a nice, clean pattern. Evidence that fits the narrative is noted after the fact. Other evidence that doesn’t fit the narrative is discarded.  
Among the persons offering advice motivated by self-interest and camouflaged as altruism, there are some examples of doctors, which brought to my mind many instances of distorted private medical services. For example, private nursing homes have much higher rates of Caesarean section instead of normal deliveries. Heart specialists in private hospitals advise much higher numbers of coronary artery bypass operations. I believe that this is a mechanism of self-deception, so that we doctors convince ourselves that we are not doing it for money but these operations are for benefiting those persons. However, this is not just about doctors, it is true for all kinds of professionals and private businesses. They don't see themselves as dishonest, many of them may be convinced that they do it to help others.

Everyday Actions Creating Civilization

The second idea from Smith that I want to touch in this post, is about small or minor actions by each of us, which taken alone are insignificant, but combined with similar actions of millions of other persons, together create the norms of our societies. Russ calls it this process, the "Emergent Order".

The economist Milton Friedman captured this strange paradox of small effects amounting to something significant when he said about supply and demand that the sum of negligible forces need not be negligible. So while my demand for apples has no impact on the price of apples, our demands all together, along with the decisions of suppliers, are what determine the price of apples. Not the greed of the grocer down the street, not my desire to get a good deal, but all our interactions together. And even though any one apple eater has no measurable or noticeable effect on the price, because she contributes an insignificant portion of the total demand for apples, apple eaters as a group have a very significant effect.Thus, Smith says that with our individual choices can lead to important social outcomes and this is how we create our society including our norms about morality, mutual trust and civilized behaviour.

This part of the book stimulated me to think about the kind of societies we are creating today. I think that when we choose our leaders and celebrities who behave in a certain way, they amplify the actions of their followers and thus determine the civilizational norms of our society. Through social media, such as Facebook and Twitter, these followers amplify their messages and gain strength from each other. The confirmation bias helps them to not see or listen to anything which does not fit in with their ideas. Thus, people with different ideas on the left and right of political spectrum, remain in their own circles and increasingly express themselves in ruthless and brutal terms, unable to see that they are mirror images of what they wish to fight.

At the same time, there is increasing acceptance of more extreme ideas. For example, when the news came about the sinking of a boat full of emigrants, some persons who are against emigrants, wrote on Twitter that it was good for feeding the fish. I think that this kind of thinking goes beyond being against emigrants - such ideas denote psychopath personalities. Thus, we creating societies where such expressions are acceptable, and persons can openly express such opinions without feeling ashamed about them. Across the world we have many political leaders, who encourage such ideas, sometimes using religions to justify them.

Conclusions

Adam Smith had written his book "The Theory of Moral Sentiments" in the mid-18th century and the original book is not so easy to read. Russ Roberts' book "How Adam Smith can change your life - An Unexpected Guide to Human Nature and Happiness" explains its ideas in an easier to understand manner. As you can see from my reflections above, these ideas from 18th century are still valid and have much to teach us. I think that Russ Robert's book is one of the more interesting books I have read recently.

*****

#adamsmith #russroberts #bookreview

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

When One Religion is Not Enough

Duane R. Bidwell’s book “When one religion isn’t enough: The lives of spiritually fluid people” (Beacon Press, Boston, US, 2018) is about persons who feel an affinity with more than one religious tradition. In this post I look at some of the ideas of this book. 

Growing up in India means growing up together with persons of different religions – India is the original multi-religious country. Often persons growing up in India can have different religions in their family histories and thus accepting different religious traditions is quite common. Duane is from a Protestant Christian background and his approach to looking at multi-religious identities seems more analytical, compared to the emotional approach I had while growing up in India.

About Duane R. Bidwell

In the book, Duane defines himself as: “I am Buddhist and Christian. Jesus is my savior, and the Buddha is my teacher … I am a minister of the Presbyterian Church (USA), part of the Reformed tradition of Christianity … I am more apt to feel tearful or joyful when chanting at the temple than when I am worshipping in church. Buddhism changes the way I know and experience God. It broadens and deepens my understanding and experience of Christianity … I identify as Buddhist/Christian because that’s what I understand God to be asking of me. I’m not worried about salvation, and I don’t mind incompatible doctrines.”

Different Approaches to Multi-Religious Identities

Persons like Duane, come from traditions that believe in one prophet or a “true God”, and when they find themselves attracted to different religious ideas, they need to find a logical explanation for their ideas. It is very different from the way I look at it, I don't need any explanations for it, it seems like a self'evident truth.

Thus, in the initial part of the book Duane raises some questions and his understanding about God:

How and why does someone become spiritually fluid? Are spiritually fluid people simply confused, syncretistic, unable to commit? Are they idolaters? How should we make sense of spiritually fluid people? Do they belong in our religious and spiritual communities? What might they teach us? And what do complex religious bonds imply about our own religious and spiritual identities, practices, and commitments?… I do not believe that God is one or that all paths reach the same mountain. Religions are not different descriptions of a single reality; they describe different (and sometimes related) realities.  
I was a little shocked when I read what Duane says here - "I do not believe that God is one or that all paths reach the same mountain." I think that a person who believes in there being different Gods for persons of different religions would look at persons having multiple-religious beliefs very differently from a person who believes that roads lead to the same God - these would be two very different ways of looking and understanding religious beliefs.

Different religions originated in India including Hinduism, Buddhism, Jainism and Sikhism – together these religions are called the Indic religions. In the Indic religions, we often say that God is one and all the different paths (religions) lead to that same ultimate truth.

Duane’s analysis of spiritual fluidity

Duane uses the term “spiritual fluidity” for persons having an affinity for more than one religion. He explains that people can come to this state of fluidity due to different events in their lives:

Normal spirituality believes in religious monogamy; people must leave one religion to cleave to another, taking on a new name, a new identity, a new set of beliefs and social mores. The old life is gone; a new one begins. But some people claim two (or more) religions at the same time. Maybe they belong to a Christian church and practice Buddhist meditation, or they grow up with a Jewish mother, a Hindu father, and an extended family that doesn’t expect them to choose one tradition or the other. Or they might publicly identify as Muslim while secretly praying to Hindu gods … it can confuse and perhaps threaten people who have only encountered singular religious and spiritual identities … More often it leads to conflict in families, communities, institutions, and individuals.

The problems in families and communities caused by belonging to multiple religious identities can lead to hiding of the true feelings – thus persons may outwardly show their beliefs only in their family or community religion, while hiding their feelings about their other spiritual beliefs:

Spiritually fluid people seem exceptional because cultural conversations in North America, Europe, and parts of the Asia-Pacific region position them that way. Public conversations tend to frame spiritually fluid people as privileged, subversive, or both—an attitude that keeps religious multiplicity out of the public eye … First, academic discourse tends to frame religious multiplicity as exotic, elite, and rare and therefore distant from what most think of as ordinary. Second, because it can be dangerous to violate family, community, and institutional expectations of normal spirituality, some spiritually fluid people—especially those bonded voluntarily to two or more traditions—fail to identify publicly as religiously multiple.Much of this (academic) writing assumes a normal spirituality, especially the ideas that (a) religious traditions have clear boundaries, (b) religions are primarily focused on doctrine, and (c) conflicting spiritual or theological perspectives must be reconciled. … Ordinary people who live religiously multiple lives are seldom celebrated and often unseen. They hide their multiple allegiances from family members who will not tolerate someone practicing a different faith; they mask themselves in one or more of their religious communities to avoid shame, judgment, punishment, or other negative consequences; and they switch from one type of religious language to another, depending on context.

Duane acknowledges the different approaches to "spiritual fluidity" among different cultures. Thus, while persons raised up in monotheistic religions feel the contradiction between the doctrines they have learned from childhood and their attraction to other spiritual ideas, indigenous persons growing up with more open traditions in Asia, Africa and South America do not always see any contradiction. Thus, in countries where monotheistic religions dominated, in the past, spiritual fluidity often had to be hidden. This may still happen to some degree.

Jewish families in Spain and Portugal converted to Catholicism to save themselves from the Inquisition but continued Shabbat rituals in secret, and Buddhists in Sri Lanka (then known as Ceylon) converted to Christianity to qualify for stable, higher-paying jobs but still participated in ceremonies at Buddhist and Hindu temples. In North and South America, governments insisted that indigenous nations “civilize” themselves by becoming Christian, a policy that made indigenous people hide their spirituality beneath a veneer of church language and practice … “The problem with Indian Presbyterians,” one denominational executive said to me more than a decade ago, “is that they want to be Indian and Presbyterian at the same time.”Outside the North Atlantic region, religious lines aren’t always so sharp. European missionaries encountered this porosity as they began to evangelize people in various regions of Asia. When Catholic priests arrived in India, for example, the emperor Akbar delighted the Jesuits who came to convert him. He assured them that he had indeed become a Christian—and then infuriated them by continuing to worship as a Muslim and, in many ways, a Hindu. This multiplicity was not what the Jesuits had in mind at all and is yet another incident that reveals how Europeans regarded the boundaries between religions as impregnable, whereas Indians saw the lines as rather porous.

Sometimes people adopt dominating religions because these allow them freedom from religious persecution or access to education, mobility and resources. Yet, at the same time, they may continue to believe in their ancestral beliefs, though they may hide these beliefs from their new religious companions.

Today’s complex religious belonging also reflects centuries of Christian expansion beyond Europe. Through encounters with local spiritualities and other religious traditions, Christian missionaries have seen spiritual fluidity as an option for centuries. Those sympathetic to local religions, like Ruben, sometimes developed spiritually fluid ideas, practices, and identities. At the same time, local residents forced or persuaded to convert to Christianity might continue to practice their original religions in secret. Other local people converted (or added Christianity to their mix of spiritualities) because of the link between Christianity, social mobility, and economic privilege. By adopting strategic multiplicity—performing Christian norms in public while practicing original traditions at home—local people gained access to otherwise unattainable economic and social goods.

Over the recent past, in India, there have been a lot of debates about religious conversions and many persons ask for strict laws to stop induced or forced conversions. However, Duane's point is that conversions can be a way of creating multiple religious identities and thus act as bridges between religions. Thus to safeguard cultural unity of persons, it may be a better strategy for Indic religions to continue to be welcoming to the converted persons, so that they can acknowledge both their religious identities instead of being forced to give up their original religious identity.

Interfaith Families and Their Children

In his book, Duane also touches on issues related to the interfaith families and children of these families who grow up surrounded by different religious traditions:

Many people who inherit complex religious bonds grow up in an interfaith family. They have a Jewish mother and a Christian father, for example, and grow up attending church and synagogue. Others might have a Christian mother and a Hindu father and refer to their family religion as Chinduism. Still others are raised by parents of two religious traditions, with aunts, uncles, grandparents, and cousins from several other traditions. 

Duane shares different life-stories of persons to explain the complexities in dealing with spiritual fluidity. One of these stories is of Sita, a Caribbean immigrant to Canada, which raises the issue of fitting different religious identities in public and private.

Until Sita started school, she thought every home honored Jesus and Hindu gods at the same time. “As I got older, I became more aware,” she remembers, “kind of realizing: Oh, OK, the Christian part is the part that fits in with society, the part I can mention in school. The Hindu stuff is the stuff I keep to myself ... I remember in school, if people asked, ‘What did you do on the weekend?,’ I felt comfortable saying we went to church. I wouldn’t have felt comfortable saying we went to puja, which is one of the words for prayer gatherings in the Hindu faith. So I just sort of instinctively learned to hide it, because it wasn’t—because if I had said it, they wouldn’t have known what I was talking about.

Conclusions

A few years ago, I had thought of conducting a research with interfaith couples to understand how they reconciled their religious differences, especially in terms of religions of their children. However, after some initial work I had given up that idea as I wanted to do other things. However, I think that if I had done that book, I would have approached this subject very differently from how Duane's has done it. Till some years ago, I had a t-shirt that I had bought in India, which showed symbols of different religions and carried the words, "God is too big to fit in one religion" - to me, those words are a better expression of how I look at multiple religious identities.

When I started reading this book, initially I was a little frustrated by the gap between my own emotional approach to spiritual fluidity compared to the analytical approach adopted by Duane. Before reading this book, I had looked at spiritual fluidity as exclusively a positive value, while I had ignored that for some persons, it can be a challenging path. I am glad that I persisted with the book and I think that I have gained some new insights from it.

I believe that in future with increasing international travels of persons from different countries, the encounters between persons of different religions and interfaith marriages are going to increase exponentially. At the same time, with a decrease in the controlling power of traditional religions, increasing number of persons are going to experiment with and adopt spiritual ideas from different traditions. Such mixed couples and their mixed families can help in building bridges between the people.

I think that Governments should document and valorise these multiple identities. For example, in the national censuses, instead of assuming that persons belong only to one religious traditions, countries should provide specific options for persons with multiple religious identities. Learning about different spiritual beliefs, celebrating all the different religious festivals, can be a way to promote peace and brotherhood in the 21st century. Duane's book provides important reflections and insights on this crucial subject.

*****

Exiled in Spinalonga

The book “The Island” by Victoria Hislop is a story about 4 generations of a family from Plaka (Crete, Greece), marked by love, betrayal and leprosy. It is also about the world of Spinalonga, where persons with leprosy in Greece were exiled for about five decades during the first half of the 20th century.

Isolation of Persons with Leprosy

From prehistoric times, communities across the world had banished persons with leprosy to the outskirts. In early 20th century, developments in microbiology had convinced the doctors that isolation of persons with leprosy was necessary to prevent the passage of infection to others.

Islands were a natural choice for their isolation. Countries had made laws that asked for compulsory shifting of persons diagnosed with leprosy to the designated isolated areas. Thus, children were taken away from their parents, mothers and fathers were taken away from their children, and forced to live in such isolated places. If women in these places became pregnant, they were forced to undergo abortions and if they had babies, these were taken away and given for adoption. These laws were scrapped only around 1960-70s, as new medicines to treat leprosy had become available.

Last year, I had visited the Nagashima island in Japan (image below), which was also used for the isolation of persons with leprosy. There I had heard about Spinalonga island in Greece, for the first time.

The Island by Victoria Hislop

During the three decades of my work with AIFO, I had heard many stories from persons with leprosy about their lost families. Thus, when I had started reading “The Island”, I already had some ideas about what I was going to find in the book.

"The Island" is the story of Eleni, a primary school teacher, her husband, Giorgis, a boatman and their two daughters Anna and Maria, who live in Plaka on the island of Crete. Giorgis supplements his income by carrying supplies to the leprosy-island of Spinalonga.

In 1939, Eleni and one of her students, Dimitri, are diagnosed with leprosy, and are forced to leave their families and shift to Spinalonga. After a few years, Eleni dies. Her daughters grow up with Giorgis. Anna marries Andreas, son of a rich land-owner. Maria is planning to get married to Andreas’ cousin when she is diagnosed with leprosy and forced to shift to Spinalonga.

It is the time of discovering new medicines for treating leprosy and a few years later, the persons are no longer forced to live in Spinalonga because the disease can be cured. Maria returns home and marries a doctor whom she had met in Spinalonga. Anna has a baby girl, Sofia, but has problems in her marriage, and a tragedy waiting for her.

The story is told in flashback with Alexis, Sofia’s daughter who has come to Plaka to learn about her mother’s family.

Comments

The Island is a well-written family saga with strong women characters. For me, its most interesting parts were the descriptions of the life in Spinalonga, including the stories about testing of new medicines for curing leprosy.

Clearly the author had done a huge amount of research to present a well-balanced picture about the situation of leprosy in the early 20th century Greece. Its strong point is that the book is never didactic, and the aspects about leprosy are well woven in the story. While talking about loss and exile, it also tells about love, friendship and solidarity.

Conclusions

The Island was a very successful book. It was converted into a 26 parts Greek-TV serial. Since then Hislop has written a few other books, which have also been successful. At the same time, she has become an ambassador for LEPRA, the British association working for the fight against leprosy.

This book brought the attention of Greek authorities about the unique history of Spinalonga, which is trying to become a UNESCO World Site of Humanity’s Heritage.

I have heard many heart-breaking stories of lost families and lost children during my travels in the old leprosy sites, though there were also some stories of hope and reunions. Though in most countries, the laws regarding forced isolation were changed during the 1970-80s, persons who had lived away from their families for decades, had often continued to live in their old leprosy centres, because those prisons had become their homes where they had forged new bonds of kinship with their fellow companions.

Earlier this year, while travelling in India, I had met Chait Singh who had been forced to leave his village and live an ashram, because he had leprosy. While telling me about his village, his eyes had filled with tears. This post is dedicated to him and to all those persons who continue to be exiled because of continuing prejudices and stigma against leprosy.

*****

#leprosy #spinalonga #historyofleprosy #historyofmedicine #bookreview #victoriahislop 

Pink Boy and Tom Girl, the world of fluid genders

When BJ, his great aunt and adopted mother, asks Jeffery, "What would you like to be when you grow up?", he thinks hard and says, "I think that I want to be a girl." BJ, her companion Sherrie and the boy Jeffery, are part of a short film on gender fluid children called "Pink Boy".

This post is about some short films on gender fluidity, about persons who are not sure about their genders. You can look at it as a kind of free film festival on gender fluidity - all the films mentioned here can be watched free on YouTube.

Gender fluidity - some concepts

Majority of children are born with male or female genitals. Most of the time, children born with male bodies think of themselves as male and most of children born with female bodies think of themselves as females.

However, sometimes, the bodies and feelings do not match. Thus, a child with male body may feel that he is a girl and a child with female body may feel that she is a boy. Often during childhood, such feelings can be fluid, in the sense that these feelings are not fixed, and they can change. For example, some children born as boys, who may have thought of themselves as girls for a certain period, as they grow up, finally decide that they prefer to be boys, while others decide that they are girls. Some can even decide that they would prefer to be some times girls and some times boys or none of the two.

These children (persons) who are not sure about their gender are called "gender fluid".

We human beings are incredibly complex and some of us do not fit into any label. My explanations about gender fluidity are only a simplified version of this complex reality.

Short film 1: Pink Boy

It is short film (15 minutes, 2016) directed by Eric Rockey. It looks at the challenges faced by a lesbian couple in raising up a gender-fluid boy. The film is told mostly from the point of view of BJ, a masculine lesbian woman. Jefferey was the son of her niece and she had adopted him when he was 2 months old.

BJ explains her initial difficulties in accepting that Jeffery wanted to dress like a princess and to play with barbie dolls. Then she decides to provide acceptance and support to Jeffery, in whatever decisions he is going to make about his gender identity. Aware that he would have to face bullies, discrimination and violence, she decides to enroll him in a martial arts training so that he can defend himself.

You can watch Pink Boy on the Vanity Fair YouTube channel and you can also check the film website for more information about the film and its background. An interview on the Vanity Fair website explains that Jeffery has now become Jesse.

Short film 2: Tom Girl

"Tom Girl" (14 minutes, 2016) is by director Jeremy Asher Lynch. It is about a seven year old boy called Jake. It has his mother and father, as well as some other persons from his life, including a psychologist, talking about what it means to have a gender fluid child and how important it is to accept the child as he is. Jake himself is incredibly clear about what this means for him.

You can watch Tom Girl on YouTube.

In the film, at one point, Jake's mother says that probably there are many other children like Jake, but we as society force them into specific gender roles.

I think that our process of guiding our children towards specific gender roles starts very early and in unconscious ways. When a one year old son is taken to a shop and if he points to a doll or a pink cap, his mother or father, just shake their heads and instead nudge him to another kind of toy - that boy is already learning that he is not supposed to like dolls or pink caps.

However, having said that, I do not think that all stereotypical ideas about male and female preferences are only a result of cultural influences, at least some of them of them are in-born.

Short film 3: It is a stereotypical day

The 4 minutes long film (2015) by Alex Harrison can be a good introduction to understanding your feelings about some of the issues surrounding gender fluidity.

The film is about 3 mornings. On the first morning, the adolescent hero wakes up, goes out and meets some people on the way to school. On the next day, he sees the same persons but some switch has been flipped and people are behaving contrary to their expected gender roles. On the third day ... you can watch it on YouTube to find out the surprise ending.

Short film 4: I am Oliver

The 4 minutes long film by Moustache Geek (2015) is about being a transgender teenager. The film looks at the life of an adolescent facing problems in school, her desire to be boy and the sympathy s/he gets from a classmate. All these things are shown through the role played by social networks and internet in our lives. The film is a personal testimony.

Short film 5: I am a boy

The 11 minutes long film by Just Sammy (2016) is about a transgender boy and his journey to accept himself. The film starts with Sammy dressing up as a girl, putting make-up, and not feeling happy about it. She does not want to be a girl. She considers cutting the vein in her wrist and committing suicide. Her family has not been supportive and has asked her to not to talk about her desire to be a boy.

Instead, Sammy decides that he is a boy and to live like a boy. He uses an elastic wrap around his breasts to hide them and puts a sock in his pants to camouflage genitals. He talks about his daily struggles with his peers, and his fears and desires about his gender identity. This film is also a personal testimony.

Short film 6: Trans guy problems

The 10 minutes long film by Isaac Eli (2017) is a wonderful film to get a glimpse into the lives of transgender boys/men (persons born as girls who feel that they are male). It is also a personal testimony.

It is a simple film - just Isaac sitting in front of the camera and talking about his problems, like what it means for him to have monthly periods; the difficulties of using public bathrooms and how he wishes for gender-neutral bathrooms (which can be used both by men and women); the difficulties of going to a swimming pool and not being able to go open chested like other boys; the love/hate relationship with binders to hide his breasts; the endless waiting for everything from top-surgery (to remove breasts) to the treatment with testosterone; and his disgust when someone talks to him as if he is a girl or is talked about with a female pronoun.

I liked this video very much. Compared to the other films, this film made me think of so many different ways our genders influence everything we do in life and how that can create challenges for persons like Isaac. I also liked it because Isaac has a very nice dog and I love dogs!

Conclusions

I hope that you will watch the films I have included in this list. If you do, please make constructive and supportive comments under each of these videos. To be an adolescent is tough, to be an adolescent who does not fit and conform, can be heart-breakingly tough.

Persons with gender fluidity issues have high rates of depression, suicides, alcoholism and substance abuse. Often they face rejections from their natural and adopted families. They also face a lot of emotional, physical and sexual violence. If you are a parent or a relative or a friend of a person who does not conform to his/her gender, be accepting, be loving and be supportive. They will have to fight the world for a life with dignity, at least make sure that they don't have to fight their families as well.

You can also read more about this issue. For example, the Gender Spectrum website has lot of good advice and information for parents and families on this subject.

All the films mentioned in this post are from Europe and USA. I looked for similar films from India, Asia and Africa but did not find any. Perhaps there are but they are in other languages! If you are aware of any good short films on this theme that are available on YouTube, please tell about them in the comments below.

For a long long time, in the developing world it was difficult to get any information about trans issues. Now, thankfully technology is changing the situation and hopefully more persons will be able to share personal testimonies, find strength in sharing their stories and experiences with others and build supportive virtual communities that can one day spill over in the real world.

***