There Is No Health Without Mental Health: Psychiatrist Dr Shaili Jain

Her father was orphaned in the vicious bloodbath of the 1947 Partition, and who went on to bravely reclaim his life. The residual vicarious trauma of the partition has perhaps always remained with Dr Shaili Jain, through her life’s work. Currently, the Medical Director for Integrated Care at the VA Palo Alto HealthCare System and Clinical Associate Professor (Affiliated) of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine, she is board-certified in General Psychiatry with specialty expertise in posttraumatic stress disorder (PTSD), primary and mental health integrated care and Women’s Health Psychiatry. Her work focuses on developing innovative ways to enhance the reach of mental healthcare for underserved populations with PTSD and her research focuses on the effectiveness of peer-support interventions for individuals with PTSD. Perhaps it was only appropriate that her debut nonfiction book, The Unspeakable Mind, examines PTSD minutely, a condition that is not spoken about as much as it should be, examining PTSD from the lens of her own father’s experiences of the Partition.

SheThePeople.TV spoke with Dr Jain about PTSD, the partition, how strong fathers raise strong daughters, and why we need more awareness about mental health and PTSD in India.

As a child, did you always know that mental health was going to be your area of focus or were there any experiences that moved you towards specializing in this field?

Not at all. I only started to consider it as a senior medical student, in England, when I did my required rotation in Psychiatry. I found Psychiatry fascinating and was instantly drawn to it. I loved how much attention is paid to details in the patient story- who they are, their values, quality of life and wellness. Psychiatry celebrates the artistry of medicine.

There is so much stigma toward the mentally ill and the psychiatrists who treat them. Societal stigma is an issue but also stigma from within the field of medicine itself, that somehow Psychiatry is not “real medicine.” The stigma meant that it took me a couple of years to commit to this career path.

I did not realize it then but the seeds of a traumatic past and my childhood experiences, as the daughter of a survivor of the 1947 Partition, were converging and guiding my life’s choices. Specializing in Psychiatry, a field dedicated to alleviating psychological distress, would eventually grant me the tools to make sense of my own family history of trauma.

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I’ve had a rich, rewarding and meaningful career, but the stigma remains. It has improved over the two decades I have been in the field, but we still have a way to go. There is no health without mental health, that must be a non-negotiable in 21st century medicine.

With the strong focus on education amongst people from India, did you face any pressure to get into the 'conventional' fields of medicine or engineering from your family?

No pressure from my parents. What they did insist on, however, was me fulfilling my intellectual potential. I enjoyed learning and did well in math and science so medical school was a logical option. I always felt I had it in me to become a doctor- I would have regretted not trying or settling for a less demanding path. Moreover, I was not pulled strongly in any other direction such as the arts, humanities or music and so that helped me choose medicine.

At that time, for to me to consider applying for medical school was audacious enough. The odds were not in my favor, I was not from a doctor family and I was the first woman in my family to attend university. Moreover, our wider Indian community discouraged girls from getting “too educated” and typically invested more in the education and future of their sons.

The older I get the more gratitude I have for two things. First, that I had a father who was a natural educator and could see talent in others. He took an interest in me and thought about my future- that makes a huge difference to a one’s confidence and abilities. Second, that he was bold enough to take, what was then, an unpopular stance: to treat girls equally to boys.

I’ve had a rich, rewarding and meaningful career, but the stigma remains. It has improved over the two decades I have been in the field, but we still have a way to go. There is no health without mental health, that must be a non-negotiable in 21st century medicine.

You upset the status quo when you make a stance that runs counter to the norm- you risk alienation and condemnation as this ruffles feathers and makes people uncomfortable. He fiercely defended his stance, and that strong defence opened a world of opportunity for me. He was way ahead of his time and, now, I see that the rest of the world is slowly catching up.

When I started medical school there was no way that I could fully appreciate what such an education would mean for my life in terms of opportunity, platform and voice. For someone like me like me, not from material wealth or privilege, earning a medical degree has changed the trajectory of my life in ways that I could not have imagined.

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The Unspeakable Mind deals with PTSD and is also a very personal narrative based on the trauma of partition that your family went through. Could you tell us why you decided to weave in the personal into this book?

My father was ten years old when he was orphaned and forced to live as a refugee in the newly independent India. Two decades later, he would emigrate to England, where I was born and raised. I spent chunks of my youth living in the shadow Partition had cast on his life and with a feeling that no matter how much I loved him, and he loved me, a part of him, forever changed in 1947, remained inaccessible.

Image Credit: Harper Collins

At the same time, we rarely travelled to India, there were no photographs of my grandparents or family heirlooms- no physical reminders of their existence - so, as a child, I often felt disconnected from this family history. I was more preoccupied with the challenges of growing up as a brown-faced girl in 1980’s England.

When I realized that Partition had, all along, been central to my own life and career choices it made sense to me that this story should be at the heart of The Unspeakable Mind. Creatively, it was gratifying to take my deceased grandparents, from the anonymous recesses they had occupied in my childhood and recreate then anew. Honoring their story was very important.

Why does the partition still haunt us as a populace? Why have we not yet been able to get the closure we need on this very horrific event in our history?

Given the enormity of the tragedies surrounding Partition, somehow it has passed largely unacknowledged by the world. There are likely many reasons why the story of the Partition is publicly under-told, a big one being that India and Pakistan, as fledgling nations, may not have had the luxury of memorializing the dead and the demands of the living had to take precedence.

As a trauma scientist, I would offer an additional explanation: the powerful human drive to deny the unspeakable. Repression, dissociation, and denial can operate on a societal level. But the science of suffering tells us that there is a big price to pay for such collective denial. Atrocities don’t remain buried forever. As powerful as the desire is to deny, in the long run, it does not work.

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I feel strongly, that this unprocessed collective trauma has engendered future spirals of violence between Hindus and Muslims. The violence that continues to be reenacted, in the 21st century, between these two nuclear-armed neighbors.

PTSD is a very real issue and yet in India, we don't seem to consider it as important enough to redress. What must be done to change this?

India is no stranger to trauma. Its unique geo-climatic conditions make it vulnerable to natural disasters, it accounts for 10% of the world’s road traffic accidents and its crimes statistics on rape and domestic violence are rising. Despite all this, I have met this resistance- on the part of influential Indian thought leaders-to PTSD being a problem in India. That somehow it is an American/Western problem.

Repression, dissociation, and denial can operate on a societal level. But the science of suffering tells us that there is a big price to pay for such collective denial. Atrocities don’t remain buried forever.

I’m cautious to project western research and scientific discovery onto India and, of course, there are always cultural differences in the way mental distress is expressed but to discard the last 20 years of advances in PTSD science is also not a good idea.

The first step is to accept that your social reality can have a profound influence on your mental health and biology. So, as an example, if you are raised in a culture where family violence is the norm or perpetrating sexual violence is acceptable, the odds are that is going to leave a mark on the way you think and behave, not only on a psychological level but on a cellular level too.

The second step is to challenge the taboos surrounding trauma. If victim-shaming tactics persist then the silence and denial surrounding trauma and PTSD will continue. Accepting that PTSD exists also requires all of us to step out of the bystander role, when needed, and take a stance about naming perpetrators and supporting survivors. Taking a stance often creates discomfort but we must look inward, at our own resistances and ambivalences to stepping up.

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Finally, diversity of voice in positions of power and influence is vital too. As an example. research agendas (i.e. which ideas and disciplines receive financial support) are set by people who have power. If those people come from one demographic, gender, socioeconomic background or political orientation then we have an immediate bias in what is given priority.

What are the things a layperson must know and understand about PTSD?

PTSD is an inextricable part of all our lives. Exposure to trauma is so common that the odds are that you, a loved one or someone with whom your life is inextricably intertwined will be impacted. None of us can afford to ignore PTSD.

PTSD cuts to the heart of life, it interferes with one’s capacity to love, create and work. This incapacity is not brought on by poor lifestyle choices, moral weakness, or character flaws but by a complex interplay among biology, genes, and environment.

PTSD seeps beyond the confines of the mind or brain, it impacts cells, organs, and bodily systems and has emerged as a risk factor for various diseases from cancer, to heart disease to obesity.

Are there any demographics particularly vulnerable to PTSD and how can one build emotional resilience?

PTSD hits the socially disadvantaged and marginalized groups the hardest. Your zip code plays a big role in determining your vulnerability to PTSD- geography really is destiny.

Women experience PTSD at 2-3 x the rate that men do. Why is this? The answer probably lies in the types of trauma that women are more likely to experience. So, as an example, sexual violence and intimate partner violence are potently traumatizing and, of course, women are much more likely to be the victims of such crimes.

PTSD seeps beyond the confines of the mind or brain, it impacts cells, organs, and bodily systems and has emerged as a risk factor for various diseases from cancer, to heart disease to obesity.

It’s vital to realize the role posttrauma social support plays not only in healing from PTSD but in even preventing the onset of PTSD. In this way, PTSD goes far beyond the biology of an individual human and extends to our society. If we all did our bit to actively support survivors of trauma, in an informed and educated way, the world would be better off for it.

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How can friends and family support a person suffering from PTSD, and what are the red flags to watch out for?

PTSD is a disorder of memory famous for causing nightmares, flashbacks, and an exaggerated startle reaction. Lesser known, but equally devastating, is how it renders a person’s emotional life barren. It mutes happiness and yields, instead, to irritability that keeps sufferers on the perpetual verge of withdrawal from the world and alienation from those who love them.

Eighty percent of PTSD sufferers have at least one other psychiatric condition, typically depression, alcoholism, drug abuse, or anxiety. All have a higher risk of death by suicide.

Unfortunately, the nature of the condition- there is much denial, avoidance, and mistrust among PTSD sufferers- means that they are not likely to seek professional attention in a timely fashion.

Lay people must elevate their mental health literacy when it comes to PTSD. Receiving high-quality mental health help from a professional is crucial. PTSD’s wounds are often invisible, to the untrained eye, so loved ones don’t urge the sufferer to get help the way they would for a physical problem. This is very unfortunate and contributes to needless suffering.

You write that PTSD can be inherited. Can you tell us more about this, and what parents to be must be aware of if they suffer from this?

Traumatic stress can spread to anyone with whom the sufferers share their lives. Trauma begets trauma. Most commonly affected are the sufferer’s family members, who are at higher risk of developing depression, anxiety and PTSD themselves.

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More recently, a new idea proposes that children of traumatized parents are at risk for similar problems because of epigenetic changes that occurred in the biology of their traumatized parents. Epigenetics refers to how PTSD may possibly alter the way genes express themselves in a trauma survivor and how such alterations can then be inherited by children on a cellular level and alter their neurons, brain molecules, neuroanatomy, and genes. These epigenetic changes are transmitted to children by a process called “intergenerational transmission” by having a negative impact on the parents’ sperm or egg quality or impacting the mother while she is pregnant.

My advice to parents? Know thy self. Do you have a trauma history? If you have not formally addressed this then it is likely it will infiltrate your current life in a negative way, including the way you love and parent your children.

Get help, get educated. This is probably the best first step to protecting your children from inheriting your trauma.

Trauma begets trauma. Most commonly affected are the sufferer’s family members, who are at higher risk of developing depression, anxiety and PTSD themselves.

As a woman in an eminent position, how can we encourage more girls to take up STEM as a career?

Girls need early and sustained exposure to high quality STEM education.

They need role models who they can relate to, whose lives look like their lives so, again, diversity not only in gender but the types of women role models are key

Girls should never feel they have to make a huge personal sacrifice for the sake of a career in STEM. I feel, largely in part to the massive sacrifices of bold and brilliant women who have come before us, women today have more options and opportunities. No doubt, the demands of a career in STEM remains considerable but it should not involve one giving up other important dreams.

Finally, let’s get rid of this artificial distinction between arts and science. The best scientists are often creative artists too and vice versa. A girl who loves dance or music or art should not feel she has to leave those passions behind to pursue a career in STEM. Rather, find a way to integrate these passions and keep them in her life and career. They will prove valuable.

And finally, is there a follow up to The Unspeakable Mind you are working on?

I’m thoroughly enjoying this 4th-trimester phase of The Unspeakable Mind. I’ve been traveling all over, for book events, talking to various audiences and have been deeply touched by the Q & A sessions. People are curious about trauma and want to understand the science. It is a dream come true for me to have this precious opportunity- to make my small contribution to our becoming a more trauma-informed society.

In terms of future projects, intergenerational trauma is something I’m very interested in knowing more about. Also, as I live in the heart of Silicon Valley, I’m intrigued by the role technology might play in treating PTSD someday.

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