Rameswaram, end of the line for some

The scenic temple town by the sea is where pilgrims go to wash off their sins. It is also the place where families abandon the mentally ill
Rameswaram, end of the line for some
A boat passing below the Pamban bridge


Rameswaram, invokes in the mind, pictures of the famed Arulmigu Ramanathaswamy temple, devotees thronging the beach to see the sun while the sound of temple bells ensures that thoughts of God are never far from the devotee’s mind. 
But presently, Rameswaram is slowly turning out to be the last refuge for those mentally ill who are usually put on buses bound for Rameswaram by their relatives and left to fend for themselves when the vehicle finally reaches its destination. 
Another way is for people to accompany the affected people to the temple town and disembark at Rameswaram bus stand. When the affected person starts wandering, the relatives board the next available bus for their homes. 
Locals say one reason for Rameswaram being chosen for such practices is due to the presence of pilgrims throughout the year from all over the country. Such tourists usually practice ‘anna dhanam’, and the abandoned ones usually feed off such benevolence. 
It is common to find mentally ill persons walking about in dirty rags, eating whatever is given by pilgrims or occasionally grabbing food from devotees or from a shop when hunger overcomes them. A government psychiatrist felt, “such people are not mad. Their minds, unable to handle extreme stress, has given up. They can be treated.” 
Hailing from rural and lower middle class backgrounds, the families who abandon their affected relatives largely lack the necessary awareness on professional care. According to officials, the local hospitals do not offer any help either, simply because the wandering destitute have never been considered an issue.
However, some kindness finds its way towards the mentally ill destitute. The Ramakrishna Mutt helps them with their hygiene needs, and also delivers food to at least 100 such destitute daily. 
The Ramnad district government’s mental health programme too has been on track. Government psychiatrist Dr J Periyar Lenin said around 5000 patients had registered with the district mental health programme from 2002 including 1000 at Rameswaram. Currently, 250 patients are receiving regular treatment at the Rameswaram taluk hospital, he added. 
A similar programme had also been started at the famed Ervaadi dargah where 80 -100 patients from various parts of Tamil Nadu and other states were admitted daily. Treatment was given in a way without infringing on the patient’s faith, Dr Lenin added.
One or two symptoms alone do not constitute mental illness. But if a person experiences many of the symptoms at same time, and has serious problems in studying, working or relating to others, then he/she needs a mental health professional’s help. People with suicidal thoughts or intent, or thoughts of harming others need immediate attention.
Global research has revealed that early intervention reduces or delays symptoms, prevents hospitalisation and improves prognosis. Even when a person does not show clear signs of mental illness, these “red flag” warning symptoms can be reason enough for professional appraisal. Such a person should be encouraged to: Have an evaluation by a mental health or other health care professional. Receive supportive counselling about daily life and stress management strategies.
Be monitored closely for conditions needing intensive care. Each individual should be assessed carefully with follow-up individualised treatment. Comprehensive treatment to prevent first symptoms from progressing to serious illness must include individual/ family counselling, vocational and educational support, participation in a multi-family problem-solving group and medication when necessary. 
Family members are valued partners and should be involved whenever possible. Learning about mental illness helps individuals and families understand symptoms, how an illness might develop and what can be done to help. Just as with other medical illnesses, early intervention is the crucial difference in preventing a serious illness later.
A mental health professional should be consulted when a person exhibits any of the following symptoms
  • Withdrawal — Recent social withdrawal and disinterest in others.
  • Drop in functioning — An unusual drop in functioning, at school, work or social activities, such as quitting sports, failing in school or difficulty in performing routine tasks.
  • Problems in processing — Difficulty with concentration, memory or logical thought and garbled speech.
  • Increased sensitivity — Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations.
  • Apathy — Loss of initiative or desire to participate in any activity.
  • Feeling disconnected — Vague feeling of being disconnected from oneself or surroundings; a sense of unreality.
  • Illogical thinking — Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or “magical” thinking typical of childhood in an adult.
  • Nervousness — Fear/suspicion of others or strong nervous feeling.
  • Unusual behaviour – Odd, uncharacteristic and peculiar behaviour.
  • Sleep/appetite change — Dramatic sleep/appetite changes or decline in personal care.
  • Mood changes — Rapid or dramatic shifts in feelings.
A few tips on communication with the mentally ill to get your point across and understand what the other person is saying
Reach out to the needy
  • Relax and stay calm.
  • Start a conversation expecting things to go smoothly.
  • Minimise distractions.
  • Listen, make eye-contact.
  • Speak one topic at a time.
  • Use “I-statements” not “you-statements”.
  • Acknowledge what the other person says and how they feel, even if you don’t agree.
  • Engage the person by asking for opinions and suggestions.
  • Watch for contradictory messages between verbal/non-verbal messages.
  • Look for common ground. Focus on observable facts; things you both saw or heard.
  • Sharing own feelings honestly reduces defensiveness on both sides.
  • Stick to present issues.
  • Use humour in easy situations.
  • Acknowledge your responsibility; don’t wait for others to do it first.
Have concern for them
  • Don’t start a conversation expecting a confrontation.
  • Don’t take it personally; remember your loved one’s illness can affect their behaviour and communication skills.
  • Don’t criticise, accuse or blame.
  • Don’t assume. Ask questions.
  • Don’t expect the other person to understand if you cannot explain it.
  • Avoid bringing up the diagnosis.
  • Don’t raise your voice or attempt to intimidate or “discipline” the person.
  • Don’t use general and loaded words such as “always” or “never”. Use specific words instead.
  • Don’t use sarcasm; avoid humour in difficult situations.
  • Avoid patronising or being condescending, if you want to be taken seriously.

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