From Cardiology to Psychiatry
Like many doctors, a subspecialty was my first love. Switching from ophthalmology, I developed a passion for becoming a cardiac surgeon in Pakistan. At that time, PIC in Lahore had just been built, its tall, dignified building visible from Jail Road. The corridors were bathed in milky light and empty, the offices inside the building spacious, the wards air-conditioned, the cafeteria clean, the security arrangements improved, and most or many medicines available. All of it looked very impressive.
That said, within about a year it became clear that the severe physical demands of cardiac surgery, sometimes a twelve-hour operation followed by standing at the patient's head all night, were beyond what I could manage. I did, however, get the chance to work in cardiology, where I learned everything from reading EKGs to inserting a temporary pacemaker. But by the time I reached America, I had already spent the bright, shining days of life in which one dreams, and by then I had become something of a joke: "Doctor sahib, let it go now." Youthful energy was fading, and the journey from "me and my success" to "us and our family's success" had arrived.
Choosing Psychiatry
For many reasons, psychiatry had now become my first dream, and in the pre-match I received three residency offers: radiology, psychiatry, and a combined medicine-pediatrics program. I chose psychiatry, and it was already becoming clear that this field held a great deal of promise for the years ahead. The first year passed in some medicine, neurology, the emergency room, and pediatrics, but in the second year psychotherapy training began, and my beloved teacher, Dr. Wilson, became my supervisor. He was undoubtedly an authoritative figure in his field, but he gave me room to ask questions. Coming from a loving family and sensible parents, two questions kept nagging at me: is psychotherapy really such a simple field, and are common sense and helpful people so lacking in people's lives that they pay hundreds of dollars to hear things we already know from home? Dr. Wilson's answer was yes.
A Lesson in Supportive Psychotherapy
Life went on. My late mother's cancer returned, and I truly came to understand the importance of this field. Dr. Wilson would simply listen to me, and I came to realize that he was helping me through supportive psychotherapy. I returned to Pakistan, and the difficult days of my mother's passing went by. Soon after returning to America, while working in the emergency room, a senior female colleague learned of my mother's death and asked me about her. As I told her, I broke down and wept. Years later, I understood that this too was supportive psychotherapy: as a psychiatrist, she knew exactly what pain I was going through.
The silver appearing in my hair also taught me how important close relatives are during the days of marriage, illness, or death. In those same years, I also learned that when a house of mourning or a hospital filled with a steady stream of visitors, elders were, in their own way, practicing different styles of psychotherapy, not professional or polished, perhaps, but crude and genuinely helpful.
The Cost of the Joint Family System
In an Eastern society, where, at least in that era, a wife became part of a large family: siblings, parents, aunts, uncles, and a couple of elders would offer their opinion on every matter. Whatever decision followed might have served the extended family's interests, but the nuclear family often paid a price in many cases. One or two brothers would spend their entire lives holding the family together: marrying off siblings, preparing dowries, building rooms in the house for everyone, until they wore themselves out. Their tired eyes, and the grieving parting of their wives' hair, told another story. Children ran freely through the streets, but the eldest or middle Bahu would be sacrificed for the family. Husbands developed blood pressure and diabetes, lived away from home for work, and amid all the applause, a family would quietly sink into failure.
From "Bhabi's cooking is wonderful" to "Ami's feet, the eldest Bhabi's daughters press so well," every Friday or Sunday the whole family would gather at one house to be entertained, or during the holidays, all the Nands and Dewars would spend three months together at their mother's house. It was great fun, but no one stopped to think that a family was paying a price so steep that an entire generation was failing. The children of that family grew up distant from their parents, their education suffered, and slowly, economic and social failures crept into their lives like darkness into the veins. Amid the noise of everyone else's success, one or two families would be buried under a pile of compliments so deep that they didn't even recognize their own failure.
Interpersonal Therapy: Drawing the Right Lines
Such families exist in America too: families where children make sacrifices, and where parents also have their likes and dislikes. Drawing the right boundaries, keeping family relationships in their proper place, and having the courage to set one's relationships right, this is a core principle of interpersonal therapy.
Improving relationships without harming oneself; defining one's own role within the family in a way that is not harmful and is beneficial for everyone, including oneself; improving the way we communicate; and handling grief, sorrow, and regret with understanding: these are the foundations of this therapy.
Interpersonal therapy looks at what is happening in your life right now: how you communicate, how you handle conflict, how you cope with change, and how connected you feel to others.
Where This Leaves Us
In many of our communities, a joint family system exists in which either the Bahu is burdened with too much responsibility, or the parents go through deeply painful circumstances. Where poverty and ignorance destroy families, and our system is currently standing at the edge of collapse, real improvement is needed. Interpersonal psychotherapy is something many families need, to help everyone understand that making the joint family system work requires sacrifice from all sides. Otherwise, in an emotionally charged society, relationships will deteriorate in ways that damage society itself and become difficult to repair.
Political turmoil, social isolation, and relationship conflicts have taken on the shape of psychological problems, and rising suicides and disputes have brought us to stand at the mouth of a volcano.