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Case Study II: Kanchan

A 35-year-old, Kanchan is married and has a teenage daughter and son, whom she no longer sees. Kanchan started having problems with her mind when her son was about two years old. She suddenly started singing and dancing and laughing aloud. The husband informed her brothers about her condition. After about a week of showing symptoms, her brothers brought her back with her children to see if they could help with treatment. According to Kanchan, it was her typhoid (high fever) that triggered her problems. Her fever took time to subside, and in that period she started having fits as well. She was being treated in the local hospital.

She ran away from home two or three times but was found by her family and neighbors before she could go far. Once, after continued medication, her condition improved and her brothers took her back to her in-laws’ house. Her husband, a fisherman, was away at sea then. Her elder sister-in-law beat her up and drove her out of the house, keeping her children. She was found by Iswar Sankalpa staff at their medical camp at Kidderpore (a locality within Kolkata) in an incoherent state in 2010.

Commenting on her two-year stay at Sarbari, our shelter for urban homeless women with psychosocial disabilities, Kanchan said:

Sarbari is a good place. I had no problems with the other residents. The other

arrangements like food and staying was good. The staff were good to us.

With medical and nursing care she regained her mind, clinical improvement was satisfactory and she went back home after our social workers contacted the family.

She started staying with her elderly parents and four brothers. The youngest brother (unmarried) is presently working in Kerala and has built the pukka (a cement and brick house with tinned roof and one medium-sized room) in which she is now living with her parents in a nearby township. Her family and neighbors are helpful and supportive. For example, her mother undertakes the household work while Kanchan works.

Kanchan earns her living by making bins (local cheap cigarettes) at home and gets around Rs. 2000 per month. She has to spend nearly Rs. 1000 monthly on her medicines which she gets herself from a nearby government hospital after meeting the doctor every month. She engages well with her doctor who she feels is a nice person. She reported that she is now aware that she needs to see her doctor regularly and continue the prescribed medicines.

Her daughter had once come to see her with a relative. Apart from that she has no contact with her family by marriage. She says:

I want to go back to my husband’s house and be with my children. I miss my

children badly.

Most of her time is spent on making biris. She goes around her neighborhood in her spare time. She has come to know of two other women with mental illness in the area and helped one of them to connect with her doctor.

Study of these above two cases shows points of similarity; apart from the correspondences in their accounts of affliction and the downward trajectories they lived through, there are similarities in their respective journeys toward recovery and how Iswar Sankalpa’s contact with them demonstrates the ideas and ideals we discussed above.

  • 1. In terms of offering care and rehabilitation, the principle of effecting least displacement and disruption in the current life situation, while facilitating active involvement of some members and resources in the community, is obvious in Arif’s case. All the interventions and care we have provided have had a minimal impact on his ongoing lifestyle. We have tried not to disrupt his way of life while delivering mental health care. The daily care given to Arif was provided by the community, and we supplied other material resources like clothing and medicines. To begin with, an exactly similar approach was not possible with Kanchan because she was in a far worse state of health, both physically and mentally, at the time of first contact. Moreover, she was more vulnerable to sexual and other abuse in the streets. She was removed to, and cared for at, the shelter. For Kanchan it took longer, but recovery was equally satisfactory. Her and our initial efforts at rehabilitation with her family were unsuccessful, but later she was able to maintain gainful activity and support herself financially in a locality of her choice. Both Arif and Kanchan have gainful employment. From a care receiver Arif has himself become a caregiver, while Kanchan also, to some extent, tries to take responsible care of others in need.
  • 2. Respect for the individual’s autonomy and choice was maintained throughout with both Arif and Kanchan. At no point was any decision, whether about medication, accommodation, contact with respective families or employment, unilaterally imposed by the care team. At every point, it was a process of discussion, explanation, information sharing and empowering for independent decision making. Usually, we think of restoration as restoration to one’s family of origin. Here we respected Arif’s decision to remain with his present community. This is a different concept of restoration. Despite Arif remembering his past job and past work experience, he chose a different employment, and we abided by his decision to choose his work. In Kanchan’s case, her first choice was to go back to her marital family and assume her previous role as a housewife. Despite her and our efforts, this option was not successful, and, realizing this, she herself decided to contact her parental family and chose her current situation and mode of supporting herself.
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