Book Review: 'CROCHET - The Gordian World of Tahir Khan' and children are NOT all right

Book Review: 'CROCHET - The Gordian World of Tahir Khan' and children are NOT all right

Oct 1, 2022 - 13:30
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Book Review: 'CROCHET - The Gordian World of Tahir Khan' and children are NOT all right

‘CROCHET – The Gordian World of Tahir Khan’ — the debut novel by 32-year-old Raman Agarwal deserves accolades for its very topical theme. One that is shrouded in ignorance and all-pervasive stigma of the monstrous proportion, a subject that is just started being talked about in a hush-hush tone in urbane upper-middle-class India. Of course, this talk is particularly limited in metropolises but about which largely the prevailing consensual paradigm in both sides of the nation ‘India and Bharat’ is — ‘Children just cannot have it — they are perfect creatures’.

Crochet breaks away from the clay-mould of this pervasive and long held false belief and through ‘The Gordian World of Tahir Khan’ debunks the prevalent societal denial and asserts convincingly that –

‘Children are NOT all right- like adults they suffer from mental illness as well- and not merely developmental disorders, but severe mental illnesses -Depression, Bipolar Disorder and Schizophrenia.’

The book also makes the right pitch — the root cause of childhood mental illness is both nature and nurture, and childhood traumas often are key triggers for the onset of mental illnesses.

CROCHET through the roller coaster life of southpaw Tahir Khan makes a powerful pitch to change the narrative around the incidence and severity of mental illnesses in children and adolescents one reader at a time.

First of its type

To the best of my knowledge (I am a voracious reader of all types of books — technical, fiction and non-fiction on mental illnesses), CROCHET is the first Indian work-fiction or nonfiction – that traverses the road not travelled in the past and addresses the subject of mental illnesses not only of Generation Z (with the early 2010s as ending birth year) but even of a part of Generation Alpha (mid-2010s as starting birth years).

Unsurprisingly then, within a couple of months of being published, CROCHET has won the ‘American Fiction Award’ (by American Book Fest)-the best book in New Age Fiction Category.

It is indeed a new age book, which brings the taboo subject out of the closet. It reminds me of my own struggle in childhood and makes me ask the existential question-‘Why no one told me this before, when I was battling life and death situation in childhood.’

To put it in context, way back in 1968, aged 10, I went down the hill in the abyss, suffering from my first bout of severe depression, persistent suicidal ideation and first unsuccessful suicide attempt-the trigger of the onset was repeated brutal childhood sexual assaults by three adults, with my mouth clasped and threat to be killed by perpetrators, if I spoke out.

Back then I had no clue what depression was, and no one told me what my ‘mystery illnesses were because then existing paradigm was — ‘children do not suffer from mental illnesses’ — the paradigm has not only remained unaltered but has further entrenched in the country.

In this review I delve deeper in the rubrics of the subject matter of the book through eyes, ears and mind of its protagonist Tahir Khan and his conversations with Alex, his early adult-hood therapist cum psychiatrist who helps Tahir to decipher the root causes of his misery in genetics cum trauma of childhood. I also hold conversations with Raman, the author of CROCHET, to throw light on how this fiction is partially rooted in the struggles and confusions of his own growing-up years and for further validation of the incidence and severity of mental illness I also hold conversation with reputed Pune-based psychiatrist Dr Bhushan Shukla to lift the veil from facts and fictions of mental illnesses. Bhushan for past two and half decades has tried to ameliorate mental illnesses in children and adolescents. I begin with most recent findings form the survey of McKinsey Health Institute which says succinctly — ‘it is difficult time to be young’.

In May 2022, the McKinsey Health Institute (MHI) after a survey of 6,000 Generation Z respondents in ten European countries, concluded Gen Z reports poorer mental health when compared with older generations. The finding echoes results of a similar survey by McKinsey of American Generation Z respondents in January this year.

In India, the subject matter of even adult mental health is just coming out of the closet. The last decade has seen some positive changes- the country got its maiden Mental Health Policy (2014) and it enacted the global best practices Mental Health Care Act (MCHA), 2017. Also, of late there have been attempts at increasing the advocacy and awareness about mental illnesses and few brave sufferers and caregivers (including few celebrities) have opened up about lived experiences of mental illnesses of self or family members in media, social media and through few books on lived experience.

But the children’s mental illness and mental health is a virgin topic and unmet need, mainstreaming of which is the need of the hour.

And CROCHET ups the ante and fills this vacuum.

Talking about the book, it begins in flashback mode, when young Tahir, an engineering student, after locking him for six months inside his hostel room, walks out in a comatose state, to go to “Bodhi Counselling and Therapy Centre at Jaipur.” Visiting a therapist was a life-altering momentous decision for Tahir which involved months of weary deliberations. And the choice of the therapy centre itself was accidental, the centre name was on an old newspaper that wrapped his hostel room window had placed it at the top of city therapy centres. Tahir is met at the therapy centre by Dr Alex, the therapist who incidentally was also a psychiatrist. And it is through the talk by Tahir session by session with Alex that the truth emerges and finally, Tahir finds his answers and moorings.

The book through the narratives of Tahir with Alex takes readers to the inner sanctum-sanctorum of Tahir and the real stories of his unflinching love for his mother Nazeema, his extreme need for his love object Ghazal whom he had met just once in a school function but with whom he talked daily on phone for hours in the night, a platonic relationship without which he could not survive and his bete noire Chayan, a bully of the worst who started tormenting him in childhood in the cricket coaching field and continued to do so in the college.

As the story progresses through twenty-one short chapters of the 270 pages of the book, with talk-therapy and medication by Alex the layers of the truth start emerging and the climax comes in the last five chapters- Answers; Dancing Queen; Kids are not Right; Love, Need and Greed and the last chapter of the book Crochet.

To cut the long story short, these three persons in the life of Tahir, who seemed very real people of flesh with whom he interacted were nothing but part of his auditory and visual hallucinations, delusions, persecutors and paranoia.

From real to hallucinations and delusions

The love:

Surreal though it may look, Nazeema, Tahir’s mother, who loved him more than anything or any person in the world, had died of lung cancer when Tahir was a child of barely four years, but till he went to engineering college he continued to see his mother and converse with him.

It was the demise of Nazeema, for whom Tahir meant the world, that first sent Tahir to a mental roller coaster and the first signs of his being mentally unwell surfaced. Dr Afzal Ali Qureshi, psychiatrist friend of Tahir’s father Azhar, detected these incipient symptoms of the impending onset of his mental illnesses. However, Azhar did not pursue diagnosis and treatment out of fear of his only son getting branded crazy and mad and due to the fear of stigma more particularly because of the family history where Musafir, the paternal grandfather of Tahir had developed psychosis after the death of his wife Saroja (while giving birth to Ajhar). Musafir thereafter lived for 14 years with full-blown Schizophrenia amid delusions and hallucinations. He always assumed Saroja was not dead but alive and by his side. In the end Musafir took his own life.

Such antecedents forced Azhar to initially dilly dally in starting Tahir’s psychiatric treatment.

The need

Ghazal was the love object and ultimate need of Tahir whom presumably he had met once in a school function but with her, Tahir conversed for hours daily and approved of everything Tahir said or did. As its layers peel out later it transpires that Ghazal simply did not exist in the real world and she was just a figment of Tahir’s imagination –which existed only in his mind and waking dreams.

The guilt

Most intriguing was the case of Chayan, the bully who daily tormented Tahir in childhood by bullying, physically assaulting and branding him a Pakistani and terrorist (Azhar with his son Tahir lived in Delhi’s refugee colony of Jehangir Puri). Chayan later moved to engineering college with Tahir where he continued bullying Tahir day and night.

But as we end to the climax in the penultimate chapter of the book it transpires that when Tahir was around ten, while being bullied and thrashed by Chayan in cricket fiend, Chayan was accidentally pushed by Tahir in self-defence and Chayan died. But the hallucinations and delusions of getting tormented by Chayan continued to haunt through adulthood.

Treatment camouflaged as vitamin

It was after this accidental death of Chayan by the hands of Tahir that his father Azhar puts Tahir under the psychiatric treatment of his psychiatrist friend Ali but the prescribed medication, a SSRI Depressant was always given to Tahir telling it was a vitamin. It was difficult for Azhar to accept his son suffered from mental illness. And administering  psychiatric medicines camouflaged as vitamin is the norm even today.

Medication non-conformity

Then Dr Ali shifted his base to USA, and Tahir got admitted to engineering college, the medication was discontinued and over next two years Tahir developed full blown Schizophrenia and ultimately, he landed at the couch of Dr Alex.

Enter talk therapy and medication

It was in session by session conversation with Dr Alex and accepting the need for psychotropic medication and ensuring full conformity to medication that inner layers of Tahir’s genetic lability (Schizophrenia of Tahir’s grandfather), childhood trauma (death of mother when Tahir was four) and the childhood guilt (accidental murder of Chayan) peeled out one by one.

The ailment has a name

In the climax of towards end of the book, Tahir one by one, starting from the grave of his mother, and further assisted by his father and a childhood friend has self-realization and self-discovery, and is relieved to find that finally his condition has a name ‘Schizophrenia.’

It transpires that Tahir’s mental illness was also aggravated by his father’s aloofness (which had roots in his own childhood) and being engrained since childhood by him to Tahir, that being winner is all which counts in life, no one remembers runners up or the loser. Looking back the burden of expectations put on young Tahir were triggers in themselves.

Inside the mind of the author

Readers will get inside 270 pages of the book, finer details of the etiology, onset and course of Tahir’s psychosis that turned into full blown Schizophrenia by the time he turned 18. But because, Raman first started writing this book when he was barely 18, when it is almost impossible to understand what mental illnesses mean, I decided to have a conversation with him. Here are the excerpts:

Raman first began writing the book in 2008, when he was a lonely teenager in an alien city trying to find his moorings. He found solace in writing his thoughts in a notebook. His original story was vastly different. It was not even called Crochet. Originally, it was a story exploring the theme of loneliness.

Author Raman Agarwal. Image courtesy Akhileshwar Sahay

Later Raman lost his notebook and drifted away from writing and had found remedy of his loneliness in newfound friends. He recommenced writing in 2010, a life defining year for him when he was shattered by his father informing about the death of his paternal grandmother. Things at his college were bad (like that of Tahir), he could not travel to attend her funeral and was soon submerged by the dark pit of loneliness from where the dire urge to write again took over him.

Writing for Raman became a means to vent out and was limited to his own experiences. Aided by internet and some serous rec=searches he recommenced serious writing by 2016 and slowly Tahir and other characters found their form and voice. Raman took to researches no doubt but CROCHET the way it has emerged has imprints of his firsthand experiences as well.

Young that Raman is, like all young Indians, his knowledge of mental illnesses is in hindsight. He candidly admits that he had no clue of what mental illnesses were all about till very recently, though he knew how terrible being lonely felt like. He just started the book to bring the story of a normal teenager who suffered in silence. And he admits that not all traumas have similar triggers, and no two triggers can be compared. For some, getting stuck in traffic can cause enough distress to upset their daily life. For others, the reason could be a death of a loved one. He adds candidly, one cannot be discarded as ‘not significant enough’ as compared to the other. All children go through stressful times at some level. Some of them can deal with it and get on with their lives. For the others, the stress could be too much to deal with. As per Raman, the core purpose of writing Crochet was to highlight the life of Tahir—a kind of the later kind.

When I probed Raman deeper what made him pick up Crochet as a subject, the first book in the country, that is about Childhood/ adolescent onset of a major mental illness Schizophrenia, he adds candidly:

“Crochet initially was a story of a lonely kid, screaming within, dying in internal turmoil. Elements of Schizophrenia in the story were a result of excessive reading. I found a deep connection between depression and delusions (and vice versa) during research, and it seeped into the story. Oftentimes, we put so much emphasis on physiological well-being, without understanding the impact of psychological well-being on the former. The two of them go hand in hand—as much for the children as for the adults”.

“In fact, it can be more severe for the children to cope because, unlike adults, children are more susceptible to getting into a shell, keeping their troubles to themselves. Parents either live in ignorance or in denial. Rama does not blame them. They are constantly fighting a conflict themselves. No parent wants their child to be socially outcasted. Raman  only wonders why no one has written about it before.”

To the question to explain how did Raman stumble on Tahir as the narrator and chief protagonist of Crochet and does Tahir has a real-life connection and what are the key messages of the book, Raman writes the key for him was asking for help and normalising psychological wellbeing. Early in the life of the published book, Raman feels gratified that a young reader wrote to him after reading Crochet, telling him, she had been considering seeing a therapist for a long time but could not bring herself to do it. And after reading the story, she decided to seek help.

Raman philosophies, the easiest thing to do is bottle their emotions within themselves. To ape what the others are doing. To try to fit into socially acceptable outfits. And he hopes that Crochet breaks those stereotypes of what normal looks like.

Raman says matter of fact — Tahir can be anyone. He can be a boy who lives next door or plays with your kids, or he can be your own too. All he wants is love, and someone to understand him.

When I questioned Raman that often severe mental illnesses like Schizophrenia and Bipolar disorder are rooted in biologically, that is have genetic lability. In the case of Tahir, it was his paternal grandfather. But the real trigger of onset of illness of Tahir is the childhood trauma of being bullied as a Pakistani and terrorist in the cricket coaching field. I asked Raman to what extent childhood bullies and the guilt of the accidental death of Chayan in childhood by the hand of Tahir could have aggravated his illness.

Raman writes back, Guilt, he believes, is one of the strongest human emotions. It is dark like shadows (Raman is a big fan of Dostoevsky’s portrayal of guilt in Crime and Punishment). Raman adds that Tahir partially blamed himself for his mother’s death as well. The feeling multiplied after Chayan’s death and pushed him into a dark pit of paranoia and delusional guilt, playing a vital role in aggravating his illness. There were of course other elements of bullying and constant pressure from his father to ‘man up’ that added to the mix.

When asked about the central message he wants to give readers of CROCHET, Raman has absolute clarity- ‘The kids are not all right! And they need help!

Given the fact that ‘CROCHET’ is the first book in the country (at least to my knowledge) about mental illnesses in children, I decided to put some critical questions to Dr Bhushan Shukla, noted Pune based psychiatrist having extensive experience of handling child and adolescent mental disorders in clinical setting and here are few pearls of wisdom he has shared.

One, children are much more susceptible to mental distress than adults due to their dependence on adults for most things. but children also have a protective mechanism at the same time. Supportive family and friends and a developing resilient brain helps them get over difficulties better than adults. So, childhood is a risk factor as well as good prognostic factor depending on the nature of disorder.

Two, about the common mental ailments observed in the younger cohorts, Dr Shukla puts them in age bracket. Firstly, 0-6 years of age – neurodevelopmental issues like autism, developmental delays and eating/elimination disorders are common, secondly in the 7-12 years age group one finds leftovers of neurodevelopmental disorders, anxiety disorders, ADD/ADHD, specific learning disabilities. And, thirdly, in 12+ – 18 years cohorts are cases of depression, anxiety disorders, relationship issues, bipolar disorder and schizophrenia. Dr Shukla admits to seeing spike in all of these in recent years.

Three, when asked how susceptible children are to more serious mental disorders say recurring depression, bipolar disorder and Schizophrenia and what the earliest onset age he has encountered in children for these illnesses, Dr Shukla adds: “Susceptibility is a difficult part to assess once a child has been diagnosed with serious conditions like severe depression, bipolar or schizophrenia. Dr Shukla admits having seen all these conditions appearing in children as young as 11-12 years old. One child received diagnosis of schizophrenia at 9.5 years.”

Four, when asked about how different are symptoms of mental illnesses in children compared to late teens and early adulthood. And how different are the treatment regimes, Dr Shukla has following to say:

“Symptoms in children are mostly disruption of behaviour rhythms, mood fluctuations, regression and effect on school and academics. Due to immature cognitive structure, crystallization of psychopathology namely phenomenological signs can be ambiguous or even absent.”

About treatment he says pharmacological treatments remain essentially the same but lot more stress needs to be on family education, school support and psychological work with the child.

Five, about the spike of mental illness in children in the Covid era and its aftermath, Dr Shukla points out to the avalanche of anxiety disorders, screen addictions and relationship issues after Covid. Serious neurodevelopmental disorders like autism and SLD that missed detection due to isolation of families too are presenting in much more worsened state.

Six, when asked about spike in cases of children with bipolar disorder in USA after publication of the book ‘The Bipolar Child’ there and has he seen similar surge in India, Dr Shukla candidly says India has not seen any such surge. Bipolar in prepubertal children remains a rare diagnosis which he encounters in practice. Just like how it was 20 years ago. Many ADHD were labelled as mood disorders in the past. Wider availability of stimulant medication must have reduced it now.

Seven, Dr Shukla has clear messages for parents whose children might be suffering from mental illnesses — get help early. Do not blindly trust doctors or AYUSH practitioners. Do not use any experimental therapies. Anything without clear clinical evidence and safety should be used very cautiously. He also has a powerful message that severe mental illnesses are NOT caused by bad parenting so parents should not whip themselves for everything that goes wrong with the child.

Finally, to explain what role childhood trauma, bullying and sexual assault play in emergence of early life mental illnesses, Dr Shukla points that all these can potentiate genetic vulnerability and bring forward the onset of illness. They can act as precipitants and perpetuating factors as well. More severe the trauma or more numerous such events, more chances of the child getting severely affected. He further adda that many times, child seems to be coping well initially but their personality can alter negatively due to these experiences. So immediate wellbeing may be a facade.

The author had first had experience with childhood mental illnesses. He is an ex-member of Goverment of India Mental Health Policy Group and ex-member of Cental Mental Health Authority. He is Principal Instigator of Whole Mind India Foundation and Action Group for Mission Zero Suicide India. 

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