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Morning MEDtalks with Dr KK Aggarwal 6th July 2018

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Dr KK Aggarwal    06 July 2018

Burari suicides: Was it a case of mass suicide or an induced psychotic disorder?

Ever since the Burari deaths were reported, it has set us all thinking and trying to find answers about what might have happened, what were the preceding events that made the entire family commit such an act? I too have been trying to understand the reason behind these mass deaths.

Mass suicides may occur for a number of reasons. People can be brainwashed to commit mass suicides. In such cases, the mind is in an extremely parasympathetic or relaxed state of mind and so becomes a suggestive mind, one which is more receptive to accept and act on the suggestions of others. A person who is in an emotional state of mind tends to be more receptive to ideas and suggestions of others and is therefore more suggestible.

The sympathetic state is the ‘fight or flight’ response of the body which comes into action when the body perceives a threat. In a sympathetic state of mind, a person would fight off suggestions through the processes of conscious defenses and critical judgments.

Suicide bombers or suicide attacks are another category of mass suicides, where the motivation may be an ideological cause or nationalism like the kamikaze, who carried out suicide aerial missions for Japan against allied forces in World War II. Mass suicides may be a means to focus attention on a particular issue. Mass suicides by farmers may be prompted by reasons such as persistent droughts, or damage to crops due to floods or any other cause. Jauhar or the custom of mass self-immolation, which was historically practiced is well known to us all.

But none of these applied to the family in Burari. So what led to this family of 11 to carry out such an act?

When I spoke to Dr Sanjay Chugh, a well-known neuropsychiatrist in Delhi, he said this could be a case of induced psychotic disorder or shared psychotic disorder, where one psychotic person in the family can induce one or more members of the family into a psychotic behavior. Typically, this disorder is characterized by transmission of delusions from the inducer, who is the originally ill patient and suffers from a psychotic disorder, to another person who may share the inducers delusions in entirety or in part (J Res Med Sci. 2011 Mar; 16(Suppl1): S453–S45). 

This disorder is usually common among people who live in close proximity and in close relationships. When one person is induced it is called Folie e deux; when it induces two, it is called Folie e trois; folie à quatre, when three people are induced, folie à cinq, when four are induced. Rarely, when all the family members share the same delusions, this is called folie à famille.

In such cases, dynamics of the family also play a major role. There are families that blindly worship the patriarch and would obey his commands without questioning his authority.

It appears from reports that in this case, Lalit probably had a psychotic disorder, who over a period of time induced others in a psychotic behavior, which ended in a mass suicide-like action. He thought he was conversing with his dead father and convinced his family that he was possessed by his father’s soul and hence was soon accepted as the head of the family as reported.

There are also reports that Lalit was particularly attracted to tantric beliefs. It all began with some ailment that his own son had, because of which he had lost his voice few years back. His voice was restored after Lalit is said to have performed some kind of tantric sacrifice, which may have reaffirmed his belief in such practices.

It has also emerged that the family was under influence of a self-styled tantric known as Gada Baba, who practiced some banyan tree occult. It has references saying that the dead bodies should replicate the prop roots of a banyan tree. The handwritten notes in the diaries found, call this as “badh or vat tapasya” saying that doing this would “make God happy”. This is also how ten of the 11 dead bodies were found hanging from an iron mesh in the house, in a formation resembling the hanging roots of a banyan tree.

The Banyan tree is associated with Yama, the God of death. The Banyan tree does not allow grass to grow under it indicating that it does not allow for any rebirth and renewal. A banyan tree is said to be immortal. It is stable and constant.

This family might have carried out the Banyan tree ritual harboring a false but firm belief that they too will not die. They were convinced by Lalit that their father’ soul would appear and save them after the ritual.

CCTV footages have shown five stools being carried into the house that would be used for the hanging, but 11 people died. This is indicative of one person who ‘masterminded’ or planned and directed the entire ritual. Incidentally, the postmortem report indicates that Lalit and his wife were the last to die.

This story needed to be told here to create awareness about induced psychotic disorder, which is reportedly a rare disorder. It is important to remember that one psychotic patient can influence others in their vicinity. Physical separation of the inductor and the recipient/s, who do not have a mental illness in such cases, may prevent sharing of delusions. The inductor often may be suffering from schizophrenia.

IMA Elections: Elections of 2018-2019 & 2019-2020

IMA election commission has invited nominations for the elections. The nominations duly filled as per prescribed proforma must reach the office of the Chief Election Commissioner positively on or before 5.00 p.m. on 31st July 2018. Nominations received after 5.00 pm on 31st July 2018 will be treated as invalid. The circulation has been sent to all the members of the Central Council (Regular member, Ex-Officio Members, Office Bearers and members of the Central Working Committee), whose names have been received at IMA (HQs.) from various branches on or before 31st March 2018.

Make public complete reports of medical colleges’ inspection within 6 weeks: CIC to MCI

The Central Information Commission (CIC) has directed the Medical Council of India to place in the public domain inspection reports of all medical institutions in the country within six weeks, in a major decision for the cause of transparency. 

HC: Doctors need not provide contact details to patients 

Thiruvananthapuram: A single bench of the high court on Wednesday stayed the Kerala State Consumer Disputes Redressal Commission order that doctors should provide their mobile numbers and contact details to their patients.

A new Dept. of Occupational and Environment Health in MAMC

As the pollution in the national Capital keeps on getting bad to worse, Maulana Azad Medical College (MAMC) is coming up with the Department of Occupational and Environment Health. The full-fledged department, with a dedicated staff, will not just do surveys but also research on the data collected to come up with effective solutions, shared the doctors.

Codex Alimentarius Commission meeting on food safety and quality standards

The UN food standards body Codex Alimentarius Commission meeting in Rome to adopt food safety and quality standards concludes today.

A joint initiative of the FAO and the WHO, the Codex Alimentarius is a collection of international food standards, which cover all the main foods, whether processed, semi-processed or raw. Codex provisions concern the hygienic and nutritional quality of food, including microbiological norms, food additives, pesticide and veterinary drug residues, contaminants, labelling and presentation, and methods of sampling and risk analysis.

Healthcare providers lack knowledge on the right inhaler technique

Healthcare providers (HCPs) lack knowledge on appropriate inhaler technique leading to ineffective therapy, according to a systematic review published in the May/June 2018 issue of the Journal of Allergy and Clinical Immunology: In Practice. Lead author Vicente Plaza, MD, PhD, from the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, and colleagues said, “These results highlight the urgent need to design efficient strategies to improve the training of [HCPs] in the appropriate use of inhalers.”

Genetics and lifestyle additive for cardiovascular risk

A poor genetic cardiovascular risk profile coupled with poor lifestyle behaviors is associated with cumulative risk for future cardiovascular events, says a study published online in JAMA Cardiology on June 27, 2018. Pim van der Harst, MD, University of Groningen, The Netherlands and senior author of the study said, “Until now, genetics have generally been left out of lifestyle studies on cardiovascular risk. We wanted to look at whether lifestyle changes will help people with a poor genetic profile or if are they just out of luck. We found that good lifestyles lower risk in all genetic risk categories to about the same relative extent.”

Cabinet approves DNA Technology (Use and Application) Regulation Bill, 2018 

The Union Cabinet has approved The DNA Technology (Use and Application) Regulation Bill 2018. The primary intended purpose of this Bill is to expand the application of DNA-based forensic technologies to support and strengthen the justice delivery system of the country. The Bill also has provisions for mandatory accreditation and regulation of DNA laboratories.

Mothers who follow 5 healthy habits may reduce obesity risk in their children

A new study led by Harvard T.H. Chan School of Public Health published online in BMJ on July 4, 2018 says that children and adolescents whose mothers follow five healthy habits - eating a healthy diet, exercising regularly, keeping a healthy body weight, drinking alcohol in moderation, and not smoking - are 75% less likely to become obese in comparison to children of mothers who did not follow any such habits.

ICMR Essay Competition-2018

The Indian Council of Medical Research (ICMR) is inviting entries from undergraduate and postgraduate medical students for 2018 ICMR Essay Competition. The last date for the 2000-worded essay is August 15, 2018 (by 5:30pm). Results will be declared on October 2, 2018. The best essays will be published in the Indian Journal of Medical Research. The two topics given are

  1. Innovation in Medicine: New Ideas for Translation
  2. Gandhi & Health: Celebrating 150 Years

The entries i.e. soft copy as single pdf file may be sent through the Principal/Director of the concerned medical college addressed to: Dr. N. C. Jain, Scientist G & Head, HRD, ICMR Hqrs., Ansari Nagar, New Delhi-110029 only through email: icmrcri.hrd@gmail.com No hard copy please.

Drink Coffee

A study published in the American Medical Associations journal JAMA Internal Medicine is encouraging coffee lovers to just brew it. The study from the U.S. National Cancer Institute used information from more than half a million British volunteers who provided blood samples and answered detailed health and lifestyle questions. Almost one-third of those in the study drank two or three cups of coffee daily, and 10,000 hardcore types guzzled at least eight cups daily. After 10 years of the study, results showed that non-coffee drinkers were more likely to have died than those who did not drink coffee.

Participate in survey on inflammatory bowel disease: 

https://docs.google.com/forms/d/e/1FAIpQLSedaDx2iXiwU1vBpYdU6ebfCap-7PYAPSqXRJTeg8ULvNOcLg/viewform

 

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI

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