Ajai R. Singh MD

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Abstracts Contd ( Mens Sana Monographs 2003-2006)

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You can browse here abstracts of Mens Sana Monographs published between May 2003 and Feb 2006. For further details see http://mensanamonographs.tripod.com


Singh A.R., Singh S.A. (2003), Psychiatric Consequences of WTC Collapse and The Gulf War, Mens Sana Monographs, Vol I: 1, May 2003, p1-12


 Along with political, economic, ethical, rehabilitative and military dimensions, psychopathological sequelae of war and terrorism also deserve our attention. The terrorist attack on the World Trade Centre (W.T.C.) in 2001 and the Gulf War of 1990-91 gave rise to a number of psychiatric disturbances in the population, both adult and children, mainly in the form of Post-traumatic Stress disorder (PTSD). Nearly 75,000 people suffered psychological problems in South Manhattan alone due to that one terrorist attack on the WTC in New York and the Pentagon in Washington. In Gulf War I, more that 1,00,000 US veterans reported a number of health problems on returning from war, whose claims the concerned government has denied in more than 90% cases. Extensive and comprehensive neurological damage to the brain of Gulf War I veterans has been reported by one study, as has damage to the basal ganglia in another, and Amyotrophic Lateral Sclerosis (ALS) in a third, possibly due to genetic mutations induced by exposure to biological and chemical agents, fumes from burning oil wells, landfills, mustard or other nerve gases. The recent Gulf War will no doubt give rise its own crop of PTSD and related disorders. In a cost-benefit analysis of the post Gulf War II scenario, the psychopathological effects of war and terrorism should become part of the social audit any civilized society engages in. Enlightened public opinion must become aware of the wider ramifications of war and terrorism so that appropriate action plans can be worked out.

Key Terms: Gulf War, Gulf War Syndrome, Post Traumatic Stress Disorder, Terrorism, Psychopathology of War and Terrorism, Organic Brain Damage due to Chemical Warfare.

 for details see http://mensanamonographs.tripod.com



Singh A.R., Singh S.A. (2003), Towards A Suicide Free Society: Identify Suicide Prevention As Public Health Policy, Mens Sana Monographs, Vol I: 2, July-August 2003, p1-16.




Suicide is amongst the top ten causes of death for all age groups in most countries of the world. It is the second most important cause of death in the younger age group (15-19 yrs.), second only to vehicular accidents. Attempted suicides are ten times the successful suicide figures, and 1-2% attempted suicides become successful suicides every year. Male sex, widowhood, single or divorced marital status, addiction to alcohol or drugs, concomitant chronic physical or mental illness, past suicidal attempt, adverse life events, staying in lodging homes or staying alone, or in areas with a changing population, all these conditions predispose people to suicides. The key factor probably is social isolation. An important WHO Study established that out of a total of 6003 suicides, 98% had a psychiatric disorder. Hence mental health professionals have an important role to play in the prevention and management of suicide. Moreover, social disintegration also increases suicides, as was witnessed in the Baltic States following collapse of the Soviet Union. Hence, reducing social isolation, preventing social disintegration and treating mental disorders is the three-pronged attack that must be the crux of any public health programme to reduce/prevent suicide. This requires an integrated effort on the part of mental health professionals (including crisis intervention and medication/psychotherapy), governmental measures to tackle poverty and unemployment, and social attempts to reorient value systems and prevent sudden disintegration of norms and mores. Suicide prevention and control is thus a movement, which involves the state, professionals, NGOs, volunteers and an enlightened public. Further, the Global Burden of Diseases Study has projected a rise of more than 50% in mental disorders by the year 2020 (from 9.7% in 1990 to 15% in 2020). And one third of this rise will be due to Major Depression. One of the prominent causes of preventable mortality is suicidal attempts made by patients of Major Depression. Therefore facilities to tackle this condition need to be set up globally on a war footing by governments, NGOs and health care delivery systems, if morbidity and mortality of the world population has to be seriously controlled. The need, first of all, is to identify suicide prevention as public health policy, just as we think in terms of Malaria or Polio eradication, or have achieved smallpox eradication.

Key Terms:

Suicide Prevention, Social Isolation, Social Disintegration, Depression, DALY (Disability Adjusted Life Years), Global Burden of Diseases, Psychiatric treatment in suicide




Singh A.R., Singh S.A. (2003), What Shall We Do About Our Concern with the Most Recent in Psychiatric Research? Mens Sana Monographs, Vol I: 3, p1-12.





Most clinicians and researchers are concerned with recent advances in psychiatry. This involves the danger whether something time-tested may get sidelined for extra-scientific reasons. That the pharmaceutical industry and super specialist researcher may keep churning out new findings to impress audiences is only a partial truth. Research progresses by refutation and self-correction. Acceptance in science is always provisional; changing paradigms, frameworks of enquiry and raising new questions is integral to breakthrough in scientific knowledge. Hence, there is in science a constant concern with the new. Moreover, the number of treatment non- responders to the time-tested swells with time, and researchers feel challenged to find ways and means of resolving their difficulties. Newer challenges need newer strategies. Obsession with the most recent can lead us astray, but a healthy evidence-based acceptance of the new is essential for advancement in psychiatric research. As indeed of research in all fields of medicine. And of science in general. The role of lithium and newer mood stabilizers in bipolar disorders are taken as examples to highlight this point.


Key Terms:

Psychiatric research, Refutation, Paradigm shift, Bipolar Disorders, Lithium, Mood-stabilizers, Treatment   non-responders, Pharmaceutical Industry.






Singh A.R., Singh S.A. (2003), Replicative Nature of Indian Research, Essence of Scientific Temper, and Future of Scientific Progress, Mens Sana Monographs, Vol I: 4, Nov- Dec 2003, p1-16.





A lot of Indian research is replicative in nature. This is because originality is at a premium here and mediocrity is in great demand. But replication has its merit as well because it helps in corroboration. And that is the bedrock on which many a fancied scientific hypothesis or theory stands, or falls. However, to go from replicative to original research will involve a massive effort to restructure the Indian psyche and an all round effort from numerous quarters.

The second part of this paper deals with the essence of scientific temper, which need not have any basic friendship, or animosity, with religion, faith, superstition and other such entities. A true scientist follows two cardinal rules. He is never unwilling to accept the worth of evidence, howsoever damning to the most favourite of his theories. Second, and perhaps more important, for want of evidence, he withholds comment. He says neither yes nor no.

 Where will Science ultimately lead Man is the third part of this essay. One argument is that the conflict between Man and Science will continue till either of them is exhausted or wiped out. The other believes that it is Science, which has to be harnessed for Man and not Man used for Science. And with the numerous checks and balances in place, Science will remain an effective tool for man’s progress. The essential value-neutrality of Science will have to be supplemented by the values that man has upheld for centuries as fundamental, and which religious thought and moral philosophy have continuously professed.

Key terms:

Replication, Refutation, Mediocrity, Scientific Temper, Religion, Value-neutrality, Ethics in Science.







Singh A.R., Singh S.A. (2004), Gandhi on Religion, Faith and Conversion: Secular Blueprint Relevant Today, Mens Sana Monographs, Vol I: 5, Jan-Feb 2004, p1-16.





Gandhi believed in judging people of other faiths from their stand point rather than his own. He welcomed contact of Hinduism with other religions, especially the Christian doctrines, for he did not want to be debarred from assimilating good anywhere else. He believed a respectful study of other’s religion was a sacred duty and it did not reduce reverence for one’s own. He was looking out for those universal principles, which transcended religion as a dogma. He expected religion to take account of practical life, he wanted it to appeal to reason and not be in conflict with morality. He believed it was his right and duty to point out the defects of his own religion, but to desist from doing so with other’s faith. He refused to abuse a man for his fanatical deeds for he tried to see them from the other person’s point of view. He believed Jesus expressed the will and spirit of God but could not accept Jesus as the only incarnate son of God. If Jesus was like God or God himself, then all men were like God or God Himself. But neither could he accept the Vedas as the inspired word of God, for if they were inspired why not also the Bible and the Koran? He believed all great religions were fundamentally equal and that there should be innate respect for them, not just mutual tolerance. He felt a person wanting to convert should try to be a good follower of his own faith rather than seek goodness in change of faith. His early impressions of Christianity were unfortunate which underwent a change when he discovered the New Testament and the Sermon on the Mount, whose ideal of renunciation appealed to him greatly. He thought Parliament of Religions or International Fellowship of Religions could be based only on equality of status, a common platform. An attitude of patronising tolerance was false to the spirit of international fellowship. He believed that all religions were more or less true, but had errors because they came to us though imperfect human instrumentality. Religious symbols could not be made into a fetish to prove the superiority of one religion over another.

 In a multi-religious secular polity like that of India, Gandhi’s ideas on religion and attitude toward other religions could serve as a secular blueprint to ponder over and implement.


Key words: Religion, Reason, Proselytization, Hinduism, Christianity, Conversion, Secularism



Singh A.R., Singh S.A. (2004), The Goal: Health for All; The Commitment: All for Health, Mens Sana Monographs, Vol I: 6, March-April 2004, p1-16.








Primary Health Care was the means by which Health for All by the Year 2000 AD was to be achieved. And Health for All was possible only if All were mobilised for Health. This meant not just governments and medical establishments, but people themselves. Primary health care is essentially health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost the community and country can afford. And in working for such positive health, the role of health experts or doctors is the same as that of a gardener faced with insects, moulds and weeds. Their work is never done. Primary health care is a health conscious people’s movement. Its implementation depends on knowledge of proper disposal of services and a persistent demand from an active and quality conscious consumer-the public. Strong political will, community participation and intersectoral coordination are its basic principles. However, the National Health Policy of India, 1983, was hardly debated in both houses when tabled. Both NHP 1983 and 2002 failed to confer the status of a Right to health, while most other nations are planning newer strategies to put Right to Health and Medical Services into practical use. Community participation in health is an aphorism that awaits genuine realisation in many countries of the world, notably of the third world. India, unfortunately, is no exception. Progressive Five Year Plans in India have reduced percentage spending over health as a part of GDP, which is an alarming state of affairs. Public awareness and activism alone can remedy this alarming condition. The people should not forget that health is not only a commodity that a benevolent government/ institution/ individual bestows on them. It has to be earned and maintained by the individual himself. Health problems cannot be solved in isolation. They will ultimately be part of our struggle for an egalitarian society, because better health care is a sign of a more evolved one.


Key terms: Primary Health care, National Health Policy, Health, Right to Health, Health for All by 2000 AD, Alma Ata Conference








Singh A.R., Singh S.A. (2004), Psychiatry, Science, Religion and Health, Mens Sana Monographs Annual 2004, Vol II: 1-3, May-Oct 2004, p1-118



The six diverse topics covered in this MSM Annual 2004 are an attempt to present to the contemporary thinking mind some of the major concerns of our society today. They include topic in the four areas of Psychiatry, Science, Religion and Health.

Psychiatry is important since it concerns psychopathology of the human mind and living. Resolving them would mean laying the foundations of correct thought and appropriate action. Science is important because this age belongs to it, and therefore there is the challenge, as also the danger, that this age maybe usurped by it. That is possible because the interests of Science and Man may clash, and the former may supercede the latter.

Religion is important because faith, the cornerstone of religion, plays a great role in guiding man’s thinking and actions. And anything that guides can also overwhelm and misguide. That thin dividing line which cannot be transgressed needs to be clearly demarcated by the contemporary rational mind. Health is important because it is often taken for granted, and its true value realised only after it is lost. Moreover, health is as much an individual as a social concern.

This volume, a collection of six monographs published between May 2003 and April 2004, covers a wide expanse of stimulating material for the reader interested in deeper understanding of issues which concern man and society today, as both grope forward in search of understanding and nodal points for concerted action.

Psychiatry, Science, Religion and Health is dedicated to the memory of esteemed Psychiatrist Prof. L.P. Shah.





Singh A.R., Singh S.A. (2004-2005), Resolution of the Polarisation of Ideologies and Approaches in Psychiatry, Mens Sana Monographs, Vol II: 4-5, Nov 2004-Feb 2005, p1-32.








The uniqueness of psychiatry as a medical speciality lies in the fact that aside from tackling what it considers as illnesses, it has perchance to comment on and tackle many issues of social relevance as well. Whether this is advisable or not is another matter; but such a process is inevitable due to the inherent nature of the branch and the problems it deals with. Moreover this is at the root of the polarisation of psychiatry into opposing psychosocial and biological schools. This gets reflected in their visualization of scope, in definitions and in methodology as well. Whilst healthy criticism of one against the other school is necessary, there should be caution against hasty application of one's frame of reference to an approach that does not intend to follow, or conform to, one's methodology. This should be done within the referential framework of the school critically evaluated, with due consideration to its methods and concepts. Similarly, as at present, there is no evidence to prove one or the other of these approaches as better, aside from personal choice. We can say so even if there is a strong paradigm shift towards the biological at present. A renaissance of scientific psychoanalysis coupled with a perceptive neurobiology, which can translate those insights into testable hypotheses, holds the greatest promise for psychiatry in the future. This suggests the need for unification of diverse appearing approaches to get a more enlightened worldview. It requires a highly integrative capacity. Just as a physicist thinks simultaneously in terms of particles and waves, a psychiatrist must think of motives, emotions and desires in the same breath as neurobiology, genetics and psychopharmacology. However, the integration must be attempted without destroying the internal cohesiveness of the individual schools. This will give a fair chance for polarisation in which a single proper approach in psychiatry could emerge, which may be a conglomerate of diverse appearing approaches of today, or one which supercedes the rest. A synthesis of cognitive psychology and neuroscience offers the greatest promise at present.



Resolution of differences, Integration of schools, Polarisation of approaches, Biological and psychosocial dichotomy, Psychoanalysis and Cognitive Neuroscience, Eclecticism in psychiatry 






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