Voices of Resilience

Understanding Uncertainty: Sumadhra's Story of Strength and Resilience


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About the Case Study

Resident’s Profile:

Marital Status:
Rehab Duration:
27 Years
Illness Duration
46 Years
Patient’s Alias Name:
Professional’s Name:
Shipra Saran
Author’s Name:
Shwetha Jois
Emotionally Unstable with Borderline Personality Disorder
Medication, Therapy and Rehabilitation

About the Resident

deWavering through the unbridled world can be a privilege for many, but not for Sumadhra. She is strong, bold, and filled with a zest for life, yet she is a prisoner of her own mind. Just as joy and comfort can cradle you in the early years, a lack of them could possibly devour a few too. 

Born and raised in the US in the 1970s, she grew up with the opportunity to learn from two different cultures while also developing her own unique identity. However, nine years later, she was forced to move back to India with her grandparents. During this time, feelings of abandonment were accompanied by a sense of darkness. As time passed, she began to feel neglected and unloved by her parents, forcing her to battle these emotions on her own at such a young age. In a year, this snowballed into her first attempt at suicide, leaving those around her in absolute shock.

Suicide is a complex issue with many contributing factors. There is no single answer to the question of why a child might attempt suicide before the age of 10, but various factors can influence a child during moments of vulnerability. It could be due to mental health conditions, trauma, bullying, or a family history of suicide. At times, it can also be due to substance abuse or access to firearms.

Owing to this, her parents rushed back from the US, uncertain of what may have led her to this point. The family moved to Mumbai, but little did they know that the issues they were distant from were about to unfold before them. As an innocent child unaware of how to manage her emotions, whims, and desires, her mind dwindled as she grew into adolescence.

The family saw multiple incidents where she would tear her mother’s clothes, break her belongings, and the sort. During this time, they witnessed unforeseen mood swings, hidden aggression, and hostile feelings towards her mother. They never expected her to directly cause any harm; however, she did! She pushed and hit her mother when she was denied her desires, resulting in a serious spinal injury. Till this point in time, they were unable to understand why she expressed aggressive and suicidal tendencies. This episode highlighted that there may be other underlying factors that led to her unpredictable nature.

People who are emotionally unstable and with borderline personality disorder often tend to act without thinking, experience delusions or hallucinations and may be struggling with anger management problems. It could also be due to substance abuse and comorbid mental health conditions. The presence of all or some of these factors can make the person feel threatened or paranoid and increase the risk of violence. It is important to note that the vast majority of people with bipolar disorder and depression are not violent. However, it is important to be aware of the risk factors for violence in these populations so that appropriate steps can be taken to prevent it.

Case History

Sumadhra's parents found her difficult to deal with, so they sent her away to college. She stayed with a relative to develop a sense of independence and responsibility. They thought some distance would help, but it was then that she started showing signs of an inability to adapt to change. She began falsely accusing her cousin of kissing her. This was the first of Sumadhra's false sexual assault claims.

Borderline personality disorder (BPD) affects how a person thinks and feels about themselves and others, as well as how they behave. People with BPD often have intense emotions that can change rapidly. They may also have impulsive behaviours, unstable relationships, and a distorted self-image. As strange as it may seem, they often tend to create narratives to feed their emotional needs.

At 23, Sumadhra's father passed away, worsening her condition. She became emotionally unstable, neglected her hygiene, and exhibited suicidal tendencies. She expressed rage and violence, making it difficult for her grieving mother. The family was devastated and in mourning. Sumadhra was unable to cope with the distress and began reacting in unimaginable ways. 

The episodes were more frequent and severe, and they had gone untreated for far too long. After a psychiatric evaluation, she was admitted to a facility for 4 years and later to another institution for 10 years. Even with 14 years of rehabilitation, she was unable to manage her symptoms and violent tendencies. During this period, she falsely accused several staff members, ranging from doctors, psychologists, patients, and security personnel, of violating her sexually. These complaints cannot be taken lightly and tend to open investigations, which could lead to the end of one’s career, imprisonment, and a wound for a lifetime. She was discharged from both institutions as they found it difficult to manage such concerns and complaints regularly.

She was unable to manage her symptoms on her own, and it had become difficult for those who tried to help her. She had no choice but to move back into her aunt's place for a while. She even tried to poison her aunt and uncle by adding soap powder to their drinking water. This made the family realise the seriousness of her mental condition and the need for constant care.

The Role of Cadabams

As a US citizen by birth, she was forced to renounce her citizenship and was given Overseas Citizenship of India (OCI) status. The court of law deemed her to need institutional care for life. This was a turning point for the family; they knew she needed care and had tried many options, but nothing seemed ideal. With a heavy heart, they admitted her to Cadabams that same year, knowing she would be there forever.

She initially found it increasingly difficult to adapt to the routine, rules, and regulations set by the centre. Surprisingly, she claims that she was in a coma when she overdosed on medication; however, the counsellor stated that this is a delusion in her mind. Even though her concerns around sexual assault have been frequent, Cadabams has overcome such challenges and created a system to manage her symptoms better. Currently, she is extremely dependent on her counsellor to manage her emotions and daily concerns.

She tends to gain satisfaction by harming herself and invoking a sense of worry or stress in another person, especially if it’s someone’s attention that she’s craving in particular. She is a very sensitive person and can be easily triggered to harm herself, making it necessary for the staff to address her issues and concerns with utmost precaution. At times, she may suddenly remove her clothes in public without being aware, creating uncomfortable situations for those around her. She would do random acts of self-harm to gain attention, like starving for days at a stretch, drinking engine oil, or trying to get electrocuted. If the staff is unable to calm her down during an episode, either her medication dosage is changed or, in extreme cases, they may resort to sedation. 

The doctors suspected that she despised her previous counsellor and was disturbed by the relationship they shared. She had previously hit her former counsellor out of anger. Her reasons for doing so could never be justified. The slightest stressor could bring out a fit of anger and provoke her, be it the lack of a spoon or unanswered calls. Keeping this in mind, her family chooses to visit her at the rehab or call her, as she cannot be controlled without professional care. However, her counsellor was changed recently, and she has been quite taken with her current counsellor and seems to be doing much better since.

Professional’s Perspective

According to Dr. Sunil, the director facilitator at Cadabams, Sumadhra has been extremely challenging to deal with for her family, especially her mother. The family sustained their needs on her father’s pension, making it difficult for them to bear the hospital bills. He explained that due to financial constraints after her father’s passing, the family is dependent on her relative to cater to their expenses, while Cadabams looks after the balance expenditure. 

Even with 27 years of rehabilitation, she’s had multiple scenarios and attempts at self-harm, which can endanger her safety or that of others around her. In early 2023, she attempted suicide by consuming liquid soap. The professional staff were shocked and immediately rushed her to the emergency treatment ward, where they flushed her stomach of all toxins and provided her with critical care. After a few weeks of treatment, she resumed her rehabilitation process with a more stringent routine. This incident was a stark reminder that even after years of treatment, people with suicidal tendencies are still vulnerable. It only takes one thought to provoke them to pull the trigger on their life.

Current Scenario

Presently, she enjoys walking in the corridor, meditating by her bed, and occasionally watching a little TV. During our interaction, she mentioned, "I don't want to watch TV because my mother can't afford it, so I've requested a radio." She understands her limitations and the repercussions of the heightened burden on her mother’s shoulders. Despite her dismay, she seems to be in a more composed state of mind now.

Author’s Notes 

I am heartbroken to share this story, but I believe it is important to raise awareness about the challenges faced by people with suicidal tendencies. We need to be more understanding and supportive of them and provide them with the resources they need to recover. Whatever the cause of concern may be, edging forward after a setback constantly tends to haunt one’s memories for eternity, as they are in a very dark and dangerous place.

To this date, it has been over 13 years since her recovery began at Cadabams when our paths crossed. As I mustered the courage to meet Sumadhra, a recovering emotionally unstable and borderline personality disorder patient, my perception of life changed in a snapshot. When I approached her, she was more than happy to sit down for a chat with me. As she talked about her day, I noticed that she seemed very particular about her needs and desires and reinstated that her morning coffee lacked sugar, which upset her. She even helps the staff care for other patients, which shows that she has a big heart despite her shortcomings. She had become aware of her issues, thoughts, and suicidal tendencies. Further, I was left speechless as she looked me in the eye and said, “If my wishes don’t get fulfilled, I get suicidal and physically violent."

The road to recovery is similar to that of snakes and ladders, where they never know where they will end up - back at the beginning or, at times, jumping the gun to the finish line. Slowly but surely, those bad days reduce, and it’s only when you look back that you realise how far you’ve come after dodging multiple snakes along the way.

Recognizing the Symptoms: Identifying Suicidal Tendencies and Seeking Help

Psychiatric suicidal patients are some of the most vulnerable people in our society. They are often unstable and unpredictable, and they may be at risk of harming themselves or others. It is important to understand the unique challenges that these patients face and to provide them with the support and resources they need to get better. Here are some signs that a person may be planning to commit suicide:

  • Talking about or looking up information about suicide
  • Gathering items such as ropes, weapons, or pills
  • Getting their affairs in order, such as writing a will, giving away prized possessions, or making arrangements for family members
  • Saying goodbye to family and friends with unusual or unexpected visits, calls, or texts. The goodbye may sound as if they are not going to be seen again and may be alarming or confusing to the receiver
  • Withdrawing from others by increasing social isolation and wanting to be alone
  • Engaging in self-destructive behaviours, such as taking unnecessary risks or increasing alcohol or drug use
  • Sudden feelings of calmness and happiness after being extremely depressed. This may mean that they have decided to attempt suicide shortly

If you notice any of these signs in someone you know, please reach out to them and offer your support. You can also call a suicide prevention hotline or a mental health professional for help.

Exploring Voices of Resilience at Cadabams

Bringing out the authentic and personal stories of residents at Cadabams is a delicate challenge. Nevertheless, we hope to highlight the patients' unwavering determination as well as the team's dedication to providing holistic care, fostering resilience and nurturing individuals. To protect their privacy, all names have been altered.

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