Voices of Resilience

Navigating through the Complexities and Perplexities of Akash’s Life


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About the Case Study

Resident’s Profile:

Marital Status:
Rehab Duration:
1.5 Years
Illness Duration
20 Years
Patient’s Alias Name:
Professional’s Name:
Anandhu Anilkumar
Author’s Name:
Shwetha Jois
OCD, Bipolar and Substance Abuse Disoder along with Tic Disorder
Medication, Therapy and Rehabilitation

About the Resident

In the midst of the chaos, there is always a beacon of resilience and hope. Although, for some, the path taken may be fraught with more unimaginable difficulties than others. Akash's life is similar to having to multitask constantly, but instead of different tasks, he is juggling multiple psychological disorders. 

As a child in the 1980s, Akash felt loved and supported by his entire family. At the tender age of 14, he had achieved great heights as a state-level cricket player. Although fun and play were on the rise, focus and execution were beginning to take a back seat. The family assumed he was battling ADHD or ADD during his 10th-grade exams, pushing his mother to help him graduate. 

However, things began to change; his abilities were deteriorating, he had started to show no regard for discipline or hygiene, and he frequently spiralled into depression. His father believed that if he went to a college with a hostel, it would foster a sense of independence and responsibility. 

Instead, this change in his environment had a negative impact on him. The warden informed the family that he used to shower for long hours yet remained messy and unkempt. He had become more forgetful, with a tendency to repeat himself as well. Simultaneously, he had begun losing interest in cricket and the discipline that came with it. He was taken back home shortly after he was unable to look after of himself.

Regardless of his early accomplishments, Akash's family noticed that he struggled with daily tasks as he grew older. He insisted on pursuing a bachelor's degree, and during this time, he had started drinking alcohol with his friends. They had access to transportation and other resources, which may have contributed to his fixation with wealthy people, which he still struggles with today.

Case History

Once he turned 20, he completely stopped speaking to anyone. He solely relied on sign language, which was another cause for concern. The family was extremely worried about his behaviour and consulted with a psychiatrist. He was diagnosed with a complex combination of mental and neurological disorders: obsessive-compulsive disorder (OCD), substance dependence, bipolar disorder, and tic disorder. This implied that he had been experiencing intrusive thoughts, mood swings, and compulsions while trying to control his substance use and had involuntary muscle movements, all at the same time. 

Akash has been battling OCD, substance dependence, bipolar disorder, and tic disorder for over 20 years. OCD causes unwanted thoughts and repetitive behaviors, while substance dependence causes a strong need to use drugs or alcohol, even with negative consequences. Bipolar disorder causes extreme mood swings, and tic disorder causes involuntary movements or vocalizations.

His OCD symptoms can be severe and debilitating, and he also struggles with compulsive behaviours, proxy compulsions, and anxiety. He is also prone to mood swings, irritability, and sleep disturbances. During proxy compulsions, he feels the need for others to repeat what he says or perform certain actions to gain gratification. This can be complicated to manage, especially if he is alone.

His OCD symptoms can be so severe that they interfere with his daily life. He may have trouble completing tasks or communicating effectively. People with OCD may need their loved ones to perform certain rituals or repeat what they say to feel satisfied. Apart from OCD, Tic disorder, which is relatively less known, is a neurological disorder that affects the nervous system. He is subject to sudden, repetitive movements or sounds called tics. He tends to twitch and clear his throat often while repeating words and phrases. 

Imagine living with a constant barrage of intrusive thoughts and compulsions while multiple other factors are also at play. You feel the need to check on things over and over again, even though you know it's irrational. You have difficulty controlling your impulses, and you experience extreme mood swings. On top of all that, you have involuntary muscle movements that you can't control. This is the reality for many people who struggle to cope with comorbid disorders. 

In 2018, he was admitted to an institution for three weeks. However, after discharge, he stopped his medication, therapy, and follow-up visits. This was when the symptoms escalated drastically, making it challenging for him to manage them. 

Keeping his sensitive nature in mind, his father believed in him and established a textile factory. He hoped that if he bestowed such responsibilities on Akash’s shoulders, he would grow to become empowered and dependable. Nevertheless, Akash struggled to communicate with employees and uphold a managerial role. This made him feel like he had disappointed his father, and he deems this event to be extremely painful and avoids talking about it. Unfortunately, in 2019, due to unforeseen circumstances, his father passed away, which further escalated his condition. Life was already incredibly demanding for him, and yet it was only starting to get tougher. 

The Role of Cadabams

He was admitted to Cadabams for two years. During rehabilitation, he exhibited multiple compulsions, tendencies, and obsessions that can be modulated with the right therapy and medication. However, due to the complexity of his condition, his medication is carefully prescribed to avoid side effects and unnecessary complications.

In due time, when he was discharged in early 2022, he discontinued his medication. This severely affected him and heightened the severity of his condition. Being mindful of his nature, his mother has been the pillar of his strength, along with his three sisters, since his father’s passing. 

However, as time passed, his needs became more unfavourable for his mother to manage alone as well. His outbursts, obsessions, and repetitive behaviour were taking over, while the symptoms of tic disorders were also increasing. He even injured his wrist when he broke a glass. This incident indicated the need for professional treatment and therapy.

It is also important to note that people with compulsive behaviours may not always be aware of the impact their behaviours have on their lives. They may be so focused on their compulsions that they do not realize the harm they are causing themselves. We need to be compassionate and understanding when dealing with someone who has compulsive behaviours. These behaviours can be very difficult to control, and people with OCD often feel a great deal of shame and guilt about them.

Seven months later, he had a severe relapse and was readmitted to Cadabams. He arrived in a manic state after consuming alcohol. Once he restarted his medication and treatment, his symptoms became relatively manageable. However, the faculty did notice signs of personality changes and frequent mood swings upon his return. The psychologists and psychiatrists understand the complex nature of his condition, as he juggles more than three disorders. In light of this, they address his concerns with absolute empathy. They also conducted a thorough analysis before concluding whether it was a mood, personality, or psychotic symptom that needed to be addressed.

Professional’s Perspective

In early 2023, his mother passed away due to depression, leaving Akash feeling broken and sometimes experiencing a sense of guilt. As time passed, he was able to find a way to cope with the pain. He shares a strong relationship with his counsellor and psychiatrist. He seeks their approval in every step, be it in sentence formation, factual data, or even the most trivial of matters. For instance, as he speaks, he repeatedly verifies if it is correct.

One of the most moving things about Akash is his deep connection to his mother. He carries a photo of her in his backpack, and he pulls it out to show others whenever he reminisces about her. Sometimes, when he realizes that his parents are no longer around, he curls up on the floor and cries for days at a stretch.

Although he still experiences severe feelings of guilt and often finds himself in tears. He is easily irritable and struggles with sleep disturbances. He did find it strenuous to follow a routine initially, but has overcome such hurdles since. His loving sisters visit him at least once a month and take him out frequently. As he is very insightful and has great memory skills, they requested that he take personality development classes to streamline his recovery process. 

Empathy, respect, and gratitude are not a cure for psychological problems, but they can play an important role in recovery. When people feel understood, valued, and supported, they are more likely to succeed in treatment. Learning a new language can improve mental health significantly as well. It provides a sense of achievement, improves cognitive function, and improves self-esteem. It also helps increase social interaction while reducing stress and anxiety. Playing a sport can also help overcome psychological problems by reducing stress and anxiety levels. It also has a positive impact on self-esteem and confidence. It can also promote social interaction and support while providing a sense of purpose and meaning.

Current Scenario

Presently, he is committed to managing his symptoms and living a fulfilling life. Over time, he has evolved into a much more well-rounded individual while maintaining a healthy routine and lifestyle. He is actively engaged in therapy and is committed to recovering. He is also a warm and outgoing person who loves to connect with others. His sister also persuaded him to attend personality development sessions and Spanish language classes from Cadabams. These sessions have enabled him to develop empathy, respect, and gratitude. He practices yoga and meditation daily, plays cricket frequently, and plans to pursue it professionally, after discharge.

Author’s Notes 

Despite these challenges, he has been a testament to the extraordinary power of the human spirit. Even to this date, his passion for the sport remains undimmed, and his skills are still as sharp as ever. His unwavering determination and love for cricket are genuinely inspiring. 

His journey is a sacrament to the fact that, even in the darkest of times, there is always hope. Akash's life is a reminder that even in the face of adversity, the human spirit can soar to greater heights. It has been a tapestry of triumphs and tribulations, but through it all, he is on the road to recovery at Cadabams. He has shared an unimaginable journey while trying to navigate through the hollows of time. 

Recognizing the Symptoms: Identifying Comorbid Disorders and Seeking Help

Individuals with complex mental health conditions, such as OCD, bipolar disorder, substance abuse disorder, and tic disorder, may experience a range of symptoms that can affect their thoughts, emotions, and behaviors. It's important to note that these conditions often co-occur, making it challenging to isolate symptoms for a specific diagnosis.

Obsessive-Compulsive Disorder (OCD)

  • Obsessions: Intrusive, repetitive, and unwanted thoughts, images, or urges that cause anxiety or distress.
  • Compulsions: Repetitive behaviors or mental acts that an individual feels compelled to perform in order to reduce anxiety or prevent a perceived negative outcome.

Bipolar Disorder

  • Mania or Hypomania: Periods of abnormally elevated or irritable mood, characterized by increased energy, decreased need for sleep, racing thoughts, and grandiosity.
  • Depression: Periods of sadness, loss of interest, fatigue, and difficulty concentrating.
  • Mood Swings: Rapid shifts between mania, hypomania, and depression.

Substance Abuse Disorder

  • Preoccupation with substance use: Constant thoughts about obtaining, using, or recovering from substance use.
  • Loss of control: Inability to control the amount of substance used or the frequency of use, despite negative consequences.
  • Physical dependence: Development of tolerance, requiring increasing amounts of the substance to achieve the same effect, and experiencing withdrawal symptoms upon cessation of use.

Tic Disorder

  • Tics: Sudden, repetitive, nonrhythmic movements or vocalizations that are involuntary and non-purposeful.
  • Motor Tics: Movements that affect the body, such as facial grimacing, shoulder shrugging, or arm jerking.
  • Vocal Tics: Sounds that come from the mouth or throat, such as grunting, sniffing, or throat clearing.

If you or someone you know is experiencing symptoms of these conditions, it's crucial to seek professional help. Cadabams offers comprehensive treatment for individuals with complex mental health conditions, including OCD, bipolar disorder, substance abuse disorder, and tic disorder. Our team of experienced psychiatrists, psychologists, and nurses provides personalized care to address the unique needs of each individual.

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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