DOWN THE MEMORY LANE: Dr. Kiran Kumar K.

Volume 13 Issues 3 March, 2023

I am Dr. Kiran Kumar K., Professor of Psychiatry at Vydehi Institute of Medical Sciences & Research Centre, Bengaluru.

I started my Psychiatry journey in 2006 at JSS Medical college, Mysuru. It’s been a wonderful expedition since then, navigating the nuances of human ‘psyche’. One aspect that has fascinated me is the genetic basis of psychiatric disorders. We now have a firm grasp of the broad structure of the genetic architecture and several key environmental risk factors have also been identified and delineated. However, in this debate of “Nature Vs Nurture”, as a clinician over the years, I have been inclining much towards a neurobiological basis of prototype severe psychiatric disorders like Schizophrenia. I have also become more and more convinced about the heritability and the genetic contribution.

In this regard, I always make it a point to elicit a robust 3 generation family history in all of my clients. When I was navigating my memory, “down the memory lane” I was reminiscing of an interesting case which gave me few insights to my practice later. I was treating a young female client with classical symptoms of Paranoid Schizophrenia. She was always accompanied by her parents and her husband for the sessions. Given my likings to a genetic basis of schizophrenia, I toiled hard to elicit a favorable genetic history from her family. However, in spite of all efforts my client had no positive family history and even more interestingly no significant psycho-social stressors. She had a very tortuous course with numerous exacerbations and significant periods of distress. The story continued for 2 years, when one day, she was accompanied only by her father for a review consultation. After my routine consultation with my client, I called in her father for a brief supportive therapy session and the ‘geneticist’ in me again asked the same question….“Are You sure that nobody in your family including extended family had any mental illness?”

He said, “Dr, I have a confession to make, I was contemplating about this from a long time and today I got this opportunity.  My daughter was born to my first wife, this information has not been divulged to my daughter or her husband. My first wife had similar illness and she committed suicide and died after a month of my daughters’ delivery. Immediately I got married to my present wife and my daughter was nurtured by her throughout and this secret has been guarded strongly by our family till date.”

Eureka! the Archimedes in me had awakened. I was full of joy, deep down I was aware of the fact that this important piece of information may not be a good prognostic factor for my client, but it was a great learning experience for me.

In our local vernacular language Kannada, we have a saying “ಪ್ರತ್ಯಕ್ಷವಾಗಿ ಕಂಡರು ಪ್ರಮಾಣಿಸಿ ನೋಡು”, which roughly translates to “Even when something is evident, examine it”. Yes, it is our duty & responsibility as professionals to carefully ‘examine’ the content provided by our clients and intellectually interpret it.