Having settled in my apartment in Bhutan, the first order of business was getting ready for the big three day tshechu in Thimphu, a festival which is a national holiday.  It's characterized by traditional dances which are all designed to chase away evil spirits and to bring harmony and good fortune to the community.  They all can look similar to the western eye, but each dance recounts specific stories from the time of Guru Rimpoche, his reincarnation Pema Lingpa, the "divine madman" Drupka Kunley, and Shabdrung Ngawang Namgyel, the charismatic leader who united Bhutan as a state in the 17th century.

Clowns with colorful animal masks and balloons or vegetables that resemble broccoli on their heads, and large codpieces are important figures, mc'ing each of the dances, and joking with the audience, getting donations. (Admission is free to the festival.)    Then there are the drummers who come into the audience and bless all who are willing to be bopped on the head (hard!)

        It's quite an experience, under the hot sun, without shade, especially on the first day, when I was fasting - for Yom Kippur - and wearing a gho, the complicated traditional dress that men wear (required for all natives in attendance, optional of course for us chillips).  Our apartment care taker, Jonah had offered me his, after I examined his five year old sone who he thought was too skinny and had too many sore throats.  Unlike every American I've ever asked, Jonah could not recall if he was skinny as a boy.   I determined that his son was quite skinny but healthy.   It's nice to be able to make theses assessments without lab testing, which is difficult to get in developing countries.  (I did ask if they checked the boy for anemia, and parasites; they had).

        The dances are slow moving and mesmerizing as is Bhutanese music, performed on long trumps (dungchens), oboes (gyalings), large drums (nag's), trumpet made from femurs (kanglings) and various cymbals, small drums, and conch shells.

        Mesmerism was the first incarnation of clinical hypnosis, a tool which I have used for decades to help children deal with anxiety, in our office and at home and in school. Relaxation mental imagery,or hypnosis, helps kids, and adults heal their headaches and stomachaches, help resolve habits like bedwetting, and much more.  
             Hypnosis is a close cousin of mindful meditation.  One can speak of hypnosis as meditation with a specific medical indication in mind.   Hypnosis is meditation with a purpose.  Though it is an extremely effective and cost effective form of therapy, it has gotten a bad reputation because of it's association with mind control and magic shows.   How would it fly here in Bhutan?

          I found that the Bhutanese, though Buddhist, do not meditate as a rule; they leave that to the monks.  But they are very open to hypnosis.   Last year, while traveling with my wife Shelly, we had the opportunity to meet the health minister for lunch.   He pulled up in his chauffeured car, at a restaurant that was like the most of the plain eateries in Bhutan,  that serve simple, nutritious meals that burn a hole in the roof of your mouth because of the chili peppers on everything. 

           "Sure, we have stress" the health minister said, in answer to my question.

           "What do you do for stress?" I asked.

           "After a busy day, I enjoy playing video games with my son," he said.  Just like home!

           He then confirmed that he thought clinical hypnosis would be a great idea for Bhutan.  Then he launched into a long discussion about how the government's project, to replace most of the cars in Bhutan with fully electric and quick charging Toyota's from Japan (tens of thousands of them!) will do much to increase the level of happiness in the country.  

         

   So my first lecture, on my first full day on the wards in JDW Referral Hospital was on clinical hypnosis.   Now this is a developing country that has no mental health facilities for children.  There are two adult psychiatrists in the whole country. One of them is temporary: Allan Crandall, a talented HVO volunteer with lots of experience caring for native Americans.  There are no child psychiatrists.  Dr. Mimi, the head of pediatrics, said there are no mental health problems among children because of the strong family structure. There are certainly single mom's, children raised by grandchildren and other relatives, and lots of stress caused by alcoholism.   But feelings are not talked about.
     Instead anxiety, sadness, and worry tend to "come out sideways" to quote one of my mentors, Dan Kohen.   They emerge as headaches, stomachaches, and, in adults "giddiness".   Dizziness  is rampant among adults.  According to Dr. Crandall, virtually all the adults with this symptom, or headaches, conversion reactions, or depression, repond well to the same therapy:
     A low dose of the old fashioned anti depressant amytriptiline, and the firm suggestion, "This WILL make you better."
       Suggestion and the power of language lies at the heart of any hypnotic intervention.   Patients, especially kids, are often in trance the moment they walk into the office or clinic.  In a society where doctors have not yet been knocked off from their pedestals, patients imbue physicians with immense respect and power.   They wait for hours to see doctors for appointments that last minutes.   Health care is free, here, but low budget.  Doctors, universally addressed as sir or madame, and nurses, called sisters and brothers are viewed as still viewed as healers. The terms "health care providers", "rendering physicians", "pcp's" or any of the other demeaning and bureaucratic jargon that has taken over American medicine are, thankfully, unknown in Bhutan.

        The three pediatricians (who make up half of the entire complement of children's doctors in the country) and the house staff certainly enjoyed the lecture.   One of them asked me if I could help her nine year old daughter, who is afraid of going to the dentist.  However, it is difficult for them to use hypnosis in outpatient visits that happen in cramped clinic rooms, usually shared with another provider -- visits that last no more than 5 minutes.  Some of the indications for hypnosis, like bed wetting, are not even problems mentioned by parents.  And, on the wards, the pediatricians and nursing staff

are overwhelmed handling children with complex congenital heart disease, renal failure, seizures, failure to thrive, severe anemia, parasitic and tropical infections like Japanese encephalitis -- all without a single pediatric sub specialist to summon for assistance and little of the shiny expensive technology on which we are dependent in the West

        So it seems like the first task will be organizing some calming self hypnosis for the medical staff.   In the meantime, nurse are interested, and the one Bhutanese psychiatrist are interested in learning clinical hypnosis.  It's interesting that even though they are so much more overwhelmed in dealing with serious illness, injury and death with resources far more limited than physicians back home - or maybe because of it - they are much more open to learning this powerful tool that acknowledges the inseparable link between mind and body.  

        What about happiness - that elusive goal that is the core of the governing principles of the country?

More on this in my next posts.  In the mean time, I  recall the father who befriended me at the festival last Sunday.   I asked him to explain the dances.  We ended up talking.  I met his wife, baby daughter and niece.  He insisted I join them for lunch in a aluminum roofed shelter in the archery range near the dzong.   He was quite concerned about the spiciness of the chiles, rice and pork that he offered me, even apologetic.  He and his wife wanted to be certain that we become facebook friends (tricky, because like all Bhutanese, his first name and surname are shared by dozens of others -- I used his FB picture to identify him.) 

              Generosity, friendliness,  and caring towards strangers may be no guarantee of happiness, 

but it certainly doesn't hurt!