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A tulpa is an alter-self created in the mind, acting independently of, and parallel to your core consciousness. The alter-self is able to think, and have their own free will, emotions, and memories. In short, a tulpa is like a sentient person living in your head, separate from your core self. A tulpa is created for self-preservation during an extended period of horrific mental/emotional, physical, and/or sexual abuse.While tulpamancy skills are a good coping mechanism the amount of time your core self is excluded in day-to-day interactions is fundamentally the same. In fact, in some instances, one of the alter-self proclaims it has the right to become an alternate core self.Each alter-self needs to discover what experiences and trauma each hold and process the experience and trauma to the degree the alter-self can integrate into the core-self.When someone begins a holistic transformation/transmuting process, no matter how dire their predicament seems to be, I KNOW if she/he is WILLING to do the mental/ emotional discovery work; releasing and transforming beliefs, thoughts and feelings, anything can be transformed/transmuted. The word ‘incurable’ or ‘impossible’ only means that the particular condition, symptom or diagnosis cannot be ‘cured’ by ‘outer’ methods and that she/he needs to GO WITHIN to effect the transformation/transmuting. The condition, symptom or diagnosis came from mental/emotional distress and will go back to nothing.When beliefs, thoughts, feelings, and behavior are accessed and addressed at the unconscious, subconscious and cellular level, the 'cause' of any and all symptoms and behavior become crystal clear--it is mental/emotional, physical, and spiritual trauma/distress manifesting in the behavior and symptoms you experience.A Transformation/Transmuting process is a clear, concise, and direct method of transforming/transmuting the mental, emotional and physical symptoms that transcends traditional protocols while retaining a professional focus. Deep Healing avoids prescription and OTC drugs, body parts removed, artificial hypnotic inductions, and psychic interventions. The process ties in directly with the experiences and needs of the person. The process is down-to-earth, to-the-point, practical, fearless and with 20+ years experience and centuries of holistic health care protocol success I know there is no doubt Deep Healing is effective.1968 Diagnostic and Statistical Manual (DSM-II), Multiple Personality Disorder was called hysterical neurosis, dissociative type, and was defined as an alteration to consciousness and identity.In 1980, the DSM-III was published, and the term "dissociative" was first introduced as a class of disorders.Separating Fact from Fiction: An Empirical Examination of Six Myths ...Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity DisorderPublished 2013, Dissociative identity disorder (DID) is defined in the fifth edition of the DSM ... The first published cases are those of Jeanne Fery, reported in 1586, .... in which DID or multiple personality disorder (MPD) had been diagnosed.Understanding Multiple Personality DisordersUnderstanding Multiple Personality Disorders“Introduction. Since the first exploration of the phenomenon of Multiple Personality Disorder some hundred years ago, the diagnosis has been the recipient of much confusion and skepticism. Because its presentation can be so dramatic and the precipitating trauma so humanly unacceptable, it was passed off as the hysterical behavior of overwrought or spoiled women. However, with the attention in recent years to the issue of child abuse, Multiple Personality Disorder has gained acceptance as a valid psychiatric diagnosis. Once considered rare, the reported incidence has increased steadily since 1980. It occurs in 1.2% of the general psychiatric population (Steele, 1989 (making it about as common as schizophrenia).Dissociative Identity Disorders (DID), specifically Multiple Personality Disorder (MPD), have received much attention in the past decade, though they are not new phenomena. In fact, these disorders were among the first psychiatric conditions to be scientifically investigated by the nineteenth-century pioneers of psychiatric medicine (Putnam, 1991). However, in the twentieth century, the work of such pioneers was largely set aside and forgotten as Freud introduced his psychoanalytic model which substituted the idea of repression for dissociation in dynamic formulations.MPD remains highly controversial among psychiatric professionals. The reality of the disorder is often challenged. Putnam feels “this distorts the scientific process and places an extra burden of proof on MPD that is not demanded of other psychiatric disorders.” MPD and DD have met all the requirements expected of other psychiatric diagnoses, and Putnam maintains that “by this standard, MPD and the dissociative disorders are as “real” as any other psychiatric condition.”Based on my research and having assisted many people with psychogenic amnesia and Dissociative Identity Disorder I know these coping strategies are caused by profound, severe, and relentless mental/emotional, physical, and/or sexual abuse. The following sources might be of interest.1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed Arlington, VA: APA, 2013. [Google Scholar]2. Putnam FW. Dissociation in children and adolescents: a developmental perspective. New York: Guilford, 1997. [Google Scholar]3. Simeon D, Loewenstein RJ. Dissociative disorders. In: Sadock BJ, Sadock VA, Ruiz P, editors. , eds. Kaplan and Sadock’s comprehensive textbook of psychiatry. 9th ed Philadelphia: Lippincott Williams & Wilkens, 2009;1965–2026. [Google Scholar]4. Putnam FW, Guroff JJ, Silberman EK, Barban L, Post RM. The clinical phenomenology of multiple personality disorder: review of 100 recent cases. J Clin Psychiatry 1986;47:285–93. [PubMed] [Google Scholar]5. Sar V. The many faces of dissociation: opportunities for innovative research in psychiatry. Clin Psychopharmacol Neurosci 2014;12:171–9. [PMC free article] [PubMed] [Google Scholar]6. Herman JL. Trauma and recovery. New York: Basic, 1992. [Google Scholar]7. Rodewald F, Wilhelm-Gößling C, Emrich HM, Reddemann L, Gast U. Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified. J Nerv Ment Dis 2011;199:122–31. [PubMed] [Google Scholar]8. Ross CA, Miller SD, Reagor P, Bjornson L, Fraser GA, Anderson G. Schneiderian symptoms in multiple personality disorder and schizophrenia. Compr Psychiatry 1990;31:111–8. [PubMed] [Google Scholar]9. Ellason JW, Ross CA, Fuchs DL. Lifetime Axis I and II comorbidity and childhood trauma history in dissociative identity disorder. Psychiatry 1996;59:255–66. [PubMed] [Google Scholar]10. Kluft RP. The confirmation and disconfirmation of memories of abuse in DID patients: a naturalistic clinical study. Dissociation 1995;8:253–8. [Google Scholar]11. Lewis DO, Yeager CA, Swica Y, Pincus JH, Lewis M. Objective documentation of child abuse and dissociation in 12 murderers with a dissociative identity disorder. Am J Psychiatry 1997;154:1703–10. [PubMed] [Google Scholar]12. Middleton W, Butler J. Dissociative identity disorder: an Australian series. Aust N Z J Psychiatry 1998;32:794–804. [PubMed] [Google Scholar]13. Swica Y, Lewis DO, Lewis M. Child abuse and dissociative identity disorder/multiple personality disorder: the documentation of childhood maltreatment and the corroboration of symptoms. Child Adolesc Psychiatr Clin N Am 1996;5:431–47. [Google Scholar]14. Dorahy MJ, Brand BL, Şar V, et al. Dissociative identity disorder: an empirical overview. Aust N Z J Psychiatry 2014;48:402–17. [PubMed] [Google Scholar]15. Carlson ET. The history of multiple personalities in the United States: I. The beginnings. Am J Psychiatry 1981;138:666–8. [PubMed] [Google Scholar]16. Ellenberger HF. The discovery of the unconscious: the history and evolution of dynamic psychiatry. New York: Basic, 1970. [Google Scholar]17. Loewenstein RJ. Anna O: reformulation as a case of multiple personality disorder. In: Goodwin JM, editor. , ed. Rediscovering childhood trauma: historical casebook and clinical applications. Washington, DC: American Psychiatric Press, 1993;139–67. [Google Scholar]18. van der Hart O, Dorahy MJ. History of the concept of dissociation. In: Dell PF, O’Neil JA, editors. eds. Dissociation and the dissociative disorders: DSM-V and beyond. New York: Routledge, 2009:3–26. [Google Scholar]19. Sidis B, Goodhart SP. Multiple personality: an experimental investigation into the nature of human individuality. New York: D. Appleton, 1905. [Google Scholar]20. van der Hart O, Lierens R, Goodwin J. Jeanne Fery. A sixteenth-century case of dissociative identity disorder. J Psychohist 1996;24:18–35. [PubMed] [Google Scholar]21. Gmelin E. Materialen für die Anthropologie. Tübingen, Germany: Cotta, 1791. [Google Scholar]22. Guillain G. J-M. Charcot, 1825–1893: his life—his work. New York: Hoeber, 1959. [Google Scholar]23. Herman JL. Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. In: Everly GS Jr, Lating JM, editors. , eds. Psychotraumatology: key papers and core concepts in post-traumatic stress. New York: Plenum, 1995;87–100. [Google Scholar]24. Chu JA. Rebuilding shattered lives: treating complex PTSD and dissociative disorders 2nd ed. Hoboken, NJ: Wiley, 2011. [Google Scholar]25. Rosenbaum M. The role of the term schizophrenia in the decline of diagnoses of multiple personality. Arch Gen Psychiatry 1980;37:1383–5. [PubMed] [Google Scholar]26. Kluft RP. First-rank symptoms as a diagnostic clue to multiple personality disorder. Am J Psychiatry 1987;144:293–8. [PubMed] [Google Scholar]27. Ross C. Dissociation in classical texts on schizophrenia. Psychosis 2014;6:342–54. [Google Scholar]28. Bleuler E. Dementia praecox or the group of schizophrenias. Oxford: International Universities, 1950. [Google Scholar]29. Dorahy MJ, van der Hart O, Middleton W. The history of early life trauma and abuse from the 1850s to the current time: how the past influences the present. In: Lanius R, Vermetten E, Pain C, editors. eds. The hidden epidemic: the impact of early life trauma on health and disease. New York: Cambridge University Press, 2010;3–12. [Google Scholar]30. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed Washington, DC: APA, 1980. [Google Scholar]31. Tutkun H, Yargic LI, Sar V. Dissociative identity disorder presenting as hysterical psychosis. Dissociation 1996;9:244–52. [Google Scholar]32. Erikson EH. Childhood and society. New York: Norton, 1964. [Google Scholar]33. Sar V. The scope of dissociative disorders: an international perspective. Psychiatr Clin North Am 2006;29:227–44. [PubMed] [Google Scholar]34. Dalenberg C, Loewenstein R, Spiegel D, et al. Scientific study of the dissociative disorders. Psychother Psychosom 2007;76:400–1. [PubMed] [Google Scholar]35. Stein DJ, Koenen KC, Friedman MJ, et al. Dissociation in posttraumatic stress disorder: evidence from the World Mental Health Surveys. Biol Psychiatry 2013;73:302–12. [PMC free article] [PubMed] [Google Scholar]36. Brand BL, Lanius R, Vermetten E, Loewenstein RJ, Spiegel D. Where are we going? An update on assessment, treatment, and neurobiological research in dissociative disorders as we move toward the DSM-5. J Trauma Dissociation 2012;13:9–31. [PubMed] [Google Scholar]37. Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D. Prevalence of dissociative disorders in psychiatric outpatients. Am J Psychiatry 2006;163:623–9. [PubMed] [Google Scholar]38. Friedl MC, Draijer N. Dissociative disorders in Dutch psychiatric inpatients. Am J Psychiatry 2000;157:1012–3. [PubMed] [Google Scholar]39. Gast U, Rodewald F, Nickel V, Emrich HM. Prevalence of dissociative disorders among psychiatric inpatients in a German university clinic. J Nerv Ment Dis 2001;189:249–57. [PubMed] [Google Scholar]40. Horen SA, Leichner PP, Lawson JS. Prevalence of dissociative symptoms and disorders in an adult psychiatric inpatient population in Canada. Can J Psychiatry 1995;40:185–91. [PubMed] [Google Scholar]41. Latz TT, Kramer SI, Hughes DL. Multiple personality disorder among female inpatients in a state hospital. Am J Psychiatry 1995;152:1343–8. [PubMed] [Google Scholar]42. Lewis-Fernández R, Martínez-Taboas A, Sar V, Patel S, Boatin A. The cross-cultural assessment of dissociation. In: Wilson JP, So-Kum Tang CC, editors. , eds. Cross-cultural assessment of psychological trauma and PTSD. New York: Springer, 2007;279–317. [Google Scholar]43. Lussier RG, Steiner J, Grey A, Hansen C. Prevalence of dissociative disorders in an acute care day hospital population. Psychiatr Serv 1997;48:244–6. [PubMed] [Google Scholar]44. Ross CA, Anderson G, Fleisher WP, Norton GR. The frequency of multiple personality disorder among psychiatric inpatients. Am J Psychiatry 1991;148:1717–20. [PubMed] [Google Scholar]45. Saxe GN, Van der Kolk BA, Berkowitz R, et al. Dissociative disorders in psychiatric inpatients. Am J Psychiatry 1993;150:1037–42. [PubMed] [Google Scholar]46. Spiegel D, Loewenstein RJ, Lewis‐Fernández R, et al. Dissociative disorders in DSM‐5. Depress Anxiety 2011;28:E17–45. [PubMed] [Google Scholar]47. Brand BL, Loewenstein RJ, Spiegel D. Dispelling myths about dissociative identity disorder treatment: an empirically based approach. Psychiatry 2014;77:169–89. [PubMed] [Google Scholar]48. Dalenberg CJ, Brand BL, Gleaves DH, et al. Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychol Bull 2012;138:550–88. [PubMed] [Google Scholar]49. Dalenberg CJ, Brand BL, Loewenstein RJ, et al. Reality versus fantasy: reply to Lynn et al. (2014). Psychol Bull 2014;140:911–20. [PubMed] [Google Scholar]50. Paris J. The rise and fall of dissociative identity disorder. J Nerv Ment Dis 2012;200:1076–9. [PubMed] [Google Scholar]51. Pope HG, Jr, Barry S, Bodkin A, Hudson JI. Tracking scientific interest in the dissociative disorders: a study of scientific publication output 1984–2003. Psychother Psychosom 2006;75:19–24. [PubMed] [Google Scholar]52. McHugh P. Do fads ever die? J Nerv Ment Dis 2013;201:357–8. [PubMed] [Google Scholar]53. Definition of FAD54. Steinberg M. Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). Rev. ed Washington, DC: American Psychiatric Press, 1994. [Google Scholar]55. Gleaves DH, May MC, Cardeña E. An examination of the diagnostic validity of dissociative identity disorder. Clin Psychol Rev 2001;21:577–608. [PubMed] [Google Scholar]56. Ross CA, Heber S, Norton GR, Anderson D. The Dissociative Disorders Interview Schedule: a structured interview. Dissociation 1989;2:169–89. [Google Scholar]57. Loewenstein RJ. An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder. Psychiatr Clin North Am 1991;14:567–604. [PubMed] [Google Scholar]58. Brand BL, Armstrong JG, Loewenstein RJ, McNary SW. Personality differences on the Rorschach of dissociative identity disorder, borderline personality disorder, and psychotic inpatients. Psychol Trauma 2009;1:188–205. [Google Scholar]59. Brand B, Loewenstein RJ. Dissociative disorders: an overview of assessment, phenomenology and treatment. Psychiatr Times 2010. (Oct);27:62–9. [Google Scholar]60. Brand BL, Chasson GS. Distinguishing simulated from genuine dissociative identity disorder on the MMPI-2. Psychol Trauma 2015;7:93–101. [PubMed] [Google Scholar]61. Brand BL, Tursich M, Tzall D, Loewenstein RJ. Utility of the SIRS-2 in distinguishing genuine from simulated dissociative identity disorder. Psychol Trauma 2014;6:308–17. [Google Scholar]62. Reinders AA, Nijenhuis ER, Quak J, et al. Psychobiological characteristics of dissociative identity disorder: a symptom provocation study. Biol Psychiatry 2006;60:730–40. [PubMed] [Google Scholar]63. Reinders AATS, Willemsen ATM, Vos HPJ, den Boer JA, Nijenhuis ERS. Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS One 2012;7:e39279. [PMC free article] [PubMed] [Google Scholar]64. Brand BL, Classen CC, McNary SW, Zaveri P. A review of dissociative disorders treatment studies. J Nerv Ment Dis 2009;197:646–54. [PubMed] [Google Scholar]65. Brand BL, Myrick AC, Loewenstein RJ, et al. A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. Psychol Trauma 2012;4:490–500. [Google Scholar]66. International Society for the Study of Trauma and Dissociation. Guidelines for treating dissociative identity disorder in adults, third revision: summary version. J Trauma Dissociation 2011;12:188–212. [PubMed] [Google Scholar]67. Adityanjee Raju GS, Khandelwal SK. Current status of multiple personality disorder in India. Am J Psychiatry 1989;146:1607–10. [PubMed] [Google Scholar]68. Lynn SJ, Fassler O, Knox JA, Lilienfeld SO. Dissociation and dissociative identity disorder: treatment guidelines and cautions. In: Fisher JE, O’Donohue WT, editors. , eds. Practitioner’s guide to evidence-based psychotherapy. New York: Springer, 2006. [Google Scholar]69. Lynn SJ, Lilienfeld SO, Merckelbach H, Giesbrecht T, van der Kloet D. Dissociation and dissociative disorders: challenging conventional wisdom. Curr Dir Psychol Sci 2012;21:48–53. [Google Scholar]70. Spanos NP. Multiple identity enactments and multiple personality disorder: a sociocognitive perspective. Psychol Bull 1994;116:143–65. [PubMed] [Google Scholar]71. Modestin J, Ebner G, Junghan M, Erni T. Dissociative experiences and dissociative disorders in acute psychiatric inpatients. Compr Psychiatry 1996;37:355–61. [PubMed] [Google Scholar]72. Tutkun H, Sar V, Yargiç LI, Ozpulat T, Yanik M, Kiziltan E. Frequency of dissociative disorders among psychiatric inpatients in a Turkish university clinic. Am J Psychiatry 1998;155:800–5. [PubMed] [Google Scholar]73. Ginzburg K, Somer E, Tamarkin G, Kramer L. Clandestine psychopathology: unrecognized dissociative disorders in inpatient psychiatry. J Nerv Ment Dis 2010;198:378–81. [PubMed] [Google Scholar]74. Sar V, Tutkun H, Alyanak B, Bakim B, Baral I. Frequency of dissociative disorders among psychiatric outpatients in Turkey. Compr Psychiatry 2000;41:216–22. [PubMed] [Google Scholar]75. Sar V, Kundakci T, Kiziltan E, et al. The Axis-I dissociative disorder comorbidity of borderline personality disorder among psychiatric outpatients. J Trauma Dissociation 2003;4:119–36. [Google Scholar]76. Ross CA. Epidemiology of multiple personality disorder and dissociation. Psychiatr Clin North Am 1991;14:503–17. [PubMed] [Google Scholar]77. Johnson JG, Cohen P, Kasen S, Brook JS. Dissociative disorders among adults in the community, impaired functioning, and Axis I and II comorbidity. J Psychiatr Res 2006;40:131–40. [PubMed] [Google Scholar]78. Şar V, Akyüz G, Doğan O. Prevalence of dissociative disorders among women in the general population. Psychiatry Res 2007;149:169–76. [PubMed] [Google Scholar]79. Tamar-Gurol D, Sar V, Karadag F, Evren C, Karagoz M. Childhood emotional abuse, dissociation, and suicidality among patients with drug dependency in Turkey. Psychiatry Clin Neurosci 2008;62:540–7. [PubMed] [Google Scholar]80. Şar V. Epidemiology of dissociative disorders: an overview. Epidemiol Res Int 2011;2011:404538. [Google Scholar]81. Brand B, Classen C, Lanins R, et al. A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians. Psychol Trauma 2009;1:153–71. [Google Scholar]82. Boysen GA, VanBergen A. A review of published research on adult dissociative identity disorder: 2000–2010. J Nerv Ment Dis 2013;201:5–11. [PubMed] [Google Scholar]83. Lilienfeld SO, Kirsch I, Sarbin TR, et al. Dissociative identity disorder and the sociocognitive model: recalling the lessons of the past. Psychol Bull 1999;125:50723. [PubMed] [Google Scholar]84. Conklin CZ, Westen D. Borderline personality disorder in clinical practice. Am J Psychiatry 2005;162:867–75. [PubMed] [Google Scholar]85. Leonard D, Brann S, Tiller J. Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact. Aust N Z J Psychiatry 2005;39:940–6. [PubMed] [Google Scholar]86. Loewenstein RJ, Putnam FW. The clinical phenomenology of males with MPD: a report of 21 cases. Dissociation 1990;3:135–43. [Google Scholar]87. Martínez-Taboas A. Multiple personality in Puerto Rico: analysis of fifteen cases. Dissociation 1991;4:189–92. [Google Scholar]88. Ross CA, Miller SD, Reagor P, Bjornson L, Fraser GA, Anderson G. Structured interview data on 102 cases of multiple personality disorder from four centers. Am J Psychiatry 1990;147:596–601. [PubMed] [Google Scholar]89. Middleton W. Dissociative disorders: a personal ‘work in progress.’ Australas Psychiatry 2004;12:245–52. [PubMed] [Google Scholar]90. Psychiatry 2006;163:1388–91. [PubMed] [Google Scholar]91. Mueller C, Moergeli H, Assaloni H, Schneider R, Rufer M. Dissociative disorders among chronic and severely impaired psychiatric outpatients. Psychopathology 2007;40:470–1. [PubMed] [Google Scholar]92. Ferdinand RF, van der Reijden M, Verhulst FC, Nienhuis FJ, Giel R. Assessment of the prevalence of psychiatric disorder in young adults. Br J Psychiatry 1995;166:480–8. [PubMed] [Google Scholar]93. Lieb R, Pfister H, Mastaler M, Wittchen H-U. Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments. Acta Psychiatr Scand 2000;101:194208. [PubMed] [Google Scholar]94. Mendez N, Martinez-Taboas A, Pedrosa O. Experiences, beliefs and attitudes of Puerto Rican psychologists toward dissociative identity disorder. Cienc Conducta 2000;15:69–84. [Google Scholar]95. Perniciaro LA. The influence of skepticism and clinical experience on the detection of dissociative identity disorder by mental health clinicians. Newton, MA: Massachusetts School of Professional Psychology, 2014. [Google Scholar]96. Dorahy MJ, Lewis CA, Mulholland C. The detection of dissociative identity disorder by Northern Irish clinical psychologists and psychiatrists: a clinical vignettes study. J Trauma Dissociation 2005;6:39–50. [PubMed] [Google Scholar]97. Beidel D, Bulik C, Stanley M. Abnormal psychology. 3rd ed Upper Saddle River, NJ: Pearson Education, 2014. [Google Scholar]98. Butcher J, Mineka S, Hooley J. Abnormal psychology. 15th ed Upper Saddle River, NJ: Pearson Education, 2013. [Google Scholar]99. Oltmanns T, Emery R. Abnormal psychology. 7th ed Upper Saddle River, NJ: Pearson Education, 2012. [Google Scholar]100. Cardeña E, van Duijl M, Weiner LA, Terhune DB. Possession/trance phenomena. In: Dell PF, O’Neil JA, editors. , eds. Dissociation and the dissociative disorders: DSM-V and beyond. New York: Routledge, 2009;171–81. [Google Scholar]101. Ross CA. Possession experiences in dissociative identity disorder: a preliminary study. J Trauma Dissociation 2011;12:393–400. [PubMed] [Google Scholar]102. Sar V, Alioğlu F, Akyüz G. Experiences of possession and paranormal phenomena among women in the general population: are they related to traumatic stress and dissociation? J Trauma Dissociation 2014;15:303–18. [PubMed] [Google Scholar]103. Kihlstrom JR. Dissociative disorders. Annu Rev Clin Psychol 2005;1:227–53. [PubMed] [Google Scholar]104. Lynn SJ, Lilienfeld SO, Merckelbach H, et al. The trauma model of dissociation: inconvenient truths and stubborn fictions. Comment on Dalenberg et al. (2012). Psychol Bull 2014;140:896–910. [PubMed] [Google Scholar]105. McHugh P. Resolved: multiple personality disorder is an individually and socially created artifact: affirmative. J Am Acad Child Adolesc Psychiatry 1995;34:957–9. [PubMed] [Google Scholar]106. Piper A, Merskey H. The persistence of folly: a critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept. Can J Psychiatry 2004;49:592–600. [PubMed] [Google Scholar]107. Spanos NP, Burgess C. Hypnosis and multiple personality disorder: a sociocognitive perspective. In: Lynn SJ, Rhue JW, editors. , eds. Dissociation: clinical and theoretical perspectives. New York: Guilford, 1994;136–55. [Google Scholar]108. Brown D, Frischholz EJ, Scheflin AW. Iatrogenic dissociative identity disorder—an evaluation of the scientific evidence. J Psychiatry Law 1999;27:549–637. [Google Scholar]109. Gleaves DH. The sociocognitive model of dissociative identity disorder: a reexamination of the evidence. Psychol Bull 1996;120:42–59. [PubMed] [Google Scholar]110. Gleaves DH, Hernandez E, Warner MS. The etiology of dissociative identity disorder: reply to Gee, Allen and Powell (2003). Prof Psychol Res Pr 2003;34:116–8. [Google Scholar]111. Kihlstrom JF, Glisky ML, Angiulo MJ. Dissociative tendencies and dissociative disorders. J Abnorm Psychol 1994;103:117–24. [PubMed] [Google Scholar]112. Spanos NP, Weekes JR, Menary E, Bertrand LD. Hypnotic interview and age regression procedures in the elicitation of multiple personality symptoms: a simulation study. Psychiatry 1986;49:298–311. [PubMed] [Google Scholar]113. Butcher JN, Graham JR, Ben-Porath YS, Tellegen A, Dahlstrom WG. Manual for the administration and scoring of the MMPI-2. Minneapolis: Minnesota University Press, 2001. [Google Scholar]114. Brand BL, Chasson GS, Polermo CA, Donato FM, Rhodes KP, Voorhees EF. Truth is in the details: a comparison of MMPI-2 item endorsements by patients with dissociative identity disorder patients versus simulators. J Am Acad Psychiatry Law (forthcoming) . [Google Scholar]115. Rogers R, Sewell KW, Gillard ND. Structured Interview of Reported Symptoms-2 (SIRS-2) and professional manual. Lutz, FL: Psychological Assessment Resources, 2010. [Google Scholar]116. Brand BL, McNary SW, Loewenstein RJ, Kolos AC, Barr SR. Assessment of genuine and simulated dissociative identity disorder on the structured interview of reported symptoms. J Trauma Dissociation 2006;7:63–85. [PubMed] [Google Scholar]117. Yu J, Ross CA, Keyes BB, et al. Dissociative disorders among Chinese inpatients diagnosed with schizophrenia. J Trauma Dissociation 2010;11:358–72. [PMC free article] [PubMed] [Google Scholar]118. Akyüz G, Doğan O, Sar V, Yargiç LI, Tutkun H. Frequency of dissociative identity disorder in the general population in Turkey. Compr Psychiatry 1999;40:151–9. [PubMed] [Google Scholar]119. Gleaves DH, Hernandez E, Warner MS. Corroborating premorbid dissociative symptomatology in dissociative identity disorder. Prof Psychol Res Pr 1999;30:341–5. [Google Scholar]120. Chu JA, Frey LM, Ganzel BL, Matthews JA. Memories of childhood abuse: dissociation, amnesia, and corroboration. Am J Psychiatry 1999;156:749–55. [PubMed] [Google Scholar]121. Coons PM. Confirmation of childhood abuse in child and adolescent cases of multiple personality disorder and dissociative disorder not otherwise specified. J Nerv Ment Dis 1994;182:461–4. [PubMed] [Google Scholar]122. Myrick AC, Chasson GS, Lanius R, Leventhal B, Brand BL. Treatment of complex dissociative disorders: a comparison of interventions reported by community therapists versus those recommended by experts. J Trauma Dissociation 2015;16:51–67. [PubMed] [Google Scholar]123. Myrick AC, Brand BL, Putnam FW. For better or worse: the role of revictimization and stress in the course of treatment for dissociative disorders. J Trauma Dissociation 2013;14:375–89. [PubMed] [Google Scholar]124. Lauer J, Black DW, Keen P. Multiple personality disorder and borderline personality disorder: distinct entities of variations on a common theme? Ann Clin Psychiatry 1993;5:129–34. [PubMed] [Google Scholar]125. Dell P, Laddis A. Is borderline personality disorder a dissociative disorder? Paper presented at the European Society for Trauma and Dissociation conference, Belfast, April; 2010. [Google Scholar]126. Korzekwa MI, Dell PF, Links PS, Thabane L, Fougere P. Dissociation in borderline personality disorder: a detailed look. J Trauma Dissociation 2009;10:346–67. [PubMed] [Google Scholar]127. Kemp K, Gilbertson AD, Torem MS. The differential diagnosis of multiple personality disorder from borderline personality disorder. Dissociation 1988;1:41–6. [Google Scholar]128. Boon S, Draijer N. The differentiation of patients with MPD or DDNOS from patients with a cluster B personality disorder. Dissociation 1993;6:126–35. [Google Scholar]129. Hall TJ. Rorschach indices of dissociation across multiple diagnostic groups. Ann Arbor, MI: ProQuest Dissertations, 2002. [Google Scholar]130. Sar V, Akyuz G, Kugu N, Ozturk E, Ertem-Vehid H. Axis I dissociative disorder comorbidity in borderline personality disorder and reports of childhood trauma. J Clin Psychiatry 2006;67:1583–90. [PubMed] [Google Scholar]131. Ross CA. Borderline. personality disorder and dissociation. J Trauma Dissociation 2007;8:71–80. [PubMed] [Google Scholar]132. Dell PF. Axis II pathology in outpatients with dissociative identity disorder. J Nerv Ment Dis 1998;186:352–6. [PubMed] [Google Scholar]133. Ellason JW, Ross CA, Fuchs DL. Assessment of dissociative identity disorder with the Millon Clinical Multiaxial Inventory–II. Psychol Rep 1995;76:895–905. [PubMed] [Google Scholar]134. Ross CA, Ferrell L, Schroeder E. Co-occurrence of dissociative identity disorder and borderline personality disorder. J Trauma Dissociation 2014;15:79–90. [PubMed] [Google Scholar]135. Sar V, Alioğlu F, Akyuz G, Karabulut S. Dissociative amnesia in dissociative disorders and borderline personality disorder: self-rating assessment in a college population. J Trauma Dissociation 2014;15:477–93. [PubMed] [Google Scholar]136. Schmahl C, Bremner JD. Neuroimaging in borderline personality disorder. J Psychiatr Res 2006;40:419–27. [PMC free article] [PubMed] [Google Scholar]137. Schlumpf YR, Nijenhuis ERS, Chalavi S, et al. Dissociative part-dependent biopsychosocial reactions to backward masked angry and neutral faces: an fMRI study of dissociative identity disorder. Neuroimage Clin 2013;3:54–64. [PMC free article] [PubMed] [Google Scholar]138. Schlumpf YR, Reinders AA, Nijenhuis ER, Luechinger R, van Osch MJ, Jancke L. Dissociative part-dependent resting-state activity in dissociative identity disorder: a controlled fMRI perfusion study. PLoS One 2014;9:e98795. [PMC free article] [PubMed] [Google Scholar]139. Sar V, Unal SN, Ozturk E. Frontal and occipital perfusion changes in dissociative identity disorder. Psychiatry Res 2007;156:217–23. [PubMed] [Google Scholar]140. Ellason JW, Ross CA. Two-year follow-up of inpatients with dissociative identity disorder. Am J Psychiatry 1997;154:832–9. [PubMed] [Google Scholar]141. Battle CL, Shea MT, Johnson DM, et al. Childhood maltreatment associated with adult personality disorders: findings from the collaborative longitudinal personality disorders study. J Pers Disord 2004;18:193–211. [PubMed] [Google Scholar]142. Classen CC, Pain C, Field NP, Woods P. Posttraumatic personality disorder: a reformulation of complex posttraumatic stress disorder and borderline personality disorder. Psychiatr Clin North Am 2006;29:87–112. [PubMed] [Google Scholar]143. Harari D, Bakermans-Kranenburg MJ, van Ijzendoorn MJ. Attachment, disorganization, and dissociation. In: Vermetten E, Dorahy M, Spiegel D, editors. , eds. Traumatic dissociation: neurobiology and treatment. Washington, DC: American Psychiatric Publishing, 2007;31–54. [Google Scholar]144. Levy KN. The implications of attachment theory and research for understanding borderline personality disorder. Dev Psychopathol 2005;17:959–86. [PubMed] [Google Scholar]145. Becker-Blease KA, Deater-Deckard K, Eley T, Freyd JJ, Stevenson J, Plomin R. A genetic analysis of individual differences in dissociative behaviors in childhood and adolescence. J Child Psychol Psychiatry 2004;45:522–32. [PubMed] [Google Scholar]146. Jang KL, Paris J, Zweig-Frank H, Livesley WJ. Twin study of dissociative experience. J Nerv Ment Dis 1998;186:345–51. [PubMed] [Google Scholar]147. Torgersen S, Lygren S, Øien PA, et al. A twin study of personality disorders. Compr Psychiatry 2000;41:416–25. [PubMed] [Google Scholar]148. Waller NG, Ross CA. The prevalence and biometric structure of pathological dissociation in the general population: taxometric and behavior genetic findings. J Abnorm Psychol 1997;106:499–510. [PubMed] [Google Scholar]149. Zanarini MC, Frankenburg FR, Yong L, et al. Borderline psychopathology in the first-degree relatives of borderline and Axis II comparison probands. J Pers Disord 2004;18:449–7. [PubMed] [Google Scholar]150. Sar V, Ross C. Dissociative disorders as a confounding factor in psychiatric research. Psychiatr Clin North Am 2006;29:129. [PubMed] [Google Scholar]151. Gee T, Allen K, Powell RA. Questioning premorbid dissociative symptomatology in dissociative identity disorder: comment on Gleaves, Hernandez and Warner (1999). Prof Psychol Res Pr 2003;34:114–6. [Google Scholar]152. Lilienfeld SO. Psychological treatments that cause harm. Perspect Psychol Sci 2007;2:53–70. [PubMed] [Google Scholar]153. Lambert K, Lilienfeld SO. Brain stains. Sci Am Mind 2007;18:46. [Google Scholar]154. Ellason JW, Ross CA. Millon Clinical Multiaxial Inventory–II. Follow-up of patients with dissociative identity disorder. Psychol Rep 1996;78:707–16. [PubMed] [Google Scholar]155. Kluft RP. Treatment of multiple personality disorder. A study of 33 cases. Psychiatr Clin North Am 1984;7:9–29. [PubMed] [Google Scholar]156. Ross CA, Haley C. Acute stabilization and three-month follow-up in a trauma program. J Trauma Dissociation 2004;5:103–12. [Google Scholar]157. Coons PM, Bowman ES. Ten-year follow-up study of patients with dissociative identity disorder. J Trauma Dissociation 2001;2:73–89. [Google Scholar]158. Coons PM. Treatment progress in 20 patients with multiple personality disorder. J Nerv Ment Dis 1986;174:715–21. [PubMed] [Google Scholar]159. Brand BL, McNary SW, Myrick AC, et al. A longitudinal naturalistic study of patients with dissociative disorders treated by community clinicians. Psychol Trauma 2013;5:301–8. [Google Scholar]160. Cronin E, Brand BL, Mattanah JF. The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders. Eur J Psychotraumatology 2014;5:1–9. [PMC free article] [PubMed] [Google Scholar]161. Jepsen EKK, Langeland W, Sexton H, Heir T. Inpatient treatment for early sexually abused adults: a naturalistic 12-month follow-up study. Psychol Trauma 2014;6:142–51. [Google Scholar]162. Foote B, Smolin Y, Neft DI, Lipschitz D. Dissociative disorders and suicidality in psychiatric outpatients. J Nerv Ment Dis 2008;196:29–36. [PubMed] [Google Scholar]163. Mueller-Pfeiffer C, Rufibach K, Perron N, et al. Global functioning and disability in dissociative disorders. Psychiatry Res 2012;200:475–81. [PubMed] [Google Scholar]164. Dissociation 1994;7:3–11. [Google Scholar]165. Ross CA, Dua V. Psychiatric health care costs of multiple personality disorder. Am J Psychother 1993;47:103–12. [PubMed] [Google Scholar]166. Lloyd M. How investing in therapeutic services provides a clinical cost saving in the long term. 2011. At 1 September 2011167. Myrick AC, Brand BL, McNary SW, et al. An exploration of young adults’ progress in treatment for dissociative disorder. J Trauma Dissociation 2012;13:582–95. [PubMed] [Google Scholar]168. Kluft RP. The older female patient with a complex chronic dissociative disorder. J Women Aging 2007;19:119–37. [PubMed] [Google Scholar]169. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Publishing, 2013.170. Carlson, E. B. & Putnam, F. W. DES: Dissociative Experiences Scale II Accessed 4/20/2016.171. International Society for the Study of Trauma and Dissociative Disorders. Trauma and Dissociative Disorders FAQs Accessed 4/20/2016.172. Mental Health America. Dissociation and Dissociative Disorders Accessed 4/20/2016.173. Steinberg, M. Interviewers’ guide to the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). Arlington, VA: American Psychiatric Publishing, 1994.I am here only to be truly helpful. I wish for you to create the life you deserve.

Thanks Alan Kulathanil for the questionWhat were the cultural differences between the Travancore and Cochin royal families?Well, I will try to answer this question in the context of Monarchial era (pre-1949) and Democratic era (post-1949)Why 1949? Because until July 1st 1949, Kingdom of Cochin and Kingdom of Travancore legally existed with Maharajas as the official sovereign. They had a standstill agreement with Dominion of Indian Union, but not part of it legally. It was on July 1st 1949, these two Kingdoms merged together to form the United States of Travancore and Kochi and merged with Indian Union as a state. So until 1949, it was monarchial era. Travancore Monarchy continued till Nov 1st 1956 as the Maharaja of Travancore became the new Maharajapramukh of Indian State of Travancore-Cochin (The Hereditary Governor before the current system of Governorship came in), while Kochi Maharaja was pensioned off.Both Travancore and Cochin Royal families are literally similar. Both of them areMalayala Samantha Kshyatriya community (deemed Kshyatriyaship) with Varmas as caste surnameBoth of them traces their origin to Imperial Cheras of Mahodayapuram. Kochi Dynasty believes, their lineage originated from Sister of last Chera Emperor, while Travancore (Venad/Kulashekaras as officially titled) believe their lineage originated from the son of last Chera Emperor. Both equally claims Chera Legacy and legacy of Vanchinadu/Mahodayapuram (the capital of Chera Empire) respectively.Both the dynasty are heavily matrilineal (the succession were thro’ female lineages) and hence the family headship was vested with their females, with their men, only a right to rule on their behalf.Both the families were heavily inter-connected with numerous marital relationships. In one account of Marthanda Varma’s history, Travancore Kingdom stopped annexing the Kochi Kingdom after the Battle of Purakkad, only because Marthanda Varma (the founder of current Travancore Dynasty) had his respects to his uncle- the King of Kochi.Both the royal families had many similar religious traditions and cultural lifestyleBoth the families weren’t lavish or extravagant in spending their resources and maintained a stricter code of public modesty.Now the differencesIn the current era (democratic era), the obvious difference are thatTravancore Royal Family as of 1949 with its key family members (H.H Maharaja Chithira Thirunal in the centre standing back and Senior Queen- H.H Senior Maharani- Sethu Parvathi Bai sitting in middle centre)Travancore Royal family with titular King- Sree Moolam Thirunal with the Imperial Sword of Travancore leading the Arattu festival of Sree Padmanabha along with other members of royal house carrying the state swordsTravancore Royal Family is a relatively very small family, enjoys huge public limelight, still remains as a celebrated and respected social institution with public homage, with many state honours and social status as similar to the royal era and its social conduct as an elitist family.Group Photo of Kochi Royal Family as in 1922Kochi Royal Family members as of today, attending a family meeting. They are nothing but commoners as of todayCochin Royal Family is a very huge family and completely forgotten by people of Kochi. Its fully converted into a commoner family with no social honours, status or any elitist traditions. It has no more public institution like set-up, rather just a cluster of many families using a common family name,I will explain this later, after telling the contexts in Monarachial era (royal period)Monarchial eraKochi Royal Family or officially titled as Perumpadappu Swaroopam (The sovereign house of Perumpadappu) was and still is ONE OF THE WORLD’S LARGEST ROYAL FAMILY.Today the family has more than 1200 members in the royal family (around 1500 if counting some associated clans to it), thus becoming a very larger royal house.In Monarchial days too, Kochi Royal family was a huge family institution. In those days, there were 11 matrilineal lineages (Thaivazhis), each lineage or clan have more than 10–15 families under it. This huge number of princes made the succession and kingship a complicated affair for Kingdom of Kochi.Comparing to Kochi, Travancore Royal Family (officially titled as Trippappur Venad Swaroopam or the Sovereign House of Venad- Trippappur branch) was comparatively very small and compact. It was so in past and still remains in same format today.In monarchial days, Travancore Royal family has a maximum of 2 matrilineal lineages (Thaivazhi) with less than 3 to 4 families per lineage. The succession format of Travancore was so simple and easy to understand and more important- so well defined.SuccessionIn Matrilineal society of Kerala, the sovereign is female who becomes the queen while her brother becomes the King to rule on her behalfTravancore Maharaja- HH Sree Chithira Thirunal Balarama Varma Maharaja with Senior Queen (his mother)- H.H Sethu Parvathi Bai and Junior Queen- H.H Karthika Thirunal (his sister)Travancore’s succession was very simple. The Brother and Sister become King and Queen and the queen’s children (the boy and girl) will become the next king and queen. The succession is so well defined and well planned in advance. If the queen doesn’t have children to succeed, adoptions take place from other royal families and the succession plan continuesKochi Maharaja- H.H Rajarishi Rama VarmaKochi’s succession was a quite complicated and extremely confusing process. Because it has a huge family with multiple clans, everyone has an equal right to become a King and Queen. Instead of a clear definition of next successor, Kochi has a complicated succession formula. The eldest female of all the 11 lineages/clans will become the Queen (Penvazhithampuran) and she may name any of her brothers or cousin brothers or nephews (who were qualified after a detailed astrological check) to become the King under her pleasure. The King holds the power as long as the female queen holds the pleasure or his death, whichever comes first. When a Queen dies, the next senior-most lady in the family becomes the Queen, and by convention, she will wait for the current King to die naturally to name her choice of new King.Due to this arrangement, the biggest problem in Kochi Dynasty was, it mostly had very aged Kings, as in majority cases, the eldest lady nominates mostly her brother as the King, who could be of elder age to her. Barring 3 or 4 occasions, Kochi never had young Kings. This has made a huge impact, as most of the newly coronated Kings don’t have much interest in actual governance as they were in the fag end of their lives and concentrate in their personal leisure and activities which they were into in their entire life. Thus the actual rule of Kochi was mostly left to the Prime Ministers of Kochi and Cabinet, making Kochi Kings more of a namesake position.This contrary in Travancore, as most of their Kings, were coronated at a very young age and open to many new ideas and actively participated in public governance. So most of the Travancore Kings always had their own identity and much popularity among the public, which Kochi Kings rarely had.Family size implicationsAs said before, Kochi’s Royal family size was beyond any comprehension. Even the most conservative estimates often show there were nearly 150+ individual families within the royal family.This huge size means, less income on per capita basis. The Kochi Kingdom was comparatively smaller Kingdom and had fewer resources. Due to this, the income of the Royal Family was limited and these limited sources of income when divided between families, each family gets a modest share. This means, there was no extravagance within Kochi Royal Family members historically. Most of the royal family members have a share of royal lands and most of them were dependent on farm revenue. In a way, they worked and lived much like any Nair households who too were dependent on farm revenue.Most of the princes of Kochi Family had alternate employment, partly out of their interest and partly for livelihood reasons. Majority of Kochi Princes were Ayurvedic Physicians, Scholars, Teachers and Accountants with the majority working for Kochi State Royal Civil Services. Even those who weren’t working for Civil Services were into some form indirect employment like under patronage of British Bureaucrats or Landlords etc. This means, even during Monarchial rule, there was a sense of commoner duty within the royal family, something uncommon in those days. This is the key reason, they effectively converted into Commoners after Independence as that trait worked so well.On the contrary, Travancore had much larger resources and hence the palace income was much higher than Kochi. Since the family structure was too small, the per capita income was very huge. Though they weren’t extravagant as such when compared to many other counterparts including the neighbouring Mysore Family, indeed they spent huge sums on creative and artistic talents and similar areas for their personal leisure. Huge sums were spent on many Palaces across the state and the royal family enjoyed many holiday trips etc. This is one reason today, you will see very large Palace guest houses in Travancore side, not much in the Kochi side.PalacesKochi Royal Family has a unique thing. Barring the King, no members of the royal family lived in Palaces. Its something very unique for Kochi Dynasty, again partly due to their size.Due to their extraordinary family size, it wasn’t possible for all family members to live in one Palace at all. Further their history was like that, it mandated multiple locations. And even so, they never lived together in one single place.Typical Princely Mansions as allotted to individual families of Kochi in Tripunithura and Thrissur.Kochi Royal Family members get state mansions for each family from the Palace Administration Board. These mansions are much like modern Houses, around 3–4 Bedroom houses with a smaller sitting room, a dining room, a kitchen, storeroom and servant quarters. Its not something of the usual grand palace as such which one imagines, rather modest houses with no grandeur other than teak/rosewood wooden interiors. Some luckier ones get 2 storied houses, while others mostly single floor ones. The princes live in such mansions or Malikkas as officially called.Hill Palace- Kochi, the official residence and office of H.H Maharaja of Kochi now a popular museum and botanical gardensWhen someone amongst the princes becomes the King, only he and his immediate family can move to the Grand Palace of Kochi Kingdom- the Hill Palace which incidentally is the Biggest Palace in entire Kerala and one among India. So residing at Hill Palace would be the key ambition of most of the Kochi Princes. Hill Palace, despite of being such a huge Palace, never accommodated other members of the royal family. Rather it served as Executive Office of the Kochi Kingdom with offices of Ministers, nobles and secretaries. So in a way, Hill Palace was more like White House, executive residence cum office of the King. The queen also has her own exclusive palace- the Elamana Palace (now converted into NSS College- Tripunithura).The other members of the royal family live in mansions mostly in Tripunithura, the royal capital and some in Thrissur city.Kowdiar Palace- Trivandrum, the current official residence of the Royal family of TravancoreContrary to Kochi, the Travancore Royal family lived in larger palaces. The royal protocols do not allow all members of the royal family live together in one place to avoid chances of extermination by enemies, but still they used to live in larger palaces, not mansions as Kochi Royal families used to live.Sree Padmanabhapuram Palace- the older Palace of Travancore Dynasty, now a popular state museum.The Sree Padmanabhapuram Palace in Kanyakumari was their base and which is also the largest wooden palace in the world. Later they built many magnificent places across the Travancore, including the famous Kowidar Palace, the current seat of the Royal Family in Trivandrum.Aluva Palace- the summer palace of Travancore Royals, now state guest house in Greater Kochi cityApart from these, the royal lodges like Lake Palace in Thekkady or Peermadu in Idukki as well as the Summer Palace in Aluva (today a suburb of Kochi city, then it was part of Travancore Kingdom).AdoptionsTravancore Royal Family was famous for its tradition of Royal Adoptions or Padiyettu as known locally. Many occasions, the royal family never had heirs to continue, due to which they introduced the concept of Royal Adoption by adopting princess of other royal families which in that era was seen as a social crime initially. Travancore constantly adopted princess mostly from North Kerala, particularly from Kolathiri family of Kannur, which made them famously known as Thekkan Kolathiri (the Kolathiri of South). This played a key role in the integration of Kerala culture as the gap of culture between North Kerala and South Kerala almost got harmonized and the culture across the state got synchronized. This is one key reason, one doesn’t see huge cultural differences between Trivandrum and Kannur which are at two ends of the state unlike other southern states where multiple intrastate cultures exist.Kochi Royal Family never believed in Adoptions as they never required at the first place due to its vast size and its unique succession format.MarriagesNote: There was no institution of legal marriage/husband-wife relationship among upper castes of Kerala until 1920s-30s period, rather it was mostly live-in relationships called SambandhamsKochi Royal House is very unique when comes to marriages. As the royal family was of huge size, the Lady royal members used to carry out sambandhams from multiple upper castes like Nampoothiris, Nairs, Ambalavasis etc as well as Varmas from smaller royal families. Nampoothiri Sambandham was much commoner as Kochi Maharaja was also the de facto head of Nampoothiri community across the state of Kerala (in his capacity as Koviladhikari- the Supreme head of Kerala Temples and in his capacity as Overlord of Avancheri Thampurakkal- the Head of Nampoothiris of Kerala). Due to the position of Kochi Raja, Nampoothiris always had an extra interest to be in relationship with the royal household as its a position of power and social status (though many within the family eventually became part of Royal Kitchen as Chefs of Maharaja which itself was an honor then). Nairs, as well as Ambalavasi men also married heavily with the Royal family, thus Kochi Royal House was a potpourri of multiple communities (the royal family even had a Christian Branch too). The princes of Kochi Royal house mostly enter sambandam with Nair women mostly.This means Kochi Kings, in general, were more flexible with upper castes customs and traditions and often accommodated many of Nairs and Nampoothiris in key government positions.This tradition still continues strongly in Kochi Royal house where members do marry Nairs, Nampoothiris and Ambalavasis commonly, not strictly within Varma community alone.Kings can legally marry a Nair Lady and unlike Nair customs of that era, he can keep his wife along with him and allow her to stay with him at Hill Palace. This legal wife was called Nethyar Amma (Britishers used to refer such ladies as CONSORT QUEEN to differentiate from actual QUEEN) who had rank of a junior princess or first lady in waiting at Queen’s court. She can live with the King during his lifetime at the Palace along with her kids but has to leave home once the King dies or terminates the relationship. However, in such cases, she and her kids enjoy a State Pension apart from the rights of the lands which the King had bestowed upon her and her kids (remember in Matrilineal customs, male have no rights over his kids, only the female has absolute rights). The children of King will remain as commoners and holds no royal titles and only the caste title of their mother along with the mother’s family name.On the contrary, Travancore was much stricter when comes to Sambandhams. Their ladies rarely preferred anyone else other than Varmas and Nampoothiris (that too only very highly reputed families and of higher social status). Royal Sambandhams were mostly reserved to vassal dynasties of Travancore and sometimes from Kochi or Kolathiri Kingdoms, rarely with Nairs or any other community in past.The King and male princes do enter sambandham with Nair ladies, but they are never allowed to visit even the Palace and never given any royal status other than a title for the main concubine/mistress of the King (Panampally Amma). Panampally Ammas and her family will remain as Nobles, but not members of the royal court, unlike Kochi. The son of the Kings will be nobles and have right to enter Palace and meet their father at will. They shall be referred legally as Thampi and Thangachis, but will not be seen as members of the royal family.Sovereignty and ProtocolsBy convention, the sovereignty of both houses was reserved to eldest female of the house.But there is a difference to Travancore by tradition. Travancore’s sovereignty has been transferred to Lord Sree Padmanabhaswamy of Trivandrum in the year 1750, thus both men and ladies of the royal house effectively became the servant of Sree Padmanabha (Sree Padmanabhadasa for men and Sree Padmanabhasevini for women)They pledge their allegiance to the Sree Padmanabha, hence ever since that, though by all royal protocols, the queen of Travancore superseded the King of Travancore. In Travancore order, there were always two queens, the Senior and Junior Queens. The elder Queen was always referred to as Attingal Mootha Thampuran and Junior Queen as Attingal Elya Thampuran as Queens of Travancore also were the independent Queen of Attingal fiedom, a small suburb of Trivandrum city. Generally, it could be mother of the King as Senior Queen and Sister of the King as Junior Queen who will rise as Senior Queen when the mother dies. In such cases, when she becomes the Senior Queen, her eldest daughter and the successor becomes the Junior Queen. The queens and ladies were referred to as Thampurattis.Queen Karthika Thirunal of Travancore- the Last QueenQueens of Travancore were much powerful. They always had freedom to move around, enter into as many as Sambandham relationships (Live-In Relationships) with men they live, attend court meetings directly and summon officials directly. Generally, Queens of Travancore always dominate the Kings as they make advises directly and even has the power to over-rule the King (though not common in history).Queens of Travancore were very fashionable and always highlighted their dressing sense as something key.Manku Thampuran- Penvazhithampuran or Kochi Queen, sister of Maharaja- Kerala VarmaOn the contrary, Kochi always had one single Queen- the Penvazhithampuran. No other lady can hold that title and she was the absolute sovereign, under whose name and behalf, the King rules. In the Kochi Kingdom, even Lady members of the royal family were referred to as Thampurans, not Thampurattis (the feminine version of Thampuran) and the Queen was referred to as Valiya-Amma Thampuran. Though the Queen of Kochi nominates the King and he rules on his behalf, the royal family has extreme conservative protocols over its ladies. Royal ladies cannot walk freely in public and if so, the roads were cleared and commoners weren’t allowed to look at them. The Queen of Kochi can’t visit Hill Palace (the logic was when she commands, the King has to be at her residence) nor she has any powers to summon any officials. She can’t legally advise government and she has no role in day-to-day governance. Royal ladies are not allowed to meet officials in person and if required by any chance, the officials must not see the ladies in person.Another factor is Kochi Royals, particularly ladies have several protocol restrictions. They were barred to wear jewels in public and not allowed to exhibit any jewellery. Initially, there were protocols against photographing royal women, but later it was allowed. But since 1900s, there was a protocol rule that ladies must be fully clothed while being photographed as it was not common for ladies of that era to cover their breasts…Ladies of Kochi Royal House in 1950, noted for their modest commoner fashionLadies of the Kochi Royal House as in 1920sUnlike popular perception, Kochi Royal ladies were too modest in their clothing. They never wore anything pompous or lavish etc.In short, the position of Kochi Royal ladies were slightly lower than their male folk, though theoretical they have higher protocol level and powers. But in practical purposes, they were more of figureheadsEducationBoth Kochi and Travancore princes/princess were not allowed to go to a public college/school for studies. They were tutored privately.Travancore was much famous for it. They often hired the best English and Indian tutors to train their princes/princess. Ever since the reign of Queen Gowri Lakshmi Bai, the focus of education was fully focused on western-style education with best English tutors being placed in Palace to tutor the princes and princess. Travancore stressed a lot on western education, thus princes were not just trained in English, but also in languages French, Spanish etc, in European literature works, in English concepts of Botony, zoology, History, Mathematics etc.Due to this reason, most of the Travancorean Princes and princess were polyglot, they were fashioned in western sensibilities of modern values etc. At the same time, Travancore ensured the princes were grounded in native customs, traditions etc and ensured they learn Carnatic Music, Kathakali, Indian mythology, Malayalam poetry and literature. Many Travancore Kings and Queens were highly educated, some were in modern research. For example, Vishakam Thirunal Maharaja was a qualified Botanist, while his Uncle and former Maharaja- Ayilam Thirunal was heavily qualified in Structural Engineering. The most celebrated ruler- Swathi Thirunal could speak 16 languages and was so keen in astronomy, zoological sciences etc while being a famous musician and composer.On the contrary, Kochi Royal family weren’t many supporters to western education. They were orthodox in many ways and never appreciated Western Education as a matter of progress. Kochi’s royal education was heavily focused on Vedic studies, with Sanskrit being the key language which princes and princess studied.But home-tutoring wasn’t possible with its large number, so a Palace school itself was started for all the royal children to go and study. The Tripunithura’s famous Palace Sanskrit School still remains with its royal legacy. They learnt more of Indian poetry, epics, dramas, works etc and focused heavily on Ayurveda, Mimamsa, Vedic maths, astrology, Vasthushastra, Dharmashastras etc.Lady students of Palace School - Pic was of a farewell function of their teacherKochi Princes were experts in many native sciences, particularly Ayurveda which happens to be their most favourite area of study. Kochi Kings always focused on institutionalizing Ayurveda as a key branch of medicine and this played a key role when Kochi King along with Zamorin of Calicut set up Kerala’s first modern Ayurvedic society- Kerala Ayurveda Samajam in 1902. Apart from Ayurveda, they were keen in many other native sciences like Gulika Shastra, Astrology and Vedas. Kochi Kingdom’s Shastrasadasu or the Great Hall of native sciences was often one of the biggest venues for traditional scholars to discuss on these topics.The Shastrasadasu or Vedic science council attended by famous scholars of Koch held under the auspices of Kochi MaharajaModern sciences were given prominence by the state governments mostly, not the royal house of Kochi.This stark difference between Kochi and Travancore Royal houses, also highlights why Travancore is often hailed as modern and progressive, not much for Kochi Kingdom.OrthodoxyTravancore Royal house was modern but conservative, whileKochi Royal house was Orthodox, but liberal.This irony always seen in their royal family cultures. Travancore Royal House always promoted western ideas, modern studies and introduced such to Kerala in a big way. For example, India’s first Zoo was started in Trivandrum way back in 1859 within 10 years after commissioning of London Zoo, the world’s first professional zoo, modelled on it. The reason was to the public to study on zoological topics, something unheard in that era. Same way, India’s first Allopathic Public Free Hospital was also started in Travancore, so that every commoner able to treat themself with modern medicine. So as Travancore was the first place in the world to declare FREE UNIVERSAL EDUCATION for all its citizens way back in 1819.So in many ways, they were pioneers. But they were so conservative when came to royal structure and power. Despite of teaching the public what democracy is in England, they refused to implement democracy in Travancore or even allow responsible govt as they were so conservative about their political structure.This is opposite in Kochi. Kochi Royal house is so orthodox, so traditionalist and never opened to modernity. There used to be a saying, Kochi Princes won’t even try wearing a shirt and pants as late as the 1880s when everyone used to. But they were so open to liberal to allow others to do so. For example, Kochi never placed any huge restrictions on press etc, whereas Travancore used. Travancore once banned Kerala’s largest Newspaper- Malayala Manorama which used to function from Kottayam (in Travancore) and the media house fled to Kochi Kingdom where it started its new Press- Irjnalakuda. Despite of publishing news against Kochi King, Manorama wasn’t banned or censured in the Kochi Kingdom, thanks to the liberal attitude of Kochi Kings and govt.Kochi’s liberal attitudes helped many business to flourish as rarely government of Kochi intervened into their business, while Travancore’s conservative and autocratic attitudes never allowed free business regime.The govt of Kochi was very orthodox when comes to religious topics, but Travancore was very modern over there. It was Travancore who abolished the casteism concept, allowed dalit entry into temples legally for the first time in Indian History till then, while the act was seen a crime by Kochi Kingdom who maintained that Temples should be exclusive to brahminical communities, not others.SportsIt would be bit surprising to know, but a hard fact, Kochi Royal Family was so obsessed with the game of Cricket. Infact it was the only Royal Family in India to declare Cricket as its official game, way back in 1870s and Kochi Princes were mad with the game. Cricket was introduced in India in 18th century (1799) by Lord Wellesley (the general who defeated Napoleon) at Thalassery Fort which was a game played between British army officials. Kochi Princes who came to visit the fort, happened to see it and enjoyed the game. It was from there, they started playing this and became obsessed.Cochin Princes Club- the royal cricket team as that of 1930 when went to Madras for participating CRF TrophyCochin Palace Oval, the oldest cricket turf in Kerala that shaped many cricketing talents from the stateSurviving princes of old Princes Club who still see Cricket as their passion even in their old ageCricket was often called Royal Game in Kochi, as only Princes were allowed to play and most of the commoners never understood what they were doing at the ground. The Palace Oval in Tripunithura was the first professional Cricket turf of Kerala where the princes used to play and the royal family started World’s first limited over tournament- the Pooja Cup (as it was played during Navaratri holidays time) in 1951. Many Kochi Princes became part of various professional clubs. As it was a princely game, cricket was heavily ignored by public then and even after independence, the govt never gave any importance until it became more democratic game since the 1980s.Trivandrum Golf Club, India’s 3rd oldest golf course which many Kings of Travancore patronizedUnlike Kochi, the royal family of Travancore never had any royal game as such. However historically since the 1890s, many Travancore princes were fond of Badminton and Tennis. They regularly used to play in the place, but never made into a professional concept as Kochi Family took with Cricket. Travancore Kings also played Golf, something introduced by Britishers, which lead to the start of Trivandrum Golf Club in 1850, India’s third oldest golf course (started as Maharaja’s Hunting and Play Lodge). The kings weren’t keen to play golf, but primarily started a Golf course to match their social status as equal to British level, after visiting Calcutta’s Royal Golf club. Not many Kings were golf players, but King Ayilam Thirunal was a regular golfer who expanded the club to today’s level. So as last king- Chithira Thirunal.GV Raja- the first Prince of Travancore, also known as Father of Kerala Sports was an adherent player of Badminton. He was first Malayalee Vice President of BCCI.But Chithira Thirunal Maharaja’s brother-in-law (consort of the Queen)- the First Prince GV Raja was celebrated across the state as Father of Kerala’s sports sector. GV Raja was an adherent lover of Cricket, so he started Kerala Cricket Association (now part of BCCI ) who was also the Vice- President of BCCI India, so as a professional tennis player that he invited then the Wimbledon champion- Bill Tilden to Trivandrum for a professional friendly match and started the famous Trivandrum Tennis club in 1938. He was also an athlete in his younger days.It was after GV Raja came to Kowidar after his marriage with Queen Karthika Thirunal, the royal family became active in sports. GV Raja used to make Queen Karthika Thirunal play Badminton regularly and made it compulsory for his children, due to which a professional Badminton court came up inside the Palace complex. His grandson- Prince Aditya Varma is a famous Badminton player and was part of state team earlier. Now the royal family started a world-class Badminton court for the public which is popular in TrivandrumSri Padmanabha Royal Indoor CourtsFoodBoth the royal families were hardcore vegetarians.Travancore House historically was flamboyant when comes to culinary topics. Travancore royal family members were historically known to be foodies and loved to enjoy their food. This is one key reason why Trivandrum historically had a very huge Sadya spread as the palace luncheons were known for its sumptuous sadyas . Travancore Kings even wanted to enjoy the famous Ambalapuzha Pal Payasam (the famous Milk Kheer of the temple), so they used to wait till late afternoons for their lunch to get the Payasam delivered straight to Trivandrum. It used to be said, Travancore Kings personally enjoyed a 15 dish Sadya (it was huge in those days), only to be completed by a choice of 4 desserts (the only one in Kerala to have so in that era)Compared to Travancore, Kochi Kings and family mostly had frugal meals. Kochi Kings were into Ayurveda mostly and hence they used to stress the importance of Sativik/Ayurvedic food. Kochi royal meals were mostly bland, not heavily spiced and rarely used any imported vegetables like tomatoes or Potatoes. The most famous Kochi royal dish was Kuruku Kalan, a heavily stirred dried Yam curry in yoghurt which was very tough to make. Kochi rulers were fans of dairy products, so most of the royal dishes in Kochi Kitchens were of diary-based. The food style of Kochi royal family were mostly similar to Nampoothiri houses, due to the Nampoothiri influence over them.By tradition and convention, Kochi Kings used to take only one Payasam afternoon, brought from the state temple- Sree Poornathresya. The famous Pathiruazhi Payasam was initially offered to the lord, only to be consumed by members of Royal family in those days.DressingBoth the royal families had similar dressing style which was common to that eraKochi Royal household ladies like elsewhere never covered their blossoms. They only wore a cotton mundu alone while inside and an upper shawl to cover their body until start of 1900s.The typical fashion of Kochi Royal ladies in 1930s with newly introduced rouka blouses and sarees. The royal ladies never wore jewellery in publicPrinces of Kochi House, who normally wear jubbas or shirts with MunduMost after 1900s, Royal ladies started wearing Rouka and sarees (both foreign imports), hence it was heavily seen with contempt in public citing as foreign fashion influence. Elderly ladies used to wear Mundu and Shawl in today's Mundu Neriyathu fashion by around 1920s and Kochi’s famous Neythar Amma- Parukutty was instrumental in promoting that fashion. She being a Neythar Amma, had no restrictions to travel unlike Queen and welded the power of the state in absence of her husband- the King. But compared to the standards of other queens across the country, the dressing style of Kochi ladies were very modest. They preferred ordinary rouka with floral pattern and cotton/silk Neriyathu mostly.Parukutty Neythar Amma, the Consort Queen of Kochi who popularized the wear of Mundu and Neriyathu among royal circlesParukutty Nethyar Amma who was the consort Queen, became Gandhian after meeting Mahatma Gandhi when the latter visited Hill Palace. Ever since that, she wore only Khadi clothes typical to Gandhian fashion and instructed all in the Hill Palace to wear Khadi Mundu. Initially, there was a heavy opposition, but eventually, every prince and princess started wearing Khadi Mundu, which became part of their official dress, the only Royal family to do so until then. To differentiate them from commoners, they never wore Gandhian caps, but their trademark Silk Caps. The males of the family never wore shirts, rather just a Mundu alone. Wearing a shirt was seen as western fashion in those days, but later started wearing Jubba which was part of Nationalist fervour within the royal family. They wore suits only for functions where British officials were presented.Kochi King Parikshit Thampuran in his typical Gandhian attire with Sardar Patel on left and VP Menon on rightThe last King- Parikshit Thampuran too was a Gandhian and never wore any silk clothes, rather always preferred modest Gandhian style Khadi Mundu and a Jubba. Even today, the majority of Kochi Royal family members were always noted for their modest dressing.Kochi King- Middukkan Thampuran in his classic attire which was an ordinary suit and a silk capAs royal robes, Kochi Kings worn silk and linen suits with a silk Chinese caps. Kochi Kings never wore crowns, rather kept the crown on their lap, a unique tradition followed since 15th century. They always wear a Silk Cap and in the court- a turban with no jewels attached.On the contrary, Travancore Royals were bit more flamboyant, though not similar to their counterparts in Mysore or Hyderabad. They always wore Silk clothes in public with turbans for men while ladies preferred traditional silk/cotton Mundu. Travancore royal ladies were too focused on their hair-dressing and invested a lot of time in huge decorative hair buns. Unlike Kochi, there was no restriction for ladies from wearing jewellery in Public, but still they kept some modest sense.Travancore Junior Queen- Bharani Thirunal as in the painting noted for her heavy jewelleryRegent Queen Sethu Lakshmi Bai of Travancore who popularly introduced Blouses with her consort Prince in western-style suitsTravancore King and Queen all in modern attires. Chithira Thirunal Maharaja in North Indian style robes was common thenSince the era of Regent Queen Sethu Lakshmi Bai, blouses became mandatory for royal ladies. Sethu Lakshmi Bai used to wear full sleeve bloused with Mulakkacha in traditional style. By this time, most of the males members started wearing western suits in public appearances. Travancore Kings used to travel extensively across India, so they used to adore typical North Indian style Maharaja robes like Jodhapuri suits, Rajasthani styled headgear etc which became part of Travancore Royal fashion. By 1930s, sleeveless blouses and light fancy sarees became popular in the royal court and Travancore Queens started wearing it which was called as the Bombay Fashion. By 1950s, they started wearing only normal public clothes as commonly wore by upper-middle class. The current Queen and Crown Princess prefer just ordinary Mundu Neriyathu just like any of their age.Post 1949, both Kochi and Travancore became part of India and by 1970s, both became commoner family.But essentially there was a difference. Kochi Royal House since late 1930s was preparing itself for becoming part of India as most of its family members slowly tuned its political attitudes towards Indian freedom movement.Kochi was the first princely state in India to formally accept the call of joining with Indian Dominion, the first princely state to host Indian Tricolor even before its formal accession into India and the only princely state to celebrate the independence event of August 15th 1947.The King was a Gandhian and he was prepared to become a commoner. Infact it was recorded in VP Menon’s autobiography that when Sardar Patel asked what Kochi King wanted in return to join India, he demanded just a copy of Panchangam (almanac) which really surprised Sardar Patel.This attitude fastly converted Kochi Royal house into a commoner family. Prior to independence, Kochi Kingdom passed a law- Valiyamma Kovilakom Trust Act that consolidated Palace Holdings under Palace Administration Board and vested its authority with the state. Due to the operationalization of this law, Palace Administration Board of Kochi has a legal cover and partially under state cover with an IAS bureaucrat heading the Board and state has to pay certain funds for maintaining palace properties which cannot be sold outrightly at the individual level. Thats the only relic remaining that highlights the stately position of Kochi Royal House.On the contrary, the Travancore Royal Family protected most of its interests via a Covenant signed between them and the Indian Union. This helped them to maintain a lot of Crown Properties and save them from Land reforms legislation of Kerala state.Kochi Kings historically withdraw from the governance of the state directly for a pretty long time even when they ruled. Due to which, there was little popularity of the royal family among public historically and post-independence, they were forgotten.Travancore royal family members (Queen and crown princess) along with state ministers and other dignitaries for a public function to honor fisherfolk who participated in rescue operations during Kerala floodsThen the Gujarat CM Narendra Modi with then the Maharaja- Uthradom Thirunal..On the contrary, Travancore Kings always maintained the image and popularity, thus had extraordinary popularity in Travancore, particularly Trivandrum. Even the state officially respects them and accords many honorary positions.This is partially derived due to the state respect to Sree Padmanabhaswamy who still enjoys a 21 Gun Salute from Kerala State which automatically extends partially to his representative- the titular King too. One can find many royals often invited in many state functions as official guests and even enjoys a protocol position that of state guests. Travancore family gets a police protection cover with a Security officer from State services to the titular King and a team of police officials for security cover at Kowidar. Whenever key state guests visit, many do visit Travancore Royal house as part of their itinerary. These factors helped the Travancore family to enjoy a stately position.

I can’t compare to all states of India with Kerala and its not fair too at this stage to make any comparisons. We are in the middle of a crisis and this is not just applicable to Kerala or South India or India as whole… Rather it's applicable to the entire world.Every government in this world is trying their level best to serve their citizens in the crisis. We can’t claim, ONLY we are doing the best. Everywhere, govts are trying to do best for their people. Maybe in some areas, we might be standing slightly better, some areas we may be lacking too.So I am not into any comparison at all. But since I write about Kerala in Quora, I feel I will write what all Kerala State has done in its fight against Corona Virus. I am talking only in specific to Kerala, not in comparison with any others.And please note, this is an evolving crisis and every day something new is being added to the fight. So sticking to things as of yesterday- 28/03/2020Contact trackingFor me personally, I consider this job done by Kerala’s DHS (Directorate of Health Services) as something the best they could do for us. Learning from Nipah outbreak experience, Kerala has used its resources to track contacts and people who been associated with the index patient (first patient in a cluster) to identify a cluster and isolate from the community. This includes detailed tracking of patient’s route from the moment he/she landed in Kerala until the moment he/she been quarantined into the hospital. Most of the tracking is done thro’ inputs made by the patient which are cross verified by officials of Public Health Inspectorate and Community Medicine Department, apart from using Police’s intelligence sources like Cyber cell to track down the mobile tower locations of the patient, special branch reports, phone records, CCTV camera recordings etc. By this manner, DHS able to identify a cluster comprising of potential secondary and tertiary contacts made by the index patient who will be either home or hospital quarantined and if any symptoms are shown, their blood samples will be tested.The DHS frequently makes regular route maps of patients and publishes in public to let people know about the time and place where the patient was and ask the public to declare to DHS, if they were in at that place at the specified time, to be declared as part of a cluster.Route Map of Patient 1 of Pathanamthitta which resulted in the start of second wave since March 2020This kind of tracking helped Kerala as of now to contain the disease to cluster level, though some have jumped out of quarantine and their actions created more clusters and patients.How Kerala's flowchart model is helping effective coronavirus contact tracingKerala launches contact-tracing programme to neutralise coronavirus threat2. TestingI have written answers before. Kerala’s strategy in combating this disease is by constant testing of samples. Kerala so far is the state that has done the highest number of testing among Indian states and its testing ratio is somewhat at par with many major affected countries like Japan or similar.Arun Mohan (അരുൺ മോഹൻ)'s answer to Why are no COVID-19 deaths reported in Kerala even though the state has the highest number of cases?States That Are Testing More Are Detecting More Cases, Data Show |If Kerala has done anything good in this sector, its solely because of regular testing and able to identify people quickly.As of yesterday (28/02/2020),Kerala tested 6,067 samples5,270 samples were negative165 are currently on treatment (Confirmed cases)1,34,370 are in isolation/surveillance (not yet confirmed)8 have recovered and still kept in observationand 1 death has been reported (the very first death in the state)This massive Pro-testing approach has helped Kerala to have nearly 10 Testing Virology labs in the state, including an NIV unit that helps faster and regular testing. As of now, Kerala has the highest number of blood sample testing facility in IndiaAs yesterday Kerala announced massive rapid testing after getting in-principle approval from ICMR. Kerala is the first state to announce so and was pressing ICMR for rapid testing permission for every single one in isolation/quarantine for last few days.3. Medical preparednessKerala was expecting to have Corona right soon after China declared its condition way back in Jan 2020. Kerala due to its very high non-resident Malayalee population living in many countries of the world was sure, they will soon get this new disease thro’ them and it was so right its judgement when the first Covid Case of India was reported in Kerala way back in Feb 2020. And it fully contained the first wave of Covid entry in Feb when it could isolate all cases and avoid spread etc.In the second wave, which happened thro’ an irresponsible family’s actions that created multiple clusters and later thro’ various foreign imports (some again were of irresponsible actions), the medical teams were so prepared to deal with emergencyDHS by March mid has already completed setting up various contingency plans, which were titled as PLAN A, PLAN B AND PLAN C. These plans were effectively communicated to entire medical and administrative officials of the states and everything has been well defined. This even includes thresh-holds for initiating each plan. Medical infra audits were carried out as part of this medical contingency plansThe Plan A which is currently ongoing has seen mobilization of resources associated with 50 Govt hospitals and 2 private hospitals on standby with total of 974 isolation beds and 22 ICUs readied for Corona carePlan B which has been initiated last day has mobilized resources for an additional 71 govt hospitals and 55 private hospitals for combating this disease which will add another 1408 beds.Plan C is the next stage (once the diseases spread comes to 3rd stage) which will mobilize 81 govt hospitals and 41 private hospitals with another addition of 3028 beds and 218 ICU bedsThese plans were drawn in March 1st week, which shows the extend of planning of Kerala Govt.The new set of plans (unofficially codenamed as PLAN D) will feature nationalization or semi-nationalization of entire Private hospitals of Kerala featuring a total bed of 69,434 beds and 5507 ICU beds. As of the latest decision, the govt decided to take over unused private hospitals and those medical colleges whose operations were suspended by MCI. 3 hospitals facilities and one Hostel complex were taken over in last 48 hours (PVS Hospital in Kochi, Anjarakady Medical College in Kannur, Shanti Jamaath Islami Hospital in Kozhikode and Sree Sankaracharya University Hostel Complex in Kochi)Collector Ernakulam (Kochi) taking over an unused hospital in Kochi city to be converted into a Covid Care Hospital facility.The Plan D features taking over hotels, hostels, lodges and other commercial units to develop into Isolation centres and Temporary Isolation centres, which shall be more than 2 Million rooms.As of now, Kerala Govt has announced opening Exclusive Covid Hospitals in every district of Kerala (14 Covid Hospitals in the level of tertiary care facility) and the first one is opened in Kochi- CMC (Cochin Medical College) which is a government Medical college and others are expected to open by this weekKerala’s first dedicated Covid Care Hospital centre in Kochi with 500 isolation beds and 70 plus ICU bedsGovt has been in talks with various community organizations and they all pledged their support for the fight. The Catholic Hospitals Association which is the second-largest Medical group after Government hospital network has decided to give all their hospitals to DHS along with their medical Staff (2660 Doctors, 10,300 Nurses, 5,500+ Paramedics and 6800 Admin staff). The Nair Service Society has assured Govt to provide its 2 hospitals and 100 plus educational institutions which they can convert into field hospitals if required. The SNDP Trust also assured Govt to provide its 1000 plus schools to be converted as field medical hospitals or treatment centres. It also assured to give its medical college to the state upon demand. So as Muslim Educational Society and Jammat e Hind Islami also assured to provide all its hospitals, madrasas, schools and colleges to the government for its better use.4. Upgrading Covid Hospital facilitiesOne key factor Kerala Govt focused on improving the facilities at all Covid care hospitals to ensure the public do not hide their medical cases to avoid visiting or isolating themselves.All Govt Covid Isolation rooms and treatment rooms are modernized and sanitized as per WHO protocols. Patients were brought to such isolation wards in dedicated Covid care ambulances and the isolation rooms were all modern and neatThe govt took extra care to ensure the food patients get at these hospitals should be as inviting as possible to shed all bias and prejudices against Govt hospitalsCovid patients gets inviting meals with options like Soups, fruits, eggs, Dosa, Appams, Rice-fish curries, chappatis, curd etc while foreign patients gets continental meals like Toasted breads, cheeses, omelettes/scrambled eggs, roasted chicken, biscuits etc. Patients do get daily milk, tea, coffee, fresh fruit juices, packed mineral water and daily newspapers (courtesy from Hindu).Dosa, eggs, oranges, fish fry: Here's the menu at COVID-19 isolation wards in KeralaThe hospital authorities have taken every wish of patients as much as possible, for example an covid affected Kid from Italy in treatment at Kochi were treated with Italian pasta, Ravoli and pizzas as the kid likes only Italian food which were ordered from an Italian restaurant nearby.5. Medical Industrial PreparednessKerala Govt has taken extra note in preparing itself for a major medical emergency. The state’s Medicine production has gone into full swing. The state-run Kerala State Drugs and Pharmaceutical Corporation has been entrusted with bulk mass production of Hand sanitizers which produced more than 1 Lakh bottles of Sanitizers and increased production targets to 1 million (10 lakh) by end of this week.1 lakh bottles of hand sanitizers in a day: Kerala goes all guns blazing against Covid-19KSDP also entrusted with mass production of 8 critical generic drugs and 2 drugs for which it holds patents to ensure no shortage.The state’s Electricity board has ordered to procure 500 new medical ventilators exclusively for Covid operations (Kerala state holds 5000 ventilators in total which is approx 12% of total available ventilators in the country). The state is going to enter talks with various manufactures for portable ventilatorsIn addition, the industry department has been asked to explore the possibility to produce 1 lakh N95 masks with any tech partnership with companies using facilities available to the department. In the meantime, the state will continue the mass production of cloth and surgical masks.As of today’s (28/03/2020) cabinet decision, Kerala Govt decided to form a medical industry cluster to manufacture indigenous medical equipment supplies at the earliest using existing facilities.The Kochi Superfab Lab, India’s only such facility were given the charge to design equipment required for such a major medical emergency. The state will produce its own Respirators, Ventilators, N95 Masks, Oxygen cylinders, Bio-Medical equipment preparing itself for the worst medical emergency.ISRO’s VSSC facility in Trivandrum and Kochi’s Technology Innovation Zone along with Kerala Start Up Mission will be fully utilized to design and develop newer and practical technologies and existing factories in Palakkad’s Kanjikode Industrial Cluster will be fully converted to produce equipment required for the medical sector. For this, a meeting of industrialists will be called tomorrow and setting the plan in motionThe state has opened a new challenge to all its technocrats and tech student entrepreneurs and start up promoters to come up with ideas for effective tech solutions to deal with a major emergency.A website- http://WWW.BREAKCORONA.IN has been started by Kerala Govt to invite newer ideas that can easily be put into action for which Kerala Govt will support financially and these projects will also generate employment and opportunities in the economy.6. Technology Usage and War RoomOne main feature which Kerala’s DHS used to control Covid spread was its Control Room set up at Kerala State Disaster Management Authority complex in Trivandrum and district headquarters. This was something which I feel, gave real-time updates to DHS on the spread and ways to control and contain it.These multiple data recording and analysis units helped to track patient history, procure data from multiple sources, feed in data and help control room unit officials to analyze patterns of travels and contact detailsIn a way, it was a full-fledged health surveillance facility. Patients route maps were made, their contacts were identified and their movements were tracked from this Hitech facility. These 24 hours of data control rooms, helped to give a clearer picture and understand the extent of spread thro’ interactive maps etc.This also includes geo-surveillance, monitoring those in quarantine with geo-fencing, GPS enabled trackers, electronic anklet monitoring systems etcScreenshot of portal that highlights patients under GPS enabled Geo-fencing to track their movements as used by District Administration- PathanamthittaCoronavirus | GPS-based tracking of all those quarantined in PathanamthittaIn addition, Kerala is using multiple data collection methods to track vulnerable people and develop maps to identify potential hot spots and nearest medical facilities. The disease mapping helps to have a strong information flow for various strategic decision making to control community transmission.Kerala uses open source public utility to fight COVID-19 - Geospatial WorldKerala govt to use ration card data for digital map on COVID-19Disease mapping to stem community transmissionApart from this, the centralized health support centre- DISHA (Direct Intervention System for Health Awareness) played a crucial role in tracking and supporting patients and other suspect cases. DISHA is a centralized call centre of DHS with a toll-free number- 1056 which was started to support patients for telemedicine and tele-support like counselling etc. But during this COVID time, it was fully converted into COVID Support and call centre facility. They notified the patient records, their queries and supported back with real-time updates of their medical conditions, moving ambulance support for them and mental counselling etc to alleviate stress.Disha 1056 call center, the nerve point of Anti-Corona operationsCoronavirus: This team at Kerala helpline desk works round the clock in fight against the pandemicNow, the state is coming up with a sophisticated Hitech War Room in the State Secretariat that has senior Bureaucrats as members to control and coordinate entire Covid operations including logistics movements during lockdown etc. A new secured line has been established- 0471-2517225 for the public to call at War Room directly.War room to coordinate effortsWar room in Kerala to supervise COVID-19 containment activities8. Lockdown SupportThe Lockdown as announced by Central Govt has affected every Indians. Kerala is no exception to this grave situation.During lockdown time, the state has focused on maximizing deliveries of essential supplies at home.The state has partnered with Zomato in Kochi, Trivandrum and Kozhikode to supply essentials from state-run Supermarket chain- Supplyco to public. 40 stores of Supplyco will start services of Zomato for home delivering of essentials including the essential kit of basic food items priced at Rs 500 (5 Kg rice, 1 litre coconut oil, 1 kg sugar, half kg of 2 kinds of pulsesSupplyco ties up with Zomato for online delivery of essential items in KochiThe state’s Consumerfed also entered into Online delivery starting from 1st of April and will extend to all districts of Kerala at the earliest. In addition, the state’s milk brand- Milma has aggressively pushed its online delivery- AM Needs more in 2 main cities which shall supply Milk, Milk products and breakfast items like bread, eggs etc. Efforts are made to extend this to other main cities too.Consumerfed’s online delivery from April 1Kerala Govt along with Police Cyberdome and a private company has launched a new Online app- ShopsApp and now asking all shops selling essential goods to mandatorily register in the ShopsApp portal. Once all the shops register, the newly formed volunteer army will be used for home delivery which will be spread across the state, not just cities alone.Shopping from local stores with home deliveryഅവശ്യ സാധനങ്ങളുടെ ലഭ്യത ഉറപ്പാക്കാൻ പൊലീസ് ആപ്The state has assured home-delivery of its essentials kits and ration supplies to the houses of poor (BPL cardholders) across the state, even in rural areas thro’ services of postal personnel as well as its own staff. Right from the day when schools where closed, personnel from Angawadi (kindergarten) and other educational departments were home delivering essentials for kids and children enrolled under each school directly.The state announced ambitious schemes to ensure HUNGER FREE Kerala. The govt clarified, not a single person in the state will starve due to the lockdownEvery family who is currently home quarantined will get Rs 1000 worth Essentials Kit of Food items from the govt for free which shall be home deliveredBPL card holders will get 35 Kg of Rice and APL cardholders will get 15 KG of Rice from Ration shops for free.Covid-19 lockdown: In a first, Kerala to home deliver food kits to the poorIn addition, a mechanism for home-delivering items from nearby shops by volunteers is plannedPolice delivering essentials to houses of elderly people who can’t go out9. Community KitchenThe govt directive is for Hunger-Free Kerala. No one will starve in KeralaFor this, the state has directed every Local Govt bodies to start Community Kitchens to cook food in bulk and provide packed food kits to people who don’t have access to cooked food. This includes homeless people, elderly people, sick people, migrant labour community and those got trapped in hostels or similar facilities overnight. All these shall be delivered to homes for a free or nominal token amount of Rs 20Meals shall be also delivered any needy just thro’ phone calls. The whole scheme has been worked out by Kudumbashree workers and packed meals costs Rs 20 only for veg and extra Rs 30 for a Chicken/Beef/Fish dishhttps://www.thenewsminute.com/article/inside-kerala-community-kitchen-during-coronavirus-lockdown-121325As of now, 748 Community Kitchens have been opened and an additional 300 will be set up soon. This service is available for lunch and dinner.So my parents who are in Kerala tried the community kitchen meal which was home delivered for Rs. 25. Rs. 30 extra if you want fish/beef/chicken. #Kerala #Alappuza @vijayanpinarayi @drthomasisaac @CMOKerala @shailajateacher pic.twitter.com/Ws2snAq5EQ— JF (@Potatodrink) March 27, 2020Kerala's Solution For Food Needs Amid Lockdown: 1,000 Community KitchensAgriculture Minister VS Sunil Kumar inspecting the facilities at Kochi’s Community kitchenKerala’s 43 lakh-strong women self-help network power community kitchens during coronavirus lockdown10. State Volunteer ArmyThe state announced an ambitious idea of forming an army of 2.45 Lakh volunteers to support various volunteering activity under a single command. Ever since the lock-down, multiple organizations are into volunteering activity causing many law & order issues and unauthorized movements. Also, there is a lack of coordination in these activities.To deal with it, the state formed a new directorate- Directorate of Social Service Force under State Youth Commission. The Directorate is to raise an army of trained volunteers to support various activities classified as 18 categories.https://www.quora.com/share/Arun-Mohan-520The key part of Volunteers is to develop emergency Isolation centres as required as movers as well as technicians. Apart from that, they are heavily required for logistics operations across the state, to supply deliveries to home, to work as care-takers and home-sitters for elderly and Covid affected patients etc.The govt announced this day before yesterday and invited online registrations thro’ its new portal- https://sannadham.kerala.gov.in/ (Sannadham in Malayalam means Volunteering) and despite of a technical glitch in registration, by now 30,000 youngsters registered for volunteering. This also includes Kerala Youth Volunteer Action Force- KYVAF (Red Shirts as known locally) designed after 2019 floods to have trained volunteer guards (5000 such trained red shirts are now available). So far only Andhra Pradesh and Kerala have formed such volunteer army.News in Asianet News about huge number of applications and responses to forming Kerala Volunteer ArmyRed Shirts in public sterilization programsKerala to set up Community Volunteer Force to support better deliveryKerala govt to form volunteer army of 2 lakh youngsters for the COVID-19 fightTechies turn volunteers to assist Kerala to contain Covid-1911. Transparency Flow of InformationThe biggest positive thing which Kerala is doing (which some proactive CMs of other states also doing) is effective and transparent flow of information.One of the important lessons learnt after Oockhi crisis of 2017 which Kerala changed since then and effectively used during floods time of 2018 and 2019 and Nipah time, was holding regular press meets and effective passing of all information available and cutting the spread of fake news.The government for the last 56 days were constantly holding daily press briefing both at State Level and district level to pass all information of the day. On the day 1 of first reporting of Covid case, a press conference was held even at an unusual hour of 1:30 AM late night to pass all information to media. Ever since that, media briefing became a mandatory thing at State level which was initially at 8 PM by Health Minister and as the state entered into Stage 2 and probably gearing for Stage 3 where multiple departments need to be involved, the baton moved to CM’s daily press meetings at 6 PM sharp.The daily press meetings of Kerala CM along with Health Minister and Chief Secretary has attracted huge public response, as a clear source of information on Covid situation.Today most of these press meetings are widely watched by entire Malayalee community, where all information of the day, all policies taken by Cabinet, all the government orders and action plan for next day are discussed with mediaPerhaps, one key tool to combat fake news is Transparency. The state issues health bulletins at every 6 hours for all affected people, all collectors are required to hold press meets or press releases on daily basis, district information officers are required to open lines to quell all public queries as well as organize programs to dispel public doubts and help the public in knowing the updates etc.Transparency Has Been Kerala’s Biggest Weapon Against the Coronavirus12. Campaign programs and quick responsesKerala government has realized the importance of massive Public Campaigns and Public relations to be used to the highest level to ensure its desired objectives reach to the public. The most successful campaign done was BREAK-THE-CHAIN campaign which has been adopted by Central Govt too and listed as a National agenda laterArun Mohan (അരുൺ മോഹൻ)'s answer to How many people participate in the campaign "break the chain" in Kerala?Arun Mohan (അരുൺ മോഹൻ)'s answer to What impact will this bring on the public as the introductory video of Kerala Police doing handwashing dance gone viral?Break The Chain Campaign was to have massive ground level sanitization and handwashing program to ensure the virus don’t spread quickly and break the chain of spread. This campaign helped the public to realize the importance of washing hands frequently and using sanitizers. Public washing kiosks came up and hand-sanitizers at the entrance of any facility became a regular thing. Videos of effective hand washes became common and the handwashing awareness video of Kerala Police became viralThe much viral Handwashing Video awareness dance by Kerala PoliceApart from campaigns, the government ensured, they are into heavy public relations. They are listening to every complaint, every grievance and standing with the public. For this govt machinery are focused on addressing public needs based on complaints reporting.For example, initially, the government didn’t give much thought about migrant labours and workers as the entire attention was over the local population. But when reports started coming in that migrant population have started fleeing to their homes and travelling on foot to their places when the lockdown came, the government machinery immediately set its attention to their problem. The govt started opening migrant workers camps across the state where they can stay and the entire cost of their food and other essentials were taken care of by the state Labour department and local MLAs. Kerala Govt even announced, they won’t use the term- Migrant Workers, rather will address them as GUEST WORKERS (Adithi Thozhilali) to honour their contributions to the state and will care themWhen Bihar’s Opposition leader Tejaswani Yadav highlighted the plight of some Bihari workers in Trivandrum over Twitter, the government quickly addressed to it and even reverted to him personally with an action taken reportI have visited the guest workers' labour camp today and spoke with workers and company representatives. The camp operates with all necessities including food and medicine.Kerala government is paying special attention to guest workers in this #COVID19 crisis. pic.twitter.com/uMsdq2NJQS— Kadakampally Surendran (@kadakampalli) March 27, 2020As of now, Kerala opened 4603 Relief camps to accommodate 1 Lakh migrant workers across the state who lost their work and got stuck in the state with no place to go. More numbers are to be expected as no one actually knows an exact number of workers. Many have fled Kerala before the lockdown came in and some haven’t turned up to government facilities too. The facilities do have all the essentials to survive until an alternative mechanism to help these people reach back to their homes is decided upon. This includes free food and sanitary requirements.Kerala opens 4603 relief camps for over one lakh migrant 'guest' workersAround 35 plus camps are opened for destitute and street dwellers across the state to be accommodated during this period.This decision has prevented a massive exodus as seen in many other North Indian states.13. Welfare schemes and supportThe state has announced a huge economic package of Rs 20,000 Crore to support people during this Covid crisis.One key feature announced was providing 2 Month social security pension (March and April) together by yesterday and today to all registered people, by delivering to their homes and via their coop bank accounts.The Govt kept its word by distributing all pensions by nowMore Photos. pic.twitter.com/H5sckkiCrL— Kadakampally Surendran (@kadakampalli) March 26, 2020How the Kerala government is shaping and implementing its Covid-19 responseKerala to disburse welfare pension for two months from next weekIn addition, the government has decided to support Tribal population by asking all tribal promoters and other officials to supply essential kits at their settlements inside the forest and educate them about the deadly virus spreadThe government announced One Month-long supplies kit per family to be supplied directly to their settlement and instructed forest guards and tribal department officials to ensure they remain insulated.Konni MLA comrade Jenish Kumar & District Collector P. B. Nooh IAS along with volunteers taking food materials to a tribal colony.It is important to work in sync during a crisis, as #Kerala has done in the past.With such common goals, we shall overcome. #KeralaFightsCorona pic.twitter.com/3uJLUW3qVR— Kadakampally Surendran (@kadakampalli) March 28, 2020Collector Pathanamthitta himself taking a load to remote forest interior as part of his personal interaction and awareness campaign among tribals of PathanamthittaThis includes conducting radio shows and public awareness videos/audios in tribal languages etc and holding tribal settlement meetings etc to ensure they listen and understand the implication of the diease.Radio shows, videos in tribal languages: How Kerala is spreading COVID-19 awarenessKerala fighting COVID-19: Awareness videos are made in various tribal languages. Local officials and health workers show these videos going to each tribal colonies.This one here is Oorali language. pic.twitter.com/VuilFvJcm5— Neethu Joseph (@neethujoseph_15) March 23, 2020How these Kerala youngsters are ensuring that the Attappadi's tribal folk are safe from COVID-19These are some measures which Kerala is doing at the moment to ensure the disease doesn’t spread much and prevent Kerala from going into a havoc situation.I am not saying, everything is perfect in Kerala. There are any shortcomings here too. But so far, Kerala is trying the best possible within its strengths, some inherent and some developed, for the betterment of community welfare.I don’t know how much of these are exclusive to Kerala. I don’t think, none of them remains and should remain exclusive to any place as we humans always try various ideas to save our fellow folks in times of mass disasters.The reason I highlighted all these, is to make a larger people aware of what we are doing to combat this virus spread and hopefully, these measures can be a guiding model for others to emulate if required, just like we too adopted many gestures from othersIn times of distress, these kind of positive stories are more of beacon of hope that humanity exists and something must be spread to all…..Let's all work together and may our humanity prevail over every disaster!!!