Can we get some respect, please?

Philippe Pinel removing physical restraints from a mentally ill woman in La Salpêtrière,France

There are a few illnesses in the world which resemble Voldemort! They exist but cannot be named or accepted. And mental illnesses top this list.Both the patient, as well as relatives, seem to be in a state of denial. In my practice,I have seen a range of behaviors which constitute this stigma. People sitting in front of me, suddenly getting a call on their cell phones, hurriedly pick it up and coolly proceed to tell the caller that they are in a cinema hall or market while making pleading faces at me; patients requesting to be seen urgently because they spotted a fellow villager entering the neurology section of the hospital (which makes him a patient with a respectable illness); or a mother who gets the child to the clinic without informing the father or grandparents!

The word  stigma, apparently originated in Greece. In Greek society, stizein was a mark placed on slaves to identify their position in the social structure and to indicate that they were of less value. The modern derivative, stigma, is therefore a distinguishing mark of social disgrace attached to patients in order to  identify and to devalue them. Stigma occurs in two different ways. One, wherein the general public, family and friends of the particular patient happen to discriminate the patient, and two, where due to this discrimination the patient himself begins to demotivate and hate himself.

There are box full of myths all over the place about the cause, nature as well as cure of mental illnesses. Hence, patients are feared for their potential violent nature, lack of will power and apparent genetic heritability of the illness. Stigma in any form is obviously painful and causes a lot of stress and loss of confidence in the person, but the amount of stigma faced by women having mental illnesses is really demoralizing.

I had a 25 year old girl, recently married who had had a relapse of psychotic illness(in which she behaved abnormally, got angry, aggressive and tried to assault the mother in law). This girl was our patient for the past two years and was completely stable with medication. Some time ago,the mother cautiously broached the topic of whether they could get her married. As is the custom, I took time to explain to her that it would be better that the prospective groom come for a counseling session; that he be in the knowhow of her illness and how it was quite harmless; that I would try and dispel myths which he may be having. If he did not agree, then it would ok.  She could get married to someone understands her illness and still accepts her!

When this was discussed within the family, it was met with strong opposition. The family felt that telling anyone would spell doom, not only for the girl, but for her younger sisters who were also of marriageable age. Hence, the mother carefully un wrapped the medicines from the wrapper, made different boxes and hid it in the girl’s clothing so that she could consume it as stealthily as possible. Unfortunately, post marriage, the girl discovered that the wardrobe given to her was in a landing where anyone could walk in any time, and hence started missing doses to avoid being discovered. This led to a relapse, the groom’s side discovering the tablets and blaming the girls’s side for cheating them.

Now they were sitting in front of me, the sulky husband, the fire brand mother in law to one side, the teary girl in the middle and the defensive mother of the bride to the other! And to take the matter to its logical conclusion, there were about 10 panchayat members who had tagged along!

The boy was unwilling to take her back, the Mom in law said, “If they lied about this, there may be other things too”. The mother who had spent heavily on the wedding, alongside a fat dowry, was livid.“Well, she was fine in our house. It is your fault she is this way. And if you want us to take the girl back, you may as well pay us back all the dowry and expenses of the marriage”. The panchayat members were cajoling, “Think about the girl. Who else will marry her? You have to give her a life. Take her back. She will listen to whatever you say and live like your servant!”(Well, this was supposed to be in support of the girl!)

In between all this, the girl was sitting eyes downcast and teary. It made me feel so low and depressed to imagine how she was facing this. She was unwanted by her own family, a burden which was now someone else’s responsibility. Otherwise, she would have to be kept at home and taken care of unto death. The husband, understandably felt cheated, but looked willing, if not for the mother in law who was already making plans for his second marriage and a second dowry! The panchayat felt that the deed had been done and it was now the girl’s fate to suffer at the hands of a spineless husband, and a tyrant mom in law!

This does not happen to be an individual instance. Whenever men develop a mental illness, we find the parents almost magically find brides for them who are willing to “adjust” to being with a husband suffering from an illness or disability. We have seen instances of husbands convincing wives (who are mentally ill) to agree to their second marriages, wives taking domestic abuse of aggressive, alcoholic  husbands with resignation and accept their husband’s infidelity with a pinch of salt. All the while feeling that either their children, or parents or the husband may feel bad if they desert them!

Parents of young girls are devasted when they hear of their child or relative having a mental illness. They take great pains to hide it from near and dear with the fear that they may spread word and spoil her future marriage prospects. All thoughts of education, job etc etc just fly out the window, and the only question that looms large is whether their daughter will get a good husband. Immediately, she becomes a second class citizen.

But reverse the picture, men seem to think that it is impossible to adjust with anything other than perfect. The minute their wives are diagnosed with a mental illness, there are barbed comments, outright disgust and a permission to insult their spouses any which way they please. Everything becomes their fault.I may be over generalizing here, but the ratio of men and families being nice and supportive to women suffering from mental illness is impossibly skewed in the wrong direction.

And the women themselves, in between suffering from an illness that shakes their very core, have to deal with a hostile world. No wonder, many of them relapse repeatedly.

Spreading awareness about mental illnesses, bringing up our girls to develop a sense of self worth, teaching them to fight back and not take crap( I mean, if the husband does accept the girl back, how could she live with him knowing that he did not even stand up to her??) may be over simplified solutions to a very complex problem. We have a long way to go. And a lot of awareness to spread. And a lot of confidence to build. Till then, there are thousands of those who suffer indignity in silence.