Baby steps towards a bigger cause.

I still remember the day when my Professor of Psychiatry  told me, that it took him quite a while to find a bride who was willing to accept a “mental” doctor for a husband!

It has been almost thirty years since, but despite enormous strides taken by science and society alike, the ground reality for patients suffering from mental illnesses, especially in India, is still one shrouded by secrecy or shame.

On a day to day basis, we encounter a wide range of patients who need help, but deny themselves, for fear of being branded as mental patients. On the other extreme, we see relatives or well wishers of patients who try their own form of counseling not realizing that they are doing more harm than good! Every patient in the inpatient department of our hospital, coming from various socio- economic- cultural- religious backgrounds, is bound by the common factor of the presence of a talisman of some kind,either round their wrist or their neck, waiting to cure the illness if the doctor cannot!

In a population which fast succumbing to the high levels of stress in today’s world, the statistics regarding mental ill health are truly scary. Every one in four individuals anywhere in the world would have suffered from  mental ill health at some point in their lives. Depression ranks third among illnesses which kills the patient. And India, estimates say, has about  50 million people who need mental health care. Unfortunately, the supply of mental health professionals to handle such a huge load of patients is dismally low! We have currently in India,  about 3800 psychiatrists,398 clinical psychologists and 850   psychiatric social workers. There are no registries for counselors at all!

Even with the intent of helping the patients as best as we can, we, as mental health professionals face the problem of having too little time and too many who need it.

Hence, I feel it is the duty of every human being to finally start recognising that we need to chip in our little bit in order to elevate the status of mental health. Government agencies, NGO’s and media can only do so much if the public at large behaves like an ostrich with its head buried in the sand.

A few things which I believe we can inculcate are:

1. Start by regarding the mind as a tangible organ of our body. One of the reasons that we refuse to consider a diseased mind is because, we cannot accurately locate the whereabouts of it. It is vague, complex and therefore out of bounds to any physical testing, apart from analysing our behavior. But this does not make it non existent. We need to start teaching the habit of recognizing emotions and their healthy expression in children, so that they learn to understand their minds early. Then on, recognizing the stress and negative emotional states may become easy and non stigmatic.
2. Do not regard mental health professional as enemies in disguise. It is frustrating to see well educated, intelligent people take their kith and kin to quacks or magico religious healers and subject them to different kinds of torture. Eg. Thrashing, burning, keeping them hungry for days, making them eat leftovers etc. The common excuse given is that they were worried that the doctor would addict them to medicines!!! As if the torture meted to them was better than suffering from an addiction! We are commonly asked whether medication can ruin kidneys or whether we can cure a disease without medicating(when they have no qualms about swallowing diclofenac indiscriminately for their arthritis!). The need of the hour is to learn to trust that the doctor knows his job as he has been trained for a minimum of two to three years in psychiatry. At least, he is better than the neighbor who makes tall claims about the state of the patient’s kidneys(which we apparently spoil by medicating) without having studied biology for the past so many years of his life. We would love to help if you would just let us.
3. Realize that, just as there are different treatment procedures for the body, the same follows for the mind. Discuss treatment options clearly, and realize, please, that we will not be standing with an electrical prong waiting to give an ECT to anyone who happens to walk inside the door!ECT is a valid, useful form of therapy and not used as punishment as depicted in many movies.
4. Many mental health professionals are reaching out to the general public by way of television, media, articles and public programs to raise awareness about mental ill health. Listen, read and believe only what is coming from a genuine source, and not what gathers most trp’s, as in the case of television channels airing programs of regression therapy and past life therapy. They are false. Period.
5. When you meet a person who confesses to feeling depressed or upset or has some trouble with his emotions, kindly refrain from offering suggestions like”You need to use your will power to come out of this” or “Look at someone worse than you, you will feel better”. Mental illnesses have nothing to do with will power. The strongest, most wealthy and physically healthy among us can succumb to mental illness. It would be better to find the best counselor in town and gently direct the person to speak with them. The counselor in turn can gauge the problem and decide whether he/she needs a psychiatrist.
6. Do not judge the patient, after treatment, based on his illness. Mental illness makes us behave uncharacteristically. Do not hold grudges against the patient for their bad behavior during the illness nor judge him/her for the rest of their lives based on this. It is harmful for their self confidence. Eg. If a person tried to attempt suicide, do not reject his application in a job place or his proposal for marriage. Instead, ask whether the person has taken his full course of treatment. Discuss with the doctor in detail, how well the person is and how much responsibility he can handle. This solves much of the problem rather than enhancing it.
7. Do not hide the fact that someone has suffered from mental illness, especially when the person is getting married. We see marriages breaking down in our consultation rooms, for this very reason, that the spouse discovered the illness after the wedding. Every person has a right to decide on the kind of spouse that they want. Deceit wont help. Give your child the confidence of owning up to facing a difficult illness and still believe in their self worth.Then look for a spouse. In an arranged marriage scenario, there may be a lot who shy away from proposals, but believe me, your daughter or son would be happier with a person who genuinely accepts them and respects them rather than live in shame and neglect.
8. Practice acceptance. We never shy away from accepting any of our physical ailments. In fact, sometimes, we exaggerate them. But mental stress and strain are denied consistently. Unless we ourselves are unaccepting of our problems, there is no way the society will accept it. It was an exhilarating moment for us when a postgraduate student of surgery came up on stage at a public function to own up that she had suffered from schizophrenia and achieved what she wanted despite of it. We need more celebrities, survivors of traumatic stress disorders and people around us to start accepting their problems without shame. Only then, can the dignity step in.

Most of what I have written about is something that we all can practice at an individual level. If we can inculcate it and spread the word, we can probably inch closer to the WHO theme of this year’s mental health day”Dignity in mental health”.