LET'S TALK ABOUT MENTAL ILLNESS

The WHO defines Health "as a state of complete physical, mental and emotional well being and not merely an absence of disease or infirmity." And yet we often find ourselves paying heed only to any of these domains in solitude. Oft neglected are the domains of mental and emotional well being or rather, the lack of it.
As someone who is a fledgling in the study of Mental Health, I'd like to share my two pennies this World Mental Health Day.

THE MENTAL ILLNESS PANDEMIC
Mental illnesses have been known to humanity since time immemorial. Even the ancient Indian scholars described mental illnesses in the Charaka Samihita. 
Despite this, mental illnesses have been treated as perhaps being "not real" or "it's in your mind"! It was seen as something that a person who's fragile would develop. So you had to merely, "Man-up!" or "Grit it out"!
But it's only off late that India is waking up to mental illness. Mental illness is real and one merely doesn't "shake out of it".
Be it the rising number of adolescent suicides, people battling various addictions or the growing awareness about depression and bipolar disorder, people are only just beginning to talk about it. And well, that's good! In fact, the World Health Organization's theme for 2017 is 'DEPRESSION: LET'S TALK' .
Mental Health issues have thus far been shrouded under the twin veils of unawareness and stigma. And unknown to the vast majority the serpent has been growing. Studies suggest that given India's demographic status - our large young adult population is most vulnerable. And given the dearth of mental health infrastructure, we are perhaps at the tipping point.
The need to arm ourselves  with the right knowledge is therefore imperative.


HOW DO I RECOGNIZE MENTAL ILLNESS?

Many of the symptoms of mental illnesses overlap with the normal feelings a person might experience over the course of time ; may be a month, a week or perhaps sometimes, even a day.  For instance , how does one know if some discomfort is a mere heartburn or a prelude to a heart attack? While physical medicine has over the years developed a battery of tests ( example : an echocardiogram ECG) , mental health still hasn't found these tools.

And so how does one tell if feeling low is related to that issue you had with your boss last night or is it a sign of depression? When does the line between having a few drinks with friends versus having an addiction, blur?

It is indeed true that it requires many years of training to make accurate diagnoses ( and yes, psychiatrists themselves need a lot of time with the patient and family to make one; and yes they too may rarely not pick up an illness in its early stages and may have to revise their diagnosis at a later date.) Yet there are a few pointers that we commonly use to pick up someone who needs psychiatric help:

• If you find yourself having thoughts of harming yourself (even if it's something like cutting your wrist) - SEEK HELP. ASAP!

• Low mood persisting for more than  a week to two,  loss of interest in something you previously liked ( meeting with friends/ relatives,  watching a movie, music etc)

• Sleep disturbances - waking up very early in the morning despite not intending to and while sleeping at your usual time ( eg. waking up at 3 or 4 am without a purpose when you would normally wake up at 6 or 7 am)

• Loss of appetite , leading to noticeable weight loss ( without an exercise/ diet regimen)

• Hearing nonexistent voices , i.e. hearing the voices of people not in your immediate vicinity

• For Addiction: If your internet addiction begins to regularly interfere with your work ( i.e. not completing an assignment because you spent too much time watching videos on the web)

• For substance abuse: If you were someone who previously had a drink or two over the weekend but now seem to crave it through the week, or your thinking about your next drink even while making an important presentation at work etc or the substance has resulted in a physical problem (such as maybe a liver disease)

 For a bystander to spot the signs of mental illness the above pointers may be useful . Additionally, if you notice a friend/ family member is:

• Talking of self harm ( even in a mocking/ self deprecating/ jovial manner)

• Unusually morose, quiet and withdrawn

• Neglecting routine hygiene/ self care

• Increasingly excitable/irritable/ cheerful - more than what would be considered appropriate in any given situation

• An addiction that is noticeably affecting not only the individual but also others around them

  OPTIONS AVAILABLE

FAQ

1.  Do I need to see a psychiatrist or a psychologist? And where do I find one?

Mental Health professionals are available in all medical colleges and most private hospitals. And despite the prevailing myth, not all mental ill health conditions require one to pop a pill. A lot many are addressed by non pharmacological approaches, counselling being one of them.

 Again counselling itself is an umbrella term and each condition requires a different approach. For instance, the approach to couple who comes with a relationship problem would be diametrically different from an approach that would be used for an individual with OCD ( Obsessive Compulsive Disorder). 

You can contact either a psychiatrist or a psychologist and they in turn will suggest the subsequent line of action.

2. What causes mental illnesses?

The current  understanding of psychiatric illnesses is that the cause is multifactorial, that is to say, no single agent can be pointed to as being the cause. That said, the eventual illness develops due to a complex interplay between genetic and environmental factors. In other words, an individual might have a genetic vulnerability to a certain illness. Subsequently whether  that individual develops the said illness will depend on their environment ( upbringing, childhood experiences, stress etc.)

These factors ultimately result in imbalances in the chemicals in the brain leading to the various symptoms of mental illness.

However, our understanding is still limited and research is on going.

3. Are mental Illnesses curable?

A vast majority of the conditions are treatable ( vs Curable). For instance Diabetes and Hypertension are treatable illnesses, medical science hasn't found a "cure" for it. So it is with a vast majority of mental illnesses as well. Among mental illnesses too, there are many different types and each will respond deferentially to treatment ( both pills and therapy).

However, what's important to note is that professional help will certainly alleviate the suffering that an individual is going through.  

4. Are all psychiatric patients kept in hospitals?

No. It was in the 19th century perhaps that persons with psychiatric illnesses were committed to homes/ asylums. 

Today, just like any other illness, a vast majority of individuals with psychiatric conditions are treated on an Out Patient Basis. Persons with severe illnesses may be admitted in hospitals for a few weeks. But there is a concerted effort to get them back into their routine jobs and integrate them with the community. 

 These are only a few of the doubts I have come across, but the myths prevailing around psychiatric illnesses are many more. 

THE WAY AHEAD

The way ahead is rocky and uncertain. The disparity between the large number of people and the minimal number of mental health professionals is perhaps the biggest impediment. It will be a while before this ratio is rectified. However even if the people in need can access the existing resources , that too can make a significant difference. And the first step here perhaps is to spread awareness.  The media must be lauded for its efforts to raise this issue and discuss it in the public domain. Celebrities talking about their battles with these issues too will help shatter some of the stigma that's stuck on. Although the picture seems murky, it's important to know that help is available for those who seek it. One needn't go through this alone. 

So, as the slogan goes, let's talk about this!