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A “sick” patient who goes for medical consultation does not always have a physical ailment that can be diagnosed and treated quickly. About 36 per cent of these patients suffers from mental illnesses, and of these 20 per cent has “somatisation” — that is, depression showing up as exhaustion, dizzy spells, intolerance to noise, tingling sensation, pain or insomnia. Their thoughts, emotions and behaviour are affected. They are always “sick”, and this makes it difficult for them to hold down a job or relate to people.
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Serious mental illnesses (psychotic disorders) are present in 0.5 per cent of this population. Such people may suffer from schizophrenia, wherein they hear voices inside their head and which command them to do strange things. They may also be paranoid — that is, convinced that everyone (even close friends and family) is determined to harm them. Depression may cause them to become unproductive, addicted to alcohol or drugs, or have suicidal thoughts. Panic and anxiety can be so extreme that he or she is unable to leave home. Maniacal behaviour may cause reckless spending or sexual promiscuity.
Mental illness is a chronic disease, just like diabetes or arthritis. Unfortunately, it is not viewed as such. The patient and his or her family may conceal the illness because they are ashamed of it. They hope it is a passing phase brought about by “bad fate”, religious or moral transgressions, or is a result of witchcraft. If the patient is a catatonic schizophrenic — that is, remains immobile in a bizarre statue-like position for hours or even days — people around may not always understand the situation. Undiagnosed patients may be denied treatment and stigmatised, or even confined, chained or beaten.
Both men and women are prone to mental illness, but the spectrum of disease slightly differs in the sexes. Men are more prone to schizophrenia and women to depression. In addition, women suffer a specific type of depression called post natal depression (PND). This can set in one to six months after the birth of a child and can last weeks or months. During this time, women feel anxious, guilty and suicidal, as they are unable to cope with the baby. Unfortunately, though it is a self-limited treatable condition, it is often ignored. The patients are at times even accused of being “possessed” and treated by quacks.
Centuries ago, Hippocrates postulated that the brain is an organ with particular functions, just like the liver or heart, and that it is prone to disease and malfunction. Scanning techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have demonstrated that he was right. Blood flow to certain areas of the brain and its actual physical size differs in those with mental illnesses.
The heart responds to exercise with an increase in its rate. Similarly, the brain responds to life events with the release of chemical neurotransmitters such as dopamine, serotonin, noradrenaline, gamma-amino butyric acid and acetylcholine. An imbalance, the excess of any chemical, a change in the ratio or relative deficiency leads to gradations of depression, anxiety and schizophrenia.
Mental illnesses tend to run in families and have a genetic basis. Members carry genes that predispose them to neurotransmitter imbalances. The genes manifest themselves if the environmental factors are conducive. Children may be victims of abuse if one or both parents are mentally ill. They may witness alcoholism, other addictions or domestic violence. Discipline may be haphazard and academic performance unstructured and poor. This may predispose them to mental illness in later life.
If an unprovoked person suddenly becomes violent or starts talking gibberish, the diagnosis of mental illness is easy. In the early stages of mental illnesses — when the symptoms may be subtle — or in paranoid schizophrenics (who may be persuasive and appear rational in their delusions), the diagnosis is not so obvious. Conversations and interviews with the patient and relatives and verbal tests eventually lead the psychiatrist to the diagnosis. There are no confirmatory blood or imaging tests. It is a subjective diagnosis that requires expertise and years of training.
Mental illnesses may be difficult to treat, even in the best of hands. Drug combinations and dosages have to be individualised. Medication has to be continued long term. The neurochemicals in the brain take time to change, and hence the response is gradual and not dramatic. Relapses can occur, especially if dosages are missed. Psychotherapy (talking to the patient) and social rehabilitation have to take place simultaneously.
The duration of therapy and pace of improvement is often discouraging. It may make the relatives fall prey to charlatans who promise a “miracle cure”. However, their methods are unscientific and may cause harm. Religious organisations with untrained personnel are not a substitute for psychiatrists or psychotherapists. And last but not the least, marriage does not cure mental illness.
Mental illness can be prevented by —
• Early identification of problem behaviour
• Adequate social support and social networking
• Learning mechanisms for coping with stress
• Effective community care
• Physical fitness plays a positive role. A family that exercises for 40 minutes a day will be physically and mentally healthy.
Source: The Telegraph (Kolkata, India)
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