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| HEALTH TRIBUNE | Wednesday, January 22, 2003, Chandigarh, India |
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Taking
care of the mentally ill INFO CAPSULE
HOMOEOPATHY & YOU |
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Taking care of the mentally ill
When I started the Department of Psychiatry at the PGI, Chandigarh, in 1963, the general rule in the hospital was that relatives could not stay with patients. They could only visit during the evening visiting hours. I soon realised the complications and got the rules for the Psychiatry Ward changed. The new rule was that not only relatives will be welcome, but also a patient will be admitted only if accompanied by a relative. This simple measure had tremendous positive impact on the functioning of the ward. Patients felt more comfortable and less disturbed in the company of their family members. Nurses’ workload was reduced. We also introduced counselling and psycho-education of family members in the evenings so that they could do a better job of the care of the ill relatives. The result was so good that the practice is continuing till today at the PGI. It is also being followed in most of the psychiatric units in general hospitals in this region. Unfortunately, the role of families has not been understood properly. Families’ role has been much maligned in psychiatric literature during the first half of the twentieth century. At that time most of psychiatrists in the West, due to the influence of the psycho-analysis movement, believed that serious mental illnesses like schizophrenia or manic depressive psychosis were caused due to psychological factors. Parents were often blamed for faulty upbringing of their children which was thought to result in serious mental illnesses. There was talk of "schizophrenigenic" mother responsible for the development of schizophrenic symptoms in children. Dominant mothers, weak father, skewed communications in the family, etc, were all blamed for serious psychopathology later in life. Such medical opinions only made matters worse for the family members of the serious mentally ill. Parents not only felt confused but also terribly guilty which further reduced their ability to help their patients. Research work over the last 50 years has fairly conclusively proved that serious mental disorders like schizophrenia, paranoid disorders, bipolar disorders (earlier name manic-depressive psychosis), etc, are essentially genetically linked biochemical disorders. Of course, the environmental factors like the family atmosphere do affect to some degree the course of any psychiatric disorder, but the role of the family is only a secondary factor in the causation of such serious mental illnesses. These diseases are now regarded basically as biological disorders. The care of a patient suffering from a long-standing mental illness is a very difficult task. The patient is often uncooperative; many times hostile and aggressive to any attempt to get him treated. Chronic schizophrenia is the prime example of this type of mental illness. Such a patient lives in a world of his imagination, withdrawing from the realities of social life. He or she may hear voices even when nobody is around, may get wrong suspicious ideas that people are out to harm him or poison him, etc. Slowly the patient’s nutrition and personal hygiene also suffers. In such difficult circumstances I have seen numerous examples of devoted family members looking after patients and slowly getting them back to recovery or at least to live a better quality of life. Continuous medication is, of course, essential in such cases, but it is the family which ensures that the patient takes medicine regularly, takes proper self care and proper food and is involved in some social activity for rehabilitation. Numerous examples come to my mind of selfless devoted care by close relatives which has brought great improvement in the outcome of long-standing mental illness. There are serious mental disorders of old age like dementia, one variety of which is called Alzheimers’ disease. In this disease, there is slow progressive deterioration of memory, intelligence, social skills, etc. Gradually, the patient is unable to live an independent life and has to be cared even for his/her eating, personal hygiene, etc. Medicines do not help very much. The care of such old people is physically very demanding and emotionally very exhausting, but numerous examples come to my mind where family members have almost totally sacrificed their lives for the care of such suffering relatives. I am thinking of a wife whose husband is in a badly disturbed state but she is putting up with the care of the ill husband single-handed. Her children are in the USA. Even when she has to go to the doctor for medicine she has to lock the room of the patient for an hour. She bears all her difficulties smilingly and continues to provide the care. Many other touching examples come to mind, but there is no point in repeating them. My purpose in this article is to express my appreciation and pay tributes to selfless devotion of numerous family members who deliberately and consciously sacrifice a part of their lives to provide loving care and emotional support to mentally ill relatives. As a doctor I salute them. But for their cooperation it would have been very difficult to provide medical care to such people, especially when psychiatric hospitals or old people’s homes are so few in our country. Family is the greatest medical asset in India. Unfortunately, the institutions of family is disintegrating, even in many urban centres in India. I hope and pray that we are able to preserve this great tradition in our country. For the families of the mentally ill, it is important to get together, unite in groups and help each other. Many such family self-help groups for schizophrenia or Alzheimers’ disease exist in the country, especially in the cities in South India. The movement is still very week in North India. I hope some enterprising parents and family members will take up the challenge to form family self-help groups. The writer is Emeritus
Professor of Psychiatry, PGI, Chandigarh. He can be contacted at phone
numbers (0172) 564224 and 567242 or at his email address:
nnwig@glide.net.in |
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INFO CAPSULE Flaws in diabetes stem cell treatment Washington: Controversy has erupted over treatment of diabetes with the help of stem cells, with some scientists here claiming that the method was misleading. The technique in question is thought to convert malleable stem cells taken from embryos into pancreatic cells that make insulin, the hormone that diabetics lack. The belief sprang from a 2001 study, which also reported that injecting such cells into mice alleviates some symptoms of the disease. But according to Harvard University’s Douglas Melton, the cells are masquerading as pancreatic cells by absorbing insulin from the fluid they are grown in. "Almost every culture media contains insulin," he is quoted by saying in Nature. ANI Is gardening safer than cycling? Sydney: If the latest survey of sport and recreation injuries is to be believed, it is safer to stick to cycling rather than picking up gardening or dancing as a hobby. Touch football, usually thought of as the safe version of the sport, produces more injuries than either horse riding or motocross, the survey released recently and reported in Sydney Morning Herald suggests. But for thrills and spills you cannot go past rugby league. Almost 60 per cent of league players get hurt in any given season, says the survey, by researchers at Central Queensland University, Rockhampton. In September, 2000, they surveyed 1337 people in the state aged between 18 and 94. They found almost one in six had needed medical treatment for at least one injury in the preceding 12 months. Some activities proved to be surprisingly hazardous. Almost 5 per cent of surveyed gardeners had medical attention for an injury, and a slightly higher number of dancers reported injuries. Swimming was found to be the most injury-free pursuit, with only 1 per cent of swimmers reporting any required treatment. Golf was the next best (2.3 per cent ) followed by walking (2.5 per cent) and recreational cycling (3.9 per cent). ANI Prolonged labour? Must be a boy! London: Doctors often joke to women experiencing prolonged labour that "it must be a boy". However, an Irish study has found it to be true. Women giving birth to boys are more likely to experience complications than those giving birth to girls. "We wanted to see whether this joke has some truth in it and, therefore, we conducted the study", Maeve Eogan, at the National Maternity Hospital in Dublin, was quoted by New Scientist as saying. The study compared 8000 babies born at the hospital between 1997 and 2000 and only included women who had spontaneously gone into labour at full term. ANI World’s first artificial organism Washington: Researchers in California have engineered the world’s first truly artificial organism. The bacterium makes an amino acid that no other organism uses to build proteins. The work is being hailed as "a very great accomplishment" and the technique promises to open unique avenues for manufacturing drugs, reports New Scientist. Amino acids are the fundamental building blocks of life, making up the proteins which constitute all living cells. The DNA of every organism on Earth contains three-letter codes, known as codons, for 20 such amino acids. The technique should help engineer proteins to make better drugs. Normally, pharmaceutical companies have to modify natural enzymes to stabilise them for use as drugs.
But if bacteria, or even higher
organisms, could be genetically engineered to produce new amino acids
that make long-lasting and more effective enzymes, drug production
could become more efficient and cheaper. ANI
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HOMOEOPATHY & YOU Of healing and pointless biases Dr Vikas Sharma HAHNEMANN not just discovered a healing principle but also a law governing the relationship between all drugs and all diseases. Unfortunately, his breakthrough was glossed over. Since its inception homoeopathy has been a victim of perpetuated prejudice. A bias which has become compulsive or, should we say, pathological, pathobias. Homoeopaths have spent a great deal of energy on fighting conventions. One reason for this may reflect genuine incredulity that conventional physicians can apparently claim to help the ailing humanity and yet reject, seemingly out-of-hand, a new system of therapeutics with an excellent clinical track record. To homoeopaths this seems, perhaps, illogical. There is a plethora of biases aimed at eclipsing homoeopathy’s great ability to treat chronic disorders. A situation that indirectly adds to the list of biases is a "write-off" by a conventional physician, even when homoeopathy could actually cure. But more often than not, it is a blind belief in the write-off which actually results out of conviction with which the patient is made to believe. Another fallout of this situation is that one realises the value of homoeopathic treatment after losing the precious time when the treatment could have been most effective. By all this, I mean to say that homoeopathy is far more effective in many cases that are generally termed as "incurables" if used properly and in time. However, one must that there are "incurables" for homoeopathy too! The second most important bias is that of homoeopathy is "slow". Often I have seen that it is this kind of silly syllogism that supports it — if homoeopathy is slow in treating asthma, a chronic disease, it is going to be slow in treating every chronic disease! Funny logic! Isn’t it? Another reason is that the time involved is compared with that of conventional system of medicine, little realising that the level at which homoeopathy works is way apart as it aims at rooting out the disease and not suppressing it. Homoeopathy is neither slow nor fast. It is a natural system, obeys the laws of nature and takes optimum time to cure. Well, the treatment of chronic diseases depends on innumerable factors patient compliance, extent and intensity of damage, age, nature of previous therapies, the physician’s competence, etc. The writer is a
Chandigarh-based homoeopath. Telephones 0172-721501, 870739. |
I
have been working in the field of mental health for the last 45 years.
During this period I also had the privilege of working in many
countries outside India, in the industrially developed West as well as
in the developing countries of Asia and Africa. One thing has been
very striking to me: while in the UK or the USA the patient generally
consulted the doctor alone, in India a patient was almost always
accompanied by at least one (and often more than one) relative.
Gradually, I realised that the families were a very important asset
for the care of the mentally ill in developing countries. Mental
health professionals must involve families fully in the total
treatment programme and care of the mentally ill.