HEALTH TRIBUNE Wednesday, October 10, 2001, Chandigarh, India
 


Today is World Mental Health Day

Where the mind is ill & the legs are in chains
Care amidst callousness
Dr N.N. Wig
T
he recent tragedy in Erwadi, Tamil Nadu, is still vivid in the minds of many of us. In a devastating fire at a religious centre, over 25 seriously mentally ill persons who were tied with iron chains were burnt to death with their legs still in fetters. The whole nation was shocked at the terrible plight of the mentally ill. The sad part is that this is not an isolated happening. The mentally ill with chains can be seen in many religious centres all over the country. The same week, The Tribune published a photograph of a mentally ill person with chains near Pingalwara, Punjab.

PRESCRIPTION
We have hope and new drugs

Dr Rajeev Gupta
M
ental disorders are showing a steep rise throughout the world and this is more evident in developed nations. An increase in the number of emotional ailments has been partially attributed to fast-rising psycho-social pressures and the rapidly changing social and family milieu. Mental health professionals agree that mental disorders are responsible for a significant level of disability and distress throughout the world.

MENTAL HEALTH & AYURVEDA 
Rishis’ total cure
Dr R. Vatsyayan, Ayurvedacharya
B
y the very laws of Sankhya philosophy, which forms the basis of Ayurveda, the journey towards perfect health and that towards enlightenment and salvation take the same path. The term for perfect health in Ayurveda is "swastha" which literally means "to be established in Self". Accordingly, complete or total health is a stage when we are fully established balanced, and happy in body, mind and soul.

 
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Today is World Mental Health Day
Where the mind is ill & the legs are in chains

Care amidst callousness
Dr N.N. Wig

The recent tragedy in Erwadi, Tamil Nadu, is still vivid in the minds of many of us. In a devastating fire at a religious centre, over 25 seriously mentally ill persons who were tied with iron chains were burnt to death with their legs still in fetters. The whole nation was shocked at the terrible plight of the mentally ill. The sad part is that this is not an isolated happening. The mentally ill with chains can be seen in many religious centres all over the country. The same week, The Tribune published a photograph of a mentally ill person with chains near Pingalwara, Punjab.

The plight of the chronically ill is indeed pitiable. many of them have been thrown out of their homes by their families. many times their property has been usurped by their greedy relatives. Their human rights and dignity have been violated. Many of them can be seen begging for food at public places and living in absolute filth and misery.

Some of them end up in government mental hospitals where the conditions are often dismal with chronic shortages of manpower and medicines in an atmosphere of apathy and neglect. Many others are locked up in their homes for months and years with very little access to modern medical treatment.

Today, on October 10 when we are celebrating World Mental Health Day globally, let us have a look at the plight of the seriously mentally ill in our country and think of the reasons which lead to such end-stage of neglect and despair. We should also consider the remedial measures which may improve the conditions of such seriously mentally ill people.

The types of serious mental illnesses: Mental and neurological disorders are very common in our society. According to the estimates of the World Health Organisation, one in four persons has a chance of suffering from these disorders in his or her lifetime. Fortunately, most of these are self-limiting, short illnesses which are easily treatable and curable. A small number of the cases tend to become prolonged and chronic. Some of the illnesses which tend to linger on and become chronic are notably a number of cases of schizophrenia and some types of manic-depressive illness. Old-age dementias and mental retardation from childhood are the other examples of prolonged mental disorders.

A vast majority of other mental disorders — like most cases of depression, anxiety, panic and phobia, obsessive disorders, hysteria, alcohol and drug problems and several other stress-related disorders — have better outcome. In young age groups, schizophrenia is responsible for most of the cases of serious disability which end up in mental hospitals or suffer from social neglect of various kinds.

Schizophrenia is a serious mental illness which affects the young people, changing their thinking, feeling and behaviour. They start experiencing strange sensations like hearing voices when nobody is around, become very suspicious or feel that people are out to harm them. In their inner state of turmoil, at times they get aggressive and violent. Family members find it difficult to understand and cope with their changed behaviour.

The treatment of the seriously mentally ill: As mentioned earlier, a vast majority of the mentally ill can be easily treated and recovered. Even in serious diseases like schizophrenia, about 30 per cent recover fully from the first attack. Another 40 to 50 per cent recover from the initial attack but get relapses which again improve with treatment. It is the remaining 15 to 20 per cent of the cases which do not fully respond to treatment and tend to become disabled by the symptoms. They become isolated, socially withdrawn with self-neglect and poor personal hygiene. They seem to be living in a world of their own fantasies away from the real world. For the treatment of schizophrenia it is important that the patient is kept on long-term medication and efforts are made for his social rehabilitation.

Preventing long-term disability: The first and foremost thing to remember is that the treatment for serious mental disorders should be started early. If a patient is left without proper medical care for months or years, his or her chances of recovery are considerably reduced. As the disease progresses, the patient tends to withdraw socially and his or her abnormal behaviour is likely to become fixed and difficult to change.

Reasons for delay in treatment: The most common reason for delay in treatment is the attitude of the family. The family finds it difficult to comprehend and accept that the patient is mentally ill. It is very common for the family to attribute the abnormal behaviour to outside forces like spirit possession etc.

A vast majority of the mentally ill are first taken to faith-healers. Many receive various types of physical torture to remove the so-called evil spirits. It is cruel and unfair to the patient to submit him or her to such indignities. I am not against religious faith. My advice to the families is to begin modern psychiatric treatment as early as possible. Along with that, the families are welcome to try religious therapy. It may provide additional help and support.

The stigma: One of the major reasons for the delay or non-availability of modern medical treatment to the seriously mentally ill is the ill-conceived and terrible stigma often attached to mental illness. People are too embarrassed, or even ashamed, to admit that one of their relatives is mentally ill. Patients are chained or locked so that neighbours may not come to know about it. It is a very sad state of affairs. As a result, most of the patients do not receive timely help.

The role of government health services: Many times, even when the family is keen on treatment, the modern psychiatric therapy is not available nearby or if it is available in the private sector, it may be very costly and unaffordable. It is sad to reflect that hardly two percent of the total budget of the country is marked for health and out of that budget, hardly one percent is spent for the care of the mentally ill. It is gross neglect of the need of the mental patients.

Under the new National Mental Health Programme, the Ministry of Health is now planning to reach some districts where psychiatrict service will become available in the coming years. It is a positive development. The government must provide mental health service within the reach of the people — such service which is good and affordable! In addition, it must financially support the families with seriously mentally ill relatives to care for.

The role of non-governmental organisations (NGOs): In several cities, particularly in South India, many NGOs have come up for the care of the mentally disabled. Apart from the social support to the families, some of them have started half-way homes and day-care centres for the long-term mentally ill. There is an urgent need for the families of the patients to get together in Punjab, Haryana and Himachal Pradesh to organise NGOs for the benefit of the mentally ill.

Dr N.N. Wig is Professor Emeritus at the PGI, Chandigarh. He has advised international institutions like the WHOand several countries on the problem and management of mental illness from time to time.

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PRESCRIPTION
We have hope and new drugs

Dr Rajeev Gupta

Mental disorders are showing a steep rise throughout the world and this is more evident in developed nations. An increase in the number of emotional ailments has been partially attributed to fast-rising psycho-social pressures and the rapidly changing social and family milieu. Mental health professionals agree that mental disorders are responsible for a significant level of disability and distress throughout the world.

The management of mental disorders has undergone a sea-change in the past two decades. One of the most important developments has been the acceptance of the fact that persons suffering from psychiatric disorders are patients who need sympathy and help. Not long back, there was a time when a psychotic patient was sent to a mental hospital or an asylum and he continued to stay there, inside the four walls, throughout his life. It was said that no mental illness could be treated and in many places (even in our country) the mentally ill were treated worse than animals. They were chained, humiliated, neglected and condemned to disease and death.

Unfortunately, even today, in many parts of the country mental patients receive the same kind of inhuman treatment from the authorities and society.

Major psychiatric illnesses like schizophrenia, severe depression, mania, psychosis, paranoid states and paranoia, dementia, obsessive disorders, phobia etc need timely, scientific and professional help.

The following information may benefit the families of the mentally ill.

1. Early identification: It is the most important step in the management of a mental ailment. Though awareness about such problems has increased and many patients are brought at early stages to doctors, I come across cases where illness remains undiagnosed and untreated for years together. It is not uncommon to see acutely ill persons who have never visited a proper medical service centre. They have been going from place to place wasting their resources and time. The common symptoms of a general mental illness are: suspiciousness, hearing voices, odd behaviour, abnormal talk, abnormal beliefs, fears and phobias, regular sleep disturbances, persistent sadness, weeping spells, suicidal ideas, loss of memory, self-destructive behaviour, muttering while alone, violence, drug and alcohol abuse etc.

2. Approaching the right source: It is very important to reach the right person or a good centre for treatment. Once one decides to take professional help from a given source, one should religiously follow the prescribed treatment. One should not change one's doctors frequently. For minor anxiety and depression one can approach the family physician or a medical specialist. But for moderate to severe mental problems, one should go to a psychiatrist.

3. The need for regular and adequate treatment: Dropouts in psychiatric treatment are major losers. As many as 20 to 40 per cent of the patients dropout after the first session or a few consultations. The common reasons of such dropouts are: side-effects of drugs, poor motivation, travelling distance, the cost factor and low awareness about the illnesses. One thing is clear. Those patients who take regular treatment do better than those who are irregular in doing so.

Irealise that it is difficult to take prolonged treatment but a half-hearted approach is a sure way to disaster.

4. Side-effects of drugs: All drugs have side-effects. What is so scaring about the drugs for psychiatric patients? The common side-effects of these drugs are: sedation, giddiness, constipation, postural hypotension, dryness of the mouth, delayed ejaculation, poor erection, tremors, excessive salivation etc. Most of these appear in the early part of the treatment. In therapeutic doses these drugs are quite safe. Dependence is a definite risk with anti-anxiety medicines and sleeping pills. These should never be taken without medical consultation. One should never accept drugs from unqualified persons.

5. The need for rehabilitation: Mental disorders should not be taken as an excuse for abstaining from work and for shying away from responsibilities. Once the acute stage is over and the disabling symptoms are under control, the patients should be encouraged to take up their tasks, responsibilities, and jobs. If an illness is prolonged, certain patients start avoiding their responsibilities and start liking their "sick status". They cease to be useful members of society.

6. Never lose hope: Hope sustains life. This is particularly true in the management of psychiatric illnesses. In the last two or three years a number of drugs have come in the market and they have changed the quality of the lives of millions of psychiatric patients.

Today, many patients are fortunate to have received effective treatment. They have shown excellent responses. There were many cases where the families had lost hope. However, treatment brought normalcy to them.

The more we are able to understand the nature of mental illness, the better treatment approaches will come up for patient management.

Hope is a very potent healer. The patient, the family and the psychiatrist should work together and achieve positive results.

The author is a consultant psychiatrist and de-addiction specialist based at the MANAS Psychology and De-addiction Centre, Tagore Nagar, Ludhiana (Phones 472822 and 472899).

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MENTAL HEALTH & AYURVEDA
Rishis’ total cure
Dr R. Vatsyayan, Ayurvedacharya

Self is the owner of the chariot. The chariot is the body. Intellect is the body's charioteer. Mind symbolises the reins.

— Kathopanishad.

By the very laws of Sankhya philosophy, which forms the basis of Ayurveda, the journey towards perfect health and that towards enlightenment and salvation take the same path. The term for perfect health in Ayurveda is "swastha" which literally means "to be established in Self". Accordingly, complete or total health is a stage when we are fully established balanced, and happy in body, mind and soul.

Though the Vedas are the earliest source of knowledge regarding the principles and prescriptions of health and longevity, the other three great texts of Ayurveda —Charak Samhita, Sushruta Samhita and Ashtang Hridayam — have equally emphasised the importance of mental health. This triad written many centuries ago divided Ayurveda into eight distinct parts; these included psychiatry. Ancient seers classified diseases according to adhisthan bheda (the seat of origin) as sharirik (physical) and manasik(mental).

Ayurveda describes mind as a subtle entity and as a ;perceiver and an analyser. Charak deals in detail with manah (mind), buddhi (intellect) and smriti (memory). He has discussed psychiatric problems under the heading of "unmada" which resembles modern-day classifications of mental diseases — anxiety, depression, obsession, personality disorders and schizophrenia.

The word "roga" in Sanskrit, meaning disease, has been derived from the basic word "ruga" which means pain or misery. Since manasik rogas (psychiatric diseases) bring more misery and suffering than the physical ones, Ayurveda has laid special stress on finding the etiology of such diseases. From the ayurvedic point of view, most of the psychiatric diseases are due to the vitiated vata, pitta and kapha, which lodge themselves in the nervous system and interfere with the normal functions of mind. Fear, anxiety, unrest and rapid mood-shifts are vata symptoms. Anger, aggression, suspicion and unrealistic ambition arise due to the pitta dosha whereas kapha gives rise to the symptoms like low drive, excessive sleep, depression and attachment to the past.

Ayurveda advises a person to control the urges of greed, grief, fear, fury, pride, shamelessness, jealousy, excessive passion and covetousness which, in today's world, are major reasons for many psychiatric problems. To lead a healthy, happy and stress-free life, adherence to sadvritta (good conduct) in the matter of diet, conduct and activity has been prescribed.

For various psychiatric ailments, ayurvedic texts mention two types of treatment - satvavjya (counselling, yoga, meditation and life-style adjustments) and yuktivyapashrya (administering appropriate medicines). Ayurveda holds a vast treasure of single herbs, classic medicines and procedures of Panchakarma which the learned seers have advised for the treatment of different psychiatric problems.

Dr R. Vatsyayan is an ayurvedic consultant based at Sanjivani Ayurvedic Centre, Ludhiana: (Phones: 423500 and 431500; e-mail-sanjivni@satyam.net.in)

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