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Remove the stigma

Dr. S. Mohan Raj
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October 10 is World Mental Health Day. Dr. S. Mohan Raj wonders why people are so apprehensive about these illnesses.

Don't discriminate...Photo: AFP
Don't discriminate...Photo: AFP

“You are the third psychiatrist my HR has sent me to for an opinion about my fitness for work,” said the young man sitting in my clinic.

He was 24 and looked like any other youngster in his mid-twenties. Two months back, he had developed schizophrenia, an illness characterised by delusions and hallucination. He was treated by a psychiatrist within a week of the onset of symptoms and had improved within a month. The treating psychiatrist gave a fitness certificate to his company.

“My HR manager did not agree. He wanted an independent opinion from another psychiatrist. He asked me to be on leave until then.”

“On medical leave?” I asked.

“No. On loss of pay.”

The second psychiatrist, whom the company had chosen, also agreed that he was fit to work. The office sat on the certificate for another three weeks. And then referred him to me for yet another opinion.

I examined him in detail. All his psychotic symptoms had remitted and he had good insight into them. He has been taking his medicines regularly. He is fit to work. I wrote a letter stating his fitness to join work. I also called his HR manager and spoke to him about the young man’s recovery and clarified his doubts. He sounded receptive.

Two weeks later, I received a call from the young man saying, “Doctor, I am waiting in another psychiatrist’s clinic. My office wants one more opinion…”

Why are people apprehensive about mental illness? What causes stigma? There is no single explanation. There are multiple factors but the most important is ignorance about mental illness.

Our lack of information or misinformation shapes our own explanatory models about the symptoms and that reflects in our attitude and behaviour towards those with present or past mental illness.

In one company, an employee who had a recent illness was warned, “If you behave like that again, you will lose your job. The employers had probably presumed that it was wilful behaviour. It is like telling someone “If you develop fever again, you will lose your job”.

Persons with mental illness face overt or covert discrimination at workplaces, educational institutions or during applications for a job. This leads to many concealing information or experiencing stigma themselves, causing delays in seeking help.

Stereotypes abound

A common myth about people with mental illness is that they are violent. This stereotype has been repeatedly reinforced by media. A murder by a mentally ill person gets overexposure in the media. But an act of goodwill or an achievement by a mentally ill person is soft news and is discarded.

In movies, if they want a character to do weird things to take the story forward, the scriptwriter furnishes a mental illness to the character. It is heartening to note that, of late, there are some movies that also explore the angst and triumph of those with different mental illnesses.

Most mental illnesses are eminently treatable, if diagnosed early. For example, the response rates in persons having the first episode of schizophrenia is inversely proportional to the duration of the untreated period. That is, the lesser the duration before treatment, the better the outcome.

Stigma and ignorance are reasons for many families not seeking treatment early. In addition, the family’s own explanatory models about the causes determine their help-seeking behaviour.

If their explanatory model for the person’s behaviour is ‘black magic’, they would seek a tantric to conduct rituals to ward off the evil magic. This is widespread and practiced across socio-economic and educational spectrums.

The basic premise of this theory is that someone can harm you by doing tantric rituals, without your permission and knowledge.

If this premise is true, it opens up tantalising possibilities. Our home ministry has given a list of people living in Pakistan who are wanted in the Mumbai attack case. If black magic works, why bother with the diplomatic route? Hire 10 tantrics and ask them to cause harm to those who masterminded the Mumbai attacks. Veerappan could have been killed long back without the loss of lives of police personnel. Osama bin Laden also could have been destroyed without a risky operation.

Similarly, many might seek the help of a faith healer, religious guru, astrologer, numerologist or a Vastu expert, depending on their explanatory models, and follow their advice.

Some of these healers recognise the symptoms and refer patients to mental health professionals for appropriate treatment. Others continue with their rituals and vital time is lost before treatment begins.

Different types

Most people consider all mental illness as one. There are various types of illness; each with its unique symptoms, causes, course and treatment. As Shakespeare wrote, ‘Though this be madness, yet there is method in it.”

Some might argue that the mental health professional’s concept of mental illness and its causation is also an explanatory model. True. But this model is one that is testable. The information is open and is available at a click or touch. Being a science, it is not a rigid model and the understanding of an illness is constantly updated based on new findings.

It is hoped that better knowledge will change people’s attitude and behaviour towards those with mental illness.

E-mail: mohanpsychiatry@yahoo.co.in


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