Twenty-four-year-old Arun had been a shy child. In an attempt to change Arun’s personality and make him ‘fit in’, his domineering father put him on a spiral of psychiatric treatment in which drugs were administered to solve his perceived character flaws. The medication created its own set of problems. By the time Arun was a young adult his various neuroses were considered a defining part of his personality, to be kept under control through medical treatment. He finally came to a psychologist who took the trouble to uncover the root of the problem. The psychologist was appalled to discover that, in fact, there was no problem at all with the youth who had been on heavy medications for years.
“There are many mental health patients like Arun who do not have a biologically embedded disease. A growing stream of thought is now asserting that all mental illness is, in fact, socially constructed and medicating the individual does not address the crisis,” says Prateeksha Sharma, who runs the Faridabad-based mental health organisation, Mansa.
Apart from healthcare professionals like her, similar voices are coming from several ‘recovered and functioning’ mental health patients. An increasing number of them are those with even serious illnesses like bipolar disorder, schizophrenia and manic depression. Without taking recourse to traditional psychiatric medical treatment, they have put their disorder behind them or are living successfully with the condition by using better social analysis and integration. Instead of institutionalisation of mentally ill patients, they advocate a community-based therapeutic approach wherever possible.
The new Mental Health Care Bill 2012 also acknowledges this model of social integration, based on representations from affected persons themselves such as the All India Federation of Persons with Mental Illness and Caregivers. Sujaya Krishnan, Joint Secretary, Ministry of Health, who steered the Bill through a two-year process of regional and national consultations, says, “Replacing the old Mental Health Act of 1987, this pro choice and pro rights Bill makes it clear that the mentally ill have the right to live in the community. Though the Bill promotes new facilities for mental treatment, institutionalisation will now be the last recourse. The Bill places an obligation on the government to ensure community based treatment.”
She concurs with the new emphasis that treatment need not be medicine based. And that the availability of more trained social service providers like the clinical psychologist and psychotherapist is vital for adopting alternative approaches that involve community, family and friends.
For 40-year-old Namita Kohli, a patient of bipolar disorder, an alternative approach meant coming out of the confines of an 18-year-long psychotropic drug regime by understanding that her sickness was the result of an ill-fitting social paradigm. She found a solution by creating a new social paradigm for herself instead of medicating and isolating herself.
Namita’s extreme mood swings had been triggered in her teens when she felt her school and college results were not good enough. “As soon as the label of bipolar disorder was given, I was administered so many suppressants that I could only sleep or watch TV. My mind froze. Everything seemed an insurmountable exertion. I could not think of completing my college degree. This vegetative state was worse than my blackest depression earlier. At other times, the medicines made me fidgety and unstable. ”
She was alarmed by her body’s reaction to the chemicals introduced over a prolonged period and aware that medical psychiatry only buried the symptoms of the disease without offering a cure or rehabilitation. She finally recovered only after she had the courage to stop drugging herself. Two years ago, she gave up allopathic medicines and turned to classical music as a form of therapy. Integrating this with homeopathic treatment and regular visits to a psychologist who helped her carry out a thorough social analysis of her condition, Namita is now working in a full-time job in Delhi, has set up a music foundation and is also giving stage performances.
That recovery from mental illness need not be medicine based, has been brought out by a first of its kind study sponsored by the Planning Commission in order to determine Five Year Plan objectives. The ‘State of Mental Health in Delhi: Prevalence of Psychiatric Morbidity, Subjective Well Being and Patterns of Help Seeking Behaviour among the General Population of Delhi’ was undertaken by Manas Foundation with the support of the Planning Commission. Analysing the responses of 2,381 people, it concluded that a high 7.6 per cent of Delhi’s population experienced mental illness or psychiatric morbidity. Modern urban stress and crumbling of traditional support structures were identified as primary culprits.
It emphasises that both psychiatric and psychological out patient services should be provided in all dispensaries and community centres regularly and “a systemic training of medical practitioners and other paramedical staff in specific psychiatric and psychological disorders need to be conducted to sensitise them as well as to aid in screening for mental illnesses”. The study recommends developing models for mental health care in urban areas with the focus on extension of mental health care to the community level.
As a former patient, Rudranath Banerji says, “It is a false notion that mental illness is inherited or genetic. A disease like diabetes is also said to ‘run in the family’ but with proper lifestyle management, it can be prevented or contained. Similarly, there is better understanding now that the triggers for all mental disorders arise from social stressors. So the way out must also be found in the social context. The medicine-led approach of psychiatry is passé.”
More patients and mental health professionals in India are advocating creation of a social support system rather than medicine-based treatment.
World Mental Health Week was observed from October 6-13