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Re-imagining mental disorders

Lack of a real understanding of the chemistry of mental illnesses invariably leads to misconceptions on how to deal with them

My friend S. has a problem. He suffers from depression and is on treatment, but that is not his real problem. His problem is dealing with well-meant advice from his circle of friends and family, including his wife. From yoga to naturopathy, from faith-healing to astrology, he has had to fend off umpteen unwanted suggestions. To top it all, he is looked down upon as a failure; a person who could not ‘keep it together’. Reactions have varied from genuine concern to condescension to downright mockery disguised as sympathy. Even his wife thinks he would be better off with some ‘counselling’.

Someone who has Parkinson’s disease or has suffered a stroke is considered genuinely ill, while psychiatric illness is considered purely an imaginary ailment that somehow is brought upon oneself by the sufferer.

Why is it so difficult to consider mental illness as any other disease? There are many reasons for this. For one, psychiatry is a late admission to the ranks of medical specialities. Though psychiatry had its origins in neurology with Jean-Martin Charcot, Sigmund Freud and his seminal work on hysteria and the unconscious mind, they parted company almost immediately. The mind-brain dichotomy only added to the confusion. The mind was considered as the province of the philosopher, the theologian and now the psychologist, who did not have to be a specialist in medicine. Psychiatry suddenly became alien to the rest of medical science.

Medical students are taught even today the extreme fallacy that psychiatric disorders are ‘functional’, for which no causative factors can be found in the body in terms of an altered physical structure or physiological state. But time and again, neurological and medical disorders as well as the effects of certain drugs that cause psychiatric symptoms have provided us tantalising clues about the origins of mental illness. It would be truer to say that psychiatric disorders are as yet incompletely understood subtle alterations in the brain, perhaps on a molecular level, which result in behavioural symptoms, which we are unable to pick up by means of crude investigative tools.

The second reason for the confusion is that anxiety, sadness and mood changes are all normally experienced by us. However, pathological anxiety and clinical depression are very different in qualitative and quantitative terms. They are just not more of the same. Normal means to tackle a low mood, like being with a friend or listening to one’s favourite music or a mental pep talk, may not really work. The sufferer ends up feeling that he must be a really bad person because he is unable to take the advice of loved ones and appreciate their attempts to make him feel better.

Adding to all this is the anti-psychiatry lobby: it believes that the concept of psychiatric illness itself is a myth and that psychiatric illness is a label given to a non-conformist by an insensitive and intolerant society. Try telling that to the relative of the actively hallucinating schizophrenic!

The most pernicious are those who propagate the notion that psychiatric illness can be treated without drugs. It is true that psychiatric medicines have side-effects and that sometimes only a partial control of symptoms is possible, but many have been able to lead productive lives because of them.

Psychiatry is still in its infancy and research is limited by the fact that we really have no animal models for psychiatric disorders such as depression and schizophrenia as many of the illness experiences are subjective. The fact is that like the universe, the human mind still remains uncharted territory. Psychiatry is only incompletely understood by other medical specialities and completely misunderstood by the layman, many of who still have some vague, distorted or watered-down notions about the unconscious mind. I have relatives of patients asking me to counsel and remove the bad hidden stuff to bring them back to normal. They see the illness as some kind of abscess to be lanced perhaps!

The brain is now being understood as a dynamic and plastic organ that continues to modify itself in response to the internal (bodily) and external (social and psychological) environment. Though neurons or brain cells do not actively divide, they strengthen their connections by forming newer and newer connections with neurotransmitters like dopamine, serotonin being responsible for the cross-talk through these connections. It is when wrong connections are made that you get psychiatric illness. This is the hardware on which drugs and electroconvulsive therapy act. The software is the programming that goes into us from the social, family, educational and other life experiences including psychotherapy, or even a profound spiritual experience.

bindumen@gmail.com

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Printable version | Apr 4, 2020 8:21:37 PM | https://www.thehindu.com/opinion/open-page/Re-imagining-mental-disorders/article14508044.ece

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