Interview: Discrimination disempowers people with mental illness

It’s common knowledge that we, as a society, still have several misconceptions about mental health, and that there is a stigma against people with mental health disorders. Patrecia Preetham of White Swan Foundation spoke to Sidney Bloch, emeritus professor, University of Melbourne, and honorary senior psychiatrist, St Vincent’s Hospital, Melbourne about the need for education on mental health. Dr Bloch emphasizes that stigma and discrimination can adversely affect the lives of people with mental illness, and that education is key to changing these attitudes in our society. Edited excerpts.

As a psychiatrist with 40 years of experience, what changes have you seen in mental health care over the years?

The answer to that is: both a little and a lot, although that sounds paradoxical. When I remember starting as a psychiatrist long time ago, the number of medications we had was very small. The side effects of those early medications were awful - shakes, tremors, dry mouth and so on. So, if you want to be mentally ill, in the last fifty years, it's better to be mentally ill today because the number of treatments that are available -, not just in drugs but in psychological treatments, social treatments - are far more advanced than it was earlier. We've also learned quite a lot about the nature of mental illness, in terms of what they are, what is going wrong in the brain and so on. But, there is a long way to go.

So with common illnesses, to take an example, autism in children is common. But as the child grows, they change in pretty serious ways and we don't know what it is. We think it’s genetic. So at the moment, we know a little bit about autism, but we have to know a lot more. Fortunately, in this era, we have better ways of doing that. With neuroimaging, we can now look into the brain with sophisticated X-rays and actually see how the brain is working. I'm not going to go into the details, but it is fascinating to be able to see parts of the brain lighting up on the computer. We also have a much better knowledge of genetics, which is important because we find that certain genes are responsible for autism. We can then make out what those genes are doing that makes the child autistic. And genetics has improved considerably since the human genome was discovered or mapped out in 2000.

If you go to the laboratories and you measure certain chemicals, neurotransmitters, and various biochemical processes in the brain, we are also able to learn a lot about serious mental illnesses. And that, of course, is the key to finding the treatments for them. And we are on the pathway, but it will take time. We have to be patient. But things are promising. That's the really important message for all of us.

In societies across the world, people suffering mental illness face a lot of stigma and discrimination. So how can we approach the issue and work towards eliminating the misconception in the society?

It is the most difficult challenge. From the beginning, people who became mentally ill were discriminated against. They were deemed to be unable to live a life like other people. And part of this is true, because if you are an eighteen-year-old student who developed a severe mental illness, and there are a number of them, the chances of developing your career, marrying and reduce quite a bit. So, people have the idea that these patients have something which is strange, and they can’t understand it.

We also have an idea that they aren’t able to live a productive life like the rest of us. So, in other words, we put a label of disability on them, and we then discriminate against them. We say well, they are incapable of working, so we won’t give them a job. They are incapable of having responsibilities of other kinds, so we won’t give them the responsibilities. This disempowers patients.

The way to try and deal with this is education. We have to inform people that this is an inaccurate way of seeing the mentally ill. Another method I’ve used is to ask patients and families to help me as a psychiatrist to reduce discrimination and stigma. I tell the patients that they can tell their families and other people that they are human beings, they have needs and emotions, and they also have an illness – but first they’re human, like everybody else.

Australia has a more mature mental health care sector with far greater social acceptance, I presume, and better access to infrastructure when compared to countries like India. So what are the key lessons for countries like India where the mental health sector is still plagued with certain societal and social issues?

Well, it's a big question and I'm not altogether sure that what you say is correct. Yes we are a reasonably developed society and we have lots of resources, psychiatry, mental health; but mental illness has always been the Cinderella, the poor relative. So, for example, a heart transplant that is done today in Melbourne will cost half a million Australian dollars. The society will pay for that. But when it comes to treating mentally ill people, it's far cheaper. But the society prefers to give money to replacing a heart, that's more exciting and more dramatic whereas mental illness, not so inviting to give the money to.

We have professions like psychiatry and psychology, psychiatric social work and mental health nurses and occupational therapists. And altogether, we have to combine our forces to do whatever we can to elevate the standards of treatments and care. But I tell you it's a long job, it's not an overnight thing.

I can remember when I was a younger psychiatrist, working in hospitals that were extremely backward, with very few resources. Now, things have improved considerably and we have outpatient clinics. So with time, one gradually brings in new possibilities and tries to increase resources from governments, they are the main providers.

And I can say that India should have it in mind that it won’t happen by tomorrow or the next day or the day after. But by looking at possibilities and by looking at the particular needs of a community in terms of mental illness, we can make slow progress. I always say to myself, you know, we own the path to better things but we mustn’t have some sort of utopia in mind. That will not happen and we will be let down and you'll feel discouraged. But what I've seen so far, things look, in some ways, very promising and we appreciate what is being done in certain areas that I've witnessed. I don't want to give the impression that we are far ahead of you by any means. What I'm going to do is exchange ideas. Like I'm here, you come to us, we can talk about how things can be improved and then we try to out that into action.