How we perceive mental health

I first heard of mental illness when I was eight or nine years old. My mother and I were walking along the road to Gandhi Bazaar. A crowd had gathered around a man with matted hair, who was in dirty torn garments. He was shaking his fists and yelling angrily at no one in particular. My mother tightened her grip on my hand and said, "Let's get away from here. He's a madman. He may be dangerous."

This stereotype of a 'madman' was further reinforced over the years by depictions of mental illness in movies and books. Somewhere along the way, I became aware that ‘mad’ people had to be treated by psychiatrists. Over time, this notion gradually changed to 'psychiatrists treat mad people'.

Mental illness = madness. This is quite likely the first idea of mental illness that takes root in people's minds when they are young. This is similar to how young children believe the sun and the moon to be of the same size! If this perception remains unaltered, it becomes a misconception that prevents people from seeking help, either for themselves or for people they care about. "You want me to see a psychiatrist! Are you saying I'm mad?" This is a common reaction to a suggestion to seek help from a psychiatrist.

Several illnesses can afflict the heart, the lungs, the kidneys, the liver and virtually every organ in the human body. So why should the brain be exempt from illness? (or: why should we treat the brain differently?)

There is a long chain of events that occur from the time the image of an object passes through the cornea of the eye, to the time when the brain interprets it. We take the process for granted because it takes just a few nanoseconds. For instance, thousands of cells work to produce that one thought, "Ah, this is chocolate ice cream!" when you look at an ice cream cone. The chain of events occurs because nerve cells communicate through chemicals called neurotransmitters. If a junction between two nerve cells in the eye malfunctions because a chemical is not making the connection, the eye won't see the ice cream. Consequently the brain won't know it is an ice cream since the parts of the brain involved in interpreting the image have lost connection.

Similarly, nerve cells and neurotransmitters are involved in thinking. If they don't work well, our thoughts and therefore, our behavior, are affected. Mental illnesses, therefore, have a biological basis, just as diabetes or Parkinson's disease do.

Nearly 90 percent of all mental illnesses are as ordinary as influenza, common cold, allergic skin rash, headache, earache, or diarrhea – conditions for which people routinely consult their General Physician (GP). If you go to a GP for a burning pain in your stomach, he will diagnose 'acidity' and give you an antacid. He will ask if you are anxious, which you probably are, and give you a medicine to reduce your anxiety. If the anxiety persists despite taking the anxiolytic medication (inhibits anxiety) for a couple of weeks, he will refer you to a psychiatrist. How different is this from being referred to an ENT specialist by your GP when your earache doesn't respond to his treatment?

Six months ago, I saw a woman, aged 35, utterly unable to cope with life because she could not stop thinking repeatedly , of things that shouldn't have mattered in the first place. The thoughts were intrusive and uncontrollable, and there was no way she could get them out of her head. She felt anxious all the time, was on treatment for high blood pressure, couldn't sleep, and couldn't eat because of nausea and a permanent burning pain in her stomach. Her husband sat listlessly beside her and spoke just once: to tell me that he wanted to get out of this marriage. He was frustrated with her behavior and fed up of her frequent visits to doctors, with no permanent relief from any of her symptoms. This was going on for all of the twelve years they had been married. No proper meals were cooked, the house was a mess, and she neglected their child. They couldn't have a single decent conversation because she snapped all the time, broke into tears or threatened to end her life.

After a diagnosis was made and medication was started, her symptoms have gradually reduced over the last six months. Now she goes to work and there is no more talk of divorce as the relationship has improved considerably. The house apparently is still a mess, but she has been talking enthusiastically about contributing to tidying up.

Whether or not people seek help for mental symptoms such as excessive sadness, fear or anger, depends on their perception of 'mental illness'. If misconceptions about mental illness can be cleared, people will deal with mental problems in the same way as they deal with physical health problems.

Dr Shyamala Vatsa is a Bangalore-based psychiatrist who has been practicing for over twenty years.