Mental health: new challenges, new allies

It's time that psychiatry should be veered into mainstream healthcare

The stigma of mental illness, especially psychosis and depression, results in avoidance to seek appropriate treatment. This crucial period, if lost, may result in chronicity. Secondly, once labelled as mentally ill, the family and medical community tend to ignore even the overt pathological conditions and their complications. Third, the lack of balanced diet, proper hygiene and inactivity exposes sufferers to a variety of diseases like skin disorders, malnutrition or obesity, anaemia, infections, etc.

Depression is not necessarily psychological or weakness of personality but it is like diabetes or hypertension. Seventy per cent of depression is biochemical (genetic) while the rest are psychogenic due to childhood abuse, broken home, etc.

In the past, depression was estimated to be 2% (out of 10% population suffering from mental illness). But more recent studies in community and those identified as co-occurring depression with physical illness, it has reached a phenomenal high at 20%. It is as common as common cold.

Depression and co-occuring illnesses: Diabetic patients have 25% chance of having depression. One in three depressed people also suffer from substance abuse. Depression occurs in 10-27% of stroke survivors. One in four people with cancer also suffer from clinical depression. Depression symptoms can be mistakenly attributed to cancer itself which can also cause loss of appetite, weight loss, sleep disorder and loss of energy.

Symptoms of depression may be found in other medical/neurological conditions like weight loss, low energy in people with diabetes, thyroid disorder, stroke and heart disease. Apathy, poor concentration, and memory loss can be seen in patients suffering from Parkinson’s and Alzheimer’s diseases.

There is also a huge grey area of psychiatric disorders and the medical community at large is not trained to treat them. Masked depression frequently presents with general debility, fatigue, palpitations, low blood pressure, gas, indigestion, constipation, aches and pain and various eating disorders. The treatments often offered are tonics, vitamins, anti-gas, analgesics and more recently the so-called brain energisers, besides the indiscriminate use of benzodiazepines.

The gender-related disorders (in males) are masturbatory guilt, jiryan, qatra, dhat, impotence and premature ejaculation; (in females) premenstrual tension, dysmenorrhoea, menopause and disorders associated with childbirth, lactation, abortion, birth control, problems during child bearing and child rearing, etc.

Children constitute 45% of our population. They express their distress by change in behaviour, like performance at school, truancy and indiscipline while a few experiment with drugs. The gastro-intestinal disorders, enuresis and headache are more frequent physical symptoms. The borderline intellectually subnormal children in a normal school appear to be ‘playful’ and ‘sharp’ but not interested in studies. They are distressed children who are trying to cope.

Post-Traumatic Stress Disorder (PTSD) is a condition which is usually the outcome of traumatic experience beyond human endurance. We have been diagnosing them as depression, hysteria or malingering. Once PTSD was accepted to be a diagnostic entity, humane methods of management have evolved.

Awareness about mental health: Rising expectations and stress management, urbanisation, slumisation and migration have raised popular expectations and the altered behaviour for their gratification. In addition there is a window in almost every second house, which opens into a wide world — the television — which is instrumental in instilling a sense of deprivation.

In the best interest of our patients, mental health and good medical practice, it is time that psychiatry should be veered into mainstream healthcare. More so because the quantum of psychiatric, psychosomatic and somatopsychic problems seen at the primary care level far exceeds the past estimates. The interface between psychiatrist and family physicians and an intense awareness programme is the need of the hour. 

Published in The Express Tribune, February 17^th, 2019.

Like Opinion & Editorial on Facebook, follow @ETOpEd on Twitter to receive all updates on all our daily pieces.