‘When you suffer a physical illness, you get sympathy. However when you suffer a mental illness, all you get is shame and ridicule’.
The stigma attached to mental illness is huge and hence a big barrier for patients who suffer it. The stigma affects the individual patient at all levels, from the simple level of seeking counselling and therapy. Firstly the person affected may not have the guts to confide in her family that she needs therapy, secondly the family may dismiss her plight by a laugh and ridicule instead of taking her seriously and thirdly they may shy away from actively searching for a good therapist and taking the final step of seeking an appointment. Most times clients come to us when they have tried everything in their control, have failed and allowed the disease to grow due to negligence. I see a client in her 12 Std and realise that she has been depressed from Std 5. She herself being a child is not aware that something is amiss and her family is equally ignorant about the signs and symptoms of depression. They only comment and pass judgements about her ‘being lazy and always aloof from people’. They keep coaxing her to mingle and open up and be more social and friendly and criticise and reprimand her for not being so but their concerns do not go beyond that to seek help from a counsellor and psychologist.
The stigma hence also comes from ignorance about what constitutes ‘mental health and mental illness’. Everyone and I repeat everyone should read a bit of basic psychology and familiarise themselves with it. Parents, teachers and guardians must know child psychology, teen psychology and adolescent behaviour. Just as common medical emergencies are handled with first aid by laypersons, first level mental signs and symptoms should be treated with seriousness and people should not allow or wait for it to escalate into a full blown illness. Nip it in the bud, a stitch in time saves nine, wise people say. Ignorance is not bliss in this matter- in fact ignorance is a curse, a burden and a liability. Your education is a sort of waste if you do not understand what constitutes a healthy mind and a healthy body. Schools have a physical drill and sports for promoting physical health but no preventive and immunisation measures for good mental health. The mind is taken for granted and mental health a given. But this could not be further from the truth.
A child of Std 7 began avoiding school and complaining of stomach aches. This went on for a month. The parents realised that when she stayed back at home after a few hours she would begin to play and be happy and the complaint would vanish. They took her to all sorts of doctors from different specialities and subjected her to all sorts of medical investigations to the extent of CT scans and MRI’s besides pathological tests. Huge amounts of expenditure was done for she was their single child and doted on her. The last resort was counselling and she was okay within a week of therapy. All she had was an ‘emotional upset with anxiety’ which needed to be addressed in detail. The symptoms vanished and the girl resumed school happily.
The stigma attached to mental illness acts as tremendous deterrent to it getting its due attention and the needed resources. All of us working in the field know that the burden of the disease is enormous. Six to seven persons among the population suffer a mental disturbance and one to two percent fall in the severe mental illness category. In contrast the resources allocated to mental illness is meagre and insufficient, the ratio of the availability of trained professionals to number of patients is hugely deficient. The rehabilitation centres for indoor and outdoor care is just not visible because they are so few in numbers. The mental hospitals are less in number compared to the need, the beds in such hospitals are again hugely insufficient. The result is the increase in costs to the families and care givers in terms of money, time and stress. We also realise that parents are willing to spend large amounts of money on medical tests and medicines but feel pinched by the counselling fee. Counselling involves time and lots of time.
Stigma is a risk factor leading to negative consequences in mental illness. We need to remove the stigma towards mental illness and develop a positive attitude towards it. 85% of disturbances are emotional in nature and can be dealt with psychological therapy and counselling. They do not need medicines and a doctor. Every disease follows a psycho-social-bio model. In only ten to fifteen percent of cases or even less the biology takes over and needs a medical intervention. In other cases the psycho-social model prevails and needs no medication and no doctor. It needs a psychological intervention to help diagnose the emotional and the social stressors that are causing the symptoms of distress. Once the disturbance is identified, a strategy is devised to handle the emotional reactions to the social situation and the client is trained in them. It is a well developed science and has progressed tremendously in the last few decades. Multiple therapy modalities are there to suit the specific individual personalities.
Mainstream cinema can do wonders in removing the stigma to emotional problems. ‘Dear Zindagi’ dealt with a seemingly simple problem of the deep rooted ‘fear of abandonment’ and the need for a psychologist, who is fondly called as ‘dimag ka doctor’. The youth in the film make an important statement when they say, ‘everyone needs a dimag ka doctor’, so what is the big deal’. Nothing can be closer to the truth. We all need a ‘dimag ka doctor’ once in our lifetime!