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Posted at: May 13, 2018, 2:34 AM; last updated: May 13, 2018, 2:34 AM (IST)

When the mind is without fear

A recent judgment by the Delhi High Court helps destigmatise mental illness. There is, however, still a long way to go

Simmi Waraich

When Reena* first came to see me, she was living in luxury. Only child to her parents, her resume boasted of education in the US. She had a background others would give their eyes and teeth for. Yet, she was consumed by self doubt and obsessive compulsive disorder (OCD), a disorder which infested her, grew into a behemoth, till she spent most of her day obsessing and checking and rechecking things. She took treatment two years back.

Reena worked in a high-pressure job for six months and in between she stopped her medication. “I don’t need it anymore. I can be strong.” She convinced herself. After four months, the OCD, a disease where the caudate nucleus (a nucleus in the basal ganglia of the brain) shows a failure to suppress signals from the prefrontal cortex, re-emerged and though she tried to be ‘strong’, she was unable to control the impulses and eventually quit her job. 

She ignored the obvious staring in her face for 18 more months. In our first session, we spent 40 minutes discussing how as one cannot control sneezing if one gets an allergy. Likewise, one cannot control obsessive thoughts even if one tries to.

A fallacy prevails in our society that you need medication for pain and fever, but for OCD, depression, etc. should you really abide by the prescription? Should willpower be the only answer to all-issues psychological?

The dichotomy is the fallout of implicit assumption that mental illnesses are ‘merely’ psychological factors. And that these aren’t biological. Most other medical or physical illnesses have done a mammoth disservice to the field of psychiatry. Reena finally comprehended that the obsessive symptoms were as real as fever or cough or a urinary infection and if they were troubling her, she could not treat them by being strong. Medication-cum-counselling was the solution. Medication helped her caudate nucleus to do its job better, just as diabetes medicines enable the pancreas to function better. 

She got married, continued to work. And then, life took a sharp turn.

After three years of marriage, her husband alleged she had not informed him about her mental illness and applied for a divorce. I called and counselled him that he could not get a divorce on these grounds as mental illness is like any physical illness and treatable and that his lawyer was misleading him. Luckily, he agreed and dropped the case. 

On May 1, the Delhi High Court delivered a very pertinent judgment. One that concerns anyone dealing with a stressful job or relationship, trying hard to strike work-life balance or has got caught in the vicious circle of — lay-off scare and performance and appraisals.  

The Delhi HC said, “Consulting a psychotherapist does not mean a person is mentally unsound. It is a common practice in today’s stressful life.”

This was in context of a woman being kept away from her one-year-old daughter merely because she was a psychiatric patient. “It is no longer a taboo in our society to consult a psychotherapist or a psychiatrist or counsellor, as it was in the earlier days. Merely because a person may go for such therapy and consultation, it does not follow that the person does not possess mental equilibrium or is mentally unsound,” the judgment went on to say. 

Here the question arises, “What is an unsound mind and why is it assumed that going to a psychiatrist qualifies a person as unfit? Why did the husband in this case think that the court would obviate the mother from meeting her daughter just because she had seen a psychiatrist!” 

Firstly, a mental illness is not sufficient or necessary for the finding of unsoundness of mind. Even if a said person has a mental illness, it does not imply that he is of unsound mind. Thus, the husband in this case was jumping the gun and impugning his wife with no valid reason. 

Most mental illnesses are treatable. Anxiety, mild to moderate depression, bipolar disorder and even schizophrenia are illnesses that people may take treatment for, at times for extended periods of time, with little or no effect on daily activities or work. In fact even in other illnesses such as diabetes or asthma, people may not be able to work and need to rest in a severe episode, just as in mental illnesses. 

  Thus, the United Nations Convention for Rights of Persons with Disabilities (UNCRPD) was adopted in 2006, which marks a shift in respect of disabilities (including disability due to mental illness). The new paradigm is based on presumption of legal capacity, equality and dignity. It asks for equal rights to be given to all with the aim that mental and physical illnesses be treated at par with no discrimination.

Still, stories of stigma, discrimination and misconceptions abound. Unfortunately, these don’t even discriminate levels of education. People suffering from mental illnesses fear revealing their illness to their employers and at times even to a close family member.

Amit* often talked about his fear of letting his 15-year-old son know about his bipolar disorder. He worried whether his son would understand. 

Meeta*, 35, whose brother succumbed to his illness by committing suicide was often looked upon derisively by her in-laws for taking her medication. When her mother-in-law was counselled that while many took treatment for diabetes, asthma or systemic lupus, etc, often from a young age, what made her believe that medicine for depression is an anomaly, there was no reply. She was then showed the difference in the brain as seen on functional MRI during depression and after treatment. She then realised that the situation is trifle better, albeit reluctantly.

Each part of the human brain is super specialised.  For example, the posterior cingulate gyrus gives us a physical sense of where we are, the parietal lobes  integrate sensory information; the fusiform gyrus does face recognition....

Over activity or low activity in certain areas can lead to depression, OCD, schizophrenia, etc. 

An increased number of people are now willing to approach mental health professionals and seek therapy. However, a larger section still holds itself back, hesitating to take treatment. Public figures like Mariah Carey, who recounted her experience with bipolar disorder, or Deepika Padukone, who openly discussed her depression and its treatment, have done their bit in reducing stigma associated with mental illnesses. 

Mariah Carey said, “Until recently I lived in denial and isolation and in constant fear someone would expose me. It was too heavy a burden to carry and I simply couldn’t do that anymore. I sought and received treatment, I put positive people around me and I got back to doing what I love — writing songs and making music.” 

Carey’s statement helped many who suffer from the dilemma of to share or not to share, to take medication or to ignore. Later the singer said, “I’m actually taking medication that seems to be pretty good. Finding the proper balance is what is most important.” 

There is still a long-long way to go, many obstacles to cross. More awareness has to created about mental illnesses. These should not to be lampooned but treated at par with other illnesses. 

Prevention begins at schools as the brain is still growing then and long-term changes can occur with mind-wellness promoting activities. 

Symptoms like low mood, racing thoughts, decreased sleep, aggression, suspiciousness or obsessive thoughts indicate that some areas of the brain are not functioning optimally and we should take treatment at the earliest possible. Going to a psychiatrist should become as ordinary as visiting a general practitioner and not a furtive affair. 

  One waits for the day.

— The writer is a Chandigarh-based psychiatrist 


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