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Mental illness to be biggest non-communicable disease in India

Oct 09, 2012

In what could be the biggest challenge for India, in the health sector, mental illness is all set to be the biggest of all the non-communicable diseases in the sub-continent, writes Prateeksha Sharma.

Of all the non-communicable diseases, the burden of mental illness to society is going to be the single highest burden by 2020. How well is India poised to deal with this challenge? According to official estimates, 7% of Indian population suffers from serious mental illness. Of these 90% have no access to any form of treatment (EPW, 2012, Feb 4)

In India most of the initiatives by the government are lead by clinical perspectives of psychiatry and psychology, which are not established in India. The entire Diagnostic and Statistical Manual (DSM), which is the cornerstone of psychiatric diagnosis, is developed and standardized in USA. The DSM looks at mental illness in a universal way and believes in giving labels to individuals based on categories decided in faraway USA, without taking into account any of the cultural and indigenous concerns.

In his recent book, Crazy Like Us, Ethan Watters talks about how diagnostic categories developed in the US were successfully ‘exported’ to the rest of the world. These categories were decided by a consensus among psychiatrists trained in a particular manner only. He sheds light on how this sort of Western approach to dealing with the complexity of human experience is not going to help any part of the population, anywhere in the world, unless the people themselves look for ways to incorporate the knowledge from the west into their cultural diversity.

It is another matter that there is a large scale protest in mental health against atrocities committed against those labeled mentally ill. There is a huge outcry against violations of human rights, the freedom of choice in situations of treatment and on the subject to the primitive electroconvulsive therapy- ECT. ECT is currently banned by the WHO , yet still practiced in many countries including India. This is being further encouraged as part of part of the incoming mental health bill to be administered in a ‘modified’ form (without anesthesia) This is a dangerous and repressive measure because it empowers the medical community to administer ECT to anyone labeled mentally ill.  

In a day and age, when there is a lot of doubt in the whole world about psychiatry and the ethical, scientific and biochemical basis of mental illness (for nothing claimed by psychiatry can be proven by tests and measures) there is a need to look at alternatives in treatment. To singularly look at mental health from the perspective of the medical community and give them powers over the rest of the populatoin will only prove counter-productive. Psychiatry largely believes in the management-of-symptoms model rather than the cure of mental illness. From the world over there is growing evidence about recovery from mental illness using the non-psychiatry paths to healing. There is a need to ask those who have recovered without psychiatric drugs or with suitable alternatives to see what they could offer. There are no such voices in those constituted to form the current mental health policy group, appointed by the Ministry of Health and Family Welfare, Government of India.

In our country, a lot of mental illness is emanating from poverty and malnutrition and also, due to drugs and alcohol addictions. The homeless have the greatest number of mentally ill among their midst. Frequently the cost of looking after the mentally ill for an individual economically marginalized household is so much, families just abandon their mentally ill members or themselves suffer further poverty.

In a recent case in Calcutta a man from Assam was admitted to a mental asylum, out of which he could not find the way out, despite being clinically fit- for two years! The consultant psychiatrist refused to discharge him, on grounds which did not prove any signs of mental illness at all. It was with the assistance of Anjali Mental Health Rights Organization, could that man be released. But his family refused to take him back.

All over the world, people are living and dealing with mental illness in numerous ways, which do not always subscribe to the medical model of disease management. It is a not-so-well-known fact that people recover even from serious mental illnesses and live healthy and productive lives, because mental illness often has a transitory nature.

How can more of this success be achieved? At the onset of a mental illness itself, if someone is identified and be allowed to deal with their crisis in an enabling environment, they need not become permanent psychiatric patients. It is also important to understand that mental illness is not necessarily always coming from the unique constitution of a person, but could be the culmination of numerous societal pressures working simultaneously.

There is talk about prevention of mental illness but few seem to know how. One of the easiest ways could be to train school teachers to identify students who show signs of departure from the norm. But in a scenario where teachers are burdened by so much syllabus-oriented pressures, one wonders how realistic it is to put this additional responsibility on them. In my own interaction with teachers on several forums I have heard how overwhelmed they feel to deal with any extra responsibilities and how much outnumbered too.

India has many traditional ways of look at conditions of the mind, including the age-old sadhus and spiritual practitioners. In a number of cases these people had conditions resembling mental illnesses.  Similarly there are alternatives in treatment too- from ayurveda, homeopathy to several other indigenous systems.

In such a multi-cultural environment is it reasonable to examine everything from a lens developed in the west alone? Though the government, in its well meaning efforts, put an entire National Mental Health Program together in 1982, unless that program incorporates alternative views, any number of professionals will fall short of desired results. The solution does not lie in increasing the number of psychiatrists in the population, but in creating models where several voices can mingle and enrich the whole dialogue.

Prateeksha Sharma is a classical musician who works in mental health sector.

Oct 13, 2012 10:43 PM


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