The Open Closet: An Illness Like Any Other

Maajid bares open the stigma associated with mental disorders when in fact it is an illness like any other affecting all ages and all strata of society

(Dr. Abdul Maajid, 38, was born in Srinagar. He received his undergraduate education in Srinagar, and completed medical degrees (MBBS and MD) from the Government Medical College (GMC) in Srinagar. Dr. Maajid is currently a consultant in Psychiatry at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) in Srinagar. In his leisure time, he does research work and community outreach activities.)


Psychiatric Disorders: No more a Ghost Story Now

In Kashmir, if an individual develops some psychiatric disturbances, normally people instead of attributing the occurrence to underlying biological (nuerohormonal) disturbances in the brain ascribe the complaint to influence of some spiritual power, yeti or ghost on the patient.

In addition, there is a false belief that poverty, violence, insecurity and unemployment are correlated with mental disorders, although these being endemic factors in this part of world that require sustained, multi-pronged interventions. Studies, however, conducted at various prestigious research centres as well as in our valley have clearly depicted that psychiatric disorders can affect any individual irrespective of age, sex, caste, creed, status in society, occupation etc.

Keeping in view this false perception in our society regarding occurrence of psychiatric illnesses as having no biological basis, the first point of contact is a local non-medical expert or faith healers, where patient is supposed to be freed of all ill omens. However, when these psychiatric disturbances become difficult to handle or at times if the concerned people are a bit aware of the illness, relatives of the patient are advised to see a doctor. And in view the common psychiatric symptoms verbalized by the patient and attributing them entirely to heart problems like palpitations, restlessness, decreased sleep, decreased interest in activities, decreased concentration, tremors, sad mood, decreased appetite (which actually are symptoms of most common psychiatric illness - Depression), the patient undergoes various investigative procedures. When nothing significant is revealed by these investigations, patient is advised to see a psychiatrist, although the initial important period when diagnosis and treatment were easy, was lost before seeking psychiatrists consultation.

The parents, relatives and friends obviously think hundred times before seeing a psychiatrist to seek help for their psychiatrically ill patient, owing to fear of stigma, in view of the fact that psychiatrist in this part of the world are supposed to treat lunatics (insane) people only. Although this shouldn’t have been a scenario at least in this turbulence-ridden valley where during last few decades the psychiatric illnesses in the form of depression, anxiety disorders (especially Post Traumatic Stress Disorders), drug abuse, suicides etc have increased alarmingly due to various factors.

Like chronic medical disorders (diabetes, hypertension, hypo/hyper-thyroidism etc), psychiatric disorders also occur due to interplay of various factors. As revealed by research and scientific data world over, hormonal disturbances in the brain of an individual can give rise to different psychiatric disorders. As in depression there is decreased quantity of serotonin and norepinephrine and in schizophrenia dopamine levels are abnormal. Genetics (hereditary factors) also play a vital role in the occurrence of psychiatric disorders. Environmental stressors in the form of natural disasters (Oct 8 earth quake, snow storm, floods) and man made disasters; unemployment particularly in this part of world has been one of the major contributory factors for such steep rise in prevalence of psychiatric disorders. There is certainly role of psychosocial, cultural and psychological factors in etiology of psychiatric illnesses.

Taking all the above facts into consideration we need to change our mindsets and get psychiatric disorders treated at the earliest possible time the way medical disorders like diabetes, hypertension etc are being attended and treated properly on priority.

As the World Health Organization has pointed out that efficient interventions to diagnose and treat the most common mental disorders like depression, anxiety disorders, schizophrenia etc are as cost-effective as those for other chronic medical disorders, still most of the states in India spend a small fraction of their health budgets on mental health although they can afford to do a lot more. So it’s unfortunate and disappointing as well that only a small proportion of patients have access to proper treatment in our set up. Non-availability of voluntary health insurance policies for psychiatric diseases worsens the scenario. Although India made a beginning in community-level interventions through implementation of the District Mental Health Programme a decade ago it, however, has managed to serve only a fraction of the population, possibly due to improper execution of plans.

So there is an urgent need to change our perception regarding the causes and treatment of these psychiatric disorders and seek a proper psychiatric consultation without any hesitation. This will obviously prevent a small wound (manageable psychiatric ailment) to become gangrene (severe psychiatric disorder/ unsound mind).

Making our community aware through media, organizing seminars, discussing mental health issues in schools and with vulnerable population, involvement of religious leaders etc could be a step forward for proper management of the patients with psychiatric illnesses.

Last but not the least let all of us follow the golden words of former WHO Director-General Gro Harlem Brundtland in the 2001 World Health Report "the present generation must be the last that allows shame and stigma to rule over science and reason". So better late than never. Let’s take up the challenge of removing stigma and discrimination for our better and sound future.