Psychiatric Disorders - Myths and Realities (A Guide for Caregivers)

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Knowledge of psychiatric disorders is inadequate in our country. So much so that often mental problems like hysteria, depression, suicidal tendencies and schizophrenia are considered as manifestations of evil spirits, fruits of bad actions, etc. Instead of taking the patient to a doctor, a Tantric or mantra-vadi consulted.

This book seeks to provide scientific information on many common mental disorders like depression, obsessive compulsive disorder and mania. More serious mental disorders like sehizophrenia and suicidal tendencies are also covered in an easily comprehensible manner. The author stresses that if personal, familial, social, financial and legal complications can be provented.

The author is Professor and Head, Department of Psychiatry, University College of medical Science, University of Delhi and GTB Hospital, Delhi. he has authored a number of books on related topics.

In our country, Psychiatry is still in underdeveloped stage. The knowledge of a common person about mental disorders is full of misconceptions. It is really sad that in the present scientific age, evil-spirit, devil, God-Goddesses, climate, astrology, luck, fruit of bad actions etc are considered to be the causes of mental disorders. Therefore, in our country, traditional therapist, priest, Muslim priest, sadhu, faked physicians, tantriks, unskilled sex-therapists etc are working as psychiatrists. Common physicians and specialists are incapable of recognizing mental disorders and referring them to psychiatrists. There are many reasons for this, out of which important are insufficient knowledge, insufficient experience, craze for money, deficiency of psychiatrists, stigma, poverty, inability of patient or his relatives to accept mental disorder etc.

The global burden of disease due to neuro-psychiatric disorders was measured to be 6.8% worldwide in 1990. This is projected to increase to 15% by the year 2020. Psychiatric disorders account for 5 of the 10 leading causes of disability across the world Mental- health disorders account for nearly a sixth of all related disorders. Yet we have just 0.4 psychiatrists and 0.02 psychologists per 100,000 people and 0.25 mental health beds per 10,000 population. The psychiatric treatment is available in few general hospitals. But mostly, the time of psychiatrists and majority of the fund is utilized in the care of drug addicts. Newspapers and audiovisual media has also failed in providing correct information about mental disorders. The result is that in people, the fear and lack of knowledge about these disorders could not be removed.

To provide correct information about mental disorders is the first aim of this book so that mental disorder can be recognized timely and treated correctly and personal, familial, financial, social and legal complications of these disorders can be prevented in time.

If the popular misconceptions about the mental disorders in common public can be removed, the possibility of curative treatment becomes high. By this book, even if a single psychiatric patient is able to lead a normal life, then this book will be successful in fulfilling its objectives. Important tips for caretakers and patients are given in each chapter.

All suggestions for future revision are welcome and will be duly acknowledged.

Let us first get to know in brief the definitions of different technical words associated with mental disorders and those related to meanings to understand the subject in depth.

Terms Used

1. Psychiatry:- This is an important branch of medicine which is related to diagnosis, treatment, and prevention of psychiatric disorders.
2. Psychology: That branch of science in which the normal processes of mind are studied. For training of psychologists, the knowledge of medicine is not necessary, therefore psychologists often help only in the investigation (not treatment) of psychiatric disorder.
3. Psychoanalysis: It is a procedure to find out the causes of origin of psychiatric disorders, for example hysteria. This procedure is also helpful in treatment. For this, the knowledge about psychiatric treatment or psychology is required.
4. Mind: It is the working capacity of brain. This capacity is of many types like thinking, memory, intelligence, mood, psychomotor activity, concentration, behaviour, insight, judgement etc.

1. Conscious:- This is about one tenth part of the mind in which there is awareness about self and environment. In daily activities, a person uses this part of the mind.
2. Unconscious:- This is that 90 percent part of the mind, about which a person is not aware. It affects the healthy and unhealthy processes of mind and a person becomes aware about it by dreams. In this, the person's primitive desires ego hunger, thirst, sexual activates are suppressed. Person cannot use this part of mind consciously. If the suppressed desires are expressed without the screening of judgement, then many symptoms are produced which take the form of a disorder later on.
3. Semiconscious :- This is that part of the mind in between conscious and unconscious, which a person can use by effort eg that part of memory which a person can use by remembering past incidents.

- id: This is that part of the mind in which primitive desires (eg repressed sexuality, aggressiveness, food related desires) are found which require immediate gratification and are based on "Pleasure-Pain principle". These desires are unjustified and unexpressed, which do not enter the consciousness.

- Ego: This is the conscious part of the mind which controls the primitive desires according to reality.

The half part of it is conscious and half is unconscious. Its main function is to save human being from stress or tension. Freud's daughter Anna Freud, said that this part of the mind develops by the age of 15 years and the evidence for this is that after this age, the child starts recognising his body parts and the feeling of self arises.

- Superego: This is that part of the mind which develops according to social and moral needs and becomes component of experience. The unconscious part of it is called ego ideal and conscious past is conscience.

The main functions of ego are development of reality, intelligence, consciousness, memory, judgement, desires, favourable adjustment, to differentiate etc.

William C. Meninger's (President of Meninger Foundation, Topeka, America) prepared mental health questionnaire .

• Do you worry without any reason?
• Do you have lack of concentration due to unknown reasons?
• Do you remain sad without any appropriate reason?
• Do you become angry frequently and often?
• Does sleeplessness disturb you regularly?
• Do you have liability of mood due to which you go from depression to mania and again depression?
• Do you constantly dislike the company of other people.
• Do you become worried on disturbance of daily routine?
• Do your children excite (or irritable) you constantly .
• Do you live in deficiency or sorrow?
• Are you fearful without any reason?
• Do you always feel that what you say is correct and other people are incorrect?
• Do you have many types of pain, the cause of which could not be detected by therapist.

Behaviour Related Characteristics of Mentally Healthy Person :

• Total adjustment with self and environment
• Satisfaction, happiness and peaceful
• Working with efficiency
• Familial, social and financial responsibilities are carried out satisfactorily.
• Use ability, capability and creativity for society, culture and welfare of humanity.
• Good relationship with neighbours Mental processes eg memory, consciousness, thinking, feeling, intellect, judgement, insight, behaviour, concentration etc working perfectly.

• Impulsive, irritable, excited, violent, abusive behaviour.
• Worry, stress, depression, mania, phobic disorders, unwelcome thoughts, irrelevant talks or activities, inappropriate suspiciousness, obsession etc.
• Not able to perform work with concentration, perfection or interest.
• Without any neurological cause, headache, weakness, decreased appetite, constipation, diarrhoea, anxiety, breathlessness, pain in any body parts etc are physical characteristics.
• Mental disturbances eg worry, or mood disorders, loss of memory, concentration, or physiological or substance induced disturbances
• Due to mental stress, the origin of physical disorders eg pain in abdomen, hypertension, migraine, asthma, impotence etc precipitation or perpetuation.
• Illegal, antisocial, sexual disturbances, addiction, alcoholism etc. activities.
• Sleep disturbances (decrease, excessive, night terrors, sleep talking or walking etc.
• Decline in judgement and awareness about illness.

Genetic:

1. Familial:- Psychosis (eg schizophrenia, mania, depression etc), personality disorders, alcoholism, mental retardation, epilepsy etc disorders are found more in people in whom any member of a family may have the problem. If mother and father, both are involved, then the chances in the offspring becomes approximately doubled.
2. Physical build :- In Pyknic (obese) people, mood disorders (mania, depression or dysthymia etc), hysteria, heart illnesses etc are found more, whereas in asthenic (long and thin) build people, schizophrenia, stress, personality disorders are found more.
3. Personality: Those who are introvert (self-absorbed, keeping quiet, having few friends, are book worms etc (schizoid personality) have more chances of schizophrenia whereas people obsessed with discipline, cleanliness, punctuality, parsimonious, orderliness etc (Obsessive personality) have more chances of obsessive compulsive disorder.
4. Physiological causes: Physical changes in adolescence, adulthood, oldage, pregnancy etc become basis for many mental disorders.
5. Other causes: Brain-infections, illnesses, head injury, vitamin or electrolytic deficiency, neurological related changes etc become causes of mental disorders.

1. Diet related: The use of few drugs, chemical substances, metals, alcohol and other addicting substances etc can produce mental disorders.
2. Psychological: Interpersonal conflict, death of a loved one, insult to self respect, loss of job, financial loss, marriage, divorce, birth of a newborn, retirement, failure in exams or love etc can originate or precipitate mental disorder.
3. Socio cultural: Reduction in social and entertainment activities, loneliness, political, natural or social accidents (e. g. robbery, terrorism, earthquake, famine, floods, social load and antagonism, inflation, unemployment etc can produce mental disorders.

1. Biological: Genetic constitution, personality, attitude, body build etc.
2. Familial :- Parental conflicts, inappropriate behaviour, for example, strict discipline, exploitation, passiveness, unsteadiness, favouritism, comparison etc.
3. School related :- Comparison by teachers, favouratism, religion, caste or discrimination due to family or financial condition, strict discipline or disrespect, deficiency of library and entertainment facilities, rapid change in school, class or time table.
4. Isolation from Social and Entertainment activities and sexual disturbances: Incorrect sex education, unhealthy sexual perversions, sexual disturbances etc.
5. Marital problems: Unmarried, physical, emotional, social and culture separation, high number of off springs or lack of children.
6. Office related: Stressful environment, strained relations with seniors, excessive work, dissatisfaction with work, unemployment, frequent change etc.
7. Financial problems: Poverty, prosperity, bad habits, for example, gambling, alcohol use, prostitution etc.
8. Religious and cultural rituals: Inappropriate reaction to widowhood or strict following of rituals.
9. Others: Overcrowding, pollution, lack of housing etc. Some of the above causes make a person more prone to mental disorders whereas some precipitate or perpetuate them.

The development of psychiatric treatment can be explained in following phases :-

Social and Legal Aspects

In 1795, a person named Pinel started the humane treatment of mental patients in Paris. They were given freedom to roam and do work, due to which they started improving. Before this, mental patients were tied, due to which they became excessively excited and violent. By treating with love and sympathy, peace prevailed in the hospital and the patients started improving early. By motivating through the social reform, Benjamin Rush in USA and Connolly and Tuke in Britain laid the foundation of social psychiatric treatment for mental patients.

In 19th century Britain, many big hospitals were open for mental patients and in 1890, Lunacy Act was enacted by which reception order from the court regulated the admission of psychiatric patients. In 1930, by amending the Act, the patients were given the right to be admitted themselves. In 1959 an amendment removed the need of certificate and the discrimation between mental patient and other patients was stopped legally.

The Indian Lunacy Act was passed in 1912 under which the treatment of mental patients was available only in asylums but in 1987, through Mental Health Act, treatment of these patients has become much easier. Under this, self-admission, emergency admission, admission in general (governmental or private) hospitals etc are now available.

Development of Psychological Procedures :- Paracelsus, a psychologist, in 15th century has opined that health and diseases are controlled by astrological positions e.g. controlled by moon and stars. The word lunacy has been derived from Lunar (moon), the meaning of which is that man is affected by moon.

A scientist, named Mesmer has expressed a view that mental disorders arise due to a liquid in body (Animal-magnetism). Based on this principle, the method of hypnosis was devised by which neurosis (mainly hysteria) has been treated successfully. Charcot, a neurologist, has said that hypnosis and suggestion are the keys to successful treatment.

After this, a psychologist named Sigmund Freud (Freud is known as "Father of Psychology") has given new direction to psychology. He has given the structural and functional definitions of mind, hypnosis and psychoanalysis, dream interpretation, psychosexual stage of development and properties of cocaine. He described the psychoanalytic causes of many mental disorders.