Patients do not Address Psychiatric Illnesses Adequately

We, at A Journalist Reveals, have been focusing on the social aspects of different types of diseases. We found Professor (Dr.) Sumit Kumar Gupta, a Senior Psychiatrist at Max Healthcare, Pitampura. A lot of patients consult him at the hospital. These patients clearly admit that as much as they understand the need for Psychiatric care, they succumb to social pressures in acknowledging and eventually addressing these needs adequately.

Social Factors of Psychiatric Diseases: Dr. Sumit says, “Every illness can be best explained in terms of biological, social and psychological basis (The Bio-Psycho-Social Model of illness). The relative significance of these three broad universal factors is different for each illness. For Psychiatric disorders, the psychological and social underpinnings are obviously more significant as compared to physical illnesses. The social factors play an overarching role not only in the genesis of psychiatric illnesses but also in the seeking of treatment and long-term outcome. Social stress can result in the appearance of psychiatric illness in a predisposed person. The un-pleasurable events like loss of a loved one, a broken relationship or loss of a job or financial adversity are usually recognized as stressors, even by a layperson. However, anything that demands adjustment from a person (even a positive change), induces stress. It is not uncommon for me and other mental health practitioners at Max Pitampura to see patients with depression precipitated after a job promotion or getting admission to a sought-after course. Nearly 80 % of women experience a few depressive symptoms after childbirth and 20% suffer from a diagnosable depressive episode. As this is counter-intuitive, the people around are unable to empathize with the sufferer and behavioral change is often attributed to callousness induced by success. This also delays the help-seeking in such cases.”

As per Dr. Gupta’s own research conducted at Max Healthcare – Pitampura, the average delay in seeking psychiatric consultation is 1 year after the first appearance of symptoms and this is no better with educated and otherwise well-to-do families. He adds, “People understand the signs and symptoms of mental illness in the light of their prevalent societal belief systems. Indian Society is truly multicultural and dynamic, with information of both the traditional belief systems and modern scientific knowledge base being disseminated through informal channels and mass media. Hence, people varyingly believe that psychiatric illnesses can be caused by some supernatural power or represent a ‘psychological weakness’ or are ‘real illnesses with some underlying pathology’. It is not uncommon to find people subscribing to more than one theory and seek simultaneous treatment with a psychiatrist and a faith-healer (my own research finding). The belief into magico-religious causes of mental illness is common even with highly educated persons, such as doctors. While disbelief in the medical model of mental illnesses, delays or prevents treatment; the psychological weakness theory results in blaming the sufferer of the mental illness.”

He continues, “We at Max Pitampura, commonly hear family members say ‘We have told them (patient) several times to overcome the symptoms by ‘willpower’, but he could not and we had to bring them to you (psychiatrist).’ I usually tell these people that ‘No one wants to suffer by choice or will. If it was possible to produce or overcome symptoms by will, no one will ever suffer from such illnesses.’ One other common statement of family members is ‘Yeh tension jyada leta hai’, for which I usually reply ‘Tension is never willfully invited. It just happens and excessive worrying is a symptom rather than a cause of mental illnesses.’”

Patient’s Attitude: Patient’s attitude towards his illness not only depends on his general understanding of mental illnesses but also by the nature of his symptoms. Pessimistic outlook is a feature of depression and many of those suffering from it does not foresee any benefit of professional help. Here, the immediate family members and society at large have a greater role in supporting and guiding the patient during this difficult time.

Dr. Sumit insists, “Some of the symptoms of mental illnesses are so strange (like ‘being possessed by a spirit’ or ‘hearing voices of God/some person’) for a layman that they believe that they cannot be symptoms of an illness, but some divine act or black magic. A few patients are brought to mental health professionals for treatment of ‘unmanageable distress’ because of such experiences and such symptoms are not revealed unless uncovered on specific inquiry. People usually provide with a rationale like ‘We are taking care of this by the intervention of an ‘Ojha’ and you should deal with the distress part only’ after such discovery.”

Recounting his experiences, Dr. Sumit says, “The worst part seen is when the behavior that is a product of mental illness is attributed to the patient himself or to ‘the mental torture by in-laws’ or ‘the result of a bad company’. I can recall an incident in which parents of a student staying in the hostel were told by college authorities to seek psychiatric consultation for his behavioral problems. The parents, who were not in regular contact with their child, were unable to find any abnormality with their child and were even prepared to file a legal suit against the college for harassment of their child. It was suggested to them to closely observe their ward for few weeks and later they themselves sought treatment.”

To be continued…