LAST Saturday was World Mental Health Day. The World Health Organisation views mental health as a serious global issue. More than 450 million people have a mental health condition and live with it every day.
Dr Andrew Mohanraj, a psychiatrist, talks about one of the most misunderstood and most feared disabling conditions and diseases.
PB was a straight As student. Then at the age of 20, everything suddenly changed. His performance took a serious dip and he often wandered around town aimlessly. At home he locked himself in his room to avoid his family. He stopped drinking water at home because he feared it was contaminated. He began hearing strange voices and became a chain smoker.
His family suspected he was mixing with bad company and thought he was on drugs.
But it wasn’t until he was referred to a psychiatrist that he was diagnosed with schizophrenia. After medication which he still takes daily, the “voices” ceased and he successfully finished his studies and works in an IT company today.
SD, a mother with two children, was a successful bank officer until her life came crashing down when her husband left her for another woman. She couldn’t concentrate on her work, began to lose weight and had to send her children away to be looked after by her parents. She felt guilty and blamed herself for her marriage breakup and became suicidal.
A friend helped her see a psychiatrist who started her on anti-depressants. Now six months later, SD is much better and has reunited with her children.
“World Mental Health Day offers an excellent opportunity for us to think about people with mental illness,” says Dr Andrew who works as Director of Aceh Psychosocial Rehabilitation Programme which he helped set up after the 2004 tsunami.
The technical adviser on mental health for the Department of Health, Province of Aceh, Indonesia, who is currently planning a similar programme in West Sumatra after the recent earthquakes there, pointed out that mental disorders occur in all cultures and at all stages of life, and are often linked to marginalisation and social disadvantage.
“The burden caused by mental disorders is often underestimated,” he adds. “At present, out of the 10 leading causes of suffering worldwide, five are psychological conditions, including depression.
“By the year 2020, depression will become the second largest cause of suffering – next only to heart disease.”
According to Dr Andrew, depression and schizophrenia are only two mental disorders among an array of psychological conditions that warrant medical or psychological attention.
Depression often goes unnoticed because some cultures ignore it. “While sadness can be considered normal and transient, depression is caused by the interaction of biological and environmental causes and can manifest in psychological and physical symptoms, including suicidal thoughts and intentions,” Dr Andrew points out.
“Chemical changes in the brain can lead to depression without any external precipitating factor.”
Schizophrenia, often first seen in late teens or young adulthood, is a more prolonged brain disorder. The hearing of “voices” or the belief that one’s mind is being read or controlled by someone else is sometimes attributed to sorcery.
Dr Andrew also points out that violence is not a symptom of schizophrenia.
“Most people with schizophrenia are withdrawn and prefer to be left alone,” says Dr Andrew. “Drugs or alcohol abuse raises the risk of violence in people with schizophrenia, particularly if the illness is untreated, but then this is also true of people who have no mental illness but abuse drugs or alcohol.”
“With early detection, schizophrenia can be controlled and people suffering from this illness can lead productive lives.
“They need not be unnecessarily subjected to social isolation. Fortunately in Malaysia, our primary health centres and hospitals are well stocked with basic psychotropic drugs.
“However, we may need to be more forceful in taking a community-based approach where people with mental illness are treated within their local environment and hospitalised only when absolutely needed.
“One step towards this would be the establishment of outreach teams that make home visits. This provides an opportunity for the family members of those suffering from severe mental illness to participate in the therapeutic intervention and appreciate the fact that family support is crucial for recovery,” concludes Dr Andrew.
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