Breaking stigma, changing culture: Sikkim's mental health traditions

Breaking stigma, changing culture: Sikkim's mental health traditions
Mental health is about your thoughts, emotions and behaviour that is regulated by several chemicals and hormones in the brain. The brain's functions span from attention, concentration, thinking patterns, motivation & reward system, goal setting, execution of plans and daily tasks, interests & hobbies, perseverance,  resiliency, decision-making ability, negotiating relationships, self-control, self-esteem, self-confidence, ability to cope with loss and failures, self-discipline & self-regulation, living life with a purpose, self-contentment, personal wellbeing and personality traits apart from controlling additional organs of the human body.
Your brain is a physical organ which has specific mental functions. Therefore, all mental disorders are physical in nature and there is no need to feel ashamed and embarrassed for suffering with it. 
 
Mental disorders are characterized by disturbances in mental activity including your thoughts, emotion and behaviour leading to impairment in personal wellbeing, relationships and daily activities.
 
Common Signs and symptoms of Mental disorders are:
1. Changes in mood: Pervasive sadness, euphoric mood,  extreme anger,  irritability,  feeling of emptiness,  apathy
2. Social aloofness and withdrawal 
3. Anhedonia,  lack of interests and desires 
4. Changes in sleep and appetite 
5. Extreme apprehension and fear, phobia, panic attack and anxiety, 
6. Obsessive thoughts, and urges, negative intrusive feelings and thoughts that are difficult to control 
7. Pathological guilt 
8. Feeling of worthlessness, helplessness, and hopelessness 
9. Preoccupation with poor self and body image, eating disorders 
10. Risk-taking behaviour such as excessive indulgence in substance and alcohol, sexual promiscuity, gambling, impulsivity 
11. Poor self-esteem, poor self-confidence and excessive self-doubt 
12. Hallucination and delusion 
13. Stress-induced disorders such as acute and chronic stress disorders 
14. Odd/ inappropriate behaviour 
15. Unexplained physical symptoms
16. Suicidal behaviour characterized by suicidal thoughts, feelings,  urges images,  plans and attempts. 
 
Mental illnesses are caused by a chemical imbalance in brain chemicals rather than a spirit, black magic, past deeds or bad Karma. Stigma, ignorance, and lack of education and understanding surrounding mental disorders promote various myths that prevent an individual and their family members from seeking appropriate help of mental health professionals.
The first contact for the care of mental illness is usually local faith and traditional healers rather than a mental health professional. People tend to avoid psychiatrists primarily because of the fear that they will be stigmatized by friends, neighbours and their society. People not only fear psychiatrist but also fear psychiatric medicine and treatment, seeing it as harmful or dangerous. This fear is amplified by family members and significant others including health care personnel who advise them against continuing medicine which could heal and cure mental illness.
Many will advise mentally ill patients to "get over it, grow strong and try other alternative treatment" - motivating people to seek early psychiatric help is the best way to help. The sooner you seek help, the outcome is better, with faster recovery. 
 
Scientific endeavour has led to the discovery of several new medicines to correct chemical imbalances in the brain that are responsible for mental disorders. These new medicines are safe and effective in treating such disorders, thereby increasing the quality of life. There are medications available now to treat depression, suicidal behaviour, anxiety, psychosis and addictive disorders. 
 
Apart from medicine, tailored made psychotherapy (counselling) along with lifestyle modification therapy to maintain personal wellbeing and prevent relapses should be prescribed and followed. It should be noted that psychotherapy is a gradual collaborative process to identify your weaknesses, strengths, problems, triggers and behaviour.
The therapist acts as a facilitator to help clients reach their own decision. Direct advice is never offered in therapy, neither are personal beliefs of the therapist enforced. Therapy or counselling needs long term investment by both the patient and mental health professional to bring the desired outcome. It's not a one time fix solution.
We have observed that there is a tendency to seek counselling support only once by a majority in a community for mental disorders. Therefore, greater long-term investments need be made both by patients and family members while dealing with mental illness', similar to treatment of hypertension, diabetes,  heart diseases and other chronic physical diseases where an individual seeks a longterm approach by regular monthly follow-ups, doctor check-ups and assessment.
 
The author is Dr Satish Rasaily, MD Psychiatry & Postdoctoral Fellowship in Addiction Medicine. IMA N Ramachandran Murthy Awardee 2018 by Indian Medical Association (National Award).
Views/Opinions expressed in the article or write up is purely of the author or writer and not of the Sikkim Chronicle. For any queries or contradictions, the author can be contacted in his/her email id.
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