A Holistic Approach to Mental Illness
Iris C F Gomes
At a seminar, titled Working Towards Positive Mental Health, at the Pedro Arrupe Institute, Raia, Dr Peter Castelino shed light on various mental disorders and the present perception of these disorders, and spoke at length on the correct approach to mental health issues.
Dr Peter Castelino is a psychiatrist and the director of COOJ (Cause of Our Joy), an organisation that provides mental health services and rehabilitates persons suffering from mental health problems. He brought to the notice of the audience the importance of envisioning the human person as body, mind and soul. Just as the New Testament says (Thessalonians 5:23) , it is only when we approach a person in this manner that we can maintain the health of each individual component. Dr Castelino said, ‘Neglect of one aspect affects the other two. It is normal to take care of one’s body and spiritual life. It is the mind that is often not given as much importance.’
The biological basis of behaviour was emphasised in its ability to undermine the role of positive nurturing. For example, a victim of a stroke can have serious and drastic personality changes if the temporal lobe is affected. This is because the limbic system, which consists of the hypothalamus, the amygdala, and the hippocampus; plays a role in emotion, motivation, memory and learning.
An imbalance of hormones and neurotransmitters (chemical substances that allow neurons in the brain to communicate with each other) can give way to a number of serious mental problems. Diminished neurotransmitters, serotonin and dopamine, could contribute to depression in people.
When Dr Castelino asked the audience, ‘What is the first thing that comes to your mind when someone says mental?’ Their response was typical with words such as pisso, pagal, nuts, disturbed and cuckoo, emerging to describe mental. He went on to explain that certain behaviours that may be normal to some could be abnormal to others. It may not necessarily be a serious problem but a difference in perspective and understanding. We must realise that mental health ranges across a spectrum. A strong indicator of mental deterioration would be significant problems in occupational and social functions.
There can be many reasons for the appearance of mental illness. A strong case is made for heredity where the predisposition for an illness, such as schizophrenia, is inherited. Biochemical changes can contribute to mental illness. For example, since dopamine levels go down due to Parkinson’s disease, medications to increase these levels are prescribed. Excessive increase in dopamine can cause mental problems. Vitamin D deficiency can lead to cognitive impairment. Family dynamics also play a part in how a person can become mentally ill. Mental conditions can be attributed to viral infections too. We must appreciate that while it could be one cause or the other, it could well be a combination of two or more factors. In other words, stress could trigger off a predisposition to a particular problem that might have lain dormant in the face of a serene environment. To understand this, a psychological theory called diathesis-stress model is used. This model evaluates the combination of the predisposition and the stressors that result in mental illness. Coping skills and support from others help stall and prevent the consequences of stressors. Thus, not everyone who is predisposed will necessarily succumb to the vulnerability.
Ten to forty per cent of the people in Goa visiting health centres are people who suffer from common mental disorders. They normally go in with problems like acidity, headaches, indigestion, etc. They do not talk about emotional problems. This is either because of the stigma attached to mental illness or their unawareness of their own mental state. Goa has a high prevalence of depression and stress related problems and has a suicide rate that is higher than the national average. Attempting to explain to the audience what depression is, Dr Castelino said, ‘All of us feel sad but depression is feeling sad for more than two weeks, continuously.’ According to the World Health Organisation 2001 report, depression, alcohol abuse and schizophrenia top the list of psychological problems with the highest percentages in the world.
Dr Castelino made the distinction between the now obsolete term, neurosis, and psychosis. A neurotic person would be aware of the problem and of reality, but in a psychosis, patients do not possess the awareness and can suffer from hallucinations and delusions. The list of general mental illnesses include: anxiety disorders, depression disorders, bipolar disorder, schizophrenia, addiction, personality disorders. There are also disorders related to sleep such as sleepwalking or somnambulism and narcolepsy; sex and eating for which examples would be sexual dysfunction and anorexia nervosa, respectively.
Child and adolescent disorders are listed as autism; ADHD (attention deficit hyperactivity disorder); conduct disorder; pica, which is an appetite for sand, paper, soil, glass, etc. and learning disorders such as dyslexia. Women’s mental health problems were categorised as post-partum depression, post-partum psychosis and premenstrual syndrome.
The inclination of a society steeped in religion is to connect mental conditions to spiritual problems terming them ‘possession by the devil’ or ‘obsession due to evil forces’. Dr Castelino said, ‘Possession is very rare.’ He indicated that the Church seeks psychiatric evaluation before going ahead with the rites of exorcism. The DSM IV (Diagnostic and Statistical Manual of Mental Disorders) had possession syndrome listed in it at one time. He cited the case of a Keralan woman speaking like an Englishman but with an Indian accent. The woman had no knowledge of English.
He further addressed questions regarding healings during religious gatherings, saying, ‘There are genuine healings. I will not deny it. But on the larger scale these are psychosomatic.’ Broaching the topic of homosexuality, which was once categorised as a mental problem in the DSM but is now excluded, he said, ‘Homosexuals need understanding, not condemnation.’
A holistic approach is the only way to assure control or cure of a mental illness. Using the example of alcoholism, which needs a combination of medication, to wean the patient off alcohol and subdue withdrawal symptoms, and psychotherapy and prayer, to sustain the desire to resist the lure of the bottle.
Psychotherapy and medication are dispensed to a patient after an assessment has been made. In some cases, ECT (electroconvulsive therapy) is given under anaesthesia. This is especially recommended in the case of pregnant women because medication can affect the unborn child.
‘Early prevention will prevent later disability,’ said Dr Castelino. Life skills can avert debilitating circumstances and aid people suffering from mental problems. Communication, for one, is sorely essential. For example, there should be open communication between parents and adolescents. Dictatorial restrictions will only lead to negative behaviour because, ‘Growth takes place through experiential learning,’ said Dr Castelino. Acceptance, forgiveness, a positive attitude, self-knowledge and empathy all come into play to empower a mentally ill person. It is essential to listen without judgement and not offer unwanted advice.
The seminar drove away any false notions connected with mental illness and opened avenues for sufferers to ask and receive help without experiencing the weight of shame.