Breaking down the barriers of mental illnesses
Health Page
Although we have learnt much over the past two decades about mental health problems and their treatment, there are still many myths and misunderstandings about mental illness and those who suffer from it. As a result, sufferers experience some degree of social stigmatization and discrimination, while the general public believes that the prospects for recovery are poor. Many people would not want mental health sufferers as their neighbours, while psychiatric patients often have trouble going about their everyday activities. Many of the attitudes and fears about mental illness are, however, unjustified and are based on fears about the mentally ill and their prospects for effective treatment or cure. Many people, for example, believe that mentally ill people are raving maniacs, erratic, unstable, and dangerous. In fact, there are only a few who would cause harm to others. Mental illness is not a simple entity. In its milder, more common forms, it involves emotional conflicts that produce symptoms and thought disturbances that interfere with a full, happy life. The more severe, but less common forms of mental illness - the psychoses - involve substantial changes in mood or personality or major distortions in perception and thought. There is now increased awareness of the many stresses that are likely to increase mental disorders. People in developing countries are particularly likely to be exposed to such stresses, which range from malnutrition and deprivation to poverty and environmental deterioration. Many of the emotional problems of the mentally ill affect mentally healthy people from time to time. It is not unusual for healthy individuals to become depressed occasionally, feel unduly tense or anxious, or overwhelmed by the everyday demands of life. Most such individuals, however, readily overcome these difficulties before long. In someone who is mentally ill, the emotional distress tends to be prolonged or precipitated by factors that others cope easily with. It is generally readily recognisable that a person who has lost touch with reality is mentally ill. However, bizarre behaviour is characteristic of only a small proportion of the mentally ill. The more common symptoms of mental illness may go unnoticed. Withdrawal from every day activities, sleep problems, feelings of utter helplessness or hopelessness, undue pessimism, and a loss of confidence are signs of mental illness that warrant treatment. Some people suffer from a persistent anxiety or fear that may be due to one cause and then to another. In other forms of mental illness, moods or behaviour may undergo a sudden change. Mental illness may also be masked or disguised in ways that make it hard to recognise. An emotionally disturbed person may complain persistently of physical ailments, although no organic cause for these complaints can be found. Some mentally ill people are perfectionists who place unrealistic demands on themselves or on others around them. Still others fall below their potential at school or at work. On the other hand, many people with emotional disorders function well despite their problems; some have even accomplished great work while under the burden of mental illness. There is no question, however, that mental health problems take their toll and reduce much of the joy of life, not only of the victims but often of their families as well. Mental illness is far more common than many people realize. In general, 10 per cent of the population is mentally ill. Mental illness affects children as often as adults. It has been estimated that 5 of the 10 leading causes of illness in the world in the early 1990's were psychiatric in origin, and that depression was the most frequent. Many of the mental illnesses tend to run a chronic or recurrent course. Although mental disorders contribute little to mortality, they make a significant contribution to the burden of disease in a community. Studies, for example, show that more working days are lost as a result of mental disorders than as a result of physical conditions. In addition, the management of mental disorders consumes a great deal of health care resources. This indicates that the economic cost of psychiatric disorders is quite high. The identification and treatment of mental disorders, therefore, not only reduces individual misery, but improves the work capacity of people and enhances their economic productivity. The major categories of mental disorders encompass the psychoses - including schizophrenia and depression - and the neuroses which include anxiety and phobias. Although the neuroses are less serious than the psychoses, they account for a considerable degree of morbidity due to the large number of people they affect. Unfortunately also, the distribution of mental health problems in the community indicates that serious psychiatric disorders as a whole are more frequent at the lower socio-economic level. The less serious mental health disorders are more evenly distributed among all classes. Most of the studies on mental illnesses in the Caribbean have been hospital-based. Despite these shortcomings, the pattern of occurrence of mental health disorders in the English-speaking Caribbean is similar to that found in North America and Europe. A general practice survey conducted in Barbados in 1977 found that anxiety disorders and depression were seventh and eighth in frequency of presentation of illnesses. Approximately 77 per cent of the patients seen with neuroses were women. The mentally ill need treatment. However, for many people there is a stigma attached to needing help for mental health problems. As a result, professional treatment of these problems is often delayed until they are so severe that extended treatment is required and the chances of cure are greatly diminished. Studies have shown that the outlook for effectively treating a mental disorder is far better when help is sought early. Contrary to a belief that few recover from mental disorders, studies show that about two-thirds of psychiatric patients experience significant signs of recovery, and of these, half will never need treatment again. In some cases, the underlying cause of the problem may not be eliminated, but the symptoms can be brought under enough control to permit the patient to function well in society. Just as physical medicine does not rely on only one method of coping with organic diseases, the treatment of mental illness involves many different approaches. Treatment usually has to be tailored to the disorder in question, since what works best for one type of mental problem may be totally ineffective for another. In addition, therapy also has to be tailored to the individual, since again what works best for one person may not be as effective for another. Among the many modes of therapy available today are traditional psychotherapy, in which patient and therapist exchange ideas aimed at discovering the roots of the problem; behaviour modification, in which patients are taught new patterns of behaviour that help them to overcome emotional obstacles; drug therapy, especially useful in treating depressed or anxious patients, as well as those with more severe psychiatric disorders such as schizophrenia; and group therapy, in which individuals with similar problems discuss them together with a therapist. There have been some important developments in mental health care over the last half-century. These include a more humane approach to patients, and the availability of a broad range of new and effective psychotherapeutic drugs which are being used in the treatment of previously incurable mental disorders. As a result of these advances, hospitalization is usually unnecessary. Most treatment for mental disorders can now be given in an out-patient setting. If hospitalization is required, it is usually only for a short period.
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