It's Time We Spoke Up And Discussed Mental Health, Isn't It?
“If untreated, depression can last for weeks, months and even years, significantly impacting various spheres of the affected individual’s life.”
Dr Samir Parikh, one of Inida's leading psychiatrists, bursts the most common myths surrounding mental health.
CHAITI NARULA catches up with DR SAMIR PARIKH, a leading psychiartist, and understands some basics that are often not spoken about openly in society. We also gain a deeper understanding of how, like any other part of the body, the brain needs attention too
Q. Firstly, what’s the percentage of Indians affected by depression or stress disorders? This would enable us to understand the intensity of the problem at hand.
Depression is one of the most common mental health related illnesses to affect a person and is found in people of all ages including children and adolescents (Kaplan and Saddock, 2007). According to the WHO, depression affects more than 300 million people globally (2018). Specifically, 1 in 20 Indians have been found to be suffering from depression, according to the National Mental Health Survey of India (2016).
Q. How can we to identify if we are depressed or on the brink of a disorder as such? What are the first tell tale signs?
Depression is a condition which involves recurrent and persistent low moods which last for at least two weeks and interfere with the affected individual’s daily life and activities such as going to school and maintaining relationships with friends and family.
Know you have a problem if you are suffering from any of these symptoms and signs of depression:
- Sadness of mood
- Social withdrawal
- Sudden increase or decrease in appetite
- Sleep disturbances
- Less interest in previously enjoyed activities
- Feelings of worthlessness and hopelessness
- Difficulty in attention and concentration
- Difficulty in decision making
- Suicidal ideation
- Frequent and unexplained somatic complaints
Depression is a clearly recognized medical condition, that needs to be taken seriously, and for which professional help is irreplaceable. It is not due to a character weakness or laziness, which can be overcome by will-power, or can pass out over time. Depression requires adequate and timely medical and psychological interventions. Professional help including psychiatric medications and psychological counselling is irreplaceable.
Q. Why is it that seeking professional help is such a taboo in society?
One of the primary obstacles which typically comes in the way of identification and management of mental illnesses is the stigma attached. It is important to consider the historical evolution of mental health, with mental illnesses being attributed to evil spirits as per ancient Greek mythologies, transcending to the relatively late advent of medications being discovered for the treatment of mental illnesses. Stemming from such an evolutionary background, it is inevitable for mental illnesses to be shrouded in stigma and self-blame.
Furthermore, there is a significant deficit in the number of experts available till date, with the recent findings by World Health Organization being indicative of a 200-300% shortage of mental health professionals in India. Another major obstacle that often blocks help seeking behaviour comprises of worries about being misjudged, not being listened to or fearing betrayal, thereby experiencing mistrust and shame. This can be further compounded by the lack of understanding and awareness amongst members of the community. It is primarily due to lack of awareness and information that families and individuals frequently turn a blind eye to potential conditions of mental health related problems and do not seek the required help. They may not know who to go to for help or may be misinformed about the nature of their problem. Often, they may not even be aware that they have a problem and can carry the agonizing pain of feeling responsible for their own suffering, experiencing a lot of guilt and self-blame.
Therefore, open mindedness is essential to fight the roots of such myths, along with increasing a widespread awareness and education about mental health. Talking about one’s distress is undoubtedly a prerequisite to seeking help. It is important to remember not to bottle up one’s feelings inside of us. Instead, we need to be willing to talk it out, vent out our emotions, while at the same time sharing our distress with our near and dear ones. Not only is this process cathartic, but also serves as an agent of encouraging willingness to seeking help.
Q. Men and women who battle depression go through professional challenges and are unable to cope. How would you advise them to go about getting back to normalcy?
A depressed individual typically does experience a disinterest in most activities and going to the workplace daily can become an effortful task. Such a task can become more challenging when amplified by the burden of pending work load, as well as dealing with the questions, expectations as well as unsolicited advice by one’s peers and colleagues! However, at such times it is important for the individual to ease back into work, as much as possible. At the same time, having a strong system of social support at the workplace can be a huge help, including emotional as well as practical support being available. And last but not the least, it is important to destigmatize mental illness, and be willing to talk about it, rather than falling prey to an avoidant approach of looking for an escape route. It is necessary to remind oneself that mental illness is a medical illness, which is not to be associated with any kind of self-blame, and recovery from the same needs to be considered as a process similar to that of a recovery from any other medical illness.
Q. Simply explain how mind/brain can be ill just as any other part of the body.
The overall well-being of an individual encompasses both physical as well as mental health. However, such a concept seems only to be understood theoretically, and gets lost in translation when it needs to be implemented in the real world. For instance, it is more acceptable for one to skip a day’s work if running a temperature, as compared to staying in home when the person is suffering from an anxiety disorder or depression. To quote another example, just as the thyroid levels in the body could be dysregulated leading to a hypo or hyperthyroidism, similarly a dysregulation of the neurotransmitters in the brain like serotonin would lead to the individual to be suffering from an anxiety disorder or depression. Therefore, it is vital for mental illnesses to be equated to, if not supersede physical illnesses, and subsequently their impact on the individual’s functioning as well as the importance of seeking treatment for such mental illnesses needs to be advocated. The causation of mental illnesses cannot be attributed to a single factor, and is typically seen as the result of an interaction of a variety of factors, including an imbalance in the neurochemicals in the brain, along with genetic, psychosocial and environmental factors.
Q. How can modern medicine help? How can one supplement it through cognitive behavioral therapy?
As the biological basis of the illness has been widely established, the role of psychiatric medications is of utmost importance, as they target the regulation of the neurotransmitters in the brain. In addition, psychotherapy, including cognitive behavior therapy and interpersonal therapy, which serve as an adjunct to the treatment, and helps them develop more adaptive coping mechanisms. If untreated, depression can last for weeks, months and even years, significantly impacting various spheres of the affected individual’s life.
Q. How can Indians today speak up more about these issues in their families, with their peers and start talking openly about it? There still seems to be a large level of resistance in speaking up about mental health and well being.
It is only by talking about your own concerns that it is possible to reach out for the support of others. In fact, sharing one’s problems in itself is the first step as it helps the individual realize that he or she is not alone. Therefore, reach out to your family, friends, or peers, and talk to them. It is necessary for all of us to create a sensitized approach within the society in order to ensure greater receptivity as well as understanding of mental health related concerns. We need to be able to offer a listening ear to others and encourage them to reach out for professional help if needed. And lastly, we need to be informed, we need to educate ourselves about these concerns in order to be equipped with the adequate knowledge to identify and guide others.
Q. What can one do if one learns that a near and dear one is battling a mental illness?
We should not hesitate to initiate the conversation with the affected persons, as it is important to give a chance to express their feelings and release their pent-up emotions. It is a myth that talking about the problem aggravates the situation. In fact, giving them a chance to vent out their feelings and emotions is more likely to help the person lighten the burden by being able to share it with someone who is concerned. In fact, if you are able to engage in a conversation about the person’s feelings, you can help the person in coping with the situation by taking a solution-oriented approach and reaching out to the existing support mechanisms. Give the person a chance to express him/herself. Convey your genuine concern and support. Giving reassurance with active listening and engaging with the person is very beneficial. Try and empathize with the individual, to try and understand his or her emotions. Show that you care for the person, and do not interrogate or form judgements. The most effective role you can play is to be a listener and offering your support. Besides being a source of support as a friend, family or a colleague, it would be beneficial if you could help the individual to reach out to the help of a professional mental health expert for adequate interventions.
Q. What could be the repercussions of mental disorders if left unaddressed?
Ignorance of mental health related issues could lead an adverse impact across various levels, including harm to self as well as others, while also reducing the life span of individuals. In fact, if left untreated over a prolonged period of time, there are greater chances of the individual feeling more helpless and hopeless and might also lead to suicidal tendencies. Furthermore, the consequences of undiagnosed or untreated mental disorders could be severe, influencing the physical, social functioning as well as overall health outcomes. Mental and behavioural problems are clearly recognized risk factors for morbidity and mortality.
Q. What are the factors today that create stress and anxiety syndrome in patients and if left unaddressed what could be the physiological manifestation of it?
Stress is such an inherent part and parcel of the air we breathe. Today’s hectic lifestyle, with the competitive race against time, excessive dependence on technology and the media, along with the consequent social isolation and its impact on the sense of self, are ample to lay the foundation for a stressful life. It is next to impossible to imagine a stress-free life for almost anyone today. There are many daily events that create stress, including a traffic jam, balancing between work and home, or having to get up early in the morning, amongst many others. In addition, the interplay of various personal, social, economic, professional, emotional and environmental factors, while managing our multiple roles, contribute to increasing the stress in our daily lives.
Chronic stress, if not managed effectively, can in the long run have major detrimental impacts on the person’s physical as well as psychological well-being, as it could increase their vulnerability to not just mental illnesses like depression or anxiety, but also physical health. To name a few, stress leads to increased risk of heart disease, high blood pressure, menstrual problems, acne and other skin problems, headaches and body aches, indigestion, eating disorders, ulcers, as well as sexual dysfunctions.
Q. What about children? Walk us through mental illness in kids and the way forward in tackling them.
There is abundant stigma associated with mental illnesses till date, stemming from which are some myths, especially for children. First and foremost, it is important to reiterate that children CAN have mental illnesses. There are many psychiatric disorders which can have an early onset in childhood. In fact, the developmental disorders are not necessarily a label for the individual life long, and most of the times can be overcome with adequate and timely identification and interventions. Secondly, children with mental illnesses CANNOT outgrow them with age. A mental condition in childhood would not simply ‘outgrow’ with age. These are disorders that requires adequate psychiatric as well as psychological interventions to be treated. Thirdly, mental illnesses are NOT the result of bad parenting. While stressful situations do play a major role in the exacerbation as well as maintenance of mental illnesses, stress alone cannot lead to the development of the illness without the presence of other etiological factors. Most of the psychiatric disorders are formed due to multiple interactions of biological, psychosocial and genetic factors.
The need of the hour today is to strongly advocate the preventive as well as curative aspects of mental health. The best model to build is an integration of private-public partnerships, so we all could join forces to work towards targeting the very grass-root levels and help make a difference in the community at large. Intervention and prevention at an early stage can help transform at-risk children into healthy and contributing adults of society. Emphasizing the role of mental health is imperative in ensuring social and emotional well-being and is crucial in the development of adequate coping resources that would help the child learnt to be prepared for and be able to effectively face the challenges of life. We must understand the importance of ensuring the mental health and well-being of children by learning to identify and deal with situations in which the child’s mental health has been compromised as well as working on preventive measures to promote positive mental health.
Q. A few success stories where patients have overcome these disorders being in the hands of a correct doctor. How should one even identify the right doctor?
It is not as important to identify the right doctor, as necessary it is for an individual to be able to reach out to a professional expert. The challenge here is to address the deficit in the availability of such professionals, given the huge gap which exists in the need of such professional experts. It is the need of the hour to ensure a greater accessibility of any such mental health expert, be it a psychiatrist, a psychotherapist, a counsellor, or even a psycho-social worker.
Q. Headaches, migraines, fatigue, feeling of disorientation have become too common. How would you explain this in relationship with untreated mental / stress/ anxiety conditions?
As mentioned above, mental and physical health of an individual are closely interrelated, and chronic stress, if not managed effectively, can in the long run have major detrimental impact on the person’s physical as well as psychological well-being, increasing the individual’s vulnerability to both mental and physical illnesses. Further, such psychological symptoms like stress, anxiety and depression may also be manifested in the form of somatic manifestations, including headaches and body aches, tiredness and fatigue, indigestion, lack of attention and concentration, indecisiveness, along with an increased risk of heart disease, high blood pressure, menstrual problems, acne and other skin problems, amongst others.
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