Malayalees glitter in the psychiatric ramp

Malayalees glitter in the psychiatric ramp

-         A study done on psychiatric patients with special reference to Govt. Mental Hospital, Trivandrum.

“Entha Sughamano?” (How are you?) – a very common pleasantry thrown at an acquaintance and the usual reply would be “Yeah, I am fine” and this fineness reflects only his physical health or physical well-being alone. On the contrary, a mentally tensed or disturbed person seldom shares his mental agonies to anyone, not even to close relatives or friends, and confines them all to himself. For a hypocritical Malayalee, perhaps it would be too embarrassing to reveal ones mental situations and to have lengthy discussions over it.

A person’s total health has been defined as a positive sense of well-being in physical, mental and social lives and not merely an absence of any illness. Mental health, thus, is an integral component of total health and so mental health is not merely an absence of mental illness. It is a balance between all aspects of life, like emotional, economical, spiritual as well as physical stature, which shows how one feels and thinks about him, others and how he faces life's various situations effectively.

Mental health problems affect people of all age groups. Various studies confirm that 5.8% of Kerala’s population is mentally ill against a national average of 2% (Report of CAG, 2011). And 20% of physically ill have mental disorders. One in ten persons in Kerala has mental disorders. One among four persons experiences mental disorders at least once in their life time. One in four families has mental disorders. In 2009 Kerala also recorded the fourth highest suicide rate in India, two and a half times the national average. This is quite an alarming statistics glaringly reflecting as social apathies we see daily in news media and around us.

What is wrong with Malayalees? The state enjoys a strategically advantageous location in the Indian mainland and socially and intellectually benefitted by whole-heartedly accepting global cultures, right from very old times. Never the state was affected by any major natural calamities sans few occasional monsoon furies and droughts. Generally, the population enjoys better living conditions compared to their counterparts in Bihar, UP or Arunachal. It enjoys one of the highest literacy rates, country’s best health and education facilities, lowest infant mortality, highest mobile phone penetration, highest per capita newspaper / TV channel readership / viewership, highest awareness on technology and most adaptable to new cultures. All positive elements which are conducive for a welfare state and are often compared with many European countries. Yet, why do we have greater incidence of mental disorders?

Convergence of the Kerala’s family structure to a nuclear entity blended with some very unique social behavioural patterns had resulted in this untoward situation. Take the case of Prakash (name changed) who was a government servant. He had a bubbling family with wife and two children. Though Prakash had all basic comforts like a happy family, own house, a government job, nil liabilities and no direct dependents, he always used to awe at the glamour and glitter of the super-rich. It was during early two thousand, he was enticed to try his bet in the booming real estate industry. Live examples of those who had made millions out of nothing have made him enthralled. Though his wife and close relatives were reluctant, he decided to make a foray into the not so familiar industry for him. The initial investment was made by selling a property of his wife. In the next few years Prakash was successful for some years in making some money which he started re-investing in new projects. He took long leave from his employment to meet the demanded pace of his flourishing business. Next few years found him to be highly flamboyant and spending on luxuries like imported cars, flashy home interiors and large scale benevolence and charity aimed at personal popularity. But one sneaky property deal pulled him into a long and complicated legal tangle where the chunk of his entire life’s fortune was indebted. As time passed, all his wealthy possessions got syphoned away owing to non-payment of loans and debts. Prakash, who had already lost his job for unauthorised absence for a long period, was at a most distressing situation in his life, having lost all his possessions and wealth. They shifted to a small rented house and children were sought admission in a nearby government school. Wife started working in a tailoring shop as a helper and they re-started all again right from the scratch. But Prakash was not the same old person. He slowly started to make retreats from social and family functions. Even within his family he uttered only a few words. Most of the time, he would sit silently in a corner, gazing at the wall. Long days of reclusive life made him totally indifferent. His remorse behaviour was not identified first. Since that did not create any problems within the family, his wife also left it as such. But eventually his condition started worsening with occasional cries and total withdrawal to himself. Their close relatives who have already severed relations with them were not available for any help or advice. As suggested by their neighbours, his wife decided to meet a god-man, who has gained some popularity in the locality. The God-man advised them to do some rituals and certain offerings and demanded a hefty amount as charges. Series of visits to the god-man and spending whatever they were left with, did not yield any positive results. Rather, the condition of Prakash was getting worse.

One day they were visited by a group of psychiatric workers, as part of their community field work. On observing Prakash and listening to his wife, they asked her to bring him to the mental hospital. After a thorough consultation with Prakash at the hospital, the doctors confirmed that Prakash is mentally ill but expressed relief that the timely medical intervention may help him to recover from it fast.

Dr.Kiran, Psychiatrist at Mental Hospital, Trivandrum urged about the need of timely medical intervention in the case of mentally ill persons. He explained that commands for all human physical movements are generated at the frontal lobes of the brain. Neuron is the basic unit of the nervous system, but they do not directly touch each other. Neuro signals are transmitted through neuro transmitters between neurons to the respective organs. There exist a tiny gap in between any two neurons and a chemical called Serotonin helps the electrical signals to pass through two neurons easily. The presence of Serotonin helps to maintain an easy and uninterrupted signal flow throughout the entire nervous system. During prolonged sadness or sorrow the level of Serotonin dips, leading to poor neuro signals and causes depression. Generally, the mood of depression can easily be overcome, but in some cases like of Prakash, it may prolong and if not treated timely, it may lead to severe mental disorders. The doctor said that prolonged non-treatment of depression may lead to degeneration of neuro cells and treatment in advanced stages may not yield desirable results, why he urges for early consultation and medication. It is here shock treatment is found to be most effective.

Scenes of shock treatment and related bawls have always been a favourite subject for film makers all the time. Dr. Kiran busted all the ill popular myths related to it. Contrary to popular beliefs and poor portrayal in feature films, shock treatments are never administered on maniac patients with violent behaviour. On the contrary, shock is highly advisable to patients with prolonged depression since the electric current helps to ease the electrical signal flow at neuro junctions. Electric current in very low voltage is passed for a fraction of a second while the patient shall be held by the attendants and they are not strapped nor nothing is clogged between their teeth to avoid biting, as generally featured in films. Films have helped only to reinstate the social stigma on shock treatment and have done enough damage to this effective remedy. And as usually portrayed in films, maniac and patients with violent behaviour are never administered to shock treatment.

Mania is the totally opposite condition of depression, which is distinguished by violent behaviour. Generally manias are two - Irritable mania characterised by loud cries and yells and Euphoric mania characterised by loud laughter and ecstasy. Some maniacs would not be easily identifiable in public and some of them would indulge in heavy investment in businesses and take unwanted risks. In real life we come face to face with live examples of maniacs and those affected with mental disorders. Illustrious writers like Vaikkom Mohammed Basheer and Madhavi Kutty were hypo-maniacs. Abraham Lincoln was infamous for his prolonged mental depression. Celebrated painter Winston Vangogh was treated for Schizophrenia which was characterised by self-mutilating, also called as Vangogh Syndrome. Earnest Hemingway was suffering from Bipolar disorder. Virginia Wolf was suffering from prolonged depression. Many of our past and living popular political leaders and administrators do have mental disorders at various levels and are rarely treated.

It is quite noticeable that Malayalees consult doctors even for mild illnesses and ailments but never ever consult a psychiatrist for their mental problems, says Dr. Kiran. He is heading a team of experts of the District Mental Health Program (DMHP) at Mental Hospital, Trivandrum. DMHP is a part of the National Mental Health Program (NMHP), aimed at conducting surveys on mental health and extending mental counselling and assistance to all the needy. DMHP activities includes seminars & presentations at schools and colleges, community mental health check-up and campaigns on mental health awareness through street plays and literature. During such a session at a city college, on a question asked to the mass of about two hundred students, only four has consulted an expert for their mental stress, though almost all of them had undergone some sort of mental pressures and disturbances in their lives. This shows an element of social stigma still prevails with the psychiatric consultation and the reason why psychiatric doctors are located remotely even in star studded hospitals.

Dr. Arun, consultant psychiatrist with Govt. Mental Hospital, Trivandrum says that social stigma towards mental treatment is more among the affluent. On the contrary, the lowest of the social order has the most cases of serious mental disorders. But the related social stigma is coming down now, which is evident from more cases in the last few years, even from parts of Tamilnadu. He too stressed on timely medical intervention even for commonly seen symptoms of mental disorders. Daily number of out-patients who visit Govt. Hospital, Trivandrum is around 150 while another 100 would be consulting other government hospitals. When private hospitals are also included, per day O.P consultation would come around 800 to 1000, which is quite shocking.

Some of the common symptoms of mental illnesses are anger, sleeplessness, lack of appetite, weight loss, lack of energy and enthusiasm, lack of attention and memory, fatigue, frustration, loss of confidence, pessimism, anxiety, suicidal tendency (suicidal thoughts are common and treatment is not needed), murder tendency, obsessive compulsive disorder, delusions about social conspiracy, talking or laughing alone, hallucination (seeing & hearing objects not there), sudden retreat from society, too anxious about physical health (doctor shopping – about 80% of regulars in hospitals), personifying the spirit of the deceased (minor illness which is an outcome of guilt feeling) etc. Females between 15 to 40 are more prone to mental disorders and may result in paralysis, multiple personality disorder, dementia and delirium. When any of the above symptoms prevails for a longer period, it is always advisable to consult a psychiatrist. The appropriate time for a psychiatric consultation would be when one feels himself difficulty or when others feel difficulty to cope up with the person.

The government hospital at Trivandrum is fully equipped to treat any many mental disorders with all state of the art treatment facilities.

Dr. Arun says sensitive minds are more prone to mental illnesses. Today’s children are highly sensitive, who are never been given opportunity to learn life skills at any level and are not at all experienced with real life hassles and hardships. Nuclear family structure, high career and money orientation and lack of emotional support lead to attention disorder amongst children, which is a common mental disorder in Kerala. Other mental disorders commonly seen in our children are conduct disorder and mental retardation. He further added that Kerala has its own unique propositions as far as mental illnesses are concerned.

Married people are generally more mentally healthy world over but in Kerala it is just reverse. Statistics say that suicide rate is more after marriage in Kerala. This is a disturbing trend which means family life is more stressful and need to be deeply examined, he says. Expecting more from the assigned roles of the spouse is one of the reasons for marital pressure which leads to mental trauma. Love, affection and care are demanded rather than being flown out on its own. Timely counselling would help to ease the relations in most of the marital issues, opines Dr.Kiran. In love marriages especially, an element of suspicion always looms since each one expects the other may repeat the practice. In campus love relationships, the youth approaches love as an investment and expects multiple returns and ultimately been dragged into distress. Sorrow in a love relation is an impurity where pure love does not emanate any sorrow feeling.

Return of discharged patients poses a major difficulty in treatments.  Discharged patients will not take medicines at home. Dwindling family sizes and poor financial status may not be conducive for a smooth mental resurrection. Sometimes the patients may not accept the presence of illness and may discontinue medication. Lack of family support and other pertinent issues may draw back the discharged patients, mostly in worse conditions. Some mental illnesses may not recur like some diseases like chicken pox. But some recur and some other prolong. And rarely some will be life-long due to lack of timely medical intervention. Vakkachan (name changed) was admitted about six months ago and appeared to be normal in behaviour. He curiously asked whether he could be helped to go outside. On further exploring it was revealed that his share in his ancestral property is being snatched by his siblings and nobody wants him to be mentally normal anymore and back to their family. He was discharged earlier also but returned in a worse condition, as triggered by familial feuds. Many relatives used to desert their mentally ill family members during festival seasons and marriage ceremonies to avoid social embarrassments.

Trivandrum Govt Mental Hospital has about 200 deserted patients, mostly north Indians. Some are deserted by their relatives while moving in trains and they would step down at Trivandrum, being the last railway station. Some of them are tribals speaking unknown language and are illiterate. In the past many are traced and returned to their distant villages accompanied by doctor.

One of the commonly found mental disorders in Kerala is Delusion which usually starts from a small suspicion. Over a period, the element of suspicion grows into an abnormal epic where the subject sees all possible connections in the inter-personal relationships, which keep on justify his delusion. Geetha (name changed) was admitted recently with an abnormal stage of high delusion. When she reached the stage of menopause she perceived that she could no longer be sexually active and that handicap sparked to a state of delusion that her husband would start to have extra-marital affairs. Relationships with relatives and neighbours were severed. The situation became worse when the daily domestic fights started to become violent. Now she is undergoing medication.

Kerala physical health fast deteriorating contributing more to mental ill health. Other disturbing factors like alcoholism and inducement of drugs hastens the pace towards mental ill health. Alcoholism has to be understood more as a psychological disorder, where the sensitive minds embrace the goblets to avoid facing life’s issues. Education and better social life helps to prevent mental illnesses.

The Mental hospital at Trivandrum was started in 1867 by the then Maharaja Ayillyam Thirunal Rama Varma. It would be a notable contradiction that one of his predecessors Maharaja Swathy Thirunal has undergone severe mental pressure under the British reign which led to his poor physical ill health and an untimely death, says Mr.Prathap Kizhakkemadom, a noted historian. During the early times, the hospital premises include wards of leprosy and TB patients. But later, the latter two were shifted to other locations. Patients were often chained and put in cells and treated by Ayurvedic experts. No lights were provided and the entire hospital precincts shall come under stark darkness after sunset. The treatments used to be crude and inhuman even till 1980s. Up to 110 patients used to be put in a single ward.

All these are part of history now. Now only 20 patients are allowed in a single ward and maximum capacity of the hospital is 450. Unlike the prevailing odds, all medicines are given to patients totally free during the course of treatment and medicines shall be given for one more month for free after discharge. Food is prepared in the kitchen as per the detailed menu under the watchful eyes of supervisors. Each dish is tasted before it is served to ensure quality and hygiene. Cleanliness is strictly practised. One bystander is allowed per patient to whom the food and facilities are given totally free. Mental Hospital at Trivandrum is a role model now which has been recognised even by WHO. The latest development in the mental health sphere is spreading the access of DMHP, by bringing the Public Health Centres (PHCs) also in the network, where PHC doctors are given training in mental health. DMHC works as monitors and offers all help to PHCs.

Though the present day Malayalee has all the basic comforts in life, much better than his counter parts in other parts of the country, he is “comfortably unhappy”. The hypocritical Malayalee’s entire life is dedicated to the aspirations dictated by the society and he often masks his inherent stimuli and basic persona. The expensive front elevation of houses built by Malayalees itself speaks volumes about the changing social psyche. The highly stressful life, social comparison and the competitive world have become the right mix which fuels the mental pressure of an ordinary Malayalee.

The psycho-social climate of Kerala witnesses a dramatic change over the past decade, owing much to the above mentioned right mix. The most prevalent mental illnesses in Kerala, known as common mental disorders (CMD), are mood disorders, psychotic illnesses and dementia. Mental illnesses are generally stigmatized in Kerala due to poor understanding of CMDs.

Psychologists advise everyone to be active in hobbies or if one does not have one, try to find one. Life has to be meaningfully and lived fully to one’s satisfaction. An occasional travel to faraway places would transform one to a better personality. One may find happiness in sharing, values and relationships. It is healthy to have a close friend with whom all personal tensions and problems can be shared. But adequate caution may be taken to identify such a close friend and making him confidant. But nowadays happiness is derived from grabbing the most expensive electronic gadget or automobile. Unknowingly the shift in happiness gives wrong signals to the next generation. Now children only see transactions and no relationships. They could not be blamed when they reciprocate this in future. Much damage has already been done. Yoga is highly recommended as a preventive measure. Minor problems may not affect a yogi. Yoga elevates one from earthly issues and big problems for some but not at all for a Yogi. Though life’s ultimate objective is freedom, Malayalees are struggling under constant pressures.

So when next time you are asked by your close friend “Entha sukhamano?”, do not hesitate to unleash your mental pressures and emotions. Because sharing is relieving.