“The lover, lunatic and the poet are all of imagination compact,” remarked the Bard, perhaps signalling that all of them have intense emotional experiences, which we all do have. The term lunatic, inappropriate in all times, is invalid now, and mental illness is the description that has replaced it.
Mental illness is not just about emotions and their intensity or lack of it, it is an umbrella under which many maladies are contained. Even for this googling generation, almost all mental illnesses are conveniently or comfortably labelled as depression. Depression is just one of the many mental illnesses that affect humans.
Depression, though a very commonly used and rather misused term (as many use it to term degenerative brain pathology, technically called dementia to simple difficulties in social functioning, as in personality disorders), is not just one type. We have all experienced losses and failures and felt low, sad and even, at times, despondent because of those events. This is called secondary depression. It is a reaction to an unpleasant event in life. Generally, this would pass in time and we would get back to our social and functional adequacy. And then, there is another one called Major or Primary Depression.
Major Depression is not event-related. It can strike anyone any time, as it is a disorder of neurochemical transmission. Though there are some factors like hypothyroidism, diabetes, certain medications, and some genetic factors that can predispose one to a Major Depressive Disorder, it is essentially a biochemical disturbance that can only be treated with medication. In the currently raging fad that makes people shrug at the very mention of a prescription, MDD is a ripe field for quacks and fakes to swindle people and waste their time in getting early and proper treatment. On this, we shall see later.
What happens when MDD strikes? The person loses sleep to begin with, and gradually loses interest in all that he was involved passionately earlier. It mars his concentration, reduces his functional competency, makes him see the world as dark, pushes him into a self-withdrawal, refuses him to take care of himself, and this ‘darkness visible’ can, at times, push him into a suicidal rumination and attempt. Depression can be considered as a serious emergency because of its potential life-taking possibility.
MDD apart, mood disregulation can also manifest as a bipolar disorder in which a person alternatively exhibits severe depressive sadness and switches imperceptibly into a ‘manic’ phase that is marked by incongruent elation and disturbing exuberance. This shifting mood makes not just the person unpredictable but also his relationships vulnerable. This again is a major mental illness and can be treated only with medication.
Mood apart, thought is what makes a man function—personally and socially. A severe form of thought disorder in which even perceptions get disarrayed is called schizophrenia. This is a very severe mental illness and it affects all social classes, both sexes, beyond religious and national boundaries in the age group 15 to 45. Unless detected and treated early, schizophrenia can devastate an individual’s life. This again is a neurochemical dysfunction coupled perhaps with genetic transmission. This is one mental illness that is most researched and even now is the focus of scientific psychiatric investigation. Medication alone can handle this malady.
Schizophrenia is characterised by, again, loss of sleep and withdrawal in the beginning. But as time passes, the individual loses focus in almost everything and is seen going further into himself. Though the affected alone can hear voices talking to him, threatening him and commenting on him, the outsider can still identify this symptom of ‘voices’. The patient would start muttering, not like what we all do when stressed or rehearsing for a stressful event, but muttering and alternatively appearing to listen as though he is in a conversation with a non-existent being.
Besides hearing voices and responding to them orally or, at times, by acting out the ‘received' commands, schizophrenia is also characterised by delusions. These false beliefs are not induced as in the religious charlatans ‘money making mockery of the public'. These delusions are baseless convictions in which even an innocent child can appear as a sinister evil conspiring and planning to harm the patient. These paranoid delusions are very common in schizophrenia. Again, it has to be reiterated that only medication can help these suffering individuals, because of the increasing popularity of the stylish fad of wondering whether counselling alone would not suffice as therapy. You cannot counsel a schizophrenic patient, because he does not have insight—the reasoning of reality that makes him accept that he is sick. His hallucinatory voices and delusional convictions are unshaken in any conversation that tries logical reasoning. Unless the neurochemical balance is corrected, he will not listen, and, therefore, not understand.
Another important and common psychiatric illness is Obsessive Compulsive Disorder. Unlike in schizophrenia, here the affected person is aware of his problems but absolutely incapable of doing anything to come out of it. OCD is again not a rare illness. It can be seen even in literary descriptions, like Lady Macbeth lamenting on the inadequacy of all the perfumes of Arabia to wash her stain. OCD is characterised by repetitive actions done consciously but without voluntary control. Unless an act is done a specific number of times the individual becomes stressed and distressed very much. There are two types of OCD symptoms—one is repetitive cleaning and the other repetitive checking. Variants of these two would be repetitive acts that may be guffawed away as quirks or habits. We check because we are scared, we clean because something is dirty. Fear and shame are the underlying emotional disturbances in OCD. Regarding OCD, medication is certainly the first line of treatment. But since the individual can listen to sense and comply with therapeutic instructions, some behavioural modification techniques, when taught alongside the prescription, would help in recovery.
Now to come to minor mental illnesses, one can see the entire human emotional and social spectrum. From simple anxiety which we all experience and conveniently describe as non-existent butterflies in the stomach, to severe panic in which we cannot get into a lift or even close the toilet door when we have to use the restroom, there are a wide range of problems. Most of them are self-remitting, that is, short-lived and event-related. Some, like phobia, persist and do not go away even with total insight and high-level intellectual capability.
Dependency on drugs or people can also be a psychiatric problem to be addressed. Addiction is another area of mental illness. Besides these, mental retardation, dementia, personality disorders, relationship problems, learning difficulties and many more come under the group called psychiatric illnesses. Even the problem encountered by many doctors who are frustrated explaining to their patient that there is no physical problem, but find them coming again and again—what was once called hypochondriasis—is a psychiatric illness.
A once popular word, hysteria, another misnomer still in usage, is also a mental illness. Hysteria was named thus as the Greeks believed that the uterus of the woman was moving all over her inside and making her do bizarre things. This is now described under two types. One is 'conversion', where one converts a psychological problem into a physical one. A common example would be having a headache when one is angry and unwilling to go to bed with their partner. The other is 'dissociation’ where the individual dis-associates from reality to escape stress or seek attention. This is commonly manifested in our country as ‘possession’ by a god or an evil spirit, according to their cultural milieu. Here, the individual, though initially behaves involuntarily, at some point enjoys the attention he or she gets and goes on to exhibit the behaviour as and when time permits and need arises.
This is a very brief outline of mental illnesses. This may not help you to understand them all. But to identify any mental illness, look out for
1) sleep disturbance
2) lack of focus in work, conversation and self-care
3) unusual and inappropriate speech or behaviour even if it is only for a brief period
4)emotional imbalance of inappropriately extreme sadness or elation
5) a gradual decline in occupational, social and interpersonal spheres of life
If you notice these, take the individual to a doctor. Don’t Google and conclude, don’t get swayed by the promises of quacks, don’t ask the opinion of every non-medical person. Mental illness is treatable and, in many cases, curable. Help them get their life back.
Dr Rudhran is psychiatrist, artist, bilingual writer. He is author of 12 books in Tamil on psychiatry, psychology and philosophy and has written and directed 10 plays, including adaptations of Sophocles, Shakespeare and Kafka. He is an ardent campaigner for mental health.