As I said in my reply to Ajeesh (CBT and Guardian article, post), I really admire the way he quickly compares the physical and psychological worlds with ease and vivid clarity. Impressive considering that you have no medical background. I agree with the observation that changing maladaptive thinking / feeling / behavior is like altering blood sugar levels / temperature etc for better health. I wish to draw your attention to an earlier post in which I have diuscussed illness and a person's attitudes to it. (07/20 to 07/27 and 07/27 to 08/03 - Health an enigma, Dimensions of health, Certain terms etc).
All is well as long as I (the patient) agrees with the opinion of the medical expert and consent to their procedures. But problems start to creep up when the medical opinion and the individual's choice start diverging. Remember the hue and cry raised when parents from ''Witnesses of Jehovah" refused permission for blood transfusion to their children. Such situation emerge rather infrequently in the practice of physical branches of medicine.
But for psychiatry which deals with intanginle aspect of the self like thoughts, feelings, emotions etc, such problems occur frequently. Similar is the issue when one is treating persons belonging to different cultures. Even though we tend to think that Kerala has a uniform culture, I often feel confused when I have to treat tribals from Wayanad or Attappady. Their concepts of normality, abnormal behavior, or even what a person ought to do with his life, are different from those held by majority of Keralites.
This is the reason why I am slightly uncomfortable when we apply the yardstick of the physical branches of medicine to psychiatry.I would like to know the valuable opinion of my readers on these issues.
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2 weeks ago
6 comments:
hi, it is a dilemma in the true sense. I am inclined to think human beings who take themselves too seriously are the ones that land up in psychiatric rooms. Except for the truly organic maladies, i am yet to hear of a person with a well developed sense of humour,, who can laugh at himself or herself, being mentally illexcept transiently following severe stress etc. Our society is a little lacking in the finer sensibilities, and a stress on development of humanities as well as the sciences in equal measure in childhood and adolescence may help to grow a generation who can handle presuures without mentally caving in. The role of a skeptical outlook is often underestimated. It helps a person to fell in control of himself, more anchored to a certain world view, which helps him withstand the vicissitudes of life better. I think a stress on the humanities and the development of the finer sensibilities, promoting a sense of humour, inculcating a skeptical world view, all from early childhood, will help reduce a lot of mental illnesses in the future. What we are doing now is basically a bandaid activity, and it doesnt really matter what we covered it with, as long as the bleeding is stopped ! I think the above principles may be useful in all societies and cultures. I am not saying mental stress will diminish, but it will help people cope better with the stress. Not being a psychiatrist, i may be mistaken, so you will excuse if there are any fundamental mistakes in my opinions. Thank you
Treating* a person without his permission is a question we face here. Mental or physical, the question is valid in both cases (The word treatment includes ‘changing a person’s subjective world’). Right?
A person with severe mental disorders may deny that he is unhealthy. He may live happy and may not like someone to change his current state of being. As you said he will not agree with the medical expert, medical opinion and the individual’s choice start diverging. It looks very simple at this level. We do not have the right to change his subjective world (it seems so). Who got the right to destroy a person's happiness and comfortable life?
Suppose one day this person tells his family that he got some revelation and if he dies soon he will be in heaven. He may kill himself any time and may also kill others of his false belief. Now it will become clear that the family have all the right or social responsibility to forcefully alter his belief (change his subjective world).
People who live in forests may not accept that they are unhealthy though they have diabetes or hypertension while laboratory – physical checkups confirm it. They may resist any attempt for treatment. I think we have to force them to treat, as far as we can go, to save their life. Some special religious groups do not treat diseases, they think that it is against the act of god. Imagine how dangerous it is when a person with this belief has STDs or a disease that is spreading so fast.
I do not know much about infant psychology. But many times I have observed that they get irritated while we put clothes on them. They may not behave so if they know the social rules. We force them, we teach them to behave like us. That is also happening in the case of mild mental health problems. Society forces us to be in a particular way. It constructs reality, punish who go sideways.
The concept of normal, abnormal, health, good, bad etc… are different in different cultures, communities, places and countries. But a man who brushes his teeth 200 times a day may be abnormal in any place. Someone can argue that brushing teeth 5 to 15 times is healthier. In the later case we have some difficulty in deciding the abnormality, we may leave the final decision to him. But we have no doubt in the first case.
One more thing to say is that disease/disorders are often determined by professionals or experts, whatever may be the patient’s findings. The health of a bridge is determined by an engineer not by a politician. So is a person with mental health problems are determined by a psychiatrist/psychologist. It is better a professional decides to do what. Change a person’s subjective world if your professional knowledge recommends it, that is my opinion.
I will look at other blog pages you have written. I thought I need to clarify me a bit. So I wrote this.
Don’t hesitate to correct me if I am wrong, I like it very much.
Thank you.
hi, what ajeesh says is somethiug that is rooted in robust common sense. We should consider ourselves as problem-solvers, in fact that is the service society expects of us. A doctor is not expected, nor should he delude himself into thinking his interactions with patients as the appropriate platform for the exercise of his philosophical or intellectual proclivities. The desire to be painfully ' politically ' correct is not a luxury the health provider should subscribe to. He is expected to direct the patient away from activlties that make his life or that of society miserable. By the way, a person approaches a prychiatrist because he is not happy with his life, and that implies a silent request to change his circumstance. Now why on earth should a qualified person have any qualms in doing so irrespective of whether he is an adivasi or a milionare ? Thank you
I liked the way Ajeesh and Sashikumar have argued their points. We can treat a person -millioanire or tribal - based on 'scientific knowledge'. But situations occur when we decide what is abnormal without understabding their culture, value systems. A psychotic who poses danger to himself or the society has to be treated. There are laws which empower the psychiatrist to do this. Similar is the situation when a person with contagious disease is roaming in the community with the risk of spreading the disease. But difficulty arises in labelling some symptoms - certain beliefs which are not in keeping with our concepts, mild degree of abnormalities in using language as pathological. These are situations that call for extra caution. Otherwise I am happy to go by the viewws expressed by both Ajeesh and Sashikumar. Thanks.
hi acttally, harish, you have not disagreed with me at all ! We are not in the business of labelling people as ill or not, we are brought to the decisiom making rtage only when a person approaches us with what he percieves as a difficulty, or his family feels so.or the society thinks so. I would like to knnw, in our society, the correlation that ynu have noticed in your practice betwen econmic poverty, religious belief, and educational status, aod the frequency of mental ilness, if there is any. I am oot talking about the genetically implicated maladhes, where these variables probably have little impact. If you have any statistics handy. That would give a pointer. Thank you for taking all this trouble..
Hi Sashi, Thank you. There is evidence showing that severe illnesses like schizophrenia is more common in the lower socio economic strata of the society. However the explanations for this is not very straight forward. The drift hypothesis says that this apparent phenomenon is caused by people with mental illnesses drifting down the social ladder as a result of illness. There are also theories with opposite arguements. I shall write in a little more detail in another blog. But there is no relation with culture, religion or education.
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