Diseases are a great drain on the resources of the community. It was usual for physical disorders to get more attention as the disability caused by them is easily visible. The burden on the community was measured by the ability of the disease to produce death, that is based on mortality caused by the disease. A disease causing higher chance of death was presumed to cause higher burden on the community. in the early years of 20th century, most attention was devoted to communicable diseases as they were the biggest threats to man. After communicable diseases were showing some decline, degenerative or so called life style diseases emerged as major burden. Still attention was focused on cancer, heart disease etc, mental illnesses where no where in the picture. Mental diseases seldom lead directly to death. Hence the disability caused by them was not visible and not measurable. It was assumed that they are not a major drain on the community. Recently international organizations like UNDP, WHO etc have shifted their emphasis from mortality to morbidity (the state of being affected with disease and living with it) as the measure of a disease's ability to become a burden to the community. The new yard stick they use is not the ability to produce death. Death actually eliminates the sufferer from the community. But diseases which impair the productivity of a person, make him live in the community after losing his ability to contribute to the community (by working), cause more burden in the long run. The statistic used to measure this is called Disability Adjusted Life Years (DALY). This is the number of years a person afflicted with a disease has to live in the community. Diseases with higher DALY are more disabling. After this change in emphasis from mortality to morbidity and DALY, mental disorders have become the major burden on the community.This is reflected in the Global Burden of disease (GBD) report of the United Nations Development Program (UNDP). Major depression has become fourth among the ten diseases causing maximum GBD. It is projected to rise to second place by 2020 (Looks like UNDP folks have also fallen to the fancy of 2020 !). This means mental illness will overtake hypertension, diabetes etc. If other psychiatric disorders like schizophrenia, bipolar disorder, substance abuse etc are added the situation is very bleak indeed.
It is true that dominant social environment shapes our values and attitudes to issues. I think this supports the post modernist view that there is no absolute reality 'out there' and each one's reality is shaped by his culture / social conditioning etc. The taste of chillies is universally unpleasant to all animals; but it is possible for us to enjoy this taste !. This is an example of how social conditioning can change biological process. Jhansi Rani and her contemporaries saw nothing out of the way in marrying her off at such a young age. Slavery was considered as a normal thing for centuries, even by great social and religious reformers. In the present social cultural context, it is not fair to touch another person in a sexual manner without consent. Law has even fixed legal age limits for giving this consent. Violating this law is a crime. Justifying such actions citing historical events is not correct. Would you argue 'Why can't people submit themselves to being slaves ? Was it not tolerated by our forefathers for many centuries !'. Obviously this is not the case.Whether this is scientific or not is not important in this context. Scientifically a girl can have sex as soon as she is physically mature for this. But legal limit is not in accordance with this. I think we should also consider psychological maturation in this context.
Vijay has raised a point on the likely benefit the society may derive from shy people. I cannot agree to this fully. Society needs, and benefits from a variety of people with different characteristics. We need all kinds of people shy, bold, extrovert, introverts, activists, contemplaters etc. But there is s difference between shyness and introversion. As I said earlier, it all depends on whether one is comfortable with one's usual character/disposition or not. An introvert is not keen to mingle with others, not happy to attend parties or large gatherings. Because of this they prefer solitary pursuits or profession which don't need much social contact. They wont enjoy being a receptionist or a air hostess. They may love solitude, introspection, contemplation. There are different kinds of personalities. If a persons ways of thinking, feeling, behaving and relating to others leads to distress or impairment it is called personality disorder. This happens when the variations in the traits is more closer to the extreme values for that trait. Persons who detest social contacts and prefer to be loners belong to Cluster A personality disorder. This cluster includes schizoid, schizotypal and paranoid personality disorders. A shy person desires social contact, is upset over his inability to socialise, envies others who socialise freely. To put it short he detests his social isolation and desires to change it. This is why I suggested ways to help them. Such persons belong to cluster C personality disorder in contrast to the cluster A person who does not desire social contact. But if he is truly comfortable in his state (it has to be borne in mind that many people say or make themselves believe they are happy just to avoid confronting the truth or fearing that it is difficult to change) he may be left alone.
Vijay's comment to my post on shyness has added a new dimension to the discussion. Whether undesirable traits / behavior etc are to treated or not ? His observation about the attitudinal shift towards different sexual orientation is true. Psychiatrists had earlier labelled homosexual orientation as a disease . Now the society (though not fully) has become more tolerant towards this. Homosexuality is also thought to have a biological basis.Unlike this issue, shyness is not a matter of choice. A homosexual person chooses or prefers this orientation; he enjoys this; only problem is the disapproval of the society. Whereas shy person does not choose to be shy. He is not enjoying this; he wants to get rid of this. This is more like a type of homosexuality which psychiatrists call ego dystonic homosexuality - a state that is not acceptable to himself. Homosexuality does not cause any impairment or distress other than the biological impossibility to bear a child. Even this problem may disappear in future, thanks to advances made in reproductive medicine. Currently treatment is offered only to ego dystonic homosexuality.A shy or anxious person sees himself as deficient and handicapped, although in a lesser degree compared to many other handicaps. I agree to Vijay's point that we need to treat only those who want to get rid of their shyness.
Anxiety has emotional (an unpleasant feeling of dread or tension), cognitive (thinking related - fear of outcome of one's action or of negative evaluation by others), behavioral (avoidance of anxiety provoking situation), and physiological (heightened arousal, increased heart rate, blood pressure etc) components. But it is not a negative thing always.It can have benefits in some situations. For example if you are doing tight rope walking or something similar which needs utmost attention and care; anxiety increase your attention and prevents mishaps. But if the anxiety is excess, the resultant increased arousal can lead to impaired performance. a child with very little anxiety about his exams may neglect studies. Too much anxiety can impair his ability to perform in the tests.In conclusion, too much anxiety is bad; too little of is also damaging. The major neurological structure responsible for anxiety is a small part of the brain called amygdala.When anxiety becomes excessive and leads to significant distress or impairment in functioning of a person, it can be labelled as Anxiety disorders. Currently the major anxiety disorders are 1) Panic disorder. Spontaneously occurring episodes of acute sever anxiety along with fast pounding hearts, tightness in chest, breathing difficulty, fear or losing control or mind going blank, intense fear etc. These episodes start mildly and increase in intensity over 19 to 15 minutes. many patients suffering from a panic attack are rushed to the emergency rooms and evaluated for heart diseases (angina, heart attack etc). 2) Phobic anxiety: Fear of animals, objects, height, darkness etc 9Simple phobia). In Social phobia there is fear of talking to others or performing in social situations. Such persons blush easily during social interactions. In all types of phobia affected persons tend to avoid such situations. They may also get panic attacks in such situations. Mere thoughts can also provoke panic attacks. Other types of anxiety disorders are Obsessive compulsive disorder, Generalised anxiety disorder etc. Anxiety disorders can also occur secondary to medical disorders (e g: thyroid disorders, Addison's disease, pheochromocytoma etc) and due to some medications. Hence it is advisable to rule out such conditions before making a diagnosis of anxiety disorders. Many people use alcohol to reduce anxiety and later become dependant on it.
Anxiety is one of the most common problems faced by man. It can be secondary to the most profound (existential anguish!) to the most mundane issues (anxiety over one's performance in a social situation). Shyness is very prevalent in children and can be a precursor of later development of social anxiety. If this is handled properly in childhood itself, later anxiety disorders may be prevented. It is important that shy children should not be treated harshly or made fun of by others. They should be told that some amount of shyness is normal during childhood and that things will ease out as they grow older. Another important remedial measure is to prevent the child avoiding social situations causing shyness. They should be persuaded gently, but persistently, to participate in situations causing shyness. May be they can start with situations causing tolerable amounts of shyness, and then proceed to more difficult situations. Initially it is better to start with socializing with small crowds, or groups with more number of familiar faces. Later they can venture out to larger groups and strangers after gaining some confidence. 'Prevention is better and easier than cure'This principle is the basis of the current treatment for many anxiety disorders. This is called 'exposure and response prevention.' Here the affected person is exposed to the anxiety provoking situation and fleeing is not allowed. Gradually the person learns to control his anxiety. Medication (anxiolytics) are also used for treatment of these disorders. But caution is warranted as some of these drugs cause dependence or it may be difficult to stop them. Relapses are common after discontinuation. It is better to use psychological methods along with drugs to reduce such relapses.
I am returning to the issue of health in this post. Health has an objective and subjective component. It may be useful to view a persons attitude. beliefs and behavior regarding health on two levels.1) Whether it is illness affirming or illness denying ?2) Whether it done consciously or unconsciously ?An ill person can deny or affirm that he has illness. If he is unconsciously denying his illness out of fear, it is denial and is not a positive thing. Such persons are not willing to confront the reality and take appropriate remedial action (that is undergoing diagnostic and therapeutic measures). They may resort to alternate treatments or faith healing etc. But sometimes an ill, mentally strong person may deny having illness (partly conscious about the reality) in order to reduce distress to himself and close kin. If he follows appropriate medical advice this may be viewed as a healthy denial. This group has a better prognosis compared to the first according to many studies. If a healthy person frequently visits health care facility complaining of ill health, one has to explore whether he is doing it with deliberate aim of gaining some reward or privilege. If this is the case it is consciously done. This is called Malingering, This is not a medical or psychiatric disorder. It has to be dealt with appropriate legal, social measures. More commonly a healthy persons comes with physical symptoms. S/he may be suffering from stress and may have associated anxiety / depression. It is a psychiatric disorder. This category is called Somatofrm Disorder, It has many sub categories. Hysterical conversion mentioned in an earlier post is one such disorder.
Another situation in which dissociation occurs is overwhelming emotional stress. It occurs in the settings of major disasters (natural or otherwise), emotinally traumatising experiences like sexual or physical abuse, torture etc. The victims tend to dissociate; may be this is a mechanism of nature to make the stress bearable, and have survival advantage.It is also shown that persons who tend to dissociate during disasters have higher rates of developing Post Traumatic Stress disorder (PTSD) later. This is a disorder characterized by hyper arousal (increased alertness and wakefulness that is unpleasant, difficulty to fall asleep, increased startle responses), flashbacks of re experiencing the situation again, avoidance of anything that reminds of the trauma etc. Children who were sexually abused also show increased chances of dissociating later in life. They are prone to develop a type of personality disorder called Borderline Personality Disorder.
Given below is an letter from a friend of mine."I wish to share a peculiar at the same time very intersting situation that prevailed in my village and many other neighbouring villages few dacades ago and would like to hear your comments on it.(Even now it exists,though rare My village in Calicut district had several families with some members who will attain a special mental state/different personality during our festival season.Abruptly they will start behaving as if they are strangers and wont be recognising their relatives or friends.They will give some advises and directions to people around them (they act as if they are from some other alien planets).During festival they will reach the temple and dance in front of the diety during the grand final where they are regarded as superstars..Before that they will meet important local personaliteis and communicate with them though incoherantly.They are called as Komarams and they have to observe certain strict rituals to attain that stauts.What baffle me is the actual reason for the almost complete disappearance of this band of people who used to dance, inflict self injury with iron swords and shout along with unbearable sounds of trumpets, from the villages,as nowadays people like tourists and our own locals wanted to record /shoot such performance for channels for commercial purposes or personal use .None of their children/ younger generations are exhibiting these type of behviour and are totally normal during the festival season . So it appears as a non genetic and need not be heritable problem!Is it because of the changing values of the community/influence of other cultures ,the realisation that they are no longer respected or given the devine status which they had enjoyed in plenty ,earlier?Was it altogether an artificial behaviour?or temporary ,reversible state of mind?Or was it a pure piece of acting?OR temporary split personality?"Response to the above: What you describe is the komaram or velichappadu (as he called in our local area). To understand this one has to know the concept of Dissociation. This particular phenomea was described and studied by Pierre Janet. He was a contemporary of Freud, though his work on dissociuation ane dates that of Freud. It is the abiity of the human mind to split itself. We know that mind has a conscious and an Unconscious part. The conscious mind is accessible to our thinking. Its contents can be recalled at will, that is if we choose to attend to them, they are within our awareness. But unconscious mind is generally not accessible by conscious attention or effort. It may reveal itself in dreams, reveries, or as elements in day dreaming, fantasy, creative thinking etc. To use the language of neuro science, the conscious mind is mostly subserved by the Cerebral cortex. The unconscious mind is largely subserved by the subcortical structures. Major structures include striatum, nucleus accumbens, globus paalidus, amygdala and many thalamic nuclei (remember the limbic system). The hypothalamus is closely interwoven into this system.
During dissociation we are able to suspend our conscious, experiencing, judging, labelling, analytical part of the mind. What remains is the primitive, emotional synthetic, (w)holistic part which experiences things in a detached manner. If you have ever had a tooth extraction you may remember the state; the dentist injects the local anesthetic, which paralyses the sensory nerves. After this he pulls at your teeth. But you dont feel the pain, only a sensation of numbness and of something pulling at something else. You are not sure that it is a part of your body that he is puling at. This is pharmacologically induced dissociation. Hypnosis can induce a similar state. One can voluntarily enter this state by auto suggestiuon or total conviction as in religiuos experiences. A similar state occurs during the 'petta thullal' at 'sabarimala', pentecostal retreats, meditation etc. A man can injure himself during this phase without feeling the pain. The descending pathways of the brain which control the relay of sensory inputs to the brain by acting on the lower motor neurones are responsible for this. Another implicated system is the endogenous opioid systtem (remembe the gate control theory of pain; opium is well known as an anesthetic and analgesic).
Altered states of mind with reuduced awareness/ hyper awareness is an interesting area. It is one of my areas of interest.
Culture shapes the way we view the external world to a very large extent. Such phenomena are rare in the so called civilised parts of the world because these are not socially sanctioned. But in the primitive cultures they are accepted and valued. Hence still prevalent.
