| IMPROVING THE LIVES OF MENTALLY ILL | | | | family had been told that her depression is due to |
| PEOPLE | | | | recurrent illness. But she gave a go. For the first |
| - BEYOND MEDICATION | | | | time she opened up and talked about her feelings |
| | | | | and the thoughts and incidences that precipitated |
| Psychiatry is a unique speciality in medicine. It | | | | depression. In the following sessions the |
| deals with the mind/psyche rather than the physic | | | | psychotherapist continued to trace the roots of |
| body. Psychiatry is also the only branch of | | | | her depression. Therapist also looked into her |
| medicine that treats conduct and if necessary | | | | childhood for the origin of her coping styles. Suba |
| against the wish of the patient. In our country the | | | | was able to work through and come to an |
| mainstay of treatment of mental illness is still with | | | | acceptance of her past and ventilated the painful |
| pills/medicine alone, which is based on medical | | | | pent up feelings, which were inside her. Her |
| model. Psychiatrist tends to treat mentally ill | | | | feelings were not just dismissed or labelled. They |
| people physically in the absence of any known | | | | were acknowledged and validated. |
| physical pathology. | | | | Suba slowly gained insight about the maladaptive |
| | | | | thoughts and coping skills and started to make |
| All over the world psychiatric services are | | | | changes in her life with the support of the ongoing |
| rendering treatment based on an integrated model | | | | therapy. |
| which takes care of the mentally ill person as a | | | | As she was living in a joint family, her interaction |
| whole rather than treating the illness with medicine | | | | with other members of the family was actually |
| alone. The integrated model of treatment takes | | | | maintaining her depression in a way. She became |
| into accounts the individual psychological factors | | | | aware of these and developed her interpersonal |
| and socio-economic circumstances that have an | | | | skills and worked towards bringing about changes |
| impact on the mental health of mentally ill patients. | | | | in her family too. |
| | | | | She became a stronger person who could cope |
| World Health Organization defines mental health as | | | | well with the normal life stresses and did not let |
| follows: | | | | them precipitate another episode of depression. |
| | | | | The psychotherapy gave us a way of |
| “Mental health is a state of well being in which | | | | understanding Suba’s depression as part of |
| the individual realises his/her abilities, can cope with | | | | her whole person by understanding all her past |
| normal life stresses, can work productively and | | | | and present experiences and relationships, rather |
| fruitfully and is able to make a contribution to his | | | | than just as an unpleasant mental illness. |
| her community “ | | | | |
| | | | | Merely managing mental illness by containing the |
| Can we restore the mental health as stated | | | | symptoms with medication is not the real |
| above with PILLS alone following the medical | | | | recovery. It needs a change on a whole-person |
| model of mental illness? | | | | level with the help of combined effort through |
| If we carry on with the medical model of mental | | | | integrated model. |
| health which locates problems solely in the | | | | |
| individual then we will continue to ignore critical | | | | In a busy outpatient consultation, it is easier for |
| factors which influence mental health and well | | | | psychiatrist to fall back on something they did |
| being. | | | | know about i.e. medical-style treatment consisting |
| | | | | of psychiatric assessment, diagnosis, biological |
| Let us look into the following vignette. | | | | investigations, medication and hospitalisation which |
| | | | | ignores seeing the patient as a PERSON but only |
| Mrs.Suba is 44, married with four children. Her | | | | as an isolated phenomenon. This leaves the |
| husband is an auto driver. She is warm, intelligent | | | | patient in the same situation and prevents from |
| and caring homemaker living in a joint/extended | | | | striving for change because the psychiatrist has |
| family and coped well with life until ten years ago | | | | defined the problem in such a way that the |
| when she suffered with the first episode of | | | | patient is prevented from realising that change is |
| depression following her first childbirth. Since then | | | | necessary. Moreover the psychiatrist is pushed to |
| she had several admissions to psychiatric hospital. | | | | repeat the same because of the success in |
| Her treatment consisted mainly of medication. She | | | | treating the previous episodes of illness with |
| has been prescribed twenty different drugs and | | | | medication and make them reluctant to try |
| has been taking at least one or two of them | | | | psychotherapy. |
| since 10 yrs. | | | | |
| During her recent admission psychotherapy | | | | The underlying message is that treating patients |
| (talking therapy/ counselling) was offered to Suba | | | | with PILLS/MEDICATION alone may be |
| to try and understand the background to and | | | | appropriate for any sort of physical illness but not |
| reasons for her depression. The psychiatrist who | | | | for mental ill. Treating mentally ill person with |
| has been treating her for many years was not | | | | medicines alone based of medical model is like |
| happy about this idea and agreed to it reluctantly. | | | | treating the diseased tree with medicinal sprays |
| Suba also had mixed feeling about starting | | | | and ignoring to strengthen the roots. |
| psychotherapy as she knew little about it and her | | | | |