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 Blooming Stars

Mental Disorders

            What is mental health? What is mental illness? What is normality? What is abnormality? What are normal and abnormal behaviors? These are questions that are not settled; they lend to debates and heated discussions in academic circles. Theoretical formulations related to the etiology (origin) of diseases depend on the various schools of psychology one follows or advocates. Etiology and epidemiology (spread and control of diseases in a given society) go hand in hand. Variables such as culture, social class, evolving societal norms, mores, habits, and customs also figure much in the determination of mental disorders. What is normal in one culture may not be so in another culture. For instance, burping or belching especially after a meal may be a sign of contentment or satisfaction and may be acceptable or tolerated in one culture; but the same behavior may be considered to be rude and socially unacceptable especially in western countries. Similarly, washing one’s mouth or gargling with clearing one’s nasal and throat cavities with all the accompanying unappetitive, obnoxious noises in the public that is not uncommon after a meal in Kerala societies may be rightly confined only to toilet rooms in other cultures.

            The trend or evolving normative behaviors may be patterned on the most influential persons in society, be they entertainers, sports heroes, singers, writers, politicians, beauty queens, wealthy, and the powerful. What is normal at one period of history may be abnormal at another period. For instance, certain terms used to address certain castes in earlier years in Kerala (India) would be considered to be offensive at the present time. The same is true of certain jokes or sayings. For instance, one of the carpenters in our construction setting used a proverb that is connected with another caste and is offensive was used to indicate his uncertainty unpredictability on the following day. His conversation unwittingly happened to be in the presence of that other caste lady. Who started crying and complained to me. I had to personally intervene to diffuse the crisis and tell the offending party not to use such offensive, stereotypical sayings that could demean a whole group of people. His argument that it was an old saying and therefore not inappropriate did not hold water with the changed times. He understood when I told him the he would not like it when he put himself in the other person’s shoes. Again, before the civil rights era in the 1960’s in the United States of America, the black race would be generally called Negroes; now the term negrowould be considered to be offensive; they would like to be called African Americans. Normality quite often is useful only as a statistical concept in research that can describe or quantify a certain characteristic or variable in a given population.

            In some primitive societies persons with psychotic disorders (major mental problems) would be considered to possess certain unusual or divine powers or abilities. And as such they could be treated with special deference. Homosexuality that was considered a mental disorder in an earlier era (in DSM–II: Diagnostic and Statistical Manual of Mental Disorders–II) is no longer considered to be so (in DSM-III). With rapid progress in affluence and westernization eating disorders, for example, characterized by severe disturbance in eating behavior are raising their ugly heads in India. More specifically, Anorexia Nervosa and Bulimia Nervosa, the two most common eating disorders (diseases), more commonly seen in women, related to maintaining a minimum body weight in one case and preventing weight gain through binge eating and other harmful ways such as vomiting and purging in the other seen in the west have started manifesting themselves in the affluent sections of India.

            Indian culture in general, for instance, is more tolerant of mental disorders than the USA culture. Ingestion of psychotomimetic (inducing psychotic behavior and personality) drugs can also alter one’s mind and generate psychotic symptoms while under the influence of those substances. A psychotic (someone who is out of touch with reality) person creating nuisance in public might be more likely picked up and committed to a mental hospital in the USA than in India. What does all this mean? Understanding and diagnosing mental disorders are very complex and multi-dimensional. A certain amount of arbitrariness and tentativeness is inevitable. A provisional diagnosis before all the data are in, especially in difficult cases, makes good sense. Many disorders may share similar symptoms. So focus will have to be on syndromes (clusters of symptoms).and differential diagnosis. Many variables need to be taken into account before understanding, classifying, and diagnosing mental disorders. Some important models of psychopathology (the study/science of mental disorders) need to be also reviewed.

 

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