In connection with mental health and illness, I want to narrate a short vignette. Recently a young lady, age 28 years, with emotional problems was referred to me by a friend. She had post-graduate education and some teaching experience. What struck me most was the fact that she was very heavily medicated with many psychotropic drugs. She was highly sedated. The client or her parents could not give me the diagnosis for which she was treated. As I was not familiar with the brand names of the psychiatric medications in India that she was prescribed by a psychiatrist, I asked my wife who is a registered nurse with over 30 years of experience in mental hospitals to look up for their generic names. We were appalled to see the heavy doses of psychotropics together with medications for side-effects that she was taking.
From the medications prescribed, I inferred that she was being treated for moderate to severe bi-polar disorder (previously known as manic-depressive disorder). In my understanding she was having an inadequate personality with some impulse control problems, possibly a condition of cyclothemia or even a very mild variety of bi-polar disorder that could benefit from some mild sedatives. I suggested the young lady’s uncle whom I considered to be sufficiently assertive to accompany her and her father on their next visit to the psychiatrist to find out her diagnosis. With difficulty the uncle was able to extract from the psychiatrist the diagnosis of mental imbalance. Interestingly every mental disorder results from mental imbalance. Prescribing medication without a diagnosis would not be a good practice in the USA. I would like to think the same is true in India. I certainly do not want to interfere with mental health practitioners outside of my field of expertise.
I provide psychological consultations/opinions in to those who seek my services in I strongly believe that the field of mental disorders is overly dependent on the medical model and the psychiatric poly-pharmacy prevalent in the USA has also become the order of the day in India. In India psychology has not asserted the role it rightly deserves in the field of mental health often proper diagnosis is not done. The medical model that considers every mental disorder as a chemical imbalance is too quick to prescribe drugs as a solution to every mental disorder. I do not by any means intend to minimize the role of anti-psychotic drugs for stabilization of severe mental disorders as chemical restraints in the place of odious, cruel, and inhuman physical restraints of old.
I hope to write about other models to understand psychopathology in the realm of psychiatry and psychology. There is some arbitrariness with regard to what constitutes mental health and mental illness. For instance, when I started my doctoral program in Clinical Psychology, homosexuality was considered to be a mental disorder in Diagnostic and Statistical Manual of Mental Disorders – II (DSM – 2), the basic essential reference book for psychiatry and psychology in the USA. Then came DSM III, IV, and IV-R, and - V. From DSM – III on homosexuality is not deemed to be a mental disorder. DSM disorders have a numerical International Classification of Diseases (ICD) code. In the coming articles I hope to give important information on mental disorders and their effective treatment, models of psychopathology (diseases of the mind), understanding mental health according to various schools of psychology, and guidelines for mental hygiene as part of holistic living.
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