• Dr. Abhimanyu Chandak

Beat Stigma about Mental Health with Knowledge!



Image Source: lunar_cat


When I told people that I wanted to take up psychiatry as my post-graduate subject of specialization 4 years back, I got just two kinds of responses. Either it was “You will also go mad treating these mad people” or “It’s an upcoming field and you can go for it.” Both the sets of people were a direct representation of where the society was with respect to it’s attitude towards mental health - Ambivalent. Perhaps people do not want to educate themselves about things that make them uncomfortable. They are satisfied with the knowledge that is passed down either by older generations or hearsay and don’t question any of it as they are scared that they will not like the answers or the answers will conflict with what they already know.


The Mental Healthcare Act, 2017 (MHCA) defines mental illness as “a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation.”[1] Stress and mental illness are so intricately woven that it is impossible to separate them and hence, it is foolish to assume that mental illness is something of a new origin. Stress has been a part of human life since we evolved from monkeys, if not even earlier.


Mental illness also has been present in human society from the beginning of time. Earlier, It was explained using supernatural models, but, as our knowledge and understanding increased, we developed other psychological and biological models. We have all heard people say that they have faced similar or more problems and have coped well or that a person develops a psychiatric illness because they are weak. Mental health is constantly evolving with demography, culture and time and there can be no fixed amount of stress/issues which lead to a mental illness. The false perception that mental illness is seen more among the young nowadays, or that its prevalence has gone up, is because of increased awareness regarding the same.


The main reasons that our society struggles with addressing mental health openly are:

1. Stigma

2. Lack of awareness and understanding

3. Hesitation of the medical community to approach these issues


What is stigma and where does it come from?


Stigma is “a negative attitude or discrimination towards something or someone based on a distinguishing characteristic.” [2] It is usually associated with mental illnesses, health conditions and disability. From an evolutionary standpoint, anything that is ill understood is feared and then stigmatized. Anything that is different or scares people or makes them feel uncomfortable and unable to decide how to respond is associated with stigma. Stigma was not created in a single day and nor can it be dealt with in a short time. Some of the ways in which we can help in reducing stigma are:


  1. Educate ourselves regarding mental health

  2. Remove the portrayal of negative stereotypes associated with mental illness in the media

  3. Use the right terminologies

  4. Provide legal and constitutional rights and support to people with mental illnesses

  5. Most importantly, not propagate the stigma ourselves by doing the same thing that has been prevalent for years


Lack of awareness and understanding


The complex nature of how psychiatric illnesses develop and the various permutations and combinations that can lead to the development of a disorder or vary in the way it presents itself makes it very difficult to educate the uninitiated towards the concept of mental health. Every disorder has a bio-psycho-social model of development, which is to say that there is a biological component (genetics, brain development, chemicals in the brain, etc.), a psychological component (our underlying way of thinking, acting, behaving, etc.) and a social component (environmental factors, like family situations, friends, work area related issues, etc.) It is also true that every psychiatric disorder presents differently in different individuals. While we may be able to predict the type of symptoms in some people it is difficult in most. The same diagnosis can have multiple different patterns of presentation depending on the multiple factors within and around the individual.


Although a lot of research is being done in mental health it is difficult to assess such a complex mechanism and even though we may understand how some different components work, the interactions between them are too unique to predict.


Our government has been dealing with more pressing matters in the past like immunization and it was right in doing so. But, as we progress forward as a country, I think it is time we shifted our focus a little and start to highlight the importance of mental health to the general public.


Hesitation of the medical community to approach these issues


The medical community itself is quite hesitant in questioning and addressing mental health issues because in general our training during our MBBS with respect to psychiatry has been very deficient.


It has always been treated as an adjunct branch and will remain so until the importance of mental wellness goes up. It’s the supply and demand principle. The incentives for doctors to openly talk about mental health issues are misaligned with societal norms. Unless the healthcare authorities actively promote mental wellness as a goal and create awareness programs, citizen level demand for access and normalised conversation will not be created. This will keep the medical community focused on physical health both as a field of study as well as practice. The instrument of change today is social media and other digital platforms. However in general, owing to busy practice schedules doctors have stayed away from building a strong personal brand on digital platforms. These doctors have the credibility to be heard from and taken seriously but they do not endeavour to use their voice online for promoting mental wellness. This leads to furthering misinformation and stigma.


We need to come out and start speaking openly about mental health as individuals, patients, caregivers and doctors to ensure that its importance goes up in the medical curriculum.


Work being done at BrainSightAI


The team at BrainSightAI is working to tackle this problem by providing a variety of products to progress research in neuropsychiary and help neurologists and mental health professionals in providing tangible proof in the form of neuroimaging to patients and caregivers.


The fMRI based services of “Voxelbox”, “Voxelbox+” and “Neuroscience as a Service(NaaS)” are designed to help understand the complicated reports of fMRI generated data and accelerate research into understanding neuropsychiatric disorders better.


Kokoro is a 4 week citizen scientist program for those who have experienced anxiety and/or depression, in which we are attempting to increase the awareness, educate and initiate open conversations regarding mental health with a special focus on depression and anxiety. This program is aimed at understanding the lived experiences of those with mental illness while also providing them with resources to understand their illnesses better.



Conclusion


As we can see, all three components are interlinked. Unless all three are addressed simultaneously we can never do away with stigma and mental illness will remain the problem it has always been.


The only way to do it is to create awareness and educate people about mental health and illnesses. It may take a while to bring about the change, but we are well on our way to get there. The present scenario and focus on mental health gives me hope that we are moving in the right direction and we will reach a point where we can talk about a mental illness the same way that we talk about something as simple as fever.


References


1. Egazette.nic.in. Published 2020. Accessed September 26, 2020.


2. How to Cope With Stigma When You Have a Mental Illness. Verywell Mind. Published 2020. Accessed September 26, 2020.


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