A six-part series, The Truth About Mental Health, will be aired every Friday on BBC World Service Radio. The series, presented by leading British psychologist Claudia Hammond, looks at the different attitudes and definitions of metal wellbeing. She speaks with SHAlINI SAKSENA about the myths associated with mental illnesses and how people in solitary confinement can stay sane and protect themselves
What are common mental health problems in IndiaIJ
Mental distress exists everywhere and although there are some broad problems common across the world, such as psychosis and dementia, it is clear that not all mental health problems are the same the world over.
Inevitably, when any of us decides what’s normal and what’s not, we label behaviour and experiences according to our own cultures. In India, for example, we speak to Professor Vikram Patel, a Wellcome Trust Senior Fellow at the london School of Hygiene and Tropical Medicine and the Sangath Centre in Goa. He doesn’t use the word “depression”. He talks to people using terms like “tension” or “losing energy”.
Did you meet Keshava (one of her patients) in IndiaIJ If yes, what are your findingsIJ Is there any hope for himIJ
We did not meet Keshava for the programme. However, we did speak to Bangalore mayor who told us his story and to Professor Vikram Patel who commented on it.
last October, he was rescued from a village near Bangalore. He had been locked alone in a small room with no windows or door for more than a decade. For years, his family had tried to get him help for his mental illness. As his symptoms worsened, they found it increasingly hard to cope and put him in a back room when people visited and eventually resorted to bricking him up totally.
But there is hope now. He is in hospital receiving treatment and his psychosis has lessened, so he is recovering. However, the suffering of all those years in solitary confinement will make the recovery take time. There is still no care available in his village, so he will have to go to a rehabilitation centre.
Tell us about your experience in IndiaIJ
There is still a big difference between care available in cities and rural areas. There is a huge shortage of psychiatrists and students who wish to be trained.
But there are also people who are trying to tackle this problem. For example, Professor Patel is training community health workers to understand mental health, encouraging them to help people get the right treatment.
Can a universal methodology be applied in treating patients all overIJ
In some programmes, there is an argument that mental healthcare needs to be scaled up in low and middle-income countries. The debate goes thus: In the developed world we have a situation where there is genuine concern of overuse of drugs and over-medicalisation of life. In the developing world, it’s the opposite. Half of those with psychosis get no treatment and many individuals are chained or locked up. So, while we must be cautious, we should go at least some of the way, so there’s better access to evidence based interventions for people with mental disorders.
We also heard from Pat Bracken, Psychiatrist and Clinical Director of the Mental Health Service in Ireland, who is part of the critical psychiatry movement. Although, he too says there are human rights issues in some places when it comes to mental healthcare, he fears the globalisation of Western notions of mental health. He favours local solutions and wants to build on the experiences of every community to take into account their cultural explanation of mental distress.
What is the reason for so many people having mental health problemsIJ
All sorts of reasons contribute to people developing mental health issues. These are: Abuse, genetic predisposition, or social factors. But, we may never know why a specific individual develops a mental problem.
Why is there such a huge treatment gapIJ
More than 90 per cent mental health resources are in high-income countries, and around the world four out of five people don’t get the treatment they need. Mental health is often treated as a Cinderella service, which means that resources are often prioritised to treat physical rather than mental problems.
Do you think that developing and poor nations are more prone to mental problemsIJ WhyIJ
No, there seems to be the same prevalence of mental problems around the world, therefore the bigger question is around how much availability there is to diagnose and treat them. In many developing and poor nations, three quarters of the population with mental problems have no access to services and even in the developed countries, it is between a third and a half.
Certain mental health problems are more prevalent in other countries, for example there is a much higher prevalence of anorexia in wealthier countries.
What can one do to remain mentally healthyIJ
There are lots of things you can do, such as taking care of yourself, or getting help early if you feel you can’t cope. Just doing simple things that you know might improve your well-being such as going for a walk or talking to others about your problems and how you’re feeling might help. Even practising mindfulness, which is popular in India, or meditation can help. It is important to find things that help you feel better before things take hold.
However, you can’t prevent all mental health problems, which is why it’s important to go for treatment early when you first notice symptoms.
Why is it that countries like Japan have a stigma attached to mental problemsIJ Did you find similar stigma in IndiaIJ
Stigma towards mental problems exists all over the world, it’s just that they vary from country to country.
In the case of Japan, some people we spoke to, suggested that because Japan has a very collective society, if someone behaves differently it is more noticeable and people find it difficult to cope with.
Stigma exists in India too, which is what made it so hard for Keshava.
What should families do if a member gets afflictedIJ
Try to get help for him/her as early as they can, and make sure it is from somewhere they know is kind and won’t be abusive.
What are the mental problems associated with solitary confinementIJ
People who’ve been in solitary confinement often feel that it attacks their sense of identity, because they have nobody to interact with and talk to. It is common for such people to experience panic and fear, and, over time, they gradually begin to lose their identity and sense of who they are.
One man we met for the programme had been locked up for several months and he spoke of picking fights with guards to remind himself who he was and that he was still a person. Once, these people out of solitary confinement, they often spend a lot of time in small room to recreate the experience they have become used to.
Tell us what you learnt from your interaction with psychologist Craig Heaney, who has worked with many people held in solitary confinement in the USIJ
Heaney has worked with people in solitary confinement in supermax prisons in the US and he has documented a lot of the problems associated with this.
Not having a routine can be very difficult, so just doing things that create a routine such as press-ups at the same time every morning, keeping tidy and maintaining personal cleanliness are good coping strategies. Doing things to keep the mind really busy is crucial. I interviewed a political prisoner who spent his time writing haiku, a short form of Japanese poetry, to keep his mind active.
What role do emotions play in mental wellbeingIJ
Emotions are central to our well-being and it is important to be aware of yours and know how to deal with them.
Trying to recognise and name an emotion that you’re feeling can be very helpful and make it much easier to cope in times of difficulty. For example if you’re upset with someone, try to think what you are feeling — are you hurt or angry or sad, and that can make it easier to deal with the problem.
Do you think that most problems can be solved by the 'mind over matter' theoryIJ
No, psychological techniques can help people look at the positive side and see their situation from an outside point of view, such as reframing. However, although these strategies can help, they won’t solve all problems.
How have we changed the way we think todayIJ
There is a growing understanding about mental problems and a recognition that people can recover from them. The stigma is reducing and people are taking mental health more seriously. There is a wider acknowledgement that if mental problems are recognised and dealt with then more people can contribute socially and economically, so it is worth for countries investing in treatment and services.