Enhancing THE LIVES OF MENTALLY ILL People
- BEYOND MEDICATION
Psychiatry is a exclusive speciality in medicine. It deals with the mind/psyche rather than the physic/body. Psychiatry is also the only branch of medicine that treats conduct and if needed against the wish of the patient. In our country the mainstay of treatment of mental illness is still with pills/medicine alone, which is based on medical model. Psychiatrist tends to treat mentally ill folks physically in the absence of any recognized physical pathology.
All over the world psychiatric services are rendering treatment based on an integrated model which takes care of the mentally ill individual as a whole rather than treating the illness with medicine alone. The integrated model of treatment takes into accounts the individual psychological elements and socio-economic circumstances that have an impact on the mental wellness of mentally ill patients.
World Health Organization defines mental wellness as follows:
“Mental health is a state of well being in which the individual realises his/her abilities, can cope with typical life stresses, can work productively and fruitfully and is able to make a contribution to his/her community “
Can we restore the mental wellness as stated above with PILLS alone following the medical model of mental illness?
If we carry on with the medical model of mental health which locates issues solely in the individual then we will continue to ignore crucial elements which influence mental health and well being.
Let us look into the following vignette.
Mrs.Suba is 44, married with four kids. Her husband is an auto driver. She is warm, intelligent and caring homemaker living in a joint/extended loved ones and coped well with life until ten years ago when she suffered with the very first episode of depression following her very first childbirth. Because then she had several admissions to psychiatric hospital. Her treatment consisted mainly of medication. She has been prescribed twenty distinct drugs and has been taking at least 1 or two of them since 10 yrs.
In the course of her recent admission psychotherapy (talking therapy/ counselling) was offered to Suba to attempt and recognize the background to and factors for her depression. The psychiatrist who has been treating her for several years was not happy about this thought and agreed to it reluctantly. Suba also had mixed feeling about beginning psychotherapy as she knew little about it and her family had been told that her depression is due to recurrent illness. But she gave a go. For the 1st time she opened up and talked about her feelings and the thoughts and incidences that precipitated depression. In the following sessions the psychotherapist continued to trace the roots of her depression. Therapist also looked into her childhood for the origin of her coping styles. Suba was able to function by means of and come to an acceptance of her past and ventilated the painful pent up feelings, which were inside her. Her feelings were not just dismissed or labelled. They had been acknowledged and validated.
Suba slowly gained insight about the maladaptive thoughts and coping skills and started to make modifications in her life with the support of the ongoing therapy.
As she was living in a joint family members, her interaction with other members of the family members was in fact maintaining her depression in a way. She became conscious of these and developed her interpersonal abilities and worked towards bringing about adjustments in her family members too.
She became a stronger individual who could cope nicely with the regular life stresses and did not let them precipitate yet another episode of depression.
The psychotherapy gave us a way of understanding Suba’s depression as component of her entire individual by understanding all her past and present experiences and relationships, rather than just as an unpleasant mental illness.
Merely managing mental illness by containing the symptoms with medication is not the genuine recovery. It wants a change on a whole-individual level with the help of combined effort by means of integrated model.
In a busy outpatient consultation, it is less difficult for psychiatrist to fall back on something they did know about i.e. medical-style treatment consisting of psychiatric assessment, diagnosis, biological investigations, medication and hospitalisation which ignores seeing the patient as a Individual but only as an isolated phenomenon. This leaves the patient in the exact same situation and prevents from striving for change due to the fact the psychiatrist has defined the issue in such a way that the patient is prevented from realising that change is needed. Moreover the psychiatrist is pushed to repeat the very same simply because of the success in treating the previous episodes of illness with medication and make them reluctant to try psychotherapy.
The underlying message is that treating patients with PILLS/MEDICATION alone could be proper for any sort of physical illness but not for mental ill. Treating mentally ill person with medicines alone based of medical model is like treating the diseased tree with medicinal sprays and ignoring to strengthen the roots.